Max Almond

• University Hospitals Birmingham NHS Foundation Trust

Background British Sarcoma Group guidelines for the management of GIST were initially informed by those published by the European Society of Clinical Oncology. This update was written by a group of experts to includes a discussion of the highlight improvements in our knowledge of the disease and recent treatment developments. The guidelines include...

Background Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC.Method...

Complete en bloc surgical resection offers the best opportunity for the cure of primary retroperitoneal sarcomas (RPS). The potential for disease recurrence, in the form of both loco-regional recurrence and distant metastases, underpins the rationale for postoperative surveillance. There is a paucity of high-quality evidence underpinning follow-up...

Background: Malignancies involving the inferior vena cava (IVC) have historically been considered not amendable to surgery. More recently, involvement of the IVC by neoplastic processes in the kidney, liver or in the retroperitoneum can be managed successfully. Methods: In this systematic review we summarize the current evidence regarding the su...

Objective: The Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) conducted a retrospective study on the disease course and clinical management of ganglioneuromas. Background: Ganglioneuromas are rare tumors derived from neural crest cells. Data on these tumors remain limited to case reports and single-institution case se...

Background: As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ageing is associated with inferior short-term survival outcomes after RPS surgery. Patients and me...

Background Desmoids are rare fibroblastic tumours whose treatment in any individual case presents a persistent challenge. We endeavoured to evaluate various clinicopathological factors contributing to tumour behaviour. Methods This is a retrospective review of 95 primary truncal sporadic fibromatosis managed between 2011 and 2020. We studied progr...

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare malignancy with a low malignant potential and strong female preponderance. Diagnosis during pregnancy is extraordinary, and management must consider the risks to the mother and foetus of tumour growth and rupture. A large 35-cm SPN was identified on magnetic resonance imaging (MRI) in a...

Background: Surgery is the mainstay of treatment for retroperitoneal sarcoma (RPS), but local recurrence is common. Biologic behavior and recurrence patterns differ significantly among histologic types of RPS, with implications for management. The Transatlantic Australasian RPS Working Group (TARPSWG) published a consensus approach to primary RPS,...

Aim: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods: International prospective cohort study of consecutive colorectal cancer patients with a d...

Background: Desmoids are rare fibroblastic tumours whose treatment in any individual case presents a persistent challenge. We endeavoured to evaluate various clinicopathological factors contributing to tumour behaviour. Methods: This is a retrospective review of 95 primary truncal sporadic fibromatosis managed between 2011 and 2020. We studied pro...

Background Desmoids are rare fibroblastic tumours whose treatment in any individual case presents a persistent challenge. We endeavoured to evaluate various clinicopathological factors contributing to tumour behaviour. Methods This is a retrospective review of 95 primary truncal sporadic fibromatosis managed between 2011 and 2020. We studied progr...

Introduction: Primary abdominal wall sarcomas are rare, heterogeneous tumours. The mainstay of management is surgery, although local recurrences (LR) and distant metastases (DM) are common. Objectives: Overall survival (OS) and disease-free survival (DFS) were primary outcomes; factors associated with prognosis secondary outcomes. Materials and...

Aim Soft tissue sarcomas (STS) are a comparatively unusual cluster of tumours; they arise from mesenchymal tissues. Surgery remains the primary and the only potentially curative treatment for most STS subtypes. Existing intraoperative margin assessment techniques are inadequate and the current gold standard for resection margin assessment of STS is...

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.

Desmoid tumours are clonal fibroblastic proliferations in soft tissues, characterised by infiltrative growth and local recurrence, but not metastasis. Various treatment strategies for desmoid tumours exist, varying from observation, medical and systemic therapy to radiotherapy and surgery. A 25-year-old woman with a background of familial adenomato...

Background: Our study aimed to compare the comprehensive complication index (CCI) to the conventional Clavien-Dindo classification (CDC) in patients undergoing surgery for primary retroperitoneal sarcoma (RPS). Methods: Data were collected for patients who underwent surgery from 2008 to 2019 at a tertiary institution. The length of hospital stay...

Background Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between postoperative complications and prognosis in patients with RPS.Methods Patients undergoing surgery for prim...

Background: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association be- tween preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods: This international cohort study included adult patients undergoing elective s...

Aim This observational study aimed to evaluate the impact of intensity of radiological surveillance on survival following resection of retroperitoneal sarcoma. Method Retrospective cohort study of patients undergoing primary resection of soft tissue sarcoma arising in the retroperitoneum, abdomen or pelvis at a single, high-volume sarcoma centre....

(248 Words) Background Surgery for retroperitoneal soft tissue sarcoma (RPS) is technically challenging, often requiring perioperative red blood cell transfusion (PBT). In other cancers, controversy exists regarding the association of PBT and oncologic outcomes. No study has assessed this association in primary RPS, or identified factors associate...

Background Primary mesenteric soft tissue sarcomas (STS) are rare and limited evidence is available to inform management. Surgical resection is challenging due to the proximity of vital structures and a need to preserve enteric function. Objectives To determine the overall survival (OS) and recurrence‐free survival (RFS) for patients undergoing pr...

Background objectives: The impact of tumor necrosis as a prognostic factor in gastrointestinal stromal tumor (GISTs) is still debated. The objective was to determine whether tumor necrosis is an independent risk factor for survival in patients with GISTs. Methods: Patients undergoing surgery for primary GIST from March 2003 to October 2018 at two...

Background Evolving surgical technology and medical treatment have led to an expansion of indications to enable resection of large hepatic tumours with involvement of other abdominal structures. Methods Twelve extended liver and abdominal resections, either ex situ with auto‐transplantation of the liver remnant or ante situm with veno‐venous bypas...

Introduction Studies reporting outcomes of liver resection for sarcoma metastases (LRSM) typically include gastrointestinal stromal tumours (GIST), or pooled analyses of “non-colorectal liver metastases”, which do not reflect the subgroup of patients with sarcomatous liver metastases. This study aimed to perform a systematic review to evaluate onco...

Background: Barrett's oesophagus is one of the most common pre-malignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little since the 1980s. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes...

Background: Biopsy sensitivity in retroperitoneal dedifferentiated liposarcoma (DDLPS) is variable. Patients with grade 3 DDLPS face a significant risk of metastatic disease and may potentially benefit from neoadjuvant therapy, making highly accurate pretherapy diagnosis essential. Our study aimed to establish whether diagnostic sensitivity could...

Retroperitoneal liposarcomas are rare tumours that carry a poorer prognosis than their extremity counterparts. Within their subtypes – well differentiated (WDL), dedifferentiated (DDL), myxoid (MLS) and pleomorphic (PLS) - they exhibit a diverse genomic landscape. With recent advances in next generation sequencing, the number of studies exploring t...

11041 Background: Extended surgery in retroperitoneal sarcoma (RPS) has resulted in less recurrences and better survival. We investigated whether outcome further improved, after the recent understanding of behavior of different RPS subtypes and introduction of multimodal therapies. Methods: Consecutive primary RPS operated at a single center were a...

Background Percutaneous biopsy is recommended before surgery for suspected retroperitoneal sarcoma (RPS) to confirm the histological diagnosis and guide surgical strategy. The present study aimed to establish the diagnostic accuracy of percutaneous core biopsy with respect to histological diagnosis and tumour grade. Methods Data on patients with s...

Introduction Solitary extramedullary plasmacytoma are rare, solid-mass tumours which appear immunophenotypically similar to multiple myeloma. The diagnosis and management of gastrointestinal plasmacytoma is complex and requires multidisciplinary input. This study presents a narrative review of intra-abdominal extramedullary plasmacytoma, illustrate...

Extended surgery remains the mainstay of treatment in retroperitoneal sarcoma, although conflicting data exist on the benefit of neoadjuvant and adjuvant therapies, particularly with regard to tumour grade and histological type. Experience of radiotherapy and chemotherapy in extremity soft tissue sarcoma can inform treatment strategies, however the...

Carcinosarcomas (CS) are uncommon, highly aggressive, biphasic tumours consisting of both sarcomatous and carcinomatous elements. They appear to originate from a common cell of origin, either via transformation from a single premature precursor or conversion of a mature epithelial cell through an epithelial-mesenchymal transition. CS should be cons...

Background: Development of a nonendoscopic test for Barrett's esophagus would revolutionize population screening and surveillance for patients with Barrett's esophagus. Swallowed cell collection devices have recently been developed to obtain cytology brushings from the esophagus: automated detection of neoplasia in such samples would enable large-...

Background: Self-expanding metal stents (SEMSs) are the palliative treatment of choice for rapid symptomatic relief in patients with malignant dysphagia. Increasingly endoscopically guided insertion is performed as a day case and without the need for fluoroscopic guidance. This consecutive case series reports 11-year experience of endoscopically g...

Purpose This study aimed to evaluate the impact on overall survival following palliative surgery to remove the primary lesion in unresectable metastatic small intestinal (SI-NET) and pancreatic neuroendocrine tumours (P-NET). Methods A systematic review of the literature and meta-analysis was performed. MEDLINE and Embase databases were searched t...

Myeloid sarcoma is an extramedullary tumour of immature granulytic cells. It is a rare condition, most often associated with acute myeloid leukaemia although in some rare cases it may present in non-leukaemic patients. It should therefore be considered as a differential diagnosis of any atypical cellular infiltrate. It may occur at any site leading...

The management of soft tissue sarcoma is challenging and varied. Centralisation of management in high volume specialist centres has revolutionised outcomes. Surgery remains the mainstay of treatment and is currently the only potentially curative therapy. Retroperitoneal soft tissue sarcoma presents a particular challenge to the surgical oncologist...

Purpose: To investigate surgical trainee feedback-seeking behaviors-directly asking for feedback (inquiry) and observing and responding to situational clues (monitoring)-in the context of workplace-based assessment (WBA). Method: A hypothetical model of trainee feedback-seeking behavior was developed using existing literature. A questionnaire, i...

Introduction: The role of surgery to resect the primary lesion in incurable metastatic small intestinal (SI-NET) and pancreatic neuroendocrine tumours (P-NET) remains controversial. Recent evidence suggests that palliative surgery may increase survival even in asymptomatic patients with non-functioning tumours. The present study investigated the va...

Barrett's oesophagus (BE) is a premalignant condition that can progress to oesophageal adenocarcinoma. Endoscopic surveillance aims to identify potential progression at an early, treatable stage, but generates large numbers of tissue biopsies. Fourier transform infrared (FTIR) mapping was used to develop an automated histology tool for detection of...

Differences in how workplace-based assessments are viewed by trainees and those who train them.

Introduction: Laparoscopic anti-reflux surgery is conventionally performed using two 10/12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our init...

The vibrational spectroscopy analytical methods offer several apparent advantages for immediate and real-time medical diagnosis. They are able detect subtle molecular changes that must be present prior to morphological tissue changes. As well as allowing molecular understanding of a diseases natural history, there are very important patient benefit...

Instrumental advances in infrared micro-spectroscopy have made possible the observation of individual human cells and even subcellular structures. The observed spectra represent a snapshot of the biochemical composition of a cell; this composition varies subtly but reproducibly with cellular effects such as progression through the cell cycle, cell...

Introduction Non-endoscopic detection of Barrett’s oesophagus (BO) and associated neoplasia would allow population screening and could potentially replace endoscopic surveillance. A swallowed cytology brush has been developed (‘Cytosponge’) for oesophageal cell collection. A recent study (BEST2) assessing the Cytosponge used immunostaining with Tre...

Introduction The efficacy of dual modality endotherapy with endoscopic resection and mucosal ablation is now well documented in the treatment of Barrett’s-associated early neoplasia. This strategy was supported by a consensus survey of international experts in 2011 with the aim of achieving high rates of complete eradication of dysplasia and intest...

doi: 10.1038/ajg.2015.55 http://www.nature.com/ajg/journal/vaop/ncurrent/abs/ajg201555a.html OBJECTIVES: Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and ev...

Endoscopic surveillance remains the core management of non-dysplastic Barrett's oesophagus, although questions regarding its efficacy in reducing mortality from oesophageal adenocarcinoma have yet to be definitively answered, and randomised trial data are awaited. One of the main goals of current research is to achieve risk stratification, identify...

Prevention is the most desirable strategy for nearly all disease processes, but this is especially true for a malignancy with a tendency for metastasis and a correspondingly poor prognosis. Chemoprevention through appropriate drug treatment is a potentially powerful means of radically reducing the incidence of esophageal cancer, and the search for...

We report results from a study utilizing infrared spectral cytopathology (SCP) to detect abnormalities in exfoliated esophageal cells. SCP has been developed over the past decade as an ancillary tool to classical cytopathology. In SCP, the biochemical composition of individual cells is probed by collecting infrared absorption spectra from each indi...

IntroductionThe indications for a total pancreatectomy (TP), its peri-operative management, provision of pancreatic surgical services and medical treatment of the inherent exo- and endocrine deficient states have all changed considerably over recent decades. The effects of these upon the incidence, indications for and outcomes of TP are unclear. Pa...

Background: Endoscopic resection (ER) is emerging as a curative technique in patients with high-grade dysplasia (HGD), intramucosal cancer (IMC), and early submucosal cancer (T1sm1) within Barrett's oesophagus. Methods: This consecutive case series of 72 patients with HGD or IMC reports outcomes of ER, with or without mucosal ablation, in a sing...

Background The optimal management of patients with Barrett's-associated low-grade dysplasia (LGD) is unclear. The objective of this study was to identify systematically all reports of endoscopic treatment of LGD, and to assess outcomes in terms of disease progression, eradication of dysplasia and intestinal metaplasia, and complication rates.Method...

Instrumental advances in vibrational microspectroscopy have made possible the observation of individual human cells and even subcellular structures. The observed spectra represent a snapshot of the biochemical composition of a cell; this composition varies subtly but reproducibly with cellular effects such as progression through the cell cycle, cel...

The incidence of oesophageal adenocarcinoma has increased by 500% over the past 30 years.(1) Improved understanding of the mechanisms of neoplastic progression provides an opportunity to reverse this trend. A thorough review of emerging strategies aiming to prevent the formation of oesophageal malignancy is presented. These include dietary modifica...

Aims: We aim to assess how our recently introduced endoscopic ultrasound (EUS) intervention service has impacted on patient management within our institution. Method: EUS interventional services were introduced within our institution in August 2010. A database of all patients undergoing these procedures is being maintained. To evaluate the clinical...

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...

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...

The vibrational spectroscopy techniques of Raman spectroscopy and Fourier-transform infrared spectroscopy offer a number of potential advantages as tools for clinical diagnosis. The ability of these methods to detect subtle biochemical changes relating to pathology opens the possibility of their use in tissue diagnosis. Potential applications inclu...

Introduction Screening for Barrett’s oesophagus could allow early detection, enabling timely diagnosis and intervention for oesophageal adenocarcinoma. Recent studies have shown the acceptability of a swallowed cytology brush (‘Cytosponge’) for cell collection. If introduced, cytological assessment would pose several challenges. Firstly, oesophagea...

The combination of the optical imaging modalities with endoscopic devices offer the opportunity for a real-time, objective, in vivo medical diagnosis. This chapter summarizes recent advances in molecular endospectroscopy providing detailed information on disease-specific molecular changes in tissues without the need for excision, slicing, fixation,...

The application of semi-supervised methodology to improve the classification performance of a Raman spectroscopic probe for the diagnosis of oesophageal cancer is described. It is well known that gold standard histopathology diagnosis can be highly subjective, particularly for diseases which have several stages, such as cancer. A 'consensus' pathol...

Survival in oesophageal cancer remains poor with high post-operative recurrence rates. PET/CT was introduced to the Three-Counties Cancer Network (3CCN) in 2006 to detect 'occult' metastatic disease not seen with conventional staging modalities. This study aims to determine whether the introduction of Integrated fluorodeoxyglucose (18F) Positron Em...

There are many remaining challenges impeding future progress in field of Clinical Diagnostics. This book presents a technical assessment and vision of clinical leaders, scoping the clinical and other diagnostic needs and the bottle-necks in their cognate fields. Issues of real environmental biological measurements from the perspective of the end-us...

Light interacts with tissue in a number of ways including, elastic and inelastic scattering, reflection and absorption, leading to fluorescence and phosphorescence. These interactions can be used to measure abnormal changes in tissue. Initial optical biopsy systems have potential to be used as an adjunct to current investigative techniques to impro...

Background. Transient Auditory Dysfunction (TAD) is a previously undescribed symptom complex of unknown cause. It is characterised by sensoneural hearing loss (unilateral or bilateral) and tinnitus, which develops over a minute, resolves completely within minutes and is not accompanied by vestibular symptoms. The condition was brought to our attent...

Transient auditory dysfunction (TAD) is a previously undescribed symptom complex of unknown cause. It is characterized by short-lasting sensorineural hearing loss (unilateral or bilateral), it is associated with tinnitus, it resolves completely within minutes, and it is not accompanied by vestibular symptoms. We conducted a cross-sectional prospect...

Early detection and targeted endoscopic resection of Barrett's esophagus-associated high-grade dysplasia (HGD) can prevent progression to invasive esophageal malignancy. Raman spectroscopy, a highly sophisticated analytical technique, has been translated into an endoscopic tool to facilitate rapid, objective diagnosis of dysplasia in the esophagus....

The management of Barrett's oesophagus and associated neoplasia has evolved considerably in recent years. Modern endoscopic strategies including endoscopic resection and mucosal ablation can eradicate dysplastic Barrett's and prevent progression to invasive oesophageal cancer. However, several aspects of Barrett's management remain controversial in...

Background: Barrett's oesophagus is one of the most common pre-malignant lesions in the world. Currently the mainstay of therapy is surgical management of advanced cancer but this has improved the five-year survival very little since the 1980s. As a consequence, improved survival relies on early detection through endoscopic surveillance programmes...

We evaluate the potential of a custom-built fiber-optic Raman probe, suitable for in vivo use, to differentiate between benign, metaplastic (Barrett's oesophagus), and neoplastic (dysplastic and malignant) oesophageal tissue ex vivo on short timescales. We measured 337 Raman spectra (λex=830  nm; Pex=60  mW; t=1  s) using a confocal probe from fres...

The ageing population and changes in incidence of upper gastrointestinal cancer will have profound changes for our management of these patients. There is much debate as how to bring forward the diagnosis of early mucosal cancer that may be curable using endoscopy or by surgery. In the older more frail patients, early disease will often be controlle...