42 results on '"Zaed Hamady"'
Search Results
2. Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT
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Joseph Shalhoub, Rebecca Lawton, Jemma Hudson, Christopher Baker, Andrew Bradbury, Karen Dhillon, Tamara Everington, Manjit S Gohel, Zaed Hamady, Beverly J Hunt, Gerard Stansby, David Warwick, John Norrie, and Alun H Davies
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venous thromboembolism ,graduated compression stockings ,surgery ,risk assessment ,non-inferiority ,low-molecular-weight heparin ,Medical technology ,R855-855.5 - Abstract
Background: Patients admitted to hospital for surgery are at an increased risk of venous thromboembolism. Pharmaco-thromboprophylaxis and mechanical prophylaxis (usually graduated compression stockings or intermittent pneumatic compression) have been shown to reduce the incidence of venous thromboembolism. The evidence base supporting the National Institute for Health and Care Excellence’s recommendation for the use of graduated compression stockings for venous thromboembolism prevention in the UK has recently been challenged. It is unclear if the risks and costs associated with graduated compression stockings are justified for deep-vein thrombosis prevention in moderate- and high-risk elective surgical inpatients receiving low-dose low-molecular-weight heparin pharmaco-thromboprophylaxis. Objectives: The primary objective was to compare the venous thromboembolism rate in elective surgical inpatients at moderate or high risk of venous thromboembolism who were receiving either graduated compression stockings and low-dose low-molecular-weight heparin (standard care) or low-dose low-molecular-weight heparin alone (intervention). Design: This was a pragmatic, multicentre, prospective, non-inferiority, randomised controlled trial. Setting: This took place in secondary care NHS hospitals in the UK. Participants: Patients aged ≥ 18 years who were assessed to be at moderate or high risk of venous thromboembolism according to the NHS England venous thromboembolism risk assessment tool (or the trust equivalent based on this form) and who were not contraindicated to low-molecular-weight heparin or graduated compression stockings were deemed eligible to take part. Interventions: Participants were randomised 1 : 1 to either low-molecular-weight heparin or low-molecular-weight heparin and graduated compression stockings. Main outcome measures: The primary outcome measure was venous thromboembolism up to 90 days after surgery. A combined end point of duplex ultrasound-proven new lower-limb deep-vein thrombosis (symptomatic or asymptomatic) plus imaging-confirmed symptomatic pulmonary embolism. Secondary outcomes included quality of life, compliance with graduated compression stockings and low-molecular-weight heparin during admission, and all-cause mortality. Results: A total of 1905 participants were randomised and 1858 were included in the intention-to-treat analysis. A primary outcome event occurred in 16 out of 937 (1.7%) patients in the low-molecular-weight heparin-alone arm compared with 13 out of 921 (1.4%) patients in the low-molecular-weight heparin plus graduated compression stockings arm. The risk difference between low-molecular-weight heparin and low-molecular-weight heparin plus graduated compression stockings was 0.30% (95% confidence interval –0.65% to 1.26%). As the 95% confidence interval did not cross the non-inferiority margin of 3.5% (p
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- 2020
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3. IL‐12 and IL‐15 induce the expression of CXCR6 and CD49a on peripheral natural killer cells
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Theresa Hydes, Angela Noll, Gabriela Salinas‐Riester, Mohammed Abuhilal, Thomas Armstrong, Zaed Hamady, John Primrose, Arjun Takhar, Lutz Walter, and Salim I. Khakoo
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CD49a antigen ,chemokine receptor 6 protein ,cytokines ,human liver ,natural killer cells ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Introduction Murine hepatic NK cells exhibit adaptive features, with liver‐specific adhesion molecules CXCR6 and CD49a acting as surface markers. Methods We investigated human liver‐resident CXCR6+ and CD49a+ NK cells using RNA sequencing, flow cytometry, and functional analysis. We further assessed the role of cytokines in generating NK cells with these phenotypes from the peripheral blood. Results Hepatic CD49a+ NK cells could be induced using cytokines and produce high quantities of IFNγ and TNFα, in contrast to hepatic CXCR6+ NK cells. RNA sequencing of liver‐resident CXCR6+ NK cells confirmed a tolerant immature phenotype with reduced expression of markers associated with maturity and cytotoxicity. Liver‐resident double‐positive CXCR6 + CD49a+ hepatic NK cells are immature but maintain high expression of Th1 cytokines as observed for single‐positive CD49a+ NK cells. We show that stimulation with activating cytokines can readily induce upregulation of both CD49a and CXCR6 on NK cells in the peripheral blood. In particular, IL‐12 and IL‐15 can generate CXCR6 + CD49a+ NK cells in vitro from NK cells isolated from the peripheral blood, with comparable phenotypic and functional features to liver‐resident CD49a+ NK cells, including enhanced IFNγ and NKG2C expression. Conclusion IL‐12 and IL‐15 may be key for generating NK cells with a tissue‐homing phenotype and strong Th1 cytokine profile in the blood, and links peripheral activation of NK cells with tissue‐homing. These findings may have important therapeutic implications for immunotherapy of chronic liver disease.
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- 2018
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4. Serious complications of pancreatoduodenectomy correlate with lower rates of adjuvant chemotherapy: Results from the recurrence after Whipple's (RAW) study
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Thomas B. Russell, Peter L. Labib, Fabio Ausania, Elizabeth Pando, Keith J. Roberts, Ambareen Kausar, Vasileios K. Mavroeidis, Gabriele Marangoni, Sarah C. Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R. Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal S. Shah, Zaed Z.R. Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori, Adam Streeter, Jemimah Denson, Mark Puckett, Shang-Ming Zhou, Matthew Browning, Keith Roberts, Sarah Thomasset, Adam Frampton, Andrew Smith, Brian Davidson, Ricky Bhogal, Michael Silva, Nehal Sureshkumar Shah, Zaed Hamady, Carolina Gonzalez-Abos, Nair Fernandes, Elsa Garcia Moller, Cristina Dopazo Taboada, Rupaly Pande, Jameel Alfarah, Samik Bandyopadhyay, Ahmed Abdelrahim, Ayesha Khan, Caitlin Jordan, Jonathan R.E. Rees, Harry Blege, William Cambridge, Olga White, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Daniel Field, Mohammed Gouda, Ruben Bellotti, Hytham K.S. Hamid, Hassan Ahmed, Catherine Moriarty, Louise White, Mark Priestley, Kerry Bode, Judith Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Stephanos Pericleous, Krishna Patel, Conrad Shaw, Nolitha Morare, Mohamad Khish Zaban, Joseph Doyle, Alan Guerrero, Andre Moguel, Carlos Chan, Michael Jones, Edward Buckley, Nasreen Akter, Kyle Treherne, Gregory Gordon, Daniel Hughes, Tomas Urbonas, Gioia Brachini, Roberto Caronna, Piero Chirletti, Teresa Perra, Nurul Nadhirah Abd Kahar, Thomas Hall, Nabeegh Nadeem, Shoura Karar, Ali Arshad, Adam Yarwood, Mohammed Hammoda, Maria Artigas, and Sandra Paterna-López
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Oncology ,Surgery ,General Medicine - Published
- 2023
5. Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study
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Thomas B. Russell, Peter L. Labib, Jemimah Denson, Fabio Ausania, Elizabeth Pando, Keith J. Roberts, Ambareen Kausar, Vasileios K. Mavroeidis, Gabriele Marangoni, Sarah C. Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R. Davidson, Ricky H. Bhogal, Daniel Croagh, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Nehal S. Shah, Zaed Z.R. Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori, Adam Streeter, Mark Puckett, Matthew G. Browning, Carolina González-Abós, Nair Fernandes, Elsa G. Moller, Cristina D. Taboada, Rupaly Pande, Jameel Alfarah, Samik Bandyopadhyay, Ahmed Abdelrahim, Ayesha Khan, Caitlin Jordan, Jonathan R.E. Rees, Collaborator: Harry Blege, Sarah Thomasset, William Cambridge, Olga White, Adam Frampton, Sarah Blacker, Jessie Blackburn, Casie Sweeney, Daniel Field, Mohammed Gouda, Ruben Bellotti, Hytham K.S. Hamid, Hassan Ahmed, Andrew Smith, Catherine Moriarty, Louise White, Mark Priestley, Kerry Bode, Judith Sharp, Rosie Wragg, Beverley Jackson, Samuel Craven, Matyas Fehervari, Madhava Pai, Laith Alghazawi, Anjola Onifade, Julliette Ribaud, Ashitha Nair, Michael Mariathasan, Niamh Grayson, Brian Davidson, Stephanos Pericleous, null Krishna Patel, Conrad Shaw, Nolitha Morare, Mohamad K. Zaban, Ricky Bhogal, Joseph Doyle, Alan Guerrero, Andre Moguel, Carlos Chan, Michael Jones, Edward Buckley, Nasreen Akter, Kyle Treherne, Gregory Gordon, Michael Silva, Daniel Hughes, Tomas Urbonas, Gioia Brachini, Roberto Caronna, Piero Chirletti, Teresa Perra, Nurul N. Abd Kahar, Thomas Hall, Nabeegh Nadeem, Zaed Hamady, Shoura Karar, Ali Arshad, Adam Yarwood, Mohammed Hammoda, Maria Artigas, and Sandra Paterna-López
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Hepatology ,Gastroenterology - Published
- 2023
6. Examining the benefit of graduated compression stockings in the prevention of hospital-associated venous thromboembolism in low-risk surgical patients:a multicentre cluster randomised controlled trial (PETS trial)
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Matthew Machin, Sarrah Peerbux, Sarah Whittley, Beverley J Hunt, Tamara Everington, Manjit Gohel, John Norrie, David Epstein, David J Warwick, Christopher Baker, Zaed Hamady, Sasha Smith, Layla Bolton, Annya Stephens-Boal, Beverley Gray, Joseph Shalhoub, and Alun Huw Davies
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Adult ,Science & Technology ,Aftercare ,Anticoagulants ,1103 Clinical Sciences ,vascular medicine ,Venous Thromboembolism ,General Medicine ,thromboembolism ,Venous Thromboembolism/prevention & control ,Patient Discharge ,Hospitals ,1117 Public Health and Health Services ,surgery ,Medicine, General & Internal ,General & Internal Medicine ,Quality of Life ,Humans ,DEEP-VEIN THROMBOSIS ,Life Sciences & Biomedicine ,Stockings, Compression ,1199 Other Medical and Health Sciences ,Stockings, Compression/adverse effects - Abstract
Introduction Hospital-acquired thrombosis (HAT) is defined as any venous thromboembolism (VTE)-related event during a hospital admission or occurring up to 90 days post discharge, and is associated with significant morbidity, mortality and healthcare-associated costs. Although surgery is an established risk factor for VTE, operations with a short hospital stay (, National Institute for Health Research (NIHR) NIHR133776
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- 2023
7. Resectability of pancreatic adenocarcinoma within UK Biobank
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Declan McDonnell, Sam Wilding, Christopher Byrne, and Zaed Hamady
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Oncology ,Surgery ,General Medicine - Published
- 2023
8. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction
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Thomas M. Drake, Matthew J. Lee, Adele E. Sayers, John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Mike Bradburn, Michael Davies, Zaed Hamady, Daniel Hind, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Paul J. Marriott, Nick Maynard, Malcolm McFall, Aravinth Muragananthan, David Murray, Pritam Singh, Gillian Tierney, Azmina Verjee, Ciaran Walsh, Jonathan RL. Wild, Timothy Wilson, S. Abbott, Y. Abdulaal, S. Afshar, M. Akhtar, D. Anderson, S. Appleton, D. Bandyopadhyay, G. Bashir, N. Behar, S. Bhandari, G. Branagan, R. Boulton, C. Borg, G. Bouras, J. Boyle, H. Brewer, L. Brown, C. Briggs, M. Cartmell, S. Chan, N. Chandratreya, P. Conaghan, J. Cornish, D. Cotton, P. Coyne, J. Crozier, T. Cook, P. Cunha, N. Curtis, A. Day, S. Dayal, R. Dennis, P. Dent, H. Dowson, R. Fallaize, S. Farag, M. El Farran, G. Faulkner, P. Giordano, T. Grey, V. Halahakoon, J. Hannay, A. Harikrishnan, S. Holtham, P. Hawkin, C. Hall, L. Hancock, J. Hartley, F. Howse, R. Kallam, G. Kakaniaris, S. Kelly, S. Lockwood, D. Leinhardt, B. Levy, R. Lal, T. Lazim, J. Lund, R. Lunevicius, P. Mathur, K. Maude, D. McArthur, B. McIlroy, A. Miles, S. Moug, M. Mondragon-Pritchard, D. Messenger, M. Mullan, A. Myers, K. Muhammad, C. Mason, J. Sarveswaran, V. Shatkar, B. Singh, B. Skelly, S. Subramonia, M. Swinscoe, B. Thava, C. Thorn, S. Panagiotopoulos, P. Patel, J. Phillips, I. Peristerakis, A. Qureshi, M. Saunders, P. Shah, A. Sheel, S. Siddiqui, P. Skaife, N. Smart, I. Smith, L. Stevenson, N. Stylianides, J. Steinke, B. Stubbs, R. Thompson, M. Varcada, D. Vimalachandran, I. Virlos, J. Watfah, N. Watson, M. Walker, N. Ventham, H. West, J. Wilson, S. Wijeyekoon, J. Ah-Chuen, T. Ahmed, F. Akram, E. Aldred, A. Ali, M. Aly, A. Amajuoyi, V. Amin, A. Andreou, A. Ansari, R. Ardley, F. Arshad, O. Ashour, A. Asour, F. Ayoub, H. Azeem, B. Azhar, C. Baillie, J. Barker, B. Barkham, R. Baron, J. Barrie, E. Barry-Yarrow, N. Battersby, G. Bazoua, C. Berger, S. Bhasin, S. Biggs, C. Bisset, N. Blencowe, A. Boddy, C. Boereboom, M. Bogdan, R. Bogle, P. Bohra, H. Bolkan, M. Boyer, J. Broadhurst, E. Brown, J. Brown, K. Burns, K. Butcher, C. Capper, T. Cash, J. Chapman, S. Chapman, A. Charalabopoulos, C. Cheek, S. Chok, W. Choong, J. Chowdhury, P. Coe, G. Conn, N. Cook, S. Cooper, C. Cox, R. Crook, G. Cuffolo, L. da Silva, B. Das, M. Davenport, J. Davies, T. Davies, S. Dean, G. Demetriou, F. Dengu, H. Dent, G. Di Benedetto, S. Dindyal, E. Donnelly, E. Douka, C. Downham, H. Edent, K. Edgerton, M. El-Sharif, O. Elamin, N. Elsaid, J. Evans, M. Evans, R. Ewe, A. Ewing, H. Ferguson, O. Fisher, J. Fletcher, A. Forouzanfar, A. Foster, R. Fox, N. Francis, V. Fretwell, D. Fung, E. Gammeri, J. Garnham, A. Geraghty, A. Gilbert, M. Gill, M. Gillespie, J. Glasbey, A. Golder, N. Green, E. Groundwater, T. Grove, H. Habib, J. Haddow, C. Halkias, A. Hampson, T. Hanna, R. Harries, K. Harvey, J. Hawkins, R. Healy, R. Heartshorne, S. Heller, L. Hendra, P. Herrod, N. Heywood, G. Hicks, P. Ng, C. Hope, P. Hopley, T. Hossain, S. Hossaini, T. Hubbard, A. Humphreys, H. Ikram, M. Ioannis, M. Iqbal, J. Jatania, P. Jenkinson, S. Jokhan, A. Jones, C. Jones, L. Jones, H. Joshi, K. Joshi, M. Joy, P. Jull, E. Kane, R. Kanitkar, S. Kauser, F. Kazmi, M. Kedrzycki, J. Kendall, T. Khan, G. King, A. Kisiel, C. Kitsis, I. Kolawole, S. Kosasih, A. Kosti, A. Kotb, A. Lau, G. Lafaurie, A. Lazzaro, R. Lefroy, H. Lennon, K. Leong, E. Lim, J. Lim, S. Lindley, D. Liu, P. Lloyd, D. Locker, C. Lowe, A. Lunt, S. Lutfi, A. Luther, S. Luwemba, P. Mahankali-Rao, D. Mai, S. Majid, A. Malik, N. Manu, R. Mapara, C. Martin, J. Martin, L. Massey, J. Mathias, S. McCain, S. McCluney, A. McNair, P. Mekhail, J. Merchant, L. Merker, S. Mir, P. Mistry, V. Miu, M. Moat, E. Mohamed, I. Mohamed, N. Moore, L. Moretti, H. Morris, T. Morrison, J. Moss, D. Mountford, R. Moynihan, D. Muldoon-Smith, J. Mulholland, E. Murgitroyd, K. Murugaiyan, I. Mykoniatis, G. Nana, T. Nash, A. Nassar, R. Newton, K. Nguyen, F. Nicholas, M. Noor, J. Nowers, C. Nugent, A. Nunn, J. O'Callaghan, R. O'Hara, A. O'Neill, J. Olivier, D. Osei-Bordom, L. Osgood, B. Panchasara, R. Parks, H. Patel, K. Pawelec, C. Payne, K. Pearson, G. Perin, B. Petronio, L. Phelan, C. Pisaneschi, J. Pitt, L. Ponchietti, A. Powell, A. Powell-Chandler, N. Pranesh, V. Proctor, N. Qureshi, M. Rahman, Z. Rai, S. Ramcharan, K. Rangarajan, M. Rashid, H. Reader, A. Rehman, S. Rehan, C. Rengifo, N. Richardson, A. Robinson, D. Robinson, B. Rossi, F. Rutherford, I. Sadien, T. Saghir, K. Sahnan, G. Salahia, B. Scott, K. Scott, A. Seager, S. Seal, E. Sezen, F. Shaban, M. Shahmohammadi, A. Shamsiddinova, S. Shankar, A. Sharpe, T. Shields, M. Shinkwin, J. Shurmer, A. Siddika, R. Simson, S. Singh, J. Sivaraj, A. Skinner, C. Smart, F. Smith, R. Smith, A. Sreedhar, E. Stewart-Parker, M. Stott, N. Symons, T. Taj, J. Tam, K. Tan, S. Tani, D. Tao, K. Thippeswamy, C. Thomas, E. Thompson, C. Thompson-Reil, F. Tongo, G. Toth, A. Turnbull, J. Turnbull, T. Wade, A. Wafi, K. Waite, N. Walker, T. Walker, U. Walsh, S. Wardle, R. Warner, J. Watt, J. Watts, J. Wayman, C. Weegenaar, M. West, M. Whyler, L. Whitehurst, M. Wiggans, G. Williams, R. Williams, A. Williamson, J. Williamson, A. Winter, L. Wolpert, J. Wong, G. van Boxel, E. Yeap, S. Zaman, B. Zappa, D. Zosimas, O. Anderson, A. Athem, M. Athersmith, T. Badenoch, S. Barker, S. Bellam, T. Boam, M. Boland, L. Blake, O. Brown, M. Butler, B. Byrne, L. Campbell, M. Chow, K. Da Costa, J. Cutting, M. Deputy, L. Devoto, P. Doody, N. Ekpete, M. Eljaafari, K. Exarchou, M. Faoury, E. Farinella, C. Gill, M. Goh, T. Gregoir, S. Growcott, S. Gunasekaran, G. Harris, R. Heard, B. Hobson, N. Iqbal, R. Jain, P. Kang, M. Khan, S. Korambayil, S. Kouris, K. Kshatriya, S. Kumar, K. Lee, S. Mahroof, K. Malik, K. Mann, S. Mansour, R. Martin, S. McKay, N. McKinley, D. McWhirter, K. Mellor, A. Mishra, K. Mockford, V. Morrison-Jones, C. Ng, R. Nunn, S. O'Neill, O. Oke, N. Obeid, R. Patel, S. Patel, K. Plunkett-Reed, M. Pouzi, S. Pywell, E. Richards, P. Sinclair, N. Slim, G. Spence, M. Swinkin, W. Tahir, K. Takacs, N. Tanner, M. Taylor, C. Valero, M. Venn, M. Venza, T. Yeong, and Nicola S. Fearnhead
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Male ,medicine.medical_specialty ,Colorectal cancer ,030230 surgery ,Malignancy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Intestinal Neoplasms ,Intestine, Small ,Humans ,Medicine ,Prospective Studies ,Aged ,business.industry ,Mortality rate ,Hazard ratio ,Cancer ,General Medicine ,medicine.disease ,United Kingdom ,Bowel obstruction ,Oncology ,Abdominal Neoplasms ,030220 oncology & carcinogenesis ,Cohort ,Female ,Surgery ,business ,Intestinal Obstruction ,Cohort study - Abstract
Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.
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- 2019
9. P-P57 The first experience of intraoperative radiotherapy for pancreatic cancer in the UK
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Rahul Bhome, Karavias Dimitrios, Armstrong Tom, Zaed Hamady, Arshad Ali, Primrose John, Neil Pearce, and Takhar Arjun
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Surgery - Abstract
Background Intraoperative radiotherapy (IORT) involves giving a targeted single fraction of high dose radiation to the resection bed. The main advantages are exclusion of vulnerable structures from the radiation field and ability to direct the electron beam to threatened margins. IORT in pancreatic cancer is not new, with Japanese centres reporting series from the 1970s. Early reports were exciting, suggesting that IORT was useful in reducing visceral pain, achieving local control and improving survival in locally advanced and unresectable patients. However, paucity of randomised trials in the ensuing decades has limited its widespread adoption. Methods With funding from the PLANETS charity (www.planetscharity.org), University Hospitals Southampton acquired a Mobetron 2000 linear accelerator (IntraOp, USA) in 2016. Testing was done at the National Physical Laboratory (Teddington, UK) over two months to collect beam data and ensure consistency in treatment delivery. Staff training included visits to the Heidelberg Cancer Centre and several dry runs. Inclusion criteria were: (i) patients with pancreatic head adenocarcinomas; (ii) threatened vascular margins; (iii) WHO performance status 1-2; (iv) no evidence of distant metastasis. Results Nineteen patients had pancreaticoduodenectomy (traditional or pylorus preserving) combined with IORT. Median age was 66 (42-81) years. Median ASA grade was 2 (2-3). 16/19 had locally advanced pancreatic cancer and 18/19 had neoadjuvant chemotherapy. Median IOERT dose was 15 (10-15) Gy, energy 7.5 (6-12) MeV, to a mean depth of 1.6 +/- 0.8 cm, with median cone size 5 (4-6) cm and bevel angle 15 (0-30) degrees. All tumours were pT1-T3 and 10/19 had positive regional nodes. 10/19 were R1 resections, with 4/19 specimens exhibiting vascular invasion and 6/19 perineural invasion. Mean operating time (including IOERT) was 534 +/- 77 min. Median length of stay was 8.5 (6-41) days. 30-day mortality was zero. 6/19 patients had post-operative complications (Clavien-Dindo 1-2 only), with clinically detectable pancreatic fistula in 1/19. Conclusions This is the first UK experience of IORT for pancreatic cancer, showing that this treatment modality is safe and feasible. With the appropriate expertise, an IORT service can be implemented within 12 months of acquiring the Mobetron system. We hope that these data will encourage other UK and European HPB units to consider setting up regional IORT services, such that larger scale prospective trials can be initiated to demonstrate its efficacy.
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- 2021
10. P-P44 Clinical outcomes of consecutive patients undergoing distal pancreatectomy over the last decade at a high volume tertiary pancreatic surgery unit
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Bhavik Patel, Richard Fristedt, Zaed Hamady, Arjun Takhar, Tom Armstrong, Mohammad Abu Hilal, Dimitrios Karavias, and Ali Arshad
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Surgery - Abstract
Background Distal pancreatectomy (DP) enables resection of lesions in the body and tail of the pancreas. Over the past decade, the Laparoscopic approach has become frequently employed. There remains scarce outcome data available following laparoscopic distal pancreatectomy over a long time period from high volume centres. Postoperative pancreatic fistula (POPF) remains the main source of morbidity and mortality after DP. The causes of POPF are multifactorial and poorly understood. The optimal method of pancreatic stump closure is still debated with variation in clinical practice. Methods All patients that underwent distal pancreatectomy at a UK tertiary pancreatic surgery centre between January 2011 and January 2021 were identified and clinical outcomes examined. Patients undergoing completion pancreatectomies were excluded. Clinical, pathological and surgical data for the included patients was retrospectively collected from the electronic patient record. Clinically significant POPF was defined as Grade B or C as per the ISGPF guidelines. For stapled stump closure, the Compression Index (CI) was calculated using closed staple height (mm) divided by the pancreatic thickness (mm). High and low CI was defined around the median. Results 233 patients (n = 90 open and n = 143 laparoscopic) were included in the final analysis. The laparoscopic approach was associated with comparable morbidity and significantly lower blood loss, shorter operative time and shorter length of stay. There were no significant differences in age, sex, final histology, closure technique, or ASA Score of 3 or more amongst patients with clinically relevant POPF (CR-POPF). The POPF group had a significantly higher BMI, drain duration and readmission rate. CI data was available for 78 cases (range 0.04-0.21). There was no significant difference in low vs high CI for patients with CR-POPF. Conclusions Laparoscopic distal pancreatectomy is associated with favourable clinical outcomes in this series. Stapled vs sutured closure of the pancreatic stump offered equivocal outcomes with relation to POPF. POPF continues to have a significant impact on a clinical recovery as evident from longer drain duration and high readmission rates. Further research is required to try to establish methods for reducing the incidence of POPF after distal pancreatectomy.
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- 2021
11. P-P30 Outcomes from resection of pancreatic metastases and non-neuroendocrine, non-pancreatic tumours
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Claire Stevens, Sirr Ling Chin, Dimitrios Karavios, Arjun Takhar, Ali Arshad, Zaed Hamady, Thomas Armstrong, Neil Pearce, and John Primrose
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Surgery - Abstract
Background Isolated metastatic disease within the pancreas is an uncommon finding. The potentially higher perioperative risk and low incidence of resectable metastases has limited the development of evidence based guidelines for pancreatic metastectomy. However, reports in the literature suggest a considered approach to resecting patients with limited disease, favourable tumour type and a significant disease free interval. The aim of this study was to examine the indications and outcomes of pancreatic resection for metastatic disease and non-pancreatic, non-neuroendocrine malignancy at a high-volume pancreatic surgery centre. Methods This is a retrospective analysis of a prospectively managed database of pancreatic resections for metastatic disease or primary non-pancreatic, non-neuroendocrine tumours at a single institution. Data collected and analysed included patient demographics, operative details and peri-operative outcomes, subsequent survival and mode of recurrence. Results Records of 711 patients who underwent pancreatic resection were examined. 21 consecutive patients met the inclusion criteria, representing 3% of the unit’s throughput. The perioperative morbidity and mortality were 33% and 0% respectively. Overall survival was 86months (95%CI 63-107) for renal cell carcinoma and 64months for other tumours. Conclusions When coupled with the low morbidity and mortality rates of a high-volume pancreatic surgery centre using careful patient selection, pancreatic metastectomy has the potential to result in good long-term survival. Recent improvement in the efficacy of systemic therapies, particularly for renal cell carcinoma and melanoma contribute to the utility of resection and to the improved survival of patients.
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- 2021
12. P-P47 Impact of neoadjuvant chemotherapy on postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy
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Lulu Tanno, Charlotte Davies, Claire Stevens, Richard Fristedt, Ali Arshad, Zaed Hamady, Thomas Armstrong, John Primrose, Dimitrios Karavias, and Arjun Takhar
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Surgery - Abstract
Background Pancreatic adenocarcinoma (PDAC) is one of the most lethal tumours with a five-year survival rate of less than 7% for all stages. However, current evidence suggests neoadjuvant treatment (NAT) may have survival benefits in those with borderline resectable disease. Post-operative pancreatic fistula (POPF) is a potential complication after pancreaticoduodenectomy (PD) and is associated with long-term morbidity. The rate of developing POPF post-PD in those receiving NAT is currently unclear. Methods Patients undergoing PD (both classical and pylorus-preserving) were identified from a prospectively collected local database. Those who received NAT prior to surgery were identified, and case-matched controls based on their age and sex, were then identified from the database. Post-operative drain amylase levels were used to compare POPF between groups. For the analysis, drain amylase levels greater than three times the upper limit of normal at day five were consistent with biochemical POPF. Results A total of 34 patients (14 females, 20 males) underwent PD after receiving NAT at our unit from January 2013 to July 2021. The median age was 66 years at the time of surgery. Two patients (5.9%) in the NAC group had biochemical leaks on day five compared to 4 (11.8%) in the case-matched control group (p = 0.7). Conclusions Our early data suggest a possibility of a lower incidence of biochemical POPF in those undergoing PD post-NAT. Aetiology on the development of POPD post-NAT is still unclear, and this requires further study and long-term follow up.
- Published
- 2021
13. P-P29 The glycated haemoglobin (HbA1c) test is not a predictor of pancreatectomy specific complications or survival
- Author
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Claire Stevens, Charmaine Hu Chan, Dimitrios Karavias, Arjun Takhar, Ali Arshad, Zaed Hamady, Thomas Armstrong, Neil Pearce, and John Primrose
- Subjects
Surgery - Abstract
Background The glycated haemoglobin (HbA1c) test is a venous blood test used as a diagnostic test for diabetes mellitus and to monitor glucose control in patients known to have diabetes. The test has been recommended by National Institute for Health Care Excellence (NICE) clinical guidelines in the pre-operative setting since 2016. The purpose of testing is to reduce perioperative morbidity and mortality by optimising management of blood glucose levels in the perioperative period. The aim of this study was to assess the prognostic value of HbA1c in pancreatic cancer patients treated with pancreaticoduodenectomy. Methods This is a retrospective analysis of a prospectively managed database of pancreatic resections at a single institution from January 2016 to December 2020. Included patients had confirmed pancreatic adenocarcinoma and underwent a pancreaticoduodenectomy with preoperative measurement of their HbA1c. Patients who were already prescribed insulin were excluded. Demographic data, survival, operative and perioperative details were collected. Included patient records were assessed for the incidence of postoperative complications in accordance with International Study Group of Pancreatic Surgery guidelines for pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage. An HbA1c greater than 41 was deemed elevated. Results There were 145 patients who met the inclusion criteria. The HbA1c level was normal in 101/145 (70%) and elevated in 44/45 (30%). The postoperative pancreatic fistula rate was 18% in the patients with a normal HbA1c and 23% in those with elevated HbA1c (p = 0.499). The rate of delayed gastric emptying was 21 and 23% in the patients with normal and elevated HbA1c respectively. There were five relaparotomies overall, one of these patients had an elevated preoperative HbA1c. There were no perioperative deaths. Overall survival was 31months (95%CI 27-35) with a normal preoperative HbAlc and 32months (95%CI 27-38) if elevated. Conclusions There is little doubt that the preoperative HbA1c is helpful in the package of preoperative assessment tests to optimise patients for surgery. However, the preoperative HbA1c level in patients planned for pancreaticoduodenectomy is not predictive of pancreaticoduodenectomy specific complications such as postoperative pancreatic fistula, delayed gastric emptying, relaparotomy or mortality. In addition, long-term overall survival is not influenced by an elevated preoperative HbAlc.
- Published
- 2021
14. P-P13 Long-term outcome after portal vein resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matched analysis
- Author
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James Russell, Claire Stevens, Rahul Bhome, Dimitrios Karavias, Ali Arshad, Arjun Takhar, Thomas Armstrong, John Primrose, Brian Green, and Zaed Hamady
- Subjects
Surgery - Abstract
Background Portal vein resection (PVR) with pancreaticoduodenectomy (PD) is often performed to achieve clear margins for patients with vascular involvement in pancreatic ductal adenocarcinoma (PDAC). However, there is evidence to suggest that patients undergoing PVR often have more advanced cancers, therefore the impact of PVR on survival and recurrence remains unclear. The aim of this study is to assess overall (OS) and recurrence free (RFS) survival in patients who underwent PVR during PD, with particular attention to margin positivity. Methods A retrospective analysis was performed on 638 patients who underwent PD during a 12-year period. Exclusion criteria included PD for non-PDAC tumours, neoadjuvant chemotherapy or intra-operative radiotherapy. 374 patients were included in the study (90 PVR and 284 non-PVR). Patient characteristics and histopathological factors associated with OS and RFS were then evaluated using univariate and multivariate Cox regression analyses. 270 patients (90 PVR and 180 non-PVR), were matched by propensity score based on perineural invasion, pT and pN staging. The Kaplan-Meier method was used to calculate survival and log-rank tests. Results Resection margin positivity was associated with shorter OS and RFS (p Conclusions Positive resection margins are associated with shorter survival times, and the SMV margin is the most significant prognostic indicator for overall survival and recurrence compared to other margins. PVR is a relatively safe procedure, however, it does not achieve the intended survival benefits of complete margin clearance. The impact on survival for margin positivity, particularly the SMV margin, and nodal metastasis should be considered when making decisions with regards to vein resection and adjuvant treatments.
- Published
- 2021
15. Clinical relevant pancreatic fistula after pancreatoduodenectomy:when negative amylase levels tell the truth
- Author
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Koop Bosscha, K.P. de Jong, Sebastiaan Festen, Daniele Greener, M. den Dulk, E. van der Harst, Gijs A. Patijn, Geert Kazemier, Vincent B. Nieuwenhuijs, Francesco Giovinazzo, M. van der Kolk, Mohammad Abu Hilal, Joris J. Scheepers, C.H.J. van Eijck, Christopher Morano, Giulio Valentino Dalla Riva, M.G. Besselink, A. Takhar, T. Armstrong, Ralph Linneman, Zaed Hamady, D. Boerma, I.H.J.T. de Hingh, Surgery, Intensive Care, Pediatric Surgery, Gastroenterology & Hepatology, Erasmus MC other, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, and Epidemiologie
- Subjects
PREDICTOR ,medicine.medical_specialty ,RESECTION ,Amylase levels ,030230 surgery ,Normal serum ,Pancreaticoduodenectomy ,Pancreatic Fistula ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,MANAGEMENT ,Humans ,Medicine ,Amylase ,Pancreas ,RISK ,biology ,business.industry ,medicine.disease ,FLUID ,Surgery ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Amylases ,biology.protein ,Drainage ,GRADE C ,business ,DRAIN - Abstract
Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940–0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81–0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
- Published
- 2021
16. Transarterial Embolization for Mitigation of Severe Hypoglycemia in 2 Patients with Primary Pancreatic Insulinoma
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Brian Stedman, Shian Patel, Sachin Modi, Zaed Hamady, Arjun Takhar, Timothy Bryant, and Rory L. O’Donohoe
- Subjects
Pancreatic Insulinoma ,Cone beam computed tomography ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Severe hypoglycemia ,Angiography ,Severity of illness ,Transarterial embolization ,medicine ,Radiology, Nuclear Medicine and imaging ,Tomography ,Embolization ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
17. Metabolic syndrome is a predictor of all site and liver-specific recurrence following primary resection of colorectal cancer: prospective cohort study of 1006 patients
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Nadia Peppa, Alex H. Mirnezami, Zaed Hamady, Declan McDonnell, Shoura Karar, and Rahul Bhome
- Subjects
Adult ,Male ,medicine.medical_specialty ,Colorectal cancer ,Disease ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,medicine ,Humans ,Stage (cooking) ,Prospective cohort study ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Metabolic Syndrome ,business.industry ,Primary resection ,Hazard ratio ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,United Kingdom ,Oncology ,030220 oncology & carcinogenesis ,Disease Progression ,030211 gastroenterology & hepatology ,Surgery ,Female ,Metabolic syndrome ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms - Abstract
Introduction: Large epidemiological studies have demonstrated the link between metabolic syndrome and cancer development, including colorectal cancer. However, the influence of metabolic syndrome on disease progression is less well studied, particularly in the post-surgical setting. This study investigates the effect of metabolic syndrome on colorectal cancer recurrence (all-site and liver-specific) after curative surgery for Stage I-III disease. Materials and methods: Consecutive patients who underwent curative resection for Stage I-III colorectal cancer in a single UK centre were prospectively recruited. Disease-free and overall survival with metabolic syndrome as a factor, were determined using the Kaplan-Meier technique. Hazard ratios for all-site and liver-specific recurrence were determined using univariable and multivariable Cox-regression models. Results: 1006 patients were recruited and followed up for a median of 50 months (IQR 30–67). 177 patients (17.6%) met the criteria for metabolic syndrome. 245 patients (25.4%) developed recurrence, 161 (16.0%) of these had liver recurrence. The presence of metabolic syndrome was associated with a reduction in disease-free survival from 69 to 58 months (p < 0.001) and overall survival from 74 to 61 months (p < 0.001). Metabolic syndrome was an independent predictor of all-site (HR 1.76; p < 0.001) and liver-specific (HR 1.74; p = 0.01) recurrence. Conclusion: Metabolic syndrome is a predictor of all-site and liver-specific recurrence after primary resection of stage I-III colorectal cancer.
- Published
- 2021
18. Compression stockings in addition to low-molecular-weight heparin to prevent venous thromboembolism in surgical inpatients requiring pharmacoprophylaxis: the GAPS non-inferiority RCT
- Author
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Tamara Everington, Rebecca Lawton, John Norrie, Jemma Hudson, David Warwick, Christopher S. Baker, Alun H. Davies, Zaed Hamady, Beverly J Hunt, Gerard Stansby, Andrew W. Bradbury, Joseph Shalhoub, Manjit S. Gohel, Karen Dhillon, and National Institute for Health Research
- Subjects
Male ,medicine.medical_treatment ,MULTICENTER ,Intermittent pneumatic compression ,030204 cardiovascular system & hematology ,law.invention ,surgery ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,PROGRAM ,DEEP-VEIN THROMBOSIS ,030212 general & internal medicine ,low-molecular-weight heparin ,education.field_of_study ,non-inferiority ,Health Policy ,risk assessment ,Venous Thromboembolism ,Middle Aged ,Thrombosis ,Pulmonary embolism ,lcsh:R855-855.5 ,Elective Surgical Procedures ,Health Policy & Services ,Female ,RISK-ASSESSMENT ,Life Sciences & Biomedicine ,Stockings, Compression ,Research Article ,medicine.medical_specialty ,lcsh:Medical technology ,medicine.drug_class ,Population ,Low molecular weight heparin ,Compression stockings ,PATIENT ,1117 Public Health and Health Services ,graduated compression stockings ,03 medical and health sciences ,medicine ,Humans ,Elective surgery ,education ,Aged ,Inpatients ,Science & Technology ,HIP ,business.industry ,Anticoagulants ,Heparin, Low-Molecular-Weight ,medicine.disease ,United Kingdom ,Health Care Sciences & Services ,0806 Information Systems ,Emergency medicine ,business ,0807 Library and Information Studies - Abstract
Background Patients admitted to hospital for surgery are at an increased risk of venous thromboembolism. Pharmaco-thromboprophylaxis and mechanical prophylaxis (usually graduated compression stockings or intermittent pneumatic compression) have been shown to reduce the incidence of venous thromboembolism. The evidence base supporting the National Institute for Health and Care Excellence’s recommendation for the use of graduated compression stockings for venous thromboembolism prevention in the UK has recently been challenged. It is unclear if the risks and costs associated with graduated compression stockings are justified for deep-vein thrombosis prevention in moderate- and high-risk elective surgical inpatients receiving low-dose low-molecular-weight heparin pharmaco-thromboprophylaxis. Objectives The primary objective was to compare the venous thromboembolism rate in elective surgical inpatients at moderate or high risk of venous thromboembolism who were receiving either graduated compression stockings and low-dose low-molecular-weight heparin (standard care) or low-dose low-molecular-weight heparin alone (intervention). Design This was a pragmatic, multicentre, prospective, non-inferiority, randomised controlled trial. Setting This took place in secondary care NHS hospitals in the UK. Participants Patients aged ≥ 18 years who were assessed to be at moderate or high risk of venous thromboembolism according to the NHS England venous thromboembolism risk assessment tool (or the trust equivalent based on this form) and who were not contraindicated to low-molecular-weight heparin or graduated compression stockings were deemed eligible to take part. Interventions Participants were randomised 1 : 1 to either low-molecular-weight heparin or low-molecular-weight heparin and graduated compression stockings. Main outcome measures The primary outcome measure was venous thromboembolism up to 90 days after surgery. A combined end point of duplex ultrasound-proven new lower-limb deep-vein thrombosis (symptomatic or asymptomatic) plus imaging-confirmed symptomatic pulmonary embolism. Secondary outcomes included quality of life, compliance with graduated compression stockings and low-molecular-weight heparin during admission, and all-cause mortality. Results A total of 1905 participants were randomised and 1858 were included in the intention-to-treat analysis. A primary outcome event occurred in 16 out of 937 (1.7%) patients in the low-molecular-weight heparin-alone arm compared with 13 out of 921 (1.4%) patients in the low-molecular-weight heparin plus graduated compression stockings arm. The risk difference between low-molecular-weight heparin and low-molecular-weight heparin plus graduated compression stockings was 0.30% (95% confidence interval –0.65% to 1.26%). As the 95% confidence interval did not cross the non-inferiority margin of 3.5% (p Limitations In total, 13% of patients did not receive a duplex ultrasound scan that could have detected further asymptomatic deep-vein thrombosis. However, missing scans were balanced between both trial arms. The subpopulation of those aged ≥ 65 years assessed as being at a moderate risk of venous thromboembolism was under-represented in the study; however, this reflects that this group is under-represented in the general population. Conclusions For elective surgical patients at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and graduated compression stockings. These findings indicate that graduated compression stockings may be unnecessary for most elective surgical patients. Future work Further studies are required to evaluate whether or not adjuvant graduated compression stockings have a role in patients receiving extended thromboprophylaxis, beyond the period of hospital admission, following elective surgery or in patients undergoing emergency surgical procedures. Trial registration Current Controlled Trials ISRCTN13911492. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 69. See the NIHR Journals Library website for further project information.
- Published
- 2020
19. Long-term outcome after portal vein resection during pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: a propensity score matched analysis
- Author
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James Russell, Claire Stevens, Rahul Bhome, Dmitrios Karavias, Ali Arshad, Arjun Takhar, Thomas Armstrong, John Primrose, Brian Green, and Zaed Hamady
- Subjects
Oncology ,Surgery ,General Medicine - Published
- 2022
20. The Use of Hellinger Distance Undersampling Model to Improve the Classification of Disease Class in Imbalanced Medical Datasets
- Author
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Zaed Hamady, Nadia Peppa, Sefer Kurnaz, Alex H. Mirnezami, Zina Z R Al-Shamaa, Adil Deniz Duru, Al-Shamaa, Zina Z. R., Kurnaz, Sefer, Duru, Adil Deniz, Peppa, Nadia, Mirnezami, Alex H., and Hamady, Zaed Z. R.
- Subjects
SELECTION ,Article Subject ,QH301-705.5 ,Computer science ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,02 engineering and technology ,Minority class ,Machine learning ,computer.software_genre ,Measure (mathematics) ,03 medical and health sciences ,0202 electrical engineering, electronic engineering, information engineering ,Hellinger ,Sensitivity (control systems) ,Biology (General) ,Hellinger distance ,SMOTE ,030304 developmental biology ,0303 health sciences ,business.industry ,Medical Datasets ,ALGORITHMS ,Baseline model ,Classification ,Class (biology) ,Majority class ,Undersampling ,020201 artificial intelligence & image processing ,Artificial intelligence ,business ,computer ,TP248.13-248.65 ,Biotechnology ,Research Article - Abstract
Mirnezami, Alexander/0000-0002-6199-8332 WOS:000594274800001 PubMed: 33204304 Imbalanced class distribution in the medical dataset is a challenging task that hinders classifying disease correctly. It emerges when the number of healthy class instances being much larger than the disease class instances. To solve this problem, we proposed undersampling the healthy class instances to improve disease class classification. This model is named Hellinger Distance Undersampling (HDUS). It employs the Hellinger Distance to measure the resemblance between majority class instance and its neighbouring minority class instances to separate classes effectively and boost the discrimination power for each class. An extensive experiment has been conducted on four imbalanced medical datasets using three classifiers to compare HDUS with a baseline model and three state-of-the-art undersampling models. The outcomes display that HDUS can perform better than other models in terms of sensitivity, F1 measure, and balanced accuracy.
- Published
- 2020
21. Implementation of enhanced recovery after surgery for pancreatoduodenectomy increases the proportion of patients achieving textbook outcome: A retrospective cohort study
- Author
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Mohammed Abu Hilal, Zaed Hamady, Chiemezie Okorocha, Ra’ed Al-jarrah, Arjun Takhar, S. Lof, Awad Shamali, Bashar Jaber, Hannah Clarke, Andrea Benedetti Cacciaguerra, T. Armstrong, and Graduate School
- Subjects
Male ,medicine.medical_specialty ,Complications ,Cost Control ,Endocrinology, Diabetes and Metabolism ,Bile Duct Diseases ,Postoperative Hemorrhage ,Bile leakage ,Patient Readmission ,Pancreaticoduodenectomy ,Cohort Studies ,Tertiary Care Centers ,Pancreatic Fistula ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Textbook outcome ,Hospital Mortality ,Treatment costs ,Pancreatic disease ,Enhanced recovery after surgery ,Enhanced recovery ,Aged ,Hepatology ,Perioperative management ,business.industry ,Gastroenterology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Costs ,Treatment Outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Cohort ,Referral center ,Length of stay ,Female ,030211 gastroenterology & hepatology ,Enhanced Recovery After Surgery ,business - Abstract
Background: Enhanced Recovery After Surgery (ERAS) for patients undergoing pancreatoduodenectomy is associated with reduced length of stay (LOS) and morbidity. However, external validating of the impact is difficult due to the multimodal aspects of ERAS. This study aimed to assess implementation of ERAS for pancreatoduodenectomy with a composite measure of multiple ideal outcome indicators defined as ‘textbook outcome’ (TBO). Methods: In a tertiary referral center, 250 patients undergoing pancreatoduodenectomy were included in ERAS (May 2012–January 2017) and compared to a cohort of 125 patients undergoing traditional perioperative management (November 2009–April 2012). TBO was defined as proportion of patients without prolonged LOS, Clavien-Dindo ≥ III complications, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, readmissions or 30-day/in-hospital mortality. Additionally, overall treatment costs were calculated and compared using bootstrap independent t-test. Results: The two cohorts were comparable in terms of demographic and surgical details. Implementation of ERAS was associated with reduced median LOS (10 days vs 13 days, p < 0.001) and comparable overall complication rate (62.0% vs 61.6%, p = 0.940) when compared to the traditional management group. In addition, a higher proportion of patients achieved TBO (56.4% vs 44.0%, p = 0.023) when treated according to ERAS principles. Furthermore, ERAS was associated with reduced mean total costs (£18132 vs £19385, p < 0.005). Conclusion: Implementation of ERAS for patients undergoing pancreatoduodenectomy is beneficial for both patients and hospitals. ERAS increased the proportion of patients achieving TBO and reduced overall costs. TBO is a potential measure for the evaluation of ERAS.
- Published
- 2020
22. Graduated compression stockings as adjuvant to pharmaco-thromboprophylaxis in elective surgical patients (GAPS study): randomised controlled trial
- Author
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Gerrard Stansby, Joseph Shalhoub, Zaed Hamady, Jemma Hudson, John Norrie, David Warwick, Christopher S. Baker, Karen Dhillon, Beverley J Hunt, Alun H. Davies, Manjit S. Gohel, Rebecca Lawton, Andrew W. Bradbury, Tamara Everington, Shalhoub, Joseph [0000-0003-1011-7440], Lawton, Rebecca [0000-0002-3079-4230], Hudson, Jemma [0000-0002-6440-6419], Bradbury, Andrew [0000-0003-0530-9667], Dhillon, Karen [0000-0001-7209-6089], Everington, Tamara [0000-0001-8886-0280], Gohel, Manjit S [0000-0001-5685-0723], Hamady, Zaed [0000-0002-4591-5226], Hunt, Beverley J [0000-0002-4709-0774], Stansby, Gerrard [0000-0001-5539-3049], Warwick, David [0000-0003-3030-442X], Norrie, John [0000-0001-9823-9252], Davies, Alun H [0000-0001-5261-6913], Apollo - University of Cambridge Repository, and National Institute for Health Research
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Low molecular weight heparin ,Compression stockings ,030204 cardiovascular system & hematology ,1117 Public Health and Health Services ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,General & Internal Medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Elective surgery ,Adjuvants, Pharmaceutic ,Aged ,Intention-to-treat analysis ,business.industry ,Research ,Absolute risk reduction ,Anticoagulants ,1103 Clinical Sciences ,General Medicine ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,Middle Aged ,medicine.disease ,Thrombosis ,Combined Modality Therapy ,GAPS trial investigators ,Pulmonary embolism ,Treatment Outcome ,Elective Surgical Procedures ,Female ,business ,Stockings, Compression - Abstract
ObjectivesTo investigate whether the use of graduated compression stockings (GCS) offers any adjuvant benefit when pharmaco-thromboprophylaxis is used for venous thromboembolism prophylaxis in patients undergoing elective surgery.DesignOpen, multicentre, randomised, controlled, non-inferiority trial.SettingSeven National Health Service tertiary hospitals in the United Kingdom.Participants1905 elective surgical inpatients (≥18 years) assessed as being at moderate or high risk of venous thromboembolism were eligible and consented to participate.InterventionParticipants were randomly assigned (1:1) to receive low molecular weight heparin (LMWH) pharmaco-thromboprophylaxis alone or LMWH pharmaco-thromboprophylaxis and GCS.Outcome measuresThe primary outcome was imaging confirmed lower limb deep vein thrombosis with or without symptoms, or pulmonary embolism with symptoms within 90 days of surgery. Secondary outcome measures were quality of life, compliance with stockings and LMWH, lower limb complications related to GCS, bleeding complications, adverse reactions to LMWH, and all cause mortality.ResultsBetween May 2016 and January 2019, 1905 participants were randomised. 1858 were included in the intention to treat analysis (17 were identified as ineligible after randomisation and 30 did not undergo surgery). A primary outcome event occurred in 16 of 937 (1.7%) patients in the LMWH alone group compared with 13 of 921 (1.4%) in the LMWH and GCS group. The risk difference between the two groups was 0.30% (95% confidence interval −0.65% to 1.26%). Because the 95% confidence interval did not cross the non-inferiority margin of 3.5% (PConclusionsFor patients who have elective surgery and are at moderate or high risk of venous thromboembolism, administration of pharmaco-thromboprophylaxis alone is non-inferior to a combination of pharmaco-thromboprophylaxis and GCS. These findings indicate that GCS might be unnecessary in most patients undergoing elective surgery.Trial registrationISRCTN13911492.
- Published
- 2020
23. Management of Hypoglycemia Secondary to Pancreatic Insulinoma with Transarterial Embolization: Insulinoma to Insulin-No-More
- Author
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Shian Patel, Brian Stedman, Zaed Hamady, Sachin Modi, Timothy Bryant, Arjun Thakhar, and Rory O’Donohoe
- Subjects
Pancreatic Insulinoma ,medicine.medical_specialty ,business.industry ,Insulin ,medicine.medical_treatment ,Internal medicine ,Transarterial embolization ,medicine ,Hypoglycemia ,business ,medicine.disease ,Gastroenterology ,Insulinoma - Published
- 2020
24. Physical activity and incident pancreatic cancer: Results from the UK Biobank prospective cohort
- Author
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Borna Assarian, Christopher Byrne, Declan McDonnell, and Zaed Hamady
- Subjects
Oncology ,Surgery ,General Medicine - Published
- 2022
25. Robotic versus open pancreaticoduodenectomy: a systematic review and meta-analysis
- Author
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Christopher Kudehinbu, Karan Rangarajan, and Zaed Hamady
- Subjects
Oncology ,Surgery ,General Medicine - Published
- 2022
26. Is Percutaneous Cholecystostomy a Good Alternative Treatment for Acute Cholecystitis in High-Risk Patients?
- Author
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Zaed Hamady, Gabriele Marangoni, Ricky Bhogal, Amit Nair, Saboor Khan, Davide Papis, Eiman Khalifa, and Jawad Ahmed
- Subjects
Adult ,Male ,medicine.medical_specialty ,Percutaneous ,Critical Illness ,medicine.medical_treatment ,Cholecystitis, Acute ,Radiography, Interventional ,Group B ,Body Mass Index ,Sepsis ,03 medical and health sciences ,Age Distribution ,0302 clinical medicine ,Risk Factors ,medicine ,Acute cholecystitis ,Humans ,Percutaneous cholecystostomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General surgery ,General Medicine ,Middle Aged ,medicine.disease ,Survival Analysis ,Surgery ,Treatment Outcome ,Cholecystectomy, Laparoscopic ,030220 oncology & carcinogenesis ,Radiological weapon ,Cholecystitis ,Drainage ,Feasibility Studies ,Female ,030211 gastroenterology & hepatology ,Cholecystectomy ,business ,Follow-Up Studies - Abstract
Cholecystectomy is the treatment of choice for acute cholecystitis but the management of high-risk surgical patients is a difficult dilemma. Percutaneous cholecystostomy (PC) could represent a safer and less invasive option. The aim of the study was to assess the outcomes of PC in high-risk patients. This is a retrospective single-center study; data were collected from our hospital electronic record system. From February 2009 to March 2014, there were 753 patients admitted with acute cholecystitis. Of these 39 were considered high risk for surgery and underwent PC during their hospital stay. The radiological approach was transperitoneal in 29 patients and transhepatic in 10 patients. Median follow-up was 19 months. There were 27 males (69.2%) and 12 females (30.8%) with a mean age of 72 years (range 41–90 years). Twenty-seven patients had PC as definitive treatment (group A) and 12 patients as a bridge to cholecystectomy (group B). There were no postprocedure complications. Five patients in group A were readmitted once with another episode of cholecystitis after PC (18.5%), one patient in group B was readmitted with cholecystitis after two years before proceeding to cholecystectomy, and two patients were readmitted after cholecystectomy (16.6%) for intra-abdominal collections treated with percutaneous radiological drainage. Seven patients died (17.9%) as a result of severe biliary sepsis during their index hospital admission. PC is a safe approach in high-risk patients with acute cholecystitis and can provide satisfactory long-term results when cholecystectomy is not a viable option.
- Published
- 2017
27. Graduated Compression Stockings as an Adjunct to Low Dose Low Molecular Weight Heparin in Venous Thromboembolism Prevention in Surgery: A Multicentre Randomised Controlled Trial
- Author
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Joseph Shalhoub, John Norrie, Manjit S. Gohel, Simon Toh, Rebecca Lawton, Christopher S. Baker, Jemma Hudson, Karen Dhillon, Andrew W. Bradbury, B J Hunt, F Heatley, Zaed Hamady, A. Stephens-Boal, Gerard Stansby, David Warwick, Tamara Everington, Alun H. Davies, and National Institute for Health Research
- Subjects
medicine.medical_specialty ,Time Factors ,Graduated compression stockings ,medicine.drug_class ,Low molecular weight heparin ,030204 cardiovascular system & hematology ,1102 Cardiovascular Medicine And Haematology ,Drug Administration Schedule ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,Fibrinolytic Agents ,Randomized controlled trial ,Quality of life ,Risk Factors ,law ,Deep vein thrombosis ,Journal Article ,medicine ,Clinical endpoint ,Humans ,030212 general & internal medicine ,Thromboprophylaxis ,Randomised controlled trial ,business.industry ,Low dose ,1103 Clinical Sciences ,Venous Thromboembolism ,Heparin, Low-Molecular-Weight ,Combined Modality Therapy ,United Kingdom ,Adjunct ,Surgery ,Treatment Outcome ,Cardiovascular System & Hematology ,Research Design ,Surgical Procedures, Operative ,Cardiology and Cardiovascular Medicine ,business ,Venous thromboembolism ,Stockings, Compression - Abstract
BACKGROUND: The evidence base upon which current global venous thromboembolism (VTE) prevention recommendations have been made is not optimal. The cost of purchasing and applying graduated compression stockings (GCS) in surgical patients is considerable and has been estimated at £63.1 million per year in England alone.OBJECTIVE: The aim was to determine whether low dose low molecular weight heparin (LMWH) alone is non-inferior to a combination of GCS and low dose LMWH for the prevention of VTE.METHODS: The randomised controlled Graduated compression as an Adjunct to Pharmacoprophylaxis in Surgery (GAPS) Trial (ISRCTN 13911492) will randomise adult elective surgical patients identified as being at moderate and high risk of VTE to receive either the current "standard" combined thromboprophylactic LMWH with GCS mechanical thromboprophylaxis, or thromboprophylactic LMWH pharmacoprophylaxis alone. To show non-inferiority (3.5% non-inferiority margin) for the primary endpoint of all VTE within 90 days, 2236 patients are required. Recruitment will be from seven UK centres. Secondary outcomes include quality of life, compliance with stockings and LMWH, overall mortality, and GCS or LMWH related complications (including bleeding). Recruitment commenced in April 2016 with the seven UK centres coming "on-line" in a staggered fashion. Recruitment will be over a total of 18 months. The GAPS trial is funded by the National Institute for Health Research Health Technology Assessment in the UK (14/140/61).
- Published
- 2017
28. Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients
- Author
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Zaed Hamady, Saboor Khan, Davide Papis, For Tai Lam, Ricky Bhogal, Jawad Ahmad, Gabriele Marangoni, and Amit Nair
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Radiofrequency ablation ,medicine.medical_treatment ,030230 surgery ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,law ,medicine ,Hepatectomy ,Humans ,Alanine aminotransferase ,Aged ,Retrospective Studies ,Chemotherapy ,Hepatology ,business.industry ,Liver Neoplasms ,Gastroenterology ,Alanine Transaminase ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Up-Regulation ,Surgery ,Treatment Outcome ,England ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Predictive value of tests ,Catheter Ablation ,Female ,Colorectal Neoplasms ,business ,Elective Surgical Procedure ,Reperfusion injury ,Biomarkers - Abstract
Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase (ALT) correlate with patient outcome after liver resection. We assessed whether postoperative day 1 (POD 1) ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient's morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because of the low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.
- Published
- 2016
29. Impact of enhanced recovery after surgery on open and laparoscopic liver surgery: A single center cohort study
- Author
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Mohammad Alzoubi, A. Al Jaiuossi, Arab Rawashdeh, A. Takhar, Zaed Hamady, Christoph Kuemmerli, M. Abu Hilal, T. Armstrong, Hannah Clarke, Francesco Giovinazzo, John N. Primrose, and A. Moekotte
- Subjects
Liver surgery ,medicine.medical_specialty ,Hepatology ,business.industry ,medicine ,Gastroenterology ,Single Center ,business ,Enhanced recovery after surgery ,Cohort study ,Surgery - Published
- 2020
30. The influence of demographics, risk and smoking status on attendance for pancreatic cancer screening
- Author
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Andrew Smith, Jennifer Law, Zaed Hamady, William Greenhalf, Andrea Sheel, Richard Charnley, Eithne Costello, John P. Neoptolemos, Christopher Halloran, Aithal Guru, Ioannis Sarantitis, and Stephen P. Pereira
- Subjects
medicine.medical_specialty ,Hepatology ,Demographics ,business.industry ,Endocrinology, Diabetes and Metabolism ,Family medicine ,Pancreatic cancer ,Gastroenterology ,medicine ,Attendance ,Smoking status ,medicine.disease ,business - Published
- 2018
31. Implementation Of continuous wound infiltration In pancreatoduodenectomy reduced hospital stay as well as fluid resuscitation
- Author
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Zaed Hamady, M. Abu Hilal, T. Armstrong, Salvatore Barbaro, Denise P. Veelo, Timothy H. Mungroop, M.G. Besselink, C.-w. Lai, A. Takhar, and Mohammad Alzoubi
- Subjects
Resuscitation ,Continuous wound infiltration ,Hepatology ,business.industry ,Anesthesia ,Gastroenterology ,Medicine ,business ,Hospital stay - Published
- 2019
32. Intraoperative fistula risk score (iFRS) in pancreatoduodenectomy: development and validation in three datasets
- Author
-
R. Van Dam, D.J. Lips, Joris J. Scheepers, Michael F. Gerhards, C. Vollmer, Victor van Woerden, E.W. Steyerberg, V. Nieuwenhuis, B. Groot Koerkamp, Brett L. Ecker, Zaed Hamady, D. van Klaveren, Bert A. Bonsing, R. Linnemann, O.R.C. Busch, I.H.J.T. de Hingh, Coen G. Rupert, F.J. Smits, T. Armstrong, Joost M. Klaase, S. van Dieren, M.G. Besselink, M. Luyer, H. van Goor, M. Abu Hilal, Geert Kazemier, A. Takhar, E. van der Harst, J. Erdmann, K. de Jong, L.B. van Rijssen, I.Q. Molenaar, T H Mungroop, C.H.J. van Eijck, Salvatore Barbaro, Awad Shamali, G. van der Schelling, and H.C. van Santvoort
- Subjects
medicine.medical_specialty ,Framingham Risk Score ,Hepatology ,business.industry ,General surgery ,Fistula ,Gastroenterology ,medicine ,medicine.disease ,business - Published
- 2019
33. Enhanced recovery program after OPEN and laparoscopic liver resection: may IT enhace the advantages offered by the minimally invasive approach?
- Author
-
A. Jayyusi, M. Abu Hilal, Arab Rawashdeh, Zaed Hamady, Francesco Giovinazzo, Mohammad Alzoubi, T. Armstrong, Salvatore Barbaro, J. Primerose, and A. Takhar
- Subjects
medicine.medical_specialty ,Hepatology ,Enhanced recovery ,business.industry ,Gastroenterology ,medicine ,business ,Surgery ,Resection - Published
- 2018
34. Corrigendum to 'Surgeon's awareness of the synchronous liver metastases during colorectal cancer resection may affect outcome' [EJSO 34 (2008) 180–184]
- Author
-
Hassan Malik, Nisreen A Alwan, Judy Wyatt, G.T. Toogood, Zaed Hamady, J.P.A. Lodge, and R. Prasad
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,General surgery ,General Medicine ,medicine.disease ,Affect (psychology) ,Outcome (game theory) ,Resection ,Internal medicine ,medicine ,Surgery ,business - Published
- 2008
35. Surgical interventions for breast cancer liver metastases – Results of a UK survey
- Author
-
Sze-Ming Ong, B. Elsberger, and Zaed Hamady
- Subjects
medicine.medical_specialty ,Breast cancer ,Oncology ,business.industry ,General surgery ,medicine ,Surgery ,General Medicine ,medicine.disease ,business ,Surgical interventions - Published
- 2016
36. Is cholecystostomy a good alternative treatment for acute cholecystitis in high risk patients?
- Author
-
A. Prasad, G. Marangoni, J. Shah, For Tai Lam, Saboor Khan, Zaed Hamady, D. Papis, Amit Nair, and E. Khalifa
- Subjects
medicine.medical_specialty ,High risk patients ,Hepatology ,business.industry ,General surgery ,Cholecystostomy ,medicine.medical_treatment ,Gastroenterology ,Acute cholecystitis ,Medicine ,business ,Alternative treatment - Published
- 2016
37. Risk independence for the identification of cystic lesions in Familial Pancreatic Cancer (FPC) kindreds
- Author
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James Nicholson, Paula Ghaneh, John P. Neoptolemos, Michael Chapman, Christopher Halloran, Andrea Sheel, Michael Raraty, Ioannis Sarantitis, Markus M. Lerch, Zaed Hamady, Pascal Hammel, Detlef K. Bartsch, Eithne Costello, Stephen P. Pereira, William Greenhalf, Colin J. McKay, Ross Carter, Guru Aithal, Jayapal Ramesh, Sara Harrison, and Andrew Smith
- Subjects
Oncology ,medicine.medical_specialty ,Pathology ,Hepatology ,business.industry ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,Gastroenterology ,Independence ,Cystic lesion ,Internal medicine ,Familial Pancreatic Cancer ,medicine ,Identification (biology) ,business ,media_common - Published
- 2017
38. Missed pancreatic ductal adenocarcinoma (PDAC) in Hereditary Pancreatitis (HP) kindreds indicate the importance of a systematic approach to secondary screening
- Author
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Markus M. Lerch, Zaed Hamady, Michael Chapman, Richard J. Jackson, Stephen P. Pereira, Colin J. McKay, Meg Finch-Jones, Jayapal Ramesh, James Nicholson, Andrew Smith, Ross Carter, William Greenhalf, Andrea Sheel, Eithne Costello, Ioannis Sarantitis, John P. Neoptolemos, Christopher Halloran, Sara Harrison, Guru Aithal, Vinciane Rebours, Paula Ghaneh, and Michael Raraty
- Subjects
Oncology ,medicine.medical_specialty ,Hereditary pancreatitis ,Pancreatic ductal adenocarcinoma ,Hepatology ,business.industry ,Endocrinology, Diabetes and Metabolism ,Internal medicine ,Gastroenterology ,Medicine ,business ,medicine.disease ,Primary screening - Published
- 2017
39. Predictors of post-operative complications following pancreaticoduodenectomy
- Author
-
Mohammed Abu-Hilal, Andrew Nickinson, Zaed Hamady, Iseult Flynn, and Gavin Smith
- Subjects
medicine.medical_specialty ,Oncology ,business.industry ,medicine.medical_treatment ,General surgery ,Medicine ,Surgery ,General Medicine ,Post operative ,business ,Pancreaticoduodenectomy - Published
- 2016
40. Laparoscopic versus open liver resection for hepatocellular carcinoma in a UK population: a single centre experience
- Author
-
A. Takhar, F. Cipriani, Zaed Hamady, Neil W. Pearce, Elisa Francone, M. Abu Hilal, M. Rawashdeh, John N. Primrose, T. Armstrong, and Awad Shamali
- Subjects
medicine.medical_specialty ,education.field_of_study ,Open liver resection ,Hepatology ,business.industry ,General surgery ,Population ,Gastroenterology ,medicine.disease ,Surgery ,Single centre ,Hepatocellular carcinoma ,Medicine ,business ,education - Published
- 2016
41. Impact of age on the short and long term outcomes following pancreaticodoudenectomy
- Author
-
R. Smith, B. Jaber, Awad Shamali, M. Abu Hilal, M. Rawashdeh, and Zaed Hamady
- Subjects
Gerontology ,Hepatology ,business.industry ,Gastroenterology ,Long term outcomes ,Medicine ,business - Published
- 2016
42. PTU-082 Right and extended right hepatic trisectionectomy: short and long term outcomes of 332 resections
- Author
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R Storey, Raj Prasad, H Sethi, Zaed Hamady, J P A Lodge, Abdul Hakeem, Giles J. Toogood, and Gabriele Marangoni
- Subjects
medicine.medical_specialty ,business.industry ,Gastroenterology ,Liver resections ,Surgery ,Resection ,Internal medicine ,Cohort ,medicine ,Long term outcomes ,Vascular resection ,business ,Contraindication ,Median survival ,Bile leak - Abstract
Introduction Despite advances in surgical and anaesthetic techniques made over the last 2 decades, right hepatic trisectionectomy (RHT) is still a challenging procedure associated with higher rates of morbidity and mortality. Some patients may even require further extension of the resection to include part of segments II/III to achieve clearance (extended right hepatic trisectionectomy, ERHT). Aim of the study was to assess and compare the early and long-term outcomes of RHT and ERHT in our Unit. Methods From January 1993 to December 2010, 252 RHT and 80 ERHT were performed (n=332). Resection for colorectal liver metastases (CRLM), HCC, cholangiocarcinoma and other were 127, 43, 25 and 57 for RHT and 60, 3, 2, 15 for ERHT respectively. Mean age was 58.3 vs 57.9 and 57.1% vs 55% were males (RHT vs ERHT, p=NS). There were 61 caudatectomy in the RHT group and 15 in the ERHT (p=0.36, NS); vascular resection (IVC or PV) was performed in 61 and 10 cases (p=0.18, NS), biliary reconstruction was performed in 75 and 7 cases (p=0.01) and total vascular exclusion was necessary in 26 and 6 cases respectively (p=NS). The amount of functional hepatic remnant was based on intra-operative judgement. Results There were 23 in-hospital deaths (6.9%, RHT: 19, ERHT: 4; p=NS). Overall morbidity was 44% (RHT) and 47.5% (ERHT). Bile leak (17 vs 3), haemorrhage (14 vs 4), sepsis (33 vs 9), cardio-vascular events (12 vs 1) and renal failure (12 vs 3) did not differ among the two groups (RHT vs ERHT; p=NS). There were 42 (12.6%) post-hepatectomy liver failure (according to “50:50 criteria”): 23 in the RHT group and 19 in the ERHT group respectively (p=0.001). Mean hospital stay was 15.8 vs 17.1 days (RHT vs ERHT, p=NS). In the CRLM cohort, 1, 5 and 10 year survival was 78%, 47% and 39% vs 79%, 47% and 37% (RHT vs ERHT, p=0.93, NS). Median survival was 49 and 43.9 months respectively (p=NS) and median follow-up was 59.7 and 56.5 months (RHT vs ERHT). Conclusion RHT and ERHT are a major undertaking with significant morbidity and mortality but represent the only chance of cure in selected patients. Liver failure is higher in the ERHT group but does not translate in increased mortality. Long-term survival in CRLM is achievable and does not differ among the two groups. Extensive liver resections even beyond conventional boundaries should not be considered an absolute contraindication to surgery. Competing interests None declared.
- Published
- 2012
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