bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P11 Ex vivo human pancreatic cancer avatars; establishing a platform to evaluate chemotherapeutic sensitivity
Authors: Hughes Daniel , Willenbrock Frances , Reddy Srikanth , Udupa Venkatesha , Silva Michael , Soonawalla Zahir , Mukerjee Somnath , O'Neill Eric 
Published: December 2022

Abstract

Background
A significant variation is observed in the response rate to chemotherapy amongst patients with pancreatic cancer. Current guidelines advocate treatment regimes based purely on the patient's level of fitness. Such an approach fails to acknowledge the individual's tumour biology. Our aim was to assess whether patient derived cancer avatars could be used to deliver personalised therapy.

Methods
Individual avatars were created from resected tumours and were cultured ex vivo either under novel perfusion culture conditions or conventional static culture. Serial assessment of avatar proliferation capacity and metabolic function was performed to determine viability over time. Avatars were treated with chemotherapy and treatment sensitivity was determined. Avatar response to chemotherapy was subsequently compared to the patient's response in order to determine whether the patient's avatar could predict a clinically meaningful response to therapy.

Results
Patient derived cancer avatars (n=13) were successfully cultured for 12 days ex vivo. Perfusion culture of avatars was associated with a preservation of proliferative capacity (p &lt; 0.01), metabolic function (p &lt; 0.01) and a reduction in apoptosis rates (p &lt; 0.05) when compared to conventional static culture. Avatars were treated with Gemcitabine and different response rates were observed varying from treatment sensitivity to resistance. A positive correlation was noted between the avatar's response and the patient's clinical response whilst on adjuvant Gemcitabine therapy.

Conclusions
Patient derived cancer avatars provide a window of insight into the tumour's response to chemotherapy and may allow for a paradigm shift in the long-term survival rates for this disease.
HPB P14 Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma
Authors: Pande Rupaly , Chughtai Shafiq , Ahuja Manish , Brown Rachel , Dasari Bobby , Marudanayagam Ravi , Mirza Darius , Roberts Keith , Sutcliffe Robert , Isaac John , Chatzizacharias Nikolaos 
Published: December 2022

Abstract

Background
Para-aortic lymph node (PALN) involvement is staged as metastatic disease but the literature is conflicting with no consensus on management. Aim: To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for PDAC.

Methods
A retrospective cohort study of prospectively maintained data of pancreatectomies for PDAC between 2011–2020. Statistical comparison between PALN+ and PALN- subgroups, using Kaplan-Meier and Cox regression analysis.

Results
81 cases had PALN sampling, 17 (21%) were positive. OS and DFS were comparable between PALN+ and PALN- patients (OS: 13.2 vs 18.8 months, p=0.161; DFS: 13 vs 16.4, p=0.179). No difference in OS or DFS was identified between PALN+ and PALN- patients when they received chemotherapy (neoadjuvant or adjuvant). On the contrary, when patients did not receive chemotherapy, PALN disease had substantially shorter OS (5.5 vs 14.2 months; p=0.015) and DFS (4.4 vs 9.8 months; p&lt;0.001). PALN involvement was not identified as an independent predictor for OS after multivariable analysis, while it was for DFS doubling the risk of recurrence.

Conclusions
PALN involvement does not affect OS when patients complete the multimodal treatment pathway and should not be considered as a contraindication to resection.
HPB P16 Impact of Frailty on Short-term Outcomes after Laparoscopic and Open Hepatectomy
Authors: Hall Lewis , Osei-Bordom Daniel , Hodson James , Joshi Kunal , Austen Luke , Bartlett David , Isaac John , Mirza Darius , Marudanayagam Ravi , Roberts Keith , Dasari Bobby , Chatzizacharias Nikolaos , Sutcliffe Robert 
Published: December 2022

Abstract

Background
Although laparoscopic hepatectomy (LH) is associated with improved short-term outcomes compared to open hepatectomy (OH), it is unknown whether frail patients also benefit from LH. The aim of this study was to evaluate the impact of frailty on postoperative outcomes after LH and OH.

Methods
Consecutive patients who underwent LH and OH between January 2011 and December 2018 were identified from a prospective database. Frailty was assessed using the modified Frailty Index (mFI), with patients scoring mFI ≥ 1 deemed to be frail.

Results
Of 1826 patients, 34.7% (N=634) were frail and 18.6% (N=340) were elderly (≥ 75 years). Frail patients had significantly higher 90-day mortality (6.6% vs. 2.9%, p&lt;0.001) and postoperative complications (36.3% vs. 26.1%, p&lt;0.001) than those who were not frail, effects that were independent of patient age on multivariate analysis. For those undergoing minor resections, the benefits of LH vs. OH were similar for frail and non-frail patients. Length of hospital stay was 53% longer in OH (vs. LH) in frail patients, compared to 58% longer in the subgroup of non-frail patients.

Conclusions
Frailty is independently associated with inferior postoperative outcomes in patients undergoing hepatectomy. However, the benefits of laparoscopic (compared to open) hepatectomy are similar for frail and non-frail patients. Frailty should not be a contraindication to laparoscopic minor hepatectomy in carefully selected patients.
HPB P21 Surgery for peri-hilar cholangiocarcinoma: The Liverpool hepatobiliary unit experience
Authors: Gilbert Timothy , Bird Nicholas , Quinn Marc , Diaz-Nieto Rafael , Jones Robert , Fenwick Stephen , Malik Hassan 
Published: December 2022

Abstract

Background
Surgery for perihilar cholangiocarcinoma (pCCA) offers the only possibility of long-term survival but remains a formidable undertaking associated with significant post-operative morbidity and mortality. We aim to share our experience of managing these complex patients within a high-volume UK centre.

Methods
A retrospective review of a prospectively maintained database was performed on all patients who underwent resection for pCCA at our unit between 2009–2021. Kaplan–Meier analysis was used to estimate overall and disease-free survival (OS/DFS). Post-op complications were graded using the Clavien-dindo classification and reported as minor (Grade1/2) or major complications (Grade3/4).

Results
102 patients underwent surgery for pCCA at our unit between 2009–2021. The majority of patients required pre-operative biliary drainage via ERCP and metal stent insertion. Following MDT and CPEX assessment eligible patients underwent an initial staging laparoscopy followed by curative resection. 30% of patients required a PVE to increase the proposed functional liver remnant volume prior to surgery. The majority of patients (76%) had Bismuth-Corlette IIIA/B or IV disease necessitating a major liver resection along with radical bile-duct resection. Post-op morbidity rates were high with 42% experiencing a major (grade3/4) complication. Of these patients 14 individuals subsequently died culminating in a 90-day mortality rate of 13.7%. Median LOS was 11 days (IQR 5–59). Median OS for the entire cohort was 36.3 months (CI:26.7–45.8) with a nominal 5-year survival rate of 34.6%. 40% of patients received adjuvant chemotherapy post-op. During follow up 59% of patients suffered disease recurrence with a median DFS of 20.1 months (CI: 11.5–33.5). The administration of palliative chemotherapy upon recurrence was associated with an improvement in survival of 11 vs 5.3 months (HR 3.5 p 0.01).

Conclusions
Surgery for pCCA remains a significant undertaking for both patient and clinician with high rates of morbidity and mortality. Long term survival is achievable but recurrence rates remain a challenge. Overall our mortality, morbidity and survival rates are comparable to that reported in other Western centres.
HPB P22 The stepwise implementation of robotic HPB program in a single UK centre; a continuum of practice
Authors: Ogbemudia Ann , Mastoridis Sotiris , Chadha Radhika , Lakunina Lana , Gordon-weeks Alex , Udupa Venkatesha , Reddy Srikanth , Silva Michael , Soonawalla Zahir 
Published: December 2022

Abstract

Background
Since the first documented use of a robot for surgery in 1985, there has been a rapid global adoption of this technology. Hepatobiliary and pancreatic (HPB) surgery centres worldwide are increasingly sharing their robotic experiences, testing its potential to become a new standard for surgery. We are among the small number of known robotic HPB programs in the UK and here describe our stepwise implementation and share our learning curve.

Methods
We performed a retrospective review of our prospective database of robotic HPB surgeries carried out by two surgeons from the start of the program in September 2021 up to May 2022. Metrics analysed included surgery console times and 30-day patient perioperative outcomes. Results are shown as mean +/- std unless stated otherwise.

Results
There were 53 cases performed in 8 months. For all cases mean patient age was 58 years (range 26–82 years), BMI was 27.3 ± 4.3 Kg/m2 and docking time was 3.20 ± 0.97 minutes.
There were 2 defined performance phases; early practice which included the following cases - marsupialisation of liver cysts (n = 7), cholecystectomies (n = 22) and radical cholecystectomies (n = 5). Intermediate practice followed when no decrease in console time was observed, and patients’ safety was maintained, and cases included liver wedge resections (n = 9) and distal pancreatectomies (n = 10).
Mean console time for marsupialisation of liver cysts was 39 ± 0.01 minutes, cholecystectomies 44 ± 0.01 minutes, radical cholecystectomies 109 ± 0.01 minutes, liver wedge resections 87 ± 0.04 minutes and distal pancreatectomies 153 ± 0.03 minutes. Length of stay for distal pancreatectomies was 6.8 ± 2.2 days and liver wedge resections 2.3 ± 1.1 days.
There was 1 conversion to open, 1 reoperation and 3 readmissions. There were 9 postoperative complications Clavien-Dindo grade I (n=1), grade II (n=5), grade IIIa (n= 2) and grade IIIb (n= 1). The rate of pancreatic fistula (International Study Group of Pancreatic Fistula classification grade B) was 3% (n=3), there were no 30-day mortalities.

Conclusions
Our outcomes show acceptable safety metrics during the implementation our HPB robotic program. Only after evaluating our learning curve and patients’ outcomes in each performance phase do we progress to the next phase, which for our program is the complex phase and includes pancreaticoduodenectomy and more complex liver resections.
HPB P24 Comparison of outcomes of Deb-TACE in patients with HCC larger than 5cm compared with HCC less than 5cm
Authors: Youssef Fady , Fouad Mina , Jackson Andrew , Hossain Tan , Aravinthan Aloysious , Sanyal Sudip 
Published: December 2022

Abstract

Background
Transarterial chemoembolization (TACE) improves survival in cirrhotic patients with intermediate-stage hepatocellular carcinoma (HCC). Drug-eluting bead (Deb)-TACE is associated with a reduction in liver toxicity and drug-related adverse effects compared with chemotherapy-TACE. This retrospective paired cohort study compares the outcomes of DEB-TACE in patients with HCC greater than and less than 5 centimeters.

Methods
Sixty-nine patients had Deb-TACE as the primary treatment for HCC over a 3-year period from May 2019 -to May 2022. Patients were paired into two unmatched groups according to tumour size. Group A; tumour size &gt; 5cm and group B tumour size &lt; 5cm. Each group was then compared following a single or repeated treatment of Deb-TACE. Tumour response was evaluated using the standardised modified Response Evaluation Criteria in Solid Tumours (mRECIST) to detect evidence of tumour size regression. Patients were classified as having either a complete response (CR), partial response (PR), stable disease (SD),or progressive disease (PD). Also, any adverse outcomes including hepatic decompensation were recorded

Results
Group A,(34.48%) 10 patients had a single session of Deb-TACE. Post-treatment surveillance showed that 4 patients (44.44%) showed CR, PR in 2 patients (22.22%), SD in 1 patient (11.11%), 2 patients (22.22%) had PD, one patient was still waiting for his follow-up surveillance. On the other hand,(65.52%)19 patients had repeated sessions, CR was evident in 2 patients (10.5%), PR in 1 patient (5.2%), SD in 3 patients (15.7%), PD in 2 patients (10.5%), 7 patients (36.84%) had initial PR followed by CR, 2 patients (10.5%) showed initial SD then PD and finally 2 patients (10.5%) were PR and became PD.
Group B, 18 (45%) patients had single Deb-TACE, Patients showing CR were 7(58.3%), PR was detected in 2 patients (16.67%), one patient (8.33%) had SD, 2 patients (16.67%%) showed PD, and 6 patients were still waiting for their surveillance, no response recorded for them. (55%) 22 patients had repeated Deb-TACE sessions. 3 patients(13.6%) showed CR, PR were 4 patients (18.18%), one patient (4.5%) had SD, PD were 6 patients (27.27%). However, 3 patients (13.6%) were PR then showed CR,3 patients (13.6%) were PR became PD and finally 2 patients (9%) were PD became CR.

Conclusions
DEB-TACE is effective for HCCs &gt; 5cm with a response rate of 66.67% in patients who had a Single DEB-TACE dose as their first treatment and it increased to 79% in patients who had repeated deb-TACE; however, that was not statistically significantly different (P = 0.48). The Patients group who had HCC &lt;5 cm showed responses up to 83% with single-dose compared to 59% for repeated DEB-TACE, this was not statistically significant with (P = 0.25) . There was no difference in complications between the two groups.
HPB P25 Incidence of pancreatitis induced vascular complications in a tertiary care hospital
Authors: Shameem Fathimath Jila , Ghazanfar Mudassar 
Published: December 2022

Abstract

Background
Pancreatitis (AP) is a common cause of hospital admission, which can lead to vascular complications such as splanchnic venous thrombosis (SpVT), pseudoaneurysm and haemorhage. These complications can happen with both acute and chronic pancreatitis and can be associated with high morbidity and mortality.
The aim of this study was to assess incidence of vascular complications in acute pancreatitis patients in a tertiary care hospital. Secondary aims included describing patient demographics, length of hospital stay, critical care admission, mortality, and assess the association between SpVT and pancreatic necrosis and mortality.

Methods
This study was done as part of year five elective project in University of Aberdeen Medical School. A retrospective study of acute pancreatitis patients who stayed in Aberdeen Royal Infirmary (ARI) or Dr. Gray's Hospital for ≥2 weeks and cases of mortality from acute pancreatitis irrespective of hospital stay between January 2018 to December 2019.
Cases were identified from Health intelligence central data as per local governance protocol. Hospital electronic system (TrackCare) was used to review the clinical and radiological details and data was entered in SPSS software version 27 for analysis. Frequencies and percentages were shown for the categorical data and chi square test was used to compare the variables. A p value less than 0.05 was taken as statistically significant.

Results
Total 293 patients were admitted with acute pancreatitis during the study period. 52 patients met the inclusion criteria for our study.
Of the 52 patients, 50 patients had a CT scan. There were 12 patients (24%) with evidence of vascular complications. 22% of patients had SVT and pseudoaneurysm was seen in 2% of cases. There was no case of haemorrhage. The overall mortality from AP during the study period was 6.5%. There was no statistically significant association between SVT and pancreatic necrosis or mortality.

Conclusions
Splanchnic venous thrombosis was a more frequent complication compared to pseudoaneurysm and haemorrhage in AP. There was no association between SVT and necrosis or mortality.
HPB P30 What is the Impact of Neoadjuvant Chemotherapy on Survival after Palliative Procedures for Pancreatic Ductal Adenocarcinoma?
Authors: Halle-Smith James , Roberts Keith 
Published: December 2022

Abstract

Background
Neoadjuvant chemotherapy (NAT) is increasingly offered to patients before attempting resection of pancreatic ductal adenocarcinoma (PDAC), most often to downstage locally advanced tumours but may also potentially control existing micrometastases. Unfortunately, curative resection may still not be possible in these patients. Therefore, the aim of this study was to evaluate the impact of neoadjuvant therapy on outcomes after palliative procedures for unresectable PDAC.

Methods
All patients who underwent a palliative procedure for PDAC between 2014–2020 were identified from our prospectively collected and maintained institutional database. Relationships between demographics, perioperative variables, chemotherapy and postoperative survival were explored.

Results
131 patients were suitable for inclusion, of which 15 patients received neoadjuvant chemotherapy (12%). The most common reason for palliative procedure was local invasion (50%) and the most common palliative procedure was combined gastrojejunostomy and hepaticojejunostomy (55%). The NAT group were significantly younger (63 years vs. 70 years; p=0.012) but other demographic information was similar. There was no significant difference in overall survival between the NAT and no NAT groups (p=0.216). Significant independent predictors of 6-month survival were palliative chemotherapy (PC) (p&lt;0.001) and locally advanced disease being the reason for unresectability (p=0.037), compared to liver or peritoneal metastases. PC was the only independent predictor of 12-month survival (p&lt;0.001).

Conclusions
NAT does not appear to significantly influence survival after palliative procedure for PDAC; PC remains the main factor determining survival. Low patient numbers in the NAT group reduce the statistical power of the present study, so multicentre collaborative studies are required to further investigate this important question.
HPB P31 Early Postoperative Anthropometric and Nutritional Measures Correlate with Fitness for Adjuvant Chemotherapy after Pancreatoduodenectomy
Authors: Halle-Smith James , Carnegy Alasdair , Loo Joan , Roberts Keith 
Published: December 2022

Abstract

Background
Adjuvant chemotherapy (AC) improves survival after pancreatoduodenectomy (PD) for periampullary cancer. Unfortunately, not all PD patients are fit for AC, and it is likely that perioperative malnutrition plays a role. Therefore, the aim of this study was to investigate the relationship between early postoperative anthropometric and nutritional measures with fitness for adjuvant chemotherapy after PD.

Methods
All patients undergoing PD for periampullary cancer between 2018–2020 at our institution were reviewed. Those who were referred for AC were included in the study and split into two groups: those who received AC and those who were not fit enough to receive AC. Demographic, perioperative, anthropometric, nutritional and outcome measures were compared between the two groups.

Results
66 patients were suitable for inclusion in the study, of which 15 (23%) were not fit for AC. Overall survival was significantly greater in the AC group (29.7 months vs. 16.7 months; p=0.037). Body mass index (BMI) was similar between the groups at admission but during inpatient stay dropped significantly more in the no-AC group (-1.34 kg/m2 vs. -0.10 kg/m2; p=0.035). BMI was also significantly lower at first follow-up (3–4 weeks after surgery) in the no-AC group (20.2 kg/m2 vs. 25.2 kg/m2; p=0.018). Albumin was similar between the two groups on admission and discharge. However, at first follow-up albumin was significantly lower in the no-AC group (31 g/L vs. 38 g/L; p=0.019). There was no difference in postoperative complications between the two groups.

Conclusions
BMI and albumin in the early postoperative period appear to be significantly related to fitness for adjuvant chemotherapy. By routinely measuring these values and intervening in those struggling with nutrition postoperatively before their first Oncology appointment, it may be possible to increase the proportion of patients fit enough to receive AC, and thus improve survival after PD. BMI and albumin have some limitations so future work should concentrate on more reliable measures such as body composition measures.
HPB P34 Complexity alone is not an indication for resection of liver cysts
Authors: Al-Khafaji Nadeem , Abdalkoddus Muhammad , Wong Newton , Roach Huw , Skipworth James , van Laarhoven Stijn , Abbadi Reyad 
Published: December 2022

Abstract

Background
Most cystic liver lesions are simple biliary cysts (SBC) and have no malignant potential. Surgical deroofing may be indicated if symptomatic. Mucinous cystic neoplasms (MCN) represent less than 5% of liver cysts but can progress to mucinous cystadenocarcinoma and therefore require formal liver resection. While an MCN would demonstrate complex features on imaging, SBC may have similar appearances following episodes of infection or bleeding. CT, MR and US scans therefore have low positive predictive value for MCN, and most complex cystic liver lesions represent SBC. As a result, the decision to resect a complex cyst can be difficult for both patients and clinicians. We aimed to review our practice.

Methods
Patients treated surgically for cystic liver lesions in a tertiary Hepatobiliary (HPB) centre between 2016 and 2019 were identified. Data on preoperative imaging, patient demographics, histology and follow up were obtained retrospectively.

Results
18 patients were treated surgically for liver cysts. Cysts were solitary in 3/18 cases. Eight were classified as complex on preoperative radiology. Five (all were complex and one was solitary) underwent formal liver resection and the remaining 13 were deroofing procedures. Patients who underwent liver resection were significantly more likely to have an asymptomatic liver cyst (4/5 vs 0/13, chi Squared, p&lt;0.01). None of the resected specimens represented MCN, and complex characteristics on imaging were attributed to episodes of bleeding or infection. 14/18 patients were followed up for a median of 9 months (range: 2–36) without major adverse events.

Conclusions
Surgical risks of liver resection must be balanced against likelihood of future malignancy. Cyst complexity alone is not an indication for resection and selected cases can be fenestrated if there are no other features to strongly suggest MCN, such as being solitary or in the absence of history suggesting cyst haemorrhage or infection