bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.189: A STUDY ON PRETREATMENT NUTRITIONAL SCORE OF ESOPHAGEAL CANCER PATIENTS WHO UNDERWENT PREOPERATIVE TREATMENT
Authors: Omoto Itaru , Uchikado Yasuto , Sasaki Ken , Osako Yusaku , Okumura Hiroshi , Owaki Tetsuhiro , Natsugoe Shoji 
Published: September 2018

Abstract

Background
Esophageal cancer tends to be malnourished due to anorexia, transit disorder, so it is important to conduct sufficient nutritional assessment and treatment. For standard treatment of neoadjuvant chemotherapy for esophageal cancer, Cisplatin + 5-fluorouracil (FP) therapy is common, but sufficient therapeutic effect has not been obtained. As a more powerful regimen, DCF therapy with Docetaxel added to FP therapy and chemoradiotherapy have been introduced. In this study, we examined pretreatment nutritional score of esophageal cancer patients who underwent neoadjuvant therapy.

Methods
We studied 105 patients undergoing preoperative treatment diagnosed as esophageal cancer or esophagogastric junctional carcinoma from July 2012 to August 2017. Esophagectomy with lymph node dissection after neoadjuvant therapy. Relationship between Glassgow Prognostic Score (GPS) and Controlling Nutrition Status Score (CONUT) score, sex, age, staging, main tumor location, adverse event, postoperative complication and tube feeding nutrition are examined.

Results
Median age was 66 years, male/female = 92/13, and cases requiring tube feeding were 29 cases. The breakdown of the clinical stage is Stage IA, B/IIA, B/IIIA, B, C/IV = 9/34/50/12. The breakdown of neoadjuvant therapy is FP/DCF/FPRT/DCFRT/other = 9/27/26/39/4. The incidences of grade 3/4 adverse events during preoperative treatment were 66 cases (63%) in 105 patients. The treatment effect is CR/PR/SD/PD = 6/41/50/8. Histopathological result is Grade 0/1a/1b/2/3 = 3/52/13/6/31. Postoperative complications were Clavien-Dindo classification Grade IIIa or more in 20 cases, in-hospital death was 1 case.CONUT score was judged to be cut-off by more than 2, there was a significant relationship between presence of tube nutrition and treatment result (P = 0.0376, 0.0231). GPS was judged to be 1 or more cutoff, there was a significant association with tube nutrition availability and histopathological result (P = 0.0019, 0.0083). There was no significant difference between occurrence of adverse events and occurrence of postoperative complications.

Conclusion
It was suggested that CONUTscore and GPS at hospitalization are useful as predictors of treatment result and histopathological result in esophageal cancer patients who undergo neoadjuvant therapy.

Disclosure
All authors have declared no conflicts of interest.
PS02.199: STRATEGY FOR TREATMENT OF NEUROENDOCRINE TUMORS OF THE ESOPHAGUS
Authors: Maeda Shinsuke , Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Osugi Harushi , Yamamoto Masakazu 
Published: September 2018

Abstract

Background
Neuroendocrine tumors of the esophagus are very rare. The prognosis is known to be poor, and there is no consensus on treatment strategy.

Methods
We investigated 27 patients who underwent surgery for neuroendocrine tumor of the esophagus at our institute between 1968 and 2017. We researched (1) Background, (2) Treatment, (3) Types of the recurrences, and (4) Prognosis.

Results
(1) Male: female = 22: 5, Median age; 64.2 (24–77), Location; Ut: Mt: Lt: Ae = 1: 15: 9: 2, Depth of the tumors: T1: T2: T3: T4 = 9: 3: 11: 4, Median length of the tumors; 57.7 mm (14–130), Pathological types; pure type: mixed type = 10:17, Lymph node metastasis; N0: N(+ ) = 3: 24. (2) Surgical approach; right thoracotomy:left thoracoabdominal incision:transhiatal approach = 24: 2: 1, Organ used for reconstruction; stomach: colon = 25: 2, Route of reconstruction; antethoracic: retrosternal: posterior mediastinal = 10: 5: 12, Neoadjuvant therapy; (+ ): (-) = 15: 12. (3) Types of recurrences; liver: lung: lymph nodes: bone: dissemination = 7: 6: 4: 2: 4. (4) Median survival time was 10 months (1–98). Compared by (a) tumor depth, (b) number of metastatic LNs, (c)with or without adjuvant therapy were as follows; (a) T1: T2–4 = 19: 5 months (P = 0.0202), (b) 0–2: > 2 = 19: 4 months (P < 0.001), (c) (+ ): (-) = 12: 5 months(P = 0.141).

Conclusion
Approximately 2/3 cases were accompanied with poorly differentiated SCC, and most of those cases were diagnosed as NET after surgery. Prognosis is poor, but pT1 cases and cases with small number of LN metastases showed better prognosis. Although without significant difference, cases with adjuvant therapy showed longer prognosis. Our opinion is, if with selection of cases and strong adjuvant therapy, surgery can be a feasible choice.

Disclosure
All authors have declared no conflicts of interest.
PS02.202: CLINICAL SIGNIFICANCE OF MEASUREMENT OF SKELETAL MUSCLE VOLUME AND SERUM NUTRITIONAL MARKERS IN ESOPHAGEAL CANCER PATIENTS
Authors: Ishida Tomo , Makino Tomoki , Tanaka Koji , Yamasaki Makoto , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
Some studies reported the association of muscle mass or nutritional state with development of postoperative morbidity. However, it remains unknown whether body composition or nutritional state influences upon clinical outcome in esophageal cancer (EC) patients undergoing surgery following neoadjuvant chemotherapy (NAC).

Methods
A total of 100 EC patients who undergone NAC followed by curative surgical resection in our hospital from 2011 to 2013 was analyzed. The cross-sectional area of psoas was measured by computed tomography at third lumbar vertebra and the Psoas Muscle Index [PMI: total psoas area at L3/(height × height)] was calculated. Pre- and post-NAC PMI in addition to prognostic nutritional index (PNI), modified Glasgow prognostic scale (mGPS), and neutrophil/lymphocyte ratio (N/L) as an inflammation or nutrition marker were evaluated in terms of their association with development of NAC adverse event, postoperative complications and long-term survival.

Results
The PMI significantly decreased during chemotherapy from 705.5 to 682.7 cm2/m2 (P = 0.0008). Pre-NAC PMI (low vs high group, cutoff: 6.36cm2/m2 for male, 3.92cm2/m2 for female) was significantly associated with serum albumin (3.5 vs 3.8g/dl P = 0.0064) and body mass index (19.6 vs 22.2kg/m2P < 0.001), and clinical response to NAC (response rate 66.7 vs 87.1% P = 0.02). Post-NAC PMI, meanwhile, correlated with development of postoperative pneumonia [Clavien-Dindo (C-D) classification grade > II] (35.0 vs 8.3% P = 0.0009) and expectoration disorder of sputum (C-D classification grade > III) (28.6 vs 10.5% P = 0.027) while neither pre- or post PMI were predictive of patient survival. Regarding serum nutritional markers, pre-NAC PNI and mGPS correlated with NAC-induced neutropenia [low vs high PNI (cutoff: 40): 100 vs 87% P = 0.019] and diarrhea (mGPS 0/1 vs 2: 27.4 vs 80.0% P = 0.017) while post-NAC mGPS (mGPS 0 vs 1/2) was predictive of development of postoperative pneumonia (11.5 vs 30.8%, P = 0.018) and expectoration disorder of sputum (10.7 vs 27.8%, P = 0.037), respectively. Notably, post-NAC mGPS (mGPS 0 vs 1/2: 76.4 vs 65.4%, P = 0.039) and N/L (N/L ≥ 2.5 vs < 2.5: 43.5 vs 82.1% P = 0.006) showed the significant association with 2-year overall survival.

Conclusion
Pre- and post-NAC PMI in addition to serum inflammation/nutrition markers might be clinically useful in predicting outcome of multidisciplinary treatments for EC patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.212: RECURRENCE PATTERN AND RISK FACTOR AFTER ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CARCINOMA
Authors: Kawai Masaru , Lee Sang-Woong , Tashiro Keitaro , Tanaka Ryo , Hiramatsu Masako , Uchiyama Kazuhisa 
Published: September 2018

Abstract

Background
Surgical procedure of esophageal cancer is invasiveness and perioperative condition for the patient play an important role for outcome. The aim of this study is investigate the impact of operative complication on the recurrence.

Methods
Between January 2010 and December 2017, total 159 patients, who had been diagnosed esophageal squamous carcinoma and undergone curative radical esophagectomy were enrolled.

Results
Recurrence was observed for 39 cases (24.5%), median value for recurrence is 493 days after operation. Pathological stage I/II/III/IV were 3/14/17/5 cases, respectively. Preoperative additional therapy was received 16 cases, including 13 cases for neoadjuvant chemotherapy and 3 cases for definitive chemoradiotherapy. The sites of recurrence were observed lymph node in 20 cases, distant metastasis in 10 cases, and three cases of local recurrence. Fifteen patients in recurrent cases are still survivals. Compared with no-recurrence group, there was no significantly difference in operative blood loss, blood transfusion and operative time. Preoperative nutritional condition, such as serum albumin level and number of lymphocyte were not difference in both groups. In addition, sarcopenia and obesity were not associated with recurrence. Concerning as inflammatory complications, anastomotic leakage was not influenced on recurrence, but pneumonia was affected to recurrence. Moreover, three year recurrent free survival was significantly lower in the case of pneumonia as postoperative complication.

Conclusion
The incidence of recurrence for esophageal squamous carcinoma is high rate, even if early stage of cancer. The site of recurrence is highly revealed as lymph node metastasis. In this study, pneumonia as postoperative complication is strongly contributed to risk factor for long term outcome. Secure postoperative respiratory management is required for improvement of long term prognosis.

Disclosure
All authors have declared no conflicts of interest.
PS02.215: DOUBLE STENT INSERTION FOR TRACHEOESOPHAGEAL FISTULA AFTER CHEMORADIOTHERAPY: A CASE REPORT AND REVIEW OF LITERATURE
Authors: Nakazato Hidetsugu , Yoshino Yutaro , Tomiyama Takeshi , Nagamine Shinji , Tomori Takehiko , Inamine Susumu , Miyagi Jun , Nagayoshi Seiji , Omine Yasushi , Miyara Tetsuhiro 
Published: September 2018

Abstract

Background
Tracheoesophageal fistula is a one of the most severe adverse events of chemoradiotherapy (CRT) for esophageal carcinoma.

Methods

Case
The patient was an 84-year-old man who was referred to our hospital due to dysphasia, which had persisted for 2 months. Upper gastrointestinal endoscopy demonstrated a semicircular esophageal tumor. Biopsy revealed squamous cell carcinoma. Further examination revealed regional lymph-node metastasis but no distant metastasis. The clinical classification, according to the TNM 7th edition was T4b(trachea)N1M0 Stage IIIC. CRT (using cisplatin (CDDP)/5-fluorouracil (5-FU) infusion with concurrent radiotherapy) was performed. At two weeks after the initiation of CRT, the patient developed pneumonia due to tracheoesophageal fistula. The respiratory infection was controllable and the tumor remained after CRT. Tracheal stent insertion and esophageal stent insertion were performed sequentially as palliative treatments.

Results
There were no specific complications in association with stent insertion and the patient was successfully discharged from the hospital.

Conclusion
Tracheal and esophageal stent insertion are considered to be safe and feasible palliative treatments for tracheoesophageal fistula.

Disclosure
All authors have declared no conflicts of interest.
PS02.216: PROPHYLAXIS OF POSTOPERATIVE VENOUS THROMBOEMBOLISM USING ENOXAPARIN AFTER ESOPHAGECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY FOR EFFECTIVENESS AND SAFETY
Authors: Yoshida Naoya , Baba Yoshifumi , Nagai Yohei , Okadome Kazuo , Kiyozumi Yuki , Iwatsuki Masaaki , Ishimoto Takatsugu , Imamura Yu , Watanabe Masayuki , Baba Hideo 
Published: September 2018

Abstract

Background
Incidence of venous thromboembolism (VTE) after esophagectomy is higher than those in other gastroenterological cancer surgery. However, the strategy of thromboprophylaxis during esophagectomy has not been established. Although effectiveness and safety of thromboprophylaxis using enoxaparin have been established in orthopedic, abdominal, and pelvic surgeries, no studies are available regarding esophagectomy.

Methods
We conducted a prospective observational study to elucidate the usefulness of enoxaparin to prophylactic VTE after esophagectomy. Thirty patients who underwent elective three-incision esophagectomy for esophageal cancer between April 2015 and October 2016 were enrolled. During the postoperative day (POD) 2 to 11, patients received a subcutaneous injection of enoxaparin (2000 IU) twice daily. The primary endpoint was the incidence of postoperative VTE. In addition, the incidence of all enoxaparin treatment-related and operation-related adverse events were also investigated. VTE was identified by VTE protocol enhanced CT, which was routinely performed during enoxaparin treatment and after enoxaparin treatment.

Results
One pulmonary embolism (PE) (3.3%) and 2 deep vein thrombosis (DVT) (6.7%) were observed during enoxaparin treatment. In addition, further one PE (3.6%) and 4 DVTs (14.3%) (one patient suffered the both) were observed after treatment. All VTEs were asymptomatic. Regarding enoxaparin-related adverse events, 4 minor bleedings without a need of stopping enoxaparin occurred. Incidence of postoperative morbidity was acceptable. In blood tests related to coagulation system, no significant differences were observed between patients with and without VTE.

Conclusion
We believe that thromboprophylaxis using enoxaparin is safe and can prevent VTE after esophagectomy. However, the effectiveness is limited in the period of treatment, additional prophylaxis following enoxaparin treatment may be recommended.

Disclosure
All authors have declared no conflicts of interest.
PS02.217: CLINICAL RESULTS OF PHOTODYNAMIC THERAPY FOR INOPERABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yi Eunjue , Ho Chung Jae , Lee Junhee , Lee Sungho , Kim Han 
Published: September 2018

Abstract

Background
Although surgical resection is the best way for curing cancer, there has been a certain portion of patients who could not undergo surgery because of various reasons. We experienced 9 cases of photodynamic therapy for esophageal cancer patients with inoperable conditions, and investigated the feasibility and safety of photodynamic therapy.

Methods
Medical records of patients of esophageal cancers who received photodynamic therapies in Korea University Anam Hospital were reviewed retrospectively. Survival, complication rates and treatment results were evaluated.

Results
A total of 9 patients (all men) with esophageal cancer had been received photodynamic therapy between 2007 and 2015. Average age at the time of treatment was 70.9 (± 4.62, ranging 64 to 78) and average follow-up periods were 18.2 (± 16.59, ranging 3.8 to 53.6). The average Charlson Comorbidity Index (CCI) were 7.3 (± 2.29, ranging 4 to 10). During the follow-up periods, 5 patients died, and only one death was related with the distant metastasis progression. There was one case of skin reaction and no other complications were appeared. There were no complication related deaths. Complete remission of esophageal cancer showed in 6 patients (66.7%) and partial remission showed in 3 patients (33.3%). Two patients with partial remission showed loco-recurrence. One patient with complete remission had to undergo surgery because of preexisting esophageal stenosis. In patients with complete remission, no recurrence was observed.

Conclusion
Photodynamic therapy is feasible and safe with acceptable rates of complications. For esophageal cancer patients with inoperable condition or refusal of surgery, photodynamic therapy could provide alternative way to treatment.

Disclosure
All authors have declared no conflicts of interest.
PS02.219: POSTOPERATIVE RECOVERY AFTER SURGERY FOR CANCERS OF THE ESOPHAGUS AND STOMACH: DOES PREOPERATIVE PATIENTS’ CONDITION PREDICT OUTCOME?
Authors: Thomaschewski Michael , Meyer Hauke , Kopeleva Olga , Keck Tobias , Hummel Richard 
Published: September 2018

Abstract

Background
Esophageal and gastric cancers usually occur at a higher age, and patients often present significant comorbidities. In combination with the risk profile of esophageal and gastric cancer surgery, the preclinical condition is relevant for morbidity and mortality after esophagectomy and gastrectomy. We aimed with the current project to investigate if postoperative physical recovery is as well significantly affected by preclinical conditions of the patient, and whether the patients’ condition might be a surrogate for the need for extensive rehabilitation.

Methods
We conducted a retrospective study on 108 consecutive patients that underwent esophagectomy (n = 56) or gastrectomy (n = 52) between 2013 and 2017. We analysed the impact of patients’ condition, BMI, age, tumor stage and complications on ICU time, respirator time, physical recovery in hospital and discharge conditions.

Results
Median age of the predominant male population (80%/65%) was 65 respectively 72 years for esophagectomy and gastrectomy. Preoperative risk was assessed as normal/increased/high risk using the Cologne Risk Score in 2%/36%/63% respectively 6%/41%/53% of cases, and ASA score was 2/3/4 in 20%/73%/7% respectively 19%/71%/10%. Preoperative patients` conditions (determined by ASA and Cologne Risk Score) also inclundig BMI, age, neoadjuvant therapy, tumor stage and tumor entity (squamous cell carcinoma versus adenocarcinoma) had no impact on postoperative ICU stay, respirator time, physical recovery and discharge condition. However, postoperative complications (determined by Clavien Dindo Score) negatively affect both discharge condition and physical recovery (P < 0.005), whereas age negatively affects discharge conditions (P < 0.005).

Conclusion
Preoperative patients’ condition seem to have no significant impact on recovery after both esophagectomy and gastrectomy. However, complications affect recovery negatively.

Disclosure
All authors have declared no conflicts of interest.
PS02.228: COMPARISON OF ESOPHAGEAL CANCER IN NORTHERN AND CENTRAL MALAYSIA
Authors: Ying Khoo Hui , Voon Kelvin , How Teoh Keat , Nagalingam Premnath , Aznan Shuhaili Mohamad , Rajan Reynu , Mohammed Taher Mustafa , Ritza Kosai Nik 
Published: September 2018

Abstract

Background
Malaysia is a unique Asian country with multiracial, multicultural and multi-religion society. It is divided into six regions geographically and each region has different population distribution and socioeconomic status. Urbanization occurs more rapidly in the central region with higher population density and household income. We would like to compare the epidemiology of esophageal cancer between Northern and Central Malaysia.

Methods
A review of esophageal cancer from two regional tertiary referral centers in Northern and Central Malaysia in 2014–2017.

Results
A total of 143 esophageal cancers were detected during the study period, 60 cases from northern region and 83 cases from central region. In both regions, the mean age of diagnosis was similar (63.3 vs 62.0). More male patients were noted in Central Malaysia (71% vs 62%). Esophageal cancer was commonest in the Chinese ethnicity in both regions. Cardioesophageal junction was the commonest location of cancer and majority of patients presented with dysphagia in both regions. For tumour histology, squamous cell carcinoma (SCC) was the commonest (49.4%) in the Central as compared to adenocarcinoma in the North (47.5%). The incidence of SCC was highest among the Indian population in both regions while adenocarcinoma was the commonest tumour in other ethnicity. Most of the patients in both regions presented with advanced disease and the incidence of stage 4 disease was higher in the North (65% vs 48%). Hence, there were more patients who underwent curative intend surgery in the central region (58% vs 28.5%).

Conclusion
The epidemiology of esophageal cancer is similar in both regions in Malaysia. Esophageal cancer is commonest among the Chinese. Further studies are needed to explore the tumour biology, host genetic factors and sociocultural practice for better understanding of esophageal cancer among the multiracial population in Malaysia.

Disclosure
All authors have declared no conflicts of interest.
RA01.01: THORACOSCOPIC ESOPHAGECTOMY IN SEMIPRONE POSITION
Authors: Pawar Suraj 
Published: September 2018

Abstract

Description
To assess the feasibility of Thoracoscopic Esophagectomy in the Dorso-Lateral position with the intention of reducing the disadvantages and increasing the benefits of lateral approach and prone approach which are the 2 conventional approaches. Methods: Thoracoscopic Esophagectomy is routinely performed in 2 positions. The left lateral decubitus position is the commonly used position at most of the centres. However prone jack-knife position as described by Cushieri is another alternative. To combine the advantages and reduce the disadvantages of the these 2, we started performing this procedure in a Dorso-Lateral position since 1st October 2008. This is a position midway between the Lateral and Prone position i.e. Left lateral position with an inclination making an angle of 45 degrees with the horizontal. Operating Surgeon and assistant are positioned anteriorly facing the ventral aspect of the patient. A three-port approach is taken with port placements in the 5th, 7th and 9th intercostals spaces in the posterior, mid and anterior axillary lines. Pneumothorax is created with CO2 pressure of 5–7 mm Hg. Although single lung ventilation is preferable the procedure can be done with routine dual lung ventilation with a 4th port being used to retract the lung if necessary.
Esophagus is mobilized en-block with posterior mediastinal lymphadenectomy. The Azygous vein and right Bronchial artery are preferably preserved to maintain vascularity of right bronchus. Following this patient is turned supine and Stomach mobilization and coeliac dissection is done laparoscopically. Left neck incision is taken and esophagus is divided in the neck. Specimen is delivered in the abdomen and extra-corporeally through a mini-laparotomy. Gastric tube is prepared and brought in the neck through posterior mediastinum underneath the azygous vein and rt.bronchial artery for anastamosis in the neck. The video shows the procedure in the Dorso-Lateral Position as we routinely perform at our centre. Conclusion: Thoracoscopic Esophagectomy with Mediastinal Lymphadenectomy in the Dorso-Lateral position is a feasible, more convenient and a safe option which can combine the benefits of the conventional left lateral and prone approaches. Surgeon comfort is enhanced in terms of more comfortable operating position and improved ergonomics.

Disclosure
All authors have declared no conflicts of interest.