bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA09.06: LONG-TERM OUTCOMES OF 650 ESOPHAGEAL CANCER PATIENTS WITH THORACOSCOPIC ESOPHAGECTOMY
Authors: Heishi Takahiro , Ishida Hirotaka , Onodera Yu , Ito Ken , Konno Takuro , Maruyama Shota , Sato Chiaki , Okamoto Hiroshi , Sakurai Tadashi , Taniyama Yusuke , Kamei Takashi 
Published: September 2018

Abstract

Background
In 1996 Akaishi et al. reported the first thoracoscopic esophagectomy (TE) in Japan. Total 650 TEs for esophageal cancer have been performed in our institute by October 2016. There are many reports about the short-term outcomes of TE compared with open esophagectomy (OE), but the long-term outcomes of TE have been under debate. The aim of this study is to investigate the survival benefits of TE and to compare with OE and long-term outcomes which other previous reports showed.

Methods
A total 750 cases who underwent TE (N = 650) or OE (N = 100) between 1994 and 2015 in our hospital were included in this study. They were divided into four groups; surgery without any preoperative treatments (group S, N = 414), surgery after neoadjuvant chemotherapy (Group NAC, clinical stage II or III, N = 116), surgery after neoadjuvant chemoradiotherapy (Group NACRT, clinical stage II or III, N = 68) and salvage surgery after definitive chemoradiotherapy (Group SALV, N = 76). In group S, 100 patients received OE and 314 received TE. The other 3 groups (Group NAC, NACRT and SALV) received only TE. 3-year, 5-year overall survival (OS) and progression-free survival (PFS) rates for each group were analyzed and compared.

Results
In group S, the 5-year OS rate of TE was 63.4% and that of OE was 68.3%, there was no significant difference (Log-Rank test P = 0.41). Stage-specific OS rates of TE and OE were also compared and there was no significant difference. PFS rates of OE and TE showed the same tendency of OS. 5-year OS rate of group NAC was 63.5%. 3-year OS of group NACRT was 61.4%. 3-year and 5-year OS of group SALV were 41.4% and 34.0%. These results were the same or better than what the previous reports showed.

Conclusion
The long-term outcomes of TE were almost same as those of OE. The TE procedure resulted in similar or potentially better long-term outcomes in case of NAC, NACRT and SALV. It's acceptable to say thoracoscopic approach is the standard of esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
RA10.01: TREATMENT STRATEGY OF ESOPHAGEAL CANCER FROM THE EXPRESSION OF HER2 AND EGFR
Authors: Inoue Seiya , Nishino Takeshi , Goto Masakazu , Yoshida Daisuke , Tangoku Akira 
Published: September 2018

Abstract

Background
Neo-adjuvant chemotherapy (NAC) became to be a standard therapeutic strategy for advanced esophageal squamous cell carcinoma in Japan. However the multidrug combination chemotherapy with 5-FU, cisplatin (FP) and docetaxel (DFP) has been well known more effective than FP, biomarker predict efficacy of NAC is not known yet. We have reported that expression of HER2 and EGFR had correlated to the response of neoadjuvant chemotherapy and prognosis. Therefore we started to evaluate them in all cases using biopsy tissue samples from 2012.

Methods
The tissues were collected from 122 patients with esophageal squamous cell carcinoma before NAC with DFP from August 2012 to August 2017, and expression of HER2 and EGFR were measured with Immunohistochemistry. HER2 positive were 2 + and 3 + expression in immunostaining. The number of the patients were 20 cases in stageII, 91 cases in stageIII, and 11 cases in stageIV. These results were compared with response to NAC and outcome of the patients.

Results
There were no differences in patient background factors such as sex, age, location and stage.One hundred nineteen of 122 cases (97.5%) were positive for EGFR and HER2 positive cases were 12 cases (9.8%). Expression patterns of EGFR and HER2 were examined, EGFR positive-HER2 negative cases were the most common pattern, and 107 cases (87.7%), both positive were 12 cases (9.8%), and both negative were 3 cases (2.4%), EGFR negative-HER2 positive were not observed. The response rates of chemotherapy was 46.2% in the EGFR positive cases, it was 42.9% in EGFR positive-HER2 negative cases. It was 75% in HER2 and EGFR positive cases, and it was significantly higher than the other pattern (P = 0.034). HER2 expression was suggested to be a biomarker of NAC with DFP especially in stage III.

Conclusion
HER2 and EGFR expression was shown to be a predictor of NAC response. The patients with both negative pattern showed poorer response. The expression pattern of HER2 and EGFR can be useful biomarker of NAC response with DFP.

Disclosure
All authors have declared no conflicts of interest.
VS01.01: STEP BY STEP INSTRUCTIONAL VIDEO OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR SURGEONS-IN-TRAINING IN A SINGAPORE INSTITUTION
Authors: Myint Oo Aung 
Published: September 2018

Abstract

Description
Tan Tock Seng Hospital is second largest hospital in Singapore. It is affiliated to two medical schools in Singapore and it is a training hospital for both undergraduate and postgraduate training. Minimally Invasive Esophagectomy for esophageal cancer is more and more popular nowadays. In our department, all the residents have to view the step by step instructional videos of mininally invasive surgeries before they can assist in the cases. The viewing of the instructional videos help them with better understanding of the procedures. The viewing of videos help them with the importance of steps, standardization of steps. With the help of instructional video, they can not only assist better in the surgery but also reduce the learning curve when they start doing the procedure themselves after the graduation from the residency programme. This is the step by step instructional video of minimally invasive esophagectomy for surgeons-in-training rotated to our department.
To view the video please follow this link:
https://www.dropbox.com/sh/3azfkz37x7zh6z8/AABXRSxJUhhtWlEA0Eo2p599a?dl=0

Disclosure
All authors have declared no conflicts of interest.
VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION
Authors: Oshikiri Taro , Nakamura Tetsu , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2018

Abstract

Description

Background
Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP).

Methods
This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified.

Results
We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%.

Conclusion
Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN.

Disclosure
All authors have declared no conflicts of interest.
VS01.06: THORACOSCOPIC EXTENDED LYMPHADENECTOMY FOR EGJ CANCER: AN OPTION TO LEARN FROM THE EAST
Authors: Giacopuzzi Simone , Weindelmayer Jacopo , De Manzoni Giovanni 
Published: September 2018

Abstract

Description
Extended thoracoscopic lymphadenectomy is not common practice in Western countries in patients with adenocarcinoma of the esophagogastric junction. In this video we present a case of a patient with siewert I adenocarcinoma with lymph node metastasis to the right recurrent laryngeal nerve not treated with neoadjuvant therapy, due to comorbidity. The operation was: extended thoracoscopic en-block lymph node dissection. video will be edited in a more rigorous manner

Disclosure
All authors have declared no conflicts of interest.
VS02.05: LAPAROSCOPIC TREATMENT OF IATROGENIC ESOPHAGEAL PERFORATION AFTER PNEUMATIC DILATION FOR ESOPHAGEAL ACHALASIA
Authors: Costantini Mario , Salvador Renato , Capovilla Giovanni , Merigliano Stefano 
Published: September 2018

Abstract

Description
We present in this video a case of laparoscopic surgical repair of an esophageal perforation during pneumatic dilation for achalasia. When diagnososed with achalasia and offered adequate treatment, the patient chose pneumatic dilation. We followed the protocol used in the European trial but, after the second dilation with a 3.5 cm balloon, a perforation of the esophageal wall occurred. Gastrografin swallow and a CT confirmed the perforation. For the worsening conditions of the patient, we preferred the surgical treatment, as opposed to the conservative one. At laparoscopy, the lesion was well visible on the left lateral wall of the esophagus, 2 cm above the cardia. The mucosa was sutured with interrupted stitches, and the muscular layer reconstructed with continuous suture. A Heller myotomy was then performed on the anterior esophageal wall, and a Dor fundoplication completed the operation. The patient was discharged in 7th POD and at a 1-year follow-up she is free of dysphagia. The laparoscopic surgical repair of esophageal perforation during pneumatic dilation is feasible: proper treatment of the basic disease with myotomy is necessary, however, to achieve good final results.

Disclosure
All authors have declared no conflicts of interest.
VS03.01: QUANTITATIVE IMAGING OF CHANGE IN MICROCIRCULATION BY SIDESTREAM DARK FIELD MICROSCOPY (SDF) AFTER ESOPHAGECTOMY
Authors: Jansen Sanne , De Bruin Daniel , Van Berge Henegouwen Mark I , Van Leeuwen Ton , Gisbertz Suzanne 
Published: September 2018

Abstract

Description
Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Transection of the left gastric and gastro-epiploic artery and veins results in compromised perfusion in the fundus area which can result in anastomotic dehiscence (5–20%), relating to high morbidity and mortality (3–4%). The main objective of this observational study is to evaluation gastric tube microcirculation with Sidestream Darkfield Microscopy (SDF).

Method
This study included 22 patients (October 2015 - June 2016). Intra-operative microscopic images of gastric tube microcirculation were obtained with SDF directly after reconstruction. Using software (AVA2.0), the following parameters were evaluated: average velocity (μm/sec), Microvascular Flow Index (MFI), Total Vessel Density (TVD), Perfusion Vessel Density (PVD), Proportion of Perfused Vessels (PPV) and the De Backer Score (DBS), to assess change in perfusion.

Results
SDF accurately visualized and evaluated microcirculation in all patients. A SDF-stabilizer was used to create stable images. The average velocity decreased significantly towards the fundus (P = 0.001). Also, MFI, PVD and PPV were significantly lower towards the fundus, compared to the base of the gastric tube (P = 0.0002). No differences in TVD and DBS were observed, which was associated to the observed vessel dilation in the fundus-area. This vessel dilation proposes that compromised venous return may play an important role in the development of necrosis and leakage. Three patients developed anastomotic leakage.

Conclusion
This is the first study presenting quantitative microcirculation imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV were accurate parameters to observe change in perfusion after reconstruction. Also, vessel dilation in the fundus suggests a role for venous return in the development of ischemia. Quantitative microcirculation with SDF could allow for intra-operative early risk stratification, and, potentially, can result in a reduction of anastomotic leakage.

Disclosure
All authors have declared no conflicts of interest.
VS03.03: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE
Authors: Jiang Yuequan 
Published: September 2018

Abstract

Description
Trans hiatal esophagectomy avoid trans-thoracic surgery and reduce postoperative complications relate to thoracic surgery. However, the limitation of Trans hiatal esophagectomy is blunt dissection might result to some sever complications. We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope. Patient was in supine position, intubated with a single-lumen endotracheal tube. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope also. The lower mediastinal lymph nodes including gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope. Cervical part: Two incisions in neck were made, a 3–4cm incision in left side, another 1–2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be gas, this let the dissection of upper esophagus and lymph nodes become easy under video scope. this technique was invented by ourself, so it is unique for the congress. This surgical technique was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
VS03.05: VASCULAR ASSESSMENT OF THE GASTRIC TUBE IN MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY USING INDOCYANINE GREEN
Authors: Nombre De Maria Momblan Dulce , Turrado-Rodriguez Victor , Torroella Alba , Ibarzabal Ainitze , Sofia Espinoza Arlena , Carolina Guzman Yoelimar , Maria De Lacy Fortuny Antonio 
Published: September 2018

Abstract

Description
One of the major concerns in esophagic surgery is the safety of the esophagogastric anastomosis. Anastomotic leak is associated with important morbidity and mortality. Leak rates have been reported in 4.7% of patients in the Ivor-Lewis procedure and 5.2% for cervical anastomosis. Leak rate has been associated with insufficient vascular supply to the gastric conduit. Indocyanine green (ICG) assessment of the vascularization may be a useful tool to avoid this dreadful complication.

Methods
A 50-year-old man with medical history of high blood pressure and right pneumothorax was diagnosed of adenocarcinoma of the lower esophagus cT3N3. Neoadjuvant chemo-radiotherapy following CROSS principles was administered. Six weeks after the end of neoadjuvant chemo-radiotherapy a minimally invasive Ivor-Lewis esophagectomy was performed. ICG helped the identification of the right gastroepiploic arcade and of the adequate vascular supply to the gastric conduit. During thoracoscopy, ICG was helpful to assess the vascular supply to the gastric conduit after pull-up into the chest and to check the vascularization of the esophagogastric anastomosis.

Results
Postoperative evolution was uneventful. Oral intake was resumed on the third postoperative day. Patient was discharged on the 8th postoperative day.

Conclusions
ICG assessment of the vascularization of the gastric conduit is feasible, safe and helpful in Ivor-Lewis minimally invasive esophagectomy and may decrease the leak rate.

Disclosure
All authors have declared no conflicts of interest.
VS03.08: ANASTOMOTIC TECHNIQUES FOR MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY
Authors: Bernardi Daniele , Asti Emanuele , Bonavina Luigi 
Published: September 2018

Abstract

Description
Minimally invasive esophagectomy has the potential to reduce the incidence of pulmonary complications and postoperative pain. This video shows two safe and reproducible technical variants for thoracoscopic stapled anastomosis. The patient is placed in a left semi-prone position after induction of anesthesia with a single lumen orotracheal tube. Triportal access and low-pressure pneumothorax (8 mmHg) are used for the procedure. Once circumferential mobilization of the esophagus is completed, intraoperative ultrasonography is performed to identify a previously placed endoscopic metal clip marking the upper tumor level. The esophagus is safely transected above this level. An end-to-side intra-corporeal esophagogastric anastomosis is performed. Technique A. The esophagus is stapled with a 60 mm cartridge (EndoGIA™ Tri-Staple™ purple). The anvil of a 25 mm circular stapler (OrVil™) is inserted transorally and retrieved through a small hole in the esophageal stump. Technique B. The 25 mm anvil is inserted through a transverse esophagotomy with a 7 cm long 2–0 polypropylene suture attached to the sharp tip. The suture is passed from inside to outside of the esophageal lumen. The esophagus is then divided distal to the anvil with an linear stapler. At this point, the anvil is pulled out with a gentle traction close to the stapled line. In both techniques, the circular stapler is introduced into the chest cavity through a mini-thoracotomy at the level of lowermost trocar and a wound retractor (Alexis™) is used. The head of the circular stapler, sealed with a surgical glove cutted at the middle finger, is then introduced into the gastric tube through a small gastrotomy on the lesser curvature. The tip of the gastric tube is perforated close to the greater curvature and engage the esophageal anvil. After checking the doughnut, transection of the remnant gastric tube is completed with a linear stapler and the specimen is retrieved through the mini-thoracotomy.

Disclosure
All authors have declared no conflicts of interest.
Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh
Authors: Ghosh Prakash , Hasnain Md Golam , Hossain Faria , Khan Md Anik Ashfaq , Chowdhury Rajashree , Faisal Khaledul , Mural Moshtaq Ahmed , Baker James , Nath Rupen , Ghosh Debashis , Maruf Shomik , Shomik Mohammad Sohel , Haque Rashidul , Matlashewski Greg , Hamano Shinjiro , Duthie Malcolm S , Mondal Dinesh 
Published: September 2018

AbstractBackgroundPost-kala-azar dermal leishmaniasis (PKDL) is a sequel to visceral leishmaniasis (VL), which is found in VL-endemic countries including Bangladesh. Because of these enigmatic cases, the success of the National Kala-azar Elimination Program is under threat. To date, diagnostic methods for PKDL cases in endemic regions have been limited to clinical examination and rK39 test or microscopy, and a suitable and accurate alternative method is needed. In this study, we investigated the application of real-time polymerase chain reaction (PCR) as a potential method for diagnosis of PKDL in comparison with microscopy.MethodsNinety-one suspected macular PKDL cases from Mymensingh district, Bangladesh, were enrolled in the study after diagnosis by clinical examination and an rK39 strip test. All of them responded after completion of the treatment with miltefosine. During enrollment, a skin biopsy was done for each patient, and both microscopy and real-time PCR were performed for detection and quantification of Leishmania donovan body (LDB) and LD DNA, respectively.ResultsReal-time PCR detected 83 cases among all suspected PKDL patients, with an encouraging sensitivity of 91.2% (83.4%–96.1%), whereas microscopy showed 50.6% (39.9%–61.2%) sensitivity. Among all suspected PKDL cases, 42 cases were positive in both microscopy and qPCR, whereas 41 cases were detected as positive through qPCR only.ConclusionsThis study provides evidence that real-time PCR is a promising tool for diagnosis of PKDL in endemic regions. In addition to diagnosis, the quantitative ability of this method could be further exploited for after-treatment prognosis and cure assessment of PKDL cases.
Vaccine Rubella: A Rare Cause of Post-transplant Hematopoietic Death, but a Major Public Health Problem
Authors: Gonzalez Vicent Marta , Molina Angulo Blanca , Echevarría Mayo Juan Emilio , Diaz Perez Miguel Angel 
Published: September 2018

AbstractWe report the first case, to our knowledge, of a child who presented with severe zonal hepatic necrosis after allogeneic hematopoietic stem cell transplantation secondary to infection with the rubella virus RA27/3 vaccine strain.
Identification of genome-wide nucleotide sites associated with mammalian virulence in influenza A viruses
Authors: Peng Yousong , Zhu Wenfei , Feng Zhaomin , Zhu Zhaozhong , Zhang Zheng , Chen Yongkun , Liu Suli , Wu Aiping , Wang Dayan , Shu Yuelong , Jiang Taijiao 
Published: September 2018

ABSTRACTMotivationThe virulence of influenza viruses is a complex multigenic trait. Previous studies about the virulence determinants of influenza viruses mainly focused on amino acid sites, ignoring the influence of nucleotide mutations.ResultsWe collected more than 200 viral strains from 21 subtypes of influenza A viruses with virulence in mammals and obtained over 100 mammalian virulence-related nucleotide sites across the genome by computational analysis. Interestingly, 50 of these nucleotide sites only experienced synonymous mutations. Further experiments showed that synonymous mutations in the top two of these nucleotide sites, i.e., PB1-2031 and PB1-633, enhanced the pathogenicity of the viruses in mice. Finally, machine-learning models with accepted accuracy for predicting mammalian virulence of influenza A viruses were built. Overall, this study highlighted the importance of nucleotide mutations, especially synonymous mutations in viral virulence, and provided rapid methods for evaluating the virulence of influenza A viruses. It could be helpful for early warning of newly emerging influenza A viruses.