bluuebunny/crossref_metadata_2025_split huggingface dataset:
583 THE INTER- AND INTRA-OBSERVER RELIABILITY OF A NOVEL VIDEO-FLUOROSCOPY PROTOCOL FOR GASTRO-ESOPHAGEAL JUNCTION ANATOMY POST-FUNDOPLICATION
Authors: Gan S , Lee N , Tan S , Edwards S , Kiroff G , Myers J 
Published: September 2020

Abstract

Despite modifications in surgical technique, the occurrence of troublesome dysphagia after fundoplication remains difficult to predict. Objective measurements on video-fluoroscopy swallow study (VFSS) may hold the key to understanding post-fundoplication dysphagia. This study reports the inter- and intra-observer reliability of video-fluoroscopic anatomical measurements of the post-fundoplication gastro-esophageal junction (GEJ).

Methods
Thirty-one patients underwent structured VFSS 6–12 months after laparoscopic total or partial fundoplication. VFSS protocol included six views: standing AP, 2x standing oblique, 2x prone oblique (POb), and prone oblique with continuous drinking. The primary observer recorded two sets of 11 variables of GEJ anatomy (3 mo interval between set 1- set 2). Further datasets (one each) were obtained from two medical students trained in two 2-hour sessions. Inter-observer reliability was determined from datasets of three observers and intra-observer reliability from primary observer. Intraclass correlation coefficients (ICC) two-way mixed-effects model was used (ICC agreement: 0.40–0.59 “fair”; 0.60–0.74 “good”; 0.75–1.00 “excellent”).

Results
ICC for inter-observer reliability was good-excellent in 47/66 measurements. All measures of maximal esophageal diameter, maximal esophageal diameter cf. wrap opening diameter and posterior distal esophageal angulation were good-excellent (ICC range 0.74–0.78; 0.84–0.91; 0.68–0.80 respectively). Four parameters recorded 83% good-excellent ICC: wrap closing diameter, minimal wrap diameter, GEJ anterior displacement and degree of axis deviation (GEJ cf. esophagus) (ICC range 0.50–0.85; 0.58–0.93; 0.56–0.79; 0.41–0.77 respectively). Absolute and axial wrap length showed low reproducibility: “good” ICC in 25% of measurements. POb measurements were most reliable: good-excellent ICC 86% of times. Intra-observer reliability was excellent in 98% of measurements (ICC range 0.74–0.99).

Conclusion
Following a structured protocol, VFSS measurements of GEJ post-fundoplication anatomy are reliable between observers except for measures of absolute and axial wrap length. Measures from the POb view showed the greatest inter-observer reliability and may have higher clinical utility. Further studies using structured VFSS are warranted to determine the correlation between troublesome dysphagia and anatomical changes of the gastro-esophageal junction post-fundoplication.
106 THE HYBRID POSITION IS SUPERIOR TO THE PRONE POSITION FOR THORACOSCOPIC ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY
Authors: Kikuchi H , Hiramatsu Y , Soneda W , Kawata S , Hirotsu A , Matsumoto T , Kamiya K , Takeuchi H 
Published: September 2020

Abstract

Thoracoscopic esophagectomy (TE) is becoming a common surgical method for esophageal cancer. TE is performed with the patient the left lateral decubitus position, prone position, or hybrid position combining the left lateral decubitus and prone positions. However, only few studies have compared the clinical utility of these TE positions.

Methods
In our institute, we introduced TE in the prone position (prone TE) in 2014, and have performed TE in the hybrid position (hybrid TE) since March 2017. The present study compared the short-term outcomes of prone TE versus hybrid TE. One-hundred-and-three patients with esophageal or esophagogastric junction cancer who underwent TE between March 2014 and December 2019 were included. Patients were divided into those who underwent prone TE (prone TE group; n = 43) and those who underwent hybrid TE (hybrid TE group; n = 60). Clinicopathological data were retrospectively reviewed and compared between groups.

Results
There were no differences between groups in age, tumor histology, and tumor location. Compared with the hybrid TE group, the prone TE group had a smaller tumor depth (P &lt; 0.001), lower grade of lymph node metastasis (P = 0.003), and less severe tumor stage (P = 0.001). The operation time for the thoracoscopic procedure was shorter in the hybrid TE group (318.9 vs 249.2 min, P = 0.002). The rate of recurrent laryngeal nerve paralysis (Clavien-Dindo grade I–III) was significantly lower in the hybrid TE group (41.9% vs 11.7%, P &lt; 0.001), whereas there were no differences between groups in the rates of anastomotic leakage, atelectasis, or pneumonia.

Conclusion
The most significant differences between prone TE and hybrid TE involved the upper mediastinal procedures. In hybrid TE, the motion of the assistant’s forceps causes less interference with the operative field, and the angle at which the operator's forceps approach the upper mediastinal lymph nodes enables the maintenance of appropriate traction. These advantages of hybrid TE appeared to result in a shorter operation time and less recurrent laryngeal nerve paralysis compared with prone TE.
146 LEVEL OF DYSPHAGIA AND QUALITY OF LIFE FOLLOWING ENDOSCOPIC TREATMENT OF LOW-GRADE DYSPLASIA AND SUPERFICIAL ESOPHAGEAL CANCER
Authors: Hauge T , Hauge T , Franco-Lie I , Amdal C , Johnson E 
Published: September 2020

Abstract

Low-grade dysplasia (LGD) and superficial esophageal cancer (high grade dysplasia, T1a and superficial T1b) can be endoscopically treated according to most international guidelines, including the European Society of Gastrointestinal Endoscopy from 2017. The aim was to assess the level of dysphagia and health-related quality of life (HRQOL) in patients who underwent endoscopic treatment.

Methods
From 2014–2018 all patients with LGD and superficial esophageal cancer were included. The patients underwent endoscopic mucosal resection (EMR) and/or radiofrequency ablation (RFA). In June 2019 the patients were contacted per mail for assessment of the level of dysphagia and HRQOL, using the Ogilvie score and the European Organisation for Research and Treatment of Cancer (EORTC) core-questionnaire QLQ-C30 together with the disease-specific module QLQ-OG25.

Results
59 out of the 86 patients alive (69%) completed the questionnaires after a median follow-up of 28 months (8–65 months). 24% of the patients answering the questionnaires underwent EMR, 31% RFA and 44% both EMR and RFA. There was no significant difference (p &gt; 0.05) regarding the level of dysphagia, weight loss, global QoL and emotional status, neither with respect to a non-cancerous reference population nor between the treatment groups. For the other variables in QLQ-C30 and QLQ-OG25, the patients experienced significant lower HRQOL. 12% had minor problems eating solid food (Ogilvie score 1), of whom all underwent EMR.

Conclusion
The majority of patients endoscopically treated for LGD and superficial esophageal cancer experienced no dysphagia after a median follow-up of 28 months. The patients experienced significant lower HRQOL when being compared to an age-matched non-cancerous reference population. There was no difference regarding the level of dysphagia, weight loss, global QoL and emotional status.
195 RANDOMISED TRIAL OF LAPAROSCOPIC NISSEN VS. ANTERIOR 180 DEGREE PARTIAL FUNDOPLICATION—LATE CLINICAL OUTCOMES AT 15–20 YEARS
Authors: Rudolph-Stringer V , Bright T , Devitt P , Game P , Jamieson G , Watson D 
Published: September 2020

Abstract

Laparoscopic Nissen fundoplication for gastro-oesophageal reflux is followed by troublesome side effects in some patients. Partial fundoplications are proposed for reflux control with less side effects. We reported earlier outcomes from a randomised control trial of Nissen vs. anterior 180° partial fundoplication, with a good outcome following anterior 180° partial fundoplication at up to 10 years follow-up. For this study we determined very late clinical outcomes at up to 20 years follow-up.

Methods
107 patients were randomised to Nissen vs. anterior 180° partial fundoplication. 15–20 year follow-up data was available for 79 (41 Nissen, 38 anterior). Outcome was assessed using a standardised clinical questionnaire that included 0–10 analogue scores and yes/no questions to evaluate reflux symptoms, side-effects and overall satisfaction with surgery.

Results
Heartburn (mean score 3.2 vs 1.4, p = 0.001) and proton pump inhibitor use (41.7% vs 17.1%, p = 0.023) were higher, dysphagia for solids (mean score 1.8 vs 3.3, p = 0.015) was less, and ability to belch was better preserved (84.2% vs 65.9%, p = 0.030) after anterior fundoplication. Overall outcome measures were similar for both groups (mean satisfaction score 8.4 vs 8.0, p = 0.444; 86.8% vs 90.2% satisfied with outcome). Six patients underwent revision from anterior to Nissen fundoplication for reflux, and 5 from Nissen to partial fundoplication for dysphagia. Two further patients underwent revision following Nissen fundoplication for reflux and paraoesophageal hernia respectively.

Conclusion
At up to 20 years follow-up Nissen and anterior 180-degree partial fundoplication achieve similar rates over overall success, but with a demonstrable trade-off between better reflux symptom control vs. more side-effects after Nissen fundoplication.
249 TEXTBOOK SURGICAL OUTCOMES IN ESOPHAGEAL CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS.
Authors: Al Azzawi M , Bolger J , Whooley J , Trench L , Allen J , Bolger E , Downey E , Arumugusamy M , Robb W 
Published: September 2020

Abstract

High quality surgery remains the cornerstone of treating esophageal malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit have defined ten surgical and perioperative “textbook” parameters that correlate with improved overall survival in patients undergoing esophageal resection. In 2013, national key performance indicators were introduced in Ireland against which esophageal cancer resection was to be benchmarked. This project examines the effect of introducing the KPIs on the proportion of patients attaining “textbook” outcomes for esophagectomy.

Methods
A retrospective review of all esophagectomies and from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 “textbook” parameters were studied pre- and post-KPI introduction.

Results
269 underwent esophagectomy, 77 pre-KPI and 192 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p = 0.6), gender (72% male, 28% female vs 67% male, 23% female, p = 0.43), ASA grade (p = 0.6) or tumour stage (p = 0.37) pre- and post-KPI. In the pre-KPI era, 13/77 (17%) patients achieved all ten textbook parameters, compared with 79/192, (41%, p = 0.001) post-KPI. This compares favourably to DUCA “textbook” data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p = 0.002), a reduction in margin positivity (21% vs 7%, p = 0.001) and reduced peri-operative mortality (6% vs 2%, p = 0.03) post-KPI.

Conclusion
There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving “textbook” outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives.
271 OESOPHAGO-GASTRIC CANCER SURVIVAL IN SCOTLAND: LESSONS LEARNT FROM ESTABLISHING A NATIONAL NETWORK
Authors: McGregor R , Couper G , Lamb P , Petty R , MacDonald A , Forshaw M 
Published: September 2020

Abstract

Oesophageal cancer is the 9th most common cancer in Scotland, with 972 new cases in 2017. It remains the 4th most common cause of cancer death, with an estimated 5 year survival of 12.1%.
Scotland’s oesophago-gastric cancer network consists of 3 regional divisions, serving a population of 5.44 million. In 2017, survival data indicated survival differences across the 3 networks. This work analyses these outcomes and provides insight into the challenges faced by national collaboration.

Methods
Upper GI Cancer Quality Performance Indicators (QPIs) for patients diagnosed between January 1st 2013 and December 2015 were collected by clinical audit staff in each NHS Board and submitted centrally to the Information Services Division (ISD). Twelve QPIs are assessed and include: % discussed at MDT, % undergoing neo-adjuvant chemotherapy/CRT, 30/90 day mortality, length of stay, and R1 resection rates. Quality assurance of the dataset was assessed by analysing 20% of records submitted. Both univariate (log rank testing and Kaplan–Meier survival curves) and multivariate survival analysis (Cox’s proportional hazards model) were then performed on all patients across the networks.

Results
—Quality assurance of the dataset was high—96% accuracy of those records analysed.—Univariate analysis showed that increased age, higher deprivation scores, poor performance status, high tumour grade, an R1 resection, and a poor Charlson comorbidity index, had worse survival. Gender was not a significant survival factor. There was no difference at either network or health board level for all patients with oesophageal cancer.—multi-variate analysis revealed survival differences across the networks for radical treatment of oesophageal adenocarcinoma. In addition, the survival of patients receiving radical radiotherapy in one network appeared better than chemoradiotherapy for SCC.

Conclusion
This body of work highlights the challenges and pitfalls of establishing a national clinical network. Importantly, data collection and accuracy are high. Moreover, unlike other national collaboratives, data submission is compulsory. Whilst survival differences were detected across the clinical networks, further in depth analysis revealed confounding factors e.g. 23% of oesophageal cancers were stage “unknown”. The algorithm used at ISD did not capture stage T4a or b accounting for most of these patients.
329 GASTRECTOMY VERSUS ESOPHAGECTOMY FOR GASTROESOPHAGEAL-JUNCTION TUMORS: SHORT- AND LONG-TERM OUTCOMES FROM A NATIONAL AUDIT
Authors: Jezerskyte E , Mertens A , van Dieren S , Eshuis W , van Berge Henegouwen M , Gisbertz S 
Published: September 2020

Abstract

Both a total gastrectomy and an esophagectomy may be technically possible in a patient with a gastroesophageal (GEJ) carcinoma. The aim of this study was to investigate the morbidity, mortality, pathology results and long-term survival in patients following an esophagectomy or a total gastrectomy for GEJ cancer.

Methods
A retrospective comparative cohort study of prospectively collected data from the Dutch Upper-GI Cancer Audit combined with survival data of the medical insurance database of the Netherlands was performed. Patients with a GEJ carcinoma in whom a total gastrectomy or an esophagectomy was performed, between 2011–2016 were included. Primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, reinterventions, radicality of surgery, (y)pTNM stage and lymph node yield were secondary endpoints.

Results
A total of 999 patients were included: 918 underwent an esophagectomy and 81 underwent a gastrectomy. Postoperative morbidity (54.9% vs 49.4%, p = 0.336), mortality (30-day; 2.3% vs 3.7%, p = 0.436; 90-day: 1.9% vs 2.5%, p = 0.662) and 3-year conditional survival (38.3% vs 30.3%, p = 0.553) did not differ significantly between groups. A longer ICU-stay (median 2 [IQR1–4] vs 1 days [IQR0–2], p &lt; 0.001) and a lower lymph node yield (median 17 [IQR 12–23] vs 21 [IQR 16–31], p &lt; 0.001) were seen following esophagectomy. The 3-year overall survival was 37.4% after esophagectomy and 28.4% after gastrectomy (HR 1.047, 95%CI 0.795–1.380, p = 0.742).

Conclusion
Patients with GEJ tumors after an esophagectomy required longer ICU-stay and had comparable short-term morbidity and mortality when compared to a total gastrectomy. Long-term overall and conditional survival was not significantly different between groups. The two procedures are therefore largely comparable from an oncological viewpoint, and the choice for either procedure might also be based on other outcomes such as quality of life.
353 ADJUVANT CAPECITABINE AND CISPLATIN VERSUS SURGERY ALONE IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA: MULTICENTER RANDOMIZED PHASE 3 TRIAL
Authors: Yun J , Lee G , Kang D , Cho J , Zo J , Kim K , Park S , Na K , Im Y , Kim S , Shim Y 
Published: September 2020

Abstract

There is limited evidence for effectiveness of adjuvant chemotherapy in esophageal squamous cell carcinoma. We conducted a multi-center randomized controlled trial to assess whether adjuvant Capecitabine and Cisplatin improve survival compared with surgery only among patients with resectable esophageal squamous cell carcinoma.

Methods
This is a multicenter randomized controlled trials conducted at five hospitals in Korea from Mar 2005 to Dec 2018. Patients were eligible if they underwent curative resection for esophageal squamous cell carcinoma and diagnosed with pathologic T2–3 or N1 stage, according to 6th edition of TNM cancer staging system. Patients who were diagnosed with cervical esophageal cancer, had previous history of cancer, or received neoadjuvant therapy were excluded. Intervention group received 4 cycles of adjuvant chemotherapy (Capecitabine 1,000 mg/m2 b.i.d for 14 days and intravenous Cisplatin 75 mg/m2 at Day1, every 3 weeks). The primary endpoint was disease free survival.

Results
136 patients were randomly assigned to adjuvant chemotherapy group (n = 68) or surgery alone group (n = 68). Seven patients who rejected chemotherapy after randomization were excluded from the final analysis. The cumulative incidence of recurrence within 18 months after surgery was significantly lower in the adjuvant chemotherapy group compared to the surgery alone group (Hazard Ratio (HR), 0.45; 95% Confidence Interval (CI), 0.22–0.91). After long-term follow-up (median 3.3 years, maximum 14 years), disease free survival and overall survival were not different between two groups. (HR, 0.77; 95% CI, 0.49–1.18 and HR, 0.85; 95% CI, 0.55–1.34, respectively.)

Conclusion
Adjuvant chemotherapy after curative resection in patients with esophageal squamous cell carcinoma reduced early recurrence but this does not extend to long-term disease free and overall survival due to limited sample size. Additional randomized controlled trials with larger sample would be necessary to confirm the effectiveness of adjuvant chemotherapy in esophageal squamous cell carcinoma.
357 HAND-SEWN VERSUS STAPLED CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CARCINOMA: STUDY OF CLINICAL OUTCOMES FROM A HIGH VOLUME CENTER OF INDIA
Authors: Purkayastha J 
Published: September 2020

Abstract

Esophageal cancer is a dreaded disease because of its adverse effects on swallowing and therefore the quality of life. Surgical resection offers the best outcome. The mainstay of any esophageal surgery is a well healed anastomosis without any leakage or stricture. Various techniques of anastomosis have been described. Hand sewn suture have been used since long. Surgical staplers have been recently introduced. We hereby describe a comparative study between these two surgical techniques.

Methods
Patients undergoing total esophagectomy with neck anastomosis between January 2013 and March 2019 were analysed. Esophagectomy was done by either trans-thoracic or trans-hiatal approach. The stomach was utilized as conduit and anastomosis was done in the neck in all patients. The gastric conduit was pulled into the neck by the posterior mediastinal route. End to side hand sewn anastomosis (HA) was done in 85 patients using 3-0 non absorbable sutures as a single full thickness layer. Side to side stapler anastomosis (SA) was done by posterior vertical and anterior horizontal firing of 45 mm blue linear stapler in 61 patients.

Results
The primary outcome measure was anastomotic leak. The secondary outcome measures included operative time, anastomosis time, blood loss, anastomotic stricture, mean intensive care unit(ICU) stay, ambulation, removal of intercostal drains, starting of feeding jejunostomy and oral feeds, mean hospital stay. Statistical analysis was done using SPSS. There was 9 cases anastomotic leak in the HA group while in the SA group there were none. Anastomotis stricture occurred in 12 patients in HA group while 3 werein the SA group and it’s statistically significant. The anastomotic time, ICU stay, time of starting oral feeds and mean hospital stay were statistically significant.

Conclusion
A well-healed anastomosis is the mainstay of the successful outcome of esophagectomy. Anastomotic leaks and strictures were the main complications of esophageal surgery. Various techniques of anastomosis have been described over the years. HA has been the standard of care since the inception of esophageal surgery. As technology developed SA got introduced and was found to have certain advantages over HA as shown in our study. SA may be used as preferred technique for esophago-gastrostomy.
364 IMPACT ON SURGICAL AND ONCOLOGIC OUTCOMES OF NEOADJUVANT CHEMOTHERAPY VERSUS SURGERY ALONE IN ELDERLY PATIENTS WITH LOCALLY INVASIVE GASTROESOPHAGEAL CANCER
Authors: Antoun A , Kammili A , Naghawi H , Alcindor T , Asselah J , Vanhuyse M , Cools-Lartigue J , Ferri L , Mueller C 
Published: September 2020

Abstract

Neoadjuvant chemotherapy (nCT) has an increasingly important role in the treatment of locally invasive gastric and esophageal adenocarcinoma. However, its outcomes have not been examined in cohorts of exclusively elderly patients who may not experience the same benefits as younger patients and are more vulnerable to adverse events from the treatment. The purpose of this study is to determine the impact of nCT on outcomes among elderly patients with gastric and gastroesophageal adenocarcinoma.

Methods
All patients who underwent curative-intent surgery for gastric and gastroesophageal adenocarcinoma between 2010 and 2018 at a high-volume multidisciplinary referral center were identified from a prospectively collected database. Early stage tumours at diagnosis (T1N0 or T2N0) and emergency resections were excluded. Patient characteristics, surgical outcomes and oncologic outcomes were verified by chart review and death dates verified using provincial registry data. Comparison was made for all variables between patients who were treated with nCT and those who were treated with surgery alone (SA). Subgroup analysis among patients aged 70+ was conducted to determine differences in outcomes among elderly patients.

Results
Of 766 cases in the database, 354 met inclusion criteria (SA: 99 vs nCT: 255). Of those who received nCT, 77 (30.3%) were ≥ 70 years of age. When compared to younger patients, this cohort experienced significantly more high-grade toxicity from chemotherapy (&lt;70: 32 (18.1%); 70+: 25 (32.5%); p = 0.017), but completion rates and timely progression to surgery were similar between groups (Table 1). Multivariate analysis among elderly patients showed that patients who had nCT had similar overall survival (HR 1.04, 95% CI 0.35-1.19) and disease-free survival (HR 1.04, 95% CI 0.41-1.36) to those who were treated with SA.

Conclusion
Neoadjuvant chemotherapy administered to elderly patients with locally advanced gastroesophaeal adenocarcinoma results in higher rates of high-grade toxicity with no difference in long term oncologic outcomes when compared to surgery alone. Consideration should be given to upfront surgery for elderly patients with resectable gastric and gastroesophageal tumours at presentation.