bluuebunny/crossref_metadata_2025_split huggingface dataset:
P214 ESOPHAGECTOMY FOR ESOPHAGEAL CANCER IN AN UPPER GI UNIT OF THE NATIONAL AND KAPODISTRIAN UNIVERSITY OF ATHENS DURING THE PERIOD 2004-2019
Authors: Mylonas K , Schizas D , Hashemaki N , Mpaili E , Ntomi V , Michalinos A , Theochari N , Theochari C , Mpoura M , Liakakos T 
Published: November 2019

Abstract

Aim
To describe the clinicopathological features and outcomes of patients registered in the esophageal cancer database of an academic upper GI unit in Greece.

Methods
We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the National and Kapodistrian University of Athens, during the period January 2004-June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence.

Results
A total of 146 patients were identified. Mean patient age was 62.3 xxx 10.3 years. Male to female ratio was 6.3:1. Overall, Ivor-Lewis, McKeown, and left thoracoabdominal esophagectomy was performed in 98 (67.1%), 34 (23.3%), 12 (8.2%), patients, respectively. Pharyngolaryngoesophagectomy was performed in 2 (1.4%) cases. R0 resection was achieved in 142 (97.7%) patients. Postoperative complications developed in 62 (45.3%) patients. Neoadjuvant chemotherapy and radiation were administered to 35 (26.9%) and 11 (8.5%) patients, respectively. Postoperative chemotherapy and radiation were administered to 68 (54.8%) and 17 (13.7%) patients, respectively. In total, 4 (2.7%), 23 (15.8%), 30 (20.6%), 55 (37.7%) 34 (23.3%) patients were Stage 0, I, II, III, IV respectively. Among patients with available follow-up information, overall recurrence and all-cause mortality rates were 41.2% and 46.2%, respectively. Median recurrence time and median time of death were 11.3 months and 2.5 years, respectively. On multivariate Cox regression, presence of positive lymph nodes (HR: 1.1, p=0.03) was predictive of higher recurrence rates, while neoadjuvant chemotherapy had a protective effect on disease relapse (HR=0.4, p=0.04). On multivariate Cox regression, need for neoadjuvant radiotherapy (HR: 6.9, p=0.001) and recurrence (HR: 3.4, p=0.002) were independently associated with higher risk of all-cause mortality.

Conclusions
In this study, we explored outcomes of patients undergoing esophagectomy for esophageal and GEJ cancer in an upper GI unit in Greece over a 15-year period. Outcomes were comparable to those reported from major referral centers across the globe.
P215 THE COMPLEX BENIGN UPPER GI MDT - A QUALITY IMPROVEMENT INITIATIVE FROM A TERTIARY CENTRE
Authors: Syed Soulat Raza , Ikenna Anderson Aneke , Alistair Sharples , C Bradbury , Stephanie Evans , Nagammapudur Balaji 
Published: November 2019

Abstract

Introduction
The Upper GI cancer Multidisciplinary team (MDT) has become an essential and integral part of the cancer treatment pathway in the management of Oesophagogastric (OG) cancer. There exists an need for the MDT management of complex benign diseases of the oesophagus which can be equally rewarding if proper decision making for treatment is achieved in this potentially challenging group of patients.

Methods
We explore the utility of a Benign Complex MDT model consisting of Surgeons, Gastroenterologists, radiologists and GI Physiologists in a tertiary teaching hospital setting.
A retrospective review of 72 patients who were discussed in the Complex Benign UGI MDT over a 2 year was undertaken. The referral pattern, decisions and outcomes have been analysed. All results were analysed using SPSS version 23. Results are reported in median +/- ranges or percentages where applicable.

Results
Patients had median age of 57 years with 62.5% being women.
30/72 (41.7%) patients had previous surgery. Majority of the referrals were made by surgeons 61/72 (84.7%) followed by gastroenterologist 10/72 (13.9%).
Dysphagia was the predominant symptom in 34/72 (47.2%) patients followed by reflux in 31/72 (43%) patients and 19.4% patients had a combination.
The purpose of an MDT referral was expert advice in 45/72 (62.5%) and consideration of surgery in 23/72 (31.9%) patients. The recommendations of the MDT was further clinic review (30%), further investigation (30.5%), surgery (18%), discharge (11%). MDT changed patient’s management in 30/72 (41.7%) cases.

Conclusion
Our results show that surgery was recommended less frequently after initial MDT discussions in patients who were initially referred for potential surgical advice. The management of complex benign conditions of the oesophagus can be challenging particularly after initial interventions. A MDT approach to the management of these patients can be recommended as equally vital to their management on recommending/avoiding further surgical or endoscopic interventions.
P217 SAFETY OF ESOPHAGEAL DILATION IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS IN A SINGLE CENTER COHORT
Authors: Weidan Zhao , Asad Ali , Craig Rosenstengle , Kuangda Shan , Yehudith Assouline-Dayan 
Published: November 2019

Abstract

Aim
This study is aimed to assess the safety of esophageal dilation (ED) in a large cohort of eosinophilic esophagitis (EoE) cases in a single center.

Background & Method
EoE, the leading cause of food impaction, is a chronic immune-mediated disorder characterized by esophageal dysfunction and mucosal eosinophilic infiltration (≥ 15 eos/hpf). ED is considered a second-line therapy for EoE after failure of medication, due to concern of perforation.
We performed a retrospective review of EoE patients who received ED at University of Iowa Hospitals and Clinics from 2006 to 2018. ED types, complications, and symptomatic improvement were extracted via chart review. Descriptive statistic with univariate analysis was performed.

Results
Of 1050 EoE patients, 160 received 295 EDs, ranging from 1-12 dilations per patient, with 67 patients requiring >1 dilations. Procedures were generally well-tolerated, without major bleeds or perforations. The overall complication rate was 6.1%, mostly post-procedural chest pain (4.8%). Three patients had sedation-related complications: one aspiration pneumonia and two ICU admissions for respiratory distress. Symptomatic improvement was documented in 87% of dilations on follow up.

Conclusion
EoE prevalence is increasing with rates of 1 cases per 1000 individuals, with up to one-third requiring ED for symptomatic relief. Previous reports suggested an increased procedure-related risk, mainly esophageal perforation. However, recent systematic reviews have shown low perforation rate of <0.3%, approximating that of other benign conditions. Our findings are consistent with current data, suggesting that ED should be considered a safe treatment for EoE along with dietary and pharmacological interventions.
P220 DEVELOPMENT OF A NEW PSYCHOLOGICAL TOOL TO IMPROVE PATIENT ABILITIES TO DEAL WITH ESOPHAGECTOMY: PRELIMINARY RESULTS
Authors: Pinto E , Fabbian A , Alfieri R , Da Roit A , Marano S , Mattara G , Pilati P , Castoro C , Turchi G P 
Published: November 2019

Abstract

Aim
This study aims to create a tool for evaluation of patient ability to deal with postoperative course after esophagectomy for cancer.

Background & Methods
Esophagectomy requires patient to be active and compliant to face up to postoperative impairments. Health related quality of life (HRQoL) data in short and medium-term after surgery show that competences used by patients are not appropriate. Lack of patient abilities to manage postoperative course influences patient recovery and reduces HRQoL.
Psychological analysis of patient clinical needs was conducted to identify peculiar patient competences involved after esophagectomy. Four competences (future forethought; context evaluation; consequences of own actions forethought; use of available resources), each relevant to four areas (clinical; familiar; working; daily-activities) were identified and converted in open-ended questions to assess patient level of skills: a 16 questions structured interview was composed.
From April to June 2019 we performed a feasibility study on 18 consecutive patients between 3rd and 15th postoperative day. They underwent esophagectomy for esophageal or esophagogastric junction cancer in two high volume centers. Patients with metastasis, with language problems due to neurological impairment or age <18 were excluded. M.A.D.I.T.-Methodology of Computerized Textual Data Analysis (University of Padua) was used.

Results
Each interview was administered orally to all patients and took 15 minutes. 5 questions were asked to be repeated. No complaints or negative comments were received.
Non-responding percentage was 0,4% (one question in one interview). Textual corpus was composed of 3210 words, passable of analysis. No differences between postoperative days administration were found.
M.A.D.I.T. analysis showed that answers were adequate and pertinent and allowed us to stratify patients in three different levels of competences (low, median, high). No need of additional competences or areas was observed.

Conclusion
This new psychological tool shows content validity, adequacy and pertinence to the study aim. It is understandable, easy, quick to be answered during any postoperative day and useful to identify patients with low abilities to deal with esophagectomy.
Therefore a multicentric study will be conducted to use this tool further in multiple-choice format with a larger number of patients, in order to identify which patients will benefit of psychological intervention for HRQoL improvement.
P221 THE ROLE OF SUBCARINAL LYMPH NODE DISSECTION IN ESOPHAGECTOMY - A 5-YEAR SINGLE CENTER EXPERIENCE
Authors: Mpaili Eustratia , Schizas Dimitrios , Mpoura Maria , Vagios Ilias , Zografos Constantinos , Michalinos Adamantios , Davakis Spyridon , Kyros Eleandros , Charalabopoulos Alexandros , Liakakos Theodore 
Published: November 2019

Abstract

Aim
To evaluate the involvement of subcarinal lymph node dissection (SLND) in the surgical treatment of esophageal cancer, as well as its impact on surgical outcomes following esophagectomy.

Background & Methods
Data on patients that underwent esophagectomy from 01/03/2014 to 01/03/2019 were prospectively collected and retrospectively reviewed. Based on the medical records, the following parameters were collected and analyzed: patient demographics, histopathological parameters, surgical- oncological outcomes. All patients were staged according to the AJCC 8th edition.

Results
A total of 79 patients underwent Ivor Lewis or McKeown esophagectomy for either squamous cell carcinoma (n= 7 patients) or adenocarcinoma of the esophagus or gastroesophageal junction (n= 72 patients). In 26 cases, esophagectomy was performed without SLND, while 53 cases underwent SLND. Among the 53 patients, 50 (94.3%) were men, and 3 (5.7 %) were women. Mean age was 61.4 years, (range 34-78). Mean nodal harvest was 34.7 lymph nodes per patient. Lymph node invasion was noted in 33 patients (62.2%), with a mean of 9 positive lymph nodes per patient. Subcarinal lymph nodes were involved in 5 out of 53 patients (9.4%). The ratio of positive subcarinal lymph nodes to resected ones was 1/2 (50%), 3/3 (100%), 1/2 (50%), 1/2 (50%) and 1/1 (100%) for each patient. Final histopathological report showed adenocarcinoma of moderate or poor differentiation (G2 2/5, G3 3/5) in all five patients (100%). Four out of 5 patients had not received neoadjuvant treatment and their pathological staging was T3N3M0. One patient had received neoadjuvant chemotherapy and his final staging was ypT3N2M0. Noteworthy, the seven patients diagnosed with squamous carcinoma, were subjected to SLND and were 100% negative for invasion histologically.

Conclusion
Subcarinal lymph nodes were infiltrated in 9.4% of patients operated for esophageal cancer. In the squamous cell cancer group, the relative infiltration rate was notably 0%. It seems that omission of subcarinal lymph node dissection during transthoracic esophagectomy cannot be justified.
P223 BILATERAL RECURRENT LARYNGEAL NERVE LYMPHADENECTOMY DURING THORACOSCOPIC ESOPHAGECTOMY IN PRONE POSITION
Authors: Jiménez-Rosellón R , Mingol F , Navío A , Bruna M , Álvarez E , Vaqué J 
Published: November 2019

Abstract

Aim
To present a video of a complete bilateral recurrent laryngeal nerve lymphadenectomy performed during minimally invasive esophagectomy using thoracoscopic video-assisted surgery in the prone position.

Background and Methods
Surgical treatment for esophageal cancer needs detailed lymphadenectomy. Indeed, the number of surgically dissected lymph nodes is important for staging accuracy and also determines patient’s prognosis, including those along the recurrent laryngeal nerve. However, recurrent laryngeal nerve dissection remains difficult and increases the appearance of postoperative complications.
This is a video of a bilateral recurrent laryngeal nerve lymphadenectomy during thoracoscopic esophagectomy performed in the prone position in a female patient with esophageal cancer.

Results
A 75 year-old female was diagnosed with recurrent squamous cell middle third esophageal carcinoma. The patient had first been diagnosed eleven years ago, receiving chemoradiotherapy as a radical treatment. The patient achieved a complete response after treatment, which remained for eleven years. Eleven years later, during routine follow-up, tumor recurrence was identified in the middle third of the esophagus. After presentation in a Multidisciplinary Group the patient underwent minimally invasive McKeown esophagectomy.
First, a video-assisted thoracoscopic surgery was performed in the prone position to mobilize the thoracic esophagus and complete a detailed mediastinal lymph node dissection, including infra-carinal lymph nodes, bilateral bronchial lymph nodes and also bilateral recurrent laryngeal nerve lymph nodes.
Afterwards, the abdominal esophagus and lymph node dissection is performed using a laparoscopic approach, and also a left cervicotomy in the supine position. An assistance laparotomy was made to externalize the specimen and make the gastric conduit. A manual end-to end esophago-gastric anastomosis was executed and finally, a feeding jejunostomy tube was placed.
The patient presented a benign postoperative course, introducing enteral nutrition and oral intake developing no complications, such as dysphonia, nor dysphagia and was discharged on the 8th postoperative day. The postoperative barium swallow radiography showed no leaks nor other complications and pathology report confirmed tumor free resection margins.

Conclusion
Detailed mediastinal lymph node dissection and exhaustive bilateral recurrent laryngeal nerve lymphadenectomy can be safely performed by minimally invasive surgery, as is shown in the video. The technique shown is feasible, achieves a complete lymph-node dissection and avoids postoperative complications such as dysphonia and recurrent laryngeal nerve palsy.
P24 TREATMENT FOR RECURRENT ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER CURATIVE ESOPHAGECTOMY
Authors: Hiroshi Okamoto , Yusuke Taniyama , Chiaki Sato , Kai Takaya , Toshiaki Fukutomi , Takahiro Oikawa , Takuro Konno-Kumagai , Naoto Ujiie , Takashi Kamei 
Published: November 2019

Abstract

Aim
The aim is to find out what treatment should be chosen at the time of recurrence of the esophageal squamous cell carcinoma (ESCC) after curative esophagectomy.

Background & Methods
ESCC patients with recurrence after curative resection have extremely poor survival rates. However, long-term survival cases and complete cure cases have also been reported. We retrospectively evaluated 184 patients with recurrent ESCC after curative esophagectomy between 2001 and 2015.

Results
M/F: 148/36, Median age: 64(36-84), Location: Upper third/Middle/Lower: 18/105/61, Pretreatment: None/Neoadjuvant chemotherapy/Neoadjuvant chemoradiotherapy (CRT)/Definitive CRT: 79/42/30/33, pT0/1/2/3/4: 3/39/18/119/5, pN0/1/2/3: 51/59/51/22, pStage1/2/3/4: 24/51/95/14 (UICC 7th), Recurrence site: Lymph node 124 (67%) [cervical 35 (19%), mediastinum 82 (45%), abdomen 35 (19%)], lung 36 (20%), liver 32 (17%), pleura 18 (10%), bone 13 (7%), brain 3 (1.6%), peritoneum 3, skin 2 (1.1%) adrenal 2, residual esophagus 1 (0.5%), gastric tube 1, colon 1, kidney 1, testis 1.
First treatment after recurrence: Surgery/CRT/chemotherapy/Best Supportive Care (BSC): 8/89/64/23. Regarding to overall survival after recurrence by the treatment groups, there was a significant difference between all groups; surgery (median 61 months) > CRT (17) > chemotherapy (9) > BSC (1). Surgery was performed to the patients with solitary lesion (lung 3, cervical lymph node 3, descending colon 1, brain 1). Prognosis of the patients with single-organ recurrence was better than that of those with multi-organ recurrence only in CRT group, and prognosis of the patients without pretreatment was better than that of those with pretreatment only in chemotherapy group. Regarding to the time from esophagectomy to recurrence, the patients with the duration of 6 months or more had a good prognosis compared with those with less than 6 months only in CRT group.

Conclusion
As treatment for recurrent ESCC after curative esophagectomy, some treatment may be recommended as much as possible. Priority is given in the order of Surgery > CRT > Chemotherapy. Surgery may be recommended for the patients with solitary recurrence of lung or cervical Lymph nodes. CRT may be recommended for the patients with single-organ recurrence, at least six months after esophagectomy. Chemotherapy may be recommended for the patients without preoperative treatment.
P27 PERORAL ENDOSCOPIC MYOTOMY (POEM) FOR TREATMENT OF ACHALASIA. CLINICAL OUTCOMES OF A SINGLE-CENTER INSTITUTE IN UK
Authors: Vrakopoulou Gavriella Zoi , Barbieri Lavinia , Ilczyszyn Andrei , Hamaoui Karim , Memos Nikolaos , Smyth Edel , Jafari Jafar , Zeki Sebastian , Wong Terence , Dunn Jason M , Botha Abraham 
Published: November 2019

Abstract

Aim
Assessment of the clinical outcomes, resolution of dysphagia, incidence of postoperative gastro-oesophageal reflux disease (GORD), and quality of life (QoL) of patients after POEM.

Background&Methods
POEM is increasingly performed worldwide for treatment of achalasia proving itself effective and safe. From a prospective database of all POEM’s performed in our institution from 2015 to 2018, we extracted data for patients with a minimum follow up period of 6 months. All patients underwent a standardized diagnostic work-up including gastroscopy, barium study and high-resolution manometry (HRM). Postoperatively, they had a surveillance gastroscopy in the 1st postoperative year. Standardized questionnaires evaluating Eckardt, GERD and achalasia QoL (Urbach) scores were completed before and after POEM. HRM and pH studies were offered to all patients after 6 months.

Results
Demographic data and procedure details can be seen in Table1. The preoperative Eckardt, GERD and Urbach scores changed significantly: the median Eckardt score of 7(4-11) decreased to a median of 1(1-9, p<0.001), the GERD score showed a reduction from 26(8-52) to 5(0-40, p<0.001) and Urbach score from 25(17-30) to 14(10-28, p<0.001). Furthermore, preoperative dysphagia score was significantly reduced from a median of 3(1-3) to a median of 0(0-3). Long-term clinical success (Eckardt score ≤ 3) was 87.2%. Postoperatively, 11 patients (29%) were taking PPI’s for chest symptoms. Nine of these agreed to undergo pH studies of whom only 1 had a DeMeester score > 14.5.

Conclusion
POEM is an effective and safe treatment option for achalasia with good relief of dysphagia and improvement in patients’ QoL.
P28 AN OPEN TRANSTHORACIC ESOPHAGECTOMY RESULTS IN HIGHER POSTOPERATIVE C-REACTIVE PROTEIN LEVELS COMPARED TO MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Babic B , van der Sluis P , Gockel I , Corvinus F , Tagkalos E , Lotichius M , Ventzki L , Lang H , Grimminger P 
Published: November 2019

Abstract

Aim
With the introduction of minimally invasive access in centers for esophageal surgery, complications as well as mortality rates decreased. Laboratory tests are used routinely to screen patients for postoperative complications as early as possible. Still, the course of several laboratory parameters after esophagectomy following different surgical approaches has not been described yet and thus, reference values do not exist. Nowadays, the interpretation of inflammatory markers depends on the expertise of the medical staff. The aim of this study is to evaluate the development of CRP and leukocytes after thoracoabdominal esophagectomy following four different surgical approaches.

Background & Methods
217 consecutive patients receiving a thoracoabdominal esophagectomy with either open, hybrid, totally minimally invasive or robot-assisted minimally invasive technique between 2008 and 2018 have been evaluated. Daily blood tests regarding C-reactive protein (CRP) and leukocytes have been performed daily in all patients. Data was collected prospectively and analyzed depending on the postoperative course and the surgical approach.

Results
There is a natural increase of leukocytes and CRP with peak values on the 2nd postoperative day (POD) after thoracoabdominal esophagectomy following all surgical approaches. The increase of inflammatory parameters is significantly higher after open esophagectomy on the first three postoperative days compared to the three minimally invasive procedures. Furthermore, postoperative CRP values > 200 mg/l on the 2nd postoperative day as well as an open esohagectomy are independently associated with postoperative complications.

Conclusion
The development of postoperative inflammatory laboratory parameters after esophagectomy is significantly depending on the surgical approach. Open esophagectomy results in significantly higher CRP and leukocyte values compared to the hybrid esophagectomy, minimally invasive esophagectomy and robot assisted minimally invasive esophagectomy. Open esophagectomy and an increase of CRP on the 2nd postoperative day above 200 mg/l are an independent positive predictor for postoperative complications in multivariate analysis.
P29 COMPARISON BETWEEN MINIMALLY INVASIVE AND OPEN ESOPHAGECTOMY IN PATIENTS AGED ≥75 YEARS: A NATIONWIDE PROPENSITY-SCORE MATCHED COHORT STUDY
Authors: Nikolaj Baranov , Linda Claassen , Frans van Workum , Camiel Rosman 
Published: November 2019

Abstract

Aim
To compare postoperative outcome in elderly undergoing either open or minimally invasive esophagectomy.

Background & Methods
Randomized controlled trials have shown improved short term outcome in patients undergoing minimally invasive compared with open esophagectomy. However, all of them have excluded patients aged 75 years or older. Evidence regarding this patient group, therefore, remains scarce.
A propensity score matched retrospective cohort study was performed in a Dutch nationwide cohort from the period of april 2011 to april 2016 of patients aged ≥75 years diagnosed with local and locally advanced esophageal cancer who underwent either minimally invasive or open esophagectomy. Primary outcomes consisted of anastomotic leakage and perioperative mortality. Secondary outcomes were the rate of other complications, reintervention and hospital/ICU readmission.

Results
After matching, 322 patients were included, 161 in the open esophagectomy and 161 in the minimally invasive esophagectomy group. In the minimally invasive group, a significantly higher incidence occurend of Clavien-Dindo ≥3 complications (RR 1.63, CI-95% 1.24—2.13), anastomotic leaks (RR 1.60, CI-95% 1.12—2.29) and reinterventions (RR 1.70, CI-95% 1.19—2.42). There were no significant differences regarding perioperative mortality, other complications and readmission rate.

Conclusion
Elderly patients diagnosed with locally advanced esophageal cancer should undergo minimally invasive esophagectomy in favor of open esophagectomy.

Keywords
Elderly, minimally invasive esophagectomy, open esophagectomy, esophageal cancer, clinical outcome, perioperative mortality.