bluuebunny/crossref_metadata_2025_split huggingface dataset:
177 CT RADIOMICS BASED ON MACHINE LEARNING PREDICTING PATHOLOGIC COMPLETE RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Leng Xue-Feng , Wang Qi-Feng , Lang Jin-Yi , Li Tao , Han Yong-Tao , Peng Lin , Yue H , Cheng J , Liu J 
Published: September 2021

Abstract

Neoadjuvant chemoradiotherapy (nCRT) has become the standard treatment for patients with locally advanced squamous cell esophageal cancer (LA-ESCC). Patients with the complete pathologic response (pCR) have significantly improved long-term survival. All efforts should be to improve the accuracy of predicting pCR. In this study, we investigate the use of radiomics based on machine learning to identify the pathologic complete response of patients with esophageal squamous cell carcinoma (ESCC) based on Computed Tomography (CT).

Methods
The study included 155 patients with pathologically confirmed LA-ESCC. All 155 patients underwent simulation CT before nCRT, Quantitative radiomics features were extracted from CT images of each patient. To explore the relationship between radiomics features and the pCR, we used five-fold cross validation to classify the training and the testing cohorts. The Least Absolute Shrinkage and Selectionator operator (Lasso) were used to select features useful for the grading of pCR in the training cohort. Different models were measured in the training cohort using accuracy, sensitivity, specificity, and area under the curve of the receiver operating characteristic curve (AUC).

Results
There were 155 patients. The pretreatment clinical stage was II in 16 patients (10.3%), III in 132 (85.2%), and IV in 7 (4.5%). Pathologic response was complete in 69 patients (44.5%), near-partial complete in 86 (55.5%). A total of 2193 radiomics features were extracted in the training set. After the use of statistical dimensionality reduction, five radiomics features were selected by Lasso to build radiomics signature. Prediction models for pCR were developed, and the model was able to predict pCR well in the training set(AUC = 0.902). In the testing cohorts, the model had a good performance in predicting pCR (AUC = 0.78).

Conclusion
This study showed that CT-based radiomics features could be used as biomarkers to predict the complete pathological response of esophageal cancer underwent Neoadjuvant chemoradiotherapy.
178 RANDOMIZED CONTROLLED TRIAL COMPARING ANGLE OF HIS ACCENTUATION WITH TOUPET FUNDOPLICATION IN PATIENTS UNDERGOING LAPAROSCOPIC HELLERS MYOTOMY: INTERIM RESULTS
Authors: Parshad Rajinder , Bale Manjunath , Bhattacharjee Hemanga , Singla Vitish , Saraya Anoop , Sharma Raju 
Published: September 2021

Abstract

Laparoscopic Heller’s Cardiomyotomy (LHCM) is the surgical treatment of choice for achalasia. Addition of an antireflux procedure is recommended to reduce the postoperative reflux. However, there is no consensus regarding the ideal antireflux procedure. In an earlier study we have shown that Angle of His accentuation (AOH) is similar to Dor fundoplication. In this study we present the interim results of an RCT comparing AOH with Toupet fundoplication as an adjunct to LHCM.

Methods
Patients of Achalasia cardia presenting after October 2017 were randomised to receive either AOH or Toupet following Heller cardiomyotomy based on computer generated random sequence. Primary outcome was incidence of post-operative symptomatic reflux and esophagitis on endoscopy. Secondary outcome was relief of dysphagia and Achalasia specific health related Quality of life assessment (ASHRQoL). Symptom scores for dysphagia, regurgitation and heartburn as well as ASHRQoL were noted pre operatively and at 3 monthly intervals. Objective evaluation was done using timed barium swallow, Upper GI endoscopy and oesophageal manometry. Data was recorded on excel spreadsheet and analysis done using SPSS v5.

Results
A total of 52 patients (25 Toupet, 27 AOH) were included in the analysis. All patients were successfully operated laparoscopically with no conversions, intraoperative perforations or perioperative mortality. The mean operative duration was 128 min in the AOH group and 146 min in the Toupet group (p &lt; 0.05). There was significant improvement in symptom scores as well as objective parameters in both groups with no difference between the 2 groups at a mean follow-up of 6 months (5-9 months; Table 1). 3 patients in AOH group (11%) and 4(16%) patients had new onset reflux with esophagitis in 2 patients in each group.

Conclusion
AOH is technically easier and can be performed in a shorter time. The symptom relief is similar in both groups with similar incidence of heartburn and esophagitis in the short term. A longer follow up is recommended in a larger number of patients.
189 GLUCOCORTICOID RECEPTOR AND SERUM- AND GLUCOCORTICOID-INDUCED KINASE-1 IN ESOPHAGEAL ADENOCARCINOMA AND ADJACENT BARRETT’S ESOPHAGUS
Authors: Gokon Yusuke , Fujishima Fumiyoshi , Taniyama Yusuke , Ueki Shunsuke , Kamei Takashi , Sasano Hironobu 
Published: September 2021

Abstract

Barrett’s esophagus (BE) is a consequence of gastroesophageal reflux disease and is predisposed to esophageal adenocarcinoma (EAC). EAC is an exemplar model of inflammation-associated cancer. Glucocorticoids suppress inflammation through glucocorticoid receptor (GR) and serum- and glucocorticoid-induced kinase−1 (Sgk1) expressions.

Methods
We immunolocalized GR and Sgk1 in EAC and the adjacent BE tissues and studied their association with clinical disease course in 87 patients with EAC who underwent surgical resection (N = 58) or endoscopic submucosal dissection (N = 29).

Results
Low GR and Sgk1 expressions in adjacent BE tissues were associated with adverse clinical outcomes (P = 0.0008 and 0.034, respectively). Patients with low Sgk1 expression in EAC cells exhibited worse overall survival (P = 0.0018). In multivariate Cox regression analysis, low GR expression in the adjacent nonmalignant BE tissues was significantly associated with worse overall survival (P = 0.023).

Conclusion
The present study indicated that evaluation of GR and Sgk1 expressions in both the EAC cells and adjacent nonmalignant BE tissues could help to predict clinical outcomes following endoscopic and surgical treatments. In particular, the GR status in BE tissues adjacent to EAC was an independent prognostic factor.
191 CURRENT STATUS OF ESOPHAGECTOMY IN JAPANESE NATIONAL CLINICAL DATABASE
Authors: Kakeji Yoshihiro , Takahashi Arata , Hasegawa Hiroshi , Takiguchi Gosuke , Oshikiri Taro , Nakamura Tetsu , Miyata Hiroaki , Kitagawa Yuko 
Published: September 2021

Abstract

The Japanese National Clinical Database (NCD) started its data registration since 2011, has grown up to a large nationwide database covering more than 95% of the surgeries performed by regular surgeons in Japan. The NCD grew rapidly harvesting over 11 million cases data between 2011 and 2018 from more than 5,000 facilities.

Methods
In this period, the surgeries of the esophagus were performed for 70,528 cases. In 2018, 93.8% of surgeries were performed at certified institutions, and 94.7% did with the participation of the board-certified surgeon. The board-certified surgeons operated 75.2% of the surgeries.

Results
Esophagectomy was performed for 47,055 patients in eight years. In 2018, 23.3% of the cases were 75 years old or more. Postoperative complications of Clavien Dindo classification grade III or higher occurred in 22.9% of all. As the patients have been getting older, the morbidities have been increasing. However, the mortalities have been kept at a low level. Postoperative 30-day and 90-day mortalities were 0.9% and 1.9%, respectively. The rates of endoscopic surgery have been increasing year by year, especially high in esophagectomy, which was 61.0% in 2018.

Conclusion
A risk-adjusted analysis based on nationwide data allows personnel to establish and provide feedback on the risks that patients face before undergoing a procedure. The risk calculator for eight main procedures are available on the websites of the hospitals that are a part of NCD. Nationwide this database is surely expecting to ensure the quality of board certification system and surgical outcomes in gastroenterological surgery.
212 USEFULNESS OF ENDOSCOPIC ESOPHAGECTOMY IN A PRONE POSITION FOR ELDERLY PATIENTS OVER 75 YEARS OLD
Authors: Ito Ken , Kamei Takashi , Chin Masahiro , Hagiwara Motohisa , Hara Yasuyuki , Kumata Hiroyuki , Hashizume Eiji 
Published: September 2021

Abstract

Surgery for esophageal squamous cell carcinoma(ESCC) is one of the most invasive surgery and high mortality rate because operation is centered on the thoracic cavity. Recently, Japan has been facing aging society, and surgery for elderly ESCC patient is increasing. In our hospital, we changed surgical position from left lateral position to prone. In this study, we investigated the surgical outcome and prognosis of ESCC operation in the patients aged ≧ 75.

Methods
From April 2011 to March 2019, 39 ESCC operations for patients aged ≧ 75 were performed in our hospital. We compered surgical position. We retrospectively examined clinicopathological factors, long-term prognosis, preoperative nutritional status (albmin, neutrophil and lymphocyte ratio), and operation factors (operation time, blood loss, recurrent nerve paralysis, complication, hospital stay).

Results
Cases in lateral position surgery were 22 and prone position were 17. The median age was 79 vs 79 years old, and the gender ratio was male: female = 16:6/14:3. No significant differences were observed in preoperative nutritional status. The operation time was 458 min vs 501 min (p = 0.126). The blood loss was 318 mL vs 195 mL (p = 0.003). The rate of recurrent nerve paralysis was 42.1% vs 29.4% (p = 0.262). The number of patients in Clavien-Dindo ≧ III complications was 40.9% vs 41.2% (p = 0.987). 3-year OS was 74.7% vs 77.3%, DFS was 78.6% vs 67.7%.

Conclusion
In ESCC patients aged ≧ 75, surgery in prone position was relatively safe. The blood loss and the recurrent nerve paralysis ware tend to be less. Recurrent nerve monitoring during operation and evaluation of perioperative swallowing function seemed to be the next subject.
258 MANAGEMENT OF OESOPHAGO-GASTRIC LEAKS FOLLOWING MINIMALLY INVASIVE IVOR LEWIS OESOPHAGO-GASTRECTOMY USING DOUBLE PIGTAIL STENTS
Authors: Tan Jeremy , Wong Wai Keong , Yeung Baldwin , Toh Bin Chet , Ong Lester , Lim Chin Hong , Lim Eugene , Eng Alvin , Ong Hock Soo , Lee Zhen Jin , Lye Tiffany , Chan Weng Hoong 
Published: September 2021

Abstract

Anastomotic leak following Ivor Lewis oesophago-gastrectomy is a major complication with high morbidity and mortality. We report our experience with three such cases where endoscopically deployed double pigtail stents (DPT) were used to help manage the leaks.

Methods
Three patients from October 1, 2019 to February 29, 2020 experienced leakage from the oesophago-gastric anastomosis following minimally invasive Ivor Lewis oesophago-gastrectomy. These occurred on post-operative day 9, day 29 and day 7 respectively. All cases were managed with endoscopic deployment of double pigtail stents along with other adjunctive measures.

Results
To date all patients remain alive, with sepsis under control. One of the patients had been able to have his double pigtail stent removed at six weeks and he has been able to commence adjuvant chemotherapy. Another patient had a follow-up contrast study one week after DPT insertion which showed no further contrast extravasation and was able to recommence oral intake. The third patient has a left empyema (managed conservatively with a combination of internal DPT and external pigtail drainage) which is gradually resolving.

Conclusion
Endoscopically deployed DPTs are a useful tool in the armamentarium for managing oesophago-gastric anastomotic leaks in selected patients following Ivor Lewis oesophago-gastrectomy. They are advantageous in that stent migration does not appear to be an issue, nor is there any problem with leakage around the stent. Patients are mostly able to restart oral intake soon after insertion of DPTs. This reduces the morbidity associated with these anastomotic leaks, and reduces the number of interventions needed.
267 INTESTINAL STEM CELL MARKERS AND ITS POTENTIAL USE IN THE CLINICOPATHOLOGICAL SETTING OF ESOPHAGEAL ADENOCARCINOMA
Authors: Shibahara Yukiko , Espin-Garcia Osvaldo , Conner James , Weiss Jessica , Derouet Mathieu , Allen Jonathan , Wilson Gavin , Allison Frances , Kalimuthu Sangeetha , Wong Rebecca , Elimova Elena , Yeung Jonathan , Darling Gail 
Published: September 2021

Abstract

Barrett’s esophagus (BE) is the primary precursor lesion of esophageal adenocarcinoma (EAC), which not only resembles the intestinal mucosa morphologically but also expresses various intestinal stem cell (ISC) markers. We hypothesized that ISC markers, Lgr5 (also a cancer stem cell marker), Ascl2 (fate determinator of ISC),Bmi1 (quiescent counterpart of Lgr5) and Cdx2 (primary regulator of ISC gene expression) have clinicopathological significance and could potentially be a predictor for survival in EAC.

Methods
Tissue microarray consisted of 64 EAC and 22 BE, and the expressions of Lgr5, Ascl2, Bmi1 and Cdx2 were analyzed using immunohistochemistry and scored independently by two pathologists. Clinicopathological factors (age, pathological grade and stage, affected lymph nodes, neoadjuvant therapy) were confounding factors, and univariable analysis using Fisher's exact tests as well as survival analysis using the Kaplan–Meier (KM) method and Cox proportional hazards regression (Cox PH) were performed to investigate its statistical significance. We performed a bioinformatic analysis of the TCGA dataset to validate the immunohistochemical findings.

Results
Among EAC, 69%, 88%, 64% and 70% expressed high Ascl2, Lgr5, Bmi1 and Cdx2, respectively. High Ascl2 and low Lgr5 expression significantly correlated to a higher number of involved lymph nodes; high Bmi1 expression significantly correlated to the pathological stage. Cdx2 was not correlated to any markers. KM analysis showed a negative impact of high Ascl2 expression on overall survival (OS; p = 0.0276) as well as progression-free survival (PFS; p = 0.0466), but not Lgr5, Bmi1 nor Cdx2. Cox PH analysis revealed Ascl2 (p = 0.011), and Cdx2 (p = 0.015) expression are independent prognostic factors for EAC.

Conclusion
Our results suggest that among the four ISC markers, Ascl2 and Cdx2 protein holds potential to be utilized as a prognostic biomarker. TCGA dataset revealed the association of ASCL2 mRNA expression with the number of positive lymph nodes but not overall survival, which implies further research is needed to explain the mechanism of Ascl2 overexpression in EAC carcinogenesis via ISC regulation.
270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH
Authors: Wu X , Gan X , Cao Q 
Published: September 2021

Abstract

Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision.

Methods
A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA.

Results
The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation.

Conclusion
This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.
281 ANALYSIS OF NON-CANCER-RELATED DEATH CASES AFTER ESOPHAGEAL CANCER SURGERY
Authors: Uemura Norihisa , Saiki Takahiro , Arai Toshiyuki 
Published: September 2021

Abstract

Many patients with esophageal cancer have problems with preoperative physiological functions related to smoking, drinking, and malnutrition. Therefore, a certain frequency of patients die from other diseases after radical resection of esophageal cancer. In this study, we examined non-cancer-related death cases after esophageal cancer surgery to clarify the clinical significance and to consider its improvements.

Methods
In this retrospective cohort study, we examined 52 patients with esophageal cancer treated surgically from 2011 to 2016. Of the 52 patients analyzed, 7 died of other diseases during postoperative follow-up. Seven of the 52 patients were women, but all 7 died of other diseases were men. The median age of the 7 patients was 72 (65–76) years, slightly older than the median age of 66 (50–76) years in all cases.

Results
The postoperative survival of the 7 patients who died from other diseases was 9.4 months, including four patients who died early within one year without recurrent lesions. Their death was due to aspiration pneumonia in 5, 1 asphyxiation, and 1 unknown. The median preoperative BMI of the 7 patients who died of other diseases was 19.5, lower than 21.4 in all cases. The median preoperative one second forced expiratory volume was 2.36 L for the 7 patients, which was lower than 2.54 L in all cases.

Conclusion
Other deaths after esophagectomy were more common in men, the elderly, thinner, and patients with reduced respiratory function. Because there are some cases of death from other diseases early after esophagectomy, early rehabilitation intervention and nutrition management are required after surgery.
342 SURGICAL TREATMENT OF ESOPHAGEAL CANCER WITH VARIATIONS OF THE AORTIC ARCH AND ITS BRANCHES
Authors: Li Baiwei , Dai Liang , Jiang Haoyao , Li Zhigang , Chen Keneng 
Published: September 2021

Abstract

The variations of the aortic arch and its branches are rare. The surgical treatment of esophageal cancer would be challenged for combination with this anomaly. This study intends to review significant group cases to analyze the influence of this variation on esophagectomy.

Methods
From 2013 to 2019, 19 patients with aortic arch and brachiocephalic vessels variations underwent esophagectomy, accounting for 0.3% during the same period. The abnormalities were distributed as follows: left-sided aortic arch combined with aberrant right subclavian artery (LAA + ARSA) occurred 13 cases, right-sided aortic arch anomalies with mirror image arch branches (RAA + MIAB) in 1 case, and right-sided aortic arch combined with aberrant left subclavian artery (RAA + ALSA) in 5 case. Of the patients with LAA + ARSA, 11 patients underwent the McKeown esophagectomy, and 2 patients via transhiatal. All patients with RAA underwent left thoracotomy approach.Perioperative outcomes and long-term survival were analyzed.

Results
The tumors were mostly located in the upper and middle thorax (47.4% and 42.1%). The R0 resection rate was 89.5% (17/19). Recurrent laryngeal nerve injury occurred in 2 patients, anastomotic fistula in 1 patient. Two patients died within 30 days postoperatively. The yield of lymph nodes was 21.8 ± 9.4. The sampling rate of lymph nodes along the recurrent laryngeal nerve was 61.5% in LAA + ARSA group, while 16.7% in RAA group. Recurrence happened in 5 cases (29.4%), including 2 regional relapse. Four patients died after recurrence, with a median time to death of 20 months (range: 10–48 months).

Conclusion
For aortic arch and brachiocephalic artery variations in esophageal cancer, aberrant right subclavian artery and right-sided aortic arch are the most common types. The surgical strategy is closely related to the aortic arch position. Due to the combined variation of the recurrent laryngeal nerve, the upper mediastinal lymph nodes dissection would be conservative, but with acceptable oncologic results.
362 SUPERIOR POLAR GASTRECTOMY ASSOCIATED WITH ANTI-REFLUX TECHNIQUE: CASE REPORT
Authors: Navío-Seller Ana , Jiménez-Rosellón Raquel , Bruna-Esteban Marcos , Vaqué-Urbaneja Javier , Mingol-Navarro Fernando 
Published: September 2021

Abstract

Superior polar gastrectomy remains an accepted surgical alternative for proximal gastric tumors, although this approach has higher rates of gastroesophageal reflux since the valvular mechanism of cardias disappears. Thus, an additional technique is needed to avoid its presence.

Methods
This is a description of surgical technique and short term results of superior polar gastrectomy associated to Kamikawa’s anti-reflux technique in a female patient with proximal gastric cancer.

Results
A 55 year-old female diagnosed with gastric adenocarcinoma. Tumor was 3 cm long, from esophago-gastric junction to subcardial region (cT3N1M0). Patient underwent perioperative chemotherapy and surgical intervention 6 weeks later. A laparoscopic superior polar gastrectomy was performed and D1+ lymphadenectomy. A laparotomy was made to externalize the surgical specimen. Saline solution was injected into submucosa of gastric pouch and two seromuscular flaps were dissected. Gastric mucous membrane was opened in the inferior part of the flaps, constructing an esophagogastric end-to-side anastomosis. Seromuscular flaps were sewn overlapping the esophago-gastric anastomosis.
Patient presented an optimal postoperative evolution, without heartburn, dysphagia neither vomiting.

Conclusion
The procedure described here is feasible and performable, and achieves correct oncological results avoiding performing a total gastrectomy and improving the gastroesophageal reflux problems derived from a superior polar gastrectomy.