bluuebunny/crossref_metadata_2025 huggingface dataset:
PS02.143: OUTCOME OF SALVAGE ESOPHAGECTOMY OF ESOPHAGEAL CARCINOMA
Authors: Nishida Masato , Seto Yasuyuki , Yagi Koichi , Sugawara Kotaro
Published: September 2018

Background

Although the incidence of postoperative complications is higher than typical surgery, salvage esophagectomy for esophageal squmous cell cancer(ESCC) is expected to achieve good prognosis when it resutles in R0 resection.

At our hospital, definitive chemo radiotherapy(dCRT) consists of irradiation(50.4 Gy/28 Fr) with concurrent chemotherapy(Nedaplatin/TS-1, or 5FU continuous administration). Salvage surgery is performed 4 weeks after the end of dCRT in case of residual disease.

Methods

Among 55 patients of salvage surgery after dCRT in our hospital between 2006 and 2016, 47 patients underwent salvage esophagectomy. These cases are retrospectively reviewed in terms of factors related to short and long term outcome and survival.

Results

The clinical T factor was 4/2/116/25 in cT1/T2/T3/T4 respectively. Clinical evaluation after dCRT was non-CR/SD in 18 cases(38%), SD in 14 (30%), PDin 2(4.3%) and recurrence after CR in 13(28%). R0 resection rate was 75%. Postoperative complications occurred in 64%. The incidence of complications exceeding Clavien-Dindo class Grade3 were 45% and all in-hospital mortality was 8.5% (4 cases). Pathological therapeutic effects were Grade1a (30%) in 14 cases and Grade3 (32%) in 15. Pathologic lymphnode metastasis was detected in 4 cases among these 15.

The median overall survival (OS) time was 20.3 months and 3 year and 5 year OS rate were 39 and 22% respectively. Univariate analysis showed R1/2 cases, clinically positive lymphnode metastasis after dCRT, and pathological Grade 0/1/2 and pT3/4 was risk factors for overall survival rate. In multivariate analysis, R1/2 resected cases (HR 7.38, 95% CI 2.42–24.6, P < 0.01) were independent risk factor.

Conclusion

It is necessary to reduce the surgical insult of salvage esophagectomy with minimal invasive procedure and postoperative treatment.

Salvage esophagectomy is highly recommended as long as it achieves R0 resection resulting in good prognosis.

Disclosure

All authors have declared no conflicts of interest.
PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT
Authors: Taniguchi Yoshiki , Tanaka Koji , Miyazaki Yasuhiro , Makino Tomoki , Takahashi Tsuyoshi , Kurokawa Yukinori , Yamasaki Makoto , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection.

Methods

The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction.

Results

After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful.

Conclusion

There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice.

Disclosure

All authors have declared no conflicts of interest.
PS02.148: ENDOSCOPIC MANAGEMENT OF GASTRO-BRONCHIAL FISTULA FOLLOWING 2-STAGE OESOPHAGECTOMY USING OVER-THE-SCOPE-CLIP (OTSC): CASE SERIES
Authors: Ying Tan Chih , Arkar Kyaw Htet , Lorenzi Bruno , Charalampopoulos Alex , Venkatesh Jayanthi Naga , Tang Cheuk
Published: September 2018

Background

Post-oesophagectomy gastro-bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non-standardized due its rarity and limited available evidence. Re-operation and surgical repair has been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non-invasiveness, increasing evidence of success rate and reduced morbidity. We present a case series of GBF managed endoscopically using over-the-scope-clip (OTSC).

Methods

A dedicated, prospective and contemporaneous regional Upper GI cancer database was searched to identify GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analysed.

Results

Three patients developed post-oesophagectomy GBF during study period. Mean age of patients was 53. Mean time of GBF diagnosis was 233 days (range: 20–608). Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and mean healing time was 15 days (range: 6–24). One patient who had significant co-morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis and heavy smoker) developed persistent leak of GBF and died from cardiac event.

Conclusion

GBF and its surgical treatment are associated with a high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in management of post-oesophagectomy GBF. Further studies are required to understand and establish its role in treatment algorithm of post-oesophagectomy GBF.

Disclosure

All authors have declared no conflicts of interest.
PS02.149: COMBINED MULTI-MODALITY TREATMENT INCLUDING ONE-STAGE SURGERY FOR SYNCHRONOUS CANCER OF THE ESOPHAGUS AND PANCREATIC AMPULLA IN AN ELDERLY PATIENT
Authors: Decker Georges , Faber Bernard , Schalbar Claude , Foxius Alain , Groot Koerkamp Helene
Published: September 2018

Background

One-stage surgery for synchronous esophageal and pancreatic cancer has only very rarely been reported, mostly in younger patients. This is to our knowledge the first case of a completed multi-modality treatment (induction chemo-radiation, one-stage surgery and adjuvant chemotherapy) in an elderly patient.

Methods

Difficult case report.

Results

A 77 years old ASA-2 male patient, with a symptomatic 4 cm long adenocarcinoma of the gastro-esophageal junction, ycT3N0M0 and an adenocarcinoma of the ampulla of Vater (cT2N0M0, discovered by chance) underwent surgery after induction chemo-radiation (CROSS scheme). The patient previously had undergone a sigmoidectomy for perforated diverticulitis by median laparotomy. A one-stage radical subtotal esophagectomy was performed combined with a duodeno-pancreatectomy (Whipple) by laparotomy and right thoracotomy. The radical resection of the esophagus and pancreatic head with 2-field lymphadenectomy and total gastrectomy (due to resection of the gastro-duodenal artery) was done with intestinal reconstruction using a long segment right coloplasty with esophago-colic anastomosis in the right chest apex. Operative time was 710 minutes and blood loss 700 ml. Post-operative course was complicated by a small perforation of the proximal jejunum requiring reoperation for over-sewing at day 10 (Dindo-Clavien grade IIIA). Thereafter uneventfull recovery and post-operative hospital stay was 34 days until discharge to patient's home. Pathology: GEJ Adenocarcinoma ypT3N0M0, G2, R0 and adenocarcinoma of the ampulla of Vater with duodenal and peri-pancreatic fat invasion pT4N1M0, G2, R0. 2 lymph nodes were involved on the pancreatic specimen out of total 62 nodes (esophagectomy 40, duodeno-pancreatectomy 22). Adjuvant chemotherapy was administered for the locally advanced pancreatic cancer. Nocturnal nutritional supplements by jejunostomy were pursued during chemotherapy and the feeding jejunostomy was removed after full functional recovery 4 months postoperatively. Pancreatic enzyme supplementation was pursued. The patient has recovered his normal nutritional habits at 3 months and all preoperative physical activities at 6 months. 6 months follow-up CT-scan showed no recurrence.

Follow-up CT-scan after 1 year is suspicious for a solitary liver metastasis currently under investigation.

Conclusion

Combined multi-modality treatment for esophageal and pancreatic treatment is feasible in otherwhise fit elderly patients (> 75 years) with an acceptable functional and metabolic outcome.

Disclosure

All authors have declared no conflicts of interest.
PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY
Authors: Gillaspie Erin , Moynagh Micheal , Said Sameh , Allen Mark , Blackmon Shanda , Cassivi Stephen , Nichols Iii Francis , Wigle Dennis , Shen K
Published: September 2018

Background

Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration.

Methods

January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration.

Results

Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia.

Conclusion

The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration.

Disclosure

All authors have declared no conflicts of interest.
PS02.154: RISK FACTORS FOR WEIGHT LOSS 1 MONTH AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Mohizuki Hiromi , Mine Shinji , Nakahama Takashi , Watanabe Masayuki , Hiki Naoki
Published: September 2018

Background

Post-operative body weight loss (BWL) of patients who underwent esophagectomy is common. One month after esophagectomy, some patients lose weight remarkably, and others not. If preoperative or operative risk factors influencing body weight loss are identified, it will be possible that nutritional intervention is given to the patient having these risk factors.

Methods

In our department, the dietician stays in a surgical ward for nutritional management of patients. Ninety-two patients who underwent esophagectomy for esophageal cancer in 2016 were reviewed. Pre-operative and operative factors were correlated with post-operative BWL. The cut-off value of BWL 1 month after esophagectomy was defined with 75 percentile.

Results

The median body weight change was -4.8% (-18.5% ∼11.7%). The patients were divided into two groups; 24 patients with ≥ 7.3% of BWL (severe BWL group) and 68 with < 7.3% of BWL (mild BWL group). Patients’ characteristics or post-operative morbidities were not statistically different in these 2 groups. The incidence of patients with reconstruction using a colon or jejunum was higher in severe BWL group. Pre-operative body weight, body mass index, and the value of prealbumin was higher in severe BWL group. On postoperative 14 day, the patients in severe BWL group were likely to have lower energy intake per kilogram of pre-operative body weight. On multivariate analysis, high body mass index [odds ratio = 5.90; 95% confidence interval (CI) = 1.03–47.8; P = 0.046], upper location of tumor [odds ratio = 3.38; 95%, CI = 1.04–11.4; P = 0.043] were independently associated with severe BWL at 1 month after surgery.

Conclusion

High body mass index of ≥ 25, upper location of tumor were unfavorable risk factors for weight loss 1 month after esophagectomy for esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.155: THE ROLE OF AQUAPORIN 1 IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yamazato Yuzo , Shiozaki Atsushi , Kosuga Toshiyuki , Shoda Katsutoshi , Arita Tomohiro , Konishi Hirotaka , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Nakanishi Masayoshi , Fujiwara Hitoshi , Okamoto Kazuma , Kishimoto Mitsuo , Otsuji Eigo
Published: September 2018

Background

Aquaporin 1 (AQP1) is a membrane protein whose main function is to transfer water via cellular membranes. Recent studies have described important roles for AQP1 in epithelial carcinogenesis and tumor behavior. The objectives of the present study were to investigate the role of AQP1 in the regulation of genes involved in tumor progression and the clinicopathological significance of its expression in esophageal squamous cell carcinoma (ESCC).

Methods

Immunohistochemistry for the AQP1 protein was performed to investigate the expression of AQP1 in primary tumor tissues of 50 human ESCC samples underwent curative esophagectomy. Samples were categorized into two groups according to the expression of AQP1 in each of cytoplasm and nuclear membrane, and relationships with the clinicopathological features and prognosis of ESCC patients were investigated. Next, the location of AQP1 protein in TE5, TE15, and KYSE70 cells was investigated using immunofluorescence analysis. In addition, apoptosis assay was performed in these ESCC cells and the gene expression profiles of AQP1-depleted TE5 cells was analyzed using microarray and bioinformatic studies.

Results

In an immunohistochemical analysis, AQP1 was primarily located in the cytoplasm and/or the nuclear membrane of carcinoma cells. The 5-year survival rate of patients with the ‘cytoplasm dominant’ expression of AQP1 (46.8%) was significantly lower than other patients (77.6%). A multivariate analysis of the 5-year overall survival rate showed that the pT categories and cytoplasm dominance groups of AQP1 were independent prognostic factors (P = 0.042 and 0.036, respectively). Immunofluorescence analysis revealed that AQP1 protein mainly existed in the cytoplasm in TE5 and TE15 cells. On the other hand, the expression of AQP1 in KYSE170 cells was confirmed on the nuclear membrane. The depletion of AQP1 using siRNA induced apoptosis in TE5 and TE15 cells. The results of microarray analysis revealed that Death receptor signaling pathway-related genes were changed in AQP1-depleted TE5 cells.

Conclusion

The results of the present study suggested that the cytoplasm dominant expression of AQP1 is related to a poor prognosis in patients with ESCC, and that it regulates tumor progression by affecting Death receptor signaling pathway. These results provide insights into the role of AQP1 as a biomarker for ESCC.

Disclosure

All authors have declared no conflicts of interest.
PS02.159: RISK FACTORS OF 90-DAY MORTALITY IN PATIENTS WITH CHILD-PUGH A LIVER CIRRHOSIS RECEIVING ESOPHAGECTOMY
Authors: Cheng Chuan , Chao Yin-Kai
Published: September 2018

Background

Extensive esophageal resections are contraindicated in patients with advanced liver cirrhosis. However, little is known about the surgical risk of esophagectomy in early liver cirrhosis patients.

Methods

The clinical records of esophageal cancer patients with Child A liver cirrhosis and received elective esophagectomy were retrospectively analyzed.

Results

There were 40 patients with a mean age of 52.73 ± 8.81 years. 24 patients received chemoradiotherapy before surgery. Despite patients with Child-A liver cirrhosis (5%) had similar 30-day mortality with non-cirrhotic patients (3.8%, P = 0.8). The 90- day mortality rate (15%) was significantly higher in cirrhotic group (6%, P < 0.001). The most common complication after surgery was pneumonia and pleural effusion. The use of thoracoscopic surgery (26.3% vs. 4.8%, P < 0.05), intraoperative jejunostomy insertion (42.9% vs. 3.8%, P < 0.001) was associated with lower 90 day mortality while receiving chemoradiotherapy before surgery was associated with higher surgical risk (25.0% vs. 0%, P < 0.05). To our surprise, the presence of esophageal and gastric varices, splenomegaly, anemia and thrombocytopenia had no impact on short-term outcome.

Conclusion

Patients with Child A liver cirrhosis is still associated with higher 90-day mortality rate than non-cirrhotic patients. The introduction of minimal invasive surgery and routine setup of feeding jejunostomy is the key to decrease surgical risk while the use of preoperative chemoradiotherapy should be re-justified.

Disclosure

All authors have declared no conflicts of interest.
PS02.160: OUTPATIENT FOLLOW-UP IN OESOPHAGO-GASTRIC SURGERY PATIENTS: A SAFE AND COST-EFFECTIVE ALLIED HEALTHCARE PROFESSIONAL MODEL
Authors: Chung Tham Ji , Wright Amy , Bolter Marilyn , Berrisford Richard , Humphreys Lee , Wheatley Tim , Sanders Grant , Ariyarathenam Arun
Published: September 2018

Background

Post-operative follow-up for post oesophago-gastric resection patients are usually conducted by clinicians. Follow-up normally continues for a 5-year period. In high volume tertiary NHS centres, there is an increased demand for outpatient clinician episodes. We have successfully trialled and implemented a model using Allied Healthcare Professionals (AHP); consisting of a Cancer Nurse Specialist (CNS) and Specialist Dietician (SD). We propose that AHP follow-up in the outpatient department is cost-effective and beneficial to patients.

Methods

An AHP clinic was implemented in our regional tertiary unit in February 2017. All post-operative patients without any on-going complications were eligible to attend the AHP clinic from their second outpatient visit. Data was collected from February 2017 to January 2018. The data was prospectively collected and retrospectively analysed. The AHP follow-up clinic was conducted by a CNS & SD, which runs in parallel with a consultant led clinic. Each patient in the AHP clinic is given an extended 30-minute consultation, compared to a standard 10-minute consultant appointment. This allows for queries to be addressed thoroughly and investigations required to be made.

Results

During this initial trial period, there were 44 AHP clinics with 197 outpatient consultations; average of 4.5 patients per clinic. There was good outpatient attendance compliance and improved patient satisfaction. In more recent patients, assessment for pancreatic insufficiency, iron, folate, B12 and vitamin D deficiencies were assessed and treated. 27 of 77 (35%) had symptoms of pancreatic insufficiency, 6 of 57 (12%) had low folate, 4 of 52 (7%) had B12 deficiency and 6 of 26 (23%) had vitamin D deficiency. All patients with deficiencies were given supplementation.

Conclusion

AHP follow-up from their second visit is safe, improves patient contact and satisfaction. Nutritional deficiencies can be detected and treatment commenced by AHPs without detriment to patient outcome. This provides a platform for cost effective use of resources. AHP follow-up increases consultant outpatient episodes available for the hospital trust. In the next phase, the AHPs intend on having 270 patient consultations per year (6 patient consultations per clinic with 45 clinics per year) with a standardised nutritional deficiency assessment.

Disclosure

All authors have declared no conflicts of interest.
PS02.164: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER
Authors: Ohga Takefumi , Kuma Sosei , Ezaki Takahiro
Published: September 2018

Background

The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer.

Methods

A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions.

Results

The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II.

Conclusion

Discussion: In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality.

Disclosure

All authors have declared no conflicts of interest.
PS02.165: THE INCIDENCE OF CHYLOTHORAX AFTER ESOPHAGECTOMY CAN BE REDUCED BY LOW FAT TUBE FEEDING
Authors: Schurink Bernadette , Mazza Elena , Ruurda Jelle , Roeling Tom , Steenhagen Elles , Bleys Ronald , Hillegersberg Richard
Published: September 2018

Background

Chylothorax is a treacherous complication after esophagectomy associated with significant morbidity. Early enteral nutrition after surgery is important for recovery, but increases the pressure in the lymphatic system due to the absorption of triglycerids. To lower the incidence of chylothorax after esophagectomy, the use of low fat-containing tube feeding was evaluated as a standard of care following esophagectomy.

Methods

All consecutive patients who underwent an esophagectomy with gastric tube reconstruction and placement of jejunostomy at the UMC Utrecht between the 1st of January 2012 and the 31st of December 2017 were included. Tube feeding was started as standard of care on postoperative day 1 with a normal fat-containing formula in the period between 2012 and 2014 and with a low fat-containing formula between 2014 and 2017. The clinical diagnosis of chylothorax was confirmed by triglyceride levels > 1.24mmol/L in 27 patients (61.4%).

Results

Between 2012–2017 200 patients were included; 88(44.0%) received normal fat-containing tube feeding, 112(56.0%) low fat-containing tube feeding. Chylothorax was significantly less observed in the low fat formula group (n = 15, 13.4% versus n = 29, 33%, P = 0.001) No difference was seen in drain output, triglyceride levels in the pleura fluid, treatment strategy and hospital mortality. At multivariable analysis normal fat formula was associated with a 5.1 [2.1–12.1] odds for postoperative chylothorax. Other factors independently associated with chylothorax were transthoracic resection, anastomotic leakage, number of resected lymph nodes, and lower body mass index.

Conclusion

Administration of low fat-containing tube feed after esophagectomy lowers the incidence of chylothorax.

Disclosure

All authors have declared no conflicts of interest.
PS02.166: OESOPHAGO-GASTRIC CANCER PATIENTS OPERATED ON IN THE PRIVATE SECTOR SURVIVE LONGER THAN NHS PATIENTS
Authors: Botha Abraham , Heymans S , Knight William , Bott Rebecca , Maisey Nick , Deere Harriet
Published: September 2018

Background

In the UK, national directives have resulted in centralisation of oesophago-gastric cancer in large National Health Service (NHS) centres. NHS cancer centres have treatment pathway targets of 30 and 60 days to complete staging and start treatment. We have treated patients with oesophago-gastric cancer both in the NHS and private sector. The purpose of this study was to assess whether the treatment and outcome was different for patients treated in the private sector.

Methods

Data was collected prospectively of consecutive oesophago-gastrectomies for OGJ cancer performed by a single surgeon from 2003–2013. After diagnosis all cases were discussed in a multi-disciplinary meeting. Neo-adjuvant chemotherapy was offered to all patients deemed to have N1 or T3 disease according to MAGIC and OEO5 study protocols. Patients in these stage groups who declined neo-adjuvant chemotherapy were offered adjuvant chemotherapy or chemo-radiation. During the first 2 years oesophago-gastrectomy was performed by open surgery, where-after laparoscopic and thoracoscopic techniques were introduced. Data analysis was by logistic regression using SPSS software.

Results

204 resections for OGJ cancer were performed during. The average age was 63 years (range 41–82), 85% had adenocarcinoma, and 78% of patients received neo-adjuvant chemotherapy. The pathological staging was pN1 64%, pT0 5%, pT1 17%, pT2 32%, pT3 42%, pT4 3%. The median hospital stay was 14 days (range 6–210), and the in-hospital mortality was 2.5%. 40 patients had their treatment in private hospitals. There was no difference in the demographics, histology, tumour stage, percentage receiving chemotherapy, type of chemotherapy or surgery between private and NHS patients. Private patients completed their staging tests within 9 days (range 126) of endoscopy and started definitive treatment within 10 days (range 2–59) of the last staging test. 26 of the 40 patients (65%) operated on in the private sector survived 5 years which was more than the 39% of NHS patients who survived 5 years (P = 0.0084).

Conclusion

Treatment for oesophago-gastric cancer is evolving. Patients with oesophago-gastric cancer treated in the private sector have better long-term survival than NHS patients which might be related to their shorter treatment pathway. Further studies will elucidate the changes in treatment required to improve survival for all UK patients with oesophago-gastric cancer.

Disclosure

All authors have declared no conflicts of interest.
PS02.168: THORACIC DUCT EMBOLIZATION IN HIGH-OUTPUT CHYLOTHORAX AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Michiura Taku , Kariya Shuji , Miki Hirokazu , Mukaide Hiromi , Inoue Kentaro , Yamamichi Keigo , Tanigawa Noboru , Hamada Madoka
Published: September 2018

Background

Chylothorax after thoracic surgery is initially managed conservatively, but when persistent high-output chylothorax (> 1000 mL/day) is managed conservatively, the mortality rate exceeds 50%. The objective of this study was to examine the clinical results of thoracic duct embolization (TDE) in cases of chylothorax after esophagectomy for esophageal cancer.

Methods

The data of 9 patients (7 men, 2 women) whounderwent TDE for persistent high-output chylothorax after esophagectomy for esophageal cancer were gathered retrospectively. Lymphangiography was used to identify the supply route of lymphatic fluid from the lumbar lymphatics to the leakage site and lipiodol extravasation and its site. Transcatheter thoracic ductography was used to identify communication between the thoracic duct and the leakage site and extravasation of the iodinated contrast agent. TDE was performed by percutaneous transabdominal approach to cut off the supply route. The technical success and clinical success (drainage volume ≥ 10mL/kg/day within 7 days after TDE) of TDE were evaluated.

Results

The technical and clinical success rates of TDE were 89.9%, with no serious complications observed. In 44% of patients, the thoracic duct had ruptured. In the other 56%, the ruptured was in a collateral route bypassing the thoracic duct; the leaking lymphatic fluid was supplied without passing through the thoracic duct in 50% of these patients, but clinical success was achieved even in such patients.

Conclusion

TDE was found to be a safe method of treatment, with no serious complications.

Disclosure

All authors have declared no conflicts of interest.
PS02.169: CLINICOPATHOLOGICAL STUDY ON POORLY DIFFERENTIATED SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Fujieda Hironori
Published: September 2018

Background

Poorly differentiated Squamous cell carcinoma (SCC) is rare among esophageal cancer. This study investigated clinicopathological features on poorly differentiated SCC of the esophagus.

Methods

Forty-three patients who underwent radical resection of SCC of the esophagus at our hospital were included. Patients were assigned to a group with poorly differentiated SCC (Group P) or a group with well and moderately differentiated SCC (Group WM).

Results

Thirty-four patients were enrolled in Group WM and 9 patients in Group P. There were no differences between the two groups in terms of age, body mass index, location of the primary lesion, data of operation day, presence or absence of adjuvant chemotherapy and post-recurrence chemotherapy. There were more women and diabetic patients in Group P. In the pathological analyses, there were no differences between the two groups in the depth of invasion. The number of lymph node metastasis of group P (4.33) was significantly higher than that of group WM (1.77) (P = 0.008). The recurrence rate was also significantly higher in group P than the MW group (88.9%, 44.4%, P = 0.019). In the recurrent cases for the MW and P groups, there were no differences in the median relapse-free survival time (MW group and P group: 183 and 351days P = 0.565) and in the median post-recurrence survival time (MW group and P group: 250 and 297 days P = 0.579). There were 5 patients (14.7%) with T1a in group MW. The patients with the T1a have low rate of lymph node metastasis. Therfore, we examined the patients with T1b invasion and more depth (29 patients in group MW, and 9 in group P). The number of lymph node metastasis of group P (4.33) was significantly higher than that of group MW (2.03) (P = 0.019). The recurrence rate was also significantly higher in group P than the MW group (88.9%, 48.3%, P = 0.034).

Conclusion

Patients with poorly differentiated SCC have higher rate of lymph node metastasis and recurrence. However, there was no difference in prognosis after recurrence by the degree of differentiation.

Disclosure

All authors have declared no conflicts of interest.
PS02.182: EFFECTIVENESS OF ANTI-PD-1 ANTIBODY MONOTHERAPY FOR THE PRIMARY MALIGNANT MELANOMA OF THE ESOPHAGUS: A CASE REPORT
Authors: Muroi Hiroto , Nakajima Masanobu
Published: September 2018

Background

Primary malignant melanoma of the esophagus (PMME) is extraordinarily rare with a high prevalence of malignancy and poor prognosis, and a standard therapy remains to be established. Since conventional therapeutic methods have been limited in their effects on treatment outcomes, innovative strategies for treating PMME are being explored, especially molecular targeting strategies. The programmed death 1 (PD-1) protein/programmed death ligand-1(PD-L1) inhibitor nivolumab is a promising agent for various cancers. To our knowledge, this is the first case report of PMME where a complete response was achieved using nivolumab.

Methods

We report an 80-year-old woman who was diagnosed with PMME with bone metastasis and lymph node metastases. Although dacarbazine combined chemotherapy was performed and continued for six cycles, the primary tumor deteriorated and liver metastases appeared. The patient then received nivolumab monotherapy (2 mg/kg, once every three weeks).

Results

After three cycles, nivolumab monotherapy for PMME resulted in a complete response as shown by positron emission tomography, computed tomography, and esophagogastroduodenoscopy.

Conclusion

In our case, nivolumab exerted a curative effect on PMME, thus suggesting that nivolumab can be effective in the treatment of this rare disease.

Disclosure

All authors have declared no conflicts of interest.
PS02.183: MORTALITY AFTER MULTIVITAMIN SUPPLEMENTATION: OVER 30 YEAR FOLLOW-UP OF THE RANDOMIZED LINXIAN DYSPLASIA NUTRITION INTERVENTION TRIAL
Authors: Fan Jin-Hu , Wang Bing , Wang Ming , Abnet Christian , Qiao Lin , Taylor Philip
Published: September 2018

Background

To evaluate the long-term effects of multivitamin supplementation on total and cause-specific mortality, overall and by gender and age groups.

Methods

The Linxian Dysplasia Nutrition Intervention Trial was a randomized, double-blind, placebo-controlled trial of multivitamins conducted in an under-nourished population of 3318 persons aged 40–69 years with esophageal squamous dysplasia in northern China for six years (1985–1991). Participants were followed for nearly 25 additional years after cessation of supplementation.

Results

For the combined over 30 year intervention and post-intervention observation period, multivitamin supplementation did not affect total mortality in all participants combined (2578 deaths, hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.90–1.04), in men (1229 deaths, HR = 0.91, 0.81–1.02) or women (1349 deaths, HR = 1.02, 0.91–1.13), or in younger (1130 deaths, HR = 1.00, 0.89–1.12) or older participants (1448 deaths, HR = 0.93, 0.84–1.04). A borderline association was observed for total mortality among older men, especially for heart disease mortality. Multivitamin supplementation reduced esaphageal/cardia cancer mortality by 27% among younger men. No effects were observed for deaths from any cancer, heart and cerebrovascular disease in either all subjects or women subgroups.

Conclusion

Taking multivitamins did not reduce total mortality in this under-nourished population. Together with previous results from the well-nourished populations, there is no evidence for an effect of multivitamin supplementation on overall mortality in either under- or well-nourished populations.

Disclosure

All authors have declared no conflicts of interest.
PS02.184: PROFILING RETURN TO INTENDED ONCOLOGIC THERAPY (RIOT) IN LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS RECEIVING ESOPHAGECTOMIES FOLLOWED BY POSTOPERATIVE CHEMOTHERAPY
Authors: Dai Wei , Shi Qiuling , Han Yongtao , Peng Lin
Published: September 2018

Background

As a novel metric to evaluate the quality of oncosurgical therapy, such as minimal invasive surgery, Return to Intended Oncologic Therapy (RIOT) has not been applied in patients with esophageal cancer (EC). This study aims to profile RIOT in locally advanced EC patients and to quantify its relationship with overall survival.

Methods

We conducted a retrospective study on consecutive locally advanced EC (T3–4 and/or N1–3) patients who received esophagectomies followed by postoperative chemotherapy (PC) from April 2015 to August 2017. RIOT included whether the patient did or did not undergo intended PC and the time between surgery and the start of PC. Overall survival at each RIOT group was compared via log-rank test. Cox regression models were used to estimate the prognostic value of RIOT.

Results

Among 658 locally advanced EC patients (547 males and 111 females) with complete PC data, 433 received minimal invasive esophagectomies (MIE) and 225 received open esophagectomies (OE). The RIOT rates were 58.0% for MIE and 54.2% for OE (P = 0.358). The 1-year overall survival rate of patients receiving PC was higher than that of patients not receiving PC (88.2% vs 76.4%; P = 0.005). After adjustment of age, gender, surgery type and postoperative length of stay, patients with PC showed significantly better OS than those without PC (HR 0.60, 95% CI 0.41–0.87; P = 0.007). Total 253 patients (MIE 168, OE 85) presented verified dates of starting PC. Median RIOT time was 42 days (min-max, 13–162) for MIE and 43 days (16–169) for OE (P = 0.855). Among those 253 patients, 179 (70.8%) started RIOT within 8 weeks. After 8 weeks, every one week delay of RIOT related to a 17% increase on the risk of death (P = 0.014).

Conclusion

Using a real world data, our study provided baseline profiles of RIOT in locally advanced EC patients who received esophagectomies and PC. Compared to OE, MIE did not show a significant advantage in RIOT rates and RIOT time. In spite of the short follow-up, successful RIOT is related to better OS. Prospective studies with longer follow-up are required for further application of RIOT in the evaluation of oncosurgical therapy.

Disclosure

All authors have declared no conflicts of interest.
PS02.191: CLINICAL SIGNIFICANCE OF JEJUNOSTOMY CATHETER FEEDING AFTER ESOPHAGECTOMY
Authors: Matsuyama Jin , Tamura Shigeyuki , Nagai Kenichi , Imamura Hiroki , Yagi Yuriko , Mokutani Yukako , Hashimoto Yasuji , Hirose Hajime , Ide Yoshihito , Kubota Masaru , Sasaki Yo , Ikenaga Masakazu , Yamada Terumasa
Published: September 2018

Background

Various attempts have been reported as nutritional therapy in the treatment of esophageal cancer, but there is not enough evidence. Preparing jejunostomy catheter during esophagectomy may allow early nutritional management after surgery, and may continue after leaving hospital. On the other hand, peri-operative chemotherapy or chemoradiotherapy are frequently performed in esophageal cancer treatment, and postoperative malnutrition may become a problem. Postoperative malnutrition affects treatment outcome, such as delaying recovery and difficulty of continuing treatment after surgery.

Methods

We considered that postoperative treatment can be continued while restoring and maintaining postoperative nutritional status by placing jejunostomy catheter during esophagectomy and we examined the safety and treatment outcome of the procedure.

Results

Out of 76 cases of thoracic esophageal cancer surgery from January 2008 to December 2017, 59 cases(77.6%) of jejunostomy catheter were prepared. The median age was 69 years old(50–82), cStageI/II/III/IV was 7/16/33/3 cases respectively, and 25 cases(42.4%) administered neoadjuvant chemotherapy. There was no complication of surgery related to preparing jejunostomy catheter, but 1 tube bending(1.7%), tube deviation in 3 cases(5.1%) and tube occlusion in 5 cases(8.5%) were confirmed during feeding period. The median day of start feeding was 2 days after surgery(1–12), the transition to home jejunostomy feeding was carried out in 45 cases(76.3%), the median period of feeding was 55 days(4- 521), and the median of caloric value was 400Kcal/day(200- 200). Postoperative chemotherapy and chemoradiotherapy were performed in 11 cases(14.5%), jejunostomy feeding was prepared in 10 cases(90.9%), nine cases(90%) continued feeding after leaving hospital. The median duration of jejunal catheter feeding was 71 days(21–101) and the median caloric value was 400Kcal/day(200 - 800).

Conclusion

Surgery for esophageal cancer is invasive, and in addition to malnutrition from preoperative state, adjuvant therapy is also frequent. Recovery of nutritional condition after surgery is not easy, and jejunal feeding is considered to help in perioperative period. Particularly in cases requiring postoperative treatment, the continuation rate of jejunal feeding is higher and the duration of jejunal feeding tends to be longer. Although jejunal catheter preparing surgery can be performed safely, countermeasures such as tube occlusion and deviation in tube management are necessary, and cooperation of medical staff is indispensable.

Disclosure

All authors have declared no conflicts of interest.
PS02.200: A COMPREHENSIVE SCREENING OF THE FRA-1 REGULATORY GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Toyozumi Takeshi , Hoshino Isamu , Sakata Haruhito , Murakami Kentaro , Kano Masayuki , Takahashi Masahiko , Sekino Nobufumi , Yokoyama Masaya , Okada Koichiro , Shiraishi Tadashi , Matsubara Hisahiro
Published: September 2018

Background

The expression of Fos-related antigen 1 (Fra-1) affects tumor progression, migration and invasion. We previously reported that a high Fra-1 expression level is associated with lymph node metastasis and a poor prognosis in patients with esophageal squamous cell carcinoma (ESCC). In this study, we identified the genes regulated by Fra-1 in ESCC.

Methods

We constructed Fra-1 knockdown models via the transfection of small interfering RNA (siRNA) into ESCC cell lines (TE10, TE11). The expression levels of the genes in the knockdown models were analyzed using a microarray experiment and Biobase Upstream Analysis (Cytoline Solutions, Tokyo, Japan), and candidate genes regulated by Fra-1 in the ESCC cell lines were detected. The actual connection of Fra-1 to the promoter region was identified in a ChIP-PCR experiment. The expression levels of the candidate genes regulated by Fra-1 in the primary tumors of surgical specimens obtained from ESCC patients (n = 135) were compared to those observed in normal tissues using real-time PCR and immunohistochemical staining, and the clinicopathological features were analyzed.

Results

The results of the Biobase Upstream Analysis and ChIP-PCR showed high mobility group protein 1 (HMGA1) and hyaluronan mediated motility receptor (HMMR) to be significant genes regulated by Fra-1. The expression levels of both HMGA1 and HMMR were found to closely correlate with the Fra-1 expression in the clinical specimens. The patients with a positive HMGA1 expression had a poorer prognosis than those with a negative expression (P = 0.017) and the patients with positive HMMR expression also had a poorer prognosis (P = 0.018). Moreover, a multivariate analysis demonstrated a positive HMGA1 expression to be a significant independent prognostic factor in the ESCC patients.

Conclusion

HMGA1 and HMMR are regulated by Fra-1 in the setting of ESCC and the HMGA1 expression is significantly associated with a poor prognosis in ESCC patients. Downregulating the HMGA1 and HMMR expression may become a practical treatment strategy against ESCC in the future.

Disclosure

All authors have declared no conflicts of interest.
PS02.206: THE SYNERGISTIC ANTITUMOR EFFECT OF APATINIB COMBINED WITH CYTOTOXIC DRUGS ON ESOPHAGEAL CANCER
Authors: Wang Feng , Chi Yanyan , Meng Xiangrui , Fan Qingxia
Published: September 2018

Background

Esophageal cancer is one of the most common malignancies in the digestive system in the world. It is difficult to acquire satisfactory effect through chemotherapy which is an essential method to advanced esophageal cancer. Apatinib, a highly selective inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2), inhibits the angiogenesis of tumors.

Methods

The mRNA and protein expression of VEGFR-2 in esophageal cancer cell lines (Eca9706, Eca109, KYSE450, KYSE70) were detected by qRT-PCR and western blot assay. These cell lines were treated with apatinib combined with cytotoxic drugs: cisplatin, paclitaxel, or 5-Fu respectively. Cell proliferation was then measured using CCK-8; cell cycle distribution and apoptosis were analyzed by flow cytometry; cell migration and invasion were evaluated by wound healing and transwell assays. Esophageal cancer xenografts model was established and used to evaluate the the antitumor effects of combination of apatinib and cytotoxic drugs in vivo.

Results

The mRNA and protein expression of VEGFR-2 were higher in Eca109 and Eca9706 cell lines than those in KYSE70 and KYSE450. The proliferation, migration, and invasion ability of esophageal cancer cells treated with apatinib combined with cytotoxic drugs were lower than those untreated cells. Furthermore, the inhibition effects of apatinib with each cytotoxic drug on the proliferation, migration, and invasion of esophageal cancer cells were greater compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The proportion of G0/G1 phase was increased and the effect of arresting cell cycle were enhanced in esophageal cancer cells treated with apatinib and cytotoxic drugs compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The combination of apatinib with each cytotoxic drug demonstrate synergistic promotion effects on the apoptosis of esophageal cancer cells compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The combination of apatinib with each cytotoxic drug displayed synergistic inhibition effects on the growth of esophageal cancer xenografts compared with those treated with either apatinib or cytotoxic drug (P < 0.05).

Conclusion

The combination of apatinib with cytotoxic drugs had the synergistic antitumor effects on esophageal cancer.

Disclosure

All authors have declared no conflicts of interest.