bluuebunny/crossref_metadata_2025_split huggingface dataset:
A O04 Prevalence and risk factors for malignant nodal involvement in early oesophago-gastric cancer: Initial results from the CONGRESS study (endosCopic resectiON, esophaGectomy or gastrectomy foR Early oeSophagogastric cancerS)
Authors: Pucher Philip , Underwood Tim , Kamarajah Sivesh , Blencowe Natalie , Griffiths Ewen , Evans Richard , Markar Sheraz , Bhandari Pradeep , Trudgill Nigel , Crosby Tom , Gossage James 
Published: November 2023

Abstract

Background
Controversy remains surrounding the optimal management of patients with T1N0 early oesophago-gastric (OG) cancer. Current guidelines recommend consideration of radical surgery for T1b disease because of the greater risk of nodal metastasis. However, data to accurately predict risk for individual patients is sparse; individual units may see only low numbers of patients with early stage disease. The endosCopic resectiON, esophaGectomy or gastrectomy foR Early oeSophagogastric cancerS (CONGRESS) study was a retrospective multinational study which aimed to characterise the impact of different management strategies, including endoscopic resection (ER) and radical surgery, for early OG cancer on a large scale.

Methods
An international multicentre retrospective study was performed. Inclusion criteria were all patients diagnosed with T1N0 OG cancer from 2015 to 2022. Led by local and regional collaborators, centralised anonymised data capture was used to record diagnostic, demographic, treatment, and outcome data. Histopathological outcomes for surgical resection specimens were compared to pre-operative staging and diagnostic data. Statistical analysis was performed to assess the association between patient demographic and histological data, and presence of malignant nodal disease.

Results
A total of 1,509 patients from 26 centres were recorded, with a median 33 months (range 0-194) follow-up from diagnosis. Initial T stage at diagnosis was T0 266/1509 (17.6%), unspecified T1 375/1509 (24.9%), T1a 319/1509 (21.1%), T1b 204/1509 (13.5%), TX 313/1509 (20.7%). Of 436 patients who underwent surgical resection, the risk of nodal metastasis for each clinically or endoscopically staged depth of invasion was T0: 5/31 (16.1%), unspecified T1: 37/193 (19.2%), T1a: 7/73 (9.6%) T1b: 21/137 (15.3%). No histological or patient factors were significantly associated with presence of positive nodes in the surgical resection specimen.

Conclusions
The risk of nodal metastases in this real-world contemporary dataset suggests a higher rate of nodal metastasis than reported in some series. Tumour depth alone is a poor predictor of nodal positivity. Further work is required to determine which patients might benefit from an organ-preserving versus resective treatment approach.
A O06 Impact of complications on survival and postoperative recovery using Comprehensive Complication Index versus Clavien-Dindo grading after laparoscopic and open D2-gastrectomy in the multicenter randomized LOGICA-trial
Authors: Triemstra Lianne , de Jongh Cas , Tedone Fabrizio , Brosens Lodewijk Lodewijk A A , Luyer Misha , Stoot Jan , Lagarde Sjoerd , van Hillegersberg Richard , Ruurda Jelle 
Published: November 2023

Abstract

Background
Complications can be classified using the most-severe Clavien-Dindo-Classification (CDC) per patient or the total complication burden per patient expressed in the Comprehensive Complication Index (CCI). This study determined the additional value of CCI to CDC in examining the impact of complications after gastric cancer surgery.

Methods
The CCI and CDC were determined in the multicenter randomized LOGICA-trial comparing laparoscopic versus open D2-gastrectomy for cancer (cT1-4aN0-3M0). Differences in median CCI between laparoscopic and open gastrectomy were compared for overall postoperative complications, and infectious, gastrointestinal, pulmonary, and cardiovascular complications. CCI and CDC were correlated to hospitalization, ICU-stay and reoperations using Spearman’s rho-test, and compared with standard Fisher’s z-transformation.

Results
Between 2015-2018, 211 patients underwent laparoscopic (n=106) or open (n=105) D2-gastrectomy, and 157 (74%) received neoadjuvant chemotherapy. Median CCI was comparable between laparoscopic versus open gastrectomy regarding overall complications (CCI 0 [IQR 0-23.5] versus 0 [IQR 0-22.6]; p=0.755) and subgroups of complications (p&gt;0.05). Both CCI and CDC showed moderate positive correlations for hospitalization (rs=0.646 versus rs=0.628; p=0.001, clinically irrelevant), and reoperations (rs=0.590 versus rs=0.599; p=0.070), and weak correlations for ICU-stay (rs=0.446 versus rs=0.440; p=0.189).

Conclusions
The CCI is a composite scoring system based on the CDC, and reflects a subjective interpretation of complication burden from the perspectives of both physicians and patients, after abdominal surgery other than gastrectomy. Implementation of CCI had no clinically relevant benefit and produced additional workload compared to CDC for assessing complication burden. Therefore, the use of CCI alongside the CDC after gastric cancer surgery is not recommended.
BS O03 Awareness of Obesity and Morbid Obesity amongst General Population: a pilot, cross-sectional survey study
Authors: Bandyopadhyay Samik , Patel Agastya , Ganguly Guruprasad , Iqbal Affan 
Published: November 2023

Abstract

Background
There has been a serious concern about Obesity and obesity related diseases - there has been co-ordinated efforts to get the message to the general population to encourage them to be more active in self-care. This study was an attempt to assess the prevalent awareness in the general population to understand whether the ongoing efforts have achieved the desired goals.

Methods
The study was coordinated with the assistance of a General practitioner in North West England. Patients attending the GP Surgery physically were requested to fill up a small questionnaire without resorting to any online resources. Patient below sixteen years of age, unwilling patients or patients with dementia were excluded from the study. The questions were focussed on defining obesity and morbid obesity, the different obesity related illnesses and the possible options available to an obese patient in need of treatment. The study was conducted over a period of two months and responses available from 226 patients who participated were analysed.

Results
73% of responders were aware of obesity as a disease entity but less than 60% could differentiate between obesity and morbid obesity. However, less than 30% were aware of the BMI value beyond which a person could be termed obese. Significantly, less than 1% could pick up four obesity associated diseases.

Conclusions
It appears that more focussed population based primary prevention is necessary to stem the obesity epidemic. Awareness appears to be patch and in a few groups, lacking. A larger population based study with subgroup analysis based on geographical location, age and ethnicity may be important to assess the situation in a greater detail.
BS O04 Can virtual reality exercise games improve compliance with preoperative prescriptive exercise programs in patients awaiting bariatric surgery?
Authors: Aburrous Mohamed , Adwan Hussamuddin , Tam Adam , Gendia Ahmed , Cota Allwyn , Finlay Ian , Clarke Michael , Clark James 
Published: November 2023

Abstract

Background
Despite the recognised benefits of increased activity prior to any surgery, non-compliance rate with prescribed exercise regimens is perceived to be higher amongst patients with obesity. Virtual-reality is becoming more recognised as an adjunctive tool within the healthcare setting. In this setting the platform enables exercise games to be played and enjoyed in the comfort of the patient’s own home, either sitting or standing depending on physical disability. The study aims to identify whether VR exercise games could be considered part of the pre-operative exercise program in patients awaiting bariatric surgery and the effects of this technology on compliance.

Methods
A pilot study using block randomisation, patients with obesity planned for laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG) between December 2020 and December 2023 were recruited to a 6-week pre-operative regular exercise (REG) programme of either regular walking activity (RWA) or exercise using Virtual Reality device (VRX). Patients who later decided not to follow the exercise protocol were included as control (NEG). Patients with epilepsy, uncontrolled arrhythmias, heart failure or those unable to use VR systems were excluded. Pre- and post-trial demographic and progress data and follow up survey using the New Zealand Physical Activity Questionnaire were collected.

Results
43 patients were recruited, 46.4kg/m2 mean referral BMI (33.8 – 65.6, SD 6.4) and 84% female. Exercise non-compliance was comparable between RWA and VRX groups (40 vs 43% respectively). 56% of NEG had their operation during short day light season (44% of REG). NEG group reported higher rate of chronic pain, poor motivation, and higher incidents of changes to surgery date (33, 33 and 22% respectively vs. none in REG). While weight loss achieved in REG prior to the operation was higher than in NEG, there was no significant difference in weight loss between the groups at 3 months follow up.

Conclusions
While the role of prehabilitation exercise prior to major elective surgery is well documented, the search for the ideal approach to achieve this is still ongoing. This pilot study demonstrates the limitations certain chronic conditions in patients with obesity have on the success of a pre-operative exercise programme. While more data is needed, it is important to bear these limitations in mind when recruiting patients to any exercise programme. The compliance rate remains unfavourable despite the use of VR technology.
BS O09 Bariatric Medical Tourism - a false economy. A case series of complications and the impact on the NHS
Authors: Beynon Victoria , Iosif Evangelia , Gaston Michaela , Hao Bo , Kerans George , Mohamed Omnia , Maheswaran Ian , Belgaumkar Ajay , Carswell Kirstin 
Published: November 2023

Abstract

Background
Increasing numbers of patients from the United Kingdom are going abroad for treatment, in order to avoid lengthy NHS waiting lists for primary weight loss surgery and to circumvent restrictions on cosmetic operations, post-bariatric surgery. News media often report individual patient stories about post-operative complications. Patients are increasingly accessing NHS emergency services when these occur. The aim of this study was to evaluate the impact on both patients and the NHS from treatment of complications associated with Bariatric medical tourism.

Methods
A retrospective case study was performed between July 2022-June 2023 at East Surrey Hospital, the nearest hospital to London Gatwick Airport. The study included all patients who presented as an emergency with complications associated with bariatric or post-bariatric procedures performed outside of the UK. Data was collected via electronic patient records, including patient demographics, BMI, original operation, complications, investigations, treatment and length of stay. A cost analysis was performed for each patient’s ‘in-patient’ stay using the ‘NHS Payment Scheme (2023/24)’. Further cost analysis of ongoing community intervention was not performed.

Results
A total of 15 patients were identified in this time frame. 13 (86.6%) were female with mean age 40 years (range 27-54). Mean BMI was 35 (range 29-44). The most common original operation was post-bariatric Abdominoplasty (46.6%), followed by Laparoscopic Sleeve Gastrectomy (26.6%). 14 (93.3%) patients had their original operation performed in Turkey. Time to emergency presentation ranged from 7-365 days. 66.7% of complications were graded Clavien Dindo score 3 or above. 8 (53.3%) patients required multiple admissions. The average length of stay was 7.5 days (range 1-37). The cost per patient to the NHS averaged at £6857.14 (£600-£28,625).

Conclusions
This study shows that medical tourism has a significant impact on NHS services, costing over £100,000 in our hospital alone, in one year. Common factors in this patient cohort included poor pre-operative optimisation, continued smoking, vitamin and mineral deficiencies and delayed presentation once complications occurred. Given that medical tourism is increasing, public health education about the risks should increase. Such efforts may mitigate the cost impact on the NHS. It is time for a national registry for international complications and a UK governance strategy is implemented.
HPB O03 ERCPs and Biliary Stenting for Ductal Stone Disease: A Call for a National Database
Authors: Curwen Oliver , Hwang Reif , Gower David , Nehra Dhiren 
Published: November 2023

Abstract

Background
According to the European Society of Gastrointestinal Endoscopy, in the context of complicated biliary stone disease, plastic stenting of the biliary tree via endoscopic retrograde cholangiopancreatography (ERCP) temporarily provides drainage of a blocked or infected biliary system. However, there is high mortality and morbidity associated with long-term endoprostheses; cholangitis as one of the main complications. Therefore, plastic stenting should only be used for a period of up to 6 months, according to latest guidelines. Our aim was to compare Trust practice with international recommendations, identifying potential causes for prolonged stent placement in patients with choledocholithiasis, and to discuss possible solutions.

Methods
Patients who underwent an ERCP across a 3-year period from NHS secure server records were identified, with further analysis of patients undergoing plastic biliary stent insertion.

Results
Of the 1118 ERCPs performed, 281 underwent plastic stenting for choledocholithiasis. Some patients were not suitable for cholecystectomy, so stents were accepted as the ceiling of care. 29 had stents in situ for over 6 months, while waiting for surgery. Of the 75 who had proceeded to cholecystectomy, 57 subsequently had stents removed in the trust. 18 still had plastic stents in situ. 5 had stents removed elsewhere, one of whom developed cholangitis and sepsis, requiring removal of the infected stent at a tertiary centre. Two patients were no longer fit for removal, and two had spontaneously passed their stents.

Conclusions
Retained biliary stents is not a rarity. There are many factors leading to delays, including long waiting lists for surgery, lack of requests to the endoscopy department and patient choice. Extrapolation of this single-trust audit would suggest that many sites are not meeting international guidelines for the duration of indwelling plastic stents. We suggest the implementation of a national database to monitor all patients with biliary endoprostheses to reduce morbidity associated with retained stents. We also recommend that incidents where harm is caused by plastic stents remaining in situ for greater than six months be treated as a Never Event.
HPB O05 Targeting the host in Pancreatic Cancer: A Novel Combination Therapeutic from Bench to Bedside
Authors: Jones Keaton , Russell Shannon , O’Neill Eric 
Published: November 2023

Abstract

Background
We have designed a novel therapeutic approach to improve immunity whilst simultaneously reversing immune suppression in pancreatic cancer. Radiotherapy can cause the release of tumour specific antigens from lethally irradiated cells, as well as the generation of neopeptides resulting from novel mutations. In addition, Eganelisib, a small molecule inhibitor that blocks the pathway responsible for the phenotypic switch towards a suppressive phenotype in myeloid cells (PI3K-gamma) promotes antitumour immunity. We hypothesise that combined treatment will improve anti-tumour immunity in pancreatic cancer.

Methods
To generate primary pancreatic tumours, (KPC) pancreatic cancer cells were injected directly into the pancreas. Radiotherapy was delivered in 3 fractions of 4Gy via CT guidance. PI3K-gamma inhibition was carried out using TG100-115. For immune phenotyping, tumours were analysed by flow cytometry, multiplex immunohistochemistry and RNA sequencing. Combination treatmenthas been applied to primary human tissue slices (Avatars) in dynamic perfusion culture.

Results
In a preclinical model of pancreatic cancer, combined treatment with radiotherapy and Eganelisib resulted in significantly increased overall survival. Analysis of the tumour immune microenvironment in this group revealed decreased numbers of suppressive myeloid cells and increased numbers of cytotoxic CD8 T cells. RNA sequencing data demonstrated that pathways associated with innate inflammation and adaptive antitumor immunity were significantly elevated.

Conclusions
We have used our preclinical data to drive the translation of this novel therapeutic combination. Preclinical data has provided robust evidence that this combination approach results in effective antitumour immunity that may render tumours sensitive to immune checkpoint therapy. We are currently designing a Phase I clinical trial combining MR-LINAC guided radiotherapy with Eganelisib for patients with locally advanced pancreatic cancer.
HPB O06 Strategy, evolution and outcomes of a ‘unit-wide’ approach to robotic surgical training – evaluation of the experience in a high-volume tertiary hepatopancreaticobiliary unit
Authors: Pencavel Tim , Worthington Tim , Riga Angela , Kumar Rajesh , Lahiri Rajiv 
Published: November 2023

Abstract

Background
Robotic surgery has been a 'slow-burning' technology in HPB Surgery in the UK, partly due to availability of robotic systems due to more rapid adoption in other subspecialties. It has also been seen as the preserve of one or two early adopters, both within units and more widely. In this study we evaluate an alternative approach to starting a robotic programme, with an a priori intent to train multiple members of the same unit following a structured process and continuous real-time outcome evaluation.

Methods
The training programme was structured in line with the Intuitive console surgeon training pathway consisting of online modules, simulation training and laboratory courses. Case acquisition was in line with the suggested escalation of difficulty laid out in the paper by Farrugia et al (J Robotic Surg 2022). Surgeons trained in pairs, with the order determined by robotic availability and previous minimally-invasive HPB experience. Regular robotic access was secured by agreement with other robotic specialties. A prospective database of cases was maintained and regularly interrogated to evaluate outcomes at a unit and surgeon level.

Results
245 cases were performed in 18 months. Case acquisition rate was similar for all surgeons. Unit volume slowed from a peak of 21 cases/month until acquisition of a 3rd Xi system, facilitating 3 regular HPB robotic lists/week. Following this both number and complexity of cases increased. All surgeons experienced a decrease in total numbers of complex cases in the first month, which had returned to baseline at 6 months (mean 9.25 v 3.5, p&lt;0.05). Overall length of stay, HDU stay and conversion rates were lower than surgeon- and case-matched historical data, with no significant increase in complication rates.

Conclusions
The introduction of a unit-wide robotic programme is feasible and results in better robotic utilisation. Case acquisition can be maintained for all surgeons. A possible further benefit is a greater acceptance of the need to share the caseload for open and laparoscopic cases during the learning curve. Robotic access is key to successful implementation and must be assessed before the programme begins. Outcomes at a unit- and surgeon- level can be maintained or improved regardless of the career stage of the surgeon prior to beginning robotics.
HPB O07 Neoadjuvant therapy response and survival in borderline resectable and locally-advanced pancreatic ductal adenocarcinoma; the largest UK case series
Authors: Khaled Yazan , Suresh Nikhil , Tetley Heather , Young Alistair , Pine James , Pathak Samir , Smith Andrew 
Published: November 2023

Abstract

Background
Neoadjuvant chemo/radiotherapy (NAT) is the treatment of choice for borderline resectable/ locally-advanced (BR/LA) pancreatic ductal adenocarcinoma (PDAC). Current preoperative imaging modalities (CT/MRI) and biomarkers lack sensitivity to predict response following NAT. The aim of this study was to evaluate preoperative PETCT and CA19-9 in predicting NAT response and survival.

Methods
A retrospective analysis of consecutive patients who underwent NAT for BR/LA PDAC between January 2013 and January 2023 was performed. Clinicopathological characteristics, treatment, and outcome were analysed. Pre- and post-NAT CA 19-9 and PETCT findings were correlated with resectability and pathological response. Overall survival (OS) and disease-free survival (DFS) comparisons were performed using log-rank model and Kaplan–Meier analysis.

Results
Tumour response following completion of NAT was evaluated in 87 (BR, n=58 and LA, n=29) patients with a median age of 73.3 years (47-87 years). FOLFIRINOX alone (93%, n=81) was mostly used as chemotherapy versus gemcitabine/nab-paclitaxel (7%). Post NAT, 51% of patients had biochemical response (CA19-9&gt;50% decrease) and 48% had metabolic response on PETCT. Overall, 31(35%) individuals (BR, n=27 and LA, n=4) underwent complete resection with 81% achieving R0 status. After univariate analysis, pre-operative PETCT metabolic response (HR, 2.1; 95% CI, 1-4.3) was the only pre-operative predictor of resectability and correlated significantly with pathological response (P&lt;0.003). In multivariate analysis, pre-operative metabolic response was the best performing predictor for resectability (P&lt;0.001), pathological response (P&lt;0.003), DFS (HR, 1.34; 95% CI, 1.3-1.9) and OS (HR, 1.45; 95% CI, 1.2-1.8). NAT patients had a median OS of 19 months, improving to 36 months for patients receiving NAT followed by curative surgery (HR 0.3; 95% CI, 0.1-0.56. P &lt; .0001).

Conclusions
PETCT metabolic response appears to be highly predictive of resectability, pathological response and survival following NAT for BR/LA PDAC. An adequate staging of PDAC and re-assessment of the tumour after neoadjuvant therapy using PETCT would allow the multidisciplinary team to choose the most appropriate treatment for the patient.