James Halle‐Smith

University Hospitals Birmingham NHS Foundation Trust

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

Keith Roberts

NIHR Surgical Reconstruction and Microbiology Research Centre

Lewis Hall

University of Birmingham

James Hodson

Queen Elizabeth Hospital Birmingham

Robert P. Sutcliffe

Queen Elizabeth Hospital Birmingham

Rupaly Pandé

NIHR Surgical Reconstruction and Microbiology Research Centre

Ravi Marudanayagam

Queen Elizabeth Hospital

Sarah Powell‐Brett

Queen Elizabeth Hospital Birmingham

B. Dasari

University Hospitals Birmingham NHS Foundation Trust

Nikolaos Chatzizacharias

Queen Elizabeth Hospital Birmingham

Ewen A. Griffiths

University Hospitals Birmingham NHS Foundation Trust

Cooperative Institutions

University of Birmingham

351

Queen Elizabeth Hospital Birmingham

313

University Hospitals Birmingham NHS Foundation Trust

127

Institut de Virologie

124

University College London

121

NIHR Birmingham Biomedical Research Centre

120

Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie

National Institute for Health Research

Yorkshire Cancer Research

University of Liverpool

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

116: INFLUENCE OF BODY COMPOSITE MEASURES ON CHYLE LEAK AFTER OESOPHAGECTOMY

Diseases of the Esophagus (2022)

James Halle‐Smith Manjunath Siddaiah‐Subramanya Abdulrahman Ghoneim Ahmed Almonib Benjamin Tan

Abstract Background and aim Chyle leak is an infrequent but potentially serious complication of oesophagectomy. Sarcopenia is an increasingly recognised prognostic factor in oesophageal cancer surgery. The aim of this study was to identify the influence of body composition and related factors on chyle leak following oesophagectomy. Methods Patients who developed chyle leak after oesophagectomy between January 2006–December 2020 were identified retrospectively from a prospectively collected and maintained dataset. A control group of patients undergoing oesophagectomy during the same time period was also collected. Relationships between chyle leak and demographics, operative factors and body composition measures were investigated as primary outcomes. Risk factors for severe chyle leak, defined as need for reintervention or greater than 1 litre of output per day, were evaluated as a secondary outcome. Results There were 26 patients who developed a chyle leak following an oesophagectomy. On univariate analysis, preoperative body mass index (BMI) (P = 0.001), subcutaneous fat index (P = 0.001) and total fat index (P = 0.004) were significantly associated with chyle leak. On multivariate analysis, a lower preoperative subcutaneous fat index was a significant independent predictor of chyle leak (P = 0.001). Sarcopenia was not found to be a significant predictor of developing chyle leaks. No significant predictors of severe chyle leak were identified. Conclusion A reduced preoperative body fat composition is a risk factor for chyle leak after oesophagectomy. Sarcopenia doesn’t predict either the occurrence or severity of chyle leak. This emphasises the importance of physiological and nutritional optimisation before oesophagectomy.

Chyle

Esophagectomy

10.1093/dote/doac015.116

Cite

Citations (0)

MS O12 - HPB The efficacy of CA19-9 in predicting resectability and survival in pancreatic cancer patients with jaundice: A retrospective cohort study

British journal of surgery (2024)

Imogen Keyte Jessica A. Turner James Halle‐Smith Keith Roberts

Abstract Background Carbohydrate antigen 19-9 (CA19-9) is the most utilised biochemical marker in pancreatic ductal adenocarcinoma (PDAC); shown to be related to resectability and prognosis. However, concurrent cholestasis, commonly seen in PDAC, can also elevate CA19-9, which may lead to unreliability and hence limit its efficacy in jaundiced patients, making management planning and prognostication more challenging. This study aims to investigate the impact of jaundice on the efficacy of CA19-9 in predicting resectability and survival in PDAC patients. Method 715 patients undergoing attempted resection for PDAC between 2010-2023 were identified from a prospectively maintained surgical database for retrospective analysis. The ability of CA19-9 to predict resectability and survival in different bilirubin sub-groups was assessed using receiver operating characteristic and Kaplan-Meier curves. Existing adjustment methodologies were applied and the curves replotted to assess their effects on the predictive efficacy of CA19-9. Multivariate analysis was then utilised to screen other potentially predictive factors which could be incorporated in the future. Results Of the 554 (77.4%) patients who underwent resection, CA19-9 predicted resectability in the first three bilirubin subgroups: ≤21 µmol/l (AUROC:0.660, 95% CI:0.551-0.769, p=0.004), 21<x≤130 µmol/l (AUROC:0.689, 95% CI:0.595-0.784, p<0.001) and 130<x≤315 µmol/l (AUROC:0.710, 95% CI:0.614-0.807, p<0.001). However, CA19-9 did not predict resectability in patients with bilirubin levels >315 µmol/l (AUROC:0.579, 95% CI:0.452-0.707, p=0.222). CA19-9 was a significant predictor of overall survival in the non-jaundiced (p=0.048) cohort but did not predict survival in patients with bilirubin levels >21 µmol/l. Existing adjustment methodologies did not improve predictive efficacy of CA19-9 for resectability or prognosis. Conclusion These findings support the prospect of decreased ability of CA19-9 to predict resectability and survival in PDAC patients with jaundice. Further investigation is required to find a method of adjusting CA19-9 values based on jaundice to aid diagnostic and treatment decision making.

CA19-9

10.1093/bjs/znae271.043

Cite

Citations (0)

BJS commission on surgery and perioperative care post-COVID-19

British journal of surgery (2021)

Egide Abahuje A M Abbas Mohamed A. Maksoud A Abdelhady S. Abdelhamid

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.

2019-20 coronavirus outbreak

Coronavirus Infections

10.1093/bjs/znab307

Cite

Citations (16)

Pyloroplasty Reduces the Need for Pyloric Dilatation After Esophagectomy

Foregut The Journal of the American Foregut Society (2023)

Seunghee Han Choi Ling Yu James Halle‐Smith Jan Dmitrewski Benjamin Tan

Background: Delayed gastric conduit emptying (DGCE) is a recognized complication of esophagectomy which can lead to prolonged vomiting, aspiration, and reduced oral intake postoperatively. To minimize the risk of DGCE, some advocate the use of pyloroplasty, however the practice is varied and controversial. The aim of this study is to investigate the effect of pyloroplasty on DGCE in esophagectomy patients. Methods: Consecutive patients that underwent an esophagectomy for esophageal cancer from September 2011 to December 2020 were identified from a prospectively maintained departmental cancer database at our institution. The primary outcome measured was the need for pyloric intervention following esophagectomy. Secondary outcomes included cardiac complications, pulmonary complications, anastomotic leaks, and chyle leaks. For those who had contrast swallow tests done prior to discharge from the index admission, dilated conduit and delayed gastric emptying were also investigated. Results: Of 458 patients included in the study, 77(17%) underwent pyloroplasty. Of the 381 patients who underwent esophagectomy without pyloroplasty, 44 (12%) of these patients later required at least one pyloric dilatation. None of the patients who underwent pyloroplasty later required pyloric dilatation. On multivariate analysis, younger age, respiratory complications after esophagectomy and pyloroplasty were significant predictors of the need for pyloric dilatation. Pyloroplasty was not significantly related to dilated conduit or delayed emptying on contrast swallow with P value of 0.979 and 0.147, respectively. Conclusions: Pyloroplasty reduces the need for pyloric dilatation postoperatively. However, further research is required to investigate the nature of this relationship, specifically in terms of contrast swallow.

Pyloroplasty

Esophagectomy

10.1177/26345161231167216

Cite

Citations (2)

Predictors of anastomotic leak and conduit necrosis after oesophagectomy: Results from the oesophago-gastric anastomosis audit (OGAA)

European Journal of Surgical Oncology (2024)

Ewen A. Griffiths James Halle‐Smith Sivesh K. Kamarajah R.P.T. Evans Dmitri Nepogodiev

Esophagectomy

10.1016/j.ejso.2024.107983

Cite

Citations (3)

P-P40 Can trainees safely perform pancreatoduodenectomy? A systematic review, meta-analysis and risk-adjusted analysis of post-operative pancreatic fistula

British journal of surgery (2021)

Rupaly Pandé James Halle‐Smith Tom Thorne James Hodson Keith Roberts

Abstract Background The complexity of pancreaticoduodenectomy (PD) and fear of morbidity, particularly post-operative pancreatic fistula (POPF), can be a barrier to surgical trainees gaining operative experience. Objective to compare the POPF rate following PD by trainees or established surgeons. Methods A systematic review of the literature was performed using PRISMA guidelines, with differences in POPF rates after PD between trainee-led vs. consultant/attending surgeons pooled using meta-analysis. Variation in rates of POPF was further explored using risk-adjusted outcomes using published risk scores and CUSUM analysis in a retrospective cohort. Results Across 14 cohorts included in the meta-analysis, trainees tended towards a lower, but non significant rate of All-POPF (odds ratio [OR]: 0.77, p = 0.45) and clinically relevant (CR)-POPF (OR: 0.69, p = 0.37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3mm (OR: 0.45, p = 0.05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted All-POPF (median: 20 vs. 26%, p < 0.001) and CR-POPF (7 vs. 9%, p = 0.020) rates than consultant/attending surgeons, based on pre-operative risk scores. After adjusting for this on multivariable analysis, the risks of All-POPF (OR: 1.18, p = 0.604) and CR-POPF (OR: 0.85, p = 0.693) remained similar after PD by trainee or consultant/attending surgeons. Conclusions PD, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.

Pancreatic fistula

10.1093/bjs/znab430.262

Cite

Citations (0)

A comparative study of risk factors for pancreatic fistula after pancreatoduodenectomy or distal pancreatectomy

HPB (2016)

James Halle‐Smith Keith Roberts James Hodson E. Vinuela R. Michael Brown

Pancreatic fistula

Steatosis

10.1016/j.hpb.2016.03.082

Cite

Citations (1)

OGC O04 A Preoperative Scoring Model to Estimate the Risk of Conduit Necrosis in Oesophagectomy Patients - Results From the Oesophago-Gastric Anastomosis Audit

British journal of surgery (2022)

James Halle‐Smith Sivesh K. Kamarajah Richard Evans Ewen A. Griffiths

Abstract Background Both conduit necrosis (CN) and anastomotic leak (AL) after oesophagectomy is associated with high morbidity and mortality and therefore identification of preoperative, modifiable risk factors are desirable. Once identified, risk factors can be used to create a risk scoring model which can be used to aid preoperative counselling and guide postoperative management. The aim of this study was to use the prospectively collected, multicentre data from the Oesophago-Gastric Anastomosis Audit (OGAA) to generate a risk scoring model for conduit necrosis and anastomotic leak after oesophagectomy. Methods This prospective multicentre cohort study included patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018 (with 90 days of follow-up). Definitions for AL and CN were those set out by the Esophageal Complications Consensus Group. Univariate and multivariate analyses were performed to identify risk factors for both AL and CN. The cohort was then randomly split into a derivation an validation set. A risk score was then produced for both AL and CN using the derivation set, then internally validated using the validation set. Results This study included 2247 oesophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% (n = 319) and CN rate was 2.7% (n = 60). Preoperative factors that were independent predictors of CN were: body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status, previous myocardial infarction (MI) and smoking history. These were converted into a risk-scoring model and internally validated using the validation set with an area under the receiver operating characteristic curve (AUROC) of 0.775. Preoperative factors that were independent predictors of AL were cardiovascular comorbidity (previous MI, peripheral vascular disease, previous stroke) and chronic obstructive pulmonary disease (COPD). This was converted to a risk scoring model but when internally validated the AUROC showed insufficient predictive ability (0.618). Conclusions The present risk scoring model provides an internally validated tool to estimate a patient's risk of CN preoperatively. This could be used to inform preoperative counselling and guide postoperative management. External validation is required to further assess the predictive ability of this score. Despite a large dataset, AL proves difficult to predict using preoperative factors.

Esophagectomy

Derivation

10.1093/bjs/znac404.036

Cite

Citations (0)

P-P49 Predicting Future Pathological and Operative Complexity in Pancreatoduodenectomy: 30 Years of Experience

British journal of surgery (2021)

James Halle‐Smith James Hodson Christopher Coldham B. Dasari Nikolaos Chatzizacharias

Abstract Background Patient selection for pancreatoduodenectomy (PD) is largely based upon local experience and established practice. This study sought to observe changes in complexity and patient cohort over time with the aim of predicting future cohort characteristic of patients undergoing PD. Methods All PDs at our institution between 1988 and 2020 were reviewed (n = 1,878) to observe changing trends in patient demographic, pathological diagnosis, operative factors and postoperative outcomes. Coefficients from regression models were reported as gradients per decade, to quantify the rate of change over time. The resulting models were then plotted to illustrate the trend across the study period, as well as forecasts for subsequent years. Results The annual volume (7 to 128) and proportion of pancreatic ductal adenocarcinoma (PDAC) (28 to 53%) increased at a linear rate. The proportion of associated vein resection (3 to 25%) and technical difficulty (type 2-4; 5 to 28%) increased in a nonlinear way, increasing more rapidly in later times. The average age (48 to 67) increased in a log linear trend. Length of stay reduced by 9.3%, whilst mortality reduced with an odds ratio of 0.69, per decade. Furthermore, When performance at our institution was compared to recently established benchmarks, it was shown that our institution regularly performed within these standards with few exceptions. By 2030 our predictions indicate that the average age will increase to 69, PDAC will comprise 62% of pathology, 40% will have an associated venous resection and 43% will be graded 2-4 in technical difficulty. Length of stay will have reduced to 9.6 days and mortality to 2%. Conclusions Despite increasing complexity of surgery and patient age, length of stay and mortality after PD are reducing. Understanding changes over time permits an estimation of a future surgical cohort where complexity will increase. It is important that surgeons continue to push boundaries. Patient selection, based upon prior experience may inhibit progression and development of services.

Academic institution

10.1093/bjs/znab430.271

Cite

Citations (0)

A comprehensive evaluation of the long-term clinical and economic impact of Strasberg A-D bile duct injury

HPB (2020)

James Halle‐Smith James Hodson D. F. Mirza Keith Roberts

10.1016/j.hpb.2020.04.107

Cite

Citations (0)