bluuebunny/crossref_metadata_2025_split huggingface dataset:
295 PREDICTION OF MORBIDITY AND MORTALITY AFTER THORACOABDOMINAL ESOPHAGEAL SURGERY
Authors: Nilsson Erik , Olsén Monika Fagervik , Trölle Ulrika , Eriksson Frances , Hermansson Michael 
Published: September 2021

Abstract

Complications after esophageal cancer surgery has been shown to decrease long-term quality-of-life and to increase the risk of postoperative mortality, making patient selection important. The physical strength of the individual patient is likely to affect the patient’s chance of withstanding a major surgical intervention. The aim of this study was to evaluate if validated physical tests can predict the risk of postoperative complications after a thoraco-abdominal esophagectomy.

Methods
All patients who had a thoraco-abdominal esophagectomy at three Swedish university hospitals from 2014–2017 were eligible for inclusion in this prospective study. In addition to a bicycle test, patients were evaluated preoperatively by a physiotherapist using eight validated physical tests. Data on postoperative complications were extracted from the Swedish National Registry for Esophageal and Gastric Cancer. Patients were divided into two groups according to Clavien Dindo (CD) classification of the most severe complication (CD 1–2 and CD 3–5). Tests results were compared between the groups. We also compared performance in each validated test to the risk of specific complications.

Results
A total of 114 patients were enrolled. 26 patients were excluded because of missing data leaving 88 patients for statistical analyses. Total 90-days mortality was 2.3%. Patients who suffered from an anastomotic leak after surgery had a significantly lower performance in the bicycle test. Performance in the preoperative shoulder abduction- and 6-minute-walk tests were significantly lower in patients who suffered from pneumonia or cardiovascular complications. Patients scoring in the lowest quartile in the hand grip-strength test had a higher frequency of complications rated as CD 3–5. No other significant differences could be shown between the CD groups.

Conclusion
In this prospective multicentre study, we found a connection between patient performance on four different preoperative physical tests (bicycle test, shoulder abduction test, 6-minute walk test and hand grip-strength test) and the risk of postoperative complications. We believe that these relatively simple tests can help the surgeon when evaluating the surgical risk for the individual patient.
305 RISK OF GENERALIZATON IN PATIENTS WITH HIGH-RISK EARLY ESOPHAGEAL CANCER: RETROSPECTIVE ANALYSIS OF PROSPECTIVELY COLLECTED DATA INCLUDING LYMPH-NODE MICROMETASTASES ASSESSMENT
Authors: Hugova Kristina , Kollar Marek , Maluskova Jana , Krajciova Jana , Pazdro Alexandr , Harustiak Tomas , Snajdauf Martin , Vackova Zuzana , Spicak Julius , Martinek Jan 
Published: September 2021

Abstract

Esophagectomy is a standard of care for patients with "high-risk" early esophageal cancer (HRC) despite a growing evidence that endoscopic treatment may be a safe alternative. Our aims were 1. to prospectively evaluate the long-term results of endoscopic and surgical treatments in consecutive patients with HRC and 2. to determine the risk of lymph node (LN) metastases and micrometastases in patients with HRC.

Methods
HRC was defined as any cancer with submucosal (sm) invasion or mucosal cancer with at least one of the following: poor differentiation, invasion to blood or lymphatic vessels and high tumor cell dissociation (TCD3). All patients (n = 69) underwent endoscopic resection (ER or ESD) and after the histopathological diagnosis of HRC, patients without contraindications were referred to surgery (n = 30). The remaining patients (n = 39) continued in endoscopic treatment, if necessary. All resected LNs were stained for hematoxylin–eosin to evaluate metastases and immunohistochemistry was used for the detection of micrometastases or isolated tumor cells.

Results
Eighteen patients (26%) had T1a and 51 (74%) had T1b cancer; 51 had adenocarcinoma (AC) and 18 had squamous cell carcinoma (SCC). The median follow-up was 32 months (3–120). No patient with mucosal invasion (15 AC, 3 SCC) experienced LN involvement. Among 17 patients with sm1 invasion, only 2 (12%, both AC)experienced generalization or LN involvement. The further rates of LN involvement were 0% (0/5) in sm2 AC, 50% (3/6) in sm2 SCC, 25% (4/16) in sm3 AC and 29% (2/7) in sm3 SCC. 60% (18/30) of surgically treated patients would have been completely cured by endoscopy (Table 1).

Conclusion
The risk of LN metastases/micrometastases was lower than expected. No patients with high-risk mucosal cancer or low-risk sm1 cancer experienced lymph node involvement. Endoscopic treatment provided long-term remission (or cure) in considerable number of patients and it may represent a valid alternative to surgery in patients with high-risk early esophageal cancer.
311 PATHOLOGIC COMPLETE LYMPH NODE REGRESSION AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Hsu Po-Kuei 
Published: September 2021

Abstract

Pathologic complete lymph node regression, which is defined as lymph nodes with evidence of neoadjuvant treatment effect but without viable residual cancer cells, are sometimes observed following neoadjuvant treatments and has been shown to be prognostic, yet with conflicting results. We aim to study its clinicopathological correlation and prognostic impact.

Methods
Patients who received neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal squamous cell carcinoma (ESCC) in a single institute are retrospectively reviewed. Lymph nodes retrieved at post-nCRT esophagectomy are re-examined by a dedicated pathologist. Patients are classified as (1) lymph node-negative with no evidence of tumor involvement or regression (true negative; plausible cN0, ypN0; group 1); (2) lymph node-negative with evidence of complete regression (e.g. fibrosis; plausible cN+ ypN0; group 2); and (3) lymph node-positive (ypN+; group 3). Kaplan–Meier curve and log-rank test, and cumulative incidence of recurrence (CIR) are used for outcome analysis.

Results
A total of 136 patients, including 73, 25, and 38 in group 1, 2, and 3, respectively, are included. Group 2 is significantly associated with lower risk for lymphovascular invasion (0%, p &lt; 0.001) and perineural invasion (4%, p = 0.038), and higher rate of pathologic complete response in primary tumor (76%, p &lt; 0.001). The 5-year overall survival rates in group 1, 2, and 3 are 42.1%, 52.8%, and 8.0%, respectively. There is no survival difference between group 1 and 2 (p = 0.454). The CIR at 24 months are 46% and 41% in group 1 and 2 (HR: 0.84, 95% CI: 0.432–1.623, p = 0.601, figure 1).

Conclusion
Pathologic complete lymph node regression correlates with treatment response in primary tumor. The outcome of patients with pathologic complete lymph node regression is comparable to that of those with true negative lymph node involvement. Pathologic complete lymph node regression could be a surrogate for chemoradiotherapy sensitivity and regarded as a good prognostic factor in patients with ESCC.
321 RANDOM SURVIVAL FOREST FOR PERSONALISED PROGNOSTICATION AFTER ESOPHAGECTOMY
Authors: Rahman Saqib , Walker Robert , Crosby Tom , Maynard Nicholas , Trudgill Nigel , Cromwell David , Underwood Timothy 
Published: September 2021

Abstract

For patients with esophageal cancer, producing accurate prediction models for long-term survival after esophagectomy has proved challenging. We investigated whether Random Survival Forests (RSF), a machine learning method, could produce an accurate prognostic model for overall survival after esophagectomy.

Methods
The study used data from the 'National Oesophago-Gastric Cancer Audit' (NOGCA) and included patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2012 and 2018 in England and Wales and who underwent a curative esophagectomy with adequate lymphadenectomy (15 lymph nodes) and survived to discharge (n = 6838). Missing data was handled using multiple imputation. 15 variables were selected for inclusion using Random Forest variable importance and used to train the final model. The same variables with non-linearity transformations were used to develop a traditional Cox regression model for comparison.

Results
Median survival was 50 months. The final RSF model had good discrimination on internal validation with a C-index of 0.7627 (0.7625–0.7629), exceeding the cox model 0.7539 (0.7541–0.7537). At 3 years post-surgery, overall survival was 56.2%. The RSF yielded a mean predicted survival of 59.3% (IQR 33.3–87.1%) with good calibration (Figure 1) compared to 57.4% (38.4%–79.8%) for the cox model. The most influential variables were lymph node involvement and pT/ypT stage, however other variables including neoadjuvant treatment completion and surgical complications were also important. Decision curve analysis was undertaken which also showed an increased net benefit with the RSF model.

Conclusion
A Random Forest survival model provided better performance in predicting survival after curative esophagectomy. This will allow more personalised predictions to be delivered clinicians and patients. An online web app is provided at https://uoscancer.shinyapps.io/NOGCA/
335 DIFFERENTIALLY EXPRESSED MICRORNAS AND PREDICTIVE TARGET GENES IN BASALOID SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Nakamura Jiro , Furuya Shinji , Hagio Kotaro , Maruyama Suguru , Shiraishi Kensuke , Shimizu Hiroki , Akaike Hidenori , Hosomura Naohiro , Kawaguchi Yoshihiko , Amemiya Hidetake , Kawaida Hiromichi , Sudo Makoto , Kono Hiroshi , Ichikawa Daisuke 
Published: September 2021

Abstract

Background/Aim: Esophageal cancer is the sixth leading cause of cancer-related deaths worldwide. Esophageal squamous cell carcinoma (ESCC) is considered as one of the most aggressive carcinomas of the gastrointestinal tract. Basaloid squamous cell carcinoma of the esophagus (BSCCE) is reported to have a poorer prognosis compared to conventional ESCC. The current study aimed to elucidate molecular differences between BSCCE and ESCC, using miRNA profiling and predictive target gene searching.

Methods
Materials and Methods: Four BSCCE and 94 ESCC patients who underwent esophagectomy were selected for this study. Cell lines were used for target gene validation. Total RNA samples, extracted from formalin-fixed paraffin-embedded blocks, were used for microarray profiling and validation of the miRNAs, selecting the candidate target genes, and elucidating their clinicopathological features. Furthermore, total RNA samples, extracted from miRNA mimic- and inhibitor-transfected cells in cell line experiments, were used for target gene validation. Both miRNA and mRNA quantifications were performed by quantitative reverse transcription-polymerase chain reaction.

Results
The microarray analysis revealed seven highly expressed miRNAs (miR-205-5p, −4732-5p, −1246, −3687, −3175, −6087, and − 1587) in the BSCCE patients when compared with control. We selected miR-4732-5p and − 3687 for the validation study, and target gene investigations were conducted for miR-3687 ultimately. Several candidates were selected after searching for the target genes via TargetScan and in the literature. Through a pilot and a validation study, progesterone receptor membrane component 2 (PGRMC2) was identified as a target gene. Further investigations revealed that PGRMC2 was associated with tumor size clinicopathologically.

Conclusion
miR-3687 may constitute a candidate marker of aggressiveness in BSCCE, and PGRMC2 is one of its target genes. Moreover, the gene may play a role in cell proliferation and local progression. Although the current study included only a small number of samples, this is the first report regarding differentially expressed miRNAs and predictive target genes in BSCCE patients.
337 MESH REINFORCEMENT OF THE HIATOPLASTY. PROTECTING THE ACHILLES' HEEL
Authors: Brandalise Andre , Lorenzetti Claudia , Aranha Nilton , Brandalise Nelson 
Published: September 2021

Abstract

Disruption of hiatoplasty is one of the main causes of anti reflux surgeries failure. There are some conditions that are associated with higher risks of disruption, leading to hernia recurrence.
Bioabsorbable meshes have a safer profile compared to the permanent ones and we show in this video its use aiming to prevent early and possibly, late recurrence.

Methods
We present a video about different indications for reinforcement of hiatal closure with bioabsorbable mesh.
With the security of bioabsorbable materials and previous experiences with these kind of meshes used in an U configuration, we are suggesting that it can be used as an inverted C over the posterior and anterior sutures placed to close the hiatal defect.
The mesh is cut during the surgery to better accommodate as an onlay protection. It can be fixed to the diaphragm in different ways, but we used fibrin glue in this series.

Results
Sixteen patients were operated with this technique. The long term results are not available at this point, but short term results are very encouraging. We have noticed a slightly higher complaint of dysphagia among these patient compared to what we use to observe in our non-mesh patients, but dilatation was not necessary in any patient.

Conclusion
The use of bioabsorbable mesh in the hiatus is safe and can be used with more frequently to prevent hiatal recurrences in specific groups of patients.

Video
https://www.dropbox.com/s/jsblif0pfjcuicu/BIOMESH.mov?dl=0.
344 THE ROLE OF TRPV2 IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kato Shunji , Shiozaki Atsushi , Fujiwara Hitoshi , Konishi Hirotaka , Kudou Michihiro , Yamazato Yuzo , Katsurahara Keita , Shoda Katsutoshi , Arita Tomohiro , Kosuga Toshiyuki , Komatsu Shuhei , Kubota Takeshi , Okamoto Kazuma , Kishimoto Mitsuo , Konishi Eiichi , Marunaka Yoshinori , Otsuji Eigo 
Published: September 2021

Abstract

Transient receptor potential vanilloid 2 (TRPV2) was recently shown to be involved in migrant potentials. Previous studies reported that TRPV2 was involved in cancer progression, migration, and invasion. The present study aimed to investigate its role in esophageal squamous cell carcinoma (ESCC).

Methods
In human ESCC cell lines, we investigated the role of TPRV2 in ESCC using a cancer function assay with the knockdown of TRPV2 by siRNA, microarray, pathway, and gene ontology analyses. The significance of TRPV2 expression in 62 ESCC samples was then evaluated by immunohistochemical staining.

Results
TRPV2 was overexpressed in TE15 and KYSE170 cells. TRPV2 depletion suppressed cell proliferation, cell cycle progression, and invasion/migration, and induced apoptosis. A pathway analysis of microarray data revealed that TRPV2 depletion down-regulated WNT/β-catenin signaling-related genes and basal cell carcinoma signaling-related genes. The suppression of cancer functions, such as proliferation, invasion, and angiogenesis, by TRPV2 depletion was predicted in the ontology analysis. Immunohistochemical staining revealed a relationship between strong TRPV2 expression and a poor prognosis in ESCC patients.

Conclusion
The present results suggest that TRPV2 regulates tumor progression by affecting WNT/β-catenin or basal cell carcinoma signaling, and that its strong expression is associated with a worse prognosis in ESCC patients. These results provide an insight into the role of TRPV2 as a therapeutic target or biomarker for ESCC.
382 INTRATHORACIC VERSUS CERVICAL ANASTOMOSIS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR OESOPHAGEAL CANCER: A RANDOMIZED CONTROLLED TRIAL (ICAN TRIAL)
Authors: Verstegen Moniek , Workum Frans , Klarenbeek Bastiaan , Bouwense Stefan , Gisbertz Suzanne , Haveman Jan Willem , Heisterkamp Joos , Kouwenhoven Ewout , Lanschot Jan , Nieuwenhuijzen Grard , Peet Donald , Polat Fatih , Ubels Sander , Hannink Gerjon , Rovers Maroeska , Rosman Camiel 
Published: September 2021

Abstract

Robust evidence is lacking whether Ivor Lewis minimally invasive esophagectomy (MIE) or McKeown MIE should be preferred for patients with mid to distal esophageal or gastro-esophageal junction Siewert I-II (GEJ) cancer.

Methods
In this multicenter randomized controlled trial, patients with esophageal (below the level of the carina) or GEJ cancer planned for curative resection were recruited. Eligible patients were randomly assigned (1:1) to either Ivor Lewis MIE or McKeown MIE. The primary endpoint was anastomotic leakage (AL) requiring endoscopic, radiologic or surgical intervention. Secondary outcome parameters were overall AL rate, postoperative complications, length of stay and mortality.

Results
A total of 262 patients were randomly assigned to Ivor Lewis MIE (n = 130) or McKeown MIE (n = 132). Seventeen patients were excluded due to not meeting inclusion criteria (n = 2), physical unfitness for surgery (n = 3), patients’ choice (n = 3), interval metastases (n = 5) or peroperative metastases (n = 4). AL necessitating reintervention occurred in 15 (12.3%) of 122 patients after Ivor Lewis MIE and in 39 (31.7%) of 123 patients after McKeown MIE (RR 0.39, 95%CI 0.22–0.65). Severe complications (Clavien-Dindo ≥3b) were observed in 10.7% after Ivor Lewis MIE and in 22.0% after McKeown MIE (RR 0.49, 95%CI 0.25–0.88).

Conclusion
This study provides evidence for a lower rate of AL requiring reintervention after Ivor Lewis MIE compared to McKeown MIE for patients with mid to distal esophageal or GEJ cancer.
388 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: FACTORS ASSOCIATED WITH ANASTOMOTIC LEAKAGE SEVERITY
Authors: Ubels Sander , Verstegen Moniek , Bouwense Stefan , Hannink Gerjon , Siersema Peter , Klarenbeek Bastiaan , Workum Frans , Rosman Camiel 
Published: September 2021

Abstract

Anastomotic leakage is a common and severe complication after esophagectomy. It is largely unknown which characteristics contribute to leakage severity. We aimed to investigate which factors are associated with leakage severity and to create an anastomotic leakage severity classification.

Methods
The TENTACLE—Esophagus is a multinational retrospective cohort study in which patients with anastomotic leakage after esophagectomy in the period 2011-2019 were included. Detailed data regarding casemix (e.g. age, sex, physical condition, comorbidity, tumor characteristics), surgical procedure (e.g. McKeown, Ivor Lewis, Orringer, anastomotic technique, omental wrap, pleural flap), leakage characteristics (e.g. contamination, drainage at leakage diagnosis, leak circumference) and treatment were collected. The primary outcome is 90-day mortality. Regression analysis will be used to analyze which leakage characteristics are associated with 90-day mortality and to compose an evidence-based anastomotic leakage severity score. The study protocol is accessible at www.tentaclestudy.com.

Results
Detailed data of 1407 patients with anastomotic leakage from 70 centers in 20 countries were collected. Anastomotic leakage occurred 0-43 days after surgery and 90-day mortality rate was 11.1%. The TENTACLE—Esophagus study data is currently being validated and it is awaiting full analysis. The results and the evidence based anastomotic leakage severity classification system will be ready for presentation at the ISDE meeting.

Conclusion
This is the largest study that investigates which factors contribute to anastomotic leakage severity after esophagectomy. The evidence-based anastomotic leakage severity classification system can be used by clinicians to grade severity of a given leak and might aid clinicians in choosing the most appropriate treatment.
400 OUTCOME OF PATIENTS THAT DO NOT UNDERGO RESECTION AFTER NEOADJUVANT TREATMENT FOR CANCER OF THE ESOPHAGUS.
Authors: Cutforth Iona , Brown Joshua , Chmelo Jakub , Navidi Maziar , Wahed Shajahan , Immanuel Arul , Phillips Alex W 
Published: September 2021

Abstract

Patients with locally advanced esophageal cancer usually receive neoadjuvant treatment prior to surgery. A proportion of patients will not receive their surgery due to disease progression. Little is known about what happens to these patients and their prognosis. The aim of this study was to evaluate outcomes in patients that have received neoadjuvant treatment but not undergone esophagectomy.

Methods
A review of a contemporaneously maintained database of all patients that underwent neoadjuvant treatment for esophageal adenocarcinoma, or squamous cell carcinoma (SCC) but did not have a subsequent esophagectomy was carried out. Patients that were diagnosed with cancer between January 2009 and December 2018 were included. All patients underwent a standardised staging protocol, and were restaged on completion of their neoadjuvant treatment. Overall survival from the date of their initial staging CT and any subsequent treatments were recorded.

Results
Over the time period 927 patients received neoadjuvant treatment, and 107 did not progress to surgery. Of the 107, 106 received neoadjuvant chemotherapy and one chemoradiotherapy. 83 of the 107 were adenocarcinoma and 24 SCC. The median age of patients who had surgery was 66 compared to 67 for those that did not.
Overall median survival for patients not having surgery was 328.5 days. 40 patients had subsequent oncological treatments. Median survival for patients who received no further treatment was 264 days, palliative chemotherapy 412 days palliative radiotherapy 418.5 days and any combination of the two was 390.5 days.

Conclusion
These results show median survival after disease progression during neoadjuvant treatment was over 10 months and this was extended with further oncological treatment with radiotherapy prolonging survival times the most to over 13 months. This information can help when counselling patients to potential treatment options.
469 ASSESSMENT OF PERFUSION OF GASTRIC CONDUIT AND PROXIMAL ESOPHAGEAL STUMP BY INDOCYANINE GREEN FLUORESCENCE IMAGING IN PATIENTS UNDERGOING ESOPHAGECTOMY
Authors: Thammineedi Subramanyeshwar Rao 
Published: September 2021

Abstract

Post esophagectomy anastomotic leakage and stricture are crucial factors in determining morbidity and mortality. Good vascularity of the gastric conduit is essential to avoid this complications. This prospective study assesses the utility of intraoperative indocyanine green (ICG) fluorescence imaging to determine gastric conduit vascularity in patients undergoing esophagectomy.

Methods
Thirteen consecutive patients who were undergoing esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from August 2019 to September 2019, were included. Three patients underwent laparoscopic-assisted transhiatal esophagectomy, ten thoraco-laparoscopic assisted esophagectomy. Reconstruction was done by gastric pull up via posterior mediastinal route. Vascularity of gastric conduit was assessed by the near-infrared camera using ICG.

Results
On visual assessment of perfusion at the tip of gastric conduit, it was dusky in 11 patients, pink in two. Fuorescence imaging showed inadequate perfusion at the tip of conduit in 12 patients, needing revision. In one patient visual inspection showed adequate perfusion, but ICG disclosed poor vascularity requiring revision of the conduit’s tip. Resection of the devitalized portion of the proximal esophageal stump was needed in 5 patients both by visual and ICG assessment. The median time to appearance of blush from the time of injection of dye was 15 seconds (10 to 23 seconds).

Conclusion
Visual inspection of the gastric conduit vascularity can underestimate perfusion and hence can compromise resection of the devitalized part. ICG fluorescence imaging is more objective and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. It could complement the visual inspection to decide the site of anastomosis.