bluuebunny/crossref_metadata_2025 huggingface dataset:
506. CLINICAL OUTCOMES OF A NEW SURGICAL TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE: RETROSPECTIVE CHART REVIEW OF 28 PATIENTS FROM GERMANY
Authors: Elshafei Moustafa
Published: September 2024

Background

Gastroesophageal reflux disease (GERD) is a troublesome gastrointestinal ailment with significant prevalence worldwide. First-line treatment is attempted with proton pump inhibitor (PPI) therapy, but about 40% of patients experience irresponsiveness. Inadequate response, intolerance, or aversion to long-term therapy are indications for anti-reflux surgery. Fundoplication techniques, magnetic sphincter augmentation, and endoscopic techniques are existing surgical options, but are often associated with postoperative complications like dysphagia. The RefluxStop implant is an emerging technology that has demonstrated effectiveness in managing patients with chronic GERD. This report summarizes the clinical outcomes of 28 patients managed with RefluxStop at a German institution.

Methods

The RefluxStop procedure was performed on 28 patients with chronic GERD in a German center between July 2021 and November 2023. Data was obtained from a retrospective chart review to present the clinical outcomes following RefluxStop surgery, including GERD Health-Related Quality of Life (GERD-HRQL), PPI use, symptom resolution, patient satisfaction, and perioperative adverse events (AEs).

Results

Twenty-eight patients were followed for 14.1±4.7 months. Baseline patient characteristics are shown in Table 1. Median GERD-HRQL score decreased by 90% from a baseline of 40 (IQR 17) to 4 (IQR 5) at follow-up. PPI use decreased from 96.4% at baseline to 7.1% at follow-up. Almost 93% of reflux symptoms were eliminated. Only one patient (3.6%) was not satisfied with treatment. All patients with dysphagia at baseline (42.9%) experienced complete resolution. No reoperations or esophageal dilations were required. Seven patients experienced minor intraoperative AEs (e.g., neck emphysema) but none were procedure- or device-related.

Conclusion

This cohort of GERD patients in Germany demonstrated the safety and effectiveness of the RefluxStop procedure. Significant improvements in quality of life, PPI use, and reflux-related symptoms were observed without consequential safety concerns for over one year. Furthermore, this study corroborates the existing evidence of favorable postoperative safety outcomes associated with RefluxStop. Additional study is necessary to continue validation of this promising new treatment option.
513. ICG -TRACHEOBRONCHIAL FLUORESCENCE IN ESOPHAGEAL SURGERY
Authors: Thammineedi Subramanyeshwar Rao
Published: September 2024

ICG-Tracheobronchial Fluorescence is a useful technique to delineate the tracheo esophageal plane during Esophagectomy. Particularly beneficial for the less trained eye and in salvage settings.

https://drive.google.com/file/d/1BXHMcAmJsDkI4bp8YmQqv85etcVuUqKj/view?usp=drive_link
520. TEMPORARY ESOPHAGEAL EXCLUSION IN THE MANAGEMENT OF DELAYED RECOGNITION OF THORACIC ESOPHAGEAL PERFORATION
Authors: Sacco Michele , Bencivenga Maria , Cucè Federica , Guerzoni Giacomo , Zenzaro Matteo , De Pasqual Carlo Alberto , de Manzoni Giovanni , Giacopuzzi Simone
Published: September 2024

Background

Perforation of the esophagus is a rare surgical emergency and timing is crucial for prognosis. Late interventions are likely to result in terminal bipolar esophageal exclusion, requiring a subsequent reconstructive procedure to restore the esophageal transit, associated with high rate of morbidity and mortality.

Methods

From January 2013 to June 2023, 32 patients with esophageal perforations referred to our center required surgical treatment. We retrospectively analyzed two cases of late middle thoracic perforation treated with temporary esophageal exclusion.

Results

A 31-year-old male presented in May 2020 after 6 days from perforation due to bolus impaction in eosinophilic esophagitis and a 79-year-old male referred us in November 2022 8 days after Boerhaave syndrome.

Direct closure wasn’t feasible due to tissue fibrosis and degeneration. In both cases we performed thoracoscopic toilette with drainage placement and bipolar temporary exclusion of the esophagus. A lateral esophagostomy was performed, and cardias was temporarily excluded. In the first case a PTFE prothesis was used as a loop around the EGJ and fixed on the abdominal esophagus, in the second case TA45 linear stapler loaded with 3.5 staples was used. For nutritional purposes a gastrostomy and a jejunostomy were placed.

Post-operatively, pleural empyema was managed conservatively with a thoracic drain and antibiotic therapy, instead mediastinal collection sustained by the perforation was drained through the tangential esophagostomy with a NG tube placed endoscopically across the perforation.

The patients were discharged in 27 and 20 POD respectively. The second patient was readmitted in 45 POD due right lobar pneumonia, treated with antibiotics.

In the first case the PTFE prothesis was laparoscopically removed after 70 days and the tangential esophagostomy sutured. In the second case esophageal transit was spontaneously restored and esophagostomy was subsequentially sutured.

Oral feeding was resumed in both patients, without resulting stenosis or leakage.

Conclusion

In selected patients with late thoracic esophageal perforations, temporary esophageal exclusion represented an alternative treatment, without mortality and with low morbidity, to terminal esophageal exclusion and a subsequent reconstructive procedure.
525. PALLIATIVE MULTIMODALITY-THERAPY, EVEN WITH ABBREVIATED IMMUNOTHERAPY CAN MAKE CURATIVE SURGERY FOR SYNCHRONOUS LUNG AND ESOPHAGEAL CANCER POSSIBLE: A CASE REPORT
Authors: Van Dyck Robbe , Decker Georges
Published: September 2024

Background

Synchronous lung and esophageal carcinomas are problematic. When both cancers are locally advanced, combined surgical treatment is rarely possible because of high-risk or insufficient respiratory reserve. Palliative treatment including immunotherapy can sometimes offer significant tumor response and potentially prolong survival in patients with PDL-1 tumor expression. However the place of immunotherapy for potentially rendering inoperable patients operable is still unknown.

Methods

Case report: A 78-year-old male with smoking history was diagnosed with synchronous locally advanced adenocarcinoma of the Gastroesophageal Junction (GEJ) cT3cN1cM0 and bilateral lung adenocarcinomas stage 4a, cT2cN1cM1a (right lower lobe 43mm confirmed by CT-guided biopsy, left upper lobe 32mm and additional S6 left lower lobe nodule). The patient was considered incurable by MDT and palliative treatment was offered as both cancers had significant PDL-1 expression (GEJ: CPS score >1, Lung: PDL-1 expression 90%). Pembrolizumab immunotherapy was started but poorly tolerated (severe myositis) and stopped again after only 6 weeks. The left-sided lung cancer had by then already regressed and stereotactic irradiation (SBRT 5x12Gy) of the right-side lung cancer was administered resulting in further local tumor control (figure).

Endoscopic tumor re-evalution showed a Siewert type 2 tumor (uT3N1) similar to the initial endoscopy 15 months before. Both side lung adenocarcinomas remained regressed and the left lower lobe nodule was unchanged (6mm). Mediastinal lymph node staging by EBUS was negative.

Thirteen months after initial diagnosis, 4 cycles of neo-adjuvant chemotherapy (FLOT) were administered. Combined synchronous surgery was finally done 16 months after initial diagnosis.

A minimally invasive combined resection included a laparoscopic & thoracoscopic Ivor-Lewis MIE, left thoracoscopic wedge of the lower lobe nodule and a right lower lobectomy with radical lymph node dissection. Post-operative course was smooth: Clavien-Dindo score 1, hospital stay 18 days.

Final pathology

Distal third adenocarcinoma (1.5x1.2cm above Z-line) with major partial response ypT2N0M0, R0, 0/43 lymph nodes (subcarinal signs of nodal response), right lower lobe tumor of 60x55mm with residual 1.2mm focus of residual viable adenocarcinoma (ypTisN0M0, R0) and left lower lobe hamartoma (6mm). Follow-up showed no recurrence 9 months after surgery (25 months from initial diagnosis).

Conclusions:

1) Despite much abbreviated palliative immunotherapy (6 weeks), SBRT and FLOT our patient was down-staged within 16 months from an initially palliative situation to a potential cure with complete resection of all tumors.

2) Synchronous combined radical laparoscopic & thoracoscopic Ivor-Lewis esophagectomy with lung lobectomy can be feasible after immuno-, chemo- and radiotherapy even in elderly patients.
540. INFILTRATION OF RESECTED OESOPHAGEAL ADENOCARCINOMA WITH ANTIGEN-EXPERIENCED PD-1 AND CD39 POSITIVE CD8+ TISSUE RESIDENT MEMORY CELLS CORRELATE WITH IMPROVED SURVIVAL
Authors: Hill Samuel Luke , Harrington Jack , James Edd , Underwood Timothy , Elliott Tim
Published: September 2024

Background

The development of novel treatments for oesophageal adenocarcinoma (OAC) represents an area of significant unmet need. Despite the application of immune checkpoint blockade alongside chemotherapy as standard of care for some patients with metastatic OAC, responses to immunotherapies are modest and 5-year survival is 17%. The reasons for this remains unclear and while tumour infiltration with CD8+ T lymphocytes (TILs) at the time of resection is associated with improved outcomes, this heterogeneous population remains incompletely characterised in OAC. Tissue resident memory cells (TRM) are increasingly understood as key mediators of immunotherapy response but their role in OAC is poorly understood.

Methods

Tumour samples were accessed by punch biopsy from the central portion of cancers resected from 44 patients undergoing curative surgery for OAC. Samples were assessed by multi-parametric flow cytometry for the presence of antigen-experienced TILs and markers of activation and exhaustion. Populations of antigen-experienced PD-1 and CD39 positive CD8+ OAC TILs were sorted, and bulk RNA sequencing (RNAseq) undertaken using a modified SmartSeq2 protocol allowing differential gene expression analysis and gene set enrichment analysis. Flow cytometric assessment of functionality was completed.

Results

Resected OAC are often highly infiltrated with antigen experienced CD8+ TILs expressing high levels of PD-1 and CD39 and an abundance of this population correlates with improved survival (%PD-1/CD39+ >Median, OS HR 0.12). RNAseq of sorted TILs identified this PD-1+ and CD39+ lymphocyte population as enriched for precursor exhausted-like CD8+ TRM (NES 2.01 p=0.00). This is correlated by their CD103+ and TIM3- predominance on flow cytometry in keeping with TRMsassociated with immunotherapy response in other cancers. This population demonstrated a maintained proliferative potential, an ability to degranulate and produce the key effector molecules IFN-γ, TNF-α and Granzyme B.

Conclusions

An abundance of a PD-1 and CD39 positive CD8+ TIL population, consistent with a precursor exhausted-like TRM population with maintained proliferative and functional capacity, is observed to correlate with improved outcomes following curative surgery for OAC. This TRM population is consistent with analogous populations observed to be responsible for immunotherapy response in other cancers and their identification may predict benefit from such approaches in OAC and allow better patient selection for treatment with immune checkpoint inhibitors.
545. HIATAL HERNIA RECURRENCE: IS OBSTRUCTIVE SLEEP APNEA A RISK FACTOR?
Authors: Latorre-Rodriguez Andres R , Babarinde Oluwatosin A , Patel Sagar , Mittal Sumeet K , Bremner Ross M
Published: September 2024

Background

A plausible mechanism explaining how obstructive sleep apnea (OSA) triggers gastroesophageal reflux disease (GERD) through hiatal hernia (HH) has been proposed but also ignored in clinical practice. We sought to determine if there were differences in the prevalence of OSA between patients undergoing redo-HH repair and a matched cohort undergoing primary HH repair.

Methods

After IRB approval, we conducted a single-center retrospective cohort study. A prospectively maintained database was queried to retrieve clinical information of all the patients who underwent HH repair by a foregut surgeon between September 2016 and July 2023. The first group included patients who underwent redo-HH repair due to HH recurrence, and the second group included patients who underwent primary HH repair. Matching was performed in a 1:2 ratio using a propensity-score method based on age, sex, body mass index (BMI), history of chronic respiratory conditions other than OSA, history of smoking, and alcohol abuse.

Results

During the study period, 63 patients underwent redo-HH repair, and 370 underwent primary HH repair. After matching, 57 patients in the redo-HH repair and 114 in the primary HH repair were included, and all covariates showed adequate balance (Table 1). Patients undergoing redo-HH repair had a slightly higher prevalence of OSA compared to those who underwent primary repair (22.8% [CI95:11.91-33.7%] vs. 14.0% [CI95:7.7-20.4%], χ2 = 2.076, p=0.150).

Conclusion

Despite not reaching statistical significance, a relatively higher prevalence of OSA among patients undergoing redo-HH was found. Our study was limited by the retrospective design and inability to characterize the severity of OSA as well as patient compliance to treatment. Future prospective studies assessing this potential causality should be undertaken.
547. DISEASE SPECIFIC MORTALITY OF EARLY-STAGE ESOPHAGEAL NEOPLASIA IN BARRETT’S ESOPHAGUS TREATED WITH ENDOSCOPIC THERAPY
Authors: Pan Sally , Hattersley Grace , Sujendran Vijayendran , Modolell Ines , O'Neill Robert , Di Pietro Massimiliano
Published: September 2024

Background

High-grade dysplasia (HGD) and intramucosal (T1a) esophageal adenocarcinoma (EAC) are indication for endoscopic eradication therapy (EET) with endoscopic resection (ER) and/or radiofrequency ablation (RFA). The goal of the endoscopic therapy is to prevent progression to advanced EAC and cure the underlying Barrett’s esophagus (BE) when present. Previous studies have showed high rate of success of EET in short term, however little is known about long term results of EET. We aimed to evaluate long-term outcome of EET with particular reference to disease specific mortality and progression to major surgery.

Methods

We conducted a single center retrospective study including patients who underwent EET for HGD and T1a EAC January 2005-December 2022. We excluded patients with gastric disease and evidence of T1b EAC at baseline ER. Primary outcomes assessed disease specific mortality (DSM) of esophageal cancer in this longitudinal cohort, which is defined as death within 12 months of progression to advanced cancer. Secondary outcomes evaluate endoscopic recurrence, progression to esophagectomy, post-procedure complications and 5-year overall survival.

Results

299 patients were included in this study. 252 were treated with a combination of ER and RFA, whereas 47 only received primary RFA. Median number of EET sessions in both patient groups is 4(p=0.48). Patients with HGD were more likely to be detected on surveillance compared to those with T1a EAC (p=0.004). We demonstrate a DSM rate of 2.7%(n=8), with a 5-year overall survival of 74.6%(n=223). 5.7%(n=17) of patients sustained severe post-procedure complications (Clavien-Dindo>3). Endoscopic recurrence occurred in 18.7%(n=56) and 6.7%(n=20) developed disease progression that required surgical intervention. Baseline T1a was associated with higher rates of esophagectomy compared to HGD (p=0.0135).

Conclusion

EET is a safe and effective treatment for patients with early-stage esophageal neoplasia. In comparison to esophago-gastric surgery, EET offers excellent results with a significantly lower morbidity and mortality risk. However, it is resource intensive as patients often require multiple treatments with long-term, routine surveillance. Patients also require strict compliance to maximize therapeutic outcomes and prevent recurrence or progression. Further studies are required to improve risk-stratification in this cohort and determine the optimal surveillance strategy post EET.
550. INTRAOPERATIVE VOLUME STATUS DOES NOT AFFECT ERAS OUTCOMES OR COMPLICATION RATES IN HYBRID ROBOTIC ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Stiles Erik , Hoctor PA-C Caolin , Udea Goro , Sternbach Joel , Low Donald , Hubka Michal
Published: September 2024

Background

Intraoperative volume management in patients undergoing esophagectomy is nuanced. Data is conflicting in regards to the benefits of volume restrictive versus liberal approaches. Within a hybrid robotic assisted minimally invasive esophagectomy (hRAMIE) population undergoing oncologic resection there is a paucity of data regarding intraoperative volume status as it affects postoperative outcomes and no data regarding the impact on enhanced recovery after surgery (ERAS) outcomes.

Methods

Demographics, anthropometrics, cancer characteristics, and perioperative outcome data were gathered between January 2020 and December 2023 at a single, tertiary referral center in patients undergoing oncologic hRAMIE. Intraoperative volume status was defined, as in other reports, by identifying the median operative volume rate per hour and normalizing via the Du Bois body surface area; above or below 225 mL/hour/m2. ERAS outcomes were reported. Complications were stratified in accordance with the Esophagectomy Complications Consensus Group guidelines. Continuous variables were compared via Mann-Whitney U-Test; categorical via Fisher's Exact. Alpha set to 0.05.

Results

96 patients (46 volume restrictive, 45 volume liberal) were identified. There were no differences in age, sex, body mass index, ASA class, Charlson Comorbidity Index, cancer histology, location, rate of neoadjuvant chemotherapy, or chemoradiotherapy. ERAS outcomes analysis reveals no statistical difference in ICU length of stay, mobilization times, return of bowel function, or length of stay (Table 1). Complications were reported in 45.8% of patients and did not differ between groups (p=0.8934). Pulmonary complications were most frequent (total 21.9%; restrictive 17.4%, liberal 28.9%, p=0.1422) followed by anastomotic leak (total 12.5%; restrictive 17.4%, liberal 8.9%, p=0.3681).

Conclusion

The current study demonstrates no impact of volume restriction on perioperative outcomes, ERAS benchmarks, or length of stay in patients undergoing hRAMIE for esophageal cancer. Data suggests that minimally invasive approaches may be associated with less total body and pleural inflammatory mediator generation, perhaps limiting susceptibility to variation in volume status. Highly powered, multicenter retrospective minimally invasive esophagectomy and volume status investigation is warranted prior to proceeding with controlled trial.
555. SUPRACLAVICULAR NODE INVOLVEMENT, A NODAL OR METASTATIC DISEASE? - A 10-YEAR EXPERIENCE IN ESOPHAGEAL CARCINOMA AT A TERTIARY REFERRAL CENTRE
Authors: Tsai Alice Yi-Chien , Guo Jhe-Cyuan , Chen Ke-Cheng , Kuo Shuenn-Wen , Huang Ta-Chen , Hsu Chih-Hung , Chen Chia-Hsien , Huang Pei-Ming , Lee Jang-Ming
Published: September 2024

Background

Despite the advance in neoadjuvant chemothepray/chemoradiotherapy and favourable outcomes of surgical management in supraclavicular lymph node (SCLN) involvement reported in recent studies, the latest AJCC/UICC TMN classification still regards SCLN metastasis as extra-regional i.e Stage IVB (M1) disease. The role of SCLN dissection and surgical management remain controversial. At National University Hospital of the present study, bilateral supraclavicular lymphadenectomy is routinely performed for resectable thoracic ESCC. The aim of this retrospective cohort study is to investigate the long-term outcome of surgical management in pathological SCLN metastasis and its survival benefit comparing to Stage IIB-IVA diseases.

Methods

Patients with ESCC who underwent esophagectomy and 3-field lymphadenectomy with curative intent between January 2013 and January 2023 at the single centre were included; cases of salvage esophagectomy post-definitive concurrent chemoradiotherapy, palliative resections, and concurrent head and neck cancers were excluded. Neoadjuvant treatments were considered in cases staged clinically as T2 and/or N1 or greater. Pathological status of lymph nodes was recorded according to JES classification. Demographics and prognostic factors were examined using univariant analysis of overall survival (OS). Patients with SCLN metastases and other LN involvements were compared and OS were analysed using Kaplan-Meier method.

Results

544 patients were included. 183 had one or more pathological LN metastasis (pN1:126, pN2 46, and PN3: 11) in which 55 patients had SCLN metastasis. Patients with LN metastasis had poorer prognosis than those without (pN0) with a Hazard Ratio (HR) of 2.68 (95% CI, 1.12-3.40, p<0.01); similar pattern was seen in patients with SCLN metastasis (HR 2.28, p<0.01). The 3-year and 5-year OS of patients with SCLN metastasis was 18.5% and 11.6% respectively whereas those of other LN metastasis was 21.4% and 15.8%; the difference between the groups was not statistically significant (p=0.525) (graph 1).

Conclusion

Lymph node status (pN) is a well-recognised prognostic factor as reaffirmed, however, within the pN positive cohort, long-term survival of patients with SCLN metastasis, considered as stage IVB (M1), was comparable (p<0.05) to those with other LN metastases. This supports the survival benefit of surgical resection with neoadjuvant therapy in SCLN metastases as following nodal disease treatment algorithm; further evaluation including systemic therapy and lymph node sub-group analysis is being conducted. Whilst randomised controlled trials such as Japanese JCOG2013 provides level I evidence, the present study provides complementary real-world experience for SCLN dissection.
560. ANALYSIS OF CLINICOPATHOLOGICAL CHARACTERISTICS AND PROGNOSIS OF SYNCHRONOUS MULTIPLE PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMAS (SMP-ESCC) AFTER RECEIVING NEOADJUVANT THERAPY
Authors: Yu Boyao , Qi Cong , Liu Zhichao , Jiang Chao , Li Zhigang
Published: September 2024

Background

SMP-ESCC is a rare subtype of esophageal cancer. Esophagectomy after neoadjuvant therapy became the standard treatment. However, there are still no studies comparing SMP-ESCC and single lesion esophageal squamous cell carcinomas (SL-ESCC) after neoadjuvant therapy. Our study aimed to analyze the differences of clinicopathological features and prognosis between SMP-ESCC and SL-ESCC.

Methods

All patients who received neoadjuvant therapy (Platinum-based chemotherapy regimen with or without radiotherapy at a total dose of 41.4-50.4 Gy/23-28 times) and plan esophagectomy were consecutively collected from January 2019 to March 2023. SMP-ESCC was defined as multiple lesions in the esophagus found at the time of diagnosis by endoscopy, with lesions more than 1 cm apart by normal mucosa, and diagnosed by pathology as squamous carcinoma or Tis. The cohort was divided into two groups (SMP-ESCC vs. SL-ESCC) with a 1:1 ratio through propensity score matching, and the differences in clinicopathological features and prognosis were compared.

Results

A total of 926 patients were enrolled, 58 (6.4%) patients had the type of SMP-ESCC. SMP-ESCC had higher pN stages (p<0.001), and a lower rate of pathological complete response (13.8% vs. 29.4%, p=0.016). SMP-ESCC had a poorer OS (49.8% vs. 65.0%, p=0.020) and DFS (21.1% vs. 61.0%, p<0.001) (Figure A-B). After matching, SMP-ESCC had a poorer 3-year DFS (33.5% vs. 60.9%, p=0.020) and a trend of poorer OS (51.0% vs. 71.7%, p=0.086) (Figure 1 C-D). Multivariate Cox regression analysis indicated that SMP-ESCC was an independent risk factor for OS (HR: 2.258, 95%CI: 1.006-5.068, p=0.048) and DFS (HR: 2.175, 95%CI: 1.157-4.092, p=0.016).

Conclusion

SMP-ESCC had a poorer response to neoadjuvant therapy compared to patients with SL-ESCC. And SMP-ESCC was an independent risk factor for OS and DFS, leading to a poorer prognosis. Therefore, SMP-ESCC need more rational and effective treatment in the perioperative period.
581. SURGICAL TREATMENT OF ACUTE SYMPTOMATIC POST-ESOPHAGECTOMY DIAPHRAGMATIC HERNIA
Authors: Milito Pamela , Lovece Andrea , Vico Eleonora , Siboni Stefano , Asti Emanuele
Published: September 2024

Background

Post esophagectomy diaphragmatic hernia (PEDH) is a rare, often asymptomatic condition, but it can also present as a life-threatening complication leading to emergency treatment. Acute onset of symptoms such as epigastric pain, shortness of breath and evidence of serious complications like strangulation, necrosis or perforation of the herniated organs represent an indication for emergency surgery.

The aim of the present study is to report the experience of a tertiary care center for esophageal disease and to describe the clinical and surgical management of acute-onset PEDH treated in an emergency setting.

Methods

A retrospective analysis of a prospectively collected database of esophagectomies for cancer (hybrid, open, transhiatal or minimally invasive) performed at our Institution between January 2013 to June 2022 was performed. Early PEDH was defined as onset within 90 days from surgery. All patients with acute presentation of volvulus, ischemia, respiratory dysfunction or perforation were treated surgically by two expert surgeons.

Results

Among 357 patients, 10 had an urgent PEDH requiring surgery within 24 hours after onset of symptoms. Early PEDH was diagnosed in 5 patients (median time 4 days) and 3 of them had a concomitant diagnosis of anastomotic leak. Late hernia was treated at median time of 249 days. Organ resection was performed in 4 patients. Surgical access was laparoscopy in 8 patients, open and thoracotomy in 2. Cruroplasty was performed in 8 cases. Mortality was 0%. Recurrence was 10%. No preoperative risk factors for PEDH were identified (Table 1).

Conclusions

Diaphragmatic hernia could be a challenging complication after esophagectomy, that could present either as an early or late complication. Its early recognition is of paramount importance given its association with anastomotic leak or strangulation. Laparoscopic repair should be considered as the approach of choice in high-volume centers and cruroplasty with or without mesh positioning should be evaluated.
590. RESOLUTION OF SYMPTOMS AFTER OESOPHAGO-GASTRIC CANCER RESECTION (RESTORED)–STANDARDISING GASTROINTESTINAL SYMPTOMS AND CONDITIONS AFTER SURGERY: A MULTI-DISCIPLINARY EXPERT DELPHI STUDY
Authors: Byrne Ben , Low Donald , Andreyev Jervoise , Blazeby Jane , Markar Sheraz , Avery Kerry , Griffiths Ewen , Cockbain Andy , Nilsson Magnus , Moss Charlotte , Van Hemelrijck Mieke , Acheampong Kobby , Evans Orla , Dunn Jason , Zeki Sebastian , Taylor Joanna , Gossage James , Huddy Fiona , Davies Andrew
Published: September 2024

Background

Oesophago-gastric cancer surgery negatively affects quality of life with a high post-operative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. We aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients.

Design

Modified 2-round Delphi consensus study of a multidisciplinary expert panel.

Results

86/127(67.7%) and 77/100(77.0%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first and second-line investigation and first-line treatments were agreed. Consensus was not reached for third line investigation of some conditions, nor for second, third or fourth-line treatments for others. 12 of 14(85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (< 1 year) and late (> 1 year) post-operative periods.

Conclusion

Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This will allow standardisation and timely diagnosis and treatment of post-operative conditions, reducing variation in care. It will facilitate comparative, prospective research to establish the incidence and response to treatment of these conditions, helping develop robust evidence to optimise patients’ quality of life.
593. DEEP LEARNING-BASED PROGNOSTIC MODEL INTEGRATING TUMOR-INFILTRATING LYMPHOCYTES FOR ESOPHAGEAL CANCER: A MULTICENTER RETROSPECTIVE COHORT STUDY
Authors: Huang Shujie , Xu Haijie , Su Yongjian , Lin Xirui , Zijie Li , Wang Sichao , Gao Zhen , Dong Yuejiao , Chen Zhuofeng , Qiao Guibin , Wu Hansheng , Hong Liangli
Published: September 2024

Background

Tumor-infiltrating lymphocytes (TILs) have been proven to be important prognostic factors for various tumors. However, their prognostic significance within the context of esophageal squamous cell carcinoma (ESCC) remains inadequately explored. This study aims to assess the prognostic potential of TILs in ESCC using deep learning (DL) methods.

Materials and Methods

We retrospectively enrolled 626 pathologically confirmed ESCC patients from two research centers. Their digital whole-slide imaging (WSI) and corresponding clinical information were collected. Subsequently, the DL method was employed to identify the tumor margin and TILs within the WSI. Tissue was divided into intra-tumor, peritumoral and stromal regions based on their distance from the tumor margin. TILs were counted in each region. Optimal cut-off values of TILs were determined using the X-tile software. To mitigate selection bias and intergroup heterogeneity, a propensity score matching (PSM) analysis was employed. Survival analysis was performed using Kaplan-Meier curves and the log-rank test. The Cox proportional hazards regression model was used to identify independent prognostic factors.

Results

We classified patients based on the cell counts and cut-off values of intra-tumor-infiltrating lymphocytes (I-TILs) and peritumoral infiltrating lymphocytes (P-TILs). Patients with high I-TILs & P-TILs were defined as those whose counts of both I-TILs and P-TILs exceeded the determined cut-off value. Patients with high I-TILs & P-TILs showed significantly better overall survival (OS, P = 0.0092) and recurrence-free survival (RFS, P = 0.0088) than patients with low I-TILs & P-TILs after PSM. Multivariable Cox proportional hazards regression further supported this conclusion and recognized I-TILs & P-TILs as an independent prognostic factor (P = 0.0136, hazard ratio = 0.63 for OS; P = 0.0098, hazard ratio = 0.63 for RFS).

Conclusion

In the present study, we identified the quantitative distribution of TILs in ESCC patients with the help of the DL method. We established that I-TILs & P-TILs serve as independent prognostic factors for these patients. Further study should focus on the lymphocyte subgroups and make better use of the spatial information to improve the predictive efficacy of TILs.
616. POST-ESOPHAGECTOMY REHABILITATION IS ASSOCIATED WITH EARLY IMPROVEMENTS IN PHYSICAL FITNESS AND SARCOPENIA: PRELIMINARY RESULTS FROM THE FITNESS AFTER OESOPHAGECTOMY (FARO) TRIAL
Authors: Prasad Pooja , Aure Ms Crystal Mira , Macdonald Jillian , Daly Jeremy , Wahed Shajahan , Greystoke Alastair , Phillips Alexander
Published: September 2024

Introduction

Curative treatment of gastro-esophageal cancer encompasses surgery and peri-operative chemo(radio)therapy. Advancements in oncological treatment and surgical techniques have resulted in incremental prognostic gains with increasing focus on survivorship and optimising quality of life (QoL). Despite enhanced recovery pathways, patients receive no assistance to improve physical functioning and QoL in the post-esophagectomy recovery period. Post-operative rehabilitation has demonstrated improvement in physical fitness and psychosocial wellbeing among other cancer subtypes. The aim of this study was to determine the impact of a patient-directed, home-based rehabilitation programme upon physical functioning in the early recovery phase following an esophagectomy.

Methods

The Fitness AfteR Oesophagectomy (FARO) study was a prospective, single-centre, parallel-group, open-label, two-arm, pragmatic randomised controlled external pilot trial. Patients were randomised to receive post-operative rehabilitation (alongside routine care- REHAB) or standard clinical care (NO-REHAB) alone in a 1:1 ratio. The rehabilitation intervention encompassed a 12-week home-based programme with weekly step-count targets, completion of resistance exercises and dietary monitoring. Cardiorespiratory fitness was determined by the 6-minute walk test (6MWT) and the functional impact of sarcopenia was assessed by the hand-grip strength (HGS). Outcomes were measured at baseline and 6 weeks post-esophagectomy. Between-group differences were analysed using linear mixed effects models.

Results

A total of 60 patients were included and randomised to REHAB (n=31) or NO-REHAB (n=29). A total of 29 patients in the REHAB group (93.5%) completed the rehabilitation programme with a 100% adherence rate. At 6 weeks post-esophagectomy, there was statistically significant improvements in the functional impact of sarcopenia as denoted by improvements in HGS in REHAB versus the NO-REHAB cohorts (mean difference= 4.237; 95% c.i 0.80-7.70; p=0.017). Cardiopulmonary fitness, as determined by the 6MWT, was comparable between cohorts with no statistically significant intergroup differences at 6 weeks (mean difference= 62.008; 95% c.i -5.85-129.91; p=0.073).

Conclusion

Post-operative rehabilitative interventions result in improvements in physical functioning in the early recovery phase following an esophagectomy. Further analysis from the FARO trial will determine if rehabilitation restores and improves QoL and recovery of cardiopulmonary fitness into survivorship.
634. SURGICAL OUTCOMES OF ESOPHAGEAL CANCER PATIENTS BASED ON PRIOR COVID DIAGNOSIS
Authors: Conrad Hope , Wang Kevin , Hamidi Mohammad , Hsu Chiu-Hsieh , Worrell Stephanie
Published: September 2024

Background

Since the Covid pandemic, many studies have been performed to determine the impact of Covid on surgical outcomes. Many researchers have found that prior Covid diagnosis puts surgical patients at higher risk of complication and mortality. The aim of this study is to determine if esophageal cancer patients undergoing esophagectomy are at higher risk based on previous Covid status.

Methods

The National Cancer Database (NCDB) was queried for all patients who underwent esophagectomy for cancer in 2020. This study was limited to the 2020 database as this was the year that Covid status was added to the NCDB registry. Patients with a Covid history and without a Covid history were compared. Only patients with complete Covid information were included in this study. Peri-operative outcomes including hospital length of stay and 30-day readmission were compared between groups. Wilcoxon rank-sum tests were performed to compare continuous variables between groups and Chi-square/Fisher’s exact tests were performed to compare categorical variables between groups.

Results

A total of 2387 patients met inclusion criteria, of which 114 (5%) had prior diagnosis of Covid and 2273 (95%) did not have prior Covid. There were no significant differences regarding basic demographics, including age, gender, neoadjuvant therapy, or pathologic staging. Both groups had similar rates of minimally invasive techniques and conversions to open surgery. There was no difference regarding 30-day readmission, however, the Covid group had a statistically longer hospital length of stay, 9 days (IQR 6-15) vs 8 days (IQR 1-11), p=0.007. On logistic regression, Covid was an independent predictor of increased overall length of stay (p=0.045).

Conclusion

Despite previous evidence that Covid patients may experience more surgical complications than their non-Covid counterparts, this NCDB study of esophageal patients undergoing esophagectomy demonstrated similar baseline demographics and outcomes with the only significant difference being longer hospital length of stay. Further research is necessary to determine risk of previous Covid diagnosis in surgical outcomes.
640. EPIPHRENIC DIVERTICULECTOMY WITH HELLER MYOTOMY AND DOR FUNDOPLICATION
Authors: Gutman Ya'ara , Braun Josef , Jacobi Harel , Goldes Yuri , Nevo Yehonatan
Published: September 2024

The attached video demonstrates epiphrenic diverticulectomy with Heller myotomy and Dor fundoplication, in a symptomatic 62 years old female patient with regurgitation and achalasia.

The video offers a unique insight into the complexities of treating this uncommon condition. In this case, a laparoscopic transhiatal approach was used. The video shows the key steps of the surgery, including challenges posed by the diverticulum's unusual location (left side of the esophagus), necessitating the careful opening of the left crura for optimal visualization and safe resection. We believe this teaching case not only sheds light on the intricacies of managing epiphrenic diverticulum but also underscores the importance of tailored approaches in addressing atypical presentations.

https://www.dropbox.com/scl/fi/jutvx1akf32nlgf8o57bp/epiphrenic-diverticuluectomy.mp4?rlkey=nmscb8y1k84g9cnfmzohtgjvp&dl=0
680. P02.06 MATTERHORN PCR BY REGION
Authors: Janjigian Yelena Y , Al-Batran Salah-Eddin , Wainberg Zev A , Van Cutsem Eric , Molena Daniela , Muro Kei , Hyung Woo Jin , Wyrwicz Lucjan , Oh Do-Youn , Omori Takeshi , Moehler Markus , Garrido Marcelo , Oliveira Sulene CS , Liberman Moishe , Oliden Victor Castro , Bilici Mehmet , Kurland John F , Xynos Ioannis , Mann Helen , Tabernero Josep
Published: September 2024

Background

FLOT was established as a perioperative therapy for GC/GEJC following the Phase 2/3 FLOT4 study conducted in Germany, with a pCR rate of 16% (Al-Batran et al, Lancet Oncol 2016). The global MATTERHORN study (NCT04592913) showed a statistically significant improvement in pCR with perioperative D+FLOT vs placebo (P) + FLOT in GC/GEJC at first interim analysis (Janjigian et al, ESMO Congress 2023). Subgroup analyses by region and country were completed to assess pCR rates with FLOT and benefit of D+FLOT across the global study population.

Methods

Participants (pts) with resectable GC/GEJC were randomized 1:1 to D 1500 mg or P every 4 weeks (Q4W) on Day 1 plus FLOT Q2W on Days 1 and 15 for 4 cycles (2 doses of D or P and 4 doses of FLOT pre- and post-operative), followed by D 1500 mg or P on Day 1 Q4W for 10 further cycles. Randomization was stratified by Asia vs non-Asia. pCR (Modified Ryan; central review) was assessed in prespecified (Asia) and post hoc regional subgroups, including 6 countries with the highest numbers of randomized pts.

Results

Of 948 pts randomized globally, 180 (19%) were in Asia. pCR outcomes with FLOT in Asia were consistent with global outcomes. pCR rates were improved with D+FLOT vs P+FLOT in all regions (Asia, Europe, North America and South America; Table), despite some imbalances in baseline characteristics and numerical differences in pCR rates by geographic location. The pCR rate with P+FLOT in the German subgroup (13%; 95% CI, 6.1–23.0) was similar to that with FLOT in the FLOT4 study. Improvement in pCR with D+FLOT vs P+FLOT was observed across subgroups by country. Similar trends across regional subgroups were observed for combined complete and near-complete response rate.

Conclusions

In MATTERHORN, pCR was consistently improved with the addition of D to perioperative FLOT in GC/GEJC across geographic regions. The study is ongoing for the primary objective of event-free survival.
764. PREDICTING AGE-SPECIFIC PREVALENCE OF BARRETT'S OESOPHAGUS IN AUSTRALIAN AND UNITED STATES
Authors: Vissapragada Ravi , Bulamu Norma , Whiteman David , Bright Tim , Yazbeck Roger , Karnon Jonathan , Watson David
Published: September 2024

Background

Barrett’s esophagus is the precursor to esophageal adenocarcinoma (EAC). EAC detected from endoscopic surveillance programs accounts for <10% of all EAC, suggesting a large number of patients with Barrett’s esophagus are likely unaccounted for. Several studies have estimated the observed prevalence of Barrett’s esophagus to be approximately 1%, but this may be an underestimate. The aim of this study is to use population incidence of EAC and rate of progression from Barrett’s esophagus from large cohort studies to estimate a realistic prevalence of Barrett’s esophagus.

Methods

A simple tree cohort model was created for progression to EAC from birth to death (100 years) for American and Australian population. Lifetime risk of esophageal cancer and adenocarcinoma were endpoints. This was then used to back-calculate age-specific and overall prevalence of Barrett’s esophagus using an optimisation algorithm.

Results

Lifetime risk of esophageal cancer and adenocarcinoma in US Whites is 0.56% and 0.36% respectively, while in Australian population is slightly higher at 0.81% and 0.61% (range 0.57% - 0.65%). Estimated overall prevalence of Barrett’s esophagus is ~3% (±0.3%) and ~5.4% (±0.6%) in US White and Australian populations, while in males is 5.3% (±0.6%) and 7.4% (±0.3%), respectively. Female cohorts were seen to have lower chance of developing esophageal cancer, adenocarcinoma, and Barrett’s esophagus.

Conclusion

Cohort studies of Barrett’s esophagus are likely to underestimate its prevalence of this silent disease. Computational models based on progression from Barrett’s esophagus to EAC accounting for undetected disease reveal higher estimates, which can help in future screening options.
780. NEOADJUVANT IMMUNOTHERAPY COMBINED WITH CHEMORADIOTHERAPY VS NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CARCINOMA (CSTAGEII-III): A MULTI-CENTER PROSPECTIVE RANDOMIZED CLINICAL TRIAL (ICROSS)
Authors: Jiao Heng
Published: September 2024

Background

The role of neoadjuvant immunotherapy combined with chemoradiation in the treatment of esophageal cancer is not yet fully understood. This study aims to compare the efficacy and safety of neoadjuvant immunotherapy combined with chemoradiation versus traditional neoadjuvant chemoradiation in treating locally advanced esophageal squamous cell carcinoma (stages cII-III).

Methods

This prospective randomized controlled trial included histologically confirmed patients with potentially resectable esophageal squamous cell carcinoma (stages cII-cIII). Patients were randomly assigned to two groups: the treatment group (Arm A) received BGB-A317 (200mg IV) combined with the CROSS regimen of chemotherapy and radiation, while the control group (Arm B) received only the CROSS chemotherapy and radiation regimen. All patients underwent surgery followed by a five-year follow-up. The primary endpoints included pathological complete response rate (pCR), tumor regression grades, and lymph node clearance.

Results

The study enrolled 67 patients (52 males, 15 females) aged between 18-75 years. Tumor locations were as follows: upper segment in 16 cases, middle segment in 45 cases, and lower segment in 6 cases. A total of 64 patients were included in the analysis. There were no significant differences between the two groups in terms of pCR rates (Arm A 41.4% vs. Arm B 30.8%, p=0.414), tumor regression grades, Surgical time (221.09 ± 37.54 minutes vs. 227.05 ± 50.28 minutes, p=0.593), Estimated blood loss (182.73 ± 337.41 ml vs. 90.47 ± 66.36 ml, p=0.109), and postoperative hospital stay (9.31 ± 4.12 days vs. 8.42 ± 1.16 days, p=0.555). However, the treatment group had significantly more lymph nodes retrieved during surgery compared to the control group (26.86 ± 7.96 vs. 20.85 ± 9.68, p=0.020). The safety profiles were similar between the groups with no significant adverse events observed.

Conclusion

For patients with locally advanced esophageal squamous cell carcinoma, neoadjuvant immunotherapy combined with chemoradiation is comparable in efficacy and safety to neoadjuvant chemoradiation alone and may facilitate more effective lymph node clearance. Although these preliminary results are encouraging, further long-term follow-up and larger-scale studies are needed to validate these clinical findings once the study is complete.
797. A COMPARATIVE ANALYSIS ON THE EFFECTIVENESS OF DIFFERENT TREATMENT MODALITIES FOR ESOPHAGEAL CARCINOMA; A SYSTEMATIC REVIEW
Authors: Rashmi WA , Ridmi WA , Lakpriya WAY , Jayaratne JPDS
Published: September 2024

Background

Esophageal carcinoma; sixth most common cancer worldwide, presents a significant clinical challenge due to its aggressive nature and often late-stage diagnosis, resulting in poor prognosis and limited treatment options. Various treatment modalities, including surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy, are utilized in clinical practice. However, the optimal treatment strategy remains uncertain, as the comparative effectiveness of these modalities is not well-defined. Past studies have provided conflicting evidence, necessitating a comprehensive evaluation to guide clinical decision-making. Therefore, this systematic review aims to compare the efficacy and safety of different treatment modalities for esophageal carcinoma, with the objective of informing evidence-based treatment approaches and improving patient outcomes.

Methods

Total 350 publications from PubMed, EMBASE, Cochrane, Google Scholar and Semantic Scholar databases were identified on the effectiveness of different treatment modalities for esophageal carcinoma between 2000 and 2024. Following deduplication, two independent reviewers initially screened the articles for eligibility with titles and abstracts, and then, with complete articles. Bias assessment using GRADE guidelines for observational studies was done. Non-English studies, case-series/case-reports/essays/book-chapters/conference-abstracts/editorials/thesis/dissertations and studies without full-texts were excluded.

Results

Overall, the effectiveness of each treatment modality for esophageal carcinoma depends on various factors, including tumor stage, histology, patient characteristics, and treatment regimen. Combination approaches, such as chemoradiotherapy or multimodal therapy, are often used to maximize treatment efficacy and improve patient outcomes.

Conclusion

Multidisciplinary collaboration, personalized treatment approach, integration of novel therapies, such as immunotherapy and targeted therapy, into standard treatment regimens, survivorship care and advocate for further research to identify optimal treatment sequencing, identify predictive biomarkers of treatment response, and explore novel therapeutic targets to improve outcomes for patients with esophageal carcinoma is recommended.