bluuebunny/crossref_metadata_2025_split huggingface dataset:
P138 IMPACT OF NEOADJUVANT FLOT CHEMOTHERAPY ON CARDIORESPIRATORY RESERVE OF PATIENTS WITH OESOPHAGOGASTRIC ADENOCARCINOMA
Authors: Chmelo J , Sinclair R C F , Navidi M , Phillips A W 
Published: November 2019

Abstract

Introduction
Neoadjuvant chemotherapy is known to have a deleterious effect on the cardiorespiratory reserve of patients with oesophagogastric cancer[1,2]. A low anaerobic threshold is associated with increased morbidity after major surgery[3] The effect that FLOT (5FU, leucovorin, oxaliplatin, docetakel) chemotherapy has upon cardiopulmonary reserve has not been reported. This work aims to quantify this effect.

Methods
Cardiopulmonary exercise testing (CPET) was completed in 18 consecutive patients with oesophagogastric cancer who received FLOT chemotherapy. CPET pre-chemotherapy and 4-5weeks post-chemotherapy measured the ventilatory anaerobic threshold (AT) and peak oxygen uptake (Vo2p). Ventilatory equivalents for CO2 (Ve/VCO2) and total ventilation (Ve) were reported. The group mean change in these objective measurements of cardiopulmonary reserve was compared before and after FLOT.

Results
Between October 2018 and January 2019 eighteen patients (median age 58.1 years, 16/18 male) were tested before and after FLOT. In 14 patients (78%) a decline in AT and VO2p was demonstrated. A mean decrease in AT of 2.1 mlkg-1min-1 (14.9 Vs 12.8 mlkg-1min-1, p=0.02) and VO2p of 2.3 mlkg-1min-1 (20.6 vs 18.3 mlkg-1min-1, p=0.01) was seen after FLOT. Ve/VCO2 and Ve were unchanged.

Conclusion
Patients receiving FLOT chemotherapy demonstrate a clinically significant decrease in cardiorespiratory reserve. This appears to be similar to that observed in patients who have previously received neoadjuvant ECX (MAGIC regimen) [1,2,4]. Further investigation into the clinical impact of this observation is required.
P139 CHYLE LEAK FOLLOWING RADICAL EN-BLOC OESOPHAGECTOMY WITH 2 FIELD NODAL DISSECTION: PREDISPOSING FACTORS, MANAGEMENT AND OUTCOMES
Authors: Milito P , Chmelo J , Kamarajah S K , Madhavan A , Wahed S , Hayes N , Immanuel A , Griffin S M , Phillips A W 
Published: November 2019

Abstract

Background
Chyle leaks may result from damage of the main thoracic duct or its tributaries during radical en-bloc sub-total oesophagectomy (STO). Treatment strategies and outcomes vary and management of this problem remains controversial. This study assessed the incidence, management and outcomes of chyle leaks in a dedicated oesophago-gastric cancer unit.

Methods
A retrospective study was conducted among patients who underwent elective STO with 2-field nodal dissection for oesophageal cancer between January 1997 and March 2019. The thoracic duct was routinely ligated during surgery. The diagnosis of post-operative chyle leak was performed clinically by a consultant and it was based on high output (> 500 ml/24h) from chest and/or abdominal drains and on visual characteristics of the fluid.

Results
1320 patients underwent surgery over the time reviewed. The study group consisted of 347 (26.3%) women and 974 (73.7%) men, with a median age of 65 (IQR 13) years. Oesophageal adenocarcinoma was diagnosed in a total of 937 (70.9%) patients, while squamous cell carcinoma in 274 (20.7%) patients. 93 (7%) patients developed a chylothorax. Univariable analysis showed that lower body weight, lower BMI, female sex and histology of a squamous cell carcinoma were significant independent predictive factors for chyle leak (p<0.005).
Chyle leak was associated with a higher risk of return to ITU (45.1% vs 10.1%, p<0.001) and longer hospital stays (median 21.5 vs 15 days, p=0.002). Overall in-hospital mortality was 3.7% and was significantly higher in the chyle leak group (10.75% vs 3.2%, p<0.001), although the causes of death were not directly related to it. Chyle leak was not associated with anastomotic leak, or wound and respiratory infection.
Chylothorax was treated surgically in 39 (41.9%) patients and conservatively in 54 (58.1%). Between these two groups, a significant difference in terms of post-operative hospital stay and in 30-day mortality rate was seen (p< 0.002 and p=0.031, respectively). Survival rate was similar in both groups.

Conclusions
Chyle Leak post oesophagectomy is associated with an increased risk of return to ITU, and longer hospital stay and increased in hospital mortality. However, surgical treatment is safe and early re-operation is recommended in order to diminish hospital stay and to decrease the 30-day mortality rate.
P141 IVOR LEWIS MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER : IMPACT OF THORACOSCOPY ON POST-OPERATIVE MORBIDITY
Authors: Louis Martin , Thibault Voron , Vincent Drubay , Marguerite Messier , Clarisse Eveno , Guillaume Piessen 
Published: November 2019

Abstract

The aim
of this study is to assess the impact of thoracoscopy versus conventional thoracotomy on postoperative and oncological outcomes in patients undergoing Ivor Lewis esophagectomy with laparoscopic gastric mobilisation for esophageal resectable cancer.

Background & Methods
Esophagectomy for cancer is a complexe procedure associated with a high rate of mortality and morbidity1,2, especially respiratory, despite recent improvements in perioperative cares and advances in surgical techniques. Recently, minimally invasive esophagectomy has shown a benefit in decreasing postoperative respiratory complications in 2 randomized trials comparing firstly the hybrid approach (Ivor Lewis with laparoscopy and right thoracotomy) to the open approach (MIRO trial3) and secondly the totally minimally invasive approach with cervical anastomosis (McKeown with laparoscopy and thoracospy) to the open approach (TIME trial4).
Few studies have focused on comparing specifically thoracosopic(TMIE) versus conventional thoracotomy approach(HYBRID) for intra-thoracic anastomosis. We performed a single-center retrospective study, including all patients undergoing either Ivor Lewis HYBRID or TMIE in our high-volume center between 2010 and 2019. The primary endpoint was major postoperative complications within 30 days (Dindo-Clavien grade≥III). Secondary endpoints included operative parameters, postoperative morbidity and mortality within 90 days and quality of oncological resection.

Results
498 patients were included, 440 underwent HYBRID and 58 TMIE. Ninety-six patients(19.3%) had major postoperative complication, 11 patients(19%) in TMIE and 85 patients(19.3%) in HYBRID. Anastomotic leak (AL) rate was significantly higher in TMIE (36.2% versus 10.8%,p<0.001). However AL in TMIE group were frequently less severe than in the HYBRID group (rate of AL type 2/3 respectively 23.8% and 50%;p=0.044). Respiratory complications were observed in 202 patients (45.9%) in the HYBRID group and in 14 patients (24.1%;p=0.002) in TMIE group, without significant difference in severe respiratory complications rate. The complete resection rate (R0 resection) (5.3% vs 3.7%) and the number of lymph nodes retrieved (25.26 vs 25.92) were comparable in both groups.

Conclusion
The TMIE approach is burdened with a significant AL rate, probably related to an unreached learning curve, which mitigates the benefit of this approach to respiratory complications. The technical difficulty caused by intrathoracic anastomosis, whose modalities are not well-established, remains a major concern.
P142 IMPACT OF NEO-ADJUVANT CHEMOTHERAPY ON CARDIORESPIRATORY RESERVE, SARCOPENIA AND QUALITY OF LIFE IN OESOPHAGO-GASTRIC CARCINOMA
Authors: Navidi M , Phillips A , Griffin M , Petrides G , Perthen J , Ali T , Greystoke A , Sinclair R 
Published: November 2019

Abstract

Background
The management of locally advanced oesophago-gastric (OG) adenocarcinoma in the UK includes three cycles of MAGIC protocol neoadjuvant chemotherapy (NAC). NAC may have a detrimental impact on fitness, quality of life and sarcopenia. Determination of the oxygen uptake at the anaerobic threshold (AT) by cardiopulmonary exercise testing (CPET) objectively measures cardiorespiratory reserve (fitness). AT can be used to predict perioperative risk. Sarcopenia is defined by decreased skeletal muscle mass and is a poor prognostic factor. Patients view their health by means of quality of life (QOL) rather than traditional clinical outcomes. This study was conducted to determine the impact of neoadjuvant chemotherapy on fitness, sarcopenia and quality of life following neoadjuvant chemotherapy.

Methods
Patients with locally advanced OG adenocarcinoma were recruited. CPET, sarcopenia and QOL were measured before and following NAC. AT and peak oxygen uptake (VO2 Peak) were used to assess fitness. CT images at staging and upon completion of NAC were used to measure sarcopenia (muscle mass and function). EORTC QOL-Core 30 and QLQ-Oesophagogastric 25 questionnaires assessed QOL.

Results
31 patients with a median age of 65 (41-81) were recruited, 27 patients completed all three cycles of NAC. The results of pre and post NAC measured parameters are outlined in the table below.

Conclusion
NAC significantly impacts fitness, sarcopenia levels and QOL. Preventing this reduction through development of ‘prehabilitation’ strategies, or optimising timing of surgery after recovery of the observed decline, may decrease perioperative risk, reduce postoperative complications and improve quality life. This should be the focus of future studies.
P143 RNA-BASED LIQUID BIOPSIES FOR BETTER CLINICAL MANAGEMENT OF BARRETT’S ESOPHAGUS AND ESOPHAGEAL ADENOCARCINOMA
Authors: Annouck Philippron , Kathleen Schoofs , Philippe Nafteux , Lieven Depypere , Jo Vandesompele , Katleen De Preter , Piet Pattyn 
Published: November 2019

Abstract

Aim
In this study we will explore several RNA types in blood, including microRNA, messenger RNA, long non-coding RNA and circular RNA as a potential liquid biomarker to facilitate early diagnosis, prognosis and monitoring of esophageal adenocarcinoma

Background & Methods
In the past decades the incidence of esophageal adenocarcinoma (EAC) has increased dramatically in most Western populations. Due to the lack of symptoms EAC is often detected in a late stage, contributing to a poor 5-year survival rate. The potential of RNA (coding and miRNA) as circulating biomarker in blood has already been shown for many cancer entities but requires further investigation for EAC.
Blood and tissue samples from patients with non-dysplastic Barrett’s esophagus (NDBE), high-grade dysplasia (HGD) and EAC have been collected. Currently, our biobank includes >5000 samples from 120 patients. A proof-of-concept study was conducted including 17 patients from three groups (EAC, HGD and NDBE). For each patient, biopsies from diseased tissue and healthy tissue as well as blood were collected and analyzed using small RNA and total RNA sequencing.

Results
Gene expression analysis was performed to identify differentially expressed genes across the three groups. The highest number of significantly differentially expressed m(i)RNAs were present in the tissues of EAC versus NDBE patients, while these differences were much lower or even absent in the plasma samples. Moreover, we have identified between 1500 and 7500 unique circular RNAs in individual EAC cancer patients’ plasma, indicating promising opportunities for a blood-based liquid biomarker for BE and EAC.

Conclusion
An exploration of several RNA types in blood and tissue biopsies has been done in patients with Barrett’s Esophagus and esophageal adenocarcinoma. Additional samples are needed to significantly increase the power of the differential expression study as well as to verify the results of our proof-of-concept study.
O144 CALCIFICATION IN THE DESCENDING AORTA PREDICTS POSTOPERATIVE LEAKAGE OF INTRA-THORACIC ANASTOMOSIS AFTER OPEN ESOPHAGECTOMY FOR CANCER
Authors: Ukkonen M , Wirta E , Khan J , Tyrväinen T , Kechagias A 
Published: November 2019

Abstract

Aim
Postoperative anastomotic leakage is a major complication in the surgery of the esophagus. In this study, we aim to examine whether calcifications of the aortic segments can predict anastomotic leakage after open esophagectomy for cancer with intra-thoracic anastomosis of a gastric conduit.

Background and methods
All patients with esophageal cancer who underwent elective esophagectomy with an intra-thoracic anastomosis at Tampere University Hospital between 2007-2018 were evaluated. Preoperative data were associated to outcome. These included demographic, anamnestic, clinical, laboratory, and radiologic data. Preoperative staging thoraco-abdominal CT-scans were re-evaluated to document the presence of calcifications in the various aortic segments.

Results
A total of 97 patients (median age 64 (43-78) years, 20% female) were analysed, with anastomotic leakage occurring in 22 patients (23%). Median time from surgery to leakage was 10 (1-32) days, and follow-up time 28 (1-143) months. From all the factors that were evaluated in the univariate analysis, only the presence of calcification in the descending thoracic aorta was associated with a higher risk of anastomotic leakage (11% vs. 33%, HR 4.571; 95% CI 1.40-15.0; p=0.011). There was a trend for anastomotic leakage in the presence of calcification in the suprarenal abdominal aorta (13% vs. 29%, p=0.057). A higher leakage rate was documented when a calcification was present in the infrarenal abdominal aorta (8.3% vs. 25%, p=0.205), and in the ascending thoracic aorta (22% vs. 30%, p=0.559), without reaching statistical significance.

Conclusion
The presence of a calcification in the descending thoracic aorta is associated with higher risk of anastomotic leakage after open esophagectomy for cancer.
P145 OPTIMAL PERIOPERATIVE PAIN MANAGEMENT IN ESOPHAGEAL SURGERY
Authors: Feenstra ten Hoope M L , Hermanides W , Gisbertz J , Hollmann S S , van Berge Henegouwen M W , Eshuis M I ,   WJ
Published: November 2019

Abstract

Aim
To compare paravertebral analgesia with epidural analgesia in thoracolaparoscopic Ivor Lewis esophagectomy.

Background
In esophagectomy, thoracic epidural analgesia (TEA) is standard of care for perioperative pain management. Although TEA is effective, it has unwanted side-effects, such as hypotension, urinary retention and epidural haematoma. Thoracoscopic guided paravertebral analgesia (PVA) is an alternative that is being applied more in thoracic surgery and supposedly has less side-effects.

Methods
In this feasibility study, TEA was compared with PVA for efficacy in two consecutive series of 25 thoracolaparoscopic Ivor Lewis esophagectomies. In PVA the catheter was placed by the surgeon under direct thoracoscopic vision. TEA consisted of continuous bupivacaine and sufentanil with a patient-controlled bolus function. PVA consisted of continuous bupivacaine and intravenous morphine patient-controlled analgesia. Primary outcome was the highest recorded Numeric pain Rating Scale (NRS) every 8 hours. Secondary outcomes included opioid consumption, vasopressor consumption, fluid administration and length of hospital stay.

Results
In both groups, the NRS was acceptable (below 5) during the first three postoperative days with no difference in overall pain. Patients with PVA had a higher NRS the first postoperative night (median 4 vs 0, p<0.001). Opioid consumption was significantly lower in patients with PVA. In TEA three catheters failed after successful insertion, in PVA only two. There was no difference in vasopressor consumption, fluid administration and length of hospital stay.

Conclusion
PVA seems to be a safe and effective alternative for TEA in thoracolaparoscopic Ivor Lewis esophagectomy. This hypothesis should be confirmed in a randomized trial.
P149 MINIMAL INVASIVE TEMPORARY GASTRIC ELECTRO STIMULATION - 1 YEAR FOLLOW
Authors: Corvinus F , Babic B , Tagkalos E , Hadzijusufovic E , Heinrich S , Lang H , Grimminger P 
Published: November 2019

Abstract

Aim
To predict the outcome of the implantation of an electronic gastric stimulation device (Enterra®, Medtronic) we established a minimal invasive procedure to perform a temporary gastric test stimulation prior to a definite implantation (1). We achieved promising short time results. This study will demonstrate the long-term results after more than 1 year.

Background & Methods
Gastroparesis (GP) is a complex disorder of gastric motility. It is defined as a delayed gastric emptying without pyloric obstruction. Due to its etiology GP is divided into three groups: diabetic (GP), postoperative (PG) and idiopathic (IP). Although electronic stimulation of the stomach is a well-established and approved procedure since over 18 years for the therapy of symptomatic GP, the response to gastric stimulation remains unpredictable.
13 patients (11 female, 2 male) with a history of symptomatic gastroparesis (4 idiopathic, 7 postoperative, 2 diabetic) were included. Patients underwent laparoscopy and received 2 temporary electrodes (Medtronic Streamline 6492®) 10 cm proximal to the pylorus into the gastric wall. Threads were passed through the abdominal wall and connected to an external gastric stimulator (Enterra, Fa. Medtronic). The device was taped to the abdominal wall by a dressing. Symptom intensity was measured by a standardized questionnaire, Gastoparesis Cardinal Symptom Index (GCSI)(2). Therapeutic response was defined as a GCSI reduction of at least 50% under the preoperative score. Half time gastric emptying was also measure pre and postoperatively using a half-solid test meal.

Results
10 of 13 patients reported a response to temporary gastric stimulation with an increase of the pre-therapeutic GCSI over 50 %. 10 patients received a permanent stimulation device. 7 patients reached the 1-year follow up. They all remained responders with a reduction of GCSI over more than 50 %. In comparison to results after 6 months gastric half time emptying continued to decrease.

Conclusion
Temporary gastric electronic stimulation can predict the long-term outcome of patients receiving a definite implantation of an electronic gastric stimulation device.
P153 DEVELOPMENT OF A NOMOGRAM FOR THE PREDICTION OF INTERVAL METASTASES AFTER CHEMORADIOTHERAPY IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yin-Kai Chao 
Published: November 2019

Abstract

Aim
To develop a nomogram for predicting interval metastases during chemoradiotherapy(CRT) in esophageal squamous cell carcinoma(ESCC) patients.

Background&Methods
During CRT for esophageal cancer, some patients develop systemic metastasis. Nomograms incorporating multiple prognostic factors are useful for individualized estimation of survival in cancer patients. However, nomograms for the prediction of interval metastases after CRT in patients with esophageal cancer are scarce.
We retrospectively reviewed the records of 358 ESCC patients who underwent CRT as first line treatment. Data were subjected to multivariate logistic regression analyses for selecting variables to be included in the nomogram. The performance of the resulting nomogram was internally and externally validated by calculating the bias-corrected concordance statistic (c-statistic) and the area under the receiver operating characteristics curve (AUROC).

Results
After CRT, 21 patients (5.9%) were found with new distant metastatic lesions. The following variables were included in the nomogram: 1) age, 2) Tumor SUXmax on pretreatment18F-FDG PET, 3) pretreatment tumor length, 4)chemotherapy regimen (Paclitaxel+Carboplatin v.s. Fluorouracil+Cisplatin). The bias-corrected c-statistic and AUROC was 0.7094.

Conclusions
At least 5.9% of ESCC patients developed interval metastasis after CRT. Our nomogram showed an adequate performance for predicting interval metastases in ESCC patients.
P154 SAFETY AND ONCOLOGICAL EFFICACY OF BILATERAL RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yin-Kai Chao, 
Published: November 2019

Abstract

Aim
We sought to evaluate the safety and oncological efficacy of bilateral recurrent laryngeal nerve (RLN) lymph node dissection (LND) in patients with esophageal squamous cell carcinoma (ESCC) who had undergone neoadjuvant chemoradiotherapy (nCRT).

Methods
The need to dissect RLN lymph nodes in patients who had undergone nCRT is controversial. No data are currently available on the clinical utility and implications of RLN nodal dissection in nCRT-treated patients with esophageal cancer.
We retrospectively examined the records of ESCC patients who were judged to be ycN-RLN(-) following nCRT. Patients were divided into two groups according to the extent of LND (standard two-field LND [STL group] versus total two-field LND [TTL group]). Only lower mediastinal and upper abdominal lymph nodes were removed in the STL group. In addition to the standard procedure, patients in the TTL group underwent resection of upper mediastinal lymph nodes located along the bilateral RLN. Using propensity score matching, 29 pairs were identified and compared with regard to perioperative complications, lymph node metastases rates, overall survival (OS), and disease-specific survival (DSS).

Results
No significant intergroup differences were identified in terms of in-hospital mortality and morbidity. Metastases to the RLN lymph nodes were identified in 20.7% (6/29) of TTL patients, being the only site of lymph node metastases in three of them. TTL was associated with lower upper mediastinal lymph node recurrence rate(6.5%) compared with STL (21.5%, p=0.134), although the overall recurrence rate was similar (STL, 44.8% versus TTL, 46.4%). No significant intergroup differences were also evident with regard to 3-year DSS and OS rates.

Conclusions
RLN LND can be safely performed in ESCC patients who had undergone nCRT, ultimately resulting in an improved local control and should be practiced as part of the surgical routine.
P155 REAL-TIME EVALUATION OF THE GASTRIC CONDUIT BASED ON THE REGIONAL O2 SATURATION (%) AND TOTAL HEMOGLOBIN INDEX IN THORACIC ESOPHAGECTOMY
Authors: Takeo Fujita , Kazuma Sato , Yuki Hirano , Hisashi Fujiwara , Hiroyuki Daiko 
Published: November 2019

Abstract

Aim
Evaluation of blood supply of gastric conduit is one of the most importance parameter in thoracic esophagectomy. Evaluation with indocyanine green is the most popular evaluation method. However, indocyanine green does not objecctive values with
Herein we introduce the new evaluation method based on the regional SO2(%) and Total hemoglobin index in thoracic esophagectomy.
Background and methods: Between February to July 2018, we evaluated 56 patients underwent thoracic esophagectomy for esophageal cancer. Regional O2 saturation level (rSO%) and total hemoglobin indexes (T-HbI) of gastric conduit was evaluated using the ToccareTM (ASTEM Co. Ltd Tokyo, Japan) to determine the optimal site of anastomosis on gastric conduit.

Results
Fifty-two patients were eligible in this study. Mean value of the rSO2(%)/T-HbI were 57.6%/0.22 at the anal side of the gastric conduit where sufficient feeding arteries were existed from right gastroepiploic artery and vein. On the other hand, mean values of the rSO2(%)/T-HbI were 59.4%/0.28 (p<0.05) at the distal side of the gastric conduit where direct feeding artery from right gastroepiploic vessel was terminated. Then, mean values of rSO2(%)/T-HbI were 46.3%/0.34 (p<0.05) at the tip of the gastric conduit, which consisted to the gradual congestion was happened prior to the tissue oxygenation in the gastric conduit.
There were 1 patient which found anastomotic leakage (1.9%) among 56 patients.

Conclusion
Evaluation of the regional SO2(%) and total hemoglobin index of the gastric conduit was non-invasiveness procedure and useful to easily determine the optimal site of anastomotic level to minimize the incidence of anastomotic leakage in thoracic esophagectomy.