bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P34 Oesophageal and Gastro-oesophageal junctional cancer recurrence post hybrid and minimally invasive oesophagectomies
Authors: Muir Duncan , Ash Stephen , Sgromo Bruno 
Published: November 2023

Abstract

Background
Minimally invasive oesophagectomy (MIO) has shown favourable short-term outcomes compared to the open and hybrid alternative, with similar oncological resection rates and mortality. Despite this, there is limited literature on recurrence patterns between operative approaches, with little reported comparing hybrid and minimally invasive oesopahgectomies. This study aimed to evaluate the differences in recurrence patterns between hybrid and totally minimally invasive oesophagectomies.

Methods
All patients undergoing an Ivor-Lewis oeosphagectomy via a hybrid (HILO) or totally minimally invasive approach were included. Patients received clinical and radiological follow-up with CT chest, abdomen and pelvis at regular intervals or in the presence of concerning symptoms.
Propensity matching was performed and matched cohorts were analysed. Statistical analysis was performed using R 4.1.2

Results
Forty HILO and 56 MIO patients were included. Overall recurrence was reduced in MIO (50% HILO vs 21% MIO p=0.003, 50% HILO vs 25% MIO, p=0.02 after matching). Distant recurrence was higher in HILO (45% HILO vs 20% MIO p=0.002, 45% HILO vs 23% MIO p=0.02 after matching). For GOJ cancers, there was reduced overall recurrence in MIO compared to HILO (52% HILO vs 9% MIO, p=0.002 overall, 24% hybrid vs 0% MIO, p=0.01 for local recurrence). These differences remained after propensity matching (52% hybrid vs 14% MIO, p=0.02 overall, 24% HILO vs 0% MIO, p=0.046 for locoregional).

Conclusions
MIO patients showed reduced overall and distant recurrence compared to the hybrid technique, with also reduced locoregional recurrence in an unmatched comparison. Reduced overall and local recurrence was seen in MIO cases for cancer of the GOJ. Resection rates and major complication rate was similar between the modalities. For future studies, an agreed definition on locoregional recurrence would be beneficial, as would a reached consensus on lymphadectomy in oesophagectomy.
OGC P36 The role of self-expanding metallic stents and surgical gastric bypass for palliation of gastric outlet obstruction caused by gastric cancer
Authors: Digby Maria , Doran Sophie , Lee Fred , Hersey Naomi , Tamhankar Anand 
Published: November 2023

Abstract

Background
The treatment of inoperable gastric cancer, causing gastric outlet obstruction (GOO) is focused on palliation of symptoms. Self-expanding metallic stent (SEMS) or surgical gastric bypass (SGB) are used to relieve GOO. Available data on SEMS and SGB are often unreliable as studies usually include patients with different causes of GOO including pancreatic or duodenal cancers or extrinsic disease. Their utility for GOO due to gastric cancer remains uncertain as gastric motility and function could be affected by the pathology. We aim to review outcomes of SEMS and SGB for GOO from gastric cancer in our unit over a 5-year period.

Methods
Retrospective review of all patients who have had SEMS or SGB for palliation of GOO from gastric cancer between 01/01/2018 and 31/12/2022. Data was collected on the pathology of the tumour, pre-intervention symptoms scoring, post-intervention symptoms scoring, length of stay, complications and survival. Thirty-five patients were identified and included in the study.

Results
Thirty patients with SEMS and five patients with SGB were analysed. Median survival was 16 weeks. Median length of stay after SEMS was 5.5 days (IQR: 1.2-12.7, range 1-83) and after SGB was 10 days (IQR: 9-11, range 8-32). 2/30 in the SEMS group had early complication requiring re-stenting and 1/5 in SGB group had early complication requiring further surgery and subsequent SEMS. Complete palliation of obstruction was achieved in 17/21 (70%) of SEMS and 4/9 (40%) of SGB patients. Complete palliation with SEMS was more likely when stomach cancer was localised (81%) rather than widespread (44%).

Conclusions
Self-expanding metallic stents are safe and effective in the palliation of symptoms in patients with gastric outlet obstruction due to gastric cancer and perhaps function better than surgical bypass. They are more effective when the obstructing gastric cancer is localised disease. Longer hospital stay associated with surgical bypass may compromise the palliative process when the survival is often limited.
OGC P41 Presentation, Management and Outcomes in Young Patients Diagnosed with Oesophageal Cancer
Authors: Smith Ossian , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Oesophageal cancer is a devastating malignancy associated with poor prognosis, primarily affecting older individuals with multiple co-morbidities. However, outcomes of younger patients have been perceived as poor due to late diagnosis and more aggressive disease subtype. This subset of patients poses unique clinical challenges and requires a better understanding of their outcomes. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with oesophageal cancer, to provide further insights into this understudied population.

Methods
A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger at the time of diagnosis of oesophageal cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following oesophagectomy were compared to publicly available outcomes.

Results
87/2485 (3.5%) of patients studied were aged 50 or below at the time of diagnosis. Mean age at diagnosis was 44.3 (range = 24-50); 71% were male. Adenocarcinoma and SCC accounted for 73% (33% poorly differentiated, 40% moderately differentiated) and 25% of cases respectively. The majority presented with c-stage III (24%), c-stage IVa (17%) and c-stage IVb (46%) disease. Initial treatment intent was curative in 43%. 1-and 3-year overall survival rates were 49% and 21% respectively - similar to the wider population. 1- and 3-year survival rates after oesophagectomy were 80% and 44.5% (versus 82.5% and 59.5% for wider population).

Conclusions
Our findings underscore the concerns about the proportion of advanced-stage diagnosis in young patients with oesophageal cancer, and poorer longer-term outcomes after curative resection. This highlights the importance of timely detection and appropriate treatment strategies in this patient group. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies as well as validating these finding in larger and more diverse patient populations.
OGC P42 Presentation, Management and Outcomes in Young Patients Diagnosed with Gastric Cancer
Authors: Smith Ossian , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
Gastric cancer poses a significant global health challenge, mainly affecting older individuals with well-established risk factors. However, outcomes in young patients have been perceived as poorer due to late diagnosis and more aggressive disease subtype. There are also a small sub-set of younger patients in which gastric cancer is genetically inherited. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with gastric cancer, to provide valuable insights into optimal therapeutic strategies.

Methods
A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger (eligible for genetic testing) at the time of diagnosis of gastric cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following gastrectomy were compared to publicly available outcomes.

Results
60/956 (6.3%) patients were aged 50 or below at the time of diagnosis. Mean age was 42.1 (range = 28-50); 48% were male. Stages III and IV of disease were observed in 27% and 57% of patients respectively. Poorly differentiated disease was observed in 53%, with HER-2 positivity in 13%. Distal gastric cancer represented 56% of cases and proximal cancer 27%. Initial treatment intent was curative in 43%. 1-year and 3-year overall survival was 51% and 33. 3-year overall survival was 92% for 20 patients who received gastrectomy versus 60% in all patients reported by NOGCA.

Conclusions
This study suggests that young patients with gastric cancer present with significantly advanced disease. Despite this, young patients show similar medium- and long-term survival rates. Well selected young patients can be offered treatment with curative intent with good medium- to long-term outcomes. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies, including the role of genetic testing, as well as validating these finding in larger and more diverse patient populations.
OGC P45 Complications in patients undergoing robotic-assisted oesophagectomy at a single centre
Authors: Cross Andrea , Brown Joshua , Joel Abraham , Wahed Shajahan , Immanuel Arul 
Published: November 2023

Abstract

Background
Robotic-assisted oesophagectomy is increasingly being utilised in the management of oesophageal cancer. The implementation into practice comes with an inevitable learning curve and it is important to ensure that this does not occur at the expense of poor patient outcomes. This study looks at the complications rates from the implementation of a robotics program at a single centre.

Methods
A retrospective review of a prospectively maintained database of oesophageal cancer patients treated at a single centre was undertaken. The robotic oesophagectomy program commenced October 2019 and all patients undergoing oesophagectomy to June 2023 were identified. Demographics, operative variables, oncological outcomes, and complications were analysed. Type of operation was robotic when at least one phase was robot-assisted, minimally invasive (MIO) when one phase was thoracosopic or laparoscopic and open when both were open. CUSUM analysis was used to determine the effect of a change in anastomotic technique due to a real time observation of an increase in anastomotic leak rate.

Results
229 patients underwent oesophagectomy; 67 robotic, 40 MIO and 122 open. Clinical stage, demographics, and CPEX parameters were similar.
There were slightly fewer complications in the robotic group overall (robotic 71.6%, MIO 72.5%, Open 74.2%); this was not statistically significant. There were significantly more anastomotic leaks in the robotic group (19.4%) compared to open (12.9%) which was noted in real time and led to a change in anastomotic technique with CUSUM analysis after this showed a diminished anastomotic leak rate (0/9 cases). Chyle leak occurred in 6% of robotic and 4% of open cases, which was not significantly different.

Conclusions
We found that the outcomes following robotic oesophagectomy were mostly comparable to conventional techniques. Whilst we found no difference in overall complications, there was a significantly higher anastomotic leak rate observed and identified which led to a change in anastomotic technique. Early results from this indicates a significant reduction in anastomotic leakage. It is crucial that all centres adopting the robotic platform closely monitor outcomes in real-time.
OGC P49 The legacy of the COVID-19 pandemic on patients with oesophago-gastric cancer
Authors: Alasmar Mohamed , Matias Nadia , Alhamed Norah Ali M , Rudge Brogan , David Moti Terngu , Abdelwahab Mohamed Ossama Yassin , Stockton Jennifer , Raslan Charef , Cairney-Hill Jess , Altarawni Mohamed , Alkhaffaf Bilal 
Published: November 2023

Abstract

Background
The COVID-19 pandemic significantly impacted on healthcare systems worldwide, and likely affected every aspect of the patient pathway from diagnosis and treatment to long-term outcomes. Whilst much has been inferred about the impact on patients with oesophago-gastric (OG) cancer, very little granular data or understanding currently exists about how and why outcomes may have differed to pre-COVID times. This study aimed to investigate the effect of the pandemic on key aspects of the patient pathway, including decision-making in MDTs and long-term survival on patients newly diagnosed with OG cancer.

Methods
This retrospective study compared patients from 2 distinct periods during the pandemic (March to August 2020 and March to August 2021) against a corresponding pre-pandemic period (March to August 2019). The setting was a regional OG tertiary cancer centre serving a population of 3.5 million people in the North West of England. The primary outcome was the rate of palliative intent pathways. Secondary outcomes included the rate of deviation from the standard of care (SoC) in MDT decision-making and changes in overall survival. MDT minutes were analysed for disease stage, management intent, treatment justification, and data on first treatment modality.

Results
402 new patients were diagnosed between March-August 2019; 158 (39.3%) and 244 (60.7%) were initially allocated to curative and palliative pathways respectively. This dropped to 261 new cases (32% curative and 68% palliative) during March-August 2020 rose back up to 386 new cases (37% curative vs 63% palliative) during March-August 2021. The change in cases allocated to palliative pathways was significant (p=0.014). One-year overall survival for was 50.5%, 56.3%, and 51.6% for new diagnoses during 2019, 2020 and 2021 (p=0.316). There was no difference of rates of pathway deviations from standard of care comparing MDT decisions made during each time-period.

Conclusions
Fewer new patients were discussed, and a greater proportion of patients were allocated to palliative pathways during the first 6 months of the COVID-19 pandemic. This was not due to deviations from standard of care - which were widely reported during this period. Caseload and pathway allocation recovered by 2021 and 1-year overall survival did not change throughout, suggesting that despite other restrictions in place, treatment delivery remained effective throughout the pandemic. Further survival analyses over the coming years are required in order to explore the longer-term impacts of the pandemic on OG cancer patients.
OGC P53 Recurrent oesophageal cancer involving complex gastro-pleural fistula: a rare case report on the role of palliative endoscopic stenting
Authors: Ling Quake Sharmaine Yen , Viswanath Yirupaiahgari 
Published: November 2023

Abstract

Background
Oesophageal cancer ranks as the 14th most common cancer in the United Kingdom and has witnessed improved survival rates due to advancements in treatment. However, despite initial treatment with curative intent, there is a risk of recurrence associated with poor prognosis. Recurrent oesophageal cancer is typically detected at an advanced stage with predominantly palliative treatment options. In rare cases, a cancer-related fistula can develop between the respiratory system and the oesophagus. This complication poses a risk of sepsis with diminished quality of life; therefore, prompt management of such fistulas with consideration of palliative endoscopic stenting is essential.

Methods
We present a case of a patient with a gastro-pleural fistula due to recurrent oesophageal cancer following initial treatment in 2016. She received neoadjuvant chemoradiotherapy which down-staged the tumour from pT3 to ypT2, followed by Ivor-Lewis oesophagectomy for a mid-oesophageal squamous cell carcinoma with complete resection margin. Metastatic disease was detected in the right superior mediastinal node in 2018, which was treated by radical chemoradiotherapy. In 2022, further recurrence was detected in a fistulating mass involving the gastric conduit, right posterior chest, pleura and overlying soft tissue. The multidisciplinary team recommended palliative chemotherapy and endoscopic stenting of the fistula.

Results
Endoscopic stenting is a palliative adjunct in advanced oesophageal cancer to alleviate dysphagia and allow oral nutrition. In this patient, we describe a novel approach of double stenting using the Ovesco Stenfix system, performed by an oesophago-gastric surgeon. Two stents were deployed in a ‘piggyback’ technique to completely occlude the fistula site and secured using Ovesco clips, hence maintaining a single conduit to pass food and fluid through the gastrointestinal tract. Stent placement was confirmed to be satisfactory with fluoroscopy. The patient was admitted 48 hours post-procedure and discharged without intra-procedural complications once oral intake was resumed.

Conclusions
Despite advances in the treatment of potentially curable oesophageal cancer, recurrence of the disease still occurs with devastating sequelae. As observed in our patient, recurrence in the form of complex fistulating mass is infrequent and associated with significant morbidity. Endoscopic palliative stenting was a safe option with good technical success.
OGC P55 The learning curve in robotic-assisted thoracic phase of oesophagectomy
Authors: Brown Joshua , Joel Abraham , Cross Andrea , Prasad Pooja , Immanuel Arul 
Published: November 2023

Abstract

Background
Robotic oesophagectomy has gained increasing prominence in the management of oesophageal cancer, offering potential benefits over open procedures including improved visualisation, enhanced dexterity, and reduced surgical trauma. The adoption of this technique, however, requires navigating a learning curve. As oesophagectomy typically involves two stages, a staggered approach to training and implementation of robotic assistance can be employed. This approach enables surgeons to focus on mastering each phase individually, whilst allowing the completion of the procedure using an established technique. This study investigates the learning curve associated with the thoracic phase during oesophagectomy for a single high-volume surgeon.

Methods
A prospectively maintained database was used to retrospectively analyse the thoracic phases of the first 40 robotic-assisted oesophagectomies and compare them to 20 open thoracic phase procedures. These cases were sequentially performed by an experienced surgeon at a UK high-volume upper GI tertiary referral centre who had already achieved competence for the robotic abdominal phase. Operating time, blood loss, nodal count, R0 rate and length of stay were reviewed to determine the number of cases required to reach parity with the open procedure.

Results
There were no significant differences between the two regarding median age, BMI or anaerobic threshold. Operation time (210 vs. 247 minutes) and one lung ventilation time (175 minutes vs. 235 minutes) were significantly longer with robotic surgery, but reported blood loss was significantly less with robotic surgery (350 vs. 100ml) and there was no difference in median node count (34 vs. 35), R0 rate (95 vs. 95%) or length of stay (10 vs. 9 days). No Parameter differences were seen between early cases and later cases.

Conclusions
The findings of this study demonstrates that although operative time was longer there were comparable outcomes between the robotic and open thoracic phases of oesophagectomy for a single high-volume surgeon. Although progressive improvement in parameters for the robotic-assisted chest phase would be expected as the surgeon acclimated to the procedure, no such changes seen in this dataset. This may indicate that the learning curve in the thoracic phase is flattened in those who have already achieved competence in the robotically-assisted abdominal phase.
OGC P57 Are Cervical Lymph Node Dissections in Oesophageal Cancer Patients Undergoing Oesophagectomy Beneficial?
Authors: TS Ye Tiffany , Mastoridis Sotiris , Mihai Radu , Khan Shad , Owen Richard 
Published: November 2023

Abstract

Background
Cervical lymph node dissection in patients undergoing oesophagectomy can be indicated when there is suspicion of involved cervical nodes, although there is controversy around the benefits of this additional procedure on the prognosis of these patients. This study aims to assess the consequences and survival after cervical lymph node dissection, and to weigh the risks and benefits of this procedure.

Methods
This retrospective study included seven patients with oesophageal squamous cell carcinoma (SCC), and one with oesophageal adenocarcinoma who underwent cervical lymph node dissection in addition to oesophagectomy at the Churchill Hospital. There was a male to female ratio of 1:3, and all had neoadjuvant chemotherapy and were staged with PET-CT. PET staging scan results were compared pre and post neo-adjuvant therapy (NAT) to assess nodal involvement. Final histopathology was also recorded.

Results
All patients had evidence of cervical nodal involvement on PET scan, two of whom developed nodal involvement only after NAT. Only two patients had neck node involvement on histopathology: one had SCC and showed good response to NAT; the other had undifferentiated carcinoma and showed new para-tracheal node involvement after NAT, later developing supraclavicular node recurrence. Two cases were complicated by recurrent laryngeal nerve (RLN) injury, one with bilateral and one with partial vocal cord palsy. There was a 5-year survival rate of 62.5%, with non-survivors uniquely having recurrent disease.

Conclusions
Lymph node dissection alongside oesophagectomy achieved good 5-year survival in this small cohort, but with a significant risk of RLN injury. Further studies investigating the proportion of metastatic neck nodes found on dissection, long term survival benefits and cancer reoccurrence are required.