bluuebunny/crossref_metadata_2025 huggingface dataset:
178. OUTCOME OF DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL COMBINATION CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER
Authors: Tanaka Koji , Momose Kota , Yamashita Kotaro , Makino Tomoki , Saitoh Takuro , Yamamoto Kauyoshi , Takahashi Tsuyoshi , Kurokawa Yukinori , Eguchi Hidetoshi , Doki Yuichiro
Published: August 2023

Background

T4b esophageal cancer, chemoradiotherapy with 5FU plus cisplatin (FP-RT) is usually performed as a treatment option. However, its therapeutic efficacy has not been satisfactory, and there is still no certain opinion on its use, including induction therapy and surgical intervention. In recent years, favorable outcomes of radiation therapy with DCF (DCF-RT) have been reported, but there is no consensus. Therefore, we aimed to retrospectively analyze the outcomes of DCF-RT of our hospital.

Methods

We retrospectively analyzed the safety and efficacy of 61 patients treated with DCF-RT for cT4 esophageal cancer from March 2014 to December 2021. The regimens were (DTX: 30/m2 Day1, CDDP: 10 mg/m2 Day1–5, 5-FU: 400 mg/m2 Day1–5) 2 courses or (DTX: 35/m2 Day1, CDDP: 40 mg/m2 Day1, 5-FU: 400 mg/m2 Day1–5) 3 courses + RT (40-60Gy).

Results

The main location of tumor was Ce/Ut/Mt/Lt = 20/8/24/2 cases. Dose reduction was required in 19 cases (33%); CTCAE ver 4.0 Grade 3 or higher adverse events were leukopenia 53%, neutropenia 51%, febrile neutropenia 19%, anorexia 12%; no treatment-related deaths were observed. Clinical response was CR/PR/SD/PD = 3/42/9/3 patients, with a response rate of 79%. Clinically downstage from T4 was achieved in 42 patients (74%), and esophagectomy was performed in 51 patients (91%). 20 patients (38%) required combined resection of T4b organs and 48 patients (94%) achieved R0 resection. Pathological response was Grade 1/2/3/NA = 12/24/12/4, and overall survival (1Y/2Y/3Y) = 86/68/54% after CRT.

In summary, DCF-RT for T4 esophageal cancer seemed to be relatively safe and may contribute to long survial.
181. SAFETY AND TIME USAGE OF CIRCULAR STAPLED ANASTOMOSIS IN THE SHIFT FROM MIE TO RAMIE
Authors: Fasting Magnus , Førland Dag , Skagemo Caroline , Mala Tom
Published: August 2023

Background

Introducing new surgical techniques may increase the potential for adverse events. There is no consensus or evidence on the optimal anastomotic technique in esophageal resection. We used the circular stapled anastomosis (CSA) technique as standard in MIE, and continued this practice during the introduction of RAMIE. Here, we evaluate the early results of reconstruction during Iwor-Lewis esophagectomy using CSA after converting from MIE to RAMIE, with redspect to safety and time usage.

Methods

The first 27 RAMIEs were included, as well as an equal number of video recorded MIEs immediately preceeding the shift to RAMIE. Patient background and short-term outcomes were recorded prospectively. The duration of the reconstruction, i.e. the time from esophageal transection to transection of the blind limb of the gastric conduit was recorded from operative videos. Both MIE and RAMIE were performed in the prone position using single lumen tube intubation. The robot was not undocked during the reconstruction. Data was registered in a patient registry approved by the Institutional Data Protection Officer with written consent by all patients.

Results

27 RAMIEs and 29 MIEs were included. Patient demographics, comorbidity and tumor disease stages were similar between the two groups. There were video recordings of 26 cases in each group. There were no conversions to thoracotomy in either group. All reconstructions were completed using CSA. The median duration of the reconstruction was 40 (range: 26–85) minutes in the MIE group and 46 (35–76) minutes in the RAMIE group (p = 0.02). There were three anastomotic leaks in each group (RAMIE 11% and MIE 10%). One patient died within 90 days of surgery in the MIE group.

Conclusion

In this study, the use of CSA during RAMIE for the reconstruction in Iwor-Lewis esophagectomy was feasible with comparable anastomotic leak rate as after MIE. The average duration of reconstruction was 6 minutes longer in the RAMIE group.
187. PROGNOSTIC IMPACT OF LYMPH NODE HARVEST FOR PATIENTS WITH NODE-NEGATIVE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A LARGE-SCALE MULTICENTER STUDY
Authors: Shang Qi-Xin , Chen Long-Qi
Published: August 2023

Background

We examined the association between the number of resected lymph nodes and survival to determine the optimal lymphadenectomy for thoracic Esophageal Squamous Cell Carcinoma (ESCC) patients with negative lymph node.

Methods

We included 1836 patients from Chinese three high-volumed hospitals with corresponding clinicopathological characters such as gender, age, tumor location, tumor grade and TNM stage of patients. The median follow-up of included patients was 45.7 months (range, 1.03–117.3). X-Tile plot was used to identify the lowest number of lymphadenectomy. The multivariate model’s construction was in use of parameters with clinical significance for survival and a nomogram based on clinical variable with P < 0.05 in Cox regression analysis. Both two models were validated using a cohort extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database between 1975 and 2016 (n = 951).

Results

More lymphadenectomy numbers were significantly associated with better survival in patients both in training cohort (Hazard ratio [HR] = 0.980; 95% Confidence Interval [CI]: 0.971, 0.988; P < 0.001) and validation cohort (HR = 0.980; 95% CI: 0.968, 0.991; P = 0.001). Cut-off point analysis determined the lowest number of 9 for thoracic ESCC patients in N0 stage through training cohort (C-index: 0.623; Sensitivity: 80.7%; 1-Specificity: 72.5%) when compared with 10 in validation cohort (C-index: 0.643; Sensitivity: 78.2%; 1-Specificity: 63.0%). The cut-off points of 9 were examined in training cohort and validated in the divided cohort from validation cohort (all P < 0.05). Meanwhile, nomograms for both cohorts were constructed and the calibration curves for both cohorts agreed well with the actual observations in terms of predicting 3-year and 5-year survival, respectively.

Conclusions

Larger number for lymphadenectomy was associated with better survival in thoracic ESCC patients in N0 stage. 9 was we got as the lowest number for lymphadenectomy in pN0 ESCC patients through this study, and our result should be confirmed further.
189. IDENTIFICATION OF M6A-RELATED SIGNATURE GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA BY MACHINE LEARNING METHOD
Authors: Shang Qi-Xin , Chen Long-Qi
Published: August 2023

Background

We aimed to construct and validate the esophageal squamous cell carcinoma (ESCC)-related m6A regulators by means of machine leaning.

Methods

We used ESCC RNA-seq data of 66 pairs of ESCC from West China Hospital of Sichuan University and the transcriptome data extracted from The Cancer Genome Atlas (TCGA)-ESCA database to find out the ESCC-related m6A regulators, during which, two machine learning approaches: RF (Random Forest) and SVM (Support Vector Machine) were employed to construct the model of ESCC-related m6A regulators. Calibration curves, clinical decision curves, and clinical impact curves (CIC) were used to evaluate the predictive ability and best-effort ability of the model. Finally, western blot and immunohistochemistry staining were used to assess the expression of prognostic ESCC-related m6A regulators.

Results

2 m6A regulators (YTHDF1 and HNRNPC) were found to be significantly increased in ESCC tissues after screening out through RF machine learning methods from our RNA-seq data and TCGA-ESCA database, respectively, and overlapping the results of the two clusters. A prognostic signature, consisting of YTHDF1 and HNRNPC, was constructed based on our RNA-seq data and validated on TCGA-ESCA database, which can serve as an independent prognostic predictor. Experimental validation including the western and immunohistochemistry staining were further successfully confirmed the results of bioinformatics analysis.

Conclusion

We constructed prognostic ESCC-related m6A regulators and validated the model in clinical ESCC cohort as well as in ESCC tissues, which provides reasonable evidence and valuable resources for prognostic stratification and the study of potential targets for ESCC.
200. COMPARISON OF SHORT-TERM OUTCOMES BETWEEN TRANSTHORACIC AND ROBOT-ASSISTED TRANSMEDIASTINAL RADICAL SURGERY FOR ESOPHAGEAL CANCER: A PROSPECTIVE STUDY
Authors: Yoshimura Shuntaro , Seto Yasuyuki
Published: August 2023

Background

The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.

Methods

Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.

Results

Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).

Conclusions

Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.
201. PREOPERATIVE HANDGRIP STRENGTH IS ASSOCIATED WITH POSTOPERATIVE PULMONARY COMPLICATIONS AFTER MAJOR ABDOMINAL SURGERY: A PROSPECTIVE MULTICENTRE INTERNATIONAL COHORT STUDY
Authors: Sellayah Renishka , Boden Ianthe
Published: August 2023

Background

Low muscle strength is a primary indicator of sarcopenia, defined by the European Working Group on Sarcopenia (EWGSOP2) and is related to postoperative complications after major surgery. Handgrip strength is easily measured preoperatively and is an alternative to skeletal muscle index assessments, which are time consuming and require specialised equipment. The current studies pertaining to handgrip and postoperative outcomes are largely retrospective, single-centre studies in populations dissimilar to Australian and New Zealand surgical patients.

Methods

Patient-level data from the Lung Infection Prevention Post Surgery—Major Abdominal—with Pre-Operative Physiotherapy study (ANZCTR 12613000664741), a randomised controlled trial conducted across three Australian and New Zealand tertiary hospitals (2013–2015) was utilised. Eligible patients were those listed for elective upper abdominal surgery. Maximum dominant handgrip was measured via standardised methods. Percentage of predicted handgrip was calculated using recognised normative values; <85% predicted was set as signifying low handgrip strength. The association between <85% of predicted handgrip and postoperative outcomes was analysed using multivariate regression modelling adjusted for covariate effects of age, gender, ASA, smoking status, and type of surgery.

Results

Of 432 participants (50% colorectal, 25% UGI/HPB) hand grip data was available for 379 (88%). Patients with low preoperative handgrip had a four-fold increased risk of developing a postoperative pulmonary complication (RR 3.95; 95% CI 1.09 to 14.2; p = 0.037) independent of other confounding variables. Handgrip had the strongest effect on postoperative pulmonary complications compared to age, gender, upper gastrointestinal, hepatobiliary surgery, ASA, and current smoking. There were consistent signals of a relationship between preoperative weak hand grip and MET calls, extraordinary physician ward consults, prolonged length of hospital stay (>14 days), sub-acute stays, and longer time to independent mobilisation.

Conclusion

This is the first study of handgrip in Australian and New Zealand surgical patients. It prospectively validates previous findings that weak handgrip is related to worse postoperative outcomes, particularly respiratory. Intriguingly, handgrip had a stronger effect on pulmonary complications than upper GI or hepatobiliary surgery. Finally, given its ease of measurement, handgrip can be assessed at first clinical contact, increasing the time available for pre-habilitation.
205. LONGITUDINAL PATIENT-REPORTED OUTCOMES AFTER MINIMALLY INVASIVE MCKEOWN ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Nie Xin , Miao Yan , He Wenwu , Li Changding , Li Zhiyu , Han Yongtao , Wang Chenghao
Published: August 2023

Background

Surgery for esophageal squamous cell carcinoma (ESCC) is characterized by a poor prognosis and high complication rate, resulting in a heavy symptom burden and poor quality of life (QOL). Neoadjuvant therapy followed by surgery improved the postoperative survival of ESCC patients. This study was a longitudinal patient-reported outcomes (PROs) evaluation to compare the effects of neoadjuvant therapy followed by minimally invasive Mckeown esophagectomy and surgery without neoadjuvant therapy from the patient’s perspective.

Methods

We investigated ESCC patients who underwent minimally invasive Mckeown esophagectomy in a single centre. Longitudinal data on clinical characteristics and PROs were collected. The MD Anderson Symptom Inventory and the European Organization for Research and Treatment of Cancer (EORTC)‘s quality of life questionnaires were used to assess symptoms and QOL before and after surgery. Compared the PROs’ trajectories during the investigation.

Results

Overall, 244 eligible ESCC patients were enrolled, of which 78 (group A) underwent neoadjuvant therapy followed by surgery, and 166 (group B) underwent surgery without neoadjuvant therapy. On postoperative day 5, dry mouth (p = 0.035) was more evident in group A. In postoperative month 1, patients in group A reported more disturbed sleep (p = 0.012) and drowsy (p = 0.050). In the sixth month, patients in group A had more symptom burden of disturbed sleep (p = 0.038), distress (p = 0.005) and lack of appetite (p = 0.049), and had worse physical (p = 0.050), role (p = 0.003) and emotional (p = 0.020) functions. Twelve months after surgery, group A had a worse social function (p = 0.019).

Conclusion

The longitudinal changes in postoperative symptoms and QOL were about the same in both groups. But at some point, especially in the sixth month after surgery, patients who underwent neoadjuvant therapy followed by surgery had a heavier symptom burden and a poorer QOL.
212. ROBOT ASSISTED ESOPHAGECTOMY WITH EXTENDED MEDIASTINAL LYMPH NODE DISSECTION
Authors: Kawakubo Hirofumi , Matsuda Satoru , Takeuchi Masashi , Kitagawa Yuko
Published: August 2023

Background

Radical surgical resection may play role in prognosis improvement of the esophageal squamous cell carcinoma (ESCC) patients. Because esophagectomy with radical lymphadenectomy is highly invasive, we introduced thoracoscopic esophagectomy in 1999, and have performed over 600 cases. In 2009, we developed a hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection and reported good long-term outcomes especially in cT1bN0M0 ESCC patients. We reported 3y and 5y RFS was 96% and 96%, and 3y and 5y OS was 94% and 92% in those patients. We introduced robot-assisted esophagectomy (RMIE) using daVinci Xi system in June 2018. We perform RMIE with the prone position instead of the hybrid position with same concept of thoracoscopic esophagectomy with extended LN dissection. Thanks to a three-dimensional magnified view, fully wristed dexterity and tremor filtration of da Vinci Xi system, the robotic system facilitates precise dissection especial for upper mediastinal lymph node dissection. We show safety introduction and technical pitfalls of robot-assisted esophagectomy with extended LN dissection. Methods: The patient is fixed on prone position. We use Monopolar curved scissors for superficial layer, bipolar cut for dissection with maryland bipolar forceps for deeper layer around Aorta and trachea, and Sharp dissection with Potts scissors around recurrent laryngeal nerves. After esophageal mobilization and mediastinal lymphadenectomy were completed, bilateral recurrent laryngeal nerve, bilateral subclavian artery, trachea, bilateral bronchus, aorta, left pulmonary artery and vein, left pleura, pericardium and hiatus are all skeletonized. Results: We could standardize surgical procedure in first 20 cases. Average operation time in the thoracic procedure is 234.4 min and 195.6 min in last 30 cases. Median blood loss is 0 mL. Postoperative pneumonia and vocal cord palsy were occurred only 4 case in last 50 cases. Conclusion: Robot assisted esophagectomy with extended LN dissection was safely introduced in our facility and it is feasible and beneficial for the lymph node dissection especially for lymph node dissection around the recurrent laryngeal nerve.
217. IMPORTANCE OF PERFORMING BARIUM SWALLOW TEST FOR COLLECT DIAGNOSIS OF ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION INCLUDING ACHALASIA
Authors: Ishii Tadashi , Kamei Takashi
Published: August 2023

Background

The clinical manifestation of achalasia is nonspecific (weight loss, vomiting); particularly, making an early diagnosis is often difficult. It often remains unrecognized for a long period or can be initially misdiagnosed as an eating disorder, such as anorexia nervosa, whose main clinical features mimic achalasia. Additionally, several overlooked patients with esophagogastric junction outflow obstruction (EGJOO), including achalasia, are should be identified in the community population.

Methods

1. We collected data from 38 patients with achalasia and examined them for diagnostic factors that could lead to a delayed diagnosis.

2. The data of a cumulative total of 489,823 hospital visits at a tertiary medical center were collected. We selected patients with the given suspected diagnoses that could be misdiagnosed, and investigated the kind of imaging tests used in them. Among them, we selected patients with symptoms persisting for >6 months, without a definitive diagnosis, and in whom upper endoscopy, but not barium swallow test, was performed. Subsequently, we performed barium swallow tests in these patients.

Results

1. The most important factor that caused a delay in the diagnosis of achalasia was non-performance of a chest CT scan or barium swallow test promptly at first physician contact.

2. We identified 39 people that could have been misdiagnosed, who had undergone upper endoscopy, but not barium swallow testing, with symptoms persisting for >6 months and without a definitive diagnosis. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO.

Conclusion

To avoid a delayed diagnosis of EGJOO, including achalasia, performing a barium swallow test promptly, in addition to routine endoscopy, appears to be extremely important. Furthermore, we successfully identified one patient with EGJOO from among the community population using an extraction algorithm.
231. ROBOT-ASSISTED TRANSMEDIASTINAL (TRANSCERVICAL & TRANSHIATAL) ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Seto Yasuyuki , Yagi Koichi , Yajima Sho , Okumura Yasuhiro , Miwa Yoshiyuki , Aikou Susumu , Yamagata Yukinori , Mitsui Takashi , Nishida Masato , Yoshimura Shuntaro , Mori Kazuhiko
Published: August 2023

Background

Esophagectomy is still main treatment mode for esophageal cancer, though it is known to be associated with severe surgical invasiveness resulting in high morbidity and mortality. Minimally invasive esophagectomy (MIE), which consisted of thoracoscopic and/or laparoscopic procedure, has been widely performed to diminish those disadvantages of open procedure. Recent reports, however, show insufficient effects of the conventional MIE. Therefore, additional improvements are needed to overcome those problems.

Methods

We developed the robot-assisted transmediastinal esophagectomy (RATME) in 2012 to prevent the postoperative complications. It is the combination of transcervical and transhiatal approach without one lung ventilation anesthesia and body change during surgery. Upper mediastinal lymphadenectomy along left recurrent laryngeal nerve (RLN) is perfomed by transcervical mediastinoscopic procedure under pneumo-mediastinum. Laparoscopic abdominal LN dissection is performed in parallel with the cervical procedure. Remnant lower and middle LN dissections, including subcarinal and main bronchus, are done using robotic procedure in which robotic arms are inserted through hiatus from abdomen. Finally, bilateral pleura can be preserved.

Results

To date, 275 RATMEs have been performed. Among them, post-operative pneumonia occurred in 33 cases (12%), and mortality is zero. Oncological outcomes, e.g., the numbers of harvested LNs, post-operative QOL, e.g., post-operative pulmonary function, were observed and reported to be better in RATME group as compared to open esophagectomy group. Survival after surgery is, also, not at all inferior.

Conclusion

RATME is a promising minimally invasive technique, overcoming the disadvantages of conventional procedures. For the patients with previous thoracic surgery, and/or impaired respiratory function who are unable to undergo transthoracic esophagectomy, RATME can offer a valuable alternative surgery as a radical treatment.
257. UPDATE OF THE INTRODUCTION OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), CLINICAL OUTCOMES OF THE LEARNING CURVE COHORT
Authors: Klarenbeek Bastiaan , Vercoulen Richard , Veenendaal Linde , Shiozaki Atsushi , Fujiwara Hitoshi , Rosman Camiel
Published: August 2023

Background

Surgical resection remains the cornerstone of curative treatment for patients with esophageal cancer. Transthoracic minimally invasive esophagectomies have reduced the occurrence of pulmonary complications, however it is still associated with significant morbidity. The Minimally Invasive transCervical Esophagectomy (MICE) is a novel surgical technique. To date this technique is not routinely performed in Western esophageal cancer patients. We aim to assess the safety and efficacy of the MICE procedure in Dutch patients with esophageal carcinoma. An update of the clinical outcomes of the learning curve cohort.

Methods

The MICE is a recently developed surgical technique in Japan. The procedure combines a laparoscopic transhiatal and single-port transcervical mediastinal dissection and aims to ensure a radical oncological resection with a reduction of pulmonary complications because a thoracotomy/scopy is avoided. Potential drawbacks may be an increased incidence of recurrent laryngeal nerve paresis (RLNP) and learning associated morbidity. A prospective pilot study was performed including consecutive patients undergoing MICE for esophageal cancer.

Results

Results will be updated up to August 2023, probably around 70 cases. A total of 50 patients were included in this study in Januari 2023 (male/female ratio 16:4, median age 71 years (IQR 52–85). Median operation time and blood loss was 350 minutes (IQR 326–360) and 100 mL (IQR 50–175). Conversion occurred in five patients (12%). Anastomotic leakage occurred in four patients (10%, 3 ECCG grade 1 and 1 ECCG grade 3). Pneumonia, pleural effusion and chyle leakage occurred in two (5%), five 12%) and two (5%) patients. Recurrent laryngeal nerve paralysis was seen in 22 patients (55%), at least 16 (73%) of which were only temporary. Median length-of-stay was 9 days (IQR 7–10).

Conclusion

MICE is a novel minimally invasive surgical technique which seems safe and effective to perform in Dutch patients with esophageal carcinoma. As expected, a higher incidence of RLNP was seen, but often only temporarily. Long-term safety and effectiveness will be prospectively evaluated in a larger population.
259. ROBOTIC ESOPHAGECTOMY AND THREE FIELD LYMPHADENECTOMY WITH INTRA-OPERATIVE RECURRENT LARYNGEAL NERVE MONITORING
Authors: Jiwnani Sabita , Gopinath Srinivas Kodaganur , Nadkarni Shravan , Tiwari Virendra , Niyogi Devayani , Pramesh C S
Published: August 2023

https://www.dropbox.com/s/uu8gju382tkch29/3FTTE_ISDE_SJ_0423.mp4?dl=0.

Background

Surgery for esophageal malignancy is associated with significant morbidity and mortality, especially in cases requiring extensive lymphadenectomy. Recurrent laryngeal nerve (RLN) injury can result in hoarseness, aspiration, pneumonia, tracheostomy, and could even be life-threatening. A 33 year old lady with a lower thoracic esophageal squamous carcinoma with left trachea-esophageal groove nodes in the superior mediastinum underwent a Xi robotic esophagectomy and three field lymphadenectomy with intra-operative recurrent laryngeal nerve monitoring after neoadjuvant chemotherapy.

Methods

We used a bronchial blocker (COOPDECH bronchial blocker, Daiken-Iki Corporation, Japan) with a single-lumen electromyographic (EMG) endotracheal tube) (NIM EMG endotracheal tube, Medtronic Xomed, Jacksonville, FL, USA) for lung isolation along with capnothorax. Semiprone position with 3 robotic ports and an assistant port was utilised. Nerve monitoring provided an audiovisual waveform when either the vagus or the RLN was stimulated and transformed the laryngeal muscle activity into EMG signals. Grounding electrodes were placed on the patient’s shoulder or near the sternum. A prerequisite for adequate and effective nerve monitoring is the avoidance of neuromuscular blockers during anesthesia.

Results

Esophageal mobilisation was done in the standard fashion. The lymphadenectomy along the recurrent laryngeal nerves in the mediastinum and neck was guided by the nerve identification and stimulation utilising the long intra-thoracic nerve monitoring probes. In the mediastinum, the right recurrent laryngeal nerve was identified taking off from the right vagus along the lateral border of the trachea and looping around the right subclavian artery. The thoracic left recurrent nerve was identified in the aorto-pulmonary window as well along the left lateral border of the trachea in the trachea-esophageal groove where the metastatic lymph nodes were identified on radiology.

Conclusion

Minimally invasive esophagectomy is now the preferred modality for surgical extirpation of esophageal malignancies, with extensive lymphadenectomy used in appropriate cases. Interventions to reduce postoperative morbidity resulting from the dissection of nodes around the RLN need to be used. The use of IONM is associated with lower RLN palsy rates and superior lymph nodal yield and needs to be investigated with large-scale randomized studies for beneficial clinical outcomes.
262. DUPILUMAB REDUCED EOSINOPHIL COUNTS AND IMPROVED HISTOLOGY GRADE/STAGE SCORES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: LIBERTY EOE TREET RESULTS
Authors: Collins Margaret , Dellon Evan S , Pela Tiffany , Aceves Seema S , Lucendo Alfredo J , Spergel Jonathan M , Sun Xian , Khodzhayev Angela , Radwan Amr , Jacob-Nara Juby
Published: August 2023

Background

In the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617) dupilumab 300 mg weekly (qw) demonstrated significant improvements in symptoms and eosinophil counts, and clinically meaningful improvement in endoscopic features vs placebo, in adults and adolescents with EoE. The objective of this analysis was to further assess the effect of dupilumab vs placebo on histologic aspects of disease in Parts A and B of LIBERTY EoE TREET.

Methods

Patients aged ≥12 years were randomized 1:1 to dupilumab 300 mg qw or placebo. Endpoints (at Week 24) were the proportion of patients achieving ≤1, ≤6, and < 15 eosinophils per high-power field (eos/hpf), change from baseline in peak eosinophil count and Histologic Scoring System (HSS) scores, specifically the severity (grade) and extent (stage) of abnormality of the 8 components (basal zone hyperplasia [BZH], eosinophil inflammation [EI], eosinophil abscess [EA], eosinophil surface layering [ESL], dilated intercellular spaces [DIS], surface epithelial alteration [SEA], dyskeratotic epithelial cells [DEC], and lamina propria fibrosis [LPF]). P-values are nominal unless otherwise specified.

Results

Dupilumab significantly increased the proportion of patients achieving ≤1, ≤6, and < 15 eos/hpf in Part A (P < 0.0001, P < 0.05, and P < 0.0001, respectively) and Part B (all P < 0.0001) vs placebo. Percent change in peak eosinophil count from baseline and HSS grade/stage scores were significantly improved with dupilumab vs placebo for Parts A and B (all P < 0.0001) (Table). Significant improvements were observed for the histologic components BZH, EI, EA, ESL, SEA grade/stage scores (P < 0.0001) in both Parts, DIS grade score in Part A (P < 0.05), and DEC grade/stage scores in Part B (P < 0.05); other components showed numeric improvements. Dupilumab was generally well tolerated.

Conclusions

Dupilumab 300 mg qw significantly decreased eosinophil counts and improved the severity and extent of histologic aspects of the disease as measured by HSS versus placebo in adults and adolescents with EoE up to 24 weeks, documenting a more global improvement in addition to eosinophil counts. Overall safety was consistent with the known dupilumab safety profile.
267. IDENTIFYING CANCER-ASSOCIATED FIBROBLAST POPULATIONS DRIVING THERAPY RESISTANCE IN GASTROESOPHAGEAL ADENOCARCINOMA
Authors: Tai Kulsum , Strasser Michael , Pal Sanjima , Bérubé Julie , Zeng Wotan , Kong Iris , Hoffman Adam , Tankel James , Bertos Nicholas , Sangwan Veena , Huang Sui , Ferri Lorenzo
Published: August 2023

Background

Peri-operative docetaxel-based triplet chemotherapy is the standard-of-care treatment for advanced gastroesophageal adenocarcinoma (GEA). However, most patients recur due to innate or acquired resistance. Although distinct populations of cancer-associated fibroblasts (CAFs) within the tumor microenvironment play important roles in conferring chemoresistance in other cancer types, this paradigm has not been extensively studied in GEA. We aim to characterize CAF heterogeneity in a well-annotated cohort of GEA patients, identifying potential biomarkers and targets to overcome chemoresistance.

Methods

Immunofluorescence and flow cytometry assays were performed to validate previously reported CAF markers from the literature in primary patient fibroblasts. To identify specific CAF markers for GEA, an atlas was developed using single-cell RNA sequencing (scRNA-seq) data obtained from 46 GEA patient samples, including 28 patients with longitudinal samples over the docetaxel-based triplet chemotherapy treatment trajectory. Differential and gene ontology analyses were performed to characterize distinct CAF subpopulations and identify dynamic CAF markers across treatment timepoints, while correlating with in-patient treatment response to chemotherapy. In parallel, tumor organoid-CAF co-cultures were established for subsequent in vitro drug testing with standard-of-care chemotherapy.

Results

CAF markers (VIM, FAP, PDPN, and S100A4) were found to be differentially expressed in fibroblasts isolated from good and poor pathological-response tumours. Analysis of scRNA-seq data reveals two main subpopulations of CAFs: myofibroblast CAFs (myCAFs) and inflammatory CAFs (iCAFs). Two markers, CCL20 and CHRDL1, were identified as differentially expressed between good and poor pathological responders in iCAFs, while nine markers, including ISG20 and C20orf27, were differentially expressed between clinical partial responders and poor responders. Dynamic CAF markers, including STAG2 and HAT1, were differentially expressed across treatment timepoints and were associated with pathological or clinical response.

Conclusions

GEA CAFs demonstrate extensive heterogeneity and comprise two major subpopulations. Several CAF markers were found to be associated with patient chemotherapy pathological or clinical response to chemotherapy, either in the chemonaïve setting or in the context of changes over the course of therapy. These putative biomarkers will be further validated and investigated, both in additional samples and in co-culture settings, to gain a better understanding of their clinical relevance and targeting potential.
280. FEASIBILITY OF ROBOTIC-ASSISTED SURGERY FOR BENIGN ESOPHAGEAL LESIONS: SINGLE-CENTER EXPERIENCE
Authors: Swangsri Jirawat , Patraithikul Premkamol , Parakonthun Thammawat , Methasate Asada
Published: August 2023

Background

Benign esophageal lesions are uncommon conditions compared to malignant cases. Thoracotomy is an extremely invasive procedure that can cause severe complications and delay recovery. Conventional VATS is limited in its approach to deep and narrow angles and difficult to manipulate due to abundance of vital structures that are always mobile in mediastinal area. Robotic-assisted surgery is a new challenge that aims to achieve minimally invasive procedures and improve postoperative outcomes for benign esophageal lesions.

Methods

We conducted a retrospective analysis of a single-center database from May 2012 to November 2022, including patients aged 20–75 years with diagnosed benign esophageal lesions such as esophageal leiomyoma and esophageal diverticulum who underwent robotic-assisted esophageal surgery using the Da Vinci Robotic surgery system. The operation was performed using either a transthoracic or transabdominal approach. Patient data, surgical procedures, interventions, and early outcomes (within 30 days post-operation) were collected and analyzed to assess postoperative variables. The study included 13 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay.

Results

The number of patients with each esophageal lesion was as follows: esophageal leiomyoma, 6 cases (46.1%); esophageal diverticulum, 3 cases (23.1%); and other benign lesions, 4 cases (30.8%). Robotics approaches were divided into 11 cases (84.6%) and 2 cases (15.4%) for transthoracic and transabdominal, respectively. The overall incidence of postoperative pulmonary complications was 5 cases (38.5%), with mild pulmonary infection occurred in 2 cases (15.4%). Other pulmonary complications occurred in the transthoracic approach due to patient characteristics related to underlying lung diseases, such as COPD and asthma. There was no evidence of 30 days mortality in our series.

Conclusion

Robotic-assisted surgery is feasible for benign esophageal surgery using both transthoracic and transabdominal approaches. Robotic devices can provide stabilization for both 3D camera views and instrument arms, particularly enhancing suturing ability. Robotic surgery is precise and maneuverable, with potential to perform intricate surgical procedures in tight angles and confined spaces such as the thoracic cavity and hiatal area. These factors can improve the overall operative outcome and enhance recovery due to minimally invasive access.
281. TOTAL LAPAROSCOPIC VERSUS OPEN GASTRIC PULL-UP FOLLOWING MINIMALLY INVASIVE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Egami Yosuke , Sugimura Keijiro , Katsuyama Shinnsuke , Katsuyama Toru , Takeda Yutaka , Murata Kohei
Published: August 2023

Backgroud

The use of minimally invasive esophagectomy (MIE) as a treatment for patients with esophageal cancer has recently become more common worldwide. However, the laparoscopic approach for reconstruction and abdominal lymph node dissection has not fully investigated. The aim of the present study was to evaluate the technical feasibility of alimentary tract reconstruction with laparoscopically assisted gastric pull-up compared with open laparotomy gastric pull-up following minimally invasive thoracoscopic esophagectomy.

Methods

63 esophageal cancer patients who underwent minimally invasive thoracoscopic esophagectomy between 2011 and 2020 were included in the present study. For reconstruction, 25 patients underwent open laparotomy gastric pull-up (OLG) while 38 patients underwent laparoscopically assisted gastric pull-up (LAG). We compared the outcomes between the two groups.

Results

No significant difference was observed in physical and tumor status between the two groups. The mean operative time was significantly longer in LAG group (549 vs 621 min, p = 0.010) and blood loss was significantly lower in LAG (561 vs 134 mL, p < 0.001). The mean number of harvested lymph nodes (47.2 vs 46.2, p = 0.840) were similar. The postoperative course showed lower incidences of overall complications (64% vs 32%, p = 0.011). No difference was observed in each complication between the two groups.

Conclusions

The findings suggest that laparoscopically assisted gastric pull-up is feasible and more effective in preventing postoperative complications.
288. POST-OPERATIVE COMPLICATIONS IN OBESE SARCOPENIC PATIENTS WITH ESOPHAGOGASTRIC ADENOCARCINOMA UNDERGOING NEOADJUVANT CHEMOTHERAPY
Authors: Convill James , Samake Maurice , Sellars Hannah , Chmelo Jakub , Brown Joshua , Petrides George , Phillips Alexander
Published: August 2023

Background

Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to mortality, various postoperative complications and the severity of these complications. Obesity has been linked with many health problems. Evidence has not been previously published regarding complication rates in obese, sarcopenic patients with esophagogastric adenocarcinoma undergoing neoadjuvant chemotherapy.

Methods

Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values of 52.4 cm2 for men and 38.5 cm2 for women were used. Obesity was defined as a BMI >30 kg/m2. Post-operative complications were prospectively collected and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as CD 0-I (no-mild complications) or CD II-V (moderate–severe complications).

Results

There were 191 patients included in the analysis. 25 patients post-NAC were both sarcopenic and obese. There was no significant difference between complication rates in the obese sarcopenic group vs the sarcopenic group.

Conclusion

EGA patients with obesity and sarcopenia post-NAC do not have a higher chance of developing complications than those patients with just sarcopenia.
296. FIBRIN SEALANT FOR THE PREVENTION OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: INTERIM REPORT OF A PROSPECTIVE, PHASE III, RANDOMIZED CONTROLLED STUDY
Authors: Wu Jia-Di , Zhao Zerui , Li Zhichao , Huang Weizhao , Wang Geng , Mao Teng , Lv Wenqiang , Peng Lin , Chen Jiyang
Published: August 2023

Purpose

Anastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy.

Methods

In this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5 mL Bioseal applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively.

Result

From February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively.

Conclusion

The application of Bioseal intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.
301. DIFFERENCES IN MULTIDISCIPLINARY CANCER CONFERENCES OF ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTIONAL CANCER REGARDING STAGING AND TREATMENT ALLOCATION—A MULTICENTER STUDY
Authors: Hannan Christine Jestin , Risso Solange León , Lindblad Mats , Loizou Louiza , Szabo Eva , Edholm David , Bartholomä Wolf Claus , Åkesson Oscar , Lindberg Fredrik , Strandberg Sara , Linder Gustav , Hedberg Jakob
Published: August 2023

Background

There are differences in esophageal cancer care across different regions in Sweden. According to Swedish national guidelines, all patients diagnosed with these tumors should be individually evaluated by regional multidisciplinary cancer conferences (MCCs) to be recommended the best possible treatment. The aim of the study was to investigate differences between the regional MCCs in Sweden regarding clinical staging and recommended treatment.

Method

Representatives for all six regional MCCs were invited to contribute with ten retrospective consecutive cases each. After anonymization radiological investigations were presented, along with the original case-specific medical history, anew at all participating regional MCCs. Each MCCs’ clinical Tumor Nodal Metastasis classification (cTNM) and treatment recommendation (curative, palliative or best supportive care) were compared between MCCs as well as with the original assessment.

Results

Five regional MCCs joined the study. Out of 50 available cases the majority were assessed anew in addition to the previous original assessment. There was not consensus among the regional MCCs regarding clinical T-stage in 42 cases (84%), clinical N-stage in 33 cases (66%), and for clinical M-stage in 16 cases (32%). In 37 cases (74%) a positron emission tomography-computed tomography (PET-CT) was available. Differences in appraisal of cTNM were not associated with PET-CT availability. The MCCs agreed on treatment recommendations in 26/50 cases (52%).

Discussion

The study shows differences, both in assessment of cTNM as well as treatment recommendations at different MCCs. A patient recommended curative treatment by one MCC could be suggested palliative care by another. To achieve more equal care for esophageal cancer patients in Sweden it is essential to increase consensus on cTNM and recommended treatment.
311. H ANASTOMOSIS FOR LOW INCIDENCE OF ANASTOMOTIC LEAKAGE, OBSTRUCTION AND GASTROESOPHAGEAL REFLUX
Authors: Hu Yang , Wu Na , Xia Qi
Published: August 2023

Background

End to end intussusception anastomosis is associated with reduced anastomotic leakage for the two layers located at different levels and decreased reflux tends for the intussuscepted structures functioning as a morphological sphincter. Nevertheless, dysphagia often presents due to the anatomy that the inner layer of stomach is larger than its outer layer causing bulge to compress the esophagus below, especially at the sight which gastric wall bends inside.

Methods

Here we present procedures to perform H Anastomosis which derives from end to end intussusception anastomosis. The critical improvement was the intussuscepted tissue was transformed from the whole layers of esophagus and stomach to the muscular layers of them. The detailed process was shown in the supplementary video which is available at https://1drv.ms/v/s!AmCqlJJZqDPDgzVKV9w4VPd_i72G?e = ubNzUN.

Results

With removing the intussuscepted seromuscular layer of stomach and muscular layer of esophagus, H anastomosis eliminates the bulge and reduces the thickness of gastric wall covering the esophagus. Postoperative dysphagia is reduced while advantages of intussusception for leakage and reflux control are preserved. These conclusions have been testified by an unpublished prospective cohort study.

Conclusion

H anastomosis is a novel gastroesophageal anastomosis technique. The preliminary study showed good postoperative outcomes regarding leakage, obstruction and gastroesophageal reflux. Further validation is needed.
313. EXPERIENCE OF 4 CASES TREATED WITH IPI + NIVO FOR RECURRENT ADVANCED ESOPHAGEAL CANCER
Authors: Miyagaki Hiromichi , Nishida Kentaro , Yoshikawa Yukihiro , Mori Souichiro , Nomura Masatoshi , Sueda Toshinori , Koga Chikato , Tei Mitsuyoshi , Tsujie Masanori , Akamaru Yusuke
Published: August 2023

Background

The results of the Checkmate 648 trial have made nivolumab plus ipilimumab available in general practice as first-line treatment for advanced recurrent esophageal squamous cell carcinoma.

Unlike regimens that include chemotherapy, this regimen can be used in patients with renal dysfunction, and the Department’s policy is to use this regimen in elderly or renally impaired patients.

We report four patients with advanced or recurrent esophageal cancer treated with nivolumab plus ipilimumab by March 2023.

Patients

Reasons for selecting this regimen; renal dysfunction (4 cases), Disease stage II/IV/recurrent: 1/1/2 patients. Course of treatment: ≤2/≥3 courses: 2/2 pts, 2nd line treatment; FOLFOX for 2 patients, FOLFOX + RT for 1 patient, none for 1 patient.

Nivolumab(administered intravenously at a dose of 360 mg per body every3weeks) plus Ipilimumab(administered intravenously at a dose of 1 mg per kilogram every 6 week) were administrated to four patients.

Adverse events: liver dysfunction in 2 patients, interstitial pneumonia in 2 patients, adrenal insufficiency in 1 patient, rheumatoid arthritis in 1 patient, thyroid dysfunction in 1 patient. Best response: PR for 2, PD for 1, NE for 1 patient.

Patient 1: 86-year-old male, mid-thoracic esophageal cancer T3N0M0 Stage II. After 2 weeks administrated IPI + NIVO, elevations of serum liver enzymes were observed and irAE hepatitis was diagnosed by liver biopsy.

Patient 4: 60-year-old woman, lower thoracic esophageal cancer, T3N2M1 (LYM) Stage IVb. After 2 courses of IPI + NIVO, she developed general malaise and headache, she was diagnosed as irAE adrenal insufficiency and started corticosteroid administration. After the fourth course, a CT scan of the chest showed a frosted glass shadow in the left upper lobe of the lung, irAE interstitial pneumonia was developed, additionally. Steroid pulse therapy was started, and the treatment was switched to FOLFOX therapy.

Conclusion

The response rate was 50%, so the treatment was seemed promising, but irAEs were observed in many patients especially with hepatitis and interstitial pneumonia, and these adverse effect forced patient difficult to continue the treatment. We should be managed to accumulate more patients to evaluate occurrence of irAE.