bluuebunny/crossref_metadata_2025 huggingface dataset:
368. THE ROLE OF PG-SGA SCORE IN PREDICTING SHORT- TERM POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY
Authors: Mylonakis Adam , Kozadinos Alexandros , Frountzas Maximos , Tsikrikou Ilianna , Kyriakidou Maria , Karanikki Eva , Lidoriki Irene , Toutouzas Konstantinos G , Theodorou Dimitrios , Schizas Dimitrios
Published: September 2024

Background

The preoperative nutritional status is increasingly recognized as a determinant of postoperative outcomes in esophageal cancer patients. This study examines the relationship between preoperative nutritional scores, particularly the Patient-Generated Subjective Global Assessment (PG-SGA), and the incidence of short-term postoperative complications.

Methods

A prospective cohort study was conducted on patients undergoing surgery for esophageal cancer across two Surgical Departments at University Hospitals in Athens, Greece. Preoperative nutritional status was assessed using the PG-SGA score. Patients were categorized based on the PG-SGA score into low to medium risk with score of 8 or less, and high risk with score of 9 or higher. Postoperative complications were classified according to the Clavien-Dindo system, and their association with nutritional status was statistically assessed.

Results

This study included 59 consecutive patients who underwent surgery for esophageal cancer with female-to-male ratio of 1:4.9 and a median age of 65.4 ± 10.4 years, 43 (72.9%) of whom had received neoadjuvant chemotherapy. Notable postoperative complications (Clavien- Dindo classification ≥III) occurred in 14 cases, including evisceration (n=1), hemorrhage (n=1), chyle leakage (n=1), anastomotic leak (n=8), pleural effusion requiring radiological intervention (n=2), and a persistent pneumothorax necessitating additional thoracic tube insertion (n=1). A statistically significant association was found between malnutrition, as indicated by the PG-SGA≥9, and the development of severe postoperative complications (Clavien- Dindo classification ≥III) (p = 0.034).

Conclusion

This study suggests that preoperative PG-SGA score is potentially significant predictors of short- term postoperative complications in esophageal cancer surgeries. Incorporating nutritional assessments into the preoperative evaluation may help identify high-risk patients and tailor perioperative care to improve surgical outcomes.
372. TREATMENT USING NIVO+CHEMO OR NIVO+IPI FOR UNRESECTABLE/RECURRENT ESOPHAGEAL SQUAMOUS CANCER IN OUR INSTITUTE
Authors: Ogata Takashi , Kanematsu Kyohei , Nagasawa Shinsuke , Morita Junya , Ohnuma Shizune , Tanabe Mie , Yamada Takanobu , Oshima Takashi , Furuta Mitsuhiro , Machida Nozomu
Published: September 2024

Introduction

Currently, regarding stage IVB esophageal cancer treatment, the esophageal cancer treatment guideline in JAPAN was revised in 2022 based on the results of two phase III trials, KN590 and CM648, and Nivolumab+Chemo and Nivolumab+Ipilimumab would be used as 1st line treatment.

Subject

NIVO+Chemo19NIVO+Ipilimumab (IPI)17

Before February 2024, a total of 160 cases of unresectable/recurrent esophageal squamous cell carcinoma have been treated using IO, IO+Chemo, and IO+IO at our institute. 19 cases were treated with NIVO+Chemo and 17 cases were treated with NIVO+IPI as the 1st line treatment. We examined the treatment backgrounds and outcomes of these subjects.

Result

Regarding patient characteristics, median age was 66/65 years in NIVO+Chemo group/NIVO+IPI group, male to female ratio was 18:1/15:2, PS0/1 was 14/5 cases in NIVO+Chemo, and 16/1 cases in NIVO+IPI. Pre-treatment status (primary unresectable/recurrent/other) were 13/5/1 in NIVO+Chemo, and 4/12/1 in NIVO+IPI. The presence/absence of post-treatment was 12/7 cases in NIVO+Chemo and 10/7 cases in NIVO+IPI. The presence/absence of irAEs was 5/14 cases in NIVO+Chemo, and 15/2 cases in NIVO+IPI. ORR was 52.6%, and median OS was 782 days, and median PFS was 190 days in NIVO+Chemo group, and 52.9%/544days/138days in NIVO+IPI group.

Consideration

Both the NIVO+Chemo and NIVO+IPI groups at our facility had longer OS and PFS than previously reported. In particular, the response rate of NIVO+IPI was as high as that of the NIVO+Chemo group, and this is thought to be since many cases of postoperative recurrence with small tumor volumes were enrolled in NIVO+IPI group. We believe that it is important to distinguish between IO/IO and IO/CHEMO as a treatment strategy for unresectable/recurrent esophageal squamous cell carcinoma.
409. TWO-STAGE OPERATIVE PROCEDURE FOR A BENIGN, COMPLICATED TRACHEOESOPHAGEAL FISTULA CAUSED BY FOREIGN BODY IMPACTION
Authors: Rajan Shiv , Kumar Vijay
Published: September 2024

Background

Benign Tracheoesophageal fistula (TOF) caused by foreign body impaction is a rare condition requiring technical expertise. There are choices available based on the individual patient's situation, including endoscopic management, local resection and defect closure, and, in rare cases, esophagectomy.

Methods

A 58-year-old male had a history of artificial tooth dislodgement that got impacted in the esophagus, resulting in dysphagia. Endoscopy showed an impacted denture with an underlying transmural esophageal perforation, closed with clips and an endoloop. Two weeks later, partially covered SEMS was placed. Failure to retrieve the SEMS after repeated attempts due to tissue ingrowths, he was referred for management. CECT showed a stent in situ with a small air-filled cavity left lateral to the tracheal bifurcation. Bronchoscopy revealed the compression of the posterior tracheal wall and the presence of an endoclip in the posterior wall of the left main bronchus (LMB).

Results

The patient was planned for a two-stage operation. In the first stage, esophagus was mobilized along with the stent and the fistulous tract was excised. The esophagus was divided at both ends in the thorax. Up to this part, the procedure was done with single-port VATS without CO2 and in the left semi-prone position with a bronchial blocker in the right main bronchus. The fistula with the LMB was closed with an intercostal muscle flap and a bovine pericardial patch with transient apnoea. During this part, we extended the incision in the fourth space to raise the flap. Cervical esophagostomy was matured, and a feeding jejunostomy was created. The postoperative phase was uneventful, and he was discharged on the 5th postoperative day. After 4 weeks, we did the second phase of surgery, where we made a 4 cm retrosternal gastric conduit and performed the hand-sewn anastomosis with the cervical esophagus, which was taken down from the skin. The patient had an uneventful postoperative course and was allowed to be taken orally on day five and discharged subsequently two days later.

Conclusions

TOF demands a multidisciplinary treatment strategy. Successful outcomes are determined by patient triage, delineation of the location and size of the defect, mediastinal contamination, and the availability of expertise.
430. PROGNOSTIC PATTERNS OF LYMPH NODES WITH COMPLETE TREATMENT RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER NEOADJUVANT CHEMORADIOTHERAPY AND NEOADJUVANT CHEMOTHERAPY
Authors: Xu Wenyi , Jian Zitao , Jiao Heng , Tang Han , Tan Lijie
Published: September 2024

Background

The prognostic significance of lymph nodes with pathological complete treatment response (pcr-LN) has not been well investigated in esophageal squamous cell carcinoma (ESCC). We aimed to determine the prognostic impact of pcr-LNs in ESCC after either neoadjuvant chemoradiotherapy (nCRT) or neoadjuvant chemotherapy (nCT).

Methods

578 patients with ESCC from two medical facilities were analyzed retrospectively, with 303 patients receiving nCRT and 275 receiving nCT. Pcr-LNs were defined as LNs exhibiting regression changes, such as fibrosis, mucin lakes, keratinization, and giant cell responses but no evidence of living tumor cells. 5 LN status subgroups were identified based on the ypN category in 8th AJCC: ypN0/pcr-LN-, ypN0/pcr-LN+, ypN1, ypN2, and ypN3. The Kaplan-Meier approach was used to analyze the overall survival (OS), and subgroup findings were compared using the log-rank test. Multivariate analysis of OS was performed using a Cox proportional hazard model.

Results

45 patients were classified into ypN0/pcr-LN+ (7.8%), 33 in the nCRT group, and 12 in the nCT group (p = 0.006). Compared to the nCRT group, the nCT group underwent a more thorough LN dissection (LN (mean (SD)): nCRT, 21.05 (8.77); nCT, 26.08 (11.66); p = 0.001). Survival analysis of OS showed the subgroup ypN0/pcr-LN+ had a significantly worse prognosis than ypN0/pcr-LN- in the nCRT group (p = 0.047), but no difference was seen in the nCT group. Multivariable analysis revealed that ypN0/pcr-LN+ patients in the nCRT group had a greater risk of mortality than ypN0/pcr-LN- patients (p = 0.0487).

Conclusion

The nCRT group had a more noticeable complete treatment response in LNs than the nCT group. However, in comparison to the nCT group, the nodal downstaging with radiotherapy in the nCRT group may not translate into improved outcomes. More aggressive systemic therapy might be required to improve the overall survival in esophageal cancer patients receiving neoadjuvant treatment.
436. IDENTIFICATION OF M6A-RELATED SIGNATURE GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA BY MACHINE LEARNING METHOD
Authors: Chen Long-Qi , Shang Qi-Xin
Published: September 2024

Background

We aimed to construct and validate the esophageal squamous cell carcinoma (ESCC)-related m6A regulators by means of machine leaning.

Methods

We used ESCC RNA-seq data of 66 pairs of ESCC from West China Hospital of Sichuan University and the transcriptome data extracted from The Cancer Genome Atlas (TCGA)-ESCA database to find out the ESCC-related m6A regulators, during which, two machine learning approaches: RF (Random Forest) and SVM (Support Vector Machine) were employed to construct the model of ESCC-related m6A regulators. Calibration curves, clinical decision curves, and clinical impact curves (CIC) were used to evaluate the predictive ability and best-effort ability of the model. Finally, western blot and immunohistochemistry staining were used to assess the expression of prognostic ESCC-related m6A regulators.

Results

2 m6A regulators (YTHDF1 and HNRNPC) were found to be significantly increased in ESCC tissues after screening out through RF machine learning methods from our RNA-seq data and TCGA-ESCA database, respectively, and overlapping the results of the two clusters. A prognostic signature, consisting of YTHDF1 and HNRNPC, was constructed based on our RNA-seq data and validated on TCGA-ESCA database, which can serve as an independent prognostic predictor. Experimental validation including the western and immunohistochemistry staining were further successfully confirmed the results of bioinformatics analysis.

Conclusion

We constructed prognostic ESCC-related m6A regulators and validated the model in clinical ESCC cohort as well as in ESCC tissues, which provides reasonable evidence and valuable resources for prognostic stratification and the study of potential targets for ESCC.

Key words

m6A, RNA methylation, esophageal squamous cell carcinoma, machine learning, experimental validation
437. MEASUREMENT OF FUNCTIONAL, PSYCHOSOCIAL, AND QUALITY OF LIFE IMPACTS OF ROBOTIC VERSUS HYBRID OESOPHAGO-GASTRECTOMY
Authors: Paine Heidi , Rayner Charles , Tehranchi Sam , Luangsomboon Aphiwat , McGuire Ms Anna , Walker Robert , Madhavan Anantha , Singh Pritam , Preston Shaun R , Abbassi-Ghadi Nima
Published: September 2024

Background

Since the introduction of Robotic-Assisted Minimally-Invasive Oesophago-gastrectomy (RAMIO), comparisons to other surgical approaches have focussed primarily on peri-operative and oncological outcomes. Few studies have focused on quality-of-life measures once the patient has been discharged home. We sought to compare physical, psychosocial, sleep, pain and employment related measures at six weeks following discharge in patients undergoing RAMIO versus Hybrid Oesophago-gastrectomy.

Methods

We performed a prospective cohort study comparing RAMIO and Hybrid Oesophago-gastrectomy. Twenty-five consecutive patients on a curative surgical pathway were recruited to each group. Participants were contacted via telephone pre-operatively and six weeks post-operatively. Parameters studied were: physical activity, social activity, sleep, pain control, and employment. Psychological wellbeing was measured using the Hospital Anxiety and Depression Scale, and quality of life with the European Organisation for Research and Treatment of Cancer questionnaires C30 (all cancer patients) and OG25 (patients undergoing oesophago-gastric cancer treatment). Results were analysed using Chi Square and Mann-Whitney-U statistical tests.

Results

There were no differences in age, ASA, or anaerobic threshold between study groups. At six weeks the RAMIO group was more likely than Hybrid to have returned to pre-operative physical and social activity (physical 7/25 vs. 1/25, p=0.04, social 13/25 vs. 5/25, p=0.03). The RAMIO group stopped regular analgesia earlier, and required fewer opiates. Patients were more likely to return to work in the RAMIO group (7/15 vs. 1/12,p=0.04). The RAMIO group had fewer cases of depression (2 vs. 9, p=0.03), lower QLQ C30 and OG25 scores, and reported higher overall health and quality of life scores (p=0.001).

Conclusion

We have demonstrated an improvement in physical and social activity, a faster return to work, a reduction in analgesia requirements, lower rates of depression and improved health and quality of life, six weeks post-operatively when comparing RAMIO to Hybrid Oesophago-Gastrectomy.

This study has highlighted additional considerations for the selection of surgical modality in oesophago-gastrectomy beyond peri-operative outcomes. Further investigation across a larger sample size and longer time frame to quantify the full spectrum of potential benefits of robotic oesophago-gastric surgery is warranted.
447. SAFETY AND FEASIBILITY OF DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY
Authors: Guerrero Pablo , Navarro Fernando Mingol , Esteban Marcos Bruna , Cruz David Quevedo , Nieto Marta , Sánchez Carmen Gutiérrez , Chicote Cristina Martínez , Urbaneja Francisco Javier Vaqué
Published: September 2024

Background

Gastroesophageal reflux is a common adverse effect after oncological surgery for tumors of the gastroesophageal junction. Some of the reasons are the radicality of the intervention as well as the placement of the anastomosis inside the thoracic cavity, where there is a constant negative pressure. In recent years, multiple methods of digestive tract reconstruction have been developed in order to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, consisting of the creation of a seromuscular flap covering the anastomosis.

Methods

We designed a retrospective observational and descriptive study including all patients who underwent esophagogastric surgery and Kamikawa doble-flap reconstruction technique from January 2019 to January 2024. The operation conditions, postoperative recovery, postoperative complications (both short and mid-long term), and follow-up data were collected and analyzed. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part.

Results

We included a total of 10 patients in our series. All of them underwent an esophagogastric resection followed by a doble-flap reconstruction technique. Thoracoscopy in prone position was the approach used in most of the patients. In these cases, the doble flap was performed using the posterior wall of the gastric remnant. Half of the patients had no postoperative complications and the other half, mild ones. Postoperative manometry and pHmetry were only performed in 4 patients due to technical difficulties. In all these cases the tests showed no alterations. Despite this, one patient reported reflux, which was controlled with PPIs.

Conclusions

The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.
453. ROBOT ESOPHAGECTOMY WITH EXTENDED MEDIASTINAL LYMPH NODE DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kawakubo Hirofumi
Published: September 2024

Background

Radical surgical resection may play role in prognosis improvement of the esophageal squamous cell carcinoma (ESCC) patients. Because esophagectomy with radical lymphadenectomy is highly invasive, we introduced thoracoscopic esophagectomy in 1999, and have performed over 600 cases. In 2009, we developed a hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection and reported good long-term outcomes especially in cT1bN0M0 ESCC patients. We reported 3y and 5y RFS was 96% and 96%, and 3y and 5y OS was 94% and 92% in those patients. We introduced robot-assisted esophagectomy (RMIE) using daVinci Xi system in June 2018 and have performed for 80 cases. We perform RMIE with the prone position instead of the hybrid position with same concept of thoracoscopic esophagectomy with extended LN dissection. Thanks to a three-dimensional magnified view, fully wristed dexterity and tremor filtration of da Vinci Xi system, the robotic system facilitates precise dissection especial for upper mediastinal lymph node dissection. We show safety introduction and technical pitfalls of robot-assisted esophagectomy with extended LN dissection. Methods: The patient is fixed on prone position. We use Monopolar curved scissors for superficial layer, bipolar cut for dissection with maryland bipolar forceps for deeper layer around Aorta and trachea, and Sharp dissection with Potts scissors around recurrent laryngeal nerves. After esophageal mobilization and mediastinal lymphadenectomy were completed, bilateral recurrent laryngeal nerve, bilateral subclavian artery, trachea, bilateral bronchus, aorta, left pulmonary artery and vein, left pleura, pericardium and hiatus are all skeletonized. Results: We could standardize surgical procedure in first 20 cases. Average operation time in the thoracic procedure is 234.4min and 190.2min in last 30 cases. Median blood loss is 0ml. Postoperative pneumonia and vocal cord palsy were occurred only 6 case in 80 cases. Conclusion: Robot assisted esophagectomy with extended LN dissection was safely introduced in our facility and it is feasible and beneficial for the lymph node dissection especially for lymph node dissection around the recurrent laryngeal nerve.

https://www.dropbox.com/scl/fi/w8na39w6bo9ivwwz7x2rh/Hirofumi-Kawakubo-ISDE-2024.mp4?rlkey=p9mvt7dotyeaj6xfwvud8vcmr&dl=0
497. ENDOFLIP AND BOTULIN TOXIN INJECTION: THERAPEUTIC MANAGEMENT IN ESOPHAGEAL AND GASTRIC MOTILITY DISORDERS
Authors: Cardoso Pedro , Gonçalves Ana Raquel , Peixoto Armando , Macedo Guilherme
Published: September 2024

Introduction

Esophageal motility disorders present diagnostic and therapeutic challenges, with dysphagia being a common symptom prompting evaluation. The Endolumenal Functional Lumen Imaging Probe (EndoFLIP) has recently gained recognition as a valuable tool for assessing esophageal function. This study aims to evaluate the utility of EndoFLIP in guiding therapeutic interventions, specifically focusing on botulinum toxin injections, among patients presenting with diverse esophageal disorders. Moreover, the study acknowledges the potential of EndoFLIP as a diagnostic adjunct during diagnostic upper gastrointestinal endoscopy in cases where therapeutic alternatives are limited or as therapeutic trial.

Methods

A retrospective analysis was conducted on 21 patients who underwent EndoFLIP assessment and subsequently received botulinum toxin injection at the same procedure. These patients were identified from records at a tertiary center, covering the period from January 2022 to February 2023. EndoFLIP procedures were analyzed, focusing on patient symptoms and indication for the procedure. Data regarding clinical symptoms, EndoFLIP findings, and therapeutic interventions were extracted and analyzed to assess the role of EndoFLIP in guiding treatment decisions for esophageal disorders. The used cutoffs for esophagogastric junction (EGJ) distensibility index were < 2 mm2/mmHg and < 10 mm2/mmHg for pyloric distensibility.

Results

All patients referred for esophageal motility evaluation with EndoFLIP presented with dysphagia as the primary symptom. Two patients presented with postprandial bloating, leading to further evaluation with impedance planimetry to assess pyloric distensibility, suspected to be due to diabetic gastroparesis. Following EndoFLIP assessment, a conclusive diagnosis was achieved in all patients: 10 patients were diagnosed with esophagogastric junction outflow obstruction, 1 patient with absent contractility, 7 patients with achalasia, and 1 patient with hypercontractile esophagus. Patients who underwent planimetry to evaluate pyloric distensibility both exhibited reduced distensibility index. Following treatment, 10 patients showed clinical improvement and 11 await clinical reassessment.

Conclusions

Regarding the evaluation of the EGJ distensibility index in patients with achalasia without indication for invasive treatment, the EndoFLIP emerges as a diagnostic tool that allows for immediate guidance if intervention is recommended. Likewise, patients with refractory gastroparesis and pylorospasm identified through EndoFLIP may benefit from toxin injection for future myotomy decision.

In conclusion, EndoFLIP serves as a valuable tool in diagnosing and guiding therapeutic interventions in patients with esophageal and gastric motility disorders. Further research is warranted to validate the role of EndoFLIP in optimizing treatment outcomes for esophageal disorders.
509. DOES SARCOPENIA AFFECT THE OUTCOME OF PATIENTS WITH ESOPHAGEAL CARCINOMA AFTER ESOPHAGECTOMY?
Authors: Merten Jennifer , Mora Nabila Gala Nacul , Hoelzen Jens Peter , Juratli Mazen , Pascher Andreas , Eichelmann Ann-Kathrin
Published: September 2024

Background

Sarcopenia is increasingly recognized as an independent predictor of clinical outcomes of cancer patients such as post-operative complications and prolonged hospital stays. Additionally, sarcopenia can also negatively impact overall survival because of reduced ability to tolerate treatments like neoadjuvant therapy and surgery. At particular risk among cancer patients is the esophageal cancer population because of tumor stenosis leading to dysphagia and impossibility of oral feeding in many patients. The purpose of the current study was to investigate the effect of preoperative sarcopenia on postoperative complications in patients undergoing esophagectomy for esophageal cancer.

Methods

This retrospective study includes all patients who underwent full-robotic abdominothoracic esophageal resection because of esophageal cancer at our institution between 06/2020 and 12/2022. The skeletal muscle index (SMI) was assessed using the preoperative computed tomographic staging scans by measuring the cross-sectional muscle area at the third lumbar vertebral level. Following cut off SMI values were used to define sarcopenia: men: 52,4 cm2/m2, women: 38,5 cm2/m2 according to Prado et al (Lancet Oncol, 2008). Recorded parameters included demographic data, neo-adjuvant treatment, histologic findings, postoperative course and overall- and disease-free survival.

Results

A total of 113 cases were included in this preliminary analysis. 97 patients (86%) were classified as having sarcopenia. Of these, 38 patients (40%) had a preoperatively or during esophageal resection implemented percutaneous endoscopic jejunostomy (PEJ) tube to ensure enteral nutrition. Despite age, groups were comparable regarding neoadjuvant treatment and histologic findings (mean age sarcopenic patients: 66y vs. 61y non-sarcopenic patients, p = 0.03). There was no difference in the incidence of occurrence of anastomotic leakage, pulmonary complications, need for re-operation, length of (ICU) stay and overall- and disease-free survival between sarcopenic and non-sarcopenic patients.

Conclusion

Incidence of sarcopenia is very high among esophageal cancer patients. In our study population, however, preoperative sarcopenia failed to predict complications or long-term outcome after esophagectomy for esophageal cancer. 40% of the sarcopenic patients received a PEJ. This relatively high proportion of implemented PEJ could have contributed to the observed comparable outcomes between sarcopenic and non-sarcopenic patients. This observation underlines the importance of prehabilitation and nutritional support for patients with preoperative sarcopenia.
566. SUPERIOR MEDISTINAL LYMPHADENECTOMY IN PRONE POSITION UTILIZING 3D-ASSISTED THORACOSCOPY. A NOVEL APPROACH
Authors: Davakis Spyridon , Mylonakis Adam , Kozadinos Alexandros , Nitsa Zoi , Sakarellos Panagiotis , Alexandrou Andreas , Charalabopoulos Alexandros
Published: September 2024

Introduction

Routine lymphadenectomy during esophagectomy includes 2-field lymphadenectomy for distal-esophageal or esophago-gastric junction adenocarcinoma. Superior mediastinal lymphadenectomy (SML) refers to extended 2-field lymphadenectomy (right or left para-tracheal nodes) or total mediastinal lymphadenectomy. The exact benefits of (SML) have long been debated, but with the evolution of prone position 3D-assisted thoracoscopy favorable outcomes can be achieved in the hand of experts.

Aim

This study aims to describe our surgical technique of 3D-assisted thoracoscopic SML during minimally invasive esophagectomy in prone position.

Material and Methods

SML included right paratracheal nodes and lymph nodes (LNs) along the right recurrent laryngeal nerve throughout its mediastinal route (including the paratracheal-retrocaval compartment) in cases of extended 2-field lymphadenectomy, as well as left paratracheal nodes and LNs along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy.

Results

Among the identified eligible cases (n=30), there was no mortality at 30- or 90-post-operative days. No anastomotic or chyle leaks were observed. Pulmonary complications occurred in 15% of patients; right recurrent laryngeal nerve palsy was noted in one patient (3.3%). The median number of resected LNs was 45, with a median count of 12 SML LNs.

Conclusions

Although limited by a small cohort sample, this study suggests that minimally invasive esophagectomy with SML may offer some benefits in terms of oncological outcomes without significant additional morbidity.

https://wetransfer.com/downloads/6329dbd1f817d7e492f8905291f946e120240309180637/42ee79017067b59a4a73138377d9d95620240309180649/f28a32
610. CROSS-BEDDED ANTI-REFLUX ANASTOMOSIS ACHIEVED LESS GASTROESOPHAGEAL REFLUX WITHOUT ADDITIONAL DYSPHAGIA COMPARED TO CONDITIONAL ANASTOMOSIS IN MCKEOWN ESOPHAGECTOMY
Authors: Wu Na , Wang Lei , Hu Yang
Published: September 2024

Background

Most esophageal cancer patients undergoing Mckeown esophagectomy had severe postoperative gastroesophageal reflux and poor quality of life. A novel anastomosis technique was invented to improve this situation. We conducted this study to investigate the incidence of gastroesophageal reflux, dysphagia, and quality of life (QoL) among patients with esophageal cancer undergoing non-intussuscepted anastomosis and cross-bedded anti-reflux (CAR) anastomosis during Mckeown esophagectomy.

Methods

Data from patients who underwent Mckeown esophagectomy for esophageal cancer from March 2022 to December 2022 were retrospectively analyzed. The incidence of gastroesophageal reflux, dysphagia, and QoL were measured. We enrolled 218 patients, including 155 patients undergoing non-intussuscepted anastomosis and 63 patients undergoing CAR anastomosis. Propensity score matching was used to provide a balanced cohort consisting of 63 paired cases. Patients’ demographics and clinical data were compared between the two arms.

Results

Before propensity score matching, there were no significant differences between the two arms in terms of sex, age, body mass index, or comorbidities. Neoadjuvant therapy was the only unbalanced variable. After propensity matching, baseline characteristics were all comparable between them. Anastomotic leakage occurred in 1 (1.6%) patient in the CAR anastomosis arm and in 2 (3.2%) in the non-intussuscepted anastomosis arm. No significant difference was observed in dysphagia severity (P=0.267). 45 (71.4%) patients in the non-intussuscepted anastomosis arm and 60 (95.2%) in the CAR anastomosis arm slept in the supine position (P=0.001). Gastroesophageal reflux was milder in the CAR anastomosis arm (P<0.001). The CAR anastomosis arm was superior to the non-intussuscepted anastomosis arm in the social functioning domain (P=0.004) and financial difficulties domain (P=0.026) of QoL.

Conclusions

CAR anastomosis achieved sufficient control of gastroesophageal reflux without causing dysphagia. It also improved QoL compared with non-intussuscepted anastomosis.

https://1drv.ms/v/s!AmCqlJJZqDPDjRcLYFEgRSPHrUDY?e=1bEAyy
763. TEXTBOOK ONCOLOGIC OUTCOME FOLLOWING TRIMODALITY THERAPY FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Mitchell Kyle , Kassab Cynthia , Antonoff Mara , Mehran Reza , Rajaram Ravi , Rice David , Swisher Stephen , Vaporciyan Ara , Walsh Garrett , Hofstetter Wayne
Published: September 2024

Background

Although the concept of textbook oncologic outcome (TOO) as an emerging quality benchmark has been validated in the general surgical oncology literature, data regarding the frequency of achieving TOO and its impact on subsequent survival outcomes in patients with esophageal adenocarcinoma (EAC) who undergo trimodality therapy remain undefined.

Methods

Patients with adenocarcinoma of the esophagus/gastroesophageal junction (GEJ, Siewert I/II) who underwent neoadjuvant chemoradiation and esophagectomy at a single institution (2000-2022) were retrospectively identified. Patients undergoing salvage resection were excluded. TOO was defined according to a published consensus definition: length of stay (LOS) ≤14 days, R0, ≥20 resected lymph nodes, no anastomotic leak (any grade), no Clavien-Dindo (CD) grade ≥3 complications, no hospital or intensive care unit (ICU) readmission, and no reoperation. Multivariable logistic regression was used to identify clinicopathologic features associated with TOO. Multivariable Cox regression and landmark analyses were used to quantify the association between TOO and OS.

Results

Of 1138 patients, TOO was observed in 38.2% (435): 90.9% (1034) R0, 60.9% (693) ≥20 lymph nodes, 89.9% (1023) no anastomotic leak, and 98.4% (1120) no in-hospital mortality. Features independently associated with reduced odds of TOO included: cervical anastomosis (OR 0.50, P=0.001), preoperative delay ≥90 days after neoadjuvant therapy (OR 0.62, P=0.004), induction chemotherapy (OR 0.74, P=0.039), coronary artery disease (OR 0.67, P=0.043). Among patients who underwent esophagectomy <90 days after neoadjuvant therapy and survived ≥30 days, TOO was independently associated with improved OS (HR 0.80, P=0.018). TOO remained associated with improved OS using 90-day (P=0.014) and 120-day (P=0.037) landmarks.

Conclusions

Although TOO is difficult to achieve following trimodality therapy for EAC, it is strongly associated with improved long-term overall survival. As such, further efforts are warranted to explore the utility of TOO as a quality benchmark in EAC patients and to validate its impact across varying practice settings.
783. ROBOTIC ASSISTED CISTERNA CHYLI EMBOLIZATION FOR ABDOMINAL CHYLE LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Denissen Laurens , Valk Jody , Jardinet Thomas , de Maat Michiel
Published: September 2024

Background

High output chyle leakage is a challenging complication following esophagectomy, carrying substantial morbidity and even mortality. Initial conservative management with parenteral feeding is commonly advised resulting in lengthy episodes of hospitalization and prolonged chest tube placement. Here, we present a case post Ivor-Lewis esophagectomy with high-output chyle leakage where we localized the leakage site to be at the cysterna chyli and subsequently treated it operatively combining robotics, fluorescence and embolization with glue.

Methods

A 74-year-old male underwent robotic-assisted minimally invasive Ivor Lewis esophagectomy for distal esophageal adenocarcinoma. Postoperatively, chylous fluid was drained from the chest up to 700-1300cc per day despite parenteral feeding. Lipiodol lymphangiography identified extravasation of contrast at the cysterna chyli and correct clipping of the thoracic duct. Due to failure of conservative management, on postoperative day 14, robotic-assisted exploration of the truncal region with intranodal injection of indocyanine green was performed.

Results

This innovative procedure revealed the leakage site medially of the coeliac trunc at the cysterna chyli. Lymphatic sealing was achieved via percutaneous endoluminal embolization using a microcatheter and Histoacryl® injections, resulting in an abrupt resolution of the leak and discharge with oral MCT diet on day 5 after reoperation.

Conclusion

This case demonstrated the feasibility and efficacy of an innovative multimodal technique combining the dexterity and fluorescence of robotic surgery with a laparoscopic application of an interventional radiology embolization technique. Because of the risk of venous emboli, we note that this technique should only be applied in cases of abdominal chyle leakage when the thoracic duct is interrupted.

https://www.dropbox.com/scl/fi/sktltdc1be41jfq4dk3lt/Video-Presentation-ISDE-2024-Robotic-Embolisation-Abdominal-Chyle-leakage-Def.mp4?rlkey=1wni1dpnjg4swiajcjdfa6isn&st=wx30jbi7&dl=0
808. ROUX-EN- Y GASTRIC BYPASS FOR REFRACTORY SEVERE GERD AFTER PROXIMAL GASTRECTOMY
Authors: Beltrán Pablo Vázquez , Cuéllar Elías Rodríguez , Caballero Javier Martínez , Montoro Dra Lucía Lavin , Fernández Dra Clara Fernández , Fajardo David Navarro , Lázaro Felipe Chacón , Herrero Eduardo Ferrero
Published: September 2024

Roux-en- Y gastric bypass for refractory severe GERD after proximal gastrectomy

Category

Gastro-esophageal reflux and hiatal hernia

Background

This is the case of a 27-year-old male diagnosed with achalasia. During dilation of the gastroesophageal junction a iatrogenic esophageal perforation occurred. Therefore, a polar gastrectomy with stapling of the lesser curvature and resection of the distal esophagus with esophagogastric anastomosis was performed. After the surgery the patient experienced symptoms of severe reflux unresponsive to PPI. Therefore, a subtotal gastrectomy with pouch construction and Roux-en-Y gastrojejunostomy was indicated.

Methods

We present an intraoperative video showing the surgical technique.

Results

The postoperative period was uneventful, with favorable response to gradual reintroduction of oral intake. The patient was discharged on the 9th POD. After a 12-month follow up the patient remains asymptomatic.

Conclusions

Surgery is currently the gold standard treatment for refractory reflux. In this case, the creation of a gastric pouch with Roux-en-Y bypass ensures the resolution of the symptoms of GERD as well as the gastric delay. Preservation of the gastroepiploic vessels to ensure an optimal gastric pouch perfusion is mandatory

https://we.tl/t-kLUqi4AqqB
Resection of a giant right coronary artery aneurysm and reconstruction with a saphenous vein graft: a 20-year follow-up—case report
Authors: Halyckyj-Smith Joshua , Rose David
Published: September 2024

Background

Coronary artery aneurysms (CAAs) are uncommon and can cause complications such as thrombosis, vessel rupture, or distal embolization. Rarely, CAAs are classified as ‘giant’, although the defining diameter is debated. The predominant cause of CAAs is atherosclerotic disease. Independently, CAAs constitute an estimated 5-year survival of 71%.

Case summary

We report the case of a 56-year-old female who presented 20 years ago with a chest infection when a murmur was auscultated on examination. Subsequently, a coronary angiogram was performed, demonstrating an extensive aneurysm of the right coronary artery (RCA). The aneurysmal segment of the RCA was resected, and a length of saphenous vein was utilized in its reconstruction. Twenty years later, the patient re-presented with dyspnoea, indicating repeat investigations; coronary angiography demonstrated a vein graft 20 years post-reconstruction that is almost indistinguishable from a native RCA.

Discussion

The optimal management strategy for CAAs is debatable, and there are no clear guidelines. However, surgical management is generally preferred in cases of GCAAs, which was also the case for this patient. This reconstruction procedure, involving resection of the aneurysmal segment of the RCA and reconstruction with a saphenous vein graft, proved to be a durable and reliable approach, with the saphenous vein graft remaining patent for over 20 years. The 20-year follow-up provides valuable insight into the long-term durability of surgical intervention, allowing for comprehensive assessment of the durability and reliability of this procedure.
Linkage equilibrium between rare mutations
Authors: Lyulina Anastasia S , Liu Zhiru , Good Benjamin H
Published: September 2024

Recombination breaks down genetic linkage by reshuffling existing variants onto new genetic backgrounds. These dynamics are traditionally quantified by examining the correlations between alleles, and how they decay as a function of the recombination rate. However, the magnitudes of these correlations are strongly influenced by other evolutionary forces like natural selection and genetic drift, making it difficult to tease out the effects of recombination. Here, we introduce a theoretical framework for analyzing an alternative family of statistics that measure the homoplasy produced by recombination. We derive analytical expressions that predict how these statistics depend on the rates of recombination and recurrent mutation, the strength of negative selection and genetic drift, and the present-day frequencies of the mutant alleles. We find that the degree of homoplasy can strongly depend on this frequency scale, which reflects the underlying timescales over which these mutations occurred. We show how these scaling properties can be used to isolate the effects of recombination and discuss their implications for the rates of horizontal gene transfer in bacteria.
NEK1 haploinsufficiency worsens DNA damage, but not defective ciliogenesis, in C9ORF72 patient-derived iPSC-motoneurons
Authors: Santangelo Serena , Invernizzi Sabrina , Sorce Marta Nice , Casiraghi Valeria , Peverelli Silvia , Brusati Alberto , Colombrita Claudia , Ticozzi Nicola , Silani Vincenzo , Bossolasco Patrizia , Ratti Antonia
Published: September 2024

The hexanucleotide G4C2 repeat expansion (HRE) in C9ORF72 gene is the major cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), leading to both loss- and gain-of-function pathomechanisms. The wide clinical heterogeneity among C9ORF72 patients suggests potential modifying genetic and epigenetic factors. Notably, C9ORF72 HRE often co-occurs with other rare variants in ALS/FTD-associated genes, such as NEK1, which encodes for a kinase involved in multiple cell pathways, including DNA damage response and ciliogenesis. In this study, we generated induced pluripotent stem cells (iPSCs) and differentiated motoneurons (iPSC-MNs) from an ALS patient carrying both C9ORF72 HRE and a NEK1 loss-of-function mutation to investigate the biological effect of NEK1 haploinsufficiency on C9ORF72 pathology in a condition of oligogenicity. Double mutant C9ORF72/NEK1 cells showed increased pathological C9ORF72 RNA foci in iPSCs and higher DNA damage levels in iPSC-MNs compared to single mutant C9ORF72 cells, but no effect on DNA damage response. When we analysed the primary cilium, we observed a defective ciliogenesis in C9ORF72 iPSC-MNs which was not worsened by NEK1 haploinsufficiency in the double mutant iPSC-MNs. Altogether, our study shows that NEK1 haploinsufficiency influences differently DNA damage and cilia length, potentially acting as a modifier at biological level in an in vitro ALS patient-derived disease model of C9ORF72 pathology.
Deep learning model optimization of 110 kV line ice-melting technology without power failure
Authors: Jia Laiqiang , Zhang Tianyi , Guo Ziqiang , Liu Ru , Duan Weiquan
Published: September 2024

In order to achieve ice disaster warning for transmission lines, this article proposes an improved method based on particle swarm optimization (PSO) backpropagation (BP) neural network for ice thickness prediction. The study selects multiple factors such as temperature, humidity, and wind speed, introducing neural network prediction methods to explore the situation of ice thickness on transmission lines. The predictions from this model demonstrate closer alignment with actual values and achieve superior prediction accuracy compared to both the BP model and the PSO-BP model, and the average absolute percentage error of improved PSO (IPSO)-BP is 0.007. Using a 110 kV line as the experimental object, the study conducts ice melting without power outage by changing of the grid currents. Additionally, this predictive model method is employed for ice warnings, assessing ice coverage levels by computing the ice coverage ratio. This facilitates precise control over the activation and deactivation of ice melting devices. The method proposed in this study addresses the issue of low accuracy resulting from the singular data types used in traditional early warning models. Future efforts should focus on further validating the applicability of this method under varying climatic and environmental conditions to achieve real-time, precise control over line ice melting.
Evidence for the Contribution of the miR-206/BDNF Pathway in the Pathophysiology of Depression
Authors: Zheng Ya-Bin , Jin Xiang
Published: September 2024

Depression is a complex disorder with substantial impacts on individual health and has major public health implications. Depression results from complex interactions between genetic and environmental factors. Epigenetic mechanisms, including DNA methylation, microRNAs (miRNAs), and histone modifications, can produce heritable phenotypic changes without a change in DNA sequence and recently were proven to mediate lasting increases in the risk of depression following exposure to adverse life events. Of these, miRNAs are gaining attention for their role in the pathogenesis of many stress-associated mental disorders, including depression. One such miRNA is microRNA-206 (miR-206), which is a critical candidate for increasing the susceptibility to stress. Although miR-206 is thought to be a typical muscle-specific miRNA, it is expressed throughout the brain, particularly in the hippocampus and prefrontal cortex. Until now, only a few studies have been conducted on rodents to understand the role of miR-206 in stress-related abnormalities in neurogenesis. However, the precise underlying molecular mechanism of miR-206–mediated depression-like behaviors remains largely unknown. Here, we reviewed recent advances in the field of biomedical and clinical research on the role of miR-206 in the pathogenesis of depression from studies using different tissues and various experimental designs and described how abnormalities in miR-206 expression in these tissues can affect neuronal functions. Moreover, we focused on studies investigating the brain-derived neurotrophic factor (BDNF) as a functional target of miR-206, where miR-206 has been implicated in the pathogenesis of depression by suppressing the expression of the BDNF. In summary, these studies confirm the existence of a tight correlation between the pathogenesis of depression and the miR-206/BDNF pathway.
Zero-Dimensional Shimura Varieties and Central Derivatives of Eisenstein Series
Authors: Sankaran Siddarth
Published: September 2024

We formulate and prove a version of the arithmetic Siegel–Weil formula for (zero dimensional) Shimura varieties attached to tori, equipped with some additional data. More precisely, we define a family of “special” divisors in terms of Green functions at archimedean and non-archimedean places and prove that their degrees coincide with the Fourier coefficients of the central derivative of an Eisenstein series. The proof relies on the usual Siegel–Weil formula to provide a direct link between both sides of the identity, and in some sense, offers a more conceptual point of view on prior results in the literature.
Epistemologies of Domination: Colonial Encounters, Heterology, and Postcolonial Pedagogy
Authors: Sajed Alina
Published: September 2024

This article theorizes and establishes some of the outlines of an epistemology of domination. An epistemology of domination interpellates the question of “how/what does the oppressor know about the oppressed?” Drawing on several studies of cultural encounters such as Ibrahim Abu-Lughod's The Arab Rediscovery of Europe, Ashis Nandy's The Intimate Enemy, and Zeynep Çelik's Europe Knows Nothing about the Orient, the discussion explores epistemic tropes around colonial encounters: the power and politics of representation; the burden of belatedness/the denial of coevalness; the over-emphasizing of Western agency. Wlad Godzich states that “Western Thought has always thematized the other as a threat to be reduced, as a potential same-to-be, a yet-not-same.” My discussion here accepts this premise but only partially, and asks the question: does domination always entail the projection of alterity as a threat, or is there a wider spectrum of epistemic projections? How does the other encounter and experience the Western self, and does such encounter modify hegemonic epistemological paradigms? Following Michel de Certeau's assertion that “what is near masks a foreignness,” I seek to complicate the relation between selfhood and otherness in the colonial encounter, and its entanglements with colonial violence. What pedagogical moments emerge from such encounters? And how do such pedagogical moments structure postcolonial epistemologies?