Imperial College London

DrPiersBoshier

Faculty of MedicineDepartment of Surgery & Cancer

Clinical Lecturer
 
 
 
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piers.boshier03 CV

 
 
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1035Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Publications

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94 results found

Butterworth JW, Boshier PR, Mavroveli S, Van Lanschot JBB, Sasako M, Reynolds J, Hanna GBet al., 2021, Challenges to quality assurance of surgical interventions in clinical oncology trials: A systematic review, EJSO, Vol: 47, Pages: 748-756, ISSN: 0748-7983

Journal article

Wen Q, Boshier P, Myridakis A, Belluomo I, Hanna GBet al., 2020, Urinary volatile organic compound analysis for the diagnosis of cancer: a systematic literature review and quality assessment, Metabolites, Vol: 11, Pages: 17-17, ISSN: 2218-1989

The analysis of urinary volatile organic compounds (VOCs) is a promising field of research with the potential to discover new biomarkers for cancer early detection. This systematic review aims to summarise the published literature concerning cancer-associated urinary VOCs. A systematic online literature search was conducted to identify studies reporting urinary VOC biomarkers of cancers in accordance with the recommendations of the Cochrane Library and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Thirteen studies comprising 1266 participants in total were included in the review. Studies reported urinary VOC profiles of five cancer subtypes: prostate cancer, gastrointestinal cancer, leukaemia/lymphoma, lung cancer, and bladder cancer. Forty-eight urinary VOCs belonging to eleven chemical classes were identified with high diagnostic performance. VOC profiles were distinctive for each cancer type with limited cross-over. The metabolic analysis suggested distinctive phenotypes for prostate and gastrointestinal cancers. The heterogenicity of study design, methodological and reporting quality may have contributed to inconsistencies between studies. Urinary VOC analysis has shown promising performance for non-invasive diagnosis of cancer. However, limitations in study design have resulted in inconsistencies between studies. These limitations are summarised and discussed in order to support future studies.

Journal article

Klevebro F, Boshier PR, Savva K, Waller A, Hage L, Ni M, Hanna GB, Low DEet al., 2020, Severe Dumping Symptoms Are Uncommon Following Transthoracic Esophagectomy But Significantly Decrease Health-Related Quality of Life in Long-Term, Disease-Free Survivors, JOURNAL OF GASTROINTESTINAL SURGERY, Vol: 25, Pages: 1941-1947, ISSN: 1091-255X

Journal article

Fadel MG, Boshier PR, Howell A-M, Iskandarani M, Tekkis P, Kontovounisios Cet al., 2020, The management of acute lower gastrointestinal bleeding using a Sengstaken-Blakemore tube, International Journal of Surgery Case Reports, Vol: 75, Pages: 394-397, ISSN: 2210-2612

IntroductionAcute lower gastrointestinal haemorrhage can potentially be life-threatening. We present a case of a massive rectal bleed which was managed successfully with a balloon tamponade device designed for upper gastrointestinal haemorrhage.Presentation of caseA 75-year-old gentleman, with a history of human immunodeficiency virus and cirrhosis with portal hypertension, presented with bright red rectal bleeding. Investigations showed a low haemoglobin level (74 g/L) and deranged clotting. Oesophago-gastro-duodenoscopy demonstrated no fresh or altered blood. Flexible sigmoidoscopy revealed active bleeding from a varix within the anterior rectal wall 4 cm from the anal verge. Efforts to stop the bleeding, including endoscopic clips, adrenaline injection and rectal packing, were unsuccessful and the patient became haemodynamically unstable. A Sengstaken-Blakemore tube was inserted per rectum and the gastric balloon was inflated to tamponade the lower rectum. The oesophageal balloon was then inflated to hold the gastric balloon firmly in place. A computed tomography angiogram demonstrated no evidence of haemorrhage with balloon tamponade. After 36 h, the balloon was removed with no further episodes of bleeding.DiscussionThe application of a balloon tamponade device should be considered in the management algorithm for acute lower gastrointestinal bleed. Advantages include its rapid insertion, immediate results and ability to measure further bleeding after the catheter has been placed.ConclusionSengstaken-Blakemore tube per rectum may effectively control massive low rectal bleeding when alternative methods have been unsuccessful.

Journal article

van Dorp L, Acman M, Richard D, Shaw LP, Ford CE, Ormond L, Owen CJ, Pang J, Tan CCS, Boshier FAT, Ortiz AT, Balloux Fet al., 2020, Emergence of genomic diversity and recurrent mutations in SARS-CoV-2, INFECTION GENETICS AND EVOLUTION, Vol: 83, ISSN: 1567-1348

Journal article

Zhou J, Otter JA, Price JR, Cimpeanu C, Garcia DM, Kinross J, Boshier PR, Mason S, Bolt F, Holmes AH, Barclay WSet al., 2020, Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London, Clinical Infectious Diseases, Vol: 2020, Pages: 1-1, ISSN: 1058-4838

BACKGROUND: Evaluation of SARS-CoV-2 surface and air contamination during the COVID-19 pandemic in London. METHODS: We performed this prospective cross-sectional observational study in a multi-site London hospital. Air and surface samples were collected from seven clinical areas, occupied by patients with COVID-19, and a public area of the hospital. Three or four 1.0 m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected by RT-qPCR and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS: Viral RNA was detected on 114/218 (52.3%) of surfaces and 14/31 (38.7%) air samples but no virus was cultured. The proportion of surface samples contaminated with viral RNA varied by item sampled and by clinical area. Viral RNA was detected on surfaces and in air in public areas of the hospital but was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67/105 (63.8%) vs. 29/64 (45.3%) (odds ratio 0.5, 95% confidence interval 0.2-0.9, p=0.025, Chi squared test)). The high PCR Ct value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS: Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19, and the need for effective use of PPE, physical distancing, and hand/surface hygiene.

Journal article

Nepogodiev D, 2020, Elective surgery cancellations due to theCOVID-19 pandemic: global predictive modelling to inform surgical recovery plans, British Journal of Surgery, Vol: 107, Pages: 1440-1449, ISSN: 0007-1323

BackgroundThe COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19.MethodsA global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations.ResultsThe best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption.ConclusionA very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.

Journal article

Hagens E, Feenstra M, Egmond M, Laarhoven H, Hulshof M, Boshier P, Low D, van Berge Henegouwen M, Gisbertz Set al., 2020, Influence of body composition and muscle strength on outcomes after multimodal esophageal cancer treatment, Journal of Cachexia, Sarcopenia and Muscle, Vol: 11, Pages: 756-767, ISSN: 2190-6009

Background: Influence of sarcopenia in combination with other body composition parameters and muscle strength on outcomes after esophageal surgery for esophageal cancer remains unclear. The objectives were to: 1. Describe the incidence of sarcopenia in relation to adipose tissue quantity and distribution and muscle strength. 2. To evaluate if neoadjuvant chemoradiation (nCRTx) influences body composition and muscle strength. 3. To evaluate the influence of body composition and muscle strength on postoperative morbidity and long-term survival.Methods: This retrospective study included patients with esophageal cancer who received nCRTx followed by surgery between January 2011 and 2016. Skeletal muscle, visceral and subcutaneous adipose tissue cross sectional areas were calculated based on CT scans and muscle strength was measured using hand grip tests, 30 seconds chair stand tests and maximal inspiratory and expiratory pressure tests prior to nCRTx and after nCRTx. Results: A total of 322 patients were included in this study. Sarcopenia was present in 55.6% of the patients prior to nCRTx and in 58.2% after nCRTx (p=0.082). Patients with sarcopenia had a significantly lower muscle strength and higher fat percentage. The muscle strength and incidence of sarcopenia increased whilst the mean BMI and fat percentage decreased during nCRTx. A BMI above 25 kg/m2 was associated with anastomotic leakage (p=0.032). Other body composition parameters were not associated with postoperative morbidity. A lower handgrip strength prior to nCRTx was associated with pulmonary and cardiac complications (p=0.023 and p=0.009 respectively). In multivariable analysis, a lower number of stands during the 30 seconds chair stand test prior to nCRTx (HR 0.93, 95%CI 0.87 – 0.99, p=0.017) and visceral adipose tissue of >128 cm2 after nCRTx (HR 1.81, 95%CI 1.30 – 2.53, p=0.001) were associated with worse overall survival. Conclusion:Sarcopenia occurs frequently in patients with esopha

Journal article

Vadhwana B, Belluomo I, Boshier PR, Pavlou C, Spanel P, Hanna GBet al., 2020, Impact of oral cleansing strategies on exhaled volatile organic compound levels, RAPID COMMUNICATIONS IN MASS SPECTROMETRY, Vol: 34, ISSN: 0951-4198

Journal article

, 2020, Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study, LANCET CHILD & ADOLESCENT HEALTH, Vol: 4, Pages: 271-280, ISSN: 2352-4642

Journal article

Harris A, Butterworth J, Boshier PR, MacKenzie H, Tokunaga M, Sunagawa H, Mavroveli S, Ni M, Mikhail S, Yeh C-C, Blencowe NS, Avery KNL, Hardwick R, Hoelscher A, Pera M, Zaninotto G, Law S, Low DE, van Lanschot JJB, Berrisford R, Barham CP, Blazeby JM, Hanna GBet al., 2020, Development of a Reliable Surgical Quality Assurance System for 2-stage Esophagectomy in Randomized Controlled Trials., Ann Surg

OBJECTIVE: The aim was to develop a reliable surgical quality assurance system for 2-stage esophagectomy. This development was conducted during the pilot phase of the multicenter ROMIO trial, collaborating with international experts. SUMMARY OF BACKGROUND DATA: There is evidence that the quality of surgical performance in randomized controlled trials influences clinical outcomes, quality of lymphadenectomy and loco-regional recurrence. METHODS: Standardization of 2-stage esophagectomy was based on structured observations, semi-structured interviews, hierarchical task analysis, and a Delphi consensus process. This standardization provided the structure for the operation manual and video and photographic assessment tools. Reliability was examined using generalizability theory. RESULTS: Hierarchical task analysis for 2-stage esophagectomy comprised fifty-four steps. Consensus (75%) agreement was reached on thirty-nine steps, whereas fifteen steps had a majority decision. An operation manual and record were created. A thirty five-item video assessment tool was developed that assessed the process (safety and efficiency) and quality of the end product (anatomy exposed and lymphadenectomy performed) of the operation. The quality of the end product section was used as a twenty seven-item photographic assessment tool. Thirty-one videos and fifty-three photographic series were submitted from the ROMIO pilot phase for assessment. The overall G-coefficient for the video assessment tool was 0.744, and for the photographic assessment tool was 0.700. CONCLUSIONS: A reliable surgical quality assurance system for 2-stage esophagectomy has been developed for surgical oncology randomized controlled trials. ETHICAL APPROVAL: 11/NW/0895 and confirmed locally as appropriate, 12/SW/0161, 16/SW/0098. TRIAL REGISTRATION NUMBER: ISRCTN59036820, ISRCTN10386621.

Journal article

Goh YM, Antonowicz S, Boshier P, Hanna Get al., 2020, Metabolic biomarkers of squamous cell carcinoma of the aerodigestive tract: a systematic review and quality assessment, Oxidative Medicine and Cellular Longevity, Vol: 2020, Pages: 1-13, ISSN: 1942-0900

Introduction. Aerodigestive squamous cell carcinomas (ASCC) constitute a major source of global cancer deaths. Patients typically present with advanced, incurable disease, so new means of detecting early disease are a research priority. Metabolite quantitation is amenable to point-of-care analysis and can be performed in ASCC surrogates such as breath and saliva. The purpose of this systematic review is to summarise progress of ASCC metabolomic studies, with an emphasis on the critical appraisal of methodological quality and reporting. Method. A systematic online literature search was performed to identify studies reporting metabolic biomarkers of ASCC. This review was conducted in accordance with the recommendations of the Cochrane Library and MOOSE guidelines. Results. Thirty studies comprising 2117 patients were included in the review. All publications represented phase-I biomarker discovery studies, and none validated their findings in an independent cohort. There was heterogeneity in study design and methodological and reporting quality. Sensitivities and specificities were higher in oesophageal and head and neck squamous cell carcinomas compared to those in lung squamous cell carcinoma. The metabolic phenotypes of these cancers were similar, as was the kinetics of metabolite groups when comparing blood, tissue, and breath/saliva concentrations. Deregulation of amino acid metabolism was the most frequently reported theme. Conclusion. Metabolite analysis has shown promising diagnostic performance, especially for oesophageal and head and neck ASCC subtypes, which are phenotypically similar. However, shortcomings in study design have led to inconsistencies between studies. To support future studies and ultimately clinical adoption, these limitations are discussed.

Journal article

Bhangu A, RIFT Study Group on behalf of the West Midlands Research Collaborative, 2020, Evaluation of appendicitis risk prediction models in adults with suspected appendicitis, British Journal of Surgery, Vol: 107, Pages: 73-86, ISSN: 0007-1323

BACKGROUND: Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. METHODS: A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16-45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). RESULTS: Some 5345 patients across 154 UK hospitals were identified, of which two-thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut-off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut-off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). CONCLUSION: Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision-making by identifying adults in the UK at low risk of appendicitis were identified.

Journal article

Halpern AL, Boshier PR, White AM, Houk AK, Helmkamp L, Mitchell JD, Meguid RA, Low DE, Fullerton DA, Weyant MJet al., 2020, A Comparison of Frailty Measures at Listing to Predict Outcomes After Lung Transplantation, Annals of Thoracic Surgery, Vol: 109, Pages: 233-240, ISSN: 0003-4975

BackgroundSarcopenia may be an important predictive factor of outcomes after lung transplantation (LTx). Serum albumin and the 6-minute walk distance (6MWD) have been shown to be a marker of LTx outcomes. We measured sarcopenia, albumin, and 6MWD in a cohort of LTx patients and analyzed the utility of these as markers of outcomes for LTx patients.MethodsWe retrospectively identified LTx recipients from 2013-2018 at our institution who underwent computed tomographic imaging during their listing evaluation. From that image, we measured skeletal muscle cross-sectional surface area at the third lumbar vertebral level, and sarcopenia was diagnosed by established cutoffs. Associations between sarcopenia, albumin, 6MWD, and survival, and hospital length of stay, complications, readmissions, and discharge destination were evaluated.ResultsSarcopenia was found in 72% (95 of 132) of patients, 18% (24 of 131) of patients were hypoalbuminemic, and 41% had a low 6MWD. Survival was not associated with presence of sarcopenia (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.46-2.42) or low 6MWD (HR, 0.86; 95% CI, 0.410-1.83). Hospital length of stay, complications, readmissions, and discharge destination were not influenced by sarcopenia or 6MWD. In contrast, hypoalbuminemia was independently associated with decreased survival (HR, 2.25; 95% CI, 1.04-4.85) and a higher grade of postoperative complications (P = .04).ConclusionsSarcopenia is prevalent in LTx patients. Neither sarcopenia nor 6MWD predicted mortality or short-term outcomes after LTx. This is in contrast to albumin levels, which were inversely associated with survival and complications. Albumin shows promise as an important predictor of mortality and short-term outcomes after LTx.

Journal article

Klevebro F, Boshier PR, Savva KV, Waller A, Hage L, Hanna GB, Low Det al., 2019, P70 SEVERE DUMPING SYMPTOMS ARE UNCOMMON FOLLOWING TRANSTHORACIC ESOPHAGECTOMY BUT SIGNIFICANTLY DECREASE HEALTH-RELATED QUALITY OF LIFE IN LONG-TERM, DISEASE FREE SURVIVORS, Diseases of the Esophagus, Vol: 32, ISSN: 1120-8694

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aim</jats:title> <jats:p>The aim of the study was to increase the knowledge about dumping symptoms after esophagectomy and the association to health-related quality of life.</jats:p> </jats:sec> <jats:sec> <jats:title>Background and Methods</jats:title> <jats:p>High quality documentation of dumping symptoms after esophagectomy is currently limited. The aim of the study was to describe the incidence of symptoms associated with dumping syndrome and their relationship with health-related quality of life after esophagectomy.</jats:p> <jats:p>The study cohort was identified from prospective IRB-approved databases from two high volume esophagectomy centers. Patients that were alive and without evidence of recurrence in April 2018 completed the validated Dumping Symptom Rating Scale and health-related quality of life questionnaires. Compound dumping symptom score was created by combining the individual scores for severity and frequency for each symptom.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In total, 171 patients who underwent esophagectomy 1995-2017 responded to the questionnaires, corresponding to a response rate of 77.0%. Median age was 66 years and median time from operation to survey was 5.5 years. Absent or mild problems in all nine dumping symptoms were reported by 94 (59.5%) patients, 19 (12.0%) patients reported moderate or severe problems in at least three symptoms, the most common being “a need to lie down,” “diarrhea,” and “stomach cramps.” Increasing compound dumping symptom score was associated with significantly decreased functio

Journal article

Boshier PR, Swaray A, O'Sullivan A, Low DE, Hanna GB, Peters CJet al., 2019, Predictive models of survival after resection of oesophageal adenocarcinoma: a systematic review and multicentre validation of models, 22nd Annual Meeting of the Association-of-Upper-Gastrointestinal-Surgeons-of-Great-Britain-and-Ireland (AUGIS), Publisher: WILEY, Pages: 66-66, ISSN: 0007-1323

Conference paper

Berthelot M, Ashcroft J, Boshier P, Henry FP, Hunter J, Lo B, Yang G-Z, Leff Det al., 2019, Use of near infrared spectroscopy and implantable Doppler for postoperative monitoring of free tissue transfer for breast reconstruction: a systematic review and meta-analysis, Plastic and Reconstructive Surgery Global Open, Vol: 7, Pages: 1-8, ISSN: 2169-7574

Background: Failure to accurately assess the perfusion of free tissue transfer (FTT) in the early postoperative periodmay contribute to failure, which is a source of major patient morbidity and healthcare costs.Goal: This systematic review and meta-analysis aims to evaluate and appraise current evidence for the use of nearinfrared spectroscopy (NIRS) and/or implantable Doppler (ID) devices compared with conventional clinicalassessment (CCA) for postoperative monitoring of FTT in reconstructive breast surgery.Methods: A systematic literature search was performed in accordance with the PRISMA guidelines. Studies in humansubjects published within the last decade relevant to the review question were identified. Meta-analysis using randomeffects models of FTT failure rate and STARD scoring were then performed on the retrieved publications.Results: 19 studies met the inclusions criteria. For NIRS and ID, the mean sensitivity for the detection of FTT failure is99.36% and 100% respectively, with average specificity of 99.36% and 97.63% respectively. From studies withsufficient reported data, meta-analysis results demonstrated that both NIRS (OR = 0.09 [0.02, 0.36], P < 0.001) and ID(OR = 0.39 [0.27, 0.95], P = 0.04) were associated with significant reduction of FTT failure rates compared to CCA.Conclusion: The use of ID and NIRS provide equivalent outcomes in detecting FTT failure and were superior to CCA.The ability to acquire continuous objective physiological data regarding tissue perfusion is a perceived advantage ofthese techniques. Reduced clinical staff workload and minimised hospital costs are also perceived as positiveconsequences of their use.

Journal article

Wirsching A, Boshier PR, Klevebro F, Kaplan SJ, Seesing MFJ, El-Moslimany R, Ross A, Low DEet al., 2019, Comparison of costs and short-term clinical outcomes of per-oral endoscopic myotomy and laparoscopic Heller myotomy, AMERICAN JOURNAL OF SURGERY, Vol: 218, Pages: 706-711, ISSN: 0002-9610

Journal article

Klevebro F, Boshier PR, Jenq W, Low DEet al., 2019, What Is the Time Burden Associated with Completion of Health-Related Quality of Life Questionnaires after Cancer Treatment?, Annual Clinical Congress of the American-College-of-Surgeons / 5th Annual Sessions of the Owen-H-Wangensteen-Scientific-Forum, Publisher: ELSEVIER SCIENCE INC, Pages: S275-S275, ISSN: 1072-7515

Conference paper

Boshier PR, Woodward C, Nikravan S, Neal JM, Warren D, Low DEet al., 2019, Selective Epidurography for the Assessment of Epidural Catheter Placement After Esophagectomy, ANNALS OF THORACIC SURGERY, Vol: 108, Pages: 905-911, ISSN: 0003-4975

Journal article

Doganay E, Boshier PR, Halliday LJ, Thomas R, Low DE, Moorthy Ket al., 2019, The impact of prehabilitation on parameters of body composition in patients undergoing multimodal therapy for oesophago-gastric (OG) cancer, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY, Pages: 36-36, ISSN: 0007-1323

Conference paper

Boshier PR, Low DE, 2019, Commentary: Per oral endoscopic myotomy (POEM): Should it now be considered the first-line therapeutic approach for patients with achalasia?, JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol: 158, Pages: 953-954, ISSN: 0022-5223

Journal article

Hanna GB, Boshier PR, Markar SR, Romano Aet al., 2019, Accuracy and Methodologic Challenges of Volatile Organic Compound-Based Exhaled Breath Tests for Cancer Diagnosis: A Systematic Review and Meta-analysis (vol 5, e182815, 2019), JAMA ONCOLOGY, Vol: 5, Pages: 1070-1070, ISSN: 2374-2437

Journal article

Wirsching A, Boshier PR, Krishnamoorthi R, Larsen MC, Irani S, Ross AS, Low DEet al., 2019, Endoscopic therapy and surveillance versus esophagectomy for early esophageal adenocarcinoma: A review of early outcomes and cost analysis, AMERICAN JOURNAL OF SURGERY, Vol: 218, Pages: 164-169, ISSN: 0002-9610

Journal article

Klevebro F, Elliott JA, Slaman A, Vermeulen BD, Kamiya S, Rosman C, Gisbertz SS, Boshier PR, Reynolds JV, Rouvelas I, Hanna GB, van Berge Henegouwen MI, Markar SRet al., 2019, Cardiorespiratory comorbidity and postoperative complications following esophagectomy: a European multicenter cohort study, Annals of Surgical Oncology, Vol: 26, Pages: 2864-2873, ISSN: 1068-9265

BACKGROUND: The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on postoperative complications for patients treated for esophageal or gastroesophageal junction cancer. PATIENTS AND METHODS: A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed. RESULTS: In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien-Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11-3.04], pneumonia (OR 1.65, 95% CI 1.10-2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04-2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien-Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia. CONCLUSIONS: The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume E

Journal article

Hanna GB, Boshier PR, Markar SR, 2019, Clinical Application of Volatile Organic Compound-Based Exhaled Breath Tests for Cancer Diagnosis-In Reply, JAMA Oncology, ISSN: 2374-2445

Journal article

Zotti OR, Herbella FAM, Armijo PR, Oleynikov D, de Aquino JL, Merhi VA, Velanovich V, Salvador R, Costantini M, Low D, Wirsching A, Boshier PR, Gurski RR, Kristem L, Patti MGet al., 2019, ACHALASIA TREATMENT IN PATIENTS OVER 80 YEARS OF AGE. A MULTICENTER SURVEY, Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S1439-S1439, ISSN: 0016-5085

Conference paper

Klevebro F, Boshier PR, Savva KV, Waller A, Hage L, Hanna G, Low Det al., 2019, ASSESSMENT OF HEALTH RELATED QUALITY OF LIFE AND DIGESTIVE SYMPTOMS IN LONG TERM, DISEASE FREE SURVIVORS FOLLOWING ESOPHAGECTOMY, Digestive Disease Week (DDW), Publisher: W B SAUNDERS CO-ELSEVIER INC, Pages: S1388-S1388, ISSN: 0016-5085

Conference paper

Klevebro F, Boshier PR, Savva KV, Waller A, Hage L, Hanna G, Low Det al., 2019, 219 – Assessment of Health Related Quality of Life and Digestive Symptoms in Long Term, Disease Free Survivors Following Esophagectomy, Gastroenterology, Vol: 156, Pages: S-1388, ISSN: 0016-5085

Journal article

Wirsching A, Klevebro F, Boshier PR, Hubka M, Kuppusamy MK, Kirtland SH, Low DEet al., 2019, The other explanation for dyspnea: giant paraesophageal hiatal hernia repair routinely improves pulmonary function, Diseases of the Esophagus, ISSN: 1120-8694

Paraesophageal hiatal hernias (PEHs) are most commonly associated with gastrointestinal symptoms; less widely appreciated is their potentially important influence on respiratory function. We hypothesize that surgical repair of PEH will significantly improve not only gastrointestinal symptoms, but also preoperative dyspnea and spirometry scores. A prospective Institutional Review Board-approved database was used to review all patients undergoing PEH repair from 2000 to 2016. Patients with pre- and postoperative pulmonary function tests assessed by spirometry were included. Postoperative changes in spirometry measurements were compared to PEH size as reflected by the percentage of intrathoracic stomach observed on preoperative contrast studies. Patients were stratified according to improvement in forced expiratory volume in 1 second (FEV1). Patients with >12% ('significant') improvement in FEV1 after surgery were compared to the remaining patient population. In total, 299 patients met the inclusion criteria. Symptomatic improvement in respiratory function was noted in all patients after PEH repair. Age, gender, BMI, presenting symptoms, Charlson comorbidity index as well as preoperative comorbidities did not significantly impact the functional outcome. Spirometry results improved in 80% of the patients, 21% of whom showed an improvement of >20% compared to the preoperative level. 'Significant' improvement in respiratory function was seen in 122 of 299 (41%) patients. Patients presenting with moderate and severe preoperative pulmonary obstruction demonstrated 'significant' improvement in FEV1 in 48% and 40% of cases, respectively. Large PEHs, characterized by a percentage of intrathoracic stomach >75%, was strongly associated with 'significant' improvement in FEV1 (P = 0.001). PEHs can impact subjective and objective respiratory status and surgical repair can result in a significant improvement in dyspnea and pulmonary function score t

Journal article

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