Qureshi, Yassar Ahmed;
(2025)
Peri-Operative Optimisation in Oesophageal and Gastric Cancer Surgery to Improve Long-Term Outcomes.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
Background: This thesis set out to determine whether pre-operative patient factors affected outcomes after oesophago-gastric cancer surgery, including age and anaemia. CPET testing was assessed as a predictive tool for the development of complications. Following surgery, the impact of complications on disease-free (DFS) and overall survival (OS) was measured. A digitally enabled enhanced recovery (ER) pathway was developed and used in clinical practise in order to assess its utility and value in monitoring and reducing complications. / Methodology: Clinical databases were used to collect data for these studies. Statistical analysis included assessments of absolute and relative frequencies, non-parametric tests for categorical variables, Cox and linear regression tests for survival analysis and Kaplan-Meir graphs with log-rank test. For the development of the ER App, the process and design are demonstrated, with qualitative presentation of results. / Results: Age demonstrated a trend towards poorer DFS in younger patients, with reduced OS in those 80 years and older. Peri-operative anaemia was associated with markers of adverse tumour characteristics, with allogenic blood transfusion use associated with increased post-operative complications. The number and severity of complications were strongly associated with reduced DFS, OS and median survival; this finding was strongest following oesophagectomy. Respiratory and infective complications were also associated with poorer OS. The development of a digital ER App facilitates the accurate recording and analysis of practise and permits real-time intervention in order to detect and treat complications earlier. With involvement of the wider MDT, it can be readily embedded in routine clinical practise. / Conclusion: Increasing severity and number of complications after surgery result in poorer DFS and OS, but can be improved by pre-operative optimisation and individualisation of care. An adaptable post-operative ER programme can assist in timely recognition of complications and prompt early treatment of these, thereby preventing progression into more serious conditions.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Peri-Operative Optimisation in Oesophageal and Gastric Cancer Surgery to Improve Long-Term Outcomes |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10203102 |
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