Publications by authors named "Hugh MacKenzie"
Objective: Quality of surgery is essential for survival in gastric adenocarcinoma, but studies examining surgeons' proficiency gain of gastrectomies are scarce. This study aimed to reveal potential proficiency gain curves for surgeons operating patients with gastric cancer.
Methods: Population-based cohort study of patients who underwent gastrectomy for gastric adenocarcinoma in Sweden between 2006 and 2015 with follow-up throughout 2020.
Background: There is limited evidence regarding the overall feasibility and success rates of the laparoscopic approach in major emergency surgery, despite its potential to improve outcomes. This study aims to investigate the association between patient, procedural, and surgical factors and likelihood of successful laparoscopic completion in emergency major surgery and derive a predictive model to aid clinical decision-making.
Method: All patients recorded in the NELA emergency laparotomy database 1 December 2013-31 November 2018 who underwent laparoscopically attempted surgery were included.
Introduction: The aim of this study was to evaluate 5-year overall survival (OS) in patients operated on for potentially curable right versus left-sided colon cancer and rectal cancer in England.
Materials And Methods: A retrospective propensity-score matched population-based cohort study was performed using data from English Hospital Episode Statistics, Office for National Statistics and National Bowel Cancer Audit dataset. Patients ≥18 who underwent elective resection for right-colon, left-colon, or rectal cancer between 2000 and 2015 were included.
Article Synopsis
- The study analyzed the effects of The National Training Program for Lapco on laparoscopic surgery rates and clinical outcomes among colorectal surgeons in England, comparing trained Lapco delegates with non-Lapco surgeons.
- Results showed a significant 37.8% increase in laparoscopic surgery by Lapco surgeons, alongside a notable decrease in 30-day and 90-day mortality rates, indicating improved patient outcomes post-training.
- Overall, the findings suggest that the Lapco training program effectively enhances surgical techniques and outcomes, with competency assessments being predictive of performance improvements after training.
Background: Complex surgical procedures including minimally invasive esophagectomy (MIE) are commonly associated with a period of proficiency gain. We aim to study the effect of reduced procedural interval upon the number of cases required to gain proficiency and adverse patient outcomes during this period from MIE.
Methods: All adult patients undergoing MIE for esophageal cancer in England from 2002 to 2012 were identified from Hospital Episode Statistics database.
Objective: The aim was to develop a reliable surgical quality assurance system for 2-stage esophagectomy. This development was conducted during the pilot phase of the multicenter ROMIO trial, collaborating with international experts.
Summary Of Background Data: There is evidence that the quality of surgical performance in randomized controlled trials influences clinical outcomes, quality of lymphadenectomy and loco-regional recurrence.
Background: Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England.
View Article and Find Full Text PDFObjective: Endovascular aneurysm repair (EVAR) has increasingly been used as the primary treatment approach for abdominal aortic aneurysm (AAA). This study examined the hypothesis that EVAR leads to an increased risk of abdominal cancer within the radiation field compared with open AAA repair.
Methods: The nationwide English Hospital Episode Statistics database was used to identify all patients older than 50 years who received an AAA repair in 2005 to 2013.
Background: While a shift to minimally invasive techniques in rectal cancer surgery has occurred, non-inferiority of laparoscopy in terms of oncological outcomes has not been definitely demonstrated. Transanal total mesorectal excision (TaTME) has been pioneered to potentially overcome difficulties experienced when operating with a pure abdominal approach deep down in the pelvis. This study aimed to compare short-term oncological results of TaTME versus laparoscopic TME (lapTME), based on a strict anatomical definition for low rectal cancer on MRI.
View Article and Find Full Text PDFBackground: Surgery proficiency gain curves must be shortened to reduce patient harm during esophagectomy learning.
Objective: This study aimed to test whether surgeon volume and surgeon age influenced the length of period of surgical proficiency gain.
Methods: This population-based cohort study included 1384 patients with esophageal cancer who underwent esophagectomy by any of the 36 highest-volume surgeons in Sweden between 1987 and 2010, with follow-up until 2016.
Background: Acute cholecystitis is a life-threatening emergency in elderly patients. This population-based cohort study aimed to evaluate the commonly used management strategies for elderly patients with acute cholecystitis as well as resulting mortality and re-admission rates.
Methods: Data from all consecutive elderly patients (≥ 80 years) admitted with acute cholecystitis in England from 1997 to 2012 were captured from the Hospital Episode Statistics database.
Background: Randomized controlled trials have shown that laparoscopic approach to surgery for perforated peptic ulcer (PPU) is associated with improved short-term outcomes; however, there is limited evidence concerning national practice. The aim of this investigation was to evaluate the effect of laparoscopic approach to PPU surgery upon mortality and morbidity in England.
Methods: Patients with a primary diagnosis of PPU, admitted as an emergency to a hospital in England, and receiving surgical intervention, between 2005 and 2012 were identified from the Hospital Episode Statistics database.
Background: Polyp detection rate (PDR) during lower gastrointestinal endoscopy (LGIE) is of clinical importance. Detecting adenomatous polyps early in the adenoma-carcinoma sequence can halt disease progression, enabling treatment at a favourable stage. High definition colonoscopy (HDC) has been used in our hospital alongside standard definition equipment since 2011.
View Article and Find Full Text PDFObjective: To study the influence of esophageal cancer surgeon volume upon mortality from upper gastrointestinal emergencies.
Background: Volume-outcome relationships led to the centralization of esophageal cancer surgery.
Methods: Hospital Episode Statistics data were used to identify patients admitted to hospitals within England (1997-2012).
Background: The interest and adoption of transanal total mesorectal excision (TaTME) is growing amongst the colorectal surgical community, but there is no clear guidance on the optimal training framework to ensure safe practice for this novel operation. The aim of this study was to establish a consensus on a detailed structured training curriculum for TaTME.
Methods: A consensus process to agree on the framework of the TaTME training curriculum was conducted, seeking views of 207 surgeons across 18 different countries, including 52 international experts in the field of TaTME.
Objective: It was hypothesized that patient survival improves with increasing surgeon age up to an age where it then decreases.
Background: Experience, physical and psychological abilities required for esophagectomy may change with increasing surgeon age.
Methods: This population-based cohort study included all patients having undergone esophagectomy for esophageal cancer in Sweden in 1987 to 2010, with follow-up until 2016.
Objective: To compare clinical outcomes after laparoscopic lavage (LL) or colonic resection (CR) for purulent diverticulitis.
Background: Laparoscopic lavage has been suggested as an alternative treatment for traditional CR. Comparative studies to date have shown conflicting results.
Objective: To identify patient factors that are associated with emergency presentation of esophageal and gastric cancer, and further to evaluate long-term prognosis in this cohort.
Background: The incidence of emergency presentation is variable, with the prognosis of patients stabilized and discharged to return for elective surgery unknown.
Methods: The primary admission of patients with esophageal or gastric cancer within the Hospital Episode Statistics database (1997-2012) was used to classify as emergency or elective diagnosis.
Objective: Endoscopic mucosal resection (EMR) is established for the management of benign and early malignant upper GI disease. The aim of this observational study was to establish the effect of endoscopist procedural volume on mortality.
Design: Patients undergoing upper GI EMR between 1997 and 2012 were identified from the Hospital Episode Statistics database.
Objective: (i) To establish at a national level clinical outcomes from patients presenting with acute para-esophageal hernia (PEH); and (ii) to determine if a hospital volume-outcome relationship exists for the management of acute PEH.
Background: Currently, no clear guidelines exist regarding the management of acute PEH, and practice patterns are based upon relatively small case series.
Methods: Patients admitted as an emergency for the treatment of acute PEH between 1997 and 2012 were included from the Hospital Episode Statistics database.
Purpose: We aimed to identify the presence and length of esophagectomy proficiency gain curves in terms of short- and long-term mortality for esophageal cancer.
Patients And Methods: Patients who underwent esophagectomy for esophageal cancer between 1987 and 2010 with follow-up until 2014 were identified from a well-established, population-based, nationwide Swedish cohort study. Proficiency gain curves were created by using risk-adjusted cumulative sum analysis for 30-day, 90-day, 1-year, 3-year, and 5-year all-cause and disease-specific mortality measures.
Background: The objectives of this national study were to examine the short-term safety and long-term survival benefit associated with surgical resection of hepatic metastases from gastric cancer.
Methods: Patients from the Hospital Episode Statistics database were classified by disease and treatment approach. Gastric cancer: 1.
Objective: To evaluate risk of psychiatric morbidity and its impact on survival in gastrointestinal surgery.
Background: Psychiatric morbidity related to surgery is poorly understood, and may be evaluated using linked hospital and primary care data.
Methods: Patients undergoing gastrointestinal surgery from 2000 to 2011 with linkage of Clinical Practice Research Datalink (CPRD), Hospital Episodes Statistics (HES), Office of National Statistics (ONS), and National Cancer Intelligence Network (NCIN) databases were studied.
Objectives: Traditionally esophageal perforation is a rare clinical emergency that confers a high rate of mortality and major morbidity. The objective of this study was to establish the annual rate and mortality from esophageal perforation and determine the effect of hospital volume on clinical outcomes.
Methods: Hospital Episode Statistics database was used for the identification of patients admitted to hospitals within England with esophageal perforation between 2001 and 2012.