Esophagogastric Cancer Research Articles

The Impact of EndoVAC in Addressing Post-Esophagectomy Anastomotic Leak in Esophageal Cancer Management

Anastomotic leakage (AL) remains a major complication after esophagectomy, especially in patients with esophagogastric cancers who have undergone neoadjuvant therapies, which can impair tissue healing. Endoscopic vacuum-assisted closure (EndoVAC) is an innovative approach aimed at managing AL by facilitating wound drainage, reducing infection, and promoting granulation tissue formation, thus supporting effective healing. This review explores the role and effectiveness of EndoVAC in treating AL post-esophagectomy in esophageal cancer patients. We present an overview of its physiological principles, including wound contraction, enhanced tissue perfusion, and optimized microenvironment, which collectively accelerate wound closure. In addition, we examine clinical outcomes from recent studies, which indicate that EndoVAC is associated with improved leak resolution rates and potentially shorter hospital stays compared to traditional methods. Overall, this review highlights EndoVAC as a promising tool for AL management and underscores the need for continued investigation to refine its protocols and broaden its accessibility. By optimizing EndoVACs use, multidisciplinary teams can improve patient outcomes and advance esophageal cancer care.

A national survey of the provision of prehabilitation for oesophagogastric cancer patients in the UK.

Studies have demonstrated that prehabilitation in oesophagogastric cancer (OGC) improves body composition, physical fitness and quality of life, and can reduce surgical complications. However, it is not offered in all OGC centres. Furthermore, definitions, funding and access to services vary. We conducted a survey of prehabilitation in OGC centres in England and Wales. OGC centres were identified through the National Oesophago-Gastric Cancer Audit (NOGCA). Survey questions were developed, piloted in two institutions and distributed via email in October 2022. Reminder emails were sent over two months until the survey closed in December 2022. Responses were received from 28 of 36 centres. There was near-universal agreement that prehabilitation should be considered standard of care for patients on curative pathways (27/28; 96%). Most centres (21/28; 75%) offered prehabilitation. The majority of respondents believed that prehabilitation should commence at diagnosis (27/28; 96%) and consist of at least aerobic training and dietitian input. Most (26/28; 93%) believed access to clinical psychologists should be included; however, only 12 (43%) had access to clinical psychologists. Respondents believed prehabilitation improves quality of life (26/28; 93%), fitness (26/28; 93%), smoking cessation (28/28; 100%), surgical complication rates (25/28; 89.3%), likelihood of proceeding to surgery (25/28; 89.3%) and overall survival (20/28; 71.4%). Despite barriers to funding and a lack of best practice guidelines, most units deliver prehabilitation. Units require higher quality evidence, consensus on the most important aspects of the intervention and core outcome sets to support the delivery of services and facilitate audit to assess the impact of their introduction.

Obstructive shock and cardiac arrest due to diaphragmatic hernia after esophageal surgery: a case report.

We report the exceedingly rare case of diaphragmatic hernia after esophageal surgery resulting in obstructive shock and cardiac arrest. An 82-year-old man, who had undergone a robotic-assisted thoracoscopic esophagectomy and gastric tube reconstruction via a subcutaneously route with three-field lymphadenectomy for esophagogastric junction cancer at another hospital 3months prior, complaining of persistent epigastric pain and nausea. Computed tomography revealed that the proximal jejunum had herniated through the esophageal hiatus into the left thoracic cavity, with dilation of the subcutaneous gastric tube and duodenum. He was urgently admitted, and a nasogastric tube was inserted. His respiratory and circulatory parameters were normal upon admission, however, nine hours after admission, there was a rapid increase in oxygen demand, and he subsequently developed shock. His blood pressure was 106/65 mmHg, pulse rate of 150bpm, respiratory rate of 30/min with an O2 saturation of 97% on High-flow nasal cannula FiO2:0.4, cyanosis and peripheral coldness appeared. Chest X-ray showed a severe mediastinal shift to the right, suggesting obstructive shock due to intestinal hernia into the thoracic cavity. Emergency surgery was planned, but shortly after endotracheal intubation, the patient experienced cardiac arrest. It was found that approximately 220 cm of small intestine had herniated into the thoracic cavity through the esophageal hiatus, and it was being strangulated by the diaphragmatic crura. A portion of the diaphragmatic crura was incised to manually reduce the herniated small intestine back into the abdominal cavity. The strangulated intestine was congested, but improvement in coloration was observed and it had not become necrotic. The procedure finished with closure of the esophageal hiatus. Intensive care was continued, but he died on postoperative day 29 because of complications including perforation of the descending colon and aspiration pneumonia. Rapid progression of small intestine hernia into the thoracic cavity, leading to obstructive shock, was suspected. While this case was rare, early recognition of the condition and prompt reduction could have potentially led to life-saving outcomes.

Risk factors for readmission following esophagectomy and gastrectomy for cancer.

Hospital readmission after surgery is a key quality indicator. This nationwide cohort study aimed to assess readmission rates following esophagectomy and gastrectomy for cancer and identify associated risk factors. Data were extracted from the Dutch Upper GI Cancer Audit (DUCA) for patients with esophagogastric cancer who underwent esophagectomy or gastrectomy with curative intent between January 2011 and June 2016. Logistic regression analysis identified risk factors for 30-day readmission. In total, 5566 patients were included. Readmission within 30days occurred in 483 of 3488 (13.8%) patients after esophagectomy and 243 of 2078 patients (11.7%) after gastrectomy. Both minor (Clavien Dindo 1-2) and major (Clavien Dindo ≥3) postoperative complications were independent predictors of readmission after esophagectomy (OR 2.99; 95%CI 2.23-4.02; p< 0.001 and OR 5.20; 95%CI 3.82-7.09; p< 0.001). Specific complications included pulmonary (OR 1.49; 95%CI 1.20-1.85; p< 0.001), gastrointestinal (OR 2.43; 95%CI 1.94-3.05; p< 0.001), and infectious (OR 2.27; 95%CI 1.60-3.22; p< 0.001). Prolonged length of stay (pLOS) was associated with higher readmission rates in patients without complications following esophagectomy (OR 1.91 95% CI 1.19-3.07; p= 0.008), but lower rates in those with complications (OR 0.65 95% CI 0.51-0.83; p< 0.001). For gastrectomy, postoperative complications were also linked to readmission (OR 3.18; 95%CI 2.30-4.40; p< 0.001), particularly gastrointestinal (OR 2.16; 95%CI 1.40-3.32; p< 0.001), and infectious (OR 3.80; 95%CI 2.53-5.71; p< 0.001). Readmission after esophagogastric resection is common, particularly among patients with both minor and major postoperative complications. Prolonged stay after esophagectomy impacts readmission risk differently based on the presence of complications.

OGC SO07 - A retrospective service evaluation of the impact of a dedicated oesophago-gastric cancer (OGC) dietitian in the OG surgical oncology team

Abstract Background Patients with OGC frequently present with malnutrition. Oncological care pathways advocate for dietitian’s to be essential member’s of the multi-disciplinary team (MDT), as it is well-established that malnutrition significantly increases rates of post-operative complications, length-of-stay (LoS) and mortality. However, due to financial constraints, specialist OGC dietetic support is not always resourced. To reduce the potential for nutrition related incidents, a dedicated OGC dietitian’s post was funded to support the pre-operative nutritional optimisation of OGC patients. The aim of this service evaluation was to evaluate the OGC dietitian’s impact on dietetic and surgical outcomes in a tertiary referral centre. Method The OGC dietitian reviewed all potentially curative patients at or within 48 hours of their first OGC surgical clinic; compared to &amp;gt;8 weeks pre-dietitian, with some patients not even reviewed before surgery. Weekly telephone or face-to-face dietetic-led clinics enabled more functional assessments (hand-grip strength (HGS)). Attendance to MDT was mandatory. Dietetic and surgical outcome data was collected for curative patients between July 2022 and April 2023 (pre-dietitian) (n=25) and July 2023 and April 2024 (OGC dietitian in-post) (n=19). Patient reported experience measures (PREMs) were collected. Data was analysed on excel. Ethical approval was not needed for this retrospective service evaluation. Results Pre-dietitian, 28% (n=7) experienced &amp;gt;5% (clinically significant) pre-operative weight loss compared to 11% (n=2) post-dietitian. 58% (n=12) patient’s post-dietitian gained weight from first dietetic contact up until date of surgery, compared to 44% (n=11) pre-dietitian. Mean HGS increased by 1.3kg (SD 2.77) from pre-operative to post-operative dietetic assessments in patients with OGC dietitian. More patient’s pre-dietitian experienced post-operative complications (42%) compared to post-dietitian at 31%. Average post-operative LoS was 19 days pre-dietitian versus 15 days post. 100% positive feedback was received from completed PREMs regarding OGC dietitian, with themes including consistent and timely communication, in-depth knowledge and empathy and compassion. Conclusion Mandatory inclusion of dietitians within the OGC pathway can support the pre-operative optimisation of patients, and impact positively on patient surgical outcomes. This service evaluation demonstrates that with increased dietetic contact, patients experience less clinically important weight loss, whilst feeling empowered and confident in their nutritional care. More research in a larger cohort of patients is required to provide an adequately powered study.

MS O02 - OGC An audit of waiting times of the oesophagogastric cancer diagnostic pathway at a high-volume, tertiary centre

Abstract Background The oesophagogastric cancer (OGC) staging pathway is extensive, contributing to prolonged waiting times from referral to treatment. NHS England guidance details the ideal timeframe from referral to finalisation of the patient’s treatment plan and stipulates a time of 21 days from OGD to communication of the treatment plan to the patient. This audit aims to compare pathway times at a tertiary cancer centre, which accepts referrals from seven different hospitals, to the current NHS target and further stratify pathway times according to patient characteristics and referring hospitals. Method Data was collected using a prospectively collected database of OGC patients who underwent staging investigations at the tertiary centre between October 2022 and October 2023. The primary outcome was OGD to communication of the treatment plan. Secondary outcomes included time from OGD to first staging investigation and the proportion of patients that had a next-day computed tomography (CT) scan. Outcomes were stratified to investigate inter-hospital variation and the effect of curative status and tumour location. Data was expressed as median and interquartile range (IQR) for continuous data or n (%) if categorical. Results 263 patients were included in this audit with a median age of 69.0 (IQR 61.5-77.0). 13.8% of patients satisfied the target time of 21 days from OGD to communication of treatment plan. Curative patients had a longer median pathway time than palliative patients (49.0 vs 35.0 days), whereas oesophageal and gastric cancer patients had similar pathway times (44.0 vs 44.5 days). Patients diagnosed at the tertiary centre had a faster time from OGD to first staging investigation than patients diagnosed at non-specialist centres. Only 13.3% of patients had a next-day CT scan following their OGD (median time 5.0 days). Conclusion The OGC staging pathway is considerably slower than the target. Faster pathway times in palliative patients can be attributed to many of these patients not requiring further staging post-CT. Potentially, targets should be re-evaluated to distinguish between palliative and curative patients. The faster staging process at the central hospital may be explained by more regular clinics run by specialist clinicians and the prompt requesting of staging investigations without awaiting MDT discussions. Alongside increasing the proportion of next-day CT scans, these factors must be addressed to streamline the entire pathway.

OGC O06 - Socioeconomic Health Inequality in Oesophago-gastric Cancer in a Single Tertiary Centre: On Behalf of Greater Manchester OG Unit

Abstract Background Oesophagogastric cancer (OGC) 5-year survival is poor (15%). Only 34% of patients are considered for potentially curative treatment, which is associated with a 41% chance of survival. In other cancer, deprivation is associated with poor outcomes. This study aims to determine the association between deprivation, tumour and treatment intent (TI), and 5-year all-cause mortality (M) in OGC. Method This retrospective cohort study analysed patients newly diagnosed with OGC (adenocarcinoma or squamous cell carcinoma) across Greater Manchester between January 2018 and January 2023. TI was defined as the treatment pathway, at completion of staging investigations, either curative (pathway to resection or definitive chemoradiotherapy) or palliative (best supportive care, palliative chemotherapy or radiotherapy). Statistical analysis encompassed methods such as binary logistic regression, Cox proportional hazards models and Kaplan-Meier survival curves with adjustments made for age, gender, and clinical stage. IMD scores were grouped from deciles into quintiles leaving 5 groups, with IMD1 representing the most deprived. Results 3027 patients were included (2102, 69.4% males). Patients in IMD1 were diagnosed 4 years younger than in IMD5 (most affluent) (median age 70 (IQR=17) vs 74 (IQR=16), p&amp;lt;0.001). There was a higher proportion of deprived patients (32.9% IMD1 vs 15.3% IMD5, p&amp;lt;0.001). The proportion of stage 4b disease in IMD1 compared with IMD5 was not different (406 (40.7%) vs 174 (37.5%), p=0.081). The median survival was lower in IMD1 compared with IMD5 (0.81 vs 0.90 years, p=0.074). Following adjustment for confounders IMD1 was associated with a poorer overall survival when compared with IMD5 (HR 1.16, CI[1.02-1.32],p=0.020). Conclusion This study highlights a significant health inequality in the outcomes of OGC. Poorer outcomes in the most deprived group were independent of tumour stage, gender and age. Urgent measures to address socioeconomic health inequalities need to be instigated.

OGC SO21 - Role of Staging Laparoscopy on oesophageal and junctional cancer management

Abstract Background Staging laparoscopy and peritoneal cytology is currently recommended as a staging tool required for oesophageal and gastro-oesophageal junction (OGJ) adenocarcinomas. However, evidence is variable regarding the utility of this investigation, leading to heterogenous practice in the UK. With improved staging sensitivity of CT and PET imaging and inclusion of routine MDT discussion for upper GI cancer patients, staging laparoscopy may not be necessary for all patients with oesophago-gastric cancer, and in fact may delay their treatment. We thus aimed to assess the impact of staging laparoscopy on the treatment algorithm of patients with oesophago-gastric cancer. Method All staging laparoscopies undertaken between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric adenocarcinoma, with a plan for curative treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, laparoscopy findings, impact on treatment intention, neoadjuvant treatment, and final histology. Primary outcome was incidence of positive microscopic or macroscopic peritoneal disease for oesophageal and OGJ malignancy. Results 127 patients were identified - 69 (55%) oesophageal, 25 (20%) GOJ, and 32 (24.4%) gastric cancer. 1/70 (1.4%) patient diagnosed endoscopically with oesophageal cancer had positive peritoneal disease, which was suspected due to pre-operative imaging findings of ascites and suspicions of linitis plastica. Of patients diagnosed with GOJ cancer, 4/25 patients (16%) had peritoneal disease present. None of the 39 patients with oesophageal/junctional tumours with clinical T1-2 disease were found to have peritoneal disease on staging laparoscopy. 6/32 (19%) patients with gastric cancer were found to have unexpected peritoneal disease present. Conclusion This study found minimal impact staging laparoscopy has on the management of primary oesophageal cancers. Consideration can be made of limiting staging in oesophageal cancer to patients with suspicious findings on CT/PET imaging. For GOJ tumours, there may be a role for limiting staging laparoscopy for Siewert 1 tumours to T3/4 tumours based on CT/PET findings. Importantly, accurate identification on primary endoscopy of the location of the tumour in relation to the gastro-oesophageal junction is necessary to help guide ongoing management.

OGC SO22 - Accuracy of CT and FDG/PET clinical staging within a dedicated multidisciplinary service for patients with oesophago-gastric cancer

Abstract Background Accurate staging for oesophago-gastric cancer is important in ensuring correct treatment pathways, avoiding unnecessary surgery and providing prognostication for patients. Previously, cross sectional imaging in accurately providing tumour (T) and nodal (N) staging has been variable for upper GI malignancies, with usage of invasive investigations such as EUS to provide more specific local staging. With the increased utilisation of specialist multidisciplinary involvement and improved technology, we aimed to assess whether CT and PET imaging may be able to provide sufficiently accurate staging required for treatment decision making. Method All patients who underwent oesoophagogastric resections between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric cancer, and underwent curative resection without neo-adjuvant treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, and final histology. Outcomes assessed included rate of understaging in clinical and pathological T and N staging, and sensitivity and specificity of imaging in identifying presence of nodal disease. Results 38 patients were included in this analysis. For oesophageal and GOJ cancers, T stage under-reporting occurred in 6/27 (22%) patients, and N under-reporting in 7/27 (27%) patients. Radiological staging correlated with final pathological staging in 55% of T staging and 59% of N staging. Sensitivity (55.56%, 95% CI 21-86%) and specificity (72.2%, 95% CI 46.5-90.3%) for nodal disease on CT/PET was low, however no tumour or nodal under-staging would have impacted management. Gastric cancer staging accuracy assessment was limited by small numbers (n=12), however T under-staging occurred in 5/12 (42%) patients and N under-staging occurred in 5/11 patients (45%). Conclusion Involvement of dedicated radiology services in multidisciplinary care for oesophago-gastric cancer provides adequate radiological staging to guide treatment. Gastric cancer clinical staging requires laparoscopic and endoscopic assessment for accurate tumour assessment and management guidance. Radiological under-staging is less common in oesophageal and GOJ tumours than gastric cancer and has minimal impact on patient management.

OGC SO04 - Impact of COVID-19 on Decision-making and Survival in Esophago-Gastric Cancer Treatment: Insights from a Multidisciplinary Approach

Abstract Background The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods. Method A retrospective cohort study involving patients referred to a UK tertiary EG cancer center during distinct six-month intervals mirroring the pandemic's evolution. Analysis focused on MDT recommendations, treatment pathways, and two-year survival rates, comparing deviations from standard care across periods. Results The study revealed a significant reduction in patient referrals and expedited treatment decisions during the pandemic peak, with a shift towards palliative care in post-pandemic cases. Although no statistically significant difference in two-year survival rates was observed, the post-pandemic period showed an increase in tumor aggressiveness and positive resection margins, suggesting potential long-term impacts of delayed diagnosis and treatment. Conclusion COVID-19 has significantly influenced MDT decision-making and patient pathways in esophago-gastric cancer care, underlining the necessity of resilient healthcare systems. Despite maintaining survival rates, the observed increase in tumor aggressiveness post-pandemic highlights the critical need for uninterrupted cancer diagnosis and treatment services during global health emergencies.

EGS SO06 - Emergency provision for Oesophago-Gastric Surgery in the United Kingdom: A National Survey

Abstract Background Oesophagogastric (OG) emergency conditions may require specialised intervention in centralised OG cancer surgery units. Recently published AUGIS OG commissioning guidance recommends OG units provide 24/7 on-call cover for internal and external OG emergency referrals with a formalised rota. However, there may be widespread inconsistent provision of OG emergency services across United Kingdom (UK) regions with significant workforce, capacity, and funding challenges. This may lead to barriers to provision of on-call OG services. Currently there is no research that establishes current OG on-call coverage or explores OG surgeons’ perceptions and attitudes towards providing this service. Method An 11-item electronic questionnaire was developed at an OG cancer unit to identify OG consultant emergency on-call coverage at NHS OG cancer units in the UK. The questionnaire was initially piloted among OG surgeons for refinement and subsequently disseminated through professional networks (AUGIS), direct contact, and snowballing. It was active for three weeks in January 2024. Secondary outcomes included: identifying barriers to providing an emergency OG service; defining the scope of conditions acceptable for transfer; understanding current referral mechanisms and examining OG consultant attitudes and perceptions towards providing an on-call OG service. Results 71 consultant OG surgeons from 26 UK OG cancer units responded (Figure 1). 61% (n=43) report participating in a 24/7 formalised emergency OG on-call rota, staffed by a median of 5 (range 3-8) surgeons. Among the nine respondents from three centres without a formal OG emergency service, all cited limited funding as the primary barrier. Only 31% (n=19) used auditable referral mechanisms like email or online systems. 97% percent (n=69) of respondents perceive an OG emergency service to be beneficial for patients, and 86% (n=61) agreed it should be nationally mandated for OG cancer units to provide a 24/7 service. Conclusion Consultant OG surgeons recognize the importance of delivering high-quality OG emergency services. However, the data indicates inconsistent delivery across the UK. Given the seriousness of OG emergencies, mandatory provision of this service with appropriate funding and remuneration is essential. Several workforce challenges, including potential impacts on OG cancer resection volume and provision of General Surgical on-call, need to be addressed. Ultimately, patients require timely and specialised intervention. As one respondent emphasized: "A situation where surgeons in non-OG centres can spend a whole night ringing around various OG centres looking for help with a Boerhaave perforation is unacceptable."

Prognostic significance and risk factors of mediastinal lymph node metastasis in esophagogastric junction cancer: a single-center, retrospective study.

Although the optimal extent of lymph node dissection in esophagogastric junction cancer (EGJC) has been reported, the efficacy of mediastinal lymph node dissection remains unclear. We aimed to identify risk factors for mediastinal lymph node metastasis and its prognostic impact in patients with EGJC. A total of 100 consecutive patients who underwent curative surgery for EGJC were eligible. We examined the rates of metastasis, prognosis, and therapeutic value index at each mediastinal lymph node station. In addition, multivariate analyses were performed to identify risk factors for mediastinal lymph node metastasis. The rates of upper, middle, and lower mediastinal lymph node metastases were 12.0%, 20.7%, and 13.2%, respectively. The 5-year overall survival rate was lower in patients with mediastinal lymph node metastasis than in those without mediastinal lymph node metastasis (11.1% vs. 59.2%, p < 0.01). The therapeutic value index was 0 in patients with upper/middle mediastinal lymph node metastasis, and mediastinal lymph node metastasis was an independent prognostic factor (hazard ratio 6.59, 95% confidence interval [CI] 2.48-17.9, p < 0.01). Additionally, the length of esophageal invasion and the presence of hiatal hernia were independent predictors of mediastinal lymph node metastasis (odds ratio 8.21, 95%CI 1.44-46.8, p = 0.02 and odds ratio 7.13, 95%CI 1.22-41.8, p = 0.03). No survival benefit of mediastinal lymph node dissection was observed. Intensive multidisciplinary treatment could be considered in patients with predicted mediastinal lymph node metastasis, such as those with longer esophageal invasion and those with hiatal hernia.

OGC SO05 - Prevalence of Malabsorption and Impact on Quality of Life After Oesophago-Gastric Cancer Surgery

Abstract Background Recent Cancer Research UK data highlights a concerning rise in oesophago-gastric cancers, with 9,200 new cases of oesophageal cancer cases and 7,000 new cases of gastric cancer annually, ranking them the 13th and 17th most prevalent cancers, respectively. Surgery offers potential cure, but survival rates remain modest. Procedures include oesophagectomy and gastrectomy with Roux-en-Y reconstruction. Patients frequently experience nutrition-impact symptoms (NIS) associated with malabsorption post-surgery, however limited data exits on how this malabsorption affects their quality of life (QoL). This study aimed to investigate the prevalence of malabsorption and its correlation with QoL following oesophago-gastric cancer surgery. Method A cross-sectional cohort observational study was conducted on 98 cancer-free patients aged 18 or older following oesophagectomy (57%, including 1% with colonic interposition), subtotal gastrectomy (21.4%), or total gastrectomy (20.4%) with curative intent at the Northern Oesophago-Gastric Unit in Newcastle Upon Tyne from January 2013 to December 2023. Data collection utilised a modified Gastrointestinal Symptom Rating Scale (mGSRS) and QoL questionnaire distributed via post or email. Participants assessed their QoL on a self-reported Likert-scale (0-10) for their own subjective QoL perception. SPSS statistical software was employed to explore correlations between post-surgery malabsorption and QoL outcomes within this patient cohort. Results Post-surgery, 44.3% of patients encountered weight management challenges, notably within the first year. Malabsorption was prevalent in 69.9% of patients, with common symptoms such as flatulence and reduced appetite. Steatorrhoea, experienced by 47.3% of patients, also commonly caused flatulence and urgent bowel movements. NIS prevalence varied among surgical procedures, with 64.1% post-oesophagectomy and 78% post-gastrectomy, particularly after total gastrectomy. Pancreatic enzyme replacement therapy remained underused at 9.4%. Malabsorption strongly correlated with reduced QoL scores (r=-0.583, p&amp;lt;0.001), regardless of the time elapsed since surgery. Patients with steatorrhoea reported significantly lower QoL scores compared to those without (MD:-1.874, 95% CI, p&amp;lt;0.001). Conclusion The study highlights a significant prevalence of malabsorption and impaired QoL among patients following oesophago-gastric surgery, particularly notable in those experiencing steatorrhoea. Despite medical advancements, these issues often go unrecognized. The multifaceted nature of NIS and their impact on QoL necessitate a multidisciplinary approach involving gastroenterologists, dietitians, and other healthcare professionals. This collaborative effort aims to identify underlying factors contributing to malabsorption, provide consistent dietetics support, and manage symptoms effectively throughout the patient's recovery. Standardised guidelines are essential for ensuring comprehensive care and addressing both physical and psychosocial aspects, thereby enhancing overall postoperative QoL and long-term health outcomes.

OGC SO03 - Impact of recent European consensus guidelines on Oligometastic Disease (OMD) and potential case load of Oesophagogastric cancer resections

Abstract Background To evaluate the impact of recently devised oligometastatic disease (OMD) criteria as per the European consensus guidelines on the eligibility of Oesophagogastric (OG) cancer patients for curative treatment. Method A retrospective analysis was conducted on OG cancer cases discussed at multidisciplinary team (MDT) meetings at a tertiary university hospital from January 2018 to December 2023. Inclusion criteria included T2-T4a adenocarcinomas, T2-T4b squamous cell carcinomas, small cell carcinoma and adeno-squamous carcinomas that were classified as M1 disease. Exclusion criteria were T4b adenocarcinomas, M1 peritoneal disease, non-adeno/ squamous carcinoma histology, M1 peritoneal cytology, and head and neck squamous cell carcinomas proximal to the thoracic inlet. Data on patient demographics, T stage, histology, and metastatic sites were analysed to identify those meeting the oligometastatic disease criteria. Results 483 of 696 were diagnosed as M1 disease. OMD was found in 59 cases (12.2%), with a median age of 72 years (43 males, 16 females). T stage distribution: 3 T2, 36 T3, 20 T4. Histology: 39 adenocarcinomas, 19 squamous cell carcinomas, 1 small cell carcinoma. Metastatic sites: non-regional lymph nodes (77.9%), liver (13.6%), lung (5.1%), bone (1.7%), adrenal (1.7%) Location of Lymph Node Involvement: 1Para-aortic11 (23.9%)2Right supra-clavicular7 (15.2%)3Porto-caval6 (13.0%)4Retro-crural5 (10.9%)5Upper mediastinal5 (10.9%)6Left Supraclavicular5 (10.9%)7Coeliac4 (8.6%)8SMA3 (6.6%) Conclusion Our data would suggest that 12.2% of patients discussed in the MDT may potentially be candidates for a curative intent treatment pathway. Although the long-term outcomes remain unclear, this approach may define a subgroup of patients who may benefit from curative intent treatment with the highest site being para-aortic nodes.

BN SO33 - The complex benign multi-disciplinary team meeting - a paradigm shift in decision making for benign oesophagogastric surgery

Abstract Background Decision making in benign OG pathology can be particularly challenging given the overlap with functional disorders, such as reflux hypersensitivity. A specialist benign oesophagogastric (OG) multidisciplinary team (MDT) may improve our ability to triage potential surgical candidates from those with functional conditions. Unlike in OG cancer, there is a paucity of evidence to support an MDT based approach in benign OG surgery. This study aims to report our experience of introducing a specialist benign OG MDT in an OG tertiary centre in the UK, examining the effect on decision making and an assessment of its acceptability and utility to clinicians. Method A review of consecutive cases discussed in the specialist benign OG MDT since inception in 2022 was undertaken. We reviewed indications, treatment plans and outcomes, any alteration in treatment pathway and final decisions. The primary outcome was the proportion of patients with a change in management as a result of MDT discussion. Where applicable, results were reported using descriptive statistics. A seven-item electronic questionnaire was also circulated to MDT members (OG surgeons, specialist gastroenterologists, GI radiographers, GI physiologists, and doctors in training), to assess the acceptability and perceived utility of the meetings. Results 74 patient cases were discussed (median age 57.5 (25-79) years). 71/74 (96.0%) of referrals were made by OG surgeons, most commonly to discuss anti-reflux procedures (53/74 (71.6%)). 34/74 (45.9%) patients had undergone previous surgery, most commonly laparoscopic fundoplication. MDT discussion led to a change in management in 43/74 (58.1%) case with recommendations of further investigation (23.0%), further OG clinic review (18.9%) and 21.6% listed for surgery. 12/74 (16.2%) were referred to other specialist services, including clinical psychology. Survey confirmed that all MDT members found their understanding of oesophageal physiology and subsequent decision-making ability in clinic was greatly enhanced. Conclusion Our results show that the complex benign MDT is an effective tool, demonstrating changes to management in over half of cases discussed, including recommending surgery less frequently following specialist review of physiology investigations. Such tests effectively identify functional disorders, such as rumination, highlighting a need for clear onward referral pathways involving specialist psychologists. The meetings have also proven to be valuable learning tools for all attendees of all grades. We strongly believe that adopting an MDT approach to benign OG conditions will enhance collaborative decision making, improve patient outcomes and therefore should be nationally mandated and recommended through AUGIS guidelines.

OGC SO29 - Patient perceptions survey on the best timed oesophago-gastric dietetic pathway

Abstract Background It is well established that patients with oesophago-gastric (OG) cancer often present with malnutrition and impact symptoms such as anorexia, dysphagia and abdominal symptoms. Dietetic input is imperative in assessing and managing these symptoms early to improve outcome measures such as nutritional status, clinical outcomes and quality of life. A service evaluation was conducted to explore patient perceptions of early dietetic intervention in the Greater Manchester OG two week wait (TWW) pathway. There is no known prior research exploring the aims of this project. The results provide a novel insight into patient perceptions. Method A mixed methods survey using Microsoft Forms including open and close-ended questions was completed using transcription of responses via telephone consultation for 8 participants. For multiple choice responses, quantitative analysis was undertaken utilising Microsoft Forms analytics. Thematic analysis was completed with the use of computer assisted qualitative data analysis software (CAQDAS). Results 100% of respondents strongly agreed that receiving information about eating and drinking during investigations was important to them. 100% of respondents disagreed that dietetic advice was difficult to understand and follow. 75% of respondents felt dietetic input to be helpful in managing nutritional impact symptoms. 25% of participants responded neutrally. 100% of respondents felt their individual needs and concerns were addressed and would recommend the service to friends/family (88% strongly agreed; 12% agreed respectively). Conclusion Dietetic input was viewed positively by service users undergoing the OG TWW pathway. Patients reported feeling reassured, and valued communication, accessibility, and a personal approach. Some patients experienced delays in receiving prescribed nutritional supplements. Consistency of nutritional information requires improvement across the multidisciplinary team. Unfamiliarity with dietetic input limits the ability of participants to provide perspectives on service improvement. These findings suggest that specialist nutritional assessment and advice is beneficial to patients. Future research should be conducted to explore the long-term impact of early dietetic interventions on health outcomes in OG cancer patients.

AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer

Abstract Background Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer. Method A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included. Results 63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m. Conclusion In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.

AHP SO10 - A review of preoperative dietetic outcomes in patients with oesophagogastric (OG) cancer undergoing surgery

Abstract Background In line with NICE guidance (2018), all patients undergoing OG surgery at GSTT are offered a dietetic assessment by a specialist dietitian before their surgery. There is emerging evidence and interest in prehabilitation programmes to improve clinical and patient-centred outcomes. Nutritional optimisation is a key component of such programmes, although the optimal nutrition interventions are not fully elucidated, particularly within the preoperative period (Casey et al., 23). There is large national variation in dietetic interventions and minimal guidance on best practice to support this patient group. Method A retrospective review was undertaken to assess whether preoperative dietetic goals for patients with OG cancer undergoing surgery between August 2022 to January 2023 were achieved. Outcomes based on weight were reviewed given its routine use and availability. Dietetic goals were categorised according to the following aims: weight gain, weight stability and weight loss. Data was collected on 44 patients and excluded from analysis were those who were not assessed by a dietitian preoperatively. The length of intervention was defined in days. Results Table 1.0 Goal Weight Gain (n=11) (all ONS) Intervention length Achieved (&amp;gt;1kg weight gain) 7 (64%) 19-46 Not achieved (&amp;lt;1kg weight gain/ weight loss) 4 (36%) 26-40 Conclusion Overall, 52% patients did not achieve their weight goal before surgery. At present in our centre, patients receive one appointment with the specialist dietitian before their surgery due to limited resource. There is a recognition that additional support is required for many patients to prepare for surgery. Prehabilitation would address this and have the potential to improve dietetic outcomes. Weight is a readily available outcome measure but does not reflect body composition or other parameters of nutritional status. More comprehensive assessment of nutritional status would support further evaluation of dietetic outcomes and their impact on clinical and patient centred outcomes.

OGC SO10 - Modification of the Complications Parameter for ‘Textbook Outcome’ in Oesophageal Cancer Surgery

Abstract Background Surgical resection is cornerstone of curative treatment for most patients with oesophageal cancer. ‘Textbook outcome’ (TBO), a composite outcome measure, was proposed to benchmark quality of care for patients undergoing oesophagogastric cancer surgery. One required parameter for TBO is the absence of ‘severe’ complications (defined as Clavien-Dindo (CD) grade ≥2). In recent years there has been debate regarding whether a CD grade 2 complication should be considered a significant deviation from the desired post-operative course. This study aimed to assess whether revised a TBO parameter of CD≥3 is associated with improved overall survival in patients undergoing oesophagectomy for cancer. Method Data were collected for consecutive patients who underwent oesophagectomy for cancer at a single tertiary centre in the United Kingdom, between January 2018 and February 2020. Patients were identified from a prospectively maintained regional database with additional datapoints sought from electronic patient records. These included baseline clinicopathological characteristics, treatment details and the previously defined postoperative outcomes required for assessment of TBO. The primary outcome of interest was overall survival. Results Ninety-one patients (68.1% male, median 67 years (IQR: 59-72)) underwent oesophagectomy. Most had clinical stage III (61.5%) or IVA disease (28.6%) and underwent neoadjuvant chemotherapy (82.4%). When classified using the CD≥2 parameter, 15.4% achieved TBO compared with 41.8% when using CD≥3. Improved overall survival was observed in patients with a TBO using CD≥3 complication parameter (p=0.033). Survival was comparable between TBO and non-TBO group with the CD≥2 cut-off (p=0.550). TBO using CD≥3 remained associated with better survival, following adjustment for confounding variables, (HR:0.50 (95%CI:0.26-0.97), p=0.042)) while TBO using CD≥2 was not (HR:0.81 (95%CI:0.33-2.00, p=0.648)). Conclusion This study demonstrates that an association between TBO and overall survival in our patient population was only evident when the parameter requiring no ‘severe complication’ was re-defined as CD≥3. Consideration of TBO for specialist units may be useful for benchmarking quality and for prognostication.

OGC SO28 - Predictors of Pulmonary Complications Following Thoracoscopic Oesophagectomy

Abstract Background Thoracoscopic oesophagectomy, a minimally invasive technique, is associated with less postoperative pain and reduced pulmonary dysfunction. There is a correlation between preoperative cardiopulmonary fitness and postoperative outcomes, with certain variables linked to a higher risk of complications following oesophagogastric cancer surgery. This review aims to identify variables that correlate with pulmonary complications after oesophagectomy. Method A retrospective review of patients undergoing thoracoscopic oesophagectomy between 2014 -2022 at a single oesophagogastric unit was performed. 96 patients were identified and separated into two groups (19 with serious complications (SC) (greater than Clavien Dindo 3b), and 77 without serious complications (Clavien Dindo 3a and below)(NC). The primary outcomes measured included FEV1, FVC, VE/VCO2, VO2 Peak, anaerobic threshold, Estimated Met Score (EMS). Secondary outcomes measured preexisting pulmonary complications, smoking status and operating (chest time, one lung ventilation time (OLVT)). Results Groups were similar in age, gender, BMI, ASA, and clinical stage. SC had a significantly less number of smokers (p=0.004) and less individuals with pulmonary disease (p=0.019). AT was higher in NC (14.15 vs 13.50, p=0.355) and VE/VCO2 was significantly greater in SC (28 vs 32, p=0.018). SC had a significantly lower FEV1 and FVC (2.12 vs 2.81, p=0.009 and 3.11 vs 3.80, p=0.010) and a trend towards a lower EMS (6.95 vs 7.25, p=0.245). There was no significant difference in chest time between NC and SC (295min vs 265min, p=0.151) and OLVT (270min vs 245min, p=0.381) in both groups. Conclusion VE/VCO2 ratio in thoracoscopic oesophagectomy patients is a significant predictor of postoperative complications and has increasing links to adverse outcomes. Smoking status and pulmonary history do not significantly correlate with pulmonary complications in our cohort. Lower EMS, FEV1, and FVC are significantly associated with complications. Although preoperative inspiratory muscle training has not broadly impacted postoperative outcomes, it may benefit specific groups. These variables are crucial for clinicians to consider when counselling patients and planning prehabilitation.