bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.128: A PROPENSITY SCORE-MATCHED ANALYSIS OF CLINICAL SIGNIFICANCE OF THE SUPRACLAVICULAR LYMPHADENECTOMY FOR SQUAMOUS CELL CARCINOMA LOCATED IN MIDDLE THORACIC ESOPHAGUS
Authors: Tsunoda Shigeru , Obama Kazutaka , Hisamori Shigeo , Hashimoto Kyoichi , Itatani Yoshiro , Tashiro Naohiro , Nishigori Tatsuto , Sakai Yoshiharu 
Published: September 2018

Abstract

Background
Supraclavicular lymph nodes (No 104) were upgraded from group 3 to group 2, which needs to be dissected in D2 surgery, for tumors located in middle thoracic esophagus in the 11th edition of Japanese classification of esophageal cancer. However, it is not based on prospective study and the evidence level remains moderate. Current evidence regarding supraclavicular lymphadenectomy is mainly based on retrospective cohort study of efficacy index without proper control. The aim of this study is to retrospectively investigate the clinical impact of supraclavicular lymphadenectomy for middle esophageal cancer.

Methods
A total of 240 consecutive patients who underwent R0 esophageal resection for clinical Stage I, II, III (UICC 8th) primary esophageal squamous cell carcinoma from 2005 to 2017 in Kyoto University Hospital were investigated. Patients who underwent salvage surgery after definitive chemoradiotherapy were excluded. Among them, 99 patients had middle esophageal cancer. All patients underwent at least abdominal and mediastinal lymphadenectomy including cervical paraesophageal (No 101) and paratracheal (No 106rec) nodes. After propensity score matching, 42 patients (21 each for with (3F) and without (2F) supraclavicular lymphadenectomy) were selected for comparison.

Results
In the propensity-matched population (n = 42), the 5-year overall survival of clinical Stage I (n = 15)/II (n = 9)/III (n = 18) was 100%/52%/57%. Though cStage, neoadjuvant therapy, ASA-PS and date of surgery (early, middle and late period) were well matched, the 5-year overall survival in 2F and 3F were 82% and 68%. The hazard ratio (3F/2F) for overall death was 2.6 (95% CI, 0.79–9.97; P = 0.1178). In terms of short term outcomes, postoperative morbidity graded as Clavien-Dindo grade 2 or higher was 48% in the both group, while respiratory complication (Clavien-Dindo grade 2 or higher) was 14% in 2F and 29% in 3F, respectively. The odds ratio was 2.4 (95% CI, 0.51–11.3; P = 0.2593).

Conclusion
This observational study failed to show any clinical benefit of supraclavicular lymphadenectomy. Given the nature of retrospective study, there might be overlooked confounding factors to select 2F or 3F. Further prospective study is warranted.

Disclosure
All authors have declared no conflicts of interest.
PS01.133: ISCHEMIC CONDITIONING OF THE STOMACH PRIOR TO ESOPHAGECTOMY: TIMING AND TECHNIQUE MATTER
Authors: Carrott Philip , Shih Terry , Reddy Rishi , Erickson Crystal , Lagisetty Kiran , Lin Jules 
Published: September 2018

Abstract

Description
This video highlights one method of gastric ischemic conditioning prior to esophagectomy. Multiple reports of ischemic conditioning have not shown benefit, but these studies generally had a short time of ischemia (7–14 days), and did not have a consistent method of conditioning that includes both short gastric and left gastric vessels. Animal data shows that 30 days is likely the minimum timing needed for development of collateral blood flow through the body of the stomach. We have treated 13 patients with between 35 and 180 days of ischemic conditioning prior to esophagectomy, and none of these patients developed a leak, with only one requiring dilation of a benign anastomotic stricture. In these patients, 5 patients underwent a concominant feeding jejunostomy. In our experience, ligation of the arterial and venous blood supply is important, as is ligation of both short gastric and left gastric vessels. If the left gastric vessels cannot be seen, lesser curvature perforating vessels high on the proximal stomach may be ligated as well. We prefer to use the laparoscopic clips to ligate these vessels, while some groups use energy devices to divide the short gastric vessels and clips to occlude the left gastric vessels. This keeps the subsequent adhesive disease to a minimum, which is likely the major barrier to longer conditioning time. Indeed, the ideal timing of the ischemic conditioning procedure is prior to starting chemo-radio-therapy, giving 100 days or more of conditioning time. The video outlines a laparoscopic procedure that we feel is optimum for ischemic conditioning of the stomach. We believe this method has cracked the code of a very morbid procedure and made it into a slightly morbid procedure, which can still have complications, but the anastomotic complications are much less severe with improved perfusion to the gastric conduit. Leaks are less frequent and less severe, and symptomatic strictures are fewer in number. Future work in this area should focus on ischemic conditioning timing, as well as cancer-specific outcomes related to the conditioning procedure.

Disclosure
All authors have declared no conflicts of interest.
PS01.136: POSTOPERATIVE OUTCOMES OF THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT ACCORDING TO THE PLATFORM OF THE ESOPHAGEAL COMPLICATIONS CONSENSUS GROUP
Authors: Van Der Werf Leonie , Busweiler Linde , Van Sandick Johanna , Van Berge Henegouwen Mark I , Wijnhoven Bas P L 
Published: September 2018

Abstract

Background
To standardize outcome reporting in esophageal surgery, the Esophageal Complications Consensus Group (ECCG) developed a standardized platform. Recently, this group published outcomes of 2704 patients that underwent an esophagectomyin 24 high-volume hospitals in the period 2015–2016. The aim of this study was to report postoperative morbidity and mortality in the Netherlands using the definitions of the ECCG.

Methods
All patients who underwent esophagectomy for cancer of the esophagus or esophagogastric junction in the Netherlands in 2016 were selected from the Dutch Upper gastrointestinal Cancer Audit (DUCA). Patient outcomes including postoperative complications, 30-day/in-hospital mortality readmission rate were reported according to the definitions of the ECCG platform (Low et al. Ann Surg 2017). Outcomes of the DUCA were compared with the recently published outcomes of the ECCG with Chi-square analysis.

Results
Some 797 patients were included from 22 hospitals. In 1 patient, the postoperative outcome was unkown. In 17 patients readmission status was unknown. Some 168 (21%) patients had an ASA score of ≥ III and 250 (31%) patients a Charlson comorbidity score of ≥ 2. In total, 498 patients (63%) had at least one postoperative complication (versus ECCG: 57%, P = 0.07). The most common complications were pneumonia (21% DUCA versus 15% ECCG, P < 0.01), anastomotic/staple-line failure or localized conduit necrosis (18% DUCA versus 11% ECCG, P < 0.01) and atrial dysrhythmia requiring treatment (13% DUCA versus 15% ECCG, P = 0.28). Readmissions occurred in 105 of 780 patients (13% DUCA versus 11% ECCG, P = 0.13). The 30-day/in-hospital mortality was 2.5% for the DUCA group and 2.4% for the ECCG group (P = 0.88).

Conclusion
The registration of complications according to the ECCG platform in the national audit promotes the use of uniform definitions and allows international comparison of outcomes. The overall complication rate, readmission rate and mortality in the Netherlands were comparable with the outcomes of the ECGG. However, anastomotic leakage and pneumonia were more frequently reported in the Netherlands.

Disclosure
All authors have declared no conflicts of interest.
PS01.139: THE CLINIC DIAGNOSIS AND TREATMENT OF PRIMARY ESOPHAGEAL ADENOCARCINOMA: ANALYSIS OF 63 CASES
Authors: Wei Jin-Chang , Jiao Gen , Song Xiang , Wang Qing , Song He , Song Wei , Wang Peng , Li Lin , Li Yu , Xu Feng 
Published: September 2018

Abstract

Background
To summarize the clinic and pathological characteristics of the primary esophageal adenocarcinoma and to discuss the reasonable diagnosis and treatment, further improve the curative effect.

Methods
The clinical data and therapeutic effect of 63 cases of esophageal adenocarcinoma treated from February 1995 to December 2011 in our department were analyzed retrospectively.

Results
There were 63 cases of primary esophageal adenocarcinoma, accounting for 0.66% (63/9608) of esophageal malignant tumors. There were 47 males and 16 females, with a ratio of 4. 4: 1, which was higher than that of esophageal squamous cell carcinoma (1.8: 1) in same period. There are no special characteristics in clinic syndrome and imaging. There were 12 cases of adenocarcinoma located in the middle thoracic segment of esophagus (19 cases) and 51 cases of lower thoracic segment of esophagus (81 cases), which were significantly different from predilection site of esophageal squamous cell carcinoma. TNM staging included 3 patients with stage I and 16 patients with stage II b. There were 23 patients with stage III and 4 patients with stage Ia. There were 32 cases of medullary type, 9 cases of mushroom type, 19 cases of ulcer type and 3 cases of constriction type. The pathological types were simple adenocarcinoma in 22 cases (34.9%), adenosquamous carcinoma in 27 cases (42.9%), adeno-Spina carcinoma in 14 cases (22.2%). All patients underwent partial esophagogastrostomy and esophagogastrostomy. 51 cases above aortic arch, 12cases below aortic arch. The resection rate was 100%, radical resection was 93.7% in 59 cases, palliative resection in 4 cases (6.3%), and positive stump in 2 cases (3.2%). The lymph node metastasis rate was 65.1% (41/63), higher than that of 31.6% esophageal squamous cell carcinoma in same period. There was no operative death in this group. The 1-year, 3-year, 5-year survival rates were 81.4%, 46.2% and 27.8% respectively, which was lower than synchronizational ESCC (89.7%, 68.2%, 38.6%).

Conclusion
Primary esophageal adenocarcinoma is a rare esophageal malignant tumor with high malignancy, strong invasion and high lymph node metastasis. It is important to pay attention to early diagnosis and treatment, mainly by surgical operation and adjuvant chemotherapy after operation to improve its long-term effect.

Disclosure
All authors have declared no conflicts of interest.
PS01.144: LYMPH NODE YIELDS AFTER ESOPHAGECTOMY: IMPACT OF APPROACH TO SURGERY AND USE OF NEOADJUVANT THERAPIES
Authors: Marwah Anindita , Perez Castro Pablo , Carroll Paul , De Perrot Marc , Keshavjee Shaf , Waddell Thomas , Pierre Andrew , Ringash Jolie , Elimova Elena , Darling Gail , Yeung Jonathan 
Published: September 2018

Abstract

Background
Although the importance of lymph node (LN) harvest for the adequate staging of esophageal cancer has been well studied, lymph node yields in the literature remain highly variable. Moreover, the effect of modern treatments of esophageal cancer such as induction therapy and minimally invasive approaches on lymph node yield is incompletely understood.

Methods
A retrospective review of 307 patients who underwent esophagectomy for esophageal cancer between 2005–2013 at Toronto General Hospital was conducted. Early in this experience, thoracoabdominal, transhiatal, Ivor Lewis and Mckeown approaches were utilized with transition over time to fully minimally invasive Ivor Lewis and Mckeown operations. Induction chemoradiotherapy is now our standard for locally advanced esophageal cancer. Demographics, histology, type and approach to esophagectomy, use of induction therapy, lymph node yield, and number of positive lymph nodes were collected. Kruskal-Wallis test was utilized for significance between groups.

Results
Our population comprised of 239 (78%) males and 68 (22%) females. Adenocarcinoma was the predominant histology at 220 (72%) with 78 (25%) squamous cell carcinoma and 9 (3%) as other histology. 144 (47%) patients had surgery alone, 147 (48%) had induction chemoradiotherapy, and 16 (5%) had induction chemotherapy. The open approach was used in 178 (58%), hybrid minimally-invasive in 33 (11%), fully minimally-invasive in 58 (19%), and transhiatal in 38 (12%). Overall, a median of 24 [IQR17–33; min 3, max 92] nodes were obtained. Induction therapy did not lower our yield (no induction 23[16–32], induction chemotherapy 32.5[17–47], induction chemoradiotherapy 25[19–33], P = 0.07). Transition to a minimally invasive approach similarly did not lower our yield, with only the transhiatal approach showing lower lymph node yield (open 26[17–33], hybrid 33[23–39], fully minimally-invasive 25[19–36], transhiatal 16[11–22], P = 0.005).

Conclusion
Lymph node yields above 20 can be routinely achieved for adequate staging. Despite the increasing use of induction therapy and minimally-invasive approaches, similar lymph node yields can and should be achieved.

Disclosure
All authors have declared no conflicts of interest.
PS01.147: BODY MASS INDEX AND PERIOPERATIVE OUTCOMES AFTER ESOPHAGECTOMY: THORACOABDOMINAL APPROACH HAS EQUIVALENT RESULTS AS MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Kroese Tiuri , Sachdeva Uma , Morse Christopher 
Published: September 2018

Abstract

Background
A thoracoabdominal approach to esophagectomy provides excellent exposure to the lower esophagus and gastroesophageal junction, particularly in obese patients and in patients with prior chest or abdominal surgery. However, thoracoabdominal esophagectomy (TE) has been associated with higher rates of perioperative complications and limits to the extent of resection, which may have oncologic consequences. Selectively approaching most obese or re-operative patients with esophageal cancer following neoadjuvant therapy through an open thoracoabdominal incision, the aim of this study was to compare perioperative complications and short-term oncologic outcomes of TE with minimally invasive Ivor-Lewis esophagectomy (MIE).

Methods
All esophageal cancer patients who underwent neoadjuvant treatment followed by MIE or TE with curative intent at a tertiary referral center between 2008 and 2017 were identified using a prospectively maintained database. Primary outcomes were oncological adequacy, including extent of lymph node resection and R0 resection rates, and perioperative complications including pneumonia, anastomotic leakage and chylothorax. Secondary outcomes included length of stay and readmission rates.

Results
A total of 171 patients were included, of whom 139 patients underwent MIE and 32 patients TE. Patients who underwent TE had a significantly higher body mass index (BMI) (mean 30.6 vs 26.5, P = 0.001) and were more likely to have relevant surgical history (56% vs 1%, P = 0.001). R0 resection rates were the same regardless of operative approach. Pathologic N-stage was the same between groups, though total lymph node yield was higher with MIE (mean 15 vs 20, P = 0.006). The rate of postoperative complications was not increased with TE. Median length of stay was one day longer in the TE group (P = 0.007).

Conclusion
In patients with esophageal cancer, resection is often more challenging in the setting of obesity or prior surgery, particularly in patients treated with neoadjuvant therapy. By selectively employing a thoracoabdominal approach in these difficult cases equivalent oncologic outcomes can be achieved, with no significant increase in postoperative complications, as compared with MIE. This study demonstrates that patient-specific selection in surgical approach can lead to comparable postoperative results. Further studies are warranted to evaluate effects on long-term outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.149: APPLICATION OF SINGLE-PORT VIDEO-ASSISTED THORACOSCOPE IN TREATING THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA USING MCKEOWN APPROACH
Authors: Lv Qiang 
Published: September 2018

Abstract

Background
This study aims to investigate the feasibility of single-port video-assisted thoracoscope (SPVATS) in treating thoracic esophageal squamous cell carcinoma (TESCC) using McKeown approach.

Methods
METHODS: 25 McKeown approach-based SPVATS surgeries (19 males and 6 females, aged 42–70years) were carried out from January 2015 to December 2017 to treat TESCC.

Results
RESULTS: All the patients were successfully completed SPVATS, with average thoracic surgery time as 150 min, intraoperative blood loss as 30–260 ml (average 90 ml), and postoperative hospital stay as 9–16d (average 12d).

Conclusion
SPVATS was technically feasible and safe in treating TESCC using McKeown approach, with less trauma and rapid postoperative recovery, so it could be used as a new surgical option for McKeown approach-based TESCC treatment.

Disclosure
All authors have declared no conflicts of interest.
PS01.150: NEW METHOD OF ESOPHAGO-GASTRO ANASTOMOSIS AFTER ESOPHAGECTOMY
Authors: Usenko Oleksandr , Sydiuk Andrii , Mazur Andriy , Klimas Andrii , Sydiuk Olena 
Published: September 2018

Abstract

Background
Medical science has introduced a lot of innovations and advanced equipment since the first esophagectomy was performed, nevertheless surgeons still continue to discuss benefits of certain methods and suggest changes to them because mortality and post-operative complications after esophagus resection remain high. The choice of the surgical approach, anastomosis location and its variety, conduit location and its variety, the volume of lymph node dissection and the use of minimally invasive present the most important and complex issues for surgeons.

Methods
The research included 40 patients who were given Lewis surgery for malignant tumors of esophagus in Shalimov's National Institute of Surgery and Transplantation: Control group comprised 20 patients who were given Lewis surgery involving end-to-side classical mechanical EGA through a circular suturing tool.; Research group comprised 20 patients who were given Lewis surgery involving invaginated mechanical EGA. (image 1).
The objects for estimation included post-operative mortality as well as the number of post-operative anastomosis complications: the number of EGA leakages in the early post-operative period and the number of post operative strictures in the EGA area three months after the surgery. Data processing was done by means of Statistic—licensed application programs for Windows. Differences were considered valid if р < 0,05.

Results
Research group did not register a single case of EGA leakage while one patient in control group (р < 0,05). had the leakage which was stopped by means of ‘Endovac’ system. There were 2 cases of esophagus post-operative strictures which developed 3 months after the surgery in the research group which was less than in the control group which saw 6 cases of strictures of EGA (р < 0,05). Neither of the groups had any cases of post-operative mortality.

Conclusion
Our results allows us to conclude that invaginated mechanical EGA within Lewis surgery reduces post-operative complications of anastomosis in patients with esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.151: STRATEGY FOR TREATMENT OF ADENOCARCINOMA IN THE ESOPHAGO-GASTRIC JUNCTION (SIEWERT TYPE II)
Authors: Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Maeda Shinsuke , Toyoshima Yukinori , Ogawa Kyohei , Ide Hiroko , Osugi Harushi , Yamamoto Masakazu 
Published: September 2018

Abstract

Background
Incidence of adenocarcinoma of the esophagogastric junction is increasing in Japan as Europe or America. However, there is no consensus on treatment strategy. The purpose of this study was to determine the optimal range of resection and lymph node dissection according to lymph node metastasis status in adenocarcinoma of the esophagogastric junction

Methods
We investigated 75 patients who were diagnosed with advanced adenocarcinoma(A) of the esophagogastric junction and 22 patients were diagnosed with early adenocarcinoma(B).

Results
(1) Location(EG: E = G: GE: G) A = 37:20:17:1 B = 5:4:13(2)The depth of tumor (m2: m3: sm1: sm2: sm3: T2: T3: T4) = 1:6:2:10:3:13:59:3)(3) Degree of lymph node metastasis(n + : n-) A = 49:26 B = 4:18 (4) Surgical approach (Right thoracotomy:Left thoracoabdominal incision:Laparotomy (Transhiatal approach) A = 13:47:15 B = 1:5:16 (5) Neoadjuvant therapy (Chemotherapy before operation:Chemo-radiotherapy before operation:Chemotherapy after operation:Chemo-radiotherapy after operation) A = 1:12:33:1 B were without neoadjuvant therapy (6) Lymph node metastasis (Number of metastasis of lymphnode/Area of the dissection of lymphnode) Cervical: Upper thoracic: Middle: Lower: abdominal A = (1/7, 2/13, 4/31, 15/62, 46/75) B = (0/1, 0/3, 0/8, 4/22) (7) Type of the recurrence (Cervical Lymph node: mediastainal lymphnode: abdominal lymphnode: dissemination: Liver: Lung: Born: Remunant esophagus: Skin: Brain: Other disease) A = (3:8:6:13:9:4:2:1:1:1) B = (0:0:0:0:1:0:1:0:0:0:3) (8) Index (metastatic rate x3-yearOS/100)A = No1: No2: No3: No.7: No11: No20: No110: No112 = 12.1:10.6:12.9:13.5:18.1:50:12.9:9.09 B were not showed because incidence of metastasis of the lymph node were low.(9) 5-years survival rate for advanced cancer was 38% and early cancer was 88%

Conclusion
Proximal gastrectomy may be a minimally invasive surgical technique in for early and advanced adenocarcinoma of the esophagogastric junction according to the lymph node metastasis status. Surgical resection has been mainstream treatment but It was necessary to perform definitive or neoadjuvant chemoradiotherapy.

Disclosure
All authors have declared no conflicts of interest.
PS01.154: COULD POSITIVE RECURRENT LARYNGEAL NERVE LYMPH NODES BE AN INDICATOR TO CERVICAL LYMPHADENECTOMY IN THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS?
Authors: Wang Hai-Jun , Fang Qiang , Peng Lin , Han Yongtao 
Published: September 2018

Abstract

Background
As three-field lymphadenectomy for esophageal carcinoma is one of the most invasive operations, this procedure should be selected only when strictly indicated.Unfortunately, there are no useful criteria for it at present. In this study, we retrospectively examine the correlation between recurrent laryngeal nerve lymph nodes(RLN) and cervical lymph nodes(CLN) metastasis.

Methods
We reviewed the outcomes between recurrent laryngeal nerve lymph nodes(RLN) and cervical lymph nodes(CLN) metastasis for patients with squamous cell carcinoma of the thoracic esophagus(ESCC) from our institution. One hundred and thirty-five patients who underwent curative esophagectomy with three-field dissection for ESCC were enrolled in this study. The relationship between RLN involvement and CLN metastasis was examined.

Results
One hundred and thirty-five patients met the inclusion criteria. The overall rate of CLN metastasis was 36.3% for all patients and was 46.9%, 25.6%, and 6.7% for patients with upper, middle, and lower thoracic esophageal tumors, respectively (P = 0.003). The overall rate of RLN metastasis was 53.3%. The rate of CLN metastasis for all patients with or without CLN involvement were 44.4% and27.0% (P = 0.036.The positive predictive value, negative predictive value, sensitivity, and specificity of RLN as the sentinel nodes to predict the CLN metastasis were 65.3%,53.5%,44.4% and 73.0%, respectively.

Conclusion
We concluded that the recurrent nerve nodal alone should not be regarded as the criteria for cervical lymph nodes dissection.

Disclosure
All authors have declared no conflicts of interest.