bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUS 3 The Intercollegiate Green Theatre Checklist
Authors: Pegna Victoria , Robb Henry , Hurst Katie , Chu James , Testa Francesca , Beatty Jasmine Winter 
Published: August 2023

Abstract

Aims
The climate crisis is scientifically irrefutable and poses a major threat to human life (1,2). Healthcare services face the paradox of managing the disease burden caused by the planetary crisis, whilst simultaneously contributing to the problem (3, 4). As surgeons, we have a duty to protect our patients and as such to decrease our environmental impact: this checklist aims to provide guidance towards more sustainable surgical practises.

Methods
A team of surgical doctors used evidence-based research, grey literature and expert advice, to identify interventions that:
The interventions centre on the 5 “Rs” of sustainability and where possible abide by the triple bottom line of sustainable quality improvement. Importantly, they are designed to specifically target recognised carbon hotspots in order to achieve a maximum reduction in the carbon footprint of surgical departments.

Results
The interventions identified were collated into a checklist with 16 recommendations to be adapted for use by surgical teams on the frontline and accompanied by a compendium of relevant evidence. The Green Theatre checklist was approved by the 3 surgical colleges in the United Kingdom and distributed among their surgical membership. It has gained wide support amongst perioperative professional bodies as well as from the Greener NHS.

Conclusion
The climate crisis necessitates immediate action. The dissemination of the Green Theatre checklist across the UK will guide surgical teams on the frontline to achieve more sustainable practices, helping the NHS reach its NetZero target.
SP1.2 Accuracy of NELA score in predicting the risk of mortality following emergency laparotomy in patients aged above and below 80: A cohort study
Authors: Saji Alwin Puthiyakunnel , Hughes Ioan , Mitra Kalyan , Hajibandeh Shahin , Hajibandeh Shahab 
Published: August 2023

Abstract

Aims
To compare accuracy of National Emergency Laparotomy Audit (NELA) score in predicting the risk of mortality following emergency laparotomy in patients aged above and below 80.

Methods
In compliance with STROCSS statement standards, a retrospective cohort study was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in two centres were included. The Receiver Operating Characteristic (ROC) curve analysis and Hosmer & Lemeshow test were conducted to evaluate the discrimination and calibration of NELA score in predicting the risk of 30-day mortality in patients aged above and below 80 years.

Results
A total of 1458 eligible patients were included; 289 patients were aged above 80 with median age of 84 (IQR 81-87) and 1168 patients were aged below 80 with median age of 60 (IQR 46-71). The risk of 30-day mortality was 13.5 % in the above 80 group and 8% in the below 80 group. ROC curve analysis showed that the AUC of NELA score was 0.78 (95% CI 0.73-0.83) in the above 80 group and 0.89 (95% CI 0.87-0.91) in the below 80 group. The score was not well-calibrated for either group.

Conclusions
The NELA score is less accurate in predicting the risk of mortality following emergency laparotomy in patients aged above 80 compared to younger patients. This may be explained by the fact that it does not take into account the measures of age-related decline in physical status of the patients.
SP1.6 The Impact of Subspecialty Surgeon on Outcomes After Emergency Laparotomy for Inflammatory Bowel Disease
Authors: Bunce James , Doleman Bret , Lund Jonathan , Tierney Gillian 
Published: August 2023

Abstract
Emergency laparotomy (Em Lap) may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult Em Laps in England and Wales and includes clinical urgency of the cases. The impact of surgeon subspecialty on outcomes after Em lap for IBD is unclear. We have investigated this association, according to the degree of urgency in IBD Em Laps, including the effect of minimally invasive surgery (MIS).
Adults with IBD in the NELA database between 2013 - 2016 were included. Surgeon subspecialty was defined as colorectal or non-colorectal. Urgencies were ‘Immediate’, ‘2-6 hours’, ‘6-18 hours’ and ’18-24 hours’. Multivariate regression was used to investigate mortality and post-operative length of stay (LOS).
There was significantly reduced mortality and LOS in IBD patients who were operated on by a colorectal surgeon in the least urgent category of Em Laps; Mortality adjusted OR 2.99 (CI 1.2 – 7.8) P=0.025, LOS IRR 1.18 (CI 1.02-1.4) P=0.025. This association was not seen in more urgent categories. Colorectal surgeons were more likely to use MIS, P&lt;0.001 and MIS was associated with decreased LOS in the least urgent cohort, P&lt;0.001, but not in the other urgencies.
We found improved outcomes in the least urgent cohort of IBD Em Laps when operated on by a colorectal surgeon in comparison to a non-colorectal general surgeon. In the most urgent cases, there was no benefit in the operation being performed by a colorectal surgeon. Further work on characterising IBD emergencies by urgency would be of value.
SP1.9 Emergency laparotomy for abdominal catastrophes secondary to lymphoma: a systematic review
Authors: James Butterworth , Brooker-Thompson Chad , Qureshi Yassar , Mohammadi Borzoueh , Dawas Khaled 
Published: August 2023

Abstract

Aim
Intestinal lymphomas can rarely present as abdominal catastrophes with perforation or small bowel obstruction. There is little data regarding their optimal surgical management and associated outcomes. We aimed to systematically review relevant published literature to assess optimal surgical approach and post-operative outcomes.

Methods
A systematic on-line literature search of Embase and Medline identified 1485 articles of which 34 relevant studies were selected, including 7 retrospective studies, 1 case series and 26 case reports. Selected articles were assessed by two reviewers to extract relevant data.

Results
95 patients with abdominal catastrophes secondary to lymphoma (predominately Burkitt (28%) and Diffuse Large B-cell lymphoma (29%)) were identified with a median age of 52 years, 40% female. The most common presentation was perforation in 69% of patients compared to obstruction (28%) and ischaemia (2%). The most common site of perforation was the ileum (32%), followed by the jejunum (27%). Small bowel resection and primary anastomosis (76%) was the most common procedure performed followed by ileocolic resection (11%), primary repair (4%) and defunctioning stoma (3%). Of those receiving small bowel resection 25% (n=18) suffered post-operative complications with a 30-day mortality of 13.8% (n=10). This compared favourably to those receiving ileocolonic resections (27% complications 18% mortality) or primary repair (25% complications and 25% mortality). Median follow-up was 8 days (range 1-96).

Conclusion
Abdominal catastrophes secondary to intestinal lymphomas are most commonly present with perforation. If suitable intra-operatively, small bowel resection offers the most favourable short-term outcomes with the lowest levels of morbidity and 30-day mortality.
SP1.11 Hospitals offering emergency laparoscopic surgery have improved outcomes
Authors: Eid Joana , Finch Louise , Mercer Stuart 
Published: August 2023

Abstract

Aims
Only 20% of patients requiring emergency surgery in the UK are offered laparoscopic surgery; there is wide variability in uptake of laparoscopic emergency surgery between hospitals, ranging from 0% to over 80% of cases. This study investigated whether hospitals with an advanced laparoscopic culture had improved outcomes.

Methods
The national NELA database was interrogated to identify patients requiring surgery for adhesional small bowel obstruction; this was selected because it is common (around 25% of cases in NELA) and often amenable to laparoscopic surgery. Hospitals were grouped into quintiles, according to the number of cases attempted by the laparoscopic approach; each group was assessed for length of stay and mortality.

Results
In 176 acute hospitals, 20597 operations were performed for adhesional SBO. Overall mortality was 6.2%. In the quintile with the lowest rate of laparoscopy, 4% of cases were started laparoscopically, compared with 44% in the highest quintile. In the lowest quintile, 4.8% of patients were discharged within 3 days, compared to 13.8% in the highest quintile; discharge at 7 days was 26% versus 37%. Overall, 30-day mortality in the group with the lowest rate of laparoscopy was 6.9%, compared with 5.4% in hospitals with the highest rate of laparoscopy (p&lt;0.001).

Conclusions
Hospitals where patients with adhesional SBO are offered laparoscopic emergency surgery demonstrate shorter lengths of stay and a significantly reduced mortality. This may be due to the benefits of the laparoscopic approach; it could also be a surrogate marker for an advanced culture of emergency surgery.
SP2.1 The Impact of Cholecystectomy on The Symptom Relief and Quality of Life of Patients with Gallbladder Dysmotility
Authors: Alamin Nadeen , Fernandes Roland , Iqbal Sara , Baumert Alizee 
Published: August 2023

Abstract

Aims
The aim of this study was to demonstrate the impact of laparoscopic cholecystectomy on the physical and mental health of patients with gallbladder dysmotility.

Methods
Retrospective data was collected from patients who had undergone a Hepatobiliary Iminoacetic Acid (HIDA) scan between June 2012 and June 2022 in a District General Hospital in South East England. Patients diagnosed with gallbladder dysmotility were then contacted and asked to participate in a telephone interview regarding their symptoms. Their health-related quality of life was measured using the HRQoL SF-12 v2 questionnaire. Differences in the resolution of symptoms between those that had undergone a cholecystectomy and those who did not, were assessed using a chi square test. The two groups were then compared using the student t-test to assess statistically significant differences.

Results
94% (n=31/33) of participants in the non-cholecystectomy group demonstrated persistent biliary pain symptoms as opposed to the 6% (n=2/33) in the cholecystectomy group. A statistically significant improvement in five out of the eight domains of the HRQoL SF-12 questionnaire was demonstrated. These domains include PCS (physical component summary), MCS (mental component summary), mental health, general health and bodily pain.

Conclusion
The results of our retrospective analysis demonstrate an improvement in both the physical and health-related quality of life symptoms in patients who underwent laparoscopic cholecystectomy. These findings support the use of laparoscopic cholecystectomy as an effective method for managing gallbladder dysmotility.
SP2.2 Time to Pancreaticoduodenectomy in a Regional Hepatobiliary Unit in the COVID recovery era
Authors: Davidson Sophie , Metwally Abdelrahman , McClements Jane 
Published: August 2023

Abstract

Aims
To assess factors influencing time from multidisciplinary (MDT) discussion to surgery for patients undergoing Whipple’s resection for malignant disease in a regional HPB unit.

Methods
Patients who underwent Whipple’s resection for cholangiocarcinoma, ampullary, duodenal and pancreatic ductal adenocarcinoma between 01/02/2021–29/11/2022 were identified from a prospectively maintained operative database. The NI Electronic Care Record was used to collect data.

Results
74 patients met the inclusion criteria. 83.8% (62/74) presented as an inpatient, compared to 74% in 2020. Patients presenting as an inpatient had a significantly shorter time to surgery than those presenting as outpatients (84.7vs152.8 days, p=0.03).
The average time from MDT to surgery without neoadjuvant therapy was 57 days. 20.3% (15/74) had neoadjuvant treatment with an average time to surgery of 248 days. This has increased since 2020 from 38 and 212 days respectively, however this was not statistically significant (p=0.051).
54.1% (40/74) had staging PET-CT compared to 26% of patients in 2020. Time to surgery with a PET-CT was not significantly different to those who had no PET-CT (107vs81.9 days, p=0.18).
13 patients (17.6%) had both ERCP and EUS. 52 patients (70.2%) had either EUS or ERCP. There is a significant difference in time to surgery for patients undergoing both EUS and ERCP compared to those undergoing one endoscopic procedure (224vs65.9 days, p=0.001).

Conclusions
Use of staging PET-CT and overall time to surgery has increased since 2020 however, this was not statistically significant. Presenting as an outpatient and undergoing both ERCP and EUS were two factors identified that lead to significant delays to surgery.
SP2.5 Modified Appleby Procedure in the Treatment of Pancreatic Neoplasms
Authors: Torres Susana , Oliveira Pedro 
Published: August 2023

Abstract

Aims
This work aims to review the state of the art regarding the patients who may benefit from resection using the modified Appleby procedure, the pre- and post-operative procedures to increase survival, and the postoperative outcomes.

Methods
Research was conducted within the PubMed and Embase databases from July 2022 to January 2023, including single or multicenter articles relative to the modified Appleby procedure but comprising a multimodal approach to pancreatic neoplasms and not only the surgical technique, and papers concerning patients over the age of 18 years.

Results
Out of the 373 articles identified and after extracting duplicates, 267 records were accessed for a title and abstract screening. Afterward, by applying the inclusion and exclusion criteria to the remaining articles and conducting a further extensive reading of the remaining articles, 53 papers were included in this review. Secondary terms relevant to this topic were also used, allowing detection of additional research, thus totalizing the 57 publications included.

Conclusion
When applied to borderline resectable and locally advanced pancreatic cancer, the efficacy of the modified Appleby procedure alone is limited, but the combination with neoadjuvant chemotherapy offers the greatest chance of achieving an R0 resection. Many surgical technical options are available, with or without preoperative artery embolization, but the best results published to date were observed when employing robotic surgery with a retroperitoneal-first approach. However, the indication for performing this surgery and all its perioperative components are still a matter of debate.
SP2.10 Meta-analysis of adjuvant chemotherapy versus no adjuvant chemotherapy for resected stage I pancreatic cancer
Authors: Evans Daisy , Ghassemi Nader , Hajibandeh Shahin , Hajibandeh Shahab , Laing Richard W , Athwal Tejinderjit 
Published: August 2023

Abstract

Aims
To evaluate comparative outcomes of pancreatic cancer resection with or without adjuvant chemotherapy in patients with stage I pancreatic cancer.

Methods
A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of pancreatic cancer resection for stage I cancer with or without adjuvant chemotherapy were included and their risk of bias were assessed using ROBINS-I tool. Survival outcomes were analysed using hazard ratio (HR) and odds ratio (OR) for the time-to-event and dichotomous outcomes, respectively.

Results
We included 5 comparative studies reporting a total of 4,037 patients with resected stage 1 pancreatic cancer of whom 2,374 patients had no adjuvant chemotherapy and the remaining 1663 patients received adjuvant chemotherapy. The use of adjuvant chemotherapy was associated with significantly higher overall survival rate (HR 0.73, 95% CI 0.63-0.84, p&lt;0.00001) compared to no use of adjuvant chemotherapy. However, there was no statistically significant difference in 1-year (81.9% versus 87.4%, OR 0.51, 95% CI 0.14-1.81, p=0.30), 2-year (60.9% versus 67.5%, OR 0.88, 95% CI 0.75-1.03, p=0.10), 3-year (51.8% versus 54.3%, OR 0.99, 95% CI 0.79-1.24, p=0.93), or 5-year survival (27.4% versus 27.5%, OR 1.11, 95% CI 0.95-1.30, p=0.19) between two groups.

Conclusions
Meta-analysis of best available evidence (level 2a) demonstrates that adjuvant chemotherapy following resected stage I pancreatic cancer seems to improve overall survival compared to no use of adjuvant chemotherapy. Randomised controlled trials are required to escalate the level of evidence and confirm these findings.
SP3.4 Barriers to deceased donor kidney organ utilisation: Results of a National Transplant ACcess to Theatre (NTACT) Audit
Authors: Mujeeb Mariyam , Borbas Balint , Tanase Andrei , Aroori Somaiah 
Published: August 2023

Abstract

Aims
Various barriers to deceased-donor kidney utilisation exist, however, there is a lack of data on these; therefore, this national audit aims to identify the barriers to prompt kidney utilisation after the arrival of organs at the implanting centre (IC).

Methods
We conducted a multicentre, prospective audit of adult deceased-donor kidney-only transplants across 14 UK centres between February and September 2022. Data was collected on time-intervals between significant checkpoints before transplantation and perceived reasons for delays. Data was recorded on RedCap and analysed using descriptive statistics.

Results
476 kidney-only transplants were recorded (59 excluded-incomplete/incorrect data). There were 215 donations after brainstem death (DBD) organs and 202 donation after circulatory death (DCD) organs. The median cold ischaemia time (CIT) for DBD organs was 10:51 (IQR: 08:07-14:44), and for DCD organs was 11:09 (IQR: 08:13-14:50). The national CIT recommendations were exceeded by 40% of DCD and 14% of DBD organs. The median time-interval between the organ’s arrival at IC and knife-to-skin was 04:16 (IQR 02:46-07:52). The median time-interval between anaesthetic induction and knife-to-skin was 00:55 (IQR: 00:39-01:10). In 17% of cases, crossmatch results arrived after organ arrival at IC, median delay was 02:30 (IQR: 00:56-04:27). Delays were reported in 34% of cases, availability of the surgical team, anaesthetic team, porters, and the operating theatre were the most common causes of delay.

Conclusions
A significant proportion of kidneys were implanted beyond nationally recommended CIT. This audit delineated the current timings of each stage of the transplantation process and will be used in future to set realistic targets to optimise current practice.
SP3.11 Laparoscopic Donor Nephrectomy (LDN) Training in the UK. A National Re-Audit of the Trainee Experience
Authors: Sharma Hemant , Wong Chang , El-Bakry Adham , Sharma Ajay , Ridgway Dan , Mehra Sanjay 
Published: August 2023

Abstract

Purpose
An Independent National-Trainee-Survey reported poor LDN training opportunities in the UK in 2014. It recommended LDN fellowships and LDN training as a part of the Transplant Curriculum. A Re-audit of the initial study was done to gauge improvement.

Methods
A short electronic survey was disseminated to surgical trainees via a web-based link (Survey-monkey) placed on the Herrick-Society forum and email/paper invitations to renal transplant units across the UK.

Results
57 (53 in 2013) responses were received from the UK in 2022. Women in transplant training are still scarce OR 0.91 (0.40-2.06, p=0.49). 03% of units in the UK offer robotic-assisted LDN at present. In comparison to 2013, in 2022, 16%vs 20% of trainees were PGY1-3; 25% vs. 14% PGY 4-6; 17% vs. 18% post-residency training; 32 % vs. 31% IMG-non-training&gt; 2 yr. transplant experience; 10%vs 09% IMG-non training &lt; 2 yr. transplant experience (p=0.67).
92% vs. 91% of trainees reported that they had performed &lt;01 LDN as primary-surgeon OR 0.87 (0.32-2.37, p=0.50). Only 33 % of trainees had been on a course for LDN. There was no correlation to seniority in training grade performing donor nephrectomies as a primary surgeon (p=0.76). There was no significant advantage to trainees on rotation (p=0.71) to service trainees (p=0.69) to perform LDN as primary surgeons. The likelihood of a trainee performing &gt;01 LDN as a primary surgeon is &lt;1 in 30 compared to &lt; 1 in 25 (2013).

Conclusions
This study reports no improvement in training opportunities in LDN. The Trainers have yet to utilize the previous 2014 report to augment training opportunities in the UK.
SP5.1 Paracrine Interferon signalling between cancer associated Fibroblasts and Cancer Cells correlates with poor survival after chemotherapy in Triple Negative Breast Cancer patients
Authors: Jones Stacey 
Published: August 2023

Abstract

Aim
To determine if expression levels of Interferon-β1 (IFNβ1) in cancer associated fibroblasts, and of Myxovirus Resistance 1 (MX1) – a downstream marker of interferon activity, in cancer cells would be predictive markers of chemotherapy response and subsequent overall survival.

Methods
Breast cancer tissue was obtained from tissue microarrays of a triple negative cohort. Expression of IFNβ1 and MX1 was determined by immunohistochemistry in 109 patients treated with adjuvant chemotherapy. The cohort was further subdivided into claudin low and high subgroups, based on immunohistochemical assessment of relative expression of claudin-3.

Results
IFNβ1 in fibroblasts was significantly, positively associated with MX1 expression in tumour cells (Spearman’s correlation r=0.210; p=0.028). High expression of IFNβ1 in fibroblasts, and of MX1 in tumour cells were each significantly associated with poorer disease-free survival (p=0.01). Dividing the cohort into claudin-low (claudin-3 negative; n=49) and claudin-high (claudin-3 positive; n=60), resulted in a stronger correlation between fibroblast IFNβ1 and tumour cell MX1 in the claudin-low group (r=0.375; p=0.008), whereas it was lost in the claudin-high group (r=0.113; p=0.389). Likewise, correlations between survival and expression of IFNβ1 in fibroblasts and MX1 in tumour cells were maintained in claudin-low cases (p&lt;0.05) but lost in claudin-highs.

Conclusion
IFNβ1 and MX1 may be of value as predictive biomarkers of chemo-response in breast cancer patients. These correlations imitate associations with chemoresistance identified in vitro using cancer associated fibroblasts and claudin-low breast cancer cell lines. Therefore, inhibiting the paracrine cross talk-between the cell types might be a viable strategy for chemo-sensitisation of breast cancers.