bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.074: ENDOSCOPIC FILLING METHOD OF POLYGLYCOLIC ACID SHEETS AND FIBRIN GLUE THE LEAK FOR THE TREATMENT OF REFRACTORY ESOPHAGOGASTRIC ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY
Authors: Tashiro Kousei , Takeno Shinsuke , Kawano Fumiaki , Miyazaki Yasuyuki , Munakata Syun , Tanoue Yukinori , Wada Takashi , Hamada Rouko , Nanashima Atsushi , Nakamura Kunihide
Published: September 2018

Background

Treatment of anastomotic leakage in the reconstruction after esophagectomy remains a challenge. Secure treatment method has been established and there is very few clinical studies. Although internal drainage using nasogastric tube has been reported recently. In this report, the authors present endoscopic filling method (EFM) for anastomotic leakage.

Methods

Six patients (five males and one female) with anastomotic leakage whose ages ranged from 54 to 77 were includes in this study. The patients underwent EFM and the anastomotic leakage was filled with polyglycolic acid sheets and fibrin glue endoscopically. Initially, tube drainage was performed, and this treatment was performed as the secondary treatment, when the improvement was not made by tube drainerge.

Results

Every patient had a jejunostomy, with any concern for nutrition. Abscess was present in all patients, but external drainerge was not required. EFM was required once to five times until the fistulas cured. There was no motality. There are no cases of relapse after discharge from the hospital. Three of them cured in the first treatment, it takes average 26 days from esophagectomy to starting oral intake. This method allows us to repair for all fistula with regardless of inflammation or infection.

Conclusion

In conclusion, the patients with reflactly esophagogastric anastomotic leakage after esophagectomy would be better served by EFM. Further study is required larger series of patients and a longer follow-up period to examine the safety and effectiveness of EFM.

Disclosure

All authors have declared no conflicts of interest.
PS01.078: AN UNUSUAL PRESENTATION OF BOERHAAVE SYNDROME
Authors: Annalisa Ng Ya-Lyn , Lee June , Lin Jinlin , Siong Ching Siok , Yih Andrew Wong Siang
Published: September 2018

Background

Oesophageal perforations are rare but potentially lethal. Boerhaave syndrome classically results in a longitudinal oesophageal perforation at the left posterolateral distal oesophagus. We present an unusual case with cervical oesophageal mucosal perforation and submucosal dissection.

Methods

We review our patient—a 53 year old lady, Mdm S, who presented after 4 days of vomiting with sepsis and diabetic ketoacidosis. CT thorax scan showed extensive long segment circumferential mural thickening and oedema of the entire oesophagus, extensive pneumotosis of the proximal half, and a focal mucosal discontinuitiy of the cervical oesophagus. There were also pneumomediastinum, fat stranding in the superior mediastinum, and a right pleural effusion.

Results

Gastroscopy and surgical exploration of the right hemithorax and neck identified a 2cm linear cervical oesophageal mucosal defect. There was no muscular perforation; an air leak test did not demonstrate a transmural perforation. Copious lavage of the mediastinum and right thoracic cavity were performed and large bore drains were placed in the neck, right thoracic cavity and superior mediastinum. A venting gastrostomy and a feeding jejunostomy were also created. Mdm S’s recovery was complicated by a persistent right pneumothorax. An interval gastroscopy revealed a line of interrupted longitudinal oesphageal mucosal defects starting at 18cm to 31 cm from the incisors. The submucosal space had opened up for the same length, and the scope easily entered the submucosal plane, where a muscle wall defect was detected at 18cm from the incisors.

Conclusion

Cervical oesophagus is an unusual site of Boerhaave's perforation. While the initial perforation was not transmural, surgical lavage and drainage were essential for sepsis control. Subsequent recovery was achieved by following principles of fistula management- diversion of gastrointestinal contents, drainage of oesophageal leak to control sepsis, optimisation of nutrition via a feeding jejunostomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.090: LAPAROSCOPIC EXCISION OF A PARAESOPHAGEAL BRONCHOGENIC CYST IN A 9-YEAR-OLD MALE
Authors: Makita Satoshi
Published: September 2018

Background

Bronchogenic cyst is a malformation of the ventral foregut. It is ofen asymptomatic and discovered as an incidental finding. In children, it comprises approximately 6% of all mediastinal masses. However, paraesophageal bronchogenic cyst is a rare and has been reported only three cases in children. We report a case of a 9-year-old male with an asymptomatic paraesophageal bronchogenic cyst.

Methods

Retrospective chart review.

Results

A 9-year-old male was detected to have retrocardiac mass lesion (2.7 × 1.9 × 1.2 cm), which was detected incidentally on an abdominal computed tomography done for acute appendicitis. No enhancement was noticed after contrast administration. Magnetic resonance imaging revealed a well-circumscribed cyst adjacent to the esophagus just above the hiatus. T1-weighted image showed a low intensity mass and the T2-weighted image showed a high intensity mass. Endoscopic ultrasonography examination of the esophagus demonstrated a cystic mass, with low-echo density. The echo also showed disruption of the fourth layer of the esophageal wall. With these findings, esophageal duplication was suspected. A laparoscopic operation was performed via 4 ports plus one puncture. 5mm laparoscope (30°angle) was inserted in the umbilical port, three 5mm trocars were placed and 3mm grasping forceps was inserted. The cyst was identified in the intra-abdominal esophageal part. Lesion removal was performed with a coagulator hook. A complete excision of the cyst was achieved without perforating of the esophagus. The postoperative courses was uneventful with home discharging on day six. The pathological diagnosis was a bronchogenic cyst because of finding a ciliated respiratory epithelium and cartilage and mucus-secreting glands.

Conclusion

Paraesophageal bronchogenic cyst is rare. However, it should be considered in the differential diagnoses for mediastinal masses at any age. Laparoscopy is a safe and effective method to deal with masses of posterior mediastinum even in children.

Disclosure

All authors have declared no conflicts of interest.
PS01.091: A DANGEROUS FOREIGN BODY IN ESOPHAGUS: ALKALINE BATTERIES
Authors: Aydin Yener , Eroglu Atila , Turkyilmaz Atila , Genc Fatma , Ulas Ali
Published: September 2018

Background

Esophageal foreign bodies are an important clinical condition leading to serious morbidity and mortality. Foreign body swallowing is most common in the group of 6 months to 6 years. Although smooth edges have a lower morbidity in foreign bodies, alkaline batteries are very dangerous. In this study, we aimed to evaluate the results of patients who ingested alkaline batteries.

Methods

We conducted a retrospective single-center study of 20 patients who were diagnosed with esophageal foreign objects following alkaline battery ingestion between January 2001 and February 2018. All cases were evaluated with posteroanterior chest X-ray and lateral X-ray. Age and sex of the patients, symptoms, localization of foreign body, the method of removing the foreign body, the passing time, length of hospital stay and morbidity and mortality rates were reviewed.

Results

The cases were 12 males and 8 females. The mean age was 3.2 years (1 month to 14 years). Five cases within 4 hours, 8 cases within 12 hours, 5 cases within 24 hours and 2 cases after 24 hours were referred to our clinic. The foreign body was located in the cervical esophagus in 10 cases, in the midthoracic esophagus in 8 cases, and in distal esophagus in two cases. All cases were quickly taken to the operating room. All cases underwent rigid esophagoscopy under general anesthesia and foreign body was removed. Sixteen cases of esophageal mucosal injury and burns were seen. Perforation and mortality were not observed in any of the cases.

Conclusion

Severe esophageal injury can occur in a short time after interaction with alkaline battery. Alkaline battery; electrolyte leak, pressure necrosis, mercury toxicity, or alkaline environment. Concentrated potassium hydroxide release has a corrosive effect. In this case, mediastinitis or tracheoesophageal fistula may ocur. Alkaline battery ingestion may result in persistent sequelae with perforation and corrosive esophagitis leading to mediastinitis. For this reason, the battery should be immediately removed by rigid esophagoscopy to prevent the development of these complications.

Disclosure

All authors have declared no conflicts of interest.
PS01.096: CHOOSING THE TREATMENT OPTION OF END-STAGE CARDIAC ACHALASIA
Authors: Koshkin Mikhail , Vasnev Oleg , Baychorov Magomet , Izrailov Roman , Shishin Kirill , Domrachev Sergey , Kazakova Svetlana
Published: September 2018

Background

Until recently the esophagectomy was the only choice in treatment of patients with end-stage achalasia. Developing of minimally invasive techniques such as a laparoscopic Heller miotomy and peroral endoscopic myotomy (POEM) allowed to use them as a treatment options. Aim: to present an experience of treatment of patents with end-stage cardiac achalasia.

Methods

Since 07.2013 till the 12.2017 eleven patients with end-stage cardiac achalasia were operated on. Among them 2 (18%) were males and 9 (82%) were females. Mean age was 54 years (26–81).

Results

POEM was performed in 6 patients, laparoscopic Heller myotomy was performed in 2, and esophagectomies were performed in 3 patients with failed previously myotomy made in other clinics. Gastric tube was used to replace the esophagus in patients underwent esophagectomy. Mean operative time was 90 min for POEM, 172 minutes for laparoscopic Heller procedure and 422 minutes for laparoscopic esophagectomy. Blood loss was insignificant in all patients. There were no clinically significant complications during the postoperative course of all patients. Mean postoperative hospital stay was 2 days after POEM, 4 days after laparoscopic Heller procedure and 11 days after esophagectomy. To asses the dysphagia after POEM and Heller procedure Eckardt scale was used. In all cases it was rated as grade 0.

Conclusion

Minimally invasive techniques such as POEM and laparoscopic Heller procedure should be the first options in surgical treatment of patients with end-stage cardiac achalasia. In case of ineffectiveness of these options esophagectomy should be performed.

Disclosure

All authors have declared no conflicts of interest.
PS01.101: SURGICAL MANAGEMENT OF ADULT ESOPHAGO-RESPIRATORY FISTULA: A TEN-YEAR EXPERIENCE.
Authors: Samarasam Inian , Phillip Rajeevan , Gnanamuthu Roy , Abraham Vijay
Published: September 2018

Background

Adult esophago-respiratory fistula is a rare condition, which is usually seen in malignancies or in benign conditions following trauma, infection or as a delayed presentation of congenitall tracheoesophageal fistula. They pose a technical challenge in stabilisation and management requiring multidisciplinary approach.

Methods

In this retrospective analysis of such cases over a period of ten years, who presented to our centre. The aetiology, presentation and treatment modalities were studied in detail. Of these,18 patients with benign esophago repiratory fistulae underwent surgical correction oft he same. This is discussed in detail.

Results

There were a total of 62 cases of adult esophago-respiratory fistula, over the 10 year period. Of the patients, 34 of the cases to be of malignant etiology and 28 of the cases to be of benign etiology such as prolonged tracheostomy, corrosive injury, infection, trauma or delayed presentation of congenital fistula. The mean age of presentation was 44 years. (range 18 to 81 years of age). There were 35 tracheoesophageal fistulae and 27 bronchoesophageal fistulae. Fourteen patients underwent esophageal stenting and 9 underwent tracheal stenting either as a temporary intervention to alleviate symptoms or as palliative intervention. Eighteen patients underwent definitive surgical intervention. Surgical repair involved approach through neck in 6 patients and thorax in 11 patients and a combination of both approaches in one patient. The esophageal end of the fistula was primarily closed or closed with the help of a pleural or pedicled muscle flap or a subtotal esophagectomy was performed. The respiratory end of the fistula was either primarily closed or with the help of a vascularized patch of the esophageal wall. The latter technique was used in four patients and is explained in detail.

Conclusion

Due to risk of fatal complications, early diagnosis, multidisciplinary approach and appropriate surgical intervention after nutritional build up is the key to successful management of adult esophago-respiratory fistula.

Disclosure

All authors have declared no conflicts of interest.
PS01.103: THE UNUSUAL CAUSES OF ODYNOPHAGIA
Authors: Tian Lim Kheng
Published: September 2018

Background

Odynophagia can be caused by infective and non-infective inflammatory processes, benign and malignant esophageal disorders such as achalasia, gastro-esophageal reflux disease and carcinoma.

Methods

We described two unusual cases of odynophagia and their individual management.

Results

Case 1 is a 21 year-old Indian man presented with 2 days history of odynophagia after taking doxycycline capsules indicated for acne. An esophagogastroduodenoscopy (OGD) was performed and showed multiple mid esophageal ulcers. Esophageal biopsy taken showed inflammatory ulcer slough with no fungal infection, dysplasia or malignancy. Doxycycline was stopped and patient recovered with complete resolution of odynophagia. Case 2 is a 55 year-old Chinese man presented with 1 day history of odynophagia and severe chest pain after eating a bowl of hot fish soup. A CT Thorax was performed which showed a localised perforation of the right wall of the esophagus with extraluminal gas posterior to the trachea. An urgent OGD was performed and an L-shaped fish bone was removed successfully and an endoclip was applied to close the puncture hole of esophagus. Patient made a full recovery without any mediastinal infection.

Conclusion

Odynophagia from mid esophageal ulcers secondary to doxycycline intake should be recognized and can be easily managed by stopping the antibiotics with complete resolution of the symptom. Fish ingestion leading to sharp bone induced penetrating esophageal injury can be safely managed by endoscopic removal and endoclip application.

Disclosure

All authors have declared no conflicts of interest.
PS01.105: PANCREATITIS IN THE ESOPHAGEAL ECTOPIC PANCREAS: A RARE CONDITION WITH DIFFERENT PRESENTATIONS! TREATMENTS AND REVIEW OF THE LITERATURE
Authors: Szachnowicz Sergio , Sallum Rubens , Libanori Hilton , Bianchi Edno , Duarte Andre , Stolzemburg Lucas , Cecconello Ivan
Published: September 2018

Background

Ectopic pancreas is an extremely rare genetic malformation in the esophagus. It is defined by pancreatic tissue outside the pancreas and usually presents as a subepithelial lesion in the esophagus. To date, there are fewer than 15 patients reported in the literature.

Methods

We present 2 cases of pancreatitis in the esophageal ectopic pancreas with different presentation, treatment and development, as well as a review of the literature.

Results

1. A 48-year-old woman admitted to the ER with acute dysphagia and chest pain. There were elevation of amylasemia and lipasemia, as well as presence of a tumor in the Gastroesophageal junction with hypersignal at the CT scan, suggesting acute inflammation. An echoendoscopy with biopsy, diagnosed ectopic pancreas in the distal esophagus. The patient was then submitted to laparoscopic resection of subepithelial tumor of the cardia, recovered by a fundoplication. The specimen confirmed pancreatic tissue with acute inflammation. 2. A 33-year-old woman with a history of episodic chest pain confused with GERD, nausea and vomiting pain episodes accompanied by elevated serum amylase and lipase levels. She was submitted to an ERCP without alterations to investigate the clinical complains. After some crisis she was hospitalized with a septic condition, where a CT scan revealed a cystic lesion in the lower mediastinum in the esophageal wall. Endoscopy was performed, showing a drainage orifice with purulent secretion in the cardia. She was treated with antibiotics and fasting. She had two more crises and was referred to our specialized service. Thoracoscopic subtotal esophagectomy with cervical anastomosis was performed for treatment of a suspected esophageal duplication cyst with recurrent infections. The specimen showed the presence of organized pancreatic tissue characterizing ectopic pancreas complicated with chronic pancreatitis.

Conclusion

The ectopic esophageal pancreas can be present as a differential of these lesions. The second case, was first admitted at a secondary care unit and the diagnosis was delayed, probably leading to a worse development and necessity of a esophagectomy. In the literature, there is only one description of 1 case of recurrent pancreatitis. We have shown that complications can range from dysphagia to abscess, requiring more invasive treatment.

Disclosure

All authors have declared no conflicts of interest.
PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY
Authors: Akaishi Ryujiro , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Okamoto Hiroshi , Sato Chiaki , Takaya Kai , Maruyama Shota , Kamei Takashi
Published: September 2018

Background

Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%.

Methods

67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed.

Results

On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue.

Conclusion

In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment.

Disclosure

All authors have declared no conflicts of interest.
PS01.111: STAGED PEDICLED JEJUNAL TRANSFER AFTER AORTOESOPHAGECTOMY FOR AORTOESOPHAGEAL FISTULA
Authors: Nakamura Tetsu , Ishida Sonoko , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Oshikiri Taro , Sumi Yasuo , Suzuki Satoshi , Kakeji Yoshihiro
Published: September 2018

Background

Aortoesophageal fistula(AEF) had been a critical and life-threatening disease. The surgical strategy which consist of aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction achieve circulatory recovery, infection control and long term survival. The objective of this study is to evaluate surgical outcomes of pedicled jejunal transfer with microvascular augmentation as esophageal reconstruction for AEF.

Methods

14 patients with aortoesophageal fistula who underwent aortic graft replacement and esophagectomy between 2010 and 2017 at Kobe University Hospital and affiliate hospitals were enrolled in this study. Patient characteristics, operative method and clinical outcomes were obtained by retrospective chart review.

Results

All 14 patients underwent aortic graft replacement with omental wrapping, esophagectomy and staged esophageal reconstruction. 10 patients (71.4%) successfully underwent staged esophageal reconstruction of pedicled jejunal transfer with microvascular augmentation and showed no leakage and no graft loss. Median survival time in the patients who underwent esophageal reconstruction was 20.3 months from initial operation. Nine of 10 patients were alive but one patient died of sepsis ten months after esophageal reconstruction.

Conclusion

Aortic graft replacement with omental wrapping and esophaegcotomy play crucial role in the treatment of AEF. Omentum is pedicled by right epiploic artery and vein to prepare good blood flow and sufficient volume of omental wraping and, consequently, stomach without right epiploic artery and vein becomes inappropriate for esophageal conduit. Pedicled jejunal transfer with microvascular augmentation contributes good post-operative outcome. The surgical strategy for AEF, which includes aortic graft replacement with omental wrapping, esophagectomy, and staged esophageal reconstruction by pedicled jejunal transfer microvascular augmentation is feasible and promising.

Disclosure

All authors have declared no conflicts of interest.
PS01.114: HYBRID OPERATION IN TREATMENT OF TRAUMATIC AORTIC ARCH RUPTURE COMBINED WITH PSEUDOANEURYSM
Authors: Tang Shoujun , Zhou Haining
Published: September 2018

Background

Traumatic aortic arch rupture combined with pseudoaneurysm is a rare but life-threatening condition, on which limited reports exist. We describe the technique of one-stage hybrid open debranching and endovascular repair by using thoracic stent-graft devices deployed to cover the whole aortic arch to exclude pseudoaneurysm.

Methods

A 31-year-old male patient was admitted because of anterior chest pain with hoarseness. The patient had suffered from fractures in the femur, radius, rib, and sternum because of a traffic accident 3 months ago. He subsequently underwent femoral and radial internal fixation operations. Imageological examination revealed an aortic arch rupture with upper mediastinal pseudoaneurysm (4.0 cm × 4.8 cm × 5.0 cm) in Zone 1. A hybrid operation of debranching combined with thoracic endovascular aortic repair (TEVAR) was performed. Postoperative angiography indicated that the aneurysm was isolated, and that the proximal stent presented no internal leakage or ‘beak-like’ change.

Results

Nervous and psychiatric symptoms did not appear after the operation.Follow-up results were positive at 7 days, 1 year, and > 2 years after operation. Computed tomography angiography of the chestshowed partially absorbed hematoma and smooth reconstruction of the blood vessels.

Conclusion

The hybrid operation of debranching combined with TEVAR expanded the indications of endovascular repair, providing a new treatment option for aortic dissecting aneurysm. Hybrid procedures avoid the need for CPB, aortic cross clamping, or hypothermic circulatory arrest. Hence, the operation (anatomical bypass) was simple, and the anatomic reconstruction required less work. This technique also avoids the tumor location; thus, the tumor body and the surrounding tissues were not pulled. In conclusion, we recommend hybrid repair of the aortic arch disease as an alternative treatment for patients who are at high surgical risks for conventional repair.

Disclosure

All authors have declared no conflicts of interest.
PS01.117: TOTAL LAPAROSCOPIC MIDCOLON RETROSTERNAL ESOPHAGEAL BYPASS FOR CORROSIVE STRICTURE ESOPHAGUS
Authors: Raja Kalayarasan
Published: September 2018

Description

Colonic bypass for corrosive stricture of the esophagus is traditionally performed using the conventional open approach. A laparoscopic mid colon retrosternal bypass has not been reported in the literature. Total laparoscopic left colic artery based mid colon retrosternal esophageal bypass is described in this report. Method: A 25-year-old female presented with acid-induced long esophageal stricture starting at 18cm from incisors refractory to endoscopic dilatation. The laparoscopic mid colon esophageal bypass was performed using 5 abdominal ports. The essential steps are colonic mobilization and assessment of the adequacy of the mesocolic vascular arcade by clamping middle colic, right colic, and ileocolic vessels proximal to their branching, creation of the retrosternal tunnel, preparation of left colic artery based colon conduit by dividing terminal ileum proximal to ileocecal junction, neck dissection to expose cervical esophagus and delivering the colonic conduit retrosternally into the neck. Reconstruction was performed by side to side esophagocoloplasty, side to side cologastric and ileocolic anastomosis. Results: The duration of surgery was 410 minutes and blood loss was 150 mL. The patient had an uneventful postoperative course. She was started on oral semisolids on postoperative day 7 and discharged on the tenth postoperative day. At 9 months follow up the patient is euphagic to solid diet with an excellent cosmetic result. Conclusion: Total laparoscopic mid colon esophageal bypass is a feasible procedure for the management of corrosive stricture of the esophagus

Disclosure

All authors have declared no conflicts of interest.
PS01.118: THE EFFECTS OF THE HERBAL MEDICINE DAIKENCHUTO (TJ-100) AFTER ESOPHAGEAL CANCER RESECTION, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL
Authors: Tangoku Akira , Nishino Takeshi , Inoue Seiya , Yoshida Takahiro
Published: September 2018

Background

Daikenchuto (TJ-100), a traditional Japanese herbal medicine, is widely used in Japan. Its effects on gastrointestinal motility, microcirculation and its anti-inflammatory effect are known. The purpose of this prospective randomized controlled trial was to investigate the effect of TJ-100 after esophagectomy in esophageal cancer patients.

Methods

Forty patients to whom subtotal esophagectomy for esophageal cancer was planned at our institute from March 2011 to August 2013 were enrolled and divided into two groups at the point of determination of the operation schedule after informed consent: TJ-100 treated group (n = 20) and Control group (n = 20). The primary end-points were maintenance of the nutrition condition and the recovery of gastrointestinal function. The secondary end-points were the serum C-reactive protein (CRP) level and adrenomedullin level during the postoperative course, the incidence of postoperative complications, and the length of hospital stay after surgery.

Results

We examined 39 patients because one patient in TJ-100 group couldn’t perform a curative surgery. The mean age of the TJ-100 group patients was significantly older than that of the control group. The rate of body weight decrease at postoperative day 21 was significantly suppressed in the TJ-100 group (3.6% vs. 7.0%, P = 0.014), but the serum albumin levels were not significantly different between the groups. The recovery of gastrointestinal function regarding flatus, defecation, and oral intake showed no significant between the groups, but postoperative bowel ill symptoms tended to be rare in the TJ-100 group. There was no significant difference in hospital stay after surgery. The serum CRP levels at postoperative day 3 tended to be suppressed in the TJ-100 group (P = 0.126). The rate of increase in adrenomedullin levels tended to be high postoperatively in the TJ-100 group, but there was no significant difference.

Conclusion

TJ-100 treatment after esophagectomy prompts the recovery of gastrointestinal motility and minimizes body weight loss. Those effects might suppress the excess inflammatory reaction related to surgery

Disclosure

All authors have declared no conflicts of interest.
PS01.123: EPIDURAL ANALGESIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: EFFICACY AND COMPLICATION PROFILE
Authors: Kingma Berend , Visser Els , Marsman Marije , Ruurda Jelle , Van Hillegersberg Richard
Published: September 2018

Background

Adequate postoperative pain management is essential to facilitate uneventful recovery after esophagectomy. Although epidural analgesia is the gold standard, it is not satisfactory in all patients. The aim of this study was to describe the efficacy and complication profile of epidural analgesia after minimally invasive esophagectomy (MIE).

Methods

A total of 108 patients who underwent a robot-assisted (McKeown) MIE for esophageal cancer were included from a single center prospective database (2012–2015). The number of patients that could receive epidural analgesia, the sensory block range per day, the number of epidural top-ups, the need for escape pain mediation (i.e. intravenous opioids), the highest pain score per day (numeric rating scale, 0–10), and epidural-related complications were assessed until postoperative day (POD) 4.

Results

Epidural catheter placement was achieved in 101 patients (94%). A complete sensory block was found in 49% (POD1), 42% (POD 2), 20% (POD3), and 30% (POD4) of patients. An epidural top-up was performed in 26 patients (24%), which was successful in 22 patients. Escape pain medication in the form of intravenous opioids were given at least once in 49 out of 108 patients (45%) on POD 1, 2, 3, or 4. Overall median highest pain scores on the corresponding days were 2.0 (range 0–10), 3.5 (range 0–9), 3.0 (range 0–8), and 4.0 (range 0–9). Epidural related complications occurred in 20 patients (19%) and included catheter problems (n = 11), hypotension (n = 6), bradypnea (n = 2), and reversible tingling in the legs (n = 1).

Conclusion

In conclusion, epidural analgesia is insufficient and escape pain medication is necessary in nearly half of patients undergoing MIE.

Disclosure

All authors have declared no conflicts of interest.
PS01.129: A NEW ANIMAL TRAINING MODEL FOR MEDIASTINAL LYMPHADENECTOMY WITH A SINGLE-PORT MEDIASTINOSCOPIC CERVICAL APPROACH
Authors: Kikuchi Hirotoshi , Soneda Wataru , Kawata Sanshiro , Hirotsu Amane , Murakami Tomohiro , Matsumoto Tomohiro , Ozaki Yusuke , Hiramatsu Yoshihiro , Kamiya Kinji , Takeuchi Hiroya
Published: September 2018

Background

Single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer is a minimally invasive surgery and can be applied to patients with low pulmonary function. However, special skills are needed to safely perform this surgical procedure as a curative operation without complications such as recurrent laryngeal nerve paralysis. To date, no animal training models for this surgical procedure has not been established. In this study, we developed a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach.

Methods

A domestic pig was intubated, with a normal tracheal tube, and placed in a spine position. Because pigs do not have clavicles, skin incision was made on the cephalic side of the left forelimb. Anterior cervical muscles were cut and cephalic parts of thymus and left thyroid were resected to deploy the operation field. Esophagus and left recurrent laryngeal nerve were identified behind the trachea. A wound edge protector (Lap-Protector) and EZ Access was attached to the wound. An artificial pneumomediastinum was created using 5–6 mmHg of CO2 gas and three 5mm ports were inserted to EZ Access. Operator dissected connective tissues around esophagus and vessels mainly using a bipolar sealing device. At the right side of the esophagus, fat tissue with 106recL lymph nodes was dissected from tracheal wall. After dissection was reached to the carina level, esophagotracheal ligament was cut and dissection on the left side of esophagus was carried out to the level of aortic arch. By displacing the trachea to the front side, 109R, 107 and 109L lymph node were dissected.

Results

Because pig's tracheal cartilage is sub-circumferential, mobility of trachea is relatively poor, and risks of tracheal membranous portion damage are low. Although there are some anatomical differences between pigs and human, this animal training model reproduces surgical procedures of mediastinal lymphadenectomy in human such as forceps operation techniques in narrow fields and effects of artificial pneumomediastinum.

Conclusion

We established a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach. This model reproduces surgical procedures in human and is useful for training surgeons who wish to start performing mediastinal lymphadenectomy by mediastinoscopic cervical approach.

Disclosure

All authors have declared no conflicts of interest.
PS01.130: VIDEO-ASSISTED THORACOSCOPE 3D AND 2D MODE COMPARATIVE ANALYSIS FOR ESOPHAGEAL CHEST SURGERY
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming
Published: September 2018

Background

To study the advantages and disadvantages of 3D and 2D thoracoscope in the thoracic surgery of esophageal carcinoma.

Methods

Retrospectively analyze esophageal cancer cases between July 2013 and July 2017 of the first affiliated hospital to Xiamen University, depending on the different mode of Video-Assisted Thoracoscopic, which can be divided into 3D-VATS group 353 cases (observation group) and 2D-VATS group 351 cases (control group). Comparing the difference in operation time, intraoperative bleeding, lymph node transmission, volume of the drain by the first 24 hours, total volume of the drain, chest tube time and postoperative complications.

Results

All the 704 patients with esophageal cancer were performed under the video-assisted thoracoscope. In terms of surgery time, 3D-VATS group (51.4 ± 13.3min) was shorter than 2D-VATS group (65.7 ± 9.1min), with statistical significance (t = -9.751, P = 0.013); on blood loss, 3D-VATS group (34.1 ± 10.5ml) was less than 2D-VATS group (50.2 ± 9.4ml) with statistical significance (t = -9.274, P = 0.009); about lymph nodes transmission, 3D-VATS group (16.8 ± 3.2) was more than 2D-VATS group (13.1 ± 3.7), with statistical significance (t = 5.213, P = 0.007); in volume of the drain by the first 24 hours, 3D-VATS group (171.2.15 ± 20.2ml) was less slightly than 2D-VATS group (180.3 ± 35.2ml), no statistical difference (t = -1.347, P = 0.281); about total volume of the drain, 3D-VATS group (530.2 ± 53.4ml) was less slightly than 2D-VATS group (553.8 ± 57.5ml), no statistical difference (t = -1.911, P = 0.093); on chest tube time, 3D-VATS group (4.2 ± 0.7d) was less slightly than 2D-VATS group (4.9 ± 1.1d), no statistical difference (t = -1.806, P = 0.069); Postoperative complications in two groups including the incidence of arrhythmia, pulmonary infection, anastomotic leakage and recurrent laryngeal nerve injury has no obvious difference (P > 0.05).

Conclusion

Video-assisted thoracoscopic surgery of esophagectomy under 3D-mode has certain advantages in operation time, intraoperative bleeding and lymph nodes transmission over 2D-mode. While in the item of volume of the drain by 24 hours, total volume of the drain, chest tube time and postoperative complications, they have no obvious difference.

Disclosure

All authors have declared no conflicts of interest.
PS01.132: RISK FACTORS OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH GASTRIC TUBE RECONSTRUCTION FOR THORACIC ESOPHAGEAL CANCER
Authors: Sugimoto Atsushi , Toyokawa Takahiro , Tamura Tatsuro , Sakurai Katsunobu , Kubo Naoshi , Tanaka Hiroaki , Yashiro Masakazu , Muguruma Kazuya , Hirakawa Kosei , Ohira Masaichi
Published: September 2018

Background

Anastomotic leakage is a major complication after esophagectomy. Recent studies reported that anastomotic leakage is associated with poor prognosis. We aimed to identify the risk factors of anastomotic leakage after esophagectomy for thoracic esophageal cancer.

Methods

We analyzed retrospectively consecutive patients who underwent esophagectomy with reconstruction using gastric tube by cervical anastomosis for thoracic esophageal cancer between January 2009 and December 2017. In the reconstruction, end-to side mechanical anastomosis with circular stapler through the posterior mediastinal route was preferred until 2014, and end-to end hand-sewn anastomosis through the retrosternal route was preferred from 2015. As inflammation-based and/or nutritional markers, prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), Controlling Nutritional Status (CONUT) score, and neutrophil lymphocyte ratio (NLR) were investigated. Receiver operator characteristic curve analyses were performed to set the cut-off value of continuous variables. Risk factors predicting anastomotic leakage were analyzed using logistic regression model.

Results

A total of 170 patients (144 males and 26 females) were evaluated. Median age was 65 years (59 − 70). Anastomotic leakage was observed in 21 patients (12.3%). A mechanical anastomosis with circular stapler (P = 0.047) and longer operative time (≧560 minutes) (P = 0.015) were identified as risk factors of anastomotic leakage in univariate analysis. Multivariate analysis including variables with P < 0.1 on univariate analyses identified lower PNI (< 45) (P = 0.044, OR 2.78, 95% CI: 1.02 − 7.56) and mechanical anastomosis with a circular stapler (P = 0.036, OR 3.30, 95% CI: 1.07 − 10.09) as independent risk factors.

Conclusion

Our findings suggested that preoperative lower PNI and mechanical anastomosis were independent risk factors of anastomotic leakage after esophagectomy. Further studies aimed at preoperative nutritional intervention and anastomotic technique are warranted.

Disclosure

All authors have declared no conflicts of interest.
PS01.142: THE IMPACT OF CERVICAL LYMPH NODE DISSECTION ON ACID AND DUODENOGASTROESOPHAGEAL REFLUX AFTER INTRATHORACIC ESOPHAGOGASTROSTOMY FOLLOWING TRANSTHORACIC ESOPHAGECTOMY
Authors: Fukaya Masahide , Miyata Kazushi , Itatsu Keita , Asai Soichiro , Yamazaki Kimitoshi , Ebata Tomoki , Nagino Masato
Published: September 2018

Background

The aim of this study was to evaluate the impact of cervical lymph node dissection on acid and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy.

Methods

Thirty one patients receiving transthoracic esophagectomy gastric tube reconstruction by intrathoracic esophagogastrostomy were subjected and divided into two groups: two field lymph node dissection group (the 2F group) and three field lymph node dissection group (the 3F group). All patients underwent 24h pH and bilirubin monitoring and gastrointestinal endoscopy one year after surgery. The results of 24h pH and bilirubin monitoring, endoscopic findings, and reflux symptoms, were compared between two groups.

Results

No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) of the 3F group (P = 0.023). DGER was observed in 2 patients (13%) of the 2F groups, whereas it was observed in 8 (53%) of the 3F group (P = 0.007). The percentage time of acid reflux in the 3F group was significant higher than that in the 2F group (median 0.8 vs 0%, P = 0.008). The percentage time of bile reflux in the 3F group was also significantly higher than that in the 2F group (median 2.600 vs 0%, P = 0.027). Four patients (25%) had reflux esophagitis in the 2F group, and nine patients (60%) had reflux esophagitis in the 3F group (P = 0.048).

Conclusion

Cervical lymph node dissection increases acid reflux and duodenogastroesophageal reflux, and can lead to the increase of the incidence of reflux esophagitis in patient with intrathoracic esophagogastrostomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.145: SIMULTANEOUS RESECTION FOR ESOPHAGEAL CANCERS WITH MULTIPLE PRIMARY CANCERS
Authors: Takeno Atsushi , Masuzawa Toru , Murakami Kohei , Kawai Kenji , Sakamoto Takuya , Naito Atsushi , Katsura Yoshiteru , Ohmura Yoshiaki , Kagawa Yoshinori , Takeda Yutaka , Murata Kohei
Published: September 2018

Background

Esophageal cancer is frequently associated with multiple primary cancers and they are sometimes found simultaneously. The aim of this retrospective study was to clarify the clinical outcome of simultaneous surgery for patients with esophageal squamous cell cancer with multiple primary cancers.

Methods

Clinicopathologic features and surgical outcomes were compared between 14 simultaneous resections (SR group) and 108 single esophagectomy (E group) among 122 patients who underwent esophagectomy for esophageal squamous cell cancer in 2005–2013.

Results

The most common site of multiple primary cancers was the stomach (6 patients; 43%), followed by the stomach (5 patients; 36%), the lung (4 patients; 29%), the tongue, the colon, and the duodenum (1 patient; 7%). The number of multiple primary cancers was double (12 patients; 86%), triple (1 patient; 7%), and quadruple (1 patient; 7%). The incidence of antecedent and subsequent cancers didn’t differ between two groups. The SR group increased blood loss and prolonged operation time. However, there were no differences in postoperative morbidity, mortality and hospital days between the two groups. The SR group had shorter overall survival than the E group (3 years MST 54% vs 74%, Log rank P = 0.056)

Conclusion

The presence of synchronous cancers complicates the surgical resection of esophageal cancer. Although simultaneous surgery for patients with esophageal squamous cell cancer with multiple primary cancers was found to be comparably safe, the overall survival was poor than the single esophagectomy group. Treatment strategy condidering multidisciplinary approach is needed to improve the survival.

Disclosure

All authors have declared no conflicts of interest.
PS01.148: UTILITY OF GASTROSTOMY VIA GASTRIC TUBE AFTER ESOPHAGEAL CANCER SURGERY
Authors: Matsumoto Yoshihisa
Published: September 2018

Background

Esophageal cancer patients often suffer from preoperative malnutrition. It is very important for them to improve their perioperative nutrition status. In our department, we have adopted jejunostomy after esophageal cancer surgery in almost all cases. However, sometimes we have experienced catheter related complications via jejunostomy. Recently, several studies reported that gastrostomy via gastric tube might reduce the catheter related complications. In this study, we compared gastrostomy with jejunostomy as postoperative results and catheter related complications.

Methods

From January 2010 to November 2016, we performed 215 consecutive esophagectomy for esophageal cancer. It was divided into 133 cases of gastrostomy group (group G) and 82 cases of jejunostomy group (group J). We analyzed clinicopathological factors (age, sex, tumor localization, tumor progression degree and preoperative chemotherapy), postoperative results (anastomotic leakage, respiratory complications, recurrent nerve palsy and postoperative hospital stay) and correlation of catheter related complications retrospectively.

Results

There were no significant differences between the two groups in clinicopathological factors and postoperative outcomes such as anastomotic leakage, recurrent nerve paralysis and postoperative hospital stay. Respiratory complications were occurred in 12 cases (8.0%)/25 cases (31.0%) (P < 0.001). Catheter related complications were occurred in 17 cases (5 in group G (3.0%), 12 in group J (9.8%) (P = 0.005) and it was significantly less in group G. The details of catheter related complications were classified into group G (duodenal perforation and dislocation) and group J (intestinal perforation, intestinal obstruction and intestinal fluid leakage).

Conclusion

The rate of catheter related complications after esophagectomy via gastrostomy in this study were lower than that via jejunostomy in previous reports. We suggest the route of enteral nutrition via gastric tube is more effective than that via jejunostomy with regard to catheter related complications.

Disclosure

All authors have declared no conflicts of interest.
PS01.165: HIGH BMI HAS NO IMPACT ON THE SURVIVAL OF CHINESE PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA TREATED WITH CURATIVE ESOPHAGECTOMY: A PROPENSITY SCORE-MATCHED STUDY
Authors: Deng Han-Yu , Lin Yidan
Published: September 2018

Background

Controversy still exists as to whether high BMI has any impact on the long-term survival of esophageal cancer patients treated with curative esophagectomy. Due to the rarity of esophageal adenocarcinoma in Chinese patients, its characteristics were rarely reported and the prognostic value of high BMI in Chinese esopaheagl adenocarcinoma patients has not been investigated yet. Therefore, we conducted this propensity score-matched study to explore the prognostic value of high BMI in Chinese patients with esophageal adenocarcinoma for the first time.

Methods

We retrospectively collected data of patients with lower thoracic esophageal adenocarcinoma who underwent curative esophagectomy in our department from January 2009 to December 2016. Patients were grouped into high BMI group (≥ 23 kg/m2) and normal BMI group (18.5–22.9 kg/m2) according to the Asian specific BMI cutoff value. Both Cox regression survival analysis and propensity score-matched analysis were applied.

Results

A total of 132 patients were included for analysis. Fifty-three patients were in the high BMI group while 79 patients were in the normal BMI group. There were no significant differences regarding age, gender, comorbidity, tumor differentiation, tumor site, lymphovascular invasion, or surgical approaches between the two groups. However, patients in the high BMI group had more stage III diseases but less rate of adjuvant therapy than patients in the normal group. For survival, there was no significant survival difference between patients with high BMI and those with normal BMI (5-year overall survival rate: 40.8%VS 48.1%; P = 0.398). In the multivariate analysis, high BMI was not found to be an independent prognostic factor of Chinese patients with esophageal adenocarcinoma (HR = 1.028, 95%CI: 0.621–1.667, P = 0.945). A total of 92 patients were included after propensity-score matched analysis, and all those baseline data were comparable between the two groups. However, there was still no significant difference of survival between patients with high BMI and those with normal BMI (5-year overall survival rate: 41.4%VS 43.3%; P = 0.760).

Conclusion

High BMI have no impact on survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy. Therefore, esophageal adenocarcinoma patients with high BMI should not be denied for curative esophagectomy.

Disclosure

All authors have declared no conflicts of interest.