bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.166: COLONIC INTERPOSITION FOR ESOPHAGEAL REPLACEMENT AFTER ESOPHAGECTOMY FOR CANCER: A SINGLE CENTER EXPERIENCE
Authors: Sabino Flávio , Guimaraes Marco , Fernandes Daniel , Eduardo Pinto Carlos , Felipe Pinto Luis , Ribeiro Luciana , Albagli Rafael , Hugo Vieira Vitor , Lopes Alberto , Da Câmara Eduardo 
Published: September 2018

Abstract

Background
The method of choice for esophageal replacement after esophagectomy for cancer is the gastric tube. However when the stomach is not available a colon graft interposition can be performed. The purpose of this retrospective study was to review our experience with colon interposition following esophagectomy for cancer and to assess the early surgical outcomes.

Methods
We reviewed clinical data from 26 consecutive patients who underwent colon interposition after esophagectomy for cancer between January 1990 and December 2017 at the Brazilian National Cancer Institute. Outcomes were compared with data in international publications on colon interposition.

Results
There were 22 (85%) males and 4 females with a mean age of 56 years (range, 28 to 79 years). Indications were adenocarcinoma in 21 (81%) and squamous cell carcinoma in 5 (19%). Seven (30%) patients received neoadjuvant treatment: in 3 cases chemotherapy and in 4 patients chemoradiation. Transhiatal esophagectomy and transthoracic esophagectomy were performed in 21 (81%) and 5 patients, respectively. The mean operative time was 389 min (range 120–660 min). The most common option for colon conduit was the left colon (63%). We performed hand-sewn anastomosis in the neck in all cases. Surgical morbidity was 65%, most commonly due to pulmonary complications. Anastomotic leakage occurred in 13 patients (50%). One case graft necrosis were observed and 9 (35%) reoperations were necessary. In-hospital mortality was 15%.

Conclusion
Our results are in line with the literature and demonstrate that colon interposition after esophagectomy is feasible and, despite having a significant morbimortality, appears to be a valuable alternative for the challenging situation where the stomach is not available.

Disclosure
All authors have declared no conflicts of interest.
PS01.170: IMPACT OF MUSCLE MASS, NUTRITIONAL STATUS AND MUSCLE STRENGTH ON OUTCOMES FOLLOWING SURGERY FOR ESOPHAGEAL CANCER
Authors: Hagens Eliza , Feenstra Minke , Van Berge Henegouwen Mark I , Gisbertz Suzanne 
Published: September 2018

Abstract

Background
Muscle function loss and loss of skeletal muscle have been associated with worse outcomes following surgery for malignancies of gastrointestinal origin. The influence on post-operative outcomes and survival after esophageal surgery remains unclear. Primary objectives of this study were to evaluate the incidence of sarcopenia and malnutrition and to evaluate the influence of skeletal muscle surface area and muscle strength on postoperative outcomes and overall survival in esophageal cancer patients.

Methods
A retrospective cohort study from a prospective database was conducted in patients with resectable esophageal cancer who underwent curative-intent treatment between January 2011 and January 2016. Skeletal muscle surface area was calculated with CT scans at L3 level and corrected for height and weight before start of treatment and in the interval between neoadjuvant treatment and surgery. Muscle strength was evaluated with various tests on muscle functions and lung function tests. Nutritional status was evaluated using BMI.

Results
273 Patients were included. There were 4 patients with sarcopenia before neoadjuvant therapy and only one patient with sarcopenia after completion of neoadjuvant therapy. Median skeletal muscle surface area was 78cm2/m2 for men and 61cm2/m2 for woman. Table 1 shows skeletal muscle surface area, muscle strength and BMI in relation to no, minor or major complications. Muscle strength and nutritional status did not have a significant influence on postoperative complications and overall survival.

Conclusion
Sarcopenia did not occur frequently in this cohort with potentially curable esophageal cancer patients. Muscle function, skeletal muscle index and BMI did not statistically influence post-operative complications or survival.

Disclosure
All authors have declared no conflicts of interest.
PS01.171: DOUBLE-PEDICLED FREE JEJUNAL TRANSFER FOR RECONSTRUCTION OF PHARYNGOLARYNGOESOPHAGECTOMY
Authors: Mukaide Hiromi , Michiura Taku , Inoue Kentaro , Miki Hirokazu , Yamamichi Keigo , Hamada Madoka 
Published: September 2018

Abstract

Background
We recently selected double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy to reduce the vascular thrombosis-induced necrosis in free jejunal transfer. We herein report our experience with this procedure.

Methods
Single-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy was performed from January 2006 to November 2013, and double-pedicled free jejunal transfer (i.e. two pairs of jejunal arteriovenous anastomoses) was performed from December 2013 to December 2016 in Kansai Medical University Hospital. We compared the perioperative outcomes and complications between these two procedures.

Results
Sixty-two patients (58 men, 4 women; median age, 66 years; age range, 51–83 years) underwent single-pedicled free jejunal transfer. Twenty-eight patients (25 men, 3 women; median age, 70 years; age range, 47–84 years) underwent double-pedicled free jejunal transfer. Twenty-eight patients received preoperative treatments. Table 1 shows the perioperative outcomes and complications.

Conclusion
No thrombus of the free jejunum occurred, no anastomotic leakage occurred, and all flaps survived in the double-pedicled free jejunal transfer group. We believe that double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy is a reliable and useful procedure.

Disclosure
All authors have declared no conflicts of interest.
PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY.
Authors: Hirata Yuki , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Nakamura Rieko , Suda Koichi , Wada Norihito , Kitagawa Yuko 
Published: September 2018

Abstract

Background
In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications.

Methods
We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016.

Results
The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group.

Conclusion
In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications.

Disclosure
All authors have declared no conflicts of interest.
PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE
Authors: Antonio Guimaraes Filho Marco , Sabino Flávio , Fernandes Daniel , Eduardo Pinto Carlos , Felipe Pinto Luis , Ribeiro Luciana 
Published: September 2018

Abstract

Background
Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed.

Methods
The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival.

Results
Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months.

Conclusion
Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care.

Disclosure
All authors have declared no conflicts of interest.
PS01.191: LAPAROSCOPIC TRANSHIATAL LOWER MEDIASTINAL LYMPHADENECTOMY FOR ESOPHAGOGASTRIC JUNCTIONAL CANCER: THE INFRACARDIAC BURSA AS A LANDMARK
Authors: Kurahashi Yasunori , Nakamura Tatsuro , Ozawa Rie , Nakanishi Yasutaka , Niwa Hirotaka , Ishida Yoshinori , Shinohara Hisashi 
Published: September 2018

Abstract

Background
Esophagogastric junction cancer has been increasing recently. As a result, opportunities to perform transhiatal lower mediastinal lymphadenectomy are also increasing. Laparoscopic surgery is useful because the operating field of this site is too deep and narrow to perform laparotomy. But the anatomy of this area is not sufficiently clarified, and since there are few structures as landmarks, it is difficult to set the range and depth of lymph node dissection.

Methods
We have been verifying anatomically and embryologically the infracardiac bursa (ICB) identified as a closed lumen between the esophagus and the right crus of the diaphragm during an operation. We standardized the procedure of transhiatal lower mediastinal lymphadenectomy setting several landmarks including ICB.

Results
In transhiatal lower mediastinal lymphadenectomy, it is possible to do a precise lymphadenectomy by setting several landmarks including the ICB and standardizing each procedure on the ventral side, dorsal side, and both sides of the esophagus. In the case of advanced cancer which invades organs around the hiatus, it is difficult to perform routine dissection by using the infracardiac bursa or the dissectable layer. Understanding of the anatomy of this area will support the safe and precise lymphadenectomy.

Conclusion
In this presentation, we will show the procedure of transhiatal lower mediastinal lymphadenectomy using the ICB as a landmark.

Disclosure
All authors have declared no conflicts of interest.
PS01.194: CLINICOPATHOLOGICAL EXAMINATION OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA TREATED WITH CURATIVE SURGERY
Authors: Kaida Sachiko , Yamaguchi Tsuyoshi , Takebayashi Katsushi , Miyake Toru , Iida Hiroya , Sonoda Hiromichi , Shimizu Tomoharu , Tani Masaji 
Published: September 2018

Abstract

Background
Compared to Western countries, Japanese esophagogastric junctional carcinoma (JC) demonstrates different epidemiologic backgrounds; squamous cell carcinoma is dominant over Barrett adenocarcinoma, and there is no consensus on surgical approach or dissection range of lymph node. JC is defined as the cancer, that is the center of the tumor is within 2 cm from the esophagogastric junction to the esophagus and stomach respectively by the Japanese Classification of Esophageal Cancer, 11th edition. According to this definition, we examined the clinicopathological features and treatment outcomes of patients who underwent curative resection and pathologically defined as JC.

Methods
From 2012 to 2018, 19 consecutive patients with JC who received with curative surgery in Shiga University of Medical Science Hospital were included. Clinicopathological classification was based on Japanese Classification of Esophageal Cancer, 11th edition.

Results
The patients consisted of 14 males and 5 females, median age was 68 (43–91) years old. Pathological diagnoses were 15 adenocarcinoma, 1 squamous cell carcinoma, 2 mixed adenoneuroendocrine carcinoma (MANEC) and 1 malignant melanoma. Patients with Barrett's esophagus were 6 cases (31.6%). Median tumor diameter was 54 mm (5–90 mm) and tumor location was E:3 cases (15.8%), EG:6 cases (31.6%), E = G:1 case (5.2%), GE:8 cases (42.1%) and G:1 case (5.2%). Surgical procedure was esophagectomy via right thoracotomy 6 cases, esophagectomy via left thoracotomy 2 case and laparotomy 11 cases. Tumor invasion was pT1:6 (31.6%), pT2:3 (15.8%), pT3:3 (15.8%) and pT4:7 (36.8%). Lymph node metastases were observed in 13 cases (68.4%) and #1,2,3:13 cases (100%), #4,5: 2 cases (15.4%), #7,8a,9: 4 cases (30.8%), #19,20: 3 cases (23.1%) and #105–110: 3 cases (23.1%). Among 7 recurrence patients, peritonitis carcinomatosa was 4 cases.

Conclusion
In all positive lymph node metastasis cases, metastasis was observed in #1, 2 and 3 lymph nodes, but metastasis to the cervical lymph node was not observed. In the G, GE cases, right thoracotomy was not performed because there were no metastases to the upper mediastinal lymph nodes. In conclusion, these results suggested that surgical operation could be reduced to proximal gastrectomy for early G, GE cases. However, the number of cases is small in this study, further investigation is necessary.

Disclosure
All authors have declared no conflicts of interest.
PS01.197: SURVIVAL COMPARISON BETWEEN IVOR-LEWIS AND MCKEOWN MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROSPECTIVE RANDOMIZED STUDY
Authors: Lee Jang-Ming , Chen Pei-Hsing 
Published: September 2018

Abstract

Background
Both Ivor Lewis (anastomosis in the chest) and McKeown (anastomosis in the neck) esophagectomy has been used to treat patients with esophageal cancer. It is unclear in literature about the survival difference performed by these two methods.

Methods
A prospective randomized trial enrolling 100 patients with esophageal cancer in the middle or lower esophagus was done to compare the survival outcome treated with minimally invasive esophagectomy by Ivor Lewis and McKeown approaches. Analysis for the retrospective patient cohort (n = 253) including Ivor Lewis (n = 115) and McKeown (n = 138) MIE in the same hospital was also performed.

Results
There is no significant difference in the overall and disease progression-free survival duration between the two groups of patients (n = 50 for each group) (Figure 1 for overall survival). Similar results were found when the comparison was done for the retrospective and whole patients cohort. Multivariate analysis demonstrates the TNM staging of the tumor to be the single significant factor for prognosis in terms of overall and disease progression-free survival. There was no significant difference in overall and disease progression- free survival between the patients with Ivor Lewis and McKeown MIE both in prospective and retrospective study cohort.

Conclusion
Ivor Lewis and McKeown MIE provide a similar survival results for the patients with esophageal cancer in the middle and lower thoracic esophagus.

Disclosure
All authors have declared no conflicts of interest.
PS01.205: FEASIBILITY OF ENHANCED RECOVERY PROTOCOL AFTER ESOPHAGEAL SURGERY IN ELDERLY PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Alberto De Pasqual Carlo , Weindelmayer Jacopo , Giacopuzzi Simone , Alberti Luca , La Mendola Roberta , Laiti Silvia , De Manzoni Giovanni 
Published: September 2018

Abstract

Background
The use of ERAS (Enhanced Recovery After Surgery) protocols, to reduce morbidity and accelerate recovery is spreading in general surgery. In dedicated centres these programs have been successfully applied after oesophageal surgery. However, some concerns have been raised about the feasibility of these protocols in elderly patients.

Methods
We retrospective reviewed 72 patients submitted to Ivor-Lewis esophagectomy in our Institution, in the period 2015–2017. We divided the patients into two groups: 47 patients (65,3%) were < 70 years old (Young Group, YG) while 25 patients (34,7%) were ≥ 70 years old (Elderly Group, EG). We compared post-operative outcomes and adherence to ERAS steps of the two groups.

Results
The two groups were not different in terms of overall morbidity rate (53,2% in YG vs 60,0% in EG P = 0,6) and pulmonary complications rate (70,2% in YG vs 72,0% in EG, P = 1). We did not reporte 90-days mortality. We did not observe differences in adherence to ERAS step: pre-operative carbohydrate load administration (78,7% in YG vs 76,0% in EG, P = 0,7), peri-dural catheter for analgesia placement (89,3% in YG vs 88,0% in EG, P = 1), ward transfer on POD 0 (61,7% in YG vs 48,0% in EG, P = 0,32), removal of naso-gastric tube on POD 1 (87,2% in YG vs 96,0% in EG, P = 0,4), resume of liquid diet on POD 1 (55,3% in YG vs 56,0% in EG, P = 1), urinary catheter removal on POD 2 (61,7% in YG vs 48,0% in EG, P = 0,3), fully mobilization on POD 3 (63,8% in YG vs 52,0% in EG, P = 0,4), resume of soft diet on POD 4 (72,3% in YG vs 68,0% in EG, P = 0,7), discharge on POD 7 (48,9% in YG vs 40,0% in EG, P = 0,6). Median day of discharge was POD 8 for both groups (P = 0,8).

Conclusion
In high-volume centres ERAS protocols can be safely applied to elderly patients undergoing esophagectomy. An experienced team is needed to achieve this results.

Disclosure
All authors have declared no conflicts of interest.
PS01.209: POPULATION-LEVEL SURVIVAL FOR ESOPHAGEAL CANCER: AN ANALYSIS OF 13,930 PATIENTS IN A REGIONALIZED, SINGLE-PAYER HEALTH SYSTEM
Authors: Gupta Vaibhav , Kidane Biniam , Ringash Jolie , Sutradhar Rinku , Darling Gail , Coburn Natalie 
Published: September 2018

Abstract

Background
Despite advances in medical and surgical treatment, esophageal cancer remains a high-fatality disease. Regionalized cancer care may improve short and long-term survival. This study defines perioperative and long-term survival for esophageal cancer on a population level.

Methods
A population-based retrospective cohort study in a single-payer health system (Ontario, Canada; population 13.6M) was performed using linked health administrative data. Adults diagnosed with adenocarcinoma or squamous cell esophageal and esophagogastric junction cancer between 2002–2014 were included. Thoracic surgery was regionalized to 15 centres of excellence by 2010. The Kaplan-Meier method was used to estimate median survival. Rates of perioperative mortality, defined as in-hospital and 90-day post discharge death, were calculated before and after regionalization. Multivariable logistic and Cox proportional hazards regression analyses were used to identify factors associated with short and long-term survival.

Results
13,930 patients were diagnosed with esophageal cancer during the study period. Median survival was 10.1 months from date of diagnosis (95% CI 9.9–10.5), and marginally better for patients with adenocarcinoma compared to squamous cell carcinoma (10.4 vs 9.0 months, P = 0.002). Cox regression analysis showed age, socioeconomic status, and region of residence were significantly associated with long-term survival. Approximately 30% of the cohort (n = 3880) underwent curative-intent surgery and had a median survival of 24.5 months (95% CI 23.4–25.9) from the date of surgery. In these patients, age, socioeconomic status, major surgical complications and year of diagnosis were significantly associated with long-term survival (P < 0.001). Perioperative mortality decreased from 13.8% in 2002 to 5.4% in 2014 (P < 0.001). Only age and major surgical complications were associated with increased perioperative mortality (P < 0.001). Surgery at a thoracic centre reduced the odds of perioperative mortality (OR 0.63, 95% CI 0.49–0.81), but did not influence long-term survival (P = 0.79).

Conclusion
Median survival for patients diagnosed with esophageal cancer remains poor but is greater than two years for patients undergoing curative-intent surgery. Perioperative mortality significantly decreased over time as surgical care was regionalized to centres of excellence, but this has not affected long-term survival. Further work should analyze variation in short and long-term survival across thoracic surgery centres of excellence.

Disclosure
All authors have declared no conflicts of interest.