bluuebunny/crossref_metadata_2025_split huggingface dataset:
931 Minimising Surgical Inpatient Bed Use and Maximising Patient Flow in Plastic Surgery: Proposal for Combined Acute Trauma Clinic with Attached Local Anaesthetic Theatre and Ambulatory Care with IV Therapy Service
Authors: Jawad A , Kadhum M 
Published: August 2023

Abstract

Background
The majority of hand trauma referrals to plastic surgery consist of minor injuries that ideally require initial washout and exploration under local anaesthetic, during which repair of most damaged structures can also be undertaken. Meanwhile, a significant proportion of acute admissions to plastic surgery are for infected wounds requiring washout, intravenous antibiotics, limb elevation, and daily wound review to ensure resolution. These occupy surgical beds of often-limited capacity, and confine otherwise generally mobile, independent patients.

Literature
Trauma clinics are well-established, often being utilised as see-and-treat services (Rea-et-al 2004), reducing the wait for a potentially unpredictable main trauma theatre, with proven cost benefit (Cullen-et-al 2021). This is further aided by patient counselling regarding waiting times for surgery (Khan & Iqbal 2021), and the model has been augmented to incorporate virtual reviews (Westley-et-al 2020). Infected wounds amenable to local anaesthetic or wide-awake-local-anaesthetic-no-tourniquet (Lalonde 2015) could similarly be managed in this environment, but may necessitate admission for intravenous antibiotics, nevertheless. However, soft-tissue infections are increasingly being managed in outpatient settings through using single/twice-daily dosed antibiotics with daily review (Ektare et al 2015).

Proposal
An ideal configuration would therefore consist of a trauma clinic space with assessment bays, local anaesthetic minor theatre, and IV infusion chair(s), staffed by a receptionist, an assessing doctor/nurse practitioner, an operating surgeon with scrub nurse/trained healthcare assistant, and an IV-trained nurse.

Conclusions
We believe that this cost-effective setup would ensure patients receive timely adequate care for acute limb trauma and infections while reducing inpatient presence and improving efficiency.
449 Carbon Fibre Versus Titanium Implant Construct in Separation Surgery with Post Adjuvant Stereotactic Ablative Radiotherapy for Spinal Oligometastatic Disease
Authors: Saha P , Uthayanan L , Cox K , Tsang E , Hwang Z , Ajayi B , Khan U , Singh Alg V , Minhas P , Lui D 
Published: August 2023

Abstract

Aim
Radical treatment for Spinal Oligometastatic Disease (OMD) was often traditionally treated with morbid Tomita En Bloc Spondylectomy. Now, Stereotactic Ablative Radiosurgery (SABR) provides curative tumour ablation without open surgery, reduced cord toxicity and better pain management. SABR delivered postoperatively to Separation Surgery (SS) has shown excellent mortality rates, infection control, maximum local-control, and better pain management. This study is the first to compare clinical safety of carbon-fibre implantation (CFI) comparing to titanium implantation (TI).

Method
Retrospective review of OMD/OPD cases that underwent separation surgery with postoperative SABR investigating tumour histology, OMD type, instrumentation used for SS (CFI versus TI), mortality, local recurrence (LR), pain management, infection, complications, hospital length of stay, ICU length of stay and palliative outcomes at a quaternary level-1 spinal unit.

Results
79 patients were in the OMD pathway, 36 patients underwent SS with/without SABR. 20 patients had SS with TI. 16 patients had SS with CFI. SS with TI±SABR: 30-day mortality-10%, 12-month mortality-15%. SS with TI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% TI: Infection-4% SS with CFI±SABR: 30-day mortality-6%, 3-year mortality-12.5%. SS with CFI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% CFI: Infection-0% Pain in both groups were associated with PD cases only.

Conclusions
SS with postoperative SABR regardless of construct material demonstrated excellent outcomes. CFI demonstrated to be superior to TI. When postoperative SABR was absent from treatment, patients had complications and was demoted to palliative decompression with neurological symptom management. This highlights the importance of SABR in conjunction to SS.
450 Anterior Separation Surgery to Allow for Stereotactic Ablative Radiotherapy: A Novel Approach Permiting Radical Oncological Treatment of Spinal Oligometastastc Disease
Authors: Saha P , Ajayi B , Minhas P , Lui D 
Published: August 2023

Abstract

Background
A paradigm shift in the treatment of spinal metastases has allowed surgeons to deliver curative results utilising radical oncological treatment. In oligometastatic disease (OMD), Stereotactic Ablative Radiotherapy (SABR) as a primary modality or adjuvant treatment to surgery has shown excellent survival outcomes, lower morbidities, and better pain management. The novel use of carbon fibre (CF) vertebral body replacement (VBR) allows optimal SABR planning, less reflection and better future surveillance imaging. CF reinforced PEEK has mechanical properties that allow high resistance to ionising radiation and low wear particles, which is better suited for planned SABR as opposed to titanium VBR and screws.

Case presentation
A 48-year-old female presented with a recurrent solitary metachronous oligometastatic breast T2 lesion. Her systemic suitability indicated for separation surgery (SS) with post-operative SABR to avoid morbid excision surgery. This case report illustrates novel treatment for spinal oligometastatic disease utilising anterior separation surgery with custom CF VBR with postoperative SABR. Due to several contraindications of posterior separation surgery, anterior surgery was opted for utilising the philosophy of Enneking radical surgery despite Enneking inappropriate resection.

Results
There were no intra-operative and post-operative complications. 30-months postoperative follow-up and imaging demonstrated that the patient was tumour-free, mobile, pain-free and living independently.

Conclusions
Utilising this novel approach, Anterior Spinal SS and SABR has shown maximum local control and can deliver curative, radical oncological control. The use of CF has properties allowing high resistance to ionizing radiation and low wear particles, which is better for planned SABR as opposed to titanium VBR and screws.
486 Virtual Reality and Surgical Oncology: Where Are We?
Authors: Ng C P Y 
Published: August 2023

Abstract

Aim
Less than 5% of patients from low- and middle-income countries (LMICs) have access to basic cancer surgery. Virtual reality (VR) is heralded as the novel tool to build surgical capacity and capabilities, yet its adoption in surgical oncology is poorly understood. The systematic review aimed to scope the utility of VR across surgical specialities and modalities and identify gaps.

Method
The systematic review was carried out by means of a search on the Web of Science, including all articles and reviews on virtual reality and surgical oncology published between January 2011 and January 2020 following the PRISMA guidance. Of 95 papers initially identified, 24 studies were included.

Results
The review revealed gaps in application, accessibility and clinical evaluation of VR. VR was applied the most in open (58.3%), followed by in endoscopic (20.8%) and robotic (20.8%) cancer surgeries. Neurosurgery led in the use of VR (n = 13, 54.2%), followed by urology (n = 8, 33.3%) and gynaecology (n = 2, 8.3%). In terms of the characteristics, 11 (57.9%) articles described VR tools with high fidelity; and 12 (63.2%), with haptic feedback. While all VR illustrated face and content validity, only 12 (63.2%) exhibited construct validity and one (5.3%) demonstrated predictive validity.

Conclusions
VR is disproportionately developed for complex, high risk cancer surgeries. The asynchrony between its development and actual global cancer surgery demand means the technology is not effectively, efficiently, and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise in affordable, clinically evaluated VR technology for high demand, common cancer surgeries required in LMICs.
832 Analysis of Surgical Outcomes and Survival Benefit of Simultaneous Resection of the Primary Colonic Tumour and Liver Metastasis – Experience of a UK Tertiary Centre Between 2013-2022
Authors: Lakshmanan V , Kane E , Hughes J , Kaul A , Arthur J , Mann K , James E , Skaife P , Malik H , Fenwick S , Jones R , Diaz-Nieto R , Hale J , McAvoy A 
Published: August 2023

Abstract

Introduction
22% of patients with colorectal cancer present with synchronous metastases. Traditionally, surgical management for these patients is performed separately although increasingly these are being done as simultaneous resections as supported by NICE, UK. Large-scale data to support this is limited and heterogeneous.

Aim
We aimed to analyse the experience of simultaneous resection at a UK tertiary centre with attention to surgical, oncological outcomes, and survival benefits.

Method
A prospective database between 2013-2022 was analysed, and clinical data were collared. Statistics performed using R.

Results
Ninety-six simultaneous resections were reviewed. 71% were left-sided including rectal and 29% were right-sided, while 69% and 31% of patients underwent minor and major liver resections respectively. The majority of cases were performed as open (77%), laparoscopic (16%), or converted to open (6.5%). 30-day mortality was 1% and morbidity rate was 55.4% (Clavien Dindo III 39.2%, IV 4%). Stoma formation rate was 34%. To date, 62% had recurrent disease, 55% received further chemotherapy and 29% had further resections. Median time to recurrence was 31.2 weeks. Median total survival was 34 months. Left-sided and minor liver resections tended towards improved survival, but this was non-significant; survival was significantly improved for those patients diagnosed via the bowel cancer screening program (BSCP).

Conclusions
Simultaneous resection of colorectal cancer and liver metastases is safe with low mortality and an acceptable morbidity rate. Overall survival of 34 months is promising with further analysis required into oncological strategies and improving uptake of the BSCP.
979 Radiofrequency Ablation a Novel Method in Radical Oncological Treatment of Spinal Oligometastatic Disease
Authors: Saha P , Tsang E , Hwang Z , Ajayi B , Minhas P , Lui D 
Published: August 2023

Abstract

Aim
Radiofrequency Ablation (RFA) is a curative novel addition to the armamentarium of radical oncological treatment. RFA as an adjunct to separation surgery may be a new technique that may have a beneficial compound effect of cytoreduction. The novel use of RFA in conjunction to radical treatment or independently for the treatment of oligometastatic disease (OMD) is investigated at a quaternary level 1 spinal center.

Method
Retrospective review of spinal OMD patients between 01/01/2017-01/12/2022. Patient demographic data, tumour histology, OMD type, surgery type and instrumentation, RFA, local recurrence (LR), infection and mortality data were analysed.

Results
15 cases of RFA. 11 out 26 separation surgeries (SS) performed for patients in the OMD/OPD pathway had adjunct RFA ± cement. Titanium SS with RFA ± cement (n = 4): 2-year LC– 0%; 2 years mortality–0% Titanium separation surgery without RFA ± cement (n = 16)–1 year LC–6% (n = 1); 30-day mortality – 12.5% There were 7 cases with independent RFA and cement, 1 case with RFA + biopsy and 3 cases with cement only. LR–0% at 6 months(n = 9), 12 months (n = 7) and 24 months (n = 5), the pain was well managed, no infection, and mortality–0% at 6 months(n = 11), 12 months (n = 7) and 24 months (n = 5).

Conclusions
RFA is promising for OMD pathway which can potentially deliver radical oncological control. As an adjunct to SS and SABR, it may offer improved cytoreductive control. The authors believe they are the first to describe this technique used in conjunction with SS where we show local recurrence of 0% at 2 years.
1047 Local Recurrence and Functional Outcomes After Metastatic Spinal Cord Compression Surgery
Authors: Yoon W Y , Lam T C 
Published: August 2023

Abstract

Aim
Metastatic Spinal Cord Compression (MSCC) is one of the most important complications of cancer. Surgical decompression is an important treatment for MSCC with proven benefits in overall survival, yet it is highly invasive and carries a significant morbidity and mortality risk. This study aims to review the outcome of MSCC decompression surgery, including local recurrence, overall survival, and post-operative ambulatory function.

Method
A retrospective review of data of 121 patients who underwent MSCC surgery at Lancashire Teaching Hospitals over 8 years and Blackpool Victoria Hospital over 5 years was performed. Competing risk regression analysis, log-rank test and multiple variable regression were used for the analysis of local recurrence, overall survival and post-operative ambulatory function at 3 months.

Results
The crude local recurrence risk was 9/121 (7.4%), and median time to recurrence was 94 days (range = 7-416 days). Previous radiotherapy to the MSCC site was strongly associated with higher local recurrence risk after MSCC surgery (SHR = 10.490, p = 0.000). Poor pre-operative ambulatory status (OR:12.347, p = 0.001) was associated with worse functional outcomes at 3rd month. Decompression surgery with instrumentation (OR = 0.186, p = 0.033), post-operative radiotherapy (OR = 0.143, p = 0.010) and higher post-operative radiotherapy dose (OR: 0.923, p = 0.006) were associated with better post-operative functional outcomes at 3rd month. The use of post-operative Systemic Anti-Cancer Therapy (HR = 0.346, p = 0.000) and haematological cancers (HR = 0.341, p = 0.006) predicted longer overall survival.

Conclusions
Our findings indicate previous irradiation to the MSCC site predicts local recurrence after MSCC surgery. Surgery with instrumentation and post-operative radiotherapy is important for the preservation of ambulatory function in the early post-operative period.
1187 A Study of Outcomes in Patients with Gastrointestinal Tract Lymphomas Who Require Inadvertent Surgery
Authors: Sarodaya V , Liemangow H , Eiswai A , Lim M 
Published: August 2023

Abstract

Aim
Patients may present with acute surgical symptoms from their lymphoma. We aimed to study postoperative outcomes and 3-year overall survival in patients who had inadvertent surgery as primary management of their gastrointestinal tract lymphomas.

Method
Suitable patients were identified using electronic records from January 2013 to December 2022. Demographics, clinicopathological characteristics and survival outcomes of these patients were collected retrospectively.

Results
A total of 25 patients were identified. The most common clinical symptom was abdominal pain (n = 18, 72%) with demonstration of an obstruction (n = 16, 64%) or perforation (n = 4, 16%) by a mass on CT scan. Small bowel was the most common site, followed by colon and stomach (55%, 24% and 21% respectively) Diffuse large B-cell lymphoma was the most common subtype (66.7%). Immunohistochemistry revealed B-lymphocyte antigen CD20 to be positive in most patients (n = 17, 68%) and Ki 67% to be high (&gt;70%) in a third (n = 8, 32%).
Upon discharge, two thirds of patients were well enough to have systemic chemotherapy (n = 19, 76%). Two patients died from surgical complications while the rest succumbed to disease progression (n = 10, 76%). The overall 3-year survival rate was 56%.

Conclusions
Patients with gastrointestinal tract lymphoma who do not die in the postoperative period after inadvertent surgery are likely to be alive at 3 years with the use of systemic chemotherapy.
326 Cardiopulmonary Exercise Test as Predictor of Postoperative Ileus in Elective Colorectal Surgery – a Prospective Cohort Study
Authors: Tay T , Fleet B , Golder U , Legga A , Davies E , Raymond T , Hawkin P , Janta E , Ryska O 
Published: August 2023

Abstract

Aim
Postoperative ileus (POI) is a complication where there is abnormal pattern of slow or absent gastrointestinal motility after surgery. Elderly, frail, and comorbid patients often undergo cardiopulmonary exercise test (CPET) to determine their risks and suitability for major surgery. A literature review on Pubmed and Web of Science reveal no studies have been published on whether CPET variables can act as a predictor of POI. Hence, we aim to investigate whether there is a correlation between CPEX and post-operative ileus or major complications after colorectal surgery.

Method
All patients with stage I-IV Colorectal cancer who underwent CPET test between January 2013-June 2021 before elective major colorectal surgery were enrolled. Anaerobic threshold (AT) was used as a marker of cardiopulmonary fitness on CPET. POI was defined in any patient with NGT inserted postoperatively. Major complications were classified using Clavien-Dindo Classification≥Grade 3. Fisher’s exact test was used for categorical variables and independent sample t-test for continuous variables.

Results
In total, 115 patients were included - 64% were males and median age was 78(51-95) years old. Mean Anaerobic threshold was 10.4(6.4-15.6) mg/kg/min. Thirty-three(29%) and fifteen(13%) patients experienced POI and major complications respectively. There were no significant differences in mean AT for those who had POI versus without (10.9 vs 10.2, p = 0.13) and those with major complications versus without (10.7 vs 10.4, p = 0.62).

Conclusions
The overall incidence of POI was relatively high. Our study did not confirm level of cardiorespiratory fitness as a predictor of postoperative ileus or major complications.
1239 Microbiology, Culture and Sensitivity Analysis During Drainage of Non-Perianal Soft-Tissue Abscesses: Do We Review the Results and How Often Do They Change Management?
Authors: Rashid S , Pizanias M , Ezzat C 
Published: August 2023

Abstract

Aim
The utility in obtaining microbiology, culture, and sensitivity (MC&S) specimens during drainage of soft-tissue abscesses is controversial. This study aimed to determine if routine MC&S analysis changed management after drainage of non-perianal abscesses.

Method
A retrospective review was undertaken of consecutive patients undergoing drainage for non-perianal superficial abscesses between July and November 2021. Data recorded included whether an MC&S specimen was taken, the result, any antimicrobial treatment and clinical outcome. Using the Auditing functions inbuilt to the software, whether the surgical team had subsequently reviewed the result was also determined.

Results
76 patients underwent abscess drainage, located in the pilonidal region (32%), axillary (24%), buttock (24%), groin (11%), neck (5%) and trunk (5%). MC&S was sent from 52 cases (69%). Results were reviewed by the surgical team in 6 cases (11%). Samples were positive in 34 cases (65%). Mixed organisms were the most common positive finding (28 cases) and sensitivity was not performed on these samples. Methicillin-sensitive S aureus was cultured from 4 cases (8%), Methicillin-resistant S aureus from 1 case (2%) and Staphylococcus lugdenensis from 1 case (2%). Post-operative antibiotics were prescribed for 25 patients. 4 patients required a further course of antibiotics postoperatively and in all these cases MC&S was taken but showed no growth.

Conclusions
Few MC&S results were reviewed by the surgical team and MC&S results did not guide management in any case. These results support the hypothesis that routine MC&S sampling is not required for typical abscesses in low-risk patients.
292 Augmented Reality: A Novel Approach T­­o Surgical Simulation, a Objective & Subjective Validation, Health Economics Study & Systematic Review
Authors: Rawaf D , ElBahnasawi M , Toms J , Harris M , Ludick C , Sheikh M , Beghal G , Tenang L , Van Flute J , Street E 
Published: August 2023

Abstract

Aim
To validate the novel LapAR for surgical simulation.

Method
Utilising a high-fidelity simulator (LapAR1), we validated efficacy alongside health economics evaluation with an appropriate systematic review analysing the various styles of training.

Results
A pilot benchmarked two appendicectomies or vaginal cuffs with two rounds of intervening LapPass2. One hour on the simulator found ‘time’ savings of 19% and 36.9%, and ‘distance(m)’ savings of 25% and 56.5% respectively. A multi-centre has shown that 10 appendectomy benchmarks, with three LapPass rounds in two weeks can reduce ‘time’ by 55-66% and ‘distance’ by 39-72%. All figures are statistically significant following multiple-regression analyses.
Self-confidence scores on a day course indicated that all areas improved by a mean of 3.82 (likert, p = 0.018).
A BMJ peer-reviewed health economics review4 was then performed using estimated costs. The potential Return on Investment (ROI) for the NHS was deduced. At 100% translation rate alongside validation data, we save £455 per patient through reduced anaesthetic time and shorter inpatient stay.
Finally, a SR (n = 26) of literature on the main four (AR vs VR vs traditional vs cadaveric) demonstrated that AR is preferred, improves procedural success & provides faster skill acquisition.

Conclusions
Reduced complication rates, anaesthetic time and ability to reduce waiting list burden would form future scopes of study. However, we can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential new gold standard.
399 The MDT Game: Implementation of a Novel Simulation Exercise to Improve Multidisciplinary Care Teaching to Medical Students
Authors: Chong S , West L , Khera G 
Published: August 2023

Abstract

Background
Multidisciplinary team (MDT) medicine is the national gold standard for cancer care. Medical students are often encouraged to observe MDTs, however such meetings discuss a high volume of complex cases at rapid pace. This presents limited opportunities for learning or engagement for a student observer. We describe a novel teaching exercise which assigns students to roles on a simulated MDT, with the aim of improving understanding of collaborative MDT working.

Method
A simulation exercise was devised which assigned individual students to one of ten roles on a gastrointestinal cancer MDT. Each student was given information about a fictional patient which pertained to their role and encouraged to discuss management options as a group. Student feedback was sought to assess understanding of MDTs and teaching quality of both the simulation exercise and observation of a formal MDT meeting.

Results
Sixty-five students provided feedback on both the simulation exercise and the facilitated MDT observation session. Most students (78%) rated the simulation exercise as either “good” (40%) or “excellent” (38%), with a statistically significant improvement in mean score for the role-play compared to formal MDT observation (mean difference 0.46, p&lt;0.001, 95% CI 0.23-0.69). Fifty-three students (82%) reported that participation in the simulation exercise improved their understanding of MDTs.

Conclusions
Multidisciplinary care teaching can be delivered to medical students in an acceptable form using principles of simulation-based training. Potential further developments for simulated MDTs include use of anonymised patient data to create more authentic vignettes and use of parallel pre- and post-test questions to assess learning.