Standard Treatment Research Articles

Pancreatic ductual carcinoma with isolated liver metastases: is it worth performing surgical resection?

Pancreatic ductal cancer is one of the most aggressive malignancy with a high incidence of advanced stages at the time of diagnosis and unsatisfactory long-term treatment results. It is believed that pancreatic ductal cancer in the presence of distant metastases identified at the stage of intraoperative revision or before surgery is a contraindication to surgical treatment. There is currently renewed interest in surgical treatment of patients with oligometastatic pancreatic cancer.Material and Methods. The search for sources was carried out in the PubMed and Elibrary systems from January 1995 to January 2024. Of the 1321 sources found, 37 were used to write the review. Data from both retrospective and prospective clinical studies that focused on the results of combined modality treatment of pancreatic cancer with isolated liver metastases were included.Results. To date, a standard treatment strategy for patients with oligometastatic pancreatic cancer has not yet been established; there are no definitive criteria for selecting patients who may benefit from surgical treatment. The current selection criteria for surgery for metastatic pancreatic cancer are far from ideal, extremely heterogeneous and, as a rule, are based only on certain clinical and instrumental data. The starting point for developing selection criteria for surgical treatment of patients with metastatic pancreatic cancer is a common understanding of what “oligometastatic pancreatic cancer” is.

Immune checkpoint inhibitor therapy as a neoadjuvant treatment for muscle-invasive bladder carcinoma

Abstract Background and objectives Immunotherapy has become a standard treatment for patients with advanced urothelial carcinoma, and neoadjuvant immunotherapy is being extensively explored. This review highlights the initial findings and key clinical therapeutic insights on immune checkpoint inhibitors in the early treatment of muscle-invasive bladder cancer across diverse patient populations. Materials and methods Relevant trials were retrieved from PubMed/MEDLINE and clinical trials databases. In addition, abstracts of major international oncology meetings (American Society of Clinical Oncology, American Association for Cancer Research, European Society of Medical Oncology, and European Council of Clinical Oncology) were reviewed until the European Society of Medical Oncology 2023 congress. The review also incorporated results from several exploratory investigations disclosed in recent years. Results This review focused on neoadjuvant immune checkpoint inhibitor monotherapy, combination therapy, and clinical biomarkers in relation to cisplatin-based chemotherapy tolerance. Most available literature consists of clinical investigations involving small sample, single-arm Phase II trials, with the primary endpoint being the pathologic complete response rate. The preliminary results from these studies are promising, demonstrating stage reduction rates comparable to or even exceeding those of standard chemotherapy, without compromising subsequent radical cystectomy. Conclusions Early results of immune checkpoint inhibitors in the neoadjuvant treatment of bladder cancer have demonstrated promising efficacy. However, these findings require confirmation in large Phase III clinical trials, with particular emphasis on long-term survival benefits and identifying patients who respond to treatment.

Effect of vitamin D adjuvant therapy on the proportion of regulatory T cells in peripheral blood and pregnancy outcome of patients with recurrent miscarriage.

Recurrent miscarriage (RM) is influenced by immune factors, particularly regulatory T cells, which can impact immune function and miscarriage risk. Vitamin D (VD) is known to regulate the immune system, potentially improving pregnancy outcomes in RM patients. This study aims to assess the effect of VD adjuvant therapy on regulatory T cells and pregnancy outcomes in RM patients. Clinical data from 104 individuals with RM admitted to our hospital between March 2022 and February 2023 were allocated at random to either the VD group (VDG) or the control group (CG), with 52 patients in each group. Both groups received standard treatment; the CG was treated with aspirin, while the VDG received additional VD therapy. Outcomes measured included regulatory T cell proportion, metabolic factors, immune inflammatory markers, and pregnancy outcomes. After treatment, the proportion of regulatory T cells in VDG was considerably higher (p < 0.05). Additionally, triglyceride levels, leptin, fasting blood glucose, and fasting insulin were lower in the VDG, whereas adiponectin levels were higher (p < 0.05). Levels of progesterone, luteinizing hormone, and 25-hydroxy VD were also higher in the VDG (p < 0.05). Furthermore, interleukin-17, gamma interferon, tumor necrosis factor-α, and C-reactive protein were lower in the VDG (p < 0.05). The pregnancy success rate in the VDG was higher, and the preterm birth rate was lower (p < 0.05). Adjuvant treatment with VD can increase the proportion of regulatory T cells in peripheral blood of individuals with recurrent abortion, regulate metabolic disorder, alleviate immune inflammation, and improve pregnancy outcome.

Hematological Changes in Newly Diagnosed Pulmonary Tuberculosis Patients on Standard Anti-TB Treatment Regimen and their Influence on Smear Conversion

Pulmonary tuberculosis (PTB) mortality remains high despite the availability of effective anti-TB therapy. Disease and treatment-associated hematological derangements at diagnosis and during therapy might contribute to this high TB mortality rate. This paper aims to determine hematological changes in newly diagnosed pulmonary tuberculosis patients on standard anti-TB treatment regimen and their influence on smear conversion. The study adopted a longitudinal design in which 55 newly diagnosed HIV negative PTB patients were followed up to the fifth month of anti-TB therapy. Blood samples (5ml) were collected for diagnosis during the second and fifth months and analyzed using automated HumaCount 5D hematology analyzer. Data was analyzed using Kruskal-wallis test with Dunn’s multiple comparisons test in Graph-Pad prism version 6.0. Throughout therapy, there was a statistically significant time-dependent decrease in median total white blood cell counts from 6.82x103/ uL at diagnosis to 5.87x103/ uL at the fifth month (P=0.0358). This decrease in total WBC count was majorly driven by significant decrease in the neutrophil numbers from 4.31x103/ uL at diagnosis to 2.97x103/ uL at the fifth month. The proportion of patients who had anemia at the fifth month of treatment increased compared to the second month post intensive phase. There was also a significant decrease in MCV, MCH and MCHC at the second month compared to diagnosis. Moreover, the median platelet count, MPV, PDW and PCT% decreased from 314x103/ uL, 8.9 fL, 10.4 fL and 0.273 at diagnosis to 232x103/ uL, 10.15 fL, 12.5 fL and 0.235 at the fifth month, respectively. High WBC count, high platelet count, low lymphocyte count and low HGB at the end of month two of therapy were shown to increase the likelihood of sputum non-conversion (OR-2.42 (95% Ci 2.07-2.82)), (OR-1.5 (95% Ci 1.01-2.22)), (OR-1 (95% Ci 1-1)) and (OR-2.58 (95% Ci 1.68-3.95)), respectively (P&lt;0.05). A significant number of PTB patients presented with anemia, thrombocytosis and leukocytosis. The proportion of patients with anemia increased over time. The study recommends screening for hematological abnormalities in patients for tailored patient interventions for better clinical outcomes.

Comparison of Neoadjuvant Chemotherapy Followed by Radical Surgery with Chemoradiation in Stage IB2 to IIB of Cervical Cancer

Background: The management of locally advanced cervical cancer (stages IB2 to IIB) remains controversial, particularly in regions with limited radiotherapy (RT) resources. While chemoradiation therapy (CRT) is the standard treatment in many Western countries, neoadjuvant chemotherapy followed by radical surgery (NACT-RS) has emerged as an alternative approach. Objectives: The comparative effectiveness and safety of NACT-RS versus CRT in terms of side effects and recurrence rates remain unclear, necessitating further investigation. Methods: A cohort study was conducted from 2020 to 2023, involving 68 patients with cervical carcinoma (stages IB2 to IIB). The patients were stratified into two treatment groups: Neoadjuvant chemotherapy followed by radical surgery (N = 17) and CRT (N = 51). The study compared pathology reports, short-term treatment complications, and one-year recurrence rates between the two groups. Results: Minor complications occurred in 41.2% of the NACT-RS group and 39.2% of the CRT group (P = 0.886), while major complications were observed in 23.5% and 25.5% of the groups, respectively (P = 0.872). All NACT-RS patients responded to chemotherapy with significant tumor size reduction (47.7 ± 8.0 vs. 11.2 ± 8.6, P &lt; 0.001) and resolution of vaginal involvement. During the one-year follow-up, no recurrences were observed in the NACT-RS group, compared to eight out of 51 (16.7%) in the CRT group (P = 0.186). Conclusions: The similar short-term complication rates and potentially lower one-year recurrence rate in the NACT-RS group suggest that this approach may be a viable alternative to CRT, particularly for young patients with bulky tumors and in areas with limited RT facilities.

Determining Whether State Policy Is in Line With Substance- and Alcohol-Related Best Practices for Domestic Violence Intervention Programs

Enhancing the effectiveness of Domestic Violence Intervention Programs (DVIPs) is necessary and may require up-to-date state-specific or national guidance. Currently, many U.S. states provide recommendations and requirements for DVIP length, content, and treatment curriculum through one or more of three types of documents: state laws, standards, and/or guidelines. However, these documents are updated irregularly and vary substantially in length, content, enforceability, and authorship expertise (i.e., legislators versus domestic violence [DV] experts and/or DV coalition members). Meanwhile, one robust yet controversial finding is that DV perpetrators with co-occurring substance use conditions have increased difficulty engaging with, sustaining attendance at, and benefiting from standard DVIP treatment (Jewell &amp; Wormith, 2010). Yet, the degree to which state-specific DVIP documents address how perpetrator substance use is to be assessed and treated within DVIPs is understudied. To fill this gap, guiding state documents were obtained as available (n= 47 states; 94%); these were coded with excellent interrater reliability (agreement = 91%). Consistent with research advances, state documents generally encouraged DVIPs to assess perpetrator substance use at intake (n= 41). However, fewer documents directed DVIP facilitators to address the link between substance use and DV within their curriculum (n= 25). Some state documents even prohibited substance use-related messages to be incorporated into the DVIP curriculum (n= 19). Unfortunately, even fewer states’ documents recommended follow-up of the perpetrator’s substance use during DVIP participation or after a substance abuse-related referral (n= 14). Efforts to align DVIP-guiding documents with knowledge related to increasing DVIP treatment effectiveness are necessary as is determining adherence to guiding documents.

A time trade-off study in the UK, Canada and the US to estimate utilities associated with the treatment of haemophilia.

Haemophilia is a rare bleeding disorder caused by a deficient or absent clotting factor, leading to frequent bleeding. Multiple intravenous (IV) infusions have been the standard prophylactic treatment; however, newer treatment options involve less frequent subcutaneous (SC) injections. To inform future health economic evaluations, this study applied the time trade-off (TTO) method for estimation of utilities associated with haemophilia treatment for both people with the disease and potential caregivers. Using the TTO method, utilities were estimated through two online surveys distributed in the UK, Canada and the US. In survey 1 (S1), adults from the general population aged 18years and above evaluated health states as if they were living with haemophilia themselves and were receiving treatment for the condition. In survey 2 (S2), adults from the general population with a child under the age of 15years evaluated health states as if they were treating their child for haemophilia. The surveys assessed the following treatment aspects: frequency of treatment, treatment device and injection site reactions. In total, 812, 739 and 703 respondents completed S1 and 712, 594 and 527 completed S2 in the UK, Canada and the US, respectively. In both surveys, the treatment device was associated with the largest impact on utilities for both people with haemophilia and caregivers. Monthly SC injections with a prefilled pen-device were associated with a significant utility gain compared with SC injections with a syringe and IV infusions. In S1, a lower treatment frequency was preferred in all three countries, while in S2, a lower treatment frequency was preferred only in the UK. Avoiding injection site reactions was associated with a significant utility gain in both surveys, but only in the UK and Canada. The study suggests that the administration of haemophilia treatment in particular has an impact on utilities for both people and caregivers living with the disease. Thus, less complex and time-consuming treatment devices are expected to improve health-related quality of life. This can be further modified additively by less frequent administration. These results can inform future health economic analyses of haemophilia and haemophilia treatment.

EGS SO31 - Does in-hospital delay in appendicectomy lead to complicated appendicitis and affect post operative outcome - a single centre study

Abstract Background Acute appendicitis is one of the most common reasons for emergency general surgical admissions in the U.K. The standard treatment for acute appendicitis is emergency appendicectomy. However, the urgency to operate on patients admitted to hospital with acute appendicitis has been widely debated, with no current standard guideline to follow. The aim of this study was to identify the effect of in-hospital delay in appendicectomy on intra operative findings of complicated appendicitis. The secondary outcome measures were the requirement of a surgical drain, overall length of stay, post-operative complications and re-admission rates. Method This was a single centre retrospective study. All patients who underwent an emergency appendicectomy, between 01/09/2023 and 30/11/2023 were included in this study. Hospital electronic patient records were screened to record the time of decision to operate, surgical start time, the delay between decision to operate and surgical start, intra-operative findings, and post-operative course. A total of 105 patients were included. These were divided into two sub-groups based on the delay between decision to operate and surgical start time; patients who had surgery within 12-hours (early) and those who had surgery after 12-hours (delayed) from the decision to operate time. Results Surgery was performed within 12-hours in 42% cases. The remaining 68% had more than a 12-hour delay, with almost 1 in 4 cases (26 /105) delayed over 24 hours. 15% cases (16) with uncomplicated appearance on pre-op imaging and delayed more than 12-hours progressed to complicated appendicitis intra-operatively. Surgical drains were required in 10% delayed cases and 6% early cases. The median length of stay was 2-days in delayed, compared to 1 day in cases performed early. Post-operative complications were higher in cases early. Although majority of these had complicated appearance in pre-op imaging. Both groups had same readmission rate. Conclusion Our study found that in-hospital delay in appendicectomy can potentially result in increased length of stay, higher rate of requirement of surgical drains and progression from imaging severity. This needs better prioritisation and theatre allocation.

Low-dose trimethoprim-sulfamethoxazole treatment for Pneumocystis pneumonia: a systematic review and meta-analysis

BackgroundThe recommended standard treatment for Pneumocystis jirovecii pneumonia (PJP) is high-dose trimethoprim-sulfamethoxazole (TMP-SMX) (15–20 mg/kg/d TMP). However, the standard regimen may cause a high incidence of dose-related adverse events (AEs). Therefore, we aimed to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of low-dose TMP-SMX regimens (&amp;lt;15 mg/kg/d of TMP) compared with the standard regimen in patients with PJP.MethodsWe searched PubMed, Embase, and the Cochrane database for relevant articles from inception to 10 March 2024. Studies were included if they focused on PJP patients receiving a low-dose TMP-SMX regimen compared with a standard regimen. The primary outcome was mortality. We assessed study quality and performed subgroup analysis and sensitivity analysis to explore potential heterogeneity among the included studies.ResultsSeven studies were included. Overall, the low-dose regimen significantly reduced the risk of mortality (odds ratio [OR] = 0.49; 95% CI, 0.30–0.80; I2 = 16%; P = 004). This finding was confirmed in further sensitivity and subgroup analyses. The low-dose regimen also significantly reduced total AEs (OR = 0.43; 95% CI, 0.29–0.62; I2 = 0%; P &amp;lt; 0.0001), and improved the incidence of most specific AEs (ORs ranged from 0.13 to 0.89). In addition, the low-dose regimen had significantly more patients completing the initial regimen (P = 0.002), fewer patients requiring dose reductions (P = 0.04), and almost significantly fewer patients requiring a switch to a second-line regimen (P = 0.06).ConclusionThe limited available evidence suggests that a low-dose TMP-SMX regimen significantly reduced mortality and total AEs in PJP patients. Thus, it is one of the potentially promising therapies to PJP and more high-quality and multi-center randomized trials should be conducted in the future.

OGC SO39 - The OUTLIVE Study - Oesophageal and JUncTional Cancer ELectIVE Surgery Morbidity and Mortality at 90-Day: A TUGS Multinational Audit

Abstract Background Oesophageal cancers are among the most common types of cancer and have a high mortality rate. Todate, oesophagectomy remains the gold standard treatment. However, considerable heterogeneity in the literature fails to generate a truly representative picture of short-term outcomes associated with these procedures. Method This multinational global audit includes all consecutive adults with clinically documented primary oesophageal malignancy undergoing elective surgery with curative intent. The study'sstudy's primary objective was to assess the 90-day mortality and morbidity rates in this population. Data was collected through a standardised dataset, and a descriptive analysis was employed. For analysis purposes, the patients were classified depending on the surgical procedure they underwent (laparoscopic, open, hybrid, converted and robotic surgery). Results A total of 622 individuals were analysed, most male [462 (74%)], with a mean Charlson Comorbidity Index of 4.30. The most common procedure was laparoscopic surgery [222 (35.7%)], followed by open surgery [198 (31.83%)]. 31 (5%) of the procedures reported an intraoperative complication, but more common in open procedures [11 (5.6%)]. 318 (51%) patients suffered postoperative complications within 90 days of surgery. The reoperation rate was 9.3%. McKeown staged procedure, compared to Ivor Lewis, had more infective complications [19% vs 11%, p=0.007] and a higher conversion to open procedures [69 (11.1%)]. 34 (11%) patients died because of a surgical complication. Conclusion No significant differences were found between the number of patients with at least one complication and the surgical approach. Nevertheless, robotic-assisted minimally invasive oesophagectomy (RAMIE) presented with the lowest complication, reoperation, and mortality rates. McKeown three-stage surgery also presented with worse clinical outcomes compared to Ivor Lewis procedures. Further studies and randomised control trials comparing different procedures in the field of elective oesophagectomy are needed to expand our knowledge in this field and guarantee the best outcomes for our patients.

The Challenges of Patients with Spinal CSF Leaks in Canada: A Cross-Sectional Online Survey.

Spinal CSF leak can cause disabling headaches and neurological symptoms. Lack of awareness, diagnostic delay and treatment inconsistencies affect the quality of CSF leak care globally. This is the first study aiming to identify and assess these challenges in Canada. A cross-sectional online survey of Canadian patients with spinal CSF leak was designed in collaboration with Spinal CSF Leak Canada, including questions on demographics, headache condition, investigations, treatments, quality of life, financial consequences and out-of-country care. The survey captured 103 respondents with confirmed spinal CSF leak diagnosis, of whom 56% were still suffering. The majority were female (80%), most being highly educated, with a mean age of 41.8 (SD: 10.37) years at the time of diagnosis. Inconsistencies in care resulted in variable durations for obtaining diagnosis and treatment. The majority of respondents (88%) had seen multiple physicians, and only 50% had seen a CSF leak specialist. Invasive imaging was not performed in 43%. CSF leak relapse after initial successful treatment occurred frequently (43%). The incidence of rebound intracranial hypertension was high (52.5%), and the treatment was difficult to access (77%). Out-of-country care was common (28%), and the impact on financial health was omnipresent (81.5%). The survey demonstrates significant gaps in spinal CSF leak care in Canada, similar to global observations. Lack of awareness and access, delayed care, and inconsistencies in investigations and management are common. Spinal CSF leak significantly impacts patients' physical, mental and financial well-being. Increased awareness, referral pathways and standardized treatment algorithms are key factors in optimizing patient care in Canada.

ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY DATA IN PATIENTS WITH VARIOUS VARIANTS OF THE GLAUCOMA PROCESS

Today, about 537 million people in the world aged 20 to 79 suffer from diabetes mellitus, in 3% of cases neovascular glaucoma is diagnosed, threatening vision loss. Neovascular glaucoma is one of the most aggressive forms of secondary glaucomas and is often refractory to standard treatment methods. In domestic and foreign literature, there is no single standard for choosing the tactics of surgical treatment of patients with neovascular glaucoma against the background of diabetic retinopathy. In this regard, studies aimed at studying the morphofunctional parameters of eyes with neovascular glaucoma against the background of diabetic retinopathy acquire not only theoretical but also obvious practical interest. In the course of further development of methods for complex effects on eye structures to reduce intraocular pressure and progression of the glaucoma process. An analysis of optical coherence tomography images of 51 patients (51 eyes) was conducted, and the main aspects were identified for further use in choosing the tactics of surgical intervention.

FISIOTERAPIA NO ZUMBIDO SOMATOSENSSORIAL: REVISÃO SISTEMÁTICA

Somatosensory tinnitus is a type of tinnitus that can be influenced by musculoskeletal and somatic factors, such as cervical or temporomandibular disorders. Physiotherapy has emerged as a noninvasive treatment option with the aim of addressing these musculoskeletal abnormalities to reduce tinnitus intensity and improve patients' quality of life. This review aims to evaluate the effectiveness of physiotherapeutic approaches in the management of somatosensory tinnitus, exploring different treatment modalities and the results obtained in clinical studies. The article was analyzed through clinical trials and observational studies were conducted, focusing on the impact of physiotherapy on somatosensory tinnitus, using outcome measures such as the Visual Analog Scale (VAS) for tinnitus intensity and the Tinnitus Handicap Inventory (THI) for quality of life. Most studies reported significant improvements in tinnitus severity and functional well-being of patients after physiotherapy interventions. Techniques such as manual therapy and myofascial release have been particularly effective in reducing symptoms in patients with cervical or temporomandibular disorders. However, a major limitation identified was the lack of standardized treatment protocols, which makes it difficult to generalize the results. Physiotherapy appears to be a promising therapeutic option for somatosensory tinnitus, particularly for patients with associated cervical and temporomandibular disorders. Future research should aim to standardize treatment protocols and include larger randomized controlled trials to further validate these findings and establish evidence-based clinical guidelines.

BN SO56 - Post-ERCP clearance of bile duct stones: Should the gallbladder be left in-situ?

Abstract Background Laparoscopic cholecystectomy (LC) has become the gold standard treatment for patients with cholelithiasis and co-existing common bile duct stones (CBSD) with the ultimate goal to prevent further biliary complications. Despite the procurement of ERCP and LC skills, there still remain a significant proportion of patients who are treated non-operatively. There has been debate on the safety of a ‘watch-and-wait’ policy post ERCP for clearance of CBDS alone. The objective of our study was to review our current practice and compare the outcomes of expectant management (EM) versus LC with an aim to evaluate the necessity of LC after ERCP. Method A retrospective review of patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019 was performed. Exclusion criteria applied to patients with previous cholecystectomy, absence of CBDS, gallbladder/pancreatic malignancy, biliary stricture and patients lost to follow-up. Patient characteristics, details of ERCP, initial plan for EM or LC, details of LC and further changes in treatment plan were extracted from the prospectively maintained database of a single institution. Age 70 years is used as cut-off to define elderly group. Primary outcomes measured were biliary-related morbidity and mortality. Secondary outcomes included all-cause mortality, operation-related morbidity and mortality. Results 265 patients were identified, with 136 patients primarily planned for EM and 129 patients initially booked for LC. The median age of patients in the EM group was greater than LC group (80 vs 62 years). 20.6% patients in the EM group re-presented with biliary events compared to 3.9% in the LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14 months. There was no significant correlation between age and complications from LC. However, 51.4% of our EM group died during follow up with a median survival of 29.5 months. Conclusion Prophylactic cholecystectomy should be performed for patients with concomitant cholelithiasis and choledocholithiasis. A conservative approach should be reserved for the elderly population who are not ideal surgical candidates. A follow-up of up to 2 years is recommended for patients who opt for a ‘watch-and-wait’ approach. Early LC is preferrable due to the risk of recurrence of biliary events and the higher risks of surgery if patients require emergency surgery. Further study is warranted to determine the optimal timing for LC. Patients should be informed about the potential recurrence of symptoms if the waiting time to surgery is longer than expected.

Differences in Outcomes Based on the Degree to Which Bone Defects Are Filled with Cancellous Allochip Bone Grafts in Hand Enchondroma Patients

Background/Objectives: Enchondroma, the most common benign cartilage tumor in the hand, often presents as pain, swelling, or pathological fractures. While curettage is the standard treatment preventing fractures, the optimal way of managing the bone cavity remains debated. In this study, we investigated the impact of a filled bone defect on radiologic and clinical outcomes among patients with enchondroma. Methods: We retrospectively reviewed patients with solitary enchondroma of the hand who underwent curettage followed by allogeneic cancellous bone chip impaction grafting. The patients were divided into two groups based on the extent to which their bone defects were filled post-curettage: Group 1 (complete filling) and Group 2 (incomplete filling, i.e., &lt;50%). We reviewed demographic data, local recurrence data, complications, information on consolidation duration, data on range of motion (ROM), and functional scores. Results: This study included 59 patients (25 males and 34 females; mean age, 30.4 ± 11.9 years, with a range of 8–78). Group 1 contained 35 patients, and Group 2 contained 24. No nonunion occurred following curettage and grafting. The mean radiological consolidation period was 6.4 weeks (range: 5–18). There was no significant difference in consolidation time between Group 1 (6.8 weeks) and Group 2 (6.9 weeks) (p = 0.166). The ROM and functional scores also showed no significant differences between the groups, with musculoskeletal society scores of 98.8 for Group 1 and 99.8 for Group 2 (p = 0.63). Conclusions: This study demonstrates that the use of the impaction technique combined with cancellous allochip bone grafting yields favorable results in the treatment of solitary hand enchondroma. The extent to which the bone defect was filled did not significantly impact the overall outcomes.

EGS SO32 - Management of Spontaneous Oesophageal Perforations in the era of Endo-Vacuum Therapy- Preliminary Results of a Single-Institution Study

Abstract Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how these should be optimally managed. Endoscopic Vacuum Therapy (EVT) has emerged as safe and effective option particularly in cases where major invasive surgery would otherwise be deferred. Herein, we sought to explore the effectiveness, patient benefit and related morbidity/mortality by exploring the strategy outcomes in SOPs prior to and during periods where EVT was available. Method A single-centre retrospective cohort study incorporating all consecutive patients (N=72) presented or transferred to our tertiary oesophagogastric unit for SOP management between 01/01/2009-31/12/2023 was undertaken. Patients with anastomotic leak post-surgery or perforation secondary to malignancy, iatrogenic, traumatic or food bolus were excluded. Primary study-outcomes were treatment type including non-operative, EVT after 01/01/2018 or other endoscopic therapy, surgical operation including laparotomy, thoracotomy, primary defect repair or over a T-tube, disconnection with oesophagostomy, stenting or other interventional radiology procedures and their rate of success or failure. Secondary outcomes were length of stay, 90-day complications requiring re-intervention or re-admission, 30-, 90-day, 1-year mortality. Results In 2009-2017 pre-EVT period, 25/72 patients were managed a) 18/25 surgically with thoracotomy and T-tube, b) non-surgical 7/25, four were palliated. 30-day, 90-day mortality were 4/25 and 2/25, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 14/25 (56%), 90-day reintervention 8/25 (32%), median LOS 27 days. In 2018-2023 EVT period , 47/72 patients were treated with a) laparotomy, left thoracotomy, defect repair over t-tube, chest drainage in 18/47, b) non-surgical 15/47, c) endoscopy 6/47, d) EVT in 14/47. 30-day mortality was 6/47, 90-day mortality 2/47, 90-day morbidity Clavien-Dindo &amp;gt;IIIa 32/47 (68%), 90-day reintervention 26/47 (55.3%), median LOS 34 days. 1-year mortality was 5/25 and 3/47 respectively. Conclusion EVT therapy appears to be a feasible additional treatment modality in the management of spontaneous oesophageal perforations. Optimal patient selection, therapeutic endoscopic expertise, knowledge of the technique, multidisciplinary approach and team collaboration are essentials for favourable outcomes. Of note, management of oesophageal perforations in a dedicated UGI centre is directly related to patient outcomes and is recommended as soon as such a diagnosis is confirmed.

BN SO30 - One hundred consecutive Laparoscopic Heller's Cardiomyotomy &amp; Fundoplication – a personal series

Abstract Background Oesophageal Achalasia (OA) is an uncommon primary oesophageal motility disorder, characterised by the loss of inhibitory neurons in the oesophageal myenteric plexus. The primary goal of treating OA is to alleviate dysphagia caused by the functional obstruction of the distal oesophagus due to the inability of the lower oesophageal sphincter (LOS) to relax appropriately after swallowing. Heller's cardiomyotomy (HCM) remains a standard treatment for OA. The aim of this study was to assess the symptomatic improvement and post-operative outcomes following HCM with fundoplication at our centre. Method All patients underwent HCM through laparoscopic blunt muscle separation technique, between January 2005 and March 2024, by a single surgeon. Retrospective review of electronic and compiled paper patient records were analysed to assess patient demographics, preoperative symptoms, operative details, length of stay (LOS), complications, post-operative symptoms, gastroscopy and pneumatic dilation (PD) as well as revisional surgery. Primary outcomes assessed were binary changes in key symptoms of weight loss, dysphagia, retrosternal pain and regurgitation. Comparison of pre and post-operative outcomes were performed using paired t-test. A p-value of &amp;lt;0.05 was considered statistically significant. Results 100 procedures involving 99 patients (average age 50 years, 43% female), 1 conversion to open and 1 revision at 3 years. ASA grades were 1 (27%), 2 (58%), and 3 (15%). Median LOS was one day, median follow-up 99 months. Post-operatively; weight loss persisted in 11% of patients from 48%, dysphagia reduced from 98% to 42%, retrosternal chest pain from 39% to 20% and regurgitation from 57% to 24% (all p&amp;lt;0.05). 2 patients required (PD) ≤30 days (CD≥3). 36 patients underwent PD at median of 13 months, 20 needed repeat PD. None of the patients developed cancer. Conclusion As demonstrated in this large series of 100 consecutive patients, HCM remains one of the best treatment modalities for OA. Key symptoms of OA significantly reduced following HCM. Our technique avoided the use of energy devices, ensured a short hospital stay and durable symptom improvement, lends support to its continued application in managing this condition.

Radiation Therapy for Cutaneous Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report and Review of the Literature

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a clinically aggressive hematologic malignancy derived from plasmacytoid dendritic cells. It commonly presents as cutaneous lesions. To date, no standard treatment protocol for BPDCN exists. Traditionally treated similarly to acute leukemia or lymphoma, its prognosis remains poor. Radiation therapy is employed for isolated skin lesions, for patients that are ineligible for chemotherapy due to age or comorbidities and for post-chemotherapy recurrence. However, very limited reports are available on radiotherapy for BPDCN. We present a case involving a 94-year-old BPDCN patient treated with radiation therapy, highlighting an atypical situation of two separate radiotherapy sessions with different dosages for isolated skin lesions. Initially, 45 Gy was administered in 15 fractions (45 Gy/15 Fr), followed by a second session of 30 Gy in 10 fractions (30 Gy/10 Fr) after disease recurrence. This case is unique in detailing radiation therapy for the exceedingly rare BPDCN, particularly dose fractionation. The findings indicate that 45 Gy/15 Fr can provide adequate local control, while even a lower dose of 30 Gy/10 Fr may be effective. This case report contributes to the limited literature by proposing potential therapeutic approaches and dosage guidelines to refine future BPDCN treatment protocols.

BN SO38 - Bile Duct Injuries Referrals and Management in a Tertiary Centre in UK– A 6-year study

Abstract Background Laparoscopic Cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis. It has been associated with serious complications, such as vascular/biliary injuries (0.4-0.7% of cases) requiring surgical, endoscopic or radiological interventions. Objective To evaluate the management, intervention and outcomes post bile duct injuries (BDI) Methods We conducted a retrospective analysis on all patients referred with BDIs from regional centres, following a planned LC operation and treated at the HPB unit of Queen Elizabeth Hospital Birmingham between 2018 - 2023. Patients were followed up for at least one year. Results In our unit, 22 (12 male) patients, with a median age of 60 years (16-85) were treated, primarily for gallstone disease (n=14). Most sustained grade E injury (n=19) and were recognised and transferred on average in 4 days (0-43 days). 20 patients had a hepaticojejunostomy. Using the Clavien-Dindo classification, three patients had grade III complications requiring intervention, and one had grade IV complication with sepsis and cardiac failure, necessitating ITU transfer for inotropic support. Discharge occurred within 10 days (4-96), with follow-up over 18.8 months (5-65). Seven await further follow-up, six were discharged and two await PTC for anastomotic stricture. Conclusion Our cohort underscores the complexity and critical nature of these injuries. Most patients required hepaticojejunostomy, with a median recognition and transfer of four days. While the early discharge and follow-up outcomes are promising, ongoing monitoring is essential, as patients might commonly develop anastomotic strictures, requiring conservative, radiological or surgical management. These findings highlight the necessity for prompt recognition and referral to specialised HPB units to optimise patient outcomes and reduce the long-term complications associated with BDIs.

BN SO25 - Laparoscopic Management of Achalasia and Iatrogenic Mucosal Perforation in a Patient with Severe Reflux Following Multiple Therapeutic Dilatations

Abstract Background Laparoscopic Heller's cardiomyotomy (LHC) is the gold standard intervention for achalasia. Owing to its well-established complications of reflux symptoms, some surgeons perform an additional fundoplication surgery, although the consensus regarding the clinical benefits of this approach remains unclear.1 A meta-analysis showed that posterior fundoplication has proven to be superior to anterior fundoplication in controlling reflux symptoms.2 Method A gentleman in his 60s reported ongoing severe reflux symptoms following multiple Rigiflex ballon dilatations for achalasia, on manometry and pH studies showed features of pathological acid reflux, incomplete lower oesophageal sphincter relaxation and defective peristalsis. As shown in the video, type 1 sliding hiatus hernia, submucosal fibrosis and peri-oesophagitis were seen intraoperatively. A short cardiomyotomy was performed, which was complicated by iatrogenic oesophageal perforation. Anterior fundoplication with mucosal closure was performed. Results Following the surgery, no leak was observed on the swallow test and the patient reported a massive improvement in reflux symptoms. The addition of fundoplication to LHC in patients with achalasia and reflux symptoms has improved clinical outcomes. Conclusion Concomitant LHC and anti-reflux surgery should be considered in patients presenting with achalasia and gastro-oesophageal reflux symptoms.