bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT
Authors: Andrae Hannah , Musholt Thomas , Lang Hauke , Grimminger Peter
Published: September 2018

Background

Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy.

Methods

Case report

A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea.

Results

After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia.

Conclusion

Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication.

Disclosure

All authors have declared no conflicts of interest.
PS02.150: SEVEN PATIENTS WITH GASTRIC-TUBE CANCER AFTER ESOPHAGECTOMY
Authors: Saito Shin , Hosoya Yoshinori , Ui Takashi , Kitayama Joji , Kanamaru Rihito , Haruta Hidenori , Kurashina Kentaro , Matsumoto Shiro , Sata Naohiro , Lefor Alan
Published: September 2018

Background

The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). The incidence of gastric tube cancer after esophagectomy has been reported to be 1.3–6.3% in Japan. Patients with early stage gastric tube cancer can be treated by endoscopic resection, however patients with advanced gastric tube cancer need to undergo the resection of the gastric tube.

Methods

A total of 497 patients underwent esophagectomy with gastric tube reconstruction between 2001 and 2015 at our institution. During the same period, gastric tube cancer was detected in seven patients including three by endoscopic submucosal dissection (ESD) and three by surgery. We investigated the clinicopathological study of these seven patient with gastric tube cancer.

Results

The incidence of gastric tube cancer was 1.4% (7/497) at our hospital. Average age was 73 years old (range, 62–84). Six patients were men and one was women. Average interval from esophagectomy to initial treatment was 78.3 ± 61.0 (months). Among seven patients with gastic tube cancer, three were treated by ESD and 3 underwent surgery. One patient went to a palliative therapy. All seven patient with gastric tube cancer, who didn’t have specific complains, were detected by regular upper gastrointestinal endoscopy. We observed a very high proportion of patients with H. pylori infection (at least five patients among seven).

Conclusion

ESD for gastric tube cancer after esophagectomy is a technically difficult procedure because of the limited working space and unusual fluid-pooling area in the reconstructed gastrictube as well as the presence of severe gastric fibrosis with staples under the suture line. A highly skilled endoscopist can perform the procedure successfully. An operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and video scope-assisted surgery enabled the resection of gastric tube without performing a sternotomy.

Disclosure

All authors have declared no conflicts of interest.
PS02.157: ESOPHAGEAL SQUAMOUS CELL CARCINOMA IS ASSOCIATED WITH CHRONIC DISEASES AS WELL AS UNHEALTHY LIFESTYLES
Authors: Nakamura Jun , Manabe Noriaki , Haruma Ken , Nakato Rui , Murao Takahisa , Fujita Minoru , Suehiro Mitsuhiko , Kawamoto Hirofumi , Kamada Tomoari , Shiotani Akiko , Matsumoto Hideo , Hirai Toshihiro , Yamatsuji Tomoki , Naomoto Yoshio
Published: September 2018

Background

Cancer and other chronic diseases such as cardiovascular disease, diabetes, chronic kidney disease, and respiratory disease share common risk factors, including aging and unhealthy lifestyles (eg, smoking and alcohol misuse). Although the recent prospective cohort large-scale study showed chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death, the relation between esophageal squamous cell carcinoma (ESCC) and non-cancer chronic diseases (NCCD) still remain unknown. The aim of this study is to assess the independent and joint associations of major NCCD and ESCC.

Methods

From April 2011 to March 2017, 406 consecutive patients with ESCC diagnosed pathologically were enrolled. Their medical records as to patients’ background, the reason for their consultation, lifestyles, and medical history were investigated retrospectively in detail.

Results

As to the reason for their consultation, 45 patients (25.3%) were diagnosed at annual medical checkup (no symptoms), 125 (70.2%) consulted a doctor for any symptoms such as dysphagia, and 8 (4.5%) had other reasons. As to lifestyles, 304 (78.1%) were drinkers of alcohol (daily amount of alcohol consumption > 20g) and 302 (77.4%) were smokers (Brinkman index > 200), respectively. As to the medical history related to cancer or gastrointestinal diseases, 25 (6.8%) had a history of laryngopharyngeal cancer, 20 (5.1%) had a history of gastric cancer, 2 (0.5%) had a history of breast cancer, one (0.3%) had a history of sclerodema, and one (0.3%) had a history of esophageal achalasia. Of the 406 ESCC patients, 305 were early ESCC and the remaining 101 were advanced ESCC. As to the medical history in patients with advanced ESCC, 22 (21.8%) had a history of cancer of other organs, and 48 (47.5%) had NCCD including hypertension (35 patients), diabetes (18 patients), and hyperlipidemia (12 patients).

Conclusion

NCCD is an overlooked risk factor for ESCC, as important as two major lifestyle factors combined (drinkers of alcohol and smokers). General physicians who follow up NCCD patients should pay attention to the coexistence of ESCC.

Disclosure

All authors have declared no conflicts of interest.
PS02.181: RISK FACTORS AND TREATMENT OF DIAPHRAGMATIC HERNIA FOLLOWING IVOR-LEWIS OESOPHAGECTOMY FOR CANCER
Authors: Puccetti Francesco , Parise Paolo , Fumagalli Romario Uberto , Cossu Andrea , De Pascale Stefano , Elmore Ugo , Marcocci Gianluca , Rosati Riccardo
Published: September 2018

Background

Oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening surgical complication characterized by an underestimated occurrence rate and unknown related risk factors. This study analyses the experience of two tertiary designated centers in order to evaluate key elements concerning development and treatment of PODH.

Methods

A cohort of consecutive patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) underwent Ivor-Lewis oesophagectomy between March 1997 and April 2017 according to three different approaches: totally open incision procedure (OILO), hybrid (HILO) and totally mininvasive to esophagectomy (MILO). All patients were retrospectively observed in the context of a postoperative calendarised follow-up in order to record the incidence and postrepair results of PODH.

Results

414 patients underwent Ivor-Lewis oesophagectomy for cancer and 22 (5.3%) developed PODH within a median follow-up period of 16 months (6 - 177). Surgical repair was generally applied by the mean of laparoscopic cruroplasty (77%) with a conversion rate of 24%. Postoperative morbidity did not include early recurrences but exclusively cardio-pulmonary complications (5 patients) with one case of respiratory failure leading to death. The discharge was reached after a median hospital stay of 6 days (2 - 95) while 3 recurrences (14%) occurred over a median follow-up period of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiotherapy, the complete pathological response (CPR) and a lymph node harvest (LNH) larger than 33 stations (p-value of 0.016, 0.001 and 0.024 respectively). The strong influence of an extended LNH was confirmed by the multivariable analyses (0.026) along with CPR which should however be considered as longer survival-related bias.

Conclusion

The minimally invasive surgery and the neoadjuvant chemoradiotherapy represent a considerable part of multimodal treatment for oesophageal cancer presenting a not statistically significant association with PODH development while a LNH including more than 33 nodes resulted to be an independent risk factor mirroring the extent of surgical demolition in oesophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS02.189: A STUDY ON PRETREATMENT NUTRITIONAL SCORE OF ESOPHAGEAL CANCER PATIENTS WHO UNDERWENT PREOPERATIVE TREATMENT
Authors: Omoto Itaru , Uchikado Yasuto , Sasaki Ken , Osako Yusaku , Okumura Hiroshi , Owaki Tetsuhiro , Natsugoe Shoji
Published: September 2018

Background

Esophageal cancer tends to be malnourished due to anorexia, transit disorder, so it is important to conduct sufficient nutritional assessment and treatment. For standard treatment of neoadjuvant chemotherapy for esophageal cancer, Cisplatin + 5-fluorouracil (FP) therapy is common, but sufficient therapeutic effect has not been obtained. As a more powerful regimen, DCF therapy with Docetaxel added to FP therapy and chemoradiotherapy have been introduced. In this study, we examined pretreatment nutritional score of esophageal cancer patients who underwent neoadjuvant therapy.

Methods

We studied 105 patients undergoing preoperative treatment diagnosed as esophageal cancer or esophagogastric junctional carcinoma from July 2012 to August 2017. Esophagectomy with lymph node dissection after neoadjuvant therapy. Relationship between Glassgow Prognostic Score (GPS) and Controlling Nutrition Status Score (CONUT) score, sex, age, staging, main tumor location, adverse event, postoperative complication and tube feeding nutrition are examined.

Results

Median age was 66 years, male/female = 92/13, and cases requiring tube feeding were 29 cases. The breakdown of the clinical stage is Stage IA, B/IIA, B/IIIA, B, C/IV = 9/34/50/12. The breakdown of neoadjuvant therapy is FP/DCF/FPRT/DCFRT/other = 9/27/26/39/4. The incidences of grade 3/4 adverse events during preoperative treatment were 66 cases (63%) in 105 patients. The treatment effect is CR/PR/SD/PD = 6/41/50/8. Histopathological result is Grade 0/1a/1b/2/3 = 3/52/13/6/31. Postoperative complications were Clavien-Dindo classification Grade IIIa or more in 20 cases, in-hospital death was 1 case.CONUT score was judged to be cut-off by more than 2, there was a significant relationship between presence of tube nutrition and treatment result (P = 0.0376, 0.0231). GPS was judged to be 1 or more cutoff, there was a significant association with tube nutrition availability and histopathological result (P = 0.0019, 0.0083). There was no significant difference between occurrence of adverse events and occurrence of postoperative complications.

Conclusion

It was suggested that CONUTscore and GPS at hospitalization are useful as predictors of treatment result and histopathological result in esophageal cancer patients who undergo neoadjuvant therapy.

Disclosure

All authors have declared no conflicts of interest.
PS02.199: STRATEGY FOR TREATMENT OF NEUROENDOCRINE TUMORS OF THE ESOPHAGUS
Authors: Maeda Shinsuke , Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Osugi Harushi , Yamamoto Masakazu
Published: September 2018

Background

Neuroendocrine tumors of the esophagus are very rare. The prognosis is known to be poor, and there is no consensus on treatment strategy.

Methods

We investigated 27 patients who underwent surgery for neuroendocrine tumor of the esophagus at our institute between 1968 and 2017. We researched (1) Background, (2) Treatment, (3) Types of the recurrences, and (4) Prognosis.

Results

(1) Male: female = 22: 5, Median age; 64.2 (24–77), Location; Ut: Mt: Lt: Ae = 1: 15: 9: 2, Depth of the tumors: T1: T2: T3: T4 = 9: 3: 11: 4, Median length of the tumors; 57.7 mm (14–130), Pathological types; pure type: mixed type = 10:17, Lymph node metastasis; N0: N(+ ) = 3: 24. (2) Surgical approach; right thoracotomy:left thoracoabdominal incision:transhiatal approach = 24: 2: 1, Organ used for reconstruction; stomach: colon = 25: 2, Route of reconstruction; antethoracic: retrosternal: posterior mediastinal = 10: 5: 12, Neoadjuvant therapy; (+ ): (-) = 15: 12. (3) Types of recurrences; liver: lung: lymph nodes: bone: dissemination = 7: 6: 4: 2: 4. (4) Median survival time was 10 months (1–98). Compared by (a) tumor depth, (b) number of metastatic LNs, (c)with or without adjuvant therapy were as follows; (a) T1: T2–4 = 19: 5 months (P = 0.0202), (b) 0–2: > 2 = 19: 4 months (P < 0.001), (c) (+ ): (-) = 12: 5 months(P = 0.141).

Conclusion

Approximately 2/3 cases were accompanied with poorly differentiated SCC, and most of those cases were diagnosed as NET after surgery. Prognosis is poor, but pT1 cases and cases with small number of LN metastases showed better prognosis. Although without significant difference, cases with adjuvant therapy showed longer prognosis. Our opinion is, if with selection of cases and strong adjuvant therapy, surgery can be a feasible choice.

Disclosure

All authors have declared no conflicts of interest.
PS02.202: CLINICAL SIGNIFICANCE OF MEASUREMENT OF SKELETAL MUSCLE VOLUME AND SERUM NUTRITIONAL MARKERS IN ESOPHAGEAL CANCER PATIENTS
Authors: Ishida Tomo , Makino Tomoki , Tanaka Koji , Yamasaki Makoto , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

Some studies reported the association of muscle mass or nutritional state with development of postoperative morbidity. However, it remains unknown whether body composition or nutritional state influences upon clinical outcome in esophageal cancer (EC) patients undergoing surgery following neoadjuvant chemotherapy (NAC).

Methods

A total of 100 EC patients who undergone NAC followed by curative surgical resection in our hospital from 2011 to 2013 was analyzed. The cross-sectional area of psoas was measured by computed tomography at third lumbar vertebra and the Psoas Muscle Index [PMI: total psoas area at L3/(height × height)] was calculated. Pre- and post-NAC PMI in addition to prognostic nutritional index (PNI), modified Glasgow prognostic scale (mGPS), and neutrophil/lymphocyte ratio (N/L) as an inflammation or nutrition marker were evaluated in terms of their association with development of NAC adverse event, postoperative complications and long-term survival.

Results

The PMI significantly decreased during chemotherapy from 705.5 to 682.7 cm2/m2 (P = 0.0008). Pre-NAC PMI (low vs high group, cutoff: 6.36cm2/m2 for male, 3.92cm2/m2 for female) was significantly associated with serum albumin (3.5 vs 3.8g/dl P = 0.0064) and body mass index (19.6 vs 22.2kg/m2P < 0.001), and clinical response to NAC (response rate 66.7 vs 87.1% P = 0.02). Post-NAC PMI, meanwhile, correlated with development of postoperative pneumonia [Clavien-Dindo (C-D) classification grade > II] (35.0 vs 8.3% P = 0.0009) and expectoration disorder of sputum (C-D classification grade > III) (28.6 vs 10.5% P = 0.027) while neither pre- or post PMI were predictive of patient survival. Regarding serum nutritional markers, pre-NAC PNI and mGPS correlated with NAC-induced neutropenia [low vs high PNI (cutoff: 40): 100 vs 87% P = 0.019] and diarrhea (mGPS 0/1 vs 2: 27.4 vs 80.0% P = 0.017) while post-NAC mGPS (mGPS 0 vs 1/2) was predictive of development of postoperative pneumonia (11.5 vs 30.8%, P = 0.018) and expectoration disorder of sputum (10.7 vs 27.8%, P = 0.037), respectively. Notably, post-NAC mGPS (mGPS 0 vs 1/2: 76.4 vs 65.4%, P = 0.039) and N/L (N/L ≥ 2.5 vs < 2.5: 43.5 vs 82.1% P = 0.006) showed the significant association with 2-year overall survival.

Conclusion

Pre- and post-NAC PMI in addition to serum inflammation/nutrition markers might be clinically useful in predicting outcome of multidisciplinary treatments for EC patients.

Disclosure

All authors have declared no conflicts of interest.
PS02.212: RECURRENCE PATTERN AND RISK FACTOR AFTER ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CARCINOMA
Authors: Kawai Masaru , Lee Sang-Woong , Tashiro Keitaro , Tanaka Ryo , Hiramatsu Masako , Uchiyama Kazuhisa
Published: September 2018

Background

Surgical procedure of esophageal cancer is invasiveness and perioperative condition for the patient play an important role for outcome. The aim of this study is investigate the impact of operative complication on the recurrence.

Methods

Between January 2010 and December 2017, total 159 patients, who had been diagnosed esophageal squamous carcinoma and undergone curative radical esophagectomy were enrolled.

Results

Recurrence was observed for 39 cases (24.5%), median value for recurrence is 493 days after operation. Pathological stage I/II/III/IV were 3/14/17/5 cases, respectively. Preoperative additional therapy was received 16 cases, including 13 cases for neoadjuvant chemotherapy and 3 cases for definitive chemoradiotherapy. The sites of recurrence were observed lymph node in 20 cases, distant metastasis in 10 cases, and three cases of local recurrence. Fifteen patients in recurrent cases are still survivals. Compared with no-recurrence group, there was no significantly difference in operative blood loss, blood transfusion and operative time. Preoperative nutritional condition, such as serum albumin level and number of lymphocyte were not difference in both groups. In addition, sarcopenia and obesity were not associated with recurrence. Concerning as inflammatory complications, anastomotic leakage was not influenced on recurrence, but pneumonia was affected to recurrence. Moreover, three year recurrent free survival was significantly lower in the case of pneumonia as postoperative complication.

Conclusion

The incidence of recurrence for esophageal squamous carcinoma is high rate, even if early stage of cancer. The site of recurrence is highly revealed as lymph node metastasis. In this study, pneumonia as postoperative complication is strongly contributed to risk factor for long term outcome. Secure postoperative respiratory management is required for improvement of long term prognosis.

Disclosure

All authors have declared no conflicts of interest.
PS02.215: DOUBLE STENT INSERTION FOR TRACHEOESOPHAGEAL FISTULA AFTER CHEMORADIOTHERAPY: A CASE REPORT AND REVIEW OF LITERATURE
Authors: Nakazato Hidetsugu , Yoshino Yutaro , Tomiyama Takeshi , Nagamine Shinji , Tomori Takehiko , Inamine Susumu , Miyagi Jun , Nagayoshi Seiji , Omine Yasushi , Miyara Tetsuhiro
Published: September 2018

Background

Tracheoesophageal fistula is a one of the most severe adverse events of chemoradiotherapy (CRT) for esophageal carcinoma.

Methods

Case

The patient was an 84-year-old man who was referred to our hospital due to dysphasia, which had persisted for 2 months. Upper gastrointestinal endoscopy demonstrated a semicircular esophageal tumor. Biopsy revealed squamous cell carcinoma. Further examination revealed regional lymph-node metastasis but no distant metastasis. The clinical classification, according to the TNM 7th edition was T4b(trachea)N1M0 Stage IIIC. CRT (using cisplatin (CDDP)/5-fluorouracil (5-FU) infusion with concurrent radiotherapy) was performed. At two weeks after the initiation of CRT, the patient developed pneumonia due to tracheoesophageal fistula. The respiratory infection was controllable and the tumor remained after CRT. Tracheal stent insertion and esophageal stent insertion were performed sequentially as palliative treatments.

Results

There were no specific complications in association with stent insertion and the patient was successfully discharged from the hospital.

Conclusion

Tracheal and esophageal stent insertion are considered to be safe and feasible palliative treatments for tracheoesophageal fistula.

Disclosure

All authors have declared no conflicts of interest.
PS02.216: PROPHYLAXIS OF POSTOPERATIVE VENOUS THROMBOEMBOLISM USING ENOXAPARIN AFTER ESOPHAGECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY FOR EFFECTIVENESS AND SAFETY
Authors: Yoshida Naoya , Baba Yoshifumi , Nagai Yohei , Okadome Kazuo , Kiyozumi Yuki , Iwatsuki Masaaki , Ishimoto Takatsugu , Imamura Yu , Watanabe Masayuki , Baba Hideo
Published: September 2018

Background

Incidence of venous thromboembolism (VTE) after esophagectomy is higher than those in other gastroenterological cancer surgery. However, the strategy of thromboprophylaxis during esophagectomy has not been established. Although effectiveness and safety of thromboprophylaxis using enoxaparin have been established in orthopedic, abdominal, and pelvic surgeries, no studies are available regarding esophagectomy.

Methods

We conducted a prospective observational study to elucidate the usefulness of enoxaparin to prophylactic VTE after esophagectomy. Thirty patients who underwent elective three-incision esophagectomy for esophageal cancer between April 2015 and October 2016 were enrolled. During the postoperative day (POD) 2 to 11, patients received a subcutaneous injection of enoxaparin (2000 IU) twice daily. The primary endpoint was the incidence of postoperative VTE. In addition, the incidence of all enoxaparin treatment-related and operation-related adverse events were also investigated. VTE was identified by VTE protocol enhanced CT, which was routinely performed during enoxaparin treatment and after enoxaparin treatment.

Results

One pulmonary embolism (PE) (3.3%) and 2 deep vein thrombosis (DVT) (6.7%) were observed during enoxaparin treatment. In addition, further one PE (3.6%) and 4 DVTs (14.3%) (one patient suffered the both) were observed after treatment. All VTEs were asymptomatic. Regarding enoxaparin-related adverse events, 4 minor bleedings without a need of stopping enoxaparin occurred. Incidence of postoperative morbidity was acceptable. In blood tests related to coagulation system, no significant differences were observed between patients with and without VTE.

Conclusion

We believe that thromboprophylaxis using enoxaparin is safe and can prevent VTE after esophagectomy. However, the effectiveness is limited in the period of treatment, additional prophylaxis following enoxaparin treatment may be recommended.

Disclosure

All authors have declared no conflicts of interest.
PS02.217: CLINICAL RESULTS OF PHOTODYNAMIC THERAPY FOR INOPERABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yi Eunjue , Ho Chung Jae , Lee Junhee , Lee Sungho , Kim Han
Published: September 2018

Background

Although surgical resection is the best way for curing cancer, there has been a certain portion of patients who could not undergo surgery because of various reasons. We experienced 9 cases of photodynamic therapy for esophageal cancer patients with inoperable conditions, and investigated the feasibility and safety of photodynamic therapy.

Methods

Medical records of patients of esophageal cancers who received photodynamic therapies in Korea University Anam Hospital were reviewed retrospectively. Survival, complication rates and treatment results were evaluated.

Results

A total of 9 patients (all men) with esophageal cancer had been received photodynamic therapy between 2007 and 2015. Average age at the time of treatment was 70.9 (± 4.62, ranging 64 to 78) and average follow-up periods were 18.2 (± 16.59, ranging 3.8 to 53.6). The average Charlson Comorbidity Index (CCI) were 7.3 (± 2.29, ranging 4 to 10). During the follow-up periods, 5 patients died, and only one death was related with the distant metastasis progression. There was one case of skin reaction and no other complications were appeared. There were no complication related deaths. Complete remission of esophageal cancer showed in 6 patients (66.7%) and partial remission showed in 3 patients (33.3%). Two patients with partial remission showed loco-recurrence. One patient with complete remission had to undergo surgery because of preexisting esophageal stenosis. In patients with complete remission, no recurrence was observed.

Conclusion

Photodynamic therapy is feasible and safe with acceptable rates of complications. For esophageal cancer patients with inoperable condition or refusal of surgery, photodynamic therapy could provide alternative way to treatment.

Disclosure

All authors have declared no conflicts of interest.
PS02.219: POSTOPERATIVE RECOVERY AFTER SURGERY FOR CANCERS OF THE ESOPHAGUS AND STOMACH: DOES PREOPERATIVE PATIENTS’ CONDITION PREDICT OUTCOME?
Authors: Thomaschewski Michael , Meyer Hauke , Kopeleva Olga , Keck Tobias , Hummel Richard
Published: September 2018

Background

Esophageal and gastric cancers usually occur at a higher age, and patients often present significant comorbidities. In combination with the risk profile of esophageal and gastric cancer surgery, the preclinical condition is relevant for morbidity and mortality after esophagectomy and gastrectomy. We aimed with the current project to investigate if postoperative physical recovery is as well significantly affected by preclinical conditions of the patient, and whether the patients’ condition might be a surrogate for the need for extensive rehabilitation.

Methods

We conducted a retrospective study on 108 consecutive patients that underwent esophagectomy (n = 56) or gastrectomy (n = 52) between 2013 and 2017. We analysed the impact of patients’ condition, BMI, age, tumor stage and complications on ICU time, respirator time, physical recovery in hospital and discharge conditions.

Results

Median age of the predominant male population (80%/65%) was 65 respectively 72 years for esophagectomy and gastrectomy. Preoperative risk was assessed as normal/increased/high risk using the Cologne Risk Score in 2%/36%/63% respectively 6%/41%/53% of cases, and ASA score was 2/3/4 in 20%/73%/7% respectively 19%/71%/10%. Preoperative patients` conditions (determined by ASA and Cologne Risk Score) also inclundig BMI, age, neoadjuvant therapy, tumor stage and tumor entity (squamous cell carcinoma versus adenocarcinoma) had no impact on postoperative ICU stay, respirator time, physical recovery and discharge condition. However, postoperative complications (determined by Clavien Dindo Score) negatively affect both discharge condition and physical recovery (P < 0.005), whereas age negatively affects discharge conditions (P < 0.005).

Conclusion

Preoperative patients’ condition seem to have no significant impact on recovery after both esophagectomy and gastrectomy. However, complications affect recovery negatively.

Disclosure

All authors have declared no conflicts of interest.
PS02.228: COMPARISON OF ESOPHAGEAL CANCER IN NORTHERN AND CENTRAL MALAYSIA
Authors: Ying Khoo Hui , Voon Kelvin , How Teoh Keat , Nagalingam Premnath , Aznan Shuhaili Mohamad , Rajan Reynu , Mohammed Taher Mustafa , Ritza Kosai Nik
Published: September 2018

Background

Malaysia is a unique Asian country with multiracial, multicultural and multi-religion society. It is divided into six regions geographically and each region has different population distribution and socioeconomic status. Urbanization occurs more rapidly in the central region with higher population density and household income. We would like to compare the epidemiology of esophageal cancer between Northern and Central Malaysia.

Methods

A review of esophageal cancer from two regional tertiary referral centers in Northern and Central Malaysia in 2014–2017.

Results

A total of 143 esophageal cancers were detected during the study period, 60 cases from northern region and 83 cases from central region. In both regions, the mean age of diagnosis was similar (63.3 vs 62.0). More male patients were noted in Central Malaysia (71% vs 62%). Esophageal cancer was commonest in the Chinese ethnicity in both regions. Cardioesophageal junction was the commonest location of cancer and majority of patients presented with dysphagia in both regions. For tumour histology, squamous cell carcinoma (SCC) was the commonest (49.4%) in the Central as compared to adenocarcinoma in the North (47.5%). The incidence of SCC was highest among the Indian population in both regions while adenocarcinoma was the commonest tumour in other ethnicity. Most of the patients in both regions presented with advanced disease and the incidence of stage 4 disease was higher in the North (65% vs 48%). Hence, there were more patients who underwent curative intend surgery in the central region (58% vs 28.5%).

Conclusion

The epidemiology of esophageal cancer is similar in both regions in Malaysia. Esophageal cancer is commonest among the Chinese. Further studies are needed to explore the tumour biology, host genetic factors and sociocultural practice for better understanding of esophageal cancer among the multiracial population in Malaysia.

Disclosure

All authors have declared no conflicts of interest.
RA01.01: THORACOSCOPIC ESOPHAGECTOMY IN SEMIPRONE POSITION
Authors: Pawar Suraj
Published: September 2018

Description

To assess the feasibility of Thoracoscopic Esophagectomy in the Dorso-Lateral position with the intention of reducing the disadvantages and increasing the benefits of lateral approach and prone approach which are the 2 conventional approaches. Methods: Thoracoscopic Esophagectomy is routinely performed in 2 positions. The left lateral decubitus position is the commonly used position at most of the centres. However prone jack-knife position as described by Cushieri is another alternative. To combine the advantages and reduce the disadvantages of the these 2, we started performing this procedure in a Dorso-Lateral position since 1st October 2008. This is a position midway between the Lateral and Prone position i.e. Left lateral position with an inclination making an angle of 45 degrees with the horizontal. Operating Surgeon and assistant are positioned anteriorly facing the ventral aspect of the patient. A three-port approach is taken with port placements in the 5th, 7th and 9th intercostals spaces in the posterior, mid and anterior axillary lines. Pneumothorax is created with CO2 pressure of 5–7 mm Hg. Although single lung ventilation is preferable the procedure can be done with routine dual lung ventilation with a 4th port being used to retract the lung if necessary.

Esophagus is mobilized en-block with posterior mediastinal lymphadenectomy. The Azygous vein and right Bronchial artery are preferably preserved to maintain vascularity of right bronchus. Following this patient is turned supine and Stomach mobilization and coeliac dissection is done laparoscopically. Left neck incision is taken and esophagus is divided in the neck. Specimen is delivered in the abdomen and extra-corporeally through a mini-laparotomy. Gastric tube is prepared and brought in the neck through posterior mediastinum underneath the azygous vein and rt.bronchial artery for anastamosis in the neck. The video shows the procedure in the Dorso-Lateral Position as we routinely perform at our centre. Conclusion: Thoracoscopic Esophagectomy with Mediastinal Lymphadenectomy in the Dorso-Lateral position is a feasible, more convenient and a safe option which can combine the benefits of the conventional left lateral and prone approaches. Surgeon comfort is enhanced in terms of more comfortable operating position and improved ergonomics.

Disclosure

All authors have declared no conflicts of interest.
RA01.06: TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY IN A PATIENT WITH PREVIOUS NISSEN FUNDOPLICATION: CAN INDOCYANINE GREEN BE A USEFUL TOOL?
Authors: Turrado-Rodriguez Victor , De Maria Momblan Dulce Nombre , Torroella Alba , Ibarzabal Ainitze , Carolina Guzman Yoelimar , Sofia Espinoza Arlena , Maria De Lacy Fortuny Antonio
Published: September 2018

Description

Total esophagectomy may be technically demanding. Previous abdominal surgeries may increase the difficulty of the technique, especially when affecting the stomach as a gastric conduit is the preferred method for reconstruction. In this video, we demonstrate that the creation of the gastric conduit is feasible even with a previous Nissen fundoplication and that the use of indocyanine green (ICG) is useful to assess the vascularization of the gastric conduit.

Methods

A 70-year-old woman with medical history of high blood pressure, hysterectomy and hiatal hernia repair with laparoscopic Nissen fundoplication presented with symptoms of dysphagia and weight loss and was diagnosed of an adenocarcinoma of the esophagus (25 to 32 cm from the incisives) cT3N1. Neoadjuvant chemo-radiotherapy following CROSS scheme was administered. A total minimally invasive esophagectomy was performed in the prone position for the thoracic time. Concerns about the length of the gastric conduit due to the fundoplication were present during surgery. ICG was used to locate the right gastroepiploic arcade, asses the vascularization of the gastric conduit, specially in the gastric fundus, and after cervicotomy, to assess the vascularization of the gastric stump before performing the anastomosis.

Results

Surgical time was 360 minutes. Postoperative evolution was satisfactory except for hoarseness due to a possible right recurrent laryngeal nerve paralysis. She was discharged on the 11th postoperative day. Pathology confirmed an adenocarcinoma of the mid esophagus ypT1bN1 (1/15).

Conclusions

Totally minimally invasive esophagectomy in the prone position is feasible even in the case of previous upper gastrointestinal surgeries, such as Nissen fundoplication. The use of ICG is useful for the identification of the gastroepiploic arcade, assessment of the vascular supply to the gastric conduit and to the anastomosis, especially when a McKeown esophagectomy is performed.

Disclosure

All authors have declared no conflicts of interest.
RA02.03: THERAPEUTIC STRATEGY FOR ADENOCARCINOMA OF ESOPHAGO-GASTRIC JUNCTION
Authors: Yago Akikazu , Akiyama Hirotoshi , Sato Kei , Sato Sho , Tanaka Yusaku , Miyamoto Hiroshi , Kosaka Takashi , Kunisaki Chikara , Endo Itaru
Published: September 2018

Background

The optimal surgical management for adenocarcinoma of the esophagogastric junction, including surgical approach, range of nodal dissection, and type of gastrectomy remains controversial.

Methods

In our two institutions, from January 2001 to September 2016, we retrospectively analyzed clinicopathological factors and long-term results of 72 patients who underwent radical resection and evaluated the priority of nodal dissection based on the therapeutic value index [ = the frequency of lymph node metastasis (%) x the 5-year survival rate (%)/100] and recurrence pattern.

Results

Median age:66 (44–94), male/female = 54/18, TG/PG = 60/12, Tumor size < 40mm/ ≥ 40mm = 32/40, pT1/2/3/4 = 14/13/28/17, pN0/1/2/3 = 32/17/8/15, intestinal/diffuse type = 39/33. pStageI/II/III = 29/17/26, 5-year survival rates were pStageI/II/III = 91.1/86.2/51.4%. Univariate analysis revealed that tumor size ≥ 40mm (vs < 40mm, P = 0.009), diffuse type (vs intestinal type, P = 0.0031) and pN2–3 (vs pN0–1, P < 0.001) patients had significantly poor prognosis, and multivariate analysis revealed that diffuse type (P = 0.018, HR 3.991, 95%CI 1.264–12.606) and pN2–3 (P = 0.040, HR 3.112, 95%CI 1.055–9.183) were independent prognostic factors. The therapeutic value index of nodal dissection was No.1/2/3/7/11d/parahiatal/lower mediastinal = 15.56/12.34/11.34/7.05/5.40/12.04/2.70, and no evidence of lymphadenectomy was observed for No.4, 5, 6, 10, 16, upper and middle mediastinum. 19 cases had disease recurrence, 3 cases were mediastinal lymph node recurrence.

Conclusion

Our study showed that distal gastric lymph nodes dissection is unnecessary, and gastrectomy with lower mediastinal and proximal gastric lymph node dissection is recommended for the treatment of adenocarcinoma of EGJ. Since diffuse type and pN2–3 were independent prognostic factors even after potentially curative resection, so additional chemotherapy might be required for such cases.

Disclosure

All authors have declared no conflicts of interest.
RA02.08: SALVAGE LYMPHADENECTOMY FOR 14 PATIENTS OF ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHRAPY
Authors: Odagiri Kazuki , Yamasaki Makoto , Tanaka Koji , Miyazaki Yasuhiro , Makino Tomoki , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

Salvage Lymphadenectomy is regarded as the only curative surgery to residual or recurrence lymph nodes of esophageal cancer after definitive chemoradiotherapy (dCRT). However, salvage lymphadenectomy is not described in the Japanese esophageal cancer treatment guideline because of little evidences for the safety and efficacy.

Methods

From January 2011 to December 2015, we performed 14 salvage lymphadenectomies to residual or recurrence LN of esophageal squamous cell carcinoma(ESCC) in Osaka University. We assessed postoperative complications and long-term outcome.

Results

Average age was 64 year-olds (SD: 5.2). Male: Female = 11: 3. cStage I: II-IV = 7: 7. Surgery to cervical LN were 11 patients and abdominal LN were 3 patients. Surgery to residual LN (res-LN) were 9 patients and recurrence LN (rec-LN) were 5 patients. rec-LN patient's median time to recurrence after dCRT was 14.3 months (10.2–29.3). 4 patients were performed lymphadenectomy resecting with adjacent organs, 3 patients were bronchus (trachea? ) and 1 patient was right subclavian artery. 4 patients had postoperative complication, two were pneumonia, one was pulmonary thrombosis and one was lymphorrhea, but there was no serious case (Clavien-Dindo Grade II or less). We didn’t have hospital death. Six of 14 patients had recurrence and died after salvage lymphadenectomy. Recurrence sites were 2 mediastinal lymph nodes and liver, lung, loco-regional and peritoneal. But no patients had recurrence of main tumor. 5-year overall survival rate was 51.1%. Median survival time in 9 patients, surgery to res-LN, was 18.9 months (10.4–132 months) and 5 patients, surgery to rec-LN, was 4.9 months (1.4–26.6 months). Surgery to res-LN patients were longer than rec-LN patients in overall survival after salvage lymphadenectomy (P = 0.395). There was no difference due to the difference in recurrence site of the cancer in overall survival after salvage lymphadenectomy.

Conclusion

Our data show salvage lymphadenectomy safety and effectiveness after dCRT. Salvage lymphadenectomy may extend the prognosis of patients with esophageal cancer after dCRT. Thus, salvage lymphadenectomy may be one of the treatment options for the patients with residual or recurrent, especially the former, lymph node after definitive CRT, although it is necessary to evaluate in many cases.

Disclosure

All authors have declared no conflicts of interest.
RA03.05: COMPARISON OF OUTCOME OF ESOPHAGECTOMY VERSUS NON-SURGICAL TREATMENT FOR RESECTABLE ESOPHAGEAL CANCER WITH CLINICAL COMPLETE RESPONSE TO NEOADJUVANT THERAPY
Authors: Koga Shuhei , Ohkura Yu , Ueno Masaki , Udagawa Harushi
Published: September 2018

Background

Treatment for patients who have achieved clinical complete response (cCR) after neoadjuvant therapy has not been established, with no consensus regarding the indications for either esophagectomy or non-surgical treatment.

Methods

Among 1545 patients with esophageal cancer at Toranomon Hospital between January 2006 and August 2017, 39 who achieved cCR after neoadjuvant treatment were divided into two groups according to treatment: esophagectomy group (n = 18) andtreatment group (n = 21) for comparison.

Results

No significant intergroup difference was observed in baseline characteristics. Pathological complete response was confirmed in 13 (72.2%) of the 18 patients who underwent esophagectomy, while residual tumor was detected at the location of primary tumor in 2 (11.1%) patients and lymph node metastasis was found in 3 (16.7%) patients. Recurrence-free survival (RFS) was significantly longer in the esophagectomy group than in the non-surgical group (P = 0.002). Disease-specific survival (DSS) was significantly longer in the esophagectomy group (P = 0.007). However, no significant intergroup difference was observed in overall survival estimated based on all deaths, including (P = 0.451).

Conclusion

With improved diagnostic accuracy, non-surgical treatment can be an option for patients estimated as cCR after treatment administered in a neoadjuvant setting. However, surgical resection is considered more appropriate because of residual tumor in some patients with cCR and because of superior DSS and RFS following esophagectomy compared with non-surgical treatment. Future studies must focus on ameliorating late postoperative complications such as respiratory failure and aspiration pneumonia.

Disclosure

All authors have declared no conflicts of interest.
RA10.03: IMPACT EXERTED BY NUTRITIONAL RISK SCREENING ON CLINICAL OUTCOME OF PATIENTS WITH ESOPHAGEAL CANCER
Authors: Wang Rui , Cai Hongfei , Cui Youbin
Published: September 2018

Background

Preoperative nutritional status of patients is closely associated with their recovery after the surgery. This study aims to ascertain the impact exerted by the nutritional risk screening on clinical outcome of patients with esophageal cancer, to provide scientific determination of nutritional support for patients suffering from esophageal cancer.

Methods

160 patients with esophageal cancer aged over 60, having got therapy at the First Hospital affiliated by Jilin University from Jun. 2016to Feb. 2017 were evaluated adopting the NRS2002. 80 cases of patients got active therapy of nutritional support, and the other patients not supported nutritionally were selected as the control group. The comparison was drawn between two groups in serum albumin, serum immunoglobulin, postoperative complications, hospitalization and hospitalization expenses. Experimental data were acquired through adopting t-test and χ2 test for statistical analysis.

Results

For all the patients, in 3 and7 days after the surgery, the serum albumin in the nutritionally supported group outstripped that in group without nutritional support (P < 0.05) regardless of the nutritional risk. For the patients in the risk of nutrition, the IgA in the nutritionally supported group outstripped that of group without nutritional support (P < 0.05) in 3 and 7 days before the surgery, and the serum IgG outstripped that of the group without nutritional support in 1 and 3 days before the surgery(P < 0.05). Two groups were not statistically different in the rate of postoperative complication (P > 0.05). In terms of the patients in the risk of nutrition, the average hospitalization of nutritionally supported group was shorter(P < 0.05), and the average hospitalization expenses were lower compared with those of the group without nutritional support. And for the patients in no risk, the hospitalization expenses of supported group surmounted those of group without nutritional support (P < 0.05), whereas the average hospitalization took on no statistic difference(P > 0.05).

Conclusion

For the patients in the risk of nutrition, preoperative nutritional support can facilitate the nutritional status and immunization-relative result after surgery, which shall also decrease the average hospitalization and hospitalization cost.

Disclosure

All authors have declared no conflicts of interest.
RA10.05: CHEMORADIOTHERAPY IMPROVES LOCO-REGIONAL CONTROL AND DISEASE-FREE SURVIVAL OVER CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA WITH SIGNET RING MORPHOLOGY
Authors: Van Hootegem Sander , Smithers Mark , Gotley David , Thomson Iain , Brosda Sandra , Thomas Janine , Gartside Michael , Wijnhoven Bas P L , Van Lanschot J J B , Lagarde Sjoerd M , Barbour Andrew
Published: September 2018

Background

The presence of signet ring cells (SRC) is associated with poorer survival in multiple cancer types. Here we aimed to determine the predictive and prognostic value of SRC in oesophageal and junctional adenocarcinoma (OAC) for patients treated with neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT).

Methods

Patients who underwent nCRT and nCT followed by surgery for OAC between 2000 and 2016 were identified from two institutional prospective databases. Pre-treatment biopsy and surgical resection pathology reports were used to determine the presence of SRC morphology. The association between SRC histology and clinicopathological characteristics including pathological response was assessed. The prognostic impact of SRC on disease-free survival (DFS) and overall survival (OS) was determined. Survival was calculated with Kaplan Meier method and differences tested with log rank test.

Results

Of the 689 study patients, 129 had SRC (nCRT; n = 65, nCT; n = 64) and 560 patients had no evidence of SRC (nCRT; n = 326, nCT; n = 234). The SRC group had higher pT stage (P = 0.004) and median number of involved nodes (P = 0.004) following nCT compared with the non-SRC group. There were no significant differences between the two groups with respect to age, gender, tumour site, pN, R status or pathological complete response. For the 129 in the SRC group, nCT patients had significantly worse DFS (median [IQR]; 12 months [50–5]) compared with nCRT patients (median [IQR]; 26 months [111–9], P = 0.021). Moreover, nCT had a worse loco-regional recurrence-free survival (P = 0.004), but not distant recurrence-free survival (P = 0.74), in the SRC group. In contrast, there were no differences in DFS (P = 0.245) or recurrence patterns between nCRT and nCT among the 560 non-SRC patients. However, there was no significant difference in OS according to SRC status following nCT (P = 0.076) or nCRT (P = 0.541).

Conclusion

For SRC OAC, nCRT is associated with better DFS and loco-regional control compared with nCT. However, the presence of SRC in OAC was not prognostic for OS following nCT or nCRT.

Disclosure

All authors have declared no conflicts of interest.