bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA01.06: TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY IN A PATIENT WITH PREVIOUS NISSEN FUNDOPLICATION: CAN INDOCYANINE GREEN BE A USEFUL TOOL?
Authors: Turrado-Rodriguez Victor , De Maria Momblan Dulce Nombre , Torroella Alba , Ibarzabal Ainitze , Carolina Guzman Yoelimar , Sofia Espinoza Arlena , Maria De Lacy Fortuny Antonio 
Published: September 2018

Abstract

Description
Total esophagectomy may be technically demanding. Previous abdominal surgeries may increase the difficulty of the technique, especially when affecting the stomach as a gastric conduit is the preferred method for reconstruction. In this video, we demonstrate that the creation of the gastric conduit is feasible even with a previous Nissen fundoplication and that the use of indocyanine green (ICG) is useful to assess the vascularization of the gastric conduit.

Methods
A 70-year-old woman with medical history of high blood pressure, hysterectomy and hiatal hernia repair with laparoscopic Nissen fundoplication presented with symptoms of dysphagia and weight loss and was diagnosed of an adenocarcinoma of the esophagus (25 to 32 cm from the incisives) cT3N1. Neoadjuvant chemo-radiotherapy following CROSS scheme was administered. A total minimally invasive esophagectomy was performed in the prone position for the thoracic time. Concerns about the length of the gastric conduit due to the fundoplication were present during surgery. ICG was used to locate the right gastroepiploic arcade, asses the vascularization of the gastric conduit, specially in the gastric fundus, and after cervicotomy, to assess the vascularization of the gastric stump before performing the anastomosis.

Results
Surgical time was 360 minutes. Postoperative evolution was satisfactory except for hoarseness due to a possible right recurrent laryngeal nerve paralysis. She was discharged on the 11th postoperative day. Pathology confirmed an adenocarcinoma of the mid esophagus ypT1bN1 (1/15).

Conclusions
Totally minimally invasive esophagectomy in the prone position is feasible even in the case of previous upper gastrointestinal surgeries, such as Nissen fundoplication. The use of ICG is useful for the identification of the gastroepiploic arcade, assessment of the vascular supply to the gastric conduit and to the anastomosis, especially when a McKeown esophagectomy is performed.

Disclosure
All authors have declared no conflicts of interest.
RA02.03: THERAPEUTIC STRATEGY FOR ADENOCARCINOMA OF ESOPHAGO-GASTRIC JUNCTION
Authors: Yago Akikazu , Akiyama Hirotoshi , Sato Kei , Sato Sho , Tanaka Yusaku , Miyamoto Hiroshi , Kosaka Takashi , Kunisaki Chikara , Endo Itaru 
Published: September 2018

Abstract

Background
The optimal surgical management for adenocarcinoma of the esophagogastric junction, including surgical approach, range of nodal dissection, and type of gastrectomy remains controversial.

Methods
In our two institutions, from January 2001 to September 2016, we retrospectively analyzed clinicopathological factors and long-term results of 72 patients who underwent radical resection and evaluated the priority of nodal dissection based on the therapeutic value index [ = the frequency of lymph node metastasis (%) x the 5-year survival rate (%)/100] and recurrence pattern.

Results
Median age:66 (44–94), male/female = 54/18, TG/PG = 60/12, Tumor size < 40mm/ ≥ 40mm = 32/40, pT1/2/3/4 = 14/13/28/17, pN0/1/2/3 = 32/17/8/15, intestinal/diffuse type = 39/33. pStageI/II/III = 29/17/26, 5-year survival rates were pStageI/II/III = 91.1/86.2/51.4%. Univariate analysis revealed that tumor size ≥ 40mm (vs < 40mm, P = 0.009), diffuse type (vs intestinal type, P = 0.0031) and pN2–3 (vs pN0–1, P < 0.001) patients had significantly poor prognosis, and multivariate analysis revealed that diffuse type (P = 0.018, HR 3.991, 95%CI 1.264–12.606) and pN2–3 (P = 0.040, HR 3.112, 95%CI 1.055–9.183) were independent prognostic factors. The therapeutic value index of nodal dissection was No.1/2/3/7/11d/parahiatal/lower mediastinal = 15.56/12.34/11.34/7.05/5.40/12.04/2.70, and no evidence of lymphadenectomy was observed for No.4, 5, 6, 10, 16, upper and middle mediastinum. 19 cases had disease recurrence, 3 cases were mediastinal lymph node recurrence.

Conclusion
Our study showed that distal gastric lymph nodes dissection is unnecessary, and gastrectomy with lower mediastinal and proximal gastric lymph node dissection is recommended for the treatment of adenocarcinoma of EGJ. Since diffuse type and pN2–3 were independent prognostic factors even after potentially curative resection, so additional chemotherapy might be required for such cases.

Disclosure
All authors have declared no conflicts of interest.
RA02.08: SALVAGE LYMPHADENECTOMY FOR 14 PATIENTS OF ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHRAPY
Authors: Odagiri Kazuki , Yamasaki Makoto , Tanaka Koji , Miyazaki Yasuhiro , Makino Tomoki , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
Salvage Lymphadenectomy is regarded as the only curative surgery to residual or recurrence lymph nodes of esophageal cancer after definitive chemoradiotherapy (dCRT). However, salvage lymphadenectomy is not described in the Japanese esophageal cancer treatment guideline because of little evidences for the safety and efficacy.

Methods
From January 2011 to December 2015, we performed 14 salvage lymphadenectomies to residual or recurrence LN of esophageal squamous cell carcinoma(ESCC) in Osaka University. We assessed postoperative complications and long-term outcome.

Results
Average age was 64 year-olds (SD: 5.2). Male: Female = 11: 3. cStage I: II-IV = 7: 7. Surgery to cervical LN were 11 patients and abdominal LN were 3 patients. Surgery to residual LN (res-LN) were 9 patients and recurrence LN (rec-LN) were 5 patients. rec-LN patient's median time to recurrence after dCRT was 14.3 months (10.2–29.3). 4 patients were performed lymphadenectomy resecting with adjacent organs, 3 patients were bronchus (trachea? ) and 1 patient was right subclavian artery. 4 patients had postoperative complication, two were pneumonia, one was pulmonary thrombosis and one was lymphorrhea, but there was no serious case (Clavien-Dindo Grade II or less). We didn’t have hospital death. Six of 14 patients had recurrence and died after salvage lymphadenectomy. Recurrence sites were 2 mediastinal lymph nodes and liver, lung, loco-regional and peritoneal. But no patients had recurrence of main tumor. 5-year overall survival rate was 51.1%. Median survival time in 9 patients, surgery to res-LN, was 18.9 months (10.4–132 months) and 5 patients, surgery to rec-LN, was 4.9 months (1.4–26.6 months). Surgery to res-LN patients were longer than rec-LN patients in overall survival after salvage lymphadenectomy (P = 0.395). There was no difference due to the difference in recurrence site of the cancer in overall survival after salvage lymphadenectomy.

Conclusion
Our data show salvage lymphadenectomy safety and effectiveness after dCRT. Salvage lymphadenectomy may extend the prognosis of patients with esophageal cancer after dCRT. Thus, salvage lymphadenectomy may be one of the treatment options for the patients with residual or recurrent, especially the former, lymph node after definitive CRT, although it is necessary to evaluate in many cases.

Disclosure
All authors have declared no conflicts of interest.
RA03.05: COMPARISON OF OUTCOME OF ESOPHAGECTOMY VERSUS NON-SURGICAL TREATMENT FOR RESECTABLE ESOPHAGEAL CANCER WITH CLINICAL COMPLETE RESPONSE TO NEOADJUVANT THERAPY
Authors: Koga Shuhei , Ohkura Yu , Ueno Masaki , Udagawa Harushi 
Published: September 2018

Abstract

Background
Treatment for patients who have achieved clinical complete response (cCR) after neoadjuvant therapy has not been established, with no consensus regarding the indications for either esophagectomy or non-surgical treatment.

Methods
Among 1545 patients with esophageal cancer at Toranomon Hospital between January 2006 and August 2017, 39 who achieved cCR after neoadjuvant treatment were divided into two groups according to treatment: esophagectomy group (n = 18) andtreatment group (n = 21) for comparison.

Results
No significant intergroup difference was observed in baseline characteristics. Pathological complete response was confirmed in 13 (72.2%) of the 18 patients who underwent esophagectomy, while residual tumor was detected at the location of primary tumor in 2 (11.1%) patients and lymph node metastasis was found in 3 (16.7%) patients. Recurrence-free survival (RFS) was significantly longer in the esophagectomy group than in the non-surgical group (P = 0.002). Disease-specific survival (DSS) was significantly longer in the esophagectomy group (P = 0.007). However, no significant intergroup difference was observed in overall survival estimated based on all deaths, including (P = 0.451).

Conclusion
With improved diagnostic accuracy, non-surgical treatment can be an option for patients estimated as cCR after treatment administered in a neoadjuvant setting. However, surgical resection is considered more appropriate because of residual tumor in some patients with cCR and because of superior DSS and RFS following esophagectomy compared with non-surgical treatment. Future studies must focus on ameliorating late postoperative complications such as respiratory failure and aspiration pneumonia.

Disclosure
All authors have declared no conflicts of interest.
RA10.03: IMPACT EXERTED BY NUTRITIONAL RISK SCREENING ON CLINICAL OUTCOME OF PATIENTS WITH ESOPHAGEAL CANCER
Authors: Wang Rui , Cai Hongfei , Cui Youbin 
Published: September 2018

Abstract

Background
Preoperative nutritional status of patients is closely associated with their recovery after the surgery. This study aims to ascertain the impact exerted by the nutritional risk screening on clinical outcome of patients with esophageal cancer, to provide scientific determination of nutritional support for patients suffering from esophageal cancer.

Methods
160 patients with esophageal cancer aged over 60, having got therapy at the First Hospital affiliated by Jilin University from Jun. 2016to Feb. 2017 were evaluated adopting the NRS2002. 80 cases of patients got active therapy of nutritional support, and the other patients not supported nutritionally were selected as the control group. The comparison was drawn between two groups in serum albumin, serum immunoglobulin, postoperative complications, hospitalization and hospitalization expenses. Experimental data were acquired through adopting t-test and χ2 test for statistical analysis.

Results
For all the patients, in 3 and7 days after the surgery, the serum albumin in the nutritionally supported group outstripped that in group without nutritional support (P < 0.05) regardless of the nutritional risk. For the patients in the risk of nutrition, the IgA in the nutritionally supported group outstripped that of group without nutritional support (P < 0.05) in 3 and 7 days before the surgery, and the serum IgG outstripped that of the group without nutritional support in 1 and 3 days before the surgery(P < 0.05). Two groups were not statistically different in the rate of postoperative complication (P > 0.05). In terms of the patients in the risk of nutrition, the average hospitalization of nutritionally supported group was shorter(P < 0.05), and the average hospitalization expenses were lower compared with those of the group without nutritional support. And for the patients in no risk, the hospitalization expenses of supported group surmounted those of group without nutritional support (P < 0.05), whereas the average hospitalization took on no statistic difference(P > 0.05).

Conclusion
For the patients in the risk of nutrition, preoperative nutritional support can facilitate the nutritional status and immunization-relative result after surgery, which shall also decrease the average hospitalization and hospitalization cost.

Disclosure
All authors have declared no conflicts of interest.
RA10.05: CHEMORADIOTHERAPY IMPROVES LOCO-REGIONAL CONTROL AND DISEASE-FREE SURVIVAL OVER CHEMOTHERAPY IN OESOPHAGEAL ADENOCARCINOMA WITH SIGNET RING MORPHOLOGY
Authors: Van Hootegem Sander , Smithers Mark , Gotley David , Thomson Iain , Brosda Sandra , Thomas Janine , Gartside Michael , Wijnhoven Bas P L , Van Lanschot J J B , Lagarde Sjoerd M , Barbour Andrew 
Published: September 2018

Abstract

Background
The presence of signet ring cells (SRC) is associated with poorer survival in multiple cancer types. Here we aimed to determine the predictive and prognostic value of SRC in oesophageal and junctional adenocarcinoma (OAC) for patients treated with neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT).

Methods
Patients who underwent nCRT and nCT followed by surgery for OAC between 2000 and 2016 were identified from two institutional prospective databases. Pre-treatment biopsy and surgical resection pathology reports were used to determine the presence of SRC morphology. The association between SRC histology and clinicopathological characteristics including pathological response was assessed. The prognostic impact of SRC on disease-free survival (DFS) and overall survival (OS) was determined. Survival was calculated with Kaplan Meier method and differences tested with log rank test.

Results
Of the 689 study patients, 129 had SRC (nCRT; n = 65, nCT; n = 64) and 560 patients had no evidence of SRC (nCRT; n = 326, nCT; n = 234). The SRC group had higher pT stage (P = 0.004) and median number of involved nodes (P = 0.004) following nCT compared with the non-SRC group. There were no significant differences between the two groups with respect to age, gender, tumour site, pN, R status or pathological complete response. For the 129 in the SRC group, nCT patients had significantly worse DFS (median [IQR]; 12 months [50–5]) compared with nCRT patients (median [IQR]; 26 months [111–9], P = 0.021). Moreover, nCT had a worse loco-regional recurrence-free survival (P = 0.004), but not distant recurrence-free survival (P = 0.74), in the SRC group. In contrast, there were no differences in DFS (P = 0.245) or recurrence patterns between nCRT and nCT among the 560 non-SRC patients. However, there was no significant difference in OS according to SRC status following nCT (P = 0.076) or nCRT (P = 0.541).

Conclusion
For SRC OAC, nCRT is associated with better DFS and loco-regional control compared with nCT. However, the presence of SRC in OAC was not prognostic for OS following nCT or nCRT.

Disclosure
All authors have declared no conflicts of interest.
VS01.07: THORACOSCOPIC ESOPHAGECTOMY WITH A HYBRID OF THE PRONE AND LEFT LATERAL DECUBITUS POSITIONS FOR ESOPHAGEAL CARCINOMA
Authors: Kawakubo Hirofumi , Mayanagi Shuhei , Kitagawa Yuko 
Published: September 2018

Abstract

Description
Because esophagectomy with radical lymphadenectomy is highly invasive, thoracoscopic esophagectomy (TE) is attracting attention as a less invasive procedure. We first performed TE with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE, and a total of 420 patients underwent TE with a hybrid position. We introduced TE with a hybrid position for the following three reasons: (1) Mobilization and lymphadenectomy around the middle and lower esophagus are easier in the prone position. Thanks to artificial pneumothorax and the gravity, the middle and lower mediastinum are opened, and which give us good surgical field. (2) Lymphadenectomy along the left recurrent laryngeal nerve (RLN) is more reliable and precise when performed in the left lateral decubitus position. We can dissect lymph node around the RLN higher position in the upper mediastinum. (3) Unexpected events requiring conversion to thoracotomy (e.g. massive bleeding, injury of other organs, dense intrathoracic adhesion, resection of adjacent organs) are easier to deal with in the left lateral decubitus position. The patient is fixed on the operating table with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position and vice versa using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left RLN is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax (7mmHg). The abdominal procedures have beenwere performed by hand-assisted laparoscopic surgery (HALS) and gastric tube reconstruction in thethrough a posterior mediastinal route was performed as s a standard surgical procedure in our institution. The magnifying effect of thoracoscope enables us to perform more precise surgery and preserve nerve and vessels, and a hybrid position is thought to be feasible and effective methods.

Disclosure
All authors have declared no conflicts of interest.
VS01.08: STEPWISE APPROACH FOR ROBOT-ASSISTED THORACOSCOPIC LEFT RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION
Authors: Chao Yin-Kai 
Published: September 2018

Abstract

Description
This video showed the stepwise approach for robot-assisted thoracoscopic left recurrent laryngeal nerve lymph node dissection. With the patient lying in the left semiprone position, a total of five trocars were positioned. Left RLN LND was begun by releasing the right esophagotracheal band. Subsequently, the trachea was gradually rotated clockwise through the application of a gentle pressure on the left edge of the tracheal cartilage with the goal of exposing and releasing the left esophagotracheal band. After the complete release of the bilateral esophagotracheal band, the esophagus was retracted toward the dorsal side with the right first robotic arm. Simultaneously, an assistant rolled back the trachea using a forceps grasping a small piece of gauze, with the aim of improving operative exposure. The left RLN was identified in the middle of the soft tissue between the trachea and the esophagus. Dissection was started from the ventral side RLN nodes and subsequently continued toward the dorsal side until the total skeletonization of the left RLN

Disclosure
All authors have declared no conflicts of interest.
VS02.09: LAPAROSCOPIC REPAIR OF RECURRENT TYPE IV PARAESOPHAGEAL HERNIA WITH COLLIS GASTROPLASTY
Authors: Hughes Timothy , Sclabas Guido , Chow Geoffrey 
Published: September 2018

Abstract

Description
Laparoscopic Repair of Recurrent Type IV Hiatal Hernia with Collis Gastroplasty In this case, we present a laparoscopic repair of a large, recurrent type four paraesophageal hernia with a Collis Gastroplasty. The patient presented 4 months after repair of an initial hernia at a separate facility with primary hiatal closure without an anti-reflux procedure. Intra-operatively, there was a giant type IV hernia with the transverse colon and the majority of the stomach in the right chest with an organ-oaxial volvulus. The colon and omentum were easily reducible, but the stomach was densely adherent within the right chest. After extensive dissection, the stomach was able to be reduced into the abdomen, but only two centimeters of intra-abdominal esophagus remained and a Collis gastroplasty was performed. A Nissen fundoplication was then performed at the end of the case. This case demonstrates three unique findings. The first is the short time to recurrence after a prior repair without any establishment of an anti-reflux barrier. The second is the unusual hernia with the majority of the stomach located in the right chest. Finally, this video demonstrates the technique of a laparoscopic Collis gastroplasty with a wedge fundectomy technique given the intra-operative findings of a short esophagus. This technique is a reproducible approach that creates a neo-esophagus that can be considered when there is axial tension after full mobilization of the esophagus. Identification of optimal location for stapler placement is facilitated by concurrent laparoscopy with endoscopic identification of the gastroesophageal junction.

Disclosure
All authors have declared no conflicts of interest.
VS03.04: MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH ROBOTIC ASSISTANCE AND IMMUNOFLUORESCENCE: MODULAR STEP UP APPROACH FOR SAFE INTRODUCTION OF NEW TECHNOLOGY
Authors: Fuchs Hans , Lambertz Rolf , Schröder Wolfgang , Leers Jessica , Bruns Christiane 
Published: September 2018

Abstract

Description
Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Aim of this study is to evaluate the introduction of new technologies in a center of excellence for upper gastrointestinal surgery.

Methods
A standardized teaching protocol of a complete OR team was performed in simulation and animal models at the center for the future of surgery (San Diego, CA) and IRCAD (Strasbourg, France) to receive certification as console surgeons. Starting 02/2017 the davinci xi and stryker ICG laparoscopy systems were introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n > 300 esophageal cases/year). After simple training procedures based on our minimally invasive expertise were performed, difficulty was increased based on a modular step up approach to safely perform robotic thoracic assisted Ivor Lewis esophagectomy.

Results
From 02/2017–02/2018, a total of 35 robotic cases were performed. All cases were performed safely without operation-associated complications. Level of difficulty was increased based on our modular step up approach without quality compromises. Video documentation using the new technology is provided.

Conclusion
The standardized training protocol and our modular step up approach allowed safe introduction of the new technology used. All cases were performed safely without operation-associated complications.

Disclosure
All authors have declared no conflicts of interest.
VS03.09: PRONE POSITION THORACOSCOPIC ESOPHAGECTOMY WITH INTRATHORACIC ESOPHAGOGASTRIC ANASTOMOSIS
Authors: Sancho-Muriel Jorge , Mingol Fernando , Nuñez Ruth , Vaqué Javier , De Jesús Milton , Cholewa Hanna , García Rafael , García-Granero Eduardo 
Published: September 2018

Abstract

Description
New minimally invasive techniques in esophageal surgery have shown promising results in postoperative care, reducing morbidity such as postoperative pain, respiratory complications due to thoracotomy and length of hospital stay among others, especially by the use of a thoracoscopic approach in the prone position. One of the reasons that limits the use of this technique the most is the intrathoracic thoracoscopic anastomosis, which is a very demanding procedure and the failure of which implicates high mortality. This video presents a thoracoscopic Ivor-Lewis esophagectomy in prone position, without selective intubation. We perform an en bloc esophagectomy with the resection of both pleuras and all of the lymphatic and adipose tissue around the esophagus up to the aortic plane, with an additional infracarinal lymphadenectomy. The subsequent reconstruction is an intrathoracic esophagogastric anastomosis using an Orvil® device and a manual tobacco-pouch suture to fit the head of the circular endostapler. This suture is reinforced by a laparoscopic endoloop. To perform this technique it is mandatory to make an assistance minithoracotomy for the placement of a gelport that allows the surgical specimen extraction and the placement of the circular endostapler without losing the pneumothorax, crucial for the surgical intervention. The aim of this video is to present step by step the thoracoscopic part of a minimally invasive, Ivor-Lewis subtotal esophagectomy, using the Orvil® device to perform the intrathoracic anastomosis.

Disclosure
All authors have declared no conflicts of interest.