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Publication Breast angiosarcoma surveillance study: UK national audit of management and outcomes of angiosarcoma of the breast and chest wall(Oxford University Press, 2021-03-22) Banks, J; George, J; Potter, S; Gardiner, M D; Ives, C; Shaaban, A M; Singh, J; Sherriff, J; Hallissey, M T; Horgan, K; Harnett, A; Desai, A; Ferguson, D J; Tillett, R; Izadi, D; Sadideen, H; Jain, A; Gerrand, C; Holcombe, C; Hayes, A; Teoh, V; Wyld, L; Royal Devon and Exeter Hospital NHS Foundation Trust; University of Sheffield; Sheffield Teaching Hospitals NHS Foundation Trust; North Bristol NHS Trust; Bristol Medical School; Frimley Health Foundation NHS Trust; University of Oxford; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Surrey and Sussex Healthcare NHS Trust; Leeds Teaching Hospitals NHS Trust; Norfolk and Norwich University Hospital NHS Foundation Trust; Imperial College London; Imperial College Healthcare NHS Trust; Royal National Orthopaedic Hospital NHS Trust; British Association of Plastic, Reconstructive and Aesthetic Surgeons; Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust; Royal Marsden Hospital; Histopathology; Oncology; General Surgery; Surgery; Medical and Dental; Shaaban, Abeer; Sherriff, Jenny; Hallissey, Mike; Desai, AnantBackground: Breast angiosarcomas are rare tumours of vascular origin. Secondary angiosarcoma occurs following radiotherapy for breast cancer. Angiosarcomas have high recurrence and poor survival rates. This is concerning owing to the increasing use of adjuvant radiotherapy for the treatment of invasive breast cancer and ductal cancer in situ (DCIS), which could explain the rising incidence of angiosarcoma. Outcome data are limited and provide a poor evidence base for treatment. This paper presents a national, trainee-led, retrospective, multicentre study of a large angiosarcoma cohort. Methods: Data for patients with a diagnosis of breast/chest wall angiosarcoma between 2000 and 2015 were collected retrospectively from 15 centres. Results: The cohort included 183 patients with 34 primary and 149 secondary angiosarcomas. Median latency from breast cancer to secondary angiosarcoma was 6 years. Only 78.9 per cent of patients were discussed at a sarcoma multidisciplinary team meeting. Rates of recurrence were high with 14 of 28 (50 per cent ) recurrences in patients with primary and 80 of 124 (64.5 per cent ) in those with secondary angiosarcoma at 5 years. Many patients had multiple recurrences: total of 94 recurrences in 162 patients (58.0 per cent). Median survival was 5 (range 0-16) years for patients with primary and 5 (0-15) years for those with secondary angiosarcoma. Development of secondary angiosarcoma had a negative impact on predicted breast cancer survival, with a median 10-year PREDICT prognostic rate of 69.6 per cent, compared with 54.0 per cent in the observed cohort. Conclusion: A detrimental impact of secondary angiosarcoma on breast cancer survival has been demonstrated. Although not statistically significant, almost all excess deaths were attributable to angiosarcoma. The increased use of adjuvant radiotherapy to treat low-risk breast cancer and DCIS is a cause for concern and warrants further study.Publication Racial disparity in curative treatment and survival from solid-organ cancers(Oxford University Press, 2021-04-06) Kamarajah, S K; Sylla, P; Markar, S R; University Hospital Birmingham NHS Trust; Newcastle University Trust Hospitals; University of Birmingham; Icahn School of Medicine at Mount Sinai; Imperial College London; Karolinska Institutet; Surgery; Medical and Dental; Kamarajah, SiveshRace is an important prognostic factor affecting receipt of surgical intervention and survival from cancer in the USA. The findings of this study highlight the importance of implementing changes aimed at narrowing the disparities in outcomes between race in patients with cancers.Publication Perioperative mortality in bariatric surgery: meta-analysis(Oxford University Press, 2021-07-16) Robertson, A G N; Wiggins, T; Robertson, F P; Huppler, L; Doleman, B; Harrison, E M; Hollyman, M; Welbourn, R; NHS Fife; University Hospitals Birmingham NHS Foundation Trust; Royal Infirmary of Edinburgh; Musgrove Park Hospital; University of Nottingham; The University of Edinburgh; Upper Gastrointestinal Surgery; Medical and Dental; Wiggins, TomBackground: Bariatric surgery is an established treatment for severe obesity; however, fewer than 1 per cent of eligible patients undergo surgery. The perceived risk of surgery may contribute to the low uptake. The aim of this study was to determine perioperative mortality associated with bariatric surgery, comparing different operation types and data sources. Methods: A literature search of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies published between 1 January 2014 and 31 July 2020. Inclusion criteria were studies of at least 1000 patients reporting short-term mortality after bariatric surgery. Data were collected on RCTs. Meta-analysis was performed to establish overall mortality rates across different study types. The primary outcome measure was perioperative mortality. Different operation types were compared, along with study type, in subgroup analyses. The study was registered at PROSPERO (2019: CRD 42019131632). Results: Some 4356 articles were identified and 58 met the inclusion criteria. Data were available on over 3.6 million patients. There were 4707 deaths. Pooled analysis showed an overall mortality rate of 0.08 (95 per cent c.i. 0.06 to 0.10; 95 per cent prediction interval 0 to 0.21) per cent. In subgroup analysis, there was no statistically significant difference between overall, 30-day, 90-day or in-hospital mortality (P = 0.29). There was no significant difference in reported mortality for RCTs, large studies, national databases or registries (P = 0.60). The pooled mortality rates by procedure type in ascending order were: 0.03 per cent for gastric band, 0.05 per cent for sleeve gastrectomy, 0.09 per cent for one-anastomosis gastric bypass, 0.09 per cent for Roux-en-Y gastric bypass, and 0.41 per cent for duodenal switch (P < 0.001 between operations). Conclusion: Bariatric surgery is safe, with low reported perioperative mortality rates.