bluuebunny/crossref_metadata_2025_split huggingface dataset:
P20 MINIMALLY INVASIVE TRATMENT OF CHYLE LEAK AFTER ESOPHAGECTOMY USING INDOCYANINE GREEN (ICG) ENHANCED FLUORESCENCE.
Authors: Alberti L , De Pasqual C A , Weindelmayer J , La Mendola R , Gervasi M C , Ridolfi C , Giacopuzzi S , de Manzoni G 
Published: November 2019

Abstract

Background
Chyle leak is a rare but life-threatening complication after esophagectomy. In Literature is reported a mortality rate up to 40% in case chyle leak after esophageal surgery. In case of re-operation, ligature of the chyle duct is mandatory. However, chyle duct identification can be difficult. To our knowledge, in Literature are reported only two cases of chyle duct identification through ICG visualization.
We present the case of a 66 years old male patient who underwent to a totally mini-invasive McKeown esophagectomy for a locally advanced esophageal adenocarcinoma, after neoadjuvant chemo-radiotherapy. In 2nd post-operative day (POD) we observed a chylous debt from the thoracic drain, sign of chyle leak. A first conservative approach was tempted, with a nihil-per-os regimen and total parenteral nutrition, with a significant reduction in drain output. However, at the resumption of oral intake, we observed a new increase of drain output. We therefore decided to re-operate the patient to seal the leak. On POD 15 the patient was submitted to a new thoracoscopy, with previous inguinal green indocyanine infiltration. During the thoracoscopy, the ICG allowed to safely identify the chyle duct and to proceed to its selective ligation. During the following days the patient’s clinical state progressively improved, allowing to restore oral feeding in POD3. No chyle debt was attested from the drainage, removed in POD 5. The patients was dismissed the next day.
In our opinion, this is a promising application for the ICG technique.
P201 LAPAROSCOPIC TRANSHIATAL OMENTAL REPAIR OF IATROGENIC ESOPHAGEAL PERFORATION IN ACHALASIA
Authors: Martina Nebbia , Pietro Riva , Anna Da Roit , Silvia Basato , Andrea Pansa , Damiano Gentile , Salvatore Marano , Carlo Castoro 
Published: November 2019

Abstract

Aim
Laparoscopic transhiatal omental patch repair(OPR) of esophageal perforation after pneumatic balloon dilatation(PBD) for achalasia.

Background&Methods
In August 2018 a 72yrs woman with a history of dysphagia for solids and liquids, nocturnal regurgitation and chest pain had a diagnosis of achalasia.
After inhalation during a barium swallow the patient developed fever, respiratory insufficiency and worsening of vital signs leading to ICU and intubation. She developed a right-pleural empyema, massive pneumothorax and right-upper lobe abscess, requiring thoracotomy and right-superior lobectomy.
She had been scheduled for a Per Oral Endoscopic Myotomy in November. After the submucosal tunnel, the procedure had been suspended due to presence of fibrosis.
In December the patient underwent a first PBD up to 30mm with symptoms resolution and 2kg weight regain.
In February, few hours after a second PBD up to 35mm, she complained mild pain at the left hemithorax and fever. 24hrs later a CTscan with water-soluble-contrast revealed a 3cm long esophageal perforation 5cm above the diaphragm and left paraesophageal mediastinal abscess without pleural involvement. Endoscopic treatment was excluded for significant dilatation of the esophagus and the fragile esophageal wall.
Because of the frailty status of the patient, the delayed diagnosis, the high risk of a direct suture of the esophageal wall through a left thoracotomy, the even higher risk of an emergency esophagectomy, we performed a laparoscopic approach. Limited dissection of the esophagogastric-junction and of the left diaphragmatic crura allowed access to the abscess cavity, no attempt to direct suture was done, a drain was placed, a pedicled omental flap was realized filling the cavity and repairing the esophageal defect. A jejunostomy was placed.

Results
The post-op period was uneventful; a CTscan with per-os contrast on POD3 and POD9 didn’t show any collection. The patient started an oral semisolid-diet on POD11. An EGDS on POD19 confirmed the presence of the OPR in the esophageal lumen and after 2-months showed a completely re-epithelialized esophagus.

Conclusions
Laparoscopic trans hiatal OPR of esophageal perforation in achalasia proved to be a minimally invasive and effective procedure in this patient due to its immunogenic and angiogenetic properties.
P202 ESOPHAGEAL VARICEAL BANDING LIGATION: SIX-YEAR EXPERIENCE OF A TERTIARY CENTER
Authors: Gkolfakis P , Miltiadou K , Gatos-Gatopoulos P , Grammatikos K , Koukoulioti E , Lazarides D Tziatzios G , Triantafyllou K , Papanikolaou I S 
Published: November 2019

Abstract

Aim
Esophageal variceal bleeding is a potentially lethal complication of portal hypertension. Endoscopic variceal band ligation (EVL) is the cornerstone of treatment for acute variceal bleeding, as well as its primary and secondary prophylaxis. Herein, we present our experience on EVL.

Materials and methods
Retrospective analysis of all cases subjected to EVL in our department from 01.01.2013 to 30.09.2018. Demographics, epidemiological data, outcomes -including number of sessions required to treat- and complications were recorded.

Results
One hundred and seventeen patients (males: 94=80.3%, mean age: 62.2±12.3 years), subjected to 224 sessions of EVL were recorded. The majority were cirrhotic (97.8%), mainly due to viral hepatitis (45.1%) and alcohol abuse (32.5%). Twenty patients (17.1%) had been previously subjected to EVL; fourty-five (39.1%) underwent EVL due to acute variceal bleeding, whereas 43 (36.7%) and 29 (25.2%) for primary and secondary prophylaxis, respectively. Variceal eradication was documented endoscopically in 49.7% of the patients treated with EVL.
Performing 2 sessions of EVL showed the best discriminative ability associated with variceal eradication [ΑUC(95%CI)=0.72(0.63-0.82), sensitivity 78%, specificity 72%]. Presence of cirrhosis, indication and endoscopic findings were not associated with success of variceal eradication (p=0.15, p=0.52 and p>0.68), whereas the etiology of cirrhosis was associated with successful eradication, as patients suffering of cirrhosis attributed to viral hepatitis had lower success rates (61% vs. 28.2%, p=0.01). In 14 (25%) patients, varices relapsed after successful eradication.
Twelve patients required rescue treatment (9 required TIPS and 3 Sensgstaken-Blakemore tube placement) to control bleeding. Complications related to EVL were documented in 13 (11.1%) patients, 69.2% of which was bleeding from post-EVL ulcers, for which however no further treatment was required.

Conclusion
In our series, 2 sessions of EVL are associated with the best therapeutic results with regards to variceal eradication, whilst patients with cirrhosis of viral etiology have lower eradication success rates.
P204 DETECTING PATHOLOGICAL COMPLETE RESPONSE IN ESOPHAGEAL CANCER AFTER NEOADJUVANT THERAPY BASED ON IMAGING TECHNIQUES: A DIAGNOSTIC SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: de Gouw D J J M , Klarenbeek B R , Dressen M , Bouwense S A W , van Workum F , Fütterer J J , Rovers M M , ten Broek R P G , Rosman C 
Published: November 2019

Abstract

Background
Up to 32% of patients with esophageal cancer show a pathological complete response (ypCR) after neoadjuvant therapy. To prevent overtreatment, the indication to perform esophagectomy in these patients should be reconsidered. Implementing an organ-preserving strategy for patients with ypCR requires an accurate assessment of residual disease after neoadjuvant treatment. The aim of this study was to systematically review the effectiveness of imaging techniques used for detection of ypCR after neoadjuvant therapy but before resection in patients with esophageal cancer.

Methods
A systematic literature search of the Medline, Embase, and Cochrane Library databases was performed from January 1, 2000, to December 13, 2017. Eligible studies were diagnostic studies that compared results of imaging modalities after neoadjuvant therapy to histopathological findings in the resection specimen after esophagectomy. Methodological quality was assessed by the Cochrane Quality Assessment of Diagnostic Accuracy Studies, version 2, model. Primary outcome measures were true positive, false positive, false negative, and true negative values of imaging techniques predicting ypCR. A meta-analysis was performed by pooling sensitivities and specificities by using a bivariate model.

Results
A total of 4420 articles were identified. After exclusion of irrelevant titles and abstracts, 360 articles were reviewed in full text. In total, four imaging modalities (computed tomography [CT], positron emission tomography [PET-CT], endoscopic ultrasound [EUS], and magnetic resonance imaging [MRI]) were used for restaging. The meta-analysis was conducted with data from 56 studies involving 3625 patients. The pooled sensitivities of CT, PET-CT, EUS, and MRI for detecting ypCR were 0.35, 0.62, 0.01 and 0.80, respectively, whereas the pooled specificities were 0.83, 0.73, 0.99, and 0.83, respectively. The positive predictive value in detecting ypCR was 0.47 for CT, 0.41 for PET-CT, not applicable for EUS, and 0.61 for MRI.

Conclusions
Current imaging modalities such as CT, PET-CT, and EUS seem to be insufficiently accurate to identify complete responders. More accurate diagnostic tests are needed to improve restaging accuracy for patients with esophageal cancer.
P205 THREE YEARS EXPERIENCE OF THE FIRST SPECIALIZED ESOPHAGEAL CENTER IN EGYPT
Authors: Ezz R 
Published: November 2019

Abstract

Introduction
Subspecialty policy is increasing all over the world aiming to improve the results of heavy esophageal surgeries.

Aim
To define the impact of having surgical specialized esophageal unit on the volume of patients and the results.

Methodology
We reviewed all esophageal cases managed in our esophageal specialized department (from May 2016 to May 2019 Group A) and we compared the results to previous 3 years (from May 2013 to May 2016 Group B) and to the international results.

Results
Esophageal surgeries performed during this period was 394 cases in group A compared to 104 cases in group B. One hundred eighty operations were performed for Gastro esophageal reflux disease (GERD) in group a (45.7%) compared to 61 cases in group B (68.7%). Forty two (10.7%) modified Heller’s cardiomyotomy (Open and laparoscopic) for achalasia were performed in group A compared to 17 cases (16.3%) in group B. Surgeries for malignant lesions were performed for 122 cases (30.9%) in group A compared to 13 cases (12.5%) in group B. Other Esophageal operations were also done for 50 cases (12.7%) in group A compared to 13 cases (12.5%) in group B.
Mortalities in group A was 5 cases in benign diseases (1.8%) and 13 cases for malignant cases (10.7%) compared to 7 cases in benign diseases (7.7%) and 5 cases for malignant conditions (23%) in group B.
Morbidities in group A was 46 cases in benign diseases (16.9%) and 31cases for malignant cases (25.4%) Compared to 23 cases in the benign diseases (25.2%) and 5 cases for malignant conditions (38.5%) in group B. Our results in group A are comparable to Hospital mortality rates for patients in medium-volume centers (7.5%)(1).Also we approach the International results for morbidities of benign esophageal disease (5.7 to- 12.7%) for fundoplication (2).

Conclusion
Having a specialized esophageal unit resulted in increase of the volume of patients and improvement of the results.
P207 COMPARISON OF OPIOID vs OPIOID PLUS LOCAL ANESTHETIC EPIDURAL ADMINISTRATION IN IVOR LEWIS ESOPHAGECTOMY
Authors: Papaioannou E , Doka P , Koziakas E , Analyti A , Danassi D , Fotopoulou G , Lampadariou A 
Published: November 2019

Abstract

Aim
of the study was the comparison of single morphine vs morphine plus ropivacaine epidural administration for intraoperative pain management in Ivor Lewis esophagectomy.

Background & Methods
In a randomized prospective clinical trial, after informed consent, 20 patients were assigned to groups A (n=10): Morphine, and B (n=10=): Morphine and ropivacaine combination, according to the medication they were administered epidurally (ed), when submitted to Ivor Lewis esophagectomy. In both groups’ patients a thoracic epidural (T5-7) was inserted preoperative, and anesthetic protocol was the same, apart from opioid analgesics, that were titrated according to patients’ requirements. In group A morphine 1.5-3mg in 10-12ml normal saline volume, while in group B morphine 1.5-3mg plus ropivacaine 0.25% in a total volume of 10-12 ml were ed administered at least 20min before surgical incision. Opioids requirement, heart rate, arterial blood pressure, increments of muscle relaxant (rocuronium bromide) repetitive doses intraoperatively, and rescue analgesics need and side effects such as nausea, vomiting, drowsiness, respiratory depression and patients’distress in case of leg movement inability were recorded postoperatively.

Results
Patients’ demographics were similar in both groups. Intraoperatively, group A received significantly higher (p<0.001) fentanyl doses (4-6mcg/kg initially and 2hrs repetitive increments of 1-2mcg) vs group B (2-2.5mcg/kg initially, 4 (40%) patients didn’t require any supplementary dose and the rest 2-3mcg/kg in 1-2 increment doses until the end of operation). Vital signs were stable in both groups. Rocuronium requirement was significantly lower (p<0.001) in group B (apart from initial dose 1mg/kg, which was the same in both groups, group B demanded repetitive dose only before single to two-lumen endotracheal tube replacement, while group A required 0.2-0.3mg increment doses hourly). All patients were transferred awake postoperatively in ICU. None of any group patients demonstrated any side effects, but 3 (30%) group A patients required rescue analgesic (pain score > 4).

Conclusion
Morphine plus ropivacaine combination administered epidurally seems to provide lower pain scores and reduces the need for extra opioids intra- and postoperatively, and reduces muscle relaxants requirement during operation. Further studies are required to support these findings.
P209 OESOPHAGEAL DISRUPTIONS- A MULTIDISCIPLINARY ALGORITHMIC APPROACH
Authors: RM Koshy , J Wong , V Menon 
Published: November 2019

Abstract

Aim
We would like to reflect on our experience to propose a multidisciplinary algorithmic approach to manage both iatrogenic and spontaneous Oesophageal disruptions.

Background & Methods
Oesophageal disruptions, present to us a challenging group of critically unwell and compromised patients who need a long-term care plan. It is crucial to have a multidisciplinary approach, with the surgeon bringing together the interventional radiologists, endoscopists and nutritionists, to obtain the best outcome.
This retrospective cohort included 23 patients with both iatrogenic and spontaneous oesophageal disruptions managed at our centre between 2013 and 2019.

Results
There were 23 patient events with 14 anastomotic leaks (12 Oesophagectomies & 1 total Gastrectomy) and 10 perforations (7 iatrogenic & 3 spontaneous). Once diagnosed by contrast studies (CECT/swallow), they were started on broad spectrum IV antibiotics and antifungals. An urgent endoscopy followed with APC and clipping as adjuncts. With a median number of two stents used, their duration was 34 and 60.5 days in the leak and the perforation groups respectively.
About 40% needed image guided drains, with cultures that guided the antibiotic regimen. Nutrition in the cancer group was via jejunostomy feeds, while the perforation group had naso-jejunal tubes put during stenting and a small group needed TPN. Patients were allowed phased oral intake based on their clinical picture and contrast studies.
The median length of stay was 41.5 & 63 days, with a re-admission rate of 2 & 4 times amongst the leak and perforation groups.
Three patients developed Clavien-Dindo grade 3 complications needing further intervention, with two of them post leak and one post perforation. The former had 1 stent embedment with erosion and 1 stricture, while the later developed small bowel obstruction due to stent migration and needed an emergency laparotomy.
Though heterogeneous, the management of these groups share useful themes. The stents and adjuncts help with source control of sepsis (leak/perforation), facilitate healing and improve nutrition.

Conclusion
Oesophageal disruptions can be managed successfully with conservative measures, with a multidisciplinary approach. An algorithmic approach makes standard of care more uniform and brings better outcomes, with minimal morbidity. Team work is key.
P21 FEASIBILITY OF ENHANCED RECOVERY PROTOCOL AFTER ESOPHAGEAL SURGERY IN ELDERLY PATIENTS
Authors: De Pasqual C A , Weindelmayer J , La Mendola R , Alberti L , Ridolfi C , Gervasi M C , Giacopuzzi S , de Manzoni G 
Published: November 2019

Abstract

Background
In dedicated centres ERAS (Enhanced Recovery After Surgery) programs have been successfully applied after esophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients.

Methods
We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, during the period 2015-2017. We divided the patients into two groups: 47 patients (65,3%) were <70 years old (Young Group, YG) while 25 patients (34,7%) were ≥70 years old (Elderly Group, EG). We compared post-operative outcomes and adherence to ERAS steps of the two groups.

Results
The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG p= 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, p= 1). EG showed a higher cardiac complications rate (3,5% in YG vs 26,7% in EG, p=0,001). We did not report 90-days mortality. We did not observe differences in adherence to the following ERAS steps: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, p=0,7), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, p=0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, p=0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, p=1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, p=0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, p=0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, p=0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, p=0,6). Median day of discharge was POD 8 for both groups (p= 0,8).

Conclusions
In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy.
P216 WHAT IS THE TIME BURDEN AND RESPONSE RATE ASSOCIATED WITH WRITTEN OR ONLINE COMPLETION OF HEALTH-RELATED QUALITY OF LIFE QUESTIONNAIRES AFTER CANCER TREATMENT?
Authors: Klevebro F , Boshier P , Jenq W , Low D 
Published: November 2019

Abstract

Background
Patient reported outcomes are increasingly important assessments to be applied in the follow-up of patients after cancer treatment. The primary aim of this study was to clarify the patient related time burden associated with completing these questionnaires. Secondary aims was to assess completion rates, and to investigate how symptomatic outcome differs according to the response time.

Method
Patients who had undergone surgical management of esophageal cancer (1991-2018) and were disease-free at the time of assessment were asked to complete a total of six questionnaires: SF36, EORTC-QLQ-C30, EORTC-QLQ-OG25, EuroQol 5D, Digestive Symptom Questionnaire, and Dumping Syndrome Rating Scale. Patients were offered either paper or online questionnaires that were completed consecutively allowing for accurate quantification of the time taken to complete each online questionnaire.

Results
In total, 117 of 147 eligible patients (79.6%) responded to the questionnaires. In the online group 60 (90.9%) responded compared to 57 (70.4%) in the paper group (P=0.002). The median age was 74.5 years in the online group compared to 70.9 years in the paper group (P=0.022). In the patients completing their questionnaires online, the six questionnaires took on average 26.4 (range 10-55) minutes to complete. The fastest quartile of patients completed the six questionnaires in 17 minutes or less (N=14). There was no significant association between time to complete the questionnaires and age, gender, time from surgery or health-related quality of life scores.

Conclusions
The results of the study demonstrates that online questionnaires in some ways might be superior to paper questionnaires, and that patients are willing and able to complete online questionnaires irrespective of age. Time to complete questionnaires was not associated with level of health-related quality of life.
P219 THE ROLE OF PET-CT IN THE EVALUATION OF LYMPH NODE INVOLVEMENT IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA - A 5-YEAR SINGLE CENTER EXPERIENCE
Authors: Vergadis Chrysovalantis , Mpaili Eustratia , Syllaios Athanasios , Mpoura Maria , Michalinos Adamantios , Karavokyros Ioannis , Alexandrou Andreas , Charalabopoulos Alexandros , Schizas Dimitrios , Liakakos Theodore 
Published: November 2019

Abstract

Aim
To determine the efficacy of positron emission tomography-computed tomography (PET-CT) in the evaluation of lymph node status during preoperative staging on patients with esophageal and gastrοesophageal junction carcinoma compared to the final histopathological findings.

Background & Methods
Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were extracted and analyzed: patient demographics, histopathological parameters, surgical and oncological outcomes. All patients were staged according to the AJCC 8th edition.

Results
A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of esophagus or gastroesophageal junction (n= 72 patients). In 60 cases, clinical staging was conducted without performing PET- CT, while 19 cases underwent PET-CT. Among the 19 patients, 16 (84.2%) were men, and 3 (15.8 %) were women. Mean age was 62 years, (range 41- 72). Mean nodal harvest per patient was 30.6 lymph nodes. Twelve out of 19 patients (63.2%) revealed lymph node invasion, with a mean of 5.6 positive lymph nodes per patient. PET-CT identified the primary tumor in all 19 patients (100%). PET-CT demonstrated 100% compliance with the final histopathological reports regarding N status in only 5 out of 19 cases (26.3%). Four patients were staged as N0 both pre- and postoperatively, while one was deemed positive by PET-CT in right paracardial lymph nodes which was histopathologically confirmed. In other 4 patients (21.1%), PET-CT was 100% false negative, whereas in 3 patients (15.8%) PET-CT was 100% false positive. In the remaining 7 patients, PET-CT findings were in accordance with the pathology report in 7 out of 25 examined lymph node stations, false positive in 9 out of 25 and false negative in 9 out of 25.

Conclusion
PET-CT seems to have a considerable number of false positive and false negative results in esophageal cancer in our study as far as N-staging is concerned. Further studies with larger sample size are needed to reach more conclusive results.