bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP7.14 The ‘Right’ Strategy? Can we change the risk profile of emergency presentations of right sided colorectal cancers?
Authors: Banks Jessica , Lee Mathew , Wilson Tim 
Published: August 2023

Abstract

Background
Up to 30% of patients with colorectal cancer present acutely and have worse outcomes than elective patients. We sought to compare cancer care quality and clinical outcomes between emergency and elective presentations of right-sided colon cancer.

Methods
This single-centre, retrospective study included all patients who underwent operative management (emergency and elective) for a right-sided colon cancer, from 1st April 2017 to 31st March 2022. Data were collected from electronic patient records and analysed to compare host and tumour factors as well as outcomes between emergency and elective cohorts.

Results
Overall 303 patients (median age 72) were included. 65 patients (22%) presented as an emergency: 36 presented in obstruction and 11 with tumour perforation, compared to 1 patient with tumour perforation in the elective group (p=&lt;0.0001). Emergency presentation was associated with more advanced tumour stage (p=0.001).
The emergency group had lower rates of laparoscopic surgery (32% vs 86% p=&lt;0.0001); higher rates of post-operative complications (47% vs 27% p=0.05); increased 90-day mortality (20% vs 3% p=0.001); and a longer hospital stay (9 vs 4 days p=0.048). 50% of emergency patients received adjuvant chemotherapy compared to 56% of elective patients (p=0.71). No differences were found between the two groups regarding demographics, comorbidities, or time to MDT discussion.

Discussion
Outcomes of acute right-hemicolectomy are poor, with inadequate access to subsequent chemotherapy. Strategies addressing acute presentations of left-sided tumours have moved towards temporisation and elective surgery; this strategy is rarely adopted for acute presentations of right-sided tumours. Delaying major resectional surgery for optimisation may improve short-term outcomes, and access to adjuvant therapies.
WTP8.3 Failing to record consent discussions on clinical records leaves us vulnerable
Authors: Mantova Maria , Mahalingam Praveena , Gambhir Raghvinder Pal Singh 
Published: August 2023

Abstract

Aims
Documenting informed consent discussions in patient clinical records is a mandatory requirement by the General Medical Council (GMC). This study aimed to evaluate the adherence to that mandate.

Methods
We looked at GMC and Royal College of Surgeon’s guidance on consent and its documentation in patients’ records. The recommendations are:
We retrospectively looked at the Electronic Patient Record (EPR) of patients admitted for surgery under the Vascular department at a tertiary centre over 3 months.
We excluded patients who passed away prior to surgery or needed Consent form 4.

Results
136 out of 150 patients admitted for surgery during the study period met the inclusion criteria. Of these, 90 were admitted electively and 46 as emergencies.
We found evidence of consent discussion for only 60% (n-54) of the elective admissions and for 59% (n-27) of emergency admissions, through clinic letters or ward entries. For the remaining, there was no recorded EPR documentation of the consenting discussion though all had a consent form signed.

Conclusions
Although GMC and Royal College of surgeons have clear guidance regarding documentation of consent in patients’ notes, this is often not followed in clinical practice. This leaves the trusts open to future litigation.
WTP8.9 3D volume assessment as an objective tool in breast asymmetry management
Authors: Makram Mahmoud , Noaman Ayman , AboZeid Mohammed , Noureldin Khaled 
Published: August 2023

Abstract

Background
The normal symmetrical appearance of the breast is a vital. It can be psychologically distressing to patients and affects their body perception when these differences are obvious. The goal of breast surgeons is minimising these differences to make them more acceptable to patients.

Methods
This study was done on 20 females seeking breast asymmetry correction. Age ranged from 18 to 45 years (mean age: 30.4). All patients had volumetric breast assessment using a (3D) imaging system (3D LifeViz®, Quantificare system). The first 10 patients were chosen randomly for breast (MRI) volumetry to confirm the results of the 3D system. The patients were managed with different single-stage surgical procedures depending upon the objective assessment of the volume difference between their breasts.

Results
Breast volume assessment using the 3D camera was done in all 20 patients pre-operatively 30 and postoperatively. The preoperative mean volume difference was 159.45 cm3, and the postoperative mean difference was 16.75 cm3, with an overall reduction in mean volume difference of 89.5%. Breast MRI volumetry was done for 10 randomly chosen patients to confirm the results and ranged between 3 and 12 cm3 (average 7.1 cm3) on the right and 0 and 15 cm3 (average 6.3 cm3) on the left. Comparing the 3D camera and MRI in assessing breast volume difference showed that the difference ranged between 1 and 5 cm3 with an average of 2.4 cm3, which was not statistically significant.

Conclusion
The 3D technology is useful objective tool to augment the surgeons’ experience. It helped to achieve an 84.57% reduction in volume difference in managing asymmetry with single-stage procedure.
WTP8.11 Late Implant Loss Following Implant-based Immediate Reconstruction of the Breast
Authors: Anena Brenda , Ravichandran Duraisamy 
Published: August 2023

Abstract

Aims
Implant-based reconstruction is the most popular reconstruction in patients undergoing mastectomy for carcinoma or risk reduction. Postoperative complications such as infection are well known to result in implant loss, but the incidence and causes of late implant loss are not well studied.

Methods
We reviewed patients who underwent an implant-based reconstruction over a 5 year period (2018-2022) and identified those who had an unplanned implant removal 3 months after reconstruction. We looked at the comorbidities, method of reconstruction, exposure to radiotherapy and reasons for removal.

Results
Amongst 196 reconstructions there were 17 (8.7%) unplanned late removals, average time to removal 11.4 months. The reasons are infection or wound healing issues (8), rupture (3), cancer recurrence (3), deflation during port removal (2) and migration (1). Radiotherapy exposure was 41% vs. 18% in non-removal group.

Conclusions
A significant number of implants continued to be lost after the immediate postoperative period. Patients should be aware of that possibility. Radiotherapy appears to increase this risk.
ThTP1.5 Evaluating the Impact of Electronic Documentation on the Consent Process for Whipples Procedures within a HPB Department
Authors: Fadipe Toks , Iqbal Affan , Jamdar Saurabh , Patel Agastya 
Published: August 2023

Abstract

Background
The Whipples is an operation associated with major morbidity. Common risks include infection, wound problems and delayed gastric emptying. Less common but significant complications include fistula, anastomotic leak and cardiorespiratory dysfunction. This often requires intensive care or further procedures. Overall, mortality is 3%. This wide array of possible post-operative outcomes must be documented accurately on a consent form. However, what is stated often varies significantly depending on the consenting clinician. We assess the effect of a transition to an entirely electronic patient record (EPR) system on the consent process and the subsequent impact of standardised electronic consent forms.

Methods
Comparison of documented risks and additional procedures against ideal consent adapted from a patient information leaflet for Whipples. Cases performed by a tertiary centre hepatobiliary surgery department. Paper consent forms from July to September 2022 compared to electronically signed consent forms obtained from the EPR system from September to November 2022. Intervention in December 2022 (automated consent form). Re-audit from December 2022 to January 2023. Descriptive statistical analysis.

Results
25 consent forms assessed. Majority of forms completed by middle grades (92%). Eighteen documented risks and four additional procedures in ideal consent. Complications such as bleeding, infection and cardiorespiratory complications consistently feature in consent forms. Transition to electronic system meant most additional procedures documented less frequently, as are other complications such as visceral injury. Broad improvements in consenting documentation following intervention.

Conclusions
Introduction of pre-filled consent forms produced swift and significant improvements in consistency of consent forms. Further assessment of other index procedures of hepatobiliary, general and vascular surgery to follow.
ThTP1.10 Whipple's for ampullary adenocarcinoma: can we predict who will develop local only recurrence and tailor treatment to individuals?
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Following pancreatoduodenectomy (PD) for ampullary adenocarcinoma (AA), cancer recurrence rates are high. There are currently no models available which can estimate which patients are likely to develop local only recurrence. Using a multicentre cohort, this study aimed to compare patients who developed local only recurrence to those who developed distant (+/- local) recurrence.

Methods
A retrospective review of patients who underwent PD for AA was carried out (2012-2015). The group that developed local only recurrence was compared to the group that developed distant (+/- local) recurrence (within five years of PD). The following were compared: demographics, preoperative comorbidities/functional status, preoperative imaging and blood tests, postoperative complications and histological details, and adjuvant treatment. Means were compared using Student’s t-test, medians were compared using the Mann Whitney U test and percentages were compared using Fisher’s exact test.

Results
Of the 394 included patients, 45% developed recurrent AA. Of these, local only recurrence, distant only recurrence, and local and distant recurrence affected 34 (20%), 94 (55%) and 41 (23%) patients, respectively (unknown site of recurrence: 7). When the group that developed local only recurrence (n=34) was compared to the group that developed distant (+/- local) recurrence (n=135), no statistically significant differences were observed.

Conclusions
In our multicentre study of patients who underwent PD for AA, 9% developed local only recurrence and 34% developed distant (+/-local) recurrence. No significant differences were observed between the two groups. This highlights the difficulties clinicians face when attempting to tailor treatment to individuals.
ThTP1.11 Closed Loop Audit on The Timing of Hot Gallbladder Surgery
Authors: Shabana Amanda , Patel Mahul , Samra Benjamin , Pustula Mary , Zhuang Qi 
Published: August 2023

Abstract

Introduction
Almost 70,000 cholecystectomies are performed each year in the United Kingdom (UK). The Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) 2016 and The National Institute for Health and Care Excellence (NICE) 2021 Guidelines on “Gallstone disease” recommend performing a Laparoscopic Cholecystectomy (LC) within 7 days of admission for hot gallbladder. We aimed to establish if guidelines were being met at a tertiary hepatobiliary unit in Oxford.

Method
Two cycles of the audit were completed using a retrospective cohort design. The first cycle of the audit was completed between January 2019 – August 2020 (n=466) to include patients that had a LC for a hot gallbladder. An intervention included an educational teaching session within the department and posters distributed of the guidelines. The second cycle of the audit was completed during November 2022 (n=50).

Results
In the second cycle, more patients had a LC within 3 days of admission (36% vs 24.7%), with the average waiting time from admission to a LC being 6.4 days. However, less patients had their LC within 7 days of admission in the second cycle (68% vs 75.3). The most common cause for delayed LC was waiting times for ERCP/MRCP and theatre availability.

Conclusion
An improvement was found in the number of LC's performed within 3 days of admission in the second audit cycle. We are, however, still not meeting the AUGIS and NICE guidelines on performing a LC within 7 days of admission. Future work will look at Intra-operative laser breakdown of gallstones to reduce waiting times.
ThTP2.12 The impact of acute systemic inflammation and the metabolic response to surgery on computed tomography body composition analyses
Authors: Brown Leo R , Ramage Michael I. , Bruce Nikki , Dick Lachlan , Sami Sharukh , Skipworth Richard J.E. 
Published: August 2023

Abstract

Aim
Body composition has been used extensively for prognostication across malignant and benign diseases. Systemic inflammation is both a key driver of cancer cachexia and a common finding in patients presenting with acute pathology. However, its influence on body composition is poorly understood. This study aimed to longitudinally assess computed tomography (CT) body composition, in patients who experienced an anastomotic leak post-oesophagectomy, as a model of acute, severe systemic inflammation.

Methods
Consecutive patients who suffered an anastomotic leak, following oesophagectomy, between 01/01/2012 and 01/01/2022 were identified from a prospectively maintained database. Changes in body composition were assessed across staging, pre-operative, post-complication and follow-up scans at the L3 vertebral level.

Results
Twenty patients (median 65 years, 90% male) were included. Of these, fifteen underwent neoadjuvant chemo(radio)therapy. Body composition was not altered by neoadjuvant treatment. Following surgery and anastomotic leak, a decrease in skeletal muscle volume (mean difference: -68.06cm3, p=0.028) was noted. Estimates of intramuscular and subcutaneous adipose tissue conversely increased (p=0.038 and p=0.039 respectively). Skeletal muscle density fell while adipose densities were higher following anastomotic leak. Although tissue radiodensity and subcutaneous fat volumes normalised on follow-up CT scans, skeletal muscle volume remained below pre-treatment levels.

Conclusion
Acute systemic inflammation has a marked effect on body composition analyses. Decreased muscle volume and increased volumes of adipose tissue were evident following the inflammatory insult. Radiodensity across muscle and adipose tissues trended towards that of water, likely secondary to oedema. Research utilising body composition variables should be interpreted with consideration of the potential of influence of underlying inflammatory status.
ThTP2.14 Robot-assisted repair of paraoesophageal hernia: a systematic review
Authors: Brooker-Thompson Chad , William Butterworth James , Doran Sophie , Qureshi Yassar , Dawas Khaled , Mohammadi Borzoueh 
Published: August 2023

Abstract

Aim
Laparoscopic repair is quoted as the standard of care for paraoesophageal herniae but limitations include the 2D image, requirement of a trained camera assistant and surgeon fatigue. Robotic-assisted (RA) repair promises improved 3D visualization and ergonomics. However, there is limited data on short and long-term outcomes from RA repair. We aimed to systematically review literature on RA repair of paraoesophageal herniae and post-operative outcomes.

Methods
A systematic on-line literature search of Embase and Medline identified 200 articles of which 13 relevant studies were selected, including 7 retrospective and 6 prospective studies. Selected articles were assessed by two reviewers to extract relevant demographic and outcome data.

Results
1601 patients received RA repair of paraoesophageal herniae with a median age of 62 years and 72% were female. The majority had Hill type 3 paraoesophageal herniae (80.5%). Predominately elective operations (86.4%) they had a mean operative time of 169.7 minutes, used mesh in 44.0% and included a fundoplication in 78.2%. Only one required open conversion. Median length of stay was 2.45 days (1.3-4.5 days). 15.4% had reported complications (dysphagia (9.7%), pneumothorax (0.4%), pneumonia (0.3%) post-operative haemorrhage (0.3%) and thrombosis (0.4%)). There were no post-operative mortalities. Few symptomatic recurrences were reported and there was a 1.8% re-operation rate within this cohort.

Conclusion
RA paraoesophageal hernia repair offers similar outcomes to those published in recent literature for laparoscopic repair, with potential for improved surgeon ergonomics and visualisation. Carefully designed, prospective trials comparing laparoscopic and robotic repair are required to further delineate the optimal surgical approach.
ThTP3.5 Electronic consent improves patient safety
Authors: Fraser-Govil Shubhangi , Cowley Sarah , Elmowafy Ahmed , Pardoe Helen 
Published: August 2023

Abstract

Background
Consent is a core pillar of patient care, especially for surgical procedures under anaesthesia. Some patients lack capacity to consent, and in these cases documentation of capacity assessment and a best interests decision is essential. Error rates on hand-written consent forms can be high and this can be reduced by using electronic consent forms. In a UK DGH, electronic consent was implemented in October 2022, and we look at the impact this has had on the process of consent in patients who lack capacity.

Methods
We examined the process required for documentation of consent in patients who lack capacity to be sent to the safeguarding team and how many they had received in the 3 years prior to electronic consent implementation. We then compared the process for the safeguarding team to be sent electronic documentation and how many they had received from October-January.

Results
For paper documentation to be received by the safeguarding team, a clinician would have to scan the MCA and email it to the safeguarding team. In the 3 years prior to October 2022, they had received 1 form. Currently, the safeguarding team request a weekly report from the electronic consent supplier and receive electronic copies directly. They have received 45 to date.

Conclusions
The implementation of electronic consent has resulted in the safeguarding team having greater insight into the number of patients who are having procedures that lack capacity. This enables them to follow up the patients and ensures better, more holistic, patient care.
ThTP3.8 Promoting Awareness and optimizing perioperative management for Jehovah's Witnesses (JW) patients: A Quality Improvement Project (QIP)
Authors: Jatania Jignesh , Locurcio Lino , Kavourides Michalis , Nishith Shikha , Singh Daya 
Published: August 2023

Abstract

Aims
The restriction in using blood products poses a unique challenge to healthcare providers during treatment of JW patients. Current trust guidelines cover the peri-operative aspects of the management. We carried out a QIP to review the awareness amongst clinicians of appropriate guidelines and protocols in managing this cohort of patients.

Methods
An online survey was sent out to clinicians of all grades within the Trust, asking specific questions related to the use of blood products and alternative options; awareness of protocols including who to contact for advice.

Results
Our results of 102 responses revealed, 76% clinicians were not familiar with the trust guidelines.
There was a wide variation in the knowledge about blood products which could be used and 42% were not aware of acceptable alternative options.
68% were not sure whom to contact for advice in and out of hours.
20% knew how to update an alert on the online medical records to identify patents’ wish of refusal for use of blood products.
94% were unaware of any preoperative and consent checklist for blood products.
50% were aware of checking Advance Directive for Refusal of Treatment (ADRT).

Conclusion
This QIP highlighted the lacunae in the awareness of trust protocols amongst clinicians of all grades. We aim to provide support and alerts on our Trust Intranet for managing this cohort of patients. Our ultimate goal is to produce a uniform national protocol available to all hospitals in the UK.
ThTP4.1 Evaluation of Post-operative Outcomes in Laparoscopic & Open Anterior Resections (AR) for Rectal Cancer: A 15 year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A 
Published: August 2023

Abstract

Aims
AR offers sphincter preserving surgery for rectal cancers, & has functionally comparable results to APER's or Hartmann’s resection. Use of mechanical stapling devices has allowed laparoscopic AR to become widely available. Aim of study is to evaluate post-operative outcomes in laparoscopic AR’s.

Methods
A cohort study collated post-operative outcomes in laparoscopic AR’s performed at a single-centre from January 2008 to February 2023. Open AR’s were recruited as controls.

Results

Conclusion
Laparoscopic AR accounted for prolonged operative times & shorter hospital stay. There were no differences in early post operative mortality & complications. Laparoscopic AR had better long term survival, This could be explained by better case selection for laparoscopic AR (since laparoscopic resection were adopted as routine practise, as opposed to open AR became less employed in recent years).
ThTP4.10 Evaluating the Outcomes of Anal Squamous Cell Carcinoma with Curative Intent- a 10-Year Experience
Authors: Noureldin Khaled , Ayantunda Abraham , Issa Mohamed , Shalaby Ahmed 
Published: August 2023

Abstract

Background
Our 10-year experience in treating anal squamous cell carcinoma (ASCC) with curative intent.

Patients and Method
Clinical and pathological data were analysed between January 2011 and December 2019. All patients underwent the standard workup and treated accordingly. Patients were followed up according to the network protocol. The outcome measures were clinicopathological characteristics, treatment modalities, response, recurrence, disease-free and overall survival.

Results
117 patients followed up over the 10-year. 26 patients treated palliatively, 11 patients with adenocarcinoma, 1 melanoma, 1 Paget disease and 1 carcinoid tumour were excluded. Median age was 65 (38-90) years with male to female ratio of 1:1.9. 3 patients were HIV+ve and 52% of the patients had AIN of varying degree of dysplasia. AJCC stages were I (16), II (18), IIIA (19), IIIB (9) and IV (15). 88.3%% of the patients had radical chemoradiotherapy while 9 patients with tumour ≤2cm underwent wide local excision. 81.8% of the patients treated with radical chemoradiotherapy had complete response while (5/77) had partial response.4 patients with incomplete response underwent salvage APER. Recurrence rate was 13%.
The overall mean survival time was 99.82 (95% CI 88.87-110.77) months with 5-year survival rate 78.0%. Overall recurrence rate was 13.0%. Mean disease-free survival time in 77 patients was 111.82 (95% CI 102.38-121;26) months. 75.3% of the patients were alive at the end of the study with an overall mortality rate was 24.7% and disease-specific mortality was 15.6%.

Conclusion
Recurrent anal SCC occurred in 1 in 10 after radical chemo-radiotherapy with disease-specific mortality of 26%.