bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGC P16 What is the prevalence of weight loss in patients undergoing oesophago-gastric surgery and the effect of dietetic intervention pre-op
Authors: Mair Reena , Farah Hafsa 
Published: December 2022

Abstract

Background
Patients with oesophago-gastric (OG) cancer are one of the highest risk groups for malnutrition. Nutrition plays a vital role in supporting this patient group. NICE guidelines (2018) recommend adults with OG cancer have tailored specialist dietetic support before, during and after radical treatment. Unfortunately the research available suggests there are low rates of preoperative dietetic input in this population, which are associated with poorer outcomes.

Methods
Data was obtained via informatics looking at patients who had an oesophagectomy or total gastrectomy between the years of March 2018 –2020 and were followed up at the Queen Elizabeth Hospital Birmingham. A sample of 66 patients was taken. Data was collected on the surgery type, weight changes and whether there was any dietetic input before and / or after surgery.

Results
79% (52) patients had an oesophagectomy and 21% (14) had a total gastrectomy.
Weight loss across all patients post-surgery was apparent post op at 3, 6 and 12 months. Clinically significant weight loss (&gt;10%) was demonstrated at 3 months (27%), 6 months (17%) and 12 months (26%). Unfortunately data was not available for 20% (6 months) and 36% at (12 months).
Only 16 (24%) patients were known to a dietitian pre-op. Out of these 8 (50%) had a feeding tube inserted pre-operatively, 7 of the patients used the tube for enteral feeding. 5 (31%) were seen for oral nutrition support and 3 (19%) for food first approach.
100% of patient had a feeding tube inserted following surgery.
100% of patients had been seen by a dietitian post op both as an inpatient and outpatient.
The percentage of patients seen by a dietitian prior to surgery that had clinically significant weight loss post-op was less than those that were not seen by a dietitian pre op (ie 19% vs 24% at 6 months respectively).

Conclusions
Patients that undergo OG surgery experience clinically significant weight loss postoperatively. The data collected highlights that dietetic input pre-op can lead to less weight loss following surgery. Additional dietetic funding and the set up of a pre-treatment clinic would enable more patients to be seen prior to surgery. Further research needs to be done with a larger sample size over a longer time-frame to provide more representative results on the effects of dietetic input both pre and post surgery.
OGC P17 Surgical and Pathological Outcomes in Patients with a CDH-1 Mutation undergoing Total Gastrectomy: A Systematic Review
Authors: Khiabany Atousa , Kamarajah Sivesh , Liew MeiSien , Griffiths Ewen 
Published: December 2022

Abstract

Background
Patients with CDH1 (E-cadherin) gene mutations have a 60–80% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy may reduce long-term risk of gastric cancers, the associated morbidity and mortality remains unclear. This systematic review aims to characterise postoperative surgical outcomes in patients choosing to undergo a prophylactic total gastrectomy.

Methods
A systematic literature search was conducted for studies reporting endoscopic surveillance, surgical outcomes and quality of life (QoL) for patients with a CDH1 mutation undergoing a total gastrectomy.

Results
A total of 991 patients were looked at across 33 studies, with 96% harbouring a CDH1 mutation (n=948). Seven hundred and seventy six patients had endoscopy results reported across 27 studies, with 72% presenting without evidence of cancer foci (n=555). Of these patients, 60% proceeded to have a total gastrectomy (n=333) and histological analysis revealed cancer foci in 83% of the gastrectomy specimens (n=276). Six hundred and forty nine patients were reported to have a total gastrectomy across 33 studies. Pathology outcomes were reported for 528 patients across 26 studies, of which 87% had pT1aN0M0 disease (n=458). Surgical complications were reported for 406 patients across 20 studies. Only 3 studies reported 0 complications. A total of 188 complications were reported across 17 studies, with the most common presentations being anastomotic strictures (23%), pulmonary complications (13%), wound infections (12%) and anastomotic leaks (11%). A total of 5 mortalities were reported in 23 studies over the follow-up period.

Conclusions
Prophylactic total gastrectomy is recommended for patients with a CDH1 mutation. Currently, reliable endoscopic surveillance is lacking and total gastrectomy remains the definitive method for preventing advanced diffuse gastric cancer. Patients choosing to undergo surgery should be provided with adequate counselling, with careful consideration of the associated morbidity.
OGC P30 Impact of COVID-19 Pandemic on endoscopy services in oesophageal and gastric cancers
Authors: Shenoy Sachin , McColl Gillian , Pickard Colette , Robertson Kevin 
Published: December 2022

Abstract

Background
Introduction: The impact of Covid-19 pandemic on the health services across the world is well documented.

Aim
We wished to determine the impact of the pandemic on the provision of endoscopy services and its effect on oesophageal and gastric cancers in our health board.

Methods
A retrospective analysis of data collected from the major cancer network pathway (MCN) database for patients diagnosed with Oesophageal and Gastric cancers for the NHS Ayrshire and Arran Health board in Scotland was performed. Data was collected for the year 2019 (pre-pandemic) and the year 2020 (pandemic) between 1st of January and 31st December for the respective years.
Number of UGI endoscopy procedures performed, mode of presentation, stage at presentation and treatment intent were primary outcome measures. Data was analysed using stata17 software

Results
Data was recorded in 99 and 91 patients with OG cancers for the year 2019 and 2020 respectively. A total of 4176 and 1763 procedures were carried out during the 2 periods respectively. An increase in emergency presentations from 22 to 46% (p&lt;0.05) was noted during this period. Dysphagia and haemetemesis were the most the common indications for the procedure. A decrease in number of routine/urgent and cancer suspect referrals from 78 to 45% was noted during the period. Only nine percent of the patients were offered radical treatment during the pandemic (from 23 percent). Palliative intent and best supportive care were recorded in 55 and 34% of the patients respectively.

Conclusions
The COVID-19 pandemic has had a significant impact on the endoscopy services and management of oesophageal and gastric cancers with an increase in non-Covid harm due to the pandemic.
OGC P33 Prognostic significance of tumour burden and operative technique 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 neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive OC treatment. Tumour burden influences the surgical approach utilised in the treatment of pulmonary metastasis from OC. In turn, this impacts patient prognosis. This systematic review sought to identify the impact of tumour burden and surgical approach on 5-year survival following metastectomy 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 number of metastatic pulmonary tumours and operative techniques utilised were included. A random effects meta-analysis model was used to compare the impact of number of metastatic pulmonary deposits (single vs multiple), and operative approach (wedge vs anatomical resection) on the 5 year survival of patients following metastectomy for metachronous pulmonary metastasis from OC.

Results
Seven non-randomised studies comprising 142 patients undergoing pulmonary metastectomy for metastatic oesophageal cancer were included. The number of metastatic deposits (single vs multiple) did not affect 5-year survival (Risk Ratio = 1.08; 95% confidence interval 0.58–2.02; p = 0.81). With respect to surgical technique, anatomical resection did not confer a survival benefit compared to wedge resection of pulmonary metastases from OC (Risk Ratio = 1.33; 95% Confidence Interval: 0.81–2.19; p = 0.26).

Conclusions
Tumour burden and surgical technique utilised does not impact upon the prognosis of patients undergoing pulmonary metastectomy for metastatic oesophageal cancer. However, current evidence from smaller non-randomised studies remains weak owing to variation in the clinicopathological features of the primary OC and pulmonary metastasis, limiting outcome assessment.
OGC P39 Absolute lymph node yield &lt;15 is associated with reduced overall survival in patients undergoing oesophagectomy for oesophageal cancer and is an important quality metric
Authors: Bolger Jarlath , Tavakoli Iran , Espin-Garcia Osvaldo , Darling Gail , Yeung Jonathan 
Published: December 2022

Abstract

Background
Surgical resection following neoadjuvant therapy with either chemotherapy or chemoradiotherapy remains the cornerstone of curative management of oesophageal cancer. In spite of this, there remains uncertainty regarding the optimal radicality of lymphadenectomy, and whether increasing lymph node yields confer a true survival benefit. This study aims to assess the impact of lymph node yield and lymph node ratio on survival following surgery for oesophageal cancer, in addition to identifying factors that may influence lymph node yield and radicality of resection.

Methods
Patients in a single centre undergoing oesophagectomy with curative intent from January 1, 2010 to December 31, 2020 were reviewed. Clinical and pathological variables were assessed, with univariable, multivariable, regression and survival analyses performed as appropriate. Regression with cut-point analysis was used to determine the optimal cut-off for lymph node ratio and for minimum number of nodes resected.

Results
Three hundred and ninety-seven patients underwent oesophagectomy in the study period, with 288 of these having a minimally invasive operation (MIE). Stage (stage 3 HR: 1.64 (1.02–2.62), p=0.04, stage 4 HR: 2.50 (1.43–5.01), p=0.001), positive margin status (HR: 2.62 (1.57–4.36), p&lt;0.001), lymph node yield &lt;15 (HR: 2.62 (1.57–4.36), p&lt;0.001) and an elevated lymph node ratio (HR: 8.42 (2.85–24.90, p&lt;0.001) predicted survival. Patients undergoing MIE had higher lymph node yields compared with open procedures (30.7 vs 25.3, p&lt;0.001). Patients undergoing neoadjuvant chemoradiation had lower lymph node yields compared with those with no neoadjuvant therapy and those with neoadjuvant chemotherapy (26.4 vs 30.6 vs 36.8 respectively, p&lt;0.001). Cut-point regression analysis determined lymph node ratio of &lt;0.05 was associated with a survival benefit. Cut-point analysis also demonstrated that resecting more than 15 lymph nodes had an associated benefit, and 15 nodes is the minimum that should be resected, consistent with guidelines.

Conclusions
Lymphadenectomy is a cornerstone of resection of oesophageal cancer. Low lymph node yield and high lymph node ratio are associated with reduced overall survival. A lymph node ratio of &lt;0.05 is associated with significant survival benefit. The minimum number of lymph nodes that should be resected in esophageal cancer is 15, consistent with current guidelines.
OGC P40 The RM Partners Cancer Hub approach to Upper Gastrointestinal Surgery during the COVID-19 pandemic
Authors: Doyle Joseph , Geropoulos Georgios , Patel Nikhil , Patel Pranav , Doran Sophie , Allum William , Jiao Long , Chaudry Asif , Bhogal Ricky , Kumar Sacheen 
Published: December 2022

Abstract

Background
The COVID-19 pandemic led to significant cancellations of major surgery to maximise critical care capacity. Our unit instituted the ‘RM Partners Cancer Hub’ based at the Royal Marsden Hospital in London, which allowed cancer surgery from multiple NHS Trusts to continue in a ‘COVID-lite’ setting. We present the outcomes for Upper GastroIntestinal (UGI) surgery managed via this approach over the course of the pandemic.

Methods
From April 2020 to April 2021, the Royal Marsden Hospital formed the ‘RM Partners Cancer Hub’. This was designed to co-ordinate resources and deliver as much oncological treatment and cancer surgery as feasible for patients across the RM Partners West London Cancer Alliance. An UGI clinical case prioritisation strategy, along with strict infection control pathways and pre-operative screening protocols were adopted.

Results
Overall, 231 patients underwent surgery for confirmed UGI cancer via the RM Partners Cancer Hub, with 213 completed resections and combined 90-day mortality rate of 3.5%. Good short-term survival outcomes were demonstrated with 2-year Disease Free Survival (DFS) and Overall Survival (OS) for oesophageal (DFS 70.8%; OS 72.9%), gastric (DFS 66.7%; OS 83.3%) and pancreatic cancer resections (DFS 68.0%, OS 88.0%). One patient developed peri-operative COVID-19 during the RM Partners Cancer Hub operation; they made a full recovery with no lasting clinical sequelae.

Conclusions
The ‘RM Partners Cancer Hub’ approach provided a workable model for delivering multidisciplinary UGI cancer care and surgery with favourable 2-year DFS and OS when compared to nationally published pre- and post-pandemic data. It also established a template for cancer service during periods of marked disruption to healthcare service delivery and should be a useful guide in the future planning of safe operating pathways.
OGC P41 Long term Outcomes after curative treatment of lower oesophageal squamous cell carcinoma: Single centre study
Authors: Patel Maitreyi , Sharif Mohammad Usman , Amalesh Thangadorai , Mukherjee Dipankar , Mukherjee Samrat 
Published: December 2022

Abstract

Background
Over the past few decades the incidence of squamous cell carcinoma (SCC) of lower oesophagus has decreased slightly. While multimodal therapy for resectable oesophageal cancer has shown definite benefits in management of adenocarcinoma of oesophagus, the ideal therapeutic modality for management of lower oesophageal SCC remains unclear. Worldwide there are a wide variations in the management of lower oesophageal squamous cell carcinoma. Except for a small proportion of patients with early cancers confined to the mucosa, curative therapies for Oesophageal SCC entail either neoadjuvant chemo-radiotherapy (CTRT) followed by oncological resection or radical chemo/radiotherapy. However, there are no clear guidelines to support either modality.
The purpose of this study was to assess various curative treatment modalities for lower oesophageal SCC and analyse the short and long term outcomes.

Methods
Data of patients with histologically proven distal oesophageal SCC treated at a single OG resection Centre in North East London between 2011 and 2021, was retrospectively collected from a prospectively maintained database. All patients were discussed in Upper GI MDT for management plan.The lower oesophagus was defined as distal third of oesophagus below the tracheal bifurcation. In the patients who underwent surgery, post operative complications were recorded according to Clavien Dindo classification.

Results
Between January 2011 to December 2021, 34 patients with lower oesophageal SCC were treated at our Centre. The median age of patients was 72 +/-2 years. 47.06% were females. The median Charlson Co morbidity index was 5. 25 (73.53%) patients received definitive chemo-radiotherapy. 20.58% received neoadjuvant treatment. Overall, 20.58% patients with lower oesophageal SCC underwent surgical resection (Five with neoadjuvant and two i.e. 5.89% went straight for surgery). Median age of patients received definitive radiotherapy was 72+/-9 years as compared to median age of 67+/- 9 years in those who underwent resection. Most patients had stage III disease (16 patients). Severe surgical complications defined as Clavein Dino Grade III/IV occurred in two patients. There were no post operative mortalities. Overall median survival was 24 months. 5-year survival 20.58%. Median survival in patients who received definitive CTRT was 13 +/- 21 months, while those who were operated had a median survival of 72 +/- 39 months.

Conclusions
We reported the management and outcomes of lower oesophageal SCC over a period of 10 years. These findings are limited due to the small number of cases. A multicentre study to assess the management and outcomes of this group of cancer will assist in the future development of guidelines.
Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death
Authors: Mbizvo Gashirai K , Schnier Christian , Simpson Colin R , Duncan Susan E , Chin Richard F M 
Published: December 2022

AbstractThis study aimed to develop a risk prediction model for epilepsy-related death in adults.In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009 and 2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index—the Scottish Epilepsy Deaths Study Score. Odds ratios were estimated with 95% confidence intervals (CIs).Here, 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency attendance (odds ratio 5.1, 95% CI 3.2–8.3), living in deprived areas (odds ratio 2.5, 95% CI 1.6–4.0), developmental epilepsy (odds ratio 3.1, 95% CI 1.7–5.7), raised Charlson Comorbidity Index score (odds ratio 2.5, 95% CI 1.2–5.2), alcohol abuse (odds ratio 4.4, 95% CI 2.2–9.2), absent recent neurology review (odds ratio 3.8, 95% CI 2.4–6.1) and generalized epilepsy (odds ratio 1.9, 95% CI 1.2–3.0). Scottish Epilepsy Deaths Study Score model variables were derived from the first four listed before, with Charlson Comorbidity Index ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points and recent epilepsy-related accident and emergency attendance given 3 points. Compared to having a Scottish Epilepsy Deaths Study Score of 0, those with a Scottish Epilepsy Deaths Study Score of 1 remained low risk, with odds ratio 1.6 (95% CI 0.5–4.8). Those with a Scottish Epilepsy Deaths Study Score of 2–3 had moderate risk, with odds ratio 2.8 (95% CI 1.3–6.2). Those with a Scottish Epilepsy Deaths Study Score of 4–5 and 6–8 were high risk, with odds ratio 14.4 (95% CI 5.9–35.2) and 24.0 (95% CI 8.1–71.2), respectively.The Scottish Epilepsy Deaths Study Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation.
South Asian Americans and anti-Black racism: critically reflexive racialization as an anti-racist vernacular discourse
Authors: Mudambi Anjana 
Published: December 2022

AbstractIn this study, I propose the concept of critically reflexive racialization as a vernacular discourse through which nondominant groups engage critical reflexivity in exploring and renegotiating their racialized identities in relation to other marginalized groups in the struggle against White supremacy. This study is based on my analysis of the discourses of South Asian Americans within the online news magazine American Kahani over the course of a year following the murder of George Floyd. I explore how they (re-)negotiate their racialized identities vis-à-vis Black Americans and in relation to anti-Black racism, critically reflecting on historical, discursive, and structural contexts around Whiteness, caste, and colorism. This study provides a lens into (anti-)racism among the South Asian American community, demonstrating a need for continued research into conversations around race within it and other communities of color.
Plant-based diets for CKD patients: fascinating, trendy, but feasible? A green nephrology perspective
Authors: Torreggiani Massimo , Fois Antioco , Lippi Françoise , Attini Rossella , Longhitano Elisa , Matarazzo Ida , Masturzo Bianca , Cabiddu Gianfranca , Versino Elisabetta , Piccoli Giorgina Barbara 
Published: December 2022

ABSTRACTClimate change is inducing us to rethink our way of life. There is widespread awareness that we need to adopt environmentally friendly approaches and reduce the amount of waste we generate. In medicine, nephrology was one of the first specialties to adopt a green approach. Plant-based or vegan–vegetarian diets, which are planet-friendly and associated with a reduced carbon footprint, were rapidly acknowledged as a valid method for reducing protein intake in the conservative management of chronic kidney disease (CKD). However, how the transition from an omnivorous to a plant-based diet should be managed is not universally agreed; there is little data in the literature and indications based on randomized trials fail to consider feasibility and patients’ preferences. Nonetheless, in some conditions the use of plant-based diets has proved safe and effective. For example, in CKD pregnancies, it has reduced unfavorable maternal and fetal outcomes. This review will present the available evidence on the benefits of plant-based diets in CKD, as well as old and new criticisms of their use, including emerging issues, such as contaminants, additives and pesticides, from a green nephrology perspective.
What do cancer-specific T cells ‘see’?
Authors: Shah Sabaria , Al-Omari Abdullah , Cook Katherine W , Paston Samantha J , Durrant Lindy G , Brentville Victoria A 
Published: December 2022

Summary
Complex cellular interactions between the immune system and cancer can impact tumour development, growth, and progression. T cells play a key role in these interactions; however, the challenge for T cells is to recognize tumour antigens whilst minimizing cross-reactivity with antigens associated with healthy tissue. Some tumour cells, including those associated with viral infections, have clear, tumour-specific antigens that can be targeted by T cells. A high mutational burden can lead to increased numbers of mutational neoantigens that allow very specific immune responses to be generated but also allow escape variants to develop. Other cancer indications and those with low mutational burden are less easily distinguished from normal tissue. Recent studies have suggested that cancer-associated alterations in tumour cell biology including changes in post-translational modification (PTM) patterns may also lead to novel antigens that can be directly recognized by T cells. The PTM-derived antigens provide tumour-specific T-cell responses that both escape central tolerance and avoid the necessity for individualized therapies. PTM-specific CD4 T-cell responses have shown tumour therapy in murine models and highlight the importance of CD4 T cells as well as CD8 T cells in reversing the immunosuppressive tumour microenvironment. Understanding which cancer-specific antigens can be recognized by T cells and the way that immune tolerance and the tumour microenvironment shape immune responses to cancer is vital for the future development of cancer therapies.