bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.017: EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING UPPER MEDIASTINAL LYMPH NODE DISSECTION IN THORACOSCOPIC RADICAL ESOPHAGECTOMY
Authors: Lee Shigeru , Fujiwara Yushi , Hashiba Ryoya , Gyobu Ken , Inazu Daiki , Naka Ryoko , Nishiyama Masaki , Osugi Harushi
Published: September 2018

Background

The development of minimally invasive surgery has yielded many benefits, therefore the number of patients undergoing thoracoscopic radical esophagectomy (TRE) for esophageal cancer has been increasing worldwide. However, in the Japanese nationwide web-based database report, the incidence of recurrent laryngeal nerve (RLN) paralysis and overall morbidity were significantly higher in the TRE group than in the open esophagectomy group. In recent years, intraoperative nerve monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centers. We tried to determine the feasibility and effectiveness of IONM of RLN during upper mediastinal lymph node dissection in TRE.

Methods

All 628 patients who underwent TRE in the left lateral decubitus position at Osaka City University Hospital between May 1995 and February 2018 were enrolled in the present study. We introduced IONM using NIM® (Medtronic) during TRE from October 2016 at our hospital. We divided retrospectively the patients into two groups: IONM group (TRE with IONM of RLN; n = 49) and No-IONM group (TRE without IONM of RLN; n = 579). Diagnosis of RLN paralysis was performed using laryngoscopy. The feasibility of IONM during TRE and the incidence of postoperative RLN paralysis were compared with those in No-IONM group.

Results

IONM could be performed for 46 patients (93.9%) in IONM group. Three patients (6.1%) could not keep single-lung ventilation using a single lumen tracheal tube with a bronchial blocker and needed to replace a tracheal tube by a double lumen tube during TRE. The incidence of postoperative RLN paralysis (CD≧ 1; CD; Clavien-Dindo classification of surgical complications) was 17.4% in IONM group and 30.2% in No- IONM group. There was a significant difference in the incidence of postoperative RLN paralysis (P < 0.05). Moreover, the right and bilateral paralysis of RLN after TRE did not occur in any patients in IONM group.

Conclusion

IONM of RLN during TRE is technically feasible. The introduction of standardized IONM of RLN during TRE is able to reduce the incidence of postoperative RLN paralysis.

Disclosure

All authors have declared no conflicts of interest.
PS02.021: TOTALLY LAPAROSCOPIC TRANSHIATAL ESOPHAGECTOMY FOR ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION: INDICATIONS, TECH. ASPECTS AND RESULTS, COMPARING TO OPEN ACCESS
Authors: Takeda Flavio , Sallum Rubens , Ribeiro Jr Ulysses , Mariano Rocha Julio , Duarte Andre , Cecconello Ivan
Published: September 2018

Background

Minimally invasive esophagectomy remains with high morbidity and mortality rates. The transhiatal technique has less surgical time, lower morbidity and an acceptable oncological surgical control for patients with adenocarcinoma of the esophagogastric junction (AGEJ), unfortunaly still infrequent by laparoscopy. The aim of this study is to present indications, technical aspects and results of the totally laparoscopic transhiatal esophagectomy (TLTE) comparing to open access (OA)

Methods

This study retrospectively reviewed esophageal cancer patients that were admitted at an oncology referral center between 2011 to 2016. The studied population was composed of 128 AEGJ, all of them characterized as Siewert I and II classification. Demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival at 60 months, between TLTE and OA. Influence of prognostic variables was assessed by Cox regression.

Results

The mean age was 63,4 ys (55–80ys), 85,4% were male. The selection of this group of patients was related to good clinical condition, however most of T2-T3 tumors. 90 patients were submitted to OA and 38 to TLTE (p-value for Log-Rank 0.11). Average follow-up was 39.8 months. By univariate analysis, curative intention resection was related to only 22% of patients in 5 ys. By univariate Cox regression, only degree of cellular differentiation was related to poor clinical stage in TLTE (p-value = 0.05). Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss from initial symptoms to the diagnosis of esophageal carcinoma are factors that predict indicate the TLTE. Considering only patients submitted to curative intent surgery, more than 21 node resection could reach a statistically significant improvement in survival rate by univariate analysis, but there were no difference between both groups.There was no mortality and morbidity rate about 7%. Comparing TLTE to OA there were no difference in survival and morbidity and mortality.

Conclusion

This is a preliminary study about low rate related to both access (TLTE and OA) in patients with AEGJ) with T2-T3 tumors, with low morbidity and no mortality series. TLTE is a safe and feasible alternative to the open approach, with decrease short-term morbidity with comparable oncological outcomes.

Disclosure

All authors have declared no conflicts of interest.
PS02.025: CHARACTERISTICS OF SUPERFICIAL BASALOID SQUAMOUS CELL CARCINOMA TREATED BY ENDOSCOPIC RESECTION
Authors: Oyama Tsuneo , Takahashi Akiko
Published: September 2018

Background

Basaloid squamous cell carcinoma (BSCC) is a rare esophageal carcinoma. And the characteristics especially in early stage is unknown.

Methods

The aim of this study is to clarify the characteristics of superficial BSCC. Thirteen patients (9 males and 4 females) with BSCC treated by endoscopic resection (12 ESD and 1 EMRC) from January 2000 to March 2017 were enrolled in this retrospective study. The median age was 67 (57–83). The median follow-up period was 24 (12–115) months. T1a-EP/LPM and T1a-MM/T1b-SM1 without lymph duct invasion (LDI) was followed up. T1a-MM/T1b-SM1 with LDI or T1b-SM2 were treated by additional treatment (AT).

Results

1. En-bloc resection and R0 resection rate was 100% and 100%, respectively. 2. Macroscopic type; 0-IIa, 0-IIb and 0-IIc was 4, 1 and 8, respectively. 3. The median tumor diameter was 27 (2–62) mm. 4. Invasion depth; T1a-LPM, T1a-MM/T1b-SM1, and T1b-SM2 was 3, 5 and 5, respectively. 5. Histological characteristics; All BSCC were covered by SCC or non-neoplastic squamous epithelium. 6. Endoscopic characteristics; SMT like appearance was found in 46% (6/13). Yellowish nodules were observed in 23% (3/13). This finding was observed, when BSCC exist superficial epithelial layer covered by thin non-neoplastic epithelium. 7. Prognosis A: T1a-LPM (N = 3). Two patients are alive without recurrence, and 1 patient died of other disease. B: T1a-MM/SM1 (N = 5). Two of 3 patients without LDI were followed up and alive. Remaining one patient wanted to be treated by CRT, and alive. Two patients had LVI, however they were followed up without AT because of patient's hope. One is alive, and another died of other disease. C: T1b-SM2 (N = 5). Two and one patients were treated by surgery and chemotherapy, respectively, and alive without recurrence. Remaining two patients were followed up without AT. One of 2 patients are alive without recurrence. Another patient dead of other disease.

Conclusion

1. All of BSCC were covered by SCC or non-neoplastic epithelium. 2. SMT like appearance and yellowish nodules under squamous cell epithelium were the characteristic endoscopic findings. 3. 40% of T1aMM/T1bSM1 had LDI. It's higher than that of SCC. Therefore, En-bloc resection is necessary for the detailed histological examination.

Disclosure

All authors have declared no conflicts of interest.
PS02.028: RESULTS OF ENDOSCOPIC VACCUM-ASSISTED CLOSURE THERAPY IN THE MANAGEMENT OF POSTOPERATIVE LEAKAGE AFTER ESOPHAGECTOMY
Authors: Hyun Jeon Jae , Kim Kwhanmien , Won Seong Yong , Cho Sukki , Jheon Sanghoon
Published: September 2018

Background

Postoperative leakage after esophagectomy is associated with significant life-threatening complications. Recently, endoscopic vacuum-assisted closure (E-VAC) has been introduced and successfully used as a new treatment option. The purpose of this study was to evaluate the safety and efficacy of the E-VAC for the management of postoperative leakage.

Methods

A total of 22 patients were treated with either intraluminal or intracavitary E-VAC therapy for the management of postoperative leakage from May 2012 to April 2018. The location of leakage was intrathoracic in 17 patients, and cervical in 5. The size of defects was small (< 1 cm) in 8 patients, moderate (1∼2 cm) in 6, and large (> 2 cm) in 5. Outcomes of E-VAC therapy were analyzed retrospectively.

Results

Complete closure of postoperative leakage was achieved in 19 of 22 patients. The location and size of defects did not affect the success of VAC therapy (all P < 0.05, respectively). The median duration of E-VAC application was 14 days (range 2∼103), and a median of 3 E-VAC systems (range, 1∼14) were used. In 19 patients who were successfully treated with E-VAC, oral feeding was possible on median 15 days after the first day of treatment. There was no mortality related with postoperative leakage.

Conclusion

E-VAC might be a well-tolerated and effective therapeutic option for the treatment of various postoperative leakage after esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS02.030: CLINICAL COURSE OF PATIENTS WITH COMPLETE RESPONSE BY CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGIEAL CANCER
Authors: Tamura Shigeyuki , Matsuyama Jin , Nagai Kenichi , Imamura Hiroki , Yagi Yuriko , Mokutani Yukako , Hashimoto Yasuji , Hirose Hajime , Kubota Masaru , Ide Yoshihito , Fukushima Yukio , Sasaki Yo
Published: September 2018

Background

Definitive chemoradiotherapy (dCRT) is one of the treatment strategies for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). In this report, we investigated the timing, pattern of recurrence, and prognosis in patients with LA-ESCC who achieved clinical complete response (cCR) following dCRT.

Methods

dCRT was performed for 71 patients with LA-ESCC from April 2006 and December 2017. We retrospectively examined the clinical records of 27 patients (38%) with ESCC who achieved cCR following dCRT assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). These patients were classified into two groups: 19 patients (Group A) who did not recognize recurrence thereafter and 8 cases (Group B) who were confirmed to have recurred until Deccember 2017. Clinicopathological features and clinical course for two groups were examined.

Results

Clinical stages before treatment were cT1/2/3/4 = 7/3/6/3 cases, cN0/1/2/3 = 8/3/6/2, cM0/1 = 18/1 and cStage I/II/III/IV = 6/4/6/3 in Group A, and cT1/2/3/4 = 1/3/2/2, cN0/1/2/3 = 1/2/4/1, cM0/1 = 8/0, cStage I/II/III/IV = 1/0/5/2 in Group B, respectively. Patients in Group B had more advanced cases than Group A. In group A, 16 out of 19 patients (84%) are still alive without recurrence and 3 have died because of hypopharyngial cancer, lung cancer, and senility, respectively. Double cancers were confirmed in 12 patients (63%) including 6 head and neck cancers. In Group B, the recurrences were confirmed at 7–26 months (Median: 12.5M) from the diagnosis of cCR. Six out of 8 patients (6/8:75%) had the recurrence of mediastinal lymph nodes. In Group B, 6 out of 8 cases (75%) confirmed death, and the period from recurrence to death was 5–18 months (median: 9.5M).

Conclusion

After cCR was obtained by dCRT, recurrence was observed in 8/27 cases (29.6%) in about 13 months. In patients with recurrence, 75% of patients had mediastinal lymph node recurrence and had poor prognosis of about 10 months. Also in patients without recurrence, double cancers were observed in 12/19 cases, suggesting the importance of surveillance for the purpose of 2nd primary cancer screening.

Disclosure

All authors have declared no conflicts of interest.
PS02.033: SIMULTANEOUS INTEGRATED BOOSTING RADIATION DOSE IN UNRESECTABLE THORACIC ESOPHAGEAL CANCER: LONG-TERM OUTCOMES OF A PHASE I/II TRIAL
Authors: Yu Wen , Fu Xiao-Long , Cai Xu-Wei , Feng Wen , Zhang Qin , Gao Lan-Ting
Published: September 2018

Background

To observe the long-term outcomes of a phase I/II trial (NCT01843049) of simultaneous integrated boost (SIB) for dose escalation in unresectable thoracic esophageal cancer.

Methods

Patients with esophageal squamous cell carcinoma were treated with escalating radiation dose of 4 levels defined as our previous works (Yu et al. Radiother Oncol 2015). A prescription dose of 62.5–64Gy was delivered to the gross tumor volume, with (Level 3 & 4) or without (Level 1 & 2) a SIB up to 70 Gy for the pre-treatment 50% SUVmax area of the primary tumor. Patients also received 2 cycles of chemotherapy of cisplatin and fluorouracil concurrently and 2 more cycles after radiotherapy.

Results

Dose escalation has been safely achieved up to Level 4 with tolerable acute toxicities as previously reported, so a phase II trial was further performed basing on Level 4. After a median follow-up duration of 21.8 (2.5–61.4) months for all 34 patients and 40.1 (13.4–61.4) months for 17 patients still alive, median overall survival time was 42.4 months for all and 18.8/42.4/not achieved (median follow-up duration, 57.6 months)/10.8 months for Level 1/2/3/4 (n = 5/10/5/14), respectively. Median progression-free survival time was 11.7 months for all and 12.2/26.4/10.1/10.8 months for Level 1/2/3/4, respectively. Eight deaths occurred within the 20 patients in Level 1, 2 and 3, including 6 due to local or regional progression, 1 liver metastasis and 1 acute esophageal hemorrhage. Nine out of the 14 patients of Level 4 died, including 5 because of severe late esophageal toxicities (perforation, fistula or hemorrhage), 1 radiation-induced pericardial effusion, 1 brain metastasis, 1 local failure and 1 non-cancer-related heart disease.

Conclusion

Severe late esophageal toxicities might have compromised long-term survival after dose of Level 4 was delivered despite of tolerable acute toxicities. Dose escalation should be carried out in an appropriate dose-fractionation window, otherwise increased toxicities might conceal the potential benefit of tumor control brought by high dose intensity. Larger numbers of patients should be enrolled into Level 3 for further assessment of treatment tolerance.

Disclosure

All authors have declared no conflicts of interest.
PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY
Authors: Ishioka Daisuke , Saito Masaaki , Takahashi Jun , Obitsu Tamotsu , Kiyozaki Hirokazu , Rikiyama Toshiki
Published: September 2018

Background

In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer.

Methods

A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated.

Results

At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT.

Conclusion

Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy.

Disclosure

All authors have declared no conflicts of interest.
PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT
Authors: Parshad Sanjeev , Sandu Parvinder , Gogna Shekar , Beniwal Abhijeet , Karwasra Rajendra
Published: September 2018

Background

Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus.

Methods

From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct.

Results

Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct.

Conclusion

Disclosure

All authors have declared no conflicts of interest.
PS02.072: ESTIMATION OF DOWN STAGING AFTER CHEMORADIOTHERAPY FOR T4 ESOPHAGEAL CANCER BY QUALITATIVE RESPONSE EVALUATION USING RENDERED MD-CT AND THE OUTCOME OF CURATIVE RESECTION
Authors: Okazumi Shinichi , Shimada Hideaki , Matsubara Hisahiro
Published: September 2018

Background

A new qualitative diagnostic image which represented the histological responses was developed using 3D-volume rendered MD-CT, and which was applied for the estimation of down staging after chemoradiotherapy (CRT) followed curative resection for T4 advanced esophageal cancer.

Methods

95 cases of T4 advanced esophageal cancer which underwent CRT were enrolled CRT protocol: 40–60Gy dose of irradiation were done and concurrently CDDP 15(mg/mm2) and 5-FU 500(mg/mm2) were administered in day 1–5 i.v.. Down staging estimation by MD-CT rendering: Contrast media (300mg iodine/ml, 3ml/kg) was administrated intravenously (3ml/sec). CT (GE: Light Speed 16) scans were performed (slice thickness: 1.3 mm) at 50 seconds delay before and after CRT. A workstation Virtual Place(AZE) was used for rendering the diagnostic image which represented histological response with specially selected colors and opacities. Down staging was diagnosed by the fibrotic change(CT value < 50HU) of the cancer tissue in the border area to the adjacent organs. The first estimation were done at 40Gy and the down staging cases were examined for resection and no down staging cases were continued to 60Gy.

Results

Down staging ratio were 48% in T4 aorta, 17% in trachea,35.7% in bronchus, and 44.4% in pulmonary vein. In the irradiation dose of 41.3 ± 2.5Gy, 24cases (25.3%) (Group A) and in 61.8 ± 3.15Gy,12 cases (12.6%) obtained down staging. 30 days after CRT, 13 cases of Group A and 10 of Group B underwent curative esophagectomy. In the pathological examination, response rate were 60.8% in group A and 80% in group B. The outcome after resection was 40% in the five year survival (n = 23).

Conclusion

The qualitative diagnostic image rendered by 3D-enhanced MD-CT was useful for the down staging evaluation after CRT to estimate curability of followed resection for T4 advanced esophageal cancer. Early estimation of the down staging at the dose of 40Gy seemed to be necessary to plan the followed resection safely and survival benefit were obtained in the curatively resected case with histological response.

Disclosure

All authors have declared no conflicts of interest.
PS02.094: EVALUATION OF ADDITIONAL TREATMENT AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL RESECTION FOR ESOPHAGEAL CANCER
Authors: Ohki Shinji , Hikichi Takuto , Yamada Leo , Ujiie Daisuke , Nirei Azuma , Tada Takeshi , Watanabe Youhei , Hanayama Hiroyuki , Hayase Suguru , Gonda Kenji , Kikuchi Hitomi , Watanabe Koh , Nakamura Jun , Saze Zenichiro , Momma Tomoyuki , Kono Koji
Published: September 2018

Background

Recently, endoscopic submucosal dissection (ESD) has been used as a less invasive treatment for superficial esophageal cancer. Additional treatment is often required after non-curative resection to prevent local recurrence and lymph node metastasis. Here, we present the outcomes of various additional treatments for patients with superficial esophageal cancer who underwent ESD.

Methods

Between 2006 and 2017, we performed ESD in 179 patients (210 lesions) with superficial esophageal cancer and 44 cases resulted in the non-curative resection diagnosed by the pathological examination. Among them, 29 patients received additional treatment, whereas 15 patients with no additional treatment were followed up. Additional treatment included esophagectomy (8 patients), chemoradiotherapy (15 patients), ablation using argon plasma coagulation (4 patients), and chemotherapy alone (2 patients). We examined the clinicopathological characteristics and prognosis of patients in the additional esophagectomy group (S group) and chemoradiotherapy group (CRT group).

Results

Twenty-three patients with pT1a-MM, pT1b, lymphatic invasion, venous invasion, and positive resection margins (both horizontal and vertical) were divided into two treatment groups. Clinicopathological characteristics of patients in the S and CRT groups were not significantly different. Pathological findings after additional esophagectomy showed one residual tumor and one lymph node metastasis. There were no recurrences in the two groups. There was no statistically significant difference in the 5-year overall survival rate between the S group (87.5%) and the CRT group (93.3%). One patient from the S group died due to respiratory pneumonia, and one patient died due to radiation pneumonia. However, five out of the 15 (33.3%) patients who were followed up with no additional treatment developed recurrence. The 5-year overall survival rate was 40.4%, which was not significantly different from that in the additional treatment group. However, the 5-year relapse-free survival rate (30%) was significantly different from that in the additional treatment group (P > 0.05).

Conclusion

Additional treatment is essential after non-curative endoscopic submucosal resection for esophageal cancer. Additional esophagectomy and chemoradiotherapy were both safe and effective in this cohort.

Disclosure

All authors have declared no conflicts of interest.
PS02.100: ASSOCIATION BETWEEN RESPONSES OF NEOADJUVANT DOCETAXEL PLUS CISPLATIN AND FLUOROURACIL (DCF) CHEMOTHERAPY AND SURVIVALS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS
Authors: Sato Yasuyoshi , Yamashita Hiroharu , Okumura Yasuhiro , Wakamatsu Kotaro , Nishida Masato , Yagi Koichi , Ogawa Masako , Aikou Susumu , Nomura Sachiyo , Seto Yasuyuki
Published: September 2018

Background

For patients with stage II/III esophageal squamous cell carcinoma (ESCC), neoadjuvant chemotherapy with cisplatin and 5-fluorouracil followed by surgery has been regarded as a standard treatment in Japan based on the result of Japan Clinical Oncology Group trial (JCOG9907). However, the survival outcome of this doublet chemotherapy has been still unsatisfactory especially in stage III patients. Triplet-regimen, consisting of docetaxel plus cisplatin and 5-fluorouracil (DCF), showed good responses and survivals in some previous phase II studies, and therefore neoadjuvant DCF seems promising for more advanced stage. We adopted neoadjuvant DCF chemotherapy for patients with advanced ESCC.

Methods

We retrospectively analyzed 48 patients with ESCC treated with DCF as neoadjuvant chemotherapy from January 2013 to October 2017 in our hospital. All patients were in clinical T3–4a/N1–2/M0 or T1b-2 with bulky lymph metastasis based on the TNM classification 7th edition. DCF regimen consisted of i.v. docetaxel (60–70 mg/m2) on day 1 and cisplatin (60–70 mg/m2) on day 1, and continuous infusion of fluorouracil (600–700 mg/m2) on days 1–5. This regimen was repeated every 4 weeks.

Results

Forty-six patients (96%) completed 2 cycles of DCF. According to revised RECIST guideline, response rate was 29% (CR, 2; PR, 12; SD, 14; PD, 8; Non-CR/non-PD, 12). Forty-two patients except PD underwent surgery; R0 resection was achieved in 40 patients. Among 34 patients observed for more than 1 year after initial treatment, 1 year survival rate and overall survival time were 72.7% [95%CI: 49.1–86.7] and 20.1 months [95%CI: 9.4–30.6] in SD, Non-CR/non-PD and PD patients, while no patients died at the 1 year and did not reach median survival in CR and PR group (P = 0.001).

Conclusion

Survival of advanced ESCC patients was strongly associated with the clinical response to neoadjuvant DCF. It might be an indicator to select good candidates for surgical therapy.

Disclosure

All authors have declared no conflicts of interest.
PS02.105: LONG-TERM RESULTS OF PREOPERATIVE CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN AND FLUOROURACIL IN PATIENTS WITH ADVANCED ESOPHAGEAL CARCINOMA
Authors: Ui Takashi , Fujii Hirofumi , Hosoya Yoshinori , Lefor Alan , Yamaguchi Hiroyuki , Mori Misuzu , Saito Shin , Kurashina Kentaro , Haruta Hidenori , Matsumoto Shiro , Kanamaru Rihito , Takahashi Kazuya , Sakuma Yasunaru , Horie Hisanaga , Kitayama Joji , Sata Naohiro
Published: September 2018

Background

Although preoperative docetaxel, cisplatin, and fluorouracil (DCF) therapy is reportedly effective in patients with advanced esophageal squamous cell cancer (ESCC), long-term results after preoperative DCF therapy are not well known. We retrospectively reviewed the long-term results after preoperative DCF therapy.

Methods

This study includes 63 patients with advanced thoracic esophageal carcinoma (excluding T4 tumors) receiving preoperative chemotherapy between February 2010 and February 2014. All patients were intended to receive two courses of treatment every four weeks, or three courses every three weeks. Patients underwent curative surgery four to five weeks after completing chemotherapy.

Results

Radical resection was performed in 58 patients (92%). R0 resection was completed in 48 patients (83%). The 5-year overall survival and progression free survival were 55% [95% confidential interval, 0.41–0.66] and 0.46% [0.34–0.58], respectively. Recurrences occurred in 34 patients (54%). Distant metastases developed in 13/48 (27%) after R0 resection. Chemotherapy-related adverse events included G4 hematotoxicity (n = 50, 79%, neutrophil < 500), febrile neutropenia (n = 16, 25%), and G3 non-hematotoxicity (n = 15, 24%).

Conclusion

These results suggest that preoperative DCF therapy may be effective and improve the long-term outcomes in patients with advanced esophageal carcinoma.

Disclosure

All authors have declared no conflicts of interest.
PS02.108: EFFECTS OF PREOPERATIVE CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kamio Yukinori , Hachiya Osamu , Fujimoto Hiroto , Takasu Naoki , Toda Makoto , Suzuki Takefumi , Sato Tamie , Nakano Ryo , Nozu Shintaro , Kimura Wataru
Published: September 2018

Background

In Japan, preoperative chemotherapy followed by surgery is the standard treatment for clinical stage II or III, excluding T4 thoracic esophageal squamous cell carcinoma (SCC). Here, we investigated the efficacy of preoperative chemotherapy in our hospital.

Methods

From January 2010 through December 2017, 33 patients with clinical stage II/III esophageal SCC underwent esophagectomy after preoperative chemotherapy with two cycles of cisplatin and 5-fluorouracil. Overall survival (OS) and clinical and pathological tumor responses were retrospectively evaluated. In addition, fluorodeoxyglucose (FDG) uptake was assessed by FDG-positron emission tomography/computed tomography (PET/CT).

Results

There were 9 patients with stage II and 24 with stage III esophageal SCC, and two cycles of chemotherapy were completed by 27 patients (81.8%). Three-year OS rates were 100% in patients with stage II and 66.7% in patients with stage III esophageal SCC, whose observation period exceeded beyond 3 years. Of the 33 patients who showed a clinical response at the primary site, 22 (66.7%) had a partial response (PR), and a 3-year OS of 85.7%, while 4 (12.1%) had a complete response (CR), and a 3-year OS of 100%. In regards to pathological response, as evaluated using The Japan Esophageal Society histological evaluation criteria, 3 patients (9.1%) were classified as grade 0, 18 (54.5%) as grade 1a, 4 (12.1%) as grade 1b, 6 (18.2%) as grade 2, and 2 (6.1%) as grade 3. Of the 22 patients who achieved PR, 14 (63.6%) were classified as either grade 0 or 1a. On the other hand, when we compared the maximum standardized uptake value (SUVmax) of FDG − PET/CT at the primary site before and after preoperative chemotherapy, the patients with high decreasing rates mostly belonged to the grade 1b-3 group. The OS rate tended to be higher in the grade 1b-3 group than in the grade 0–1a group.

Conclusion

Our present results suggest that, although pathological responses do not necessarily correspond to clinical tumor reduction, a good pathological response is potentially related to a better prognosis. Furthermore, the FDG uptake value may reflect pathological effects that occur owing to preoperative chemotherapy.

Disclosure

All authors have declared no conflicts of interest.
PS02.111: A 5-YEAR EXPERIENCE IN ANASTOMOTIC LEAK AFTER NEODJUVANT FOLLOWED ESOPHAGECTOMY IN A BRAZILIAN UNIVERSITY HOSPITAL
Authors: Vieira Felipe , Schramm Ricardo , Chedid Marcio , Ricardo Da Rosa André , Dario Kruel Cleber
Published: September 2018

Background

Neoadjuvant treatment of esophageal cancer is world accepted since 2012 (1), showing benefits in long-term survival. However, there is still controversy relating to potential complications with the use of antineoplastic drugs and radiotherapy, notably because of the higher incidence of cervical esophageal leak. Our study describes a five-year experience in anastomotic leaks in esophagectomies after neoadjuvant therapy in a southern Brazilian referral center.

Methods

We have analyzed all patients submitted to the combined treatment of neoadjuvant therapy plus esophagectomy between 2012–2016, including patients with squamous cell carcinoma and adenocarcinoma. We describe the number of patients that experienced anastomotic leak after surgery. The diagnosis of an anastomotic leak is based in any quantity of digestive secretion in the neck wound, seen on the post-operative period. It did not secrete bacteriological analysis. McKeown and transhiatal esophagectomy were used, and esophagogastric anastomosis were conducted in the cervical region.

Results

Between the years of 2012–2016, thirty-six patients were submitted to a combined treatment of neoadjuvant therapy plus esophagectomy. Of these patients, 20 (55%) evolved with anastomotic leaks. All of these leaks occurred in the cervical region, and were treated in a conservative way.

Conclusion

The incidence of anastomotic leaks was exceptionally high, regardless of the usual care. Possible causes of this high number of leaks could be related to diagnostic criterion, the patient's own characteristics, local alterations associated to the neoadjuvant treatment, the surgical technique, or even microbiological factors. New studies are necessary with the goal to determine which of these factors contributes in the most significant way, with the means to improve the results of this unpleasant esofagectomy complication. 1) VAN HAGEN, P. et al. Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer. New England Journal Of Medicine,[s.l.], v. 366, n. 22, p.2074–2084, 31 maio 2012. New England Journal of Medicine (NEJM/MMS). http://dx.doi.org/10.1056/nejmoa1112088.

Disclosure

All authors have declared no conflicts of interest.
PS02.113: NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY ESOPHAGECTOMY FOR LOCALLY BORDERLINE RESECTABLE THORACIC ESOPHAGEAL CANCER
Authors: Miyata Kazushi , Fukaya Masahide , Nagino Masato
Published: September 2018

Background

Nowadays, it has emerged that conventional neoadjuvant chemotherapy for locally borderline resectable esophageal cancer is not effective. However, it still remains controversial which treatment is best. We aimed to evaluate neoadjuvant chemoradiotherapy for locally borderline resectable esophageal cancer.

Methods

Twenty six patients (23 men, 3 women) who underwent esophagectomy after neoadjuvant chemoradiotherapy between January 2011 and December 2016 were subjected. Radiotherapy was administered at 40 Gy with concurrent chemotherapy which consisted of 5-fluorouracil and cisplatin for all 26 patients. The therapeutic effect of neoadjuvant chemoradiotherapy and surgical outcomes including rates of curative resection and pathological complete response, and postoperative complications were retrospectively reviewed. Postoperative complications were defined as any event requiring specific medical or surgical treatment, which were assessed by the Clavien-Dindo classification. The evaluation criteria of neoadjuvant chemoradiotherapy were assessed by the RECIST guideline (ver.1.1).

Results

For primary tumor, 24 patients showed partial response and 2 showed stable disease. Therefore, the response rate to the primary tumor was 92.3%. For metastatic lymph nodes, on the other hand, 11 patients showed partial response and 8 showed stable disease and 1 showed progressive disease, and the response rate was 55%. Two patients were unresectable, three patients had R2 resection, and the remaining 21 patients (81%) had curative resection (R0). In the R0 resected group, the 5-year survival rate was 57%. The median operative time, bleed loss, and postoperative hospital stays were 546 minutes (178–963), 720ml (262–5170) and 34days (17–99), respectively. Postoperative complications were observed in 22 patients. The incidences of more than grade2 postoperative pneumonia, vocal cord palsy, and anastomosis leakage were 8/26 (31%), 8/26 (31%) and 3/26 (12%). There were treatment-related mortality in 2 patients. Seven patients (27%) achieved histologically complete response.

Conclusion

Neoadjuvant chemoradiotherapy for locally borderline resectable esophageal cancer is effective in increasing curative resection rate. In addition, patients who underwent curative resection can expect long-term survival.

Disclosure

All authors have declared no conflicts of interest.
PS02.122: PREOPERATIVE CHEMOTHERAPY WITH BIWEEKLY DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Endo Fumitaka , Akiyama Yuji , Iwaya Takeshi , Nikai Haruka , Umemura Akira , Baba Shigeaki , Chiba Takehiro , Kimura Toshimoto , Takahara Takeshi , Otsuka Koki , Nitta Hiroyuki , Mizuno Masaru , Kimura Yusuke , Koeda Keisuke , Sasaki Akira
Published: September 2018

Background

Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can have severe adverse events, including neutropenia and febrile neutropenia. Feasibility of DCF is a concern especially for elderly patients, patients with moderate organ disorder, and those with dysphagia or insufficient oral intake causing malnutrition. We introduced biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and efficacy of bDCF therapy for patients with advanced esophageal squamous cell carcinoma who underwent radical esophagectomy after chemotherapy.

Methods

The parent DCF regimen consisted of 60–70 mg/m2 of docetaxel on day 1, administered intravenously for 2 h; 80 mg/m2 of cisplatin on day 1, administered intravenously for 2 h; and 5-fluorouracil administered by continuous infusion at a dose of 800 mg/m2 on days 1–5. The DCF regimen was repeated every 3–4 weeks. The bDCF regimen consisted of docetaxel (30 mg/m2) on days 1 and 15 in combination with cisplatin (80 mg/m2 on day 1) and 5-fluorouracil (800 mg/m2 on days 1–5), repeated every 4 weeks.

Results

Thirty-seven patients were treated with the DCF regimen (DCF group) and 22 patients were treated with the bDCF regimen (bDCF group). The age of patients was significantly higher in the bDCF group than in the DCF group. The bDCF group had more patients with heart and pulmonary comorbidities. Biweekly DCF group was significantly higher in the clinical response rate (DCF group 62.2% vs. bDCF group 86.4%, P = 0.0472). Grade 3 or 4 neutropenia was less frequent in the bDCF group (40.9%) than in the pDCF group (81.1%) (P = 0.0016). Among non-hematologic toxicities, anorexia was less frequent in the bDCF group (0%) than in the pDCF group (18.9%) (P = 0.0298). There were no significant differences between the groups in postoperative morbidity rate (bDCF group 45.5% vs. pDCF group 32.4%).

Conclusion

Preoperative bDCF therapy was feasible and safety without reduction of the efficacy of DCF therapy for fragile patients such as elderly patients, patients with moderate functional disorder, and that with malnutrition caused by dysphagia or insufficient oral intake.

Disclosure

All authors have declared no conflicts of interest.
PS02.126: NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL TUMORS: REAL LIFE BEYOND STUDY PROTOCOLS
Authors: Giacopuzzi Simone , Weindelmayer Jacopo , Pavarana Michele , Simoni Nicola , De Manzoni Giovanni
Published: September 2018

Background

Neoadjuvant therapy is in common clinical practice in the treatment of patients with esophageal cancer. In our department a phase 2 clinical trial was conducted for a neoadjuvant chemoradiotherapy protocol in patients under 75 with ECOG grade 0–2. At the end of the study, which led to encouraging results, the criteria for inclusion of patients in a neoadjuvant therapy protocol were extended. The aim of this work is to compare the results of the historical group of selected patients (protocol group) with the group of patients treated at the end of the study (real life group).

Methods

two groups of patients were considered: a historical group from 2003 to 2011 and a more recent group, from 2012 to 2018. The patients of the historical group (protocol group) were selected according to the precise inclusion criteria. The recent group (real life group) includes all patients who, by extension of disease and by comorbidity, could enter into a multimodal strategy in an intention to treat perspective. these two groups were compared for: protocol type, protocol completion, surgery rate, surgery radicality, pathological response and survival.

Results

In the real life group, 99 patients were referred to protocols different from the protocol considered standard in our department, because they were deemed not able to tolerate the treatment; the rate of completion of intention to treat strategy was 84,5 in the protocol group compared to 80,5 of the real life group (P = 0.326). Rate of radicality were 93,9 vs 92,4 in the protocol group vs to the real life group (P = 0.311). PCR was 49,6 and 35,9 respectively (P = 0.001). 5y disease relate survival was 51,3% for protocol group compared to 42,8 of the real life group in operated on patients (P = 0.467). Considering patient in the real life group that would have been within the inclusion criteria of the protocol group, R0 was 92,9, CPR 35,5 and 5y DRS 49,6 (P = 0581).

Conclusion

multimodal therapy is certainly the standard of care in these patients, but real life is not as bright as we would like to believe

Disclosure

All authors have declared no conflicts of interest.
PS02.130: BRAIN METASTASIS IN ESOPHAGEAL CANCER: SINGLE CENTER EXPERIENCE
Authors: Weindelmayer Jacopo , Treppiedi Elio , La Mendola Roberta , Giacopuzzi Simone , De Manzoni Giovanni , Parisi Cristiano
Published: September 2018

Background

Multimodal therapy is the treatment of choice in patients with esophageal cancer. This therapeutic strategy has led to an improvement in disease related survival. Despite the pathological response to therapy, the recurrence rate is not negligible. Brain localization is not an elective site of metastasis of the esophageal tumors but with the new chemoradiotherapy strategies it seems to evidence an increase in incidence in the different series. Objectives of the current study is to assess brain metastases frequency, therapeutic strategy and survival.

Methods

This is a single centre observational retrospective study: from 2006 to 2017, at Upper G.I. Surgery Division of Verona University, 327 patients (144 squamous cell carcinoma-SCC and 183 adenocarcinoma-ADK) with locally esophageal SCC or ADK have been operated. Nineteen patients (6%) with brain metastases were identified and classified as sinchronous (< 6 months after surgery) and metachronous (> 6 months) We evaluated the timing of metastasis occurrence, the features of the primary tumour, the therapy adopted, the distribution of metastases and survival.

Results

Of the nineteen metastatic patients, five were SCC and 14 were ADK patients. Ten patients presented synchronous metastasis and 9 metachronous. Eleven had a single metastasis, whilst 8 presented multiple lesions. Metastases were mostly sovratentorial. 7 patients were treated with surgery + stereotactic radiosurgery (SRS), 4 with surgery + whole brain radiotherapy (WBRT), 5 with only WBRT, 2 with only SRS and 1 case was treated with palliative care. Median overall survival of the brain metastasis group was 25 months, significantly lower than non metastatic patients (132 months), local metastasis (34 months) and other distant metastasis (29 months).

Conclusion

Brain metastasis from oesophageal or oesophago-gastric junction represent a minority of the patients and present a poor prognosis. Despite that, an aggressive treatment for limited lesions can lead to a prolonged overall survival and should therefore be evaluated in specialised centres.

Disclosure

All authors have declared no conflicts of interest.
PS02.135: THE BALLOON DILATION WITH AIR INJECTION AGAINST STENOSIS OF ESOPHAGEAL CANCER
Authors: Ami Katsunori
Published: September 2018

Background

Recently the strictures of esophageal cancer were treated by the balloon dilation and/or stenting. These treatments were effective but several cases made to reduce a QOL with perforation after intervention. Especially a radiation-induced esophageal stricture with esophageal cancer presented high rate of perforation after stenting. Therefor we researched retrospective prognostic analysis that patient with stenosis by esophageal cancer was treated the balloon dilation only.

Methods

We performed the balloon dilation for 10 patients with stenosis by esophageal cancer in our hospital. The age mean was 76.3 years old (68–91). The men were 7. Eight patients were after chemo-radiotherapy (CRT) and two patients were after chemotherapy (CT). We used CRE™ Fixed Wire Balloon Dilators C.R.E. (Controlled Radial Expansion, Boston Scientific®). The balloon dilation was performed with air injection (not used liquid) and not used stent. The air prevented over dilatation.

Results

The median survival time after dilation was 4.95 months. All patient were improve the dysphagia and possible to swallowing. The perforation induce balloon dilation did not occurred.

Conclusion

Generally, the prognosis of advanced esophageal cancer patient with stenosis after CRT or CT was short. Therefor it may unnecessary that the stent insertion had risk of perforation against these patients. The insufficient balloon dilation with air injection preserved sufficient inner cavity of esophagus for esophageal cancer patient with stenosis after CRT or CT.

Disclosure

All authors have declared no conflicts of interest.
PS02.142: CONVERSION SURGERY: A FEASIBLE GOAL FOR AFTERWARDS IN CARDIA CANCER TREATMENT
Authors: Alberti Luca , Giacopuzzi Simone , Alberto De Pasqual Carlo , Weindelmayer Jacopo , La Mendola Roberta , De Manzoni Giovanni
Published: September 2018

Background

Conversion surgery is a surgical treatment aiming R0 resection after chemotherapy of tumors that were originally regarded as technically or oncologically unresectable or only marginally resectable. Performing surgery in such patients may result in a long-term survival. The current experience concerns stage IV gastric cancer patients with marginally resectable metastasis, while the evidence concerning cardia tumors are poor. We report a case of primary cardia cancer with potentially unresectable metastasis, successfully treated by a multidisplinary approach including chemotherapy and surgery.

Methods

We report a case about a 65-year-old man affected by EGJ adenocarcinoma (Siewert II) with multiple hepatic metastases and para-aortic adenopathy (cT3N + M1 according to UICC 7th edition). He received intensive chemotherapy with Taxotere, Cisplatin and 5 FU. After therapy, primary tumor and liver lesions had markedly regressed according to CT, using RECIST guidelines. The endoscopy confirmed the reduction in the cardia lesion with negative biopsies. For that reason, the patient was addressed to follow up.

Results

After 6 years of follow up, endoscopy indicated a local relapse with a pathological diagnosis of adenocarcinoma. CT scan showed a clinical stage was cT3N + M0. The patient was treated with neoadjuvant concurrent chemoradiotherapy. After treatment the exams showed a partial response. The patient was eligible for conversion surgery and we proceeded to laparotomy total gastrectomy with D2 lymphadenectomy. We performed also exeresis of a liver nodule, which resulted fibrous. The surgical procedure was radical (R0). According to histological examination, the postoperative stage was ypT0N0. Treatment-induced response at the primary tumor site, evaluated according to SPR classification and TRG classification, was SPR 1 and TRG 1.

Conclusion

Despite limited evidence in literature about conversion surgery in cardia carcinoma, this case shows that intensive chemotherapy allows for conversion of unresectable cardia cancer to resectable cancer, resulting in long-term survival. The following surgical resection provided a R0 resection, leaving no macroscopic residual tumor. This result indicates a potential strategy for patients affected by unresectable cardia cancer. Clearly this strategy requires further analysis to be confirmed. However, based on our case report, the conversion surgery seems safe and feasible, associated with R0 resection.

Disclosure

All authors have declared no conflicts of interest.