James Gossage

King's College London, Londinium, England, United Kingdom

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Publications (48)236.15 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aims to establish the prevalence and predictors of anxiety and depression among esophageal cancer patients, post-diagnosis but prior to curatively intended surgery. This was a cross-sectional study using data from a hospital-based prospective cohort study, carried out at St Thomas' Hospital, London. Potential predictor variables were retrieved from medical charts and self-report questionnaires. Anxiety and depression were measured prior to esophageal cancer surgery, using the Hospital Anxiety and Depression Scale. Prevalence of anxiety and depression was calculated using the established cutoff (scores ≥8 on each subscale) indicating cases of 'possible-probable' anxiety or depression, and multivariable logistic regression analyses were performed to examine predictors of emotional distress. Among the 106 included patients, 36 (34%) scored above the cutoff (≥8) for anxiety and 24 (23%) for depression. Women were more likely to report anxiety than men (odds ratio 4.04, 95% confidence interval 1.45-11.16), and patients reporting limitations in their activity status had more than five times greater odds of reporting depression (odds ratio 6.07, 95% confidence interval 1.53-24.10). A substantial proportion of esophageal cancer patients report anxiety and/or depression prior to surgery, particularly women and those with limited activity status, which highlights a need for qualified emotional support.
    Diseases of the Esophagus 11/2015; DOI:10.1111/dote.12437 · 1.78 Impact Factor
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    ABSTRACT: The prognostic role of the extent of lymphadenectomy during surgery for esophageal cancer is uncertain and requires clarification. To clarify whether the number of removed lymph nodes influences mortality following surgery for esophageal cancer. Conducted from January 1, 2000, to January 31, 2014, this was a cohort study of patients who underwent esophagectomy for cancer in 2000-2012 at a high-volume hospital for esophageal cancer surgery, with follow-up until 2014. The main exposure was the number of resected lymph nodes. Secondary exposures were the number of metastatic lymph nodes and positive to negative lymph node ratio. The independent role of the extent of lymphadenectomy in relation to all-cause and disease-specific 5-year mortality was analyzed using Cox proportional hazard regression models, providing hazard ratios (HRs) with 95% CIs. The HRs were adjusted for age, pathological T category, tumor differentiation, margin status, calendar period of surgery, and response to preoperative chemotherapy. Among 606 included patients, 506 (83.5%) had adenocarcinoma of the esophagus, 323 (53%) died within 5 years of surgery, and 235 (39%) died of tumor recurrence. The extent of lymphadenectomy was not statistically significantly associated with all-cause or disease-specific mortality, independent of the categorization of lymphadenectomy or stratification for T category, calendar period, or chemotherapy. Patients in the fourth quartile of the number of removed nodes (21-52 nodes) did not demonstrate a statistically significant reduction in all-cause 5-year mortality compared with those in the lowest quartile (0-10 nodes) (HR, 0.86; 95% CI, 0.63-1.17), particularly not in the most recent calendar period (HR, 0.98; 95% CI, 0.57-1.66 for years 2007-2012). A greater number of metastatic nodes and a higher positive to negative node ratio was associated with increased mortality rates, and these associations showed dose-response associations. This study indicated that the extent of lymphadenectomy during surgery for esophageal cancer might not influence 5-year all-cause or disease-specific survival. These results challenge current clinical guidelines.
    JAMA SURGERY 09/2015; DOI:10.1001/jamasurg.2015.2611 · 3.94 Impact Factor
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    ABSTRACT: The molecular genetic relationship between esophageal adenocarcinoma (EAC) and its precursor lesion, Barrett's esophagus, is poorly understood. Using whole-genome sequencing on 23 paired Barrett's esophagus and EAC samples, together with one in-depth Barrett's esophagus case study sampled over time and space, we have provided the following new insights: (i) Barrett's esophagus is polyclonal and highly mutated even in the absence of dysplasia; (ii) when cancer develops, copy number increases and heterogeneity persists such that the spectrum of mutations often shows surprisingly little overlap between EAC and adjacent Barrett's esophagus; and (iii) despite differences in specific coding mutations, the mutational context suggests a common causative insult underlying these two conditions. From a clinical perspective, the histopathological assessment of dysplasia appears to be a poor reflection of the molecular disarray within the Barrett's epithelium, and a molecular Cytosponge technique overcomes sampling bias and has the capacity to reflect the entire clonal architecture.
    Nature Genetics 07/2015; 47(9). DOI:10.1038/ng.3357 · 29.35 Impact Factor
  • O Hynes · A Champion · A Gardiner · A Davies · J Gossage ·
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    ABSTRACT: Introduction Weight loss is a predictor of poorer outcomes in patients undergoing OG cancer surgery. Patients present with weight loss and difficulties with eating and drinking. The majority will receive neoadjuvant chemotherapy (NAC) which may further impact on nutritional status. This study looks at the effect of weight loss on postoperative hospital length of stay (LOS) in patients undergoing Oesophagectomy/TG for OG cancer. Method A retrospective observational study was carried out on 74 patients who underwent Oesophagectomy/TG for OG cancer at GSTFT in 2014. Data on preoperative weight loss, NAC and postoperative LOS was collated. Weight loss was assessed by comparing weight at diagnosis to weight on the day before surgery. For patients who were weight stable/gain, further assessment of weight loss during NAC was undertaken. Results Two patients died in hospital and were excluded. Two patients did not have any information available of preoperative weight changes and so were also excluded. Table 1apresents the demographics and descriptive statistics (using Microsoft Xcel) of results for the total study population (n = 7). Table 1bdisplays the demographics and descriptive statistics for the subgroup of patients who were weight stable/gain overall preoperatively. Patients who are weight stable throughout chemotherapy have a shorter median LOS than those who lose weight and regain it. Conclusion Patients who lose weight before surgery are likely to stay in hospital for longer afterwards. The results of this study support the need for preoperative nutritional optimisation in this patient population. The subgroup analysis, although a small sample size, supports a proactive rather than reactive approach to this. In many centres, Dietitian referral relies on the presence of weight loss or nutritional problems. Further studies are required to elucidate optimal preoperative nutritional interventions to improve treatment and patient reported outcomes. Disclosure of interest None Declared.
    Gut 06/2015; 64(Suppl 1):A473.1-A473. DOI:10.1136/gutjnl-2015-309861.1035 · 14.66 Impact Factor
  • O Hynes · A Champion · A Gardiner · A Davies · J Gossage ·

    Gut 06/2015; 64(Suppl 1):A473.2-A474. DOI:10.1136/gutjnl-2015-309861.1036 · 14.66 Impact Factor
  • CM Iezzi · JA Gossage · AR Davies · SK Archer ·
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    ABSTRACT: Introduction Patients who have undergone a transhiatal oesophagectomy (THO) are at risk of pharyngeal dysphagia and subsequent aspiration due to potential disruption in deglutitive biomechanics and/or neuropraxic injury to the recurrent laryngeal nerve. An evaluation was conducted of a new multidisciplinary enhanced recovery pathway (ERP) where all patients undergoing oesophagectomy with cervical anastomosis are seen both pre and post operatively by Speech and Language Therapy (SLT). Method All patients undergoing THO are provided with pre operative counselling and assessment to exclude pre morbid pharyngeal dysphagia. A clinical exam is conducted on day two post surgery and an SLT assisted water soluble swallow (WSS) is conducted on day three, enabling evaluation of deglutitive biomechanics, effectiveness of postural strategies in eliminating aspiration, in conjunction with assessment of anastomic integrity. Data on all patients who underwent THO between February 2014–February 2015 were collected to evaluate SLT intervention, incidence of pharyngeal dysphagia and patient outcomes using the Functional Oral Intake Scale (FOIS). Results 42 patients underwent THO. No patients had pre-morbid pharyngeal dysphagia. Post operatively 62% (n = 26) of patients presented with pharyngeal dysphagia on radiological examination with reduced hyolaryngeal excursion, reduced epiglottic deflection and opening of the upper oesophageal sphincter. 38.1% (n = 16) patients were identified at bedside assessment as high risk of aspiration and pharyngeal dysphagia was confirmed on WSS. In 100% of these (n = 16) no aspiration occurred when a chin tuck strategy was recommended at onset of WSS. A further 10 patients aspirated on WSS; a chin tuck strategy was recommended and this was effective in eliminating aspiration in 80% (n = 8). All patients were able to commence sips of clear fluid on day three if anastomotic leak was excluded despite pharyngeal dysphagia and aspiration risk with implementation of postural techniques. Overall, 90.5% (n = 38) of patients were tolerating oral intake at time of discharge (FOIS score > 6). Four patients with anastomotic leaks were excluded from outcome measures. Conclusion Results suggest that involvement of SLT in ERP helps identify patients at risk of aspiration and introduction of strategies e.g. chin tuck can eliminate aspiration which may improve patient care. Further research is indicated to determine the effect of SLT input on patient outcomes. Disclosure of interest None Declared.
    Gut 06/2015; 64(Suppl 1):A122.2-A123. DOI:10.1136/gutjnl-2015-309861.251 · 14.66 Impact Factor
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    ABSTRACT: Increasing numbers of older patients are undergoing surgery. Older surgical patients are at a higher risk of perioperative complications and mortality. Multimorbidity, frailty, and physiological changes of ageing contribute to adverse outcomes. These complications are predominantly medical, rather than directly surgical. Guidelines recommend preoperative assessment of comorbidity, disability, and frailty in older patients undergoing surgery and closer perioperative collaboration between surgeons and geriatricians. We conducted a survey to assess knowledge and beliefs of surgical trainees toward common perioperative problems encountered in older surgical patients. Paper-based survey. Unselected UK surgical training-grade physicians (CT1-ST8) attending the 2013 Congress of The Association of Surgeons of Great Britain and Ireland, Glasgow, UK, May 1-3, 2013. A total of 160 eligible UK surgical trainees attending the conference were invited to participate in the survey. Of them, 157 participated. Of the trainees, 68% (n = 107) reported inadequate training and 89.2% (n = 140) supported the inclusion of geriatric medicine issues in surgical curricula. Of the respondents, 77.2% (n = 122) were unable to correctly identify the key features required to demonstrate mental capacity, and only 3 of 157 respondents were familiar with the diagnostic criteria for delirium. Support from geriatric medicine was deemed necessary (84.7%, n = 133) but often inadequate (68.2%, n = 107). Surgical trainees support closer collaboration with geriatric medicine and shared care of complex, older patients (93.6%, n = 147). UK surgical trainees believe that they receive inadequate training in the perioperative management of complex, older surgical patients and are inadequately supported by geriatric medicine physicians. In this survey sample, trainee knowledge of geriatric issues such as delirium and mental capacity was poor. Surgical trainees support the concept of closer liaison and shared care of complex, older patients with geriatric medicine physicians. Changes to surgical training and service development are needed. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of Surgical Education 04/2015; 72(4). DOI:10.1016/j.jsurg.2015.01.019 · 1.38 Impact Factor

  • Journal of Clinical Oncology 02/2015; 33(9). DOI:10.1200/JCO.2014.59.9506 · 18.43 Impact Factor
  • A. Walker · T. Holme · M. Kelly · J. Gossage · R. Mason ·

    International Surgical Congress of the; 01/2015

  • Radiological Society of North America 2014 Scientific Assembly and Annual Meeting; 11/2014
  • Source
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    ABSTRACT: Background: In adults, colon interposition is a rare operation used when a gastric pull-up is not available. There is very little data published on outcomes from this procedure. Aims: 1. Identify the number of colon interpositions performed in the UK over the last 12 years. 2. To question the surgeons performing them on their techniques and problems. 3. To gain quality of life data on the patients from the largest centres. Methods: 1. Analysis of Healthcare Episode Statistics (HES) data to identify centres undertaking colon interposition. 2. An online survey of UK consultants, identifying current methods and experiences. 3. A quality of life survey of patients who have undergone colonic interposition (SF-36v2 with additional GI questions.) Results: HES data reported 279 interpositions since 2001, 18 of which were paediatric. The two largest units were St Thomas’ and Birmingham with 39 and 40 cases respectively. Thirty-four surgeons replied to our survey (79% response rate). Most surgeons used left-sided colon with 81% preferring substernal placement. Anastomotic leak and stricture were the main postoperative problems. Five surgeons reported polyp formation within the colonic interposition. The quality of life survey was performed on patients from the two largest centres with a 56% response rate. 21% patients had physical quality of life scores above the population average and 46% had mental scores above population average. All patients had early satiety to some extent and 80% had dysphagia. 76% regularly take reflux medication. There was a mean weight loss of 13⋅1% body weight (10⋅6 kg) since before their illness. 16% patients still relied on a feeding tube for nutrition. Twenty patients had substernal placement of colon, 3 had subcutaneous and 2 posterior mediastinal. These groups had similar physical quality of life outcomes, but those with subcutaneous placement had significantly worse Emotional Role scores (p=<0⋅004) and Mental Summary Scores (p=<0⋅001) than those with substernal placements. Conclusion: Colon interposition has a high risk of early complications but can result in an acceptable quality of life in the long term. These patients are complex and require multi-disciplinary input from specialist surgeons, gastroenterologists, dieticians and psychologists.
    Abstracts of the association of upper gastrointestinal surgeons of great britain and ireland, annual meeting 18-19 september 2014, Brighton; 09/2014
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    ABSTRACT: Purpose: Neoadjuvant chemotherapy is established in the management of most resectable esophageal and esophagogastric junction adenocarcinomas. However, assessing the downstaging effects of chemotherapy and predicting response to treatment remain challenging, and the relative importance of tumor stage before and after chemotherapy is debatable. Methods: We analyzed consecutive resections for esophageal or esophagogastric junction adenocarcinomas performed at two high-volume cancer centers in London between 2000 and 2010. After standard investigations and multidisciplinary team consensus, all patients were allocated a clinical tumor stage before treatment, which was compared with pathologic stage after surgical resection. Survival analysis was conducted using Kaplan-Meier analysis and Cox regression analysis. Results: Among 584 included patients, 400 patients (68%) received neoadjuvant chemotherapy. Patients with downstaged tumors after neoadjuvant chemotherapy experienced improved survival compared with patients without response (P < .001), and such downstaging (hazard ratio, 0.43; 95% CI, 0.31 to 0.59) was the strongest independent predictor of survival after adjusting for patient age, tumor grade, clinical tumor stage, lymphovascular invasion, resection margin status, and surgical resection type. Patients downstaged by chemotherapy, compared with patients with no response, experienced lower rates of local recurrence (6% v. 13%, respectively; P = .030) and systemic recurrence (19% v. 29%, respectively; P = .027) and improved Mandard tumor regression scores (P = .001). Survival was strongly dictated by stage after neoadjuvant chemotherapy, rather than clinical stage at presentation. Conclusion: The stage of esophageal or esophagogastric junction adenocarcinoma after neoadjuvant chemotherapy determines prognosis rather than the clinical stage before neoadjuvant chemotherapy, indicating the importance of focusing on postchemotherapy staging to more accurately predict outcome and eligibility for surgery. Patients who are downstaged by neoadjuvant chemotherapy benefit from reduced rates of local and systemic recurrence.
    Journal of Clinical Oncology 09/2014; 32(27). DOI:10.1200/JCO.2014.55.9070 · 18.43 Impact Factor

  • AUGIS 2014; 09/2014

  • AUGIS 2014; 09/2014

  • AUGIS 2014; 09/2014

  • AUGIS 2014; 09/2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neoadjuvant chemotherapy is established in the management of most resectable esophageal and esophagogastric junction adenocarcinomas. However, assessing the downstaging effects of chemotherapy and predicting response to treatment remain challenging, and the relative importance of tumor stage before and after chemotherapy is debatable.
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    ABSTRACT: Cancer genome sequencing studies have identified numerous driver genes, but the relative timing of mutations in carcinogenesis remains unclear. The gradual progression from premalignant Barrett's esophagus to esophageal adenocarcinoma (EAC) provides an ideal model to study the ordering of somatic mutations. We identified recurrently mutated genes and assessed clonal structure using whole-genome sequencing and amplicon resequencing of 112 EACs. We next screened a cohort of 109 biopsies from 2 key transition points in the development of malignancy: benign metaplastic never-dysplastic Barrett's esophagus (NDBE; n=66) and high-grade dysplasia (HGD; n=43). Unexpectedly, the majority of recurrently mutated genes in EAC were also mutated in NDBE. Only TP53 and SMAD4 mutations occurred in a stage-specific manner, confined to HGD and EAC, respectively. Finally, we applied this knowledge to identify high-risk Barrett's esophagus in a new non-endoscopic test. In conclusion, mutations in EAC driver genes generally occur exceptionally early in disease development with profound implications for diagnostic and therapeutic strategies.
    Nature Genetics 06/2014; 46(8):837-43. DOI:10.1038/ng.3013 · 29.35 Impact Factor
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    ABSTRACT: Accurate selection of patients for radical treatment of esophageal cancer is essential to avoid early recurrence and death (ERD) after surgery. We sought to evaluate a large series of consecutive resections to assess factors that may be associated with this poor outcome. This was a cohort study including 680 patients operated for esophageal cancer between 2000 and 2010. The poor outcome group comprised 100 patients with tumor recurrence and death within 1 year of surgery. The comparison group comprised 267 long-term survivors, defined as those surviving more than 3 years from surgery. Pathological characteristics associated with poor outcome were analyzed using logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). On the adjusted model T stage and N stage predicted poor survival, with the greatest risk being patients with locally advanced tumors and three or more involved lymph nodes (OR 10.6, 95% CI 2.8-40.0). Poor differentiation (OR 2.8, 95% CI 1.4-5.5), chemotherapy response (OR 3.6, 95% CI 1.2-10.6), and involved resection margins (OR 2.7, 95% CI 1.2-6.0) were all significant independent prognostic markers in the multivariable model. There was a trend toward worse survival with lymphovascular invasion (OR 2.0, 95% CI 0.9-4.2) and low albumin (OR 1.9, 95% CI 0.8-4.4) but not of statistical significance in the adjusted model. Esophageal cancer patients with poorly differentiated tumors and three or more involved lymph nodes have a particularly high risk of ERD after surgery. Accurate risk stratification of patients may identify a group who would be better served by alternative oncological treatment strategies. J. Surg. Oncol. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 04/2014; 109(5). DOI:10.1002/jso.23511 · 3.24 Impact Factor
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    ABSTRACT: The optimal surgical approach to tumours of the oesophagus and oesophagogastric junction remains controversial. The principal randomized trial comparing transhiatal (THO) and transthoracic (TTO) oesophagectomy showed no survival difference, but suggested that some subgroups of patients may benefit from the more extended lymphadenectomy typically conducted with TTO. This was a cohort study based on two prospectively created databases. Short- and long-term outcomes for patients undergoing THO and TTO were compared. The primary outcome measure was overall survival, with secondary outcomes including time to recurrence and patterns of disease relapse. A Cox proportional hazards model provided hazard ratios (HRs) and 95 per cent confidence intervals (c.i.), with adjustments for age, tumour stage, tumour grade, response to chemotherapy and lymphovascular invasion. Of 664 included patients (263 THO, 401 TTO), the distributions of age, sex and histological subtype were similar between the groups. In-hospital mortality (1·1 versus 3·2 per cent for THO and TTO respectively; P = 0·110) and in-hospital stay (14 versus 17 days respectively; P < 0·001) favoured THO. In the adjusted model, there was no difference in overall survival (HR 1·07, 95 per cent c.i. 0·84 to 1·36) or time to tumour recurrence (HR 0·99, 0·76 to 1·29) between the two operations. Local tumour recurrence patterns were similar (22·8 versus 24·4 per cent for THO and TTO respectively). No subgroup could be identified of patients who had benefited from more radical surgery on the basis of tumour location or stage. There was no difference in survival or tumour recurrence for TTO and THO.
    British Journal of Surgery 04/2014; 101(5). DOI:10.1002/bjs.9456 · 5.54 Impact Factor

Publication Stats

328 Citations
236.15 Total Impact Points


  • 2014-2015
    • King's College London
      • Division of Cancer Studies
      Londinium, England, United Kingdom
    • Karolinska Institutet
      • Department of Molecular Medicine and Surgery
      Сольна, Stockholm, Sweden
  • 2006-2015
    • Guy's and St Thomas' NHS Foundation Trust
      • • Upper Gastrointestinal Surgical Unit
      • • Department of Histopathology/Cytology
      Londinium, England, United Kingdom
    • WWF United Kingdom
      Londinium, England, United Kingdom
  • 2008-2014
    • ICL
      Londinium, England, United Kingdom
    • Kent Hospital
      Warwick, Rhode Island, United States
  • 2008-2010
    • East Sussex Healthcare NHS Trust
      Eastbourne, England, United Kingdom