bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.175: EVALUATION OF ASSOCIATIONS BETWEEN GASTRIC TUBE PREPARATION METHODS AND THE INCIDENCE OF CERVICAL ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER
Authors: Miyawaki Yutaka , Sato Hiroshi , Sakuramoto Sinich , Okamoto Koujun , Yamaguchi Shigeki , Koyama Isamu
Published: September 2018

Background

In esophageal reconstruction, the gastric tube (GT) is superior in elevation and handiness of the maneuver; therefore, GT is most often selected as a reconstruction conduit. Although some leakages from esophagogastric anastomoses are induced by ischemic or congested peripheral blood flow in the reconstruction conduits, the association between the GT and the incidence of anastomotic leakage (AL) is unclear.

Methods

Between February 2013 and September 2017, 188 consecutive patients who underwent an esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstructions using narrow gastric tubes (Gr.N) until May 2016, which is when we began preparing and using stretched GTs (Gr.S). We retrospectively evaluated the incidence of AL.

Results

AL occurred in 29 of 188 (15.4%) patients, and the frequency of AL occurrence in Gr.S was lower than that in Gr.N (P = 0.034). Sex, body mass index, Brinkman index, and presence of hypertension or anemia were significantly associated with AL (P = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). The multivariate logistic regression analysis suggested that the type of GT used and the Brinkman index were independent risk factors for AL (P = 0.016 and 0.020, respectively).

Conclusion

Our results demonstrated that the difference in the GT preparation method was an independent risk factor for AL after cervical esophagogastrostomy. We suggest that the method of GT preparation could contribute to a reduction of AL after esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.182: TOOLS FOR INDIVIDUALIZED SURVIVAL PREDICTION IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Gupta Vaibhav , Coburn Natalie , Kidane Biniam , Hess Kenneth , Compton Carolyn , Ringash Jolie , Darling Gail , Mahar Alyson
Published: September 2018

Background

Clinical, pathological and molecular information combined with cancer stage in prognostication algorithms can offer more personalized estimates of survival, which may guide treatment choices. Our aim was to evaluate the quality of prognostication tools in esophageal cancer.

Methods

We systematically searched MEDLINE & Embase from 2005- 2017 for studies reporting development or validation of models predicting long-term survival in esophageal cancer. We evaluated tools using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies guidelines and the American Joint Committee on Cancer acceptance criteria for risk models.

Results

We identified 16 prognostication tools for patients treated with curative intent and one for patients with metastatic disease. These tools frequently excluded adenocarcinoma, contained outdated data and were developed with a limited sample size. Nine tools were developed in China for squamous cell cancer, and 11 used data on patients diagnosed prior to 2010. The majority of tools excluded key prognostic factors such as age and sex. Tumor stage and grade were the most commonly, but not universally, included factors. Twelve tools were designed to predict overall survival; five predicted cancer-specific survival. Bootstrap internal validation was performed for most tools; c-statistics ranged from 0.63–0.77 and graphically evaluated calibration was ‘good’. Five tools were externally validated; c-statistics ranged from 0.70–0.77.

Conclusion

Existing tools cannot be confidently used for esophageal cancer prognostication in current clinical practice. Better quality tools may help to more individually and accurately estimate disease course, select further treatments, and risk-stratify for future clinical trials.

Disclosure

All authors have declared no conflicts of interest.
PS01.187: ASSESSMENT OF THE BLOOD SUPPLY USING THE INDOCYANINE GREEN FLUORESCENCE METHOD AND POSTOPERATIVE ENDOSCOPIC EVALUATION OF ANASTOMOSIS DURING ESOPHAGECTOMY
Authors: Kitagawa Hiroyuki , Iwabu Jun , Namikawa Tsutomu , Hanazaki Kazuhiro
Published: September 2018

Background

Postoperative anastomotic leakage is a severe complication after gastric tube reconstruction during esophagectomy. The aim of this study was to evaluate the usefulness of postoperative endoscopic assessment of anastomosis and its correlation with intraoperative indocyanine green (ICG) fluorescence assessment of the gastric tube.

Methods

We retrospectively reviewed 72 consecutive patients who underwent gastric tube reconstruction using the ICG fluorescence method during esophagectomy. Forty-six patients underwent the ICG line-marking method (LMM group; ICG before gastric tube creation). The other 26 underwent the conventional procedure and comprised the control group (ICG after gastric tube creation). Postoperative endoscopic assessment (PEA) of anastomosis was performed 7 days after surgery and results were classified as follows: grade 1 (normal or partial white coat), grade 2 (ulcer comprising less than half the circumference), and grade 3 (ulcer comprising more than half the circumference).

Results

Anastomotic leakage occurred in 7 of 72 patients (9.7%). The incidence of anastomotic leakage in the LMM group was tended to be lower than those in the control group (6.5% vs. 15.4%; P = 0.244). Of the 40 patients who underwent PEA, 3 (7.5%) had leakage. PEA grading was significantly associated with anastomotic leakage (P < 0.001). Better intraoperative ICG assessment was significantly associated with better endoscopic assessment grade (P = 0.041).

Conclusion

Intraoperative ICG assessment of the gastric tube was associated with PEA grading on anastomosis during esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.193: VISUALIZED EVALUATION OF BLOOD FLOW TO THE GASTRIC CONDUIT CONTRIBUTES TO REDUCTION OF COMPLICATION IN ESOPHAGEAL RECONSTRUCTION
Authors: Noma Kazuhiro , Shirakawa Yasuhiro , Ogawa Toshihiro , Maeda Naoaki , Ninomiya Takayuki , Tanabe Shunsuke , Sakurama Kazufumi , Fujiwara Toshiyoshi
Published: September 2018

Background

Evaluation of the blood supply to gastric conduits is critically important to avoid complications following esophagectomy. We commenced visualized evaluation of blood flow using indocyanine green (ICG) fluorescent imaging from July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method.

Methods

We analysed and compared two groups, those before and after introduction of ICG evaluation. We performed propensity score matching (PS-M), compared clinical outcomes and analysed how the visualized evaluation reduced the risk of complications.

Results

Sixty-eight matched pairs were analysed. The leakage rate in the ICG group was significantly lower than the non-ICG group for each severity grade both in the entire cohort (285 subjects) and after PS-M, while the rate of other major complications, including recurrent laryngeal nerve (RLN) palsy and pneumonia, were not different between the two groups in the entire cohort and after PS-M. The duration of postoperative intensive care unit (ICU) stay was approximately one day shorter in the ICG than the non-ICG group in the entire cohort, and approximately two days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) severity grades. Odds ratio with ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1, 0.241 for CD ≥ 2 and 0.2153 for CD ≥ 3).

Conclusion

Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication.

Disclosure

All authors have declared no conflicts of interest.
PS01.199: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF CIRCULAR STAPLING VERSUS TRIANGULATING STAPLING ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CANCER
Authors: Katsuda Masahiro , Hayata Keiji , Nakamori Mikihito , Nakamura Masaki , Ojima Toshiyasu , Yamaue Hiroki
Published: September 2018

Background

Several studies have reported that the triangulating stapling method decreases the incidence of anastomotic stricture after esophagectomy, but no randomized, controlled trial has confirmed the efficacy of the triangulating stapling method for cervical esophagogastrostomy. We compared triangulating stapling and circular stapling for cervical esophagogastric anastomosis regarding the decrease in anastomotic stricture after esophagectomy for thoracic esophageal cancer.

Methods

Between August 2010 and April 2014, 100 patients enrolled in this randomized, controlled trial at the Wakayama Medical University Hospital were allocated randomly to either the circular stapling group (n = 49) or the triangulating stapling group (n = 51). The primary end point was the incidence of anastomotic stricture within 12 months postoperatively. This randomized, controlled trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN000004848).

Results

There were no differences between the circular stapling and triangulating stapling groups in terms of clinical data. The amount of time required for esophagogastric anastomosis was slightly greater for the triangulating stapling group (22 minutes) than for the circular stapling group (18 minutes) (P = .028). Anastomotic stricture occurred in 8 patients (17%) in the circular stapling group and 9 patients (19%) in the triangulating stapling group (P = .935). The rate of anastomotic leakage was 11% for the circular stapling group and 2% for the triangulating stapling group (P = .073).

Conclusion

This RCT compared 2 techniques of cervical esophagogastric anastomosis after esophagectomy for esophageal cancer. This study is the first to compare these 2 methods in a randomized, controlled fashion.This study could not show that the triangulating stapling method was superior to the circular stapling method for cervical esophagogastrostomy to reduce anastomotic stricture. The triangulating stapling method, however, might have the potential to decrease the rate of anastomotic leakage; a large-scale RCT will be required to assess this question.

Disclosure

All authors have declared no conflicts of interest.
PS01.203: PREOPERATIVE PATIENT-RELATED FACTORS ASSOCIATED WITH PROGNOSIS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Kitagawa Hiroyuki , Iwabu Jun , Namikawa Tsutomu , Hanazaki Kazuhiro
Published: September 2018

Background

To investigate the impact of the preoperative patient-related factors on survival after esophagectomy in patients with esophageal cancer.

Methods

We retrospectively reviewed 140 patients with esophageal cancer who underwent esophagectomy. Preoperative comorbidities, nutritional and inflammation status including the neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS), and their pathological findings were analyzed to assess their relationships with prognosis.

Results

Univariate analysis demonstrated that a history of cardiovascular disease (CVD), a GPS of 1 or 2, lack of neo-adjuvant chemotherapy (NAC), no thoracoscopic esophagectomy, blood loss volume ≥ 255 ml, the number of lymph node metastasis (LNM) ≥ 2, lymphatic invasion, venous invasion, and residual cancer were associated with poor survival. Multivariate analysis revealed that a history of CVD (hazard ratio [HR], 2.129; 95% confidence interval [CI], 1.327–4.226; P = 0.041), a GPS of 1 or 2 (HR, 3.232; 95% CI, 1.516–6.437; P = 0.003), LNM ≥ 2 (HR, 3.133; 95% CI, 1.355–7.760; P = 0.007), and pathological residual cancer (HR, 2.429; 95% CI, 1.050–5.105; P = 0.039) were independently associated with poor survival, and NAC was associate with better survival (HR, 0.289; 95% CI, 0.118–0.667; P = 0.003).

Conclusion

Preoperative patient-related factors including a history of CVD and a GPS of 1 or 2 were predictors of poor prognosis after esophagectomy in patients with esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS01.207: TRANSHIATAL AND INTERCOSTAL PLEURAL DRAINS AFTER HYBRID IVOR LEWIS ESOPHAGECTOMY: A COMPARATIVE ANALYSIS IN 100 CONSECUTIVE PATIENTS
Authors: Bernardi Daniele , Asti Emanuele , Sironi Andrea , Bonitta Gianluca , Bonavina Luigi
Published: September 2018

Background

In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of the present study was to compare short-term outcomes of trans-hiatal and intercostal pleural drainage. We hypothesized that a trans-hiatal pleural drain introduced through the sub-xyphoid port site incision at laparoscopy could reduce postoperative pain and enhance patient recovery.

Methods

This was an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to an historical cohort of patients treated with the conventional intercostal drain connected to under-water seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on-demand were recorded. Postoperative complications were scored according to the Dindo-Clavien classification.

Results

Over a 2-year period, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinico-pathological variables were similar in the two groups. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality nor statistical significant difference in the rate of grade ≥ 3 postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P < 0.001). The length of hospital stay was similar in the two groups. No complications related to the method of pleural drain occurred up to 3 months after hospital discharge. There was only one hospital readmission in the transhiatal group due to severe nutritional impairment.

Conclusion

Transhiatal pleural drainage connected to a portable vacuum system can safely replace the intercostal drain after hybrid Ivor-Lewis esophagectomy in selected patients. It has the potential to reduce postoperative pain and use of nonsteroidal antinflammatory drugs, and to enhance recovery from surgery.

Disclosure

All authors have declared no conflicts of interest.
PS01.215: SUPERIOR MEDIASTINAL LYMPHADENECTOMY IN TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY FOR CANCER: CLINICAL AND ONCOLOGICAL OUTCOMES
Authors: Soile Oluwasunmisola , Shanmuganathan Kanatheepan , Hussain Aadil , Akitikori Temisanren , Farhangmehr Neda , Sdralis Elias , Lorenzi Bruno , Charalabopoulos Alexandros
Published: September 2018

Background

Minimally invasive oesophagectomy (MIO) is a challenging procedure associated with high rate of complications and mortality. The exact benefits of superior mediastinal lymphadenectomy (SML) have long been debated with no clear evidence pertaining to better outcomes for patients. With this study we aim to compare the short-term outcomes of MIOs that also underwent SML against the UK national average.

Methods

Thirty-nine consecutive patients underwent totally MIO under a surgical team from September 2016 to December 2017. SML included left and right paratracheal nodes (including the paratracheal retrocaval compartment) as well as the nodes along the left and right recurrent laryngeal nerves throughout their mediastinal course. Eligible patients had to have undergone SML during either a 3-stage or a 2-stage MIO. Comparisons of the following outcomes were made against the data released by the UK National Oesophago-Gastric Cancer Audit (NOGCA) 2017; anastomotic leak rate, chyle leak rate, 30-day mortality, 90-day mortality, length of stay (LOS), cardiac complications, respiratory complications, wound infection, unplanned surgery.

Results

Seven patients were identified as eligible according to the criteria. 30- and 90- day mortality was reduced in the participant group compared to national average (0% vs 1.9% and 0% vs 3.3% respectively). Wound infection and cardiac complications were also reduced in the participant group (0% vs 5.3% and 0% vs 2.8% respectively). There were no anastomotic or chyle leaks noted (vs National 3.8% and 6.3% respectively), but conversely rate of respiratory complications was considerably higher in our group (42.8% vs 16.9%). There was 1 right recurrent laryngeal nerve palsy noted. Median LOS was longer in the sample group (16 vs 12 days), with no reoperations (0 vs 10.2%). Median total lymph node count was 45 (IQR, 37–68), with median SML count being 8 (IQR, 5–22).

Conclusion

The small sample size is immediately recognised as a limiting and influencing factor in the results of this study. However MIOs with SML may provide some, although not comprehensive, benefit in oncological outcomes without adding any further significant morbidity. Larger studies are needed to assess the role SML can play in improving patient outcomes.

Disclosure

All authors have declared no conflicts of interest.
PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Hol Jeroen , Heisterkamp Joos , Langenhoff Barbara
Published: September 2018

Background

Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented.

Methods

Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old.

Results

From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively.

Conclusion

No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone.

Disclosure

All authors have declared no conflicts of interest.
PS01.219: SINGLE-PORT THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Yuan Yong
Published: September 2018

Background

This study was conducted to optimize the surgical procedures for single-port thoracoscopic esophagectomy, and to explore its potential advantages over multi-port minimally invasive esophagectomy.

Methods

For single-port thoracoscopic esophagectomy, the patient was placed in left lateral-prone position and a 4-cm incision through the 4th-5th intercostal space was taken on the postaxillary line. The 10-mm camera and two or three surgical instruments were used for the VATS esophagectomy and radical mediastinal lymph node dissection. The camera position was different for the upper and lower mediastinal regions. Mobilization of stomach was conducted via multiple-port laparoscopic approach. Cervical end-to-side anastomosis was completed by hand-sewn procedures.A propensity-matched comparison was made between the single-port and four-port thoracoscopic esophagectomy groups.

Results

From 2014 to 2016, 56 matched patients were analyzed. There was no conversion to open surgery or operative mortality. The use of single-port thoracoscopic esophagectomy increased the length of operation time in comparison with using multiple-port minimally invasive technique (mean, 257 vs. 216 min, P = 0.026). The time taken for thoracic procedure in the single-port group was significant longer that in the multi-port group (mean, 126 vs. 84 min, P < 0.001). There were no significant differences between groups in the number of lymph nodes dissected, blood loss, complications or hospital stay (P > 0.05). In single-port thoracoscopic group, the pain in the abdomen was more severe than that in the chest (P = 0.042). The pain scores for postoperative day 1 and day 7 were significantly lower in the single-port group as compared with multiple-port group (P = 0.038 and P < 0.001), a similar trend could be seen for the pain score on postoperative day 3 (P = 0.058).

Conclusion

Single-port thoracoscopic esophagectomy contributes to reducing postoperative pain with an acceptable increase of operation time, which does not compromise surgical radicality and has similar short-term postoperative outcomes when compared with multiple-port minimally invasive approach.

Disclosure

All authors have declared no conflicts of interest.
PS01.226: FEASIBILITY OF CONVERSION THORACOSCOPIC ESOPHAGECTOMY AFTER TRIPLET CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR T4 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Akiyama Yuji , Iwaya Takeshi , Endo Fumitaka , Nikai Haruka , Umemura Akira , Baba Shigeaki , Chiba Takehiro , Kimura Toshimoto , Takahara Takeshi , Otsuka Koki , Nitta Hiroyuki , Mizuno Masaru , Kimura Yusuke , Koeda Keisuke , Sasaki Akira
Published: September 2018

Background

Recently, induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported effective for T4 esophageal squamous cell carcinoma. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) as conversion surgery after DCF for T4 esophageal squamous cell carcinoma.

Methods

Medical records of 64 consecutive patients with T4 (with or without distant metastasis) thoracic esophageal squamous cell carcinoma treated with induction DCF chemotherapy were reviewed. Twenty-tree patients underwent conversion TE after induction DCF.

Results

The invading organs of T4 tumor were tracheobronchus in 8 patients, thoracic aorta in 13 patients, and pericaridium and diaphragm in 3 patients each. Average courses of DCF treatment were 2.8 courses. The mean total operation time was 556.3 min and that of the thoracic procedure was 258.9 min. The mean blood loss was 166.2 mL and that during the thoracic procedure was 33.5 mL. All patients underwent complete resection under TE. No patient experienced accidental conversion to open thoracotomy or intraoperative morbidity including adjacent organ injury. Postoperative morbidity rate was 34.8%. There were no serious complications related to surgery requiring reoperation. Postoperative hospital stay was 24.3 (range, 13–38) days. Five patients had recurrence: four had distant metastasis (lung (2), liver (3), one patient had overlapped), and one had mediastinal lymph node recurrence. There was no local recurrence at the site of primary T4 tumor.

Conclusion

TE as conversion surgery after DCF therapy for initial T4 esophageal squamous cell carcinoma can be safely performed. The strategy of induction DCF followed by conversion TE could be an alternative in the treatment for T4 advanced esophageal squamous cell carcinoma.

Disclosure

All authors have declared no conflicts of interest.
PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER
Authors: Muneoka Yusuke , Kawachi Yasuyuki , Makino Shigeto , Sato Yu , Kitami Chie , Kawahara Mikako , Nishimura Atsushi , Nikkuni Keiya
Published: September 2018

Background

Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated.

Methods

We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups.

Results

There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively.

Conclusion

MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease.

Disclosure

All authors have declared no conflicts of interest.
PS01.233: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE
Authors: Jiang Yuequan
Published: September 2018

Background

Trans hiatal esophagectomy avoid trans-thoracic surgery and reduce postoperative complications relate to thoracic surgery. However, the limitation of Trans hiatal esophagectomy is blunt dissection might result to some sever complications. We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope.

Methods

Patient was in supine position, intubated with a single-lumen endotracheal tube. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope also. The lower mediastinal lymph nodes including subcarinal lymphnode were dissected under laparoscope (figure 1, 2) Cervical part: Two incisions in neck were made, a 3–4cm incision in left side, another 1–2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be insufflated with carbon dioxide gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope (figure 5, 6, 7, 8).

Results

Comparing to (Minimal invasive esophagectomy) MIE group, the dissection frequency of lymph nodes was relatively lower at stations 2R, 4R and 10 in TTA group, but the metastasis rate was similar. Moreover, both the dissection and metastasis frequency at the other stations were no difference between the TTA and MIE. Despite high incidence in recurrent laryngeal nerve palsy (single-side), The TTA was significantly superior to the MIE with a shorter surgical duration, shorter ICU/hospital stay, and lower postoperative pulmonary complications.

Conclusion

The TTA procedure of esophagectomy was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.245: COMPARISON OF ONCOLOGIC RESECTION OF LAPROSCOPIC VERSUS ROBOTIC VATS ESOPHAGECTOMY FROM A REGIONAL CANCER CENTER IN INDIA
Authors: Krishnamurthy Swamyvelu
Published: September 2018

Background

Robotic surgery being a new technology in developing countries little is known about its oncological safety and outcome in esophageal surgeries.

Methods

We evaluated 46 consecutive patients of esophageal cancer who underwent laproscopic (n = 30) and Robotic VATS (Video Assisted Thoracic Surgery) (n = 16) esophagectomy, both with cervical anastomosis. All cases were operated by a single surgeon over a period of 2 years.

Results

30 patients (18 male, 12 female), average age 54 years underwent laproscopic VATS procedure and 16 patients (8 male, 8 female), average age 57 years underwent Robotic VATS esophagectomy. Compared to laproscopic group, Robotic VATS procedure averaged a slightly longer operative time (190 mins versus 168 mins) with almost similar blood loss (160 ml versus 150 ml). Lymph node yield for Robotic procedure was slightly better than laproscopic group (18 versus 14.3). None of the patients in both groups had positive margins. 8 patients in laproscopic group and 4 in Robotic arm underwent Neo-adjuvant therapy. Clinical and pathologic staging was similar in both groups. Average hospital stay was better for Robotic arm (8 days versus 11 days).

Conclusion

Laproscopic and Robotic VATS esophagectomy yield almost similar peri-operative oncologic results with Robotic surgery taking slightly longer operative time but yielding better lymph nodes and shorter hospital stay in comparison to laproscopic arm. Shifting from laproscopic to Robotic surgery is easy and is non-inferior in terms of immediate oncologic outcomes.

Disclosure

All authors have declared no conflicts of interest.
PS02.005: THORACOSCOPIC ESOPHAGECTOMY IN PRONE POSITION USING A PRECEDING ANTERIOR APPROACH FOR ESOPHAGEAL CANCER: LONG-TERM AND SHORT-TERM OUTCOMES
Authors: Ozawa Soji , Oguma Junya , Kazuno Akihito , Yamamoto Miho , Nimomiya Yamato , Yatabe Kentaro
Published: September 2018

Background

The purpose of this study was to clarify the long-term and short-term outcomes of consecutive patients who underwent thoracoscopic esophagectomy in prone position using a preceding anterior approach for the resection of esophageal cancer at a single institution.

Methods

We retrospectively reviewed a database of 690 patients with thoracic esophageal cancer who had undergone a thoracoscopic esophagectomy (TE, 351 patients) or an esophagectomy through thoracotomy (OE, 343 patients) between 2003 and 2017. To compare the long-term outcomes of TE and OE, we used a propensity score matching analysis and a Kaplan-Meier survival analysis. To analyze the short-term outcomes of TE, patients were chronologically divided into three groups (117 patients per group). As for thoracoscopic procedure, the esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The intraoperative factors, the number of dissected lymph nodes, and the incidence of adverse events were compared among the three period groups.

Results

As for long term outcome, 203 patients from each group, for a total of 406 patients, were completely selected and paired. The 5-year survival of the TE patients (66.8%) was better than that of the OE patients (56.4%) (P = 0.044). The thoracoscopic times were 226 min, 241 min, and 214 min (P < 0.001), and the blood losses during the thoracoscopic procedure were 36.1 mL, 43.3 mL, and 18.0 mL (P < 0.001), respectively, according to the period groups. The mean numbers of harvested lymph nodes in the chest were 22.2, 25.1, and 28.9 (P < 0.001). The rates of recurrent laryngeal nerve palsy were 23.9%, 29.9%, and 8.6% (P < 0.001).

Conclusion

The long-term outcome of TE patients might be better than that of OE patients. As for the short-term outcomes, intraoperative factors, quality of lymph node dissection, and reduction of adverse events were best in the third period group. Establishment of standard procedure and accumulation of surgical cases seemed to make TE a safe and effective procedure for esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.007: DEVELOPING A ROBOT-ASSISTED ESOPHAGECTOMY PROGRAM IN A HIGH-VOLUME TRANSHIATAL ESOPHAGECTOMY CENTER
Authors: Keeney-Bonthrone Toby , Chang Andrew , Lin Jules , Lynch William , Carrott Philip , Lagisetty Kiran , Orringer Mark , Reddy Rishi
Published: September 2018

Background

Esophagectomies have high morbidity rates regardless of approach. Minimally invasive approaches have been shown to have lower complication rates compared to open operations for Transthoracic and Three-hole (McKeown type) esophagectomies. We examined the perioperative outcomes of a transhiatal robot-assisted approach compared to concurrent transhiatal esophagectomies at the same institution.

Methods

A retrospective review was performed of all transhiatal and robot-assisted transhiatal esophagectomies performed for esophageal cancer at a single large academic center between January 2013 and December 2017. Outcomes assessed included postoperative complications, procedure time, length of stay, unexpected ICU admissions, 30-day readmission and 30-day mortality. A multivariate logistic regression model, adjusted for demographics, comorbidities and disease severity, was used to evaluate outcomes.

Results

378 transhiatal (THE) and 87 robot-assisted (RTHE) esophagectomies met inclusion criteria. RTHE was associated with higher rates of pleural effusion requiring drainage, pneumothorax, pulmonary embolism and respiratory failure, as well as empyema requiring treatment. RTHE was associated with a higher number of lymph nodes resected. 56.3% of RTHEs used epidurals vs. 92.3% of THEs. Epidural use had no statistical association with the incidence of pulmonary complications. Differences in atrial fibrillation, anastomotic leak, pneumonia, procedure length, length of stay, 30-day survival and readmission rates were not statistically significant.

Conclusion

Implementation of a new robot-assisted transhiatal esophagectomy program was associated with higher rates of pulmonary complications and empyema, although there were no differences in length of stay. Further investigation is needed to understand the difference in complications.

Disclosure

All authors have declared no conflicts of interest.
PS02.010: ESTABLISHMENT OF THE UPPER GI INTERNATIONAL ROBOTIC ASSOCIATION (UGIRA)
Authors: Kingma Berend , Chaudry M , Chiu Philip , Grimminger Peter , Luketich James , Van Hillegersberg Richard
Published: September 2018

Background

Robot-assisted surgery is increasingly performed for both benign and malignant upper gastro-intestinal disease. However, no global consensus exists regarding exact techniques and implementation methods of robotic esophageal and gastric surgery. To facilitate the effective implementation and advancement of these procedures, evidence based guidelines should be generated. In this context, the ‘Upper GI International Robotic Association’ (UGIRA) was established in 2017. Until now, 20 experienced robotic surgeons from 10 different countries in Europe (The Netherlands, Germany, United Kingdom, Denmark), Asia (Japan, Hong Kong, North-Korea, Taiwan), North-America (United States of America), and South-America (Brazil) have confirmed to become a member of the UGIRA. By means of an oral presentation, we would like to announce the establishment of the UGIRA and to introduce its primary aims, which are: To set up a web-based registry for international data collection.An international registry is created to enable international collaboration on research. Data collection should especially focus on the robotic elements of upper gastro-intestinal surgery, such as trocar positions, anastomotic technique, conduit stapling technique, and conduit diameter in esophagectomy.To establish guidelines for robotic upper gastro-intestinal surgical procedures.The approach to robotic upper gastro-intestinal surgical procedures should be standardized by formulating step-by-step guidelines. These guidelines will encompass robotic surgery for both benign (i.e. hiatal hernia, fundoplication) and malignant disease (i.e. esophageal and gastric cancer), with the exception of bariatric procedures.To form effective training programs that involve proctoring by experienced surgeons.In order to safely implement robotic surgery, training pathways that involve proctoring should be followed. The UGIRA will serve as the core platform to establish these training pathways and to appoint proctors in all continents. Completion of the training pathway will result in UGIRA credentialing.

Methods

Not applicable.

Results

Not applicable.

Conclusion

The UGIRA was recently established to facilitate the effective implementation and advancement of robotic esophageal and gastric surgery worldwide. To this end, the primary aims include setting up a web-based international registry, establishing guidelines for robotic upper gastro-intestinal procedures, and forming effective training pathways that involve proctoring.

Disclosure

All authors have declared no conflicts of interest.
PS02.011: ESOPHAGECTOMY IN A LOW VOLUME SINGLE CENTER FAVORING A TOTAL MINIMALLY INVASIVE APPROACH: 55 PATIENTS IN 7 YEAR
Authors: Gehwolf Philipp , Schmid Thomas , Öfner-Velano Dietmar , Wykypiel Heinz
Published: September 2018

Background

In Austria esophageal cancer is not very common. The incidence is 8.8/100.000 per year, thus esophageal cancer is on rank 18 of the most common carcinomas. Multimodal treatment inclouding surgery is standard for locally advanced esophageal cancer with a 5-year survival rate of around 40% in patients treated with a curative intent.

Methods

Retrospective single institution study in a tertiary care center using prospectively collected data we discuss our surgical procedure with patient survival as primary endpoint and morbidity as secondary endpoint.

Results

From 2010–1017, 55 Patients received an esophageal resection. The mean age was 61.5 years, five patients (9%) were female. Squamous cell carcinoma appeared in 37%, adenocarcinoma in 59% and a verrucous carcinoma in 4% of our patients. 98% of patients received an esophagectomy with gastric tube pull up, in 2% the colon was used for reconstruction. For patients with carcinoma located in the lower and middle thoracic esophagus a thoracic anastomosis was targeted (78%), in carcinomas of the upper thoracic esophagus a left cervical anastomosis (22%) was performed. Depending on location and comorbidities patients received either a conventional operation (11%), a hybrid operation with laparotomy and thoracoscopic esophageal resection (59%) or a totally minimal invasive approach (30%). The 60 days mortality was < 2%, the need for reoperation < 10%. Major complications (Clavien-Dindo III-V) were observed in 30%.

Conclusion

Esophagectomy is a high-risk operation with serious mortality and morbidity. However, patients may profit from a tailored approach with intent for the minimally invasive approach even in a low volume center when expertise in high-end endoscopic surgery is available.

Disclosure

All authors have declared no conflicts of interest.
PS02.019: THORACOSCOPIC INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS WITH PATIENT IN PRONE POSITION
Authors: Vecchiato Massimo , Ziccarelli Antonio , Petri Roberto , Lirusso Chiara , Martino Antonio
Published: September 2018

Description

After laparoscopic gastric conduit creation the patient is placed in prone position, with single-lumen endotracheal intubation. A right pneumothorax at 8 mmHg is created with a port at the apex of the scapula; two operative trocars are inserted in the right 5th and 9th intercostal spaces. The esophageal dissection in performed with an en bloc linfadenectomy. The distal part of the esophagus is tied up with a loop; the esophagus in then divided with an electrocautery scissor. A manual purse-string is made in the proximal esophageal stump with a Prolene 2/0. The envil of a circular stapler is put inside the chest through a port or during the laparoscopic procedure opening the right pleura; so it is introduced in the esophageal stump and the purse-string is closed. The incision of the lower port is enlarged and a laparoscopic wound retractor device is inserted. The specimen and the gastric conduit are retrieved; the stapler is introduced trough the laparoscopic wound retractor tip and through a small gastrostomy in the gastric tube; the puncturing shaft is pulled out through the greater gastric curve. We ensure the gastric conduit to the stapler with a second envil; it is introduced in the chest. After opening the stapler and loosing the second envil we perfomed the esophago-gastric anastomosis. A linear stapler is used to remove the excess of the stomach with the gastrostomy. Some interrupted stitches fixed the anastomosis to the mediastinal pleura. Two right chest tubes are inserted.

Disclosure

All authors have declared no conflicts of interest.
PS02.029: USEFULNESS OF TRIAMCINOLONE INJECTION TO PREVENT STRICTURE AFTER CIRCUMFERENTIAL ESOPHAGEAL ESD
Authors: Oyama Tsuneo , Takahashi Akiko
Published: September 2018

Background

ESD is a standard treatment for superficial esophageal cancer in Japan. Stricture is one of important complication of esophageal ESD, and it makes quality of life of the patient worse. Usefulness of Triamcinolone (TA) injection to prevent stricture after semi-circumferential ESD has been reported. However, usefulness of TA injection after circumferential esophageal ESD is still unclear.

Methods

The aim of this study is to clarify the usefulness of triamcinolone injection to prevent stricture after circumferential ESD. A total of forty-nine patients treated by circumferential esophageal ESD from 2004 to 2017 in Saku Central Hospital Advanced Care Center were enrolled to this retrospective study. Fifty mg TA was injected into submucosal layer just after ESD, and TA injection was repeated in two-weeks interval by the ESD ulcer healed. When the length of circumferential ESD was 50mm or longer, 100 mg Triamcinolone was injected just after ESD, and 50mg TA injection was repeated in two-weeks interval. Fifteen mm endoscopic balloon dilatation (EBD) was performed when the scope couldn’t pass the ESD ulcer. The primary endpoint was the number of balloon dilatation. The secondary endpoints were duration from ESD to ulcer healing, complications and the difference between Barrett's esophageal adenocarcinoma (EAC) and squamous cell carcinoma (SCC).

Results

1. Median number of EBD in Non-TA and TA group were 15 (13–33) and 3 (0–23), respectively (P < 0.01) 2. Median duration from ESD to ulcer healing were 6 (3–23) and 4 (1–24) months. respectively. (P = 0.47) 3. Complications: Perforation rate due to EBD was 6.3% (1/16) and 3.0%(1/33). Both patients were treated by conservative therapy. 4. Difference between EAC and SCC: There were nine EAC and forty SCC patients in TA group. The number of EBD were 5.3 (5–11) and 5.4 (3 -11), respectively. Duration of ulcer healing were 10 (4–14) and 6.5 (1–24), respectively. There was no significant difference between two groups.

Conclusion

Triamcinolone injection is safe and effective treatment to prevent stricture after circumferential ESD, not only for SCC but also for EAC.

Disclosure

All authors have declared no conflicts of interest.
PS02.036: FAILURE PATTERNS AND LATE TOXICITIES OF CONCURRENT CHEMORADIOTHERAPY FOR CERVICAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA: FROM A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Li Hongxuan , Liu Jun , Fu Xiao-Long
Published: September 2018

Background

From a prospective observational study, we aim to observe failure patterns and late toxicities of concurrent chemoradiotherapy (CCRT) among patients with cervical esophagus squamous cell carcinoma (CESCC).

Methods

All patients were pathologically confirmed with no distant metastasis. All the patients received CCRT followed by consolidate chemotherapy. Elective nodal irradiation was given and platinum-based doublet chemotherapeutic regimens were chosen for both concurrent chemotherapy and consolidate chemotherapy. All patients were followed up every 3 months in the first 2 years after CCRT and every 6 months thereafter. Re-examinations included cervical CT, chest CT, barium esophagram, abdominal CT or B ultrasound, esophagoscopy when necessary.

Results

Ninety-two patients were enrolled from March 2007 to July 2014. The median radiation dose was 60Gy (range: 50–63Gy). The median follow-up time was 34 months for all patients and 51.5 months for survival patients. Three-years and 5-year OS were 49.8% and 44.4% (the median OS: 36 ± 5.631months). Treatment failures occurred in 54 patients, including 30 cases (32.6%) with loco-regional failures alone (LF), 14 cases (15.2%) with distant metastasis alone, and 10 cases (10.9%) with both failures. Among the patients with LF, in-field recurrence occurred in 32 cases (80%, 32/40), out-field recurrence occurred in 8 cases (20%, 8/40). Among the 24 patients with distant metastasis, pulmonary metastasis occurred in 13 patients (54%, 13/24). Totally 52 patients were dead. Thirty-five patients died of LF, 11 patients died of distant metastasis, 2 patient died of unrelated diseases, and another four patients died of severe toxicities (4.3%), three of them died of esophageal fistula and another 1 patient died of laryngeal edema. The major late complication was esophageal symptom. There were 7 cases that had 3th grade strictures. Most of them could be relieved by continuous dilatation programme.

Conclusion

The efficacy of CCRT for CESCC was satisfactory. In-field LF is still the predominant failure pattern after CCRT for cervical esophageal SCC. Improving in-field local control and reducing distant metastasis may contribute to better efficacy.

Disclosure

All authors have declared no conflicts of interest.