75 results on '"J Shenfine"'
Search Results
2. Multicentre factorial randomized clinical trial of perioperative immunonutrition versus standard nutrition for patients undergoing surgical resection of oesophageal cancer
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L A Mudge, D I Watson, B M Smithers, E A Isenring, L Smith, G G Jamieson, A Aly, S Archer, M Ballal, J Barbon, A Barbour, K Benton, J Bessell, M Bond, Melissa Berryman, T Bright, R Cade, A Cardamis, R Carroll, K Cashman, L Chan, B Chapman, S Chapman, D Chen, J Chisholm, W Davidson, P Devitt, C Dong, R Doola, S Edwards, K Epari, M Farley, J Farrow, M Ferguson, D Fletcher, K Forbes, K Fullerton, P Game, S Gan, D Gotley, B Gout, J Gray, S Heaney, M A Johnson, M Johnstone, S Kariyawasam, J Karnon, A Kelaart, L Kellett, E Kennedy, R Krane, S Lemass, R Lindstrom-Sowman, J Loeliger, A Lord, John Ludbrook, C McFarlane, M McPhee, S Y-X Ooi, L Pearce, K Pettigrew, E Putrus, G Rassias, A Shanks, J Shenfine, E L Smith, J Singleton, J Spillane, L Sputore, B Steer, T Sullivan, L Teleni, D Tolcher, J Thomas, S Thompson, T Thorpe, C Watterson, V Wills, A Wilton, K Wright, and T Wright
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Male ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Adenocarcinoma ,Preoperative care ,Perioperative Care ,law.invention ,03 medical and health sciences ,Enteral Nutrition ,Postoperative Complications ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,medicine ,Humans ,Prospective Studies ,Elective surgery ,Prospective cohort study ,Aged ,Intention-to-treat analysis ,business.industry ,Incidence ,Perioperative ,Middle Aged ,Intention to Treat Analysis ,Surgery ,Esophagectomy ,Treatment Outcome ,Parenteral nutrition ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,030211 gastroenterology & hepatology ,Immunotherapy ,business ,Follow-Up Studies - Abstract
Background Preoperative immunonutrition has been proposed to reduce the duration of hospital stay and infective complications following major elective surgery in patients with gastrointestinal malignancy. A multicentre 2 × 2 factorial RCT was conducted to determine the impact of preoperative and postoperative immunonutrition versus standard nutrition in patients with oesophageal cancer. Methods Patients were randomized before oesophagectomy to immunonutrition (IMPACT®) versus standard isocaloric/isonitrogenous nutrition, then further randomized after operation to immunonutrition versus standard nutrition. Clinical and quality-of-life outcomes were assessed at 14 and 42 days after operation on an intention-to-treat basis. The primary outcome was the occurrence of infective complications. Secondary outcomes were other complications, duration of hospital stay, mortality, nutritional and quality-of-life outcomes (EuroQol EQ-5D-3 L™, European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-OES18). Patients and investigators were blinded until the completion of data analysis. Results Some 278 patients from 11 Australian sites were randomized; two were excluded and data from 276 were analysed. The incidence of infective complications was similar for all groups (37 per cent in perioperative standard nutrition group, 51 per cent in perioperative immunonutrition group, 34 per cent in preoperative immunonutrition group and 40 per cent in postoperative immunonutrition group; P = 0·187). There were no significant differences in any other clinical or quality-of-life outcomes. Conclusion Use of immunonutrition before and/or after surgery provided no benefit over standard nutrition in patients undergoing oesophagectomy. Registration number: ACTRN12611000178943 (https://www.anzctr.org.au).
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- 2018
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3. Low impact
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SJD Harley, TA Eldredge, LR Warren, and J Shenfine
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General Medicine - Abstract
Junior surgeons’ perceptions of their own research
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- 2019
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4. Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review
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S. M. Griffin, J. Shenfine, and L. J. Dunn
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Gastroenterology ,Reflux ,General Medicine ,medicine.disease ,digestive system diseases ,surgical procedures, operative ,medicine.anatomical_structure ,Esophagectomy ,Internal medicine ,Barrett's esophagus ,Metaplasia ,medicine ,Columnar Metaplasia ,Adenocarcinoma ,Esophagus ,Risk factor ,medicine.symptom ,business - Abstract
Barrett's metaplasia is a well-recognized risk factor for esophageal adenocarcinoma. It is believed to develop in response to the injurious effects of gastroesophageal reflux. Following subtotal esophagectomy and reconstruction with a gastric conduit, many patients experience profound reflux into the remnant esophagus. Barrett's-like epithelium has been described in these patients, and they have been identified as a potential human model in which to study the early events in the development of metaplasia. This phenomenon also raises clinical concerns about the long-term fate of the esophageal remnant following surgery and the potential for further malignant change. This systematic review summarizes the literature on the prevalence and timing of Barrett's metaplasia occurring after esophagectomy, reviews the evidence regarding risk factors and malignant progression in such patients, and considers the implications for clinical practice.
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- 2013
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5. A Randomized Controlled Clinical Trial of Palliative Therapies for Patients With Inoperable Esophageal Cancer
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S. Michael Griffin, Paul McNamee, Nick Steen, J. Shenfine, and John H. Bond
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Male ,medicine.medical_specialty ,Time Factors ,Esophageal Neoplasms ,Cost effectiveness ,Critical Illness ,Decision Making ,Kaplan-Meier Estimate ,Risk Assessment ,Severity of Illness Index ,Statistics, Nonparametric ,Catheterization ,law.invention ,Randomized controlled trial ,law ,Cause of Death ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Confidence Intervals ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,Prospective cohort study ,Geriatric Assessment ,Aged ,Probability ,Aged, 80 and over ,Evidence-Based Medicine ,Hepatology ,business.industry ,Esophageal disease ,Palliative Care ,Gastroenterology ,Cancer ,Esophageal cancer ,medicine.disease ,Survival Analysis ,Surgery ,Clinical trial ,Treatment Outcome ,Quality of Life ,Female ,Stents ,Deglutition Disorders ,business - Abstract
A dramatic rise in incidence, an aging population, and expensive palliative treatments have led to an escalating burden on clinicians managing inoperable esophageal cancer with only limited evidence of effectiveness. This study compares the clinical effectiveness and cost-effectiveness of self-expanding metal stents (SEMSs) with other palliative therapies to aid clinicians in making an evidence-based treatment choice.We conducted a prospective, multicenter, randomized, controlled, clinical trial with 215 patients followed until death or study closure. The primary outcome measures were dysphagia, quality of life (QL) 6 weeks following treatment, and total cost of treatment. Secondary outcome measures included treatment-associated morbidity, mortality, survival, and cost-effectiveness. An intention-to-treat analysis was carried out.There was a significant difference in mean dysphagia grade between treatment arms 6 weeks following treatment (P=0.046), with worse swallowing reported by rigid stent-treated patients (mean dysphagia score difference=-0.49; 95% confidence interval (CI) -0.10 to -0.89, P=0.014). Global QL scores were lower at both 1 and 6 weeks following treatment for patients treated by SEMSs (mean difference QL index week 1=-0.66; 95% CI: -0.02 to -1.30, P=0.04; mean difference QL index week 6=-1.01; 95% CI -0.30 to -1.72, P=0.006). These findings were associated with higher post-procedure pain scores in the SEMS patient group (mean difference of the European Organisation for Research and Treatment of Cancer QLQ C-30 pain symptom score at week 1=11.13; 95% CI: 2.89-19.4; P=0.01). Although mean EQ-5D QL values differed between the treatments (P0.001), this difference dissipated following generation of quality-adjusted life year values. Total costs varied between treatment arms but these findings canceled out when SEMSs were compared with non-SEMS therapies (95% CI -845.15-1,332.62). These results were robust to sensitivity analysis. There were no differences in the in-hospital mortality or early complication rates, but late complications were more frequent after rigid stenting (risk ratio=2.47; 95% CI 1.88-3.04). There was a survival advantage for non-stent-treated patients (log-rank statistic=4.21, P=0.04).The treatment choice for patients with inoperable esophageal cancer should be between a SEMS or a non-stent treatment after consideration has been given to both patient and tumor characteristics and clinician and patient preferences.
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- 2009
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6. Spontaneous rupture of the oesophagus
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Nick Hayes, DL Richardson, Dayalan Karat, Peter J. Lamb, J Shenfine, and S. M. Griffin
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Adult ,Male ,Spontaneous rupture ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Contrast Media ,Esophageal Diseases ,Nasogastric Decompression ,medicine ,Humans ,Hospital Mortality ,Prospective Studies ,Thoracotomy ,Esophagus ,Prospective cohort study ,Aged ,Aged, 80 and over ,Rupture, Spontaneous ,medicine.diagnostic_test ,business.industry ,Length of Stay ,Middle Aged ,Surgery ,Endoscopy ,Early Diagnosis ,Treatment Outcome ,medicine.anatomical_structure ,Parenteral nutrition ,Radiological weapon ,Drainage ,Female ,Tomography, X-Ray Computed ,business - Abstract
Background The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. Methods Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a non-operative approach, whereas the remainder underwent thoracotomy. Results The median time to diagnosis was 24 (range 4–604) h. Initial diagnosis was by contrast swallow in 18 of 24 patients, computed tomography in 15 of 17 and endoscopy in 18 of 18. There were no deaths among 17 patients who were managed non-operatively with targeted drainage, intravenous antimicrobials, nasogastric decompression and enteral nutrition. Of 31 patients who underwent primary thoracotomy and oesophageal repair (over a Τ tube in 29), 11 died in hospital. Three patients could not be resuscitated adequately and did not have surgical intervention. Conclusion Spontaneous oesophageal rupture represents a spectrum of disease. Accurate radiological and endoscopic evaluation can identify those suitable for radical non-operative treatment and those who require thoracotomy.
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- 2008
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7. Chained time trade-off and standard gamble methods
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Nick Steen, S. Michael Griffin, Sharon Glendinning, J Shenfine, John Bond, and Paul McNamee
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medicine.medical_specialty ,Health economics ,Actuarial science ,business.industry ,Health Policy ,Public health ,Economics, Econometrics and Finance (miscellaneous) ,Cancer ,Context (language use) ,medicine.disease ,Time-trade-off ,humanities ,Quality of life (healthcare) ,medicine ,Standard gamble ,Operations management ,business ,Health state valuation - Abstract
It may be difficult to value palliative health states using health state valuation methods such as the time trade-off (TTO) and standard gamble (SG) where health states are traditionally valued relative to perfect/good health and death. Chained methods have been developed to help in this context. However, few studies have compared the values produced by chained TTO and SG methods. To address this issue, a study was conducted to measure the health state values associated with oesophageal cancer using chained TTO and SG techniques. The methods were found to be acceptable amongst the sample respondents, who had previously been treated for oesophageal cancer. There were no significant differences between the health state values produced by the TTO and the SG methods. Within each method, however, there were significant differences between the health states valued. It is concluded that the use of health state valuation techniques such as the TTO and SG is feasible amongst people with a history of oesophageal cancer.
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- 2004
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8. Posters—Upper GI 41–60
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S. M. Griffin, Nick Steen, John H. Bond, Paul McNamee, S Glendinning, and J Shenfine
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medicine.medical_specialty ,Randomized controlled trial ,Cost effectiveness ,business.industry ,law ,medicine ,Cancer ,Surgery ,medicine.disease ,business ,Intensive care medicine ,law.invention - Published
- 2004
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9. Measuring quality of life and utilities in esophageal cancer
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John Bond, J Shenfine, and Paul McNamee
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Gerontology ,Health economics ,Palliative care ,business.industry ,Health Policy ,Mortality rate ,General Medicine ,Esophageal cancer ,medicine.disease ,Health outcomes ,Outcome (game theory) ,Quality of life (healthcare) ,Medicine ,Pharmacology (medical) ,business - Abstract
For many years indicators such as mortality rates, levels of morbidity and cure measured the success of treatments for esophageal cancer. However, it is now recognised that quality of life (QOL) is an important measure of outcome. This is especially so for esophageal cancer, where the therapeutic options include curative treatments or palliative care. A number of measures have been developed but few QOL studies have been conducted in esophageal cancer. A health economics approach to outcome measurement, that seeks to quantify individual preferences (or utilities), offers a number of advantages. However, it is important to recognize that these methods are still under development. Nevertheless, by seeking to measure the strength of individual preferences, utilities provide additional information for decisions regarding which treatments provide the most optimal outcomes.
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- 2003
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10. Oesophagus Posters
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S. M. Griffin, SM Davies, Nick Hayes, J Shenfine, Peter J. Lamb, and S. M. Dresner
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Clinical Practice ,medicine.medical_specialty ,business.industry ,General surgery ,Gastroenterology ,medicine ,Oesophageal carcinoma ,Audit ,business - Published
- 2001
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11. Prognostic significance of peri-operative blood transfusion following radical resection for oesophageal carcinoma
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J Shenfine, Nick Hayes, S. M. Griffin, S. M. Dresner, and Peter J. Lamb
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Adult ,Male ,medicine.medical_specialty ,Blood transfusion ,Esophageal Neoplasms ,medicine.medical_treatment ,Adenocarcinoma ,Perioperative Care ,Predictive Value of Tests ,Risk Factors ,Immune Tolerance ,medicine ,Carcinoma ,Humans ,Survival analysis ,Aged ,Retrospective Studies ,business.industry ,Transfusion Reaction ,Retrospective cohort study ,General Medicine ,Perioperative ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Surgery ,Squamous carcinoma ,Esophagectomy ,Treatment Outcome ,Oncology ,Carcinoma, Squamous Cell ,Lymph Node Excision ,Female ,Lymphadenectomy ,business ,Immunocompetence - Abstract
Introduction: Peri-operative allogeneic blood transfusion may exert an immunomodulatory effect and has been associated with early recurrence and decreased survival following resection for several gastro-intestinal malignancies. The aim of this study was to evaluate the prognostic influence of transfusion requirements following radical oesophagectomy for cancer. Methods: A consecutive series of 235 patients undergoing subtotal oesophagectomy with two-field lymphadenectomy in a single centre from April 1990 to June 1999 were studied. Results: The median age was 64 years (30–79) with a male to female ratio of 3:1. The predominant histological subtype was adenocarcinoma (n=154) compared to squamous carcinoma (n=81). To avoid the influence of surgical complications data were excluded from the 5.5% of patients suffering in-hospital mortality. In the remaining patients, median blood loss was 900 ml (200–5500) with 46% (103/222) requiring transfusion (median 3 units, range 2–21). Median survival of non-transfused patients was 36 months compared to only 19 months for those receiving transfusion (log-rank=4.44; 1 df, P=0.0352). Non-transfused patients had significantly higher 2 and 5-year survival rates of 62% and 41% respectively in contrast to only 40% and 25% in those receiving blood transfusion. Even after stratification of results according to disease stage or the presence of major complications, survival was significantly worse in those receiving transfusion. Multivariate analysis demonstrated that in addition to nodal status, >4 units transfusion was an independent prognostic indicator.Conclusion: Post-operative transfusion is associated with a significantly worse prognosis following radical oesophagectomy. Meticulous haemostasis and avoidance of unnecessary transfusion may prove oncologically beneficial.
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- 2000
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12. A Call for Standardization of Antireflux Surgery in the Lung Transplantation Population
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Jeffrey P. Pearson, PA Corris, J. Shenfine, JH Dark, Andrew G.N. Robertson, Chris Ward, and M Griffin
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medicine.medical_specialty ,medicine.medical_treatment ,Population ,Bronchiolitis obliterans ,Disease ,Humans ,Medicine ,Lung transplantation ,Survivors ,Risk factor ,education ,Bronchiolitis Obliterans ,Survival rate ,Transplantation ,education.field_of_study ,Lung ,business.industry ,Reproducibility of Results ,medicine.disease ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Gastroesophageal Reflux ,business ,Follow-Up Studies ,Lung Transplantation - Abstract
Long-term survival post lung transplant is reduced significantly by Bronchiolitis Obliterans Syndrome. It is suggested that extra-esophageal reflux disease is a risk factor for Bronchiolitis Obliterans Syndrome and that antireflux surgery may be beneficial. However, practice between centers varies greatly. We suggest a need for improved evidence and standardization.
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- 2009
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13. Cytokeratin expression in breast cancer: Phenotypic changes associated with disease progression
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J. Shenfine, L.A. Webb, D. A. Browell, Mark White, L.G. Lunt, W.J. Cunliffe, Brian K. Shenton, C.N. Robson, I Brotherick, J.R. Young, MJ Higgs, and M. Egan
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Messenger RNA ,medicine.diagnostic_test ,Biophysics ,Cancer ,Cell Biology ,Hematology ,Biology ,medicine.disease ,Molecular biology ,Pathology and Forensic Medicine ,Flow cytometry ,Cytokeratin ,Endocrinology ,Breast cancer ,Tumor progression ,medicine ,Cancer research ,Keratin 8 ,Cytometry - Abstract
Transition from a normal to a cancerous state is marked by alterations in the cytoskeletal structure of those cells involved. We have examined such changes to determine if these transitions are markers of disease progression. Cytokeratin (CK) protein and messenger RNA (mRNA) expression were examined in malignant and benign breast tissues. Flow cytometric results demonstrated a significant correlation between cytokeratin protein expression detected by 5D3 antibody, specific for cytokeratins 8, 18, and 19 and axillary node metastasis (P = 0.01). A threshold of positivity of 338,000 molecules/cell was determined and reflected the wide range in cytokeratin levels expressed by normal or benign tissues. Examination of cytokeratins 8, 18, and 19 revealed a consistent pattern of expression with respect to tumor grade. Only cytokeratin 19 showed significant correlation with increasing tumor size (P = 0.006). mRNA expression for cytokeratin 8 was significantly higher in node-positive compared with node-negative disease (P = 0.02). Cytokeratin 18 mRNA levels were significantly lower in both node-negative (P = 0.03) and node-positive (P = 0.02) patients when compared with benign samples. Increased levels of cytokeratin 18 mRNA showed an inverse relationship with protein expression (P = 0.05). The results indicate that cytokeratin expression in breast cancer may be associated with tumor progression. Furthermore, the alteration in the expression of individual cytokeratins deserves further investigation to determine the consequences of these changes with respect to cellular function. Cytometry 32:301–308, 1998. © 1998 Wiley-Liss, Inc.
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- 1998
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14. Columnar metaplasia in the esophageal remnant after esophagectomy: a systematic review
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L J, Dunn, J, Shenfine, and S M, Griffin
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Esophagectomy ,Barrett Esophagus ,Metaplasia ,Esophagus ,Esophageal Neoplasms ,Humans ,Adenocarcinoma - Abstract
Barrett's metaplasia is a well-recognized risk factor for esophageal adenocarcinoma. It is believed to develop in response to the injurious effects of gastroesophageal reflux. Following subtotal esophagectomy and reconstruction with a gastric conduit, many patients experience profound reflux into the remnant esophagus. Barrett's-like epithelium has been described in these patients, and they have been identified as a potential human model in which to study the early events in the development of metaplasia. This phenomenon also raises clinical concerns about the long-term fate of the esophageal remnant following surgery and the potential for further malignant change. This systematic review summarizes the literature on the prevalence and timing of Barrett's metaplasia occurring after esophagectomy, reviews the evidence regarding risk factors and malignant progression in such patients, and considers the implications for clinical practice.
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- 2013
15. Colorectal surgery, appendix, and small bowel
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A. K. Agarwal, J. Shenfine, H. El-Khalifa, and David J. Leaper
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Fissure-in-ano 226Haemorrhoids 228Fistula-in-ano 234Pilonidal sinus 238Rectal prolapse 240Acute anorectal infection (abscess) 244Appendicectomy 246Excision of Meckel's diverticulum 252Ileostomy 254Colostomy 260Bowel resection and anastomosis 264Right hemicolectomy 270Left hemicolectomy 274Transverse colectomy 280Sigmoid colectomy 282...
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- 2011
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16. Anti-reflux surgery in lung transplant recipients: outcomes and effects on quality of life
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J.H. Dark, S. M. Griffin, J. Shenfine, Paul A. Corris, Dayalan Karat, Chris Ward, A Krishnan, Jeffrey P. Pearson, Andrew G.N. Robertson, and T Small
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Fundoplication ,Nissen fundoplication ,Pulmonary function testing ,Body Mass Index ,Patient satisfaction ,Quality of life ,Surveys and Questionnaires ,medicine ,Lung transplantation ,Humans ,Prospective Studies ,Prospective cohort study ,Laparoscopy ,Lung ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Surgery ,Respiratory Function Tests ,Treatment Outcome ,Patient Satisfaction ,Gastroesophageal Reflux ,Quality of Life ,Female ,business ,Body mass index ,Lung Transplantation - Abstract
Fundoplication may improve survival after lung transplantation. Little is known about the effects of fundoplication on quality of life in these patients. The aim of this study was to assess the safety of fundoplication in lung transplant recipients and its effects on quality of life. Between June 1, 2008 and December 31, 2010, a prospective study of lung transplant recipients undergoing fundoplication was undertaken. Quality of life was assessed before and after surgery. Body mass index (BMI) and pulmonary function were followed up. 16 patients, mean ± sd age 38 ± 11.9 yrs, underwent laparoscopic Nissen fundoplication. There was no peri-operative mortality or major complications. Mean ± SD hospital stay was 2.6 ± 0.9 days. 15 out of 16 patients were satisfied with the results of surgery post fundoplication. There was a significant improvement in reflux symptom index and DeMeester questionnaires and gastrointestinal quality of life index scores at 6 months. Mean BMI decreased significantly after fundoplication (p = 0.01). Patients operated on for deteriorating lung function had a statistically significant decrease in the rate of lung function decline after fundoplication (p = 0.008). Laparoscopic fundoplication is safe in selected lung transplant recipients. Patient benefit is suggested by improved symptoms and satisfaction. This procedure is acceptable, improves quality of life and may reduce deterioration of lung function.
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- 2011
17. Combined percutaneous-endoscopic management of a perforated esophagus: A novel technique
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S. Michael Griffin, Nick Hayes, DL Richardson, and J Shenfine
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Male ,Novel technique ,medicine.medical_specialty ,Percutaneous ,Perforation (oil well) ,Endoscopic management ,Esophageal Fistula ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Esophagus ,Esophageal Perforation ,medicine.diagnostic_test ,Esophageal disease ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Surgery ,Endoscopy ,medicine.anatomical_structure ,Fluoroscopy ,Female ,Esophagoscopy ,Presentation (obstetrics) ,business - Abstract
Surgery has been the mainstay of treatment for spontaneous full-thickness rupture of the esophagus for the last 50 years. In an acute presentation with contamination of the mediastinal or pleural cavities, this remains the definitive course of action. However, the management when diagnosis has been delayed is more contentious. This is a description of a novel approach with a combined percutaneousendoscopic technique that was used in 2 such cases.
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- 2001
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18. Prognostic value of maximum standardized uptake values from preoperative positron emission tomography in resectable adenocarcinoma of the esophagus treated by surgery alone
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Bernard Mark Smithers, Andrew Barbour, David C. Gotley, Janine Thomas, J. Shenfine, Ian Martin, and David Wong
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Adult ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Population ,Standardized uptake value ,Adenocarcinoma ,Preoperative care ,Disease-Free Survival ,Fluorodeoxyglucose F18 ,medicine ,Humans ,education ,Neoadjuvant therapy ,Cancer staging ,Aged ,Aged, 80 and over ,Univariate analysis ,education.field_of_study ,business.industry ,Gastroenterology ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Surgery ,Esophagectomy ,Positron-Emission Tomography ,Multivariate Analysis ,Preoperative Period ,Esophagogastric Junction ,Radiopharmaceuticals ,business - Abstract
Preoperative staging for esophageal adenocarcinoma is suboptimal for predicting outcomes when compared with pathological data. The aim of this study was to assess if the quantitative values obtained by preoperative 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are independent prognostic indicators for survival in patients with resectable adenocarcinoma of the esophagus undergoing surgical treatment without neoadjuvant therapy. Patients were identified from a prospective database, survival analyses were undertaken using log rank and Cox method. The median follow-up was 44 months (range 18-61 months). Between November 2002 and November 2005, 45 consecutive patients underwent FDG-PET followed by surgery. The median age was 72 years (range 38-82 years). On univariate analysis of overall survival and disease-free survival, preoperative FDG-PET maximum standardized uptake value (SUV(max); P= 0.008 and P= 0.015, respectively) and postoperative pathological stage (P= 0.001 and P= 0.001, respectively) as well as postoperative histological grade (P= 0.001 and P= 0.001, respectively) were significantly associated with outcome. Multivariate analysis demonstrated that only the postoperative pathological variables were independent predictors of outcome (Wald 11.81, P= 0.001). Preoperative FDG-PET SUV(max) is associated with outcome after esophageal adenocarcinoma resection but remains less accurate than postoperative variables. A high FDG-PET SUV(max) could be used to identify a high-risk population who would benefit most from neoadjuvant therapies.
- Published
- 2009
19. Thoracic vertebral osteomyelitis secondary to chronic esophageal perforation
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Michael J. Gibson, Palaniappan Lakshmanan, S. Michael Griffin, Loveena Sreedharan, and J Shenfine
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medicine.medical_specialty ,medicine.medical_treatment ,Perforation (oil well) ,Thoracic Vertebrae ,Esophagus ,Back pain ,medicine ,Vertebral osteomyelitis ,Humans ,Orthopedics and Sports Medicine ,Endoscopy, Digestive System ,Esophageal Perforation ,business.industry ,Osteomyelitis ,Middle Aged ,medicine.disease ,Dysphagia ,Magnetic Resonance Imaging ,Surgery ,medicine.anatomical_structure ,Spinal Fusion ,Spinal fusion ,Thoracic vertebrae ,Chronic Disease ,Female ,Neurology (clinical) ,Radiology ,medicine.symptom ,business - Abstract
Background Context Osteomyelitis secondary to perforation of the esophagus is a rare condition. Thoracic osteomyelitis after chronic esophageal perforation has never been described in the literature. Purpose We report a case of vertebral osteomyelitis resulting from a chronic esophageal perforation. Study Design/Setting Case report/University hospital. Methods A 52-year-old woman presented with dysphagia, severe mid back, and epigastric pain over a 6-week period. Endoscopic and radiological investigations revealed the presence of a paraspinal inflammatory mass protruding into the posterior esophageal wall. Two weeks after admission, the patient developed septic complications which required surgical intervention. This revealed the presence of an esophageal perforation and osteomyelitis of the T4–T5 and T7–T8 vertebrae. After T-tube closure of the esophageal perforation along with surgical debridement of the vertebrae and a 6-week course of antibiotics, the patient made a sound recovery. However, there was persistence of back pain with exaggerated thoracic spine kyphosis at T7–T8 which needed thoracic spine stabilization with pedicle screw instrumentation and fusion. Results This treatment led to complete recovery with no recurrence of symptoms at 8-months' follow-up. Conclusions To date this is the first case of thoracic osteomyelitis secondary to a chronic esophageal perforation to be reported in the literature. A high index of suspicion of this diagnosis is warranted in patients who present with similar clinical and radiological findings to enable prompt diagnosis and avoid the high mortality of esophageal perforation.
- Published
- 2007
20. Lichen planus in the oesophagus: are we missing something?
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Preston and J Shenfine
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Pathology ,medicine.medical_specialty ,Esophageal Neoplasms ,Disease ,Esophageal Diseases ,Asymptomatic ,Chromoendoscopy ,stomatognathic system ,medicine ,Humans ,Esophagus ,Stage (cooking) ,skin and connective tissue diseases ,Aged ,integumentary system ,Hepatology ,business.industry ,Gastroenterology ,Lichen Planus ,Cancer ,Middle Aged ,medicine.disease ,Dermatology ,Natural history ,stomatognathic diseases ,medicine.anatomical_structure ,Epidermoid carcinoma ,Carcinoma, Squamous Cell ,Disease Progression ,Female ,medicine.symptom ,business ,Precancerous Conditions - Abstract
Lichen planus of the oesophagus is rare with a predilection for middle-aged to elderly women. There is a potential risk of malignant transformation to squamous cell carcinoma. Squamous cell carcinoma of the oesophagus still accounts for 30-40% of oesophageal cancer cases in the west and is almost exclusively the disease still encountered in the rest of the world. An increased awareness of oesophageal lichen planus is suggested in patients with cutaneous, oral or vulval disease. Endoscopic investigation of patients with lichen planus, possibly initially limited to those with oesophageal symptoms, and consideration of surveillance in patients with proven oesophageal lichen planus, will aid understanding of natural history of lesions and may help detect early stage tumours. Squamous cell carcinoma still accounts for 30-40% of oesophageal cancer cases in the west and is almost exclusively the disease still encountered elsewhere. Lichen planus of the oesophagus is potentially a premalignant condition for squamous cell carcinoma that could be surveilled in order to detect early-stage tumours with a consequent greater chance of cure. Oesophageal lichen planus is, however, rare, frequently asymptomatic and although the majority of cases occur in conjunction with lichen planus in other sites, the oesophageal features may be subtle and easily missed by endoscopic assessment. Furthermore, the histological changes are difficult to interpret and there may be significant underreporting. As a consequence, the true prevalence of these lesions is hard to determine. The difficulties in detection may mean that we are underestimating the frequency of oesophageal lichen planus. Endoscopic detection may be aided by the use of magnification indigo carmine chromoendoscopy and this warrants further evaluation. The risk of malignant transformation is currently unknown but may parallel that of oral lesions at approximately 1-3%. An increased awareness of the condition can only help to identify more cases and increase our understanding of this interesting condition.
- Published
- 2006
21. A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer
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John H. Bond, S. M. Griffin, Paul McNamee, J Shenfine, and Nick Steen
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Male ,medicine.medical_specialty ,lcsh:Medical technology ,Esophageal Neoplasms ,Cost effectiveness ,Cost-Benefit Analysis ,Psychological intervention ,State Medicine ,law.invention ,Randomized controlled trial ,Swallowing ,Quality of life ,law ,Humans ,Medicine ,Intensive care medicine ,Aged ,Aged, 80 and over ,business.industry ,Health Policy ,Palliative Care ,Middle Aged ,Dysphagia ,United Kingdom ,Quality-adjusted life year ,Clinical trial ,lcsh:R855-855.5 ,Female ,Quality-Adjusted Life Years ,medicine.symptom ,business - Abstract
Objectives To compare whether treatment with self-expanding metal stents (SEMS) is more cost-effective than treatment with conventional modalities in patients with inoperable oesophageal cancer. Quality of life effects were also considered. Design A multicentre pragmatic, randomised controlled trial with health economic analysis. Setting Seven NHS hospitals selected to represent a cross-section of UK hospitals in terms of facilities and staffing. Participants All patients attending the centres with oesophageal cancer deemed unsuitable for surgery were assessed for inclusion in the main trial; 217 patients were randomised. A health state utilities substudy was also performed in 71 patients who had previously received curative surgery for oesophageal cancer. Interventions Eligible patients were randomised to one of four treatment groups within two study arms. Assessments were performed at enrolment, 1 week following treatment and thereafter at 6-weekly intervals until death, with prospective data collection on complications and survival. Structured interviews to elicit patient preferences to health states and treatments were performed in a substudy. Main outcome measures Dysphagia grade and quality of life were examined at 6 weeks. Survival, resources consumed from randomisation to death and quality-adjusted life-years were also considered. Results There was no difference in cost or effectiveness between SEMS and non-SEMS therapies, and 18-mm SEMS had equal effectiveness to, but less associated pain than, 24-mm SEMS. Rigid intubation was associated with a worse quality of swallowing and increased late morbidity. Bipolar electrocoagulation and ethanol tumour necrosis were poor in primary palliation. A survival advantage was found for non-stent therapies, but there was a significant delay to treatment. The length of stay accounts for the majority of the cost to the NHS. Patients were found to have distinct individual treatment preferences. Conclusions It was suggested that rigid tubes and 24-mm SEMS should no longer be recommended and bipolar electrocoagulation and ethanol tumour necrosis should not be used for primary palliation. The choice in palliation would between non-stent and 18-mm SEMS treatments, with non-stent therapies being made more available and accessible to reduce delay. A multidisciplinary team approach to palliation is also suggested. A randomised controlled clinical trial of 18-mm SEMS versus non-stent therapies with survival and quality of life end-points would be helpful, as would an audit of palliative patient admissions to determine the reasons and need for inpatient hospital care, with a view to implementing cycle-associated change to reduce inpatient stay. A study of delays in palliative radiotherapy treatment is also suggested, with a view to implementing cycle-associated change to reduce waiting time.
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- 2005
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22. Pattern of recurrence following subtotal oesophagectomy with two field lymphadenectomy
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S M Dresner, J Wayman, J Shenfine, A Harris, N Hayes, and S M Griffin
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Surgery - Abstract
Aims Despite increasingly radical surgery for oesophageal cancer many patients continue to represent with recurrent disease. This study aimed to evaluate the pattern of failure following attempted curative oesophagectomy with mediastinal and upper abdominal lymphadenectomy. Methods Some 212 consecutive patients undergoing R0 resection for malignancy between 1 April 1990 and 1 April 1999 were followed up for evidence of recurrence. Clinical evaluation was supported by ultrasonography, computed tomography, isotope scan, endoscopy and laparotomy with biopsy assessment if appropriate. Patients were excluded if recurrence was diagnosed on clinical grounds alone. Statistical analysis was performed using χ2 and log rank tests. Results Some 142 patients with adenocarcinoma and 70 with squamous carcinoma (SCC) were followed up for a median of 14 (range 1–108) months. Sex and age distribution were similar for both histological subtypes (men: women 3: 1; median age 64 (30–79) years). Twenty patients died from non-cancer related causes, including 11 (5 per cent) from postoperative complications. Some 89 patients (42 per cent) developed proven recurrent disease of which seven are alive and 82 dead. The median time to recurrence was 11 (2–40) months with a median time to death thereafter of 3 (1–21) months. The pattern of recurrence was locoregional in 23 per cent (oesophageal bed 15 per cent, upper abdominal 3 per cent, upper mediastinal 3 per cent, cervical 2 per cent) and haematogenous in 18 per cent (comprising liver 8 per cent, bone 4 per cent, cerebral 3 per cent, lung 2 per cent, skin 1 per cent) with peritoneal dissemination in 1 per cent. While there was no difference in the overall pattern of dissemination for each histological subtype, the incidence of cervical and upper mediastinal recurrence was significantly higher for adenocarcinoma compared with SCC (χ2 = 5·9, 1 d.f., P < 0·02). The timing of recurrence was similar for both histological subtypes: 60 per cent of all recurrence occurred within 12 months of surgery, with distant and locoregional recurrence occurring at a median of 10 (2–40) and 11 (2–32) months respectively. Conclusions The low incidence of upper mediastinal and cervical recurrence suggests that more extensive lymphadenectomy is unlikely to impact upon survival. Improved staging modalities are required to identify the significant number of patients who develop early recurrence in the first year following surgery in order to offer them multimodality therapies of non-surgical palliation.
- Published
- 2000
23. Authors' reply: Spontaneous rupture of the oesophagus (Br J Surg 2008; 95: 1115–1120)
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J Shenfine and S. M. Griffin
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Spontaneous rupture ,medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,business - Published
- 2009
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24. Cytokeratin expression in breast cancer: phenotypic changes associated with disease progression
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I, Brotherick, C N, Robson, D A, Browell, J, Shenfine, M D, White, W J, Cunliffe, B K, Shenton, M, Egan, L A, Webb, L G, Lunt, J R, Young, and M J, Higgs
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Adult ,Aged, 80 and over ,Breast Neoplasms ,Middle Aged ,Blotting, Northern ,Flow Cytometry ,Antibodies ,Gene Expression Regulation, Neoplastic ,Phenotype ,Humans ,Keratins ,Female ,Genetic Testing ,RNA, Messenger ,Aged - Abstract
Transition from a normal to a cancerous state is marked by alterations in the cytoskeletal structure of those cells involved. We have examined such changes to determine if these transitions are markers of disease progression. Cytokeratin (CK) protein and messenger RNA (mRNA) expression were examined in malignant and benign breast tissues. Flow cytometric results demonstrated a significant correlation between cytokeratin protein expression detected by 5D3 antibody, specific for cytokeratins 8, 18, and 19 and axillary node metastasis (P = 0.01). A threshold of positivity of 338,000 molecules/cell was determined and reflected the wide range in cytokeratin levels expressed by normal or benign tissues. Examination of cytokeratins 8, 18, and 19 revealed a consistent pattern of expression with respect to tumor grade. Only cytokeratin 19 showed significant correlation with increasing tumor size (P = 0.006). mRNA expression for cytokeratin 8 was significantly higher in node-positive compared with node-negative disease (P = 0.02). Cytokeratin 18 mRNA levels were significantly lower in both node-negative (P = 0.03) and node-positive (P = 0.02) patients when compared with benign samples. Increased levels of cytokeratin 18 mRNA showed an inverse relationship with protein expression (P = 0.05). The results indicate that cytokeratin expression in breast cancer may be associated with tumor progression. Furthermore, the alteration in the expression of individual cytokeratins deserves further investigation to determine the consequences of these changes with respect to cellular function.
- Published
- 1998
25. PTH-141 Could upper GI Cancer Explain False Positive Faecal Occult Blood Test (FOBT) Results in the Bowel Cancer Screening Programme?
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Gayle Clifford, J Shenfine, H Jaretzke, and Colin J Rees
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medicine.medical_specialty ,education.field_of_study ,Gi symptoms ,medicine.diagnostic_test ,Colorectal cancer ,business.industry ,Population ,Gastroenterology ,Colonoscopy ,medicine.disease ,Screening programme ,Internal medicine ,medicine ,Upper GI cancer ,In patient ,Faecal occult blood test ,education ,business ,human activities - Abstract
Introduction The Bowel Cancer Screening Programme (BCSP) commenced in England in 2006 using the Hemoccult guaiac faecal occult blood test (FOBt). The study aimed to evaluate if significant numbers of upper GI cancers were being diagnosed in patients with a positive FOBt in the absence of colonic pathology. Methods A quantitative data analysis of all BCSP patients with a negative colonoscopy cross referenced with all patients within screening age (60yrs > ) diagnosed with upper GI cancer in the North East of England, comprising of South of Tyne, North of Tyne, Teesside, Durham and Darlington. Results Collectively the North East Bowel Cancer Screening centres carried out 5176 colonoscopies from 2008–2011, resulting in 1108 (21.4%) normal investigations. In the same time period 589 patients were diagnosed with upper GI cancer. 243 were invited to participate in BCSP and 109 (45%) took part. 33/109 (30%) patients were diagnosed with upper GI cancer prior to submitting FOBt, leaving 76 (70%) presumably undiagnosed. 72/76 (94.8%) returned a negative FOBt, 2 (2.6%) returned an unclear subsequently followed by 2 negative FOBt kits according to BCSP practise, leaving 2 (2.6%) patients with a positive FOBt who subsequently had a normal colonoscopy. At the time of screening both patients were symptomatic with upper GI symptoms, and diagnosed with upper GI cancer within 3 months of screening. Conclusion These data suggest that carrying out an upper GI investigation in FOBt positive and colonoscopy negative patients is not justified. Consideration to investigate maybe given in the presence of upper GI symptoms; however, further work is needed to evaluate the prevalence of upper GI symptoms in this population. Disclosure of Interest None Declared.
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- 2013
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26. OC-128 The effect of obesity on the radicality of subtotal oesophagectomy for oesophageal adenocarcinoma
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J Shenfine, H V Jones, A Krishnan, S Wahed, and S. M. Griffin
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medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Gastroenterology ,Overweight ,medicine.disease ,Surgery ,Internal medicine ,medicine ,Adenocarcinoma ,Lymphadenectomy ,Underweight ,medicine.symptom ,Stage (cooking) ,Risk factor ,business ,Body mass index - Abstract
Introduction Obesity is on the increase in the UK and is a known risk factor for adenocarcinoma of the oesophagus. It is recognised that oesophagectomy in obese patients is more difficult with concerns that radicality of resection is reduced. The aims of this study were to evaluate body mass index (BMI) in patients with oesophageal adenocarcinoma who underwent subtotal oesophagectomy with radical lymphadenectomy and to evaluate the effect of obesity on lymph node (LN) dissection and survival. Methods All patients who underwent subtotal oesophagectomy for adenocarcinoma between January 2000 and December 2010 were identified from a prospectively maintained database. All other histological types were excluded. Patients were categorised according to BMI using the WHO criteria: underweight (2), normal (18.5–24.99 kg/m 2 ), overweight (25-29.99 kg/m 2 ) and obese (≥30 kg/m 2 ). Demographics, presence of Barrett9s oesophagus or reflux disease, operative time, R0 resections, complications, LN resection and positivity were analysed. Long-term and disease free survival were calculated using the Kaplan–Meier method. Results 413 patients were identified. 23 had no BMI recorded and were excluded leaving 390 patients: eight underweight; 117 normal BMI; 172 overweight; 93 obese. BMI significantly increased over time (mean BMI 26.0 in 2000–2001, 27.8 in 2010, p=0.041). Obese patients were younger compared to normal BMI patients (mean age 60.1 and 64.4 respectively, p=0.003). The incidence of Barrett9s oesophagus and reflux disease were not significantly different between groups. Operating time was significantly longer for obese patients (p=0.018). R0 resections were similar between groups (normal patients 96.4% and obese 95.5%). The mean number of LNs resected (33 for both normal BMI and obese groups) and the LN ratio did not differ significantly between groups. Obese patients had significantly lower disease stages (32.3% stage 1 obese patients vs 16.2% stage 1 normal BMI patients, p=0.006). Overall survival was longer for obese patients compared with those of normal BMI (81 months vs 55 months, p=0.004). When matched for stage, this difference did not reach significance (p=0.236). Disease free survival did not differ between groups. The overall complication rate was similar between groups (70.1% for normal BMI, 66.3% for obese). Conclusion This is the first study to evaluate BMI in a homogenous group of patients with adenocarcinoma undergoing subtotal oesophagectomy with a standardised radical lymphadenectomy. BMI and obesity among these patients increased with time. The radicality of surgery, in terms of LN yields and R0 resections, did not reduce in the obesity group and this is further supported by equivalent stage-matched long-term survival. Competing interests None declared.
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- 2012
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27. Letter to the editor
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S. M. Griffin, J Shenfine, and M. Webb
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medicine.medical_specialty ,business.industry ,General surgery ,medicine.medical_treatment ,Gastroenterology ,Locally advanced ,MEDLINE ,Nutritional status ,General Medicine ,Esophageal cancer ,medicine.disease ,Self Expandable Metal Stents ,Quality of life ,medicine ,business ,Neoadjuvant therapy - Published
- 2011
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28. Self-Expanding Esophageal Stents and Neoadjuvant Therapy
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S. M. Griffin, J Shenfine, and M. Webb
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medicine.medical_specialty ,Oncology ,Surgical oncology ,business.industry ,medicine.medical_treatment ,General surgery ,Perforation (oil well) ,medicine ,Surgery ,Bowel perforation ,business ,Neoadjuvant therapy - Published
- 2010
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29. Presentation, management and outcome of oesophageal malignancy in patients aged over 75 years
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Nick Hayes, J Shenfine, S. M. Dresner, J Wayman, and S. M. Griffin
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medicine.medical_specialty ,education.field_of_study ,Palliative care ,business.industry ,medicine.medical_treatment ,Population ,Esophageal cancer ,Malignancy ,medicine.disease ,Dysphagia ,Surgery ,Radiation therapy ,Barrett's esophagus ,medicine ,Lymphadenectomy ,medicine.symptom ,business ,education - Abstract
Background Subjects over 75 years old constitute an increasing proportion of the general population and hitherto the management of most malignant diseases in this elderly group has been predominantly palliative. The aim of this study was to assess the mode of presentation, management and outcome of treatment in patients aged over 75 years presenting with oesophageal malignancy. Methods Data were collected prospectively from all patients aged over 75 years at presentation who were diagnosed at or referred to a single centre between October 1989 and May 1998. All patients underwent a full protocol of staging investigations and assessment of co-morbid disease. The main modality of therapy and its outcome were analysed, as was the overall survival. Statistical analysis was with the χ2, Mann–Whitney and log rank tests. Results Eighty patients were studied (41 men). The median age at presentation was 82 (range 75–97) years. Adenocarcinoma was the predominant histological subtype (46, 58 per cent) compared with squamous cell carcinoma (SCC; 34, 42 per cent). Most patients were referred by a gastroenterologist (34 patients) or general practitioner (25). Dysphagia and weight loss were the commonest presenting symptoms (67 patients), with dyspepsia a significantly more frequent symptom for adenocarcinoma (22 of 46 versus six of 34; P < 0·05). Patients with adenocarcinoma had more often received acid suppressing medication (20 of 46 versus seven of 34; P < 0·05). The median duration of symptoms was 5 months and was significantly longer for adenocarcinoma than SCC (7 versus 4 months; P < 0·05). Twenty-nine (26 per cent) of 80 patients were unfit for surgery mainly because of co-morbid cardiorespiratory disease, despite being staged as suitable for resection. A further 37 (46 per cent) were staged as having irresectable local disease or distant metastases and could not be offered surgery. Three patients declined surgery and two with high-grade dysplasia in Barrett's oesophagus remain under surveillance. Thirty-nine patients (49 per cent) were palliated with external beam and endoluminal radiotherapy, twenty-eight (35 per cent) had oesophageal dilatation and endoprosthesis insertion, two patients had no intervention and a further two had laser therapy. Nine (11 per cent) underwent Ivor–Lewis subtotal oesophagectomy with two-tier lymphadenectomy. The overall median survival for all modalities of therapy was 183 (95 per cent confidence interval 143–223) days. There was a significant survival benefit for those undergoing surgery compared with other options (402 versus 171 days; P = 0·0204). Survival following palliative measures was significantly better for radiotherapy than for dilatation and endoprosthesis insertion (214 versus 80 days; P = 0·0006). Conclusion While surgical resection in selected patients offers the only chance of long-term survival, the advanced nature of oesophageal malignancy at presentation coupled with the high incidence of significant co-morbid disease precludes its use in most elderly patients. Thorough staging and careful assessment of overall fitness are crucial in identifying those suitable for surgery as well as establishing which palliative measures are most appropriate.
- Published
- 1999
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30. Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophageal reflux disease based on preoperative oesophageal manometry (Br J Surg 2008; 95: 57–63)
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J Shenfine, L. J. Dunn, A G N Robertson, Dayalan Karat, and S. M. Griffin
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medicine.medical_specialty ,Oesophageal manometry ,business.industry ,Reflux ,MEDLINE ,Disease ,Gastroenterology ,Preoperative care ,law.invention ,Surgery ,Randomized controlled trial ,law ,Gastro ,Internal medicine ,medicine ,business - Abstract
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved,appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
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- 2008
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31. The Niti-S Oesophageal Stent Reduces Migration Rates in the Palliation of Malignant Dysphagia
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Nick Hayes, Michael D. W. Griffin, Shaun R. Preston, Daya Karat, Ravi Chirukandath, Christopher G. Streets, and J Shenfine
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medicine.medical_specialty ,Oesophageal stent ,business.industry ,Gastroenterology ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Surgery ,Malignant dysphagia - Published
- 2007
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32. Oesophageal physiology in a UK specialist centre
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S. M. Dresner, J Shenfine, Nicholas Hayes, and Selwyn M. Griffin
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medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,medicine ,business - Published
- 2000
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33. The influence of perioperative blood transfusion on survival following radical esophagectomy
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S. M. Dresner, J Shenfine, Nicholas Hayes, Peter J. Lamb, and Selwyn M. Griffin
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medicine.medical_specialty ,Blood transfusion ,Hepatology ,Esophagectomy ,business.industry ,medicine.medical_treatment ,Gastroenterology ,medicine ,Perioperative ,business ,Surgery - Published
- 2000
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34. Spontaneous esophageal rupture: A 5 year experience
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Selwyn M. Griffin, Y. Ks Viswanath, J Shenfine, S. M. Dresner, and Nicholas Hayes
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medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,medicine ,business ,Spontaneous esophageal rupture ,Surgery - Published
- 2000
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35. Management of spontaneous rupture of the oesophagus
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J Shenfine, Y. Vishwanath, S. M. Dresner, Nick Hayes, and S. M. Griffin
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Radiography ,medicine.medical_treatment ,Perforation (oil well) ,Intensive care unit ,law.invention ,Surgery ,law ,medicine ,Vomiting ,Retching ,Thoracotomy ,medicine.symptom ,Chest radiograph ,business - Abstract
Aims Spontaneous rupture of the oesophagus (SRO) is a rare and often fatal event. The aim of this study was to evaluate the presentation, management and outcome of SRO in a single unit. Methods Data were collected on all patients presenting with SRO over a 5-year period with respect to presenting features, diagnostic investigations and subsequent management. Statistical analysis was by Student's t test, χ2 and Fisher's exact tests. Results Fourteen patients were identified, 12 men and two women with a median age of 64 (range 18–78) years; eight were tertiary referrals. Thirteen of 14 patients presented with chest or upper abdominal pain following vomiting or retching and 13 had an abnormal initial chest radiograph; only one presented with Mackler's triad of pain, vomiting and surgical emphysema. The median delay to diagnosis was 21 (range 1–84) h; this delay did not significantly affect outcome (P = 0·16). An endoscopic assessment and contrast swallow were performed in all patients. Nine of ten patients with a demonstrable leak and full-thickness tear were managed surgically and the four patients with no leak were managed conservatively (P = 0·005); surgical management consisted of thoracotomy, lavage, repair of the perforation and a feeding jejunostomy. Seven patients had a repair over a T tube and two had a primary repair. All conservatively managed patients had contained, controlled or intramural perforations and two also required a feeding jejunostomy. Patients requiring surgery had a longer hospital stay (mean(s.d.) 57·9(34·8) versus 22·2(30·7) days; P = 0·081) and a significantly longer intensive care unit stay (P = 0·044). The overall mortality rate from SRO was 14 per cent (two patients); no deaths occurred in the conservatively managed group. Conclusions SRO continues to be diagnosed late despite a classical history and/or abnormal chest radiograph. Endoscopic assessment of perforations is safe and in combination with a contrast swallow can confidently predict patients with contained or controlled rupture in whom non-operative management is successful.
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- 2000
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36. An international Delphi consensus on patient preparation for metabolic and bariatric surgery.
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Clyde DR, Adib R, Baig S, Bhasker AG, Byrne J, Cameron D, Catalain C, Clare K, de Beaux A, Drummond G, Fawal H, Fried M, Ghanem O, Graham Y, Goel R, Hopkins G, Husain F, Joyce B, Kermansaravi M, Kothari S, Kow L, Leite S, Madhok B, Mahon D, Miller K, Miras A, Moussa O, Neto MG, Nimeri A, O'Kane M, Parmar C, Peterli R, Poggi L, Saliminen P, Sarkar R, Shenfine J, Sogg S, Stenberg E, Suter M, Taha S, Tahrani A, Vilallonga R, Voon K, Welbourn R, Zerrweck C, Lamb P, Mahawar KK, Yang W, and Robertson AGN
- Abstract
Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m
2 ), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations. This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS. These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS., (© 2024 World Obesity Federation.)- Published
- 2024
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37. Combined and intraoperative risk modelling for oesophagectomy: A systematic review.
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Grantham JP, Hii A, and Shenfine J
- Abstract
Background: Oesophageal cancer is the eighth most common malignancy worldwide and is associated with a poor prognosis. Oesophagectomy remains the best prospect for a cure if diagnosed in the early disease stages. However, the procedure is associated with significant morbidity and mortality and is undertaken only after careful consideration. Appropriate patient selection, counselling and resource allocation is essential. Numerous risk models have been devised to guide surgeons in making these decisions., Aim: To evaluate which multivariate risk models, using intraoperative information with or without preoperative information, best predict perioperative oesophagectomy outcomes., Methods: A systematic review of the MEDLINE, EMBASE and Cochrane databases was undertaken from 2000-2020. The search terms used were [(Oesophagectomy) AND (Model OR Predict OR Risk OR score) AND (Mortality OR morbidity OR complications OR outcomes OR anastomotic leak OR length of stay)]. Articles were included if they assessed multivariate based tools incorporating preoperative and intraoperative variables to forecast patient outcomes after oesophagectomy. Articles were excluded if they only required preoperative or any post-operative data. Studies appraising univariate risk predictors such as preoperative sarcopenia, cardiopulmonary fitness and American Society of Anesthesiologists score were also excluded. The review was conducted following the preferred reporting items for systematic reviews and meta-analyses model. All captured risk models were appraised for clinical credibility, methodological quality, performance, validation and clinical effectiveness., Results: Twenty published studies were identified which examined eleven multivariate risk models. Eight of these combined preoperative and intraoperative data and the remaining three used only intraoperative values. Only two risk models were identified as promising in predicting mortality, namely the Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and POSSUM scores. A further two studies, the intraoperative factors and Esophagectomy surgical Apgar score based nomograms, adequately forecasted major morbidity. The latter two models are yet to have external validation and none have been tested for clinical effectiveness., Conclusion: Despite the presence of some promising models in forecasting perioperative oesophagectomy outcomes, there is more research required to externally validate these models and demonstrate clinical benefit with the adoption of these models guiding postoperative care and allocating resources., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
- Published
- 2023
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38. Preoperative risk modelling for oesophagectomy: A systematic review.
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Grantham JP, Hii A, and Shenfine J
- Abstract
Background: Oesophageal cancer is a frequently observed and lethal malignancy worldwide. Surgical resection remains a realistic option for curative intent in the early stages of the disease. However, the decision to undertake oesophagectomy is significant as it exposes the patient to a substantial risk of morbidity and mortality. Therefore, appropriate patient selection, counselling and resource allocation is important. Many tools have been developed to aid surgeons in appropriate decision-making., Aim: To examine all multivariate risk models that use preoperative and intraoperative information and establish which have the most clinical utility., Methods: A systematic review of the MEDLINE, EMBASE and Cochrane databases was conducted from 2000-2020. The search terms applied were ((Oesophagectomy) AND (Risk OR predict OR model OR score) AND (Outcomes OR complications OR morbidity OR mortality OR length of stay OR anastomotic leak)). The applied inclusion criteria were articles assessing multivariate based tools using exclusively preoperatively available data to predict perioperative patient outcomes following oesophagectomy. The exclusion criteria were publications that described models requiring intra-operative or post-operative data and articles appraising only univariate predictors such as American Society of Anesthesiologists score, cardiopulmonary fitness or pre-operative sarcopenia. Articles that exclusively assessed distant outcomes such as long-term survival were excluded as were publications using cohorts mixed with other surgical procedures. The articles generated from each search were collated, processed and then reported in accordance with PRISMA guidelines. All risk models were appraised for clinical credibility, methodological quality, performance, validation, and clinical effectiveness., Results: The initial search of composite databases yielded 8715 articles which reduced to 5827 following the deduplication process. After title and abstract screening, 197 potentially relevant texts were retrieved for detailed review. Twenty-seven published studies were ultimately included which examined twenty-one multivariate risk models utilising exclusively preoperative data. Most models examined were clinically credible and were constructed with sound methodological quality, but model performance was often insufficient to prognosticate patient outcomes. Three risk models were identified as being promising in predicting perioperative mortality, including the National Quality Improvement Project surgical risk calculator, revised STS score and the Takeuchi model. Two studies predicted perioperative major morbidity, including the predicting postoperative complications score and prognostic nutritional index-multivariate models. Many of these models require external validation and demonstration of clinical effectiveness., Conclusion: Whilst there are several promising models in predicting perioperative oesophagectomy outcomes, more research is needed to confirm their validity and demonstrate improved clinical outcomes with the adoption of these models., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2023
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39. Routine Esophagograms After Hiatus Hernia Repair Minimizes Reoperative Morbidity: A Multicenter Comparative Cohort Study.
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Liu DS, Wee MY, Grantham JP, Ong BS, Ng SG, To MS, Zhou X, Irvine T, Bright T, Thompson SK, Dandie L, Shenfine J, and Watson DI
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- Humans, Reoperation adverse effects, Herniorrhaphy methods, Cohort Studies, Postoperative Complications epidemiology, Postoperative Complications surgery, Postoperative Complications etiology, Morbidity, Recurrence, Surgical Mesh adverse effects, Laparoscopy methods, Hernia, Hiatal surgery, Hernia, Hiatal complications
- Abstract
Objective: Determine the utility of routine esophagograms after hiatus hernia repair and its impact on patient outcomes., Background: Hiatus hernia repairs are common. Early complications such asre-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Whether routine postoperative esophagograms enable early recognition of these complications, expedite surgical management, reduce reoperative morbidity, and improve functional outcomes are unclear., Methods: Analysis of a prospectively-maintained database of hiatus hernia repairs in 14 hospitals, and review of esophagograms in this cohort. Results: A total of 1829 hiatus hernias were repaired. Of these, 1571 (85.9%) patients underwent a postoperative esophagogram. Overall, 1 in 48 esophagograms resulted in an early (<14 days) reoperation, which was undertaken in 44 (2.4%) patients. Compared to those without an esophagogram, patients who received this test before reoperation (n = 37) had a shorter time to diagnosis (2.4 vs 3.9 days, P = 0.041) and treatment (2.4 vs 4.3 days, P = 0.037) of their complications. This was associated with lower rates of open surgery (10.8% vs 42.9%, P = 0.034), gastric resection (0.0% vs 28.6%, P = 0.022), postoperative morbidity (13.5% vs 85.7%, P < 0.001), unplanned intensive care admission (16.2% vs 85.7%, P < 0.001), and decreased length-of-stay (7.3 vs 18.3 days, P = 0.009). Furthermore, we identified less intraoperative and postoperative complications, and superior functional outcomes at 1-year follow-up in patients who underwent early reoperations for an esophagogram-detected asymptomatic re-herniation than those who needed surgery for late symptomatic recurrences., Conclusions: Postoperative esophagograms decrease the morbidity associated with early and late reoperations, and should be considered for routine use after hiatus hernia surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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40. Outcomes of 325 one anastomosis gastric bypass operations: an Australian case series.
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Gricks B, Eldredge T, Bessell J, and Shenfine J
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- Anastomosis, Roux-en-Y, Australia epidemiology, Humans, Retrospective Studies, Weight Loss, Gastric Bypass adverse effects, Gastric Bypass methods, Obesity, Morbid surgery
- Abstract
Background: The One Anastomosis Gastric Bypass (OAGB) is a relatively novel procedure. Studies have demonstrated that it is at least as effective as other bariatric procedures but with fewer major complications and shorter operating time, yet OAGB is performed less partially due to a paucity of supportive evidence. We report the outcomes of a prospectively maintained database of patients undergoing laparoscopic OAGB., Methods: All OAGB procedures performed by two surgeons across two hospitals from 2016 to 2019 were recorded in a prospectively maintained database. Patients with at least 1 year of follow up were included in this study and missing data was obtained from patient records. The primary outcome was percentage excess weight loss (EWL). The secondary outcome was surgical complication rate., Results: Three hundred and twenty-five patients with a mean pre-operative body mass index of 43.3 kg/m
2 were included. The majority (85.2%) had a biliopancreatic limb length of 150 cm. The median EWL was 74.2% and 79.4% of patients achieved at least 50% EWL. There were no deaths, the overall re-operation rate was 4.9% and 1.9% of patients developed stomal ulcers. Seven patients went on to have a Roux-en-Y conversion predominantly for symptomatic reflux., Conclusion: OAGB leads to excellent weight loss and is at least as safe as more commonly performed procedures, it may be a suitable treatment for a greater number of patients than it is being offered to at present., (© 2022 Royal Australasian College of Surgeons.)- Published
- 2022
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41. Once in a Bile - the Incidence of Bile Reflux Post-Bariatric Surgery.
- Author
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Eldredge TA, Bills M, Ting YY, Dimitri M, Watson MM, Harris MC, Myers JC, Bartholomeusz DL, Kiroff GK, and Shenfine J
- Subjects
- Australia, Bile, Gastrectomy adverse effects, Gastrectomy methods, Humans, Incidence, Retrospective Studies, Bariatric Surgery adverse effects, Bile Reflux complications, Bile Reflux etiology, Gastric Bypass adverse effects, Gastric Bypass methods, Gastroesophageal Reflux complications, Gastroesophageal Reflux etiology, Obesity, Morbid surgery
- Abstract
Purpose: Excellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No 'gold standard' investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB)., Methods: Fifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy., Results: Gastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms., Conclusion: Despite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed., Clinical Trial Registry: Australian New Zealand Clinical Trials Registry number ACTRN12618000806268., (© 2022. Crown.)
- Published
- 2022
- Full Text
- View/download PDF
42. Comparison of oesophageal and gastric cancer in the evaluation of urgent endoscopy referral criteria.
- Author
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Kumar L, Kholmurodova F, Bull J, Bright T, Watson DI, and Shenfine J
- Subjects
- Aged, Australia epidemiology, Endoscopy, Female, Humans, Male, Middle Aged, Referral and Consultation, Esophageal Neoplasms diagnosis, Esophageal Neoplasms epidemiology, Esophageal Neoplasms surgery, Stomach Neoplasms diagnosis, Stomach Neoplasms epidemiology, Stomach Neoplasms surgery
- Abstract
Background: The objective of the study is to identify differences in epidemiology and clinical presentation between oesophageal and gastric cancer and to evaluate the sensitivity of the Australian urgent endoscopy referral guidelines., Methods: Design; Observational cohort study from February 2013 to October 2018., Setting: A single tertiary specialist oesophago-gastric cancer centre: Flinders Medical Centre, South Australia., Participants: Patients with oesophageal and gastric cancer that had surgery with curative intent 61.9% oesophageal cancer, 38.1% gastric cancer., Main Outcome Measures: Differences between oesophageal and gastric cancer in terms of demographical variables, first presenting symptoms and sensitivity of the Australian urgent endoscopy referral guidelines., Results: Oesophageal cancer presented at a median age of 64.4 years old, with a male: female ratio of 6:1, and dysphagia as the first presenting symptom in 61%. Gastric cancer presented at a median age of 69.5, with a 2:1 male: female ratio and predominantly non-specific symptoms-blood loss (36%), weight loss, nausea, and anorexia (21%) and epigastric pain (13%). The Australia urgent endoscopy referral guidelines had 76% sensitivity for oesophageal cancer detection compared with a 33% sensitivity for gastric cancer in this cohort. Delays from symptom onset to referral occurred for most patients with timeframes over four times the recommended 2-week timeframe., Conclusion: There should be a separate urgent referral guideline for oesophageal and gastric cancer. These should include dysphagia for oesophageal cancer and blood loss (anaemia, haematemesis, melaena) for gastric cancer. Delays from symptom onset to referral indicate the need for further education of the public and general practitioners on symptoms warranting urgent referral., (© 2021 Royal Australasian College of Surgeons.)
- Published
- 2021
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43. Diagnosing anastomotic leak post-esophagectomy: a systematic review.
- Author
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Barbaro A, Eldredge TA, and Shenfine J
- Subjects
- Anastomosis, Surgical adverse effects, Humans, Anastomotic Leak diagnosis, Anastomotic Leak etiology, Esophageal Neoplasms surgery, Esophagectomy adverse effects
- Abstract
Esophagectomy is the gold-standard treatment for esophageal cancer; however, postoperative anastomotic leakage remains the primary concern for surgeons. No consensus exists on the optimal investigations to predict an anastomotic leak. This systematic review aims to identify a single test or combination of tests with acceptable sensitivity and specificity to identify anastomotic leak after esophagectomy and to formulate a diagnostic algorithm to facilitate surgical decision-making. A systematic review of PubMed and EMBASE databases was undertaken to evaluate diagnostic investigations for anastomotic leak post-esophagectomy. Each study was reviewed and where possible, the sensitivity, specificity, positive predictive value, and negative predictive value were extracted. The review identified 3,204 articles, of which 49 met the inclusion criteria. Investigations most commonly used for diagnosis of anastomotic leak were: C-reactive protein (CRP), oral contrast imaging, computed tomography (CT), pleural drain amylase concentration, and the 'NUn score'. The sensitivity of CRP for detecting anastomotic leak varied from 69.2% to 100%. Oral contrast studies sensitivities varied between 16% and 87.5% and specificity varied from 20% to 100%. Pleural drain amylase sensitivities ranged between 75% and 100% and specificity ranged from 52% to 95.5%. The NUn score sensitivities ranged from 0% to 95% and specificity from 49% to 94.4%. No single investigation was identified to rule out anastomotic leak in asymptomatic patients. However, the authors propose a diagnostic algorithm incorporating CRP, pleural drain amylase concentration, and CT with oral contrast to aid clinicians in predicting anastomotic leak to facilitate safe, timely discharge post-esophagectomy., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2021
- Full Text
- View/download PDF
44. HIDA and Seek: Challenges of Scintigraphy to Diagnose Bile Reflux Post-Bariatric Surgery.
- Author
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Eldredge TA, Bills M, Myers JC, Bartholomeusz D, Kiroff GK, and Shenfine J
- Subjects
- Humans, Imino Acids, Radionuclide Imaging, Bariatric Surgery adverse effects, Bile Reflux diagnostic imaging, Bile Reflux etiology, Obesity, Morbid surgery
- Abstract
Introduction: Oesophageal bile reflux after bariatric surgery may trigger development of Barrett's oesophagus. Gastro-oesophageal reflux of bile is captured by hepatobiliary iminodiacetic acid (HIDA) scintigraphy; however, anatomical and physiological changes after bariatric surgery warrant protocol modifications to optimise bile reflux detection., Methods: HIDA scintigraphy occurred 6 months after either sleeve gastrectomy, Roux-en-Y gastric bypass or one-anastomosis gastric bypass. Standard HIDA scanning involves (i) 6-h fast and 24-h abstinence from opioids; (ii) IV administration of 99mTc di-isopropyl iminodiacetic acid; and (iii) dual anterior/posterior 60-min dynamic scanning of the duodenum, stomach and oesophagus. Three challenges were identified, and modifications were implemented, namely, (1) anatomical localisation of refluxed bile on planar scintigraphy was improved by adding a SPECT/CT for 3D imaging; (2) impaired cholecystokinin-controlled gallbladder emptying, following bypassed duodenum, was addressed by ingestion of a 'fatty meal'; and (3) intestinal hypomotility after gastric bypass was counteracted by longer scan duration (75-90 min) to allow bile to pass beyond the gastro-jejunal anastomosis., Results: HIDA scan was undertaken in 18 patients, 13 of whom underwent the modified protocol. The tailored protocol ameliorated issues identified with the standard HIDA scan protocol; thus, accurate anatomical localisation was achieved in all patients, no delayed gallbladder emptying was observed, and bile was observed beyond the gastro-jejunal anastomosis in all gastric bypass patients. The modified technique was well tolerated by patients., Conclusion: A tailored HIDA scan protocol with addition of a SPECT-CT scan, ingestion of a fatty meal and prolonged scanning duration results in enhanced bile reflux detection in post-bariatric surgical patients.
- Published
- 2020
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45. A delayed presentation of traumatic right hemidiaphragm injury repaired via a laparoscopic approach: A case report.
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Ong BS, Heitmann PT, and Shenfine J
- Abstract
Introduction: Diaphragmatic injury is a rare clinical entity which presents a diagnostic and therapeutic challenge. It is three times more common following blunt trauma than penetrating trauma and results in larger tears. A high index of suspicion is required to diagnose diaphragmatic injury. A missed diagnosis following acute injury can later result in life-threatening complications., Case Presentation: We describe the successful management of a right hemidiaphragmatic injury presenting two weeks following blunt thoracoabdominal trauma using a laparoscopic mesh repair., Discussion: Diaphragmatic injury is rare, with right-sided injuries less common due to the buffering effect of the liver. The diagnosis is made within 24 hours of injury in 75% of cases (Haranal and et al., 2018) [1]. In our patient, symptoms of a right-sided diaphragmatic injury manifested two weeks following a motor vehicle collision. A CT scan of the chest and abdomen confirmed the diagnosis. According to DeBlasio, intermittent symptoms of visceral herniation or incorrect x-ray interpretation are the main reasons for a delayed diagnosis (DeBlasio et al., 1994) [2]. Contrary to common practice where thoracotomy is the preferred method for repair in the absence of associated abdominal injuries, we demonstrated that a right-sided diaphragmatic injury can be successfully managed with a laparoscopic mesh repair., Conclusion: Traumatic diaphragmatic injury remains a challenge to emergency physicians and trauma surgeons. Clinicians should be aware of the differing clinical presentations, investigations, and management. Surgical repair can be achieved via laparoscopy, thoracoscopy, laparotomy, and/or thoracotomy. In the case of an isolated right-sided diaphragmatic injury, laparoscopic mesh repair should be considered., Competing Interests: None., (© 2020 The Author(s).)
- Published
- 2020
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46. Double trouble: two sites of internal hernia following total gastrectomy.
- Author
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Barnett DR, Cockbain AJ, Shenfine J, and Thompson SK
- Subjects
- Aged, Female, Gastrectomy methods, Hernia, Diaphragmatic etiology, Humans, Intestinal Diseases etiology, Gastrectomy adverse effects, Hernia etiology, Postoperative Complications etiology
- Published
- 2019
- Full Text
- View/download PDF
47. Doctor-doctor: the impact of early career higher degrees in surgical research.
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Eldredge TA, Harley SJD, Warren LR, and Shenfine J
- Subjects
- Adult, Australia epidemiology, Career Choice, Cross-Sectional Studies methods, Education, Medical, Undergraduate statistics & numerical data, Female, Humans, Male, Research trends, Students, Medical statistics & numerical data, Surgeons statistics & numerical data, Young Adult, Research statistics & numerical data, Students, Medical psychology, Surgeons education
- Published
- 2018
- Full Text
- View/download PDF
48. Response to a Letter to the Editor Re: Detecting Bile Reflux-the Enigma of Bariatric Surgery.
- Author
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Eldredge TA, Myers JC, Kiroff GK, and Shenfine J
- Subjects
- Humans, Bariatric Surgery, Bile Reflux, Gastroesophageal Reflux, Obesity, Morbid surgery
- Published
- 2018
- Full Text
- View/download PDF
49. Detecting Bile Reflux-the Enigma of Bariatric Surgery.
- Author
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Eldredge TA, Myers JC, Kiroff GK, and Shenfine J
- Subjects
- Bariatric Surgery adverse effects, Bile Reflux epidemiology, Bile Reflux etiology, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux epidemiology, Gastroesophageal Reflux etiology, Humans, Obesity, Morbid complications, Obesity, Morbid diagnosis, Obesity, Morbid epidemiology, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Postoperative Complications etiology, Radionuclide Imaging, Reproducibility of Results, Risk Factors, Bile Reflux diagnosis, Diagnostic Techniques, Digestive System standards, Obesity, Morbid surgery
- Abstract
Duodeno-gastro-esophageal reflux, or bile reflux, is a condition for which there is no diagnostic gold standard, and it remains controversial in terms of carcinoma risk. This is pertinent in the context of an increasingly overweight population who are undergoing weight-loss operations that theoretically further increase the risk of bile reflux. This article reviews investigations for bile reflux based on efficacy, patient tolerability, cost, and infrastructure requirements. At this time, whilst no gold standard exists, hepatobiliary scintigraphy is the least invasive investigation with good-patient tolerability, sensitivity, and reproducibility to be considered first-line for diagnosis of bile reflux. This review will guide clinicians investigating bile reflux.
- Published
- 2018
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50. Quality and outcomes of synchronous two-team Ivor-Lewis oesophagectomy: Revisiting a variant technique.
- Author
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Hummel R, Mees ST, Smith L, Jamieson GG, Kiroff G, and Shenfine J
- Subjects
- Adenocarcinoma mortality, Adult, Aged, Carcinoma, Squamous Cell mortality, Esophageal Neoplasms mortality, Esophagectomy mortality, Esophagectomy standards, Feasibility Studies, Female, Humans, Length of Stay statistics & numerical data, Length of Stay trends, Male, Middle Aged, Postoperative Complications epidemiology, Quality Improvement statistics & numerical data, Retrospective Studies, Survival Analysis, Treatment Outcome, Adenocarcinoma surgery, Carcinoma, Squamous Cell surgery, Esophageal Neoplasms surgery, Esophagectomy methods, Quality Improvement trends
- Abstract
Background and Objectives: In 1975, a modification of popular two-stage Ivor-Lewis oesophagectomy was published with synchronous resection in chest and abdomen. As data on this technique are rare and inconsistent, we aimed to investigate safety, feasibility, and outcome of this approach., Methods: Outcome of 201 patients undergoing synchronous oesophagectomy from 2000 to 2013 was analysed retrospectively. Two groups (early: 2000-2006; late: 2007-2013) were analysed to allow comparison of outcome over time., Results: Patients in the later period had fewer respiratory comorbidities (P = 0.010), median blood loss decreased significantly over time while lymph node yield increased (P < 0.001). Overall complications occurred in 58.9 (early) versus 51.7% (late) of patients (P = 0.320), anastomotic leaks in 14.3 versus 6.7% (P = 0.112), respiratory complications in 48.2 versus 34.8% (P = 0.063). Thirty-day/90-day mortality was 2.7% versus 3.4, respectively, 8.1% versus 6.8% (P ≤ 0.793). Long-term survival was better in the later cohort (P = 0.004)., Conclusions: Our data of 201 patients over a period of 14 years suggests that this technique is a quick, feasible, safe, and reasonable alternative to standard two-stage Ivor-Lewis oesophagectomy. Quality of this approach and ultimate outcomes have improved over time, with similar complication rates/outcomes to literature accepted standards for two-stage approach, especially in the later time period. J. Surg. Oncol. 2016;114:719-724. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
- Full Text
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