bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.106: PSEUDODIVERTICULOSIS-RELATED ESOPHAGEAL MASS WITH INTENSE FDG UPTAKE
Authors: Sawada Ryuichiro , Oshikiri Taro , Nakamura Tetsu , Miura Yukiko , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Sumi Yasuo , Suzuki Satoshi , Kakeji Yoshihiro
Published: September 2018

Background

Esophageal intramural pseudodiverticulosis (EIPD) is rare condition. The usual symptom is dysphagia mainly due to benign stenosis, and other variety of symptoms and complications have been reported. Only few articles have shown EIPD leading to esophageal mass formation like malignancy. Here, we report EIPD related to esophageal mass with increased up take of 18F-fluorodeoxyglucose followed by esophagectomy.

Methods

A 48-year-old man presented with dysphagia caused by esophageal stricture. Esophagoscopy showed a protruding submucosal lesion and lumen stenosis in lower third of esophagus. The esophageal mucosa was intact, but one small hole was observed. Positron emission tomography-computed tomography showed the FDG-avid lesion in the lower esophagus. In addition to symptom persistence, possibility of malignancy offered him surgical resection. In the prone position, minimally invasive esophagectomy with gastric tube reconstruction was performed.

Results

The pathology of the surgical specimen showed that many cystic spaces lined by stratified squamous epithelium were present in the submucosa and partially in the muscularis propria. There was mucosal depression connecting with the cystic spaces, and submucosa was thickened with fibrosis. The dilated spaces formed flask-shaped lesion and intramural tracking parallel to the esophageal lumen. Based on these findings, esophageal intramural pseudodiverticulosis with no evidence of malignancy was diagnosed. The postoperative course was uneventful, and the patient was discharged 18 days after operation.

Conclusion

EIPD can result in inflammatory mass formation with high up take of FDG and the cavities can protrude into muscularis propria. The present report can be helpful in the assessment of PET-positive tumor. We should consider EIPD in unknown mass in the thoracic esophagus. Early diagnosis followed by conservative therapy may allow adequate control without surgery. The pathogenesis of EIPD remains to be fully clarified, and additional studies will be needed to elucidate the mechanism.

Disclosure

All authors have declared no conflicts of interest.
PS01.109: A RARE TUMOR OF THE CERVICAL ESOPHAGUS: SCHWANNOMA
Authors: Aydin Yener , Eroglu Atila , Ulas Ali , Keskin Hilmi , Ozmen Sevilay
Published: September 2018

Background

Schwannomas esophagus is very rarely seen. In this study, a schwannoma case with cervical esophagus was presented.

Methods

A 26-year-old female presented with dysphagia. In esophageal ultrasonography, a homogeneous, hypoechoic, and smooth-sided lesion originating from the proximal esophagus muscularis propria was detected. MRI revealed a well-defined mass lesion located in the cervical esophagus.

Results

The left cervical incision was performed and the lesion was enucleated. After the enucleation, saline was inserted into the enucleated area, and air was injected into the nasogastric tube to investigate the possibility of mucosal injuries. The esophageal muscle layers were then primarily closed with absorbable sutures. Frozen section examination was benign. Postoperative histopathological evaluation was assessed as accordance with schwannoma (Figure). Oral diet was started on the 3th postoperative day. There were no complications postoperatively. The patient was discharged on the 5th postoperative day.

Conclusion

The vast majority of esophageal tumors are cancer. Benign esophagial tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. Esophageal schwannoma is very rare and difficult to diagnose by endoscopy and imaging methods. In these cases, surgery provides both definitive diagnosis and treatment.

Disclosure

All authors have declared no conflicts of interest.
PS01.122: LONG-TERM QUALITY OF LIFE IN PATIENTS AFTER MCKEOWN VERSUS IVOR LEWIS ESOPHAGECTOMY
Authors: Jezerskyte Egle , Gisbertz Suzanne , Van Berge Henegouwen Mark I , Saadeh Luca , Scarpa Marco
Published: September 2018

Background

Treatment of distal esophageal and gastroesophageal junction (GEJ) cancers is challenging. The therapy for these cancers mainly consist of (neo)adjuvant chemo(radio)therapy and surgery. There are different surgical approaches possible for these patients: transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). However, there is no evidence which is the preferred approach in terms of oncology, morbidity and quality of life. The aim of this study was to investigate the difference in the long-term quality of life in patients undergoing McKeown (McK) versus Ivor Lewis (IL) esophagectomy in a tertiary referral center.

Methods

Consecutive patients after either McK or IL for distal oesophagus, GEJ or proximal gastric carcinoma were asked to fill in EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires to evaluate quality of life during the period of January 2014 – December 2017. EORTC QLQ-INFO25 quality of life questionnaire was used to evaluate information needs of patients in both groups. All answers with a long follow up (> 1 year) after surgery were analysed.

Results

In the McK group 62 and in the IL group 110 patients were included. Median follow up was 3 years for McK and 2 years for IL. Median age was 62,4 years. Cognitive functioning was significantly better in the IL group (P = 0.038). Complaints of dyspnoe (P = 0.004) and dysphagia (P = 0.028) were significantly higher in the McK group. Patients after IL had significantly less trouble with eating with others (P = 0.003), trouble with taste (P = 0.032), chocking when swallowing (P = 0.022) and trouble with talking (P = 0.038). There was no significant difference in global health status or physical, role, social or emotional functioning. Furthermore there was no difference in symptoms of nausea, fatigue, pain, discomfort or information scores between McK and IL groups.

Conclusion

After a follow up of > 1 year no differences in global health status or physical, role, social or emotional functioning scales between McK and IL esophagectomy were found. However, significant differences in some symptom scales and cognitive functioning were observed in favor of IL. These findings should be taken into consideration when deciding between a McK and IL esophagectomy in patients where both procedures are feasible.

Disclosure

All authors have declared no conflicts of interest.
PS01.141: TREATMENT STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA COMPLICATED WITH HEAD AND NECK CANCER
Authors: Maeda Masato , Kawamorita Keisuke , Koreyasu Ryohei , Ueda Shou , Takayanagi Tomoyasu , Kobayashi Toshiki , Hashomoto Yosuke , Fujimoto Yasuhiro , Yonezawa Kei , Miyashita Tadashi
Published: September 2018

Background

The frequency of complication of head and neck cancer to thoracic esophageal cancer is high, and treatment methods and their order will be determined from the viewpoints of curability and quality of life.

Methods

We review the course of three cases we experienced and give some consideration.

Results

[Case 1] A 68-year-old man with cT2N0M0 Mt esophageal cancer and cT2N0M hypopharyngeal cancer. Two courses of DCF (DOC + CDDP + 5 FU) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy with three fields lymph nodes dissection, one course of DCF was added, and CRT (60 Gy/30 fr) combined with weekly CBDCA was administered to the neck. The case is alive without recurrence for 5 years and 9 months from the start of treatment. [Case 2] A 72-year-old man with cT2N0M0 Mt esophageal cancer and cT3N2bM0 hypopharyngeal cancer. Three courses of TCS (DOC + CBDCA + TS-1) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy, CRT (60 Gy) combined with biweekly CDDP was administered to the neck. The case is alive without recurrence for 5 years and 7 months. [Case 3] A 63-year-old man with LtMt multiple esophageal cancer (4 lesions, cT3N2M0) and cT2N1M0 hypopharyngeal cancer, and cT1bN0M0 gastric cancer. Though the hypopharyngeal cancer remained in PR after 2 courses of DCF, aiming at larynx preservation, thoracoscopic subtotal esophagectomy was performed, and gastric lesion was excised at the time of creating the stomach tube. After the operation, CRT (70 Gy) combined with weekly CBDCA made the hypopharyngeal lesion CR. Another cancer was demonstrated in the residual esophagus in 1 year and 3 months and surgical resection of the residual esophagus and the larynx with reconstruction with free jejunal transplantation was performed. The case is alive without recurrence for 2 years and 5 months after reoperation.

Conclusion

Salvage surgery may be necessary for metachronous multiple cancer cases, non-CR cases, and local recurrence cases as in case 3. We think that we can aim at compatibility of curability and maintenance of quality of life by treatment method which aims at preservation of larynx, combining with chemoradiotherapy and esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.143: ANALYSIS OF THORACOSCOPE, LAPAROSCOPY COMBINED WITH TOTAL LARYNGECTOMY IN TREATMENT OF CERVICAL ESOPHAGEAL CARCINOMA OPERATION
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming
Published: September 2018

Background

To investigate the feasibility and efficacy of cervical esophageal carcinoma operation through thoracoscope, laparoscopy combined with total laryngectomy.

Methods

Retrospect and analyze the data of 53 patients with cervical esophageal carcinoma undergone surgical treatment in Department of Thoracic Surgery, First Hospital Affiliated to Xiamen University from May.2010 to May.2017. Operation procedure: separate esophagus under thoracoscope, rebuild gastric tube, resect full throat, perform tracheostoma permanently, apply gastric-pharyngeal anastomosis.

Results

Thoracic operation time was 50 ∼ 65 min, average 57 min; abdominal operation time was 46 ∼ 62 min, average 54 min; neck surgery time was 117 ∼ 137 min, average 125 min. The amount of intraoperative bleeding was 78∼ 260 ml, average 180 ml. The postoperative hospital stay was 7 ∼ 15d, average 10d. All the cases were squamous cell carcinoma, 6 cases of high differentiated squamous cell carcinoma, 31 cases of squamous cell carcinoma, 10 cases of middle-low differentiated squamous cell carcinoma, 6 cases of low differentiated squamous cell carcinoma. All the resection edges had been proved no residual tumor left by pathological examination. In 53 cases, lymph node metastasis occurred in 48 cases, anastomotic fistula occurred in 1 cases, 2 cases of pulmonary infection, 1 cases of gastric emptying and 1 case anastomotic stenosis happed, and there is no death case. All the patients were followed up from 1 months to 5 years, the 1st, 3rd, 5th year survival rate was 83.8%, 51.2% and 23.1% respectively.

Conclusion

Cervical esophageal carcinoma operation treatment should be taken actively, Gastric pharyngeal anastomosis is an effective mean to treat cervical esophageal carcinoma.

Disclosure

All authors have declared no conflicts of interest.
PS01.152: BODY TEMPERATURE IN THORACOSCOPIC ESOPHAGECTOMY AND AIR CONDITIONING SYSTEM OF OPERATION ROOM
Authors: Usuki Hisashi , Kishino Takayoshi , Fujiwara Masao , Okano Keiichi , Suzuki Yasuyuki
Published: September 2018

Background

It is well known that the perioperative hypothermia often cause the perioperative complications. In this study the hypothermia during the thoracoscopic esophagectomy and the relationship between the hypothermia and the air conditioning system of operation room were evaluated.

Methods

The subject of this study was 58 patients with esophageal cancer. Fifty of them were male and the others were female and the age was 65.2 + -8.4 years old. Forty three of 58 patients underwent the surgery in the old operation rooms (Group A) and 15 of them underwent it in the operation rooms with new air condirioning system (Group B). The 18 measuring points were picked up for each patient, which were from 10 to 180 minutes after start. The body temperatures were measured every 10 minutes after starting anesthesia. The temperature difference comparing with the starting point of surgery and the frequency of hypothermic state were evaluated. ‘Hypothermic state’ was defined that the temperature reduce more than 0.3 centigrade in comparison with the temperature at the starting point of surgery in this study.

Results

< 1 > The body temperature reduced early 60 minutes and then rose slowly. It reduce 0.22 + -0.35 centigrade at 60 minutes after starting surgery in comparison with the starting point of surgery. < 2–1 > The temperature of the patients in Group A reduced 0.24 + -0.03 centigrade and 0.32 + -0.09 centigrade at 30 and 60 minutes after starting surgery. But, the temperature of the patients in Group B reduced only 0.05 + -0.01 centigrade at 30 minutes after starting surgery and the temperature recovered at 60 minutes. These differences were statistically significant. < 2–2 > The total measuring points were 774 points in Group A and 270 points in Group B. The hypothermic state was observed 353 measuring points (45.6%) in Group A, and only 8 points (3.0%) in Group B. This difference was statistically significant.

Conclusion

The new operation rooms, in which the temperature of the air flow for the patients and that for surgeons can be set separately, is useful for keeping the body temperature of the patients adequately.

Disclosure

All authors have declared no conflicts of interest.
PS01.153: MEDIASTINOSCOPIC ESOPHAGECTOMY FOR THE PATIENT OF ESOPHAGEAL CARCINOMA WITH CHRONIC OBSTRUCTIVE LUNG DISEASE(COPD)
Authors: Ohara Masanori , Yamabuki Takumi
Published: September 2018

Background

Respiratory failure is one of fatal postoperative complication after esophagectomy. The patient with COPD is tendency to contraindication of esophagectomy. Thoracoscopic esophagectomy preserve respiratory function comparing with open esophagectomy. We suppose to preserve more respiratory function with mediasinoscopic esophagectomy.

Methods

77-year-old male. He had home oxygen therapy(HOT) by 1 liter oxygen per minute. Diagnosis was lower esophageal carcinoma with metastasis of upper mediastinum and cardiac lymphnode. We performed mediasinoscopic esophagectomy with lymphnode dissection.

Results

Pathological findings revealed adenocarcinoma with metastasis of cardiac and bilateral laringial nerve lymphnode. He recovered after one week mecanical ventilation. He discharged after rehabilitation.

Conclusion

The patient with COPD has high risk of esophagectomy. However, we suppose mediastinoscopic esophagectomy is one of the hopeful option incase of sufficient informed consent.

Disclosure

All authors have declared no conflicts of interest.
PS01.162: IS THERE A DIFFERENCE IN SURVIVAL BETWEEN YOUNGER AND OLDER GASTRIC CANCER (INCLUDING AEG II AND AEG III) PATIENTS AFTER GASTRECTOMY?
Authors: Babic Benjamin , Matthias Corvinus Florian , Hadjijusufovic Edin , Tagkalos Evangelos , Lang Hauke , Grimminger Peter
Published: September 2018

Background

The incidence of gastric cancer decreases in the western world, however, it remains one of the most common diseases (1). There is just little data from Europe comparing the outcome of young and elderly gastric cancer patients. This study compares, depending on the age of 266 patients, the outcome of 266 consecutive gastrectomy cases due to gastric cancer

Methods

266 consecutive patients with gastric cancer received a gastrectomy between 2008–2016 at our comprehensive cancer centre. The mean age of the patients in this study was 64 years old (21- 93 years). All patients were followed up regarding survival. The patients were separated in 6 different groups, depending on the age at the time of operation. The different groups were re-analysed and compared to each other regarding median and 5-year survival.

Results

In this collective the 5-year survival rate for all patients was 43%. There were more diffuse type adenocarcinomas in Patients < 40 years. In younger patients the tumour was staged in an advanced stadium compared to the elderly patients group. There is a significantly higher 5-year survival rate for younger patients after gastrectomy. There is no significant difference, when separating patient groups in to decades of age.

Conclusion

Young patients have a higher 5-year survival rate after gastrectomy compared to old patients. However, comparing patients from chronologic age in decades, the significance is not reproducible. Therefore gastrectomy or subtotal gastrectomy is the determining therapeutic approach for gastric cancer with an acceptable outcome in both young and elderly patients. Older patients might have an lower 5 year survival rate not only due to the cancer or the surgical therapy itself, it is related to comorbidities and a lower rate in neoadjuvant therapy as well

Disclosure

All authors have declared no conflicts of interest.
PS01.166: COLONIC INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY FOR CANCER: A SINGLE CENTER EXPERIENCE
Authors: Sabino Flávio , Guimaraes Marco , Fernandes Daniel , Eduardo Pinto Carlos , Felipe Pinto Luis , Ribeiro Luciana , Albagli Rafael , Hugo Vieira Vitor , Lopes Alberto , Da Câmara Eduardo
Published: September 2018

Background

The method of choice for esophageal replacement after esophagectomy for cancer is the gastric tube. However when the stomach is not available a colon graft interposition can be performed. The purpose of this retrospective study was to review our experience with colon interposition following esophagectomy for cancer and to assess the early surgical outcomes.

Methods

We reviewed clinical data from 26 consecutive patients who underwent colon interposition after esophagectomy for cancer between January 1990 and December 2017 at the Brazilian National Cancer Institute. Outcomes were compared with data in international publications on colon interposition.

Results

There were 22 (85%) males and 4 females with a mean age of 56 years (range, 28 to 79 years). Indications were adenocarcinoma in 21 (81%) and squamous cell carcinoma in 5 (19%). Seven (30%) patients received neoadjuvant treatment: in 3 cases chemotherapy and in 4 patients chemoradiation. Transhiatal esophagectomy and transthoracic esophagectomy were performed in 21 (81%) and 5 patients, respectively. The mean operative time was 389 min (range 120–660 min). The most common option for colon conduit was the left colon (63%). We performed hand-sewn anastomosis in the neck in all cases. Surgical morbidity was 65%, most commonly due to pulmonary complications. Anastomotic leakage occurred in 13 patients (50%). One case graft necrosis were observed and 9 (35%) reoperations were necessary. In-hospital mortality was 15%.

Conclusion

Our results are in line with the literature and demonstrate that colon interposition after esophagectomy is feasible and, despite having a significant morbimortality, appears to be a valuable alternative for the challenging situation where the stomach is not available.

Disclosure

All authors have declared no conflicts of interest.
PS01.170: IMPACT OF MUSCLE MASS, NUTRITIONAL STATUS AND MUSCLE STRENGTH ON OUTCOMES FOLLOWING SURGERY FOR ESOPHAGEAL CANCER
Authors: Hagens Eliza , Feenstra Minke , Van Berge Henegouwen Mark I , Gisbertz Suzanne
Published: September 2018

Background

Muscle function loss and loss of skeletal muscle have been associated with worse outcomes following surgery for malignancies of gastrointestinal origin. The influence on post-operative outcomes and survival after esophageal surgery remains unclear. Primary objectives of this study were to evaluate the incidence of sarcopenia and malnutrition and to evaluate the influence of skeletal muscle surface area and muscle strength on postoperative outcomes and overall survival in esophageal cancer patients.

Methods

A retrospective cohort study from a prospective database was conducted in patients with resectable esophageal cancer who underwent curative-intent treatment between January 2011 and January 2016. Skeletal muscle surface area was calculated with CT scans at L3 level and corrected for height and weight before start of treatment and in the interval between neoadjuvant treatment and surgery. Muscle strength was evaluated with various tests on muscle functions and lung function tests. Nutritional status was evaluated using BMI.

Results

273 Patients were included. There were 4 patients with sarcopenia before neoadjuvant therapy and only one patient with sarcopenia after completion of neoadjuvant therapy. Median skeletal muscle surface area was 78cm2/m2 for men and 61cm2/m2 for woman. Table 1 shows skeletal muscle surface area, muscle strength and BMI in relation to no, minor or major complications. Muscle strength and nutritional status did not have a significant influence on postoperative complications and overall survival.

Conclusion

Sarcopenia did not occur frequently in this cohort with potentially curable esophageal cancer patients. Muscle function, skeletal muscle index and BMI did not statistically influence post-operative complications or survival.

Disclosure

All authors have declared no conflicts of interest.
PS01.171: DOUBLE-PEDICLED FREE JEJUNAL TRANSFER FOR RECONSTRUCTION OF PHARYNGOLARYNGOESOPHAGECTOMY
Authors: Mukaide Hiromi , Michiura Taku , Inoue Kentaro , Miki Hirokazu , Yamamichi Keigo , Hamada Madoka
Published: September 2018

Background

We recently selected double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy to reduce the vascular thrombosis-induced necrosis in free jejunal transfer. We herein report our experience with this procedure.

Methods

Single-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy was performed from January 2006 to November 2013, and double-pedicled free jejunal transfer (i.e. two pairs of jejunal arteriovenous anastomoses) was performed from December 2013 to December 2016 in Kansai Medical University Hospital. We compared the perioperative outcomes and complications between these two procedures.

Results

Sixty-two patients (58 men, 4 women; median age, 66 years; age range, 51–83 years) underwent single-pedicled free jejunal transfer. Twenty-eight patients (25 men, 3 women; median age, 70 years; age range, 47–84 years) underwent double-pedicled free jejunal transfer. Twenty-eight patients received preoperative treatments. Table 1 shows the perioperative outcomes and complications.

Conclusion

No thrombus of the free jejunum occurred, no anastomotic leakage occurred, and all flaps survived in the double-pedicled free jejunal transfer group. We believe that double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy is a reliable and useful procedure.

Disclosure

All authors have declared no conflicts of interest.
PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY.
Authors: Hirata Yuki , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Nakamura Rieko , Suda Koichi , Wada Norihito , Kitagawa Yuko
Published: September 2018

Background

In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications.

Methods

We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016.

Results

The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group.

Conclusion

In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications.

Disclosure

All authors have declared no conflicts of interest.
PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE
Authors: Antonio Guimaraes Filho Marco , Sabino Flávio , Fernandes Daniel , Eduardo Pinto Carlos , Felipe Pinto Luis , Ribeiro Luciana
Published: September 2018

Background

Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed.

Methods

The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival.

Results

Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months.

Conclusion

Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care.

Disclosure

All authors have declared no conflicts of interest.
PS01.191: LAPAROSCOPIC TRANSHIATAL LOWER MEDIASTINAL LYMPHADENECTOMY FOR ESOPHAGOGASTRIC JUNCTIONAL CANCER: THE INFRACARDIAC BURSA AS A LANDMARK
Authors: Kurahashi Yasunori , Nakamura Tatsuro , Ozawa Rie , Nakanishi Yasutaka , Niwa Hirotaka , Ishida Yoshinori , Shinohara Hisashi
Published: September 2018

Background

Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection.

Methods

We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB.

Results

In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy.

Conclusion

In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark.

Disclosure

All authors have declared no conflicts of interest.
PS01.194: CLINICOPATHOLOGICAL EXAMINATION OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA TREATED WITH CURATIVE SURGERY
Authors: Kaida Sachiko , Yamaguchi Tsuyoshi , Takebayashi Katsushi , Miyake Toru , Iida Hiroya , Sonoda Hiromichi , Shimizu Tomoharu , Tani Masaji
Published: September 2018

Background

Compared to Western countries, Japanese esophagogastric junctional carcinoma (JC) demonstrates different epidemiologic backgrounds; squamous cell carcinoma is dominant over Barrett adenocarcinoma, and there is no consensus on surgical approach or dissection range of lymph node. JC is defined as the cancer, that is the center of the tumor is within 2 cm from the esophagogastric junction to the esophagus and stomach respectively by the Japanese Classification of Esophageal Cancer, 11th edition. According to this definition, we examined the clinicopathological features and treatment outcomes of patients who underwent curative resection and pathologically defined as JC.

Methods

From 2012 to 2018, 19 consecutive patients with JC who received with curative surgery in Shiga University of Medical Science Hospital were included. Clinicopathological classification was based on Japanese Classification of Esophageal Cancer, 11th edition.

Results

The patients consisted of 14 males and 5 females, median age was 68 (43–91) years old. Pathological diagnoses were 15 adenocarcinoma, 1 squamous cell carcinoma, 2 mixed adenoneuroendocrine carcinoma (MANEC) and 1 malignant melanoma. Patients with Barrett's esophagus were 6 cases (31.6%). Median tumor diameter was 54 mm (5–90 mm) and tumor location was E:3 cases (15.8%), EG:6 cases (31.6%), E = G:1 case (5.2%), GE:8 cases (42.1%) and G:1 case (5.2%). Surgical procedure was esophagectomy via right thoracotomy 6 cases, esophagectomy via left thoracotomy 2 case and laparotomy 11 cases. Tumor invasion was pT1:6 (31.6%), pT2:3 (15.8%), pT3:3 (15.8%) and pT4:7 (36.8%). Lymph node metastases were observed in 13 cases (68.4%) and #1,2,3:13 cases (100%), #4,5: 2 cases (15.4%), #7,8a,9: 4 cases (30.8%), #19,20: 3 cases (23.1%) and #105–110: 3 cases (23.1%). Among 7 recurrence patients, peritonitis carcinomatosa was 4 cases.

Conclusion

In all positive lymph node metastasis cases, metastasis was observed in #1, 2 and 3 lymph nodes, but metastasis to the cervical lymph node was not observed. In the G, GE cases, right thoracotomy was not performed because there were no metastases to the upper mediastinal lymph nodes. In conclusion, these results suggested that surgical operation could be reduced to proximal gastrectomy for early G, GE cases. However, the number of cases is small in this study, further investigation is necessary.

Disclosure

All authors have declared no conflicts of interest.
PS01.197: SURVIVAL COMPARISON BETWEEN IVOR-LEWIS AND MCKEOWN MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROSPECTIVE RANDOMIZED STUDY
Authors: Lee Jang-Ming , Chen Pei-Hsing
Published: September 2018

Background

Both Ivor Lewis (anastomosis in the chest) and McKeown (anastomosis in the neck) esophagectomy has been used to treat patients with esophageal cancer. It is unclear in literature about the survival difference performed by these two methods.

Methods

A prospective randomized trial enrolling 100 patients with esophageal cancer in the middle or lower esophagus was done to compare the survival outcome treated with minimally invasive esophagectomy by Ivor Lewis and McKeown approaches. Analysis for the retrospective patient cohort (n = 253) including Ivor Lewis (n = 115) and McKeown (n = 138) MIE in the same hospital was also performed.

Results

There is no significant difference in the overall and disease progression-free survival duration between the two groups of patients (n = 50 for each group) (Figure 1 for overall survival). Similar results were found when the comparison was done for the retrospective and whole patients cohort. Multivariate analysis demonstrates the TNM staging of the tumor to be the single significant factor for prognosis in terms of overall and disease progression-free survival. There was no significant difference in overall and disease progression- free survival between the patients with Ivor Lewis and McKeown MIE both in prospective and retrospective study cohort.

Conclusion

Ivor Lewis and McKeown MIE provide a similar survival results for the patients with esophageal cancer in the middle and lower thoracic esophagus.

Disclosure

All authors have declared no conflicts of interest.
PS01.205: FEASIBILITY OF ENHANCED RECOVERY PROTOCOL AFTER ESOPHAGEAL SURGERY IN ELDERLY PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Alberto De Pasqual Carlo , Weindelmayer Jacopo , Giacopuzzi Simone , Alberti Luca , La Mendola Roberta , Laiti Silvia , De Manzoni Giovanni
Published: September 2018

Background

The use of ERAS (Enhanced Recovery After Surgery) protocols, to reduce morbidity and accelerate recovery is spreading in general surgery. In dedicated centres these programs have been successfully applied after oesophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients.

Methods

We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, in the period 2015–2017. We divided the patients into two groups: 47 patients (65,3%) were < 70 years old (Young Group, YG) while 25 patients (34,7%) were ≥ 70 years old (Elderly Group, EG). We compared post-operative outcomes and adherence to ERAS steps of the two groups.

Results

The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG P = 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, P = 1). We did not reporte 90-days mortality. We did not observe differences in adherence to ERAS step: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, P = 0,7), peri-dural catheter for analgesia placement (89,3% in YG vs 88,0% in EG, P = 1), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, P = 0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, P = 0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, P = 1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, P = 0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, P = 0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, P = 0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, P = 0,6). Median day of discharge was POD 8 for both groups (P = 0,8).

Conclusion

In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy. An experienced team is needed to achieve this results.

Disclosure

All authors have declared no conflicts of interest.
PS01.209: POPULATION-LEVEL SURVIVAL FOR ESOPHAGEAL CANCER: AN ANALYSIS OF 13,930 PATIENTS IN A REGIONALIZED, SINGLE-PAYER HEALTH SYSTEM
Authors: Gupta Vaibhav , Kidane Biniam , Ringash Jolie , Sutradhar Rinku , Darling Gail , Coburn Natalie
Published: September 2018

Background

Despite advances in medical and surgical treatment, esophageal cancer remains a high-fatality disease. Regionalized cancer care may improve short and long-term survival. This study defines perioperative and long-term survival for esophageal cancer on a population level.

Methods

A population-based retrospective cohort study in a single-payer health system (Ontario, Canada; population 13.6M) was performed using linked health administrative data. Adults diagnosed with adenocarcinoma or squamous cell esophageal and esophagogastric junction cancer between 2002–2014 were included. Thoracic surgery was regionalized to 15 centres of excellence by 2010. The Kaplan-Meier method was used to estimate median survival. Rates of perioperative mortality, defined as in-hospital and 90-day post discharge death, were calculated before and after regionalization. Multivariable logistic and Cox proportional hazards regression analyses were used to identify factors associated with short and long-term survival.

Results

13,930 patients were diagnosed with esophageal cancer during the study period. Median survival was 10.1 months from date of diagnosis (95% CI 9.9–10.5), and marginally better for patients with adenocarcinoma compared to squamous cell carcinoma (10.4 vs 9.0 months, P = 0.002). Cox regression analysis showed age, socioeconomic status, and region of residence were significantly associated with long-term survival. Approximately 30% of the cohort (n = 3880) underwent curative-intent surgery and had a median survival of 24.5 months (95% CI 23.4–25.9) from the date of surgery. In these patients, age, socioeconomic status, major surgical complications and year of diagnosis were significantly associated with long-term survival (P < 0.001). Perioperative mortality decreased from 13.8% in 2002 to 5.4% in 2014 (P < 0.001). Only age and major surgical complications were associated with increased perioperative mortality (P < 0.001). Surgery at a thoracic centre reduced the odds of perioperative mortality (OR 0.63, 95% CI 0.49–0.81), but did not influence long-term survival (P = 0.79).

Conclusion

Median survival for patients diagnosed with esophageal cancer remains poor but is greater than two years for patients undergoing curative-intent surgery. Perioperative mortality significantly decreased over time as surgical care was regionalized to centres of excellence, but this has not affected long-term survival. Further work should analyze variation in short and long-term survival across thoracic surgery centres of excellence.

Disclosure

All authors have declared no conflicts of interest.
PS01.213: COMPARISON OF MANUAL VERSUS MECHANICAL INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSIS IN RADICAL 2-STAGE MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER
Authors: Charalabopoulos Alexandros , Farhangmehr Neda , Akitikori Temisanren , Shanmuganathan Kanatheepan , Soile Oluwasunmisola , Hussain Aadil , Tang Cheuk , Venkatesh Jayanthi Naga , Lorenzi Bruno
Published: September 2018

Background

While in open esophagectomy a plethora of studies comparing outcomes of mechanical (circular or linear stapler) versus hand-sewn intra-thoracic anastomosis have been published, little evidence exists regarding 2-stage minimally invasive esophagectomy; In the majority of published studies the mechanical anastomosis is favored. Construction of the intra-thoracic esophago-gastric anastomosis in minimally invasive esophagectomy is the procedure's rate limiting step. We aim to present our results of hand-sewn versus mechanical anastomosis in 2-stage minimally invasive esophagectomy.

Methods

Data of 113 consecutive patients over a 20-month period that underwent 2-stage minimally invasive esophagectomy for cancer in our institution were analyzed. Inclusion criteria included only 2-stage and only minimally invasive esophagectomies for cancer. 43 cases underwent fully minimally invasive esophagectomy and 70 had laparoscopic-assisted hybrid esophagectomy. A fully hand-sewn anastomosis with 3/0 v-lock barbed suture was formed in 38% of cases and a mechanical anastomosis with a 25mm or 28mm circular stapler was formed in 62% of cases. Comparison between anastomotic techniques was assessed through Chi-Square and Log-Rank analysis.

Results

Median age was 68(IQR,47–82) in manual anastomosis group and 65(IQR,31–81) in circular stapler group. Of the manual anastomosis group, 74% received neo-adjuvant treatment versus 20% of the mechanical anastomosis group. In the manual anastomosis group n = 3(6.97%) developed a leak; of these, n = 2 were stented and n = 1 was subclinical requiring no intervention. There was one sepsis-related death; 30-day mortality was 2.3%. In the mechanical anastomosis group n = 2(2,8%) developed anastomotic leak (one combined with tracheo-esophageal fistula) and both were stented and eventually resulted in mortality. 30-day mortality was 2.8%. No conduit necrosis was noticed. Anastomotic strictures requiring dilatation were seen in n = 4(9.3%) in the manual anastomosis group versus n = 5(7.1%) in the mechanical anastomosis group. No statistically significant difference was found between the groups in terms of leak (P = 0.312), stricture (P = 0.698) and mortality rate (P > 0.005). Median length of stay was 11 days (7–70) in the manual anastomosis group and 12 days (7–51) in mechanical anastomosis group.

Conclusion

Outcomes between manual and mechanical intra-thoracic anastomosis in minimally invasive esophagectomy show no difference within our study group. Both are equally safe and efficient, with surgeon's preference taking priority.

Disclosure

All authors have declared no conflicts of interest.
PS01.223: ‘ENERGY-LESS TECHNIQUE’ WITH MINI-CLIPS FOR RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION IN PRONE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Saeki Hiroshi , Nakashima Yuichiro , Kubo Nobuhide , Hirose Kosuke , Sasaki Shun , Jogo Tomoko , Taniguchi Daisuke , Edahiro Keitaro , Korehisa Shotaro , Nakanishi Ryota , Ando Koji , Oki Eiji , Maehara Yoshihiko
Published: September 2018

Background

Esophagectomy with radical mediastinal lymph node dissection remains the standard option for the curative treatment of esophageal squamous cell carcinoma. However, meticulous lymph node dissection along the recurrent laryngeal nerve (RLN), often results in recurrent laryngeal nerve paralysis (RLNP), leading to postoperative laryngopharyngeal dysfunction. Recently, thoracoscopic radical esophagectomy has been performed as a minimally invasive surgery for esophageal cancer. Although thoracoscopic surgery appears to reduce the risk of postoperative pulmonary complications and permits earlier postoperative recovery, the issue of postoperative RLNP remains unresolved.

Methods

We had attempted to simply cut the vessels around RLN sharply with scissors without using energy device in order to prevent RLN paralysis. However, these procedures often result in minor bleeding. Then we introduced the use of mini-clips for hemostasis before cutting the vessels with scissors. In this study, we analyzed data from 64 patients with esophageal cancer who underwent thoracoscopic esophagectomy in prone position. The patients were divided into two groups according to the period of operation: before and after the introduction of energy-less techniques with mini-clips. Surgical results were compared between the 2 groups.

Results

With regard to RLNP, the incidence was 24.0% in the before group; this incidence went down to 5.1% in the after group, after the introduction of energy-less techniques with mini-clips (P = 0.0259). Moreover, length of hospital stay after surgery was significantly shortened, from 36.1 days to 22.0 days, after the introduction of energy-less techniques with mini-clips (P = 0.0075). There were two operators performing thoracoscopic esophagectomy at our institution: surgeon A, a senior doctor with a 22-year career; and surgeon B, a junior doctor with a 12-year career. We compared all surgical results and found that there were no differences between the two doctors.

Conclusion

Our energy-less technique with mini-clips in RLN lymph node dissection could keep the surgical field dry by preventing minor bleeding. This contributed both to prevent RLNP and to shorten the patient's hospital stay. This technique was also considered useful for standardizing procedures within our institution, because special skills were not needed.

Disclosure

All authors have declared no conflicts of interest.
PS01.231: EFFICACY OF ARTIFICIAL PNEUMOTHORAX WITH SINGLE-LUMEN TRACHEAL TUBE VENTILATION IN THORACOSCOPIC SUBTOTAL ESOPHAGECTOMY IN THE SEMI- PRONE POSITION
Authors: Saito Masaaki , Kiyozaki Hirokazu , Obitsu Tamotsu , Ishioka Daisuke , Takahashi Jun , Rikiyama Toshiki
Published: September 2018

Background

Thoracoscopic esophagectomy for esophageal cancer performed with single-lumen tracheal tube ventilation in the semi-prone position provides the advantages of easier anesthesia induction; easiness of left-sided recurrent laryngeal nerve lymph node dissection; and shortening of the transit time to laparotomy. The aim of this study was to clarify the surgical safety and anesthetic procedure associated with thoracoscopic esophagectomy with single-lumen tracheal tube ventilation by intraoperative monitoring of respiratory status and hemodynamic changes.

Methods

A total of 30 patients with esophageal cancer who underwent thoracoscopic subtotal esophagectomy at our institute from January 2014 to December 2017 were retrospectively reviewed. Cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), end-tidal carbon dioxide pressure (EtCO2), and tidal volume (TV) using FloTrac system were measured.

Results

There were no significant changes in CI, SVRI, and MAP during artificial pneumothorax. Conversely, PaCO2 and EtCO2 gradually increased during artificial pneumothorax (P < 0.05) and decreased to almost their original levels thereafter. Furthermore, progressive reduction in tidal volume was observed in four cases after anti- side pneumothorax due to the injury of the left pleura with lymph node dissection. The mean TV and mean PaO2 were 0.42 L and 229.0 mmHg during artificial pneumothorax, respectively.

Conclusion

There was no exaggerated circulatory or ventilatory depression during artificial pneumothorax in the semi-prone position. Artificial pneumothorax with single-lumen tracheal tube ventilation in thoracoscopic subtotal esophagectomy may be a reliable anesthetic procedure. However, further examinations in the future will be necessary to determine its safety.

Disclosure

All authors have declared no conflicts of interest.