bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.221: IMPROVED TECHNIQUES AND TREATMENT OUTCOMES IN SINGLE-PORT MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Fujiwara Hitoshi , Shiozaki Atsushi , Konishi Hirotaka , Kosuga Toshiyuki , Kubota Takeshi , Okamoto Kazuma , Otsuji Eigo
Published: September 2018

Background

We have improved the transcervical procedures for radical esophagectomy without thoracotomy for esophageal cancer since 2014, based on the excellent handling and visibility in the deep mediastinum provided by single-port mediastinoscopic technique. This study was to present our latest procedures of single-port mediastinoscopic radical esophagectomy and treatment outcomes for esophageal cancer.

Methods

(Surgical procedure) First, en bloc lymphadenectomy in the upper and middle mediastinum was performed including the lymph nodes along the left recurrent laryngeal nerve and tracheal bifurcation (subcarinal and bilateral main bronchial lymph nodes) by using a left cervical approach with a single-port mediastinoscopic technique, then, the lymph nodes along the right recurrent laryngeal nerve was done under direct vision by using a right cervical approach. Following the cervical procedures, the esophagus was completely mobilized with en bloc lymphadenectomy in the lower mediastinum by using a laparoscopic transhiatal approach. Finally, the cervical esophagus was transected, and the esophagus was resected through the abdominal incision. This operation was indicated not only for the patients with clinical T1–2 tumors, but also for those with clinical T3 tumors which showed a good response to preoperative chemotherapy. The perioperative outcomes of 111 patients who underwent this operation were reviewed. In addition, overall survival was analyzed and compared between transthoracic and transmediastinal esophagectomy groups (TTE, n = 177 vs. TME, n = 131).

Results

The background characteristics were as follows; squamous/adeno, 106/5; Ce/Ut/Mt/Lt/Ae, 2/20/58/26/5; cT1–2/T3, 51/60; cN0/N1–2, 53/58; cM0/M1lym, 104/7; cStage I-II/III-IV, 62/49 (TNM7th); preoperative chemotherapy (yes/no), 64/47. The operation time and blood loss were 370 min and 205 ml (median), respectively, and R0 resection rates were 97.3%. Postoperatively, pneumonia was observed in 8 patients (7.2%, C-D grade II or more), while vocal cord palsy was detected in 33 patients (29.7%, C-D grade I or more). Recent introduction of intraoperative nerve monitoring with NIM response 3.0 significantly reduced the palsy in laryngoscopic findings. Overall survival was not significantly different in each clinical stage between TTE and TME groups.

Conclusion

Single-port mediastinoscopic esophagectomy is feasible as a radical and minimally invasive option for esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER
Authors: Tang Hua , Huang Kenan , Ding Xinyu , Wu Bin , Xu Zhifei
Published: September 2018

Background

Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.

Methods

Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications.

Results

No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage.

Conclusion

A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS01.227: THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE
Authors: Cossu Andrea , Parise Paolo , Puccetti Francesco , Garutti Leonardo , Ferrari Carlo , Elmore Ugo , Rosati Riccardo
Published: September 2018

Background

Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age.

Methods

A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥ 71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD).

Results

As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. P = 0.001), mortality (0% group A, 3% group B and 5.5% group C. P = 0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. P = 0.001). A statistically significant higher incidence of anastomotic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-groups.

Conclusion

Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.228: THORAX AFFECTS OPERATION TIME IN VATS ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER
Authors: Takeno Shinsuke , Kawano Fumiaki , Tashiro Kousei , Hamada Rouko , Wada Takashi , Tanoue Yukinori , Nanashima Atsushi
Published: September 2018

Background

Thoracoscopic esophagectomy (TE) was reported that increased morbidity in the National Clinical Data analysis in Japan and technical proficiency is required as the esophageal surgery team. The aim of this study is to assess the degree of surgical difficulty from operation time and to applicate for esophageal surgery team-building and the education of next-generation.

Methods

Consecutive initial 33 cases by the same operator was statistically examined concerning the correlation between chest operation time and the empirical effect of the time shortening, BMI, obstructive pulmonary disorders, Rib cage area, tumor progression, preoperative treatment as an indicator of the degree of surgical difficulty. Rib cage area measured in the preoperative CT Imaging.

Results

As the factors affecting the extension of operating time, the narrower upper rib cage area correlated with the prolonged operation time in the univariate (P = 0.0279) and multivariate (P = 0.0125) analysis. Empirical time reduction (P = 0.0429) also was correlated with chest operation time. In addition, there was a significant correlation between chest operation time and blood loss (P = 0.0007).

Conclusion

In the training of TE, operating surgeon or first assistant should start from the patient with broad upper rib cage area in chest CT.

Disclosure

All authors have declared no conflicts of interest.
PS01.234: MINIMALLY INVASIVE ESOPHAGECTOMY IN PATIENTS WITH MORBID OBESITY
Authors: Velasco Hernandez Norbeto , Rivaletto Lucas , Horiuchi Hector , Zicavo Maria , De Battista Gerrini Santiago
Published: September 2018

Background

The first publication of minimally invasive esophagectomy in prone position (MIE PP) was developed by Cuschieri in 1994. This approach was described to access the posterior mediastinum and esophagus for mobilization and resection. In 2006, after several reports, Palanivelu presented his study, which was one of the most important series published at that time.The objective is to analyze the mortality of a group of patients with morbid obesity that underwent MIE PP. Retrospective, observational study.

Methods

From November 2011 to June 2017, 52 esophagectomies were performed in H.I.G.A San Martín and Instituto de Diagnóstico of La Plata city. Out of the 52 cases, only 36 of them were MIE PP, and were the ones chosen to be included in the study.

Results

Perioperative mortality was 8.3% (3 cases) Two cases, in the group of patients with obesity (IMC ≥ 30) were due to pneumonia and heart failure and surgery was performed using the McKeown procedure. Another case was in the group of patients without obesity (IMC ≤ 30) due to mediastinitis by leak, and the surgery performed was applying Ivor-Lewis procedure. These results did not evidence statistically significance (P ≤ 0.54) However, in the analysis of patients with morbid obesity (BMI ≥ 35) when compared with all the remaining cases, the difference was significant (P = 0.02)

Conclusion

There are many publications suggesting that obesity is not a risk factor for mortality after MIE. However, in our study, although it is a series with a small number of cases, there was evidence that mortality increases in patients with BMI ≥ 35

Disclosure

All authors have declared no conflicts of interest.
PS01.236: MEDIASTINOSCOPIC SALVAGE ESOPHAGECTOMY FOR RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY IN A PREVIOUSLY PNEUMONECTOMIZED PATIENT
Authors: Okumura Tomoyuki , Seto Yasuyuki , Aikou Susumu , Moriyama Makoto , Sekine Shinich , Hojo Shozo , Arai Mie , Baba Hayato , Hirano Katsuhisa , Shibuya Kazuto , Hashimoto Isaya , Yoshioka Isaku , Nagata Takuya , Fujii Tsutomu
Published: September 2018

Background

Mediastinoscopic esophagectomy is a minimally invasive surgery for thoracic esophageal cancer avoiding one-lung ventilation or transthoracic procedure.

Methods

We performed for the first time in the literature, salvage esophagectomy with combination of mediastinoscopic cervical approach and laparoscopic/mediastinoscopic transhiatal approach for recurrent thoracic esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT) in a patient who had previously undergone a left pneumonectomy for primary lung cancer.

Results

A 66-year-old man was diagnosed as local recurrence of lower ESCC (cT3N0M0 cStage II) at 9 years after dCRT. His medical history included left-sided pneumonectomy for lung adenocarcinoma 9 years previously. Then the patient was diagnosed as lower thoracic ESCC (cT3N1M0 cStage III) at 2 months after pneumonectomy. He received dCRT consisting of CDDP/5-FU infusion and irradiation (60 Gy) and achieved complete response. No evidence of tumor recurrence was observed at endoscopic surveillance up until 6 years after dCRT. For this present surgery, a cervical wound was made and the intramediastinal procedure was performed under pneumomediastinum. After mobilization of upper/middle thoracic esophagus, the esophageal wall was safely separated from the remaining part and the stump of the left main bronchus. Dense adhesions between the esophagus and fibrotic tissue at the site of previous left mediastinal pleural resection was divided using a sealing device. In the abdomen, 5 ports were inserted to perform abdominal and transhiatal procedures under CO2 insufflation. After mobilization of the stomach, fibrotic scar tissue around the lower esophagus was divided using a sealing device and the peri-esophageal space dissected from cervical and transhiatal approach were connected to completely mobilize the thoracic esophagus. The esophagectomy was uneventfully carried out followed by reconstruction with gastric conduit via retrosternal rout. Pathological findings demonstrated a moderately differentiated ESCC (pT3-AD pN1 M0 pStage III), indicating that R0 resection was successfully performed. The patient has been closely observed as an outpatient and was alive and healthy at 3 months after the operation without tumor recurrence.

Conclusion

Mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who had a previous pneumonectomy, even in salvage surgery for recurrent cancer after dCRT.

Disclosure

All authors have declared no conflicts of interest.
PS01.241: HYBRID MINIMALLY INVASIVE TECHNIQUE OF OESOPHAGECTOMY FOR OESOPHAGEAL CARCINOMA
Authors: Virk Satpal , Singla Saurabh
Published: September 2018

Background

Oesophagectomy is challenging procedure involving multiple body cavities. The traditional open procedure being either transthoracic or transhiatal, carries significant morbidity and mortality. There is continuing debate between the two approaches. Minimally invasive oesophagectomy has swung the pendulum towards transthoracic procedure, though it remains a complex and technically demanding procedure. This study was done to assess the feasibility, and benefit of hybrid minimally invasive technique over open technique.

Methods

Patients of oesophageal cancer were selected from January 2005 to December 20,017. After 2012 open technique was replaced with minimally invasive technique. Open technique included Ivor Lewis, McKeown's or transhiatal. Hybrid minimally invasive technique included laparoscopic gastric mobilisation and thoracic part using small thoracotomy. Anastomosis was done using hand sewn technique. The short term outcome, including postoperative complications were analysed from prospectively collected data.

Results

One hundred sixty three patients underwent open procedure and 103 patients underwent hybrid minimally invasive esophagectomy. Total operative time was shorter in laparoscopic group (325.6 minutes vs 232.6 minutes, P < 0.05). The number of transfused patients were significantly smaller in laparoscopic group (40.75% vs 13.6%, P < 0.05). The postoperative course without complication was observed in 68.1% and 79.3% in open vs laparoscopic group respectively. Serious complications included myocardial infarction and gastric tube necrosis and bleed. There was no anastomotic leak in chest anastomosis but there was overall 17.3% leak in neck anastomosis, higher in open group 20.8% vs 16.6% in minimally invasive group. Mortality was higher ion open group (5.5% vs 2%, P < 0.05). On multivariate analysis, age more than 60 years, chest complications and cardiovascular comorbidity were associated with increased mortality.

Conclusion

Hybrid minimally invasive procedure is feasible and safe procedure for patients with oesophageal cancer. it is associated with shorter operative time and less postoperative complications. Even laparoscopic gastric tube mobilisation alone adds to in decreasing the morbidity in esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.242: HIATAL HERNIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Mungo Benedetto , Gleisner Ana , Rincon-Cruz Lorena , Thornton Loree , Mccarter Martin
Published: September 2018

Background

Hiatal hernias (HH) are a known, yet poorly studied, post-surgical complication of esophagectomy. The aim of this study was to analyze in a retrospective fashion the MIE experience at our institution, in order to individuate factors associated with post-surgical HH development.

Methods

We reviewed data from MIE performed at University of Colorado from July 2013 to July 2017. Our most common approach of choice is Ivor Lewis MIE with circular stapled end to side anastomosis. We divided our patient population in two groups: those who developed a HH at any time post operatively and those who did not. We compared pre-, intra- and post-operative clinical variables of interest in the two groups using Pearson chi-squared and Fisher's exact test for binomial variables and Two-sample Wilcoxon rank-sum (Mann-Whitney) test for continuous variables.

Results

91 patients underwent MIE in the study period: 11 developed HH in a time frame ranging from one week to two years post operatively. 8 patients had a HH involving one or more intra-abdominal organs other than the stomach; 3 patients had a HH interesting mostly the tubulized stomach. 7 patients required a reoperation. There were no statistically significant differences in the prevalence of pre-operative comorbidities between the two groups. Patient who developed a HH were significantly less likely to have had prior abdominal or thoracic surgery (Pr = 0.039). As expected, they were also significantly more likely to require a reoperation (Pr = 0.000). There were no statistically significant differences in intra-operative variables between the two groups, including operative time and anastomotic technique, nor where there differences in incidence of post operative complications other than HH. We did observe a trend towards higher rate of preoperative chemotherapy and radiation in the HH group. Of note, we did attempt to prevent HH by means of tacking abdominal organs to the abdominal wall, however this did not prove to significantly decrease HH incidence.

Conclusion

HH occurs in a non-negligible percentage of patients undergoing MIE. Lack of prior surgery appears to be significantly associated with HH, perhaps due to lesser adhesion burden acting as a mean of organ fixation.

Disclosure

All authors have declared no conflicts of interest.
PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER
Authors: Hyun Kim Chang , Kim Jin-Jo
Published: September 2018

Background

A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer

Methods

We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes.

Results

The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient.

Conclusion

TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve.

Disclosure

All authors have declared no conflicts of interest.
PS02.004: THE FEASIBILITY AND EFFECTIVENESS OF ‘TOTAL ENDOSCOPIC 2.5 FIELD LYMPH NODE DISSECTION’ IN TREATMENT OF THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zheng Bin , Hong Ruopeng , Zhang Shuliang , Zeng Taidui , Chen Hao , Xu Jinxin , Zheng Wei , Chen Chun
Published: September 2018

Background

Due to the difficulty of dissection, surgical trauma, postoperative complications and other factors, the promotion of 3-field lymph node dissection is subject to certain restrictions. We try to explore and summarize a method of lymph node dissection, ‘endoscopic 2.5 lymph node dissection ’, that is, thoracoscopy combined with laparoscopic radical abdominal field, chest field and lower cervical paraesophageal lymph nodes (including 101 group below thyroid artery).

Methods

Retrospective analysis of 240 patients with thoracic esophageal squamous cell carcinoma from November 1, 2015 to December 31, 2017. All patients underwent endoscopic 2.5-field lymphadenectomy. The average age is (58.2 ± 9.5) years old. During the thoracoscopic part, when we do the lymphadenectomy along recurrent laryngeal nerves in the upper mediastimun and lower neck, we used a combination of ‘esophageal suspension method’, ‘lymph node rolling dissection method’ and ‘multi-angle pulling method’ to reveal the lymph nodes (Figure 1). Surgical related factors were collected and analyzed. Continuous follow-up was performed to record the recurrence and metastasis of patients and postoperative survival.

Results

Lymphadenectomy level of the right recurrent laryngeal nerve could reach the level above the right inferior thyroid artery, and the left could reach the level of 101 station. All operations were successfully completed. The incidence of pulmonary infection was 11.7%, the incidence of anastomotic leakage was 1.3%, the hoarseness rate was 7.9% and the incidence of chylothorax was 4.2%. The average number of total, abdominal and thoracic lymph nodes dissected were higher than the number of guidelines requirement and most of the previous literature. The average postoperative hospital stay was 8.4 days. The local recurrence rate, metastasis rate and survival rate of all the patients were not inferior to those reported in the past.

Conclusion

In patients with thoracic esophageal squamous cell carcinoma, the use of ‘total endoscopic 2.5-field lymph noede dissection’, could expand the range of lymph node dissection, and reached the super-thoracic and lower cervical level, which is beneficial to improve the degree of dissection along the recurrent laryngeal nerves. The procedure is safe and feasible, the results of short-term follow-up results are good, and it is worth further promotion.

Disclosure

All authors have declared no conflicts of interest.
PS02.006: OPERATIVE INDICATION AND PROCEDURES OF THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Kamei Takashi
Published: September 2018

Background

Thoracoscopic esophagectomy has been performed for two decades and becomes widely spread. We evaluate our cases who undergone the thoracoscopic esophagectomy and consider the future prospective of this operation.

Methods

702 patients who received thoracoscopic esophagectomy in our institute from March 1995 to October 2017 were enrolled and studied retrospectively. Operative indication is an all of the clinically resectable cases including with a neoadjuvant treatment or definitive chemoradiotherapy before surgery. Overall survival rate of the patients with thoracoscopic approach and with thoracotomy until 2001 was analyzed. Long term outcome of the patients with thoracoscopic esophagectomy was compared to the result from comprehensive registry of esophageal cancer in Japan. Short term results of the perioperative parameters were analyzed between left lateral decubitus position and prone position.

Results

There was no significant differences of the survival rate between thoracoscopic group and thoracotomy group based on pathological stage. 5 year survival without neoadjuvant treatment was 88.9% (pStageI), 71.5%(pStageIIA), 68.1%(pStageIIB), 40.9%(pStageIII), respectively.5 year survival rate of cStageII and III with neoadjuvant chemotherapy was 65.7% and 5 year survival rate of the salvage esophagectomy after failure of definitive chemoradiotherapy was 31.4%. Every outcomes are as good as any reported results in esophagectomy. In the comparison of the lateral position with the prone position, total blood loss was significantly lower in prone position. Inflammatory response after surgery was improved more rapidly in prone group, therefore, prone position is recommended as a minimally invasive procedure for thoracoscopic esophagectomy.

Conclusion

Thoracoscopic esophagectomy will develop further as a standard operation for esophageal cancer. However, from the point of view of the safety, an appropriate educational systems of this advanced procedure should build.

Disclosure

All authors have declared no conflicts of interest.
PS02.009: APPLICATION OF SINGLE-PORT VIDEO-ASSISTED THORACOSCOPE IN TREATING THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA USING MCKEOWN APPROACH
Authors: Lv Qiang
Published: September 2018

Background

Early radical resections are the main treatment methods towards esophageal squamous cell carcinoma (ESCC). Classic transthoracic esophagectomy (McKeown approach) could resect esophagus lesion as a whole piece, so the surgical results could be satisfactory and the regional lymph node dissection could be clean. With the maturation of video-assisted thoracoscope in thoracic surgeries, good vision, subtle operating system, and mature operating technologies have made the multi-portal thoracoscopic minimally invasive laparoscopic esophageal resection more and more mature. Meanwhile, SPVATS gradually appeared, which was firstly used in simple thoracic surgeries, and further applied to lung and mediastinal tumor resection; relevant summaries have been reported, and the feasibility of SPVATS for standard mediastinal lymph node dissection was also further verified.The application of SPVATS towards TESCC has also been gradually carried out. Would minimally invasive esophagectomy be safe? Whether SPVATS could be used in the McKeown approach for TESCC? Whether SPVATS could safely resect esophagus, and perform standard dissection towards local esophageal region and mediastinal lymph nodes, as well as avoid damaging the surrounding organs and tissues? Some scholars had compared SPVATS and multi-portal VATS in treating medio-inferior TESCC.

Methods

METHODS: 25 McKeown approach-based SPVATS surgeries (19 males and 6 females, aged 42–70years) were carried out from January 2015 to December 2017 to treat TESCC, including 2 case in upper thoracic segment, 15 cases in median thoracic segment, and 8 cases in inferior thoracic segment. All the cases were pathologically diagnosed as SCC preoperatively. SPVATS was performed to free thoracic esophagus and dissect the lymph nodes, and laparoscopy was performed to free stomach and to perform esophagus-left gastric collum anastomosis.

Results

RESULTS: All the patients were successfully completed SPVATS, with average thoracic surgery time as 150 min, intraoperative blood loss as 30–260 ml (average 90 ml), and postoperative hospital stay as 9–16d (average 12d).

Conclusion

CONCLUSIONS: SPVATS was technically feasible and safe in treating TESCC using McKeown approach, with less trauma and rapid postoperative recovery, so it could be used as a new surgical option for McKeown approach-based TESCC treatment.

Disclosure

All authors have declared no conflicts of interest.
PS02.013: THORACOSCOPIC ESOPHAGECTOMY WITH RADICAL LYMPH NODE DISSECTION FOR THORACIC ESOPHAGEAL CARCINOMA IN THE LEFT LATERAL DECUBITUS POSITION
Authors: Sato Hiroshi , Miyawaki Yutaka , Aikawa Masayasu , Okamoto Kojun , Sakuramoto Shinichi , Yamaguchi Shigeki , Koyama Isamu
Published: September 2018

Background

The rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan. We retrospectively reviewed short term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation in a single institution. This study aimed to evaluate the feasibility of applying this procedure.

Methods

Between July 2013 and March 2017, 83 patients with esophageal cancer underwent thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation. The thoracic procedure is performed as follows: The lymph nodes around the right recurrent laryngeal nerve are dissected. On the cranial side, the lymph node dissection is advanced to the level of the inferior thyroid artery. Then, the assistant rotates the trachea toward the ventral side, and the lymph nodes around the left recurrent laryngeal nerve are dissected. The middle and inferior mediastinal lymph nodes are dissected including supradiaphragmatic lymph nodes and the dorsal lymph nodes around the thoracic descending aorta. Then, the esophagus is transected using an automatic suture device. Finally, the tracheal bifurcation area lymph nodes are dissected. We retrospectively analyzed these patients.

Results

The completion rate of thoracoscopic esophagectomy was 94.0%, and the procedure was converted to thoracotomy in five patients, due to hemorrhage, severe adhesion. The mean intrathoracic operative time, intrathoracic blood loss, and number of dissected mediastinal lymph nodes were 220.0 min, 130.1 mL, and 22.0, respectively. Postoperative complications included pneumonia (8.4%), anastomotic leakage (16.9%), and recurrent nerve paralysis (8.4%). Postoperative (30d) mortality was 1/83 (1.2%) due to ARDS.

Conclusion

Standardization of the procedure for thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation, with a standardized clinical pathway for perioperative care led to favorable surgical outcomes.

Disclosure

All authors have declared no conflicts of interest.
PS02.014: COST-EFFECTIVENESS OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Liu Chao-Yu , Liu Chia-Chuan
Published: September 2018

Background

The cost-effectiveness of minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for esophageal squamous cell carcinoma (ESCC) has not been established. Recent cost studies have shown that MIE is associated with a higher surgical expense, which is not consistently offset by savings through expedited post-operative recovery, therefore suggesting a questionable benefit of MIE over OE from an economic point of view. In the current study, we compared the cost-effectiveness of MIE versus OE for ESCC.

Methods

Between April 2000 and December 2013, a total of 251 consecutive patients undergoing MIE or OE for ESCC were enrolled. After propensity score (PS)-matching the MIE group with the OE group for clinical characteristics, 95 patients from each group were enrolled to compare the peri-operative outcomes, long-term survival, and cost.

Results

After PS-matching, the baseline characteristics were not significantly different between groups. Perioperative outcomes were similar in both groups. MIE was superior to OE with respect to a shorter intensive care unit (ICU) stay, while the complication rate (except for hoarseness) and survival were similar. Post-operative cost was significantly less in the MIE group due to a shorter ICU stay; however, reduced post-operative cost failed to offset the higher surgical expense of MIE.

Conclusion

MIE for ESCC failed to show cost-effectiveness regarding overall expense in our study, but costs less in the postoperative care, especially for ICU care. More cost studies on MIE in other health care systems are warranted to verify the cost-effectiveness of MIE.

Disclosure

All authors have declared no conflicts of interest.
PS02.016: MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE IN THE FIRST 100 CASES
Authors: Eroglu Atila , Daharli Coskun , Aydin Yener , Ulas Ali , Alici Haci
Published: September 2018

Background

In this study, the efficiency of minimally invasive esophagectomy in esophageal cancer was examined.

Methods

A total of 100 consecutive patients who were hospitalized due to esophageal cancer and planned minimally invasive esophagectomy were evaluated prospectively between September 2013 and December 2017 in our clinic. Laparoscopic and thoracoscopic esophagectomy was performed in all of the patients included in the study. Inoperable cases were not included in the study. Age and sex of the patients, symptoms, localization of tumor, histopathological type, surgical modality, operation time, length of hospital stay and morbidity and mortality rates were reviewed.

Results

Thirty-eight (38%) patients were male and 62 (62%) patients were female. The mean age was 55.5 ± 10.8 (32–75 years). The most symptoms were dysphagy (96%) and weight loss (39%). Eighty-one patients (81%) had squamous cell cancer, ten (10%) had adenocarcinoma and nine had another form of esophageal cancer. Neoadjuvant chemoradiotherapy was performed in 36 of the 100 patients. Laparoscopic and thoracoscopic esophagectomy and intrathoracic anastomosis were performed in 94 patients (94%). Laparoscopic and thoracoscopic esophagectomy and neck anastomosis were performed in six patients (6%). The mean duration of operation was 260.1 ± 33.4 minutes (185–335 minutes). The mean intraoperative blood loss was 114.2 ± 191.4 ml (10–800 ml). In 51 (51%) of the patients, complications occurred in perioperative, early postoperative and late postoperative periods. In postoperative complications, anastomotic leak rate was eight patients (8%) and pulmonary complication rate was 21 patients (21%). While mortality was seen in three patients that had diabetes mellitus and hypertension, the 30-day mortality was 2% and the hospital mortality was 3%. The mean hospital stay was 11.2 ± 8.3 days (range 8–44). In our study, the probability of one-year overall survival was 91% and the probability of two years overall survival was 66%.

Conclusion

Minimally invasive esophagectomy is a safe and preferred method with low mortality, acceptable morbidity, short operative time and short hospital stay and has become a routine approach in the treatment of esophageal cancers. Multicenter studies to be performed in the near future will further assist in defining the benefits of minimally invasive esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS02.018: MINIMALLY INVASIVE ESOPHAGECTOMY (MIE): FROM HYBRID, TO FULLY MINIMALLY-INVASIVE (MIE) AND TO ROBOTIC ASSISTED MIE (RAMIE): A SINGLE SURGEON ANALYSIS
Authors: Tagkalos Evangelos , Hadzijusufovic Edin , Matthias Corvinus Florian , Babic Benjamin , Lang Hauke , Grimminger Peter
Published: September 2018

Background

The incidence of esophageal carcinoma is increasing in the western world and esophageal resection is the essential therapy depending on the tumor stage. Several studies report advantages of minimally invasive esophagectomies (MIE) versus conventional open procedures. The use of totally MIE (thoraco- and laparoscopic) or robotic assisted MIE (RAMIE) compared to the hybrid approaches remain unclear.

Methods

Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. 25 were treated with a hybrid MIE (hybrid), another 25 with a totally MIE (MIE) and another 25 with a robotic assisted MIE (RAMIE). All patients were operated by the same specialized surgeon in our center. Demographic data), duration of total hospital- and intensive-care-stay (ICU), number of remote lymph nodes and histopathological R-status, as well as operating times were compared. The complications were assessed according to the Dindo-Clavien classification.

Results

The overall 30- and 90-day mortality rate were 0% and 1.33% (1/75) respectively. Hospital stay (P = 0.262), ICU stay (P = 0.079), number of resected lymph nodes (P = 0.863) and R status (P = 0.132) did not differ significantly between the groups. However more pneumonias and wound infections (P = 0.046 and P = 0.003 respectively) were found in the hybrid group when compared to the minimally invasive group (MIE und RAMIE).

Conclusion

Although the MIE as well as the RAMIE group contained the first 25 patients treated in this clinic with this procedures, comparable results with regard to oncological outcomes and morbidity could be achieved. Additionally the minimally invasive approaches seem to be assosiated with low occurence of pneumonia and wound infects.

Disclosure

All authors have declared no conflicts of interest.
PS02.022: INDOCYANINE GREEN: A USEFUL TOOL IN MINIMALLY INVASIVE ESOPHAGEAL CANCER SURGERY
Authors: Turrado-Rodriguez Victor , Nombre De Maria Momblan Dulce , Ibarzabal Ainitze , Torroella Alba , Gerardo Diaz Del Gobo Rafael , Maria De Lacy Fortuny Antonio
Published: September 2018

Background

Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras.

Methods

A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above.

Results

The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed.

Conclusion

ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer

Disclosure

All authors have declared no conflicts of interest.
PS02.023: SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY FOR TREATING ESOPHAGEAL CANCER
Authors: Lee Jang-Ming , Yang Sunn-Mao , Huang Pei-Ming
Published: September 2018

Background

Single-incision throacoscopic and laparoscopic procedure has been applied to treating various diseases. In the current study, we applied this novel surgical technique in the minimally invasive esophagectomy for esophageal cancer.

Methods

Minimally invasive esophagectomy (MIE) with single-port approach in the thoracoscopic and laparoscopic procedures was attempted for patients with esophageal cancer. Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3–4 cm incision was created both in the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients with single-incision and multi-incision MIE.

Results

We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006–2015. There were 12 patients having postoperative complications (25%), including 4 (8.3%) of anastomotic leakage one (2.1%) of pulmonary complications and 3 (6.3%) with vocal cord palsy in the patients undergoing single-incision MIE (SIMIE). There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (P < 0.05). There was no surgical mortality in the single-incision MIE group.

Conclusion

Minimally invasive esophogectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.

Disclosure

All authors have declared no conflicts of interest.
PS02.026: EXPANDABLE METALLIC STENTS IN ESOPHAGEAL: EXPERIENCE IN THE NATIONAL CENTER FOR MINIMAL ACCESS SURGERY
Authors: Neri Jimenez Felipe , Torres Julían
Published: September 2018

Background

Expandable metallic stents are one of the treatment alternatives currently palliative treating benign and malignant stenosis of the gastrointestinal tract and biliopancreátic order to improve the quality of life of patients. Our aims are to show the results achieved by our group in the placement of self-expanding metal stents in patients with malignant or benign strictures of the upper digestive tracts referred from different parts of the country.

Methods

A number of cases were prospectively evaluated the Cuban experience of 101 self-expanding stent insertion (Niti-S Stent) in 86 patients treated at the National Center for Minimal Access Surgery, diagnosed with malignant and benign strictures of the upper digestive tractus.

Results

The highest proportion of inserted prosthesis was performed in malignant stenosis (86%) and in the group of 60 and more years old (81, 3%). The most frequent complications were chest pain (100%) immediately and migration of the stent in benign and on tumor growth in malignant. A hole that had subsequently died.

Conclusion

Self-expanding metal stents have emerged as an alternative effective and safe, for the treatment of malignant and benign stenoses of the digestive system. Most reports report small series of cases consecutively without a control group, which has made it difficult to evaluate world. In our study we want to show the first experience achieved in our country. Conclusions: utility Stents for palliation of malignant and benign strictures high digestive shown.

Disclosure

All authors have declared no conflicts of interest.
PS02.027: EXERCISE TRAINING DURING NEO-ADJUVANT THERAPY IN PATIENTS UNDERGOING SURGERY FOR CANCER OF THE GASTRO-ESOPHAGEAL JUNCTION
Authors: De Heer Pieter , Christensen Jesper , Simonsen Caper , Banck-Petersen Anna , Kristensen Thomas , Garbyal Rajendra , Pedersen Bente , Bo Svendsen Lars , Højman Pernille , Kofoed Steen
Published: September 2018

Background

Neoadjuvant chemo- or chemo-radiotherapy before tumor resection is first-line treatment in patients with GEJ but associated with considerable symptom burden and complication risk which may impair treatment efficacy and quality of life. Strategies to improve treatment tolerability are therefore warranted.

Methods

Fifty GEJ cancer patients were allocated without randomization to an exercise-group or usual care control-group. The exercise-group was prescribed 2 weekly sessions including aerobic interval exercise and resistance training for 12 weeks. The primary endpoint was risk of treatment failure defined as any serious adverse event (SAE) precluding surgery. Risk of other SAEs and quality of life (in both groups); and exercise-adherence and change in aerobic fitness, muscle strength, and body composition (in the exercise-group) was recorded.

Results

Risk of treatment failure was 5% in the EX-group and 21% in the CON-group, and risk of pre-operative hospitalization was 15% in the EX-group and 38% in the CON-group. Risk of post-operative complications was similar between groups. The exercise-group attended on average 17.4 sessions and improved fitness (+ 8%), muscle strength (+ 15–22%) and FACT-E total score (+ 12-points).

Conclusion

Pre-operative exercise was feasible and led to favorable changes in fitness, strength and quality of life. Further, it may be associated with lower risk of treatment failure and hospitalization during neoadjuvant therapy, which could have important implications for future perioperative management of patients with GEJ cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER
Authors: Okamoto Hiroshi , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Maruyama Shota , Kamei Takashi
Published: September 2018

Background

Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC.

Methods

We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015.

Results

Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively.

Conclusion

DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation.

Disclosure

All authors have declared no conflicts of interest.