bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.246: ESOPHAGECTOMY-SPECIFIC OBJECTIVE STRUCTURED ASSESSMENT OF TECHNICAL SKILL (E-OSATS): CONSENSUS ON ESSENTIAL STEPS THROUGH DELPHI METHODOLOGY
Authors: Eddahchouri Yassin , Gisbertz Suzanne , Van Berge Henegouwen Mark I , Klarenbeek Bastiaan , Rosman Camiel 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy (MIE) is a technically demanding procedure, but without consensus regarding essential steps and assessment of surgical technique. The objective of this study was to determine expert consensus on essential steps in MIE as a first step in the development of an ‘esophagectomy-specific objective structured assessment of technical skills’ tool (E-OSATS).

Methods
Essential steps were defined for both MIE with intrathoracic- and cervical anastomosis, based on local expert opinion, peer-reviewed literature and surgical textbooks. In round table discussion disparities between experts were resolved, and an online Delphi questionnaire was sent to an international expert panel of minimally invasive upper GI surgeons. Based on replies and comments steps were adjusted and resent in iterative fashion.

Results
A total of 137 and 138 essential steps were identified for the MIE with intrathoracic- and cervical anastomosis respectively. After the first Delphi round 24 out of 36 (67%) invited international experts replied, and consensus was reached in 99 out of 137 (72%) and 95 out of 138 steps for both procedures respectively.

Conclusion
A Delphi method seems feasible in determining essential steps as a first step in the development of an E-OSATS for both MIE with intrathoracic- and cervical anastomosis. The second Delphi round is currently pending.

Disclosure
All authors have declared no conflicts of interest.
PS02.001: IMPLICATIONS OF JEJEUNOSTOMY OMISSION IN COMBINATION WITH EARLY FEEDING IN A MINIMALLY INVASIVE ESOPHAGECTOMY COHORT
Authors: Carroll Paul , Allison Frances , Yeung Jonathan , Darling Gail 
Published: September 2018

Abstract

Background
Early oral feeding in esophagectomy is recognised as safe in esophagectomy. Typically, enteral feeding has been used in combination to avoid weight loss in the recovery period post surgery. Recently, avoidance of jejeunal feeding has been shown to be efficacious with respect to nutritional safety over one year post surgery. In Toronto, jejeunostomy insertion is routinely omitted in our minimally invasive esophagectomy practice.

Methods
This study sought to determine the nutritional impact this practice has by determining the examining a retrospective cohort before and after the practice change in 2016. Only patients with complete weight measurement follow up to 1 year were incorporated. Data displayed as median and interquartile range (IQR).

Results
The initial results analysis consists of a total of 63 patients (n = 38 with feeding Jej (FJ) and n = 25 without (NFJ). Median BMI at surgery was 26 kg/m2 (23.1–30.5) with no differences between the groups identified: FJ BMI 25.9 (23–29.4) vs NFJ 26.8(23.9–32.2). Length of stay was 10 days in both groups. At one year, BMI was 23.4 (20.6–26.0) with no difference between the groups, FJ 22.4 (20.6–25.9) vs 23.4 (20.9- 27.7), P = 0.798. Median weight loss at 1 year was 11.2kg (9.1%). More weight loss was identified in the NFJ group in the 1st month, 4kg (1.9–5.1) vs 7kg (4.5–10.4) (P = 0.035) but subsequent intervals demonstrated no significant difference. Readmissions within one year were higher in the FJ group (n = 10, of which 2 needed operative intervention for jejeunostomy site issues), as compared to a single admission in the NFJ group for a para-conduit hernia repair.

Conclusion
Early commencement of oral nutrition in combination with the omission of feeding jejeunostomy insertion has no prolonged nutritional impact after the 1st month. Overall, Body mass index is reduced in esophagectomy patients over the first year irrespective of feeding approach.

Disclosure
All authors have declared no conflicts of interest.
PS02.008: MINIMAL INVASIVE OSEOPHAGECTOMY FOR CARCINOMA OESOPHAGUS BY USING WITH AN INNOVATIVE TECNIQUE: OUR EXPERIENCE
Authors: Pawar Suraj 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy(MIE) is associated with lower morbidity and mortality compared to open procedures. In order to retain the benefits and overcome disadvantages of the left lateral decubitious and fully prone positions, a modified semiprone position was developed at our centre.We aim to describe our growing experience of operating patients of esophageal carcinoma with MIE in a semiprone position.

Methods
A retrospective review of hospital records of all patients who underwent MIE for esophageal carcinoma at our oncological surgical centre from January 2007 till December 2017 was done. A modified semi-prone position (dorsolateral) was developed i.e. left lateral position with an inclination of 45 degrees with the horizontal. All surgeries were performed under general + Epiduralanesthesia with a double lumen endotracheal tube. Esophageal mobilization was done by thoracoscopic approach in a semiprone position andthoracoscopic 2 field lymhadenectomy was done and end-to-end cervical anastomosis was done in the neck. From the records, we obtained intraoperative parameters and post-operative complications. A multidisciplinary follow-up was established for all patients for a period of 2 `to 5 years.

Results
Retrospective data of 214 patients was included in this study. Mean length of hospital stay was 15.46 ± 4.48 days (range from 3 to 33 days) and mean number of lymph nodes dissected were 15.64 ± 5.98 (range 0 to 32). The mean blood loss was 282.92 ± 197.22 ml. Operative time for the total surgical procedure and 211.29 ± 54.62 minutes. Only 7% of the patients had intra-operative complications like arrhythmia, azygous vein bleeding, cardiac arrhythmia, hypotension, splenic bleeding, and others. Most common immediate post-operative complications were pulmonary related (22.7%) and wound infections (8.7%). Approximately 6% of the patients died in the early and delayed post operative period

Conclusion
MIE with mediastinal lymphadenectomy in the semiprone position is a feasible, convenient and safe option which can combine the benefits of the two conventional left lateral and prone approaches. Further large scale studies are required to support our findings.

Disclosure
All authors have declared no conflicts of interest.
PS02.015: EXPERIENCES OF COMPLETE LAPARO-THORACOSCOPIC MINIMALLY INVASIVE ESOPHAGECTOMY WITH SIDE-TO-SIDE ESOPHAGOGASTROSTOMY
Authors: Kamiya Satoshi , Rouvelas Ioannis , Klevebro Fredrik , Lindblad Mats , Nilsson Magnus 
Published: September 2018

Abstract

Background
Recently minimally invasive esophagectomy (MIE) has become more common over the world. Since 2014 we applied the laparo-thoracoscopic minimally invasive esophagectomy with intrathoracic side-to-side esophagogastrostomy. In this study, we present our experiences of minimally invasive Ivor-Lewis (IL) technique.

Methods
In succession to laparoscopic abdominal operation with upper abdominal lymphadenectomy and formation of the gastric tube conduit, patients were turned to prone position. After middle and lower mediastinal lymphadenectomy, the gastric conduits were pulled up to the chest through the hiatus and the specimens were removed. The side-to-side anastomoses were done using linear triple stapler and the defects were closed with thoracoscopic suturing. The outcomes of minimally invasive IL during 2014–2018 have been compared with those of open IL for esophageal adenocarcinoma.

Results
Among 279 patients with esophagectomy a minimally invasive IL was done in 118 3 cases (2.5%) were converted to open technique due to technical or oncological reasons. There were no significant differences in age, sex, BMI and ASA score at baseline. In the MIE group the peroperative blood loss and operation time was reduced 100 ml vs 550 ml (P < 0.01), and 395 min vs 420 min (P < 0.01). The numbers of harvested lymph nodes were superior in MIE group: 33 vs 23 (P < 0.01). Although there were no significant differences in the incidence of postoperative complication rate (36% vs 38%) and leakage rate (20% vs 16%), 1-year and 3-year overall survival rate were significantly better in MIE group (0.76 and 0.63, respectively (P = 0.01) as compared to open procedure (0.73 and 0.42, respectively) (P = 0.01). MIE was proven to be an independent factor for better prognosis in a Cox regression analysis.

Conclusion
Our minimally invasive Ivor-Lewis esophagectomy technique is feasible and might achieve better prognosis. Future research has to provide further evidence whether the method can minimize the risk and severity of postoperative complications including anastomotic leakages and improve survival.

Disclosure
All authors have declared no conflicts of interest.
PS02.020: ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION (SIEWERT I AND II): DOES TRANSHIATAL APPROACH SUFFICIENT FOR A STANDAND LYMPHADENECTOMY? A MULTIVARIABLE STUDY ANALYSIS
Authors: Takeda Flavio , Sallum Rubens , Ribeiro Jr Ulysses , Mariano Rocha Julio , Duarte Andre , Cecconello Ivan 
Published: September 2018

Abstract

Background
The surgical treatment of adenocarcinoma of the esophagogastric junction surgical treatment (AGEJ) is still controversial, particularly concerning to survival and postoperative complications. To compare thoracoscopic esophagectomy (group A) with transhiatal esophagectomy (group B) in patients with AGEJ in relation to the occurrence of complications and mortality; number of ressected lymph nodes, the positive and the ratio between the ressected and positive; overall and disease free survival; and survival after relapse.

Methods
There was a selection of 147 patients from 2000 to 2017. Epidemiological data were analyzed and compared between the groups. Postoperative complications were evaluated. The anatomopathological staging was evaluated, analyzing the resected lymph nodes. Analysis of overall survival, disease free survival and survival after relapse were made, besides multivariate analysis of survival related factors.

Results
In relation to the complications, group A presented greater occurrence of hoarseness and surgical infections. In relation to mortality, group A presented 2 cases (3.7%) and group B presented 4 (4.3%), without statistical difference. In group A, the average number of ressected lymph nodes was 31.88 and in group B was 20.73 (P < 0.001), however the average number of affected lymph nodes was 3.96 in group A and 4.25 in group B. The general overall survival was 42.3%, in group A was 38.9% and in group B was 47.6% (P = 0.298). In the multivariate analysis of overall survival only lymphatic invasion (P = 0.005), diabetes mellitus (P = 0.038) and surgical infection (p-0.001) were significant. However, in tumors with stage until 2B, group A overall survival was 80.4% and group B was 38.5% (P = 0.001).

Conclusion
Both methods are safe with similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a larger ressection in the number of lymph nodes. Overall survival and disease free survival are similar, however until stage 2B thoracoscopic esophagectomy improves overall survival. Diabetes and lymphatic invasion interfere in overall and disease free survival.

Disclosure
All authors have declared no conflicts of interest.
PS02.032: PRETREATMENT INFLAMMATORY STATUS INFLUENCES THE PROGNOSIS OF CT4B ESOPHAGEAL CARCINOMA PATIENTS UNDERGOING DEFINITIVE CHEMORADIOTHERAPY
Authors: Sugawara Kotaro , Yagi Koichi , Nishida Masato , Yamashita Hiroharu , Seto Yasuyuki 
Published: September 2018

Abstract

Background
The outcome of definitive chemoradiotherapy (dCRT) for patients with cT4b esophageal carcinoma (EC) remains poor. Also, few studies focused on the prognostic factors in cT4b EC patients undergoing dCRT.

Methods
80 patients undergoing dCRT for cT4b EC between 2006 and 2016 were retrospectively reviewed. All were in ECOG-PS 0–1. For evaluation of the pretreatment status, we employed demographic data, BMI, inflammatory marker (CRP), nutritional marker (Alb, prognostic nutritional index (PNI)) and tumor factors (clinical staging, pretreatment stenosis, tumor marker).

Results
There were 62 men with a mean age of 65 years (range, 41–83 years). 77 patients were squamous cell carcinoma, while 3 were adenocarcinoma. There were 12 (15%) patients with cM1 (lym) status. 36 (45.0%) patients had esophageal stenosis. 70 patients had cN + before dCRT, while 22 had cN + after dCRT. 30 patients (37.5%) had a CRP > 10 mg/l before dCRT, while 15 patients (18.8%) were in poor-nutritional status (PNI < 40). Of 80 patients, 1 patient gave up the treatment developing cerebral infarction. We analyzed survival in the 79 patients completing dCRT. Esophageal perforations were occurred in 5 (6.3%) patients. The 1- and 3-year overall survival rates were 59.8% and 38.3%, respectively. Salvage surgery was performed in 29 (36.3%) patients. R0 resection was achieved in 20 (69.0%) patients. Surgery-related death was developed in 3 patients. Pathological complete response was found in 10 (34.5%) patients. The 1- and 3-year overall survival rates of these 29 patients were 64.3% and 40.5%, respectively. Lastly, we evaluated prognostic factors in 79 patients. In univariable analysis, PNI < 40 (HR 2.43, 95% CI 1.19–4.63, P = 0.02), CRP ≥ 10 mg/l (HR 2.21, 95% CI 1.23–3.95, P = 0.01), pretreatment stenosis (HR 1.68, 95% CI 0.94–3.00, P = 0.08), cN + status after dCRT (HR 1.84, 95% CI 0.98–3.33, P = 0.06) were associated with poor prognosis. Subsequent multivariable Cox proportional hazards model revealed that CRP ≥ 10 mg/l (HR 2.00, 95% CI 1.03–3.81, P = 0.04) and cN + status after dCRT (HR 2.02, 95% CI 1.05–3.73, P = 0.03) were both independent risk factors for poor prognosis.

Conclusion
The outcome of dCRT for cT4b EC is acceptable. Pretreatment inflammatory status significantly influences the prognosis of patients undergoing dCRT.

Disclosure
All authors have declared no conflicts of interest.
PS02.041: VITAMIN D SIGNALING PATHWAYS CONFER THE SUSCEPTIBILITY OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Ji Aifang , Zhou Yang 
Published: September 2018

Abstract

Background
Experimental studies have determined the chemopreventive effects of vitamin D against theesophageal squamous cell carcinoma (ESCC); however, results from the epidemiological studies arenot yet well established. The current study aimed to evaluate the associations between plasmavitamin D levels and variants on vitamin D metabolic-related genes with the risks for ESCC.

Methods
A hospital-based case-control study was performed. 670 ESCC patients and 598 controls were recruited in a Northern Chinese population. The vitamin D levels in the plasma were determined with the ELISA detection kits provided by R&D Company and following the manufacturer's instructions. The coefficients of variation for the 25(OH)D levels between-assay and within-assay were less than 12.5%. Common variants on vitamin D metabolism-related genes CYP24A1, DHCR7, GC, CYP27B1, and vitamin D receptor (VDR) and theplasma 25(OH)D level were determined. The genomic DNA was extracted from the blood lymphocyte cells with the QIAamp DNA Mini Kit (Qiagen, Germany). The SNPs were genotyped using the GenomeLab SNPstream 12-plex Genotyping System (Beckman Coulter, Inc., Fullerton, CA) following the manufacturer's instructions. The unconditional logistic regression method was applied to determine the associations between the variants and vitamin D level and ESCC.

Results
we evaluated 6 common variants on genes related to vitamin D metabolism including DHCR7 (rs3829251), DBP (rs12512631 and rs115563), CYP24A1 (rs2296241), CYP27B1 (rs4646536) and VDR (rs11568820) and their association with ESCC risk. For rs2296241, rs11568820 and rs4646536, interaction analysis shows that higher the plasma 25(OH)D levels are associated with a decreased ESCC risk.For rs3829251, rs3829251 and rs1155563, the plasma 25(OH)D levels did not vary across genotypes for any of the polymorphisms. The variants rs2296241 on CYP24A1 and rs11568820 on VDR are significantly associated with ESCC cancer.

Conclusion
Vitamin D signaling pathways may participate in the ESCC development. Further studies with larger sample size are warranted to confirm the results. Intervention studies are needed to determine whether vitamin D supplementation may reduce the ESCC risk in the Chinese population.

Disclosure
All authors have declared no conflicts of interest.
PS02.052: AUTO-ANTIBODIES AGAINST TUMOR ANIGENS ARE USEFUL BIOMARKERS IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Shimada Hideaki , Yajima Satoshi , Oshima Yoko , Ito Masaaki , Nanami Tatsuki , Suzuki Takashi , Funahashi Kimihiko , Otsuka Seiko , Hoshino Isamu , Nabeya Yoshihiro 
Published: September 2018

Abstract

Background
Serum antibodies are induced even ata the eraly phase of carcinogenesis. Serum p53 antibodies (s-p53-Abs) have been developed and approved as routine blood test for monitoring esophageal squamous cell carcinoma (SCC). Recently, we have developed new ELISA systems to detect serum anti-IgG auto-antibodies against tumor antigens in patients with esophageal (SCC). In this paper, we focused on serum auto-antibodies against p53, NY-ESO-1, Galectin-1 and RalA.

Methods
Serum samples of patients with esophageal SCC were obtained before surgery. Serum anti-IgG antibodies against several tumor antigens were analyzed by newly developed ELISA systems. Target tumor antigens were p53, NY-ESO-1, Galectin-1 and RalA. Cut-off values were fixed using mean + 3SD of values of a total of 74 healthy controls. Changing pattern of serum p53 antibodies titers was also assessed during postoperative follow-up.

Results
Positive rates of serum antibodies were 18% for p53, 31% for NY-ESO-1, 10% for Galectin-1 and 9% for RalA. Positive rates of these antibodies in healthy controls were 0%. Combination assay improved positive rates without increased false positive rates as follows; p53 + NY-ESO-1 = 40%, p53 + NY-ESO-1 + Galectin-1 = 47%, p53 + NY-ESO-1 + Galectin-1 + RalA = 51%. Although some patients with extremely-high antibody titer for p53 persistently positive even after curative surgery, changing patterns of serum titers seemed to be associated with clinical outcome.

Conclusion
Although antibody titer of s-p53-Abs seemed to be associated with tumor burden, the titer gradually decresed at the last several months of the terminal stage. Such independent changing pattern of serum autoantibodies may have adding information to conventinal serum markers. We have developed new ELISA system to detect serum autoantibodies for patients with esophageal SCC. Although the positive rates of single serum auto-antibody were still relatively low, combination assay with plural auto-antibodies may be useful.

Disclosure
All authors have declared no conflicts of interest.
PS02.058: EXTENSIVE ANALYSIS OF IMMUNECHECKPOINT RECEPTORS AND TUMOR INFILTRATING T-CELLS WITH RESPECT TO THEIR PROGNOSTIC RELEVANCE IN ESOPHAGEAL ADENOCARCINOMA
Authors: Gebauer Florian , Loeser Heike , Fuchs Hans , Leers Jessica , Schroeder Wolfgang , Quaas Alexander , Bruns Christiane 
Published: September 2018

Abstract

Background
Immunotherapy has grown to a rapidly advancing sphere of research on modern strategies for treatment of cancer. A well-known way of immunomodulation is the principle of immune checkpoints leading to a down-regulated immune response in tumor microenvironment. Recently, beside the PD1/PD-L1 pathway, several immunecheckpoint pathways have been found. However, almost nothing is known about the expression and the correlation as prognostic factor in esophageal adenocarcinoma.

Methods
Two tissue micro arrays (TMA) were construced, a multi-spot TMA with up to 8 spots from different tumor areas of 165 patients and a valdiation single-spot TMA of 620 patients with EAC. Immunehistochemistry analysis were performed for LAG3, Tim3, IDO, VISTA, MHC1, MHC2, CD3, CD8, CD20 and CD38 and correlated with clinico-pathological and survival data. Data were additionally correlated with molecular data like TP53 mutational and HER2-neu status.

Results
LAG3 was detectable in 13.5% of all tumors, VISTA in 40.2%, IDO in 57.9%, Tim3 in 36.3%. There was only minor intratumoral heterogeneity between the luminal and infiltration area of the tumor for all analyzed immunecheckpoints. LAG3 and VISTA expression on tumor infiltrating T-cells (TIL) was associated with superior overall-survival compared to LAG3 and VISTA negative tumors. In pT1/2 tumors, VISTA was found as excellent independent prognosticator identifiying long-term surivors in case of VISTA expression. High amount of CD3 positive TILs was also associated with a better OS than CD3 poor tumors.

Conclusion
We conducted an extensive analysis of the immunecheckpoint status and presecnce of TILs in EAC. To the best of our knowledge, this is the first report in a large patients cohort correlating the expression of LAG3, Tim3, IDO and VISTA in EAC. The prognostic impact of LAG3 and VISTA expression suggests potential promising targets for novel immune checkpoint inhibition therapies beyond the PD1/PD-L1 inhibition as it is already established in head and neck cancer and NSCLC.

Disclosure
All authors have declared no conflicts of interest.
PS02.059: ENHANCED EXPRESSION OF NT5E IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kataoka Atsuko , Yamada Kazuhiko , Sugimoto Takayuki , Hagiwara Teruki , Nohara Kyoko , Soma Daisuke , Yamashita Satoshi , Dohi Taeko , Kawamura Yuki I 
Published: September 2018

Abstract

Background
Epigenetic changes such as DNA methylation are involved in the onset of ESCC. Previously, we have conducted transcriptome and methylome analyses using a paired specimen of ESCC and adjacent non-cancerous tissues and found promotor hypomethylation of NT5E with altered gene expression level in ESCC. NT5E has been known to be an extracellular nucleoside metabolism-related enzyme; however, the significance of its expression in ESCC has never been clarified. In this study, we aimed to evaluate the ESCC-related alteration of the expression of NT5E in using many cases of ESCC.

Methods
Formalin-fixed, paraffin-embedded sections of surgical specimens from 67 ESCC patients who had undergone esophagectomy or endoscopic submucosal dissection between April 2008 and December 2015 in our hospital were immunostained using anti-NT5E antibody, and classified into NT5E-negative and NE5E-positive groups. To evaluate the mRNA expression of NT5E, qRT-PCR was performed using paired normal and ESCC frozen tissue samples from 24 patients.

Results
Compared with matched normal mucosa, cancer tissues showed significantly higher NT5E mRNA expression (P < 0.05). Histologically, normal esophageal mucosa showed almost no staining of NT5E. Contrastingly, NT5E expression was clearly detected in 34 of 67 ESCC specimens (50.7%). There is no significant difference in clinicopathological factors between NT5E-positive and NT5E-negative groups.

Conclusion
NT5E gene and protein expression was both upregulated in ESCC; its functional significance in relation to malignancy is underinvestigation.

Disclosure
All authors have declared no conflicts of interest.