bluuebunny/crossref_metadata_2025_split huggingface dataset:
384 SHORT-TERM OUTCOMES OF INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSES UNDER MINIMALLY INVASIVE ESOPHAGECTOMY VIA A PRONE POSITION
Authors: Mine Shinji , Watanabe Masayuki , Kanamori Atushi , Imamura Yu , Okamura Akihiko , Hashimoto Takashi , Hashiguchi Tadasuke , Kuniyasu Tetsushi , Nasu Motomi , Fujiwara Daisuke , Ozaki Asako , Yoshino Kohei , Kajiyama Yoshiaki , Tsurumaru Masahiko 
Published: September 2021

Abstract

Although minimally invasive esophagectomy (MIE) has been performed for esophageal cancer worldwide, intra-thoracic anastomosis under prone positions is still challenging. In this retrospective study, we reviewed our short-term results of this anastomotic technique in our institution.

Methods
From November 2016 to December 2019, we performed 319 esophagectomies. Of these patients, 28 patients (9%) underwent intra-thoracic esophago-gastric anastomosis under MIE.

Procedures
The left side of an esophageal stump which had been closed using a linear stapler was opened for anastomosis. Then, the anterior wall of a gastric conduit, around 5 cm below the tip, was opened for anastomosis. Linear staplers were inserted in both esophageal stump and gastric conduit and side-to-side anastomosis was performed. The opening for insertion was closed using a hand-sewn anastomosis in 2 layers.

Results
Five patients (18%) suffered anastomotic leakage with Clavien-Dindo 2 and 3a, and all of them recovered by conservative treatments. Two patients (2/19, 11%) showed anastomotic stricture which improved by several endoscopic dilatations. Six patients (6/19, 32%) showed the reflux esophagitis of Grade C.

Conclusion
Although we have not experienced severe or critical post-operative complications, the short-term results of intra-thoracic anastomosis under MIE were not sufficient. Additional progresses in techniques are required.
444 CORRELATION BETWEEN PATHOLOGIC COMPLETE RESPONSE TO NEOADJUVANT THERAPY AND RECURRENCE IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Pandey Durgatosh , Pandey Rambha , Julka Pramod Kumar 
Published: September 2021

Abstract

Multimodal treatment options in carcinoma esophagus include neoadjuvant chemoradiotherapy or chemotherapy followed by surgery. The degree of pathologic response to different neoadjuvant options and its impact on the oncologic outcome is a matter of debate.
With this background we carried out this study to analyze the rate of pathologic complete re-sponse (pCR) and its effect on recurrence in patients with carcinoma esophagus treated with various combinations of neoadjuvant chemotherapy/radiotherapy and surgery.

Methods
The records of all patients with carcinoma esophagus registered in our clinics between June 2012 and December 2014 were retrieved from a prospectively maintained database and were analyzed. of the 70 patients with histologically proven esophageal cancer who were treated with curative intent during this period, those with pCR (15) were followed up for a minimum of 5 years. These 15 patients are the subjects of this study.

Results
Forty eight (48) patients received neoadjuvant chemotherapy (NACT), 16 were treated with short course radiotherapy (SRT), and 3 patients received neoadjuvant chemoradiation (CRT). Four patients developed metastatic disease on neoadjuvant therapy.
66 patients (63 after neoadjuvant therapy and 3 upfront) underwent transthoracic esophagect-omy. Pathological CR was seen 12 patients (25%) in NACT-surgery arm, 2 (12%) in SRT-surgery and 1 (33%) in CRT-surgery groups. Three patients had postoperative mortality due to pulmo-nary complications. At 5 yrs, 14 out of 15 patients with pathological CR are alive and disease free. One patient developed brain metastases after 3 years and died.

Conclusion
Neoadjuvant therapy followed by radical surgery is a safe and effective treatment option for the management of carcinoma esophagus. Pathologic CR strongly correlates with recurrence-free survival. The relative significance of pCR after different types of neoadjuvant therapies need to be tested in future studies.
450 FACTORS AFFECTING CIRCUMFERENTIAL RESECTION MARGIN AFTER ESOPHAGECTOMY AND ITS PROGNOSTIC SIGNIFICANCE-LARGE SINGLE CENTRE EXPERIENCE
Authors: Jiwnani Sabita , Pramesh C S , Ashok Apurva , Tiwari Virendra 
Published: September 2021

Abstract

The evidence regarding the importance of circumferential resection margin (CRM) as a prognostic factor after esophagectomy is inconclusive in the era of neoadjuvant therapy. We retrospectively analysed our prospectively maintained database for factors that affect CRM positivity, and whether a positive CRM affects event free and overall survival. 2843 patients underwent esophagectomy with curative intent from October 2004 to 2019 at our centre. CRM was analysed as negative, close but technically free (&lt;1 mm) and involved.

Methods
Data on the following variables was retrospectively extracted from prospective database. CRM status was noted for clinic-radiological T and N stage, level of growth, histology, differentiation grade and neoadjuvant treatment. Intra-operative details such as surgical procedure, approach, surgeon grade, lymphadenectomy and resection status were analysed. On final histopathology; proximal and distal margins, lymph node positivity, lymphovascular invasion(LVI), tumour regression grade(TRG) were analysed. The effect of CRM on development of recurrence and overall survival was evaluated. CRM data was available for 2439 (85.78%) patients. 71.2% of the patients received neoadjuvant chemotherapy. Factors were analysed separately for both close and positive margins.

Results
75.8% had negative, 15.6% close and 8.6% positive CRM. Univariately, T stage, adenocarcinoma, poor differentiation, transhiatal approach, R+ resection, positive margins, TRG &gt; 3, LVI and upfront surgery predicted positive CRM. On multivariate, negative CRM was seen in T1/T2 stage [OR 0.325, 95% CI-0.144-0.732, p = 0.007], squamous carcinoma [OR 0.574, 95% CI-0.351-0.958, p = 0.027], R0 resection [OR 0.228, 95% CI-0.086-0.599, p = 0.003] while positive CRM was seen in upfront surgery [OR 2.32, 95% CI-1.55-3.46, p &lt; 0.001], positive nodes [OR 1.748, 95% CI-1.19-2.56, p = 0.004] and LVI [OR 2.73, 95% CI-1.87-3.98, p &lt; 0.001]. Median event-free survival in CRM negative was 64 months compared to 14 months in CRM positive (p &lt; 0.001).

Conclusion
Positive CRM involvement is a prognostic indicator in patients undergoing esophagectomy and associated with worse event-free and overall survival. CRM-positive disease in esophageal cancer may represent residual tumor, advanced disease, aggressive biology, or poor response to neoadjuvant treatment. All attempts should be made to achieve a clear circumferential resection margin. More evidence is needed to evaluate if adjuvant therapy is justified in these patients and the type of therapy also needs to be determined.
486 UTILITY OF 18F-FDG/PET FOR PREDICTING HISTOPATHOLOGICAL RESPONSE TO NEOADJUVANT INDUCTION CHEMOTHERAPY AND CHEMORADIOTHERAPY FOR ESOPHAGEAL AND JUNCTIONAL CARCINOMA
Authors: Sabino Flávio , Guimarães-Filho Marco , Carneiro Michel , Ribeiro Luciana , Fernandes Daniel , Felipe Pinto Luis 
Published: September 2021

Abstract

Neoadjuvant treatment followed by esophagectomy is the standard therapy for patients with resectable esophageal cancer. Data have demonstrated that patients with pathologic complete response (pCR) have better survival. Several studies have been exploring whether 18F-FDG/PET performed during neoadjuvant treatment can predict a pCR, but the results are conflicting. The aim of this study was to assess the role of 18F-FDG PET/CT for predicting the histopathological response to neoadjuvant induction chemotherapy (IC) and chemoradiotherapy (CR).

Methods
Patients with proven squamous cell or adenocarcinoma of the esophagus or GEJ were enrolled in this prospective study. Patients received two cycles of IC with carboplatin and paclitaxel followed by concurrent CR and then esophagectomy. Metabolic response was evaluated according to PERSIST criteria by 18F-FDG PET/CT performed at baseline, at day 14 of chemotherapy and four to eight weeks after the completion of CR. Tumoral pretreatment, induction and posttreatment FDG-standardized uptake value normalized to lean body mass SULmean and percentage change were assessed. These parameters were correlated with the pathologic response using the Mandard tumor regression grade (TRG) scale.

Results
Thirty patients finished the IC plus CR and 16 had esophagectomy. The median age was 57 years, 75% were male and 56% had adenocarcinoma. The mean of SULmean prior to treatment, after one cycle of IC and after CR were respectively 6.12, 4.67 and 1.52. After one cycle of IC, one patient had metabolic progression, eight remained stable and seven had partial metabolic response. All metabolic responders had good histopathological response (Mandard 1 or 2). After CR, five patients had complete metabolic response (CMR). However, three of them had poor histopathological response (Mandard &gt;2).

Conclusion
Our initial results suggests that the early PERSIST-based metabolic response evaluation appears useful to predict a good histopathological response. Thus, an interim 18FFDG PET/CT may help to identify good responders during the neoadjuvant treatment. However, the late metabolic response evaluation after CR had a poor pathologic correlation. In this way, a CMR after CR should not be assumed to be synonymous of complete pathologic response.
546 INTENSIVE SURVEILLANCE AFTER CURATIVE INTENT SURGERY FOR ESOPHAGEAL CANCER: INITIAL RESULTS OF THE ENSURE STUDY
Authors: Elliott Jessie A , Markar Sheraz R , Klevebro Fredrik , Ni Melody Zhifang , Nilsson Magnus , Zaninotto Giovanni , Hanna George B , Reynolds John V ,   ENSURE Study Group
Published: September 2021

Abstract

Emerging data demonstrate long-term survival after salvage interventions for local or oligometastatic recurrence after planned curative resection for esophageal cancer, providing rationale for postoperative surveillance. However, the impact of intensive surveillance on oncologic outcome is unknown. This multicenter collaborative study aimed to characterize oncologic surveillance protocols across esophageal cancer centers internationally and determine the independent effect of intensive surveillance on oncologic outcome.

Methods
The ENSURE international multicenter study included consecutive patients who underwent surgery with curative intent for cTxNxM0 esophageal cancer from June 2009 to June 2015. Intensive surveillance was defined as use of cross-sectional imaging, at least annually, during the first three postoperative years. The estimated sample size of 4425 provided 90% power to detect a 5% increase in 5-year overall survival (OS, primary outcome measure). Secondary outcome measures included disease-free (DFS) and disease-specific survival (DSS), surveillance strategies, incidence of oligometastatic recurrence, treatment strategies, and HRQOL. The study was registered on ClinicalTrials.gov (NCT03461341).

Results
4597 patients were included. The participating 27 centres undertook mean(SD) 52.3(17.1) esophageal cancer resections annually between 3.5 ± 1.3 attending surgeons. 37%, 11% and 19% centers utilized postoperative surveillance CT, PET-CT and endoscopy, respectively. Among all patients, intensive surveillance was associated with improved OS (HR0.92 [0.85–0.99]) but not DSS (HR0.93 [0.85–1.01]) or DFS (HR0.97 [0.90–1.04]), and on multivariable analysis, intensive surveillance did not provide oncologic benefit (OS HR1.10 [0.99–1.22], DSS HR1.12 [1.00–1.25]), but reduced observed DFS (HR1.19 [1.08–1.31]). Evaluating surveillance modalities, neither surveillance endoscopy nor laboratory tests improved oncologic outcome, however flexible nasolaryngoscopy was associated with improved OS (HR0.84 [0.69–1.0]).

Conclusion
ENSURE, the first study powered to assess the impact of postoperative surveillance protocols on oncologic outcome in esophageal cancer, demonstrated no overall survival benefit following intensive imaging surveillance, with reduced observed disease-free survival time. However, routine assessment for secondary aerodigestive malignancies may be of oncologic benefit. The present data do not support the use of intensive imaging surveillance among all patients following esophageal cancer surgery. Further reports detailing subgroup analyses and HRQOL impact are anticipated.
558 OUTCOMES OF PER ORAL ENDOSCOPIC MYOTOMY IN ACHALASIA IN PATIENTS WITH END-STAGE ESOPHAGUS
Authors: Raja Siva , Adhikari Saurav , Sudarshan Monisha , Sanaka Madhusudhan , Murthy Sudish , Thota Prashanti , Gabbard Scott , Ahmad Usman 
Published: September 2021

Abstract

Per oral endoscopic myotomy (POEM) has emerged as a favorable alterative to Heller myotomy for achalasia. However data is limited on the effectiveness in palliation of symptoms in patients who have an esophagus with a sigmoid/tortuous configuration, or a mega-esophagus with width more than 5 cm, due to long-standing achalasia. Our objective is to investigate the outcomes after POEM procedure in patients diagnosed with achalasia and considered end-stage.

Methods
A retrospective cohort study was conducted in a large hospital between April 2014 and July 2019. A total of 504 patients were identified with 218 undergoing POEM during the study time period of which 57 patients had a sigmoid or tortuous esophagus, and/or had a barium column width of more than 5 cm on timed barium esophagograms (TBE). Primary outcome was symptom relief during follow-up, defined as a post-operative Eckardt score ≤ 3. We also explored integrated resting pressure (IRP) on manometry, barium column height and width on TBE, complications and procedure related parameters. Statistical analyses were performed using R.

Results
Significant decrease in median Eckardt scores were observed, 7.5 [6,8.8] pre-operatively to 0 [0,1] at 2 months (p &lt; 0.001). At 2 years, 12 of 14 patients (85%), reported scores of ≤3. Improvements at 2 months were noted in median IRP (25.4 mmHg [15.5, 35.9] vs. 4.0 mmHg [2.2,9.0]), 1 min TBE height (11.5 cm [7.5,15.0] vs. 6.8 cm [4.7,9.0]) and width (5.0 cm [4.1,6.1] vs. 2.8 cm [1.9,3.1]), p &lt; 0.001. At 2 years, they were 9.5 cm [5,12.8] and 3.0 cm [2.4,4.5], respectively. Post-operative pH studies in 35(61%) patients demonstrated a DeMeester score ≥ 14.72 in 17(49%) patients. Almost all patients reported return to activities of daily living within 7 days.

Conclusion
POEM is an effective and safe modality in achalasia patients with end-stage esophagus. Patients in this cohort historically have had poor outcome to interventions and our data shows excellent short-to-medium term outcome with low morbidity after POEM. Given its efficacy, minimal invasiveness and short return to function, POEM is a reasonable first and gold standard palliative therapy in this difficult cohort and should be attempted before considering esophagectomy.
590 VARIATION IN RECEIPT OF THERAPY AND SURVIVAL WITH PROVIDER-VOLUME IN NON-CURATIVE ESOPHAGO-GASTRIC CANCER: A POPULATION-BASED ANALYSIS
Authors: Hallet Julie , Davis Laura , Mahar Alyson , Lui Ying , Zuk Victoria , Gupta Vaibhav , Earle Craig , Coburn Natalie 
Published: September 2021

Abstract

While surgical care by high-volume providers for esophago-gastric cancer (EGC) yields better outcomes, volume-outcome relationships are unknown for systemic therapy. We examined receipt of therapy and outcomes in the non-curative management of EGC based on medical oncology provider-volume.

Methods
We conducted a population based retrospective cohort study of non-curative EGC over 2005–2017 by linking administrative healthcare datasets. The volume of new EGC consultations per medical oncology provider per year was calculated and divided into quintiles. High-volume (HV) providers were defined as the 4-5th quintiles. Outcomes were receipt of chemotherapy and overall survival (OS). Multivariate logistic and Cox-proportional hazards regressions examined the association between management by HV provider, receipt of systemic therapy, and OS.

Results
7,011 EGC patients with non-curative management consulted with medical oncology. One-year OS was superior for HV providers (&gt;11 patients/year), with 28.4% (95%CI: 26.7–30.2%) compared to 25.1% (95%CI: 23.8–26.3%) for low-volume (p &lt; 0.001). After adjusting for age, sex, comorbidity burden, rurality, income quintile, and diagnosis year, HV provider was independently associated with higher odds of receiving chemotherapy (OR 1.13, 95%CI 1.01–1.26), and independently associated with superior OS (HR 0.89, 95%CI 0.84–0.93).

Conclusion
Medical oncology provider-volume was associated with variation in non-curative management and outcomes of EGC. Care by a HV provider was independently associated with higher odds of receiving chemotherapy and superior OS, after adjusting for case-mix. This information is important to inform disease care pathways and care organization; increase in the number of HV providers may reduce variation and improve outcomes.
619 HIGH DISCOVERY RATE OF GASTRODUODENAL EOSINOPHILIA BUT NOT EOSINOPHILIC ESOPHAGITIS IN PATIENTS WITH CHRONIC GASTROINTESTINAL SYMPTOMS
Authors: Talley Nicholas , Kamboj Amol , Chey William , Rasmussen Henrik , Lacy Brian , Hirano Ikuo , Chehade Mirna , Gonsalves Nirmala , Peterson Kathryn , Lembo Anthony , Schmitt Colleen , Rothenberg Marc , Genta Robert , Pletneva Maria , Turner Kevin , Pasha Malika , Dellon Evan , Sandborn William 
Published: September 2021

Abstract

Although the prevalence of eosinophilic gastrointestinal disorders (EGIDs) is increasing, there is evidence that eosinophilic gastritis and/or duodenitis (EG/EoD) are underdiagnosed. Patients with EG/EoD often present with chronic, non-specific gastrointestinal (GI) symptoms, similar to patients with functional GI disorders. We hypothesized that systematic evaluation, including multiple esophageal, gastric and duodenal biopsies, of patients with chronic GI symptoms might reveal a high rate of gastroduodenal eosinophila, with or without eosinophilic esophagitis (EoE).

Methods
We performed a prospective multi-center study of patients with non-specific GI symptoms for ≥6 months, from 20 sites. Patients completed a questionnaire assessing abdominal pain, abdominal cramping, early satiety, bloating, nausea, vomiting, diarrhea, and loss of appetite. Those with daily average symptom severity scores ≥3/10 for any single symptom underwent esophagogastroduodenoscopy (EGD) with collection of 4 esophageal (EoE), 8 gastric, and 4 duodenal biopsies, analyzed by central pathologists. Histologic criteria for EoE was ≥15eos/hpf in ≥1 esophageal site and for EG/EoD was peak eosinophil counts ≥30/hpf in ≥5 gastric hpfs and/or 3 duodenal hpfs—criteria used in randomized trials.

Results
Of 556 patients screened, 405 (73%) met symptom criteria and underwent EGD; 181 patients (45%, mean age 45, 73% female) who underwent EGD met the histologic criteria for EG/EoD, and of these, 7% also had EoE diagnosed. Overall 2% met histologic criteria for EoE alone. Of patients who met the histologic criteria for EG/EoD, 93% were previously diagnosed with gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), or functional dyspepsia (FD) (Figure 1). The average duration of GI symptoms in the screened population as well as those that met histologic criteria for EG/EoD was 11 years.

Conclusion
Forty-five percent of patients with moderate-to-severe GI symptoms who underwent EGD met histologic criteria for EG/EoD. Over 90% of these patients had previously been diagnosed with GERD, IBS, and/or FD, and had minimal overlap with EoE. EGD with systematic gastroduodenal biopsies, and intentional evaluation for tissue eosinophilia, should be performed in patients with chronic GI symptoms. Accurate diagnosis of EG/EoD is required for appropriate, targeted treatment and improved outcomes of patients with moderate-to-severe GI symptoms.
621 PL02.05 LONG-TERM TREATMENT OF PATIENTS WITH EOSINOPHILIC GASTRITIS AND/OR EOSINOPHILIC DUODENITIS WITH LIRENTELIMAB, A MONOCLONAL ANTIBODY AGAINST SIGLEC-8
Authors: Peterson Kathryn , Chehade Mirna , Murray Joseph , Falk Gary , Gonsalves Nirmala , Genta Robert , Rothenberg Marc , Bledsoe Adam , Durrani Sandy , Vaezi Michael , Shaw Camilla , Rasmussen Henrik , Singh Bhupinder , Chang Alan , Kamboj Amol , Hirano Ikuo , Dellon Evan 
Published: September 2021

Abstract

Eosinophilic esophagitis (EoE), gastritis (EG), and/or duodenitis (EoD) are associated with accumulation and activation of eosinophils and mast cells in the esophagus, stomach, and/or duodenum, respectively. Lirentelimab (AK002), an antibody against siglec-8, depletes eosinophils and inhibits mast cells. We performed an open-label extension (OLE) study of subjects who completed ENIGMA (a randomized, double-blind, placebo-controlled phase 2 study of lirentelimab in adults with symptomatic, biopsy-confirmed EG and/or EoD, with or without EoE) to evaluate long-term responses.

Methods
Subjects who received 4 monthly infusions of lirentelimab or placebo during ENIGMA (n = 59) were eligible for the OLE; they received monthly, escalating doses of lirentelimab (0.3 or 1 mg/kg escalating to 3 mg/kg). Symptoms were assessed weekly using an electronic daily patient-reported outcome questionnaire and total symptom scores (TSS) were calculated. Patients underwent upper endoscopy with biopsy at screening and at the end of ENIGMA (day 99, week 16, blinded); in the OLE, endoscopies were performed on day 323 (30 weeks after the first dose in the OLE). Histopathology was assessed by a single pathologist.

Results
Fifty-eight subjects entered the OLE; 45 completed ≥52 weeks lirentelimab (including exposure during ENIGMA) and 29 completed 70 weeks. Mean TSS improved through week 70 (Figure 1). Subjects receiving 70 weeks lirentelimab (ENIGMA+OLE) had further improvements in TSS from baseline (mean reductions: 68% at weeks 29–30, 70% at weeks 51–52, 75% at weeks 69–70). Symptom scores (abdominal pain, nausea, vomiting, early satiety, appetite loss, abdominal cramping, bloating, diarrhea) decreased significantly from baseline. Treatment response was not associated with concomitant EoE. The most common adverse event was mild to moderate infusion-related reactions, usually with the first infusion.

Conclusion
In the OLE of the ENIGMA study, patients with EG and or EoD (with or without concomitant EoE) who received lirentelimab had sustained tissue eosinophil depletion and significant long-term symptom improvement. Symptoms continued to improve with duration of treatment. Lirentelimab appears to be a promising targeted treatment for EG and/or EoD.