bluuebunny/crossref_metadata_2025 huggingface dataset:
367. RANDOMISED CONTROLLED TRIAL (FEASIBILITY STUDY) OF PROPHYLACTIC PYLORIC BALLOON DILATATION DURING IVOR LEWIS ESOPHAGECTOMY TO PREVENT DELAYED GASTRIC EMPTYING
Authors: Abdelrahman Mohamed , Neilens Helen , Yates Victoria , Lord Amber , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Wheatley Tim , Chan David
Published: September 2022

Early delayed gastric emptying (DGE) occurs in up to 37% of patients following esophagectomy. This can contribute to increased anastomotic leak and respiratory infection rates. Although the treatment of DGE in the form of pyloric balloon dilatation (PBD) post-operatively is well established, there is no consensus on the optimal approach in the prevention of DGE.

The aim is to carry out a randomised control trial to determine the efficacy of prophylactic PBD in the prevention of DGE following esophagectomy. This presentation details the protocol, recruitment strategy and potential timeline for a feasibility study addressing this. We detail the rationale, objectives, design, and methods of this study. Patients will be recruited over a three to six-month period (starting in January 2022) and randomised to either a control group (no intervention) or a treatment group (prophylactic PBD).

The Chief Investigator has obtained approval from the UK Health Research Authority (HRA) and Research Ethics Committee (REC) on 01/12/21 (IRAS project ID: 287659).

As a feasibility study, the objectives will be to ascertain the following: Number of patients approached; Number of patients who agreed to be randomised; Number of patients successfully randomised; Number of patients who dropped out; Successful measurement of outcome measures (delayed gastric emptying, pneumonia, anastomotic leak).

Prophylactic pyloric balloon dilatation is potentially a safe and effective procedure which can significantly improve outcomes in patients after an esophagectomy. This protocol describes details for the feasibility study to be carried out which will allow important learning points for the main randomised controlled trial.
374. THE ROLE OF EARLY MOBILIZATION AFTER ESOPHAGEAL CANCER SURGERY
Authors: Schuring Nannet , Geelen SJG , van Berge Henegouwen MI , Steenhuizen SCM , van der Schaaf M , van der Leeden M , Gisbertz SS
Published: September 2022

A key component of the Enhanced Recovery After Surgery pathway for esophagectomy is early mobilization. Evidence on a specific protocol of early and structured mobilization is scarce, which explains variation in clinical practice. This study aims to describe and evaluate the early mobilization practice after esophagectomy for cancer in a tertiary referral center in the Netherlands.

This retrospective cohort study included data from a prospectively maintained database of patients who underwent an esophagectomy between 01-01-2015 and 01-01-2020. Early mobilization entailed increase in activity with the first target of ambulating 100 meters. Primary outcomes were the number of postoperative days (PODs) until achieving this target and the reasons for not achieving this target. Secondary outcomes were the relationship between preoperative factors (e.g. Sex, BMI, ASA-score) and achieving the target on POD1, and the relationship between achieving the target on POD1 and postoperative outcomes (e.g. readmissions, postoperative complications).

In total 384 patients were included. The median POD of achieving the target was 2 (IQR 1-3), with 173 (45.1%) patients achieving this on POD1. Main reasons for not achieving the target on POD1 was due to hemodynamic instability (22.7%). Male sex was associated with achieving the target on POD1 (OR = 2.08, p = 0.007); achieving the target on POD1 was not associated with postoperative outcomes.

Ambulation up to 100 m on POD1 is achievable in patients after esophagectomy, with men having higher odds for achieving this target. No relationship between early mobilization and postoperative outcomes was found, however it may have effect on other parameters, such as improved long-term recovery, this should be investigated further in a larger patient cohort. ERAS pathways focusing on esophagectomy care are encouraged to incorporate 100 m ambulation on POD1 in their guideline as first postoperative target.
383. A LONGITUDINAL STUDY OF ENDOSCOPIC NASO-LEAKAGE NEGATIVE PRESSURE DRAINAGE FOR ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY
Authors: Liu Xin-Yang , He Meng-jiang , Tan Li-Jie , Zhou Ping-Hong , Lin Miao
Published: September 2022

Postoperative anastomotic leak is a threatening complication after esophagectomy. Recently, endoscopic naso-leakage negative pressure drainage has become a promising choice when satisfactory drainage could not be attained using chest drainage or other conservative therapies. This study aims to evaluate the efficacy of endoscopic naso-leakage negative pressure drainage for anastomotic leak by longitudinal analyses, so as to focus on the intra-individual changes associated with the drainage in the disease course and to minimize the between-subjects variations.

We conducted a retrospective longitudinal study based on patients who were diagnosed with anastomotic leak after esophagectomy and treated with endoscopic naso-leakage negative pressure drainage in Zhongshan Hospital Fudan University, from 2018 to 2021. We hypothesize that maximum temperature (Tmax), maximum heart rate (HRmax), White blood cell count (WBC), and C reactive protein (CRP) had a two-piece linear spline growth curve with a notch at the time of drainage. Linear mixed-effects regressions were used to test the hypothesis of whether endoscopic naso-leakage negative pressure drainage changed the pattern of development of these clinical parameters with time.

Thirty patients were included, among which 83.3% were male, with a median age of 77 years. The median postoperative time to drainage was 16.5 days (range 6–66). Observations for Tmax, HRmax, WBC and CRP were 1366, 1372, 394, and 296, respectively. After adjusting for age, sex and body mass index, Tmax, HRmax, WBC and CRP showed similar pattern. There was no significant change over time before naso-leakage negative pressure drainage, while the four parameters all decreased significantly over time after naso-leakage negative pressure drainage. There was no overlap of the confidence intervals of slopes before and after drainage. (Table).

The slope over time of Tmax, HRmax, WBC and CRP changed significantly after naso-leakage negative pressure drainage. Naso-leakage negative pressure drainage brought gradual decrease of these inflammatory parameters and could serve as a promising management for postoperative anastomotic leak after esophagectomy.
391. MINIMALLY INVASIVE ESOPHAGECTOMY IN PRONE POSITION. INITIAL EXPERIENCE OF NATIONAL CANCER INSTITUTE MEXICO
Authors: Takahashi Alberto Mitsuo Leon , Basave Horacio Noe Lopez , Silva Leonardo Saul Lino , Barragan José Abraham Fabela , Hernandez Rosa Angelica Salcedo , Gomez Angel Herrera , Morales Carolina Castillo
Published: September 2022

Transthoracic approach in esophageal cancer increases oncologic outcomes but open surgery associates with poor respiratory outcomes. Minimally invasive thoracoscopic (MIT) has been selected for minimizing postoperative complications and faster recovery. It is thought that long term outcomes are equivalent to open surgery. Prone position (PP) is becoming more world important because it reduces respiratory complications and blood loss. It provides a clean surgical field and allows more lymph node harvests due to the better exposure.

Observing the benefits of PP to perform esophagectomy in cancer patients, we obtained pre-certification in Japan and started in 2017. This is a retrospective study in patients with esophageal cancer operated from January 2017 to December 2021 in the National Cancer Institute. We used AJCC 8th to clinical stage; early stage was operated and locally advanced stage did neoadjuvant treatment and surgery. Our surgical results show complications and mortality on postoperative day 60 (Clavien-Dindo and ECCG classification) and short oncological results in PP-MIT esophagectomy.

There were 25 PP-MITesophagectomies, median age was 57 y.o. and 84% were men. The general characteristics are indicated in image 1. The main clinical stages were locally advanced in 96% (CS III and IVA), all received neoadjuvant therapy (80% QT/RT) with a partial response of 76%. The major complications (Clavien >3) were 12% and one patient died of arrhythmia on the 10th day. Complications were classified by using the ECCG classification, are shown in image 1. The pathological results are in image 1. The mean survival was 32.1 (24.8–39.5) months and cancer specific survival was 76%.

Esophagectomy has a high risk of complications and mortality and is one of the most complex surgeries in the digestive tract.

In our cancer institute, we separated surgical groups to place experts in each area. Our initial experience of PP-MIT esophagectomy was a good oncological control with low complications, despite advanced cancer with poor prognosis requiring multimodal treatment.
394. ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGO-GASTRIC SURGERY
Authors: Pattynama Lisanne , Pouw Roos , van Berge Henegouwen Mark , Daams Freek , Gisbertz Suzanne , Bergman Jacques , Eshuis Wietse
Published: September 2022

Anastomotic leakage (AL) is one of the most serious complications of upper gastro-intestinal (UGI) surgery. Recently endoscopic vacuum therapy (EVT), using an endoscopically placed sponge, was introduced as treatment of AL. The aim of this study was to describe the initial experiences with EVT in a tertiary referral center, in the treatment of AL after esophago-gastric surgery.

For this retrospective cohort study, all patients treated with EVT for AL in the UGI tract at a tertiary referral center, between January 2018 and October 2021, were included. In this period, patients with AL, based on CT-scan or endoscopic findings, were primarily treated with EVT. Cases were identified from the endoscopy reporting system, with a search including all available terms for EVT, and from the prospective UGI surgery database. Data on patient characteristics, EVT and outcomes were analyzed. The primary endpoint was success rate of EVT alone, defined as closure of the defect assessed by endoscopy or CT-scan.

A total of 38 patients were included (Table 1). Successful treatment with EVT was achieved in 28 patients (74%, 95%CI[57,87]). In 10 patients EVT failed: one deceased during treatment (due to radiation pneumonitis) and 9 underwent additional surgery: two due to an EVT-related complication (a trachea-esophageal fistula and iatrogenic expansion of the defect during overtube placement) and 7 because defect closure was not achieved. EVT-associated complications occurred in two patients, as described above.

Median hospital stay was 42 days. Median duration of EVT was 27 days, with median 6 EVT-related endoscopies and 5 days between sponge-exchanges.

EVT is a paradigm shifting treatment, potentially preventing surgical re-intervention in patients with AL after UGI surgery, with a success rate of 74%. More experience with the technique and indications for use will likely improve success rates in the future.
404. SURVEILLANCE STRATEGY AFTER CURATIVE RESECTION FOR OESOPHAGEAL SQUAMOUS CELL CANCER USING THE HAZARD FUNCTION
Authors: Kanematsu Kyohei , Sakurai Toru , Kubo Yuto , Utsunomiya Daichi , Kubo Kentaro , Kurita Daisuke , Ishiyama Koshiro , Oguma Junya , Daiko Hiroyuki
Published: September 2022

The optimal surveillance period and frequency after curative resection for oesophageal squamous cell carcinoma (OSCC) remain unclear, and current guidelines are mainly based on traditional Kaplan–Meier analyses of cumulative incidence rather than risk analysis. The aim of this study was to determine a suitable follow-up surveillance program following oesophagectomy for OSCC using the hazard function.

A total of 1187 patients who underwent curative resection for OSCC between 2000 and 2014 were retrospectively analyzed. The changes in the estimated hazard rates (HRs) of recurrence over time were analyzed according to tumour-node-metastasis stage.

Four hundred seventy-eight (40.2%) patients experienced recurrence during the follow-up period (median, 116.5 months). The risk of recurrence peaked at 9.2 months after treatment (HR = 0.0219) and then decreased to half the peak value at 24 months post-surgery. The HRs for Stage I and II patients were low (<0.007) post-treatment. The HR for Stage III patients peaked at 9.9 months (HR = 0.031) and the hazard curve declined to a plateau at 30 months. Furthermore, the HR peaked at 10.8 months (HR = 0.052) in Stage IV patients and then gradually declined from 50 months.

According to tumour-node-metastasis stage, changes in the HRs of postoperative recurrence in OSCC varied significantly. Intensive surveillance should be undertaken for 3 years in Stage III patients and for 4 years in Stage IV patients, followed by annual screening. For Stage I OSCC patients, a reduction in the surveillance intensity could be taken into consideration.
418. STRATEGIES FOR OLIGOMETASTATIC AFTER CURATIVE RESECTION OF ESOPHAGEAL CANCER
Authors: Tajima Kohei , Kanamori Kohei , Yatabe Kentaro , Yamamoto Miho , Kazuno Akihito , Syoji Yoshiaki , Koyanagi Kazuo
Published: September 2022

The recurrence rates in patients with esophageal cancer who are treated by curative esophagectomy is reported to be 29-43%. Recently, the concept of oligometastasis recurrence (OLR) has gained attention.

To clarify the relationship between treatment strategy and prognosis of patients with OLR after esophagectomy. We included 124 patients with recurrence among 446 patients who underwent esophagectomy for esophageal cancer.

OLR was defined as five or fewer recurrences in a single organ or five or fewer recurrences in a single lymph node. Patients were divided into two groups: OLR and non-OLR group. Recurrence within 6 months after surgery was defined as early recurrence. The relationship between early recurrence and prognosis was examined. We focused on liver and lung metastases and examined treatment methods and prognosis.

Of the recurrence patients, 40 (32%) were in the OLR group and 84 (78%) were in the non- OLR group. The overall survival was 49 months in the OLR group and 17 months in the non-OLR group (p < 0.001). Survival after recurrence was 26 months in the OLR group and 6 months in the non-OLR group (p < 0.001). In comparison of the early relapse and non-early relapse groups, both OS and survival after recurrence tended to be worse in the early relapse group (p = 0.05). The prognosis was better in the lymph node recurrence group and worse in the liver recurrence group (p = 0.05).

Oligometastasis is related to prognosis in patients with recurrence after esophagectomy, and patients with early recurrence or liver recurrence may have a poor prognosis.
428. CHARACTERIZATION OF CD82/KAI1 IN ESOPHAGEAL ADENOCARCINOMA
Authors: Ludwig Alexandra , Limberger Beate , Nowotny Robert , Gockel Ines , Thieme René
Published: September 2022

The incidence of esophageal adencocarcinoma (EAC) has increased in last decades. Regardless to improved perioperative chemotherapies and surgical approaches, the prognosis for EAC in advanced stages is poor. CD82 is a tumor suppressor gene, and its downregulation correlates with invasive growth, metastases formation and advanced clinical stages. CD82 might influence the Wnt/ß-catenin signaling pathway.

We used an in vitro Barrett’s esophagus cell culture model, represented by esophageal squamous cell epithelium (EPC1, EPC2), metaplasia (CP-A), dysplasia (CP-B) and esophageal adenocarcinoma (OE33, OE19, SKGT4, FLO1). Antisense LNA Oligonucleotides (GapmeRs, Qiagen) were used to achieve a transient knockdown of CD82 in OE33 and OE19 cells. mRNA and proteins were analyzed by q-RT-PCR and western blot analyses, respectively. A fluorescence antibody specific to CD82 was used for flow cytometry analysis. Proliferation assay, colony formation assay and boyden chamber assay were performed after CD82-knockdown to further analyze cell proliferation, cell growth and survival, colony forming and cell migration.

CD82 was expressed in all investigated cell lines by flow cytometry with a significant overexpression in OE19 and FLO1 cells. A stable downregulation of CD82 was achieved in OE33 and OE19 cells. Proliferation assays showed a significantly higher proliferation rate at 72 hours after CD82-knockdown in OE33 cells. A significantly higher mRNA expression of vimentin was observed after CD82-knockdown in OE33. Colony formation assay showed a significantly higher colony count after CD82-knockdown in both cell lines. Cell migration was increased after CD82-downregulated in OE33 and OE19 cells.

CD82 might influence the expression of mesenchymal marker proteins, cell migration abilities and the process of colony forming and thus enhance the metastatic potential of OE33 and OE19 cells. Low expression of CD82 could alter metastasis and cancer progression but further molecular characterizations are needed to elucidate the impact on carcinogenesis of EAC.
430. MICRONUTRIENT INSUFFICIENCY AFTER SURGERY FOR OESOPHAGOGASTRIC NEOPLASMS: A PROSPECTIVE INTERVENTION STUDY NAMED THE VITAMIN STUDY
Authors: Van der Velden Ariadne Lisa , Vermeer Thomas Adriaan , Boerma Evert-Jan Gijsbert , Belgers Eric Henricus Johannes , Stoot Jan Henri Marie Basile , Leers Mathie Peter Gertruda , Sosef Meindert Nico , Vijgen Guy Hubertus Elisabeth Joseph
Published: September 2022

Oesophageal and gastric cancer are among the top ten cancers worldwide. Both diseases have major impact on the nutritional status and quality of life (QoL). Preoperative malnutrition is reported in 42–80%. However, studies investigating postoperative nutritional status are scarce and postoperative identification and treatment of micronutritional deficiencies are currently lacking in (inter-)national guidelines. The aim of this study is to identify and target micronutrient deficiencies after surgery for oesophageal or gastric neoplasms.

This is a single centre prospective intervention trial with inclusion of 248 patients who underwent oesophagectomy (n = 124) or (sub)total gastrectomy (n = 124). Patients will receive a tailormade multivitamin supplement which differs per group and additionally a calcium supplement. Baseline measurements consist of blood withdrawal, faecal elastase-1 analysis, QoL and dietary behaviour. After 6, 12 and 24 months from baseline, measurements are repeated, and a supplement questionnaire is added. The primary objective is micronutrient deficiency (yes/no). Secondary objectives include occurrence and symptoms of pancreas insufficiency (n, %), time between surgery and start of supplementation (mean in months) and QoL at all time points.

Inclusion started in December 2021 and is still recruiting. Currently, preliminary results of 40 included patients are available, whereby 24 patients underwent oesophagectomy and 16 patients underwent gastrectomy (table 1). In this population, 87.5% developed at least one micronutrient deficiency, equally seen per subgroup. The most profound deficiencies found are vitamin D (55.0%), ferritin (40.0%), Iron (32.5%), zinc (22.5%). Other deficiencies found are folic acid (12.5%), calcium (7.5%), vitamin B6 (5.0%) and vitamin B12 (2.5%). Decreased faecal elastase-1 (< 200 mg/kg) was found in 15% of the total population.

Literature regarding the incidence of micronutrient deficiencies and supplementation after oesophageal and gastric surgery is scarce. If micronutrient deficiencies are significantly present in this population and daily supplementation can prevent and resolve these deficiencies, routine monitoring and supplementation of micronutrient deficiencies can be implemented in the standard postoperative care of oesophageal and gastric surgery.
434. A SINGLE INSTITUTIONAL SURGICAL RESULT OF ESOPHAGEAL RECONSTRUCTION WITH SUPERCHARGED JEJUNAL INTERPOSITION FOR PATIENTS WHO LOST BOTH ESOPHAGUS AND STOMACH
Authors: Su Ying-chieh , Fong Yao , Chen Chao-kun
Published: September 2022

Esophagectomy and gastrectomy are life saving surgeries for severe corrosive injury patients with detergent ingestion. Esophageal reconstruction to restore ingesting ability was performed with colon conduit traditionally. But the sustainability of colon conduit was doubtful. Jejunal graft with supercharged technique is a promising procedure that promise a conduit of smaller diameter and better resistant of lumen distention.

The medical records of patient in Chimei Medical Center (CMC) between 2010 to April 2022 were reviewed with keyword of supercharged jejunal graft. The data including patient characteristics, hospital stays, operative technique, and post operative outcomes were collected.

Eight patients, 5 female and 3 male, aged 22 to 60 years (median: 45), underwent esophageal reconstruction with supercharged jejunal interposition due to loss of both esophagus and stomach. Seven patients lost esophagus and stomach for detergent ingestion and the rest one has both esophageal and gastric cancer. The following time is between 1 month to 11.5 years (median: 4.4 years). There is no flap loss, no surgical mortality, and all 8 patients still survive to date. All patient could intake solid food.

Supercharged jejunal interposition can be safely performed for patient who can’t have gastric tube interposition after esophagectomy. It has good resistance for distention and is an idea substitute of esophagus for young patients who needs a conduit that last lifelong.
437. SURGEON’S BEHAVIOR STEERING PATIENTS TO PARTICIPATE IN A CLUSTER RANDOMIZED TRIAL ON ACTIVE SURVEILLANCE FOR ESOPHAGEAL CANCER
Authors: Van Der Zijden Charlène J , de Veer M , Hermus M , van der Wilk BJ , Wijnhoven BPL , Stiggelbout AM , Dekker JWT , Coene PPLO , van Busschbach JJ , van Lanschot JJB , Lagarde SM , Kranenburg LW
Published: September 2022

Shared decision making (SDM) is used to involve patients in the decision-making process. Researchers have shown that clinicians, often unintendedly, use steering behavior which may persuade patients to choose for a specific treatment. Well-balanced information provision towards patients can be challenging when participation in a randomized trial is discussed. This study investigates if and how surgeons use steering behavior when patients are eligible to participate in a stepped-wedge cluster randomized trial.

Patients with locally advanced esophageal cancer, planned to undergo neoadjuvant chemoradiotherapy (nCRT) followed by standard surgery, were included prior to their first surgical consultation. During this consultation, the surgeon discussed the possibility to participate in a trial on active surveillance after nCRT as experimental treatment. Standard care (i.e. surgical resection) was offered to patients who refused participation. Randomization occurred on the institutional level and therefore both surgeons and patients were aware of allocated treatment in the experimental arm before making a decision. Consultations were audiotaped and transcribed verbatim. Data were analyzed using thematic content analysis.

Twenty consultations were recorded between June and December 2020. Surgeons used various techniques to steer patients towards a specific treatment, mostly towards participation. An imbalanced presentation of pros and cons of treatment options probably influenced patients’ preferences: positive framing of active surveillance was used to steer patients towards opting for active surveillance, negative framing of active surveillance was used to make surgical resection more attractive. Besides using steering language, also the timing at which the alternative treatment option was discussed resulted in more focus on either of the treatment options.

Various types of steering behavior were identified, including an imbalanced presentation of pros and cons, steering language and the timing at which different treatment options were discussed. Awareness of steering behavior in clinicians is the first step in improving objective information provision and thus shared decision making.
447. IMPACT OF PERIOPERATIVE MANAGEMENT BASED ON ERAS IN THORACIC ESOPHAGEAL CANCER SURGERY
Authors: Muroya Takahiro , Yokoyama Hiroshi , Yoshida Eri , Abe Atsumi , Hakamada Kenichi
Published: September 2022

Esophagectomy for esophageal cancer is one of the most invasive surgeries, thus it has high morbidity and mortality rates. A multidisciplinary perioperative management is required for improvement in surgical outcomes. Early recovery after surgery (ERAS) is now standard in the care of patients and has been associated with reduced complication rates and hospital stays. The aim of this study was to evaluate the impact of perioperative management based on ERAS for thoracic esophageal cancer patients.

A total 357 patients performed esophagectomy between January 2009 and August 2020 were enrolled. Patients were classified into non-ERAS (NE) group (n = 174) and ERAS (E) group (n = 183). Operative outcomes were compared between two groups. Postoperative complications were graded according to Clavien-Dindo classification. The complication defined as above Grade 3. Nutritional Status was evaluated with Controlling nutritional status (CONUT). Changes in body weight (BW) and area of psoas muscle mass at 3 months after surgery were evaluated.

Operative factors such as operative time and blood loss were not significant different between the NE and E groups. In E group, Postoperative any complications (p = 0.023), respiratory complications (p = 0.043) were significantly less than in NE group. CONUT score was lower on postoperative 1 month (p = 0.025) and 3 months (p = 0.044) in E group. Reduction rate of BW and psoas muscle mass index (PMI) on postoperative 3 months in E group was lower than in NE group (BW: 5.6 ± 6.4% vs 7.8 ± 5.2% (p = 0.045), PMI: 6.7 ± 14.9% vs 12.3 ± 13.3% (p = 0.021)).

ERAS could be effective for maintenance of a better nutritional status and prevention of the postoperative respiratory complication and loss of the BW and PMI.
459. MULTIDISCIPLINARY TREATMENT STRATEGY FOR ADVANCED CERVICAL ESOPHAGEAL CANCER AIMED AT PRESERVING THE LARYNX
Authors: Tanabe Shunsuke , Noma Kazuhiro , Hashimoto Masashi , Maeda Naoaki , Shirakawa Yasuhiro , Fujiwara Toshiyoshi
Published: September 2022

In the treatment of advanced cervical esophageal cancer, the availability of laryngeal preservation has a great effect on quality of life. Factors affecting laryngeal preservation include tracheal invasion of the tumor, extension to the pharyngeal side, and duplication of head and neck cancer. In our institute, we provide multimodal treatment aiming at preserving the larynx as much as possible. We report on preoperative treatment and surgical outcome for patients with advanced cervical esophageal cancer.

Of the 713 cases of esophageal cancer surgery from 2014 to March 2021, 29 cases of advanced cervical esophageal cancer were examined for preoperative treatment and surgical outcome. In our institution, non-T4 cases are first introduced with Docetaxel + Cisplatin +5-FU (DCF) chemotherapy. For cT4 cases and cases who DCF therapy did not respond, we added radiation therapy to DCF for local control. For resectable cases, we performed esophagectomy actively.

The primary diagnosis was StageII:III:IV = 6:19:4 (UICC 8th). Preoperative treatment was performed in 28 cases, 26 cases with neoadjuvant chemotherapy (NAC), and 2 cases with chemoradiotherapy (CRT). NAC regimen was DCF in all cases. The therapeutic effect of NAC was evaluated PR in 15 of 26 cases and SD in 11. Laryngeal preservation was possible in 11 of 15 NAC-PR cases (73.3%) and 7 of 11 NAC-SD cases (63.6%), and the laryngeal preservation rate was higher in the NAC responder group. Recurrence was observed in 15 cases. 10 cases were in the laryngeal preservation group, but only 2 cases had local recurrence.

This study suggests that the response of NAC may increase the laryngeal preservation rate. Laryngectomy does not necessarily contribute to the control of local recurrence. But patients with positive margins have a poor prognosis. And it is important to make an appropriate decision as to whether radiation therapy or surgery should be performed for patients who do not respond to chemotherapy.
460. SARCOPENIA AFTER NEOADJUVANT CHEMOTHERAPY IS ASSOCIATED WITH DEVELOPMENT OF MODERATE TO SEVERE POST-OPERATIVE COMPLICATIONS IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS
Authors: Convill James , Chmelo Jakub , Prasad Pooja , Brown Joshua , Petrides George , Phillips Alexander
Published: September 2022

Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to various postoperative complications and to the degree of severity of these complications. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Whether sarcopenia pre- or post-neoadjuvant chemotherapy (NAC) for esophagogastric adenocarcinoma (EGA) is associated with postoperative complications is not fully understood.

Patients diagnosed with EGA between January 2017 and December 2020 and undergoing NAC followed by esophagectomy from a single high-volume center had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4cm2 for men and 38.5cm2 for women). Post-operative complications were prospectively evaluated and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as either CD 0-I (no-mild complications) or CD II-V (moderate–severe complications).

There were 144 patients included in the analysis. 62 patients had FLOT NAC and 82 patients had ECX NAC. Pre-NAC sarcopenia was not associated with the development of moderate–severe postoperative complications (p = 0.075). However, sarcopenia assessed on restaging scan post-NAC was found to be associated with moderate–severe postoperative complications (p = 0.044).

EGA patients with sarcopenia post-NAC are more likely to develop moderate–severe post-operative complications than those without sarcopenia. Strategies to treat sarcopenia and prevent its further development are desperately needed in order to reduce post-operative complications.
462. IMPACT OF THE RATIO OF THE VISCERAL FAT AREA TO PSOAS MUSCLE AREA ON SURVIVAL FOR SURGICALLY RESECTED ESOPHAGEAL CANCER
Authors: Sakai Makoto , Sohda Makoto , Uchida Shintaro , Yamaguchi Arisa , Watanabe Takayoshi , Saito Hideyuki , Nakazawa Nobuhiro , Kuriyama Kengo , Sano Akihiko , Ogawa Hiroomi , Yokobori Takehiko , Shirabe Ken , Saeki Hiroshi
Published: September 2022

Sarcopenia (the loss of skeletal muscle volume and/or quality) and obesity have received increasing attention in many malignancies because they are associated with postoperative complications and poor surgical outcomes. The synergic effects of muscle mass reduction with excess body adiposity in surgically resected esophageal cancer (EC) patients remains controversial, especially in non-obese patients.

One hundred and six patients with EC who underwent surgery between 2006 and 2014 were included in this study. Reduction in muscle mass and excess body adiposity were defined as the ratio of the visceral fat area (VFA) to psoas muscle area (PMA) (V/P ratio) on the same axial computed tomography (CT) slice at the third lumbar vertebra (L3).

A high V/P ratio was associated with higher age (p = 0.03), higher body mass index (BMI) (p<0.001), higher VFA (p<0.001), and increased age-adjusted Charlson comorbidity index (ACCI) (p = 0.005). Multivariate analysis revealed a high V/P ratio to be an independent prognostic factor for poor overall survival (OS) in EC patients who underwent surgery (p = 0.003). The prognostic value of the V/P ratio was still significant in EC patients with a BMI < 25.

A high V/P ratio was associated with poor survival in surgically resected EC patients, even in non-obese patients. The V/P ratio as a surrogate marker of relative muscle mass reduction and fat accumulation may have prognostic value in EC patients regardless of body composition differences.
471. OUTCOMES OF RETROSTERNAL RECONSTRUCTION ROUTE FOR ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS IN OUR HOSPITAL
Authors: Kurata Kanako , Horioka Kohei , Akagawa Shin , Kobayashi Kiichiro , Nishihara Kazuyoshi , Nakano Toru
Published: September 2022

In cervical esophagogastric anastomosis after esophagectomy for esophageal cancer, the main reconstructive routes are retrosternal and posterior mediastinal. Since April 2019, the retrosternal route has been the standard procedure at our hospital. We report on the results of reconstruction by a retrosternal route at our hospital.

This study included 38 patients with esophageal cancer (squamous cell carcinoma) who underwent resection and reconstructed by the retrosternal route between April 2019 and March 2021. We evaluated the short-term postoperative outcomes of these patients.

All the reconstructed organs were the gastric tube. The anastomosis method was a Circular stapler: 33 cases and a Linear stapler: 5 cases. The median start of oral intake after surgery was 3 days, and the median postoperative length of stay was 16 days. Perioperative complications of Clavien-Dindo classification grade 3 or higher occurred in 4 cases: anastomotic leakage grade IIIa: 3 cases and grade IVa: 1 case. Complications within 1 month after the operation were anastomotic stenosis grade IIIa in 1 case, and within 6 months were anastomotic stenosis grade IIIa in 2 cases.

In our department, anastomotic leakage of a retrosternal route reconstruction was about 10%, which was similar to the domestic data (all reconstruction route). The stylization of surgical techniques and instruments used contributes to the reduction of postoperative complications, especially anastomotic leakage. In addition to establishing surgical techniques, careful perioperative management including rehabilitation and nutritional management is also important for preventing complications.
479. THE ROLE OF PET/CT IN PREDICTING THE PATHOLOGICAL RESPONSE TO NEOADJUVANT IMMUNOCHEMOTHERAPY FOR RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yang Weixiong , Wang Xiaoyan , Luo Hui , Zhang Shuishen , Gan Yi , Zeng Bo , Liu Zhenguo , Cheng Chao
Published: September 2022

Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with ﻿pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post-hoc analysis aimed to evaluate the performance of 18F-FDG PET/CT to predict the pathological response to neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC).

Fifty-eight resectable ESCC patients who received neoadjuvant PD-1 blockade in combination with chemotherapy were enrolled in the final analysis. The scans of 18F-FDG-PET/CT were acquired at baseline (scan-1) and after immunochemotherapy but prior to surgery (scan-2). Maximum standardized uptake value (SUVmax), mean standard uptake value (SUVmean), tumor-to-blood pool SUVmax ratio (SUVTBR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were evaluated for their association with the pathological response to immunochemotherapy.

The TLG and MTV at scan-1 was significantly lower in pCR than that in non-pCR group. At scan-2, the SUVmax, SUVmean, SUVTBR, TLG and MTV were significantly lower in pCR. Decrease in TLG and MTV between scan-2 and scan-1 were significantly higher in the pCR group. In the receiver operating characteristic curve analysis, SUVmax, SUVmean, SUVTBR, TLG and MTV in scan-2 showed excellent predictive value for the pCR of primary tumors. Furthermore, SUVmax at scan-2 were significantly higher in positive lymph nodes than that in negative ones, suggested a high negative predictive ability (98.6%) with a cut-off value at 1.4.

The parameters of 18F-FDG PET/CT have the excellent performance for predicting pCR after the combined neoadjuvant immunochemotherapy in resectable ESCC.
484. UPFRONT SURGERY VERSUS PREOPERATIVE TREATMENT FOR PATIENTS AGED 80 YEARS OLDER WITH ESOPHAGEAL CANCER
Authors: Sakurai Toru , Utsunomiya Daichi , Kubo Kentaro , Kanematsu Kyohei , Kurita Daisuke , Ishiyama Koshiro , Oguma Junya , Daiko Hiroyuki
Published: September 2022

In recent years, with the aging of the population, there have been more opportunities to operate on very elderly esophageal cancer patients over the age of 80.

The safety of neoadjuvant chemotherapy has become the standard, but for very elderly patients is not clear. In our hospital, it is selected if general condition is acceptable. This time, we examined cases of very elderly esophageal cancer patients aged over 80 years performed esophagectomy at our hospital.

The subjects were 28 patients aged 80 years or older who underwent esophagectomy at our hospital for advanced esophageal cancer from January 2017 to December 2020.

A retrospective study was performed by dividing into the upfront surgery group (S) and the preoperative treatment group (Neo: neoadjuvant chemotherapy group, preoperative chemoradiation group, salvage surgery group).

The primary endpoints were recurrence rate and recurrence-free survival (month), and the secondary endpoints were preoperative adverse event incidence, R0 achievement rate, and perioperative complication rate in the preoperative treatment group.

Median age is 82 years (range: 80-89 years). S/Neo= 21/7 cases. Chemotherapy were DCF: 1 case, FOLFOX: 2 cases, FP: 2 cases, CDDP + VP: 1 case. Preoperative adverse event incidence of Grade 3 or higher was 14.2%. The R0 achievement rate was 90%/100% (S/Neo, p= 0.442; t-test). Perioperative complications rate of Clavien-Dindo IIIa or higher was 33.3%/71.4% (S/Neo, p= 0.083; t test). The recurrence rate was 57.1%/14.2% (S/Neo), which were significantly lower in the Neo than in the S(p= 0.049; Logistic regression model). The median recurrence-free survival was 13 months in the S and 10 months in the Neo.

It is necessary to select a treatment method that balances curative and postoperative QOL for the elderly based on organ function, tumor factors, social background, etc. Since it is difficult to use CDDP for very elderly patients, FOLFOX is the first choice at our hospital. Operation techniques such as less invasive mediastinoscopic and two-staged surgery are selected. From the results of this study, preoperative treatment may reduce the recurrence rate.
488. RADIOFREQUENCY ABLATION OF LOW-GRADE DYSPLASIA IS COST-EFFECTIVE FOR PATIENTS WITH LONG-SEGMENT BARRETT'S OESOPHAGUS
Authors: Vissapragada Ravi
Published: September 2022

Barrett’s oesophagus is a precursor to oesophageal adenocarcinoma (OAC), which can be lethal if found at late stages. Stages of Barrett's oesophagus are generally divided into non-dysplasia or dysplasia. There is little doubt that patients with high-grade dysplasia require endoscopic intervention, usually with ablative techniques. Endoscopic treatment of low-grade dysplasia (LGD) has been more controversial, however. Our main aim was to improve cost-effectiveness of LGD ablation using length of Barrett's oesophagus to select high-risk individuals.

A cost-utility analysis was undertaken using a Markov cohort model, which simulated progression and regression of non-dysplastic Barrett’s oesophagus (NDBE) to EAC (cycle length of 6 months, time horizon of 35 years). Health states included: NDBE, regression of metaplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), EAC, and death. Cost pertaining to investigations and treatments were sourced from local health network. Quality-adjusted life-year (QALY) data were taken from literature values. Initial estimates of transition probabilities between health states were derived from literature and calibrated to lifetime risk of HGD and OAC using standardised methodology. One-way and probabilistic sensitivity analysis were conducted.

Several strategies (39 total) were tested in this cost-utility analysis and were broadly divided into selective (length-based) or non-selective LGD ablation. In addition to LGD ablation, surveillance intervals for NDBE were altered to improve cost-effectiveness. In non-selective group of strategies, only 1 was found to be cost-effective, whereas 24 of 28 length-based LGD ablation strategies were found to be cost-effective (at a willingness to pay threshold of AU$50,000/QALY). Probabilistic analysis (1000 simulations) showed that exclusion of individuals with short segment Barrett's oesophagus (SSBE) from surveillance with ablation of LGD in long-segment Barrett's oesophagus (LSBE) was the most cost-effective strategy (AU$33,031/QALY).

Patients with long-segment Barrett's oesophagus are at significantly higher risk of progression to adenocarcinoma. Results of this study indicate reducing endoscopic surveillance for SSBE with routine surveillance for LSBE with ablation of LGD when detected is cost-effective in 100% of the simulations. Several studies in recent years have shown similar results. Thus ablation of LGD in Barrett's oesophagus requires serious consideration, especially for high-risk individuals.
498. MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER AND A HISTORY OF LIVER TRANSPLANTATION: A LITERATURE REVIEW AND CASE SERIES
Authors: Uzun Eren , Grimminger Peter
Published: September 2022

The survival after liver transplantation is continually improving. With evidence of an increased risk of de-novo malignancies after liver transplantation, it is urgent to improve the treatment of an esophageal cancer in patients with a history of liver transplantation. With this study we wanted to show a case series of totally minimally invasive Esophagectomy for patients with a history of liver transplantation, as well as an literature review.

We performed a systematic literature review according to the PRISMA guidance to identify the documented cases of an operative procedure in patients with a history of liver transplantation. Baseline characteristics, tumor stages as well as operative and postoperative management is compared with the case series of 2 cases operated minimally invasive in our center.

Seven studies were identified, with a total of 15 patients who underwent esophagectomy after liver transplantation. In 67% of the cases, including our two patients, alcohol associated liver cirrhosis was the indication for the liver transplantation. All reported cases proceed an open surgical approach for the Esophagectomy, except for 1 case with an open abdominal approach and a thoracoscopic chest procedure. The two cases in our center underwent a totally minimally invasive esophagectomy. The mean length of stay in the hospital was 21.5 days, compared to 8 and 14 days in our presented cases.

The importance of an optimal treatment of esophageal cancer after liver transplantation is evident. With this case series we showed that it is technically feasible to proceed a total minimally invasive Esophagectomy for patients with a history of liver transplantation in a curative intention. For a successful and radical treatment of malignancies after liver transplantation a multidisciplinary procedure is necessary.
503. TOTAL ESOPHAGECTOMY AND GASTRIC PULL UP FOR POST CORROSIVE ESOPHAGEAL STRICTURE: FEASIBLE IN MOST CASES WITH EXCELLENT OUTCOME
Authors: Ezz Reda , Sabry Karim
Published: September 2022

Post corrosive esophageal stricture represent a big national problem in Egypt because of bad culture of using (POTASH K2CO3) a highly corrosive substance for washing clothes with accidental (children) or sometimes suicidal (adult) swallow of this corrosive substance.

Extensive esophageal stricture resulted is the late consequence of such swallow with complete or partial dysphagia leading to severe malnutrition and death of many patients. Dilation was successful in mild cases and many other cases required surgery.

We present our new surgical strategy in managing 96 cases of post corrosive esophageal stricture including early feeding jejunostomy as well introduction of MI technique.

From January 2016 to January 2022 ,96 cases of failed dilation post corrosive esophageal stricture were included in the study. Three- fields total esophagectomy and gastric pull up with cervical stapled esophago-gastric anastomosis was the operation used for all cases. Pyloroplasty and feeding jejunostomy were done for all cases We followed the cases for development of any complications (leak, bleeding, respiratory problems and stricture).

Laparoscopy was used in 49 (51%) cases and was successfully completed in 42cases (86%). Right thoracotomy and left cervicotomy were used in all cases. Mean operative time was 368 minutes. Early complications were in the form of leak: cervical 12 cases (12.5%), from pyloroplasty 3 cases (3%). All cases managed conservatively. Only one pyloroplasty leak required exploration. Bleeding occurred in 5 cases (5%) and managed conservatively. Respiratory problems occurred in 37 cases (39%) requiring prolonged intubation in 3 cases (3%). Postoperative dysphagia was noted in 9 cases (9%) due to anastomotic stricture managed by dilation. No mortality recorded.

Our short- and long-term results of total esophagectomy and gastric pull up for post corrosive esophageal stricture are excellent with low morbidity and no mortality.
505. OUTCOMES AFTER ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY: REVIEW OF 1000 PATIENTS IN A SINGLE CENTER
Authors: Yang Yang , Li Chunguang , Li Zhigang
Published: September 2022

Robot-assisted minimally invasive esophagectomy (RAMIE), an increasingly adopted surgical approach, has been demonstrated with higher surgical efficiency and better lymph node dissection than thoracoscopic minimally invasive esophagectomy (MIE) in the Phase III RAMIE trial. We present the safety and feasibility of RAMIE for the surgical treatment in a large group of patients.

We reviewed 1000 consecutive patients undergoing RAMIE between November 2015 to March 2022 in our institution. Demographic data, intraoperative parameters, and postoperative outcomes including length of hospital stay, morbidity and mortality were assessed. The primary endpoint of the study was operative (30-day) mortality.

Squamous cell carcinoma accounted for 93.8% of all diseases. Most tumors were located in the mid-thoracic esophagus (46.3%) and clinically staged as T2 and T3 (87.4%). The proportion of preoperative therapy was 33.4% All patients received total robot-assisted thoracoscopic-laparoscopic esophagectomy, except for 49 planned hybrid surgery (thoracoscopy or laparotomy). The rate of conversion to open surgery was 3.2% and R0 resection was 96.8%. Overall postoperative complications occurred in 45.2% of patients (C-D grade III: 10.3%) including pulmonary complications (8.6%), anastomotic leakage (8.2%), and vocal cord paralysis (22.4%). Median length of hospital stay was 11 days and 30-day mortality was 0.5%.

RAMIE resulted in acceptable surgical results, postoperative outcomes and low mortality, which can be performed safely with good results in an experienced center.