bluuebunny/crossref_metadata_2025_split huggingface dataset:
O30 NON-RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER; A NATIONWIDE STUDY ON INCIDENCE, RISK FACTORS AND OUTCOMES IN SWEDEN
Authors: Edholm David , Hollertz Petter , Sandström Per , Björnsson Bergthor , Björk Dennis , Halldestam Ingvar , Dzhendov Todor , Lindblad Mats 
Published: November 2019

Abstract

Aim
To identify potential risk factors for a microscopically non-radical esophageal cancer resection (R1) and investigate how such a resection affects long-term survival.

Background & Methods
Esophageal cancer resections that are considered R1 have been associated with worse survival. The Swedish National Register for Esophageal and Gastric Cancer includes information on all esophageal cancer resections in Sweden. All patients having undergone esophageal resection with curative intent 2006-2017 were included. Risk factors for R1 resection were assessed through logistic regression. Factors predicting five-year survival were assessed through Cox-regression, adjusted for T-stage, N-stage, age and R-status.

Results
The study included 1,504 patients. The margins were microscopically involved in 146 patients (10%). Of these the circumferential margin was involved in 115 (8%). The proximal margin was involved in 55 patients (4%) and the distal in 30 (2%). In 54 (4%) specimens two margins were involved. Independent risk factors for R1-resection were absence of neoadjuvant treatment and clinical T3 stage or higher. The 5-year survival for the entire cohort was 41%, but only 19% for those with an R1 resection. Independent risk factors for death within 5-year from resection were regional lymph node metastasis (Hazard Ratio (HR) 2.6 (95% CI 2.2-3.1), histopathological stage T3 or higher (HR 1.2 95% CI 1.1-1.5), age above 60 years and R1-resection (HR 1.6 95% CI 1.4-2.0)

Conclusion
Involved margin in the resected specimen is an independent risk factor predicting worse 5-year survival. Besides striving for adequate surgical margins, the rate of R1-resections could be decreased through neoadjuvant treatment in fit patients.
P31 SURGICAL MANAGEMENT OF ACQUIRED TRACHEOESOPHAGEAL FISTULA CAUSED BY ESOPHAGEAL DIVERTICULUM
Authors: Yifeng Sun , Shuguang Hao , Xufeng Guo , Yu Yang , Bo Ye , Xiaobin Zhang , Haoyao Jiang , Zhigang Li 
Published: November 2019

Abstract

Aim
To assess the safety and feasibility of surgical treatment for acquired tracheoesophageal fistula caused by esophageal diverticulum.

Background & Methods
There are rare studies of the treatment for acquired tracheoesophageal fistulas (TEFs) or bronchoesophageal fistulas (BEFs) caused by traction esophageal diverticula. Between Jan. 2014 and Apr. 2019, twelve patients were admitted to our department for TEF/BEF combined with esophageal diverticula. Clinical characteristics of the twelve patients were retrospectively reviewed.

Results
Among the 12 orifices in the airway side, there were two at the carina, three at the right main bronchus and seven at the right intermediate bronchus. All orifices in the esophagus side opened at the diverticula wall. All TEF/BEFs received surgical treatment. Firstly, the fistula tunnels were dissected easily. Then, interrupted sutures repaired the fistula orifices in the airway membrane. A limited diverticulectomy with the fistula resection was done in the esophagus. Separate layers of repair were performed for the defect in the esophagus. The serratus anterior muscle flap interposition was performed in all 12 cases. There were no postoperative morbidity and mortality. No recurrence fistula and symptomatic diverticula occurred. The airway and esophagus were unobstructed during the follow-up period.

Conclusion
Acquired TEF/BEFs caused by esophageal diverticula can be treated successfully by surgery. A limitated diverticulectomy is sufficient to ensure esophagus remodeling.
O32 LYON CONSENSUS CRITERIA SIGNIFICANTLY CHANGES THE PH IMPEDANCE DIAGNOSIS OF GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Authors: Alexandros Ioannou , Daniele Mandolesi , Stavroula Chaita , Francesco Torresan , Franco Bazzoli 
Published: November 2019

Abstract

Aim
To investigate the Lyon Consensus Criteria impact on Ph-Impedance diagnosis of GERD and their relation to high resolution manometric tracing results.

Background & Methods
GERD is a complex disease with a heterogeneous symptom profile and a multifaceted pathogenic basis that defies a simple diagnostic algorithm or categorical classification. The Lyon Consensus defines parameters on esophageal testing that conclusively establish the presence of GERD and characteristics that rule out GERD. We retrospectively evaluated according the new criteria our patients underwent pH-Impedance one year before the publication of Lyon Consensus Criteria and analyzed the differences in relation to the older diagnostic criteria.

Results
130 patients (56 M, median age 52,03 R18-77) Ph-impedance exams for suspected typical and atypical GERD were re-evaluated. According to Lyon criteria for conclusive evidence of GERD 15,38% of them were over-diagnosticated and 1,53% had inconclusive evidence of the disease using the past criteria. In the evaluation of 94 patients with typical symptoms 23,4% were over-diagnosticated in according to the past diagnostic criteria. Statistical analysis of manometric values of the patients highlight that LES basal pressure (median 108.95, R38.7-283.4) (p=0,049) and UES residual pressure (median 7.8 R0.6-63.5) (p=0,003) significantly predict the Lyon criteria pH-impedance outcome. Analysis of manometric values of the patients with typical symptoms revealed that LES residual pressure (median 5,21 R0,1-20,7) (p=0,007) and Total Number of refluxes (median 28,03 R1-122) (p=0,013) significantly predict the Lyon criteria pH-impedance outcome.

Conclusion
Lyon Consensus Criteria significantly changes the pH-impedance diagnosis in patients undergoing testing for suspected GERD. In patients with typical symptoms new criteria allow not to overdiagnose 25% of GERD patient. Manometric values analysis significantly correlates and predict the Lyon criteria pH-impedance outcome.
P33 UPPER ESOPHAGEAL SPHINCTER (UES) ABNORMALITIES ARE SIGNIFICANT DIAGNOSTIC FINDINGS IN PATIENTS WITH ATYPICAL GERD UNDERWENT PH-IMPEDANCE AND HIGH RESOLUTION MANOMETRY (HRM)
Authors: Ioannou Alexandros , Mandolesi Daniele , Chaita Stavroula , Torresan Francesco , Bazzoli Franco 
Published: November 2019

Abstract

Aim
To investigate UES function in patients underwent esophageal testing with pH-impedance and HRM for suspected GERD

Background & Methods
GERD is a complex condition with a typical: heartburn, regurgitation or epigastric pain and an atypical presentation with symptoms such as chronic cough, hoarseness, globus, dysphagia or throat clearing caused by the retrograde movement of gastric contents above the UES into the laryngopharynx. The association between GERD and abnormalities of UES and esophageal motility is not clearly known. HRM has allowed accurate measurement and evaluation of UES and esophageal function. We evaluate the UES function of the HRM exams in patients underwent pH-impedance for suspected GERD with typical or atypical symptoms.

Results
HRM tracings of 60 patients (35F, median age 53,08 R23-74), 35 with typical (20F, m.a 51,42 R24-74) and 25 with atypical (15F, m.a 51,73 R29-74) symptoms who underwent Ph-impedance for suspected typical and atypical GERD were evaluated. 40% of those with typical presentation had a positive pH-impedance for GERD versus 8% of those with atypical symptoms. Patients with typical symptoms presented in 42,85% UES abnormalities versus 60% of the patients with atypical presentation. From those patients with typical GERD symptoms that had a positive pH-impedance the 40% had a concomitant UES abnormality versus 100% of the patients with atypical presentation and a confirmed GERD diagnosis. Statistical analysis revealed a significant association between positive pH-impedance result and LES residual pressure in patients with typical (p=0,045) and atypical (p=0,038) symptoms.

Conclusion
UES abnormalities is the prevalent diagnostic finding in patients with atypical GERD underwent pH-impedance. UES dysfunction characterize all patients diagnosticated with atypical GERD by Ph-impedance.
P35 GASTROESOPHAGEAL REFLUX DISEASE (GERD) AFTER BARIATRIC SURGERY – EXPLORING THE PATHOPHYSIOLOGICAL MECHANISMS AROUND THE OESOPHAGOGASTRIC JUNCTION
Authors: Hatem Al Saadi , Alistair Sharples , Carl Bradbury , Vittal Rao , Balaji Nagammapudur 
Published: November 2019

Abstract

Background
It is not uncommon to get de novo GERD after certain types of bariatric surgery. Sleeve gastrectomy (SG), Adjustable Gastric Band ( AGB) and the One anastomosis gastric bypass (OAGB) have been frequently implicated to cause GERD. Roux Y gastric bypass (RYGB) is usually proposed as a curative procedure in patients who develop GERD after a LSG or LAGB.

Hypothesis
The alteration in mechanics around the Oesophagogastric junction (OGJ) after all types of bariatric surgery predispose to the development of GERD in varying proportions including the RYGB.

Aims
To theoretically explore the changes around the OGJ in the 4 most common types of bariatric procedures: AGB, SG, OAGB and RYGB

Methods and results
The following 6 variables that are frequently implicated in causing reflux are equated with each procedure and a score produced to quantify the potential effect on the OGJ. Elimination of the angle of HisInterruption of the Sling fibresInterruption of the Phreno-oesophageal membranePredisposition to the herniation through the hiatus.Effect on the Lower Oesophageal Sphincter residual pressure.Creation of a high-pressure zone below the LES promoting reflux.
Based in a standardised technique of performing the 4 common operations, the following scores were obtained.
AGB affected 5/6 variables, SG affected 6/6 variables, RYGB affected 5/6 variables and OAGB affected 5/6 variables that influence the antireflux barrier mechanism around the OG junction.

Conclusion
All bariatric surgeries technically affect the dynamics around the OGJ and indirectly reduce the efficacy of the antireflux barrier mechanisms. The varying contribution of certain individual factors may affect the relative incidence of GERD after surgery after different types of bariatric surgeries. The common recommendation that RYGB serves as a magic bullet against GERD is to be taken in context of the above mechanisms in action.
P37 LIMITED MEDIASTINAL LYMPHADENECTOMY FOR ELDERLY PATIENTS OVER 75 YEARS OLD WITH THORACIC ESOPHAGEAL CARCINOMA IS PERMISSIBLE
Authors: Naoto Ujiie , Yusuke Taniyama , Chiaki Sato , Kai Takaya , Hiroshi Okamoto , Toshiaki Fukutomi , Takuro Konno , Takeshi Naitoh , Michiaki Unno , Takashi Kamei 
Published: November 2019

Abstract

Aim
The aim of this study is to investigate the influence on postoperative complications and survival rate by the difference in the number of mediastinal lymph node dissection for elderly patients over 75 years old with thoracic esophageal carcinoma.

Background & Methods
In esophagectomy for thoracic esophageal carcinoma, mediastinal lymphadenectomy is an essential procedure for the radical cure and also an invasive procedure. In elderly patients, especially, the postoperative complications are likely to be serious, and less-invasive surgical procedure is preferred. We sometimes perform limited mediastinal lymphadenectomy for elderly patients with thoracic esophageal carcinoma depending on the case, but the influence on survival rate is controversial. 55 patients who underwent esophagectomy for thoracic esophageal carcinoma over 75 years old between 2007 and 2015 were included in this study. Patients were divided into two groups by number of mediastinal lymph node dissection: normal group (15 or more: n=28) and limited group (less than 15: n=27). The short- and long-term outcomes were retrospectively examined to those groups.

Results
The median age of the normal and limited group were 76.5 and 79, respectively. No significant differences were demonstrated in clinical stage, operation time and estimated blood loss between these groups. The incidences of postoperative circulatory complications were 37.0% in the normal group and 25.0% in the limited group, but there was no statistically significant difference (P = 0.43). In the normal group, the postoperative respiratory complications (46.4 vs. 14.8%, P = 0.011) and recurrent laryngeal nerve paralysis (21.4 vs. 3.7%, P = 0.049) were significantly higher than that of the limited group. The 5-year overall survival rate (OS) and the 5-year relapse free survival rate (RFS) did not show statistical differences between the normal and limited group (OS: 45.0 vs. 46.0%, P = 0.44; RFS: 39.7 vs. 37.7%, P = 0.57).

Conclusion
In the limited mediastinal lymphadenectomy group, the postoperative respiratory complications and recurrent laryngeal nerve paralysis have a low occurrence rate. There was no difference in the survival rate between these groups. It was considered that limited mediastinal lymphadenectomy for elderly patients with thoracic esophageal carcinoma is permissible to prevent postoperative complications.
P38 RESECTION MARGINS AFTER ONCOLOGICAL ESOPHAGECTOMY ; DOES THE DEFINITION OF THE R STATUS MATTER?
Authors: Penelope St-Amour , Michael Winiker , Christine Sempoux , Nicolas Demartines , Markus Schäfer , Styliani Mantziari 
Published: November 2019

Abstract

Aim
This study aimed to compare long-term survival and recurrence of patients depending on their R status: R0 (>1mm of clearance), R1 (positive margins with 0mm clearance) and R0+ (margins with <1mm clearance).

Background & Methods
Resection margin (R) status is a known prognostic factor after curative esophagectomy. Different definitions of microscopic margin involvement are currently used. The American College of Pathologists defines R1 as a direct contact of the tumor with the resection margin (0mm), whereas the Royal College of Pathologists considers a positive margin as being within 1mm distance (<1mm) from the tumor.
All consecutive patients between 2012-2018 undergoing a curative esophagectomy for squamous cell cancer or adenocarcinoma of the esophagus or gastroesophageal junction were included. Clinical features, overall survival and recurrence were compared between patients with R0, R1 and R0+ status, with a specific subgroup analysis of locally advanced (cT3/4) tumors to eliminate baseline differences. Categorical variables were compared with the x2 or Fisher’s exact test, continuous variables with the ANOVA tests, whereas the Kaplan-Meier method with the log rank test was used for survival analyses.

Results
Among the 174 included patients, 126 (72.5%) resections were R0, 14 (8%) R1 and 34 (19.5%) R0+ resection. R0 patients had a better overall (OS) (median 59 months, 95%CI 34-84) and disease-free survival (DFS) (median not reached) compared to R1 (OS 20 months, 95%CI 8-32, DFS 9 months, 95%CI 7-11) and R0+ patients (OS 24months, 95% CI 19-29, DFS 13, 95%CI 3-23). Pairwise comparison revealed a similar OS (p=0.47) but a trend to better median DFS for R0+ patients compared to R1 (p=0.051). Within the locally advanced subgroup, R0 patients also had a better OS (median 59 months versus 20 months for R1 and 24 months for R0+, p=0.012) and DFS (33 months versus 9 and 18 months respectively, p<0.001).

Conclusion
R0 resection has a superior overall and disease-free survival after esophagectomy than R1 and R0+. A margin clearance of <1mm had a similar overall survival as a direct positive margin, whereas in more advanced tumor stages, the distinction between R1 and R0+ only seems relevant regarding tumor recurrence.
P40 CONDITIONAL SURVIVAL AFTER CURATIVE TREATMENT OF ESOPHAGEAL CANCER
Authors: Hagens E R C , Feenstra BSc M L , van Berge Henegouwen M I , Eshuis W J , Hulshof M C C M , van Laarhoven H W M , Gisbertz S S 
Published: November 2019

Abstract

Aim
To assess conditional survival and design a nomogram predicting the conditional probability of survival for esophageal cancer patients after surgery.

Background and methods
Conditional survival accounts for the time already survived after surgery and may be informative in addition to conventional static survival estimates during follow-up.
Consecutive patients with esophageal cancer who received neoadjuvant chemoradiation followed by an esophagectomy between January 2004 and 2019 in the Amsterdam UMC, The Netherlands were included. Conditional survival was defined as the probability of surviving “y” years after already surviving for “x” years. Cox proportional hazard models were used to evaluate predictors for overall survival. A nomogram was constructed to predict 5-year survival correcting for time already survived.

Results
660 patients were included in this study. The median overall survival was 46.4 months (95%CI 39.1–53.8). The probability to achieve 5-year overall survival after resection increased from 46% directly after surgery to 55%, 67%, 79% and 88% per additional year survived. ypN-stage was the strongest predictor for overall survival (HR6.50, p<0.001, for ypN3 with ypN0 as reference), followed by pulmonary complications (HR1.16, p=0.002), cardiac comorbidity (HR1.27, p=0.040) and ypT-stage (HR1.461, p=0.039 for ypT2-3 with ypT0 as reference). These variables were included in the nomogram (figure 1), which predicts survival with a C-statistic of 0.70.

Conclusion
The proposed nomogram showed an accurate prediction of survival in patients after esophageal cancer surgery, taking the years already survived after surgery into account. This nomogram can be helpful in counselling patients in the follow-up after esophageal cancer surgery.
P42 EFFICACY OF ENDOSCOPIC TREATMENT FOR CONTAINED LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Lubbers M , van Workum F , Berkelmans G , Rosman C , Luyer MD , Nieuwenhuijzen GAP , van Det MJ , Kouwenhoven EA 
Published: November 2019

Abstract

Aim
Anastomotic leakage after esophagectomy (AL) is a severe complication that often needs aggressive and invasive treatment. However, there is no consensus on what strategy is best. The aim of this study was to analyse the different treatment strategies for AL and evaluate their outcomes.

Background and methods
A retrospective analysis was performed on all patients who developed AL after Ivor Lewis Esophagectomy (IL) from January 2011 until September 2016 in three high volume hospitals. Treatment of AL was based on local expertise, without common guideline. The different treatment strategies (surgical and endoscopic) were compared for patients with contained (confined to the mediastinum) and uncontained AL (leakage with intrapleural complications).
Endpoints were the amount of re-interventions, readmission to the ICU, ICU- and hospital stay, time to restart oral feeding and mortality.

Results
Seventy-three patients with AL were identified in this multicentre cohort with either a contained or an uncontained leak. Basic variables were similar in both groups.
A contained leak was identified in 39 patients. An endoscopic approach was chosen in 25 patients (64%) and was successful in 19 (76%). Fourteen patients (36%) were primarily treated with a surgical approach that was successful in 11 (79%). Significantly more patients were (re)admitted to the ICU in the surgical group versus the endoscopic group (100% vs 52%, p=0.003). The ICU and hospital stay, time to restart oral intake and mortality were not significantly different in both groups.
An uncontained leak was seen in 34 patients. Endoscopic treatment was chosen in 14 patients (41%) and was successful in 10 (71%). A surgical approach was performed in 20 patients (59%) and was successful in 12 (60%). (Re)admission rate to the ICU was significantly higher in the surgical group (95% vs 57%, p=0.012). The ICU- and hospital stay and time to restart oral intake were similar. There was no mortality in this cohort.

Conclusion
The classification of leakages into contained and uncontained might help to determine treatment strategy. In this multicentre cohort, the endoscopic approach for contained leaks appears to be feasible and successful. The operative approach remains the preferred option for uncontained anastomotic leakage.
P43 IS THERE AN OPTIMAL DEFINITION FOR POSITIVE CIRCUMFERENTIAL RESECTION MARGIN IN LOCALLY ADVANCED OESOPHAGEAL CANCER?
Authors: B Brac , F Renaud , H Behal , M Messier , E Leteurtre , C Mariette , C Eveno , G Piessen 
Published: November 2019

Abstract

Aim
The utility of Circumferential Resection Margin (CRM) status in predicting prognosis in oesophageal cancer remains controversial, with two different definitions of a positive CRM, one from the College of American Pathologists (CAP) (tumour at margin) and the other from the Royal College of Pathologists (RCP) (tumour within 1 mm)1-3. This study aimed to analyze the validity of these definitions in oesophageal tumours and explore the optimal cutoff value for CRM to predict survival.

Background & Methods
Patients who underwent curative radical oesophageal resection for locally advanced (>pT2) adenocarcinoma or squamous cell carcinoma of the oesophagus were selected from 2007 to 2016. Patients with positive longitudinal resection margins were excluded. CRM was histologically reassessed using an ocular micrometer. Overall survival (OS) and disease-free survival (DFS) were estimated with uni and multivariate analyses.

Results
From 860 resected patients, 283 fulfilling the inclusion criteria were selected. CRM was measured as follows: CRM=0mm (n=48), 0<CRM ≤1mm (n=123) and CRM>1mm (n=112). In univariate (figure 1) and multivariate analysis R1 resection, according to both definitions was significantly associated with poor OS (CAP: HR=2.26,p<0.001; RCP: HR=1.42,p=0.035). However only CAP definition accurately predicted DFS (CAP: HR=2.25,p<0.001; RCP: HR=1.28,p=0.094). When comparing the 3 CRM groups and taking 0 < CRM ≤1mm as reference, only CRM=0 predicted OS and DFS (p<0.001). A CRM cutoff at 0.1 mm was the best to predict OS and differed according to histology.

Conclusion
Among existing definitions of CRM, CAP definition was more accurate to predict prognosis and recurrence. New cutoffs are promising.
P44 THE EXTENT AND CONSEQUENCES OF LYMPHADENECTOMY IN ESOPHAGEAL CANCER SURGERY: A CASE VIGNETTE SURVEY
Authors: Didi J J.M. de Gouw , Mirre Scholte , Suzanne S  Gisbertz , Bas P L. Wijnhoven , Maroeska M  Rovers , Bastiaan R  Klarenbeek , Camiel Rosman 
Published: November 2019

Abstract

Background
Lymph node dissection (LND) is part of standard operating procedure in resectable esophageal cancer patients regardless of lymph node status. The aim of this case vignette survey was to acquire expert opinions on current practice of LND, and to determine potential consequences of non-invasive lymph node staging on the extent of LND and postoperative morbidity.

Methods
An online survey including 5 short clinical cases (case vignettes) was sent to 272 esophageal surgeons worldwide. Extent of standard LND, potential changes in LND based on accurate lymph node staging and consequences for postoperative morbidity were evaluated.

Results
86 esophageal surgeons (median experience in esophageal surgery of 15 years) participated in the survey (response rate 32%). Standard LND varied considerably between experts, for example pulmonary ligament, splenic artery, aortopulmonary window and paratracheal lymph nodes are routinely dissected in less than 60%. The omission of (parts of) LND is expected to decrease the number of chyle leakages, pneumonias laryngeal nerve pareses and reduce operating time. In order to guide surgical treatment decisions, a diagnostic test for lymph node staging after neoadjuvant therapy requires a minimum sensitivity of 92% and specificity of 90%.

Conclusion
This expert case vignette survey study shows that there is no consensus on the extent of standard LND. Esophageal surgeons seem more willing to extend LND rather than omit LND, based on accurate lymph node staging. The majority of surgeons expect that less extensive LND can reduce post-operative morbidity.