bluuebunny/crossref_metadata_2025 huggingface dataset:
364. IMPROVING PERIOPERATIVE OESOPHAGECTOMY OUTCOMES WITH THE USE OF ROBOTIC SURGERY AT A HIGH VOLUME UK CENTRE
Authors: Rayner Charles , Paine Heidi , Luangsomboon Aphiwat , McGuire Ms Anna , Walker Robert , Madhavan Anantha , Singh Pritam , Abbassi-Ghadi Nima , Preston Shaun R
Published: September 2024

Background

There is a rapid movement towards adoption of robotically assisted minimally invasive oesophagectomy (RAMIO) in the United Kingdom. Transition from an open or laparoscopic oesophagectomy to a RAMIO programme, which carries considerable financial and training cost, must ensure parity of oncological and perioperative outcomes. We sought to compare our centre’s results as we performed the three standard approaches to two-phase oesophagectomy undertaken in the UK: Open/Open (Open); laparoscopic/robotic abdomen with open chest (Hybrid); and RAMIO.

Methods

This prospective cohort study investigated the experience of five surgeons in a single high-volume UK institution. We analysed all consecutive patients undergoing two-phase transthoracic oesophagectomy for oncological reasons between 2018 and 2023. The study period was divided into three cohorts: Open (2018-2020, n=61), Hybrid (2020-2023, n=82) and RAMIO (2023, n=61). Patient demographics, tumour characteristics, perioperative outcomes, and oncological data were compared. Data were analysed using Kruskal-Wallis and Chi-squared statistical tests.

Results

No significant differences were observed in patient demographics or tumour stage between the groups. Comparison of Open vs. Hybrid vs. RAMIO demonstrated a significant reduction of major complications (Clavien-Dindo ≥III), 34.4% vs. 23.2% vs. 19.7%, respectively (p=0.033); pulmonary complications, 36.1% vs. 25.4% vs. 16.4% (p=0.007); and median length of hospital stay, 14 vs. 12 vs. 9 days (p=0.001), all favouring the RAMIO group in sub-group analysis.

Comparison of Open vs. Hybrid vs. RAMIO demonstrated a non-significant reduction in anastomotic leak rate, 11.5% vs. 2.4% vs. 6.6%, respectively (p=0.112); and mortality, 4.9% vs. 1.2% vs. 0% (p=0.19), favouring the RAMIO group. Median lymph node yields were comparable across the groups, 49 vs. 43 vs. 44 (p=0.165).

Conclusions

This single-institution study demonstrates potential benefits of transitioning from open or hybrid to RAMIO for oesophagectomy. RAMIO was associated with significantly reduced pulmonary complications, major complications and a shorter length of hospital stay. Oncological outcomes remained on par across techniques. These findings have important patient, financial, and resource implications, and support the continued adoption of RAMIO in the UK.
386. SAFETY AND FEASIBILITY OF PERSONALIZED NEOANTIGEN DC VACCINES IN POSTOPERATIVE ESOPHAGUS SQUAMOUS CELL CARCINOMA: A PHASE 1B TRIAL
Authors: Chen Long-Qi , Liu Yixin , Yang YuShang , Chen Yueyun
Published: September 2024

Background

Immunotherapy, as a neoadjuvant treatment, currently stands at the forefront of esophageal squamous carcinoma research. Yet, the landscape of post-surgery adjuvant therapy remains largely unexplored, especially for patients who experience inadequate responses or develop resistance to initial immunotherapy. Addressing this gap, we have undertaken a single-center, single-arm, prospective, and exploratory clinical study. This study aims to evaluate the efficacy of a personalized neoantigen-loaded dendritic cell vaccine (Neo-DCVac) as a novel adjuvant treatment in ESCC patients who have previously undergone neoadjuvant immunochemotherapy (nICT).

Methods

Neo-DCVac was designed and administered to 12 ESCC patients undergoing radical mastectomy post-nICT. Tailored adjuvant therapy was based on tumor immune microenvironment (TIME) analysis, following Lam's Stratified Treatment Strategy. The immunization schedule included five doses at weeks 1, 2, 4, 6, and 8, with bi-monthly boosts during the consolidation phase, sustained over a year. Primary endpoints were safety and post-vaccination immune response. Secondary endpoints included 1- and 2-year overall survival (OS) and progression-free survival. T-cell response to neoantigen peptides was assessed using enzyme-linked immunospot (ELISPOT), flow cytometry, and enzyme-linked immunosorbent asssay (ELISA), alongside single-cell sequencing to explore the vaccine's efficacy mechanism.

Results

From April 2021 to October 2023, a total of 12 ESCC patients were enrolled. The occurrence of all-grade AEs was 38.5% (5/12), all of grade 1-2, with no dose-limiting toxicities. No treatment interruptions or treatment-related deaths were observed. Till October 27 2023, the median follow-up was 31.2 months. Survival analysis revealed 1-year and 2-year disease-free survival (DFS) and overall survival (OS) rates of 88.3%, 66.7%, and 100.0%, 91.7%, respectively. Patients with diver genes had a longer median DFS (not reached) compared with patients without diver genes (10.8 months, P = 0.001). Post-vaccine immunization, all patients showed a marked increase in peripheral blood T cell subtypes (CD3, CD4, CD8), with significant neoantigen peptide response in 75% (9/12) as evidenced by ELISPOT and ELISA tests. Single-cell sequencing coupled with CoNGA analysis revealed a distinct MAIT cell population, displaying 65 clonotypes and 146 cells with consistent GEX profiles and TCR sequences. GLIPH2 analysis on Neo-Vac immunotherapy patients identified shared peptide-MHC specificities, notably in patient ES0-01, and similar patterns in patients ES0-04 and ES0-07, suggesting T cell expansion and neoantigen-specific responses post-vaccination.

Conclusions

The neoantigen DC vaccine demonstrated favorable safety and exhibited notable efficacy in ESCC.
401. CLINICAL SIGNIFICANCE OF SIGNAL REGULATORY PROTEIN ALPHA AND CLUSTER OF DIFFERENTIATION 47 EXPRESSION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Li Junpeng , Ozawa Yohei , Mozumi Takeru , Taniyama Yusuke , Sato Chiaki , Okamoto Hiroshi , Ishida Hirotaka , Kamei Takashi
Published: September 2024

Background

This study focuses on assessing the expression of Signal Regulatory Protein Alpha (SIRPα) and Cluster of Differentiation 47 (CD47) in Esophageal Squamous Cell Carcinoma (ESCC) and their impact on prognosis. Given the prominence of the CD47-SIRPα axis in cancer for inhibiting macrophage-mediated phagocytosis, this research aims to explore their role and significance in the development and treatment of ESCC.

Methods

In this study, 100 ESCC patients who underwent esophagectomy were included. Resected specimens were stained immunohistochemical staining for SIRPα and CD47. SIRPα expression was classified as high or low with cut-off value of 3%. CD47 expression was evaluated by Combined Positive Score (CPS) and Tumor Proportion Score (TPS) methods with setting a 10% threshold for high and low expression. The five-year survival rates were compared across groups over a median observation period of 61 months. This study reveals the correlation between these biomarkers and postoperative prognosis.

Results

Total 79 males and 21 females were included in this study and mean age was 68.7-year-old. The high SIRPα expression group (48 patients) revealed significantly worse 5-year overall survival rate than the low expression group (52 patients) (56.4 vs 82.8%, P=0.0098). For CD47, both evaluated by using CPS and TPS, the high expression group also showed significantly worse 5-year overall survival rate than its low group (48.8 vs 89.5%, P<0.0001, and 48.4 vs 87.5%, P<0.0001 respectively). Relapse free survival also showed significantly worse survival rate in high expression group of SIRPα and CD47.

Conclusion

The expression levels of SIRPα and CD47 serve as important biomarkers for predicting the prognosis of ESCC. They may influence prognosis by inhibiting macrophage-mediated tumor cell phagocytosis and modulating anti-tumor immune responses, offering new targets for ESCC treatment.
405. SELECTIVE ANTERIOR GASTROPEXY WITH OR WITHOUT FUNDOPLICATION FOR THE TREATMENT OF GRADE III/IV HIATAL HERNIA
Authors: Osterballe Lene , Aahlin Eirik Kjus , Alamili Mahdi , Storli Per Even , Goll Rasmus , Mortensen Kim Erlend
Published: September 2024

Background

The optimal approach to a paraoesophageal hernia (PEH) repair is unclear. Several steps during the procedure are still for discussion. Most surgeons dealing with PEH surgery agree on removal of the hernia sac from the mediastinum and a hiatoplasty with non-absorbable suture. Whether to perform an anti-reflux procedure or/and a gastropexy is unclear. Few studies exist on the subject but without clear favor of an anti-reflux procedure and/or a gastropexy.

The aim of this upcoming study is to test if the anti-reflux procedure is redundant for patients suffering from PEH with obstructive rather than regurgitation symptoms.

Methods

We are setting up a pragmatic, prospective, multicentre, two-armed study. Study beginning June 2024. Sample size calculation with 108 patients in each arm. Both arms will do hernia sac excision, closure of hiatus and gastropexy. One arm will in addition do an anti-reflux procedure. Our objectives are 1) To assess safety of anterior gastropexy with and without fundoplication regarding peri- and postoperative complications. 2) To compare efficacy of anterior gastropexy with and without fundoplication regarding symptom control and clinical recurrence. 3) To assess health related quality of life pre- and post-surgery in patients treated with the two strategies for PEH.

Results

Our primary outcome is disease specific and health related quality of life before surgery and 3-6-12 months after surgery. Secondary outcomes are per- and post-operative complications according to the clavien-dindo score and radiological status/recurrence 12 months after surgery.

Conclusion

The study will add on to existing knowledge about essential technical steps of PEH surgery. Do the patients benefit from a fundoplication or is this potentially complicating procedure redundant regarding long-term symptom control.
411. IMPACT OF FEEDING ADJUNCTS AND RADIOLOGICAL SARCOPENIA ON OUTCOMES IN NEO-ADJUVANT TREATED OESOPHAGEAL CANCER PATIENTS
Authors: Burns Flora Agnes , Convill James , Samake Maurice , Petrides George , Phillips Alexander
Published: September 2024

Introduction

Nutritional management plays a pivotal role in the care of patients with oesophageal cancer, particularly for those presenting with complete dysphagia, which poses a significant management challenge. Establishing adequate nutrition is not only a prerequisite for initiating neo-adjuvant treatment in cases of potentially curable disease but is also crucial for patient survival and quality of life. Additionally, emerging evidence suggests that sarcopenia, significantly predicts post-operative complications following oesophageal surgery. Our study aims to evaluate the impact of feeding adjuncts during neo-adjuvant treatment on outcomes, including post-operative complications, and to investigate the prevalence and implications of radiological sarcopenia in these patients.

Methods

Data from the Northern Oesophago-Gastric Cancer Unit database was used to identify patients diagnosed with oesophageal cancer and discussed at the multidisciplinary team (MDT) meetings from 2017 to 2021. The focus was on those deemed curable with planned neo-adjuvant treatment followed by surgery. Through MDT notes review, patients were identified that required feeding adjuncts prior to surgery. Demographics, tumour characteristics, treatment modalities, hospital stay length, complication rates, and survival outcomes were collected. Radiological sarcopenia was evaluated at initial staging and re-staging computed tomography (CT) scans.

Results

353 patients were included; 15 required pre-operative feeding adjuncts. This subgroup was predominantly male (73%), with a higher proportion having squamous cell carcinoma (SCC) (34% V 17%). Progression to surgery was lower in the adjunct group (73% V 87%, p=0.11). Post-operative hospital stay and one-year survival rates were comparable between groups. The adjunct group had a higher incidence of severe post-operative complications (50% Vs 28% Clavien-Dindo grade ≥3, p=0.08). Radiological sarcopenia was higher in the adjunct group (70% Vs 52%, p=0.18), with no cases of sarcopenia reversal after re-staging in the adjunct group, versus 9% in the non-adjunct group.

Conclusion

These findings highlight an association between complete dysphagia in patients with potentially curable oesophageal cancer and increased rates of post-operative complications and pre-operative radiological sarcopenia. Notably, these patients are more likely to be female and have SCC. The data underscore the critical need for diligent monitoring and nutritional support for patients requiring feeding adjuncts in the neo-adjuvant phase, emphasizing the broader implications of nutritional status on surgical outcomes and overall patient care in oesophageal cancer management.
413. LYMPH NODE MAJOR PATHOLOGIC RESPONSE IS A POTENTIAL PROGNOSTIC FACTOR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Xu Wenyi , Jiang Dongxian , Sun Tiantao , Tang Han , Tan Lijie
Published: September 2024

Background

Esophageal cancer ranks tenth in incidence and is the sixth most common cause of cancer-related deaths. Neoadjuvant chemoradiotherapy before and after surgery has been shown to improve ESCC patients' survival compared with surgery alone. However, the outcomes of nCRT are heterogeneous, and clinical or pathological methods that can predict nCRT responses have been extensively studied. There are currently no standard grading methods that assess the treatment response in lymph nodes after nCRT. We aimed to assess the clinicopathological relevance and determine the prognostic significance of lymph node major pathologic response (MPR) after nCRT in ESCC patients.

Methods

Patients who received nCRT for ESCC followed by surgery were retrospectively reviewed and classified into different lymph node stage (LNS) according to their pathological regression: LNS0 (no tumor cells in lymph node before nCRT); LNS1 (residual tumor cells in lymph node after nCRT≤50%; major pathologic response); LNS2 (residual tumor cells in lymph node after nCRT>50%; not major pathologic response).

Results

In total, 187patients, comprising 91,49 and 47 patients with LNS stage of 0(no tumor cells in lymph node before nCRT),1(major pathologic response), or 2(not major pathologic response), respectively, were included. The result showed that the higher LNS stage was strongly associated with decreased overall survival (P<0.001) and disease-free survival (P<0.001), and increased recurrence risks (P=0.002). The cox regression showed MPR was significantly an independent prognostic factor of OS and DFS. Among 96 patients with clinically positive LNs,54patients (56.3%) showed discordance between the PT and LN pathological regression grades.

Conclusions

Residual tumor cells in lymph node after nCRT≤50% could be defined as lymph node major complete response. The Lymph node MPR can be an independent prognostic indicator of ESCC patients who received nCRT plus curative surgery.
417. POSTOPERATIVE CHYLE LEAK - LESS LIKELY IN OBESE PATIENTS AND ASSOCIATED WITH POSTOPERATIVE MORTALITY
Authors: Linder Gustav , Hedberg Jakob , Edholm David , Nilsson Magnus
Published: September 2024

Background

Esophagectomy can be complicated by postoperative chyle leak (PCL). PCL is a rare condition but accounts for considerable morbidity and can be challenging to manage. Predisposing factors and the impact of PCL on survival are not fully understood.

This study aimed to investigate risk factors for PCL in a national cohort and its associations, if any, with outcomes and survival.

Methods

All patients with esophageal cancer in the Swedish Registry for Esophageal and Gastric Cancer (NREV) who underwent esophagectomy between 2006 and 2018 with information on complications were included in this study. Risk factors and protective factors of PCL were explored with multivariable logistic regression and 90-day mortality was described. Adjusted and overall survival was studied with Cox-regression and the Kaplan-Meier method.

Results

The study included 1540 patients that underwent esophageal resection. 51 patients (3.3%) had PCL of which 32 (62.7%) were managed operatively. Median time in hospital increased with 14 days from 15 to 29 days in patients with PCL compared to patients without.

In multivariable logistic regression, overweight (BMI>25) and obese (BMI>30) patients were significantly less likely to suffer from postoperative chyle leak, OR 0.41 (0.19-0.88 95%CI) and OR 0.28 (0.08-0.97) respectively.

In patients with PCL, 90-day mortality was increased three-fold, 15.7% vs 5.0%, and median survival was six months shorter (28.8 vs 34.8 months) compared to patients without PCL.

Despite this, PCL was not significantly associated with poor overall survival in multivariable adjusted analysis, HR 1.12 (0.75-1.66 95%CI).

Conclusion

Postoperative chyle leak remains a serious complication following esophagectomy. This study finds a reduced risk of PCL in obese patients by unknown mechanisms that should be further explored. Even though short-term mortality is clearly affected by PCL this complication does not seem to impact long-term survival.
429. BARRETT'S ESOPHAGUS IN CHILDREN
Authors: Sosnova Sofya , Bataev Saidkhassan , Khaspekov Dmitry , Bataev Ali , Tsatsa Maxim
Published: September 2024

Background

In children, Barrett's esophagus (BE) is much less common than in adults and has its own characteristics. If in adult practice the treatment tactics are quite restrained, then in childhood they are, on the contrary, as radical as possible. Barrett's esophagus is a consequence of pathological gastroesophageal reflux disease, which is considered an obligate precancerous disease, which determines the relevance of research in this direction.

Material and research methods

345 children with GERD were examined over 10 years. BE was detected in 52 children, which accounted for 14% of cases. Of these, 20 children had peptic stricture of the esophagus. They were included in the 2nd group of the study. The first group - 32 children without peptic stenosis of the esophagus.

The treatment tactics for patients in the first group are fundoplication, after 3 months eradication of BE (electrodestruction or cryodestruction). In the second group - a course of bougienage, fundoplication, with destruction BE, or extirpation of the esophagus for extended peptic strictures of the esophagus.

Results

Of the 52 children, boys predominated (71%). The average age was 10.2 years

In all cases in the first group, antireflux surgery produced a positive result, although it did not affect the regression of metaplasia in the category of patients with an endoscopically negative form.

In all patients of the second group, a positive result was obtained, GER was stopped, stenosis and metaplasia of the esophagus were eliminated. Eradication of metaplasia in 45% (9 children) of cases was achieved by extirpation of the esophagus due to extensive peptic stenosis (4-6 cm), and in 55% (11 children) - postoperative endoscopic destruction BE.

Conclusions

BE detected in childhood is subject to eradication upon its detection, regardless of the absence of signs of high-grade dysplasia, which is more likely to occur in adulthood.

Patients with an endoscopically negative form of BE require clinical observation with morphological control once a year.

Extirpation of the esophagus with simultaneous coloesophagoplasty is indicated in children with peptic strictures (4-6 cm) that are not amenable to balloon dilatation against the background of fundoplication for 6 months or more.
432. POSTOPERATIVE SAFETY AND TOLERABILITY OF INTRAMUSCULAR OCTREOTIDE IN PATIENTS WITH GASTROESOPHAGEAL CANCER: AN OPEN-LABEL PHASE 2 PILOT STUDY
Authors: Holmén Anders , Lampi Maria , Klevebro Fredrik
Published: September 2024

Background

Dietary peptides are believed to contribute to persistent weight loss following gastrectomy or esophagectomy due to cancer. Previous studies have suggested that this effect might be partially mitigated by octreotide. This study aims to investigate the safety and tolerability of intramuscular Sandostatin® LAR depot 10mg, including the frequency and nature of adverse events. It serves as a pilot study for future research aiming to comprehensively assess its effects.

Methods

A prospective open-label phase-2 study was conducted from November 2021 to June 2023. Twenty patients (10 undergoing gastrectomy, 10 undergoing esophagectomy) were enrolled. Patients received three doses of intramuscular Sandostatin® LAR depot 10mg at 7 days, 1 month, and 2 months post-surgery. All patients were evaluated at 7 days, 1, 2, 3, and 6 months post-surgery.

The primary endpoint was safety, determined by the incidence and nature of adverse events, with no occurrence of serious or severe events defined as successful. Tolerability was defined as at the completion of the treatment protocol by at least 90% of patients.

Secondary endpoints included weight loss (percent from baseline), Health-Related Quality of Life (assessed via EORTC-QLQ-C30 and OG25 at baseline, 1, 2, 3, and 6 months post-surgery), and the proportion of subjects requiring enteral nutrition via jejunostomy.

Results

The study protocol was completed by 95% of participants. No serious or severe adverse events were reported. Median weight loss at 6 months was 11% (3 months: 7%, 2 months: 4%, 1 month: 5%). Mean and median Global Quality of Life (part of EORTC-QLQ-C30) remained unchanged at 6 months compared to baseline (mean: 67.6 vs. 67.2; median 66.7 [25-100] vs 70.8 [16.7-100]). The percentage of subjects requiring enteral nutrition was 40%, 30%, and 15% at 1, 2, and 3 months respectively.

Conclusion

This pilot study suggests that Sandostatin® LAR depot was well tolerated and safe, with no serious or severe adverse events observed. Weight loss, Health Related Quality of Life, and the proportion of subjects requiring enteral nutrition were consistent with expectations. Future studies should consider a double-blinded randomized controlled design preferably with dose-response assessment for more robust investigation.
442. POSTOPERATIVE ADJUVANT RADIOTHERAPY REDUCES LOCOREGIONAL RECURRENCE IN PATIENTS WITH BORDERLINE RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zhang Guoqing , Mu Teng , Zhao Jia , Li Xiangnan
Published: September 2024

Background

borderline resectable esophageal squamous cell carcinoma (Br-ESCC) patients who underwent R0 resection had a significantly improved prognosis. However, local recurrence cannot be ignored. We sought to investigate the efficacy of postoperative adjuvant radiotherapy in reducing locoregional recurrence in patients with Br-ESCC.

Methods

we established a new resection status, Rbr+, which was defined as no clear boundary between the mass/scar and the outer aortic/tracheal membrane, no visible cancer remaining on the outer aortic/tracheal membrane, and a pathologically negative circumferential margin. patients with Br-ESCC who underwent curative esophagectomy at our center from January 2018 to December 2021 were eligible for this study. Patient characteristics, and perioperative variables were included in this study. univariable and multivariable analyses were performed to compare locoregional recurrence based on the logistic regression model. The Kaplan-Meier method and Cox proportional hazard model were used to compare overall and cause-specific survival.

Results

A total of 99 patients were included, among whom 27 (27.3%) had a locoregional recurrence. 71.7% (71/99) were classified as Rbr+ resection, and 28.3% (28/99) were classified as Rbr- resection. With a median postoperative follow-up of 55.3 months (range, 24.3-70.8 months), 25 patients out of 71 with Rbr+ resection suffered from local recurrence. However, 2 patients out of 28 with Rbr- resection suffered from locally recurrence. The locoregional recurrence was 25%(7/28) and 41.9%(18/43) in Rbr+ resection with and without postoperative adjuvant radiotherapy. While, the locoregional recurrence was 8.33%(1/12) and 6.25%(1/16) in Rbr- resection patients with and without postoperative adjuvant radiotherapy.

Conclusion

Rbr+ resection was independently associated with locoregional recurrence in patients with Br-ESCC. postoperative adjuvant radiotherapy was independently associated with overall and cause-specific survival in patients with Br-ESCC.
455. SHOULD THE DIAGNOSTIC THRESHOLD FOR PH MONITORING IN GASTROESOPHAGEAL REFLUX DISEASE DIFFER BETWEEN THE EAST AND THE WEST?
Authors: Wong Ian , Yam Ben Ka-Pan , Kwok Ryan Chun-Lok , Tsang Steven Ka-Chun , Wong Claudia Lai-Yin , Chan Desmond Kwan-Kit , Law Betty Tsz-Ting , Chan Fion Siu-Yin , Law Simon
Published: September 2024

Background

The Montreal definition's reliance on troublesome typical symptoms alone is inadequate for diagnosing 'actionable' Gastroesophageal Reflux Disease (GERD). Lyon consensus 2.0 updated conclusive evidence of GERD, incorporating Los Angeles grade B or above esophagitis and Acid Exposure Time (AET) exceeding 6% in ambulatory reflux monitoring. The Seoul Consensus 2020 presents varied opinions on applying the same standards to the Asian population. A meta-analysis determined the Asian upper limit of AET as 3.2%. This study aims to compare Lyon 1.0 and 2.0 consensus compositions and assess the sensitivity and specificity of different AET thresholds in predicting Grade B or above esophagitis.

Methods

Patients with refractory GERD symptoms or considering anti-reflux surgery underwent objective GERD workup, including 24-hour catheter-based or 96-hour wireless ambulatory pH monitoring, High-Resolution Manometry, and upper endoscopy. This retrospective cohort study analyzed patient data from 2011-2023, excluding those with prior anti-reflux surgery, bariatric surgery, or myotomy for achalasia. Patients were categorized based on Lyon Consensus 1.0 and 2.0 as 'Non-GERD,' 'Borderline GERD,' 'Borderline GERD with evidence,' and 'Conclusive GERD.' Sensitivity, specificity, and Area-Under-Curve (AUC) were calculated using AET thresholds of 3.2%, 4%, 6%, and 7.2% to predict Grade B or above esophagitis.

Results

Between July 2011 and August 2023, 257 patients underwent pH monitoring and were included in the analysis, with 247 (93.8%) being ethnic Chinese. The number of patients categorized as conclusive GERD was significantly higher in Lyon 2.0 (134, 52.1%) compared to Lyon 1.0 (109, 42.4%), p < 0.001. Sensitivity and specificity for predicting Grade B or above esophagitis were as follows: AET 3.2% (83.3%, 48.8%), AET 4% (65.3%, 52.4%), AET 6% (73.8%, 66%), AET 7.2% (69.0, 72.1%). AET 7.2% demonstrated the highest AUC of 70.6% (Figure 1). Among patients classified as conclusive GERD, 67 (50%) underwent antireflux surgery.

Conclusion

Using the Asian threshold of AET 3.2% yields the highest sensitivity for detecting Grade B or above esophagitis. Additionally, the AUC is higher compared to using AET 4.0%. However, it is important to note that AET alone should not be the sole parameter for diagnosing actionable GERD, as even with the lowest AET threshold of 3.2%, 16.7% of patients with Grade B or above esophagitis would be missed.
458. THORACOSCOPY VERSUS ENDOSCOPY IN THE TREATMENT OF ESOPHAGEAL LEIOMYOMA: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Zhang Shaoyuan , Geng Zihan , Yang Xinyu , Ren Changhao , Zhou Pinghong , Tan Lijie
Published: September 2024

Background

Esophageal leiomyoma, also called Esophageal Smooth Muscle Tumor (SMT), is one of the most common benign tumors of the esophagus. Surgical treatment is the most widely used method, including thoracic surgery such as thoracotomy, and VATS, and endoscopic surgery such as ESD and STER. We aimed to conduct a retrospective analysis of all esophageal leiomyoma surgeries in our center to assist decision-making in minimally invasive surgery for leiomyomas.

Methods

From January 2015 to September 2023 patients with pathologically diagnosed esophageal leiomyoma at our hospital were retrospectively enrolled. Those who had any pathological malignant component or lack of detailed clinical information were excluded. At the same time, a 1:1 propensity matching analysis was conducted for thoracoscopy and endoscopic surgery. The matching factors included age, gender, tumor location, and size and the caliper was set as 0.2.

Results

Finally, 1376 patients were included, of whom 153 underwent thoracic surgery and 1223 underwent endoscopic treatment. Endoscopic surgeries were mainly composed of ESD (54.5%) and STER (45.5%), with respective proportions, of which 2 cases used thoracoscopic-assisted endoscopic resection. In the surgical group, 131 patients, accounting for 85.6%, underwent thoracoscopic surgery, of which 65 patients (42.5%) used endoscopic-assisted examination during the operation. In terms of operation time, endoscopic resection was shorter than surgical surgery (44.9 ±39.7 versus 109.4 ± 67.9 min, p<0.001). Similarly, for the postoperative hospitalization days, endoscopic resection was shorter than surgical surgery (2.0 [1.0, 3.0] versus 5.0 [3.0, 6.0] days, p<0.001), we also found that the maximum diameter of surgical resection specimens was significantly larger than that of endoscopic surgery (1.3 [0.8, 2.5] versus 5.0 [3.5, 7.0] cm, p <0.001). After PSM, the operation duration (p=0.031) and hospital stay (p<0.001) were still statistically different between the surgical treatment group and the endoscopic group.

Conclusion

Most esophageal leiomyomas can be resected endoscopically, which can shorten the operation duration and hospital stay compared with thoracic surgery. When the maximum diameter of the tumor is too large or near important organs, thoracic surgery should be the first choice. In order to prevent possible esophageal mucosal damage, thoracoscopic surgery combined with intraoperative endoscopy examination is a safe and effective surgical treatment method.
459. DIAPHRAGMATIC RELAXING INCISION IN THE REPAIR OF DIAPHRAGMATIC HERNIA FOLLOWING OESOPHAGECTOMY: A RETROSPECTIVE STUDY
Authors: Bartz Sam , Sosef Meindert Nico , Belgers Drs Eric Henricus Johannes
Published: September 2024

Background

After oesophagectomy diaphragmatic hernia (DH) is a well-known long-term complication. Approximating the crura around the tubular stomach is often challenging, especially in cases with a wide hiatus. This study evaluates a surgical technique involving a relaxing incision.

Methods

This retrospective study included all post-oesophagectomy patients from 2016 to 2023 who underwent repair for diaphragmatic hernia. Primary outcome measures included incidence over time, postoperative complications, recurrence of DH, surgical technique, and length of hospital stay.

Results

13 patients were included, the relaxing incision was 12 times located on the left side and once on the right. All patients experienced symptoms and 81.3% of the patients were males. The median diameter of the hernia was 70 mm (range 65-100 mm), and the median of the surgical duration was 155 minutes. Complications occurred in 2 patients (2 times transient dysphagia). One recurrence was observed 13 months postoperatively, requiring reintervention. The median hospitalization length was 6 days, with 30.8% needing readmission. In Table 1 additional outcomes and characteristics are presented.

Conclusion

As far as known, this is the largest series of patients post-oesophagectomy in whom DH was repaired using a diaphragmatic relaxation incision. The relaxation incision proves to be a safe method for achieving an effective cruraplasty. It is essential for experienced laparoscopic surgeons to be aware of this technique when managing post-oesophagectomy patients.
460. THE ADDITIONAL VALUE OF CERVICAL ULTRASOUND IN THE DETECTION OF CERVICAL LYMPH NODE METASTASES IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Van Doesburg Jasmijn , Schuring N , Vries MHM , Duvivier KM , de Graaf P , Daams F , van Berge Henegouwen MI , Gisbertz SS
Published: September 2024

Background

Esophageal cancer patients with cervical lymph node metastases, staged according to the 8th edition of the American Joint Committee on Cancer (AJCC), are considered to have stage IV disease and are generally not eligible for treatment with curative intent. External cervical ultrasound (US) used to be standard in the diagnostic workup for detection of cervical lymph node metastases in the Netherlands, but is no longer included in the esophageal cancer guideline. This study aimed to assess the additional value of US over 18FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients, to reassure justified removal of cervical US from the guideline.

Methods

This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed to identify patients with suspected cervical lymph node(s). Primary outcome was detection rate of cervical lymph node metastases on ultrasound and/or 18FDG PET-CT. Golden standard was etiology based on Fine Needle Aspiration (FNA).

Results

This study included 768 patients, with a median age of 66 years. Patients were predominantly male (75.0%) and the majority had an adenocarcinoma (71.9%). On 18FDG PET-CT, 77 patients had suspected cervical lymph nodes. Of those, 39 proved malignant. Seven malignant lymph nodes were missed on 18FDG PET-CT. 18FDG PET-CT had a positive predictive value (PPV) of 50.6%, a negative predictive value (NPV) of 99.0%, a sensitivity of 84.8% and a specificity of 94.7%. Based on US alone, 134 patients had suspected cervical lymph nodes. Of those, 45 proved malignant. One malignant lymph node was missed on US. US had a PVV of 33.6%, a NPV of 99.8%, a sensitivity of 97.8% and a specificity of 87.7%. In total, suspected cervical lymph nodes were documented in 151 patients (19.7%). FNA was conducted in 134 out of 151 patients. Of those, 46 proved malignant. No major complications after FNA were reported. For 21 patients, this resulted in stage migration and changed policy from curative intent to palliative.

Conclusion

Standard US increases the number of FNA conducted for benign cervical lymph nodes, as the positive predictive value is low (33.6%). However, it does have an additional value as it identifies 15% of cervical lymph node metastases that were not seen on 18FDG PET-CT.
467. DISTRIBUTION OF LYMPH NODE INVOLVEMENT IN PATIENTS WITH GASTRO-ESOPHAGEAL JUNCTION ADENOCARCINOMA
Authors: Walmsley James , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Tham Ji Chung , Wheatley Tim , Chan David SY
Published: September 2024

Background

Curative cancer surgery relies on understanding the lymphatic spread of the tumour to guide lymphadenectomy. The lymphatic involvement in patients with esophageal squamous cell carcinoma (SCC) has been evaluated extensively in large cohort studies from the East where SCC predominates, but the pattern of lymph node spread in gastro-esophageal junction (GEJ) adenocarcinoma is less clear. The primary aim of this study was to compare differences in the pattern of lymph node involvement according to the Siewert classification.

Methods

Consecutive patients who underwent curative resection for GEJ adenocarcinoma between February 2010 and April 2023 were analysed from a prospectively maintained database. Patient demographic data, neo-adjuvant treatment, operation type and histopathological report data were collected and analysed according to the pathological Siewert classification of GEJ cancer.

Results

807 patients who underwent curative surgery for GEJ adenocarcinoma were analysed. The median lymph node yield was 26 (5-81). Comparing positive para-esophageal node yields, Type I and II tumours were similar but both significantly higher than Type III. For positive para-gastric nodes, Type 2 and 3 tumours were similar but both significantly higher than type 1. The significance of these comparisons is presented in table 1. There were no differences comparing other specific nodal groups.

Evaluating the effect of node involvement on overall survival positive node status and positive hepatic artery nodes were found to be independent factors adversely affecting survival.

Conclusion

Siewert type I tumours have greater proximal lymph node involvement compared to type III tumours with higher proportions of positive para-esophageal nodes. Type III tumours on the other hand have higher proportions of para-gastric nodes. Type II tumours have similar para-esophageal node involvement to type 1 tumours and similar para-gastric involvement to type III tumours. Involvement of more specific nodal groups does not seem to vary between the sub types.
474. SELF EXPANDABLE METAL STENT AS A BRIDGE TO RESECTION IN ESOPHAGEAL CANCER – A NATIONAL REGISTER ANALYSIS ON MORTALITY
Authors: Persson Saga , Rouvelas Ioannis , Edholm David , Lindblad Mats , Nilsson Magnus , Klevebro Fredrik , Tsai Jon
Published: September 2024

Background

Patients with esophageal cancer commonly present with malnutrition and weight loss due to dysphagia.

Self Expandable Metal Stent (SEMS) have been used to relieve dysphagia and optimize nutrition prior to surgery and during neoadjuvant treatment. However, SEMS is associated with various complications and studies have further found a decreased survival in patients preoperatively treated with SEMS. The aim of the study was to investigate whether SEMS as a bridge to resection has an impact on mortality.

Methods

All patients with esophageal cancer in the Swedish National Register for Esophageal and Gastric cancer (NREV) between 2006 and 2018 were included.

Patient data, tumor and treatment characteristics were assessed. Resected patients who received SEMS preoperatively were compared to patients who did not receive SEMS with regard to patient, tumor and treatment characteristics. Overall survival was explored by multivariable Cox regression models and adjusted for age, ASA score, preoperative BMI, clinical T-stage and neoadjuvant chemo- or chemoradiotherapy. Primary outcome was mortality.

Results

In total, 1841 resected patients with esophageal cancer and curative intent were identified. Of these, 83 patients received SEMS as a bridge to resection. T-stage was more advanced in patients with SEMS than those without SEMS, but there was no difference in N-stage, ASA-score or preoperative BMI. Early mortality (<90 days) and total mortality was higher in the SEMS group (12.4% vs 5.3%, p=0.002 and 77.1 % vs 58.2%, p<0.001 respectively. Mean follow-up time was 45 months for the all included patients. SEMS was an independent predictor of earlier death in multivariable analysis (Hazard Ratio 1,710; CI 95% 1,27-2,23; p=<0,001).

Conclusion

SEMS as a bridge to resection in the treatment of esophageal cancer seem to be associated with poor outcome with regard to both early and late mortality.
485. OMENTOPLASTY AS AN ADJUNCT IN ESOPHAGECTOMY
Authors: Thammineedi Subramanyeshwar Rao
Published: September 2024

This video highlights the role of Omentum as a patch on anterior aspect of stomach tube pulled up as an adjunt to repair. It can decrease the chance of air leak and potentially decrease the morbidity.

https://drive.google.com/file/d/1AJPKYbxXX8JsJgqbAEFidOv_9Zbeo568/view?usp=drive_link
487. A RARE CASE OF BRONCHOGENIC CYST ESOPHAGUS
Authors: Vijaya Kumar K , Ramesh K , Parthasarathi R , Palanivelu C
Published: September 2024

Introduction

Bronchogenic cyst is a relatively rare congenital malformation that develops from abnormal budding of the ventral foregut during the early stage of gestation. Histologically, the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands.

Case report

We present a 20 yrs male with chest discomfort during swallowing for 6 months. Evaluated with Upper GI scopy showed smooth mucosal elevation 30-35 cm from incisors. CECT Chest Showed features of Intramural cystic lesion of size 7x7cm.Patient was evaluated and taken up for surgery. Robotic Thoracoscopic cyst excison was done. Intraoperatively 7x7cm cystic lesion in lower esophagus infra carinally. Cyst has no communication with mucosa. Post operatively patient recovered well, Drin removed on 3 rd Post operative day and Patient was discharged on 4 th day. Histopathology showed the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands

https://1drv.ms/v/s!AklfEcoVwf9chCmLN-FSXBA2yV3B
494. DO WE NEED GENDER SPECIFIC GUIDELINES FOR ESOPHAGEAL CANCER MANAGEMENT?
Authors: Abdulrahman Maan , Abdulrahman Rand , Viani-Walsh Dylan , Hashem Jamal , Grogan Liam , O'Niell Brian , Kumar Nitya , Sorensen Jan , Walsh Thomas Noel
Published: September 2024

Background

The incidence of esophageal cancer is disproportionately greater in males, but trials of treatments are not gender stratified. It is unclear whether the response or outcome following neoadjuvant chemoradiotherapy (NCR) is gender specific. This study compared the presentation, response to NCR and outcome of female with male patients. (48)

Methods

A prospectively maintained database of 205 esophageal carcinoma patients treated with curative intent between 1998 and 2019 was interrogated for the impact of gender on presentation, response to NCR treatment and survival. (32 words)

Results

Of 205 patients, 59 (29%) females were significantly older than males [mean (SD) age 66.1 (10.8) v. 61.6 (11.2) (p=0.008)]. Sixty-six percent of females had squamous cell carcinoma (SCC) while 116 (79.5%) males had adenocarcinoma (AC) (<0.001). Females with SCC had a mean age 66.7 years versus 58.9 years for males (p=0.006). Seventy-eight percent of females had a clinical complete response (cCR), versus 43.8% of males (P<0.001). Sixty-nine percent of females with AC had a cCR versus 39% of males (p=0.04). Controlling for age, diagnostic stage and treatment type, females survived significantly longer than males [HR 0.71 CI 0.52-0.98 (p=0.035)]. (100 words)

Conclusion

This study found that females were on average a decade older with a significantly greater cCR rate, and a superior survival advantage compared to males. This suggests that randomized trials should stratify for gender. (35 words)
501. CLINICAL APPLICATION OF OESOPHAGEAL CELL COLLECTION DEVICE AND BIOMARKER TESTING IN SYMPTOMATIC REFLUX DISEASE: A NATIONAL RETROSPECTIVE COHORT STUDY
Authors: Chien Siobhan , Glen Paul , Bryce Gavin , Cruickshank Neil , Penman Ian , Robertson Kevin , Phull Perminder , Crumley Andrew , Gunjaca Ivan , Apollos Jeyakumar , Miller Michael , Fletcher Jonathan , Fullarton Grant
Published: September 2024

Background

Oesophageal cell collection device (OCCD) and biomarker testing was implemented nationally across Scotland in 2020 following the COVID-19 pandemic for symptomatic reflux patients referred to secondary care. Collected cells undergo biomarker testing for the presence of trefoil factor 3 (TFF3), an indicator of intestinal metaplasia (IM), in addition to atypia and p53. This national retrospective cohort study is the first to evaluate the clinical application of OCCD testing in symptomatic reflux patients and aims to assess whether OCCD and biomarker testing can safely be used as a triage tool for upper gastrointestinal (UGI) endoscopy in this cohort within secondary care.

Methods

Over a 32-month period, all patients undergoing OCCD testing with Cytosponge™ for investigation of reflux symptoms across 11 Scottish health boards were identified from prospectively maintained databases. In addition to OCCD testing, all patients also underwent clinical assessment either by UGI specialist nurses or consultants in secondary care. Individual patient records were interrogated to collect baseline demographics, OCCD test result and ongoing clinical management. Further analysis was performed on patients who subsequently underwent UGI endoscopy. All OCCD tests for Barrett’s surveillance were excluded from analysis.

Results

1385 OCCD tests were performed for reflux symptoms in 1305 patients. 1103/1385 tests (79.6%) were TFF3 negative: 912/1305 (69.9%) patients discharged with no additional investigations. 355/1305 patients (27.2%) subsequently underwent UGI endoscopy. When insufficient tests with missing biomarker data were excluded, 50/314 patients (15.9%) had biopsies demonstrating IM: biomarkers were significantly more likely to be positive in this group (35.5% vs. 3.2%, p<0.001) (Table 1). 10/1103 patients with a TFF3 negative result (0.9%) had biopsies showing IM, dysplasia or malignancy. 1 patient had a TFF3 negative result but was diagnosed with oesophageal adenocarcinoma 27 months later.

Conclusion

OCCD and biomarker testing is effectively identifying those symptomatic reflux patients requiring further investigation with UGI endoscopy within the real-world setting. Biomarker testing is clearly aiding the diagnosis of Barrett’s oesophagus within this patient cohort. However, clinical assessment remains crucial to identify those with red flag symptoms and judicious follow-up of the discharged group will be critical to validate the ongoing use of OCCD testing in the long-term.
502. COMPARING NEOADJUVANT TREATMENTS REGARDING DYSPHAGIA AND WEIGHT CHANGES FOR PATIENTS WITH OESOPHAGEAL OR GASTRO OESOPHAGEAL CANCER
Authors: Ericson Jessica , Klevebro Fredrik , Sunde Berit
Published: September 2024

Background

Dysphagia is the main symptom for patients diagnosed with cancer in the oesophagus or gastro oesophageal junction (GOJ), but there are lack of recent studies confirming this. Several studies have reported relief of dysphagia during neoadjuvant treatment but there might also be side effects affecting nutritional status resulting in weight loss. We wanted to investigate if there are differences between the mainly used neoadjuvant treatments in Sweden today, namely CROSS, FLOT, and other treatments (OT), for example prolonged neoadjuvant treatment due to oligometastatic cancer. Aims of this study was to investigate dysphagia, weight changes, and main causes of healthcare referral.

Methods

All patients with cancer in the oesophagus or GEJ receiving neoadjuvant treatment followed by subsequent oesophagectomy at Karolinska University hospital in Stockholm, Sweden January 2017 to June 2022 were included in the study. Data were extracted from the local prospective database and the electronic medical records.

To grade the severity of dysphagia we used the five graded Ogilvie score. The weight as well as the dysphagia score was evaluated before oncological treatment and before surgery. The patients were divided into three groups, them receiving CROSS, FLOT and OT, respectively.

Results

There were 69 patients receiving CROSS, 68 receiving FLOT and 28 receiving OT.

The patients experienced relief of dysphagia in all groups, CROSS p<0.001, FLOT p<0.001 and OT p<0.001.

Patients receiving CROSS lost 1.32 kg weight (-8.5 kg to 6.4 kg), while those receiving FLOT gained 0.08 kg (-5.5 kg to 11.1 kg) and OT lost 0.49 kg (-20 kg to 8 kg).

Dysphagia was the main symptom for patients diagnosed with oesophageal cancer or GEJ (65%), other causes (9%), followed by anaemia (8 %), reflux (6%), pain (6%) and au passant (5%).

Conclusion

All groups experienced statistically significant relief of dysphagia during the neoadjuvant treatments. There were small differences in weight changes between the treatment groups, although patients undergoing chemoradiotherapy treatment lost more weight compared to those only receiving chemotherapy. Main cause of referral is dysphagia.

Key words

Oesophageal cancer, neoadjuvant therapy, dysphagia, weight