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November 1997 - October 2016
Publications
Publications (85)
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
The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery is poorly understood. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.
Methods
This international, multicentre, cohort study at 235 hospitals in 24 countries includ...
Background
Several techniques have been described for esophagogastric anastomosis following esophagectomy. This study compared the outcomes of circular stapled anastomoses with semi-mechanical technique using a linear stapler.
Methods
Perioperative data were extracted from a contemporaneously collected database of all consecutive esophagectomies f...
Background:
Rupture of the costal margin is uncommon. Whilst most often seen after major trauma, we describe its occurrence in patients with no direct chest trauma.
Methods:
A search was performed in our thoracic surgery database for all patients with rupture of the costal margin. Patients were excluded if the injury was a result of trauma. Data...
Background:
Segmentectomy has emerged as a lung parenchymal sparring alternative to the gold standard lobectomy in non-small cell lung cancer (NSCLC) patients. We hypothesized that there is parity between functional, local recurrence and survival outcomes.
Patients and methods:
Parenchymal sparring procedures including anatomical segmentectomies...
Introduction: Treatment of potentially curative oesophago-gastric carcinoma has evolved over the last 15 years, but remains challenging. Improvements in early detection and stage, surgical and peri-operative care in conjunction with oncological therapy are hypothesised to have improved survival. Method: A retrospective analysis was undertaken on pa...
Introduction: Postoperative complications following the resection of oesophago-gastric carcinoma can result in considerable early morbidity and mortality, however the long-term effects are less clear. Reports in international literature are mixed, so it remains unclear if leak and other complications reduce overall survival and disease free surviva...
BACKGROUND: This multicentre cohort study sought to define a robust pathological indicator of clinically meaningful response to neoadjuvant chemotherapy in oesophageal adenocarcinoma. METHODS: A questionnaire was distributed to 11 UK upper gastrointestinal cancer centres to determine the use of assessment of response to neoadjuvant chemotherapy. Re...
The complex interplay of the tumour microenvironment (TME) and its role in disease progression and response to therapy is poorly understood. The majority of studies to date focus on individual components or molecules within the TME and so lack the power correlative analysis. Here we have performed a multi-parameter analysis of the TME in 62 resecta...
The optimal management of resectable oesophageal adenocarcinoma is controversial, with many centres using neoadjuvant chemotherapy following the Medical Research Council (MRC) oesophageal working group (OE02) trial and the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. The more intensive MAGIC regimen is used primarily in gastric cance...
Background: Debate continues regarding the best treatment regimen to use in esophageal adenocarcinoma with many centres using neo-adjuvant cisplatin and 5-fluorouracil (following the OE-02 trial results) and others using peri-operative ECF (as used in the MAGIC trial).
Nottingham University Hospitals is one of the largest centres treating this dis...
There is a growing recognition that current pre-clinical models do not reflect the tumor microenvironment in cellular, biological and biophysical content and this may have a profound effect on drug efficacy testing especially in the era of molecular-targeted agents. Here we describe a method to directly embed low passage patient tumor-derived tissu...
Lung cancer surgery leads to long term survival for some patients but little is known about how patients decide whether to accept the associated surgical risks. The objective of this qualitative study was to explore patients' attitudes to the risks associated with lung cancer surgery.
Fifteen patients with resectable lung cancer, recruited via mult...
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 insi...
Objectives To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC).
Design Cross-sectional study from individual patients, between 1January 2008 and 31March 2012.
Setting Linked National Lung Cancer Audit and Hospital Episode S...
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 a...
Oesophageal adenocarcinoma metastatic to the axilla is a rare occurrence. The authors present a case of a woman who developed
an axillary metastasis from a completely excised oesophageal adenocarcinoma with no prior evidence of nodal disease. With
aggressive local treatment, including multiple local operations and radiotherapy, she remains alive an...
Background:
In comparison with other European and North American countries, England has poor survival figures for lung cancer. Our aim was to evaluate the changes in survival since the introduction of the National Lung Cancer Audit (NLCA).
Methods:
We used data from the NLCA to identify people with non-small-cell lung cancer (NSCLC) and stratified...
The MAGIC trial demonstrated the perioperative regimen of Epirubicin (E), Cisplatin (C) and 5-Fluorouracil (F) to have an overall survival benefit for patients with gastro-esophageal adenocarcinomas. We present our experience of the peri-operative regimen of ECF/ECX(X = Capecitabine) in operable gastro-esophageal adenocarcinoma.
Analysis of retrosp...
Introduction MAGIC1 regimen of three cycles of ECF chemotherapy pre- and post-op is widely used in gastric cancer but its use in oesophageal cancer remains controversial. We have compared post operative survival outcomes of oesophageal and GOJ cancer patients entered into either OEO22 (2 cycles of CF pre-operatively) or MAGIC regimen to determine i...
Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies.
Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patie...
Meaningful exposure to oesophageal cancer surgery during general thoracic surgical training is restricted to few centres in the United Kingdom. Our Regional Tertiary Unit remains a rare 'large-volume' oesophagectomy centre. We aimed to determine the proportion of patients operated by trainees and their perioperative outcomes.
From January 2004 to S...
A joint initiative by the British Thoracic Society and the Society for Cardiothoracic Surgery in Great Britain and Ireland was undertaken to update the 2001 guidelines for the selection and assessment of patients with lung cancer who can potentially be managed by radical treatment.
Postpneumonic empyema is the most common form of empyema thoracis and is still recognised as a major cause of morbidity and prolonged hospital stay. We reviewed 106 patients retrospectively who underwent surgical management of pleural empyema over a period of three years from August 2005. We identified 81 patients (76%) (58 males, mean age 52 years...
Residual air spaces on chest radiographs after pneumothorax surgery are not uncommon. We aimed to study their incidence and impact on surgical outcomes.
Four hundred and twenty-seven patients [283 men and 144 women with a median age of 31 (14-96) years] underwent surgery for pneumothorax from 1995 to 2005 in a single unit. Video-assisted thoracosco...
Spontaneous oesophageal rupture (Boerhaave's syndrome) is an uncommon but serious condition. A retrospective review was undertaken of the management of 34 patients (age range 17-85 years) presenting between 1991 and 2006. Contrast swallow was possible in 22 patients, confirming the diagnosis in 17. Five patients showed pleural effusion on chest X-r...
Nutritional status has been reported as a predictor of complications following surgery for lung cancer. However, the impact of impaired nutrition in the long term has not been extensively studied. We have analysed our own experience after lobectomy for non-small cell lung cancer (NSCLC).
Six hundred and forty-two consecutive patients undergoing lob...
Selection of patients for treatment of oesophagogastric cancers rests on accurate staging. Laparoscopy has become a safe and effective staging tool in upper gastrointestinal cancers because of its ability to detect small peritoneal and liver metastases missed by imaging techniques. The aim of this study was to evaluate the role of staging laparosco...
A 68-year-old man, who underwent a left lower lobectomy for a typical carcinoid tumor 30 years previously, presented with a 2-year history of left-sided chest pain. A computed tomographic scan, an octreotide scan, and pleural biopsy all showed recurrence of carcinoid tumor in the pleura. He underwent left chest wall resection, and histopathologic e...
The significance of tumor cell type on survival after esophageal resection for carcinoma is uncertain. We reviewed our experience in order to compare the outcome in the two main histologic groups.
Between January 1987 and April 2000, 621 patients underwent esophagectomy with curative intention for squamous cell carcinoma or adenocarcinoma. The post...
Our aim was to investigate the prevalence of intra-operative nerve damage and its association with chronic pain.
Our prospective study of 33 patients used nerve conduction studies to assess intercostal nerve function during elective thoracic surgical procedures. We used two methods to study nerve conduction: pre-operative magnetic stimulation (in 1...
Our questionnaire study set out to assess the prevalence of chronic pain after thoracic surgery, the contribution of the neuropathic component of chronic pain and the impact of chronic pain on patients' lives.
A questionnaire was sent to 1152 patients who had undergone thoracic surgery in our department between 7 months and 7 years ago. The questio...
There are limited and conflicting data available concerning the incidence of inadvertent splenectomy and its impact on the outcome in patients who have undergone oesophagectomy. The aim of this study is to identify the factors associated with a likelihood of inadvertent splenectomy and its influence on early and long-term outcome in patients having...
Pulmonary blastoma is a rare primary lung tumor with poor prognosis that commonly presents at a younger age than the non-small cell lung carcinoma (NSCLC). Classically they are large, symptomatic tumors with lymph nodal metastasis and carry poor prognosis. We report our experience of 7 patients with pulmonary blastoma who presented with varying cli...
Spontaneous hemothorax is an uncommon condition usually associated with trauma, iatrogenic interventions, or rupture of pleural adhesions, and pneumothorax. We report the unique case of spontaneous hemothorax in a 35-year-old woman resulting from uterine hemorrhage in whom fenestrations in the diaphragm allowed blood to pass from the abdomen to the...
PURPOSE: To determine whether other pathological variables such as the degree of differentiation of the cancer cells and the presence of tumour cells on the resection margins on microscopy (R1 resection) did alter survival following resection for non-small-cell lung cancer (NSCLC).
METHODS: The clinical and pathological records of the 857 consecuti...
PURPOSE: The reported accuracy of surgical biopsy for interstitial lung disease (ILD) is highly variable. We have audited our results to determine whether operative techniques do alter outcomes.
METHODS: 123 patients [68 men and 55 women with a median age of 57 (range from 18 to 84) years] underwent lung biopsy for diffuse interstitial lung disease...
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Oesophagectomy for carcinoma provides a chance of cure but carries significant risk. This study defined risk factors for death after oesophageal resection for malignant disease.
Between 1990 and 2003, 773 oesophagectomies for oesophageal cancer were performed. Continuous variables were categorized into quartiles for analysis. Predictors of operativ...
Although several studies have examined early outcome following redo antireflux surgery, there is little data on the long-term efficacy of these procedures. We reviewed our experience of these operations in order to assess the long-term results which can be achieved by choosing redo antireflux procedures based on the results obtained from pre-operat...
Many studies have analysed prognostic factors following oesophagectomy, but few have examined survival determinants in node-negative (N0) oesophageal cancer. The prognostic significance of a number of histological variables following surgical resection of N0 oesophageal cancer was studied.
The case notes of 219 patients undergoing potentially curat...
The histologic determinants of survival after surgical resection of stage II nonsmall cell lung cancer are poorly understood. We analyzed the prognostic significance of a number of histologic features after complete resection of T1-2N1M0 nonsmall cell cancer of the lung.
The case notes and histology of all patients who underwent a potentially curat...
Benign intratracheal thyroid tissue is a rare cause of upper airway obstruction. Treatment by radical resection or submucosal excision is advocated in the literature. We report the case of a female patient presenting with stridor due to true thyroid ectopia, which we managed by endoscopic resection. We present our experience of her follow-up 3 year...
Surgically treated, stage I (T1N0 and T2N0) nonsmall cell lung cancer has a relatively favorable prognosis. Our aim was to determine whether performing a pneumonectomy in this group of patients has an impact on survival.
Four hundred eighty-five patients with stage I nonsmall cell lung cancer undergoing lung resection between 1991 and 2000 were stu...
The factors affecting long-term survival following oesophagectomy for oesophageal cancer are poorly understood. We examined the significance of microscopic tumour involvement at the circumferential resection margin (CRM) on postoperative survival following oesophagectomy. The case notes of 329 patients who underwent a potentially curative oesophage...
These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.
These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.
Previous work has suggested that intercostal nerve injury is a major factor in the aetiology of chronic post-thoracotomy pain. The aim of this study was to establish if there was identifiable intercostal nerve injury during thoracotomy.
Intercostal nerves were stimulated and motor evoked potentials were recorded from intercostal muscles in 13 patie...
To determine whether patient gender affects the outlook following lung resection for non-small cell lung cancer (NSCLC).
Prospectively collected data on 833 patients undergoing lung resection for NSCLC between 1990 and 2000 in a single unit were analysed.
581 patients were male (mean age 64.7 +/- 7 years) and 252 were female (mean age 62.6 +/- 7.8...
The development of laparoscopic antireflux surgery has stimulated interest in laparoscopic para-oesophageal hiatal hernia repair. This review of our practice over 10 years using a standard transthoracic technique was undertaken to establish the safety and effectiveness of the open technique to allow comparison. Sixty patients with para-oesophageal...
Chronic post-thoracotomy pain is a continuous dysaesthetic burning and aching in the general area of the incision that persists at least 2 months after thoracotomy. It occurs in approximately 50% of patients after thoracotomy and is usually mild or moderate. However, in 5% the pain is severe and disabling. No one technique of thoracotomy has been s...
Calman-Hine recommendations for improvement of cancer services include the establishment of MPMs. Our approach is to meet before a combined clinic and to record the clinical details and management decisions on a computerised database. A printed summary is attached to the case records ready for the consultation. After the patient is seen, informatio...
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With the introduction of the New Deal and the Calman Report, the duration of higher specialist training will be halved. We have examined the effect of reduced on-call rotas on exposure to relatively uncommon out-of-hours emergencies in cardiothoracic surgery. Operations for post-infarction ventricular septal defect, aortic dissection or transection...
The need to specifically demonstrate multiple tissue components on a single section has led to experimentation with combinations of different staining techniques. Eosinophils, mast cells, and neural tissues in the same tissue section were stained with astra bluelvital new red (ABVNR) in combination with immunohistochemical demonstration of neural a...
Lobar herniation is a rare complication of heart-lung transplantation (HLT). We describe a case of right lower lobe herniation
through the pericardial window into the left pleural space diagnosed 54 days after operation. Extensive adhesions precluded
a lobectomy through a right thoracotomy approach, therefore the lobe was simply excluded and left i...
Advanced age increases the risk of any major surgical intervention, particularly esophageal resection. High morbidity and increased mortality have been reported in operations for esophageal cancer in the elderly.
To determine outcome, risk factors, and the advisability of esophageal resection in the elderly, a single-institution retrospective revie...
We evaluated the effect of brief neoadjuvant chemotherapy in patients with apparently operable adenocarcinoma of the oesophagus. Two courses of mitomycin (6 mg/m2), ifosfamide (3 g/m2) and cisplatin (50 mg/m2;MIC) were given followed by evaluation of response by barium swallow and computed tomography scan. Of 20 patients, 17 completed both courses...
Seven oesophageal squamous carcinomas, treated with pre-operative chemotherapy (mitomycin-C, ifosfamide and cisplatin-MIC), with a course finishing 21 days prior to resection, were examined by electronmicroscopy. In one treated case detailed light microscopy failed to reveal any tumour. Five of the remaining six tumours showed cytotoxic damage in t...
We have evaluated the effect of mitomycin 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2 (MIC) in two groups of patients with squamous or undifferentiated carcinoma of the oesophagus, as either preoperative or primary treatment. Response was assessed by barium swallow, CT scan, and measurement of metastases where present. Toxicity was acceptabl...
Quantitation of mast cells and eosinophils is of value in studies of allergic or parasitic tissue inflammation. We describe a new method that combines two reliable stains, astra blue and vital new red, to stain both mast cells and eosinophils in the same tissue section. The mast cells stain violet-blue and the eosinophils bright red. Because this m...
It is over 100 years since Osgood, in his paper “a peculiar form of oesophagismus”, described the clinical features of the condition we know as diffuse oesophageal spasm (DOS) [1]. However, the aetiology of the disease is still unknown and reports of its pathological features are scant.
Lobar herniation is a rare complication of heart-lung transplantation (HLT). We describe a case of right lower lobe herniation through the pericardial window into the left pleural space diagnosed 54 days after operation. Extensive adhesions precluded a lobectomy through a right thoracotomy approach, therefore the lobe was simply excluded and left i...
