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  1. Article ; Online: Implications of Highly Penetrant Genetic Variants on Breast Surgery.

    Davey, Matthew G / Tormey, Shona

    Clinical breast cancer

    2024  Volume 24, Issue 3, Page(s) 180–183

    Abstract: It seems the most probable beneficiaries from the molecular era are those harboring hereditary genetic variants, which are responsible for 5% to 10% of all breast cancer diagnoses. There are several key implications of such variants on clinical practice, ...

    Abstract It seems the most probable beneficiaries from the molecular era are those harboring hereditary genetic variants, which are responsible for 5% to 10% of all breast cancer diagnoses. There are several key implications of such variants on clinical practice, from expedited anticipation of primary cancer diagnoses, which can have their risk mitigated by risk reduction surgery, to pragmatism surrounding the management of male breast cancer patients. This communication discusses the implications of highly penetrant (or pathogenic) hereditary variants in contemporary breast surgery practice.
    MeSH term(s) Humans ; Male ; Breast Neoplasms/genetics ; Breast Neoplasms/surgery ; Breast Neoplasms/diagnosis ; Mastectomy ; Breast Neoplasms, Male/surgery ; Genetic Predisposition to Disease ; Genetic Testing
    Language English
    Publishing date 2024-01-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2106734-X
    ISSN 1938-0666 ; 1526-8209
    ISSN (online) 1938-0666
    ISSN 1526-8209
    DOI 10.1016/j.clbc.2024.01.001
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  2. Article: Targeted Endocrine Agents should be the Dominant Systemic Therapies Prescribed in Luminal A Breast Cancer.

    Davey, Matthew G / Kerin, Michael J

    Breast cancer : basic and clinical research

    2023  Volume 17, Page(s) 11782234221145409

    Language English
    Publishing date 2023-01-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2423804-1
    ISSN 1178-2234
    ISSN 1178-2234
    DOI 10.1177/11782234221145409
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  3. Article ; Online: Molecular profiling in contemporary breast cancer management.

    Davey, Matthew G / Kerin, Michael J

    The British journal of surgery

    2023  Volume 110, Issue 7, Page(s) 743–745

    MeSH term(s) Humans ; Female ; Breast Neoplasms ; Biomarkers, Tumor ; Gene Expression Profiling
    Chemical Substances Biomarkers, Tumor
    Language English
    Publishing date 2023-02-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znad017
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  4. Article ; Online: Evaluating the safety profile of anti-platelet therapy in patients undergoing elective inguinal hernia repair: a systematic review and meta-analysis.

    Davey, Matthew G / Joyce, William P

    Irish journal of medical science

    2023  Volume 193, Issue 2, Page(s) 897–902

    Abstract: Introduction: There remains no consensus surrounding the safety of prescribing anti-platelet therapies (APT) prior to elective inguinal hernia repair (IHR).: Aims: To perform a systematic review and meta-analysis evaluating the safety profile of APT ... ...

    Abstract Introduction: There remains no consensus surrounding the safety of prescribing anti-platelet therapies (APT) prior to elective inguinal hernia repair (IHR).
    Aims: To perform a systematic review and meta-analysis evaluating the safety profile of APT use in patients indicated to undergo elective IHR.
    Methods: A systematic review was performed in accordance with PRISMA guidelines. Meta-analyses were performed using the Mantel-Haenszel method using the Review Manager version 5.4 software.
    Results: Five studies including outcomes in 344 patients were included. Of these, 65.4% had APT discontinued (225/344), and 34.6% had APT continued (119/344). The majority of included patients were male (94.1%, 288/344). When continuing or discontinuing APT, there was no significant difference in overall haemorrhage rates (odds ratio (OR): 1.86, 95% confidence interval (CI): 0.29-11.78, P = 0.130) and in sensitivity analysis using only RCT data (OR: 0.63, 95% CI: 0.03-12.41, P = 0.760). Furthermore, there was no significant difference in reoperation rates (OR: 6.27, 95% CI: 0.72-54.60, P = 0.590); however, a significant difference was observed for readmission rates (OR: 5.67, 95% CI: 1.33-24.12, P = 0.020) when APT was continued or stopped pre-operatively. There was no significant difference in the estimated blood loss, intra-operative time, transfusion of blood products, rates of complications, cerebrovascular accidents, myocardial infarctions, or mortality observed.
    Conclusion: This study illustrates the safety of continuing APT pre-operatively in patients undergoing elective IHR, with similar rates of haemorrhage, reoperation, and readmission observed. Clinical trials with larger patient recruitment will be required to fully establish the safety profile of prescribing APT in the pre-operative setting prior to elective IHR.
    MeSH term(s) Humans ; Male ; Female ; Hernia, Inguinal/surgery ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/methods ; Reoperation ; Hemorrhage
    Language English
    Publishing date 2023-08-01
    Publishing country Ireland
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-023-03480-w
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  5. Article: Evaluating the Fragility of Long-Term Outcomes for Neoadjuvant versus Adjuvant Chemotherapy Prescription in Early Breast Cancer: Pooled Data from 10 Randomised Clinical Trials.

    Davey, Matthew G / Kerin, Michael J

    Breast cancer (Dove Medical Press)

    2022  Volume 14, Page(s) 343–350

    Abstract: Introduction: Randomised clinical trials (RCTs) report similar outcomes following neoadjuvant (NAC) and adjuvant chemotherapy (AC) in breast cancer. "Fragility Indices" (FI) test significance reversal reported in RCTs.: Aim: To evaluate the FI of ... ...

    Abstract Introduction: Randomised clinical trials (RCTs) report similar outcomes following neoadjuvant (NAC) and adjuvant chemotherapy (AC) in breast cancer. "Fragility Indices" (FI) test significance reversal reported in RCTs.
    Aim: To evaluate the FI of findings from RCTs assessing outcomes of NAC and AC.
    Methods: A systematic review was performed as per PRISMA guidelines. RCTs of interest were identified and data pooled. Fisher's exact test was used to calculate FI for reversal of statistical significance for dichotomous outcomes. "Fragility Quotient" (FQ) was calculated by division of the calculated FI by the sample size.
    Results: Ten RCTs including 4928 patients. Mean follow-up was 8.2 years. For breast conservation surgery (BCS), the FI was 500 and FQ was 0.10781. For local recurrence (LR), the FI was 42 and FQ was 0.00852. FI and FQ varied for LR at 0-4 years (FI: 9), 5-9 years (FI: 2), 10-14 years (FI: 4), and 15+ years (FI: 3). Regarding distant recurrence (DR), the FI was 13 and FQ was 0.00264. FI and FQ trended downwards over time: 0-4 years (FI: 56), 5-9 years (FI: 18), 10-14 years (FI: 4), and 15+ years (FI: 4). For breast-cancer-specific mortality (BCSM), the overall FI was 51 and FQ was 0.01035. FI and FQ varied for BCSM at 0-4 years (FI: 5), 5-9 years (FI: 19), 10-14 years (FI: 8), and 15+ years (FI: 5). For overall survival (OS), the FI was 17 and FQ was 0.00345. FI and FQ were calculated with respect to OS at 0-4 years (FI: 19), 5-9 years (FI: 17), 10-14 years (FI: 19), and 15+ years (FI: 1).
    Conclusion: FIs comparing survival following NAC and AC were of moderate-to-high fragility, indicating weak statistical significance. BCS eligibility following NAC was of low fragility, ratifying the oncological and surgical safety of NAC versus AC.
    Level of evidence: Systematic Review of Level I Randomised Control Trials.
    Language English
    Publishing date 2022-10-17
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2520722-2
    ISSN 1179-1314
    ISSN 1179-1314
    DOI 10.2147/BCTT.S379393
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  6. Article ; Online: Using menopause status and 21-gene expression assay to inform chemotherapy benefit in node-positive breast cancer.

    Davey, Matthew G / Kerin, Michael J

    Breast cancer research and treatment

    2022  Volume 195, Issue 1, Page(s) 83–84

    MeSH term(s) Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Breast Neoplasms/drug therapy ; Breast Neoplasms/genetics ; Breast Neoplasms/metabolism ; Chemotherapy, Adjuvant ; Female ; Gene Expression Profiling ; Humans ; Menopause ; Receptors, Estrogen/metabolism
    Chemical Substances Receptors, Estrogen
    Language English
    Publishing date 2022-07-10
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-022-06671-8
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    Zs.A 1655: Show issues Location:
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  7. Article: Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer - A systematic review and meta-analysis.

    Davey, Matthew G / Joyce, William P

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2022  Volume 21, Issue 3, Page(s) 173–180

    Abstract: Introduction: Frailty describes patients who are at an extreme risk of vulnerability to stressors that may lead to adverse clinical outcomes. The impact of frailty on clinical, oncological and survival outcomes in colorectal cancer (CRC) remains unclear. ...

    Abstract Introduction: Frailty describes patients who are at an extreme risk of vulnerability to stressors that may lead to adverse clinical outcomes. The impact of frailty on clinical, oncological and survival outcomes in colorectal cancer (CRC) remains unclear.
    Aim: To determine the anticipated oncological and survival outcomes for patients who are frail when diagnosed and undergo treatment with curative intent for CRC.
    Methods: A systematic review and meta-analysis was performed as per PRISMA guidelines. Descriptive statistics were used to determine associations between frailty and survival outcomes. The impact of frailty on disease-free and overall survival were expressed as hazard Ratios (HRs) and 95% confidence intervals (CIs) were estimated using the time-to-effect generic inverse variance and Mantel-Haenszel method.
    Results: Nine studies including 15,555 patients were included, of whom 8.1% were frail (1206/14,831). The mean age was 77.1 years (range: 42-94 years), 61.1% were female (9510/15,555) and mean follow-up was 48.0 months. Overall, frailty was associated with an increased risk of mortality (HR: 2.95, 95% CI: 1.64-5.29, P < 0.001) and worse disease-free survival (HR: 1.80, 95% CI: 1.34-2.41, P < 0.001). Frailty was also associated with an increased risk of mortality at 1-year (HR: 3.70, 95% CI: 1.00-13.66, P = 0.050) and 5-years (HR: 2.79, 95% CI: 1.65-4.71, P < 0.001) follow-up respectively.
    Conclusion: Frailty is associated with poorer oncological and survival outcomes in patients diagnosed and treated with curative intent for CRC. CRC multidisciplinary team meetings should incorporate these findings into the management paradigm for these patients and patient counselling should be tailored to include these findings.
    MeSH term(s) Humans ; Female ; Aged ; Male ; Frailty/complications ; Colorectal Neoplasms/complications ; Colorectal Neoplasms/surgery
    Language English
    Publishing date 2022-07-02
    Publishing country Scotland
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2022.06.001
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    Zs.A 5756: Show issues Location:
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  8. Article ; Online: Evaluating opioid prescribing patterns following discharge from elective surgical procedures: a worrying trend during the 'opioid crisis' - an audit of elective surgical procedures.

    Meldon, Aengus / Davey, Matthew G / Joyce, William P

    Irish journal of medical science

    2023  Volume 192, Issue 6, Page(s) 2993–2999

    Abstract: Background: The 'opioid crisis' has reached epidemic proportions globally. Importantly, 30% of opioid dependency stem from opioids obtained on hospital discharge prescriptions.: Aim: The aim of this study is to evaluate opioid prescription patterns ... ...

    Abstract Background: The 'opioid crisis' has reached epidemic proportions globally. Importantly, 30% of opioid dependency stem from opioids obtained on hospital discharge prescriptions.
    Aim: The aim of this study is to evaluate opioid prescription patterns on discharge of post-operative patients in an Irish Hospital.
    Methods: A retrospective cohort study was undertaken in a single institution during the 5 year eligibility period (January 2017-October 2021). Comparisons in opioid prescription patterns following minor (inguinal hernia repair (IHR), intermediate (laparoscopic cholecystectomy (LC)) and major (colonic resection (CR)) were made. Descriptive statistics were performed using SPSS version 26.0 RESULTS: In total, 300 patients were included in this study with mean age 59.6 years (range: 20-92). Of these, 112 patients underwent IHR (37.3%), 116 patients underwent LC (38.7%), and 72 patients underwent CR (24.0%). The mean age at diagnosis was 61 years, 53 years and 58 years for IHR, LC and CR, respectively (P < 0.001). Patients undergoing CR were more likely to have greater comorbidity burden (3.1 vs. 1.2 (IHR) vs. 1.8 (LC) respectively (P = 0.030). On discharge, 27.8% of CR patients received opioids (20/72) compared to 24.1% of IHR (28/116) and 15.9% of LC (18/113) patients, respectively (P = 0.126).
    Conclusion: We observed considerable variability in opioid prescribing patterns following minor, intermediate and major operations in our centre. Care is required when prescribing opioids in the post-operative setting, and opioid prescription guidelines are required to both tackle and prevent an escalation of this 'opioid crisis'.
    MeSH term(s) Humans ; Middle Aged ; Analgesics, Opioid/therapeutic use ; Elective Surgical Procedures ; Retrospective Studies ; Patient Discharge ; Pain, Postoperative/drug therapy ; Practice Patterns, Physicians' ; Drug Prescriptions
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-04-20
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-023-03363-0
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  9. Article ; Online: Evaluating the utility of robotic axillary lymph node dissection in patients with invasive breast cancer: a systematic review.

    Thornton, Róisín / Davey, Matthew G / Kerin, Michael J

    Irish journal of medical science

    2023  

    Abstract: Robot-assisted axillary lymph node dissection (RALND) has been proposed to improve surgical and oncological outcomes for patients with breast cancer. To perform a systematic review of current literature evaluating RALND in patients with invasive breast ... ...

    Abstract Robot-assisted axillary lymph node dissection (RALND) has been proposed to improve surgical and oncological outcomes for patients with breast cancer. To perform a systematic review of current literature evaluating RALND in patients with invasive breast cancer. A systematic search was performed in accordance with the PRISMA guidelines. Studies outlining outcomes following RALND were included. Two studies involving 92 patients were included in this review. Of these, 41 underwent RALND using the da Vinci
    Language English
    Publishing date 2023-11-16
    Publishing country Ireland
    Document type Journal Article ; Review
    ZDB-ID 390895-1
    ISSN 1863-4362 ; 0021-1265
    ISSN (online) 1863-4362
    ISSN 0021-1265
    DOI 10.1007/s11845-023-03561-w
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  10. Article: Readmission rates following major colorectal surgery.

    Shorten, Aoife / Davey, Matthew G / Joyce, William P

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2023  Volume 22, Issue 2, Page(s) 116–120

    Abstract: Background: Readmissions following colorectal surgery (CRS) have negative clinical, psychological and financial implications. Identifying patients at risk of readmission remains challenging.: Aims: To determine factors predictive of those likely to ... ...

    Abstract Background: Readmissions following colorectal surgery (CRS) have negative clinical, psychological and financial implications. Identifying patients at risk of readmission remains challenging.
    Aims: To determine factors predictive of those likely to require readmission at 40-days following major CRS and to identify novel strategies capable of reducing readmissions.
    Methods: Consecutive patients were studied from a prospectively maintained database. All patients were operated on by a single surgeon in a high-volume centre. Where applicable, photography was recorded by patients and emailed directly to the institutional email of the consultant surgeon. Data was recorded and analysed using descriptive statistics.
    Results: 515 patients were included over a 15-year period (2007-2022). The mean age at surgery was 64 years (18-93). The majority of patients were male (56.9%, n=293) and underwent cancer surgery (58.2%, n=299). Overall, 55 patients were readmitted within 40 days of major CRS (10.7%). Patients with pre-treatment diagnoses of heart failure (P=0.012), ischemic heart disease (P=0.002), renal impairment (P<0.001), atrial fibrillation (P=0.006), hypercholesterolemia (P=0.001), asthma (P=0.013) and hypertension (P=0.001) were more likely to require readmission. The majority of patients were readmitted for definitive management of surgical site issues (SSIs) (43.7% n=24). Other reasons included bowel obstruction (9.1%, n=5), pelvic sepsis (7.3%, n=4) and gastrointestinal upset (7.3%, n=4).
    Conclusion: This series demonstrated that patients with cardiopulmonary comorbidities were more likely to be readmitted following major CRS and most readmissions are SSI related. Readmissions for SSIs can be reduced by patients sending photography to the treating surgeon which could reduce readmissions and A&E attendances.
    MeSH term(s) Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Postoperative Complications/epidemiology ; Postoperative Complications/diagnosis ; Patient Readmission ; Colorectal Surgery ; Risk Factors ; Digestive System Surgical Procedures/adverse effects ; Retrospective Studies
    Language English
    Publishing date 2023-12-02
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2023.11.003
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