bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P45 Ciliated Hepatic Foregut Cysts: Not as Rare as Previously Believed
Authors: Hughes Daniel , Tsakok Maria , Patel Nikhil , Rendek Aniko , Bungay Helen , Silva Michael 
Published: December 2022

Abstract

Background
Ciliated hepatic foregut cysts (CHFCs) are uncommon cystic lesions within the liver. CHFCs can undergo a malignant transformation to form a primary squamous cell carcinoma of the liver. The true incidence and natural history of CHFCs is unknown and the risk of malignant transformation is unclear. We present a single centre’ s experience of CFHC management.

Methods
A retrospective review of a departmental database identified all patients with CHFCs over a 4 year time period. Patients with CHFCs confirmed on histological assessment or suspected on radiological imaging were included in this study. Clinical information regarding patient demographics, symptomatic presentation, surgical management and histopathological features were noted. The radiological characteristics of CHFCs were recorded and the malignant transformation rate was calculated

Results
15 patients with CHFC were identified (7 histologically confirmed and 8 radiologically suspected cases). All patients were asymptomatic and the CHFCs were incidental findings.No CHFC developed an interval change in cyst features or underwent a malignant transformation during follow up. MRI serves as the most sensitive modality to diagnose CHFC

Conclusions
CHFCs may be more prevalent than previously reported. Definitive management should encompass a patient centred discussion regarding the merits of long term follow up with serial imaging versus resection on an individual basis once CHFC is diagnosed.
HPB P47 Management of acalculous cholecystitis: Experiences from a district general hospital
Authors: Suresan Srutti , Shaukat Mubasher , Ahmad Reddin , BinSahl Abdullah , Naeem Hamza , Peter Mark 
Published: December 2022

Abstract

Background
Acalculous cholecystitis (AC) is a serious inflammatory condition of the gallbladder with associated high morbidity and mortality. Definitive management of AC involves cholecystectomy and/or cholecystostomy in combination with antibiotic therapy. Due to the lack of consensus regarding the optimal management of AC leading to possible variability in clinical practice, this study aims to review the management of AC in this busy district general hospital.

Methods
Data were collected retrospectively on consecutive patients with diagnosis of cholecystitis from March 2018 to March 2020. The data was analysed and patients with confirmed gallstones on imaging and no clinical/radiological signs of cholecystitis were excluded. In this two-year study period, a total of 61 patients were treated for AC.

Results
Twenty-eight patients were managed conservatively with antibiotics (median age of 68 and median ASA of 2). Thirty-three patients were offered definitive management; cholecystostomy (2 inpatients), laparoscopic cholecystectomy (9 inpatients and 13 elective patients), 5 remain on the waiting list for surgery and 4 declined surgery. Among patients who were offered definitive management, the median age was 62 and median ASA was 2. Seven patients developed complications of AC; 2 patients underwent acute laparoscopic cholecystectomy, 2 patients were offered elective laparoscopic cholecystectomy after having a cholecystostomy, 1 patient underwent cholecystostomy, 1 patient was offered elective laparoscopic cholecystectomy after antibiotic treatment and 1 patient was treated with antibiotics alone. 30-day readmission rate was similar between patients with conservative management (5 patients) and definitive management (4 patients).

Conclusions
With similar re-admission rates, this small study suggests that definitive management options may not be superior to antimicrobial therapy alone and demonstrates that management can be tailored according to clinical needs. A larger prospective study is recommended to fully assess the efficacy and safety of laparoscopic cholecystectomy, cholecystostomy and antibiotic therapy in managing AC.
HPB P53 Outcomes after remnant cholecystectomy: is laparoscopic approach feasible?
Authors: Ibrahim Rashid , Abdalkoddus Muhammad , Mownah Omar A , chanthu Aye , Yao Lu , Aroori Somaiah 
Published: December 2022

Abstract

Background
Subtotal cholecystectomy (STC) is perceived as a safe approach in difficult cholecystectomies to prevent bile duct and vascular injury. However, the gallbladder remnant can become symptomatic, necessitating further surgical intervention. This study aims to evaluate the safety profile and peri-operative outcomes of remnant cholecystectomy (RC)

Methods
We retrospectively reviewed the records of all patients that underwent STC from 2009 to 2019. Patients that underwent RC were included in the study.

Results
We identified 97 STC patients during the study period. Of this cohort, 16 patients (16.5%) presented with symptoms attributed to remnant gallbladder. The median age of this group was 64 years [Inter quartile range (IQR) 54–69] with equal male to female distribution. The median body mass index: 31kg/m2 (IQR 28–33). Twelve patients then proceeded to RC. All cases were performed by a consultant Hepatobiliary surgeon in an elective setting. The median operative time was 88 minutes (IQR 80–96) with 67% completed laparoscopically. No patients suffered bile duct injury. Median hospital was 3 days (IQR 1–5). Readmission rate was zero. One patient suffered with post-op hypotension requiring inotropic support. Overall mortality is zero. At the end of the follow up period [median of 14 months (IQR 2–26)], 8 patients (67%) reported symptoms resolution.

Conclusions
Remnant cholecystectomy is a safe operation that can be performed laparoscopically. It has a low complications rate and relatively short hospital stay when performed by an experienced surgeon. However, symptomatic resolution is not achievable in all cases.
HPB P54 General surgery telemedicine clinics: here to stay post-pandemic?
Authors: Urbonas Tomas , King Emily , Pepes Sophia , Ceresa Carlo , Gordon-Weeks Alex , Reddy Srikanth 
Published: December 2022

Abstract

Background
The telemedicine clinic in general surgery has become widespread since the onset of the COVID-19 pandemic and has remained so following relaxation of restrictions on conventional face-to-face appointments. However, there has been significant scepticism regarding its continued utility. In particular, there is a concern that patients cannot be adequately assessed and counselled for invasive procedures, which may result in high cancellation rates on the day of procedure. The aim of this study was to assess the cancellation rate on the day of surgery for procedures booked in telemedicine clinics.

Methods
We conducted a retrospective analysis of surgical procedures booked via hepatopancreatobiliary (HPB) and general surgery telemedicine clinics from March 2020 to November 2021. From September 2020 onwards, telemedicine clinics were only run for laparoscopic cholecystectomies for benign gallbladder disease. The primary outcome was the cancellation rate of surgical cases booked from telemedicine clinics. Statistical analysis was done using JASP 0.16.2 software.

Results
We identified 240 cases booked for surgery from telemedicine clinic. 162 patients (68%) were female; the median age of the study population was 51 (16–81). 186 (78%) patients had gallstones, 19 (8%) gallbladder polyps, 13 (5%) secondary liver tumour, 5 (2%) liver cyst, 5 (2%) pancreatic tumour, 4 (1.7%) primary liver tumour, 2 (0.8%) gallbladder tumour and 6 (2.5%) other pathologies. 225 patients (94%) underwent surgery on their first admission. Procedures included 192 cholecystectomies, 10 open segmental liver resections, 6 laparoscopic segmental liver resections, 4 distal pancreatectomies, 3 open right hepatectomies, 2 Whipple procedures, 2 laparoscopic deroofing of the liver cyst, 2 laparoscopic lymph node biopsy, 1 extended right hepatectomy, 1 left hepatectomy, 1 small bowel resection and 1 exploratory laparotomy. 15 (6%) patients had surgery cancelled on the day of surgery, 14 of those were for laparoscopic cholecystectomy, 1 for laparoscopic liver resection. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. The majority 212 (88%) of patients were ASA class 1–2; only 28 (12%) were ASA class 3. There was no significant association between high ASA (3) and cancellation rate (Chi square test 5% vs 14% p=0.062).

Conclusions
Telemedicine clinic in general surgery was often the only option to assess and plan operative management for newly referred patients during the COVID-19 pandemic. Our series showed that it was feasible to assess and counsel patients on the phone even for major HPB procedures with a minimal cancellation rate on the day of operation.
OGC P04 Spatial sampling of Barrett's oesophagus reveals that tumour heterogeneity is not a useful predictor of progression to cancer
Authors: Katz-Summercorn Annalise , Peneva Iliana , Frangou Anna , Jammula Sriganesh , O'Donovan Maria , Tripathi Monika , Malhotra Shalini , di Pietro Massimiliano , Devonshire Ginny , Redmond Aisling , Wedge David , Fitzgerald Rebecca 
Published: December 2022

Abstract

Background
Intra-tumour heterogeneity has been well-described in oesophageal adenocarcinoma and Barrett's oesophagus (BE) segments also consist of multiple clones (groups of cells which share mutations). In BE there is some suggestion that the number of individual genetic clones within the segment and the diversity of the segment can be predictors of progression to cancer. However, this was with pre- whole genome sequencing (WGS) methods. In this study we consider the detailed spatial maps of ten patients with different disease trajectories, using WGS, to determine the heterogeneity and correlate it with their progression.

Methods
We performed WGS (50x) on 35 high-quality, frozen, endoscopic biopsies taken spatially from ten cases (8 males, 2 females, median age 75 (range 31–83). This included 4 long-term non-dysplastic (ND) patients with long BE segments and 6 patients with dysplasia. We used the copy number and purity information (from Battenberg) and the somatic mutation clustering information (from DPClust) to infer the clonal and subclonal architecture of individual biopsies and looked at the spatial relationship between biopsies within the segment.

Results
In both ND and dysplastic BE we saw cells with unrelated patterns of mutations, or clones, implying completely separate origins for different parts of the segments. This suggests independent or parallel evolution. There was a higher burden of shared (truncal) mutations in the dysplastic biopsies (p=0.049), indicating a more recent clonal sweep with some clones being outcompeted. Dysplastic samples had more subclonal copy number aberrations and more clonal driver mutations. In addition, most of the driver gene alterations in the dysplastic trees occurred early, whereas CDKN2A, the p16 locus, was the only truncal mutation found on the ND clone trees. We did not find the number of clones or the diversity of the segment to differ between the two groups.

Conclusions
Each individual patient showed complex, distinct genomic features and evolutionary trajectories. Some cases arose from a single ancestral clone, while others had few shared mutational variants suggesting multiple clones. Importantly, in this sample of cases we did not see any trend that the clonal diversity or number of clones correlated with progression to cancer. This is different to previous studies and highlights the importance of multiple sampling to determine the propensity for cancer progression even if the samples look similar histologically.
OGC P06 Has the affluent oesophageal cancer population in Scotland fared worseduring the Covid-19 pandemic?
Authors: Khan Khurram , Baxter Mark , Gall Lewis , Samuelson Catherine , Narramneni Lakshmi , Al-Zuabi Manaf , Bryce Gavin , Shareef Hala , Petty Russell , Forshaw Matthew 
Published: December 2022

Abstract

Background
COVID-19 has significantly disrupted cancer care. This has impacted on staging, management and survival of oesophageal cancer as health services worldwide had to adapt. Responding to the pandemic, the UK government declared a national lockdown on 23rd March 2020. Our aim was to determine the impact of COVID-19 and socio-economic deprivation on patients with oesophageal cancers.

Methods
This was a retrospective cohort study. Consecutive new patients presenting in NHS Scotland to five regional OG cancer MDTs covering 93.2% of the Scottish population between October 2019 and September 2020 were identified. Electronic health records were reviewed. Patient's residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). Patients were divided into two groups: most deprived (SIMD 1–5) and least deprived (SIMD 6–10) and results compared. The study period was divided into pre- and post-lockdown, based on the first UK national lockdown on 23rd March 2020.

Results
728 patients with were identified, 5 were excluded due to unrecognised postcode. 365 (50.5%) were in the more deprived and 358 (49.5%) were in least deprived group. 488 (67.0%) were male and the median age was 71 years (range 25-95).
Deprivation and lockdown: Age, sex, WHO performance status and route of referral was not significantly different. No clinically meaningful difference in median time to gastroscopy was observed. Palliative intent treatment increased in the most deprived from 67.0% to 71.4% and in least deprived from 54.0% to 74.0% (p=0.002).
The overall survival for the whole cohort decreased post-lockdown (11.3 vs 7.8 months, p=0.001). Pre-lockdown the median survival for most deprived group was 8.9 vs 15 months for the least deprived group (p=0.001). Post-lockdown the median survival was similar irrespective of socioeconomic status (7.8 vs 6.9 months, p=0.99). The medial survival did not changed post-lockdown for the most deprived group (8.9 vs 7.8 months, p=0.480). However, the median survival for the least deprived group significantly decreased post lockdown (15 vs 6.9 months, p&lt;0.001).
A test of heterogeneity between lockdown period and SIMD group supported the suggestion that least deprived group did worse post-lockdown (HR 1.45, p=0.035).

Conclusions
This national study highlights that the least deprived patients had survival advantage pre-lockdown, which has been completely lost due to the lockdown. This disproportionate impact on the least deprived patients could be because early cancers were not diagnosed in the least deprived population.
OGC P07 A Preoperative Predictive Tool to Assess the Need for Staging Laparoscopy in Oesophagogastric Cancer Patients
Authors: Halle-Smith James , Bage Timothy , Kamarajah Sivesh , Pande Rupaly , Whiting John , Griffiths Ewen 
Published: December 2022

Abstract

Background
Staging laparoscopy (SL) has become commonplace in the preoperative staging pathway for oesophagogastric (OG) cancer due to the tendency for peritoneal carcinomatosis (PC) to be present, which may be macroscopic peritoneal metastases (PM) or positive peritoneal cytology (PPC). The aim of this study was to develop an objective risk scoring system to predict both PM and PPC at SL.

Methods
A prospectively collected and maintained database of all OG cancer patients treated between 2006-2020 was reviewed. Univariate and multivariate analyses were performed to identify risk factors for both PM and PPC at SL. A risk score was then produced for both PM and PPC, then internally validated.

Results
Amongst 968 patients who underwent SL, 96 (9.9%) patients had PM and 81 (8.4%) had PPC at SL. Tumour site (p&lt;0.001), CT T stage (p&lt;0.001) and N stage (p=0.029) were significantly associated with PM at SL. (p&lt;0.001). Tumour site (p&lt;0.001), biopsy histology (p=0.041) CT T stage (p&lt;0.001) and N stage (p&lt;0.001) were significantly associated with PPC. The risk scoring model for PM included cancer site and CT T stage. This was successfully tested on the validation set (AUROC = 0.730). The risk scoring model for PPC included cancer site, CT T and N stage. This was successfully tested on the validation set (AUROC = 0.773).

Conclusions
The present risk scores are valid tools with which to predict the risk PM and PPC in patients undergoing SL for OG cancer and may help to avoid subjecting patients to unnecessary SL.
OGC P08 A machine-learning approach to predict Upper Gastrointestinal multidisciplinary team treatment decisions
Authors: Thavanesan Navamayooran , Vigneswaran Ganesh , Rahman Saqib , Underwood Timothy 
Published: December 2022

Abstract

Background
The complexity of the Upper Gastrointestinal (UGI) multidisciplinary team (MDT) is growing, leading to rising clinician workload, time pressures and demands. This increases heterogeneity or ‘noise’ within decision-making for patients with oesophageal cancer (OC) and may lead to inconsistent treatment decisions. In this context, machine learning (ML) approaches offer the potential to standardize, automate and produce more consistent, data-driven decisions. Such models benefit from incorporating information-rich, diverse datasets to increase predictive model accuracy.
The aim of this study was to develop a model capable of predicting UGI MDT treatment decisions for OC patients (whether the patient should receive surgery alone (S), chemotherapy prior to surgery (C+S) or chemoradiotherapy prior to surgery (CRT+S)) using only variables available at the time of the first treatment decision.

Methods
We conducted a retrospective analysis of patients who underwent oesophageal cancer resections between 2010–2016. Twenty pre-operative clinical variables available to the MDT were used to develop a predictive machine learning model using a penalised Multinomial Logistic Regression (MLR) classifier with 10-fold cross-validation and 5 repeats.

Results
A total of 399 cases were identified with a male: female ratio of 3.6:1, and median age of 66.1yrs (range 32–83 yrs). The overall model accuracy was 61.4% (Kappa 0.399). A Receiver Operator Characteristic analysis produced an Area Under Curve of 87.7% for Surgery vs. CRT+S, 86.9% for Surgery vs C+S and 66.1% for C+S vs CRT+S when trialled on a validation set.

Conclusions
These results suggest even basic ML modelling techniques offer the potential to model and predict current UGI MDT treatment decisions when selecting patients for surgery or neoadjuvant therapy options. Such models may allow prioritization of caseload, improve efficiency, potentially reduce waiting times, and offer data-driven decisions where more complex cases pose challenges. While this study is the first step in such a process, future work will need to incorporate additional data modalities such as medical imaging and histopathology as well as expansion to other ML classifier algorithms to determine the best performing models in order to improve overall predictive accuracy.
OGC P13 Outcomes of Endoscopically Guided Stent Insertion in the Upper GI Tract in a Single Centre
Authors: Hossain Tanvir , Le Giang , Purbe Ripak , Kee Ling , Bushra Anika , Jackson Andrew , Trotter Martin , Parsons Simon L 
Published: December 2022

Abstract

Background
Self-expanding metal stents (SEMS) are useful for palliation in patients suffering from dysphagia for malignant disease in the upper gi tract. Patients can resume oral intake, so improving nutrition and quality of life. Establishing the efficacy and complication rate of stents are important for informing patients to aid decision making when giving consent for SEMS insertion in the scenario of a short life expectancy.

Methods
A single centre's records were interrogated over a 10 year period for stents inserted in the upper gi tract. Data for stents inserted between 2011 and 2021 was retrospectively collected from electronic records for baseline demographics and outcomes in terms of complications and then subject to analysis. There was missing data in a number of domains and analysis was done on data available, no imputation of data was performed.

Results
Five hundred and sixty eight patient episodes were identified with a mean age of 73. There were 386 males and 170 females. Sites of obstruction were Lower Third of the oesophagus 279, mid-oesophagus 71, GOJ 37, upper oesophagus 15, unknown 9, duodenum 3, Cardia 1, and stomach other 1. Surgeons inserted 394 (70%) of stents and gastroenterologists 167 (30%). There were 212 covered stents, 248 not specified, 29 partially covered and 3 uncovered.
When outcomes were measured, 276 had no complication (69%), 105 had a (any) complication (25%) and 32 had missing data (8%). There were 14 cases of bleeding (3%). There were 25 cases of stent migration (6%) and 54 cases of tumour overgrowth (13%). There were 43 cases of stent obstruction (10.4%), 3 cases of some stricturing (0.73%) and 366 with no blockage or stricture reported (88.6%), 1 case could not be determined. There were 2 cases of perforation (0.48%). Median survival was 105 days with IQR 44–210.

Conclusions
Our results for adverse events are not too dissimilar to the literature however there may be an under-reporting of some adverse events due to the terminal nature of the disease process the majority of the patients in this group have. Stents can relieve dysphagia and help regain quality of life. However there is a significant complication rate that should be taken into account. This information from a large dataset is useful to inform potential stent patients to aid decision-making. Data for significant known symptoms such as reflux and retrosternal chest pain were not reliably available and a prospectively kept database measuring PROMs information including relief of dysphagia will better inform patients.