Imperial College London

ProfessorGeorgeHanna

Faculty of MedicineDepartment of Surgery & Cancer

Professor of Surgical Sciences and Head of Division
 
 
 
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Contact

 

+44 (0)20 3312 2125g.hanna

 
 
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Assistant

 

Ms Caroline Hurley +44 (0)20 3312 2124

 
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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
to

436 results found

Borsci S, Uchegbu I, Buckle P, Ni Z, Walne S, Hanna GBet al., 2018, Designing medical technology for resilience: integrating health economics and human factors approaches, EXPERT REVIEW OF MEDICAL DEVICES, Vol: 15, Pages: 15-26, ISSN: 1743-4440

JOURNAL ARTICLE

Boshier PR, Fehervari M, Markar SR, Purkayastha S, Spanel P, Smith D, Hanna GBet al., 2018, Variation in Exhaled Acetone and Other Ketones in Patients Undergoing Bariatric Surgery: a Prospective Cross-sectional Study., Obes Surg

BACKGROUND: Dietary restriction together with alteration of the gastrointestinal tract results in major metabolic changes and significant weight loss in patients undergoing bariatric surgery. Current methods of measuring these changes are often inaccurate and lack a molecular basis. The objective of this study was to determine the role of exhaled ketones as non-invasive markers of nutritional status in patients undergoing surgical treatment of obesity. METHODS: Patients at different stages of treatment for obesity were recruited to this single-centre cross-sectional study. The sample time points were as follows: (i) at the time of initial attendance prior to dietary or surgical interventions, (ii) on the day of surgery following a low carbohydrate diet, and (iii) > 3 months after either Roux-en-Y gastric bypass or sleeve gastrectomy. The concentrations of ketones within breath samples were analysed by selected ion flow tube mass spectrometry. RESULTS: Forty patients were recruited into each of the three study groups. Exhaled acetone concentrations increased significantly following pre-operative diet (1396 ppb) and bariatric surgery (1693 ppb) compared to the start of treatment (410 ppb, P < 0.0001). In comparison, concentrations of heptanone (6.5 vs. 4.1 vs. 1.4 ppb, P = 0.021) and octanone (3.0 vs. 1.4 vs. 0.7 ppb, P = 0.021) decreased significantly after dieting and surgical intervention. Exhaled acetone (ρ - 0.264, P = 0.005) and octanone (ρ 0.215, P = 0.022) concentrations were observed to correlate with excess body weight at the time of sampling. Acetone and octanone also correlated with neutrophil and triglyceride levels (P < 0.05). CONCLUSION: Findings confirm breath ketones, particularly acetone, to be a potentially clinically useful method of non-invasive nutritional assessment in obese patients.

JOURNAL ARTICLE

Boshier PR, Ziff C, Adam ME, Fehervari M, Markar SR, Hanna GBet al., 2018, Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis, DISEASES OF THE ESOPHAGUS, Vol: 31, ISSN: 1442-2050

JOURNAL ARTICLE

Chin S-T, Romano A, Doran SLF, Hanna GBet al., 2018, Cross-platform mass spectrometry annotation in breathomics of oesophageal-gastric cancer, SCIENTIFIC REPORTS, Vol: 8, ISSN: 2045-2322

JOURNAL ARTICLE

Doran SLF, Romano A, Hanna GB, 2018, Optimisation of sampling parameters for standardised exhaled breath sampling, JOURNAL OF BREATH RESEARCH, Vol: 12, ISSN: 1752-7155

JOURNAL ARTICLE

Francis NK, Curtis NJ, Conti JA, Foster JD, Bonjer HJ, Hanna GB, EAES committeeset al., 2018, EAES classification of intraoperative adverse events in laparoscopic surgery., Surg Endosc

BACKGROUND: Surgical outcomes are traditionally evaluated by post-operative data such as histopathology and morbidity. Although these outcomes are reported using accepted systems, their ability to influence operative performance is limited by their retrospective application. Interest in direct measurement of intraoperative events is growing but no available systems applicable to routine practice exist. We aimed to develop a structured, practical method to report intraoperative adverse events enacted during minimal access surgical procedures. METHODS: A structured mixed methodology approach was adopted. Current intraoperative adverse event reporting practices and desirable system characteristics were sought through a survey of the EAES executive. The observational clinical human reliability analysis method was applied to a series of laparoscopic total mesorectal excision (TME) case videos to identify intraoperative adverse events. In keeping with survey results, observed events were further categorised into non-consequential and consequential, which were further subdivided into four levels based upon the principle of therapy required to correct the event. A second survey phase explored usability, acceptability, face and content validity of the novel classification. RESULTS: 217 h of TME surgery were analysed to develop and continually refine the five-point hierarchical structure. 34 EAES expert surgeons (69%) responded. The lack of an accepted system was the main barrier to routine reporting. Simplicity, reproducibility and clinical utility were identified as essential requirements. The observed distribution of intraoperative adverse events was 60.1% grade I (non-consequential), 37.1% grade II (minor corrective action), 2.4% grade III (major correction or change in post-operative care) and 0.1% grade IV (life threatening). 84% agreed with the proposed classification (Likert scale 4.04) and 92% felt it was applicable to their practice and incorporated all desirab

JOURNAL ARTICLE

Garas G, Markar SR, Malietzis G, Ashrafian H, Hanna GB, Zacharakis E, Jiao LR, Argiris A, Darzi A, Athanasiou Tet al., 2018, Induced Bias Due to Crossover Within Randomized Controlled Trials in Surgical Oncology: A Meta-regression Analysis of Minimally Invasive versus Open Surgery for the Treatment of Gastrointestinal Cancer, ANNALS OF SURGICAL ONCOLOGY, Vol: 25, Pages: 221-230, ISSN: 1068-9265

JOURNAL ARTICLE

Jamel S, Markar SR, Malietzis G, Acharya A, Athanasiou T, Hanna GBet al., 2018, Prognostic significance of peritoneal lavage cytology in staging gastric cancer: systematic review and meta-analysis, GASTRIC CANCER, Vol: 21, Pages: 10-18, ISSN: 1436-3291

JOURNAL ARTICLE

Markar SR, Mackenzie H, Askari A, Faiz O, Hoare J, Zaninotto G, Hanna GBet al., 2018, Population-based cohort study of surgical myotomy and pneumatic dilatation as primary interventions for oesophageal achalasia, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 1028-1035, ISSN: 0007-1323

JOURNAL ARTICLE

Markar SR, Mackenzie H, Jemal S, Faiz O, Cunningham D, Hanna GBet al., 2018, Emergency Presentation of Esophagogastric Cancer Predictors and Long-term Prognosis, ANNALS OF SURGERY, Vol: 267, Pages: 711-715, ISSN: 0003-4932

JOURNAL ARTICLE

Markar SR, Mackenzie H, Ni M, Huddy JR, Askari A, Faiz O, Griffin SM, Lovat L, Hanna GBet al., 2018, The influence of procedural volume and proficiency gain on mortality from upper GI endoscopic mucosal resection, GUT, Vol: 67, Pages: 79-85, ISSN: 0017-5749

JOURNAL ARTICLE

Markar SR, Mackenzie H, Wiggins T, Askari A, Karthikesalingam A, Faiz O, Griffin SM, Birkmeyer JD, Hanna GBet al., 2018, Influence of national centralization of oesophagogastric cancer on management and clinical outcome from emergency upper gastrointestinal conditions, BRITISH JOURNAL OF SURGERY, Vol: 105, Pages: 113-120, ISSN: 0007-1323

JOURNAL ARTICLE

Murray AC, Markar S, Mackenzie H, Baser O, Wiggins T, Askari A, Hanna G, Faiz O, Mayer E, Bicknell C, Darzi A, Kiran RPet al., 2018, An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 32, Pages: 3055-3063, ISSN: 0930-2794

JOURNAL ARTICLE

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, International TaTME Registry Collaborativeet al., 2018, Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry., Ann Surg

OBJECTIVE: To determine the incidence of anastomotic-related morbidity following Transanal Total Mesorectal Excision (TaTME) and identify independent risk factors for failure. BACKGROUND: Anastomotic leak and its sequelae are dreaded complications following gastrointestinal surgery. TaTME is a recent technique for rectal resection, which includes novel anastomotic techniques. METHODS: Prospective study of consecutive reconstructed TaTME cases recorded over 30 months in 107 surgical centers across 29 countries. Primary endpoint was "anastomotic failure," defined as a composite endpoint of early or delayed leak, pelvic abscess, anastomotic fistula, chronic sinus, or anastomotic stricture. Multivariate regression analysis performed identifying independent risk factors of anastomotic failure and an observed risk score developed. RESULTS: One thousand five hundred ninety-four cases with anastomotic reconstruction were analyzed; 96.6% performed for cancer. Median anastomotic height from anal verge was 3.0 ± 2.0 cm with stapled techniques accounting for 66.0%. The overall anastomotic failure rate was 15.7%. This included early (7.8%) and delayed leak (2.0%), pelvic abscess (4.7%), anastomotic fistula (0.8%), chronic sinus (0.9%), and anastomotic stricture in 3.6% of cases. Independent risk factors of anastomotic failure were: male sex, obesity, smoking, diabetes mellitus, tumors >25 mm, excessive intraoperative blood loss, manual anastomosis, and prolonged perineal operative time. A scoring system for preoperative risk factors was associated with observed rates of anastomotic failure between 6.3% to 50% based on the cumulative score. CONCLUSIONS: Large tumors in obese, diabetic male patients who smoke have the highest risk of anastomotic failure. Acknowledging such risk factors can guide appropriate consent and clinical decision-making that may reduce anastomotic-related morbidity.

JOURNAL ARTICLE

Acharya A, Markar SR, Ni M, Hanna GBet al., 2017, Biomarkers of acute appendicitis: systematic review and cost-benefit trade-off analysis, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 31, Pages: 1022-1031, ISSN: 0930-2794

JOURNAL ARTICLE

Ahmad T, Bouwman RA, Grigoras I, Aldecoa C, Hofer C, Hoeft A, Holt P, Fleisher LA, Buhre W, Pearse RM, Ferguson M, MacMahon M, Shulman M, Cherian R, Currow H, Kanathiban K, Gillespie D, Pathmanathan E, Phillips K, Reynolds J, Rowley J, Douglas J, Kerridge R, Garg S, Bennett M, Jain M, Alcock D, Terblanche N, Cotter R, Leslie K, Stewart M, Zingerle N, Clyde A, Hambidge O, Rehak A, Cotterell S, Huynh WBQ, McCulloch T, Ben-Menachem E, Egan T, Cope J, Halliwell R, Fellinger P, Haisjackl M, Haselberger S, Holaubek C, Lichtenegger P, Scherz F, Schmid W, Hoffer F, Cakova V, Eichwalder A, Fischbach N, Klug R, Schneider E, Vesely M, Wickenhauser R, Grubmueller KG, Leitgeb M, Lang F, Toro N, Bauer M, Laengle F, Haberl C, Mayrhofer T, Trybus C, Buerkle C, Forstner K, Germann R, Rinoesl H, Schindler E, Trampitsch E, Bogner G, Dankl D, Duenser M, Fritsch G, Gradwohl-Matis I, Hartmann A, Hoelzenbein T, Jaeger T, Landauer F, Lindl G, Lux M, Steindl J, Stundner O, Szabo C, Bidgoli J, Verdoodt H, Forget P, Kahn D, Lois F, Momeni M, Pregardien C, Pospiech A, Steyaert A, Veevaete L, De Kegel D, De Jongh K, Foubert L, Smitz C, Vercauteren M, Poelaert J, Van Mossevelde V, Abeloos J, Bouchez S, Coppens M, De Baerdemaeker L, Deblaere I, De Bruyne A, De Hert S, Fonck K, Heyse B, Jacobs T, Lapage K, Moerman A, Neckebroek M, Parashchanka A, Roels N, Van Den Eynde N, Vandenheuvel M, Van Limmen J, Vanluchene A, Vanpeteghem C, Wouters P, Wyffels P, Huygens C, Vandenbempt P, Van de Velde M, Dylst D, Janssen B, Schreurs E, Aleixo FB, Candido K, Batista HD, Guimaraes M, Guizeline J, Hoffmann J, Lobo S, Marques Lobo FR, Nascimento V, Nishiyama K, Pazetto L, Souza D, Rodrigues RS, Vilela dos Santos AM, Jardim J, Sa Malbouisson LM, Silva J, do Nascimento Junior P, Baio TH, Pereira de Castro GI, Watanabe Oliveira HR, Amendola CP, Cardoso G, Ortega D, Brotto AF, De Oliveira MC, Rea-Neto A, Dias F, Travi ME, Zerman L, Azambuja P, Knibel MF, Martins A, Almeida W, Neder Neto C, Tardelli MA, Caser E, Machaet al., 2017, Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery, BRITISH JOURNAL OF ANAESTHESIA, Vol: 119, Pages: 258-266, ISSN: 0007-0912

JOURNAL ARTICLE

Antonowicz S, Bodai Z, Wiggins T, Markar S, Boshier P, Kudo H, Rosini F, Goldin R, Gabra H, Fitzgerald RC, Takats Z, Hanna GBet al., 2017, Detoxification loss drives aldehydemetabolic reprogramming and contributes to genotoxicity in oesophageal adenocarcinoma, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 46-46, ISSN: 0007-1323

JOURNAL ARTICLE

Borsci S, Buckle P, Huddy J, Alaestante Z, Ni Z, Hanna GBet al., 2017, Usability study of pH strips for nasogastric tube placement, PLOS ONE, Vol: 12, ISSN: 1932-6203

JOURNAL ARTICLE

Borsci S, Buckle P, Uchegbu I, Ni M, Walne S, Hanna GBet al., 2017, Integrating human factors and health economics to inform the design of medical device: A conceptual framework, Pages: 49-52, ISSN: 1680-0737

© Springer Nature Singapore Pte Ltd. 2018. The reliability and clinical utility of a medical device are required to demonstrate its impact and to enhance its success in the market. To fully establish these attributes it is necessary to investigate the context of use and the needs of the users. In healthcare, there is a growing use of human factors and health economics methods to generate evidence of the potential success of a new device. This requires investigating not only the device itself but also the elements surrounding the technology - e.g., end-users, environment of use, other operators and technologies, etc. Acquiring this information in the early stages of device development is essential. This enables designers to appreciate the operational challenges and barriers that the device will face in real life settings and may enable improved design to better fit with the environment in terms of ease of use, safety and cost effectiveness. Human factors and health economics experts have not traditionally worked together to achieve this. However, both health economists and human factors experts need to understand and map the context of use to develop realistic scenarios for the cost-effectiveness analysis and for usability testing of a new device. This paper presents a new conceptual framework for the integration of human factors and health economics to evaluate new diagnostics devices. The framework is currently under test, and its full implementation represents an ongoing aim of the National Institute for Health Research Diagnostic Evidence Co-operative of London.

CONFERENCE PAPER

Boshier PR, Huddy JR, Zaninotto G, Hanna GBet al., 2017, Dumping syndrome after esophagectomy: a systematic review of the literature, DISEASES OF THE ESOPHAGUS, Vol: 30, ISSN: 1442-2050

JOURNAL ARTICLE

Boshier PR, Knaggs AL, Hanna GB, Marczin Net al., 2017, Perioperative changes in exhaled nitric oxide during oesophagectomy, JOURNAL OF BREATH RESEARCH, Vol: 11, ISSN: 1752-7155

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, EJSO, Vol: 43, Pages: 454-460, ISSN: 0748-7983

JOURNAL ARTICLE

Brodie BA, Marker SR, Romano A, Sharma R, Spalding DR, Hanna GBet al., 2017, Non-invasive exhaled breath volatile organic compound analysis for the diagnosis of pancreatic cancer, BRITISH JOURNAL OF SURGERY, Vol: 104, Pages: 37-37, ISSN: 0007-1323

JOURNAL ARTICLE

El-Osta A, Woringer M, Pizzo E, Verhoef T, Dickie C, Ni MZ, Huddy JR, Soljak M, Hanna GB, Majeed Aet al., 2017, Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis, BMJ OPEN, Vol: 7, ISSN: 2044-6055

JOURNAL ARTICLE

Faiz O, Hanna GB, 2017, Understanding Administrative Data, ANNALS OF SURGERY, Vol: 265, Pages: E29-E29, ISSN: 0003-4932

JOURNAL ARTICLE

Faiz O, Hanna GB, 2017, Understanding Administrative Data., Ann Surg, Vol: 265

JOURNAL ARTICLE

Frampton AE, Miller HC, Malczewska A, Ottaviani S, Stronach EA, Flora R, Kaemmerer D, Schwach G, Pfragner R, Faiz O, Kos-Kudla B, Hanna GB, Stebbing J, Castellano L, Frilling Aet al., 2017, MicroRNAs Associated with Small Bowel Neuroendocrine Tumours and Their Metastases, 14th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease, Publisher: KARGER, Pages: 22-22, ISSN: 0028-3835

CONFERENCE PAPER

Harris-Birtill D, Singh M, Zhou Y, Shah A, Ruenraroengsak P, Gallina ME, Hanna GB, Cass AEG, Porter AE, Bamber J, Elson DSet al., 2017, Gold nanorod reshaping in vitro and in vivo using a continuous wave laser, PLOS ONE, Vol: 12, ISSN: 1932-6203

JOURNAL ARTICLE

Markar S, Wiggins T, Antonowicz S, Lagergren J, Mughal M, Hanna Get al., 2017, Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial, ECCO European Cancer Congress, Publisher: ELSEVIER SCI LTD, Pages: S3-S4, ISSN: 0959-8049

CONFERENCE PAPER

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