bluuebunny/crossref_metadata_2025_split huggingface dataset:
23 GASTRIC BYPASS AS REVISION SURGERY FOR FAILED FUNDOPLICATIONS
Authors: Ezz Reda 
Published: September 2021

Abstract

Laparoscopic fundoplication as anti-reflux technique has emerged and widely expanded as a cost effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). Long-term success rate ranges from 80–90% with this procedure, but side effects still exist even with experienced surgeons.
Patients with a failed anti-reflux procedure are becoming a more common problem nowadays. Although most of these patients can be managed medically, still some of them will require revisional surgery.

Methods
We presented our experience from January 2015 to June 2019 facing cases of failed fundoplications. 59 cases with failed fundoplication requiring revision were included in the study. Redo fundoplications were decided preoperatively or intraoperatively to be difficult or unsafe to be done for these cases. Revision surgery for these cases was done using either distal gastrectomy and RY gastro-jejunostomy (22 cases) when the hiatal dissection was not feasible or unsafe due to obscure anatomy or Truncal vagotomy and RY gastro-jejunostomy (37 cases) when the hiatal dissection was easy and feasible.

Results
Laparoscopy was used in 49 cases and was successfully completed in 42cases (%) and 7conversion (%). Improvement of symptoms: Recurrent reflux or dysphagia was noted in 19 cases (32%) and complete disappeared in 26 cases (44%). One case had leak from the GJ and another one got hematemesis. Both cases were managed conservatively. Nine patient (15%) had bile gastritis with abdominal pain. Five patients (8.5%) complained of dumping symptoms. No mortality was recorded.

Conclusion
RY gastro-jejunostomy for failed fundoplications is a valid, feasible surgical option when redo fundoplication is difficult to be done or if associated with possible or expected complications.
243 PROGNOSTIC IMPACT OF CXCR7 AND CXCL12 EXPRESSION IN PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA
Authors: Goto Masakazu , Shibahara Yukiko , Baciu Cristina , Allison Frances , Derouet Mathieu , Yeung Jonathan , Darling Gail , Liu Mingyao 
Published: September 2021

Abstract

Chemokines are major regulators of cell trafficking and adhesion. The chemokine CXCL12 and its receptors, CXCR4 and CXCR7, have recently been reported as biomarkers in various cancers, including esophageal squamous cell carcinoma; however, there are few studies of these chemokines in esophageal adenocarcinoma (EAC). In this study, we investigated the relationship between expression of CXCL12, CXCR4 and CXCR7, and prognosis in patients with EAC.

Methods
This study examined 55 patients with EAC who were treated in Toronto General Hospital from 2001 to 2010. Tissue microarray immunohistochemistry was used to evaluate the expression of CXCL12, CXCR4 and CXCR7. Evaluation of immunohistochemistry was performed by a pathologist without knowledge of patients’ information and scored based on a semiquantitative scoring system. The average score from multiple cancer tissues on the microarray was utilized and patients were divided into high or low expression groups using the median score as a cutoff point. These results were compared with the patients’ clinicopathological features and survival.

Results
The score of CXCR7 was positively correlated with that of CXCL12 (r = 0.3154). High CXCR7 expression was significantly associated with lymphatic invasion (present vs absent, P = 0.005), higher number of lymph node metastases (pN0–1 vs pN2–3, P = 0.0014) and TNM stage (Stage I-II vs III-IV, P = 0.0168). Patients with high CXCR7 (n = 23) expression was associated with worse overall (OS) and disease-free survival (DFS) (P = 0.0221, 0.0090, respectively), and patients with high CXCL12 (n = 24) tended to have worse OS and DFS (P = 0.1091, 0.1477, respectively). High expression of both CXCR7 and CXCL12 was an independent prognostic factor for DFS on multivariable analysis (HR0.3, 95%CI: 0.1–0.8, P = 0.0115).

Conclusion
High CXCR7 expression was associated with poor prognosis in patients with EAC, and high expression of CXCR7 and its ligand CXCL12, had a stronger association on prognosis. Further study of this potential biomarker using whole tissue samples and larger sample size is warranted.
245 A RETROSPECTIVE ANALYSIS OF ADVERSE EVENTS OF PERORAL ENDOSCOPIC MYOTOMY
Authors: Drazilova Dagmar , Vackova Zuzana , Hucl Tomas , Stirand Petr , Kieslichova Eva , Ryska Ondrej , Spicak Julius , Martinek Jan 
Published: September 2021

Abstract

Peroral endoscopic myotomy (POEM) has rapidly vindicated its position within the spectrum of achalasia treatment methods due to its excellent efficacy and safety. Nevertheless, POEM remains an invasive intervention which still carries risk of potential complications. The aim of our detailed analysis was to assess the perioperative and early postoperative adverse events in patients undergoing POEM at our institution.

Methods
We retrospectively evaluated the prospectively collected data from all consecutive patients who underwent POEM 12/2012–5/2018 at our institution and searched for periprocedural complications.
Surgical classification Clavien Dindo (C-D) was used to assess the severity of adverse events.

Results
A total of 243 POEM procedures were performed. 73 procedures (30.0%) passed uneventfully while in 170 procedures (70.0%), 208 adverse events occurred. Minor AEs (C-D I,II) were as follows: allergic reaction to antibiotics (2/243; 0.8%), anaesthesia-related complications (14; 5.8%), pain requiring analgesics (158; 65%), fever (20; 8.2%), pneumonia (3; 1.2%) and irreversible loss of taste and smell (1; 0.4%).
Major adverse events (CD III and more) included: post-POEM leak from mucosal incision requiring endoscopic clipping (5; 2.0%), pneumothorax (2; 0.8%), pleural effusion (1; 0.4%), scrotum emphysema (1; 0.4%) and death due to sudden cardiac arrest (1; 0.4%).

Conclusion
Minor POEM-related adverse events are rather common. Although being rare, severe complications, and even fatal, may still occur. Overall, POEM can be considered a safe procedure.
303 LONG-TERM SURVIVAL AND PULMONARY COMPLICATIONS IN MEDIASTINOSCOPIC ESOPHAGECTOMY
Authors: Konishi Hirotaka 
Published: September 2021

Abstract

The radical esophagectomy for esophageal cancer is an invasive therapy due to a long one-lung ventilation. The mediastinoscopic esophagectomy in consideration of pulmonary complications became eligible for Japanese health insurance.

Methods
Radical esophagectomies (R0/1, gastric tube reconstruction) by thoracotomy/thoracoscopy (groupT) or mediastinoscopy (groupM) were performed for 118/58 or 225 patients with esophageal cancer. The long-term therapeutic results of mediastinoscopic radical esophagectomy are investigated.

Results
In clinicopathological features, younger and lower PS patients, neoadjuvant chemotherapy, advanced cases, or R1 resection were more frequent in groupT (p &lt; 0.01). Pulmonary complication was not significantly different in both groups (15.5 vs 11.0%, p = 0.19), whereas the any complications, including the recurrent nerve paralysis, were significantly frequent in groupM. The 5-years overall survival was better in group M (53.0% vs 68.2%, p = 0.04), but it may be because of the difference of cancer progression. In the subgroup analysis, the overall survival rate was similar in each clinical stage. The survival of patients with pulmonary complication was significantly worse in groupT.

Conclusion
The survival of patients underwent trans-mediastinoscopic radical esophagectomy was not different from that with conventional esophagectomy. The influence of pulmonary complications on survival may be lower in mediastinoscopic esophagectomy.
333 THE LONG-TERM TREATMENT OUTCOMES OF ESOPHAGEAL SCC WITH MM/SM1 INVASION AFTER ENDOSCOPIC RESECTION
Authors: Naito Sakiko , Yoshio Toshiyuki , Yoshimizu Shoichi , Ishiyama Akiyoshi , Tsuchida Tomohiro , Itoi Takao , Fujisaki Junko 
Published: September 2021

Abstract

Resent advances in endoscopic resection (ER) provide us increasing chances for resecting esophageal SCC with muscularis mucosae (MM) and submucosal (SM) invasion. We perform additional therapy such as chemoradiotherapy (CRT) or esophagectomy considering the risk of metastasis and patient’s condition. However, there is only a few reports about long-term outcome after ER for such cases.

Methods
We retrospectively studied 188 case of esophageal SCC with pathological MM invasion resected by ER (161 cases) and SM1(27 cases) from 2005 to 2016 in Cancer Institute Hospital. We recommended CRT or esophagectomy as additional treatment for the cases which had lymphovascular invasion (LVI) or DI (droplet infiltration) considering patients’ conditions. Median observation period of them were 71 months.

Results
The SM1 cases had significantly higher rate of LVI than the MM cases. Of 161 MM cases, 2 cases had recurrence, however, they are alive after CRT or CRT following esophagectomy. Of 27 SM1 cases, 3 cases had LN recurrence, underwent RT or CRT or CRT following esophagectomy, one case died of esophageal SCC and the others survive. The rate of metastatic cases was higher in SM1 than that in MM. Overall survival rate in 5 years were 89.8% in MM and 81.8% in SM1. Cause specific survival rate in 5 years were 100% in both MM and SM1.

Conclusion
The long-term outcomes of ER for MM/SM1 invasive esophageal SCC was good with appropriate additional therapy which we should perform in high risk cases for LN metastasis considering patients’ condition.
383 LAPAROSCOPIC CREATION OF RETROSTERNAL ROUTE FOR GASTRIC CONDUIT RECONSTRUCTION; SAFE AND FEASIBLE PROCEDURE
Authors: Horikawa Manabu , Oshikiri Taro , Kitamura Yu , Horie Kazumasa , 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

Reconstruction routes after esophagectomy include posterior mediastinal, retrosternal, and subcutaneous route. We have performed posterior mediastinal reconstruction, but this route has higher risks of gastro-tracheal fistula and hiatal hernia. To avoid these complications, now we take the retrosternal route as our first choice by creating the route laparoscopically before pulling-up gastric conduit. We report the successful and safe procedure.

Methods
We performed laparoscopic creation of retrosternal route in 13 thoracoscopic/robot-assisted minimally invasive esophagectomies since August 2019. In practice, a peritoneal incision at the dorsal side of the xiphoid process is started. Then, via 12 mm port on the surgeon's right hand inserted slightly to the right and cranial side of the umbilical camera port, we dissect loose connective tissues from the caudal side to the cranial side behind the sternum and inside the internal thoracic vessels as landmarks. The time required to create the route and pleural injury rate during the procedure was examined.

Results
Thirteen cases were divided into two groups as early period group (seven cases) and later period group (six cases) respectively. The time required for route creation was 31.3 minutes(average) in the early period group, and 16.7 minutes in the later period group. There is tendency towards faster in later period group than in earlier one. The overall pleural injury rate was 15% (2 of 13 cases). Although it was difficult to determine the amount of bleeding, it was visually observed that the bleeding during the route creation was lower in the later period group than in the early period group.

Conclusion
The entire laparoscopic procedure to create retrosternal route makes it easier to observe and preserve the pleura and internal thoracic vessels compared to blind blunt dissection. As a conclusion, laparoscopic creation of retrosternal route for gastric conduit reconstruction is safe and feasible with good learning curve.

Video
https://www.dropbox.com/sh/p0wc3x46n33jp23/AADwiWHYIEUNUX6qZsERVIOga?dl=0.
39 THE OUTCOMES OF MESENTERIC EXCISION FOR ESOPHAGEAL CANCER SURGERY
Authors: Sakaguchi Masazumi , Hosogi Hisahiro , Tokoro Yukinari , Yagi Daisuke , Kanaya Seiichiro 
Published: September 2021

Abstract

We reported the esophagus, trachea, recurrent laryngeal nerves (RLNs), and regional lymph nodes are contained in a common compartment, which we named mesotracheoesophagus. We believe complete resection of the mesotracheoesophagus is ‘mesenteric excision’ for esophageal cancer, which is the fundamental principle of intestinal cancer surgery. Since June 2011, we have performed minimal invasive esophagectomy (MIE) based on this concept. This study was aimed to evaluate outcomes of our MIE.

Methods
We performed a retrospective study of patients with esophageal cancer who underwent MIE at our hospital between June 2011 and March 2019.

Procedure
First, the dorsal side of the esophagus was dissected along a dissectable layer recognized outside the mesotracheoesophagus. After complete mobilization of the dorsal side of the esophagus, the trachea and RLNs were released from the mesotracheoesophagus and the rest of the fat tissue was dissected for radical LN dissection in the upper mediastinum.

Results
We identified consecutive 151 eligible patients. The median age was 68 year-old (IQR 35–83) and 117 patients were male. Tumor location was Ce:Ut:Mt:Lt:Ae = 1:12:67:58:13. Histologic cell-type was squamous cell carcinoma (SqCC):adenocarcinoma = 142:9. The clinical stage (TNM 8th edition) was I:II:III:IVa = 45:39:56:2 and I:IIB:III:IVA = 2:1:5:1 in patients with SqCC and in those with adenocarcinoma, respectively. R0 resection was performed in all patients. The Clavian-Dindo classification grade III and higher RLN paralysis rate was 7.3% and the pneumonia 5.3%. The mortality rate was 1.3%. Three-year disease free survival rate was 62.3%. Three-year overall survival rate was 71.7%.

Conclusion
The outcomes of mesenteric excision for esophageal cancer surgery were acceptable.

Video
https://www.dropbox.com/s/y1lm3uurr4t86vq/2020%20ISDE%20Abstract.mov?dl=0.
390 STRATEGY FOR TREATMENT OF EARLY ADENOCARCINOMA (T1) OF THE ESOPHAGOGASTRIC JUNCTION ACCORDING TO LYMPH NODE METASTASIS STATUS AND VASCULAR INVASION
Authors: Narumiya Kosuke , Kudo Kenji , Maeda Shinsuke , Toyoshima Yukinori , Ogawa Kyohei , Ide Hiroko , Osugi Harushi , Yamamoto Masakazu 
Published: September 2021

Abstract

Incidence of adenocarcinoma of the esophagogastric junction is increasing in Japan. However, in early cases (T1), there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection according to lymph node metastasis status and vascular invasion in early adenocarcinoma (T1) of the esophagogastric junction.

Methods
We investigated patient characteristics, surgical procedures, recurrence pattern, and optimum extent of lymph node dissection in 22 patients who underwent surgery in our hospital from 2000 to 2016 and were diagnosed with early adenocarcinoma of the esophagogastric junction (by Nishi’s classification).

Results
Four patients with lymph node metastasis, the depth of invasion was sm2 and lymphatic invasion was positive (ly1–ly3, focal lymphatic invasion to prominent lymphatic invasion). In all cases, the site of lymph node metastasis was the lesser gastric curvature. None of the patients developed postoperative lymph node recurrence. An examination of the outcomes revealed that the metastases were hematogenous in all patients with a depth of invasion of sm2 and a positive venous invasion (v1, focal vascular invasion).

Conclusion
We conclude that transhiatal esophagectomy should be selected as a minimal requirement, and that dissection of the abdominal lymph node (particularly on the lesser curvature side of the superior part of the stomach) is sufficient, for patients with early adenocarcinoma of the esophagogastric junction. In cases where the depth of invasion is sm2 or greater and vascular invasion is present, patients may require adjuvant therapy regardless of lymph node metastasis status.
393 DECONVOLUTING THE COMPLEXITY OF LONG NON-CODING RNAS AND ESOPHAGEAL CARCINOMA FOR POTENTIAL CLINICAL IMPLICATIONS
Authors: Luan Siyuan , Yang Yushang , Zhang Shouyue , Zeng Xiaoxi , Xiao Xin , Fu Leilei , Liu Bo , Yuan Yong 
Published: September 2021

Abstract

Long non-coding RNAs (lncRNAs), a type of transcriptional products with more than 200 nucleotides in length, have been less characterized compared to protein-coding RNAs so far. However, it is increasingly evident that lncRNAs are key players involved in multiple genetic and epigenetic activities during the carcinogenesis of neoplastic diseases. Currently, accumulating data have pointed out the close connection between lncRNAs and esophageal carcinoma (EC), shedding light on further unravelling the complexity of lncRNAs and EC.

Methods
In this review, we thoroughly collect the evidence regarding original studies on EC-related lncRNAs by searching in MEDLINE/PubMed, Embase and WOS/SCI. We especially focus on summarizing EC-related lncRNAs based upon more updated evidence, and further discuss their different features from various perspectives, including regulatory mechanisms, functional roles in cancer hallmarks, as well as potential diagnostic and therapeutic applications, which would together reveal the complexity of lncRNAs and EC for potential clinical applications.

Results
We discuss over thirty EC-related lncRNAs in total, most of which function as oncogenes that promote cancer development, while the others function as tumor suppressors. Regulatory mechanisms included sponging miRNAs, direct interaction with proteins, and exosome visicle-based intercellular communication. Based upon these modes of actions, lncRNAs play multiple roles in cancer hallmarks such as uncontrolled cell growth, evasion of programmed cell death, invasion and metastasis. Moreover, lncRNAs packaged in exosomes have unique potency to serve as diagnostic biomarkers; some lncRNAs show great potential to predict patients' chemical resistance and may be crucial targets to improve chemoradiotherapy and targeted therapy.

Conclusion
Over the past few years, the research of EC-related lncRNAs maintain obviously rapid development, yet further exploration of exact mechanisms and clinical applications that lncRNAs can offer need to be done. Indeed, LncRNAs hold the promise of being applied in multiple clinical scenarios, especially early diagnosis of EC, improvement of sensitivity to chemotherapy/radiotherapy, and development of small-molecule targeted drugs.
421 USE OF BIOABSORBABLE MESH TO REINFORCE HIATAL CLOSURE—EARLY RESULTS
Authors: Brandalise Andre , Azevedo Mauricio , Lorenzetti Claudia , Oliveira Guilherme , Aranha Nilton 
Published: September 2021

Abstract

The hiatoplasty is one of the keypoints of hiatal hernia surgery.
Reherniation is known to be a frequent reason for recurrence and reoperation.
Biodegradable materials for reinforcement have been.
shown in some series to reduce these outcomes with very low risks of mesh-related complications.
Long term reports, however, have shown conflicting results.
This may be because meshes have been used in complicated cases, in which other variables can be involved in unfavourable outcomes.

Methods
Based on the safe profile of absorbable meshes, we have used meshes to reinforce the hiatoplasty in patients with theoretical higher risks of hernia recurrence.
Twenty four patients were operated using bioabsorbable mesh (Gore Bio A®), implanted as an onlay inverted C over a completely closed hiatus.
Two surgeons were responsible for all the surgeries.
There were 16 (66,6%) women and 8 (33,3%) men.
The main reasons for using a mesh were: primary large hiatal hernias (4 cm or more)—14 cases; redo hiatal hernias—8 cases; increased abdominal pressure—2 cases.

Results
All surgeries were performed between April 2018 and January 2020.
Meshes were fixed to the diaphragm using absorbable sutures, fibrin sealant or cyanoacrylate.
In all cases, a Nissen fundoplication was performed.
There were no conversions.
Two (8,3%) patients complained of troublesome dysphagia requiring intervention. One had to be operated within the first 48 hours after surgery: 2 stitches of the hiatus were removed and the fundoplication was converted into a Toupet. The other patient was submitted to endoscopic dilatation and still referes mild dysphagia.
In a short follow up period (1–19 months), 23 patients (95,8%) are asymptomatic.

Conclusion
The use of bioabsorbable mesh in the hiatus is safe and have shown good symptomatic outcomes in the short follow up period. Objective results and longer follow up are needed to see if additional reinforcement of hiatoplasty contributes to reduce recurrence and reoperation rates.
477 MINIMALLY INVASIVE MEDIASTINOSCOPIC IVOR-LEWIS ESOPHAGECTOMY WITH CERVICAL ANASTOMOSIS FOR ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA PATIENT UNDER INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING
Authors: Suzuki Akihiro , Mori Kazuhiko , Hirose Shuntaro , Tashiro Jo , Matsubara Taketo , Kaido Toshimi 
Published: September 2021

Abstract

In early 2000s, cervical anastomosis after esophagectomy was associated with a higher rate of recurrent nerve trauma than thoracic anastomosis. Recently, new technologies have been developed that reduce surgical complications. Mediastinoscopic esophagectomy is reportedly less invasive and allows faster recovery than thoracoscopic esophagectomy. Intraoperative nerve monitoring (IONM) prevents recurrent laryngeal nerve (RNL) palsy. We present the case of minimally invasive mediastinoscopic Ivor-Lewis Esophagectomy (MMIE) under IONM performed on an elderly esophagogastric junction (EGJ) adenocarcinoma patient.

Methods
An 84-year old man was consulted for adenocarcinoma of GEJ without lymphnode metastasis. Despite his advanced age, he had no comorbidities. We planned to perform MMIE under IONM.
The procedure started with a patient lithotomy, and three trocars plus small incision were made in the upper abdomen. Celiac lymphadenectomy was performed. Subsequently, a 35 mm incision was made in the left side of the neck and a monitor was attached to left vagus nerve. Three trocars were placed with single incision surgical devices and pneumomediastinum was noticed. Mediastinoscopic esophagectomy was performed. Gastric tube reconstruction via mediastinum with cervical anastomosis was performed.

Results
The operation was successful. Total operation time was 393 minutes, with an estimated blood loss of 5 mL. There were no intraoperative and postoperative complications, and no RLN palsy occurred.

Conclusion
MMIE with cervical anastomosis under IONM is safe and less invasive especially for the respiratory system as a thoracotomy is unnecessary.

Video
https://www.dropbox.com/s/9yqkzg3pm619pf6/%E7%B8%A6%E9%9A%94%E9%8F%A12%E5%88%8656%E7%A7%92.mp4?dl=0.