bluuebunny/crossref_metadata_2025_split huggingface dataset:
P151 NEVER SMOKER WITH ESOPHAGEAL SQUAMOUS-CELL CARCINOMA: DIFFERENT DEMOGRAPHICS BUT COMPARABLE SUVIVAL
Authors: Alexandru Lintis , Thibault Voron , Vincent Drbay , Marguerite Messier , Clarisse Eveno , Guillaume Piessen 
Published: November 2019

Abstract

Aim
To assess clinical characteristics, tumor behavior and long-term of esophageal squamous-cell carcinoma in never-smoker (NS) and smoker (or former smoker) (S) patients.

Background & Methods
Despite a progressive decrease in the incidence of esophageal squamous-cell carcinoma (ESCC) in Europe since decades, related to the decrease in smoking, new cases of ESCC are observed in patients who have never smoked. Similar cases are described for head and neck cancers and non-small cell lung carcinomas, for which increased radiosensitivity and favorable prognosis is described.
We conducted a retrospective analysis on single-center prospectively maintained database, including all patients undergoing esophagectomy for ESCC between 2010 and 2017. The primary endpoint was overall survival(OS). Secondary endpoints included disease-free survival(DFS), pathological response to preoperative treatment according to Mandard's classification (Tumor Regression Grade; TRG) and clinical characteristics of patients.

Results
Three hundred and two patients underwent esophagectomy for ESCC during study period, 57 in NS group and 245 in S group. Esophageal cancers in NS patients were more frequently observed in women (68.4% vs 20%;p<0.001) and older (65.42 vs 60.69; p<0.001) than patients in S group. Tumor location (ie. cervical, upper third, middle third, lower third/EGJ) was similar between the 2 groups. Neoadjuvant radiochemotherapy was more frequently performed in S group (64.2% vs 49.1%;p=0.035) and malnutrition was less frequent in NS group (6.3% vs 20.9%;p=0.05). Tumoral characteristics (usT and usN) were comparable between the 2 groups. Pathological response to preoperative radichemotherapy was similar between NS and S group: (TRG1-2: 53.8% vs 53.7%). Postoperative complications were more frequent in S group (77.4% vs 63.2%;p=0.024), with more postoperative deaths (5.8% vs 0; p=0.080). NS patients had better OS than S patients, without reaching significance (mean survival: 46.1±4.7 months vs 35.9±2.0 months;p=0.080), and better DFS (40.0±5.3 months vs 30.0±2.1;p=0.077)

Conclusion
Esophageal squamous cell carcinoma in never-smoker is characterized by low male-female sex-ratio, reduced post-operative morbidity and mortality. However, pathological response to preoperative radiochemotherapy and long-term outcomes seem to remain unaffected by tobacco use.
P157 GIANT PEDUNCULATED OESOPHAGEAL LIPOSARCOMAS: A CASE AND REVIEW OF RESECTION TECHNIQUES
Authors: Ng Y Annalisa , Lee June , Lin Jinlin , Ching Siok Siong , Wong S Andrew 
Published: November 2019

Abstract

Aim
Liposarcomas are rare causes of oesophageal tumours, accounting for <1% of tumours. We present a case of giant oesophageal liposarcoma with a discussion focusing on resection techniques.

Background & Methods
A 54-year-old gentleman presented to the hospital with symptoms of anaemia and weight loss for 3 months. A CT scan and oesophagogastroduodenoscopy (OGD) showed a giant, pedunculated polyp extending from the cervical oesophagus to cardioesophageal junction (CEJ) with mucosal ulceration at its distal aspect. Endoscopic ultrasound (EUS) revealed a 24 x 6 cm submucosal pedunculated mass with lipomatous regions and core biopsy only showed rare groups of spindle cells with no malignancy. Resection was advised in view of occult bleeding from polyp and endoscopic resection was deemed unsuitable in view of a highly vascular stalk and large size of polyp. He underwent surgical resection via a left cervical oesophagostomy with gastrostomy for polyp retrieval. Final histology showed a dedifferentiated liposarcoma arising within a giant fibrovascular polyp.

Results
Open surgery has classically been standard of treatment, but endoscopic resection is less morbid and invasive. Endoscopic techniques described include using a retraction suture followed by division of the polyp stalk using ultrasonic shears, using a snare, endoscopic submucosal dissection (ESD), and application of hemoclips following diathermy. In cases where endoscopic resection is not feasible, surgery such as oesophagostomy, oesophagectomy and laparotomy for resection and retrieval of the tumour have been described. Main reason for oesophagectomy was the presence of a submucosal (rather than polypoid, pedunculated) large tumour. For resection via oesophagostomy, stalk transection can be performed via stapling devices or suture ligation.

Conclusion
Giant oesophageal liposarcomas are very rare tumours. Such tumours are usually polypoid, arising from a pedicle in the proximal oesophagus. Resection techniques have shifted from oesophagectomy to less invasive means such as endoscopic resection or oesophagostomy. Decision on type of resection technique depends on tumour characteristics and location; with the guiding principle being resection with clear margins in order to prevent local recurrence.
P158 RESULTS OF A NATIONAL SURVEY ABOUT PERIOPERATIVE CARE IN GASTRIC RESECTION SURGERY
Authors: Bruna M , NAVARRO C , BAEZ C , RAMIREZ J , ORTIZ M , MINGOL F , VAQUE J 
Published: November 2019

Abstract

Introduction
Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons.

Methods
A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery.

Results
Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6 hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48 hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24 hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol.

Conclusions
The implementation of enhanced recovery after surgery measures in nonbariatric gastric resection surgery is not widespread in our country.
P159 THE IMPACT OF POSTOPERATIVE COMPLICATIONS ON LONG-TERM SURVIVAL AND DISEASE RECURRENCE FOLLOWING OESOPHAGO-GASTRIC CANCER RESECTION
Authors: Saunders J H , Yanni F , Dorrington M S , Bowman C R , Vohra R S , Parsons S L 
Published: November 2019

Abstract

Aim
Postoperative complications following the resection of oesophago-gastric carcinoma can result in considerable early morbidity and mortality, however the long-term effects are less clear. Literature reports are mixed, so it remains unclear if complications reduce survival, as has been demonstrated in colorectal cancer.

Background & Methods
Some 1100 patients who underwent oesophago-gastric resection between 2006-16 were stratified by complication severity to determine the effect of leak and severe non-leak related complications on overall survival, recurrence and disease free survival.

Results
The median age was 69 years, 48% had stage III disease, with cancer recurrence in 39%. Clavien-Dindo (CD) complications ≥ III occurred in 22.2% of patients. The most common complications were pulmonary (30%), with a 13% incidence of pneumonia, 10% atrial dysrhythmia and 9.6% anastomotic leak. In comparison to CD 0-I complication free patients, those with CD III-IV leak did not suffer a significantly reduced survival. However patients with CD III-IV non-leak related complications were associated with a significant reduction in median overall survival (19.7 vs. 42.7 months) and disease free survival (18.4 vs. 36.4 months). Cox regression revealed age, stage, resection margin, and CD III-IV non-leak complications as independently associated with poor overall and disease free survival.

Conclusion
This cohort demonstrates that whilst leak does not affect long-term survival, other severe postoperative complications do significantly reduce overall survival and disease recurrence. A reduction in these complications, such as pneumonia, seen with adoption of hybrid / minimally invasive surgery may help change this pattern of disease recurrence and reduced survival.
P16 PREEMPTIVE ENDOLUMINAL VACUUM THERAPY TO REDUCE ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: A GAME-CHANGING APPROACH?
Authors: Gubler C , Vetter D , Schmidt H , Müller P , Morell B , Raptis D , Gutschow C 
Published: November 2019

Abstract

Background
Endoluminal vacuum therapy (EVT) is an accepted treatment for anastomotic leakage (AL) after esophagectomy. A novel concept is to use this technology in a preemptive setting, with the aim to reduce AL rate and postoperative morbidity.

Methods
Preemptive EVT (pEVT) was performed intraoperatively in 19 consecutive patients undergoing minimally invasive esophagectomy, immediately after completion of esophago-gastrostomy. Twelve patients (63%) were high-risk cases with severe comorbidity. The EVT device was removed routinely three to six (median 5) days after esophagectomy. Endpoints of this study were AL rate and postoperative morbidity.

Results
There were 20 anastomoses at risk in 19 patients. One patient (5.3%) experienced major morbidity (Clavien-Dindo grade IIIb) unrelated to anastomotic healing. He underwent open re-anastomosis at postoperative day 12 with pEVT for redundancy of the gastric tube and failure of transition to oral diet. Mortality after 30 days was 0% and anastomotic healing was uneventful in 19/20 anastomoses (95%). One minor contained AL healed after a second course of EVT. Except early proximal dislodgement in one patient, there were no adverse events attributable to pEVT. The median comprehensive complication index 30 days after surgery was 20.9 (IQR 0-26.2).

Conclusions
PEVT appears to be a novel and safe procedure that may have the potential to improve surgical outcome in patients undergoing esophagectomy.
P160 miR-24-3p REGULATES CDX2 DURING THE PROCESS OF INTESTINALIZATION OF THE CARDIAC-TYPE EPITHELIUM IN A HUMAN MODEL OF BARRETT´S ESOPHAGUS
Authors: Manuel Pera , Marta Garrido , Gabriel Gil , Matteo Fassan , Marta Climent , Miriam Aylagas , Lara Nonell , Roger Anglada , Mar Iglesias , Vicenza Guzzardo , Luis Grande , Carme de Bolós 
Published: November 2019

Abstract

Aim
The aim of this study was to identify miRNAs differentially expressed between CDX2 positive and negative glands of Barrett’s esophagus and, based on this, to examine the function of specific miRNAs on the regulation of CDX2.

Background & Methods
Cardiac-type epithelium has been proposed as an intermediate stage between normal squamous epithelium and intestinal metaplasia (IM) in the development of Barrett´s esophagus. Deregulation of certain miRNAs and their effects on CDX2 expression might contribute to the intestinalization process of cardiac-type epithelium.
miRNA expression profiling using OpenArray technology in microdissected cardiac-type glands with and without fully CDX2 expression was performed in biopsies from patients who developed cardiac-type epithelium in the remnant esophagus after esophagectomy. Data were validated using real-time PCR in esophageal adenocarcinoma cell lines and in situ miRNA/CDX2 co-expression analysis in cardiac-type mucosa samples. The effect of miR-24-3p precursor transfection on CDX2 expression was assessed in the esophageal adenocarcinoma cell lines FLO-1 and KYAE-1.

Results
CDX2 positive glands were characterized by an unique miRNA profile with a significant downregulation of miR-24-3p, miR-520e-3p, miR-548a-1, miR-597-5p, miR-133a-3p, miR-30a-5p, miR-638, miR-625-3p, miR-1255b-1, miR-1260a and upregulation of miR-590 (Figure A). miRNA-24-3p was identified as potential regulator of CDX2 gene expression in three bioinformatics algorithms, and this was confirmed in esophageal adenocarcinoma cell lines (Figure C). Furthermore, miR-24-3p expression negatively correlates with CDX2 in cardiac-type mucosa samples with different stages of mucosal intestinalization (Figure B).

Conclusion
These results imply that miRNA-24-3p directly targets CDX2, and downregulation of miRNA-24-3p is associated with the acquisition of an intestinal phenotype in cardiac-type epithelium.
Figure: (A) OpenArray results showing downregulation of 10 miRNAs in CDX2 positive glands and upregulation of one miRNA (miR-590). (B) miR-24-3p in situ hybridization: intestinal metaplastic glands were characterized by a positive staining for CDX2 (red) and faint to negative miR-24-39. Adjacent non-intestinalized CDX2-negative glands showed a moderate miR-24-3p expression. (C) Transfection of KYAE-1 cells with miR-24-3p and miR-24-39 inhibitor. A significant CDX2 decrease was observed.
O161 LASTING SYMPTOMS AFTER ESOPHAGEAL RESECTION (LASER) – EUROPEAN MULTI-CENTER CROSS-SECTIONAL STUDY
Authors: Markar S , Zaninotto G , Castoro C , Johar A , Lagergren P , Elliott J , Gisbertz S , Mariette C , Alferi R , Huddy J , Sounderajah V , Pinto E , Scarpa M , Klevebro F , Sunde B , Murphy C , Greene C , Ravi N , Piessen G , Brenkman H , Ruurda J , Van Hillegersberg R , Lagarde S , Wijnhoven B , Pera M , Roigg J , Castro S , Matthijsen R , Findlay J , Antonowicz S , Maynard N , McCormack O , Ariyarathenam A , Sanders G , Cheong E , Jaunoo S , Allum W , Van Lanschot J , Nilsson M , Reynolds J , van Berge Henegouwen M , Hanna G 
Published: November 2019

Abstract

Aim
Long-term functional outcomes and the associations to health-related quality of life (HRQOL) after esophagectomy is largely unknown. LASER is a multi-center European study aimed to identify the most prevalent symptoms, and those with the greatest impact upon HRQOL among patients surviving more than one-year after esophagectomy for cancer, and to develop a clinically relevant symptom-based tool to measure HRQOL.

Background & Methods
Between 2010 and 2016, patients from 20 European Centers who underwent esophagectomy for esophageal cancer, and were disease-free at least one year postoperatively were invited to complete the LASER questionnaire, EORTC-QLQ30 and OG25. Specific symptom questionnaire items that were associated with a poor HRQOL as identified by EORTC-QLQC30 and OG25 were identified by multivariable linear and logistic regression analysis and combined to form a tool, which was tested using receiver operating characteristics curve analysis.

Results
A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had had symptoms associated with their esophagectomy and 52.4% of patients had sought medical treatment for their symptoms. Ongoing weight loss was reported by 10.4% of patients while 32.4% were struggling to maintain their body weight, and 18.8% of patients required supplemental oral nutrition. Only 13.8% of patients had returned to work with the same activities as before.
Three LASER symptoms in multivariate analysis were correlated with poor HRQOL; pain on scars on chest (Odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81±0.02 and 0.82±0.09 respectively.

Conclusions
Two-thirds of patients experience symptoms related to their esophagectomy more than one year after surgery. The three key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased long-term term support.
P162 ENHANCED RECOVERY PROTOCOL COMPLIANCE AND CLINICAL OUTCOMES IN ESOPHAGECTOMY FOR CANCER: DESIGN OF A MEASURING INSTRUMENT
Authors: Moons J , Lerut T , Van Achterberg T , Depypere L , Nafteux P 
Published: November 2019

Abstract

Objectives
Success of an enhanced recovery program (ERP) is not easily measured/quantified. Can a newly developed measuring instrument help to determine compliance and thus success of an ERP?

Methods
From the introduction of our ERP (May 2017), 200 consecutive potential curative esophagectomies for cancer were reviewed. A newly developed instrument with 12 prospectively recorded benchmarks was used to measure compliance. Each patient was scored for all benchmarks, reflecting how well the protocol-timeline was followed. A mean score of ≥70% of all benchmarks in a patient is considered compliant with the ERP-protocol.

Results
Sixty-three percent (125/200) of the patients were compliant (Fig1A). Compliance to the ERP showed significant beneficial effects on clinical outcomes: the comprehensive complications index was significantly lower in the compliant group compared to the not-compliant group: 22.6 versus 43.3; p<0.0001. This resulted in a significant lower median (IQR) length of stay between both groups: 9 (8-10) days versus 14 (11-22) days; p<0.0001. Some of the benchmarks showed a direct relation to individual complications, e.g. the percentage of pneumonias is correlated to the benchmark ‘active mobilization on postoperative day1’ (Fig1B)

Conclusion
Higher compliance to the ERP protocol helps to reduce postoperative complications and thus shortens the postoperative hospital stay.
P163 OUTCOMES OF DISTAL PANCREATECTOMY AND SPLENECTOMY DURING 2-STAGE ESOPHAGECTOMY FOR CANCER
Authors: Syllaios Athanasios , Mpaili Eustratia , Mpoura Maria , Meropouli Antonia , Davakis Spyridon , Schizas Dimitrios , Karavokyros Ioannis , Charalabopoulos Alexandros , Liakakos Theodore 
Published: November 2019

Abstract

Aim
The aim of the study was to assess safety, feasibility and outcomes of esophagectomy with distal pancreatectomy and splenectomy for T4a esophageal and esophagogastric junction adenocarcinoma.

Background & Methods
From 01/10/2018 to 01/03/2019, three patients were operated in our Unit for adenocarcinoma of the distal esophagus or esophagogastric junction with 2-stage esophagectomy combined with distal pancreatectomy and splenectomy. Records were reviewed and clinicopathological outcomes presented.

Results
All patients were males with a mean age of 55 years (Range: 44-64). Two out of three had undergone neoadjuvant chemotherapy. Mean operative time was 420 min. (Range: 360- 480 min.). Mean blood loss was 180 ml (Range: 150-230ml). Mean ICU stay was 2.33 days (Range:1-3 days). Mean length of stay was 20 days (Range: 15-25 days). Postoperative complications observed was pneumonia in n=1. R0 resection was achieved in all patients while positive lymph node ratio was 0.3 (Range: 0- 0.73). Adjuvant chemotherapy was administered in all patients.

Conclusion
Two-stage esophagectomy for cancer along with distal pancreatectomy and splenectomy may be safely performed in specialized Upper GI Units offering adequate postoperative clinical and oncological outcomes. Further studies with larger sample size are needed to reach reproducible results.
P164 Esophageal perforations. Fighting between time, severity and individualization: a collective interhospital Upper GI Unit experience.
Authors: Mpaili Eustratia , Syllaios Athanasios , Mpoura Maria , Davakis Spyridon , Vailas Michail , Zografos Konstantinos , Tsimpoukelis Antonios , Alexandrou Andreas , Schizas Dimitrios , Charalabopoulos Alexandros 
Published: November 2019

Abstract

Aim
Esophageal perforation is a serious injury associated with high morbidity and mortality. The management ranges from observation to operative treatment. The aim of this study was to evaluate safety and efficacy of different treatment strategies in patients with esophageal perforation depending on the severity and time from diagnosis to treatment.

Background & Methods
We performed a retrospective review of a prospective esophageal perforation database from two Upper GI Units between 01/01/2014 and 31/12/2018. Patients admitted for esophageal perforation were identified and reason of perforation, perforation site, time of diagnosis, management, length of stay (LOS) and outcomes were recorded.

Results
Sixteen patients were identified. Reason of perforation was Boerhaave's syndrome in n=9 (56.2%), iatrogenic in n=4 (25%) and foreign body in n=2 (12.5%) patients. Perforation site was distal esophagus in n=11 (68.7%) mid- esophagus in n=3 (18.7%) and Upper esophagus in n=2 (12.5%) patients. Time from perforation to diagnosis was 24h in n=12 (75%) and 48h in n=4 (25%) patients. Treatment in patients diagnosed the first 24h was esophagectomy in n=5 (41.6%), primary closure in n=2 (16.6%) and feeding tube along with thoracotomy and washout in n=2 (16.6%). Conservative management was offered in n=2 (16.6%). Patients diagnosed after 24h were managed with chest drains (50%) and stent insertion (50%). Mean LOS in patients that required surgical intervention was 18.2 days (Range: 6-60), while mean LOS in those who did not required was 11.1 days (Range: 1-37) Eleven (68.7%) patients were discharged in good clinical condition.

Consclusion
Esophageal perforations should be treated in specialized Upper GI Units due to the severity of the injury. Treatment plan should be individualized.
P166 SPONTANEOUS ESOPHAGEAL RUPTURE – BOERHAAVE SYNDROME
Authors: Movchan B  , Usenko O , Zgonnyk A , Vynogradov R 
Published: November 2019

Abstract

Aim
To study the most effective method of treatment in patients with spontaneous rupture of the esophagus.

Background
The timely diagnosis of Boerhaave syndrome presents great difficulties due to its rarity, a variety of clinical manifestations, often simulating different pathologies from other organs and are difficult to treat.

Methods
From 2003 to 2019 9 patients with Bourhave's syndrome were treated at the clinic, primary care was provided to 6 patients in the community. All patients were admitted to the clinic with external left-sided esophageal-pleural fistula, 1 patient had a spontaneous rupture of the esophagus in the cliniс, the defect of the esophagus wall defect was completed, which led to successful results.

Results
Treatment in the remaining patients was started with adequate enteral nutrition and effective drainage of the pleural cavity. As a result of the use of pleural double-lumen drainage with active sanation with antiseptics and subsequent aspiration, with the exception of feeding through the mouth in four patients, it was possible to eliminate the esophageal-pleural fistula, profuse bleeding and death of the patient.
Against the background of ongoing conservative therapy in two patients, it was not possible to eliminate the esophago-pleural fistula. A left-sided thoracotomy was performed with excision of the fistula with the decortication of the lung and the extirpation of the esophagus with the formation of an esophagostomy.
Subsequently, these patients underwent retrosternal colic esophagoplasty. Two patients underwent Lewis surgery with drainage of the pleural cavity.

Conclusion
Boerhaave syndrome has a very high mortality rate, however, with a timely diagnosis and adequate surgical tactics, it develops into the formation of an esophageal-pleural fistula. In this case, the most effective treatment is excision of the fistulous course with extirpation of the esophagus and subsequent esophagoplasty. The use of esophageal stents is possible in extremely depleted patients or in elderly patients, due to the frequent occurrence of hypergranular esophagitis. Esophageal stents should be removed as soon as possible when confidence in the elimination of the esophageal-pleural fistula occurs.