Publications by authors named "J Huddy"

46 Publications

Minimal access rectal cancer surgery: an observational study of patient outcomes from a district general hospital with over a decade of experience with robotic rectal cancer surgery.

Colorectal Dis 2021 Jun 22. Epub 2021 Jun 22.

Department of Colorectal Surgery, Frimley Park Hospital, Camberley, Surrey, UK.

Aim: Robotic surgery for colorectal cancer has been slower to become established than in other specialties. This study outlines the outcomes from laparoscopic and robotic surgery performed by a subspecialist rectal cancer team in a District General Hospital.

Methods: Outcomes from consecutive patients undergoing minimal access rectal cancer surgery between July 2008 and January 2020 were analysed. Comparisons were made between short-term outcomes including conversion rates, anastomotic leaks and pathological outcomes, as well as long-term survival and cancer recurrence.

Results: 337 patients were included for analysis, 204 (60.5%) underwent robotic surgery. Demographic characteristics and use of neo-adjuvant chemoradiotherapy were similar between groups. However, patients having robotic surgery had significantly lower tumours than in the laparoscopic group (7.6cm versus 9.8cm, p=0.003). Conversion to open surgery in the robotic group was significantly less likely (9.8% versus 22.6%, p=0.001). Operative mortality, clinical leakage, and major complications were similar between groups. While asymptomatic 'radiological' leaks were significantly more common following robotic surgery (13.7% versus 5.3%, p=0.017) this did not affect the long-term stoma-closure rate. Pathological outcomes were similar with the exception of shorter mean distal resection margins (25.9mm versus 32.8mm, p=0.001) for the robotic group of patients. There was no statistical difference in 5 year survival between groups (78.7% robotic versus 85.4% laparoscopic, p=0.263) nor local recurrence (2.0% robotic versus 3.8% laparoscopic, p=0.253).

Conclusions: These results illustrate how the selective use of robotic surgery by a dedicated rectal cancer team can achieve low rates of cancer recurrence and low permanent stoma rates.
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June 2021

Patient-reported outcomes after oesophagectomy in the multicentre LASER study.

Br J Surg 2021 May 11. Epub 2021 May 11.

Oesophago-gastric Centre, Churchill Hospital, University of Oxford, Oxford, UK.

Background: Data on the long-term symptom burden in patients surviving oesophageal cancer surgery are scarce. The aim of this study was to identify the most prevalent symptoms and their interactions with health-related quality of life.

Methods: This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery in 20 European centres between 2010 and 2016. Patients had to be disease-free for at least 1 year. They were asked to complete a 28-symptom questionnaire at a single time point, at least 1 year after surgery. Principal component analysis was used to assess for clustering and association of symptoms. Risk factors associated with the development of severe symptoms were identified by multivariable logistic regression models.

Results: Of 1081 invited patients, 876 (81.0 per cent) responded. Symptoms in the preceding 6 months associated with previous surgery were experienced by 586 patients (66.9 per cent). The most common severe symptoms included reduced energy or activity tolerance (30.7 per cent), feeling of early fullness after eating (30.0 per cent), tiredness (28.7 per cent), and heartburn/acid or bile regurgitation (19.6 per cent). Clustering analysis showed that symptoms clustered into six domains: lethargy, musculoskeletal pain, dumping, lower gastrointestinal symptoms, regurgitation/reflux, and swallowing/conduit problems; the latter two were the most closely associated. Surgical approach, neoadjuvant therapy, patient age, and sex were factors associated with severe symptoms.

Conclusion: A long-term symptom burden is common after oesophageal cancer surgery.
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May 2021

Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK.

BMJ Open 2021 04 13;11(4):e042944. Epub 2021 Apr 13.

Department of Surgery and Cancer, Imperial College London, London, UK

Objectives: This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs).

Design: Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool.

Setting: The study was conducted in relation to POCTs used in all aspects of healthcare.

Participants: Forty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients.

Results: Thematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use).

Conclusions: Findings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.
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April 2021

Experiences of a "COVID protected" robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic.

J Robot Surg 2021 Feb 11. Epub 2021 Feb 11.

Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK.

The recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a "COVID protected" robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. "COVID protected" robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in "COVID protected" units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.
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February 2021