Robert N Whistance

• MB ChB BSc MRCS MRCEM
• ST5 at Cwm Taf Health Board

Background: Colorectal cancer (CRC) is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs); however, the impact of RCTs is diminished by a lack of coordin...

Background: Trials are robust sources of data for clinical practice; however, trial outcomes may not reflect what is important to communicate for decision-making. The study compared clinicians' views of outcomes to include in a core outcome set for colorectal cancer (CRC) surgery, with what clinicians considered important information for clinical...

Core outcomes sets (COS) are an agreed minimum group of outcomes to measure in trials. Core information sets (CIS) are defined as the agreed minimum information required for clinical decision-making. Theoretically, these concepts should be closely aligned, however, there is no evidence that COSs adequately inform CISs. This study compared COS and C...

Patient reported outcome measures (PROMs) are standard in the assessment of colorectal cancer (CRC) treatment, but the range and complexity of available PROMs may be hindering evidence synthesis. This systematic review aimed to 1) summarise PROMs in studies of CRC surgery and 2) categorise PRO content to inform the future development of an agreed m...

Outcome reporting in bariatric surgery needs uniformity. A core outcome set is an agreed minimum set of outcomes reported in all studies of a particular condition, but members of the bariatric multidisciplinary team might value outcomes differently. The aim of this study was to summarise existing outcome reporting in bariatric surgery, to inform th...

Outcome reporting in bariatric surgery needs a core outcome set (COS), an agreed minimum set of outcomes reported in all studies of a particular condition. The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS. Outcomes reported in randomized controlled trials (RCTs) and large non-randomize...

Background: The use of neoadjuvant therapy before surgery for gastrointestinal cancer is increasing; however, patients may not complete both treatment components. Understanding completion rates of each treatment stage is necessary for treatment evaluation and to inform decision-making. This study evaluates reporting for recent neoadjuvant surgical...

To evaluate the short- and long-term outcomes of concomitant aortic (AVr) and mitral (MVr) valve repair. This retrospective analysis of prospectively collected data identified patients who had undergone AVr and MVr surgery from March 1996 to October 2009. Patients were included if they had undergone combined repair on the aortic and mitral valves....

Video-assisted thoracoscopic surgery (VATS) for thymoma has uncertain safety and effectiveness in comparison with trans-sternal resection. This feasibility study compared short- and mid-term outcomes for patients undergoing these two procedures, highlights weaknesses in current research and makes recommendations for long-term technological evaluati...

Synthesis of patient-reported outcome (PRO) data is hindered by the range of available PRO measures (PROMs) composed of multiple scales and single items with differing terminology and content. The use of core outcome sets, an agreed minimum set of outcomes to be measured and reported in all trials of a specific condition, may improve this issue but...

This study evaluated the effect of preoperative symptoms on long-term survival and valve reintervention in patients undergoing aortic valve repair (AVr) for severe degenerative aortic insufficiency (AI). Between March 1996 and June 2010, 274 patients underwent AVr for severe AI. Seventy-seven were performed in asymptomatic patients (Group I) and 19...

Background Informed consent is required before any surgery or invasive procedure is performed. Achieving ethically valid informed consent can be difficult: too little information may leave patients poorly informed and too much information may be overwhelming. As such interventions to promote information provision for informed consent are warranted....

Objective: To systematically review audio-visual (AV) interventions for promoting informed consent (IC) in clinical practice and to consider the impact of reading age adjustment. Methods: Systematic review of randomized controlled trials (RCTs) comparing AV interventions to standard IC in clinical practice. Outcomes included recall (immediate <1...

To evaluate the effect of higher post-operative valve gradient on freedom from valve re-intervention and death in patients undergoing aortic valve repair (AVr). Patients who underwent AVr between March 1996 and June 2010 were divided into 2 groups: I: peak gradient (PG) <20 mmHg (n=358) and II: PG ≥20 mmHg (n=113). Age (53.6±16.0 vs. 50.6±16.4 year...

Background: National guidelines recommend that fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) is performed in all patients being considered for radical treatment of oesophageal or oesophago-gastric cancer without computerised tomography scan (CTS) evidence of metastasis. Guidance also mandates that all patients with c...

AimEvaluation of surgery for colorectal cancer (CRC) is necessary to inform clinical decision-making and healthcare policy. The standards of outcome reporting after CRC surgery have not previously been considered. Method Systematic literature searches identified randomized and nonrandomized prospective studies reporting clinical outcomes of CRC sur...

Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken. However, it is a complex process which requires patients be provided with information which they can understand and retain, opportunity to consider their options, and to be able to express their opinions and ask questions...

Valve repair has emerged as an important intervention for the management of bicuspid aortic valve disease. This systematic review aims to assess the safety, efficacy and durability of bicuspid aortic valve repair. Initial searches yielded 682 abstracts, reduced by de-duplication to 370, of which 56 full papers were accessed and 30 met the inclusion...

Background: The role of laparoscopy in two-stage hepatectomy for bilobar colorectal liver metastases (CRLMs) has not yet been extensively investigated. Patients and methods: We reviewed a prospectively collected database of 302 consecutive patients undergoing laparoscopic liver resection at our institution between 2003 and 2011. Results: Eight...

To examine the midterm clinical outcome of pulmonary valve replacement (PVR) with prosthetic valves. We reviewed 37 consecutive patients who underwent PVR with biological prosthetic valves between September 1999 and June 2010. The median age was 22.6 years (range: 6 to 70 years; three children). The primary diagnosis was Tetralogy of Fallot in 20 p...

Significant mitral regurgitation (MR) may arise from isolated annular dilatation secondary to lone atrial fibrillation (AF) and associated atrial remodelling. The aim of the present study is to assess the outcome of surgery for this condition. Between November 2007 and July 2011, 20 patients underwent mitral valve (MV) repair for severe MR secondar...

The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement (redo-MVR) at our institution. Forty-nine patients (24 males) underwent redo-MVR with either bioprosthetic (n = 24) or mechanical valves (n = 25) between January 2000 and 2010. Median age of patients was 63 years (range 21–80 year...

OBJECTIVES; This study aimed to investigate the early and late outcomes of patients undergoing aortic valve replacement (AVR) with previous coronary artery bypass grafting (CABG) and patent grafts. Between January 2000 and March 2010, 104 patients (87 males) with previous CABG ± concomitant surgery and patent grafts underwent AVR. The median age of...

During recent years there has been an increase in the referral pattern for surgery for non-rheumatic calcific mitral stenosis (CMS). Valve replacement for this condition presents some unique challenges, yet the management of CMS remains inadequately described. Herein are discussed the techniques and outcomes of surgery for CMS.

Screening is an important strategy for reducing cancer-related mortality in developed countries. Programmes for breast and cervical cancer screening are well established, while protocols for prostate, colorectal and ovarian cancer are still being developed [1–7]. Population screening programmes help to detect both invasive cancers and pre-malignant...

Whipple's disease is a chronic condition that is characterized by diarrhea, weight loss and arthropathy, and caused by infection with the fastidious bacterium Tropheryma whipplei. Although once rare, Whipple's disease is being increasingly described owing mainly to advances in molecular genetics and an improved isolation of the organism. Whilst car...

Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesente...

The aim of this systematic review is to scrutinize and summarize the design, conduct and reporting standards of articles recently published describing health-related quality of life (HRQL) outcomes of treatment of upper gastrointestinal cancer. Some 2312 abstracts were published between January and July 2009 and initial elimination of papers reduce...

This comprehensive, yet concise, book describes the basic surgical techniques required of junior trainees across the breadth of surgical specialties. It consists of 14 chapters, beginning with theatre conduct, instrument handling and suturing, before providing detailed descriptions of the elementary skills required to handle blood vessels, bowel an...

The aim of this study was to investigate the early and late outcomes of patients undergoing pulmonary embolectomy for acute massive pulmonary embolus. Twenty-one patients (15 male, 6 female) underwent pulmonary embolectomy at our institution between March 2001 and July 2010. The median age was 55 years (range, 24 to 70 years). Of these, 9 patients...

Objective: The Carpentier-Edwards (CE) Physio II ring is a new prosthetic ring designed to accommodate the changing pathology seen in the spectrum of degenerative valve disease, particularly the larger anterior leaflet in repair of the Barlow valve. The aim of our study was to assess the safety and efficacy of mitral valve (MV) repair with the CE...

This is the first report of the construction of a modified Blalock-Taussig shunt using a Contegra conduit reinforced with Goretex in a 4-year-old boy. The patient had a complex cardiac history with a primary diagnosis of pulmonary atresia, hypoplastic right ventricle (RV) and RV-coronary artery fistula.

We sought to determine the long-term performance of homograft and truncal valve after complete repair of common arterial trunk. From January 1964 to June 2008, 32 patients (median age, 14 days; range, 5 days to 2.5 years) underwent primary homograft repair of common arterial trunk. Twenty-four (75%) were neonates. The homograft used in the right ve...

Conventional cardiopulmonary bypass can trigger a systemic inflammatory response syndrome similar to sepsis. Aetiological factors include surgical trauma, reperfusion injury, and, most importantly, contact of the blood with the synthetic surfaces of the heart-lung machine. Recently, a new cardiopulmonary bypass system, mini-extracorporeal circulati...

We set to examine the mid-term outcome after aortic valve replacement (AVR) with Soprano pericardial stented bioprosthesis measuring <or=20 mm. Sixty-eight patients underwent AVR between June 2003 and January 2006 (50 women; median age 77 years; range 60-89 years). Preoperatively, 60 patients (88.2%) were in New York Heart Association (NYHA) class...

This study tested the scale properties and validity of the ten-item body image scale (BIS) in patients undergoing surgery for colorectal cancer (CRC). Patients completed the BIS and a validated measure of health-related quality of life (European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30) after open or laparoscopic resection....

This international study aimed to test the measurement properties of the updated European Organisation for Research and Treatment of Cancer (EORTC) questionnaire module for colorectal cancer, the QLQ-CR29. The QLQ-CR29 was administered with the QLQ-C30, core questionnaire, to 351 patients from seven countries. Questionnaire scaling and reliability...