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Background Sepsis and infection are the leading cause of morbidity and mortality after surgery, but the inflammatory response to the trauma of surgery can make diagnosis challenging. Carbon-13 breath delta value (13C BDV) has been shown to be discriminant as a novel diagnostic marker for sepsis and infection. We aim to assess biomarkers including BDV following major hepatopancreatobiliary (HPB) surgery to diagnose postoperative infection/sepsis. Methods 20 participants undergoing HPB surgery were recruited prospectively. Breath samples were collected from baseline preoperatively, and on postoperative days (POD) 1–9, with plasma and peripheral blood mononuclear cell (PBMC) samples preoperatively, POD1, 4 and 8. Breath samples were analysed using infrared laser spectroscopy to generate BDV (per mil). Plasma was analysed for cytokines using MesoScale Discovery immunoassay, Procalcitonin (PCT) using ELISA, and Cell surface marker expression on monocytes was phenotyped using flow cytometry. Differences between groups who did and did not develop infective complications was analysed using two-way ANOVA and Mann Whitney U test. Results 5/20 participants developed infective complications, with a mean day of diagnosis POD5. There was no difference between BDV in patients with or without infection. Monocyte count was increased in infected participants at all timepoints, and monocyte expression of PD-L1 on POD1, and CD155 and HLA-DR on POD4 was upregulated, +13.09% (95%CI 1.59 to 24.61, p Conclusions Monocyte expression of PD-L1, HLA-DR and CD155 is associated with infection, +13.09% (p

Aims Minor hepatectomy, which is increasingly carried out laparoscopically (LLR), is a cornerstone of curative treatment for hepatocellular carcinoma (HCC). The majority of relevant publications however originate from regions with endemic viral hepatitis. Although the incidence of HCC in the UK is increasing, little is known about outcomes following LLR. Methods Consecutive patients undergoing minor (involving ≤2 segments) LLR or open resection (OLR) at our institute between 2014–2021 were compared. Selection from a plethora of factors potentially impacting disease free survival (DFS) was optimised with Lasso regression. To enable analysis of patients having repeat resection, multivariate frailty modelling was utilised to calculate hazard ratios (HR). Results There were 111 liver resections with 55 and 56 patients undergoing LLR or OLR, respectively. LLR patients had a shorter hospital stay (5±2 vs. 7±2 days; p Conclusions In the studied population minor LLR was associated with shorter hospital stay and fewer complications while offering non-inferior long-term outcomes. Neoadjuvant and adjuvant therapy for HCC are increasingly being employed and it is hoped that the outcome predictors identified here, may aid in selecting patients who are most likely to benefit from these adjuncts.

IntroductionLiver transplantation (LT) remains integral to the management of end-stage chronic liver disease (CLD). However, referral thresholds and assessment pathways remain poorly defined. Distance from LT centre has been demonstrated to impact negatively on patient outcomes resulting in the development of satellite LT centres (SLTCs). We aimed to evaluate the impact of SLTCs on LT assessment in patients with CLD and hepatocellular carcinoma (HCC).MethodsA retrospective cohort study was undertaken including all patients with CLD or HCC assessed for LT at King’s College Hospital (KCH) between October 2014 and October 2019. Referral location, social, demographic, clinical and laboratory data were collected. Univariable and multivariable analyses (MVA) were performed to assess the impact of SLTCs on patients being accepted as LT candidates and contraindications being identified.Results1102 and 240 LT assessments were included for patients with CLD and HCC, respectively. MVA demonstrated significant associations with; patients living greater than 60 min from KCH/SLTCs and LT candidacy acceptance in CLD, and less deprived patients and LT candidacy acceptance in HCC. However, neither variable was associated with identification of LT contraindications. MVA demonstrated that referrals from SLTCs were more likely to result in acceptance of LT candidacy and less likely to result in a contraindication being identified in CLD. However, such associations were not demonstrated in HCC.ConclusionSLTCs improve LT assessment outcomes in CLD but not HCC reflecting the standardised HCC referral pathway. Developing a formal regional LT assessment pathway across the UK would improve equity of access to transplantation.

Background: We report our experience of treating anastomotic strictures using a novel type of fully covered metal stent (FCSEMS). This stent, known as the Kaffes Stent, is short-length with an antimigration waist and easily removable due to long retrieval wires deployed within the duodenum. Methods: 62 patients who had this stent inserted were prospectively analysed. Results: 81% of patients had long-term resolution of their stricture with a significant improvement in liver function tests. Complication rates were 15% with one patient requiring biliary reconstruction. Conclusions: This type of FCSEMS is effective and safe at resolving anastomotic strictures.