bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Closed-Incision Negative Pressure Wound Therapy in Reducing Postoperative Complications in Breast Reconstruction After Radiotherapy: A Propensity Score Analysis
Authors: Alameddine Khaled O , Salinas Cristina A , Yan Maria , Martinez-Jorge Jorys , Vijayasekaran Aparna , Tran Nho V , Harless Christin A
Published: September 2024

Background

Implant-based breast reconstruction following radiotherapy can lead to significant postoperative complications. Closed-incision negative pressure wound therapy (ciNPWT) has emerged as a potential intervention to reduce these complications.

Objectives

To assess the effectiveness of ciNPWT in reducing postoperative complications in patients undergoing implant-based breast reconstruction after radiotherapy.

Methods

A retrospective single-center cohort study was conducted, including patients who underwent implant-based breast reconstruction after mastectomy and radiotherapy between January 1, 2015, and December 31, 2022. We utilized a procedure-level analysis model with patients contributing distinct observations for multiple procedures. Our primary outcome measures included fluid collection, infection, and wound complications. Propensity score analysis was employed to adjust for potential confounders, such as BMI, smoking history, and diabetes history, creating a balanced comparison between the ciNPWT-treated and untreated groups.

Results

In our study of 301 breast reconstructions postradiotherapy from 2015 to 2022, encompassing 218 unique patients, we found significant benefits of ciNPWT. During an average of 2.2-year follow-up, the ciNPWT group demonstrated no infections, contrasting with a 10.4% rate in the non-ciNPWT group (P < .0001). Wound complications were also significantly lower in the ciNPWT group (1.9% vs 11.2%; P = .00848). Demographic differences were adjusted using inverse probability of treatment weights. The findings suggest ciNPWT’s promising role in enhancing postoperative outcomes in breast reconstruction postradiotherapy.

Conclusions

Our study suggests that the use of ciNPWT in implant-based breast reconstruction postradiotherapy can potentially reduce postoperative complications. This intervention can improve patient outcomes and may offer cost-saving benefits in the long run.

Level of Evidence: 3 (Therapeutic)
ChatMol: interactive molecular discovery with natural language
Authors: Zeng Zheni , Yin Bangchen , Wang Shipeng , Liu Jiarui , Yang Cheng , Yao Haishen , Sun Xingzhi , Sun Maosong , Xie Guotong , Liu Zhiyuan
Published: September 2024

Motivation

Natural language is poised to become a key medium for human–machine interactions in the era of large language models. In the field of biochemistry, tasks such as property prediction and molecule mining are critically important yet technically challenging. Bridging molecular expressions in natural language and chemical language can significantly enhance the interpretability and ease of these tasks. Moreover, it can integrate chemical knowledge from various sources, leading to a deeper understanding of molecules.

Results

Recognizing these advantages, we introduce the concept of conversational molecular design, a novel task that utilizes natural language to describe and edit target molecules. To better accomplish this task, we develop ChatMol, a knowledgeable and versatile generative pretrained model. This model is enhanced by incorporating experimental property information, molecular spatial knowledge, and the associations between natural and chemical languages. Several typical solutions including large language models (e.g. ChatGPT) are evaluated, proving the challenge of conversational molecular design and the effectiveness of our knowledge enhancement approach. Case observations and analysis offer insights and directions for further exploration of natural-language interaction in molecular discovery.

Availability and implementation

Codes and data are provided in https://github.com/Ellenzzn/ChatMol/tree/main.
Imaging findings in suspected penile fracture: alternative diagnoses and surgical correlation
Authors: von Stempel Conrad , Kirkham Alex , Cayetano Alcaraz Axel , Ralph David , Christopher Nim , Muneer Asif , Sangster Pippa , Alnajjar Hussain , Li Chi-ying , Walkden Miles , Allen Clare , Pendse Doug , Ramachandran Navin , Heffernan Ho Dan , Dickinson Louise , Hubbard Rachel , Giganti Francesco , Lee Wai Gin
Published: September 2024

Objectives

The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF).

Methods

Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded.

Results

One hundred and ninety-three patients were included. One hundred and four (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. Ninety-nine (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked the site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration (median 20 mm, IQR 10-30; P < .0001).

Conclusions

US has a high positive predictive value in the confirmation of PF. MRI improves the detection and characterizing the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities.

Advances in knowledge

Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration.
Bowel cleansing, dysbiosis, and postoperative infection: the dots are starting to connect
Authors: Alverdy John C
Published: September 2024

When preparing the bowel for surgery using purgative cleansing of either oral polyethylene glycol versus 0.9% normal saline enemas, the degree of dysbiosis is the same and is temporary recovering toward normal by postoperative day 30. When examining all infections, independent of treatment group, it appears that many infections arise from among the gut microbiota
Impact of mechanical bowel preparation on the gut microbiome of patients undergoing left-sided colorectal cancer surgery: randomized clinical trial
Authors: Žukauskaitė Kristina , Horvath Angela , Gricius Žilvinas , Kvietkauskas Mindaugas , Baušys Bernardas , Dulskas Audrius , Kuliavas Justas , Baušys Rimantas , Letautienė Simona Rūta , Vaicekauskaitė Ieva , Sabaliauskaitė Rasa , Baušys Augustinas , Stadlbauer Vanessa , Jarmalaitė Sonata
Published: September 2024

Background

Postoperative complications after colorectal cancer surgery have been linked to the gut microbiome. However, the impact of mechanical bowel preparation using oral preparation agents or rectal enema on postoperative infections remains poorly understood. This study aimed to compare the impact of oral preparation and rectal enema on the gut microbiome and postoperative complications.

Methods

This open-label pilot RCT was conducted at the National Cancer Institute, Vilnius, Lithuania. Patients with left-side colorectal cancer scheduled for elective resection with primary anastomosis were randomized 1 : 1 to preoperative mechanical bowel preparation with either oral preparation or rectal enema. Stool samples were collected before surgery, and on postoperative day 6 and 30 for 16S rRNA gene sequencing analysis. The primary outcome was difference in β-diversity between groups on postoperative day 6.

Results

Forty participants were randomized to oral preparation (20) or rectal enema (20). The two groups had similar changes in microbiome composition, and there was no difference in β-diversity on postoperative day 6. Postoperative infections occurred in 12 patients (32%), without differences between the study groups. Patients with infections had an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

Conclusion

Mechanical bowel preparation with oral preparation or rectal enema resulted in similar dysbiosis. Patients who experienced postoperative infections exhibited distinct gut microbiome compositions on postoperative day 6, characterized by an increased abundance of bacteria from the Actinomycetaceae family, Actinomyces genus, Sutterella uncultured species, and Enterococcus faecalis species.

Registration number

NCT04013841 (http://www.clinicaltrials.gov).
Deciphering the physiopathology of neurodevelopmental disorders using brain organoids
Authors: Dionne Olivier , Sabatié Salomé , Laurent Benoit
Published: September 2024

Neurodevelopmental disorders (NDD) encompass a range of conditions marked by abnormal brain development in conjunction with impaired cognitive, emotional and behavioural functions. Transgenic animal models, mainly rodents, traditionally served as key tools for deciphering the molecular mechanisms driving NDD physiopathology and significantly contributed to the development of pharmacological interventions aimed at treating these disorders. However, the efficacy of these treatments in humans has proven to be limited, due in part to the intrinsic constraint of animal models to recapitulate the complex development and structure of the human brain but also to the phenotypic heterogeneity found between affected individuals. Significant advancements in the field of induced pluripotent stem cells (iPSCs) offer a promising avenue for overcoming these challenges. Indeed, the development of advanced differentiation protocols for generating iPSC-derived brain organoids gives an unprecedented opportunity to explore human neurodevelopment.

This review provides an overview of how 3D brain organoids have been used to investigate various NDD (i.e. Fragile X syndrome, Rett syndrome, Angelman syndrome, microlissencephaly, Prader-Willi syndrome, Timothy syndrome, tuberous sclerosis syndrome) and elucidate their pathophysiology. We also discuss the benefits and limitations of employing such innovative 3D models compared to animal models and 2D cell culture systems in the realm of personalized medicine.
Peracetic acid efficacy on disinfection of photostimulable phosphor plates
Authors: Ruiz Débora Costa , Ocampo Thaís Santos Cerqueira , Franco Eduardo Martinelli , Correia-Dantas Iago Filipe , Mattos-Graner Renata de Oliveira , Haiter-Neto Francisco , Freitas Deborah Queiroz
Published: September 2024

Objectives

To evaluate the antimicrobial efficacy of white vinegar, acetic acid, and peracetic acid on photostimulable phosphor (PSP) plates disinfection, and to assess the disinfectant influence on the radiographic quality.

Methods

Eight PSP plates (Express system) were contaminated with Streptococcus mutans and Candida albicans. These plates were wiped with tissues without any substance, with white vinegar, acetic acid, and peracetic acid, followed by an agar imprint. Number of microbial colonies formed was recorded. Afterwards, the quality of radiographs was tested using the more efficient disinfectant. Before disinfection and after every five disinfections, two radiographs of an acrylic-block and two radiographs of an aluminium step-wedge were acquired for each plate. Density, noise, uniformity, and contrast were analysed. Three oral radiologists evaluated the images for the presence of artefacts. One-way analysis of variance compared changes on grey values among the disinfections (α = .05). Intra- and inter-examiner agreement for the presence of artefacts was calculated by weighted Kappa.

Results

Peracetic acid was the only one that eliminated both microorganisms. Density and uniformity decreased after 100 disinfections, and contrast changed without a pattern in the course of disinfections (P ≤ .05). Small artefacts were observed after 30 disinfections. Intra- and inter-examiner agreements were almost perfect.

Conclusions

Disinfection with peracetic acid eliminated both microorganisms. However, it also affected density, uniformity, and contrast of radiographs, and led to the formation of small artefacts.
251. THE COMPARISON OF UNIPORTAL VERSUS MULTIPORTAL VIDEO-ASSISTED THORACIC SURGERY FOR ESOPHAGEAL CANCER: A PROPENSITY-WEIGHTED ANALYSIS
Authors: Yuan Yong
Published: September 2024

Background

Uniportal video-assisted thoracoscopic surgery (VATS) has been widely used, however, there are few studies on uniportal VATS for esophagectomy.

Methods

Data from patients with clinical stage T1–3/N0/M0 thoracic esophageal cancer who underwent surgery between January 2017 and December 2020 were retrospectively collected and retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to assess the outcomes.

Results

Overall, 55 patients who underwent uniportal, and 212 patients who underwent multiportal, VATS were identified. Surgery-related postoperative complications (Clavien-Dindo grades 1–2) occurred less frequently after uniportal than multiportal VATS in both crude and IPTW models (10.1% versus 28.8%, respectively; P = 0.018). The median postoperative length of stay was 9 (9–10) days in the uniportal VATS and 10 (9–14) days in the multiportal VATS group (P = 0.006 after IPTW). Upon IPTW analysis, in uniportal and multiportal VATS groups, the rates of pneumonia (grades 1-2) were 7.3% and 23.2% (P = 0.037). The visual analog scale (VAS) was administered on postoperative first 7 days and were significantly lower in the uniportal VATS group (P < 0.001). No surgical mortality was observed in the uniportal VATS group, and the survival benefit between the two groups was comparable before (P = 0.320) and after IPTW (P = 0.824).

Conclusion

Uniportal VATS for esophagectomy resulted in a lower rate of postoperative complications with less postoperative pain, and is practical for treating patients with esophageal cancer.
262. EOSINOPHILIC ESOPHAGITIS: A SEVEN YEAR ANALYSIS OF EPIDEMIOLOGY IN A UNITED KINGDOM COUNTY
Authors: Sivarajan Sri , Arkle Thomas , Kotha Soumya , Ritchie Thomas , Gopaul Steven , Kumar Bhaskar
Published: September 2024

Background

Eosinophilic Esophagitis (EoE) is growing in incidence internationally. It is an immune-mediated disease that is characterised by esophageal mucosal eosinophilia and esophageal dysfunction. Awareness of EoE is also crucial for Esophagogastric surgeons as symptoms may mimic reflux disease or neoplasia, key considerations for an accurate differential diagnosis. Presently, there are no incidence estimates of EoE in the adult population in the UK. This study seeks to establish a cohort of EoE patients in Norfolk, a county in the East of England region, and to describe the incidence, characteristics, and diagnostic features of affected patients in both the adult and paediatric populations.

Methods

A retrospective analysis was performed of a prospectively maintained pathology database servicing a population of 761,000 persons in Norfolk. All newly diagnosed cases of EoE across a seven-year period between January 2017 and December 2023 were identified. Patients included for analysis had a histological diagnosis of EoE with >15 eosinophils/hpf and symptoms of oesophageal dysfunction. Patient electronic health care records were reviewed for histology reports, endoscopic findings, and clinical history. The primary outcome was incidence of EoE within the county. Secondary outcomes assessed included: patient characteristics; allergy and atopy history; endoscopic features, biopsy protocol and referral indication.

Results

187 (median age 43 (4-85) years, Male: Female (126:61)) new cases of EoE were identified, of whom eight were in the paediatric age group of ≤16 years. The average annual incidence of EoE was 4.29 [95% CI 2.92, 5.66] and 0.89 [95% CI 0, 1.39] per 100,000 person/years in adult and paediatric groups respectively, with a significantly higher incidence in adults (RR 4.86 (95% CI [2.39 – 9.85] P<0.005) (Figure 1). The most common referral indications for endoscopy were dysphagia (80.7%) and food bolus obstruction episodes (25.1%). The most common endoscopic feature of EoE was circular rings (49.2%).

Conclusion

This is the first study reporting incidence of EoE in the UK adult population. There was a significantly greater incidence of EoE in adults compared to the paediatric population. However, there was no significant change in incidence of EoE in either group over the study period. Incidence estimates identified are similar to those reported in other European populations. Importantly 18.2% of patients had normal appearance of oesophagus on endoscopy, which reinforces the need to take oesophageal biopsies where there is clinical suspicion. Ideally, prospective registry data is needed for a comprehensive characterisation of incidence and prevalence of EoE.
272. HOSPITAL VARIATION IN PALLIATIVE TREATMENT FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER: A NATIONWIDE POPULATION-BASED STUDY IN THE NETHERLANDS
Authors: Geerts Julie , Vissers Pauline , Mostert Bianca , Wijnhoven Bas , Haberkorn Brigitte , Rosman Camiel , Creemers Geert-Jan , Westdorp Harm , van der Sangen Maurice , Verhoeven Rob
Published: September 2024

Background

Palliative care for patients with esophageal (EC) includes a large variety of treatments and data on variation of palliative care across centers are unknown. This study aims to evaluate treatment variation at the hospital level for EC and GC patients in the Netherlands.

Methods

A nationwide retrospective cohort study was conducted using population-based data from the Netherlands Cancer Registry. Patients diagnosed with inoperable advanced (cT4B) or synchronous metastatic (cM1) EC between 2015-2022 were included. Probability of receiving potentially life-prolonging treatment (palliative resection, chemoradiotherapy or systemic treatment) according to hospital of diagnosis was analyzed using multilevel logistic regression analysis. Hospitals were categorized in tertiles according to this probability (high, medium, low) and overall survival (OS) was assessed using cox regression analysis.

Results

8,580 EC patients were included. Potentially life-prolonging treatment ranged from 23.5%-74.0% across hospitals of diagnosis (p<0.0001). After adjustment for patient and tumor characteristics, the probability of receiving these treatments was associated with hospital of diagnosis (p<0.0001). 13 of 79 hospitals demonstrated a significantly lower probability of giving potentially life-prolonging treatment. Patients diagnosed in hospitals with low probability of potentially life-prolonging treatment with had significantly worse OS than medium- (HR 0.85 (0.80-0.90) p<0.0001) or high-probability hospitals (HR 0.77 (0.73-0.82) p<0.0001).

Conclusion

This study shows substantial variation in palliative treatment for EC and GC care across Dutch hospitals, emphasizing the challenge of defining optimal treatment plans. Hospital of diagnosis was significantly associated with the probability of receiving potentially life-prolonging treatment and also with overall survival. These results suggest that appropriate selection of patients for treatment with potentially life-prolonging treatment leads to improved OS.
286. TREATMENT WITH CURATIVE INTENT FOR OLIGOMETASTATIC GASTROESOPHAGEAL CANCER-RESULTS OF A PROSPECTIVE MULTICENTER STUDY
Authors: Norén Nora , Rouvelas Ioannis , Nilsson Magnus , Lundell Lars , Szabo Eva , Edholm David , Hedberg Jakob , Smedh Ulrika , Hermansson Michael , Lindblad Mats , Klevebro Fredrik
Published: September 2024

Background

Oligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option in selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer.

Methods

In a multicenter collaborative study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered treatment with combined systemic and local therapy within the study. Primary endpoints were treatment safety and feasibility, secondary outcomes included postoperative mortality, treatment response, progression-free and overall survival. Subgroup analyses were stratified based on oligometastatic location.

Results

A total of 29/35 patients completed systemic and local treatment with surgical resection, liver ablation or definitive chemoradiotherapy. The majority of postoperative complications were mild-moderate, no patient died due to postoperative complications within 30 days of surgery. Median progression-free survival was 7.1 (interquartile range 4.3-12.4) months and median overall survival was 23.8 (interquartile range 12.3-33.0) months.

Conclusion

This study found combined systemic and local treatment to be a safe treatment option and to potentially improve long-term survival in strictly selected patients with oligometastatic gastroesophageal cancer.
293. OUTCOMES AFTER SURGICAL TREATMENT OF OESOPHAGOGASTRIC CANCER WITH SYNCHRONOUS LIVER METASTASES: A MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: van Hootegem Sander , De Pasqual Carlo , Giacopuzzi Simone , Van Daele Elke , Vanommeslaeghe Hanne , Moons Johnny , Nafteux Philippe , van der Sluis Pieter , Lagarde Sjoerd , Wijnhoven Bas
Published: September 2024

Background

Approximately 10-12% of patients with oesophageal and gastric cancer (OGC) present with oli-gometastatic metastases at diagnosis. It remains unclear if there is a role for radical surgery in these patients. We aimed to assess the outcomes of OGC patients who underwent simultaneous treatment for the primary tumour and synchronous liver metastases.

Methods

Patients with OGC who underwent surgical treatment between 2008 and 2020 for the primary tumour and up to five synchronous liver metastases aiming for complete tumour removal or ablation (i.e. no residual tumour) were identified from four institutional databases. The primary outcome was overall survival (OS), calculated with the Kaplan-Meier method. Secondary outcomes were disease-free survival and postoperative outcomes.

Results

Thirty-one patients were included with complete fol-low-up data in 30 patients. Twenty-six patients (84%) received neoadjuvant therapy followed by response evaluation. Median OS was 21 months [IQR 9-36] with a 2- and 5-year survival rates of 43% and 30%, respectively. While disease recurred in 80% of the patients (20 of 25 patients) after a radical resection, patients with a solitary liver metastasis had a median OS of 34 months. The number of liver metastases was a prognostic factor for OS (solitary metastasis aHR 0.330; p-value = 0.025). Thirty-day mortality was zero and complications occurred in 55% of the patients.

Conclusion

Long-term survival can be achieved in well-selected patients who undergo surgical resection of the primary tumour and local treatment of synchronous liver metastases. In particular, patients with a solitary liver metastasis seem to have a favourable prognosis.
303. VACUUM-STENT TREATMENT FOR TRANSMURAL DEFECTS IN THE UPPER GASTRO-INTESTINAL TRACT: CASE SERIES AND NEW INSIGHTS IN A TERTIARY REFERRAL CENTER
Authors: Pattynama Lisanne , Eshuis Wietse , Bergman Jacques , van Berge Henegouwen Mark , Pouw Roos
Published: September 2024

Background

Transmural defects in the upper gastro-intestinal (GI) tract are associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has recently been established as promising endoscopic treatment option for such defects and is most often applied using endoscopically placed vacuum-sponges. The vacuum-stent is a novel device to apply EVT, combining the advantages of negative pressure wound therapy and an intraluminal stent, allowing for oral intake.

Methods

The aim of this prospective cohort study is to describe the experiences of, and lessons learned by a tertiary referral center with EVT experience since 2018, regarding the vacuum-stent for transmural defects in the upper GI tract. All patients treated with a vacuum-stent between November 2022 and October 2023 were included. Outcome measures included successful defect closure, reasons of treatment failure, adverse events and strictures.

Results

31 patients were included. Baseline characteristics and outcomes are displayed in Table 1. Success rates of combined vacuum-stent and –sponge treatment and vacuum-stent treatment alone were respectively 83% and 78%. In this cohort, some notable reasons of failure were observed: a defect too close to the upper esophageal sphincter (UES), inadequate vacuum on the esophago-jejunal anastomosis, a carcinoma at a persisting perforated ulcer, and adverse events. Two adverse events occurred (6%): two patients developed a secondary defect at the site of the proximal vacuum-stent flange, of whom one had a cervical anastomosis with a narrow proximal esophagus and one Boerhaave syndrome. Three out of four patients with a severe structure had underwent a McKeown esophagectomy.

Conclusion

The vacuum-stent is a valuable treatment option for AL after Ivor Lewis esophagectomy, Boerhaave syndrome and iatrogenic defects with success rates of 78-83%. Treating cervical anastomotic leaks is not recommended by us, due to the narrow lumen of the proximal esophagus, the proximity of the UES and high risk of severe strictures. Furthermore, caution is recommended in case of a narrow esophagus. In our experience, vacuum-stent and –sponge treatment complement each other and might be indicated in different situations. Sharing experiences on the topic is important to assess the best techniques and indications, to be able to reach the full potential of the vacuum-stent and further increase the success rate.
311. PROGNOSTIC VALUE OF DIFFERENT CIRCUMFERENTIAL MARGIN SITES IN OESOPHAGEAL CANCER: A 10-YEAR COHORT STUDY
Authors: Elshaer Ahmed , Jones Sian , Mehta Samir , Hayden Jeremy , Cockbain AJ , Sarela Abeezar , Dexter Simon , Grabsch Heike
Published: September 2024

Background

There’s a growing interest towards the prognostic value of circumferential resection margin (CRM) involvement in oesophageal cancers. However, there is no sufficient data about the association of the site-specific CRM and survival. In this study, we analysed the influence of different involved CRM sites on survival.

Methods

This study included patients who had curative oesophagectomy for oesophageal cancer between 2010 till June 2021. Follow up till April 2022 was achieved. Patients with involved proximal or distal margins were excluded. The sites of CRM were defined anatomically to anterior (pericardial), posterior (aorta), lateral (pleurae). The outcomes between different CRM margins were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases.

Results

117 patients had CRM-positive after curative oesophagectomy during the study period. 33 cases had multi-involved CRM sites, while 84 patients had single involved CRM site. Posterior margins were the most common involved site 37/117 (31.6%). No differences in baseline pathological criteria (pT, pN stages and type of cancer) and neoadjuvant therapy. Positive anterior margins carried the worst overall (OS) and disease-free (DFS) survival compared to lateral and posterior margins (OS: 29 vs 41 vs 32 months respectively, p-value 0.37, DFS: 19.2 vs 32.1 vs 28.7 months respectively, p-value 0.39). Multi-involved CRM sites led to worse OS and DFS in comparison with single involved CRM site (OS: 19 vs 32 months respectively, p-value 0.008, DFS: 12.1 months vs 27.6 months respectively, p-value 0.05).

Conclusion

The site of involved CRM should be rigorously assessed in oesophagectomy specimens. The involved margin sites within CRM had different survival rates, with inferiority towards anterior resection margins. Larger studies are required to better evaluate the prognostic significance of various CRM sites.
315. SHORT-TERM RESULTS OF ROBOT-ASSISTED SURGERY FOR ESOPHAGEAL CANCER IN JAPAN 5 YEARS AFTER INSURANCE COVERAGE
Authors: Noma Kazuhiro , Matsumoto Hijiri , Kunitomo Tomoyoshi , Kawasaki Kento , Hashimoto Masashi , Kashima Hajime , Maeda Naoaki , Kikuchi Satoru , Tanabe Shunsuke , Fujiwara Toshiyoshi
Published: September 2024

Background

In Japan, robot-assisted surgery (RAMIE) for esophageal cancer surgery was covered by insurance in 2018, and its introduction has been rapidly progressing since then. In our department, RAMIE has been introduced and performed in 250 cases so far. In the process, we have improved the short-term results by introducing the standardization and NIM (neuromonitoring) according to the characteristics of RAMIE. In addition, we have recently expanded the use of RAMIE in advanced cancer patients due to its usefulness in stable operation. In this meeting, we will review the short- and mid-term results and discuss current issues.

Methods

We analyzed the short-term results of all 213 RAMIE cases performed at our department, and compared them with the short-term results of 51 post-standardization (late) MIE cases previously reported. The mid-term results to date were also reviewed.

Results

A total of 213 patients were included. 211, 222 mins thoracic operation time. 235, 190 ml blood loss in comparison to MIE (vs. RAMIE). Postoperative outcomes were similar: overall complications (>Grade II) were 49, 54.9%, respiratory complications were 19.6, 23.9%, and recurrent nerve palsy was 15.7, 17.4%. Risk analysis demonstrated that paralysis in RAMIE was significantly related to prolonged thoracic operation time (p=0.021) and NIM (Odds=0.38, p=0.0447). In comparison between patients with early-stage and advanced cancer, pneumonia and anastomotic complications were not different. Prognosis was 81.7/64.2% (UICC 8th) for 3-year survival in cStage II/III patients.

Conclusion

RAMIE was considered to be highly useful for short-term and medium-term outcomes at this time.
328. NORMAN RUPERT BARRETT (1903 – 1979)
Authors: Tang Linda
Published: September 2024

Norman Rupert Barrett (1903 – 1979) was an Adelaide born thoracic surgeon. Barrett is most well-known for his contribution to ‘Barrett’s Oesophagus’. He was born into the Barrett Brothers malt producing family. He left Australia at the age of 10 and travelled throughout Europe and arrived in England in the wake of World War I. Following the Great War, Barrett sat his surgical examinations. Ironically, while the 21st century boasts well rounded surgeons and safe working hours, Barrett was at one point chastised for leaving the hospital grounds for a short walk while on call.

The origin of the term ‘Barrett’s Oesophagus’ may not be quite as you imagine. Barrett initially describes the oesophagus being lined with columnar epithelium but attributes this to a congenitally shortened oesophagus leading to part of the stomach entering the chest. Later on, it was described by Allison and Johnstone that this was, in fact, the oesophagus and proposed ulcers in this region better termed ‘Barrett’s ulcers’. Only several years later was this pathology accepted by Barrett. Now ‘Barret’s Oesophagus’ is well known to us as the term used to describe the adaptive metaplastic change of the squamous epithelium of the oesophagus to columnar epithelium from the stomach; it is the pathological waymark for endoscopists in the development of Oesophageal Cancer.
329. PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE I/II ESOPHAGOGASTRIC JUNCTION CANCER WITH ESOPHAGEAL INVASION
Authors: Shoji Yoshiaki , Tajima Kohei , Kanamori Kohei , Ogimi Mika , Ninomiya Yamato , Yamamoto Miho , Kazuno Akihito , Nabeshima Kazuhito , Nishi Takayuki , Koyanagi Kazuo
Published: September 2024

Background

Mediastinal lymph node dissection (LND) is a critical factor to decide the surgical strategy for Esophagogastric junction (EGJ) cancers. As a result of a prospective multicenter study in Japan, surgical algorithm including the extent of LND for EGJ cancers has recently been proposed according to the length of esophageal invasion. However, preoperative measure predicting upper mediastinal LN metastasis is still lacking, and the oncologic efficacy of mediastinal LND remain unknown.

Methods

The aim of this study was to identify preoperative factors predicting mediastinal LN metastasis, and we hypothesized that preoperative CT image would be of utility. Patients who underwent surgical treatment for Siewert Type I/II EGJ cancer with esophageal invasion with curative intent between 2000 and 2022 at the Tokai University Hospital were retrospectively reviewed.

Results

A total of 103 patients were enrolled. Among them, 55, 74, and 74 patients underwent upper, middle, and lower mediastinal LND, respectively. Upper/middle/lower mediastinal LN metastasis was observed in 14/13/23 of those patients, respectively, with lower thoracic paraesophageal LNs (29%), middle thoracic paraesophageal LNs (18%), and right recurrent nerve LNs (16%) being the three most common metastatic sites. Estimated invasion depth of the primary lesion≧cT3 (p≦0.007), tumor size≧4cm (p≦0.002), esophageal invasion length≧4cm (p≦0.007) and minor axis of the LN≧5mm by preoperative CT image (p<0.001) were significant preoperative factors related to mediastinal LN metastasis.

Conclusion

Clinical T factor, tumor size, the size of mediastinal LN by CT image, as well as esophageal invasion length, were important preoperative factors to predict mediastinal LN metastasis, and those factors should be taken into consideration to decide the surgical strategy for EGJ cancers with esophageal invasion. Survival impact of mediastinal LND still remain unclear, and further accumulation of cases and prospective studies are awaited.
336. EFFICACY AND SAFETY OF PHOTODYNAMIC THERAPY FOR SECONDARY PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER CHEMORADIOTHERAPY OR RADIOTHERAPY FOR ANOTHER MALIGNANCY
Authors: Fujiwara Takahisa , Kadota Tomohiro , Yamashita Hiroki , Minakata Nobuhisa , Watanabe Takashi , Inaba Atsushi , Sunakawa Hironori , Nakajo Keiichiro , Shinmura Kensuke , Yano Tomonori
Published: September 2024

Background

Photodynamic therapy (PDT) using talaporfin sodium is known as the effective, safe, and less invasive treatment for local failure after chemoradiotherapy (CRT) or radiotherapy (RT) for esophageal squamous cell carcinoma (ESCC). The secondary primary ESCC sometimes occur at different site after CRT/RT for ESCC or other cancer, and PDT may be considered for such lesion if endoscopic resection and surgery are not suitable for patients. However, the actual therapeutic efficacy remains unclear. This study aims to evaluate the efficacy and safety of PDT using talaporfin sodium for untreated secondary primary ESCC with a history of CRT/RT for another malignancy.

Methods

This retrospective study enrolled the patients underwent PDT using talaporfin sodium for untreated secondary primary ESCC in the treatment field of prior CRT/RT for another malignancy at the National Cancer Center Hospital East from September 2016 to October 2021. The inclusion criteria of PDT in this study were as follow; 1) invasion depth limited within T2, 2) <3/4 of the esophageal circumference, 3) absence of lymph node or distant metastasis, and 4) patient’s refusal or unsuitable physical condition for surgery. We evaluated the rate of local complete response (L-CR), incidence of adverse events, and clinical outcomes.

Results

Ten patients were enrolled in this study. Previous malignancy organ was hypopharynx (n=1), lung (n=2), and esophagus (n=7). All secondary primary ESCC were diagnosed as T1b. Finally, L-CR was achieved in 6 patients (L-CR rate: 60.0%). Among 6 patients with L-CR, one had local recurrence, one had lymph node recurrence, and the remaining four had no recurrence. During the median follow-up of 27.5 months, one patient with L-CR died from other diseases. Adverse events included grade ≤2 esophageal pain in 2 patients, photosensitivity and esophageal stricture in each one, and no esophageal perforation or treatment-related death.

Conclusion

As retreatment with RT is not available, PDT may be the treatment options for the secondary primary ESCC after CRT/RT for another malignancy.
339. MANAGEMENT OF OESOPHAGO-PLEURAL FISTULAS WITH ENDOSCOPIC VACUUM THERAPY: A PROMISING APPROACH
Authors: Srikanth Diya , Ng Annalisa YL , Ching Siok Siong , Lin Jinlin , Wong Andrew SY , Lee June
Published: September 2024

Background

Boerhaave syndrome is a rare and serious condition requiring prompt management to prevent severe complications and improve patient outcomes. One significant complication is an oesophago-pleural fistula. These fistulas often result in aspiration pneumonia, empyema, and mediastinitis. Conventional management with surgery has high complication and mortality rates. Endoscopic vacuum therapy (EVT) is a less invasive technique for the management of oesophageal fistulas, involving endoscopic placement of a vacuum-assisted sponge within the oesophageal defect, promoting healing via continuous wound drainage and tissue granulation.

Methods

We report the case of a gentleman who initially presented with Boerhaave syndrome, was treated with open oesophageal repair, and was re-admitted 3 weeks later for an oesophago-pleural fistula with pleural collections. EVT was administered to the oesophageal defect twice weekly for 29 days and the effectiveness of therapy was monitored with serial oesophagogastroduodenoscopies, contrast studies, and computed tomography scans of the thorax to monitor the resolution of the pleural collections. During this period, the fistula defect showed gradual granulation tissue growth, resulting in full closure of the mucosal defect.

Results

The use of EVT has shown to result in successful closure of fistulas, resolution of sepsis with reduced need for surgical intervention, and shorter hospital stays. EVT combines coverage of the oesophageal defect and adequate drainage of the cavity behind the defect, often without the need for additional external drain placement. These findings highlight the role of EVT as a valuable adjunct in the management of oesophageal fistulas, particularly in cases requiring rescue therapy. Limitations of EVT include risk of bleeding, fistula formation/recurrence, need for frequent endoscopic interventions, stricture formation, and inability for oral intake due to occlusion of the gastrointestinal tract.

Conclusion

EVT represents a paradigm shift in the management of oesophageal fistulas, offering a less invasive alternative with the ability to promote wound healing, control sepsis, and reduce the need for high-risk redo oesophageal surgery. Further prospective studies and trials are needed to reach a consensus about its technical aspects, such as pressure settings and procedure intervals; as well as to evaluate its efficacy as a potential first-line treatment for oesophageal fistulas.
343. DIAGNOSTIC VALUE OF ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSESOPHAGEAL NEEDLE ASPIRATION (EBUS-TENA) IN LESIONS ADJACENT TO BOTH THE TRACHEA/BRONCHUS AND ESOPHAGUS
Authors: Zhou Haining , Tang Shoujun , Zhong Chuan
Published: September 2024

Objective

To investigate the clinical diagnostic value of endobronchial ultrasound-guided transesophageal needle aspiration (EBUS-TENA) in lesions adjacent to both the trachea/bronchus and esophagus

Methods

The clinical data of 12 patients who underwent EBUS-TENA from February 2019 to February 2022 were collected. The operative physicians and nurses worked closely with each other and meticulously cared the patients. The vital signs changes were observed and recorded, as well as intraoperative adverse events and the acquired specimens.

Results

All the 12 patients underwent surgery successfully, and hair-like tissue strips were obtained in each case. There were 8 cases of central lung cancer and 4 cases of mediastinal tumor. The preoperative vital signs scores showed no significant difference with the intraoperative and postoperative scores (P>0.05). A few complications occurred, including 2 case of mild cough, 2 case of nausea and vomiting, with no symptoms of severe cough and dyspnea, haemorrhage, mediastinal infection, pneumothorax, mediastinal emphysema and other complications.

Conclusion

EBUS-TENA has significant effect in successfully obtaining pathological tissue specimens especially for lesions adjacent to both the trachea/bronchus and esophagus, improving disease positive diagnosis rate, reducing patients discomfort and the risk of surgery.
344. SURGICAL APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE: THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY
Authors: Tang Shoujun , Zhou Haining , Zhong Chuan
Published: September 2024

Objective

To explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate.

Methods

A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy.

Results

Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P < 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P > 0.05).

Conclusion

Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.
354. NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY SURGERY VERSUS UPFRONT SURGERY FOR ESOPHAGEAL CANCER: LONG-TERM OUTCOMES IN A CROSS TRIAL STUDY CENTER
Authors: Carresi Agnese , Ponce Carmen Mestre , van der Aa Dillen C , Eshuis Wietse , van Berge Henegouwen Mark I , Gisbertz Suzanne S
Published: September 2024

Background

Since the publication of the CROSS-trial, showing improved survival following neoadjuvant chemoradiotherapy + surgery (CRT-S) compared to upfront surgery (U-S) for esophageal cancer, this neoadjuvant regimen has become standard care in the Netherlands. Given the relatively low R0 rate in the U-S arm (69%) and lymph node yield (LNY) in both arms (15 U-S, 18 CRT-S) observed in the CROSS-trial, the present study aimed to compare survival of patients who underwent CRT-S versus U-S in a tertiary referral center that participated in the CROSS-trial, within the era that the trial was performed.

Methods

This retrospective study included patients, who underwent an esophagectomy between 2004-2010, and met the CROSS-trial inclusion criteria. Primary outcome was 10-year overall survival (OS), and patients with CRT-S and U-S were compared. Secondary outcomes were R0-resection rate, LNY and positive LNY. Subgroup analyses were performed for histology (adenocarcinoma [AC] and squamous cell carcinoma [SCC] and for surgical approach (transthoracic [TTE] and transhiatal [THE] esophagectomy).

Results

We included 288 patients: 144 after CRT-S, 144 after U-S. 112 (39%) participated in the CROSS-trial. 10-year OS was not significantly better for CRT-S (40%) versus U-S (34%; p=0.183). In SSC, OS following CRT-S was 49% and after U-S 35% (p=0.228), versus 38% and 34% in AC (p=0.396). Following TTE, OS was better compared to THE in both CRT-S and U-S groups: 44% and 39% (p=0.369) versus 32% and 29% (p=0.590). R0-rates were 96% (CRT-S) and 86% (U-S). Median LNY was equal: 23. 55 (38%) and 100 (69%) patients had positive lymph nodes after respectively CRT-S and U-S.

Conclusion

This study showed that, with a radical TTE, comparable OS results can be achieved, and therefore CRT may not be indicated in all patients. Further analyses are necessary to identify patients who may benefit from the additional local treatment that CRT is (e.g SCC or involved circumferential resection margin). Additionally, surgical techniques have improved since the CROSS-trial, with less surgical trauma in minimally invasive esophagectomy. This may result in better outcomes for surgery nowadays, indicating the need for further studies in the current era.
359. INNOVATIVE USE OF WEERDA DIVERTICULOSCOPE FOR REMOVAL OF AN IMPACTED SHARP FOREIGN BODY IN THE CERVICAL OESOPHAGUS MIMICKING MALIGNANCY
Authors: Vaz Osborne Peter , Cardozo Arun , Chaudhury Madhu , Stockwell Robert , Turner Paul , Ward Jeremy , Pursnani Kishore , Shetty Vinutha Daya
Published: September 2024

Background

Chronically impacted sharp foreign bodies (FB) of the cervical or upper thoracic oesophagus can present a diagnostic dilemma. Fifty percent of sharp objects tend to lodge in the upper oesophagus and frequently cause perforation. A multidisciplinary approach is warranted. Eventually, surgery by cervical oesophagotomy/thoracotomy may be required. The Weerda diverticuloscope offers excellent endoscopic visibility and access to the lumen of the upper oesophagus allowing for removal of FBs and mitigating risks of a major surgical procedure.

Methods

We report an interesting case of a 27 year old gentleman being investigated for dysphagia. The patient notes were obtained from the electronic patient records. The radiological images were sourced from the picture archiving and communication system (PACS) and endoscopy from stored images. The patient was radiologically diagnosed as having T4 malignancy but consecutive biopsies suggested Actinomycosis. Patient thereafter recollected having a fist fight and losing his dentures. This triggered the use of the Weerda diverticuloscope, a bivalved rigid diverticuloscope (Karl Storz, Tuttlingen, Germany). It has a distal fibreoptic illumination that is designed for trans-oral stapling of pharyngeal pouches

Results

Under general anaesthesia, the Weerda diverticuloscope was introduced into the cervical oesophagus. The tips of the jaws positioned just proximal to the embedded dental prosthesis. The diverticuloscope was suspended for stabilisation in the same manner as for endoscopic stapling of a pharyngeal pouch and the jaws were distracted to allow endoscopic access. A 5mm rigid telescope was passed alongside a pair of heavy endoscopic scissors and the prosthesis was divided into 3 parts. The central intraluminal component was removed first using endoscopic forceps, followed by gentle disimpaction and extraction of the remaining two components embedded in the oesophageal wall.

Conclusion

Foreign bodies in the oesophagus rarely can mimic cancer or chronic granulomatous diseases. A multidisciplinary approach is occassionally recommended in their management. There have been a few published reports of the use of the Weerda diverticuloscope to remove upper oesophageal FBs successfully. It’s use, however, is not often considered routinely. We recommend the use of this technique at centres where expertise in endoscopic management of Zenker’s diverticula is available and when endoscopic retrieval has failed.