Oxford Experience Research Articles

Survival Trends for Uterine Sarcomas from a Tertiary Center: The Oxford Experience.

Uterine sarcomas are rare and aggressive gynecological malignancies. We evaluated the epidemiology, treatment outcomes and survival rates in uterine sarcoma patients managed in our institute. The medical records of women with histology proven uterine sarcoma, including leiomyosarcoma (LMS), adenosarcoma (ADS), and endometrial stromal sarcoma (ESS), treated at our institution from February 2010 to February 2022, were analyzed. In total, 41 patients were identified. In detail, LMS, ADS, and high-grade and low-grade ESS were identified, respectively, in 60.9%, 19.5%, 12.1%, and 7.3% of the cases. The majority of women affected by LMS (72%) underwent primary surgery and 40% of them also received adjuvant chemotherapy. A surgical approach was the preferred mode of treatment in 83% of the recurrences. The median OS (overall survival), DFS (disease free survival), and PFS (progression free survival) for the LMS group were 25, 44.5, and 8 months, respectively. The 5-year survival rates for LMS, ADS, and ESS groups were 30.5%, 100% and 37.5%, respectively. The 5-year survival for LMS was found to be significantly worse than for other histology types (p = 0.016). Our study provides valuable data for the evaluation of treatment strategies and survival trends among these rare cancers. The management and follow-up planning of each subtype requires a thorough patient-focused multidisciplinary discussion.

Maxillary obturator fabrication for partial/hemi-maxillectomy patients. Can we avoid a second general anaesthetic? The Oxford experience

Maxillary obturator fabrication for partial/hemi-maxillectomy patients. Can we avoid a second general anaesthetic? The Oxford experience

Frontal sinus stenting in endoscopic sinus surgery: the 10-year Oxford experience.

Frontal sinus stents have been introduced to reduce frontal sinus re-stenosis after surgery and to improve outcomes. This study was a retrospective analysis of 19 patients who had endoscopic sinus surgery with approach to the frontal sinus and insertion of a soft sinus stent. The frontal recess was patent in 78.9 per cent and stenosed in 21.1 per cent of patients; no completely closed recesses were observed. Mean follow up was 20.7 months, and time period of stenting was 9.8 months on average; complications were observed in 47.4 per cent of the patients, with post-operative sinonasal infection being the most common. In the authors' experience, indications for frontal sinus stenting include recalcitrant chronic rhinosinusitis after multiple functional endoscopic sinus surgeries (especially in chronic rhinosinusitis with nasal polyps), patients with history of important craniofacial surgery or trauma, and recurrent mucoceles. The stent was overall well tolerated as only minor complications were observed. Close clinical follow up is mandatory.

24. Is it best to leave the fibular donor site dressing in place for 3 weeks? 9 years data audit of outcomes

The aim introduces an audit of outcomes in the Oral and Maxillofacial Head and Neck department over the last 9 years about fibular donor site morbidity (DSM) (n=86). DSM is a well-recognized complication of fibular free-flap reconstruction with 30% risk of complications, wound dehiscence, tendon exposure, graft failure. There is no consensus on how long to leave graft undisturbed. We aim to outline oxford experience leaving the bolster for 21 days, using the same type of dressing.

A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature.

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes. Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020. Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks. In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

Safety and Operational Efficiency of Restructuring and Redeploying a Transcatheter Aortic Valve Replacement Service During the COVID-19 Pandemic: The Oxford Experience

BackgroundThe risk of nosocomial COVID-19 infection for vulnerable aortic stenosis patients and intensive care resource utilization has led to cardiac surgery deferral. Untreated severe symptomatic aortic stenosis has a dismal prognosis. TAVR offers an attractive alternative to surgery as it is not reliant on intensive care resources. We set out to explore the safety and operational efficiency of restructuring a TAVR service and redeploying it to a new non-surgical site during the COVID-19 pandemic. MethodsThe institutional prospective service database was retrospectively interrogated for the first 50 consecutive elective TAVR cases prior to and after our institution's operational adaptations for the COVID-19 pandemic. Our endpoints were VARC-2 defined procedural complications, 30-day mortality or re-admission and service efficiency metrics. ResultsThe profile of patients undergoing TAVR during the pandemic was similar to patients undergoing TAVR prior to the pandemic with the exception of a lower mean age (79 vs 82 years, p < 0.01) and median EuroScore II (3.1% vs 4.6%, p = 0.01). The service restructuring and redeployment contributed to the pandemic-mandated operational efficiency with a reduction in the distribution of pre-admission hospital visits (3 vs 3 visits, p < 0.001) and the time taken from TAVR clinic to procedure (26 vs 77 days, p < 0.0001) when compared to the pre-COVID-19 service. No statistically significant difference was noted in peri-procedural complications and 30-day outcomes, while post-operative length of stay was significantly reduced (2 vs 3 days, p < 0.0001) when compared to pre-COVID-19 practice. ConclusionsTAVR service restructuring and redeployment to align with pandemic-mandated healthcare resource rationalization is safe and feasible.

Partial Breast Reconstruction with Perforator Flaps to Facilitate Breast Conservation in Women with Breast Cancer: Oxford Experience over 7 Years and Report on Follow-Up.

Partial Breast Reconstruction with Perforator Flaps to Facilitate Breast Conservation in Women with Breast Cancer: Oxford Experience over 7 Years and Report on Follow-Up.

Sentinel lymph node biopsy for oral cancer: the Oxford experience

Sentinel lymph node biopsy for oral cancer: the Oxford experience

Deformity Surgery: return to Theatre and Complications, an Oxford experience

Introduction An average of 100 patients every year undergo orthognathic surgery for surgical management of deformity at the John Radcliffe Hospital in Oxford. We have previously presented our 5 year return to theatre (RTT) data and advocated a two surgeon RTT protocol.

Early magnetic resonance imaging in suspected scaphoid fractures: the Oxford experience

Early magnetic resonance imaging in suspected scaphoid fractures: the Oxford experience

OC23 ENDOSCOPIC VEIN HARVESTING A SINGLE CENTRE REVIEW: THE OXFORD EXPERIENCE

Abstract Background: Endoscopic vein harvesting (EVH) has an increase central rule in CABG and recent studies has indicated the endoscopic technique as a safe and effective option. Nonetheless for many years there has been some controversy on the long term patency of the vein caused by endothelial damages, the technique has acknowledge advantages of low rate of wound infections, neuropathy and pain on the surgical site and a good cosmetic result and patient satisfactory. We reported a 2 years Oxford experience with EVH. Methods: We have retrospectively analysed from local database 518 patients that had endoscopic vein harvested at Oxford University Hospital from January 2017 to May 2018. All the patient received a ultrasound of the legs to assess the quality and size of the veins prior to the operation. A small incision of 3 cm was made below knee and the vein was harvested with Maquet Vasoview Hemopro 2 then a comprisse bandage was placed Results: The group of patient that received EVH were mainly man, with associate comorbidities and was the 99% of the vein harvested in our center. The length and quality of conduits were assessed by the surgeon. There were no intraoperative complications and 1 conversion to open technique for equipment failure. There was 1 patient that developed sierus discharge. All patients expressed satisfaction and early mobilization. Conclusion: In our Experience the endoscopic vein harvesting is a very safe technique, with a low risk of complications, associate with a very good cosmetic results and patient satisfaction.

Long-Term Results in Isolated Metopic Synostosis: The Oxford Experience over 22 Years.

Metopic synostosis causing trigonocephaly is treated by fronto-orbital advancement and remodeling to correct the deformity and cerebral distortion and to treat intracranial hypertension in a small number of cases. The aim of this study was to evaluate complications, revisions, and long-term outcomes. A retrospective chart review was performed on consecutive metopic craniosynostosis patients treated between February of 1995 and February of 2017 at the Oxford Craniofacial Unit. Two hundred forty-five patients with isolated metopic synostosis were seen. Two hundred two patients underwent fronto-orbital advancement and remodeling. Fifty patients were girls and 152 patients were boys. Mean age at surgery was 16.8 months. Mean weight preoperatively was 12 kg. All patients received blood transfusion. Mean postoperative stay was 6 days. Average follow-up time was 8 years (range, 0.5 to 22 years). There were eight major complications (4 percent). Six patients (2.9 percent) required secondary calvarial expansion for late raised intracranial pressure. Thirty-one (15 percent) had other subsequent procedures, including wire removal and forehead shape contouring with alloplastic onlay. Raised intracranial pressure before surgery was confirmed in two cases by intracranial pressure monitoring. Trigonocephaly is caused by metopic synostosis and is treated by fronto-orbital advancement and remodeling to restore both internal and external skull configuration. After surgery, the authors identified a 2.9 percent risk of late raised intracranial pressure requiring a secondary calvarial expansion, necessitating prolonged follow-up in all cases. Temporal hollowing and forehead contour defects were not uncommon. This is the largest reported series of metopic synostosis. Therapeutic, IV.

Discussion: Long-Term Results in Isolated Metopic Synostosis: The Oxford Experience over 22 Years.

Discussion: Long-Term Results in Isolated Metopic Synostosis: The Oxford Experience over 22 Years.

P568 The impact of a virtual clinic on clinical decision-making and healthcare resource use vs. standard care: The Oxford experience

P568 The impact of a virtual clinic on clinical decision-making and healthcare resource use vs. standard care: The Oxford experience

P152 Fertility and reproduction in a tertiary IBD centre: the Oxford experience

P152 Fertility and reproduction in a tertiary IBD centre: the Oxford experience

Antenatally Detected Congenital Pulmonary Airway Malformations: The Oxford Experience.

Congenital airway pulmonary malformations are increasingly being diagnosed, but their management continues to remain controversial. Our approach has been to offer surgery to mitigate the risk of infection and possible malignancy. All patients routinely undergo a CT scan of the chest postnatally and once the diagnosis is confirmed, minimal access surgery is offered. Our anesthetists provide single-lung ventilation to enhance the operative view. We conducted a retrospective review over a 10-year period, during which 91 patients were prenatally suspected to have a cystic lung lesion. There were 88 live births of which 29 (33%) cases were initially managed conservatively based on CT findings. Five of these patients, however, became symptomatic needing surgery. A total of 64 (73%) patients underwent surgery with the most common lesions being congenital pulmonary airway malformations (CPAMs) (24), hybrid lesions (19), and pulmonary sequestrations (12). The median age at surgery was 5 months (1 day to 17 months). Using a minimal access approach, 41 (64%) cases were completed with 17 performed open from the onset. Open surgery was indicated in neonates who became symptomatic within the first few weeks of life as well as patients in respiratory distress that would not tolerate either single-lung ventilation or gas insufflation. There were six further conversions to open from minimal access surgery due to poor visualization or technical difficulties. One patient needed a perioperative blood transfusion and one patient had a more prolonged stay due to persistent air leak managed conservatively. Among asymptomatic patients, evidence of microscopic disease was seen, which included infection as well as two cases of tumors, one pleuropulmonary blastoma seen as part of a CPAM, and one rhabdomyomatous dysplasia seen in the CPAM component of a hybrid lesion. In our experience, excising asymptomatic lesions is safe with minimal complications. Single-lung ventilation in combination with thoracoscopy provides excellent vision. There is a risk of infection and a definite, albeit low, risk of malignancy, which may outweigh the benefits of conservative management.

The five-year Oxford experience of paediatric ultrasound-guided percutaneous biopsies

The five-year Oxford experience of paediatric ultrasound-guided percutaneous biopsies

The Oxford Experience: Clinical Features And Outcomes of 25 NMDAR-Ab Positive Patients Including Those With Atypical Presentations (P5.189)

The Oxford Experience: Clinical Features And Outcomes of 25 NMDAR-Ab Positive Patients Including Those With Atypical Presentations (P5.189)

Clinical Trials for New Implants in Spinal Surgery. The Oxford Experience

Surgical implants have come under increasing scrutiny in recent years. A number of high profile failures have highlighted the importance of quality assurance and research that supports their use. Well designed clinical trials provide an objective way of assessing the effectiveness and safety in human subjects that can then be evaluated by the wider orthopaedic community. This article highlights some of the problems with current implant regulations and the stages in designing a clinical trial for an orthopaedic implant.

OP017: The Oxford experience with Buccinator and FAMM flaps for oral cavity and oropharyngeal reconstruction

Purpose The Buccinator and Facial Artery Musculo-Mucosal (FAMM) flaps can be used to reconstruct a wide range of intra-oral defects including floor of mouth, tonsillar fossa and lateral tongue. We describe our experience with the Buccinator and FAMM flaps in the aforementioned areas and a novel use for the reconstruction of oropharyngeal tumours at the tongue base and lateral pharyngeal wall. Materials and methods We retrospectively reviewed all patients who underwent Buccinator and FAMM flap reconstruction examining indication, operative details, and post-operative outcomes. We describe our technique for its novel use in lateral pharynx/tongue base reconstruction through neck dissection access. Results There were no flap failures with all patients achieving primary healing with minimal complications. All donor sites closed directly with mouth opening at pre-operative status by 21 days post-op. Deeper flaps were adequately visualised and monitored using flexible nasoendoscopy. Conclusion In our experience Buccinator and FAMM musculo-mucosal flaps are an extremely versatile ‘like for like’ local flap option due to their long arc of rotation that we have used for the first time to successfully reconstruct the tongue base and lateral pharynx. As inset can be achieved via neck dissection access this avoids lip/jaw split as per conventional oropharyngeal surgical management further minimising morbidity.