bluuebunny/crossref_metadata_2025 huggingface dataset:
RA07.03: NON-ENDOSCOPIC SCREENING FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA: INTERIM ANALYSIS
Authors: Bhatt Maunil , Shah Parth , Gandhi Fenil , Patel Parth , Patel Dhwani , Patel Deep , Parmar Vipal , Mehta Bhavna , Rajput Sanjay , Godfrey Tony , Litle Virginia
Published: September 2018

Background

Esophageal Squamous Cell Carcinoma(ESCC) comprises 90% of esophageal cancer worldwide which typically presents at advanced stages and has extremely poor outcomes. Established risk factors for ESCC include tobacco, alcohol and betel nut use. We hypothesized that a screening program for high risk subjects could be established in a low- to middle-income country, using a low-cost, non-endoscopic, retrievable capsule sponge device called EsophaCap(EC).

Methods

The Institutional Review Board-approved study was conducted in western India from March 2017 through February 2018. Patients with high risk characteristics(smoking, tobacco, betel nut, alcohol, hot beverage consumption) were included. Patients with severe dysphagia, current upper aerodigestive tract cancer, metastatic cancer, esophageal varices, cirrhosis, and portal hypertension were excluded. Following EC specimen retrieval, endoscopic biopsies were collected at 20cm, 30cm and from any visible mucosal abnormalities. Cytology and biopsy specimens underwent H&E staining. An interim analysis was performed to make necessary changes given the lack of baseline data in this field.

Results

Of the 100 enrolled subjects(85% males, median age 50 years), 93% successfully swallowed the EC and 90% completed endoscopy. The median patient experience score on a 6-point visual analog scale was 5(‘minimal discomfort’). Six(7%) subjects had ESCC on their biopsy. In 2 ESCC patients with mild dysphagia, sponge cytology accurately detected atypical squamous cells(ASC) and dysplasia(100% Sensitivity & Specificity). The other 4 ESCC patients had moderate dysphagia with a near-complete obstruction. In 2 asymptomatic patients with no mucosal abnormalities on endoscopy or biopsies, sponge cytology detected ASC. Longitudinal follow-up of these patients is ongoing. On biopsies from twenty-one(23%) patients, leukoplakia was identified.

Conclusion

ESCC screening using the EC is feasible with good patient tolerance. Analysis of the cytology samples with H&E staining is potentially accurate for patients with non-obstructive lesions but has a high false negative rate in patients with advanced lesions, when the EC can’t traverse the obstruction. An unusually high rate of leukoplakia was detected in this population and will be evaluated as a potentially pre-malignant lesion with increased risk for development of ESCC. Future studies will include high-throughput sequencing to identify molecular changes that may correspond with leukoplakia or dysplastic cells retrieved with the EC.

Disclosure

All authors have declared no conflicts of interest.
RA08.01: WIDE-FIELD ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE TREATMENT OF BARRETT’S ESOPHAGUS NEOPLASIA (WF-ESD)
Authors: Omae Masami , Konradsson Magnus , Wang Naning , Baldaque-Silva Francisco
Published: September 2018

Background

The role of ESD on Barrett's esophagus (BE) neoplasia has been studied in some small series with suboptimal results, mainly due to positive lateral margins (LM). We started ESD of neoplastic BE on 2011. Due to early suboptimal results because of positive lateral margins (LM), we decided to start performing wide-field ESD of Barrett's neoplasia from 2015. With the new approach resection is performed, as described for wide-field colorectal EMR with wider (5–10mm) free margins, after careful BE assessment. Our aim was to evaluate the feasibility, safety and efficacy of wide field ESD (WF-ESD) for resection of BE neoplasia comparing it to conventional ESD (c-ESD).

Methods

We asessed the patients and tumor characteristics and technical issue in all ESDs compared with c-ESD with WF-ESD. In order to reduce stricture risk, from 2015, oral steroids were used in patients with more than 3/4 resection of all circumferential lumen of the esophagus. The primary outcomes were the rates of en bloc, R0 and curative resection rates. The secondary outcomes were the rate of negative LM and adverse events rate such as bleeding, perforation and stricture rate. This study was approved by the Stockholm Regional Ethical Committee (2013–596-31).

Results

Total sixty-four consecutive ESD cases of early Barrett neoplasia were performed in 50 patients in our center between 2011–14 and 2015–17. The mean age was 67.1 ± 9.9 vs 67.2 ± 10.0, the male/female was 13/6 vs 25/6 in c-ESD and WF-ESD. In primary outcomes, en-block resection rate was 91.3 vs 100% (21/23 vs 41/41), R0 resection rate was 69.6 vs 85.4% (16/23 vs 35/41), curative resection rate was 56.5 vs 78.0% (13/23 vs 32/41) (P > 0.05). In the secondary outcomes, negative rate in LM was 26.1 vs 2.4% (6/23 vs 1/41), adverse event rate including perforation and bleeding was 4.3 vs 9.8%(1/23 vs 4/41) and stricture rate was 21.7 vs 2.4% (5/23 vs 1/41) with P < 0.01 for LM and P < 0.05 for stricture rate.

Conclusion

Wide field ESD is associated with improved efficacy and good safety profile in the treatment of neoplastic BE. More studies are necessary to confirm its role in the management of BE.

Disclosure

All authors have declared no conflicts of interest.
RA08.04: IMPORTANT ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS FOR PREDICTING SUBMUCOSAL TUMOR INVASION IN SUPERFICIAL BARRETT ADENOCARCINOMA
Authors: Namikawa Ken , Nakano Kaoru , Akazawa Naoki , Ishiyama Akiyoshi , Fujisaki Jyunko
Published: September 2018

Background

Predicting the depth of invasion of superficial Barrett adenocarcinoma (s-BA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics related to s-BA submucosal invasion.

Methods

We retrospectively reviewed 67 lesions in 63 cases with pathologically defined s-BA (SSBE, n = 56; LSBE, n = 7) that underwent endoscopic resection at our hospital from January 2004 to December 2017. Initial treatment included endoscopic mucosal resection (EMR) (n = 4), endoscopic submucosal dissection (ESD) (n = 99), and surgery (n = 33). We grouped 133 lesions into two groups based on depth of tumor invasion: group M comprised 87 intramucosal tumors and group SM comprised 49 submucosal tumors. We defined characteristic criteria for submucosal invasion as follows: tumor size ≥ 21 mm, complex macroscopic type; composed of > 2 macroscopic types, biopsy-por; biopsy specimens including poorly differentiated adenocarcinoma. Endoscopic ultrasound (EUS) was performed only in cases in which predicting the depth of tumor invasion was difficult.

Results

In group M, the median tumor diameter was 13 (range, 1–82) mm and included 68 SSBEs and 19 LSBEs. In group SM, the median tumor diameter was 23 (range, 4–55) mm and included 41 SSBEs and 8 LSBEs. Tumors larger than 21 mm were seen in 12 (13.8%) patients in group M and 25 (51.0%) in group SM. Complex macroscopic type tumors were present in 20 patients (23.0%) in group M and 30 (61.2%) in group SM. Biopsy-por was present in 2 (2.3%) in group M and 12 (24.5%) in group SM. Multivariate analysis indicated the above three characteristics as independent predictors of submucosal invasion; in particular, biopsy-por was highly significant (P < 0.001, odds ratio, 10.81). EUS was performed in 55 lesions including 28 tumors invading the submucosa. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS for predicting submucosal invasion were 46.4%, 70.4%, 61.9%, and 57.5%, respectively.

Conclusion

Tumor size ≥ 21 mm, complex macroscopic type, and biopsy specimens including poorly differentiated adenocarcinoma were independent predictors of submucosal invasion. Specificity of EUS was relatively high for cases that were difficult to predict depth of tumor invasion.

Disclosure

All authors have declared no conflicts of interest.
RA08.05: ENDOSCOPIC THERAPY AND SURVEILLANCE VERSUS ESOPHAGECTOMY FOR EARLY ESOPHAGEAL ADENOCARCINOMA: A REVIEW OF EARLY OUTCOMES AND COST ANALYSIS
Authors: Boshier Piers , Wirsching Andrea , Krishnamoorthi Rajesh , Larsen Michael , Irani Shayan , Ross Andrew , Low Donald
Published: September 2018

Background

Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (clinical stage T1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early EC.

Methods

Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015 at a single high-volume center. To ensure comparability between treatment groups only those patients who were deemed medically fit to undergo esophagectomy, regardless of ultimate management, were included. Cost analysis was performed for each patient group and was compared to procedural outcomes.

Results

Forty-three patients met the inclusion criteria for this study (endoscopic therapy n = 20; esophagectomy n = 23). All patients who underwent endoscopic therapy had clinical stage T1A, whilst 15 patients in the esophagectomy group had T1B disease (P < 0.001). Patient groups were well matched for all other baseline characteristics (P > 0.05). For patients undergoing endoscopic therapy a median of six interventions were performed per patient (range 2–18). Same day discharge was achieved after 98% of all endoscopic procedures with 72% of cases performed under general anesthesia. Endoscopic dilations due to stricture formation were required in five (25%) patients after endoscopic therapy. Esophagectomy was associated with a median hospital stay of 9 (8–13) days and greater procedure specific morbidity compared to endoscopic therapy. Median treatment costs for patients undergoing esophagectomy were significantly greater than that incurred for patients receiving endoscopic therapy only ($53,849, 95%-confidence interval: 50,541–88,784 vs. $22,640, 95%CI: 18,754–46,705, P < 0.001). The minimum cost associated with esophagectomy in the current study was approximately four times greater than for endoscopic therapy ($40,410 vs. $9236). In comparison the maximum cost incurred for surgical and endoscopic therapy were $247,808 and $127,508 respectively. Overall costs were significantly correlated to either number and severity or postoperative complications or number of endoscopic procedures performed (P < 0.002).

Conclusion

In patients with early EC endoscopic therapy was associated with lower rates of procedure specific morbidity compared to esophagectomy. Despite an increased number of interventions and longer duration of therapy, overall costs were significantly lower in patients undergoing endoscopic therapy when compared to esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
RA08.06: ONGOING CHALLENGES IN CLINICAL ASSESSMENT OF NODAL STATUS IN T1 ESOPHAGEAL ADENOCARCINOMA
Authors: Nobel Tamar , Barbetta Arianna , Hsu Meier , See Tan Kay , Bains Manjit , Adusumilli Prasad , Bott Matthew , Isbell James , Sihag Smita , Jones David , Molena Daniela
Published: September 2018

Background

Endoscopic resection has emerged as an esophageal-preserving treatment for T1 esophageal adenocarcinoma (EAC); however, only patients with negligible risk of nodal metastasis should receive this option. Since preoperative reliable diagnostic tools are lacking, scoring systems have been developed to assess risk of lymph node metastasis (LNM). The purpose of this study was to provide external validation of two previously published scoring systems for clinical prediction of nodal status in patients with T1 EAC.

Methods

In adherence with patient selection criteria in the two previously published scoring systems (figure 1), we identified patients with T1 EAC (n = 230) who underwent esophagectomy without neoadjuvant treatment from a prospective database between 1995 and 2017. Clinicopathologic characteristics were compared between patients with LNM and without. Risk scores were tabulated in accordance with the two scoring systems. Predictive accuracy of the scores were evaluated by c-index and calibration plots, and compared using Venkatraman's test for paired receiver operating characteristics curves.

Results

Groups were similar in age, location and nodes harvested. There were 38 (17%) patients with positive LNM; 3/66 (5%) T1a and 35/164 (21%) T1b. LNM was associated with poor differentiation (25% vs 42; P = 0.001), positive LVI (16.1% vs 71.1; P < 0.001) and longer tumors (1.6 cm vs 2.2; P = 0.004). Median score A was 6.2 (IQR 4.2–7.6) for patients without LNM versus 12.5 (8–13.5) with LNM. Median score B was 2 for T1a and 3 for T1b patients without LNM versus 5 for T1a and T1b with LNM. AUCs of the two scoring systems were similar (score A 0.86, [95% CI 0.81–0.91] vs B 0.83 [0.77–0.89], P = 0.89). For patients with LNM (n = 38), all were high risk for LNM according to score A and 37 (97%) met criteria for esophagectomy according to B. In those without LNM (n = 192), 138 (72%) were high risk for LNM and 102 (53%) met criteria for esophagectomy.

Conclusion

Both scoring systems demonstrated good predictive accuracy for LNM; however, B may be simpler to implement. Most patients classified as high risk or for esophagectomy did not have nodal metastasis on pathology. Future scoring systems must better identify which patients are candidates for organ preservation on the basis of LNM.

Disclosure

All authors have declared no conflicts of interest.
RA08.07: NOMOGRAM PREDICTING LONG TIME SURVIVAL FOR M1 ESOPHAGEAL CANCER
Authors: Liu Mina
Published: September 2018

Background

Esophageal cancer is the sixth most common cause of cancer deaths globally, and causes the deaths of over 400,000 people worldwide annually. For the patients with M1 diseases, the population has been growing over the past 20 years. Chemotherapy is the standard treatment for them, however, the survival is not satisfactory, with 5-year relative survival less than 5%. Very limited patients were able to survive more than two years. Our study aimed to evaluate the clinicopathologic characteristics of the long-time survivals and construct a clinical nomogram using the Surveilance, Epidemiology, and End Results (SEER) database.

Methods

Information of patients diagnosed with M1 stage esophageal cancer from 2010–2014 was retrieved from SEER database. Patients with unknown TNM stage or unknown metastatic sites were not included. Demographic and clinicopathologic characteristics were compared between LTS (long time survivals: patients who have survived for no less than 2 years) and STS (shorter time survivals: patients who have survived for less than 2 years). Cox regression analysis was performed to evaluate prognostic factors. A nomogram comprising demographic and clinicopathologic factors was established to predict 1-year survival and 2-year survival for patients with M1 diseases.

Results

A total of 3133 patients from the SEER database were included for analysis. The demographic and clinicopathologic variables of the LTS and the STS groups were summarized and compared. Compared with the STS, married people and patients with Grade I-II differentiated diseases were significantly more likely to be LTS. Also, LTS were associated with less bone metastasis and more surgery. Seven point three percent married patients have survived more than two years, however, only 4.5% single or divoiced or widow patients were LTS. Among the 3313 patients, 123 patients recieved surgery, and as high as 28.5% patients were LTS. The OS nomogram (Figure 1) was based on the eleven variables: gender, age, marital status, T stage, histology, grade, bone metastasis, brain metastasis, liver metastasis, lung metastasis, and surgery. Figure 1 Nomogram predicting 1-year and 2-year OS for M1 stage esophageal cancer

Conclusion

We developed a nomogram predicting 1- and 2-year overall survival for M1 stage esophageal cancer. The prognostic model may improve clinicians’ abilities to predict individualized survival and to make treatment recommendations

Disclosure

All authors have declared no conflicts of interest.
RA09.02: LYMPH NODE RESPONSE AFTER NEOADJUVANT CHEMORADIATION THERAPY FOR ESOPHAGEAL ADENOCARCINOMA: TIME FOR AN APPROPRIATE YPN CLASSIFICATION
Authors: Depypere Lieven , De Hertogh Gert , Moons Johnny , Provoost An-Lies , Lerut Toni , Sagaert Xavier , Coosemans Willy , Van Veer Hans , Nafteux Philippe
Published: September 2018

Background

Response of the primary tumor and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation. Response on the primary tumor is well established using T(umor) R(egression) G(rading). However, little is known about the prognostic value of lymph node response in these patients.

Methods

Hematoxylin-eosin slides of 193 adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with neoadjuvant chemoradiation therapy between 2008 and 2015 were all reassessed by a senior pathologist. Lymph node response (LNR) was defined as a combination of central fibrosis and at least one other characteristic such as hemosiderin pigment, acellular mucin pools, foam cells, giant cells or calcifications. Lymph nodes were categorized in four categories: 1° as positive (ypN+) when viable tumor was found according to TNM 8th edition. 2° as negative (ypN0) in absence of any viable tumor. 3° as lymph nodes with signs of LNR (LNR+). 4° as lymph nodes without signs of LNR (LNR-). All patients were grouped according to lymph node positivity and lymph node regression. Multivariate and survival analysis were performed by Cox proportional hazard regression analysis.

Results

Thirty-four patients were ypN + /LNR + , 60 were ypN + /LNR-, 41 were ypN0/LNR + and 58 were ypN0/LNR-. Median overall survival was respectively 41.0 months, 18.5 months, 31.2 months and 62.9 months. Survival was significantly different between ypN0 groups (P = 0.045) but not between ypN + groups (P = 0.299). Multivariate analysis showed that LNR was an independent prognosticator (P = 0.011).

Conclusion

In cN + esophageal adenocarcinoma patients treated with neoadjuvant chemoradiation with final pathology being ypN0 after esophagectomy, median overall survival is doubled when no signs of LNR were found suggesting these patients were in fact true N0 and that ypN0/LNR + have a similar prognosis as ypN + /LNR + . Using these four categories of ypN allows for more precise evaluation of the impact of induction therapy.

Disclosure

All authors have declared no conflicts of interest.
RA09.03: PERINEURAL INVASION (PNI) IN ESOPHAGEAL CANCER: IMPROVING THE VALUE OF MODERN STAGING: A META-ANALYSIS
Authors: Leng Xue-Feng , Zhu Yi , Cheng Lei , Cheng Xin , Jin Jian , Yuan Yong
Published: September 2018

Background

Esophageal cancer treatment is largely determined by tumor stage. Despite improvements made in the treatment of different types of this malignant disease, staging has still in continuous renewal. The role of perineural invasion (PNI) in staging remains debated. We have assessed the relation of PNI with metastatic pattern to evaluate whether PNI might add significant new information to staging.

Methods

We performed a systematic literature search that was focused on the PNI in esophageal cancer published up to February 2018. Studies with neoadjuvant-treated patients were excluded. Data on T stage, N stage and other characteristics were extracted. Data were analyzed for the relevance of the presence of PNI, lymph node metastases, and the tumor invasion on the depth of esophageal structure and outcomes.

Results

A total of 9 cohorts were retrieved, covering 2207 patients. PNIs are invariably associated with poor outcome. Moreover, a total analysis of 2207 patients showed improved PNI in T3 + T4 (OR = 0.25, 95% CI: 0.15–0.44, and P < 0.00001), 674 of 2204 patients showed PNI more favored in N positive (OR = 0.61, 95% CI: 0.38–0.96, and P = 0.03), and 461 of 1788 patients showed improved PNI in G3 + G4 (OR = 0.70, 95% CI: 0.54–0.92, and P = 0.010) compared with T1 + T2, N − , and G1 + G2 patients, respectively.

Conclusion

PNI is an adverse prognostic factor in esophageal cancer. We have shown that PNIs have valuable prognostic information in advanced T, N stage and poor cell differentiation. Therefore, we propose that PNI may provide a vital clue to esophageal cancer staging in the future.

Disclosure

All authors have declared no conflicts of interest.
RA09.05: MDM2 AND ERCC1: NOVEL BIOMARKERS TO PREDICT THE RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR ESOPHAGEAL CANCER PATIENTS
Authors: Ito Ken , Konno Takuro , Onodera Yu , Ishida Hirotaka , Maruyama Shota , Okamoto Hiroshi , Sato Chiaki , Heishi Takahiro , Sakurai Tadashi , Taniyama Yusuke , Kamei Takashi
Published: September 2018

Background

Neoadjuvant chemotherapy (NAC) by 5-fluorouracil (5-FU) and cisplatin followed by esophagectomy has been established as a standard approach for the patients with clinical stage II/III esophageal squamous cell carcinoma (ESCC) in Japan. However, NAC is not always effective in all these patients, and it is important to identify biomarkers for predicting the response. Therefore, the present study aimed to identify markers for predicting the response to chemotherapy and the clinical outcomes.

Methods

This study included 62 ESCC patients who underwent esophagectomy following NAC. We performed immunohistochemical analyses for murine double minute 2 (MDM2), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), and excision repair cross-complementing rodent repair deficiency-1 (ERCC1) in surgical specimens following NAC and assessed the associations of the findings with clinicopathological features in individual patients.

Results

The MDM2 status and ERCC1 status demonstrated significant inverse associations with the response to NAC (MDM2: P = 0.025, ERCC1: P = 0.021). In addition, a high TP status in the tumor was significantly associated with tumor differentiation (P = 0.008), depth of invasion (P < 0.001), lymphatic invasion (P = 0.003), venous invasion (P < 0.001) and tumor stage (P = 0.006). Moreover, a high DPD status was associated with tumor differentiation (P = 0.008), depth of invasion (P < 0.001), venous invasion (P = 0.003) and tumor stage (P = 0.007). The TP status also significantly predicted the eventual clinical outcome of patients following surgery.

Conclusion

Recently, overexpression of MDM2 has been reported for poor prognosis in patients with ESCC treated by chemoradiotherapy. 5-FU metabolic enzymes, such as TP andDPD, have been investigated for sensitivity to 5-FU. ERCC1, a key component of homologous recombination-based repair of interstrand DNA cross-links, has been reported to predict sensitivity to cisplatin. In our study, MDM2 and ERCC1 immunoreactivity predict chemosensitivity of NAC based on 5-FU and cisplatin. High intratumoral TP status and DPD status are associated with tumor progression and prognosis in ESCC patients receiving NAC.

Disclosure

All authors have declared no conflicts of interest.
RA09.06: LONG-TERM OUTCOMES OF 650 ESOPHAGEAL CANCER PATIENTS WITH THORACOSCOPIC ESOPHAGECTOMY
Authors: Heishi Takahiro , Ishida Hirotaka , Onodera Yu , Ito Ken , Konno Takuro , Maruyama Shota , Sato Chiaki , Okamoto Hiroshi , Sakurai Tadashi , Taniyama Yusuke , Kamei Takashi
Published: September 2018

Background

In 1996 Akaishi et al. reported the first thoracoscopic esophagectomy (TE) in Japan. Total 650 TEs for esophageal cancer have been performed in our institute by October 2016. There are many reports about the short-term outcomes of TE compared with open esophagectomy (OE), but the long-term outcomes of TE have been under debate. The aim of this study is to investigate the survival benefits of TE and to compare with OE and long-term outcomes which other previous reports showed.

Methods

A total 750 cases who underwent TE (N = 650) or OE (N = 100) between 1994 and 2015 in our hospital were included in this study. They were divided into four groups; surgery without any preoperative treatments (group S, N = 414), surgery after neoadjuvant chemotherapy (Group NAC, clinical stage II or III, N = 116), surgery after neoadjuvant chemoradiotherapy (Group NACRT, clinical stage II or III, N = 68) and salvage surgery after definitive chemoradiotherapy (Group SALV, N = 76). In group S, 100 patients received OE and 314 received TE. The other 3 groups (Group NAC, NACRT and SALV) received only TE. 3-year, 5-year overall survival (OS) and progression-free survival (PFS) rates for each group were analyzed and compared.

Results

In group S, the 5-year OS rate of TE was 63.4% and that of OE was 68.3%, there was no significant difference (Log-Rank test P = 0.41). Stage-specific OS rates of TE and OE were also compared and there was no significant difference. PFS rates of OE and TE showed the same tendency of OS. 5-year OS rate of group NAC was 63.5%. 3-year OS of group NACRT was 61.4%. 3-year and 5-year OS of group SALV were 41.4% and 34.0%. These results were the same or better than what the previous reports showed.

Conclusion

The long-term outcomes of TE were almost same as those of OE. The TE procedure resulted in similar or potentially better long-term outcomes in case of NAC, NACRT and SALV. It's acceptable to say thoracoscopic approach is the standard of esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
RA10.01: TREATMENT STRATEGY OF ESOPHAGEAL CANCER FROM THE EXPRESSION OF HER2 AND EGFR
Authors: Inoue Seiya , Nishino Takeshi , Goto Masakazu , Yoshida Daisuke , Tangoku Akira
Published: September 2018

Background

Neo-adjuvant chemotherapy (NAC) became to be a standard therapeutic strategy for advanced esophageal squamous cell carcinoma in Japan. However the multidrug combination chemotherapy with 5-FU, cisplatin (FP) and docetaxel (DFP) has been well known more effective than FP, biomarker predict efficacy of NAC is not known yet. We have reported that expression of HER2 and EGFR had correlated to the response of neoadjuvant chemotherapy and prognosis. Therefore we started to evaluate them in all cases using biopsy tissue samples from 2012.

Methods

The tissues were collected from 122 patients with esophageal squamous cell carcinoma before NAC with DFP from August 2012 to August 2017, and expression of HER2 and EGFR were measured with Immunohistochemistry. HER2 positive were 2 + and 3 + expression in immunostaining. The number of the patients were 20 cases in stageII, 91 cases in stageIII, and 11 cases in stageIV. These results were compared with response to NAC and outcome of the patients.

Results

There were no differences in patient background factors such as sex, age, location and stage.One hundred nineteen of 122 cases (97.5%) were positive for EGFR and HER2 positive cases were 12 cases (9.8%). Expression patterns of EGFR and HER2 were examined, EGFR positive-HER2 negative cases were the most common pattern, and 107 cases (87.7%), both positive were 12 cases (9.8%), and both negative were 3 cases (2.4%), EGFR negative-HER2 positive were not observed. The response rates of chemotherapy was 46.2% in the EGFR positive cases, it was 42.9% in EGFR positive-HER2 negative cases. It was 75% in HER2 and EGFR positive cases, and it was significantly higher than the other pattern (P = 0.034). HER2 expression was suggested to be a biomarker of NAC with DFP especially in stage III.

Conclusion

HER2 and EGFR expression was shown to be a predictor of NAC response. The patients with both negative pattern showed poorer response. The expression pattern of HER2 and EGFR can be useful biomarker of NAC response with DFP.

Disclosure

All authors have declared no conflicts of interest.
VS01.01: STEP BY STEP INSTRUCTIONAL VIDEO OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR SURGEONS-IN-TRAINING IN A SINGAPORE INSTITUTION
Authors: Myint Oo Aung
Published: September 2018

Description

Tan Tock Seng Hospital is second largest hospital in Singapore. It is affiliated to two medical schools in Singapore and it is a training hospital for both undergraduate and postgraduate training. Minimally Invasive Esophagectomy for esophageal cancer is more and more popular nowadays. In our department, all the residents have to view the step by step instructional videos of mininally invasive surgeries before they can assist in the cases. The viewing of the instructional videos help them with better understanding of the procedures. The viewing of videos help them with the importance of steps, standardization of steps. With the help of instructional video, they can not only assist better in the surgery but also reduce the learning curve when they start doing the procedure themselves after the graduation from the residency programme. This is the step by step instructional video of minimally invasive esophagectomy for surgeons-in-training rotated to our department.

To view the video please follow this link:

https://www.dropbox.com/sh/3azfkz37x7zh6z8/AABXRSxJUhhtWlEA0Eo2p599a?dl=0

Disclosure

All authors have declared no conflicts of interest.
VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION
Authors: Oshikiri Taro , Nakamura Tetsu , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Suzuki Satoshi , Kakeji Yoshihiro
Published: September 2018

Description

Background

Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP).

Methods

This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified.

Results

We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%.

Conclusion

Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN.

Disclosure

All authors have declared no conflicts of interest.
VS01.06: THORACOSCOPIC EXTENDED LYMPHADENECTOMY FOR EGJ CANCER: AN OPTION TO LEARN FROM THE EAST
Authors: Giacopuzzi Simone , Weindelmayer Jacopo , De Manzoni Giovanni
Published: September 2018

Description

Extended thoracoscopic lymphadenectomy is not common practice in Western countries in patients with adenocarcinoma of the esophagogastric junction. In this video we present a case of a patient with siewert I adenocarcinoma with lymph node metastasis to the right recurrent laryngeal nerve not treated with neoadjuvant therapy, due to comorbidity. The operation was: extended thoracoscopic en-block lymph node dissection. video will be edited in a more rigorous manner

Disclosure

All authors have declared no conflicts of interest.
VS02.05: LAPAROSCOPIC TREATMENT OF IATROGENIC ESOPHAGEAL PERFORATION AFTER PNEUMATIC DILATION FOR ESOPHAGEAL ACHALASIA
Authors: Costantini Mario , Salvador Renato , Capovilla Giovanni , Merigliano Stefano
Published: September 2018

Description

We present in this video a case of laparoscopic surgical repair of an esophageal perforation during pneumatic dilation for achalasia. When diagnososed with achalasia and offered adequate treatment, the patient chose pneumatic dilation. We followed the protocol used in the European trial but, after the second dilation with a 3.5 cm balloon, a perforation of the esophageal wall occurred. Gastrografin swallow and a CT confirmed the perforation. For the worsening conditions of the patient, we preferred the surgical treatment, as opposed to the conservative one. At laparoscopy, the lesion was well visible on the left lateral wall of the esophagus, 2 cm above the cardia. The mucosa was sutured with interrupted stitches, and the muscular layer reconstructed with continuous suture. A Heller myotomy was then performed on the anterior esophageal wall, and a Dor fundoplication completed the operation. The patient was discharged in 7th POD and at a 1-year follow-up she is free of dysphagia. The laparoscopic surgical repair of esophageal perforation during pneumatic dilation is feasible: proper treatment of the basic disease with myotomy is necessary, however, to achieve good final results.

Disclosure

All authors have declared no conflicts of interest.
VS03.01: QUANTITATIVE IMAGING OF CHANGE IN MICROCIRCULATION BY SIDESTREAM DARK FIELD MICROSCOPY (SDF) AFTER ESOPHAGECTOMY
Authors: Jansen Sanne , De Bruin Daniel , Van Berge Henegouwen Mark I , Van Leeuwen Ton , Gisbertz Suzanne
Published: September 2018

Description

Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Transection of the left gastric and gastro-epiploic artery and veins results in compromised perfusion in the fundus area which can result in anastomotic dehiscence (5–20%), relating to high morbidity and mortality (3–4%). The main objective of this observational study is to evaluation gastric tube microcirculation with Sidestream Darkfield Microscopy (SDF).

Method

This study included 22 patients (October 2015 - June 2016). Intra-operative microscopic images of gastric tube microcirculation were obtained with SDF directly after reconstruction. Using software (AVA2.0), the following parameters were evaluated: average velocity (μm/sec), Microvascular Flow Index (MFI), Total Vessel Density (TVD), Perfusion Vessel Density (PVD), Proportion of Perfused Vessels (PPV) and the De Backer Score (DBS), to assess change in perfusion.

Results

SDF accurately visualized and evaluated microcirculation in all patients. A SDF-stabilizer was used to create stable images. The average velocity decreased significantly towards the fundus (P = 0.001). Also, MFI, PVD and PPV were significantly lower towards the fundus, compared to the base of the gastric tube (P = 0.0002). No differences in TVD and DBS were observed, which was associated to the observed vessel dilation in the fundus-area. This vessel dilation proposes that compromised venous return may play an important role in the development of necrosis and leakage. Three patients developed anastomotic leakage.

Conclusion

This is the first study presenting quantitative microcirculation imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV were accurate parameters to observe change in perfusion after reconstruction. Also, vessel dilation in the fundus suggests a role for venous return in the development of ischemia. Quantitative microcirculation with SDF could allow for intra-operative early risk stratification, and, potentially, can result in a reduction of anastomotic leakage.

Disclosure

All authors have declared no conflicts of interest.
VS03.03: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE
Authors: Jiang Yuequan
Published: September 2018

Description

Trans hiatal esophagectomy avoid trans-thoracic surgery and reduce postoperative complications relate to thoracic surgery. However, the limitation of Trans hiatal esophagectomy is blunt dissection might result to some sever complications. We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope. Patient was in supine position, intubated with a single-lumen endotracheal tube. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope also. The lower mediastinal lymph nodes including gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope. Cervical part: Two incisions in neck were made, a 3–4cm incision in left side, another 1–2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be gas, this let the dissection of upper esophagus and lymph nodes become easy under video scope. this technique was invented by ourself, so it is unique for the congress. This surgical technique was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
VS03.05: VASCULAR ASSESSMENT OF THE GASTRIC TUBE IN MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY USING INDOCYANINE GREEN
Authors: Nombre De Maria Momblan Dulce , Turrado-Rodriguez Victor , Torroella Alba , Ibarzabal Ainitze , Sofia Espinoza Arlena , Carolina Guzman Yoelimar , Maria De Lacy Fortuny Antonio
Published: September 2018

Description

One of the major concerns in esophagic surgery is the safety of the esophagogastric anastomosis. Anastomotic leak is associated with important morbidity and mortality. Leak rates have been reported in 4.7% of patients in the Ivor-Lewis procedure and 5.2% for cervical anastomosis. Leak rate has been associated with insufficient vascular supply to the gastric conduit. Indocyanine green (ICG) assessment of the vascularization may be a useful tool to avoid this dreadful complication.

Methods

A 50-year-old man with medical history of high blood pressure and right pneumothorax was diagnosed of adenocarcinoma of the lower esophagus cT3N3. Neoadjuvant chemo-radiotherapy following CROSS principles was administered. Six weeks after the end of neoadjuvant chemo-radiotherapy a minimally invasive Ivor-Lewis esophagectomy was performed. ICG helped the identification of the right gastroepiploic arcade and of the adequate vascular supply to the gastric conduit. During thoracoscopy, ICG was helpful to assess the vascular supply to the gastric conduit after pull-up into the chest and to check the vascularization of the esophagogastric anastomosis.

Results

Postoperative evolution was uneventful. Oral intake was resumed on the third postoperative day. Patient was discharged on the 8th postoperative day.

Conclusions

ICG assessment of the vascularization of the gastric conduit is feasible, safe and helpful in Ivor-Lewis minimally invasive esophagectomy and may decrease the leak rate.

Disclosure

All authors have declared no conflicts of interest.
VS03.08: ANASTOMOTIC TECHNIQUES FOR MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY
Authors: Bernardi Daniele , Asti Emanuele , Bonavina Luigi
Published: September 2018

Description

Minimally invasive esophagectomy has the potential to reduce the incidence of pulmonary complications and postoperative pain. This video shows two safe and reproducible technical variants for thoracoscopic stapled anastomosis. The patient is placed in a left semi-prone position after induction of anesthesia with a single lumen orotracheal tube. Triportal access and low-pressure pneumothorax (8 mmHg) are used for the procedure. Once circumferential mobilization of the esophagus is completed, intraoperative ultrasonography is performed to identify a previously placed endoscopic metal clip marking the upper tumor level. The esophagus is safely transected above this level. An end-to-side intra-corporeal esophagogastric anastomosis is performed. Technique A. The esophagus is stapled with a 60 mm cartridge (EndoGIA™ Tri-Staple™ purple). The anvil of a 25 mm circular stapler (OrVil™) is inserted transorally and retrieved through a small hole in the esophageal stump. Technique B. The 25 mm anvil is inserted through a transverse esophagotomy with a 7 cm long 2–0 polypropylene suture attached to the sharp tip. The suture is passed from inside to outside of the esophageal lumen. The esophagus is then divided distal to the anvil with an linear stapler. At this point, the anvil is pulled out with a gentle traction close to the stapled line. In both techniques, the circular stapler is introduced into the chest cavity through a mini-thoracotomy at the level of lowermost trocar and a wound retractor (Alexis™) is used. The head of the circular stapler, sealed with a surgical glove cutted at the middle finger, is then introduced into the gastric tube through a small gastrotomy on the lesser curvature. The tip of the gastric tube is perforated close to the greater curvature and engage the esophageal anvil. After checking the doughnut, transection of the remnant gastric tube is completed with a linear stapler and the specimen is retrieved through the mini-thoracotomy.

Disclosure

All authors have declared no conflicts of interest.
Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh
Authors: Ghosh Prakash , Hasnain Md Golam , Hossain Faria , Khan Md Anik Ashfaq , Chowdhury Rajashree , Faisal Khaledul , Mural Moshtaq Ahmed , Baker James , Nath Rupen , Ghosh Debashis , Maruf Shomik , Shomik Mohammad Sohel , Haque Rashidul , Matlashewski Greg , Hamano Shinjiro , Duthie Malcolm S , Mondal Dinesh
Published: September 2018

Background

Post-kala-azar dermal leishmaniasis (PKDL) is a sequel to visceral leishmaniasis (VL), which is found in VL-endemic countries including Bangladesh. Because of these enigmatic cases, the success of the National Kala-azar Elimination Program is under threat. To date, diagnostic methods for PKDL cases in endemic regions have been limited to clinical examination and rK39 test or microscopy, and a suitable and accurate alternative method is needed. In this study, we investigated the application of real-time polymerase chain reaction (PCR) as a potential method for diagnosis of PKDL in comparison with microscopy.

Methods

Ninety-one suspected macular PKDL cases from Mymensingh district, Bangladesh, were enrolled in the study after diagnosis by clinical examination and an rK39 strip test. All of them responded after completion of the treatment with miltefosine. During enrollment, a skin biopsy was done for each patient, and both microscopy and real-time PCR were performed for detection and quantification of Leishmania donovan body (LDB) and LD DNA, respectively.

Results

Real-time PCR detected 83 cases among all suspected PKDL patients, with an encouraging sensitivity of 91.2% (83.4%–96.1%), whereas microscopy showed 50.6% (39.9%–61.2%) sensitivity. Among all suspected PKDL cases, 42 cases were positive in both microscopy and qPCR, whereas 41 cases were detected as positive through qPCR only.

Conclusions

This study provides evidence that real-time PCR is a promising tool for diagnosis of PKDL in endemic regions. In addition to diagnosis, the quantitative ability of this method could be further exploited for after-treatment prognosis and cure assessment of PKDL cases.
Vaccine Rubella: A Rare Cause of Post-transplant Hematopoietic Death, but a Major Public Health Problem
Authors: Gonzalez Vicent Marta , Molina Angulo Blanca , Echevarría Mayo Juan Emilio , Diaz Perez Miguel Angel
Published: September 2018

We report the first case, to our knowledge, of a child who presented with severe zonal hepatic necrosis after allogeneic hematopoietic stem cell transplantation secondary to infection with the rubella virus RA27/3 vaccine strain.
Identification of genome-wide nucleotide sites associated with mammalian virulence in influenza A viruses
Authors: Peng Yousong , Zhu Wenfei , Feng Zhaomin , Zhu Zhaozhong , Zhang Zheng , Chen Yongkun , Liu Suli , Wu Aiping , Wang Dayan , Shu Yuelong , Jiang Taijiao
Published: September 2018

Motivation

The virulence of influenza viruses is a complex multigenic trait. Previous studies about the virulence determinants of influenza viruses mainly focused on amino acid sites, ignoring the influence of nucleotide mutations.

Results

We collected more than 200 viral strains from 21 subtypes of influenza A viruses with virulence in mammals and obtained over 100 mammalian virulence-related nucleotide sites across the genome by computational analysis. Interestingly, 50 of these nucleotide sites only experienced synonymous mutations. Further experiments showed that synonymous mutations in the top two of these nucleotide sites, i.e., PB1-2031 and PB1-633, enhanced the pathogenicity of the viruses in mice. Finally, machine-learning models with accepted accuracy for predicting mammalian virulence of influenza A viruses were built. Overall, this study highlighted the importance of nucleotide mutations, especially synonymous mutations in viral virulence, and provided rapid methods for evaluating the virulence of influenza A viruses. It could be helpful for early warning of newly emerging influenza A viruses.
Identification of potential microRNAs associated with Herpesvirus family based on bioinformatic analysis
Authors: Lamkiewicz Kevin , Barth Emanuel , Barth Emanuel , Ibrahim Bashar
Published: September 2018

MicroRNAs (miRNAs) are known key regulators of gene expression on posttranscriptional level in many organisms encoded in mammals, plants and also several viral families. To date, no homologous gene of a virus-originated miRNA is known in other organisms. To date, only a few homologous miRNA between two different viruses are known, however, no gene of a virus-originated miRNA is known in any organism of other kingdoms. This can be attributed to the fact that classical miRNA detection approaches such as homology-based predictions fail at viruses due to their highly diverse genomes and their high mutation rate.

Here, we applied the virus-derived precursor miRNA (pre-miRNA) prediction pipeline ViMiFi, which combines information about sequence conservation and machine learning-based approaches, on Human Herpesvirus 7 (HHV7) and Epstein-Barr virus (EBV). ViMiFi was able to predict 61 candidates in EBV, which has 25 known pre-miRNAs. From these 25, ViMiFi identified 20. It was further able to predict 18 candidates in the HHV7 genome, in which no miRNA had been described yet. We also studied the undescribed candidates of both viruses for potential functions and found similarities with human snRNAs and miRNAs from mammals and plants.