bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P51 Development of a symptom response questionnaire following therapeutic interventions for patients recovering from oesophagogastric cancer resection
Authors: Barman Sowrav , Chevallay Mickael , Evans Orla , Taylor Joanna , Dunn Jason , Baker Cara , Kelly Mark , Knight William , Gossage James , Zeki Sebastian , Davies Andrew 
Published: November 2023

Abstract

Background
Patients frequently experience symptoms after major oesophagogastric (OG) cancer resection which can delay quality of life resolution. Multiple symptoms can arise simultaneously making diagnosis of the underlying problem(s) and subsequent treatment complex. While diagnostic tests can offer valuable insight, some conditions are treated empirically and a positive response to therapy can go some way to confirming the diagnosis. Whilst numerous baseline symptom questionnaires exist, there is currently no established questionnaire to assess treatment response to an intervention following OG cancer surgery.

Methods
A survey of 362 OG cancer patients in survivorship phase identified their most important symptoms after surgery. A questionnaire based on validated EORTC symptom questionnaires including those derived from EORTC QLQ- CR 29, Bil 21, C30, ST022, OES 18 and OG25 has been developed to assess intervention impact on symptoms. For each reported symptom the patient is asked to grade the degree to which the symptom affected them before and after the intervention on a Likert scale.This study reports the development of the questionnaire and patient feedback following pyloric dilatation for delayed gastric emptying at 2 and 4 weeks post-procedure.

Results
The development of the questionnaire incorporated the use of previously validated EORTC questions and two measures that compared the patient’s symptoms before and after therapeutic intervention. All 12 patients involved in the initial development and first-stage review of the questionnaire rated it as easy or very easy to complete. A subsequent consecutive validation cohort of 27 patients undergoing pyloric dilatation for delayed gastric emptying also described the questionnaire as easy or very easy in 100% of cases.

Conclusions
Symptom response to an intervention is not routinely collected in a prospective setting despite potentially offering important clues as to accuracy of underlying diagnosis and documenting efficacy of the treatment. Patient recall of response to treatment retrospectively may be inaccurate and susceptible to bias. To best of our knowledge, this is the first questionnaire to detail symptomatic responses to therapeutic interventions in patients after OG cancer surgery. The questionnaire appears to be acceptable to patients and easy to complete. Further validation is needed before the questionnaire can be widely used, including testing with various interventions and on a digital platform.
OGC P52 Short and long-term outcomes of minimally versus open gastrectomy for cancer; a retrospective analysis over 15 years
Authors: Worthington Lucy , Abdullatheef Kalathil Mohammad , Al-Daghri Khalid , Alkhaffaf Bilal , Waheed Unazia 
Published: November 2023

Abstract

Background
Minimally invasive gastrectomy (MIG) is a well-established approach for the management of gastric cancer. However, much of the evidence base has come from the Far East where patient characteristics are significantly different and therefore not necessarily applicable to Western practice. In the UK (NOGCA 2022), less than 20% of gastrectomy is undertaken using a MIG approach with limited information regarding the distribution between total or partial MIG. This area therefore urgently requires further exploration. Our study aimed to review short and long-term outcomes of patients undergoing open and MIG over a 15-year period.

Methods
This was a retrospective analysis of all consecutive patients who underwent MIG and open gastrectomy (OG) for cancer between 2007 to 2022. The setting was a regional tertiary oesophago-gastric centre in the North-West of England serving a population of over 3.5 million people. Patients were further subcategorised into total (TG) or partial resections (PG -defined as sub-total or distal gastrectomy). Patient demographics and co-morbidities, peri-operative treatments, disease-related data, in addition to short and long-term outcomes were collected. Outcome choice was informed by the GASTROS core outcome set for surgical studies in gastric cancer.

Results
372 patients were included (OG 245; LG 105; LG converted 22). 166 underwent PG (MIG = 39.8%) and TG 187 (MIG = 18%). No difference in patient co-morbidities, staging or peri-operative chemotherapy rates between groups was found.
LOS was 15.2 days for OG and 14.4 days for LG (p = 0.220). Median lymph nodes resected was 20 for OG and 21 for LG (p = &lt;0.004). R0 rates were 90% for OG and 94% for LG (p=0.441). Overall survival was similar (1075 days for OG vs 1114 days for LG (p=&lt;0.751)). No differences were found in TG or PG.

Conclusions
Outcomes following MIG in this study were not statistically different to OG. This was mirrored in a sub-group analysis of total and partial gastrectomy. This data suggests that MIG is an appropriately safe alternative to open gastrectomy. Further multi-centre studies are required to validate these findings. A randomised control trial may be challenging to recruit to due to limited uptake of MIG across the UK.
OGC P54 Catastrophic dumping after gastrectomy in a patient with absent pituitary treated with octreotide – case report
Authors: Adnan Patel Ebrahim , Jain Anchal , Bennett John , Roberts Geoffrey 
Published: November 2023

Abstract

Background
Gastrectomy results in a profound change in appetite, satiety and response to food. Most people will adapt and manage to maintain adequate enteral nutrition, however severe symptoms can hamper quality of life. Early dumping, defined as noxious symptoms occurring within an hour of food, arises due to a combination of vastly increased satiety gut hormone secretion and fluid shifts. Late dumping (reactive hypoglycaemia) occurs due to enhanced post-prandial incretin hormone secretion. We present a case of severe dumping in a patient with absent pituitary treated with the global counter-regulatory hormone octreotide.

Methods
A 71-year-old patient with absent pituitary underwent total gastrectomy and oesophago-jejunal anastomosis for a greater curve gastric adenocarcinoma. Post-operatively, the patient developed an overall aversion to eating along with significant nausea and vomiting, diarrhoea, abdominal fullness, and tachycardia. Anti-emetics including droperidol, metoclopramide, and haloperidol yielded limited response. NJ feeding also triggered symptoms and was stopped. Parenteral nutrition was the principal source of diet. A trial of a somatostatin analogue, octreotide, resulted in significant improvement of patient symptoms. A dose increase and then conversion to monthly lanreotide was tolerated well resulting in complete resolution of symptoms and no side effects.

Results
The pituitary gland and hypothalamus are central to regulating appetite and satiety through complex signalling pathways. Hormone signals, including GLP-1, GIP, PYY and ghrelin act on central circuits within the hypothalamus to modulate intake, gastric emptying, and satiety. With an absent pituitary, these hormonal signalling pathways including somatostatin are disrupted. Octreotide therapy likely works through a combination of central suppression of gut hormone signalling as well as peripheral reduction in gut hormone secretion.

Conclusions
Dumping syndrome is a multifactorial, quality of life limiting consequence of upper GI resection. In patients with altered central appetite control circuitry the symptoms may be so severe as to prevent any enteral intake, including via NJ tube. Interestingly, considering this an endocrinology problem and acting to suppress all hormonal signalling with octreotide had immediate and enduring success in the presented case. This may represent a route for management of patients with significant dumping symptoms and nutritional compromise after gastrectomy or oesophagectomy.
OGC P61 Audit of diagnosis and treatment of early pneumonia after elective oesophagogastric resections
Authors: Gupta Ayushi , Gudal Ahmad , Miah Mujahidul , Soares Ana , Pollara Gabriele , Dawas Khaled 
Published: November 2023

Abstract

Background
Respiratory complications after oesophagogastric (OG) cancer surgery are common and present as some of the most severe. Post-operative respiratory complications reduce disease free and overall survival. Incorrect use of antibiotics can have negative outcomes. Are the diagnosis criteria clear and do such patients receive the correct management?
This audit assesses diagnoses of pneumonia against the US Centers for Disease Control (CDC) criteria and antibiotic choice against National Institute for Health and Care Excellence (NICE) guidelines in a regional OG cancer surgery centre (which may be replicated in many other OG centres).

Methods
We examined records of 109 patients who underwent elective OG surgery at University College Hospital London between July 2021 and June 2022. The post-operative period was defined as 7 days from the initial operation.

Results
30.2% of all patients were treated with antibiotics for pneumonia in the post-operative period. 42.4% of these patients had a sputum sample taken at the time of clinical suspicion of pneumonia, and 42.8% of these grew one or more relevant organisms. 69.7% of treated patients were prescribed a NICE-approved antibiotic.
17.4% of all patients developed pneumonia per the US CDC criteria and these patients had a longer stay in ICU (10.6 days compared to 5.3 days) and hospital (29.4 days compared to 14.3 days) than those who did not. 30-day mortality rate was 0% in this group.

Conclusions
This audit identified variability in diagnosis and antibiotic prescribing in post-operative pneumoniae. Sputum analysis was used inconsistently to diagnose and guide antibiotic therapies; cultures were often taken after antimicrobials were initiated, with patients treated symptomatically rather than based on microbiology results.
Recommendations following this audit comprised; the use of CDC criteria to promote accurate diagnosis in the post-operative period, and regular multidisciplinary review of antibiotic agents prescribed to ensure appropriate targeted treatment.
OGC P63 The Influence of PET-CT on the Therapeutic Pathway of Oesophageal and Oesophago-Gastric Junction Cancers. A Clinical Audit in a High Volume UGI Cancer Unit in the UK
Authors: Rizkallah Nayer , Abushawaly Amr , Johnson Angel , Clarke Simone , Yanni Fady 
Published: November 2023

Abstract

Background
Patients with oesophageal and oesophago-gastric Junction (OGJ) cancers require accurate staging to decide on intent of treatment (curative or palliative). The literature reported higher accuracy (82% vs. 64%, P = 0.004) and sensitivity (74% vs. 47%) for PET-CT when compared to CT for detecting distant disease. Consequently, the National Institute for Health and Care Excellence (NICE) recommends PET-CT for all oesophageal and GOJ cancers except T1a tumors. This audit investigated how PET-CT affected the treatment plan of oesophageal and OGJ cancer patients and its impact on MDT decisions and patients’ waiting time before first treatment is started.

Methods
Retrospective data collection from our institutional electronic database for all oesophageal and OGJ cancer patients that had undergone PET-CT as part of cancer staging in the last 9 months. Data collected was basic demographics, waiting time for PET-CT and discrepancy between CT and PET-CT in finding distant metastasis or other incidental findings. The influence of this on the MDT outcomes was investigated and the delay in cancer treatment secondary to further investigations was recorded.

Results
A total of 44 oesophageal and OGJ cancer patients had staging PET-CT. Out of 44 patients, 33 (75%) were males. The average age was 67 (45-85) years. Average waiting time for PET-CT was 17(1-57) days. Fourteen (32%) patients had discrepancy between CT and PET-CT. In Group A, 5 (11%) patients, PET-CT reported distant metastasis. In Group B, 9 (20%) patients, PET-CT detected active uptake in colon (n=4), cervical LNs (n=2), thyroid (n=1), tonsils & prostate (n=1) and spine (n=1). Further investigations (endoscopy, ultrasound, biopsy etc.) added a delay with an average of 15 (1-28) days.

Conclusions
It is proven that PET-CT is essential in staging non metastatic oesophageal and OGJ cancers. It is important for MDTs to be vigilant that PET-CT can delay the start of first treatment for those patients by picking up non UGI cancer related pathology. This initiates a cohort of further investigations, creating some delay. Therefore, timely PET-CT scanning and reporting is recommended e.g during pre-MDT referral triage meetings. Selecting patients for PET-CT may also be helpful based on accurate CT reporting of cancer TNM stage.
OGC P68 Surgical performance of Minimally Invasive Esophagectomy is associated with patient outcome on a national level - A video assessment study
Authors: Ketel Mirte , Klarenbeek Bastiaan , Abma Inger , van Det Marc , van Esser Stijn , Law Simon , de Steur Wobbe , Sosef Meindert , Wijnhoven Bas , Hannink Gerjon , Rosman Camiel , van Workum Frans 
Published: November 2023

Abstract

Background
It is highly likely that suboptimal surgical performance is associated with less favorable patient outcomes in minimally invasive esophagectomy (MIE). Establishing this association can lead to programs that promote better surgical performance of MIE and improve patient outcomes.

Methods
In this nationwide cohort study, 7 blinded expert MIE surgeons assessed performance of surgical videos of MIE performed in 2022, using a previously developed and validated competency assessment tool (CAT), the MIE-CAT. Hospitals were divided into quartiles based on their MIE-CAT score. Patient outcomes of 2021-2022 registered in the Dutch Upper-GI Clinical Audit were compared between highest (top 25%) and lowest (bottom 25%) performing quartiles. Multilevel logistic regression, with clustering of patients within hospitals was used to analyze associations between performance and outcomes, and to correct for casemix. Primary outcome parameter was severe postoperative complications (Clavien-Dindo≥3) within 30 days after surgery.

Results
MIE-CAT scores ranged from range 93.9-118.8. In total, 970 patients were included. Severe postoperative complications occurred in 18.7% (n=41/219) in the highest performing quartile versus 39.2% (n=40/102) in the lowest performing quartile (RR=0.50, 95%CI 0.24-0.99). Moreover, there were less conversions (1.8% versus 8.9%, RR=0.21, 95%CI 0.21-0.21), less peroperative complications (2.7% versus 7.8%, RR=0.21, 95%CI 0.04-0.94) and overall less postoperative complications (46.1% versus 65.7%, RR=0.54, 95%CI 0.24-0.96). Oncological outcomes R0 resection and lymph node yield increased with oncologic specific-performance scores (e.g. hiatus dissection/thoracic esophagus dissection and abdominal/thoracic lymph node dissection respectively). ). A strong association between high anastomotic-phase score and a lower anastomotic leakage rate was observed (4.6% versus 17.7%, RR=0.14, 95%CI 0.06-0.31).

Conclusions
Better surgical performance was associated with decreased perioperative complications and better oncological outcome for esophageal cancer patients undergoing MIE. If surgical performance of MIE can be improved, significantly better patient outcomes may be possible.
OGC P69 Omentectomy as part of radical surgery for gastric cancer: results of a multicenter prospective cohort study
Authors: Keywani K , Borgstein A B J , Boerma D , van Esser S , Eshuis W J , van Berge Henegouwen M I , Gisbertz S S 
Published: November 2023

Abstract

Background
Omentectomy is routinely performed in patients with gastric cancer as part of sub(total) gastrectomy with modified D2 lymphadenectomy. However, there is little evidence for a survival benefit of omentectomy. This study investigated both the prevalence of metastases in the greater omentum and the survival prognosis for patients afflicted with such omental involvement.

Methods
This was a multicenter prospective cohort study (OMEGA study) of consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. After resection, the omentum was separated from the gastrectomy specimen distal to the gastroepiploic vessels and sent separately for pathological examination. The main endpoints were the presence of metastases in the greater omentum and the 5-year overall survival of patients with omental metastases. Pathological factors associated with locoregional recurrence and/or metastases were tested with multivariable regression analysis.

Results
Of 100 included patients, five had metastases in the greater omentum. All five patients had advanced tumors and microscopically non radical resection (R1). Metastases in the greater omentum correlated significantly with a microscopically non-radical resection, tumour expansion in the oesophagus or duodenum, linitis plastica or a proximal gastric tumour with diameter of at least 5 cm, stage III-IV disease and (y)pM1 category. Five-year overall survival was 0.0% in patients with omental metastases and 44.2% in patients without omental metastases (p=0.001). Median overall survival was seven months in patients with omental metastases and 53 months in patients without omental metastases.

Conclusions
The incidence of metastases in the greater omentum is low, and when present, it is associated with advanced and unresectable disease with impaired overall survival. Omentectomy as part of radical gastrectomy for gastric cancer may not contribute to survival benefit in cases of undetected omental metastases and may therefore be omitted. Our forthcoming randomized controlled trial aims to investigate the non-inferiority of omentum preservation as compared to omentectomy in terms of 3-year overall survival.
OGC V02 Linear Stapler Technique for Oesophagogastric Anastomosis during a RAMIE: A Demonstration of Tips, Tricks, and Challenges
Authors: Salem Riadh , Sgromo Bruno 
Published: November 2023

Abstract

Background
Minimally invasive oesophagectomy (MIO) has gained popularity as a preferred surgical approach for treating oesophageal cancer. Our unit has been performing MIOs for the past 5 years, and more recently, we have adopted robotic assisted minimally invasive oesophagectomy (RAMIE). Our preferred method for creating an anastomosis involves using linear staplers to create a side-to-side anastomosis, followed by suturing to close the enterotomy. In this video, we demonstrate our anastomosis technique during a RAMIE, providing tips and highlighting challenges that may arise during the procedure.

Methods
An oesophagotomy is created on the medial side of the staple line. 32Fr orogastric tube is passed to ensure adequate enterotomy. After positioning of the gastric conduit, a gastrotomy is made anteriorly and 3cm from the tip of the conduit. Full thickness sutures are placed at the 12, 6 and 3 o’clock positions on the oesophagotomy and gastronomy. This will insure proper alignment and the overlap of 3cm allowing for side-to-side anastomosis. The cartridge of the stapler is introduced into the conduit and the anvil into the oesophagotomy. The remaining enterotomy is closed using two V-lock sutures.

Results
The linear stapler oesophagogastric anastomosis is a viable option due to its various advantages. Firstly, it is easy to learn, making it accessible to surgeons of different skill levels. Additionally, it is reproducible, ensuring consistent results across different cases. Compared to circular or handsewn techniques, the linear stapler technique involves fewer surgical steps, saving time and reducing complexity and the literature indicates similar leak rate compared to other techniques. Moreover, the stricture rate is likely lower with this technique, although other factors may also contribute to this outcome.

Conclusions
In conclusion, the linear stapler technique for oesophagogastric anastomosis in MIOs and RAMIEs offers several advantages. It is easy to learn, reproducible, and saves time by involving fewer surgical steps. The leak rate is comparable to other techniques, and the stricture rate is likely lower.
Longitudinal evolution of diffusion metrics after left hemisphere ischaemic stroke
Authors: Boucher Johémie , Marcotte Karine , Bedetti Christophe , Houzé Bérengère , Descoteaux Maxime , Brisebois Amélie , García Alberto Osa , Rochon Elizabeth , Leonard Carol , Desautels Alex , Brambati Simona M 
Published: November 2023

Abstract
White matter is often severely affected after human ischaemic stroke. While animal studies have suggested that various factors may contribute to white matter structural damage after ischaemic stroke, the characterization of damaging processes to the affected hemisphere after human stroke remains poorly understood. Thus, the present study aims to thoroughly describe the longitudinal pattern of evolution of diffusion magnetic resonance imaging metrics in different parts of the ipsilesional white matter after stroke. We acquired diffusion and anatomical images in 17 patients who had suffered from a single left hemisphere ischaemic stroke, at 24–72 h, 8–14 days and 6 months post-stroke. For each patient, we created three regions of interest: (i) the white matter lesion; (ii) the perilesional white matter; and (iii) the remaining white matter of the left hemisphere. We extracted diffusion metrics (fractional anisotropy, mean, axial and radial diffusivities) for each region and conducted two-way repeated measures ANOVAs with stage post-stroke (acute, subacute and chronic) × regions of interest (white matter lesion, perilesional white matter and remaining white matter). Fractional anisotropy values stayed consistent across time-points, with significantly lower values in the white matter lesion compared to the perilesional white matter and remaining white matter tissue. Fractional anisotropy values of the perilesional white matter were also significantly lower than that of the remaining white matter. Mean, axial and radial diffusivities in the white matter lesion were all decreased in the acute stage compared to perilesional white matter and remaining white matter, but significantly increased in both the subacute and chronic stages. Significant increases in mean and radial diffusivities in the perilesional white matter were seen in the later stages of stroke. Our findings suggest that various physiological processes are at play in the acute, subacute and chronic stages following ischaemic stroke, with the infarct territory and perilesional white matter affected by ischaemia at different rates and to different extents throughout the stroke recovery stages. The examination of multiple diffusivity metrics may inform us about the mechanisms occurring at different time-points, i.e. focal swelling, axonal damage or myelin loss.
Cardioneuroablation for the treatment of ictal-associated cardiac asystole: case report and literature review
Authors: Tan Jian Liang , Markman Timothy M , Santangeli Pasquale , Hyman Matthew C 
Published: November 2023

Abstract

Background
Ictal-associated bradyarrhythmia or asystole can be a manifestation of malignant seizure syndromes. In patients with ictal-associated hypervagotonia and asystole, cardioneuroablation may provide a promising alternative to permanent pacemaker implantation.

Case summary
We present a case of a 47-year-old female with a 1.5-year history of ongoing uncontrolled seizures with multiple semiologies despite multiple antiepileptic drugs who had episodes of symptomatic severe sinus bradycardia (15–30 b.p.m.) and sinus pauses (15–16 s). She underwent a successful cardioneuroablation for ictal-induced asystole with complete resolution of bradyarrhythmias.

Discussion
This case highlights the utility of cardioneuroablation in patient with ictal-induced cardiac bradyarrhythmia and asystole. Cardioneuroablation may be an approach to avoid permanent pacemakers in this population.