bluuebunny/crossref_metadata_2025_split huggingface dataset:
83 10-YEAR CHANGES IN DIETARY HABITS AND MEDICAL KNOWLEDGE OF ESOPHAGEAL CANCER IN A HIGH-INCIDENCE AREA: A POPULATION-BASED STUDY
Authors: Tian D , Huang H , Jiang K , Wen H , Fu M 
Published: September 2020

Abstract

Yanting was reported as a high-incidence area of EC with an unclear etiology. Many preventative measures and control policies have been performed during recent years in Yanting County, but no study has examined the changes in dietary habits and medical knowledge of EC during this decade. This study aimed to compare the differences in dietary habits, food group intake and medical knowledge of EC among residents of Yanting between 2007 and 2017.

Methods
Using a self-designed questionnaire, we investigated rural residents from Yanting county in the year 2007 and 2017. The 10-year changes of demographic features, personal dietary habits, food groups and medical knowledge of EC were compared. The results were then statistically analyzed. This study is based on a household survey of 570 and 898 rural residents aged 18+ years from Yanting County conducted in 2007 and 2017, respectively.

Results
Participants in the year 2007 were more likely to consume foods of lower toughness, have a slower speed of eating, have hotter temperature food, and have rice as a staple food less often (P &lt; 0.05). Residents in the year 2007 ate more preserved foods but fewer fresh foods than those in the year 2017 (P &lt; 0.05). Participants in the year 2017 improved their medical knowledge compared to those in the year 2007, which was conceptualized as a clear understanding of medical insurance for EC, common causes of EC, therapeutic measures for EC, preventive measures for EC, and government interventions (P &lt; 0.05).

Conclusion
Although the medical knowledge of participants in year 2017 have changed a lot, most of them also never head of detail knowledge on EC. Residents in the year 2017 had healthier dietary habits and better medical knowledge of EC than those in the year 2007, while prevention and control measures in Yanting should be strengthened persistently.
91 SIMPLE, HIGHLY SENSITIVE CLINICAL PREDICTION SCORES FOR RULING OUT ESOPHAGEAL ADENOCARCINOMA IN PATIENTS WITH BARRETT’S ESOPHAGUS
Authors: Chahal D , Pi S , Sharma V , Duggan S , Donnellan F , Enns R 
Published: September 2020

Abstract

Barrett’s Esophagus (BE) is a risk factor for development of Esophageal Adenocarcinoma (EAC). Detection of EAC at an earlier stage is known to improve patient outcomes, but only a very small proportion of patients with BE will progress to EAC. Even in the context of established risk factors, it is difficult to rule out EAC in patients with BE prior to or during endoscopy.

Methods
We performed a retrospective chart review of all patients with non-dysplastic BE, dysplastic BE and EAC diagnosed at St. Paul’s Hospital from 2012–2016 to investigate patient characteristics that would establish a risk score to discriminate patients with EAC from those without EAC.

Results
132 patients were identified. Patients with EAC had higher rate of smoking history (52.4% vs. 20.7%, p = 0.002), higher rate of prior malignancy (33.3% vs. 8.1%, p = 0.001), older mean age (71.0 +/− 8.3 vs. 61.3 +/− 12.2, p = 0.001), greater frequency of carcinoid malignancy (9.5% vs 0.0%, p = 0.024), greater incidence of family history of breast cancer (22.2% vs. 6.2%, p = 0.027) and lung cancer (23.5% vs. 4.1%, p = 0.004) and greater rate of endoscopic mucosal irregularity (85.7% vs. 28.8%, p &lt; 0.001). A clinical risk score to discriminate between patients with EAC from those without EAC had an AUC of 0.90 and NPV of 0.97.

Conclusion
We have devised clinical risk scores that could be used Risk scores, in combination with established factors such as degree of dysplasia, may help triage patients with BE appropriately with regards to timing of endoscopy. By ruling out EAC and in low risk patients, high risk patients might be monitored more carefully which could lead to earlier detection of EAC and improved patient outcomes.
176 SURGICAL MANAGEMENT OF CORROSIVE INJURIES OF ESOPHAGUS AND STOMACH—A 5 YEAR SINGLE CENTER EXPERIENCE
Authors: Raj A , S P , Bhoopathi S , Ahanatha Pillai S 
Published: September 2020

Abstract

Corrosive injuries to the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's last 5-year experience in surgical management of corrosive injuries of oesophagus and stomach.

Methods
The aim of this study was to analyze the circumstance, demographic features, clinical findings and complications of caustic ingestion, the various surgical procedures performed and their short and long term outcomes. The records of 20 patients who underwent surgery for corrosive injuries of the oesophagus and stomach in our institution over a 5-year period (Jan2015-Dec2019) were retrospectively analyzed.

Results
Of 20 patients 13(65%) were accidental and 7(35%) were suicidal. Median age was 31 years with 75%males & 25%females. Presenting complaints were weight-loss(95%), dysphagia(65%) & vomiting(50%). Distributions of strictures were oesophageal, gastric or combined. 70% (N = 14) underwent feeding jejunostomy(FJ) as initial procedure. Isolated oesophageal strictures were managed by dilatation followed by gastric-pull through(N = 4)/coloplasty(N = 2). Isolated gastric strictures were managed Antrectomy (N = 5), distal/total gastrectomy (N = 2). Combined strictures were managed with coloplasty with antrectomy and Billroth I (N = 3) or coloplasty with Colo-jejunal anastomosis (N = 1). One patient underwent emergency esophagogastrectomy+cervical-oesophagostomy for perforation. Mortality rate was 15%(3/20).

Conclusion
Management of corrosive strictures varied between individual patients requiring a injury based surgery. Extensive injury with perforation, peritonitis or mediastinitis needed emergency surgery but associated with high mortality. Dilatation frequently failed in long segment strictures. High pharyngeal strictures were associated with higher morbidity. Isolated gastric strictures were easiest to manage. Corrosive strictures of oesophagus and stomach are difficult to manage and surgery has to be tailored according to site and extent of oesophageal/gastric stricture.
232 HYBRID MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: FIVE-YEAR SURVIVAL RESULTS OF THE MIRO TRIAL.
Authors: Nuytens F , Dabakuyo-Yonli S , Meunier B , Pezet D , Collet D , DJourno X , Brigand C , Perniceni T , Carrère N , Mabrut J , Msika S , Peschaud F , Prudhomme M , Mariette C , Markar S , Piessen G 
Published: September 2020

Abstract

Multiple randomized controlled trials have demonstrated the short term benefits of (hybrid) minimally invasive esophagectomy (MIE) over open esophagectomy. Data regarding long term results are more conflicting with similar or even better results in the MIE arm. In this follow-up study of the MIRO-trial we evaluated the long-term 5-year outcomes including overall survival (OS), disease-free survival (DFS) as well as the pattern of disease recurrence, along with evaluation of potential prognostic factors affecting these outcomes.

Methods
From October 2009 till April 2012, we conducted a multicentre, open-label, prospective, randomized, controlled trial including patients who were diagnosed with thoracic esophageal cancer and eligible for curative surgical resection (Ivor-Lewis procedure). Patients were randomized between hybrid minimally invasive esophagectomy and open esophagectomy. The primary end-point of the initial MIRO trial was major intra- and postoperative complication (Clavien-Dindo ≥2) within 30 days after surgery. The primary end-points of this follow-up study were OS and DFS. Additional secondary end points were defined as site of disease recurrence and potential prognostic or mediating factors associated with DFS and OS.

Results
207 patients underwent randomization. The median follow-up was 58,2 (95% CI, 56,5– 63,8) months. The 5y OS was 59% (95% CI, 48–68) and 47% (95% CI, 37–57) in the hybrid- and open-procedure group respectively (HR, 0,71, 95% CI, 0,48-1,06). The 5y DFS was 52% (95% CI, 42–61) in the hybrid-procedure group vs. 44% (95%CI, 34–53) in the open-procedure group. (HR 0.81 (95% CI, 0,55-1,17). There was no significant difference in recurrence rate (p = 0.519) or -location (p = 0.692) between groups. In a multivariate analysis, major postoperative and pulmonary complications were identified as prognostic factors of impaired OS (p &lt; 0.0001;p = 0.005) and DFS (p = 0.002;p = 0.006).

Conclusion
Besides a significant reduction in postoperative overall and pulmonary complication rate, minimally invasive (hybrid) esophagectomy offers long-term oncological results that are at least equivalent to open esophagectomy. Postoperative and pulmonary complications are independent prognostic factors for impaired overall- and disease-free survival, providing additional proof that minimally invasive esophagectomy could even be associated with better long-term oncological results compared to open esophagectomy mediated by a reduction in postoperative complications.
242 ABANDONING RESECTIONAL INTENT IN PATIENTS INITIALLY DEEMED SUITABLE FOR ESOPHAGECTOMY; A NATIONWIDE STUDY OF RISK FACTORS AND OUTCOMES
Authors: Edholm D , Lindblad M , Linder G 
Published: September 2020

Abstract

The main curative treatment for esophageal cancer is resection. In some cases, patients initially deemed suitable for resection become unsuitable, often due to signs of generalized disease or having become unfit for surgery.
The aim of the present study was to assess frequency and risk factors for patients initially deemed suitable for esophagectomy becoming ineligible for resection.

Methods
All patients in the Swedish National Quality Register for Esophageal and Gastric Cancer from 2006 to 2016 were included and risk factors associated with becoming ineligible for resection were analyzed and adjusted in multivariable logistic regression analysis calculating Odds ratios (ORs) with 95% Confidence intervals (CIs).

Results
A total of 1792 patients were planned for resection, of these 303 (17%) became ineligible for resection (114 patients were non-resectable and 189 patients never progressed to surgery). High and intermediate educational level was associated with an increased probability of resection (OR 1.80 95% CI 1.21–2.66 and OR 1.49 95% CI 1.07–2.09, respectively) while patients with clinically advanced disease were more likely to become ineligible (cT4a: OR 0.34, 95%CI 0.14–0.0.87, cN3: OR 0.26, 95%CI 0.09–0.79 respectively). Patients given neoadjuvant treatment were also more likely to become ineligible for surgery (OR 0.62 95%CI 0.46–0.86).

Conclusion
Of those planned for resection for esophageal cancer, 17% never progressed to esophagectomy. High educational level was associated with an increased chance of undergoing resection whereas clinically advanced disease and neoadjuvant treatment were independent factors associated with increased risk of abandoning resectional intent.
253 COMPARISON OF LEFT LATERAL POSITION AND PRONE POSITION IN THORACOSCOPIC ESOPHAGECTOMY
Authors: Tabuchi S , Koyanagi K , Koganezawa I , Nakagawa M , Yokozuka K , Kobayashi T , Miyoshi K , Ozawa Y , Sano T , Tomita K , Tsutsui R , Shigoka M , Chiba N , Katayanagi S , Hidaka E , Kawachi S 
Published: September 2020

Abstract

Thoracoscopic esophagectomy for esophageal cancer has been widely introduced and performed in many institutions. However, the position is different by institutions in left lateral position and prone position. We first started thoracoscopic esophagectomy in the left lateral position (group L), then it was changed in the prone position (group P). In the study, we assessed the differences in the surgical results and early operative complications according to the patients’ position.

Methods
A total of 20 patients underwent thoracoscopic esophagectomy. The group L included 12 patients consisted of 8 male and 4 females with median age of 72 between 2015 and 2017. The group P included 8 patients consisted of 5 male and 3 females with median age of 70 between 2017 and 2020. The surgical results and postoperative complications were compared between the two groups.

Results
The operative time was 504 minutes in the group L, 614 minutes in the group P (p = 0.043), and the blood loss was 55 mL in the group L and 65 mL in the group P (p = 0.615). Recurrent laryngeal nerve palsy was observed in 2 cases in the group L and none in the group P. And, the pneumonia was observed in 1 case of the group L. In our hospital, the operative time was longer in the prone position than in the left lateral position, but the complication tended to be little.

Conclusion
Although sample number was small in our study, the prone position might have some advantages because no pneumonia and recurrent laryngeal nerve palsy occurred in the group P. Furthermore, we experienced better ergonomics in the prone position because movement of the forceps was easier in the prone position.
255 OUTCOME OF ADDITIONAL ESOPHAGECTOMY AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR C-MM-SM1ESOPHAGEAL CANCER.
Authors: Fujita H , Minamiya Y , Nagaki Y , Sato Y , Wakita A , Motoyama S 
Published: September 2020

Abstract

For patients diagnosed cT1(MM-SM1)N0 esophageal cancer, we perform endoscopic submucosal dissection (ESD) as a primary treatment. Furthermore, additional treatments were performed for the patients diagnosed pT1b(SM) in resected tumor by ESD. Our aim of this study is to investigate whether additional esophagectomy after non-curative ESD can be considered a valid treatment.

Methods
Forty-four patients who received esophagectomy with lymph node (LN) dissection in neck, mediastinum and upper abdomen as additional surgery after non-curative ESD between 2006 and 2019 were enrolled. Histological examination revealed that squamous cell carcinoma in 41 and adenocarcinoma in 3 patients. We examined the rate of pathological LN metastasis and outcomes of patients received esophagectomy.

Results
The cT was LPM in 9(20%), MM-SM1 in 35 (80%) patients. However, the pT was MM in 3(7%), SM1 in 14 (32%) and SM2 in 27 (61%) patients. Lymphatic invasion was positive in 32 (73%) and venous invasion was positive in 16(36%) patients. Seven patients had pathological metastatic LN (1–2 LNs/case) (total 10 metastatic LNs). The metastatic LNs existed in neck, mediastinum and upper abdomen. The recurrences were occurred in 2 patients (No.106recL LN and No. 112ao-A LN). One patient died by esophageal cancer (LN recurrence, 38 months alive). One patient died of gastric tube ulcer perforation (16 months).

Conclusion
We showed that esophagectomy with extended LN dissection is sufficient as additional treatment for the patients treated non-curative ESD. To expand the indications of ESD for pSM esophageal cancer, new methods are needed, such as the risk diagnosis of LN metastasis using genetic analysis.
256 DRAINAGE OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: THROUGH THE FISTULA OR NOT, WHICH IS BETTER?
Authors: Dai L , Zhao X , Yang Y , Fu H , Chen K 
Published: September 2020

Abstract

Thoracic abscess and/or mediastinal abscess due to anastomotic leakage after esophagectomy are very serious postoperative complications, and adequate surgical drainage is of critical importance to treatment. In this study, we compared the treatment efficacies of two drainage methods (through-the-fistula or not-through-the-fistula).

Methods
We retrospectively collected the esophageal cancer patients who underwent surgery from Jan 2016 to Aug 2019 who had complications of anastomotic leakage which was above grade III according to Lerut grading system. The drainage methods of thoracic/mediastinal abscess were drainage tube through-the-fistula (TF) (with the aid of X-ray or endoscope) and not-through-the-fistula (nTF) (via thorax or neck). According to the time from drainage tube placed to stable of the fistula, the patients were divided into fast stable group (&lt;14 days) and slow stable group (≥14 days), and the differences of clinical characteristics and drainage methods were compared.

Results
Among the 495 cases underwent surgery, 43 (8.7%) had anastomotic leakage, 20 (4.0%) of which were grade III. 8 obtained fast stable and 12 were slow stable. As to drainage efficacy, there were 87.5% and 16.7% of the cases adopted TF drainage in fast stable group and slow stable group, respectively (P = 0.002). As to safety, there were 1 case in TF group that needed repeated drainage, whereas in nTF group, there were 2 cases died of bleeding and 2 cases needed repeated drainage (P = 0.319). Furthermore, there were 2 residual cavity cases after recovery in the nTF group.

Conclusion
TF drainage is safe and reliable for the thoracic/mediastinal abscess caused by anastomotic leakage after esophagectomy, which was better compared to nTF drainage, and facilitated recovery of the anastomosis.
261 LENGTH OF HOSPITAL STAY AND THE ASSOCIATION WITH READMISSION AFTER UNCOMPLICATED ESOPHAGECTOMY. SIGNIFICANT HOSPITAL VARIATION IN THE NETHERLANDS.
Authors: Voeten D , Werf L , Sandick J , Hillegersberg R , Berge Henegouwen M 
Published: September 2020

Abstract

Prolonged length of hospital stay is a negative outcome of esophageal cancer surgery, not only for the patient; it also leads to increased hospital costs. Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay and to investigate its association with readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients after an uncomplicated esophagectomy.

Methods
All patients registered in the Dutch Upper GI Cancer Audit (DUCA) who underwent a potentially curative esophageal cancer resection between 2015 and 2018 were considered for inclusion. Patients were excluded if they had an intraoperative and/or postoperative complication, if they were retransferred to the intensive care unit, or if they had undergone a re-intervention. Length of hospital stay was dichotomized around the national median into “short admissions” and “long admissions”. Hospital variation was evaluated using a case-mix corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with readmission rates was investigated using the χ2-statistic.

Results
A total of 1,007 patients was included for analyses. National median length of hospital stay was 9 days, ranging from 6.5–12.5 days among 17 hospitals. The percentage of “short admissions” per hospital ranged from 7.7% to 93.5%. After correction for case-mix variables, 2 hospitals had significantly higher “short admission” rates and 4 hospitals had significantly lower “short admission” rates (figure 1). Overall, 6.2% (hospital variation [0.0%–13.2%]) of patients was readmitted. Hospital readmission rates were not significantly different between hospitals with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19).

Conclusion
Based on these nationwide audit data, length of hospital stay after an uncomplicated esophagectomy varied significantly between hospitals and ranged from 6.5 to 12.5 days among Dutch hospitals. Short length of hospital stay was not associated with a higher readmission rate. The hospital variation indicates that enhanced recovery programs are not implemented at the same level of efficacy among hospitals in the Netherlands. Nationwide improvement might lead to a substantial reduction of hospital costs.
302 IS 18F-FDG PET/CT PARAMETERS USEFUL IN PREDICTING PATHOLOGICAL RESPONSE TO NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CARCINOMA?
Authors: Tustumi F , Takeda F , Duarte P , Albenda D , Sallum R , Ribeiro Junior U , Buchpiguel C , Cecconello I 
Published: September 2020

Abstract

The 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT) provides an ability to functionally evaluate metabolic activity improving patient selection for surgical treatment. The value of SUVmax, MTV and TLG from FDG PET/CT of primary tumor and lymph nodes in the setting of neoadjuvant chemoradiotherapy for esophageal cancer in predicting pathological response to neoadjuvant therapy is the aim of this study.

Methods
A retrospective cohort study was performed, assessing the correlation of SUVmax and volumetric parameters (MTV and TLG) of 18F-FDG PET/CT prior and post to neoadjuvant therapy for esophageal carcinoma with the pathological response as outcomes.

Results
One hundred and seventeen patients were included. The higher AUC values in predicting pathological complete response were obtained for the primary tumor, on post neoadjuvant therapy. These variables showed high sensibility, but low specificity (SUVmax: AUC: 0.71, 95% CI: 0.55–0.87; MTV: AUC: 0.7, 95% CI: 0.54–0.86; TLG: AUC 0.71, 95% CI: 0.55–0.87).

Conclusion
PET-Scan functionally evaluates metabolic activity, and the absolute values and changes of SUVmax and volumetric variables provide important information for pathological tumor response to neoadjuvant chemoradiotherapy.
304 DOES INTRAOPERATIVE FLUID MANAGEMENT INFLUENCE THE POSTOPERATIVE HOSPITALIZATION IN PATIENTS UNDERGOING ROBOTIC-ASSISTED ESOPHAGECTOMY
Authors: Tatakuri M , Murthy H , K J 
Published: September 2020

Abstract

Esophageal resection is a formidable surgery which is often associated with high morbidity and mortality rate despite an improvement in postoperative care. Fluid administration has been described to be a major factor that contributes to the development of postoperative complications after esophagectomy. The aim was to study the relationship between intraoperative fluid administration and the postoperative hospitalization stay

Methods
After hospital ethical committee approval, 69 patients who underwent Robotic-assisted esophagectomy dated from January 2011 to till date were accessed from the hospital electronic databank. Single lung ventilation was used in all of the patients during the thoracic approach. 69 patients were divided into two groups with respect to patients in first group who received 4 litres and below and the second group who received 4litres and above of crystalloids. Variables studied were ASA status, demographic data, intraoperative fluids administered, ventilator mode, positioning, postoperative parameters studied were icu stay, sepsis, ionotropic support, respiratory distress, reexploration, readmission to icu.

Results
None of the variables studied except fluid administration were shown as risk factor.

Conclusion
Anesthetic regimen directed at a restrictive intraoperative fluid of less than 4 litres has reduced the postoperative morbidity rates and the duration of hospital stay in patients undergoing Robotic esophagectomy.