bluuebunny/crossref_metadata_2025_split huggingface dataset:
476 ICG FLUORESCENCE IN IDENTIFICATION OF THORACIC DUCT
Authors: Thammineedi Subramanyeshwar Rao 
Published: September 2021

Abstract

Not applicable because it is a Video presentation.

Methods
Not applicable because it is a Video presentation.

Results
Not applicable because it is a Video presentation.

Conclusion
Not applicable because it is a Video presentation.

Video
Video shows visualisation of thoracic duct during esophagectomy by real-time fluorescent imaging. Intraoperative fluorescence lymphangiography was performed by injecting 2.5 mg of ICG into small bowel mesentery at Laparoscopy.At Thoracoscopy, Thoracic duct was visualised after 65 minutes. ICG fluorescence lymphangiography provides a feasible, reliable and real-time imaging of thoracic duct during esophagectomy, thereby potentially reducing thoracic duct injuries. https://drive.google.com/open?id=1ROGQ1K-yWkO-B3oSk8dGbsRu4iCKGfJq.
551 INCREASED POSTOPERATIVE MORBIDITY AFTER TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN ELDERLY PATIENTS
Authors: Baranov Nikolaj , Baranov Nikolaj , Van Workum Frans , Rosman Camiel 
Published: September 2021

Abstract

The incidence of elderly patients with esophageal cancer is increasing. The aim of this study is to compare postoperative outcomes after esophagectomy between elderly patients and younger patients and to compare outcomes after totally minimally invasive esophagectomy (TMIE) and open esophagectomy (OE) in these age groups.

Methods
Data was retrieved from the Dutch Upper Gastrointestinal Cancer Audit (DUCA), a national surgical outcome registry. The primary outcome parameter was severe complications, defined as Clavien Dindo ≥3. Secondary outcome parameters were postoperative complications, reintervention rate, length of hospital stay and mortality. Outcome parameters were compared between patients aged ≥75 years and &lt; 75 years and between TMIE and OE in these age groups. We adjusted for the following casemix parameters: gender, Charlson Co-morbidity Index score ASA score and neoadjuvant therapy. A sensitivity analysis was performed with different age groups: &lt;65, 65–69, 70–74, 75–79 and ≥ 80 years.

Results
Of all 5539 included patients 14.0% were aged ≥75 years and 86.0% were aged &lt;75 years. Severe complications were observed more frequently in the elderly group compared to the younger group (RR = 1.15 [1.04–1.27], p = 0.007). Interestingly, there was an increased risk of severe complications after TMIE in both the elderly group (RR = 1.50 [1.19–1.90], p = 0.001) and the younger group (RR = 1.41 [1.28–1.56], p &lt; 0.001). No difference in mortality between TMIE and OE was found. Sensitivity analyses of TMIE compared to OE across all age groups showed increased risk of severe complications. Adjustment for casemix for all analysis did not change the results.

Conclusion
Severe complications after esophagectomy occur more frequently in elderly compared to younger patients. TMIE in elderly patients did not result in less morbidity and was in fact associated with more severe complications compared to OE across all age groups, which may be due to a learning curve effect.
563 VARIATION IN TREATMENT PATTERNS AND OUTCOMES FOR RESECTED ESOPHAGEAL CANCER AT DESIGNATED THORACIC SURGERY CENTERS
Authors: Gupta Vaibhav , Levy Jordan , Kidane Biniam , Mahar Alyson , Ringash Jolie , Sutradhar Rinku , Darling Gail , Coburn Natalie 
Published: September 2021

Abstract

Ontario defined designated thoracic surgery centres to provide high-volume care for patients undergoing esophageal cancer resection. The objective of this study was to compare thoracic centres’ performance to non-thoracic centres, and to assess variation in treatment patterns and outcomes across thoracic centres.

Methods
A retrospective cohort study (2002–2014) was conducted in Ontario, Canada (population 13.6 million), examining adults with resected esophageal cancer. Case mix, use of neoadjuvant therapy, surgical outcomes (lymph node yield and positive margin rates) and survival were described across the 15 thoracic centres. Multivariable regression was used to estimate the effect of having surgery at designated thoracic centres on postoperative (in-hospital & 90-day post-discharge) mortality and overall survival, adjusting for case mix.

Results
Of 3,880 patients meeting study criteria, 2,213 had pathology data available and were included in the analysis. Average age was 64 years, 85.7% had adenocarcinoma, 50.2% were pT3, and 38.4% were pN0. Patients at thoracic centres (82.6%) received more neoadjuvant therapy, but there was no difference in positive margin rates, lymph node harvest, postoperative mortality and overall survival between thoracic and non-thoracic centres. Across thoracic centres, rates of neoadjuvant therapy varied from 16.4–81.6%, positive margin rates varied from 8.2–29.6%, median lymph node harvest varied from 7–20 nodes, postoperative mortality varied from 0–18.7%, and median survival varied from 17–26 months.

Conclusion
There was significant variability in treatment patterns, surgical outcomes, and survival among patients treated at designated thoracic centres. Feedback of patient outcomes to surgeons and hospitals, and translating best practices from high-performing hospitals to other hospitals, is the next step in improving outcomes.
616 MULTIMODAL TREATMENT OF LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A NETWORK META-ANALYSIS
Authors: Jin Zixian , Chen Dong , Chen Meng , Ren Sijia , Wang Chunguo , Zhang Bo , Zhang Jian , Zhu Hongyu , Xue Fenglai , Wu Sikai , Zhu Chengchu , Shen Jianfei 
Published: September 2021

Abstract

The best treatment for the esophageal squamous cell carcinoma has not been determined. To determine the most effective and safest treatment mode for locally advanced resectable esophageal squamous cell carcinoma through a network meta-analysis.

Methods
A Bayesian model was used for a network meta-analysis comparing the efficacy and safety of surgery alone, neoadjuvant therapy, and adjuvant therapy.

Results
Overall survival rate: Adjuvant chemoradiotherapy and neoadjuvant chemoradiotherapy were significantly advantageous over surgery alone [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.57–0.93; HR 0.75, 95%CI 0.65–0.86]. Adjuvant chemotherapy may not be as effective as surgery alone [HR 1.08, 95%CI 0.84–1.39], although there was no statistical difference. There was no statistically significant difference between adjuvant chemoradiotherapy and neoadjuvant chemoradiotherapy. Disease-free survival rate: Compared with surgery alone, neoadjuvant chemoradiotherapy had significant benefits [HR 0.65, 95%CI 0.53–0.78]; adjuvant chemoradiotherapy had similar, but not significant, benefits [HR 0.7, 0.95%CI 0.45–1.06]. The difference between neoadjuvant chemoradiotherapy and adjuvant chemoradiotherapy was also not statistically significant.

Conclusion
Both neoadjuvant chemoradiotherapy and adjuvant chemoradiotherapy appear to be the best supplements to surgery for locally advanced resectable esophageal squamous cell carcinoma.
618 STUDY ON THE RELATIONSHIP BETWEEN GASTROESOPHAGEAL REFLUX SYMPTOMS AND ESOPHAGEAL MICROBIOTA
Authors: Chen Songfeng , Zhang Mengyu , Zhuang Qianjun , Xiao Yinglian 
Published: September 2021

Abstract

The occurrence of gastroesophageal reflux symptoms is related to the changes of esophageal mucosal sensitivity and esophageal motility. Studies have found that changes in gut microbiota can cause lower digestive tract symptoms by changing intestinal sensitivity and intestinal motility. The current study aimed to explore whether changes of esophageal microbiota can cause gastroesophageal reflux symptoms by altering esophageal sensitivity and esophageal motility.

Methods
Patients who were admitted to our hospital due to heartburn and reflux symptoms were prospectively included. Ten healthy volunteers and 10 patients with duodenal ulcer were included as controls. Both patients’ and healthy volunteers’ distal esophagus mucosal tissues and gastric fluid were collected under endoscopy for extraction of bacterial DNA. Patients and volunteers were divided into different groups according to disease situations, esophageal motility status, proton pump inhibitor (PPI) treatment efficacy. The α-diversity, β-diversity and specific composition of the microbiota among different groups were compared.

Results
A total of 12 patients with gastroesophageal reflux disease (G), 16 patients with functional esophageal disorder (F), 10 healthy volunteers (H), and 10 duodenal ulcer patients (D) were included. Esophageal mucosal microbiota analysis revealed that the microbiota composition was similar in patients with gastroesophageal reflux disease and functional esophageal disorders, which significantly different from that in healthy volunteers and patients with duodenal ulcers. Both gastroesophageal reflux disease patients and functional esophageal disorder patients had higher proportion of Pseudomonas than healthy controls and duodenal ulcer patients (G vs. F vs. H vs. D = 25.5% vs. 41.9% vs. 0.2% vs. 1.2%；P = 0.041).

Conclusion
The microbiota composition of patients with gastroesophageal reflux disease and patients with functional esophageal disorder were similar and were both significantly different from that of healthy volunteers and patients with duodenal ulcer. The increased proportion of Gram-negative bacteria such as Pseudomonas may play an important role in the occurrence of gastroesophageal reflux symptoms.
626 ENDOSCOPIC VACUUM THERAPY FOR ANASTOMOTIC LEAK IN ESOPHAGECTOMY AND TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Tavares Guilherme , Tustumi Francisco , Tristão Luca Schiliró , Serafim Maria Carolina Andrade , Orlandini Marina Feliciano , Datrino Letícia Nogueira , Santos Clara Lucato , Bernardo Wanderley Marques 
Published: September 2021

Abstract

One of the main complications related to esophagogastric surgery, due to esophageal and gastric cancer, is the anastomotic leak. The placement of endoluminal stents is the most frequent endoscopic therapy in these cases. However, since its introduction, endoscopic vacuum therapy has been shown to be a promising alternative. This study primarily aims to evaluate the efficacy and safety of endoscopic vacuum therapy for the treatment of anastomotic leak in esophagectomy and total gastrectomy.

Methods
A systematic review and meta-analysis was performed. Studies that evaluated the use of endoscopic vacuum therapy for anastomotic leak in esophagectomy and total gastrectomy were included.

Results
Twenty-three articles were included. A total of 559 patients were evaluated. Endoscopic vacuum therapy showed a fistulous orifice closure rate of 81.6% (rate: 0.816; 95% CI: 0.777–0.864) and, when compared to the stent, there is a 16% difference in favor of endoscopic vacuum therapy (risk difference [RD]: 0.16; 95% CI: 0.05–0.27). The risk for mortality in the endoscopic vacuum therapy was 10% lower than in endoluminal stent therapy (RD: −0.10; 95% CI: −0.18 to −0.02).

Conclusion
Endoscopic vacuum therapy might have a higher rate of fistulous orifice closure and a lower rate of mortality, compared to intraluminal stenting.
654 PHARYNGEAL POUCH SURGERY IN OCTO- AND NONAGENARIANS IS SAFE AND EFFECTIVE: A MULTICENTER COMPARATIVE COHORT STUDY
Authors: Liu David , Afzal Mohamed , Bright Tim , Watson David , Devitt Peter , Thompson Sarah 
Published: September 2021

Abstract

Surgery is the only effective treatment strategy for a symptomatic pharyngeal pouch. However, octo- and nonagenarians are often denied referral to a surgeon because of perceived increased risks. Here, we examine the perioperative outcomes of pharyngeal pouch surgery in octo- and nonagenarians in comparison to patients under 80 years-of-age.

Methods
Analysis of a prospectively maintained database of 113 patients (≥80 years-of-age: 27, &lt;80 years-of-age: 86) who underwent pharyngeal pouch surgery across seven hospitals from 1 January 2006 to 30 September 2020.

Results
Patients ≥80 years-of-age had comparable operative time, complication profile, intensive care admission, emergency reoperation, and revisional surgery as their younger counterparts. The severity of complications was not significantly different between the two age groups. No surgical mortality was recorded. Multivariate analysis demonstrated that diverticulectomy combined with cricopharyngeal myotomy independently predicted higher rates of complications (OR: 4.53, 95% CI: 1.43-14.33, p = 0.010), but also greater symptomatic improvement (OR: 4.36, 95% CI: 1.50-12.67, p = 0.007). Importantly, a greater proportion of octo- and nonagenarians experienced improved swallowing than patients &lt;80 years-of-age (96.3% vs. 74.4%, p = 0.013). Advanced age was not predictive of complications on multivariate analysis.

Conclusion
In appropriately selected patients, pharyngeal pouch surgery can be safely offered to patients above 80 years-of-age resulting in significant improvement in their quality-of-life. These patients should not be denied surgery on the basis of advanced age alone.
666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Serafim Maria , Santos Clara , Orlandini Marina , Datrino Letícia , Tavares Guilherme , Tristão Luca , Bernardo Wanderley , Tustumi Francisco 
Published: September 2021

Abstract

Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy.

Methods
A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (&gt; 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied.

Results
Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22).

Conclusion
Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.
685 THE IMPACT OF ADJUVANT THERAPY ON SURVIVAL FOR NODE-NEGATIVE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PROPENSITY SCORE MATCHED ANALYSIS
Authors: Leng Xue-feng , He Wenwu , Jiang Yingchun , Leng Xuefeng , Luo Qiyu , Mao Tianqin , Zheng Kai , Han Yongtao 
Published: September 2021

Abstract

At present, the primary treatment of esophageal cancer is surgery-based comprehensive treatment, including adjuvant therapy such as chemotherapy and/or radiotherapy. However, the role of adjuvant therapy for esophageal squamous cell carcinoma (ESCC) with pathologically node-negative (pN0) disease is controversial. This study aimed to evaluate the impact of postoperative adjuvant therapy on survival in patients with pN0 ESCC.

Methods
Patients with ESCC who underwent R0 esophagectomy in the Department of Thoracic Surgery of Sichuan Cancer Hospital from Jan. 2008 to Dec. 2013 were involved. Patients were divided into two groups: surgery alone (Group S) or surgery + adjuvant therapy (Group S + A). The primary outcomes were overall survival (OS) and disease-free survival (DFS) between the two groups, and every consecutive case was followed up to death or the last follow-up.

Results
The study involved 387 patients with pN0 ESCC. After propensity score matching, each group consisted of 150 patients. In the overall cohort, the 5-year OS (p = 0.004) and 5-year DFS (p = 0.003) rates were higher in Group S + A than in Group S. In matched samples, the same outcomes were observed (5-year OS: p = 0.026; 5-year DFS: p = 0.014). Postoperative chemotherapy was associated with longer OS (p = 0.02) and DFS (p = 0.004); T3 tumors (p = 0.004) and &lt; 15 lymph node dissections (p = 0.002) were independent risk factors for pN0 ESCC.

Conclusion
As the study revealed, adjuvant therapy, especially chemotherapy, prolonged OS and DFS for patients with ESCC who had pN0 disease. Fewer lymph node dissections and T3 stage tumors were independent risk factors for OS and DFS.
698 ENDOLUMINAL VACUUM THERAPY (EVT) AS A TREATMENT FOR ESOPHAGEAL LEAKS; 10-YEARS’ EXPERIENCE FROM A TERTIARY UK ESPHAGOGASTRIC CENTRE
Authors: Afzal Zeeshan , Gourgiotis Stavros , Hardwick Richard , Safranek Peter , Sujendran Vijay , Bennett John , O'Neill Robert , Noorani Ayesha , Hindmarsh Andrew 
Published: September 2021

Abstract

Esophageal leaks present a significant management challenge, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with esophageal leaks from a range of different causes that were treated with EVT in a tertiary UK hospital over a 10-year period.

Methods
Between April 2011 and March 2021, 45 patients with a median age of 67 years (31–92) who had an esophageal leak were treated with EVT. All patients were treated with an ad-hoc endoluminal vacuum device (EVD) constructed using V.A.C GRANUFOAMTM (KCI) and a standard nasogastric (Ryles) tube. The median Apache II score for patients at the time of leak diagnosis was 20 (6–36). The cause of the leak was anastomotic in 16 patients (36%), iatrogenic in 14 patients (31%), spontaneous in 14 patients (31%), and traumatic in 1 patient (2%). Information related to treatment and outcome was recorded prospectively.

Results
Successful resolution of the leak was achieved in 39 (87%) patients. The median number of EVD changes required to heal the leak was 6 (1–17). There were no complications related to insertion of the EVD. The median length of hospital stay was 49 days (1–108). Six (13%) patients died during treatment. Six (13%) patients had complications during treatment requiring further intervention; 2 (4%) had a significant bleed requiring angiography and aortic stent placement, 1 (2%) had a stroke, 1 (2%) had a pulmonary embolism, 1 (2%) had a myocardial infarction, and 1 (2%) contracted COVID-19.

Conclusion
EVT is a safe and effective treatment that can be used successfully to treat esophageal leaks from a disparate range of leak causes in selected critically unwell patients. Further studies are required to develop a standardized procedure and management pathway which will enable broader adoption of EVT in this group of patients.
704 OBSERVATIONAL MEDICAL TREATMENT OR SURGERY FOR GIANT PARAOESOPHAGEAL HIATAL HERNIA IN ELDERLY PATIENTS.
Authors: Braghetto Italo , Korn Owen , Lanzarini Enrique , Musleh Maher , Figueroa Manuel , Rojas Jorge 
Published: September 2021

Abstract

Giant paraoesophageal hernias (GPHH) occur frequently in the elderly, account for about 5–10% of all hiatal hernias. Up to now persists the controversy between expectant medical treatment versus surgical treatment, regarding which is the most appropriate option depending on the presence or absence of symptoms. The aim of this study is to assess whether an indication for surgical repair of PHH is possible in older patients adequately evaluated before surgerymptoms.

Methods
Patients and method: Prospective study including patients hospitalized from January 2015 to December 2019 with GPHH more than 70 years old, comparing 2 group of patients which were separated in: Group A including a cohort of 23 patient in whom observational and conservative was indicated by gastroenterologist and Group B includes 66 patients in whom elective laparoscopic hiatal hernia repair was indicated at the moment of its diagnosis.

Results
Charlson’s score and ASA II or III were more frequent in group A. Emergency hospitalization was exclusively seen in group A and elective surgery in Group B. Symptomatic patients were seen in both groups (86.9 and 86.4% respectively). Symptoms period before the hospitalization was more prolonged in group A (21.8 + 7.8 vs 6.2 + 3.5 years) (p = 0.001). Symptoms of acute complications were seen frequently in Group A UCI and hospital stay were significantly more prolonged in Group A due to sepsis, emergency surgery and complications. In hospital mortality occurred in 5/23 patients (21.7%) in group A vs 1/66 patients (1.5%), Group B.

Conclusion
727 EXOCRINE PANCREATIC INSUFFICIENCY AFTER ESOPHAGECTOMY: A SYSTEMATIC REVIEW OF LITERATURE
Authors: Blonk Lotte , Wierdsma N J , Jansma E P , Kazemier G , Peet D L , Straatman J 
Published: September 2021

Abstract

Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life.

Methods
Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included.

Results
Four studies, including 158 patients, were selected. Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels &lt;200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18-24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels &lt;200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms.

Conclusion
Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion.