bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.122: PREOPERATIVE CHEMOTHERAPY WITH BIWEEKLY DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Endo Fumitaka , Akiyama Yuji , Iwaya Takeshi , Nikai Haruka , Umemura Akira , Baba Shigeaki , Chiba Takehiro , Kimura Toshimoto , Takahara Takeshi , Otsuka Koki , Nitta Hiroyuki , Mizuno Masaru , Kimura Yusuke , Koeda Keisuke , Sasaki Akira 
Published: September 2018

Abstract

Background
Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can have severe adverse events, including neutropenia and febrile neutropenia. Feasibility of DCF is a concern especially for elderly patients, patients with moderate organ disorder, and those with dysphagia or insufficient oral intake causing malnutrition. We introduced biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and efficacy of bDCF therapy for patients with advanced esophageal squamous cell carcinoma who underwent radical esophagectomy after chemotherapy.

Methods
The parent DCF regimen consisted of 60–70 mg/m2 of docetaxel on day 1, administered intravenously for 2 h; 80 mg/m2 of cisplatin on day 1, administered intravenously for 2 h; and 5-fluorouracil administered by continuous infusion at a dose of 800 mg/m2 on days 1–5. The DCF regimen was repeated every 3–4 weeks. The bDCF regimen consisted of docetaxel (30 mg/m2) on days 1 and 15 in combination with cisplatin (80 mg/m2 on day 1) and 5-fluorouracil (800 mg/m2 on days 1–5), repeated every 4 weeks.

Results
Thirty-seven patients were treated with the DCF regimen (DCF group) and 22 patients were treated with the bDCF regimen (bDCF group). The age of patients was significantly higher in the bDCF group than in the DCF group. The bDCF group had more patients with heart and pulmonary comorbidities. Biweekly DCF group was significantly higher in the clinical response rate (DCF group 62.2% vs. bDCF group 86.4%, P = 0.0472). Grade 3 or 4 neutropenia was less frequent in the bDCF group (40.9%) than in the pDCF group (81.1%) (P = 0.0016). Among non-hematologic toxicities, anorexia was less frequent in the bDCF group (0%) than in the pDCF group (18.9%) (P = 0.0298). There were no significant differences between the groups in postoperative morbidity rate (bDCF group 45.5% vs. pDCF group 32.4%).

Conclusion
Preoperative bDCF therapy was feasible and safety without reduction of the efficacy of DCF therapy for fragile patients such as elderly patients, patients with moderate functional disorder, and that with malnutrition caused by dysphagia or insufficient oral intake.

Disclosure
All authors have declared no conflicts of interest.
PS02.126: NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL TUMORS: REAL LIFE BEYOND STUDY PROTOCOLS
Authors: Giacopuzzi Simone , Weindelmayer Jacopo , Pavarana Michele , Simoni Nicola , De Manzoni Giovanni 
Published: September 2018

Abstract

Background
Neoadjuvant therapy is in common clinical practice in the treatment of patients with esophageal cancer. In our department a phase 2 clinical trial was conducted for a neoadjuvant chemoradiotherapy protocol in patients under 75 with ECOG grade 0–2. At the end of the study, which led to encouraging results, the criteria for inclusion of patients in a neoadjuvant therapy protocol were extended. The aim of this work is to compare the results of the historical group of selected patients (protocol group) with the group of patients treated at the end of the study (real life group).

Methods
two groups of patients were considered: a historical group from 2003 to 2011 and a more recent group, from 2012 to 2018. The patients of the historical group (protocol group) were selected according to the precise inclusion criteria. The recent group (real life group) includes all patients who, by extension of disease and by comorbidity, could enter into a multimodal strategy in an intention to treat perspective. these two groups were compared for: protocol type, protocol completion, surgery rate, surgery radicality, pathological response and survival.

Results
In the real life group, 99 patients were referred to protocols different from the protocol considered standard in our department, because they were deemed not able to tolerate the treatment; the rate of completion of intention to treat strategy was 84,5 in the protocol group compared to 80,5 of the real life group (P = 0.326). Rate of radicality were 93,9 vs 92,4 in the protocol group vs to the real life group (P = 0.311). PCR was 49,6 and 35,9 respectively (P = 0.001). 5y disease relate survival was 51,3% for protocol group compared to 42,8 of the real life group in operated on patients (P = 0.467). Considering patient in the real life group that would have been within the inclusion criteria of the protocol group, R0 was 92,9, CPR 35,5 and 5y DRS 49,6 (P = 0581).

Conclusion
multimodal therapy is certainly the standard of care in these patients, but real life is not as bright as we would like to believe

Disclosure
All authors have declared no conflicts of interest.
PS02.130: BRAIN METASTASIS IN ESOPHAGEAL CANCER: SINGLE CENTER EXPERIENCE
Authors: Weindelmayer Jacopo , Treppiedi Elio , La Mendola Roberta , Giacopuzzi Simone , De Manzoni Giovanni , Parisi Cristiano 
Published: September 2018

Abstract

Background
Multimodal therapy is the treatment of choice in patients with esophageal cancer. This therapeutic strategy has led to an improvement in disease related survival. Despite the pathological response to therapy, the recurrence rate is not negligible. Brain localization is not an elective site of metastasis of the esophageal tumors but with the new chemoradiotherapy strategies it seems to evidence an increase in incidence in the different series. Objectives of the current study is to assess brain metastases frequency, therapeutic strategy and survival.

Methods
This is a single centre observational retrospective study: from 2006 to 2017, at Upper G.I. Surgery Division of Verona University, 327 patients (144 squamous cell carcinoma-SCC and 183 adenocarcinoma-ADK) with locally esophageal SCC or ADK have been operated. Nineteen patients (6%) with brain metastases were identified and classified as sinchronous (< 6 months after surgery) and metachronous (> 6 months) We evaluated the timing of metastasis occurrence, the features of the primary tumour, the therapy adopted, the distribution of metastases and survival.

Results
Of the nineteen metastatic patients, five were SCC and 14 were ADK patients. Ten patients presented synchronous metastasis and 9 metachronous. Eleven had a single metastasis, whilst 8 presented multiple lesions. Metastases were mostly sovratentorial. 7 patients were treated with surgery + stereotactic radiosurgery (SRS), 4 with surgery + whole brain radiotherapy (WBRT), 5 with only WBRT, 2 with only SRS and 1 case was treated with palliative care. Median overall survival of the brain metastasis group was 25 months, significantly lower than non metastatic patients (132 months), local metastasis (34 months) and other distant metastasis (29 months).

Conclusion
Brain metastasis from oesophageal or oesophago-gastric junction represent a minority of the patients and present a poor prognosis. Despite that, an aggressive treatment for limited lesions can lead to a prolonged overall survival and should therefore be evaluated in specialised centres.

Disclosure
All authors have declared no conflicts of interest.
PS02.135: THE BALLOON DILATION WITH AIR INJECTION AGAINST STENOSIS OF ESOPHAGEAL CANCER
Authors: Ami Katsunori 
Published: September 2018

Abstract

Background
Recently the strictures of esophageal cancer were treated by the balloon dilation and/or stenting. These treatments were effective but several cases made to reduce a QOL with perforation after intervention. Especially a radiation-induced esophageal stricture with esophageal cancer presented high rate of perforation after stenting. Therefor we researched retrospective prognostic analysis that patient with stenosis by esophageal cancer was treated the balloon dilation only.

Methods
We performed the balloon dilation for 10 patients with stenosis by esophageal cancer in our hospital. The age mean was 76.3 years old (68–91). The men were 7. Eight patients were after chemo-radiotherapy (CRT) and two patients were after chemotherapy (CT). We used CRE™ Fixed Wire Balloon Dilators C.R.E. (Controlled Radial Expansion, Boston Scientific®). The balloon dilation was performed with air injection (not used liquid) and not used stent. The air prevented over dilatation.

Results
The median survival time after dilation was 4.95 months. All patient were improve the dysphagia and possible to swallowing. The perforation induce balloon dilation did not occurred.

Conclusion
Generally, the prognosis of advanced esophageal cancer patient with stenosis after CRT or CT was short. Therefor it may unnecessary that the stent insertion had risk of perforation against these patients. The insufficient balloon dilation with air injection preserved sufficient inner cavity of esophagus for esophageal cancer patient with stenosis after CRT or CT.

Disclosure
All authors have declared no conflicts of interest.
PS02.142: CONVERSION SURGERY: A FEASIBLE GOAL FOR AFTERWARDS IN CARDIA CANCER TREATMENT
Authors: Alberti Luca , Giacopuzzi Simone , Alberto De Pasqual Carlo , Weindelmayer Jacopo , La Mendola Roberta , De Manzoni Giovanni 
Published: September 2018

Abstract

Background
Conversion surgery is a surgical treatment aiming R0 resection after chemotherapy of tumors that were originally regarded as technically or oncologically unresectable or only marginally resectable. Performing surgery in such patients may result in a long-term survival. The current experience concerns stage IV gastric cancer patients with marginally resectable metastasis, while the evidence concerning cardia tumors are poor. We report a case of primary cardia cancer with potentially unresectable metastasis, successfully treated by a multidisplinary approach including chemotherapy and surgery.

Methods
We report a case about a 65-year-old man affected by EGJ adenocarcinoma (Siewert II) with multiple hepatic metastases and para-aortic adenopathy (cT3N + M1 according to UICC 7th edition). He received intensive chemotherapy with Taxotere, Cisplatin and 5 FU. After therapy, primary tumor and liver lesions had markedly regressed according to CT, using RECIST guidelines. The endoscopy confirmed the reduction in the cardia lesion with negative biopsies. For that reason, the patient was addressed to follow up.

Results
After 6 years of follow up, endoscopy indicated a local relapse with a pathological diagnosis of adenocarcinoma. CT scan showed a clinical stage was cT3N + M0. The patient was treated with neoadjuvant concurrent chemoradiotherapy. After treatment the exams showed a partial response. The patient was eligible for conversion surgery and we proceeded to laparotomy total gastrectomy with D2 lymphadenectomy. We performed also exeresis of a liver nodule, which resulted fibrous. The surgical procedure was radical (R0). According to histological examination, the postoperative stage was ypT0N0. Treatment-induced response at the primary tumor site, evaluated according to SPR classification and TRG classification, was SPR 1 and TRG 1.

Conclusion
Despite limited evidence in literature about conversion surgery in cardia carcinoma, this case shows that intensive chemotherapy allows for conversion of unresectable cardia cancer to resectable cancer, resulting in long-term survival. The following surgical resection provided a R0 resection, leaving no macroscopic residual tumor. This result indicates a potential strategy for patients affected by unresectable cardia cancer. Clearly this strategy requires further analysis to be confirmed. However, based on our case report, the conversion surgery seems safe and feasible, associated with R0 resection.

Disclosure
All authors have declared no conflicts of interest.
PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT
Authors: Andrae Hannah , Musholt Thomas , Lang Hauke , Grimminger Peter 
Published: September 2018

Abstract

Background
Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy.

Methods

Case report
A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea.

Results
After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia.

Conclusion
Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication.

Disclosure
All authors have declared no conflicts of interest.
PS02.150: SEVEN PATIENTS WITH GASTRIC-TUBE CANCER AFTER ESOPHAGECTOMY
Authors: Saito Shin , Hosoya Yoshinori , Ui Takashi , Kitayama Joji , Kanamaru Rihito , Haruta Hidenori , Kurashina Kentaro , Matsumoto Shiro , Sata Naohiro , Lefor Alan 
Published: September 2018

Abstract

Background
The prolonged survival of patients receiving surgery for esophageal cancer has led to an increased incidence of adenocarcinoma arising in the gastric tube used for reconstruction (gastric tube cancer). The incidence of gastric tube cancer after esophagectomy has been reported to be 1.3–6.3% in Japan. Patients with early stage gastric tube cancer can be treated by endoscopic resection, however patients with advanced gastric tube cancer need to undergo the resection of the gastric tube.

Methods
A total of 497 patients underwent esophagectomy with gastric tube reconstruction between 2001 and 2015 at our institution. During the same period, gastric tube cancer was detected in seven patients including three by endoscopic submucosal dissection (ESD) and three by surgery. We investigated the clinicopathological study of these seven patient with gastric tube cancer.

Results
The incidence of gastric tube cancer was 1.4% (7/497) at our hospital. Average age was 73 years old (range, 62–84). Six patients were men and one was women. Average interval from esophagectomy to initial treatment was 78.3 ± 61.0 (months). Among seven patients with gastic tube cancer, three were treated by ESD and 3 underwent surgery. One patient went to a palliative therapy. All seven patient with gastric tube cancer, who didn’t have specific complains, were detected by regular upper gastrointestinal endoscopy. We observed a very high proportion of patients with H. pylori infection (at least five patients among seven).

Conclusion
ESD for gastric tube cancer after esophagectomy is a technically difficult procedure because of the limited working space and unusual fluid-pooling area in the reconstructed gastrictube as well as the presence of severe gastric fibrosis with staples under the suture line. A highly skilled endoscopist can perform the procedure successfully. An operative technique for the resection of gastric tube cancer by means of lifting the anterior chest wall and video scope-assisted surgery enabled the resection of gastric tube without performing a sternotomy.

Disclosure
All authors have declared no conflicts of interest.
PS02.157: ESOPHAGEAL SQUAMOUS CELL CARCINOMA IS ASSOCIATED WITH CHRONIC DISEASES AS WELL AS UNHEALTHY LIFESTYLES
Authors: Nakamura Jun , Manabe Noriaki , Haruma Ken , Nakato Rui , Murao Takahisa , Fujita Minoru , Suehiro Mitsuhiko , Kawamoto Hirofumi , Kamada Tomoari , Shiotani Akiko , Matsumoto Hideo , Hirai Toshihiro , Yamatsuji Tomoki , Naomoto Yoshio 
Published: September 2018

Abstract

Background
Cancer and other chronic diseases such as cardiovascular disease, diabetes, chronic kidney disease, and respiratory disease share common risk factors, including aging and unhealthy lifestyles (eg, smoking and alcohol misuse). Although the recent prospective cohort large-scale study showed chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death, the relation between esophageal squamous cell carcinoma (ESCC) and non-cancer chronic diseases (NCCD) still remain unknown. The aim of this study is to assess the independent and joint associations of major NCCD and ESCC.

Methods
From April 2011 to March 2017, 406 consecutive patients with ESCC diagnosed pathologically were enrolled. Their medical records as to patients’ background, the reason for their consultation, lifestyles, and medical history were investigated retrospectively in detail.

Results
As to the reason for their consultation, 45 patients (25.3%) were diagnosed at annual medical checkup (no symptoms), 125 (70.2%) consulted a doctor for any symptoms such as dysphagia, and 8 (4.5%) had other reasons. As to lifestyles, 304 (78.1%) were drinkers of alcohol (daily amount of alcohol consumption > 20g) and 302 (77.4%) were smokers (Brinkman index > 200), respectively. As to the medical history related to cancer or gastrointestinal diseases, 25 (6.8%) had a history of laryngopharyngeal cancer, 20 (5.1%) had a history of gastric cancer, 2 (0.5%) had a history of breast cancer, one (0.3%) had a history of sclerodema, and one (0.3%) had a history of esophageal achalasia. Of the 406 ESCC patients, 305 were early ESCC and the remaining 101 were advanced ESCC. As to the medical history in patients with advanced ESCC, 22 (21.8%) had a history of cancer of other organs, and 48 (47.5%) had NCCD including hypertension (35 patients), diabetes (18 patients), and hyperlipidemia (12 patients).

Conclusion
NCCD is an overlooked risk factor for ESCC, as important as two major lifestyle factors combined (drinkers of alcohol and smokers). General physicians who follow up NCCD patients should pay attention to the coexistence of ESCC.

Disclosure
All authors have declared no conflicts of interest.
PS02.181: RISK FACTORS AND TREATMENT OF DIAPHRAGMATIC HERNIA FOLLOWING IVOR-LEWIS OESOPHAGECTOMY FOR CANCER
Authors: Puccetti Francesco , Parise Paolo , Fumagalli Romario Uberto , Cossu Andrea , De Pascale Stefano , Elmore Ugo , Marcocci Gianluca , Rosati Riccardo 
Published: September 2018

Abstract

Background
Oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening surgical complication characterized by an underestimated occurrence rate and unknown related risk factors. This study analyses the experience of two tertiary designated centers in order to evaluate key elements concerning development and treatment of PODH.

Methods
A cohort of consecutive patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) underwent Ivor-Lewis oesophagectomy between March 1997 and April 2017 according to three different approaches: totally open incision procedure (OILO), hybrid (HILO) and totally mininvasive to esophagectomy (MILO). All patients were retrospectively observed in the context of a postoperative calendarised follow-up in order to record the incidence and postrepair results of PODH.

Results
414 patients underwent Ivor-Lewis oesophagectomy for cancer and 22 (5.3%) developed PODH within a median follow-up period of 16 months (6 - 177). Surgical repair was generally applied by the mean of laparoscopic cruroplasty (77%) with a conversion rate of 24%. Postoperative morbidity did not include early recurrences but exclusively cardio-pulmonary complications (5 patients) with one case of respiratory failure leading to death. The discharge was reached after a median hospital stay of 6 days (2 - 95) while 3 recurrences (14%) occurred over a median follow-up period of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiotherapy, the complete pathological response (CPR) and a lymph node harvest (LNH) larger than 33 stations (p-value of 0.016, 0.001 and 0.024 respectively). The strong influence of an extended LNH was confirmed by the multivariable analyses (0.026) along with CPR which should however be considered as longer survival-related bias.

Conclusion
The minimally invasive surgery and the neoadjuvant chemoradiotherapy represent a considerable part of multimodal treatment for oesophageal cancer presenting a not statistically significant association with PODH development while a LNH including more than 33 nodes resulted to be an independent risk factor mirroring the extent of surgical demolition in oesophagectomy.

Disclosure
All authors have declared no conflicts of interest.