bluuebunny/crossref_metadata_2025 huggingface dataset:
350. SALVAGE RADIATION THERAPY FOR OLIGO-RECURRENCES AFTER RADICAL TREATMENT OF ESOPHAGEAL CANCER
Authors: Mummudi Naveen , Srinivasan Shashank , Jiwnani Sabita , Tibdewal Anil , Karimundackal George , Pramesh CS , Agarwal Jai Prakash
Published: September 2022

Loco-regional recurrences following surgery or radical radiation therapy for esophageal cancers represent a significant clinical problem. We performed a retrospective study to assess the safety and efficacy of salvage radiation for oligo-recurrence after primary curative therapy for esophageal cancer.

Esophageal cancer patients treated with salvage radiotherapy between January 2011 and March 2020 at our institution were screened. Patients were included if they had undergone prior treatment for esophageal carcinoma with curative intent using either surgery or radiotherapy and had developed local/locoregional/isolated distant recurrences. Recurrences were diagnosed based on CT scan or/and FDG PET-CT scan. Treatment plan was discussed in a multi-disciplinary tumour board and patients were followed up as per institution policy. Survival rates were estimated using the Kaplan–Meier method and data was analyzed using IBM SPSS Statistics for Windows (Version 26.0. Armonk, NY: IBM Corp.)

Oligo-recurrence was diagnosed in 33 patients; thirty patients had loco-regional-recurrence (LRR), 3 had distant metastasis); 28 patients underwent surgery as initial treatment; 5 received definitive RT. Recurrence was detected at a median of 21 months. Of the 30 patients with LRR, 25 patients received chemo-radiation and 5 received RT alone. At a median follow-up of 18 months, 20 patients were alive and 61% had controlled disease. Overall survival at 1- & 2- year were 83% and 65% respectively. Concurrent chemotherapy administration and RT dose of >56Gy were independent predictors for OS. No grade 3/4 acute or chronic toxicity were observed.

Salvage RT with or without concomitant chemotherapy for loco-regional recurrences after surgery for esophageal cancer is safe and effective. Advanced, modern RT techniques may reduce treatment related morbidity and improve outcomes.
355. CAMRELIZUMAB COMBINED WITH CHEMOTHERAPY OR APATINIB AS NEOADJUVANT THERAPY FOR LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PHASE 2 TRIAL
Authors: Qi Yu , Meng Xiangrui , Shan Zhengzheng , Fan Qingxia , Wang Feng
Published: September 2022

At present, esophageal squamous cell carcinoma (ESCC) has a dismal prognosis with huge unmet clinical needs. Chemotherapy or angiogenesis inhibitor showed synergistic effects with immunotherapy in preclinical and clinical studies. With the potential benefit of combining PD-1 inhibitor with chemotherapy or angiogenesis inhibitor, we conducted a phase 2 trial (NCT03917966) to assess the efficacy and safety of camrelizumab plus chemotherapy or apatinib as neoadjuvant therapy for locally advanced ESCC.

This is an open-label, non-randomized phase 2 trial of patients with stage cT2-4aN0-3 M0 ESCC. Cohort A enrolled patients who received 1 cycle of camrelizumab as induction therapy (200 mg Q3W) and 2 cycles of camrelizumab (200 mg Q2W) plus docetaxel and nedaplatin. Cohort B planned to enroll patients with 4 cycles of camrelizumab (200 mg Q2W) and apatinib (250 mg QD). Surgery was performed within 4–6 weeks after neoadjuvant therapy. The primary endpoint was major pathological response (MPR) rate. Secondary endpoints included pathological complete response (pCR) rate, R0 resection rate, disease-free survival, overall survival, and safety.

Between Feb 2020 and Oct 2021, 62 patients were enrolled in cohort A, with a median age of 66 years. As of Apr 20, 2022, 59 patients completed neoadjuvant therapy and 48 completed surgery. In the surgery set, all patients reached R0 resection, 37 (77.1%) reached MPR, 19 (39.6%) reached pCR, and 44 (91.7%) had TNM downstaging. Any grade and grade ≥ 3 adverse events occurred in 88.7% and 14.5% of 62 patients, respectively. No new safety signals or treatment-related deaths were observed. Cohort B started recently, and only 2 of 40 planned patients had been enrolled, thus were not analyzed.

Neoadjuvant camrelizumab in combination with chemotherapy in patients with locally advanced ESCC showed promising pathological response and downstaging effect with good tolerance. Another cohort of neoadjuvant camrelizumab plus apatinib for locally advanced ESCC is ongoing, which will be reported in the future.
369. GENOMIC ALTERATIONS AND SURVIVAL AFTER TREATMENT OF EAC BY SURGERY WITHOUT CHEMO- OR RADIOTHERAPY
Authors: Levert-Mignon Angelique , Trinh Anne , Falkenback Dan , Barnet Megan , Naeini Marjan , Grady John , McCabe Mark , Goldstein Leonard , Johansson Jan , Lord Reginald
Published: September 2022

Prognostic biomarkers for esophageal adenocarcinoma (EAC) remain elusive but may be helpful in treatment planning, as TNM staging often fails to accurately predict survival. Advanced stage patients are treated by peri-operative chemo/radiotherapy; biomarkers associated with survival are thus likely to represent both true prognostic markers as well as markers of response to chemo/radiotherapy. Here we present first-pass genomic findings for a cohort of optimally staged EAC patients treated by surgery alone.

DNA was extracted from fresh frozen EAC and matching normal squamous esophageal tissues obtained at esophagectomy from 65 consenting patients who did not receive any neo- or adjuvant chemo- or radiotherapy due to institutional preference at the time of tissue collection. Library preparation and sequencing for a targeted 600 cancer-associated gene panel designed using the Roche/NimbleGen EZ Choice Library NimbleDesign platform were conducted on Illumina-based platforms followed by analysis with an accredited bioinformatics pipeline. The panel design incorporated the entire coding region plus 10 bp of flanking intron of each gene.

Mean age 70 yrs; 88% male. All patients underwent an en bloc esophagectomy (mean 35 lymph nodes). TNM (7th ed.) stages were 61% Stage 3, 18% stage 2, 14% stage 1, 6% stage 4. At median 9.5 years follow-up, 20 (31%) patients remained alive. Copy number changes were common, reflecting chromosomal instability. Less than 8% of patients had high tumour mutational burden (>10mut/MB), associated with mutations in DNA repair genes. Commonest somatic mutations included TP53 (HR: 0.43) and LRP1B (HR: 1.7). Pathways implicated included RTK signalling (PIK3CA, EGFR, KRAS), DNA damage (BRCA1, PALB2, MGMT) and histone remodelling (ARID1A, ARID2, KMT2D).

Peri-operative treatment means linking genomic changes independent of stage to clinical outcomes is difficult. Neoadjuvant and/or adjuvant treatment is now standard for T2–4 or node positive EAC. This cohort of 65 patients, most of whom had stage 3 disease and all of whom underwent optimal staging with en bloc esophagectomy, represents a unique opportunity to analyze characteristics of EAC without confounding by peri-operative treatment. An EAC-specific DNA sequencing panel approach offers potential for personalized therapy.
373. STRATEGIES ON OPTIMAL LYMPHADENECTOMY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE ANALYSIS OF 1517 CASES IN A SINGLE CANCER CENTER
Authors: Li Kexun , Leng Xue Feng , Du Kunyi , Liu Kun , He Wenwu , Wang Qifeng , Luo Xi , Wang Chenghao , Wang Kangning , Liu Guangyuan , Wei Xing , Li Haojun , Zhou Qiang , Li Zhiyu , Jiang Longlin , Zheng Kai , Li Changding , Mao Tianqin , Luo Xi , Fang Qiang , Xiao WenGuang , Han Yongtao , Peng Lin
Published: September 2022

The incidence and mortality of esophageal cancer are high-ranking in the world in cancer, it is the forth primary cause of cancer-related death and has the sixth highest incidence rate in China. Our purpose is to discuss the impact of the number of lymph nodes dissection in esophagectomy for esophageal squamous cell carcinoma to patients’ overall survival (OS), especially in the patients who have positive lymph nodes in recent years.

Data were from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database. We retrospective analyzed patients who underwent esophagectomy from Jan. 2010 to Dec. 2016. Patients were divided into two groups: Negative lymph nodes in the pathological results were assigned to N0 group, while patients with positive lymph nodes were divided into N+ group. The median number of resected lymph nodes (RLNs) during operation was 24, patients were assigned to group A/N0 and A/N+ according to RLNs number of 15–24, and number of RLNs more than 24 were assigned to group B/N0 and B/N+.

After 62.8 months of median follow-up time, 1517 patients who received esophagectomy were included. In the N+ group, the median overall survival (OS) of N+ A group was 27.8 months (95% CI 23.8–31.8) compared to N+ B group was 33.3 months (95% CI 28.2–38.5). The OS at 1, 3, and 5 years were 80%, 40%, and 30% in the N+ A group, and there were 82%, 48%, and 35% in the N+ B group, respectively (P = 0.038 < 0.05). (HR 1.18, 95% CI 1.008–1.380, P = 0.038).

Increasing the harvest of number of lymph nodes during surgery more than 24 could improve the OS of esophageal squamous cell carcinoma patients. It is demonstrated patients without lymph metastasis have a better OS than those with lymph metastasis. When we reached dissection more than 15 lymph nodes, there will be no more benefits in OS for further harvest of lymph node numbers. Patients with different stages may be given different lymph nodes dissection strategies.
376. THE IMPACT OF OVERALL SURVIVAL ON TWO-FIELD OR THREE-FIELD LYMPHADENECTOMY IN MIDDLE AND LOWER THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Li Kexun , Leng Xuefeng , Li Changding , Liu Kun , He Wenwu , Luo Xi , Wang Chenghao , Wang Qifeng , Wang Kangning , Liu Guangyuan , Zhou Qiang , Jiang Longlin , Li Haojun , Mao Tianqin , Du Kunyi , Fang Qiang , Xiao WenGuang , Han Yongtao , Peng Lin
Published: September 2022

More than 50% of esophageal cancer cases worldwide occur in China. Squamous cell carcinoma is the main subtype of esophageal cancer in East Asian. The manner of lymphadenectomy during surgery is related to the OS, but the effect of removed lymph node count for middle and lower thoracic esophageal squamous cell carcinoma (ESCC) in China is still controversial.

Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database) from Jan. 2010 to Dec. 2017. Patients were divided into two groups: For patients without suspicious tumor-positive cervical lymph nodes, 2-field systematic lymphadenectomy was performed and were belonged 2F group, while patients with suspicious tumor-positive cervical lymph nodes, 3-field systematic lymphadenectomy was performed and were put into 3F group. According to the quartile number of resected lymph nodes during operation. Four subgroups were designed for analysis in 2F group and 3F group, depending on the intensity of the lymphadenectomy.

After 60.0 months (95% CI 56.5–63.4) of median follow-up time. The median OS of 2F group patients was 46.9 months (95% CI 39.3–54.5), 3F group was 34.0 months (95% CI 26.1–42.0). The OS at 1, 3, and 5 years were 87%, 57%, and 46% in the 2F group. In the 3F group, the OS rates at 1, 3, and 5 years were 82%, 49%, and 41% (P = 0.029). According to the quartile number of RLNs, there were different survival outcomes in 3F sub-groups, while in the 2F groups, the OS between A/B/C/D group was not significantly different (Fig A & B).

ESCC patients with suspicious tumor-positive cervical lymph nodes have significantly worse OS than patients who without tumor-positive cervical lymph nodes. Different lymph nodes number removed in 3F patients could lead the entirely different survival outcomes. However, this still needs further large scale study to verify in China.
378. FLOT VS ECX: A COMPARISON OF TWO NEOADJUVANT CHEMOTHERAPY REGIMEN’S EFFECTS ON SARCOPENIA IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS
Authors: Convill James , Chmelo Jakub , Prasad Pooja , Brown Joshua , Petrides George , Phillips Alexander
Published: September 2022

Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. Neoadjuvant chemotherapy (NAC) may contribute to sarcopenia development. FLOT, although superior to ECX in terms of survival, has been reported to have higher toxicities. The aim of this study was to compare the effect of ECX and FLOT on sarcopenia and lean body mass (LBM) in EGA patients.

Patients diagnosed with EGA between January 2017 and December 2020 and undergoing ECX/FLOT NAC followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4cm2/m2 for men and 38.5cm2/m2 for women). LBM (kg) was calculated using a previously published formula.

153 patients were included in the analysis. Sarcopenia increased from 77/153 (50.3%) pre-NAC to 98/153 (64.1%) post-NAC (p < 0.005). There were 48/82 (58.5%) ECX and 29/65 (44.6%) FLOT patients sarcopenic pre-NAC. 60/82 (73.2%) ECX and 38/65 (58.5%) FLOT patients were sarcopenic post-NAC and pre-operatively. There was no statistically significant difference observed for development of sarcopenia after NAC between the two NAC regimens (p = 0.793). Similarly, LBM significantly decreased during NAC (p = 0.007), but this effect did not vary between NAC regimen (p = 0.917).

Radiological sarcopenia is highly prevalent in EGA patients and significantly increases during NAC. However, this study suggests that there is no difference in the degree of sarcopenia between ECX and FLOT NAC regimens. Impact of pre- and post-FLOT related sarcopenia on treatment outcomes needs to be established alongside strategies to treat this syndrome and prevent its further development.
384. A 10-YEAR EXPERIENCE WITH ANASTOMOTIC LEAKS IN UPPER GASTROINTESTINAL SURGERY
Authors: Law Jia Hao , Ng Charmaine Zhi-Mei , Lauw Sarah-Kei , So Jimmy Bok Yan , Kim Guo Wei , Shabbir Asim
Published: September 2022

Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge despite advancements in surgical techniques and investigation modalities. We seek to identify key clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries in our practice.

592 patients underwent UGI surgeries with an anastomosis in a single center between January 2011 and Jan 2021. The cohort comprises were 237 (40.0%) distal gastrectomies, 120 (20.3%) total gastrectomies, 104 (17.6%) Roux-en-y bariatric bypasses, 53 (9.0%) Ivor-Lewis esophagectomies, 41 (6.9%) proximal gastrectomies, 17 (2.8%) palliative gastro-jejunostomies and 20 (3.4%) Mckeown esophagectomies. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed.

The overall occurrence of AL was 6.4%. AL was highest in esophagectomies (13.7%) and total gastrectomies (10.0%). Clinical parameters associated with AL include HR >120 BPM, desaturation, bilious or food contents in drain and leukocytosis. On multivariate analysis, HR >120 BPM and leukocyte count >19x1000000000/L were independent predictors of AL. Patients with high-risk anastomosis who had pre-emptive investigations, were more likely to be managed with antibiotics instead of requiring invasive therapy (p = 0.025). Methylene blue test, oral contrast study and Computed Tomography scan with intravenous and oral contrast had respective false negatives of 50.0%, 20.0% and 9.1%, while esophagogastroduodenoscopy had none.

Our study demonstrates that the presence of a triad including desaturation, tachycardia and leukocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed to exclude a AL. A practice of evaluating high risk anastomosis prior to feeding decreases need for surgical intervention and improves the chances of successful conservative treatment.
388. PREOPERATIVE TREATMENT AND THORACOSCOPIC ESOPHAGECTOMY FOR BORDERLINE RESECTABLE ESOPHAGEAL CANCER
Authors: Kawada Hironori
Published: September 2022

Preoperative DCF therapy is recommended for cStage II/III esophageal cancer based on the results of JCOG1109. However, there is no established treatment strategy for Borderline Resectable (BR) esophageal cancer that is suspected of invading vital organs. And the pros and cons of thoracoscopic surgery have not been clarified. We have been performing preoperative chemoradiotherapy (NACRT) followed by thoracoscopic subtotal esophagectomy for BR esophageal cancer. Details and short-term results are presented.

After 2 courses of FP therapy and 40 Gy total dose (2 Gy x 20 times) of fractionated conventional irradiation, patients underwent thoracoscopic subtotal esophagectomy with D2 dissection if T4 factor was considered to have been removed by CT evaluation.

From April 2017 to present, NACRT was performed in 25 BR esophageal cancer patients. Two of them were unresectable, and thoracoscopic subtotal esophagectomy was performed in 23 cases. All patients had squamous cell carcinoma. 4 patients had complications of Clavien-Dindo Grade III or higher. The median postoperative hospital stay was 23 days. Of the 23 cases that were resectable, R0 resection could be performed in 21 cases (91.3%). The pathological response of the primary tumor was Grade3 in 11 patients (47.8%), Grade2 in 5 (21.7%), and Grade1 in 7 (30.4%). Pathological-CR including regional lymph nodes was 7 cases (30.4%).

NACRT is effective for BR esophageal cancer, and thoracoscopic subtotal esophagectomy can be performed safely. We would like to continue to study the long-term results of NACRT with more cases in the future.
389. BENEFITS OF BILATERAL THORACOSCOPIC SURGERY IN THE PRONE POSITION FOR A LARGE ESOPHAGEAL TUMOR
Authors: Uemura Norihisa , Ishihara Makoto , Saeki Satomi , Ito Takaaki , Tsukahara Tetsuo , Tabata Koki , Yamashita Hiromasa , Takeuchi Mamiko , Arai Toshiyuki , Amemiya Takeshi
Published: September 2022

Esophageal gastrointestinal stromal tumors (GISTs) are relatively less symptomatic and may have a significantly large tumor diameter at diagnosis. Large esophageal tumors are difficult to resect because it is tough to maintain the surgical field in the narrow mediastinal region. In addition, because GIST has a risk of dissemination if the tumor collapses during surgery, it must be resected with as little force as possible.

We herein report a middle and lower thoracic esophageal GIST with a maximum lateral diameter of 12 cm that could be safely resected by a bilateral thoracoscopic approach in the prone position. The case was that of a 70-year-old man. Since his tumor diameter was large and the surrounding organs were severely compressed, it was deemed to be borderline resectable, and preoperative chemotherapy with imatinib was decided. However, administration of imatinib did not result in tumor shrinkage, and interstitial pneumonia occurred. Thus, the final decision was to resect it.

It was difficult to remove the left side of the tumor by normal thoracoscopic operation from the right side as the tumor was large. There was also the risk of the tumor collapsing due to unreasonable traction. Therefore, we selected a surgical procedure in which the left and right sides of the tumor were detached by bilateral thoracoscopic operation in the prone position and then the tumor was removed from the abdominal cavity by a transesophageal hiatal operation under laparotomy. Followed by gastric tube reconstruction by the posterior sternal route. The postoperative course was uneventful.

In this case, taking advantage of the thoracoscopic approach from both sides, the tumor could be safely resected without unreasonable traction. Furthermore, the prone position has the advantage that bilateral thoracoscopic operation is possible without changing the position. This technique could also be applied for the excision of esophageal cancer involving the left side.
392. A CASE REPORT AND REVIEW OF MANAGEMENT OF AORTOESOPHAGEAL FISTULA SECONDARY TO OESOPHAGEAL MALIGNANCIES
Authors: Pang Jolyn , Ng Ya-Lyn Annalisa , Wong Siang Yih Andrew
Published: September 2022

Aortoesophageal fistula (AOF) is a rare but life-threatening condition. We present a case of AOF secondary to oesophageal Squamous Cell Carcinoma (SCC) treated with Thoracic Endovascular Aortic Repair (TEVAR) and a literature review of cases of AOF secondary to oesophageal malignancies treated with TEVAR.

We performed a literature review of patients with oesophageal malignancies complicated by AOF who underwent endovascular stenting as treatment.

A total of 16 articles with 22 patients were found during the review. The majority (18 out of 22 patients, 82%) were male. 18 (82%) presented with haemorrhage and 9 (41%) presented with hypotension. Of the eight studies where location of oesophageal tumour was mentioned, 7 (88%) were in the mid-thoracic oesophagus. Survival at 6 months post-stenting was up to 45%.

Early recognition of AOF, effective resuscitation and early intervention is critical in survival of patients with AOF. TEVAR has been shown to have good outcomes with high technical success rate.
397. NEOADJUVANT CHEMORADIOTHERAPY VERSUS NEOADJUVANT CHEMOTHERAPY AND POSTOPERATIVE COMPLICATIONS AFTER ESOPHAGECTOMY FOR CANCER
Authors: Olafsdottir Halla , Dalqvist Emmy , Hamida Osama , Onjukka Eva , Klevebro Fredrik , Nilsson Magnus , Gagliardi Giovanna , von Döbeln Gabriella Alexandersson
Published: September 2022

Postoperative complications after esophagectomy are common. Neoadjuvant chemotherapy or chemoradiotherapy in addition to surgery is the standard treatment with curative intent for patients with locally advanced esophageal cancer. The aims of our study were to analyze if the addition of neoadjuvant radiotherapy to chemotherapy and surgery increases the rate and severity of postoperative complications and to evaluate if radiotherapy doses to the heart and lungs were associated with postoperative complications.

The study was based on a prospectively collected database of esophageal cancer patients that were operated on between October 2008 and March 2020. Patients treated with neoadjuvant chemoradiotherapy were compared to patients treated with neoadjuvant chemotherapy. All postoperative complications were graded according to the Clavien Dindo classification. The primary outcome was 30-day postoperative complications. Logistic regression was used to determine the effect of radiotherapy on complication rates. Several dose/volume parameters for the lungs and the heart were considered.

During the study period esophagectomy was performed on 275 patients after neoadjuvant treatment (93 after chemotherapy and 182 after chemoradiotherapy). The median total radiation dose was 41.4 Gy, the median lung dose was 6.2 Gy and the median dose to the heart was 20.3 Gy. Neoadjuvant chemoradiotherapy compared to chemotherapy showed no association with postoperative complications of a Clavien Dindo score of ≥2 or severe postoperative complications (Clavien Dindo ≥3b). Taxane-containing chemotherapy had a statistically significant association with postoperative complications (table 1). The radiotherapy dose to the heart and lungs had no significant association with postoperative complications.

In our cohort, the addition of preoperative radiotherapy to chemotherapy did not increase the rate of postoperative complications. However, an association between postoperative complications and taxane-containing chemotherapy regimens given with or without concomitant radiotherapy was noted.
400. RISK FACTORS OF DELAYED GASTRIC EMPTYING AFTER ESOPHAGECTOMY WITH GASTRIC INTERPOSITION: AN ANALYSIS OF 810 CASES
Authors: Yu Ming Ru , Leow Osbert Qi Yao , Chao Yin-Kai
Published: September 2022

Delayed gastric emptying (DGE) after esophagectomy is not uncommon and would significantly impair patient’s quality of life. Risk factors of DGE remained poorly understood. This study aimed to assess this unresolved issue.

We performed a retrospective study in patients with esophageal cancer who underwent esophagectomy and reconstructed with the gastric substitute between 2000 to 2020. DGE was defined as less than 50% emptying of the contrast medium within 10 minutes on postoperative esophagography. Multivariable logistic analysis was performed to identify patient-, tumor- and procedure-related factors that increase the risk of DGE.

Among 810 eligible patients, the incidence of DGE was 12.2%. Patients who developed DGE had higher incidence of pneumonia (23.2% vs. 10.7%, p < 0.001), longer hospital stay (25.16vs.19.89 days, p < 0.001), and higher rate of in-hospital mortality (4% vs. 1%, p = 0.014). Multivariate analysis identified pre-existing COPD (OR, 2.38; p = 0.004), whole stomach reconstruction (vs. gastric tube, OR, 6.96; p = 0.001) and posterior mediastinum route (vs. retrosternum, OR, 5.35; p = 0.002) as independent risk factors for DGE. The incidence of DGE was 0.6% in patients who received gastric tube reconstruction via retrosternum route as opposed to 20.6% who received whole stomach reconstruction via posterior mediastinum route.

DGE after esophagectomy is associated with increased morbidity and mortality. Type of gastric conduit and route of reconstruction played important roles in the development of DGE.
403. FRAILTY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGECTOMY
Authors: Chowdhury Sheuli , Conroy Molly A , Johnson Alicia J , Qureshi Alia P , Wood Stephanie G
Published: September 2022

Careful selection and optimization of esophageal cancer patients for esophagectomy is necessary and has been shown to improve outcomes. Preoperative frailty measures, both objective and subjective, may predict postoperative outcomes after minimally invasive esophagectomy (MIE) and be applied to surgical decision-making and patient selection. We hypothesize that measures of increased frailty are associated with major complications after MIE for esophageal cancer.

This is a prospective cohort study of patients undergoing MIE for esophageal cancer in a US academic tertiary hospital over one year (2021). We tested preoperative frailty by measuring two-flight stair climb times, pulse change during stair climb, grip strength, and Edmonton Frail Scale (EFS) score. Postoperative complications in the first 30 days were classified based on Clavien-Dindo, with Grade III or above defined as a major complication (primary outcome). We calculated Spearman correlations among the four different frailty measures. We performed t-tests to compare frailty measures in patients with and without major complications.

Thirty-four patients were enrolled with a mean age of 64 (SD 11) and 79.4% male. EFS score, grip strength, and stair climb time were significantly correlated (p < 0.05), as shown in Figure 1. There was a significant difference in EFS scores between groups with or without major complications (4.7 vs 3.0, p = 0.04, respectively), with a higher score representing increased frailty. Other frailty measures did not meet significance between groups for major complication, including stair climb time (difference of 11.0 s, 95% CI: −0.38-22.4) and grip strength (difference of 7.7 kg, 95% CI: −0.94-16.3). No difference was seen in pulse change by complication status.

A higher Edmonton Frail Scale score is associated with major postoperative complications following MIE. Patients with higher EFS score should be counseled on increased surgical risk of morbidity and prehabilitation should be considered. Other measures such as stair climb time and grip strength may support the preoperative frailty assessment in esophageal cancer patients, as they were highly correlative with each other.
411. MAJOR INTRAOPERATIVE COMPLICATIONS IN MINIMALLY INVASIVE ESOPHAGECTOMIES
Authors: Söderström Henna , Moons Johnny , Nafteux Philippe , Uzun Eren , Grimminger Peter , Luyer Misha DP , Nieuwenhuijzen Grard AP , Nilsson Magnus , Hayami Masaru , Degisors De Sebastien , Piessen Guillaume , Vanommeslaeghe Hanne , Van Daele Elke , Cheong Edward , Gutschow Christian A , Vetter Diana , Schuring Nannet , Gisbertz Suzanne , Räsänen Jari
Published: September 2022

Studies have shown minimally invasive esophagectomy (MIE) to be a feasible surgical technique in treating esophageal carcinoma, with equal oncological results as open surgery. The number of MIEs in Europe are increasing. Postoperative complications have been recently reviewed by a multicenter study that benchmarked MIE outcomes. There are no studies, to date, regarding major intraoperative complications during MIE and their effect on patient survival.

Data was gathered retrospectively from 10 European centers with a minimum MIE experience of 3 years and more than 20 procedures annually. All intention-to-treat, minimally invasive laparoscopic/thoracoscopic esophagectomies with gastric conduit reconstruction for esophageal- and GE junction cancers operated between 2003–2019 were reviewed. Major intraoperative complications were defined as loss of conduit, erroneous transection of vascular structures, significant injury to other organs including bowel, heart, liver or lung, splenectomy, major anesthesiologic complications including intubation injuries, arrhythmias, pulmonary embolism and myocardial infarction. We also included minor intraoperative events that led to additional repair or resection of vascular structures or airways.

Amongst 2862 MIE cases we identified 99 patients with 103 intraoperative complications. Of the 34 different complications the most common were vascular lesions during laparoscopy (n = 40). There were 20 splenic artery and -capsular injuries, 11 requiring splenectomy. Four losses of conduit due to gastroepiploic artery injury and five colon injuries were reported. Six tracheobronchial lesions needed repair, and 12 patients had significant lung parenchyma injuries. During thoracoscopy nine of the 13 cases with bleeding were converted and an additional 5 patients required postoperatively emergency re-intervention for thoracic bleeding. There were 2 on-table deaths. 10 of the 99 patients died in-hospital.

This study offers a good overview of the wide range of possible intraoperative complications. Knowing the pitfalls can help trainees, and experienced surgeons, avoid common complications. Unfortunately, this study does not offer us incidence, which would require a prospective trial. On-table deaths are exceedingly rare.

There is a possible underreporting of complications, an issue not avoided by implementing specific surveying criteria. Surgical registries need to capture intraoperative complications better in the future.
412. FEASIBILITY AND SAFETY OF MINIMALLY INVASIVE SURGERY FOR OESOPHAGEAL DUPLICATION CYST IN ADULTS– EXPERIENCE FROM AN OESOPHAGO-GASTRIC SURGERY UNIT
Authors: Surendran Suraj , Samuel Ashish , Paul Negine , Yacob Myla , Abraham Vijay , Gnanamuthu Roy , Samarasam Inian
Published: September 2022

Oesophageal duplication cyst (ODC) is a rare congenital anomaly of the foregut. The reports of ODCs presenting in adulthood is relatively rare. Surgical excision is the ideal treatment. Traditionally, the excision is performed via a thoracotomy with its resultant morbidity. Minimally invasive surgical (MIS) approaches are feasible and can potentially reduce the postoperative discomfort and reduce the hospital stay. We aimed to study the feasibility and safety of MIS for ODC in adults.

A retrospective review of all adult patients with ODCs treated in an oesophago-gastric surgery unit, between January 2015 and March 2022, was performed. All patients received MIS. The demographic, clinico-radiological, and operative details and outcomes were analysed.

Nine patients (Female 7; mean age, 36.2 ± 4.4 years) were included. Chest pain was the commonest symptom (44.0%). Oesophago-gastroscopy showed normal mucosa in all patients. Endoscopic-ultrasound was performed in all except one; no cysts had atypical features. The cysts were frequently located in the distal thoracic oesophagus (78%) and the median (range) cyst size was 6.3(3.9–13.5) cm. All patients received MIS (Thoracoscopy,8; Thoraco-laparoscopic, 1); no conversion to open surgery. The techniques resection techniques were enucleation (5), stapler-assisted resection (3) or partial excision (1). The 30-day morbidity was 22.2% (Staple line leakthoracoscopic repair, 1; pleural collectionimage-guided drainage, 1). The median (range) hospital stay was 7(3–25) days and there was no mortality.

MIS is feasible and safe for the management of adult ODCs and should be offered to patients, irrespective of the timing of its presentation or the location and size of the cyst.
415. A WEBCAST FOR THE EDUCATION AND INFORMATION OF PATIENTS WITH BARRETT’S ESOPHAGUS AND BARRETT’S CANCER
Authors: Etzold Christian , Gockel Ines , Thieme René
Published: September 2022

To provide expert knowledge to patients becomes more and more important, especially during the Sars-CoV-2 pandemics, where self-helping groups could not meet and on-site information events could not take place. We discovered a need due to patients’ uninformedness about diagnostic procedures, treatment options and advice for disease prevention or special nutrition and medications after the diagnosis of Barrett’s esophagus and Barrett’s cancer.

A webpage was created, including a video streaming platform (https://webcast.barrett-initiative.de/). The events were performed live with the opportunity to ask questions via the chat function. Vimeo was used for the live streaming. Three to four lecturers were invited and one moderator organized the sequence of talks and questions. Additionally, the webpage is contains an encyclopedia, to explain disease related terms in a patient-orientated language. The invitation was done based on our nation-wide patient network based on genes for barrett’s (g4b) study https://www.barrett-konsortium.de/. Patients used a desktop computer (65%), mobile phones (28%), and tablets (7%) to join the video sessions.

The lecture series was started with a kick-off event in September 2021 to give a bright overview about reflux, Barrett’s esophagus und Barrett’s cancer. Four special topic events were conducted, dealing with tumor biology, cancer prevention, diagnostics needed for the correct staging and how the diagnostic will guide the therapy by explaining the expertise review board, discussing operability and prehabilitation. The series will be continued by the endoscopic and surgical treatment options. There were 1,100 views to the webpage. While during the kick-off 204 patients were online, approx. 71 to 171 patients saw the following events during the live sessions.

Based on the questions by our patients and the continuous participation at our livestream events, we discovered an urgent need to provide a platform to patients, where they can find disease specific information in a patients-oriented language. Therefore, all lectures were deposited to a media archive where they are available to patients. We implemented our webcast project as a growing platform to cover aspects from the disease development, to diagnosis, treatment, and follow-up care.
422. ROBOT-ASSISTED MINIMALLY INVASIVE THORACO-LAPAROSCOPIC ESOPHAGECTOMY VERSUS MINIMALLY INVASIVE ESOPHAGECTOMY FOR RESECTABLE ESOPHAGEAL ADENOCARCINOMA, A RANDOMIZED CONTROLLED TRIAL (ROBOT-2-TRIAL)
Authors: Tagkalos Evangelos , Berlth Felix , Uzun Eren , Hadzijusufovic Edin , Grimminger Peter P
Published: September 2022

For patients with esophageal adenocarcinoma or cancer of the gastroesophageal junction, radical esophagectomy with 2-field lymphadenectomy is the cornerstone of the multimodality treatment with curative intent. Both conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE) were shown to be superior compared to open transthoracic esophagectomy considering postoperative complications. However, no randomized comparison exists between MIE and RAMIE in the Western World for patients with esophageal adenocarcinoma.

This is an investigator-initiated and investigator-driven multicenter randomized controlled parallel-group superiority trial. All adult patients (age ≥ 18 and ≤ 90 years) with histologically proven, surgically resectable (cT1-4a, N0–3, M0) esophageal adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 218) with resectable esophageal adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction are randomized to either RAMIE (n = 109) or MIE (n = 109). T.

The primary outcome of this study is the total number of resected abdominal and mediastinal lymph nodes specified per lymph node station.

Short-term results and the primary endpoint (total number of resected abdominal and mediastinal lymph nodes per lymph node station) will be analyzed and published after discharge of the last randomized patient within this trial.

This is the first randomized controlled trial designed to compare RAMIE to MIE as surgical treatment for resectable esophageal adenocarcinoma or adenocarcinoma of the gastroesophageal junction in the Western World. The hypothesis of the proposed study is that RAMIE will result in a higher abdominal and mediastinal lymph node yield specified per station compared to conventional MIE.
423. POSTOPERATIVE SKELETAL MUSCLE MASS IN ESOPHAGEAL CANCER SURGERY PATIENTS AFTER NEOADJUVANT CHEMOTHERAPY
Authors: Daichi Utsunomiya
Published: September 2022

Recently, the significant decrease in skeletal muscle mass after esophagectomy in patients who underwent neoadjuvant chemotherapy, which in turn has been reported to affect long-term survival. The results of JCOG1109 have been published, and while DCF has become the standard of care as neoadjuvant chemotherapy, its toxicity has also been pointed out. In this study, we analyzed the relationship between changes in body composition before and after neoadjuvant chemotherapy and postoperative complications after esophagectomy.

Among esophageal cancer patients who underwent esophagectomy after preoperative chemotherapy from September 2018 to May 2020, 74 patients were included, excluding patients with recurrence within 1 year after surgery and patients with gastrointestinal fistula. The relationship between body composition and postoperative complications, and changes in body weight and skeletal muscle mass were analyzed.

The male-to-female ratio was 60:14, and the median age was 65.0 years. When the subjects were divided into DCF and Others, there was a significant difference in skeletal muscle loss in the Others group. There was no significant difference in the incidence of postoperative complications by chemotherapy, nor an incidence of postoperative complications between the DCF and Others. There was no significant difference in weight loss between the DCF group and the Others group, but a significant decrease in skeletal muscle mass in the DCF group at one year. The decrease up to 4 months after surgery was particularly large.

In the present analysis, DCF therapy as preoperative treatment had no effect on the occurrence of postoperative complications, but was associated with a long-term decrease in skeletal muscle mass, suggesting that the toxicity of DCF therapy may have a long-term effect. Although the tumor suppression effect of preoperative treatment was proven, long-term nutritional and rehabilitative interventions were considered necessary to establish a truly favorable long-term prognosis for the patients.
429. DETECTION OF MOLECULAR RESIDUAL DISEASE (MRD) USING MATCHED TUMOR-MARGIN SEQUENCING IN EARLY STAGE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Lu Di , Tong Yu , Zhai Jianxue , Wang Zhizhi , Chen Zhiming , Wu Hua , Li Shaobin , Cai Kaican
Published: September 2022

Residual disease is one of the main sources of recurrence in post-surgical esophageal squamous cell carcinoma (ESCC). However, the prognostic value of histologically-defined surgical margin status is limited by its suboptimal accuracy in indicating patients’ outcomes. Here, we explored the potential of margin-molecular residual disease (MRD) based on next-generation sequencing (NGS) as a feasible and more reliable biomarker for identifying patients with a high risk of recurrence.

NGS data from 22 early stage ESCC patients with matched tumor and histologically negative resection margin, as well as normal epithelial tissue samples, were retrospectively reviewed. Comparisons of the respective mutational landscapes, as extracted by profiling using a 425-cancer-gene panel (GeneseeqPrime®), were performed. Associations of disease-free survival (DFS) with clinical features and margin-MRD were analyzed.

A total of the 11 (50%) patients with histologically negative margin had detectable somatic mutations as assessed by NGS. TP53 alterations were highly enriched in the tumor (ptumor-normal = 0.001) and the margin (pmargin-normal = 0.015) samples compared with the normal tissues, whereas NOTCH1 alterations were much more common in the normal samples (ptumor-normal = 0.001, pmargin-normal = 0.001). Tumor-specific mutations were detected in six (6/11, 55%) of the NGS-positive margins. Survival analysis showed that those having MRD-positive margins had an unfavorable DFS compared with those having MRD-negative margins (p = 0.08, HR (95%CI): 3.28 (0.81–13.4)).

In this study, the presence of mutations in a considerable proportion of histologically negative resection margins and a tendency for worse prognosis in patients carrying MRD-positive margins was demonstrated. Our findings suggest that margin-MRD may serve as a more accurate prognostic predictor for disease recurrence, and highlight the clinical relevance of using NGS to detect MRD for proper prognostic stratifications and precise treatment guidance.
436. DIFFERENCES IN MULTIDISCIPLINARY TEAM ASSESSMENT ON ESOPHAGEAL CANCER PATIENTS IN SWEDEN—A MULTICENTRE STUDY
Authors: Hannan Christine Jestin , Risso Solange León , Lindblad Mats , Szabo Eva , Edholm David , Bartholomä Wolf Claus , Åkesson Oscar , Lindberg Fredrik , Strandberg Sara , Linder Gustav , Hedberg Jakob
Published: September 2022

There are differences in esophageal cancer care across different counties in Sweden. According to national guidelines, all patients should be offered equal care which should be administrated by regional multidisciplinary cancer conferences (MCCs). The aim of the study was to investigate differences between the six regional MCCs in Sweden regarding clinical stageing and recommended treatment.

Ten consecutive cases per participating center, 60 cases in total, were planned for inclusion. After anonymization the radiological investigations were presented, along with the original case-specific medical history, anew at the six regional MCCs. Estimation of clinical TNM and treatment allocation (curative, palliative or best supportive care) were compared between MCCs as well as with the original assessment. Interim analysis was performed in April 2022 when ten cases had been presented at five of the six regional MCCs.

All available cases were assessed at five MCCs in addition to the previous original assessment (60 assessments). The mean age for the first ten cases was 74.8 years (SD ± 9.8 years). Eight out of ten cases were men. In estimations of T- and N-stage the MCCs agreed in only one out of ten cases. In half of the cases more than three different estimations of N-stage were made. For clinical M-stage there was exact agreement in three cases. In determination of recommended treatment, all five MCCs were in agreement on half of the cases.

Preliminary data show striking differences, both in assessment of TNM as well as treatment recommendation at different MCCs. One patient, recommended curative treatment by one MCC could be allocated to palliative care by another. Inclusion is ongoing and further analysis of these differences are warranted to achieve more equal care for esophageal cancer patients in Sweden.

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438. THE NEED FOR INFORMATION AND SUPPORT IN DECISION-MAKING IN PATIENTS WITH ESOPHAGEAL CANCER WHO PREFER STANDARD SURGERY OR ACTIVE SURVEILLANCE
Authors: Van Der Zijden Charlène J , Hermus M , van der Wilk BJ , Chang R , Dekker JWT , Coene PPLO , Nieuwenhuijzen GAP , Rosman C , Heisterkamp J , Hartgrink HH , Wijnhoven BPL , van Lanschot JJB , van Busschbach JJ , Lagarde SM , Kranenburg LW
Published: September 2022

Shared decision making (SDM) is the cornerstone of patient-centered care and is associated with improved treatment outcomes. Making a well-informed decision can be challenging. Patients have to weigh possible outcomes and take into account a certain level of uncertainty. This study investigated patients’ information and supportive needs during the decision-making process to prefer active surveillance or standard surgery after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer.

Patients who underwent nCRT for carcinoma of the esophagus or esophagogastric junction and refused participation in a randomized trial on active surveillance versus standard surgery were included. Patients were interviewed about their need for information and support and received questionnaires on information- and decision-making preferences and health literacy 3 months after completion of nCRT or before surgery. Interviews were audiotaped and transcribed verbatim. Data were analyzed according to the principles of grounded theory.

Forty patients were included of which 20 preferred surgery and 20 preferred active surveillance. Overall, patients’ information needs were met. Patients highly value support received from their loved ones and appreciate emphatic doctors who actively involved them in the decision-making process while paying attention to their individual needs and values. Information resources as the internet and conversations with others were largely used to confirm the treatment decision. Patients prefer to receive information from doctors first and they predominantly rely on this information to make a treatment decision.

The importance of shared decision making and the role of doctors in this process is underlined by patients’ wish to be guided in decision-making. The role of healthcare professionals is essential at the initial phase of the decision-making process. After patients seem to have made a treatment decision, the influence of extern resources (including doctors) is limited.