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An ERP in UGI cancer surgery was feasible, safe, and effective.

A 3-year-old patient presented for elective adenotonsillectomy to treat symptomatic obstructive sleep apnoea. The patient had not been assessed at a pre-operative anaesthesia clinic but had undergone uneventful general anaesthesia twice in the previous two years. An uneventful operative course was complicated by the development of clinical instability over the first 6 h postoperatively culminating in cardiorespiratory arrest. Subsequent investigation demonstrated the acute development of tumour lysis syndrome in the setting of a new onset, undiagnosed acute leukaemia. The patient died on the third postoperative day. The use of dexamethasone for prophylaxis against postoperative nausea and vomiting was the likely aetiology of the acute tumour lysis syndrome in this case. This is the first documented peri-operative death due to tumour lysis syndrome after adminstration of dexamethasone. We discuss the various problems encountered with this case and review the recent literature and case reports on tumour lysis syndrome in the operating theatre.

IntroductionThe impact of the COVID-19 pandemic (caused by the SARS-CoV-2 virus) on individuals with cancer has been profound. It has led to increased anxiety, distress and deconditioning due to reduced physical activity. We aim to investigate whether SafeFit, a multimodal intervention of physical activity, nutrition and psychological support delivered virtually by cancer exercise specialists (CES), can improve physical and emotional functionings during the COVID-19 pandemic.Methods and analysisA phase III non-randomised intervention trial, target recruitment of 1050 adults with suspected or confirmed diagnosis of cancer. All recruited participants will receive the multimodal intervention delivered by CES for 6 months. Sessions will be delivered 1-to-1 using telephone/video conferencing consultations. CES will work with each participant to devise a personalised programme of (1) physical activity, (2) basic dietary advice and (3) psychological support, all underpinned by behaviour change support.Primary outcomePhysical and emotional functioning as measured by the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ-C30). Secondary outcomes: overall quality of life measured by EORTC-QLQ-C30 and EQ-5D-5L, health economics, patient activation, self-efficacy to self-manage chronic disease, distress, impact of COVID-19 on emotional functioning, self-reported physical activity, functional capacity and nutrition. Adherence to the intervention will also be measured and a process evaluation conducted.Ethics and disseminationEthical approval was obtained from the Health Research Authority (reference number 20/NW/0254). Results of this trial will be disseminated through publication of peer-reviewed articles, presentations at scientific conferences, and to the public and people with cancer in collaboration with our patient and public involvement representatives and partners.Trial registration numberNCT04425616.

surgical unit between 24 th May 2016 and the 22 nd June 2016 were eligible for inclusion in this study. All patients were assessed by a member of the study team within 48 hours of the patients being admitted. A prospective review of the patient's medical and nursing records was undertaken to obtain the data outcomes required. Results: 500 patients (female 236:264 male; mean age 59 years (range 17-100years)) were recruited during the study period. In total 450 patients were from general surgery and 50 patients were from general medicine. Age, cancer diagnosis, emergency admission and female gender were all factors positively linked to increasing incidence of malnutrition. Three hundred and six patients (61%) had presenting symptoms which deleteriously impacted on nutritional status. These included nausea and vomiting (n¼138; 27.6%), diarrhoea or constipation (n¼23; 4.6%), pain (n¼92; 18.4%). Poor appetite and anorexia was reported in 175 patients (34%). Poor tissue viability was reported in 21 patients (4.2%). 130 patients (25%) were nil by mouth at the time of initial assessment by the study team in view of pending surgery. Patients who had a planned admission to hospital had a lower risk of undernutrition using the MUST screening tool when compared to patients admitted as an emergency admission, 25 patients (14.3%) versus 74 patients (22.8%). Our locally used validated nutritional risk screening tool reported 77 planned admission patients (44%) versus 158 emergency patients (48%) were either malnourished or at high risk for malnutrition. Conclusion: Many factors contribute to altered nutritional status. This reinforces the need for robust nutritional screening on admission to hospital and subsequent timely nutritional assessment by trained professionals followed by remedial nutritional treatment. Reference [1] BAPEN.org.uk.

Studies have shown that optimal fluid administration is essential in post-operative surgical management (1,2). Oedema is associated with delayed wound healing, cardiac and respiratory complications and delayed gastrointestinal motility. Problems with the management of fluid balance were highlighted in a survey (3) , which concluded that often peri-operative fluid management was suboptimal in the UK. The aim of the present study was to compare the fluid management of patients who received early enteral nutrition (EEN) or conventional (CON) post-operative management, i.e. nil by mouth. Length of hospital stay, post-operative morbidity and mortality, volume of fluid delivered, cumulative fluid balance and development of oedema were recorded, in addition to other endpoints. A total of 120 patients (median age 64 (range 35-82) years, sixty oesophageal, thirty-three gastric, twenty-eight pancreatic cancer) were recruited across three National Health Service Trusts over a 3-year period. There were two randomisation groups: group A (EEN) received EEN, commenced within 12 h of leaving the operating theatre; group B (CON) were 'nil by mouth' with hydration maintained with intravenous (IV) fluids, until deemed safe by the operating surgeon to commence oral diet and fluids.

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BackgroundRisk profile assessment and corrective interventions using optimisation of health status and prehabilitation represent an important strategy in the management of patients with a suspected cancer diagnosis.AimTo determine the feasibility of pre-treatment optimisation and prehabilitation commenced at index primary care consultation, to improve patients’ preparation for treatment by maximising the time available.Design & settingBetween January 2015 and May 2016, 195 patients presenting to 12 GP practices were deemed eligible to enter the study, of which 189 (96.9%, median age 60 [21–91] years and 65 months; 124 female) were recruited and consented to the prehabilitation bundle.MethodAll patients were simultaneously referred to secondary care using urgent suspected cancer (USC) pathways. The primary outcome measures were definitive diagnosis and treatment plan.ResultsFifteen patients (7.9%) were diagnosed with cancer (three breast, three colon, two lung, two skin [one melanoma, one sarcoma], one tonsil, one vocal cord, one pancreas, one prostate, one ependymoma) and 62 were diagnosed with other significant medical conditions (47 gastrointestinal, 13 sepsis, two respiratory) requiring secondary care assessment and treatment. Of the 15 patients with cancer, 11 (73.3%) underwent potentially curative treatment, and four (26.7%) palliative treatment. Of the total study cohort, 84 (44%) required a form of optimisation in primary care, and patients with cancer were more likely to require optimisation than others (n = 10 [63%] versus n = 74 [43%], χ2 9.384, P = 0.002).ConclusionOne in 12 primary care USC patients had cancer (5.6% receiving potentially curative treatment), one in three had other systemic health issues, and overall two in five benefited from healthcare intervention. Primary care optimisation was feasible and associated with important allied health benefits.