bluuebunny/crossref_metadata_2025 huggingface dataset:
PS01.149: APPLICATION OF SINGLE-PORT VIDEO-ASSISTED THORACOSCOPE IN TREATING THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA USING MCKEOWN APPROACH
Authors: Lv Qiang
Published: September 2018

Background

This study aims to investigate the feasibility of single-port video-assisted thoracoscope (SPVATS) in treating thoracic esophageal squamous cell carcinoma (TESCC) using McKeown approach.

Methods

METHODS: 25 McKeown approach-based SPVATS surgeries (19 males and 6 females, aged 42–70years) were carried out from January 2015 to December 2017 to treat TESCC.

Results

RESULTS: All the patients were successfully completed SPVATS, with average thoracic surgery time as 150 min, intraoperative blood loss as 30–260 ml (average 90 ml), and postoperative hospital stay as 9–16d (average 12d).

Conclusion

SPVATS was technically feasible and safe in treating TESCC using McKeown approach, with less trauma and rapid postoperative recovery, so it could be used as a new surgical option for McKeown approach-based TESCC treatment.

Disclosure

All authors have declared no conflicts of interest.
PS01.150: NEW METHOD OF ESOPHAGO-GASTRO ANASTOMOSIS AFTER ESOPHAGECTOMY
Authors: Usenko Oleksandr , Sydiuk Andrii , Mazur Andriy , Klimas Andrii , Sydiuk Olena
Published: September 2018

Background

Medical science has introduced a lot of innovations and advanced equipment since the first esophagectomy was performed, nevertheless surgeons still continue to discuss benefits of certain methods and suggest changes to them because mortality and post-operative complications after esophagus resection remain high. The choice of the surgical approach, anastomosis location and its variety, conduit location and its variety, the volume of lymph node dissection and the use of minimally invasive present the most important and complex issues for surgeons.

Methods

The research included 40 patients who were given Lewis surgery for malignant tumors of esophagus in Shalimov's National Institute of Surgery and Transplantation: Control group comprised 20 patients who were given Lewis surgery involving end-to-side classical mechanical EGA through a circular suturing tool.; Research group comprised 20 patients who were given Lewis surgery involving invaginated mechanical EGA. (image 1).

The objects for estimation included post-operative mortality as well as the number of post-operative anastomosis complications: the number of EGA leakages in the early post-operative period and the number of post operative strictures in the EGA area three months after the surgery. Data processing was done by means of Statistic—licensed application programs for Windows. Differences were considered valid if р < 0,05.

Results

Research group did not register a single case of EGA leakage while one patient in control group (р < 0,05). had the leakage which was stopped by means of ‘Endovac’ system. There were 2 cases of esophagus post-operative strictures which developed 3 months after the surgery in the research group which was less than in the control group which saw 6 cases of strictures of EGA (р < 0,05). Neither of the groups had any cases of post-operative mortality.

Conclusion

Our results allows us to conclude that invaginated mechanical EGA within Lewis surgery reduces post-operative complications of anastomosis in patients with esophagectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.151: STRATEGY FOR TREATMENT OF ADENOCARCINOMA IN THE ESOPHAGO-GASTRIC JUNCTION (SIEWERT TYPE II)
Authors: Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Maeda Shinsuke , Toyoshima Yukinori , Ogawa Kyohei , Ide Hiroko , Osugi Harushi , Yamamoto Masakazu
Published: September 2018

Background

Incidence of adenocarcinoma of the esophagogastric junction is increasing in Japan as Europe or America. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection according to lymph node metastasis status in adenocarcinoma of the esophagogastric junction

Methods

We investigated 75 patients who were diagnosed with advanced adenocarcinoma(A) of the esophagogastric junction and 22 patients were diagnosed with early adenocarcinoma(B).

Results

(1) Location(EG: E = G: GE: G) A = 37:20:17:1 B = 5:4:13(2)The depth of tumor (m2: m3: sm1: sm2: sm3: T2: T3: T4) = 1:6:2:10:3:13:59:3)(3) Degree of lymph node metastasis(n + : n-) A = 49:26 B = 4:18 (4) Surgical approach (Right thoracotomy:Left thoracoabdominal incision:Laparotomy (Transhiatal approach) A = 13:47:15 B = 1:5:16 (5) Neoadjuvant therapy (Chemotherapy before operation:Chemo-radiotherapy before operation:Chemotherapy after operation:Chemo-radiotherapy after operation) A = 1:12:33:1 B were without neoadjuvant therapy (6) Lymph node metastasis (Number of metastasis of lymphnode/Area of the dissection of lymphnode) Cervical: Upper thoracic: Middle: Lower: abdominal A = (1/7, 2/13, 4/31, 15/62, 46/75) B = (0/1, 0/3, 0/8, 4/22) (7) Type of the recurrence (Cervical Lymph node: mediastainal lymphnode: abdominal lymphnode: dissemination: Liver: Lung: Born: Remunant esophagus: Skin: Brain: Other disease) A = (3:8:6:13:9:4:2:1:1:1) B = (0:0:0:0:1:0:1:0:0:0:3) (8) Index (metastatic rate x3-yearOS/100)A = No1: No2: No3: No.7: No11: No20: No110: No112 = 12.1:10.6:12.9:13.5:18.1:50:12.9:9.09 B were not showed because incidence of metastasis of the lymph node were low.(9) 5-years survival rate for advanced cancer was 38% and early cancer was 88%

Conclusion

Proximal gastrectomy may be a minimally invasive surgical technique in for early and advanced adenocarcinoma of the esophagogastric junction according to the lymph node metastasis status. Surgical resection has been mainstream treatment but It was necessary to perform definitive or neoadjuvant chemoradiotherapy.

Disclosure

All authors have declared no conflicts of interest.
PS01.154: COULD POSITIVE RECURRENT LARYNGEAL NERVE LYMPH NODES BE AN INDICATOR TO CERVICAL LYMPHADENECTOMY IN THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS?
Authors: Wang Hai-Jun , Fang Qiang , Peng Lin , Han Yongtao
Published: September 2018

Background

As three-field lymphadenectomy for esophageal carcinoma is one of the most invasive operations, this procedure should be selected only when strictly indicated.Unfortunately, there are no useful criteria for it at present. In this study, we retrospectively examine the correlation between recurrent laryngeal nerve lymph nodes(RLN) and cervical lymph nodes(CLN) metastasis.

Methods

We reviewed the outcomes between recurrent laryngeal nerve lymph nodes(RLN) and cervical lymph nodes(CLN) metastasis for patients with squamous cell carcinoma of the thoracic esophagus(ESCC) from our institution. One hundred and thirty-five patients who underwent curative esophagectomy with three-field dissection for ESCC were enrolled in this study. The relationship between RLN involvement and CLN metastasis was examined.

Results

One hundred and thirty-five patients met the inclusion criteria. The overall rate of CLN metastasis was 36.3% for all patients and was 46.9%, 25.6%, and 6.7% for patients with upper, middle, and lower thoracic esophageal tumors, respectively (P = 0.003). The overall rate of RLN metastasis was 53.3%. The rate of CLN metastasis for all patients with or without CLN involvement were 44.4% and27.0% (P = 0.036.The positive predictive value, negative predictive value, sensitivity, and specificity of RLN as the sentinel nodes to predict the CLN metastasis were 65.3%,53.5%,44.4% and 73.0%, respectively.

Conclusion

We concluded that the recurrent nerve nodal alone should not be regarded as the criteria for cervical lymph nodes dissection.

Disclosure

All authors have declared no conflicts of interest.
PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Zhang Xiaobin , Li Zhigang
Published: September 2018

Background

The minimally invasive esophagectomy (MIE) has been developed in the past three decades. In our institution, the MIE was first introduced in 2012, and the proportion of MIE was used for over 70% in 2016–2017. This study aimed to compare the postoperative recovery outcomes between MIE and open esophagectomy in different period.

Methods

A total of 725 patients were enrolled in this study including 248 patients who underwent open esophagectomy within 2012–2013 and 477 patients who underwent MIE within 2016–2017. All patients received McKeown esophagectomy with two-field lymphadenectomy. And the perioperative complications were recorded according to the Esophagectomy Complications Consensus Group (ECCG) complication definitions.

Results

There was no statistically difference between OPEN and MIE groups with regard to preoperative characters except for age (60.8 ± 7.2 vs. 62.7 ± 7.7, P < 0.001) and body mass index (22.4 ± 3.0 vs. 23.1 ± 3.0, P = 0.002). One (0.2%) patient in the MIE group died within 90 days from anastomotic leakage, compared to 6 (2.4%) patients in the OPEN group (P = 0.004). The length of hospital stay was shorter in the MIE group (11 range 6–131 days, vs. 15 range 9–164 days, P < 0.001). The MIE group was in favor of lower complications (32.3% vs. 46.4%, P < 0.001). Pneumonia was the most common complications in both groups (12.6% in MIE vs. 27.4% in OPEN, P < 0.001). 15 (3.1%) patients in the MIE group experienced atrial arrhythmias compared with 30 (12.1%) in the OPEN group (P < 0.001). Lower anastomotic leakage was noted in the MIE group (11.5% vs. 25.4%, P < 0.001), as well as the wound infection (0.2% vs. 2.8%, P = 0.001), than in the OPEN group. The recurrent nerve injury was higher in the MIE group (11.7% vs. 6.5%, P = 0.024) but with more lymph nodes dissection along the recurrent laryngeal nerve (3.8 ± 2.8 vs. 1.4 ± 2.0, P < 0.001).

Conclusion

The MIE was associated with better postoperative recovery outcomes and lower mortality. MIE technique should be considered as the mainstay surgical treatment for esophageal cancer in the current and future period.

Disclosure

All authors have declared no conflicts of interest.
PS01.161: THE VERRUCOUS CARCINOMA OF THE ESOPHAGUS: A RARE HIGHLY DIFFERENTIATED SQUAMOUS CELL CARCINOMA
Authors: Gehwolf Philipp , Oberhuber Georg , Schmid Thomas , Öfner-Velano Dietmar , Wykypiel Heinz
Published: September 2018

Background

The verrucous carcinoma of the esophagus is a rare, very slowly growing and uncommonly metastasizing locally progressive and highly differentiated squamous cell carcinoma. The genesis of the tumor is not completely clarified but often associated with human papilloma virus or chemical toxic exposure of the mucosa. On endoscopy it appears as an exophytic, villous, with whitish hyperkeratosis, endosonographically pretending a uT3N + situation. Patients often present with dysphagia and unspecific reflux symptoms. Often several biopsies of the tumor are needed to make the diagnosis, because few routinely taken standard biopsies often show unspecific inflammation or mycotic Infections. However, the carcinoma is subjacent. Diseases on rare occasions often need extensive diagnostics, therefore we want to cal in mind the verrucous carcinoma of the esophagus.

Methods

Small case series in a single center patient collective.

Results

From 2010 to 2017, 55 patients underwent an esophageal resection. In two patients (3,6%) a verrucous carcinoma was diagnosed. That is far more often than expected.

Conclusion

In patients with dysphagia and macroscopic villous structure on endoscopy, further samples should be taken despite benign primary histology and a reference pathologist should be involved.

Disclosure

All authors have declared no conflicts of interest.
PS01.164: NEUROENDOCRINE CARCINOMA OF THE ESOPHAGUS: AN ANALYSIS OF 72 COHORT PATIENTS SURGICALLY TREATED FROM A SINGLE CHINESE MEDICAL CENTER
Authors: Deng Han-Yu , Lin Yidan
Published: September 2018

Background

Esophageal neuroendocrine carcinoma (NEC) is a rare malignant tumor, and it is rarely reported in large cohort studies. Therefore, the prognostic factors of esophageal NEC were not well established. In this study, we tried to analyse a large cohort of esophageal NEC patients aiming to investigate its possible prognostic factors.

Methods

Patients who underwent esophagectomy for esophageal NEC in our department from January 2007 to June 2015 were identified and analyzed. Both univariate and multivariate analyses were applied to identify potential prognostic factors.

Results

A total of 72 patients were identified for analysis. After a median follow-up time of 54.8 months, the median survival time of those patients was 21.5 months. One-year, three year, and five-year survival rates were for all those patients were 75.0%, 33.4%, and 28.4% respectively. In the univariate analysis, TNM stage (P = 0.001), lymph node metastasis (P = 0.008), and adjuvant therapy (P = 0.001) were found to significantly influence the overall survival time of those patients; while in multivariate analysis, only TNM stage (P = 0.018) and adjuvant therapy (P = 0.002) were found to be independent prognostic factors.

Conclusion

Esophageal NEC was extremely rare with poor prognosis. TNM stage and adjuvant therapy are the independent prognostic factors of esophageal NEC.

Disclosure

All authors have declared no conflicts of interest.
PS01.172: A NOVEL VALGUS NESTED RING ANASTOMAT AND ITS APPLICATION IN ESOPHAGUS SURGERY
Authors: He Wenwu , Han Yongtao , Lin Peng
Published: September 2018

Description

Here we introduce our patent (A novel valgus nested ring anastomat and its application in esophagus surgery, patent number: 201,610,968,664.6, ZL201621191883.X), it is different from our usual stapler, we think it can reduce the occurrence of anastomotic bleeding, fistula, stenosis, and its application can achieve rapid recovery after surgery.

Disclosure

All authors have declared no conflicts of interest.
PS01.177: ERAS HYBRID IVOR LEWIS ESOPHAGECTOMY
Authors: Zacherl Johannes , Albinni Said , Radlspöck Wolfgang , Kertesz Viktoria , Lechmann Andrea , Platter Thomas , Vavrovsky Gerhard , Öhler Leopold
Published: September 2018

Background

We introduced a multiprofessional fast track programme in esophagectomy in order to increase surgical safety and to reduce the perioperative burden to the patient.

Methods

Consecutive patients scheduled for oncological Hybrid Ivor Lewis (HIL) procedure were included. An adapted ERAS protocol beginning from the process of preoperative risk estimation involving internists, oncologists, physiotherapists, psychologists, dietricians, surgeons and anesthesiologists to make patients fit for surgery. In locally advanced tumor stages neoadjuvant treatment was adopted according to interdisciplinary consensus. Perioperative measures were undertaken to enhance recovery and to reduce morbidity by an adopted ERAS protocol. Parameters regarding surgical safety, oncological quality of surgery, duration of hospital stay, unplanned readmissions and survival were recorded.

Results

Since 2014 94 patients underwent esophageal resection. Among them 80 had an Ivor Lewis procedure, 69 patients (female, 16; mean age, 66a) underwent HIL for cancer. The majority received neoadjuvant treatment before HIL (chemotherapy, 47; radiochemotherapy, 10). R-0 rate was 92,8%, mean number of examined lymphnodes was 33,5. Major morbidity (Clavien-Dindo III-V) occurred in 13,04%, anastomotic leaks in 7,2%, 8 (11,6%) patients underwent redo surgery. 6 (8,7%) patients needed prolonged mechanical ventilation. Hospital, 30d- and 90d-mortality was 2.9, 2.9 and 4,3%, respectively. Median hospital stay was 12 days (8–57) in all patients and 26 days (14–57) in patients with major morbidity. Unplanned readmission occurred in 7,2%. Overall, ERAS protocol was fulfilled in 66,7% of cases. Estimated 2-year overall survival is 82%.

Conclusion

Adopting an ERAS protocol with dedicated interprofessional perioperative care operative safety compares favourably with other reports. Performing the abdominal part endoscopically does not impair surrogate parameters of oncological quality. However, length of hospital stay seems to be optimizable.

Disclosure

All authors have declared no conflicts of interest.
PS01.178: ANALYSIS OF SURGICAL OUTCOME OF COMBINED RESECTION OF ADJACENT ORGANS IN ESOPHAGEAL CANCER
Authors: Tanaka Koji , Yamasaki Makoto , Makino Tomoki , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro
Published: September 2018

Background

If the cancer remains after chemotherapy or chemoradiotherapy for cT4b esophageal cancer, curative resection is sometimes performed. In cases where T4 is not released, combined resection of adjacent organs is necessary for R0 resection. But its significance is controversial. The aim of this study is to examine the significance of combined resection of adjuacent organs for T4 esophageal cancer.

Methods

Of the 209 patients who were diagnosed as cT4b esophageal cancer finally resected from 2000 to 2015, the relationship between clinicopathological factors and prognosis was retrospectively analyzed in 32 patients who underwent combined resection of T4 adjuacent organs.

Results

Preoperative factors: Ce/Ut/Mt/Lt = 10/14/6/2, cN Yes/No = 29/4, cM Yes/No = 7/25, preoperative treatment Yes/No = 32/0, type of preoperative treatment: chemotherapy/chemotherapy + CRT/CRT = 11/11/10, clinical response: responder/nonresponder = 22/10, T4 Organ: airway (trachea, bronchus)/blood vessel (aorta, large vessel)/gastrointestinal (pancreas, liver) = 28/2/2. Organ of ombined resection: airway/blood vessel/airway + blood vessel/digestive organ = 21/7/1/4. Postoperative factors: pT: 0/3/4 = 4/11/17. pN: 0/1–3 = 9/23, pM: 0/1 = 25/7. The 3-year overall survival rate (3yOS) of 32 patients was 31.2%. Preoperative treatment clinical effect: 3yos of responder/nonresponder = 47.8%/0%, which was significantly better in the responder(P = 0.013). Resection of respiratory tract: 3yos of yes/no = 27.3%/45.7%, (P = 0.071). There was no significant difference in prognosis regardless of cN, cM and pN status. 3yOS of pM 0/1 = 40.7%/0% (P = 0.030) and was significantly better in pM0. Multivariate analysis of OS revealed that the therapeutic effects (OR: 3.49, P = 0.040), resection of the trachea (OR: 3.10, P = 0.017) were independent prognostic factors.

Conclusion

Even in ct4b cases of combined resection of adjacent oragan, the 3-year survival rate was relatively good. However, the prognosis of cases with poor preoperative therapeutic effect and cases with tracheal complication were poor. It seems necessary to judge surgical indication carefully.

Disclosure

All authors have declared no conflicts of interest.
PS01.180: IMPACT OF INTRAOPERATIVE FLUID MANAGEMENT ON POSTOPERATIVE CARDIOPULMONARY FUNCTION AFTER THORACIC ESOPHAGECTOMY: A RETROSPECTIVE COHORT STUDY
Authors: Kobayashi Makoto
Published: September 2018

Background

This study aims to investigate the impact of intraoperative infusion balance on postoperative hemodynamics and oxygenation in patients undergoing elective transthoracic esophagectomy. Although adequate volume control is often deemed imperative to reduce complications, definitions of practical infusion dosages for the fluid management during surgery are absent.

Methods

In this retrospective cohort study, we examined 200 patients who underwent transthoracic esophagectomy from 2008 to 2017. During anesthesia, we followed our protocol that recommends the infusion volume of 10 mL/kg/h. Postoperatively, we followed the postoperative fluid protocol (Kobayashi M. Dis Esophagus 2010 23:565–71). Then, we collected data on actual volume of water infused both intraoperatively and postoperatively, and also evaluated ratios of intrapulmonary shunting (Qs/Qt), the occurrence of hypotension, the necessity of fluid resuscitation, and postoperative complications.

Results

In this study, postoperative hypotension was more frequent in patients who required more amount of fluid during surgery than the amount anticipated per the protocol. In addition, we determined a correlation of the amount of fluid volume between during surgery and postoperative day 0 (P = 0.001)(Fig.1a). Notably, an increased amount of intraoperative fluid did not deteriorate Qs/Qt (Fig.1b) or elevate the risk of postoperative complications.

Conclusion

This study deduces that higher increase in the intraoperative infusion volume could predict postoperative variation in the circulation after esophagectomy. In addition, although postoperative hypotension readily caused more infused volume than the expected balance, overdosed infusion in POD 0 demonstrated no apparent correlation with the impairment of pulmonary function.

Disclosure

All authors have declared no conflicts of interest.
PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD
Authors: Ujiie Naoto , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Okamoto Hiroshi , Maruyama Shota , Onodera Yu , Kamei Takashi
Published: September 2018

Background

Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma.

Methods

All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups.

Results

In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605).

Conclusion

Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy.

Disclosure

All authors have declared no conflicts of interest.
PS01.185: STATUS OF SUBCARINAL LYMPH NODE METASTASIS AND DISSECTION STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA
Authors: Chen Long-Qi , Wang Yun-Cang , Deng Han-Yu
Published: September 2018

Background

The subcarinal lymph node metastasis, although with the debate whether it is a characteristic of lung cancer or esophageal cancer, is prevalent in esophageal carcinoma, and with the incidence of 4.1%-17.5% according to some estimates. The aim of this study is to assess the pattern of subcarinal lymph node metastasis and the dissection strategy for thoracic esophageal carcinoma.

Methods

A large cohort, retrospective study was conducted on 596 patients with thoracic esophageal carcinoma treated from July 2008 to December 2010. The metastasis rate of subcarinal lymph node was investigated. Survival of patients treated by different dissection strategies was compared. The effectiveness index was used to assess the outcome of subcarinal lymph node dissection.

Results

Of 596 patients, 447 had documented subcarinal lymph node dissection (75.0%). According to whether the subcarinal lymph node was harvested or not, they were divided into two groups: dissection group (n = 447) and non-dissection group (n = 149). Their 5-year survival rates were 48.3 ± 1.7 months for dissection group vs. 38.1 ± 2.8 months for non-dissection group (P < 0.001). The overall subcarinal node metastasis rate in the dissection group was 12.5% (56/447). Based on the status of subcarinal nodes, there was a significant difference in survival, 52.3 ± 1.8 months with negative nodes (n = 391) compared to 19.9 ± 2.2 months for those with positive nodes (n = 56) (P < 0.001). Subgroup analysis was further conducted for the positive subcarinal nodes patients. The metastasis rates in patients with upper, middle and lower esophageal cancer were 5.4%, 15.1% and 10.1%, respectively (P < 0.05 for comparison between patients with upper and other segments). The effectiveness indices for these three groups of patients were as 0%, 4.8% and 27.2%, respectively. The metastasis rates for T0, T1, T2, T3 and T4 esophageal carcinoma were 0%, 0%, 3.5%, 10.7% and 19.0%, respectively (P < 0.05 for comparison between T0/T1/T2 and T3/T4 tumors.

Conclusion

Thoracic esophageal carcinoma has a high incidence of subcarinal lymph node metastasis, especially among those with middle and lower esophageal cancer, and for deeper invaded tumors. Therefore, for middle and lower esophageal tumors, subcarinal lymph node dissection is necessary, whereas for T1/2 upper esophageal tumors, subcarinal lymph node dissection can be spared from subcarinal lymph node dissection.

Disclosure

All authors have declared no conflicts of interest.
PS01.192: ROUTINE CHEST X-RAY AFTER REMOVAL OF CHEST TUBES IS NOT NECESSARY DURING THE POSTOPERATIVE COURSE OF ESOPHAGECTOMY
Authors: Kingma Berend , Marges Onno , Van Hillegersberg Richard , Ruurda Jelle
Published: September 2018

Background

Chest X-rays (CXRs) are commonly performed after removing chest tubes post-esophagectomy. However, literature on cardiopulmonary surgical patients suggests that a CXR might safely be reserved for patients who develop clinical respiratory signs or symptoms. Omitting unnecessary CXRs can save costs, radiation exposure, and logistic challenges, which aids the optimization of the postoperative care pathway. Therefore, the aim of this study was to investigate the clinical relevance of routinely performing a CXR after chest tube removal following esophagectomy.

Methods

A single-center prospectively maintained database was used to select all patients who underwent esophagectomy with gastric conduit reconstruction between 2015 and 2017. Patients who received a routine CXR 4 hours after removal of at least one chest tube or thoracic Jackson-Pratt drain were included. The radiological reports of routine CXRs were retrospectively evaluated for mentioning of intrapleural air or fluid. Cases requiring re-insertion of a chest tube on the day of routine CXR or the day afterwards were identified. Furthermore, the patients’ vital parameters were retrospectively reviewed from clinical documentation.

Results

Some 118 patients were included and esophagectomy was performed by a minimally invasive transthoracic (78%), an open transthoracic (14%), or a minimally invasive transhiatal (8%) approach. A total of 231 routine CXRs were performed after the removal of chest tubes (70%) and Jackson-Pratt drains (30%). Intrapleural air was found in 78 cases (34%) and was a new finding ipsilateral to previous chest tube or drain removal in 33 cases (14%). Intrapleural fluid was mentioned in 87 cases (38), which was new and ipsilateral to previous chest tube or drain removal in 24 cases (10%). Re-insertion of a chest tube was performed in 7 cases (3%). The routine CXR prior to chest tube re-insertion had shown intrapleural air (n = 3, 1%), intrapleural fluid (n = 2, 1%), or no abnormalities (n = 2, 1%). Clinical respiratory signs or symptoms (i.e. anamnestic dyspnea, an increased respiratory rate, dropping saturation levels, or need for oxygen support) occurred in all 7 patients who required chest tube re-insertion.

Conclusion

In conclusion, clinical respiratory signs or symptoms can safely guide the decision on whether to perform a CXR after chest tube or drain removal.

Disclosure

All authors have declared no conflicts of interest.
PS01.195: UNCOMPLICATED GASTRIC CONDUIT FOR ESOPHAGEAL REPLACEMENT
Authors: Perwaiz Azhar , Kapoor Deeksha , Singh Amanjeet , Chaudhary Adarsh
Published: September 2018

Background

Stomach is the most common conduit used for esophageal replacement. An properly constructed conduit is of paramount importance to success of the surgical procedure. We share our method (power point presentation) of creating gastric conduit with good results.

Methods

Standarized surgical technique (power point presentation) applied over last 50 consecutive esophagectomy for carcinoma esophagus during March 2016 and September 2017 in our institution by a single surgen and the surgical results were analysed. The primary end points were anastomotic leak, conduit necrosis and the secondary end points were need for anastomotic or pyloric dilatation.

Results

Radical esophagectomy for carcinoma esophagus with gastric pull up and neck anastomosis were performed in all (n = 50, male; 39, female;11, mean age of 51.3 + -11.2 years). There were 41 hybrid (thoracoscopy and laparotomy) and 9 total thoracolaparoscopic procedure. There were 0% anastomotic leak or conduit necrosis and at follow up of 3 months there were only 2 cases who needed anastomotic dilatation and none required pyloric dilatation.

Conclusion

Surgical complication related to the conduit can be minimised by standarising the surgical technique of its creation.

Disclosure

All authors have declared no conflicts of interest.
PS01.201: A CASE OF GASTRO-STERNAL FISTULA OF GASTRIC TUBE AFTER ESOPHAGECTOMY: A CASE REPORT
Authors: Kato Daiki , Yamada Kazuhiko , Soma Daisuke , Nohara Kyoko , Yamashita Satoshi , Kataoka Atsuko , Wake Hitomi , Yokoi Chizu , Kokudo Norihiro
Published: September 2018

Background

Peptic ulcer occurring in the gastric tube after esophagectomy sometimes penetrates into the mediastinal structures. We reported a case of sternal penetration of gastric tube ulcer successfully treated.

Methods

A CASE REPORT:

Results

A 73-years-old man who had undergone video-assisted thracoscopic esophagectomy (VATS) with 3-field lymphadenectomy reconstructed by retrosternal route after neoadjuvant chemo-radiation therapy. He visited outpatient complaining mild pain and redness of skin on anterior chest wall after 7 months of esophagectomy. Computed tomography (CT) revealed gastric tube ulcer penetrated into sternum. Upper GI endoscopy showed active ulcer in lower gastric tube. Biopsy was confirmed no malignant cell but bone tissues. He was admitted and started medication of proton pomp inhibiter and nutritional therapy. After 1 month he was improved symptoms and endoscopic findings.

Conclusion

There was a rare case of penetration into sternum due to gastric tube ulcer. In the literatures, 4 cases were reported about penetration into sternum. All four cases had symptoms of pain and redness of skin and were diagnosed with upper GI endoscopy and CT. Two cases underwent surgery and another cases were treated conservational therapy.

Disclosure

All authors have declared no conflicts of interest.
PS01.204: ANASTOMOTIC LEAKS AFTER IVOR-LEWIS ESOPHAGECTOMY: INDOCYANINE GREEN NEAR-INFRERED ANGIOGRAPHY FOR GASTRIC CONDUIT BLOOD SUPPLY EVALUATION
Authors: Parise Paolo , Cossu Andrea , Garutti Leonardo , Puccetti Francesco , Elmore Ugo , Rosati Riccardo
Published: September 2018

Background

Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer.

Methods

This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed.

Results

Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes.

Conclusion

Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited.

Disclosure

All authors have declared no conflicts of interest.
PS01.210: VIDEO-ASSISTED SALVAGE ESOPHAGECTOMY: SHORT- AND LONG-TERM OUTCOMES
Authors: Shichinohe Toshiaki , Murakami Soichi , Ebihara Yuma , Kurashima Yo , Hirano Satoshi
Published: September 2018

Background

Salvage surgery is only one therapeutic option which enable to cure intractable esophageal cancer after definitive chemo-radiotherapy. Although video-assisted esophagectomy (VAE) is now widely accepted as a standard operation for primary esophageal cancer, the application of VAE to salvage surgery is still controversial since salvage surgery is known as high-risk operation. In this study, we investigated 27 cases of salvage surgery and assessed the feasibility of the operation by analyzing their short and long-term outcomes.

Methods

VAE was applied to 26 cases and laparoscopic lymphadenectomy was applied to 1 case. The procedure of the VAE included prone position esophagectomy (n = 8), esophagectomy by hand-assisted thoracoscopic surgery (n = 10) and mediastinoscope-assisted transhiatal esophagectomy (n = 5). Our current operative procedure after year 2010 is PPE. The fields of lymph node dissection for salvage esophagectomy have been limited to the stations that had metastasis before CRT and the lymphatic stations which newly recognized as suspected metastasis. Postoperative complications were defined according to the Clavien-Dindo classification.

Results

Video assisted surgery was applied to 96% of patients including one case of laparoscopic abdominal lymphadenectomy. One case required open surgery for suspicious of direct invasion of tumor. R0 rate of the operations was scored 78%. Postoperative complication rate defined as ≥ C-D II plus any grade of anastomotic leakage and recurrent laryngeal nerve palsy was 63%. The rate of anastomotic leakage, respiratory complication, and RLN palsy were 23%, 15%, and 12%, respectively. Operative death was 0%, whereas in-hospital mortality was 3.7%. Overall survival of esophagectomy cases showed 24% in 3-year and 8% in 5-year. According to subgroup analysis by pathological R status after operation, the survival outcomes of pR0 group (n = 20) reached 32% in 3-year and 10% in 5-year OS, whereas no patient reached 3-year survival in pR1/2 group (n = 6; P = 0.02).

Conclusion

Although salvage VAE should be applied in high-experienced institutions under the careful consideration of indication, it appears to be balanced operation for safety, and less invasiveness, as well as curability.

Disclosure

All authors have declared no conflicts of interest.
PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION
Authors: Shanmuganathan Kanatheepan , Akitikori Temisanren , Soile Oluwasunmisola , Hussain Aadil , Farhangmehr Neda , Sdralis Elias , Lorenzi Bruno , Charalabopoulos Alexandros
Published: September 2018

Background

Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis.

Methods

A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04.

Results

Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis.

Conclusion

In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures.

Disclosure

All authors have declared no conflicts of interest.
PS01.214: METASTATIC YIELD OF SUPERIOR MEDIASTINAL LYMPHADENECTOMY AND ASSOCIATION WITH PET IN INTRATHORACIC OESOPHAGEAL CARCINOMA TREATED WITH MINIMALLY INVASIVE OESOPHAGECTOMY
Authors: Hussain Aadil , Shanmuganathan Kanatheepan , Akitikori Temisanren , Soile Oluwasunmisola , Farhangmehr Neda , Lorenzi Bruno , Charalabopoulos Alexandros
Published: September 2018

Background

Lymph node status in oesophageal carcinoma is an important prognostic factor and predictor of survival. However, specific metastatic distribution patterns, especially for superior mediastinal lymph nodes, are not defined; they may be dependent on tumour location, histology and use of neoadjuvant treatment. Consensus for an optimal surgical strategy with regards to superior mediastinal lymphadenectomy (SML) has therefore not been formed. We aim to assess the metastatic yield of superior mediastinal nodes in intra-thoracic oesophageal cancer while correlating results with preoperative PET-CT.

Methods

Data from 39 consecutive 2-stage and 3-stage fully Minimally Invasive Oesophagectomies (MIO) performed by a single surgical team for intra-thoracic oesophageal or gastro-oesophageal junction carcinoma (Siewert I/II) between September 2016 and December 2017 were analysed. In n = 7 (18%), SML was performed. Of these n = 1 was for mid-oesophageal adenocarcinoma (ACA) and n = 6 were for squamous cell carcinoma (SCC) (5 for mid-oesophageal and 1 for distal oesophageal, which had a 2-stage procedure). Histological superior mediastinal nodal analysis was correlated with pre-operative PET-CT.

Results

Median total lymph node count was 45 (IQR, 37–68), with median SML count of 8 (IQR, 5–22). Of 7 SML’s, n = 1 (14.2%) revealed metastasis in 1/5 right paratracheal nodes. The patient had 3-stage MIO with no neo-adjuvant treatment for mid-oesophageal SCC. Final staging was pT3N2(6/45)M0. Preoperative PET-CT showed low avidity in right paratracheal nodes. Of the rest, 5 had negative PET-CT and 1 showed PET-positive paratracheal nodes, not confirmed histologically. The latter patient had neoadjuvant chemoradiotherapy for distal oesophageal ACA.

Conclusion

Although a small sample-sized study it demonstrates that PET-CT has a role in identifying metastatic superior mediastinal nodes. It can aid in the decision of resecting avid nodes but it should be born in mind that PET could have false positive results due to surrounding inflammation not uncommonly found in the lungs. False positivity (not confirmed histologically) may be also attributed to complete pathological lymph node response post neo-adjuvant treatment. SML’s role is not as clear in distal oesophageal/GOJ cancer compared to mid-oesophageal, but PET-CT seems a useful adjunct. In the West, SML shows a low metastatic yield for intra-thoracic oesophageal cancer.

Disclosure

All authors have declared no conflicts of interest.
PS01.217: COMPARISON OF THE SHORT-TERM OUTCOMES OF LATERAL POSITIONING AND PRONE POSITIONING DURING THORACOSCOPIC ESOPHAGECTOMY
Authors: Kishino Takayoshi , Ando Yasuhisa , Suto Hironobu , Asano Eisuke , Oshima Minoru , Fujiwara Masao , Okano Keiichi , Usuki Hisashi , Suzuki Yasuyuki
Published: September 2018

Background

Video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer is being performed at an increasing number of institutions. In our institute, at first, we had performed VATS-E in the left lateral position without pneumothorax. But, we introduced VATS-E in the prone position with pneumothorax, because of difficulty of visual development for a surgical site by assistant. This study aimed to compare the two methods and to clarify the advantage in the prone position.

Methods

Thirty-one patients who underwent VATS-E at the Department of Gastroenterological Surgery, Kagawa University, from August 2013 to January 2018 were divided into two groups by the patient position. For the first 17 patients, we used the left lateral position (Group L); for the next 14 patients, we used the prone position (Group P). We compared the short-term outcomes in these two approaches.

Results

There were no significant differences in the most operative factors; duration of the thoracoscopic esophagectomy (354 min. in Group L and 309 min. in Group P, P = 0.153), operative hemorrhage (421 ml in Group L and 228ml in Group P, P = 0.054), infusion volume (8.8 ml/kg/hr. in Group L and 8.2ml/kg/hr. in Group P, P = 0.415), urinary volume (2.3 ml/kg/hr. in Group L and 1.7ml/kg/hr. in Group P, P = 0.202). However, C-reactive protein (CRP) level in post-operative day 3 (17.2 in Group L and 13.8 in Group P, P = 0.046) and procalcitonin (PCT) level in post-operative day 3 (1.8 in Group L and 0.3 in Group P, P = 0.049) was significantly lesser in Group P. And, Period until ambulation (4.0 days in Group L and 1.3 days in Group P, P < 0.001) was significantly shorter in Group P.

Conclusion

In conclusion, VATS-E in the prone position is lesser invasive and faster recovery than in the left lateral position.

Disclosure

All authors have declared no conflicts of interest.
PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER
Authors: Lin Yidan , Deng Hanyu
Published: September 2018

Background

Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center.

Methods

Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis.

Results

The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups.

Conclusion

RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions.

Disclosure

All authors have declared no conflicts of interest.