Imperial College London

Mr Daniel Richard Leff

Faculty of MedicineDepartment of Surgery & Cancer

Reader in Breast Surgery
 
 
 
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Contact

 

d.leff Website

 
 
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Location

 

016Paterson WingSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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265 results found

Almukhtar A, Batcup C, Bowman M, Winter Beatty J, Leff D, Demirel P, Porat T, Judah Get al., 2024, Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework, International Journal of Surgery, Vol: 110, Pages: 554-568, ISSN: 1743-9159

Background:The health sector contributes significantly to the climate crisis. Operating theatres in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. We systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in operating theatres, categorising these using the TheoreticalDomains Framework (TDF).Method:Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000- June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants weremapped to TDF domains and further themes as required.Findings:Twenty-one studies were selected for analysis and assessment (seventeen surveys and four interview studies) comprising 8286 participants, including surgeons, nurses and anaesthetists. Eighteen themes across ten TDF domains were identified. The mostcommon barriers to adoption of green behaviours in operating theatres were in domains of: ‘knowledge’ (N=18) e.g. knowledge of sustainable practices;‘environmental context and resources’ (N=16) e.g.‘personnel shortage and workload and inadequate recycling facilities; ‘social influences’ (N=9) e.g. lack ofleadership/organisational mandate or support; ‘beliefs about consequences’ (N=9) e.g. concerns regarding safety. Intention was the most common facilitator, with eleven studies citing it.Discussion:Despite intentions to adopt sustainable practices in operating theatres, this review identifies several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, inst

Journal article

Courtney A, Leff DR, 2024, Mastitis and Mammary Abscess Management Audit (MAMMA) in the UK and Ireland, British Journal of Surgery, Vol: 111, ISSN: 0007-1323

BackgroundThe aim of this multicentre prospective audit was to describe the current practice in the management of mastitis and breast abscesses in the UK and Ireland, with a specific focus on rates of surgical intervention.MethodsThis audit was conducted in two phases from August 2020 to August 2021; a phase 1 practice survey and a phase 2 prospective audit. Primary outcome measurements for phase 2 included patient management pathway characteristics and treatment type (medical/radiological/surgical).ResultsA total of 69 hospitals participated in phase 2 (1312 patients). The key findings were a high overall rate of incision and drainage (21.0 per cent) and a lower than anticipated proportion of ultrasound-guided aspiration of breast abscesses (61.0 per cent). Significant variations were observed regarding the rate of incision and drainage (range 0–100 per cent; P < 0.001) and the rate of needle aspiration (range 12.5–100 per cent; P < 0.001) between individual units. Overall, 22.5 per cent of patients were admitted for inpatient treatment, out of whom which 72.9 per cent were commenced on intravenous antibiotics. The odds of undergoing incision and drainage for a breast abscess or being admitted for inpatient treatment were significantly higher if patients presented at the weekend compared with a weekday (P ≤ 0.023). Breast specialists reviewed 40.9 per cent of all patients directly, despite the majority of patients (74.2 per cent) presenting within working hours on weekdays.ConclusionsVariation in practice exists in the management of mastitis and breast abscesses, with high rates of incision and drainage in certain regions of the UK. There is an urgent need for a national best-practice toolbox to minimize practice variation and standardize patient care.

Journal article

Che Bakri NA, Kwasnicki RM, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff DRet al., 2023, ASO author reflections: objective outcome measure of upper limb function following axillary lymph node dissection and sentinel lymph node biopsy, Annals of Surgical Oncology, Vol: 30, Pages: 7133-7134, ISSN: 1068-9265

Journal article

Che Bakri NA, Kwasnicki RMM, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff DRRet al., 2023, ASO Visual Abstract: The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity After Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, ANNALS OF SURGICAL ONCOLOGY, ISSN: 1068-9265

Journal article

Kedrzycki M, Elson D, Leff D, 2023, Guidance in breast-conserving surgery: tumour localization versus identification, British Journal of Surgery, Vol: 110, Pages: 920-922, ISSN: 0007-1323

In breast-conserving surgery (BCS), the tumour is removed with the goal of preserving as much healthy breast tissue as possible. Breast conservation comes with a risk of positive resection margins, an independent predictor of ipsilateral tumour recurrence, necessitating reoperation1. Contemporary data from the UK Get it Right First Time1 suggest high average reoperation rates of around 19 %. Current tumour localization techniques can only guide surgeons to the tumour epicentre, but fail to provide identification of the boundary between tumour and normal tissue. Imaging techniques, such as intraoperative ultrasonography (IOUS), intraoperative MRI (iMRI) or fluorescence-guided surgery (FGS), enable visualization of the tumour in its entirety and may provide improved operative precision2–5.

Journal article

Che Bakri NA, Kwasnicki R, Giannas E, Tenang L, Khan N, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff Det al., 2023, The Use of Wearable Activity Monitors to Measure the Upper Limb Physical Activity after Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy, Annals of Surgical Oncology, ISSN: 1068-9265

Journal article

Boland M, Grant Y, Kovacevic L, Hunter J, Henry F, Wood S, Mossialos E, Thiruchelvam P, Leff Det al., 2023, Assessing the Patient-level Costs of Staged Versus Immediate Autologous Breast Reconstruction in Patients with Breast Cancer, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S613-S614, ISSN: 1068-9265

Conference paper

Bakri NAC, Kwasnicki R, Tenang L, Giannas E, Ghandour O, Moenig C, Imam Z, Dhillon K, Ashrafian H, Darzi A, Leff Det al., 2023, Upper Limb Recovery Following Mastectomy with and without Breast Reconstruction Measured Using Wearable Activity Monitors, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S614-S615, ISSN: 1068-9265

Conference paper

Khanna P, Boland M, Amiras D, Joshi M, Leff Det al., 2023, Accuracy and Feasibility of Intraoperative Augmented Reality in Breast Cancer Surgery - A Systematic Review, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S502-S503, ISSN: 1068-9265

Conference paper

Khanna P, Boland M, Amiras D, Joshi M, Leff Det al., 2023, Augmented Reality for Pre-operative Planning for Breast Oncoplastic Surgery, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S504-S505, ISSN: 1068-9265

Conference paper

Jiwa N, Ford L, Roberts D, Danckert N, Marchesi J, Leff D, Takats Zet al., 2023, Identification of Nipple Biofluid Analytes by Desorption Electrospray Ionization (DESI) Mass Spectrometry and Its Interaction with the Nipple Fluid Microbiota, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S550-S551, ISSN: 1068-9265

Conference paper

Thiruchelvam P, Leff D, Upadhyay N, 2023, MRI Study of Non-wire Localisation Devices for Clinically Occult Breast Tumor Localization, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S431-S432, ISSN: 1068-9265

Conference paper

Boland M, Thiruchelvam P, Leff D, 2023, Isotropy of Seed Localisation for Breast-conserving Surgery - A Laboratory Assessment, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S446-S447, ISSN: 1068-9265

Conference paper

Kedrzycki M, Leiloglou M, Shankthakumar D, Chalau V, Thiruchelvam P, Elson D, Leff Det al., 2023, 5-ALA- induced Fluorescence for Tumor Visualization in Breast-conserving Surgery: Part 2 of the "GLOW" Study, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S475-S476, ISSN: 1068-9265

Conference paper

Kedrzycki M, Leiloglou M, Shankthakumar D, Chalau V, Thiruchelvam P, Leff D, Elson Det al., 2023, Fluorescence and Multispectral Imaging in Breast-conserving Surgery - Proof of Concept Trial, 24th Annual Meeting of The American Society of Breast Surgeons (ASBrS), Publisher: SPRINGER, Pages: S447-S448, ISSN: 1068-9265

Conference paper

Shanthakumar D, Leiloglou M, Kelliher C, Darzi A, Elson DS, Leff DRet al., 2023, A comparison of spectroscopy and imaging techniques utilizing spectrally resolved diffusely reflected light for intraoperative margin assessment in breast-conserving surgery: a systematic review and meta-analysis, Cancers, Vol: 15, ISSN: 2072-6694

Up to 19% of patients require re-excision surgery due to positive margins in breast-conserving surgery (BCS). Intraoperative margin assessment tools (IMAs) that incorporate tissue optical measurements could help reduce re-excision rates. This review focuses on methods that use and assess spectrally resolved diffusely reflected light for breast cancer detection in the intraoperative setting. Following PROSPERO registration (CRD42022356216), an electronic search was performed. The modalities searched for were diffuse reflectance spectroscopy (DRS), multispectral imaging (MSI), hyperspectral imaging (HSI), and spatial frequency domain imaging (SFDI). The inclusion criteria encompassed studies of human in vivo or ex vivo breast tissues, which presented data on accuracy. The exclusion criteria were contrast use, frozen samples, and other imaging adjuncts. 19 studies were selected following PRISMA guidelines. Studies were divided into point-based (spectroscopy) or whole field-of-view (imaging) techniques. A fixed-or random-effects model analysis generated pooled sensitivity/specificity for the different modalities, following heterogeneity calculations using the Q statistic. Overall, imaging-based techniques had better pooled sensitivity/specificity (0.90 (CI 0.76-1.03)/0.92 (CI 0.78-1.06)) compared with probe-based techniques (0.84 (CI 0.78-0.89)/0.85 (CI 0.79-0.91)). The use of spectrally resolved diffusely reflected light is a rapid, non-contact technique that confers accuracy in discriminating between normal and malignant breast tissue, and it constitutes a potential IMA tool.

Journal article

Dave R, Elsberger B, Taxiarchi V, Gandhi A, Kirwan C, Kim B, Camacho E, Coles C, Copson E, Courtney A, Horgan K, Fairbrother P, Holcombe C, Kirkham J, Leff D, McIntosh SB, O'Connell R, Pardo R, Potter S, Rattay T, Sharma N, Vidya R, Cutress Ret al., 2023, Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study, BREAST CANCER RESEARCH AND TREATMENT, ISSN: 0167-6806

Journal article

Che Bakri NA, Kwasnicki R, Khan N, Ghandour O, Lee A, Grant Y, Dawidziuk A, Darzi A, Ashrafian H, Leff Det al., 2023, Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: a systematic review and meta-analysis, Annals of Surgery, Vol: 277, Pages: 572-580, ISSN: 0003-4932

Objective: To evaluate the impact of ALND and SLNB on upper limb (UL) morbidity in breastcancer patients.Summary Background: Axillary de-escalation is motivated by a desire to reduce harm ofALND. Understanding the impact of axillary surgery and disparities in operative procedureson post-operative arm morbidity would better direct resources to the point of need and cementthe need for de-escalation strategies.Methods: Embase, Medline, CINAHL and PsychINFO were searched from 1990 until March2020. Included studies were randomized-controlled and observational studies focusing on ULmorbidities, in breast surgery patients. The study followed the Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of upper limbmorbidity comparing SLNB and ALND at less than 12 months, 12-24 months and beyond 24months were analyzed.Results: Sixty-seven studies were included. All studies reported a higher rate of lymphedemaand pain after ALND compared to SLNB. The difference in lymphedema and pain prevalencebetween SLNB and ALND was 13.7% (95% CI 10.5-16.8, p<0.005) and 24.2% (95% CI 12.1-36.3, p<0.005) respectively. Pooled estimates for prevalence of reduced strength and rangeof motion after SLNB and ALND were 15.2% vs 30.9% and 17.1% vs 29.8% respectively.Type of axillary surgery, greater BMI, and radiotherapy were some of the predictors for ULmorbidities.Conclusions: Prevalence of lymphedema after ALND was higher than previously estimated.ALND patients experienced greater rates of lymphedema, pain, reduced strength, and ROMcompared to SLNB. The findings support the continued drive to de-escalate axillary surgery.

Journal article

Che Bakri NA, Kwasnicki RM, Khan N, Ghandour O, Lee A, Grant Y, Dawidziuk A, Darzi A, Ashrafian H, Leff DRet al., 2023, Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients A Systematic Review and Meta-Analysis, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 572-580, ISSN: 0003-4932

Conference paper

Goble M, Caddick V, Patel R, Modi H, Darzi A, Orihuela-Espina F, Leff Det al., 2023, Optical neuroimaging and neurostimulation in surgical training and assessment: a state-of-the-art review, Frontiers in Neuroergonomics, Vol: 4, Pages: 1-8, ISSN: 2673-6195

Introduction: Functional near-infrared spectroscopy (fNIRS) is a non-invasive optical neuroimaging technique used to assess surgeons' brain function. The aim of this narrative review is to outline the effect of expertise, stress, surgical technology, and neurostimulation on surgeons' neural activation patterns, and highlight key progress areas required in surgical neuroergonomics to modulate training and performance.Methods: A literature search of PubMed and Embase was conducted to identify neuroimaging studies using fNIRS and neurostimulation in surgeons performing simulated tasks.Results: Novice surgeons exhibit greater haemodynamic responses across the pre-frontal cortex than experts during simple surgical tasks, whilst expert surgical performance is characterized by relative prefrontal attenuation and upregulation of activation foci across other regions such as the supplementary motor area. The association between PFC activation and mental workload follows an inverted-U shaped curve, activation increasing then attenuating past a critical inflection point at which demands outstrip cognitive capacity Neuroimages are sensitive to the impact of laparoscopic and robotic tools on cognitive workload, helping inform the development of training programs which target neural learning curves. FNIRS differs in comparison to current tools to assess proficiency by depicting a cognitive state during surgery, enabling the development of cognitive benchmarks of expertise. Finally, neurostimulation using transcranial direct-current-stimulation may accelerate skill acquisition and enhance technical performance.Conclusion: FNIRS can inform the development of surgical training programs which modulate stress responses, cognitive learning curves, and motor skill performance. Improved data processing with machine learning offers the possibility of live feedback regarding surgeons' cognitive states during operative procedures.

Journal article

Bakri NAC, Kwasnicki R, Tenang L, Giannas E, Dhillon K, Darzi A, Leff Det al., 2023, Objective Comparison of Post-operative Activity after Sentinel Lymph Node Biopsy versus Axillary Lymph Node Dissection Using Wearable Activity Monitors - The 'BRACELET' Study, CANCER RESEARCH, Vol: 83, ISSN: 0008-5472

Journal article

Godden AR, Micha A, O'Connell RL, Mohammed K, Kirby AM, Thiruchelvam PTR, Leff DR, MacNeill FA, Rusby JEet al., 2023, Pre-operative Radiotherapy And Deep Inferior Epigastric Artery Perforator (DIEP) flAp study (PRADA): Aesthetic outcome and patient satisfaction at one year, JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY, Vol: 78, Pages: 19-28, ISSN: 1748-6815

Journal article

Wu Z, Reyzabal MDI, Sadati SMH, Liu H, Ourselin S, Leff D, Katzschmann RKK, Rhode K, Bergeles Cet al., 2023, Towards a Physics-Based Model for Steerable Eversion Growing Robots, IEEE ROBOTICS AND AUTOMATION LETTERS, Vol: 8, Pages: 1005-1012, ISSN: 2377-3766

Journal article

Kedrzycki M, Leiloglou M, Shanthakumar D, Chalau V, Thiruchelvam P, Elson D, Leff Det al., 2023, 5-ALA-induced Fluorescence for Tumor Visualization in Breast-conserving Surgery: Part 2 of the “GLOW” Study, The American Society of Breast Surgeons 24th Annual Meeting

Conference paper

Kedrzycki M, Leiloglou M, Shanthakumar D, Chalau V, Thiruchelvam P, Leff D, Elson Det al., 2023, Fluorescence and Multispectral Imaging in Breast-conserving Surgery – Proof of Concept Trial, The American Society of Breast Surgeons 24th Annual Meeting

Conference paper

Shanthakumar D, Leiloglou M, Kelliher C, Darzi A, Elson D, Leff Det al., 2023, Tissue optics for margin assessment in breast conserving surgery: Systematic review & meta-analysis, Association of Breast Surgery Conference

Conference paper

Shanthakumar D, Leiloglou M, Chalau V, Kedrzycki M, Darzi A, Elson D, Leff Det al., 2023, Intra-operative multispectral imaging for precision in breast conserving surgery, Association of Breast Surgery Conference

Conference paper

Leiloglou M, Kedrzycki M, Shanthakumar D, Chalau V, Elson D, Leff Det al., 2023, Fluorescence and multispectral imaging use for tumour identification in breast conserving surgery, Association of Breast Surgery Conference

Conference paper

Chon HTW, Kedrzycki M, Leiloglou M, Kirupananthan T, Elson D, Leff Det al., 2023, Fluorescence guided surgery imaging systems for breast cancer identification: A systematic review, Association of Breast Surgery Conference

Conference paper

Leiloglou M, Shanthakumar D, Gkouzionis I, Chalau V, Leff D, Elson Det al., 2023, Investigation of multispectral imaging classification routines for intraoperative margin assessment in breast conserving surgery, European Conferences on Biomedical Optics

Conference paper

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