bluuebunny/crossref_metadata_2025_split huggingface dataset:
77 CUTOFF VALUE OF SERUM C-REACTIVE PROTEIN ON THE FIFTH POSTOPERATIVE DAY IS EFFECTIVE TO RULE OUT ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Hubaud V , Bottet B , Chenesseau J , Gust L , Bouabdallah I , Brioude G , Trousse D , Thomas P , D'journo X 
Published: September 2020

Abstract

Anastomotic leakage is one of most severe complications after esophagectomy. There is no consensus on the best method of identification of such complications. Serum C-reactive protein measurement on postoperative day 5 (POD) has been reported to be reliable to rule-out leakage.

Methods
We prospectively assessed the medical records of consecutive post-esophagectomy patients from January 2019 to January 2020. We analyzed serum CRP and complete blood cell counts from the day before surgery to the POD5. A CRP level ≤ 150 mg/l at POD5 was considered sufficient to start oral feeding. In contrast a CRP level &gt; 150 mg/l at POD5 lead to a computed tomography (CT) with oral contrast to rule-out the presence of an anastomotic leakage. Anastomotic leakage was classified according to ECCG classification. Sensibility, sensitivity, positive and negative predictive value of CRP were calculated.

Results
Over a 12-month period, 52 patients were included (Figure 1). Measurement of CRP on POD5 was ≤150 mg/l in 34 (64%) patients (32 without fistula and 2 with fistula diagnosed after POD5) and &gt; 150 mg/L in 18 (36%) patients (8 without fistula and 10 with fistula). Twelve (23%) patients developed anastomotic fistula. The cutoff value of CRP ≤150 mg/l on the POD5 was associated with sensitivity 83%, specificity 80%, positive predictive value 56% and negative predictive value 94%. The CRP protocol allowed to avoid 30/52 (57%) unnecessary postoperative CT-scan.

Conclusion
On the basis of a high negative predictive value, a CRP level at POD5 ≤ 150 mg/l can be effective to eliminate an anastomotic leakage and to start oral feeding without any further exams. This information is useful in the context of ERAS protocols to reduce hospital discharge and decrease hospital costs.
541 UTILIZING THE INTERNATIONAL WEB-BASED ESODATA DATABASE TO AUDIT AND DOCUMENT EVOLUTION IN ECCG COMPLICATIONS INCIDENCE, DEFINITIONS AND QUALITY MEASURES
Authors: Kuppusamy M ,   International Esodata Study Group
Published: September 2020

Abstract

The Esophageal Complications Consensus Group (ECCG) standardized the reporting of complications associated with esophagectomy in 2015. Since then, international data on patients’ perioperative outcomes have been prospectively recorded in the web-based Esodata.org dataset. This international collaboration provides a unique opportunity to utilize a standardized reporting platform to report current esophagectomy outcomes as well as the evolution of outcomes and quality measures associated with esophagectomy over time.

Methods
Esophagectomy data on complications and quality measures have prospectively been collected on the Esodata dataset since 2015. Between January 2017 and January 2019, 41 high volume centers recorded outcomes on 3,318 esophageal resections at their institutions. Current complication incidence, as well as trends in patient demographics, operative approaches and quality outcome measures were compared between the 2,407 esophagectomies done between 2015 and 2016 and the 3,318 patients recorded between 2017–2018. Overall results of 6,022 resections in the entire Esodata database as of January 2019 are also reported.

Results
Demographic outcomes of 6,022 patients included males 78.3%, mean-age 63.3, resections for cancer 96.6%. Operative demographics included minimally invasive procedures 52.8%, chest anastomosis 63.7%, neoadjuvant chemoradiotherapy 48.7% and R0 resections 93.5%. Quality measure outcomes included readmissions 9.7%, 30- and 90-day mortality 2.0% and 4.5%, transfusions 12%, escalation in care 22.1%, and discharge home 89.4%. For trends in complications, see Table 1. Trends in quality measures demonstrated improvements in readmissions 11.1–8.5%, blood transfusions 14.3–10.2%, escalation in care 24.5–20% but a decrease in patients being discharged home 91.4–87.8%. Anastomotic leak increased from 11.7% to 13.1% (NS) but leaks requiring surgery decreased 3.3–3.0%.

Conclusion
The ECCG complications, definitions and quality measures platform provided a standardized approach to not only benchmark outcomes including complications but also to assess trends in service delivery and outcomes over time. The International Esodata Study Group and the Esodata database provided a robust vehicle for assessing contemporary international demographics and outcomes, monitoring practice trends and carrying out future prospective studies.
605 STEPWISE APPROACH TO ROBOTIC SURGERY IN A HIGH-VOLUME CENTER WITHOUT PREVIOUS EXPERIENCE IN ROBOTIC ESOPHAGEAL SURGERY
Authors: Riva P , Pansa A , Da Roit A , Basato S , Marano S , Castoro C 
Published: September 2020

Abstract

Minimally Invasive esophagectomy has been introduced to reduce the trauma associated with open surgery while keeping the same oncological outcome. Robotic platforms could facilitate this.
Even with the increasing availability of surgical robots and the standardization of the technique, it can be difficult to convince high volume centers to change their surgical approach.
Our aim is to assess the impact of the learning curve for robotic surgery in a high-volume laparoscopic center.

Methods
We retrospectively analyzed a prospectively collected database in a tertiary referral center for esophagogastric surgery. We identified two groups composed by the patients who underwent Ivor-Lewis (IL) esophagectomy by a hybrid laparoscopic (HL) approach (standard laparoscopy + open thoracotomy) and those who underwent a hybrid robotic (HR) approach (robotic abdominal part + open thoracotomy) with the Davinci Xi surgical platform for lower esophageal or EGJ cancer from November 2018 to September 2019.
Data regarding post-operative stay, complications, leaks, total number of lymph nodes and length of surgery were analyzed. Complications were reported according to the ECCG classification.

Results
We selected 50 consecutive IL cases among which there were our first 17 HR cases. There were no differences in terms of demographics, comorbidities and neoadjuvant treatments between the two groups.
No statistical difference was observed in post-operative stay(median 12 vs 10 days in HL and HR respectively, p = 0.09), overall complication rate was 33% in HL and 35% in HR(p = 0.9), patients with leaks 1(3.03%) in HL and 1(5.88%) in HR(p = 0.6), total lymph nodes median of 38 in HL vs 30 in HR(p = 0.4). Only the total length of surgery was statistically longer in the HR group (median 446 vs 478 min, p = 0.01).

Conclusion
We showed that in the setting of a high-volume center with no previous robotic surgery expertise, robotically performing only the abdominal phase could represent an effective alternative to familiarize with the robotic system without compromising the clinical outcome and workflow.
We understand that the main advantages would be seen when using the robot during the thoracic part. After these first cases we will proceed to adopt it during the most demanding part of the operation.
95 DIRECT ORAL FEEDING AFTER A MINIMALLY INVASIVE ESOPHAGECTOMY: A SINGLE-CENTER PROSPECTIVE COHORT STUDY
Authors: Fransen L , Janssen T , Aarnoudse M , Nieuwenhuijzen G , Luyer M 
Published: September 2020

Abstract

A recent randomized controlled trial showed the safety and feasibility of direct oral feeding following a minimally invasive esophagectomy (MIE). However, significant differences were found regarding complication rate between hospitals, potentially influencing the effect of direct oral feeding. This study aimed to investigate the effect of direct oral feeding compared to the standard of care in a center with low anastomotic leakage and overall complication rates following a MIE.

Methods
Patients in this single-center prospective cohort study received either direct oral feeding (intervention group) after a MIE with intrathoracic anastomosis or nil-by-mouth for 5 days postoperative and tube feeding (standard of care). Primary outcome was time to functional recovery—defined as adequate pain control with oral analgesics, recovery of mobility, sufficient caloric intake, no intravenous fluid therapy and no signs of active infection—and length of hospital stay. Secondary outcomes included anastomotic leakage, pneumonia, cardiopulmonary complications and other (surgical) complications.

Results
Baseline characteristics were similar in the intervention (n = 85) and control (n = 111) group. Median time to functional recovery was respectively 7 versus 9 days in the intervention and control group (p &lt; 0.001). Median length of hospital stay was respectively 8 versus 10 days in the intervention and control group (p &lt; 0.001). Thirty-day postoperative complications were significantly lower in the intervention group (p = 0.037). Anastomotic leakage and pneumonia rates did not differ between the intervention and control group (respectively 11.8% vs. 10.8%, p = 0.834; 27.1% vs. 33.3%, p = 0.651). Chyle leakage only occurred in the control group (18.9%, p &lt; 0.001). All other postoperative complications were similar between groups.

Conclusion
Direct oral feeding in a center with a low postoperative complication rate after a MIE results in a reduced time to functional recovery and a shorter length of hospital stay. Importantly, the 30-day postoperative complication rate was significantly lower in patients directly starting oral feeding.
132 ANTI-REFLUX SURGERY FOR CONTROLLING RESPIRATORY SYMPTOMS OF GASTRO-ESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Authors: Tustumi F , Bernardo W , Rocha J , Szachnowicz S , Seguro F , Bianchi E , Takeda F , Miranda Neto A , Sallum R , Cecconello I 
Published: September 2020

Abstract

Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD.

Methods
A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed.

Results
Of the screened articles, 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2–84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3–87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9–78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: -0.46; 95% CI -0.77, −0.16).

Conclusion
Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.
167 VOLATILE ORGANIC COMPOUND PROFILING FOR DETECTION OF ESOPHAGEAL CANCER IN EXHALED BREATH
Authors: Vissapragada R , Dharmawardhana N , Watson D , Yazbek R 
Published: September 2020

Abstract

Endoscopic surveillance for Barrett’s esophagus (BE) is invasive but remains the standard modality for early diagnosis of esophageal adenocarcinoma (EAC) and intervention. Human breath contains an array of volatile organic compounds (VOC) that change in disease conditions. VOC detection provides a potential source of biomarkers for non-invasive, real-time identification of EAC. This study aimed to characterize a VOC-profile applicable to the detection of EAC and to provide pilot data to design a future validation trial.

Methods
Breath samples were collected in our endoscopy unit from BE, EAC, and control patients. Samples were collected in FlexFoil bags (SKC ltd) using previously standardized methods. Hydrogen, methane and other VOCs were quantified by QuinTron BreathTracker® and selected-ion flow tube mass spectrometry (SIFT-MS, Syft®) respectively. 250 reported cancer-related VOCs were selected for analysis. Non-parametric tests were used to identify candidate VOCs, and logistic regression analysis was then applied to determine the best predictors for EAC. Receiver Operating Characteristic (ROC) Curves were developed to determine the sensitivity and specificity of the model.

Results
68 individuals were enrolled in the study (Controls, n = 37; BE, n = 21; EAC, n = 10). 8 VOCs were identified with significant concentration differences between the three groups: Trimethylbenzene (3 iso-forms), Dimethyl Sulfide, 4-isopropyl toluene, 1-butanol, trichloroethylene, hydrogen sulfide, methyl mercaptan, p-isopropenyl toluene. Logistic regression analysis of these 10 compounds demonstrated predictive probability of EAC from other groups with ROC curves calculating an area under the curve of 0.85.

Conclusion
Previous studies have supported the utility of VOCs in exhaled breath as non-invasive real-time tests for the identification of some other cancer types. This pilot study has identified potential VOCs which might identify individuals with EAC. A larger study will be needed to validate and confirm these findings.
260 FAILURE TO CURE IN PATIENTS UNDERGOING ESOPHAGEAL CARCINOMA SURGERY: HOSPITAL OF SURGERY INFLUENCES PROSPECTS FOR CURE. A NATIONWIDE COHORT STUDY.
Authors: Voeten D , Werf L , Wijnhoven B , Hillegersberg R , Berge Henegouwen M 
Published: September 2020

Abstract

Failure to cure is a composite outcome measure that could be used for hospital comparison in surgical esophageal carcinoma care. It was first described by Clavien et al. in 1992 and was defined as the event where the procedural purpose was not fulfilled. The aim of the current study was to describe failure to cure in terms of incidence, hospital variation, and as an outcome parameter for salvage esophagectomy (surgical resection after definitive chemoradiotherapy).

Methods
All patients registered in the Dutch Upper GI Cancer Audit (DUCA) who underwent potentially curative esophageal carcinoma surgery between 2011 and 2018, were included in this nationwide cohort study. Failure to cure was defined as: 1) no esophagectomy due to intra-operative metastasis or locally irresectable tumour, 2) macroscopically or microscopically incomplete resection (pR1, R2), or 3) 30-day or in-hospital mortality. Association of patient, tumor and hospital characteristics with failure to cure was analyzed using multivariable logistic regression in the total population and in salvage surgery patients. Hospital variation was evaluated using multivariable regression and displayed in a case-mix corrected funnelplot.

Results
Some 6,045 patients from 22 hospitals were included of whom 701 (11.6%) had failure to cure (hospital variation [5.9%–19.0%]). Higher age, more preoperative weight loss, higher ASA-score, junctional tumors, higher T-stage and N-stage, no neoadjuvant chemoradiotherapy, and resection before 2014 were associated with failure to cure. After case-mix correction, 2 hospitals had statistically significant lower than expected failure to cure percentages, and 2 hospitals had higher percentages (figure1). In the patients undergoing salvage esophagectomy (n = 151), the failure to cure percentage was 32.5%. This was 27.6% in high-volume hospitals (&gt;40 annual esophagectomies) and 47.6% in medium-volume hospitals (20–40 annual esophagectomies) (p = 0.03).

Conclusion
This was the first study to describe failure to cure for oesophageal carcinoma patients. The incidence of failure to cure was 11.6%, which is an important prognostic parameter for patients that should be used for expectation management. Given the significant hospital variation in the incidence of failure to cure, improvement is needed. Since salvage procedures are more often successful in high-volume hospitals, further centralization of this technically challenging procedure is warranted.
293 NITROUS OXIDE CRYOBALLOON ABLATION IS A SAFE, EFFECTIVE AND DURABLE ENDOSCOPIC TREATMENT FOR DYSPLASTIC TREATMENT-NAïVE AND PREVIOUSLY-ABLATED NEOPLASTIC BARRETT’S ESOPHAGUS
Authors: Dbouk M , Brewer O , Shin E , Ngamruengphong S , Voltaggio L , Montgomery E , Canto M 
Published: September 2020

Abstract

Nitrous oxide cryoballoon (CB) ablation can effectively and safely eradicate dysplasia and intestinal metaplasia (IM) in patients with dysplastic BE but the durability of treatment effect is unknown. We evaluated the safety, efficacy and durability of CB ablation for complete eradication of dysplasia and IM

Methods
We analyzed the outcomes of consecutive BE patients treated with CB at a single academic medical center for dysplastic BE. We excluded patients with adenocarcinoma and those treated primarily with radiofrequency ablation (RFA). CB ablation was applied to all visible BE using the CB focal ablation system and default cryogen dose of 10 seconds, after eradication of neoplastic-type lesions with endoscopic mucosal resection (EMR). Primary endpoints were complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM) at 1, 2, 3, 4 years. Kaplan-Meir analysis was performed to assess durability where any recurrence was considered a failure.

Results
70 patients (HGD = 64%; 65.7% = treatment-naive) were followed up for median of 27.4 months. CE-D and CE-IM at 1 year were 96.7% and 73.8%, respectively. The median number of CB sessions to achieve CE-IM at 1 year was 3 (IQR 2-3.5). The rates of CE-D and CE-IM allowing for re-treatment with CB or “touch-up” APC were above 90% at 2, 3 and 4 years, with no difference between treatment-naïve and previously-ablated patients. The durability of CB response in patients who achieved CE-D or CE-IM at 1 year followed until last follow-up or recurrence of dysplasia or IM are presented in Figure 1.

Conclusion
Recurrence rate of IM after initial CB eradication is low patient with no patients progressing to cancer or beyond their baseline dysplasia grade. CB ablation has high efficacy, safety, and durability for eradicating dysplasia and intestinal metaplasia in dysplastic BE as a primary or rescue therapy.
326 DEFINITIVE CHEMORADIOTHERAPY COMPARED TO NEOADJUVANT CHEMORADIOTHERAPY WITH ESOPHAGECTOMY FOR LOCO-REGIONAL ESOPHAGEAL CANCER: NATIONAL POPULATION-BASED COHORT STUDY
Authors: Kamarajah S , Phillips A , Hanna G , Low D , Markar S 
Published: September 2020

Abstract

Ongoing randomized controlled trials seek to evaluate the potential organ-preservation strategy of definitive chemoradiotherapy as a primary treatment for esophageal cancer. This population-based cohort study aimed to assess survival following definitive chemoradiotherapy (DCR) with or without salvage esophagectomy (SALV) in the treatment of esophageal cancer.

Methods
Data from the National Cancer Database (NCDB) from 2004 to 2015, was used to identify patients with non-metastatic esophageal cancer receiving either DCR (n = 5,977) or neoadjuvant chemoradiotherapy with planned esophagectomy (NCRS) (n = 13,555). Propensity score matching (PSM) and multivariable analyses were used to account for treatment selection bias. Subset analyses compared patients receiving salvage esophagectomy after DCR (SALV) with NCRS.

Results
Comparison of baseline demographics of the unmatched cohort revealed that patients receiving NCRS were younger, had a lower burden of medical comorbidities, lower proportion of squamous cell carcinoma (SCC) and more positive lymph nodes. Following matching, NCRS was associated with significantly improved survival compared with DCR (HR: 0.60, 95% Confidence Interval (CI): 0.57—0.63, p &lt; 0.001), which persisted in subset analyses of patients with adenocarcinoma (HR: 0.60, 95%CI: 0.56—0.63, p &lt; 0.001) and SCC (HR: 0.58, 95%CI: 0.53—0.63, p &lt; 0.001). There was no difference in overall survival between SALV and NCRS (HR: 1.00, 95%CI: 0.90—1.11, p = 1.0).

Conclusion
Surgery remains an integral component of the management of patients with esophageal cancer. Neoadjuvant therapy followed by planned esophagectomy appears to remain the optimum curative treatment regime in patients with loco-regional esophageal cancer.
339 OPTIMAL CUTOFF VALUE OF INTEGRATED LOWER ESOPHAGEAL SPHINCTER RELAXATION PRESSURE FOR ACHALASIA USING STARLET HIGH-RESOLUTION MANOMETRY SYSTEM
Authors: Masuda T , Yano F , Omura N , Tsuboi K , Hoshino M , Yamamoto S , Sakashita Y , Akimoto S , Fukushima N , Kashiwagi H 
Published: September 2020

Abstract

The Starlet high-resolution manometry (HRM) system is currently used in Japan. HRM provides integrated relaxation pressure (IRP) of which value represents adequacy of lower esophageal sphincter (LES) relaxation. The upper limit of normal IRP for the Starlet was proposed as 26 mmHg using healthy subjects. However, few studies have addressed whether this cutoff may well-distinguish patients diagnosed with/without achalasia. We propose the optimal cutoff of IRP for detecting achalasia using the Starlet.

Methods
Patients who underwent HRM test using the Starlet system at our institution between July 2018 and December 2019 were included. Of these, we excluded patients who had a history of achalasia surgery and/or endoscopic intervention, or whose HRM testing of poor quality. Achalasia was diagnosed if impaired esophageal emptying was evident based on timed barium esophagogram, upper endoscopy, and/or computed tomography. The optimal cutoff value of IRP was estimated using the receiver operating characteristic curve analysis. We further investigate difference in IRP values between achalasia subtypes to identify characteristics of patients who are more likely to be misdiagnosed.

Results
In total, 145 patients met study criteria. The mean age in our cohort was 52.5 ± 15.5 years, 89 patients (61.4%) were men. Of these, 42 patients (29.0%) were diagnosed with achalasia. In achalasia patients, IRP values extended to a wide-range from minimal 18.7 to maximal 63.9 mmHg. The optimal cutoff value of IRP was 24.7 mmHg with sensitivity 90.5% and specificity 90.3% (AUC 0.96 [95% CI; 0.92¬ to 0.99]). Patients with achalasia type I based on Chicago classification were most likely to have IRP value below the threshold of 25 mmHg (4/19 patients [21.1%]).

Conclusion
The optimal cutoff value of IRP to distinguish achalasia was ≥25 mmHg using the Starlet HRM system. This value was nearly close to the upper limit of normal IRP value of 26 mmHg in healthy volunteers. Achalasia type I was more likely to have normal IRP value indicating that comprehensive foregut assessment (eg, timed barium esophagogram, upper endoscopy, and computed tomography) is still valuable for management of achalasia.