bluuebunny/crossref_metadata_2025_split huggingface dataset:
533 IMPACT OF LOCAL MICROBIOME ON THE ONSET OF ESOPHAGEAL ADENOCARCINOMA FOR THE DEVELOPMENT OF A STRATEGY FOR PREVENTION AND TREATMENT
Authors: Ricchitelli S 
Published: September 2020

Abstract

Esophageal adenocarcinoma (EAC) is one of the most aggressive gastrointestinal tumor. High mortality is due to difficulties in diagnosis at an early stage and to its biological aggressive features. Little is know about the association between esophageal microbiome dysbiosis and EAC pathogenesis. The aim of the study is the identification of a specific esophageal local microbiota that can be related to the pathogenesis and to the onset of EAC

Methods
We investigated the resident microbiome in 38 biopsies from Tumoral (T) and Non-Tumoral (NT) tissues obtained from 19 patients submitted to distal-EAC, cardiac-EAC, ESCC resection in Upper GI Surgery Division, Humanitas Research Hospital (Rozzano, Milano). We have analyzed the microbiota in biopsies obtained from EAC Tumoral tissues (T) and Non-Tumoral tissues (NT). After genomic DNA extraction the V3V4-hypervariable regions of the 16S-rRNA bacterial gene were amplified and sequenced on MiSeq Illumina sequencer. The Bioinformatic Data Analysis has been perfomed using the CLC Genomic Workbench.

Results
Alpha diversity analysis showed an increased microbial species richness in Esophageal Squamo-Cellular Carcinoma (ESCC) respect to distal/cardiac EAC and tissues without metaplasia. PERMANOVA statistical analysis was applied to estimate Beta Diversity significance. Bray-Curtis index showed a statistically significant different microbiome composition when comparing both cardiac and distal EAC versus ESCC (p-value 0.022 and 0.010 respectively) and when comparing samples with and without metaplasia. Relative abundances analysis obtained after the comparison of distal EAC, cardiac EAC and ESCC identified specific bacterial species in each group. Streptococcus genus is present only in cardiac EAC, Helicobacter pylori only in distal EAC.

Conclusion
Our study evidenced an increased microbial species richness in samples deriving from ESCC compared to EAC and samples without metaplasia. A significant difference was found comparing EAC with ESCC or with/without metaplasia tissues, mirroring a reduced biodiversity in EAC and metaplasia. We speculated a generalized alteration of the local microbiome from healthy to diseased tissue, characterized by certain bacterial strains that developed through the creation of a chronic inflammatory milieu that triggers the carcinogenic cascade.
543 DISSEMINATION AND SAFETY OF ROBOT-ASSISTED ESOPHAGECTOMY IN JAPAN
Authors: Nishigori T , Obama K , Ichihara N , Uyama I , Inomata M , Watanabe M , Kakeji Y , Seto Y , Miyata H , Sakai Y 
Published: September 2020

Abstract

Robot-assisted surgery for gastrointestinal cancers began to be covered by universal health insurance in April 2018 in Japan. However, the current status of this new procedures such as the number of patients and clinical outcomes was unclear. The aim of this study to retrospectively examine the dissemination and safety of robot-assisted esophagectomy (RAE) in Japan using a nationwide web-based database, or the National Clinical Database (NCD).

Methods
The study included patients who underwent RAE or conventional minimum invasive esophagectomy (MIE) and were registered in the NCD in 2018. The outcomes were operative mortality and the numbers of hospitals and surgeons performing the surgeries.

Results
The number of patients undergoing RAE and MIE was 122 and 4799, respectively. RAE was performed at 28 hospitals by 37 surgeons, while MIE was done at 523 hospitals by 837 surgeons. In terms of annual case volume per hospital, RAE was likely to be performed in higher volume centers. The number of patients undergoing RAE per month in Japan was less than 5 before insurance coverage began. It has increased to more than 10 since April. Operative mortality occurred in 2 (1.6%) patients following RAE, while it occurred in 78 (1.6%) following MIE.

Conclusion
RAE was safely introduced in Japan. The number of patients undergoing RAE and surgeons and hospitals performing it were gradually increasing but still limited.
565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY
Authors: Khaw R , Munro S , Sturrock J , Jaretzke H , Kamarajah S , Phillips A 
Published: September 2020

Abstract

Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss.

Methods
Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes.

Results
594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases.
Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge.
Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%.

Conclusion
Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.
569 LAPAROSCOPIC REPAIR OF A VOLUMINOUS SYMPTOMATIC HIATAL HERNIA USING AN ABSORBABLE SYNTHETIC MESH
Authors: Cocozza E , Berselli M , Livraghi L , Quintodei V , Latham L 
Published: September 2020

Abstract

In symptomatic voluminous paraesophageal hiatal hernias not only a laparoscopic surgical approach, but also the use of mesh can be considered too.
The use of surgical protesis in hiatal henia repair was a debated surgical topic in the last years
A laparoscopic repair of a symptomatic type III hiatal hernia by plastic of the hiatus, fundoplicatio and use of an absorbable glycolic acid/trimethylene carbonate synthetic mesh is showed.

Methods
The patient was a 59 years old male suffering from recurrent aspiration pneumonias. Surgery was performed by a standardized tecnique in a high volume laparoscopic surgical centre. The hernia sac was removed and the plastic of the esophageal hiatus was performed. After the mesh placement a Nissen fundoplicatio was performed. No drain was placed.

Results
In the postoperative period a contrat-soluble swallow was performed and it resulted in a good transit witout any sign of recurrence. The patient was discharged with an appropiate oral intake. One year after surgery the patient is asymptomatic and in good conditions.

Conclusion
A voluminous symptomatic hiatal hernia can be successfully treated in a high-volume and long-term experienced laparoscopic surgical.
The use of an absorbable, handily positionable and synthetic mesh can help to gain a lower rate of recurrence without any risk for the patients.
The technical skill and all the surgical steps never are renounceable because of the presence of the mesh.
Further studies with a longer-term follow-up and a international live debate are necessary.

Video
https://www.dropbox.com/s/384ujzm3rnoqe0a/Hiatal%20Hernia%20Dr.%20Cocozza%20ISDE%202020.mp4?dl=0
572 NUTRITIONAL PATTERNS MAY AFFECT ESOPHAGEAL ACID EXPOSURE, AND THE NUMBER AND TYPE OF GASTROESOPHAGEAL REFLUXES
Authors: Morozov S , Kropochev V , Isakov V 
Published: September 2020

Abstract

The role of nutritional patterns on esophageal function testing parameters is not widely studied. Earlier published data focused on symptoms of GERD and their association with the food structure.
Aim of the study was to assess the influence of nutritional patterns on esophageal acid exposure and types and number of gastroesophageal refluxes

Methods
The data of complete examination of 165 participants served as a source data for the study. Diagnosis of GERD was based on clinical data (heartburn and acid regurgitation at least once a week for not less than 6 month, actual during last 3 month, history of effective PPI treatment), GERD-Q questionnaire (≥8 points), endoscopic evaluation (Excera II, Olympus, Japan) and 24-hours esophageal pH-impedance studies (Ohmega, MMS, the Netherlands; 2 pH, 6 impedance catheters, UnisensorAG, USA). Food frequency questionnaire was used to analyse food structure. StatSoft (USA) software was used for correlation analysis.
The work has been performed within RSF 19–76-30014.

Results
We enrolled 124 GERD patients and 41 controls.
Significant (P &lt; 0.05) correlation of AET was with energy value of the ration (Spearman rank R = 0.19), amount of fat (R = 0.2).
Significant correlation of number of GERs was with energy values (R = 0.35), protein (R = 0.3), fat (R = 0.33), alcohol (R = 0.28) and dietary fibre (R = -0.22) consumption.
Number of acid GERs correlated with calorie (R = 0.35), fat (R = 0.32), protein (R = 0.25), carbohydrates (R = 0.24) and alcohol (R = 0.24) consumption.
Number of weak-acid GERs correlated with calories (R = 0.22), fat (R = 0.21), protein (R = 0.22), alcohol (R = 0.23) and dietary fibre (R = -0.24) consumption.
High GERs correlated with fat (R = 0.3), protein (R = 0.22), alcohol (R = 0.25) and fibre (R = -0.25).

Conclusion
High energy value, consumption of fat and alcohol showed direct medium-strength correlation with esophageal acid exposure and the total number gastroesophageal refluxes. The total number of gastroesophageal refluxes, number of weak acid and high gastroesophageal refluxes had inverse correlation with the amount of dietary fibre consumed. Found trends are used to establish nutritional patterns for reflux events in GERD patients.
577 EFFECTIVENESS OF CADAVER SURGICAL TRAINING FOR THORACOSCOPIC ESOPHAGECTOMY
Authors: Shichinohe T , Murakami S , Ebihara Y , Kurashima Y , Narazaki H , Hirano S 
Published: September 2020

Abstract

Thoracoscopic esophagectomy (TE) requires advanced surgical skills. Learning TE only through conventional on-the-job- training (OnJT) is difficult. Therefore, it is necessary to establish a safe and efficient educational program to learn the procedure. In our department, cadaver surgical training (CST) has been used to learn our standard procedure of prone position TE. In this presentation, we describe the usefulness of CST as an education tool for the surgical training of TE.

Methods
Cadavers embalmed by Thiel fixation were used for the training. To be eligible, the trainee must possess the surgical skills to perform laparoscopic gastrectomy and have the motivation to perform TE. Our program included self-study and lectures and evaluating the trainee using our original manual and evaluation sheet. During the CST practice, one cadaver was assigned to each trainee, and the trainee experienced whole procedure both as the operator and the assistant. After the training, feedback was given using the same evaluation sheet.

Results
Ten surgeons were evaluated using the technical evaluation sheet (12 items, 5 points per item, total 60 points), the average of the total points increased from 23 to 43 points after the training. The item with largest increase and highest score after the training was “thoracic duct dissection” (1.8 to 4.0). The item “Left recurrent laryngeal nerve (RLN) dissection” was the worst in both pre- and post-training as the average score was only increased from 1.6 to 3.1. On the other hand, the item “Right RLN dissection” score showed a moderate change from 1.7 to 3.5.

Conclusion
CST for mastering the whole surgical procedure of TE was useful in terms of overall quality of the operative performance. On the other hand, it seemed to be insufficient for mastering the lymph node dissection around the left recurrent laryngeal nerve. Development of a comprehensive education program combined with learning the whole procedure by CST and repetition training for a highly difficult procedure by simulation is necessary.
582 ANALYSIS OF FACTORS ASSOCIATED WITH CHANGE IN UES AND LES RESTING PRESSURE IN THE START AND END OF HRM STUDY
Authors: Morozov S , Kropochev V , Bredenoord A 
Published: September 2020

Abstract

Lower and upper esophageal sphincter resting pressures' evaluation is not within Chicago classification, but is a part of a standard esophageal HRM examination. As the results of measurements at the beginning and at the end of examination are often discrepant, national guidelines in Russia recommend to record both. The aim of the study was to analyse possible factors that may affect the change between the results of the recordings of UES and LES resting pressures.

Methods
High-resolution esopophageal manometry examinations were performed in upright position with solid-state 36 channel 10 Fr catheter (Unisensor, USA) and Solar (MMS, the Netherlands) equipment. Resting pressures (RP) were measured at rest for ≥30 seconds at the beginning of the examination and after 10 water swallows. Beck depression inventory (BDI-II) was used to assess psychological status. Correlation analysis by Spearman (StatSoft, USA) was used to reveal factors affecting the change in resting pressures at the beginning and at the end of HRM study. Change of pressure was presented as a quotient of dividing the second P value by the first (ΔP).

Results
Eighty-four patients, age (M ± m) 48.5 ± 13.2 y.o. were enrolled. Hiatal hernia was present in 37 subjects.
UES mean RP differed significantly at the beginning (123.7 ± 76.6 mmHg) and at the end of examination (87.9 ± 64.1), P &lt; 0.0001. LES RP didn’t differ significantly at the start and at the end of examination.
The results of correlation analysis of factors affecting ΔP are shown in the table 1. Those with a decrease of UES resting pressure at the end of examination (n = 63) were younger compared to the group with no change or an increase of it (46.3 ± 12.7 y.o. vs 56.0 ± 13.1 y.o., p = 0.003).

Conclusion
Upper esophageal resting pressure measured at the end of the high resolution esophageal examination is lower compared to the initial values in great proportion of patients. Despite the importance of the finding is unknown, this should be considered when the function of the upper esophageal sphincter is studied.
114 VATS ESOPHAGECTOMY: DOES PATIENT OPERATIVE POSITION DURING THORACOSCOPIC MOBILISATION INFLUENCE OUTCOMES? A PROSPECTIVE COMPARATIVE STUDY
Authors: Choudhary Y , Pokharkar H , Patil A , Mistry R 
Published: September 2020

Abstract

VATS esophagectomy can be done in lateral, prone and semiprone positions. Present evidence available comparing semiprone with lateral position is retrospective. We have conducted this study to provide prospective data on perioperative outcomes in patients undergoing Video Assissted Thoracoscopic (VATS) esophagectomy in Semiprone (SP) and Lateral decubitus position (LP) in a single centre.

Methods
48 patients (SP =24 & LP =24) undergoing VATS esophagectomy (2017 to 2019) were analysed. Preoperative details (tumor characteristics, preoperative treatment and pulmonary function test), intraoperative details [operative time, blood loss, mean EtCO2, arterial blood gas analysis (ABG) at the end of one lung ventilation(OLV), number of ports used, need for lung reinflation and retraction] and postoperative details [duration of ICU stay, cardiovascular and respiratory complications, pain scores (VAS) and tidal volume improvement (spirometry reading) on first five postoperative days, circumferential resection margin (CRM) status, total and recurrent laryngeal nerve (RLN) nodal yield were noted.

Results
Preoperative data in both arms were comparable. Ports used (5 vs 3, p &lt; 0.0001), need for lung retraction (22 vs 4patients, p &lt; 0.0001), duration of ICU stay (2 days vs 1 day, p = 0.0327), spirometry readings for POD 1st-5th (p &lt; 0.05) and pain scores (p &lt; 0.05) for POD 1st-5th was significantly less in SP group. There were fewer respiratory complications in SP group (10 vs 4, p = 0.110). LP group had shorter duration of surgery (3.7 vs 4.2 hours, p = 0.0398). There were no differences in tumor characteristics, blood loss, ABG at the end of OLV, mean EtCO2, lung reinflation rate, cardiovascular complications, CRM involvement, total and RLN nodal yield.

Conclusion
Similar oncological clearance was achieved by both techniques of esophageal mobilization. Semiprone position is associated with lesser postoperative pain and better preservation of respiratory function.
162 IMPACT OF FLOW SPEED OF ICG FLUORESCENCE IN THE GASTRIC CONDUIT AND THORACIC INLET SPACE ON ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Koyanagi K , Ozawa S , Ninomiya Y , Yatabe K , Higuchi T , Yamamoto M 
Published: September 2020

Abstract

We have previously demonstrated that the flow speed of indocyanine green (ICG) fluorescence in the gastric conduit wall could predict anastomotic leakage after esophagectomy. Surround organs via retrosternal route is considered to affect the blood flow in the gastric conduit and anastomotic leakage. In the study, we investigated the impact of the flow speed of ICG fluorescence in the gastric conduit wall and thoracic inlet space on anastomotic leakage after esophagectomy.

Methods
A total of 142 patients, who underwent esophagectomy with three-field lymph node dissection, simultaneous reconstruction using a gastric conduit, and cervical anastomosis via retrosternal route, were prospectively investigated. Using ICG fluorescence imaging, blood flow speed of the gastric conduit wall was assessed before and after anastomosis (pre speed and post speed (cm/s)) and correlated with clinicopathological findings. Parameters of thoracic inlet space was assessed using CT scan and correlated with blood flow speed of the gastric conduit wall and anastomotic leakage.

Results
Median pre speed was 2.54 (0.73–6.10) cm/s and median post speed was dropped by 1.77 (0.32–8.67) cm/s. Speed reduction (pre speed—post speed) and speed reduction rate ((pre speed—post speed)/pre speed) were negatively correlated with thoracic inlet area (TIA) (P = 0.004, P = 0.021). Pre speed and post speed of the patients with anastomotic leakage were significantly slower than those of the patients without anastomotic leakage, respectively (P &lt; 0.001 and P = 0.050). In 115 patients with pre speed more than 1.98 cm/s, TIA was significantly associated with anastomotic leakage after esophagectomy (P &lt; 0.001).

Conclusion
We clearly demonstrated that retrosternal route reduced the blood flow of the gastric conduit wall using ICG fluorescence imaging. Narrow thoracic inlet space might obstruct the blood flow of the gastric conduit wall and cause anastomotic leakage after esophagectomy.
164 EFFECTIVENESS OF ONE-TIME ENDOSCOPIC SCREENING PROGRAM IN PREVENTION OF ESOPHAGEAL CANCER IN CHINA: A MULTI-CENTER POPULATION-BASED COHORT STUDY
Authors: Chen R , Liu Y , Song G , Li B , Zhao D , Hua Z , Wang X , Li J , Hao C , Zhang L , Liu S , Wang J , Zhou J , Zhang Y , Li B , Li Y , Feng X , Li L , Dong Z , Wei W , Wang G 
Published: September 2020

Abstract

Esophageal cancer is one of the most common cancers worldwide and half of all new cases occurred in China. Population-based endoscopic screening has been carried out in some high-risk areas in China since 2005, but previous evidence was based predominately on small-sample, single-center studies. We undertook a population-based, multi-center cohort study to estimate the effectiveness of endoscopic screening program in reducing the incidence and mortality of esophageal in high risks areas in China.

Methods
This study was conducted in six areas in China from 2005 to 2015. All permanent residents aged 40–69 yeas were identified as target subjects. We defined those who were invited and undertook endoscopic screening as the screened group, and those who refused screening as the non-screened group. The target subjects who were not invited to screening was assigned to the control group. The effectiveness of endoscopic screening and screening program were evaluated by comparing the reductions in the incidence and mortality from esophageal cancer in those screened or those invited to screening with reductions in the control group, respectively.

Results
Our cohort analysis included 637 500 people: 299 483 in the control group and 338 017 in the invited to screening group, 113 340 (33.53%) of whom were screened eventually. Compared with subjects in the control group, esophageal cancer incidence and mortality were reduced by 26% (relative risk(RR) 0.74, 95% confidence interval(CI), 0.69–0.79) and 60% (0.40, 0.36–0.45) respectively in those screened, and they were reduced by 15% (0.85, 0.82–0.89) and 33% (0.67, 0.63–0.71) respectively in those invited to screening.

Conclusion
Among individuals aged 40–69 years in high risk areas of esophageal cancer, one-time endoscopic screening program was associated with a significant decrease in esophageal cancer incidence and mortality.
214 OESOPHAGECTOMY POST INDUCTION THERAPY: COMPLETE PATHOLOGICAL RESPONDERS VERSUS OTHERS
Authors: Pokharkar H , Patil A , Mistry R , Choudhary Y , Kaushik T 
Published: September 2020

Abstract

Induction therapy is reported to improve outcomes in patient with loco regionally advanced cancer of oesophagus; benefit is most in patient who respond to neoadjuvant therapy. This study compares outcomes between patients with complete pathological response (Group A) and others (Group B).

Methods
This is a retrospective analysis of prospectively maintained database of 257 patients with cancer oesophagus undergoing surgery after neoadjuvant therapy between 2009 and 2019. Parameters analysed were stage at presentation, type of induction therapy, pTNM stage, pattern of failure and overall survival.

Results
209(81%) patients received chemotherapy alone and 48(19%) chemoradiation. 43(17%) patients had complete pathological response. Of the complete responders 21/209(10%) and 22/48(45.8%) patients had received chemotherapy alone and chemoradiation respectively. Majority of patients in both groups were T3/4 (Group A:93%, Group B:93.9%) and node positive (GroupA:81.4%, GroupB:85%). Median number of lymph nodal yield for Group A and Group B was 22 and 20 respectively. Three(7%) patients in Group A had local recurrence and 2(4.7%) had distant failure. The same for non responders was 34(15.9%) and 49(22.9%). The median survival for Group A is 7.03 years and Group B is 2.1 years.

Conclusion
The overall median survival is significantly higher for complete pathological responder as compared to partial or non responders. Despite complete pathological response some patients will have recurrences. Chemoradiation is associated with higher complete pathological response compared to chemotherapy alone.