bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.152: DEVELOPMENT OF INTESTINAL PNEUMATOSIS AND PORTAL VENOUS GAS AFTER ESOPHAGECTOMY IS NOT INDICATIVE OF ISCHEMIC BOWEL AND CAN BE SUCCESSFULLY MANAGED NON-OPERATIVELY
Authors: Gillaspie Erin , Moynagh Micheal , Said Sameh , Allen Mark , Blackmon Shanda , Cassivi Stephen , Nichols Iii Francis , Wigle Dennis , Shen K 
Published: September 2018

Abstract

Background
Pneumatosis intestinalis has long been a marker of advanced bowel ischemia and prompts urgent laparotomy. In post-operative settings, the presence of pneumatosis represents a significant management dilemma. We share a case-series of post-esophagectomy patients with pneumatosis intestinalis and no corollary intra-abdominal pathologic findings on re-exploration.

Methods
January 2000 to December 2017, 1760 patients underwent Ivor-Lewis esophagectomy or gastrectomy with jejunostomy-tube placement. Charts were reviewed retrospectively to identify patients with pneumatosis intestinalis discovered in the post-operative period. Demographic data, operative details and postoperative course were reviewed including incidence and details of re-exploration.

Results
Eleven patients met inclusion criteria. Nine were male (81.8%) and mean age was 69 years. All patients had radiographic confirmation of pneumatosis intestinalis and in many cases portal venous gas (Figure 1). Clinical course was variable without discernable trends in vitals or laboratory values. Development of significant postoperative ileus along with delivery of enteral tube feeds through a jejunostomy tube preceded development of the pneumatosis in all patients. Nine patients were re-explored and none had evidence of bowel ischemia.

Conclusion
The finding of pneumatosis intestinalis in the post-operative setting can be alarming and pose a management dilemma. With the advent of improved and readily available imaging, there has been an increase in findings that have no corollary physical symptomatology. In this series of patients, despite dramatic radiographic findings, none had ischemic bowel. Pneumatosis intestinalis alone in patients who have undergone esophagectomy should not be considered an indication for emergency re-exploration.

Disclosure
All authors have declared no conflicts of interest.
PS02.154: RISK FACTORS FOR WEIGHT LOSS 1 MONTH AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Mohizuki Hiromi , Mine Shinji , Nakahama Takashi , Watanabe Masayuki , Hiki Naoki 
Published: September 2018

Abstract

Background
Post-operative body weight loss (BWL) of patients who underwent esophagectomy is common. One month after esophagectomy, some patients lose weight remarkably, and others not. If preoperative or operative risk factors influencing body weight loss are identified, it will be possible that nutritional intervention is given to the patient having these risk factors.

Methods
In our department, the dietician stays in a surgical ward for nutritional management of patients. Ninety-two patients who underwent esophagectomy for esophageal cancer in 2016 were reviewed. Pre-operative and operative factors were correlated with post-operative BWL. The cut-off value of BWL 1 month after esophagectomy was defined with 75 percentile.

Results
The median body weight change was -4.8% (-18.5% ∼11.7%). The patients were divided into two groups; 24 patients with ≥ 7.3% of BWL (severe BWL group) and 68 with < 7.3% of BWL (mild BWL group). Patients’ characteristics or post-operative morbidities were not statistically different in these 2 groups. The incidence of patients with reconstruction using a colon or jejunum was higher in severe BWL group. Pre-operative body weight, body mass index, and the value of prealbumin was higher in severe BWL group. On postoperative 14 day, the patients in severe BWL group were likely to have lower energy intake per kilogram of pre-operative body weight. On multivariate analysis, high body mass index [odds ratio = 5.90; 95% confidence interval (CI) = 1.03–47.8; P = 0.046], upper location of tumor [odds ratio = 3.38; 95%, CI = 1.04–11.4; P = 0.043] were independently associated with severe BWL at 1 month after surgery.

Conclusion
High body mass index of ≥ 25, upper location of tumor were unfavorable risk factors for weight loss 1 month after esophagectomy for esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.155: THE ROLE OF AQUAPORIN 1 IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yamazato Yuzo , Shiozaki Atsushi , Kosuga Toshiyuki , Shoda Katsutoshi , Arita Tomohiro , Konishi Hirotaka , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Nakanishi Masayoshi , Fujiwara Hitoshi , Okamoto Kazuma , Kishimoto Mitsuo , Otsuji Eigo 
Published: September 2018

Abstract

Background
Aquaporin 1 (AQP1) is a membrane protein whose main function is to transfer water via cellular membranes. Recent studies have described important roles for AQP1 in epithelial carcinogenesis and tumor behavior. The objectives of the present study were to investigate the role of AQP1 in the regulation of genes involved in tumor progression and the clinicopathological significance of its expression in esophageal squamous cell carcinoma (ESCC).

Methods
Immunohistochemistry for the AQP1 protein was performed to investigate the expression of AQP1 in primary tumor tissues of 50 human ESCC samples underwent curative esophagectomy. Samples were categorized into two groups according to the expression of AQP1 in each of cytoplasm and nuclear membrane, and relationships with the clinicopathological features and prognosis of ESCC patients were investigated. Next, the location of AQP1 protein in TE5, TE15, and KYSE70 cells was investigated using immunofluorescence analysis. In addition, apoptosis assay was performed in these ESCC cells and the gene expression profiles of AQP1-depleted TE5 cells was analyzed using microarray and bioinformatic studies.

Results
In an immunohistochemical analysis, AQP1 was primarily located in the cytoplasm and/or the nuclear membrane of carcinoma cells. The 5-year survival rate of patients with the ‘cytoplasm dominant’ expression of AQP1 (46.8%) was significantly lower than other patients (77.6%). A multivariate analysis of the 5-year overall survival rate showed that the pT categories and cytoplasm dominance groups of AQP1 were independent prognostic factors (P = 0.042 and 0.036, respectively). Immunofluorescence analysis revealed that AQP1 protein mainly existed in the cytoplasm in TE5 and TE15 cells. On the other hand, the expression of AQP1 in KYSE170 cells was confirmed on the nuclear membrane. The depletion of AQP1 using siRNA induced apoptosis in TE5 and TE15 cells. The results of microarray analysis revealed that Death receptor signaling pathway-related genes were changed in AQP1-depleted TE5 cells.

Conclusion
The results of the present study suggested that the cytoplasm dominant expression of AQP1 is related to a poor prognosis in patients with ESCC, and that it regulates tumor progression by affecting Death receptor signaling pathway. These results provide insights into the role of AQP1 as a biomarker for ESCC.

Disclosure
All authors have declared no conflicts of interest.
PS02.159: RISK FACTORS OF 90-DAY MORTALITY IN PATIENTS WITH CHILD-PUGH A LIVER CIRRHOSIS RECEIVING ESOPHAGECTOMY
Authors: Cheng Chuan , Chao Yin-Kai 
Published: September 2018

Abstract

Background
Extensive esophageal resections are contraindicated in patients with advanced liver cirrhosis. However, little is known about the surgical risk of esophagectomy in early liver cirrhosis patients.

Methods
The clinical records of esophageal cancer patients with Child A liver cirrhosis and received elective esophagectomy were retrospectively analyzed.

Results
There were 40 patients with a mean age of 52.73 ± 8.81 years. 24 patients received chemoradiotherapy before surgery. Despite patients with Child-A liver cirrhosis (5%) had similar 30-day mortality with non-cirrhotic patients (3.8%, P = 0.8). The 90- day mortality rate (15%) was significantly higher in cirrhotic group (6%, P < 0.001). The most common complication after surgery was pneumonia and pleural effusion. The use of thoracoscopic surgery (26.3% vs. 4.8%, P < 0.05), intraoperative jejunostomy insertion (42.9% vs. 3.8%, P < 0.001) was associated with lower 90 day mortality while receiving chemoradiotherapy before surgery was associated with higher surgical risk (25.0% vs. 0%, P < 0.05). To our surprise, the presence of esophageal and gastric varices, splenomegaly, anemia and thrombocytopenia had no impact on short-term outcome.

Conclusion
Patients with Child A liver cirrhosis is still associated with higher 90-day mortality rate than non-cirrhotic patients. The introduction of minimal invasive surgery and routine setup of feeding jejunostomy is the key to decrease surgical risk while the use of preoperative chemoradiotherapy should be re-justified.

Disclosure
All authors have declared no conflicts of interest.
PS02.160: OUTPATIENT FOLLOW-UP IN OESOPHAGO-GASTRIC SURGERY PATIENTS: A SAFE AND COST-EFFECTIVE ALLIED HEALTHCARE PROFESSIONAL MODEL
Authors: Chung Tham Ji , Wright Amy , Bolter Marilyn , Berrisford Richard , Humphreys Lee , Wheatley Tim , Sanders Grant , Ariyarathenam Arun 
Published: September 2018

Abstract

Background
Post-operative follow-up for post oesophago-gastric resection patients are usually conducted by clinicians. Follow-up normally continues for a 5-year period. In high volume tertiary NHS centres, there is an increased demand for outpatient clinician episodes. We have successfully trialled and implemented a model using Allied Healthcare Professionals (AHP); consisting of a Cancer Nurse Specialist (CNS) and Specialist Dietician (SD). We propose that AHP follow-up in the outpatient department is cost-effective and beneficial to patients.

Methods
An AHP clinic was implemented in our regional tertiary unit in February 2017. All post-operative patients without any on-going complications were eligible to attend the AHP clinic from their second outpatient visit. Data was collected from February 2017 to January 2018. The data was prospectively collected and retrospectively analysed. The AHP follow-up clinic was conducted by a CNS & SD, which runs in parallel with a consultant led clinic. Each patient in the AHP clinic is given an extended 30-minute consultation, compared to a standard 10-minute consultant appointment. This allows for queries to be addressed thoroughly and investigations required to be made.

Results
During this initial trial period, there were 44 AHP clinics with 197 outpatient consultations; average of 4.5 patients per clinic. There was good outpatient attendance compliance and improved patient satisfaction. In more recent patients, assessment for pancreatic insufficiency, iron, folate, B12 and vitamin D deficiencies were assessed and treated. 27 of 77 (35%) had symptoms of pancreatic insufficiency, 6 of 57 (12%) had low folate, 4 of 52 (7%) had B12 deficiency and 6 of 26 (23%) had vitamin D deficiency. All patients with deficiencies were given supplementation.

Conclusion
AHP follow-up from their second visit is safe, improves patient contact and satisfaction. Nutritional deficiencies can be detected and treatment commenced by AHPs without detriment to patient outcome. This provides a platform for cost effective use of resources. AHP follow-up increases consultant outpatient episodes available for the hospital trust. In the next phase, the AHPs intend on having 270 patient consultations per year (6 patient consultations per clinic with 45 clinics per year) with a standardised nutritional deficiency assessment.

Disclosure
All authors have declared no conflicts of interest.
PS02.164: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER
Authors: Ohga Takefumi , Kuma Sosei , Ezaki Takahiro 
Published: September 2018

Abstract

Background
The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer.

Methods
A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions.

Results
The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II.

Conclusion
Discussion: In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality.

Disclosure
All authors have declared no conflicts of interest.
PS02.165: THE INCIDENCE OF CHYLOTHORAX AFTER ESOPHAGECTOMY CAN BE REDUCED BY LOW FAT TUBE FEEDING
Authors: Schurink Bernadette , Mazza Elena , Ruurda Jelle , Roeling Tom , Steenhagen Elles , Bleys Ronald , Hillegersberg Richard 
Published: September 2018

Abstract

Background
Chylothorax is a treacherous complication after esophagectomy associated with significant morbidity. Early enteral nutrition after surgery is important for recovery, but increases the pressure in the lymphatic system due to the absorption of triglycerids. To lower the incidence of chylothorax after esophagectomy, the use of low fat-containing tube feeding was evaluated as a standard of care following esophagectomy.

Methods
All consecutive patients who underwent an esophagectomy with gastric tube reconstruction and placement of jejunostomy at the UMC Utrecht between the 1st of January 2012 and the 31st of December 2017 were included. Tube feeding was started as standard of care on postoperative day 1 with a normal fat-containing formula in the period between 2012 and 2014 and with a low fat-containing formula between 2014 and 2017. The clinical diagnosis of chylothorax was confirmed by triglyceride levels > 1.24mmol/L in 27 patients (61.4%).

Results
Between 2012–2017 200 patients were included; 88(44.0%) received normal fat-containing tube feeding, 112(56.0%) low fat-containing tube feeding. Chylothorax was significantly less observed in the low fat formula group (n = 15, 13.4% versus n = 29, 33%, P = 0.001) No difference was seen in drain output, triglyceride levels in the pleura fluid, treatment strategy and hospital mortality. At multivariable analysis normal fat formula was associated with a 5.1 [2.1–12.1] odds for postoperative chylothorax. Other factors independently associated with chylothorax were transthoracic resection, anastomotic leakage, number of resected lymph nodes, and lower body mass index.

Conclusion
Administration of low fat-containing tube feed after esophagectomy lowers the incidence of chylothorax.

Disclosure
All authors have declared no conflicts of interest.
PS02.166: OESOPHAGO-GASTRIC CANCER PATIENTS OPERATED ON IN THE PRIVATE SECTOR SURVIVE LONGER THAN NHS PATIENTS
Authors: Botha Abraham , Heymans S , Knight William , Bott Rebecca , Maisey Nick , Deere Harriet 
Published: September 2018

Abstract

Background
In the UK, national directives have resulted in centralisation of oesophago-gastric cancer in large National Health Service (NHS) centres. NHS cancer centres have treatment pathway targets of 30 and 60 days to complete staging and start treatment. We have treated patients with oesophago-gastric cancer both in the NHS and private sector. The purpose of this study was to assess whether the treatment and outcome was different for patients treated in the private sector.

Methods
Data was collected prospectively of consecutive oesophago-gastrectomies for OGJ cancer performed by a single surgeon from 2003–2013. After diagnosis all cases were discussed in a multi-disciplinary meeting. Neo-adjuvant chemotherapy was offered to all patients deemed to have N1 or T3 disease according to MAGIC and OEO5 study protocols. Patients in these stage groups who declined neo-adjuvant chemotherapy were offered adjuvant chemotherapy or chemo-radiation. During the first 2 years oesophago-gastrectomy was performed by open surgery, where-after laparoscopic and thoracoscopic techniques were introduced. Data analysis was by logistic regression using SPSS software.

Results
204 resections for OGJ cancer were performed during. The average age was 63 years (range 41–82), 85% had adenocarcinoma, and 78% of patients received neo-adjuvant chemotherapy. The pathological staging was pN1 64%, pT0 5%, pT1 17%, pT2 32%, pT3 42%, pT4 3%. The median hospital stay was 14 days (range 6–210), and the in-hospital mortality was 2.5%. 40 patients had their treatment in private hospitals. There was no difference in the demographics, histology, tumour stage, percentage receiving chemotherapy, type of chemotherapy or surgery between private and NHS patients. Private patients completed their staging tests within 9 days (range 126) of endoscopy and started definitive treatment within 10 days (range 2–59) of the last staging test. 26 of the 40 patients (65%) operated on in the private sector survived 5 years which was more than the 39% of NHS patients who survived 5 years (P = 0.0084).

Conclusion
Treatment for oesophago-gastric cancer is evolving. Patients with oesophago-gastric cancer treated in the private sector have better long-term survival than NHS patients which might be related to their shorter treatment pathway. Further studies will elucidate the changes in treatment required to improve survival for all UK patients with oesophago-gastric cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.168: THORACIC DUCT EMBOLIZATION IN HIGH-OUTPUT CHYLOTHORAX AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Michiura Taku , Kariya Shuji , Miki Hirokazu , Mukaide Hiromi , Inoue Kentaro , Yamamichi Keigo , Tanigawa Noboru , Hamada Madoka 
Published: September 2018

Abstract

Background
Chylothorax after thoracic surgery is initially managed conservatively, but when persistent high-output chylothorax (> 1000 mL/day) is managed conservatively, the mortality rate exceeds 50%. The objective of this study was to examine the clinical results of thoracic duct embolization (TDE) in cases of chylothorax after esophagectomy for esophageal cancer.

Methods
The data of 9 patients (7 men, 2 women) whounderwent TDE for persistent high-output chylothorax after esophagectomy for esophageal cancer were gathered retrospectively. Lymphangiography was used to identify the supply route of lymphatic fluid from the lumbar lymphatics to the leakage site and lipiodol extravasation and its site. Transcatheter thoracic ductography was used to identify communication between the thoracic duct and the leakage site and extravasation of the iodinated contrast agent. TDE was performed by percutaneous transabdominal approach to cut off the supply route. The technical success and clinical success (drainage volume ≥ 10mL/kg/day within 7 days after TDE) of TDE were evaluated.

Results
The technical and clinical success rates of TDE were 89.9%, with no serious complications observed. In 44% of patients, the thoracic duct had ruptured. In the other 56%, the ruptured was in a collateral route bypassing the thoracic duct; the leaking lymphatic fluid was supplied without passing through the thoracic duct in 50% of these patients, but clinical success was achieved even in such patients.

Conclusion
TDE was found to be a safe method of treatment, with no serious complications.

Disclosure
All authors have declared no conflicts of interest.
PS02.169: CLINICOPATHOLOGICAL STUDY ON POORLY DIFFERENTIATED SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Fujieda Hironori 
Published: September 2018

Abstract

Background
Poorly differentiated Squamous cell carcinoma (SCC) is rare among esophageal cancer. This study investigated clinicopathological features on poorly differentiated SCC of the esophagus.

Methods
Forty-three patients who underwent radical resection of SCC of the esophagus at our hospital were included. Patients were assigned to a group with poorly differentiated SCC (Group P) or a group with well and moderately differentiated SCC (Group WM).

Results
Thirty-four patients were enrolled in Group WM and 9 patients in Group P. There were no differences between the two groups in terms of age, body mass index, location of the primary lesion, data of operation day, presence or absence of adjuvant chemotherapy and post-recurrence chemotherapy. There were more women and diabetic patients in Group P. In the pathological analyses, there were no differences between the two groups in the depth of invasion. The number of lymph node metastasis of group P (4.33) was significantly higher than that of group WM (1.77) (P = 0.008). The recurrence rate was also significantly higher in group P than the MW group (88.9%, 44.4%, P = 0.019). In the recurrent cases for the MW and P groups, there were no differences in the median relapse-free survival time (MW group and P group: 183 and 351days P = 0.565) and in the median post-recurrence survival time (MW group and P group: 250 and 297 days P = 0.579). There were 5 patients (14.7%) with T1a in group MW. The patients with the T1a have low rate of lymph node metastasis. Therfore, we examined the patients with T1b invasion and more depth (29 patients in group MW, and 9 in group P). The number of lymph node metastasis of group P (4.33) was significantly higher than that of group MW (2.03) (P = 0.019). The recurrence rate was also significantly higher in group P than the MW group (88.9%, 48.3%, P = 0.034).

Conclusion
Patients with poorly differentiated SCC have higher rate of lymph node metastasis and recurrence. However, there was no difference in prognosis after recurrence by the degree of differentiation.

Disclosure
All authors have declared no conflicts of interest.