bluuebunny/crossref_metadata_2025 huggingface dataset:
435. PREVALENCE OF OESOPHAGEAL PREMALIGNANT LESIONS AMONG PATIENTS REFERRED FOR GASTRO-OESOPHAGEAL-DUODENOSCOPY AT A TERTIARY CARE HOSPITAL IN NORTHERN, SRI LANKA
Authors: Rajasooriyar Ida Chrishanthi , Gobishangar Sreekanthan , Namasivayam Vikneswaran , De Silva Chandu , Amaratunga Priyani , Sarma Sundaramoorthy Iyer Thuraisamy , Thusyanthan Vinayagamoorthi , Kajendran Anuradha , Thanenthiran Antony Joseph , Murugathas Thanuja , Balendran Karthiha , Theepan Jathavani MM , Surenthirakumaran Rajendra
Published: September 2024

Background

Oesophageal cancer is the second leading cause of cancer-related mortality in Sri Lanka, where a higher prevalence is found among Tamil-speaking Sri Lankans. Endoscopic screening with Lugol’s chromo endoscopy in high-incidence populations reduces mortality from oesophageal cancer. The objective of this study is to determine the prevalence of premalignant oesophageal lesions - squamous dysplasia and Barrett’s oesophagus and the associated risk factors among Tamil patients undergoing oesophageal-gastro-duodenoscopy (OGD).

Methods

Consecutive patients undergoing OGD for dyspeptic and gastric acid reflux symptoms were recruited. An interviewer-administered questionnaire was used for data collection. During OGD, the oesophagus was examined under white light imaging, narrow band imaging (NBI), and Lugol’s iodine chromo endoscopy. Biopsies were taken from abnormal mucosa and sent for pathological diagnosis. Statistical software SPSS (V25) was used to analyse the data.

Results

The study incorporates 410 participants. The majority (61.7%) were females and the median age was 57 (Interquartile range 21) years.

On Endoscopy under white light and NBI 11.0%(n=45) had squamous neoplasia. Of them, 16.0% had Low grade dysplasia (LGD), 2.0% had invasive carcinoma and the remaining 82.0% had inflammatory or reactive changes.

Endoscopic Barrett’s oesophagus (BO) was found in 17.0% (n=69) and 5.0% (n=19) had both endoscopic and histological confirmation of BO. Of them, 21.0% had LGD. In regression analysis, male gender was at higher risk for BO (OR- 1.251, 95%CI 0.420 – 3.730).

Overall, 3.0% of the participants had premalignant lesions.

Conclusions

The prevalence of premalignant lesions in a symptomatic population was only 3.0%. Further studies with a larger number of targeted population is needed to assess the exact prevalence.
444. QUALITY OF LIFE OF CHILDREN AFTER ESOPHAGEAL REPLACEMENT
Authors: Sosnova Sofya , Bataev Saidkhassan , Razumovsky Alexander , Alkhasov Abdumanap , Bataev Ali , Feoktistova Elena
Published: September 2024

Introduction

For reconstruction of the esophagus in children colon interposition and reconstruction of the esophagus by stomach should are most often used. This work aims to compare the quality of life of patients in these groups to determine the optimal method for esophageal reconstruction in children.

Material and methods.

For 6 years 167 esophageal replacement was performed at the Filatov Children's Hospital. Of these, 57 children were evaluated for quality of life through a questionnaire, which was carried out when the child was re-admitted for follow-up examinations. All operations were performed by the same team of surgeons. We compiled the questions in the questionnaires specifically for this group of patients, which are shown in the table 1. The questionnaire for children under 14 years of age was completed by parents. Older children 14-year-olds filled out the questionnaire independently.

The respondents were divided into 2 groups. Group 1 – 26 children who underwent reconstruction of the esophagus by stomach. The 2nd group included 29 children after colonic interpositions. In terms of gender, age and indications for surgery were comparable in both groups. Patients were interviewed from 6 months to 5 years after surgery.

Results

Tab. 1 Comparative analysis of results interviewed patients in two groups

Despite the fact that esophageal reconstruction by stomach is easier to perform and it is even possible to perform this operation laparoscopically, as can be seen from the table above, children have significantly more problems in many indicators affecting the quality of life.

Conclusions

Reconstruction of the esophagus by stomach should be used for: reoperations after failed colon interposition; malformations and other pathologies of the colon and the “loose” type of blood supply to the colon. The operation of choice, in our opinion, is colon interposition, which demonstrates the best indicators of quality of life.
452. THE TREATMENT STRATEGY FOR RECURRENT OR UNRESECTABLE ESOPHAGEAL CANCER USING IMMUNE CHECKPOINT INHIBITORS
Authors: Toriumi Tetsuro , Miyawaki Yutaka , Lee Seigi , Kobayashi Ryota , Takabatake Kazuya , Ebara Gen , Sato Hiroshi , Sakuramoto Shinichi
Published: September 2024

Background

Cisplatine+5-FU (CF) was the first regimen for patients with recurrent or unresectable esophageal cancer in Japan. Nevertheless, the efficacy of the treatment was limited, and the prognosis of these patients was very poor. Recently, CF + Pembrolizumab (CF+Pmeb), CF + Nivolumab (CF+Nivo), Ipilimumab + Nivolumab (Ipi+Nivo) regimens were covered by the Japanese national health insurance system, and we get the option to use immune checkpoint inhibitor for advanced esophageal cancer.

Methods

Forty-six patients with recurrent or unresectable esophageal cancer treated with regimens including immune checkpoint inhibitors, were included in this study. We compared best overall response (BOR) among these three regimens. Besides, we also reviewed the validity of conversion surgery.

Results

Of the 46 patients, 17 and 29 patients were treated for recurrent and unresectable esophageal cancer, respectively. Among the patients with unresectable cancer, 3 patients were diagnosed with CR and 3 patients underwent conversion surgery, whose regimens were CF+Pmeb or CF+Nivo. We could achieve R0 resection in all 3 patients with conversion surgery. Postoperative complications grade 2 or more did not occur in these 3 patients. Recurrence has not been observed yet, though the follow-up periods were short (3 to 5 months). Among the patients with recurrence, 2 patients achieved a CR after treatment with CF+immuno checkpoint inhibitor.

Conclusion

Regimens with immune checkpoint inhibitors would be the hopeful treatment for advanced esophageal cancer patients. Conversion surgery would also play an important role in improving the prognosis.
470. INTENSIVE EARLY SURVEILLANCE FOLLOWING ESOPHAGECTOMY IDENTIFIES DISTINCT PATTERNS OF RECURRENCE
Authors: Xiao Karren , Bolger Jarlath , Allison Frances , Darling Gail , Yeung Jonathan
Published: September 2024

Background

There remains a lack of consensus about the protocol for follow-up following esophagectomy. Some centers will utilize a purely radiological approach to follow-up, while others will include routine endoscopy and blood markers. Furthermore, the frequency of follow-up is debated, though many centers will follow-up every 3 months due to the high recurrence rate in the first year. We follow patients every 3 months for the first year, every 6 months for the next year, then yearly to 5 years, solely with CT scans unless symptoms indicate endoscopy. We sought to examine our recurrence rate and survival using this follow-up protocol.

Methods

We reviewed our prospectively collected database for recurrence following esophagectomy in patients operated from March 2018 to May 2022. Consenting patients >18 years of age who underwent esophagectomy were included. Demographics including age, sex, and BMI, tumor factors including pathologic stage, tumor regression grade, and neoadjuvant therapy and post-recurrence treatment data were collected.

Results

We identified 190 patients who underwent esophagectomy and 69 patients had a recurrence. Patients with recurrence were younger (61.3 +/- 10.2 vs 66.4 +/- 10.1, p=0.001), were more likely pT3 (59.4% vs 36.4%, p=0.013) and have a tumor regression grade of 3 (27.5% vs 7.4%, p=0.002). There was no difference between patients with R1 resections vs R0 (5.8% vs 6.6%, p=0.824). Most recurrences were identified on CT scan (95.8%). For patients who recurred within 3 months, the mean time from operation to death was 9.11 months. Patients who recurred between 3-6mo, 6-9mo, and 9-12mo died at 17.1mo, 15.7mo, and 17.5mo following surgery, respectively. Patients who recurred in the next year died around 40 months from surgery.

Conclusion

As with other reports in the literature, recurrence is highest in the first year after esophagectomy. Patients recurring in the first 3 months had a short survival following esophagectomy and may represent missed micrometastatic disease at staging. Interestingly, patients who recurred between 3-12 months all had a similar time to death from the date of operation, suggesting lead-time bias for those detected at 3-6months. Early and later recurrence appear to have distinct biological behaviours. With improved and tailored adjuvant therapies, earlier detection may yet be beneficial and will require further study.
471. MANAGEMENT OF EARLY ESOPHAGEAL CANCER - A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Campbell Sally , Davey Matthew , Donlon Noel
Published: September 2024

Background and Objectives

Optimal surgical management for early oesophageal cancer remains controversial. We aimed to perform a network meta-analysis (NMA) of studies comparing outcomes after open esophagectomy (OE), minimally invasive esophagectomy (MIE), endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early oesophageal cancer.

Methods

A systematic search of electronic databases was undertaken. A network meta-analysis was performed as per PRISMA-NMA guidelines. Statistical analysis was performed using R and Shiny.

Results

21 studies including 10,002 patients with stage Tis, T1a or T1b oesophageal carcinoma were included. Overall, 3,103 patients underwent ESD (31%, 3103/10,002), 6,191 underwent OE (61.9%, 6,191/10,002), 502 underwent EMR (5.2%, 502/10,002) and 206 underwent MIE (2.1%, 206/10,002). At NMA, at approximately 3.5 years follow up, there was a significant difference in recurrence rates of Tis, T1a or T1b disease following OE (odds ratio (OR): 0.32, 95% CI 0.12 – 0.83) as compared to EMR. Compared to ESD, estimated 5 year overall survival for Tis, T1a and T1b disease were equivocal following OE and EMR respectively (OR: 0.98, 95% CI 0.66 – 1.44), (OR: 0.88, 95% CI 0.38-2.04). When compared with ESD, superior resection rate was observed in OE (OR: 4.04 95% CI 2.56, 6.37) and MIE (OR: 16.49, 95% CI 2.19, 123.86). OE had the highest rate of pulmonary complications. Compared with ESD, pulmonary complications were significantly different to those who underwent OE (OR: 4.06, 95% CI 2.28 – 7.22). OE had the highest rate of recurrent laryngeal nerve injury, post operative ileus and procedure specific mortality as compared to ESD, EMR and MIE which was not found to be significantly different at NMA. ESD and EMR exhibited advantages over OE and MIE in certain procedural aspects including procedure duration, length of hospital stay and cost.

Conclusions

OE was associated with superior surgical outcomes compared to ESD. Disease recurrence was also higher in EMR compared to OE with improved cost-effectiveness for ESD and EMR. ESD demonstrated reduce morbidity as compared to OE. Considering these results, OE, MIE, ESR and EMR are all feasible options for primary early oesophageal cancer, contingent on surgeon and institutional expertise.
481. STRONG SYMPTOMATIC IMPROVEMENT AT 1 YEAR AND BEYOND FOLLOWING REFLUXSTOP SURGERY FOR GASTRO-ESOPHAGEAL REFLUX DISEASE: A 40-PATIENT COHORTT
Authors: Lehmann Thorsten
Published: September 2024

Background

Despite well-established medical and surgical options for gastro-esophageal reflux disease (GERD), there remains a high unmet need for a treatment that improves symptoms without adverse effects. Symptoms of bloating, inability to belch or vomit, and dysphagia are among the more common side effects of standard anti-reflux surgery. RefluxStop is a novel device for the treatment of GERD that does not encircle the food passageway to avoid such side effects. The surgical technique is based on restoration of the normal anatomy of the gastroesophageal junction and maintaining the lower esophageal sphincter within the abdomen.

Methods

This study presents a case series of 40 patients who underwent RefluxStop surgery between July 2021 and November 2022 reaching at least 12 months of follow-up. A retrospective review of medical records was conducted. Baseline GERD Health-Related Quality of Life (GERD-HRQL) score was reported in addition to demographic and clinical characteristics. At follow-up, GERD-HRQL score, patient-reported GERD symptoms, and proton-pump inhibitor (PPI) use were reported. Peri-operative procedure-related and device-related adverse events (AEs) were recorded.

Results

Baseline patient characteristics are presented in Table 1. Mean follow-up was 14.5 (range 12-19) months. Mean GERD-HRQL score decreased dramatically from 19.5±3.8 at baseline to 1.1±2.2 at follow-up, reflecting a 91.9% improvement. At follow-up, reflux was reported as a symptom in only two patients (5%) (described as mild and occasional in one of them). None reported regurgitation or dysphagia. Only two patients (5%) reported bloating. The necessity for PPI therapy decreased from 97.5% (n=40) at baseline to 2.5% at follow-up. There were no intra-operative AEs or reoperations.

Conclusion

These data provide real-world evidence on the performance of RefluxStop in clinical practice. In this series of patients, the outcomes at 1 year and beyond indicate excellent effectiveness in reducing or eliminating GERD symptoms, as demonstrated by spontaneously reported symptoms and the validated, disease-specific, quality-of-life questionnaire. The discontinuation of PPI therapy is an additional indicator of effective symptomatic improvement. Importantly, this treatment did not induce dysphagia, a common consequence of established anti-reflux surgical techniques. RefluxStop is a promising option for patients with chronic GERD seeking definitive treatment while minimizing AEs.
484. DELTA-IRP AS A NEW HIGH-RESOLUTION MANOMETRY METRIC TO PREDICT THE POSITIVE OUTCOME OF LAPAROSCOPIC HELLER-DOR IN PATIENTS WITH ACHALASIA
Authors: Pittacolo Matteo , Costantini Andrea , Nezi Giulia , Provenzano Luca , Capovilla Giovanni , Vittori Arianna , Santangelo Matteo , Forattini Francesca , Nicoletti Loredana , Moletta Lucia , Costantini Mario , Valmasoni Michele , Savarino Edoardo V , Salvador Renato
Published: September 2024

Background

There is no consensus on the definition of failure after treatment in patients with esophageal achalasia. The Eckardt score (ES) is commonly used to define clinical outcome, but objective metrics based on high-resolution manometry (HRM) or other tools are lacking. Aim of this study was to identify any HRM objective parameters useful to predict a positive outcome after surgical treatment with laparoscopic Heller-Dor (LHD).

Methods

Patients who had undergone LHD between 2012 and 2022, with pre- and postoperative HRM at our Center, were enrolled. Patients were divided according to the outcome of treatment between success group (SG, symptom relief or resolution) and failure group (FG, ES>3 or the need for additional treatment). Further to the traditional HRM metrics commonly evaluated, we also measured the difference between median values of pre- and postoperative Integrated Relaxation Pressure (∆-IRP). A ROC curve analysis was applied to assess the accuracy of each HRM parameter identified. Data are reported in Table 1.

Results

We enrolled 358 patients (F:M=177:187): 331 in the SG and 27 in the FG. The ∆-IRP was higher in SG [22mmHg (IQR:15-31)] than in FG [14.3mmHg (IQR:9.9-18.3), p=0.04]. The univariate analysis is showed in Table 1. At multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (p<0.01). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.55 mmHg (sensibility 71%, specificity 70%).

Conclusions

Our data showed that the ∆-IRP with a threshold of 16.5 mmHg could represent a new objective tool to predict the positive outcome of LHD in patients with esophageal achalasia.
492. OUTCOMES OF ESOPHAGECTOMY IN THE ELDERLY- IS IT WORTH THE EFFORT?
Authors: Jiwnani Sabita , Karthik V , Baskaran D , Tiwari Virendra , Pramesh CS
Published: September 2024

Background

Esophageal cancer is the sixth most common cancer in India and most patients are diagnosed at locally or loco-regionally advanced stages. Multimodal management offers the best chance of cure, with surgery being the cornerstone. With improved life expectancy, elderly patients with esophageal cancer are being referred for surgery more frequently. Although recent studies have shown encouraging outcomes, increased post-operative complications are common. The aim of our study was to evaluate morbidity and survival in patients above 70 years undergoing curative surgery for esophageal cancer from 2011 to 2021 at our centre.

Methods

Of 2291 patients undergoing esophagectomy, 122 were above 70 years, ten were inoperable. Mean age was 73.3 years (70-84 years), with 78% males and 83% squamous cell carcinoma, most common location being lower-third (63.6%). Of the 110 patients, 80 (72.7%) received neoadjuvant treatment, 68(61.8%) were ASA grade II or more. McKneown’s approach was common, utilized in 55%, of which minimally invasive in 53%, with Ivor- Lewis, left thoraco-abdominal and transhiatal approaches in the rest. Mean blood loss was 350 ml, with mean operative time of 270 minutes and circumferential positivity rate of 12.7%.

Results

The mean ICU stay was 1 day, with the mean hospital stay being 13 days. Almost half (49%) had Clavien-Dindo grade III or higher morbidity, with pulmonary complications seen in 27%. Anastomotic leakage was seen in 20/110 (18%), with only 2 patients needing an intervention. 30-day mortality was 8.2%. Recurrences were seen in 21 patients, anastomotic and regional recurrences in 6, distant in 6, regional with distant in 9. The median recurrence free survival was 26 months with 3-year RFS of 43.7%. With a median follow-up of 25 months, median overall survival was 30 months and 3-year OS was 45.3%.

Conclusion

Despite higher post-operative morbidity and mortality, elderly patients have reasonable recurrence free and overall survival outcomes with curative surgery. With continuing refinements in prehabilitation, operative techniques, wider adoption of minimally invasive surgery, intra-operative management and post-operative care, early post-operative outcomes are likely to improve further. Elderly patients with resectable esophageal cancer should not be denied surgery.
503. HEALTH-RELATED QUALITY OF LIFE FOLLOWING CURATIVE INTENT TREATMENT FOR ESOPHAGEAL CANCER: IMPACT OF TREATMENT PATHWAY ON PATIENT-REPORTED OUTCOMES IN SURVIVORSHIP
Authors: Boyle Ellen , Loganathan Nithiesh , Elliott Jessie A , Greene Christine , Murphy Conor F , Donlon Noel E , Donohue Claire L , Ravi Narayanasamy , Reynolds John V
Published: September 2024

Background

Recent improvements in treatment modalities for esophageal cancer have resulted in improved survival outcomes, and optimisation of health-related quality of life (HR-QL) in survivorship is now an increasing focus. This study aimed to compare HR-QL in survivorship following treatment with definitive chemoradiation (dCRT), neoadjuvant chemoradiation and surgery (nCRT), neoadjuvant chemotherapy and surgery (nCT), and surgery only (S).

Methods

This was a cross-sectional study of patients who underwent oesophageal cancer treatment between 2010 and 2021. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Scores were calculated according to the European Organisation for Research and Treatment of Cancer manual. A mean difference of ten points or more for symptom and function scales was considered clinically significant. One-way ANOVA was performed to detect statistically significant differences between treatment groups.

Results

Some 125 patients were included. Global HR-QL was similar between treatment groups (mean±SD, dCRT 67.4±20.9, nCRT 71.5±19.6, nCT 80.0±15.0, S 69.0±20.0, P=0.265). Analysis of functional scales found lower emotional functioning (S 71.1±25.5 vs dCRT 87.1±15.6, nCRT 79.6±19.5, nCT 88.9±26.3, P=0.028) and body image scores (S 71.8±29.2 vs dCRT 87.9±22.5, nCRT 83.3±27.8, nCT 91.1±19.8, P=0.056) among patients treated with surgery only. Dysphagia (P=0.034), trouble with coughing (P=0.014) and choking when swallowing (P=0.018) were increased following dCRT as compared with surgical treatment. Following surgical treatment, patients reported more diarrhoea as compared with dCRT (P=0.020), while dCRT was associated with increased constipation (P=0.004).

Conclusion

Overall HR-QL was similar between groups, but distinct patterns of symptoms were observed in different cohorts. Symptoms related to swallow function were more common in patients treated with dCRT, while patients who underwent surgery exhibited more diarrhoea, possibly reflective of increased dumping syndrome. Interestingly, patients who received surgery upfront reported lower scores for emotional functioning and body image in the long-term after treatment, as compared with other groups. Further research is needed to determine the differential psychological impact of major resectional upper GI surgery among patients presenting with early stage versus locally advanced disease.
528. IMPACT OF SARCOPENIA AND MYOSTEATOSIS ON THE SURGICAL OUTCOME OF PATIENTS WITH ESOPHAGEAL CANCER
Authors: Scarton Alessia , Pierobon Elisa Sefora , Capovilla Giovanni , Moletta Lucia , Salvador Renato , Zanchettin Gianpietro , Provenzano Luca , Sartori Roberta , Zampieri Sandra , Corradin Simone , De Pasqual AnnaLaura , Sandri Marco , Valmasoni Michele
Published: September 2024

Background

Alterations in muscle mass, sarcopenia and myosteatosis might negatively affect the surgical outcome of patients with cancer. Body composition correlation with biochemical markers and impact on surgical outcome in esophageal cancers is yet to be fully determined.

Study design

Patients with esophageal and esophageal-gastric junction cancer undergoing resection with curative intent were enrolled in a prospective clinical trial from to 2019 to 2023. Patients were assessed at presentation for anthropometric measures, past medical history and biohumoral markers. Contrast-enhanced CT-scans were used to analyze body composition and to detect low lumbar skeletal muscle index (SMI) and low mean muscle attenuation. We investigated the association between the presence of sarcopenia and/or myosteatosis and malnutrition or systemic inflammatory state.

Results

We enrolled 130 esophagogastric cancer patients who underwent Ivor-Lewis esophagectomy. Postoperative morbidity was not significantly higher in the sarcopenic group compared to non-sarcopenic patients (p=0.35). Myosteatosis and albumin level weren’t associated with post-operative morbidity (p=0.11).

No differences in overall survival were found in patients with myosteatosis or sarcopenia compared to subjects with normal body composition (p=0.12 and p=0.16).

Conclusion

Our preliminary data shows no significant correlations between sarcopenia and myosteatosis and postoperative outcome and survival following esophagectomy for esophageal cancer. These findings from an high volume center suggest that factors other than these body composition parameters may play a more significant role in determining postoperative outcomes in patients undergoing esophagectomy. Further research is warranted to elucidate additional prognostic indicators and optimize patients care in this population.
532. OPERATIVE TRENDS AND CLINICAL OUTCOMES OF OPEN, LAPAROSCOPIC AND ROBOTIC APPROACHES TO HIATAL AND PARAOESOPHAGEAL HERNIAS-A STUDY OF 1834 PATIENTS
Authors: Ueda Goro , Low Donald , Stiles Erik , Sternbach Joel , Kuppusamy Madhan Kumar , Hubka Misho
Published: September 2024

Background

Indications for repair of hiatal and paraesophageal hernia (HH/PEH) repair evolved significantly over the past two decades, impacted by the increasing application of minimally invasive surgical (MIS) approaches. This transition underscores the importance of evaluating the operative trends and clinical outcomes associated with open (open), laparoscopic (lap), and robotic surgeries especially in cases of giant hernias (over 50% intrathoracic stomach). Understanding these dynamics is crucial, especially as MIS becomes increasingly prevalent in managing complex cases, including giant hernias. The aim of this study is to assess critical outcomes achieved during the evolution from open to lap to robotic HH/PEH repair in a high volume center.

Methods

This is a retrospective review of 1834 patients undergoing open (958), lap (390), and robot (486), consecutive HH/PEH repairs prospectively entered into an IRB approved database from 2000 to 2023 at a high-volume center.

Patient demographics, operative techniques, and top three most common presenting symptoms were studied overtime. Impact of operative technique, hernia type and size, operative outcomes including length of stay (LOS), radiographic recurrence (esophagram at 3 and 12 months), revisional surgery, on post-operative symptom resolution was evaluated.

Results

Annual volume increased overtime, with 418 repairs (78% robotic) in the last two years. Average hernia size decreased over the study period. The majority of patients (99.1%) presented with symptoms (Fig 1) and robotic repair had significantly better symptomatic resolution than open surgery (p<0.05). This advantage persists with symptoms in giant hernias (p<.001) LOS decreased over the study period (Fig 1). Overall radiographic recurrence (8.6%) and reoperative rate (2.4%) did not differ among operative techniques, however robotic repair had higher radiographic recurrence rate in case of giant hernia (18%, p<.001).

Conclusion

The operative volume of HH/PEH repair has increased overtime associated with the increased application along with advancements in MIS and robotic operative techniques. Surgical interventions markedly ameliorate HH/PEH symptoms, with greater improvement observed in large hernia cases. Significant improvement in LOS and at least equivalent clinical results favors MIS, particularly robotic surgery. Although the incidence of anatomic recurrent hernia and reoperation is relatively low continued assessment of especially robotic operations to decrease this incidence further is warranted.
542. POST-ESOPHAGECTOMY PARACONDUIT HIATAL HERNIA DEVELOPMENT AND RECURRENCE
Authors: Singh Anupama , McAllister Miles A , Pezeshkian Fatemehsadat , Wee Jon O , Rochefort Matthew M , Swanson Scott J , Jaklitsch Michael T , Bueno Raphael , Wiener Daniel C , Shemmeri Ealaf
Published: September 2024

Background

Hiatal hernia post esophagectomy is a delayed postoperative complication. Historically, in open surgery, the incidence is rare. The increased utilization of minimally invasive methods has increased the incidence of hiatal hernias. Current literature is limited to case series. There is even less on frequency and management of re-recurrent cases. Our objectives were to identify the incidence of hiatal hernia post esophagectomy and the outcomes of the recurrent cases.

Methods

A retrospective analysis of prospective data at a single center was conducted on esophagectomies performed 2017 to 2022. Non-gastric conduit reconstructions were excluded. Baseline patient demographics including comorbidities, type of tumor, neoadjuvant therapy, surgical approach (open versus minimally invasive [MIE]), and conduit construction were recorded. Radiographic presence of non-gastric conduit abdominal contents was defined as hiatal hernia. Time of hiatal hernia occurrence, details of the repair and timing re-recurrence was recorded. Associated factors described in literature including baseline demographics, neoadjuvant therapy, operative technique, conduit diameter and use of pexy techniques were analyzed with univariate analysis. P<0.05 was considered significant.

Results

A total of 565 esophagectomies met inclusion criteria, 78% (439/565) were MIE. Robotic-assisted comprised 33% (143/439) of the MIE cohort. A hiatal hernia was identified in 3% of patients (15/565). All had malignancy and were Ivor Lewis (11/15, 73%) or 3-hole (4/15, 27%). The majority had an MIE (13/15, 86%), one had open esophagectomy (6%), and one had hybrid (1/15, 6%). There was no difference in risk factors between the hernia and non-hernia groups. Median time to hernia was 5 months (IQR: 4, 12). All underwent repair. Recurrent hernia occurred in 33% of patients (5/15), all within the robotic-assisted MIE.

Conclusion

Hiatal hernia post esophagectomy occurred in 3% of cases, and most cases occurred within the MIE group. Recurrence of hernias occurred in robotic-assisted esophagectomy patients. Analysis of patient-specific factors such as prior hiatal hernia, body-mass index, neoadjuvant therapy, operative technique, conduit pexy technique all did not reveal significant correlation with hiatal hernia development. The recurrence of hiatal hernia all required redo repairs. Though we had no deaths in the hiatal hernia cohort, repeat surgeries affect morbidity in esophagectomy patients. Further analysis is needed to identify ways to minimize hernia recurrence in minimally invasive esophagectomy.
562. COMPARATIVE ANALYSIS OF THE OUTCOMES OF GASTRECTOMY VS. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE TREATMENT OF GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY
Authors: Narumiya Kosuke , Toyoshima Yukinori , Kudo Kenji , Hosoda Kei , Osugi Harushi , Ide Hiroko , Okamura Yukiyasu
Published: September 2024

Background

Although multimodal treatment and minimally invasive surgery for esophageal cancer have improved therapeutic outcomes for esophagectomy, this improvement has led to many reports of metachronous cancers following esophagectomy. After esophagectomy for esophageal cancer, the locations where metachronous cancers occur most frequently are the oropharynx, hypopharynx, and larynx, followed by the gastric tube. Due to a paucity of reports, much remains unknown about gastric tube cancer, such as the site of common occurrence, pattern of metastasis, treatment method. This study investigated the clinical characteristics of patients with gastric tube cancer and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection.

Methods

Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared.

Results

The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed.

Conclusion

In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.
567. EPIDEMIOLOGY OF BARRETT'S ESOPHAGUS IN ICELAND; INCIDENCE AND PROGRESSION TO NEOPLASM FROM A LARGE POPULATION-BASED STUDY
Authors: Namikawa Ken , Konráðsson Magnús , Fridgeirsson Hilmar , Sigmundsson Helgi , Jónasson Jón , Björnsson Einar
Published: September 2024

Background

Barrett’s esophagus (BE) is the known precursor to esophageal adenocarcinoma (EAC). Previous studies have demonstrated a wide variety of progression rate whereas no nationwide data regarding the progression has been reported. The aims of the study were to evaluate the prevalence of BE and neoplasms in BE, and progression to those in a large population based and nationwide.

Methods

This was a retrospective study and patients from 7 institutions who were identified through a database of centralized pathology laboratory in an expert center. Demographics and relevant clinicopathological features were obtained from medical records of patients with a pathologically confirmed BE by presence of intestinal metaplasia between 1990 and 2022.

Results

A total of 811 patients were identified with BE, 551 men (67.9%), male to female ratio 2.1:1, and with a median age at diagnosis of 63 years (IQR 53-73). At the time of BE diagnosis, the prevalence of neoplasm was 13.9%, (56 LGD, 14 HGD, and 43 EAC). Out of 56 LGD, 16.1% progressed to HGD (n=6) or EAC (n=3). Among 698 BE patients without neoplasm at the time of BE diagnosis, the cumulative incidence of neoplasm was 6.9% (29 LGD, 7 HGD, and 12 EAC) with median observation-period of 7 years (IQR: 4-9). In total, 161 cases of neoplasm (65.8% in long-segment, 34.2% in short-segment BE) were diagnosed in this BE cohort; 67.2% at time of BE diagnosis; and 32.8% without dysplasia at diagnosis progressed to neoplasm during follow-up.

Conclusion

In this large population-based study of patients with BE, around 14% were diagnosed as harboring neoplasm concomitantly with BE, which accounted for approximately 67% of all neoplasms. During the median follow-up of 7 years, about 7% of BE showed dysplastic or malignant progression.
570. ADRENAL METASTASES OF ESOPHAGEAL CANCER: SURGICAL MANAGEMENT OF SINGLE METASTASES
Authors: Lanz Laura Gomez , Palacios Jorge De Tomas , Lerma Maria Tudela , Jalon Jose Maria Monturiol , Sanchez Enrique Velasco
Published: September 2024

Background

Therapeutic possibilities of single metastases of esophageal carcinoma are evaluated.

Methods

We show the case of a patient diagnosed and treated for adenocarcinoma of the esophagus, who one year after surgery was diagnosed with a single adrenal metastasis.

The patient underwent chemotherapy treatment at the time of diagnosis of metastasis, after concluding the treatment and his disease remained stable, being the suprarenal the only site of recurrence, surgical treatment was proposed.

Results

the patient underwent a laparoscopic suprarenalectomy, with a 2 hour recovery, without complications and discharged on the third postoperative day.

Conclusion

surgical treatment of single metastases of esophageal cancer is possible and can make the patient free of disease.

In our center this option is proposed, when after diagnosis and after concluding chemotherapy treatment, the recurrence remains stable, there are no new lesions, and if this location is resectable.

In our center we have performed in the last year, two cases of adrenal metastasis of esophageal cancer.
606. THE CHANGES OF THORACOSCOPIC OR LAPAROSCOPIC APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE IN JAPAN
Authors: Yajima Satoshi , Suzuki Takashi , Shiratori Fumiaki , Yamakawa Teruki , Okubo Kazunori , Oshima Yoko , Shimada Hideaki
Published: September 2024

Background

The surgical treatment for esophageal rupture includes various approaches such as thoracotomy, laparotomy, thoracoscopy, and laparoscopy.

These approaches aim to: Suture the perforation site, sealing it with omentum. or esophageal resection and reconstruction. Cleanse and drain the mediastinum or thoracic cavity. Adding gastrostomy or intestinal as needed. Many reports showed the usefulness of minimally invasive surgeries. In this study, we added our cases and discussed the surgical techniques and outcomes.

Method

I searched for reported cases in PubMed and the Journal of Health Care and Society and supplemented them with my experimental cases for analysis. All reports published between 2001 and the end of 2022 were included in this study.

Results

From 2001 to 2022, there have been 15 reports (16 cases) of idiopathic esophageal rupture using arthroscopic techniques, including our cases, 14 cases in men and 3 cases in women. The ages of the patients ranged from 39 to 78 years (mean 61 years, median 61 years), and the rupture sites were the lower esophagus in 15 cases (88%) and the middle part in 2 cases (12%). The time from onset of symptoms to surgery ranged from 4 to 77 hours. The approach method was thoracoscopy in 7 cases (41%), laparoscopy in 8 cases (47%), and a combination of thoracoscopic and laparoscopy in 2 cases (12%). Complications of Clavien-Dindo classification IIIa or higher were observed in 3 patients (18%). There were two cases each of thoracoscopic and laparoscopic complications in which complications were observed. The time from arthroscopic surgery to discharge was 12-120 days (mean 36.7 days, median 30.5 days). For cases with a thoracoscopic approach, the period from surgery to discharge is 23-120 days (average 50.1 days, median 39 days), and for cases with a laparoscopic approach, the period from surgery to discharge is 12-82 days (average 30 days). days, median 21 days).

Discussion

Spontaneous esophageal rupture develops various disease patterns such as mediastinum limited type with mild symptoms and intrathoracic rupture type. There are various treatment approaches, including conservative therapy, endoscopic closure, and surgery. The laparoscopic approach seemed to reduce the length of hospital stays.

Conclusion

The surgical approach for spontaneous esophageal rupture has been changed from thoracotomy to laparoscopic surgery. The trans hiatal procedure will increase among laparoscopic surgery. Spontaneous esophageal rupture is a remarkably highly invasive disease, and we thought that a less invasive and simpler treatment would be desirable.
608. ASSOCIATION BETWEEN SYSTEMIC IMMUNE-INFLAMMATION INDEX (SII) AND THE RISK OF ALL-CAUSE, CANCER, AND NON-CANCER MORTALITY IN THE GENERAL POPULATION
Authors: Xia Peng , Wu Siyu , Liu Zhao , Li Xing , Gao Shan
Published: September 2024

Background

The system immune-inflammation index (SII), based on the counts of platelet, neutrophil and lymphocyte, was recognized as an accurate immunoinflammatory predictor. In order to identify the association between SII with all-cause, cancer and non-cancer mortality among general population, we conducted this prospective cohort study.

Methods

25955 participants (≥ 18 years) were included from 2005-2018 National Health and Nutrition Examination Survey (NHANES) and grouped according to the SII quartiles. The association between SII and mortality was identified by multivariate Cox regression and restricted cubic spline (RCS) analyses. Survival outcomes were assessed using Kaplan-Meier analyse.

Results

In fully adjusted model, the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of individuals in Q4 of SII were 1.24 (1.09, 1.41) for all-cause mortality and 1.41 (1.23, 1.63) for non-cancer mortality compared with Q1. The aHR and 95% CIs in Q2 of SII were 0.70 (0.50, 0.99) and in Q3 were 0.68 (0.52, 0.87) compared with Q1 for cancer mortality. In RCS analyses, J-shaped curves were observed in the association between SII with all-cause and non-cancer mortality. Additionally, a U-shaped curve was identified between SII and cancer mortality with a threshold SII value of 445.22.

Conclusion

Therefore, our findings imply that SII can serve as a potential prognosis indicator among general population. Elevated SII is associated with higher all-cause and non-cancer mortality. Besides, both lower and higher SII can serve as predictive factors for cancer mortality.
612. THE UTILITY OF H ANASTOMOSIS IN INFLATABLE MEDIASTINOSCOPE-ASSISTED TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Wu Na , Hu Yang
Published: September 2024

Objectives

In this article we present a novel technique to improve the outcome of mediastinoscope-assisted transhiatal esophagectomy (MATHE).

Methods

H anastomosis is derived from intussusceptive anastomosis, which reinforced the barrier from the alimentary canal cavity to the mediastinum and fromed an one-direction valve to preventing gastroesophageal reflux. H anastomosis improved the blood supply of gastric tube by reduce the thickness of intussuscepted tissue to adapt to the narrow esophageal bed in MATHE.

Results

Anastomotic leakage, gastroesophageal reflux and dysphagia were well controlled.

Conclusions

The good outcomes of H anastomosis in MATHE need further validation.

https://1drv.ms/v/s!AmCqlJJZqDPDjRjAwgLApB_mkRVp?e=b8Iflp
614. LAPAROSCOPIC RE DO FUNDOPLICATION
Authors: Parthasarathi R , Cumar Bharath , Ramesh N
Published: September 2024

Background

Laparoscopic fundoplication though an effective form of therapy for patients with refractory gastroesophageal reflux disease, can fail due to poor patient selection or compromised surgical technique. Re do laparoscopic fundoplication for failed anti reflux surgery is a challenging task prone to further failures if not properly done.

Methods

Retrospective analysis of consecutive patients who underwent laparoscopic redo fundoplication in a tertiary care center between January 2012 and March 2022.

Results

There were a total of 24 patients that underwent redo fundoplication during the study period. Wrap migration was noted in 8 (33.3%) patients while the wrap was too tight which led to dysphagia in 5

(20.8%) patients. Two patients had previously undergone laparoscopic redo fundoplication while one patient initially underwent open Nissen’s fundoplication. All the patients were managed successfully laparoscopically without any conversion. The median time interval between the first surgery and the redo operation was 8 months (3 months to 12 years). Symptomatic improvement was observed in 20 (83.3%) while 4 (16.7%) patients continued to have symptoms.

Conclusion

Laparoscopic redo fundoplication can yield satisfactory results in patients after initially failed anti reflux surgery when performed in experienced centers. Proper case selection and meticulous surgical technique to address the primary cause of failure is paramount.
622. COMPARISON OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY WITH CONVENTIONAL MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A MULTI-INSTITUTIONAL COHORT STUDY
Authors: Tsunoda Shigeru , Obama Kazutaka , Hosogi Hisahiro , Kanaya Seiichiro , Matsufuji Shohei , Noshiro Hirokazu , Shibasaki Susumu , Suda Koichi , Uyama Ichiro , Ohuchida Kenoki , Okabe Hiroshi , Nishigori Tatsuto
Published: September 2024

Background

The Japanese public insurance system approved robot-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer in 2018. Since then, an increasing number of RAMIE has been performed every year. However, it is unclear whether RAMIE is more beneficial than conventional minimally invasive esophagectomy (MIE) in terms of short-term and long-term outcomes.

Methods

A total of 396 patients (RAMIE, 145; MIE, 251) with resectable esophageal cancer who underwent esophagectomy between 2016 and 2019 at 6 institutions were included. A propensity score matching analysis was performed to compare the short-term outcome. Two-stage esophagectomy, salvage surgery, and palliative resection were excluded.

Individual propensity scores were calculated based on the following 15 variables: age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS), hemodialysis, oral steroid use, obstructive pulmonary disease, histology, tumor location, clinical T, N, M classification, preoperative therapy, field of lymphadenectomy, and organ used for reconstruction.

Results

After matching 272 patients were analyzed. RAMIE took the significantly longer operating time (629min; 570min, p=0.0005), but the amount of blood loss (90g; 84g), number of harvested mediastinal nodes (24; 25), and in-hospital mortality (1.5%; 0.7%) were comparable. RAMIE group showed a trend of less severe post-operative morbidity (Clavien–Dindo grade III or higher) (18%; 27%) and significant reduction of recurrent laryngeal nerve palsy (23%; 35%, p=0.046).

The 5-year overall and relapse-free survival in the RAMIE and MIE groups were 65%; 61% [hazard ratio (HR), 0.77; 95% CI: 0.51, 1.17], and 61%; 51% (HR, 0.73; 95% CI: 0.51, 1.06), respectively.

Conclusion

RAMIE was safely performed even during the early period of its application. Despite the longer operating time, RAMIE would be a promising alternative to MIE, with a better trend of short- and long-term outcomes, including a significantly lower incidence of postoperative recurrent laryngeal nerve palsy.
633. DOES SARCOPENIA PREDICT NEOADJUVANT CHEMOTHERAPY TOXICITY IN OESOPHAGEAL ADENOCARCINOMA PATIENTS?
Authors: Dayanamby Abbienaya , Chmelo Jakub , Convill James , Samake Maurice , Petrides George , Bradshaw Alexander , Phillips Alexander W
Published: September 2024

Background

Sarcopenia, defined as the loss of muscle mass and function, is associated with a high risk of adverse outcomes in the cancer population. Radiologically defined sarcopenia has been linked to both short- and long-term outcomes after oesophagectomy for cancer. Neoadjuvant treatment plays a crucial role in the treatment of locally advanced oesophagogastric cancer. It is not fully clear whether patients with low muscle mass are more prone to sustaining acute chemotherapy toxicities during neoadjuvant chemotherapy (NAC) prior to oesophagectomy, especially when ECX or FLOT chemotherapy regimens are used.

Methods

Patients undergoing NAC and oesophagectomy between January 2016 and December 2022 had their skeletal muscle index analysed (SMI) at the time of initial staging. SMI was computed from staging CT scan slices as the lean muscle mass at the level of the third lumbar vertebra and the height of the patient. Patients were then divided into two categories depending on whether their NAC was completed fully (FLOT four cycles, ECX three cycles) or whether NAC treatment was incomplete. The Mann-Whitney U test was used to statistically test the hypothesis of any difference in SMI between these two groups.

Results

There were 208 patients included in this study. 109 patients had ECX and 90 patients had FLOT. Fourteen patients (6.7%) did not complete NAC treatment fully but progressed to oesophagectomy. The median (IQR) SMI of patients who did not complete NAC treatment was 46.54 cm2/m2 (43.40-51.32) compared to 50.87 cm2/m2 (45.88-57.33) for those who received all prescribed NAC cycles (p=0.026).

Conclusion

This study demonstrated that patients with higher SMI are better equipped to withstand the side effects of NAC and complete this treatment. It appears that strategies to improve sarcopenia before or during NAC are needed. Prehabilitation might be one of these strategies, and therefore, the effect of various prehabilitation regimens on sarcopenia needs to be further explored.