bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.159: THE IMPROVED POSTOPERATIVE RECOVERY OUTCOMES FROM MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Zhang Xiaobin , Li Zhigang 
Published: September 2018

Abstract

Background
The minimally invasive esophagectomy (MIE) has been developed in the past three decades. In our institution, the MIE was first introduced in 2012, and the proportion of MIE was used for over 70% in 2016–2017. This study aimed to compare the postoperative recovery outcomes between MIE and open esophagectomy in different period.

Methods
A total of 725 patients were enrolled in this study including 248 patients who underwent open esophagectomy within 2012–2013 and 477 patients who underwent MIE within 2016–2017. All patients received McKeown esophagectomy with two-field lymphadenectomy. And the perioperative complications were recorded according to the Esophagectomy Complications Consensus Group (ECCG) complication definitions.

Results
There was no statistically difference between OPEN and MIE groups with regard to preoperative characters except for age (60.8 ± 7.2 vs. 62.7 ± 7.7, P < 0.001) and body mass index (22.4 ± 3.0 vs. 23.1 ± 3.0, P = 0.002). One (0.2%) patient in the MIE group died within 90 days from anastomotic leakage, compared to 6 (2.4%) patients in the OPEN group (P = 0.004). The length of hospital stay was shorter in the MIE group (11 range 6–131 days, vs. 15 range 9–164 days, P < 0.001). The MIE group was in favor of lower complications (32.3% vs. 46.4%, P < 0.001). Pneumonia was the most common complications in both groups (12.6% in MIE vs. 27.4% in OPEN, P < 0.001). 15 (3.1%) patients in the MIE group experienced atrial arrhythmias compared with 30 (12.1%) in the OPEN group (P < 0.001). Lower anastomotic leakage was noted in the MIE group (11.5% vs. 25.4%, P < 0.001), as well as the wound infection (0.2% vs. 2.8%, P = 0.001), than in the OPEN group. The recurrent nerve injury was higher in the MIE group (11.7% vs. 6.5%, P = 0.024) but with more lymph nodes dissection along the recurrent laryngeal nerve (3.8 ± 2.8 vs. 1.4 ± 2.0, P < 0.001).

Conclusion
The MIE was associated with better postoperative recovery outcomes and lower mortality. MIE technique should be considered as the mainstay surgical treatment for esophageal cancer in the current and future period.

Disclosure
All authors have declared no conflicts of interest.
PS01.161: THE VERRUCOUS CARCINOMA OF THE ESOPHAGUS: A RARE HIGHLY DIFFERENTIATED SQUAMOUS CELL CARCINOMA
Authors: Gehwolf Philipp , Oberhuber Georg , Schmid Thomas , Öfner-Velano Dietmar , Wykypiel Heinz 
Published: September 2018

Abstract

Background
The verrucous carcinoma of the esophagus is a rare, very slowly growing and uncommonly metastasizing locally progressive and highly differentiated squamous cell carcinoma. The genesis of the tumor is not completely clarified but often associated with human papilloma virus or chemical toxic exposure of the mucosa. On endoscopy it appears as an exophytic, villous, with whitish hyperkeratosis, endosonographically pretending a uT3N + situation. Patients often present with dysphagia and unspecific reflux symptoms. Often several biopsies of the tumor are needed to make the diagnosis, because few routinely taken standard biopsies often show unspecific inflammation or mycotic Infections. However, the carcinoma is subjacent. Diseases on rare occasions often need extensive diagnostics, therefore we want to cal in mind the verrucous carcinoma of the esophagus.

Methods
Small case series in a single center patient collective.

Results
From 2010 to 2017, 55 patients underwent an esophageal resection. In two patients (3,6%) a verrucous carcinoma was diagnosed. That is far more often than expected.

Conclusion
In patients with dysphagia and macroscopic villous structure on endoscopy, further samples should be taken despite benign primary histology and a reference pathologist should be involved.

Disclosure
All authors have declared no conflicts of interest.
PS01.164: NEUROENDOCRINE CARCINOMA OF THE ESOPHAGUS: AN ANALYSIS OF 72 COHORT PATIENTS SURGICALLY TREATED FROM A SINGLE CHINESE MEDICAL CENTER
Authors: Deng Han-Yu , Lin Yidan 
Published: September 2018

Abstract

Background
Esophageal neuroendocrine carcinoma (NEC) is a rare malignant tumor, and it is rarely reported in large cohort studies. Therefore, the prognostic factors of esophageal NEC were not well established. In this study, we tried to analyse a large cohort of esophageal NEC patients aiming to investigate its possible prognostic factors.

Methods
Patients who underwent esophagectomy for esophageal NEC in our department from January 2007 to June 2015 were identified and analyzed. Both univariate and multivariate analyses were applied to identify potential prognostic factors.

Results
A total of 72 patients were identified for analysis. After a median follow-up time of 54.8 months, the median survival time of those patients was 21.5 months. One-year, three year, and five-year survival rates were for all those patients were 75.0%, 33.4%, and 28.4% respectively. In the univariate analysis, TNM stage (P = 0.001), lymph node metastasis (P = 0.008), and adjuvant therapy (P = 0.001) were found to significantly influence the overall survival time of those patients; while in multivariate analysis, only TNM stage (P = 0.018) and adjuvant therapy (P = 0.002) were found to be independent prognostic factors.

Conclusion
Esophageal NEC was extremely rare with poor prognosis. TNM stage and adjuvant therapy are the independent prognostic factors of esophageal NEC.

Disclosure
All authors have declared no conflicts of interest.
PS01.172: A NOVEL VALGUS NESTED RING ANASTOMAT AND ITS APPLICATION IN ESOPHAGUS SURGERY
Authors: He Wenwu , Han Yongtao , Lin Peng 
Published: September 2018

Abstract

Description
Here we introduce our patent (A novel valgus nested ring anastomat and its application in esophagus surgery, patent number: 201,610,968,664.6, ZL201621191883.X), it is different from our usual stapler, we think it can reduce the occurrence of anastomotic bleeding, fistula, stenosis, and its application can achieve rapid recovery after surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.177: ERAS HYBRID IVOR LEWIS ESOPHAGECTOMY
Authors: Zacherl Johannes , Albinni Said , Radlspöck Wolfgang , Kertesz Viktoria , Lechmann Andrea , Platter Thomas , Vavrovsky Gerhard , Öhler Leopold 
Published: September 2018

Abstract

Background
We introduced a multiprofessional fast track programme in esophagectomy in order to increase surgical safety and to reduce the perioperative burden to the patient.

Methods
Consecutive patients scheduled for oncological Hybrid Ivor Lewis (HIL) procedure were included. An adapted ERAS protocol beginning from the process of preoperative risk estimation involving internists, oncologists, physiotherapists, psychologists, dietricians, surgeons and anesthesiologists to make patients fit for surgery. In locally advanced tumor stages neoadjuvant treatment was adopted according to interdisciplinary consensus. Perioperative measures were undertaken to enhance recovery and to reduce morbidity by an adopted ERAS protocol. Parameters regarding surgical safety, oncological quality of surgery, duration of hospital stay, unplanned readmissions and survival were recorded.

Results
Since 2014 94 patients underwent esophageal resection. Among them 80 had an Ivor Lewis procedure, 69 patients (female, 16; mean age, 66a) underwent HIL for cancer. The majority received neoadjuvant treatment before HIL (chemotherapy, 47; radiochemotherapy, 10). R-0 rate was 92,8%, mean number of examined lymphnodes was 33,5. Major morbidity (Clavien-Dindo III-V) occurred in 13,04%, anastomotic leaks in 7,2%, 8 (11,6%) patients underwent redo surgery. 6 (8,7%) patients needed prolonged mechanical ventilation. Hospital, 30d- and 90d-mortality was 2.9, 2.9 and 4,3%, respectively. Median hospital stay was 12 days (8–57) in all patients and 26 days (14–57) in patients with major morbidity. Unplanned readmission occurred in 7,2%. Overall, ERAS protocol was fulfilled in 66,7% of cases. Estimated 2-year overall survival is 82%.

Conclusion
Adopting an ERAS protocol with dedicated interprofessional perioperative care operative safety compares favourably with other reports. Performing the abdominal part endoscopically does not impair surrogate parameters of oncological quality. However, length of hospital stay seems to be optimizable.

Disclosure
All authors have declared no conflicts of interest.
PS01.178: ANALYSIS OF SURGICAL OUTCOME OF COMBINED RESECTION OF ADJACENT ORGANS IN ESOPHAGEAL CANCER
Authors: Tanaka Koji , Yamasaki Makoto , Makino Tomoki , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
If the cancer remains after chemotherapy or chemoradiotherapy for cT4b esophageal cancer, curative resection is sometimes performed. In cases where T4 is not released, combined resection of adjacent organs is necessary for R0 resection. But its significance is controversial. The aim of this study is to examine the significance of combined resection of adjuacent organs for T4 esophageal cancer.

Methods
Of the 209 patients who were diagnosed as cT4b esophageal cancer finally resected from 2000 to 2015, the relationship between clinicopathological factors and prognosis was retrospectively analyzed in 32 patients who underwent combined resection of T4 adjuacent organs.

Results
Preoperative factors: Ce/Ut/Mt/Lt = 10/14/6/2, cN Yes/No = 29/4, cM Yes/No = 7/25, preoperative treatment Yes/No = 32/0, type of preoperative treatment: chemotherapy/chemotherapy + CRT/CRT = 11/11/10, clinical response: responder/nonresponder = 22/10, T4 Organ: airway (trachea, bronchus)/blood vessel (aorta, large vessel)/gastrointestinal (pancreas, liver) = 28/2/2. Organ of ombined resection: airway/blood vessel/airway + blood vessel/digestive organ = 21/7/1/4. Postoperative factors: pT: 0/3/4 = 4/11/17. pN: 0/1–3 = 9/23, pM: 0/1 = 25/7. The 3-year overall survival rate (3yOS) of 32 patients was 31.2%. Preoperative treatment clinical effect: 3yos of responder/nonresponder = 47.8%/0%, which was significantly better in the responder(P = 0.013). Resection of respiratory tract: 3yos of yes/no = 27.3%/45.7%, (P = 0.071). There was no significant difference in prognosis regardless of cN, cM and pN status. 3yOS of pM 0/1 = 40.7%/0% (P = 0.030) and was significantly better in pM0. Multivariate analysis of OS revealed that the therapeutic effects (OR: 3.49, P = 0.040), resection of the trachea (OR: 3.10, P = 0.017) were independent prognostic factors.

Conclusion
Even in ct4b cases of combined resection of adjacent oragan, the 3-year survival rate was relatively good. However, the prognosis of cases with poor preoperative therapeutic effect and cases with tracheal complication were poor. It seems necessary to judge surgical indication carefully.

Disclosure
All authors have declared no conflicts of interest.
PS01.180: IMPACT OF INTRAOPERATIVE FLUID MANAGEMENT ON POSTOPERATIVE CARDIOPULMONARY FUNCTION AFTER THORACIC ESOPHAGECTOMY: A RETROSPECTIVE COHORT STUDY
Authors: Kobayashi Makoto 
Published: September 2018

Abstract

Background
This study aims to investigate the impact of intraoperative infusion balance on postoperative hemodynamics and oxygenation in patients undergoing elective transthoracic esophagectomy. Although adequate volume control is often deemed imperative to reduce complications, definitions of practical infusion dosages for the fluid management during surgery are absent.

Methods
In this retrospective cohort study, we examined 200 patients who underwent transthoracic esophagectomy from 2008 to 2017. During anesthesia, we followed our protocol that recommends the infusion volume of 10 mL/kg/h. Postoperatively, we followed the postoperative fluid protocol (Kobayashi M. Dis Esophagus 2010 23:565–71). Then, we collected data on actual volume of water infused both intraoperatively and postoperatively, and also evaluated ratios of intrapulmonary shunting (Qs/Qt), the occurrence of hypotension, the necessity of fluid resuscitation, and postoperative complications.

Results
In this study, postoperative hypotension was more frequent in patients who required more amount of fluid during surgery than the amount anticipated per the protocol. In addition, we determined a correlation of the amount of fluid volume between during surgery and postoperative day 0 (P = 0.001)(Fig.1a). Notably, an increased amount of intraoperative fluid did not deteriorate Qs/Qt (Fig.1b) or elevate the risk of postoperative complications.

Conclusion
This study deduces that higher increase in the intraoperative infusion volume could predict postoperative variation in the circulation after esophagectomy. In addition, although postoperative hypotension readily caused more infused volume than the expected balance, overdosed infusion in POD 0 demonstrated no apparent correlation with the impairment of pulmonary function.

Disclosure
All authors have declared no conflicts of interest.
PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD
Authors: Ujiie Naoto , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Okamoto Hiroshi , Maruyama Shota , Onodera Yu , Kamei Takashi 
Published: September 2018

Abstract

Background
Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma.

Methods
All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups.

Results
In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605).

Conclusion
Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.185: STATUS OF SUBCARINAL LYMPH NODE METASTASIS AND DISSECTION STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA
Authors: Chen Long-Qi , Wang Yun-Cang , Deng Han-Yu 
Published: September 2018

Abstract

Background
The subcarinal lymph node metastasis, although with the debate whether it is a characteristic of lung cancer or esophageal cancer, is prevalent in esophageal carcinoma, and with the incidence of 4.1%-17.5% according to some estimates. The aim of this study is to assess the pattern of subcarinal lymph node metastasis and the dissection strategy for thoracic esophageal carcinoma.

Methods
A large cohort, retrospective study was conducted on 596 patients with thoracic esophageal carcinoma treated from July 2008 to December 2010. The metastasis rate of subcarinal lymph node was investigated. Survival of patients treated by different dissection strategies was compared. The effectiveness index was used to assess the outcome of subcarinal lymph node dissection.

Results
Of 596 patients, 447 had documented subcarinal lymph node dissection (75.0%). According to whether the subcarinal lymph node was harvested or not, they were divided into two groups: dissection group (n = 447) and non-dissection group (n = 149). Their 5-year survival rates were 48.3 ± 1.7 months for dissection group vs. 38.1 ± 2.8 months for non-dissection group (P < 0.001). The overall subcarinal node metastasis rate in the dissection group was 12.5% (56/447). Based on the status of subcarinal nodes, there was a significant difference in survival, 52.3 ± 1.8 months with negative nodes (n = 391) compared to 19.9 ± 2.2 months for those with positive nodes (n = 56) (P < 0.001). Subgroup analysis was further conducted for the positive subcarinal nodes patients. The metastasis rates in patients with upper, middle and lower esophageal cancer were 5.4%, 15.1% and 10.1%, respectively (P < 0.05 for comparison between patients with upper and other segments). The effectiveness indices for these three groups of patients were as 0%, 4.8% and 27.2%, respectively. The metastasis rates for T0, T1, T2, T3 and T4 esophageal carcinoma were 0%, 0%, 3.5%, 10.7% and 19.0%, respectively (P < 0.05 for comparison between T0/T1/T2 and T3/T4 tumors.

Conclusion
Thoracic esophageal carcinoma has a high incidence of subcarinal lymph node metastasis, especially among those with middle and lower esophageal cancer, and for deeper invaded tumors. Therefore, for middle and lower esophageal tumors, subcarinal lymph node dissection is necessary, whereas for T1/2 upper esophageal tumors, subcarinal lymph node dissection can be spared from subcarinal lymph node dissection.

Disclosure
All authors have declared no conflicts of interest.
PS01.192: ROUTINE CHEST X-RAY AFTER REMOVAL OF CHEST TUBES IS NOT NECESSARY DURING THE POSTOPERATIVE COURSE OF ESOPHAGECTOMY
Authors: Kingma Berend , Marges Onno , Van Hillegersberg Richard , Ruurda Jelle 
Published: September 2018

Abstract

Background
Chest X-rays (CXRs) are commonly performed after removing chest tubes post-esophagectomy. However, literature on cardiopulmonary surgical patients suggests that a CXR might safely be reserved for patients who develop clinical respiratory signs or symptoms. Omitting unnecessary CXRs can save costs, radiation exposure, and logistic challenges, which aids the optimization of the postoperative care pathway. Therefore, the aim of this study was to investigate the clinical relevance of routinely performing a CXR after chest tube removal following esophagectomy.

Methods
A single-center prospectively maintained database was used to select all patients who underwent esophagectomy with gastric conduit reconstruction between 2015 and 2017. Patients who received a routine CXR 4 hours after removal of at least one chest tube or thoracic Jackson-Pratt drain were included. The radiological reports of routine CXRs were retrospectively evaluated for mentioning of intrapleural air or fluid. Cases requiring re-insertion of a chest tube on the day of routine CXR or the day afterwards were identified. Furthermore, the patients’ vital parameters were retrospectively reviewed from clinical documentation.

Results
Some 118 patients were included and esophagectomy was performed by a minimally invasive transthoracic (78%), an open transthoracic (14%), or a minimally invasive transhiatal (8%) approach. A total of 231 routine CXRs were performed after the removal of chest tubes (70%) and Jackson-Pratt drains (30%). Intrapleural air was found in 78 cases (34%) and was a new finding ipsilateral to previous chest tube or drain removal in 33 cases (14%). Intrapleural fluid was mentioned in 87 cases (38), which was new and ipsilateral to previous chest tube or drain removal in 24 cases (10%). Re-insertion of a chest tube was performed in 7 cases (3%). The routine CXR prior to chest tube re-insertion had shown intrapleural air (n = 3, 1%), intrapleural fluid (n = 2, 1%), or no abnormalities (n = 2, 1%). Clinical respiratory signs or symptoms (i.e. anamnestic dyspnea, an increased respiratory rate, dropping saturation levels, or need for oxygen support) occurred in all 7 patients who required chest tube re-insertion.

Conclusion
In conclusion, clinical respiratory signs or symptoms can safely guide the decision on whether to perform a CXR after chest tube or drain removal.

Disclosure
All authors have declared no conflicts of interest.
PS01.195: UNCOMPLICATED GASTRIC CONDUIT FOR ESOPHAGEAL REPLACEMENT
Authors: Perwaiz Azhar , Kapoor Deeksha , Singh Amanjeet , Chaudhary Adarsh 
Published: September 2018

Abstract

Background
Stomach is the most common conduit used for esophageal replacement. An properly constructed conduit is of paramount importance to success of the surgical procedure. We share our method (power point presentation) of creating gastric conduit with good results.

Methods
Standarized surgical technique (power point presentation) applied over last 50 consecutive esophagectomy for carcinoma esophagus during March 2016 and September 2017 in our institution by a single surgen and the surgical results were analysed. The primary end points were anastomotic leak, conduit necrosis and the secondary end points were need for anastomotic or pyloric dilatation.

Results
Radical esophagectomy for carcinoma esophagus with gastric pull up and neck anastomosis were performed in all (n = 50, male; 39, female;11, mean age of 51.3 + -11.2 years). There were 41 hybrid (thoracoscopy and laparotomy) and 9 total thoracolaparoscopic procedure. There were 0% anastomotic leak or conduit necrosis and at follow up of 3 months there were only 2 cases who needed anastomotic dilatation and none required pyloric dilatation.

Conclusion
Surgical complication related to the conduit can be minimised by standarising the surgical technique of its creation.

Disclosure
All authors have declared no conflicts of interest.
PS01.201: A CASE OF GASTRO-STERNAL FISTULA OF GASTRIC TUBE AFTER ESOPHAGECTOMY: A CASE REPORT
Authors: Kato Daiki , Yamada Kazuhiko , Soma Daisuke , Nohara Kyoko , Yamashita Satoshi , Kataoka Atsuko , Wake Hitomi , Yokoi Chizu , Kokudo Norihiro 
Published: September 2018

Abstract

Background
Peptic ulcer occurring in the gastric tube after esophagectomy sometimes penetrates into the mediastinal structures. We reported a case of sternal penetration of gastric tube ulcer successfully treated.

Methods
A CASE REPORT:

Results
A 73-years-old man who had undergone video-assisted thracoscopic esophagectomy (VATS) with 3-field lymphadenectomy reconstructed by retrosternal route after neoadjuvant chemo-radiation therapy. He visited outpatient complaining mild pain and redness of skin on anterior chest wall after 7 months of esophagectomy. Computed tomography (CT) revealed gastric tube ulcer penetrated into sternum. Upper GI endoscopy showed active ulcer in lower gastric tube. Biopsy was confirmed no malignant cell but bone tissues. He was admitted and started medication of proton pomp inhibiter and nutritional therapy. After 1 month he was improved symptoms and endoscopic findings.

Conclusion
There was a rare case of penetration into sternum due to gastric tube ulcer. In the literatures, 4 cases were reported about penetration into sternum. All four cases had symptoms of pain and redness of skin and were diagnosed with upper GI endoscopy and CT. Two cases underwent surgery and another cases were treated conservational therapy.

Disclosure
All authors have declared no conflicts of interest.