bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.2 High Nuclear Receptor 4A1 (NR4A1) expression is associated with poor prognosis in breast cancer patients
Authors: Jones Stacey 
Published: August 2023

Abstract

Aim
To evaluate the relevance of NR4A1 expression with respect to clinical prognostic markers and outcomes in a breast cancer cohort, as well as the METABRIC dataset.

Methods
Breast cancer tissue was obtained from a tissue microarray comprising all tumour subtypes, with common factor of use of adjuvant chemotherapy (n=305). Expression of NR4A1 was determined by immunohistochemistry. METABRIC data were accessed via cBioPortal. Records with suitable NR4A1 expression data and clinical data of relevance were obtained (n=1886). For both cohorts, cases were then dichotomised into high or low NR4A1 expression by performing receiver operator curve analyses, and relationships between expression and survival were tested.

Results
Kaplan-Meier survival analyses showed that high NR4A1 nuclear protein expression was associated with a poorer disease-free survival (DFS) and disease-specific survival (DSS), by means of 487 days, p=0.005; 621 days, p=0.001 respectively in the whole cohort. A sub-analysis of triple negative and ER-negative breast cancers also showed that high NR4A1 nuclear protein expression was associated with both a shorter DFS, by 1452 days, p=0.002; 1141 days, p=0.006 respectively and DSS, by 1603 days, p=0.001; 1187 days, p=0.001 respectively. Analyses of the METABRIC dataset demonstrated no significant influence of NR4A1 mRNA expression on DFS (p=0.978) or DSS (p=0.288) in the whole cohort, or the molecular subgroups, or depending on chemotherapy use.

Conclusion
High nuclear NR4A1 expression correlates with decreased DFS and DSS after chemotherapy in breast cancer and these findings suggest that NR4A1 could act as a potential target for inhibitor drugs in breast cancer.
SP6.6 Long-term effects of one-anastomosis gastric bypass on liverhistopathology in NAFLD cases: a prospective study
Authors: Salman Mohammed , Noureldin Khaled , Issa Mohamed , Fadlallah Elhaj Mujahid Gasemelseed , Agwa Hisham , Shalaby Ahmed 
Published: August 2023

Abstract

Background
Weight reduction can effectively improve nonalcoholic fatty liver disease (NAFLD), which is a constant companion of severe obesity. This study aimed to determine the effect of one-anastomosis gastric bypass (OAGB) on pathological liver changes in severely obese cases with NAFLD.

Methods
The present prospective research comprised 67 subjects with morbid obesity scheduled for OAGB during the period from February 2015 to August 2018. Clinical, biological, and histologic data were evaluated pre and 15 months postoperatively.

Results
Fifteen months after surgery, a considerable reduction was noted in the grades of fat deposition, liver cell ballooning, and lobular inflammatory changes, in addition to the total NAS score. Fifteen months after surgery, nonalcoholic steatohepatitis (NASH) disappeared in 42% of the patients. A significant regression of fibrosis stage occurred after surgery in 79.1% of patients (p &lt; 0.001). After surgery, patients had substantial reductions in aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, HbA1c, total cholesterol, and Low-density lipoprotein (p &lt; 0.001, for all comparisons). Diabetes mellitus, hypertension, and dyslipidemia resolved in 54%, 59%, and 69% of the patients, respectively.

Conclusion
OAGB resolved NASH from nearly 42% of patients and reduced the histological features of NAFLD 15 months after surgery. Bariatric procedures might be adopted as a therapeutic modality in severely obese cases with NAFLD after the failure of lifestyle modifications.
SP8.3 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis
Authors: Falola Adebayo , Dada Oluwasina , Ndong Abdourahmane , Akande Damilola 
Published: August 2023

Abstract

Aim
Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review.

Method
Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. 452 articles were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis.

Results
The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, responsible for 46.25%, 26.31% and 12.23% of cases, respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI: 17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria.

Conclusions
Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies and it is significantly influenced by surgical intervention time.
SP10.5 Effectiveness of Enhance Recovery After Surgery (ERAS) Protocols in Malignant Colorectal Cancer Resections: A 15 year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A 
Published: August 2023

Abstract

Aims
ERAS improves post operative recovery following colorectal resections. ERAS is applicable to both laparoscopic and open surgery. Aim of study is to assess effectiveness of ERAS in malignant colorectal cancer (CRC) resections.

Methods
Single-centre cohort study evaluated post operative outcomes in elective malignant CRC resections from January 2008 to February 2023. CRC resections performed without ERAS were used as controls.

Results

Conclusion
ERAS was employed in more laparoscopic CRC resections. ERAS discontinuation in major surgical complications. Despite prolonged operation in ERAS group (p &lt; 0.0001), hospital stay was significantly shorter (p &lt; 0.0001). Survival rates were better in the ERAS group (Logrank p &lt; 0.05), explained by ERAS wholly implemented & non ERAS were historical cases. Delayed ERAS occurred in 6.9 % of cases & can account towards delays in hospital discharge. This study demonstrated a targeted rehabilitation programme and early diagnosis of surgical complications can facilitate post-operative recovery.
SP10.6 Comparison of clinicopathological features of colorectal cancer during and after lockdown
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan 
Published: August 2023

Abstract

Aims
When the UK entered the lockdown, the cancer pathways changed in order to deal with the pandemic and protect cancer patients who are at high risk from the virus. The objective of our study is to compare the clinicopathological features of colorectal cancer (CRC) during and after lockdown.

Methods
Patients who underwent colorectal surgeries for CRC between Feb-2020 to Aug-2022 were included in the study. All patient related and disease specific details were obtained from the prospectively collected database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21 (group-B: after lockdown). Patient demographics and pathological details were collected and analysed using standard statistical tests.

Results
A total of 528 patients underwent surgeries during this period, of which 422 had cancer resections. During lockdown 187 patients had cancer resections (Group-A) and 235 patients had surgery for cancer after lockdown (Group-B). The median age of patients is 72 and 73 years in group-A and B respectively (p-value:0.29). There is no difference between the two groups with respect to tumour, nodal staging and extramural vascular invasion. The median lymphnode yield is 20 (range:0-80) in group-A compared to group-B where the yield was 21 (range:0-102) (p-value:0.720). There were 44 patients with rectal cancer in group-A of which 4.55% had circumferential resection margin positivity (CRM) and 6.77% (4 of 59) of rectal cancers patients in group-B had CRM positivity (p-value:0.229).

Conclusions
There was no difference in clinicopathological features of patients having colorectal surgery during and after lockdown.
SP10.14 Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess. A meta-analysis
Authors: Nour Hussameldin M , Elmansi Abdalla Hashim E. , Magsi Abdul Malik , Peristeri Dimitra V , Mcwhirter Alexandra , Al Jebaie Khalid , Sajid Muhammed S 
Published: August 2023

Abstract

Aims
Wound packing following incision and drainage of perianal abscess has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage of perianal abscess.

Methods
Standard medical electronic databases were searched and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software.

Results
Three RCTs on 490 patients undergoing incision and drainage of perianal abscess were included. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2 = 0.15; chi2 = 9.32; df = 6; I2 = 36 %; p= 0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively.

Conclusion
Not packing the wound post incision and drainage of perianal abscess is associated with significantly reduced VAS pain scores and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.
SP11.7 Do women surgeons have autonomy in the operating theatre? Exploring the lived experience of female surgical trainees
Authors: Govind Garima , Mahendran Arunthathi 
Published: August 2023

Abstract

Background
Female surgeons routinely face biases at work such as microaggressions, mistitling, lack of opportunities and are held up to a higher standard than their male colleagues. Female trainees feel that their abilities are routinely underestimated, and literature shows they are objectively given less operative autonomy than male colleagues.

Methods
Snowball sampling recruited nine participants to the study. Four participated in a focus group, and the remaining five participated in a one-on-one semi structured interview. The focus group and interviews were transcribed and analysed using thematic analysis to understand the lived experience of female surgical trainees and their experience of autonomy in the operating theatre.

Results
Autonomy was associated with being able to make decisions peri- and intra-operatively and with being trusted to carry out the operation. Participants believed that positive relationships between themselves, their trainers and the wider theatre team is paramount to improving autonomy. A major barrier in improving training and autonomy is a disconnect between organisations and trainees’ learning needs.

Discussion
an appropriate level of autonomy is vital for trainees’ development and career progression. Due to persisting biases in surgery, the training needs of female surgical trainees are unique, and this study has brought their lived experiences of operative autonomy to light. It is vital that women surgeons are visibly represented in leadership roles at all levels so that they can advocate for, not only for their female counterparts, but for all surgical trainees, allowing a more individualised training programme and ultimately improving the overall training experience.
WTP2.4 Can we predict parathyroid adenoma size preoperatively with biochemical markers?
Authors: Kho Jason , Kuan Jen Yee , Turner Paul , Shetty Vinutha 
Published: August 2023

Abstract

Aim
In primary hyperparathyroidism, parathyroidectomy remains the mainstay of treatment. However, localising abnormal parathyroid glands can often prove challenging, and re-operations may be necessary. We aim to evaluate any correlation that might exist between parathyroid hormone (PTH) levels, preoperative peak corrected calcium levels and cinacalcet use with adenoma size.

Methods
We retrospectively reviewed consecutive parathyroidectomies performed for primary hyperparathyroidism by two experienced upper gastrointestinal surgeons (VS and PT) in a teaching hospital between April 2013 and December 2022. Hospital database was accessed to obtain data for biochemical markers, operation notes and histopathology reports. Spearman correlation coefficient was computed to evaluate linear relationship between PTH, peak calcium levels and adenoma size. Mann-Whitney-U test was used to compare cinacalcet use and adenoma sizes. P-value&lt;0.05 was statistically significant.

Results
170 parathyroidectomies for primary hyperparathyroidism were performed during the study period. Patient cohort was predominantly female (n=131, 77.1%). Mean age of study population was 58±12 years. There were positive correlations between adenoma size and preoperative peak corrected calcium levels (R=0.25, p=0.001) and PTH levels (R=0.4, p&lt;0.001) respectively. In patients who took cinacalcet preoperatively (n=46, 27.1%), there was an association with larger adenoma size (18±8mm vs 22±12mm, p=0.009).

Conclusion
Higher preoperative PTH levels and peak corrected calcium levels along with cinacalcet use may be associated with larger adenoma sizes. Further studies are required to validate these findings.
WTP2.9 Early Deceased Donor Kidney Transplant outcomes: Results from a Prospective National Transplant Access to Theatre (NTACT) Audit
Authors: Borbas Balint , Mujeeb Mariyam , Tanase Andrei , Aroori Somaiah 
Published: August 2023

Abstract

Background
Renal transplantation is increasing, yet there is a paucity of data describing post-operative complications. Therefore, this national audit aims to identify the incidence of early complications that impact patient outcomes.

Methods
We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on significant checkpoints pre, intra and post-operatively, assessing for 30-day complication and mortality rates. Data was recorded on RedCap and analysed using descriptive statistics.

Results
476 kidney-only transplants were recorded, (59 excluded for incomplete/incorrect data). Of 417, 215 were donation after brainstem death (DBD) organs and 202 were donation after circulatory death (DCD) organs. The 30-day mortality was 0.47% (n=2/417). The primary graft function rate was 81%. The 30-day readmission rate was 18%, and median number of readmissions was 1 (IQR: 1-3). Of the readmitted recipients, 92% were readmitted once and 8% were readmitted more than. The 30-day reoperation rate was 12%, and median number of reoperations was 1 (IQR: 1-2), of these, 91% had 1 reoperation and 9% had more than 1 reoperation. Most common indications for reoperations were bleeding 49% (n=25), assessment of graft perfusion 17% (n=9), and wound dehiscence 10% (n=5). We noted a difference in rates of reoperations between DCD and DBD organs, 16% and 9% respectively, however, this was not significant. There was no significant difference in the readmission and mortality rate between DBD and DCD organs.

Conclusion
The overall early postoperative complication rates and 30-day mortality following deceased donor kidney transplantation are low.
WTP3.8 Histological stage and five-year outcomes in patients who undergo pancreatoduodenectomy for distal cholangiocarcinoma: an international multicentre study
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Patients with a distal cholangiocarcinoma (CC) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. Patients with early disease are known to have better outcomes. This study aimed to investigate and quantify the relationship between histological stage and five-year recurrence/survival.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre study of PD outcomes (29 centres in 8 countries, n=1484). CC patients were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test.

Results
A total of 205 patients (13.8%) had CC confirmed. The number of patients with T1, T2, T3 and T4 disease was 11 (5%), 25 (12%), 158 (78%), and 8 (4%), respectively (Tx: 3). Five-year recurrence was 9%, 32%, 70% and 75%, respectively. T1-2 patients (vs T3-4) had lower rates of five-year recurrence (OR: 0.1, 95% CI: 0.1-0.3). Five-year survival was 90%, 60%, 23% and 38% in patients with T1, T2, T3 and T4 disease, respectively. T1-2 patients (vs T3-4) had higher rates of five-year survival (OR: 5.8, 95% CI: 2.8-12.3). 69 patients (34%) had no lymph node involvement and 136 (66%) had positive regional lymph nodes. N0 patients (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.1-0.5) and higher five-year survival (OR: 4.5, 95% CI: 2.4-8.7) rates.

Conclusions
In our multicentre study of PD outcomes, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates in patients with CC.
WTP4.3 A Service Evaluation of Emergency Laparotomy and Total Parenteral Nutrition at a Single Teaching Hospital
Authors: Ashmore Daniel , Lee Matthew , Wilson Timothy 
Published: August 2023

Abstract

Aims
Malnourished patients undergoing emergency general surgery (EGS) have a greater risk of mortality than those not malnourished. There is often a need for nutritional support in EGS. This study investigated the risk factors for total parenteral nutrition (TPN) in patients undergoing emergency laparotomy, and whether there is an association with the NELA risk score.

Methods
A five-year review (June 2016-2021) of the local NELA database and referrals to the Nutrition Support Team was performed. Pre-operative, operative and post-operative data for patients who received TPN and those who did not was collected. Associations between risk factors including NELA score and TPN use were examined using chi squared test and Mann Whitney U, as appropriate.

Results
There were 931 NELA patients, of which 22.8% (n=173) received TPN. Intestinal obstruction was the commonest indication for surgery at 51.3% (n=478) with no difference in age or sex. Despite patients receiving TPN being more likely to be frail (0.004), have higher ASA scores (0.001), lower albumin levels (&lt;0.001), and worse pre- and post-operative NELA scores (both 0.002), stoma formation (0.002) and mortality (&lt;0.001) was half that in patients without TPN. Sub-analysis reveals this was irrespective of when TPN was administered.

Conclusions
Two mutually exclusive explanations exist. TPN may be a predictor of disease severity and subsequent clinical intervention, or it may indeed improve the nutritional and clinical outcomes in this high risk EGS group. Further studies are needed to clarify this, in addition to the most appropriate method of identifying malnutrition in NELA-eligible patients.
WTP4.4 A national survey of NELA Leads to identify current nutrition practices and pathways in NELA-eligible emergency general surgery patients
Authors: Ashmore Daniel , Wilson Timothy , Halliday Vanessa , Lee Matthew 
Published: August 2023

Abstract

Aims
No nutritional data are collected by the National Emergency Laparotomy Audit (NELA), despite the association of malnutrition with worse outcomes. This study aimed to describe the current practices, pathways and barriers encountered in identifying malnutrition in NELA-eligible patients.

Methods
Following piloting and validity assessment, anaesthetic and surgical NELA Leads at hospitals across England and Wales that submitted data to NELA’s 7th report were emailed a survey link. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional subtype was performed in SPSSv26. University of Sheffield ethical approval was obtained.

Results
There were 166/289 NELA Leads and 117/167 hospitals that completed the survey (57.4% and 70.1% response rates, respectively). Respondents reported low rates of nutritional screening (25.3%) and assessment (15.7%) for malnutrition pre-operatively with no awareness of local screening tools (41.0%) despite 68% of units having a Nutrition Support Team. Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%). Post-operative pathways were common (71.7%). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support and responsibility. NELA Leads indicated nutrition risk is inadequately identified, and is an important missing data item from NELA (71.2%). Responses were not correlated with hospital laparotomy volume or professional subtype.

Conclusions
Identifying malnutrition risk in NELA patients requires attention. Barriers are wide reaching and include a lack of time, knowledge and ownership. Nutrition pathways that encompass the pre-operative phase and incorporation of malnutrition data in NELA may support improvements.