bluuebunny/crossref_metadata_2025_split huggingface dataset:
718 DIFFERENCES BETWEEN INTRACORPOREAL AND EXTRACORPOREAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY: IS THERE A BETTER WAY?
Authors: Takeda F , Aissar Sallum R , Ribeiro U , Cecconello I , Nahas S 
Published: September 2021

Abstract

Introduction
Esophagectomy remains good option to curative intent for esophageal carcinoma. However, quality of life for post-operative symptoms such as reflux, gastric emptying delayed and dysphagia is on debate. Some studies advocate relations between those symptoms to gastric tube conformation and discrepancies between intra and extracorporeal gastric tube construction. We aimed to analyze differences between both methods.

Methods
During 2014–2020, patients underwent to esophagectomy by thoracoscopic approach with cervical anastomosis (McKeown procedure). The abdominal part was performed by totally laparoscopic (group A) or hybrid (group B) hand-assisted gastric tubulization. Clinical parameters, symptoms of reflux, gastric tube evaluated by tomography, post-operative endoscopic findings were assessed and compared between groups. Multivariable analysis was performed.

Results
36 group A and 56 group B, 55 (59.7%) were squamous cell carcinoma and 60 (66.6%) did neoadjuvant chemoradiotherapy. Mean follow-up was 32 months. Group A had more gastric tube diameter (p &lt; 0.001), alimentary stasis (p &lt; 0.001), redundant conformation (p &lt; 0.05) and distant from axial central point of the thorax (p &lt; 0.05); all evaluated by tomography. And also, more symptoms of reflux and gastric empty delay by reflux symptoms index (RSI) (p &lt; 0.001); and numbers of esophagitis grade B and C by upper endoscopy (p &lt; 0.01). After multivariable analysis, intracorporeal (p &lt; 0.001) and diameter more than 4.2 cm (p &lt; 0.01) was related to worst RSI.

Conclusion
The intracorporeal gastric tube reconstruction may lead wider gastric tube conformation, which might be related to gastric empty delay, resulting in intense reflux symptoms confirmed by upper endoscopy.
719 REDUCED MEAN NOCTURNAL BASELINE IMPEDANCE AIDS DIAGNOSIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE AND LARYNGOPHARYNGEAL REFLUX DISEASE
Authors: Park Jin-soo , Van der Wall Hans , Falk Gregory 
Published: September 2021

Abstract

Laryngopharyngeal reflux disease (LPR) and gastro-esophageal reflux disease (GERD) occur due to acidic gastric refluxate causing symptoms. Baseline esophageal impedance has been shown to be reduced with prolonged acid exposure. Mean nocturnal baseline impedance (MNBI) is a novel measure that has shown promise in GERD but has not been evaluated in LPR. This study aimed to assess the role of MNBI in LPR and GERD patients.

Methods
Off-therapy impedance-pH tracings were blindly reviewed for 187 patients previously prospectively allocated clinical diagnoses of LPR (n = 105) or GERD (n = 82). Conventional impedance-pH measures and MNBI were analysed for the two groups.

Results
MNBI was significantly lower in the distal esophagus in GERD patients compared with LPR (1679 ± 914 vs. 2109 ± 863; p = 0.001). Similarly, in the proximal esophagus, MNBI was lower in GERD than LPR (2289 ± 579 vs. 2541 ± 471; p = 0.001). In the pharynx, MNBI was similar between the two groups (2116 ± 699 vs. 2133 ± 770; p = 0.878). Distal acid exposure time (AET) and the number of distal acid reflux episodes negatively correlated with distal esophageal MNBI (r = −0.195; p = 0.007) and (r = −0.330; p &lt; 0.001) respectively.

Conclusion
Baseline impedance was reduced in both LPR and GERD at both distal and proximal esophageal measurements, and more severely reduced in GERD. Baseline impedance is strongly and inversely related to acid exposure in the esophagus. Pharyngeal MNBI was not reduced or different between groups. Distal and proximal esophageal MNBI may be useful in diagnosis of LPR as well as GERD.
732 TUMOR INFILTRATING NEUTROPHILS ARE A POOR PROGNOSTIC MARKER FOR ESOPHAGEAL CANCER PATIENTS RECEIVING NEOADJUVANT CHEMORADIOTHERAPY
Authors: Cabalag Carlos , Prall Owen , Ciciulla John , Galea Laurence , Thio Niko , Chong Lynn , Hii Michael W , Neeson Paul J , Arnau Gisela Mir , Phillips Wayne A , Clemons Nicholas J , Duong Cuong P 
Published: September 2021

Abstract

Significant advances have been made in our understanding of the tumor immune microenvironment (TIM) and tumor infiltrating lymphocytes (TILs). Nevertheless, there is little understanding of the changes in the TIM in response to neoadjuvant chemoradiotherapy (CRT). Thus, our aim was to investigate the changes in the TIM with neoadjuvant CRT in EC by assessing the immune cell infiltrate, the expression of immune related genes, and their association with treatment response and prognosis.

Methods
To decipher the effects of neoadjuvant CRT on the TIM, we obtained 58 paired pre-treatment and post neoadjuvant CRT treated EC specimens. TILs and tumor infiltrating neutrophils (TIN) were quantified in pre-treatment biopsies and surgical resection specimens following neoadjuvant CRT. To evaluate the immune transcriptomics, RNA was extracted from these specimens and gene expression was assessed using the Nanostring Platform based on the PanCancer Immune Profiling Panel. Immunohistochemistry (IHC) was performed to validate findings from the immune transcriptomics.

Results
TIL counts were not prognostic for disease specific survival (DSS). We observed higher expression of immune-suppressive inflammatory chemokines (TGFß-1 and IL-16) in post-neoadjuvant treated samples compared to pre-treatment biopsies. In samples collected after neoadjuvant CRT, low expression of genes related to anti-tumor T cell cytotoxic activity1 was significantly associated with disease recurrence. In patients with residual disease, multivariate analysis revealed a high neutrophil count, but not TIL count, was significantly associated with inferior DSS (HR 3.8 [1.3– 10.8]; p = 0.01).

Conclusion
In EC, the tumor microenvironment after neoadjuvant CRT remains largely immune-suppressive. We discovered that the presence of TINs in patients with residual disease post neoadjuvant CRT is an independent adverse prognostic factor. Collectively, our results suggest that an inflammatory pro-tumoral microenvironment associated with TINs may contribute to treatment resistance and progressive disease in EC.
753 SCARLESS APPROACH FOR KILLIAN JAMIESON DIVERTICULUM: TRANSORAL ENDOSCOPIC ASSISTED ESOPHAGODIVERTICULOSTOMY
Authors: Samuel Tay , Denise Zhang , Voon Kelvin 
Published: September 2021

Abstract

Killian-Jamieson Diverticulum (KJD) is a rare variant of proximal esophageal diverticulum that arises from the Killian-Jamieson area (antero-lateral). It differs from the more common Zenkers diverticulum which usually arise from the posterior aspect of the proximal esophagus. The choice of surgical intervention for symptomatic KJD is still unclear due its rare incidence and surgeons still prefer the transcutaneous cervical approach. Here we present the transoral endoscopic assisted esophagodiverticulostomy approach and the relevant literature.

Methods
26 year old male presented with progressive dysphagia for the past two years. A Killian-Jamieson Diverticulum was diagnosed after an Oesophagogastroduodenoscopy and Barium swallow. Patient underwent a transoral endoscopic assisted esophagodiverticulostomy.

Results
The surgery was uneventful and no complications were observed post-operatively. A year after the surgery patient is asymptomatic and no sign of recurrence.

Conclusion
Transoral endoscopic assisted esophagodiverticulostomy is a safe approach for treatment of symptomatic KJD. In this era of minimally invasive surgery it should be considered when formulating a treatment approach based on its obvious advantages.
792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.
Authors: Van Der Wilk Berend , Hagens Eliza R C , Eyck Ben M , Gisbertz Suzanne S , Hillegersberg Richard , Nafteux Philippe , Schröder Wolfgang , Nilsson Magnus , Wijnhoven Bas P L , Lagarde Sjoerd M , Berge Henegouwen Mark I 
Published: September 2021

Abstract

To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy.

Methods
Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models.

Results
In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy.

Conclusion
Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.
796 OUTCOMES OF DELAYED SURGERY IN PATIENTS WITH RESIDUAL DISEASE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER
Authors: Overtoom Hidde , Eyck Ben , Wilk Berend , Noordman Bo , Sluis Pieter , Lagarde Sjoerd , Wijnhoven Bas , Lanschot Jan 
Published: September 2021

Abstract

Standard treatment for locally advanced oesophageal cancer is neoadjuvant chemoradiotherapy (nCRT), plus surgery 6-8 weeks later. Time to surgery (TTS) after nCRT seems safe up to 12 weeks, and possibly improves patient condition and pathological response. However, it is unknown whether prolonged TTS is safe in patients with residual disease. The aim of this study was to investigate whether prolonged TTS leads to inferior surgical outcomes and survival in patients with residual disease after nCRT.

Methods
Patients with pathologically confirmed residual disease 4-6 weeks after nCRT who underwent preoperative PET/CT and surgery were selected from the preSANO-trial and SANO-trial. Patients were stratified by TTS ≤12 weeks versus TTS &gt;12 weeks after completion of nCRT. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), peroperative unresectability, microscopically radical resections (R0), tumour regression grade (TRG), postoperative complications and risk of distant dissemination. Effects of TTS on OS, PFS and distant dissemination were analysed with Cox regression, adjusted for Charlson comorbidity index (CCI) at baseline, as well as WHO performance score and weight loss after nCRT.

Results
Forty-two patients were included in the TTS &gt;12 weeks and 132 patients in the TTS ≤12 weeks group. Median follow-up was 20.6 months (IQR 16.1-30.3). Adjusted hazard ratios for OS and PFS were 0.50 (95% CI: 0.24-1.02) and 0.47 (95% CI: 0.25-0.91), respectively, in favour of TTS &gt;12 weeks. Patients with TTS &gt;12 weeks had more postoperative complications (89% vs 72%, p = 0.049), but comparable peroperatively unresectable tumours (11.9% vs. 3.8%, p = 0.11), R0-resections (89% vs 87%, p = 0.89), and TRG-scores (p = 0.97) compared to patients with TTS ≤12 weeks. Patients with TTS &gt;12 weeks showed less distant dissemination (HR 0.40, 95% CI: 0.18-0.88).

Conclusion
Prolonged TTS beyond 12 weeks in patients with clinically proven residual disease after nCRT did not have a negative effect on OS and on PFS, but was correlated with an increase in postoperative complications. The (non-significantly) better survival outcomes for TTS &gt;12 weeks may be explained by the fact that patients had a lower risk of developing distant dissemination, which may reflect improved selection prior to surgery.
80 THE PROGNOSTIC FACTORS ASSOCIATED WITH LONG-TERM SURVIVAL IN THE PATIENTS WITH SYNCHRONOUS OLIGOMETASTATIC ESOPHAGEAL ADENOCARCINOMA
Authors: Iwatsuki Masaaki , Harada Kazuto , Baba Hideo , Ajani Jaffer 
Published: September 2021

Abstract

Patients with gastrointestinal cancer are increasingly being diagnosed with oligometastatic disease due to the development of sensitive imaging. Oligometastases (OLM) represent a clinical and anatomical manifestation of resistant localized cancer and/or metastases. However, oligometastatic disease is complicated by the lack of uniformity due to the heterogeneity of cancer, therefore, differing prognoses. The aim of this study is to identify the factors associated with long-term survival in the patients with synchronous oligometastatic esophageal adenocarcinoma (EAC).

Methods
Between 2002 and 2016, of 1400 patients with EAC (esophagus and Siewert types I and II) treated at our institute, 233 patients initially diagnosed with stage IVB were enrolled. OLM was defined as only metastasized to one organ and less than 5 metastases. We retrospectively analyzed the association between clinicopathological factors and prognosis, especially focused on the pattern of metastases.

Results
Eighty-five patients (36.5%) had OLM, and 148 (63.5%) had non-oligometastais (Non-OLM). The patients in OLM had significantly better overall survival (OS) than the patients in Non-OLM (p = 0.0001). Univariate analysis showed pattern of metastases (lymphatic OLM) and treatment method (consolidative local radiotherapy: CLT) were significantly associated with prognosis (p = 0.04 and 0.01). Multivariate analysis revealed that lymph node metastases (cN0-N1), number of metastasis (solitary) and treatment (CLT) were independent predictors for OS of patients with OLM. (p = 0.03, 0.01 and 0.001). In OLM patients, the patients with lymphatic OLM who received CLT had more favorable prognosis (5-years survival rate 25%).

Conclusion
This study suggests that CLT is one of the promising modalities for oligometastatic patients with EAC, especially the patients with lymphatic OLM.
811 WHETHER 10 WATER SWALLOWS NECESSARY TO OBTAIN REPRODUCIBLE RESULTS OF HIGH-RESOLUTION OESOPHAGEAL MANOMETRY?
Authors: Morozov Sergey , Kropochev Vasily , Artemov Alexey 
Published: September 2021

Abstract

Not less than ten wet swallows assessment in the primary test position is recommended by Chicago classification 4.0 for high-resolution oesophageal manometry (HREM); however, the required number of measurements are not sufficiently supported.

Aim
to evaluate the number of wet swallows necessary for correct interpretation of the results of lower esophageal sphincter integrated relaxation pressure (IRP) with low probability of type I and II errors.

Methods
Patients referred to perform HREM were enrolled. Solid-state 10Fr catheter and Solar (Laborie) software were used. Minimum 10 swallows by 5 mL water were obtained. These were analysed for cumulative means of IRP after 1…9 measurements. Conclusion made at each moment was compared with one based on 10 measurements. The results were characterized as true/false positive/negative for calculation of diagnostic accuracy. To exclude sample influence, Monte-Carlo simulation of sequential decision-making was performed with the use of sequential probability ratio test. Association of the diagnostic accuracy from recall was studied with the use of receiver operating characteristic curve (ROC) analysis.

Results
One hundred subjects were enrolled (25 with disorders of EGJ outflow). During the simulation, the probability of matching the decisions based on the 10 measurements and lower number of them was high. ROC analysis showed that actual probability to obtain false-positive results was twice as lower then ‘allowed’ rate of 5%. The probability to make false-negative results did not exceed 10% in any number of measurements. The probability that the conclusions made after 2 and after 10 measurements match was 0.9584 in those with disorders of EGJ outflow and 0.9652 in those without (figure 1).

Conclusion
The standard number of measurements required to support the presence of disorders of EGJ outflow during evaluation of 5 mL wet swallows in the primary position is excessive. Values of the IRP after 2 swallows allows to make similar decision to that after 10 swallows with &gt;95% probability. This allows to reduce the number of wet swallows to assess in the primary position and save time for assessments in alternative position or perform provocation tests.
820 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND PRECANCEROUS LESIONS
Authors: Liu Yuzhi 
Published: September 2021

Abstract

With the development of endoscopic technology, endoscopic mucosal dissection (ESD) has become one of the standard treatments for superficial esophageal squamous cell carcinoma and precancerous lesion (SESCC-PL). However, the efficacy and safety of ESD in some special SESCC-PL patients is still unclear. The purpose of this study was to analyze the efficacy and safety of ESD in patients with SESCC-PL, especially for some special patients.

Methods
Firstly, according to the depth of lesions, all patients were divided into three groups: the epithelium and lamina propria group (M1-M2), the muscularis mucosae and submucosal superficial layer group (M3-SM1) and the submucosal deep layer group (≥SM2). Secondly, according to the age of patients, all patients were divided into two groups: elderly group (≥ 65 years old) and non-elderly group (&lt;65 years old). Finally, all patients were divided into two groups: patients with liver cirrhosis group and patients without liver cirrhosis group. The efficacy and safety of ESD for these patients were analyzed.

Results
There was no significant difference in operation time, resection speed, en bloc resection rate, bleeding rate, muscularis propria injury rate, perforation rate and intraoperative esophageal stricture rate in three groups with different depths of lesion. However, the R0 resection rate among the three groups decreased with the increase of lesion depth (P &lt; 0.001). There was no significant difference in all surgical indexes between the non-elderly group and the elderly group (all P &gt; 0.05). And there was also no significant difference in all surgical indexes including bleeding rate between the patients with liver cirrhosis and without liver cirrhosis (all P &gt; 0.05).

Conclusion
This study proved that ESD is safe and effective for all kinds of patients with SESCC-PL, especially for patients with lesion depth ≥ M3, elderly patients and patients with liver cirrhosis, ESD can still achieve a satisfactory treatment effect and a good survival prognosis. Liver cirrhosis is not a contraindication to ESD.
822 HOW THE OPERATING SURGEON'S ASSESSMENT OF RADICALITY INFLUENCES SURVIVAL AFTER ESOPHAGEAL CANCER SURGERY
Authors: Linder Gustav , Lindblad Mats 
Published: September 2021

Abstract

The operating surgeon’s assessment of surgical radicality following esophagectomy is reported to the Swedish National Registry for Esophageal and Gastric cancer(NREV). The variable provides means to identify risk factors for non-curative resections and study whether the surgeon’s assessment independently prognosticates survival.

Methods
All patients in NREV undergoing esophagectomy between 2006–2018 was grouped according to the surgeon’s assessment of radicality: Curative-, Borderline-curative- and Palliative resection. The cohort was followed until death, emigration or end of follow-up. Factors affecting group allocation was studied with multivariable logistic regression and survival with cox-regression and the Kaplan–Meier method.

Results
Of 1860 resected patients, esophagectomy was deemed curative in 1515(81%), borderline-curative in 179(10%), palliative in 63(3%) and missing in 103(6%). Median survival was 44.6, 20.0, 11.5 and 29.6 months respectively. Advanced stage (e.g., stage IVa), OR 7,37 (1,93–28,1 95%CI) and blood-loss &gt;1000 mL, OR 1.90 (1,17-3,08), increased the risk of borderline-curative resection. Minimally invasive surgery and multidisciplinary treatment decision (MDT) decreased the risk of borderline-curative resection, OR 0.42 (0,23-0,77) and OR 0.41 (0,22-0,77). Adjusted for well-established prognostic factors, e.g. age, p-TNM and R1-resection, the surgeon’s assessment was an independent variable for survival; borderline-curative HR 1,38 (1,11-1,72), palliative HR 1,91 (1,38-2,63).

Conclusion
The surgeon’s operative assessment of radicality following esophagectomy appears to independently prognosticate survival. Advanced stage and large-volume intraoperative blood loss increases the risk while minimally invasive surgery and MDT decreases the risk for borderline-curative resection.
9 SURGICAL TECHNIQUES AND POTENTIAL OF MEDIASTINAL LYMPHADENECTOMY IN ROBOTIC SURGERY
Authors: Oshikiri Taro , Takiguchi Gosuke , Urakawa Naoki , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Nakamura Tetsu , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2021

Abstract

Procedure of minimally invasive esophagectomy in prone position (Conventional prone-MIE) is standardized leading to feasible short outcomes. On the other hand, robot assisted MIE (Robotic MIE) was approved as Japanese health insurance treatment since 2018. Especially, reduction of recurrent laryngeal nerve (RLN) palsy leading to aspiration pneumonia is expected for Robotic MIE. The purpose of this study is to clarify the potential of Robotic MIE for improvement of short outcomes.

Methods
Twenty-four Robotic MIEs in introduction period since 2018 and 128 Conventional prone-MIEs in established period since 2015 from all of the 375 cases were compared using propensity score matching.

Results
Operative times in both entire and thoracic procedures were significantly longer in Robotic MIE. There were no significant differences between two groups in the number of harvested lymph nodes, amount of the blood loss, left RLN palsy rate (13% vs 14%, &gt; Clavien-Dindo classification: C-D grade I), right RLN palsy rate (4% vs 8%, &gt; C-D grade I), and pneumonia rate (7% vs 7%, &gt; C-D grade II).

Conclusion
Short outcomes of Robotic MIE in introduction period were not inferior to those of Conventional prone-MIE in established period. More improvement is expected for Robotic MIE via learning curve. In conclusion, Robotic MIE has hidden potential to outstrip Conventional prone-MIE in outcomes.

Video
https://www.dropbox.com/s/7byc8nsqupgetsp/2020%20ISDE%20movie%20for%20submission.wmv?dl=0.