bluuebunny/crossref_metadata_2025_split huggingface dataset:
487 MINIMALLY INVASIVE ESOPHAGECTOMY AFTER A NEOADJUVANT PROTOCOL WITH INDUCTION CHEMOTHERAPY AND CHEMORADIATION
Authors: Sabino Flávio , Guimarães-Filho Marco , Ribeiro Luciana , Fernandes Daniel , Felipe Luis 
Published: September 2021

Abstract

Neoadjuvant chemoradiation (CR) became the standard of care for the treatment of resectable esophageal cancer, but the survival rates are still worse than the observed in other gastrointestinal malignancies. The optimal neoadjuvant approach is still matter of debate. Based on these considerations, we started a phase II trial (QUIMERA) to investigate the safety and efficacy of preoperative induction chemotherapy followed by CR and minimally invasive surgery for esophageal cancer. We report the initial results.

Methods
Patients with confirmed squamous cell or adenocarcinoma of the thoracic esophagus or GEJ (Siewert type I or II), aged 18–75 years, with a PS 0–2, clinical stage cT1b-3 cN0–2 were eligible. After staging, patients received two cycles of IC with carboplatin (175 mg/m2) and paclitaxel (AUC = 5) on days 1 and 22, followed by radiotherapy (45 Gy (25 x 1.8 Gy)) and chemotherapy (carboplatin (AUC = 2) and paclitaxel (50 mg/m2) weekly for five weeks. After re-staging, patients with no stage M1 disease and/or inoperable T4 disease proceeded to surgery, minimally invasive esophagectomy in prone position, 8–12 weeks after the completion of chemoradiation.

Results
From March 2017 to December 2019, 86 were registered in the clinical trial. Forty-eight were excluded due to T4 or M1 disease, 26 patients finished the IC + chemoradiation protocol. Sixteen minimally invasive esophagectomy were performed. There were no conversions to open surgery. The surgical outcomes are presented in Table 1. The mean node count in the surgical specimen was 27 (13-49). A complete pathological response was observed in 6 (37,5%) cases (4 SCC; 2 Adenocarcinoma).

Conclusion
Our initial results are encouraging and suggests that IC followed by chemoradiation is a safe, feasible, active and well-tolerated regimen and that it may increase the PCR, especially for squamous cell carcinoma. The minimally invasive esophagectomy following the IC + CR was feasible, safe and had an adequate oncologic result. After the protocol completion there will be data available for a definitive evaluation of the procedure.
523 STAGING PET-CT LENGTH AND SURVIVAL IN PATIENTS UNDERGOING RESECTIONS FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Coe Peter , Lo Terence , Peckham-Cooper Adam , Sarela Abeezar , Hayden Jeremy , Mehta Samir 
Published: September 2021

Abstract

Esophagectomy is associated with considerable morbidity and mortality and a significant reduction in quality of life. Early identification of patients at high-risk of early recurrence and death would allow a more informed discussion about the benefits of surgery. Previous studies have shown that histological tumour length may be an independent predictor of survival. In this study we have determined whether tumour length at diagnosis can predict survival after esophagectomy.

Methods
From a single-centre prospective clinical database (2012 to 2018), we obtained data on tumour characteristics and 18F-FDG PET-CT (PET-CT) measurement of tumour length. The primary endpoint was overall survival (OS).We performed multivariate modelling using semi-parametric Cox models, and additionally explored flexible parametric modelling using fractional polynomials to explore non-linear relationships. Relationships between tumour length and known prognosticators were assessed using standard statistical techniques.

Results
We included 300 patients with esophageal adenocarcinoma and pre-operative PET-CT imaging. Tumour length was measurable on PET-CT in 91% of patients (274) (median 4.7 cm, range 1.3–12). 77% of patients received neo-adjuvant therapy. One and five-year overall survival rates were 79% and 44%, respectively. There was no relationship between survival and tumour length. One year survival for patients with tumours greater than 8 cm was 67% compared with 82% for tumours less than 8 cm although this was not statistically significant (p = 0.86). Tumour length was associated with tumour stage but not resection margin positivity or number of positive lymph nodes.

Conclusion
Tumour length as measured by PET-CT at diagnosis does not predict survival in patients undergoing esophagectomy for esophageal adenocarcinoma. This data supports the notion that tumour length by itself should not be used as a means of stratifying treatment.
620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE
Authors: Peterson Kathryn , Genta Robert , Rasmussen Henrik , Youngblood Bradford , Kamboj Amol 
Published: September 2021

Abstract

Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms.

Methods
52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment.

Results
45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group.

Conclusion
In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.
630 IMPACT OF LOW SKELETAL MUSCLE MASS AND DENSITY ON OUTCOMES OF LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS TREATED WITH RADICAL RADIOTHERAPY
Authors: Wang Yuan , Yang Ningjing , Jia Hongyuan , Liang Long , Wu Lei , Wang Qifeng , Li Tao 
Published: September 2021

Abstract

Low skeletal muscle mass and density are independent predictors of clinical outcomes in multiple gastrointestinal cancers. However, its effect on the long-term survival of locally advanced esophageal cancer patients undergoing radical radiotherapy is still unclear.

Methods
Patients with stage II-III esophageal cancer undergoing radical radiotherapy, enrolled in a observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding overall survival (OS).

Results
165 patients (75.8% males, median age 63) were included, from March-2012 to September-2017. Before radiotherapy, 26.7% patients had low skeletal-muscle-mass and 23.0% patients had low skeletal-muscle-density. After radiotherapy, 40.6% patients had low skeletal-muscle-mass and 30.3% patients had low skeletal-muscle-density.The median OS of high skeletal-muscle-mass/density group was significantly higher than that of low skeletal-muscle-mass/density group before radiotherapy (28.7 vs 28.2 months, p = 0.041; 29.6 vs 16.9 months, p = 0.025). The median OS of high skeletal-muscle-mass/density group was also significantly higher than that of low skeletal-muscle-mass/density group after radiotherapy (30.3 vs 20.3 months, P = 0.012; 29.6 vs 17.2 months, p = 0.018).

Conclusion
Low skeletal muscle mass and density are associated with long-term outcome in patients undergoing radical radiotherapy. It is suggested that oncologists should pay more attention to the management of muscle mass and density of patients with esophageal cancer undergoing radiotherapy in order to improve their nutritional status and long-term survival.
637 ANALYSIS OF THE OUTCOMES OF HAND-SEWN COMPARED TO THE STAPLED ANASTOMOSIS AFTER TOTAL GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS.
Authors: Honório Fernanda , Filho João Emílio Pinheiro , Tristão Luca , Santos Clara , Datrino Letícia , Orlandini Marina , Serafim Maria Carolina , Tavares Guilherme , Tustumi Francisco , Dias André , Waisberg Jaques 
Published: September 2021

Abstract

The complications related to esophagojejunal anastomosis are among the leading issues in the postoperative period of total gastrectomy. This review aims to evaluate the surgical outcomes of hand-sewn esophageal anastomosis compared to mechanical anastomosis for the reconstruction of total gastrectomy.

Methods
A systematic review and meta-analysis of comparative studies evaluating hand-sewn and stapled anastomosis was performed.

Results
A total of 12 studies were selected, comprising 1761 individuals. The operation time was higher in the hand-sewn anastomosis group (mean difference [MD] = 22.13 minutes; 95%CI: 3.97, 40.29). However, the risk for anastomotic fistula was not different between the groups (difference risk [DR] = 0.00; 95%CI: −0.03, 0.03). Also, the rate of intracavitary abscess (DR = -0.02; 95%CI: −0.07, 0.02); the reoperation rate (DR = -0.00; 95%CI: −0.01, 0.01); postoperative complications (DR = 0.12; 95%CI: −0.01, 0.25); postoperative mortality (DR = 0.02; 95%CI: −0.02, 0.06); anastomotic stenosis (DR = -0.01; 95%CI: −0.03, 0.00); and length of hospital stay (mean difference [MD] = 3.52 days; 95%CI: −0.49, 7.53) were no different between groups.

Conclusion
The results indicate that the hand-sewn and stapled esophageal anastomosis have similar surgical outcomes. Stapled anastomosis has a shorter operation time being.
642 PL02.01 DOES A HIGH MANDARD SCORE REALLY DEFINE A POOR RESPONSE TO CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA?
Authors: Knight William , Baker Cara , Griffin Nyree , Kelly Mark , Davies Andrew , Gossage James 
Published: September 2021

Abstract

A high Mandard score corresponds to a non-response to chemotherapy in the primary tumour in oesophageal adenocarcinoma. However, some patients experience tumour volume reduction and a nodal downstaging despite a high score. This study compares survival and recurrence patterns in these patients.

Methods
Clinicopathological factors were analysed using multivariable Cox regression assessing time to death and recurrence. CT estimated tumour volume change was examined in a subgroup of consecutive patients. Mean pre-chemotherapy and post chemotherapy tumour volumes were compared across Mandard groups and nodal responders.

Results
555 patients were included. Median survival was 55 months (Mandard 1,2,3) and 21 months (Mandard 4,5). In the Mandard 4,5 group (332 patients), comparison between complete nodal responders and persistent nodal disease showed improved survival (90 vs 18 months), recurrence rates (locoregional 14.75% vs 28.74, systemic 24.59% vs 48.42%) and CRM positivity (22.95% vs 68.11). Complete nodal response independently predicted improved survival (HR 0.34(0.16–0.74). Post-chemotherapy tumour volume reduction was greater in patients with a complete nodal response (−16.3 cm3 vs −7.7 cm3 p 0.033) with no significant difference between Mandard groups. Conclusion: Patients with a complete nodal response to chemotherapy have significantly improved outcomes despite a poor Mandard score. High Mandard score does not correspond with a non-response to chemotherapy in all cases and patients with nodal downstaging may still benefit from adjuvant chemotherapy.
652 LAPAROSCOPIC FUNDOPLICATION IS EFFECTIVE TREATMENT FOR PATIENTS WITH GASTROESOPHAGEAL REFLUX AND ABSENT ESOPHAGEAL CONTRACTILITY
Authors: Tran Steven , Gray Ronan , Kholmurdova Feruza , Thompson Sarah , Myers Jennifer , Bright Tim , Irvine Tanya , Watson David 
Published: September 2021

Abstract

Anti-reflux surgery in the setting of preoperative esophageal dysmotility is contentious due to fear of persistent long-term dysphagia, particularly in individuals with an aperistaltic esophagus (absent esophageal contractility). Emerging evidence suggests fundoplication is safe and effective in patients with esophageal dysmotility. This study aimed to determine the long-term postoperative outcomes following fundoplication in patients with absent esophageal contractility versus normal motility.

Methods
A case control study was performed, using a prospectively maintained database to identify all (40) patients with absent esophageal contractility on preoperative manometry who subsequently underwent fundoplication (36 anterior partial, 4 Nissen). Cases were propensity matched based on age, gender, and fundoplication type with another 708 patients who all had normal motility. Groups were assessed using prospective symptom assessment questionnaires to assess heartburn, dysphagia for solids and liquids, regurgitation, and satisfaction with surgery. Outcomes were compared at baseline and at 1, 5 and 10 years follow-up.

Results
Across follow-up to 10 years, no significant differences were found between the two groups for any of the assessed postoperative symptoms. Multivariate analysis found that patients with absent contractility had worse preoperative dysphagia (adjusted mean difference 1.09, p = 0.048), but postoperatively there were no significant differences in dysphagia scores at 5 and 10 year follow-up. No differences in overall patient satisfaction were identified across the follow-up period.

Conclusion
Laparoscopic anterior partial fundoplication in patients with absent esophageal contractility achieves acceptable symptom control without significantly worse dysphagia compared to patients with normal contractility. Patients with medically refractory reflux who have absent contractility should still be considered for surgical intervention.
670 THE STERNO-TRACHEAL DISTANCE IS AN IMPORTANT FACTOR OF ANASTOMOTIC LEAKAGE OF RETROSTERNAL GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY
Authors: Inoue Seiya 
Published: September 2021

Abstract

Anastomotic leakage (AL) is a serious complication after esophagectomy. The retrosternal (RS) route has been selected majorly to reduce reflux and related pneumonia and considering mediastinal recurrences. AL has been developed more in RS than posterior mediastinal (PM) route reconstruction. Therefore, we suspected the sterno-tracheal distance (STD) might be related to AL and started the selection according to the STD from 2009.

Methods
A total of 221 patients who underwent a sub total esophagectomy with gastric tube reconstruction during January 2004—April 2017 were investigated. The patients were classified into the 'after STD selection' (A; n = 144) group and the 'before STD selection' (B, n = 77) group. The incidences of and the risk factors for AL between the two groups were compared.

Results
The incidence of AL was high in the B group (18.2%), and 78.6% of the patients who developed AL were treated with RS route reconstruction. The median STDs of the patients with AL and no AL were 10.3 mm and 14.5 mm, respectively (p = 0.001). These results demonstrated that the STD was a risk factor for AL in RS route. Based on these results, 13 mm was set as the cutoff value. After STD selection, the median STD increased from 14.0 mm to 17.3 mm (p = 0.001), and the incidence of AL decreased significantly from 26.2% to 11.1% in RS route (p = 0.037).

Conclusion
The STD was the independent risk factor for AL in the RS route. RS route reconstruction should be avoided for the patients with STD &lt;13 mm.
695 METASTASIS OF THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODE AS PREDICTOR FOR CERVICAL LYMPH NODE DISSECTION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Leng Xue-feng , He Wenwu , Leng Xuefeng , Luo Qiyu , Mao Tianqin , Deng Xuyang , Han Yongtao 
Published: September 2021

Abstract

Lymph node(LN)metastasis is a common metastasis mode of esophageal squamous cell carcinoma (ESCC). The purpose of this study is to explore whether recurrent laryngeal nerve LNs metastasis can be used as a predictor of cervical LN dissection.

Methods
The postoperative pathological examination results of patients with ESCC who underwent three-field LN dissection in Sichuan Cancer Hospital from January 2010 to January 2016 were retrospectively collected to explore the relationship between the recurrent laryngeal nerve LN metastasis and cervical LN metastasis. At the same time, analyzed survival data to determine whether cervical LN dissection should be performed on patients with thoracic ESCC.

Results
Among all the study subjects, 53.3% (72/135) patients had metastasis in the thoracic recurrent laryngeal nerve LNs, and 36.3% (49/135) patients had metastasis in the cervical LN. 44.4% (32/72) Patients with metastasis in the thoracic recurrent laryngeal nerve LN tended to have a high incidence of cervical LN metastasis (P = 0.035). Subgroup analysis showed that 60% (81/135) patients had upper thoracic ESCC, and 46.9% (38/81) patients had cervical LN metastasis (P = 0.002). Survival analysis showed that patients with cervical LN metastasis had poor survival (P &lt; 0.001). Multivariate analysis showed that bilateral recurrent laryngeal nerve LN metastasis was an independent risk factor for survial(P = 0.029).

Conclusion
Patients with bilateral recurrent laryngeal nerve LN metastasis in upper thoracic ESCC can be used as a predictor of cervical LN dissection.
696 LONG-TERM OUTCOMES OF MINIMALLY INVASIVE ESOPHAGECTOMY COMPARED TO OPEN ESOPHAGECTOMY: A RETROSPECTIVE ANALYSIS OF 2958 CASES IN SINGLE CANCER CENTER
Authors: Leng Xue-feng , Li Kexun , Wang Qifeng , He Wenwu , Liu Kun , Li Zhiyu , Zheng Kai , Luo Qiyu Qiyu , Li KunZhi , Mao Tianqin , Deng Xuyang , Luo Xi , Fang Qiang , Peng Lin , Han Yongtao 
Published: September 2021

Abstract

Esophageal cancer is the fourth primary cause of cancer-related death in the male in China.The cornerstone of treatment for resectable esophageal cancer is surgery. With the development of minimally invasive esophagectomy (MIE), it is gradually adopted as an alternative to open esophagectomy (OE) in real-world practice. The purpose of this study is to explore whether MIE vs. OE will bring survival benefits to patients with the advancement of treatment techniques and concepts.

Methods
Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database). We retrospective analyzed esophageal cancer patients who underwent esophagectomy from Jan. 2010 to Nov. 2017. Patients were divided into two groups: MIE and OE groups. Clinical outcome and survival data were compared using TNM stages of AJCC 8th edition.

Results
After 65.3 months of median follow-up time, 2958 patients who received esophagectomy were included. 1106 of 2958 patients (37.4%) were underwent MIE, 1533 of 2958 patients (51.8%) were underwent OE. More than half of the patients (56.7%, 1673/2958) were above stage III. The median overall survival (OS) of 2958 patients was 51.6 months (95% CI 45.2–58.1). The MIE group's median OS was 74.6 months compared to 42.4 months in the OE group (95% CI 1.23–1.54, P &lt; 0.001). The OS at 1, 3, and 5 years were 90%, 68%, 58% in the MIE group; 85%, 54%, 42% in the OE group,respectively (P&lt;0.001).

Conclusion
The nearly 8-year follow-up data from this single cancer center suggests that with the advancement of minimally invasive surgical technology, MIE can bring significant benefits to patients' long-term survival compared with OE. Following the continuous progression of minimally invasive surgery and establishing a mature surgical team, MIE should be encouraged.
714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW
Authors: Bull Charles , Pucher Philip H , Gossage James 
Published: September 2021

Abstract

The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery.

Methods
A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores.

Results
28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis.

Conclusion
Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.