bluuebunny/crossref_metadata_2025 huggingface dataset:
502. CORRELATION OF LYMPH NODE SIZE WITH METASTATIC INVOLVEMENT IN PATIENTS WITH OESOPHAGEAL CANCER
Authors: Dutt Koel , Walmsley James , Jayasurya Philip , Bracey Tim , Ariyarathenam Arun , Berrisford Richard , Humphreys Martyn Lee , Sanders Grant , Wheatley Tim , Chan David SY
Published: September 2022

Accurate assessment of lymph node involvement is vital in the staging and prognostication of oesophagogastric cancers. Radiological lymph node size is an established criterion for metastatic involvement. Enlarged lymph nodes are generally interpreted as metastatic. However, there is little data on the correlation between lymph node size and metastatic infiltration confirmed on histopathology. This study aims to correlate lymph node size in oeosphageal cancer resection specimens with frequency of metastatic involvement.

Regional lymph nodes from oesophagectomy specimens of 32 consecutive patients who had pathologically confirmed N1 disease were analysed from May 2019 to May 2021. The number of positive and negative lymph nodes for each patient were counted. The largest diameter of each positive and negative lymph node was measured. The frequency of metastatic involvement was then calculated and correlated to lymph node size.

A total of 956 lymph nodes from 32 patients were analysed. Median age was 73.5 (48-80) years, there were 28 male and 4 female patients and 30 of them had adenocarcinoma with the remaining 2 reported as squamous cell carcinoma. Of 956 nodes, 94 (9.8%) were found to have metastatic involvement. The median size for the positive lymph nodes was 4.16 mm compared to 3.15 mm for the negative nodes (p=0.20). Ninety two percent of involved nodes were less than 10 mm diameter. Ninety four percent of the reactive nodes also measured less than 10mm (p=0.347).

There was no significant difference in size between metastatic and reactive lymph nodes with the majority of nodes with metastatic infiltration in oesophageal cancer resection specimens measuring less than 10 mm in diameter. Lymph node size is not a reliable indicator of metastatic involvement in patients with oesophageal cancer.
504. LONG-TERM PROGNOSIS AND CAUSES OF DEATH IN CLINICAL STAGE I ESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGECTOMY
Authors: Niihara Masahiro , Yamashita Keishi , Higuchi Tadashi , Chuman Motohiro , Washio Marie , Sakuraya Mikiko , Hiki Naoki
Published: September 2022

For patients with clinical stage (cStage) I esophageal cancer that were not indicated for endoscopic resection, esophagectomy was the standard treatment if surgery was desired. The long-term prognosis after surgical resection of cStage I esophageal cancer was 86.5% of the 5-year survival rate in the results of the JCOG0502 study. The aim of this study was to review the long-term survival the causes of death in cStage I esophageal cancer patients after esophagectomy.

Between January 2004 to February 2021, 138 patients underwent radical esophagectomy for the treatment of cStage I esophageal cancer in our institution. These cases also included non-curative resection cases after endoscopic resection. The patient cohort contained 116 (84 %) males, and 22 (16 %) patients. The median age was 68.5 years (range, 49–82). We estimated long-term overall and cancer-specific cumulative mortality for these patients. In addition, we analyzed the deaths from other causes. The median follow-up period was 52 months.

The 5-year survival rates and cancer-specific survival rate were 82.8% and 87.3%, respectively. There were two surgery-related deaths. Other-cause deaths were observed in 19 patients. The causes were other cancers in 7 patients, respiratory diseases (pneumonia, acute exacerbation of COPD) in 4 patients, heart failure in 1 patient, and unknown in 7 patients. The breakdown of other cancers was cervical esophageal cancer in 1 patient, hypopharyngeal cancer in 3 patients, lung cancer in 2 patients, and malignant lymphoma in 1 patient. Of the 4 patients who were caused by respiratory disease, 3 had recurrent laryngeal nerve palsy as postoperative complication.

The long-term prognosis of cStage I esophageal cancer patients after esophagectomy in our institution was comparable to that of other clinical trials. Head and neck cancer and lung cancer accounted for the majority of deaths due to other causes. In addition, most of the cases caused by respiratory disease had postoperative recurrent laryngeal nerve palsy. It was considered that attention should be paid to aspiration even during outpatient follow-up.
516. MICRONUTRIENT DEFICIENCIES AFTER GASTROESOPHAGEAL CANCER SURGERY
Authors: Blonk Lotte , Gooszen JAH , Fakkert R , Eshuis WJ , Rietveld S , Straatman J , Gisbertz SS , van Berge Henegouwen MI
Published: September 2022

Due to inadequate dietary intake and altered digestion and absorption of nutrients, patients after gastroesophageal cancer surgery are at high risk of becoming malnourished and to develop deficiencies in micronutrients. The goal of this study was to determine the prevalence of specific micronutrient deficiencies during follow-up.

This single center prospective study included patients who underwent resection for esophageal or gastric cancer and were still alive at follow-up between January 2016 and December 2017. All patients in this study were guided by a dietician and dietary supplements or tube feeding was prescribed in case of inadequate dietary intake. Blood samples were examined for possible deficiencies in calcium, ferritin, folic acid, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin D, vitamin E, and zinc. Primary endpoint of this study was the prevalence of specific micronutrient deficiencies.

149 patients after esophagectomy and 32 after gastrectomy were included. After esophagectomy early postoperative deficiencies (<12 months after surgery, measurements performed in 68 patients) and late postoperative deficiencies (≥12 months after surgery, measurements performed in 81 patients) were seen in vitamin D (35.8% and 25.0%) and zinc (22.6% and 16.7%). After gastrectomy vitamin D (47.4%), zinc (29.4%), vitamin B1 (15.8%) and ferritin (15.8%) were found to be deficient <12 months after surgery (measurements performed in 19 patients). Vitamin D (46.2%), zinc (16.7%), vitamin A (15.4%), and ferritin (15.4%) were deficient in the late postoperative period (measurements performed in 13 patients).

This single center prospective study showed that, despite active nutritional guidance, deficiencies in vitamin D, vitamin B1, vitamin A, zinc, and ferritin are prevalent following gastroesophageal resection for cancer and should therefore be routinely checked during follow-up and prophylactic supplementation to prevent deficiencies is indicated.
532. INDOCYANINE GREEN FLUORESCENCE DETECTED THE IMPAIRED BLOOD FLOW IN THE GASTRIC CONDUIT WITH ULCER SCARS: A PROSPECTIVE PRELIMINARY STUDY
Authors: Ichikawa Hiroshi , Muneoka Yusuke , Usui Kenji , Kano Yosuke , Ishikawa Takashi , Hirose Yuki , Miura Kohei , Tajima Yosuke , Shimada Yoshifumi , Sakata Jun , Kosugi Shin-ichi , Wakai Toshifumi
Published: September 2022

We previously identified the presence of peptic or endoscopic submucosal dissection (ESD) ulcer scars in the stomach as a risk factor for anastomotic leakage of esophagogastric anastomosis after esophagectomy. In this study, we investigated the association between peptic or ESD ulcer scars and blood flow at the gastric conduit using indocyanine green (ICG) fluorescence imaging.

We prospectively enrolled 17 patients who underwent cervical esophagogastric anastomosis after esophagectomy for thoracic esophageal cancer (15 men and 2 women with a median age of 70 years). Blood flow in the wall of gastric conduit was evaluated using ICG fluorescence imaging detected by a near-infrared camera system during the operation. The flow velocity of ICG fluorescence in the gastric wall was calculated by dividing the distance (cm) by moving time of ICG fluorescence (second) from the pylorus to the point of final branch of the right gastroepiploic artery.

In 17 patients, four had peptic or ESD ulcer scars in the stomach. One patient with ESD ulcer scars in the lesser curvature side resected during the creation of conduit was included in 13 without ulcer scars. The median flow velocity was significantly lower in patients with ulcer scars than that in patients without ulcer scars (1.15 cm/s vs. 2.17 cm/s, P < 0.01). Anastomotic leakage was occurred only in two patients; one had ESD ulcer scar in the greater curvature side with the velocity of 1.17 cm/s, and one had no ulcer scars with the velocity of 1.67 cm/s.

Peptic or ESD ulcer scars were associated with the impaired blood flow in the wall of gastric conduit. Intraoperative ICG fluorescence imaging is a promising modality to evaluate the risk of anastomotic leakage after esophagectomy.
533. OUTCOMES OF RADIOFREQUENCY ABLATION TO TREAT BARRETT’S OESOPHAGUS: AN IRISH MULTICENTRE STUDY
Authors: Kyle Eimear , Donohoe Claire
Published: September 2022

The standard two-step approach of endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) has shown to be both safe and effective in achieving complete eradication of intestinal metaplasia (CEIM). Despite confidence in the regimen, the long-term sustainability of CEIM has not been well-described, nor has the ideal number of RFA sessions and frequency and length of surveillance. This study used the RIBBON database in Ireland to analyse these factors.

Analysis was performed on 398 eligible patients who underwent at least one session of RFA to treat BE from 2009 to 2021 in major centres across Ireland. Patients included had a minimum of 12 months follow-up (FU), with a total 1433.76 patient-years of FU analysed. CEIM was defined as histological and endoscopic absence of BE at post-RFA FU.

Patient outcomes were categorised according to recurrence status at FU: sustained CEIM, primary recurrence, treatment failure and unknown outcomes. They were also grouped according to the extent of dysplasia using the Vienna Grading System.

Of the 398 patients, 78.14% were male, the mean age at diagnosis was 61.55 years, mean length of Barrett’s segment was 5.36cm, and baseline dysplasia was 19.3% intramucosal carcinoma (IMC), 19% high-grade dysplasia (HGD), 23.3% low-grade dysplasia (LGD) and 37.1% non-dysplastic BE (NBDE). Of these patients, 321 (80.65%) achieved CEIM, at similar proportions. Of those, 67 (20.87%) experienced recurrence over 404.97 patient-years of FU. Further recurrence following subsequent treatment was rare (6 cases). The most common type of recurrence was NDBE (95.64%), and dysplastic recurrence was uncommon (4.36%). The mean time to recurrence was 647.21 days.

The results of this study showed that CEIM was achieved by RFA in the majority of cases, with dysplastic recurrence occurring at a very low rate, equating to significantly reduced disease progression.

There was a significant difference between the mean number of treatments for those who achieved sustained CEIM (4.15) and those who experienced recurrence (3.29). It is clear that some adjustments to the existing treatment and surveillance regimen could result in improvements in outcome.
536. PREVENTING ESOPHAGO-GASTRIC ANASTOMOTIC LEAKS; THE ROLE OF LOAD-BEARING SUTURES
Authors: Walsh Thomas
Published: September 2022

The leak rate of esophago-gastric anastomosis remains at 10 to 30% despite technological advances and robotic techniques. From the moment of recovery from anaesthesia, the anastomosis is subjected to incessant distraction by the diaphragm with each inspiratory effort. It was hypothesized that eliminating all possible tension on the anastomosis during the vulnerable healing phase, by employing tension-bearing sutures between conduit and pleura, would provide the greatest opportunity for success. This study evaluated such a strategy.

A prospectively maintained database of all esophagectomies performed over a 21-year period, was interrogated for the anastomotic leak rate following the introduction of a tension-elimination anastomotic technique. This consisted of securing the gastric conduit to the mediastinal pleura using load-bearing sutures inserted obliquely. When these were secured, the anastomosis became floppy, and remaining so throughout the vulnerable phase of healing, when collagenase digestion reduces anastomotic tensile strength by two-thirds. All patients had a contrast study performed between day 5 to 7 and all intra-hospital mortalities underwent autopsy to determine the cause of death. Clinical, radiological and autopsy leaks were recorded.

There were 145 intra-thoracic esophago-gastric anastomoses created in 143 patients (two patients required salvage re-resection for tumour recurrence); of which 77% were male, and 65.3% were for adenocarcinoma. Fifty-five percent were stapled and 45% were hand-sewn. There was only 1 confirmed leak during the study period and 1 patient died from a mediastinal haemorrhage, which at autopsy was considered to possibly be the result of sepsis as a result of an occult anastomotic leak.

The low anastomotic leak-rate is attributed to the protective effect of the load-bearing sutures; preventing any traction on the anastomosis, the most incessant source of which is the piston-like action of the diaphragm and the gripping of the diaphragmatic crura. It is intuitive that eliminating all tension during the most vulnerable phase of healing would also reduce any risk posed by minor impairments of blood supply or technical imperfections of anastomotic technique, facilitating anastomotic success.
542. A CASE REPORT OF METACHRONOUS CERVICAL ESOPHAGEAL CANCER 7 YEARS AFTER ESOPHAGECTOMY WITH MULTIDISCIPLINARY TREATMENT
Authors: Kato Daiki , Yamada Kazuhiko , Nohara Kyoko , Enomoto Naoki , Yagi Shusuke , Suyama Yuto , Aso Kenta , Akazawa Naoki , Yokoi Chizu , Kokudo Norihiro
Published: September 2022

Background: It is important to check for secondary cancer after esophagectomy. Especially, radiation or chemotherapy for recurrent esophageal cancer, were often performed, and it may be difficult to select treatment for metachronous cancer. We report a case of surgical resection for metachronous cervical esophageal cancer after 7 years for thoracic esophageal cancer with multidisciplinary treatment.

Method: A 73-year-old woman underwent right thoracotomy and intrathoracic anastomosis before preoperative chemotherapy for lower thoracic esophageal cancer cT3N3M1 (LN104R) 7 years ago. Final pathological finding was UICC-pT3N3M1 and postoperative additional irradiation was performed. Fifteen months after surgery, there was recurrence of LN112AoP, and definitive chemoradiation therapy was performed. The lesion maintained complete response. Seven years later, upper gastrointestinal endoscopy revealed residual cervical esophageal cancer, and the diagnosis was cT1b (SM) N0M0.

Result: Since re-CRT was difficult because of history of irradiation and CRT, we selected surgical cervical esophagectomy without thoracotomy. After partial excision of sternum to widen the view of the upper mediastinum, bilateral laryngeal recurrent nerves were preserved, and trachea and cervical esophagus were exposed. We resected cervical esophagectomy and reconstructed by pedicled jejunum with microvascular anastomosis. The stump of gastric conduit in the thoracic cavity was closed. The final pathology was UICC-pT1bN0M0.

Conclusion: There are some cases in which long-term survival can be obtained even for advanced esophageal cancer. It is important to check for secondary cancer after esophagectomy. Radiation therapy and chemotherapy are often used for recurrence of esophageal cancer. We experienced surgical resection for metachronous cervical esophageal cancer 7 years after multidisciplinary treatment for esophageal cancer.
546. THE IMPACT OF PREOPERATIVE DENTITION ON POSTOPERATIVE SPUTUM SURVEILLANCE CULTURE AND POSTOPERATIVE PNEUMONIA IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Enomoto Naoki , Yamada Kazuhiko , Kato Daiki , Yagi Shusuke , Nohara Kyoko , Kokudo Norihiro
Published: September 2022

Preoperative dental cleaning and treatment are increasingly performed as part of perioperative management, and postoperative pneumonia has been reported to be reduced by these dental interventions in patients with esophageal cancer.

However, few studies have surveyed the impact of dentition on postoperative sputum culture and pneumonia.

Fifty-five consecutive patients who underwent subtotal esophagectomy at Center Hospital of the National Center for Global Health and Medicine between November 2015 and August 2020 were included. Salvage cases, two-stage procedures, and cases with inadequate dental findings were excluded. The number of lost teeth was investigated, and the relationship between sputum surveillance cultures collected on the first to fourth day after surgery and the development of postoperative pneumonia was analyzed.

Postoperative sputum surveillance culture revealed pathogenic organisms in 31 (56%) patients. Candida species/P. aeruginosa/Klebsiella species/E. cloacae/S. maltophilia/S. pneumoniae/S. aureus were detected in 27/13/9/7/5/4/4/4%, respectively. Pathogenic organisms were detected significantly more frequently in cases with more than ten lost teeth (p<0.01, odds ratio 6.42, 95% CI 1.58-26.1).

Twelve patients (22%) had postoperative pneumonia with Clavien-Dindo grade 2 or higher. Postoperative pneumonia occurred significantly more frequently in patients with more than ten lost teeth (p=0.03, odds ratio 4.62, 95% CI 1.20-17.8). Postoperative pneumonia occurred significantly more frequently in patients in whom pathogens were detected (p=0.046, odds ratio 5.75, 95% CI 1.12-29.4).

Patients with many lost teeth tended to have pathogens detected in early postoperative surveillance cultures before the onset of pneumonia and have more risk of developing postoperative pneumonia.
569. INCIDENCE AND ONCOLOGICAL IMPLICATIONS OF THYROID INCIDENTALOMAS IN ESOPHAGEAL CANCER PATIENTS
Authors: Van Doesburg Jasmijn , Kalff Marianne , Voeten Daan , Engelsman Anton , Jol Saskia , Daams Freek , Gisbertz Suzanne
Published: September 2022

Although thyroid incidentalomas are regularly encountered during imaging of esophageal cancer, their oncological significance remains unknown. The aim of this study was to describe the incidence and etiology of thyroid incidentalomas observed during the diagnostic workup of esophageal cancer patients.

This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016. Radiology and multidisciplinary team meeting reports were reviewed for thyroid incidentalomas. In case of thyroid incidentaloma, the 18FDG-PET/CT or CT was reassessed by a radiologist blinded for the original report. The primary outcome was the incidence and etiology of thyroid incidentalomas.

This study included 1,110 esophageal cancer patients, with a median age of 66 years. Most patients were male (77.2%) and had an adenocarcinoma (69.4%). Thyroid incidentalomas were reported in 115 patients (10.4%)/ In 23 (20.0%) patients, additional diagnostics were required to characterize the lesion and two thyroidal lesions proved malignant. One patient was diagnosed with an esophageal cancer metastasis and one patient with a primary thyroid carcinoma. Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of generalized disseminated esophageal disease and no longer eligible for curative treatment.

In this study, thyroid incidentalomas were regularly observed, although their oncological significance is limited. Therefore, further etiological examination of thyroidal incidentaloma should only be considered when clinical consequences are to be expected.
603. NEOADJUVANT DCF VERSUS CRT IN COMPLEX TREATMENT OF LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CANCER
Authors: Akhmedov Parvin , Kononets Pavel , Abouhaidar Omar , Tryakin Alexey
Published: September 2022

Both neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy improve tumor resectability, lead to downstaging of tumor process and increase overall and disease-free survival rates. This study investigates the efficacy and outcomes after neoadjuvant chemotherapy with DCF regimen and chemoradiotherapy for patients with locally advanced esophageal squamous cell carcinoma.

We retrospectively analyzed the results of 130 patients from 2013 to 2018 who received preoperative DCF chemotherapy (docetaxel 70 mg/m2 on day 1, cisplatin 70 mg/m2 on day1, 5-FU 750 mg/m2 on days 1-5, total 4 courses) followed by surgery or chemoradiotherapy (paclitaxel 175 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, 5-FU 750 mg/m2 on days 1-5 and 46 Gy) followed by surgery. Surgery included both open and minimal invasive esophagectomy with regional lymphadenectomy. Data, surgical results, treatment related complications and long-term results were compared in two groups.

Patient characteristics did not differ between the two groups. Incidence of > grade 2 complications were higher in the DCF group. Incidence of neutropenia was in 72.3% versus 30.7% in the CRT group, febrile neutropenia 18.4% and 7.7%, respectively. The R0 resections were similar (98.3%). Chylothorax was noted only in two patients in the CRT group (3.0%). Complete pathological response in the CRT group was in 35.3% versus 20.0% in the DCF group. 3-year overall survival in the DCF and CRT groups was 70.7% and 64.6%, and 3-year disease-free survival was 60.0% and 49.2%, respectively (p<0,05).

Thus, 4 courses of DCF is not inferior compared to CRT in terms of survival rates and becomes an alternative to CRT in the complex treatment of locally advanced squamous cell carcinoma of the esophagus.
604. DOES MINIMALLY INVASIVE ESOPHAGECTOMY REDUCE POSTOPERATIVE PULMONARY COMPLICATIONS? AN INTERNATIONAL COHORT STUDY FROM THE OESOPHAGOGASTRIC ANASTOMOSIS AUDIT (OGAA)
Authors:   Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative
Published: September 2022

There is limited data characterizing the external validity of randomised trials on MIE for esophageal cancers. This study aimed to characterise the global impact of minimally invasive esophagectomy (MIE) on postoperative pulmonary complications (PPC).

Patients undergoing open (OE, n=350), hybrid (HE, n=368), and MIE for esophageal cancers were identified from the Oesophagogastric Anastomosis Audit (OGAA). Primary outcome was PPC and secondary outcomes were anastomotic leaks (AL) and 90-day mortality.

PPC rates were lower after MIE compared to OE and HE (38% vs 39% vs 31%, p=0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.57, CI95%: 0.44 - 0.74).

On adjusted analyses, MIE was not associated with higher AL (OR: 2.05, CI95%: 1.26 - 3.34) and 90-day mortality (OR: 4.55, CI95%: 2.70 - 7.69) compared to OE. Stratified analyses demonstrated lower PPC rates after MIE compared to OE in patients operated in high volume centers and high-income countries.

In contrast to previous reports, global adoption of MIE is associated with reduced PPC with no compromise in AL or overall complications. Introduction of MIE in standardized fashion with guidance from expert, high-volume surgeons justify benefits of MIE.
605. NEOADJUVANT FLOT FOR LOCALLY ADVANCED ESOPHAGEAL CANCERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kamarajah Sivesh , Evans Richard , Griffiths Ewen
Published: September 2022

Whilst multimodality treatment is established as standard of care for locally advanced esophageal cancers the precise choice of oncological neoadjuvant treatment remains unclear. Uptake of FLOT is increasing, yet collective experience in patients with esophageal cancer is unclear. This study aimed to assess the effectiveness of FLOT as first-line treatment in this patient population.

A systematic review was performed using Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed Publisher, Cochrane, and Google Scholar until 28st December 2021, for studies of treatment-naive patients of any age who received FLOT as first-line treatment of locally advanced esophageal or gastric cancer. The primary outcome was overall survival. Secondary outcomes were progression-free survival, rates of grade 3 or 4 adverse events; and oncological outcomes

This systematic review included six studies comprising 895 patients, of which 479 (54%) patients received FLOT. All studies included patients with distal or gastroesophageal junction esophageal and 441 (92%) had esophageal adenocarcinoma. Pooled overall survival at 1-year, 2-year and 3-year were 81.7% (CI95%: 71.1% - 88.9%), 59.2% (CI95%: 47.4% - 69.9%), and 49.8% (CI95%: 28.9 - 70.8%). Pooled recurrence rates from three studies were 22.6% (CI95%: 12.3% - 37.7%). Oncological outcomes were reported for margin-negative resections (overall: 94.1%, CI95%: 88.1% - 97.2%), complete pCR (overall: 15.2%, CI95%: 7.1% - 29.7%), major pathological response (overall: 41.6%, CI95%: 24.6% - 60.8%).

There is limited evidence on FLOT for patients with esophageal or gastroesophageal cancers, despite the increasing use of FLOT in clinical practice. Standardisation in reporting oncological and surgical outcomes following FLOT are needed and future research and randomised controlled trials comparing FLOT are required.
612. GENDER DIFFERENCES IN JAPANESE PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Manabe Noriaki , Nakamura Jun , Yamatsuji Tomoki , Fujiwara Yoshinori , Katsumata Ryo , Ayaki Maki , Fujita Minoru , Naomoto Yoshio , Haruma Ken
Published: September 2022

Esophageal squamous cell carcinoma (ESCC) is the seventh most common cancer and the sixth leading cause of cancer-related death worldwide, and has a male preponderance. The gender-based differences in clinical presentation and risk factor exposure are not fully studied. The aim of this study was to compare males and females with this disease.

We retrospectively investigated the clinical data of 503 consecutive patients with ESCC from April 2011 to December 2019. Data collected included patient demographics, clinical presentation, pathology and risk factor exposure. We analyzed the differences in clinical characteristics and risk factor exposure between males and females with ESCC.

Four hundred and sixty-nine patients with ESCC were included. The male to female ratio was 4.6:1. There was no significant difference in clinical presentation and pathology. There were significant differences between risk factor exposure between the two genders: smoking and alcohol consumption was an association in more than 90% of males but in less than 50% of females. The analysis including all patients showed no significant difference in survival rates, but when limited to patients with stage 3 or higher disease, survival rates were significantly higher in females (Figure).

Smoking and alcohol consumption, traditionally considered risk factors, are less associated with female patients with ESCC, and other environmental risk factors might be more involved in this gender.
619. THE STRATEGY OF THE SURGICAL TREATMENT FOR ESOPHAGEAL NEUROENDOCRINE CARCINOMA
Authors: Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Maeda Shinsuke , Ogawa Kyohei , Toyoshima Yukinori , Ide Hiroko , Osugi Harushi , Hosoda Kei
Published: September 2022

Esophageal neuroendocrine carcinoma (ENEC) are rare and aggressive behavior with early dissemination and poor prognosis. According to previous reports, including case reports and reviews, the incidence of ENEC ranges from about 0.8–2.8%. Unfortunately, the rarity of this tumor has not yet permitted the prospective recruitment of patients in clinical trials, in order to establish the optimal therapy. The purpose of this study was to determine the optimal surgical treatment of ENEC.

The histological diagnosis of ENEC was determined by examination of surgically resected specimens in patients who underwent surgery. The patients were selected from a prospective study of Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University from 1968 to 2021. We study 27 cases of ENEC who performed operation with lymph node dissection. We investigated (1) the patient characteristics, (2) pathological findings including immunohistochemical profiles, (3) recurrence pattern, and survival curves, (4) ki-67 index. This study was approved by the ethics committee of Tokyo Women’s Medical University in Tokyo Japan.

(1) gender (mail: female=23: 4), depth (T1: T2; T3: T4)=8: 3: 12: 4 Lymph node (N0: N1)=2: 25 (2) Immunohistochemistry of synaptophysin: chromogranin A: NCAM = 70.4%: 45%: 60% (3) recurrence pattern (liver: lung: Lymph node: bone: dissemination = 8: 6: 4: 2: 4) 50% survival rate (T1: T2-4= 19 months: 6.5 months) p=0.0202, numbers of lymph node (0-2: 3< = 19 months: 4mnths)p<0.001, (4) ki-67 index 82.23%(57.36%-98.71%)

Cases in which long-term survival was obtained by surgical treatment was T1 or 0-2 numbers of lymph node. Ki-67 index was more than 80%.
629. TRENDS AND ESOPHAGEAL FINDINGS IN UPPER ENDOSCOPY AT MNAZI MMOJA HOSPITAL, ZANZIBAR
Authors: Gubi Mariam , Said Sanaa , Amour Ahlam
Published: September 2022

The Zanzibar islands are a group of islands found off the coast of East Africa. The main referral hospital is based on Unguja Island and this is the only government hospital with gastroenterologists and endoscopy services. Many patients may go for long periods before gaining access to these services.

This paper aims to describe trends and esophageal findings in upper endoscopy as well as describe a case study of adenocarcinoma of the esophagus.

Data was collected retrospectively from January 2014 to December 2021. Records were reviewed to assess total number of endoscopies done as well as to determine the diagnosis of those with esophageal findings. The total number of endoscopies combines both upper and lower endoscopy. The following data were registered total number of endoscopies, cancer of esophagus, esophagitis, esophageal varieces as well as any other esophageal disorder diagnosis found.

A total of 2955 endoscopies were undertaken between January 2014 to December 2019. Of those 176 were found to have an esophageal abnormality although specific diagnosis was missing for records from the years 2015, 2016 and 2017.

The commonest disorder was esophagitis followed by esophageal cancer and varieces. Other disorders were much rarer and are placed under the category others which include submucosal tumors, Mallory-Weiss tears, esophageal strictures and fistula.

There has been a gradual increase in the number of endoscopies done over the period of 2014 to 2021. Despite previous beliefs, esophageal varieces and infectious causes were not the commonest finding. Esophagitis and esophageal cancer were common in our setting and causes should be determined.
647. A CASE OF ACUTE GASTRIC TUBE ULCER BLEEDING SAVED BY EMERGENCY SURGERY
Authors: Higashida Masaharu , Kubota Hisako , Endo Shunji , Fujiwara Yukinori , Yoshimatsu Kazuhiko , Ueno Tomio
Published: September 2022

Gastric tube ulcer is recognized as one of the complications after esophageal cancer surgery. When a ulcer bleeds, or penetrates to the pericardial space, or perforates, it often follows a fatal course due to its anatomical position and the complexity of surgical treatment. We report a case of persistent bleeding from a gastric tube ulcer after esophageal cancer operation, which was unable to treat endoscopically.

The case was a 67-year-old man. Thoracoscopic subtotal esophagectomy and posterior mediastinal route subtotal gastric reconstruction were performed for middle thoracic esophageal cancer. His fifth-year regular endoscopy revealed a gastric tube ulcer. As a cause of myalgia, the patient was prescribed NSAIDs every day by a nearby doctor. Initially, no bleeding was observed, and discontinuance of NSAIDs and conservative treatment with PPI was continued. However, five months later, sudden hematemesis was observed at night, and he was transferred to a nearby doctor. Emergency endoscopy revealed gastric tube ulcer bleeding. And he was transferred to our hospital in an emergency.

However, two days later, hematemesis and persistent ulcer hemorrhage were observed. Due to the difficulty of cauterizing to heartbeat, emergency surgery was performed. The first attempt was made to approach by a posterior mediastinal route, but it was difficult to confirm the ulcer and it was difficult to control bleeding without compression. Adding the thoracotomy, the ulcer was confirmed under direct vision. An ulcer defect was about 5 cm, bleeding was from the ulcer margin. Barbed suture closure and the omental patch were performed. The postoperative course was uneventful and discharged from the hospital 21 days after the operation.

We experienced a rare case of acute hemorrhagic gastric tube ulcer that was difficult to treat conservatively and was saved by emergency surgery. After reconstruction of esophageal cancer, there are complicated situations such as the route of the elevated gastric tube, the position of the ulcer, and the risk of perforation to the pericardial space. Prompt and accurate medical care is required.
The Limits of Human Rights Law: A Reply to Corina Heri
Authors: Zahar Alexander
Published: September 2022

In this reply to Corina Heri, I argue that her article confuses human rights violations associated with the impacts of climate change with a putative class of violations going to the causation of climate change. Because the latter class has no prospect of being realized, the scope of Heri’s argument is much narrower than she makes out. Human rights law is limited to impact cases. It adds nothing to climate change mitigation law.
PhaMMseqs: a new pipeline for constructing phage gene phamilies using MMseqs2
Authors: Gauthier Christian H , Cresawn Steven G , Hatfull Graham F
Published: September 2022

The diversity and mosaic architecture of phage genomes present challenges for whole-genome phylogenies and comparative genomics. There are no universally conserved core genes, ∼70% of phage genes are of unknown function, and phage genomes are replete with small (<500 bp) open reading frames. Assembling sequence-related genes into “phamilies” (“phams”) based on amino acid sequence similarity simplifies comparative phage genomics and facilitates representations of phage genome mosaicism. With the rapid and substantial increase in the numbers of sequenced phage genomes, computationally efficient pham assembly is needed, together with strategies for including newly sequenced phage genomes. Here, we describe the Python package PhaMMseqs, which uses MMseqs2 for pham assembly, and we evaluate the key parameters for optimal pham assembly of sequence- and functionally related proteins. PhaMMseqs runs efficiently with only modest hardware requirements and integrates with the pdm_utils package for simple genome entry and export of datasets for evolutionary analyses and phage genome map construction.
Genomic novelty within a “great speciator” revealed by a high-quality reference genome of the collared kingfisher (Todiramphus chloris collaris)
Authors: Eliason Chad M , Hains Taylor , McCullough Jenna , Andersen Michael J , Hackett Shannon J
Published: September 2022

Islands are natural laboratories for studying patterns and processes of evolution. Research on island endemic birds has revealed elevated speciation rates and rapid phenotypic evolution in several groups (e.g. white-eyes, Darwin’s finches). However, understanding the evolutionary processes behind these patterns requires an understanding of how genotypes map to novel phenotypes. To date, there are few high-quality reference genomes for species found on islands. Here, we sequence the genome of one of Ernst Mayr’s “great speciators,” the collared kingfisher (Todiramphus chloris collaris). Utilizing high molecular weight DNA and linked-read sequencing technology, we assembled a draft high-quality genome with highly contiguous scaffolds (scaffold N50 = 19 Mb). Based on universal single-copy orthologs, we estimated a gene space completeness of 96.6% for the draft genome assembly. The population demographic history analyses reveal a distinct pattern of contraction and expansion in population size throughout the Pleistocene. Comparative genomic analysis of gene family evolution revealed that species-specific and rapidly expanding gene families in the collared kingfisher (relative to other Coraciiformes) are mainly involved in the ErbB signaling pathway and focal adhesion. Todiramphus kingfishers are a species-rich group that has become a focus of speciation research. This draft genome will be a platform for future taxonomic, phylogeographic, and speciation research in the group. For example, target genes will enable testing of changes in sensory structures associated with changes in vision and taste genes across kingfishers.
Associations of 24-Hour Light Exposure and Activity Patterns and Risk of Cognitive Impairment and Decline in Older Men: The MrOS Sleep Study
Authors: Blackwell Terri L , Figueiro Mariana G , Tranah Gregory J , Zeitzer Jamie M , Yaffe Kristine , Ancoli-Israel Sonia , Kado Deborah M , Ensrud Kristine E , Lane Nancy E , Leng Yue , Stone Katie L ,   Osteoporotic Fractures in Men (MrOS) Study Group
Published: September 2022

Background

Older men with the worse alignment of activity and light may have lower levels of cognition and increased rates of cognitive decline.

Methods

This cohort consisted of 1 036 older men (81.1 ± 4.6 years) from the MrOS Sleep Study (2009–2012). Light and activity levels were gathered by wrist actigraphy. Phasor analysis was used to quantify the alignment of light–dark and rest-activity patterns (magnitude) and their temporal relationship (angle). Global cognitive function (Modified Mini-Mental State examination [3MS]) and executive function (Trails B test) were measured, then repeated 4.2 ± 0.8 years later. Linear regression models examined the associations of phasor magnitude and angle with cognition and cognitive decline. Models were adjusted for age, clinic, race, education, and season.

Results

Smaller phasor magnitude (worse aligned light and activity patterns) was associated with lower initial level and increased decline in executive function. Compared to those with higher phasor magnitude, those with lower magnitude took an average of 11.1 seconds longer to complete the Trails B test (quartile 1 vs quartile 4, p = .02). After follow-up, Trails B completion time increased an average of 5.5 seconds per standard deviation decrease in phasor magnitude (95% confidence interval [CI] 0.7–10.4, p = .03). There were no associations with phasor angle, and none with magnitude and global cognition (3MS).

Conclusion

Among older men, worse alignment of light and activity patterns was associated with worse initial performance and increased decline in executive function, but not related to global cognition. Interventions that improve the alignment of light and activity may slow cognitive decline in older adults.
Multiple testing and variable selection along the path of the least angle regression
Authors: Azaïs Jean-Marc , De Castro Yohann
Published: September 2022

We investigate multiple testing and variable selection using the Least Angle Regression (LARS) algorithm in high dimensions under the assumption of Gaussian noise. LARS is known to produce a piecewise affine solution path with change points referred to as the knots of the LARS path. The key to our results is an expression in closed form of the exact joint law of a $K$-tuple of knots conditional on the variables selected by LARS, the so-called post-selection joint law of the LARS knots. Numerical experiments demonstrate the perfect fit of our findings. This paper makes three main contributions. First, we build testing procedures on variables entering the model along the LARS path in the general design case when the noise level can be unknown. These testing procedures are referred to as the Generalized $t$-Spacing tests and we prove that they have an exact non-asymptotic level (i.e. the Type I error is exactly controlled). This extends work of [ 31] where the spacing test works for consecutive knots and known variance. Second, we introduce a new exact multiple testing procedure after model selection in the general design case when the noise level may be unknown. We prove that this testing procedure has exact non-asymptotic level for general design and unknown noise level. Third, we prove exact control of the false discovery rate under orthogonal design assumption. Monte-Carlo simulations and a real data experiment are provided to illustrate our results in this case. Of independent interest, we introduce an equivalent formulation of the LARS algorithm based on a recursive function.
Line contact lubricated by a fluid described by non-Newtonian Giesekus model
Authors: Kudish Ilya I , Pashkovski Eugene , Patterson Reid
Published: September 2022

Modelling hydrodynamic lubrication helps engineers and material scientists designing lubricants that minimize viscous energy losses without compromising the durability of engine components. This type of modelling requires selecting lubricant rheological constitutive equations that provide realistic information on fluid behaviour within tribological contact zones. Due to complexity of differential constitutive equations the modelling effort was limited to generalized Newtonian or Oldroyd-B fluids. In this paper, we present more realistic description of hydrodynamic lubrication using the Giesekus fluid capturing both viscous shear thinning and the development of elastic stresses at high Weissenberg numbers. The problem analysis is done using a modified regular perturbation method with respect to the small mobility parameter $\alpha $. The perturbation analysis modification is caused by the fact that the problem contains several a priori unknown boundaries. The actual perturbation solutions for functions of pressure and gap, as well as the coordinate of exit from the contact and the exit film thickness, are obtained as linear functions of $\alpha $. The effects of the model parameters such as the mobility factor, relaxation time and the polymer contribution to viscosity on pressure, shear and extensional viscosities within the contact zone are analysed. It is shown that the presence of polymers helps to increase the gap and reduce the viscous losses associated with hydrodynamic friction. This result is consistent with empirical observations of fuel economy enhancement for polymer-containing lubricants.
Stabilization of partial differential equations by sequential action control
Authors: Brodskyi Yan , Hante Falk M , Seidel Arno
Published: September 2022

We present a framework of sequential action control (SAC) for stabilization of systems of partial differential equations which can be posed as abstract semilinear control problems in Hilbert spaces. We follow a late-lumping approach and show that the control action can be explicitly obtained from variational principles using adjoint information. Moreover, we analyse the closed-loop system obtained from the SAC feedback for the linear problem with quadratic stage costs. We apply this theory to a prototypical example of an unstable heat equation and provide numerical results as the verification and demonstration of the framework.
Cost of postoperative complications after general surgery at a major Canadian academic centre
Authors: Roach Eileen , de la Maza Luis , Rieder Scott , Vigneswaran Laavanyah , Maeda Azusa , Okrainec Allan , D Jackson Timothy
Published: September 2022

Background

In a fiscally constrained health care environment, the need to reduce unnecessary spending is paramount. Postoperative complications contribute to hospital costs and utilization of health care resources.

Objective

The purpose of this observational study was to identify the cost associated with complications of common general surgery procedures performed at a major academic hospital in Toronto, Ontario.

Methods

The institutional National Surgical Quality Improvement Program database was used to identify complications in patients who underwent general surgical procedures at our institution from April 2015 to February 2018. A mix of elective and emergent cases was included: bariatric surgery, laparoscopic appendectomy, laparoscopic cholecystectomy, thyroidectomy, right hemicolectomy and ventral incisional hernia repair. The total cost for each visit was calculated by adding all the aggregate costs of inpatient care. Median total costs and the breakdown of cost components were compared in cases with and without complications.

Results

A total of 2713 patients were included. Nearly 6% of patients experienced at least one complication, with an incidence ranging from 1.1% after bariatric surgery to 23.8% after right hemicolectomy. The most common type of complication varied by procedure. Median total costs were significantly higher in cases with complications, with a net increase ranging from $2989 CAD (35% increase) after bariatric surgery to $10 459 CAD (161% increase) after ventral incisional hernia repair.

Conclusion

Postoperative complications after both elective and emergent general surgery procedures add substantially to hospital costs. Quality improvement initiatives targeted at decreasing postoperative complications could significantly reduce costs in addition to improving patient outcomes.
Measuring shared decision-making in younger and older adults with depression
Authors: Brodney Suzanne , Valentine K D , Vo H A , Cosenza Carol , Barry Michael J , Sepucha Karen R
Published: September 2022

Background

This study examined the performance of the shared decision-making (SDM) Process scale in patients with depression, compared alternative wording of two items in the scale and explored performance in younger adults.

Methods

A web-based non-probability panel of respondents with depression aged 18–39 (younger) or 40–75 (older) who talked with a health-care provider about starting or stopping treatment for depression in the past year were surveyed. Respondents completed one of two versions of the SDM Process scale that differed in the wording of pros and cons items and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider or together). A subset of respondents completed a retest survey by 1 week. We examined how version and age group impacted SDM Process scores and calculated construct validity and retest reliability. We hypothesized that patients with higher SDM Process scores would show less decisional conflict using the SURE scale (range = 0–4); top score = no conflict versus other and less regret (range 1–4; higher scores indicated more regret).

Results

The sample (N = 494) was majority White, non-Hispanic (82%) and female (72%), 48% were younger and 23% had a high school education or less. SDM Process scores did not differ by version (P = 0.09). SDM Process scores were higher for younger respondents (M = 2.6, SD = 1.0) than older respondents (M = 2.3, SD = 1.1; P = 0.001). Higher SDM Process scores were also associated with no decisional conflict (M = 2.6, SD = 0.99 vs. M = 2.1, SD = 1.2; P < 0.001) and less decision regret (r = −0.18, P < 0.001). Retest reliability was intraclass correlation coefficient = 0.81.

Conclusions

The SDM Process scale demonstrated validity and retest reliability in younger adults, and changes to item wording did not impact scores. Although younger respondents reported more SDM, there is room for improvement in SDM for depression treatment decisions.