bluuebunny/crossref_metadata_2025_split huggingface dataset:
O55 COMPUTED TOMOGRAPHY CAN PREDICT OUTCOMES AFTER CAUSTIC INGESTION?
Authors: Weindelmayer J , Veltri A , Zenzaro M , Gobbi L , Ceccherini G , Deguidi G , Gervasi M , Casella F , Strazimiri E , De Manzoni G , Giacopuzzi S 
Published: November 2019

Abstract

Aim
our aim was to evaluate if CT could predict outcomes in terms of treatment in patient with caustic ingestion injury.

Background and methods
endoscopy has long been the gold standard for initial evaluation of caustic ingestion injury. Lately several studies suggested CT-scans to have an equal or even superior accuracy in emergency evaluation and prediction of esophageal stricture formation. Wishing to avoid complications of endoscopic procedures, new radiological grading system are being defined to supplement or replace the ones currently used. On the basis of the available evidence, we proposed a radiological 3 grade-score: grade I (well-defined visceral wall, homogenous post-contrastographic enhancement, no wall/perivisceral fat tissue edema), grade IIA (thickened and hypointense mucosa with post-contrastographic enhancement, wall/perivisceral fat tissue edema), grade IIB (necrotic mucosa with slight post-contrastographic external wall enhancement), grade III (transmural necrosis, defined by two of three between: lack of post-contrastografic wall enhancement, not defined visceral wall, blurred perivisceral fat tissue). Retrospectively we collected patients’ CT-scans which were reviewed by a radiologist, two senior surgeons and six resident surgeons; CT-scans performed within 48 hours after the ingestion were considered significant. We also tracked patients’ clinical history and compared the outcomes.

Results
of 50 patients that were admitted in our division in the last 10 years, we reviewed CT-scans of 23 patients; 15 were performed within 48 hours after the caustic ingestion. From the analysis of the data we observed that clinicians scored similarly, especially for grades I and III. Of these patients, 26,6 % had elective surgery (I: 0%; IIA: 0%; IIB: 75%; III: 25%), 20 % underwent emergency surgery (I: 0%; IIA: 33%; IIB: 0%; III: 66%), 53,4 % had conservative management (I: 25%; IIA: 12,5%; IIB: 37,5%; III: 25%). For what concerns the effectiveness of the score, we found high negative predictive value for grade I (all patients were treated conservatively), although highest grade had good specificity (0,86) regarding the needs of reconstructive surgery.

Conclusion
our radiological classification seems a worthwhile tool at the two extreme grades; on the contrary, for intermediate scores is still necessary an endoscopic-integrated approach to define which treatment achieve.
P57 MOTILITY DISORDERS OF THE ESOPHAGUS - A RISK FACTOR FOR THE DEVELOPMENT OF BARRETT'S ESOPHAGUS?
Authors: Laura Knepper , Anne-Kathrin Bär , Dolores Müller , Hans Fuchs , Claudia Fuchs , Sebastian Brinkmann , Seung-Hun Chon , Wolfgang Schröder , Christiane J  Bruns , Jessica M  Leers 
Published: November 2019

Abstract

Aim
This study aims to investigate the extent to which esophageal motility affects the development and progression of Barrett's mucosa in GERD patients.

Background and Methods
The Barret´s esophagus is becoming even more important against the background of an increasing incidence of adenocarcinoma of the esophagus1. The question as to why only a few patients with gastroesophageal reflux disease (GERD) develop a Barrett's esophagus has not been clarified. A cohort of 315 GERD patients with and without Barrett's esophagus who received High Resolution Manometry (HRM) as part of their regular diagnostics was therefore examined in this study. The evaluation of the HRM results was based on the Chicago classification version 3.02 and was compared with endoscopic and histological findings.

Results
Out of the 315 GERD patients, 67 had a Barrett's esophagus. The two patient groups (GERD without Barrett and GERD with Barrett) did not differ in demographic data and risk profile (hiatal hernia 71.4% vs 10.2%). In pH metry, both groups achieved a comparable DeMeester score as well as a similar fraction time (49.6 vs 44.2, 13% vs 11.7%). In both groups, approximately 40% of patients showed motility disorders. The mean basal pressure and the mean DCI also showed comparable values (21.2 vs 21.3, 1189.2 vs 1249.2). However, when comparing patients within the Barrett cohort with a long and a short segment Barrett (LSB, SSB), differences in peristalsis and pressure build-up of the distal esophagus become clear. Patients with an LSB showed a lower basal pressure of the lower esophageal sphincter (LES) and lower mean DCI (12.9 vs 25.0, 1230.0 vs 1389.3). In addition, they presented a hypotonic LES more frequently (54.6% vs 17.4%). Patients with LSB also showed motility disorders more often (54.6 vs 39.1), especially ineffective motility and fragmented peristalsis (18.2% vs 10.9%, 9.1% vs 2.2%).

Conclusion
The differences in motility disorders between Barrett and non-Barrett patients already described in other publications3 could not be confirmed in this study, despite the large cohort of 315 patients. However, the differences between LSB and SSB patients suggest that esophageal motility disorders can at least influence the severity of this disease.
P58 IMPACT OF SYSTEMATIC ENTERAL NUTRITION IN OESOPHAGEAL OR OESOGASTRIC JUNCTION (OG) CANCERS INVOLVED IN A CURATIVE STRATEGY
Authors: Hélène Marin , Maxime Warlaumont , Guillaume Pieesen 
Published: November 2019

Abstract

Aim
In the absence of severe dysphagia or major weight loss, most patients treated for OG cancer do not have enteral nutrition (EN) instituted before neoadjuvant treatment. The aim of this work was to compare the impact of a systematic NE (NES) or on demand (NED) on the course of the therapeutic sequence, the post-operative follow-up: post-operative complications of grade Clavien-Dindo> II and Complication Comprehensive Index (CCI); and oncologic results (median follow-up: 36 months).

Background & Methods
Among 682 patients with OG cancer operated between 2007 and 2015, 313 patients with <20% weight loss and no severe dysphagia (Atkinson <IV) were included. Control group with NES (n = 140) and group with NED (n = 173) were compared with propensity score adjustment.

Results
In the NES group, the tumor stage was more advanced (clinical stage III: 78.6% vs 61.4% p = 0.001) and the more frequent undernutrition (28.6% vs 14.6% p = 0.002). After adjustment, there was no significant difference between the two groups regarding the risk of severe complications (25.7% vs 24.9% p = 0.682), the median CCI (20.9 vs 20.9, p = 0.08) and 90-day mortality (4.3% vs. 5.2% p = 0.706). In case of perioperative chemotherapy, the rate of patients benefiting from the complete therapeutic sequence was higher in the NES group (80.4% vs 62.2% p = 0.0192 ie OR = 2.5). Overall survival was similar between the 2 groups (p = 0.509).

Conclusion
In OG cancers, systematic NE does not modify the operative and oncological follow-ups with respect to an on-demand NE, but more frequently makes it possible to achive the therapeutic sequence in the case of perioperative chemotherapy.
P59 PREDICTORS FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY AND IMPACT ON SURVIVAL
Authors: Eliza R C. Hagens , Maud A  Reijntjes BSc , Anderegg M C J , Suzanne S  Gisbertz , van Berge Henegouwen Mark I 
Published: November 2019

Abstract

Aim
To identify predictors for anastomotic leakage after esophagectomy and to determine the influence of anastomotic leakage on short-term and long-term survival.

Background and methods
Identifying predictors of anastomotic leakage after esophagectomy may contribute to its prevention. The influence of anastomotic leakage on long-term survival is unclear. A retrospective cohort study was conducted in consecutive patients who underwent an esophagectomy with reconstruction in the Amsterdam UMC, location AMC, between January 1993 and January 2019. Logistic regression and Cox regression models were used to assess predictors for anastomotic leakage and to assess survival.

Results
1747 patients were included, of which 326 (18.7%) developed anastomotic leakage. Independent predictors of cervical anastomotic leakage were diabetes mellitus, cT4-stage and a gastroesophageal junction tumor. ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis were independent predictors of intrathoracic anastomotic leakage (table 1). 30-day mortality was 2% in patients without, and 4% of patients with anastomotic leakage (p=0.076). Anastomotic leakage did not significantly influence long-term survival when corrected for confounders (HR 0.96 95%CI 0.81 – 1.14, p=0.618).

Conclusion
Independent risk factors for anastomotic leakage after esophagectomy are diabetes mellitus, cT4-stage and a gastroesophageal junction tumor for cervical anastomosis, and ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis for intrathoracic anastomosis. 30-day mortality was higher in the anastomotic leakage group. We found no correlation between anastomotic leakage and long term survival.
P61 CARDIAC TAMPONADE - A SERIOUS COMPLICATION AFTER COLON CONDUIT INTERPOSITION: A CASE REPORT
Authors: Jarosciakova S , Harustiak T , Tvrdon J , Lischke R 
Published: November 2019

Abstract

Aim
Graft redundancy and anastomotic stricture after colon interposition are well-known late complications. Cardiac compression by distended colon conduit is uncommon. There is a few reports in the literature. We present a case of 58-year-old patient with a major dilatation of colon conduit occurred 7 years after esophagectomy and gastrectomy.

Case report
The patient was admitted to district general hospital with 4-hour history of abdominal pain. Chest X- ray and abdominal computer tomography (CT) scan revealed distended colon conduit, pneumomediastinum, small-bowel ileus and pneumoretroperitoneum. An attempt to insert a nasogastric tube failed and an emergency laparotomy was performed. At operation, a band causing small bowel strangulation and adhesions were divided. The bowel appeared viable and a clear perforation was not found. Resection was not necessery. For next 10 hours, progressing hemodynamic instability and sepsis required intravenous vasoactive medication and orotracheal intubation. Chest CT scan showed massive distention of substernal colon conduit with compression of heart and pulmonary arteries. The patient was referred to our institution. Prompt endoscopy was performed with suction of air and liquid content from colon and nasogastric tube was inserted. The colonic mucosa was viable without necrosis and perforation. Hemodynamics improved immediately after decompression of colonic roll. An exploratory laparotomy revealed fatal extensive ischemia infarction of the bowel and the patient died within 4 hours after surgery.

Concluson
Extrapericardial cardiac tamponade is a rare complication after substernal esophageal reconstruction and could lead to bowel hypoperfusion or ischemia. Early recognition of symptoms and management with conduit decompression are important.
P62 RISK FACTORS AND OUTCOMES ASSOCIATED WITH ANASTOMOTIC LEAKS (AL) FOLLOWING OESOPHAGECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sivesh K Kamarajah , Aaron Lin , Thahesh Tharmaraja , Yashvi Bharwada , James R Bundred , Dmitri Nepogodiev , Richard PT Evans , Pritam Singh , Ewen A Griffiths 
Published: November 2019

Abstract

Introduction
Anastomotic leaks (AL) are a major complication after oesophagectomy. This meta-analysis aimed to determine identify risks factors for AL (pre-operative, intra-operative and post-operative factors) and assess the consequences to outcome on patients who developed an AL.

Methods
This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 31st December 2018. A meta-analysis was conducted with the use of random-effects modelling and prospectively registered with the PROSPERO database (Registration CRD42018130732).

Results
This review identified 174 studies reporting outcomes of 74,226 patients undergoing oesophagectomy. The overall pooled AL rates were 11%, ranging from 0 - 49% in individual studies. Majority of studies were from Asia (n=79). In pooled analyses, 23 factors were associated with AL (17 preoperative and six intraoperative).
AL were associated with adverse outcomes including pulmonary (OR: 4.54, CI95%: 2.99 - 6.89, p<0.001) and cardiac complications (OR: 2.44, CI95%: 1.77 - 3.37, p<0.001), prolonged hospital stay (mean difference: 15 days, CI95%: 10 - 21 days, p<0.001 and in-hospital mortality (OR: 5.91, CI95%: 1.41 - 24.79, p=0.015).

Conclusion
AL are a major complication following oesophagectomy accounting for major morbidity and mortality. This meta-analysis identified modifiable risk factors for AL which can be a target for interventions to reduce anastomotic leak rates. Furthermore, identification of both modifiable and non-modifiable risk factors will facilitate risk stratification and prediction of AL enabling better perioperative planning, patient counselling and informed consent.
P63 REQUIREMENTS FOR A NEW DIAGNOSTIC TEST TO DETECT LYMPH NODE METASTASES IN ESOPHAGEAL CANCER: A HEALTH-ECONOMIC MODELLING STUDY
Authors: Scholte M , de Gouw D J J M , Klarenbeek B R , Grutters J P C , Rosman C , Rovers M M 
Published: November 2019

Abstract

Background
Curative treatment for esophageal cancer consists of neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy with lymph node dissection (LND). Despite only 31-38% of patients harbour positive lymph nodes, all patients undergo LND with associated morbidity. Ideally, a non-invasive diagnostic test would indicate if LND is needed, however it is unknown what requirements such a test should have to justify minimizing LND from a cost-effectiveness perspective.

Objective
To determine the potential cost-effectiveness, minimally required accuracy and maximum cost of a hypothetical new diagnostic test.

Methods
A decision tree with state-transition model was constructed for patients with resectable esophageal cancer who received nCRT and are scheduled for esophagectomy. The current strategy including LND was compared to omitting LND based on a hypothetical diagnostic test in terms of costs and QALYs. Input data for the LND strategy was derived from literature. Consequences of omitting LND on procedure time, complications and hospital stay were based on a worldwide case vignette study among esophageal surgeons (N=89). Deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty.

Results
Assuming 100% sensitivity of LND and 100% accuracy of the hypothetical test at zero costs, the hypothetical test yielded 0.004 QALYs (95%CI -0.020 – 0.013), while saving €3,025 (95%CI -5652 – 3576) per patient compared to LND. Assuming 100% sensitivity of LND, the hypothetical test would require 98% sensitivity at zero costs to be cost-effective compared to LND. Sensitivity of LND might be lower, since not all LN stations are routinely dissected. Assuming 90% sensitivity of LND, it would require 88% sensitivity at zero costs or 89% at a maximum cost of €1,674 per patient to be cost effective.

Conclusions
The room for improvement for new diagnostic techniques is highly dependent on the sensitivity of LND. A new diagnostic test may have up to 2% lower sensitivity than LND to be cost-effective compared to LND.
O64 META-ANALYSIS OF PROGNOSTIC FACTORS FOR OVERALL SURVIVAL IN PATIENTS UNDERGOING OESOPHAGECTOMY FOR OESOPHAGEAL CANCERS
Authors: Kamarajah Sivesh K , Marson Ella J , Zhou Dengyi , Wyn-Griffiths Freddie , Richard P T Evans , Bundred James R , Singh Pritam , Griffiths Ewen A 
Published: November 2019

Abstract

Aims
The objective of this meta-analysis was to assess statistically the impact of patient-level, operative, and tumour characteristics on overall survival of patients undergoing curative resection for oesophageal cancer.

Introduction
Oesophageal cancer is staged using the American Joint Comission on Cancer (AJCC) staging system. Numerous other prognostically important histopathological and demographic characteristics have been reported.

Methods
This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus and Cochrane CENTRAL databases up to 31st December 2018. A meta-analysis was conducted with the use of random-effects modelling to determine pooled univariable hazard ratios (HRs) and prospectively registered with the PROSPERO database (Registration CRD42018130732).

Results
One-hundred and sixty-six articles including 70,299 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these the strongly associated prognostic factors were T stage (HR: 2.07, CI95%: 1.77 - 2.43, p<0.001), N stage (HR: 2.24, CI95%: 1.95 - 2.59, p<0.001), perineural invasion (HR: 1.54, CI95%: 1.36 - 1.74, p<0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82 - 2.59, p<0.001), poor tumour grade (HR: 1.53, CI95%: 1.34 - 1.74, p<0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30 - 1.66, p<0.001).

Conclusion
Several tumour biological variables not included in the AJCC 8th edition classification can impact on overall survival. These require incorporation into prognostic models to ensure a personalised approach to prognostication and treatment.
P66 ENSURE: EUROPEAN INVESTIGATION OF SURVEILLANCE AFTER RESECTION FOR ESOPHAGEAL CANCER
Authors: Jessie A Elliott , Sheraz R Markar , Fredrik Klevebro , Magnus Nilsson , Giovanni Zaninotto , George B Hanna , John V Reynolds ,   ENSURE Study Collaborators
Published: November 2019

Abstract

Aim
To characterize oncologic surveillance protocols across European esophageal cancer centers and determine the independent impact of intensive surveillance on oncologic outcome.

Background
Emerging data demonstrate long-term survival after salvage interventions for local or oligometastatic recurrence after planned curative resection for esophageal cancer, providing rationale for postoperative surveillance. However, the impact of intensive surveillance on oncologic outcome and health-related quality of life (HRQOL) is unknown.

Methods
First, a survey of surveillance protocols across European esophageal cancer centres was undertaken (Phase 1). Then, an international multicentre study including consecutive patients who underwent surgery with curative intent for cTxNxM0 esophageal or junctional cancer from June 2009 to June 2015 was initiated (Phase 2). The estimated sample size of 4425, with 31% undergoing intensive surveillance, will provide 90% power to detect a 5% increase in 5-year overall survival (primary outcome measure). Secondary outcome measures include disease-free survival, incidence of oligometastatic recurrence, treatment strategies, and HRQOL. Subgroup analyses by age, histologic type and HER-2 status are planned. The study is registered on ClinicalTrials.gov (NCT03461341).

Results
For Phase 1, 27 centres across 13 European and North American countries participated. Centers undertook 52.3±17.1 esophageal cancer resections per year between 3.5±1.3 attending surgeons. The majority of centers utilized a standardized surveillance protocol for all patients (23, 85.2%). Routine laboratory investigations, nutritional profiling and tumor markers were assessed in 10 (37.0%), 9 (33.3%) and 4 (14.8%) of centers, respectively. 10 centers (37.0%) utilized routine postoperative surveillance computed tomography, of whom 3 (11.1%) also undertook routine postoperative PET-CT in follow-up. Surveillance endoscopy was performed in 7 centers (18.9%). Centers undertaking intensive imaging surveillance had fewer attending surgeons (P=0.036) but similar surgeon volume (P=0.832). Surveillance intensity was not associated with national health expenditure (P=0.733). For Phase 2, data for 4010 patients (31.1% intensive surveillance) from 18 centres across 9 European countries have been submitted to date, with results expected in September 2019.

Conclusion
The ENSURE study will provide the first appropriately powered evidence assessing the impact of postoperative surveillance strategies on oncologic outcome and HRQOL following potentially curative resection for esophageal cancer.
P67 SEMIMECHANICAL ANASTOMOSIS DURING ESOPHAGECTOMY: A NEW GOLD STANDARD?
Authors: Mazza E , Strignano P , Fop F , Patrono D , Catalano G , Salizzoni M , Romagnoli R 
Published: November 2019

Abstract

Aim
The aim of this single-center retrospective study was to compare the surgical outcomes of semimechanical (SM) and totally manual (TM) anastomoses during esophagectomy regardless of the surgical access and of the type of esophageal replacement.

Background and Methods
Several techniques for esophageal anastomosis during esophagectomy have been described, all of which are associated with variable leakage and stricture rates. Given the significant morbidity of esophageal fistula, reducing its incidence is of paramount importance. We report our single-center experience with the semimechanical technique, as compared to the totally manual technique.
312 partial esophagectomies performed between January, 1998 and April, 2018 were analyzed. The series was split into a training period (1/1998-9/2015), when both TM and SM techniques were used, and a validation period (10/2015-4/2018), during which SM technique became standard practice. Propensity score matching was used to reduce confounding.

Results
The training period included 212 esophagectomies (90 TM, 122 SM); SM technique was initially used in the neck and afterwards also in the thorax, mainly with gastric conduits (92%), whereas the TM group contained a prevalence of jejunal loops (48%). SM anastomosis was associated with a significant reduction of both fistula (0.8% versus 12.2%; p<0.001) and stricture rate (0% versus 6.7%; p=0.005). After propensity score matching the difference in fistula (0% versus 13.5%; p=0.013) and stricture rate (0% versus 9.6%; p=0.022) was confirmed. During the validation period, which included 100 esophagectomies performed with SM anastomosis, 1 fistula (1%) and 1 stricture (1%) were observed.

Conclusions
SM technique for esophageal anastomosis outperforms TM technique and allows achieving very low complications rates.