bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-OGC18 Does cardiopulmonary testing help predict long-term survival after oesophagectomy?
Authors: Chmelo Jakub , Khaw Rachel A , Sinclair Rhona C F , Navidi Maziar , Phillips Alexander W 
Published: December 2021

Abstract

Background
Oesophagectomy is associated with a high rate of morbidity and mortality. Preoperative cardiopulmonary fitness has been correlated with outcomes within major surgery. Variables derived from CPET have been associated with postoperative outcomes. It is unclear whether preoperative cardiorespiratory fitness of patients undergoing oesophagectomy is associated with long-term survival. The aim of this study was to evaluate whether any of the cardiopulmonary exercise testing (CPET) variables that are routinely derived in patients with oesophageal cancer may aid in predicting long-term survival after oesophagectomy.

Methods
Patients undergoing CPET followed by trans-thoracic oesophagectomy for oesophageal cancer with curative intent between January 2013 and January 2017 from single high-volume centre were retrospectively analysed. The relationship between predictive co-variables including CPET variables, and survival was studied with a Cox proportional hazard model. Receiver operation curve (ROC) analysis was conducted to find cut-off values for CPET variables predictive of 3-year survival.

Results
A total of 313 patients were analyzed. The ventilatory equivalent for carbon dioxide (VE/VCO2) at anaerobic threshold was the only CPET variable independently predictive of long-term survival in multivariable analysis (HR 1.049, 95% CI 1.011-1.088, p = 0.011). Pathological stage III and IV disease was the other co-variable found to be independently predictive of survival. ROC analysis of the VE/VCO2 failed to demonstrate a predictive cut-off value of 3-year survival (AUC=0.564, 95% CI 0.499-0.629, p = 0.056).

Conclusions
A high VE/VCO2 before oesophagectomy for malignant disease is an independent predictor of long-term survival and may be an important variable for consideration when counselling patients.
P-OGC22 Incidence and relevance of clinically indeterminate non-regional lymph nodes in the treatment of oesophageal cancer
Authors: Pucher Philip , White Annabelle , Padfield Olivia , Davies Andrew , Maisey Nick , Qureshi Asad , Subesinghe Manil , Baker Cara , Gossage James 
Published: December 2021

Abstract

Background
Metastatic involvement of non-regional supraclavicular or superior mediastinal lymph nodes in distal oesophageal cancer is rare, but has important implications for prognosis and management. The management of non-regional lymph nodes which appear indeterminate on CT and FDG PET-CT (subcentimetre nodes or those with preserved normal morphology, but increased FDG avidity) can present a diagnostic dilemma. This study investigates the incidence, work-up, and clinical significance of non-regional clinically indeterminate FDG avid lymph nodes.

Methods
A single centre retrospective review of all FDG PET-CT scans conducted over 5 years was conducted. Patients with mid- or distal oesophageal cancer with non-regional FDG avid nodes were identified. Subsequent work-up, management, and outcomes were retrieved from electronic health records.

Results
Reports for 1189 PET-CT scans were reviewed. A total of 79 patients met the inclusion criteria. Of these, 18 (23%) were deemed to have disease and performance status potentially amenable to radical surgery, and underwent further assessment. The indeterminate lymph nodes were successfully sampled via endobronchial ultrasound (EBUS) or ultrasound-guided fine needle aspiration (US-FNA) in 100% of cases. 15/18 (83.3%) of samples were benign and proceeded to surgery. Outcomes for patients who proceeded to surgery were similar to other cohorts. None had pathology suggesting false negative lymph node sampling.

Conclusions
EBUS and US-FNA are effective means of sampling clinically indeterminate non-regional lymph nodes, and can significantly impact prognosis, and management. Further investigations in this context are of value in this cohort and should be pursued.
P-OGC24 Comparison of the histopathological regression after neoadjuvant FLOT versus ECX in resectable gastroesophageal adenocarcinoma
Authors: Prasad Pooja , Chmelo Jakub , Brown Joshua , Bradshaw Alexander , Fergie Bridget , Wahed Shajahan , Phillips Alexander 
Published: December 2021

Abstract

Background
Neoadjuvant chemotherapy is a key component in the treatment of resectable oesophagogastric cancer (OGC). Histopathological tumour regression is associated with a prognostic benefit in OGC. There is increased usage of the FLOT regimen as part of neoadjuvant chemotherapy (NAC) for these tumours. The initial phase 2 trial demonstrated complete pathological response (pCR) in 15% for FLOT versus 6% for ECX but there is no data outside a trial setting. The aim of this study was to evaluate the differences in pCR and the extent of downstaging between patients receiving FLOT versus ECX in the neoadjuvant setting.

Methods
Consecutive patients treated for OGC in a single, high-volume UK centre between 2018 and 2021 were identified from a contemporaneously maintained database. Patients underwent 3 cycles of ECX or 4 cycles of FLOT as part of NAC. Histopathological tumour regression was assessed by the Mandard classification. A comparison of T- and N stage migration between FLOT and ECX was performed. Major pCR was defined as TRG 1-2 based on the Mandard classification.

Results
The study included 162 patients. 6/84 (7.1%) patients receiving ECX and 5/78 (6.4%) patients receiving FLOT achieved a pCR (p = 0.853). 11/84 (13.1%) patients in the ECX group and 12/78 (15.4%) patients in the FLOT group achieved a major pCR (p = 0.677).
With regards to stage migration by T-stage, 36 (42.9%) patients were downstaged and 6 patients (7.1%) were upstaged with ECX. Amongst FLOT patients, 42 (53.8%) were downstaged and 8 (10.3%) upstaged (p = 0.189). When comparing N-stage, 29 (34.5%) patients achieved downstaging and 28 (33.3%) were upstaged with ECX. 30 (38.5%) patients were downstaged and 20 (25.6%) were upstaged with FLOT (0.563).

Conclusions
There was no significant difference in pCR and stage migration rates between patients receiving neoadjuvant ECX and FLOT. pCR rates were lower than previously reported, and it is unclear if the difference in prognosis will translate comparable outcomes between patients receiving ECX versus FLOT.
P-OGC26 Learning curves in minimally invasive esophagectomy- a systematic review and evaluation of benchmarking parameters
Authors: Prasad Pooja , Wallace Lauren , Navidi Maziar , Phillips Alexander 
Published: December 2021

Abstract

Background
Minimally invasive techniques are increasingly used in the treatment of esophageal cancer. The learning curve for minimally invasive oesophagectomy (MIO) is variable and can impact on patient outcomes. The aim of this study was to review the current evidence on learning curves in MIO and identify which parameters are used for benchmarking.

Methods
A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to February 2020. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if an assessment of the learning curve was reported on, regardless of which (if any) statistical method was used.

Results
Twenty-nine studies comprising 3741 patients were included. Twenty-two studies reported on a combination of thoracoscopic, hybrid and total MIO, 6 studies reported robotic assisted MIO (RAMIE) alone and 1 study evaluated both RAMIE and thoracoscopic esophagectomies. Operating time was the most frequently used parameter to determine learning curve progression (23/39 studies), with number of resected lymph nodes, morbidity and blood loss also frequently used. Learning curves were found to plateau at 7-60 cases for thoracoscopic esophagectomy, 12-175 cases for total and thoracoscopic/hybrid esophagectomy and 9-85 cases for RAMIE.

Conclusions
Multiple parameters are employed to gauge MIO learning curve progression. However, there are no validated or approved sets of outcomes. Further work is required to determine the optimum parameters that should be utilised to ensure best patient outcomes and required length of proctoring.
P-OGC35 Does Adjuvant Chemotherapy Provide Additional Survival Benefit AfterNeoadjuvant Chemotherapy or Chemoradiotherapy and Esophagectomy forEsophageal Adenocarcinoma?
Authors: Kamarajah Sivesh , Markar Sheraz , Phillips Alexander , Kunene Victoria , Fackrell David , Salti George , Dahdaleh Fadi , Griffiths Ewen 
Published: December 2021

Abstract

Background
The evidence assessing the additional benefits of adjuvant chemotherapy (AC) following neoadjuvant therapy (NAT; i.e. chemotherapy or chemoradiotherapy) and esophagectomy for esophageal adenocarcinoma (EAC) are limited. This study aimed to determine whether AC improves long-term survival in patients receiving NAT and esophagectomy.

Methods
Patients receiving esophagectomy for EAC following NAT from 2004 - 2016 were identified from the National Cancer Data Base (NCDB). Patients with survival &lt; 6 months were excluded to account for immortality bias. Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival.

Results
Overall 12,972 (91%) did not receive AC and 1,255 (9%) received AC. After PSM there were 2,485 who received AC and 1,254 who did not. After matching, AC was associated with improved survival (median: 38.5 vs 32.3 months, p &lt; 0.001), which remained after multivariable adjustment (HR: 0.78, CI 95% : 0.71 - 0.87, p &lt; 0.001). On multivariable interaction analyses, this benefit persisted in subgroup analysis for nodal status: N0 (HR: 0.85, CI 95% : 0.69 - 0.96, p = 0.039), N1 (HR: 0.66, CI 95% : 0.56 - 0.78, p &lt; 0.001), N2/3 (HR: 0.80, CI 95% : 0.66 - 0.97, p = 0.024) and margin status: R0 (HR: 0.77, CI 95% : 0.69 - 0.86, p &lt; 0.001), R1 (HR: 0.60, CI 95% : 0.43 - 0.85, p = 0.004). Further, patients with stable disease following NAT (HR: 0.60, CI 95% : 0.59 - 0.80, p &lt; 0.001) or downstaged (HR: 0.80, CI 95% : 0.68 - 0.95, p = 0.009) disease had significant survival benefit after AC, but not patients with upstaged disease.

Conclusions
AC following NAT and esophagectomy is associated with improved survival, even in node-negative and margin-negative disease. NAT response appears crucial in identifying patients who will benefit maximally from AC, and thus future research must be focused on identifying tumors that respond to chemotherapy to maximize this prognostic benefit.
P-OGC42 Hiatus Hernia following Minimally Invasive Oesophagectomy - a Single Centre Experience
Authors: Rana Mridul , Sanga Akshata , Mastoridis Sotiris , Sgromo Bruno 
Published: December 2021

Abstract

Background
Hiatus hernia is an established complication following oesophagectomy, with a higher incidence when a minimally invasive approach (MIO) is undertaken. Literature reports the incidence post-MIO to be vary between 4.5% -26%. There is no clear consensus on the optimum operative management of this complication. The aim of this study was to establish the incidence of hiatus hernia post MIO (HiHO) at a single hospital site, identify predisposing factors, and evaluate subsequent surgical management of this complication.

Methods
Single-center data were retrospectively analysed of MIOs conducted consecutively between May 2018 and October 2020. A minimum follow-up period of 6 months was required for inclusion. HiHO was defined by radiological confirmation. Data collected included patient demographics, comorbidities, risk factors for hiatus hernia and patient’s post-operative course. Statistical analyses were performed using Fischer’s exact or independent t-test as appropriate.

Results
50 patients who underwent MIO were included; mean follow up of 1.92 years. 7 (14%) presented with HiHO. There was no significant difference in age or gender between patients with and without HiHO. HiHO patients had a significantly lower BMI (95% CI 1.083-8.271; P = 0.012) and were more likely to have underlying lung conditions (P = 0.029). A higher incidence of pre-existing hiatus hernia was present among the HiHO group (43% vs 21%). Of those developing HiHO, 6 (86%) were symptomatic requiring surgical reduction with crural repair of hiatus or colopexy; 2 had a recurrence of HiHO requiring subsequent colopexy.

Conclusions
This study represents the largest single centre analysis of hiatus hernia post minimally invasive oesophagectomy. Our results correlate with the literature, that there is a significant risk of hiatus hernia following minimally invasive oesophagectomy. This risk is increased among patients with pre-operative hiatus hernia, low BMI, and pre-existing lung conditions. Crural repair or colopexy are options for surgical management of HiHO. Colopexy may potentially prevent recurrence of HiHO. A larger study size and a consensus from experts in the field would be beneficial in guiding operative management of HiHO to improve patient outcomes.
P-OGC44 Multi-omic cohort study of Barrett’s oesophagus reveals structural variation and retrotransposon activity to occur early in cancer evolution
Authors: Katz-Summercorn Annalise , Jammula Sriganesh , Frangou Anna , Peneva Iliana , O'Donovan Maria , Tripathi Monika , Malhotra Shalini , Pietro Massimiliano di , Abbas Shujath , Devonshire Ginny , Januszewicz Wladyslaw , Blasko Adrienn , Nowicki-Osuch Karol , MacRae Shona , Northrop Alex , Redmond Aisling , Wedge David , Fitzgerald Rebecca 
Published: December 2021

Abstract

Background
Barrett’s oesophagus (BE) is the main risk factor for the development of oesophageal adenocarcinoma (OAC), yet few patients ever go on to progress to cancer. The acquisition of events during the metaplasia-dysplasia-cancer sequence is poorly characterised. We present a large, unbiased, multi-omics analysis of a cross-sectional cohort of pre-cancer samples, with the aim of providing a comprehensive insight into the diversity and molecular changes driving the disease to cancer.

Methods
We generated and integrated the genomic (50x), transcriptomic and epigenomic (850K EPIC array) landscapes of snap-frozen endoscopic biopsies from 146 patients with a range of outcomes (27 long-standing non-dysplastic; 12 prior to progression to dysplasia; 14 low-grade; 25 high-grade; 21 intramucosal carcinoma; 47 cases of BE taken adjacent to OAC) and 642 person years of follow-up. All biopsies were reviewed independently by 3 pathologists and had associated annotation with detailed clinical information.

Results
The total number of structural variants (SV) captured the most variance between samples. Complex SVs and LINE-1 retrotransposon activity were observed even before dysplasia had developed and increased with progression. Increasing SV burden was associated with chromothripsis (12%, 18/146) and breakage-fusion bridges (BFBs; 8%, 13/146). In more than 50% of these, the BFBs were in chromosome 17, harbouring the oncogenes ERBB2 and CDK12, for which expression was significantly higher. With progression there was increased expression of genes related to cell-cycle checkpoint, DNA repair and chromosomal instability, and the epigenetic silencing of genes in WNT-signalling and cell-cycle pathways.

Conclusions
Genomic complexity occurs very early in the natural history of BE and increasing genomic instability appears to tip the balance towards cancer. This may inform the potential for progression to cancer beyond the clinically discernible phenotype. Efforts to better understand the triggers for chromosomal breakages and rearrangements that underly progression will aid clinical prediction and prevention strategies.
P-OGC49 Reporting on Patient and Public Involvement in Oesophago-gastric Research Trials using the GRIPP 2 checklist
Authors: Musbahi Aya , Immanuel Arul 
Published: December 2021

Abstract

Background
There is increasing evidence on the value of PPI reporting (patient public
involvement) in all research. GRIPP2 (Guidance for Reporting Involvement of Patients and the Public) is the first international guidance for reporting of patient and public involvement in health and social care research. Associations with improved relevance and applicability may reduce research waste and target research funds more appropriately. The aim of this study was to review the reporting of PPI amongst all oesophago-gastric clinical trials undertaken between 2015 and 2021.

Methods
An electronic search in databases Medline, Embase and the Cochrane Library was
conducted to identify all clinical trials pertaining to oesophagogastric cancer from 2015 to 2021(with the exception of reviews, case reports and conference abstracts). Articles were scanned by two authors to identify if reporting of PPI had taken place.

Results
A total of 334 studies were found, of which 285 met the inclusion and exclusion criteria.Only 4 studies had reported on PPI. Two of which reported positive involvement and two reported negatively. None of the studies reported using the GRIPP 2 checklist and when reported by this study, none achieved all points on the GRIPP2 SF checklist. An analysis on the extent of PPI involvement in these studies was carried out.

Conclusions
PPI is poorly reported across oesophago-gastric research trials.
P-OGC51 A Review of Post-Oesophagectomy Benign Anastomotic Strictures
Authors: Musbahi Aya , Immanuel Arul 
Published: December 2021

Abstract

Background
Benign anastomotic strictures (BAS) are a known risk of oesophageal resection, leading to significant post-operative morbidity and a reported incidence of BAS varies widely from 8.83% to 42.38%. This review aims to assess incidence, risk factors for development as well as treatment.

Methods
An electronic search using specific search terms using Medline, Embase and the
Cochrane Library to identify all articles studying the development of BAS in adults post
oesophagectomy was carried out. Inclusion criteria were patients who underwent any form of oesophagectomy for malignant disease (Ivor Lewis, McKeown, thoracoabdominal, transhiatal,minimally invasive); patients in study &gt;18-year-old; study reported only benign anastomotic strictures and any study design with a minimum of 6 patients. Only articles published in the English language were included. Review articles, case reports and conference abstracts were all excluded

Results
Seven studies reported on the incidence of BAS and an average of 34.1% was found. Cervical anastomosis, anastomotic leak development. Cardiovascular disease, diabetes and gastric conduit and smaller gun size in a stapled anastomosis were also found to be associated with BAS. Hypertension, neoadjuvant chemotherapy, transhiatal oesophagectomy or transthoracic were not found to be associated with BAS. The mainstay of management appears to be endoscopic balloon dilatation with adverse reported outcomes related to stent management.

Conclusions
BAS after oesophagectomy is common. Several risk factors have been identified and balloon dilatation appears to be the mainstay of treatment.
P-OGC55 Current treatment modalities and median survival for patients with gastric and oesophagogastric cancers with isolated peritoneal metastasis
Authors: Ma Adler Shing Chak , Lam Stephen , Otify Eman , Yousfi Abdulfatah , Stearns Adam , Kumar Bhaskar 
Published: December 2021

Abstract

Background
Gastric cancer with peritoneal metastases carries a median survival of only 3-7 months without treatment. Meanwhile, cancers arising from the oesophago-gastric junction (OGJ) are rapidly increasing in incidence in the Western population and are also commonly associated with peritoneal metastases. In order to measure the efficacy of emerging modes of treatment for peritoneal disease, it is essential to describe the treatments patients currently receive and the impact of these on survival – data for which is poorly described in the literature and lacking in the UK setting.

Methods
This was a single hospital-based retrospective cohort study covering the period from March 2012 to January 2020 at a tertiary referral centre. 50 patients were identified from multidisciplinary team (MDT) meeting records receiving a diagnosis of gastric adenocarcinoma with isolated peritoneal disease. 31 patients were identified receiving a diagnosis of true (Siewert II or III) junctional adenocarcinoma with isolated peritoneal disease. We calculated median survival time for all patients and also by treatment modality.

Results
Mean age of patients with gastric adenocarcinoma and isolated peritoneal disease was 71 years (range 44-90). Overall median survival was 6.6 months (IQR 2.4-19.3). Median survival was 11.2 months (IQR 3.7-21.5) for patients receiving systemic chemotherapy (n = 26) and 2.4 months (IQR 1.2-5.1) for patients receiving best supportive care alone (n = 15).
Mean age of patients with junctional adenocarcinomas and isolated peritoneal disease was 70 years (range 37-89). Overall median survival was 7 months (IQR 3-19). Median survival was 10.5 months (IQR 6.5-20.5) for patients receiving systemic chemotherapy (n = 20) and 3.5 months (IQR 2-6) for patients receiving best supportive care alone (n = 6).

Conclusions
Our results demonstrate the poor prognosis of both gastric and oesophagogastric cancer patients with isolated peritoneal disease. Prognosis figures are comparable between the two cancer types. Findings are in line with previous studies performed outside the UK which have shown that available treatments extend survival by no more than 3-9 months, highlighting the desperate need for new treatment modalities.
P-OGC56 Do patients presenting with obstructing oesophageal cancer have worse outcome?
Authors: Chien Siobhan , Khan Khurram , Gall Lewis , MacKay Colin , Macdonald Andrew , Craig Carol , Forshaw Matthew 
Published: December 2021

Abstract

Background
Oesophageal cancer carries a poor prognosis. Despite the availability of urgent Upper GI endoscopy in the United Kingdom, a substantial proportion of patients with newly diagnosed oesophageal cancer present late with near total dysphagia and an obstructing tumour at the index endoscopy. There is little data analysing the effect of obstructing oesophageal cancer at presentation on overall prognosis. The aim of the study was to analyse if patients presenting with obstructing oesophageal cancer have a worse outcome.

Methods
A retrospective cohort study of all newly diagnosed oesophageal cancers (adenocarcinoma and squamous cell carcinoma) and high grade dysplasia registered in a single UK Regional Upper GI MDT between October 2019 and September 2020 was performed. Electronic records were interrogated and patients dichotomised into two groups based on if they were obstructed endoscopically or not on the index endoscopy and the results were compared. Median follow up was 7 months.

Results
243 patients (68 (28.0%) obstructed and 175 (72.0%) non-obstructed) with median age of 70 were identified. There were more females in the obstructed group (44.1% vs 25.7%, p = 0.005). ECOG performance status was worse in the obstructed group: ECOG-0 (30.9% vs 50.3%, p = 0.006). Adenocarcinoma was more common in non-obstructed group (69.1% vs 54.4%, p = 0.031). More patients in the obstructed group had a T4 tumour (38.2% vs 18.9%, p = 0.002), however, nodal and metastatic status were similar. Rates of curative intent treatment were similar. At median follow-up of 7 months (IQR 3-13), more patients in obstructed group were deceased (72.1% vs 49.7%, p = 0.002).

Conclusions
Obstructing oesophageal cancer at presentation is a marker of advanced disease and despite curative treatment intent, overall survival is worse compared to passable tumours. New screening techniques such as Cytosponge combined with public health interventions to encourage early presentation may enable earlier diagnosis and improved survival.