bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS P28 Transhiatal oesophagectomy to salvage transacted oesophagus from laparoscopic paraoesophageal hernia repair
Authors: (Linda) Lin Yi-Tzu , Almonib Ahmed , Tan Benjamin 
Published: December 2022

Abstract

Background
Perforation of oesophagus and stomach during paraoesophageal hernia (POH) repair can be caused by traction on the lower oesophagus, gastro-oesophageal junction (GOJ) and fundus, or a thermal injury from the energy device during dissection. Iatrogenic complete transaction of oesophagus during elective laparoscopic POH repair is extremely rare. Here we reported this unusual complication.

Methods
A 79-year-old man with a history of hypertension and hypothyroidism underwent elective laparoscopic POH repair in a district hospital. During the surgery, oesophagus was transacted above the level of GOJ due to constant traction on the lower oesophagus and GOJ. Patient remained haemodynamically stable and was transferred to our tertiary centre next day.
Patient was taken to theatre for midline laparotomy. Intraoperatively, stomach, omentum and transverse colon were in the chest and reduced carefully. The oesophageal stump, approximately 20cm from hiatus, was found in the mediastinum with the use of a nasogastric tube. It was also noted that there were several serosal tears on the proximal stomach and left gastric vessels were already divided. Unfortunately, oesophageal stump was ischaemic and friable. Therefore we decided to perform transhiatal oesophagectomy. Oesophagus was fully mobilised via cervical and abdominal incisions and was resected above the level of clavicle. Cervical oesophagogastric anastomosis was performed with semi-mechanical end-to-side EndoGIA 30mm blue and interrupted 3-0 PDS. Postoperatively, he was transferred to intensive care unit for ongoing care.

Results
Patient was off inotropes of Day 2 and extubated on Day 3 postoperatively. He developed pneumonia and atrial fibrillation and was treated with intravenous antibiotics and amiodarone. He has recovered well and is currently awaiting transfer to the ward.

Conclusions
Complete transection of oesophagus due to of traction in laparoscopic POH is an extremely uncommon complication. Transhiatal oesophagectomy can be considered as a management option in selected cases.
HPB P15 A retrospective cohort study investigating the progression of sarcopenia and its impact on outcomes in patients with pancreatic cancer undergoing neoadjuvant chemotherapy
Authors: Anand Jyotsna , Pande Rupaly , Choudhary Surabhi , Roberts Keith 
Published: December 2022

Abstract

Background
Pancreatic ductal adenocarcinoma (PDAC) is a devastating disease, with surgical resection providing the best chance of survival. However, many patients are not eligible for surgery. Neoadjuvant therapy (NAT) offers the potential to downsize the disease to enable resection for patients with borderline resectable (BR) or locally advanced (LA) PDAC. This study aims to assess changes in body composition during NAT, in particular, the progression of sarcopenia, and how this impacts outcomes in these patients.

Methods
This is a retrospective cohort study including 65 patients with BR or LA-PDAC who underwent NAT between January 2017 and December 2020. Routine baseline and post-NAT computed tomography scans were analysed for changes in sarcopenia and adiposity measurements. The impact of these changes on chance of resection and overall survival was assessed. Additionally, the effect of pancreatic enzyme replacement therapy (PERT) on these changes and outcomes was investigated.

Results
Muscle mass and adiposity decreased during NAT (p&lt;0.05). 42% received resection following NAT. Those who were still not eligible for resection experienced greater reductions in muscle mass (-0.84cm2/m2 vs - 0.36cm2/m2, p=0.005) and subcutaneous adipose (-43.3cm2 vs -19.7cm2, p=0.033). Changes in body composition were not independently associated with overall survival. Patients receiving PERT experienced less reduction in muscle mass (-0.41cm2/m2 vs -0.82cm2/m2, p=0.0009).

Conclusions
This study suggests that there is progression of sarcopenia and a reduction in adiposity during NAT, which could preclude surgical resection of PDAC. PERT may reduce the progression of sarcopenia. Larger studies in this field are required to draw reliable conclusions.
HPB P37 Outcomes following EUS choledocho-duodenostomy for the palliative treatment of peri-ampullary cancer following unsuccessful ERCP – A single centre experience
Authors: Kourdouli Amar , Barrie Jenifer , Cameron Ian , James Martin , Sanyal Sudip , Venkatachalapathy Suresh 
Published: December 2022

Abstract

Background
EUS-guided choledocho-duodenostomy is an option to relieve jaundice after a failed ERCP, in patients with locally advanced or metastatic peri-ampullary cancers. We aim to assess the technical success, safety and outcomes of the procedure in our practice.

Methods
All consecutive adult patients that underwent EUS-guided CBD stent placement after a failed ERCP between December 2019 and May 2022 at the Queens Medical Centre, Nottingham were included. Studied variables included demographics, technical characteristics and outcomes including length of stay, normalisation of bilirubin level, complication rate and 30-day mortality rate.

Results
Twenty-six consecutive patients were included in this study (12 males, 14 females). The mean age was 75 (range 52–92) years. Pancreatic cancer was present in 15 patients (57.6%), 4 patients (15.3%) each had ampullary cancer and other malignant peri-ampullary lesions while 3 patients (11.5%) had duodenal cancer. Metastatic disease was present in 13 patients (50%). Mean ECOG status was 2 (n= 13). ERCP was unsuccessful due to an inability to cannulate the CBD (n= 3), duodenal tumour infiltration (n=10), destroyed ampulla (n=6) and inaccessible papilla (n=5).
EUS-guided CBD stent placement was successful in 24 patients (92.3%). The mean CBD diameter at presentation was 19.5 mm (range 14–32) and mean distance between the bile duct and duodenum was 4.2 mm.
The complication rate was 15.3% (4/26 patients). Complications included cholecystitis, stent blockage, slow bleeding and bowel perforation after a displaced stent. Median post-procedure LOS was 5.5 days. A reduction in bilirubin to &lt;50% was observed in 19 patients (73%) by discharge. There were 2 biliary re-interventions in the group. The overall 30-day mortality rate was 38.4% (n=10) with a procedure specific mortality of 11.5% (n=3).

Conclusions
EUS-guided choledocho-duodenostomy is an effective and safe option to relieve jaundice in this group of patients.
HPB P42 Investigating Factors Associated with Favourable Pathological Tumour Regression After Neoadjuvant Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma
Authors: Halle-Smith James , Leung Prudence , Roberts Keith 
Published: December 2022

Abstract

Background
Neoadjuvant chemotherapy (NAT) is increasingly used in the management of pancreatic ductal adenocarcinoma (PDAC). Pathological response of the tumour to NAT can be assessed using grading systems such as the College of American Pathologists (CAP) system, with favourable regression being associated with improved survival. The aim of the study was to investigate factors associated with favourable tumour regression in patients undergoing pancreatoduodenectomy (PD) for PDAC

Methods
Patients who received NAT before undergoing PDAC resection at our institution between 2012 and 2020 were reviewed. Interactions between chemotherapy, tumour staging, carbohydrate antigen 19–9 (Ca19–9) levels, perioperative factors and pathological tumour regression grading (TRG) were explored.

Results
27 patients were suitable for inclusion with a median follow-up of 17.9 months. 7 (26%) patients had a favourable response to NAT. Demographic details and initial tumour staging was similar between the groups. There was a significant difference in the change in Ca19–9 levels from the start of NAT to the end of NAT between the favourable and non-favourable TRG groups, with a significantly greater reduction in Ca19–9 observed in the favourable TRG group [median -1,862 U/mL (IQR: -7,028 U/mL to -121U/mL)] compared to the unfavourable TRG group [median -194 U/mL (-635 U/mL to -3.9 U/mL); p=0.011). There was no significant difference in the chemotherapy regime, number of cycles or number of patients who had a dose reduction due to adverse effects. The time from diagnosis to chemotherapy and time from end of chemotherapy to surgery were also similar.

Conclusions
In this small retrospective study, a greater reduction in Ca19–9 was significantly associated with a favourable TRG, which has been associated with improved survival. Patient numbers are limited due to the recent introduction of regression grading to pathology reporting guidelines so multicentre collaboration should be encouraged to identify more factors associated with favourable tumour regression. Translational research may also be able to identify other factors (e.g. gene expression) which are associated with favourable tumour regression.
HPB P51 The impact of the SARS-CoV-2 pandemic upon pancreatic cancer treatment (CONTACT Study): a UK national observational cohort study
Authors: Hall Lewis , McKay Siobhan , Halle-Smith James , Soane Joshua , Osei-Bordom Daniel , Magill Laura , Pinkney Thomas , Radhakrishna Ganesh , Valle Juan , Corrie Pippa , Roberts Keith 
Published: December 2022

Abstract

Background
The SARS-CoV-2 pandemic has had an unprecedented impact on healthcare systems, and cancer patients were amongst the most vulnerable. CONTACT is a national multidisciplinary study assessing the impact of the SARS-CoV-2 pandemic upon diagnostic and treatment pathways among patients with pancreatic ductal adenocarcinoma (PDAC).

Methods
A novel, mixed prospective and retrospective design, with retrospective case identification of both cohorts, and trainee-performed data collection. The treatment of consecutive patients with newly diagnosed PDAC from a pre-COVID cohort (07/01/2019–03/03/2019) were compared to a cohort diagnosed during the first wave of SARS-CoV-2 in the UK (‘COVID’ cohort, 16/03/2020–10/05/2020), with 12-month follow-up.

Results
Among 984 patients (pre-COVID: n=483, COVID: n=501), across 96 hospitals, the COVID cohort were less likely to receive staging investigations other than CT scan (148/501, 29.5% vs 180/486, 37.2%; p=0.01). Among patients treated with curative intent, there was a reduction in the proportion of patients recommended surgery (42/77, 54.5% vs 72/94, 76.6%, p=0.001) and increase in the proportion recommended neoadjuvant therapy (35/77, 45.5% vs 22/94, 23.4%, p=0.002). Among patients within a non-curative pathway, fewer patients were recommended (201/424, 47.4% vs 223/389, 57.3%, p=0.004) or received palliative therapy (87/424, 20.5% vs 103/389, 26.5%, p=0.045). Ultimately, fewer patients in the COVID cohort underwent resection surgery (29/501, 6.4% vs 45/483, 9.3%, OR 0.64, 95%CI: 0.37–0.97, p=0.036), whilst more patients received no treatment whatsoever (347/501, 69.3% vs 286/483, 59.2% p=0.009). There was no difference in median survival between the COVID and pre-COVID cohorts, (105 days, IQR: 86–124 vs 130 days, IQR: 108–157, p=0.093).

Conclusions
The CONTACT study confirms alarming reduction in the staging and treatment provided to patients with PDAC diagnosed during the SARS-CoV-2 pandemic. Restoration of cancer services to pre-pandemic standards must be urgently addressed.
HPB P65 Resection margin status and five-year survival following pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Authors: Russell Thomas , Labib Peter , Aroori Somaiah 
Published: December 2022

Abstract

Background
Fit patients with a resectable cancer affecting the pancreatic head may be offered pancreatoduodenectomy (PD). Although this remains the only curative intent treatment option, few patients achieve long-term survival as early disease recurrence is common. This study aimed to investigate the correlation between resection margin status and five-year survival in PD patients whose postoperative histology confirmed pancreatic ductal adenocarcinoma (PDAC).

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 postoperative histology suggestive of PDAC were identified and compared to one another by their resection margin status. Five-year survival rates were compared using Fisher's exact test.

Results
A total of 885 patients had PDAC (59.6%) and 798 of these (90.2%) had resection margin data available. Of these, 393 (49.2%) had no positive margins (R0), 403 (50.5%) had at least one positive resection margin (R1), and 27 (3.4%) had an incomplete resection where tumour was knowingly left in situ at the time of surgery (R2). Five-year survival was 30.0%, 16.9% and 14.8% in those with R0, R1 and R2 disease, respectively. Patients with R0 disease had significantly higher five-year survival compared to those with R1-2 disease (30.0% vs 16.7%, p&lt;0.00001).

Conclusions
In our multicentre international study of PD patients, almost half of all those with PDAC had no positive resection margins. Whilst these patients had improved outcomes compared to those with at least one positive margin, less than a third achieved five-year survival.
HPB P69 Minimally invasive versus open management of chronic pancreatitis - A systematic review
Authors: Kourdouli Amar , Garceae Giuseppe 
Published: December 2022

Abstract

Background
Surgical treatment for chronic pancreatitis (CP) is usually performed via an open approach through drainage (pancreaticojejunostomy) or resection (pancreaticoduodenectomy, Beger) procedures or a combination of both (Frey's procedure). Minimally invasive (laparoscopic, robotic) management for patients with CP represents a technical challenge. The aim of this systematic review is to report the outcomes of these minimally invasive procedures among themselves and compare them with reported data from the literature for open procedures.

Methods
A systematic literature search using Embase and Medline was performed to identify articles reporting CP.

Results
Twelve studies with 186 patients undergoing a laparoscopic procedure for their intractable abdominal pain caused by their CP. Sixty-six-point six percent of patients (n=124) underwent a laparoscopic drainage procedure while 33.3% (n=62) had a partial or total resection of their pancreas. Total pain relief was achieved in 66.7–100% following laparoscopic pancreatojejunostomy, 93% following laparoscopic Frey's procedure, 90% following laparoscopic total pancreatectomy and islet transplantation and 70% following laparoscopic distal pancreatectomy.

Conclusions
Laparoscopic procedures for CP are safe and feasible for a carefully selected group of patients. However, more robust comparisons are required between laparoscopic and open approaches in the form of multi-centre randomised controlled trials.
OGC P11 Recurrent laryngeal nerve injury after oesophagectomy: incidence, management and clinical sequelae
Authors: Chien Siobhan , Gall Lewis , Khan Khurram , Craig Carol , MacKay Colin , Macdonald Andrew , Forshaw Matthew 
Published: December 2022

Abstract

Background
Recurrent laryngeal nerve palsy (RLNP) resulting from injury during the cervical-stage of oesophagectomy is a recognised complication that can be associated with significant morbidity. This study aimed to investigate the incidence of RLNP within our local practice, to describe its management, short- and long-term sequelae.

Methods
Consecutive patients undergoing transhiatal oesophagectomy or 3-stage oesophagectomy with cervical anastomosis for both benign and malignant disease within a single UK regional centre between 1 January 2010 and 31 December 2019 were included from a prospectively collected database. Electronic records were interrogated and patients dichotomised into two groups – postoperative RLNP (paresis or paralysis) compared to no RLNP.

Results
182 patients were eligible for analysis. 33 patients (18.1%) developed RLNP after oesophagectomy. Patients with RLNP were significantly more likely to develop postoperative pneumonia (57.6% vs. 34.2%; p=0.017) and ARDS (9.1% vs. 0.7%; p=0.019), and were more likely to require ICU admission (30.3% vs. 14.8%; p=0.044). They were also found to have a longer length of hospital stay (24 vs. 15 days; p=0.001). 18 patients (54.5%) with RLNP required ENT review with 3 patients (9.1%) requiring vocal cord collagen injection. After a median 34 months (IQR 21.75-67) follow-up, 36.4% (12/33) patients had made a full and 42.4% (14/33) patients had made a partial recovery.

Conclusions
Judicious surgical technique in an attempt to avoid initial RLN injury, as well as proactive involvement of SALT and ENT specialists when injury does occur, are vital to reduce the significant pulmonary morbidity associated with this common complication of oesophagectomy.
OGC P25 Outcomes of Laparoscopic Vs Open Oesophagectomy in a single high volume centre
Authors: Hossain Tanvir , Jackson Andrew , Youssef Fady , Trotter Martin , Yanni Fady , Zanotti Daniela , Catton James , Welch Neil , Vohra Ravi , Parsons Simon L 
Published: December 2022

Abstract

Background
Oesophageal cancer has a poor 5 year survival and surgery is the mainstay of curative treatment for the majority of cases. Minimally invasive surgery is practiced in a number of formats (open thorax/open abdomen, open thorax/lap abdomen, thoracoscopic/lap abdomen) and its benefits have been subject to a number of trials.

Methods
We interrogated a prospectively recorded database of oesophagogastric cancer surgery from a large single centre to compare oesophagectomy cases performed with curative intent comparing laparoscopic abdomen plus open thorax versus a totally open operation. Transhiatal oesophagectomies were excluded. Baseline data was compared to establish whether groups were equally matched and outcomes of length of stay, any complication, anastomotic leak, number of lymph nodes yielded, 30 day mortality and 90 day mortality were subject to statistical analysis. Missing data was not imputed.

Results
Sixty-nine hybrid oesophagectomies (laparoscopic abdomen, open thoracic phase) and 373 totally open procedures were performed between January 2017-May 2022. Both groups were equally matched in terms of age, performance status, ASA, tumour site, gender ratio and histology. LOS was 11.6 vs 13.5 (lap vs open / days), P=0.72. Complication rate was 33.3% v 37.3% (lap vs open) P= 0.53. Anastomotic leak rate was 10.1% vs 8.9% (lap vs open) P=0.73. Number of lymph nodes yielded was 25.8 ± 2.17 vs 24 ± 0.59 (lap vs open, mean ± s.e). Thirty day mortality was 2.9% vs 2.17% (lap vs open) P=0.66. Ninety day mortality was 7.25% vs 4.19% (lap vs open) P=0.27.

Conclusions
This 5 year dataset of equally matched laparoscopic abdominal phase vs totally open oesophagectomy procedures shows no statistically significant difference in the outcomes that were measured. The laparoscopic approach would be expected to inflict a lesser stress response than open surgery. Oesophagectomy along with possible complications may inflict a stress response that masks the benefits from laparoscopic surgery. This data supports the notion that the laparoscopic abdomen approach is not inferior to an open procedure. Interrogation of a larger 10 year dataset would be worthwhile to confirm this. Furthermore, this current study may be merely be reflective of the learning curve for the laparoscopic approach and a prospective study of our practice will be worthwhile.
OGC P32 Prognostic impact of clinicopathological features following metastectomy for metachronous pulmonary metastasis from oesophageal cancer: a systematic review and meta-analysis
Authors: Prasad Pooja , Nevins Edward J , Brown Joshua , Phillips Alexander W 
Published: December 2022

Abstract

Background
Disease recurrence following treatment for oesophageal cancer (OC) remains common despite incremental gains from receipt of neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive OC treatment. Clinicopathological features of the primary oesophageal tumour have implications on the development of metastatic disease and overall survival. This systematic review sought to identify the prognostic impact of clinicopathological features of the primary oesophageal tumour following treatment of metachronous pulmonary metastasis from OC.

Methods
A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the clinical and pathological features of the primary OC tumour among patients undergoing treatment for metachronous pulmonary metastasis were included. A random effects meta-analysis model was used to compare the impact of gender (male vs female), primary OC pathological T-stage (pT1/2 vs pT3/4) and pathological N-stage (N0 vs N1+), on 5-year survival following pulmonary metastectomy.

Results
Seven non-randomised studies comprising 110 patients undergoing pulmonary metastectomy for metastatic OC were included. Gender did not have an impact upon 5-year survival (Risk Ratio (RR) =0.65; 95% confidence interval(CI):0.37–1.15; p=0.14). A lower primary OC T-stage (T1/2) was associated with improved 5-year survival following pulmonary metastectomy compared to advanced T-stages (T3/4), though this did not reach statistical significance (RR= 1.76; 95% CI:0.96–3.20; p=0.07). The absence of nodal disease (N0) in the primary disease did not confer a survival benefit over those patients with nodal involvement (N1+) proceeding to pulmonary metastectomy (RR= 1.45; 95% CI:0.86–2.46; p=0.18).

Conclusions
Patient gender and pathological T- and N-stages of the primary tumour do not impact upon prognosis following metastectomy for metachronous pulmonary metastasis from OC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the treatment of the primary oesophageal tumour, limiting outcome assessment.