bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU3.1 Effect of COVID-19 on stoma formation rates in elective left sided colorectal cancer resections
Authors: ElZanati Hisham , Zohdy Mohamed , Samuel Sajanee , Marimuthu Kalimuthu 
Published: November 2022

Abstract

Aims
The primary aim of the study was to assess the effect of COVID-19 on rate of stoma formation in elective left sided colorectal cancer resections. Other possible effects of COVID-19 on the management of these patients were explored too.

Methods
Retrospective review of elective left sided colorectal cancer resections over a 2 years period. Patients were divided into 2 groups, Pre-COVID (4/2019–3/2020) and Post-COVID (4/2020–3/2021) There were 43 resections in the Pre-COVID group and 21 resections in the post-COVID group

Results
Patient demographics were comparable in both groups. There was a 30% reduction in total number of colorectal cancer resections and 50% reduction in left sided resections. There was a 3 fold increase in patients not anastomosed primarily post-COVID (from 20.5% to 61%). There was a 2 fold increase in patients ending up with a stoma including patients undergoing primary anastomosis but with defunctioning stomas(from 38.4% to 72.2%). Procedures completed laparoscopically were more or less comparable in both groups. Conversion rate was slightly higher in the post-COVID group (from 14.3% to 21%).

Conclusion
Significant increase in stoma formation in the post COVID group most likely due to guidelines from the royal college early in the pandemic but other possibilities include delay in treatment. More studies are required as the pandemic continues to explore this further and determine whether this was justified and to enable us to adapt to the new normal and assess whether we can return safely to our pre-COVID practice without compromising patient outcomes or adding to their morbidity.
TU3.2 Has Covid-19 Pandemic affected the management of patient's with colorectal cancer?
Authors: Gumaa Duaa , Agrawal Aarushi , Akhtar Mansoor 
Published: November 2022

Abstract

Introduction
Patients on the cancer pathway should be investigated on the 2 weeks wait pathway, but Covid-19 pandemic had universal impact on the Healthcare systems. One of the main worries was the impact on cancer patients due to delayed diagnosis and management. Our study looks at the timeframe of investigations for colorectal cancer during the second wave of the pandemic compared to pre covid time.

Method
Retrospective study looking at the waiting time to investigate patients with +ve qFIT test during the second wave of pandemic (from November 2020 till March 2021).

Results
During this period 150 patients had +ve qFIT test, the main presenting symptom was Change in bowel habits. 90 patients were investigated with colonoscopy, only 16 (17%) patients had the colonoscopy done within 2 weeks from the qFIT result. 23 patients had colonoscopy 2–3 weeks from the result. 30 patients (33%) had the colonoscopy between 3–4 weeks, and 21 patients had to wait between 1–6 months to have the colonoscopy.
Out of the 150 patients, 60 patients were investigated primarily with CT scan or CT colon.

Conclusion
During the covid-19 pandemic, majority of patients in our trust were investigated within one month of +ve qFIT test but yet there was some delay in carrying out the investigations compared to the normal pathway and more patients had CT scans as primary investigations before being referred for colonoscopy.
TU3.4 A relook into the effects of Covid-19 on emergency theatre utilisation
Authors: Rizkalla Nagy , Khalid Ayesha , Merrit Jack , Khaliq Abdual , Khaira Harmeet 
Published: November 2022

Abstract

Background
In 2020 we assessed changes in delivery of emergency surgeries due to the pandemic in a local district general hospital. Significant delays in emergency theatre utilisation were partly abrogated with the early introduction of a second emergency theatre so that Covidpositive, negative and unknown cases could be operated in series (and occasionally in parallel) with minimal disruption.

Aims
We aimed to re-audit emergency theatre utilisation later on during the pandemic to assess the effects of having more established protocols and following recommendations from our first audit.

Methods
Retrospective study of all emergency theatre cases performed during the month of July 2021 compared with previously presented November 2020. Parameters of theatre utilisation included: sending times, anaesthetic times, operating times, recovery time in theatre and total recovery time

Results
The mean time taken to send for patients from wards decreased by 27% in late pandemic versus early (n=110 vs 111, p=1.25*10–7); this was also an improvement on pre-pandemic figures by 17%. Anaesthetic time decreased by 31% (p=0.0001, n=110 vs 111). Recovery time required in theatre decreased by 26% (p = 0.06, n=110 vs 111). Total recovery time however increased by 19% (p=0.097, n=110 vs 111).

Conclusion
Improved Covid testing and testing protocols have most likely had a positive impact on theatre utilisation by reducing sending times, anaesthetic times and recovery times in theatre.
Increases in total recovery time are likely a by-product of increased elective work.
TU3.5 Increasing stoma requirements during the COVID-19 pandemic
Authors: Kumaran Naren , Vijayaregu Vishal , Abdelqader Bushra , Chang Wen Yuan , Sangal Sam , Polson Robin 
Published: November 2022

Abstract

Aims
The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact.

Methods
All patients diagnosed with colorectal cancer in the authors’ tertiary surgical unit in three 4-month intervals were included. These corresponded to before the pandemic (March–June 2019), during the UK's first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The incidence of stomas was compared between groups.

Results
In patients undergoing elective surgery the incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during the first wave and increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.

Conclusion
A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
TU3.6 Surgical training salvage during COVID-19: a hospital quality perspective
Authors: Luton Oliver , Mellor Katie , Eley Catherine , Lewis Wyn , Egan Richard 
Published: November 2022

Abstract

Introduction
Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during the COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance.

Materials and Method
Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 50 HSTs (median age 36 (range 29–46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA).

Results
During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p&lt;0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p&lt;0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p&lt;0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p&lt;0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015).

Discussion
Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.
TU3.8 Advice and Guidance: an effective communication tool between primary and secondary care in the COVID era?
Authors: Radnaeva Irina , Ward Stephen 
Published: November 2022

Abstract

Introduction
Advice and Guidance is a digital communication tool that allows primary care physicians to seek advice from secondary care clinicians prior or instead of direct referrals.

Aims
Our audit aims to analyse the number of Advice and Guidance e-referrals made to General Surgery consultants at the Queen Elizabeth Hospital Birmingham and measure the outcomes of those conversations in order to determine the usefulness and value of the given platform as well as analyse the timescale of the replies.

Methods
We have retrospectively analysed the outcomes of all the referrals to General Surgery made via Advice and Guidance platform between July 2020 and September 2021. The responses were categorised into 7 different outcomes, main ones being “outpatient clinic referral”, “further investigation required”, “advice from a different specialty is needed” and “advice on management only”. Time taken to reply to the referrals was also analysed.

Results
At total of 2244 referrals were included in this audit. 61% of the referrals were deferred to outpatient clinic for further review, 18% required further investigations, in 10% advice only was given and 8% were referred to a different specialty. Time taken to reply to a referral was 5 days on average.

Conclusions
Advice and Guidance is an appropriate tool that allows direct communication between GPs and General Surgical consultants and is set to reduce the number of unnecessary outpatient clinic referrals made. This in turn reduces pressure on the already stretched secondary care system, especially in the ongoing COVID-19 pandemic.
TU4.2 Robotic surgery for colorectal cancer: a single-center experience
Authors: Butnari Valentin , Mansuri Ahmer , Kaul Sandeep , Huang Joseph , Nirooshun Rajendran 
Published: November 2022

Abstract

Aim
To present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH.

Methods
We report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay.

Results
The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III.
The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM.

Conclusion
We report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.
TU4.4 ‘Nurse led Colorectal 2ww clinic’: Impact on early assessment and faster diagnosis of colorectal cancer
Authors: Chowdhury Ashim , Shrestha Anuj , Williams Larissa , Aravind Biju , Basnyat Pradeep , Shrestha Ashish 
Published: November 2022

Abstract

Background
Colorectal cancer (CRC) is the second most common cancer death in the UK with a 5-year relative survival rate is 57%, which has improved over the last 30 years. Early detection of the cancer has a great impact on its prognosis. In our large district general hospital, we receive GP 2 week pathway referrals for suspected CRC with an average monthly referral of 726. Therefore, the aim of this study is to assess if recently introduced nurses led colorectal rapid access clinic has any impact on early assessment that can facilitate faster diagnosis.

Method
A retrospective analysis of a prospectively collected data of the patient referred through a 2-week colorectal clinic pathway from outpatient referral system, was carried out from April, 2021 to November, 2021. Patient feedback and clinician advice and guidance were also evaluated in the same period.

Result
A total of 900 patients were reviewed in our Nurse led clinic with CRC detection rate of 2% approximately. Final diagnosis of cancer been made within the 28th day. Increment of 21% was seen in referrals per month. Optimal slots of 195/week are required but the nurse led clinic capacity is only 40/week. Despite the increased referral, patients are being provided with results within day 13 with positive feedback from the patients.

Conclusion
Despite of overwhelmed referrals, final diagnosis is provided within 28 days. Nurse Led Colo-rectal Clinic could be the answer to relieving the capacity, financial pressures and providing high quality safe patient care for our already strained NHS.
TU4.5 qFIT test: the future of colorectal cancer investigation
Authors: Agrawal Aarushi , Gumaa Duaa , Akhtar Mansoor 
Published: November 2022

Abstract

Introduction
Colorectal cancer is one of the most common cancers. In 2013 in the UK, 41,112 people were diagnosed with colorectal cancer and 15,903 people died from it.
The qFIT(quantitative faecal immunochemical test) is now widely used in the National Bowel Cancer Screening Program (NBSCP). It is also a good test to identify symptomatic people at higher risk of having a diagnosis of colorectal cancer. We present single center experience with Q fit testing.

Methods
Retrospective cohort study performed in a large district general hospital looking at the outcome of patients with +ve qFIT test (≥10 micrograms).

Results
Over the period from July 2020 till November 2021, over 2000 patients had qFIT tests to investigate red flag lower GI symptoms. Out of the 2000 patients, 448 patients had +ve qFIT. Over 70% of the patients Referred by the GP with Change in bowel habits, the test was organized by the hospital not the primary care.
260 patients were investigated with colonoscopy, 17 patients had histology confirming colorectal cancer. 172 patients were not fit enough for colonoscopy and were investigated with CT colon/CT, only 3 patients out of this group had features suggesting colorectal cancer on the CT scan.

Conclusion
20 out of 448 patients were diagnosed with colorectal cancer, the rest of the patients had either benign colorectal polyps or diverticular disease. As the qFIT test is now more widely used, it needs to be organised by the primary care centers to speed up the process of diagnosis and management.
TU4.6 Comparison between the outcome of patient's with qFIT&gt;120 and patients with qFIT&lt;120.Can qFIT&lt;120 be considered a negative test??
Authors: Agrawal Aarushi , Gumaa Duaa , Akhtar Mansoor 
Published: November 2022

Abstract

Introduction
When FIT is used for symptomatic patients presenting to primary care a positive result is considered ≥10 mcgHb/gStool. When qFIT is used for the asymptomatic screening population (i.e NBCSP) a positive result is ≥120mcgHb/gStool.
During covid-19 Pandemic the 120 cut off was used in some of the hospitals to triage patients who require further investigations for either colonoscopy or CT scan.

Methods
Retrospective cohort study done in general district hospital comparing the pathology identified in patients with Qfit results&gt;120 and patients with result &lt;120.

Results
In the period between July 2020 and November 2021, 448 patients had +ve qFIT result (≥10 micrograms).In the first group, 340 patients had qFIT result &lt;120. 191 patients had colonoscopy with 8 confirmed colorectal cancer, and 137 patients had CT/CT colon with only 1 patient was found to have colorectal cancer. Overall 2.6% of the patients had cancer.
While in the second group, 108 patients had qFIT&gt;120. 69 patients had colonoscopy with 9 confirmed cancer. the rest of the patients had CT/CT colon with 2 patients showing features of malignancy. Overall 10.1% of the patients had cancer.

Conclusion
The incidence of colorectal cancer in patients with qFIT result &gt;120 is much higher than the other group, but the incidence of colorectal cancer in patients with qFIT&lt;120 is still significant and the patients shouldn't be discharged without investigations.
TU4.8 An Analysis of Rectal Cancer Patient Treatment and Outcomes in a large NHS Trust
Authors: Hamer Natalie , Hand Rebecca , Kaur Japsimar , Thambi Prem , Wadd Nicholas , Jha Madan 
Published: November 2022

Abstract

Introduction
Rectal cancer (RC) is a common cancer in the UK. Treatment options include surgery, chemotherapy, radiotherapy or a combination of these in the form of neoadjuvant or adjuvant treatment.

Aim
To analyse the treatment type and outcomes of our RC patients.

Methods
We performed an analysis of prospectively collected data on patients diagnosed with RC between Jan-2013 and Dec-2020 in our trust. Details included demographics, histology, staging, treatment and mortality. Twenty patients out of 1202 were excluded due to missing information leaving 1182 for further analysis.

Results
404 patients did not receive resectional surgery due to patient choice (30), inoperability of the tumour (259), or co-morbidity (115).
A total of 778 patients were found to have operable disease with TNM staging as follows; Stage1–291, Stage2–231, Stage3–217, Stage4–39. Among them 302 went on to receive neo-adjuvant treatment of which 67 (22.2%) had a complete response to treatment (ypT0). The remaining 476 patients received primary surgery; 268 did not require any additional treatment and 199 went on to have adjuvant chemo/radiotherapy. Nine patients had further intervention due to incomplete resection or disease recurrence.
The majority of the tumours were adenocarcinomas (97%). Other types included; malignant melanoma, neuroendocrine tumours, and squamous cell carcinomas. The overall 1-year and 5-year mortality for the group receiving primary surgery were 5.0% and 20.4%. In the neoadjuvant group these were 3.6% and 20.9%.

Conclusion
We present data from a large NHS trust demonstrating a multimodal approach which has enabled us to achieve good overall outcomes.
TU4.9 Major elective colorectal surgery at a non-acute site: is it safe or not?
Authors: Hammoudeh Zaid , Williams Gethin , Codd Rhodri 
Published: November 2022

Abstract

Introduction
Recent reorganisation resulted in elective surgical services being separated from emergency facilities due to a new hospital site in our Health Board. Clinicians were initially concerned with regards to postoperative complications and the potential need for transfer to the acute site (6 miles away) for ongoing emergency management. There are no ICU or emergency theatre facilities at the cold site. We audited the first year of the service reconfiguration.

Methods
This study looked at unexpected transfer of major colorectal surgical patients occurring between December 2020 to 2021 from the elective hospital to the acute site. The prospectively maintained departmental database was interrogated.

Results
There were 263 patients undergoing colorectal operations over 12 months. 31 patients (12%) required step-up to the acute hospital for further post-operative care. 10 returned to theatre (4 anastomotic leaks, 1 anastomotic bleed, 1 fluid collection washout, 3 SBO, 1 stoma revision). The remaining 21 patients were managed conservatively by the surgical team (8) or taken over by the medical team (13). The main surgical reason for step-up was due to anastomotic leakage (7). Other step-up reasons included cardiorespiratory compromise (9), infection (6), bowel obstruction (3) and bleeding (2). Median time for transfer was day 4 (range 0–11 days) postoperatively. No transfer delay causing harm was reported. The 30-day mortality rate for all 263 patients was 0%.

Conclusion
Transfer to the acute site seems to have been safe, timely and effective in its first year. Patients have received appropriate and emergency care for these unpredictable complications.
TU4.10 Short term outcomes of patients undergoing transanal total mesorectal excision versus robotic low anterior resection
Authors: Jaskani Sadia , Khan Aftab , Kukreja Neil 
Published: November 2022

Abstract

Introduction
Robotic Low anterior resection has a potential benefit because of its technical difficulty to access the narrow pelvic cavity. The aim of the study was to compare short-term outcomes of patients who underwent TaTME versus Robotic TME for low rectal cancers.

Methods
Retrospective analysis of cases from a single institution was undertaken. Data including demographics, operative details, inpatient complications, and clinical outcomes were collected from patients' notes. Comparative analysis between the two groups was performed using non-parametric statistical tests.

Results
The total sample size was 35 patients who underwent low anterior resection at a single center. Of the 17 patients who had Laparoscopic Transanal Total mesorectal excision (LLAR), (15 LLAR + 2 RLAR converted to LLAR), and Robotic Low anterior resection (RLAR) was performed in 18 patients. Mean age in both groups was comparable (66.5±9.93). There was no significant difference in patient demographics in both groups including Gender (Males 88.2% vs 61.1%), ASA grade, BMI (29.4), and WHO status. There was a statistically significant difference in tumor height from anal verge between both groups, mean LLAR 13.78cm, RLAR 7.5cm (p-value 0.04). There was no difference in circumferential resection margins (p-value 0.366) and number of lymph nodes harvested (mean LLAR 17 vs RLAR 20). Post-operative margins (R0) were positive in 3/17 patients in LLAR group and 1/18 patients in RLAR group (p-value 0.261). There was no difference in post-operative calvin-dindo complication rate and hospital readmission rate.

Conclusion
There was no significant difference identified in clinical and short term oncological outcomes between the two groups