bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.204: ANASTOMOTIC LEAKS AFTER IVOR-LEWIS ESOPHAGECTOMY: INDOCYANINE GREEN NEAR-INFRERED ANGIOGRAPHY FOR GASTRIC CONDUIT BLOOD SUPPLY EVALUATION
Authors: Parise Paolo , Cossu Andrea , Garutti Leonardo , Puccetti Francesco , Elmore Ugo , Rosati Riccardo 
Published: September 2018

Abstract

Background
Indocyanine Green—Angiography (ICG-A) has been recently introduced for visceral perfusion evaluation. Aim of this study is to assess whether the intraoperative use of ICG-A can improve the evaluation of blood supply of the gastric conduit in Ivor-Lewis esophagectomy for cancer.

Methods
This is an interim analysis of a prospective interventional study ongoing at our Institution, on 160 Ivor-Lewis esophagectomy patients. After an intravenous bolus of ICG during the abdominal and thoracic stage, the gastric conduit perfusion was evaluated by means of a near infrared ICG-A and graded as ‘well’, ‘hypo-perfused’ or ‘ischemic’. If present, the ischemic or hypo-perfused area was resected. Demographic and clinical parameters and others, such as conduit perfusion speed, intra or post-operative hypotensive episodes have been analyzed.

Results
Currently 26 patients have been enrolled. An anastomotic leak of any grade was identified in 7 patients. Patients were divided in Group A (7 patients) who developed a leak and Group B (19 patients) who do not. No statistically significant differences were evidenced on demographic and preoperative clinical features, except for higher cigarette smoking history incidence in Group A. Those who developed a leak had an ‘hypo-perfused’ conduit at ICG-A in 71.4% and those who do not in only 15.8% (p 0.014). Median time from ICG injection to appearance of fluorescence at the basis of the gastric conduit was significantly longer in Group A than in Group B, 36 sec. (32–43.5) vs 28 sec. (20–39.8) (p 0.04) but median gastric conduit perfusion speed was similar. Patients in Group B had a higher median width of the conduit than Group A, 5cm (5.0–6.0) vs 4 (4.0–5.0) (p 0.032). Post-operative prolonged hypotensive episodes were seen more frequently in Group A than Group B (p 0.028). No differences were evidenced in terms of fluids infusions, blood loss, conduit length or intraoperative hypotensive episodes.

Conclusion
Preliminary results seem to show the usefulness of ICG-A in identifying patients at risk of leakage. Nevertheless no reduction of leakage incidence was induced by surgical strategy modification, probably because post-operative events may affect clinical course too. Definitive data have to be awaited.

Disclosure
All authors have declared no conflicts of interest.
PS01.210: VIDEO-ASSISTED SALVAGE ESOPHAGECTOMY: SHORT- AND LONG-TERM OUTCOMES
Authors: Shichinohe Toshiaki , Murakami Soichi , Ebihara Yuma , Kurashima Yo , Hirano Satoshi 
Published: September 2018

Abstract

Background
Salvage surgery is only one therapeutic option which enable to cure intractable esophageal cancer after definitive chemo-radiotherapy. Although video-assisted esophagectomy (VAE) is now widely accepted as a standard operation for primary esophageal cancer, the application of VAE to salvage surgery is still controversial since salvage surgery is known as high-risk operation. In this study, we investigated 27 cases of salvage surgery and assessed the feasibility of the operation by analyzing their short and long-term outcomes.

Methods
VAE was applied to 26 cases and laparoscopic lymphadenectomy was applied to 1 case. The procedure of the VAE included prone position esophagectomy (n = 8), esophagectomy by hand-assisted thoracoscopic surgery (n = 10) and mediastinoscope-assisted transhiatal esophagectomy (n = 5). Our current operative procedure after year 2010 is PPE. The fields of lymph node dissection for salvage esophagectomy have been limited to the stations that had metastasis before CRT and the lymphatic stations which newly recognized as suspected metastasis. Postoperative complications were defined according to the Clavien-Dindo classification.

Results
Video assisted surgery was applied to 96% of patients including one case of laparoscopic abdominal lymphadenectomy. One case required open surgery for suspicious of direct invasion of tumor. R0 rate of the operations was scored 78%. Postoperative complication rate defined as ≥ C-D II plus any grade of anastomotic leakage and recurrent laryngeal nerve palsy was 63%. The rate of anastomotic leakage, respiratory complication, and RLN palsy were 23%, 15%, and 12%, respectively. Operative death was 0%, whereas in-hospital mortality was 3.7%. Overall survival of esophagectomy cases showed 24% in 3-year and 8% in 5-year. According to subgroup analysis by pathological R status after operation, the survival outcomes of pR0 group (n = 20) reached 32% in 3-year and 10% in 5-year OS, whereas no patient reached 3-year survival in pR1/2 group (n = 6; P = 0.02).

Conclusion
Although salvage VAE should be applied in high-experienced institutions under the careful consideration of indication, it appears to be balanced operation for safety, and less invasiveness, as well as curability.

Disclosure
All authors have declared no conflicts of interest.
PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION
Authors: Shanmuganathan Kanatheepan , Akitikori Temisanren , Soile Oluwasunmisola , Hussain Aadil , Farhangmehr Neda , Sdralis Elias , Lorenzi Bruno , Charalabopoulos Alexandros 
Published: September 2018

Abstract

Background
Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis.

Methods
A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04.

Results
Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis.

Conclusion
In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures.

Disclosure
All authors have declared no conflicts of interest.
PS01.214: METASTATIC YIELD OF SUPERIOR MEDIASTINAL LYMPHADENECTOMY AND ASSOCIATION WITH PET IN INTRATHORACIC OESOPHAGEAL CARCINOMA TREATED WITH MINIMALLY INVASIVE OESOPHAGECTOMY
Authors: Hussain Aadil , Shanmuganathan Kanatheepan , Akitikori Temisanren , Soile Oluwasunmisola , Farhangmehr Neda , Lorenzi Bruno , Charalabopoulos Alexandros 
Published: September 2018

Abstract

Background
Lymph node status in oesophageal carcinoma is an important prognostic factor and predictor of survival. However, specific metastatic distribution patterns, especially for superior mediastinal lymph nodes, are not defined; they may be dependent on tumour location, histology and use of neoadjuvant treatment. Consensus for an optimal surgical strategy with regards to superior mediastinal lymphadenectomy (SML) has therefore not been formed. We aim to assess the metastatic yield of superior mediastinal nodes in intra-thoracic oesophageal cancer while correlating results with preoperative PET-CT.

Methods
Data from 39 consecutive 2-stage and 3-stage fully Minimally Invasive Oesophagectomies (MIO) performed by a single surgical team for intra-thoracic oesophageal or gastro-oesophageal junction carcinoma (Siewert I/II) between September 2016 and December 2017 were analysed. In n = 7 (18%), SML was performed. Of these n = 1 was for mid-oesophageal adenocarcinoma (ACA) and n = 6 were for squamous cell carcinoma (SCC) (5 for mid-oesophageal and 1 for distal oesophageal, which had a 2-stage procedure). Histological superior mediastinal nodal analysis was correlated with pre-operative PET-CT.

Results
Median total lymph node count was 45 (IQR, 37–68), with median SML count of 8 (IQR, 5–22). Of 7 SML’s, n = 1 (14.2%) revealed metastasis in 1/5 right paratracheal nodes. The patient had 3-stage MIO with no neo-adjuvant treatment for mid-oesophageal SCC. Final staging was pT3N2(6/45)M0. Preoperative PET-CT showed low avidity in right paratracheal nodes. Of the rest, 5 had negative PET-CT and 1 showed PET-positive paratracheal nodes, not confirmed histologically. The latter patient had neoadjuvant chemoradiotherapy for distal oesophageal ACA.

Conclusion
Although a small sample-sized study it demonstrates that PET-CT has a role in identifying metastatic superior mediastinal nodes. It can aid in the decision of resecting avid nodes but it should be born in mind that PET could have false positive results due to surrounding inflammation not uncommonly found in the lungs. False positivity (not confirmed histologically) may be also attributed to complete pathological lymph node response post neo-adjuvant treatment. SML’s role is not as clear in distal oesophageal/GOJ cancer compared to mid-oesophageal, but PET-CT seems a useful adjunct. In the West, SML shows a low metastatic yield for intra-thoracic oesophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.217: COMPARISON OF THE SHORT-TERM OUTCOMES OF LATERAL POSITIONING AND PRONE POSITIONING DURING THORACOSCOPIC ESOPHAGECTOMY
Authors: Kishino Takayoshi , Ando Yasuhisa , Suto Hironobu , Asano Eisuke , Oshima Minoru , Fujiwara Masao , Okano Keiichi , Usuki Hisashi , Suzuki Yasuyuki 
Published: September 2018

Abstract

Background
Video-assisted thoracoscopic esophagectomy (VATS-E) for esophageal cancer is being performed at an increasing number of institutions. In our institute, at first, we had performed VATS-E in the left lateral position without pneumothorax. But, we introduced VATS-E in the prone position with pneumothorax, because of difficulty of visual development for a surgical site by assistant. This study aimed to compare the two methods and to clarify the advantage in the prone position.

Methods
Thirty-one patients who underwent VATS-E at the Department of Gastroenterological Surgery, Kagawa University, from August 2013 to January 2018 were divided into two groups by the patient position. For the first 17 patients, we used the left lateral position (Group L); for the next 14 patients, we used the prone position (Group P). We compared the short-term outcomes in these two approaches.

Results
There were no significant differences in the most operative factors; duration of the thoracoscopic esophagectomy (354 min. in Group L and 309 min. in Group P, P = 0.153), operative hemorrhage (421 ml in Group L and 228ml in Group P, P = 0.054), infusion volume (8.8 ml/kg/hr. in Group L and 8.2ml/kg/hr. in Group P, P = 0.415), urinary volume (2.3 ml/kg/hr. in Group L and 1.7ml/kg/hr. in Group P, P = 0.202). However, C-reactive protein (CRP) level in post-operative day 3 (17.2 in Group L and 13.8 in Group P, P = 0.046) and procalcitonin (PCT) level in post-operative day 3 (1.8 in Group L and 0.3 in Group P, P = 0.049) was significantly lesser in Group P. And, Period until ambulation (4.0 days in Group L and 1.3 days in Group P, P < 0.001) was significantly shorter in Group P.

Conclusion
In conclusion, VATS-E in the prone position is lesser invasive and faster recovery than in the left lateral position.

Disclosure
All authors have declared no conflicts of interest.
PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER
Authors: Lin Yidan , Deng Hanyu 
Published: September 2018

Abstract

Background
Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center.

Methods
Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis.

Results
The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups.

Conclusion
RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions.

Disclosure
All authors have declared no conflicts of interest.
PS01.221: IMPROVED TECHNIQUES AND TREATMENT OUTCOMES IN SINGLE-PORT MEDIASTINOSCOPIC RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Fujiwara Hitoshi , Shiozaki Atsushi , Konishi Hirotaka , Kosuga Toshiyuki , Kubota Takeshi , Okamoto Kazuma , Otsuji Eigo 
Published: September 2018

Abstract

Background
We have improved the transcervical procedures for radical esophagectomy without thoracotomy for esophageal cancer since 2014, based on the excellent handling and visibility in the deep mediastinum provided by single-port mediastinoscopic technique. This study was to present our latest procedures of single-port mediastinoscopic radical esophagectomy and treatment outcomes for esophageal cancer.

Methods
(Surgical procedure) First, en bloc lymphadenectomy in the upper and middle mediastinum was performed including the lymph nodes along the left recurrent laryngeal nerve and tracheal bifurcation (subcarinal and bilateral main bronchial lymph nodes) by using a left cervical approach with a single-port mediastinoscopic technique, then, the lymph nodes along the right recurrent laryngeal nerve was done under direct vision by using a right cervical approach. Following the cervical procedures, the esophagus was completely mobilized with en bloc lymphadenectomy in the lower mediastinum by using a laparoscopic transhiatal approach. Finally, the cervical esophagus was transected, and the esophagus was resected through the abdominal incision. This operation was indicated not only for the patients with clinical T1–2 tumors, but also for those with clinical T3 tumors which showed a good response to preoperative chemotherapy. The perioperative outcomes of 111 patients who underwent this operation were reviewed. In addition, overall survival was analyzed and compared between transthoracic and transmediastinal esophagectomy groups (TTE, n = 177 vs. TME, n = 131).

Results
The background characteristics were as follows; squamous/adeno, 106/5; Ce/Ut/Mt/Lt/Ae, 2/20/58/26/5; cT1–2/T3, 51/60; cN0/N1–2, 53/58; cM0/M1lym, 104/7; cStage I-II/III-IV, 62/49 (TNM7th); preoperative chemotherapy (yes/no), 64/47. The operation time and blood loss were 370 min and 205 ml (median), respectively, and R0 resection rates were 97.3%. Postoperatively, pneumonia was observed in 8 patients (7.2%, C-D grade II or more), while vocal cord palsy was detected in 33 patients (29.7%, C-D grade I or more). Recent introduction of intraoperative nerve monitoring with NIM response 3.0 significantly reduced the palsy in laryngoscopic findings. Overall survival was not significantly different in each clinical stage between TTE and TME groups.

Conclusion
Single-port mediastinoscopic esophagectomy is feasible as a radical and minimally invasive option for esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.225: SINGLE HOLE PNEUMOPERITONEUM COMBINED WITH LAPAROSCOPIC RADICAL MASTECTOMY FOR ESOPHAGEAL CANCER
Authors: Tang Hua , Huang Kenan , Ding Xinyu , Wu Bin , Xu Zhifei 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.

Methods
Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications.

Results
No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage.

Conclusion
A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.227: THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE
Authors: Cossu Andrea , Parise Paolo , Puccetti Francesco , Garutti Leonardo , Ferrari Carlo , Elmore Ugo , Rosati Riccardo 
Published: September 2018

Abstract

Background
Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age.

Methods
A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥ 71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD).

Results
As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. P = 0.001), mortality (0% group A, 3% group B and 5.5% group C. P = 0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. P = 0.001). A statistically significant higher incidence of anastomotic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-groups.

Conclusion
Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.228: THORAX AFFECTS OPERATION TIME IN VATS ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER
Authors: Takeno Shinsuke , Kawano Fumiaki , Tashiro Kousei , Hamada Rouko , Wada Takashi , Tanoue Yukinori , Nanashima Atsushi 
Published: September 2018

Abstract

Background
Thoracoscopic esophagectomy (TE) was reported that increased morbidity in the National Clinical Data analysis in Japan and technical proficiency is required as the esophageal surgery team. The aim of this study is to assess the degree of surgical difficulty from operation time and to applicate for esophageal surgery team-building and the education of next-generation.

Methods
Consecutive initial 33 cases by the same operator was statistically examined concerning the correlation between chest operation time and the empirical effect of the time shortening, BMI, obstructive pulmonary disorders, Rib cage area, tumor progression, preoperative treatment as an indicator of the degree of surgical difficulty. Rib cage area measured in the preoperative CT Imaging.

Results
As the factors affecting the extension of operating time, the narrower upper rib cage area correlated with the prolonged operation time in the univariate (P = 0.0279) and multivariate (P = 0.0125) analysis. Empirical time reduction (P = 0.0429) also was correlated with chest operation time. In addition, there was a significant correlation between chest operation time and blood loss (P = 0.0007).

Conclusion
In the training of TE, operating surgeon or first assistant should start from the patient with broad upper rib cage area in chest CT.

Disclosure
All authors have declared no conflicts of interest.