bluuebunny/crossref_metadata_2025_split huggingface dataset:
P22 PRELIMINARY EXPERIENCE WITH PROPHYLACTIC THORACIC ENDOVASCULAR AORTIC REPAIR (PRO-TEAVAR) IN PATIENTS AFFECTED BY ADVANCED ESOPHAGEAL CANCER
Authors: Gervasi Maria Clelia , De Pasqual Carlo Alberto , Weindelmayer Jacopo , Mezzetto Luca , Scrsone Lorenzo , Giacopuzzi Simone , Veraldi Gian Franco , de Manzoni Giovanni 
Published: November 2019

Abstract
Bleeding from the thoracic aorta is potentially fatal in patients with advanced esophageal cancer (AEC). Esophageal malignancy is the third most common cause of aorto-esophageal fistula (AEF), after thoracic aortic aneurysm and ingestion of foreign body. The involvement of aortic wall often contraindicates chemo-radiotherapy (CRT) treatment, thus reducing life expectancy of these patients. Thoracic endovascular aortic repair (TEVAR) is a well described mini-invasive technique that can be also applied for coverage of aortic lumen in case of invasion by esophageal cancer (EC). Only few cases have been published with this atypical indication. Between 2016 and 2018, in our tertiary hospital three patients affected by AEC involving the thoracic aorta were treated by means of prophylactic TEVAR (ProTEVAR). We did not observe procedure-related complications and all patients were reconsidered fit for preoperative or definitive CRT.
P23 MALNUTRITION INDICES AS PROGNOSTIC FACTORS FOR POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS
Authors: Irene Lidoriki , Dimitrios Schizas , Efstratia Mpaili , Maria Mpoura , Natasha Hasemaki , Adamantios Michalinos , Alkistis Kapelouzou , Ioannis Karavokyros , Theodore Liakakos 
Published: November 2019

Abstract

Aim
To investigate the impact of malnutrition on postoperative complications in esophageal cancer patients.

Background and Methods
Malnutrition is common in esophageal cancer patients due to the debilitating nature of their disease. Several methods of nutritional assessment have emerged as significant prognostic factors for short-and long-term outcomes in patients operated for esophageal cancer. The study sample consisted of 85 patients with esophageal (n=11) and gastroesophageal junction (n=74) cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and March 2019. Out of them, 65 patients underwent esophagectomy, while 20 patients underwent total gastrectomy. The assessment of nutritional status included the Geriatric Nutritional Risk Index (GNRI), the Patient Generated Subjective Global Assessment (PG-SGA) and sarcopenia. GNRI was based on preoperative values of patients’ serum albumin and body weight. The preoperative assessment of sarcopenia was based on Skeletal Muscle Index (SMI) derived from analysis of CT scans using SliceOmatic® Software version 4.3 (Tomovision, Montreal, Canada). Postoperative complications were graded according to Clavien-Dindo classification. Minor complications included categories I-II, whereas major complications included categories III-V.

Results
Thirty nine patients (47.6%) developed postoperative complications. More specifically, 21 patients (24.7%) developed minor complications and 18 patients (21.2%) developed major complications, while anastomotic leakage occurred in 10 patients (11.8%). Eighty patients (94.1%) had a high-risk GNRI (<92), while 5 patients (5.9%) had a low-risk GNRI (≥92). Forty four patients (51.8%) were diagnosed with sarcopenia. The mean PG-SGA score was 8.82 ± 5.57. Patients with a high-risk GNRI demonstrated significantly higher rate of overall complications compared to low-risk GNRI patients (100% vs 44.2%, p<0.05 respectively). Moreover, the rate of anastomotic leakage was significantly higher in the sarcopenia group than in the non-sarcopenia group (29% vs 3.4%, p<0.05). Nonetheless, PG-SGA was not significantly associated with postoperative outcomes.

Conclusion
Higher-risk scores on the GNRI are associated with an increased risk for developing postoperative complications, while sarcopenia is associated with higher risk for anastomotic leakage among esophageal cancer patients. Preoperative assessment of GNRI and sarcopenia should be performed in all patients in order to detect patients who are at greater risk of postoperative morbidity.
P25 DETECTION OF CIRCULATING TUMOR CELLS IN POTENTIALLY RESECTABLE ADENOCARCINOMA OF DE DISTAL ESOPHAGUS AND THE GASTRO-ESOPHAGEAL JUNCTION DOES NOT INCREASE IN PORTAL VENOUS BLOOD SAMPLES COMPARED TO PERIPHERAL VENOUS BLOOD SAMPLES
Authors: Lieven Depypere , Annouck Philippron , Katleen De Preter , Willy Coosemans , Hans Van Veer , Piet Pattyn , Philippe Nafteux 
Published: November 2019

Abstract

Aim
To compare the number of circulating tumor cells (CTCs) in portal venous blood samples of patients with potentially resectable adenocarcinoma of de distal esophagus and the gastro-esophageal junction (EAC) with the number of CTCs in peripheral venous blood samples.

Background and Methods
Detection of (CTCs) in potentially resectable (EAC) is rare in peripheral venous blood samples(1). In lung carcinoma patients, the number of circulating tumor cells was more than 300 fold in the pulmonary vein, compared to the number in peripheral venous blood samples (2).
In patients undergoing esophagectomy for cancer, peripheral blood was sampled immediately preoperatively and portal vein blood was sampled intraoperatively during abdominal lymph node dissection. Samples were analyzed for CTCs using the parsortix device (ANGLE): a semi-automated microfluidic system that captures cells based on their size and rigidity. A four-color immunofluorescence technique was used and CK positive, CD45 negative, Hoechst positive and morphologically intact cells with the morphology of a CTC were counted manually.
The method was previously compared with the commercially available Cellseach® system and no difference in CTC yield between both methods.

Results
20 patients with potentially resectable EAC were evaluated. One peripheral venous sample and two portal venous samples were not applicable. In 5 out of 19 peripheral venous samples (26,3%), one or more CTC’s could be detected, while in this was only the case in 3 out of 18 portal venous samples (16.7%).

Conclusions
The number of detected CTCs in potentially resectable EAC was not increased in portal venous samples compared to peripheral venous samples. Further research is needed on why detection rate of CTCs in potentially resectable EAC is so low and how detection rate could be increased.
O26 QUALITY OF LIFE FOR ACHALASIA PATIENTS IS THE SAME AFTER PER-ORAL ENDOSCOPIC MYOTOMY (POEM) AND HELLER MYOTOMY
Authors: Gavriella Zoi Vrakopoulou , Francesco Di Maggio , Lavinia Barbieri , Sebastian Zeki , Jason M Dunn , Terence Wong , Jafar Jafari , Abraham Botha 
Published: November 2019

Abstract

Aim
This study aimed to compare the efficacy and safety of LHM and POEM for esophageal achalasia.

Background & Methods
Laparoscopic Heller’s myotomy (LHM) has been the gold standard of treatment, however per-oral endoscopic myotomy (POEM) was recently established as a treatment option for achalasia. A prospective review was performed for all patients submitted to LHM or POEM in our institution from 10/2012 to 06/2018, and have completed a minimum follow up period of 6 months. The diagnostic work-up included gastroscopy, barium study and high-resolution manometry (HRM). All patients underwent a clinical evaluation 6 weeks after treatment and a surveillance gastroscopy in the 1st postoperative year. HRM and pH studies were offered to all patients after 6 months. Standardized questionnaires evaluating Eckardt, GERD and achalasia QoL (Urbach) scores were completed pre- and postoperatively. Statistical analyses were performed with SPSS version 23.0. Repeated measurements analysis of variance was used to compare changes in mean values during follow up and between the two types of surgery. P values < 0.05 were considered significant.

Results
Eighty patients (34 women and 46 men) with mean age 42.6 years (16.2) underwent POEM (n=39) or LHM (n=41). QoL score was significantly improved in both study groups (p<0.001) with a similar degree of improvement (p=0.486). Eckardt scores showed a significant improvement in both groups, but repeated measurements analysis revealed a significant effect with time (p=0.038) with a greater improvement in POEM group. Moreover, Eckardt score change was similar between LHM and POEM patients without prior treatments (p=0.724), but in those with prior treatments the improvement trended higher in POEM group (p=0.087). GERD score had a similar and significant decrease in both groups (p=0.439), but in those with prior treatments the improvement was greater in LHM group (p=0.018). There was no significant difference regarding the complication rates for both groups (Clavien-Dindo I-IIIa).

Conclusions
POEM compares favorably with LHM as treatment for achalasia, as statistically significant improvement in QoL, GERD and Eckardt scores was recorded in both groups. In patients with prior treatments, POEM tends to achieve a greater improvement of Eckardt score and LHM a greater reduction regarding GERD score.
P36 DE NOVO GORD AFTER ROUX Y GASTRIC BYPASS: UNCOMMON BUT POSSIBLE – A LOOK AT THE WHY FACTORS
Authors: Hatem Al Saadi , Alistair Sharples , Bridie Cornes , Vittal Rao , Balaji Nagammapudur 
Published: November 2019

Abstract

Background
Roux Y gastric bypass (RYGB) is the preferred bariatric surgical option in patients with Gastro oesophageal reflux disease (GORD). However, de novo GORD after RYGB although uncommon is possible and present challenges in further management. Proposed mechanisms have been a large gastric pouch or a short alimentary limb.

Objective
Analyse anatomical causes of De Novo GORD post RYGB

Methods
Data of patients who presented with new onset GORD after RYGB were collected and analysed.

Results
Specific and remediable anatomical factors contributing to de novo GORD was found in 8 patients post RYGB (3 Males and 5 Females). Onset of symptoms ranged from 1.16-15 years. Mean age was 53.14 and mean BMI 37.39. One patient had R-Y gastric bypass for peptic ulcer disease in the past.
Diagnostic work up included; Barium swallow (85.7%), CT Abdomen (42.9%), OGD (57.1%).
Diagnosis of candy cane (CC) syndrome was seen in 50 % of cases (n=4) followed by Gastro-gastric fistula (n=1), gastric pouch herniation (n=1) and pouch herniation with CC syndrome (n=2). Excision of excess CC limb achieved resolution in symptoms of reflux. 4 patients are awaiting surgical anatomical correction.

Conclusion
De novo GORD after RYGB can be challenging. These patients need thorough anatomic and physiologic assessment to identify potentially correctable anatomical causes. A long CC, herniated gastric pouch, gastro-gastric fistula are anatomical causes identified in our study. Identification and evaluation of this sub group of patients has not been reported in the past but are likely to be increasingly encountered.
P41 C-REACTIVE PROTEIN AS A PREDICTOR FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL SURGERY
Authors: Hagens E R C , Lam MSc W C , Eshuis W J , Lameris W , van Berge Henegouwen M I , Gisbertz S S 
Published: November 2019

Abstract

Aim
To determine the accuracy and optimal cut-off values of CRP to predict anastomotic leakage.

Background and methods
CRP is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications in gastrointestinal surgery, but optimal cut-off values and diagnostic accuracy are undetermined.
A prospective observational study was conducted including consecutive patients with an esophageal carcinoma scheduled for an esophagectomy with gastric tube reconstruction between April 2016 and October 2018 in the Amsterdam UMC, location AMC, The Netherlands. CRP was measured routinely on post-operative day (POD) 3, 5 and 7. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT-scan or by endoscopy or if saliva was draining form the neck incision in clinical suspicion of leakage. The diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden’s index was adopted to determine the cut-off value.

Results
200 patients were included. POD 5 showed the highest area under the ROC to predict anastomotic leakage with a cut-off value of 120 mg/L. The optimal cut-off value for CRP to predict anastomotic leakage or any complication is shown in table 1 with the corresponding area under the ROC, sensitivity, specificity, positive predicting value and negative prediction value.

Conclusion
CRP on postoperative day 5 is a feasible marker to predict anastomotic leakage, using a cut-off value of 120 mg/L, resulting in a negative predicting value of 96% and a specificity of 92%. When CRP exceeds 120 mg/L on postoperative day 5 additional investigations should be considered.
P60 CRITICAL APPRAISAL OF GASTRIC CONDUIT ISCHAEMIC CONDITIONING PRIOR TO OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sivesh K Kamarajah , Charlie Boyle , James R Bundred, , Benjamin HL Tan 
Published: November 2019

Abstract

Aim
Anastomotic leaks remain a major complication following oesophagectomy, accounting for high morbidity and mortality. Recently, gastric ischaemic conditioning (GIC) has been proposed to improve anastomotic integrity through neovascularisation of the gastric conduit. This systematic review aims to determine the impact of GIC on postoperative outcomes after oesophagectomy.

Background & Methods
A systematic literature search was performed to identify studies reporting GIC for any indication of oesophageal resection. Random-effects meta-analyses were conducted for main outcomes.

Results
Nineteen studies were included reporting GIC, of which 13 were comparative studies. GIC were performed through ligation in 13 studies and embolisation in six studies. GIC did not appear reduce anastomotic leakages (OR 0.80, CI95: 0.51 - 1.24, p=0.3), anastomotic strictures (OR 0.75, CI95: 0.35 - 1.60, p=0.5), overall complications (OR 1.02, CI95: 0.48 - 2.16, p=0.9), major complications (OR 1.06, CI95: 0.53 - 2.11, p=0.9), or in-hospital mortality (OR 0.70, CI95: 0.32 - 1.53, p=0.4). However, preconditioning reduced the rates of conduit necrosis (OR 0.30, CI95: 0.11 - 0.77, p=0.013).

Conclusion
Gastric preconditioning through does not appear to reduce overall rates of anastomotic leakage after oesophagectomy but seems to reduce severity of leakages. More in depth studies are recommended.
P65 USPIO-MRI FOR PRE-OPERATIVE LYMPH NODE STAGING AFTER NEOADJUVANT CHEMORADIOTHERAPY: FEASIBILITY AND VALIDATION FRAMEWORK
Authors: J. J. M. de Gouw D , R. Klarenbeek B , Maas M C , Slagt C , Mühling J , M. Rovers M , van der Post R S , J. Hermans J , Scheenen T W J , Rosman C 
Published: November 2019

Abstract

Background
Extensive lymph node dissections during esophagectomy may be omitted in patients with esophageal cancer without lymph node metastases, reducing associated morbidity. A promising technique to detect lymph node metastases is MRI with ultrasmall superparamagnetic iron oxide nanoparticles (USPIO, ferumoxtran-10). To validate USPIO-enhanced MRI in patients with esophageal cancer, a framework is designed to compare lymph nodes of the MRI scans with histopathology data on a node-to-node level.

Methods
USPIO-nanoparticles are intravenously infused 24 to 36 hours before MRI. USPIO-enhanced MRI is performed before and after nCRT. After nCRT, patients are scanned under general anesthesia immediately prior to surgery in the MR system of the hybrid MITeC operation room with controlled mechanical ventilation. During controlled prolonged apneu, a four-minute iron-sensitive MRI acquisition is used to visualize suspicious esophageal lymph nodes without motion artefacts. Resected specimens, still containing USPIO, are measured ex-vivo in a preclinical 7T MR system before histopathological examination. A radiological assessment of the presence of suspicious lymph nodes in-vivo is matched to the ex-vivo nodes on preclinical MRI, providing the ground truth for the presence of metastases.

Results
Currently, five patients have completed the full study protocol. Two patients underwent the first UPSIO-MRI but did not undergo surgery due to progressive disease. First results show that MRI under anesthesia prior to surgery with controlled mechanical ventilation was possible resulting in a clinically relevant spatial resolution to visualize possibly malignant lymph nodes. In these five patients, the radiologist found 58 lymph nodes with a mean diameter of 8.4 mm before nCRT and 40 lymph nodes with a mean diameter of 7.4 mm after nCRT. In total, 126 lymph nodes were analyzed by histopathology. Suspicious nodes were identified and could be matched using corresponding anatomical landmarks to the ex-vivo MRI, which showed good visual agreement with esophageal specimen after resection.

Conclusions
We performed USPIO-enhanced MRI in patients with esophageal cancer and proposed a method to validate USPIO-enhanced MRI to detect suspicious lymph nodes in these patients. Results on the feasibility of USPIO-enhanced MRI to detect metastatic lymph nodes after nCRT are still awaited.
P71 NUTRITIONAL JEJUNOSTOMY IN ESOPHAGECTOMY FOR CANCER, A NATIONAL REGISTER-BASED COHORT STUDY OF ASSOCIATIONS WITH POSTOPERATIVE OUTCOMES AND SURVIVAL
Authors: Anders Holmén , Masaru Hayami , Eva Szabo , Ioannis Rouvelas , Thorhallur Ágústsson , Fredrik Klevebro 
Published: November 2019

Abstract

Aim
The aim was to increase the knowledge about nutritional jejunostomies in curative intended treatment of esophageal and gastroesophageal junction cancer.

Background and Methods
The insertion of a jejunostomy in conjunction with esophagectomy is performed to decrease the risk for malnutrition and improve recovery. These possible benefits have, however, not been scientifically proven.
All patients in Sweden, treated with esophagectomy due to cancer 2006-2017 in the Swedish National Register for Esophageal and Gastric Cancer, were included in this retrospective population-based cohort study. The indication for jejunostomy was not defined in the register. The patients were stratified into two groups: esophagectomy with jejunostomy, and esophagectomy alone.

Results
A total of 1024 patients (54.73%) had a jejunostomy inserted in conjunction with esophagectomy, while 847 patients (45.27%) were treated without jejunostomy. The median age was 66 years, and 79% of the patients were male. The groups were similar in regard to age, performance status, baseline dysphagia and weight, ASA-score, tumor location, neoadjuvant treatment, and use of minimally invasive technique.
The patients in the jejunostomy group had more squamous cell carcinoma (20.3% vs. 17.8%, P=0.005), and more locally advanced tumors. There were no significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate. The risk of pneumonia was increased in the jejunostomy group (11.8% vs. 7.2%, P=0.001). For patients with postoperative anastomotic leaks the risk for postoperative Clavien-Dindo score of IIIb or more was reduced (79.7% vs. 94.7%, P=0.037, adjusted odds ratio 0.20, 95% CI 0.04-0.97).

Conclusions
Jejunostomy is a safe method to ensure postoperative nutrition after esophagectomy, and might reduce the risk for severe outcomes in patients who suffer an anastomotic leak.
P73 CONTRIBUTION TO THE IMPROVEMENT OF CARDIAC LOAD BY RADICAL SURGERY FOR ADVANCED ESOPHAGEAL HIATAL HERNIA
Authors: Shunsuke Tanabe , Yasuhiro Shirakawa , Naoaki Maeda , Kazuhiro Noma , Toshiyoshi Fujiwara 
Published: November 2019

Abstract

Aim
The aim of this study is to clarify whether radical surgery for advanced esophageal hiatal hernia contribute to the improvement of cardiac load.

Background & Methods
In Japan, endoscopic surgery for esophageal hiatal hernia is increasing. In many cases, patients with mixed type hernia have the main symptom of meal passage disorder due to gastric torsion. On the other hand, there are cases in which the contents of hernia squeeze the heart and lung and the symptoms of respiratory and circulatory system get worse. And there are cases where cardiac load is exacerbated and QOL is got worse. Therefore, in addition to conventional surgical adaptation criteria such as vomiting and food loss, cardiac load aggravation may be added to the new surgical adaptation criteria. In this study, we measured BNP before and after surgery in the case of mixed type hiatal hernia who underwent surgery at our hospital, and examined changes in cardiac load. Our surgical procedure of laparoscopic fundoplication is basically toupet fundplication. In the elderly patients, the formation of toupet fundplication is about half a cycle, which is slightly looser than usual, in order to avoid passage obstruction of the wrap. If the esophageal hiatus is too large and it is difficult to suture closure, try to reduce the air pressure of laparoscopic surgery as much as possible to reduce the resistance to the suture closure. And we try not to damage the diaphragm leg.

Results
We experienced 70 esophageal hiatal hernia surgeries in 2012-2018 and 45 patient had mixed type hiatal hernia. In mixed type hiatal hernia case, 18 cases (40.0%) had chest symptoms such as fatigue and dyspnea on exertion. And there were 12 cases in which BNP could be measured before and after surgery as an evaluation for the presence of cardiac load. Postoperative BNP decreased in 11 of 12 cases from preoperative values. Almost all cases chest symptoms improved. In the above 45 cases, there have been no cases of reoperation and very few cases have taken proton pump inhibitors after surgery.

Conclusion
Surgical cases of giant hiatal hernia may increase in the future, especially in the elderly. Surgery for giant hiatal hernia can contribute to the improvement of cardiac load.
P74 A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS OF ANASTOMOTIC TECHNIQUES FOR OESOPHAGECTOMY FOR MALIGNANCY
Authors: Sivesh K Kamarajah , James R Bundred , Pritam Singh , Sandro Pasquali , Ewen A Griffiths 
Published: November 2019

Abstract

Aims
This systematic review and network meta-analysis evaluates the evidence for the techniques for oesophagogastric (OG) anastomosis and their impact on perioperative outcomes.

Background
Current evidence on the benefits of different anastomotic techniques (hand-sewn (HS), circular stapled (CS), triangular stapler (TS) or linear stapler/semi-mechanical (LSSM) techniques after oesophagectomy is conflicting.

Methods
A systematic literature search was conducted to identify randomised and non-randomised studies reporting techniques for the OG anastomosis. Network meta-analysis of postoperative anastomotic leaks and strictures was performed.

Results
This study included 15 randomised and 22 non-randomised studies (n=8,618). LSSM (OR: 0.49, CI95%: 0.33 - 0.74, p=0.001) and CS (OR: 0.68, CI95%: 0.48 - 0.95, p=0.027) and anastomoses were associated with lower anastomotic leak rates than HS anastomosis. LSSM anastomosis was found to be superior to CS (OR: 0.15, CI95%: 0.08 - 0.28, p <0.001), TS (OR: 0.32, CI95%: 0.19 - 0.54, p <0.001) and HS (OR: 0.15, CI95%: 0.05 - 0.46, p=0.001) anastomoses respectively in anastomotic stricture rates. LSSM was ranked the best technique with high probability for anastomotic leaks and strictures.

Conclusions
Stapled anastomoses, specifically LSSM were associated with lower anastomotic leaks and strictures rates following oesophagectomy. Therefore, current evidence suggests superiority of the LSSM technique for OG anastomosis.