Imperial College London

DrPiersBoshier

Faculty of MedicineDepartment of Surgery & Cancer

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

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Publications

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110 results found

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

Wen Q, Myridakis A, Boshier PR, Zuffa S, Belluomo I, Parker AG, Chin S-T, Hakim S, Markar SR, Hanna GBet al., 2023, A complete pipeline for untargeted urinary volatolomic profiling with sorptive extraction and dual polar and nonpolar column methodologies coupled with gas chromatography time-of-flight mass spectrometry., Analytical Chemistry, Vol: 95, Pages: 758-765, ISSN: 0003-2700

Volatolomics offers an opportunity for noninvasive detection and monitoring of human disease. While gas chromatography-mass spectrometry (GC-MS) remains the technique of choice for analyzing volatile organic compounds (VOCs), barriers to wider adoption in clinical practice still exist, including: sample preparation and introduction techniques, VOC extraction, throughput, volatolome coverage, biological interpretation, and quality control (QC). Therefore, we developed a complete pipeline for untargeted urinary volatolomic profiling. We optimized a novel extraction technique using HiSorb sorptive extraction, which exhibited high analytical performance and throughput. We achieved a broader VOC coverage by using HiSorb coupled with a set of complementary chromatographic methods and time-of-flight mass spectrometry. Furthermore, we developed a data preprocessing strategy by evaluating internal standard normalization, batch correction, and we adopted strict QC measures including removal of nonlinearly responding, irreproducible, or contaminated metabolic features, ensuring the acquisition of high-quality data. The applicability of this pipeline was evaluated in a clinical cohort consisting of pancreatic ductal adenocarcinoma (PDAC) patients (n = 28) and controls (n = 33), identifying four urinary candidate biomarkers (2-pentanone, hexanal, 3-hexanone, and p-cymene), which can successfully discriminate the cancer and noncancer subjects. This study presents an optimized, high-throughput, and quality-controlled pipeline for untargeted urinary volatolomic profiling. Use of the pipeline to discriminate PDAC from control subjects provides proof of principal of its clinical utility and potential for application in future biomarker discovery studies.

Journal article

Baggaley AE, Lafaurie GBRC, Tate SJ, Boshier PR, Case A, Prosser S, Torkington J, Jones SEF, Gwynne SH, Peters CJet al., 2023, Pressurized intraperitoneal aerosol chemotherapy (PIPAC): updated systematic review using the IDEAL framework, British Journal of Surgery, Vol: 110, Pages: 10-18, ISSN: 0007-1323

Journal article

Mitra A, Choi S, Boshier P, Razumovskaya-Hough A, Belluomo I, Spanel P, Hanna Get al., 2022, The human skin volatolome: a systematic review of untargeted mass spectrometry analysis, Metabolites, Vol: 12, Pages: 1-18, ISSN: 2218-1989

The analysis of volatile organic compounds (VOCs) can provide important clinical information (entirely non-invasively); however, the exact extent to which VOCs from human skin can be signatures of health and disease is unknown. This systematic review summarises the published literature concerning the methodology, application, and volatile profiles of skin VOC studies. An online literature search was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis, to identify human skin VOC studies using untargeted mass spectrometry (MS) methods. The principal outcome was chemically verified VOCs detected from the skin. Each VOC was cross-referenced using the CAS number against the Human Metabolome and KEGG databases to evaluate biological origins. A total of 29 studies identified 822 skin VOCs from 935 participants. Skin VOCs were commonly sampled from the hand (n = 9) or forearm (n = 7) using an absorbent patch (n = 15) with analysis by gas chromatography MS (n = 23). Twenty-two studies profiled the skin VOCs of healthy subjects, demonstrating a volatolome consisting of aldehydes (18%), carboxylic acids (12%), alkanes (12%), fatty alcohols (9%), ketones (7%), benzenes and derivatives (6%), alkenes (2%), and menthane monoterpenoids (2%). Of the VOCs identified, 13% had putative endogenous origins, 46% had tentative exogenous origins, and 40% were metabolites from mixed metabolic pathways. This review has comprehensively profiled the human skin volatolome, demonstrating the presence of a distinct VOC signature of healthy skin, which can be used as a reference for future researchers seeking to unlock the clinical potential of skin volatolomics. As significant proportions of identified VOCs have putative exogenous origins, strategies to minimise their presence through methodological refinements and identifying confounding compounds are discussed.

Journal article

Boshier PR, Klevebro F, Schmidt A, Han S, Jenq W, Puccetti F, Seesing MFJ, Baracos VE, Low DEet al., 2022, Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 5689-5697, ISSN: 1068-9265

Journal article

Boshier PR, Klevebro F, Schmidt A, Han S, Jenq W, Puccetti F, Seesing MFJ, Baracos VE, Low DEet al., 2022, ASO Visual Abstract: Impact of Early Jejunostomy Tube Feeding on Clinical Outcome and Parameters of Body Composition in Esophageal Cancer Patients Receiving Multimodal Therapy, ANNALS OF SURGICAL ONCOLOGY, Vol: 29, Pages: 5698-5698, ISSN: 1068-9265

Journal article

Boshier PR, Swaray A, Vadhwana B, O'Sullivan A, Low DE, Hanna GB, Peters CJ, POEM Biomarkers Consortium and OCCAMS Consortiumet al., 2022, Systematic review and validation of clinical models predicting survival after oesophagectomy for adenocarcinoma, British Journal of Surgery, Vol: 109, Pages: 418-425, ISSN: 0007-1323

BACKGROUND: Oesophageal adenocarcinoma poses a significant global health burden, yet the staging used to predict survival has limited ability to stratify patients by outcome. This study aimed to identify published clinical models that predict survival in oesophageal adenocarcinoma and to evaluate them using an independent international multicentre dataset. METHODS: A systematic literature search (title and abstract) using the Ovid Embase and MEDLINE databases (from 1947 to 11 July 2020) was performed. Inclusion criteria were studies that developed or validated a clinical prognostication model to predict either overall or disease-specific survival in patients with oesophageal adenocarcinoma undergoing surgical treatment with curative intent. Published models were validated using an independent dataset of 2450 patients who underwent oesophagectomy for oesophageal adenocarcinoma with curative intent. RESULTS: Seventeen articles were eligible for inclusion in the study. Eleven models were suitable for testing in the independent validation dataset and nine of these were able to stratify patients successfully into groups with significantly different survival outcomes. Area under the receiver operating characteristic curves for individual survival prediction models ranged from 0.658 to 0.705, suggesting poor-to-fair accuracy. CONCLUSION: This study highlights the need to concentrate on robust methodologies and improved, independent, validation, to increase the likelihood of clinical adoption of survival predictions models.

Journal article

Robb H, Scrimgeour G, Boshier P, Przedlacka A, Balyasnikova S, Brown G, Bello F, Kontovounisios Cet al., 2022, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 36, Pages: 5907-5920, ISSN: 0930-2794

Background3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption. Therefore, the authors undertook a scoping review to clarify the current and future roles of 3D modelling in oesophagogastric surgery, highlighting gaps in the literature and implications for future research.MethodsA scoping review protocol was developed using a comprehensive search strategy based on internationally accepted guidelines and tailored for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). This is available through the Open Science Framework (osf.io/ta789) and was published in a peer-reviewed journal. Included studies underwent screening and full text review before inclusion. A thematic analysis was performed using pre-determined overarching themes: (i) surgical training and education, (ii) patient education and engagement, and (iii) operative planning and surgical practice. Where applicable, subthemes were generated.ResultsA total of 56 papers were included. Most research was low-grade with 88% (n = 49) of publications at or below level III evidence. No randomised control trials or systematic reviews were found. Most literature (86%, n = 48) explored 3D reconstruction within operative planning. These were divided into subthemes of pre-operative (77%, n = 43) and intra-operative guidance (9%, n = 5). Few papers reported on surgical training and education (14%, n = 8), and were evenly subcategorised into virtual reality simulation (7%, n = 4) and anatomical teaching (7%, n = 4). No studies utilising 3D modelling for patient engagement and education were found.ConclusionThe use

Journal article

Antonowicz S, Abbassi-Ghadi N, Bodai Z, Wiggins T, Markar S, Boshier P, Goh YM, Adam M, Lu H, Kudo H, Rosini F, Goldin R, Moralli D, Green C, Peters C, Habib N, Gabra H, Fitzgerald R, Takats Z, Hanna Get al., 2021, The smell of oesophageal adenocarcinoma: opportunities for tests and treatments, UGI Congress, Publisher: OXFORD UNIV PRESS, ISSN: 0007-1323

Conference paper

Boshier PR, Klevebro F, Jenq W, Puccetti F, Muthuswamy K, Hanna GB, Low DEet al., 2021, Long-term variation in skeletal muscle and adiposity in patients undergoing esophagectomy, DISEASES OF THE ESOPHAGUS, Vol: 34, ISSN: 1120-8694

Journal article

Savva K-V, Hage L, Belluomo I, Gummet P, Boshier PR, Peters CJet al., 2021, Assessment of the burden of Small Intestinal Bacterial Overgrowth (SIBO) in patients after oesophagogastric (OG) cancer resection, Journal of Gastrointestinal Surgery, Vol: 26, Pages: 924-926, ISSN: 1091-255X

Journal article

Kontovounisios C, 2021, The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol, BMJ Open, Vol: 11, Pages: 1-4, ISSN: 2044-6055

IntroductionThree-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional (2D) medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training as well as patient engagement and education. In comparison to other surgical specialties, oesophagogastric surgery has been slow in their adoption of this technology. Herein the authors outline a scoping review protocol that aims to analyse the current role of 3D modelling in oesophagogastric surgery and highlight any unexplored avenues for future research. Methods and AnalysisThe protocol was generated using internationally accepted methodological frameworks. A succinct primary question was devised, and a comprehensive search strategy developed for key databases (MEDLINE, Embase, Elsevier Scopus and ISI Web of Science). These were searched from their inception to 1/6/2020. Reference lists will be reviewed by hand and grey literature identified using OpenGrey and Grey Literature Report. The protocol was registered to the Open Science Framework (osf.io/ta789). Two independent reviewers will screen titles, abstracts and perform full text reviews for study selection. There will be no methodological quality assessment to ensure a full thematic analysis is possible. A data charting tool will be created by the investigatory team. Results will be analysed to generate descriptive numerical tabular results and a thematic analysis performed. Ethics and Dissemination Ethical approval was not required for the collection and analysis of the published data. The scoping review report will be disseminated through a peer-reviewed publication and international conferences.Registration detailsThe scoping review protocol has been registered on the Open Science Framework (osf.io/ta789)

Journal article

Klevebro F, Boshier PR, Savva K, Waller A, Hage L, Ni M, Hanna GB, Low DEet al., 2021, 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

Belluomo I, Boshier PR, Myridakis A, Vadhwana B, Markar SR, Spanel P, Hanna GBet al., 2021, Selected ion flow tube mass spectrometry for targeted analysis of volatile organic compounds in human breath, NATURE PROTOCOLS, Vol: 16, Pages: 3419-3438, ISSN: 1754-2189

Journal article

Lin G-P, Vadhwana B, Belluomo I, Boshier PR, Spanel P, Hanna GBet al., 2021, Cross Platform Analysis of Volatile Organic Compounds Using Selected Ion Flow Tube and Proton-Transfer-Reaction Mass Spectrometry, JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY, Vol: 32, Pages: 1215-1223, ISSN: 1044-0305

Journal article

Woodfield G, Belluomo I, Boshier PR, Waller A, Fayyad M, von Wagner C, Cross AJ, Hanna GBet al., 2021, Feasibility and acceptability of breath research in primary care: a prospective, cross-sectional, observational study, BMJ Open, Vol: 11, Pages: 1-10, ISSN: 2044-6055

Objectives To examine the feasibility and acceptability of breath research in primary care.Design Non-randomised, prospective, mixed-methods cross-sectional observational study.Setting Twenty-six urban primary care practices.Participants 1002 patients aged 18–90 years with gastrointestinal symptoms.Main outcome measures During the first 6 months of the study (phase 1), feasibility of patient enrolment using face-to-face, telephone or SMS-messaging (Short Message Service) enrolment strategies, as well as processes for breath testing at local primary care practices, were evaluated. A mixed-method iterative study design was adopted and outcomes evaluated using weekly Plan-Do-Study-Act cycles, focus groups and general practitioner (GP) questionnaires.During the second 6 months of the study (phase 2), patient and GP acceptability of the breath test and testing process was assessed using questionnaires. In addition a ‘single practice’ recruitment model was compared with a ‘hub and spoke’ centralised recruitment model with regards to enrolment ability and patient acceptability.Throughout the study feasibility of the collection of a large number of breath samples by clinical staff over multiple study sites was evaluated and quantified by the analysis of these samples using mass spectrometry.Results 1002 patients were recruited within 192 sampling days. Both ‘single practice’ and ‘hub and spoke’ recruitment models were effective with an average of 5.3 and 4.3 patients accrued per day, respectively. The ‘hub and spoke’ model with SMS messaging was the most efficient combined method of patient accrual. Acceptability of the test was high among both patients and GPs. The methodology for collection, handling and analysis of breath samples was effective, with 95% of samples meeting quality criteria.Conclusions Large-scale breath testing in primary care was feasible and acceptable. This study provides a practical fra

Journal article

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

Antonowicz S, Bodai Z, Wiggins T, Markar SR, Boshier PR, Goh YM, Adam ME, Lu H, Kudo H, Rosini F, Goldin R, Moralli D, Green CM, Peters CJ, Habib N, Gabra H, Fitzgerald RC, Takats Z, Hanna GBet al., 2021, Endogenous aldehyde accumulation generates genotoxicity and exhaled biomarkers in esophageal adenocarcinoma, Nature Communications, Vol: 12, ISSN: 2041-1723

Volatile aldehydes are enriched in esophageal adenocarcinoma (EAC) patients’ breath and could improve early diagnosis, however the mechanisms of their production are unknown. Here, we show that weak aldehyde detoxification characterizes EAC, which is sufficient to cause endogenous aldehyde accumulation in vitro. Two aldehyde groups are significantly enriched in EAC biopsies and adjacent tissue: (i) short-chain alkanals, and (ii) medium-chain alkanals, including decanal. The short-chain alkanals form DNA-adducts, which demonstrates genotoxicity and confirms inadequate detoxification. Metformin, a putative aldehyde scavenger, reduces this toxicity. Tissue and breath concentrations of the medium-chain alkanal decanal are correlated, and increased decanal is linked to reduced ALDH3A2 expression, TP53 deletion, and adverse clinical features. Thus, we present a model for increased exhaled aldehydes based on endogenous accumulation from reduced detoxification, which also causes therapeutically actionable genotoxicity. These results support EAC early diagnosis trials using exhaled aldehyde analysis.

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

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

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

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

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