Imperial College London

Professor the Lord Darzi of Denham PC KBE FRS FMedSci HonFREng

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Surgery
 
 
 
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Contact

 

+44 (0)20 3312 1310a.darzi

 
 
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Location

 

Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
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1321 results found

Attaelmanan I, Bhatti YA, Harris M, Prime M, Darzi Aet al., The development and diffusion of surgical frugal innovations – lessons for the NHS, LSE International Health Policy Conference 2017

CONFERENCE PAPER

Byrne B, Aylin P, Bottle RA, Faiz OD, Darzi A, Vincent CAet al., Failure to engage in surgical quality improvement research is associated with poorer quality of care, Royal Society of Medicine, Coloproctology section: Overseas meeting in Leuven

CONFERENCE PAPER

Byrne B, Faiz O, Darzi A, Vincent Cet al., Do gastrointestinal cancer patients want to decide where they have tests and surgery? A questionnaire study., Digestive Disorders Federation

CONFERENCE PAPER

Khan DZ, Oude Vrielink TJC, Marcus H, Darzi A, Mylonas Get al., NeuroCYCLOPS: development and preclinical validation of a robotic platform for endoscopic neurosurgery, European Association of Neurosurgical Societies (EANS 2016), Publisher: European Association of Neurosurgical Societies

CONFERENCE PAPER

Kogkas A, Darzi A, Mylonas GP, Gaze-Driven Human-Robot Interaction in the Operating Theatre, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

CONFERENCE PAPER

Leff DR, Shetty K, Yang GZ, Darzi Aet al., Persistent Attentional Demands Despite Laparoscopic Skills Acquisition, JAMA Surgery, ISSN: 2168-6262

JOURNAL ARTICLE

Oude Vrielink TJC, Darzi, Mylonas G, microCYCLOPS: A Robotic System for Microsurgical Applications, 6th Joint Workshop on New Technologies for Computer/Robot Assisted Surgery (CRAS 2016)

CONFERENCE PAPER

Qiu SY, Pellino G, Fiorentino F, Rasheed S, Darzi A, Tekkis P, Kontovounisios Cet al., A review of the role of Neurotensin and its receptors in colorectal cancer, Gastroenterology Research and Practice, ISSN: 1687-630X

Neurotensin (NTS) is a physiologically occurring hormone which affects the function of the gastrointestinal (GI) tract. In recent years, NTS, acting through its cellular receptors (NTSR), has been implicated in the carcinogenesis of several cancers. In colorectal cancer (CRC), a significant body of evidence, from in vitro and in vivo studies, is available which elucidates the molecular biology of NTS/NTSR signalling and the resultant growth of CRC cells. There is growing clinical data from human studies which corroborate the role NTS/NTSR plays in the development of human CRC. Furthermore, blockade and modulation of the NTS/NTSR signalling pathways appears to reduce CRC growth in cell cultures and animal studies. Lastly, NTS/NTSR also shows potential of being utilized as a diagnostic biomarker for cancers as well as targets for functional imaging. We summarize the existing evidence and understanding of the role of NTS and its receptors in CRC.

JOURNAL ARTICLE

Seneci CA, Leibrandt KL, Wisanuvej PW, Shang JS, Darzi AD, Yang GZYet al., Design of a smart 3D-printed wristed robotic surgical instrument with embedded force sensing and modularity, IROS 2016, ISSN: 2153-0866

CONFERENCE PAPER

Taylor MJ, Kaur M, Sharma U, Taylor D, Reed JE, Darzi Aet al., Using virtual worlds for patient and public engagement., Int J Technol Knowl Soc, Vol: 9, Pages: 31-48, ISSN: 1832-3669

Patient and public involvement is fundamental in healthcare and many methods attempt to facilitate this engagement. The present study investigated use of computer-generated environments known as 'virtual worlds' (VW) as an involvement method. The VW used in the present research was Second Life, which is 3-dimensional, publically accessible and internet-based. It is accessed using digital self-representations, or 'avatars', through which users navigate the virtual environment and communicate with one another. Participants were patients with long-term conditions, frequently involved in shaping health research and care. Some had mobility and communication difficulties, potentially making involvement through traditional face-to-face modes of engagement challenging. There were 2 stages to this study. Stage-1: Participants were introduced to VWs and Second Life. This was followed by a face-to-face focus group discussion (FGD) in order to gain their views on use of SL. Stage-2: An FGD attended by 8 people (4 patients, 3 researchers, 1 healthcare professional) was conducted in Second Life. Training and support on using Second Life had been provided for participants. The FGD took place successfully, although some technical and communication difficulties were experienced. Data was collected in the form of interviews and questionnaires from the patients about their experience of using the virtual world. Participants recognised the potential of VWs as a platform for patient engagement, especially for those who suffer from chronic conditions that impact severely upon their mobility and communication. Participant feedback indicated that potential barriers include technical problems with VW programs and potential user inexperience of using VWs, which may be counteracted by ensuring provision of continuous training and support. In conclusion, this study established the feasibility of using VWs for patient FGDs and indicates a potential of use of VWs for engagement in future, partic

JOURNAL ARTICLE

Vuik SI, Mayer E, Darzi A, A quantitative evidence base for population health: applying utilization-based cluster analysis to segment a patient population, Population Health Metrics, ISSN: 1478-7954

Background: To improve population health it is crucial to understand the different care needs within a population. Traditional population groups are often based on characteristics such as age or morbidities. However, this does not take into account specific care needs across care settings, and tends to focus on high needs patients only. This paper explores the potential of using utilisation-based cluster analysis to segment a general patient population into homogenous groups.Methods: Administrative datasets covering primary and secondary care were used to construct a database of 300,000 patients, which included socio-demographics variables, morbidities, care utilisation, and cost. A k-means cluster analysis grouped the patients into segments with distinct care utilisation, based on six utilisation variables: non-elective inpatient admissions, elective inpatient admissions, outpatient visits, GP practice visits, GP home visits, and prescriptions. These segments were analysed post-hoc to understand their morbidity and demographic profile.Results: Eight population segments were identified, and utilisation of each care setting was significantly different across all segments. Each segment also presented with different morbidity patterns and demographic characteristics, creating eight distinct care user types. Comparing these segments to traditional patient groups shows the heterogeneity of these approaches, especially for lower needs patients.Conclusions: This analysis shows that utilisation-based cluster analysis segments a patient population into distinct groups with unique care priorities, providing a quantitative evidence base to improve population health. Contrary to traditional methods, this approach also segments lower needs populations, which can be used to inform preventative interventions. In addition, the identification of different care user types provides insight into needs across the care continuum.

JOURNAL ARTICLE

king HK, shang JS, liu JL, Seneci CA, wisanuvej PW, giataganas PG, patel NS, clark JC, vitiello VV, bergeles CB, pratt PP, di marco AD, kerr KK, darzi AD, yang GZYet al., Micro-IGES Robot for Transanal Robotic Microsurgery., In The Hamlyn Symposium on Medical Robotics.

CONFERENCE PAPER

patel NP, seneci CS, yang GZY, darzi AD, teare JTet al., Flexible platforms for natural orifice transluminal and endoluminal surgery. Endoscopy International Open, 2(02), E117-E123., Endoscopy International Open

JOURNAL ARTICLE

Alexander J, Gildea L, Balog J, Speller A, McKenzie J, Muirhead L, Scott A, Kontovounisios C, Rasheed S, Teare J, Hoare J, Veselkov K, Goldin R, Tekkis P, Darzi A, Nicholson J, Kinross J, Takats Zet al., 2017, A novel methodology for in vivo endoscopic phenotyping of colorectal cancer based on real-time analysis of the mucosal lipidome: a prospective observational study of the iKnife., Surg Endosc, Vol: 31, Pages: 1361-1370

BACKGROUND: This pilot study assessed the diagnostic accuracy of rapid evaporative ionization mass spectrometry (REIMS) in colorectal cancer (CRC) and colonic adenomas. METHODS: Patients undergoing elective surgical resection for CRC were recruited at St. Mary's Hospital London and The Royal Marsden Hospital, UK. Ex vivo analysis was performed using a standard electrosurgery handpiece with aspiration of the electrosurgical aerosol to a Xevo G2-S iKnife QTof mass spectrometer (Waters Corporation). Histological examination was performed for validation purposes. Multivariate analysis was performed using principal component analysis and linear discriminant analysis in Matlab 2015a (Mathworks, Natick, MA). A modified REIMS endoscopic snare was developed (Medwork) and used prospectively in five patients to assess its feasibility during hot snare polypectomy. RESULTS: Twenty-eight patients were recruited (12 males, median age 71, range 35-89). REIMS was able to reliably distinguish between cancer and normal adjacent mucosa (NAM) (AUC 0.96) and between NAM and adenoma (AUC 0.99). It had an overall accuracy of 94.4 % for the detection of cancer versus adenoma and an adenoma sensitivity of 78.6 % and specificity of 97.3 % (AUC 0.99) versus cancer. Long-chain phosphatidylserines (e.g., PS 22:0) and bacterial phosphatidylglycerols were over-expressed on cancer samples, while NAM was defined by raised plasmalogens and triacylglycerols expression and adenomas demonstrated an over-expression of ceramides. REIMS was able to classify samples according to tumor differentiation, tumor budding, lymphovascular invasion, extramural vascular invasion and lymph node micrometastases (AUC's 0.88, 0.87, 0.83, 0.81 and 0.81, respectively). During endoscopic deployment, colonoscopic REIMS was able to detect target lipid species such as ceramides during hot snare polypectomy. CONCLUSION: REIMS demonstrates high diagnostic accuracy for tumor type and for established histological fe

JOURNAL ARTICLE

Bouras G, Burns EM, Howell AM, Bottle A, Athanasiou T, Darzi Aet al., 2017, Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair., Hernia

OBJECTIVE: To study the effects of short-term complications on recurrence following laparoscopic inguinal hernia repair using routine data. BACKGROUND: Linked primary and secondary care databases can evaluate the quality of inguinal hernia surgery by quantifying short- and long-term outcome together. METHODS: Longitudinal analysis of linked primary care (Clinical Practice Research Datalink) and hospital administrative (Hospital Episodes Statistics) databases quantified 30-day complications (wound infection and bleeding) and surgery for recurrence after primary repair performed between 1st April 1997 and 31st March 2012. RESULTS: Out of 41,545 primary inguinal hernia repairs, 10.3% (4296/41,545) were laparoscopic. Complications were less frequent following laparoscopic (1.8%, 78/4296) compared with open (3.5%, 1288/37,249) inguinal hernia repair (p < 0.05). Recurrence was more frequent following laparoscopic (3.5%, 84/2541) compared with open (1.2%, 366/31,859) repair (p < 0.05). Time to recurrence was shorter for laparoscopic (26.4 months SD 28.5) compared with open (46.7 months SD 37.6) repair (p < 0.05). Overall, complications were associated with recurrence (3.2%, 44/1366 with complications; 1.7%, 700/40,179 without complications; p < 0.05). Complications did not significantly increase the risk of recurrence in open hernia repair (OR = 1.49; 95% CI 0.97-2.30, p = 0.069). Complications following laparoscopic repair was significantly associated with increased risk of recurrence (OR = 7.86; 95% CI 3.46-17.85, p < 0.05). CONCLUSIONS: Complications recorded in linked routine data predicted recurrence following laparoscopic inguinal hernia repair. Focus must, therefore, be placed on achieving good short-term outcome, which is likely to translate to better longer term results using the laparoscopic approach.

JOURNAL ARTICLE

Bouras G, Markar SR, Burns EM, Huddy JR, Bottle A, Athanasiou T, Darzi A, Hanna GBet al., 2017, The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study., Eur J Surg Oncol, Vol: 43, Pages: 454-460

BACKGROUND: The objective was to evaluate incidence, risk factors and impact of postoperative symptoms following esophagogastric cancer resection in primary care. METHODS: Patients undergoing esophagogastrectomy for cancer from 1998 to 2010 with linked records in Clinical Practice Research Datalink, Hospital Episodes Statistics and Office of National Statistics databases were studied. The recording of codes for reflux, dysphagia, dyspepsia, nausea, vomiting, dumping, diarrhea, steatorrhea, appetite loss, weight loss, pain and fatigue were identified up to 12 months postoperatively. Psychiatric morbidity was also examined and its risk evaluated by logistic regression analysis. RESULTS: Overall, 58.6% (1029/1755) of patients were alive 2 years after surgery. Of these, 41.1% had recorded postoperative symptoms. Reflux, dysphagia, dyspepsia and pain were more frequent following esophagectomy compared with gastrectomy (p < 0.05). Complications (OR = 1.40 95%CI 1.00-1.95) and surgical procedure predicted postoperative symptoms (p < 0.05). When compared with partial gastrectomy, esophagectomy (OR = 2.03 95%CI 1.26-3.27), total gastrectomy (OR = 2.44 95%CI 1.57-3.79) and esophagogastrectomy (OR = 2.66 95%CI 1.85-2.86) were associated with postoperative symptoms (p < 0.05). The majority of patients with postoperative psychiatric morbidity had depression or anxiety (98%). Predictors of postoperative depression/anxiety included younger age (OR = 0.97 95%CI 0.96-0.99), complications (OR = 2.40 95%CI 1.51-3.83), psychiatric history (OR = 6.73 95%CI 4.25-10.64) and postoperative symptoms (OR = 1.78 95%CI 1.17-2.71). CONCLUSIONS: Over 40% of patients had symptoms related to esophagogastric cancer resection recorded in primary care, and were associated with an increase in postoperative depression and anxiety.

JOURNAL ARTICLE

Chana P, Joy M, Casey N, Chang D, Burns EM, Arora S, Darzi AW, Faiz OD, Peden CJet al., 2017, Cohort analysis of outcomes in 69 490 emergency general surgical admissions across an international benchmarking collaborative., BMJ Open, Vol: 7

OBJECTIVE: This study aims to use the Dr Foster Global Comparators Network (GC) database to examine differences in outcomes following high-risk emergency general surgery (EGS) admissions in participating centres across 3 countries and to determine whether hospital infrastructure factors can be linked to the delivery of high-quality care. DESIGN: A retrospective cohort analysis of high-risk EGS admissions using GC's international administrative data set. SETTING: 23 large hospitals in Australia, England and the USA. METHODS: Discharge data for a cohort of high-risk EGS patients were collated. Multilevel hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals. RESULTS: 69 490 patients, admitted to 23 centres across Australia, England and the USA from 2007 to 2012, were identified. For all patients within this cohort, outcomes defined as: 7-day and 30-day inhospital mortality, readmission and length of stay appeared to be superior in US centres. A subgroup of 19 082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at 7 days in this subgroup. 30-day mortality (OR=1.47, p<0.01) readmission (OR=1.42, p<0.01) and length of stay (OR=1.98, p<0.01) were worse in English units. Patient factors (age, pathology, comorbidity) were significantly associated with worse outcome as were structural factors, including low intensive care unit bed ratios, high volume and interhospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handovers was associated with shorter length of stay. CONCLUSIONS: Key factors that influence outcomes were identified. For patients who underwent surgery, outcomes were similar at 7 days but not at 30 days. This may be attributable to better infrastructure and resource allocation towards EGS in the US and Australian centres.

JOURNAL ARTICLE

Harling L, Lambert J, Ashrafian H, Darzi A, Gooderham NJ, Athanasiou Tet al., 2017, Elevated serum microRNA 483-5p levels may predict patients at risk of post-operative atrial fibrillation., Eur J Cardiothorac Surg, Vol: 51, Pages: 73-78

OBJECTIVES: Post-operative atrial fibrillation (POAF) is the commonest post-operative cardiac arrhythmia, affecting ∼1 in 3 patients undergoing coronary artery bypass grafting (CABG). Although its aetiology is complex, atrial substrate changes may pre-dispose to its onset. This study aims to ascertain the atrial microRNA signature of POAF and determine the potential for circulating microRNA as a pre-operative biomarker for this arrhythmia. METHODS: Thirty-four patients undergoing non-emergent, on-pump CABG were prospectively recruited. Right atrial biopsies were taken intra-operatively and snap frozen for RNA extraction. Plasma was obtained at 24 h pre-operatively and at 2 and 4 days post-operatively. POAF was defined by continuous Holter recording. Inter-group comparisons were performed using Student's t-test or analysis of variance as required. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic accuracy of pre-operative serum miRNA as a POAF biomarker. RESULTS: Sixteen microRNAs were differentially expressed in the atrial myocardium of POAF patients when compared with those maintaining sinus rhythm. miR-208a was the most underexpressed [fold change (FC) = 2.458] and miR-483-5p the most overexpressed (FC = 1.804). miR-483-5p also demonstrated significant overexpression in the pre-operative serum of these patients, with ROC analysis demonstrating an overall predictive accuracy of 78%. CONCLUSIONS: This study provides the first description of atrial myocardial and circulating plasma microRNA in POAF patients. Our findings suggest POAF may be associated with pre-existing atrial substrate differences predisposing to arrhythmogenesis. Moreover, this study highlights the potential for miR-483-5p in biomarker development. Further work must now perform prospective, targeted validation of these results in a larger patient cohort.

JOURNAL ARTICLE

Howell A-M, Burns EM, Hull L, Mayer E, Sevdalis N, Darzi Aet al., 2017, International recommendations for national patient safety incident reporting systems: an expert Delphi consensus-building process, BMJ QUALITY & SAFETY, Vol: 26, Pages: 150-163, ISSN: 2044-5415

JOURNAL ARTICLE

Kulendran M, Borovoi L, Purkayastha S, Darzi A, Vlaev Iet al., 2017, Impulsivity predicts weight loss after obesity surgery., Surg Obes Relat Dis

OBJECTIVE: There is evidence that executive function, and specifically inhibitory control, is related to obesity and eating behavior. The goal of this study was to determine whether personality traits and inhibitory control predict weight loss after bariatric procedures. Although the impressive weight reduction after bariatric surgery has been shown in short- and medium-term studies, the effect of personality traits on this reduction is uncertain. Specifically, the effect of impulsivity is still largely unknown. SETTING: Patients attending either a multidisciplinary information session or outpatient clinic at the Imperial Weight Management Centre were recruited with informed consent into the trial over a 4-month period from January to April 2013. Participants were invited to attend behavioral testing on an outpatient basis in a silent room invigilated by a single researcher. METHODS: Forty-five bariatric patients participated in the study (25 patients had a gastric bypass, with a mean BMI of 41.8 and age of 39.0 years; 20 had a sleeve gastrectomy, with a mean BMI of 47.2 and age of 49.0 years). All patients completed personality measures of impulsivity-Barratt's Impulsivity Scale, as well as behavioral measures of impulsivity-the stop-signal reaction-time (SSRT) task measuring inhibitory control and the temporal discounting task measuring reward processing. Those measures were examined in relation to weight loss 6 months after surgery. RESULTS: The surgical procedure and changes in the behavioral measure of inhibitory control (SSRT) were found to be significant predictors of reduction in body mass index (BMI) in patients undergoing bariatric surgery. The sleeve gastrectomy group found a reduction in BMI of 14.1%, which was significantly less than the 25% reduction in BMI in the gastric bypass group. The direction (parameter estimate) of the significant effect was positive for SSRT change, which indicates that pre- and postreduction in impulsivity predicts reduction

JOURNAL ARTICLE

Leff DR, Yongue G, Vlaev I, Orihuela-Espina F, James D, Taylor MJ, Athanasiou T, Dolan R, Yang G-Z, Darzi Aet al., 2017, "Contemplating the Next Maneuver" Functional Neuroimaging Reveals Intraoperative Decision-making Strategies, ANNALS OF SURGERY, Vol: 265, Pages: 320-330, ISSN: 0003-4932

JOURNAL ARTICLE

Leff DR, Yongue G, Vlaev I, Orihuela-Espina F, James D, Taylor MJ, Athanasiou T, Dolan R, Yang GZ, Darzi Aet al., 2017, "Contemplating the Next Maneuver": Functional Neuroimaging Reveals Intraoperative Decision-making Strategies., Ann Surg, Vol: 265, Pages: 320-330

OBJECTIVE: To investigate differences in the quality, confidence, and consistency of intraoperative surgical decision making (DM) and using functional neuroimaging expose decision systems that operators use. SUMMARY BACKGROUND DATA: Novices are hypothesized to use conscious analysis (effortful DM) leading to activation across the dorsolateral prefrontal cortex, whereas experts are expected to use unconscious automation (habitual DM) in which decisions are recognition-primed and prefrontal cortex independent. METHODS: A total of 22 subjects (10 medical student novices, 7 residents, and 5 attendings) reviewed simulated laparoscopic cholecystectomy videos, determined the next safest operative maneuver upon video termination (10 s), and reported decision confidence. Video paradigms either declared ("primed") or withheld ("unprimed") the next operative maneuver. Simultaneously, changes in cortical oxygenated hemoglobin and deoxygenated hemoglobin inferring prefrontal activation were recorded using Optical Topography. Decision confidence, consistency (primed vs unprimed), and quality (script concordance) were assessed. RESULTS: Attendings and residents were significantly more certain (P < 0.001), and decision quality was superior (script concordance: attendings = 90%, residents = 78.3%, and novices = 53.3%). Decision consistency was significantly superior in experts (P < 0.001) and residents (P < 0.05) than novices (P = 0.183). During unprimed DM, novices showed significant activation of the dorsolateral prefrontal cortex, whereas this activation pattern was not observed among residents and attendings. During primed DM, significant activation was not observed in any group. CONCLUSIONS: Expert DM is characterized by improved quality, consistency, and confidence. The findings imply attendings use a habitual decision system, whereas novices use an effortful approach under uncertainty. In the presence of operative cues (primes), novices disengage

JOURNAL ARTICLE

Manfield JH, Yu KK-H, Efthimiou E, Darzi A, Athanasiou T, Ashrafian Het al., 2017, Bariatric Surgery or Non-surgical Weight Loss for Idiopathic Intracranial Hypertension? A Systematic Review and Comparison of Meta-analyses, OBESITY SURGERY, Vol: 27, Pages: 513-521, ISSN: 0960-8923

JOURNAL ARTICLE

Nouraei SA, Mace AD, Middleton SE, Hudovsky A, Vaz F, Moss C, Ghufoor K, Mendes R, O'Flynn P, Jallali N, Clarke PM, Darzi A, Aylin Pet al., 2017, A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework., Clin Otolaryngol, Vol: 42, Pages: 11-28

OBJECTIVES: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data. DESIGN: A Hospital Episode Statistics N = near-all analysis. SETTINGS: The English National Health Service. MAIN OUTCOME MEASURES: Local audit data were used to assess and triangulate the quality of the administrative dataset. Within the national dataset, cancer sites, morbidities, social deprivation, treatment, complications, and in-hospital mortality were recorded. RESULTS: Within local audit datasets, the accuracy of assigning newly-derived Cancer Site Strata and Resection Strata were 92.3% and 94.2%, respectively. Accuracy of morbidities assignment was 97%. Within the national dataset, we identified 17 623 major head and neck cancer resections between 2002 and 2012. There were 12 413 males and mean age at surgery was 63 ± 12 years. The commonest cancer site strata were oral cavity (42%) and larynx-hypopharynx (32%). The commonest resection site was the larynx (n = 4217), and 13 211 and 11 841 patients had neck dissection and flap-based reconstruction, respectively. There were prognostically significant baseline differences between patients with oromandibular and pharyngolaryngeal malignancy. Patients with pharyngolaryngeal malignancies had a greater burden of morbidities, lower socio-economic status, fewer primary resections, and a sixfold increased risk of undergoing their major resection during an emergency hospital admission. Mean length of stay was 25 days and each complication linearly increased it by 9.6 days. There were 609 (3.5%) in-hospital deaths and a basket of seven medical and three surgical complications significantly increased the risk of in-hospital death. At least one potentially lethal complication occurred in 26% of patients. The risk of in-hospital death in a patient with no potentially lethal complication was 1.1% and thi

JOURNAL ARTICLE

Pinto C, Garas G, Harling L, Darzi A, Casula R, Athanasiou Tet al., 2017, Is endovascular treatment with multilayer flow modulator stent insertion a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm?, Ann Med Surg (Lond), Vol: 15, Pages: 1-8

A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated. The outcomes of interest were all-cause survival, aneurysm-related survival, branch vessel patency and major adverse events. Aneurysm-related survival exceeded 78% in almost all studies, with the exception of one where the MFMS was inserted outside the instructions for use. In that study the aneurysm-related survival was 28.9%. The branch vessel patency was higher than 95% in 10 studies and not reported in one. At 12-month follow-up, several studies showed a low incidence of major adverse events, including stroke, paraplegia and aneurysm rupture. We conclude that MFMS represent a suitable and safe treatment for high-risk patients with TAAA maintaining branch vessel patency when used within their instructions for use. However, a number of limitations must be considered when interpreting this evidence, particularly the complete lack of randomised controlled trials (RCTs), short follow-up in all studies, and heterogeneity of the pathologies among the different populations studied. Further innovative developments are needed to improve MFMS safety, expand their instructions for use, and enhance their efficacy.

JOURNAL ARTICLE

St John ER, Al-Khudairi R, Ashrafian H, Athanasiou T, Takats Z, Hadjiminas DJ, Darzi A, Leff DRet al., 2017, Diagnostic Accuracy of Intraoperative Techniques for Margin Assessment in Breast Cancer Surgery A Meta-analysis, ANNALS OF SURGERY, Vol: 265, Pages: 300-310, ISSN: 0003-4932

JOURNAL ARTICLE

Taylor MJ, Vlaev I, Taylor D, Kulendran M, Gately P, Al-Kuwari H, Darzi A, Ahmedna Met al., 2017, Cardiac autonomic regulation as a predictor for childhood obesity intervention success., Int J Obes (Lond)

Childhood obesity is a major public health concern; behavioural interventions induce weight reduction in some, but success is variable. Heart rate variability (HRV) has been associated with impulse control and extent of dieting success. This study investigated the relationship between HRV and post childhood obesity intervention weight-management success, and involved recording the frequency-domain HRV measures ratio between low frequency and high frequency power (LF/HF) and high frequency power (HF), and the time-domain measure, percentage of successive beat-to-beat intervals that differ by more than 50ms (PNN50). It was expected that greater LF/HF and lower HF would be associated with greater post-intervention weight gain, and that greater PNN50 would be associated with greater impulse control. Seventy-four participants aged 9-14 (M=10.7; s.d.: 1.1) attended a weight-management camp, where HRV was recorded. Stop signal reaction time (SSRT) was also recorded as a measure of impulse control. As expected, SSRT was positively associated with pre-intervention body mass (r=0.301, P=0.010) and negatively associated with PNN50 (β=0.29, P=0.031). Post-intervention body mass change was positively associated with LF/HF (β=0.34, P=0.037), but was not associated with HF. Lifestyle interventions may have a greater chance of effectively supporting long-term weight-management for children with lower LF/HF; assessing HRV of obese children may be helpful in informing obesity treatment decisions.International Journal of Obesity advance online publication, 21 February 2017; doi:10.1038/ijo.2017.25.

JOURNAL ARTICLE

Tonutti M, Elson DS, Yang GZ, Darzi AW, Sodergren MHet al., 2017, The role of technology in minimally invasive surgery: state of the art, recent developments and future directions., Postgrad Med J, Vol: 93, Pages: 159-167

The diffusion of minimally invasive surgery has thrived in recent years, providing substantial benefits over traditional techniques for a number of surgical interventions. This rapid growth has been possible due to significant advancements in medical technology, which partly solved some of the technical and clinical challenges associated with minimally invasive techniques. The issues that still limit its widespread adoption for some applications include the limited field of view; reduced manoeuvrability of the tools; lack of haptic feedback; loss of depth perception; extended learning curve; prolonged operative times and higher financial costs. The present review discusses some of the main recent technological advancements that fuelled the uptake of minimally invasive surgery, focussing especially on the areas of imaging, instrumentation, cameras and robotics. The current limitations of state-of-the-art technology are identified and addressed, proposing future research directions necessary to overcome them.

JOURNAL ARTICLE

A R A S S V A D P A, 2016, Systematic Review of the Use of Hospital Administrative Data to Assess Functional Decline, Journal of Aging Science, Vol: 04

JOURNAL ARTICLE

Acharya A, Markar S, Sodergren M, Malietzis G, Darzi A, Athanasiou T, Khan Aet al., 2016, Adjuvant chemotherapy confers no survival benefit following curative surgery for peri-ampullary adenocarcinoma: a Meta-Analysis, 19th Annual Scientific Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 24-24, ISSN: 0007-1323

CONFERENCE PAPER

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