Imperial College London

MrJamesKinross

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Senior Lecturer in Colorectal Surgery
 
 
 
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+44 (0)20 3312 1947j.kinross CV

 
 
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1029Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
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198 results found

Lam K, Nazarian S, Gadi N, Hakky S, Moorthy K, Tsironis C, Ahmed A, Kinross JM, Purkayastha Set al., 2022, Patient perspectives on surgeon-specific outcome reports in bariatric surgery, Surgery for Obesity and Related Diseases, ISSN: 1550-7289

BACKGROUND: Surgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning these data are unknown. OBJECTIVES: The aims of this study were to determine patient awareness, views and priorities for outcome reporting in bariatric surgery, and to provide recommendations for future surgeon-specific outcome reporting through the United Kingdom National Bariatric Surgery Registry. SETTING: Bariatric surgical unit in a UK university teaching hospital. METHODS: We adapted a previously validated questionnaire and surveyed the views of 150 patients in a single bariatric surgical unit. We collected data concerning awareness, views, and future priorities for outcome reporting. RESULTS: A full 73% of participants were unaware they could access SSOR. Of the participants that were unaware, 75% stated that they would have accessed SSOR had they been aware they could. Of the participants that had previously accessed SSOR, 86% stated they understood the data, although 61% indicated it did not influence their choice of surgeon. The majority of participants favored public release of outcome reports at the surgeon-level (75%) and hospital-level (83%). The 3 main priorities indicated by participants for future outcome reporting were complication rates (91%), patient reported outcome measures (90%), and reoperation rate (89%), all at the surgeon level. CONCLUSION: Patient awareness of outcome reporting is poor. Efforts must be made to increase awareness of SSOR. Patients should be incorporated as key stakeholders in determining future outcome reporting in bariatric surgery.

Journal article

Lam K, Chen J, Wang Z, Iqbal F, Darzi A, Lo B, Purkayastha S, Kinross Jet al., 2022, Machine learning for technical skill assessment in surgery: a systematic review, npj Digital Medicine, Vol: 5, ISSN: 2398-6352

Accurate and objective performance assessment is essential for both trainees and certified surgeons. However, existing methods can be time consuming, labor intensive and subject to bias. Machine learning (ML) has the potential to provide rapid, automated and reproducible feedback without the need for expert reviewers. We aimed to systematically review the literature and determine the ML techniques used for technical surgical skill assessment and identify challenges and barriers in the field. A systematic literature search, in accordance with the PRISMA statement, was performed to identify studies detailing the use of ML for technical skill assessment in surgery. Of the 1896 studies that were retrieved, 66 studies were included. The most common ML methods used were Hidden Markov Models (HMM, 14/66), Support Vector Machines (SVM, 17/66) and Artificial Neural Networks (ANN, 17/66). 40/66 studies used kinematic data, 19/66 used video or image data, and 7/66 used both. Studies assessed performance of benchtop tasks (48/66), simulator tasks (10/66), and real-life surgery (8/66). Accuracy rates of over 80% were achieved, although tasks and participants varied between studies. Barriers to progress in the field included a focus on basic tasks, lack of standardization between studies, and lack of datasets. ML has the potential to produce accurate and objective surgical skill assessment through the use of methods including HMM, SVM, and ANN. Future ML-based assessment tools should move beyond the assessment ofbasic tasks and towards real-life surgery and provide interpretable feedback with clinical value for the surgeon.

Journal article

Roberts DC, Chidambaram S, Kinross JM, 2022, The role of the colonic microbiota and bile acids in colorectal cancer, CURRENT OPINION IN GASTROENTEROLOGY, Vol: 38, Pages: 179-188, ISSN: 0267-1379

Journal article

Ramaboli M, Nesengani L, Katsidzira L, Haller D, Kinross J, Ocvirk S, O'Keefe SJDet al., 2022, Interactions between the environmental and human microbiota in the preservation of health and genesis of disease: symposium report, CURRENT OPINION IN GASTROENTEROLOGY, Vol: 38, Pages: 146-155, ISSN: 0267-1379

Journal article

Challoner BR, Woolston A, Lau D, Buzzetti M, Fong C, Barber LJ, Anandappa G, Crux R, Assiotis I, Fenwick K, Begum R, Begum D, Lund T, Sivamanoharan N, Sansano HB, Domingo-Arada M, Tran A, Eccles B, Ellis R, Falk S, Hill M, Krell D, Murugaesu N, Nolan L, Potter V, Saunders M, Shiu K-K, Guettler S, Alexander JL, Lázare-Iglesias H, Kinross J, Murphy J, Loga KV, Cunningham D, Chau I, Starling N, Ruiz-Bañobre J, Dhillon T, Gerlinger Met al., 2022, Genetic and immune landscape evolution defines subtypes of MMR deficient colorectal cancer

<jats:title>Abstract</jats:title><jats:p>Mismatch repair deficient colorectal cancers have high mutation loads and many respond to immune checkpoint-inhibitors. We investigated how genetic and immune landscapes co-evolve in these tumors. All cases had high truncal mutation loads. Driver aberrations showed a clear hierarchy despite pervasive intratumor heterogeneity: Those in WNT/βCatenin, mitogen-activated protein kinase and TGFβ receptor family genes were almost always truncal. Immune evasion drivers were predominantly subclonal and showed parallel evolution. Pan-tumor evolution, subclonal evolution, and evolutionary stasis of genetic immune evasion drivers defined three MMRd CRC subtypes with distinct T-cell infiltrates. These immune evasion drivers have been implicated in checkpoint-inhibitor resistance. Clonality and subtype assessments are hence critical for predictive immunotherapy biomarker development. Cancer cell PD-L1 expression was conditional on loss of the intestinal homeobox transcription factor CDX2. This explains infrequent PD-L1 expression by cancer cells and likely contributes to the high recurrence risk of MMRd CRCs with impaired CDX2 expression.</jats:p>

Journal article

Kanneganti A, Tan BY, Nik Ab Rahman NH, Leow AS, Denning M, Goh ET, Lim LJ, Sia C-H, Chua YX, Kinross J, Tan M, Tan LF, Wan YM, Sharma AK, Danuaji R, Komal Kumar RN, Sheng CK, Kheng CP, Abdul Karim SS, Abdul Ghani MN, Mahmud S, Chan YH, Sharma VK, Sim K, Ooi SBet al., 2022, Safety attitudes, burnout and wellbeing among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study., Singapore Med J, ISSN: 0037-5675

INTRODUCTION: The COVID-19 pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on safety attitudes among healthcare workers (HCWs) as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety. METHODS: A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: Safety Attitudes Questionnaire (SAQ); Oldenburg Burnout Inventory; and Hospital and Anxiety Depression Scale. We performed multivariate mixed model regression to assess for independent associations with the SAQ Total Percentage Agree Rates (PAR). RESULTS: We obtained 3,163 responses. A SAQ Total PAR of 35.7%, 15.0%, 51.0% and 3.3% was calculated among respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest in respondents from India at 70.9%-85.4% versus 56.3%-63.6%, respectively. Multivariate analyses revealed that meeting burnout and depression thresholds, and shifts lasting ≥ 12 hours were significantly associated with lower SAQ Total PAR. CONCLUSION: Addressing factors contributing to high burnout and depression, and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities as this pandemic continues.

Journal article

Harewood R, Wooldrage K, Robbins EC, Kinross J, von Wagner C, Cross AJet al., 2022, Adenoma characteristics associated with post-polypectomy proximal colon cancer incidence: a retrospective cohort study, British Journal of Cancer, ISSN: 0007-0920

BackgroundColorectal cancer (CRC) screening is less effective at reducing cancer incidence in the proximal colon compared to the distal colorectum. We aimed to identify adenoma characteristics associated with proximal colon cancer (PCC).MethodsEndoscopy and pathology data for patients with ≥1 adenoma detected at baseline colonoscopy were obtained from 17 UK hospitals between 2001 and 2010. Multivariable Cox regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for PCC, and, for comparison, distal CRC incidence, by adenoma characteristics.ResultsAmong 18,431 patients, 152 and 105 developed PCC and distal CRC, respectively, over a median follow-up of 9.8 years. Baseline adenoma characteristics positively associated with PCC incidence included number (≥3 vs. < 3: aHR 2.10, 95% CI: 1.42–3.09), histology (tubulovillous/villous vs. tubular: aHR 1.61, 95% CI: 1.10–2.35) and location (any proximal vs. distal only: aHR 1.70, 95% CI: 1.20–2.42), for which there was borderline evidence of heterogeneity by subsite (p = 0.055). Adenoma dysplasia (high vs. low grade) was associated with distal CRC (aHR 2.42, 95% CI: 1.44–4.04), but not PCC (p-heterogeneity = 0.023).ConclusionsBaseline adenoma number, histology and proximal location were independently associated with PCC and may be important to identify patients at higher risk for post-polypectomy PCC.

Journal article

Mahajan AP, Inniss DA, Benedict MD, Dennis AA, Kantor T, Salavitabar A, Stegink C, Nelson J, Kinross J, Cohen MSet al., 2022, International Mixed Reality Immersive Experience: Approach via Surgical Grand Rounds, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, Vol: 234, Pages: 25-31, ISSN: 1072-7515

Journal article

Sivananthan A, Gueroult A, Zijlstra G, Martin G, Baheerathan A, Pratt P, Darzi A, Patel N, Kinross Jet al., 2021, A feasibility trial of HoloLens 2™; Using mixed reality headsets to deliver remote bedside teaching during COVID-19, JMIR Formative Research, ISSN: 2561-326X

BackgroundCOVID-19 has had a catastrophic impact measured in human lives. Medical education has also been impacted: appropriately stringent infection control policies have precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching.MethodsTwo MR sessions were led by senior doctors wearing the HoloLens™ headset. The trainers selected patients requiring their specialist input. The headset allowed bi-directional audio-visual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of COVID-19 on bedside teaching and the MR sessions were evaluated using pre- and post-round questionnaires, using Likert scales. Data related to clinician exposure to at risk patients and use of PPE were collected.ResultsPre-questionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (7, IQR 6-7). Post-session questionnaires showed that overall users subjectively agreed the MR session was helpful to their learning (6, IQR 5.25 – 7) and that it was worthwhile (6, IQR 5.25 – 7). Mixed-reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. ConclusionsThis study is proof of principle that HoloLens™ can be used effectively to deliver clinical bedside teaching This novel format confers significant advantages in terms of: minimising exposure of trainees to COVID-19; saving PPE; enabling larger attendance; and convenient accessible real-time clinical training.

Journal article

Lewis JA, Khan S, Tilney HS, Wilson JM, Vitone LJ, Souvatzi M, Singh B, Kinross JMet al., 2021, An observational analysis of a novel digital rectoscope., Diseases of the Colon and Rectum, Vol: 64, Pages: e728-e734, ISSN: 0012-3706

BACKGROUND: This is an analysis of the first 50 in-human uses of a novel digital rigid sigmoidoscope. The technology provides digital image capture, telemedicine capabilities, improved ergonomics, and the ability to biopsy under pneumorectum while maintaining the low cost of conventional rigid sigmoidoscopy. The primary outcome was adverse events, and the secondary outcome was diagnostic view. PRELIMINARY RESULTS: Fifty patients underwent outpatient (n = 25) and surgical rectal assessment (n = 25), with a mean age of 60 years. This included 31 men and 19 women with 12 different clinical use indications. No adverse events were reported, and no defects were reported with the instrumentation. Satisfactory diagnoses were obtained in 48 (96%) of 50 uses, images were captured in 48 (96%) of 50 uses, and biopsies were successfully taken in 13 uses (26%). No adverse events were recorded. Independent reviewers of recorded videos agreed on the quality and diagnostic value of the images with a κ of 0.225 (95% CI, 0.144-0.305) when assessing whether the target pathology was adequately visualized. IMPACT OF INNOVATION: The improved views afforded by digital rectoscopy facilitated a satisfactory clinical diagnosis in 96% of uses. The device was successfully deployed in the operating room and outpatients irrespective of bowel preparation method, where it has the potential to replace flexible sigmoidoscopy for specific use cases. The technology provides a high-quality image and video that can be securely recorded for documentation and medicolegal purposes with agreement between blinded users despite a lack of standardized training and heterogenous pathology. We perceive significant impact of this technology for the assessment of colorectal anastomoses, the office management of colitis, "watch and wait," and for diagnostic support in rectal cancer diagnosis. The technology has significant potential to facilitate proctoring and training, and it now requires prospectiv

Journal article

Beatty JW, Clarke JM, Sounderajah V, Acharya A, Rabinowicz S, Martin G, Warren LR, Yalamanchili S, Scott AJ, Burgnon E, Purkayastha S, Markar S, Kinross JM, PANSURG-PREDICT Collaborativeet al., 2021, Impact of the COVID-19 pandemic on emergency adult surgical patients and surgical services: an international multi-center cohort study and department survey., Annals of Surgery, Vol: 274, Pages: 904-912, ISSN: 0003-4932

OBJECTIVES: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. BACKGROUND: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on this cohort is not understood, and risk predictors are yet to be identified. METHODS: PREDICT is an international longitudinal cohort study comprising surgical patients presenting to hospital between March and August 2020, conducted alongside a survey of staff redeployment and departmental restructuring. A subgroup analysis of 3176 adult emergency patients, recruited by 55 teams across 18 countries is presented. RESULTS: Among adult emergency surgical patients, all-cause in-hospital mortality (IHM) was 3 6%, compared to 15 5% for those with COVID-19. However, only 14 1% received a COVID-19 test on admission in March, increasing to 76 5% by July.Higher Clinical Frailty Scale scores (CFS >7 aOR 18 87), ASA grade above 2 (aOR 4 29), and COVID-19 infection (aOR 5 12) were independently associated with significantly increased IHM.The peak months of the first wave were independently associated with significantly higher IHM (March aOR 4 34; April aOR 4 25; May aOR 3 97), compared to non-peak months.During the study, UK operating theatre capacity decreased by a mean of 63 6% with a concomitant 27 3% reduction in surgical staffing. CONCLUSION: The first wave of the COVID-19 pandemic significantly impacted surgical patients, both directly through co-morbid infection and indirectly as shown by increasing mortality in peak months, irrespective of COVID-19 status.Higher CFS scores and ASA grades strongly predict outcomes in surgical patients and are an important risk assessment tool during the pandemic.

Journal article

Clifford RE, Harji D, Poynter L, Jackson R, Adams R, Fearnhead NS, Vimalachandran D, ReCaP Steering Committee and Collaboratorset al., 2021, Rectal cancer management during the COVID-19 pandemic (ReCaP): multicentre prospective observational study, British Journal of Surgery, Vol: 108, Pages: 1270-1273, ISSN: 0007-1323

Journal article

Khatri C, Ward AE, Nepogodiev D, Ahmed I, Chaudhry D, Dhaif F, Bankhad-Kendall B, Kaafarani H, Bretherton C, Mahmood A, Marais L, Parsons N, Bhangu A, Metcalfe A, Parsons N, Khatri C, Siaw-Acheampong K, Chaudhry D, Dawson BE, Evans JP, Glasbey JC, Gujjuri RR, Heritage E, Jones CS, Kamarajah SK, Khatri C, Keatley JM, Lawday S, Li E, Mckay SC, Nepogodiev D, Pellino G, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Bhangu A, Ademuyiwa AO, Agarwal A, Al Ameer E, Alderson D, Alser O, Arnaud AP, Augestad KM, Bankhead-Kendall B, Benson RA, Chakrabortee S, Blanco-Colino R, Brar A, Bravo AM, Breen KA, Buarque IL, Caruana E, Cunha MF, Davidson GH, Desai A, Di Saverio S, Edwards J, Elhadi M, Farik S, Fiore M, Fitzgerald JE, Ford S, Gallo G, Ghosh D, Gomes GMA, Griffiths E, Halkias C, Harrison EM, Hutchinson P, Isik A, Kaafarani H, Kolias A, Lawani I, Lederhuber H, Leventoglu S, Loffler MW, Martin J, Mashbari H, Mazingi D, Mohan H, Moore R, Moszkowicz D, Ng-Kamstra JS, Metallidis S, Moug S, Niquen M, Ntirenganya F, Outani O, Pata F, Pinkney TD, Pockney P, Radenkovic D, Ramos-De la Medina A, Roberts K, Santos I, Schache A, Schnitzbauer A, Stewart GD, Shaw R, Shu S, Soreide K, Spinelli A, Sundar S, Tabiri S, Townend P, Tsoulfas G, van Ramshorst G, Vidya R, Vimalachandran D, Wright N, Simoes JFF, Mak JKC, Kulkarni R, Sharma N, Nankivell P, Tirotta F, Parente A, Breik O, Kisiel A, Cato LD, Saeed S, Bhangu A, Griffiths E, Pathanki AM, Ford S, Desai A, Almond M, Kamal M, Chebaro A, Lecolle K, Truant S, El Amrani M, Zerbib P, Pruvot FR, Mathieu D, Surmei E, Mattei L, Marin H, Dudek J, Singhal T, El-Hasani S, Nehra D, Walters A, Cuschieri J, Davidson GH, Ho M, Wade RG, Johnstone J, Bourke G, Brunelli A, Elkadi H, Otify M, Pompili C, Burke JR, Bagouri E, Chowdhury M, Abual-Rub Z, Kaufmann A, Munot S, Lo T, Young A, Kowal M, Wall J, Peckham-Cooper A, Winter SC, Belcher E, Stavroulias D, Di Chiara F, Wallwork K, Qureishi A, Lami M, Sravanam S, Mastoridis S, Shah K, Chidambaram S, Smet al., 2021, Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study, BMJ Open, Vol: 11, Pages: 1-10, ISSN: 2044-6055

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before t

Journal article

Mahajan AP, Inniss DA, Benedict MD, Dennis AA, Kantor T, Kinross JM, Cohen MSet al., 2021, The First International Surgical Grand Rounds Using Immersive Mixed Reality Headset Devices, JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, Vol: 233, Pages: S116-S116, ISSN: 1072-7515

Journal article

Patel R, Suwa Y, Kinross J, von Roon A, Woods AJ, Darzi A, Singh H, Leff DRet al., 2021, Neuroenhancement of surgeons during robotic suturing, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, ISSN: 0930-2794

BackgroundThe initial phases of robotic surgical skills acquisition are associated with poor technical performance, such as low knot-tensile strength (KTS). Transcranial direct-current stimulation (tDCS) can improve force and accuracy in motor tasks but research in surgery is limited to open and laparoscopic tasks in students. More recently, robotic surgery has gained traction and is now the most common approach for certain procedures (e.g. prostatectomy). Early-phase robotic suturing performance is dependent on prefrontal cortex (PFC) activation, and this study aimed to determine whether performance can be improved with prefrontal tDCS.MethodsFifteen surgical residents were randomized to either active then sham tDCS or sham then active tDCS, in two counterbalanced sessions in a double-blind crossover study. Within each session, participants performed a robotic suturing task repeated in three blocks: pre-, intra- and post-tDCS. During the intra-tDCS block, participants were randomized to either active tDCS (2 mA for 15 min) to the PFC or sham tDCS. Primary outcome measures of technical quality included KTS and error scores.ResultsSignificantly faster completion times were observed longitudinally, regardless of active (p < 0.001) or sham stimulation (p < 0.001). KTS was greater following active compared to sham stimulation (median: active = 44.35 N vs. sham = 27.12 N, p < 0.001). A significant reduction in error scores from “pre-” to “post-” (p = 0.029) were only observed in the active group.ConclusiontDCS could reduce error and enhance KTS during robotic suturing and warrants further exploration as an adjunct to robotic surgical training.

Journal article

Koller KR, Wilson A, Normolle DP, Nicholson JK, Li JV, Kinross J, Lee FR, Flanagan CA, Merculieff ZT, Iyer P, Lammers DL, Thomas TK, O'Keefe SJDet al., 2021, Dietary fibre to reduce colon cancer risk in Alaska Native people: the Alaska FIRST randomised clinical trial protocol., BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055

INTRODUCTION: Diet, shown to impact colorectal cancer (CRC) risk, is a modifiable environmental factor. Fibre foods fermented by gut microbiota produce metabolites that not only provide food for the colonic epithelium but also exert regulatory effects on colonic mucosal inflammation and proliferation. We describe methods used in a double-blinded, randomised, controlled trial with Alaska Native (AN) people to determine if dietary fibre supplementation can substantially reduce CRC risk among people with the highest reported CRC incidence worldwide. METHODS AND ANALYSES: Eligible patients undergoing routine screening colonoscopy consent to baseline assessments and specimen/data collection (blood, urine, stool, saliva, breath and colon mucosal biopsies) at the time of colonoscopy. Following an 8-week stabilisation period to re-establish normal gut microbiota post colonoscopy, study personnel randomise participants to either a high fibre supplement (resistant starch, n=30) or placebo (digestible starch, n=30) condition, repeating stool sample collection. During the 28-day supplement trial, each participant consumes their usual diet plus their supplement under direct observation. On day 29, participants undergo a flexible sigmoidoscopy to obtain mucosal biopsy samples to measure the effect of the supplement on inflammatory and proliferative biomarkers of cancer risk, with follow-up assessments and data/specimen collection similar to baseline. Secondary outcome measures include the impact of a high fibre supplement on the oral and colonic microbiome and biofluid metabolome. ETHICS AND DISSEMINATION: Approvals were obtained from the Alaska Area and University of Pittsburgh Institutional Review Boards and Alaska Native Tribal Health Consortium and Southcentral Foundation research review bodies. A data safety monitoring board, material transfer agreements and weekly study team meetings provide regular oversight throughout the study. Study findings will first be shared with AN

Journal article

Mason SE, Manoli E, Alexander JL, Poynter L, Ford L, Paizs P, Adebesin A, McKenzie JS, Rosini F, Goldin R, Darzi A, Takats Z, Kinross JMet al., 2021, Lipidomic profiling of colorectal lesions for real-time tissue recognition and risk-stratification using rapid evaporative ionisation mass spectrometry., Annals of Surgery, Vol: 00, ISSN: 0003-4932

OBJECTIVE: Rapid Evaporative Ionisation Mass Spectrometry (REIMS) is a metabolomic technique analysing tissue metabolites, which can be applied intra-operatively in real-time. The objective of this study was to profile the lipid composition of colorectal tissues using REIMS, assessing its accuracy for real-time tissue recognition and risk-stratification. SUMMARY BACKGROUND DATA: Metabolic dysregulation is a hallmark feature of carcinogenesis, however it remains unknown if this can be leveraged for real-time clinical applications in colorectal disease. METHODS: Patients undergoing colorectal resection were included, with carcinoma, adenoma and paired-normal mucosa sampled. Ex vivo analysis with REIMS was conducted using monopolar diathermy, with the aerosol aspirated into a Xevo G2S QToF mass spectrometer. Negatively charged ions over 600-1000m/z were used for univariate and multivariate functions including linear discriminant analysis. RESULTS: 161 patients were included, generating 1013 spectra. Unique lipidomic profiles exist for each tissue type, with REIMS differentiating samples of carcinoma, adenoma and normal mucosa with 93 1% accuracy and 96 1% negative predictive value for carcinoma. Neoplasia (carcinoma or adenoma) could be predicted with 96 0% accuracy and 91 8% negative predictive value. Adenomas can be risk-stratified by grade of dysplasia with 93 5% accuracy, but not histological subtype. The structure of 61 lipid metabolites was identified, revealing that during colorectal carcinogenesis there is progressive increase in relative abundance of phosphatidylglycerols, sphingomyelins and mono-unsaturated fatty acid containing phospholipids. CONCLUSIONS: The colorectal lipidome can be sampled by REIMS and leveraged for accurate real-time tissue recognition, in addition to risk-stratification of colorectal adenomas. Unique lipidomic features associated with carcinogenesis are described.

Journal article

Van Den Heede K, Chidambaram S, Winter Beatty J, Chander N, Markar S, Tolley NS, Palazzo FF, Kinross JK, Di Marco AN, PanSurg Collaborative and the PREDICT-Endocrine Collaborativeet al., 2021, The PanSurg-PREDICT Study: endocrine surgery during the COVID-19 pandemic, World Journal of Surgery, Vol: 45, Pages: 2315-2324, ISSN: 0364-2313

BACKGROUND: In the midst of the COVID-19 pandemic, patients have continued to present with endocrine (surgical) pathology in an environment depleted of resources. This study investigated how the pandemic affected endocrine surgery practice. METHODS: PanSurg-PREDICT is an international, multicentre, prospective, observational cohort study of emergency and elective surgical patients in secondary/tertiary care during the pandemic. PREDICT-Endocrine collected endocrine-specific data alongside demographics, COVID-19 and outcome data from 11-3-2020 to 13-9-2020. RESULTS: A total of 380 endocrine surgery patients (19 centres, 12 countries) were analysed (224 thyroidectomies, 116 parathyroidectomies, 40 adrenalectomies). Ninety-seven percent were elective, and 63% needed surgery within 4 weeks. Eight percent were initially deferred but had surgery during the pandemic; less than 1% percent was deferred for more than 6 months. Decision-making was affected by capacity, COVID-19 status or the pandemic in 17%, 5% and 7% of cases. Indication was cancer/worrying lesion in 61% of thyroidectomies and 73% of adrenalectomies and calcium 2.80 mmol/l or greater in 50% of parathyroidectomies. COVID-19 status was unknown at presentation in 92% and remained unknown before surgery in 30%. Two-thirds were asked to self-isolate before surgery. There was one COVID-19-related ICU admission and no mortalities. Consultant-delivered care occurred in a majority (anaesthetist 96%, primary surgeon 76%). Post-operative vocal cord check was reported in only 14% of neck endocrine operations. Both of these observations are likely to reflect modification of practice due to the pandemic. CONCLUSION: The COVID-19 pandemic has affected endocrine surgical decision-making, case mix and personnel delivering care. Significant variation was seen in COVID-19 risk mitigation measures. COVID-19-related complications were uncommon. This analysis demonstrates the safety of endocrine surgery during this

Journal article

Bala L, Kinross J, Martin G, Koizia LJ, Kooner AS, Shimshon GJ, Hurkxkens TJ, Pratt PJ, Sam AHet al., 2021, A remote access mixed reality teaching ward round, The Clinical Teacher, Vol: 18, Pages: 386-390, ISSN: 1743-4971

BackgroundHeterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID‐19 pandemic, with limited exposure to patients for clinical teaching.MethodsWe conducted a proof‐of‐concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round.ResultsStudents unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education.DiscussionWe have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high‐quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.

Journal article

Cardiothoracic Interdisciplinary Research Network and COVIDSurg Collaborative, 2021, Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study., Journal of Thoracic and Cardiovascular Surgery, Vol: 162, Pages: e355-e372, ISSN: 0022-5223

Journal article

COVIDSurg Collaborative Co-authors, 2021, Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score, British Journal of Surgery, Vol: 108, Pages: 1274-1292, ISSN: 0007-1323

Since the beginning of the COVID-19 pandemic tens of millions of operations have been cancelled1 as a result of excessive postoperative pulmonary complications (51.2 per cent) and mortality rates (23.8 per cent) in patients with perioperative SARS-CoV-2 infection2. There is an urgent need to restart surgery safely in order to minimize the impact of untreated non-communicable disease.As rates of SARS-CoV-2 infection in elective surgery patients range from 1–9 per cent3–8, vaccination is expected to take years to implement globally9 and preoperative screening is likely to lead to increasing numbers of SARS-CoV-2-positive patients, perioperative SARS-CoV-2 infection will remain a challenge for the foreseeable future.To inform consent and shared decision-making, a robust, globally applicable score is needed to predict individualized mortality risk for patients with perioperative SARS-CoV-2 infection. The authors aimed to develop and validate a machine learning-based risk score to predict postoperative mortality risk in patients with perioperative SARS-CoV-2 infection.

Journal article

Lam K, Purkayastha S, Kinross JM, 2021, The ethical digital surgeon, Journal of Medical Internet Research, Vol: 23, Pages: 1-3, ISSN: 1438-8871

This viewpoint explores the ethical and regulatory consequences of the digital transformation of the operating room. Surgical robotics is undergoing significant change and future advances will center around the capture and use of data. The consequences of creating this surgical data pipeline must be understood and digital surgical systems must prioritize the safeguarding of patient data. Moreover, data protection laws and frameworks must adapt to the changing nature of surgical data. Finally, digital surgeons must understand changing data legislation and best practice on data governance to act as guardians not only for their own but also for their patients’ data.

Journal article

Harewood R, Disney R, Kinross J, von Wagner C, Cross AJet al., 2021, Medication use and risk of proximal colon cancer: a systematic review of prospective studies with narrative synthesis and meta-analysis, Cancer Causes and Control, Vol: 32, Pages: 1047-1061, ISSN: 0957-5243

PurposeEvidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk.MethodsMEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted.ResultsTwenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73–0.89) but no associations between HRT (RR 0.92, 95% CI 0.83–1.02), OC (RR 1.06, 95% CI 0.98–1.14) or statin use (RR 0.94, 95% CI 0.67–1.31), and proximal colon cancer incidence compared to never/non-use. One study on metformin and one on anti-hypertensives reported no association. Sources of between-study heterogeneity included study design, period of exposure ascertainment, exposure source, and exposure comparison, but this exploration was hindered by the small numbers of studies.ConclusionDespite some studies on NSAID or HRT use, evidence on the impact of a range of medications on proximal colon cancer risk is limited. This highlights the need for more research to inform chemoprevention strategies.

Journal article

Reynolds IS, O'Connell E, Fichtner M, Blümel A, Mason SE, Kinross J, McNamara DA, Kay EW, O'Connor DP, Das S, Burke JP, Prehn JHMet al., 2021, An insight into the driver mutations and molecular mechanisms underlying mucinous adenocarcinoma of the rectum., Diseases of the Colon and Rectum, Vol: 64, Pages: 677-688, ISSN: 0012-3706

BACKGROUND: Mucinous adenocarcinoma of the rectum accounts for 10% of all rectal cancers and has an impaired response to neoadjuvant chemoradiotherapy and worse overall survival. To date, insufficient genomic research has been performed on this histological subtype. OBJECTIVE: This study aims to define the mismatch repair deficiency rate and the driver mutations underpinning mucinous adenocarcinoma of the rectum and to compare it with rectal adenocarcinoma not otherwise specified. DESIGN: Immunohistochemistry and sequencing were performed on tumor samples from our tumor biobank. SETTINGS: This study was conducted across 2 tertiary referral centers. PATIENTS: Patients with mucinous adenocarcinoma and rectal adenocarcinoma not otherwise specified who underwent rectal resection between 2008 and 2018 were included. MAIN OUTCOME MEASURES: Mismatch repair status was performed by immunohistochemical staining. Mutations in the panel of oncogenes and tumor suppressor genes were determined by sequencing on the MiSeq V3 platform. RESULTS: The study included 33 patients with mucinous adenocarcinoma of the rectum and 100 patients with rectal adenocarcinoma not otherwise specified. Those with mucinous adenocarcinoma had a mismatch repair deficiency rate of 12.1% compared to 2.0% in the adenocarcinoma not otherwise specified cohort (p = 0.04). Mucinous adenocarcinoma and adenocarcinoma not otherwise specified rectal tumors had similar mutation frequencies in most oncogenes and tumor suppressor genes. No difference was found in the KRAS mutation rate (50.0% vs 37.1%, p = 0.29) or BRAF mutation rate (6.7% vs 3.1%, p = 0.34) between the cohorts. No difference was found between the cohorts regarding recurrence-free (p = 0.29) or overall survival (p = 0.14). LIMITATIONS: The major limitations of this study were the use of formalin-fixed, paraffin-embedded tissue over fresh-frozen tissue and the small number of patients included, in particular, in the mucinous rectal cohort. CONCLUSIONS

Journal article

Kinross JM, Mason SE, Mylonas G, Darzi Aet al., 2021, Next-generation robotics in gastrointestinal surgery (vol 17, pg 430, 2020), NATURE REVIEWS GASTROENTEROLOGY & HEPATOLOGY, Vol: 18, Pages: 589-589, ISSN: 1759-5045

Journal article

Van den Heede K, Chidambaram S, Beatty JW, Chander N, Markar S, Tolley NS, Palazzo FF, Kinross JK, Di Marco ANet al., 2021, The PanSurg-PREDICT study: endocrine surgery during the COVID-19 pandemic (Apr, 10.1007/s00268-021-06099-z, 2021), World Journal of Surgery, Pages: 1-1, ISSN: 0364-2313

Journal article

Barker GF, Pechlivanis A, Bello AT, Chrysostomou D, Mullish BH, Marchesi J, Posma JM, Kinross JM, Nicholson J, O'Keefe SJ, Li JVet al., 2021, Aa022 a high-fiber low-fat diet increases fecal levels of lithocholic acid derivative 3-ketocholanic acid, Digestive Disease Week, Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S393-S394, ISSN: 0016-5085

Conference paper

Sivananthan A, Machin M, Zijlstra G, Harris S, Radhakrishnan S, Crook P, Phillip G, Denning M, Patel N, Darzi A, Kinross J, Brown Ret al., 2021, A grassroots junior doctor communication network in response to the COVID-19 pandemic: a service evaluation, BMJ Open Quality, Vol: 10, ISSN: 2399-6641

BackgroundCOVID-19 was declared a worldwide pandemic on 11th March 2020. Imperial NHS Trust provides 1412 inpatient beds staffed by 1200 junior doctors and faced a large burden of COVID-19 admissions.Local problemA survey of doctors revealed only 20% felt confident that they would know to whom they could raise concerns and that most were getting information from a combination of informal work discussions, trust emails, social media and medical literature. MethodsThis quality improvement project was undertaken aligning with SQUIRE 2.0© guidelines. Through an iterative process, a digital network; ICON (Imperial Covid cOmmunications Network) using existing smartphone technologies was developed. Concerns were collated from the junior body (Google Form®) and convey them to the leadership team (vertical - bottom up) and improve communication from leadership to the junior body (vertical - top down using WhatsApp and Zoom®). Quantitative analysis on engagement with the network (members of the group and number of issues raised) and qualitative assessment (thematic analysis on issues) was undertaken.ResultsMembership of the ICON WhatsApp group peaked at 780 on 17th May 2020. 197 concerns were recorded via the Google Form® system between 20th March and 14th June 2020. There were five overarching themes; organisational and logistics; clinical strategy concerns; staff safety and wellbeing; clinical (COVID-19) and patient care; and facilities. 94.4% of members agreed ICON was helpful in receiving updates and 88.9% agreed ICON improved collaboration. ConclusionsThis work demonstrates that a coordinated network, utilising existing smartphone technologies and a novel communications structure, can improve collaboration between senior leadership and junior doctors. Such a network could play an important role during times of pressure in a healthcare system.

Journal article

Goh ET, Denning M, Purkayastha S, Kinross Jet al., 2021, 190 Determinants of Psychological Well-Being in Healthcare Workers During the Covid-19 Pandemic: A Multinational Cross-Sectional Study, The British journal of surgery, Vol: 108, ISSN: 0007-1323

Abstract <h4>Introduction</h4> The Covid-19 pandemic has placed unprecedented pressures on healthcare systems globally, impacting working conditions, safety attitudes and the psychological well-being of healthcare workers. This cross-sectional study explores the prevalence and predictors of anxiety/depression amongst healthcare workers in the UK, Singapore, and Poland. <h4>Method</h4> From 22 March to 18 June 2020, healthcare workers from the UK, Singapore and Poland were invited to complete a self-administered questionnaire on psychological well-being. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Other components of the questionnaire include demographic information, Safety Attitudes Questionnaire (SAQ) measuring safety culture and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Multivariate logistic regression was used to determine predictors of anxiety and depression. <h4>Results</h4> Of 3537 healthcare workers who participated in the study, 701 (20%) screened positive for anxiety and 389 (11%) for depression. Significant predictors of depression and anxiety include low SAQ score, nursing role, redeployment, burnout, and depression. There was significant overlap between anxiety and depression. The doctor role was protective. <h4>Conclusions</h4> Our findings demonstrate a significant burden of anxiety and depression amongst healthcare workers during Covid-19. These findings highlight the impact of Covid-19 on psychological well-being and suggests which groups would benefit from targeted support.

Journal article

Capece D, D'Andrea D, Begalli F, Goracci L, Tornatore L, Alexander JL, Di Veroli A, Leow S-C, Vaiyapuri TS, Ellis JK, Verzella D, Bennett J, Savino L, Ma Y, McKenzie JS, Doria ML, Mason SE, Chng KR, Keun HC, Frost G, Tergaonkar V, Broniowska K, Stunkel W, Takats Z, Kinross JM, Cruciani G, Franzoso Get al., 2021, Enhanced triacylglycerol catabolism by Carboxylesterase 1 promotes aggressive colorectal carcinoma., Journal of Clinical Investigation, ISSN: 0021-9738

The ability to adapt to low-nutrient microenvironments is essential for tumor-cell survival and progression in solid cancers, such as colorectal carcinoma (CRC). Signaling by the NF-κB transcription-factor pathway associates with advanced disease stages and shorter survival in CRC patients. NF-κB has been shown to drive tumor-promoting inflammation, cancer-cell survival and intestinal epithelial cell (IEC) dedifferentiation in mouse models of CRC. However, whether NF-κB affects the metabolic adaptations that fuel aggressive disease in CRC patients is unknown. Here, we identified carboxylesterase 1 (CES1) as an essential NF-κB-regulated lipase linking obesity-associated inflammation with fat metabolism and adaptation to energy stress in aggressive CRC. CES1 promoted CRC-cell survival via cell-autonomous mechanisms that fuel fatty-acid oxidation (FAO) and prevent the toxic build-up of triacylglycerols. We found that elevated CES1 expression correlated with worse outcomes in overweight CRC patients. Accordingly, NF-κB drove CES1 expression in CRC consensus molecular subtype (CMS)4, associated with obesity, stemness and inflammation. CES1 was also upregulated by gene amplifications of its transcriptional regulator, HNF4A, in CMS2 tumors, reinforcing its clinical relevance as a driver of CRC. This subtype-based distribution and unfavourable prognostic correlation distinguished CES1 from other intracellular triacylglycerol lipases and suggest CES1 could provide a route to treat aggressive CRC.

Journal article

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