bluuebunny/crossref_metadata_2025 huggingface dataset:
609. MINIMALLY INVASIVE CERVICAL ESOPHAGECTOMY (MICE): FIRST RESULTS OF A DUTCH PILOT STUDY
Authors: van Veenendaal LM , Vercoulen RJMT , Shiozaki A , Fujiwara H , Rosman C , Klarenbeek BR
Published: September 2022

Surgical resection remains the cornerstone of curative treatment for patients with esophageal cancer. Transthoracic minimally invasive esophagectomies have reduced the occurrence of pulmonary complications, however it is still associated with significant morbidity. The Minimally Invasive Cervical Esophagectomy (MICE) is a novel surgical technique. To date this technique is not routinely performed in European esophageal cancer patients. We aim to assess the safety and efficacy of the MICE procedure in Dutch patients with esophageal carcinoma.

The MICE is a recently developed surgical technique in Japan. The procedure combines a laparoscopic transhiatal and single-port transcervical mediastinal dissection and aims to ensure a radical oncological resection with a reduction of pulmonary complications because a thoracotomy/scopy is avoided. A prospective pilot study was performed including consecutive patients undergoing MICE for esophageal cancer.

Twenty patients were included. The male/female ratio was 16:4 with a median age of 71 years (IQR 52-85). Median operation time and blood loss was 350 minutes (IQR 326-360) and 100 ml (IQR 50-175). Conversion occurred in five patients (20%). Recurrent laryngeal nerve paralysis was seen in seven patients (35%), at least six of which were temporary. Anastomotic leakage occurred in three patients (15%, 2 ECCG grade 1 and 1 ECCG grade 3). Pneumonia, chyle leakage and hemothorax all occurred once in different patients (Clavien-Dindo grade 2, 4 and 3a, respectively). The median length-of-stay was 10 days (IQR 7-10).

MICE is a novel minimally invasive surgical technique which seems safe and effective to perform in Dutch patients with esophageal carcinoma. As expected, a higher incidence of RLNP was seen, in most cases only temporarily. Long-term safety and effectiveness will be prospectively evaluated in a larger population.
610. NOVEL HYBRID TECHNIQUES FOR DELAYED RECONSTRUCTION OF THE CERVICAL PART OF A LEFT COLON INTERPOSITION: A CASE REPORT
Authors: Maurice Karim , El Samadoni Ayman , Khalil Ashraf Abolfotooh , Elsharkawy Omar Ahmed , El-Refaie Yehia , El-Kady Mohamed Nabil , El-Sabbagh Omar , Hamour Dina , Milad Nader , Mashhour Shady , Safwat Yehia M , Amin Ayman A
Published: September 2022

Conduit necrosis following colon interposition for esophageal replacement is a devastating complication with a high morbidity and mortality rates. Survivors often face a challenging journey of complex reconstructive procedures. A multi-disciplinary approach is paramount to tailor the management according to the patient's anatomy, nutritional and psychological status, conduit alternatives and routes. This case report provides a series of novel reconstructive techniques, each of which could be helpful for esophageal surgeons facing such difficult situation.

A 36 years old female, with a history of corrosive ingestion at the age of 5 years, who was subjected to series of regular dilatation since then, presented with a tight stricture not passing a wire. She underwent a subcutaneous isoperistaltic left colon interposition. The postoperative course was complicated with necrosis of the cervical part of the graft with infection of the subcutaneous tunnel. Resection was done with esophagostomy and colostomy in the neck. The patient survived the acute stage, feeding was established through the colostomy opening in the neck. Delayed reconstruction was planned 6 months later.

The skin between the two openings in the neck was considered posterior wall of the conduit, and transaxillary pedicled thoracodorsal artery perforator flap (TDAP) was used to reconstruct the anterior wall (1,2). Partial flap loss occurred (3). Debridment and gastrostomy were done. The result was two gaps on both ends of the flap (3). The food regurgitated upwards from the gastrostomy. An antireflux stent was placed inside the flap to bridge the defects and allow oral intake (4). The TDAP-colon side was closed using a local flap from TDAP and skin graft (5,6). The esophageal side was closed primary and covered by a supraclavicular flap (7-12).

Management of graft failure should focus on controlling sepsis and nutrition. Attempts should be made to preserve any surviving part of the conduit as long as it doesn’t add to sepsis. A combination of Myocutaneous flaps could be used to replace the cervical part of the conduit as TDAP and supraclavicular flaps. Stent could be used successfully to bridge a failure in a skin flap. Finally, a dedicated team is paramount for a successful outcome.
614. SIGNIFICANCE OF LAPAROSCOPIC SURGERY IN OPEN THORACOTOMY ESOPHAGECTOMY
Authors: Ikebe Masahiko , Tsutsumi Takashi , Inokuchi Shoich , Takayama Hiroomi , Yasuda Kazuhiro , Bandoh Toshio , Utsunomiya Toru
Published: September 2022

The usefulness of laparoscopic surgery in esophageal cancer surgery has been reported in the MIRO trial, but there are few reports of laparoscopic surgery in esophageal subtotal resection, which is the standard surgical procedure in Japan. Furthermore, chest procedures are often performed by thoracoscopic surgery, making it difficult to evaluate laparoscopic operations. This time, we retrospectively examined the usefulness of laparoscopic procedure in right thoracotomy surgery.

From 2007 to 2019, 135 patients with esophageal cancer who underwent thoracotomy and subtotal esophagectomy and were reconstructed by gastric tube (post-sternal route, cervical anastomosis) were included. In the laparoscopic group (Lap group), gastric mobilization and perigastric lymph node dissection were performed under 5-port. The stomach was pulled out of the abdominal cavity with a small laparotomy of 4-5 cm to prepare a gastric tube. In the case of open surgery (Open group), epigastric midline incision (15-20 cm) was performed up to the navel.

There were 67 cases in the Lap group and 68 cases in the Open group. There was no difference in thoracotomy time between the two groups. In the Lap group, the amount of bleeding was significantly less than in the Open group (289g vs 376g), and the operation time was longer. Lung complications of Clavien-Dindo classification Grade 2 or higher were significantly less in the Lap group (10% vs 24%). There was no difference between the two groups in anastomotic insufficiency and recurrent laryngeal nerve palsy. The number of dissected lymph nodes was significantly higher in the Lap group.

Laparoscopic abdominal manipulation in open esophageal cancer surgery was useful in reducing pulmonary complications.
622. EVALUATION OF THE PSOAS MUSCLE INDEX ON CLINICAL OUTCOMES IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA RECEIVING NEOADJUVANT CHEMOTHERAPY
Authors: Tanaka Ryo , Imai Yoshiro , Matsuo Kentaro , Honda Kotaro , Lee Sang-Woong
Published: September 2022

Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies. Muscle mass, defined as the psoas muscle index (PMI), is an important parameter of sarcopenia. However, the relationship between esophageal cancer and PMI has not been fully investigated, especially in patients receiving neoadjuvant therapy.

We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer.

We included 112 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and post-neoadjuvant chemotherapy psoas muscle index were evaluated for associations with postoperative complications, in addition to survival. Psoas muscle index (PMI) cutoffs were 6.0 cm2/m2 for men and 4.0 cm2/m2 for women. In this study, sarcopenia was defined based on the value of PMI.

63 patients (56.3%) were diagnosed with sarcopenia after receiving neoadjuvant chemotherapy (NAC). Patients with sarcopenia after NAC were significantly older than patients without sarcopenia. No significant difference was found in gender or ASA score. The rate of postoperative complication in the patients with sarcopenia was higher than that in the patients without sarcopenia (40.0% vs 24.5%; p=0.090). Especially, the rate of postoperative pneumonia in the patients with sarcopenia was significantly higher than that in the patients without sarcopenia (23.8% vs 6.1%; p=0.012).

Cross sectional measures of sarcopenia after neoadjuvant chemotherapy could predict postoperative complications in multidisciplinary treatments for esophageal cancer. It is important to maintain or improve nutritional status by intervention from the time of neoadjuvant chemotherapy.
631. OPERATIVE OUTCOMES OF ROBOTIC GASTROPEXY IN THE TREATMENT OF GIANT PARAESOPHAGEAL HERNIA IN PATIENTS WITH PREDOMINANTLY OBSTRUCTIVE SYMPTOMS
Authors: Habib Fahim , Luketich James , Pennathur Arjun , Copelli Susan , Schuchert Matthew , Sarkaria Inderpal
Published: September 2022

Our approach to the repair of giant paraesophageal hernia (GPEH) has undergone a paradigm shift. In cases with predominantly obstructive symptoms, following hernia repair, we have transitioned from a mandatory antireflux procedure to a comprehensive extended gastropexy. Further, we have successfully adopted the robotic platform, faithfully replicating the tenets of the operation that we previously refined using the laparoscopic approach. The objective of this study was to describe operative outcomes with this approach.

With IRB approval, we retrospectively analyzed prospectively collected data. Operative technique included complete mediastinal dissection of the hernia sac, reduction of contents, tension free return of the stomach to its normal intraabdominal position, preservation of the crural lining, and repair of the crura with nonabsorbable suture. For patients with predominantly obstructive symptoms and minimal reflux, in lieu of an antireflux procedure, we performed an extended gastropexy involving accentuation of the angle of His and placement of a series of horizontal mattress sutures between the greater curvature of the stomach along the line of the short gastric vessels and the diaphragm.

Between 2014 and 2021, 113 patients underwent robotic GPEH repair with gastropexy (median age 74.3 ± 9.05 years, 79.6% female, elective 78.7% vs. 21.2% urgent). Majority were Type III GPEH (75.2% vs 24.7% Type IV) and 22.3% had an organ-axial volvulus. Most common presenting symptoms were dysphagia (35.4%), vomiting (23.8%) and chest pain (17.7%). All operations were completed robotically. Cardinal tenets of GPEH repair were achieved in all cases. Average length of stay was 5.85 ± 5.18 days. Two patients (1.7%) died within 30 days, and 24.7% developed a postoperative complication, 13 (11.5%) were readmitted and 4 (3.5%) required reoperation.

In patients with a GPEH who have predominantly obstructive symptoms, a robotic approach that adheres to the principal tenets of GPEH repair with an extended gastropexy in lieu of an antireflux procedure appears to be feasible and safe. Further studies that evaluate functional outcome and long-term follow-up to assess durability appear to be warranted.
634. PERIOPERATIVE MORBIDITY AND MORTALITY AFTER STANDARD TWO-FIELD AND RADICAL THREE-FIELD ESOPHAGECTOMY – RESULTS FROM A RANDOMIZED TRIAL
Authors: Pramesh CS , Karimundackal George , Jiwnani Sabita , Shetmahajan Madhavi , Ranganathan Priya , Parab Swapnil , Niyogi Devayani , Tiwari Virendra , Mistry Rajesh , Badwe Rajendra
Published: September 2022

The role of radical lymphadenectomy in esophageal cancer is controversial. While standard two-field lymph node dissection (2FLND) is considered the standard of care, the role of prophylactic radical three-field lymph note dissection (3FLND) is debatable. We conducted a large randomized trial comparing oncological outcomes between 2FLND and 3FLND for operable esophageal cancer. Here, we report the perioperative complications in the trial.

Patients with operable esophageal squamous cell/adenocarcinoma between 18-75 years of age with no clinicoradiological supracarinal lymph node metastases were eligible. Patients were randomly allocated intraoperatively with allocation concealment (stratified by histology, T, N stage, level of growth, and neoadjuvant treatment) to 2FLND or 3FLND. Patients randomized to 2FLND underwent removal of all infracarinal mediastinal and D2 abdominal lymph nodes; patients randomized to 3FLND in addition had bilateral supracarinal mediastinal and lower cervical neck lymph node dissection. Intraoperative and postoperative details including perioperative complications were collected. Chi-square test was used for categorical and the Student t test for numeric variables.

A total of 700 patients were recruited between Jan 2005 and Dec 2019 (359 2FLND, 341 3FLND). Demographic data are presented in the Table. More patients undergoing 3FLND required prolonged ventilation (4.2 vs 12%, p<0.001), had pulmonary complications (25.6 vs 38.1%, p<0.001) and anastomotic leaks (11.7% vs 17.6%, p=0.03). There were no differences in cardiac complications (0.8 vs 2.6%, p=0.08), chyle leaks (3.1 vs 3.5%, p=0.83), major morbidity (CD score >3a; 14.8% vs 19.4%, p=0.13) and mortality (4.5 vs 5.9%, p=0.4) in the two groups.

Pulmonary complications and anastomotic leaks occur more frequently with 3FLND than 2FLND while major morbidity and mortality were similar. Oncological outcomes will dictate whether 3FLND is beneficial in patients with operable esophageal cancer.
640. ESOPHAGECTOMY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION ADENOCARCINOMA IN RYGB PATIENTS. A LITERATURE REVIEW ON OPERATIVE TECHNIQUES, SAFETY AND ONCOLOGIC OUTCOME
Authors: Diab Abdul-Rahman , DuCoin Christopher
Published: September 2022

Roux-en-Y gastric bypass (RYGB) surgery changes the anatomy of the gastrointestinal tract, and thus renders the surgical management of esophageal and gastroesophageal junction adenocarcinoma cases technically confusing. No consensus exists regarding the the optimal surgical technique in terms of safety and oncologic outcomes in these cases. The aim of this study is to compile and analyze the available operative/technical data in the literature on surgical management of esophageal and gastroesophageal junction adenocarcinoma in RYGB patients.

A literature review was performed in Cochrane Database, Embase, Medline, PubMed, and Scopus electronic databases to find all cases of esophagectomy for esophageal and gastroesophageal junction adenocarcinoma in RYGB patients. Keywords used were esophageal adenocarcinoma, esophagogastric junction adenocarcinoma, gastric bypass, bariatric surgery, esophagectomy, Ivor Lewis esophagectomy, transhiatal esophagectomy, and thoracoabdominal esophagectomy. All abstracts retrieved were screened, and for each one deemed relevant, the full text was obtained. Finally, 11 articles containing 17 cases were studied and analyzed. Extracted data included: Esophagectomy type, incision type, gastric pouch management, conduit used, Roux limb management, and most importantly complications and oncologic outcome.

Esophagectomy was Ivor Lewis, transhiatal, and thoracoabdominal in 58.82%, 23.53% and 17.65% respectively. Esophagectomy was open in 46.67%, and minimally invasive in 53.33%. Gastric pouch was reconnected to the excluded stomach in 14.29%, while it was resected in 85.71%. Gastric, colonic and jejunal conduits were used in 87.5%, 6.25% and 6.25% respectively. In 63.64%, the Roux limb (RL) was connected to the abdominal wall and a feeding jejunostomy was placed. In the remaining 36.36%, the RL was either totally resected, or its proximal end was anastomosed to the distal end of the biliopancreatic limb. No complications were reported.

No differences in oncologic outcome or safety were observed between open versus minimally invasive esophagectomy. Minimally invasive esophagectomy is safe and technically feasible with appropriate oncologic outcomes for esophageal and gastroesophageal junction adenocarcinoma patients with previous gastric bypass. Therefore open esophagectomy is not necessary. Post RYGB Esophageal and gastroesophageal junction adenocarcinoma might be underreported, and the number of cases will undoubtedly continue to increase in the coming years.
641. ALPORT SYNDROME WITH ESOPHAGEAL LEIOMYOMA TREATED WITH CONSERVATIVE DISTAL ROBOTIC MYOTOMY: AVOIDING ESOPHAGECTOMY?
Authors: Takeda Flavio Roberto , Sallum Rubens Antonio Aissar , Meira Jose Donizete , Gusbert Luis Gustavo , Nobre Karolyne Ernesto Luiz Lopes , Nobre Josean Victor Lopes Higino , Ribeiro Ulysses , Cecconello Ivan
Published: September 2022

Alport Syndrome manifests as dysmorphic hematuria associated or not with nephrotic syndrome, renal failure and visual and auditory impairment, in addition to family history. Leiomyoma is the most common benign neoplasm of the esophagus, but it is rare in childhood, and controversies persist as to the best option for its surgical treatment. We report the case of an 8-year-old female patient diagnosed with Alport syndrome and association with esophageal leiomyoma.

An 8-year-old female had 3 episodes of pneumonia related to bronchoaspiration. During childhood, he presented pictures of retrosternal pain related to dysphagia, which had worsened in intensity in the last 2 years. She had a hypothesis of achalasia, she underwent an Endoscopic Poem Myotomy. During the procedure, a mass was observed in the distal esophagus and a biopsy showed that it was an esophageal leiomyoma. Given the close association of this tumor with Alport Syndrome, biopsy confirmed the diagnosis. She was then submitted to robotic surgery for possible esophagectomy, however, only partial resection of the Leiomyoma was performed avoiding esophagectomy.

Due to young age and the morbidity of esophageactomy, only partial resection of the Leiomyoma was performed, with significant improvement in esophageal emptying for liquids and solids in the postoperative period and hospital discharge after 5 days. Considering leiomyomatosis a benign disease, partial resection was permitted since the histological aspects such as high rates of Ki67% and cellular morphological features were not found.

The case in question presented a diagnosis due to the severe manifestations that were provided by the esophageal leiomyoma in a patient with atypical epidemiological characteristics, such as age group and sex. The conservative surgical strategy was chosen due to the patient's age and the surgical result was satisfactory, being suggested in similar cases.
642. RESULTS COMPARING SAFE (SUPERCHARGED CERVICAL ANASTOMOSIS FOR ESOPHAGECTOMY AND GASTRIC PULL-UP) AND NON-SAFE PROCEDURE: PROPENSED MATCHED SCORE STUDY
Authors: Takeda Flavio Roberto , Sallum Rubens Antonio Aissar , Gusbert Luis Gustavo , Ribeiro Ulysses , Cecconello Ivan
Published: September 2022

Esophagectomy is a high-risk surgical procedure. Anastomotic leakage is the most feared complication and is likely related to diminished anastomotic perfusion. “Supercharged” microvascular anastomosis has been performed in select patients to supplement the blood supply to the graft and anastomosis, after esophagectomy. This study aimed to evaluate results after performing the supercharged cervical anastomosis for esophagectomy procedure.

This retrospective cohort study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma with or without SAFE procedure between 2009-2021. Demographic features were assessed such as gender, age, histological type, staging; complications were evaluated (anastomotic leakage, clinical and surgical complications); mortality and overall survival; all those setting was compared between groups after propensed matched score system (PMS). Univariable and multivariable analysis were done.

The study enrolled 421 patients, 71 with SAFE procedure and 350 without SAFE procedure. After PMS (1:1), 65 patients remained in each group. which included 100 (77.0%) men, with a mean age of 65.3 years. Univariable analysis showed SAFE procedure less occurrence of leakage HR 3.05 (1.32-5.34), less clinical complications HR 3.24 (1.56-5.67). In multivariable analysis, SAFE procedure was related to less occurrence of leakage HR 3.1 (2.43-4.32). Comparinfg both overall survival (3 ys), SAFE group had better results (SAFE 52.3%; non SAFE 31.2%)

The supercharged cervical anastomosis for esophagectomy procedure may be related to low occurrence of anastomotic leakage and improve overall survival.
643. PRACTICAL IMAGING REVIEW OF EXPECTED FINDINGS AND POSSIBLE COMPLICATIONS RELATED TO MULTIMODAL TREATMENT OF ESOPHAGEAL CANCER
Authors: Takeda Flavio Roberto , Oliveira Victor Rodrigues , de Paiva Magalhaes Daniel , Neves Yuri Costa Sarno , Sallum Rubens Antonio Aissar , Ribeiro Ulysses , Cecconello Ivan
Published: September 2022

Esophageal cancer has been a major health issue, representing the eighth most common cancer worldwide. In the last decades, esophageal cancer treatment has evolved rapidly and a multimodality approach has been increasingly used. Main treatment options for locally advanced tumors include surgery resection, neoadjuvant or definitive chemoradiotherapy and palliative endoscopic dilation/stenting. In that context, radiology plays an important role in the early identification and management of treatment related complications.

Retrospective analysis of the radiological exams of esophageal cancer patients in the ICESP (Cancer Institute of Sao Paulo) followed by selection of several cases (more than 300 cases) illustrating the expected findings and the main complications related to each treatment modality (surgical, endoscopic and radiotherapy-related).

Five main different complications were selected and the radiological findings were classified using the HARMS mnemonic: Hiatal hernia; Anastomotic fistula, Radiation-induced injury, Mediastinal and pleural-pulmonary abscess and stenting-related injuries. For each classification, several images were selected using the different methods of esophageal imaging - mainly upper gastrointestinal series and computed tomography.

After categorization it is possible to recognize and familiarize with post-treatment complications using the “HARMS” mnemonic. Therefore, we present a review for the radiologists describing what is important to report as well as a compilation of possible image findings that oncologists, surgeons and endoscopists must be aware of.
649. MODIFIED EN BLOC ESOPHAGECTOMY WITH TOTAL LYMPHADENECTOMY IN PATIENTS WITH RESIDUAL TUMOR AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Hsu Po-Kuei
Published: September 2022

The optimal type of esophagectomy and extent of mediastinal lymphadenectomy for patients who had received neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) remain debatable. We hypothesized that a more radical resection could be associated with better survival without adding morbidity.

Data of patients who received trimodal treatments (neoadjuvant chemoradiotherapy followed by surgery) for ESCC between 2016 and 2021 in a single center were analyzed. Modified en bloc esophagectomy (mEBE) is defined as removal of the esophagus tube en bloc with adjoining locoregional soft tissue and lymph nodes, using the concept of mesoesophagus. Total lymphadenectomy includes dissection of lymph nodes around bilateral recurrent laryngeal nerves. Outcomes after mEBE with total lymphadenectomy were compared to those after conventional esophagectomy (CE).

A total of 154 patients, including 42 and 112 receiving mEBE and CE, respectively, were included. Compared to CE, the mEBE was associated with a longer operative time (560 vs. 540 min, p<0.001) and higher total resected lymph node (19 vs. 17, p=0.001); whereas the complication rates and length of stay were similar between two groups. There was no overall survival (OS) difference between mEBE and CE groups in patients with ypT0N0 stage. However, in patients with residual tumors (non-ypT0N0), the 3-year OS rates were 58.5% and 40.8% in mEBE and CE groups, respectively (p=0.010).

In patients with ESCC, mEBE with total lymphadenectomy after neoadjuvant chemoradiotherapy is safe without adding perioperative morbidity. Moreover, it is associated with better OS compared to CE, especially in patients who have residual tumor after neoadjuvant treatments.
651. LAPAROSCOPIC TOTAL FUNDOPLICATION IS SUPERIOR TO MEDICAL TREATMENT FOR REDUCING THE CANCER RISK IN BARRETT'S ESOPHAGUS: A LONG-TERM ANALYSIS
Authors: Szachnowicz Sergio , Duarte André Fonseca , Nasi Ary , da Rocha Julio Rafael Mariano , da Costa Bernal Seguro Francisco , Bianchi Edno Tales , Tustumi Francisco , de Moura Eduardo Hornoux Guimaraes , Sallum Rubens Antonio Aissar , Cecconello Ivan
Published: September 2022

Background: The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation.

Methods: A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett’s esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett’s esophagus length, the Groups were 180 (Group A) and 190 (Group B).

Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms, in promoting Barrett’s esophagus regression or blocking its progression. Also was more efficient in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia, using age and BMI as covariates. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (OR: 0.51; 95% CI: 0.27 to 0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08 to 0.81, for adenocarcinoma or high-grade dysplasia).

Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.
653. DOES MIE REDUCE PULMONARY COMPLICATIONS IN A REAL-WORLD SCENARIO?
Authors: Gopinath Srinivas Kodaganur , Jiwnani Sabita , Karimundackal George , Tiwari Virendrakumar , Niyogi Devayani , Ranganathan Priya , Pramesh CS
Published: September 2022

Pulmonary complications are a common cause of morbidity, and occurs in upto 30% after esophagectomy. Randomised trials have shown significant decrease in pulmonary complications after minimally invasive esophagectomy (MIE). We conducted a study to evaluate whether this was true in a real-world scenario.

We performed a retrospective analysis of a prospectively maintained database of patients undergoing esophagectomy. Data of consecutive patients undergoing MIE or open Mc-keown transthoracic esophagectomy (OE) between 2013 and 2021 were included. Categorical variables were compared by Pearson’s Χ2 test or Fisher’s exact test. Multivariate logistic regression analysis was performed to analyse the relation between pulmonary complications and potential related factors to identify independent predictors of pulmonary complications.

A total of 1046 patients underwent MIE or OE between 01/01/2013 and 31/12/2021. The mean age was 54.2+/-9.9 y; 413 (39.5%) were smokers; 862 (82.4%) patients underwent neo-adjuvant chemotherapy; 411 patients(41.1%) underwent MIE( 309- VATS, 102- Robotic) while the remaining 635 underwent OE. Overall, 354(33.8%) patients had pulmonary complications, of which 234(22.4%) were CD 3a and above. Pulmonary complications were reduced by 11.6% (171/635, 26.9% with OE vs 63/411, 15.3% with MIE; p=0.001)(). On multivariate analysis, age > 60y, open surgery, FEV1,3-field lymphadenectomy and ASA grade(II and III) were found to be significant predictors of pulmonary complications (table 1)

Adoption of MIE results in fewer pulmonary complications in the real world; however, the large differences seen in randomised trials may not be replicable in a real-world scenario. Elderly patients, those with low FEV1 values, a higher ASA grade and those who have undergone a 3-field lymphadenectomy may develop significant pulmonary complications in spite of undergoing MIE.
656. EPIMIOLOGICAL ASPECTS OF PROGRESSION FROM BARRETT'S ESOPHAGUS IN DYSPLASIA AND ESOPHAGEAL ADENOCARCINOMA: LONG FOLLOW UP IN A HIGH VOLUME CENTER
Authors: Szachnowicz Sergio , Gallon Eduardo , Dardin Felipe Augusto , Duarte André Fonseca , Sallum Rubens Antonio Aissar , Cecconello Ivan
Published: September 2022

Barrett's Esophagus (BE) affects approximately 3 million people in Brazil and an increase in its incidence has been observed in recent years. Especially in scenarios with social and financial limitations, it is of fundamental importance to study the epidemiological factors related to a higher risk of progression from EB to dysplasia in our specific population to optimize these patients' follow-up.

A retrospective analysis of patients with BE with long follow-up at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, regarding epidemiological aspects associated with a higher incidence of BE progression to dysplasia and adenocarcinoma.

Statistical analyzes were performed to establish correlations between the variables sex, age, smoking, ethnicity, BMI, Barrett's extension and the presence of esophageal dysplasia and adenocarcinoma. We found that sex, smoking, ethnicity and Barrett's extent are variables that are related to a higher incidence of adenocarcinoma.

This study confirmed that males, smoking and white patients, besides patients with long Barrett's epythelium were associated with higher risk to develop dysplasia and adenocarcinoma.
657. COMPARISON BETWEEN GASTRIC TUBE AND COLOPLASTY IN ESOPHAGECTOMY AND ESOPHAGEAL BYPASS IN ESOPHAGEAL STENOSIS DUE TO INGESTION CORROSIVE SUBSTANCE
Authors: Seguro Francisco Carlos Bernal Da Costa , Tustumi Francisco , Szachnowicz Sergio , Ferros Lucas Sousa Maia , Silva Andrey Blaya E , Sallum Rubens Antonio Aissar , Cecconello Ivan
Published: September 2022

The treatment of ingestion of caustic agents is controversial in the literature. Surgical therapy has been shown to be the best way to proceed, but the surgical methodology has been varied according to the patient's involvement. This study aims to expose the experience of a single institution in relation to the methodology used for the surgical treatment of esophageal stenosis by ingestion of a caustic substance.

A retrospective study was carried out in which data were collected from 27 patients who underwent a surgical procedure for the treatment of esophageal stenosis due to alkali ingestion at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between 2010 and 2019 and their subsequent comparison between the conduits used in the surgical intervention. Fisher's test was performed to compare the groups regarding cervical leakage and post-surgical symptoms with a significance level of 5%.

Of the 27 surgical procedures for esophageal stenosis due to alkali ingestion, 12 performed gastric conduits and 15 colon conduits. When comparing the groups regarding cervical leaks, no statistically significant difference was noted (p = 0.7060). There were also no statistically significant differences regarding the presence of symptoms in the postoperative period (p > 0.99...)

Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control.

Surgical intervention by both gastric and colon conduits showed no differences in cervical leakage and symptom control.
659. ORGANOAXIAL GASTRIC VOLVULUS DETERMINING GASTROESOPHAGEAL REFLUX DISEASE: A FORGOTTEN RELATION CAUSE
Authors: Szachnowicz Sergio , Bianchi Edno Tales , Navarrete João Gabriel Bom , Nunes Lucas Pinto , de Paula Daniel Meirelles
Published: September 2022

Gastric volvulus is a rare clinical and occurs when the stomach rotates 180° in its transverse or longitudinal axis. Symptoms may range from mild abdominal pain to volvulus necrosis. Gastroesophageal reflux disease (GERD) is not very often associated with abdominal gastric volvulus. Usually, the volvulus is primary and results from anatomical ligament defects. Organoaxial volvulus is the most common type and is defined by the rotation of the stomach around the Pylorus or Gastroesophageal Junction.

Two cases will be presented where the treatment of organo-axial gastric volvulus was performed by video laparoscopy. The literature revision will try to bring some aspects of the problems in missing the diagnosis of the volvulus before operation.

Two male patients, 24 and 47 years old, underwent surgery, both with extra-esophageal symptoms of GERD associated with symptoms of gastroparesis. Endoscopy, barium swallow and gastrography, manometry, pHmetry, and scintigraphy gastric emptying test were performed, showing a delayed gastric emptying time leading to reflux in both patients.

Both patients had a good evolution after surgery. The release of the gastric anatomical ligaments was performed, as well as the rotated gastric fundus. The gastric fundus was used to perform a partial fundoplication, with the stomach being fixed to the pillars and diaphragmatic surface, fixing the stomach in a normal anatomical position.

Gastric volvulus can be an unexpected cause of GERD, and the symptoms usually are refractory without surgical treatment. The appropriate surgical technique can bring good results and symptom relief to patients.
SYNPRED: prediction of drug combination effects in cancer using different synergy metrics and ensemble learning
Authors: Preto António J , Matos-Filipe Pedro , Mourão Joana , Moreira Irina S
Published: September 2022

Background

In cancer research, high-throughput screening technologies produce large amounts of multiomics data from different populations and cell types. However, analysis of such data encounters difficulties due to disease heterogeneity, further exacerbated by human biological complexity and genomic variability. The specific profile of cancer as a disease (or, more realistically, a set of diseases) urges the development of approaches that maximize the effect while minimizing the dosage of drugs. Now is the time to redefine the approach to drug discovery, bringing an artificial intelligence (AI)–powered informational view that integrates the relevant scientific fields and explores new territories.

Results

Here, we show SYNPRED, an interdisciplinary approach that leverages specifically designed ensembles of AI algorithms, as well as links omics and biophysical traits to predict anticancer drug synergy. It uses 5 reference models (Bliss, Highest Single Agent, Loewe, Zero Interaction Potency, and Combination Sensitivity Score), which, coupled with AI algorithms, allowed us to attain the ones with the best predictive performance and pinpoint the most appropriate reference model for synergy prediction, often overlooked in similar studies. By using an independent test set, SYNPRED exhibits state-of-the-art performance metrics either in the classification (accuracy, 0.85; precision, 0.91; recall, 0.90; area under the receiver operating characteristic, 0.80; and F1-score, 0.91) or in the regression models, mainly when using the Combination Sensitivity Score synergy reference model (root mean square error, 11.07; mean squared error, 122.61; Pearson, 0.86; mean absolute error, 7.43; Spearman, 0.87). Moreover, data interpretability was achieved by deploying the most current and robust feature importance approaches. A simple web-based application was constructed, allowing easy access by nonexpert researchers.

Conclusions

The performance of SYNPRED rivals that of the existing methods that tackle the same problem, yielding unbiased results trained with one of the most comprehensive datasets available (NCI ALMANAC). The leveraging of different reference models allowed deeper insights into which of them can be more appropriately used for synergy prediction. The Combination Sensitivity Score clearly stood out with improved performance among the full scope of surveyed approaches and synergy reference models. Furthermore, SYNPRED takes a particular focus on data interpretability, which has been in the spotlight lately when using the most advanced AI techniques.
Introduction
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter introduces the applications and interpretations of uniform laws such as the 1980 United Nations Convention on Contracts for the International Sale of Good (CISG). It notes how the second edition of Global Sales and Contract Law (GSCL) used the functional comparative approach to ensure that the issue is without any dogmatic intricacies. Additionally, the chapter lists the abbreviations pertaining to civil codes, commercial codes, codes of obligation, and sale of goods Acts. The work aims to consider as many of the world’s jurisdictions as possible through the use of case studies instead of listing every possible narrative for each jurisdiction text.
Contract and the Law
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explains the law applicable to a sales contract. It is a prerequisite to determining the applicable law in line with the contract and nature of the transaction. One of the issues over the matter is the content and extent of obligations between both parties. Religious values or norms could impact the specificity of nuanced international sales laws. On the other hand, international commercial arbitration requires separate consideration as the survey of modern business practice identified its preferred method of dispute resolution. Almost all international commercial arbitral laws give parties the authority to choose the law viable for the contract.
General Remarks on Validity
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores the notion of validity. In the context of the CISG, matters of validity can be understood as those where a contract is considered as void ab initio. Validity is a tool used to serve different policy objectives at different times. Contracts declared as an absolute nullity are mostly for the protection of the legal system as a whole, while relative nullity protects the interests of a party rather than the broader legal system. Additionally, a contract valid only with ratification is essentially void until it receives ratification. The chapter tackles the uniform projects’ approach to validity.
Mistake and Error
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter tackles common law misinterpretation. It regards mistakes as one of the most difficult contract law topics as it overlaps between other doctrines. A discrepancy between the way the contract has been legally interpreted and the way one party understood the contract is needed to ensure a party could rely on the contract mistake. Mistakes have been a vital concept within civil law jurisdictions, whereas its relative importance within the common law has varied considerably over time and location due to the possibility of misinterpretations. Common law jurisdictions recognize three types of misrepresentation: innocent, negligent, and fraudulent.
Pre-Contractual Duties
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter tackles pre-contractual duties which depend on what stance a legal system takes towards the general principle of good faith. The principle of good faith and fairness differs in how it influences the construction and interpretation of contractual rights and duties. All legal systems, which recognize a principle of good faith, acknowledge that parties assume a certain degree of responsibility to protect the legal interests of the other party during negotiation. The degree of responsibility range from information duties, honesty, and confidentiality. Additionally, the principle of freedom also gives the power to break off contract negotiations.
General Remarks on Seller’s Obligations
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores the obligations of sellers. It starts with the characteristic obligations of sellers such as delivering goods to the buyer, transfer of title, and sales contracts. In the absence of contractual stipulations, it is vital to turn to the default provisions. Civil law jurisdictions do not typically comprehensively corral the obligations of the seller in one particular part of the civil code or code of obligations. However, common law systems are typically structured differently, and thus it is easier to find nearly all obligations of the seller in a single piece of legislation. The chapter expounds on the additional obligations of sellers such as sources and documentation.
Transfer of Title by a Non-Owner
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explains the transfer of title by a non-owner. Buyers looking into reselling their purchased goods will be placed under sales contracts as sellers. In a commercial environment, buyers demand that their reliance on becoming the owner or authorized reseller be protected. Situations involving the sale of goods encumbered with third party rights are discussed separately in the context of legal defects. The state of awareness of buyers differs among legal systems. Nemo Dat rule, on the other hand, favors the rights of the original owner which is employed by common law legal systems. The chapter includes the protections of bona fide recipients as well.
Interest
Authors: Schwenzer Ingeborg , Muñoz Edgardo
Published: September 2022

This chapter explores the concept of interest. The concept of interest and its justification has been under scrutiny and dispute from philosophical, religious, and moral perspectives. Contractual agreements on the obligation to pay interest are enforced in the vast majority of legal systems. Additionally, the rate of interest is included in the obligation. Legal systems display a significant degree of uniformity where the parties go beyond the limits of their freedom to fix a contractual interest rate. Both parties are required to go under default provisions if they failed to have an agreement on paying interest.
Thermal stabilisation of the short DNA duplexes by acridine-4-carboxamide derivatives
Authors: Kostelansky Filip , Miletin Miroslav , Havlinova Zuzana , Szotakova Barbora , Libra Antonin , Kucera Radim , Novakova Veronika , Zimcik Petr
Published: September 2022

The short oligodeoxynucleotide (ODN) probes are suitable for good discrimination of point mutations. However, the probes suffer from low melting temperatures. In this work, the strategy of using acridine-4-carboxamide intercalators to improve thermal stabilisation is investigated. The study of large series of acridines revealed that optimal stabilisation is achieved upon decoration of acridine by secondary carboxamide carrying sterically not demanding basic function bound through a two-carbon linker. Two highly active intercalators were attached to short probes (13 or 18 bases; designed as a part of HFE gene) by click chemistry into positions 7 and/or 13 and proved to increase the melting temperate (Tm) of the duplex by almost 8°C for the best combination. The acridines interact with both single- and double-stranded DNAs with substantially preferred interaction for the latter. The study of interaction suggested higher affinity of the acridines toward the GC- than AT-rich sequences. Good discrimination of two point mutations was shown in practical application with HFE gene (wild type, H63D C > G and S65C A > C mutations). Acridine itself can also serve as a fluorophore and also allows discrimination of the fully matched sequences from those with point mutations in probes labelled only with acridine.
Direct hOGG1-Myc interactions inhibit hOGG1 catalytic activity and recruit Myc to its promoters under oxidative stress
Authors: Bangalore Disha M , Tessmer Ingrid
Published: September 2022

The base excision repair (BER) glycosylase hOGG1 (human oxoguanine glycosylase 1) is responsible for repairing oxidative lesions in the genome, in particular oxidised guanine bases (oxoG). In addition, a role of hOGG1 in transcription regulation by recruitment of various transcription factors has been reported. Here, we demonstrate direct interactions between hOGG1 and the medically important oncogene transcription factor Myc that is involved in transcription initiation of a large number of genes including inflammatory genes. Using single molecule atomic force microscopy (AFM), we reveal recruitment of Myc to its E-box promoter recognition sequence by hOGG1 specifically under oxidative stress conditions, and conformational changes in hOGG1-Myc complexes at oxoG lesions that suggest loading of Myc at oxoG lesions by hOGG1. Importantly, our data show suppression of hOGG1 catalytic activity in oxoG repair by Myc. Furthermore, mutational analyses implicate the C28 residue in hOGG1 in oxidation induced protein dimerisation and suggest a role of hOGG1 dimerisation under oxidising conditions in hOGG1-Myc interactions. From our data we develop a mechanistic model for Myc recruitment by hOGG1 under oxidising, inflammatory conditions, which may be responsible for the observed enhanced gene expression of Myc target genes.
Geographic encoding of transcripts enabled high-accuracy and isoform-aware deep learning of RNA methylation
Authors: Huang Daiyun , Chen Kunqi , Song Bowen , Wei Zhen , Su Jionglong , Coenen Frans , de Magalhães João Pedro , Rigden Daniel J , Meng Jia
Published: September 2022

As the most pervasive epigenetic mark present on mRNA and lncRNA, N6-methyladenosine (m6A) RNA methylation regulates all stages of RNA life in various biological processes and disease mechanisms. Computational methods for deciphering RNA modification have achieved great success in recent years; nevertheless, their potential remains underexploited. One reason for this is that existing models usually consider only the sequence of transcripts, ignoring the various regions (or geography) of transcripts such as 3′UTR and intron, where the epigenetic mark forms and functions. Here, we developed three simple yet powerful encoding schemes for transcripts to capture the submolecular geographic information of RNA, which is largely independent from sequences. We show that m6A prediction models based on geographic information alone can achieve comparable performances to classic sequence-based methods. Importantly, geographic information substantially enhances the accuracy of sequence-based models, enables isoform- and tissue-specific prediction of m6A sites, and improves m6A signal detection from direct RNA sequencing data. The geographic encoding schemes we developed have exhibited strong interpretability, and are applicable to not only m6A but also N1-methyladenosine (m1A), and can serve as a general and effective complement to the widely used sequence encoding schemes in deep learning applications concerning RNA transcripts.