bluuebunny/crossref_metadata_2025 huggingface dataset:
169. PROPENSITY SCORE MATCHING ANALYSIS OF THE EFFECT ON PROGNOSIS OF PROPHYLACTIC NECK DISSECTION FOR ESOPHAGEAL CANCER
Authors: Nishida Masato , Sato Shinsuke , Nagai Erina , Taki Yusuke , Watanabe Masaya , Oba Noriyuki
Published: August 2023

Background

There is still no definite evidence regarding the prognostic effect of #104 prophylactic dissection.

Materials and Methods: We conducted a retrospective study of patients who underwent esophagectomy regarding the prognostic effect of #104 prophylactic dissection by propensity score matching analysis. Between 2012/1 and 2020/12, 302 patients with esophageal malignant tumors underwent radical subtotal esophagectomy via the right thoracic approach at our hospital. The histological types were limited to squamous cell carcinoma, adenocarcinoma, and basal cell carcinoma, and clinical (c)T4b (TNM 7th edition), cM1, cervical esophageal cancer, salvage surgery cases, R1/2 cases, and cases with synchronous advanced multiple cancers were excluded. This resulted in the analysis of the 220 cases comparing between the 3-filed and 2-filed dissection groups. R version 4.1.2 was used for statistical analysis. The predicted probability of #104 dissection was calculated by logistic regression model.

Propensity score matching was performed to match patients between 2 groups according to age, tumor location, preoperative treatment, postoperative pneumonia, pathological (p)T factor, and pN factor by nearest neighbor method within caliper. P < 0.05 was considered statistically significant.

Results

Both DSS and DFS were significantly better in the 2-filed dissection group. Baseline characteristics showed that the 3-filed dissection group had significantly more patients of tumor location Mt and Ut, more squamous cell carcinoma as the histologic type, and more cases with preoperative treatment. In the 3-field dissection group, operative time was significantly longer and the postoperative complications was increased such as recurrent nerve palsy and cervical lymphatic leakage. Pathologic results showed higher grades of pT and pN. Four patients in the 3-field dissection group had p104 metastasis, and only 1 of these survived without recurrence. On the other hand, 5 patients of the 2-field dissection group had #104 as the first recurrence site, and 3 of these had simultaneous distant metastasis. There was no significant difference in DSS and DFS between groups after propensity score matching (DSS p = 0.852, DFS p = 0.768).

Conclusions

This retrospective study did not confirm a prognostic benefit of prophylactic dissection of the #104 region. This will be elucidated by results of the ongoing RCT, JCOG2013 trial.
183. NEOADJUVANT CAMRELIZUMAB PLUS CHEMOTHERAPY (NICE) VERSUS CROSS REGIMENS IN OESOPHAGEAL SQUAMOUS CELL CARCINOMA, A PROPENSITY-SCORE MATCHED ANALYSIS
Authors: Yang Yuxin , Zhu Kaiyuan , Liu Zhichao , Liu Jun , Yang Yang , Li Bin , Li Chunguang , Li Zhigang
Published: August 2023

Background

The CROSS regimen represents standard neoadjuvant management for oesophageal squamous cell carcinoma (ESCC) for the last decade, while the utility of Camrelizumab plus chemotherapy (NICE) is increasingly gaining attention. In the absence of published Randomized Controlled Trials, there remains a paucity of robust information on comparison of these two modalities. This study aims to compare the treatment response and short-term outcomes of NICE followed by oesophagectomy with that after CROSS-induced chemoradiotherapy, in treatment for ESCC.

Methods

A total of 234 patients staged as clinical II-IV, 117 in each arm, was enrolled in this study after propensity-score match. The primary outcomes were tumor response and survival. Secondary outcomes were toxicity and postoperative complications. Pathological response of tumor was evaluated by Chirieac tumor regression grade (TRG) and major pathological response (MPR) as well as responders were defined as TRG1–2 N0. Complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria and severity per Clavien-Dindo. Survival was evaluated by Kaplan–Meier method using Breslow test, and freedom from recurrence with the competing risk of death estimated per Fine-Gray method.

Results

After matching, R0 resection (93.2% vs 94.9%, P = 0.784), pCR (ypT0N0) (25.6% vs 30.8%, P = 0.468), MPR (46.2% vs 47.0%, P = 0.896) rates and TRG1/2 grades (P = 0.331) were comparable between CROSS and NICE regimens. However, NICE was associated with more lymph nodes yield (P < 0.001) and higher risk of anastomotic leak (type2/3) (P = 0.030)(Fig. 1A-C). The 1-year overall survival was 86.6% and 93.5% for CROSS and NICE (P = 0.088) with comparable recurrence risk (21% vs 21%, P = 0.520) (Fig. 1D/E). Patients with pCR or responders showed similar K-M curves, but in nonresponder subgroup analysis, NICE regimen demonstrated superior survival benefit than CROSS (P = 0.035) (Fig. 1F-H).

Conclusion

In this matched study, NICE is safe and feasible for ESCC with comparable perioperative outcomes compared to CROSS. Moreover, NICE regimen shows superior survival benefit in nonresponder group than CROSS, suggesting its more powerful systemic treatment effects. However, Prospective RCT studies are needed to further verify these findings.
188. VITAMIN D RECEPTOR INDUCES OXIDATIVE STRESS TO PROMOTE ESOPHAGEAL SQUAMOUS CELL CARCINOMA PROLIFERATION VIA THE P53 SIGNALING PATHWAY
Authors: Shang Qi-Xin , Chen Long-Qi
Published: August 2023

Background

Esophageal squamous cell carcinoma (ESCC) is a common pathological esophageal cancer with poor prognosis. Vitamin D deficiency reportedly occurs in ESCC patients, and this is related to single nucleotide polymorphism of vitamin D receptor (VDR). We investigated the effect of VDR on ESCC proliferation, invasion, and metastasis and its potential mechanism.

Methods

ESCC and normal tissues were collected from 20 ESCC patients. The ESCC tissue microarray contained 116 pairs of ESCC and normal tissues and 73 single ESCC tissues. VDR expression and its clinicopathological role were determined by real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry staining. sh-VDR and VDR overexpression were used to validate the effect of VDR on ESCC cell phenotype, and tandem mass tag-based quantitative proteomics and bioinformatics methods identified differential VDR-related proteins. The downstream pathway and regulatory effect were analyzed using ingenuity pathway analysis (IPA). Differentially expressed proteins were verified through parallel reaction monitoring and western blot. In vivo imaging visualized subcutaneous tumor growth following tail vein injection of VDR-deficient ESCC cells.

Results

High VDR expression was observed in ESCC tissues and cells. Gender, T stage, and TNM stage were related to VDR expression, which was the independent prognostic factor related to ESCC. VDR downregulation repressed ESCC cell proliferation, invasion, and migration in vitro and subcutaneous tumor growth and lung metastases in vivo. The cell phenotype changes were reversed upon VDR upregulation, and differential proteins were mainly enriched in the p53 signaling pathway. TP53 cooperated with ABCG2, APOE, FTH1, GCLM, GPX1, HMOX1, JUN, PRDX5, and SOD2 and may activate apoptosis and inhibit oxidative stress, cell metastasis, and proliferation. TP53 was upregulated after VDR knockdown, and TP53 downregulation reversed VDR knockdown-induced cell phenotype changes.

Conclusions

VDR may inhibit p53 signaling pathway activation and induce ESCC proliferation, invasion, and metastasis by activating oxidative stress.
195. OUTCOME OF A PATIENT CHOICE PROTOCOL OF SURGERY OR SURVEILLANCE FOR CLINICAL COMPLETE RESPONDERS TO NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CARCINOMA
Authors: Walsh Thomas
Published: August 2023

Background

Following neoadjuvant chemoradiotherapy (NCR) esophagectomy is mandated, regardless of response. But patients with pathological complete response (pCR) cannot benefit from resection but are exposed to its risks; and denying resection risks accusation of undertreatment of patients who succumb to recurrent disease. The majority cCR patients have a pCR. We hypothesized that offering patients a choice between surgery and surveillance would result in a non-inferior outcome. This cohort study examined the outcome of this policy.

Patients and Methods: Between 1998 and 2019, 205 patients were treated with curative intent, of whom 152 (74%) underwent NCR. They were re-staged with endoscopy, biopsy and computerized tomography (CT) six to ten weeks after completion of NCR. Of 152 so treated, 80 (52%) had a cCR. The decision to operate on cCR patients was based on patient preference. Survival time was analysed based on clinical response in all patients and with histopathological response in patients treated surgically.

Results

Of 80 (52%) patients that had a cCR 51 (64%) chose surgery and 29 (36%) chose surveillance. The mean ages of the surgery and surveillance cohorts were 59 and 70 years respectively (p < 0.001). Of 51 cCR patients undergoing surgery 35 (69%) had a pCR. The mean survival of the surgery cohort was 76 months (median 50.0; SD 74.9; range 2.2 to 268 months) compared to 56 months (median 24.6; SD 62.7; range 6.1 to 206) for surveillance. When adjusted for age, Cox regression estimated an insignificant hazard ratio of 1.22 (95% CI 0.65 to 2.32; p = 0.53).

Conclusion

Survival of cCR patients who chose surveillance was not statically inferior to those choosing surgery. This was true for both adenocarcinoma (AC) and squamous cell carcinoma (SCC). A cCR was predictive of pCR in the majority of patients. Allowing patients to choose between surveillance and surgery is prudent, especially those patients at greatest operative risk and lowest risk for residual disease.
216. SHORT-TERM OUTCOMES OF 111 CASES OF MEDIASTINOSCOPIC ESOPHAGECTOMY FOR ALL ESOPHAGEAL CANCERS
Authors: Mitsui Takashi , Hakozaki Yuhei , Saito Kazuyuki , Okuyama Takashi , Yoshitomi Hideyuki
Published: August 2023

Background

Mediastinoscopic esophagectomy (ME) as a radical surgery for esophageal cancer is considered promising because of its low complication rate of pneumonia. In our hospital, ME with three-field lymphadenectomy is the first choice for radical esophagectomy and is indicated for all cases of esophageal cancer, including borderline resectable, locally invasive tumors, conversion surgery, and salvage surgery. However, there have been few reports of ME for highly advanced esophageal cancer, and its safety and feasibility are unknown.

Methods

From April 2018 to April 2023, we retrospectively investigated all cases of radical esophagectomy at our hospital. Patient characteristics and perioperative short-term outcomes were investigated.

Results

cStage 0/I/II/III/IV were 7/20/26/37/21 respectively. 70% of patients were treated with neoadjuvant chemotherapy. ME was performed in 111 cases, thoracoscopy and thoracotomy in 0 cases. The conversion rate from ME to thoracotomy was 0.9%. The mean operation time was 547 min and blood loss was 215 mL. Postoperative complications of classified as grade II in the CD classification occurred in 19.8%, and more than grade IIIa occurred in 13.5%. The mean postoperative hospital stay was 20 days. The number of dissected lymph nodes was 47. The completion rate of R0 surgery was 94%.

Conclusion

ME for all esophageal cancers, including borderline resectable tumors and locally invasive tumors, was safe and feasible. ME with three-field lymphadenectomy may be the first choice for radical esophagectomy.
224. A SUCCESSFUL CASE OF VACUUM-STENT TREATMENT FOR BOERHAAVE SYNDROME
Authors: Pattynama Lisanne , Eshuis Wietse J , Pouw Roos
Published: August 2023

Background

Boerhaave syndrome is a rare disease, associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has gained a greater role in the treatment of transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome. Recently, a vacuum-stent was introduced as a new device to apply EVT. While allowing for oral intake of a soft diet, this device combines the benefits of negative pressure wound therapy and an intraluminal stent.

Methods

This video describes a patient with Boerhaave syndrome, successfully treated with a vacuum-stent, including the technical aspects of the technique. First, a guidewire was placed and the vacuum-stent was advanced over the guidewire and introduced into the esophagus. The vacuum-stent was placed over the defect and deployed using the distal release system. Lastly, the vacuum-stent was connected to a vacuum pump, which was set to a pressure of -125 mmHg on the day of placement and -75 mmHg from the second day on. Generally, a vacuum-stent was removed after 7 days. If the defect persisted, another vacuum-stent was placed.

Case/Results: A 36-year-old male presented with severe abdominal pain after emesis. CT-scan showed suspicion of a defect in the distal esophagus and an endoscopy was performed. Endoscopy showed a defect of 2 cm in length with moderate degree of debris. It was decided to initiate treatment with vacuum-stent. The vacuum stent was exchanged once per week and after a total of 31 days, the defect was closed, confirmed by CT-scan with oral contrast. During treatment, oral intake was extended to a soft diet. One day after removal, the patient resumed oral intake and was discharged.

Conclusions

The vacuum-stent seems to be a safe and possibly organ-saving treatment option for transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome.

Link to video: https://we.tl/t-IA5oM70TX5
249. AUTOMATED PREDICTION SYSTEM USING COMPUTER VISION FOR ESOPHAGEAL STRICTURE AFTER ESOPHAGEAL ENDOSCOPIC RESECTION
Authors: Takeuchi Masashi , Kawakubo Hirofumi , Matsuda Satoru , Kitagawa Yuko
Published: August 2023

Background

Although endoscopic submucosal dissection (ESD) is a standard treatment for early esophageal cancer, post-treatment esophageal stricture (ES) is the most common complication, especially in patients with circumferential resection range greater than three-quarters. This study sought to establish an automated system for predicting ES after ESD from endoscopic video using computer vision. We believe that this automation can help endoscopists to perform appropriate decision-making, such as whether to perform steroid injection during ESD or preventative balloon dilatation after ESD.

Methods

This study assessed recorded endoscopic videos of 73 patients who underwent ESD for superficial esophageal cancer. A deep neural network-based classifier—DeepES—was developed to assess whether ES would occur. The model was trained and tested using k-4 folds cross-validation, and the area under the curve (AUC) values of DeepES were calculated to validate the model performance against several clinicopathological factors.

Results

For the 73 patients evaluated by k-4 folds cross-validation, overall accuracy for the DeepES was 0.712, meaning ES could be correctly predicted by AI for 52 patients.

The AUC value of DeepES was higher (AUC 0.709) compared with circumferential resection range (AUC 0.680) and pathological tumor depth (AUC 0.570).

Conclusion

DeepES has a higher accuracy for predicting ES during ESD than other factors, including circumferential resection range and pathological tumor depth. Use of DeepES enables optimal decision-making during ESD, such as whether to perform preventative strategies, including balloon dilatation. This report is the first to show the value of state-of-the-art technologies using computer vision for ESD to prevent ES.
253. ESOPHAGEAL REGENERATION FOLLOWING IMPLANTATION OF A TISSUE ENGINEERED ESOPHAGEAL IMPLANT: UNDERSTANDING THE REGENERATION TIME COURSE AND TRANSLATION TO THE CLINIC
Authors: Fodor William
Published: August 2023

Diseases of the esophagus, damage of the esophagus due to injury or congenital defects during fetal esophageal development, i.e., Esophageal Atresia (EA), typically require surgical intervention to restore esophageal continuity. The development of novel tissue engineered tubular structures would improve the treatment options for these conditions by providing an alternative that is organ sparing and can be manufactured to fit the exact dimensions of the defect. Biostage has developed an autologous tissue engineered Esophageal Implant, composed of an electrospun cellular scaffold seeded with autologous mesenchymal stromal cells, that can stimulate repair and regeneration of segmental defects in the esophagus following surgical implantation. Biostage has received approval from the FDA on an Investigational New Drg (IND) application for a clinical trial in adults requiring esophageal reconstruction. A discussion of the regeneration time course, in adults and in a pediatric model as well as the critical features of the IND, the Regulatory process for treating adults with the intention to treat Esophageal Atresia and the clinical study parameters highlight the novelty of this tissue engineered combination product.
270. PERIOPERATIVE CHEMOTHERAPY FOR OPERABLE GASTRO-ESOPHAGEAL JUNCTION OR GASTRIC CANCER: FLOT VERSUS ANTHRACYCLINE TRIPLETS
Authors: Geerts Julie F M , Zijden Charlène , Sluis Pieter C , Spaander Manon C W , Nieuwenhuijzen Grard A P , Rosman Camiel , Laarhoven Hanneke W M , Verhoeven Rob H A , Wijnhoven Bas P L , Lagarde Sjoerd L , Mostert Bianca
Published: August 2023

Background

Since the FLOT4-AIO study (2019) showed improved survival in patients treated with neoadjuvant fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) compared to those treated with neoadjuvant anthracycline triplets, FLOT became standard of care in the Netherlands and most Western countries. The aim of this study was to compare the overall survival (OS), pathological response and surgical outcomes of FLOT chemotherapy to anthracycline triplets in the Netherlands, using real-world population level data.

Methods

Patients diagnosed with resectable (cT2-4a/cTxN0–3/NxM0) gastro-esophageal junction and gastric carcinoma between 2015–2020 were selected from the Netherlands’ Cancer Registry. Patients were included if they received neoadjuvant FLOT or anthracycline triplets whether this was followed by resection or not. OS was calculated from start of neoadjuvant therapy, analyzed using cox regression analysis and adjusted for sex, age, comorbidities, performance status, cT-stage/cN-stage and tumor grade. Secondary outcomes included the pathological complete response (pCR), proportion of patients that fully completed neoadjuvant chemotherapy (100% of scheduled cycles permitting dose reductions), proportion of patients that underwent (radical) surgical resection and proportion receiving adjuvant therapy.

Results

778 included patients were treated with FLOT and 913 with anthracycline triplets. Patients treated with FLOT underwent more staging diagnostic laparoscopies (DLS) (73.5% vs. 44.1%, p < 0.0001). Adjusted OS was better after neoadjuvant FLOT (HR = 0.84, 95% CI 0.72–0.98, p = 0.03). 3-year and 5-year OS were 56.4% and 46.6% after FLOT and 52.7% and 45.5% after anthracycline triplets, respectively. A higher proportion of patients treated with FLOT fully completed neoadjuvant chemotherapy (78.5% vs. 73.1%, p = 0.009) and had R0 resections (86.2% vs. 85.2%, p = 0.007). No statistically significant differences were seen in the proportions of patients that underwent resection, received adjuvant therapy, or had pCR.

Conclusion

Real-world population level data showed better OS of patients treated with FLOT chemotherapy compared to anthracycline triplets. No statistically significant difference was observed in pCR or resection rates. Thus, not every outcome as described in the FLOT4-AIO trial could be reproduced in a real-world population, despite improved staging with DLS in the FLOT group. Divergent baseline characteristics and less intensive neoadjuvant treatments in real-world patients compared to patients in clinical trials may contribute to this discrepancy.
290. RISK OF ESOPHAGEAL CANCER AFTER BARIATRIC SURGERY: COMPARISON BETWEEN SLEEVE GASTRECTOMY AND GASTRIC BYPASS AT 10 YEARS, A NATIONWIDE STUDY
Authors: Gronnier Caroline , Poghosyan Tigran , Lazzati Andrea
Published: August 2023

Backgroud

The risk of esophageal cancer after bariatric surgery is a matter of debate. Several studies have reported that bariatric surgery patients have a lower risk of cancer. However, esophageal cancer is associated with gastroesophageal reflux disease, which may increase after bariatric surgery and in particular after sleeve gastrectomy.

Objectives

The objective of this study is to evaluate the risk of esophageal cancer after two bariatric procedures: sleeve gastrectomy (SG) and gastric bypass (GBP).

Methods

Data from patients operated on for bariatric surgery between 2007 and 2020 in France were extracted from a national discharge database (PMSI). Adult patients operated on for SG or GBP were included and followed up until December 2020. Patients were divided into two groups according to the procedure initially performed. The endpoints were the occurrence of esophageal and cardia cancers. To assess the effect of the type of bariatric procedure on the development of cancer, a multivariate analysis was performed using a marginal Cox model after matching on propensity score (PS). In the sensitivity analysis, we used different models: standard Cox regression, Cox regression adjusted on propensity score, and Cox model with adjustment for inverse probability of treatment weighting.

Results

Of the 367,169 patients included, 68.7% were SGs and 31.3% were GBPs. The two groups differed at inclusion in terms of age, sex, BMI, and comorbidities. Median follow-up was 6.0 years (IQR 3.0–8.0 years) for the entire cohort, and approximately 35,000 patients were followed for at least 10 years. A total of 88 esophageal cancers were identified, including 64 after SG and 24 after GBP. In multivariate analysis, no significant difference was found between SG and GBP on cancer incidence (HR 1.6, 95%CI 0.9–2.7, p = 0.09 for OS versus GBP). No differences were found in sensitivity analyses.

Conclusion

In this large national cohort of bariatric surgery patients, no significant differences were found in the incidence of esophageal and cardia cancer between OS and GBP.
295. RELATIONSHIP BETWEEN ABDOMINAL FAT DISTRIBUTION AND PROGRESSION OF BARRETT’S ESOPHAGUS TO ADENOCARCINOMA
Authors: Towatari Shuichiro
Published: August 2023

Background

Obesity was known to be a risk factor of the incidence of Barrett’s esophagus (BE) and Barrett’s esophageal adenocarcinoma (BEA). Especially excessive visceral fat has recently reported to promote some cancers, including BEA. This study aimed to clarify the impact of abdominal fat distribution on the progression of BE to adenocarcinoma in long-segment BE (LSBE) and short-segment BE (SSBE).

Methods

Study 1: We retrospectively reviewed the 124 patients with pathologically defined superficial BEA who underwent endoscopic resection, including 4 endoscopic mucosal resection (EMR) and 85 endoscopic submucosal dissection (ESD), or surgical operation (35 esophagectomy) in our institution between January 2004 and December 2018. 124 BEA cases included 34 LSBE (length ≥ 3 cm) cases and 90 SSBE (length ≥ 1 and < 3 cm) cases. Using computed tomography volumetry, we measured areas of visceral (VFA) and subcutaneous (SFA) fat at the level of the umbilicus, and calculated the VFA/SFA ratio in each patient, defining high-VFA/SFA ratio (≧1.0) and low-VFA/SFA ratio (<1.0). VFA/SFA ratio were compared and analyzed between BEA with LSBE group and BEA with SSBE group.

Study2: We divided 62 patients who had LSBE into two groups based on prognosis of BEA; BEA with LSBE (34 patients) and non-BEA with LSBE group (18 patients). Abovementioned parameters were compared and analyzed between these two groups.

Study3: Abovementioned parameters were compared and analyzed between BEA with SSBE (90 cases) and non-BEA with SSBE group (100 controls).

Results

study1: High VS ratio were seen in 22 (64.7%) patients among BEA with LSBE group and 34 (37.8%) patients among BEA with SSBE group, which is statistically significant (p = 0.0072).

Study2: High VS ratio were seen in 6 (33.3%) patients among non-BEA with LSBE group. This result was statistically significant compared to BEA with LSBE group (0.038).

Study3: In non-BEA with SSBE, 32 patients (32.0%) had High VS ratio, showing no significant difference compared to BEA with SSBE.

Conclusion

High VFA/SFA ratio was significantly associated with progression of long-segment Barrett’s esophagus to esophageal adenocarcinoma.
300. ENDOSCOPIC FOLLOW-UP OF RADICALLY RESECTED SUBMUCOSAL ESOPHAGEAL ADENOCARCINOMA: PRELIMINARY RESULTS OF AN ONGOING PROSPECTIVE, INTERNATIONAL, MULTICENTER COHORT REGISTRY (PREFER TRIAL)
Authors: Pouw Roos , Nieuwenhuis Esther , Jansen Marnix , Koch Arjun , Spaander Manon , Nagengast Wouter , Westerhof Jessie , Bisschops Raf , De Hertogh Gert , Neuhaus Horst , Beyna Torsten , Bourke Michael , Weusten Bas , Alkhalaf Alaa , Pech Oliver , Seewald Stefan , Haidry Rehan , Schoon Erik , Schlag Christoph , De Wulf Dominiek , Houben Martin , Messman Helmut , Dewint Pieter , Ortiz Jacobo , Meijer Sybren , Bergman Jacques , Pouw Roos
Published: August 2023

Introduction

Current guidelines advise esophagectomy for submucosal esophageal adenocarcinoma (T1b EAC). Data from retrospective studies suggest that endoscopic follow-up (FU) may be a valid alternative in patients without signs of lymph node metastases (LNM) at baseline. Our aim is to evaluate the safety of a watchful waiting strategy with regular endoscopic FU as an alternative in patients treated endoscopically for T1b EAC (NCT03222635).

Methods

This study, conducted at 19 hospitals in Europe and Australia, aims to include 141 patients with 5-year FU. After endoscopic resection of T1b EAC (R0), patients are re-staged with endoscopic ultrasound (EUS) and CT/PET. Patients (N0M0) undergo strict endoscopic FU with gastroscopy and EUS. CT/PET is repeated after 1 year. The cohort is divided into ‘high-risk’ (submucosal invasion ≥500um, a/o poorly/undifferentiated tumor (G3–4), a/o lymphovascular invasion (LVI+)) and ‘low-risk’ (risk features absent). Outcome parameters are 5-year disease specific survival, overall survival, rates of LNM and local recurrence.

Results

134 patients (112 men, median age 69) underwent median FU of 22 (IQR 11–35) months: 87 high-risk and 47 low-risk. 6 patients (4% [95%CI 0.2–8.8]) were diagnosed with LNM after median FU of 8 (IQR 5–16) months. 2/6 underwent neoadjuvant chemo(radio)therapy with esophagectomy (ypT0N1M0, ypT0N0M0), 1/6 underwent esophagectomy only (pT0N2M0), 3/6 underwent selective surgical LN resection.

7 patients (5% [95%CI 0.8–9.6] were diagnosed with an intra-luminal tumor recurrence not eligible for endoscopic re-treatment after median FU of 7 (IQR 6–15) months. 2/7 underwent esophagectomy (pT1bN0M0, pTisN0M0), 1/7 had neoadjuvant chemoradiotherapy and esophagectomy (ypT1aN0M0), 3/7 underwent (chemo)radiotherapy only, of which 1 patient eventually died as result of stenosing EAC, 1/7 refused additional treatment.

No distant metastases were diagnosed. Five patients died of an EAC-unrelated cause. Five patients discontinued FU due to old age. Two patients were lost to FU.

Conclusion

The preliminary analysis from our ongoing prospective study suggest that in patients with radically removed high- or low-risk T1b EAC, without LNM at baseline, a strict endoscopic follow-up protocol is feasible and the window for curative therapy remains open for those patients who develop LNM (4%) or a local intra-luminal recurrence (5%) during FU. Most patients demonstrate uneventful FU.
326. LONG-TERM OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY (MERAS) PROTOCOLS IN PERI-OPERATIVE MANAGEMENT OF MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Chen Maohui , Zheng Bin , Huang Yizhou , Zhang Shuliang , Zeng Taidui , Ning Chenhui , Chen Chun
Published: August 2023

Introduction

Enhanced recovery after surgery (ERAS) programs consists of a set of pre-, intra- and post-operative protocols to minimize perioperative burden, reduce postoperative complications and morbidity, optimize postoperative recovery, and shorten hospital stay. The rare studies available demonstrate positive results for long-term survival of ERAS in gastric, colon and rectal cancers, however, it is not clear whether the ERAS regimen can improve the long-term prognosis of esophageal cancer. Therefore, we conducted this study to compare post-operative morbidity, functional recovery, and length of hospital stay in patients undergoing esophagectomy following the implementation of modified ERAS (mERAS) protocols or conventional standard care (SC), and to determine the effect of the ERAS protocol after esophagectomy on long-term survival.

Materials and methods: This retrospective clinical study was conducted from 1st June 2014 to 31st December 2016, included 229 consecutive patients with esophageal carcinoma who underwent esophagectomy. The mERAS protocols were implemented in our department of Fujian Medical University Union Hospital on 1st November 2015. After that time, all patients were treated according to the protocols (mERAS group). And before that time, all patients were treated with conventional standard care (SC group). We chose the cohort of patients, because the patients underwent surgery most recently prior to the patients in mERAS group.

Results

There was no significant difference between the two groups, with the exception of the percentage of patients who had cocomitant disease. The rate of cardiac diseases or hypertension in mERAS group was higher than that in SC group (24.4% vs. 13.8%). Incidence rate of anastomotic leakage was significantly lower in mERAS patients than in SC patients (0% vs. 13.8%, P = 0.000). Incidence rate of chylous leakage was significantly lower in mERAS patients than in SC patients (0.7% vs. 6.4%, P = 0.015). In patients with 5% preoperative weight loss, survival was better in the mERAS group than in the SC group.

Conclusion

The advantage of ERAS concerns the surgeon, care team, the patient and the society as a whole. Our study indicated that implementation of mERAS protocols in patients undergoing minimally invasive esophagectomy could resulted in better postoperative recovery and reduced postoperative complications.
332. NO NEED FOR A SPONGE! ENDOLUMINAL VACUUM THERAPY WITH A SIMPLE FENESTRATED SURGICAL DRAIN FOR MANAGEMENT OF BENIGN OESOPHAGEAL PERFORATIONS
Authors: Sivarajan Sri , Kulasegaran Suheelan , Kumar Bhaskar
Published: August 2023

Background

Conventional endoluminal vacuum therapy (EVT) uses a sponge and can be an effective technique for management of benign esophageal perforations. We describe a unique method of positioning a simple fenestrated surgical drain with applied vacuum suction at or through the site of perforation. We aimed to see whether this was a safe and effective management approach for benign esophageal perforations whilst reducing the frequency and need for general anaesthetic (GA) based endoscopic exchanges.

Methods

A retrospective case-series was performed on consecutive patients with benign esophageal perforations from 2019 to 2023 at a tertiary hospital in the United Kingdom. Included patients had undergone initial management of benign esophageal perforation with EVT and fenestrated surgical drain. The drain was either placed in an intraluminal or intracavitary position depending on the size of perforation. Primary outcome assessed was complete epithelialisation of the fistulous orifice with EVT. Secondary outcomes included: 90-day mortality, Length of Stay (LOS), re-operation, complications, percentage of EVT procedures under GA, duration of EVT and interval between endoscopic exchanges.

Results

Seven patients met inclusion criteria (median age: 66 (23–79) years). In four instances aetiology of perforation was iatrogenic from gastroscopic procedures with remaining cases due to Boerhaave’s syndrome, foreign body ingestion and benign ulceration. Six patients achieved full healing of perforation with EVT, with one patient requiring oesophageal stenting. There was 0%, 90-day mortality and two patients underwent re-operation for thoracic drainage procedures. Median LOS was 22 days and mean duration of EVT was 14 days. Patients underwent on average 2.6 gastroscopies during admission, 75% of which were performed without GA. The mean interval between EVT repositioning/exchange was 8 days.

Conclusion

EVT with a surgical drain achieved complete healing in all but one case of benign esophageal perforation. In contrast to EVT with sponge it can be performed without GA and with a longer duration between drain exchanges and gastroscopies. Additionally, as the same drain can be used for the duration of therapy it may reduce material cost. Further studies should perform prospective and direct comparisons with alternative EVT strategies for benign esophageal perforations.
340. LONG-TERM ONCOLOGIC OUTCOMES OF ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION AND SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Chen Yung-Hsin , Lee Jang-Ming
Published: August 2023

Purpose

For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes.

Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model.

Results

The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1).

For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS.

Conclusion

For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes.

Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.
347. LASER CAPTURE MICRODISSECTION AND WHOLE GENOME SEQUENCING OF ESOPHAGEAL ADENOCARCINOMA SAMPLES WITH MINIMAL TUMOUR
Authors: Wilson Gavin , Cotton James , Liang Sheng-Beng , Allison Frances , Bach Yvonne , Allen Jonathan , Darling Gail , Elimova Elena , Kalimuthu Sangeetha , Yeung Jonathan
Published: August 2023

Background

Esophageal adenocarcinoma (EAC) samples, particularly biopsies, can have low tumour cellularity, which limits their use for sequencing. Previous studies have focused on untreated resection specimens with high cellularity (i.e. TCGA requiring 60% cellularity on histology). Laser capture microdissection (LCM) is a method to enrich tumour cells from histological specimens and has been successfully used in other samples. We hypothesize that LCM can enrich for tumour from biopsies and resection specimens with very low cellularity.

Methods

Biopsy and resection EAC specimens were subjected to laser capture microdissection and whole genome sequencing (N = 49 biopsies and N = 15 resections) as part of the MOCHA trial (NCT04219137). LCM samples were reviewed by a board-certified pathologist to quantify tumour cellularity prior to LCM. Matched germline DNA was extracted from patient blood. Samples were processed using an in-house pipeline to call somatic single nucleotide variants (SNVs), insertions, deletions, copy number changes, and structural variants. Post LCM tumour cellularity was estimated from the WGS data.

Results

We had slightly higher WGS tumour cellularity for biopsies (66.2% +/− 16.8) and resections (71.3% +/− 18.0) than TCGA (58.1% +/− 17.5), while our histological cellularity was much lower than TCGA’s 60% cutoff at 32.2% +/− 24.5 for biopsies and 31.0% +/− 22.7 for resections. Overall, our LCM strategy led to an increase of 35.4 +/− 25.1% for cellularity by WGS compared to the histology. Finally, we observed a similar tumour ploidy and SNV composition as TCGA, which further verified that our tumour enrichment strategy was successful.

Conclusion

We have successfully applied an LCM strategy to enrich for tumour cells from low cellularity specimens. For example, we have successfully enriched for tumour cells from specimens with as low as 1% histological cellularity. We are currently exploring the results of this dataset including clinical correlations, changes in potential driver mutations from biopsy to resection, and comparing our results to treatment response.
349. TOTALLY MECHANICAL STAPLED SIDE-TO-SIDE VERSUS CIRCULAR END-TO-SIDE ANASTOMOSIS FOR MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY: A MULTICENTER ANALYSIS
Authors: Gao Hui-jiang , Yu Xiang-Yang , Hu Shi-Yu , Huang Chu-Jiang , Du De-Long , Yu Xin , Yu Zhen-Tao , Ma Kai
Published: August 2023

Background

Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal cancer. However, it is currently unknown if fully mechanical stapled side-to-side anastomosis for Ivor Lewis TMIE could be preferred for patients in whom both procedures are oncologically feasible.

Methods

The study was performed in 2 high-volume China esophageal cancer centers between Feb 2015 through Dec 2022. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing Ivor Lewis TMIE were included. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reoperations, length of stay, mortality, and overall survival (OS).

Results

147 patients were included in this study. The incidence of anastomotic leakage requiring reintervention or reoperation was 12.9% after fully mechanical stapled side-to-side versus 11.8% after circular end-to-side anastomosis (P = 0.852). Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture (5.7% vs 17.1%, p = 0.032). Pulmonary complications (20.0% vs 23.7%), recurrent laryngeal nerve palsy (7.1% vs 5.3%), chyle leakage (10.0 vs 7.9%), atrial fibrillation (12.9 vs 13.2) and median hospital length of stay (12 vs 11 days) were comparable between the two arms (all P > 0.05). R0 resection rate was similar between the groups. Overall survival was comparable between the two arms (hazard ratio [HR], 0.81, 95% CI, 0.62–1.21, P = 0.208). The cumulative 5-year OS was 44.3% in the fully mechanical stapled side-to-side anastomosis arm, as compared with 39.5% in the circular end-to-side anastomosis arm.

Conclusion

Compared to circular end-to-side anastomosis in patients in whom both procedures are oncologically feasible, there was no significant difference in the incidence of anastomotic leakage and other postoperative morbidity and OS with a fully mechanical stapled side-to-side anastomostic Ivor Lewis esophagectomy. Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture.
361. THE IMPACT OF A PROGRAM TO IMPROVE PREOPERATIVE NUTRITION AND REHABILITATION FOR ESOPHAGEAL CANCER PATIENTS
Authors: Nakano Toru , Koyama Kaori , Sawada Kentaro , Mitamura Atsushi , Miura Tomoya , Kitamura Yo , Sato Yoshihiro , Sakurai Hiroto , Takami Kazuhiro , Nagao Munetaka , Kondo Noriko , Yamamoto Kuniharu , Tsujinaka Shingo , Katayose Yo , Shibata Chikashi
Published: August 2023

Background

Improvement of the preoperative inflammation, nutrition, and other systemic conditions may reduce surgical complications and improve the prognosis of cancer. The usefulness of preoperative nutritional therapy and rehabilitation has recently been discussed. We created a novel program of preoperative rehabilitation and nutritional support to improve postoperative outcomes. We examined the nutritional status and blood electrolyte predisposition before and after this program.

Methods

Thirty five patients who underwent esophagectomy for esophageal cancer. These patients performed muscle strengthening exercise and received jelly beverage containing branched-chain amino acids immediately after rehabilitation and immune-modulating liquid diets for 7 consecutive days before surgery. Nutritional guidance was provided by a dietitian, who set a daily energy target of 30 kcal/kg and a protein target of 1.2 g/kg. Upper and lower limb strength training was performed with a physical therapist. Blood biochemical data on nutrition such as serum Alb, PreAlb, CRP, levels were compared after preoperative support.

Results

Thirty five patients who underwent esophagectomy for esophageal cancer in this period and evaluate their blood and serum samples. The average age of the patients was 66 years, 29 men and 6 women. Serum Alb level was 4.01 ± 0.4 g/dl before admission and 3.74 ± 0.35 g/dl the day before surgery (p = 0.04), and serum transthyretin level was unchanged from 28.9 ± 5.5 mg/dl to 26.1 ± 4.75 mg/dl. Serum CRP level tended to decrease from O.23 ± 0.528 mg/dl before admission to 0.14 ± 0.23 mg/dl the day before surgery. Other index of nutritional status did not change significantly before or after the program.

Improvements in preoperative inflammation and nutrition are expected to decrease surgical complications and contribute to cancer prognosis. Our study and intervention in the present study may have decreased inflammation, although it was not a clear objective improvement in nutritional status. The short duration of the intervention may have prevented a significant difference. A less prolonged hospitalization is not realistic and the most effective nutritional rehabilitation intervention should be devised in the future.
368. UNIPORTAL VATS MCKEOWN ESOPHAGECTOMY FOR LOWER THIRD ESOPHAGEAL SQUAMOUS CELL CANCER
Authors: Rajan Shiv , Kumar Vijay
Published: August 2023

https://wetransfer.com/downloads/bc83bc97967d74f093629397fd7b5ed720230505000919/8c1e7aa0e8a6b089152303025bfbfd7120230505000947/ff511d

Background

Minimally invasive esophagectomy has become the standard surgical procedure for the carcinoma esophagus worldwide. It is performed with multiport VATS or robotically. Uniport VATS technique has gained a recent popularity among thoracic surgeons for resecting lung cancers. Here we describe our technique of performing uniportal McKeown esophagectomy in semi prone position without using carbon dioxide.

Methods

The surgery was performed on a middle aged male patient who was diagnosed with a locally advanced squamous cell cancer of lower third of the esophagus. Multidisciplinary meeting planned three cycles of Docetaxel, cisplatin and 5 fluorouracil regimen and subsequent surgery was planned after patient had a partial response.

Results

The thoracic phase was performed by uniport VATS and abdominal phase was performed by standard multiport technique. Neck anastomosis was performed with linear stapler in side to side manner. Total time of the surgery was 280 minutes. Intraoperative and postoperative period was uneventful. Patient was discharged home on ninth postoperative day on oral diet.

Conclusion

Uniportal VATS McKeown Esophagectomy is a feasible and safe technique with all short term advantages of minimally invasive approach. The coaxial ergonomics together with the semi prone positioning, allows the best surgical maneuvering.
376. DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY
Authors: Chicote Cristina Martínez , Navarro Fernando Mingol , Tamarit Mireia Navasquillo , Sánchez Carmen Gutiérrez , Guerrero-Antolino Pablo , Andrés Beatriz Castro , Olmo Nuria García , Esteban Marcos Bruna , Urbaneja Francisco Javier Vaqué
Published: August 2023

Background

Gastroesophageal reflux is a frequent adverse effect after oncological surgery of the gastroesophageal junction because of the radicality of the intervention and the placement of the anastomosis inside the thoracic cavity. Different surgical techniques have been developed that seek to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, which consists of the creation of a seromuscular flap surrounding the anastomosis.

Methods

Retrospective observational and descriptive study including all patients in whom this technique has been performed from January 2019 to January 2023. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part.

Results

A total of 8 patients were operated. In 2 cases the anastomosis was performed by laparotomy, 1 by laparoscopy, 4 by right thoracoscopy and 1 by left thoracoscopy. Half of the patients had no postoperative complications and the other half had mild ones. Manometry and pHmetry were requested of all patients after 6 months but only performed in 2 due to technical difficulties. In both cases the tests showed no alterations, but one of the patients reported reflux controlled with PPIs. Other suffered from occasional dysphagia and was being treated with periodic endoscopic dilatations.

Conclusions

The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.