bluuebunny/crossref_metadata_2025_split huggingface dataset:
697 ESOPHAGECTOMY ANASTOMOTIC LEAKS DECREASE LONG TERM SURVIVAL AFTER SURGERY FOR ESOPHAGEAL CANCER: MOVING FROM RESCUE TO PREVENTION.
Authors: Cheang Catherine , Patil Pradeep 
Published: September 2021

Abstract

Multimodal therapy including esophagectomy is the standard of care for esophageal cancer with a view to achieve long-term survival. Leaks from esophageal anastomoses are associated with major short-term morbidity and mortality. The aim of this study was to analyse our anastomotic leaks following esophagectomy for cancer, their effect on short-term mortality and any effect on long term survival.

Methods
All patients undergoing esophagectomy for esophageal cancer over 10 years from 2011 to 2020 in our centre were selected for this study from a prospectively maintained database. Patients with leaks were identified by reviewing their case records, electronic records, endoscopy and radiological results. All leaks including non-clinical radiological leaks were included in the study. Overall survival was calculated from date of surgery to death or otherwise censored. Statistical analysis was carried out using SPSS.

Results
104 consecutive patients were identified of whom 10 patients (9.6%) had anastomotic leaks. 8 of these patients (80%) were rescued and were well enough to be discharged home. The median survival of patients with leaks was 11.6 months compared to 52.9 months for patients without leaks. The 3-year survival was 30% in patients with leaks compared to 59.9% (p = 0.23, Fisher’s exact) in patients without leaks. The Kaplan Meier survival analysis curves are shown here and the difference in survival was very close to being statistically significant with p = 0.089 (Log Rank) and p = 0.056 (Breslow).

Conclusion
Esophageal anastomotic leak rates are still exceedingly high at 10%. The rescue rate of 80% is significantly better compared to previous decades. Despite the high rescue rate, these patients have extremely poor long-term survival rates. The future should aim for innovative technology and strategies to eliminate esophageal anastomotic leaks for optimal short- and long-term outcomes.
721 DOES AGE AFFECT OESOPHAGECTOMY SURVIVAL: A COHORT STUDY
Authors: Park Jin-soo , Van der Wall Hans , Falk Gregory 
Published: September 2021

Abstract

Oesophagectomy is the mainstay in the curative management of oesophageal cancer. Curative surgery is associated with considerable morbidity and potential mortality. Surgeons are increasingly treating older patients presenting with oesophageal cancer as the population ages. This study aimed to assess the effect of age on short term surgical outcomes, mortality, as well as overall and disease-free survival, in patients undergoing curative oesophagectomy for cancer.

Methods
Patient data were analysed from a prospectively maintained database. Demographic, surgical, and survival outcomes were compared between groups according to age less than 75 years or 75 and older.

Results
Oesophagectomy was performed in 351 patients between 1990 and 2019 (283 patients &lt;75 years, 68 patients ≥75 years). There was a higher rate of neoadjuvant chemotherapy in the &lt;75 year old group than the ≥75 group (37.7% vs. 7.4%; p &lt; 0.001); the two groups were otherwise similar. The 30-day mortality between younger and older groups was similar (2.5% and 2.9%; p = 0.827). There was no statistically significant difference in 5-year survival rates between groups (50.3% vs. 38.6%; p = 0.063), or median survival (22.6 vs. 19.3 months; p = 0.053). There was no difference in 5-year disease-free survival (45.1% and 35.7%; p = 0.158).

Conclusion
Overall survival, disease-free survival, and 30-day mortality rates in patients 75 years old and older were similar to their younger counterparts. Based on these results, older patients should not be precluded from consideration of potentially curative oesophagectomy on age alone, providing surgery may be performed at reasonable risk.
722 SAFE (SUPERCHARGED CERVICAL ANASTOMOSIS FOR ESOPHAGECTOMY AND GASTRIC PULL-UP) PROCEDURE: LONG TERM RESULTS FROM 61 PATIENTS
Authors: Takeda F , Tutihashi R , Aissar Sallum R , Busnardo F , Ribeiro U , Cecconello I , Nahas S 
Published: September 2021

Abstract

Esophagectomy still represents a challenge surgical procedure. Anastomotic leakage is the most feared complication and is likely related to diminished anastomotic perfusion. ‘Supercharged’ microvascular anastomosis has been performed in select patients to supplement the blood supply to the graft and anastomosis, after esophagectomy. This study aimed to evaluate results after performing the supercharged cervical anastomosis for esophagectomy procedure.

Methods
This prospective cohort study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were selected in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas were evaluated using indocyanine and SPY before and after supercharged cervical anastomosis for esophagectomy. Post esophagectomy complications were also recorded.

Results
The study enrolled 61 patients, which included 47 (77.0%) men, with a mean age of 67.3 years. Median additional surgical time was 112 min (IQ 90–180), Leakage occurred in 1.6% of the patients (microanastomosis thrombosis), whereas the corresponding anastomotic stricture rates were 3.2% (mean follow-up was 25 mounths). Perfusion analyses showed a 28% improvement in the anastomotic area after venous anastomosis and a 37% improvement after arterial and venous anastomosis.

Conclusion
The supercharged cervical anastomosis for esophagectomy procedure may be related to low occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.
729 RELATION OF POSTOPERATIVE MORBIDITY WITH QUALITY OF LIFE FOLLOWING ESOPHAGEAL SURGERY FOR CANCER: A EUROPEAN MULTICENTER STUDY
Authors: Schuring Nannet , Markar Sheraz R , Jezerskyte Egle , Sprangers Mirjam A G , Johar Asif , Berge Henegouwen Mark I , Gisbertz Suzanne S 
Published: September 2021

Abstract

Despite improvements in perioperative esophageal cancer care, severe postoperative complications occur in 17.2% of the patients. Postoperative complications are associated with reduced health-related quality of life (HR-QoL), and severe complications may have a profound negative effect on the HR-QoL.The aim of this study was to investigate the relation between postoperative morbidity and reported HR-QoL in patients following esophagectomy for cancer.

Methods
Disease-free patients at least one year following esophagectomy for cancer in one of the participating LASER study centers between 2010 and 2016 were included. Patients completed the LASER, EORTC-QLQ-C30 and QLQ-OG25 questionnaires at least one year following surgery. The primary outcome was the relation between reported HR-QoL and occurrence of postoperative complications and to compare the HR-QoL in the study population with the reference values of the general population. Subgroup analysis was performed in patients with ‘no’ or ‘minor’ (Clavien-Dindo grade I-IIIa) and ‘severe’ (Clavien-Dindo grade ≥ IIIb) complications, using univariable and multivariable logistic regression analysis.

Results
Among 645 included patients, 283 patients with ‘no’, 207 patients with ‘minor’ and 155 patients with ‘severe’ postoperative complications were included. The mean age of the patients was 64 years (SD 9), with a mean time since surgery of 4.4 years (SD 1.7). Neither significant or clinically relevant differences were found in the HR-QoL scores between patients with and without complications, nor were differences observed in subgroup analysis for severity of postoperative complications. Compared to the general population, patients reported worse HR-QoL in all domains except ‘Global Health’ and ‘Emotional Functioning’, and more symptomatology in all symptom domains except ‘Pain'.

Conclusion
HR-QoL between patients at a median of 4.4 years after esophagectomy for cancer did not differ. Differences were neither significant nor clinically relevant and furthermore, no differences were observed in subgroup analysis for severity of postoperative complications according to Clavien-Dindo.
74 LAPAROSCOPIC MANAGEMENT OF A PULSION EPIPHRENIC OESOPHAGEAL DIVERTICULUM SECONDARY TO ACHALASIA.
Authors: Tan Jeremy , Yeung Baldwin , Ong Lester , Toh Bin Chet , Wong Wai Keong , Lim Chin Hong 
Published: September 2021

Abstract

This is a video submission of a laparoscopic resection of an epiphrenic oesophageal pulsion diverticulum secondary to achalasia. A Heller’s cardiomyotomy is also performed together with a Toupet fundoplication.

Methods
The patient is a 40 year old woman with a 12 month history of worsening dysphagia, reflux symptoms, as well as occasional regurgitation of food, worse at night. Barium swallow showed a distal oesophageal diverticulum and oesophageal manometry confirmed type 1 achalasia. Upper GI endoscopy showed no other intra-luminal findings.

Results
The patient underwent a laparoscopic resection of the diverticulum, together with a Heller’s cardiomyotomy and Toupet fundoplication. There were no post-operative complications. She remains well and asymptomatic at 9 month follow-up.

Conclusion
Pulsion diverticula secondary to achalasia are a known but rare entity. A few variations exist on how to manage this condition surgically, especially with respect to the type of fundoplication. We present our preferred technique for dealing with this condition.

Video
https://www.dropbox.com/s/dg4edkamykugupn/Oesophagealdivert.mp4?dl=0
740 CAMRELIZUMAB IN COMBINATION WITH PREOPERATIVE CHEMOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A SINGLE-ARM, OPEN-LABEL, PHASE II STUDY
Authors: Wang Feng , Qi Yu , Meng Xiangrui , Fan Qingxia 
Published: September 2021

Abstract

At present, ESCC has a dismal prognosis with huge unmet clinical needs. With the potential benefit of combining PD-1 inhibitor with nCT, we conducted a phase II trial to assess the efficacy and safety of Camrelizumab plus nCT for locally advanced ESCC.

Methods
45 patients (pts) with histologically confirmed stage II/III/IVa(cT2-4aN0-3 M0) ESCC were enrolled from February 2020 to March 2021.The study was divided into two stages, stage1: we administered 1 cycle of Camrelizumab for induction therapy (200 mg q2 weeks); stage2: pts received 2 cycle of Camrelizumab (200 mg every 3 weeks) plus docetaxel and nedaplatin, followed by surgery within 4 ~ 6 weeks after neoadjuvant therapy completion. Primary endpoint was major pathologic response (MPR). Secondary endpoints included pathologic complete response (pCR), R0 resection rate, disease-free survival (DFS) and overall survival (OS).

Results
At the cutoff date of Mar 9, 2021, 45 eligible pts were enrolled, neoadjuvant treatment was completed in 39 pts. Thus far 32 pts were resected, all patients underwent an R0 resection. Postoperative pathology showed that TNM stage decreased in 28 pts with 87.5% reduction rate. 19 pts (59.38%) reached major pathologic response, 9 pts (28.13%) reached pathologic complete response (no surgery related mortality). A total of 75.56% had AEs with 13.33% of grade ≥ 3 AEs. Date for median DFS and OS were not matured.

Conclusion
Camrelizumab in combination with preoperative chemotherapy followed by surgery for locally advanced ESCC showed promising downstaging effect and MPR with good tolerance, and its efficacy and safety could be further studied in later trials. Clinical trial information: NCT03917966.
743 SIEWERT TYPE II GASTRIC CARDIA CANCER: ANALYSIS OF THE RESULTS OF DIFFERENT SURGICAL OPTIONS
Authors: Navío-Seller Ana , Abelló-Audí David , Navasquillo-Tamarit Mireia , De Jesús-Acosta Milton Emmanuel , Bruna-Esteban Marcos , Vaqué-Urbaneja Javier , Mingol-Navarro Fernando , García-Granero-Ximénez Eduardo 
Published: September 2021

Abstract

The management of gastric cardia tumors should be carried out from a multidisciplinary approach, there is currently a clear controversy regarding the most appropriate surgical approach to use in type II tumors. Depending on their topographic anatomical characteristics based on the degree of gastric invasion and esophageal, the surgical technique may change: esophagectomy, gastrectomy with distal esophagectomy, or total esophageal gastrectomy.

Methods
Retrospective and analytical study of patients diagnosed with type II gastric cardia adenocarcinoma (based on the results of the pathological study of the resection specimen) who underwent surgical treatment in our center from June 2012 to June 2020. Different preoperative parameters, the surgical techniques used and the results obtained were analyzed.

Results
25 patients were studied, 84% male. 60% were locally advanced tumors with 56% affected nodes. 12 Ivor-Lewis esophagectomies, 5 esophagogastrectomies with coloplasty, and 5 extended total gastrectomies were performed. There was no resection proximal or distal margin involvement, but circumferential margin was affected in 60% of cases of extended gastrectomy and in 1 case of Ivor-Lewis esophagectomy. Median number of lymph nodes removed was 22(5–37) and 2(0–12) affected, being higher in total esophagogastrectomy. Postoperative morbidity was 40% and 90-day mortality 4% (1 case). The mean follow-up was 37 months, noting recurrence in 9 cases (36%), with disease-free survival of 44%.

Conclusion
The surgical treatment approach in type II gastric tumors is controversial, and there are multiple options to consider. According to the results of this study, the Ivor-Lewis esophagectomy shows to be a safe approach with satisfactory oncological results in tumors that do not require a total esophagogastrectomy.
745 YIELD OF EXTENDED AND TOTAL MEDIASTINAL LYMPHADENECTOMY IN OESOPHAGEAL CANCER
Authors: Abelló David , Aguilar Karen Stephanie , Navío Ana , Avelino Lourdes , Cholewa Hanna , Mingol Fernando , Bruna Marcos , Vaqué Javier , García-Granero Eduardo 
Published: September 2021

Abstract

The extent of lymphadenectomy in oesophageal cancer surgery is currently controversial, although current evidence shows that survival is directly related to the number of lymph nodes removed during surgery.

Methods
Descriptive study of patients with oesophageal cancer who underwent oesophagectomy with extended and total mediastinal lymphadenectomy using a minimally invasive approach (right prone thoracoscopy, laparoscopy and left cervicotomy) in our hospital for 2 years (2019 and 2020). Extended lymphadenectomy was indicated in patients with adenocarcinoma of the distal oesophagus, while total lymphadenectomy was indicated in patients with squamous tumours and adenocarcinoma of the middle oesophagus. The characteristics of the series studied and the results obtained in the 90 days postoperatively are described.

Results
26 patients, mean age 65 ± 7.8 years, were operated. 21 with total mediastinal lymphadenectomy and 5 with extended lymphadenectomy. 80.7% received neoadjuvant treatment (CROSS scheme). The mean number of lymph nodes removed was 33.6 ± 14.3, with a 50% probability of being affected. As much in the lymphadenectomy of the right (106R) as in the left (106 L) recurrent groups, it was more frequently affected in the distal oesophagus adenocarcinomas. Postoperative morbidity was not negligible, with anastomotic leak rate of 7.7% (thoracic location) and 23.1% (cervical location) the majority mild, 23.1% of recurrent injury and 11.5% of chylothorax. Mortality at 90 days was 15.38%.

Conclusion
Based on our results, extended and total lymphadenectomy increases as much the global number of lymph nodes removed as the lymph nodes cancer-positive. In addition, it supports the performance of wide lymphadenectomies also in adenocarcinomas of the distal oesophagus. We cannot forget the greater radicalism is taxed with significant morbidity. We should remember the limitation of this study is the low number of cases, the extent of lymphadenectomy continues to be a matter of controversy.
757 AN APPROACH TO ACCELERATE HEALING AND SHORTEN THE HOSPITAL STAY OF PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY
Authors: Luo KongJia , Luo KongJia , Zhong JiuDi , Tan ZiHui , Wei YiTong , Su XiaoDong , Wen ZheSheng , Rong TieHua , Hu Yi 
Published: September 2021

Abstract

To explore the comprehensive role of systemic endoscopic intervention in healing esophageal anastomotic leak. To our knowledge, this paper is the first to discuss the outcome of anastomotic leaks and the association with healing time rather than whether the leak was fully healed.

Methods
In total, 3919 consecutive patients with esophageal cancer who underwent esophagectomy and immediate esophageal reconstruction between January 2012 and August 2019 at Sun Yat-Sen University Cancer Center were screened. In total, 203 patients (5.10%) diagnosed with postoperative anastomotic leakage were included. The participants were divided into three groups according to differences in diagnosis and treatment procedures. Ninety-four patients received conventional management, 87 patients received endoscopic diagnosis only, and the remaining 22 patients received systematic endoscopic intervention, including transnasal inner drainage, endoscopic fibrin glue repair and endoscopic clipping. The primary endpoint was overall healing of the leak after oncologic esophageal surgery.

Results
In total, 173 (85.2%; 95% CI, 80.3–90.1%) of the 203 patients were successfully healed, with a mean healing time of 64.42 ± 3.82 days (median: 51 days; range: 13 368 days), and the overall healing rates differed significantly among the three groups according to the stratified log-rank test (P &lt; 0.001). The median healing time of leakage was 44 days (95% CI: 27.15–60.86 days) in the endoscopic intervention group, 51 days (95% CI: 44.86–57.14 days) in the endoscopic diagnostic group, and 66 days (95% CI: 58.09–73.91 days) in the conventional group.

Conclusion
Tailored endoscopic treatment for postoperative esophageal anastomotic leakage based on endoscopic diagnosis is feasible and effective. Systematic endoscopic intervention shortened the treatment period and reduced mortality and should therefore be considered in the management of this disease.
779 USE OF INDOCYANINE GREEN TO ASSESS THE CORRECT VASCULARIZATION OF GASTROPLASTY IN MCKWEON ESOPHAGECTOMY
Authors: González Lourdes Avelino , Tamarit Mireia Navasquillo , Audí David Abelló , Cholewa Hanna , Esteban Marcos Bruna , Navarro Fernando Mingol , Urbaneja Javier Vaqué 
Published: September 2021

Abstract

Cervical anastomostic leakage in esophageal surgery is one of the most serious complications and its incidence is 10–30% according to series. ndocyanine green is being used in multitude of surgical procedures in colorectal and hepatobiliary surgery. In this video we try to prove its usefulness to assess the adequate vascularization of the gastroplasty with the aim of reducing anastomotic leak due to not-well perfusion.

Methods
A left lateral cervicotomy was performed and proximal esophagus was divided. Then a handsewn purse-string suture was performed and the anvil of CEA 25 stapler was introduced into the esophagus. Gastroplasty was performed with endoGIA section by minilaparotomy. An intravenous infussion of Indocyanine green was used to assess the vascularization "in situ" of the gastroplasty. The gastroplasty was pull up through the retrosternal space and when the plasty was positioned in a correct way, the optimal site for the anastomosis was chosen. Mechanical T-L anastomosis with CEA 25 stapler was performed and it was covered with an omental flap.

Video
https://drive.google.com/file/d/1kqmNzJCdlJFOcxKBYRp0jamoHz6Gwgt7/view?usp=sharing.
794 DOES TRACHEOSTOMY PREDISPOSE GASTROESOPHAGEAL REFLUX?
Authors: Bianchi Edno Tales , Tustumi Francisco , Szachnowicz Sergio , Nasi Ary , Lopes Leticia Nobre , Duarte Andre Fonseca , Seguro Francisco Carlos Bernal Costa , Cardoso Paulo Francisco Guerreiro , Sallum Rubens Antonio Aissar , Cecconello Ivan , Nahas Sergio Carlos 
Published: September 2021

Abstract

Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux in patients with tracheostomy and describe its characteristics.

Methods
Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.

Results
Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the body mass index was 26.3 ± 4.85. The prevalence of gastroesophageal reflux was 45.2%. Baseline characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in only 31% of the patients and was not correlated with reflux between the groups (p = 0.285). Regarding the symptoms, 48% had heartburn symptoms and only 30% had a combination of typical symptoms (heartburn + regurgitation).

Conclusion
The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.
800 ASSOCIATION OF MULTIPLE RAPID SWALLOW PARAMETERS WITH SYMPTOMS IN PATIENTS WITH INEFFECTIVE AND NORMAL ESOPHAGEAL MOTILITY
Authors: Razia Deepika , Razia Deepika , Mittal Sumeet K 
Published: September 2021

Abstract

Multiple rapid swallows (MRS) is a provocative test to assess inhibitory swallowing mechanisms and esophageal peristaltic reserve. MRS response has been purposed to predict post-fundoplication dysphagia and has been associated with increased acid exposure time. Recently it was added to the Chicago classification v 4.0 protocol as an adjunctive test. This study aimed to understand the association of MRS parameters with symptoms in patients within ineffective (IEM) or normal esophageal motility (NEM).

Methods
After IRB approval, a prospectively maintained esophageal motility database was retrospectively reviewed to identify patients with IEM and NEM who also had an MRS evaluation. Patients with previous gastroesophageal surgery, manometric hiatal hernia, or a diagnosed motility disorder (except IEM) were excluded. Patient-reported symptoms (0–4) (heartburn, regurgitation, dysphagia, and chest pain) were grouped by score: 0, 1–2, or 3–4. We compared the prevalence of normal or abnormal MRS and individual MRS parameters (distal contractile integral [DCI], integrated relaxation pressure, distal latency, adequate inhibition, and post-MRS DCI/mean single swallow DCI ratio) with patient-reported symptoms.

Results
From 2019–2020, a total of 531 patients (254 = IEM, 277 = NEM) met the inclusion criteria and formed the study cohort. The presence of normal or abnormal MRS results was not associated with any patient-reported symptom in either the NEM or IEM group. Furthermore, patient-reported symptoms were not associated with individual MRS parameters in either group.

Conclusion
In patients with IEM and NEM, adjunct assessment with MRS does not correlate with patient-reported symptoms. Further studies are needed to assess the role of MRS as an adjunctive test during routine manometry.