bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.157: APPLICATION OF THE COMPLETELY MOBILIZED REMNANT STOMACH IN ESOPHAGOPLASTY FOR LOWER THORACIC ESOPHAGEAL CARCINOMA FOLLOWING DISTAL GASTRECTOMY
Authors: Mao Zhangfan , Huang Jie , Xie Songping 
Published: September 2018

Abstract

Background
Reconstruction of the esophagus for the patients following distal gastrectomy (DGE)is a significant challenge for surgeons. Remnant stomach seems to be a better choice compared with colon or jejunal. But many complicated surgical methods were performed because of limitation of feeding vessels. We found the remnant stomach remained viable when all the feeding vessels were dissected. We used the completely mobilized stomach to reconstruct esophagus successfully in 29 lower thoracic esophageal carcinoma patients with a history of DGE.

Methods
The clinical data of 29 patients were retrospectively analyzed from August 2005 to March 2017 who accepted esophagoplasty by the completely mobilized remnant stomach. All the vessels of the remnant stomach were dissected including short gastric, posterior gastric, left gastric and left gastroepiploic vessels. The DGE included 2 Billroth I and 27 Billroth II.

Results
No perioperative death, no remnant stomach necrosis occurred. One Leakage was the iatrogenic injury on the remnant stomach. The other postoperative complications were the pulmonary infection(5) and arrhythmia(4).

Conclusion
The completely mobilized remnant stomach was viable and functional after dissecting all the feeding vessels. Application of it was a new and feasible surgical method to perform esophagoplasty with the simpler procedure and less complication.

Disclosure
All authors have declared no conflicts of interest.
PS01.158: WHAT IS THE IDEAL RECONSTRUCTIVE TECHNIQUE FOR TYPE 2 GEJ TUMOURS—ESOPHAGOGASTROSTOMY OR ESOPHAGOJEJUNOSTOMY
Authors: Chandramohan Servarayan , Varadharajan Visvarath , Chinnathambi Madeshwaran , Manickavasagam Kanagavel , Jebaraj Abishai , Chandramohan Apsara 
Published: September 2018

Abstract

Background
In the management of OG junction tumors the border issue arises in type 2 cancers. It can be managed with various options like esophago gastrectomy (Ivor Lewis), transabdominal extended transhiatal gastrectomy or total esophago gastrectomy depends upon the extent strectomy of the tumor above and below. After resection the reconstruction can be either with stomach or jejunum or colon. However the functional result after either of these procedures varies. The aim of this study is to know the functional outcome of different reconstruction methods after esophagogastrectomy for locally advanced Type 2 OG junction tumours.

Methods
148 consecutive patients who underwent surgery for OG junction tumors in the last 6 years were evaluated. Of them 62 locally advanced type2 OG junction tumors were included in our study. 26 underwent Ivor Levis procedure with gastric replacement. 36 underwent extended transhiatal gastrectomy with esophago jejunal anastamosis. Intra operative details like pyloroplasty, Operative time, blood loss, the distal margin, nodal clearance was noted. The functional outcome since immediate postoperative period to 1 year of follow up is reviewed retrospectively and prospectively in few cases.

Results
There is no significant difference in operating time, blood loss. Two patients with Partial gastrectomy had positive distal margin even though it is not statistically significant. The average number of nodes harvested is higher with total gastrectomy group with jejunal anastamosis and it is statistically significant between 2 groups (P < 0.05).The GERD is more with gastric conduit when compared to Jejunal reconstruction but the weight loss is more with jejunal reconstruction when compared with gastric reconstruction.

Conclusion
The functional outcome and oncological outcome are superior with jejunal reconstruction after total gastrectomy when compared with gastric reconstruction after Ivor Lewis procedure.

Disclosure
All authors have declared no conflicts of interest.
PS01.160: PERIOPERATIVE PERFUSION ASSESSMENT WITH QUANTITATIVE FLUORESCENCE ANGIOGRAPHY
Authors: Nerup Nikolaj , Bo Svendsen Morten , Bo Svendsen Lars , Achiam Michael 
Published: September 2018

Abstract

Background
Anastomotic leakage (AL) occurs relatively frequent in oncologic esophageal surgery and is associated with increased morbidity and mortality, and risk of local recurrence of cancer. Poor anastomotic perfusion is probably an important factor of AL.
Traditionally; perfusion has been assessed visually and manually by palpation, methods proven to be irreproducible and not possible in a minimal-invasive environment. Few studies on ICG-FA used in esophageal resection exists and some have shown promising results. However, most studies only use a visual interpretation of the angiography, leading to observer bias. In addition, this subjective visual assessment only allows a binary outcome; perfusion or no perfusion. A quantitative (q-ICG) approach enables a scaled, objective assessment, useful in lowering the risk of AL, however, also in exploring interventions and risk factors leading to improved or attenuated perfusion. The aim of this study was to establish a valid, reproducible perioperative q-ICG method.

Methods
Design and validation: A Q-ICG method for assessment of ICG-FA was developed in a porcine model, using seven pigs. To establish which metric of Q-ICG to use, neutron labeled microspheres were injected intraarterially as microspheral flow is considered the gold standard in microvascular flow assessment. Tissue samples from the stomach were excised and the regional flow was calculated, this was compared with Q-ICG metrics by correlation analysis. Attenuated perfusion: In seven pigs, the stomach and segments of small bowel were partly devascularized and local lactates were correlated to Q-ICG. Improved perfusion: As glucagon-like peptide-2(GLP-2) enhances fore- and midgut perfusion, 20 pigs underwent small bowel resection and anastomosis and randomized to GLP-2 or placebo, to test if Q-ICG could determine a difference in perfusion.

Results
We found excellent correlation of the q-ICG metric ‘normalized slope’ to regional microspheral flow (r = 0.92–0.96, P = 0.001). In addition, local lactate measurements of the devascularized stomach and small bowel correlated to the normalized slope of q-ICG (Spearman rho = 0.8). Q-ICG found significant improved anastomotic perfusion of pigs treated with GLP-2 (P < 0.05).

Conclusion
We established and validated a method of Q-ICG in normal, attenuated and improved perfusion, that may be useful in esophageal surgery, where construction of an anastomosis requires an optimal perfusion.

Disclosure
All authors have declared no conflicts of interest.
PS01.163: EVALUATION OF A TECHNIQUE OF SINGLE LAYER CONTINUOUS ESOPHAGOGASTRIC ANASTOMOSIS USING POLIGLECAPRONE 25
Authors: Parshad Sanjeev , Karwasra Rajendra , Kumar Ravinder 
Published: September 2018

Abstract

Background

Methods
This was a prospective study on patients who underwent esophagectomy for carcinoma oesophagus from May 2016 to August 2017. The patients who expired in immediate post operative period were excluded from study for evaluation of anastomotic leak and those patients who could not be followed up for at least six months were also excluded from study for evaluation of development of post operative stricture. End to side anastomosis was placed on the anterior surface of stomach using two suture lengths of 2–0 polyglecaprone 25. Anastomosis was done in single continuous layer with full thickness bites. At the end the stomach conduit was tucked to prevertebral fascia by a single stitch. During post operative period, Jejunal feeding was started on 2nd post operative day. Ryle's tube was removed on 5th post operative day and clear liquids were started. Gastrograffin study was done only if clinical suspicion of leak was there on day 7. Semisolid puree diet was started on day 7 and neck drain was removed on day 10.
Patients were followed up for six months and specifically asked for symptoms of dysphagia.Symptoms of dysphagia were recorded and graded on the basis of Mellow-Pinkas scoring system.

Results
Mckeowns esophagectomy was performed in 18 patients, transhiatal in 8 patients and Ivor Lewis in 1 patient. Average time taken for anastomosis was 17 min. Anastomotic leak was seen in four patients(14.81%) and all leaks could be managed conservatively. Only two patients(7.40%) presented with dysphagia which required dilatations. The cost of suture used was least as compared to other techniques.

Conclusion
Anastomotic leak rate of the present technique was found to be comparable to other techniques whereas the post operative stricture formation was significantly less. Poliglecaprone 25 looses all its tensile strength by third week and this may be the reason for low stricture rates. We conclude that Esophagogastic anastomosis with a single layer continuous technique using 2–0 poliglicaprone 25 gives good results having comparable leak rates to other techniques. The rate of anastomotic stricture formation is quite low as compared to other techniques.The anastomosis takes less than seventeen minutes and is quite cost effective.

Disclosure
All authors have declared no conflicts of interest.
PS01.167: MUMELE STUDY: MULTICENTER STUDY ON INCIDENCE OF MEDIASTINAL LEAKS AFTER ESOPHAGECTOMY
Authors: Fumagalli Romario Uberto , Celotti Andrea , De Pascale Stefano , Rosati Riccardo , Cossu Andrea , Parise Paolo , Bonavina Luigi , Bernardi Daniele , Degiuli Maurizio , Reddavid Rossella , De Manzoni Giovanni , Weindelmayer Jacopo , Portolani Nazario , Baiocchi Gianluca , Santi Stefano , Pallabazzer Giovanni 
Published: September 2018

Abstract

Background
Mediastinal anastomotic leak (ML) represent one of the most feared complication of esophageal resection. The incidence of ML, and of the associated mortality rate and the treatment strategy are variously reported. A standard strategy for diagnosis and treatment is difficult to establish

Methods
In order to evaluate the incidence, predictive factors, treatment and mortality of ML in 7 Italian surgical centers with interest in esophageal surgery (5 high volume centers) a retrospective study including all esophagectomies (E) with intrathoracic esophagogastric anastomosis performed in a 3 year period (2014–2017), was planned. ML were defined according to the classification proposed by the Esophagectomy Complications Consensus Group.

Results
The data of 501 E were collected. Overall incidence of ML was 11.8%. Surgical approach significantly influenced the rate of ML: leakage rate was highest for totally minimally invasive (TMIE) and lowest for hybrid esophagectomy (HE) (respectively 20 and 9%). No other predictive factor was found. Overall 30 and 90 day (d) mortality rate (M) were respectively 1,4% and 3,2%; 30 and 90 d M for leaks were respectively 5% and 15,3%; 90 d M for TMIE and HE were 5,9% and 1,8% respectively. Endoscopy was the first line treatment in 49% of leaks, with a need for retreatment in 17,2% of cases. Surgery was needed globally in 44,1% of ML. Endoscopic treatment appeared to have the lowest M (6,9%). Removal of the gastric tube with stoma formation was necessary in 8 cases (13.6%).

Conclusion
The incidence of mediastinal leaks after esophagectomy in the MUMELE study is high mainly in TMIE group. General and specific (leak) mortality rate is however low. Early ‘aggressive’ treatment of severe leaks is mandatory, with no hesitation to redo surgery if first attempt of conservative management fails.

Disclosure
All authors have declared no conflicts of interest.
PS01.168: IS IT POSSIBLE TO PREVENT GASTRIC TUBE NECROSIS FOLLOWING ESOPHAGECTOMY?
Authors: Nishikawa Katsunori , Tanaka Yujiro , Tanishima Yuichiro , Akimoto Shunsuke , Yano Fumiaki , Mitsumori Norio , Yanaga Katsuhiko 
Published: September 2018

Abstract

Background
Gastric tube necrosis (GN) following esophagectomy is a rare, but critical and life threatening complication. Unlike anastomotic leakage due to local ischemia, GN involves extensive full thickness ischemia resulting from vascular insufficiency. Most cases of GN need total or partial replacement of gastric tube. Although quantitative assessment of tissue perfusion during esophageal surgery contributed to reduce the incidence of postoperative anastomotic complications, GN remains a serious complication to be solved.

Methods
Data were collected retrospectively from 271 patients who underwent esophagectomy and gastric tube reconstruction at a single center between 2008 and 2018, in which cases of GN were identified. Gastric mobilization was mainly performed laparoscopically using a hand-assisted maneuver. The short gastric and left gastric arteries were divided, and the right gastric and gastroepiploic arteries were both preserved. The gastric tube 3.5 cm in width was created along the greater curvature. Intraoperative assessment of perfusion of the gastric tube was performed using our novel Thermal Imaging System (TIS) in all patients. Quantitative tissue perfusion scores defined as anastomotic viability index (AVI) were calculated at various points from the anastomosis.

Results
The inpatient mortality rate was 1.8% (n = 5). Anastomotic leak (AL) developed in 8.8% (n = 24) of the study group. The mean AVI score of cases with AL was 0.58, which was significantly lower than that without AL (0.71, P < 0.001). GN occurred in two patients (0.7%). The AVI score of the both GN cases were relatively high at 0.74 and 0.82. In one of the cases, circumferential full thickness ischemia 10 cm in length from the esophagogastric anastomosis was revealed by contrast CT scans and endoscopy, which was later identified to be due to severe vascular impairment.

Conclusion
TIS can be used as a reliable intraoperative assessment tool for perfusion of the gastric tube. We assume that most AL would be caused by delayed anastomotic healing due to poor vascularization of the gastric tube. On the other hand, obvious difference in AVI scores between AL and GN may indicate the involvement of different etiology. Given that development of GN seemed to be caused by acute failure in vascularization during the early postoperative period.

Disclosure
All authors have declared no conflicts of interest.
PS01.173: MANAGEMENT OF INTRATHORACIC AND CERVICAL ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW
Authors: Verstegen Moniek , Bouwense Stefan , Van Workum Frans , Ten Broek Richard , Siersema P D , Rovers Maroeska , Rosman Camiel 
Published: September 2018

Abstract

Background
Anastomotic leakage affects up to 30% of patients after esophagectomy each year and leads to considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy has the best clinical outcome, based on currently available literature.

Methods
A systematic literature search was performed in Medline, Embase and Web of Science until April 2017. All studies reporting on the treatment of anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale.

Results
Nineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Regarding intrathoracic anastomotic leakages, mortality rates in the conservative, endoscopic stent, endoscopic drainage, endoscopic vacuum assisted closure system and surgery treatment group were 14%, 8%, 8%, 0%, and 50%, respectively. Regarding cervical anastomotic leakages, mortality rates in the conservative, endoscopic stent and endoscopic dilatation group were 8%, 29%, and 0%, respectively.

Conclusion
Due to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting one treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. A prospective registration study could provide answers to issues as which leakage characteristics determine its severity and which treatment options have the best outcomes for a given anastomotic leakage severity.

Disclosure
All authors have declared no conflicts of interest.
PS01.183: ENDOSCOPIC TREATMENT OF ESOPHAGOGASTRIC ANASTOMOSIS FISTULA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: REPORT OF THREE CASES AND REVIEW OF THE LITERATURE
Authors: Antonio Guimaraes Filho Marco , Sabino Flávio , Camara Eduardo , Ferreira Andre , Mello Gustavo , Pelosi Alexandre , Guaraldi Simone 
Published: September 2018

Abstract

Background
Anastomotic leaks after esophagectomy can lead to severe complications and account for 40% of postoperative deaths. During the last decades, several types of endoscopic treatments have became available, such as the use of esophageal stent and the use of vacuum therapy. In this paper we report one case of cervical anastomotic fistulas after esophagectomy treated with vacuum therapy and two cases treated with stent.

Methods
Three cases of cervical anastomotic fistulas after esophagectomy treated with an endoscopic aproach (stent and vacuum therapy) are reported.

Results

Case 1
61-year-old male with an mid-esophagus adenocarcinoma was treated with neoadjuvant chemotherapy and minimally invasve esophagectomy. On the 10th post-operative day (POD) a partial dehiscence of the anastomosis with communication with the mediastinum was identified, forming a cavity with a large amount of purulent secretion. A sponge attached to a nelaton probe, similar to the VAC device, was positioned inside the mentioned cavity and coupled to a continuous aspiration system. There was a gradual clinical improvement and on the 30th POD the sponge was finally removed. The patient was discharged on the 50th POD. Case 2: A 62-year-old male with a adenocarcinoma in the thoracic esophagus received neoadjuvant chemoradiotherapy and a minimally invasive esophagectomy. On the 7th POD, an anastomotic fistula draining by the chest tube was diagnosed. A stent that was positioned over the fistula area. The patient was discharged on the 28th POD with the stent, that was removed six weeks later. Case 3: 58 years old male patient presented with a superficial squamous cell carcinoma of the mid-thoracic esophagus. A minimally invasive esophagectomy was performed.On the 7th POD, a EGD was performed and showed a fistulous orifice in the esophagogastric anastomosis. A metal stent that was positioned over the fistula area. The patient evolved with empyema and a pulmonary decortication was performed by on the 17th POD. After progressive clinical improvement he was discharged on the 34th POD.

Conclusion
Esophageal stent has been successful used in treating this surgical complication. Recently, VAC therapy, is becoming an promising therapy for this complication, with lower morbidity and mortality rates and greater success in the closure of the anastomotic fistula when compared to the esophageal stent.

Disclosure
All authors have declared no conflicts of interest.
PS01.186: QUANTITATIVE PERFUSION EVALUATION AFTER GASTRIC TUBE RECONSTRUCTION USING FLUORESCENCE IMAGING
Authors: Jansen Sanne , De Bruin Daniel , Strackee Simon , Van Bavel Ed , Van Leeuwen Ton , Van Berge Henegouwen Mark I , Gisbertz Suzanne 
Published: September 2018

Abstract

Background
Poor fundus perfusion is seen as the major factor for the development of anastomotic necrosis, leakage and strictures. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Imaging the fluorescense of intravenously administered fluorophores is an optical, non-contact method to image blood flow in real-time. However, quantitative parameters for perfusion evaluation are stil lacking. The objective of this study is to test fluorescence imaging derived quantitative parameters for perfusion evaluation of the gastric tube during surgery and to correlate these parameters to patient outcome in terms of anastomotic leakage.

Methods
This study included 22 patients (October 2015 - June 2016). Indocyanine green (ICG) was injected intravenously and the fluorescense intensity of the gastric tube was imaged for 2–3 minutes. At 4 locations, quantitative analysis of the fluorescent intensity over time was performed to obtain perfusion related parameters: the maximal intensity, mean slope and influx timepoint. These parameters were tested for significant differences between the four perfusion areas of the gastric tube (from normal to decreased perfusion) with a repeated ANOVA test. Furthermore, these parameters and the distance of the end of the gastroepiploic artery to the fundus and distance of the demarcation of the fluorescent signal to the fundus were compared with patient outcome in terms of anastomotic leakage development.

Results
The fluorescent signal could be detected in all analyzed patients (n = 20). Maximal intensity, mean slope and influx timepoint were significantly different between the base of the gastric tube and the fundus (P < 0.0001). While the distance of the watershed and the demarcation of ICG to the fundus varied between patients, the distance of the demarcation of ICG to the fundus was significantly higher in the three patients who developed anastomotic leakage (P < 0.0001). No allergic reactions on ICG were witnessed.

Conclusion
Intra-operative fluorescence imaging is feasible to visualize perfusion quantitatively in gastric-tube surgery, using the parameters maximal intensity, mean slope and influx timepoint. A low slope and a large distance between the fluorescence demarcation and the fundus were seen in patients who developed anastomotic leakage and could therefore allow for early risk stratification of necrosis.

Disclosure
All authors have declared no conflicts of interest.