bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.119: THE IMPACT OF RECEIVING ADJUVANT CHEMOTHERAPY ON SURVIVAL IN PATIENTS WITH LOCALLY ADVANCED ADENOCARCINOMA OF THE OESOPHAGUS
Authors: Madhavan Anantha , Phillips Alex , Wyatt Nicola , Boreham Charlotte , Navidi Maziar , Michael Griffin S
Published: September 2018

Background

Surgery remains the fundamental modality for achieving disease cure in patients with oesophageal adenocarcinoma In those with locally advanced disease, in the UK, is usually used in conjunction with perioperative chemotherapy as per the Magic trial. Not all patients manage to progress to the adjuvant component of the chemotherapy regimen, and its impact on outcome has not been determined. The aim of this review was to compare outcomes in those patients that received neoadjuvant treatment only with those that received neoadjuvant and adjuvant chemotherapy.

Methods

A retrospective review of patients who underwent treatment with curative intent for locally advanced oesophageal adenocarcinoma between 2006 to 2016 at a single institution was performed. Outcomes of patients who were staged T3 and above or had evidence of nodal disease and received perioperative chemotherapy were reviewed. Outcomes were stratified according to whether patients received only neoadjuvant chemotherapy or both neoadjuvant and adjuvant chemotherapy.

Results

A total of 413 patients underwent transthoracic oesophagectomy and two field lymphadenectomy with perioperative chemotherapy. 276 (67%) received only neoadjuvant chemotherapy, with 137 (33%) receiving at least one cycle of adjuvant chemotherapy. Pathological staging was comparable between groups (P = 0.17). Overall estimated median survival was 30 months (neoadjuvant only) Versus 37 months (Both) P = 0.2. In patients that were found to be node positive median survival was 22 months (neoadjuvant) versus 28 months (both) P = 0.21. For node negative patients median survival was not reached in both groups.

Conclusion

These results indicate a trend towards improved survival with the addition of adjuvant chemotherapy. This may be of greater impact in those patients with nodal involvement. Further studies are required to fully evaluate the impact of adjuvant chemotherapy in patients surgically treated for oesophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.120: NEOADJUVANT CHEMOTHERAPY VERSUS NEOADJUVANT CHEMORADIOTHERAPY FOR CANCER OF THE OESOPHAGUS OR GASTRO-OESOPHAGEAL JUNCTION: LONG-TERM RESULTS
Authors: Von Döbeln Gabriella , Klevebro Fredrik , Jacobsen Anne-Birgitte , Hilmer Nielsen Niels , Johnsen Gjermund , Hatlevoll Ingunn , Idar Glenjen Nils , Friesland Signe , Lundell Lars , Nilsson Magnus
Published: September 2018

Background

NeoRes I is a randomized phase II trial comparing neoadjuvant chemoradiotherapy with neoadjuvant chemotherapy in the treatment of resectable oesophageal cancer.

Methods

Patients with biopsy-proven adenocarcinoma or squamous cell carcinoma in the oesophagus or gastro-oesophageal junction (Siewert type I and II), T1N1 or T2–3N0–1 and M0-M1a (AJCC 6th edition) were randomized to receive three 3-weekly cycles of cisplatin 100 mg/m2 day 1 and fluorouracil 750 mg/m2/24 hours, days 1–5 with or without the addition of concurrent radiotherapy 40 Gy, 2 Gy/fraction, 5 days a week, followed by oesophageal resection with two-field lymphadenectomy. Primary endpoint was complete histopathological response rate. Survival and recurrence patterns were evaluated as secondary endpoints.

Results

Between 2008 and 2013, 181 patients were enrolled in 10 participating institutions in Sweden and Norway. Patients were well matched for pre-treatment characteristics T3: 64,1%, T2: 34,8%, T1: 1,1%. Adenocarcinoma: 72,4%, squamous cell carcinoma: 27,6%. Proximal/middle: 16,6%, distal: 65,2%, cardia (Siewert type II): 18,2%. < 60 years: 36,5%, 60–75 years: 63,5%. Treatment-related complications have previously been described with no significant differences between the treatment groups although postoperative complications were more severe in the chemoradiotherapy group. At the time of this analysis, median follow-up time for living patients was 63 months. Overall 5-year survival was better among those who achieved complete histopathological response (74,9%, 95% CI 54,2–87,2% versus 39,3%, 95% CI 30,6–47,8%, P = 0002). Despite the previously reported higher rate of tumour tissue response in those who received neoadjuvant chemoradiotherapy, this was not translated into better survival. Five-year progression-free survival was 38,6%, 95% CI 28,4–48,6% (chemoradiotherapy) versus 32,4%, 95% CI 22,9–42,4% (chemotherapy), P = 0,48. Five-year overall survival was 41,2%, 95% CI 30,9–51,3% (chemoradiotherapy) versus 38,9%, 95% CI 28,7- 49,0% (chemotherapy), P = 0,95. There were no differences in recurrence patterns between the two treatment-groups.

Conclusion

This is to our knowledge the largest completed randomized trial comparing neoadjuvant chemotherapy with neoadjuvant chemoradiotherapy followed be oesophageal resection in patients with cancer in the oesophagus or gastro-oesophageal junction. We found no overall or progression-free survival advantages by adding radiotherapy, despite better tumour tissue response.

Disclosure

All authors have declared no conflicts of interest.
PS02.128: SENSE OR NONSENSE OF A PALLIATIVE ESOPHAGECTOMY IN CASE OF UNEXPECTED OLIGOMETASTATIC DISEASE
Authors: Depypere Lieven , Moons Johnny , Lerut Toni , Coosemans Willy , Van Veer Hans , Nafteux Philippe
Published: September 2018

Background

Screening is an important tool in staging esophageal cancer as only patients without suspicion of metastases are considered for surgery-based treatment. Nevertheless unexpected metastatic disease is still found in some patients during surgery. In these cases should esophagectomy be aborted, or is there a place for palliative resection?

Methods

Between 2002 and 2015, 681 patients with locally advanced potentially resectable esophageal cancer were scheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients potentially curative esophagectomy was performed. In twelve patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of the metastases. Ten of them were oligometastatic (≤ 4 single organ metastases). In 117 patients esophagectomy was not performed with among them 50 patients because of disease progression. Fourteen of these patients were also single organ oligometastatic and ten of them received systemic treatment. 10 single organ oligometastatic patients that underwent esophageal resection (group1) were compared to 10 non-resected—but treated—counterparts (group2) and to 228 patients that underwent a potentially curative esophagectomy with persistent pathological lymph nodes (group3). Clinicopathological data were retrospectively reviewed and survival of the three groups was compared from date of pathological diagnosis.

Results

In the oligometastatic esophagectomy patients, 5 had lung metastases, 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. In the oligometastatic non-resected patients, 2 had lung metastases, 5 liver and 3 brain metastases. Median overall survival was 21.4, 12.1 and 20.2 months in the respective groups. (group1 vs group2: P = 0.042; group2 vs group3: P = 0.002; group1 vs group3: P = 0.88).

Conclusion

Survival is prolonged in patients undergoing palliative esophagectomy in case of unexpected single organ oligometastatic disease during surgery and is comparable to survival of patients with persistent pathological lymph nodes. Palliative resection in unexpected oligometastatic disease seems to be justified.

Disclosure

All authors have declared no conflicts of interest.
PS02.131: PATTERN OF LYMPHATIC METASTASIS OF CERVICAL ESOPHAGEAL CANCER
Authors: Li Jiancheng , Shi Xiuling
Published: September 2018

Background

Cervical esophageal cancer were rarely surgeryed Analysis and discussion of lymph node metastasis of cervical esophageal cancer

Methods

From July 2008 to June 2017, 10 cases of successful esophagectomy of cervical esophageal cance in our hospital underwent radical resection. Surgical dissection range was the neck and the upper mediastinum. A total of 231 lymph nodes were dissected. The lymph nodes were summarized and grouped in different ways, and analyzed the law of lymph node metastasis.

Results

7 cases of esophageal cancer, lymph node metastasis occurred, and the rate of lymph node metastasis was 70% (7/10), of which 1 case was T1b stage. 17 lymph node metastases, the degree of lymph node metastasis was 7.36% (17/231), including 4 esophageal lymph nodes, 12 cervical lymph nodes and 1 upper right mediastinal lymph node.

Conclusion

Cervical esophageal cancer lymph node metastasis can spread occur early metastasis, and the metastasis site were mainly in neck..

Disclosure

All authors have declared no conflicts of interest.
PS02.134: COMPARISON OF PUSH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH OPEN GASTROSTOMY IN ADVANCED ESOPHAGEAL CANCER PATIENTS
Authors: Mahawongkajit Prasit
Published: September 2018

Background

In esophageal cancer treatment, nutrition by feeding tube has been demonstrated to improve patient tolerance of treatment, quality of life, and long term outcomes. The open gastrostomy and percutaneous endoscopic gastrostomy (PEG) push technique are procedures that avoid cancer cells seeding and also improve patient nutritional status. The aim of this study is to compare the results of the push PEG and open gastrostomy in patients with advanced esophageal cancer.

Methods

A retrospective study was analyzed in the advanced esophageal cancer patients who indicated and received feeding support between January 2016 and December 2017.

Results

28 patients in push PEG and 36 patients in open gastrostomy presented the following comparative data: mean operative duration time shorter in push PEG (11.9 min) than open gastrostomy (35.1 min), less blood loss in push PEG (0.8 mL) than open gastrostomy (5.6 mL), less pain score in push PEG (2.4) than open gastrostomy (5.9) and shorter hospitalization in push PEG (1.8 days) than open gastrostomy (2.6 days). Both groups showed no readmission or 30 day mortality. The adverse events of open gastrostomy demonstrated higher than push PEG group.

Conclusion

Both push PEG and open gastrostomy were the safe options for advanced esophageal cancer patients indicating for enteral nutrition and to avoid cancer cell seeding. The push PEG demonstrated the effective minimally invasive procedure, was safe and with fewer complications.

Disclosure

All authors have declared no conflicts of interest.
PS02.153: HER2 PATHWAY CONTROL SENSITIVITY TO CISPLATIN IN ESOPHAGEAL ADENOCARCINOMA CELL LINES
Authors: Dakpo Eugenia , Derouet Mathieu , Yeung Jonathan , Darling Gail
Published: September 2018

Background

Adenocarcinoma of the esophagus is increasing in frequency and is the 6th most common cause of cancer death in North America. Cisplatin has been the backbone of neoadjuvant therapy but despite improved 5-year survival with neoadjuvant chemoradiation, many tumor cells survive chemotherapy leading to distant metastases. This study investigated the molecular changes in tumors when they become cisplatin resistant by focussing on the HER family of proteins.

Methods

We created 2 cisplatin resistant cell lines and a matching control by exposing the adenocarcinoma cell lines SK-GT-4 and FLO-1 to repeated cycles of cisplatin. Resistance to cisplatin was assessed at the end of the treatment. The expression levels of the HER family members was assessed. Cell proliferation, resistance to cisplatin and siRNA transfection were used to assess the role of HER family members in cisplatin resistance in EAC.

Results

The cisplatin resistant cell line displayed a lower rate of proliferation than the matching control (1.5 fold difference after 72h, P < 0.05). When the level of HER family members in the cisplatin resistant and control cell lines were measured, we observed a downregulation of HER2 in both cisplatin resistant cell lines (FLO-1: 78.31 mean expression (control) vs 17.43 mean expression (cisplatin resistant), P < 0.05), whereas the EGFR level were unchanged (FLO-1: 154.76 mean expression (control) vs 137.64 mean expression (cisplatin resistant), P > 0.05). In order to confirm this observation, we downregulated HER2 by siRNA and by a HER2 specific inhibitor in control cells. Resistance to cisplatin was similar to the cisplatin resistant cell lines (3.33μM cisplatin for 72h, death rate: 72.1% control vs 23.6% HER2 siRNA, P < 0.05). Similar results were observed in two other EAC cell lines (OE33 And JHESO-AD1).

Conclusion

Our results suggest that there is a correlation between HER2 level/activity and cisplatin resistance in EAC cells. It appears that as EAC cells acquire cisplatin resistance, they block the HER2 pathway.

Disclosure

All authors have declared no conflicts of interest.
PS02.158: DISTRIBUTION OF LYMPH NODE METASTASES IN ESOPHAGEAL CARCINOMA [TIGER STUDY]: A MULTINATIONAL OBSERVATIONAL STUDY
Authors: Hagens Eliza , Van Berge Henegouwen Mark I , Gisbertz Suzanne
Published: September 2018

Background

Lymph node status is an important prognostic parameter in esophageal carcinoma and an independent predictor of survival. Distribution of metastatic lymph nodes may vary with tumor location within the proximal or distal esophagus, tumor histology, tumor invasion depth and neoadjuvant therapy. Surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy differs worldwide. Especially for adenocarcinoma the distribution of lymph node metastases has not yet been described in large series. Aim of the present study is to evaluate the distribution of lymph node metastases in esophageal carcinoma specimens following transthoracic esophagectomy with a 2-or 3-field lymphadenectomy.

Methods

The TIGER-study is an international observational cohort study with 58 participating centers. All patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival.

Results

We aim to start inclusion on 1/03/2018 and will present the first results during the congress.

Conclusion

The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed on the basis of these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics.

Disclosure

All authors have declared no conflicts of interest.
PS02.170: EFFICACY OF PERIOPERATIVE IMMUNONUTRITION OF ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Kanekiyo Shinsuke , Takeda Shigeru , Iida Michihisa , Nishiyama Mitsuo , Kitahara Masahiro , Tokumitsu Yukio , Tomochika Shinobu , Suzuki Nobuaki , Yoshino Shigefumi , Hazama Shoichi , Nagano Hiroaki
Published: September 2018

Background

Malnutrition is frequent in esophageal cancer patients and aggravated by operation, increasing postoperative complications and mortality. Although a preoperative immunonutrition pharmaceutics diet significantly reduced the incidence of postoperative infectious complications, the effect of perioperative immunonutrition of esophagectomy for esophageal cancer still remains unclear.

Methods

This study design was a prospective randomized study. 40 patients with thoracic esophageal carcinoma who underwent esophagectomy were divided into two groups. Continiously 7 days before and after surgery, they enrolled and received either immunomodulating enteral nutrition (IMPACT® Group: IG) or standard enteral nutrition (Ensure® Group: EG). The nutrition statement, postoperative ICU stay, postoperative hospital stay, morbidity and mortality were investigated prospectively.

Results

There was no difference of patient demographics between two groups. Retinol-binding protein as rapid turnover protein was significantly higher on postoperative day (POD) -1, POD 7 and POD 14 in the IG than in the EG (P = 0.009, P = 0.004 and P = 0.024, respectively). The incidence of postoperative infectious complications and changes to therapeutic antibiotics was significantly lower in the IG than in the EG (P = 0.048 and P = 0.012, respectively). No difference was observed in postoperative ICU stay and postoperative hospital stay between two groups. The 5-year PFS in the IG and EG groups were 75% and 64% (P = 0.188), respectively, and OS were 68% and 55% (P = 0.187), respectively.

Conclusion

This study showed that immunonutrition would be effective to improve the early nutritional status and reduce postoperative infectious complications.

Disclosure

All authors have declared no conflicts of interest.
PS02.171: STUDY OF LONG TERM FOLLOW-UP OF EXERCISE LEVELS FOLLOWING PARTICIPATION IN A PREHABILITATION PROGRAMME IN OESOPHAGO-GASTRIC (OG) CANCER SURGERY
Authors: Doganay Emre , Mckinnon Tom , Osborn Hayley , Winter-Blyth Venetia , Moorthy Krishna
Published: September 2018

Background

Sedentary behaviour is emerging as an important field of scientific enquiry for cancer survivorship research. The aim of this study is to evaluate the impact of PREPARE, a multi-modal pre-operative optimization programme, and the impact this has on sustained activity following completion of cancer treatment.

Methods

66 patients were approached in clinic or sent letters to consent for the study. Median follow up time was 14 months. Patients either consented to telephone questionnaire or exercise testing or both. Telephone questionnaire included the validated Godin-Shephard Leisure-Time physical activity questionnaire in oncology, and exercise testing included the validated Chester-Step test, to obtain an accurate METS score. Scores were calculated at baseline (P1), 6–8 weeks postoperative (P4) and at follow up.

Results

66 patients were included in the study. Of these, 13 (19%) patients were excluded due to disease progression, death or declined to participate. The remaining 43 (65%) who were included in the study either consented for telephone questionnaire (74%) or exercise testing (60%) or both. Median follow up time was 14 months since surgery. Majority of the patients remained active at follow up; 23 (77%) were active, 5 (16%) were moderately active and, 4 (12%) were insufficiently active/sedentary. Overall, the median weekly METS scores were 5.8 (equivalent moderate intensity activity). On exercise testing, there was an improvement in median METS scores. At P1, baseline median METS were 5.0, at P4 5.0 and at 14 months 6.5. There was an overall increase in median self-efficacy scores. At P1, baseline scores were 8.3, at P4 8.5 and at 14 months 9.

Conclusion

There is emerging evidence to support the benefits of physical activity in cancer survivors and the impact this has on overall survival, quality of life and symptomatology. Starting prehabilitation at the time of diagnosis leads to improved confidence and sustained activity levels in the post-treatment period.

Disclosure

All authors have declared no conflicts of interest.
PS02.176: LINE-1 METHYLATION LEVEL AND LOCAL IMMUNE RESPONSE IN ESOPHAGEAL CANCER
Authors: Baba Yoshifumi , Yagi Taisuke , Kiyozumi Yuki , Hiyoshi Yukiharu , Iwatsuki Masaaki , Miyamoto Yuji , Yoshida Naoya , Baba Hideo
Published: September 2018

Background

In cancer cells, DNA methylation may be altered in two principle ways; global DNA hypomethylation and site-specific CpG island promoter hypermethylation. Since Long interspersed element-1 (LINE-1 or L1; a repetitive DNA retrotransposon) constitutes a substantial portion (approximately 17%) of the human genome, the extent of LINE-1 methylation is regarded as a surrogate marker of global DNA methylation. In previous studies, we demonstrated that LINE-1 hypomethylation was strongly associated with a poor prognosis in esophageal cancer, supporting its potential role as a prognostic marker (Ann Surg 2012). We also found that LINE-1-hypomethylated tumors showed highly frequent genomic gains at various loci containing candidate oncogenes such as CDK6 (Clin Cancer Res 2014). Given that immunotherapy, as represented by PD-1/PD-L1-targeting antibodies, has increasingly gained attention as a novel treatment strategy for esophageal cancer, better understanding of local immune response status in esophageal cancer is important. The aim of this study is to evaluate the relationship between LINE-1 methylation level and local immune response in esophageal cancer.

Methods

Using a non-biased database of 305 curatively resected esophageal cancers, we evaluated PD-L1 expression and TIL status (CD8 expression) by immunohistochemical analysis (Ann Surg 2017).

Results

TIL positivity was significantly correlated with longer overall survival (log-rank P < 0.0001). TIL-negative cases demonstrated significantly lower LINE-1 methylation level compared with TIL-positive cases (P = 0.012). This finding certainly supports that LINE-1 methylation level may influence the local immune response status.

Conclusion

PD-L1 expression was not related with LINE-1 methylation level. Further investigations in this field would provide deeper insights into esophageal tumor immunology and assist the development of new therapeutic strategies against esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.180: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OESOPHAGO-GASTRIC CANCER SURGERY: EVALUATION OF A SINGLE-CENTRE EXPERIENCE
Authors: Allen Sophie , Chakravartty Saurav , Timbrell David , Rockall Timothy , Prabhu Pradeep , Preston Shaun , Sultan Javed
Published: September 2018

Background

Cardiopulmonary exercise testing (CPEX) is an objective measure of functional capacity adapted to predict post-operative morbidity. CPEX may also identify optimisable cardio-respiratory comorbidity, prompting treatment modification or specialist referral. The role of CPEX in patient optimisation before oesophago-gastrectomy is yet to be evaluated. This study aims to assess the utility of CPEX in altering management and optimising patients prior to oesophago-gastrectomy.

Methods

All patients who underwent pre-operative CPEX testing and two phase oesophago-gastrectomy (January 2012 to January 2018) were included. All changes in patient management brought about by CPEX findings were evaluated. In addition, the role of validated risk-stratifying CPEX parameters (anaerobic threshold (AT), VO2 peak and FEV1) in predicting post-operative complications was assessed.

Results

236 patients underwent surgery. Median AT and VO2 peak were 11.95(7–24)ml/kg/min and 773(403–1552)ml/min/m2 respectively. 46% (109/236) of patients (VO2 peak > 800ml/min/m2) were graded ‘low risk’, 42% (99/236) ‘intermediate risk’ (VO2 peak = 600–800ml/min/m2), and 12% (28/236) ‘high risk’ (VO2 peak < 600ml/min/m2) for developing post-operative cardio-pulmonary complications. Based on CPEX findings, management plans were altered in 84 patients (36%). Cardiac comorbidity was identified in 55 patients (23%) with immediate alteration of cardiac medications in 9% (21/236) and another 11% (27/236) requiring specialist cardiology review. Medication for respiratory optimisation was initiated in 3% (7/236) and formal respiratory review sought in 5% (12/236). ‘Intermediate’ and ‘high risk’ patients had similar rates of overall complication (63% vs 63%, P = 1.00), cardio-pulmonary complication (48% vs 47%, P = 0.17), anastomotic leak (11% vs 15%, P = 0.33) and 90-day mortality (6% vs 4%, P = 0.40) compared with ‘low risk’ groups. CPEX variables (AT, VO2 peak, FEV1) did not predict complications, length of critical care or overall stay on Receiver Operating Characteristic curves (AUROC < 0.5) and multivariate logistic regression models.

Conclusion

CPEX findings changed management in 36% of patients, enabling optimisation before oesophago-gastrectomy. ‘Confounding by intention’ is a bias reducing the strength of association between test results and post-operative complications due to the propensity to medically intervene on the basis of the test findings. This study highlights the possibility that the high intervention rate may explain the poor correlation between test results and post-operative outcome.

Disclosure

All authors have declared no conflicts of interest.
PS02.187: RELATIONSHIP BETWEEN REGIONAL LYMPH NODE SIZE AND PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS
Authors: Kobayashi Teruyuki , Yamasaki Makoto , Tanaka Koji , Makino Tomoki , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

Surgery for esophageal cancer, in many cases performed after chemotherapy or chemoradiotherapy. Because treatment policy is determined by pretreatment evaluation, improvement of diagnosis accuracy is important. Commonly, metastatic diagnosis is performed by uniformly defining the size. We examined whether evaluation of N classification reflecting more prognosis can be done by examining lymph node metastasis criteria by area in CT.

Methods

We surveyed 300 cases of thoracic esophageal cancer (squamous cell carcinoma) who underwent surgery at our hospital from September 2010 to December 2014. We defined lymph node with a minor axis of 5 mm or more from CT (5 mm slice) before treatment as ‘visible node’. We changed the cut off of lymph node short diameter for each area to 5 mm, 10 mm and 15 mm, and those with long diameter/short diameter ratio less than 1.5 were designated as ‘metastasis’. We examined the optimal size of lymph node which reflect prognosis. We compared the correlation with the prognosis based on the N category of the 8th edition UICC TNM classification and the 11th edition Japanese Classification of Esophageal Cancer, using the cutoff of short diameter examined for each area.

Results

We evaluated the cut off of each area lymph node except paraesophageal, 15 mm in the cervical, 10 mm in the recurrent nerve, 15 mm in the upper trachea, 15 mm in the lower trachea, and 10 mm in the epigastric. Classification based on the N classification of the 8th edition UICC TNM classification, overall survival declined in the order of N categories.

Conclusion

From this result, it was suggested that diagnosis based on lymph node size in CT reflects prognosis by prescribing cut off for each site. From now on, it would be possible to raise the diagnostic accuracy of N classification further by subdivision of cut off and accumulation of the case.

Disclosure

All authors have declared no conflicts of interest.
PS02.201: EXPRESSION AND ROLE OF CLIC1 IN HUMAN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kobayashi Toshiyuki , Shiozaki Atsushi , Fujiwara Hitoshi , Konishi Hirotaka , Nako Yoshito , Kosuga Toshiyuki , Shoda Katsutoshi , Arita Tomohiro , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Nakanishi Masayoshi , Okamoto Kazuma , Kishimoto Mitsuo , Otsuji Eigo
Published: September 2018

Background

Recent studies have reported important roles for chloride intracellular channel 1 (CLIC1) in various cancers; however, its involvement in esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of the present study was to investigate the role of CLIC1 in human ESCC.

Methods

CLIC1 expression in human ESCC cell lines was analyzed by Western blotting. Knockdown experiments were conducted with CLIC1 siRNA, and their effects on cell proliferation, the cell cycle, apoptosis, migration, and invasion were analyzed. The gene expression profiles of cells were analyzed using a microarray analysis. An immunohistochemical analysis was performed on 61 primary tumor samples obtained from ESCC patients who underwent esophagectomy.

Results

ESCC cells strongly expressed CLIC1. The depletion of CLIC1 using siRNA inhibited cell proliferation, induced apoptosis, and promoted cell migration and invasion. The results of the microarray analysis revealed that the depletion of CLIC1 regulated apoptosis via the TLR2/JNK pathway. Immunohistochemistry showed that CLIC1 was present in the cytoplasm of carcinoma cells, and that the very strong or very weak expression of CLIC1 was an independent poor prognostic factor.

Conclusion

The present results suggest that the very strong expression of CLIC1 enhances tumor survival, while its very weak expression promotes cellular movement. The present study provides an insight into the role of CLIC1 as a switch among tumor behaviors in ESCC.

Disclosure

All authors have declared no conflicts of interest.
PS02.204: GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW
Authors: Gentile Damiano , Riva Pietro , Da Roit Anna , Basato Silvia , Marano Salvatore , Castoro Carlo
Published: September 2018

Background

Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC.

Methods

A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed.

Results

A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis.

Conclusion

Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended.

Disclosure

All authors have declared no conflicts of interest.
PS02.205: MALIGNANCY DEVELOPING IN CORROSIVE INJURED ESOPHAGUS
Authors: Chandramohan Servarayan , Manickavasagam Kanagavel , Chinnathambi Madeshwaran , Jebaraj Abishai , Chandramohan Apsara , Varadharajan Visvarath
Published: September 2018

Background

Malignancy developing in a corrosive injured esophagus has been described in the literature. Though the possibility of malignancy developing in a corrosive esophagus is expected to be around 1000 fold no team has managed large numbers. The aim of this study is to analyse the pattern of presentation and problems encountered in managing these difficult patients.

Methods

13 patients with corrosive malignancy encountered between 1991 and 2016 were included in this study. Patients basic demographic profile, incidence, time interval between ingestion of corrosive and occurrence of malignancy, site of malignancy, symptoms at presentation, stage, management and survival were analysed.

Results

There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months.

Conclusion

There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient.. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months.

Disclosure

All authors have declared no conflicts of interest.
PS02.211: MALIGNANCY IN GASTRIC CONDUIT: ANALYSIS OF OUTCOME
Authors: Chandramohan Servarayan , Chinnathambi Madeshwaran , Varadharajan Visvarath , Manickavasagam Kanagavel , Jebaraj Abishai , Chandramohan Apsara
Published: September 2018

Background

Stomach is the best conduit available after esophageal resection for both benign and malignant esophageal disorders. Malignancy in the gastric conduit after esophageal resection is a rare occurrence with worst outcome.

Methods

13 cases of gastric conduit malignancy admitted in our institution from 2006 to 2016 were analysed. Malignancy in the conduit may be a second primary or a recurrence of the tumor bed or at anastamotic site. Indication for surgery, Demographic profile, Interval between occurrence and primary disease, site, type, stage and grade of malignancy, route of the conduit (retro sternal/posterior mediastinum), presence of pyloroplasty, post operative therapy and complications were analysed.

Results

The mean interval between primary esophageal malignancy and conduit cancer was 4.3 years. 6 cases represented the second primary, 4 represented anastamotic recurrence and 3 cases of bed recurrence. All cases were adenocarcinoma. Out of 13 patients 8 were advanced malignancy. Out this 8, one patient had conduit pulmonary fistula. Only feeding/stenting procedure and chemo/RT were done. In the remaining 5 patients wedge resection in 1patient and total conduit gastrectomy in 4 patients with colonic replacement were done. Comparing 2 cases of substernal with 2 cases of posterior mediastinal colonic conduit placement the post operative pulmonary complications are less and no need for delay in RT in substernal route. Median overall survival in non surgical patients was 6.2 months (range 4–11 months) and 1.9 months (range 6months -5.6 years) in surgical patients.(P = 0.003)

Conclusion

Colonic reconstruction and even partial resection is possible in the management of conduit malignancy after esophagectomy and even yields survival closer to primary gastric maligmancy. Placement of the conduit in the substernal route offers some advantage in treating the tumour bed with radiotherapy. Continuous postoperative monitoring after esophagectomy with the monotored surveillance program is needed to select appropriate cases for better results.

Disclosure

All authors have declared no conflicts of interest.
PS02.213: PREDICTING ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: THE VALUE OF C-REACTIVE PROTEIN. A NATIONWIDE REGISTER STUDY
Authors: Nilsson Erik , Johansson Jan , Falkenback Dan , Jeremiasen Martin , Åkesson Oskar , Hermansson Michael
Published: September 2018

Background

Anastomotic leakage (AL) after oesophageal surgery is a serious complication, leading to increased postoperative mortality. Early detection and treatment is essential. The aim of this study was to investigate if inflammatory serum parameters in the early postoperative course after oesophageal cancer surgery, could predict development of an AL.

Methods

All patients in Sweden with AL after thoraco-abdominal surgery for oesophageal or gastroesophageal junction cancer from 2006–01-01 to 2017–01-31 were collected from the Swedish National Registry for esophageal and gastric cancer (NREV). Two matched controls for each AL-patient were also selected from the registry. Pre-, per- and postoperative variables were collected from NREV. The following parameters were collected from patient charts: number of days from surgery to AL, diagnostic modality, method of treatment, serum levels of C-reactive protein (CRP), White blood cell count (WBC) and serum-Albumin taken on postoperative day 1 to 7 (POD1–7). Thoracic- and cervical anastomosis were analysed separately. Perioperative data and inflammatory markers were compared between controls and AL-patients. Receiver Operating Characteristic (ROC) curves was constructed to identify optimal cut-off values and a multivariate analysis was performed to identify independent risk factors.

Results

A total of 155 patients with AL and 307 controls (n = 462) were analysed. In patients with thoracic anastomosis median levels of CRP and WBC were significantly different on POD 2–7 and on POD 4–7 comparing AL-patients to controls. In patients with cervical anastomosis there was a significant difference in WBC levels on POD 1–7. ROC-curve analysis identified CRP on POD3 (cut-off 221) and POD4 (cut-off 203) as the best candidates for predicting AL in patients with a thoracic anastomosis, displaying an area under curve of 0.754 (Sensitivity 59%, Specificity 83%) and 0.731 (Sensitivity: 57%, Specificity 82%).

Conclusion

In this nation-wide register study we found that a model combining S-CRP levels on POD 3 and POD 4 after a thoraco-abdominal esophagectomy, could identify patients with increased risk of anastomotic leakage several days before it was diagnosed. However, since the sensitivity of this test is relatively low for predicting AL, it must be assessed in a larger clinical context.

Disclosure

All authors have declared no conflicts of interest.
PS02.221: THE SUCCESSFUL CONSERVATIVE MANAGEMENT OF CHYLOTHORAX WITH ETILEFRINE AND SOMATOSTACHIN ANALOG AFTER ESOPHAGECTOMY: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Yoshino Yutaro , Nakazato Hidetsugu , Tomiyama Takeshi , Nagamine Shinji , Tomori Takehiko , Inamine Susumu , Miyagi Jun , Nagayoshi Seiji , Omine Yasushi , Miyara Tetsuhiro
Published: September 2018

Background

Chylothorax is a severe complication after esophagectomy and is sometimes difficult to treat. Patients are treated with surgical and conservative therapies, including nutritional management.

Methods

Case: The patient was an 80-year-old man who had complained of dysphagia. Upper gastrointestinal endoscopy demonstrated a Borrmann type 2 tumor in the lower esophagus. Biopsy revealed squamous cell carcinoma. He was referred to our hospital after radiotherapy (40 Gy). The clinical stage, according to the UICC 7th edition, was cT3N1M0 cStage IIIA. Transthoracic esophagectomy with 2-field lymph node dissection was performed. The thoracic duct was observed. The postoperative chylothorax volume was < 1000 ml/day and required continuous drainage management.

Results

The single use of somatostatin analog failed to reduce the patient's chylothorax. Treatment with etilefrine and somatostachin analog led to the resolution of the patient's chylothorax.

Conclusion

The management of chylothorax with etilefrine and somatostachin analog may be a treatment option for patients with a low chylothorax volume or elderly patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.223: EFFECTIVENESS OF ETILEFRINE REGIMEN FOR CHYLOTHORAX AFTER ESOPHAGECTOMY WITH THORACIC DUCT RESECTION
Authors: Umino Ryosuke , Ohkura Yu , Ueno Masaki , Udagawa Harushi
Published: September 2018

Background

Management of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached. The aim of this study was to clarify the usefulness of an etilefrine regimen to broaden the medical treatment options for postoperative chylothorax after esophagectomy with resection of the thoracic duct.

Methods

A total of 371 consecutive patients with esophageal cancer were identified from a prospectively constructed database at the Department of Gastroenterological Surgery, Toranomon Hospital between January 2011 and February 2017. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I, II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these 371 patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.

Results

Conservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; P = 0.078). The 14 patients among 19 patients was resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; P = 0.052). And also, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention.

Conclusion

The findings of this study suggest the effectiveness of etilefrine in patients with chylothorax following esophagectomy. The drug was effective even in post-TDR chylothorax, an often intractable condition that is difficult to treat conservatively. However, when the effectiveness of etilefrine regimen is unexpectedly poor, it is important to switch from drug therapy to surgical treatment in the early stage of this complication.

Disclosure

All authors have declared no conflicts of interest.
PS02.224: ESOPHAGEAL CANCER IN MALAYSIA: THE NEED FOR EARLY DETECTION!
Authors: Ying Khoo Hui , Voon Kelvin , How Teoh Keat , Yee Lim Shyang , Nagalingam Premnath , Aznan Shuhaili Mohamad , Rajan Reynu , Mohammed Taher Mustafa , Ritza Kosai Nik
Published: September 2018

Background

Esophageal cancer is one of the deadliest cancer in Malaysia. However, neither the incidence nor prevalence has been recorded nationally. We report our experience in dealing with esophageal cancer in Penang Hospital (PH) and Universiti Kebangsaan Malaysia Medical Center (UKMMC), two tertiary hospitals in Northern and Central region of Malaysia, respectively.

Methods

A review of 143 esophageal cancer that were diagnosed in PH and UKMMC in year 2014–2017.

Results

Among the 143 esophageal cancers, 60 cases were from HPP and 83 from UKMMC. The mean age at diagnosis was 62.5 ± 14.2. 67.4% were male patients. Esophageal cancer was commonest in Chinese ethnicity (41%), followed by Malay (29.9%), Indian (17.4%) and others (11.8%). Dysphagia was the commonest presenting symptom (84.6%) and the mean duration of symptoms were 14 weeks. Majority of the cancers were located at the cardioesophageal junction (38.6%), followed by lower third of esophagus (32.1%), mid esophagus (23%), upper third of esophagus (11.5%) and cervical esophagus (5.7%). More than 90% of patients presented with advanced disease, 35% and 55% of patients with stage 3 and stage 4 disease, respectively. Squamous cell carcinoma (45.8%) was the commonest histology type, slightly more than adenocarcinoma (45.1%). The rest were neuroendocrine tumour, gastrointestinal tumour and lymphoma. To date, surgery with curative intend were done in 44.1% of patients while the rest were managed with palliative treatment.

Conclusion

It is striking that majority of patients presented with late disease. Disease awareness campaign, early detection and multimodality treatment are crucial to improve outcomes of patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.225: PROGNOSTIC VALUE OF LYMPH NODE METASTASIS IN DIFFERENT SITES IN PATHOLOGICAL T3 ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS
Authors: Wang Ying-Jian , Li Kun-Kun , Liu Xue-Hai , Guo Wei
Published: September 2018

Background

The aim of this study was to evaluate the impact of different sites of lymph node metastasis in pathological T3 (pT3) esophageal squamous cell carcinoma patients (ESCC).

Methods

We retrospectively reviewed 300 consecutive ESCC patients who underwent radical minimally invasive esophagectomy (MIE) and two-field lymphadenectomy from 2010 to 2015. After exclusion, 111 cases were analyzed. Patients were divided into 3 groups (mediastinal metastasis, abdominal metastasis, and simultaneous metastasis) according to their lymph node metastatic sites. Disease-free survival (DFS) and disease-specific survival (DSS) were analyzed.

Results

The results showed that the incidence of lymph node metastasize to mediastinum, abdomen, and simultaneous was 55 (49.5%), 21(18.9%), 35(31.6%), respectively. Patients in simultaneous metastasis group had a higher cancer recurrence (log-rank test; P = 0.0341; Figure 1A) than mediastinum and abdomen metastasis group. Similarly, patients in simultaneous metastasis group had greater rate of cancer-related death (log-rank test; P = 0.0177; Figure 1B) than mediastinum and abdomen metastasis group. In the multivariate model, metastasis site was an independent risk factor in both DFS (P = 0.0402; HR, 1.4071; 95% CI, 1.0171–1.9466) and DSS (P = 0.0238; HR, 1.4342; 95% CI, 1.0507–1.9577).

Conclusion

Simultaneous mediastinal and abdominal lymph node metastasis is associate with a relatively poor prognosis in pT3 ESCC patients.

Disclosure

All authors have declared no conflicts of interest.