Krishna Moorthy

Hyundai Motor Company

Background Prehabilitation is safe, feasible and may improve a range of outcomes in patients with oesophago-gastric cancer (OGC). Recent studies have suggested the potential of prehabilitation to improve body composition, sarcopenia and physical fitness, reduce surgical complications and improve quality of life. Despite this, prehabilitation servic...

Introduction Obesity drives maladaptive changes in the white adipose tissue (WAT) which can progressively cause insulin resistance, type 2 diabetes mellitus (T2DM) and metabolic dysfunction associated liver disease (MASLD). Obesity-mediated loss of WAT homeostasis can trigger liver steatosis through dysregulated lipid pathways such as those related...

Esophageal adenocarcinoma is a prominent example of cancer characterized by frequent amplifications in oncogenes. However, the mechanisms leading to amplicons that involve breakage-fusion-bridge cycles and extrachromosomal DNA are poorly understood. Here, we use 710 esophageal adenocarcinoma cases with matched samples and patient-derived organoids...

Background Obesity drives maladaptive changes in the white adipose tissue (WAT) which can progressively cause insulin resistance, type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated liver disease (MASLD). Obesity-mediated loss of WAT homeostasis can trigger liver steatosis through dysregulated lipid pathways such as those related t...

Purpose Chronic abdominal pain after RYGB is a known issue. Identifying the potential patient-related and modifiable risk factors might contribute to diminish the risk for this undesirable outcome. Methods A single-center retrospective cohort study with prospective data collection was conducted with inclusion of all patients who underwent RYGB sur...

A variety of mutational processes drive cancer development, but their dynamics across the entire disease spectrum from pre-cancerous to advanced neoplasia are poorly understood. We explore the mutagenic processes shaping oesophageal adenocarcinoma tumorigenesis in 997 instances comprising distinct stages of this malignancy, from Barrett Oesophagus...

e16096 Background: The impact of cancer on psychological health and health related quality of life (HRQoL) is complex and involves an interaction between pre-existing and cancer related psychological morbidity and symptoms. Factors such as self-efficacy are known predictors of recovery and HRQoL. The aim of this study is to assess the impact of mul...

1587 Background: Prehabilitation is associated with increased tolerance to oncology treatments, reduced post-operative complications and hospitalisations. Most prehabilitation programmes are delivered in hospitals or community centres. However, large-scale implementation is limited by problems of access, workforce demands, travel costs and sustaina...

e13636 Background: Cancer symptoms and treatment consequences such as fatigue, nausea, distress and breathlessness contribute to inactivity, malnutrition, sarcopenia and ultimately poor clinical outcomes. Multimodal prehabilitation, with a focus on physical activity, nutrition and emotional well-being, is associated with improved treatment outcomes...

6648 Background: Prehabilitation is increasingly being recognised as a high-priority intervention to improve physical and psychological health in cancer patients, prevent treatment-related functional decline and to reduce the incidence and severity of post-surgical complications. The aim of this study is to develop a health economic (HE) model to e...

Aims: To investigate whether the elevation in the post-prandial concentrations of the gut hormones Glucagon-Like Peptide-1 (GLP-1), Oxyntomodulin (OXM) and Peptide YY (PYY), accounts for the beneficial changes in food preferences, sweet taste function and eating behaviour after RYGB. Materials and methods: This was a secondary analysis of a rand...

Background: Home-based and supervised prehabilitation programmes are shown to have a positive impact on outcomes in patients with oesophago-gastric (OG) cancer. The primary aim of this study was to establish the feasibility of delivering a digital prehabilitation service. Methods: Patients undergoing treatment for OG cancer with curative intent...

Background: Prehabilitation programmes aim to optimise patients before and after cancer treatment including surgery. Previous studies in surgical patients demonstrate that prehabilitation improves pre-operative fitness and overcomes the negative impact of neoadjuvant chemotherapy on fitness. The aim of this study was to assess the impact of prehab...

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...

Oesophageal adenocarcinoma (OAC) provides an ideal case study to characterize large-scale rearrangements. Using whole genome short-read sequencing of 383 cases, for which 214 had matched whole transcriptomes, we observed structural variations (SV) with a predominance of deletions, tandem duplications and inter-chromosome junctions that could be ide...

Prehabilitation aims to optimize a patient’s functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esoph...

Background and aim Despite recent advancements in perioperative care, postoperative morbidity following an esophagectomy remains substantial. Studies in other major abdominal surgery, have shown that prehabilitation can improve short-term outcomes. This single-center cohort study investigated the effect of prehabilitation in patients undergoing min...

Oesophageal adenocarcinoma (OAC) provides an ideal case study to characterize large-scale rearrangements. Using whole genome short-read sequencing of 383 cases, for which 214 had matched whole transcriptomes, we observed structural variations (SV) with a predominance of deletions, tandem duplications and inter-chromosome junctions that could be ide...

Background Surgeon specific outcome reports (SSOR) in the UK can be accessed freely by the general public to promote transparency and informed decision-making. However, the views amongst bariatric patients concerning this data are unknown. Objectives The aims of this study were to determine patient awareness, views and priorities for outcome repor...

Postoperative morbidity following esophagectomy remains substantial. Studies in major abdominal surgery have shown that prehabilitation can improve postoperative outcomes. This single-center study investigated the influence of prehabilitation on postoperative outcomes in patients undergoing minimally invasive Ivor-Lewis esophagectomy (MIE-IL). Data...

Enhanced Recovery After Surgery (ERAS) protocols are widely used in oesophageal cancer surgery. Multiple studies have demonstrated that ERAS protocols are associated with a shorter length of stay and a reduction in the incidence of post-operative complications after oesophagectomy. However, there is substantial heterogeneity in the content of ERAS...

Background Roux-en-Y gastric bypass is recognised as a standard of care in the treatment of diabetes mellitus and obesity. However, the optimal length of the Roux-en-Y gastric bypass limbs remains controversial, with substantial variation in practice. Specifically, a longer biliopancreatic limb length of 150 cm (‘long limb’) has been hypothesised t...

Background : The COVID-19 pandemic has created unprecedented pressures on healthcare systems worldwide, necessitating a reorganisation of elective services. Within all specialties, including bariatric surgery, this required a re-evaluation of patient prioritisation to limit harm due to delays in treatment while ensuring those who will benefit most...

Background: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving internatio...

Background Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Methods Between January 2016 and April 2019, all patients with...

Objective: Roux-en-Y gastric bypass (RYGB) characteristically enhances postprandial levels of glucagon-like peptide 1 (GLP-1), a mechanism that contributes to its profound glucose-lowering effects. This enhancement is thought to be triggered by bypass of food to the distal small intestine with higher densities of neuroendocrine L-cells. We hypothe...

Background Prognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims to explore the relationship between pre-treatment endoscopic tumour morphology and postoperative s...

Background An excessively long-blind end of the alimentary limb following a Roux-en-Y gastric bypass (RYGB), known as a ‘candy cane’ (CC), may cause symptoms including abdominal pain, regurgitation and vomiting. Very few studies have examined the efficacy of surgical resection of the CC. Objectives The aim of this study was to assess sensitivity o...

Abstract Background: Prehabilitation is thought to reduce post-operative respiratory complications by optimising fitness before surgery. This prospective, single-centre study aimed to establish the effect of pre-operative exercise on cardiorespiratory fitness in oesophageal cancer patients and characterise the effect of adherence and weekly physica...

Background Sedentary behavior is emerging as an important field of scientific enquiry for cancer survivorship. The posttreatment period is associated with prolonged recovery, deterioration in quality of life, disability, poor mental health, and reduced productivity. Exercise in cancer survivors has been linked with reduced fatigue, improved functio...

Open esophagectomy (OE) for esophageal and gastroesophageal junctional cancers is associated with high morbidity. Completely minimally invasive esophagectomy (CMIE) techniques have evolved over the last two decades and significantly reduce surgical trauma compared to open surgery. Despite this, long-term oncological outcomes following CMIE compared...

Background Obesity surgery has pronounced effects on metabolic profile of patients with type 2 diabetes mellitus (T2DM); however, reports on long-term remission rates based on the standardised and holistic criteria by the International Diabetes Federation (IDF) and effects on T2DM microvascular complications are scarce in the literature. In this re...

Centralization of care has improved outcomes in esophagogastric (EG) cancer surgery. However, specialist surgical centers often work within clinical silos, with little transfer of knowledge and experience. Although variation exists in multiple dimensions of perioperative care, the differences in operative technique are rarely studied. An esophageal...

Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combine...

Objective: Roux-en-Y gastric bypass (RYGB) augments postprandial secretion of glucagon-like peptide 1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY). Subcutaneous infusion of these hormones ("GOP"), mimicking postprandial levels, reduces energy intake. Our objective was to study the effects of GOP on glycemia and body weight when given for 4 w...

Background: Roux-en-Y gastric bypass (RYGB) is a successful treatment for diabetes and obesity, possibly because it augments post-prandial secretion of the gut hormones glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM) and peptide YY (PYY). Subcutaneous infusion of GLP-1, OXM and PYY (GOP) mimicking hormone levels observed after RYGB reduces foo...

Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality...

Background Compliance with enhanced recovery programmes (ERPs) in oesophago-gastric (OG) surgery is challenging due to high rates of complications. Higher compliance is associated with better outcomes; however compliance is difficult to assess due to variable reporting and lack of standardisation of descriptors within an ERP. This study aims to und...

Background Sedentary behaviour is emerging as an important field of scientific enquiry for cancer survivorship research. The aim of this study is to evaluate the impact of PREPARE, a multi-modal pre-operative optimization programme, and the impact this has on sustained activity following completion of cancer treatment. Methods 66 patients were app...

Poster presentation showing a single centre experience of the mini gastric bypass/one anastomosis gastric bypass as a viable alternative to Roux-en-Y gastric bypass as a revisional procedure

The older surgical patient is well known to be at high risk of increased mortality and medical complications in the perioperative period. These occur due to a variety of patient and service related factors. The need for physician support is recognised and liaison models of care can reduce complications and length of stay (LOS) in some surgical spec...

Retrospective analysis of mini-gastric bypass versus Roux-en-Y gastric bypass as revision procedures following failed sleeve gastrectomy or gastric banding

Introduction: An excessively long blind-end of the alimentary limb following RYGB, known as a ‘candy cane’ (CC), may cause symptoms such as pain, gastrointestinal symptoms and weight regain. Very few studies have examined the efficacy of surgical resection of the CC. We aimed to assess symptom resolution following CC surgery. Methods: Single centr...

Evidence suggests that structured training programs for laparoscopic procedures can ensure a safe standard of skill acquisition prior to independent practice. Although minimally invasive esophagectomy (MIO) is technically demanding, no consensus on requirements for training for the MIO procedure exists. The aim of this study is to determine essenti...

Background: Adverse surgical incidents affect both patients and health professionals. This study sought to explore the effect of surgical incidents on operating theatre staff and their subsequent behaviours. Methods: Eligible studies were primary research or reviews that focused on the effect of incidents on operating theatre staff in primary, s...

Appendix S1. List of MeSH terms and text words used in databases: MEDLINE, EMBASE, CINAHL and PsycINFO Table S1 Key characteristics and findings of selected articles Table S2 Subthemes and overarching themes extracted from each article in the review

The objective of this systematic review is to identify key components of enhanced recovery protocols (ERP) that lead to improved length of hospital stay (LOS) following esophagectomy. Relevant electronic databases were searched for studies comparing clinical outcome from esophagectomy followed by a conventional pathway versus ERP. Relevant outcome...

Background: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity, or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. Method...

The feasibility and safety of enhanced recovery protocols (ERP) have been demonstrated in a large number of surgical specialties. Several studies have shown improved post-operative outcomes and economic benefit from the use of ERPs in oesophageal cancer surgery. However, these improvements are not always translated more widely into clinical practic...

More work needed on improving fitness for surgery

Objective: To investigate the characteristics and culture of antibiotic decision making in the surgical specialty. Methods: A qualitative study including ethnographic observation and face to face interviews with participants from six surgical teams at a teaching hospital in London was conducted. Over a three month period: 1) thirty ward rounds (...

Background: Gastric leak after laparoscopic sleeve gastrectomy (LSG) is a serious complication. Currently, the literature lacks long-term outcomes in LSG and leak rates after reinforcement of the staple line. The aims are two-fold: to present leak rates from using staple line reinforcement and six year outcomes of LSG in relation to resolution of...

Introduction: Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted. Methods: This study aimed to define a group of imp...

Small bowel neuroendocrine tumours are the commonest malignancy arising in the small intestine and have substantially increased in incidence in recent decades. Patients with small bowel neuroendocrine tumours commonly develop lymph node and/or distant metastases. Here, we examine the role of staging in 84 surgically treated patients with small bowe...

To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist...

Background Full implementation of safety checklists in surgery has been linked to improved outcomes and team effectiveness; however, reliable and standardized tools for assessing the quality of their use, which is likely to moderate their impact, are required. Study Design This was a multi-center prospective study. A standardized observational ins...