bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.137: SALVAGE ESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY: EXPERIENCES OF A SINGLE INSTITUTION
Authors: Guo Xufeng , Li Zhigang
Published: September 2018

Background

Definitive chemoradiotherapy (dCRT) is considered a standard treatment for locally advanced esophageal cancer. Despite of long-term survival of 15–20% after such treatment, locoregional recurrence occurs in around 40–60%. Further radiotherapy is often contraindicated because the maximal tolerable dose has been achieved. As for salvage chemotherapy, the treatment outcome is disappointing. Salvage surgery is another choice but its role still remains debatable. The present study was designed to evaluate the safety and efficacy of salvage esophagectomy.

Methods

18 consecutive cases of salvage esophagectomy after dCRT by a single institution were analyzed.

Results

(1) 16 males and 2 females. There were 6 cases (33.3%) and 12 cases (66.7%) of recurrent and persistent tumor after dCRT respectively; (2) All the patients were treated with McKeown operation stytle combing thoracic and abdominal lymph nodes dissection. Esophagus was replaced by stomach of 15 cases and colon of 3 cases respectively. Radical resection (R0) was performed in 12 cases, palliative resection (R2) in 6 cases. There were 4 cases of pathological complete response (pCR); (3) The incidence of postoperative complications was 61.1% (11/18), including 6 cases of pulmonary infection, 4 cases of anastomotic leak, 2 cases of incision infection, one case of respiratory insufficiency, one case of recurrent laryngeal nerve paralysis, one case of chylothorax, one case of aortic bleeding caused by empyema; (4) One patient died in perioperative period because of aortic bleeding due to empyema. The follow-up period was from 2 to 26 months, and the median follow-up time was 9 months. There were 13 patients survived and 5 patients died at the last follow-up date including one death in perioperative period, 2 cases died of local-regional recurrence and metastasis respectively.

Conclusion

Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT, but the incidence of postoperative complications is high. Accurate clinical staging is especially important after dCRT and ycT4, ycN + patients should be avoided. R0 resection and recurrence after long disease free period are favorable prognostic factors.

Disclosure

All authors have declared no conflicts of interest.
PS02.138: SALVAGE ESOPHAGECTOMY: SINGLE ONCOLOGICAL CENTER EXPERIENCE
Authors: Sabino Flávio , Guimaraes Marco , Eduardo Pinto Carlos , Fernandes Daniel , Felipe Pinto Luis , Albagli Rafael , Ribeiro Luciana
Published: September 2018

Background

Surgical resection is considering the gold standard in esophageal cancer treatment, with 15–40% cure global rates. Radical exclusive chemoradiotherapy (CRT) is used in patients with local advanced esophageal cancer or without clinical conditions for esophagectomy, with a 5-year overall survival up to 30%. However, locoregional control is poor with a 40–60% recurrence rate and salvage esophagectomy maybe an option for these patients.

Methods

Our objective is to report the experience of a single high volume oncological institution with salvage esophagectomy.

Retrospective analysis of 28 patients medical records, with esophageal cancer, submitted to Salvage Esophagectomy in Brazilian NCI after radical exclusive CRT or RT between January 1990 and December 2015.

Results

Median age was 56 years and most are male (78,5%). Esophageal middle third was the tumor principal location (50%) and histological type was squamous cell carcinoma (82%). Thoracic approach for esophagectomy was the principal surgical technique, and gastric tube the most used conduit for reconstruction (78,5%). Surgery was R0 in 83% of the cases, with a surgical morbidity of 64%. Median hospital time was 15 days (8–58) and surgical mortality 14% (4 patients), with 7% in the first 30 days. Median overall survival was 22,3 months.

Conclusion

Our results are in line with published data in the literature. Besides surgical morbidity and mortality, Salvage Esophagectomy remains de only chance of cure for patients with locoregional recurrence after radical exclusive CRT.

Disclosure

All authors have declared no conflicts of interest.
PS02.139: THE TREATMENT STRATEGY AND CLINICAL OUTCOMES FOR SALVAGE ESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY
Authors: Ogawa Kyohei , Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Maeda Shinsuke , Toyoshima Yukinori , Ide Hiroko , Osugi Harushi , Yamamoto Masakazu
Published: September 2018

Background

Definitive chemoradiotherapy for esophageal cancer which was unresectable tumor has become common therapy. In recently, we have perform chemoradiotherapy for resectable tumor because esophagectomy for esophageal cancer is an invasive surgical procedure. But some cases were recurrent. We examined the treatment strategy and clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer.

Methods

We reviewed 46 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive chemoradiotherapy with more than 50Gy of radiation from 2000 to 2017. We exam (1) Back ground (2) Term after Chemoradiotherapy (3)Surgical approach (4) Route of reconstruction (5)Rang of lymphanodectomy (6)Complication (7)Prognosis.

Results

Age 63.0(43–79), Male: Female = 44:2, Location: Upper/Middle/Lower = 15/25/8, T1/T2/T3/T4 = 11:2:25:8 R0: R1: R2 = 35:9:2 (2) Within1 year/More than 1 year = 31/15 (3) Neck digection/Right thoracotomy: Left thoracotomy: laparotomy = 8:31:5:2 (4) Mediastinal rute/Ante/Retro = 34:9:3 (5) 1 Field:2 Field:3 Field = 11:27:8 (6) Anastleakage/Pneumonia/Abcess/Meningitis/Fluid in the thoracic cavity = 11: 9: 4: 1: 8 (7) 5-years survival rate was 36%. Hospital death was4.3%

Conclusion

There were high rate complications for salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Patients should be carefully selected for salvage esophagectomy.Surgeons should consider the indications and techniques for esophageal surgery to increase cure rates and decrease morbidity.

Disclosure

All authors have declared no conflicts of interest.
PS02.140: OUTCOMES OF SALVAGE SURGERY IN PATIENTS WITH RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY
Authors: Slaman Annelijn , Eshuis Wietse , Draaisma Werner , Gisbertz Suzanne , Bergman Jacques , Van Laarhoven Hanneke , Meijer Sybren , Hulshof Maarten , Van Berge Henegouwen Mark I
Published: September 2018

Background

Definitive chemoradiotherapy for esophageal cancer can be a treatment option in selected patients. In patients with locoregional recurrence after definitive chemoradiotherapy, additional curative esophagectomy may be possible, but evidence for this ‘salvage’ esophagectomy is limited. The aim of this study was to evaluate clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy.

Methods

A prospectively maintained database was used to select patients who underwent esophagectomy for locoregional recurrent cancer of the esophagus or gastroesophageal junction after dCRTx (‘salvage esophagectomy’) and patients who underwent curative esophagectomy following neoadjuvant chemoradiotherapy (‘nCRTx esophagectomy’) between January 2013 and January 2018. Patients underwent salvage resection without direct reconstruction (2-stage salvage procedure) or with a direct reconstruction. Perioperative outcomes of salvage esophagectomy were compared to nCRTX esophagectomy. Oncologic outcomes were evaluated using the Kaplan-Meier method.

Results

A total of 16 patients underwent salvage esophagectomy and 330 patients underwent nCRTx esophagectomy during the study period. Direct reconstruction was performed in 3 patients (13.3%) of the salvage group versus 328 patients (99.1%) who underwent nCRTx esophagectomy (P < 0.001). R0-resection rate was higher after esophagectomy following nCRTx than after salvage surgery (97.0% versus 68.8% respectively, P < 0.001). Difference in morbidity did not reach statistical significance (58.8% versus 81.3% respectively, P = 0.115). The combined (30-day and in-hospital) mortality and 90-day mortality were significantly higher after salvage esophagectomy (2.4% versus 31.1% and 4.7% versus 42.9%, both P < 0.001). Median follow-up of all surviving patients was 21.4 months (IQR, 10.0–36.2). The overall survival in the salvage group had a median of 4.3 months (95% CI, 0–10.0) versus a median of 43.7 months (95% CI, 33.9–53.5) in the nCRTx esophagectomy group. The cumulative 1-year and 3-year survival of the salvage group were 42.2% and 28.1%. Within 5 years after surgery all patients in the salvage esophagectomy group had died.

Conclusion

Definitive chemoradiotherapy followed by esophagectomy for esophageal carcinomas is associated with a high proportion of R1 resections and high mortality rates. It is recommended to evaluate these results in larger patient cohorts. Salvage resections should only be performed in strongly selected patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.141: RESULTS AND PROSPECTS OF SALVAGE SURGERY AFTER DEFINITIVE CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Nabeya Yoshihiro , Hoshino Isamu , Nagata Matsuo , Takiguchi Nobuhiro , Ikeda Atsushi , Soda Hiroaki , Tonooka Toru , Gunji Hisashi , Yoshizumi Arihito , Imazeki Hiroshi , Minashi Keiko , Hironaka Shuichi
Published: September 2018

Background

Salvage surgery for esophageal cancer (squamous cell carcinoma) patients with locoregional failure after definitive chemoradiotherapy (dCRT) is high risk, and no surgical consensus has been established. We evaluated our 2 procedures of salvage surgery for failure which was confirmed by GS, CT, and PET: [SE] esophagectomy followed by reconstruction for patients ≤ 80 yo, without cT4 at the initial presentation, and whose recurrent/residual tumor can be removed as a R0 resection, and [SL] dissection of only metastatic abdominal lymph nodes for patients without any other failure.

Methods

All patients received dCRT ≥ 50 Gy followed by salvage surgery. In 17 patients who underwent SE from 2009 to 2014, prophylactic dissection of cervical or 106 tbL nodes was often omitted, poststernal route was preferred, LigasureTM was routinely used, and aggressive nutritional intervention with enteral nutrition was perioperatively supplied. In SL for 5 patients until 2016, No. 3 and 7 nodes were removed.

Results

[SE] Sixteen patients received R0 resection. Postoperative complications were noted in 6 patients (35%), and pleural effusion was the most common (24%). However, neither anastomotic leakage nor in-hospital death developed. Median overall survival (OS) time is 44 months, and provisional 5-year OS rate is 41%. While 7 patients died of esophageal caner, one died from another caner and 3 died from other illness. Tentative 5-year disease-free survival (DFS) rate is 54%. Between cases with relapse after CR and cases with residual tumor, no significant difference was found in postoperative recurrence (2/8 vs. 5/9, P = 0.33) and survival (provisional 5-year OS rate: 50 vs. 33%, P = 0.45/provisional 5-year DFS rate: 70 vs. 40%, P = 0.22), while the relapsed patients after CR showed a little better outcome. [SL] Three patients have no relapse for 60/36/18 months after SL. One developed bone metastasis in 54 months after SL. One patient developed repeated abdominal recurrence and underwent SL again.

Conclusion

SE can be safely performed with strict planning, secure surgery and appropriate perioperative care. SL can also be beneficial as a less invasive salvage surgery to selected patients. Strict decision-making and appropriate postoperative follow-up method with attention to other diseases should be established based on further studies.

Disclosure

All authors have declared no conflicts of interest.
PS02.144: ESOPHAGOPLASTY WITH FREE JEJUNUM FLAP AFTER COLON-ESOPHAGUS CONDUIT ISCHEMIA
Authors: Papp Andras , Vereczkei Andras , Pavlovics Gabor , Horvath Ors
Published: September 2018

Background

Colon interposition is mainly used as a second line treatment, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign and congenital diseases in patients with long-life expectancy. Colon provides extended conduit length, reliable blood supply and low incidence of reflux. However, the early and late postoperative ischemic complication rate is 5–15%.

Methods

Colon ischemia can frequently cause anastomosis complications, which can be safely treated with dilation or surgery. The most serious but rare complication is the acute conduit necrosis. More severe cases of necrosis require conduit take down with proximal esophageal diversion and placement of an enteral feeding tube. An uncommon complication is the colonic stricture due to chronic ischemia, which can be treated with conservative methods such as dilation and stenting. Surgery is indicated since the impaired deglutition can compromise the quality of life. Supercharged or free jejunal interposition is a suitable alternative conduit for esophageal replacement in patients with otherwise limited delayed reconstructive options. Good functional outcomes can be achieved despite the formidable technical challenges in this group of patients.

Results

In three such cases, we could successfully use a free jejunal flap for reconstruction; the replacement type was different, using substernal, presternal and sternotomy routes. The arterial blood supply was provided by the internal mammary artery. Saphenous graft was used to interconnect to external jugular or innominate vein to reestablish the venous drainage. All three patients survived without further complication.

Conclusion

Overall, it can be stated that free jejunal graft transplantation can be used to resolve complicated cases that cannot be reconstructed with any other methods and jejunum offers a good swallowing function and quality of life.

Disclosure

All authors have declared no conflicts of interest.
PS02.145: TREATMENT FOR CHYLOTHORAX AFTER THORACIC ESOPHAGECTOMY
Authors: Kanabuchi Sawa , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Takaya Kai , Okamoto Hiroshi , Maruyama Shota , Kamei Takashi
Published: September 2018

Background

Chylothorax is relatively rare complication in esophagus cancer surgery. But once it happens, appropriate treatment is absolutely essential to avoid another severe complication. We report our treatment results of chylothorax after thoracoscopic esophagectomy and represent the appropriate treatment strategy for this complication.

Methods

We examined 468 patients who underwent thoracoscopic esophagectomy for esophageal cancer from January 2009 to November 2017. Thoracic duct was mostly preserved except the case which had cancer invasion. Also, MRI scan was performed in all cases to detect the location of thoracic duct preoperatively. When the surgical approach was planned for chylothorax after esophagectomy, 250ml of 20% soybean oil was administrated through jejunostomy tube 30 minutes prior to the surgery. Thoracic duct is usually detected at the inferior mediastinum by thoracoscopy and applies ligation or clipping. Treatment effect can be checked during the surgery by interruption of soybean oil leakage which was easily recognized before ligation.

Results

Postoperative chylothorax was detected in seven out of 468 cases (1.50%). Thoracic duct had been preserved in all of those seven cases. Among them, two cases improved just by drainage and five needed to undergo thoracoscopic thoracic duct ligature. The mean amount of daily thoracic drainage was 1106 ml in the ligation group whereas 565 ml in the conservative treatment group. The median hospitalization days after surgery among ligation and conservative group was 33.5 and 25days, the median day until oral intake was 21 and 13 days, the median days until thoracic drain removal was 10.5 and 9 days, respectively.

Conclusion

In the case of chylothorax after esophagectomy, early oral intake and short hospitalization was possible by performing thoracoscopic thoracic duct ligature, especially in the case which had large amount of pleural effusion drainage. MRI was useful equipment to detect the variant of thoracic duct and to perform thoracoscopic thoracic duct ligature safely.

Disclosure

All authors have declared no conflicts of interest.
PS02.156: IMPROVING COMPLIANCE WITH ENHANCED RECOVERY PROTOCOLS IN OESOPHAGO-GASTRIC CANCER SURGERY: A COLLABORATIVE QUALITY IMPROVEMENT PROJECT
Authors: Doganay Emre , Halliday Laura , Barber Susan , Mccormack Orla , Moorthy Krishna
Published: September 2018

Background

Compliance with enhanced recovery programmes (ERPs) in oesophago-gastric (OG) surgery is challenging due to high rates of complications. Higher compliance is associated with better outcomes; however compliance is difficult to assess due to variable reporting and lack of standardisation of descriptors within an ERP. This study aims to understand variability in ERPs across two OG cancer centres and analyse impact of cross-site engagement and collaborative quality improvement (QI) on ERP compliance.

Methods

The collaborative QI project consisted of workshops and meetings that involved presentations and assessment of variations across ERPs, with prospective recording of ERP compliance at each site and cross-site feedback of results. Compliance and outcomes for 2016 were compared with 2017 to assess impact of QI initiative.

Results

At site A, overall mobilisation improved from 25% to 28% (P = 0.448) and oral intake from 19% to 56% (P = 0.002). There were no improvements in NGT (65% to 54%) and drain removal (69% to 53%). At site B, mobilisation improved from 51% to 68% (P = 0.097), NGT removal from 37% to 51% (P = 0.196), and drain removal from 15% to 32% (P = 0.412). There was no improvement in oral intake (47% to 34%). At site A, all complications reduced from 56% to 46% (P = 0.401), pneumonia from 47% to 22% (P = 0.024), and grade 3 complications from 22% to 15% (P = 0.605). At site B, all complications reduced from 58% to 54% (P = 0.697), pneumonia from 46% to 37% (P = 0.353), and grade 3 complications from 23% to 20% (P = 0.678). At site A, the median length of hospital stay reduced from 11 days to 9 days (P = 0.024), with no improvement at site B (12 to 14 days).

Conclusion

Engagement between clinical teams across the two sites resulted in improvement in postoperative outcomes. Compliance with individual ERP elements was observed across a few domains. Challenges encountered in this project included a lack of standardised definitions of ERP descriptors, variability in measures and variations in the individual elements within each ERP.

Disclosure

All authors have declared no conflicts of interest.
PS02.161: METABOLIC MARKERS OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA: A SYSTEMATIC REVIEW AND POOLED ANALYSIS
Authors: Mei Goh Yan , Boshier Piers , Antonowicz Stefan , Hanna George
Published: September 2018

Background

Oesophageal squamous cell carcinoma (ESCC) is a major global health burden associated with poor survival. Patients suffering from this condition typically present at an advanced stage due to non-specific early symptoms. An increasing emphasis on early detection has led to the investigation of novel biomarkers of ESCC. This systematic review aims to define existing biomarkers of ESCC and to identify perturbations in associated metabolic pathways.

Methods

A systematic online literature search (1946–January 2018) was performed to identify studies reporting metabolic biomarkers of ESCC. Pooled point estimate of the hierarchal summary ROC curve of analysed metabolites was performed using bivariate meta-analyses. Conduct of this review was in accordance with the recommendations of the Cochrane Library and MOOSE guidelines.

Results

An online search identified 628 potential relevant studies, of which eight (including a total 508 patients) met inclusion criteria. All publications represented phase-I biomarker discovery studies. Methods used to assess metabolites in patients with ESCC included liquid chromatography-mass spectrometry (n = 6), gas chromatography-mass spectrometry (n = 1) and 1H-nuclear magnetic resonance (n = 1). Sample types utilised were plasma (n = 5), tissue (n = 2) and urine (n = 1). A total of 1670 metabolites were identified as being associated with ESCC. Key metabolic pathways involved included tricarboxylic acid cycle and in pathways of oxidative stress. Metabolites identified increased in ESCC are breakdown products of fatty acid synthesis and glycerophospholipid metabolism e.g.: palmitic acid, oleic acid, LysoPC(24:0), LysoPC(18:2), L-carnitine, branched chain amino acids e.g.: valine, leucine, isoleucine and phenylalanine. Metabolites decreased in ESCC are breakdown products of amino acid metabolism e.g: glutamine, carbohydrates e.g.: glucose and organic acids e.g.: α-ketoglutaric acid oxime. Pooled analysis of findings from five studies showed an area under the receiver-operating characteristic analysis curve of 0.96, sensitivity 88.0% (95% CI 80.8%-92.7%) and specificity 93.5% (95% CI 96.9%- 86.8%).

Conclusion

This is the first review to define metabolic biomarkers associated with ESCC. Significant variability in identified metabolites is evidence of the broad range of analytical techniques employed and the diversity of metabolic pathways associated with this disease. Notwithstanding, findings provide important insight in to those metabolites associated with ESCC and provide a basis for future studies.

Disclosure

All authors have declared no conflicts of interest.
PS02.162: THREE-YEAR OVERALL SURVIVAL UPDATE FROM PHASE II STUDY OF CHEMOSELECTION WITH DCF AND SUBSEQUENT CONVERSION SURGERY FOR LOCALLY ADVANCED UNRESECTABLE ESOPHAGEAL CANCER
Authors: Yokota Tomoya , Kato Ken , Hamamoto Yasuo , Tsubosa Yasuhiro , Ogawa Hirofumi , Ito Yoshinori , Hara Hiroki , Ura Takashi , Kojima Takashi , Chin Keisho , Hironaka Shuichi , Kii Takayuki , Kojima Yasushi , Akutsu Yasunori , Matsushita Hisayuki , Kawakami Kentaro , Mori Keita , Nagai Yushi , Asami Chika , Kitagawa Yuko
Published: September 2018

Background

A multicenter phase II trial revealed that docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (IC) and subsequent conversion surgery (CS) was tolerable and effective in patients with locally advanced unresectable esophageal cancer (LAUEC) (Br J Cancer 2016;115:1328–1334). Here, we report updated 3-year analyses to further characterize the impact of DCF-IC followed by CS.

Methods

Esophageal cancer patients with clinical T4 disease and/or unresectable supraclavicular lymph node metastasis were eligible. The treatment starts with 3 cycles of DCF-IC, followed by CS if resectable, or by concurrent radiation plus chemotherapy with 5-fluorouracil and cisplatin (CF-RT) if not resectable. This updated analysis represents 3-year overall survival (OS), 3-year progression free survival (PFS), location of relapse, and subsequent therapy.

Results

As of October 11, 2017, 25 patients were dead. The median follow-up period in patients surviving without death was 39.3 months (95%CI: 38.7 - 41.7months). The estimated 1-year OS was 66.7% and lower limit of 95% confidence interval was 54.6%. The estimated 3-year OS was 46.6% (95% CI; 34.2 - 63.5%). The OS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6% (95%CI: 38.1 - 67.3%) and the estimated 3-year PFS was 39.6% (95%CI: 27.7 - 56.6%). The PFS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year PFS: 61.3% vs. 25%). The recurrence or progression in primary site was observed in 31% of non R0 group. There was no significant difference in the rates of distant metastasis between the two groups (non R0 group vs. R0 group; 21% vs. 16%). The subsequent therapy after protocol therapy included chemotherapy (n = 18), radiotherapy (n = 11), and surgery (n = 5).

Conclusion

This longer follow up of DCF-IC followed by CS strategy for patients with LAUEC revealed promising OS and PFS. Based on this phase 2 trial, JCOG1510, a prospective randomized controlled trial to compare chemoselection with DCF-IC followed by CS versus CF-RT as a standard treatment is in preparation for LAUEC.

Disclosure

All authors have declared no conflicts of interest.
PS02.163: A CASE OF SEPARATION SURGERY WITH DRAINAGE TUBE-LESS (DRESS) ESOPHAGOSTOMY FOR ADVANCED CANCER WITH A RESPIRATORY FISTULA
Authors: Tanoue Yukinori , Takeno Shinsuke , Kawano Fumiaki , Tashiro Kousei , Hamada Rouko , Miyazaki Yasuyuki , Nanashima Atsushi
Published: September 2018

Background

Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported.

Methods

Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery).

Results

Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free.

Conclusion

Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed.

Disclosure

All authors have declared no conflicts of interest.
PS02.167: IMPACT OF POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOPHAGUS FOR CARCINOMA ON LONG-TERM SURVIVAL
Authors: Snajdauf Martin , Harustiak Tomas , Pazdro Alexandr , Lischke Robert
Published: September 2018

Background

Esophagectomy with 2–3 field lymph node dissection is one of the most invasive surgical treatment for malignancy and is still associated with a high mortality and morbidity despite improvements in surgical techniques and postoperative management. The impact of postoperative complications on perioperative morbidity is widely accepted. But the impact of postoperative complications on long-term survival remains controversial.

Methods

A retrospective analysis was performed on patient who underwent transthoracic esophagectomy with intrathoracic anastomosis for esophageal cancer between January 2005 and December 2012 in our department (415 patients). We excluded non-radical resections (R1, R2 – 27 patients, 6.5%) and patients who died within 90 day after operation (20 patients, 4.8%). Data on gender, BMI, histologic diagnosis, tumor staging, neoadjuvant treatment, comorbidities, technical complications and postoperative medical complications were reviewed. Considered postoperative complications were anastomotic leak, empyema, chyle leak, pneumonia, ARDS, cardiac arrhythmia, wound infection and urinary tract infection. We analysed separately extrapolated serious complications Clavien Dindo 3–4 and their possible impact on overall survival. Prognostic factors were assessed by multivariate analysis.

Results

Total number of analysed patients was 363. The median follow up was 8.5 years. From the baseline characteristics, the presence of atrial fibrillation (P = 0.0157, HR 2.376) and hypertension (P = 0.0093, HR 1.488), higher staging pT3–4 (0.0146, HR 1.437) and presence of lymph node metastasis pN + (P < 0.001, HR 2.263) had a negative impact on overall survival. Among the postoperative complications, only chyle leak (P = 0.0327, HR 4.023) had a negative prognostic factor on overall survival.

Conclusion

In this single institution series, among the postoperative complications only chylothorax affect negatively the overall survival. Accurate ligation of resected thoracic duct stumps to minimize chyle leak is important to improve outcomes. The influence of others postoperative complications wasn’t significant. We assume important to exclude postoperative mortality from analysis to prevent bias.

Disclosure

All authors have declared no conflicts of interest.
PS02.172: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER
Authors: Ohga Takefumi , Kuma Sosei , Ezaki Takahiro
Published: September 2018

Background

The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer.

Methods

A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions.

Results

The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II.

Conclusion

In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality.

Disclosure

All authors have declared no conflicts of interest.
PS02.173: SURGICAL MANAGEMENT OF TRACHEOESOPHAGEAL FISTULAS IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Slaman Annelijn , Eshuis Wietse , Van Boven Wim , Gisbertz Suzanne , Van Berge Henegouwen Mark I
Published: September 2018

Background

Tracheoesophageal fistula is a severe complication that can occur in patients who are treated for esophageal cancer. There is currently no consensus about the best surgical treatment. The aim of this study was to evaluate the results after surgical treatment of tracheoesophageal fistulas in patients with a history of esophageal cancer in a tertiary referral center.

Methods

Consecutive patients with a history of esophageal cancer who were surgically treated for tracheoesophageal fistulas between January 2010 and December 2017 were included. Primary outcome was success rate after surgical treatment. Surgical treatment was defined as successful if no combined (30-day or in-hospital) mortality and no recurrences occurred.

Results

Twenty patients underwent 26 surgical treatments for tracheoesophageal fistulas. Median age was 64 years (IQR 59–68). One patient developed a tracheoesophageal fistula elsewhere and was referred to our center. The incidence of tracheoesophageal fistulas following esophagectomy in our center was 1.9% (n = 13). Other tracheoesophageal fistulas were caused by traumatic intubation (n = 3) or definitive chemoradiation (n = 3). Surgery consisted of covering the tracheal defect with a muscle flap (n = 15), and/or pericardial patch (n = 11) or primary sutures (n = 5) possibly with resection of the reconstruction (n = 6). The median follow-up was 7.8 months (IQR 1.5–38.2). Treatment was successful in 60.0% of the patients (n = 12). Overall morbidity and combined (in-hospital and 30-day) mortality rates were 65.0% and 35.0%, respectively. In the last 5 patients the muscle flap was fixated to the tracheal defect and reinforced by bovine or autogenic pericardium in whom there was no mortality. Recurrences occurred in 7 patients (35.0%), but only 5 were physically eligible for secondary surgical treatment. The other patients died due to the recurrence. Patients with infectious cause of their tracheoesophageal fistula (n = 11) had more complications (7 versus 6 patients), higher mortality (5 versus 2 patients) and more recurrences (5 versus 2) than non-infectious tracheoesophageal fistulas.

Conclusion

Tracheoesophageal fistula is a severe complication and is associated with high mortality and recurrence rates. Surgical treatment should only be performed in tertiary referral centers. Using muscle flaps with reinforcement of pericardium might reduce the morbidity and mortality, but larger patient groups should be investigated.

Disclosure

All authors have declared no conflicts of interest.
PS02.174: THE ACTION OF A NOVEL RADIOSENSITISER WITHIN THE OESOPHAGEAL ADENOCARCINOMA TUMOUR MICROENVIROMENT
Authors: Buckley Amy , Lynam-Lennon Niamh , Kennedy Susan , Cannon Aoife , O’Toole Dermott , Maher Stephen , Reynolds John , Ravi Narayanasamy , Kennedy Breandán , O'Sullivan Jacintha
Published: September 2018

Background

Oesophageal Cancer (OAC) is an aggressive disease with survival rates of ∼15-20%. Current therapeutic regimes focus on neo-adjuvant therapy (chemo-radiation) prior to surgery. Unfortunately, only 20–30% of patients show a beneficial response, with 70–80% of patients as non-responders. This major clinical challenge of treatment resistance reinforces the need for the identification of novel treatments which can act as radio-sensitisers in the neo-adjuvant setting.

Methods

Through a drug screening approach in-vivo, we have identified a novel anti-angiogenic and anti-metabolic compound, 11B_CC8 with radiosensitising activity. The ability of 11B_CC8 to act as an anti-metabolic agent under hypoxia was evaluated using the XFe24 Seahorse analyser and the Don Whitley i2 workstation. The ability of 11B_CC8 to radiosensitise our isogenic OAC cells under hypoxic conditions was assessed by clonogenic assay. The effect of 11B_CC8 on inflammatory, metabolic and angiogenic protein secretions from OAC treatment naïve tumour conditioned media (TCM) was evaluated by multiplex ELISA. Fresh treatment naïve patient biopsies were screened for their metabolic activity using the XFe24 seahorse analyser at baseline and post- treatment with 11B_CC8. The elucidation of the possible mechanism of action of 11B_CC8 was evaluated by Mass-Spectrometry.

Results

Our novel anti-angiogenic and anti-metabolic agent can enhance radiosensitivity in our isogenic model of OAC under both normoxic and hypoxic (0.5% O 2) conditions. 11B_CC8 significantly reduces oxygen consumption rate (OCR) under normoxic but not hypoxic conditions. Ex-vivo, 11B_CC8 significantly reduced the secretion of IL1β (P = 0.0117). Real-time ex-vivo metabolic rate analysis of our treatment naïve OAC biopsies showed significantly elevated OCR, when compared to Extracellular Acidification rate, a measure of glycolysis (P = 0.0059). Treatment with 11B_CC8 produced a reduction in OCR (P = 0.0039).

Conclusion

Our novel anti-angiogenic and anti-metabolic agent can enhance radiosensitivity in-vitro under both normoxic and hypoxic conditions. Ex-vivo, treatment naïve OAC human patient samples, 11B_CC8 can significantly reduce the secretion of IL1β and altered metabolic programming, specifically oxidative phosphorylation in human explants.

Disclosure

All authors have declared no conflicts of interest.
PS02.175: CLINICAL CHARACTERISTICS AND TREATMENT OF NEUROENDOCRINE CARCINOMA OF THE ESOPHAGUS
Authors: Morita Masaru , Kagawa Masaki , Nakaji Yu , Sugiyama Masahiko , Yoshida Daisuke , Ota Mitsuhiko , Ikebe Masahiko , Taguchi Ken-Ichi , Toh Yasushi
Published: September 2018

Background

Neuroendocrine carcinoma (NEC) of the esophagus is a rare and highly aggressive disease; however, an appropriate treatment strategy remains to be established, especially for surgical resection. The objective of this study is to clarify the clinical characteristics of NEC of the esophagus and to determine the optimal surgical strategy.

Methods

Nineteen patients who were immunohistochemically diagnosed with NEC of the esophagus from 1998 to 2017 were included in this study. The clinical features and therapeutic outcomes were examined.

Results

1. Clinical features

Sixteen of 19 patients showed protruding or localized type with or without ulceration. Only five patients were negative for both lymph node and organ metastasis and eight cases were positive for metastasis to distant organs and/or distant lymph nodes.

2. Surgical treatment

Five patients underwent esophagectomy. Four cases were classified as cStage I (cT1bN0M0); the other case was classified as cStage III (cT3N2M0). The preoperative diagnoses, based on the examination of biopsy specimens, were NEC (n = 2), SCC (n = 1), adenocarcinoma (n = 1), and carcinoma (n = 1). Subtotal and distal esophagostomy were performed in 3 and 2 patients, respectively. Salvage esophagectomy for recurrent disease was performed after definitive chemotherapy in one patient. Anastomotic leakage, which was conservatively healed, developed in one patient. Two patients with histologically-positive node metastasis died at 8 and 13 months, respectively, while another 3 patients (pT1bN0, n = 2; pT2N0, patient, n = 1) are currently alive without any recurrence, at 12, 45 and 72 months after esophagectomy, respectively.

3. Non-surgical treatment

Systemic chemotherapy was performed as the main treatment for 13 patients with advanced NEC. The regimens included cisplatin combined with irinotecan or etoposide (n = 10), cisplatin plus 5-fluorouracil (n = 2) and UFT plus irinotecan (n = 1). The MST was 13 months (range, 6–17 months).

Conclusion

The possibility of NEC should be kept in mind when we encounter protruded tumors of a distinctive shape. Consistent with previous reports, the prognosis of NEC of the esophagus is dismal, irrespective of the administration of systemic chemotherapy. However, surgical resection is considered to be a treatment option for cStage I/II NEC without node metastasis, as a long-term survival after esophagectomy was achieved by some patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.178: THE EFFECT OF INFLAMMATION AND NUTRITIONAL STATUS AND SARCOPENIA ON ESOPHAGEAL CANCER SURGERY
Authors: Soma Daisuke , Yamada Kazuhiko , Nohara Kyoko , Yamashita Satoshi , Wake Hitomi , Kokudo Norihiro
Published: September 2018

Background

An inflammation-based prognostic score, the modified Glasgow Prognostic Score (mGPS), has been established as a useful tool for predicting postoperative outcome in patients with cancer. Recently, depletion of skeletal muscle mass (sarcopenia) has been linked to poor outcome in several types of cancers. In this study investigated the relationship between these factors in patients with operable esopahgeal cancer.

Methods

Skeletal muscle mass was assessed in 87 patients who underwent esophagectomy from Jan. 2014 to Dec. 2016. The skeletal muscle tissue areas were measured by the ZioStation. The evaluated samples were slices of the third lumbar vertebrae (L3) in the inferior direction. The muscle area normalized by the square of the height (m2) is called the skeletal muscle index (SMI) (cm2/m2). The modified Glasgow prognostic score (mGPS) was measured using C-reactive protein (CRP) and albumin levels (mGPS 2: CRP > 1.0 mg/dL and albumin < 3.5 g/dL; mGPS 1: CRP > 1.0 mg/dL; mGPS 0: CRP ≤ 1.0 mg/dL). Patients were given mGPS- L group(mGPS0)or mGPS- H(mGPS1,2).

Results

The decrease of the skeletal muscle was higher in the mGPS2 than in the mGPS0. The rate of respiratory complications significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.01). For other complications the differences were not significant. Kaplan-Meier analysis and log-rank test revealed that Sarcopenia and mGPS-H predicted a higher risk of mortality (P = 0.0034 and 0.0001). Univariate analyses revealed that the mGPS, Stage and Sarcopenia were associated with mortality. Multivariate analyses using these 3 factors revealed that only mGPS (HR: 3.18; 95% CI: 1.70–8.70; P = 0.02) and Sarcopenia (HR: 3.39; 95% CI: 1.27–10.6; P = 0.01) were an independent risk factor of mortality.

Conclusion

The mGPS was closely related on the progression of sarcopenia, and both the mGPS-H and Sarcopenia were poor prognostic factor respectively.

Disclosure

All authors have declared no conflicts of interest.
PS02.179: NUTRITIONAL STATUS DIFFERENCES BETWEEN YOUNG AND ELDERLY PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Lidoriki Irene , Schizas Dimitrios , Mpaili Efstratia , Michalinos Adamantios , Mpoura Maria , Kapelouzou Alkistis , Liakakos Theodore
Published: September 2018

Background

Esophageal cancer patients often suffer from malnutrition. Older people constitute a group of patients more susceptible to nutritional status deterioration. The aim of this study is to investigate the differences in nutritional status between elderly patients and patients younger than 65 years of age with esophageal and gastroesophageal junction cancer.

Methods

The study sample consisted of 73 patients with esophageal (n = 11) and gastroesophageal junction cancer (n = 62) who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and December 2017. Patients were divided into 2 groups according to their age, those younger than 65 years (n = 39) and those older than 65 years (n = 34). The preoperative assessment of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), laboratory tests, anthropometric measurements, handgrip strength, unintentional weight loss during the last six months and Skeletal Muscle Index (SMI) derived from analysis of CT scans.

Results

Malnutrition and sarcopenia were more prevalent in the group of older patients compared to the group of younger ones (73.5% vs 41%, P < 0.05 and 60% vs 35.3%, P < 0.05). PG-SGA was significantly higher in elderly patients (12.35 vs 8.23, P < 0.05), while SMI and handgrip strength were significantly lower in elderly patients (48.47 cm2/m2 vs 55.5 cm2/m2, P < 0.05 and 31 kg vs 39.1 kg, P < 0.05 respectively). Among the laboratory tests, albumin, hemoglobin and hematocrit were lower in the group of older patients (3.86 g/dL vs 4.15 g/dL, P < 0.05, 12.25 g/dL vs 13.17 g/dL, P < 0.05 and 36.5 vs 39.5, P < 0.05, respectively), whereas platelet-to-lymphocyte ratio was higher (205.4 vs 156.2, P < 0.05). Concerning anthropometric measurements, corrected mid arm muscle area and calf circumference were lower in older patients (42.15 cm2 vs 49.26 cm2, P < 0.05 and 34.86 cm vs 36.89 cm, P < 0.05, respectively), whereas no significant differences were observed in Body Mass Index values and unintentional weight loss between the two groups.

Conclusion

Geriatric patients with esophageal and gastroesophageal junction cancer have more compromised nutritional status compared to their younger counterparts. Preoperative nutritional assessment should be performed in all such patients in order to detect those who will benefit from perioperative nutritional support.

Disclosure

All authors have declared no conflicts of interest.
PS02.185: SIGNET RING OESOPHAGOGASTRIC ADENOCARCINOMAS HAVE POORER PROGNOSIS THAN MATCHED CONTROLS IN A MULTICENTRE STUDY
Authors: Khan Niall , Donohoe Claire , Phillips Alexander , Michael Griffin S , Reynolds John
Published: September 2018

Background

Controversy exists as to the relevance of the signet ring carcinoma (SRC) histological subtype of oesophagogastric adenocarcinoma to long-term prognosis. Some studies report a favourable prognosis while others report the contrary.

Methods

Retrospective analysis of outcomes of patients who underwent surgery with curative intent in two high volume centres (2000–15). Tumours were analysed according to location (oesophageal, junctional or stomach). Propensity score match (PSM) analysis was used to match patients with signet ring histology to those with oesophagogastric adenocarcinomas based on age, tumour location, use of neoadjuvant and adjuvant chemotherapy and pathological stage.

Results

A total of 2500 patients with oesophagogastric adenocarcinomas were treated, of whom 198 (7.9%) had signet ring histology. SRCs were more likely to have positive lymph nodes at pathological analysis (59% versus 50%, P = 0.009). Patients with oesophageal SRCs (n = 10) had a particularly poor prognosis with 23% 2 year survival and none alive at 5 years. The five year survival rate for patients with early SRC tumours (Stage 0/I/IIa) was 65% versus 85% for other early cancers (P < 0.003). PSM was used to match 195 of the SRC cases to 573 controls based on stage and treatment. Overall survival was significantly poorer in the SRC group (44.3 ± 8.6 versus 59.8 ± 8.5 months, 5 year OS 41% v 50%, P = 0.027).

Conclusion

Patients with the SRC variant of oesophagogastric cancer have a poorer prognosis. Genomic studies to identify the composition of such tumours as well as identify strategies to improve treatment for this subtype are warranted.

Disclosure

All authors have declared no conflicts of interest.