bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.016: MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE IN THE FIRST 100 CASES
Authors: Eroglu Atila , Daharli Coskun , Aydin Yener , Ulas Ali , Alici Haci 
Published: September 2018

Abstract

Background
In this study, the efficiency of minimally invasive esophagectomy in esophageal cancer was examined.

Methods
A total of 100 consecutive patients who were hospitalized due to esophageal cancer and planned minimally invasive esophagectomy were evaluated prospectively between September 2013 and December 2017 in our clinic. Laparoscopic and thoracoscopic esophagectomy was performed in all of the patients included in the study. Inoperable cases were not included in the study. Age and sex of the patients, symptoms, localization of tumor, histopathological type, surgical modality, operation time, length of hospital stay and morbidity and mortality rates were reviewed.

Results
Thirty-eight (38%) patients were male and 62 (62%) patients were female. The mean age was 55.5 ± 10.8 (32–75 years). The most symptoms were dysphagy (96%) and weight loss (39%). Eighty-one patients (81%) had squamous cell cancer, ten (10%) had adenocarcinoma and nine had another form of esophageal cancer. Neoadjuvant chemoradiotherapy was performed in 36 of the 100 patients. Laparoscopic and thoracoscopic esophagectomy and intrathoracic anastomosis were performed in 94 patients (94%). Laparoscopic and thoracoscopic esophagectomy and neck anastomosis were performed in six patients (6%). The mean duration of operation was 260.1 ± 33.4 minutes (185–335 minutes). The mean intraoperative blood loss was 114.2 ± 191.4 ml (10–800 ml). In 51 (51%) of the patients, complications occurred in perioperative, early postoperative and late postoperative periods. In postoperative complications, anastomotic leak rate was eight patients (8%) and pulmonary complication rate was 21 patients (21%). While mortality was seen in three patients that had diabetes mellitus and hypertension, the 30-day mortality was 2% and the hospital mortality was 3%. The mean hospital stay was 11.2 ± 8.3 days (range 8–44). In our study, the probability of one-year overall survival was 91% and the probability of two years overall survival was 66%.

Conclusion
Minimally invasive esophagectomy is a safe and preferred method with low mortality, acceptable morbidity, short operative time and short hospital stay and has become a routine approach in the treatment of esophageal cancers. Multicenter studies to be performed in the near future will further assist in defining the benefits of minimally invasive esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS02.018: MINIMALLY INVASIVE ESOPHAGECTOMY (MIE): FROM HYBRID, TO FULLY MINIMALLY-INVASIVE (MIE) AND TO ROBOTIC ASSISTED MIE (RAMIE): A SINGLE SURGEON ANALYSIS
Authors: Tagkalos Evangelos , Hadzijusufovic Edin , Matthias Corvinus Florian , Babic Benjamin , Lang Hauke , Grimminger Peter 
Published: September 2018

Abstract

Background
The incidence of esophageal carcinoma is increasing in the western world and esophageal resection is the essential therapy depending on the tumor stage. Several studies report advantages of minimally invasive esophagectomies (MIE) versus conventional open procedures. The use of totally MIE (thoraco- and laparoscopic) or robotic assisted MIE (RAMIE) compared to the hybrid approaches remain unclear.

Methods
Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. 25 were treated with a hybrid MIE (hybrid), another 25 with a totally MIE (MIE) and another 25 with a robotic assisted MIE (RAMIE). All patients were operated by the same specialized surgeon in our center. Demographic data), duration of total hospital- and intensive-care-stay (ICU), number of remote lymph nodes and histopathological R-status, as well as operating times were compared. The complications were assessed according to the Dindo-Clavien classification.

Results
The overall 30- and 90-day mortality rate were 0% and 1.33% (1/75) respectively. Hospital stay (P = 0.262), ICU stay (P = 0.079), number of resected lymph nodes (P = 0.863) and R status (P = 0.132) did not differ significantly between the groups. However more pneumonias and wound infections (P = 0.046 and P = 0.003 respectively) were found in the hybrid group when compared to the minimally invasive group (MIE und RAMIE).

Conclusion
Although the MIE as well as the RAMIE group contained the first 25 patients treated in this clinic with this procedures, comparable results with regard to oncological outcomes and morbidity could be achieved. Additionally the minimally invasive approaches seem to be assosiated with low occurence of pneumonia and wound infects.

Disclosure
All authors have declared no conflicts of interest.
PS02.022: INDOCYANINE GREEN: A USEFUL TOOL IN MINIMALLY INVASIVE ESOPHAGEAL CANCER SURGERY
Authors: Turrado-Rodriguez Victor , Nombre De Maria Momblan Dulce , Ibarzabal Ainitze , Torroella Alba , Gerardo Diaz Del Gobo Rafael , Maria De Lacy Fortuny Antonio 
Published: September 2018

Abstract

Background
Minimally invasive approach to esophageal cancer has been accepted as the standard of care in many centers. Nontheless, some technical difficulties are encountered during surgery. A proper vascularization of the gastric tube is mandatory to avoid the dreadful complication of a leak or of gastric conduit necrosis. On the other hand, there is controversy on the identification of sentinel lymph node in early esophageal cancer and on the extent of lymphadenectomy in locally advanced tumours. Indocyanine green (ICG) is a sterile, anionic, water-soluble but relatively hydrophobic, tricarbocyanine molecule, which is bound to plasma proteins when intravenously injected. It is extracted by the liver appearing in the bile around 8 minutes after injection. When injected outside the blood vessels, ICG reaches the nearest lymph node within 15 minutes and after 1 to 2 hours it binds to the regional lymph nodes. The usual dose of ICG is 0.1 - 0.5mg/mL/kg. ICG becomes fluorescent once excited with near-infrared (NIR) light at about 820 nm. The fluorescence released by ICG may be detected using specially developed cameras.

Methods
A systematic review of the literature of ICG in esophageal surgery was carried on February 2018 using the following terms: esophagus, indocyanine green, ICG, surgery, angiography, lymph node, and combinations of the above.

Results
The technique of ICG angiography for vascular assessment of the gastroepiploic arcade and gastric conduit is explained and the published results are review. The use of ICG for the evaluation of sentinel lymph node in early esophageal cancer and of lymph node mapping for regional lymph nodes is explained and current evidence is reviewed.

Conclusion
ICG use in esophageal surgery is still a novel and promising technique. It could help to reduce anastomotic leak by means of vascular assessment of the gastric conduit, locate lymph nodes out of the usual fields of lymphadenectomy and locate the sentinel lymph node in early esophageal cancer

Disclosure
All authors have declared no conflicts of interest.
PS02.023: SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY FOR TREATING ESOPHAGEAL CANCER
Authors: Lee Jang-Ming , Yang Sunn-Mao , Huang Pei-Ming 
Published: September 2018

Abstract

Background
Single-incision throacoscopic and laparoscopic procedure has been applied to treating various diseases. In the current study, we applied this novel surgical technique in the minimally invasive esophagectomy for esophageal cancer.

Methods
Minimally invasive esophagectomy (MIE) with single-port approach in the thoracoscopic and laparoscopic procedures was attempted for patients with esophageal cancer. Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3–4 cm incision was created both in the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients with single-incision and multi-incision MIE.

Results
We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006–2015. There were 12 patients having postoperative complications (25%), including 4 (8.3%) of anastomotic leakage one (2.1%) of pulmonary complications and 3 (6.3%) with vocal cord palsy in the patients undergoing single-incision MIE (SIMIE). There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (P < 0.05). There was no surgical mortality in the single-incision MIE group.

Conclusion
Minimally invasive esophogectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.

Disclosure
All authors have declared no conflicts of interest.
PS02.026: EXPANDABLE METALLIC STENTS IN ESOPHAGEAL: EXPERIENCE IN THE NATIONAL CENTER FOR MINIMAL ACCESS SURGERY
Authors: Neri Jimenez Felipe , Torres Julían 
Published: September 2018

Abstract

Background
Expandable metallic stents are one of the treatment alternatives currently palliative treating benign and malignant stenosis of the gastrointestinal tract and biliopancreátic order to improve the quality of life of patients. Our aims are to show the results achieved by our group in the placement of self-expanding metal stents in patients with malignant or benign strictures of the upper digestive tracts referred from different parts of the country.

Methods
A number of cases were prospectively evaluated the Cuban experience of 101 self-expanding stent insertion (Niti-S Stent) in 86 patients treated at the National Center for Minimal Access Surgery, diagnosed with malignant and benign strictures of the upper digestive tractus.

Results
The highest proportion of inserted prosthesis was performed in malignant stenosis (86%) and in the group of 60 and more years old (81, 3%). The most frequent complications were chest pain (100%) immediately and migration of the stent in benign and on tumor growth in malignant. A hole that had subsequently died.

Conclusion
Self-expanding metal stents have emerged as an alternative effective and safe, for the treatment of malignant and benign stenoses of the digestive system. Most reports report small series of cases consecutively without a control group, which has made it difficult to evaluate world. In our study we want to show the first experience achieved in our country. Conclusions: utility Stents for palliation of malignant and benign strictures high digestive shown.

Disclosure
All authors have declared no conflicts of interest.
PS02.027: EXERCISE TRAINING DURING NEO-ADJUVANT THERAPY IN PATIENTS UNDERGOING SURGERY FOR CANCER OF THE GASTRO-ESOPHAGEAL JUNCTION
Authors: De Heer Pieter , Christensen Jesper , Simonsen Caper , Banck-Petersen Anna , Kristensen Thomas , Garbyal Rajendra , Pedersen Bente , Bo Svendsen Lars , Højman Pernille , Kofoed Steen 
Published: September 2018

Abstract

Background
Neoadjuvant chemo- or chemo-radiotherapy before tumor resection is first-line treatment in patients with GEJ but associated with considerable symptom burden and complication risk which may impair treatment efficacy and quality of life. Strategies to improve treatment tolerability are therefore warranted.

Methods
Fifty GEJ cancer patients were allocated without randomization to an exercise-group or usual care control-group. The exercise-group was prescribed 2 weekly sessions including aerobic interval exercise and resistance training for 12 weeks. The primary endpoint was risk of treatment failure defined as any serious adverse event (SAE) precluding surgery. Risk of other SAEs and quality of life (in both groups); and exercise-adherence and change in aerobic fitness, muscle strength, and body composition (in the exercise-group) was recorded.

Results
Risk of treatment failure was 5% in the EX-group and 21% in the CON-group, and risk of pre-operative hospitalization was 15% in the EX-group and 38% in the CON-group. Risk of post-operative complications was similar between groups. The exercise-group attended on average 17.4 sessions and improved fitness (+ 8%), muscle strength (+ 15–22%) and FACT-E total score (+ 12-points).

Conclusion
Pre-operative exercise was feasible and led to favorable changes in fitness, strength and quality of life. Further, it may be associated with lower risk of treatment failure and hospitalization during neoadjuvant therapy, which could have important implications for future perioperative management of patients with GEJ cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER
Authors: Okamoto Hiroshi , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Maruyama Shota , Kamei Takashi 
Published: September 2018

Abstract

Background
Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC.

Methods
We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015.

Results
Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively.

Conclusion
DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation.

Disclosure
All authors have declared no conflicts of interest.
PS02.034: EFFICACY AND SAFETY OF SALVAGE PHOTODYNAMIC THERAPY USING TALAPORFIN SODIUM FOR LOCAL FAILURE AFTER CHEMORADIOTHERAPY IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Amanuma Yusuke , Ohashi Shinya , Tamaoki Masashi , Horimatsu Takahiro , Muto Manabu 
Published: September 2018

Abstract

Background
We previously conducted an investigator-initiated trial of photodynamic therapy (PDT) using talaporfin sodium (talaporfin-PDT) and laser irradiation (PD-laser) against local failure after chemoradiotherapy (CRT) in patients with esophageal cancer (EC) and reported a high local complete response rate (L-CR) (88.5%) (Yano et al., Oncotarget 2017). Thereafter, talaporfin-PDT has been applied clinically as a salvage treatment for local failure after CRT in Japan since October 2015. The current study retrospectively reviewed the efficacy and safety of talaporfin-PDT in patients who underwent this treatment in our clinical practice.

Methods
This study was a single-center retrospective observational study. Patients who received salvage talaporfin-PDT for local failure of EC limited to T1–2 after definitive CRT or radiotherapy from May 2011 to July 2017 in our hospital were included. PDT was applied with an intravenous administration of talaporfin sodium (40 mg/kg) followed 4 h later by diode laser irradiation at 100 J/cm2. The primary and secondary endpoints were the rate of L-CR and the safety of PDT, respectively. The criteria for L-CR were as follows: 1) no residual tumor, 2) disappearance of post-PDT ulcer and scar formation, and 3) disappearance of cancer cells as assessed histologically.

Results
Thirty-one patients were analyzed in this study (26 men, 5 women, median age: 68 years). Histological types were squamous cell carcinoma and adenocarcinoma (30 and 1 patients, respectively). The failure patterns of lesions after CRT were recurrence after achieving a CR and residual lesion just after CRT (25 and 6 patients, respectively). The recurrent T stages were T1a, T1b, and T2 (1, 18, and 12 patients, respectively). The median total laser exposure dose was 500 J (range: 200–900). The L-CR rates were 84.2% (16/19), 41.7% (5/12), and 61.3% (19/31) in patients with T1, T2, and all stages, respectively. No severe adverse events greater than grade 3 related to PDT were observed. Although four patients had grade 2 esophageal stenosis after PDT, the stenosis was controlled by endoscopic balloon dilation.

Conclusion
Salvage talaporfin-PDT is a safe and curative treatment for local failure, especially stage T1, after CRT in patients with EC.

Disclosure
All authors have declared no conflicts of interest.
PS02.035: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE SUPERFICIAL OESOPHAGUS SQUAMOUS CELL CANCER WITHOUT STRICTURES ON FOLLOW-UP
Authors: Baldaque-Silva Francisco , Konradsson Magnus , Wang Naning , Omae Masami 
Published: September 2018

Abstract

Description
The optimal treatment for oesophageal superficial squamous cell cancer (SCC) is end bloc resection, that in large lesions is only possible with endoscopic submucosal dissection (ESD). Resections larger than 3cm, in the upper esophagus and encompassing more than 3/4 of the luminal circumference, are associated with high stricture rate. That risk is virtually 100% in cases of circumferential ESD. High focus had been given to preventive measurements such as steroids injection, oral steroids or cell sheet transplantation. Usually highly osmotic substances such as Glicerol ® are used for subepitelial lifting. Hyaluronic acid has high viscosity and anti-inflammatory proprieties, that due to its high cost is not widely used in ESD or is used in low concentration formulas and low volume. We report a case of a 7.5 cm long circumferential oesophageal ESD performed with injection of a high volume and concentration of hyaluronic acid that was not associated with stricture in the follow-up. A 73 years-old male patient was referred to our clinic due to the presence of a long superficial lesion and biopsies positive for SCC. We performed chromoendoscopy with lugol that revealed the presence of a ca 6cm long Paris IIa-b, circumferential SCC in the middle esophagus with ‘Tatami-no-me ‘and ‘pink-color’ signs, without ulcers or other endoscopic signs of deep invasion. The PET-CT was negative for metastasis. After multidisciplinary conference and patient's consent an ESD was performed under full narcosis using Dualknife ® and hyaluronic acid for subepitelial injection. A 7.5 cm circumferential ESD specimen was resected and the patient was discharged at day 3 without complications under proton pump Inhibitors and a step-down dose of 30mg/d of oral prednisolone. The pathological result revealed R0 resection of a SCC with invasion of the superficial muscularis mucosae (T1a) and no lymphovascular engagement. The follow-up at 2, 5, 8 weeks and 6, 9 and 12 months revealed the absence of stricture. There was no cancer recurrence in the last follow-up (1 year). Long circumferential ESD of oesophageal SCC is possible with curative intent. The combination of PPI, oral steroids and high volume/concentration of hyaluronic acid, avoided stricture formation in this case.

Disclosure
All authors have declared no conflicts of interest.
PS02.037: NETWORK AND PATHWAY-BASED ANALYSIS OF GENES ASSOCIATED WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: He Wenwu , Han Yongtao , Yuan Kun , Lin Peng 
Published: September 2018

Abstract

Background
As a highly malignant and aggressive tumor, Esophageal Squamous Cell Carcinoma (ESCC) is not sensitive to chemoradiotherapy and chemotherapy. Although diagnostic methods and treatments have improved over the last few years, the 5-year survival rate of ESCC patients remains generally poor. The development of high-throughput technology has witnessed the great achievements in localization ESCC related genes/proteins, and many genes/proteins are considered as potential targets for detection or treatment. To take a further quest for a thorough understanding of the biological processes involved in the pathogenesis of ESCC at the molecular level, the potential pathogenesis of ESCC needs to be deciphered at a phylogenetic level.

Methods
The interaction of these genes was explored by collecting genes associated with ESCC, using gene enrichment assays, pathway enrichment assays, pathway crosstalk analysis and extraction of ESCC-specific subnetwork to describe the relevant biochemical processes.

Results
Through GO enrichment analysis, many molecular functions related to response to chemical, cellular response to stimulus and cell proliferation were found to be significantly enriched in ESCC-related genes. The results of pathway and pathway crosstalk analysis showed that pathways associated with multiple malignant tumors, the immune system and metabolic processes were significantly enriched in ESCC-related genes. Through the analysis of specific subnetwork, we obtained some novel ESCC-related potential genes, such as MUC13, GSTO1, FIN, GRB2, CDC25C and so on.

Conclusion
The molecular mechanism of ESCC is extremely complex. Some inducing factors change the expression status of many genes. The abnormal expression of genes mediates the biological processes involved in immunity and metabolism, apoptosis and cell proliferation, leading to the occurrence of tumors. Gene MUC13, RYK, FIN may be potential prognostic indicators of ESCC. GRB2 and CDC25C may be potential targets of ESCC in proliferation. Our work may provide valuable information for understanding the molecular mechanisms for the development of ESCC.

Disclosure
All authors have declared no conflicts of interest.