Bilal Alkhaffaf

Northern Care All NHS Foundation Trust | University of Manchester

Objective The reporting of outcomes in surgical trials for gastric cancer is inconsistent. The GASTROS study ( GA stric Cancer S urgery TR ials R eported O utcome S tandardisation) aims to address this by developing a core outcome set (COS) for use in all future trials within this field. A COS should reflect the views of all stakeholders, including...

Objective: Development of a core outcome set (COS) for clinical effectiveness trials in esophageal cancer resection surgery. Background: Inconsistency and heterogeneity in outcome reporting after esophageal cancer resection surgery hampers comparison of trial results and undermines evidence synthesis. COSs provide an evidence-based approach to t...

Background Gastrectomy remains the cornerstone of curative treatment for gastric cancer but is associated with significant risks of complications. This study aimed to explore the impact of service centralisation in Greater Manchester on outcomes following gastrectomy for cancer. Outcomes were compared against international benchmarks to evaluate im...

Background Patients are living longer with the long-term morbidity of oncological and surgical therapies as oesophageal cancer outcomes improve. Existing symptomatology and quality of life tools are cumbersome and moreover not designed for the post-treatment survivorship setting. The LASER study identified six key symptoms thought to predict poor h...

Background Spontaneous Oesophageal Perforation (SOP) is a rare gastro-intestinal surgical emergency with devastating morbidity and mortality. Given the rarity of the entity, there is no up-to-date evidence on outcomes in the context of centralized esophagogastric services neither consensus guidelines nor standardized treatment algorithms on how the...

Background The COVID-19 pandemic necessitated rapid adaptation in healthcare delivery, affecting cancer care pathways. This study assesses the impact of these changes on multidisciplinary team (MDT) decision-making and survival outcomes in esophago-gastric cancer patients across pre-pandemic, peak pandemic, and post-pandemic periods. Method A retr...

Background Iatrogenic oesophageal perforation (IOP) following diagnostic and therapeutic interventions at the oesophagus or adjacent organs are responsible for nearly half of oesophageal perforations. If not recognised within 24 hours of injury, then they are associated with devastating morbidity and mortality. Available treatment options encompass...

Background Anastomotic leak (AL) is a serious complication following oesophagectomy that occurs in 10-15% of patients. Endoscopic vacuum therapy (EVT) is a novel non-operative approach to managing AL that has become increasingly popular recently. However, little is known about EVT’s effectiveness in managing ALs compared to more established approac...

Background There has been a significant shift in the surgical management of oesophageal cancer, with increased popularity of minimally invasive oesophagectomy in comparison to open approaches. Data thus far has largely focused on the peri-operative and short-term benefits with limited study on long-term oncological outcomes. This study aims to expl...

Background Bariatric surgery is an effective treatment for obesity. Whilst short-term complication rates are low, little is known about the longer-term impacts on patients and health services. Even less is known about the true impact of the increasing trend of Health Tourism (HT) in this field. This study aimed to explore this topic further to quan...

Background Bariatric surgery has been consistently demonstrated to provide effective long-term sustained weight loss and remission of several life-threatening conditions. The most common bariatric procedures undertaken globally include laparoscopic sleeve gastrectomy (SG) and gastric bypass2. These procedures are safe and have low associated mortal...

Background The EORTC QLQ-STO22 (QLQ-STO22) is a firmly established and validated measure of health-related quality of life (HRQoL) for people with gastric cancer (GC), developed over two decades ago. Since then there have been dramatic changes in treatment options for GC. Also, East Asian patients were not involved in the development of QLQ-STO22,...

Objective This study investigated if hybrid oesophagectomy with minimally invasive gastric mobilization and thoracotomy enabled faster recovery than open surgery. Methods In eight UK centres, this pragmatic RCT recruited patients for oesophagectomy to treat localized cancer. Participants were randomly allocated to hybrid or open surgery, stratifie...

Aim: Whilst bariatric surgery is the most effective treatment for severe obesity, the aim of this study was to evaluate whether postoperative weight loss is similar in patients with or without metabolic syndrome. Methods: We performed a 5-year observational retrospective comparative cohort analysis of bariatric surgery in 333 patients (72% women...

Background Oesophagectomy is a high-risk intervention associated with significant rates of morbidity. Pneumonia is a complex spectrum of infective and non-infective aetiology, varying in severity and is common after oesophagectomy. Inconsistent definitions of pulmonary complications pose significant challenges in both the clinical and research sett...

Background Bariatric surgery is a safe and effective treatment for obesity and it's associated co-morbidities. Limited access to surgery in the NHS and a combination of cheaper costs and aggressive advertising by international clinics has led to a surge in people seeking surgery abroad. There is a perception that an indeterminate volume of bariatri...

Background The combination of surgery and peri-operative chemotherapy is a well-established cornerstone of treatment with curative intent for gastric cancer in the UK. However, this approach has not necessarily been adopted globally. Hyperthermic intraperitoneal chemotherapy (HIPEC) and intraoperative radiation therapy (IORT) may improve survival a...

Background Hospital Acquired Pneumonia (HAP) is a frequently occurring complication following oesophagectomy, often associated with poorer outcomes. After oesophagectomy, HAP can occur in conjunction with other pulmonary and non-pulmonary complications such as anastomotic leak. Single lung ventilation during oesophagectomy can lead to altered lung...

Background Anastomotic leaks and perforations of the upper gastrointestinal (UGI) tract are life-threatening conditions which result in significant rates of morbidity. There is no consensus with respect to how these challenging cases should be optimally managed. Endoluminal vacuum therapy (EVT) is a novel approach for the management of leaks and pe...

Background Bariatric surgery is a safe and effective treatment for obesity and associated co-morbidities. Equality of access to bariatric surgery in the NHS has long posed a serious challenge with significant variation in eligibility criteria between different regions. Obesity disproportionately affects more deprived groups and some ethnic minoriti...

Background Laparoscopic adjustable gastric banding (LAGB), once one of the most popular surgical treatments for obesity, now represents less than 10% of procedures undertaken nationally. No accurate figures exist regarding how many UK patients have undergone LAGB; approximately 5000 procedures were submitted to NBSR between 2013-2015. Alongside pro...

Background Dietitians in clinical practice face the challenge of providing high quality care whilst demonstrating clinical effectiveness and continuous improvement. Assessing the effectiveness of dietetic intervention is vital in ensuring the provision of clinically effective dietetic services. Nutritional outcome measures are key in identifying th...

Background The COVID-19 pandemic significantly impacted on healthcare systems worldwide, and likely affected every aspect of the patient pathway from diagnosis and treatment to long-term outcomes. Whilst much has been inferred about the impact on patients with oesophago-gastric (OG) cancer, very little granular data or understanding currently exist...

Background Bariatric surgery is a safe and highly effective treatment for obesity. Whilst the risks of surgery are generally low, emergency presentations can be extremely challenging to manage, particularly in a cohort with complex health needs. In the UK, a large proportion of cases are undertaken outside of the NHS. Little is known about the burd...

Background Following an international consensus agreement of patients and healthcare professionals (GASTROS Study), ‘nutritional outcomes’ have been identified as critically important to report in surgical trials for gastric cancer. A previous review has demonstrated that nutritional outcomes are rarely reported by trials, and little is known about...

Background Gastric cancer patients are at increased risk of disease-related malnutrition due to the disease and the consequences of treatment. The variation in post-operative nutrition for this patient group may be impacting on outcomes, and further research has been recommended by the National Institute for Health and Care Excellence to help ascer...

Background Minimally invasive gastrectomy (MIG) is a well-established approach for the management of gastric cancer. However, much of the evidence base has come from the Far East where patient characteristics are significantly different and therefore not necessarily applicable to Western practice. In the UK (NOGCA 2022), less than 20% of gastrectom...

Background Endoluminal vacuum therapy (EVT[BA1] ) is a novel, yet relatively well established tool in the management of upper gastrointestinal (UGI) leaks and perforations. Despite a growing body of evidence supporting its use, management strategies and techniques used in the context of EVT are yet to be standardised. Furthermore, the uptake of EVT...

Background Gastric cancer poses a significant global health challenge, mainly affecting older individuals with well-established risk factors. However, outcomes in young patients have been perceived as poorer due to late diagnosis and more aggressive disease subtype. There are also a small sub-set of younger patients in which gastric cancer is genet...

Background Oesophageal cancer is a devastating malignancy associated with poor prognosis, primarily affecting older individuals with multiple co-morbidities. However, outcomes of younger patients have been perceived as poor due to late diagnosis and more aggressive disease subtype. This subset of patients poses unique clinical challenges and requir...

Background The UK has one of the highest rates of oesophageal adenocarcinoma worldwide. Surgical resection, with peri-operative chemotherapy, is the cornerstone of curative treatment. The evidence base for which surgical approach is best (including open, hybrid, totally laparoscopic/thoracoscopic, and robotic surgery) is negatively affected by hete...

Background The management of upper gastrointestinal (UGI) leaks and perforations is complex and challenging. Patients often have multiple comorbidities, have undergone major surgical interventions with protracted pathways, and are associated with compromised nutritional states. Endoluminal Vacuum therapy (EVT) is a novel approach to managing UGI le...

Background and purpose Non-alcoholic fatty liver disease (NAFLD) has increasing worldwide prevalence, fuelled by rising obesity rates, and weight reduction is the mainstay of its management. We sought to study the effect of bariatric surgery, the most effective long-term treatment for obesity and associated metabolic disorders, on liver function in...

Background Patients with severe obesity are often required to lose weight before undergoing bariatric surgery to reduce anaesthetic and surgical risks. In the past, this group have been given the option of having an intragastric balloon (IGB) before proceeding with surgery. Since March 2022, our Tier-4 Specialist and Complex Obesity Service (T4-SCO...

Background: Mortality, morbidity, and organ failure are important and common serious harms after surgery. However, there are many candidate measures to describe these outcome domains. Definitions of these measures are highly variable, and validity is often unclear. As part of the International Standardised Endpoints in Perioperative Medicine (StEP...

Introduction: Failure to rescue (FTR) is an important outcome measure after esophagectomy and reflects mortality after postoperative complications. Differences in FTR have been associated with hospital resection volume. However, insight into how centers manage complications and achieve their outcomes is lacking. Anastomotic leak (AL) is a main con...

Anastomotic leak (AL) is a common but severe complication after esophagectomy, and over 10% of patients with AL suffer mortality. Different prognostic factors in patients with AL are known, but a tool to predict mortality after AL is lacking. This study aimed to develop a prediction model for postoperative mortality in patients with AL after esopha...

Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study is...

Background The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams. Materials and Methods The current study i...

Aims Feeding jejunostomy (FJ) to support enteral nutrition has traditionally been placed using an open approach (OA). As minimally invasive surgery (MIS) for oesophageal and gastric surgery gains popularity, it is imperative to develop a standardised technique and examine its safety. We describe our MIS approach to FJ insertion and compare outcomes...

The treatment landscape for gastric cancer (GC) is constantly evolving with therapies affecting all aspects of health-related quality of life (HRQoL) which need careful monitoring. While there are HRQoL measures designed specifically to capture issues relevant to patients with GC, these might be outdated and only relevant to patients in westernised...

Background Age ≥ 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group dur...

Background International stakeholder participation is important in the development of core outcome sets (COS). Stakeholders from varying regions may value health outcomes differently. Here, we explore how region, health income and participant characteristics influence prioritisation of outcomes during development of a COSfor gastric cancer surgery...

Background International stakeholder participation is important in the development of core outcome sets (COS). Stakeholders from varying regions may value health outcomes differently. Here, we explore how region, health income and participant characteristics influence prioritisation of outcomes during development of a COS for gastric cancer surgery...

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the corona-virus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre, and observational cohort study of MBS performed between May 01, 2020, and...

Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2...

Abstract Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus...

Abstract Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus...

Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2...

Why diabetes control is important before metabolic surgery.

Abstract Background Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this...

Background Surgery is the primary treatment that can offer potential cure for gastric cancer, but is associated with significant risks. Identifying optimal surgical approaches should be based on comparing outcomes from well designed trials. Currently, trials report different outcomes, making synthesis of evidence difficult. To address this, the aim...

Background Core outcome sets (COS) should be relevant to key stakeholders and widely applicable and usable. Ideally, they are developed for international use to allow optimal data synthesis from trials. Electronic Delphi surveys are commonly used to facilitate global participation; however, this has limitations. It is common for these surveys to be...

Introduction The COVID-19 pandemic has resulted in unparalleled changes to patient care, including the suspension of cancer surgery. Concerns regarding COVID-19-related risks to patients and healthcare workers with the re-introduction of major complex minimally invasive and open surgery have been raised. This study examines the COVID-19 related ris...

Introduction The Covid-19 pandemic has resulted in unprecedented and challenging changes to surgical practice, especially with the suspension of cancer surgery. There have been concerns regarding Covid-19 risk and infection to patients and healthcare workers, during major complex open surgical intervention, especially with minimally invasive surger...

Background The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs. Although this rapid adaption was initially necessary, the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis are not well known. Moreover, as the health care trusts plan the re...

Background: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international collaborative group set up to study anastomotic leak outcomes after oesophagectomy for cancer. This Delphi study aimed to prioritize future research areas of unmet clinical need in RCTs to reduce anastomotic leaks. Methods: A modified Delphi process was overseen by the O...

Background International stakeholder participation is important in the development of core outcome sets (COS). Stakeholders, however, may value health outcomes differently when regional differences are considered. Here, we explore how region, health income and participant characteristics influence prioritisation of outcomes during development of a...

Background: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of...

Bariatric and metabolic surgery (BMS) is the most effective intervention available for weight loss. However, the high morbidity and mortality associated with perioperative COVID-191 has led to the cancellation of millions of surgeries including BMS procedures. There are also concerns that obesity treatment, including BMS, might be especially overlo...

PurposeGroin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation.Methods Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal...

Objective: The objectives of this nested study were to (1) assess whether changes in scores between rounds altered the final degree of consensus achieved in three Delphi surveys conducted as part of COS development projects (anal, gastric, and prostate cancer), and (2) explore participants' reasons for changing scores between rounds. Study design...

Background Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of s...