bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.234: MINIMALLY INVASIVE ESOPHAGECTOMY IN PATIENTS WITH MORBID OBESITY
Authors: Velasco Hernandez Norbeto , Rivaletto Lucas , Horiuchi Hector , Zicavo Maria , De Battista Gerrini Santiago 
Published: September 2018

Abstract

Background
The first publication of minimally invasive esophagectomy in prone position (MIE PP) was developed by Cuschieri in 1994. This approach was described to access the posterior mediastinum and esophagus for mobilization and resection. In 2006, after several reports, Palanivelu presented his study, which was one of the most important series published at that time.The objective is to analyze the mortality of a group of patients with morbid obesity that underwent MIE PP. Retrospective, observational study.

Methods
From November 2011 to June 2017, 52 esophagectomies were performed in H.I.G.A San Martín and Instituto de Diagnóstico of La Plata city. Out of the 52 cases, only 36 of them were MIE PP, and were the ones chosen to be included in the study.

Results
Perioperative mortality was 8.3% (3 cases) Two cases, in the group of patients with obesity (IMC ≥ 30) were due to pneumonia and heart failure and surgery was performed using the McKeown procedure. Another case was in the group of patients without obesity (IMC ≤ 30) due to mediastinitis by leak, and the surgery performed was applying Ivor-Lewis procedure. These results did not evidence statistically significance (P ≤ 0.54) However, in the analysis of patients with morbid obesity (BMI ≥ 35) when compared with all the remaining cases, the difference was significant (P = 0.02)

Conclusion
There are many publications suggesting that obesity is not a risk factor for mortality after MIE. However, in our study, although it is a series with a small number of cases, there was evidence that mortality increases in patients with BMI ≥ 35

Disclosure
All authors have declared no conflicts of interest.
PS01.236: MEDIASTINOSCOPIC SALVAGE ESOPHAGECTOMY FOR RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY IN A PREVIOUSLY PNEUMONECTOMIZED PATIENT
Authors: Okumura Tomoyuki , Seto Yasuyuki , Aikou Susumu , Moriyama Makoto , Sekine Shinich , Hojo Shozo , Arai Mie , Baba Hayato , Hirano Katsuhisa , Shibuya Kazuto , Hashimoto Isaya , Yoshioka Isaku , Nagata Takuya , Fujii Tsutomu 
Published: September 2018

Abstract

Background
Mediastinoscopic esophagectomy is a minimally invasive surgery for thoracic esophageal cancer avoiding one-lung ventilation or transthoracic procedure.

Methods
We performed for the first time in the literature, salvage esophagectomy with combination of mediastinoscopic cervical approach and laparoscopic/mediastinoscopic transhiatal approach for recurrent thoracic esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT) in a patient who had previously undergone a left pneumonectomy for primary lung cancer.

Results
A 66-year-old man was diagnosed as local recurrence of lower ESCC (cT3N0M0 cStage II) at 9 years after dCRT. His medical history included left-sided pneumonectomy for lung adenocarcinoma 9 years previously. Then the patient was diagnosed as lower thoracic ESCC (cT3N1M0 cStage III) at 2 months after pneumonectomy. He received dCRT consisting of CDDP/5-FU infusion and irradiation (60 Gy) and achieved complete response. No evidence of tumor recurrence was observed at endoscopic surveillance up until 6 years after dCRT. For this present surgery, a cervical wound was made and the intramediastinal procedure was performed under pneumomediastinum. After mobilization of upper/middle thoracic esophagus, the esophageal wall was safely separated from the remaining part and the stump of the left main bronchus. Dense adhesions between the esophagus and fibrotic tissue at the site of previous left mediastinal pleural resection was divided using a sealing device. In the abdomen, 5 ports were inserted to perform abdominal and transhiatal procedures under CO2 insufflation. After mobilization of the stomach, fibrotic scar tissue around the lower esophagus was divided using a sealing device and the peri-esophageal space dissected from cervical and transhiatal approach were connected to completely mobilize the thoracic esophagus. The esophagectomy was uneventfully carried out followed by reconstruction with gastric conduit via retrosternal rout. Pathological findings demonstrated a moderately differentiated ESCC (pT3-AD pN1 M0 pStage III), indicating that R0 resection was successfully performed. The patient has been closely observed as an outpatient and was alive and healthy at 3 months after the operation without tumor recurrence.

Conclusion
Mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who had a previous pneumonectomy, even in salvage surgery for recurrent cancer after dCRT.

Disclosure
All authors have declared no conflicts of interest.
PS01.241: HYBRID MINIMALLY INVASIVE TECHNIQUE OF OESOPHAGECTOMY FOR OESOPHAGEAL CARCINOMA
Authors: Virk Satpal , Singla Saurabh 
Published: September 2018

Abstract

Background
Oesophagectomy is challenging procedure involving multiple body cavities. The traditional open procedure being either transthoracic or transhiatal, carries significant morbidity and mortality. There is continuing debate between the two approaches. Minimally invasive oesophagectomy has swung the pendulum towards transthoracic procedure, though it remains a complex and technically demanding procedure. This study was done to assess the feasibility, and benefit of hybrid minimally invasive technique over open technique.

Methods
Patients of oesophageal cancer were selected from January 2005 to December 20,017. After 2012 open technique was replaced with minimally invasive technique. Open technique included Ivor Lewis, McKeown's or transhiatal. Hybrid minimally invasive technique included laparoscopic gastric mobilisation and thoracic part using small thoracotomy. Anastomosis was done using hand sewn technique. The short term outcome, including postoperative complications were analysed from prospectively collected data.

Results
One hundred sixty three patients underwent open procedure and 103 patients underwent hybrid minimally invasive esophagectomy. Total operative time was shorter in laparoscopic group (325.6 minutes vs 232.6 minutes, P < 0.05). The number of transfused patients were significantly smaller in laparoscopic group (40.75% vs 13.6%, P < 0.05). The postoperative course without complication was observed in 68.1% and 79.3% in open vs laparoscopic group respectively. Serious complications included myocardial infarction and gastric tube necrosis and bleed. There was no anastomotic leak in chest anastomosis but there was overall 17.3% leak in neck anastomosis, higher in open group 20.8% vs 16.6% in minimally invasive group. Mortality was higher ion open group (5.5% vs 2%, P < 0.05). On multivariate analysis, age more than 60 years, chest complications and cardiovascular comorbidity were associated with increased mortality.

Conclusion
Hybrid minimally invasive procedure is feasible and safe procedure for patients with oesophageal cancer. it is associated with shorter operative time and less postoperative complications. Even laparoscopic gastric tube mobilisation alone adds to in decreasing the morbidity in esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.242: HIATAL HERNIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Mungo Benedetto , Gleisner Ana , Rincon-Cruz Lorena , Thornton Loree , Mccarter Martin 
Published: September 2018

Abstract

Background
Hiatal hernias (HH) are a known, yet poorly studied, post-surgical complication of esophagectomy. The aim of this study was to analyze in a retrospective fashion the MIE experience at our institution, in order to individuate factors associated with post-surgical HH development.

Methods
We reviewed data from MIE performed at University of Colorado from July 2013 to July 2017. Our most common approach of choice is Ivor Lewis MIE with circular stapled end to side anastomosis. We divided our patient population in two groups: those who developed a HH at any time post operatively and those who did not. We compared pre-, intra- and post-operative clinical variables of interest in the two groups using Pearson chi-squared and Fisher's exact test for binomial variables and Two-sample Wilcoxon rank-sum (Mann-Whitney) test for continuous variables.

Results
91 patients underwent MIE in the study period: 11 developed HH in a time frame ranging from one week to two years post operatively. 8 patients had a HH involving one or more intra-abdominal organs other than the stomach; 3 patients had a HH interesting mostly the tubulized stomach. 7 patients required a reoperation. There were no statistically significant differences in the prevalence of pre-operative comorbidities between the two groups. Patient who developed a HH were significantly less likely to have had prior abdominal or thoracic surgery (Pr = 0.039). As expected, they were also significantly more likely to require a reoperation (Pr = 0.000). There were no statistically significant differences in intra-operative variables between the two groups, including operative time and anastomotic technique, nor where there differences in incidence of post operative complications other than HH. We did observe a trend towards higher rate of preoperative chemotherapy and radiation in the HH group. Of note, we did attempt to prevent HH by means of tacking abdominal organs to the abdominal wall, however this did not prove to significantly decrease HH incidence.

Conclusion
HH occurs in a non-negligible percentage of patients undergoing MIE. Lack of prior surgery appears to be significantly associated with HH, perhaps due to lesser adhesion burden acting as a mean of organ fixation.

Disclosure
All authors have declared no conflicts of interest.
PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER
Authors: Hyun Kim Chang , Kim Jin-Jo 
Published: September 2018

Abstract

Background
A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer

Methods
We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes.

Results
The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient.

Conclusion
TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve.

Disclosure
All authors have declared no conflicts of interest.
PS02.004: THE FEASIBILITY AND EFFECTIVENESS OF ‘TOTAL ENDOSCOPIC 2.5 FIELD LYMPH NODE DISSECTION’ IN TREATMENT OF THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zheng Bin , Hong Ruopeng , Zhang Shuliang , Zeng Taidui , Chen Hao , Xu Jinxin , Zheng Wei , Chen Chun 
Published: September 2018

Abstract

Background
Due to the difficulty of dissection, surgical trauma, postoperative complications and other factors, the promotion of 3-field lymph node dissection is subject to certain restrictions. We try to explore and summarize a method of lymph node dissection, ‘endoscopic 2.5 lymph node dissection ’, that is, thoracoscopy combined with laparoscopic radical abdominal field, chest field and lower cervical paraesophageal lymph nodes (including 101 group below thyroid artery).

Methods
Retrospective analysis of 240 patients with thoracic esophageal squamous cell carcinoma from November 1, 2015 to December 31, 2017. All patients underwent endoscopic 2.5-field lymphadenectomy. The average age is (58.2 ± 9.5) years old. During the thoracoscopic part, when we do the lymphadenectomy along recurrent laryngeal nerves in the upper mediastimun and lower neck, we used a combination of ‘esophageal suspension method’, ‘lymph node rolling dissection method’ and ‘multi-angle pulling method’ to reveal the lymph nodes (Figure 1). Surgical related factors were collected and analyzed. Continuous follow-up was performed to record the recurrence and metastasis of patients and postoperative survival.

Results
Lymphadenectomy level of the right recurrent laryngeal nerve could reach the level above the right inferior thyroid artery, and the left could reach the level of 101 station. All operations were successfully completed. The incidence of pulmonary infection was 11.7%, the incidence of anastomotic leakage was 1.3%, the hoarseness rate was 7.9% and the incidence of chylothorax was 4.2%. The average number of total, abdominal and thoracic lymph nodes dissected were higher than the number of guidelines requirement and most of the previous literature. The average postoperative hospital stay was 8.4 days. The local recurrence rate, metastasis rate and survival rate of all the patients were not inferior to those reported in the past.

Conclusion
In patients with thoracic esophageal squamous cell carcinoma, the use of ‘total endoscopic 2.5-field lymph noede dissection’, could expand the range of lymph node dissection, and reached the super-thoracic and lower cervical level, which is beneficial to improve the degree of dissection along the recurrent laryngeal nerves. The procedure is safe and feasible, the results of short-term follow-up results are good, and it is worth further promotion.

Disclosure
All authors have declared no conflicts of interest.
PS02.006: OPERATIVE INDICATION AND PROCEDURES OF THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Kamei Takashi 
Published: September 2018

Abstract

Background
Thoracoscopic esophagectomy has been performed for two decades and becomes widely spread. We evaluate our cases who undergone the thoracoscopic esophagectomy and consider the future prospective of this operation.

Methods
702 patients who received thoracoscopic esophagectomy in our institute from March 1995 to October 2017 were enrolled and studied retrospectively. Operative indication is an all of the clinically resectable cases including with a neoadjuvant treatment or definitive chemoradiotherapy before surgery. Overall survival rate of the patients with thoracoscopic approach and with thoracotomy until 2001 was analyzed. Long term outcome of the patients with thoracoscopic esophagectomy was compared to the result from comprehensive registry of esophageal cancer in Japan. Short term results of the perioperative parameters were analyzed between left lateral decubitus position and prone position.

Results
There was no significant differences of the survival rate between thoracoscopic group and thoracotomy group based on pathological stage. 5 year survival without neoadjuvant treatment was 88.9% (pStageI), 71.5%(pStageIIA), 68.1%(pStageIIB), 40.9%(pStageIII), respectively.5 year survival rate of cStageII and III with neoadjuvant chemotherapy was 65.7% and 5 year survival rate of the salvage esophagectomy after failure of definitive chemoradiotherapy was 31.4%. Every outcomes are as good as any reported results in esophagectomy. In the comparison of the lateral position with the prone position, total blood loss was significantly lower in prone position. Inflammatory response after surgery was improved more rapidly in prone group, therefore, prone position is recommended as a minimally invasive procedure for thoracoscopic esophagectomy.

Conclusion
Thoracoscopic esophagectomy will develop further as a standard operation for esophageal cancer. However, from the point of view of the safety, an appropriate educational systems of this advanced procedure should build.

Disclosure
All authors have declared no conflicts of interest.
PS02.009: 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
Early radical resections are the main treatment methods towards esophageal squamous cell carcinoma (ESCC). Classic transthoracic esophagectomy (McKeown approach) could resect esophagus lesion as a whole piece, so the surgical results could be satisfactory and the regional lymph node dissection could be clean. With the maturation of video-assisted thoracoscope in thoracic surgeries, good vision, subtle operating system, and mature operating technologies have made the multi-portal thoracoscopic minimally invasive laparoscopic esophageal resection more and more mature. Meanwhile, SPVATS gradually appeared, which was firstly used in simple thoracic surgeries, and further applied to lung and mediastinal tumor resection; relevant summaries have been reported, and the feasibility of SPVATS for standard mediastinal lymph node dissection was also further verified.The application of SPVATS towards TESCC has also been gradually carried out. Would minimally invasive esophagectomy be safe? Whether SPVATS could be used in the McKeown approach for TESCC? Whether SPVATS could safely resect esophagus, and perform standard dissection towards local esophageal region and mediastinal lymph nodes, as well as avoid damaging the surrounding organs and tissues? Some scholars had compared SPVATS and multi-portal VATS in treating medio-inferior TESCC.

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, including 2 case in upper thoracic segment, 15 cases in median thoracic segment, and 8 cases in inferior thoracic segment. All the cases were pathologically diagnosed as SCC preoperatively. SPVATS was performed to free thoracic esophagus and dissect the lymph nodes, and laparoscopy was performed to free stomach and to perform esophagus-left gastric collum anastomosis.

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
CONCLUSIONS: 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.
PS02.013: THORACOSCOPIC ESOPHAGECTOMY WITH RADICAL LYMPH NODE DISSECTION FOR THORACIC ESOPHAGEAL CARCINOMA IN THE LEFT LATERAL DECUBITUS POSITION
Authors: Sato Hiroshi , Miyawaki Yutaka , Aikawa Masayasu , Okamoto Kojun , Sakuramoto Shinichi , Yamaguchi Shigeki , Koyama Isamu 
Published: September 2018

Abstract

Background
The rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan. We retrospectively reviewed short term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation in a single institution. This study aimed to evaluate the feasibility of applying this procedure.

Methods
Between July 2013 and March 2017, 83 patients with esophageal cancer underwent thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation. The thoracic procedure is performed as follows: The lymph nodes around the right recurrent laryngeal nerve are dissected. On the cranial side, the lymph node dissection is advanced to the level of the inferior thyroid artery. Then, the assistant rotates the trachea toward the ventral side, and the lymph nodes around the left recurrent laryngeal nerve are dissected. The middle and inferior mediastinal lymph nodes are dissected including supradiaphragmatic lymph nodes and the dorsal lymph nodes around the thoracic descending aorta. Then, the esophagus is transected using an automatic suture device. Finally, the tracheal bifurcation area lymph nodes are dissected. We retrospectively analyzed these patients.

Results
The completion rate of thoracoscopic esophagectomy was 94.0%, and the procedure was converted to thoracotomy in five patients, due to hemorrhage, severe adhesion. The mean intrathoracic operative time, intrathoracic blood loss, and number of dissected mediastinal lymph nodes were 220.0 min, 130.1 mL, and 22.0, respectively. Postoperative complications included pneumonia (8.4%), anastomotic leakage (16.9%), and recurrent nerve paralysis (8.4%). Postoperative (30d) mortality was 1/83 (1.2%) due to ARDS.

Conclusion
Standardization of the procedure for thoracoscopic esophagectomy in the left lateral decubitus position under artificial pneumothorax by CO2 insufflation, with a standardized clinical pathway for perioperative care led to favorable surgical outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS02.014: COST-EFFECTIVENESS OF MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Liu Chao-Yu , Liu Chia-Chuan 
Published: September 2018

Abstract

Background
The cost-effectiveness of minimally invasive esophagectomy (MIE) versus open esophagectomy (OE) for esophageal squamous cell carcinoma (ESCC) has not been established. Recent cost studies have shown that MIE is associated with a higher surgical expense, which is not consistently offset by savings through expedited post-operative recovery, therefore suggesting a questionable benefit of MIE over OE from an economic point of view. In the current study, we compared the cost-effectiveness of MIE versus OE for ESCC.

Methods
Between April 2000 and December 2013, a total of 251 consecutive patients undergoing MIE or OE for ESCC were enrolled. After propensity score (PS)-matching the MIE group with the OE group for clinical characteristics, 95 patients from each group were enrolled to compare the peri-operative outcomes, long-term survival, and cost.

Results
After PS-matching, the baseline characteristics were not significantly different between groups. Perioperative outcomes were similar in both groups. MIE was superior to OE with respect to a shorter intensive care unit (ICU) stay, while the complication rate (except for hoarseness) and survival were similar. Post-operative cost was significantly less in the MIE group due to a shorter ICU stay; however, reduced post-operative cost failed to offset the higher surgical expense of MIE.

Conclusion
MIE for ESCC failed to show cost-effectiveness regarding overall expense in our study, but costs less in the postoperative care, especially for ICU care. More cost studies on MIE in other health care systems are warranted to verify the cost-effectiveness of MIE.

Disclosure
All authors have declared no conflicts of interest.