Recent Submissions

  • The Warwick Experience of the Oncotype DX Breast Recurrence Score Assay as a Predictor of Chemotherapy Administration

    Khan, Mashuk Alam; Henderson, Laura; Clarke, Dalayan; Harries, Simon; Jones, Lucie; Khan, Mashuk Alam; Henderson, Laura; Clarke, Dalayan; Harries, Simon; Jones, Lucie; et al. (Karger Publishers, 2018-10-13)
    Introduction: Oncotype DX® analyses the expression of 21 genes within tumour tissue to determine a Recurrence Score® (RS). RS is a marker of risk for distant recurrence in oestrogen receptor-positive early breast cancer, allowing patient-specific benefit of chemotherapy to be evaluated. Our aim was to determine whether the introduction of Oncotype DX led to a net reduction in chemotherapy use. Methods: Consecutive patients that underwent Oncotype DX at Warwick Hospital were reviewed. Patients were anonymised and re-discussed at a multidisciplinary team meeting (MDM; without RS), and treatment recommendations were recorded. This was compared to the original MDM outcome (recommendations made with RS). Differences were analysed using Wilcoxon signed-rank test. Results: 67 patients were identified. Proportions of high, intermediate and low risk were 28, 33 and 39% (n = 19/22/26), respectively. Without RS, 56 (84%) patients were recommended for chemotherapy and 3 were not. The remaining 8 patients were deemed borderline for requiring chemotherapy and referred for discussion with an oncologist. With availability of RS, 34 (50%) patients were recommended for chemotherapy, and 24 (43%) patients were spared chemotherapy (p < 0.0005). The net reduction in chemotherapy was 33%. Conclusion: There has been a significant reduction in chemotherapy usage in patients at Warwick since the introduction of Oncotype DX. Keywords: Chemotherapy; Multigene assay; Oncotype DX; Recurrence Score.
  • Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay : experience of over 1100 patients

    Clarke, D.; Sinha, A.; Ion, L.; Weston, S.; Jones, Lucie; Harries, Simon; Clarke, D.; Sinha, A.; Ion, L.; Weston, S.; et al. (American Association for Cancer Research, 2019-02-15)
    This poster abstract from the 2018 San Antonio Breast Cancer Symposium reports a single institutions's experience of one step nucleic acid assay (OSNA) for the intraoperative assessment of the sentinel node in breast cancer patients.
  • The Impact of TAILORx study on the recommendation of chemotherapy - the Warwick experience

    Sein, Tin; Gerome, Ellen; Harries, Simon; Athwal, Ruvinder; Jones, Lucie; Sein, Tin; Gerome, Ellen; Harries, Simon; Athwal, Ruvinder; Jones, Lucie; et al. (Elsevier, 2019-05)
    This Association of Breast Surgery Conference abstract discusses the impact of the TAILORx Breast Cancer Trial on the recommendation of chemotherapy at Warwick Hospital.
  • One Step Nucleic Acid Amplification Sentinel Lymph Node sampling as a predictor of axillary node status in early invasive breast cancer : a UK single centre experience

    Jerome, Ellen; Sein, Tin; Jones, Lucie; Harries, Simon; Athwal, Ruvinder; Jerome, Ellen; Sein, Tin; Jones, Lucie; Harries, Simon; Athwal, Ruvinder; et al. (Elsevier, 2019-05)
    This Association of Breast Surgery Conference abstract reports a UK single centre experience of using One Step Nucleic Acid Amplification Sentinel Lymph Node sampling as a predictor of axillary node status in early invasive breast cancer.
  • Colorectal cancer diagnosis rate within 3 years of a normal lower gastrointestinal endoscopy : retrospective cohort study

    Yershov, Danylo; Aslam, Imran; Osborne, Martin; Yershov, D.; Aslam, I.; Osborne, M.; General Surgery; Medical and Dental; South Warwickshire University NHS Foundation Trust (Wiley, 2020-09-21)
    This conference abstract from the 15th Scientific and Annual Meeting of the European Society of Coloproctology reports on a retrospective cohort study into the colorectal cancer diagnosis rate within 3 years of a normal lower gastrointestinal endoscopy.
  • Delayed enterocutaneous fistula formation secondary to an inverted non-absorbable suture post midline laparotomy closure

    Yershov, Danylo; Murphy, P.; Ferguson, H.; Yershov, D.; Murphy, P.; Ferguson, H.; Surgery; Medical and Dental; South Warwickshire University NHS Foundation Trust (Wiley, 2020-07-06)
    This Association of Coloproctology of Great Britain and Ireland Annual Meeting abstract reports the case of a delayed enterocutaneous fistula formation secondary to an inverted non-absorbable suture post midline laparotomy closure.
  • Does the pathological response correspond to the apparent radiological response in patients undergoing neoadjuvant chemotherapy?

    Sein, Tin; Asiedu, Yvonne; Amin, Verda; Vatish, Jamie; Athwal, Ruvinder; Harries, Simon; Jones, Lucie; Sein, Tin; Asiedu, Yvonne; Amin, Verda; et al. (Elsevier, 2020-06)
    This abstract from an Association of Breast Surgery 2020 presentation addresses the question of whether the pathological response in patients undergoing neoadjuvant chemotherapy corresponds to the apparent radiological response.
  • Prepectoral immediate implant-based reconstruction using Braxon® acellular dermal matrix - multicentre study from the United Kingdom

    Chandarana, Mihir; Harries, Simon; Parmeshwar, Rishikesh; Harries, Simon; Surgery; Medical and Dental; Royal Infirmary of Edinburgh; South Warwickshire University NHS Foundation Trust; University Hospital of Morecambe Bay NHS Foundation Trust (Elsevier, 2020-06)
    This abstract from an Association of Breast Surgery 2020 presentation reports a UK multicentre study into the use of Braxon® acellular dermal matrix for prepectoral immediate implant-based reconstruction.
  • A single-centre experience of telephone assessment of patients referred to two week-wait colorectal surgery clinics in England

    Woods, P.; Wanigasooriya, Kasun; O'Connor, P.; Sarma, Diwakar R.; Lal, N.; Busby, K.; Ferguson, H.; Woods, P.; Wanigasooriya, K.; O'Connor, P.; et al. (Wiley, 2021-10-03)
    Poster presentation reporting a single-centre experience of telephone assessment of patients referred to two week-wait colorectal surgery clinics in England.
  • Exploring the Role of Self-Motives in Postgraduate Trainees' Feedback-Seeking Behavior in the Clinical Workplace: A Multicenter Study of Workplace-Based Assessments From the United Kingdom

    Gaunt, Anne; Markham, Deborah; Pawlikowska, Teresa; Gaunt, Anne; Markham, Deborah; Pawlikowska, Teresa; Surgery; Medical and Dental; South Warwickshire University NHS Foundation Trust (Lippincott, Williams & Wilkins, 2018-10)
    Purpose To explore trainees’ feedback-seeking behavior in the postgraduate surgical workplace using a self-motives framework. Self-motives include self-assessment “to obtain accurate information about the self,” self-improvement “to improve one’s traits, abilities, and skills,” self-enhancement “to enhance the favorability of self views,” and self-verification “to maintain consistency between one’s central self-view and new self-relevant information.”
  • Investigating the rate of successful day case discharges for laparoscopic cholecystectomies between June-November 2019

    Pancharatnam, Rohan; Abraham, Sheryl; Adeniran, Anjolaoluwa; Candan, Jonathan; Pancharatnam, Rohan Andrew; Abraham, Sheryl; Adeniran, Anjolaoluwa; Candan, Jonathan; Medical and Dental; South Warwickshire University NHS Foundation Trust (Oxford University Press, 2021-04)
    Introduction Laparoscopic Cholecystectomy (LC) is the gold standard treatment for symptomatic gallstones. The British Association of Day Surgery (BADS) recommend that at least 60% of LCs are performed as day cases. We investigated the rate of successful discharge for LCs and factors contributing to unexpected overnight stays. Methods Retrospective data analysis was performed on elective LCs between June-November 2019. Electronic records were reviewed for: admission and discharge date; time of procedure; length of procedure; training grade of the surgeon; use of total intravenous anaesthesia (TIVA) or volatile anaesthesia; use of IV morphine in theatre/recovery and reasons for failed discharge. Results A total of 119 patients underwent elective LC, of which 63 were planned day cases. 46 patients (73.0%) listed as day cases were successfully discharged the same day. LCs performed before 1pm had a success rate of 78.8% compared to 45.5% after 1pm (p < 0.05). There was no statistically significant difference in success rates due to length of procedure; training grade of the surgeon; method of induction (TIVA or Volatile) or use of IV morphine in theatre/recovery. 17 planned day cases failed same day discharge. 7 of these patients (41.2%) reported pain and 4 (23.3%) reported nausea, vomiting or dizziness. Conclusion This centre successfully discharged 73.0% of planned day case LCs, although only 52.9% of elective LCs were listed as day cases. Success rates were positively associated with am procedures compared to pm. We recommend a review of operation scheduling and evening staffing in order to increase the probability of discharge on the same day.
  • The Impact of endoscopic tattooing of colonic cancers on lymph node yield at pathological assessment

    Aslam, Imran; Iqbal, Nasir; Wild, B; Francombe, James; Ramcharan, Sean; Aslam, Imran; Iqbal, Nasir; Wild, B; Francombe, James; Ramcharan, Sean; et al. (Wiley, 2018-10-09)
    Objective: The presence of tattoo at endoscopic assessment of colon cancers prior to resection has been reported to improve lymph node yield at pathological assessment. This study determined if there was a difference at our institution and the factors that may alter the yield when compared to those that were not tattooed.
  • The utility of isotope bone scans in asymptomatic patients with advanced breast cancer.

    Amin, Verda; Sein, Tein; Jones, Lucie; Harries, Simon; Athwal, Ruvinder; Amin, Verda; Sein, Tein; Jones, Lucie; Harries, Simon; Athwal, Ruvinder; et al. (Elsevier, 2021-05)
    A conference poster on the use of isotope bone scans in asymptomatic patients with advanced breast cancer.
  • Multisite ileal and jejunal Crohn's, and the Heineke-Mickulicz strictureplasty

    George, B.; Murphy, P.; Ferguson, H.; Bignell, M.; Lovegrove, R.; Papettas, T.; Patel, A.; Sinha, R.; Murphy, P.; Ferguson, H.; et al. (Wiley, 2022-09)
    The video is a comprehensive teaching video on stricturing small bowel Crohn's for higher surgical trainees looking at the nature, identification, treatment and results of surgery. It is referenced, and includes operative video and stills. It lasts just over 7 minutes.
  • The L!RIC Trial and early surgery for Crohn's

    Hawker, P.; Murphy, P.; Bignell, M.; Ferguson, H.; Lovegrove, R.; Papettas, T.; Patel, A.; Sinha, R.; Hawker, P.; Murphy, P.; et al. (Wiley, 2022-09)
    This is a teaching video for surgical trainees that takes a look at the pros and cons of early surgery for Crohn's disease and the influence of the L!RIC Trial on our thinking. The video is presented by both a surgeon and a gastroenterologist. The video is referenced and contains laparoscopic and endoscopic video as well as stills. The video lasts 4 minutes.
  • The Kono S anastomosis - Surgical technique

    Murphy, P.; Ferguson, H.; Papettas, T.; Sinha, R.; Patel, A.; George, B.; Brignall, M.; Lovegrove, R.; Murphy, P.; Ferguson, H.; et al. (Wiley, 2022-02)
    This video uses a novel mix of surgical cartoon and operative surgery to describe the important steps in the making of a Kono S anastomosis. Areas of difficulty and confusion are highlighted.
  • Spontaneous adrenal hemorrhage. Report of two cases and review of pathogenesis, diagnosis and management

    Charalampakis, Vasileios; Stamatiou, Dimitrios; de Bree, Eelco; Christodoulakis, Manousos; Zoras, Odysseas; Charalampakis, Vasileios; Stamatiou, Dimitrios; General Surgery; Colorectal and General Surgery; Medical and Dental; et al. (Oxford University Press, 2018-06)
    Adrenal hemorrhage represents a relatively rare condition, usually associated with meningococcal septicemia. It is an underestimated cause of acute decompensation, multiorgan failure and death, usually diagnosed post-mortem. Depending on its etiology adrenal hemorrhage is categorized as traumatic and non-traumatic. The technical advancement of imaging modalities, has made diagnosis and management more efficient. Assessment of hemodynamic stability, exclusion of a hormonal active adrenal tumor and assessment for adrenal insufficiency, are of cardinal importance. Angiographic embolization has contributed significantly in better outcomes as emergency laparotomy is associated with high morbidity and mortality rates. Hereby we present two cases of spontaneous adrenal hemorrhage associated with extensive retroperitoneal bleeding and hemodynamic instability. Both underwent angiography with one requiring embolization with favorable outcome. Investigation for exclusion of underlying adrenal tumor, adrenal insufficiency and follow-up imaging are presented in detail for both cases.
  • The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up.

    Charalampakis, Vasileios; Seretis, Charalampos; Daskalakis, Markos; Fokoloros, Christos; Karim, Ahmed; Melissas, John; Charalampakis, Vasileios; General Surgery; Medical and Dental; University of Crete, Greece; South Warwickshire University NHS Foundation Trust; George Eliot Hospital NHS Trust; University Hospitals Birmingham NHS Foundation Trust; Royal Marsden NHS Foundation Trust (Elsevier, 2018-11)
    Background: Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up. Objectives: To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome. Setting: Bariatric Unit, University Hospital of Heraklion, Greece. Methods: Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded. Results: A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study. Conclusions: Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome. Keywords: Long-term follow-up; Quality of life; Sleeve gastrectomy.
  • Correction to: Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

    Griffiths, Ewen A; Hodson, James; Vohra, Ravi S.; Marriott, Paul; Katbeh, Tarek; Zino, Samer; Nassar, Ahmad H. M.; CholeS Study Group; West Midlands Research Collaborative; Marriott, Paul; et al. (Springer, 2019-01)
    The list of the CholeS management group, Collaborators and Data Validators were omitted from the Acknowledgments in: Griffiths EA, Hodson J, Vohra RS, Marriott P; CholeS Study Group; Katbeh T, Zino S, Nassar AHM; West Midlands Research Collaborative. Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc. 2019 Jan;33(1):110-121. doi: 10.1007/s00464-018-6281-2.
  • Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

    Griffiths, Ewen A; Hodson, James; Vohra, Ravi S.; Marriott, Paul; CholeS Study Group; Katbeh, Tarek; Zino, Samer; Nassar, Ahmad H. M.; West Midlands Research Collaborative; Marriott, Paul; et al. (Springer, 2019-01)
    Background: A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods: Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall's tau for dichotomous variables, or Jonckheere-Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results: A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion: We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty. Keywords: Cholecystectomy; Difficulty grading; Laparoscopic; Operative difficulty; Surgery.

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