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Publication Impact of laparoscopic surgery on lymph node harvest in elective colorectal cancer surgery(Wiley, 2020-07) Gallagher, Jessica; Cook, Timothy; Gallagher, Jessica; Cook, Timothy; Medical and DentalBackground: Lymph node (LN) harvest is a key part of colorectal cancer staging.The widely accepted standard is a minimum of 12 nodes per specimen. A greater number of nodes has been associated with a better prognosis. There are conflicting data on LN harvests in laparoscopic compared with open resections. This study aimed to assess if surgical access impacts on LN harvest and potential differences between right and left-sided resections.Methods: Data were collected on patients undergoing elective colorectal cancer resections between April 2016 and March 2018. Surgical access, type of operation and LN yield were recorded.Results: There were 516 patients (M:F 301:215), 350 laparoscopic, 126 open, 40 converted-to-open. Mean LN harvests for laparoscopic and open right-sided resections were 26.3 and 29.1 respectively. LN harvests were 23 and 23.3 for laparoscopic and open left-sided colonic resections respectively. Mean LN yield for rectal resections was laparoscopic: 19.3 and open: 22.3. There was no difference in the proportion of patients with fewer than 12 LNs following right-sided resections. A larger proportion of patients undergoing laparoscopic left-sided colonic and rectal resections had fewer than 12 LNs (Left colon: 13.9% vs 3.9%, Rectum: 18.2% vs 10.2%).Discussion: High mean LN harvests are achievable in laparoscopic and open colorectal surgery. The proportion of patients with fewer than 12 LNs was greater after laparoscopic resection. These data can be “lost” when average LN yields are presented. Caution must be taken in interpreting LN data and ongoing monitoring is required to ensure minimum standards are achievedPublication 123. Lymph node harvest in colorectal cancer resections: does surgicalurgency affect number of nodes?(Wiley, 2020-07) Gallagher, Jessica; Cook, Timothy; Gallagher, Jessica; Cook, Timothy; Additional Clinical ServicesBackground: Lymph node harvest is a key part of staging in colorectal cancer.The widely accepted standard is a minimum of 12 nodes per specimen. A higher total number of nodes has been associated with a better prognosis. It has previously been suggested that urgent or emergency colorectal cancer resections result in insufficient node harvests. The aim of this study was to compare lymph node harvests inpatients undergoing elective and emergency colorectal cancer resections patients.Methods: Data were collected on patients undergoing colorectal cancer resections between April 2016 and March 2018. The type of operation, urgency of surgery and lymph node yield were recorded.Results: There were 582 patients (M:F 332:250), of whom 66 (11%) underwent surgery on an urgent or emergency basis. Fewer than 12 nodes were harvested in 39(7.6%) of elective patients and 4 (6%) of urgent/emergency patients. The mean number of nodes harvested was 24 for planned patients and 26.5 for urgent/emergency patients. The proportion undergoing right sided resections was higher in the urgent/emergency group (53% vs. 42%). Comparison of right sided resections showed a mean yield of 27.1 for planned cases and 27.7 for urgent/emergency patients. The yield was also similar for left sided resections (planned – 21.8, urgent/emergency - 25.2).Discussion: This study has shown that, in a large volume unit, lymph node harvests in patients undergoing urgent or emergency colorectal cancer resection are equivalent to those having planned surgery. This permits accurate staging and adjuvant treatment planning for those patients presenting acutely.Publication WS13.399 The impact of surgical urgency on lymph node harvests in colorectal cancer resections(Wiley, 2020-12-07) Gallagher, Jessica; Cook, Timothy; Gallagher, Jessica; Cook, Timothy; Medical and DentalBackground: Lymph node harvest is a key part of staging in colorectal cancer. The widely accepted standard is a minimum of 12 nodes per specimen. A higher total number of nodes has been associated with a better prognosis. It has previously been suggested that urgent or emergency colorectal cancer resections results in insufficient node harvests. The aim of this study was to compare lymph node harvests in patients undergoing elective and emergency colorectal cancer resections patients. Methods: Data were collected on patients undergoing colorectal cancer resections between April 2016-March 2018. The type of operation, urgency of surgery and lymph node yield were recorded. Results: There were 582 patients (M:F 332:250). 66 (11%) underwent surgery on an urgent or emergency basis. Fewer than 12 nodes were harvested in 39 (7.6%) of elective patients and 4 (6%) of urgent/emergency patients. The mean number of nodes harvested was 24 for planned patients and 26.5 for urgent/emergency patients. The proportion undergoing right sided resections was higher in the urgent/emergency group (53% vs 42%). Comparison of right sided resections showed a mean yield of 27.1 for planned cases and 27.7 for urgent/emergency patients. The yield was also similar for left sided resections (planned – 21.8, urgent/emergency - 25.2). Discussion: This study has shown that, in a large volume unit, lymph node harvests in patients undergoing urgent or emergency colorectal cancer resection are equivalent to those having planned surgery. This permits accurate staging and adjuvant treatment planning for those patients presenting acutely.Publication What should be included in case report forms? Development and application of novel methods to inform surgical study design: a mixed methods case study in parastomal hernia prevention(BMJ Publishing Group, 2022-10-05) Murkin, Charlotte; Rooshenas, Leila; Smart, Neil; Daniels, I R; Pinkney, Tom; Shabbir, Jamshed; Rockall, Timothy; Bennett, Joanne; Torkington, Jared; Randall, Jonathan; Brandsma, H T; Reeves, Barnaby; Blazeby, Jane; Blencowe, Natalie; Bennett, Joanne; Medical and DentalObjectives: To describe the development and application of methods to optimise the design of case report forms (CRFs) for clinical studies evaluating surgical procedures, illustrated with an example of abdominal stoma formation. Design: (1) Literature reviews, to identify reported variations in surgical components of stoma formation, were supplemented by (2) intraoperative qualitative research (observations, videos and interviews), to identify unreported variations used in practice to generate (3) a 'long list' of items, which were rationalised using (4) consensus methods, providing a pragmatic list of CRF items to be captured in the Cohort study to Investigate the Prevention of parastomal HERnias (CIPHER) study. Setting: Two secondary care surgical centres in England. Participants: Patients undergoing stoma formation, surgeons undertaking stoma formation and stoma nurses. Outcome measures: Successful identification of key CRF items to be captured in the CIPHER study. Results: 59 data items relating to stoma formation were identified and categorised within six themes: (1) surgical approach to stoma formation; (2) trephine formation; (3) reinforcing the stoma trephine with mesh; (4) use of the stoma as a specimen extraction site; (5) closure of other wounds during the procedure; and (6) spouting the stoma. Conclusions: This study used multimodal data collection to understand and capture the technical variations in stoma formation and design bespoke CRFs for a multicentre cohort study. The CIPHER study will use the CRFs to examine associations between the technical variations in stoma formation and risks of developing a parastomal hernia.Publication Intestinal obstruction(Elsevier, 2022-11-24) Griffiths, Shelly; Glancy, Damian; Griffiths, Shelly; Glancy, Damian; Medical and DentalIntestinal obstruction is a common surgical emergency, accounting for up to 20% of admissions with acute abdominal pain. Of these, 80% will have small bowel obstruction, the most common cause being adhesions. Colorectal cancer is the most common cause of large bowel obstruction. The cardinal features of obstruction are abdominal pain, vomiting, distension and absolute constipation. Initial management comprises adequate fluid resuscitation, decompression with a nasogastric tube and early identification of strangulation (signs of which may include tachycardia, tenderness, fever and leucocytosis) requiring operative intervention. Appropriate use of contrast imaging can differentiate between patients that are likely to settle conservatively and those that will require surgery.