bluuebunny/crossref_metadata_2025_split huggingface dataset:
P156 ASSESSMENT OF HEALTH RELATED QUALITY OF LIFE AND DIGESTIVE SYMPTOMS IN LONG-TERM, DISEASE FREE SURVIVORS AFTER ESOPHAGECTOMY
Authors: Boshier P R , Klevebro F , Savva K V , Waller A , Hage L , Hanna G B , Low D E 
Published: November 2019

Abstract

Background
Esophagectomy has been associated with decreased health related quality of life (HRQOL) and persistent gastrointestinal symptoms. The aim of this study was to investigate HRQOL and symptom evolution in disease free patients up to 20 years following esophagectomy.

Methods
The study cohort was identified from prospective, IRB approved esophagectomy databases from two high volume centers for the management of esophageal cancer. Patients that were alive and without evidence of disease recurrence in April 2018 completed HRQOL and symptom questionnaires, including: Digestive Symptom Questionnaire, SF36, EORTC QLQ-C30, and EORTC QLQ-OG25. Patients were assessed in three cohorts: <2 year; 2 to 5 years, and; >5 years following surgery.

Results
In total 171 patients who underwent esophagectomy between 1995-2017, responded to the questionnaires, corresponding to a response rate of 81.3%. Median age was 66.2 years, and median time from operation to survey was 5.6 years (range 0.3-23.1). Early satiety was the most commonly reported symptom in all patients irrespective of timeframe (87.4%; range 82-92%). Dysphagia was seen to decrease over time (58% at <2yrs; 28% at 2-5yrs; 20% at >5 yrs. P=0.013). Weight loss scores demonstrated non-statistical improvement over time. All other symptom scores including heartburn, regurgitation, respiratory symptoms and pain scores remained constant over time. The average level of HRQOL did not improve from levels one year after surgery compared to patients up to 23 years following esophagectomy.

Conclusion
With the exception of dysphagia, which improved over time, esophagectomy was associated with decreased HRQOL and lasting gastrointestinal symptoms >20 years after surgery. In additional to oncological outcomes, the impact of esophagectomy on long-term HRQOL and associated functional disorders should be considered by all members of the multidisciplinary team when counseling and caring for patients undergoing esophagectomy
P169 COMPARISON OF LAPAROSCOPIC TOUPET FUNDOPLICATION AND MAGNETIC SPHINCTER AUGMENTATION IN PATIENTS WITH 3-5 CM HIATUS HERNIA
Authors: Lazzari V , Milito P , Scaramuzzo R , Asti E , Bonavina L 
Published: November 2019

Abstract

Aim
To compare quality of life in patients with large hiatus hernia undergoing laparoscopic Toupet fundoplication and magnetic sphincter augmentation.

Background and Methods
Laparoscopic Toupet fundoplication (LTF) and laparoscopic magnetic sphincter augmentation (MSA) have been compared in a previous retrospective study (Asti E et al, Medicine, 2016) in patients with small hiatal hernia (<3 cm). There is no universal consensus in the use of MSA in patients with large hiatus hernia.
This is an observational, retrospective, comparative cohort study. Patients with <3 cm or >5 cm hiatus hernia measured by endoscopy and barium swallow study and those with previous esophago-gastric surgery were excluded. The primary outcome was quality of life based on the Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire. Secondary outcomes were proton pump inhibitors (PPI) use, incidence of dysphagia and gas-related symptoms, and hiatus hernia recurrence rate.

Results
Between March 2007 and June 2018, 150 patients with GERD met the inclusion criteria; 88 underwent a LTF and 62 a MSA procedure. Both groups had similar preoperative features. The mean follow-up was 64 months and all patients were followed for at least one year after surgery. There was no statistically significant difference between LTF and MSA in GERD-HRQL scores (p=0.178), PPI use (p=0.327), gas-related symptoms (p=0.162), dysphagia (p=0.254), and reoperation rate (p=0.167).

Conclusion
Both LTF and MSA have similar safety profile and disease-specific quality of life in patients with large hiatal hernia.
P174 ESOPHAGEAL CANCER SURGERY: EXPERIENCES WITH ANASTOMOTIC LEAK TREATMENTS AT A HIGH-VOLUME CENTER
Authors: Emil Ainsworth Jochumsen , Michael Hareskov Larsen , Alan Patrick Ainsworth 
Published: November 2019

Abstract

Aim
To study treatments and interventions for anastomotic leak following esophagectomy at a high volume center.

Background and Methods
Anastomotic leak is a severe and common complication of esophagectomies. Anastomotic leak patients treated between Jan 1 2016 and Dec 31 2018 were retrospectively identified from an institutional database of patients undergoing esophagectomies and were further analyzed. The primary out- comes for the assessed interventions were success- rate of intervention and length-of-stay. The following anastomotic leak treatments were assessed by this study: Conservative treatment, esophageal stents, endoscopic vacuum assisted closure therapy (E-VAC) and surgically placed drains.

Results
The study population consisted of 223 patients, 28 (12.6%) of who suffered anastomotic leaks. The distribution of the interventions and conservative treatment is illustrated in Figure 1. The success-rate of E-VAC was 75.0% (n=8), compared to a rate of 25.0% for stents (n=4) and 59.1% for conservative treatment (n=13). Surgically placed drains had a success-rate of 100.0%, but were only performed on 3 patients in total.

Conclusion
E-VAC was the most effective non- surgical leak intervention in terms of success-rate. Due to the design of this study, the effectiveness of conservative treatment was likely under- estimated.
P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS
Authors: Sheraz R Markar , Melody Ni , Suzanne Gisbertz , Jennifer Straatman , Donald van der Peet , Miguel A Cuesta , George B Hanna , Mark I van Berge Henegouwen 
Published: November 2019

Abstract

Aims
The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1.

Methods
Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset.

Results
115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested.
Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest.
Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66).

Conclusions
MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.
P177 REINFORCED CRURAL REPAIR FOR LARGE HIATUS HERNIA: PRELIMINARY RESULTS WITH PHASIX ST® MESH
Authors: Panici Tonucci T , Sironi A , Lazzari V , Riva C G , Milito P , Asti E , Bonavina L 
Published: November 2019

Abstract

Aim
The aim of the study was to assess safety, quality of life and recurrence rate after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh (PHASIX ST®).

Background & Methods
Safety and effectiveness of absorbable meshes for laparoscopic hiatus hernia repair are still debated, with several studies reporting conflicting outcomes. This may be due to patient selection, technique of repair, type of mesh, definition of recurrent hernia and length of follow up. An observational, single-center study was conducted in patients undergoing laparoscopic crural repair reinforced with PHASIX ST®, a monofilament resorbable mesh (poly-4-hydroxybuterate) with a hydrogel barrier on one side. Data were extracted from hospital charts and a prospectively updated research database. The quality of life was assessed by the GastroEsophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire. Clinical evaluation, upper gastrointestinal endoscopy and/or barium swallow study were performed at 6 – 24 months of follow up. Recurrent hernia was defined as the maximum vertical height of stomach > 2 cm above diaphragm at endoscopy and/or barium swallow study.

Results
103 consecutive patients were implanted with PHASIX ST® mesh from January 2017 to May 2019. The overall postoperative morbidity rate was 2.9%. The average follow up was 13 months with 31 (30%) patients reaching 2-year. The mean postoperative GERD-HRQL score significantly improved compared to baseline (4.6 ± 3.9 vs 16.6 ± 4.1, p<0,001). Recurrent hernia was found in 3 of 79 (3.8%) patients followed for at least 6 months after surgery. None of the patients required reoperation for adverse events or symptomatic hernia recurrence.

Conclusion
The use of PHASIX ST® mesh to reinforce crural repair for large hiatus hernias is safe and seems to be effective in the short-term follow up.
P179 THORACOSCOPIC EXTENDED 2-FIELD LYMPH NODE DISSECTION FOR ESOPHAGEAL CANCER. IMPLEMENTATION AND SURGICAL TECHNIQUE
Authors: Kyros Eleandros , Zografos Konstantinos , Vagios Ilias , Hasemaki Natasha , Karydakis Lysandros , Skotsimara Antonia , Vergadis Chrysovalantis , Karavokyros Ioannis , Liakakos Theodore , Charalabopoulos Alexandros 
Published: November 2019

Abstract

Aim
Lymphadenectomy in minimally-invasive esophageal cancer surgery still remains challenging and standardization of surgical procedures is of extreme importance. The aim of this study is to present our safe and reproducible technique in thoracoscopic superior lymphadenectomy during esophagectomy for cancer.

Background & Methods
In esophageal cancer surgery, dissection of the superior mediastinal lymph-nodes is of high importance. For adequate mediastinal lymph-node dissection, an extensive operating field is required along with appropriate equipment and experience. Thoracoscopy in prone position provides excellent visualization of the operative field comparing to thoracotomic phase. A step-by-step explanation of our surgical technique during thoracoscopic superior lymphadenectomy is provided.

Results
All patients were placed in prone position. The entire posterior mediastinal pleura was incised; azygos arch was divided with clips, facilitating dissection of the left side of the posterior mediastinum. The descending thoracic aorta was freed anteriorly, separating the esophagus; the thoracic duct was dissected and divided with vascular clips. Esophageal hiatus was dissected circumferentially and the esophageal wall was freed from the pericardiumanteriorly. Subcarinal lymph-nodes were dissected en bloc. Upper thoracic esophagus was separated from the membranous part of the trachea. The right recurrent laryngeal nerve lymph nodes were dissected at the level of the right subclavian artery, with extreme caution to avoid nerveinjury. Left recurrent laryngeal nerve was identified by posterior traction of the esophagus using a full thickness transluminal suture;by pulling it through a separate skin incision, the relative lymph nodes were dissected.

Conclusion
It is interesting that, higher number of lymph-nodes are harvested with this procedure which may be the result of better visualization/access. Overall, our technique has been standardized, is safe and reproducible and could be adopted by specialized Upper GI Units.
O18 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE STUDY)
Authors: van Workum Frans , Verstegen Moniek , Klarenbeek Bastiaan , Siersema Peter , Schouten Jeroen , Hannink Gerjon , van Berge Henegouwen Mark , Daams Freek , Polat Fatih , Willem Haveman Jan , Heisterkamp Joos , Nieuwenhuijzen Grard , Wijnhoven Bas , van Det Marc , Singh Pritam , Kouwenhoven Ewout , Griffiths Ewen , Bouwense Stefan , Rosman Camiel 
Published: November 2019

Abstract

Aim
The aim of this study is to investigate which factors contribute to anastomotic leakage severity and to compose an evidence based anastomotic leakage severity score. Secondly, we aim to investigate which anastomotic leakage characteristics are associated with success of different anastomotic leakage treatments and to compare the effectiveness of different initial anastomotic leakage treatments for anastomotic leakage classified according to severity and leakage characteristics.

Background
Anastomotic leakage occurs in 0%-30% after esophagectomy for cancer. It is a severe complication with mortality rates approximately ranging from 2%-12%. In addition, it is associated with a prolonged ICU treatment and hospital stay. Anastomotic leakage severity is currently graded according to how it is treated (grade I: conservative treatment, grade II: endoscopic/radiologic intervention and grade III: surgical intervention). However, this scoring system cannot be used to guide decision making when anastomotic leakage is diagnosed in a clinical setting. Factors that may influence the severity of the anastomotic leakage are (amongst others) location of the anastomosis, estimated surface of the defect, estimated circumference of the defect, extent of contamination, degree of sepsis and time from diagnosis until therapy. However, little is known about to what extent these and other factors contribute to anastomotic leakage severity. In addition, there is a paucity of data on what leakage characteristics dictate the success of a specific treatment.

Methods
We will perform an international multicenter retrospective cohort study. All adult patients with anastomotic leakage according to the ECCG definition after esophagectomy and gastric conduit reconstruction for esophageal cancer are suitable for inclusion. We aim to include at least 1000 patients. The primary outcome parameter is 90-day mortality. Secondary outcome parameters are in-hospital mortality, 30-day mortality, 180-day mortality, comprehensive complications index, total number of reinterventions, hospital and ICU length of stay and hospital related costs.

Results
Data collection will take place from April 2019 until December 2019. Study results are expected in June 2020.

Conclusion
We hypothesize that we will be able to identify factors that influence the severity of the anastomotic leakage and to compose a leakage severity score. Furthermore, we expect to identify leakage characteristics dictating the success of a specific treatment.
P189 PREDICTORS OF BARRETT’S OESOPHAGUS PROGRESSION : WHERE ARE WE?
Authors: Sara Jamel* , Amy Thie , Karina Tukaniva , Sheraz R Markar , George B Hanna 
Published: November 2019

Abstract

Introduction
Barrett’s esophagus (BE) is a well-established precursor lesion for oesophageal adenocarcinoma, which carries an overall poor prognosis (1-2). Patients diagnosed with Barrett’s oesophagus therefore undergo regular endoscopic surveillance to detect neoplastic lesions at an early stage to allow curative treatments (3). The low incidence of esophageal adenocarcinoma (EAC) in Barrett’s oesophagus patients highlights the need for risk stratification tools of patients on surveillance. In this review, we present current potential biomarkers and their associated diagnostic accuracy for the prediction of progression in BE.

Materials and methods
We searched MEDLINE, EMBASE, Web of Science, CENTRAL and Pubmed publisher. All studies on factors of Be progression were included. Two authors independently assessed the trials and extracted data. Quality assessment of studies was performed using QUADAS scoring. Pooled analysis was performed through Medusa software.

Results
The inclusion criteria were met by 25 studies. All the studies evaluated diagnostic accuracy of the biomarker to detect progression of Barrett’s to high grade dysplasia (HGD) and EAC. The biomarkers were p53 mutation in 6 studies, Methylation in 4 studies, Clinical factors in 7 studies and genetic factors in 5 studies and other biomarkers in 7 studies.
The pooled sensitivity and specificity for BO were 83.4 % [95 % confidence interval (CI): 68-95 %] and 75.6 % (95 % CI: 68-88 %), respectively. In particular, the use of p53 and methylation in BO patients appeared to be associated with a good diagnostic accuracy to predict neoplastic progression in BE.
Therefore, further biomarker research may provide promising results in risk stratification and prediction of progression to HGD and oesophageal adenocarcinoma in context of BE.

Conclusions
The evidence from this systematic review is suggestive of a crucial role of biomarkers in prediction of BE progression. Further work in translating biomarkers for routine clinical use may eventually lead to accurate risk stratification.
P195 THE STRUCTURE OF A CONSULTATION HOUR FOR BENIGN DISEASES OF THE UPPER GASTROINTESTINAL TRACT AT A CENTRE OF EXCELLENCE FOR ESOPHAGEAL AND GASTRIC SURGERY
Authors: Knepper L , Müller D T , Fuchs H , Fuchs C , Brinkmann S , Schröder W , Bruns C J , Leers J M 
Published: November 2019

Abstract

Aim
The aim of the study is to analyze the structure and the patient population of a consultation hour for benign diseases of the upper gastrointestinal tract at a centre of excellence for esophageal and gastric surgery.

Background and Methods
The increasing specialization in visceral surgery leads to a higher number of special consultation hours, e.g. for benign diseases of the esophagus and stomach. In this study we examine both the reasons for an introduction at a specialized clinic and the therapy suggestions. The clinical and demographic data of all patients who visited an appointment for functional diseases of the upper gastrointestinal tract of the University Hospital Cologne during the entire year 2018 were collected prospectively for this study and evaluated at the end of the year.

Results
In 2018, a total of 412 patients attended the benign OGI consultation hour (54% male). 107 patients (26%) attended more than once. 293 patients attended the consultation hour for the first time. The following diagnoses most frequently led to the presentation in the special consultation hour: GERD (n=262, 63%), achalasia (n=52, 13%), upside-down-stomach (n=24, 6%), dysphagia of unknown genesis (n=15, 4%), and other motility disorders of the esophagus (n=14, 3%). 190 patients received an EGD because they had not received an endoscopic examination in the last year. Functional diagnostics were performed in almost all new presentations: High- resolution-manometry (n=243), 24h-pH-metry (n=199). Even though the surgical department led the consultation hour, a conservative approach was recommended to 231 patients (56%). Surgery was recommended to 156 patients (38%) and an endoscopic approach was recommended in 25 cases (6%). Overall, 101 patients (43%) received an operation during the observation period. Most common indication for surgery was GERD (n=63, 62%). Of those 63 patients, 42 received a laparoscopic Nissen fundoplication.

Conclusion
The demand for a specialized clinic for reflux treatment is significant and includes a high degree of diagnostics. A differentiation of the symptoms is decisive in order to select the right patients for surgical therapy. Only about every third patient is recommended for surgery.
P197 LONG-TERM HEALTH-RELATED QUALITY OF LIFE AFTER BENIGN ESOPHAGEAL PERFORATION
Authors: Laura Knepper , Sebastian Brinkmann , Hans F Fuchs , Arnulf H Hoelscher , Kathrin Kuhr , Seung Chon , Wolfgang Schroeder , Christiane J Bruns , Jessica M Leers 
Published: November 2019

Abstract

Aim
This study aims to evaluate long-term outcome and health related quality of life in patients with benign esophageal perforations.

Background and Methods
Esophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum therapy (EVT) are established methods in the management of this emergency condition. As health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic intervention not much is known about HRQoL, particular in the long-term follow-up of patients treated for benign esophageal perforation with different treatment strategies. Patients treated for benign esophageal perforation at the University Hospital Cologne from January 2003 to December 2014 were therefore investigated. Primary outcome and management of esophageal perforation were documented and long-term quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI), the Health-Related Quality of Life Index (HRQL) for patients with gastroesophageal reflux disease (GERD) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires for general and esophageal cancer specific QoL (QLQ-C30 and QLQ-OES18).

Results
Patients were divided based on primary treatment into an endoscopic (46.5%), surgical (34.5%) and conservative treatment group (19%). Short- and long-term outcome, as well as quality of life were compared. HRQoL was measured after a median follow-up of 49 months. HRQoL was generally reduced in patients with benign esophageal perforation. Endoscopically treated patients showed the highest GIQLI overall score and highest EORTC general health status, followed by the conservative and the surgical group.

Conclusion
HRQoL in patients with benign esophageal perforation is reduced even in the long-term follow-up. Temporary stent or EVT is effective and provides a good alternative to surgery not only in the short-term but also in the long-term follow-up.