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  1. Article ; Online: Regular follow-up with cervical cytology is of questionable value following surgical treatment of microinvasive cervical cancer.

    Ashmore, Ayisha A / Abdul, Summi / Phillips, Andrew / Bali, Anish / Tamizian, Onnig / Asher, Viren

    European journal of obstetrics, gynecology, and reproductive biology

    2024  Volume 296, Page(s) 307–310

    Abstract: Objectives: To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to ... ...

    Abstract Objectives: To assess the follow-up smears and their outcomes of patients with conservatively managed early-stage cervical cancer as per UK guidelines within our service. To evaluate whether intensive follow-up can detect pre-cancer early compared to the standard 3 yearly follow-up.
    Study design: Retrospective review.
    Methods: All patients treated for early stage (stage 1A1 and 1A2) with cervical cancer from 01/2002 to 01/2020 at University Hospitals of Derby and Burton were included. Patients who had initial hysterectomy were excluded from our analysis. Review conducted using electronic patient records for treatment, histology, and follow-up smears. Number of abnormal follow-up smears and number of recurrent cervical cancers were considered the main outcome measures.
    Results: 98 cases were identified. 81 (82.65 %) were stage 1A1 and 17 (17.35 %) were stage 1A2. 74 (75.51 %) patients had squamous histology and 24 (24.49 %) had adenocarcinomas. Median follow-up was 11.08 years (4043 days). 510 follow-up smears were performed, of which 33 (6.47 %) were abnormal. 5 of these abnormal smears showed low grade dyskaryosis (0.98 %) and 2 smears showed high grade dyskaryosis (0.39 %). The positive predictive value of follow-up smears to detect pre-cancerous changes was 5.71 %. There were no recurrent cancers detected.
    Conclusions: Microinvasive cervical cancer is effectively managed with conservative surgery. There were no recurrent cancers detected in our cohort during follow-up and there were only 2 high grade dyskaryoses detected (n = 2/510, 0.39 %). We therefore believe that reducing the intensity of follow up of these patients should be considered.
    MeSH term(s) Female ; Humans ; Uterine Cervical Neoplasms/pathology ; Uterine Cervical Dysplasia/diagnosis ; Follow-Up Studies ; Cytology ; Neoplasm Recurrence, Local ; Vaginal Smears ; Retrospective Studies
    Language English
    Publishing date 2024-03-19
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 190605-7
    ISSN 1872-7654 ; 0301-2115 ; 0028-2243
    ISSN (online) 1872-7654
    ISSN 0301-2115 ; 0028-2243
    DOI 10.1016/j.ejogrb.2024.03.020
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    Zs.A 837: Show issues Location:
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  2. Article ; Online: Denominator Based Studies Need Full Disclosure of the Origins of Patients Treated.

    Phillips, Andrew / Asher, Viren

    Annals of surgical oncology

    2019  Volume 26, Issue Suppl 3, Page(s) 876

    MeSH term(s) Carcinoma, Ovarian Epithelial ; Cytoreduction Surgical Procedures ; Disclosure ; Female ; Humans ; Ovarian Neoplasms ; Truth Disclosure ; Tumor Burden
    Language English
    Publishing date 2019-07-31
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-019-07651-x
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    Zs.A 4042: Show issues Location:
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  3. Article ; Online: What are the implications of radiologically abnormal cardiophrenic lymph nodes in advanced ovarian cancer? An analysis of tumour burden, surgical complexity, same-site recurrence and overall survival.

    Addley, Susan / Asher, Viren / Kirke, Rathy / Bali, Anish / Abdul, Summi / Phillips, Andrew

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2022  Volume 48, Issue 12, Page(s) 2531–2538

    Abstract: Introduction: Our paper evaluates the relationship between radiologically abnormal cardiophrenic lymph nodes (CPLN) in advanced ovarian cancer and pattern of disease distribution, tumour burden, surgical complexity, rates of cytoreduction and same-site ... ...

    Abstract Introduction: Our paper evaluates the relationship between radiologically abnormal cardiophrenic lymph nodes (CPLN) in advanced ovarian cancer and pattern of disease distribution, tumour burden, surgical complexity, rates of cytoreduction and same-site recurrence. Impact of suspicious CPLN and CPLN dissection on overall survival also determined.
    Materials and methods: Retrospective review of index CT imaging for 151 consecutive patients treated for stage III/IV ovarian malignancy in a large UK cancer centre to identify radiologically abnormal CPLN. Corresponding surgical, histo-pathological and survival data analysed.
    Results: 42.6% of patients had radiologically 'positive' CPLN on index CT. Radiological identification of CPLN involvement demonstrated a sensitivity of 82% within our centre. Patients with cardiophrenic lymphadenopathy on pre-operative CT had significantly more co-existing ascites (p = 0.003), omental (p = 0.01) and diaphragmatic disease (p < 0.0001). At primary debulking (PDS), suspicious CPLN were associated with significantly higher surgical complexity scores, without feasibility of complete cytoreduction being impacted. Cardiophrenic involvement at initial diagnosis was associated with same-site relapse at recurrence (p = 0.001). No significant difference in overall survival was demonstrated according to CPLN status following either PDS or delayed debulking (DDS). CPLN dissection did not improve patient outcomes.
    Conclusion: Radiological identification of abnormal CPLN is reliable. Suspicious CPLN appear to represent a surrogate marker of tumour volume - in particular, heralding upper abdominal disease - and should prompt anticipation of high complexity surgery and referral to an appropriate centre. Patients with prior CPLN involvement are more likely to develop same-site recurrence at relapse. Our survival data suggests cardiophrenic LN disease does not worsen patient prognosis and that the therapeutic benefit of CPLN dissection remains unclear.
    Language English
    Publishing date 2022-06-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2022.06.006
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    Zs.A 1149: Show issues Location:
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  4. Article ; Online: Neo-adjuvant chemotherapy does not reduce surgical complexity nor the accuracy of intra-operative visual assessment of disease in advanced ovarian cancer.

    Addley, Susan / McGowan, Mark / Crossland, Harriet / Johnson, Amoy / Asher, Viren / Bali, Anish / Abdul, Summi / Phillips, Andrew

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2023  Volume 49, Issue 11, Page(s) 107078

    Abstract: Aim: Compare the surgical complexity and histological accuracy of visual inspection of disease in patients undergoing primary debulking (PDS) versus delayed debulking surgery (DDS) following neo-adjuvant chemotherapy (NACT) for advanced ovarian cancer ( ... ...

    Abstract Aim: Compare the surgical complexity and histological accuracy of visual inspection of disease in patients undergoing primary debulking (PDS) versus delayed debulking surgery (DDS) following neo-adjuvant chemotherapy (NACT) for advanced ovarian cancer (AOC).
    Materials and methods: All patients undergoing PDS or DDS for stage III / IV AOC at a UK cancer centre between January 2014-October 2021 were included. Retrospective data was collected accessing an electronic gynaecological oncology database, operation and histology records. Comparative frequencies of surgical procedures performed were calculated for primary versus delayed cohorts; and correlation between intra-operative suspicion of disease and specimen histology at PDS and DDS compared.
    Results: N=232. PDS was performed in 45.3% and DDS in 54.7% of patients; achieving complete cytoreduction in 77.2%. Appendicectomy, pelvic and para-aortic nodal dissection were undertaken significantly more often at primary surgery; whilst right diaphragm stripping, pelvic peritonectomy, splenectomy and cholecystectomy were more likely following NACT. We found no variation in bowel resection rates between cohorts. For the majority of specimens, there was no difference in correlation between intra-operative suspicion of disease and final histopathology - with a significantly lower positive predictive value for visual assessment demonstrated only for liver capsule and pelvic peritoneum at DDS.
    Conclusion: NACT does not appear to reduce the complexity of surgery, including rates of bowel resection; nor accuracy of intra-operative visual assessment of disease. We therefore caution against both deferring to NACT to facilitate less radical delayed debulking; and any presumption that macroscopically abnormal tissue at DDS may represent inert post-NACT 'burn-out', mitigating indication for excision. We instead suggest reservation of the neo-adjuvant pathway for patients with poor PS and radiologically-confirmed surgical stopping points; and advocate equivalent and maximal cytoreductive effort to remove all visibly abnormal tissue in both the upfront and delayed surgical settings.
    MeSH term(s) Male ; Humans ; Female ; Neoadjuvant Therapy/methods ; Retrospective Studies ; Cytoreduction Surgical Procedures/methods ; Carcinoma, Ovarian Epithelial/pathology ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/surgery ; Ovarian Neoplasms/pathology ; Chemotherapy, Adjuvant/methods ; Genital Neoplasms, Male/pathology ; Neoplasm Staging
    Language English
    Publishing date 2023-09-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2023.107078
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    Zs.A 1149: Show issues Location:
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  5. Article ; Online: Does the character of the hospital of primary management influence outcomes in patients treated for presumed early stage endometrial cancer and atypical endometrial hyperplasia: a comparison of outcomes from a cancer unit and cancer centre.

    McGowan, Mark / Addley, Susan / Davies, James / Abdul, Summi / Asher, Viren / Bali, Anish / Dudill, William / Phillips, Andrew

    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

    2022  , Page(s) 1–6

    Abstract: A retrospective study from 2015 to 2020 comparing overall survival (OS) outcomes of a cancer unit and centre for presumed early stage endometrial cancers is presented. Cancer centres manage these presumed early endometrial cancer (EC) in situations of ... ...

    Abstract A retrospective study from 2015 to 2020 comparing overall survival (OS) outcomes of a cancer unit and centre for presumed early stage endometrial cancers is presented. Cancer centres manage these presumed early endometrial cancer (EC) in situations of complex co-morbidities, surgical challenges as well as their own local unit patients. Our analysis compares 138 patients at KMH (unit) and 282 patients at RDH (centre) on OS, patient demographics, grading histology and final histology. Patients with presumed early stage EC can be reassured regarding no difference in OS between the cancer unit and centre management (
    Language English
    Publishing date 2022-09-30
    Publishing country England
    Document type Journal Article
    ZDB-ID 604639-3
    ISSN 1364-6893 ; 0144-3615
    ISSN (online) 1364-6893
    ISSN 0144-3615
    DOI 10.1080/01443615.2022.2126753
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    Zs.B 2461: Show issues Location:
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  6. Article ; Online: Does the Performance of Splenectomy as Part of Cytoreductive Surgery Carry a Worse Prognosis Than in Patients Not Receiving Splenectomy? A Propensity Score Analysis and Review of the Literature.

    Davies, James / Asher, Viren / Bali, Anish / Abdul, Summi / Phillips, Andrew

    Journal of investigative surgery : the official journal of the Academy of Surgical Research

    2020  Volume 35, Issue 1, Page(s) 70–76

    Abstract: Background & objectives: Ultra-radical (UR) procedures, including splenectomy, are utilized to increase complete cytoreduction rates during Cytoreductive Surgery (CRS) performed with the aim of complete macroscopic clearance of disease. The purpose of ... ...

    Abstract Background & objectives: Ultra-radical (UR) procedures, including splenectomy, are utilized to increase complete cytoreduction rates during Cytoreductive Surgery (CRS) performed with the aim of complete macroscopic clearance of disease. The purpose of this study was to investigate if splenectomy negatively impacts survival when undertaken during CRS for advanced ovarian cancer (AOC) and compare published splenectomy and cytoreduction rates.
    Methods: A retrospective review of all consecutive patients who underwent cytoreductive surgery for AOC between 16/05/2013-28/01/2019. Survival, baseline patient characteristics, complications and surgical parameters were recorded. Propensity scored matching (PSM) was performed to reduce bias.
    Results: 154 patients identified over 71 months. 97 underwent standard, 57 underwent UR surgery, 27 patients received splenectomy (17.5%) No difference was seen in overall survival (OS) between all patients (median OS 34 months (95%CI 25.9-41.1) and patients who underwent splenectomy (median OS not yet reached) (p = >0.05). After PSM for various baseline covariates, no significant difference in splenectomy versus non-splenectomy patients (3-year survival 54% compared to 56%) (P > 0.05). Three splenectomy specific complications occurred; one each of pancreatic tail injury, left pleural effusion and streptococcal pharyngitis during chemotherapy. We found wide variation in utilization of splenectomy in published case series; from 9% to 35%.
    Conclusions: Splenectomy performed as part of CRS is not detrimental to survival in AOC. There is a wide variation in utilization of splenectomy in published case series with little correlation with cytoreduction rates.
    MeSH term(s) Cytoreduction Surgical Procedures/adverse effects ; Female ; Humans ; Ovarian Neoplasms/surgery ; Prognosis ; Propensity Score ; Retrospective Studies ; Splenectomy/adverse effects
    Language English
    Publishing date 2020-12-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639444-9
    ISSN 1521-0553 ; 0894-1939
    ISSN (online) 1521-0553
    ISSN 0894-1939
    DOI 10.1080/08941939.2020.1824043
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    Zs.A 2364: Show issues Location:
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  7. Article ; Online: Lactate Is a Reliable Predictor of ICU Length of Stay Following Ultra-radical Ovarian Cancer Surgery.

    Addley, Susan / McGowan, Mark / Asher, Viren / Bali, Anish / Abdul, Summi / Cullimore, Victoria / Crossland, Harriet / Phillips, Andrew

    Anticancer research

    2022  Volume 42, Issue 4, Page(s) 1979–1986

    Abstract: Background/aim: With a greater proportion of women with advanced ovarian cancer (AOC) successfully undergoing radical cytoreductive surgery, the demand on peri-operative resources - including intensive care (ICU) beds - is also on the rise. Extended ... ...

    Abstract Background/aim: With a greater proportion of women with advanced ovarian cancer (AOC) successfully undergoing radical cytoreductive surgery, the demand on peri-operative resources - including intensive care (ICU) beds - is also on the rise. Extended post-operative ICU length of stay (LOS) confers increased patient morbidity and mortality. Several variables associated with prolonged ICU LOS following AOC surgery have been identified. We aimed to evaluate the predictive value of serum lactate levels.
    Patients and methods: All patients undergoing ultra-radical surgery for AOC in a large cancer centre over a 34-month period between 2018-2021 were identified via the institution tumour registry. Data were collected retrospectively via electronic care and operating records; biochemistry, radiology, and histopathology databases.
    Results: In total, 63 patients were identified. Elevated intra-operative serum lactate levels were associated with significantly longer length of ICU post-operative stay. Longer time for hyperlactaemia to normalise following surgery also conferred significantly longer ICU, high dependency and total hospital LOS. Greater blood loss, higher surgical complexity and peritoneal carcinomatosis score, and longer operating time were associated with higher - and persistently elevated - peri-operative lactate levels.
    Conclusion: Serum lactate in the context of ultra-radical surgery for AOC represents an accessible and inexpensive marker with potential to not only reliably predict LOS, but also to serve as a dynamic prompt for early targeted intervention. Early recognition and correction of hyperlactaemia following AOC may reduce ICU LOS limiting both the resource pressure and patient morbidity/mortality sequelae.
    MeSH term(s) Female ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Ovarian Neoplasms/surgery ; Retrospective Studies
    Chemical Substances Lactic Acid (33X04XA5AT)
    Language English
    Publishing date 2022-03-28
    Publishing country Greece
    Document type Journal Article
    ZDB-ID 604549-2
    ISSN 1791-7530 ; 0250-7005
    ISSN (online) 1791-7530
    ISSN 0250-7005
    DOI 10.21873/anticanres.15676
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    Zs.A 1642: Show issues Location:
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  8. Article ; Online: Evaluation of changes to work patterns in multidisciplinary cancer team meetings due to the COVID-19 pandemic: A national mixed-method survey study.

    Soukup, Tayana / Winters, David / Chua, Kia-Chong / Rowland, Philip / Moneke, Jacqueline / Skolarus, Ted A / Bharathan, Rasiah / Harling, Leanne / Bali, Anish / Asher, Viren / Gandamihardja, Tasha / Sevdalis, Nick / Green, James S A / Lamb, Benjamin W

    Cancer medicine

    2023  Volume 12, Issue 7, Page(s) 8729–8741

    Abstract: Background: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on ... ...

    Abstract Background: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision-making, communication, or participation in the context of MDT meetings specifically.
    Methods: This was a mixed method, prospective cross-sectional survey study taking place in the United Kingdom between September 2020 and August 2021.
    Results: The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID-19 that MDTs would like to maintain. However, IT-related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID-19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = -5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = -4.537, p = 0.001) at MDT meetings.
    Discussion: Our study explored the perception of change since COVID-19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings.
    MeSH term(s) Humans ; Prospective Studies ; Cross-Sectional Studies ; Pandemics ; Patient Care Team ; COVID-19/epidemiology ; Neoplasms/epidemiology ; Neoplasms/therapy
    Language English
    Publishing date 2023-01-17
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2659751-2
    ISSN 2045-7634 ; 2045-7634
    ISSN (online) 2045-7634
    ISSN 2045-7634
    DOI 10.1002/cam4.5608
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  9. Article ; Online: Poor anaerobic threshold and VO

    Element, Keziah / Asher, Viren / Bali, Anish / Abdul, Summi / Gomez, Dhanny / Tou, Samson / Curtis, Richard / Low, James / Phillips, Andrew

    Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

    2021  Volume 42, Issue 2, Page(s) 294–300

    Abstract: This study assessed Cardiopulmonary Exercise Testing (CPET) in predicting oncological outcomes, post-operative recovery and complications in advanced ovarian cancer (AOC) cytoreductive surgery. We reviewed all patients who had CPET prior to AOC ... ...

    Abstract This study assessed Cardiopulmonary Exercise Testing (CPET) in predicting oncological outcomes, post-operative recovery and complications in advanced ovarian cancer (AOC) cytoreductive surgery. We reviewed all patients who had CPET prior to AOC cytoreductive surgery with evidence of upper abdominal disease on preoperative imaging at the University Hospitals of Derby and Burton (UHDB) between August 2016 and July 2019. Patients were stratified by AT and maximum VO
    MeSH term(s) Anaerobic Threshold ; Bacterial Toxins ; Cytoreduction Surgical Procedures ; Exercise Test ; Humans ; Ovarian Neoplasms/surgery
    Chemical Substances Bacterial Toxins ; Clostridium perfringens epsilon-toxin
    Language English
    Publishing date 2021-05-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 604639-3
    ISSN 1364-6893 ; 0144-3615
    ISSN (online) 1364-6893
    ISSN 0144-3615
    DOI 10.1080/01443615.2021.1893669
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  10. Article ; Online: Primary and Interval Debulking Surgery Provide Similar Survival and Platinum Sensitivity Outcomes in Advanced Ovarian Cancer: A Retrospective Study.

    Glover, Oliver / Asher, Viren / Bali, Anish / Abdul, Summi / Collins, Anna / Phillips, Andrew

    Anticancer research

    2020  Volume 40, Issue 7, Page(s) 3925–3929

    Abstract: Background/aim: CHORUS and EORTC55971 trials demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery (IDS) or primary debulking surgery (PDS) offered the same survival rates. These trials have since been criticised due to poor ... ...

    Abstract Background/aim: CHORUS and EORTC55971 trials demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery (IDS) or primary debulking surgery (PDS) offered the same survival rates. These trials have since been criticised due to poor surgical complexity. We compared overall (OS), progression free (PFS), and platinum sensitivity in advanced ovarian cancer (AOC) patients undergoing IDS or PDS, who had received either intermediate or high complexity surgery to achieve complete cytoreduction.
    Patients and methods: All patients with AOC treated between February 2014 and May 2019 obtaining complete cytoreduction with intermediate/high surgical complexity were included. Recurrence was defined according to GCIG criteria on radiological findings and/or CA125 levels.
    Results: Seventy-one patients (38 PDS and 33 IDS) with full recurrence data were identified. No statistical difference was seen between groups in OS, PFS or platinum sensitive interval.
    Conclusion: PDS or IDS were both acceptable treatment options for AOC, showing similar survival and platinum sensitivity outcomes in patients undergoing intermediate or high complexity surgery.
    MeSH term(s) Aged ; Carcinoma, Ovarian Epithelial/drug therapy ; Carcinoma, Ovarian Epithelial/pathology ; Carcinoma, Ovarian Epithelial/surgery ; Chemotherapy, Adjuvant ; Cytoreduction Surgical Procedures/methods ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/diagnosis ; Organoplatinum Compounds/administration & dosage ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/surgery ; Progression-Free Survival ; Retrospective Studies ; Survival Rate
    Chemical Substances Organoplatinum Compounds
    Language English
    Publishing date 2020-07-03
    Publishing country Greece
    Document type Journal Article
    ZDB-ID 604549-2
    ISSN 1791-7530 ; 0250-7005
    ISSN (online) 1791-7530
    ISSN 0250-7005
    DOI 10.21873/anticanres.14383
    Database MEDical Literature Analysis and Retrieval System OnLINE

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