bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.229: SHORT- AND LONG-TERM OUTCOMES OF MINIMALLY INVASIVE TRANSTHORACIC ESOPHAGECTOMY FOR ELDERLY PATIENTS WITH ESOPHAGEAL CANCER
Authors: Muneoka Yusuke , Kawachi Yasuyuki , Makino Shigeto , Sato Yu , Kitami Chie , Kawahara Mikako , Nishimura Atsushi , Nikkuni Keiya 
Published: September 2018

Abstract

Background
Recently, the number of elderly patients with esophageal cancer is increasing as the aging of population in Japan. Because of the benefit to reduce postoperative pulmonary complications, minimally invasive transthoracic esophagectomy (MIE) is being increasingly implemented in surgical treatment for esophageal cancer. However, short- and long-term outcomes of MIE in elderly patients have not been fully investigated.

Methods
We retrospectively reviewed the records of 86 patients with thoracic esophageal cancer who underwent MIE between January 2010 and December 2014 at Nagaoka Chuo General Hospital. We classified the patients into two groups according to their age: the elderly group (≥ 75 years old, n = 19) and the non-elderly group (< 75 years old, n = 67). We compared the short- and long-term outcomes between the two groups.

Results
There were no significant differences between the two groups in gender, comorbidity, the extent of lymphadenectomy, TNM status, or Stage (0/I/II/III/IVa/IVb: elderly group 1/1/9/8/0/0 vs. non-elderly group 5/12/26/21/2/1). Conversion rate to open esophagectomy is 10.5% in the elderly group and 6.0% in the non-elderly group (P = 0.610). The proportion of patients who received preoperative chemotherapy was significantly lower in the elderly group (21.1% vs. 67.2%, P < 0.01). With regard to surgical outcomes, there were no significant differences in operative time (301 vs. 343 min), the amount of blood loss (126 vs. 110 ml), or the median length of hospital stay (14 vs. 14 days) between the two groups. Overall morbidity was not significantly different between the two groups (47.4% vs. 49.3%, P = 0.885). The incidence of postoperative complications that were ≥  grade II according to the Clavien-Dindo classification was higher in the elderly group, but the difference was not statistically significant (42.1% vs. 25.4%, P = 0.156). The 5-year overall survival rates were 56.8% and 62.9% (P = 0.449), and the 5-year disease specific survival rates were 67.4% and 69.3% in the elderly and non-elderly groups (P = 0.564), respectively.

Conclusion
MIE in elderly patients with esophageal cancer can be safely performed and the long-term outcome was acceptable. However, there is a possibility of selection bias in this retrospective single-institutional study. Further multi-institutional prospective study is necessary to establish the evidence for clinical benefit of MIE for this disease.

Disclosure
All authors have declared no conflicts of interest.
PS01.233: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE
Authors: Jiang Yuequan 
Published: September 2018

Abstract

Background
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.

Methods
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 subcarinal lymphnode were dissected under laparoscope (figure 1, 2) 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 insufflated with carbon dioxide gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope (figure 5, 6, 7, 8).

Results
Comparing to (Minimal invasive esophagectomy) MIE group, the dissection frequency of lymph nodes was relatively lower at stations 2R, 4R and 10 in TTA group, but the metastasis rate was similar. Moreover, both the dissection and metastasis frequency at the other stations were no difference between the TTA and MIE. Despite high incidence in recurrent laryngeal nerve palsy (single-side), The TTA was significantly superior to the MIE with a shorter surgical duration, shorter ICU/hospital stay, and lower postoperative pulmonary complications.

Conclusion
The TTA procedure of esophagectomy 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.
PS01.245: COMPARISON OF ONCOLOGIC RESECTION OF LAPROSCOPIC VERSUS ROBOTIC VATS ESOPHAGECTOMY FROM A REGIONAL CANCER CENTER IN INDIA
Authors: Krishnamurthy Swamyvelu 
Published: September 2018

Abstract

Background
Robotic surgery being a new technology in developing countries little is known about its oncological safety and outcome in esophageal surgeries.

Methods
We evaluated 46 consecutive patients of esophageal cancer who underwent laproscopic (n = 30) and Robotic VATS (Video Assisted Thoracic Surgery) (n = 16) esophagectomy, both with cervical anastomosis. All cases were operated by a single surgeon over a period of 2 years.

Results
30 patients (18 male, 12 female), average age 54 years underwent laproscopic VATS procedure and 16 patients (8 male, 8 female), average age 57 years underwent Robotic VATS esophagectomy. Compared to laproscopic group, Robotic VATS procedure averaged a slightly longer operative time (190 mins versus 168 mins) with almost similar blood loss (160 ml versus 150 ml). Lymph node yield for Robotic procedure was slightly better than laproscopic group (18 versus 14.3). None of the patients in both groups had positive margins. 8 patients in laproscopic group and 4 in Robotic arm underwent Neo-adjuvant therapy. Clinical and pathologic staging was similar in both groups. Average hospital stay was better for Robotic arm (8 days versus 11 days).

Conclusion
Laproscopic and Robotic VATS esophagectomy yield almost similar peri-operative oncologic results with Robotic surgery taking slightly longer operative time but yielding better lymph nodes and shorter hospital stay in comparison to laproscopic arm. Shifting from laproscopic to Robotic surgery is easy and is non-inferior in terms of immediate oncologic outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS02.005: THORACOSCOPIC ESOPHAGECTOMY IN PRONE POSITION USING A PRECEDING ANTERIOR APPROACH FOR ESOPHAGEAL CANCER: LONG-TERM AND SHORT-TERM OUTCOMES
Authors: Ozawa Soji , Oguma Junya , Kazuno Akihito , Yamamoto Miho , Nimomiya Yamato , Yatabe Kentaro 
Published: September 2018

Abstract

Background
The purpose of this study was to clarify the long-term and short-term outcomes of consecutive patients who underwent thoracoscopic esophagectomy in prone position using a preceding anterior approach for the resection of esophageal cancer at a single institution.

Methods
We retrospectively reviewed a database of 690 patients with thoracic esophageal cancer who had undergone a thoracoscopic esophagectomy (TE, 351 patients) or an esophagectomy through thoracotomy (OE, 343 patients) between 2003 and 2017. To compare the long-term outcomes of TE and OE, we used a propensity score matching analysis and a Kaplan-Meier survival analysis. To analyze the short-term outcomes of TE, patients were chronologically divided into three groups (117 patients per group). As for thoracoscopic procedure, the esophagus was mobilized from the anterior structure during the first step and from the posterior structure during the second step. The lymph nodes around the esophagus were also dissected anteriorly and posteriorly. The intraoperative factors, the number of dissected lymph nodes, and the incidence of adverse events were compared among the three period groups.

Results
As for long term outcome, 203 patients from each group, for a total of 406 patients, were completely selected and paired. The 5-year survival of the TE patients (66.8%) was better than that of the OE patients (56.4%) (P = 0.044). The thoracoscopic times were 226 min, 241 min, and 214 min (P < 0.001), and the blood losses during the thoracoscopic procedure were 36.1 mL, 43.3 mL, and 18.0 mL (P < 0.001), respectively, according to the period groups. The mean numbers of harvested lymph nodes in the chest were 22.2, 25.1, and 28.9 (P < 0.001). The rates of recurrent laryngeal nerve palsy were 23.9%, 29.9%, and 8.6% (P < 0.001).

Conclusion
The long-term outcome of TE patients might be better than that of OE patients. As for the short-term outcomes, intraoperative factors, quality of lymph node dissection, and reduction of adverse events were best in the third period group. Establishment of standard procedure and accumulation of surgical cases seemed to make TE a safe and effective procedure for esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.007: DEVELOPING A ROBOT-ASSISTED ESOPHAGECTOMY PROGRAM IN A HIGH-VOLUME TRANSHIATAL ESOPHAGECTOMY CENTER
Authors: Keeney-Bonthrone Toby , Chang Andrew , Lin Jules , Lynch William , Carrott Philip , Lagisetty Kiran , Orringer Mark , Reddy Rishi 
Published: September 2018

Abstract

Background
Esophagectomies have high morbidity rates regardless of approach. Minimally invasive approaches have been shown to have lower complication rates compared to open operations for Transthoracic and Three-hole (McKeown type) esophagectomies. We examined the perioperative outcomes of a transhiatal robot-assisted approach compared to concurrent transhiatal esophagectomies at the same institution.

Methods
A retrospective review was performed of all transhiatal and robot-assisted transhiatal esophagectomies performed for esophageal cancer at a single large academic center between January 2013 and December 2017. Outcomes assessed included postoperative complications, procedure time, length of stay, unexpected ICU admissions, 30-day readmission and 30-day mortality. A multivariate logistic regression model, adjusted for demographics, comorbidities and disease severity, was used to evaluate outcomes.

Results
378 transhiatal (THE) and 87 robot-assisted (RTHE) esophagectomies met inclusion criteria. RTHE was associated with higher rates of pleural effusion requiring drainage, pneumothorax, pulmonary embolism and respiratory failure, as well as empyema requiring treatment. RTHE was associated with a higher number of lymph nodes resected. 56.3% of RTHEs used epidurals vs. 92.3% of THEs. Epidural use had no statistical association with the incidence of pulmonary complications. Differences in atrial fibrillation, anastomotic leak, pneumonia, procedure length, length of stay, 30-day survival and readmission rates were not statistically significant.

Conclusion
Implementation of a new robot-assisted transhiatal esophagectomy program was associated with higher rates of pulmonary complications and empyema, although there were no differences in length of stay. Further investigation is needed to understand the difference in complications.

Disclosure
All authors have declared no conflicts of interest.
PS02.010: ESTABLISHMENT OF THE UPPER GI INTERNATIONAL ROBOTIC ASSOCIATION (UGIRA)
Authors: Kingma Berend , Chaudry M , Chiu Philip , Grimminger Peter , Luketich James , Van Hillegersberg Richard 
Published: September 2018

Abstract

Background
Robot-assisted surgery is increasingly performed for both benign and malignant upper gastro-intestinal disease. However, no global consensus exists regarding exact techniques and implementation methods of robotic esophageal and gastric surgery. To facilitate the effective implementation and advancement of these procedures, evidence based guidelines should be generated. In this context, the ‘Upper GI International Robotic Association’ (UGIRA) was established in 2017. Until now, 20 experienced robotic surgeons from 10 different countries in Europe (The Netherlands, Germany, United Kingdom, Denmark), Asia (Japan, Hong Kong, North-Korea, Taiwan), North-America (United States of America), and South-America (Brazil) have confirmed to become a member of the UGIRA. By means of an oral presentation, we would like to announce the establishment of the UGIRA and to introduce its primary aims, which are: To set up a web-based registry for international data collection.An international registry is created to enable international collaboration on research. Data collection should especially focus on the robotic elements of upper gastro-intestinal surgery, such as trocar positions, anastomotic technique, conduit stapling technique, and conduit diameter in esophagectomy.To establish guidelines for robotic upper gastro-intestinal surgical procedures.The approach to robotic upper gastro-intestinal surgical procedures should be standardized by formulating step-by-step guidelines. These guidelines will encompass robotic surgery for both benign (i.e. hiatal hernia, fundoplication) and malignant disease (i.e. esophageal and gastric cancer), with the exception of bariatric procedures.To form effective training programs that involve proctoring by experienced surgeons.In order to safely implement robotic surgery, training pathways that involve proctoring should be followed. The UGIRA will serve as the core platform to establish these training pathways and to appoint proctors in all continents. Completion of the training pathway will result in UGIRA credentialing.

Methods
Not applicable.

Results
Not applicable.

Conclusion
The UGIRA was recently established to facilitate the effective implementation and advancement of robotic esophageal and gastric surgery worldwide. To this end, the primary aims include setting up a web-based international registry, establishing guidelines for robotic upper gastro-intestinal procedures, and forming effective training pathways that involve proctoring.

Disclosure
All authors have declared no conflicts of interest.
PS02.011: ESOPHAGECTOMY IN A LOW VOLUME SINGLE CENTER FAVORING A TOTAL MINIMALLY INVASIVE APPROACH: 55 PATIENTS IN 7 YEAR
Authors: Gehwolf Philipp , Schmid Thomas , Öfner-Velano Dietmar , Wykypiel Heinz 
Published: September 2018

Abstract

Background
In Austria esophageal cancer is not very common. The incidence is 8.8/100.000 per year, thus esophageal cancer is on rank 18 of the most common carcinomas. Multimodal treatment inclouding surgery is standard for locally advanced esophageal cancer with a 5-year survival rate of around 40% in patients treated with a curative intent.

Methods
Retrospective single institution study in a tertiary care center using prospectively collected data we discuss our surgical procedure with patient survival as primary endpoint and morbidity as secondary endpoint.

Results
From 2010–1017, 55 Patients received an esophageal resection. The mean age was 61.5 years, five patients (9%) were female. Squamous cell carcinoma appeared in 37%, adenocarcinoma in 59% and a verrucous carcinoma in 4% of our patients. 98% of patients received an esophagectomy with gastric tube pull up, in 2% the colon was used for reconstruction. For patients with carcinoma located in the lower and middle thoracic esophagus a thoracic anastomosis was targeted (78%), in carcinomas of the upper thoracic esophagus a left cervical anastomosis (22%) was performed. Depending on location and comorbidities patients received either a conventional operation (11%), a hybrid operation with laparotomy and thoracoscopic esophageal resection (59%) or a totally minimal invasive approach (30%). The 60 days mortality was < 2%, the need for reoperation < 10%. Major complications (Clavien-Dindo III-V) were observed in 30%.

Conclusion
Esophagectomy is a high-risk operation with serious mortality and morbidity. However, patients may profit from a tailored approach with intent for the minimally invasive approach even in a low volume center when expertise in high-end endoscopic surgery is available.

Disclosure
All authors have declared no conflicts of interest.
PS02.019: THORACOSCOPIC INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS WITH PATIENT IN PRONE POSITION
Authors: Vecchiato Massimo , Ziccarelli Antonio , Petri Roberto , Lirusso Chiara , Martino Antonio 
Published: September 2018

Abstract

Description
After laparoscopic gastric conduit creation the patient is placed in prone position, with single-lumen endotracheal intubation. A right pneumothorax at 8 mmHg is created with a port at the apex of the scapula; two operative trocars are inserted in the right 5th and 9th intercostal spaces. The esophageal dissection in performed with an en bloc linfadenectomy. The distal part of the esophagus is tied up with a loop; the esophagus in then divided with an electrocautery scissor. A manual purse-string is made in the proximal esophageal stump with a Prolene 2/0. The envil of a circular stapler is put inside the chest through a port or during the laparoscopic procedure opening the right pleura; so it is introduced in the esophageal stump and the purse-string is closed. The incision of the lower port is enlarged and a laparoscopic wound retractor device is inserted. The specimen and the gastric conduit are retrieved; the stapler is introduced trough the laparoscopic wound retractor tip and through a small gastrostomy in the gastric tube; the puncturing shaft is pulled out through the greater gastric curve. We ensure the gastric conduit to the stapler with a second envil; it is introduced in the chest. After opening the stapler and loosing the second envil we perfomed the esophago-gastric anastomosis. A linear stapler is used to remove the excess of the stomach with the gastrostomy. Some interrupted stitches fixed the anastomosis to the mediastinal pleura. Two right chest tubes are inserted.

Disclosure
All authors have declared no conflicts of interest.
PS02.029: USEFULNESS OF TRIAMCINOLONE INJECTION TO PREVENT STRICTURE AFTER CIRCUMFERENTIAL ESOPHAGEAL ESD
Authors: Oyama Tsuneo , Takahashi Akiko 
Published: September 2018

Abstract

Background
ESD is a standard treatment for superficial esophageal cancer in Japan. Stricture is one of important complication of esophageal ESD, and it makes quality of life of the patient worse. Usefulness of Triamcinolone (TA) injection to prevent stricture after semi-circumferential ESD has been reported. However, usefulness of TA injection after circumferential esophageal ESD is still unclear.

Methods
The aim of this study is to clarify the usefulness of triamcinolone injection to prevent stricture after circumferential ESD. A total of forty-nine patients treated by circumferential esophageal ESD from 2004 to 2017 in Saku Central Hospital Advanced Care Center were enrolled to this retrospective study. Fifty mg TA was injected into submucosal layer just after ESD, and TA injection was repeated in two-weeks interval by the ESD ulcer healed. When the length of circumferential ESD was 50mm or longer, 100 mg Triamcinolone was injected just after ESD, and 50mg TA injection was repeated in two-weeks interval. Fifteen mm endoscopic balloon dilatation (EBD) was performed when the scope couldn’t pass the ESD ulcer. The primary endpoint was the number of balloon dilatation. The secondary endpoints were duration from ESD to ulcer healing, complications and the difference between Barrett's esophageal adenocarcinoma (EAC) and squamous cell carcinoma (SCC).

Results
1. Median number of EBD in Non-TA and TA group were 15 (13–33) and 3 (0–23), respectively (P < 0.01) 2. Median duration from ESD to ulcer healing were 6 (3–23) and 4 (1–24) months. respectively. (P = 0.47) 3. Complications: Perforation rate due to EBD was 6.3% (1/16) and 3.0%(1/33). Both patients were treated by conservative therapy. 4. Difference between EAC and SCC: There were nine EAC and forty SCC patients in TA group. The number of EBD were 5.3 (5–11) and 5.4 (3 -11), respectively. Duration of ulcer healing were 10 (4–14) and 6.5 (1–24), respectively. There was no significant difference between two groups.

Conclusion
Triamcinolone injection is safe and effective treatment to prevent stricture after circumferential ESD, not only for SCC but also for EAC.

Disclosure
All authors have declared no conflicts of interest.
PS02.036: FAILURE PATTERNS AND LATE TOXICITIES OF CONCURRENT CHEMORADIOTHERAPY FOR CERVICAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA: FROM A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Li Hongxuan , Liu Jun , Fu Xiao-Long 
Published: September 2018

Abstract

Background
From a prospective observational study, we aim to observe failure patterns and late toxicities of concurrent chemoradiotherapy (CCRT) among patients with cervical esophagus squamous cell carcinoma (CESCC).

Methods
All patients were pathologically confirmed with no distant metastasis. All the patients received CCRT followed by consolidate chemotherapy. Elective nodal irradiation was given and platinum-based doublet chemotherapeutic regimens were chosen for both concurrent chemotherapy and consolidate chemotherapy. All patients were followed up every 3 months in the first 2 years after CCRT and every 6 months thereafter. Re-examinations included cervical CT, chest CT, barium esophagram, abdominal CT or B ultrasound, esophagoscopy when necessary.

Results
Ninety-two patients were enrolled from March 2007 to July 2014. The median radiation dose was 60Gy (range: 50–63Gy). The median follow-up time was 34 months for all patients and 51.5 months for survival patients. Three-years and 5-year OS were 49.8% and 44.4% (the median OS: 36 ± 5.631months). Treatment failures occurred in 54 patients, including 30 cases (32.6%) with loco-regional failures alone (LF), 14 cases (15.2%) with distant metastasis alone, and 10 cases (10.9%) with both failures. Among the patients with LF, in-field recurrence occurred in 32 cases (80%, 32/40), out-field recurrence occurred in 8 cases (20%, 8/40). Among the 24 patients with distant metastasis, pulmonary metastasis occurred in 13 patients (54%, 13/24). Totally 52 patients were dead. Thirty-five patients died of LF, 11 patients died of distant metastasis, 2 patient died of unrelated diseases, and another four patients died of severe toxicities (4.3%), three of them died of esophageal fistula and another 1 patient died of laryngeal edema. The major late complication was esophageal symptom. There were 7 cases that had 3th grade strictures. Most of them could be relieved by continuous dilatation programme.

Conclusion
The efficacy of CCRT for CESCC was satisfactory. In-field LF is still the predominant failure pattern after CCRT for cervical esophageal SCC. Improving in-field local control and reducing distant metastasis may contribute to better efficacy.

Disclosure
All authors have declared no conflicts of interest.