bluuebunny/crossref_metadata_2025_split huggingface dataset:
O115 Is humeral head resurfacing still a valid treatment for younger patients? 10-15-year patient follow up data for the global conservative anatomic prosthesis
Authors: Khokhar O , Khan S , Cash T , Khokhar H , Waseem M 
Published: May 2023

Abstract

Introduction
Humeral head resurfacing has fallen out of favour owing to high reported revision rates. We present 10-15 year follow up data for the Global Conservative Anatomical Prosthesis (CAP).

Methods
Patients who underwent humeral head resurfacing using the Global CAP between March 2005 and May 2010 were contacted via telephone. All operations were performed by a single surgeon. Patients rated pain and satisfaction on a 11-point numerical scale (0-10). Oxford shoulder scores (OSS) and Quick-DASH scores were also completed.

Results
Some 46 patients (49 resurfacings) were identified. 20 patients were deceased, 3 had been revised, 3 were uncontactable and 1 developed dementia. Complete data was obtained for 19 patients (73% response rate). The mean respondent age at time of surgery was 68.8 years. 68% were female. The principal indication was osteoarthritis (74%). The mean pain score was 2.2 with a mean satisfaction score of 6.9. The mean OSS was 43.1 and mean Quick-DASH 14.1 indicating good shoulder function. When stratified according to age at time of surgery, younger patients (&lt;65) were found to have higher OSS (p=0.036) and lower Quick-DASH scores (p=0.029) at follow up (Mann-Whitney U Test).

Conclusion
At 10 year follow up, patients who underwent humeral head resurfacing had low pain scores, high satisfaction scores and good patient reported outcome measures. We propose that humeral head resurfacing retains value, particularly for painful osteoarthritis in younger patients who do not wish to undergo total shoulder replacement. The operation is simple and preserves humeral bone stock for future surgery.
O116 Clinical innovation network analysis (CINA) and readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review
Authors: McLean K , Knight S , Diehl T , Varghese C , Ng N , Potter M , Zafar S , Bouamrane M , Harrison E 
Published: May 2023

Abstract

Introduction
Increasing numbers of digital health interventions (DHIs) for remote postoperative monitoring have recently been developed and evaluated. We aimed to review DHIs for postoperative monitoring and evaluate their readiness for implementation into routine care.

Methods
This systematic review identified studies on implementation and evaluation of DHIs for postoperative monitoring published before 31st December 2021 (PROSPERO ID: CRD42021264289). Studies which included postoperative monitoring use-cases for general postoperative recovery or specific complications were defined according to their IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stages of innovation. A novel clinical innovation network analysis (CINA) using co-authorship and citations of previous work was used to examine collaboration and progression. The WHO framework for monitoring and evaluating DHIs was used for narrative synthesis.

Results
Seventy-five novel DHIs were identified from 7,605 records. Of these, 76.0% (n= 57/75) were classed as early-stage innovations (IDEAL stage 1 & 2a), and none had achieved routine implementation. There is limited evidence of collaboration based on co-authorship or citations, with 91.3% (n=63/69) of studies beyond IDEAL stage 1 without prior publications. There were notable differences in evaluation, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or impact of these interventions on the cost, efficiency or quality of care.

Conclusion
Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
O120 A functional assessment of hepatic ischaemic injury on hepatocellular carcinoma behaviour
Authors: Cheemungtoo G , Dobbins J , Tingle S , Mahendran B , Bates L , Zatorska M , Clark J , Figueiredo R , Govaere O , Wilson C 
Published: May 2023

Abstract

Introduction
Hypothermic oxygenated perfusion (HOPE) preservation improves outcomes after donation after cardiac death (DCD) liver transplantation. Database analysis has also suggested significantly lower hepatocellular carcinoma (HCC) recurrence rates in recipients with HOPE-DCD livers compared to non-perfused livers. Whilst HOPE may protect against severe hepatic ischaemia-reperfusion injury, the exact mechanisms for lower recurrence rates are not fully understood. As HOPE preservation fluid, or perfusate, dynamically flushes out many inflammatory and ischaemic markers from the donor liver, the effect of these contents on in-vitro HCC cell behaviour was investigated.

Methods
An HCC cell line, HepG2, was functionally assessed following treatment with HOPE perfusate samples from 3 human livers declined for transplant. In-vitro HepG2 proliferation, stemness and initiation were assessed by an MTS assay, cytokeratin-19 (K-19) immunocytochemistry, and a colony-forming assay respectively. All experiments were conducted with approval by an ethical committee.

Results
All 3 HOPE perfusate samples resulted in significant HepG2 proliferation and increased aggressive behaviour potential. At 24 hours, HepG2 proliferation was significantly greater after treatment with 1:2 perfusate dilution compared to blank perfusate (p&lt;0.05). Membrane invadopodia development, signifying an increased invasive potential, was also noted at 24 hours with treatments of 1:2 and 1:20, without observed differences in K-19 expression compared to untreated controls.

Conclusion
End-timepoint HOPE perfusate from declined livers facilitate increased HepG2 proliferation and aggression. HOPE may reduce early tumour recurrence in HCC patients by dynamically flushing out these liver-secreted trophic factors.
O122 The use of directly injectable cancer therapies: a systematic review
Authors: Kler A , Fok M , Vimalachandran D 
Published: May 2023

Abstract

Introduction
DIT allows for targeted delivery to a cancer. This could deescalate treatments through reduced use of systemic chemotherapy, radiotherapy dosage, and avoidance of major surgery. Palliative cancers can benefit through similar means to maintain quality of life and avoid permanent interventions (such as stomas). There is no mainstream use of DIT. Therefore, the aim of this review was to assess the role of DIT in all cancers.

Methods
A systematic search was performed in the Pubmed, Web of Science, Embase and Google databases. Two authors independently searched the literature and extracted data onto a dedicated proforma. Human and animal studies were included.

Results
8,380 papers were identified, 49 studies were included; comprising of 1,087 patients for lung, H+N, brain, oesophagogastric and colorectal cancer. Four studies performed neoadjuvant DIT, where one showed all lung tumours down staged to an operative state. The remainder showed no advantage in survival or response. Palliative intra-tumoural cisplatin (in three studies) showed promise for malignant airway obstruction, where good responses were shown in &gt; 50% of patients (single report). Cisplatin was also favourable in palliative H+N cancers (ORR=66% in one report). A minority of studies (4/49) exhibited grade 3 toxicity or higher.

Conclusion
DIT is safe to administer and demonstrated promise in the palliation of malignant airway obstruction and advanced/recurrent H+N cancer. Further studies are required to verify these results. Additionally, more reports are required to determine its role in neoadjuvant treatment.
DIT:Direct injection of chemotherapy
ORR:objective response rate
H+N:head and neck
O126 Repeat hepatic resection for recurrent colorectal metastasis
Authors: Khawaja A H , Khasati L , Hanks M , Zaitoun A M , Cameron I , Gomez D 
Published: May 2023

Abstract

Introduction
Liver resection offers the best curative treatment for hepatic metastases secondary to colorectal (CR) cancer. The aim of this study was to compare survival outcomes between patients having liver resection once (OR) versus those having redo-liver (RR) resection for hepatic metastases.

Methods
This was a retrospective study done on 171 patients who underwent hepatic resection (97 had OR & 74 had RR) from January 2009 to January 2020 across East Midlands hospitals.

Results
Mean age of patients in OR group was 75 years & RR group was 74. Male: female ratio was 2:1 for OR and 1.34:1 for RR group. Mean period between first and second liver resection was around 15.4 months. Minimum follow up period after surgery was 3 years. Up to the point of study till Jan.2023, overall there were 58 deaths reported out of a total of 97 patients in OR group, while in the RR group there were 39 deaths reported out of 74 patients. At 3 years follow up from initial resection, overall survival in OR patients was 58% while in the RR group was 65%. At 5 years follow up, overall survival in OR group was 40% while that of RR group was 45%. It was also noted that in the RR group, 67% (1/3) patients had lymph node positive disease (≥N1).

Conclusion
Beneficial outcome has been reported with regards to overall survival in patients undergoing redo hepatic resection and supports its role as the preferred choice of management for recurrent liver metastasis.
O127 Application of machine learning approaches in the diagnosis and management of colorectal cancer
Authors: Chowdary P , Kmiotek E K , Mirnezami R 
Published: May 2023

Abstract

Introduction
Colorectal cancer (CRC) is one of the most common cancers worldwide. In recent years, Artificial Intelligence (AI) and Machine Learning (ML) algorithms have gained traction in CRC research for their ability to efficiently analyse large volumes of variables and offer objective data driven models to optimise clinical decision making. The present review provides a contemporary summary of the current application of these approaches in CRC.

Methods
A literature search was performed on AI models and ML learning in CRC and relevant articles were scrutinized.

Results
AI aided detection systems were successful in identifying CRC, and able to outperform endoscopists in detecting adenomas (detection rate 0.29 vs. 0.20, p &lt; 0.001). ML models based on radiomics showed promise in identifying CRC metastasis and even outperforming national guideline-based models (AUC 0.83 vs. 0.73, p&lt;0.01) in predicting risk of T1 CRC metastasis to lymph nodes. ML models were also able to identify novel genomic targets, predict response to oncological therapy, and predict 5-year disease free survival in stage II and III CRC (AUC of 0.698). In the operative context, AI can be trained to identify surgical steps and operative actions with accuracy scores of over 80% as well as.

Conclusion
AI modelling takes advantage of increasing digital medical data keeping to allow rapid high-volume data analysis which has found application in the diagnosis, staging, treatment, and prognosis of CRC and may be useful in the development of intra-operative guidance systems to optimize surgical approaches and training.
O128 Time trends in opioid prescribing after discharge following colectomy in england: a cross-sectional study
Authors: Baamer R , Humes D J , Toh L , Knaggs R , Lobo D N 
Published: May 2023

Abstract

Introduction
Opioid prescribing patterns after discharge following colectomy within a population from England are not well characterised. This study aimed to report changes in opioid prescribing prevalence, formulation choices and opioid analgesics over time.

Methods
This cross-sectional analysis included people undergoing colectomy between 2010 and 2019 using primary (Clinical Practice Research Datalink) and linked secondary care (Hospital Episode Statistics) data. The prevalence of initial opioid prescription within 90 days of surgical discharge was calculated, and prescription characteristics in terms of analgesics and formulation were described. Trend analysis was performed using the Cochran Armitage test, and percentage change between 2010 and 2019 was tested using univariate logistic regression.

Results
Of the 95,155 individuals undergoing colectomy within the study period, 15,503 (16.3%) received opioid prescriptions. There was a decreasing trend in the prevalence of post-discharge opioids for opioid naïve people (P&lt;0.001), with a decrease from 11.4% in 2010 to 6.7% in 2019 (-41.3%, p&lt;0.001). Whereas the prevalence remained stable for patients prescribed opioids prior to surgery (p=0.637). The prescribing of immediate release formulations decreased from 86% in 2010 to 82% in 2019 (-4.65%). Codeine represented 44.5% of all prescriptions and prescribing increased by 14.5% between 2010 and 2019. Moreover, morphine and oxycodone prescriptions rose significantly by 76.6% and 131%, respectively, while tramadol prescribing dropped by 48%.

Conclusion
This study identified a changing pattern of opioid prescribing following colectomy, with prescribing prevalence decreasing for opioid naïve people. Trends suggested decreased tramadol prescribing, but a shift toward increasing codeine, oxycodone and morphine prescriptions.
O131 Martius flaps for rectovaginal fistulae – a systematic review and metanalysis
Authors: Swindon D , Izwan S , Ng J , Chan E , Abbas N , Von Papen M , Sahebally S M 
Published: May 2023

Abstract

Introduction
Rectovaginal fistulae (RVF) are notoriously challenging to treat. Martius flap (MF) is a technique employed to manage RVF, among various other procedures, with none being universally successful. We aimed to assess the outcomes of RVF managed with MF interposition.

Methods
A PRISMA-compliant meta-analysis searching for all studies specifically reporting on the outcomes of MF for RVF was performed. The primary objective was the mean success rate, secondary objectives included complications and recurrence. The MedCalc software (version 20.118) was used to conduct proportional meta-analyses of data. Weighted mean values with 95% CI are presented and stratified according to aetiology where possible.

Results
Twelve non-randomized (11 retrospective, 1 prospective) studies, assessing 137 MF procedures were included. The mean age of the study population was 42.2 +/- 15.7 years. There were 45 primary and 92 recurrent RVF. The weighted mean success rate for MF when performed for primary RVF was 91.4% (95% CI: 79.45- 98.46; I2= 32.1%; p=0.183) and that for recurrent RVF was 77.5% (95% CI: 62.24- 89.67; I2= 58.1%; p=0.008). The weighted mean complication rate was 29% (95% CI: 8.98- 54.68; I2= 85.4%; p&lt;0.0001) and the overall recurrence rate was 12.0% (95% CI: 5.03- 21.93; I2= 52.3%; p=0.021). When purely radiotherapy-induced RVF were evaluated, the mean overall success rate was 94.6% (95% CI: 83.33- 99.75; I2= 0%; p=0.350).

Conclusion
MF interposition appears to be an effective treatment modality for RVF. Future randomized studies should be conducted to confirm these findings and to compare MF with other surgical techniques.
O133 Network meta-analysis of neoadjuvant therapy in rectal cancer
Authors: Fok M , Fowler H , Clifford R , Kler A , Gittens J , Toh S , Wade R , Vimalachandran D 
Published: May 2023

Abstract

Introduction
Locally advanced rectal cancer can be treated with neoadjuvant chemoradiotherapy prior to surgical resection. This treatment can significantly downstage rectal tumours and consequently lead to improved long term survival and reduced risk of local reoccurrence. Controversy exists regarding the optimal regime for neoadjuvant therapy. A network meta-analysis allows the integration of multiple treatments to be compared simultaneously in a single analysis. This network meta-analysis aims to assess which neoadjuvant regime gives the highest rate of pathological complete response (pCR).

Methods
An extensive literature search for randomised controlled trials of neoadjuvant therapy in rectal cancer was performed. The primary outcome was pCR at surgical resection. Direct and indirect comparisons were performed with a frequentist Network Meta-Analysis and results tested for consistency.

Results
Following critical appraisal of 3720 studies, 16 randomised control trials were included in the study. Regimes of neoadjuvant therapy included short course radiotherapy with concurrent chemotherapy or without, long course chemoradiotherapy, long course chemoradiotherapy with either induction of consolidation chemotherapy, and radiotherapy alone (45gy). Short course radiotherapy combined with chemotherapy was shown to produce significantly higher pCR in patients with rectal cancer. Short course radiotherapy without chemotherapy was shown to have the lowest rate of pCR.

Conclusion
There is strong evidence to suggest that short course chemoradiotherapy is the best regime to produce the highest pCR in patients with rectal cancer.
O139 High resolution anoscopy for anal intraepithelial neoplasia surveillance: new service delivery in Wales
Authors: Saji A P , Soliman F , Horwood J , Hargest R 
Published: May 2023

Abstract

Introduction
Anal intraepithelial neoplasia (AIN) is a pre-malignant precursor to anal squamous cell carcinoma (SCC). High Resolution Anoscopy (HRA) is utilised in the surveillance of these lesions allowing significant magnification and inspection of the perianal, vulval and anal squamous epithelium to obtain targeted biopsies from areas of suspicion. We present the experience of Wales's first HRA surveillance program.

Methods
A retrospective review of AIN patients enrolled into HRA screening was performed. The ease of establishing HRA, of running the service, histological outcomes, risk factors and complications were obtained.

Results
A business case for HRA equipment was authorised – capital cost £23850, warranty £19080 for 4 years, disposable proctoscope £25 per patient. Two surgeons trained in the use of the equipment with industry support. Twenty-six patients underwent HRA and biopsy (male: female 11:15). Patients included those with one or more of the following recognised risk factors including: transplant/immunocompromised (30.8%), HPV (50%), smoking currently or previous (61.5%), MSM (9.1% of males), VIN (86.7% of females). A total of 122 biopsies were taken (median 4 per patient (1-17)). Eight patients (30.8%) attended two or more sessions. There were no complications perioperatively. Ten patients (38.5%) found to have AIN3. Three females (20%) had VIN3. Three patients (11.5%) found to have SCC and referred to local oncology services.

Conclusion
HRA is a safe and effective surveillance programme for patients with AIN. Magnification enhances the ability to target biopsies to areas of suspicion at an early stage. Recording of images is useful in planning subsequent assessments.
O142 The application of robotic surgical approaches in the management of midgut neuroendocrine tumours: a systematic review
Authors: Jatin N , Aryan A , Zainab S , Reza M 
Published: May 2023

Abstract

Introduction
Robotic-assisted surgery (RAS) promises good outcomes in midgut adenocarcinoma surgery. However, its effectiveness in midgut neuroendocrine tumours (MNETs) is unknown. This study aimed to assess the current use, user interface and any emerging developments of RAS in MNET treatment using the literature available.

Methods
This review was carried out using PRISMA guidelines. MEDLINE, EMBASE and Web of Science were searched on 22nd October 2022. All studies reporting primary data on robotic surgery in midgut neuroendocrine tumours or carcinoid tumours were included. The midgut was defined to be from the duodenojejunal flexure to the splenic flexure.
Methodological quality was assessed using the Joanna Briggs critical appraisal tool.

Results
According to our systematic review protocol, nineteen studies were selected. A total of twenty-six patients were identified. RAS was used for right colectomy, right hemicolectomy, ileal resection, caecal resection, intracorporeal anastomosis and complete mesocolic excision. It offered an optimal user interface with enhanced visuals, fine dexterity, and ergonomic work position. Innovative developments in tumour-healthy tissue boundary and vasculature visualisation were reported.

Conclusion
Although the evidence base is limited, RAS for MNETs is safe and feasible. We recommend more extensive prospective-randomised controlled trials comparing it with laparoscopy and open surgery. Developments in contrast dyes and tumour-specific probes are very promising.
O143 Management strategies and outcomes for small bowel neuroendocrine tumours with involvement of the superior mesenteric vascular root: a systematic review
Authors: Kmiotek E K , Lakda S , Mirnezami R 
Published: May 2023

Abstract

Introduction
Small intestine neuroendocrine tumours (SI-NETs) are the most common small bowel tumours. A particularly challenging subset of these tumours are those that involve the superior mesenteric artery (SMA) or vein (SMV) for which the role and feasibility of surgery is often questioned. This review aimed to identify and evaluate the management strategies used for these complex SI-NETs.

Methods
Primary studies concerning SI-NETs with SMA and/or SMV involvement were identified from PubMed and Embase review and data abstraction was performed.

Results
Initial literature search identified 155 potentially eligible studies, from which nine non-randomised primary retrospective studies met inclusion criteria. Treatments identified include stenting the SMV, debulking and resection, auto-transplantation, and endovascular occlusion and tumour excision (EVOTE) procedures. The level of involvement of the SMA and SMV was associated with resectability such that more proximal involvement yielded a lower likelihood of successful resection. Auto-transplantation strategies may show promise in more proximal mesenteric root involvement. To date, one study reported a case of a patient with SMV encasement who was successfully treated with auto-transplantation of ileocolic and ileojejunal segments after resection of the affected structures.

Conclusion
The present study highlights a role for aggressive surgical and multimodal management in cases of SI-NETs with vascular involvement of the mesenteric root. The use of classification systems to stratify mesenteric masses by level of vascular involvement can help identify patients who could benefit from resection. Large scale prospective studies are needed to better elucidate the effectiveness of surgical management strategies in these challenging SI-NETs.