bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P12 The Current Landscape of Nutritional Care in Oesophahgogastric Cancer: Insights from The National Oesophagogastric Nutrition Audit (NONA)
Authors: Casey Patrick , Gossage James , Ford Kate , Huddy Fiona , Owen Kellie , Markar Sheraz , McLaughlin John , Sultan Javed 
Published: November 2023

Abstract

Background
Specialist nutritional support is important during treatment for oesophagogastric (OG) cancer yet current practice remains unstandardised across the UK. The National Oesophagogastric Nutrition Audit (NONA) aimed to describe the current landscape of OG dietetic services in the UK and Ireland, with a specific focus on resource allocation, barriers to dietetic support, and the provision of support throughout the cancer pathway.

Methods
Tertiary cancer units, secondary care, and community services across the UK and Ireland were invited to complete a 28-point electronic questionnaire. Team leaders and senior specialist OG dietitians were the target respondents. All data points were peer-reviewed, piloted, and revised by the NONA steering committee before distribution. Data points covered a range of areas related to resources, skill mix, provision of support throughout the cancer pathway, and involvement with national audit and research.

Results
Complete responses were received from 50 units (surgical units, n=35 and oncology units, n=10). Secondary care/community services were underrepresented (n=5). The majority (77%) of tertiary surgical units agreed or strongly agreed they were able to provide adequate nutritional care in the post-operative period. However, confidence dropped significantly during the early diagnostic phase and in the neoadjuvant period, with 52% and 67% of units disagreeing that they could provide adequate dietetic support, respectively. Inadequate funding, understaffing, and prioritisation of inpatients were commonly reported barriers. There was significant variation in practice regarding nutritional service structure, and staffing resources across specialist units.

Conclusions
The NONA survey provides a ‘real-world’ landscape of nutritional care for patients with OG cancer. Lack of funding, resource, and evidence-base may explain the variation seen in services provided across the UK. Further research and consensus is required to help standardise nutritional care, guide service specification, and improve nutritional outcomes for patients with OG cancer. Further national consensus frameworks to standardise care in the UK are currently underway.
OGC P15 Analysing the Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four prospective Clinical Trials performed across the UK and Ireland
Authors: Barman Sowrav , Walker Robert , Knight William , Baker Cara , Kelly Mark , Gossage James , Allen Sophie , Preston Shaun , Sultan Javed , Rockall Timothy , Robb William , Tully Roisin , Underwood Tim , West Malcom , Jack Sandy , Levett Denny , Grocott Mike , Leggett Samantha , Davies Andrew 
Published: November 2023

Abstract

Background
Prehabilitation is increasingly being used in patients undergoing multi-modality treatment for oesophago-gastric (OG) cancer. Most studies to date have been small, single centre trials lacking statistical power. The results of larger randomised trials are still awaited. There remain considerable uncertainties regarding the outcome measures that may benefit from prehabilitation, the exact nature of the intervention and the mechanisms behind any observed benefit. This collaborative study sought to combine data from four prospective clinical prehabilitation trials performed in the UK and Ireland to determine the overall impact of the intervention on patient outcomes following oesophagogastric cancer surgery.

Methods
Anonymised data from four prospective prehabilitation trials conducted in the UK and Ireland (Southampton, Guildford, Dublin, and St Thomas’, London) in patients undergoing multi-modality treatment for oesophagogastric cancer was combined. The studies included two randomized and two non-randomized clinical trials. The primary outcome measures were differences in complications and length of stay. Secondary outcomes were changes in BMI, fitness (VO2 max), chemotherapy completion rates and tumour regression. In total, 180 patients were included from four studies, with 93 patients in the prehabilitation group and 87 patients in the control group.

Results
Severe complications (Clavien Dindo &gt;=3) were observed less frequently in the prehabilitation group (19% vs 34%; p=0.038). Hospital length of stay also favoured prehabilitation (10 vs 11 days) albeit not statistically significant. Chemotherapy completion rates were significantly higher following prehabilitation (96% vs 63%; p&lt;0.001). There were non-significant improvements in VO2 max change following neo-adjuvant therapy (delta 1.35 vs 2.39; p=0.25), anaerobic threshold change (delta 1.20 vs 2.20; p=0.11) and chemotherapy response (Mandard 1-3 57% vs 44%; p=0.178).

Conclusions
Despite some limitations in terms of heterogeneity of study methodology and prehabilitation interventions, this study has highlighted a willingness of individual units to collaborate and tangible clinical benefits across a range of outcome measures in a larger OG patient population. Current initiatives to agree national standards for delivering prehabilitation and the results of on-going trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.
OGC P17 Reporting nutritional outcomes following gastrectomy: A systematic mapping review
Authors: Patel Minal , Waheed Unaiza , Khan Shiraz , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Following an international consensus agreement of patients and healthcare professionals (GASTROS Study), ‘nutritional outcomes’ have been identified as critically important to report in surgical trials for gastric cancer. A previous review has demonstrated that nutritional outcomes are rarely reported by trials, and little is known about how best to measure them. In preparation for future work on establishing an optimum approach to report and measure nutritional outcomes, a mapping review was undertaken to examine current approaches used by researchers in this field.

Methods
We conducted a systematic literature search (using MEDLINE, Embase, CINAHL, Cochrane and PsychInfo) and included randomised control trials and prospective studies reporting any form of nutritional outcome in patients following gastrectomy, between 2012 and 2022. The review was conducted using PRISMA guidelines and registered on the PROSPERO database (CRD42022365652). Full text reviews and data extraction were completed independently by three reviewers. Datapoints of interest included general trial and surgery characteristics, study types, duration and frequency of nutritional outcomes and the utility of nutritional screening measurement tools. Data collection and analysis was conducted on Microsoft Excel.

Results
3288 abstracts were screened, yielding 87 studies (17220 patients) eligible for inclusion. 90% of trials were based in East Asia. 24% of trials reported biochemical, anthropometric, and weight-based outcomes. 21 different biochemical tests were reported by 74% trials, the most common marker being ‘albumin’. Anthropometric measurements were heterogenous with BMI and skeletal muscle index being the most frequently reported. 66% of studies reported patient weight as an outcome. 28% studies reported both nutritional screening and assessment. 48% of trials utilised screening tools. The frequency and time points at which nutritional outcomes were measured varied greatly.

Conclusions
This mapping review highlights significant variation in the reporting of nutritional outcomes. Consensus agreement is required to establish the optimum approach to use in trials and clinical practice.
OGC P18 10-year survival following oesophagectomy and 2-field lymphadenectomy: a retrospective cohort study
Authors: Linder Cortland , Kaushal Devesh , Tan LamChin , Malik Amman 
Published: November 2023

Abstract

Background
Only 12.6% of patients with oesophageal cancer in the UK will survive over 10 years. While oesophagectomy remains the best option for resectable oesophageal cancers, there is debate about the extent of lymphadenectomy during surgery and its impact on short and long-term outcomes. We analyzed the outcomes, including 5- and 10-year survivals, for patients undergoing oesophagectomy and radical lymphadenectomy by a single surgeon.

Methods
All patients who underwent oesophagectomy for any stage of oesophageal cancer in a single tertiary centre in the United Kingdom, with or without neoadjuvant chemotherapy, were identified from a prospectively maintained database from 2006-2017. We describe long term survival by number of lymph nodes resected and lymph node ratio (the ratio between the number of positive nodes and total nodes resected).

Results
Median survival following oesophagectomy was 66.3 months (95% CI: 53-71) with a minimum follow-up of 5 years. Most patients had adenocarcinomas (85.9%) followed by squamous carcinomas (8.5%). For all histologies, overall 5-year survival was 54% and 10-year survival was 40%. For patients with adenocarcinoma, resecting ≥24 lymph nodes improved survival compared with &lt;24 nodes (median 73 months and 59 months respectively, p&lt;0.038). The number of lymph nodes resected was an independent predictor of survival (p&lt;0.001). For patients with any histology, a lower lymph node ratio indicated better survival (p&lt;0.01).

Conclusions
This study demonstrates an improved long-term survival following oesophagectomy combined with lymphadenectomy of ≥24 nodes. We did not have any loss to follow-up with a long follow-up period, strengthening reported results.
OGC P24 The impact of early enteral feed composition on the rate of chyle leak post-oesophagectomy
Authors: Pan Sally , Bushra Raisa , Cheah Lilyanne , Ribbits Alexander , Grimes Sam , O’Neill J Robert 
Published: November 2023

Abstract

Background
Patients undergoing oesophagectomy are at significant risk of malnutrition and benefit from peri-operative enteral feeding. Chyle leak presents in up to 20% of patients undergoing an oesophageal resection and is associated with immunosuppression, malnutrition and increased complications. Early enteral feeding can increase the rate of chyle leak in these patients. Enteral feed with a high percentage of fat as medium chain triglycerides (MCT) is more easily absorbed and can reduce chyle production. We evaluated the impact of early enteral MCT-rich feed on the prevalence and severity of chyle leak post-oesophagectomy. Secondary outcomes include length stay, and post-operative weight change.

Methods
Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Following specialist dietician input, patients received enteral feed on post-operative day 1 – 5 with Nutrison Protein Plus Energy (standard; 5.8% total fat, 0.9% (MCT)) (2015-June 2021) or Nutrison Peptisorb Plus HEHP (HEHP; 5% total fat and 3% MCT) enteral feed (June 2021 to Dec 2022). All patients transitioned to standard feed on post-operative day 6 onwards and were discharged on IDDSI level 4 diet and supplemental jejunal feeding.
Patients who did not commence early enteral feeding were excluded from analysis.

Results
A total of 329 patients were included. Patients who received early enteral HEHP feed had fewer chyle leaks (5/52; 9.6%) compared to patients who received early enteral standard feed (68/277; 24.5% p=0.017). The proportion of ECCG grade I and II leaks was similar between groups. No patients required surgical intervention for a chyle leak during the study period. The HEHP group had a shorter critical care (p&lt;0.001) and total length of hospital stay (p=0.011). Weight change from pre-operative baseline was equivalent in both groups at 6 weeks (standard; -4.5%, HEHP; -2.3%, P=0.066) and 3 months (standard; -5.6%, HEHP -4.0%, P=0.400).

Conclusions
In the context of routine jejunostomy use and early enteral feeding post-oesophagectomy, HEHP feed on post-operative day 1- day 5 was associated with a significantly lower chyle leak rate with corresponding shorter length of stay compared to standard feed. No difference was noted in post-operative weight change between groups which was relatively well preserved up to 3 months post-operatively.
OGC P25 Impact of minimally-invasive oesophagectomy on post-operative analgesia and surrogate outcomes
Authors: Ribbits Alexander , Bushra Raisa , Pan Sally , Cheah Lilyanne , O’Neill Robert 
Published: November 2023

Abstract

Background
Minimally invasive oesophagectomy (MIO) via either two (MIO2) or three phases (MIO3) has been proposed to reduce post-operative pain and correspondingly improve patient recovery compared to open Ivor-lewis (ILO), Left thoracoabdominal oesophagectomy (LTA) or hybrid-ILO (lap abdomen, open thoracotomy). The primary aim of this study was to audit analgesia outcomes according to surgical approach via maximum daily pain score, daily and total post-operative opiate usage. Secondary outcomes included return of GI function, mobility, and rates of post-operative pneumonia, escalation in ward care or re-intubation due to respiratory failure.

Methods
Retrospective review of records from consecutive patients undergoing oesophagectomy at a single tertiary centre between January 2015 and December 2022. Post-operative analgesia consisted of thoracic epidural and patient controlled analgesia (PCA) for patients undergoing thoracotomy and PCA+/- paravertebral analgesia for those undergoing MIO. Patients remaining ventilated due to early post-operative complications were excluded from analysis.
Opioid usage was converted to oral morphine equivalents for comparison. Patient mobility was prospectively recorded by a physiotherapist using the Manchester Mobility Score (MMS). Pneumonia was defined as either rising inflammatory makers or fever and any new respiratory symptom, oxygen requirement or pulmonary imaging changes.

Results
Of a total 328 eligible patients, 225 underwent open oesophagectomy, 80 MIO, and 23 hybrid-ILO. Pain scores were similar on post-operative day 0-5 across approaches. MIO was associated with a significantly lower median total opioid usage (MIO2-624mg, MIO3-720mg) compared to open (ILO-1608mg, LTA-1984mg ) and hybrid-ILO-1977mg (P&lt;0.001).
There was no significant difference in pneumonia, escalation or reintubation rates between the different approaches. MIO was associated with an earlier return of bowel function (P&lt;0.001) and patients undergoing MIO achieved the maximum MMS score earlier than those undergoing thoracotomy (P&lt;0.001).

Conclusions
Equivalent post-operative analgesia can be achieved between open and minimally invasive oesophagectomy when multimodal approaches including epidural anaesthesia are employed. MIO is however, associated with an approximately threefold reduction in opiate use with corresponding earlier return of gut function, and improved post-operative mobility compared to ILO, LTA or hybrid-ILO. Where feasible and can safely be employed, suitable patients may benefit from a minimally invasive oesophagectomy over open or hybrid approaches as part of an enhanced recovery pathway supported by a multidisciplinary team.
OGC P27 Resection margin strategy in gastric cancer surgery: the European REMARCS (Resection MARgin for Cancer of the Stomach) survey
Authors: Chevallay Mickael , Berlth Felix , De Manzoni Giovanni , Piessen Guillaume , Davies Andrew , Koessler Thibaud , Meyer Hans-Joachim , Möhler Markus , Grabsch Heike , Grimminger Peter , Allum William , Pera Manuel , Hölscher Arnulf , Mönig Stefan 
Published: November 2023

Abstract

Background
Surgery with negative resection margins and appropriate lymphadenectomy is the only curative treatment for gastric cancer. The adequate proximal resection margins length in European guidelines is between 5 to 8 centimeters depending on the histological subtype. However, these recommendations are based on outdated studies with limited data. The peri-operative treatment modalities have evolved, and the application of these resection margin cut-offs may not be as uniform as before. The aim of our study was to assess the current European practice in gastric cancer surgery with particular attention to resection margins.

Methods
A panel of 13 international experts composed of surgeons, pathologists, and oncologists developed a web-based survey containing 45 questions about center demographic, resection margin strategy, and post-operative care. The survey was distributed to Upper Gastrointestinal (UGI) surgeons through UGI and visceral surgical societies mailing lists and social media between February and June 2022. Participants were excluded if they did not answer a minimum of 80% completion of the questionary).

Results
172 surgeons from 154 centers in 19 countries responded to the survey. The most represented countries were Germany 60 (35%), Switzerland 30 (18%) and Italy 16 (9%). The mean surgical years’ experience of the responders was 20.8 and their caseload was 23.2 cases per year. For intestinal type gastric tumor, a proximal resection margin length of a minimum of 5 centimeters was advocated by 119 (77%) of the responders. For diffuse, a resection margin of a minimum of 8 cm was applied by 98 (63%) of the surgeons. Macroscopic inspection of the specimen was routinely performed by 110 respondents (64%).

Conclusions
The real-world data from our questionnaire shows that the length of resection margins proposed by actual guidelines are not strictly applied in European centers. Further data from clinical research are needed to standardize resection margin cut-off. This could help European surgeons to propose more organ-sparing strategies to their patients.
OGC P29 Cost of complications after Upper Gastrointestinal Cancer surgery: the case for pre-habilitation illustrated
Authors: Herbert Geraint L , Robinson David , Powell Arfon G , Barlow Rachael , Abdelrahman Tarig , Khalid Usman , Lewis Wyn G 
Published: November 2023

Abstract

Background
Upper Gastro Intestinal (UGI) cancer surgery carries considerable risk and cost in terms of human and financial resource. Reported complication rates after oesophagectomy and gastrectomy are 65% and 42% respectively and can range from relatively minor morbidity to major life-threatening events, all with the potential to increase Length of Stay (LoS) and cost which can be graded by the Clavien-Dindo (CD) system. This study aimed to study the impact of complications on LoS and quantify the associated economic costs.

Methods
Consecutive 754 patients with UGI cancer (420 oesophageal, 334 gastric), undergoing potentially curative treatment (median age 67 yr., 590 m, 164 f, 684 Adeno Ca, 36 SCC, 205 Ivor-Lewis oesophagectomy, 146 Trans Hiatal oesophagectomy, 142 total gastrectomy, 134 subtotal gastrectomy, 97 open and close, 11 Three-stage oesophagectomy, 10 salvage resections, 8 oesophagogastrectomy) were studied. The cost of each night’s stay was limited to direct costs, including ward and medical staff expenditure.

Results
Median LoS was 13 (IQR-7) days. The number of patients related to CD score were; Zero-326, I-41, II-224, IIIa-44, IIIb-28, IVa-36, IVb-4 and V-16, with median LoS of 11, 14, 14, 23, 25, 32, 44 and 9 days respectively. The added LoS for each complication cohort was 3 days for CD I and II, then 12, 14, 21, and 33 days for CD IIIa, IIIb, IVa and IVb respectively. Average added cost for each grade of complication per patient was £844.44 for CD I and II, £3,377.76 for IIIa, £8,519.40 for IIIb, £14,927.70 for IVa and £36,047.85 for IVb.

Conclusions
Overall hospital and CC LoS increased related to complication grade, other than CD V, with an average ward cost per additional day of £281.48 and CC cost of £1426.15. Average cost of an uncomplicated oesophagectomy or gastrectomy was estimated to be £16,544. As well as the adverse impact on patients’ recovery and well-being, complications have a large fiscal impact on healthcare systems and in many cases can dwarf the first treatment cost. These findings illustrate a strong clinical and business case for investment in effective strategies to boost complication free surgery including pre-habilitation.
OGC P35 A clinical audit looking at how efficient the current pathways are for detecting upper oesophageal cancer
Authors: Siempis Timoleon , Harris Andrew , McCain Scott , Kennedy Ray , MacAulay Graeme , Gray Ronan , Kennedy Andrew 
Published: November 2023

Abstract

Background
Dysphagia is a red flag symptom of possible oesophageal cancer. Patients are referred to gastroenterology, Upper GI Surgery or Otolaryngology. The referral pathway is determined by whether the symptoms are thought to be oropharyngeal or oesophageal in nature. Often, correlation between patient’s perception of the level of dysphagia and the anatomical location of the underlying cause is unreliable. This can result in a number of patients receiving either a delayed complete examination of the oesophagus or not receiving one at all. Our aim was to identify potential delays in the diagnostic pathway of patients with suspected upper oesophageal malignancy.

Methods
A retrospective analysis of 348 patients with a confirmed histological diagnosis of oesophageal cancer between January 2021 – March 2023 was performed. Only patients with cervical oesophageal cancer up to 20cm were included. The time between GP referral and commencement of treatment was compared against NHS England standards. The initial investigation ordered for those patients after being referred to the specialist was reviewed in order to identify any diagnostic delays. According to NICE guidelines, all patients with dysphagia should be referred for oesophago-gastro-duodenoscopy (OGD) urgently. Barium swallow should not be the first line investigation for suspected oesophageal cancer.

Results
14 cervical oesophageal cancer cases were identified. 5 cases discussed at UGI Multidisciplinary meeting with incidental diagnosis were excluded. All remaining 9 cases were discussed at both Head and Neck and UGI MDMs. 6/9 patients were first referred to ENT with dysphagia. The remaining 3/9 were referred to either Gastroenterology or UGI. 4/9 patients had OGD whereas 5/9 had barium swallow and 7/9 rigid oesophagoscopy organized by ENT. Interestingly, 4/5 barium swallow tests were the first line investigation. Median interval from GP referral till start of treatment was 108 days which is almost double compared to the standards (62 days).

Conclusions
This study highlights significant delays in the diagnostic pathway of patients referred from GP with dysphagia and suspected cervical oesophageal cancer. It appears that this group of patients enters a pathway without a clear diagnostic consensus. Patients with red flag dysphagia symptoms for suspected malignancy should have direct visualisation of the oesophagus irrespective of whether the initial assessment occurs within head and neck or upper gastrointestinal suspected cancer pathways.