Publications
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Ahmed A, Morales-Conde S, Legrand M, et al., 2021, Clinical outcomes of pre-attached reinforced stapler reloads in bariatric surgery: A prospective case series, INTERNATIONAL JOURNAL OF SURGERY OPEN, Vol: 32, ISSN: 2405-8572
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- Citations: 1
Giamas G, Castellano L, Feng Q, et al., 2021, CK1 delta modulates the transcriptional activity of ER alpha via AIB1 in an estrogen-dependent manner and regulates ER alpha-AIB1 interactions (Expression of Concern of Vol 37, Pg 3110, 2009), NUCLEIC ACIDS RESEARCH, Vol: 49, Pages: 3602-3602, ISSN: 0305-1048
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- Citations: 1
Glasbey JC, Omar O, Nepogodiev D, et al., 2021, Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 88-96, ISSN: 0007-1323
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- Citations: 43
Gall TMH, Alrawashdeh W, Soomro N, et al., 2020, Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves., BJS Open, Vol: 4, Pages: 1100-1108
BACKGROUND: Minimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students. METHODS: Surgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded. RESULTS: The median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27·00 (i.q.r. 22·25-28·33) versus 18·00 (16·50-19·04) respectively, P < 0·001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7·00 (4·75-9·63) versus 22·25 (20·75-25·25); P < 0·001) and interrupted (8·25 (6·38-10·13) versus 29·50 (23·75-31·50); P < 0·001) sutures. For the MS group, the robotic group completed 8·67 interrupted sutures with 15·50 errors in 40 min, compared with only 3·50 sutures with 40·00 errors in the laparoscopic group (P < 0·001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0·001). CONCLUSION: The acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.
Sodergren MH, Mangal N, Wasan H, et al., 2020, Immunological combination treatment holds the key to improving survival in pancreatic cancer, JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY, Vol: 146, Pages: 2897-2911, ISSN: 0171-5216
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- Citations: 11
Gall TMH, Pencavel TD, Cunningham D, et al., 2020, Transition from open and laparoscopic to robotic pancreaticoduodenectomy in a UK tertiary referral hepatobiliary and pancreatic centre - Early experience of robotic pancreaticoduodenectomy, HPB, Vol: 22, Pages: 1637-1644, ISSN: 1365-182X
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- Citations: 10
Bhogal RH, Patel PH, Doran SLF, et al., 2020, Approach to upper GastroIntestinal cancer surgery during the COVID-19 pandemic - Experience from a UK cancer centre, EJSO, Vol: 46, Pages: 2156-2157, ISSN: 0748-7983
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- Citations: 4
Alsafi A, Jawad ZAR, Jiao LR, 2020, Percutaneous Trans-Jejunal Pancreatic Duct Drainage to Treat a Post-Operative Pancreatico-Cutaneous Fistula, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1564-1567, ISSN: 0174-1551
Gavriilidis P, Sutcliffe RP, Roberts KJ, et al., 2020, No difference in mortality among ALPPS, two-staged hepatectomy, and portal vein embolization/ligation: A systematic review by updated traditional and network meta-analyses, HEPATOBILIARY & PANCREATIC DISEASES INTERNATIONAL, Vol: 19, Pages: 411-419, ISSN: 1499-3872
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- Citations: 4
Fang C, An J, Bruno A, et al., 2020, Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases, Hepatology International, Vol: 14, Pages: 437-453, ISSN: 1936-0533
Three-dimensional (3D) visualization involves feature extraction and 3D reconstruction of CT images using a computer processing technology. It is a tool for displaying, describing, and interpreting 3D anatomy and morphological features of organs, thus providing intuitive, stereoscopic, and accurate methods for clinical decision-making. It has played an increasingly significant role in the diagnosis and management of liver diseases. Over the last decade, it has been proven safe and effective to use 3D simulation software for pre-hepatectomy assessment, virtual hepatectomy, and measurement of liver volumes in blood flow areas of the portal vein; meanwhile, the use of 3D models in combination with hydrodynamic analysis has become a novel non-invasive method for diagnosis and detection of portal hypertension. We herein describe the progress of research on 3D visualization, its workflow, current situation, challenges, opportunities, and its capacity to improve clinical decision-making, emphasizing its utility for patients with liver diseases. Current advances in modern imaging technologies have promised a further increase in diagnostic efficacy of liver diseases. For example, complex internal anatomy of the liver and detailed morphological features of liver lesions can be reflected from CT-based 3D models. A meta-analysis reported that the application of 3D visualization technology in the diagnosis and management of primary hepatocellular carcinoma has significant or extremely significant differences over the control group in terms of intraoperative blood loss, postoperative complications, recovery of postoperative liver function, operation time, hospitalization time, and tumor recurrence on short-term follow-up. However, the acquisition of high-quality CT images and the use of these images for 3D visualization processing lack a unified standard, quality control system, and homogeneity, which might hinder the evaluation of application efficacy in different clinical cente
COVIDSurg Collaborative, Jiao LR, 2020, Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study, The Lancet, Vol: 396, Pages: 27-38, ISSN: 0140-6736
BackgroundThe impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.MethodsThis international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation.FindingsThis analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1&mi
Sripadam R, Mukherjee S, Wadsley J, et al., 2020, ESPAC-5F: Four-arm, prospective, multicenter, international randomized phase II trial of immediate surgery compared with neoadjuvant gemcitabine plus capecitabine (GEMCAP) or FOLFIRINOX or chemoradiotherapy (CRT) in patients with borderline resectable pancreatic cancer., Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
Ghaneh P, Palmer DH, Cicconi S, et al., 2020, ESPAC-5F: Four-arm, prospective, multicenter, international randomized phase II trial of immediate surgery compared with neoadjuvant gemcitabine plus capecitabine (GEMCAP) or FOLFIRINOX or chemoradiotherapy (CRT) in patients with borderline resectable pancreatic cancer., Journal of Clinical Oncology, Vol: 38, Pages: 4505-4505, ISSN: 0732-183X
<jats:p> 4505 </jats:p><jats:p> Background: Patients with borderline resectable pancreatic cancer have poor survival and low resection rates. Neoadjuvant therapy may improve the outcome for these patients. The aim of this trial was to determine the feasibility and efficacy of a comparison of immediate surgery versus neoadjuvant GEMCAP or FOLFIRINOX or CRT. Methods: Eligible patients with NCCN defined borderline resectable (following central review of the baseline CT scan) and biopsy proven pancreatic cancer were randomised (stratified by centre) to receive immediate surgery, or neoadjuvant therapy of either 2 cycles of GEMCAP, or 4 cycles of FOLFIRINOX or 50.4Gy capecitabine-based CRT in 28 daily fractions over 5 ½ weeks. Patients were restaged at 4-6 weeks and underwent surgical exploration if still borderline resectable. Resected patients received adjuvant therapy. Follow up was 12 months. There was quality assurance of surgery and CRT. Primary endpoints were recruitment rate and resection rate (R1/R0). Secondary endpoints included overall survival and toxicity. A target of 90 patients was set to determine feasibility and resection rates. Rates will be presented as point estimates and survival compared across treatment arms using a log-rank test. Analyses will be on an ITT basis. Results: Between August 2014 and December 2018, 90 patients were randomised with 88 included in the full analysis set (32 immediate surgery, 20 GEMCAP, 20 FOLFIRINOX, 16 CRT). Median age was 63 years, 44% were men. WHO performance status was 0 and 1 in 45% and 55% respectively. Median CA19-9 was 603 kU/L at baseline. 44 (79%) patients completed neoadjuvant therapy. Recruitment rate was 21 patients per year. Resection rate was 62% for immediate surgery and 55% for neoadjuvant therapy (p=0.668). R0 resection rate on resected patients was 15% and 23% respectively (p=0.721). One year survival rate was 40% [95% CI, 26% – 62%] for immediate surgery and 77% [95%CI
Kawka M, Gall TM, Jiao LR, 2020, Minimum invasive associating liver partition and portal vein ligation for staged hepatectomy, Laparoscopic, Endoscopic, and Robotic Surgery, Vol: 3, Pages: 1-5
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gained interest, as the potential alternative to portal vein embolisation for inducing future liver remnant hypertrophy in patients at risk of post-hepatectomy liver failure but is associated with high morbidity and mortality. As a result, several variant ALPPS have been reported to reduce ALPPS related morbidity and mortality. ALPPS is able to induce more extensive hypertrophy in a shorter time-period than portal vein embolisation. Minimally-invasive surgery, which has known benefits with regards to morbidity and mortality, has also been applied to ALPPS, with promising results regarding safety and feasibility and patient outcomes. Evidence suggests that both laparoscopic and robot-assisted ALPPS present technically feasible and safe options for patients. Minimally-invasive ALPPS offers a clear benefit to patients, including reduction of fibrous adhesions, shorter length of hospital stay, and lower morbidity. However, the technical difficulty of the procedure still limits its wide application, even to experienced hepato-pancreato-biliary centres.
Kamarajah SK, Bundred JR, Marc OS, et al., 2020, A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy, HPB, Vol: 22, Pages: 329-339, ISSN: 1365-182X
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- Citations: 26
Kamarajah SK, Bundred J, Saint Marc O, et al., 2020, Robotic versus conventional laparoscopic pancreaticoduodenectomy a systematic review and meta-analysis, EJSO, Vol: 46, Pages: 6-14, ISSN: 0748-7983
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- Citations: 51
Gall T, Alrawashdeh W, Soomro N, et al., 2019, Laparoscopic and robotic training in abdominal surgery: a randomised controlled trial, 22nd Annual Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 16-16, ISSN: 0007-1323
Saso S, Galazis N, Iacovou C, et al., 2019, Managing growing teratoma syndrome: new insights and clinical applications, FUTURE SCIENCE OA, Vol: 5, ISSN: 2056-5623
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- Citations: 4
Kamarajah SK, Bundred J, St Marc O, et al., 2019, A Systematic Review and Networked Meta-Analysis of Surgical Approach Techniques for Pancreaticoduodenectomy, International Surgical Conference of the Association-of-Surgeons-in-Training (ASIT), Publisher: WILEY, Pages: 19-19, ISSN: 0007-1323
White L, Patel B, Gall T, et al., 2019, A retrospective analysis of portal vein embolisation followed by major hepatectomy in a single institution, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY, Pages: 98-98, ISSN: 0007-1323
Ottaviani S, Stebbing J, Frampton AE, et al., 2019, Author Correction: TGF-beta induces miR-100 and miR-125b but blocks let-7a through LIN28B controlling PDAC progression, Nature Communications, Vol: 10, ISSN: 2041-1723
Liu DSK, Prado MM, Giovannetti E, et al., 2019, Can circulating tumor and exosomal nucleic acids act as biomarkers for pancreatic ductal adenocarcinoma?, Expert Review of Molecular Diagnostics: new diagnostic technologies are set to revolutionise healthcare, Vol: 19, Pages: 553-558, ISSN: 1473-7159
Qiu S, Jiao LR, 2019, Improving detection combined with targeted therapy for small hepatocellular carcinoma, Annals of Translational Medicine, Vol: 7, ISSN: 2305-5839
Jiao LR, Fajardo Puerta AB, Gall TMH, et al., 2019, Rapid induction of liver regeneration for major hepatectomy (REBIRTH): A randomized controlled trial of portal vein embolisation versus ALPPS assisted with radiofrequency., Cancers, Vol: 11, ISSN: 2072-6694
To avoid liver insufficiency following major hepatic resection, portal vein embolisation (PVE) is used to induce liver hypertrophy pre-operatively. Associating liver partition with portal vein ligation for staged hepatectomy assisted with radiofrequency (RALPPS) was introduced as an alternative method. A randomized controlled trial comparing PVE with RALPPS for the pre-operative manipulation of liver volume in patients with a future liver remnant volume (FLRV) ≤25% (or ≤35% if receiving preoperative chemotherapy) was conducted. The primary endpoint was increase in size of the FLRV. The secondary endpoints were length of time taken for the volume gain, morbidity, operation length and post-operative liver function. Between July 2015 and October 2017, 57 patients were randomised to RALPPS (n = 29) and PVE (n = 28). The mean percentage of increase in the FLRV was 80.7 ± 13.7% after a median 20 days following RALPPS compared to 18.4 ± 9.8% after 35 days (p < 0.001) following PVE. Twenty-four patients after RALPPS and 21 after PVE underwent stage-2 operation. Final resection was achieved in 92.3% and 66.6% patients in RALPPS and PVE, respectively (p = 0.007). There was no difference in morbidity, and one 30-day mortality after RALPPS (p = 0.991) was reported. RALPPS is more effective than PVE in increasing FLRV and the number of patients for surgical resection.
Özdemir T, Schmitt A, Cesaretti M, et al., 2019, Intraoperatively malpositioned stent as a complication of common bile duct injury during laparoscopic cholecystectomy, Annals of Hepato-biliary-pancreatic Surgery, Vol: 23, Pages: 84-86, ISSN: 2508-5778
Injuries occurring during laparoscopic bile duct exploration in the course of laparoscopic cholecystectomy may represent threatening complications and lead to inappropriate management. We present a case of patient with biliary colic who underwent laparoscopic cholecystectomy. During the procedure, a common bile duct injury occurred, compelling conversion to open approach, and the patient was treated using a manually inserted biliary stent. She was referred with severe right upper quadrant pain six weeks after the surgery. Investigation with endoscopic retrograde cholangiopancreatography showed a malpositioned biliary stent with completely extra-biliary trajectory. This is thought to be the first description of a malpositioned common bile duct stent through the common biliary duct as a complication of the commonly performed surgical procedure of bile duct exploration.
Gall TMH, Gerrard G, Frampton AE, et al., 2019, Can we predict long-term survival in resectable pancreatic ductal adenocarcinoma?, Oncotarget, Vol: 10, Pages: 696-706, ISSN: 1949-2553
Objective: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive tumour associated with poor 5-year survival. We aimed to determine factors which differentiate short and long-term survivors and identify a prognostic biomarker. Methods: Over a ten-year period, patients with resected PDAC who developed disease recurrence within 12 months (Group I) and those who had no disease recurrence for 24 months (Group II) were identified. Clinicopathological data was analysed. Ion Torrent high-throughput sequencing on DNA extracted from FFPE tumour samples was used to identify mutations. Additionally, peripheral blood samples were analysed for variants in cell-free DNA, circulating tumour cells (CTCs), and microRNAs. Results: Multivariable analysis of clinicopathological factors showed that a positive medial resection margin was significantly associated with short disease-free survival (p = 0.007). Group I patients (n = 21) had a higher frequency of the KRAS mutant mean variant allele (16.93% ± 11.04) compared to those in Group II (n = 13; 7.55% ± 5.76, p = 0.0078). Group I patients also trended towards having a KRAS c.35G>A p.Gly12Asp mutation in addition to variants in other genes, such as TP53, CDKN2A, and SMAD4. Mutational status of cell-free DNA, and number of CTCs, was not found to be useful in this study. A circulating miRNA (hsa-miR-548ah-5p) was found to be significantly differentially expressed. Conclusions: Medial resection margin status and the frequency of KRAS mutation in the tumour tissue are independent prognostic indicators for resectable PDAC. Circulating miRNA hsa-miR-548ah-5p has the potential to be used as a prognostic biomarker.
Gall TM, Belete S, Khanderia E, et al., 2019, Circulating tumour cells and cell-free DNA in pancreatic ductal adenocarcinoma, American Journal of Pathology, Vol: 189, Pages: 71-81, ISSN: 0002-9440
Pancreatic cancer is detected late in the disease process and has an extremely poor prognosis. A blood-based biomarker that can enable early detection of disease, monitor response to treatment, and potentially allow for personalised treatment, would be of great benefit. This review analyses the literature regarding two potential biomarkers: circulating tumour cells (CTCs) and cell-free DNA (cfDNA) with regards to pancreatic ductal adenocarcinoma (PDAC). The origin of CTCs and the methods of detection are discussed and a decade of research examining CTCs in pancreatic cancer is summarized, including both levels of CTCs and analyzing their molecular characteristics, and how this may affect survival in both advanced and early disease and allow for treatment monitoring. The origin of cfDNA is discussed and the literature over the past 15 years is summarized. This includes analyzing cfDNA for genetic mutations and methylation abnormalities which has the potential to be used for PDAC detection and prognosis. However, the research certainly remains in the experimental stage warranting future large trials in these areas.
Nepogodiev D, Walker K, Glasbey JC, et al., 2018, Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study, BJS Open, Vol: 2, Pages: 400-410, ISSN: 2474-9842
BackgroundAcute illness, existing co‐morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery.MethodsThis prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2‐week blocks over a continuous 3‐month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation.ResultsA total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30‐day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30‐day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin‐converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c‐statistic 0·65).DiscussionFollowing major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability.
Nasser S, Lathouras K, Nixon K, et al., 2018, Impact of right upper quadrant cytoreductive techniques with extensive liver mobilization on postoperative hepatic function and risk of liver failure in patients with advanced ovarian cancer, GYNECOLOGIC ONCOLOGY, Vol: 151, Pages: 466-470, ISSN: 0090-8258
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Jayant K, Sodergren MH, Reccia I, et al., 2018, A systematic review and meta-analysis comparing liver resection with the rf-based device habib (TM)-4x with the clamp-crush technique, Cancers, Vol: 10, Pages: 1-17, ISSN: 2072-6694
Liver cancer is the sixth most common cancer and third most common cause of cancer-related mortality. Presently, indications for liver resections for liver cancers are widening, but the response is varied owing to the multitude of factors including excess intraoperative bleeding, increased blood transfusion requirement, post-hepatectomy liver failure and morbidity. The advent of the radiofrequency energy-based bipolar device Habib™-4X has made bloodless hepatic resection possible. The radiofrequency-generated coagulative necrosis on normal liver parenchyma provides a firm underpinning for the bloodless liver resection. This meta-analysis was undertaken to analyse the available data on the clinical effectiveness or outcomes of liver resection with Habib™-4X in comparison to the clamp-crush technique. The RF-assisted device Habib™-4X is considered a safe and feasible modality for liver resection compared to the clamp-crush technique owing to the multitude of benefits and mounting clinical evidence supporting its role as a superior liver resection device. The most intriguing advantage of the RF-device is its ability to induce systemic and local immunomodulatory changes that further expand the boundaries of survival outcomes following liver resection.
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