bluuebunny/crossref_metadata_2025_split huggingface dataset:
754 STEEP RAMP TEST: AN ALTERNATIVE TO ASSESS PHYSICAL FITNESS BEFORE OESOPHAGECTOMY IN CANCER PATIENTS
Authors: Crull David , Mekenkamp I , Ruinemans G M F , Det M J , Kouwenhoven E A 
Published: September 2021

Abstract

Oesophagectomy patients are at high risk of perioperative complications. An important predictor for a complication is inadequate preoperative physical fitness. Cardiopulmonary Exercise Test (CPET) is the golden standard for measuring VO₂ max. The Steep Ramp Test (SRT) is an alternative with a lower patient burden and cost, but provides an estimation of VO₂ max. The aim was to determine whether SRT is an adequate alternative for CPET to determine preoperative fitness in oesophageal cancer patients.

Methods
The population consisted of 113 oesophageal cancer patients of a single centre that have performed CPET and SRT within a timeframe of two weeks. The agreement between SRT and CPET was analysed using a t-test, the Pearson correlation, the Intraclass Correlation Coefficient (ICC) and the Bland-Altmann analysis. A CPET-measured VO₂ max of 17 mL/kg/min was the set threshold for adequate operative fitness, based on current literature.

Results
The mean difference between the CPET and SRT was 2.77 mL/kg/min (95% CI, 2.14–3.41). The Pearson correlation was 0.792 (P &lt; 0.001). The ICC was 0.879 (95% CI, 0.825–0.917). In 93 (82.3%) patients, SRT was higher than the CPET. The limits of agreement (LOA) for the Bland-Altmann were − 3.89 − +9.44. Thirty-one (27.4%) patients performed better on SRT than the set threshold plus the upper LOA. Twenty-three patients scored inadequate on CPET, of whom 14 patients (60.9%) SRT was sufficient.

Conclusion
VO₂ max as estimated by SRT differs from the VO₂ max as measured by CPET. In patients that are well above the threshold of adequate preoperative fitness, the difference is of clinical irrelevance. In conclusion: SRT is a promising alternative to CPET for determining preoperative physical fitness, it might render CPET obsolete for fit individuals which leads to a lower burden for the patient and substantial cost reduction.
770 CONSIDERABLE EFFECT OF UPPER MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH
Authors: Wang Xiaojin , Gan Xiangfeng , Cao Qingdong 
Published: September 2021

Abstract

Conventional minimally invasive esophagectomy requires transthoracic surgery, which could increase the risk of many perioperative complications. Mediastinoscopy-assisted transhiatal esophagectomy has been proposed for years, but the traditional methods have shortcomings, such as unclear vision, especially during the dissection of upper mediastinal lymph nodes. We proposed a novel approach of upper mediastinal lymphadenectomy with mediastinoscopy through a left-neck incision, and investigated the effect of lymphadenectomy and other perioperative outcomes.

Methods
This approach for upper mediastinal lymphadenectomy includes three parts. (I) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) could be accomplished during esophagectomy under mediastinoscopy. (II) At the level of the lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, instruments are used to access the right RLN. Lymphadenectomy of up to 2 cm could be accomplished at the upper edge of the RSA. (III) Between the trachea and esophagus, the left and right main bronchi are exposed along the trailing edge of the trachea down to the carina, and lymphadenectomy can be performed here.

Results
This lymphadenectomy had been completed successfully on 117 patients, and 1 was converted to thoracotomy due to intraoperative tracheal membrane damage. The average operation time was 181.4 ± 43.2 minutes, bleeding volume was 106.4 ± 87.9 mL. The number of dissected LNs of upper mediastinal, the left RLN, the right RLN and the subcarinal was 11.2 ± 6.3, 5.1 ± 2.8, 3.2 ± 1.3 and 3.8 ± 2.1 respectively. 10 cases of (8.5%) anastomotic fistula were resolved with proper drainage and nutritional support. There were 25 cases (21.2%) of anastomotic strictures, 10 cases (8.5%) of pleural effusion, 20 cases (16.9%) of hoarseness. The incidence of hoarseness was 2.5% in three months postoperation.

Conclusion
These results showed that the lymphadenectomy through the left neck approach was not inferior than other surgical approaches in the amount of upper mediastinal LNs resection and perioperative outcome. Further research is needed to discover its impact on the long-term prognosis of ESCC patients.
771 IMPACT OF NATIONWIDE CENTRALIZATION OF ESOPHAGEAL, GASTRIC, AND PANCREATIC SURGERY ON TRAVEL DISTANCE AND EXPERIENCED BURDEN IN THE NETHERLANDS
Authors: Luijten Josianne , Nieuwenhuijzen Grard , Sosef Meindert , Hingh Ignace , Rosman Camiel , Ruurda Jelle , Duijvendijk Peter , Heisterkamp Joos , Steur Wobbe , Laarhoven Hanneke , Besselink Marc , Koerkamp Bas Groot , Santvoort Hjalmar , Lemmens Valery , Vissers Pauline 
Published: September 2021

Abstract

This study aims to assess the impact of nationwide centralization of surgery on travel distance and travel burden among patients with esophageal-, gastric-, and pancreatic cancer according to age in the Netherlands. As centralization of care increases to improve postoperative outcomes, travel distance and experienced burden might increase.

Methods
All patients who underwent surgery between 2006–2017 for esophageal-, gastric- and pancreatic cancer in the Netherlands were included. Travel distance between patient’s home address and hospital of surgery in kilometers was calculated. Questionnaires were used to assess experienced travel burden in a subpopulation (n = 239). Multivariable ordinal logistic regression models were constructed to identify predictors for longer travel distance.

Results
Over 23,838 patients were included, in whom median travel distance for surgical care increased for esophageal cancer (n = 9,217) from 18 to 28 km, for gastric cancer (n = 6,743) from 9 to 26 km and for pancreatic cancer (n = 7,878) from 18 to 25 km (all p &lt; 0.0001). Multivariable analyses showed an increase in travel distance for all cancer types over time. In general, patients experienced a physical and social burden, and higher financial costs, due to travelling extra kilometers. Patients aged &gt;70 years travelled less often independently (56% versus 68%), as compared to patients aged ≤70 years.

Conclusion
With nationwide centralization, travel distance increased for patients undergoing esophageal-, gastric-, and pancreatic cancer surgery. Younger patients travelled longer distances and experienced a lower travel burden, as compared to elderly patients. Nevertheless, on a global scale travel distances in the Netherlands remain limited.
772 TREATMENT DECISION MAKING DURING THE OUTPATIENT CLINIC VISIT IN PATIENTS DIAGNOSED WITH ESOPHAGOGASTRIC CANCER, A MIXED METHOD DESIGN
Authors: Luijten Josianne , Brom Linda , Nieuwenhuijzen Grard , Westerman Marjan , Vissers Pauline , Verhoeven Rob 
Published: September 2021

Abstract

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer. Little is known about which factors attribute to practice variation. The aim of this study is to investigate the possible differences in treatment decision-making (TDM) after the Multi-Disciplinary Team Meeting (MDTM) advice.

Methods
To gain in-depth understanding of TDM quantitative data was gathered by the Netherlands Cancer Registry (i.e., proposed treatment and received treatment) and clinician’s and patient’s perspectives were assessed. In eight hospitals, 26 outpatient clinic consults were observed, 30 in-depth interviews with clinicians were conducted, and 3 focus groups with patients were conducted. In addition, focus groups with clinicians were held to enrich and further explore the gathered data. Thematic content analysis approach was used.

Results
Surgery with curative intent was proposed during the MDTM in 63%,65% and 72% in patients diagnosed with esophageal cancer in a hospital with respectively low, middle, or a high probability of undergoing treatment with curative intent, respectively. For gastric cancer this was 75%, 82%, 82%, respectively. Changes in the MDTM proposal and received treatment occurred rarely. Clinicians held similar opinions regarding TDM, however its implementation into practice varied. Differences consisted of discussing all treatment options versus only the most fitting treatment option, and the thoroughness of discussing the benefits and harms. Most patients wished to undergo treatment with curative intent.

Conclusion
Differences in the believes and personalities of the attending clinicians might attribute to variation in TDM. Variation in practice according to the hospital of diagnosis was mainly observed in the MDTM proposal as hospitals with a high probability of undergoing treatment with curative intent proposed surgery more often. Changes in the MDTM proposal and received treatment occurred rarely.
773 LAPAROSCOPIC FUNDOPLICATION IN A DOG WITH GASTROESOPHAGEAL REFLUX DISEASE
Authors: Edelmuth Rodrigo , Hyndman Philip , Spector Daniel , Palma Douglas , Greenberg Jacques , Zarnegar Rasa 
Published: September 2021

Abstract

Antireflux procedures in humans are well stablished. However, the veterinarian literature lack of information on antireflux procedures. To our knowledge, this is the first ever documented laparoscopic fundoplication performed on a canine. A one-year male, Belgian Malinois was presented for consultation of progressive chronic regurgitation and hypersalivation. Given the persistent clinical signs despite medical management, laparoscopic fundoplication was recommended and elected.

Methods
Laparoscopic fundoplication was performed. The dog was induced under general anesthesia and prepared for ventral abdominal surgery in dorsal recumbency. A direct approach to the abdominal cavity was made just cranial to the umbilicus on midline and a 5 milimiter port placed routinely with a blunt trocar. Pneumoperitoneum was set at 8 to 10 millimeters of mercury.

Results
The patient was hospitalized postoperatively receiving methadone, maropitant, ondansetron, erythromycin, metoclopramide, pantoprazole and intravenous crystalloid fluid therapy. A liquid/soft diet was offered from 17-hours postoperatively which the dog ate readily with a normal appetite. No vomiting nor regurgitation was noted during the dog’s hospitalization. Patient was discharged 47 hours after surgery. Activity restriction was recommended for 14 days. The owner was recommended to adhere strictly to a diet comprised of a liquid consistency for the first seven days fed over three-to-four meals, followed by a slow gradual increase in consistency to canned soft food by three weeks.

Conclusion
Reflux is probably more prevalent in canines than previously thought and possible implementation of antireflux testing and procedures may need to be considered in this population.

Video
https://drive.google.com/file/d/1-H0rrRhsIXXSVaHM_iU1QVvr_BqPqIg2/view?usp=sharing.
788 VARIABLE GEOGRAPHICAL DIFFERENCES OF AMBULATORY ESOPHAGEAL REFLUX MONITORING IN MEXICO
Authors: Vazquez-Elizondo Genaro , Remes-Troche José María , Coss-Adame Enrique , Suárez-Morán Edgardo , Valdovinos-Díaz Miguel Ángel , Durán-Rosas Cristina , Fuentes-Ernult Victoria , Zamorano-Orozco Yolanda , Molina Angelina , Achem Sami 
Published: September 2021

Abstract

Ambulatory esophageal reflux monitoring (AEpH) is useful in evaluating persistent or refractory esophageal symptoms despite adequate pharmacologic and/or surgical therapy. There is limited information whether there are geographical or regional differences in the diagnostic outcome of this test.

Aim
Characterize the diagnostic outcome of AEpH in a diverse population of Mexico. Analyze whether there is regional geographical diagnostic variability.

Methods
Data was collected from four major referral centers representing diverse geographical areas of Mexico: Mexico City-Central (two centers, years 2016-2020), Veracruz-South (years 2015-2020) and Monterrey-North (years 2013-2020). Consecutive patients undergoing AEpH with persistent GERD symptoms despite PPI therapy and negative upper endoscopy (no erosive disease &gt;C or D LA classification) were entered into a data base and analyzed. Patients were classified as: NERD (acid exposure time (AET &gt; 6.0%); hypersensitive esophagus (normal AET and positive symptom index (SI) or positive symptom association probability [SAP]); functional heartburn (NL AET, neg SI/SAP). Statistics: ANOVA, Chi-square and descriptive methods were used to compare variables among groups.

Results
969 cases met inclusion criteria: 311 (32.1%) Central, 430 (44.3%) South, and 228 (23.5%) North. The results are summarized in the table. There were more women 618(63.8%) than men 351(36.2%); p &lt; 0.001 with a mean age 47.7 ± 14.3. Patients were older in Central-Mexico 49.3 ± 13.6 years vs South 47.5 ± 15 and North 46.1 ± 13.6; p = 0.033. Functional heartburn was the most common diagnosis overall and more prevalent in Central-Mexico 171(55%) vs North 97(42.5%) and South 160(37.2%); p &lt; 0.001. NERD was more predominant in the South 171(39.8%) vs North 72(31.6%) and Central-Mexico 98(31.5%); p = 0.029. Hypersensitive esophagus was more frequent in the North 59(25.9%) vs South 99(23%), and Central 42(13.5%); p &lt; 0.001.

Conclusion
This is the first large data base study to evaluate the outcome of ambulatory esophageal reflux pH testing in Mexico. Our findings indicate a geographical variability of GERD phenotypes and suggest that further investigations are warranted to determine the causes of this distribution.
789 HIGH RESOLUTION ESOPHAGEAL MOTILITY: VARIABLE GEOGRAPHIC DISTRIBUTION IN A LARGE MEXICAN COHORT
Authors: Vazquez-Elizondo Genaro , Remes-Troche José María , Coss-Adame Enrique , Suárez-Morán Edgardo , Valdovinos-Díaz Miguel Ángel , Durán-Rosas Cristina , Fuentes-Ernult Victoria , Zamorano-Orozco Yolanda , Molina Angelina , Achem Sami 
Published: September 2021

Abstract

High resolution esophageal manometry (HREM) has been in use for about a decade. However, there is no available information regarding geographical or regional differences in diagnostic outcome.

Aim
Characterize the indications, demographics and diagnostic outcome of HREM in a diverse population of Mexico.

Methods
Data was collected from four major referral centers representing diverse geographical areas of Mexico: central—Mexico City (two centers, years 2016-2020), south (Veracruz, years 2015-2020) and north (Monterrey, years 2013—2020). All consecutive cases referred for HREM were entered into a data base and analyzed using Chicago 3 classification. Data was evaluated using chi-square to compare frequencies among groups.

Results
2,932 patients included: Central n = 877(29.9), North n = 1003(34.2), South n = 1052(35.9). Mean age 47.9(11-93), women 1,795(61.2), men 1,137(38.8). Nationwide, the most common indications for testing were: GERD n = 1677(57.2), followed by dysphagia 587(20), atypical GERD 244(8.3), post-operative GERD 230(7.9), chest pain 114(3.9), and post-operative dysphagia 78(2.8). HREM was normal in 1,468(49.9) patients. Table shows the diagnostic distribution among centers: Central-Mexico had more abnormal cases 531(60.5) (p &lt; 0.0.001) vs 407(40.6) North and 532(50.6) South. Achalasia was more commonly diagnosed in the South n = 104(19.5) whereas outlet obstruction 39(967) p &lt; 0.001 and spastic disorders were more common in the North 47(11.8) p = 0.002. Weak peristaltic disorders were more common in Central-Mexico 369(78.8) p &lt; 0.001.

Conclusion
This study represents the first large comparative multicenter HREM data base project in Mexico. In this cohort, most patients receiving HREM are women and those whose indication was GERD. These findings indicate variable regional geographical distribution of HERM diagnosis. Our study suggests that further investigation into the causes and epidemiological distribution of motility disorders is warranted.
802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION
Authors: Razia Deepika , Razia Deepika , Mittal Sumeet K 
Published: September 2021

Abstract

Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction.

Methods
After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up.

Results
During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1).

Conclusion
Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.
810 REPRODUCIBILITY OF REPEATED MEASUREMENTS OF OESOPHAGEAL MOTILITY METRICS WITHIN A STUDY
Authors: Morozov Sergey , Kropochev Vasily , Artemov Alexey 
Published: September 2021

Abstract

To compare reproducibility of repeated measurements of oesophageal motility metrics after 5 wet swallows within a study.

Methods
Patients referred for high-resolution esophageal manometry (HREM) to assess oesophageal motor function were enrolled. Solid-state 36-channel 10 Fr catheter (Unisensor AG) and Solar (MMS) software were used. Minimum 10 water swallows by 5 mL each were obtained. Two operators independently assessed the results of examination. Records of swallows were divided into 2 series by 5 measurements each. These series were compared by key metrics: integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), and contractile front velocity (CFV). Non-parametric statistics was used to compare the results.

Results
We enrolled 46 men and 68 women, age (mean ± SD) 48.8 ± 11.5 y.o. Of them, 52 patients had GERD, 25-different types of achalasia and 37 had no oesophageal disorders. The inter-observer agreement between 2 series of measurements reached 98%. No significant difference was found between the mean results of IRP, DCI, DL and CFV in 2 series of measurements (table 1).

Conclusion
No significant differences between studied HREM metrics in two series of measurements were found. The results of two series by 5 measurements within a study are reproducible. This may indicate the possibility of reducing the standard number of measurements. Reduction of time necessary for standard examination may allow additional time for functional tests (solid food swallows, RDC or MRS).
819 INSTITUTIONAL VARIATION IN THE ORGANIZATION OF CLINICAL PATHWAYS IN ESOPHAGOGASTRIC CANCER, A MIXED METHOD MULTIPLE CASE STUDY
Authors: Luijten Josianne , Vissers Pauline , Verhoeven Rob , Nieuwenhuijzen Grard , Westerman Marjan 
Published: September 2021

Abstract

The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer and was related to survival. However, little is known which factors attribute to this variation. In this study we aimed to gain in-depth understanding of the organization of clinical pathways and in particular factors and processes determining the organization of healthcare for esophagogastric cancer patients.

Methods
A mixed method study design consisting of quantitative and qualitative data was conducted. Quantitative data was gathered by the Netherlands cancer registry (e.g., outpatient clinic consultations and performed diagnostics). A thematic content analyses of the current sub-study focused on clinician’s perspectives using semi-structured interviews (n = 30), and observations of outpatient clinic consults (n = 26) as well as multidisciplinary team meetings (n = 16) in eight hospitals.

Results
Quantitative analyses showed that surgeons were more often consulted in hospitals with a high probability whereas geriatricians were more often consulted in hospitals with a low probability of receiving treatment with curative intent. Qualitative analyses showed that the organization of clinical pathways were analyzed according to three levels: regional, local and patient level. Hospitals differed regarding triage, patients discussed during an multidisciplinary team meeting, the revision of radiological images, and restaging after neoadjuvant treatment. Furthermore, assessment of patients physical and cognitive condition by fitness tests, pre-habilitation and/or geriatric assessment differed significantly.

Conclusion
Specific parts of the clinical pathways differed significantly between hospitals such as the consultation of a geriatrician and pre-habilitation. These results might provide implications for further research in order to optimize clinical pathways.
823 INDUCTION CHEMOTHERAPY WITH 2-WEEKLY DCF REGIMEN FOR SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Kaito Akio , Haruki Shigeo , Tanioka Toshiro , Ito Koji , Hasegawa Fumi , Arita Kaida , Ohata Yoshiteru , Takiguchi Noriaki 
Published: September 2021

Abstract

Tri or 4-weekly Decetaxel, Cisplatin and Fluorouracil (DCF) regimen for esophageal squamous cell carcinoma (ESCC) was reported to be highly effective as a neoadjuvant chemotherapy, however higher hematologic toxicity rate was problematic with this regimen. JCOG0807 study revealed 2-weekly DCF regimen was less toxic and effective for unresectable or metastatic ESCC, however its efficacy for resectable ESCC as an induction chemotherapy is unknown.

Methods
The aim of this study was to clarify the safety and efficacy of 2-weekly DCF regimen for resectable ESCC. We reviewed 94 pts with ESCC who received 2-weekly DCF regimen (30 mg/m2 docetaxel on days 1 and 15, 80 mg/m2 cisplatin on day 1, 800 mg/m2 fluorouracil on days 1–5, repeated every 3 weeks) between Apr. 2010 and Dec. 2019. Clinical stage II, III, IVA and IVB ESCC pts were included. Those with cT4b and cM1 other than No.104 nodes were excluded. The safety, efficacy and survival were retrospectively investigated.

Results
Fifty-eight pts were enrolled. Clinical stage was II in 6, III in 39, IVA in 6 and IVB in 7. Common grade 3/4 adverse events were neutropenia (19%), hyperglycemia (7%), and febrile neutropenia (3%). Treatment related death was occurred in one (2%) for neutropenia. The overall response rate (RR) was 50% and disease control rate was 93%. The R0 resection rate was 81% without in-hospital deaths. Grade 2/3 pathological RR was 38% and pCR rate was 7%. Median survival time (MST) was 84 mts and 5-yr OS was 59% with a median observational period of 37 mts.

Conclusion
The 2-weekly DCF regimen for resectable ESCC showed tolerable hematologic toxicity, relatively better efficacy and survival. This regimen can be an alternative choice as an induction chemotherapy for ESCC.