Imperial College London

MrKrishnaMoorthy

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Senior Lecturer in Upper Gastrointestinal
 
 
 
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Contact

 

+44 (0)20 3312 7640k.moorthy

 
 
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Location

 

Academic Surgical Unit 10th FlooQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

261 results found

Ortega PM, Scholtz S, O'Donnell K, Hakky S, Purkayastha S, Tsironis C, Moorthy K, Aggarwal R, Ahmed ARet al., 2024, Risk Factors for Chronic Abdominal Pain After RYGB: Are Patients Adequately Selected Beforehand?, Obes Surg

PURPOSE: Chronic abdominal pain after RYGB is a known issue. Identifying the potential patient-related and modifiable risk factors might contribute to diminish the risk for this undesirable outcome. METHODS: A single-center retrospective cohort study with prospective data collection was conducted with inclusion of all patients who underwent RYGB surgery between 2015 and 2021. Data from the NBSR and medical records were used. Patients with chronic abdominal pain were defined when pain lasting or recurring for more than 3 to 6 months. RESULTS: Six hundred sixty-four patients who underwent RYGB surgery were included with a median follow-up of 60.5 months. Forty-nine patients (7.3%) presented with chronic abdominal pain. Postoperative complications (OR 13.376, p = 0.020) and diagnosis of depression (OR 1.971, p = 0.037) were associated with developing abdominal pain. On the other hand, ex-smokers (OR 0.222, p = 0.040) and older age (0.959, p = 0.004) presented as protective factors. CONCLUSION: Postoperative complications and diagnosis of depression are risk factors for chronic pain after RYGB. The role of the bariatric MDT remains crucial to select these patients adequately beforehand.

Journal article

Peters CJ, Ang Y, Ciccarelli FD, Coles H, Coleman HG, Contino G, Crosby T, Devonshire G, Eldridge M, Freeman A, Grehan N, McCord M, Nutzinger B, Zamani S, Parsons SL, Petty R, Sharrocks AD, Skipworth RJE, Smyth EC, Soomro I, Underwood TJ, OCCAMS Consortium, Fitzgerald RCet al., 2024, A decade of the Oesophageal Cancer Clinical and Molecular Stratification Consortium, Nature Medicine, Vol: 30, Pages: 14-16, ISSN: 1078-8956

Journal article

Kazachenka A, Loong JH, Attig J, Young GR, Ganguli P, Devonshire G, Grehan N, TheOCCAMS Consortium, Ciccarelli FD, Fitzgerald RC, Kassiotis Get al., 2023, The transcriptional landscape of endogenous retroelements delineates esophageal adenocarcinoma subtypes, NAR Cancer, Vol: 5, Pages: 1-20, ISSN: 2632-8674

Most cancer types exhibit aberrant transcriptional activity, including derepression of retrotransposable elements (RTEs). However, the degree, specificity and potential consequences of RTE transcriptional activation may differ substantially among cancer types and subtypes. Representing one extreme of the spectrum, we characterize the transcriptional activity of RTEs in cohorts of esophageal adenocarcinoma (EAC) and its precursor Barrett's esophagus (BE) from the OCCAMS (Oesophageal Cancer Clinical and Molecular Stratification) consortium, and from TCGA (The Cancer Genome Atlas). We found exceptionally high RTE inclusion in the EAC transcriptome, driven primarily by transcription of genes incorporating intronic or adjacent RTEs, rather than by autonomous RTE transcription. Nevertheless, numerous chimeric transcripts straddling RTEs and genes, and transcripts from stand-alone RTEs, particularly KLF5- and SOX9-controlled HERVH proviruses, were overexpressed specifically in EAC. Notably, incomplete mRNA splicing and EAC-characteristic intronic RTE inclusion was mirrored by relative loss of the respective fully-spliced, functional mRNA isoforms, consistent with compromised cellular fitness. Defective RNA splicing was linked with strong transcriptional activation of a HERVH provirus on Chr Xp22.32 and defined EAC subtypes with distinct molecular features and prognosis. Our study defines distinguishable RTE transcriptional profiles of EAC, reflecting distinct underlying processes and prognosis, thus providing a framework for targeted studies.

Journal article

Abbas S, Pich OA, Devonshire G, Zamani S, Katz-Summercorn A, Killcoyne S, Cheah C, Nutzinger B, Grehan N, Lopez-Bigas N, Edwards PAW, Fidziukiewicz EM, Redmond A, Freeman AC, Smyth E, O'Donovan M, Miremadi A, Malhotra S, Tripathi M, Coles H, Flint C, Eldridge M, Jammula S, Davies J, Crichton C, Carroll NH, Hardwick R, Safranek P, Hindmarsh A, Sujendran VJ, Hayes S, Ang Y, Sharrocks AR, Preston S, Bagwan I, Save V, Skipworth RJER, Hupp T, O'Neill JR, Tucker O, Beggs A, Taniere P, Puig S, Contino GJ, Underwood TC, Walker RL, Grace B, Lagergren J, Gossage J, Davies A, Chang F, Mahadeva U, Goh VD, Ciccarelli F, Sanders G, Berrisford R, Chan D, Cheong E, Kumar B, Sreedharan LL, Parsons S, Soomro I, Kaye P, Saunders J, Lovat L, Haidry R, Scott M, Sothi S, Lishman SB, Hanna GJ, Peters C, Moorthy K, Grabowska A, Turkington R, McManus D, Coleman HD, Petty R, Bartlett FC, Fitzgerald R, Secrier Met al., 2023, Mutational signature dynamics shaping the evolution of oesophageal adenocarcinoma, NATURE COMMUNICATIONS, Vol: 14

Journal article

Behary P, Alessimii H, Miras AD, Tharakan G, Alexiadou K, Aldhwayan MM, Purkayastha S, Moorthy K, Ahmed AR, Bloom SR, Tan TMet al., 2023, Tripeptide gut hormone infusion does not alter food preferences or sweet taste function in volunteers with obesity and prediabetes/diabetes but promotes restraint eating: a secondary analysis of a randomized single-blind placebo-controlled study, Diabetes, Obesity and Metabolism: a journal of pharmacology and therapeutics, Vol: 25, Pages: 1731-1739, ISSN: 1462-8902

AimsTo investigate whether the elevation in postprandial concentrations of the gut hormones glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM) and peptide YY (PYY) accounts for the beneficial changes in food preferences, sweet taste function and eating behaviour after Roux-en-Y gastric bypass (RYGB).Materials and methodsThis was a secondary analysis of a randomized single-blind study in which we infused GLP-1, OXM, PYY (GOP) or 0.9% saline subcutaneously for 4 weeks in 24 subjects with obesity and prediabetes/diabetes, to replicate their peak postprandial concentrations, as measured at 1 month in a matched RYGB cohort (ClinicalTrials.gov NCT01945840). A 4-day food diary and validated eating behaviour questionnaires were completed. Sweet taste detection was measured using the method of constant stimuli. Correct sucrose identification (corrected hit rates) was recorded, and sweet taste detection thresholds (EC50s: half maximum effective concencration values) were derived from concentration curves. The intensity and consummatory reward value of sweet taste were assessed using the generalized Labelled Magnitude Scale.ResultsMean daily energy intake was reduced by 27% with GOP but no significant changes in food preferences were observed, whereas a reduction in fat and increase in protein intake were seen post-RYGB. There was no change in corrected hit rates or detection thresholds for sucrose detection following GOP infusion. Additionally, GOP did not alter the intensity or consummatory reward value of sweet taste. A significant reduction in restraint eating, comparable to the RYGB group was observed with GOP.ConclusionThe elevation in plasma GOP concentrations after RYGB is unlikely to mediate changes in food preferences and sweet taste function after surgery but may promote restraint eating.

Journal article

Ubels S, Matthée E, Verstegen M, Klarenbeek B, Bouwense S, van Berge Henegouwen MI, Daams F, Dekker JWT, van Det MJ, van Esser S, Griffiths EA, Haveman JW, Nieuwenhuijzen G, Siersema PD, Wijnhoven B, Hannink G, van Workum F, Rosman C, TENTACLE Esophagus collaborative group, Writing Committee, Heisterkamp J, Polat F, Schouten J, Singh P, Study collaboratorset al., 2023, Practice variation in anastomotic leak after esophagectomy: Unravelling differences in failure to rescue., Eur J Surg Oncol, Vol: 49, Pages: 974-982

INTRODUCTION: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main contributor to FTR. This study aimed to assess differences in FTR after AL between centers, and to identify factors that explain these differences. METHODS: TENTACLE - Esophagus is a multicenter, retrospective cohort study, which included 1509 patients with AL after esophagectomy. Differences in FTR were assessed between low-volume (<20 resections), middle-volume (20-60 resections) and high-volume centers (≥60 resections). Mediation analysis was performed using logistic regression, including possible mediators for FTR: case-mix, hospital resources, leak severity and treatment. RESULTS: FTR after AL was 11.7%. After adjustment for confounders, FTR was lower in high-volume vs. low-volume (OR 0.44, 95%CI 0.2-0.8), but not versus middle-volume centers (OR 0.67, 95%CI 0.5-1.0). After mediation analysis, differences in FTR were found to be explained by lower leak severity, lower secondary ICU readmission rate and higher availability of therapeutic modalities in high-volume centers. No statistically significant direct effect of hospital volume was found: high-volume vs. low-volume 0.86 (95%CI 0.4-1.7), high-volume vs. middle-volume OR 0.86 (95%CI 0.5-1.4). CONCLUSION: Lower FTR in high-volume compared with low-volume centers was explained by lower leak severity, less secondary ICU readmissions and higher availability of therapeutic modalities. To reduce FTR after AL, future studies should investigate effective strategies to reduce leak severity and prevent secondary ICU readmission.

Journal article

Christodoulidis G, Halliday LJJ, Samara A, Bhuva N, Park W-HE, Moorthy Ket al., 2023, Personalized Prehabilitation Improves Tolerance to Chemotherapy in Patients with Oesophageal Cancer, CURRENT ONCOLOGY, Vol: 30, Pages: 1538-1545, ISSN: 1198-0052

Journal article

Moorthy K, Halliday LJ, Noor N, Peters CJ, Wynter-Blyth V, Urch CEet al., 2023, Feasibility of implementation and the impact of a digital prehabilitation service in patients undergoing treatment for oesophago-gastric cancer, Current Oncology, Vol: 30, Pages: 1673-1682, ISSN: 1198-0052

Background: Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital prehabilitation service. Methods: Patients undergoing treatment for OG cancer with curative intent were recruited into the study. During the COVID-19 pandemic, patients were offered a digital prehabilitation service. Following the lifting of COVID-19 restrictions, patients were also offered both a hybrid clinic-based in-person service and a digital service. Implementation and clinical metrics from the two prehabilitation models were compared. Results: 31 of 41 patients accepted the digital service (75%). Of the people who started the digital programme, 3 dropped out (10%). Compliance with the weekly touchpoints was 86%, and the median length of programme was 12 weeks. Twenty-six patients enrolled in the in-person service. Two patients dropped out (10%). Average compliance to weekly touchpoints was 71%, and the median length of programme was 10 weeks. In the digital group, sit to stand (STS) increased from 14.5 (IQR 10.5–15.5) to 16 (IQR 16–22); p = 0.02. Median heart rate recovery (HRR) increased from 10.5 (IQR 7.5–14) to 15.5 (IQR 11–20) bpm; p = 0.24. There was a significant drop in distress (median 3 (IQR 0–5) to 1 (IQR 0–2); p = 0.04) and a small drop in anxiety (median 3 (0–5) to 2 (0–3); p = 0.22). There was no difference in the postoperative complication rate and length of hospital stay between the two groups. Discussion: This study has shown that digital prehabilitation can be delivered effectively to patients with OG cancer, with high engagement and retention rates. We observed improvements in some physical and psychological parameters with the digital service, with comparable clinical outcomes to the in-person service.

Journal article

Halliday LJ, Boshier PR, Doganay E, Wynter-Blyth V, Buckley JP, Moorthy Ket al., 2023, The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer, DISEASES OF THE ESOPHAGUS, Vol: 36, ISSN: 1120-8694

Journal article

Singh P, Gossage J, Markar S, Pucher PH, Wickham A, Weblin J, Chidambaram S, Bull A, Pickering O, Mythen M, Maynard N, Grocott M, Underwood Tet al., 2022, Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: 1096-1106, ISSN: 0007-1323

Journal article

Janssen THJB, Fransen LFC, Heesakkers FFBM, Dolmans-Zwartjes ACP, Moorthy K, Nieuwenhuijzen GAP, Luyer MDPet al., 2022, Effect of a multimodal prehabilitation program on postoperative recovery and morbidity in patients undergoing a totally minimally invasive esophagectomy, DISEASES OF THE ESOPHAGUS, Vol: 35, ISSN: 1120-8694

Journal article

Ortega PM, Fehervari M, Hakky S, Purkayastha S, Tsironis C, Moorthy K, Ahmed Aet al., 2022, Refractory Pain Post Roux-en Y Gastric Bypass: defining a management strategy, Publisher: SPRINGER, Pages: 22-23, ISSN: 0960-8923

Conference paper

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, Vol: 18, Pages: 704-713, 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

Ng AWT, Contino G, Killcoyne S, Devonshire G, Hsu R, Abbas S, Su J, Redmond AM, Weaver JMJ, Eldridge MD, Tavaré S, Oesophageal Cancer Clinical and Molecular Stratification OCCAMS Consortium, Edwards PAW, Fitzgerald RCet al., 2022, Rearrangement processes and structural variations show evidence of selection in oesophageal adenocarcinomas, Communications Biology, Vol: 5, ISSN: 2399-3642

Oesophageal adenocarcinoma (OAC) provides an ideal case study to characterize large-scale rearrangements. Using whole genome short-read sequencing of 383 cases, for which 214 had matched whole transcriptomes, we observed structural variations (SV) with a predominance of deletions, tandem duplications and inter-chromosome junctions that could be identified as LINE-1 mobile element (ME) insertions. Complex clusters of rearrangements resembling breakage-fusion-bridge cycles or extrachromosomal circular DNA accounted for 22% of complex SVs affecting known oncogenes. Counting SV events affecting known driver genes substantially increased the recurrence rates of these drivers. After excluding fragile sites, we identified 51 candidate new drivers in genomic regions disrupted by SVs, including ETV5, KAT6B and CLTC. RUNX1 was the most recurrently altered gene (24%), with many deletions inactivating the RUNT domain but preserved the reading frame, suggesting an altered protein product. These findings underscore the importance of identification of SV events in OAC with implications for targeted therapies.

Journal article

Moorthy K, Halliday L, 2022, Guide to Enhanced Recovery for Cancer Patients Undergoing Surgery: ERAS and Oesophagectomy, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 224-228, ISSN: 1068-9265

Journal article

Bartella I, Fransen LFC, Gutschow CA, Bruns CJ, Henegouwen MLVB, Chaudry MA, Cheong E, Cuesta MA, Van Daele E, Gisbertz SS, van Hillegersberg R, Hoelscher A, Mercer S, Moorthy K, Nafteux P, Nilsson M, Pattyn P, Piessen G, Rasanen J, Rosman C, Ruurda JP, Schneider PM, Sgromo B, Nieuwenhuijzen GA, Luyer MDP, Schroeder Wet al., 2021, Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy-an expert consensus based on a modified Delphi process, DISEASES OF THE ESOPHAGUS, Vol: 34, ISSN: 1120-8694

Journal article

Moussa O, Ortega P, Mansour S, Flod S, Cousins J, Hameed S, Tan T, Miras A, Chahal H, Hakky S, Moorthy K, Tsironis C, Ahmed A, Purkayastha Set al., 2021, Bariatric surgical services within a pandemic can continue safely: the initial experience of a UK centre of excellence., Obesity Surgery, ISSN: 0960-8923

Journal article

Mueller PC, Kapp JR, Vetter D, Bonavina L, Brown W, Castro S, Cheong E, Darling GE, Egberts J, Ferri L, Gisbertz SS, Gockel I, Grimminger PP, Hofstetter WL, Hoelscher AH, Low DE, Luyer M, Markar SR, Moenig SP, Moorthy K, Morse CR, Mueller-Stich BP, Nafteux P, Nieponice A, Nieuwenhuijzen GAP, Nilsson M, Palanivelu C, Pattyn P, Pera M, Rasanen J, Ribeiro U, Rosman C, Schroeder W, Sgromo B, van Berge Henegouwen M, van Hillegersberg R, van Veer H, van Workum F, Watson D, Wijnhoven BPL, Gutschow CAet al., 2021, Fit-for-Discharge Criteria after Esophagectomy: An International Expert Delphi Consensus, DISEASES OF THE ESOPHAGUS, Vol: 34, ISSN: 1120-8694

Journal article

Samarasinghe S, Sudlow A, Dimitriadis GK, Ahmed AR, Purkayastha S, Tsironis C, Hakky S, Moorthy K, Aylwin SJB, Panagiotopoulos S, El-Hassani S, Patel AG, Chahal H, Hameed S, le Roux CW, Pournaras DJ, Miras ADet al., 2021, Simple tool to prioritize access to bariatric surgery for people living with obesity during the COVID-19 pandemic, British Journal of Surgery, Vol: 108, Pages: e179-e180, ISSN: 0007-1323

Journal article

Halliday LJ, Doganay E, Wynter-Blyth V, Osborn H, Buckley J, Moorthy Ket al., 2021, Adherence to Pre-operative Exercise and the Response to Prehabilitation in Oesophageal Cancer Patients, JOURNAL OF GASTROINTESTINAL SURGERY, Vol: 25, Pages: 890-899, ISSN: 1091-255X

Journal article

Miras A, Kamocka A, Pérez-Pevida B, Purkayastha S, Moorthy K, Patel A, Chahal H, Frost G, Bassett P, Castagnetto-Gissey L, Coppin L, Jackson N, Umpleby M, Bloom S, Tan T, Ahmed A, Rubino Fet al., 2021, The effect of standard versus longer intestinal bypass on GLP-1 regulation and glucose metabolism in patients with type 2 diabetes undergoing roux-en-Y gastric bypass. The long-limb study, Diabetes Care, Vol: 44, Pages: 1-9, ISSN: 0149-5992

ObjectiveRoux-en-Y gastric bypass (RYGB) characteristically enhances post-prandial levels of Glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothesised that if this is the predominant mechanism behind the enhanced secretion of GLP-1, a longer intestinal bypass would potentiate the post-prandial peak in GLP-1, translating into higher insulin secretion and thus additional improvements in glucose tolerance. To investigate this, we conducted a mechanistic study comparing two variants of RYGB that differ in the length of intestinal bypass.Research Design and MethodsFifty-three patients with type 2 diabetes and obesity were randomised to either ‘standard limb’ RYGB (50cm biliopancreatic limb) or ‘long limb’ RYGB (150cm biliopancreatic limb). They underwent measurements of GLP-1 and insulin secretion following a mixed meal and insulin sensitivity using euglycaemic hyperinsulinaemic clamps at baseline, 2 weeks and at 20% weight loss after surgery.ResultsBoth groups exhibited enhancement in post-prandial GLP-1 secretion and improvements in glycaemia compared to baseline. There were no significant differences in post-prandial peak concentrations of GLP-1, time to peak, insulin secretion, and insulin sensitivity. ConclusionThe findings of this study demonstrate that lengthening of the intestinal bypass in RYGB does not affect GLP-1 secretion. Thus, the characteristic enhancement of GLP-1 response after RYGB might not depend on delivery of nutrients to more distal intestinal segments.

Journal article

Christodoulidis G, Halliday LJ, Wynter-Blyth V, Moorthy K, Bhuva Net al., 2021, The impact of personalized prehabilitation on tolerance to chemotherapy in patients with gastric and oesophageal cancer. A controlled study, Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: ELSEVIER, Pages: S1056-S1056, ISSN: 0923-7534

Conference paper

Zaninotto F, Wynter-Blyth V, Hug A, Halley M, Long L, Rankin M, Moorthy Ket al., 2021, Feasibility of implementing a digital prehabilitation service for cancer patients in the NHS, Congress of the European-Society-for-Medical-Oncology (ESMO), Publisher: ELSEVIER, Pages: S1179-S1179, ISSN: 0923-7534

Conference paper

Halliday LJ, Doganay E, Wynter-Blyth VA, Hanna GB, Moorthy Ket al., 2020, The impact of prehabilitation on post-operative outcomes in oesophageal cancer surgery: a propensity score matched comparison, Journal of Gastrointestinal Surgery, Vol: 25, Pages: 2733-2741, ISSN: 1091-255X

BackgroundPatients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive.MethodsBetween January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics.ResultsSeventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8–17 days; control = median 13 days, IQR 11–20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications.ConclusionPrehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.

Journal article

Knight WRC, McEwen R, Byrne BE, Habib W, Bott R, Zylstra J, Mahadeva U, Gossage JA, Fitzgerald RC, Noorani A, Edwards PAW, Grehan N, Nutzinger B, Hughes C, Fidziukiewicz E, MacRae S, Northrop A, Contino G, Li X, de la Rue R, Katz-Summercorn A, Abbas S, Loureda D, O'Donovan M, Miremadi A, Malhotra S, Tripathi M, Tavaré S, Lynch AG, Eldridge M, Secrier M, Devonshire G, Perner J, Jammula S, Davies J, Crichton C, Carroll N, Safranek P, Hindmarsh A, Sujendran V, Hayes SJ, Ang Y, Sharrocks A, Preston SR, Oakes S, Bagwan I, Save V, Skipworth RJE, Hupp TR, O'Neill JR, Tucker O, Beggs A, Taniere P, Puig S, Underwood TJ, Walker RC, Grace BL, Barr H, Shepherd N, Old O, Lagergren J, Davies A, Chang F, Goh V, Ciccarelli FD, Sanders G, Berrisford R, Harden C, Lewis M, Cheong E, Kumar B, Parsons SL, Soomro I, Kaye P, Saunders J, Lovat L, Haidry R, Igali L, Scott M, Sothi S, Suortamo S, Lishman S, Hanna GB, Moorthy K, Peters CJ, Grabowska A, Turkington R, McManus D, Coleman H, Khoo D, Fickling Wet al., 2020, Endoscopic tumour morphology impacts survival in adenocarcinoma of the oesophagus, European Journal of Surgical Oncology, ISSN: 0748-7983

BackgroundPrognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims to explore the relationship between pre-treatment endoscopic tumour morphology and postoperative survival.MethodsPatients with endoscopic descriptions of tumours were identified from the prospectively managed databases including the OCCAMS database. Tumours were classified as exophytic, ulcerating or stenosing. Kaplan Meier survival analysis and multivariable Cox regression analyses were performed to determine hazard ratios (HR) with 95% confidence intervals.Results262 patients with oesophageal adenocarcinoma undergoing potentially curative resection were pooled from St Thomas’ Hospital (161) and the OCCAMS database (101). There were 70 ulcerating, 114 exophytic and 78 stenosing oesophageal adenocarcinomas. Initial tumour staging was similar across all groups (T3/4 tumours 71.4%, 70.2%, 74.4%). Median survival was 55 months, 51 months and 36 months respectively (p < 0.001). Rates of lymphovascular invasion (P = 0.0176), pathological nodal status (P = 0.0195) and pathological T stage (P = 0.0007) increased from ulcerating to exophytic to stenosing lesions. Resection margin positivity was 21.4% in ulcerating tumours compared to 54% in stenosing tumours (p < 0.001). When compared to stenosing lesions, exophytic and ulcerating lesions demonstrated a significant survival advantage on multivariable analysis (HR 0.56 95% CI 0.31–0.93, HR 0.42 95% CI 0.21–0.82).ConclusionThis study demonstrates that endoscopic morphology may be an important pre-treatment prognostic factor in oesophageal cancer. Ulcerating, exophytic and stenosing tumours may represent different pathological processes and tumour biology.

Journal article

Patel K, Askari A, Moorthy K, 2020, Long-term oncological outcomes following completely minimally invasive esophagectomy versus open esophagectomy, DISEASES OF THE ESOPHAGUS, Vol: 33, ISSN: 1120-8694

Journal article

Kamocka A, McGlone ER, Pérez-Pevida B, Moorthy K, Hakky S, Tsironis C, Chahal H, Miras AD, Tan T, Purkayastha S, Ahmed ARet al., 2020, Candy cane revision after Roux-en-Y gastric bypass, Surgical Endoscopy, Vol: 34, Pages: 2076-2081, ISSN: 0930-2794

BACKGROUND: An excessively long-blind end of the alimentary limb following a Roux-en-Y gastric bypass (RYGB), known as a 'candy cane' (CC), may cause symptoms including abdominal pain, regurgitation and vomiting. Very few studies have examined the efficacy of surgical resection of the CC. OBJECTIVES: The aim of this study was to assess sensitivity of preoperative diagnostic tools for CC, as well as perioperative outcomes and symptom resolution after CC revision surgery. SETTING: High volume bariatric centre of excellence, United Kingdom. METHODS: Observational study of CC revisions from 2010 to 2017. RESULTS: Twenty-eight CC revision cases were identified (mean age 45 ± 9 years, female preponderance 9:1). Presenting symptoms were abdominal pain (86%), regurgitation/vomiting (43%), suboptimal weight loss (36%) and acid reflux (21%). Preoperative tests provided correct diagnosis in 63% of barium contrast swallows, 50% of upper gastrointestinal endoscopies and 29% computed tomographies. Patients presenting with pain had significantly higher CC size as compared with pain-free group (4.2 vs. 2 cm, p = 0.001). Perioperative complications occurred in 25% of cases. Complete or partial symptom resolution was documented in 73% of patients undergoing CC revision. Highest success rates were recorded in the regurgitation/vomiting group (67%). CONCLUSION: Surgical revision of CC is associated with good symptom resolution in the majority of patients, especially those presenting with regurgitation/vomiting. However, it carries certain risk of complications. CC diagnosis may frequently be missed; hence more than one diagnostic tool should be considered when investigating symptomatic patients after RYGB.

Journal article

Jammula S, Katz-Summercorn AC, Li X, Linossi C, Smyth E, Killcoyne S, Biasci D, Subash VV, Abbas S, Blasko A, Devonshire G, Grantham A, Wronowski F, O'Donovan M, Grehan N, Eldridge MD, Tavare S, Fitzgerald RCet al., 2020, Identi fication of Subtypes of Barrett ?s Esophagus and Esophageal Adenocarcinoma Based on DNA Methylation Pro files and Integration of Transcriptome and Genome Data, GASTROENTEROLOGY, Vol: 158, Pages: 1682-+, ISSN: 0016-5085

Journal article

Halliday LJ, Doran SLF, Sgromo B, Viswanath YKS, Tucker O, Patel B, Jambulingam PS, Dawas K, Mercer S, Baker C, Mughal M, Hanna GB, Moorthy Ket al., 2020, Variation in esophageal anastomosis technique-the role of collaborative learning, DISEASES OF THE ESOPHAGUS, Vol: 33, ISSN: 1120-8694

Journal article

Konradsson M, Henegouwen MIVB, Bruns C, Chaudry MA, Cheong E, Cuesta MA, Darling GE, Gisbertz SS, Griffin SM, Gutschow CA, van Hillegersberg R, Hofstetter W, Hoelscher AH, Kitagawa Y, van Lanschot JJB, Lindblad M, Ferri LE, Low DE, Luyer MDP, Ndegwa N, Mercer S, Moorthy K, Morse CR, Nafteux P, Nieuwehuijzen GAP, Pattyn P, Rosman C, Ruurda JP, Rasanen J, Schneider PM, Schroeder W, Sgromo B, Van Veer H, Wijnhoven BPL, Nilsson Met al., 2020, Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process, DISEASES OF THE ESOPHAGUS, Vol: 33, ISSN: 1120-8694

Journal article

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