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Article ; Online: Combined positron emission tomography and contrast enhanced CT (PET/CeCT) is a feasible single investigation in the staging of oesophagogastric cancers: single-centre pilot study experience during the COVID-19 pandemic.

Jones, M / Higgs, S / Dwerryhouse, S / Markos, V / Mason, K / Green, C / Nawwar, A / Searle, J / Lyburn, I

Annals of the Royal College of Surgeons of England

2023

Abstract: Introduction: Staging of oesophagogastric (OG) cancers usually involves endoscopy (OGD), and separate visits for contrast enhanced computed tomography (CeCT) and positron emission tomography (PET/CT). At the height of the COVID-19 pandemic, some of our ... ...

Abstract	Introduction: Staging of oesophagogastric (OG) cancers usually involves endoscopy (OGD), and separate visits for contrast enhanced computed tomography (CeCT) and positron emission tomography (PET/CT). At the height of the COVID-19 pandemic, some of our patients underwent single-visit combined staging with PET/CeCT. We compare this novel pathway with standard separate imaging in time to completion of staging, to start of treatment, and cost. Methods: We identified all patients discussed at our OG multidisciplinary team (MDT) meeting in 2020. Clinical records revealed dates of investigations and treatments. Data were tabulated in Excel, with statistical analysis in SPSS. All patients followed the same MDT process and image reviewing criteria. Costs were compared using prices supplied by finance departments. Results: A total of 211 new patients were discussed at our MDT in 2020. Of these, 48 patients had combined PET/CeCT staging, and 68 had separate scans. Median time (interquartile range) in days from OGD to final imaging was 9 (6-23) for the combined group versus 21 (16-28) for the separate group ( Conclusions: PET/CeCT allows accurate radiological staging of OG cancers with a single scan. Patients completed staging and started treatment faster, with a potential saving of £10,509 in one year. PET/CeCT has become standard staging at our trust, and we aim to incorporate radiotherapy planning images too.
Language	English
Publishing date	2023-11-20
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2023.0070
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Article ; Online: Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of gastro-oesophageal junctional adenocarcinomas: A 10-year cohort study.

Elshaer, Ahmed Mohammed / Wijeyaratne, Manuk / Higgs, S M / Hornby, S T / Dwerryhouse, S J

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 10, Page(s) 107016

Abstract: Background: Gastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative ... ...

Abstract	Background: Gastro-oesophageal junctional (GOJ) cancers have been, more latterly, considered a distinct tumor entity with characteristic genetic profiles. The optimal multimodal therapy of advanced GOJ cancers remains debatable. In this comparative study, we analyzed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced GOJ adenocarcinomas. Methods: This study included patients with locally advanced but resectable GOJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019 at our institution. Follow up to May 2021 was completed. The outcomes between CT and CRT groups were retrospectively analyzed. The long-term follow up data was obtained via direct contact with the patients during oncological clinics, cross-checked with hospital/national patients' electronic databases. Results: 107 patients had GOJ cancers; 90 (84%) patients met our inclusion criteria. Perioperative chemotherapy was administrated in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups. Conclusion: Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for GOJ adenocarcinomas compared to peri-operative chemotherapy, without an increase in postoperative complications or morbidity rates. However, it wasn't associated with improved overall or disease-free survival rates.
Language	English
Publishing date	2023-08-11
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.2023.107016
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Gastric schwannoma: a benign tumour often mistaken clinically, radiologically and histopathologically for a gastrointestinal stromal tumour--a case series.

Williamson, J M L / Wadley, M S / Shepherd, N A / Dwerryhouse, S

Annals of the Royal College of Surgeons of England

2012 Volume 94, Issue 4, Page(s) 245–249

Abstract: Introduction: Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are ... ...

Abstract	Introduction: Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are therefore diagnosed as gastrointestinal stromal tumours (GISTs). Operative resection is usually curative as they are almost always benign, underpinning the importance of differentiating them from GISTs. Methods: Three cases of gastric schwannomas were identified over a seven-year period. The clinical details and management were reviewed retrospectively. Results: There were two women and one man with a mean age of 62 years (range: 51-69 years). Two patients presented with bleeding and one with abdominal pain. The mean tumour size was 5.2 cm (range: 2-10 cm) and the tumours were resected completely following total or wedge gastrectomies. Histology in all cases showed spindle cells with a cuff of lymphoid tissue. Immunohistochemistry confirmed positive S100 staining and negative CD117 and DOG-1 staining in all cases. Conclusions: We report our experience with these unusual primary stromal tumours of the gut and their presentations, pre-operative investigations, operative findings and pathological findings are discussed. Operative resection in all cases has been considered curative, which is supported by previous series confirming the excellent prognosis of gastric schwannomas.
MeSH term(s)	Aged ; Diagnosis, Differential ; Female ; Gastrointestinal Stromal Tumors/diagnostic imaging ; Gastrointestinal Stromal Tumors/pathology ; Gastrointestinal Stromal Tumors/surgery ; Gastroscopy/methods ; Humans ; Male ; Middle Aged ; Neurilemmoma/diagnostic imaging ; Neurilemmoma/pathology ; Neurilemmoma/surgery ; Stomach Neoplasms/diagnostic imaging ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Tomography, X-Ray Computed
Language	English
Publishing date	2012-05-19
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/003588412X13171221590935
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Article ; Online: Life-threatening gastrointestinal haemorrhage from a large Meckel's diverticulum.

Vaughan-Shaw, Peter G / Dwerryhouse, Simon

BMJ case reports

2013 Volume 2013

MeSH term(s)	Adolescent ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Meckel Diverticulum/complications ; Meckel Diverticulum/pathology
Language	English
Publishing date	2013-02-05
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2012-008441
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Article: Re: The secret (GTN) of successful ERCP cannulation: a prospective randomised controlled study. J R Coll Edin 47 (4): 634-637.

Chadwick, M A / Weale, A R / Dwerryhouse, S

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

2004 Volume 1, Issue 5, Page(s) 309–10; author reply 310

MeSH term(s)	Catheterization/methods ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Humans ; Nitroglycerin/therapeutic use ; Prospective Studies ; Vasodilator Agents/therapeutic use
Chemical Substances	Vasodilator Agents ; Nitroglycerin (G59M7S0WS3)
Language	English
Publishing date	2004-11-16
Publishing country	Scotland
Document type	Comment ; Letter
ZDB-ID	2102927-1
ISSN	1479-666X
ISSN	1479-666X
DOI	10.1016/s1479-666x(03)80063-x
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Article ; Online: Protocol for developing quality assurance measures to use in surgical trials: an example from the ROMIO study.

Blencowe, Natalie S / Skilton, Anni / Gaunt, Daisy / Brierley, Rachel / Hollowood, Andrew / Dwerryhouse, Simon / Higgs, Simon / Robb, William / Boddy, Alex / Hanna, George / Barham, C Paul / Blazeby, Jane

BMJ open

2019 Volume 9, Issue 3, Page(s) e026209

Abstract: Introduction: Randomised controlled trials (RCTs) in surgery are frequently criticised because surgeon expertise and standards of surgery are not considered or accounted for during study design. This is particularly true in pragmatic trials (which ... ...

Abstract	Introduction: Randomised controlled trials (RCTs) in surgery are frequently criticised because surgeon expertise and standards of surgery are not considered or accounted for during study design. This is particularly true in pragmatic trials (which typically involve multiple centres and surgeons and are based in 'real world' settings), compared with explanatory trials (which are smaller and more tightly controlled). Objective: This protocol describes a process to develop and test quality assurance (QA) measures for use within a predominantly pragmatic surgical RCT comparing minimally invasive and open techniques for oesophageal cancer (the NIHR ROMIO study). It builds on methods initiated in the ROMIO pilot RCT. Methods and analysis: We have identified three distinct types of QA measure: (i) entry criteria for surgeons, through assessment of operative videos, (ii) standardisation of operative techniques (by establishing minimum key procedural phases) and (iii) monitoring of surgeons during the trial, using intraoperative photography to document key procedural phases and standardising the pathological assessment of specimens. The QA measures will be adapted from the pilot study and tested iteratively, and the video and photo assessment tools will be tested for reliability and validity. Ethics and dissemination: Ethics approval was obtained (NRES Committee South West-Frenchay, 25 April 2016, ref: 16/SW/0098). Results of the QA development study will be submitted for publication in a peer-reviewed journal. Trial registration number: ISRCTN59036820, ISRCTN10386621.
MeSH term(s)	Esophageal Neoplasms/surgery ; General Surgery/standards ; Humans ; Quality Assurance, Health Care ; Randomized Controlled Trials as Topic/standards
Language	English
Publishing date	2019-03-01
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2018-026209
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Article: Juvenile polyposis syndrome affecting the stomach: a case report.

Kelly, Steven / Dwerryhouse, Simon / Safranek, Peter / Hardwick, Richard

Journal of medical case reports

2008 Volume 2, Page(s) 314

Abstract: Introduction: Juvenile polyposis syndrome(JPS) is a rare autosomal dominant inherited condition. Hamartomatous polyps can affect the entire gastrointestinal tract but usually predominate in the colon. In this case report we present an unusual case of ... ...

Abstract	Introduction: Juvenile polyposis syndrome(JPS) is a rare autosomal dominant inherited condition. Hamartomatous polyps can affect the entire gastrointestinal tract but usually predominate in the colon. In this case report we present an unusual case of JPS that presented with massive gastric polyposis requiring a total gastrectomy. Case presentation: A 51-year-old man presented with symptoms of gastric outlet obstruction and upper gastrointestinal bleeding. Gastroscopy showed massive gastric polyposis with a large antral polyp that had prolapsed through the pylorus causing gastric outlet obstruction. Initially endoscopic polypectomy was performed, but due to progressive symptoms a total gastrectomy was then performed. Histology confirmed massive gastric juvenile polyposis. Conclusion: Massive gastric polyposis is an uncommon manifestation of juvenile polyposis syndrome. This case illustrates important principles in managing this condition.
Language	English
Publishing date	2008-09-30
Publishing country	England
Document type	Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947
ISSN	1752-1947
DOI	10.1186/1752-1947-2-314
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Article ; Online: Pregnancy after prophylactic total gastrectomy.

Kaurah, Pardeep / Fitzgerald, Rebecca / Dwerryhouse, Sarah / Huntsman, David G

Familial cancer

2010 Volume 9, Issue 3, Page(s) 331–334

Abstract: Hereditary diffuse gastric cancer is an autosomal dominant inherited cancer predisposition syndrome characterized by susceptibility to diffuse gastric and lobular breast cancers. Since current screening options for diffuse gastric cancer are ineffective, ...

Abstract	Hereditary diffuse gastric cancer is an autosomal dominant inherited cancer predisposition syndrome characterized by susceptibility to diffuse gastric and lobular breast cancers. Since current screening options for diffuse gastric cancer are ineffective, prophylactic total gastrectomy (PTG) is a recommended option for unaffected germline CDH1 mutation carriers. It is unknown whether pregnancy after surgery is possible or advisable due to potential maternal nutritional deficiencies. In this report we describe the pregnancy outcomes in three CDH1 mutation positive women after PTG and in a CDH1 mutation negative woman after total gastrectomy for early gastric cancer.
MeSH term(s)	Adult ; Antigens, CD ; Cadherins/genetics ; Female ; Gastrectomy/adverse effects ; Genetic Predisposition to Disease ; Humans ; Pregnancy ; Pregnancy Outcome ; Stomach Neoplasms/genetics ; Stomach Neoplasms/prevention & control ; Young Adult
Chemical Substances	Antigens, CD ; CDH1 protein, human ; Cadherins
Language	English
Publishing date	2010-01-09
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	1502496-9
ISSN	1573-7292 ; 1389-9600
ISSN (online)	1573-7292
ISSN	1389-9600
DOI	10.1007/s10689-009-9316-y
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Article: Salvage oesophagectomy after local failure of definitive chemoradiotherapy.

Gardner-Thorpe, J / Hardwick, R H / Dwerryhouse, S J

The British journal of surgery

2007 Volume 94, Issue 9, Page(s) 1059–1066

Abstract: Background: Definitive chemoradiotherapy (CRT) is one treatment option for locally advanced oesophageal carcinoma. CRT typically consists of high-dose (50-66 Gy) external beam radiotherapy concurrent with 5-fluorouracil and cisplatin. When definitive ... ...

Abstract	Background: Definitive chemoradiotherapy (CRT) is one treatment option for locally advanced oesophageal carcinoma. CRT typically consists of high-dose (50-66 Gy) external beam radiotherapy concurrent with 5-fluorouracil and cisplatin. When definitive CRT fails to achieve local control, salvage oesophagectomy is frequently the only treatment available that can offer a chance of long-term survival. Methods: Online databases were searched for publications relating to salvage oesophagectomy and definitive CRT. Nine series containing a total of 105 patients were reviewed. Demographics, indications for surgery, type of resection, complications and outcome data were extracted. Results: Each centre performed one to three salvage resections per year comprising 1.7-4.1 per cent of the oesophagectomy workload. The overall anastomotic leak rate was 17.1 per cent. The in-hospital mortality rate was 11.4 per cent. Five-year survival rates of 25-35 per cent were achieved. Prognostic factors for increased survival were R0 resection (P = 0.006) and longer interval between CRT and recurrence (P = 0.002). Conclusion: Salvage resection after CRT is feasible for selected patients but is a formidable undertaking. Restaging investigations after CRT for potentially resectable tumours in fit candidates should include endoscopy and positron emission tomography-computed tomography. Salvage oesophagectomy is carried out with the goal of cure and it should be attempted only if an R0 resection is technically possible.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Cisplatin/administration & dosage ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/therapy ; Esophagectomy ; Fluorouracil/administration & dosage ; Humans ; Middle Aged ; Neoplasm Recurrence, Local/surgery ; Postoperative Complications/etiology ; Salvage Therapy/methods ; Survival Rate ; Treatment Outcome
Chemical Substances	Cisplatin (Q20Q21Q62J) ; Fluorouracil (U3P01618RT)
Language	English
Publishing date	2007-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2985-3
ISSN	0007-1323 ; 0263-1202 ; 1355-7688
ISSN	0007-1323 ; 0263-1202 ; 1355-7688
DOI	10.1002/bjs.5865
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Article ; Online: Histopathological and molecular analysis of gastrectomy specimens from hereditary diffuse gastric cancer patients has implications for endoscopic surveillance of individuals at risk.

Barber, M E / Save, V / Carneiro, F / Dwerryhouse, S / Lao-Sirieix, P / Hardwick, R H / Caldas, C / Fitzgerald, R C

The Journal of pathology

2008 Volume 216, Issue 3, Page(s) 286–294

Abstract: Hereditary diffuse gastric cancer (HDGC) is caused by germline E-cadherin (CDH1) mutations in 25-40% of tested families. Management options for asymptomatic mutation carriers are fraught, since endoscopic surveillance can miss cancer foci and ... ...

Abstract	Hereditary diffuse gastric cancer (HDGC) is caused by germline E-cadherin (CDH1) mutations in 25-40% of tested families. Management options for asymptomatic mutation carriers are fraught, since endoscopic surveillance can miss cancer foci and prophylactic gastrectomy has profound clinical sequelae. The aims of this study were to evaluate the impact of current surveillance practices on pre-operative diagnosis and to characterize the microscopic lesions in gastrectomy specimens to better inform clinical practice. Histological assessment and mapping of endoscopic surveillance and gastrectomy specimens were performed for eight asymptomatic CDH1 mutation carriers. E-cadherin expression and proliferation were analysed and evidence of epithelial-mesenchymal transition (EMT) was sought by immunohistochemistry for vimentin and cytokeratin 8/18. Four of eight patients had lesions detected at endoscopic surveillance. A median of 20.5 (range 0-66) signet ring foci were identified per gastrectomy (including in situ lesions and pagetoid spread). Foci were predominantly identified in the fundus and body (90% endoscopic biopsies and 85% in gastrectomy). The likelihood of detecting foci pre-operatively was positively correlated with the number of biopsies taken and the number of lesions in the gastrectomy specimen. E-cadherin expression in gastrectomy specimens was reduced or absent in all of the foci compared with the intervening gastric tissue, suggesting that these lesions are polyclonal. The foci had a low proliferative index (<2%) and there was no evidence for EMT. Multiple endoscopic biopsy sampling of the gastric mucosa increases the yield of microscopic cancer foci. The low proliferative index and lack of EMT suggests that these foci may represent an indolent stage of HDGC.
MeSH term(s)	Adult ; Biomarkers, Tumor/analysis ; Biopsy ; Cadherins/analysis ; Cadherins/genetics ; Carcinoma, Signet Ring Cell/chemistry ; Carcinoma, Signet Ring Cell/genetics ; Carcinoma, Signet Ring Cell/pathology ; Cell Proliferation ; Fluorescent Antibody Technique ; Gastric Mucosa/chemistry ; Gastric Mucosa/pathology ; Gastroscopy ; Genetic Predisposition to Disease ; Germ-Line Mutation ; Humans ; Immunohistochemistry ; Keratin-8/analysis ; Male ; Middle Aged ; Stomach Neoplasms/chemistry ; Stomach Neoplasms/genetics ; Stomach Neoplasms/pathology ; Vimentin/analysis
Chemical Substances	Biomarkers, Tumor ; CDH1 protein, human ; Cadherins ; Keratin-8 ; Vimentin
Language	English
Publishing date	2008-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3119-7
ISSN	1096-9896 ; 0022-3417
ISSN (online)	1096-9896
ISSN	0022-3417
DOI	10.1002/path.2415
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