Author: Soto-Castillo, Juan Jose ; Frazer, Ricky Dylan ; Adamson, Ellis ; Agarwal, Ansh ; Dearden, Helen Clare ; Pillai, Manon ; Matthews, Diana ; Khalid, Mahrukh ; Waddell, Tom ; Vasudev, Naveen ; Grumett, Simon Aird ; Pickering, Lisa M ; McGrane, John ; Chadwick, Alice ; Charnley, Natalie ; McCarthy, Eleanor ; Lindsay, Duncan

484Background: In patients with increased risk of recurrence after surgical resection of renal cell carcinoma (RCC), adjuvant treatment with pembrolizumab has been shown to reduce recurrences and improve overall survival. This treatment is now offered as standard of care in England. In the KEYNOTE 564 trial 96.3% of patients who received pembrolizumab experienced at least one adverse event and 32.4% of patients experienced an adverse event of grade 3-5. 38.9% of trial patients discontinued treatment early; 21.3% due to adverse events and 10.5% due to disease recurrence. 7.4% of patients who were treated with pembrolizumab were treated with high dose systemic steroids (≥40mg prednisolone per day). Aims: To evaluate how real world data compares to the findings of KEYNOTE 564, in UK centres. Methods: This was a retrospective review of 182 patients treated with adjuvant pembrolizumab following surgery for RCC across 7 centres in the UK between 2022-2024. Toxicity, discontinuation, use of steroids, and recurrences were assessed. Results: 182 patients were started on adjuvant pembrolizumabbetween 2022-2024. Median FU is 8.4 months. Overall, 18 patients (9.9%) have experienced recurrence, and 15 (83.3%) of these occurred during treatment. 82 (45.1%) patients are currently undergoing treatment, and 41 (22.5%) patients completed the full 12-month course. 59 (32.4%) patients did not complete the full course, 44 (24.1%) due to toxicity and 15 (8.2%) due to recurrence. Mean number of cycles completed for patients discontinuing treatment was 3.4 (range 1 – 8). Toxicity was varied with endocrine (24%), skin (23%) & colitis (12%) being the most common toxicities of all grades. 24 (13.2%) and 3 (1.6%) patients experienced grade 3 and grade 4 toxicities respectively. The commonest toxicity leading to treatment discontinuation was colitis (27.3%). The number of patients requiring steroids for toxicity management was 59 (32.4%) with 34 (18.6%) requiring high dose steroids and 7 (3.8%) requiring additional immunosuppressive agents (methotrexate (3), infliximab (3) and MMF (1)). 26 (14.2%) patients required hospitalisation for management of toxicity. There was 1 treatment-related death due to complications from colitis and nephritis. Conclusions: In our group of patients, discontinuations of Pembrolizumab due to toxicity and recurrence rates were similar to data from KEYNOTE 564. A larger proportion of patients in our real world data were treated with high dose steroids (19%) compared to the trial (7.4%).

04 Dec 2023·British Journal of Surgery

Outcomes of Emergency Surgical patients with acute pathology managed without emergency laparotomy - a single site review

Author: Manor, Kristin ; Capozzi, Patrizia ; Bakrania, Shiv

AbstractAimTo establish the outcomes of Emergency General Surgery patients admitted with acute pathology that did not progress to Emergency LaparotomyMethodRetrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Review of patient demographics, diagnostics, diagnosis and management. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology.ResultsA total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023.39 (6.3%) patients had an Emergency Laparotomy.17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology.Of the 17 patients without laparotomy 12 were female patients.Median age of 86 years (range 42 – 91 years).At 30 days post admission 6 patients who did not proceed to laparotomy were alive.7 patients survived to discharge, 5 were discharged home and 2 were discharged to a Nursing Home for full nursing care requirements.ConclusionSurgeons are starting to explore the issues around futility in emergency general surgery. This snapshot retrospective review shows alignment with the very limited published literature. We recognise our numbers are extremely limited. Further data collection and analysis is needed to explore futility in emergency general surgery.

01 Mar 2022·Medico-Legal Journal

Are the recommendations in coronial prevention of future death (PFD) reports realistic and achievable?

Article

Author: King, Rebecca ; Benbow, Emyr Wyn

Prevention is better than cure. Coroners are not often thought to have a role in prevention, even though they have a duty to produce prevention of future death reports. Such reports are supposed to stimulate changes to prevent further deaths from recognised problems, but we speculated that they do not achieve their purpose. The reports are categorised, published online and are publicly available. This study set out to analyse prevention of future death reports to understand how far they prompt change, in two healthcare-related categories. Reports dated in 2020 were reviewed and data were collated detailing the contents of each one and whether there was a response. Results showed that the prevention of future death reports are inconsistent with regard to the details they included and there is no evidence that concerns raised by Coroners stimulate significant, widespread change in the healthcare system.

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