bluuebunny/crossref_metadata_2025 huggingface dataset:
333. HIGH CERVICAL ANASTOMOSIS USING NARROW GASTRIC TUBE CAN REDUCE LEAKAGE AFTER MCKEOWN ESOPHAGECTOMY
Authors: Guo Xufeng
Published: August 2023

Background

Anastomotic leakage is one of the most serious complications after esophagectomy. High cervical anastomosis with narrow gastric tube has the potential to reduce the leakage after McKeown esophagectomy.

Methods

A total of 533 patients who received McKeown radical resection for esophageal cancer in Shanghai Chest Hospital from March 2018 to March 2023 were included in this study, including 281 patients in the normal anastomosis (NA) group and 252 patients in the high anastomosis (HA) group. Potential confounding factors in baseline characteristics were balanced by 1:1 propensity score matching (PSM). We compared the pathological and perioperative results before and after matching between the HA group and NA group, and finally used univariate and multivariate logistic analysis to analyze the independent risk factors of anastomotic leakage.

Results

After matching, 190 patients remained in both groups. In the comparison of pathological and surgical results, we found that the HA group had an advantage in lymph node harvest (Before matching: 21.3 ± 9.7 vs. 15.8 ± 7.5, p < 0.001; After matching: 21.1 ± 10.0 vs. 15.8 ± 7.7, p < 0.001). There were no significant differences in operation time, blood loss and R0 resection rate between the two groups after matching. The grade of tumor differentiation in HA group was better than that in NA group (p < 0.001), and the pathological staging was earlier than that in NA group (p < 0.001). Overall postoperative complications, including pulmonary infection (p < 0.001), anastomotic leakage (p < 0.001), recurrent laryngeal nerve paralysis (p = 0.031), and pleural effusion (p < 0.001), were significantly lower in the HA group than those in the NA group. Multivariate analysis indicated that age > 65 [odds ratio (OR) = 1.433, 95% confidence interval (CI) 1.248–1.753; p = 0.003], T4a (OR = 1.19, 95% CI 1.023–1.629; p = 0.016), Neoadjuvant treatment (OR = 0.075, 95% CI 0.038–0.150; p < 0.001) and HA (OR = 0.631, 95% CI 0.213–0.707; p = 0.014) were independent predictors for anastomotic leakage.

Conclusions

For patients undergoing McKeown esophagectomy, high anastomosis can effectively reduce the incidence of anastomotic leakage and reduce overall perioperative complications. It is a recommended optimized surgical procedure.
339. CYTOPLASMIC TRANSLOCATION OF BCLAF1 REGULATES SIX1 MRNA STABILITY THROUGH YTHDF2 TO PROMOTE AEROBIC GLYCOLYSIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zhang Peipei , Zhang Weiguang , Jiang Junfei , Kang Mingqiang
Published: August 2023

Background

Esophageal cancer is highly prevalent in China, with esophageal squamous cell carcinoma (ESCC) being the predominant pathological type. However, the unclear pathogenesis of ESCC presents a challenge for identifying effective targets for molecular targeted therapy. RNA methylation is an important epigenetic regulatory mechanism that may play a key role in carcinogenesis. Our research has identified BCLAF1 as an oncogene in ESCC and contributes to cancer progression through an m6A-dependent mechanism.

Methods

Paraffin specimens and immunohistochemistry (IHC) were used to analyze the correlation between BCLAF1 and ESCC patient prognosis. Edu proliferation, clone formation, scratch, transwell, flow cytometry, and Seahorse assays were conducted to investigate the impact of BCLAF1 on ESCC cells. Subcutaneous xenograft tumor and lung metastasis models in nude mice were performed to assess the role of BCLAF1 in vivo. Immunofluorescence (IF), mass spectrometry, and co-immunoprecipitation analyses were utilized to study the binding relationship between YTHDF2 and BCLAF1. MeRIP-seq, RIP-seq, and RNA-seq analyses determined the RNA profile bound by YTHDF2. Rescue experiments were employed to examine the BCLAF1/YTHDF2/SIX1 axis.

Results

IHC and IF assays confirmed that BCLAF1 is mainly located in the cytoplasm of ESCC tissues and cells. BCLAF1 is associated with poor prognosis of ESCC patients and also promote malignant progression of ESCC in vitro and in vivo. Mechanistic studies have revealed that BCLAF1 can interact with the m6A reader protein YTHDF2 without affecting its stability, and could affect the binding capacity of YTHDF2 to downstream target SIX1 mRNA in an m6A-dependent manner. Knockdown of YTHDF2 can upregulate the level of SIX1 mRNA and promote aerobic glycolysis in ESCC, which could be rescued by the overexpression of BCLAF1.

Conclusion

BCLAF1 is a potent oncogene, and its encoded protein undergoes non-classical cytoplasmic translocation in ESCC. Cytoplasmic BCLAF1 directly interacts with YTHDF2 to regulate its function as a reader protein that recognizes and binds m6A sites, enhancing the stability of downstream targets such as SIX1 mRNA, activating the aerobic glycolysis pathway, and ultimately leading to malignant progression of ESCC.
352. GENERATION OF PATIENT-DERIVED ESOPHAGEAL ADENOCARCINOMA ORGANOIDS FROM CIRCULATING TUMOR CELLS
Authors: Aiyar Niharikaa , Shathasivam Premalatha , Rispoli Thaiane , Naeem Mansur , Akhter Akhi , Elimova Elena , Bach Yvonne , Allison Frances , Darling Gail , Wilson Gavin , Yeung Jonathan
Published: August 2023

Background

Esophageal adenocarcinoma (EAC) is diagnosed in nearly 40% of patients when their cancer has already metastasized. Circulating tumor cells (CTCs) play a critical role in the metastatic cascade and need to be investigated in the context of EAC, but these must be expanded due to their scarcity in blood. Organoid models have been shown to recapitulate tumor heterogeneity and in vivo drug sensitivity. Thus, we aim to generate and characterize CTC-derived organoids from EAC patients.

Methods

CTCs were isolated from 32 blood samples obtained from 13 EAC patients using two methods: (1) Ficoll-based density gradient centrifugation followed by CD45+ cell depletion using magnetic-activated cell sorting (MACS) and/or (2) immunodensity separation using the RosetteSep CTC Enrichment Cocktail (Stemcell Technologies). Isolated CTCs were embedded and grown in Matrigel domes. Cultures were dissociated into single cells which were magnetically labelled and captured on a microfluidic chip. The captured cells were stained with DAPI, anti-CD45, anti-CK11, anti-CK13, and anti-CK18 antibodies. These cells were then visualized and quantified using fluorescence microscopy.

Results

Organoids were generated from twenty-one out of thirty-two samples, after two to six weeks in culture, with an average of 20.76 ± 6.435 organoids per sample. These EAC CTC derived organoids underwent a growth arrest once they reached an arbitrary size but were able to regenerate upon dissociation and re-seeding. However, no increase in the size or number of organoids was observed post-passaging. Of the nine CTC-derived organoid samples characterized using microfluidic capture and immunostaining, all nine had the presence of CD45 negative, CK positive, and DAPI positive cells.

Conclusion

In this study, we validated commonly used CTC isolation methods and were able to demonstrate that CTCs isolated can be cultured to generate organoids. Additional investigation is required to overcome the growth arrest which occurs during culture.
362. AUTOMATED DETECTION OF UPPER MEDIASTINAL LYMPH NODES METASTASIS OF ESOPHAGEAL SQUAMOUS CANCER USING BERT ON COMPUTED TOMOGRAPHY
Authors: Ma Zhao , Li Yang , Li Xiangchun , Jiang Hongjing
Published: August 2023

Upper mediastinal lymph node (LN) metastasis is the extremely frequent metastasis lymph node site and dissection of this site of lymph node harbors a high risk of recurrent laryngeal nerve injury. Prediction of LN metastasis before dissection is necessary for personalized therapy. We developed a pre-training unsupervised deep learning model based on Bidirectional Encoder Representation from Transformers (BERT) to extract features from pre-operational CT images and detect patients with LN metastasis. A total of 3769 esophageal cancer patients from 2012 to 2020 with complete post-surgical pathology in our institute were included in this study, 823 of which had upper mediastinal LN metastasis. The extracted features of CT images were labeled with the LN metastasis status of the corresponding patients and then divided into training and validation groups (7:3) for training. In order to keep balancing of the positive and negative ratio in the test dataset, 800 patients were randomly selected from the validation group (1:1). The BERT-based pretrained learning model achieved a AUROC of 0.651 on detection of upper mediastinal LN metastasis. The specificity of this model could reach up to 0.732. Our model can be used to improve diagnostic ability of upper mediastinal LN metastasis before surgery.
373. THE PROGNOSTIC IMPACT OF TIME DELAYS IN OESOPHAGEAL CANCER SURGERY: 10-YEAR EXPERIENCE OF A HIGH-VOLUME CENTRE
Authors: Mcgregor Richard , Magnoli Matteo , Sayers Judith , Couper Graeme , Deans Chris , Lamb Peter , Skipworth Richard
Published: August 2023

Background

Over the last twenty years, treatment of oesophageal cancer has changed towards a multimodal approach to achieve better clinical outcomes. Detailed staging paradigms and neoadjuvant treatment have resulted in a longer time period before oesophagectomy, but literature on the prognostic impact of longer waiting times is scarce in this field. The aim of this study was to determine whether hospital (HD) or time to surgery (TTSD) delays adversely impact patient outcomes.

Methods

All patients who underwent oesophagectomy for oesophageal cancer between January 2009 and February 2020 at the Royal Infirmary of Edinburgh (RIE) were identified from a prospectively maintained database.

Two different time delays were considered. Hospital delay, defined as the time between date of diagnosis and start of treatment (i.e. neoadjuvant chemotherapy or straight to surgery). Time to surgery delay (time between the end of neoadjuvant regimen and surgery). The primary endpoint was to investigate whether hospital or time to surgery delay affected overall survival (OS). Secondary endpoints anaylsed whether hospital or time to surgery delays affected post-operative complication rate, 30 day mortality, or disease-free survival (DFS).

Results

A total of 512 patients were included for analysis over the 10 year study period. ‘Delayed treatment’ (DT) was calculated as greater than the median ‘hospital delay’, which was 56 days. ‘Early treatment’ (ET) was therefore defined as <56 days. Similarly, median time to surgery was 35 days, and delay in time to surgery (DTTS) was defined as ≥35 days.

Kaplan–Meier survival analysis and the log rank tests did not find any significant difference in OS, DFS, post-operative complications, or 30 day mortality with either time delay. Further multivariate analyses showed that hospital and time to surgery delay, were not independent prognostic variables.

Conclusion

In our study group a hospital delay longer than 8 weeks did not impact on OS, DFS, or post-operative complications. Moreover, a time to surgery delay over 5 weeks appears safe, and did not impact overall survival.
375. RURAL PATIENTS HAVE A PROLONGED INPATIENT RECOVERY PROCESS AFTER ESOPHAGECTOMY COMPARED TO NON-RURAL PATIENTS AT A HIGH-VOLUME ESOPHAGEAL PROGRAM
Authors: Schroeder Julia , Lagisetty Kiran , Lynch William , Lin Jules , Chang Andrew , Orringer Mark , Reddy Rishindra
Published: August 2023

Background

Geographic access to care plays a large role in health disparities in esophageal cancer care, with rural individuals often travelling further to access complex healthcare services. We sought to characterize peri-operative outcomes in patients undergoing esophagectomy for loco-regional cancer at a single academic tertiary care center based on geographic home location. We hypothesize that rural patients will have worse peri-operative outcomes after esophagectomy, despite receiving care at the same high-volume hospital.

Methods

Prospectively collected data from patients with loco-regional esophageal cancer who underwent esophagectomy at a single academic medical center between 2003 to 2022 were analyzed based on county. The counties were aggregated into previously existing state-level ‘metropolitan’ versus ‘rural’ designations per the Rural Health Information Hub guidelines. Distance traveled by the patients were calculated using driving distance between the patient’s reported zip code and hospital address. Demographics, pre-operative treatment, surgical complications, post-operative outcomes, length of stay (LOS), and mortality of the two groups were analyzed using chi-squared, paired t-tests, and single-factor ANOVA.

Results

The cohort consisted of 1545 patients with 76.0% from metropolitan counties and 24.0% from rural counties. Patients were more likely to be male in both groups (p = 0.004), with no significant differences in pre-operative characteristics. Both groups had similar rates of pre-operative chemotherapy (p = 0.11) and pre-operative radiation (p = 0.58). Rural patients traveled greater distances for healthcare services compared to metropolitan patients (rural: 192.4 ± 101.2 miles; metropolitan: 63.4 ± 36.7 miles; p < 0.001). Post-operatively rural patients had higher rates of pneumonia (p = 0.04) and more initial ICU visits (p < 0.001). Rural patients had longer ICU LOS (p < 0.001), but no difference in total hospital LOS (p = 0.28) or 30-day mortality (p = 0.35).

Conclusion

Rural patients tended to have a more complex inpatient recovery process after esophagectomy despite receiving surgery at the same high-volume institution and no differences in pre-operative characteristics (BMI, smoking history, and co-morbidities). It is unclear as to the reason for differences in pneumonia rates and ICU stays. Future studies should focus on the impact of rural location on disparities for individuals undergoing esophagectomy.
377. EARLY POSTOPERATIVE ORAL FEEDING IS SAFE FOLLOWING MAJOR UPPER GASTROINTESTINAL SURGERY (PROPENSITY SCORE MATCHING STUDY)
Authors: Papp Andras , Sindler Lili , Halvax Peter , Csontos Armand , Szako Lajos , Vereczkei Andras , Papp Csenge
Published: August 2023

Background

The traditional feeding method, which started 5–7 days after upper gastrointestinal (UGI) tumor resections is the widely accepted method worldwide. ERAS protocol is becoming more and more common, but there is still not enough evidence that early postoperative oral feeding is safe following major UGI surgery.

Patients and Methods: A propensity score matching study was conducted at the University of Pecs, Department of Surgery, Hungary between January 2020 and July 2022. The study included patients with UGI tumor resections where our early oral feeding (EOF) protocol were applied. Data were collected retrospectively and the EOF- group was compared with a control group, who have been cared for the traditional feeding method during this period.

Results

the study included 50 patients, 25 in the early oral feeding group, and 25 case-matched patients in the traditional oral feeding group. The start of the oral feeding was on day 2.09 in the EOF, and on day 5.52 in the LOF group. Statistically significant decreases were observed in the EOF group in the postoperative length of stay (8.875 days vs 12.06 days), first bowel movement, and length of postoperative intravenous fluid therapy. There were no significant differences in mortality, anastomosis insufficiency, anastomosis inflammation and stricture.

Conclusions

Our results confirmed, that in the EOF group the mortality and anastomosis leakages do not increase compared to the traditional feeding protocol. However EOF decreased the length of hospital stay resulted earlier recovery, and the quality of life was improved by starting early oral feeding.
378. GASTRIC FILLING IN NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER
Authors: Hwang Yang , Chen Beini , Mai Tao , Lee Dominique , Thomson Iain , Smithers Mark , Frankel Adam
Published: August 2023

Background

Neoadjuvant Chemoradiotherapy (nCRT) for locally advanced oesophageal cancer improves survival. Currently, there is equipoise in the survival benefit of nCRT versus neoadjuvant chemotherapy. Excessive radiotherapy to the gastric conduit prior to surgery has long been a concern. Recent studies have linked radiation doses to the gastric fundus around 30 Gy to an increased risk of anastomotic leak. This study reviews a simple process aiming to reduce radiation dose to the gastric fundus.

Methods

This is a single-centre, retrospective analysis of 63 adult patients treated with nCRT (CROSS protocol) then oesophagectomy with a gastric conduit reconstruction. The Gastric Fill (GF) arm were given 500 mL of water prior to radiotherapy planning and treatment. The control group were consecutive patients prior to the implementation of the GF protocol. The fundus was mapped on radiotherapy software and planned to treat it like other organs at risk. Radiation dose to the fundus was recorded and compared between the two groups.

Results

The GF arm included 25 patients, with 38 patients in the control arm. Patients drank 350–800 mL of water prior to planning and treatment. There were no reported aspiration events. Radiotherapy techniques included VMAT and 3DCRT. All GF patients were treated with VMAT. There was a higher proportion of mid-oesophageal tumours in the control group (21% compared with 4%). The mean volume of gastric fundus in the GF group (mean = 215 cc, SD 144) was higher than the control group (mean = 155 cc, SD 100). The proportion of gastric fundus receiving >30 Gy was lower in the GF group (mean = 10.9% SD = 16.0) compared with the control group (mean = 19.1% SD = 24.8).

Conclusion

Analysis did not show statistically significant difference between the groups, however, there was a trend suggesting radiation to the gastric fundus was reduced in the GF group. This study shows the feasibility of a simple and low risk intervention in reducing the radiation to the future gastric conduit. Further review with a larger cohort, and impact on anastomotic complications would be of interest for future review.
393. A RADIOMICS STRATEGY BASED ON CT INTRA-TUMORAL AND PERITUMORAL REGIONS FOR PREOPERATIVE PREDICTION OF NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Wang Yun , Li Zhiyang
Published: August 2023

Background

The standard treatment for esophageal cancer patients is neoadjuvant chemoradiotherapy followed by surgery. However, some of these patients do not achieve pathological complete response with this therapy, resulting in poor outcomes. The objective of this study is to develop a method for selecting patients who can achieve pathological complete response through pre-neoadjuvant therapy chest-enhanced CT scans.

Methods

The study enrolled 201 patients with esophageal cancer and divided them into a training set and a testing set in a 7:3 ratio. Radiomics features of intra-tumoral and peritumoral images were extracted from preoperative chest-enhanced CT scans of these patients. The features underwent dimensionality reduction in two steps, using Student’s t-test and least absolute shrinkage and selection operator. The selected intra-tumoral and peritumoral (including marginal and adjacent ROI) features were used to build models with four machine learning classifiers. The models with satisfactory accuracy and stability levels were considered to perform well. Finally, the performance of these well-performing models on the testing set was displayed using ROC curves.

Results

Among the 16 models, the best-performing models were the integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models. In the training set, the two models had average ROC AUCs of 0.906 and 0.918 respectively, with relative standard deviations (RSDs) of 6.26 and 6.89. In the testing set, the AUCs were 0.845 and 0.871, respectively. There was no significant difference in the ROC curves between the two models.

Conclusion

The addition of peritumoral radiomics features to the radiomics analysis may improve the predictive performance of pathological response for esophageal cancer patients to neoadjuvant chemoradiotherapy. The integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models developed in this study show potential for predicting pathological complete response in esophageal cancer patients and may help in selecting patients for neoadjuvant therapy.
395. SURGICAL PROCEDURE AND PERIOPERATIVE OUTCOME OF TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Shiozaki Atsushi , Fujiwara Hitoshi , Konishi Hirotaka , Nishibeppu Keiji , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Otsuji Eigo
Published: August 2023

Background

We started performing mediastinal lymph node dissection by a laparoscopic transhiatal approach (LTHA) in 2009. To date, 548 patients had undergone our method during various esophageal surgical procedures, including esophagogastric junction cancer (EGJC). Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a simple technique for transmediastinal esophagectomy (TME) without thoracic approach (435 cases). Seventy five patients with EGJC were treated by TME.

Methods

Left single-port mediastinoscopic cervical approach was performed with pneumomediastinum. Mainly for advanced SCC, upper mediastinal lymph node dissection including recurrent laryngeal nerve LNs was performed with intraoperative monitoring using NIM system. Next, LTHA was performed for en bloc mediastinal lymph node dissection. The esophageal hiatus was opened, and working space was secured by Long Retractors. The posterior plane of the pericardium was extended. The posterior side of LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura. Reconstruction with narrow gastric conduit was performed through substernal tract.

Results

Patients with EGJC performed TME were analyzed (n = 75, SCC/Adeno/Others = 37/35/3). Upper mediastinal lymph node metastasis was found in 13 cases (SCC/Adeno = 6/7), middle mediastinal lymph node metastasis was found in 10 cases (SCC/Adeno = 3/7), and all of them had advanced tumors. Their perioperative outcome was compared with those performed the right thoracotomy (n = 41). The operative time and bleeding were decreased by TME. The number of resected mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in TME group were not inferior to the right thoracotomy group. In 93.3% of patients treated by TME, extubation was performed at 0 POD. Postoperative respiratory complication was decreased by TME (TME:6.7%, thoracotomy:17.1%).

Conclusions

This procedure, TME, resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications in patients with EGJC.
423. DYSPHAGIA AND RE-INTERVENTION AFTER MYOTOMY FOR ACHALASIA: A MATTER OF TECHNIQUE, OR A MATTER OF TIME?
Authors: Campagna Ryan , Pourak Kian , Bahar Piroz , Oh Eugene , Lagisetty Kiran , Orringer Mark , Lin Jules , Chang Andrew , Reddy Rishindra
Published: August 2023

Background

Achalasia is an incurable neurodegenerative disease of the esophagus. Palliative treatment includes disruption of the lower esophageal sphincter via multiple techniques, including open Heller myotomy (OHM), laparoscopic Heller myotomy (LHM), and per-oral esophageal myotomy (POEM). There is a paucity of data comparing long-term outcomes between OHM, LHM, and POEM. We sought to evaluate the relationship of these methods with clinical outcome parameters using our institution’s experience.

Methods

Patients greater than 3 years removed from myotomy for achalasia were studied. Post-operative Eckardt Symptom (ES) score and daily proton pump inhibitor (PPI) usage was recorded. Patients underwent timed barium esophagram (TBE) as clinically indicated. Retention was defined as a persistent column >5 cm at 5 minutes. Post-operative interventions included Savary dilation, Botox injection, pneumatic dilation, surgical myotomy, and esophagectomy. Groups were stratified by surgery type (OHM, LHM, POEM) and by time since surgery (3–6 years, 6–10 years, >10 years). A logistic regression analysis was performed examining the relationship of surgery type, time, symptomatic/objective outcomes, and post-operative interventions.

Results

172 patients had long-term data available. Mean follow up was 7.8 years (3.1–19.5 years). Nearly one-third of patients had a post-operative intervention (31%, 53/172). On regression analysis, OHM was associated with a higher risk of intervention (OR 9.4, p < 0.05). Barium retention was significantly associated with LHM (OR 15.9, p < 0.05) and the 3–6 year post-operative period (OR 11.1, p < 0.05). PPI usage was not associated with surgery type, but was associated with the 3–6 year post-operative period (OR 3.2, p < 0.05). There was no significant association of dysphagia with surgery type or time.

Conclusion

Post-operative barium retention and interventions are associated with specific myotomy techniques, but not time. PPI usage is associated with the early post-operative period, but not technique. Neither myotomy technique nor time alone are sufficient to predict risk of abnormal ES or dysphagia.
435. CIRCULAR-STAPLED ESOPHAGOGASTROSTOMY USING THE KEYHOLE PROCEDURE: TECHNICAL ASPECTS AND CLINICAL OUTCOMES
Authors: Tanaka Tsuyoshi , Goto Ai , Shibasaki Susumu , Suzuki Kazumitsu , Serizawa Akiko , Akimoto Shingo , Nakauchi Masaya , Inaba Kazuki , Uyama Ichiro , Suda Koichi
Published: August 2023

Background

The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes.

Methods

We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery.

Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS.

Results

Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p < 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001).

Conclusions

The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.
447. PERIOPERATIVE OUTCOMES AFTER THORACOSCOPIC AND OPEN TRANSTHORACIC ESOPHAGECTOMY FOR CANCER
Authors: Pramesh C S , Karimundackal George , Jiwnani Sabita , Tiwari Virendra , Niyogi Devayani , Shetmahajan Madhavi , Ranganathan Priya , Parab Swapnil , Yadav Parveen , Purwar Pallavi , Ashok Apurva , Gopinath Srinivas , Mistry Rajesh
Published: August 2023

Background

Surgery for esophageal cancer is complex and associated with considerable postoperative morbidity. Several strategies have been attempted to decrease morbidity after esophageal resection including enhanced recovery programmes, concentration of surgery in high-volume centres, and minimally invasive surgical approaches. Randomized trials showing superior perioperative outcomes with thoracoscopic esophagectomy have sometimes not been replicated in real-world studies. We compared our short-term outcomes including postoperative complications, morbidity and mortality after thoracoscopic and open transthoracic esophagectomy for cancer.

Methods

We performed a retrospective analysis of a prospectively maintained database of esophageal resections for cancer at a tertiary referral cancer centre between Oct 2003 and Dec 2022. Consecutive patients undergoing either thoracoscopic or open transthoracic esophagectomy (TTE) with a cervical anastomosis were included in the study. Operative time, blood loss, lymph node yield, postoperative morbidity and mortality after surgery were compared between the two groups. Categorical data were analysed using the chi square test and numeric data using the Student t test. A p value of 0.05 was considered statistically significant and no adjustment was made for multiple comparisons.

Results

A total of 3328 patients were operated for esophageal cancer between 1st October 2003 and 31st Dec 2022. 897 patients who underwent thoracoscopic and 1591 patients who underwent open TTE were included in the study. Comparison between the two groups on the different variables are shown in the table. On multivariable logistic regression analysis, extended radical lymphadenectomy, higher modified risk score and open thoracic approach were significantly associated with increased postoperative morbidity.

Conclusion

Our series of thoracoscopic esophagectomy, one of the largest in the world, validates the results of randomized trials in the real-world setting, with significant reductions in operative blood loss, ICU stay, postoperative pulmonary complications, wound infections, and major morbidity. Thoracoscopic approach remained an independent determinant of decreased postoperative morbidity.
450. LINEAR STAPLED TECHNIQUE FOR ROBOTIC ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY AND GASTRECTOMY: TECHNIQUE, STEPWISE INTRODUCTION, REPRODUCIBILITY AND OUTCOMES
Authors: Bull Alexander , Abbassi Nima , Singh Pritam , Madhavan Anantha , Immanuel Arul , Preston Shaun
Published: August 2023

Background

Robotic-assisted surgery (RAS) for esophagectomy and gastrectomy is gaining in popularity. Compared to open oesophagectomy and conventional minimally invasive techniques, RAS is associated with decreased rates of complications, increased harvested lymph nodes and shorter length-of-stay. However, high anastomotic leak rates (20–27%) have been seen within randomised trials and case series, with up to 50% early in some published series. We present our technique and results of the staged introduction of a linear anastomosis.

Methods

The technique was initially developed by a single surgeon at open surgery; then adapted to thoracoscopic surgery and finally reproduced at RAS by several surgeons across two centres. Using a prospectively maintained database we reviewed the first forty-two cases utilising a modified linear anastomosis technique for oesophageal anastomosis. Outcomes, with particular focus on the anastomosis were reviewed. We also describe in detail the technical steps involved in our technique for a side-to-side linear semi-mechanical stapled anastomosis using a tri-stapler, with a 2-layer V-lock closure of the common enterotomy, during robotic surgery (video https://www.dropbox.com/s/ljf3zmuy68qry7b/Anastomosis%20technique_Short_Sound.mp4?dl=0).

Results

Forty patients had a two-stage esophagectomy, one with colonic reconstruction, and two, total gastrectomy. Median age was 62 (range 47–85). 93% (39/42) were adenocarcinomas, the remainder were squamous cell carcinomas. The anastomosis was performed via an open approach in the initial 11, thoracoscopically in 4, then robotically in 27 (including the two gastrectomies). The first 20 anastomoses were performed by one surgeon, who then taught four others. Two grade I anastomotic leaks occurred (4.7%), both were treated conservatively. There was no 30-, 90-day, or in hospital mortality. Non-anastomotic complications occurred in 14/42 (33.3%) of patients, most commonly respiratory (5/42, 11.9%).

Conclusion

We report a reproducible technique for semi-mechanical linear stapled anastomosis and its safe introduction into esophageal and gastric resections, including RAS. Anastomotic leak rates are below the internationally reported rates, even in the early phase of its introduction in open, thoracoscopic and RAS. With good training and mentorship this may help more centres safely introduce a RAS esophago-gastric programme, improve patient outcomes and reduce length of stay.
454. GASTROINTESTINAL QUALITY OF LIFE, BODY COMPOSITION AND INFLUENCING FACTORS, IN ESOPHAGEAL CANCER SURVIVORS FOLLOWING CURATIVE ESOPHAGECTOMY
Authors: Boyle Ellen , Elliott Jessie , Greene Christine , Murphy Conor , Donlon Noel , Donohoe Claire , Ravi Narayasamy , Reynolds John
Published: August 2023

Background

Recent improvements in treatment modalities for locally advanced esophageal cancer have resulted in markedly improved survival outcomes. This has resulted in an increasing population of esophageal cancer survivors. Surgery is the mainstay of treatment, which has a high risk of post-operative morbidity. This study focused on characterising health-related quality of life with a specific interest in the gastrointestinal quality of life of esophageal cancer survivors following curative esophagectomy.

Methods

This was a cross-sectional cohort study of patients who underwent oesophageal cancer surgery between 2010 and 2015. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Body composition was assessed using surveillance computed tomography scans. Linear and logistic regression analyses were utilised to determine the impact of treatment and pathologic variables on survivorship issues.

Results

Gastrointestinal symptoms were common, with persistent eating symptoms independently predictive of overall poor HR-QL on multivariable analysis (P = 0.026, odds ratio [OR] 1.05 [95% confidence interval [95% CI] 1.01–1.10]). Persistent eating symptoms were independently associated with impaired physical and role function (both P < 0.001). Cervical anastomosis was associated with increased risk of dumping syndrome (P = 0.013, OR 0.34 [95% CI 0.14–0.80]), while squamous histology was independently associated with increased Gastrointestinal Symptom Rating Scale (P = 0.027) and Sigstad dumping syndrome scores (P = 0.034).

Conclusion

Persistent gastrointestinal and nutritional issues are common after esophagectomy. These eating symptoms are associated with impaired health-related quality of life. Further research is warranted to investigate how patient pathways can be enhanced to minimise the long-term impact of curative treatment for patients with esophageal cancer.
465. COMPLETE RESPONSE IN BARRETT’S HIGH-GRADE DYSPLASIA WITH THE UTILISATION OF RADIOFREQUENCY ABLATION: A SYSTEMATIC REVIEW
Authors: Prasad Pooja , Brown Joshua , Sellars Hannah , Phillips Alexander
Published: August 2023

Background

Radiofrequency ablation (RFA) is increasingly utilised as part of the endoscopic treatment of Barrett’s esophagus (BE) with high-grade dysplasia as a recognised alternative to surgical resection. The aim of this review is to summarise the current evidence on the utility of RFA in achieving complete clearance of HGD within BE and any resultant treatment complications with this endoscopic therapeutic option.

Methods

A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to December 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if the patient cohort included patients with HGD undergoing RFA, regardless of whether other endoscopic and/or surgical techniques were subsequently utilised and analysed.

Results

Fourteen studies comprising 1411 patients were included. Among this cohort, 850 patients with HGD underwent at least one session of RFA. Complete eradication of HGD was noted in 800/850 (94.1%) of patients. The pooled estimates of complete eradication of HGD and intestinal metaplasia (IM) were 92.5% (95% CI 87.6%–96.2%) and 81.8% (95% CI 74.9%–87.9%), respectively. The incidence of adverse events related to RFA was low, with esophageal stricture being the most common (10.6%). Long-term follow-up reported in the included studies showed sustained eradication of HGD with recurrence noted in 22 (2.6%) of patients.

Discussion

RFA is a safe and effective treatment option for patients with HGD within BE. However, data from larger patient cohorts, ideally within a trial setting, are needed, to establish the long-term treatment efficacy and identify cohorts that may not benefit from this procedure or require multiple treatments.
469. LONG-TERM QUALITY OF LIFE FOLLOWING ESOPHAGECTOMY FOR CANCER: RESULTS FROM A PILOT STUDY UTILIZING NOVEL TECHNOLOGY FOR PATIENT-REPORTED OUTCOMES
Authors: Prasad Pooja , Jaretzke Helen , Sellars Hannah , Brown Joshua , Chmelo Jakub , Phillips Alexander
Published: August 2023

Background

The physiological impact of an esophagectomy has long-term ramifications upon patient’s health-related quality of life (HR-QOL) and psychosocial functioning. Capturing long-term QoL can identify patients who may benefit from rehabilitative interventions to mitigate the lasting symptoms following esophagectomy. We sought to develop and pilot a remote method of digitally capturing QoL up to 10 years following esophagectomy. The aim of this study is to determine post-esophagectomy QoL ≥ 5 years, as part of this pilot.

Methods

A novel software to remotely capture QoL was piloted in November 2022, utilising electronic forms on digital devices including tablets to record data. Patients were contacted by a dedicated data manager to complete HR-QOL questionnaires (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and OG25 modules). This was completed either at the time of routine outpatient visits or remotely by patients, assessing HR-QOL up to 10 years post-esophagectomy. Linear mixed models were constructed to assess the mean score difference among patients at 5 years and beyond, post-esophagectomy.

Results

Of 220 eligible patients completing the HR-QOL questionnaires, 8 patients (10.9%) were 5 years on following an esophagectomy. Physical and emotional functioning remained adversely impacted at 5 years post-esophagectomy with lower overall scores across these domains. Symptoms including pain, heartburn and bilious reflux persisted at 5 years post-esophagectomy. Patients engaged with the novel software utilised to capture HR-QOL with 100% of those approached completing questionnaires.

Discussion

Functioning and symptoms adversely affecting HR-QOL persist into survivorship following esophagectomy. Given the clinically relevant deterioration in the longer term, there is a need to develop post-treatment rehabilitation interventions that can be embedded as part of peri-operative patient optimisation and recovery.
472. STATEWIDE TRENDS IN ESOPHAGECTOMY APPROACH: DATA FROM A REGIONAL THORACIC QUALITY COLLABORATIVE
Authors: Reddy Rishindra , Mollberg Nathan , Adams Kumari , Popoff Andrew , Lam Geoffrey , Lall Shelly , Lagisetty Kiran
Published: August 2023

Background

Esophagectomy patients continue to have high morbidity and mortality. Regional quality collaboratives have been shown to improve care around cardiac surgery. Our statewide cardiac surgery collaborative (33 programs) created thoracic surgery collaborative 10 years ago, sharing data to improve care at all locations. There were 17 programs participating in sharing lung cancer surgery data, and 10 programs sharing esophageal cancer surgery data. We reviewed trends in esophagectomy approach and perioperative outcomes from the quality collaborative.

Methods

Prospectively collected data from patients with loco-regional esophageal cancer who underwent esophagectomy between 2014 to 2022 were analyzed. We evaluated 3 separate 3-year cohorts. Pre-operative assessment, surgical approach lymph node harvest, post-operative outcomes, and length of stay (LOS) were analyzed using linear regression and chi squared tests.

Results

Annual esophagectomy volume ranged from 114 to 145 cases per year. There was significant increase in use of preoperative CT scans (p = 0.02) and a trend towards higher use of endoscopic resection as part of the staging paradigm (p = NS). There was a notable shift towards more minimally invasive esophagectomy approaches (p < 0.0001) with robotic assisted minimally invasive esophagectomy being the most common in the recent cohort (Figure). Lymph node harvest trended towards higher yield over time, but was only significant with the open trans-thoracic approaches (p < 0.01). There were no significant differences noted in rates of positive margin or in length of stay.

Conclusion

Regional quality collaboratives allow for tracking of esophageal cancer care at a broader level than single institutions. We noted increased use of minimally invasive techniques, specifically robotic assisted over the past decade with trends towards improved lymph node dissection. Despite the increase use of minimally invasive surgery, length of stay did not change.
476. PATIENTS WITH TRACHEOSTOMY HAVE HIGHER INCIDENCE OF ESOPHAGEAL REFLUX AND DON’T PRESENT TYPICAL SYMPTOMS
Authors: Bianchi Edno Tales , Cardoso Paulo , Szachnowicz Sergio , Nasi Ary , Tustumi Francisco , Seguro Francisco , Duarte Andre , Sallum Rubens
Published: August 2023

Background

Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD.

With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased.

Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics.

Method

Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination.

Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.

Results

Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux.

In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285).

48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14).

Conclusion

The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.
486. FOR SYNCHRONOUS ESOPHAGEAL CARCINOMA AND PULMONARY LESION: IS IT APPROPRIATE TO PERFORM COMBINED RESECTION?
Authors: Liu Yixin , Yang Yushang , Chen Longqi
Published: August 2023

Background

Reports on esophageal cancer with concurrent lung lesion cases are rare and mostly individual cases. Furthermore, the safety and feasibility of combined resection for patients with synchronous pulmonary lesions and esophageal cancer had always been a controversial topic. In the current study, we retrospectively analyzed the clinical data of patients who underwent simultaneous surgical resection for esophageal cancer with concurrent lung lesions, and explored their clinical characteristics, treatment outcomes, especially postoperative complications and prognosis.

Method

Patients who underwent esophagectomy between February 2009 and December 2022 were retrospectively reviewed at our center, and those with combined lung resection at the same setting were matched in a 1:1 propensity score matched (PSM) ratio to esophagectomy-alone patients. The main postoperative complications (including pneumonia, anastomotic leakage, pleural effusion, and other complications) and overall survival were compared.

Results

Of the 7152 esophagectomies, 222 cases of combined resection for synchronous pulmonary lesion (including 105 pneumatoceles, 71 benign nodules, and 46 malignant nodules) were eligible, and 1:1 ratio PSM esophagectomy-alone patients were matched. Wedge resection was the most frequent procedures (181, 81.5%). No significant differences were found in the incidence of postoperative complication between combined resection and esophagectomy-alone: pneumonia (21.2% vs. 20.7%), anastomotic leakage (7.2% vs. 6.3%), pleural effusion (15.3% vs. 13.1%). Moreover, different type of pulmonary lesions and extent of pulmonary resection also unaffected the incidence of postoperative complications. Survival analysis showed no significant difference for combined surgery or esophagectomy-alone.

Conclusion

In this large sample size study, combined resection dose not elevate the incidence of postoperative complications and weaken the overall survival for patients with synchronous esophageal carcinoma and pulmonary lesion. Therefore, for patients with clinically diagnosed esophageal cancer combined with lung lesions requiring surgery, the risk of concurrent resection may be acceptable.
The association between perception of noise from a mechanical heart valve and symptoms of anxiety and depression
Authors: Dehli Lena N , Norekvål Tone M , Haaverstad Rune , Eide Geir Egil , Oterhals Kjersti
Published: August 2023

Aims

Patients with symptomatic aortic valve stenosis are efficiently treated by aortic valve replacement (AVR), using a biological or mechanical valve. For some patients with mechanical valves, the metallic clicking sound may be problematic. The aim of this study was to investigate the perceived disturbance from the sound of a mechanical valve and the association between noise perception and symptoms of anxiety and depression.

Methods and results

The study had a cross-sectional design. In April 2013, all patients who had undergone AVR at one university hospital during the period 2000–12 were invited by post to participate. The primary variables were assessed using a valve-specific questionnaire and the Hospital Anxiety and Depression Scale. Of the 912 (77%) respondents, 245 had mechanical valves. Of these, 59 (24%) were women, the mean (standard deviation) age was 61 (11) years, and the mean time since surgery was 7 (3) years. The valve-specific questionnaire showed that 84% of the patients could sometimes or often hear the valve sound. A moderate positive correlation was found between valve prosthesis noise disturbance and anxiety, r = 0.35 (P = 0.001), and depression, r = 0.27 (P = 0.001). In a multiple linear regression analysis, valve noise perception was only significantly associated with anxiety among several other bio-psychosocial factors.

Conclusion

This study shows an association between valve noise disturbance and symptoms of anxiety and highlights the importance of preparing all patients for the sound from the mechanical valves that arises after surgery.