bluuebunny/crossref_metadata_2025_split huggingface dataset:
627 PL11.02 ENSURE: AN INTERNATIONAL MULTICENTRE STUDY EXPLORING WHETHER SURVEILLANCE AFTER ESOPHAGEAL CANCER SURGERY IMPACTS ONCOLOGICAL AND QUALITY OF LIFE OUTCOMES
Authors: Elliott Jessie A , Markar Sheraz R , Klevebro Fredrik , Johar Asif , Goense Lucas , Lagergren Pernilla , Zaninotto Giovanni , Hillegersberg Richard , Nilsson Magnus , Hanna George , Reynolds John V ,   ENSURE Study Group*
Published: September 2021

Abstract

Although established and emerging therapies for recurrent esophageal cancer (EC) may impact on survival and health related quality of life (HR-QL), surveillance protocols after the primary curative treatment of EC are varied and inconsistent, reflecting a limited evidence-base to guide an optimum approach. Specifically, whether advantages exist for an intensive surveillance protocol is unknown and was the focus of this study.

Methods
ENSURE was an international multicentre observational study of consecutive patients undergoing surgery with curative intent for esophageal and junctional cancers (2009–2015) across 20 European and North American centers (NCT03461341). Intensive surveillance (IS) was defined as routine annual CT/PET-CT during the first three postoperative years, and compared with standard surveillance (SS) with investigation as clinically indicated. The primary outcome measure was overall survival (OS), secondary outcomes included treatment, disease-specific survival (DSS), disease-free survival (DFS), recurrence pattern, and HR-QL. Multivariable linear, logistic and Cox proportional hazards regression analyses were performed to determine the independent impact of surveillance on oncologic outcomes and HR-QL.

Results
4,682 patients were studied, 45.5% underwent IS. At median follow-up of 60 months, 47.5% developed recurrence; oligometastatic in 39% of cases, with 31% receiving best supportive care, 60% chemotherapy and/or radiation, and 8% surgical resection. IS was associated with reduced symptomatic recurrence (OR0.17 [0.12–0.25]), increased tumor-directed therapy (OR2.09 [1.58–2.77]), and improved OS (HR0.90 [0.82–0.98], 5-year OS 47.9 ± 1.2% versus 43.2 ± 1.1%). On multivariable analysis, significantly improved OS with IS was maintained for patients who underwent surgery alone (HR0.60 [0.47–0.78]) and in those with lower pathological (y)pT stages (Tis-2, HR0.72 [0.58–0.89]). IS was associated with greater anxiety (P = 0.016), but similar overall HR-QL.

Conclusion
These data suggest that IS may improve oncologic outcomes, particularly in patients with early stage disease at presentation or with a favorable pathological stage post induction therapy. This may be relevant to guideline development and provide a framework and rationale for RCTs. It may also inform shared decision-making with patients at a time where therapeutic options for recurrence are expanding.
631 CLINICAL APPLICATION VALUE OF THE SYSTEMIC-IMMUNE-INFLAMMATION-INDEX FOR PREDICTING SURVIVAL IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA UNDERGOING CHEMORADIOTHERAPY OR RADIOTHERAPY
Authors: Wang Yuan , Lyu Jiahua , Xiao Ling , Liu Yudi , Liu Xiao , Li Ke , Zhang Rongke , Chen Taiyu , Zhang Hangyue , Tang Chunhan , Li Tao 
Published: September 2021

Abstract

The systemic immune-inflammation index(SII), a prognostic index integrating neutrophils, platelets and lymphocytes, has been shown to have predictive value for several common cancers. The study aim was to explore the clinical application value of the SII for prognosis of patients with esophageal squamous-cell carcinoma (ESCC) treated with radical chemoradiotherapy (CRT) or radiotherapy (RT).

Methods
Overall, 180 patients with ESCC who received radiotherapy with or without chemotherapy, from March 20, 2012 to December 25, 2017 were retrospectively analyzed. Based on serum measurements before/after/during treatment, the SII at ESCC was calculated by multiplying the sera absolute neutrophil and platelet counts, and then, divided by the absolute lymphocyte count. The Kaplan–Meier method and Cox proportional regression models were used to analyze the relationship between SII at different time points, the ratio of before and after radiotherapy and overall survival (OS).

Results
The area under ROC-curve of Ratio of SII before and after radiotherapy(RT-pre/Post-SII) was 0.635. The AUC of SII-values before, during and after radiotherapy was 0.618, 0.624 and 0.453, respectively. The cutoff-value of RT-pre/Post-SII was 0.498, and the patients were divided into low RT-pre/Post-SII group(&lt;0.498) and high RT-pre/Post-SII group(≥0.498). RT-pre/Post-SII was related to tumor-length, KPS and severe thrombocytopenia in ESCC patients(P &lt; 0.05). The median-OS in the high and low RT-pre/Post-SII group were 909 days, and 466 days, respectively. Multivariate analysis showed that KPS(P = 0.045), lymphatic-metastasis(P = 0.032), Mid-RT SII(P &lt; 0.001) and RT-pre/Post-SII(P = 0.003) was independent prognostic factors affecting the prognosis of patients in ESCC treated with RT/CRT.

Conclusion
The calculation of SII value is simple, reliable and repeatable and can improve the accuracy of a patient’s prognosis. ESCC patients treated with RT or CRT with high SII before, and during radiotherapy are most likely to benefit from early anti-inflammatory or immunotherapy before and during radiotherapy, while immunological intervention for SII after radiotherapy is of little significance. Confirmation of these results by a large-sample prospective study is desirable.
632 SUTURED VERSUS MESH-AUGMENTED HIATUS HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Petric Josipa , Bright Tim , Liu David , Wee Melissa , Watson David 
Published: September 2021

Abstract

Repair of large hiatus hernias is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or non-absorbable) repair. This meta-analysis systematically reviewed published randomized control trials (RCTs) comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life.

Methods
A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals.

Results
Seven RCTs were found which compared mesh-augmented (non-absorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6–12 months, 10.1% mesh versus 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3–5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time (P = 0.05, OR 2.33, 95% CI 0.03–24.69).

Conclusion
Mesh repair for hiatus hernia does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.
651 A META-ANALYSIS OF SURVIVAL AFTER NEOADJUVANT CHEMORADIOTHERAPY VERSUS NEOADJUVANT CHEMOTHERAPY IN RESECTABLE LOCALLY ADVANCED ESOPHAGEAL CANCERS BASED ON HISTOLOGIC SUBTYPES
Authors: Waratchanont Rawat , Leelapatanadit Jirat , Asanprakit Wichitra , Kaewkangsadan Viriya , Sattaporn Sukchai 
Published: September 2021

Abstract

Neoadjuvant treatments provided survival benefits over surgery alone in resectable locally advanced esophageal and esophagogastric junction (EGJ) cancer patients. Both neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) are shown to be effective treatments. However, the direct comparison between two methods based on histologic subtypes, squamous cell carcinoma (SCC) and adenocarcinoma (AC) is still limited. This study examined the hypothesis that nCRT could provide the better overall survival (OS) than nCT.

Methods
A comprehensive search of studies comparing nCRT and nCT in patients with esophageal and EGJ cancer based on histologic subtypes was conducted. A meta-analysis of randomized (8 articles) and non-randomized (15 articles) studies was performed using odds ratio (OR) and 95% confidence intervals (CI95%). The OS was the main objective, whereas the secondary objective were complete pathological response (pCR) rate, curative resection (R0) rate, locoregional progression free-survival (L-PFS) rate, postoperative complications and mortality.

Results
Twenty three articles included 1,671 SCC and 9,285 AC patients. Neither 3- nor 5-year OS was found to be different. However, SCC patients receiving nCRT showed the better 3-year OS (OR 1.67, CI95% 1.17–2.40, p = 0.005). Both pCR and R0 rates were superior in nCRT group (OR 3.30, CI95% 2.46–4.44 and 2.46, CI95% 1.66–3.65, p &lt; 0.00001, respectively). The better 3-year L-PFS was observed in nCRT group (OR 1.47, CI95% 1.17–1.85, p = 0.008), but 5-year L-PFS was comparable. The 30-day mortality was comparable, while 90-day mortality was higher in nCRT group (OR 1.32, CI95% 1.01–1.72, p = 0.04).

Conclusion
The nCRT provided the better overall survival especially in SCC patients and also increased locoregional control. Meanwhile, postoperative complications and mortality were higher after nCRT. Due to clinical heterogeneity, the multidisciplinary team management for each patient is required before treatment.
667 PEGYLATED RECOMBINANT HUMAN GRANULOCYTE COLONY STIMULATING FACTOR IN DEFINITIVE CHEMORADIOTHERAPY OF ESOPHAGEAL CANCER: PRELIMINARY RESULTS
Authors: Zhu Hongcheng , Zhu Huijun , Ai Dashan , Chen Yun , Liu Qi , Zhao Kuaile 
Published: September 2021

Abstract

To compare the efficiency and safety of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF), on the risk of neutropenia in patients with esophageal squamous cell carcinoma (ESCC) of definitive chemoradiotherapy (dCRT).

Methods
ESCC patients receiving dCRT in our hospital were adopted in this study. Patients in the PEG-rhG-CSF group were treated with preventive PEG-rhG-CSF 6 mg subcutaneously at 24–48 h after completion of chemotherapy of each cycle, while the control group was not. The usage of rhG-CSF was permitted when the absolute neutrophil count (ANC) ≤2 × 109/L, or white blood cell count (WBC) ≤3 × 109/L.

Results
A total of 34 ESCC patients were in the PEG-rhG-CSF group and 41 were in the control group. Improved chemotherapy cycle completion and radiation dose completion were identified in the PEG-rhG-CSF group (P &lt; 0.001). Leukocyte recovery and neutrophil recovery, (P &lt; 0.001). PEG-rhG-CSF reduced incidence of neutropenia, and time to ANC recovery in different chemotherapy cycles, with (Cycle 1–2, P &lt; 0.001 ~ P = 0.02) or without RT (Cycle 3–4, P = 0.04 ~ P = 0.8799). Antibiotics utilization rates were significantly higher in the PEG-rhG-CSF group during concurrent chemotherapy with RT, but not during consolidative CRT (Cycle 3 and Cycle 4: P &gt; 0.05).

Conclusion
PEG-rhG-CSF prescribed as prophylaxis reduces acute toxicities by concurrent CRT and contributes to completion of dCRT regime in locally advanced ESCC therapeutics. The significance was not observed in chemotherapy alone without RT in the current findings.
668 USEFULNESS OF PRONE-POSITION COMPUTED TOMOGRAPHY AS PREOPERATIVE SIMULATION OF THORACOSCOPIC ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER
Authors: Higuchi Tadashi , Koyanagi Kazuo , Ninomiya Yamato , Yatabe Kentaro , Yamamoto Miho , Tajima Kohei , Ozawa Soji 
Published: September 2021

Abstract

The study aimed to evaluate the usefulness of prone-position computed tomography (CT) for predicting relevant thoracic procedure outcomes in minimally invasive esophagectomy (MIE) for thoracic esophageal cancer.

Methods
A total of 59 patients underwent esophagectomy between May 2019 and December 2020 in Tokai University Hospital. Preoperative CT imaging was conducted with the patient in both the supine and prone positions, and the magnitude of change in the intramediastinal space was calculated. In the 56 patients (94.9%) who had undergone MIE, the effects of such a difference on the surgical outcomes were analyzed.

Results
A significant correlation of the magnitude of change in VE (distance between ventral aspect of vertebral body and the midpoint of esophagus) with the surgical outcome was revealed in the 17 patients (30.4%) in whom the magnitude of change in VE was over the 75th percentile. That is, in this subgroup, VE showed a negative correlation with the thoracic operation time (p = 0.01) and blood loss during the thoracic procedure (p = 0.01). Multivariate analysis identified a magnitude of change in VE □9 mm as an independent risk factor for postoperative pneumonia.

Conclusion
This study indicates that preoperative prone-position CT imaging is useful for predicting the level of ease or difficulty of securing an adequate operative field, surgical outcomes, and the risk of postoperative pneumonia in MIE.
675 FUNDOPLICATION VERSUS ORAL PROTON PUMP INHIBITORS FOR GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS
Authors: Tristão Luca Schiliró , Tustumi Francisco , Tavares Guilherme , Datrino Letícia Nogueira , Serafim Maria Carolina Andrade , Orlandini Marina Feliciano , Santos Clara Lucato , Bernardo Wanderley Marques 
Published: September 2021

Abstract

Gastroesophageal reflux disease (GERD) is a widely studied and highly prevalent condition. However, few is reported about the exact efficacy and safety of fundoplication (FPT) compared to oral intake proton-pump inhibitors (PPI). This systematic review and meta-analysis of randomized clinical trials (RCT) aims to compare PPI and FPT in relation to the efficacy, as well as the adverse events associated with these therapies.

Methods
This systematic review was guided by PRISMA statement. Search carried out in June 2020 was conducted on Medline, Cochrane, EMBASE and LILACS. The inclusion criteria were (I) patients with GERD; (II) Randomized clinical trials, comparing oral intake PPI with FPT; (III) relevant outcomes for this review. The exclusion criteria were (I) reviews, case reports, editorials and letters (II) transoral or endoscopic FPT (III) studies with no full text. No restrictions were set for language or period. Certainty of evidence and risk of bias were assessed with GRADE Pro and with Review Manager Version 5.4 bias assessment tool.

Results
Ten RCT were included. Meta-analysis showed that heartburn (RD = −0.19; 95% CI = −0.29, −0.09) was less frequently reported by patients that underwent FPT. Furthermore, patients undergoing surgery had greater pressure on the lower esophageal sphincter than those who used PPI (MD = 7.81; 95% CI 4.79, 10.83). There was no significant difference between groups in the percentage of time with pH less than 4 in 24 hours, sustained remission and Gastrointestinal Symptom Rating Scale. Finally, FPT did not increase significantly the risk for adverse events such as postoperative dysphagia and impaired belching.

Conclusion
FPT is a more effective therapy than PPI treatment for GERD, without significantly increasing the risk for adverse events. However, before indicating a possible surgical approach, it is extremely important to correctly assess and select the patients who would benefit from FPT, such as those with severe erosive esophagitis, severe respiratory symptoms, low adherence to continuous drug treatment and patients with non-acid reflux, to ensure better results.
684 MODERATELY DIFFERENTIATED ESOPHAGEAL SQUAMOUS CELL CARCINOMA HAS A POOR PROGNOSIS AFTER NEOADJUVANT CHEMORADIOTHERAPY
Authors: Leng Xue-feng , Mao Tianqin , Yan Jiaxin , Leng Xuefeng , Han Yongtao 
Published: September 2021

Abstract

Neoadjuvant chemoradiotherapy (NCRT) plus surgery is the standard treatment for esophageal squamous cell carcinoma (ESCC); however, further analysis is needed to detail the histopathological characteristics of ESCC and their clinical significance after NCRT. This study aimed to present the pathological characteristics of ESCC and their association with prognosis after NCRT.

Methods
All patients with ESCC who underwent NCRT followed by surgical resection at Sichuan Cancer Hospital (China) from January 2018 to December 2019 were included. Resection specimens of both the primary disease and lymph nodes were re-evaluated by an experienced pathologist. After NCRT, the pathological characteristics of the residual tumor were evaluated based on the Japanese residual tumor pattern, Mandard tumor regression grade (Mandard-TRG), local inflammatory infiltration classification, and lymph node status.

Results
Among the 103 patients with ESCC included in this study, the pathological complete response (pCR) rate was 34% (35/103). The pCR rate of patients with poorly differentiated tumors (31/72) was higher (43.1%) than that of patients with well or moderately differentiated tumors (P &lt; 0.05). The residual tumor rate was 66% (68/103). A positive correlation was noted between the Japanese residual tumor pattern and Mandard-TRG (Kendall’s tau-b = 0.857, P &lt; 0.001). Tumor infiltration depth, lymph node positivity, moderate differentiation, and tumor recurrence were associated with poor oncological outcomes (P &lt; 0.05).

Conclusion
Patients with poorly differentiated tumors can obtain an excellent short-term response; however, they have extremely poor long-term survival. For patients with moderately differentiated tumors, both the short- and long-term outcomes are poor. Lymph node status after NCRT is a prognostic factor for ESCC treated with NCRT.
70 IMPACT OF LYMPH NODE YIELD ON SURVIVAL IN PATIENTS UNDERGOING NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY SURGERY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER
Authors: Guo Xufeng 
Published: September 2021

Abstract

A survival benefit of neoadjuvant chemoradiotherapy (nCRT) added to surgery has been demonstrated and therefore is regarded as standard of care for patients with locally advanced esophageal cancer in many countries. It remains unclear whether it is necessary to perform extended lymphadenectomy for patients with esophageal squamous cell carcinoma (ESCC) after nCRT. This study aimed to evaluate the impact of lymph node yield (LNY) on survival in ESCC patients undergoing nCRT plus esophagectomy.

Methods
Patients receiving R0 resection for locally advanced ESCC were included from the prospective randomized NEOCRTEC5010 trial [surgery (S) alone vs nCRT plus S]. With Cox proportional hazard regression models, the association between survival and LNY as a categorical variable (&lt;20 vs ≥20 nodes) was analyzed in the nCRT group as well as the pCR subgroup.

Results
Compared with the S group, the nCRT group achieved a better 5-year OS (65.9% vs 55.8%; P = 0.010). Less LNY [20 (IQR 15–27) vs 26 (IQR 19–35); P &lt; 0.001] and positive nodes [0 (IQR 0–1) vs 1 (IQR 0–2.5); P &lt; 0.001] were harvested in nCRT group compared to S group. The number of LNY was significantly associated with OS [HR, 0.363; 95% CI, 0.208–0.635; P &lt; 0.001] and DFS (HR, 0.423; 95% CI, 0.249–0.719; P = 0.001) for patients in nCRT group. Furthermore, an increased LNY was not associated with worse postoperative complications.

Conclusion
The benefit of a higher lymph node yield on overall and disease-free survival is identified for the patients with ESCC who received nCRT followed by esophagectomy. Therefore, an extended lymphadenectomy should be the standard of care after nCRT.
703 SARCOPENIA OBESITY AND MYOSTEATOSIS ARE RISK FACTORS FOR COMPLICATIONS FOLLOWING RESECTION OF OESOPHAGOGASTRIC CANCERS
Authors: Siddaiah-subramanya Manjunath , Kamarajah Sivesh , Halle-Smith Jame , Ghoneim Abdulrahman , Sinha Yashashwi 
Published: September 2021

Abstract

Oesophagogastric cancer resection carries a morbidity, as high as 60%. Better patient selection, not only with regards to clinical stage but also with fitness reduces morbidity and improves outcome. Assessment of sarcopenia (SMI) and incremental shuttle walk test (ISWT) are two such tools to evaluate patients’ fitness. We investigate the influence of these two tools in predicting post-operative outcomes following Oesophagogastric resection.

Methods
All patients who underwent Oesophagogastric cancer resection between 2017–2019 and consented to participate in ISWT were included and outcomes evaluated retrospectively. Patient demographics, comorbidity profile and distance walked in ISWT were collected from the hospital cancer database. SMI was calculated on the pre-operative staging CT at the level of L3. Outcomes assessed included overall complications, major complications (Clavien-Dindo III-V) and 30-day mortality.

Results
Sixty-seven patients (median age = 67) met the inclusion criteria with majority receiving neoadjuvant chemotherapy (79%). Overall complication rate was 69% including 34% major complications. There was no difference in overall and major complication between patients with ISWT distance of &gt;350 and &lt; 350 m. Sarcopenia was diagnosed in 58% of the patients. Adjusted analyses showed female patients (OR: 9.31, CI95%: 1.49–94.15, p = 0.030), myosteatosis (OR: 7.52, CI95%: 1.64–48.62, p = 0.017), and sarcopenic obesity (OR: 6.16, CI95%: 3.28–36.59, p = 0.021) to be independent predictors of overall complications. Correlation plot shows no interaction between SMI and ISWT scores. Conclusion: The study shows that ISWT does not predict post-operative mortality and morbidity following Oesophagogastric cancer resection. Sarcopenia is associated with higher overall complication rates. SMI and ISWT score do not correlate in predicting post-operative outcomes. We recommend that assessment of sarcopenia to be used routinely as a pre-operative assessment tool for prediction of outcomes in patients undergoing Oesophagogastric cancer resection.
711 POST-REFLUX SWALLOW-INDUCED PERISTALTIC WAVE IS IMPAIRED IN LARYNGOPHARYNGEAL AND GASTRO-OESOPHAGEAL REFLUX DISEASE
Authors: Park Jin-soo , Van der Wall Hans , Falk Gregory 
Published: September 2021

Abstract

Laryngopharyngeal reflux (LPR) and gastro-oesophageal reflux disease (GORD) result from the reflux of gastric contents. The post-reflux swallow-induced peristaltic wave (PSPW) induces chemical clearance following reflux events. PSPW index is a novel parameter that has been validated in GORD, but not in LPR. This study aimed to assess the efficacy of chemical clearance by assessing PSPW indices in patients with LPR and GORD.

Methods
Reviewers blindly analysed off-therapy impedance-pH tracings from 187 patients divided into LPR (n = 105) or GORD (n = 82) by predominant symptom profile. Conventional impedance-pH measures and PSPW indices were analysed for the two groups.

Results
Mean PSPW index in the LPR group was higher than in the GORD group (39.7% (±17.7%) vs. 20.6% (±13.4%); p &lt; 0.001). Abnormally low PSPW index (&lt;61%) was seen in 85 (81%) of the LPR group, and 80 (97.6%) of the GORD group (p &lt; 0.001). Area under the ROC curve for PSPW index to diagnose LPR was 0.828 (95% CI: 0.767–0.889; p &lt; 0.001). The LPR group had a lower AET (1.5% vs. 8.1%; p &lt; 0.001) and fewer distal reflux episodes (46.5 (±24.5) vs. 64.4 (±39); p &lt; 0.001).

Conclusion
PSPW was impaired in patients with LPR as well as oesophageal GORD, indicating an abnormality of chemical clearance following a reflux episode in both groups. PSPW index was more severely impaired in gastro-oesophageal reflux disease (GORD). The present study shows PSPW index is useful in aiding in the diagnosis of both LPR and GORD.