bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P56 Service Evaluation of Hot Gall bladder Pathway
Authors: Muhammad Ahmad Muhammad Salah , Ramzy Elmaradny Ahmed , Mourad Moustafa 
Published: November 2023

Abstract

Background
Management of acute cholecystitis has traditionally been conservative. Initially patients are treated with antibiotics posted for LC after 4-6 weeks.Surgery during acute settings was previously avoided due to fear of injuring surrounding structures. NICE guidelines published in October 2014 now advises that patients presenting with acute cholecystitis should have LC within a week which has been proven to be safe and effective. With respect to acute pancreatitis the standard of care should be lap chole during index admission for all non-severe cases. The purpose of this study is to evaluate the management of patients admitted with acute gall stone diseases.

Methods
It was a retrospective study of all the patients admitted with acute gall stone diseases and compare the outcomes after introduction of Hot Gall Bladder Pathway.
We screened a total of 245 patients who had been included in this study between October 2018 to March 2020 with two groups:
Data were collected form EZ Notes,IT Systems,Databases,Observations and Paper Records.

Results
Acute cholecystitis with no associated organ dysfunction who underwent Laparoscopic Cholecystectomy within week of diagnosis in the pre Hot GB List period was 43%(31/74) wheras in the Post Hot GB List period was 81% (93/116). Mild Acute Biliary Pancreatitis who underwent LC within index admission was 30% (5/17) in the preHot GB List Period wheras 78%(14/19) of patients with gall stone pancreatitis under went LC during the same admission after the beginning of Hot GB lists.

Conclusions
We had achieved almost 81% of the expected outcome in surgically dealing with patients presenting with acute cholecystitis and 78% with patients presenting with gall stone pancreatitis after introduction of Hot Gall bladder pathway. Safe and cost-effective hot gall bladder service can be provided by the EGS with input from upper GI surgeons with acceptable morbidity and a satisfactory outcome. Hot gall bladder pathway has proven to be effective in treatment of GS related diseases without significant increase in complication rate. It also helps avoiding readmissions, Gall stone related complications, reduces bed occupancy and improves patients’ quality of life.
HPB P57 Outcomes of Transarterial Chemoembolization (TACE) at East Lancashire Hospitals NHS Trust
Authors: Zafar Nowera , Jamal Zohaib , Sultana Asma 
Published: November 2023

Abstract

Background
Hepatocellular carcinoma (HCC) accounts for 85%–90% of all primary liver cancers and is a significant cause of morbidity and mortality worldwide. The aim of this study was to evaluate the efficacy and safety of the procedure at ELHT. TACE is an image-guided IR locoregional therapy for unresectable hepatocellular carcinoma patients to improve their survival. It has emerged as an efficacious palliative option for inoperable cases as it is less invasive and known to have fewer complications. It may also act as a bridge for liver transplantation.

Methods
This is a retrospective study with data collected over 2 years. Treatment-naive patients aged 18 and above with unresectable HCC with a Child-Pugh Class A/B were selected. Treatment response was assessed after every TACE session using CT or MRI within 6 weeks of TACE, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Safety was assessed based on technical success and the number of complications.

Results
35 patients underwent TACE (median age - 79). The commonest underlying etiologies were liver cirrhosis (25%) and alcohol (22%). Of the total 90 sessions, partial response was seen in 44% (39 sessions) followed by complete response in 23% (21). For 22% (20), the outcome was stable disease. Since 74% of the patients had multiple sessions, efficacy per patient showed a result of complete response in 44% and partial response in 18%.1 year survival rate was 60%, 21% had a recurrence and 22.8% developed complications (3 liver abscesses). The technical success achieved was 97.7%.

Conclusions
TACE is safe and effective for treating HCC patients, who are unsuitable for thermal ablation or surgery as it offers comparable survival benefits. ELHT showed a successful disease control (complete, partial response + stable disease) of 89% through TACE. Liver abscess was the commonest compilation in our study (22%) - this was higher when compared with the existing literature (an average of approximately 6%).
HPB P60 Satisfaction Rates with Telephone Follow-Up Clinic Appointments
Authors: Murugan Veylamuthen , Wong Tiffany , Fouad Mina , Sanyal Sudip 
Published: November 2023

Abstract

Background
Since the onset of the COVID-19 pandemic, telephone follow-up (TFU) clinics have become an integral part of delivering healthcare. Advantages of telephone clinics include reducing costs and increasing efficiency. This quality improvement project (QIP) was conducted to evaluate patient satisfaction rates with hepato-pancreato-biliary (HPB) telephone follow-up clinic appointments and improve those rates.

Methods
The Likert-scale is a 13-item questionnaire tool ranging from 1-5 (1=strongly disagree, 5=strongly agree) and was used to assess patient satisfaction with TFUs, both before and after implementation of measures for improvement. Satisfactory cut-off point (score of 4) was analysed across all responses. Retrospective questionnaires were completed for 100 patients pre-interventions, and for 42 patients post-interventions. All patients were verbally consented. Presentation of initial findings and education surrounding areas to be improved at a departmental meeting, and use of a structured teleconsultation template were the measures implemented for improvements. Outcomes included overall satisfaction rates across gender and age groups.

Results
The overall satisfactory rate with TFUs improved from 75% to 95.2%. When analysed according to sex, the satisfactory rates improved for males from 67.6% to 91.7%, and for females from 79.4% to 96.7%. As for satisfactory rates according to age, improvements were noted in 3 out of the 4 pre-determined age groups; &lt;50 years improved from 72.2% to 100%, 50-59 years declined from 88.9% to 80%, 60-69 years improved from 71.4% to 100% and &gt;70 years improved from 72% to 93.7%.

Conclusions
Initial findings were positive but there was still room for improvement. The 2 main interventions used were discussion and teaching in a departmental meeting, and the implementation of a teleconsultation template. Implementation of these measures were successful in significantly improving the satisfactory rates with TFUs.
OGC P02 Neutrophil/lymphocyte ratio and long-term survival after pancreatoduodenectomy for malignancy
Authors: Arain Zohaib , Alghazawi Laith ,   RAW Study Collaborators, Fehervari Matyas , Spalding Duncan 
Published: November 2023

Abstract

Background
Previous authors have highlighted that preoperative neutrophil/lymphocyte ratio (NLR) may be of prognostic importance in patients who undergo pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC), ampullary carcinoma (AA) or cholangiocarcinoma (CC) of the pancreatic head/periampullary region. Various cut-off thresholds have been suggested. This study aimed to compare the five-year survival rates of PD patients with high preoperative NLR to those with low preoperative NLR (using thresholds from recent studies).

Methods
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Patients were grouped by their underlying cancer type and divided into “high NLR” (PDAC: ≥ 3.74, AA: ≥3.0, CC: ≥2.75) and “low NLR” (PDAC: &lt;3.74, AA: &lt;3.0, CC: &lt;2.75) groups. Five-year survival rates were compared using Fisher’s exact test.

Results
Out of 1484 patients, 885 (59.6%) had PDAC, 394 (26.5%) had AA and 205 (13.8%) had CC, and NLR was available in 88.4%, 89.1% and 92.2% of cases, respectively. The median NLR was 2.7 (range: 0.1-34.0), 2.8 (range: 0.3-103.0) and 2.7 (range:0.1-83.3) for patients with PDAC, AA and CC, respectively. Low NLR did not correlate with improved five-year survival rates in any of the studied cancers (PDAC: 24.5% vs 23.8%, p=0.9, AA: 56.1% vs 51.2%, p=0.4, CC: 34.4% vs 25.8%, p=0.2).

Conclusions
In our multicentre study of PD outcomes, preoperative NLR was not useful for predicting five-year survival in patients with PDAC, AA or CC.
OGC P03 A protocol for investigation and management of late effects after Upper GI surgery
Authors: Pecorella Ilaria , Grimes Sam , Sunderland Nicola , Wong Leslie , Warren Sophie , Chinyama Nyarai , Smith Ben , Bennett John , Hardwick Richard , Sarker Anita , Modolell Ines , Roberts Geoffrey 
Published: November 2023

Abstract

Background
Upper GI surgery, and particularly upper GI cancer surgery can result in quality of life limiting symptoms months and years later. While some of these symptoms may be unavoidable, there are a number of conditions which can be treated with the intention of improving quality of life. We developed and assessed the impact of a CNS and dietitian-led protocol for the investigation and management of late effects after upper GI cancer surgery at Addenbrooke’s Hospital, Cambridge.

Methods
A multi-disciplinary team including nurses, dietitians, pharmacists and with medical input from surgery, gastroenterology and clinical biochemistry produced a pragmatic guideline for the investigation and management of gastrointestinal, nutritional and endocrinological late effects. The protocol was instituted then retrospectively assessed for impact.
The patients were divided in two groups, according to the beginning of their investigations: before or after the introduction of the protocol. Key measures were: proportion of patients being investigated for late effects, the time from presentation of symptoms to diagnosis and which late effects patients were diagnosed.

Results
In the analysis we included a total of 63 patients, 43 from the pre-protocol group and 20 from the post-protocol group. Patients investigated more than once have been interpreted individually making 51 cases pre-protocol and 22 post-protocol. In the pre-protocol group, 78.43% of patients were investigated for late effects. Among them 55% were diagnosed SIBO, 22.9% PEI. In the post-protocol group, 36.36% of patients were investigated for late effects. Among them 50% were diagnosed SIBO and 37.5% PEI. The average time from symptoms to diagnosis in the pre-protocol group was 10 months while in the post-protocol group 2 months.

Conclusions
The protocol has proved a popular adjunct to AHP-led follow-up clinics. The time from symptom onset to diagnosis has significantly improved from 10 to 2 months with the new protocol. Interestingly, the protocol appears to have reduced the number of patients investigated, however as the proportion of patients with SIBO has not changed, suggesting some patients may not be being identified. However, this may reflect the small study numbers and will likely change over time. We are keen to demonstrate our early experience with this standardised, nurse/dietitian-led approach to management of symptoms after Upper GI cancer surgery.
OGC P04 Total Gastrectomy is associated with greater Overall Survival than Subtotal Gastrectomy in Stage III Gastric Adenocarcinoma with Signet Rings
Authors: Patel Nikhil , Doyle Joseph , Al-Hasan Yousef , Patel Pranav , Bhogal Ricky , Allum William , Asif Chaudry Mohammed , Kumar Sacheen 
Published: November 2023

Abstract

Background
Presence of signet rings is a poor prognostic factor in advanced gastric adenocarcinoma (GAc), and is associated with lower chemo(radio)sensitivity, higher locoregional and distant recurrence rates, and lower overall survival (O.S) rates than non-signet ring gastric Ac. Incidence of signet ring GAc is increasing in Europe, Asia and USA, accounting for 35-45% of new cases of GAc. D2 lymphadenectomy and perioperative chemo(immuno)therapy enable better locoregional and systemic disease control, and reduced rate of cancer-related death in GAc. We hypothesise that total gastrectomy is associated with greater O.S than subtotal gastrectomy in signet ring positive GAc.

Methods
All patients who underwent elective gastrectomy for signet ring positive GAc from October 2013 - February 2023 at a single, tertiary, specialist cancer centre in the UK were included in this study. Demographic details including age, BMI, tumour staging (TNM classification), Charlson co-morbidity score, and use of neo(adjuvant) chemo(immuno)therapy were collected. Post-operative histopathology including tumour differentiation, lymphovascular invasion, lymph node yield, recurrence and survival time since surgery were collected. Statistical analyses were performed on matched data subsets using the Datatab platform, including Chi-squared, Student’s T-test and Fisher’s exact tests. Log-rank tests were performed on survival data.

Results
A total of 51 patients (32 male, 19 female) underwent elective total or subtotal gastrectomy for GAc with signet rings (27 total, 24 subtotal gastrectomy). There was no significant difference in mean age, BMI, tumour differentiation, nodal (N) or metastasis (M) stage between these two cohorts. A total of 14/24 (58.3%) patients underwent neoadjuvant chemo(immuno)therapy before subtotal gastrectomy, compared to 21/27 (77.8%) of patients who underwent total gastrectomy (p=0.135). Overall survival was greater among patients that underwent subtotal gastrectomy for stage I cancer (p=0.08), whereas total gastrectomy led to better survival in stage III disease (p=0.131).

Conclusions
This study demonstrates a trend towards greater O.S with total gastrectomy for stage III signet ring positive gastric adenocarcinoma. We suggest total gastrectomy enables better locoregional disease control in advanced cases which have higher risk of lymph node spread. The potential oncological and survival benefits of this methodology need to be weighed up against the increased morbidity and quality of life implications of total gastrectomy.
OGC P05 18FDG-PET-CT is superior to CT in detecting locoregional and distant recurrence after oesophago-gastrectomy for distal oesophageal/gastro-oesophageal junctional cancer
Authors: Patel Nikhil , Doyle Joseph , Al-Hasan Yousef , Patel Pranav , Bhogal Ricky , Allum William , Asif Chaudry Mohammed , Kumar Sacheen 
Published: November 2023

Abstract

Background
Recurrent oesophageal and gastro-oesophageal junctional cancers (OGJC) are associated with poor survival. Evaluation of symptoms, monitoring of tumour markers, and spiral computed tomography (CT) can be used in postoperative surveillance to identify potential recurrence. 18FDG-PET-CT may be used when CT is equivocal despite positive clinical and biochemical markers, and may enable early diagnosis of recurrent disease. We hypothesise that 18FDG-PET-CT is superior to CT in identifying recurrent OGJC and may have a role in routine surveillance post-oesophago-gastrectomy.

Methods
Patients with recurrent OGJC after two-stage oesophago-gastrectomy performed in a single, tertiary, specialist UK cancer centre, who were investigated for suspected recurrence with 18FDG-PET-CT and CT within 1 month of each other, up to 5 years after primary resection were included. Demographic details including age, tumour staging (TNM classification), histological subtype, resection margin status, and serum CA19-9 and CEA levels at the time of recurrence were collected. Radiology reports were reviewed to determine whether recurrence was identified on CT, 18FDG-PET-CT or both. Statistical analyses were performed on the Datatab platform. Sensitivity of both imaging modalities at identifying recurrence was calculated.

Results
A total of n=65 (58 male, 7 female) patients were included. Locoregional, distant, and both locoregional and distant recurrence were identified in n=17 (26.2%), n=22 (33.8%) and n=26 (40.0%) patients respectively. 18FDG-PET-CT (63/65, 96.9% sensitivity) was superior to CT (57/63, 87.7% sensitivity) in detecting all recurrence (p=0.02) and distant recurrence (100% compared to 81.8% sensitivity). Eight patients had recurrence identified on 18FDG-PET-CT, but not by CT (n=4 distant recurrence, n=1 locoregional recurrence, n=3 distant and locoregional recurrence). Of n=5 patients who received treatment for recurrence, n=3 had single-site recurrence. Median survival following detection in this subgroup was 2 years.

Conclusions
This study demonstrated that 18FDG-PET-CT was significantly more sensitive than CT in detecting all recurrent OGJC, and distant recurrence. This modality may have a role in surveillance following oesophago-gastrectomy for OGJC. Its greater sensitivity may enable early diagnosis of recurrence when performed following identification of clinical or biochemical features suspicious for recurrent disease. This could enable appropriate patients to undergo further systemic anti-cancer therapy to treat recurrence, prevent further disease progression and improve survival. Further studies considering economic and logistical factors including availability of equipment to perform a higher volume of scans are required to support these findings.
OGC P07 The utility of cardiopulmonary exercise testing (CPEX) in the management of patients with oesophago-gastric cancer
Authors: D’Sa Shalyn J , Koshy Renol , O' Packham Andrew , Bowrey David 
Published: November 2023

Abstract

Background
The assessment of fitness for surgery of patients with oesophago-gastric (OG) cancer remains a challenge. Accurately “triaging” patients is vital in determining which patients with potentially operable cancer go forward for surgery. Over the last decade, CPEX has been introduced at most centres, although its utility remains unclear.

Methods
Between 2015-2020, 346 patients with OG cancer underwent pre-operative CPEX testing. The (i) anaerobic threshold (AT), (ii) maximum oxygen uptake at peak exercise (V ̇O2peak) and (iii) ventilatory equivalent for CO2 (VE/V CO2) were determined, and their influence on treatment outcomes ascertained.

Results
The MDT 'triaged' 27% of patients unfit for surgery based on their poor CPEX measures (AT: 11.2 vs. 10.2, p=0.002; VO2 peak: 20.3 vs. 17.1, p=0.001; VE/VE CO2: 1.81 vs. 1.58, p=0.001).
60/165 (36%) patients resected, suffered a Clavien-Dindo grade»3 complication, with no association with preoperative CPEX-derived variables (AT:10.9 vs 11.25, p=0.314; VO2 peak: 19.4 vs 19.4, p=0.825; VE/VECO2: 36.3 vs. 37.2, p=0.35).
Multi-variate analysis demonstrated significant associations between poorer CPEX-derived measures and longer HDU stay (AT: p=0.016; VO2 peak: p=0.04), longer hospital stay (AT: p=0.027; VO2 peak: p=0.02) and higher 90-day mortality (AT: p=0.012; VO2 peak: p=0.04).

Conclusions
CPEX testing was a useful adjunct to the MDT algorithm in helping clinicians to triage patients for surgery. It was however not useful in identifying an “at risk” group within the subset considered fit for surgery.
OGC P08 Siewert type III gastro-oesophageal junction adenocarcinoma; total gastrectomy vs. oesophagectomy
Authors: Walmsley James , Browning Matthew , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Chung Tham Ji , Wheatley Tim , Chan David S Y 
Published: November 2023

Abstract

Background
Tumours of the gastro-oesophageal junction are amenable to different surgical resections. There is an increasing body of evidence to suggest Siewert type III tumours should be managed as gastric cancers and hence may be more appropriately resected via total gastrectomy.
The aim of this study was to compare the outcomes of total gastrectomy and oesophagectomy in patients diagnosed with Siewert type III gastro-oesophageal junction (GOJ) adenocarcinoma.

Methods
Consecutive patients who underwent curative surgery [total gastrectomy (n=42) or oesophagectomy (n=35)] between 1 January 2010 – 03 April 2023 for Siewert type III GOJ adenocarcinoma were analysed prospectively [median age 68 years, (range 43-83 years), 76.6% male, neo-adjuvant treatment 74.0%]. The primary outcome measure was overall 5 and 10-year survival. Secondary outcomes included: 30- and 90-day mortality, lymph node harvest, positive node harvest, margin involvement, anastomotic leak and length of stay.

Results
Demographic details between both groups of patients were similar. Patients undergoing total gastrectomy had a significantly shorter length of hospital stay compared with patients undergoing oesophagectomy (median 8 vs. 10 days, p&lt;0.006). Distal margin involvement was significantly higher in patients undergoing oesophagectomy (0% vs. 12.1 %, p=0.027). Overall, 5 and 10-year survival was significantly higher in patients undergoing total gastrectomy (62% and 52% vs. 36% and 22% respectively, p=0.013). There were no significant differences in lymph node harvest (median 29.5 vs. 33.0 nodes), anastomotic leak rates (2.4% vs. 11.4%), 30- (2.4% vs 0%) and 90-day (2.4% vs 2.9%) mortality.

Conclusions
Patients undergoing total gastrectomy have improved short and long-term outcomes compared with patients undergoing oesophagectomy for Siewert type III GOJ adenocarcinoma.
OGC P09 Benchmarking of OG cancer care across the United Kingdom: a collaboration of 2 national clinical audit systems
Authors: Forshaw Matthew , Anderson David , Urquhart Christine , Cromwell David 
Published: November 2023

Abstract

Background
Clinical audit plays an important role in benchmarking cancer services to ensure the delivery of high-quality care. The UK has 2 separate clinical audits (NOGCA in England and Wales, and QPI data in Scotland) analysing the process and outcomes of care for oesophagogastric (OG) cancer patients. Both cover the care pathway from diagnosis to the end of primary treatment. Comparative analysis has not previously been undertaken between these 2 audits. We aim to demonstrate that the 2 systems can be interrogated to provide valuable population and benchmarking data, and present the results of a successful collaborative project.

Methods
Data was extracted from the 2 audits for all epithelial OG cancers diagnosed between 01/01/17 and 31/12/19 (n=34,584). Analysis was then undertaken, with a particular focus on: 1) disease stage at presentation; 2) proportion of patients undergoing CT staging 3) proportion of patients receiving curative/non-curative treatment; 4) Curative treatment patterns; and 5) short-term outcome measures (adjusted mortality, key pathology outcomes). Descriptive statistics were derived for each country and stratified by patient/tumour characteristics. Mortality rates and longitudinal margins were adjusted for case-mix using multiple logistic regression. Statistical tests were 2-sided; threshold of significance set at p&lt;0.05.

Results
Baseline demographics were similar. Staging CTs were less commonly performed in England (83.1%; Scotland=98.5%; Wales=92.2%). Metastatic disease at presentation was highest in Scotland (40%-42%; England=30%-34%; Wales=36%-39%). England (40%) had highest proportion of MDT derived curative treatment plans (compared to Scotland=29% and Wales=34%). However, actual curative treatment rates (24-31%) were more similar and these differences narrowed after correction for population and staging differences. Curative treatment patterns are shown in Table 1. Mortality rates were similar in the 3 nations. Longitudinal margin positivity was significantly lower in Scotland (2.4%; England=5.4% and Wales=8.2%). Excision of &gt;15 lymph nodes was highest in England.

Conclusions
The 2 audit systems used in the UK to analyse the care and outcomes for patients diagnosed with OG cancer share sufficient data definitions and overlap to allow meaningful comparison. The data presented here represents an important benchmark of current UK OG practice. Most results were similar although some important differences were highlighted which require further exploration.