bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN O03 Quality of life of patients with gastroesophageal reflux disease: findings from a systematic literature review
Authors: Goldsmith Paul , Das Shuchesmita , Hoffsten Johanna 
Published: November 2023

Abstract

Background
Gastroesophageal reflux disease (GERD), affecting over a billion people worldwide, is associated with significant impairment and productivity loss. Understanding the quality of life among GERD patients may provide important clinical relevance to treatment management and highlight the patient perspective. The aim of this study was to conduct a systematic review of GERD and quality of life, including any potential effects on treatment management.

Methods
MEDLINE, Embase, and the Cochrane Library were searched for randomized controlled trials, case-control, and cohort studies published in English from 2013 to 2023. Eligible studies included adult GERD patients with quality of life data from a disease-specific or generic instrument. Data analysis contained a narrative synthesis of pre- and post-procedural total scores.

Results
Eight trials and 34 observational studies were included. The disease-specific instruments GERD Health-Related Quality of Life (GERD-HRQL) (n = 35) and Gastrointestinal Quality of Life Index (GIQLI) (n = 4) had baseline mean scores ranging from 13.3 to 37.1 and 72.0 to 96.3, which changed to 1.3 to 31.6 and 94.8 to 119.8 post-treatment, respectively. Besides the Reflux Symptom Index (RSI) (n = 3), EQ-5D, Psychological General Well-Being (PGWB), SF-36, and GastroEsophageal Reflux Symptom Score (GERSS) were only used by single studies to evaluate the quality of life among GERD patients. In general, these results indicated an improvement post-treatment.

Conclusions
As a general finding, patients with GERD have poor quality of life and active treatment seems to influence and improve GERD patients’ quality of life, considering the pre-post results of GERD-HRQL and GIQLI scores. As expected, generic quality of life instruments are seldom used.
OGBN O04 Modern surgery and endoscopic procedures for gastro-oesophageal reflux in lung transplant recipients: a systematic review and meta-analysis
Authors: Ali Iihan , Namgoong Christoper , Das Bibek , Robb Henry , Fehervari Matyas 
Published: November 2023

Abstract

Background
Gastro-Oesophageal Reflux Disease (GORD) is a major cause of morbidity and rejection following lung transplantation. Interventional treatment of GORD is a widely accepted management strategy for GORD in the context of lung transplant surgery. We conducted a systematic review of all modern interventions to treat GORD following lung transplantation to identify the optimum management strategy for these patients.

Methods
We conducted a literature search of MEDLINE, Embase and the Cochrane library, using a tailored search strategy, from inception until 18/10/2022. Articles reporting outcomes of Anti-Reflux Surgery (ARS) following lung transplantation were included. Two independent reviewers performed screening, full text review and data extraction using the COVIDENCE platform. The study protocol was registered on PROSPERO (CRD42022379748).

Results
The screen identified 236 studies, with 21 deemed suitable for inclusion. These studies included a total of 1063 patients. The procedures described included fundoplication (n = 19), (Nissen, Toupet, Dor), Stretta (n=1) and LINX (n=1) procedures. Follow up ranged from 50 days to 6.9 years. 6 studies reported FEV1 outcomes which all demonstrated stable or improved lung function following ARS. From identified literature, 9 papers reported survival outcomes with 4 studies demonstrating improved survival following ARS.

Conclusions
ARS appears to be an effective management strategy for GORD in the context of lung transplantation. However, modern alternatives, such as Stretta and LINX require further clinical evaluation to assess their impact on lung function and survival.
OGBN O05 Short term outcomes after mesh hiatal hernioplasty versus suture cruroplasty in hiatus hernia repair at a busy District General Hospital
Authors: Patel Maitreyi , Suresh Reena , Woods-orugboh James , Shetty Jeevith , Amalesh Thangadorai , Mukherjee Samrat , Mukherjee Dipankar 
Published: November 2023

Abstract

Background
Laparoscopic cruroplasty for giant hiatus hernias utilizing non-absorbable sutures, has been demonstrated to be safe with good symptomatic relief. However, recurrence rates as high as 42% have been reported. Hiatoplasty using synthetic mesh was introduced to reduce recurrence. However, there are concerns due to complications, most notably oesophageal erosion. Due to the lack of high-quality comparative data between different types of mesh for hiatus hernia repairs, there is little evidence to guide use of mesh. We aimed to assess outcomes comparing suture cruroplasty (SC) with mesh hiatus hernioplasty (MHH) after HH repair in our unit at a busy DGH.

Methods
We retrospectively collected data of consecutive patients undergoing hiatus hernia repair between January 2016 and December 2021. Data was obtained from electronic patient records form hospital system. Primary outcomes assessed were recurrence and re-operation rates at follow up. Secondary outcomes assessed were peri-operative morbidity. We used PTFE coated composite (dual gore) mesh for MHH. Data were analysed using the two-tailed t-test for continuous data and χ2 or Fishers exact tests for categorical data. Level of statistical significance was set at p value of &lt;0.05.

Results
145 patients (SC= 98, MHH= 47) underwent hiatus hernia repair. Indications were paraesophageal (Type II-IV) HH in 58.62%, and large Type I HH in 41.38%. Conversion rate was 0.67%. There was no significant difference in post –operative morbidity. An outcome without postoperative complications was achieved in 77.24% of cases overall. After a mean follow-up of 17 months, hernia recurrence (10.2% versus 14.89%, p=0.42) and re-operation rates (5.1% versus 8.51%, p=0.47) were not significantly different. There were no mesh erosions. Overall, 132patients (91.03%) had relief from symptoms, 115 (79.31%) were able to stop GORD medications.

Conclusions
Suture cruroplasty and mesh hernioplasty produce comparable results with respect to recurrence and re-operation rates. Recurrence rates after repair are low, and are asymptomatic in most cases. A long-term follow up will enable to identify any significant future impact of method or modality of repair on patient outcome.
OGBN O07 Factors in recurrence following 862 giant paraesophageal hernia repairs
Authors: Nguyen Chu Luan , Zhou Michael , Tovmassian David , Seyfi Doruk , Isaacs Anna , Gooley Suzanna , Falk Gregory 
Published: November 2023

Abstract

Background
Repair of giant paraesophageal hernia (PEH) is associated with a considerable hernia recurrence rate by objective measures. This study evaluated trends in outcomes of laparoscopic non-mesh repair of giant PEH over 30 years, and factors associated with anatomical recurrence.

Methods
Data was extracted from a single-surgeon prospective database of laparoscopic repair of giant PEH from 1991-2021. Upper endoscopy was performed within 12 months postoperatively and selectively thereafter. Any supra-diaphragmatic stomach was defined as anatomical recurrence. Cases were chronologically divided into tertiles with trends in casemix, operative factors and outcomes evaluated. Patient and hernia characteristics, and technical operative factors, including “composite repair” (360-degree fundoplication with esophagopexy and cardiopexy to right crus), were evaluated with univariate and multivariate analysis.

Results
862 repairs met selection criteria. Mean age 69.3years, majority(65.8%) female and hernia type III(87.4%) with median hernia size 66%. There was an increasing proportion of “composite repair” after the first decade(Group1, 2.7%;Group2, 81.9%;Group3, 100%;p&lt;0.001).There were less anatomical hernia recurrence(Group1, 36.6%;Group2, 22.9%;Group3, 22.7%;p&lt;0.001) over time. The overall anatomical recurrence rate was 27.3% with median followup 33months(IQR 16, 68). There were 10(1.2%) Clavien-Dindo grade ≥III complications including two perioperative deaths(0.2%). Multivariate analysis identified age&lt;70years, presence of Barrett’s, absence of “composite repair”, and hiatus closure under tension as independent factors associated with recurrence(HR1.27,95%CI0.88-1.82,p=0.01;HR1.58,95%CI1.12-2.23,p=0.009;HR1.72,95%CI1.2-2.44,p=0.002;HR2.05,95%CI1.33-3.17,p=0.001,respectively).

Conclusions
Hernia recurrence rates decreased with increasing case volume. This coincided with the increasing adoption of “composite repair”, supporting the possible improvement in recurrence rates with this approach. Repair was associated with substantial anatomical recurrence associated with patient and technique factors. Patient factors included age &lt;70 years, Barrett’s esophagus, and hiatus tension. “Composite repair” was associated with lower recurrence rate.
OGC O02 CLDN18.2 expression in resectable gastroesophageal cancers: associated clinical and molecular signatures and impact of neoadjuvant chemotherapy on intra-tumour heterogeneity
Authors: Cammarota Antonella , Devonshire Ginny , Miremadi Ahmad , Zhuang Lizhe , Zamani Shawn , Smith Rebecca , Masqué-Soler Neus , Ustaoglu Ahsen , Rimassa Lorenza , Fitzgerald Rebecca , Smyth Elizabeth 
Published: November 2023

Abstract

Background
Claudin 18.2 (CLDN18.2), a key component of tight junctions, is overexpressed in up to 40% of oesophagogastric adenocarcinoma (OGA) and is a clinically validated biomarker in the unresectable setting. However, data is required in the resectable stages, including chemotherapy effects, relationship with genomic and immune factors, and measures of heterogeneity.

Methods
CLDN18.2 (ab222512, Abcam) and PD-L1 (E1L3N, Cell Signaling) were assessed by immunohistochemistry on adjacent FFPE slides in 57 patients with resectable OGA. Positivity was defined as 2+/3+ staining in ≥40% of tumour cells for CLDN18.2 and combined positive score (CPS)≥1 for PD-L1. Twenty-four patients (43%) had additional tumour samples to assess CLDN18.2 intra-tumour heterogeneity. Tumour mutational burden (TMB) and copy number aberrations (CNAs) were estimated from WGS and tumour microenvironment (TME) composition from transcriptomic data. Mann Whitney/t-test was used to compare clinical and molecular characteristics, and log-rank test to compare survival curves. Statistical significance was set at p=0.05.

Results
Fifty-seven patients with resected OGA (79% after neoadjuvant chemotherapy (nCT)) were evaluated. CLDN18.2 was expressed in 18% and CLDN18.2 expression was not associated with clinicopathological features or survival. CLDN18.2 copy numbers (n=57, p=0.24) and RNA levels (n=20, p=0.48) were not associated with staining intensity. Compared to CLDN18.2-ve, CLDN18.2+ve cases did not differ in PD-L1 expression, TMB, CNAs, or TME composition (all p&gt;0.05). However, exposure to chemotherapy was significantly associated with lack of CLDN18.2 (OR=0.2, 95% CI 0.04-0.79, p=0.03) and, among CLDN18.2+ve cases, CLDN18.2 status concordance between tumour samples was 100% in treatment-naïve but only 29% in cases exposed to chemotherapy.

Conclusions
CLDN18.2+ve and CLDN18.2-ve tumours had similar clinical, genomic and immune features. However, exposure to chemotherapy substantially contributes to CLDN18.2 intra-tumour heterogeneity. Larger cohorts will need to clarify whether the evaluation of multiple tumour samples is required for an accurate assessment of CLDN18.2 expression.
OGC O05 Linear stapled technique for robotic assisted minimally invasive oesophagectomy and gastrectomy: technique, stepwise introduction, reproducibility and outcomes
Authors: Bull Alexander , Paine Heidi , Abbassi Nima , Singh Pritam , Madhavan Anantha , Immanuel Arul , Preston Shaun 
Published: November 2023

Abstract

Background
Robotic-assisted surgery (RAS) for oesophagectomy and gastrectomy is gaining in popularity. Compared to open oesophagectomy and conventional minimally invasive techniques, RAS is associated with decreased rates of complications, increased harvested lymph nodes and shorter length-of-stay. However, high anastomotic leak rates (20-27%) have been seen within randomised trials and case series, with up to 50% early in some published series. We present our technique for a linear anastomosis and the results of its staged introduction.

Methods
Initially developed by a single surgeon at open surgery, it was adapted to thoracoscopic procedures and then reproduced during RAS by several surgeons across two centres. Using a prospectively maintained database we reviewed the first sixty-three cases utilising a modified linear anastomosis technique for oesophageal anastomosis. Outcomes, with particular focus on the anastomosis were reviewed. We also describe in detail the technical steps involved in our technique for a side-to-side linear semi-mechanical stapled anastomosis using a tri-stapler with a 2-layer V-lock closure of the common enterotomy, during robotic surgery (video).

Results
Sixty-one patients had a two-stage oesophagectomy (one for benign disease), one with colonic reconstruction and two total gastrectomy. Median age was 63 (range 47-85). 89% (55/62) were adenocarcinomas, the remainder squamous cell carcinomas. The anastomosis was performed via an open approach initially in 11, thoracoscopically in 4, then robotically in 48 (including the gastrectomies). The first 20 anastomoses were performed by one surgeon, who then proctored four others. Two Type I anastomotic leaks (3.2%) and two Type I conduit necrosis occurred. There was no in hospital mortality. Non-anastomotic complications occurred in 28/63 (44.4%) of patients, most commonly respiratory (15/63, 23.8%).

Conclusions
We report a reproducible technique for semi-mechanical linear stapled anastomosis and its safe introduction into oesophageal and gastric resections including RAS, with anastomotic leak rates below the internationally reported rates, even in the early phase of its introduction in open, thoracoscopic and RAS. This technique, combined with training and mentorship may help more centres safely introduce a RAS oesophago-gastric programme, and improve patient outcomes.
OGC O06 Long term outcomes of immune checkpoint inhibition in oesophageal cancer
Authors: Owen Richard , Fuchs Hannah , James Sabrina , Lord Simon , Underwood Tim , Karydis Ioannis , Petty Russell , Middleton Mark , Lu Xin ,   LUD2015-005 Project Team
Published: November 2023

Abstract

Background
Phase III studies have shown a survival benefit for the addition of immune checkpoint inhibitors (ICIs) to conventional chemotherapy for patients with gastro-oesophageal cancer. Large scale studies of chemo-immunotherapy prior to and after surgery are under way. We studied the clinical and biological effects of adding the PD-L1 inhibitor durvalumab (D) to peri-operative chemotherapy or chemoradiotherapy in a multi-centre phase II trial and used multiple phenotyping approaches to identify features associated with benefit.

Methods
Patients suitable for surgery were given D for 4 weeks, then one of Oxaliplatin and Capecitabine (CapOx), fluorouracil, leucovorin, oxaliplatin and taxotere (FLOT), or chemoradiotherapy (CXRT, CROSS regimen) were given with D before surgery, and D was continued for up to 12 further infusions postoperatively. Toxicity, response, and survival were recorded until death, for 3 years or until June 2022 when the study ended. Comparisons were made with propensity score matched patients treated over the same period in the one of the participating sites. Tumour phenotyping was with single cell and bulk sequencing approaches.

Results
11 pts received D-CapOx, 9 D-FLOT and 15 D-CXRT. Treatment side effects were as expected. Only 2 out of 35 patients did not have surgery, due to progressive disease on D-CXRT. Two (5.7%) and 6 (17.1%) patients had complete or partial pre-op responses (RECIST) and 3 (8.6%) had progression prior to surgery. Tumour regression at surgery (Mandard 1-3) occurred in 24/33 pts. 2-year survival was 81.8%, 77.8% and 77.8% respectively in the 3 arms. After propensity score matching, there was a survival advantage after addition of ICI (p=0.047). In selected patients we also demonstrate molecular features associated with response.

Conclusions
Adding D to standard neo-adjuvant regimens for gastro-oesophageal cancer is well tolerated. Survival times and response rates exceeded those expected for the regimens used (2-year survivals with FLOT 68% and CROSS 67%) in this non-randomised multi-centre trial. There was a survival advantage from the addition of ICI when compared to a matched cohort of patients treated in one of the study centres over the same period. Specific pre-treatment tumour phenotypes were associated with durable cure.
OGC O07 The prognostic role of positive peritoneal cytology in gastric cancer
Authors: Chidambaram Swathikan , Owen Richard , Maynard Nick , Shamiyah Khalid , Saunders John , Sultan Javed , Bhatti Khalid , Pera Manuel , Dalcero Mariagiulia , Ruurda Jelle , Van Hillegersberg Richard , Triemstra Lianne , van Berge Henegouwen Mark , Gisbertz Suzanne , Keywani Kamran , Piessen Guillaume , Youcef Amina , Grimminger Peter 
Published: November 2023

Abstract

Background
Locally advanced non-metastatic gastric cancer is primarily managed with surgical resection and peri-operative oncological therapies. Positive peritoneal cytology is often considered to be indicative of disseminated malignancy. We have previously shown that conversion from positive (Cy+) to negative (Cy0) cytology with systemic therapy, and absence of macroscopic disease, improves survival. With the advent of novel chemo- and radiotherapy regimes as well as immunotherapy, we recognise a lack of current understanding of the role of peritoneal cytology as a prognostic factor. Our study aims to determine the role of positive peritoneal cytology as a prognostic factor in gastric cancer.

Methods
This is an international multi-centre retrospective cohort study including high-volume, gastric cancer tertiary referral centres. Adult patients without macroscopic metastatic disease who underwent peritoneal cytology, and subsequently multi-modality treatment including surgical resection between 2011 and 2021 were included. The primary outcome measure is overall survival at 1, 3 and 5 years. Secondary outcome measures include recurrence-free survival at 1, 3 and 5 years; 30-day and 90-day major postoperative morbidity; and subset survival analyses were performed in patients who converted to Cy0 in restaging laparoscopy after neoadjuvant therapy. Statistical analysis was performed using R software.

Results
This is an interim analysis of the data of 280 patients with a mean age of 64.9 (0.72). 231 patients received pre-operative chemotherapy. 51.0% underwent open gastrectomy (41.2% laparoscopic and 4.64% robotic). 55% of patients underwent a total gastrectomy. 25.9% patients had positive cytology on laparoscopy, while 9.71% had indeterminate cytology. There was significant variation in the sites of peritoneal washings (Figure 1). So far, only 1 patient has shown conversion from positive to negative cytology after oncological therapy. At 1 year, the mortality rate was 41.5% (figure 2), while the recurrence rate was 41.4%.

Conclusions
In this interim report, we demonstrate significant heterogeneity in the way peritoneal cytology is performed, and the peri-operative management of this cohort. The POPEC study closes to patient recruitment at the end of August 2023, and thus at AUGIS we plan to report on the final findings of this study with an anticipated sample size of over 1000 patients.
AHP P04 Utilisation of Jejunostomy (JEJ) placement post Oesophagogastrectomy (OG) surgery and the difference in unintentional weight loss between patients who were placed with a JEJ at the time of surgery compared to those without
Authors: Cross Kayleigh 
Published: November 2023

Abstract

Background
The optimal pathway for reinstating nutrition orally or enterally remains a matter of debate post OG surgery. Historically all patients undergoing OG had routine JEJ placement and there are many studies to support this. However more recently, some trusts are moving away from this notion and opting for selective JEJ placement due to suboptimal tube utilisation rates, psychological impact for patients, enhanced recovery after surgery (ERAS) pathways, wider range of oral nutritional supplements on the market, adaptive hospital menus and snack boxes, Naso-jejunal tubes (NJT) being placed instead of JEJ, JEJ tube complications and more enhanced specialist Dietetic input.

Methods
Data was collected retrospectively from electronic notes for all patients who underwent an OG between April 2020- April 2021 which was during the start of the covid pandemic. The data was reviewed for 2 years following their surgery and compared percentage weight loss of patients with JEJ placed versus patients without at 1-2 months, 3 months, 6 months, 9 months, 1 year and 2 years post surgery. Utilisation rates of JEJ tube were also reviewed alongside establishing if patients did not have JEJ placement at time of OG, required enteral feeding as part of their recovery.

Results
58 OG’s Conducted between 30/4/2020-29/4/21, of which 65.5% had JEJ placed.

Conclusions
Selective JEJ placement during OG surgery requires careful consideration given 23.7% patients didn't use JEJ post discharge and 2years post OG, weight loss was the same in both groups. However, 1year post OG, the non-JEJ group lost nearly double the amount to the JEJ group, highlighting further research is required to inform this debate; especially as the weight loss could be attributed to cancer recurrence which has not been accounted for. Collaborative working between Dietitians, surgeons and nurse specialists is essential if selective JEJ placement is to occur. Data will be repeated during non-covid times to yield more meaningful data.