Irish Journal of Medical Science (1971 -) (2018) 187 (Suppl 4):S115–S171 https://doi.org/10.1007/s11845-018-1861-7
XLIIIrd Sir Peter Freyer Memorial Lecture and Surgical Symposium
Arts Millennium Building, National University of Ireland Galway 7th & 8th September 2018
Irish Journal of Medical Science Volume 187 Supplement 4 DOI 10.1007/s11845-018-1861-7 S116 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S117 S118 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Sponsors 2018
The 43rd Sir Peter Freyer Meeting gratefully acknowledges the support given to the meeting by the following companies:
Sponsors
Acelity
Applied Medical
C. R. Bard
Galway Clinic
Genomic Health
Greunenthal Pharma Ltd
Johnson & Johnson Medical Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S119
Leo Pharma
M.E.D. Surgical
Medserv
Medtronic
Olympus Medical
PEI
Sanofi Ireland Ltd
Tekno Surgical Ltd S120 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S121
FRIDAY, 7th SEPTEMBER 2018
SESSION 1: BREAST CLINICAL & ENDOCRINE Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Máirtín Ó Tnúthail Theatre, AM150 Theatre Chairs: Ms Ruth Prichard & Mr Robert Kennedy
9.00 a.m. A 10-Year Review of Patient Satisfaction Following Breast Reconstruction at University Hospital Limerick Paper 1: JDuffy1, M McCumskey1, I Balasubramanian1,TWeston2,STormey1, A Merrigan1 (1) Department of Breast Unit, University Hospital Limerick, St. Nessan’s Road, Dooradoyle, Ireland; (2) Department of Psychology, York University, Toronto, Ontario, Canada
9.10 a.m. Evaluating the Cost Effectiveness of Trastuzumab in the Neoadjuvant Setting Paper 2: AMcGuire1, JAL Brown1,DPJoyce1,CO’Neill2, MJ Kerin1 (1) Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland; (2) School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Northern Ireland
9.20 a.m. Neoadjuvant Chemotherapy – Impact on Breast Surgery Practice over 10 Years in a Regional Cancer Centre Paper 3: NO’Halloran1,ALowery1,CCurran1, R McLaughlin1, C Malone1,KSweeney1,MKeane2,MJKerin1 (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland; (2) Department of Medical Oncology, Galway University Hospital, Galway, Ireland
9.30 a.m. The Usefulness of the Pre-Operative Neutrophil / Lymphocyte Ratio and Platelet / Lymphocyte Ratio in Predicting Breast Cancer Recurrence Paper 4: C Cullinane, M McCumiskey, A Lal, BA Merrigan, S Tormey Department of Breast Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
9.40 a.m. Progesterone Receptor Status as a Prognostic Indicator in Oestrogen Receptor Positive Breast Cancer Patients - A Systematic Review Paper 5: E Dunne, M Boland, N Bhatt, A Lowery Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland
9.50 a.m. The Projected Impact of a Weight Loss Strategy on Predicted Breast Cancer Risk Paper 6: A Cotter, HP Redmond, MA Corrigan Cork Breast Research Centre, Cork University Hospital, Cork, Ireland
10.00 a.m. Assessment of Validity of A Standardized Pre-Operative Nomogram for Prediction of Central Nodal Metastasis in Papillary Thyroid Carcinoma Paper 7: L Mc Loughlin, I Balasubramanian, MJ Kerin, A Lowery Department of Surgery, Galway University Hospital, Galway, Ireland
10.10 a.m. Under-Recognition of Primary Hyperparathyroidism in a Tertiary Centre Setting Paper 8: A White1,DPO’Leary1, C Sanchez Belmar1, S Costelloe2,MMajeed1, A Achakzai1,HPRedmond1 (1) Department of General and Endocrine Surgery, Cork University Hospital, Wilton, Cork, Ireland; (2) Department of Biochemistry, Cork University Hospital, Wilton, Cork, Ireland
10.20 a.m. The Role of Microrna Single Nucleotide Polymorphisms (Misnps) in Differentiated Thyroid Cancer: A Review and Meta- Analysis Paper 9: J Birrane, U McVeigh, P Owens, MJ Kerin, A Lowery Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland
10.30 a.m. COFFEE S122 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 2: UROLOGY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Patrick F Fottrell Theatre, AM200 Theatre Chairs: Professor Thomas Lynch & Ms Catherine Dowling
9.00 a.m. A 20 Year Review of Bladder Cancer in Ireland Paper 10: SO’Meara1,NRBhatt1, TED McDermott1,RJFlynn1,RPManecksha2,AZThomas2 (1) Department of Urology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland; (2) Department of Surgery, Trinity College Dublin, Dublin, Ireland
9.10 a.m. A 3-Year Audit of Compliance with the NCCP Guidelines for Referral to the Rapid Access Prostate Clinic at St James’s Hospital Paper 11: GLavelle1,UHaroon1, P Lonergan1,LCasey1,MO’Brien1, S Bowen1, T Conroy1,MCremin1,CEnright2,TLynch1, RManecksha1 (1) Department of Urology, St James’s Hospital, James’s Street, Dublin 8, Ireland; (2)DepartmentofCancerAudit,StJames’s Hospital, James’s Street, Dublin 8, Ireland
9.20 a.m. Radical Cystectomy for Bladder Cancer: A Comparison of Stage Migration and Review of Outcomes Paper 12: EO’Beirn, H Economos, L McLoughlin, K Walsh, G Durkan, S Jaffry, E Rogers, F D'Arcy, N Nusrat, C Dowling Department of Urology, Galway University Hospital, Galway, Ireland
9.30 a.m. Hospitalisation Due to Infection Post TRUS Guided Prostate Biopsy Paper 13: L Scanlon, A Cahill, JA O’Kelly, M Broe, K O’Connor, F O’Brien Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
9.40 a.m. The Implementation of a Protected Emergency Theatre Pathway for Acute Urological Admissions Paper 14: MHegazy1, S Anderson1, N Nusrat1,SJaffry1, E Rogers1,GDurkan1,PO’Malley1, R McLaughlin2, K Clarkson3, K Walsh1, FD’Arcy1, C Dowling1 (1) Department of Urology, Galway University Hospital, Ireland; (2) Department of Surgery, Galway University Hospital, Ireland; (3) Department of Anaesthesia and Intensive Care, Galway University Hospital, Galway, Ireland
9.50 a.m. Management of Patients with Acute Urinary Retention Discharged from the Emergency Department Paper 15: U Haroon1, S Inder 1,RKhalid1, R Manecksha1,IAhmed1,TLynch2 (1) Department of Urology, St. James Hospital, Dublin 8, Ireland; (2) Department of Surgery, Trinity College Dublin, Dublin, Ireland
10.00 a.m. Intraductal Carcinoma of The Prostate: Is There a Need for Genetic Screening? Paper 16: SO’Grady Coyne1,UHaroon1,MO’Neill2, C Gullman3,ICheema1, J Forde1,LMcLornan1 (1) Department of Urology, Beaumont Hospital, Dublin 9, Ireland; (2) Department of Urology, James Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland; (3) Department of Pathology, Beaumont Hospital, Dublin 9, Ireland
10.10 a.m. Transobturator Sub-Urethral Sling Insertion for Post Prostatectomy Urinary Incontinence: A Single Centre Experience Paper 17: MS Inder, PE Lonergan, JF Sullivan, RP Manecksha, TH Lynch Department of Urology, St James Hospital, Dublin, Ireland
10.20 a.m. Inevitability of Performing Prostate Multi-Parametric MRI (Mpmri) on Younger Men with Raised PSA Referred to a Rapid Access Prostate Clinic (RAPC) Paper 18: JO’Kelly, M Broe, L Scanlon, E Redmond, A Cahill, F O’Brien, K O’Connor Department of Urology, Cork University Hospital, Wilton, Cork, Ireland
10.30 a.m. COFFEE Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S123
SESSION 3: LOWER GI SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Mr Mark Regan & Mr Ronan Waldron
9.00 a.m. Assessing the Appropriateness of Colonoscopy Referrals and Post Colonoscopy Follow Up in a Single Centre Paper 19: ACotter,WJoyce Department of Surgery, Galway Clinic, Doughiska, Galway, Ireland
9.10 a.m. Abdominoperineal Resections Now and Then, Have Outcomes Changed? Paper 20: C Murphy1, I Stephens1, I Reynolds1,BO’Neill2,BO’Sullivan3, J Deasy1, J Burke1, D Mc Namara1 (1) Department of Colorectal Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; (2) Department of Radiation Oncology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; (3) Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
9.20 a.m. Appropriateness of Colonoscopy Paper 21: EBrennan1, S Johnston2,DHehir2 (1) Department of Medicine, University of Limerick, Castletroy, Limerick, Ireland; (2) Department of Surgery, Midlands Regional Hospital Tullamore, Arden Road, Tullamore, Co. Offaly, Ireland
9.30 a.m. MicroRNAs in Rectal Cancer: Novel Biomarker to Predict Response to Neoadjuvant Therapies and Survivial in Rectal Cancer Paper 22: RM Waldron1,KGilligan1, NM Miller1,MRJoyce2, AJ Lowery1,2,MJKerin1,2 (1) Department of Surgery, Galway University Hospital, Galway, Ireland; (2) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
9.40 a.m. Correlation of Immunohistochemical Mismatch Repair Protein Status in Colorectal Carcinoma Biopsy and Excision Specimens Paper 23: ÉJ Ryan, B Creavin, O O’Brien, ME Kelly, HM Mohan, R Geraghty, K Sheehan, D Winter Department of Colorectal Disease, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
9.50 a.m. Distal Enteral Nutrition Can Replace Long-Term Parenteral Nutrition in Selected Patients with a High Output Loop Jejunostomy or Enterocutaneous Fistula. A Twelve-Year Review Paper 24: S Power1, G McConnell1,SFeehan1,PNeary2 (1) Department of Nutrition and Dietetics, Tallaght Hospital, Tallaght, Dublin 24, Ireland; (2) Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
10.00 a.m. Influence of Neoadjuvant Radiation on Short-Term Surgical Outcomes in Rectal Cancer: A Systematic Review Paper 25: MAradaib1, S Panteleimonitis2,MHarper2, A Parvaiz2,3 (1) Department of General and Colorectal Surgery, Beacon Hospital, Beacon Court, Sandyford, Ireland; (2) School of Health Sciences and Social Work, University of Portsmouth, PO1 2FR, United Kingdom; (3) Department of Colorectal Surgery, Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
10.10 a.m. Risk of Colon Cancer after Acute Uncomplicated Diverticulitis. Is Routine Colonoscopy Necessary? Paper 26: N Hardy1, S Liptrot2, B Mehigan1, J Larkin1,PMcCormick1, H Al Chalabi 2 (1) Department of Surgery, St James Hospital, Dublin 8, Dublin 8, Ireland; (2) Department of Surgery, Royal Derby Hospital, Derby, United Kingdom
10.20 a.m. Robotic Assisted Colorectal Surgery at University Hospital Limerick Paper 27: D Westby1, T Connelly1, R Sehgal1, KHJ Chang1,DWaldron1, E Condon1, JC Coffey1,2, C Peirce1 (1) Department of Colorectal Surgery, University Hospital Limerick, Ireland (2) Graduate Entry Medical School, University of Limerick, Ireland
10.30 a.m. COFFEE S124 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 4: BREAST RESEARCH Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Máirtín Ó Tnúthail Theatre, AM150 Theatre Chairs: Mr Karl Sweeney & Ms Shona Tormey
11.00 a.m. Utility of a Nomogram to Predict Axillary Nodal Status In Breast Cancer Patients Scheduled for Mastectomy Paper 28: S Hembrecht, D Evoy, J Rothwell, J Geraghty, R Prichard, D McCartan Department of Breast and Endocrine Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
11.10 a.m. Assessing the Concordance between 9 Deleteriousness Prediction Methods for Missense Variants in a Targeted Resequencing Study of a West of Ireland Breast Cancer Population Paper 29: UMcVeigh1,TPMcVeigh2, N Miller1, D W Morris3,MJKerin1 (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland; (2) Department of Clinical Genetics, Our Lady’sChildren’s Hospital Crumlin, Dublin, Ireland; (3) Department of Biochemistry, NUI Galway, Ireland
11.20 a.m. Changes in and Predictors of Length of Stay in Hospital after Mastectomy Paper 30: A Tamas, P Cromwell, E McDermott, D Evoy, J Rothwell, J Geraghty, R Prichard, D McCartan Department of Breast Surgery, St Vincent’s University Hospital, Dublin, Ireland
11.30 a.m. Relationship between the Metabolic Syndrome and Mammographic Breast Density in Breast Cancer Paper 31: P Shokuhi1, S McGarrigle2,CSullivan3, T Boyle1, D Alazawi1,SO’Keeffe3, J Kennedy4, E Connolly1 (1) Department of Surgery, St James’s Hospital, James’s Street, Dublin 8, Ireland; (2) Department of Surgery, Trinity College Dublin, Dublin 8, Ireland; (3) Department of Radiology, St James’s Hospital, Dublin 8, Ireland; (4) Department of Oncology, St James’s Hospital, Dublin 8, Ireland
11.40 a.m. A Review of the Treatment of Luminal A Breast Cancer in a Regional Cancer Centre from 2005 to 2015 Paper 32: R Pereira, N O’Halloran, C Malone, K Sweeney, R McLaughlin, A Lowery, MJ Kerin Discipline of Surgery, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
11.50 a.m. Identification and Validation of Circulating MicroRNAs to Distinguish Metastatic from Local Luminal A Breast Cancer Paper 33: PMcAnena1,KTanriverdi2,CCurran1,JFreedman2, K Gilligan1,ALowery1,JBrown1,MJKerin1 (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland; (2) Department of Medicine, University of Massachusetts, Boston, MA, USA
12.00 p.m. Comparison of Family History Risk Stratification Models in Irish Women at Increased Personal Risk of Breast Cancer Paper 34: A Stakelum, D Evoy, J Rothwell, J Geraghty, R Prichard, D McCartan, E McDermott Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
12.10 p.m. Consequences of Human Endogenous Retrovirus-K (HERV-K) Protein Expression in Breast Cancer Paper 35: DD Bhattacharyya, E Dervan, K Bharadwaj , S Glynn Lambe Institute for Translational Research, National University of Ireland, Galway
12.20 p.m. The Evolution of the Axillary Management of Breast Cancer in a Regional Cancer Centre – Impact of ACOSOG Z0011 Trial Paper 36: EO’Beirn, N O’Halloran, P McAnena, I Balasubramanian, A Lowery, R McLaughlin, K Sweeney, C Malone, MJ Kerin Department of Surgery, Galway University Hospital, Galway, Ireland
12.30 p.m. LUNCH Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S125
SESSION 5: GENERAL SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Patrick F Fottrell Theatre, AM200 Theatre Chairs: Mr Diarmuid Ó Ríordáin & Professor Paul Ridway
11.00 a.m. The Adequacy of Lymph Node Harvest in Colon Cancer Surgery Performed in a Non-Specialist Centre; Is There A Future? Paper 37: PHiggins1,WKhan1, I Khan1, R Waldron1, T Nemeth2, F Bennani2, K Barry1 (1) Department of Surgery, Mayo University Hospital (Saolta Health Care Group), Castlebar, Mayo, Ireland; (2) Department of Pathology, Mayo University Hospital (Saolta Health Care Group), Castlebar, Mayo, Ireland
11.10 a.m. Colonoscopy Quality Assurance in Private Hospitals: Is Participating in Quality Improvement Programs Beneficial? Paper 38: M Aradaib, Endoscopy Unit Group, MR Kalbassi Department of General and Colorectal Surgery, Beacon Hospital, Beacon Court, Sandyford, Dublin, Ireland
11.20 a.m. An Evaluation of the Impact of a Dedicated Emergency Surgical Service on the Management and Outcomes of Acute Appendicitis Paper 39: R McGrath, H Mustafa, Y Khodear, K Alromhein, Y Kayyal, M Corrigan, E Andrews, P Redmond, A Zaheer Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland
11.30 a.m. Mural Thickening on Conventional Computed Tomography Versus Endoscopic Findings. Is There An Accurate Correlation? Paper 40: NE Donlon, M Zafar, R Headon, K St. John, W Khan, I Khan, R Waldron, K Barry Department of Surgery, Mayo University Hospital, Saolta Health Care Group, Castlebar, Mayo, Ireland
11.40 a.m. The Effect of BMI on Colonoscopy Failure Rate Paper 41: ANiMhathuna1, L Devane1,VVeitch2,DMcNamara2,JO’Riordan1 (1) Department of Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland; (2) Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
11.50 a.m. Impact of an Acute Surgical Unit in Appendicitis: A Systematic Review and Meta-Analysis Paper 42: I Balasubramanian, B Creavin, D Winter Department of Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
12.00 p.m. Is Computerised Tomography of the Head Always Appropriate? Paper 43: CBrady1,RO’Keeffe1, O Shinners1, D Hehir2, S Johnston2 (1) Department of GEMS, University of Limerick, Limerick, Ireland; (2) Department of Surgery, HSE MRH Tullamore, Arden Rd, Tullamore, Ireland
12.10 p.m. Multi-Visceral Resection with Preoperative Radiotherapy Does Not Increase Perioperative Complications in a Series of Retroperitoneal Sarcomas Paper 44: LYL Tan 1,CClancy2, U Hayden2, C Gillham3,AGillis2, P Ridgway2 (1) School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland; (2) Department of Surgery, Tallaght Hospital, Tallaght, Dublin 24, Ireland; (3) Department of Sarcoma, Irish Sarcoma Group, Ireland
12.20 p.m. Identifying and Reducing Risks in Functional Endoscopic Sinus Surgery (FESS) Through a Hierarchical Task Analysis (HTA) Paper 45: M Corbett1,PO'Connor2, D Byrne3,MThornton1,IJKeogh1 (1) Department of Otorhinolaryngology, Galway University Hospital, Galway, Ireland; (2) Department of Psychology, Galway University Hospital, Galway, Ireland; (3) Department of Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
12.30 p.m. LUNCH S126 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 6: UPPER GI SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Ms Helen Heneghan & Mr Chris Collins
11.00 a.m. Clinical Impact of Delaying Access to Bariatric Surgery in Ireland Paper 46: AIqbal1, S Berenjian1, A Tomas, IJ Meurling3,DO’Shea2,3, J Geoghegan1, H Heneghan1,2 (1) Department of Surgery, St. Vincent’s University Hospital, Dublin, Ireland; (2) Department of Endocrinology & Diabetes Mellitus St Vincent’s University Hospital, Weight Management Unit, St Columcille’s Hospital, Ireland
11.10 a.m. Efficacy of Current Early Immunosuppression Practices in the Irish Liver Transplant Population Paper 47: H Hughes, J Ryan, EL Rogers, T Gallagher Department of Hepatopancreaticobiliary and Liver Transplant Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
11.20 a.m. Negative Intraluminal Pressure Therapy (Nipt) For Complex Esophageal Perforations or Anastomotic Leaks Paper 48: M Flood, P Boland, M Arumugasamy, TN Walsh Department of Upper Gastrointestinal Surgery, Beaumont and Connolly Hospitals, Dublin, Ireland
11.30 a.m. Options in Bariatric Surgery: Modelled Decision Analysis Supports Roux-En-Y Gastric Bypass and Sleeve Gastrectomy as the Treatments of Choice Paper 49: S Keogh, J Bloger, S Brady, A Rogers, M Arumugasamy, W Robb Department of Upper GI Surgery, Beaumont Hospital, Beaumont, Dublin 9, Ireland
11.40 a.m. Enhanced Recovery after Bariatric Surgery: Clinical Outcomes in a Tertiary Referral Bariatric Centre Paper 50: A Tamas, S Berenjian, A Iqbal, IJ Meurling, D O'Shea, J Geoghegan, H Heneghan Department of Upper GI, St. Vincent's University Hospital, Dublin, Ireland
11.50 a.m. The 5 F’s Of Gallbaldder Disease. Is This Still A Valid Concept? Paper 51: NE Donlon1, K St. John1,CDavis1, Q Luqman1,WKhan1,IKhan1, R Waldron1,TNemeth2, F Bennani2, K Barry1 (1) Department of Surgery, Mayo University Hospital, Saolta Health Care Group, Castlebar, Mayo, Ireland; (2) Department of Pathology, Mayo University Hospital, Saolta Health Care Group, Castlebar, Mayo, Ireland
12.00 p.m. Upper Gastrointestinal Mucosal Morphology and the Enteroendocrine Response after Oesophagectomy Paper 52: C Murphy1, J Elliott1,NDocherty1,NRavi2, J Reynolds2, C le Roux1 (1) Department of Conway Institute, UCD, Belfield, Dublin, Ireland; (2) Department of Surgery, St James’s Hospital, Dublin 8, Ireland
12.30 p.m. LUNCH Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S127
SESSION 7: ORAL AND MAXILLOFACIAL SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Mr Tom Barry & Mr Paddy McCann 1.30 p.m. Mandibular Angle Fractures Containing A Wisdom Tooth; Should The Wisdom Tooth Be Removed? Paper 53: P Sexton, T Barry, PJ Mc Cann Department of Oral and Maxillofacial Surgery, Galway University Hospital, Galway, Ireland
1.40 p.m. Oral and Maxillofacial Surgery, The Surgical Conundrum - A Literature Review Paper 54: PKielty,BO’Connor, C Cotter Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland
1.50 p.m. Quality Improvement Project: Improving the Quality of OMFS Clerk Ins Paper 55: M McKeown, A Cooper, J Grudgings, A Sewell, J Stenhouse, B Swinson, A Ketabchi, JG Smith Department of Oral and Maxillofacial, Altnagelvin Area Hospital, Derry, Northern Ireland
2.00 p.m. Retrospective Audit, Comparing Retainer A to Retainer B between January 2016-January 2017 Paper 56: A Murray, BJ Rainey, C Campbell Department of Oral and Maxillofacial, Altnagelvin Area Hospital, Derry, Northern Ireland
2.10 p.m. Analysis of the Time to Completion of Radiological Imaging from Biopsy Date in an Oral and Maxillofacial Unit in the West of Ireland Paper 57: P Sexton, M Nolan, T Barry, PJ McCann Department of Oral and Maxillofacial, Galway University Hospital, Galway, Ireland
2.20 p.m. Injury Scheme Claims in Gaelic Games. A Review of Maxillofacial Injuries from 2007-2016 Paper 58: P Sexton, C Mac Dhaibheid, T Barry, PJ Mc Cann Department of Oral and Maxillofacial, Galway University Hospital, Galway, Ireland
2.30 p.m. COFFEE
SESSION 8: TRAUMA AND ORTHOPAEDIC SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Mr Michael O’ Sullivan & Mr Stephen Kearns
1.30 p.m. Future Demand for Elective Total Hip Replacements (THR) Paper 59: A Mealy, J Sorensen Department of Healthcare Outcome Res Centre, RCSI, Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland
1.40 p.m. The Use of Twitter by Trauma and Orthopaedic Surgery Journals: Twitter Activity, Impact Factor and Alternative Metrics Paper 60: HHughes1, A Hughes2,CMurphy2 (1) Department of Trauma and Orthopaedic Surgery, St Vincent’s University Hospital, Dublin, Ireland; (2) Department of Trauma and Orthopaedic Surgery, University Hospital Galway, Ireland
1.50 p.m. Vascular Status and Complications after ORIF of Ankle Fractures Paper 61: H Lutfi, R Nanda, S Van Helden, J Oskam, R Brohet Department of Trauma and Orthopaedic Surgery, Isala, Dokter van Heesweg 2, Zwolle, Leliestraat 354, Zwolle, Netherlands
2.00 p.m. Anticoagulation on Discharge from Midlands Regional Hospital Tullamore Paper 62: E Roche, A Farrell, V Heffernan, S Clinton, C Larney, C Kehoe, E Sheehan Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital Tullamore, Tullamore, Offaly, Ireland
2.10 p.m. Early Results of a Modified Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study Paper 63: D Giotikas, N Tarazi, L Spalding, M Nabergoj, M Krkovic Department of Trauma and Orthopaedic Surgery, Cambridge University Hospital, Cambridge, United Kingdom S128 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
2.20 p.m. Outcomes Following Orthopaedic Surgical Wound Closure with Suture Compared with Non-Absorbable Staples in Adults. A Systematic Review and Meta-Analysis Paper 64: P Mc Quail1, B McCartney2, P McKenna2 (1) Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland; (2) Department of Trauma and Orthopaedic Surgery, Waterford University Hospital, Waterford, Co. Waterford, Ireland
2.30 p.m. Coffee
SESSION 9: PLASTIC AND RECONSTRUCTIVE SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Ms Shirley Potter & Mr Niall McInerney
1.30 p.m. Assessment of the Physical, Functional, and Psychological Fidelity of “Suture-Self”, A New Simulated Skin Model Designed to Improve Surgical Skills Paper 65: YSweeney1, B Reid-McDermott2, D Byrne2, S Potter1 (1) Department of Plastic Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland; (2) Department of Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
1.40 p.m. Primary Cutaneous Malignant Melanoma in the Elderly: The Septuagenarian Years and Beyond. A Single Unit Experience Paper 66: KI Abdul Jalil, B O’Sullivan, N Ajmal, B Kneafsey Department of Plastic Surgery & Reconstructive Surgery, Beaumont Hospital, Dublin 9, Ireland
1.50 p.m. Squamous Cell Carcinoma of the Scalp: Features of Disease at This Anatomic Location and Considerations As to Why Irish Elderly Male Farmers are At Particular Risk Paper 67: EFahy,CSugrue,JKelly Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
2.00 p.m. Are the Indicative Numbers Required for Certificate of Completion of Training (CCT) attainable for current Irish Plastic Surgery Trainees? Paper 68: CM Sugrue, PJ Regan, A Hussey Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland
2.10 p.m. Deliberate Self-Harm Presenting To Plastic And Hand Surgeons - Missed Opportunities For Suicide Prevention? Paper 69: E Concannon1,SCarr1, A Doherty2,SJMcInerney3, J Birrane1,LKearney1,AJHussey1, S Potter1,JLKelly1, NM McInerney1 (1) Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland (2) Department of Psychiatry, Galway University Hospital, Galway, Ireland (3) Department of Psychiatry, St Michaels Hospital, Toronto and University of Toronto, Canada
2.20 p.m. Surgical Management of Cutaneous Squamous Cell Carcinoma in Mid-West Ireland: A Retrospective Study Paper 70: O Ni Dhomhnallain, C Hackett, B Ramsay, M Lynch, K Ahmad Department of Dermatology, University Hospital Limerick, St. Nessan’s Road, Dooradoyle, Ireland
2.30 p.m. Changes to Staging Malignant Melanoma: How the New AJCC 8th Edition Affects our Management Paper 71: EFarrell1, P Cromwell2,HWaller2,ALally3,DMcCartan2, D Evoy2 (1) Department of CST1, St Vincent’s University Hospital Dublin, Nutley Avenue, Dublin 4, Ireland; (2) Department of Breast Endocrine General Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Dermatology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
2.40 p.m. Coffee Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S129
SESSION 10: PLENARY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Professor Ronan Cahill, Professor Paul Redmond & Professor Arnold Hill
3.00 p.m. Spatiotemporal Visualization of Mesenteric Morphogenesis Paper 72: K Byrnes1, D Walsh1,LWalsh1,RMirapeix2, W Lamers3,PDockery4, K McDermott5,JCCoffey1 (1) Department of Surgery, University of Limerick, Dooradoyle, Limerick, Ireland; (2) Department of Anatomy and Embryology, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain; (3) Department of Anatomy and Embryology, University of Maastricht, Maastricht,, Netherlands; (4) Department of Anatomy, National University of Ireland, Galway, Ireland; (5) Department of Anatomy, University of Limerick, Dooradoyle, Limerick, Ireland
3.10 p.m. Neoadjuvant Chemoradiation for Esophageal Cancer Impairs Pulmonary Physiology Preoperatively and Impacts on Postoperative Respiratory Complications and Quality of Life Paper 73: J A Elliott, L O’Byrne, G Foley, C F Murphy, SL Doyle, S King, E M Guinan, N Ravi, JV Reynolds Department of Surgery, Trinity Centre for Health Sciences, St. James’s Hospital, Dublin, Ireland
3.20 p.m. Evaluating a Novel Adipose Tissue Engineering Strategy for Breast Reconstruction Post-Mastectomy Paper 74: NO’Halloran1,KGilligan1, E Dolan2, S Khan1, R Dwyer1,MJKerin1,GDuffy2,ALowery1 (1) Discipline of Surgery, The Lambe Institute for Translational Research, NUI Galway, Ireland; (2) Discipline of Anatomy, School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Ireland
3.30 p.m. Optical Discrimination of Primary Colorectal Cancer using Systemic Indocyanine Green with Near-infrared Paper 75: Laparoscopy and Microscopy: Clinical Pilot Experience DWu1,DO’Shea1, N Mulligan2, E Loughman3, HA Khokhar4,RCahill4 (1) Department of Chemistry, Royal College of Surgeons in Ireland; Ireland; (2) Department of Pathology, Mater Misericordiae University Hospital, Ireland; (3) Department of Medical Physics, Mater Misericordiae University Hospital, Ireland; (4) Department of Surgery, Mater Misericordiae University Hospital, 47 Eccles Street, Dublin 7, Ireland
3.40 p.m. Cytosporone B, NR4A1 Agonist, as a Modulator of Colorectal Tumour Inflammation Paper 76: MIsmaiel1, A Baird2, D Crean2,DWinter1 (1) Department of General Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) School of Veterinary Medicine and Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland
3.50 p.m. Histopathological Variables Associated with Poor Treatment Response to Neoadjuvant Chemoradiotherapy and Adverse Oncological Outcomes in Locally Advanced Rectal Cancer Paper 77: BCreavin,ERyan,RGeraghty,AHanly,RKennelly,SMartin,RO’Connell, K Sheahan, D Winter Department of Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
4.00 p.m. The Diagnostic Accuracy of Ultrasound Guided Fine Needle Aspiration and Core Needle Biopsy in Diagnosing Axillary Lymph Node Metastasis in the Post Z011 Era: A Systematic Review and Meta-Analysis Paper 78: I Balasubramanian1, C Fleming2, M Corrigan2,HPRedmond3,MJKerin3,ALowery3 (1) Department of Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland; (3) Department of Breast and Endocrine Surgery, Galway University Hospital, Ireland
4.10 p.m. PERioperative Fluid Management in Elective ColecTomy (PERFECT) – A National Audit of Current Practice Paper 79: CFleming1, Irish Surgical Research Collaborative2 (1) Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland; (2) Department of Surgical Training, Royal College of Surgeons in Ireland, Ireland
4.20 p.m. Prevalence of Myocardial Injury in Gastrointestinal Surgery Patients. A Multicentre Prospective Cohort Study Paper 80 KAhmed1, G Abdulaal2, M Hassan3, J Rehman4,EMulligan3,SJohnston3, A Rayis3,IKhan4,RWaldron4,WKhan4, C Collins5, SZeeshan2, M Joyce5, K Barry4,SWalsh1 (1) Discipline of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland; (2) Department of Surgery, Letterkenny University Hospital, Saolta Hospital Group, Ireland; (3) Department of Surgery, Midland Regional Hospital, Tullamore, Ireland; (4) Department of Surgery, Mayo University Hospital, Saolta Hospital Group, Ireland; (5) Department of Surgery, University Hospital Galway, Saolta Hospital Group, Ireland S130 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
4.30 p.m. Upper Third Rectal Cancers Treated with Surgery Alone Have Superior Outcomes to Lower Rectal Cancers Regardless of Tumour and Surgical Factors Paper 81: M Flanagan, C Clancy, D McNamara, J Burke Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
4.40 p.m. The Impact of Hospital-Volume and Surgeon-Volume on Patient Outcomes following Appendicectomy Paper 82: RM O’Connell, S Abd Elwahab, K Mealy Department of General Surgery, Wexford General Hospital, Wexford, Ireland
5.15 p.m. SIR PETER FREYER MEMORIAL LECTURE Introduction: Professor Michael Kerin & Mr Kilian Walsh Speaker: Professor Conor Delaney, Chair of the Digestive Disease and Surgery Institute, Cleveland Clinic Topic: Approaching Industrial Standards for Rectal Cancer Surgery Location: The Colm Ó hEocha Theatre - AM250 Theatre
SATURDAY, 8th SEPTEMBER 2018
SESSION 11: VASCULAR & CARDIOTHORACIC SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Máirtín Ó Tnúthail Theatre, AM150 Theatre Chairs: Professor Stewart Walsh & Mr Tony Moloney
9.30 a.m. Total Endovascular Management of Aorto-Iliac Occlusive Disease Paper 83: B Ghoneim, M ElSherif, M ELSharkawi, N Hynes, W Tawfick, S Sultan Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
9.40 a.m. Endoscopic Vein Harvest: First Irish Experience of a Minimally Invasive Conduit Harvesting Paper 84: S Siddiqui, R Kelly, D Veerasingam, M DaCosta, A Soo Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
9.50 a.m. Age-Related Arteriopathy Assessment; Should Future Abdominal Aortic Aneurysm Screening Criteria be Determined by Age? Paper 85: MCahill-Collins1, M ElSharkawi1,MElsherif1,EDoran2, W Tawfick1,SSultan1,2, N Hynes2 (1) Western Vascular Institute, Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Ireland; (2) Galway Clinic, Doughiska, Galway, Ireland
10.00 a.m. Remote Ischemic Preconditioning in the Management of Intermittent Claudication Randomized Controlled Trial Paper 86: KAhmed1, S Hernon1, S Mohammed1,MTubassum2,MNewell1,SWalsh1 (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland; (2) Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
10.10 a.m. Long-Term Outcomes of Eversion Endarterectomy for Iliac Artery Occlusive Disease Paper 87: C Dooley, M Power Foley, T Aherne, M Medani, E Mulkern, C McDonnell, M O’Donohoe Department of Vascular Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
10.20 a.m. The Application of rACR Scoring System in Reducing Unnecessary Temporal Artery Biopsies in The Diagnosis of Giant Cell Arteritis Paper 88: SHamlin2, T Mansoor1,NLynch1,DMoneley1 (1) Royal College of Surgeons, Dublin, Ireland (2) Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S131
10.30 a.m. Diagnostic Performance of Ankle-Brachial Index: Building on a Foundation of Sand? Paper 89: M Alagha W Mahmood, M Tubassum, SR Walsh Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
10.40 a.m. Outcomes of Multidisciplinary Team Consensus for Lung Cancer Resection without Preoperative Histology Paper 90: R Weedle, E Keane, K Craven, A Soo Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
11.00 a.m. COFFEE
SESSION 12: GENERAL SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Patrick F Fottrell Theatre, AM200 Theatre Chairs: Mr Eoghan Condon & Mr Gerry McEntee
9.30 a.m. Emergency Cholecystectomy in Ireland, State of the Nation Paper 91: S Abd Elwahab, K Mealy Department of General Surgery, Wexford General Hospital, Wexford, Ireland
9.40 a.m. Negative Appendicectomy Rate As A Quality Metric. The Impact of All Embedded Versus Random Sampling Technique Paper 92: NE Donlon1,MAKhan1, P Higgins1,WKhan1,IKhan1,RWaldron1,TNemeth2, F Bennani 2, K Barry1 (1) Department of Surgery, Mayo University Hospital, Saolta Health Care Group, Castlebar, Mayo, Ireland; (2) Department of Pathology, Mayo University Hospital, Saolta Health Care Group, Castlebar, Mayo, Ireland
9.50 a.m. The Value of Ultrasonography in Characterising Polypoid Lesions of the Gallbladder Paper 93: C Toale, S Cassidy, F Hand, J Conneely, G McEntee Department of Hepatobiliary Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland
10.00 a.m. Response Rates in Surgical Questionnaires: A Prediction Model Paper 94: V Meyer, R Pol, J Lange, M El Moumni, R El Gannamani Department of General Surgery, UMC Groningen, Hanzeplein 1, 9713GZ, Netherlands
10.10 a.m. Do Children Undergoing Appendicectomy Have Better Outcomes in Specialist Paediatric Centres? Paper 95: RM O’Connell, S AbdElwahab, K Mealy Department of General Surgery, Wexford General Hospital, Wexford, Ireland
10.20 a.m. Incidence and Management of Low Grade Appendiceal Mucinous Neoplasm (LAMN) – A Single-Centre Experience Paper 96: M Salama, W Shabo, B Sami, AR Nasr Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
10.30 a.m. An Audit of Contaminant Blood Cultures in Surgical Patients at Wexford General Hospital Paper 97: A Page, RM O’Connell, F Ofori-Kuma, S Khan, I Ivanovski, K Mealy, K Schmidt Department of General Surgery, Wexford General Hospital, Newtown Road, Wexford, Ireland
10.40 a.m. Continuing Education of NCHDs Improves the Appropriateness of PPI Prescribing in Surgical Patients Paper 98: F Howley, L O'Connell, RM O'Connell, OAhmed, K Schmidt, I Ivanovski, S Khan, F Ofori-Kuma, K Mealy Department of Surgery, Wexford General Hospital, Wexford, Ireland
11.00 a.m. COFFEE S132 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 13: EVIDENCE BASED MEDICINE & ONCOLOGY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Ms Carmel Malone & Mr John Burke
9.30 a.m. KRAS, BRAF, MSI and CIMP Status in Mucinous Tumours of the Colon and Rectum: A Systematic Review and Meta- Analysis Paper 99: IReynolds1, A Balhareth1,SFurney2,EKay3, DA McNamara1,JHMPrehn2,JPBurke1 (1) Department of Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; (2) Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; (3) Department of Pathology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
9.40 a.m. Overall Survival of Unresectable Melanoma at Galway University Hospital between 2005 And 2017: A Retrospective Review Paper 100: A Bhardwaj1,PDonnellan2 (1) Department of Clinical Research, National University of Ireland, Galway, Ireland; (2) Department of Oncology, Galway University Hospital, Galway, Ireland
9.50 a.m. Simultaneous Resection of Colorectal Carcinoma and Liver Metastatis, A Safe Alternative Paper 101: GW de Klein1, VB Nieuwenhuijs1,GAPatijn1,MSLLiem2, JM Klaase3, HL Van Westreenen1 (1) Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB Zwolle, Netherlands; (2) Department of Surgery, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, Netherlands; (3) Department of Surgery, Universitair Medisch Centrum Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
10.00 a.m. The Association of Body Composition Parameters, as a Surrogate for Inflammation, on Outcomes in Non-Metastatic Colorectal Cancer May be Modulated Using Anti-Inflammatory Therapy Paper 102: CFleming1,EO’Connell1, R Kavanagh2,PO’Leary1,MMaher2,OJO’Connor2, P Redmond1 (1) Department of Academic Surgery, Cork University Hospital, Wilton, Cork, Ireland; (2) Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
10.10 a.m. Nurse Specialist Support in Sarcoma Services: An Analysis in Unscheduled Workflow Paper 103: U Hayden, C Clancy, C Gibbons, A Gillis, PF Ridgway Department of Surgery, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
10.20 a.m. An Audit of Local Implementation of the National Surviving Sepsis Campaign Sepsis Screening Form Paper 104: SStam1,KO’Kelly2, JAM Jais2, N Foley1, V Hamilton3, F Cooke1 (1) Department of Surgery, University Hospital Waterford, Dunmore Road, Waterford, Ireland; (2) School of Medicine, University College Cork, Cork, Ireland; (3) Department of Anaesthesia, University Hospital Waterford, Ireland
10.30 a.m. Attitudes and Beliefs of Clinicians Regarding Barriers and Enablers in Conducting Perioperative Clinical Trials: A Qualitative Study Paper 105: D Waters2,ELitton1, N Zeps1, T Corcoran1, A Nichol1,NMcDonnell1, L Higgins1, N Gobat1, P Sukumar1,SWebb1 (1) Department of Intensive Care, St John of God Hospital, Subiaco WA 6008, Australia; (2) Department of Urology, Galway University Hospital, Galway, Ireland
10.40 a.m. Fasting Times Before and After Surgery - Evidence for Recent Recommendations Paper 106: P Kielty, D Sleeman Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland
10.50 a.m. Re-audit on Appropriateness of Head Computed Tomography in Minor Head Injury (MHI) Presenting to Emergency Department, University Hospital Waterford from 29th August 2017 to 29th September 2017 Paper 107: AS Aprjanto1, SA Sallihudin2, SH Siddiqui1, A Abdulrazak1, D Fitzgerald1, M Doyle1,BMcCann1 (1) Department of Emergency Medicine, University Hospital Waterford, Waterford, Ireland; (2) Department of Medical, Connolly Hospital Blanchardstown, Dublin 15, Ireland
11.00 a.m. COFFEE Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S133
SESSION 14: LOWER GI SURGERY Time Allowed: 7 Minutes Speaking 3 Minutes Discussion Location: The Colm Ó hEocha Theatre, AM250 Theatre Chairs: Mr Fiachra Cooke & Mr Eddie Myers
9.30 a.m. Role of Pelvic Drains in Infraperitoneal Anastomosis: A Systematic Review and Meta-Analysis Paper 108: H Hidayat, A Zafar Department of Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
9.40 a.m. Safe Adoption of Robotic Colorectal Surgery Using Structured Training: Early Irish Experience Paper 109: M Aradaib1, P Neary1,AHafeez1,RKalbassi1, A Parvaiz2, D O'Riordain1 (1) Department of General and Colorectal Surgery, Beacon Hospital, Sandyford, Ireland; (2) Department of Colorectal Surgery, Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
9.50 a.m. Sedation and Bowel Preparation for Colonoscopy in Elderly: A Nationwide Survey in Ireland Paper 110: HHamid1,AZafar1,BEgan2,LO’Donnell2, I Khan1 (1) Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland; (2) Department of Gastroenterology, Mayo University Hospital, Castlebar, Mayo, Ireland
10.00 a.m. Systematic Review and Meta-Analysis of Randomised Trials Comparing Primary Resection and Anastamosis with Hartmann’s Procedure for the Management of Acute Perforated Diverticulitis with Generalised Peritonitis Paper 111: ÉJ Ryan, B Creavin, OK Ryan, ME Kelly, DC Winter Department of Colorectal Disease, St Vincent’s, Elm Park, Dublin 4, Ireland
10.10 a.m. The Impact of Intraoperative Ultrasonography on Resection of Colorectal Liver Metastases Paper 112: SDoran1, S Brennan2, H Moriarty2, F Hand1,PSWaters1, JC Conneely1,GMcEntee1, L Lawler2, T Geoghegan2, H Fenlon2 (1) Department of Surgery, Mater Misericordiae Hospital, Dublin 7, Ireland; (2) Department of Radiology, Mater Misericordiae Hospital, Dublin 7, Ireland
10.20 a.m. The Feasibility of Laparoscopy for Complicated and Uncomplicated Paediatric Appendicitis in a District Hospital Setting Paper 113: H Hamid, A Maatough, F Atwan, A Khadr, H Ajeeb, S Mansoor, D Toomey, T Ejaz Department of Surgery, Mullingar Regional Hospital, Mullingar, Westmeath, Ireland
10.30 a.m. Outcomes of Laparoscopic Hepatectomy as Compared to open Resection for Colorectal Liver Metastases Paper 114: F Hand, C Toale, R Lahani, S Cassidy, PS Waters, G McEntee, JC Conneely Department of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
10.40 a.m. Outcomes of Patients Treated With Upfront Cholecystostomy For Severe Acute Cholecystitis Paper 115: T DeGeus,¹ HK Moriarty.,¹ R Fleck2, F Hand2, PS Waters,² JC Conneely,² G McEntee,² LP Lawler¹, T Geoghegan ¹, C Farrelly¹ (1) Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland; (2) Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Dublin
11.00 a.m. The Significance of Mucin Pools Post Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer Paper 116: IReynolds1, DA McNamara1,EWKay2, JHM Prehn3, B O'Neill4, J Deasy1,JPBurke1 (1) Department of Surgery, Beaumont Hospital, Dublin 9, Ireland; (2) Department of Pathology, Beaumont Hospital, Dublin 9, Ireland; (3) Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland; (4) Department of Radiation Oncology, Beaumont Hospital, Dublin 9, Ireland
11.00 a.m. COFFEE S134 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 15: REGIONAL NETWORKS AND HOSPITAL GROUPS - FUTURE OF SURGICAL CARE IN IRELAND Location: The Colm Ó hEocha Theatre - AM250 Theatre Chairs: Professor Michael Kerin, Mr David Moore & Ms Ailín Rogers
11.30 a.m. Surgery Workforce Planning Professor Francis Murray Director National Doctors Training and Planning Health Services Executive
11.40 a.m. View from RCSI Postgraduate Surgery Dr Kieran Ryan Managing Director of Surgical Affairs Royal College of Surgeons in Ireland
11.50 a.m. View from General Surgery Professor Kevin Barry Consultant Surgeon Director of RCSI Irish Surgical Training Programme Mayo University Hospital
12.00 p.m. Overview of National Surgical Programmes Professor Deborah McNamara Consultant Surgeon Beaumont Hospital
12.10 p.m. What Academic Surgery Requires Professor Aoife Lowery Associate Professor of Translational Research NUI Galway
12.20 p.m. View from Urology National Programme Mr Eamonn Rogers Consultant Urological Surgeon Galway University Hospital
12.30 p.m. Discussion
POSTER ASSESSMENT Chairs: Mr Conor Shields, Mr Dermot Hehir & Ms Aisling Hogan Location: Rooms AM107 & AM108, Arts Millennium Building
BREAST CLINICAL 1. Pink Ribbon Blues - A Case of Male Breast Cancer S Hembrecht, P Healy, SR Tee, E McDermott Department of Breast and Endocrine Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
2. Fibromatosis of the Breast – A 10 Year Institutional Experience and Review of the Literature MR Boland1,JO’Mahony2,SO’Keeffe2, C Gillham3,AMaguire4, D Alazawi1,TJBoyle1, EM Connolly1 (1) Department of Breast Surgery, St James’ Hospital, Dublin 8, Ireland; (2) Department of Radiology, St. James’ Hospital, Dublin 8, Ireland; (3) Department of Radiation Oncology, St. James’ Hospital, Dublin 8, Ireland; (4) Department of Pathology, St. James’ Hospital, Dublin 8, Ireland
3. Can a Pre-Operative Full Blood Count Help Predict Breast Recurrence? C Cullinane, M McCumiskey, A Lal, BA Merrigan, S Tormey Department of Breast Surgery, University Hospital, Limerick, Ireland Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S135
CARDIOTHORACIC SURGERY 4. LIMAX Nd:YAG Laser-Assisted Thoracoscopic Resection of Pulmonary Metastases; A Single Centre’s Initial Experience JMcLoughlin,KO’Sullivan, R Brown, D Eaton Department of Cardiothoracic Surgery, Mater Hospital, Eccles St, Dublin, Ireland
5. Early Experience of Using Bilateral Internal Mammary Graft in a Y Configuration for Coronary Artery Bypass Graft Surgery R Weedle, A Soo Department of Cardiothoracic Surgery, Galway University Hospital, Galway, Ireland
ENDOCRINE 6. Non-Invasive Encapsulated Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): A Single Centre Experience L McLoughlin1,2, I Balasubramanian1,2, MJ Kerin1,2,ALowery1,2 (1) Department of Surgery, Galway University Hospital, Galway, Ireland; (2) Lambe Institute for Translational Research, NUI Galway, Galway, Ireland
GENERAL SURGERY 7. Piloting Outpatient Surgery; Minor Ops in Wexford RT Fitzpatrick, R M O'Connell, F Ofori-Kuma, K Schmidt, K Mealy, A Khan, I Ivanowski Department of Surgery, Wexford General Hospital, Wexford, Ireland
8. Adult- Onset Acute Appendicitis as a Manifestation of Colorectal Cancer: A 10- Year Multi-Centre Study QUlAin1, Y Bashir1, E Eguare1, O Al Sahaf1, K Conlon2 (1) Department of General Surgery, Naas General Hospital, Naas, Co Kildare, Ireland; (2) Department of PSU, Trinity College, Ireland
9. Distal Intestinal Obstruction Syndrome in Adult Patients with Cystic Fibrosis MA Aamir, MA Aremu Department of Surgery, Letterkenny University Hospital, Letterkenny, Co. Donegal, Ireland
LOWER GASTROINTESTINAL SURGERY 10. Blow Hole Decompression Colostomy for Acute Left-Sided Colonic Obstruction JdeHaas1, W de Vos tot Nederveen Cappel2, V Nieuwenhuijs1, E Van Westreenen1 (1) Department of General Surgery, Isala Hospital, Dr. van Deenweg 2, 8011XM ZWOLLE, Netherlands; (2) Department of Gastroenterology, Isala Hospital, Dr. van Deenweg 2, 8011XM ZWOLLE, Netherlands
11. Evolution of the Management of Complex Colorectal Polyps CO’Brien, CX Cheung , N Foley, F Cooke Department of Surgery, University Hospital Waterford, Dunmore Road, Waterford, Ireland
OTOLARYNGOLOGY HEAD AND NECK SURGERY 12. A Review of the Treatments for Otomycosis DWestby1,JFenton2 (1) Department of Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland; (2) Department of ENT, University Hospital Limerick, Dooradoyle, Limerick, Ireland
PLASTIC AND RECONSTRUCTIVE SURGERY 13. The Role of Core Sutures in Partial Flexor Tendon Repairs – A Biomechanical Analysis CM Sugrue, G Rahmani, JL Kelly Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
14. An Anatomical Study of Pectoralis Major Muscle Advancement Flaps for Sternal Defect Reconstruction: How Far Can They Reach? N O'Keeffe1, E Concannon1, A Stanley2, P Dockery2, N McInerney1,JLKelly1,2 (1) Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland (2) Department of Anatomy, National University of Ireland, Galway, Ireland
15. Full Thickness Skin Grafts for Lower Leg Defects- A Viable Reconstruction Option CM Sugrue, JK Kelly Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
16. Thermographic Imaging of Perforators and Perforasomes, Imaging Beyond the Visible Spectrum O Hennessy1, R McLoughlin2, N McInerney1, A Hussey1, S Potter1 (1) Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland (2) Department of Radiology, Galway University Hospital, Galway, Ireland S136 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
17. Determining the Effect of External Stressors and Cognitive Distraction onMicrosurgical Skills and Performance in Plastic Surgery Trainees S Carr1, B Reid McDermott2, N McInerney1,AHussey1,DByrne2,SPotter1 (1) Department of Plastic & Reconstructive Surgery, Galway University Hospital, Galway, Ireland; (2) Irish Centre for Applied Patient Safety and Simulation (ICAPSS), Galway University Hospital, Galway, Ireland
TRAINING & EDUCATION 18. Gross Negligence Manslaughter and Tprotocohe Hadiza Bawa-Garba Uprising N Foley, F Cooke Department of Surgery, University Hospital Waterford, Waterford, Ireland
19. Suturing Skills in Medical Students - The Design and Development of an Acceptable Homemade Suture Pad Simulator SJ Kang, PJ Choi, ZW Chiang, K Labib, N Clements School of Medicine, College of Medicine, Nursing and Health Sciences, NUI Galway, Galway, Ireland
TRAUMA AND ORTHOPAEDIC SURGERY 20. An Orthopaedic Fracture Clinic Service Audit: A Complete Loop MN Baig, O Ni Bhroin, R Auckloo, C MacDhaibheid, U Baig, F Byrne Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
21. Establishing ‘The Reasonable Patient’s’ Expectation of ‘Material Risks’ To Be Disclosed When Consenting For Total Hip Arthroplasty P Mc Quail, J Cashman Department of Trauma and Orthopaedics, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
22. The Anti-Coagulated Trauma Patient: An Audit of Surgeons’ and Anaesthetists’ Knowledge of Doacs in the Emergency Peri-Operative Period G Crozier Shaw, J Gibbons, A Francis, P Keogh, P Kenny, O Flannery Department of Trauma and Orthopaedic Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
UPPER GI SURGERY 23. Cancer of Unknown Primary: Incidence and Clinical Course M Alzamzami, TM Connelly, A Mehmood, MS Khan, G O’Donoghue Department of Surgery, University Hospital, Waterford, Ireland
24. Longterm Outcome of Chronic Pancreatitis Patients YBashir,DO’Connor, Q Ulain, H Ní Chonchubhair1, S Duggan, K Conlan Professorial Surgical Unit, Trinity College Dublin, Department of Surgery, Trinity Centre of Learning and Development, Tallaght Hospital, Dublin 24, Ireland
25. Prevalence of Diabetes Mellitus in Patient with Chronic Pancreatitis QUlAin1, O Griffin2,SDuggan2,KConlon2 (1) Department of General Surgery, Naas General Hospital, Naas, Co Kildare, Ireland; (2) Department of Professorial Surgical Unit, Trinity Learning Centre, Ireland
UROLOGY 26. Comparing MRI PIRADS V2 Scores and Template Biopsies of the Prostate ACotter,DBouchier-Hayes Department of Surgery, Galway Clinic, Doughiska, Galway, Ireland
27. The Modern Dangers of Being a Man - Male Genital Trauma, A Ten-Year Review RA Keenan, A U Nic A Riogh, A Fuentes, PJ Daly, IM Cullen Department of Surgery, University Hospital Waterford, Waterford, Ireland
28. Assessment of Referral Patterns for Boys with Undescended Testes R Amoateng, E Kiely, J O’Kelly, K Breen, L Scalon, E Redmond Department of Urology, University College Cork, Cork, Ireland
29. Metabolic Profiling of Patients with Urolithiasis – Outcomes from an Irish Tertiary Referral Centre NO’Dwyer, S Considine, B McGuire Department of Urology, St Vincent’s Hospital, Dublin 4, Ireland
30. A Review of Elective Suprapubic Catheter Insertion and Whether Change of Practice to Ultrasound Guided Insertion is Indicated L Scanlon, JA O’Kelly, M Broe, F O’Brien, E Kiely, C Brady, K O’Connor Department of Urology, Cork University Hospital, Wilton, Cork, Ireland Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S137
31. A Quality Improvement Audit to Improve the Biochemical Work Up of Emergency Admissions with Urolithiasis S O Meara1,NRBhatt1, TED McDermott1,RJFlynn1, AZ Thomas 2,RPManecksha2 (1) Department of Urology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland; (2) Department of Surgery, Trinity College Dublin, Dublin, Ireland
VASCULAR SURGERY 32. The Impact of Elevated NT-Probnp on Clinical Outcomes in Non-Cardiac Vascular Procedures M Javaherian, W Tawfick, N Hynes, G Flaherty, S Sultan Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Ireland
33. The Effects of Normalising Hyperhomocysteinaemia On Clinical and Operative Outcomes in Patients with Carotid Artery Stenosis A BenSaaud, W Tawfick, G Flaherty, S Sultan Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, Galway University Hospital, Galway, Ireland
34. Analysing the Society for Vascular Surgery/American Association for Vascular Surgery Scoring Systems for Outcomes Post Endovascular Aortic Repair P Canning1, W Tawfick2, G Doherty3, N Hynes2,4,SSultan2,4 (1) St. James’s Hospital, Dublin, Ireland (2) Western Vascular Institute, Galway University Hospital, Galway, Ireland (3) School of Medicine, National University of Ireland, Galway, Ireland (4) Galway Clinic, Royal College of Surgeons of Ireland, Galway, Ireland
35. A Single Centre Study Comparing Restenosis Rates Using Bovine Biologic Patch Repair during Carotid Endarterectomy Vs the Literature G Greene, S Sultan Department of Vascular Surgery, Galway University Hospital, Galway, Ireland
36. Contemporary Review of Bypass Surgery in the Endovascular Era C Ryan1, W Tawfick2, M ElSherif2, M Curtain 2, N Hynes3, S Sultan 2 (1) School of Medicine, College of Nursing and Health Sciences, National University of Ireland, Galway, Ireland; (2) Western Vascular Institute, Galway University Hospital, Galway, Ireland; (3) Department of Vascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
37. Late Open Interventions Post EVAR R Elkady1,WTawfick1, N Hynes2,SSultan1 (1) Department of Vascular Surgery, Galway University Hospital, NUI Galway, Galway, Ireland; (2) Department of Vascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
38. Endovascular Management of Peri-aortic Fibrosis. Mid-Term Outcomes NO’Reilly1,WTawfick1, P Canning1,BGhoneim1,AElHelaly1,N Hynes2, E Kavanagh1, S Sultan1,2 (1) Western Vascular Institute, Galway University Hospital, Galway, Ireland (2) Galway Clinic, Royal College of Surgeons in Ireland, Galway, Ireland
39. Surgeon-Performed Ultrasound for Venous Disease: Time and Cost Savings WMahmood1, M Alaghamidha1, SR Walsh2 (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland; (2) Department of Vascular Surgery, Galway University Hospital, Ireland
40. Best Medical Management of Vascular Patients, an Audit and Review of the Electronic Discharge in University Hospital, Limerick C Mahony, D Power, T Moloney Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland S138 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
SESSION 1: BREAST CLINICAL AND ENDOCRINE increased cost of treatment compared to the adjuvant group (€3,921.84, 95%CI 33.34 to 7,810.34; p=0.048). Importantly, no significant differ- 1. A 10-Year Review of Patient Satisfaction Following Breast ence was found comparing 3 year DFS for the adjuvant and neoadjuvant Reconstruction at University Hospital Limerick groups (Coef -0.93, 95%CI -8.90 to 7.04; p=0.819). Calculating QALYs there was no significant difference between the groups, adjuvant 2.53 JDuffy1,MMcCumskey1, I Balasubramanian1, T Weston2,STormey1, (range 0.24 – 2.55) and neoadjuvant 2.54 (range 2.31 – 2.55). A Merrigan1 Assessing cost effectiveness, the cost/QALY with the adjuvant Trastuzumab group was €17,977/QALY and the neoadjuvant (1) Department of Breast Unit, University Hospital Limerick, St. Nessan’s Trastuzumab group was €19,290/QALY. Road, Dooradoyle, Ireland; Conclusions: While there is a significantly increased cost of neoadjuvant (2) Department of Psychology, York University, Toronto, Ontario, Trastuzumab treatment, on assessing cost effectiveness, little difference is Canada seen between the two groups, showing neoadjuvant Trastuzumab to be a cost effective treatment. Introduction: One of the main reasons women undergo breast reconstruc- tion following mastectomy is to improve their quality of life (QoL). It has 3. Neoadjuvant Chemotherapy – Impact on Breast Surgery Practice been reported that up to 1/3rd of women who undergo a mastectomy will over 10 Years in a Regional Cancer Centre undergo a breast reconstruction. It has been suggested that patients post reconstruction report fluctuations in their satisfaction with their recon- NO’Halloran1,ALowery1, C Curran1,RMcLaughlin1,CMalone1,K struction over time, making it difficult to evaluate which surgical tech- Sweeney1, M Keane2,MJKerin1 nique maintains the highest level of satisfaction and QoL. Aim: To assess quality of life and satisfaction in patients undergoing (1) Department of Surgery, Lambe Institute for Translational Research, breast reconstruction following mastectomy between 2006 and 2016 NUI Galway, Ireland; within University Hospital Limerick (UHL). (2) Department of Medical Oncology, Galway University Hospital, Methods: 175 patients were retrospectively surveyed using Breast Q from Galway, Ireland patients within a prospectively kept reconstruction database. Patients were excluded if they were male, deceased or had evidence of Introduction: Neoadjuvant chemotherapy (NAC) is the standard of care in locoregional or systemic recurrence. Results analyzed using SPSS v22. locally advanced breast cancer. This treatment sequence facilitates breast Results: 63% (110/175) of patients responded to this survey. Our results conserving surgery (BCS) over mastectomy or allows surgical treatment show that those patients who underwent a Latissimus Dorsi (LD) recon- of patients inoperable at baseline. The aim of this study was to assess what struction had significantly higher levels of satisfaction compared to pa- impact the introduction of NAC for the treatment of breast cancer has had tients who underwent an implant-only reconstruction (p=0.013). This on surgical practice in a regional cancer centre over a ten year period. trend was also found to be stable up to 10 years postoperatively. Methods: Patients treated with chemotherapy from 2005-2014 were iden- However, mean psychosocial, sexual and physical well-being scores were tified from a prospectively maintained database. Clinicopathological de- not statistically different between these two groups (p=0.481, p=1.0; tails, timing of chemotherapy delivery and surgical procedures carried out p=1.0). were analysed. Conclusion: Patients undergoing breast reconstruction at UHL were gen- Results: One thousand six hundred and nineteen patients were included. erally satisfied following surgery. Although patients receiving LD recon- The NAC group had a higher T stage (p<0.001) and higher grade disease struction reported significantly higher levels of satisfaction than those than the adjuvant group (p=0.017). Luminal A breast cancer was less receiving implant-only reconstruction over a 10-year period, this did not likely to be treated with NAC. The proportion of patients treated with impact self-reported measures of quality of life. NAC increased from 12.1% in 2005 to 48.3% in 2014 (p<0.001). There was an increase in the BCS rate over time (p=0.002), however a higher 2. Evaluating the Cost Effectiveness of Trastuzumab in the proportion of the neoadjuvant group (55.5%) underwent mastectomy. A Neoadjuvant Setting higher rate of disease recurrence was observed in the neoadjuvant group (p<0.001). Timing of chemotherapy did not influence the rate of breast A McGuire1, JAL Brown1, DP Joyce1,CO’Neill2,MJKerin1 reconstruction post-mastectomy, however, timing did influence the type of reconstruction carried out (p=0.003). 1 Discipline of Surgery, School of Medicine, National University of Conclusion: The number of breast cancer patients being treated with Ireland, Galway, Ireland; NAC is increasing, which is influencing the rate of breast conserving 2 School of Medicine, Dentistry and Biomedical Sciences, Queens surgery, though mastectomy is still an important aspect of the surgical University Belfast, Northern Ireland management of those in receipt of neoadjuvant chemotherapy.
Introduction: Analysis of a chemotherapeutics cost effectiveness com- 4. The Usefulness of the Pre-Operative Neutrophil/Lymphocyte Ratio pares the cost and clinical impact of a new treatment against current and Platelet/Lymphocyte Ratio in Predicting Breast Cancer standards of care. Multiple studies have shown adjuvant Trastuzumab Recurrence to be the gold standard therapy cost effective therapy for HER2 positive breast cancer. The aim of this study was to address the cost-effectiveness C Cullinane, M McCumiskey, A Lal, BA Merrigan, S Tormey of Trastuzumab administered in the neo-adjuvant setting against the cur- rent gold standard. Department of Breast Surgery, University Hospital Limerick, Methods: Clinical details and treatment for all HER2 receptor positive Dooradoyle, Limerick, Ireland breast cancer patients were collected from a prospectively maintained database, and the cost of treatment was calculated for each intervention. Introduction: The systemic inflammatory response is an established factor The QALY was calculated for all patients at three years of follow up, in cancer development and progression. Inflammation can support tu- using previously published assigned utilities for survival. mour growth, invasion, angiogenesis and eventually metastasis. An ele- Results: In total, 225 patients were analyzed, 166 patients had adjuvant vated ratio of peripheral neutrophil to lymphocytes and platelet to lym- Trastuzumab and 59 neoadjuvant Trastuzumab. Multivariate analysis re- phocytes have been recognised as a poor prognostic indicator in various vealed patients treated by neoadjuvant Trastuzumab had a significantly cancers. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S139
Aim: To determine if the Neutrophil to Lymphocyte Ratio (NLR) and Background: The correlation between increased BMI (body mass index) Platelet to Lymphocyte Ratio (PLR) can act as a predictor of recurrence in and postmenopausal breast cancer is well documented. patients undergoing Primary Breast Cancer Surgery within University Aims: The first objective of this study was to investigate the extent of Hospital Limerick between 2010 and 2014. obesity among the patients attending a family history clinic. An additional Methodology: NLR and PLR were recorded on those patents undergoing aim was to assess if weight reduction could significantly reduce lifetime Primary Breast Cancer Surgery at the time of diagnosis. Pre-operative breast cancer risk in the post menopausal subset of patients. NLR and PLR in patients who remained disease free were compared to Materials and methods: 2624 women attended the clinic between 2014 patients who had a recurrence of their disease. and 2017. Risk stratification of patients was based on a calculated IBIS Results: Data collected from 385 Breast Cancer Patients compared pre- risk score. A percentage of weight was deducted for all over weight operative NLR and PLR in 297 patients who remained disease free to 88 patients according to their BMI (see table I) to give them a normal BMI patients who had a recurrence of their disease. The mean NLR was higher (between 18.0 and 25). Their IBIS risk score was then recalculated using in those who had a recurrence of their disease compared to those who their ‘normalised’ BMI. remained disease free, 3.23 compared to 2.81 (p 0.026). Conversely the TABLE I PLR was found to be lower, although not significantly, in those patients who had a recurrence of their disease, 179.60 compared to 180.84 (p 0.24). BMI WHO CLASSIFICATION PERCENTAGE AMOUNT Conclusion: As both the NLR and PLR are relatively costless laboratory OF WEIGHT DEDUCTED ‘ ’ results that are routinely obtained pre-operatively, the application of these TO NORMALISE BMI parameters into an improved individualised Breast Cancer risk assess- 25-29.9 PRE OBESE - 20% ment would be a cost-effective adjunct into clinical practice. 30-34.9 OBESITY CLASS 1 - 30% 35-39.9 OBESITY CLASS 2 -40% 5. Progesterone Receptor Status as a Prognostic Indicator in Oestrogen Receptor Positive Breast Cancer Patients - A Systematic OVER 40 OBESITY CLASS 3 - 50% Review
E Dunne, M Boland, N Bhatt, A Lowery Results: BMI data was available on 1863 women, mean BMI was 27.02. In total 68.9% of post menopausal women attending the clinic had a BMI Department of Surgery, Lambe Institute for Translational Research, NUI of over 25. By ‘normalising’ BMI’s of this cohort of women there was a Galway, Ireland lifetime risk reduction of breast cancer development of up to 5.5% ac- cording to IBIS risk stratification. Introduction: The role of progesterone receptor (PR) status in determining Conclusions: For women post menopause, losing weight can potentially prognosis in oestrogen receptor (ER) positive breast cancer patients re- reduce their overall lifetime risk of developing breast cancer. More ded- mains controversial. icated resources are needed to tackle obesity and the associated risk of Aim: The aim of this review was to determine whether absence of PR breast cancer. receptor expression was a negative prognostic indicator in patients with ER positive disease. 7. Assessment of Validity of A Standardized Pre-Operative Methods: A comprehensive search of MEDLINE/Pubmed, Embase, and Nomogram for Prediction of Central Nodal Metastasis in Papillary the Cochrane Library was performed in accordance with PRISMA guide- Thyroid Carcinoma lines. Studies pertaining to progesterone receptor status and its effect on survival in breast cancer patients were identified. The primary outcome L Mc Loughlin, I Balasubramanian, MJ Kerin, A Lowery recorded was hazard ratio (HR) for disease free (DFS) and overall sur- vival (OS) in PR negative cases. Secondary outcomes included percent- Department of Surgery, Galway University Hospital, Galway, Ireland age DFS and OS. Studies deemed eligible for inclusion were quality assessed. Introduction: The role of prophylactic central neck dissection in papillary Results: 4 retrospective cohort studies met inclusion criteria, involving a thyroid carcinoma (PTC) is debated. Our aim was to determine if a stan- total of 9,419 patients, of which 1061 were ER+ PR-. PR status was found dardized preoperative nomogram for prediction of central lymph node to be a significant independent prognostic indicator in all four studies. metastases in use by the Australia and New Zealand Endocrine Mean hazard ratio for DFS in PR negative patients across the four studies Surgeons Society is valid in our patient cohort. was 2.60 (Range: 1.66-3.91). Mean hazard ratio for OS in PR negative Methods: This was a retrospective analysis of a prospectively maintained patients across the four studies was 3.20 (Range: 1.62-4.78). Included database of 289 patients undergoing treatment for PTC at our institution studies demonstrated significantly increased percentage disease free sur- from 2007 to 2017. 125 patients undergoing total thyroidectomy and vival in ER+PR+ patients compared to ER+PR- patients at two years central lymph node dissection were included. Using the pre-operative (97.7% vs 90.4%; p<0.05) and median follow up (83.7% vs 76.1%; nomogram, a predictive score was retrospectively calculated for each p=0.001). patient based on 5 variables- age, gender, tumour size, site and Conclusion: PR expression is an independent negative prognostic indica- multifocality. The accuracy of the pre-operative scoring system in tor in ER+ breast cancer which is traditionally considered to have a good predicting nodal disease was assessed by calculation of area under the prognosis and should be considered accordingly when planning treat- receiver operating characteristic curve (AUROC). Logistic regression ment. was used to determine the relationship between the individual variables and presence of histologically confirmed lymph node metastases. 6. The Projected Impact of a Weight Loss Strategy on Predicted Results: Of 125 patients undergoing total thyroidectomy and central Breast Cancer Risk lymph node dissection, 95 (76%) were female. Mean age was 44.65 years. Central lymph node metastasis were present in 66 (52.8%). The A Cotter, HP Redmond, MA Corrigan AUROC for the pre-operative nomogram was 0.616 and therefore a poor predictor of nodal metastases. Of the individual variables analysed, only Department of Cork Breast Research Centre, Cork University Hospital, male gender was associated with significant risk of central nodal metas- Cork, Ireland tases (P=0.031). S140 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Conclusion: The pre-operative nomogram as a predictor of central lymph Results: After screening, 11 case-control studies investigating miSNPs node metastasis is unreliable in our cohort. Male gender was the only risk and DTC remained. rs2910164 was the most commonly investigated factor found to predict increased risk of nodal disease. miSNP (7/11 papers). We conducted a meta-analysis of studies investi- gating its role in DTC. The majority of miSNPs have been the subject of 8. Under-Recognition of Primary Hyperparathyroidism in a Tertiary just one study, and in populations of a single ethnicity. Centre Setting Conclusions: There exists early evidence for an important role of miSNPs in thyroid cancer pathogenesis. Discrepant results observed AWhite1,DPO’Leary1, C Sanchez Belmar1, S Costelloe2,MMajeed1,A in those SNPs that have been the subject of multiple studies may be Achakzai1,HPRedmond1 explainable by methodological shortcomings and differences in mi- nor allele frequency between different ethnic groups. Further large, (1) Department of General and Endocrine Surgery, Cork University well-designed studies are required to clarify the contribution of Hospital, Wilton, Cork, Ireland; miSNPs to DTC. (2) Department of Biochemistry, Cork University Hospital, Wilton, Cork, Ireland SESSION 2: UROLOGY
Introduction: Surgery represents an excellent curative option for patients 10. A 20 Year Review of Bladder Cancer in Ireland with PHPTwith very high success rates (>95%). However, detection rates appear to be low and awareness of PHPT and its implications for patients S O Meara1,NRBhatt1, TED McDermott1,RJFlynn1, RP Manecksha2, amongst physicians is likely under recognized. AZ Thomas2 Aim: To evaluate the workup of patients with hypercalcemia to establish and determine rates of surgical referral and subsequent treatment for hy- (1) Department of Urology, Tallaght University Hospital, Tallaght, perparathyroidism if indicated. Dublin 24, Ireland; Methods: New presentations of hypercalcemia (>2.65 mmol/L) from 01/ (2) Department of Surgery, Trinity College Dublin, Dublin, Ireland 07/2016-30/06/2017 were identified from the Laboratory Information System at Department of Clinical Biochemistry, CUH. Demographic in- Introduction: Bladder carcinoma is one of the most commonly diagnosed formation was obtained from the electronic medical records. Patient re- cancers worldwide, however various studies have reported on marked cords were reviewed to establish if subsequent endocrine (medical/surgi- international variation in incidence and mortality rates1-3. The aim of this cal) referrals were made study was to report national figures on incidence, survival and risk factors Results: 1,165 patients with new hypercalcaemia were identified within of bladder cancer. This retrospective review is the first to offer a compre- the defined period. Of these, 150 (12.3%) had PTH levels checked within hensive analysis of incidence rates, mortality and potential risk factors in 6 months. Sub-analysis identified 57 patients had tests performed by the Irish population from 1995-2014. primary care centers and 93 from secondary care centers. Only 8 patients Methods: This was a retrospective study of incidence and survival (5.3%) went on to have surgical review with 1 being made from a primary trends in bladder cancer in the Irish population from 1995-2014 care centre. The mean age was calculated at 61 years with a based on data from the National Cancer Registry of Ireland predominance-favouring women 3:1. The mean serum calcium for the (NCRI). Patient demographics and potential contributing factors 1,015 patients with elevated serum calcium and no PTH measurement were studied. was 2.72, the mean serum for those patients who had PTH levels checked Results: A total of 8198 cases of bladder cancer were diagnosed from was 2.81 and the mean for patients referred to surgeons was 2.94. 1995-2014, with majority of cases occurring in males (70.9%). Age- Conclusion: This study demonstrates a low percentage of patients with standardised incidence decreased in both sexes over the twenty years. hypercalcaemia are appropriately investigated for potential underlying The 10-year survival has improved markedly from 39.3% in 1994-98 to PHPT. Subsequent medical and surgical endocrine referral rates are also 56% in 2010-14. The proportion of smokers reduced from 51% (1995) to extremely low. 32% (2014). The median area-based deprivation score was 4 (range 1-5), with 5 meaning most deprived. The number of grade 3 tumours has risen 9. The Role of Microrna Single Nucleotide Polymorphisms (Misnps) from 33.5% to 75%. in Differentiated Thyroid Cancer: A Review and Meta-Analysis Conclusion: Our findings show a decrease in the incidence of bladder cancer in Ireland with improved survival, most likely due to earlier diag- J Birrane, U McVeigh, P Owens, MJ Kerin, A Lowery nosis, improved treatment and a reduction in smoking rates. The marked increase in high-grade tumours is important for service planning as it Department of Surgery, School of Medicine, Nursing and Health affects long term follow-up and treatment in this cohort. Sciences, Lambe Institute for Translational Research, NUI Galway, Galway, Ireland 11. A 3-Year Audit of Compliance with the NCCP Guidelines for Referral to the Rapid Access Prostate Clinic at St James’s Hospital Introduction: The incidence of differentiated thyroid cancer (DTC) is increasing worldwide. While the disease is predominantly sporadic, there GLavelle1, U Haroon1, P Lonergan1, L Casey1,MO’Brien1, S Bowen1, is growing recognition of a familial predisposition to DTC, in addition to TConroy1, M Cremin1, C Enright2, significant geographic and ethnic variation in incidence rates. Despite T Lynch 1, R Manecksha1 this, germline mutations consistently associated with the disease have been difficult to identify. Single nucleotide polymorphisms (SNPs) relat- (1) Department of Urology, St James’s Hospital, James’s Street, Dublin 8, ing to microRNA functioning (miSNPs) have been proposed in the liter- Ireland; ature as potentially important genetic contributors to disease. (2) Department of Cancer Audit, St James’s Hospital, James’s Street, Methods: Pubmed and SCOPUS databases were searched identify case Dublin 8, Ireland control studies investigating miSNPs DTC. Data relating to the increase in relative risk posed by possession of miSNPs were extracted from each case Introduction: Referral to a Rapid Access Prostate Clinic (RAPC) is based control study. Data on matching of controls to cases were summarised. The on guidelines determined by the National Cancer Control Programme miRNA product affected by each SNP was listed and a brief background (NCCP) and little is known about the quality and accuracy of these provided on plausible mechanisms linking its expression to DTC. referrals. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S141
Aim: The aim of this study was to audit compliance with the NCCP 13. Hospitalisation Due to Infection Post TRUS Guided Prostate guidelines of referrals made to the RAPC at St. James’s Hospital. Biopsy Method: Data was collected prospectively on all referrals made to the RAPC from April 2015 to February 2018. L Scanlon, A Cahill, JA O’Kelly, M Broe, K O’Connor, F O’Brien Results: 730 referrals were made to the RAPC over the 35-month duration of the audit. The mean age at referral was 62.9 years (range Department of Urology, Cork University Hospital, Wilton, Cork, Ireland 27-90years)withameanPSAof11.9μg/ml (range 0.069-1,572 μg/ml). 98% of referrals included at least one PSA result and a Introduction: Infection and sepsis are uncommon but serious complica- documented digital rectal examination was included in 74% of re- tions of Trans-rectal ultrasound (TRUS) guided prostate biopsies, studies ferrals. Overall, 174 referrals (23.8%) were incomplete or unsuit- report 0-6% of patients require hospitalisation as a result(1)(2). able. The table shows the reasons for exclusion from the RAPC Aims: We aimed to carry out a review of sepsis and infection requiring with age outside referral guidelines (48.3%) and only one PSA re- hospitalisation after TRUS guided prostate biopsies in our institution. sult (29.3%) being the most common reasons. Methods: A retrospective analysis of TRUS biopsies performed in Cork Conclusion: A large proportion of referrals made to the RAPC at St. University Hospital between January 2013 and November 2017 was un- James’s Hospital did not comply with the NCCP guidelines. Greater dertaken. Microbiology reports, paper and electronic patient records were awareness of the RAPC referral guidelines is needed. reviewed to identify patients who were hospitalised due to infection after undergoing a TRUS biopsy. Statistical analysis was carried out using SPSS. Reason for exclusion from RAPC (n=174) n (%) Results: In a four year period, 1333 TRUS biopsies were performed. 45(3.4%) patients were admitted with post biopsy infections. Of those Age outside referral guidelines 84 (48.3) hospitalised 16 patients had a positive urine culture, 13 patients had a Only one PSA result 51 (29.3) positive blood culture, 5 had both. E.coli and coliform were the most Already known to urology service 16 (9.2) commonly detected organisms. 3.2%(32/989) of first time biopsy patients Post urinary tract infection 7 (4.0) were hospitalised compared to 3.8%(13/344) of patients who had a pre- vious TRUS biopsy. There was no statistically significant correlation Undocumented 7 (4.0) between previous TRUS biopsy and hospitalisation(r=0.023,p=0.204), Outside catchment area 4 (2.3) the organism detected and prophylactic IV antibiotics use(r=- No PSA included 3 (1.7) 0.099,p=0.517), or between length of stay and either the organism detect- Normal age-specific PSA 2 (1.1) ed or positive blood culture results(r=0.149,p=0.211, r=0.126,p=0.411 respectively). Conclusion: Our data demonstrates that infection post TRUS biopsy can result in hospitalisation of a significant number of patients. Slightly higher 12. Radical Cystectomy for Bladder Cancer: A Comparison of Stage rates of admission occurred in patients with a previous biopsy, however Migration and Review of Outcomes this was not statistically significant. This highlights the need for caution when preforming TRUS biopsies. EO’Beirn, H Economos, L McLoughlin, K Walsh, G Durkan, S Jaffry, E Rogers, F D’Arcy, N Nusrat, C Dowling 14. The Implementation of a Protected Emergency Theatre Pathway for Acute Urological Admissions Department of Urology, Galway University Hospital, Galway, Ireland M Hegazy1, S Anderson1,NNusrat1,SJaffry1, E Rogers1,GDurkan1,P Introduction: Bladder cancer treated with radical cystectomy (RC) O’Malley1, R McLaughlin2,KClarkson3,KWalsh1,FD’Arcy1,C and pelvic lymph node dissection (PLND) can be associated with Dowling1 high morbidity and mortality. Tumor stage, grade, the present of variant pathology, and treatment with neo-adjuvant chemotherapy, (1) Department of Urology, Galway University Hospital, Ireland; can all affect prognosis. (2) Department of Surgery, Galway University Hospital, Ireland; Aim: We conducted an 11-year review to evaluate treatment outcomes, (3) Department of Anaesthesia and Intensive Care, Galway University and compared tumor demographics resected prior to and after 2012 to Hospital, Galway, Ireland investigate stage migration. Methods: Information was collected and assessed on all patients who Introduction: The Saolta University Healthcare Group consists of seven underwent RC and PLND in our institution between January 2007 and hospitals covering a population of approximately 709,000(1).University December 2017. Hospital Galway is the only tertiary referral centre for acute urological emergencies within the group. Previously, there was no dedicated emer- Results: A total of 115 patients, 84 men (73%) with a median age of 66 gency surgery pathway for urological cases and these were added to a years (range 37-90) were treated. Median follow up was 6 years (range 1- congested emergency list. Research has demonstrated that an increased 11). Variant histology, other than standard urothelial carcinoma, was pres- time to definitive surgical intervention for urinary tract calculi leads to ent in 21 patients; CIS was present in 37 patients. Pathology was carci- increased mortality(2). Problem areas were identified in the emergency noma in situ (CIS) in 12.5%, T0 in 9%, Ta in 4.5%, T1 in 9%, T2 in 16%, surgical pathway and a multidisciplinary team identified potential solu- T3 in 23% and T4 in 26%. Advanced disease (T3/T4) was found in 53% tions. Recommendations included the utilisation of a dedicated algorithm of patients prior to 2013 compared to 55% after (p=0.6) (Table 1). The to improve governance and prioritization of emergency cases, creating overall positive margin rate was 35%. An overall mean of 9 lymph nodes extra theatre capacity, and the development of dedicated specialty- (±7) were resected in 83 patients; of which 27% overall had node positive specific emergency pathways. (N+) disease. N+ disease was present in 36% prior to 2013 and 20% after Aim: An audit of emergency theatre waiting times and length of hospital (p=0.13). stay was carried out to assess the impact of the reforms. Conclusion: We found no evidence of stage migration as there was no Methods: Data was prospectively collected prior to and after the imple- significant difference in rate of advanced disease in those operated prior to mentation of the recommended changes on emergency admissions with 2013 compared to later years. obstructing calculi. S142 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Results: Mean waiting time on the emergency list decreased from 55.8 Methods: Across a 5 year period, 30 biopsies positive for IDC-P were hours to 13.2 hours. The saving of 42.6 hours per case translates to 852 identified from a prospectively kept database. Full chart, histopathology, bed days saved per annum. Mean length of stay reduced from 5.2 days to radiology review and patient interviews were performed. 2.8 days. Results: Mean age and PSA at time of diagnosis were 67 years (range 53- Conclusion: The implementation of protected, specialty-specific acute 85) and 20.13 ng/ml (range 2-166). 22 (73%) had an abnormal DRE surgical pathways has streamlined the turnover of acute urological cases. finding. IDC-P was documented in 87% of samples on initial reporting The implementation of day of surgery transfers from referring institutions and futher 13% were identified following immunohistochemical staining. and ring-fenced emergency surgical beds are the next frontier in further Associated invasive prostate adenocarcinoma was found in all specimens. streamlining the emergency theatre pathway. 3 (10%) were Gleason 3+3, 3 (10%) Gleason 3+4, 7 (23%) Gleason 4+3, 9 (30%) Gleason 4+4 and 8 (27%) Gleason 4+5. Imaging revealed 10 15. Management of Patients with Acute Urinary Retention (33%) had localised, 7 (23%) locally advanced and 13 (43%) had meta- Discharged from the Emergency Department static disease. Regarding treatment, 7 (23%) had radical prostatectomy, 11 (37%) radical radiotherapy and 12 (40%) hormonal/chemotherapy. First- UHaroon1,SInder1, R Khalid1, R Manecksha1, I Ahmed1,TLynch2 degree family history was established in 8 (27%) of patients. Conclusion: Our study suggests an association between IDC-P and high (1) Department of Urology, St. James Hospital, Dublin 8, Ireland; grade, advacned stage prostatic adenocarcinoma with an established fa- (2) Department of Surgery, Trinity College Dublin, Dublin, Ireland milial link in 27% of patients. Further studies are required to establish evidence based guidance on genetic counselling in IDC-P. Objective: To evaluate our management of patients presenting with acute urinary retention (AUR) who were assessed and discharged from the 17. Transobturator Sub-Urethral Sling Insertion for Post emergency department (ED) and to review their subsequent urological Prostatectomy Urinary Incontinence: A Single Centre Experience follow-up. Methods: A retrospective audit of 199 consecutive episodes in 166 (161, MS Inder, PE Lonergan, JF Sullivan, RP Manecksha, TH Lynch 97% male) patients entered on the ED AUR pathway over 45 months was performed. Electronic patient records and charts were reviewed. Clinical Department of Urology, St James Hospital, Dublin, Ireland characteristics, type of AUR, subsequent trial without catheter (TWOC) and follow-up were recorded. Introduction: The use of the trans-obturator male sling for male stress Results: Of the 161 males with AUR, Eighty patients(49%) had urinary incontinence (SUI) after radical prostatectomy (RP) has been Spontaneous and 81(51%) had a precipitated AUR, mainly due to infec- shown to have certain advantages over the artificial urinary sphincter. tion (33%), constipation (31%), alcohol intake and recent anesthesia Aim: Our aim was to assess outcomes of the AdVance™ sub-urethral (10%). Non BPH causes of AUR included prostate cancer, stricture, med- sling insertions in men presenting with post RP SUI. ication side-effects. In 96 (58%) patients this was their first episode of Methods: We studied a consecutive cohort of men undergoing sub- AUR. urethral sling insertion following RP. Parameters assessed included pre Overall, 111 (67%) had a successful TWOC at a mean 13 +/-5 days. and post-operative urinary function (ICIQ-SF), 24 hour pad use and com- 16 patients went on to have a further episode of AUR and 6 went on plications. Degree of incontinence was classified as mild (1-2 pads/day), to have multiple AUR episodes. Those who failed, 12 (22%) had a moderate (3-5 pads/day) or severe (≥6 pads/day). Results were compared successful second TWOC. Increasing age, time to TWOC and re- between group 1 (patients without previous radiation treatment) and sidual volumes on catheterization were associated with failed group 2 (patients with post RP radiotherapy). TWOC. Results: 106 patients were included, mean age of 67.6years. Pre-operative 32 patients had intervention for their AUR, (28 TURP, 3 urethrotomy, 1 degree of incontinence was mild (23.6%), moderate (54.7%) and severe circumcision) with a mean waiting time of 168 +/-126 days. 13 are (21.7%). 50.9% of patients underwent Robotic assisted radical prostatecto- awaiting intervention and 26 are managed by long-term catheterization. my. Median interval from radical surgery to sling insertion was 44.2 months. Conclusion: The outpatient based AUR pathway is a feasible and effec- Group 1 included 92 patients. Complete cure for mild incontinence was tive model of managing AUR presenting to the ED. However, waiting 95.7%, moderate incontinence 84.6% and severe incontinence 76.5%. times to TWOC and intervention must be reduced to deliver optimum Group 2 included 14 patients. Cure rate for patients with moderate incon- patient care. tinence was 33.3% and severe incontinence 16.7%. None of the patients with mild incontinence pertaining to group 2 were cured. 16. Intraductal Carcinoma of The Prostate: Is There a Need for On follow up survey, the ICIQ-SF score (mean, range), decreased from Genetic Screening? 16.9 (8–21.0) to 6.6 (0–21) (p < 0.0004). Conclusion: With appropriate patient selection, sub-urethral slings repre- SO’Grady Coyne1,UHaroon1,MO’Neill2, C Gullman3,ICheema1,J sent a good alternative to the AUS for all degrees of post RP incontinence. Forde1,LMcLornan1 18. Inevitability of Performing Prostate Multi-Parametric MRI (1) Department of Urology, Beaumont Hospital, Dublin 9, Ireland; (Mpmri) on Younger Men with Raised PSA Referred to a Rapid (2) Department of Urology, James Connolly Memorial Hospital, Access Prostate Clinic (RAPC) Blanchardstown, Dublin 15, Ireland; (3) Department of Pathology, Beaumont Hospital, Dublin 9, Ireland JO’Kelly, M Broe, L Scanlon, E Redmond, A Cahill, F O’Brien, K O’Connor Introduction: Intraductal carcinoma of the prostate (IDC-P) is characterised by carcinoma which occupies the ducts +/- acini and dem- Department of Urology, Cork University Hospital, Wilton, Cork, Ireland onstrates significant architectural and cytological atypia. Its finding is associated with advanced, high grade prostatic carcinoma (1). Recent Introduction: Recent studies such as PROMIS and PRECISION have studies suggest an association between the BRCA1/BRCA2 gene muta- focussed on the benefit of performing mpMRI prior to prostate biopsy. tion and increased familial risk of breast, prostate, endometrial or ovarian One concern is the cost of performing MRI on all patients prior to prostate carcinoma (2). This study reviewed clinicopathological features, potential biopsy. We investigated the pros and cons of performing pre-biopsy familial link and management. mpMRI in men ≤55 years. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S143
Method: We performed a retrospective analysis of all men ≤55 years (2) Department of Radiation Oncology, Beaumont Hospital, Beaumont referred to a RAPC at a single institution from 2012-2017. Two groups Road, Dublin 9, Ireland; were compared, Group A had an mpMRI prior to initial biopsy and Group (3) Department of Plastic and Reconstructive Surgery, Beaumont B proceeded directly to systematic trans-rectal ultrasound(TRUS) guided Hospital, Beaumont Road, Dublin 9, Ireland biopsy. We assessed prostate cancer (PC) detection rates, number of targeted biopsies, MRIs undertaken and time to MRI. Introduction: The management of low rectal cancers has undergone sig- Results: We identified 134 men. PC detection in Group A and B was 14/ nificant change in recent years. Improved chemoradiotherapy and opera- 19(73%) and 65/114(57%) respectively. Median time from referral to tive techniques have facilitated sphincter preserving surgery for cases MRI was 4(2-17) versus 9(2-63) weeks (p<0.05). previously requiring APR, however a subset of patients still require APR. In Group A 10/19 (53%) were able to undergo targeted biopsy. In Group Aim: The aim of this study was to assess if outcomes have improved in B 4/65 (6%) patients deemed suitable for active surveillance were patients who underwent APR between 2008-2016 versus those who upstaged following targeted biopsy of MRI detected lesions. underwent APR between 1998-2007. 30/49 (61%) patients with previous benign biopsy had a subsequent MRI. Methods: A retrospective review of a prospectively maintained database 2/30(7%) were diagnosed with PC following targeted biopsy of MRI was undertaken. Patients who underwent APR for rectal adenocarcinoma identified lesions. between 1998 and 2016 were eligible for inclusion. The following data In total, 95/114(83%) in Group B underwent MRI. was collected; age, sex, neoadjuvant treatment, TNM stage, LVI, PNI, Conclusion: Prostate MRI when feasible should be performed initially in margin status, TRG, presence of pCR, use of VRAM, recurrence and all younger patients referred with a suspicion of prostate cancer. This overall survival. Fishers exact test, log-rank test and Kaplan Meier improves the patient pathway significantly. This should not require sig- methods were used to compare groups. nificant additional resources as the vast majority of these patients undergo Results: 131 patients underwent APR for rectal cancer between 1998-2016. MRI during their clinical course. There was no difference between sex (p=0.85), T-stage (p=0.15), M-stage (p=0.57), pCR (p=0.50), local (p=0.71) or distant recurrence (p=0.20) or SESSION 3: LOWER GI overall survival (p=0.94). Margin positivity rates decreased from 20.8% to 10.3% (p=0.13). A statistically significant difference was found between the 19. Assessing the Appropriateness of Colonoscopy Referrals and Post number of patients receiving neoadjuvant chemoradiotherapy pre and post Colonoscopy Follow Up in a Single Centre 2008 (35.9% vs. 85.9% p<0.0001) as well as node positivity (50.9% vs 30.7% p=0.03). Patients who underwent a VRAM were less likely to have ACotter,WJoyce positive margins (2.8% vs 19.0%, p=0.02). Conclusion: Reduced rates of margin positivity and node positivity are Department of Surgery, Galway Clinic, Doughiska, Galway, Ireland likely the result of improved operative technique and neoadjuvant che- moradiotherapy. Despite these improvements no difference in recurrence Introduction: Colonoscopy referrals are increasing exponentially. or survival was identified. Currently healthcare systems are under extreme pressure to meet this demand. Frequently, questions are raised regarding the appropriateness 21. Appropriateness of Colonoscopy of referrals. Aims: There were three aims of this study; firstly to assess if colonoscopy EBrennan1, S Johnston2,DHehir2 referrals were appropriate, secondly to investigate if surveillance endos- copies were following guidelines and lastly to detect whether pathological (1) Department of Medicine, University of Limerick, Castletroy, Limerick, findings were found for those referred with ‘red flag’ symptoms. Ireland; Methods: 532 colonoscopies were included. Data collected on patients in- (2) Department of Surgery, Midlands Regional Hospital Tullamore, cluded gender, age, reason for referral or follow up, anti coagulant/anti platelet Arden Road, Tullamore, Co. Offaly, Ireland medication, ability to complete endoscopy and colonoscopy outcomes. Results: Overall, there were 63 (11.8%) surveillance colonoscopies for Background: Colonoscopy is the gold standard for investigating colorec- cancer, IBD and polyps. All adhered to the NICE guidelines and British tal pathology; long waiting times may increase strain on resources1 and Gastroenterology follow up protocols. inappropriate referrals may further prolong waiting. This study aims to There were 439 referrals for colonoscopies. The most common reasons examine the diagnostic yield of colonoscopy based on reason for referral were PR bleeding (19.8%), abdominal pain (19.8%) & change in bowel and examine the tumour dispersion within the population. habit (16.2%). In total 66% of indications were deemed clearly appropri- Methods: 1278 colonoscopies performed over for a one-year period were ate, 19% were uncertain in the absence of more detailed information and categorised based on the indication for colonoscopy and if the indication 15% were clearly inappropriate. was in line with the American society of gastrointestinal endoscopy Overall, there was a low pathological yield, 46.1% were normal. (ASGE) guidelines or not. Diagnostic yield - defined as the number of Including diverticulosis, fissures and haemorrhoids as benign conditions, colonoscopies with a finding of a tumour or polyp, stricture, source of the figure for non-pathological findings rose to 80.4%. Three colon can- bleeding or inflammation as a percentage of the total colonoscopies per- cers were detected. Red flag symptoms of weight loss, anemia, change in formed – was calculated for each indication. bowel habit and PR bleeding did not detect significant rates of disease. Results: 1003 colonoscopies were performed for ASGE indications while Conclusion: More detailed referrals including clinical examination find- 275 were not. Colonoscopies performed for ASGE indications had a ings are necessary to stratify patients more efficiently into risk categories higher diagnostic yield than colonoscopies performed for other indica- so that those with cancer are reviewed and scoped promptly. tions (40% vs 27% p<0.005). Colitis was the indication that had the highest diagnostic yield (76%). 41 tumours were detected (3%). Rectal 20. Abdominoperineal Resections Now and Then, Have Outcomes bleeding most commonly lead to tumour detection (19 cases). The aver- Changed? age age of tumour detection was 70 years. 30% of inappropriate referrals were in patients under 40 years of age. CMurphy1, I Stephens1, I Reynolds1,BO’Neill2,BO’Sullivan3,J Conclusion: There was a significant proportion of inappropriate referrals Deasy1, J Burke1,DMcNamara1 for colonoscopy. A standardised colonoscopy referral form and protocol (1) Department of Colorectal Surgery, Beaumont Hospital, Beaumont will reduce the number of inappropriate referrals and alleviate pressure on Road, Dublin 9, Ireland; growing waiting lists. S144 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
References: Methods: A retrospective review of the St. Vincent’s University Hospital 1. Colonoscopy waiting times reach all-time high [Internet]. Cancer.ie. histopathology electronic database was performed. Patients with CRC 2017 [cited 11 November 2017]. Available from: https://www.cancer.ie/ who had MMR IHC performed on both their preoperative endoscopic about-us/news/colonoscopy-waiting-times biopsy and subsequent surgical resection from 01/01/2010 - 01/01/2016 were included. Concordance of MMR staining between biopsy and re- 22. Micrornas In Rectal Cancer: Novel Biomarker To Predict section specimens was examined. Response To Neoadjuvant Therapies And Survival In Rectal Cancer Results: Between 2000 to 2016, 53 patients had IHC for MMRPs per- formed on both their preoperative endoscopic biopsy and resection spec- RM Waldron1,KGilligan1, NM Miller1,MRJoyce2, AJ Lowery1,2,MJ imens; 10 patients (18.87%) demonstrated loss of 1 or more MMRPs on Kerin1,2. their biopsy specimen. The remainder (81.13%) showed preservation of staining for all MMRPs. There was 100% agreement in MMR IHC status (1) Department of Surgery, Galway University Hospital, Galway, between the preoperative endoscopic biopsies and corresponding resec- Ireland; tion specimens (k = 1.000, p<0.000) with a sensitivity of 100% [95% CI (2) Department of Surgery, Lambe Institute for Translational Research, 69.15-100] and specificity of 100% [95% CI 91.78-100] for detection of Galway, NUI Galway, Ireland dMMR specimens. Conclusion: Endoscopic biopsies are a suitable source of tissue for MMR Introduction: Neoadjuvant chemo-radiotherapy is used in locally ad- IHC analysis in CRC. This may provide a number of advantages to both vanced rectal cancer to0 reduce tumour burden prior to surgical resection patients and clinicians in the management of CRC. and pathological complete response to neoadjuvant therapy is considered to be a useful prognostic marker. The identification of predictive bio- 24. Distal Enteral Nutrition Can Replace Long-Term Parenteral markers of response to neoadjuvant therapy would contribute to more Nutrition in Selected Patients with a High Output Loop accurate selection of rectal cancer patients for appropriate therapy. Jejunostomy or Enterocutaneous Fistula. A Twelve-Year Review Aim: To investigate the potential of circulating microRNA’s as novel non- invasive biomarker to predict patient response and outcomes rectal cancer SPower1, G McConnell1,SFeehan1, P Neary2 patients treated with neoadjuvant chemo-radiotherapy. Methods: RNA was extracted from blood and rectal cancer tissue using (1) Department of Nutrition and Dietetics, Tallaght Hospital, Tallaght, the MagnaPure Compact automated extraction system. RNA was reverse Dublin 24, Ireland; transcribed and PCR-amplified utilising a TaqMan based system. (2) Department of Surgery, Tallaght University Hospital, Dublin 24, Normalisation and Statistical analysis was performed utilising Q-base Ireland and SPSS. Demographics, type of surgical intervention, tumour grading and staging and five-year survival were noted. Introduction: Parenteral nutrition (PN) carries metabolic risk, is expen- Results: The study enrolled 20 patients with a diagnosed rectal cancer and 20 sive, and complicates discharge. Long-term PN is typically used to man- age and gender matched healthy controls. Circulating miR-21(p =0.03) and age patients with high output loop jejunostomy or enterocutaneous fistula miR-153(p=0.01) in cancer patients were shown to be significantly upregu- (ECF). In 2006, we trialled the use of distal enteral nutrition (EN) in this lated as compared to normal healthy controls while Circulating miR- patient group. 143(p=<0.01) and miR-519c(p=0.04) significantly downregulated. miR-29c Aim: To prospectively study if EN could (i) replace PN (ii) save our was shown to be statistically significantly downregulated in rectal cancer institution money (iii) facilitate discharge home tissue samples while miR-21(p=<0.01) and miR-590-5p (p=<0.01) were sig- Methods: Patients were included if they (i) had high output jejunostomy nificantly upregulated. Circulating miR-21(p=0.043) and tissue based miR- or ECF, where conservative management of ECF had failed (ii) were PN- 590-5p(p=0.05) were downregulated in those patients who had a pCR as dependent (iii) had >75cm of viable small bowel distal to the stoma or compared to those who had no response to NeoCRT. ECF. Bowel length was estimated by radiological imaging. Eligible pa- Conclusion: MicroRNA expression at the time of diagnosis was used to tients underwent bedside insertion of a 16 Fr balloon gastrostomy into the assess response to neoadjuvant chemo-radiotherapy and may provide a distal limb of the small bowel. Polymeric EN formula was infused at way in the future to select appropriate therapy for patients. 10ml/hr and titrated upwards over several days. PN was weaned accordingly 23. Correlation of Immunohistochemical Mismatch Repair Protein Results: From 2006-2018, 8 patients met the inclusion criteria. All were Status in Colorectal Carcinoma Biopsy and Excision Specimens successfully weaned from PN. Median days to discontinuation of PN and median in-patient EN days were 6 (1-28) and 38.5 (7-216), respectively. ÉJ Ryan1,BCreavin1,OO’Brien1, ME Kelly1, HM Mohan1,R In our institution, PN regimens cost 430-960% of comparable EN regi- Geraghty1, K Sheehan1,DWinter1 mens. One patient received EN for 216 days at a cost saving of approx- imately €20,700. Fifty percent (n=4) were discharged home on EN for a Department of Colorectal Disease, St Vincent’s University Hospital, Elm period of 22-197 days. Park, Dublin 4, Ireland Conclusion: Distal EN can replace PN in carefully-selected patients with high output loop jejunostomy or ECF. It offers enormous cost-saving Introduction: Microsatellite instability (MSI) is reflective of a deficient potential and is a viable alternative to long-term PN, even in the home mismatch repair system (dMMR), which may be due to either sporadic or environment. constitutional mutations in the mismatch repair gene system. Mismatch repair (MMR) status may be determined by immunohistochemistry (IHC) 25. Influence of Neoadjuvant Radiation on Short-Term Surgical for mismatch repair proteins (MMRPs) on CRC resection specimens. Outcomes in Rectal Cancer: A Systematic Review IHC performed on endoscopic biopsy may be as reliable as that per- formed on surgical resections. M Aradaib1,MHarper2, A Parvaiz3 Aim: To evaluate the reliability of MMR IHC staining on preoperative CRC endoscopic biopsies compared to matched-surgical resection (1) Department of General and Colorectal Surgery, Beacon Hospital, specimens. Beacon Court, Sandyford, Ireland; Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S145
(2) School of Health Sciences and Social Work, University of Portsmouth, screening programme, routine colonoscopy following an episode of CT- PO1 2FR, United Kingdom; diagnosed acute uncomplicated diverticulitis is unnecessary in the ab- (3) Department of Colorectal Surgery, Champalimaud Foundation, Av. sence of other alarming clinical signs of colorectal cancer. We suggest Brasilia, 1400-038, Lisbon, Portugal that this group of patients may suitable for protocolized symptom-driven follow-up shared with primary care. Introduction: Colorectal cancer is the third most common cancer in men and the second in women worldwide. Neoadjuvant radiotherapy plays a 27. Robotic Assisted Colorectal Surgery at University Hospital major role in the management. To date, there has been little agreement on Limerick the actual influence of pre-operative radiation on short-term outcomes following rectal resection. DWestby1, T Connelly1,RSehgal1,ChangKH1, Waldron D1, Condon Aim: To examine the current evidence addressing the influence of neo- E1, JC Coffey1,2,CPeirce1 adjuvant radiation on short-term surgical outcomes in rectal cancer. Methods: A comprehensives search was carried out in October 2017. (1) Department of Colorectal Surgery, University Hospital Limerick, Search terms were: (rectal cancer OR colorectal cancer) AND (neoadju- Ireland; vant radio* OR neoadjuvant chemoradio*) AND (surgical outcomes OR (2) Graduate Entry Medical School, University of Limerick, Ireland anastomotic leak* OR operative time OR blood loss OR hospital stay OR complications OR margins of excision OR mortality OR morbidity OR Introduction: Minimally invasive surgery has revolutionized surgical pro- conversion to open) cedures for the past three decades. The department of surgery at the Results: Nine original studies containing a total of 24,590 patients were University Hospital Limerick (UHL) has taken the next step with the included. 9442 patients received neoadjuvant radiation in comparison to implementation of a robotic assisted surgical programme. The Da Vinci 15,148 patients who had surgery alone. There was no increase in mortal- Xi robot was installed in UHL in 2016 and provides the operating surgeon ity in the neoadjuvant therapy group. Outcomes definitions and reporting with three-dimensional vision, 7° of wrist-like motion, tremor filtering, was variable between authors. There was no agreement on the actual motion scaling, better ergonomics, and less fatigue. effect of neoadjuvant radiotherapy on the rate of surgical morbidities. Aim: The aim of this study is to present our robotics data since the However, authors who utilised large databases and adjusted for con- implementation of the colorectal robotics programme. founders concluded that there was no association between neoadjuvant Methods: A retrospective review of a prospectively maintained colorectal radiotherapy and worse short-term surgical outcomes. robotics registry was conducted from June 2016 to June 2018. Paper and Conclusion: It appears that there is emerging evidence from large data- electronic charts were utilized to obtain demographic and clinicopatho- bases indicating the absence of correlation between neoadjuvant radiation logical data. Salient perioperative robotic parameters such as docking and worse short-term surgical outcomes. However, a consistent conclu- time, estimated blood loss, and total operative time were recorded. sion from high-quality studies is still lacking. To investigate this further, Results: A total of 62 robotic colorectal surgeries were conducted during more studies are required. the study period (F: 35, M:27) mean age 61.73 ± 12.42 yrs. The average length of stay (LOS) was 8.23 days overall. By excluding 4 outliers the 26. Risk of Colon Cancer after Acute Uncomplicated Diverticulitis. Is mean LOS was 6.47 days. The mean docking time was 28.56 ± 12.92 Routine Colonoscopy Necessary? mins. The average operative time overall was 268.02 ± 74.80 mins. Mean estimated blood loss was 80.40 ± 82.22 mls. Average lymph node yield N Hardy1, S Liptrot2, B Mehigan1, J Larkin1, P McCormick1,HAl for cancer cases was 14.92 ± 7. Chalabi 2 Conclusions: The robotic assisted colorectal surgical programme has been successfully implemented in UHL. Trends for all key robotic per- (1) Department of Surgery, St James Hospital, Dublin 8, Dublin 8, formance indicators have improved significantly since the initiation of the Ireland; programme. Oncological outcome remains in-line with international (2) Department of Surgery, Royal Derby Hospital, Derby, United guidelines. Kingdom SESSION 4: BREAST RESEARCH Introduction: It has long been recommended that patients undergo follow up colonoscopy to exclude colon cancer after an episode of acute diver- 28. Utility of A Nomogram to Predict Axillary Nodal Status In Breast ticulitis. The role of colonoscopy following an episode of acute uncom- Cancer Patients Scheduled for Mastectomy plicated diverticulitis remains controversial. Aim: Our aim was to evaluate the need for colonoscopy after an episode S Hembrecht, D Evoy, J Rothwell, J Geraghty, R Prichard, D McCartan of acute uncomplicated diverticulitis, diagnosed both clinically and by computed tomography scan. Department of Breast and Endocrine Surgery, St. Vincent’s University Methods: We performed a retrospective case review of patients with first Hospital, Elm Park, Dublin 4, Ireland presentation of acute uncomplicated diverticulitis over a six year period at two centres: Royal Derby Hospital, Derby, UK; and St. James’s Introduction: Despite advances in estimating prognosis and predicting University Hospital, Ireland. response to adjuvant systemic therapy, the status of the axillary lymph Results: A total of 5461 were admitted with a primary diagnosis of acute nodes remains a critical component in surgical planning and determina- diverticulitis. Of those 4758 (87.1%) underwent colonoscopy either dur- tion of the need for adjuvant therapy, particularly radiotherapy following ing their acute presentation or during follow-up. 2383 patients underwent mastectomy. urgent CT abdomen during their acute presentation. In 64 patients Aim: The aim of this study is to evaluate the ability of a nomogram (1.17%) a histological diagnosis of colonic malignancy was made. The proposed by Dighe et al1 (BJS 2017) to predict axillary nodal status in yield of colonic neoplasia at any stage in our study (1.17%) was equiva- breast cancer patients scheduled for mastectomy. lent to that detected by screening programmes in asymptomatic individ- Methods: Patients undergoing mastectomy for the surgical treatment uals among an international standards (0.8-1.1%) and comparable to the of breast cancer between 2011 and 2017 were included. Our unit estimated prevalence of 1.4% among adults older than 65 years. policy is that patients undergoing mastectomy and immediate re- Conclusion: The incidence of colorectal cancer in patients presenting with construction in whom staging axillary ultrasound is negative under- acute diverticulitis was low at 1.17%. Unless colonoscopy is part of a go a upfront sentinel lymph node biopsy (SLNB) as a day case S146 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 procedure. Patients demographics, procedure details, final patholog- Introduction: Across a range of surgical specialties, enhanced recovery ic axillary stage were correlated with the variables included in the after surgery pathways have resulted in improvements in clinical out- nomogram by Dighe et al (size, subtype, mode of detection, comes with shorter length of stay (LOS). multifocality, patient age and vascular invasion). Aim: The aim of this study is to evaluate the factors affecting LOS in Results: During the study period, 279 women (average age 50) underwent patients undergoing mastectomy. SLNB as an upfront procedure. A total of 73 (26%) patients had node Methods: Patients undergoing mastectomy for breast cancer between positive SLNB. Ten of these patients had micrometastases and had no 2012 to 2016 were included. This study excluded patients undergoing further axillary treatment. The ROC for the nomogram of node negative immediate reconstruction as this would be an additional mitigating factor versus node positive was 0.62. in increased LOS. Patients demographics, comorbidities, procedure de- Conclusion: Despite a normal axillary ultrasound, 26% of patients under- tails, intra- and post-operative analgesia modality and final histopatho- going mastectomy had axillary nodal metastases on final pathology. The logic data were incorporated. use of a nomogram could help reduce the number of stand-alone upfront Results: During the study period, a total of 202 patients underwent mas- sentinel biopsy procedures and limit its use to patients at greatest risk of tectomy without reconstruction. The majority had a LOS of more than 2 nodal disease. days (n=143, 71%). The receipt of neoadjuvant chemotherapy did not impact LOS (p=0.307). The type of synchronous axillary procedure did 29. Assessing the Concordance between 9 Deleteriousness Prediction influence LOS. A higher proportion of patients undergoing axillary Methods for Missense Variants in a Targeted Resequencing Study of lymph node dissection at time of mastectomy had a LOS of more than a West of Ireland Breast Cancer Population 2 days (80%) than those undergoing sentinel node biopsy (62%) (p=0.013). Patient age was not associated with any difference in LOS. U McVeigh1, TP McVeigh2,NMiller1, D W Morris3,MJKerin1 Conclusion: This study will form the basis for a quality improvement initiative aimed at enhanced recovery after mastectomy. A high propor- (1) Department of Surgery, Lambe Institute for Translational Research, tion of patients have a hospital stay exceeding two days. Efforts to reduce NUI Galway, Ireland; this will focus on pre-operative patient education, increased use of region- (2) Department of Clinical Genetics, Our Lady’s Children’s Hospital al blocks and less reliance of patient controlled analgesia post operatively. Crumlin, Dublin, Ireland; (3) Department of Biochemistry, NUI Galway, Ireland 31. Relationship between the Metabolic Syndrome and Mammographic Breast Density in Breast Cancer Introduction: Breast cancer (BC) is the most common female malig- nancy; 2,800 new Irish cases diagnosed annually. Pathogenic vari- P Shokuhi1, S McGarrigle2, C Sullivan3,TBoyle1, D Alazawi1,S ants in BRCA1 and BRCA2 account for ~3% of all BC cases. O’Keeffe3, J Kennedy4, E Connolly1 Variants of reduced penetrance in other genes may explain the fa- milial clustering observed in a further 25% of cases. Large multi- (1) Department of Surgery, St James’s Hospital, James’sStreet,Dublin8, gene panels utilise the cost-effectiveness and high-throughput asso- Ireland; ciated with next-generation sequencing (NGS). However, these (2) Department of Surgery, Trinity College Dublin, James’s Street, Dublin panels include loci with a weak association to BC. The increased 8, Ireland; diagnostic yield given by NGS is hindered by an increased identi- (3) Department of Radiology, St James’s Hospital, James’s Street, Dublin fication of missense variants of unknown significance (VUS). 8, Ireland; Accurately predicting the deleteriousness of variants is crucial for (4) Department of Oncology, St James’s Hospital, James’s Street, Dublin identifying true pathogenic mutations. Ample prediction tools are 8, Ireland available, but inconsistencies between predictions have been noted and complicate the selection process for practical application. Introduction: The metabolic syndrome(MetS) is prevalent among Aim: We aimed to investigate the level of agreement among 9 breast cancer patients and is associated with increased breast can- deleteriousness-scoring methods when applied to missense variants in cer risk. Mammographic breast density(BD) is also positively as- candidate BC susceptibility genes in an Irish population. sociated with increased breast cancer risk. The relationship be- Results: Targeted-resequencing was performed on 167 gDNA samples (91 tween MetS and mammographic BD is unclear and requires fur- BC patients; 77 unaffected controls) using a Roche-Nimblegen custom ther investigation. 282-gene panel. Bioinformatic analysis was performed following GATK Aim: The aim of this study was to examine the relationship between the best practices, 2016. PLINK1.9 was used to identify first-/second-degree MetS and its component features with breast density. relationships within our cohort. Population stratification was performed Method: 196 women with breast cancer were recruited. Body composi- using 1000Genomes data to confirm ethnicity. Variant annotation was tion (Body Mass Index(BMI), waist circumference(WC)) was measured achieved using VEP and SnpEff; 1,452 missense variants were identified. objectively prior to surgery. Metabolic profiles were measured in blood Prediction scores were obtained from 9 deleteriousness-scoring methods, taken. MetS was defined according to the International Diabetes including 6 function prediction scores and 3 ensemble scores. Federation(IDF). BD was classified according to ‘BI-RADS’. Conclusion: The degree of concordance among these tools will be Participants were categorised into those with ‘Dense’(BI-RADS score 3 discussed. Pathogenic variants identified will be investigated for enrich- or 4) or ‘Less Dense’(BI-RADS score 1 or 2) breasts. ment within our cohort. Results: An inverse relationship was observed between adiposity and BD. Participants with ‘dense’ breasts had significantly lower 30. Changes in and Predictors of Length of Stay in Hospital after BMI(p=0.0034), WC(p=0.0007), systolic BP(p= 0.03), insulin Mastectomy level(p=0.009) and glycated haemoglobin(p=0.008) than those with ‘less dense’. HDL was significantly higher in those with ‘dense’(p= ATamas, P Cromwell, E McDermott, D Evoy, J Rothwell, J Geraghty, R 0.03). ‘less dense’ breasts were significantly more likely to be insu- Prichard, D McCartan lin resistant(HOMA-IR ≥2)(50.6% versus 20% respectively);p=0.01. Other components of the MetS (Serum triglycerides, glucose and Department of Breast Surgery, St Vincent’s University Hospital, Dublin, diastolic BP) did not differ significantly. No differences in overall Ireland survival were observed. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S147
Conclusion: Although both MetS and BD are positively associated with Results: Mir-331 was significantly over-expressed in the circulation of breast cancer risk; it is unlikely that the MetS is related to an increase in patients with metastatic disease compared to patients with local disease breast cancer risk through a mechanism involving BD. and healthy controls (p<0.001 and p<0.001 respectively), while mir-195 was significantly under-expressed (p<0.001 and p=0.043). In combina- 32. A Review of the Treatment of Luminal A Breast Cancer in a tion, these miRNAs produced an ROC curve with an AUC of 0.902 in Regional Cancer Centre from 2005 to 2015 distinguishing metastatic from local breast cancer. Conclusion: We identified and provisionally validated 2 circulating R Pereira, N O’ Halloran, C Malone, K Sweeney, R McLaughlin, A miRNAs that distinguish metastatic from local breast cancer, suggesting Lowery, MJ Kerin potential roles of mir-331 as a promoter and mir-195 as a suppressor of metastasis. Further research is required to elucidate the precise functions Discipline of Surgery, The Lambe Institute for Translational Research, of these miRNAs in breast cancer. NUI Galway 34. Comparison of Family History Risk Stratification Models in Irish Background: Systemic chemotherapy is an important component of Women at Increased Personal Risk of Breast Cancer breast cancer treatment. Breast cancer subtype has an influence on the effectiveness of this treatment modality. Over recent years, Luminal A A Stakelum, D Evoy, J Rothwell, J Geraghty, R Prichard, D McCartan, E breast cancer has been shown to respond less favourably to systemic McDermott chemotherapy than other subtypes. The aim of the study was to examine evolving practices in the treatment of Luminal A breast cancer in a re- Department of Breast and Endocrine Surgery, St Vincent’s University gional cancer centre. Hospital, Elm Park, Dublin 4, Ireland Methods: 2097 patients treated for Luminal A breast cancer at Galway University Hospital were included in the study. Clinicopathological de- Introduction: Risk stratification models available to estimate a woman’s tails, treatment received and disease outcomes were assessed. personal lifetime risk of breast cancer vary with regard to the input var- Results: Fewer patients with Luminal A breast cancer were treated with iables. Some models, such as Claus tables, assess solely risk conferred by systemic chemotherapy over time (p<0.001). There was an increasing family history while others include factors such as parity, body mass trend for chemotherapy to be delivered neoadjuvantly in recent years index and previous breast biopsies. (p<0.001). Patients treated with NAC were younger (56 +/- 11 years) than Aim: The aim of this study is to evaluate the correlation of individual risk those treated with adjuvant (63 +/- 9 years) or no chemotherapy (73 +/- 14 estimates generated by the Tyrer-Cuzick model and Claus tables in a years). Complete pathological response was achieved in 13.8% of pa- cohort of Irish women. tients with 46.9% of patients achieving a grade 3 Miller-Payne response. Methods: Women attending a dedicated risk family history clinic for risk T3 and node positive disease was predictive of neoadjuvant chemother- assessment and surveillance were included. Family history inclusive of all apy (p<0.001). Patients treated with NAC had higher disease recurrence 2nd degree relatives and components of the Tyrer-Cuzick model (version (21%) than those treated with adjuvant chemotherapy (8.1%) or no che- 7) were collected prospectively. Lifetime risks (Tyrer-Cuizck) and risk to motherapy (6.3%). age 79 (Claus tables) were collected for each individual. The study was Conclusion: In conclusion this study demonstrates the major change in registered with the hospital audit registry. the breast cancer management strategy of Luminal A breast cancer with Results: The average age was 42 and 52% of women had a completed a reduction in chemotherapy use and incorporation of Oncotype into the pregnancy to term. Half of the patients had a BMI ≥25kg/m2. In the treatment paradigm. majority of cases assessed, the lifetime risk estimate generated from the Tyrer-Cuzick model exceeded that assessed through family history alone. 33. Identification and Validation of Circulating MicroRNAs to In 72% of cases, the excess in risk estimate was greater than 5%. In 17% Distinguish Metastatic from Local Luminal A Breast Cancer of cases, the excess risk corresponded to an increase in breast cancer risk stratification group (NICE). PMcAnena1,KTanriverdi2, C Curran1, J Freedman2, K Gilligan1,A Conclusion: Awareness of risk factors beyond family history is important Lowery1, J Brown1,MJKerin1 in accurate risk stratification for women at increased personal risk to ensure surveillance and chemoprevention advice are risk appropriate. (1) Department of Surgery, Lambe Institute for Translational Research, NUI Galway, Ireland; 35. Consequences of Human Endogenous Retrovirus-K (HERV-K) (2) Department of Medicine, University of Massachusetts, Boston, MA, Protein Expression in Breast Cancer USA DD Bhattacharyya, E Dervan, K Bharadwaj, S Glynn Introduction: Metastatic Breast cancer is the leading cause of cancer re- lated death in women. Non-invasive prognostic markers to expedite the Lambe Institute for Translational Research, National University of early identification of metastasis are required to optimise treatment deci- Ireland, Galway sions and improve patient outcomes. MicroRNA (miRNA) are small, non-coding RNAs that regulate gene expression and are implicated in a Introduction: HERV-K belongs to a family of viruses present in our ge- variety of cellular processes including metastasis. Circulating miRNAs nome with similarities to present day exogenous retroviruses1. This virus show great promise in contributing to the diagnosis, prognosis, evaluation expresses several proteins but knowledge of it in human cancers is limited of response to therapy and treatment of breast cancer to the envelope (Env) protein. Elevated HERV-K env protein has been Aim: To identify and validate circulating miRNAs to distinguish meta- shown in breast cancer (BrCa) both in in vitro and in vivo studies2–6 static from locally confined breast cancer Aims: This project aims to understand the regulation of expression of Methods: Analysis of subtype (Luminal A) and age matched plasma HERV-K proteins through induction by steroid hormones and nitric oxide samples from metastatic disease or local disease (n=4 each) were profiled (NO) treatments in subtypes of BrCa cells and to elucidate the role of using Next Generation Sequencing. Validation was performed on whole HERV-K in tumour invasiveness using siRNA-mediated knockdown. blood extracted from patients with distant metastaic disease (n=22), local Results: Compared to controls, androgen and oestrogen receptor (ER) disease (n=31) and healthy controls (n=21) RNA using TaqMan qRT- positive T47D cells had a strong dose-dependent response to steroid PCR. Mir-16 and mir-425 were used as endogenous controls. treatments, while triple negative breast cancer (TNBC) cell line MDA- S148 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
MB-231 didn’t. NO treatment elevated HERV-K levels in MDA-MB-231 outcomes are achieved when complex surgery including pancreatic, oe- cells but was inhibited in T47Ds. siRNA-knockdown of Env in MDA- sophageal and rectal surgery are carried out in high-volume centres. MB-231 cells showed decreased migration and invasiveness. However, it is unclear as to whether or not colon cancer patients would Conclusion: HERV-K expression induction after treatments correlate with receive the same benefit. Lymph node adequacy is a key performance clinical manifestations of BrCa as NOS2 tumour epithelial levels correlate indicator of successful oncological colonic resection. with poor outcome in ER negative and TNBC subtypes. However, Aim: To assess the adequacy of lymph node clearance during colonic HERV-K levels are decreased in ER positive T47D cells alluding to a resection in a non-specialist centre post introduction of the National protective role of NO in this subtype. This could be due to differences in Cancer Strategy. NO signalling between ER positive and negative tumours and tumour Methods: Retrospective analysis was performed of a prospectively main- microenvironment of the subtypes. Reduced invasiveness and migration tained database examining the lymph node clearance of all oncological of TNBC cells upon knockdown of Env suggests an essential role of resections for colon cancer over a seven-year period (Nov 2010-Dec HERV-K in invasiveness. Our findings indicate that HERV-K may be 2017) at a satellite unit with links to a regional specialist centre. useful as an associated marker in BrCa prognosis. Primary outcome measured was number of lymph nodes retrieved. Secondary outcomes included resection margins, 30-day complication 36. The Evolution of the Axillary Management of Breast Cancer in a rate and survival at one year. Regional Cancer Centre – Impact of ACOSOG Z0011 Trial Results: 167 patients were included. Mean age was 71.0 ±11.6. A major- ity were male (n=90, 53.6%). The majority of resections were right sided EO’Beirn, N O’Halloran, P McAnena, I Balasubramanian, A Lowery, R (n=112,66.7%) with 78.6% of all resections being undertaken electively. McLaughlin, K Sweeney, C Malone, MJ Kerin All margins were free of tumor. The average lymph node count was 19.93 ±8.63(4,62) with only 17(10.2%) of specimens containing 12 nodes. The Department of Surgery, Galway University Hospital, Galway, Ireland anastomotic leak rate was 3.3%. There was no association between sur- geon or pathologist volume, nor emergent status and meeting lymph node Background: The Z0011 trial concluded that Axillary Lymph Node count (p=0.14,0.29,0.97). Dissection (ALND) could be safely omitted in selected breast cancer Conclusion: This study demonstrates that colonic cancer surgery can be patients with a positive sentinel lymph node biopsy (SLNB) These results safely performed in a non- specialist centre with technical outcomes com- have led to a change in the surgical management of the axilla in breast parable to those of high volume centres. cancer. The aim of this study is to determine the impact of Z0011 on axillary management of breast cancer at our centre. 38. Colonoscopy Quality Assurance in Private Hospitals: Is Methods: Data was collected on all consecutive breast cancer patients Participating in Quality Improvement Programs Beneficial? who underwent breast cancer surgery including an axillary procedure from 2004 to 2017. 2864 consecutive patients were included. Patients M Aradaib, Endoscopy Unit Group, MR Kalbassi were divided into pre Z0011 (surgery before 2012, n=1886 ) and post Z0011 (surgery after 2012, n=978 ). Surgical practice was compared Department of General and Colorectal Surgery, Beacon Hospital, between these groups with respect to axillary surgery. Beacon Court, Sandyford, Ireland Results: Overall, primary SLND was performed more frequently post- Z0011, pre-Z0011 (n= 1342) vs. post-Z0011 (n=781) ( 71.1% vs 79.9%, Introduction: Colonoscopy is a widely used procedure in diagnosis and p <0.001). Primary ALND was performed more frequently pre-Z0011, treatment of gastrointestinal disorders, and it plays a fundamental role in pre-Z0011 (n=544) vs. post-Z0011 (n=197) (28.9% vs. 20.1%, p <0.001). colorectal cancer management and screening. The interest in quality as- Overall reduction in rate of SLND proceeding to ALND, pre-Z0011 surance in colonoscopy has increased over the last few years, and several (n=338) vs. post-Z0011 (n=92) (25.2% vs. 11.8%, p<0.001). Analysing quality improvement programs were developed to steer this development. patients with <3 positive SLNs, there is a reductions in rate of SLND Aim: To report the colonoscopy quality indicators in our institute and to proceeding to ALND post-Z0011 (n=75) vs. pre-Z0011 (n=299) (10.2% compare our outcomes to the national Irish (CONJOINT) and the inter- vs 24.2%, p <0.001). In this same cohort, there is no significant difference national (JAG) guidelines before and after enrolling into these two quality in mean ages (54.2 vs 52.5, p <0.199), grade or subtype. T1 and T2 were improvement programs. less likely to proceed to ALND post Z0011 (p<0.05) and T3 and T4 are Methods: Analysis of prospectively maintained database of all colonos- more likely to proceed to ALND post Z0011 (p<0.05). copies performed in our institute between April 2016 and April 2018. Conclusion: The recommendations from Z0011 have been adopted into Results: A total of 4966 patients had colonoscopy in our unit between clinical practice, with significantly fewer node positive patients undergo- April 2016 and April 2018 performed by six surgeons and four gastroen- ing ALND. terologists. 49.1% were males, and 50.9% were females. Median age was 57 years (range 15 – 93). The number of scopes performed by each SESSION 5: GENERAL endoscopist, caecal intubation rate, comfort level, polyp detection and retrieval rates and the number of adverse events were in line with the 37. The Adequacy of Lymph Node Harvest in Colon Cancer Surgery recommendations in both audits. Conversely, sedation dose, rectal retro- Performed in a Non-Specialist Centre; Is There A Future? version rate, and adequate bowel preparation rate did not meet the stan- dard in the first audit. However, they improved significantly and met the PP Higgins1,WKhan1,IKhan1,RWaldron1, T Nemeth2, F Bennani2,K guidelines in the subsequent audit. Barry1 Conclusion: Our results showed that participation in the national and inter- national quality improvement programs improve quality of colonoscopy (1) Department of Surgery, Mayo University Hospital, Saolta Health service. Weencourage all endoscopy units to participate in these programs. Care Group; (2) Department of Pathology, Mayo University Hospital. Saolta Health 39. An Evaluation of the Impact of a Dedicated Emergency Surgical Care Group Service on the Management And Outcomes of Acute Appendicitis
Background: Despite recent medical advances, surgery remains the main- R McGrath, H Mustafa, Y Khodear, K Alromhein, Y Kayyal, M stay treatment in colon cancer. It is well established that better patient Corrigan, E Andrews, P Redmond, A Zaheer Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S149
Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland 2017 were retrospectively reviewed.Where patients were identified as having mural thickening of the oesophagus, stomach or colon, results of Introduction: In April 2017, a dedicated, consultant led Emergency subsequent endoscopic evaluations were documented. Only patients with Surgery Service (ESS) was initiated in a level one trauma centre, reports of mural thickening who had follow-up endoscopy Ireland. We measured its effect on the most common general surgical (oesophagoduodenoscopy, colonoscopy, sigmoidoscopy) were included emergencies requiring operative intervention. in the study, (n=307). Data was analysed using SPSSv24. Aims: To compare patient length-of-stay, negative appendicectomy rate, Results: We divided the cohort into three groups, those with positive open appendicectomy rate, incidence of complicated/perforated appendi- findings at endoscopy corresponding to the exact site of the mural thick- citis and frequency of imaging modalities used in patients presenting with ening, those with normal endoscopies despite CT identified acute appendicitis before and after introduction of an Emergency Surgery anomalies,and finally, those with incidental findings. As expected, pa- Service(ESS). tients who were symptomatic were significantly more likely to have en- Methods: Clinical, pathological and radiological data were retrospective- doscopic findings correlating with CT. We did however, observe a signif- ly collected on all appendicectomies performed from May 2016-2018. icant disparity between radiological and endoscopic findings in the sec- Cases performed before the start of ESS (May 2016-2017) were desig- ond group, with low rates of pathology identified. nated ‘Pre-ESS’ group (n=390) and cases after the introduction of ESS Conclusion: This study identifies the need for robust criteria when con- (May 2017-2018) were designated ‘Post-ESS’ group (n=317). templating endoscopic evaluation to investigate patients with CT evi- Results: dence of mural thickening, especially in those patients who are asymp- tomatic. This can only serve to guide clinicians and reduce potential complications associated with endoscopy. Pre-ESS(n=129) Post-ESS(n=177) p-value Average 3.9 3.8 0.4 41. The Effect of BMI on Colonoscopy Failure Rate length-of-stay(days) 1 1 2 2 ’ 1 Negative 79/390(20.3%) 45/317(14.2%) 0.035 A Ni Mhathuna , L Devane ,VVeitch, D McNamara ,JORiordan appendicectomies Negative paediatric 39/143(27.3%) 23/120(19.2%) 0.12 (1) Department of Surgery, Tallaght University Hospital, Tallaght, Dublin appendicectomies 24, Ireland; Ultrasound performed 175/390(44.9%) 143/317(45.1%) 0.95 (2) Department of Gastroenterology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland CT performed 112/390(28.7%) 130/317(41%) 0.001 MRI performed 1/390(0.3%) 32/317(10.1%) <0.001 Introduction: Caecal intubation is a measure of quality colonoscopy, with Complicated/Perforated 61/390(15.6%) 49/317(15.5%) 0.95 international standards recommending >90% completion rate. Identifying Appendicitis patients with higher risk of colonoscopy failure, where alternatives to Post-op complications 30/390(7.7%) 16/317(5%) 0.16 colonoscopy are increasingly available, may result in more efficient allo- cation of colonoscopy services. Open 57/390(14.7%) 8/317(2.5%) <0.001 Aim: This study aims to determine the effect of BMI on colonoscopy failure rates. There was a significant reduction in average length-of-stay. Additionally, Methods: Consecutive patients undergoing elective colonoscopy were pro- there was a reduction in the rate of negative appendicectomies of 6.1%. spectively included over one month. Colonoscopy failure was defined as This was associated with an increase in the utilisation of imaging since the failure of caecal intubation (CI). Anthropometric measurements, caecal intu- introduction of ESS. bation time (CIT) or failure, sedation, bowel preparation, therapeutic proce- Conclusions: A dedicated, consultant led ESS significantly reduces the dures, patient comfort, complications and endoscopist experience were re- rate of negative appendicectomies and decreases the rate of open opera- corded. Data were analysed using Fisher’s exact test and Student’st-test. tions. Early clinical assessment by experienced surgeons, along with the Results: A total of 294 patients were included (M=132, F=162) with an appropriate utilisation of imaging modalities improves patient outcomes, overall completion rate of 93.9%. Patients with BMI<18.5 had a signif- avoids unnecessary surgery and optimises use of hospital resources. icantly higher failure rate (28.6%, p=0.02) than those with BMI≥18.5<30 (4.46%) or obese patients (BMI>=30, 8.2%). There was a trend towards a 40. Mural Thickening on Conventional Computed Tomography higher failure rate in females vs males (8.6% vs 3%, p=0.052). CIT was Versus Endoscopic Findings. Is There An Accurate Correlation? shorter in patients with BMI <18.5 (420s, p=0.03) compared to other BMI groups (BMI≥18.5<30, 696s; BMI≥30, 721s). CIT was prolonged in NE Donlon, M Zafar, R Headon, K St. John, W Khan, I Khan, R Waldron, patients >55years (725s, p<0.01), females (753s, p<0.01), and for inex- KBarry perienced endoscopists (756s, p<0.01). No other factors affected CIT or failure rates. Department of Surgery, Mayo University Hospital, Saolta Health Care Conclusion: This study shows a significantly higher colonoscopy failure Group, Castlebar, Mayo, Ireland rate in underweight females of 28.6% which exceeds national guidelines, alternatives to colonoscopy should be considered in this group in order to Introduction: The identification of mural thickening on Computed reduce patient discomfort and the burden on colonoscopy lists from re- Tomography (CT) inevitably results in the undertaking of endoscopy petitive failed scopes. for further evaluation. It poses a difficult diagnostic dilemma especially in the absence of clear guidelines 42. Impact of an Acute Surgical Unit in Appendicitis: A Systematic Aim: The aim of the current study was to retrospectively analyse conven- Review and Meta-Analysis tional CT reports, identifying those patients in whom gastrointestinal wall mural thickening was observed, and correlate these reports with subse- I Balasubramanian, B Creavin, D Winter quent endoscopic evaluation. Method: Formal reports for patients undergoing thoracoabdominopelvic Department of Surgery, St. Vincent’s University Hospital, Elm Park, CT or isolated abdominopelvic CT between January 2017 and December Dublin 4, Ireland S150 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Background: The provision of emergency general surgical services is 44. Multi-Visceral Resection with Preoperative Radiotherapy Does undergoing a paradigm shift towards a consultant led, patient centered Not Increase Perioperative Complications in a Series of model in order to improve patient outcomes. The aim of this current study Retroperitoneal Sarcomas is to use meta-analytical techniques to assess the efficacy of acute surgical unit (ASU) in appendectomy. LYL Tan1,CClancy2, U Hayden2, C Gillham3,AGillis2, P Ridgway2 Methods: A meta-analysis was conducted according to the PRISMA guidelines. A comprehensive literature search of PubMed, Embase (1) School of Medicine, Trinity College Dublin, College Green, Dublin 2, and Scopus for published studies comparing ASU and traditional Ireland; (TRAD) model on appendectomy outcomes was performed. (2) Department of Surgery, Tallaght Hospital, Tallaght, Dublin 24, Random-effects methods were used to analyze key outcomes with Ireland; data presented as odds ratio (OR) with 95% confidence interval (CI). (3) Department of Sarcoma, Irish Sarcoma Group, Ireland Results: Fourteen comparative studies describing outcomes in 7,980 pa- tients were identified, 4,258 patients were included in the ASU model Introduction: Retroperitoneal Sarcomata (RPS) are rare lesions but when (53.4%). ASU model had a shorter time to theatre (WMD: -0.40, 95% CI: they occur, adequate surgery has demonstrated direct correlation between -0.65 to 0.15, p: 0.002), length of hospital stay (WMD: -0.25, 95% CI: - disease specific survival and local control. Usually, extended 0.46 to -0.05, p: 0.02)and complication rate (OR: 0.76, 95% CI: 0.59 to multivisceral resections are required for R0 resections. Despite the nec- 0.99, p: 0.04) for appendectomy patients. ASU model did not significant- essary acceptance of narrow margins at key non-resectable structures, the ly affect night time operating (OR: 1.04, 95% CI: 0.66 to 1.65, p: 0.86) role for preoperative radiotherapy remains controversial. negative appendectomy rates (OR: 0.98, 95% CI: 0.77-1.27, p: 0.91) or Aim: This observational study describes a series of multivisceral resection conversion rate (OR: 1.45, 95% CI: 0.70 to 2.98, p: 0.32). for RPS in a unit where preoperative radiotherapy is frequently employed. Conclusion: ASU model improves outcomes and quality ofcare in patients Methods: Referred patients are discussed at the hub and spoke ISG MDT undergoing emergency appendectomy without any adverse implications. at SVUH since 2013. A prospective database for all sarcomas managed in our institution discussed at the sarcoma MDT is maintained. All patients 43. Is Computerised Tomography of the Head Always Appropriate? undergoing multivisceral resection for RPS from 2015-2017 inclusive were extracted. Electronic records were searched to confirm database CBrady1,RO’Keeffe1, O Shinners1,DHehir2, S Johnston2 information. Results: From 2015-2017, 120 sarcoma cases from Tallaght (1) Department of GEMS, University of Limerick, Limerick, Ireland; University Hospital were discussed at the MDT. Twenty-one were (2) Department of Surgery, HSE MRH Tullamore, Arden Rd, Tullamore, retroperitoneal and pelvic sarcomas. Of those that required Ireland multivisceral resections, 8 were well differentiated liposarcomas, the remaining were pleomorphic sarcomas or myxoid liposarcomas. Introduction: CT of the head is a common imaging modality in the man- Neoadjuvant radiation was given in 83% of patients. The most fre- agement of patients with possible intracranial pathology and has signifi- quent viscera resected were kidney/ureter (58%), colon (58%), fem- cant radiation and cost implication. oral nerve/psoas/quadratus/iliacus/diaphragm (50%), spleen/pancre- Aim: (1) To evaluate the appropriate use of CT imaging of the head in as/adrenal (35%) and major vasculature/stomach/ovary (15%). 75% patients attending the Emergency Department (ED). were true R0 resections, 0% were R2. Significant post-operative (2) To identify the relevant significant indicators for predicting clinically morbidity (Clavien-Dindo >/=3) occurred in 15% patients. 1 patient significant outcomes in head CT imaging in non-traumatic patients. required re-operation. There were no 30-day mortalities. Methods: Radiology records of patients undergoing head CT at the ED Conclusions: Despite a high rate of neoadjuvant radiotherapy, operative between November 2016 and October 2017 were interrogated using the outcomes are comparable with those from international centres. Radiological Information System in patients over the age of 18. Patients Oncological outcomes are being prospectively studied. with pre-diagnosed intracranial pathology were excluded. Multivariate logistical regression was used to identify the total number of scans that 45. Identifying And Reducing Risks In Functional Endoscopic Sinus had clinically significant outcomes and to identify predictors of clinically Surgery (FESS) Through A Hierarchical Task Analysis (HTA) important abnormal CT findings in the non-traumatic patient cohort. Results: 1358 scans met the inclusion criteria. 433 (31.9%) indicated for MCorbett1, P O'Connor2, D Byrne3,MThornton1,IJKeogh1) trauma and 925 (68.1%) for non-traumatic indicators. See Fig. 1. Common indictors utilised on order request forms for non-traumatic head (1) Department of Otorhinolaryngology, University Hospital Galway, CTs were; focal neurological deficit (36.5%), headache (32.5%), collapse Galway, Ireland; (17.9%), dizziness/syncope (15.6%), visual disturbance (14.7%), GCS (2) Department of Psychology, University Hospital Galway, Galway, <15 (12.3%) and seizure (10.8%). Ireland; Conclusions: Our findings suggest the potential over usage of CT in (3) Department of Applied Patient Safety and Simulation, University patients with possible intracranial pathology. Further prospective evalua- Hospital Galway, Galway, Ireland tion may support he use of detailed appropriate clinical examination as an alternative. Introduction: Functional Endoscopic Sinus Surgery (FESS) is a common procedure performed in all major ENT centres. Understanding the mech- anisms behind human errors in FESS has potential to reduce the adverse Traumatic Non Traumatic Overall Total events and improve the risks. 433 (31.9%) 925 (68.1%) 1,358 (100%) Aims: To develop a Hierarchical Task Analysis (HTA) of steps required to Normal 389 (89.9%) 853 (92.2%) perform Functional Endoscopic Sinus Surgery (FESS). To complete an analysis of tasks resulting in the identification of errors, frequency, sever- Abnormal 44 (10.1%) 72 (7.8%) ity, and reduction through remediation. Methods: A triangulation of methods was used in order to derive the steps required to complete a FESS: (1) a literature review was conducted of Figure 1. % of scans which yielded clinically significant outcomes. published descriptions of FESS techniques; (2) observations of three Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S151
FESS; (3) interviews with 5 surgeons on FESS techniques. Data sets were Introduction: Acute cellular rejection (ACR) occurring within six months combined to develop a task analysis of a correct approach to conducting after liver transplantation is associated with an increased risk of graft FESS. A review by 12 surgeons, and observation of 20 FESS resulted in failure, morbidity and death. refinement of the task analysis. With input from 5 consultant surgeons Aim: To determine the adequacy of early post-operative immuno- and 2 consultant anaesthetists, a Systematic Human Error Reduction and suppression in the Irish liver transplant population and the associ- Prediction Approach (SHERPA) was used to identify the risks and miti- ated ACR rates. gating steps in FESS. Methods: All liver transplants performed in St. Vincent’sUniversity Results: 10 tasks and 48 subtasks required to complete a FESS were Hospital between January 2016 and February 2017 were included detailed. A measure of risk for each step was calculated, and risk reduc- (n=54). Patients who died or required a second transplant during the tion methods at each step identified. same admission were excluded. Statistical analysis was carried out Conclusions: HTA and SHERPA are valuable tools to deconstruct perfor- to identify correlations between post-operative immunosuppressive mance and to highlight errors in FESS. The HTA and SHERPA ap- therapy and ACR rates. proaches are useful learning and assessment tools for novice surgeons. Results: The rate of ACR at six months was 25.9%. There was no The information offers the opportunity to improve surgical training and difference in ACR rates between patients commenced on enhance patient safety. Tacrolimus compared to Basiliximab, however, only 26.3% of those commenced on Basiliximab were started as per protocol. It took SESSION 6: UPPER GI more than 14 days to reach therapeutic levels in 17% of patients, however, increased time to therapeutic level did not increase the 46. Clinical Impact of Delaying Access to Bariatric Surgery in risk of ACR. Those with impaired renal function peri-operatively Ireland (83%) did not have an increased risk of ACR and did not take more time to reach therapeutic Tacrolimus levels. AIqbal1,SBerenjian1,ATomas,IJMeurling3,DO’Shea2,3,JGeoghegan1, Conclusion: Rates of ACR in the Irish liver transplant population are HHeneghan1,2 concordant with those documented in contemporary international studies. However, there remains a need to improve compliance with (1) Department of Surgery, St. Vincent’s University Hospital, Dublin, immunosuppression prescribing, timing protocol, documentation of Ireland; peri-operative renal function and rational for immunosuppression (2) Department of Endocrinology & Diabetes Mellitus St Vincent’s dosage adjustments. A re-audit will be carried out in six months University Hospital, Weight Management Unit, St Columcille’s after the implementation of a new protocol with the intention of Hospital, Ireland reducing rates of ACR.
Introduction: Bariatric surgery has been available as part of the Irish 48. Negative Intraluminal Pressure Therapy (Nipt) For Complex public health system for patients BMI>40 kg/m2 (or>35 kg/m2 with Esophageal Perforations or Anastomotic Leaks co-morbidities) since 2002. However, access to surgery is challenging, with eligible patients waiting up to 5 years for surgery. M Flood, P Boland, M Arumugasamy, TN Walsh Aim: To determine the clinical impact of delaying access to bariatric surgery. Methods: Patients who have been on a public waiting list for bariatric Department of Upper Gastrointestinal Surgery, Beaumont and Connolly surgery in Ireland were recently re-evaluated with regards to change in Hospitals, Dublin, Ireland weight and clinical status. Thorough clinical assessments were performed by a multidisciplinary bariatric team. Introduction: Esophago-gastric or esophago-jejunal anastomosis de- Results: Over a 9-month period, 89 patients were re-evaluated prior to hiscence and esophageal perforation are life threatening conditions undergoing bariatric surgery, having been on a waiting list for an average due to the risk of breakdown following repair and the sequelae of (±SD) of 3.6±1.6 years. Patients were first referred to the national Weight sepsis. Of many approaches described, negative intraluminal pres- Management Clinic 6.5±2.5 years prior to surgery. In the time between sure therapy (Berrisford et al, EurJ Cardio-Thoracic Surg initial and recent surgical evaluations, weight remained stable (mean 33;2008;742-744) is favoured in this unit. 159.7±36.2kg to 156.4±37.5kg, p=0.605). However, 55% of patients de- Aims: To reviewed our experience of NIPT as a management op- veloped significant new weight-related comorbidity(ies) over the wait- tion for complex oesophageal and anastomotic leaks we identified period, including cardiovascular and cerebrovascular events, diabetes, success rate and duration of hospital stay. diabetes complications, hypertension, sleep apnoea and malignancy. Methods: NIPT is a minimally invasive method performed as open or There were also three mortalities in this period. The OSMRS increased endoscopic placement of an intra-luminal drainage tube with side- significantly by the time patients proceeded to surgery [median OSMRS holes, placed across the defect and brought through the stomach/ increased from 2 to 3, p=0.012). jejunum and through the abdominal wall, like a PEG tube. A nega- Conclusion: Delaying bariatric operations causes significant deterioration tive pressure of 10cm H20 is applied and continuous oral sterile in patients’ health status and increases patient risk for surgery. This could water ingestion maintains tube patency. Nutrition is provided paren- increase postoperative morbidity and decrease the clinical and cost- terally or jejunally. effectiveness of surgery. Public health systems should pursue strategies Results: Eleven patients were treated with NIPT over 7 years of which 4 to accelerate access to surgery to decrease obesity-related complications had anastomotic leaks, 4 had iatrogenic perforations (2 failed stenting and and mortality. 1 delayed diagnosis) and 3 had Boerhaave’s syndrome; eight were male. Age ranged from 19-71 years. Median duration of drain application was 47. Efficacy of Current Early Immunosuppression Practices in the 19 days. For 5 of 11 patients, NIPT was combined with formal operative Irish Liver Transplant Population intervention. Complete restoration of the GI tract continuity was achieved in all patients. No significant morbidity and no mortalities were recorded. H Hughes, J Ryan, EL Rogers, T Gallagher Conclusions: NIPT is a minimally invasive treatment option for complex oesophageal/anastomotic leaks. We advocate its use, alone or alongside Department of Hepatopancreaticobiliary and Liver Transplant Surgery, surgical intervention, in complex anastomotic leaks or perforations. St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Insertion under sedation reduces the risks of general anaesthesia. S152 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
49. Options in Bariatric Surgery: Modelled Decision Analysis intraoperative bronchospasm. No anastomotic or staple line leaks/bleeds Supports Roux-En-Y Gastric Bypass and Sleeve Gastrectomy as were encountered. Mean±SD LOS was 2.1 ± 1.9 days (median 2days). the Treatments of Choice Thirty-day hospital re-admission occurred in 2(3.2%) patients and reop- eration in 2(3.2%) patients. Total body weight lost at 3-months and 6- S Keogh, J Bloger, S Brady, A Rogers, M Arumugasamy, W Robb months postoperatively was 16±7% and 24±8%. Conclusion: Applying an ERABS protocol was feasible, safe, associated Department of Upper GI Surgery, Beaumont Hospital, Beaumont, Dublin with low morbidity, acceptable LOS and low 30-day re-admission and 9, Ireland reoperation rates. The presence of multiple medical co-morbidities should not preclude use of an ERABS protocol. Introduction: Obesity is a chronic disease associated with significant morbidity and mortality. Bariatric surgery has been shown to signif- 51. The 5 F’s Of Gallbaldder Disease. Is This Still A Valid Concept? icantly reduce both morbidity and mortality. Numerous surgical strategies exist, but the most frequently used world-wide are adjust- NE Donlon1,KSt.John1,CDavis1,QLuqman1,WKhan1,IKhan1,R able gastric banding, sleeve gastrectomy and Roux-en-Y bypass. It Waldron1, T Nemeth 2,FBennani2, K Barry1 is not clear which of these strategies provides the optimal quality-of- life pay-off. (1) Department of Surgery, Mayo University Hospital, Saolta Health Aim: Modelled decision analysis allows comparison of different treat- Care Group, Castlebar, Mayo, Ireland; ment interventions allowing for plausible differences in input variables. (2) Department of Pathology, Mayo University Hospital, Saolta Health This facilitates establishment of the optimal intervention under numerous Care Group, Castlebar, Mayo, Ireland conditions. Methods: Modelled decision analysis was performed from the patient’s Introduction: Gallstones, particularly cholesterol gallstones, are common perspective comparing best medical therapy, adjustable gastric banding, in Western populations resulting in symptoms such as biliary colic or sleeve gastrectomy and Roux-en-Y bypass. Input variables were calcu- engender complications including acute cholecystitis and gallstone pan- lated based on previously published decision analyses and a systematic creatitis. Although gallstones are common, the literature attests that only a search of obesity-related literature. Utilities were based on previously minority of patients with gallstones develop symptoms or complications. published studies. One-way sensitivity analysis was performed. Aims: We endeavoured to ascertain if the long established medical school Sensitive variables underwent three-way analysis. teaching of “female, fertile, forty, fat, fair” regarding gallbladder disease Results: The optimal treatment strategy in the base case was Roux-en-Y still applies in the current era. gastric bypass with a quality adjusted life year payoff of 1.53 QALYs at 2 Methods: A database was prospectively compiled from January 2012 years post-procedure. Sleeve gastrectomy provided 1.49 QALYs. until December 2017. All patients undergoing elective cholecystectomy, Medical therapy and adjustable gastric banding provided 0.98 and 0.96 regardless of indication were included. QALYs respectively. Rate of complications in Roux-en-Y bypass and the Results: A total of 1154 patients underwent cholecystectomy during the utility of sleeve gastrectomy and Roux-en-Y bypass proved sensitive. If study period. 854 (74%) patients were female, with a mean age of 51 complication rates are high, sleeve gastrectomy becomes the optimal years in the female cohort and a mean age of 57 years in the male group. strategy. Sensitive thresholds were established for the utility of sleeve Indications for surgery included; biliary colic, previous episodes of cho- gastrectomy and Roux-en-Y bypass. lecystitis and gallbladder polyps (n=5), an entity which is the subject of Conclusion: Sleeve gastrectomy and Roux-en-Yoffer similar outcomes in debate regarding continued surveillance versus early intervention. Three terms of QALY payoffs. Decision making should be in line with institu- patients had histology demonstrating gallbladder carcinoma, and one fur- tional and patient preference. ther patient had evidence of dysplasia. Body Mass Index (BMI) varied significantly across the study group with a range of 18-48. 50. Enhanced Recovery after Bariatric Surgery: Clinical Outcomes Conclusions: While gallbladder disease is still predominantly a disease in a Tertiary Referral Bariatric Centre affecting females, the incidence of symptomatic gallbladder disease is increasing in males. Rising obesity rates in western society represent an A Tamas, S Berenjian, A Iqbal, IJ Meurling, D O’Shea, J Geoghegan, H increasing challenge for the surgeon necessitating weight loss strategies Heneghan and potentially in some cases, bariatric surgery input prior to elective cholecystectomy. Department of Upper GI, St. Vincent’s University Hospital, Dublin, Ireland 52. Upper Gastrointestinal Mucosal Morphology and the Enteroendocrine Response after Oesophagectomy Introduction: There is paucity of data on Enhanced Recovery After Bariatric Surgery (ERABS) protocols. This study reports outcomes of this C Murphy1, J Elliott1, N Docherty1, N Ravi2, J Reynolds2,CleRoux1 protocol utilized within a tertiary-referral bariatric centre. Method: Data on consecutive primary procedures performed over 9 (1) Department of Conway Institute, UCD, Belfield, Dublin, Ireland; months within an ERABS protocol were prospectively recorded. (2)DepartmentofSurgery,StJames’s Hospital, Dublin 8, Ireland Interventions utilized included shortened preoperative fasts, specific an- esthetic protocols, early postop mobilization and feeding, avoidance of Introduction: Unintentional weight loss and malnutrition are prevalent fluid overload, incentive spirometry and use of laxatives. after oesophagectomy, developing in the context of enhanced Results: A total of 62 primary procedures were performed over a 9-month enteroendocrine (EE) signalling, altered appetite and early satiation. period (42% gastric bypass, 58% sleeve gastrectomy). Mean±SD age was Aim: To characterise enteroendocrine cell, and GLP-1-secreting L-cell, 47±7 years, preoperative BMI 52.1±9.5 kg/m2 and 77% were female. density after oesophagectomy. Median ASA score was 3, and median OSMRS (obesity surgery mortal- Methods: In a cross-sectional design, disease-free patients after ity risk score) also 3. Type 2 diabetes mellitus, hypertension, oesophagectomy, and unoperated control subjects were recruited. dyslipidaemia, and sleep apnea were present in 37%, 60%, 37% and At endoscopy, duodenal biopsies were collected, along with 51%, respectively. There was no mortality. Postoperative morbidity rate EORTC and Sigstad questionnaires, and body composition. was 4.9% (n=3). Morbidity included early small bowel obstruction, Immunohistochemistry, staining for chromogranin-A (CgA) and bleeding from a liver retraction injury, and an ICU admission for glucagon-like peptide-1 (GLP-1), markers of the EE cell and L- Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S153 cell populations, respectively, was performed. The mucosal cell applicability to the subject area, initially based upon title and abstract, and density and GLP-1:CgA ratio were calculated. subsequently by reading the entire articles of those considered potentially Results: 15 patients, a median of 20.8 (0.89-6.25) months postoperatively, relevant. and 11 age, sex, and weight-matched controls were studied. Neither total Results: A total of thirteen studies were included in the review. These EE cell density (Median(range): 30(4-148) vs. 44(9-82), P = 0.48), nor L- demonstrated: cell density (Median(range): 11(1-83) vs. 14(5-28), P=0.62), differed sig- 1. A distinct lack of exposure to OMFS in undergraduate Medicine. nificantly between oesophagectomy and control participants, respectively. 2. Dental professionals have a greater understanding of the scope of the EE cell density was not associated with % body weight loss after specialty when compared to Medical Professionals. oesophagectomy(P=0.34). While L-cell proportion, based on GLP-1:CgA 3. There are enigmatic boundaries separating the surgical specialties of ratio, was similar between groups (Median(range): 0.37 (0.25-0.70) vs. 0.38 OMFS, ENT and Plastic surgery. (0.28-0.56), P=0.95), there was a correlation between GLP-1:CgA ratio, Conclusions and altered appetite after oesophagectomy (P=0.008, r2 = 0.46). With even a small degree of exposure to OMFS at undergraduate level Conclusions: Enteroendocrine cell density did not differ between cohorts, having been shown to increase awareness of, and interest in the specialty, nor did it relate to weight loss after oesophagectomy. Altered appetite was the onus is on faculty members and Universities alike to promote OMFS associated with relative L-cell proportion, however. Duodenal to those in Medical school and beyond. enteroendocrine cell hyperplasia does not appear to explain the enhanced gut signal after oesophagectomy. Other factors such as enteroendocrine 55. Quality Improvement Project: Improving the Quality of OMFS cell activity or gastrointestinal transit time, may be more important ex- Clerk Ins planatory mechanisms. M McKeown, A Cooper, J Grudgings, A Sewell, J Stenhouse, B SESSION 7: ORAL AND MAXILLO FACIAL SURGERY Swinson, A Ketabchi, JG Smith
53. Mandibular Angle Fractures Containing A Wisdom Tooth; Department of Oral and Maxillofacial, Altnagelvin Area Hospital, Should The Wisdom Tooth Be Removed? Northern Ireland
P Sexton, T Barry, PJ Mc Cann Introduction: A detailed clerk-in helps to safeguard patients during their hospital admission. An efficient admissions process ensures patients are Department of Oral and Maxillofacial Surgery, Galway University ready for theatre promptly and avoids costly time delay. This Quality Hospital, Galway, Ireland Improvement (QI) project aims to improve the standard of clerk in by OMFS Dental Core Trainees (DCT). RCS England use a Crabel score as a Introduction: Fracture of the mandible is a common Maxillofacial injury quality assessment tool related to medical record keeping.1The aim of this with the angle being the most commonly affected. The treatment of an QI project is for 90% of clerk ins to achieve 10/10 on a locally modified angle fracture is often complicated by the mandibular third molar in the Crabel score by May 2018. line of fracture. Divergent opinions exist regarding the extraction or pres- Methods: Using a model for improvement method, PDSA cycleswere ervation of such teeth. The management of these teeth has produced much undertaken.2Each cycle analysed 10 patient charts. study and controversy Cycle 1 intervention - staff training alone Aims: To retrospectively analyse post-operative wisdom tooth extraction Cycle 2 intervention - implementation of OMFS clerk in pro-forma rates in patients with a fracture through the angle of the mandible who Cycle 3 intervention - modification of pro-forma underwent plate fixation and retention of the wisdom tooth. Cycle 4 intervention- prompt reminder Methods: Using the hospital radiology system, patient operative and dis- Cycle 5 intervention - DCT feedback charge notes. We recorded all patients who presented with a fracture of Results: Cycle 0 - 70% baseline data from record keeping project (2015) the mandible. Cycle 1 - 60% (2016) Results: During this six-year period 439 mandible fractures occurred, 229 Cycle 2 - 71% (October 2017) were classified as fractures through the angle involving the wisdom tooth Cycle 3 - 74% (December 2017) socket. 147 (65%) of these fractures retained the third molars and 3 (2%) Cycle 4 - 86% (February 2018) of these patients returned within a 6-month period for removal of plates Cycle 5 - data collection ongoing (May 2018) and retained wisdom tooth Conclusion: Dental trainees involved in the surgical admission of a pa- Conclusion: Surgeons should evaluate each angle fracture on a case by tient benefit from a guided document to aid this process. Induction train- case basis. However, we ascertain that third molars should not be routine- ing alone was found to be inadequate. The implementation of an OMFS ly removed and should only be removed when they inhibit fracture re- clerk-in pro forma has improved the efficiency of day case admissions duction, pose a potential infection risk or disturb occlusal stability. and ensured all patients have an up to date thorough medical history. Using a PDSA cycle to assess this has allowed opportunity for change. 54. Oral and Maxillofacial Surgery, The Surgical Conundrum - A Literature Review 56. Retrospective Audit, Comparing Retainer A to Retainer B be- tween January 2016-January 2017 PKielty,BO’Connor, C Cotter A Murray, BJ Rainey, C Campbell Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland Department of Oral and Maxillofacial, Altnagelvin Area Hospital Derry, Introduction: This paper aims to review the current literature pertaining to the Northern Ireland understanding of, and exposure to OMFS. We evaluated research concerning knowledgeofOMFS,concerning thescopeofthespecialtyandwhento refer, Introduction: Orthodontic retention is paramount in the majority of ortho- as well as perceived career pathway and length of training. dontic cases.Most recent research would suggest that retainers should be Methods: An electronic search of the literature was performed using the worn lifelong. It has been shown that if people stop wearing retainers after PubMed database and The Cochrane Library to identify articles relevant to one to two years there is a risk of long-term relapse of the teeth(Little the subject area. Studies were then assessed for inclusion eligibility and 1981;Little 1988). S154 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Aims: To compare the number of replacement A and B retainers from, Limited information is available in published literature on longitudinal January 2016-January 2017 and to assess the reasons for remakes. To Oral and Maxillofacial (OMF) injury trends. OMF injury at any age can establish, how often we are replacing retainers and why we are replacing carry with it a potential lifelong morbidity and financial burden to the the retainers;eg; breakage, lost, lack of compliance and other. To assess if patient. The Gaelic Athletic Association (GAA) have governed and pro- material B is fracturing more. moted Gaelic games nationally since 1884. In recent years the GAA have Methods: A Retrospective study from Jan 2016 to Jan 2017 involving 119 taken considerable measures to care for the welfare of players with the use patients. All patients in this period were included. Reason for replacement of compulsory safety equipment, rule changes and injury benefit insur- highlighted in the clinical notes, and log of the material used highlighted ance schemes. in the dental lab logbook.This was recorded on a data sheet.Standard Aim: To ascertain the incidence of OMF trauma in Gaelic games partic- used, Campbell et al.,(2011) reported replacement rate of 34% FT wear ipants at all levels from 2005 to 2016. and 15% with PT wear. Methods: The open-access Gaelic Athletic Association Annual Reports Results: When assessing against our standard overall 42% of retainers from 2005-2016 were reviewed to obtain annual injury-claim data. were remade. A 38% and B 46% Standard 15% not reached (Campbell et Results: A total of 7163 Oral and maxillofacial injuries (eye, head, face, al.,(2011) reported replacement rate of 34% FT wear and 15% with PT jaw, nose and teeth) were reported. Players participating in Gaelic football wear). Odds ratio 0.8333 95% Cl:0.4012 to 1.7310 were 2.6 times more likely to sustain an OMF injury versus hurling/ Conclusion: This study demonstrates that there is no difference be- camogie. (Fig.1.) tween retainer A and retainer B in terms of failings.The reason for Conclusions: Considering the GAA’s introduction of different rules re- remakes is attributed to other factors, such as patient selection and garding the regulation of fouls and safety equipment there is still a steady free replacement retainers, which are some the factors attributing to increase in OMF injuries being reported. Reports of safety equipment higher replacement rates. modification in the literature may be responsible for the increase in inju- ries. The reporting of OMF injuries in the literature to date has been 57. Analysis of the Time to Completion of Radiological Imaging from somewhat restricted, possibly due to limited interest in the area. Further Biopsy Date in an Oral and Maxillofacial Unit in the West of Ireland research into reasons for reduced reporting and safety equipment dissat- isfaction should be explored. P Sexton, M Nolan, T Barry, PJ McCann
Department of Oral and Maxillofacial, Galway University Hospital, OMF All levels of Comparison All levels of Galway, Ireland Injury football Ratio Hurling/Camogie Total 5159 2.6 1964 Introduction: On average, the number of new cases of head and neck (H&N) cancer diagnosed in Ireland each year is 608 (170 females, 438 male). Radiological Imaging in the form of CT and/or MRI plays an SESSION 8: TRAUMA AND ORTHOPAEDIC SURGERY integral role in diagnosis, staging and treatment planning. With increasing pressure on hospital resources a delay in investigation to treatment can 59. Future Demand For Elective Total Hip Replacements (THR) negatively impact on the H&N patient’s anxiety levels, cancer prognosis and quality of life A Mealy, J Sorensen Aims: To investigate if radiological imaging is readily available to H&N surgeons at UHG and imaging is performed within current recommended Department of Healthcare Outcome Res Centre, RCSI, Beaux Lane waiting times. House, Mercer Street Lower, Dublin 2, Ireland Methods: Retrospective review of patient’s biopsy dates, operative log- books, pathology reports and radiology data bases from 2013 to 2016. Introduction: The population in Ireland is aging, with the number of Results: A total of 68 patients with H&N malignancies were recorded. 53 people over 65 years expected to rise to 1 million by 2041. This is going were included in the study. The median biopsy result to scan time was to have consequences on the demand of THR. 26.6 days. The median waiting time for squamous cell carcinoma diag- Aim: To model the future demand of THR, taking into account the his- nosis was 16.7 days and for non-SCC diagnoses, 33.4 days. torical development in incidence and productivity and to assess different Conclusions: Overall, radiological imaging was readily available to H&N assumptions of the future performance. surgeons at this institution. A review of current practice needs to be Method: Population projections until 2046 were obtained from CSO. implemented as current radiology waiting times do not conform to current THR data were obtained from NQAIS. Incidence rates were estimated guidelines. for sex and 5 year age bands and used to calculate the future demand. Different scenarios of productivity were used to estimate future need of 58. Injury Scheme Claims in Gaelic Games. A Review of Oral and bed capacity, surgical capacity and financial cost. We specified scenarios Maxillofacial Injuries from 2005-2016 where the incidence rate was increased and the length of stay and cost reduced by 3-5% per year. We also estimated the required improvement P Sexton, C Mac Dhaibheid, T Barry, PJ Mc Cann in efficiency if the future demand should be delivered within the existing capacity. Department of Oral and Maxillofacial Surgery, Galway University Results: There has been an increase in the THR incidence rate since 2011. Hospital, Galway, Ireland The avgLOS has declined from 7.9 in 2011 to 5.7 in 2016. In the steady state scenario, the number of procedures are expected to rise from 3,500 Introduction: Hurling, Camogie, Gaelic football and handball collectively to 6,000 by year 2046 and this has similar affects on the number of bed known as Gaelic games continue to rise in popularity across the world. days used, surgical teams and cost. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S155
Conclusion: This analysis shows that the future population development Methods: Data of 178 patients were analyzed retrospectively. The prima- has dramatic consequence on the resources needed to provide THR. To ry outcome measure was development of complications. The main pre- sustain the future demand it is required to either improve efficiency or dictive variable was vascular status. A poor vascular status was defined as provide additional resources. an ankle brachial pulsatile index less than 0.8, a toe pressure less than 50 mmHg or significant stenosis on the arterial duplex of the leg. In only 60.The Use of Twitter by Trauma and Orthopaedic Surgery 2.2% of patients vascular status was known before operation. Univariate Journals: Twitter Activity, Impact Factor and Alternative Metrics analysis identified hypertension, wound compromising medication, DM, PAD and age as significant risk factors. Multivariate regression analysis H Hughes1,AHughes2,CMurphy2 identified age, DM and PAD as independent risk factors. Vascular status was not included in regression analysis because of the low numbers. (1) Department of Trauma and Orthopaedic Surgery, St Vincent’s Conclusion: In conclusion, too little is know about vascular status before University Hospital, Dublin, Ireland; ORIF of ankle fractures in elderly patients. This study suggests that a poor (2) Department of Trauma and Orthopaedic Surgery, University Hospital vascular status is a risk factor for complications after ORIF of ankle Galway, Ireland fractures in the elderly.
Introduction: Social media (SoMe) platforms have become leading 62. Anticoagulation on discharge from Midlands Regional Hospital methods of communication and dissemination of scientific information. Tullamore Aim: To analyse the prevalence and activity of Trauma and Orthopaedic (T&O) Surgery journals on Twitter, with the hypothesis that Impact E Roche, A Farrell, V Heffernan, S Clinton, C Larney, C Kehoe, E Factor is positively associated with Twitter use. Sheehan Methods: The top 50 T&O Surgery journals, ranked by 2016 Impact Department of Trauma and Orthopaedics, Midlands Regional Hospital Factor, were analysed. The Twitter profiles of each journal, or affiliated Tullamore, Offaly, Ireland society, were identified. Twitonomy software analysed the Twitter pro- files over a one-year period. Twitter Klout Scores and Altmetric Scores Aim: To audit current practice regarding anticoagulation on discharge for were recorded for each journal to approximate SoMe influence. Statistical all patients admitted to the Orthopaedic trauma ward in Midland Regional analysis was carried out to identify correlations between journal Impact Hospital Tullamore (MRHT) following lower limb trauma and subse- Factors, SoMe activity, Klout Scores and Altmetric Scores. quently develop an optimal anticoagulation regime for lower limb trauma Results: 22 journals (44%) had dedicated Twitter profiles. 14 journals discharges. (28%) had affiliated societies with profiles and 14 journals (28%) had Methods: A retrospective, single centre audit was performed evaluating no Twitter presence. The mean Impact Factor was 2.16 +/- 0.14 (range, discharge anticoagulation given to patients with lower limb trauma 1.07-5.16). Journals with dedicated Twitter profiles had higher Impact discharged from the Orthopaedic trauma ward in MRHT over a 1 month Factors than those without (mean 2.41 vs 1.61; P=0.005). A greater num- period. A retrospective risk assessment of these patients was performed ber of Twitter followers was associated with higher Impact Factors (R2 according to the Plymouth Hospital Group protocol. Discharge summa- 0.317, P=0.03). Journals with higher Twitter Klout Scores had higher ries and discharge prescriptions were reviewed to identify patients sent Impact Factors (R2 0.357, P=0.016). Altmetric Score was positively as- home on various anticoagulation regimes. The rates of complications post sociated with Impact Factor (R2 0.310, P=0.015). Journals with higher discharge were recorded. numbers of retweets (virtual citations in the Twittersphere) had higher Results: All patients discharged from the trauma ward over a 1-month Altmetric Scores (R2 0.463, P=0.015). period were assessed for inclusion in the study (n=85). Only those with Conclusion: Altmetrics are likely to play a significant role in literature lower limb injuries were included (n=38). Patient demographics: Male=15, evaluation going forward alongside traditional metrics. Engagement with Female=23, Age=70.5 +/-20.5. 58% patients were discharged on anti-co- Twitter by T&O surgeons should be encouraged. agulation (n=22) while 42% patients discharged without anticoagulation (n=16). Of those discharged, 37% were identified as high risk (n=14). 61. Vascular Status and Complications after ORIF of Ankle 88% of patients identified as high risk were sent home on anticoagulation Fractures (n=12) however the type, dose and frequency of anticoagulation varied considerably. 5% of those included in the study developed a CT proven H Lutfi, R Nanda, S Van Helden, J Oskam, R Brohet PE (n=2). There was one mortality from an occlusive CVA. Conclusion: Prior to introduction of a scoring system, 88% of high risk Department of Surgery, Isala, Dokter van Heesweg 2, Zwolle, Leliestraat patients were identified and discharged on anticoagulation but there was 354, Zwolle, Netherlands considerable variation in anticoagulation received. This has identified a need to develop a protocol such that all patients at increased risk of DVT/ Introduction: Ankle fracture is one the most common type of fracture in PE following lower limb trauma are identified and treated appropriately. the elderly, which in some cases has to be treated by open reduction and internal fixation (ORIF). The prevalence of complications following 63. Early Results of a Modified Induced Membrane Technique in the ORIF varies from 5-40%. Risk factors for complications after ORIF are Management of Traumatic Bone Loss in the Lower Limb: A Cohort age, smoking, male gender, peripheral arterial disease (PAD) and diabetes Study mellitus (DM) among others. Aim: The purpose of this study was to determine how often information D Giotikas, N Tarazi, L Spalding, M Nabergoj, M Krkovic about vascular status is known in elderly patients before they undergo ORIF of an ankle fracture. The subquestion is whether there is a relation between Department of Trauma and Orthopaedic Surgery, Cambridge University a poor vascular status and the occurrence of complications in these patients. Hospital, Cambridge, United Kingdom, United Kingdom S156 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Introduction: Data is limited on the management of acute traumatic bone SESSION 9: PLASTIC AND RECONSTRUCTIVE SURGERY loss in the lower limbs using the Masquelet technique. Aim: We present our technique and early results using a modified 65. Assessment of the Physical, Functional, and Psychological Masquelet technique. Fidelity of “Suture-Self”, A New Simulated Skin Model Designed to Methods: Retrospective cohort study. Fourteen open fractures of the femur Improve Surgical Skills and tibia were included in the study between November 2013 and December 2014. A modified Masquelet technique was used to manage the open frac- YSweeney1, B Reid-McDermott2, D Byrne2,SPotter1 tures. Reamer-Irrigator-Aspirator (RIA, De Puy Synthes) was used for bone graft harvesting and antibioticloaded absorbable calcium sulphate pellets were (1) Department of Plastic Surgery, Galway University Hospital, added to the cement spacer and to the bone graft. Union, infection, compli- Newcastle Road, Galway, Ireland; cation and failure rates were analysed using descriptive statistics. (2) Department of Irish Centre for Applied Patient Safety and Simulation, Results: The mean follow up was 15 months. The mean bone defect was Galway University Hospital, Galway, Ireland 56.6 mm. Eight fractures (57.1 %) progressed to union at an average of 42.1 weeks. Infection developed in three fractures (21.4%). Overall, the Introduction: It is important to maximise preoperative learning and postop- induced membrane technique was abandoned in five (35.7 %) cases. erative consolidation, and to provide educational tools that can be utilised to Conclusion:The modified induced membrane technique shows substan- allow surgical training to thrive. The availability of simulated skin products to tial rate of failure in the acute trauma setting in the lower limb. In the support trainees to advance beyond the novice stage is lacking. absence of sound published evidence the authors now use the technique Aim: A prototype high-fidelity skin simulator called ‘Suture-Self’ was in selected cases only. developed to address the gap of a suitable skills and assessment tool for senior surgical trainees. 64. Outcomes Following Orthopaedic Surgical Wound Closure With Method: ‘Suture-Self’ was developed with epidermal, dermal and hypo- Suture Compared With Non-Absorbable Staples In Adults. A dermal layers, and elastic features of normal skin to support more ad- Systematic Review and Meta-Analysis vanced tissue-handling skills. A questionnaire was developed to evaluate the physical, functional, and psychological fidelity of the simulator, and PMcQuail1, B McCartney2, P McKenna circulated to advanced surgical trainees and consultants. Results: Twenty-five surgical trainees and consultants were recruited. (1) Department of Trauma and Orthopaedics, Cappagh National ‘Suture-Self’ was rated as ‘very similar’ and ‘similar’ in physical appear- Orthopaedic Hospital, Finglas, Dublin 11, Ireland; ance to human skin by 66% of respondents. The majority of respondents (2) Department of Trauma and Orthopaedics, Waterford University rated the function of ‘Suture-Self’ as ‘similar’ when achieving apposition Hospital, Waterford, Co. Waterford, Ireland of skin edges (n=14) and applying tension across the wound (n=12). The majority of respondents rated the overall similarity of ‘Suture-Self’ to Introduction: Orthopaedic surgical site infections (SSI’s) prolong total human skin as ‘very similar’ (n=12). ‘Suture-Self’ was deemed ‘very hospital stays by a median of 2 weeks per patient, approximately double useful’ as a learning and assessment tool by 72% of respondents. re-hospitalization rates, and increase healthcare costs by more than 300%. Conclusion: ‘Suture-Self’ performed very well when tested by surgical Patients with orthopaedic SSI’s have significant reductions in their health- trainees and consultants. The responses support its potential use for learning related quality of life. and assessment of more senior trainees as it is similar to human skin in Aim: We performed a systematic review and meta-analysis to com- anatomical structure, texture, elasticity, and overall functional performance. pare differences in outcomes between use of sutures and non- Skin lesions can be added to diversify tasks for the surgical trainee. absorbable staples for closure of orthopaedic surgical wounds in adults. The primary outcomes were rates of superficial and deep 66. Primary Cutaneous Malignant Melanoma in the Elderly: The SSI. Secondary outcomes included wound dehiscence, length of Septuagenarian Years and Beyond. A Single Unit Experience hospital stay, patient satisfaction and pain during removal of clo- sure material. KI Abdul Jalil, B O’Sullivan, N Ajmal, B Kneafsey Method: Data sources including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, clinicaltrials.gov and National Institute for Department of Plastic Surgery & Reconstructive Surgery, Beaumont Health and Research were searched for randomised controlled trials Hospital, Dublin 9, Ireland (RCT’s) meeting inclusion criteria. Sixteen RCT’s published between 1987 and 2017 were included. Background: Age is a recognized independent poor prognostic factor for Results: Overall, wound infection outcomes (superficial and deep malignant melanoma (MM). Patients aged ≥ 70 years old represent ap- infections combined) showed no statistically significant difference proximately a quarter of patients diagnosed with primary cutaneous MM between closure with staples compared with sutures with a relative in Ireland. Although surgical resection remains the cornerstone for cura- risk of 1.17 (95% CI 0.59-2.30, p=0.66). A subgroup analysis was tive treatment for MM, the percentage of patient receiving surgical treat- performed specific to hip wound infection outcomes. A sensitivity ment tend to fall with age. In this study, we evaluated the impact of age (≥ analysis demonstrated sutures to be statistically significantly 70 years old) on the management of MM in our unit. favourable (p=0.04) in terms of hip wound infection outcomes. Methods: Retrospective review of 132 patients, aged ≥ 70 diagnosed with There was no statistically significant difference among secondary primary cutaneous malignant melanoma between January 2000- outcomes between sutures and staples groups. December 2013, in Beaumont Hospital, Dublin, Ireland. Conclusion: It appears the choice of sutures or staples in closure of or- Result: In line with literature, patients aged ≥ 70 had a higher proportion thopaedic wounds has no effect on wound complications. However, cau- of head and neck melanoma, more Breslow Thickness (BT) of tion is needed in applying the findings to different population groups due Intermediate (1.0-4.0mm) and Thick (<4.0mm): 46% and 30% respec- to heterogeneity across studies. tively. However, only 89% received wide local excision and 37% Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S157 underwent sentinel lymph node biopsy (SLNB). In relation to SLNB, 68. Are the Indicative Numbers Required for Certificate of from a total of 100 cases melanoma with diagnosis of BT ≥ 1mm, only Completion of Training (CCT) attainable for current Irish Plastic 42% underwent SLNB. The incidence of SLNB metastasis was 20%. In Surgery Trainees? this study, SLNB was not found to be prognostic of Recurrence Free Survival. CM Sugrue, PJ Regan, A Hussey Conclusion: This study highlights the age-related disparities in sur- gical management of primary cutaneous melanoma. Although Department of Plastic & Reconstructive Surgery, Galway University SLNB were performed as part of guideline in management of mel- Hospital, Galway, Ireland anoma, however, the relationship between age and SLNB is not established. Introduction: As surgical training becomes more streamlined there is a shift towards competency based training. The Joint Committee on 67. Squamous Cell Carcinoma of the Scalp: Features of Disease at Surgical Training (JCST) determines specific competencies and the num- This Anatomic Location and Considerations As to Why Irish Elderly bers required prior to awarding CCT. The aim of this study is to determine Male Farmers are At Particular Risk if the CCT indicative numbers are attainable for current Irish Plastic Surgery Trainees. E Fahy, C Sugrue, J Kelly Methods: An analysis was performed of data recorded prospectively in elogbook by Plastic Surgery Specialist Registrars (SpR) over a three-year Department of Plastic & Reconstructive Surgery, Galway University period (2015–2017). Frequency of indicative procedures either super- Hospital, Galway, Ireland vised or performed were recorded. The mean number of indicative pro- cedures per trainee per department was calculated and conveyed as a 5- Background: In clinical practice, Cutaneous Squamous Cell year projection. The difference between the projection and the CCT in- Carcinoma(SCC) affecting the Scalp(SSCC) are often noted to dicative numbers was determine and expressed as a percentage (%) occur in elderly males that are typically bald farmers. While this Results: Elogbook data from 16 SpR’s were obtained between 2015 - is understandable considering the occupational hazard of increased 2017. Trauma procedures such as, zone 2 flexor tendon repairs (180%, sun exposure along with the high rate of baldness in the older 54.1/30), neurosynthesis (174%, 86.9/50) and lower limb reconstruction male population, the observation lead us to question how SSCCs (137%, 68.5/50) were above the required numbers. Similarly, was the compared to other SCC sites in terms of high risk features and numbers of aesthetic surgery (131% 131.6/100) and breast reconstruction outcomes. (106%, 42.4/40). Free tissue transfer was the lowest frequency of all Methods: Pathology reports of 267 incidences of SSCCs in 227 procedures, with Irish trainees only obtaining 23 % of the required num- patients in the west of Ireland from 2009-2017 were retrospec- bers over 5 years. tively assessed for features including age at diagnosis, sex, size of Conclusion: Both trainees and trainers may use the data to monitor the lesion, pTNM Stage, Clark level, degree of infiltration, distance acquisition of operative experience over time and target training where from treatment centre; association with having another SSCC, necessary. SCC of non-scalp site, Basal Cell Carcinoma(BCC) or malignant melanoma(MM); and presence of recurrence and metastasis. Data 69. Deliberate Self-Harm Presenting To Plastic And Hand Surgeons - was then compared to recognized high risk features of cutaneous Missed Opportunities For Suicide Prevention? SCCs in general. Results: SSCCs made up 6.5% of all cutaneous SCC incidences over nine E Concannon1,SCarr1, A Doherty2, SJ McInerney3, J Birrane1,L years. Average age at diagnosis 78.9years. Males made up 92.5% of all Kearney1, AJ Hussey1, S Potter1,JLKelly1,NMMcInerney1 SSCC incidences(m:f of 12.4:1). Average size at greatest dimension was 2.21cm. The average distance of patient’s homes from their treatment 1 Department of Plastic & Reconstructive Surgery, Galway University centre was 76.9km. Having a SSCC with a larger diameter was associated Hospital, Galway, Ireland with living further from treatment [r-score:0.2751, p-value:0.0123]. In 2 Department of Psychiatry, Galway University Hospital, Galway, those with subsequent SCC, average time to event was 1.88 years. Ireland There were 4 cases of recurrence and 4 cases of metastasis of 267 inci- 3 Department of Psychiatry, St Michaels Hospital, Toronto and dences(1.498% each). One recurrence occurred in a female, all other University of Toronto, Canada recurrences and metastases affected males. Conclusion: Males are disproportionately affected by SSCCs com- Introduction: Deliberate self-harm (DSH) is a common source of referral pared to women as well as to the general SCC m:f ratio. SSCCs to plastic and hand surgery services. Appropriate management of these presented with relatively large occurrences, putting them at higher patients is complex and includes the need for close liaison with mental AJCC cSCC stage as well as higher risk of nodal metastasis accord- health services. DSH is the single biggest risk factor for completed sui- ing to the literature. However, a low rate of recurrence and metas- cide, increasing the risk by a factor of 66 (1). tasis was noted in our patient population. In those with larger le- Aim: To audit and analyse the clinical pathway and demographic charac- sions and high-risk features, further distance to treatment centre was teristics of deliberate self-harm (DSH) patients referred to plastic and associated, noteworthy as patients with malignancy living further hand surgery services. from treatment centres tend to present later and suffer worse out- Methods: This 6-year retrospective series captured patients referred to comes. This may be a worth considering in patients living in rural plastic surgery services following DSH within the SAOLTA Hospital settings such as farmers. SSCCs observed in our patient population group. Patients were identified through HIPE, cross-referenced with the showed features of relatively large lesions with associated high-risk national suicide research foundation database. Data was collecting features and further distances from treatment centres, but a low pertaining to demographics, psychiatric history, details of DSH injuries, recurrence and metastasis rate. admission pathway and operative intervention. S158 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Results: Forty-nine patients were referred to plastic surgery services during Introduction: The 8th edition of the AJCC melanoma staging guidelines the study period, accounting for sixty-one individual presentations. Male to were released in 2017. Major changes to the new edition include the female ratio was 26(53%): 23 (47%). Mean age was 40 (range 21-95). removal of mitoses as a staging criterion, rounding up to the nearest Concomitant alcohol or illicit substance use was recorded in 17 of 61 0.1mm and the introduction of 0.8-1.0mm thickness as a threshold for (28%) presentations. Mortality from suicide occurred in 4 patients (8%). differentiating T1a from T1b lesions. With these new changes the AJCC Mental health assessment was not carried out in 7 presentations (11%). recommend that all patients staged as T1b should be considered for sen- Documentation of patient risk for repeat self-harm/suicide occurred in 26 tinel node mapping. (42.6%) presentations. Aim: To determine the clinical impact of new changes to AJCC melano- Conclusion: This study demonstrates significant diversity in management ma guidelines. of this vulnerable patient group and may inform development of referral Methods: A retrospective review of all melanoma MDM discussions in pathways to improve safety of transfer, surgical admission and discharge our institution in 2017 was conducted. All cases discussed at the MDM in consultation with mental health services. were included. Skin cancers other than melanoma were excluded. Reference: Pathological stage was noted and patients were restaged using the 8th 1.Hawton K, Zahl D, Weatherall R. Suicide following deliberate self- edition AJCC. The number of hypothetical changes to staging were not- harm: long-term follow-up of patients who presented to a general hospi- ed. Ethical approval was obtained. tal. Br J Psychiatry. 2003;182:537-542. Results: 301 discussions took place in 2017, following exclusion criteria, 247 remained of which 66 were T1 lesions. Seventeen of these 66 were 70. Surgical Management of Cutaneous Squamous Cell Carcinoma altered. 7 were downstaged to T1a based on new criteria, and the remain- in Mid-West Ireland: A Retrospective Study ing were upstaged to T1b resulting in a potential three further patients who may be considered for SNB. O Ni Dhomhnallain, C Hackett, B Ramsay, M Lynch, K Ahmad Conclusion: Melanoma is staged in order to characterise tumour status, determine prognosis and to standardise clinical and surgical decision mak- ’ Department of Dermatology, University Hospital Limerick, St. Nessans ing. The impact of changes to this AJCC staging will need to be continu- Road, Dooradoyle, Ireland ously reviewed to determine long term impact on surgical resources. Introduction: Surgical Excision remains the gold standard for manage- SESSION 10: PLENARY ment of cutaneous squamous cell carcinomas (SCCs). Currently there are no national guidelines for the management of non-melanoma skin cancer. 72. Spatiotemporal Visualization of Mesenteric Morphogenesis The British Association of Dermatologists recommends 5mm margins for low-risk and 6mm for high-risk SCCs. In 2014, a skin cancer multidisci- K Byrnes1,DWalsh1, LWalsh1, R Mirapeix2,WLamers3, P Dockery4,K plinary meeting (MDM) was introduced in UHL. 5 1 Aim: To quantify the incomplete excision rate for cutaneous SCCs pre- McDermott , JC Coffey and post-introduction of the skin cancer MDM, using years 2012 and 2015. Adequacy of histopathology reports was also assessed. (1) Department of Surgery, University of Limerick, Dooradoyle, Method: A computer-generated list of all cutaneous SCCs excised in Limerick, Ireland; 2012 and 2015 was obtained from the pathology department. Patient (2) Department of Anatomy and Embryology, Autonomous University of demographics and tumour characteristics were collected using the hospi- Barcelona, Bellaterra, Barcelona, Spain; tal’siLabsystem. (3) Department of Anatomy and Embryology, University of Maastricht, Results: In 2012, 11.57% (36/311) of SCCs were incompletely excised, Maastricht,, Netherlands; with 50% of these undergoing re-excision. In 2015, 12.73% (35/275) of (4) Department of Anatomy, National University of Ireland, University SCCs were incompletely excised, with 37% undergoing re-excision. In road, Galway, Ireland; 2012, incomplete excisions were most commonly performed by GPs (5) Department of Anatomy, University of Limerick, Dooradoyle, (33%), followed by ENT and Maxillofacial Surgeons (27%), General Limerick, Ireland Surgeons (19%) and Dermatologists (11%). In 2015, 46% of incomplete excision were by ENT and Maxillofacial Surgeons, followed by GPs Introduction: Clarification of the mesenteric anatomy prompts further (17%), General Surgeons (14%) and Dermatologists (9%). Excision mar- investigation of its development. Although embryological planes are gins were unspecified in histology reports in 20% (63/311) of cases in commonly exploited during colorectal surgery, the exact morphogenesis 2012 and 12% (32/274) in 2015. of the mesentery remains unclear. This study aimed to generate a four- Conclusion: Despite recommended surgical margins for SCCs, the in- dimensional model of the mesentery during embryogenesis. complete excision rate remains high, at 11.57% in 2012 and 12.73% in Methods: Embryological (n=10) specimens from 4 to 8 weeks of develop- 2015. Histology reports improved with excision margins specified in 88% ment were sectioned, stained and digitized. Regression analysis (SIFT; of cases in 2015, vs. 80% in 2012. ImageJ2, v1.50e, NIH, US) stacked sections in their true alignment. Manual tracing highlighted areas of regional anatomy. An internal panel 71. Changes to Staging Malignant Melanoma: How the New AJCC of 2 reviewers verified manual tracings. Shape interpolation (Cinema4D; 8th Edition Affects our Management Maxon Computer GmbH, Germany) between developmental stages gen- erated a four-dimensional model of mesenteric and intestinal development. EFarrell1, P Cromwell2,HWaller2, A Lally3, D McCartan 2,DEvoy2 Results: Rendered volumes had a high degree of spatial overlap between operators (Sørensen–Dice similarity coefficient (Mean ± SD) of meso- (1) Department of CST1, St Vincent’s University Hospital Dublin, Nutley derm .9949 ± .0085 [.994–.996]). Three-dimensional visualisation of Avenue, Dublin 4, Ireland; fore-, mid- and hindgut regions of the mesentery enabled identification (2) Department of Breast Endocrine General Surgery, St Vincent’s of continuity between these regions. Shape interpolation produced a spa- University Hospital, Elm Park, Dublin 4, Ireland; tiotemporal model of mesenteric development from 4 to 8 weeks. (3) Department of Dermatology, St Vincent’s University Hospital, Elm Cadaveric dissection and comparison with foetal models confirmed de- Park, Dublin 4, Ireland velopmental observations. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S159
Conclusions: The mesentery, continuous from oesophagogastric junc- of breast reconstruction. The aim of this study was to assess the effect of tion to mesorectum, maintains all abdominal digestive organs in po- adipose depot and treatment factors on the suitability and oncological safety sition and in systematic continuity. This developmental model pro- of ADSCs for use in breast regeneration and to assess a hyaluronic acid vides an anatomical framework for understanding and further inves- hydrogel as a scaffold biomaterial in novel breast regeneration techniques. tigating abdominal organogenesis. The use of four-dimensional Methods: ADSCs were isolated from the breast and abdomen of breast modelling facilitates insight into the developing mophology of em- cancer patients treated with or without neoadjuvant chemotherapy and bryological strucutres. normal healthy controls. Immunophenotype, adipogenic potential expres- sion of adipogenic and cancer driver genes and chemokine secretion was 73. Neoadjuvant Chemoradiation for Esophageal Cancer Impairs assessed. The biomechanical properties of the ideal hyaluronic acid hy- Pulmonary Physiology Preoperatively and Impacts on drogel for breast adipose regeneration purposes was determined by Postoperative Respiratory Complications and Quality of Life assessing hyaluronic acid concentration, crosslinking density and optimal lipoaspirate load. JAElliott,LO’Byrne, G Foley, C F Murphy, SL Doyle, S King, E M Results: ADSCs isolated from the breast of patients treated with neoad- Guinan, N Ravi, JV Reynolds juvant chemotherapy and the abdomen of breast cancer patients demon- strated better adipogenic potential and improved oncological safety with Department of Surgery, Trinity Centre for Health Sciences, St. James’s decreased expression of cancer driver genes and oncological chemokine Hospital, Dublin, Ireland secretion compared to the ADSCs from breast adipose tissue of patients not treated with neoadjuvant chemotherapy. Hydrogels of 2% w/v Introduction: Neoadjuvant therapies may impact pulmonary function, but hyaluronic acid at a 2x crosslinking density loaded with adipocytes at whether this has clinical consequences postoperatively or in survivorship 6.7% of total gel volume were found to have biomechanical properties with modern quality-assured protocols has not been systematically most suitable for breast reconstruction. studied. Conclusion: In the modern era, breast regeneration using novel stem cell Aim: To assess the impact of neoadjuvant therapy on pulmonary physi- and adipocyte techniques including hyaluronic acid hydrogels, has the ology and clinical outcomes in locally advanced esophageal cancer potential to create a more appropriate, oncologically safe, cosmetically (LAEC). and clinically improved breast reconstruction. Methods: Consecutive patients between 2010-2016 were included. A lung dose-volume histogram of V20 <25% was set for radiation, with 75. Optical Discrimination of Primary Colorectal Cancer using total radiation between 40-44Gy. FEV1, FVC and DLCO were assessed Systemic Indocyanine Green with Near-infrared Laparoscopy and at baseline and one month post induction therapy. Radiation-induced lung Microscopy: Clinical Pilot Experience injury (RILI EORTC grade≥2), comprehensive complications index (CCI), Clavien-Dindo, and pulmonary complications were prospectively DWu1,DO’Shea1, N Mulligan2, E Loughman3, HA Kockhar 4, R Cahill4 monitored. EORTC HR-QL was assessed among disease-free patients in survivorship. (1) Department of Chemistry, RCSI, Ireland; Results: 384 patients were studied, 228 post-chemoradiation (nCRT), and (2) Department of Pathology, MMUH, Ireland; 156 post-chemotherapy (nCT). FEV1 (P=0.0002), FVC (P=0.003) and (3) Department of Medical Physics, MMUH, Ireland; DLCO (P<0.0001) significantly decreased after induction therapy. (4) Department of Surgery, MMUH, 47 Eccles Street, Dublin 7, Ireland Compared with nCT, nCRT was associated with significantly greater reduction in DLCO (14±14% vs 7±15%; P=0.009). Five patients Introduction: Indocyanine green (ICG) with near-infrared (NIR) (2.2%) developed RILI precluding surgical resection. nCRT (P=0.02) laparoendoscopy enhances real-time tissue microperfusion appreciation and smoking (P=0.003) were independently associated with %ΔDLCO, Aim: Can it also reveal neoplastic tumours as metabolically distinct by while loss of lean body mass predicted reduction in FEV1 and FVC. On similar direct visualization and image analysis? multivariable analysis, post-treatment DLCO, but not nCRT, predicted Methods: The colorectal tumours of 26 consecutive patients were imaged, CCI (P=0.002), prolonged ventilator support (P=0.027) and reduced following intravenous ICG (0.25 mg/kg), peroperatively and ex vivo after physical function in survivorship (P=0.02). resection using an endo-laparoscopic device. The continuous high- Conclusion: These data highlight that neoadjuvant therapy alters pulmo- resolution grey-scale (NIR fluorescence) and RGB (white light) video nary physiology, however added radiation has a greater effect on pulmo- recordings underwent post-hoc analysis for texture and fluorescence pat- nary diffusion capacity, which is linked to short- and long-term clinical terns using Image J/MatLab Software (NIH). Signaling differences be- consequences. Although clinical RILI is rare, this more nuanced largely tween tumour and co-adjacent normal mucosa and between malignant subclinical impact highlights a potential modifiable index of risk. and neoplastically suspicious tumours were scrutinised, some of which (n=5) were subsequently proven non-malignant. Unstained tissue sec- 74. Evaluating a Novel Adipose Tissue Engineering Strategy for tions were studied by NIR Scanning (Odyssey, LICOR) and fluorescence Breast Reconstruction Post-Mastectomy microscopy (Nikon, ANDOR). Results: Within the field of view (FOV), colorectal cancers distinctively NO’ Halloran1, K Gilligan1, E Dolan2,SKhan1,RDwyer1, M Kerin1,G concentrated ICG both grossly and microscopically allowing their optical Duffy2,ALowery1 distinction <15 minutes post-ICG administration with tumoural surface texture heterogeneity evident. Software analysis of fluorescence intensi- 1. Discipline of Surgery, The Lambe Institute for Translational Research, ties showed early differentiation of adenocarcinoma attributable to a char- NUI Galway acteristic pattern ICG rapid-influx within 120 seconds. A distinctively 2. Discipline of Anatomy, School of Medicine Nursing and Health elevated signal intensity was observed up to six hours remaining readily Sciences, NUI Galway detectable in the ex vivo resected specimen. Comparative analysis of the log-fluorescence signal intensity over time from selected FOV points Introduction: Adipose tissue engineering and adipose derived stem cells consistently showed distinctive dataset trends for malignant (divergent) (ADSCs) have the potential to overcome limitations of current methods versus dysplastic (convergent) tumours. S160 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
Conclusions: Direct continuous intraoperative NIR-ICG interrogation Results: 286 patients were treated with neoadjuvant chemoradiotherapy acts a tumour-identifier by allowing clinically relevant in situ visual char- and TME (TRG 2, n= 195; TRG 3, n= 91). On univariable analysis, acterisation of neoplastic metabolism. Characteristic longitudinal fluores- Tumour Budding (TB) (p<0.001), lymphovascular invasion (LVI) cence trends, identified via software analysis, possibly distinguishes in- (p=0.002), extramural invasion (EMVI) (<0.001), perineural invasion vasive from non-invasive neoplasia. (PNI) (p=0.001) and positive lymph nodes were associated with TRG 3. TB (OR 3.072, 95% CI 1.406-6.709, p=0.005) and EMVI (OR 76. Cytosporone B, NR4A1 Agonist, as a Modulator of Colorectal 2.821, 95% CI 1.277-6.235, p=0.01) were associated with TRG 3 on Tumour Inflammation multivariable analysis. TB was an independent predictor of worse overall survival (OS) (HR 2.737, 95% CI 1.427-5.250, p=0.002) on multivariable MIsmaiel1, A Baird2, D Crean2,DWinter1 analysis. Tumour budding (HR 2.077, 95% CI 1.166-3.701, p=0.013) and PNI (HR 1.970, 95% CI 1.052-3.687, p=0.034) predicted worse disease- (1) Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland; free survival (DFS). TRG 3 was associated with worse OS (59.3% Vs (2) School of Veterinary Medicine and Conway Institute, University 73.8%, p=0.001) and DFS (56% Vs 69.2%, p=0.014). College Dublin, Dublin, Ireland Conclusion: Pathological factors may predict response to neoadjuvant che- moradiotherapy. Assessment of pathological variables in pre-treatment biop- Introduction: Colorectal cancer (CRC) is one of the leading causes of sies may help stratify patients into neoadjuvant therapeutic regimes. cancer-related morbidity and mortality worldwide despite advances in treat- ment. A strong relationship between chronic inflammation and risk of can- 78. The Diagnostic Accuracy of Ultrasound Guided Fine Needle cer initiation and progression is established. Nuclear orphan receptor family Aspiration and Core Needle Biopsy in Diagnosing Axillary Lymph 4A (NR4A) have emerged over the past decade as key regulators of inflam- Node Metastasis in the Post Z011 Era: A Systematic Review and matory pathways, albeit their function in CRC remains unknown. Meta-Analysis Aim: We aim to test the efficacy of Cytosporone B (CsnB), an NR4A1 1 2 2 3 agonist, as a modulator of inflammatory processes in human colonic I Balasubramanian , C Fleming , M Corrigan , HP Redmond ,MJ 3 3 tumour tissue. Kerin ,ALowery Method: Tumour and normal control tissue (n=19), obtained from pa- tients undergoing colorectal resection were exposed to CsnB at a range (1) Department of Surgery, St. Vincent’s University Hospital, Elm Park, of concentrations (4μM-100μM) ex vivo. Supernatant was collected and Dublin 4, Ireland; RNA was isolated from tissues at 8hrs. Cytokine/chemokine array (from (2) Department of Breast Cancer Research Centre, Cork University four pooled patients) was used to examine 104 secreted proteins associ- Hospital, Cork, Ireland, Ireland; ated with inflammation and quantitative enzyme-linked immunosorbent (3) Department of Breast and Endocrine Surgery, Galway University assay (ELISA) / qRT-PCR was used to confirm targets of interest Hospital, Ireland., Ireland identified. Results: Cytokine/chemokine array analysis revealed 39 targets had Introduction: Axillary lymph node (LN) status remains a significant prog- ≥ 2 fold increase in tumour compared to normal. 19 of these targets nostic indicator in breast cancer. We aimed to compare the diagnostic were attenuated ≥ 2 fold with addition of CsnB. Multiple targets accuracy of Ultrasound guided fine needle aspiration (US-FNA) and identified by the array, e.g. TNFα, IL-8, CCL4, MCP-1 were con- US guided core needle biopsy (US-CNB) in axillary staging. firmed using quantitative ELISA and/or qRT-PCR. Moreover, spe- Methods: A comprehensive search of all published studies investigating the cifically IL-8 protein was significantly greater in tumour (7610 ± diagnostic accuracy of US-CNB and US-FNA of axillary LN in breast 1600 pg/g) compared to normal (1380 ± 390 pg/g), p=0.001 and cancer was performed. Studies were included if raw diagnostic data was with the addition of CsnB notable reduction to (4500± 790 pg/g), available for both US-FNA and US-CNB and compared with final histology p=0.002 was observed. results. Relevant data were extracted from each study for systematic review. Conclusion: Colorectal tumour-secreted drivers of dysregulated inflam- Analysis was performed using a random-effects model. Pooled sensitivity mation are attenuated by NR4A1 agonist CsnB. and specificity of FNA and CNB were attained using a bivariate model. Results: Data pertaining to 1,353 patients from 6 studies that met the 77. Histopathological Variables Associated with Poor Treatment inclusion criteria were included in the final analysis. The pooled analysis Response to Neoadjuvant Chemoradiotherapy and Adverse showed that the sensitivity of US-CNB in diagnosing axillary nodal me- Oncological Outcomes in Locally Advanced Rectal Cancer tastases was superior to US-FNA [88% (95% CI: 84% - 91%)] versus [74% (95% CI: 70% - 78%)]. Both US-CNB and US-FNA exhibited high B Creavin, E Ryan, R Geraghty, A Hanly, R Kennelly, S Martin, R specificity of 100%. The reported complication rates are significantly O’Connell, K Sheahan, D Winter higher in US-CNB in comparison to US-FNA (7.1% versus 1.3%, p<0.05). Conversely, the requirement for a repeat diagnostic procedure Department of Surgery, St. Vincent’s University Hospital, Elm Park, was significantly higher in US-FNA (3.9% versus 0.5%, p< 0.05). Dublin 4, Ireland Conclusion: US guided-CNB is a superior diagnostic technique com- pared to US guided FNA for axillary staging in breast cancer. The appro- Introduction: Neoadjuvant chemoradiotherapy reduces local recurrences priate application of this information in the post ACOSOG Z011 era following resection of locally advanced rectal cancer. However, not all remains controversial. tumours respond with potentially adverse effects on patient outcome. Aim: To determine if certain histopathological features of rectal cancers are 79. PERioperative Fluid Management in Elective ColecTomy related to tumour regression following neoadjuvant chemoradiotherapy. (PERFECT) – A National Audit of Current Practice Methods: Patients staged ≥T3 or any stage N+ were referred for long course neoadjuvant chemoradiotherapy (CRT) (50-54 Gy). Tumour C Fleming1, Irish Surgical Research Collaborative2 Regression Grade (TRG 2 and 3) was correlated with histopathological findings in resected specimens. Partial response (TRG 2) was compared (1) Department of Academic Surgery, Cork University Hospital, Wilton, with non-response (TRG 3) using univariate and multivariate logistic Cork, Ireland; regression. Survival was assessed using Kaplan Meier analysis. (2) Department of Surgical Training, RCSI, Ireland Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S161
Introduction: There is contradictory evidence regarding the merits of re- levels. The data suggest a history of chemoradiotherapy as a factor that stricted vs. liberal perioperative IV fluid administration in bowel surgery. needs consideration when evaluating and monitoring patients in the peri- Aim: This study sought to audit perioperative fluid management in elec- operative period. There is a real clinical need to develop guidelines to tive colectomy in Ireland and to analyse the impact of such on operative identify, investigate and follow-up these patients. outcomes. Method: A National Surgical Trainee Collaborative review of perioperativ 81. Upper Third Rectal Cancers Treated with Surgery Alone Have fluid management was performed. Data from each site was collected prospec- Superior Outcomes to Lower Rectal Cancers Regardless of Tumour tively over a selected three week period within a pre-defined two month and Surgical Factors block. Collected variables included: demographics, type of operation/ anaesthethic, volume/type of fluid administration pre-, intra- and post-opera- M Flanagan, C Clancy, D McNamara, J Burke tively, 30D morbidity and mortality. Primary outcome was fluid balance 24hrs post-op with further analysis to identify the impact of this on 30D Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland morbidity. A ROC curve was generated to identify the critical volume at which fluid balance was associated with 30D morbidity. Introduction: The implementation of preoperative chemoradiation and Results: Ninety-four patents were enrolled from seventeen hospitals. total mesorectal excision has reduced local recurrence rates in rectal can- Mean age was 64 years. 48.9% (N=46) were managed by ERAS and cer. However, neoadjuvant treatment in upper third rectal cancer is con- 50% (N=47) received bowel preparation. Most procedures were lap- troversial. This study uses meta-analytical techniques to compare out- aroscopic [69% (N=65)], a 10% conversion rate was observed. comes of upper third rectal tumours treated without neoadjuvant therapy Median fluid balance at 24hrs was +715mls (IQR 165-1486mls). relative to those of the distal rectum. On multivariate analysis, high BMI (p=0.02), indication for surgery Methods: Meta-analysis was performed using the PRISMA guidelines. (p=0.02) and critical care admission (p=0.008) were significantly Databases were searched for studies comparing outcomes between upper predictive of 30D morbidity. While overall fluid balance was not third and more distal rectal cancers undergoing primary resection, without significant, 24hr fluid balance >+665mls was associate with in- neoadjuvant treatment for upper third tumours. Upper third tumours were creasedriskof30Dmorbidity. defined as tumours located from 10-15cm from the anal verge. Results Conclusion: This was the first Irish Surgical Trainee Collaborative per- were reported as odds ratios (OR) with 95% confidence intervals formed Nationally in Ireland. In general, perioperative fluid management (95% CI). was within an accepatable range with minimal impact on 30D morbidity. Results: 174 citations were reviewed; 5 studies comprising of 3,969 pa- tients were included in the analysis. There was no difference in the rate of 80. Prevalence of Myocardial Injury in Gastrointestinal Surgery T3/4 tumors (OR: 1.366, 95% CI: 0.989-1.887, p=0.058), lymph node Patients. A Multicentre Prospective Cohort Study positivity (OR: 1.024, 95% CI: 0.884-1.187, p=0.750) and CRM positiv- ity (OR: 0.778, 95% CI: 0.479-1.264, p=0.311) between upper third and KAhmed1, G Abdulaal2, M Hassan3,JRehman4, E Mulligan3,S more distal rectal cancers. However local recurrence (OR: 0.519, 95% CI: Johnston3, A Rayis3, I Khan 4, R Waldron4, W Khan4, C Collins5,S 0.318-0.846, p=0.009) and distant recurrence (OR: 0.601, 95% CI: 0.500- Zeeshan2, M Joyce5, K Barry4,SWalsh1 0.723, p<0.001) were reduced in patients with upper third rectal cancer. Conclusions: Despite similar T-status, lymph node positivity and margin (1) Discipline of Surgery, Lambe Institute for Translational Research, positivity, local recurrence and distant recurrence are reduced for upper NUI Galway, Ireland; rectal tumours. These data suggest upper third rectal cancer represents a (2) Department of Surgery, Letterkenny University Hospital, Saolta biologically more inert disease phenotype than more distal tumours. Hospital Group, Ireland; Further randomised studies on the benefit of neoadjuvant chemoradio- (3) Department of Surgery, Midland Regional Hospital, Tullamore, therapy in this cohort are required. Ireland; (4) Department of Surgery, Mayo University Hospital, Saolta Hospital 82. The Impact of Hospital-Volume and Surgeon-Volume on Patient Group, Ireland; Outcomes following Appendicectomy (5) Department of Surgery, University Hospital Galway, Saolta Hospital Group, Ireland RM O’Connell, S Abd Elwahab, K Mealy
Introduction: There is consensus on diagnosis and management of myo- Department of General Surgery, Wexford General Hospital, Wexford, cardial infarction, but less information is known about subclinical post- Ireland operative myocardial injury which can be manifested only as elevation of troponin in totally asymptomatic patients. Postoperative elevation of tro- Introduction: Acute Appendicitis is a common surgical emergency, and ponin levels is associated with major cardiac events and previously iden- appendicectomy is one of the most frequently performed surgical proce- tified as an independent predictor for mortality at 30 days and 1-year dures worldwide. However, there is a lack of published data on the impact follow-up. There is a need for more data about the problem and the best of surgeon- and hospital-volumes on patient outcomes following approach to treat and follow these patients. appendicectomy. Materials and methods: We conducted a Prospective Observational Aim: To establish if hospital grade, hospital-volume, or surgeon-volume Multicentre Cohort Study on patients undergoing elective gastrointestinal impacted patient outcomes following appendicectomy. surgery in 4 university hospitals. We monitor patients clinically, ECG Methods: NQAIS (National Quality Assurance and Improvement changes and troponin levels pre-operatively and the first three days post System) data for all appendicectomies performed in Ireland between operatively January 2014 and November 2017 was examined, and data relating to Results: A total of 101 patients (56 Males & 45 females) were included. patient demographics, type of surgery (open/laparoscopic/laparoscopic Mean age of participants was 63.87 (SD 14.76) years with normal base- converted to open), length of stay (LOS), mortality, admission to critical line renal profiles and 184.4 minutes as mean operating time. Troponin care and re-admission rates were collected. elevation was observed in 32 patients; only 4 (3.96%) developed recent Results: 25,802 appendicectomies were performed, 15,896 of which were changes in ECGs while 3 patients (2.97%) reported chest pain in adults, and 20,598 were laparoscopic procedures. Patients treated in Conclusion: The prevalence of postoperative myocardial injury in our model 3 hospitals had lower LOS (2.96 v 3.37days, p<0.0001) than study was 31.68% representing patients with elevated post-op troponin patients treated in model 4 hospitals, but they also had lower rates of S162 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 laparoscopic procedures (87.38% v 95.56% p<0.0001) and higher admis- (EVH) is a new minimally invasive vein harvesting technique that sion rates to critical care (1.91% v 0.75% p<0.0001). No significant significantly reduces wound complications. EVH commenced in outcome difference was seen between those treated by high-volume UHG on 14th February 2017. Here we report our first year expe- (>62 cases/year) or low volume surgeons (<20 cases/year). Patients treat- rience of introducing this technique. ed in high-volume hospitals (>260 cases/year) had higher rates of lapa- Aim: To assess the impact of EVH during the first year of its use. roscopic procedures (94.9% v 83.5%, p<0.0001), lower rates of admis- Method: Data was collected retrospectively from a prospectively main- sion to critical care (0.85% v 2.25%, p<0.0001) and lower 7-day re- tained electronic database of all CABG patients from February 2017 to admission rates (2.54% v 3.55%, p=0.02) than those operated in low- February 2018. volume hospitals (<161 cases/year). Results: 117 patients underwent CABG procedure. Out of these, 57 pa- Conclusion: Hospital grade and surgeon-volume have minimal impact on tients (49%) had EVH. For the first 10 cases, the average harvesting time patient outcomes following appendicectomy, but patient outcomes are per vein graft length was 35 minutes. For the last 10 cases, the average better in high-volume hospitals. harvesting time per vein graft length was 16 minutes. There was negligi- ble blood loss in all cases. There were 4 conversions (7%) to open LSV SESSION 11: VASCULAR & CARDIOTHORACIC harvesting. There was no conversion in last 26 cases. Post operatively, average pain score was 1/10. 2 patients (3.5%) developed haematoma at 83. Total Endovascular Management of Aorto-Iliac Occlusive the LSV harvest site, which did not require intervention. At 6 weeks Disease check there were no wound complications. In contrast, during the same period, 5 patients who had open LSV harvest, developed surgical site B Ghoneim, M ElSherif, M ELSharkawi, N Hynes, W Tawfick, S Sultan infection. All 5 required antibiotics and dressings. 2 required VAC dress- ing and prolonged hospital stay. Department of Vascular Surgery, Galway University Hospital, Galway, Conclusion: EVH, although challenging, could be introduced safe- Ireland ly with appropriate mentoring. The adoption of EVH has signifi- cantly improved wound infection rate in patients undergoing Objectives: We aim to compare the effectiveness of total endovascular CABG in UHG. repair of aorto-iliac occlusive disease to the gold standard of aorto-bi- femoral bypass. 85. Age-Related Arteriopathy Assessment; Should Future Methods: Patients with aorto-iliac occlusive disease were managed either Abdominal Aortic Aneurysm Screening Criteria be Determined by using an endovascular Endologix aorto-iliac stent-graft, or kissing Age? balloon-expandable iliac stents or open aorto-bi-femoral bypass. Procedure details and outcomes were documented. MCahill-Collins1,MElSharkawi1, M Elsherif1,EDoran2, W Tawfick1, Results: From 2002-2018 a total of 830 patients underwent S Sultan1,2, N Hynes2 revascularisation for peripheral arterial disease (PAD). Of those 66 pa- tients had aorto-iliac occlusive disease. Twenty underwent Endologix aorto-iliac stent-grafting. Twenty were managed with kissing stents, while 1.Western Vascular Institute, Department of Vascular and Endovascular twenty-six had an aorto-bi-femoral bypass. There was no difference in Surgery, Galway University Hospital, Galway, Ireland; demographics, risk factors and clinical presentation. Immediate haemo- 2.Galway Clinic, Doughiska, Galway, Ireland dynamic improvement was 90% for Endologix patients, 95% for kissing stents and 100% for bypass (p=0.282). Immediate clinical success and Introduction: Population screening of men over 65years, in regions where ≥ technical success were 100% for all three groups. Mean length of inten- prevalence is 4%, reduces aneurysm-related mortality by half within 4 sive care unit (ICU) stay was 0.75-days for Endologix, 0-days for kissing years of screening. stents and 3.6-days for bypass patients. At three years, sustained clinical Aim: Primary aim is to determine prevalence of AAA in men ≥70 improvement was 95% for Endologix, 90% for kissing stents and 77% for years and impact on future screening guidelines and cost-effec- bypass (p=0.232). Three-year Freedom from re-intervention was 90% for tiveness. Secondary aim is to estimate prevalence of relevant co- Endologix, 85% for kissing stents and 88% for bypass (p=0.857). morbidities. Amputation-free survival at three-years was 95% for Endologix, 100% Method: From October 2014 to April 2017, free screening invita- for kissing stents, 92% for bypass (p=0.341). Overall survival was 90% tions were sent to males in three locations in west of Ireland. for Endologix, 75% for kissing stents and 96% for bypass (p=0.102). Screening targeted males ≥70 years or ≥65 years with a relevant Conclusion: Total endovascular repair of aorto-iliac occlusive disease is co-morbidity. Data collection included abdominal ultrasound scan, an effective and safe alternative to invasive bypass procedures, with ankle brachial index (ABI), blood pressure, body mass index and shorter ICU stay. abdominal circumference. Results: 530 invitations were sent, with a response rate of 96.6% (n=512/ 84. Endoscopic Vein Harvest: First Irish Experience of a Minimally 530). On average 46 men screened at 11 screening events. 90.6% (n=464) Invasive Conduit Harvesting were ≥70 years, 63% (n=323) had hypertension, 63% (n=323) has history smoking history (8.9% (n=46) current), and 7% (n=36) had family his- S Siddiqui, R Kelly, D Veerasingam, M DaCosta, A Soo tory of AAA. 18% (n=92) diabetes, 3.1% (n=16) peripheral vascular disease, 5.1%(n=26) coronary artery disease, 5.9% (n=30) cerebrovascu- Department of Cardiothoracic Surgery, University Hospital Galway, lar disease, 2.2% (n=11) carotid artery disease, 0.2% (n=1) renal artery Saolta University Health Care Group, Ireland disease, and 18.5% (n=95) history of cancer. Undiagnosed AAA was detected in 7.8% (n=36/464) ≥ 70years with none in those aged 65- Introduction: Despite multiple randomized trials, coronary artery 70years. 1.2% (n=6) underwent successful EVAR. The remaining 5.6% bypass grafting (CABG) remains the gold standard coronary (n=30) were referred to surveillance. Cost for the 512 patients, including revascularisation technique. The long saphenous vein (LSV) is follow-up and elective repair, was €207,772. This compares to €840,672 the most common conduit harvested using an open technique. on emergency management if the 36 detected had ruptured. However, the open technique is associated with severe wound Conclusion: Our Screening of males ≥ 70 years showed a significant complications and poor cosmesis. Endoscopic vein harvesting detection rate (7.8%) and was cost effective. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S163
86. Remote Ischemic Preconditioning in the Management of Conclusion: Eversion iliac endarterectomy offers a novel, safe and dura- Intermittent Claudication Randomized Controlled Trial ble alternative to endovascular intervention with satisfactory primary, secondary and limb salvage rates KAhmed1, S Hernon1,SMohammed1,MTubassum2, M Newell1,S 1 Walsh 88. The Application of rACR Scoring System in Reducing Unnecessary Temporal Artery Biopsies in The Diagnosis of Giant (1) Department of Surgery, Lambe Institute for Translational Research, Cell Arteritis NUI Galway, Ireland; (2) Department of Vascular Surgery, Galway University Hospital, SHamlin2, T Mansoor1,NLynch1,DMoneley1 Galway, Ireland Introduction: Animal data suggest that remote ischaemic conditioning (RIC) (1) Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland; can improve blood flow in ischaemic limbs and, consequently, may benefit (2) Royal College of Surgeons, Dublin, Ireland claudication patients Supervised exercise is the preferred first-line intervention for patients with intermittent claudication (IC) but is constrained by limited Introduction: The gold standard test for diagnosing Giant Cell arteritis is a availability and logistical issues, particularly in rural settings Temporal Artery Biopsy (TAB). The proposed ACR criteria, and more Aim: To evaluate Remote ischaemic preconditioning in management of recently the rACR criteria is a scoring system developed to aid diagnosis intermittent claudication patients Aim: We aim to investigate the utility of the rACR criteria compared to Methods: We undertook a randomised clinical trial to evaluate RIC’s the original ACR criteria in reducing unnecessary TAB. effect in claudication patients. Stable IC patients were randomly allocated Method: We conduct a retrospective study of 59 patients undergoing TAB to receive RIC alone, structured resistance exercise (SE) alone, RIC plus in the last 5 years in Beaumont Hospital. We collect demographic data, SE or to a control group which received standard advice and risk factor biochemical results, presenting features, and histology results. The ACR modification. Patients received their intervention over a 28-day period. score and rACR score is compiled. RIC patients attended an RIC clinic every 3 to 4 days to undergo 4 cycles Results: Data was analysed from 53 samples and ACR scores were com- of 5 minutes upper limb ischaemia followed by 5 minutes reperfusion piled. 17 scored < 3 and 36 scored 3-5. All 11 positive biopsies were in induced with a standard blood pressure cuff the 3-5 score range. 45 patients were analysed with rACR scores. 8 were Results: 45 patients were randomised, of whom 40 completed the trial (10 excluded due to not meeting the inclusion criteria. Of the 11 positive patients per group). The RIC alone, SE alone and RIC plus SE groups all biopsies, 2 were in the 3-4 score range, and 9 were in the ≥5 score range. demonstrated significant improvements in pain-free walking distance and In the ACR method, 18.2% of all positive biopsies score as Low Risk pre- ankle-brachial pressure indices at 30 days. There were no differences in biopsy. In the rACR method 63.6% of all positive biopsies score in the the magnitude of improvements between the groups Low and Intermediate Risk group pre-biopsy and 15.6% of all positive Conclusion: Compare with standard care RIC is promising as a home- biopsies score in the High Risk group pre-biopsy. delivered intervention. It appears to be equivalent to SE in the treatment Conclusion: The rACR scoring system may be a useful tool to categorise of IC. with no apparent additive benefit to combining the two interven- patients into Low, Intermediate, and High Risk of GCA pre biopsy. tions in this small size sample. large scale RCT is needed for validation Performing TAB is of benefit in Low and Intermediate Risk groups but may be of minimal benefit in the High Risk group. 87. Long-Term Outcomes of Eversion Endarterectomy for Iliac Artery Occlusive Disease 89. Diagnostic Performance of Ankle-Brachial Index: Building on a Foundation of Sand? C Dooley, M Power Foley, T Aherne, M Medani, E Mulkern, C ’ McDonnell, M O Donohoe M Alagha, W Mahmood, M Tubassum, SR Walsh
Department of Vascular Surgery, Mater Misericordiae Hospital, Eccles Department of Vascular Surgery, Galway University Hospital, Ireland Street, Dublin 7, Ireland Background: The ankle-brachial index (ABI) is the mainstay of periph- Introduction: The emergence of endovascular iliac interventions over the past eral arterial disease (PAD) diagnosis. A recent Cochrane review found two decades has resulted in a significant reduction in open iliac surgery. little evidence for the diagnostic accuracy of the test and recommended However, for patients with TASC C and D iliac disease, open intervention further cross-sectional studies of ABI in the diagnosis of PAD. remains the gold standard of care. Iliac eversion endarterectomy (IEE) via a Methods: A prospective database of patients attending a regional vascular retroperitoneal approach offers an operative alternative to both endovascular laboratory was interrogated to identify patients who underwent an ABI intervention and extensive trans-peritoneal iliac revascularization. and lower limb arterial duplex in the same sitting. The duplex acted as the Methods: In this series data were extracted over a 17-year period from reference standard with a stenosis >50% in any of the iliac, femoro- January 2000 to December 2017. All patients had significant iliac arterial popliteal or infra-popliteal considered diagnostic for PAD. The diagnostic disease and underwent IEE. Included patients underwent regular duplex performance of ABI was evaluated. ultrasound follow up with extracted patient, operative and follow-up data Results: ABI plus arterial duplex was performed in 226 legs (118 patients) systematically recorded using Microsoft Excel. over a one-year period. The ABI was normal (0.9 to 1.4) in 78 limbs, 32 Results: In total 35 patients underwent IEE with a mean age of 66 years of which were noted to have a significant stenosis on arterial duplex. Of (range 46-82). A majority of patients (57%) had an American Society of the 148 limbs with an abnormal ABI (<0.9 or >1.4), 106 were found to Anaesthesiologists of three. Indications for intervention included both debil- have a significant stenosis. The area under the ROC curve for ABI was itating claudication 48.5% (n=17) and critical limb ischemia 51.5% (n = 18). 0.71 (95% CI 0.58 to 0.84), indicating moderate predictive ability. ABI Ten required adjunctive revascularization at the time of initial intervention. had a sensitivity for PAD of 76.8% and a specificity of 52.3%. 41% of The mean follow up was 35 months (range 1 - 132) with a cumulative patients with a negative test had significant PAD on duplex ultrasound. patency post procedure of 82.1% at 12-months. Seven patients required some Conclusion: In this series, ABI has only moderate predictive ability as a form of secondary re-intervention. Two patients required amputations giving diagnostic tool for PAD. In particular, a negative ABI cannot be taken to a limb salvage rate of 94%. 12 patients are still under surveillance more than 5 infer absence of PAD. The inclusion of waveform analysis may improve years since the operation with a patency rate of 67%. the test’s performance. S164 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
90. Outcomes of Multidisciplinary Team Consensus for Lung Cancer Conclusion: EmC rates didnot increase following published reports. it Resection without Preoperative Histology had comparable conversion rates and outcomes to ElC. Results suggest that emergency service delivery model needs review as mean interval to R Weedle, E Keane, K Craven, A Soo EmC exceeded the one day recommendation. Figure 1. Numbers of Elective and Emergency Cholecystectomies in Department of Cardiothoracic Surgery, Galway University Hospital, previous 4 years including Same Day Emergency Cholecystectomy Galway, Ireland Introduction: Lung resection remains the cornerstone of treatment for 92. Negative Appendicectomy Rate As A Quality Metric. The Impact resectable non-small cell lung cancer (NSCLC). of All Embedded Versus Random Sampling Technique Aim: We aimed to assess the accuracy of our thoracic multidisciplinary team in recommending treatment for NSCLC and pulmonary metastasis in patients NE Donlon1,MAKhan1, P Higgins1,WKhan1,IKhan1, R Waldron1,T who do not have a confirmed preoperative histological diagnosis. Nemeth2, F Bennani 2, K Barry1 Methods: A retrospective review was performed of patients undergoing lung resection at the recommendation of the thoracic MDT for suspected NSCLC (1) Department of Surgery, Mayo University Hospital, Saolta Health or pulmonary metastasis in our unit between May 2016 and January 2018. Care Group, Castlebar, Mayo, Ireland; Patients with confirmed histological diagnosis were excluded. Patient demo- (2) Department of Pathology, Mayo University Hospital, Saolta Health graphics, operative details, and postoperative histology were collected. Care Group, Castlebar, Mayo, Ireland Results: 117 patients underwent lung resection. Twenty-six patients with histological diagnoses were excluded. Of patients included for analysis Introduction: Historically high negative appendicectomy rates(NAR) (n=91), 57% (n=51) were male, mean age 66.74 years. Of patients who have been accepted to offset the risks of perforation, previously exceeding underwent lung resection for suspected NSCLC (n=70), final histology 20%. However, with improved imaging modalities and clinical scoring revealed 57 primary lung carcinomas, 2 carcinoid tumours, 3 pulmonary algorithms,there is growing demand for lower negative appendicectomy metastases from known colorectal cancer, 1 SCLC, 1 MALToma, and 6 rates. The definition of a negative appendicectomy varies between insti- benign diagnoses. Overall the positive predictive value of MDT consen- tutions and pathology laboratories with most practicing random sampling sus for NSCLC in the absence of preoperative histology was 85.7%. Of techniques. patients who underwent wedge resections for suspected metastatic dis- Objectives: 1.To establish the NAR in our institution.2.Correlate imaging ease or limited resection of suspected NSCLC (n=21), histology for 8 modalities with histological findings.3.Evaluate the analytical practice of patients confirmed metastasis from known primary cancers, 1 SCLC, 6 our pathology laboratory. primary lung carcinomas, 1 lymphoma, 5 benign diagnoses. The positive Methods: Patients who underwent an appendicectomy between predictive value of MDT consensus for recommending wedge resection January2012 and December2017 were identified using a prospectively in the absence of preoperative histology was 71%. maintained pathology database.The histology findings were cross refer- Conclusion: Performing lung resection without preoperative histology is enced against our radiology system to correlate findings.Data was reasonable with the consensus of MDT and appropriate patient counselling. analysed using SPSSV24. SESSION 12: GENERAL Results: From 1,156 patients,53% were males(n=613),with a mean age of 24 years. 81%(n=937)of histology reports were classified as inflamed, in- 91. Emergency Cholecystectomy in Ireland, State of the Nation cluding acutely inflamed, perforated or gangrenous. Fourteen patients had carcinoma identified histologically, with one pseudomyxoma peritoneii ’ S Abd Elwahab, K Mealy case. Thirteen patients had faecolith s and twenty specimens contained enterobius vermicularis. Sixty-two patients(37 female,25 male)had a histo- Department of General Surgery, Wexford General Hospital, Wexford, logically normal appendix equating to a NAR of 5.4%. Seventy-six spec- Co.Wexford, Ireland imens demonstrated lymphoid hyperplasia,27 were fibrosed and six dem- onstrated atrophy, which if included in the histologically normal cohort, Introduction: Literature suggests that emergency cholecystectomy equates to a NAR of 14.7%.(p<0.001). All patients with a CT scan sugges- (EmC), defined as cholecystectomy in an emergency admission and with- tive of appendicitis had histologically proven appendicitis. in a week from onset of symptoms; should be the norm. We aimed to Conclusion: There is no current concensus on an appropriate definition of study whether surgical practice in Ireland changed following these a negative appendicectomy. In addition to this a standardised algorithm recommendations. should be adopted by all pathology laboratories in the assessment of Methodology: we examined the National Quality Assurance Intelligence appendix specimens to provide accurate nationwide figures regarding System (NQAIS) database to compare EmC and elective cholecystecto- negative appendicectomy rates. my (ElC) in the period between Jan 2014 and Dec 2017 in terms of rates of emergency versus elective cholecystectomy, operative technique, 93. The Value of Ultrasonography in Characterising Polypoid conversion-to-open rate, re-admissions, ICU admission rates, and wheth- Lesions of the Gallbladder er operative volume affected outcomes. Results: 17,902 cholecystectomies were done, majority were ElC (84.1% C Toale, S Cassidy, F Hand, J Conneely, G McEntee vs 15.9%). Female:male ratio was 3.2:1, and mean age was 48.4±0.11 yrs (p>0.05 between the two groups). ElC rate showed an upward trend while Department of Hepatobiliary Surgery, Mater Misericordiae Hospital, EmC rate was steady across the study period (figure 1). Laparoscopy was Eccles Street, Dublin, Ireland used in 95.8% of ElC vs 91.2% in EmC(p=0.08); conversion-to-open rate was 2% in ElC vs 4% in EmC (p value = 0.07); high volume centres had Introduction: Current guidelines recommend cholecystectomy for polyps higher conversion rate (4.3%) compared to low volume centers (0%) exceeding 8mm on ultrasound, due to the risk of malignant change above (p=0.003). Mean pre-opertive EmC LOS was 3.6 (SD=4.3, range=0-51) this threshold. days; the overall LOS was 4.9 days (SD=9.1, range 0-161). There was no Aim: This study sought to assess the impact of this policy on the yield of significant difference in ICU, 7-or 30-days readmissions. true polypoid lesions of the gallbladder. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S165
Methods: Patients undergoing cholecystectomy from January 2015 Introduction: Acute appendicitis is a common surgical emergency in chil- to March 2018 were eligible for inclusion. Clinico-pathological dren. The majority of appendicectomies in children are performed by features were retrospectively reviewed from a prospectively main- general surgeons, rather than specialist paediatric surgeons. tained database. Histology of patient gallbladders in whom gall- Aim: To establish the ratio of appendicectomies performed in specialist bladder polyps were the primary indication for surgery were fur- paediatric centres (SPCs) in Ireland, and to compare patient outcomes ther assessed. Patients in whom incidental polyps were identified between SPCs and general hospitals. only on histology were not included. Methods: NQAIS (National Quality Assurance and Improvement System) Results: 815 patients underwent cholecystectomy in the study time data for all appendicectomies performedonchildrenunder17inIreland period. Of these, 70 (8.8%) were identified pre-operatively as hav- between January 2014 and November 2017 was examined, and data relat- ing polypoid gallbladder lesions on ultrasound. Histological analysis ing to patient demographics, type of surgery, length of stay (LOS), mortal- confirmed the presence of polyps in 32 (46%) of patients. 38 (54%) ity, admission to critical care and re-admission rates were collected. did not have identifiable polyps. Of the 32 patients in whom polyp- Results: 9,906 children underwent appendicectomy during this pe- oid lesions were histologically identified, 29 (91%) were shown to riod, 7,919 (79.94%) of whom were treated in general hospitals, and have benign ‘pseudopolyps’ (polypoid cholesterolosis, papillary hy- 1,987 (20.06%) in SPCs. Children treated in SPCs were significant- perplasia, adenomyomatosis). Three patients were diagnosed with ly younger (10.07 v 11.65 years, p<0.0001). Children between 3-4 neoplastic polyps. Of the 32 patients in whom no polyps were iden- and 5-6 years were more likely to be operated on laparoscopically in tified, 13 (41%) had gallstones, and 8 (25%) had evidence of chron- SPCs (35% v 16.55%, p=0.0007, and 34.86% v 25.43%, p=0.021 ic cholecystitis. The remainder had no identifiable pathology. Polyp respectively), but above the age of 10 children in general hospitals size on US was not predictive of finding a polypoid lesion on his- were more likely to receive laparoscopic surgery (p<0.0001). Pre- tology (p=0.2113). However, all malignant polyps were larger than operative LOS was lower in SPCs, significantly in children between 8mm on imaging. 7 and 12, but children in general hospitals had lower overall LOS Conclusion: Ultrasound overestimates the prevalence of gallbladder (p<0.0001). Children treated in SPCs had lower 7-day and 30-day polyps. This study calls into question the rationale of current guidelines readmission rates (OR 0.7, p=0.03, and OR 0.77 p=0.0225 in the management of gallbladder polyps detected with ultrasonography. respectively). Conclusion: Most children undergoing appendicectomy in Ireland do so 94. Response Rates in Surgical Questionnaires: A Prediction Model in general hospitals, but being treated in an SPC may provide a marginal outcome advantage in younger children. V Meyer, R Pol, J Lange, M El Moumni, R El Gannamani 96. Incidence and Management of Low Grade Appendiceal Mucinous Neoplasm (LAMN) – A Single-Centre Experience Department of General Surgery, UMC Groningen, Hanzeplein 1, 9713GZ, Netherlands M Salama, W Shabo, B Sami, AR Nasr Introduction: A survey study is a relatively easy and widely used tool to gather information on patient outcomes and professionals’ expertise and Department of General Surgery, Our Lady of Lourdes Hospital, opinions. With the availability of email and online survey providers there Drogheda, Co. Louth, Ireland has been a huge surge in survey studies, but varying response rates and non-response bias threaten the validity of their outcomes. Every survey is Introduction: Low grade appendiceal mucinous neoplasms (LAMN) are unique, but the main commonality is response rate. Historically many rare and poorly-understood. Despite ultrasound, Computed aspects of study design have been influenced to alter response rate, but Tomography(CT) and colonoscopy availability, preoperative diagnosis as of date we still do not know what an “acceptable” or “high” response remains challenging. Currently there is no consensus regarding the ap- rate is. propriate management, and optimal surgical approach (open versus Aim: With the number of survey studies being undertaken there is laparoscopy). a clear need for understanding the average response rate, to learn Aim: To determine the incidence of LAMN in appendicectomy speci- what it is below par and finally how to influence it. We aim to mens, the role of preoperative imaging in their diagnosis and to evaluate provide an overview of variables influencing response rate and also the surgical approach for its management. propose a prediction model in order to approach what an average Method: A retrospective study of all cases of LAMN treated in our insti- response rate is. tution between 1ST January 2007 and 1ST January 2017 was carried out. Method/Results: We performed a systematic survey of the literature of the Data of all patients with histology confirmed LAMN were reviewed and last 10 years identifying all survey studies reporting on response rate in analysed. the surgical field. In 3600 included studies we identified 21 different Results: Out of 4163 appendicectomy carried out, 26 histology specimens factors which influence response rate such as survey mode, reminders, confirmed LAMN ( 0.62%) 11 males & 15 females (age 22-93 years). Of country of origin, interviewees and constructed a prediction model. the 22 who had Preoperative CT, LAMN was suggested in 16 patients. Conclusion: Interview studies are widely used, but the quality of surveys Four cases had no preoperative CT. Clinical presentation was variable, 12 and their response rates is heterogeneous at best. We provide a prediction presented with clinical acute appendicitis, 2 with left iliac fossa and 4 with model that aids researchers in survey development and shows researchers altered bowel. Seven cases were incidentally diagnosed. In this study, 11 what an average response rate should be. had laparoscopic appendicectomy, 4 had laparoscopic appendectomy with excision of caecal cuff and 7 had right hemi-colectomy . For asso- ’ 95. Do Children Undergoing Appendicectomy Have Better ciated pathology 2 had total colectomy ,1 Hartmann sprocedureand1 Outcomes In Specialist Paediatric Centres? ovarian abscess. Conclusions: The optimal surgical approach for treating LAMN remains RM O’Connell, S AbdElwahab, K Mealy controversial. There is debate concerning the use of laparoscopic versus open surgery. Laparoscopy is a safe and effective approach but care Department of General Surgery, Wexford General Hospital, Newtown should be taken to avoid iatrogenic rupture. The choice approach depends Road, Wexford, Ireland on surgeon experience. S166 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
97. An Audit of Contaminant Blood Cultures in Surgical Patients at SESSION 13: EVIDENCE BASED MEDICINE & ONCOLOGY Wexford General Hospital 99. KRAS, BRAF, MSI and CIMP Status in Mucinous Tumours of A Page, RM O’Connell, F Ofori-Kuma, S Khan, I Ivanovski, K Mealy, K the Colon and Rectum: A Systematic Review and Meta-Analysis Schmidt I Reynolds1, A Balhareth1,SFurney2, E Kay3, DA McNamara1,JHM 2 1 Department of General Surgery, Wexford General Hospital, Newtown Prehn ,JPBurke Road, Wexford, Ireland (1) Department of Surgery, Beaumont Hospital, Beaumont Road, Dublin Introduction: Contaminant blood cultures create a clinical and economi- 9, Ireland; cal burden, contributing to an increased length of stay, additional inves- (2) Department of Physiology & Medical Physics, Royal College of tigations and inappropriate antimicrobial use. Coagulase Negative Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Staphylococci (CoNS) are skin flora and represent 70-80% of contami- (3) Department of Pathology, Beaumont Hospital, Beaumont Road, nant cultures, however differentiation from true positive cultures requires Dublin 9, Ireland correlation of laboratory and clinical information. Aim: To identify the rate of contaminant blood cultures in surgical inpa- Introduction: Mucinous differentiation is present in 5-15% of colorectal tients at Wexford General Hospital before the introduction of blood cul- cancers (CRC). This subtype of CRC responds poorly to chemoradiother- ture taking sets in March 2018. apy and is associated with an overall worse prognosis for patients. It is Method: Inpatients between 1st December 2017 and 1st March 2018 were likely that this cancer develops due to mutations in alternative genetic identified. The electronic lab system was used to identify those with posi- pathways when compared to non-mucinous adenocarcinoma and this in tive cultures during this time period. Each culture taken was considered turn may in part be responsible for it's reduced response to chemoradio- separately. We recorded the organism isolated, number of positive bottles therapy and poor prognosis. and comments from Microbiology. We used patient records to identify the Aim: The aim of this study was to determine the KRAS, BRAF, MSI and reason for inpatient admission and episodes of sepsis during admission. CPG island methylator phenotype status in mucinous versus non mucin- Results: 177 sets of blood cultures were recorded between 1st December ous CRC. 2017 and 1st March 2018. 23 positive cultures were identified. 8 blood Method: A systematic review and meta-analysis was undertaken. cultures (4.52%) were identified as contaminants on review of laboratory All studies that compared KRAS, BRAF, MSI and CIMP status and clinical data; 7 of these isolated CoNS and a further 1 blood culture between patients with mucinous and non-mucinous CRC were grew Micrococcus Luteus which was identified as a contaminant. considered for inclusion. A random-effects model was used for Conclusion: Contaminants account for a significant proportion of positive analysis. cultures in surgical inpatients at WGH. Blood cultures in our institution Results: Mucinous CRC was significantly associated with KRAS muta- are taken by syringe and are subsequently transferred into blood culture tions (OR 1.46, 95% CI 1.08-2.00, p = 0.014), BRAF mutations (OR bottles, potentially increasing the opportunity for contamination. 3.49, 95% CI 2.50-4.87, p<0.001), microsatellite instability (OR 3.98, 95% CI 3.30-4.79, p<0.001) and CIMP high subtype (OR 3.56, 95% 98. Continuing Education of NCHDs Improves the Appropriateness CI 2.85-4.43, p<0.001). of PPI Prescribing in Surgical Patients Conclusion: Mucinous CRC are more likely to have KRAS and BRAF mutations. Furthermore they are more likely to demonstrate MSI and be F Howley, L O'Connell, RM O'Connell, OAhmed, K Schmidt, I of the CIMP high subtype. The progression of this subtype of colorectal Ivanovski, S Khan, F Ofori-Kuma, K Mealy cancer along alternative genetic pathways may account in part for the resistance to treatment and worse prognosis observed in mucinous ade- Department of Surgery, Wexford General Hospital, Newtown Road, nocarcinomas. Based on these findings mucinous CRC may be less likely Wexford Town, Ireland to respond to treatments commonly used in CRC such as 5-Fluorouracil and EGFR inhibitors. Introduction: Proton pump inhibitors (PPIs) are the mainstay in treatment of acid-related disorders. However, the prescribing rate is out of propor- 100. Overall Survival of Unresectable Melanoma at Galway tion to the known prevalence of acid-related disorders. University Hospital between 2005 And 2017: A Retrospective Review Aim: The aim of this study was to assess the impact of Non-consultant Hospital Doctors’ (NCHDs) education on PPI prescribing practice in A Bhardwaj1, P Donnellan2 Wexford General Hospital. Methods: A prospective review of the clinical notes and drug kardex of (1) Department of Clinical Research, National University of Ireland, surgical inpatients was carried out over a four-month period. Admitting Galway, Ireland; diagnosis, comorbidities and concurrent medications were documented, (2) Department of Oncology, Galway University Hospital, Galway, Ireland along with whether a PPI was prescribed. Weekly teaching sessions were used to educate NCHDs on the PPI prescribing guidelines. One year later, Introduction: Malignant melanoma is a type of cancer that develops from a re-audit was carried out over a three-month period for comparison. melanocytes. It can spread to a regional or distant site that makes it Standards published by Scarpignato et al (2016) were used to identify difficult to resect and gradually lowers the life tendency of survival. whether a PPI was appropriately prescribed. Aim: To describe the overall survival rates among the patients diagnosed Results: Our results showed a marked decrease in the rate of inappropriate with unresectable melanoma. PPI prescribing over a one-year interval (70% inappropriate in 2017 vs Methods: Data were retrospectively collected from the radiotherapy and 23% in 2018). Of those patients prescribed a PPI de novo on admission, histopathology database, MDM list, clinical trial unit, hospital pharmacy the decrease was even more marked (72% vs 29%). Biliary pathologies and PAS system between 2005 and 2017. Data collected included patient were the most common diagnoses among those inappropriately pre- demographics and clinic-pathological characteristics, date of unresectable scribed a PPI. Esomeprazole is the most commonly prescribed PPI. melanoma, anatomical location, treatment received. Overall Survival was Conclusions: The rate of inappropriate PPI prescribing in Wexford reported using the Kaplan-Meier survival curve in survival rates and General Hospital has decreased following ongoing NCHD education. median survival using SPSS. Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S167
Results: A total of 116 patients met the study criteria, with 6.9% (n=8) at (1) Department of Academic Surgery, Cork University Hospital, Wilton, stage III, mean age of 65yrs and 93.1% (n=108) at stage IV, mean age of Cork, Ireland; 63 years, of clinical unresectable melanoma, where 58.6% (n=68) were (2) Department of Radiology, Cork University Hospital, Wilton, Cork, males and 41.4%(n=48) were females. At the end of the study 51.7% Ireland (n=60) males and 30.2% (n=53) females were died. The overall survival rate for unresectable melanoma was 18.1%, with 95% of CI (10.90 to Introduction: It is long established that inflammation promotes and neg- 16.70%). For the patients at stage M0 was 85.70%, at stage M1a was atively impacts cancer. Obesity correlates with a basal inflammatory state 50%, at stage M1b 15.4% with 95% of CI (9.59 TO 51.38%) and at stage, as does sarcopenia. M1c was 9.3% with 95% of CI (8.48 to 14.60%). Aim: To explore if such body composition parameters (BCPs) can be Conclusion: Among patients, unresectable melanoma was predomi- used as surrogates for inflammation to predict outcomes in colorectal nant in males with higher mortality. Patients at stage M1c had the cancer (CRC) and whether this effect can be modulated using periopera- lower overall survival rate with high mortality than the patients at tive anti-inflammatory therapy. earlier stages. Method: Patients with non-metastatic CRC presenting for elective resection were analysed. Exclusion criteria included: active/ 101. Simultaneous Resection of Colorectal Carcinoma and Liver chronic infection; chronic inflammatory conditions; anti-inflamma- Metastatis, A Safe Alternative tory/steroid use. IV Taurolidine (treated) or 0.9%saline (placebo) were administered perioperatively. Pre-operative cytokine levels were measured using standard ELISA. Volumetric measurement, GW de Klein1, VB Nieuwenhuijs1,GAPatijn1,MSLLiem2, JM Klaase3, on pre-operative staging CT, of total, visceral and subcutaneous HL Van Westreenen1 adiposity and sarcopenia at lumbar level using standard OsiriX software was performed. Ratio of visceral (V:TFR) and (1) Department of Surgery, Isala Zwolle, Dokter van Heesweg 2, 8025 AB subcutaneous:total fat area (SC:TFR) were calculated. BCPs were Zwolle, Netherlands; compared to operative (post-operative infection) and oncological (2) Department of Surgery, Medisch Spectrum Twente, Koningsplein 1, [early recurrence (<2years) and disease-specific mortality] 7512 KZ Enschede, Netherlands; outcomes. (3) Department of Surgery, Universitair Medisch Centrum Groningen, Results: Sixty patients were included (N=28 placebo, N=32 treat- Hanzeplein 1, 9713 GZ Groningen, Netherlands ed). Median age was 69 years (range 59-72). BCPs at baseline were comparable between groups. In the placebo group, sarcopenia Introduction: As much as 25-30% of the patients presenting with colo- was significantly associated with post-operative infection [OR 1.2 rectal carcinoma has metastatic disease, mostly liver metastases. If resect- (0.34-1.54) p=0.04] and early recurrence [OR 1.29 (0.37-1.62) able, a simultaneous resection is increasingly performed, because of faster p=0.03] while high V:TFR was significantly associated with post- recovery, shorter length of stay, and efficiency. operative infection [OR 1.3 (0.63-1.64) p=0.03, early recurrence Aim: This study evaluates the safety and applicability of simultaneous infection [OR 1.3 (0.63-1.64) p=0.03] and disease-specific mortal- resection. ity infection [OR 1.3 (0.63-1.64) p=0.03]. These significant asso- Method: Patients with colorectal carcinoma and synchronous liver ciations were not observed in the treated group. metastasis who were treated with simultaneous resection between Conclusion: CT-measured BCPs are predictive of outcomes in non- July 2013 and September 2017 were included. Patients only treat- metastatic CRC. These significant associations were not observed in pa- ed with radio frequency ablation (RFA) were excluded. Patients tients treated with a perioperative anti-inflammatory. were analyzed on morbidity and mortality. Clavien-Dindo scores of 3 or higher (re-intervention) were considered as significant morbidity. Subgroups were analyzed in order to identify risk groups. Results: For this analysis 54 patients were included. The colorectal resection was performed 38 times for colon carcinoma and 16 times Round 1 : n(%) Round 2 : n(%) for rectal carcinoma. In 7 cases the liver resection was major (3 15/02/2017 to 29/08/2017 to Couinaud segments or more). The operation was performed 15/03/2017 29/09/2017 laparoscopically in 8 patients, 40 patients had open surgery, and 6 patients had partly open and partly laparoscopic surgery. No post- Presentation cards analysed. 63 45 operative mortality was reported. In 20% of the patients, significant Presentations within 24 hours of morbidity occurred. Unplanned hospital readmission occurred in MHI 30% of the patients, for various reasons. Morbidity for colon resec- Inclusion criteria fulfilled 30 23 tion and rectal resection was not different. No higher morbidity was NICE criteria fulfilled and CT 5/5 (100%) 2/2 (100%) reported for major liver resections relative to minor resections, 0% performed and 23% respectively (p=0,32). NICE criteria not fulfilled and 7/25 (28%) 4/21 (19%) Conclusion: Simultaneous resection in both colon carcinoma and rectum CT performed carcinoma with liver metastasis can be performed safe in a selective group Patients >65years old 6/30 (20%) 9/23 (28%) of patients, even with major liver resection. 30-day re-presentation rate 1/30 (3%) 3/23 (13%) 102. The Association of Body Composition Parameters, as a Presentations more than 24 Surrogate for Inflammation, on Outcomes in Non-Metastatic hours of MHI Colorectal Cancer May be Modulated Using Anti-Inflammatory Presentations 11 10 Therapy CT performed 10/11 (91%) 10/10 (100%) Patients >65years old 3/11 (27%) 0/10 (0%) CFleming1,EO’Connell1, R Kavanagh2,PO’Leary1,MMaher2,OJ O’Connor2, P Redmond1 30-day re-presentation rate 0/11 (0%) 2/10 (20%) S168 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171
103. Nurse Specialist Support in Sarcoma Services: An Analysis in mortality. These authors are continuing the audit cycle and implementing Unscheduled Workflow education sessions to increase use of the sepsis screening form.
U Hayden, C Clancy, C Gibbons, A Gillis, PF Ridgway 105. Attitudes and Beliefs of Clinicians Regarding Barriers and Enablers in Conducting Perioperative Clinical Trials: A Qualitative Department of Surgery, Tallaght University Hospital, Tallaght, Dublin Study 24, Ireland DWaters2,ELitton1,NZeps1, T Corcoran1,ANichol1,NMcDonnell1,L Introduction: Clinical Nurse Specialists (CNS) play a crucial role in Higgins1,NGobat1, P Sukumar1,SWebb1 supporting patients with Sarcoma. Frequently, the nurse-patient interac- tion is a key determinant in the efficiency of service delivered. Relatively (1) Department of Intensive Care, St John of God Hospital, Subiaco WA little is known about workflow of such direct patient contact roles as they 6008, Australia; pertain to workforce planning. (2) Department of Urology, Galway University Hospital, Galway, Ireland Methods: We sampled 127 patients from our prospective database at one centre over a 2.5 year period. Study period commenced on the Introduction: Clinical trials are required to determine which treatment plans first interaction between CNS and patient in the lead up to diagnosis are most effective and most cost-effective. Integrating clinical trials in routine and ended 30 days after completion of their definitive initial treat- clinical practice is a proposed method of increasing participation in clinical ment to reduce long follow-up biases. Time spent in direct patient trials. The attitudes and beliefs of clinicians undertaking clinical trials is a key contact was recorded and rounded to nearest minute. Other details component in conducting a successful trial. Our aim is to identify barriers or were also recorded such as where the contact occurred (ward, clinic, enablers perceived by surgeons and anaesthetists that would be necessary phone) and whether it was pre or postoperative. Quality of interac- and sufficient to conduct clinical trials in peri-operative medicine. tions were studied with a non-blinded questionnaire. Time spent co- Method: Semi-structured interviews were conducted. Interviews were ordinating MDT/diagnostic/treatment were excluded. Data was audiotaped, transcribed and analysed with NVIVO software. analysed non-parametrically. Results: Only 5/18 clinicians were actively involved in research. When Results: All patients had a positive view of the CNS-patient interactions. asked if they would like to be doing some research or more than they are A mean of 208 minutes were spent with each patient journey studied. currently doing; 7 were interested in doing more, 5 were not interested and Slightly more pre versus post treatment interactions were seen, which was 6 might be interested depending on the circumstances. Absolute barriers to statistically significant (p=0.012). Surprisingly, a significantly less pro- involvement were that the trial is feasible, design is valid and that they feel portion (28%) of interactions occurred as an inpatient in contast to pre- the research question is important. The 2 greatest enablers for involvement treatment (46%). were a personal interest in knowing the answer to the question and the Conclusion: These data suggests a significant amount of time is spent by availability of research/administrative staff to assist with the trial. The avail- the CNS in unscheduled, much valued, direct patient contact. This key ability of research and administrative staff is a strong enabler and was nursing role should be protected by adequate nursing resourcing as well mentioned by most clinicians. Unsurprisingly lack of spare time and in- as clerical support to mitigate against time spent in co-ordination roles. creased workload were identified as the two main barriers to participation. Conclusion: Most clinicians would be interested in participating in re- 104. An Audit of Local Implementation of the National Surviving search given the right circumstances. This highlights the importance of Sepsis Campaign Sepsis Screening Form dedicated research staff in order to maximize participation of clinicians. 1 ’ 2 2 1 3 1 SStam,KOKelly , JAM Jais , N Foley , V Hamilton , F Cooke 106. Fasting Times Before and After Surgery - Evidence for Recent Recommendations (1) Department of Surgery, University Hospital Waterford, Dunmore Road, Waterford, Ireland; PKielty,DSleeman (2) School of Medicine, University College Cork, Cork, Ireland; (3) Department of Anaesthesia, University Hospital Waterford, Ireland Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: Sepsis is ‘life-threatening organ dysfunction caused by a dysregulated host response to infection’. The surviving sepsis campaign Introduction: Fasting leads to headaches, nausea, dehydration and mal- run by the HSE published its initial guideline in 2014. Since then there nutrition. By recognising and avoiding the detrimental effects of malnu- has been a 20% reduction in sepsis related mortality in Irish hospitals. trition, the surgical team can help to directly improve patient outcomes. Aims: The aim of this audit was to examine compliance with the sepsis Methods: An electronic search of the literature was performed using the screening form in surgical patients. PubMed database and The Cochrane Librarytoidentifyarticlesrelevantto Methods: Charts were reviewed on 5 surgical wards in UHW over two 2- the subject area. Studies were then assessed for inclusion eligibility and appli- week periods in November 2017 and February 2018. Note was made of cability to the subject area, initially based upon title and abstract, and subse- any patient with a temperature spike. Charts were interrogated for a sepsis quently by reading the entire articles of those considered potentially relevant. screening form. In addition, data collated included compliance with sepsis Results: A total of fifteen studies were included in the review. The in- 6 bundle. creased nutritional needs of the surgical patient are now well documented Results: Of 330 national early warning score charts (NEWS) reviewed, on in the literature. By optimising a patient’s pre- and post-operative nutri- 5 surgical wards, 24 patients were noted to have had a temperature spike. tional status, health professionals can help to mitigate the effects of sur- Of these, only 2 had a formal sepsis 6 form completed. Incidentally, these gery, disease and infection on the healing process. two patients were the only ones to have had a lactate measurement, and Conclusion: Modern surgical practice has seen a departure from were the only patients who had full adherence to the sepsis 6 bundle of care protracted periods of fasting surrounding the surgical period. The integra- (p<0.001). 66% of patients had blood cultures taken (p=0.394), and urine tion of the dietician into the multidisciplinary surgical team allows for output monitoring (p=0.296). Only 8% of patients were given oxygen. early screening of nutritional status, calculation of energy requirements Conclusion: Sepsis screening is not simply a ‘form filling exercise’;itis via indirect calorimetry where available, and pre- and post- procedure an important tool to aid early recognition and management of sepsis. The prophylaxis against malnutrition. While some patients require special early recognition of sepsis is associated with lower morbidity and consideration (diabetics, trauma patients, those with GORD or those at Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S169 risk of gastric or intestinal paresis, for example), the importance of con- group (WMD: 0.98, P :< 0.04).However no significant difference was sistently meeting a patient’s nutritional demands throughout the surgical observed between the two groups in in terms of radiological anastomotic journey is well documented in the literature, and aids both the patient and dehiscence (RR: 0.77, 95% CI: 0.39 to 1.53) mortality rate (RR: 0.83, the surgical team in achieving an optimal result. 95% CI: 0.39–1.77),surgical reinterventions(RR: 1.07, 95% CI: 0.52 to 2.21), wound infection(RR: 1.08, 95% CI: 0.45 to 2.60) or respiratory 107. Re-audit on Appropriateness of Head Computed Tomography complications(RR: 0.81,95% CI: 0.43 to 1.56). in Minor Head Injury (MHI) Presenting to Emergency Department, Conclusions: Prophylactic use of pelvic drains after infraperitoneal anas- University Hospital Waterford from 29th August 2017 to 29th tomosis does not confer any benefit against anastomotic leakage or other September 2017 postoperative complications.
AS Aprjanto1, SA Sallihudin2, SH Siddiqui1, A Abdulrazak1,D 109. Safe Adoption of Robotic Colorectal Surgery Using Structured Fitzgerald1, M Doyle1, B McCann1 Training: Early Irish Experience
(1) Department of Emergency Medicine, University Hospital Waterford, M Aradaib, P Neary, A Hafeez, R Kalbassi, D O’Riordain Dunmore Road, Waterford, Ireland; (2) Department of Medical, Connolly Hospital Blanchardstown, Dublin Department of General and Colorectal Surgery, Beacon Hospital, 15, Ireland Beacon Court, Sandyford, Ireland
Introduction: Re-evaluating adherence to appropriate imaging for adults Introduction: Robotic surgery enhances the precision of minimally inva- presenting with minor head injury (MHI) to University Hospital sive surgery through improved three-dimensional views and articulated Waterford(UHW) Emergency Department as outlined in NICE ‘Head instruments. There has been increasing interest in adopting this technol- Injury’ Guideline 176. Results compared to previous department audit ogy to colorectal surgery and this has recently been introduced to the Irish performance. health system. Methods: Patients triaged as Head Injury on IPMS, 15/02/2017 to 15/03/ Aim: This paper gives an account of our early institutional experience with 2017 [Round 1] and 29/08/2017 to 29/09/2017 (Round 2).Data from adoption of robotic surgery in colorectal service using structured training. individual cards presenting with MHI were analysed in spreadsheets. Methods: Analysis of prospectively maintained database for 55 consecu- Results: Presentations with MHI were [n=63] vs. (n=45). Presentations tive cases performed by 4 colorectal surgeons, at the beginning of their category; Category 2 [3/63] vs. (1/45), Category 3 [37/63] vs. (25/45), robotic experience, undergoing training as per the European Academy of Category 4 [23/63] vs. (18/45) and Category 5 [0/63] vs. (1/45). Robotic Colorectal Surgery (EARCS) programme. CT scans performed on those fulfilling criteria [5/5(100%)] vs. (2/ Results: Fifty-five patients underwent robotic surgery between January – 2(100%)). No patients were admitted for observation. No patients have 2017 and January 2018 (M:F, 34:21). Median age 60 years (35 87). 33 GCS less than 13. patients had colorectal cancers (11 received neoadjuvant chemoradiother- Conclusion: UHW emergency department is delivering good standard apy). 21.8% of patients had BMI>30. Procedures performed were low of care for adult patients presenting with MHI. All cases fulfilling anterior resection (n=19), sigmoid colectomy (n=9), right colectomy (n=22), ventral mesh rectopexy (n=3), APR (n=1) and reversal of imaging criteria were appropriately imaged. Case-by-case decisions ’ – were made as deemed appropriate by the medical practitioner. Hartmann s procedure (n=1). Median blood loss 40 ml (0 400). Mean operative time was 233 minutes (SD: 79.07) for right colectomy and 368 SESSION 14: LOWER GI minutes (SD: 104.65) for anterior resection. Median hospital stay was 6 days (IQR: 5–7). No 30-day mortality, intraoperative complications, con- 108. Role of Pelvic Drains in Infraperitoneal Anastomosis: A version nor anastomotic leakage. Median LN harvest was 15 in non- – – Systematic Review and Meta-Analysis neoadjuvant cases (range:7 23) and 8 in neoadjuvant cases (range:2 14). Conclusion: Our early results demonstrate that colorectal robotic surgery HHidayat,AZafar is feasible and can be adopted safely through structured training without compromising clinical or oncological outcomes Department of Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland 110. Sedation and Bowel Preparation for Colonoscopy in Elderly: A Nationwide Survey in Ireland Introduction: Colorectal surgery mostly involves the formation of infraperitoneal anastomosis. Pelvic sepsis resulting from anastomotic HHamid1, A Zafar1,BEgan2,LO’Donnell2,IKhan1 leakage is one of the major complications after rectal surgery. All the data available on the role of prophylactic pelvic drainage in infraperitoneal (1) Department of Surgery, Mayo University Hospital, Castlebar, Co. anastomosis is divergent and remains to be validated. Mayo, Ireland; Aim: To assess the efficacy and safety of the prophylactic use of pelvic (2) Department of Gastroenterology, Mayo University Hospital, drains in infraperitoneal anastomosis Castlebar, Co. Mayo, Ireland Methods: Electronic databases such as MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Introduction: The practice of colonoscopy in elderly is not standardized in Controlled Trials were searched for randomised controlled trials (RCTs) Europe. comparing pelvic drainage with non-drainage as intervention groups after Aim: To assess the current sedation and bowel preparationpractices for infraperitoneal anastomosis. Meta-analysis was conducted following colonoscopy in eldelrly Irish patients. PRISMA guidelines. Methods: A structured 21 item questionnaire was mailed to 204 consul- Results: Four RCTs describing outcomes in 1122 patients were included. tant surgeons and adult gastroenterologists. Endoscopists’ routine of el- Patients who received prophylactic pelvic drains after infraperitoneal derly patients monitoring, sedation, and bowel preparation methods for anastomosis did not significantly differ from the non-drainage group in colonoscopy were assessed. The endoscopists’ perceived barriers to op- terms of anastomotic dehiscence rate(risk ratio (RR) 1.06, 95% confi- timal bowel preparation were evaluated. dence intervals (CI) 0.72 to 1.56; P :0.77) .Patients in the non-drainage Results: A 48.5% (99 endoscopists) response was obtained. The respon- group had a significantly shorter length of hospital stay than the drainage dents performed an average of 13 colonoscopies per week. The majority S170 Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 of colonoscopies in elderly patients (95%) were carried out under seda- delineate tumour deposits at hepatectomy. We aimed to assess the corre- tion. The most frequently used agent for sedation in elderly was midazo- lation between IOUS and preoperative imaging in patients undergoing lam in 90%, while propofol and diazepam were preferred in 6% and 4% surgery for colorectal liver metastases (CRLM) of the cases, respectively. Respondents routinely monitored vital signs Methods: From 2013, all patients undergoing hepatic resection for CRLM and pulse oximetry (100%), and/or electrocardiography (35%), and sup- were included for analysis. Demographic data was sought from a contem- plemental oxygen was routinely administered in 90% of the cases. poraneous database and interrogated retrospectively. Primary outcome Endoscopists’ satisfaction with sedation was greater among those using measured was concordance between the surgical plan made following propofol than in the groups using conventional sedation (score on a 10- multidisciplinary discussion and final operative notes. In cases where point visual analogue scale, 9.5±0.8 vs. 8.3±0.9, p = 0.003). Sixty-two additional lesions were seen intraoperatively or noted to be in a different percent of the respondents used polyethylene glycol for bowel prepara- position to preoperative imaging, or if lesions seen preoperatively were no tion in elderly, and 88% respondents believed that patients-related factors longer visible, discordance was noted. were the main barriers to optimal bowel preparation. Results: All patients who underwent CRLM resection with IOUS were Conclusion: Use of sedation and physiologic monitoring is currently the included for analysis. 127 patients underwent hepatectomy over a 5 year standard practice during colonoscopy in elderly Irish patients. period. One patient was excluded due to incomplete data. Forty seven pa- Benzodiazepines remain the most commonly used sedative agents. tients (37%) had discordance between preoperative imaging and intraoper- Patients-related barriers are the prime contributors to poor bowel prepa- ative ultrasonography. Twenty eight patients (28/126- 22%) had further ration in the geriatric population. metastatic deposits identified, 12/126 (10%) had preoperatively identified metastases unidentifiable at the time of surgery and 7/126 (6%) had a known 111. Systematic Review and Meta-Analysis of Randomised Trials lesion identified in a location which changed the plan of resection. Comparing Primary Resection and Anastamosis with Hartmann’s Conclusions: The number of cases where lesions were not identifiable with Procedure for the Management of Acute Perforated Diverticulitis IOUS at the time of surgery is an interesting finding which shows how with Generalised Peritonitis IOUS can contribute to tissue sparing surgical techniques. The significant number of new lesions identified on IOUS demonstrates the importance of ÉJ Ryan, B Creavin, OK Ryan, ME Kelly, DC Winter thorough scanning to ensure full metastatic clearance is achieved.
Department of Colorectal Disease, St Vincent’s, Elm Park, Dublin 4, Ireland 113. The Feasibility of Laparoscopy for Complicated and Uncomplicated Paediatric Appendicitis in a District Hospital Setting Introduction: Surgical strategies for acute perforated diverticulitis with generalised peritonitis (Hinchey III/IV) remain controversial. H Hamid, A Maatough, F Atwan, A Khadr, H Ajeeb, S Mansoor, D Aim: To compare the safety and clinical efficacy of primary resection and Toomey, T Ejaz anastomosis (PRA) with the Hartmann’s Procedure (HP) for Hinchey III/ IV diverticulitis from published randomised control trials (RCTs). Department of Surgery, Mullingar Regional Hospital, Mullingar, Co. Methods: A systematic literature search was conducted through PubMed/ Westmeath, Ireland MEDLINE, Embase and the Cochrane Central Register of Clinical Trials to identify RCTs that involved patients with Hinchey III/IV diverticulitis. Data Introduction: Studies have demonstrated considerably better outcomes of extraction was performed according to the guidelines and recommendations laparoscopy in comparison to open approach in management of paediatric from the preferred reporting items for systematic reviews and meta-analyses complicated appendicitis. The extent to which published laparoscopy checklist (PRISMA). The methodological quality of the included studies outcomes are transferable to routine practice beyond high-volume paedi- was assessed systematically (GRADE criteria) and a meta-analysis was atric tertiary centres is currently unknown. conducted using a random effects model to control for heterogeneity. Aim: The aim of this study is to evaluate the short-term outcomes of Results: After the removal of duplicates three randomized controlled trials paediatric laparoscopic appendicectomy in an Irish district hospital. were identified from 251 potential studies. The analysis included 254 Methods: The medical records of all patients (< 16 years) who underwent patients of whom 116 underwent PRA. Overall, after combining the first appendicectomy between January2014andDecember2015were (emergency surgery) and second (stoma reversal) procedures, the stoma reviewed. Patients who had laparoscopic appendicectomy for pathologi- reversal rate was 94/111 (84.7%) in the PRA group and 80/130 (61.5%) in cally proven inflamed appendix were divided into complicated and un- the HP group (Odds ratio persistent stoma 3.12, 95% confidence interval complicated groups based on the description of the operative note. 1.67 – 5.84 in favour of HP) There was no significant difference in 30-day Results: There were 154 patients included in our study. Conversion rate mortality, major complications and stoma rates after the first operation or was 1.3%. Thirty-six (23.4%) had complicated appendicitis. The median for major morbidity and mortality overall. age at diagnosis was 11, and most (73%) of the procedures were per- Conclusion: This systematic review demonstrates that PRA used in the formed by general surgeons. Nine (5.8%) had at least one postoperative management of Hinchey grade III/IV diverticulitis leads to a higher stoma complication, and surgical site infection occurred in three (1.9%) patients. reversal rate, with no compromise to patient safety compared with the The uncomplicated group had earlier resumption of soft diet, shorter standard management, HP. operative time and hospital stay, and fewer postoperative morbidities and readmission rates compared to the complicated group. 112. The Impact of Intraoperative Ultrasonography on Resection of Conclusions: Both uncomplicated and complicated paediatric appendici- Colorectal Liver Metastases tis can safely be managed in a district hospital setting using minimally invasive approach, with internationally comparable short-term outcomes. SDoran1, S Brennan2,HMoriarty2,FHand1, PS Waters1, JC Conneely1, G McEntee1,LLawler2, T Geoghegan2, H Fenlon2 114. Outcomes of Laparoscopic Hepatectomy as Compared to open Resection for Colorectal Liver Metastases (1) Department of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland; F Hand, C Toale, R Lahani, S Cassidy, PS Waters, G McEntee, JC Conneely (2) Department of Radiology, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland Department of Surgery, Mater Misericordiae Hospital, Eccles Street, Dublin 7
Introduction: Despite preoperative imaging with CT, PET CT and MRI, Introduction: Minimally invasive surgery in the management of colorec- intraoperative ultrasound (IOUS) is routinely used to definitively tal liver metastases (CRLM) is increasing. Laparoscopic liver resection is Ir J Med Sci (2018) 187 (Suppl 4):S115–S171 S171 associated with reduced overall morbidity and favourable outcomes when toms, five were due to inadvertent dislodgement). Time to reinsertion compared to open resection. Here we report outcomes of laparoscopic ranged from 2 to 107 days, average 33 days. 29 (35%) had no further liver resection from a single centre, comparing morbidity and overall intervention post removal of cholecystostomy. One required subsequent survival to those undergoing open resection. drainage of a hepatic abscess. Nine patients died of non-cholecystostomy Methods: All consecutive liver resections performed from 1 January 2012 related illness during the three year follow-up period. to 31 December 2016 were included in our analysis. Patients undergoing Conclusion: Cholecystostomy remains an important treatment method of liver resection for indications other than CRLM were excluded. A pro- acute cholecystitis in the short term, or as an alternative treatment option spectively maintained database was interrogated for clinicopathological in those unsuitable for surgery. variables, operative details and postoperative outcomes. Survival curves were measured using Kaplan Meier. 116. The Significance of Mucin Pools Post Neoadjuvant Results: A total of 145 patients underwent resection of CRLM in the Chemoradiotherapy for Locally Advanced Rectal Cancer study period, 30 (20.7%) of whom underwent laparoscopic resection. I Reynolds1, DA McNamara1, EW Kay2, JHM Prehn3, B O'Neill4,J Median operative time in the laparoscopic group was 2.5h with 4 patients Deasy1,JPBurke1 (13.3%) requiring intraoperative blood transfusion. When outcomes of the laparoscopic group were compared to those post open resection; ma- 1. Department of Surgery, Beaumont Hospital, Beaumont Road, Dublin jor complications (Clavien Dindo grade 3 or more) were seen in 3.3% of 9, Ireland; the laparoscopic group versus 9.5% in the open resection group (p=0.46). 2. Department of Pathology, Beaumont Hospital, Beaumont Road, While the laparoscopic group had a better 3 year survival (89.6% vs Dublin 9, Ireland; 71.9%), no significant difference was appreciated in overall survival be- 3. Department of Physiology & Medical Physics, Royal College of tween groups (p=0.294). Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Conclusion: With careful patient selection, laparoscopic liver resection is fea- 4. Department of Radiation Oncology, Beaumont Hospital, Beaumont sible and can result in improved postoperative outcomes. Our experience Road, Dublin 9, Ireland indicates a number possible benefits following a laparoscopic approach includ- ing reduced major complication rate and comparable oncological outcomes. Introduction: Neoadjuvant radiotherapy is utilized for locally advanced rectal cancer to optimize local control. A subset of patients form mucin 115. Outcomes of Patients Treated With Upfront Cholecystostomy pools following radiotherapy but the effect of mucin pools on clinico- ForSevereAcuteCholecystitis pathological outcomes following curative proctectomy for rectal cancer remains unknown. T DeGeus,¹ HK Moriarty.,¹ R Fleck2, F Hand2, PS Waters,² JC Aim: The aim of this study was to determine the effect of mucin pools on Conneely,² G McEntee,² LP Lawler¹, T Geoghegan ¹, C Farrelly¹ clinicopathological outcomes. Methods: A review of a prospectively maintained rectal cancer database ¹Department of Radiology, Mater Misericordiae University Hospital, Dublin was performed. Patients who underwent curative proctectomy following ²Department of Hepatobiliary Surgery, Mater Misericordiae University long-course chemoradiotherapy between January 2007 and December Hospital, Dublin 2016 were included. Survival was compared using Kaplan Meier curves and a log-rank test. Introduction: holecystostomy is an increasingly popular treatment method for Results: 494 patients underwent proctectomy for rectal cancer during the acute cholecystitis, both in patients unsuitable for surgery and those failing to study period and 297 patients were eligible for inclusion; of these 36 settle with conservative management. The purpose of this study was to assess (12.1%) had mucin pools on final histopathology. There were no differences the short and long term outcomes of patients post cholecystostomy. between patients with mucin pools and those without in age at diagnosis Methods: A review of consecutive patients who underwent percutaneous (p=0.096), sex (p=0.845), procedure type (p=0.568), tumour differentiation ultrasound and fluoroscopic guided cholecystostomy tube insertion over a (p=0.776), lymphovascular invasion (p=0.225), extramural venous invasion 3 year period (01/01/2015 to 31/12/2017) was performed. Patients were (p=0.222), perineural invasion (p=0.151), margin positivity (p=0.602), or identified using NIMIS and the hospital internal computer system. lymph node positivity (p=0.255). Tumours with mucin pools were less likely Outcomes assessed included; cholecystectomy, cholecystostomy reinser- to be ypT3/T4 (25.0% vs. 51.0%, p=0.003), were more likely to have a good tion, no further interventions, and mortality. response (83.3% vs. 53.6%, p<0.001) and more likely to have a complete Results: There were 63 patients in total (45 male,19 female). Patient age pathological response (41.7% vs. 19.2%, p=0.006). Mucin pool formation did range was 29 to 93, mean 70 years. 49 were transhepatic drain insertions, 2 not influence local recurrence (p=0.339), distant recurrence (p=0.086) or were direct gallbladder punctures. Route of insertion was not specified in 13 overall survival (p=0.142). cases. 45 patients (69%) had a subsequent tubogram to assess patency of the Conclusions: The presence of mucin pools following neoadjuvant che- cystic duct prior to catheter removal or to assess position (n=37). 16 patients moradiotherapy for rectal cancer represents a surrogate marker of re- subsequently underwent cholecystectomy (12 laparoscopic,4 open). 7 sponse to treatment and downstaging, but does not influence survival. (11%) had a cholecystostomy reinserted (2 were due to recurrence of symp-