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1. Delayed Surgical Intervention After Chemoradiotherapy in Esophageal Cancer: (DICE) Study

Author

Chidambaram, Swathikan, Owen, Richard, Sgromo, Bruno, Chmura, Magdalena, Kisiel, Aaron, Evans, Richard, Griffiths, Ewen A, Castoro, Carlo, Gronnier, Caroline, MaoAwyes, M, Gutschow, Christian A, Piessen, Guillaume, Degisors, Sébastien, Alvieri, Rita, Feldman, H, Capovilla, Giovanni, Grimminger, Peter P, Han, Shiwei, Low, Donald E, Moore, Jonathan, Gossage, James, Voeten, Dan, Gisbertz, Suzanne S., Ruurda, Jelle, van Hillegersberg, Richard, D’journo, Xavier Benoit, Phillips, Alexander W, Rosati, Ricardo, Hanna, George B, Maynard, Nick, Hofstetter, W, Ferri, Lorenzo, Berge Henegouwen, Mark I., and Markar, Sheraz R.

Published
2023
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2. Multicenter, Prospective Cohort Study of Oesophageal Injuries and Related Clinical Outcomes (MUSOIC study)

Author

Owen, Richard P., Chidambaram, Swathikan, Griffiths, Ewen A., Sultan, Javed, Phillips, Alexander W., Vohra, Ravindra, Preston, Shaun, Gossage, James, Hanna, George B., Underwood, Tim J., Maynard, Nick, Markar, Sheraz R., Scabbiolo, Zoe, Kawka, Michal, Burke, Rosemary, Evans, Richard, Shang, Ersong, Gill, Rajinder, Lee, Rachel, Ong, Zun Zheng, Bull, Alexander, and Walker, Robert

Published
2023
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4. Oxaliplatin/capecitabine or carboplatin/paclitaxel-based preoperative chemoradiation for resectable oesophageal adenocarcinoma (NeoSCOPE): Long-term results of a randomised controlled trial

Author

Mukherjee, Somnath, Hurt, Christopher, Radhakrishna, Ganesh, Gwynne, Sarah, Bateman, Andrew, Gollins, Simon, Hawkins, Maria A., Canham, Joanne, Grabsch, Heike I., Falk, Stephen, Sharma, Ricky A., Ray, Ruby, Roy, Rajarshi, Cox, Catrin, Maynard, Nick, Nixon, Lisette, Sebag-Montefiore, David J., Maughan, Timothy, Griffiths, Gareth O., and Crosby, Tom D.L.

Published
2021
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6. The Prognostic Impact of Minimally Invasive Esophagectomy on Survival after Esophagectomy following a Delayed Interval after Chemoradiotherapy; A Secondary Analysis of the DICE Study

Author

MS CGO, Cancer, Markar, Sheraz R, Sgromo, Bruno, Evans, Richard, Griffiths, Ewen A, Alfieri, Rita, Castoro, Carlo, Gronnier, Caroline, Gutschow, Christian A, Piessen, Guillaume, Capovilla, Giovanni, Grimminger, Peter P, Low, Donald E, Gossage, James, Gisbertz, Suzanne S, Ruurda, Jelle, van Hillegersberg, Richard, D'journo, Xavier Benoit, Phillips, Alexander W, Rosati, Ricardo, Hanna, George B, Maynard, Nick, Hofstetter, Wayne, Ferri, Lorenzo, Berge Henegouwen, Mark I, Owen, Richard, MS CGO, Cancer, Markar, Sheraz R, Sgromo, Bruno, Evans, Richard, Griffiths, Ewen A, Alfieri, Rita, Castoro, Carlo, Gronnier, Caroline, Gutschow, Christian A, Piessen, Guillaume, Capovilla, Giovanni, Grimminger, Peter P, Low, Donald E, Gossage, James, Gisbertz, Suzanne S, Ruurda, Jelle, van Hillegersberg, Richard, D'journo, Xavier Benoit, Phillips, Alexander W, Rosati, Ricardo, Hanna, George B, Maynard, Nick, Hofstetter, Wayne, Ferri, Lorenzo, Berge Henegouwen, Mark I, and Owen, Richard

Published
2024

10. Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial

Author

Ragunath, Krish, Rameh, Bashir, Fullarton, Grant, Tucker, Art, Penman, Ian, Rodgers, Colin, Neale, James, Edwards, Cathryn, Wise, Adelyn, Jones, Stephen, Church, Nicholas, Vaidya, Kishor, Balata, Sherzad, Todd, John, Gibbons, Michael, Johnston, David, Anderson, Mark, Davies, Gareth, Dickey, William, Murdock, Andrew, Turner, Graham, Goddard, Andrew, Gore, Stephen, Haigh, Chris, Harding, Timothy, Jackson, Lucina, Murray, Iain, Worthingon, Joy, Lee, Thomas, Lim, Peik Loon, McLoughlin, James, Macdonald, Christopher, Mairs, Philip, Monk, David, Preston, Sean, Pugh, Stirling, Smart, Howard, Soliman, Ashraf, Isaacs, Peter, Aldulaimi, David, Trudgill, Nigel, Teare, Julian, Benhamida, Abduljalil, Bell, Andrew, Boulton-Jones, Robert, Daneshmend, Tawfique, Suzuki, Hisaharu, Cullen, Sue, Fitzgerald, Rebecca, Ransford, Rupert, Rahman, Mohammad Mesbahur, Tebala, Giovanni Domenico, Hallissey, Michael, Kelly, Carrie, Hickish, Tamas, Taha, Ali, Rademaker, Johan, Whitehead, Mark, Kelly, Sean, Phull, Perminder, Sharma, Naveen, Perry, Ian, Sankara-Raman, Vankatraman, Ali, Haythem, Khan, Iqbal, Curtis, Howard, Wadley, Martin, Stone, Adam, Sukumaran, Sumesh, Higham, Andrew, Lewis, Stephen, Haycock, Adam, Usselmann, Bernhard, Johnston, Simon Douglas, Tham, Tony, Campbell, Stewart, Douds, Andrew, Dunn, Jason, Sargeant, Ian, Narain, Mark, Maynard, Nick, Chilton, Andrew, Green, Susi, Loft, Duncan, Decadt, Bart, Mendall, Michael, Heydtmann, Mathis, Fisher, Neil, Jankowski, Janusz A Z, de Caestecker, John, Love, Sharon B, Reilly, Gavin, Watson, Peter, Sanders, Scott, Ang, Yeng, Morris, Danielle, Bhandari, Pradeep, Brooks, Claire, Attwood, Stephen, Harrison, Rebecca, Barr, Hugh, and Moayyedi, Paul

Published
2018
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11. Lasting Symptoms After Esophageal Resection (LASER): European Multicenter Cross-sectional Study

Author

Markar, Sheraz R., Zaninotto, Giovanni, Castoro, Carlo, Johar, Asif, Lagergren, Pernilla, Elliott, Jessie A., Gisbertz, Suzanne S., Mariette, Christophe, Alfieri, Rita, Huddy, Jeremy, Sounderajah, Viknesh, Pinto, Eleonora, Scarpa, Marco, Klevebro, Fredrik, Sunde, Berit, Murphy, Conor F., Greene, Christine, Ravi, Narayanasamy, Piessen, Guillaume, Brenkman, Hylke, Ruurda, Jelle P., Van Hillegersberg, Richard, Lagarde, Sjoerd, Wijnhoven, Bas, Pera, Manuel, Roig, José, Castro, Sandra, Matthijsen, Robert, Findlay, John, Antonowicz, Stefan, Maynard, Nick, McCormack, Orla, Ariyarathenam, Arun, Sanders, Grant, Cheong, Edward, Jaunoo, Shameen, Allum, William, Van Lanschot, Jan, Nilsson, Magnus, Reynolds, John V., van Berge Henegouwen, Mark I., and Hanna, George B.

Published
2020
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15. Building a FutureG Future Requires Investments

Author

Maynard, Nick and Seraphin, Arun

Subjects
Telecommunication systems, National security, Investments, Wireless telecommunications equipment, Wireless telecommunications equipment, Aerospace and defense industries, Business
Abstract

The Defense Department has correctly identified FutureG as a critical technology area that will lay the groundwork for continued U.S. leadership in information technology, which is vital for maintaining our [...]

Published
2023

16. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer : a modified Delphi consensus process

Author

Chidambaram, Swathikan, Patel, Nikhil M, Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A, Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H, Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B Mark, van Berge Henegouwen, Mark I, van Hillegesberg, Richard, Watson, David I, Vohra, Ravinder, Maynard, Nick, Markar, Sheraz R, Chidambaram, Swathikan, Patel, Nikhil M, Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A, Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H, Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B Mark, van Berge Henegouwen, Mark I, van Hillegesberg, Richard, Watson, David I, Vohra, Ravinder, Maynard, Nick, and Markar, Sheraz R

Abstract

BACKGROUND: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. METHODS: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. RESULTS: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. CONCLUSION: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.

Published
2023
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17. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer:a modified Delphi consensus process

Author

Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, van Berge Henegouwen, Mark I., van Hillegesberg, Richard, Watson, David I., Vohra, Ravinder, Maynard, Nick, Markar, Sheraz R., Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, van Berge Henegouwen, Mark I., van Hillegesberg, Richard, Watson, David I., Vohra, Ravinder, Maynard, Nick, and Markar, Sheraz R.

Abstract

BACKGROUND: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. METHODS: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. RESULTS: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. CONCLUSION: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.

Published
2023

19. Research protocol for the Paraesophageal hernia symptom tool, a prospective multi-center cohort study to identify the need and threshold for surgery and assess the symptom response to surgery

Author

Menon, Nainika, primary, Guidozzi, Nadia, additional, Chidambaram, Swathikan, additional, Puri, Aiysha, additional, Sounderajah, Viknesh, additional, Ferri, Lorenzo, additional, Griffiths, Ewen A, additional, Low, Donald, additional, Maynard, Nick, additional, Mueller, Carmen, additional, Pera, Manuel, additional, van Berge Henegouwen, Mark I, additional, Watson, David I, additional, Zaininotto, Giovanni, additional, Hanna, George B, additional, and Markar, Sheraz R, additional

Published
2023
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20. Risk Prediction Model of 90-Day Mortality after Esophagectomy for Cancer

Author

D'Journo, Xavier Benoit, Boulate, David, Fourdrain, Alex, Loundou, Anderson, van Berge Henegouwen, Mark I, Gisbertz, Suzanne S, O'Neill, J Robert, Hoelscher, Arnulf, Piessen, Guillaume, van Lanschot, Jan, Wijnhoven, Bas, Jobe, Blair, Davies, Andrew, Schneider, Paul M, Pera, Manuel, Nilsson, Magnus, Nafteux, Philippe, Kitagawa, Yuko, Morse, Christopher R, Hofstetter, Wayne, Molena, Daniela, Jimmy Bok-Yan, So, Immanuel, Arul, Parsons, Simon L, Larsen, Michael Hareskov, Dolan, James P, Wood, Stephanie G, Maynard, Nick, Smithers, Mark, Puig, Sonia, Law, Simon, Wong, Ian, Kennedy, Andrew, Kangning, Wang, Reynolds, John V, Pramesh, C S, Ferguson, Mark, Darling, Gail, Schröder, Wolfgang, Bludau, Marc, Underwood, Tim, van Hillegersberg, Richard, Chang, Andrew, Cecconello, Ivan, Ribeiro, Ulysses, de Manzoni, Giovanni, Rosati, Riccardo, Kuppusamy, Madhankumar, Thomas, Pascal Alexandre, Low, Donald E, Weindelmayer, J., Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, D'Journo, Xavier Benoit, Boulate, David, Fourdrain, Alex, Loundou, Anderson, van Berge Henegouwen, Mark I, Gisbertz, Suzanne S, O'Neill, J Robert, Hoelscher, Arnulf, Piessen, Guillaume, van Lanschot, Jan, Wijnhoven, Ba, Jobe, Blair, Davies, Andrew, Schneider, Paul M, Pera, Manuel, Nilsson, Magnu, Nafteux, Philippe, Kitagawa, Yuko, Morse, Christopher R, Hofstetter, Wayne, Molena, Daniela, So, Jimmy Bok-Yan, Immanuel, Arul, Parsons, Simon L, Larsen, Michael Hareskov, Dolan, James P, Wood, Stephanie G, Maynard, Nick, Smithers, Mark, Puig, Sonia, Law, Simon, Wong, Ian, Kennedy, Andrew, Kangning, Wang, Reynolds, John V, Pramesh, C S, Ferguson, Mark, Darling, Gail, Schröder, Wolfgang, Bludau, Marc, Underwood, Tim, van Hillegersberg, Richard, Chang, Andrew, Cecconello, Ivan, Ribeiro, Ulysse, de Manzoni, Giovanni, Rosati, Riccardo, Kuppusamy, Madhankumar, Thomas, Pascal Alexandre, and Low, Donald E

Subjects
Male, medicine.medical_specialty, Time Factors, Esophageal Neoplasms, medicine.medical_treatment, 030230 surgery, Logistic regression, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, SDG 3 - Good Health and Well-being, Risk Factors, Internal medicine, medicine, Humans, Retrospective Studies, Original Investigation, Models, Statistical, Performance status, Receiver operating characteristic, business.industry, Mortality rate, Esophageal cancer, Middle Aged, medicine.disease, Prognosis, Esophagectomy, 030220 oncology & carcinogenesis, Cohort, Surgery, Female, business, Body mass index
Abstract

Importance: Ninety-day mortality rates after esophagectomy are an indicator of the quality of surgical oncologic management. Accurate risk prediction based on large data sets may aid patients and surgeons in making informed decisions. Objective: To develop and validate a risk prediction model of death within 90 days after esophagectomy for cancer using the International Esodata Study Group (IESG) database, the largest existing prospective, multicenter cohort reporting standardized postoperative outcomes. Design, Setting, and Participants: In this diagnostic/prognostic study, we performed a retrospective analysis of patients from 39 institutions in 19 countries between January 1, 2015, and December 31, 2019. Patients with esophageal cancer were randomly assigned to development and validation cohorts. A scoring system that predicted death within 90 days based on logistic regression ß coefficients was conducted. A final prognostic score was determined and categorized into homogeneous risk groups that predicted death within 90 days. Calibration and discrimination tests were assessed between cohorts. Exposures: Esophageal resection for cancer of the esophagus and gastroesophageal junction. Main Outcomes and Measures: All-cause postoperative 90-day mortality. Results: A total of 8403 patients (mean [SD] age, 63.6 [9.0] years; 6641 [79.0%] male) were included. The 30-day mortality rate was 2.0% (n = 164), and the 90-day mortality rate was 4.2% (n = 353). Development (n = 4172) and validation (n = 4231) cohorts were randomly assigned. The multiple logistic regression model identified 10 weighted point variables factored into the prognostic score: age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume. The prognostic scores were categorized into 5 risk groups: very low risk (score, =1; 90-day mortality, 1.8%), low risk (score, 0; 90-day mortality, 3.0%), medium risk (score, -1 to -2; 90-day mortality, 5.8%), high risk (score, -3 to -4: 90-day mortality, 8.9%), and very high risk (score, =-5; 90-day mortality, 18.2%). The model was supported by nonsignificance in the Hosmer-Lemeshow test. The discrimination (area under the receiver operating characteristic curve) was 0.68 (95% CI, 0.64-0.72) in the development cohort and 0.64 (95% CI, 0.60-0.69) in the validation cohort. Conclusions and Relevance: In this study, on the basis of preoperative variables, the IESG risk prediction model allowed stratification of an individual patient's risk of death within 90 days after esophagectomy. These data suggest that this model can help in the decision-making process when esophageal cancer surgery is being considered and in informed consent.

Published
2021
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22. Influence of postoperative complications following esophagectomy for cancer on quality of life: A European multicenter study

Author

Schuring, N., primary, Jezerskyte, E., additional, van Berge Henegouwen, M.I., additional, Sprangers, M.A.G., additional, Lagergren, P., additional, Johar, A., additional, Markar, S.R., additional, Gisbertz, S.S., additional, Markar, Sheraz R., additional, Zaninotto, Giovanni, additional, Castoro, Carlo, additional, Johar, Asif, additional, Lagergren, Pernilla, additional, Elliott, Jessie A., additional, Gisbertz, Suzanne S., additional, Mariette, Christophe, additional, Alfieri, Rita, additional, Huddy, Jeremy, additional, Sounderajah, Viknesh, additional, Pinto, Eleonora, additional, Scarpa, Marco, additional, Klevebro, Fredrik, additional, Sunde, Berit, additional, Murphy, Conor F., additional, Greene, Christine, additional, Ravi, Narayanasamy, additional, Piessen, Guillaume, additional, Brenkman, Hylke, additional, Ruurda, Jelle P., additional, Hillegersberg, Richard Van, additional, Lagarde, Sjoerd, additional, Wijnhoven, Bas, additional, Pera, Manuel, additional, Roig, José, additional, Castro, Sandra, additional, Matthijsen, Robert, additional, Findlay, John, additional, Antonowicz, Stefan, additional, Maynard, Nick, additional, McCormack, Orla, additional, Ariyarathenam, Arun, additional, Sanders, Grant, additional, Cheong, Edward, additional, Jaunoo, Shameen, additional, Allum, William, additional, Lanschot, Jan Van, additional, Nilsson, Magnus, additional, Reynolds, John V., additional, van Berge Henegouwen, Mark I., additional, and Hanna, George B., additional

Published
2023
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23. Benchmarking Complications Associated with Esophagectomy

Author

Low, Donald E., Kuppusamy, Madhan Kumar, Alderson, Derek, Cecconello, Ivan, Chang, Andrew C., Darling, Gail, Davies, Andrew, D’Journo, Xavier Benoit, Gisbertz, Suzanne S., Griffin, S. Michael, Hardwick, Richard, Hoelscher, Arnulf, Hofstetter, Wayne, Jobe, Blair, Kitagawa, Yuko, Law, Simon, Mariette, Christophe, Maynard, Nick, Morse, Christopher R., Nafteux, Philippe, Pera, Manuel, Pramesh, C. S., Puig, Sonia, Reynolds, John V., Schroeder, Wolfgang, Smithers, Mark, and Wijnhoven, B. P. L.

Published
2019
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27. A O05 MUlti-center cohort Study of Oesophageal Injuries and related Clinical outcomes (MUSOIC) study

Author

Chidambaram, Swathikan, primary, Kawka, Michael, additional, Sultan, Javed, additional, Phillips, Alexander, additional, Scabbiolo, Zoe, additional, Evan, Richard, additional, Maynard, Nick, additional, Vohra, Ravinder, additional, Griffiths, Ewen, additional, Gossage, James, additional, Underwood, Tim, additional, Walker, Robert, additional, and Markar, Sheraz, additional

Published
2022
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29. UEG and EAES rapid guideline: Update systematic review, network meta‐analysis, CINeMA and GRADE assessment, and evidence‐informed European recommendations on surgical management of GERD

Author

Markar, Sheraz, primary, Andreou, Alexandros, additional, Bonavina, Luigi, additional, Florez, Ivan D., additional, Huo, Bright, additional, Kontouli, Katerina‐Maria, additional, Low, Donald E., additional, Mavridis, Dimitris, additional, Maynard, Nick, additional, Moss, Alan, additional, Pera, Manuel, additional, Savarino, Edoardo, additional, Siersema, Peter, additional, Sifrim, Daniel, additional, Watson, David I., additional, Zaninotto, Giovanni, additional, and Antoniou, Stavros A., additional

Published
2022
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30. Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS)/Perioperative Quality Initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy

Author

Singh, Pritam, Gossage, James, Markar, Sheraz, Pucher, Philip H, Wickham, Alex, Weblin, Jonathan, Chidambaram, Swathikan, Bull, Alexander, Pickering, Oliver, Mythen, Monty, Maynard, Nick, Grocott, Mike, Underwood, Tim, Levett, Denny, West, Malcolm, and Noble, Fergus

Subjects
Esophagectomy, Postoperative Care, Postoperative Complications, Quality of Life, Humans, Surgery, Ireland, United Kingdom
Abstract

Background Pulmonary complications are the most common morbidity after oesophagectomy, contributing to mortality and prolonged postoperative recovery, and have a negative impact on health-related quality of life. A variety of single or bundled interventions in the perioperative setting have been developed to reduce the incidence of pulmonary complications. Significant variation in practice exists across the UK. The aim of this modified Delphi consensus was to deliver clear evidence-based consensus recommendations regarding intraoperative and postoperative care that may reduce pulmonary complications after oesophagectomy. Methods With input from a multidisciplinary group of 23 experts in the perioperative management of patients undergoing surgery for oesophageal cancer, a modified Delphi method was employed. Following an initial systematic review of relevant literature, a range of anaesthetic, surgical, and postoperative care interventions were identified. These were then discussed during a two-part virtual conference. Recommendation statements were drafted, refined, and agreed by all attendees. The level of evidence supporting each statement was considered. Results Consensus was reached on 12 statements on topics including operative approach, pyloric drainage strategies, intraoperative fluid and ventilation strategies, perioperative analgesia, postoperative feeding plans, and physiotherapy interventions. Seven additional questions concerning the perioperative management of patients undergoing oesophagectomy were highlighted to guide future research. Conclusion Clear consensus recommendations regarding intraoperative and postoperative interventions that may reduce pulmonary complications after oesophagectomy are presented.

Published
2022

33. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process

Author

Chidambaram, Swathikan, primary, Patel, Nikhil M, additional, Sounderajah, Viknesh, additional, Alfieri, Rita, additional, Bonavina, Luigi, additional, Cheong, Edward, additional, Cockbain, Andy, additional, D’Journo, Xavier Benoit, additional, Ferri, Lorenzo, additional, Griffiths, Ewen A, additional, Grimminger, Peter, additional, Gronnier, Caroline, additional, Gutschow, Christian, additional, Hedberg, Jakob, additional, Kauppila, Joonas H, additional, Lagarde, Sjoerd, additional, Low, Donald, additional, Nafteux, Philippe, additional, Nieuwenhuijzen, Grard, additional, Nilsson, Magnus, additional, Rosati, Riccardo, additional, Schroeder, Wolfgang, additional, Smithers, B Mark, additional, van Berge Henegouwen, Mark I, additional, van Hillegesberg, Richard, additional, Watson, David I, additional, Vohra, Ravinder, additional, Maynard, Nick, additional, and Markar, Sheraz R, additional

Published
2022
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35. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process

Author

Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, Henegouwen, Mark I. van Berge, van Hillegesberg, Richard, Watson, David, I, Vohra, Ravinder, Maynard, Nick, Markar, Sheraz R., Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, Henegouwen, Mark I. van Berge, van Hillegesberg, Richard, Watson, David, I, Vohra, Ravinder, Maynard, Nick, and Markar, Sheraz R.

Abstract

Background: There is currently a lack of evidence-based guidelines regarding surveillance for recurrence after esophageal and gastric (OG) cancer surgical resection, and which symptoms should prompt endoscopic or radiological investigations for recurrence. The aim of this study was to develop a core symptom set using a modified Delphi consensus process that should guide clinicians to carry out investigations to look for suspected recurrent OG cancer in previously asymptomatic patients. Methods: A web-based survey of 42 questions was sent to surgeons performing OG cancer resections at high volume centers. The first section evaluated the structure of follow-up and the second, determinants of follow-up. Two rounds of a modified Delphi consensus process and a further consensus workshop were used to determine symptoms warranting further investigations. Symptoms with a 75% consensus agreement as suggestive of recurrent cancer were included in the core symptom set. Results: 27 surgeons completed the questionnaires. A total of 70.3% of centers reported standardized surveillance protocols, whereas 3.7% of surgeons did not undertake any surveillance in asymptomatic patients after OG cancer resection. In asymptomatic patients, 40.1% and 25.9% of centers performed routine imaging and endoscopy, respectively. The core set that reached consensus, consisted of eight symptoms that warranted further investigations included; dysphagia to solid food, dysphagia to liquids, vomiting, abdominal pain, chest pain, regurgitation of foods, unexpected weight loss and progressive hoarseness of voice. Conclusion: There is global variation in monitoring patients after OG cancer resection. Eight symptoms were identified by the consensus process as important in prompting radiological or endoscopic investigation for suspected recurrent malignancy. Further randomized controlled trials are necessary to link surveillance strategies to survival outcomes and evaluate prognostic value.

Published
2022

36. Lasting Symptoms After Esophageal Resection (LASER):European Multicenter Cross-sectional Study

Author

Markar, Sheraz R., Zaninotto, Giovanni, Castoro, Carlo, Johar, Asif, Lagergren, Pernilla, Elliott, Jessie A., Gisbertz, Suzanne S., Mariette, Christophe, Alfieri, Rita, Huddy, Jeremy, Sounderajah, Viknesh, Pinto, Eleonora, Scarpa, Marco, Klevebro, Fredrik, Sunde, Berit, Murphy, Conor F., Greene, Christine, Ravi, Narayanasamy, Piessen, Guillaume, Brenkman, Hylke, Ruurda, Jelle P., Van Hillegersberg, Richard, Lagarde, Sjoerd, Wijnhoven, Bas, Pera, Manuel, Roig, José, Castro, Sandra, Matthijsen, Robert, Findlay, John, Antonowicz, Stefan, Maynard, Nick, Mccormack, Orla, Ariyarathenam, Arun, Sanders, Grant, Cheong, Edward, Jaunoo, Shameen, Allum, William, Van Lanschot, Jan, Nilsson, Magnus, Reynolds, John V., Henegouwen, Mark I.van Berge, Hanna, George B., Markar, Sheraz R., Zaninotto, Giovanni, Castoro, Carlo, Johar, Asif, Lagergren, Pernilla, Elliott, Jessie A., Gisbertz, Suzanne S., Mariette, Christophe, Alfieri, Rita, Huddy, Jeremy, Sounderajah, Viknesh, Pinto, Eleonora, Scarpa, Marco, Klevebro, Fredrik, Sunde, Berit, Murphy, Conor F., Greene, Christine, Ravi, Narayanasamy, Piessen, Guillaume, Brenkman, Hylke, Ruurda, Jelle P., Van Hillegersberg, Richard, Lagarde, Sjoerd, Wijnhoven, Bas, Pera, Manuel, Roig, José, Castro, Sandra, Matthijsen, Robert, Findlay, John, Antonowicz, Stefan, Maynard, Nick, Mccormack, Orla, Ariyarathenam, Arun, Sanders, Grant, Cheong, Edward, Jaunoo, Shameen, Allum, William, Van Lanschot, Jan, Nilsson, Magnus, Reynolds, John V., Henegouwen, Mark I.van Berge, and Hanna, George B.

Abstract

Objective:To identify the most prevalent symptoms and those with greatest impact upon health-related quality of life (HRQOL) among esophageal cancer survivors.Background:Long-term symptom burden after esophagectomy, and associations with HRQOL, are poorly understood.Patients and Methods:Between 2010 and 2016, patients from 20 European Centers who underwent esophageal cancer surgery, and were disease-free at least 1 year postoperatively were asked to complete LASER, EORTC-QLQ-C30, and QLQ-OG25 questionnaires. Specific symptom questionnaire items that were associated with poor HRQOL as identified by EORTC QLQ-C30 and QLQ-OG25 were identified by multivariable regression analysis and combined to form a tool.Results:A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had symptoms associated with their esophagectomy. Ongoing weight loss was reported by 10.4% of patients, and only 13.8% returned to work with the same activities.Three LASER symptoms were correlated with poor HRQOL on multivariable analysis; pain on scars on chest (odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81 ± 0.02 and 0.82 ± 0.09 respectively.Conclusion:Two-thirds of patients experience significant symptoms more than 1 year after surgery. The 3 key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased support.

Published
2022

37. Identifying a core symptom set triggering radiological and endoscopic investigations for suspected recurrent esophago-gastric cancer: a modified Delphi consensus process

Author

MS CGO, Cancer, Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, van Berge Henegouwen, Mark I., van Hillegesberg, Richard, Watson, David I., Vohra, Ravinder, Maynard, Nick, Markar, Sheraz R., MS CGO, Cancer, Chidambaram, Swathikan, Patel, Nikhil M., Sounderajah, Viknesh, Alfieri, Rita, Bonavina, Luigi, Cheong, Edward, Cockbain, Andy, D'Journo, Xavier Benoit, Ferri, Lorenzo, Griffiths, Ewen A., Grimminger, Peter, Gronnier, Caroline, Gutschow, Christian, Hedberg, Jakob, Kauppila, Joonas H., Lagarde, Sjoerd, Low, Donald, Nafteux, Philippe, Nieuwenhuijzen, Grard, Nilsson, Magnus, Rosati, Riccardo, Schroeder, Wolfgang, Smithers, B. Mark, van Berge Henegouwen, Mark I., van Hillegesberg, Richard, Watson, David I., Vohra, Ravinder, Maynard, Nick, and Markar, Sheraz R.

Published
2022

38. Lasting Symptoms After Esophageal Resection (LASER): European Multicenter Cross-sectional Study

Author

MS CGO, Cancer, Markar, Sheraz R, Zaninotto, Giovanni, Castoro, Carlo, Johar, Asif, Lagergren, Pernilla, Elliott, Jessie A, Gisbertz, Suzanne S, Mariette, Christophe, Alfieri, Rita, Huddy, Jeremy, Sounderajah, Viknesh, Pinto, Eleonora, Scarpa, Marco, Klevebro, Fredrik, Sunde, Berit, Murphy, Conor F, Greene, Christine, Ravi, Narayanasamy, Piessen, Guillaume, Brenkman, Hylke, Ruurda, Jelle P, Van Hillegersberg, Richard, Lagarde, Sjoerd, Wijnhoven, Bas, Pera, Manuel, Roig, José, Castro, Sandra, Matthijsen, Robert, Findlay, John, Antonowicz, Stefan, Maynard, Nick, McCormack, Orla, Ariyarathenam, Arun, Sanders, Grant, Cheong, Edward, Jaunoo, Shameen, Allum, William, Van Lanschot, Jan, Nilsson, Magnus, Reynolds, John V, Henegouwen, Mark I van Berge, Hanna, George B, MS CGO, Cancer, Markar, Sheraz R, Zaninotto, Giovanni, Castoro, Carlo, Johar, Asif, Lagergren, Pernilla, Elliott, Jessie A, Gisbertz, Suzanne S, Mariette, Christophe, Alfieri, Rita, Huddy, Jeremy, Sounderajah, Viknesh, Pinto, Eleonora, Scarpa, Marco, Klevebro, Fredrik, Sunde, Berit, Murphy, Conor F, Greene, Christine, Ravi, Narayanasamy, Piessen, Guillaume, Brenkman, Hylke, Ruurda, Jelle P, Van Hillegersberg, Richard, Lagarde, Sjoerd, Wijnhoven, Bas, Pera, Manuel, Roig, José, Castro, Sandra, Matthijsen, Robert, Findlay, John, Antonowicz, Stefan, Maynard, Nick, McCormack, Orla, Ariyarathenam, Arun, Sanders, Grant, Cheong, Edward, Jaunoo, Shameen, Allum, William, Van Lanschot, Jan, Nilsson, Magnus, Reynolds, John V, Henegouwen, Mark I van Berge, and Hanna, George B

Published
2022

41. Governance models to support patient safety when undergoing maximal effort cytoreductive surgery for advanced ovarian/fallopian tube/primary peritoneal cancer – a joint statement of ACPGBI, ASGBI, AUGIS and BGCS

Author

Maxwell‐Armstrong, Charles, primary, Dobbs, Stephen, additional, Tierney, Gill, additional, Maynard, Nick, additional, Wood, Nick, additional, Kaufmann, Angelika, additional, McCarthy, Kathryn, additional, Bharathan, Balamurali, additional, and Bird, Lisa, additional

Published
2022
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42. AUGIS Surv-G: Prediction of long-term survival after gastrectomy using Random Survival Forests

Author

Rahman, Saqib A, Maynard, Nick, Trudgill, Nigel, Crosby, Tom, Park, M, Wahedally, H, Underwood, Timothy, and Cromwell, David

Abstract

Background: no well validated and contemporaneous tools for personalised prognostication of gastric adenocarcinoma exist. This study aimed to derive and validate a prognostic model for overall survival after surgery for gastric adenocarcinoma using a large national dataset and a non-linear Random Survival Forest (RSF) methodology.Patients and methods: national audit data from England and Wales were used to identify patients who underwent a potentially curative gastrectomy for adenocarcinoma of the stomach. A total of 2931 patients were included and 29 clinical and pathological variables considered for their impact on survival. A RSF was then trained and validated internally using bootstrapping with calibration and discrimination (time dependent AUC) assessed.Results: the median survival of the cohort was 69 months, with a 5-year survival of 53.2%. Ten variables were found to significantly influence survival and included in the final model, with the most important being lymph node positivity, pT stage and achieving an R0 resection. Patient characteristics including ASA grade and age were also influential. On validation the model achieved excellent performance with a five-year tAUC of 0.80 (95%CI 0.78-0.82) and good agreement between observed and predicted survival probabilities. A wide spread of predictions for three- (14.8-98.3%, IQR 43.2-84.4%) and five-year (9.4-96.1%, IQR 31.7-73.8%) survival were seen.Conclusions: a prognostic model for survival after a potentially curative resection for gastric adenocarcinoma was derived and exhibited excellent discrimination and calibration of predictions. After appropriate external validation, it could provide utility in both prognostication for patients and for benchmarking of treatment responses.

Published
2021

43. The AUGIS Survival Predictor: Prediction of Long-Term and Conditional Survival After Esophagectomy Using Random Survival Forests.

Author

Rahman, Saqib A., Walker, Robert C., Maynard, Nick, Nigel Trudgill, Crosby, Tom, Cromwell, David A., and Underwood, Timothy J.

Abstract

Objective: The aim of this study was to develop a predictive model for overall survival after esophagectomy using pre/postoperative clinical data and machine learning. Summary Background Data: For patients with esophageal cancer, accurately predicting long-term survival after esophagectomy is challenging. This study investigated survival prediction after esophagectomy using a Random Survival Forest (RSF) model derived from routine data from a large, well-curated, national dataset. Methods: Patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2012 and 2018 in England and Wales who underwent an esophagectomy were included. Prediction models for overall survival were developed using the RSF method and Cox regression from 41 patient and disease characteristics. Calibration and discrimination (time-dependent area under the curve) were validated internally using bootstrap resampling. Results: The study analyzed 6399 patients, with 2625 deaths during follow-up. Median follow-up was 41 months. Overall survival was 47.1% at 5 years. The final RSF model included 14 variables and had excellent discrimination with a 5-year time-dependent area under the receiver operator curve of 83.9% [95% confidence interval (CI) 82.6%–84.9%], compared to 82.3% (95% CI 81.1%—83.3%) for the Cox model. The most important variables were lymph node involvement, pT stage, circumferential resection margin involvement (tumor at < 1 mm from cut edge) and age. There was a wide range of survival estimates even within TNM staging groups, with quintiles of prediction within Stage 3b ranging from 12.2% to 44.7% survival at 5 years. Conclusions: An RSF model for long-term survival after esophagectomy exhibited excellent discrimination and well-calibrated predictions. At a patient level, it provides more accuracy than TNM staging alone and could help in the delivery of tailored treatment and follow-up. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Evaluation of tumor regression by neoadjuvant chemotherapy regimens for esophageal adenocarcinoma: a systematic review and meta-analysis.

Author

Chidambaram, Swathikan, Sounderajah, Viknesh, Maynard, Nick, Owen, Richard, and Markar, Sheraz R

Subjects
NEOADJUVANT chemotherapy, COMBINED modality therapy, ADENOCARCINOMA, TREATMENT effectiveness, CHEMORADIOTHERAPY, ESOPHAGEAL motility disorders, RECTAL cancer
Abstract

Locally advanced esophageal adenocarcinomas (EACs) are treated with multimodal therapy, namely surgery, neoadjuvant chemotherapy (NAC) or chemoradiotherapy (CRT) depending on patient and tumor level factors. Yet, there is little consensus on choice of the optimum systemic therapy. To compare the pathological complete response (pCR) after FLOT, non-FLOT-based chemotherapy and chemoradiotherapy regimes in patients with EACs. A systematic review of the literature was performed using MEDLINE, EMBASE, the Cochrane Review and Scopus databases. Studies were included if they had investigated the use of chemo(radio)therapy regimens in the neoadjuvant setting for EAC and reported the pCR rates. A meta-analysis of proportions was performed to compare the pooled pCR rates between FLOT, non-FLOT and CRT cohorts. We included 22 studies that described tumor regression post-NAC. Altogether, 1,056 patients had undergone FLOT or DCF regimes, while 1,610 patients had received ECF or ECX. The pCR rates ranged from 3.3% to 54% for FLOT regimes, while pCR ranged between 0% and 31% for ECF/ECX protocols. Pooled random-effects meta-meta-analysis of proportions showed a statistically significant higher incidence of pCR in FLOT-based chemotherapy at 0.148 (95%CI: 0.080, 0.259) compared with non-FLOT-based chemotherapy at 0.074 (95%CI: 0.042, 0.129). However, pCR rates were significantly highest at 0.250 (95%CI: 0.202, 0.306) for CRT. The use of enhanced FLOT-based regimens have improved the pCR rates for chemotherapeutic regimes but still falls short of pathological outcomes from CRT. Further work can characterize clinical responses to neoadjuvant therapy and determine whether an organ-preservation strategy is feasible. [ABSTRACT FROM AUTHOR]

Published
2023
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48. O-BN01 The para-oesophageal hernia symptom tool (post): A modified delphi consensus study

Author

Puri, Aiysha, primary, Patel, Nikhil, additional, Sounderajah, Viknesh, additional, Ferri, Lorenzo, additional, Griffiths, Ewen, additional, Low, Donald, additional, Maynard, Nick, additional, Mueller, Carmen, additional, Pera, Manuel, additional, van Berge Henegouwen, Mark, additional, Watson, David, additional, Zaninotto, Giovanni, additional, Hanna, George, additional, and Markar, Sheraz, additional

Published
2021
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