bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.182: TOOLS FOR INDIVIDUALIZED SURVIVAL PREDICTION IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Gupta Vaibhav , Coburn Natalie , Kidane Biniam , Hess Kenneth , Compton Carolyn , Ringash Jolie , Darling Gail , Mahar Alyson 
Published: September 2018

Abstract

Background
Clinical, pathological and molecular information combined with cancer stage in prognostication algorithms can offer more personalized estimates of survival, which may guide treatment choices. Our aim was to evaluate the quality of prognostication tools in esophageal cancer.

Methods
We systematically searched MEDLINE & Embase from 2005- 2017 for studies reporting development or validation of models predicting long-term survival in esophageal cancer. We evaluated tools using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies guidelines and the American Joint Committee on Cancer acceptance criteria for risk models.

Results
We identified 16 prognostication tools for patients treated with curative intent and one for patients with metastatic disease. These tools frequently excluded adenocarcinoma, contained outdated data and were developed with a limited sample size. Nine tools were developed in China for squamous cell cancer, and 11 used data on patients diagnosed prior to 2010. The majority of tools excluded key prognostic factors such as age and sex. Tumor stage and grade were the most commonly, but not universally, included factors. Twelve tools were designed to predict overall survival; five predicted cancer-specific survival. Bootstrap internal validation was performed for most tools; c-statistics ranged from 0.63–0.77 and graphically evaluated calibration was ‘good’. Five tools were externally validated; c-statistics ranged from 0.70–0.77.

Conclusion
Existing tools cannot be confidently used for esophageal cancer prognostication in current clinical practice. Better quality tools may help to more individually and accurately estimate disease course, select further treatments, and risk-stratify for future clinical trials.

Disclosure
All authors have declared no conflicts of interest.
PS01.187: ASSESSMENT OF THE BLOOD SUPPLY USING THE INDOCYANINE GREEN FLUORESCENCE METHOD AND POSTOPERATIVE ENDOSCOPIC EVALUATION OF ANASTOMOSIS DURING ESOPHAGECTOMY
Authors: Kitagawa Hiroyuki , Iwabu Jun , Namikawa Tsutomu , Hanazaki Kazuhiro 
Published: September 2018

Abstract

Background
Postoperative anastomotic leakage is a severe complication after gastric tube reconstruction during esophagectomy. The aim of this study was to evaluate the usefulness of postoperative endoscopic assessment of anastomosis and its correlation with intraoperative indocyanine green (ICG) fluorescence assessment of the gastric tube.

Methods
We retrospectively reviewed 72 consecutive patients who underwent gastric tube reconstruction using the ICG fluorescence method during esophagectomy. Forty-six patients underwent the ICG line-marking method (LMM group; ICG before gastric tube creation). The other 26 underwent the conventional procedure and comprised the control group (ICG after gastric tube creation). Postoperative endoscopic assessment (PEA) of anastomosis was performed 7 days after surgery and results were classified as follows: grade 1 (normal or partial white coat), grade 2 (ulcer comprising less than half the circumference), and grade 3 (ulcer comprising more than half the circumference).

Results
Anastomotic leakage occurred in 7 of 72 patients (9.7%). The incidence of anastomotic leakage in the LMM group was tended to be lower than those in the control group (6.5% vs. 15.4%; P = 0.244). Of the 40 patients who underwent PEA, 3 (7.5%) had leakage. PEA grading was significantly associated with anastomotic leakage (P < 0.001). Better intraoperative ICG assessment was significantly associated with better endoscopic assessment grade (P = 0.041).

Conclusion
Intraoperative ICG assessment of the gastric tube was associated with PEA grading on anastomosis during esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.193: VISUALIZED EVALUATION OF BLOOD FLOW TO THE GASTRIC CONDUIT CONTRIBUTES TO REDUCTION OF COMPLICATION IN ESOPHAGEAL RECONSTRUCTION
Authors: Noma Kazuhiro , Shirakawa Yasuhiro , Ogawa Toshihiro , Maeda Naoaki , Ninomiya Takayuki , Tanabe Shunsuke , Sakurama Kazufumi , Fujiwara Toshiyoshi 
Published: September 2018

Abstract

Background
Evaluation of the blood supply to gastric conduits is critically important to avoid complications following esophagectomy. We commenced visualized evaluation of blood flow using indocyanine green (ICG) fluorescent imaging from July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method.

Methods
We analysed and compared two groups, those before and after introduction of ICG evaluation. We performed propensity score matching (PS-M), compared clinical outcomes and analysed how the visualized evaluation reduced the risk of complications.

Results
Sixty-eight matched pairs were analysed. The leakage rate in the ICG group was significantly lower than the non-ICG group for each severity grade both in the entire cohort (285 subjects) and after PS-M, while the rate of other major complications, including recurrent laryngeal nerve (RLN) palsy and pneumonia, were not different between the two groups in the entire cohort and after PS-M. The duration of postoperative intensive care unit (ICU) stay was approximately one day shorter in the ICG than the non-ICG group in the entire cohort, and approximately two days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) severity grades. Odds ratio with ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1, 0.241 for CD ≥ 2 and 0.2153 for CD ≥ 3).

Conclusion
Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication.

Disclosure
All authors have declared no conflicts of interest.
PS01.199: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF CIRCULAR STAPLING VERSUS TRIANGULATING STAPLING ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CANCER
Authors: Katsuda Masahiro , Hayata Keiji , Nakamori Mikihito , Nakamura Masaki , Ojima Toshiyasu , Yamaue Hiroki 
Published: September 2018

Abstract

Background
Several studies have reported that the triangulating stapling method decreases the incidence of anastomotic stricture after esophagectomy, but no randomized, controlled trial has confirmed the efficacy of the triangulating stapling method for cervical esophagogastrostomy. We compared triangulating stapling and circular stapling for cervical esophagogastric anastomosis regarding the decrease in anastomotic stricture after esophagectomy for thoracic esophageal cancer.

Methods
Between August 2010 and April 2014, 100 patients enrolled in this randomized, controlled trial at the Wakayama Medical University Hospital were allocated randomly to either the circular stapling group (n = 49) or the triangulating stapling group (n = 51). The primary end point was the incidence of anastomotic stricture within 12 months postoperatively. This randomized, controlled trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN000004848).

Results
There were no differences between the circular stapling and triangulating stapling groups in terms of clinical data. The amount of time required for esophagogastric anastomosis was slightly greater for the triangulating stapling group (22 minutes) than for the circular stapling group (18 minutes) (P = .028). Anastomotic stricture occurred in 8 patients (17%) in the circular stapling group and 9 patients (19%) in the triangulating stapling group (P = .935). The rate of anastomotic leakage was 11% for the circular stapling group and 2% for the triangulating stapling group (P = .073).

Conclusion
This RCT compared 2 techniques of cervical esophagogastric anastomosis after esophagectomy for esophageal cancer. This study is the first to compare these 2 methods in a randomized, controlled fashion.This study could not show that the triangulating stapling method was superior to the circular stapling method for cervical esophagogastrostomy to reduce anastomotic stricture. The triangulating stapling method, however, might have the potential to decrease the rate of anastomotic leakage; a large-scale RCT will be required to assess this question.

Disclosure
All authors have declared no conflicts of interest.
PS01.203: PREOPERATIVE PATIENT-RELATED FACTORS ASSOCIATED WITH PROGNOSIS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Kitagawa Hiroyuki , Iwabu Jun , Namikawa Tsutomu , Hanazaki Kazuhiro 
Published: September 2018

Abstract

Background
To investigate the impact of the preoperative patient-related factors on survival after esophagectomy in patients with esophageal cancer.

Methods
We retrospectively reviewed 140 patients with esophageal cancer who underwent esophagectomy. Preoperative comorbidities, nutritional and inflammation status including the neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS), and their pathological findings were analyzed to assess their relationships with prognosis.

Results
Univariate analysis demonstrated that a history of cardiovascular disease (CVD), a GPS of 1 or 2, lack of neo-adjuvant chemotherapy (NAC), no thoracoscopic esophagectomy, blood loss volume ≥ 255 ml, the number of lymph node metastasis (LNM) ≥ 2, lymphatic invasion, venous invasion, and residual cancer were associated with poor survival. Multivariate analysis revealed that a history of CVD (hazard ratio [HR], 2.129; 95% confidence interval [CI], 1.327–4.226; P = 0.041), a GPS of 1 or 2 (HR, 3.232; 95% CI, 1.516–6.437; P = 0.003), LNM ≥ 2 (HR, 3.133; 95% CI, 1.355–7.760; P = 0.007), and pathological residual cancer (HR, 2.429; 95% CI, 1.050–5.105; P = 0.039) were independently associated with poor survival, and NAC was associate with better survival (HR, 0.289; 95% CI, 0.118–0.667; P = 0.003).

Conclusion
Preoperative patient-related factors including a history of CVD and a GPS of 1 or 2 were predictors of poor prognosis after esophagectomy in patients with esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.207: TRANSHIATAL AND INTERCOSTAL PLEURAL DRAINS AFTER HYBRID IVOR LEWIS ESOPHAGECTOMY: A COMPARATIVE ANALYSIS IN 100 CONSECUTIVE PATIENTS
Authors: Bernardi Daniele , Asti Emanuele , Sironi Andrea , Bonitta Gianluca , Bonavina Luigi 
Published: September 2018

Abstract

Background
In a previous proof of concept study, transhiatal pleural drain has been shown to be safe and effective after hybrid Ivor Lewis esophagectomy. Aim of the present study was to compare short-term outcomes of trans-hiatal and intercostal pleural drainage. We hypothesized that a trans-hiatal pleural drain introduced through the sub-xyphoid port site incision at laparoscopy could reduce postoperative pain and enhance patient recovery.

Methods
This was an observational retrospective cohort study. Two methods of pleural drainage were compared in patients undergoing hybrid Ivor Lewis esophagectomy. Patients treated with a transhiatal drain connected to a vacuum bag were compared to an historical cohort of patients treated with the conventional intercostal drain connected to under-water seal and suction. Postoperative morbidity, total and daily drainage output, serum albumin levels, and total dose of paracetamol and ketorolac administered on-demand were recorded. Postoperative complications were scored according to the Dindo-Clavien classification.

Results
Over a 2-year period, 50 patients with transhiatal drain and 50 with intercostal drains met the criteria for inclusion in the study. Demographic and clinico-pathological variables were similar in the two groups. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality nor statistical significant difference in the rate of grade ≥ 3 postoperative complications. The total volume of drain output and the serum albumin levels were similar in the two groups. The total dose of ketorolac was significantly reduced in patients with transhiatal drain (P < 0.001). The length of hospital stay was similar in the two groups. No complications related to the method of pleural drain occurred up to 3 months after hospital discharge. There was only one hospital readmission in the transhiatal group due to severe nutritional impairment.

Conclusion
Transhiatal pleural drainage connected to a portable vacuum system can safely replace the intercostal drain after hybrid Ivor-Lewis esophagectomy in selected patients. It has the potential to reduce postoperative pain and use of nonsteroidal antinflammatory drugs, and to enhance recovery from surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.215: SUPERIOR MEDIASTINAL LYMPHADENECTOMY IN TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY FOR CANCER: CLINICAL AND ONCOLOGICAL OUTCOMES
Authors: Soile Oluwasunmisola , Shanmuganathan Kanatheepan , Hussain Aadil , Akitikori Temisanren , Farhangmehr Neda , Sdralis Elias , Lorenzi Bruno , Charalabopoulos Alexandros 
Published: September 2018

Abstract

Background
Minimally invasive oesophagectomy (MIO) is a challenging procedure associated with high rate of complications and mortality. The exact benefits of superior mediastinal lymphadenectomy (SML) have long been debated with no clear evidence pertaining to better outcomes for patients. With this study we aim to compare the short-term outcomes of MIOs that also underwent SML against the UK national average.

Methods
Thirty-nine consecutive patients underwent totally MIO under a surgical team from September 2016 to December 2017. SML included left and right paratracheal nodes (including the paratracheal retrocaval compartment) as well as the nodes along the left and right recurrent laryngeal nerves throughout their mediastinal course. Eligible patients had to have undergone SML during either a 3-stage or a 2-stage MIO. Comparisons of the following outcomes were made against the data released by the UK National Oesophago-Gastric Cancer Audit (NOGCA) 2017; anastomotic leak rate, chyle leak rate, 30-day mortality, 90-day mortality, length of stay (LOS), cardiac complications, respiratory complications, wound infection, unplanned surgery.

Results
Seven patients were identified as eligible according to the criteria. 30- and 90- day mortality was reduced in the participant group compared to national average (0% vs 1.9% and 0% vs 3.3% respectively). Wound infection and cardiac complications were also reduced in the participant group (0% vs 5.3% and 0% vs 2.8% respectively). There were no anastomotic or chyle leaks noted (vs National 3.8% and 6.3% respectively), but conversely rate of respiratory complications was considerably higher in our group (42.8% vs 16.9%). There was 1 right recurrent laryngeal nerve palsy noted. Median LOS was longer in the sample group (16 vs 12 days), with no reoperations (0 vs 10.2%). Median total lymph node count was 45 (IQR, 37–68), with median SML count being 8 (IQR, 5–22).

Conclusion
The small sample size is immediately recognised as a limiting and influencing factor in the results of this study. However MIOs with SML may provide some, although not comprehensive, benefit in oncological outcomes without adding any further significant morbidity. Larger studies are needed to assess the role SML can play in improving patient outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Hol Jeroen , Heisterkamp Joos , Langenhoff Barbara 
Published: September 2018

Abstract

Background
Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented.

Methods
Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old.

Results
From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively.

Conclusion
No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone.

Disclosure
All authors have declared no conflicts of interest.
PS01.219: SINGLE-PORT THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Yuan Yong 
Published: September 2018

Abstract

Background
This study was conducted to optimize the surgical procedures for single-port thoracoscopic esophagectomy, and to explore its potential advantages over multi-port minimally invasive esophagectomy.

Methods
For single-port thoracoscopic esophagectomy, the patient was placed in left lateral-prone position and a 4-cm incision through the 4th-5th intercostal space was taken on the postaxillary line. The 10-mm camera and two or three surgical instruments were used for the VATS esophagectomy and radical mediastinal lymph node dissection. The camera position was different for the upper and lower mediastinal regions. Mobilization of stomach was conducted via multiple-port laparoscopic approach. Cervical end-to-side anastomosis was completed by hand-sewn procedures.A propensity-matched comparison was made between the single-port and four-port thoracoscopic esophagectomy groups.

Results
From 2014 to 2016, 56 matched patients were analyzed. There was no conversion to open surgery or operative mortality. The use of single-port thoracoscopic esophagectomy increased the length of operation time in comparison with using multiple-port minimally invasive technique (mean, 257 vs. 216 min, P = 0.026). The time taken for thoracic procedure in the single-port group was significant longer that in the multi-port group (mean, 126 vs. 84 min, P < 0.001). There were no significant differences between groups in the number of lymph nodes dissected, blood loss, complications or hospital stay (P > 0.05). In single-port thoracoscopic group, the pain in the abdomen was more severe than that in the chest (P = 0.042). The pain scores for postoperative day 1 and day 7 were significantly lower in the single-port group as compared with multiple-port group (P = 0.038 and P < 0.001), a similar trend could be seen for the pain score on postoperative day 3 (P = 0.058).

Conclusion
Single-port thoracoscopic esophagectomy contributes to reducing postoperative pain with an acceptable increase of operation time, which does not compromise surgical radicality and has similar short-term postoperative outcomes when compared with multiple-port minimally invasive approach.

Disclosure
All authors have declared no conflicts of interest.
PS01.226: FEASIBILITY OF CONVERSION THORACOSCOPIC ESOPHAGECTOMY AFTER TRIPLET CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR T4 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Akiyama Yuji , Iwaya Takeshi , Endo Fumitaka , Nikai Haruka , Umemura Akira , Baba Shigeaki , Chiba Takehiro , Kimura Toshimoto , Takahara Takeshi , Otsuka Koki , Nitta Hiroyuki , Mizuno Masaru , Kimura Yusuke , Koeda Keisuke , Sasaki Akira 
Published: September 2018

Abstract

Background
Recently, induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported effective for T4 esophageal squamous cell carcinoma. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) as conversion surgery after DCF for T4 esophageal squamous cell carcinoma.

Methods
Medical records of 64 consecutive patients with T4 (with or without distant metastasis) thoracic esophageal squamous cell carcinoma treated with induction DCF chemotherapy were reviewed. Twenty-tree patients underwent conversion TE after induction DCF.

Results
The invading organs of T4 tumor were tracheobronchus in 8 patients, thoracic aorta in 13 patients, and pericaridium and diaphragm in 3 patients each. Average courses of DCF treatment were 2.8 courses. The mean total operation time was 556.3 min and that of the thoracic procedure was 258.9 min. The mean blood loss was 166.2 mL and that during the thoracic procedure was 33.5 mL. All patients underwent complete resection under TE. No patient experienced accidental conversion to open thoracotomy or intraoperative morbidity including adjacent organ injury. Postoperative morbidity rate was 34.8%. There were no serious complications related to surgery requiring reoperation. Postoperative hospital stay was 24.3 (range, 13–38) days. Five patients had recurrence: four had distant metastasis (lung (2), liver (3), one patient had overlapped), and one had mediastinal lymph node recurrence. There was no local recurrence at the site of primary T4 tumor.

Conclusion
TE as conversion surgery after DCF therapy for initial T4 esophageal squamous cell carcinoma can be safely performed. The strategy of induction DCF followed by conversion TE could be an alternative in the treatment for T4 advanced esophageal squamous cell carcinoma.

Disclosure
All authors have declared no conflicts of interest.