bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA02.05: IS ROUTINE SUBCARINAL LYMPH NODE DISSECTION NECESSARY IN SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA?
Authors: Tang Han , Tan Lijie , Wang Hao , Shen Yaxing 
Published: September 2018

Abstract

Background
Esophageal squamous cell carcinoma (ESCC) tends to metastasize in a multidirectional fashion through the extensive submucosal lymphatics, even in early stage. Subcarinal lymph nodes (LNs) is regarded as one of regional lymph node stations for esophageal cancer and suggested to be dissected by Guildlines. However, the metastatic rate of subcarinal LNs is relatively low and dissection reportedly may increase pulmonary complications. The purpose of this study was to investigate the impact of subcarinal LN dissection on short-term and long-term outcomes in patients with superficial ESCC and aimed at illustrating the value of subcarinal LN dissection in superficial ESCC.

Methods
From January 2010 to December 2015, 490 patients with pT1 ESCC were enrolled in the study. Patients in subcarinal dissection (Group 1) or non-dissection group (Group 2) were matched randomly in a 2:1 ratio, eventually, 255 patients were selected for further statistical analysis.

Results
The metastasis rate of subcarinal LNs in superficial ESCC was 1.24% and significantly lower than perigastric, paraesophageal or bilateral recurrent laryngeal nerves station (7.14–9.96%). Compared with Group 1, Group 2 had shorter operation time (193 ± 35 vs. 204 ± 39, P = 0.016), less blood loss (157 ± 48 vs. 178 ± 29, P = 0.011), less harvested LNs (20.7 ± 8.8 vs. 24.5 ± 9.5, P = 0.002) as well as lower incidence of pulmonary complications (9.4 vs. 20%, P = 0.032). At a median follow-up of 46 months, the recurrent rates in two groups were similar (16.5 vs. 15.3%, P = 0.809). The 3-year overall survival(OS) rate of Group 1 and 2 was 89.7% and 90.4%, correspondingly, the 3-year disease-free survival (DFS) was 83.5% and 88.5%, respectively. Survival analysis revealed no OS (P = 0.992) and DFS (P = 0.665) reductions in Group 2. Subgroup analyses stratified by pT and pN status also confirmed no significant differences in OS and DFS. In univariate and multivariate analyses, subcarinal LN dissection was not a predictive factor of prognosis in superficial ESCC.

Conclusion
The present study was the first available analysis investigating values of subcarinal LN dissection in superficial ESCC. Our results showed subcarinal LN dissection did not contribute to improved survival, whereas may increase the risk of postoperative pulmonary complications in superficial ESCC. Therefore, subcarinal LN dissection could be omitted for patients with superficial ESCC.

Disclosure
All authors have declared no conflicts of interest.
RA02.07: A TWO-STAGE OPERATION USING A FREE JEJUNAL FLAP FOR GASTRECTOMIZED ESOPHAGEAL CANCER
Authors: Yagi Koichi , Nishida Masato , Sugawara Kotaro , Seto Yasuyuki 
Published: September 2018

Abstract

Background
The stomach is not available as a reconstruction organ in previously and synchronously gastrectomized esophageal cancer patients. In these patients, a pedicled jejunum or colon is mainly used for the reconstruction organ instead of the stomach, however, its reconstruction procedure is different among the institutes. In our department, a two-stage operation using a free jejunal flap (FJF) is performed when the stomach is unavailable.

Methods
A two-stage operation using a FJF for gastrcectomized esophageal cancer performed between 2010 and 2016 were retrospectively analyzed to evaluate a safety and feasibility of our operation.

Results
A two-stage operation using a FJF was performed for 30 cases, 19 for previously gastrectomized cases, and 11 for synchronous cases, respectively. Among 30 cases, thoracic and cervical esophageal cancer cases were 25 and 5, respectively. For 25 cases of the thoracic esophageal cancer, a subtotal esophagectomy, making a cervical esophagostomy and a jejunal tube placement was performed at the first stage, a reconstruction through the subcutaneous route using a FJF with vascular anastomoses by plastic surgeons was performed at the second stage. Median operation time of first and 2nd stage was 334 and 503 minutes, respectively. An internal thoracic artery was used for a recipient artery in all cases. In 4 of 5 cases of cervical esophageal cancer, a subtotal esophagectomy, esophago-jejuno anastomosis, making a jejunostoma using a FJF was performed at the first stage, the reconstruction of the anal side of a jejunostoma was performed by using a pedicled intestine at the second stage. Median operation time of first and second stage was 640 and 260 minutes, respectively. Clavien-Dindo grade IIIb or IV postoperative complication was seen in 3 cases (10%) after the first stage, 3 cases (10%) after the second stage. Necrosis of a FJF and anastomotic leakage was seen in 0 (0%) and 5 cases (17%), respectively.

Conclusion
A two-stage operation using a FJF needs plastic surgeon's cooperation, but is considered to be safe and feasible operation when a stomach is not available.

Disclosure
All authors have declared no conflicts of interest.
RA03.04: COMPARISON OF THE CLINICAL OUTCOMES OF ESOPHAGECTOMY AND CHEMORADIOTHERAPY AFTER NONCURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Koterazawa Yasufumi , Nakamura Tetsu , Oshikiri Taro , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2018

Abstract

Background
Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional definitive treatment owing to the possibility of residual tumor cells or lymph node metastasis. The aim of this study was to elucidate the efficacy and clinical outcomes of these additional treatments.

Methods
ESD was performed for cT1a esophageal cancer, and additional definitive treatment was recommended for patients who had undergone noncurative ESD for submucosa (SM) or muscularis mucosae cancers with lymphovascular invasion and a positive resection margin. The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy with lymph node dissection and 31 received chemoradiotherapy (CRT) by choice or because their conditions did not permit surgery.

Results
The median follow-up periods were 45 months (range, 3–89 months) in the esophagectomy group and 41 months (range, 12–84 months) in the CRT group. Overall survival didn’t differ between the groups (P = 0.46). But there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence owing to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, 6 patients; CRT group, 10 patients), none in the esophagectomy group had a recurrence, whereas 4 in the CRT group died of esophageal cancer (P = 0.031).

Conclusion
Overall survival did not differ between the esophagectomy and CRT groups after noncurative ESD. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion.

Disclosure
All authors have declared no conflicts of interest.
RA04.02: THE COMPLICATIONS AND LONG-TERM SURVIVAL IN TRANS-MEDIASTINAL RADICAL ESOPHAGECTOMY
Authors: Konishi Hirotaka , Fujiwara Hitoshi , Shiozaki Atsushi , Shoda Katsutoshi , Kosuga Toshiyuki , Kubota Takeshi , Okamoto Kazuma , Otsuji Eigo 
Published: September 2018

Abstract

Background
(Bachground) The radical esophagectomy for esophageal cancer is an invasive therapy for a long one-lung ventilation. We have been stylized trans-mediastinal radical esophagectomy in order to relieve the pulmonary complications.

Methods
(Candidates) The radical esophagectomy (R0/1, gastric tube reconstruction) by thoracotomy/thoracoscopy (groupT) or mediastinoscopy (groupM) were performed for 120/58 or 131 esophageal cancer patients. The long-term therapeutic results of trans-mediastinal radical esophagectomy and complications (Clavien-Dindo classification≧ 2) are investigated.

Results
(Results) In clinicopathological features, neoadjuvant therapy, cStage III/IV advanced cases, or R1 resection was significant in groupT (P < 0.01). The frequency of anastomotic leakage and recurrent nerve paralysis were not different in both group (P = 0.94, 0.69, respectively), whereas pulmonary complication was significantly decreased (25.2 vs 10.9%, P = 0.003). Any complications were slightly frequent in groupT than in group M (32.4 vs 29.5%, P = 0.59). The 5-years overall survival was slightly better in group M than in group T due to the effects of disease stage (53.5% vs 63.4%, P = 0.19). In the subgroup analysis, the overall survival rate was similar in each clinical stage.

Conclusion
(Discussion) The trans-mediastinal radical esophagectomy was effective for the relief of pulmonary complication, and was not inferior to the esophagectomy by thoracotomy or thoracoscopy in the prognosis.

Disclosure
All authors have declared no conflicts of interest.
RA04.07: A NOVEL TECHNIQUE FOR CERVICAL GASTROESOPHAGEAL ANASTOMOSIS DURING MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Jiang Yuequan 
Published: September 2018

Abstract

Background
Anastomotic leakage, fibrous stricture and gastroesophageal reflux are three major complications of gastroesophageal anastomosis, particularly in cervical anastomosis. Our aim was to evaluate the safety and efficacy of a novel cervical anastomosis technique (NA) by comparing it to the traditional side-to-side anastomosis (SS), and the end-to-side anastomosis using a circular stapler (CS) in terms of postoperative leakage, stricture and reflux.

Methods
A total of 390 patients with thoracic esophageal cancer underwent a minimally invasive esophagectomy with cervical anastomosis (192 with NA, 34 with SS and 164 with CS) in our institute from January 2013 and May 2016. The new anastomotic technique was improved from a type of side-to-side anastomosis technique which was reported by Collard et al. The difference of our new technique is that the part of the anastomotic stump was pushed into the tubular stomach. It let the end part of esophagus was embedded in the gastric tube while the end portion of the stomach was also reversed into the gastric tube (figure 1, 2, 3). The major postoperative complications including postoperative leakage, stricture and reflux were compared using three armed controlled study.

Results
With regard to the incidence of anastomotic leakage and reflux, the patients who underwent Jiang's anastomosis had a significantly lower rate than those in the SS group and CS group (Leaks: 1.0% vs. 8.8% and 8.5%, P = 0.025, 0.001; Reflux: 5.7% vs. 23.5% and 18.3%, P = 0.003, 0.001). The incidence of dysphagia was 10.4% with an occurrence rate of 1.5% for anastomotic strictures in the NA group. It was significant lower than that in the CS group (41.5% vs. 18.9%, P < 0.05) but not significantly different from that in SS group (11.8% vs. 2.9%).

Conclusion
The novel anastomotic technique remarkably reduced the incidence of gastroesophageal-anastomotic leakage, stricture and reflux and was a safe and effective technique for minimally invasive esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
RA05.09: THE INFLUENCE OF AGE ON OVERALL SURVIVAL AND COMPLICATIONS AFTER IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGEAL SURGERY
Authors: Baranov Nikolaj , Van Workum Frans , Van Der Maas Jolijn , Kouwenhoven Ewout , Van Det Marc , Van Den Wildenberg Frits , Polat Fatih , Nieuwenhuijzen Grard , Luyer Misha , Rosman Camiel 
Published: September 2018

Abstract

Background
Worldwide, the number of elderly patients suffering from esophageal cancer is increasing due to the increasing incidence of esophageal cancer and increasing life expectancy of the general population. The effect of age on morbidity, mortality and survival after Ivor Lewis totally minimally invasive esophagectomy (TMIE) with curative intention are not well known since elderly patients have been excluded in randomized trials.

Methods
A retrospective analysis of a prospectively documented database from December 2010 to June 2017 was performed, including all patients who underwent Ivor Lewis TMIE with curative intent for esophageal cancer in three Dutch hospitals. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Postoperative complications, in-hospital mortality, 30 and 90 days mortality, long-term complications and survival were compared between these two groups.

Results
Four hundred and forty-six patients were included, 89 patients in the elderly group and 357 patients in the younger group. In the elderly group, a significantly higher incidence of non-surgical complications (77.5% versus 66.7%; P = 0.048), cardiovascular complications (24.7% versus 14.0%; P = 0.014) and delirium (27.0% versus 11.8%; P = 0.000) was found. There was no significant difference in surgical complications, overall complications, 30-day mortality, 90-day mortality, 1-year survival and 2-year survival.

Conclusion
Although Ivor Lewis TMIE in elderly patients is associated with a higher rate of non-surgical complications, it can be safely performed without increasing postoperative mortality.

Disclosure
All authors have declared no conflicts of interest.
RA06.04: THE DEVELOPMENT AND NATURAL HISTORY OF A HIATA HERNIA
Authors: Abdelmoaty Walaa , Dunst Christy , Walters Jarvis , Tugulan Carmen , Doan Huy , Zihni Ahmed , Filicori Filippo , Davila Bradley Daniel , Reavis Kevin , Swanstrom Lee , Demeester Steven 
Published: September 2018

Abstract

Background
Little is known about the initial development and natural history of a hiatal hernia.

Methods
A database containing 12,050 upper gastrointestinal (UGI) studies dating from 1991 to 2013 was queried to identify patients that had more than one study a minimum of 5 years apart showing a hernia. The x-ray films or digital images were reviewed and the type and size of any hernia determined.

Results
There were 56 patients with 133 UGI studies. On initial UGI; 13 patients had no hernia, 35 patients had a sliding hernia (SH), and 8 patients had a paraesophageal hernia (PEH). Follow-up UGI results are shown in the Figure. A third or fourth UGI study was available for 17 patients. Over a median of 41 months, the most recent UGI showed that the majority (78%) of SH increased in size, with 1 changing to PEH. Among patients with PEH, 2 were already completely intrathoracic stomachs and on most recent UGI 4 of the remaining 6 increased in size with 1 turning into complete intrathoracic stomach.

Conclusion
Most PEHs (77%) started out as a SH. Over time the majority of both SH and PEH increase in size, with many PEH becoming completely intrathoracic stomachs. Given the risks associated with a PEH, patients with SH should be re-evaluated for progression of their hernia.

Disclosure
All authors have declared no conflicts of interest.
RA06.07: PSYLLIUM SUPPLEMENTATION EFFECT ON ESOPHAGEAL FUNCTION TESTING AND SYMPTOMS IN PATIENTS WITH NON-EROSIVE GERD
Authors: Morozov Sergey , Isakov Vasily , Konovalova Mariya 
Published: September 2018

Abstract

Background
Epidemiological data showed negative correlation between heartburn frequency and amount of dietary fiber consumed. However no interventional study was performed to prove clinically beneficial effect of dietary fibers in gastroesophageal reflux disease (GERD) patients.
The aim of the study was to investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive GERD patients (NCT01882088)

Methods
Thirty six NERD patients were examined using food frequency questionnaire and in case of less than 20 g/day dietary fibre intake underwent high-resolution esophageal manometry and 24-hours esophageal pH-impedance. Language-specific GERD-Q questionnaire was used to assess symptoms. Repeated examinations were performed after 10 days of usual diet supplemented by psyllium 15.0 gram a day. Complete data of 30 NERD patients were available for the final analysis. Study design is shown in a figure 1. Wilcoxon matched pairs test was used to assess changes in the studied parameters

Results
The decrease in proportion of patients experiencing heartburn as well as GERD-Q score decrease were found. Minimal resting lower esophageal sphincter pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4, P = 0.023. No change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes decreased from 67.9 ± 17.7 to 42.4 ± 13.5, P < 0.001 (Table 1).

Conclusion
Supplementation of diet with psyllium 5.0 gram TID in NERD patients led to significant increase of minimal esophageal resting pressure, decrease of number of gastroesophageal refluxes and frequency of heartburn per week. The work was supported by Federal Agency of Scientific Organizations of Russia (0529–2017-0057)

Disclosure
All authors have declared no conflicts of interest.
RA07.04: DIAGNOSTIC UTILITY OF ENDOBRONCHIAL ULTRASONOGRAPHY FOR THE TRACHEOBRONCHIAL INVASION OF ESOPHAGEAL CANCER
Authors: Nishino Takeshi , Yoshida Takahiro , Inoue Seiya , Goto Masakazu , Tangoku Akira 
Published: September 2018

Abstract

Background
Preoperative precise diagnosis of invasion to the trachea and bronchi from advanced esophageal cancer is important to estimate the prognosis and resectability. But it is difficult to diagnose the invasion to the tracheobronchial adventitia by conventional examination, like CT scan, MRI, bronchoscopy, etc. The purpose of this study is to clarify the diagnostic utility of endobronchial ultrasonography (EBUS) for the invasion to the trachea and bronchi of esophageal cancer.

Methods
We examined the diagnostic utility of EBUS in cadaver, by comparing echoic image and actual tracheobronchial structure using tracheal invasion model. The model was made by cauterizing adventitia with the electrical scalpel. The cancer image model was made by injecting the agarose gel into esophageal muscular layer. And we also examined for clinical T3 or T4b esophageal cancer cases using EBUS for the diagnosis of tracheobronchial invasion.

Results
Normal image of tracheal wall was shown as three layers (high-low-high echoic layers) by EBUS. Echoic image of the tracheal invasion model in cadaver showed disappearance of the deepest high echoic layer. Histological examination proved interruption of tracheal adventitia by cauterization. Echoic image of tumor image model showed disappearance of the deepest high echoic layer and clearly observed tumor like agarose gel through the tracheal wall. These indicated the deepest high echoic layer correspond with the tracheal adventitia layer. EBUS could be visualized esophageal cancer invasion to the tracheobronchial adventitia. We performed EBUS for 32 cases of T3 or T4b esophageal cancer had been suspected the tracheobronchial invasion. 9 cases were diagnosed as T3 without invasion to the trachea or bronchi and received neo-adjuvant therapy following surgery, and all cases of these were confirmed precise diagnosis of EBUS in histological findings. 23 cases were diagnosed as T4b with invasion to the trachea or bronchi and received definitive chemo-radiation, and one patient received esophagectomy and pharyngolaryngectomy for salvage surgery and also confirmed accuracy of preoperative diagnosis using EBUS in histological findings.

Conclusion
EBUS is useful to diagnose the tracheobronchial invasion of esophageal cancer. Precise diagnosis of the tracheobronchial invasion using EBUS will help us to perform R0 resection and improve the prognosis of cT4b esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Yang Hong 
Published: September 2018

Abstract

Background
To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients.

Methods
Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared.

Results
The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases.

Conclusion
Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.