bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P35 Fluorescence guided resection of Liver Tumours: Same day administration of indocyanine green with SPY- Colour Segmented Fluorescence imaging to identify tumours intra-operatively
Authors: Karmarkar Rahi , Benjafield Anastasia , Aroori Somaiah 
Published: December 2022

Abstract

Background
Indocyanine green (ICG) fluorescence imaging is a real-time navigation tool that has shown promising liver surgery results. Several regimes have been described regarding optimum timing and dose of ICG administration. Visually different fluorescent enhancement patterns correlate with different pathologies to aid the identification of lesions intra-operatively. This study aims to present our experience with using the Colour Segmented Fluorescence (CSF) model and same-day administration of low dose ICG in the resection of liver tumours.

Methods
We present a single surgeon (SA) experience using indocyanine green fluorescence image-guided surgery (I-FIGS) at University Hospitals Plymouth, UK. I-FIGS was used between November 2020 and March 2022 in 15 patients with suspected liver tumours. ICG was administered intravenously at a dose of 0.02 to 0.03 mg/kg IV 2–3 hours prior to liver surgery. Using the SPY CSF mode, the image is scaled to NIRF fluorescence intensity to identify the liver tumours and their margins intra-operatively.

Results
A total of fifteen patients (eight males) with a median age of 71 years (36–86) underwent I-FIGS during the study period. Of these, 67% underwent laparoscopic liver surgery, 78% underwent non-anatomical resections, and 33% underwent re-do liver surgery. The average size of the tumour was 40.6 mm, and median number of tumours was one. All lesions were visible in CSF mode, and all had a signet ring appearance. The histology of the tumours confirmed a well to moderately differentiated colorectal metastasis in 13 (86%) patients and hepatoma in two patients. R0 resection was achieved in 11 (76%) of patients. In two patients with R1 resection, the tumour was right on the right hepatic vein, and R0 would not have been possible. The resection margins were clear in two other patients but &lt;1mm. The overall false positive rate in our experience with I-FIGS was 3%.

Conclusions
In our limited experience, low-dose ICG administered at least 2–3 hours prior to surgery can accurately identify liver tumours and their margins in CSF mode. Superficially located lesions are easily identifiable under CSF mode, and CSF mode helped us identify the lesions and mark the resection margin. The use of ICG is an important advancement in liver surgery, and further research is needed to optimise image interpretation and correlate with clinical resection outcomes.
HPB P38 Bile duct injuries during cholecystectomy – Experience of referrals to a tertiary centre over a 7 year period
Authors: Thillai Manoj , Reetoo Salil , White Molly , Nicoll Kenneth , Thomasset Sarah 
Published: December 2022

Abstract

Background
Laparoscopic Cholecystectomy is a common procedure performed both in elective & emergency setting for gall stone disease. Current literature states that the incidence of bile duct injuries is between 0.5–1.5%. These are iatrogenic catastrophe associated with significant perioperative morbidity, mortality, reduced long-term survival and reduced quality of life. Early identification and referral is key in help managing these injuries. In delayed cases, the choice and timing of the appropriate reconstructive procedure have a critical role in long-term prognosis.

Methods
A retrospective analysis of all patients referred to the Royal Infirmary of Edinburgh between 2014 and 2021 was undertaken. All patients referred with suspected bile duct injuries were included in the study. Strasberg – type A (cystic duct leak), bile leaks following subtotal cholecystectomy and trauma were excluded. All injuries were classified according to the Strasberg classification.

Results
A total of 34 patients were identified during the study period. Five patients (15%) had previously had abdominal surgery. Six patients (18%) had CBD stones at the time of cholecystectomy. Twenty one patients (62%) who sustained a bile duct injury were undergoing elective surgery. Bile duct injury was identified intraoperatively in 21 (62%) of cases. Eighteen patients (52%) were referred immediately, within 24 hours of the injury. Eight patients were referred early (within 72 hours) and eight patients were referred late (&gt;10 days since injury). An E2 injury was most commonly seen, with 11 patients having this type of injury, followed by an E1 injury which was seen in 7 patients. An arterial injury was seen in 4 patients. A hepaticojejunostomy was the most commonly performed surgical procedure (22 out of 27 patients treated surgically). Immediate repair (within 72hours) was performed in 18 patients and this group of patients had the shortest hospital stay (10 days) and lowest long-term complication rate (5%).

Conclusions
The majority of bile duct injuries that were referred happened during elective cholecystectomies. Significant delays in the identification of bile duct injuries and referral to tertiary centres persist. These delays continue to have a significant impact on hospital stay and long-term complications rates.
HPB P39 Do indeterminate pulmonary nodules in patients undergoing resection for pancreas cancer influence pulmonary metastasis and survival outcomes?
Authors: Oyende Olamide , Anis Fady , Cameron Iain , Gomez Dhanny , Sanyal Sudip 
Published: December 2022

Abstract

Background
The significance of indeterminate pulmonary nodules (IPNs) on preoperative imaging in the surgical resection of pancreatic cancers remains a clinical dilemma. IPNs are defined as ≥ 1 well-defined, non-calcified lung nodules that are ≤ 1cm in diameter. We report the prevalence and impact of IPNs in surgically managed pancreatic cancer patients from our centre.

Methods
We studied patients who had attempted/successful surgical resection of pancreatic cancers between 2014 and 2020. The summary statistics are presented as frequencies and percentages, while Fisher's exact test was used to calculate p value for the compared variables including the presence of IPNs, pulmonary metastasis and death. P value of &lt;0.05 was considered statistically significant.

Results
Our study included 262 patients – 204 (77.9%) had surgical resections including pancreaticoduodenectomy (with or without portal venous resection) or total or distal pancreatectomy, while 58 (22.1%) had trial dissection, bypass and/or laparoscopy. All patients had a preoperative chest computed tomography (CT) scan. 25/262 (9.5%) had IPN on preoperative CT scans.
15/25 (60%) had solitary IPN, 2/25 (8%) had two IPNs, 3/25 (12%) had three IPNs, 1/25 (4%) had 6 IPNs and 4/25 (16%) reported multiple/plural IPNs. In patients with more than 1 IPN, only one patient had unilateral pulmonary nodules.
23/262 (8.8%) developed pulmonary metastasis. Of these, none had IPN preoperatively. There was no statistically significant association between IPN and pulmonary metastasis (p = 0.1428).
Neoadjuvant chemotherapy was given to 13/262 patients. None of these patients had IPN pre-operatively, but 4 of them had recurrent/metastatic disease (3 Liver & 2 Pulmonary). IPN was found in 3 patients on post-operative imaging, all three developed metastatic disease after pancreaticoduodenectomies. As at 31st of October 2021, 177/262 patients had died. There was a statistically significant association between pulmonary metastasis and mortality (p = 0.0379). On the other hand, an association between IPN and mortality showed no statistical significance (p = 1.0).

Conclusions
Our study suggests that IPN is not linked to pulmonary metastasis in pancreatic cancer patients that were offered surgical resection. The presence of IPN did not impact mortality. Therefore, we conclude that IPN should not be used as a determining factor for surgical management of pancreatic cancers.
HPB P41 Pitfalls in establishing a preoperative diagnosis; correlating the radiological and histopathological findings of suspected intraductal papillary neoplasm of the bile duct (IPNB)
Authors: Hughes Daniel , Turaga Sanchit , Gordon-Weeks Alex , Fryer Eve , McWeeney Doireann , Bungay Helen , Silva Michael 
Published: December 2022

Abstract

Background
Intraductal papillary neoplasm of the bile duct (IPNB) represents a cohort of uncommon biliary tract tumours. It is commonly unrecognised or misdiagnosed in cross sectional imaging of the liver. This rare tumour is of significant clinical importance as it serves as a pre-cursor lesion for Cholangiocarcinoma. The diagnostic work up of a patient with a suspected IPNB remains predominantly based on imaging and as of yet no consensus has been achieved regarding the optimal diagnostic algorithm. The aim of this study was to compare the radiological and clinico-pathological features of patients with confirmed or suspected IPNB managed in a single tertiary center.

Methods
Retrospective review of a departmental database of consecutive patients with suspected IPNB was performed. Clinical information regarding patient demographics, disease presentation, radiological imaging characteristics and histo-pathological features was analysed.

Results
Eighteen patients with suspected IPNB were noted, of which histological confirmation was present in eight cases (62%). The most frequent presentation of IPNB was of an incidental finding (50%). The diagnosis of IPNB was made following MRI in 63% of cases. Invasive adenocarcinoma was present in five patients (63%). In the remaining three patients, low grade dysplasia was noted within their IPNB tumours.

Conclusions
IPNB is frequently associated with concurrent invasive malignancy. Observation alone is insufficient. Radiological assessment of these tumours remains as the fundamental investigation for diagnosis. However, without confirmatory histology perioperatively, the diagnosis cannot be assured therefore the decision for management must be based upon a patient-centered discussion and a careful evaluation of risk.
HPB P48 Minimally invasive HPB surgery in the UK from consultant and trainee perspectives
Authors: Kourdouli Amar , Dennison Ashley , Garcea Giuseppe 
Published: December 2022

Abstract

Background
This survey took a ‘'snapshot’’ of prevailing attitudes towards minimally invasive HPB surgery from a consultant and trainee perspective.

Methods
Between November 2020 and January 2021, two google surveys were emailed to all HPB tertiary centres in the UK. The questionnaire contained 33 and 31 questions respectively regarding minimally invasive practice and training.

Results
Thirty-five HPB consultants completed the survey. The most common indications for conversion were failure to progress (91.4%), excessive blood loss (85.7%), access issues (85.7%). The majority (78.8%) of HPB surgeons undertook minimally invasive distal pancreatectomy (MIDP). One consultant undertook minimally invasive pancreaticoduodenectomy (MIPD), 48.4% declared not performing MIPDs due to uncertainty of its superiority. Eighty-five-point seven percent performed minimally invasive minor liver resection and segementectomy (MImLRS), 70.6% reported better outcomes with this approach; 28.6% of consultants performed minimally invasive major liver resection (MIMLR), 23.3% reported better outcomes with MIMLR. Half of HPB trainees did not have access to complex laparoscopic HPB procedures; 72.2% desired fellowship training.

Conclusions
MImLRS and MIDP are accepted approaches by most HPB consultants correlating with a perception that outcomes are better/comparable to open approaches, in contrast to MIPD and MIMLR. HPB trainees lack laparoscopic HPB exposure leading them to seek further experience with fellowships.
HPB P59 Is the lymph node ratio a relevant prognostic score neo-adjuvant chemotherapy for pancreatic cancer?
Authors: Pande Rupaly , Hodson James , Chatzizacharias Nikolaos , Sutcliffe Robert , Bartlett David , Marudanayagam Ravi , Mirza Darius , Isaac John , Roberts Keith 
Published: December 2022

Abstract

Background
Lymph node ratio (LNR) is a strong prognostic marker in pancreatic cancer (PDAC). In recent years, use of neoadjuvant chemotherapy (NAT) has increased, where it is associated with a higher rate of N0 resections, compared with a surgery first approach. The prognostic accuracy of the LNR after NAT has not been assessed.

Methods
Retrospective review of prospectively collected data from 2008–2020 of all patients undergoing pancreaticoduodenectomy (PD) for PDAC. Basic demographics, pathological and clinical outcomes were analysed using standard statistical tests. Cox regression and Kaplan-Meier analyses were performed.

Results
Retrospective review of prospectively collected data from 2008–2020 of all patients undergoing pancreaticoduodenectomy (PD) for PDAC. Basic demographics, pathological and clinical outcomes were analysed using standard statistical tests. Cox regression and Kaplan-Meier analyses were performed.

Conclusions
NAT reduces the predictive accuracy of the LNR in resected pancreatic cancer; alternative prognostic models will require development.
HPB P66 Resection margin status, five-year recurrence and five-year survival in ampullary adenocarcinoma and cholangiocarcinoma patients who undergo pancreatoduodenectomy
Authors: Russell Thomas , Labib Peter , Aroori Somaiah 
Published: December 2022

Abstract

Background
Patients with a suspected early cancer affecting the periampullary region may be offered resection in the form of pancreatoduodenectomy (PD) if they are a suitable candidate. Whilst this offers some patients a potential cure, the operation is high-risk and disease recurrence is common. Patients who are found to have ampullary adenocarcinoma (AA) or cholangiocarcinoma (CC) on their postoperative histology are known to have relatively favourable oncological outcomes if their resection margins are clear. This study aimed to investigate the correlation between a positive margin and both five-year recurrence and five-year survival.

Methods
Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following pancreatoduodenectomy performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients with postoperative histology suggestive of AA and CC were identified and compared to one another by their resection margin status. Five-year recurrence and survival rates were compared using Fisher's exact test.

Results
A total of 394 patients had AA (26.5%) and 364 of these (92.4%) had their resection margin status recorded. Of these, 295 (81.0%) had no positive margins (R0), 69 (19.0%) had at least one positive margin (R1) and zero (0.0%%) had an incomplete resection (R2). Patients with R0 disease had lower five-year recurrence (41.4% vs 63.8%, p=0.0012) and higher five-year survival rates (59.0% vs 30.4%, p&lt;0.00001) compared to those with R1 disease. A total of 205 patients had CC (13.8%) and 202 of these (98.5%) had their resection margin status recorded. Of these, 113 (55.9%) had no positive margins (R0), 86 (42.6%) had at least one positive margin (R1) and three patients (1.5%) had an incomplete resection (R2). Patients with R0 disease had lower five-year recurrence (60.2% vs 76.7%, p=0.015) and higher five-year survival rates (38.1% vs 15.1%, p=0.0004) compared to those with R1 disease.

Conclusions
In our multicentre study, the majority of patients who underwent PD for AA or CC had no positive resection margins. These patients had significantly improved five-year outcomes.
HPB P67 Patterns of recurrence after pancreatoduodenectomy for pancreatic cancer and the effect of palliative chemotherapy on survival
Authors: Russell Thomas , Labib Peter , Aroori Somaiah 
Published: December 2022

Abstract

Background
Pancreatoduodenectomy (PD) is recommended in fit patients with suspected early pancreatic ductal adenocarcinoma (PDAC) affecting the pancreatic head. Unfortunately, recurrence rates are high and only a minority achieve long-term survival. This study aimed to study the patterns of recurrence in patients who undergo PD for PDAC and investigate the impact of palliative chemotherapy on survival.

Methods
Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients with PDAC who developed recurrence within five years of their operation were identified. The site of recurrence and details of palliative chemotherapy (if any) was recorded for each patient. Overall survival (OS) and time from recurrence to time of death was compared between those that received palliative chemotherapy and those that did not using the Mann-Whitney U test.

Results
In total, 885 patients (59.4%) had PDAC. Excluding the 37 patients who died within 90-days, 583 (68.8%) developed recurrent disease within five years (on imaging). The median number of months from time of surgery to time of recurrence was ten months (range: 0–58). Of those with recurrence, 30.4% had local recurrence only, 28.4% had local and distal recurrence, and 41.7% had distant recurrence only. The most common sites of recurrence were the liver (40.7%), the superior mesenteric artery area (33.3%), locoregional lymph nodes (20.2%), the omentum/peritoneum (14.9%), the pancreatic anastomosis site (11.8%), the superior mesenteric vein/portal vein area (10.8%), and the coeliac trunk area (9.4%). Among those with recurrence, 46.1% received palliative chemotherapy. The median number of cycles was four (range: 1–12). Just 41.2% of patients completed their planned course; 28.0% stopped their treatment due to disease progression and 17.4% stopped their treatment due to toxicity. Patients who received palliative chemotherapy had similar median OS to those who did not (both 18 months, p=0.6), however, time from recurrence to time of death was significantly longer in the former (9 vs 3 months, p&lt;0.0001).

Conclusions
In our multicentre study, over two thirds of PD patients with PDAC developed disease recurrence within five-years of their operation. Just under half of these received palliative chemotherapy. Time from recurrence to time of death was significantly longer in those who did receive palliative chemotherapy.
HPB P68 Multimetric MRI detects improved quality of the future liver remnant post-dual vein embolization – a novel finding
Authors: Sundaravadanan Senthil , Welsh Fenella , Sethi Pulkit , Cresswell Ben , Connell John , Knapp Sina , Nunez Luis , Kelly Matt , Brady Michael , Banerjee Rajarshi , Rees Myrddin 
Published: December 2022

Abstract

Background
Optimisation of the future liver remnant (FLR) is crucial to the safety of extended liver resections. This study aimed to assess volume and quality of the FLR pre- and post-dual vein embolisation (DVE) by MRI, in patients with insufficient FLR, needing major hepatectomy.

Methods
Of 81 patients recruited in a clinical trial (Precision1:NCT04597710), seven consecutive patients with colorectal liver metastases underwent multiparametric MRI (Hepatica®) pre- and post-DVE (right hepatic and portal vein). One patient had DVE after a first-stage hepatectomy. FLR volume, fibro-inflammation map (corrected T1) and fat (proton density fat fraction, PDFF) was determined.

Results
All 7 patients underwent uncomplicated DVE, with significant increase in median(range) %FLR volume at liver surgery [45.7(27.0–57.8)% versus 32.4 (19.5–37.7)%, p=0.016], 46 days (range 28–77) post-DVE. Median(range) FLR cT1 scores reduced post-DVE [747.33 (684–884)ms, versus 771.25(726–945)ms, p=0.047; healthy range&lt;794ms], as did median(range) PDFF scores [3.4 (2–13.25)% versus 6 (1.5–22.5)%, p=0.078; healthy range &lt;5.6%]. No patient developed post-hepatectomy liver failure (PHLF).

Conclusions
This novel, non-invasive and readily accessible MRI technique shows that volume and quality of the FLR improves after DVE. This is a significant step in improving surgical decision making in patients with borderline FLR, preventing PHLF and improving outcomes.
OGC P03 Staging of Barrett's neoplasia using artificial neural networks, proof of concept study
Authors: Abdelrahim Mohamed , Siggens Katie , Saiko Masahiro , Maeda Naoto , Htet Hein , Subramaniam Sharmila , Longcroft-Wheaton Gaius , Bhandari Pradeep 
Published: December 2022

Abstract

Background
Endoscopic differentiation between intramucosal and submucosal Barrett's neoplasia has several important implications but remains challenging even for expert endoscopists. Recent studies demonstrated promising results on AI-assisted detection of Barrett's neoplasia, but data on AI-assisted staging is limited. We aimed to develop and validate an AI system for classification of Barrett's neoplasia into intramucosal or submucosal, and compare its performance to expert endoscopists.

Methods
The model, based on VGG-16 architecture, was trained on 117 images of prospectively collected and annotated Barrett's neoplastic lesions. Rotation and random flip were used for data augmentation. The ground truth was the histological staging of endoscopically resected specimens performed by two pathologists with expertise in Barrett's neoplasia. Images comprised of WLI, enhanced imaging, and magnification views. The model was designed to classify images as either intramucosal (pT1a) or submucosal (pT1b). Performance of the AI system was compared to a group of three experts.

Results
The AI model was tested on an independent dataset of 90 images. The accuracy, sensitivity and specificity and AUC of the AI model in differentiating between intramucosal and submucosal neoplasia was 70.9%, 72.5%, 65.7%, and 0.781 respectively. Mean accuracy, sensitivity and specificity of experts were 73.3%, 63.3% and 83.3% respectively. Processing speed of the AI system was 5 ms/image.

Conclusions
This study demonstrates the feasibility of AI-assisted staging of Barrett's neoplasia on endoscopic images. The AI model's performance was comparable to that of experts. More work is needed to further develop this early model and validate its use on real-time video sequences.