Castle Hill Hospital Research Articles

A Comparison of Short-Term Outcomes of Robotic-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery Following Lung Cancer Surgery at a Tertiary Hospital in the United Kingdom: A Propensity-Matched Analysis.

Robot-assisted thoracic surgery (RATS) is gaining popularity in lung resection surgeries; however, its quality outcome measures require further evaluation. This study compared the short-term perioperative outcomes of lung resection surgeries performed using RATS and video-assisted thoracic surgery (VATS) at a tertiary hospital in the UK. We performed a retrospective comparative analysis of 496 patients who underwent lung resection surgery at Castle Hill Hospital in the UK between January 2021 and April 2024. In the pre-matched cohort, 162 patients underwent RATS compared to 334 who underwent VATS. Using propensity matching based on the patient's forced expiratory volume in one second (FEV1) percentage of predicted age and body mass index (BMI), we included 324 patients in the analysis. Of these, 162 underwent RATS, and 162 underwent VATS, demonstrating satisfactory performance indicators. The results from our analysis depicted that RATS had a significantly lower rate of prolonged air leak (≥7 minutes) than VATS (5.5% versus 7.1%, mean difference -1.32, 95% CI: -0.89-3.08, p = 0.034). RATS patients also had shorter duration of hospital stay (3.8 ± 4.1 days versus 4.7 ± 4.8, mean difference -0.901, 95% CI: -1.886-0.084; p = 0.073) and had more mediastinal lymph node dissections (39.5% versus 35.2%) than VATS. However, the proportion of patients who were upstaged after histopathological analysis of the resected lymph nodes was not different between the two groups. Furthermore, the groups had no significant differences regarding the infection rate, intermittent positive pressure ventilation (IPPV) use, and theatre return. Robotic and video-assisted technologies produced equivalent results for the majority of the short-term outcomes evaluated. Additional research is necessary to confirm RATS's efficacy and determine its potential advantages over VATS for lung resection surgeries.

Electromagnetic Navigational Bronchoscopy Learning Curve Regarding Pneumothorax Rate and Diagnostic Yield.

Electromagnetic navigational bronchoscopy (ENB) has emerged as an innovative technique for diagnosing peripheral and central nodules, offering an improved diagnostic yield compared to conventional bronchoscopy with fewer complications. That being said, pneumothorax remains a frequent complication. This retrospective study conducted at Castle Hill Hospital, UK, analysed ENB procedures over four years to assess the diagnostic yield and pneumothorax rates, exploring learning curves and procedural improvements specifically focusing on the diagnostic yield and pneumothorax rate as markers of change. A total of 246 patients underwent 358 peripheral lung biopsies, revealing an overall diagnostic yield of 61.3%. The diagnostic yield increased from 58.2% in 2020-2021 to 66.0% in 2022-2023while the pneumothorax rate decreased significantly from 9.8% to 3.4% (p = 0.021*). The majority of pneumothorax cases occurred following upper lobe procedures. The study depicts the importance of procedural experience in improving outcomes, suggesting a learning curve effect. Additionally, it emphasizes the potential for technological advancements, such as robotic assistance, to mitigate operator-dependent variability and improve reproducibility in ENB procedures. These findings contribute to optimizing diagnostic pathways for lung lesions and improving patient safety in ENB interventions.

The emerging use of immunotherapy as a treatment option in metastatic renal cell carcinoma: Real-world evidence from a single UK tertiary cancer centre.

e16509 Background: The landscape of systemic anticancer therapy (SACT) options for the treatment of metastatic renal cell carcinoma (mRCC) has recently evolved following results from the CheckMate 214 trial in 2018 which demonstrated improved overall survival in patients with International mRCC Database Consortium (IMDC) intermediate- and poor-risk mRCC clear cell histological subtype receiving combination immunotherapy (Ipilimumab/Nivolumab) in the first-line setting compared to Sunitinib. This is in addition to other treatment options including: vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs) (e.g. Sunitinib, Pazopanib, Tivozanib, Cabozantinib, etc.), combination immunotherapy/TKI (e.g. Avelumab/Axitinib), VEGF/mammalian target of Rapamycin (mTOR) inhibitors (e.g. Lenvatinib/Everolimus) and single-agent immunotherapy (e.g. Nivolumab) in both first- and second-line settings. Methods: An audit of SACT prescribing practices in mRCC between 2019-2022 in a single UK tertiary cancer centre (Castle Hill Hospital, Hull, UK) was conducted as part of a national collaboration multi-centre UK audit looking into the real-world landscape and treatment choices in mRCC. Information was derived from the Somerset Cancer Registry and a dataset containing 87 patients with a coded diagnosis of ‘malignant neoplasm of kidney, except renal pelvis (CX64X)’ and ‘secondary malignant neoplasm of kidney & renal pelvis (C790)’ was generated. Results: Of the 81 patients included in the final analysis, 65% (n = 53) were male and 81% (n = 66) had a clear cell histological subtype. The main sites of metastases were lung (n = 58) and lymph nodes (n = 45). Most of the patients (n = 72) received either one or two lines of SACT. Of those with clear cell mRCC, 74% (n = 51/69) were classed as having IMDC intermediate- or poor-risk features with almost half (n = 34/69) receiving combination Ipilimumab/Nivolumab. Comparing overall survival (OS) and progression-free survival (PFS) to the published Kaplan-Meier curves in the CheckMate 214 trial, no significant differences in OS (p = 0.6) and PFS (p = 0.13) were observed, although there was an overall trend towards improved PFS in the first 6 months (82.4% vs 63.3%) in our local dataset. Conclusions: The results of our real-world evaluation of prescribing practices in mRCC favoured the use of combination immunotherapy in the first-line setting for the treatment of IMDC intermediate- and poor-risk clear cell mRCC with similar outcomes to the published data in the CheckMate 214 trial. The overall trend towards improved PFS in the first 6 months in our local dataset highlights the importance of patient selection when using immunotherapy.

Abstract P1-01-06: Predictor of sentinel node positivity in screen-detected invasive breast cancer

Abstract Introduction: Sentinel lymph node biopsy represents the standard of care for staging axilla in breast cancer patients who are clinically node negative. ACOSOG Z11 trial results questioned the importance of low burden nodal disease. Results from the SOUND trial on omission of axillary surgery in selected patients with early stage breast cancer are still awaited. Breast screening programs aim to detect cancers at an early stage and are expected to have low burden of nodal disease. The aim of our study was to determine predictors of sentinel node biopsy positivity in invasive breast cancers detected on screening mammography. Methods: This retrospective study included patients with node negative invasive breast cancer detected on screening mammogram performed between April 2018 and March 2020 and subsequently underwent curative surgery including sentinel node biopsy at breast care unit of Castle Hill Hospital, Cottingham, U.K. We looked at patient’s clinical, radiological and pre-operative pathological features and correlated them with histological results of sentinel node biopsy. Statistical analysis of the data was performed using SPSS version 22 and p-value of 0.05 was considered significant. Results: We identified 304 patients who met inclusion criteria. The mean age of these patients was 62.71 ± 7.2 years (range 47-78 years). Majority (88%) of women were postmenopausal. Overall, the sentinel node positivity rate was 11.76%. Women over the age of 55 years were less likely to be node positive compared to younger women (9.9% vs 22%, p=0.016). Tumours less than 10mm in size had node positive rate of 5.5% compared to tumour larger than 21mm (25%, p = 0.000). In comparison to grade 2and grade 3 tumours, grade 1 tumours had lower node positivity rate, (5% vs 14.4%) but the difference did not reach statistical significance (p= 0.073). All women with tubular and mucinous histological subtypes (n=13) were node negative. All women with grade 1 tumours less than 10mm in size (n=48) had a negative sentinel node biopsy compared to women with grade 2 tumors more than 20mm (9/32=28% positivity rate) and p-value of 0.000. There was no association between oestrogen, progesterone and HER2 receptor status with sentinel lymph node positivity rate. Conclusion: In selected screen detected patients including those above the age of 55 years, having grade 1 cancer, and less than 10 mm size on pre-treatment imaging, there might be scope for omission of axillary surgery. Citation Format: Raouef Ahmed Bichoo, Mohammed Bilal Elahi, Dorin Dumitru, Naila Bint Ihsan, Eiman Khalifa, Masuma Sarker, Tapan K Mahapatra, Brendan Paul Wooler, Peter Kneeshaw, Kartikae Grover. Predictor of sentinel node positivity in screen-detected invasive breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-01-06.

1385 “Pre-Op Fasting Times Audit in Colorectal Surgery at A University Teaching Hospital”

Abstract Aim Hull University teaching hospitals NHS trust has guidelines for patient fasting times prior to major elective surgery. We aimed to assess the compliance of pre-op fasting times for patients undergoing elective colorectal surgery. Method An initial and later re-audit was undertaken, prospectively, of 20 consecutive patients admitted for elective colorectal surgery at Castle Hill Hospital. Data was collected on a structured proforma and was completed following patient’s interview, ORMIS (operation room system) and Lorenzo (hospital intranet). Results Initial audit demonstrated 10% (2 out of 20) and 5% (1 out of 20) compliance with liquid and solid fasting times, respectively. Following implementation of changes, re-audit demonstrated 60% (12 out of 20) and 0% (0 out of 20) compliance with liquid and solid fasting times respectively Conclusions We concluded that liquid fasting times can be improved further by communication between theatre staff and ward. Whilst solid fasting times can be improved but at an expense of losing a theatre space. A further re-audit [planned in a month period.

Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

As part of the UK National Health Service (NHS) preparations to manage the impact of the COVID-19 pandemic on hospital services, clinical guidelines that emphasized the expansion of the acute care capacity in managing the anticipated surge in COVID-19 cases were implemented. Clinical wards were reconfigured and routine face-to-face outpatient clinics were suspended. Some of the changes include workforce and facilities reorganization. One of the changes implemented at the Hull University Teaching Hospitals NHS Trust (HUTHT), was the relocation of the Complex Rehabilitation Ward from its 15- bed base in the Queen’s Centre for Oncology to a repurposed 12-bed surgical ward within the main Castle Hill Hospital (CHH) building in March 2020. Methods: A comparative review of the admissions and outcome measures data (admission diagnosis; referral source; PCAT: Patient Categorization Tool; LOS: Length of Stay; Bed occupancy and discharge destinations) over a 4-month period (March-June 2020) was undertaken and compared to retrospective data from a corresponding 4-month (March-June 2019) period in the previous year to determine the impact of the ward relocation on the delivery of specialist rehabilitation to patients with complex needs during the pandemic episode. Results: A reduction in total number of admitted patients (n=28 in 2019; n=18 in 2020) with reduced bed occupancy from 99% in 2019 to 72% in 2020 despite a reduction in bed base was noted following the ward relocation. A shorter length of stay with a mean of 29 days was noted following relocation of the ward while an increase in patient complexity as demonstrated by the PCAT scores was observed. The proportion of patients achieving a home discharge destination as opposed to other residential care facilities increased, accounting for 89% among discharged patients. Conclusion: This review demonstrated some of the impact of the measures implemented to combat the 1st wave of the coronavirus pandemic, specifically the relocation of the specialist inpatient rehabilitation ward in a tertiary hospital setting. Though a higher proportion of the admitted patients had increased complexity, a shorter length of stay with a significant proportion of the patients achieving a home discharge destination were observed following ward-relocation in 2020 compared to a similar quarter in 2019. The findings also reflected a reduction in bed occupancy despite reduced bed base capacity. Though there is a noted reduction in duration of stay in hospital and a greater proportion the patients achieved a home discharge destination, this was achieved with a compromise on the rehabilitation process due to the constraints of the new ward environment. Significant impact in the quality of the therapy programmes delivered was observed. The longer-term impact of this will need to be monitored. This review highlights the need for consideration of specialist rehabilitation as part of the acute response planning process in pandemic and mass casualty events.

60P Real-world experience of immunotherapy in elderly cancer patients in a UK cancer centre

Cancer tends to affect the elderly; however, they are less represented in clinical trials. Therefore, real-world data of Immune-related adverse events (irAEs) of patients on immune checkpoint inhibitor (ICIs) can be a useful tool to guide clinical practice. Patients aged ≥65 yrs, with non-small cell lung cancer (NSCLC), malignant melanoma (MM) or renal cell carcinoma (RCC) on ICI ( non- curative intent) either as monotherapy (MT) or in combination (CT), between 2016 – 2018 at Castle Hill Hospital were included in this retrospective analysis to review irAEs and outcome (analyses performed with SPSS v25). Of 90 patients identified; 43 were NSCLC, 30 MM and 17 RCC. 87.8% received αPD-1, 6.7% αCTLA-4, 3.3% αPDL-1 combination αPD-1/αCTLA-4 and 2.2% combination αPD-1/αCTLA-4. Median age was 71 yrs. 92.2% had ECOG performance status of 0-1. Median follow up was 14.5 months. 35/90 (38.8%) had an irAE; 94.2% (33/35) on MT and 5.8% (2/35) on CT. Clinically significant irAE was observed in 30/90 (33.3%) patients with near 1/5th (20/90) suffering from Grade 3 toxicities. 12.2% (11/90) of patients had pre-existing autoimmune disease, 45.4% (5/11) of them experienced irAE. Most common IrAEs witnessed were colitis12 (13.3%), thyroiditis 5 (5.6%), pneumonitis 5 (5.6%) and dermatitis 3 (3.3%). There were 2 cases of grade 5 irAE with αPD-1 MT (1 pneumonitis,1 nephritis). 86.6% (26/30) with clinically significant irAE required corticosteroids with almost half of them needing systemic corticosteroids. Steroid sparing immunosuppression was used in 13.3% (4/30). 63.3% (19/30) had admission, average stay of 12.3 days accounting for 233 bed days. This rate is higher compared to all age group (42%). Colitis 11/19 and pneumonitis 3/19 led to most admissions. Progression free survival (PFS) and overall survival (OS) was higher in patients with irAE Vs no irAE ( PFS 16.3 months [95% CI 7.9, 24.8] Vs 4.6 months [95% CI 1.7, 7.6], p= 0.003; OS 30 months [95% CI 18, 41.9] Vs 7.4 months [95% CI 3.2, 11.6], p=0.01). Incidence of irAE in elderly were comparable to our cohort of patient that includes all age group though more inpatient care observed in this group. There appears to be a toxicity-efficacy relationship with irAEs; however, larger studies are required to validate this.

Validation of Cardiac Surgery Score (CASUS) in Postoperative Cardiac Patients.

Introduction. Cardiac Surgery Score (CASUS) was introduced in 2005 as the first postoperative scoring system specific for patients who had cardiac surgery. Prior to this, European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been used preoperatively, while Intensive Care National Audit and Research Centre Score (ICNARC) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, which are widely used in general intensive care unit population, have been used to score cardiac patients postoperatively. The development of CASUS by Hekmat and colleagues for use in postoperative cardiac patients aims to change this. We wanted to validate CASUS against the well-established preoperative Logistic EuroSCORE, and postoperative APACHE II and ICNARC scores. Method. Institutional approval for this study was granted by the Audit and Clinical Governance Committee. We analyzed prospectively collected data of patients who had cardiac surgery in Castle Hill Hospital between January 2016 and September 2018. All patients who underwent surgery in the unit would have had Logistic EuroSCORE, APACHE, and ICNARC scores calculated as standard. CASUS was then calculated for these patients based on their day 1 postoperative variables. The scoring systems were compared and data presented as area under the receiver operating characteristic curve. Result. Our study shows that CASUS is the best predictor of mortality followed by ICNARC, Logistic EuroSCORE, and APACHE II. ICNARC score remains the most accurate predictor of renal and pulmonary complication followed by CASUS. Conclusion. CASUS is a useful scoring system in post-cardiac surgery patients. The accuracy of CASUS and ICNARC scores in predicting mortality, pulmonary, and renal complications are comparable.

Impact of Integrase Inhibitors on Weight

Current evidence suggests that Integrase Strand Transfer Inhibitors (INSTI) are associated with excess weight gain. These increases are particularly significant for black people and women. Clinic notes of 84 patients stable on INSTI for at least 18 months and attending HIV outpatient clinics at Castle Hill Hospital, Hull Royal Infirmary, Grimsby Hospital and Scunthorpe Hospital were included. Data including height and weight was collected at 18, 30, 42 and 54 months, following commencement of INSTI. Statistical analysis was performed using STATA. 65% of patients were male. The mean age at baseline was 50 and the mean age at diagnosis was 40. Median CD4 count was 669 and viral load was 0 within the last 6 months. 64% of patients were White British, 7% White Other, 21% Black and 9% other. At 30 months, mean weight increased by 1.41kg, statistically significant at p<0.0065. At 42 months, mean weight increased by 2.53kg, significant at p= 0.0056. At 54 months, mean weight increased by 1.33kg; however this was not significant. Differences in weight amongst the sexes, different ethnicities and different categories of infection as classified by the CDC was observed but was not statistically significant. Two adverse events- myocardial infarction and stroke were reported but no patient on INSTI died. Patients stable on INSTI gained weight but the clinical significance of this is unclear, especially as weight changes in patients stable on other antiretrovirals have not been compared. Further research to assess cardiometabolic impact of weight gain following INSTI is required.

Profile of tezacaftor/ivacaftor combination and its potential in the treatment of cystic fibrosis.

Cystic fibrosis (CF) is a life-limiting autosomal recessive disease caused by dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) ion channel. Management of CF has traditionally relied upon managing complications of CFTR protein dysfunction and this has led to a steady improvement in survival of CF patients. However, the landscape of CF care has changed substantially over the last decade with the discovery of CFTR modulators that aim to increase or potentially restore the function of the disease-causing CFTR protein. This narrative review summarizes the development of CFTR therapies so far with emphasis on tezacaftor/ivacaftor combination therapy. We have also summarized the Phase II results of triple combination therapy which promises an effective CFTR modulator therapy for more than 90% of CF patients.

A major contribution to practice and to the education and training of practitioners in radiotherapy; an interview with Professor Andy Beavis, Consultant Clinical Scientist and Head of Radiation Physics at the Department of Radiation Physics, Queen’s Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK

A major contribution to practice and to the education and training of practitioners in radiotherapy; an interview with Professor Andy Beavis, Consultant Clinical Scientist and Head of Radiation Physics at the Department of Radiation Physics, Queen’s Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK

Development of a composite model derived from cardiopulmonary exercise tests to predict mortality risk in patients with mild-to-moderate heart failure

ObjectiveCardiopulmonary exercise testing (CPET) is used to predict outcome in patients with mild-to-moderate heart failure (HF). Single CPET-derived variables are often used, but we wanted to see if a composite...

An analysis of a nationwide survey of current trend in breast reconstruction

An analysis of a nationwide survey of current trend in breast reconstruction

Melanosis coli in the absence of anthranoid laxative use harbouring adenoma

Colorectal DiseaseVolume 15, Issue 8 p. 1044-1045 Correspondence Melanosis coli in the absence of anthranoid laxative use harbouring adenoma R. L. Loveday, R. L. Loveday Faculty of Health and Social Care, University of Hull, Hull, HU6 7RX UK Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorM. A. Hughes, M. A. Hughes Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorJ. A. Lovel, J. A. Lovel Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorG. S. Duthie, G. S. Duthie [email protected] Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UK Hull York Medical School, University of Hull, Hull, HU6 7RX UKSearch for more papers by this author R. L. Loveday, R. L. Loveday Faculty of Health and Social Care, University of Hull, Hull, HU6 7RX UK Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorM. A. Hughes, M. A. Hughes Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorJ. A. Lovel, J. A. Lovel Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UKSearch for more papers by this authorG. S. Duthie, G. S. Duthie [email protected] Humber and Yorkshire Coast Bowel Cancer Screening Centre, Castle Hill Hospital, Hull, HU16 5JQ UK Hull York Medical School, University of Hull, Hull, HU6 7RX UKSearch for more papers by this author First published: 22 April 2013 https://doi.org/10.1111/codi.12254Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume15, Issue8August 2013Pages 1044-1045 RelatedInformation

WS3.1 Gastric aspiration into the CF lung – relationship with reflux symptoms and lung function

WS3.1 Gastric aspiration into the CF lung − relationship with reflux symptoms and lung function G.L. Crossfield1, A. Krishnan2, J. Lordan3, S. Bourke4, A. Anderson4, P.W. Dettmar5, I.A. Brownlee6, C. Ward7, J.P. Pearson1. 1Institute of Cell and Molecular Bioscience, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; 2Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; 3Institute of Transplantation, The Freeman Hospital, Newcastle Upon Tyne, United Kingdom; 4Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; 5Technostics Ltd, Daisy Building, 2nd Floor, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom; 6Food and Human Nutrition Department, Nanyang Polytechnic, Newcastle University, Singapore; 7 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom

WS3.2 Higher levels of fecal calprotectin levels are associated with SIBO in cystic fibrosis after lung transplantation

WS3.1 Gastric aspiration into the CF lung − relationship with reflux symptoms and lung function G.L. Crossfield1, A. Krishnan2, J. Lordan3, S. Bourke4, A. Anderson4, P.W. Dettmar5, I.A. Brownlee6, C. Ward7, J.P. Pearson1. 1Institute of Cell and Molecular Bioscience, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; 2Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; 3Institute of Transplantation, The Freeman Hospital, Newcastle Upon Tyne, United Kingdom; 4Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; 5Technostics Ltd, Daisy Building, 2nd Floor, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom; 6Food and Human Nutrition Department, Nanyang Polytechnic, Newcastle University, Singapore; 7 Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom

Neurological conditions presenting as airway reflux cough

To the Editor: The association of cough with neurological conditions is well described [1–4]. Herein, we report four patients with chronic cough who each presented to our cough clinic (Castle Hill Hospital, Cottingham, UK) with a different neurological diagnosis. Each of the patients had normal chest radiology and pulmonary function, they were not on angiotension converting enzyme inhibitors, and no obvious underlying respiratory pathology was identified. A summary of all the relevant investigations performed on each patient are detailed in table 1. View this table: Table 1. Summary of results of the four cases A 66-yr-old nonsmoking male presented with a non-productive cough for several years which was profound on rising from bed in the morning and associated with eating, but no symptoms of dyspepsia. Interestingly, he also complained of numbness over the left side of his head up to his mid upper arm. Clinical examination showed wasting of scapular muscles and biceps with absent sensations and areflexia in both lower limbs. Oesophageal pH monitoring and manometry were abnormal, with a DeMeester score of 18.3. Blood tests and cerebrospinal fluid analysis were normal. Anatomical and malignant pathology was excluded by radiological investigations. Neurophysiological studies revealed sensory polyneuropathy with a dorsal column lesion and focal radiculopathy at the right cervical (C)3, C4 and, possibly C6, levels. Autonomic testing of heart rate variability showed lack of variation of heart rate during inspiration and expiration (table 1). A diagnosis of mononeuritis multiplex was made and cough was probably secondary to vagal neuropathy causing …

Number of lymph nodes recovered as an independent prognostic factor in predicting outcome in patients with pathologically node-negative rectal cancer following preoperative chemo/radiotherapy.

606 Background: To determine the importance of number of lymph nodes recovered on outcome in pathological node negative rectal cancer patients who had received chemo/radiotherapy prior to surgery. Methods: We retrospectively analysed data from 262 patients with locally advanced rectal cancer who received pre-operative chemo/radiotherapy at Castle Hill Hospital, Cottingham and Nottingham University Hospital between 2001 and 2008. Patients were treated with CT planned radiotherapy to a dose of 45-50 Gy in 25 fractions with concurrent fluoropyrimidine chemotherapy. Surgery was normally performed at an interval of 6-8 weeks. There were 152 patients who were found to be pathologically node negative for further analysis. Median follow-up was 51.5 months Patients were grouped into < 10 nodes recovered or > 10 nodes recovered. Disease free survival (DFS) and overall survival (OS) was assessed using Log rank test. Multivariate analysis was performed using Cox-regression analysis. Results: Of the 152 patients analysed, 67.1 % (n=102 ) had fewer than 10 nodes recovered and 32.8% (n=50) had greater than 10 nodes recovered. The median number of nodes recovered was 7 (range 0-39). There was a improvement in 5 year DFS and OS in group who had more than 10 nodes recovered compared to group with less than 10 nodes recovered ( DFS at 5yrs :86.5% vs. 61.5%, p=0.01, OS at 5 yrs : 77.8% vs. 67.4% , P =0.059). On multivariate analysis pathological T-stage , circumferential resection margin (CRM) status and number of lymph nodes recovered were found to be independent predictors of disease free survival (p=0.002). Conclusions: The number of lymph nodes retrieved following surgery for locally advanced rectal cancer patients following chemo/radiotherapy is an independent prognostic factor in pathologically node negative patients. This may need to be considered when making subsequent adjuvant chemotherapy decisions.

The evolving role of simulators and training in robotic urological surgery: Which assessment tool to use?

The evolving role of simulators and training in robotic urological surgery: Which assessment tool to use?

Readmission audit in a single plastic surgery unit in light of recent department of health policy on non-payment for emergency readmissions

s / International Journal of Surgery 10 (2012) S53–S109 S68 ABSTRACTS pain (associated with removal of non-absorbable sutures) favours the use of absorbable sutures in the elective-hand-surgery. Further RCTs are required. 0687: READMISSION AUDIT IN A SINGLE PLASTIC SURGERY UNIT IN LIGHT OF RECENT DEPARTMENT OF HEALTH POLICY ON NONPAYMENT FOR EMERGENCY READMISSIONS John Martin, Adnan Tahir, Haroon Siddiqui. Department of Plastic Surgery, Jame's Cook University Hospital, Middlesbrough, UK Introduction: In April 2011 a Department of Health policy came into effect stating that no tariffs would be paid for readmission of patients to hospital within 30 days of discharge. The purpose of this audit was to determine the reasons behind readmissions in our unit. Methods:We evaluated readmissions over a one-year period fromOctober 2009 to October 2010. A total of 140 patients were identified. 50 patients were randomly selected to conduct this audit. We also compared the readmission rate in plastic surgery to other specialties in our hospital. Results: Readmission to plastic surgery made up one per cent of the total readmissions in our hospital over a one-year period. Of the patients readmitted in plastic surgery, 34/50 (68 per cent) were emergencies and 16/50 (32 per cent) were elective. 18 per cent of readmissions were planned as part of ongoing treatment, for example delayed grafting of a wound bed, but were wrongly coded as readmissions. 8 per cent of readmissions were unrelated to the original admission. Conclusions: This audit has shown that this rule is difficult to apply in surgical practice and coding entries for planned or unplanned admissions are complex and inaccurate in the NHS. 0744: RE-RUPTURE RATE FOLLOWING PRIMARY FLEXOR TENDON REPAIR OF THE HAND WITH POTENTIAL CONTRIBUTING RISK FACTORS: CASE SERIES Mazin Ibrahim, Mai Rostom, Mohamed Asim Khan, Alastair James Platt. Castle hill hospital, Cottingham, UK Aim: Flexor tendon injuries of the hand are common with over 3,105 per annum in the UK. This study was aimed to investigate re-rupture rate following primary flexor tendon repair at our institution and to identify potential risk factors. Method: 51 patients with 101 flexor tendons' injuries who underwent primary repair over one year period were reviewed. Data was collected on age, gender, occupation, co morbidities, injured fingers, hand dominance, smoking status, time to surgery, surgeon grade, type of repair and suture, and antibiotic use. Causes of re-rupture were examined. Results: Re-rupture rate was 10.9%. Mean age was 35.8. Primary tendon repairs with re-rupture were compared to those without re-rupture. Univariate and multivariate analysis was undertaken to identify significant risk factors. Significantly higher rate was noted when the repair was performed on the dominant hand (p-value 1⁄4 0.009), in zone 2 (0.001), and when a delay more than 72 hours occurred (0.01). Multivariate regression analysis identified repair in zone 2 injuries to be the most significant predictor of re-rupture. Conclusions: Re-rupture rate of 10.9% was associated with delay in surgery, repair on dominant hand, and zone 2 repairs. Careful consideration for these factors is crucial to reduce this rate. 0803: PLASTIC SURGERY TOURISM COMPLICATIONS PRESENTING TO AN NHS HOSPITAL – A ONE YEAR RETROSPECTIVE STUDY Nicholas Segaren , Kumaran Shanmugarajah , Sheraz Markar , Neil Segaren , Onur Gilleard , Kalpesh Vaghela . Chelsea and Westminster Hospital, London, UK; Queen Victoria Hospital, East Grinstead, UK; Royal Derby Hospital, Derby, UK; Kingston General Hospital, London, UK Aim: The advent of cosmetic surgery tourism packages has led to an increase in the number of people from the UK flying to foreign destinations to undertake procedures by plastic surgeons that may not have any affiliation to a regulatory body. Any complications from these operations are dealt with in NHS funded units back in the United Kingdom. We wanted to investigate the potential impact that these presentations had on our department. Method: We conducted a retrospective study examining all presentations to Chelsea and Westminster Hospital for complications following plastic surgery procedures undertaken abroad. The data was collected from January 2011 to the end of December 2011. Results: There were 21 patients in total, nineteen females and two males, the mean age was 38.6. Fourteen patients presented with complications from craniofacial procedures, and six following breast augmentation procedures. One patient was admitted with an infected buttock implant. The average in-patient stay was 2.6 days. Conclusions: The popularity of cosmetic surgery abroad is increasing and therefore the complication rates will rise in the future. The recent scandal regarding the PIP breast implants has further highlighted the potential dangers of cut price cosmetic surgery abroad. 0825: AN AUDIT EXPLORING THE ADEQUACY OF CONSENT FORMS IN PATIENTS RECEIVING EMERGENCY BURNS TREATMENT Samim Ghorbanian , Nicki Bystrzonowski , Pundrique Sharma , B Philips . 1 Lister Hospital, Stevenage, UK; Broomfield Hospital,