bluuebunny/crossref_metadata_2025_split huggingface dataset:
P120 MULTIMODAL THERAPY IN ESOPHAGEAL CANCER BEYOND CLINICAL TRIAL: SINGLE CENTRE EXPERIENCE
Authors: Giacopuzzi S , Alberti L , Weindelmayer J , De Pasqual C A , Torroni L , Verlato G , De Manzoni G 
Published: November 2019

Abstract

Aim
investigate factors influencing the choice of neoadjuvant treatment type in the real world, analyzing our single high-volume center experience.

Background & Methods
The neoadjuvant chemoradiotherapy is the standard of care for esophageal cancer [1-2]. This consensus stems from the results of CCT performed on highly selected patients. However, the best treatment for non-selected patients remains unclear. In our clinical practice the treatment considered the goal standard is a TCF with 50GyRT [3-4-5], which showed an R0 resection rate of 88% and 5 y OS of 43%, better than CROSS trial.
Despite these results, since 2012 not all patients underwent the same ideal treatment. We analyzed a real life patients group, that from the oncological point of view, they would be treated with our protocol in an intention to treat setting.

Results
From 2012 to 2017, 244 patients were treated. Analyzing retrospectively our data, it emerges that we have chosen the therapeutic strategy based on patient's characteristics: those aged over 75 yrs or with severe comorbidities were addressed to a “weakened” treatment: 37 with chemotherapy, 24 with radiotherapy and 55 with concomitant chemoradiotherapy different from our protocol. 125 with our protocol. Further selection involved lymph node status and patients with lymph node involvement (>N2 were referred to chemotherapy. The results confirmed that the protocol achieves better results in pathological response (pT0N0 in protocol 40,8% vs 18.2% in standard chemoradiotherapy – p value <0.001) and overall survival, especially for squamous hystotype. Regarding adenocarcinoma, chemotherapy and our protocol obtain good results for OS, although they differ on pathological response (pCR: 40.8% vs 5.4%). Most of the patients referred to chemotherapy had nodes involvement at the diagnosis (88.9%) and pathological response on nodes was significantly worse than protocol (pN0: 26.7% in chemotherapy vs 77.5%), however survival was similar between the two treatments.

Conclusion
Chemoradiotherapy is currently the gold standard of treatment but it cannot be consider the only treatment, especially for real life patients, less ideal but still requiring treatment. Clinical trials are certainly useful in providing information on highly selected patients, but clinical practice must consider patients whose conditions require tailored treatment.
P121 ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): VALIDATION PROTOCOL
Authors: Eddahchouri Yassin , van Workum Frans , Rosman Camiel 
Published: November 2019

Abstract

Aim
The objective of this study is to develop the ‘Esophagectomy-specific Objective Structured Assessment of Technical Skills’ tool (E-OSATS) and determine its validity, reliability and feasibility of use.

Background & Methods
Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure. Increased morbidity and mortality are associated with the long learning curve of the procedure. Specific and structured feedback may shorten the learning curve and decrease the associated morbidity and mortality. Consensus regarding the essential procedural steps has recently been achieved and allows for development and validation of a procedure specific assessment tool for MIE (E-OSATS).
The E-OSATS was created by anchoring previously defined essential steps for both Ivor-Lewis (IL) and McKeown (McK) approach. Ten video recordings of novice surgeons (<15 MIE performed) and 10 recordings of expert surgeons (>100 MIE performed) should be rated by two independent, blinded and trained raters. Records of time needed for the assessment are created. Inter-rater and test-retest reliability will be determined. Validity will be determined by analyzing differences between novice and expert surgeons.

Results
All IL video recordings are collected, McK collection is still pending. First assessments of video recordings are expected to take place in August 2019. We aim to collect all assessments before December 2019.

Conclusion
We hypothesize that we will demonstrate the feasibility, reliability and validity of the E-OSATS in MIE specific assessment of technical skill. This tool will allow for specific and structured feedback and will potentially shorten the learning curve and decrease learning associated morbidity.
P123 ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE4) WITH INTRATHORACIC ANASTOMOSIS: PROMISING RESULTS AND LESSONS LEARNED IN 100 PATIENTS
Authors: Tagkalos E , van der Sluis P C , Hadzijusufovic E , Babic B , Uzun E , van Hillegersberg R , Lang H , Grimminger P P 
Published: November 2019

Abstract

Aim
The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 with intrathoracic anastomosis for esophageal cancer within our case series of 100 consecutive patients.

Background & Methods
Robot assisted minimally-invasive esophagectomy (RAMIE) with intrathoracic anastomosis is gaining popularity as a treatment for esophageal cancer. In this study, we present the results of 100 RAMIE procedures using the da Vinci Xi robotic system (RAMIE4). The aim of this study was to describe postoperative complications and short-term oncologic outcomes for RAMIE4 within our case series of 100 consecutive patients. Between January 2017 and February 2019, data of 100 consecutive patients with esophageal carcinoma undergoing modified Ivor-Lewis esophagectomy were prospectively collected. All operations were performed by the same surgeon using an identical intrathoracic anastomotic reconstruction technique with the same perioperative management and pain control regimen. Intra-operatively and post operatively complications were graded according to definitions stated by the Esophagectomy Complications Consensus Group (ECCG).

Results
Mean duration of the surgical procedure was 416 min (± 80). In total, 70 patients (70%) had an uncomplicated operative procedure and postoperative recovery. Pulmonary complications were most common and were observed in 17 patients (17 %). Anastomotic leakage was observed in 8 patients (8%). Median ICU stay was 1 day and median overall postoperative hospital stay was 11 days. 30 day mortality was 1%. A R0 resection was reached in 92% of patients with a median number of 29 dissected lymph nodes.

Conclusion
RAMIE4 with intrathoracic anastomosis for esophageal cancer or cancer located in the esophagus was technically feasible and safe. Postoperative complications and short term oncologic results were comparable to the highest international standards nowadays. These results could only be obtained due to a structured RAMIE training pathway. The superiority of RAMIE compared to conventional minimally invasive esophagus is currently investigated in multiple randomized controlled trials. Results of these trials will define the role for RAMIE for patients with esophageal cancer in the future.
P125 HEALTH-RELATED QUALITY OF LIFE ONE YEAR AFTER THE DIAGNOSIS OF OESOPHAGEAL AND JUNCTIONAL CANCER: A POPULATION-BASED STUDY FROM THE SWEDISH NATIONAL REGISTRY FOR ESOPHAGEAL AND GASTRIC CANCER
Authors: Berit Sunde , Mats Lindblad , Marlene Malmström , Jakob Hedberg , Pernilla Lagergren , Magnus Nilsson 
Published: November 2019

Abstract

Aim
The aim of this study is to describe and analyse patient reported HRQoL one year after the diagnosis of oesophageal and junctional carcinoma in an unselected cohort comprising both palliative and curative intent patients.

Background & Methods
Short and long-term health-related quality of life (HRQoL) has been extensively described in operated oesophageal cancer patients in several population-based studies. However, the knowledge of HRQoL in patients with palliative intent management is not well described, and further, documentation of HRQoL in curative intent patients treated with definitive chemoradiotherapy is also quite scarce. A nation-wide population-based cohort, of patients diagnosed between 2009 and 2016 collected in the Swedish National Registry for Esophageal and Gastric Cancer (NREV) with prospectively registered exposure data and Health-related quality of life (HRQoL) outcome data. Validated instruments from the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 were used, and data was analysed with means and adjusted mean differences.

Results
In patients alive one year after diagnosis, 1,156 responded to the HRQOL questionnaires and were included in the analyses. Both curative and palliative intent patients reported severe symptoms of problems in oesophageal specific domains. In the comparison between the curative and palliative intent groups, more prominent symptoms among palliative patients were detected regarding dysphagia (MD 11; 95% ci: 7-15) and anxiety (MD 10; 95% ci: 6 -15). Levels of anxiety were reported with high levels in all groups analysed and problems with dysphagia was also more common in patients treated with definitive chemoradiotherapy compared with surgically treated patients (MD 11; 95% ci: 4 -18) diagnosed in locally advanced disease stages.

Conclusion
One year after diagnosis high levels of anxiety were reported in all subgroups of oesophageal and junctional cancer patients, and problems with dysphagia are a major problem in the palliative intent subcohort and in patients treated with definitive chemoradiotherapy.
P126 HIGH ESOPHAGOTRACHEAL FISTULA DURING STENT TREATMENT OF AN ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Tagkalos Evangelos , Andrae Hannah K , Musholt Thomas J , Lang Hauke , Grimminger Peter P 
Published: November 2019

Abstract

Aim
We present a case of a 71 year old female with a combined anastomotic leakage after ivor-lewis resection and esophagotracheal perforation.

Background & Methods
Anastomotic leakage after esophageal resection is still associated with high morbidity and mortality throughout hospitalization. Nowadays there are several methods to accomplish sufficient closure of the anastomotic leakage such as clipping and using fibrin sealant in smaller leakages. Severe insufficiencies are commonly treated using esophageal stents. In our case the use of such a stent (10cm covered) placed to an anastomotic leak following esophagectomy with high intrathoracic anastomosis lead to an esophagotracheal fistula that was treated in a two-step approach. Firstly a tracheotomy was performed and the cuff of the tracheal cannula was blocked below the esophagotracheal fistula to prevent respiratory insufficiency. The stent was removed and an endosponge therapy was induced in order to manage the anastomotic leak. Finally, the semicircular wound could be covered by a fibrin sealant for final closure. In a second step, via open cervical surgery, the esophagotracheal fistula was resected, followed by overstitching of the pars membranacea and the esophagus and interposition of a muscle flap of the left pectoralis major muscle between trachea and esophagus.

Results
Postoperatively the patient was extubated with spontaneous breathing and the tracheal tube could be removed five days after surgery. After four days, the patient started drinking and enteral nutrition could be increased with a constant sufficiency of the gastric interponate. A postoperative contrast swallow at day 11 showed no leak and a good emptying of the gastric conduit. The control of the recurrent laryngeal nerves showed no abnormalities.

Conclusion
Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection, especially in patients with a low BMI, to prevent esophageal stent perforations. Furthermore, the combination of an esophagotracheal fistula and an anastomotic leak does not have to result in a cervical outlet and removal of the gastric conduit. Patients should be delivered to specialized upper GI surgical centers, which have a high standard of complex esophageal surgery and endoscopic intervention possibilities.
P13 DIFFERENCE IN LONG-TERM QUALITY OF LIFE BETWEEN MCKEOWN AND IVOR LEWIS ESOPHAGECTOMY
Authors: Jezerskyte E , Saadeh L M , Hagens E R C , Sprangers M A G , Noteboom L , van Laarhoven H W M , Eshuis W J , van Berge Henegouwen M I , Gisbertz S S 
Published: November 2019

Abstract

Aim
The purpose of this study was to investigate the difference in long-term health-related quality of life (HR-QoL) between McKeown and Ivor Lewis esophagectomy in a tertiary referral center.

Background & Methods
The therapy of esophageal cancers consist of (neo)adjuvant chemo(radio)therapy and surgery. Often different surgical approaches are possible such as transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). Evidence is scarce on whether either of these approaches is better in terms of survival, perioperative morbidity, pathology results and quality of life.
Patients with mid-, distal esophageal, gastroesophageal (GEJ) or cardia carcinoma who have undergone a McKeown or an Ivor lewis esophagectomy in the period of 2003 – 2018 were included in this study. EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires were handed out during the outpatient clinic visits and a follow-up of at least one year was ensured. Problems with eating, reflux and nausea and vomiting were chosen as primary HR-QoL domain endpoints while the remaining HR-QoL domains, postoperative complications and pathology results were observed as secondary endpoints. Correction for confounders age and gender was performed.

Results
147 patients were included in the McKeown group and 120 in the Ivor Lewis group. Mean age was 63.5 years and median follow-up was three years (range 12-137 months). No significant difference was found in problems with eating, reflux and nausea and vomiting. Significantly more problems with eating with others were found in McKeown group (β=10.435, 95% CI 4.474 – 16.395) and anastomotic leakage was significantly more common after McKeown esophagectomy (p=0.004). No significant difference was found in Clavien Dindo classification. During Ivor Lewis esophagectomy significantly more lymph nodes were resected (p<0.001). Number of lymph node metastases and R0 resection rate did not differ between groups.

Conclusion
No major differences in long-term HR-QoL were found in patients with mid-, distal esophageal, GEJ or cardia carcinoma following McKeown or Ivor Lewis esophagectomy. Problems with eating with others and anastomotic leakages were more common after McKeown esophagectomy, however, Clavien Dindo classification and radicality of surgery were similar between the two groups. Results of this study could assist the patient during the decision-making process prior to the surgery.
P131 REVEALING THE ERGONOMIC CRISIS OF AN UPPER GASTROINTESTINAL ROBOTIC SURGEON – STILL A LOT TO IMPROVE IN MINIMALLY INVASIVE SURGERY
Authors: Fuchs H , Ahn F , Leers J , Schröder W , Höfler C , Bruns C 
Published: November 2019

Abstract

Introduction/Aim
Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Even though robotic technology was primarily developed to improve perioperative outcomes, many robotic surgeons complain about ergonomics when using existing devices. Aim of this study is to evaluate the ergonomics of the newest robotic technology in a center of excellence for upper gastrointestinal surgery.

Background and Methods
Starting 02/2017 the latest available robotic system (davinci xi) was introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n>300 esophageal cases/year). Surgeons ergonomics were studied using a standardized video capture and touch sensor protocol (Fig 1 & 2). Data recorded were analyzed to study whether the new robotic system was used in an ergonomic fashion throughout robotic esophageal surgery.

Results
From 02/2017 – 05/2019, a total of 90 mainly upper gastrointestinal robotic cases including 45 Esophagectomies for cancer and 25 Heller Myotomies were performed. All cases were performed safely without operation-associated intraoperative complications.
Even though experienced robotic console surgeons used the robotic device, the davinci xi arm rest was used in less than 25% of surgery time (Fig. 3), resulting in loss of efficacy when using the robotic range of motion. Video documentation using the new technology is provided to showcase the dilemma.

Conclusion
Robotic technology allows for safe minimally invasive upper gastrointestinal surgery. Further development in robotics should focus on improvement of surgeons ergonomics.
P134 NASOGASTRIC TUBE UTILIZATION IN PATIENTS UNDERGOING ESOFAGUECTOMY: AN UNNECESSARY PROCEDURE
Authors: Menéndez M , Mingol F , Bruna M , Vaqué F J , Alvarez E , Hurtado L , Pérez C , García-Granero E 
Published: November 2019

Abstract

Aim
To evaluate the rate of complications and hospital stay length in patients undergoing esophagectomy in whom a descompressive tube was not utilized during the postoperative period.

Background & Methods
A descriptive and retrospective study was performed at our Health Care Center. All patients undergoing esophagectomy from March 2015 to April 2018, in which no decompressive tube was placed in the plasty during the postoperative period were included. We evaluated epidemiological variables, postsurgical morbidity -including nausea, vomiting or plasty emptying problems- postsurgical mortality, decompressive tube placement necessity and hospital stay lenght.

Results
A total of 41 patients were included, with an average age of 61.1 years. 82.9% were males. 43.9% were hypertensive, 63.4% were smokers and 13.1% were diabetics. 78% of patients had received neoadjuvant chemotherapy and / or radiotherapy prior to surgery. The surgical technique used was Mc Keown's esophagectomy in 23 patients (56.1%) and Ivor-Lewis tecnique in 18 (43.9%). In 85.4% of the cases, a thoracoscopic approach was used; and in 48.8% laparoscopy was utilized for abdominal approach. For the reconstruction, a gastroplasty was performed in 36 patients (87.8%) and a coloplasty was performed in 5 of them (12.2%). The anastomosis was performed manually in 53% of cases, and mechanically in 47%, by utilizing a circular stapler. The rate of complications was : 1 necrosis of the coloplasty (2,4%) who died because of a multiorganic failure; 2 stenosis of the anastomosis (4,8%) treated by endoscopic dilatations and 4 anastomosis leaks (9,8%). The mortality rate was 4,8%. 1 patient died due to coloplasty necrosis and the other one because of an acute respiratory distress syndrome (ARDS).

Conclusion
The non-use of a descompressive probe during the postoperative period of an esophagectomy does not entail a higher rate of complications compared to the available literature.This fact can improve the comfort of the patient and reduce hospital stay length.
P136 COMPARISON OF TOTALLY MINIMALLY AND HYBRID IVOR LEWIS ESOPHAGECTOMY FOR CANCER OF DISTAL ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION
Authors: Stefano de Pascale , Uberto Fumagalli Romario 
Published: November 2019

Abstract

Aim
Aim of this retrospective study is the comparison of the short-terms outcomes and QoL of Hybrid Ivor Lewis (HIL) and Totally Minimally Invasive Ivor Lewis (TMIIL).

Background & Methods
Minimally invasive techniques for esophagectomy represents a challenging procedure with aiming to decrease cardiopulmonary complications and guarantee better quality of life (QoL) compared to open techniques, without compromising oncological radicality. Patients with cancer of distal esophagus and EGJ were included into (HIL) and (TMIIL) groups in the period January 2017 – March 2019. General features, intraoperative and postoperative results were analyzed. For all the patients a feeding jejunostomy was performed. The surgical radicality and number of resected nodes were also evaluated. QoL was determined preoperatively, at 7 and 90 days postoperatively with EORTC QLQ-C30 questionnaire.

Results
Eighteen and 24 patients were submitted to TMIIL and HIL respectively. General features were similar in the two groups. Median intervention duration was 360 minutes [range: 240-420] in TMIIL group and 335 minutes [range: 150-400] for HIL group (p=0.0647). Median blood losses were similar for TMIIL and HIL group, 100 ml [range:50-400] and 175 ml [50-350] respectively (p=0.0831). No differences were observed in terms of postoperative complications CD≥2. One exitus occurred in HIL group (CD=5), none in TMIIL group (p=n.s). No differences were evidenced for median number of lymphnodes harvested in the two group as well for rate of R0 and R1 resections. Results obtained from the QoL questionnaires evidenced a reduction of postoperative pain during the first 7 postoperative day for patients in the TMIIL group compared to HIL; these data were confirmed by the analysis conducted on postoperative day 90, as well for the global health status, physical functioning and role functioning.

Conclusion
Our experience evidenced TMIIL esophagectomy seems to give the similar results, of HIL influencing positively the QoL within 90-day after surgery. Duration of surgery and anastomotic leaks are the key elements influencing the learning curve. Randomized controlled trials are necessary to confirm the good results obtained and to give recommendations to avoid a high rate of complications
P137 OUTCOME OF PATIENTS UNDERGOING ENDOSCOPIC MUCOSAL RESECTION FOR CANCER OF THE OESOPHAGUS FROM A SINGLE CENTRE
Authors: Chmelo J , Milito P , Madhavan A , Griffin S M , Wahed S , Hayes N , Immanuel A , Phillips A W 
Published: November 2019

Abstract

Aim
To evaluate the outcomes patients undergoing endoscopic mucosal resection (EMR) as a therapeutic and or diagnostic treatment for oesophageal cancer.

Background
Management of early oesophageal cancer usually involves major surgery (oesophagostomy) which has a reported morbidity of 50% and mortality of 3%. EMR is increasingly used as a treatment for patients with early (T1 N0) oesophageal cancer. It may also be employed as a diagnostic tool in those where previous biopsies have been insufficient in proving a cancer.

Methods
A retrospective review of patients who underwent EMR with a curative intent for cancer of the oesophagus or oesophago-gastric junction (OGJ) at a single centre between October 2006 and February 2019 was conducted. Patients were included in the study if the EMR sample was positive for T1a or T1b cancer.

Results
Overall 144 patients were identified who underwent 276 therapeutic or diagnostic procedures. 141 patients were diagnosed with adenocarcinoma and 3 patients with squamous cell cancer (SCC). T1a stage was confirmed for 120 patients with adenocarcinoma and one with SCC. 21 patients with adenocarcinoma and 2 with SCC were staged as T1b. 78 patients underwent EMR as their sole treatment for cancer- three year cancer related survival was 89% and 5 year 69%. A further 49 patients progressed to having surgery (gastrectomy (2), trans-thoracic oesophagectomy (47). Six (12%) were node positive.
There was no mortality associated with EMR, however bleeding requiring intervention or readmission was observed after 29 procedures (11%) and perforation was seen after 3 procedures (1.1%).

Conclusion
EMR is a safe procedure in the treatment of early oesophageal or OG junctional cancer. However survival may not be as high as expected in patients similarly staged but undergoing more radical treatment.