Introduction Low-grade appendiceal mucinous neoplasms (LAMNs) are classified as non-perforated (pTis, pT3) or perforated (pT4), and considered precursors of pseudomyxoma peritonei (PMP). This study aims to quantify the risk of developing PMP from pTis and pT3 LAMNs. Materials and Methods Retrospective analysis of a prospectively collected database identified LAMN patients referred to a specialist centre from 2004 to 2019. pT4 LAMNs and other appendix tumours were excluded. All patients had specialist review of their pathology, operation note, and a CT scan (at least 6 weeks post-operatively). Surveillance CTs were then performed at 6, 12, 24, 36, 48, & 60 months, with tumour markers (CEA, CA19-9, CA125). Results 193 pT3/pTis LAMN patients were included (pTis=153, pT3=40). Median follow-up=6.45 (3.91-22.13) years, M:F ratio=1:1.57, and median age=57 (23-83) years. Initial surgery included: appendicectomy (67%), appendicectomy + visceral resection (6%), and right hemicolectomy (27%). R1 resections were identified in 5/193 patients (2.5%). 3 R1 patients underwent re-operation (2 caecal pole excision and 1 ileocecectomy), none of which had residual tumour. 8/193 patients (4%) were lost to follow up. None of the remaining 185 developed PMP. Conclusion This is the largest reported series of pTis/pT3 LAMNs with standardised follow-up in the literature. LAMNs correctly classified as pT3/pTis (after careful specialist review of pathology, operation note, and a baseline post-operative CT) have negligible risk of developing PMP and should have low intensity surveillance. If completely excised, further surgery is not indicated. R1 resections should be considered on an individual basis at a specialist centre.

BACKGROUND:Cytoreductive surgery (CRS) is effective for colorectal cancer peritoneal metastases (CRPM) at increasing overall survival (OS) compared to systemic anticancer treatment (SACT) alone. The addition of Oxaliplatin heated intraperitoneal chemotherapy (HIPEC) has been shown in a randomized controlled trial to result in increased complications without significant OS benefit. This study evaluates outcomes for CRPM patients undergoing CRS+HIPEC with Oxaliplatin (Ox) 368mg/m2 (30 min), versus Mitomycin C (MMC) 35mg/m2 (90min).  METHODS: A prospective CRPM real-world database was used to collect outcomes for patients undergoing CRS+HIPEC at a single center. OS, recurrence-free (RFS), peritoneal RFS (PeRFS) were compared amongst all patients with histologically proven CRPM, those with completeness of cytoreduction (CC) score =0/1, and those with CC score=0/1 who were SACT naïve.  RESULTS: Between April 2005 and April 2021, 409 patients underwent CRS+HIPEC: 271 (66%) had MMC, 138 (34%) Ox. Of these, 395 (97%) had histologically confirmed CRPM, 336 (85%) achieved CC=0/1, 188 (47%) were SACT naïve; median OS =39.5, 44.4, and 47.2 months respectively. MMC versus Ox median OS in CC0/1=43.7 (95% CI 35.9-48.3) versus 50.1 (39.7-70.2) months, P = .28; Median OS in SACT naïve=45.7 (39.4-65.9) versus 59.9 (38.3-82.0) months, P = .31; multivariable analysis for CC0/1, SACT naïve patients showed Ox was comparable to MMC: HR=0.90, (0.64-1.27) P = .55 versus HR=0.88, (0.53-1.44) P = .60, respectively. Ox resulted in a significantly improved PeRFS in CC0/1 patients (MMC=9.0 versus Ox=12.6months, P = .01). A multivariable model for PeRFS showed a HR=0.63, (0.43-0.95), P = .03 for Ox.  CONCLUSION: This study suggests a role for Ox HIPEC in CRPM which should be explored further in clinical trials.

Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.

Treatment guidelines provided by PRODIGE-7 recommend perioperative systemic chemotherapy before cytoreductive surgery (CRS) for colorectal cancer peritoneal metastases (CRPM). Toxicity with multimodal treatment needs to be better defined. Chemotherapy response and impact on survival have not been reported. We assessed CRPM patients who received systemic oxaliplatin/irinotecan before CRS (preoperative) with Mitomycin C (35 mg/m2, 90 min) or Oxaliplatin (368 mg/m2, 30 min) heated intraperitoneal chemotherapy (HIPEC). Secondary analysis was performed from a prospective database. Overall survival (OS) in chemotherapy responders (R) and nonresponders (NR) was compared. Toxicity was assessed by rate of adverse events (AEs). From April 2005 to April 2021, 436 patients underwent CRS + HIPEC; 125 (29%) received preoperative chemotherapy. The 112 (90%) received oxaliplatin (64, 57%) or irinotecan (48, 43%). R, defined as complete (CR) or partial response on preoperative imaging and/or postoperative histology, was seen in 71, 63% (53.8-72.3); 16, 14% (8.4-22.2) had CR. Median OS in R versus NR was 43.7 months (37.9-49.4) versus 23.9 (16.3-31.4) p = 0.007, HR 0.51 (0.31-0.84). OS multivariable analysis showed HR 0.48 (0.25-0.95), p = 0.03 for chemotherapy response corrected by peritoneal cancer index, completeness of cytoreduction score. CRS led to 21% grade 3-4 AEs versus 4% for preoperative chemotherapy. HIPEC grade 3-4 AEs were 0.5%. Preoperative chemotherapy response is an independent predictor for OS in CRPM. Perioperative chemotherapy is used in the multimodal treatment of colorectal cancer peritoneal metastases (CRPM). Preoperative chemotherapy response is an independent predictor for overall survival in patients with CRPM. Grade 3-4 adverse events related to mitomycin C (35 mg/m2) and Oxaliplatin (368 mg/m2) heated intraperitoneal chemotherapy are rare (0.5%).

Journal of Surgical OncologyVolume 125, Issue 2 p. 317-319 LETTER TO THE EDITOR The need for tailored posttreatment surveillance for low-grade appendiceal mucinous neoplasms (LAMN) Luca G. Campana, Corresponding Author Luca G. Campana luca.giovanni.campana@gmail.com orcid.org/0000-0002-8466-8459 Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK Correspondence Luca G. Campana, Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK. Email: luca.giovanni.campana@gmail.comSearch for more papers by this authorMalcolm S. Wilson, Malcolm S. Wilson Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorRebecca Halstead, Rebecca Halstead Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorJonathan Wild, Jonathan Wild Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorSarah T. O'Dwyer, Sarah T. O'Dwyer Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKSearch for more papers by this author Luca G. Campana, Corresponding Author Luca G. Campana luca.giovanni.campana@gmail.com orcid.org/0000-0002-8466-8459 Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK Correspondence Luca G. Campana, Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK. Email: luca.giovanni.campana@gmail.comSearch for more papers by this authorMalcolm S. Wilson, Malcolm S. Wilson Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorRebecca Halstead, Rebecca Halstead Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorJonathan Wild, Jonathan Wild Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UKSearch for more papers by this authorSarah T. O'Dwyer, Sarah T. O'Dwyer Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Manchester, UK Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UKSearch for more papers by this author First published: 31 October 2021 https://doi.org/10.1002/jso.26702Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume125, Issue2February 2022Pages 317-319 RelatedInformation

Objective The aim of this study was to assess the nutritional status of patients presenting with small bowel obstruction (SBO), along with associated nutritional interventions and clinical outcomes. Design Prospective cohort study. Setting 131 UK hospitals with acute surgical services. Participants 2069 adult patients with a diagnosis of SBO were included in this study. The mean age was 67.0 years and 54.7% were female. Primary and secondary outcome measures Primary outcome was in-hospital mortality. Secondary outcomes recorded included: major complications (composite of in-hospital mortality, reoperation, unplanned intensive care admission and 30-day readmission), complications arising from surgery (anastomotic leak, wound dehiscence), infection (pneumonia, surgical site infection, intra-abdominal infection, urinary tract infection, venous catheter infection), cardiac complications, venous thromboembolism and delirium. Results Postoperative adhesions were the most common cause of SBO (49.1%). Early surgery (<24 hours postadmission) took place in 30.0% of patients, 22.0% underwent delayed operation and 47.9% were managed non-operatively. Malnutrition as stratified by Nutritional Risk Index was common, with 35.7% at moderate risk and 5.7% at severe risk of malnutrition. Dietitian review occurred in just 36.4% and 55.9% of the moderate and severe risk groups. In the low risk group, 30.3% received nutritional intervention compared with 40.7% in moderate risk group and 62.7% in severe risk group. In comparison to the low risk group, patients who were at severe or moderate risk of malnutrition had 4.2 and 2.4 times higher unadjusted risk of in-hospital mortality, respectively. Propensity-matched analysis found no difference in outcomes based on use or timing of parenteral nutrition. Conclusions Malnutrition on admission is associated with worse outcomes in patients with SBO, and marked variation in management of malnutrition was observed. Future trials should focus on identifying effective and cost-effective nutritional interventions in SBO.

Emergency general surgery comprises patients with surgical problems requiring surgical intervention or post-operative surgical patients who require further surgical intervention or symptom palliation at any time of the day or night. Beyond the cases discussed below, this will include also emergency presentations from all of the sub-specialty chapters covered so far. Over 600,000 emergency hospital admissions are made to general surgery. Of these patients, they comprise the sickest patient cohort relative to the majority of elective patients, which results from sepsis, shock, or organ dysfunction from the underlying causative pathology, as well as the impact of any pre-existant comorbid states. This often has a significant impact on patient outcome, with high rates of morbidity and mortality relative to elective surgery. With this in mind, a lot of work has been channelled into improving outcomes for these patients. Furthermore, emergency and trauma surgery is beginning to establish itself as a subspecialty in itself. This chapter starts by making applied discussion of the assessment and initial investigation of acute abdominal pain, a complaint that comprises half of the annual 600,000 emergency general surgical admissions. It covers the pertinent features of diagnosis, investigation, and management of a range of common or serious emergency surgical and trauma cases that will be encountered on the acute surgical take. Kidney transplantation is not in itself an emergency operation when you consider the degree of pre-operative preparation of recipient donors, but is included in this chapter as it is commonly encountered by junior trainees on the emergency theatre list when donors are found at short notice.

OBJECTIVE: This study aims to explore the views of members of theater teams regarding the proposed introduction of a workplace-based assessment of nontechnical skills of surgeons (NOTSS) into the Intercollegiate Surgical Curriculum Programme in the United Kingdom. In addition, the previous training and familiarity of the members of the surgical theater team with the concept and assessment of NOTSS would be evaluated.DESIGN: A regional survey of members of theater teams (consultant surgeons, anesthetists, scrub nurses, and trainees) was performed at 1 teaching and 2 district general hospitals in South Yorkshire.RESULTS: There were 160 respondents corresponding to a response rate of 81%. The majority (77%) were not aware of the NOTSS assessment tool with only 9% of respondents reporting to have previously used the NOTSS tool and just 3% having received training in NOTSS assessment. Overall, 81% stated that assessing NOTSS was as important as assessing technical skills. Trainees attributed less importance to nontechnical skills than the other groups (p <= 0.016). Although opinion appears divided as to whether the presence of a consultant surgeon in theater could potentially make it difficult to assess a trainee's leadership skills and decision-making capabilities, overall 60% agree that the routine use of NOTSS assessment would enhance safety in the operating theater and 80% agree that the NOTSS tool should be introduced to assess the nontechnical skills of trainees in theater. However, a significantly lower proportion of trainees (45%) agreed on the latter compared with the other groups (p = 0.001).CONCLUSIONS: Our survey demonstrates acceptability among the theater team for the introduction of the NOTSS tool into the surgical curriculum. However, lack of familiarity highlights the importance of faculty training for assessors before such an introduction. (C) 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Aims:In 2013, the JCST published guidelines for the award of a CCT in General Surgery citing global operative experience together with other professional credentials.The aim of this study was to determine whether these guidelines were achievable within contemporary MMC UKsurgical training.Methods: The CVs and online portfolios of 155 consecutive CCT applicants with certification dates between 1 November 2012 and 12 December 2013 to (119 male, 36 female) were analyzed with specific reference to curricular guidelines.Results: No inter-deanery differences emerged related to global guidelines.The median total operative caseload was 1802 (range 783-3764), with 104 applicants (67%) achieving the defined guideline of 1600, which was unrelated to subspecialty preference (p = 0⋅133).Median emergency laparotomy caseload was 102 (1-335) with 85 applicants (55%) achieving the guideline of 100, (data excluding, but guideline including, segmental laparotomy and Hartmann's), which was related to subspecialty preference, with GI trainees more likely to exceed the guideline than non-GI counterparts (median 111 vs. 92, < 0⋅001).Allowing for this, first quartiles for all indicative procedures matched the guideline numbers with the exception of infra-inguinal bypass.The median number of publications achieved was 7 [0-100, median 4 (0-30) as first author], and median national or international presentations 10 (0-67).The academic guidelines of 3 peer reviewed publications and 3 presentations were achieved by 136 (88%), and 146 (94%) respectively, and requisite courses by 28%.Conclusions: Global operative and academic achievements varied widely with two thirds of applicants achieving elective operative guidelines, and over half achieving the requisite experience in emergency laparotomy.A total of 5% of trainees achieved all the non-operative guidelines.Measures to identify trainees in the lower quartile early within training allied to enhanced simulation resource should be considered to rectify this apparent surgical training experience shortfall.

website. Descriptive analysis undertaken using Google Analytics, and correlated to registrations. Social influence score calculated using Klout. Results: Registration page traffic analysis showed 1586 unique views resulting in 641 individuals registering (46% conversion rate). 285 views were from social media sources, resulting in an additional 131 collaborators recruited (20% of total). Traffic source analysis identified a separate ASiT webpage as resulting in the majority of registration views (15.8%), followed by Facebook (8%), Twitter (4.8%) and YouTube (1.5%). A Twitter ‘social influence’ (Klout) score of 42/100 was obtained during this period. Conclusions: Use of free social media substantially aided dissemination and collaborator recruitment by 20% in a short time period. We recommend Facebook, Twitter and targeted websites as effective forms of communication for study recruitment.

Histone deacetylases play an important role in multiple processes, including gene expression, proliferation, apoptosis, cytoskeletal organization, migration and angiogenesis. Histone deacetylase inhibitors are able to induce cell death and growth arrest as targeted anticancer agents. Whilst only two, vorinostat and romidepsin, are licensed in oncology, several have reached Phase III trials and many more are in Phase I and II. In addition to this, multiple novel drugs, including more targeted agents, are emerging from preclinical studies. This paper examines the outcomes of recent clinical trials in 11 key histone deacetylase inhibitors, both as monotherapy and in combination with other antitumor drugs. An overview of the advantages and disadvantages between the different classes and individual drugs is discussed, as well as a brief outlook on the future developments in the field.

Initially found expressed in neuronal and then later in endothelial cells, it is well established that the transmembrane glycoproteins neuropilin-1 (NRP1) and neuropilin-2 (NRP2) play essential roles in axonal growth and guidance and in physiological and pathological angiogenesis. Neuropilin expression and function in epithelial cells has received little attention when compared with neuronal and endothelial cells. Overexpression of NRPs is shown to enhance growth, correlate with invasion and is associated with poor prognosis in various tumour types, especially those of epithelial origin. The contribution of NRP and its ligands to tumour growth and metastasis has spurred a strong interest in NRPs as novel chemotherapy drug targets. Given NRPs role as a multifunctional co-receptor with an ability to bind with disparate ligand families, this has sparked new areas of research implicating NRPs in diverse biological functions. Here, we review the growing body of research demonstrating NRP expression and role in the normal and neoplastic epithelium.