bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN O06 Enhancing Surgical Decision-Making with High-Resolution Manometry and Distal Contractile Integral in Preoperative Assessment for Magnetic Sphincter Augmentation (LINX)
Authors: Miah Ismail , Wong Terry , Gossage James , Zeki Sebastian , Jafari Jafar 
Published: November 2023

Abstract

Background
Preoperative assessment for magnetic sphincter augmentation (MSA) (LINX) involves evaluating the Mean Distal Amplitude (MDA) on conventional manometry to assess the patient suitability and risk of post-operative dysphagia. In the last decade high-resolution manometry (HRM) has superseded conventional manometry owing to obtaining more clinical information on the oesophageal motility, including the Distal Contractile Integral (DCI) that incorporates contractile amplitude, duration and contractility propagation length within the oesophageal body. The purpose of this study is to translate the MDA to modern DCI as preoperative marker to MSA.

Methods
This retrospective study includes patients referred to oesophageal laboratory at Guy’s Hospital between March and May 2023. Patients underwent HRM with ten 5ml water swallows that provided manometric information to compute mean DCI and MDA (MDA waveforms at 11cm, 7cm and 3cm above the GOJ were used). Statistical analysis investigated the relationship between MDA and mean DCI using Pearson correlation, Student t-test, ROC curve analysis and relevant metrics assess the cut-off threshold accuracy and reliability in classifying normal MDA.

Results
270 patients were included in the study (female:male=190:80 males, mean age 52.1 years). There was strong direct correlation between MDA and mean DCI (r=0.71, p&lt;0.0001) (Figure 1). Patients with normal MDA had a significantly higher mean DCI compared with weak MDA at 11cm (601mmHgscm vs 167.15mmHgscm, p&lt;0.0001) 7cm (286.4mmHgscm vs 741mmHgscm, p&lt;0.001), 3cm (592mmHgscm vs 192.6mmHgscm, p&lt;0.0001) and overall MDA (714.2mmHgscm vs 259mmHgscm, p&lt;0.001) (Figure 2). ROC curve analysis revealed the mean DCI thresholds for normal MDA to be 615mmHgscm at 11cm, 419mmHgscm at 7cm, 318mmHgscm at 3cm and 453mmHgscm for the overall MDA (Table 1).

Conclusions
The findings of this study show HRM and the clinical measurement DCI may be a suitable preoperative assessment for MSA. This translation of MDA to modernisation in manometry may assist surgeons adopt DCI which is regarded as more robust assessment that offers more detailed clinical information of the oesophageal motility health and disorder.
OGC O01 Minimally invasive or open oesophagectomy for localised oesophageal cancer: long-term follow-up of the ROMIO pragmatic randomised controlled trial
Authors: Blazeby Jane , Metcalfe Chris 
Published: November 2023

Abstract

Background
Patients with localised oesophageal cancer are frequently offered neoadjuvant treatment and surgery, with the benefit of improved survival but an expected at least short term negative impact on quality of life (QoL). Minimally invasive surgical techniques may reduce the QoL impacts by reducing tissue damage. The ROMIO study compared hybrid with open oesophagectomy, to test the hypothesis that hybrid allows faster recovery whilst maintaining the survival benefit of surgery. We have previously reported no evidence of a difference in early complications or recovery of physical function. Here we present the results of the comparison of longer term QoL and survival.

Methods
A pragmatic multi-centre randomised controlled trial was conducted in nine UK cancer centres. Patients with localised adenocarcinoma or squamous cell cancer were selected by multi-disciplinary teams for oesophagectomy with or without neoadjuvant treatment. Patients were randomly allocated to laparoscopic abdominal surgery and thoracotomy (hybrid) or open oesophagectomy. Surgery was quality assured by provision of a protocol, pre-operative video assessment of the 40 participating surgeons, and intra-operative photographs of key surgical components. Here we report on survival, and patient reported outcomes measured using the EORTC QLQ-C30, over 2 to 3 years post-randomisation.

Results
At enrolment 469 (89%) of 527 participants had an adenocarcinoma, 371 (71%) had a clinically staged T3 or T4a tumour, 296 (56%) had clinically positive nodes, and 438 (83%) underwent neoadjuvant treatment. Kaplan-Meier estimates of survival at 24 months were 66% in the hybrid surgery group (95% confidence interval 60% to 71%) and 65% in the open surgery group (95% confidence interval 57% to 69%) with the difference between the two groups being consistent with chance. Preliminary analyses did not provide evidence of a difference in patient reported quality of life following the two surgical approaches.

Conclusions
In contrast to the previous MIRO study, the ROMIO study has not identified any differences between hybrid and open surgery in complications, short-term recovery of physical function, or survival and quality of life over two to three years post-randomisation. Both approaches remain common in UK practice, with ROMIO providing evidence of their safety. Potentially, a fully minimally invasive approach, as investigated in the ROMIO phase 2b substudy and the TIME study, is required to realise the potential benefits of minimally invasive approaches.
OGC O04 The influence of age in oesophageal cancer treatment decisions: a machine-learning approach
Authors: Thavanesan Navamayooran , Farahi Arya , Walters Zoë , Underwood Timothy , Vigneswaran Ganesh 
Published: November 2023

Abstract

Background
Although patient age plays a crucial role in determining curative treatment options for Oesophageal cancer (OC), the exact extent of its influence is not well defined. We used an interpretable machine learning (ML) approach to model for the first time the exact impact of age in combination with other key decision-drivers, such as tumour and patient characteristics, on the predicted probability of receiving different types of curative treatment as determined by a single centre OC multidisciplinary team (MDT).

Methods
Retrospective analysis of 399 OC patients undergoing curative treatment between 2010-2020 at a tertiary unit. A random forests (RF) classifier model was trained to predict curative treatment decisions for OC patients (neoadjuvant chemotherapy (NACT) + surgery, neoadjuvant chemoradiotherapy (NACRT) + surgery or surgery alone). Variable importance (VI) and Partial Dependence (PD) analyses were used to map the importance of age in the model, its influence on the predicted probability of each treatment decision, and how that relationship was affected when interacting with other decision-driver co-variates.

Results
Age was the most important variable for the model (26% of total importance). PD analysis demonstrated that patients over 70 years had a substantially higher predicted base probability of receiving curative surgery and lower probability of NACT. Moreover, while the probability of receiving surgery and NACT was primarily driven by disease characteristics (T and N staging) in patients &lt; 70 years, age became increasingly important in predicting a surgery-only decision in those &gt;70 years (P&lt; 0.001). The base probability of surgery and NACRT decisions was additionally influenced by performance status and age, but age alone for NACT patients.

Conclusions
We have successfully combined ML modelling with PD analysis in a novel approach within the OC space to delineate the relationship between age and OC treatment decisions. Age heavily influences curative decisions for OC patients but plays a greater role in patients with specific tumour characteristics. This study provides the basis of a ML approach for examining subconscious decision-drivers in the management of OC. This in turn allows OC MDTs to examine areas of potential health inequality which may result from variability within that decision-making framework.
AHP P02 Retrospective study reviewing post-operative feeding after gastric cancer surgery and the impact on outcomes
Authors: Bennett Helen , Harris Rhiannon , Owen Kellie , Grimshaw Kate , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Gastric cancer patients are at increased risk of disease-related malnutrition due to the disease and the consequences of treatment. The variation in post-operative nutrition for this patient group may be impacting on outcomes, and further research has been recommended by the National Institute for Health and Care Excellence to help ascertain the safest and most effective method of nutrition support. The aim of this study was to help inform best practice regarding nutrition post-gastrectomy. The outcomes reviewed included length of stay (LOS), weight changes, complications and readmissions, and chemotherapy completion rates.

Methods
A regional tertiary Oesophago-gastric Centre was the setting for this study. Quantitative data of patients who had a gastrectomy secondary to gastric cancer over a 12-month period was collated. Weights from four timepoints during the multimodal treatment pathway were included. Baseline characteristics were reviewed, and patients grouped based upon their post-operative feeding route (no artificial nutrition, enteral nutrition, parenteral nutrition). Patients were also stratified by resection (partial, total or extended-total). IBM SPSS v26 was utilised for data analysis. Non-parametric tests were used as much of the data was not normally distributed.

Results
44 patients were included, (35 males) age 34-84 years. Partial gastrectomy patients lost an average of 7.2% bodyweight by six months post-operatively, versus 16.5% and 10.7% amongst those who had total and extended-total procedures. 27% (n=12) were known to be readmitted within six months of surgery, half with nutrition-related complaints. 19 patients received adjuvant chemotherapy, with 52% known to complete this. Weight loss in the initial post-operative period between those who did and did not complete chemotherapy was significantly different (6.8% versus 8.6%) (p=0.027). The patients with supplementary enteral nutrition completed chemotherapy, versus half of those only receiving oral nutrition.

Conclusions
Weight loss and inadequate nutrition after gastrectomy is significant and may have an impact on treatment pathways including the need for readmission. The study demonstrates a relationship between post-operative nutrition and adjuvant chemotherapy completion and warrants future prospective investigation. The study highlights the importance of providing adequate nutrition support throughout treatment and beyond for those patients undergoing a resection for gastric cancer.
AHP P06 Optimizing Coagulation Screen Practices in CVC Removal Amongst Surgical Patients: A Retrospective Audit Assessing Necessity, Compliance, and Implications
Authors: Shamiyah Khalid , Curry Nicola , Cunningham Chris 
Published: November 2023

Abstract

Background
Conflicting findings in recent literature question the significance of traditional coagulation variables in predicting bleeding associated with central venous catheter (CVC) removal. This audit evaluates the necessity and compliance of conducting same-day coagulation screens at Churchill Hospital. The study assesses the practice's relevance, compliance rates, and associated costs, offering implications for clinical decision-making, resource utilization, and potential modifications to current practices. The findings may lead to the adoption of new predictive factors or a targeted approach to coagulation testing, optimizing patient care and resource allocation in CVC removals.

Methods
This retrospective audit focused on surgical patients in the upper gastrointestinal, hepatobiliary and pancreatic, lower gastrointestinal, and transplant surgery departments at the Churchill Hospital. The study encompassed all instances of central venous catheter (CVC) removal that occurred between January 1st, 2022, and December 31st, 2022. Data retrieval was conducted using electronic patient records, and coagulation test results were interpreted utilizing the reference ranges available in the electronic patient record system (INR 0.9-1.2, PT 9-12, APTT 20-30).

Results
78 patients had an average age of 53 years and a mean hospital stay of 35 days. The average duration of CVC in-situ was 8.9 days. Patients underwent an average of 5.07 coagulation tests per stay, equivalent to 0.28 tests per admission day. Among the audited patients (n=67), 41.8% had same-day coagulation screens, 17.9% had the screen one day prior to CVC removal, and 40.3% had the screen more than one day before removal. Analysis showed that 88% had normal INR values, with only eight patients having abnormal values. Furthermore, 74.6% and 58.2% had normal PT and APTT values, respectively.

Conclusions
This retrospective audit of CVC removals in surgical patients at Churchill Hospital revealed a concerning in-compliance rate of 44% with coagulation screens during CVC removals. Most patients had normal coagulation parameters, questioning the need for same-day screens. Delays and high costs (£64.76 per patient, £12.95 per screen) were incurred. Individualized risk-based approach, considering bleeding history, could be more efficient. Implementing targeted coagulation testing saves costs and optimizes resource utilization. Further evaluation required to improve patient care and resource allocation in CVC removals, reducing reliance on routine same-day screens.
EGS P02 Lessons learnt from 450 Endoluminal vacuum therapy (EVT) procedures in the treatment of upper gastrointestinal perforations and leaks
Authors: Farooq Naheed , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Endoluminal vacuum therapy (EVT[BA1] ) is a novel, yet relatively well established tool in the management of upper gastrointestinal (UGI) leaks and perforations. Despite a growing body of evidence supporting its use, management strategies and techniques used in the context of EVT are yet to be standardised. Furthermore, the uptake of EVT in the UK is limited to a small number of centres. This project aimed to summarise the key lessons learnt from our initial experience of 450 EVT procedures, to inform others about how this technique can be integrated into regular clinical practice.

Methods
This study draws on experiential reflections and analysis of a prospective database of 450 EVT procedures in 59 patients in our unit from October 2018 – June 2023. This included patients who had undergone oesophago-gastric (OG) cancer resections, bariatric surgery (index procedures both in the UK and abroad) and those presenting with benign disease (oesophageal perforation and iatrogenic injury). The setting was a regional tertiary OG and bariatric centre in the North West of England serving a cancer and benign population of 3.5 million people and a larger undetermined population for bariatric emergencies.

Results
51/59 (86%) patients were successfully managed with 446 EVT procedures. Patient, system and technical factors were identified which when addressed, facilitated expeditious healing of leaks, and enabled active management patients unfit for more invasive interventions. Factors included understanding the indications for using and stopping EVT, control of sepsis, and optimisation of nutrition and glycaemic control. Technical factors included sponge placement, managing foreign material (e.g. redundant sutures and drains) and approaches to managing necrosis. System factors included supporting a training programme, the necessity of a comprehensive team approach and the financial and governance challenges with adopting a novel intervention.

Conclusions
EVT is as an effective technique in the management of complex UGI leaks and perforations. There are multiple patient, financial, logistical, governance and systems factors that present as challenges to the implementation of this technique into routine practice. An integrated team-based approach is key to adoption of EVT by other centres into their routine practice.
EGS P10 A multi-centre prospective cohort study to identify factors predictive of poor functional recovery for older patients facing major gastrointestinal surgery (OCTAGON study): A subgroup analysis of older patients undergoing non-curative procedures or conservative management
Authors: Daniels Sarah , Rashid Adil , Lee Matthew , Moug Susan , Wilson Tim , Brown Steven , Wyld Lynda 
Published: November 2023

Abstract

Background
Increasing age and frailty are associated with ‘futile’ emergency GI surgery and increased 30-day mortality after elective surgery. Consequently, older patients may be deemed “unfit” for major GI surgery, due to perceived risk of poor outcomes such as prolonged hospitalisation, poor functional recovery or mortality. Little is known about the baseline health characteristics and outcomes of the “unfit” group, with only a small number of studies performed on this patient group to date. This study aimed to comprehensively assess the baseline characteristics and functional trajectories of patients deemed “unfit” for major surgery using validated questionnaires.

Methods
This prospective, multicentre cohort study included patients aged 65 years or older with a diagnosis of elective or emergency GI pathology amenable to curative major GI surgery. Patients who underwent risk-adapted procedures or conservative management instead of curative major GI surgery formed the “unfit” cohort. Risk-adapted procedures included endoluminal stenting, defunctioning stomas and percutaneous tumour ablation. Baseline patient characteristics were recorded. Patients were followed up at 6 weeks, 3 months, and 6 months to assess survival, patient reported functional recovery using the World Health Organization Disability Assessment Schedule (WHO-DAS) questionnaire and quality of life using EQ-5D-5L.

Results
19 patients formed the “unfit” cohort. 10 patients presented electively and 9 presented as an emergency. Within the elective group 30% were classified as frail and 20% required carers, in comparison to 89% and 56% respectively in the emergency group. Baseline WHODAS indicated higher patient reported disability in the emergency group. 6-month mortality was 40% in the elective group and 44% in the emergency group. At 6 weeks, functional status declined in both the elective and emergency groups. Only small numbers of patients completed follow-up at 3 and 6 months due to death prior to follow-up.

Conclusions
This study comprehensively assessed baseline functional status and quality of life in elective and emergency patients who were “unfit” for major GI surgery. The study found high rates of baseline frailty and functional disability, particularly amongst those who presented via emergency pathways. Over half of patients were alive at 6 months, but with high levels of functional impairment, suggesting that these patients may benefit from early involvement from geriatric and palliative care specialists. Further research is needed to improve outcomes in this understudied surgical population.
EGS P13 Adherence to Guidelines for Post-Splenectomy Patients in a Primary Care Practice in North West England
Authors: Sharif Faraz , Alam Imran , Tankard Justin 
Published: November 2023

Abstract

Background
Splenectomy is indicated in haematological, oncological disorders and occasionally during emergency (trauma) surgery. Given the spleens role in the immunological response, overwhelming infection remains an area of concern for post-splenectomy patients with low prevalence (0.1-0.5%) but high mortality (∼50%). Strep pneumoniae, H influenzae Type B and Neisseria meningitidis are common bacterial perpetrators.
At present, Public Health England and the British Society for Haematology recommends regular influenza, pneumococcal and meningococcal vaccinations for patients with asplenia or hyposplenism. They should also be on lifelong prophylactic antibiotics.
This audit aimed to assess the adherence to vaccination and antibiotic prophylaxis guidelines for post-splenectomy patients.

Methods
19 patients post splenectomy patients were identified at a primary care practice in North West England. Data was retrospectively collected from the last 10 years with two researchers manually searching through their GP records. Parameters collected included both compliance and timeliness with vaccinations and antibiotic prophylaxis as per national guidance. Where there was a deviation from the guidance, the records were again searched to identify any cause.

Results
109/162 (67.3%) ‘vaccination opportunities’ for the recommended yearly influenza vaccination were successfully delivered.
17/19 (89.4%) patients had no documented initial pneumococcal vaccination at time of splenectomy.
23/162 (14.2%) influenza and 22/37 (56.4%) pneumococcal vaccination opportunities were missed with no documentation explaining why.
Only 1 patient received the recommended MenACWY/MenB vaccination at diagnosis, 5 received delayed vaccinations and 13/19 (68.4%) patients received no meningitis vaccination.
7/19 (37%) patients were not on prophylactic antibiotics as recommended with no documented explanation. 2 of those patients were issued one-off antibiotic prescriptions and 1 had their prescription stopped due to non-compliance.

Conclusions
Significant improvement is needed with regards to antibiotic prophylaxis, pneumococcal and meningococcal vaccinations with over 50% of vaccinations being missed. Poor documentation and a shift to electronic health records are possible factors that have affected data collection, particularly as a significant number of the splenectomies performed were prior to 2000. Recommendations include routine reviews for asplenic patients, encouragement for opportunistic vaccination and increasing awareness of the risks of post-splenectomy sepsis and the benefits of vaccinations. Future scope could include looking at the same guidelines for other hyposplenic/asplenic conditions.