Author: Jason Curtis

Life Expectancy of Octogenarians Following EVAR (2023)

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Type of publication:
Conference abstract

Author(s):
*Sultana E.; *Seraj S.; *Jones S.

Citation:

British Journal of Surgery. Conference: ASiT Surgical Conference 2023. Liverpool United Kingdom. 110(Supplement 7) (pp vii183), 2023.

Abstract:
Background: The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients. Method(s): A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October 2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using the SPSS software to calculate a Kaplan-Meier curve. Result(s): 294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median: 75); 87.4% were male. 169 patients died during follow up (n = 64 >=80 years, n = 105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0 – 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1 – 152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p = 0.017). Median years post-EVAR for >=80 years was 3.02 – 4.98 and <80 years was 5.12 – 6.87. Conclusion(s): Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be considered when discussing elective options with patients and their relatives.

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Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis (2024)

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Type of publication:
Journal article

Author(s):
*Papoutsis, Dimitrios; *Underwood, Martyn; *Parry-Smith, William; Tzavara, Chara.

Citation:
Archives of Gynecology & Obstetrics. 2023 Oct 11.

Abstract:
BACKGROUND: There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. OBJECTIVES: To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. SEARCH STRATEGY: We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023. SELECTION CRITERIA: Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included. DATA COLLECTION AND ANYSIS: Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. MAIN RESULTS: There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74). CONCLUSION: Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.

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The Short- and Long-Term Safety and Efficacy Profile of Subtotal Cholecystectomy: A Single-Centre, Long-Term, Follow-Up Study (2023)

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Type of publication:
Journal article

Author(s):
*Bodla, Ahmed Salman; *Rashid, Muhammad Umair; *Hassan, Maleeha; *Rehman, Saad; *Kirby, George.

Citation:
Cureus. 15(8):e44334, 2023 Aug. [epub ahead of print]

Abstract:
Background Subtotal cholecystectomy (STC) has been reported as an effective method to remove the gallbladder if the hepatocystic triangle anatomy is unfavourable. However, the evidence regarding its long-term outcomes from the United Kingdom (UK) is lacking. This study aimed to assess its short and long-term outcomes with a minimum of one-year follow-up. Methodology We retrospectively analysed all elective and emergency STCs performed in a single UK NHS Trust between 2014 and 2020. Relevant data were collected using electronic patient records and questionnaire-based, long-term, telephonic follow-up (median follow-up of 3.7 years). Outcomes examined were immediate/short-term complications (biliary injury, bile leak, return-to-theatre) and long-term problems (recurrent symptoms, choledocholithiasis, cholangitis/pancreatitis). Results There were a total of 50 STC cases (58% females) out of 4,341 cholecystectomies performed (1.15%), with the median age, body mass index, and length of stay being 69.5 years, 29 kg/m2 and eight days, respectively. Twenty-eight (56%) were emergency. No patient endured bile duct injury. Seven (14%) patients had postoperative bile leak which was significantly more common when Hartmann's pouch was left open (33% vs. 8%; p = 0.03). No bile duct injury was reported. Most were managed conservatively (endoscopic retrograde cholangiopancreatography + stent: four; radiological drainage: one; no intervention: one). Only one patient required laparoscopic lavage and drainage. The true incidence of developing choledocholithiasis over the long term was 4/50 (8%) in our study. The median interval between STC and the diagnosis of postoperative choledocholithiasis was 15.9 months. All four patients had undergone type 1 STC (where the remnant of Hartmann's pouch was closed with sutures); however, subsequent cross-sectional imaging (magnetic resonance cholangiopancreatography or computed tomography) showed that the gallbladder remnant was visible in only two of these four patients. Conclusions STC is a safe option in difficult situations and prevents bile duct injury. Although the risk of bile leak can be reduced by closing Hartmann's pouch remnant, this may slightly increase the risk of subsequent stone formation. Infrequent occurrence of recurrent gallstone-related symptoms or complications favours its use

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Pleural-based giant solitary fibrous tumour with associated hypoglycaemia: unusual presentation with pulmonary hypertension in a patient with Doege-Potter syndrome (2023)

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Type of publication:
Journal article

Author(s):
*Gohir, Qasim; Ghosh, Shilajit; *Bosher, Olivia; Crawford, Emma; *Srinivasan, Koottalai; *Moudgil, Harmesh

Citation:
Clinical Medicine, Sep2023; 23(5): 518-520.

Abstract:
Refractory hypoglycaemia in a patient with a solitary fibrous tumour (SFT) is very rare and was first reported in 1930 independently by Doege and Potter, leading to it being named 'Doege–Potter syndrome'. Here, we report the unusual case of a 77-year-old woman with a giant solitary fibrous pleural tumour who presented with complicating pulmonary hypertension and associated heart failure with hypoglycaemia, and subsequently underwent curative resection of the pleural mass with clinical improvement.

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Patients' frailty and co-morbidities do not affect short-term mortality following emergency colorectal cancer surgery (2023)

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Type of publication:
Journal article

Author(s):
*Mak, Richard; Deckmann, Nico; Collins, Danielle; Maeda, Yasuko.

Citation:
The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh & Ireland. February 2024, 22(1):52-59

Abstract:
AIM: To investigate the effects of frailty and co-morbidities on short and medium-term outcome following emergency colorectal cancer surgery. METHODS: Data of patients who underwent emergency colorectal cancer operations between January 2013 and December 2016 were reviewed retrospectively. Collected data included demographic and operative variables, clinical frailty scale (CFS), Charlson comorbidity index (CCI) and cause of death with minimum 3 years follow-up. RESULTS: Three-hundred and six patients (median age 72, range 18-100 years) underwent emergency colorectal cancer surgery; Some 74 (24.2%) patients had metastatic cancer at the time of emergency surgery, 77 (25.2%) were frail (CFS >=4), while 118 (38.6%) were comorbid (CCI of >=8). Thirty-day mortality was 4.2% (13 patients) and a further 12 patients died within 90 days (8.2%). By 1 year 73 (23.9%) patients had died, and by 3 years 151 (49.3%) patients died. Frailty did not impact 30-day mortality (6.5% vs 3.5%, p = 0.26) but frail patients (CFS >=4) had a higher mortality rate at 90 days (16.9% vs 5.2%, p < 0.05), 1 year (37.7% vs 19.2%, p < 0.05) and 3 years (61.0% vs 45.4%, p < 0.05). Similarly, higher comorbidity (CCI >=8) did not impact 30-day mortality (5.9% vs 3.2%, p = 0.25), but they had a higher mortality rate at 90 days (14.4% vs 4.3%, p < 0.05), 1 year (40.7% vs 13.3%, p < 0.05), and 3 years (76.3% vs 32.4%, p < 0.05). CONCLUSION: Thirty-day mortality after emergency colorectal cancer surgery in frail and comorbid patients are similar to that of the general population.

Should gastric band slippage be managed with laparoscopic unclipping and re-clipping? (2023)

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Type of publication:
Conference abstract

Author(s):
*Maharaj G.; *Jain R.; *Riera M.

Citation:
14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023

Abstract:
INTRODUCTION: Laparoscopic Adjustable Gastric Band (LABG) is a popular bariatric procedure. Gastric band slippage is a recognised complication. Treatment options include band removal or unclip. Subsequent re-clip/reposition of a previously unclipped band may provide further weight loss. This study aims to examine patient outcomes following un-clipping of slipped gastric bands. METHOD(S): Electronic Records of patients who underwent gastric band unclipping during a ten year period were examined. RESULT(S): 11 female patients underwent gastric band unclipping, five as emergencies. Nine patients (82%) had confirmed band slippage/pouch dilatation. Mean age at unclip was 46.5yrs. Median duration band insertion to unclip was 7yrs (range 3-11yrs). 8 patients underwent subsequent band reclip/reposition. 1 patient had attempted re-clip converted to removal. Median duration unclip to re-clip was 9months (range 4-14months). 3/8 patients with re-clipped bands had no further procedures and maintained weight loss. Of the remaining five patients, two had early removal because of acute dysphagia on days-2 and 5 post re-clipping. The other three patients eventually suffered further slippage and band intolerance. Median duration re-clip to band removal 2yrs (range 0-4yrs). Two patients were never re-clipped (one had symptomatic removal, the other is awaiting a further procedure). In total, seven bands were removed (64%). Four of these patients suffered significant weight regain, with two requiring revisional surgery. CONCLUSION(S): This study is small. However 64% of patients who underwent gastric band unclipping had subsequent removal. Hence gastric band unclipping does not appear to provide added benefit to patient care, and exposes them to additional procedures.

A Case of the Cascade Stomach; Laparoscopic Sleeve of Fundoplication (2023)

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Type of publication:Conference abstract

Author(s):*Davies S.; *Maharaja G.; *Riera M.

Citation:14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023

Abstract:A Case of the Cascade Stomach; Sleeve of Fundoplication Introduction The cascade stomach is a long standing known entity often referred to as 'cup and spill deformity' but very little is known on the management of these cases particularly surgically. Cases often present with acid reflux and vomiting due to the physiological and anatomical deformity of the stomach and are subsequently referred to the benign upper gastrointestinal/bariatric surgeon to manage. Surgical options reported in the literature are sparse but include gastropexy, laparoscopic sleeve gastrectomy and laparoscopic fundoplication. Methods We present this unusual condition as a case report, discuss the challenges in management and propose surgical management options. Conclusion Although rare this cases propose a challenge to the benign UGI surgeon as currently there is very little in the literature to support best management options. This unusual case was managed with a laparoscopic Nissen's fundoplication and we further propose that this should potentially be the standard recognised course of treatment in these cases due to the pathophysiological nature of this condition and the functional process which often leads to these patients to be high risk of acid reflux.

Improving the care of patients with obesity needing joint replacement - time for a combined ortho-bariatric approach? (2023)

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Type of publication:Conference abstract

Author(s):Sinha Y.; Ikram S.; Ballinger T.; Gouveia S.; Burak M.; Wiggins T.; *Bathgate S.;

Citation:Obesity Surgery. Conference: 14th Annual Scientific Meeting of British Obesity and Metabolic Surgery Society, BOMSS 2023. Birmingham United Kingdom. 33(Supplement 1) (pp S129), 2023. Date of Publication: July 2023.

Abstract:Introduction Patients with obesity awaiting joint replacement surgery of the lower limbs may benefit from referral to weight-management services. (1) NICE provides BMI criteria for referral to tertiary bariatric services, however this does not always translate into clinical practice. (2, 3) Our aim was to assess the number and management of patients with obesity attending orthopaedic clinics for consideration of lower limb joint replacement. Methods A retrospective analysis was undertaken of all patients attending orthopaedic clinics for joint replacement secondary to osteoarthritis, in the lower limbs, at a single centre, over a two year period. Details of demographics, BMI, comorbidities and management plans were recorded from electronic patient records. Results 335 patients (60% of 558 cases) had BMI recorded and were used for subsequent analysis. 36% (n=120) of patients were eligible for referral to weight-management services. 10% (n=32) were refused joint replacement surgery due to BMI, of which 81% (n=26) were eligible for referral to weight-management services. Instead of surgery, these 32 patients were offered: physiotherapy (n=10, 38%), analgesia (n=12, 46%), non-specific weight-loss advice (n=16, 62%), GP referral for weight-loss (n=6, 23%), and tertiary service referral for weight-loss (n=2, 8%). Conclusions BMI is an important risk factor for orthopaedic operations and increased efforts should be made to record it pre-operatively. An MDT approach would capture the notable proportion of patients who are not being appropriately referred to weight-management services which may impact on their quality of life and postoperative outcomes.

Retrospective multicentre study comparing survival outcomes in chronic lymphocytic leukaemia (CLL) with genetic risk stratification (2023)

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Type of publication:Conference abstract

Author(s):Qureshi I.; Mandal A.; Foster N.; Rose S.; Sharma K.; McIlroy G.; *Cherian G.; *Lane S.; Wandroo F.; Talbot G.; Pemberton N.; Parry H.; Moss P.; Paneesha S.

Citation:British Journal of Haematology. Conference: 63rd Annual Scientific Meeting of the British Society for Haematology. Birmingham United Kingdom. 201(Supplement 1) (pp 67-68), 2023. Date of Publication: April 2023.

Abstract:Purpose: This retrospective West Midlands multicentre study of CLL patients was conducted to review results of genetic testing in CLL patients and impact on survival. Method(s): 349 patients across the West Midlands were included in this retrospective study collected between December 2018 and March 2022. Clinical centres were asked to obtain data relating to the type and number of lines of treatment, overall response and reported genetic abnormalities. Treatment and response were categorised as per international workshop on chronic lymphocytic leukaemia (iwCLL) criteria.1 Genetic testing comprised fluorescence in situ hybridisation (FISH) for copy number abnormalities of 17p &11q, IgHV mutation status and Oxford Gene Technology CLL Next-Generation Sequencing (NGS) Panel to detect sequence variants in key genes associated with CLL (including NOTCH1, SF3B1, BIRC3, ATM and TP53). Patients were risk stratified into good, poor or not poor risk categories as per Rodriguez-Vicente et al.2 Statistical Analysis and Results: For 349 patients analysed, 143 (41%) patients were under active surveillance, and 206 (59%) patients received 1st line treatment. Out of the 206 patients that received 1st line treatment, 92 (44%) patients proceeded to 2nd line treatment, 31 (15%) patients proceeded to 3rd line treatment and 21 (10%) of patients required treatment beyond 3rd line Within the poor risk category, 173 patients were identified with 38 had TP53 deletion or mutation and 135 patients had other poor risk mutations such as NOTCH1, SF3B1, ATM. Statistical analysis did not show a difference in survival either from the diagnosis or from the date of NGS sample in the two groups of high-risk patients. Conclusion(s): The data identifies a cohort of patients with poor outcome that are negative for TP53 mutation, highlighting the importance of NGS in CLL patients at the point of treatment.

Acoustic Times or . . . Scan you believe it! - A quality publication. Ultrasound governance: communicating standards during a pandemic (2023)

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Type of publication:Conference abstract

Author(s):*Brown H.

Citation:Ultrasound. Conference: 53rd Annual Scientific Meeting of the British Medical Ultrasound Society. Cardiff United Kingdom. 31(2) (pp NP32), 2023. Date of Publication: May 2023.

Abstract:Introducing new governance processes into a multisite ultrasound department during a pandemic led to the re-thinking of the models of communication used to share governance objectives. The introduction of peer review audit can be challenging for staff. Clear communication is vital to ensure staff are not threatened by the process and are able to use it as a learning opportunity to shape their practice and development, thereby improving patient safety. A monthly newsletter Acoustic Times was introduced to explain the processes and changes giving the opportunity to provide the evidence base and links to national guidance. Peer review audit and learning meetings were introduced and held virtually across sites to identify and share any individual or group learning points. Processes and documents were either redesigned or introduced, with supporting rationale and evidence provided through the newsletter including: evidence based protocols; standard setting; peer review audit, including supporting learning outcomes and CPD; actionable reporting; preceptorship; service user feedback; and equipment QA. Further supported learning was provided on critical reflection, specific focus on technical aspects of clinical examinations, sharing of external learning events, CPD and inhouse ultrasound training. Benefits of the newsletter include: more focus on improving consistency of practice and setting standards; faster reporting of audit findings and reaudits; and improved engagement with consultant colleagues. It also provides an accessible record of the development of governance processes which has been shared with sonographers in other organisations. Setting and communicating clearly defined quality standards and protocols is key to the design of safe working practices and patient safety in healthcare environments.1 Open and honest governance processes with clear, accessible and useable documentation are key in staff engagement and ownership of quality improvement.