bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.224: MODIFIED INTRATHORACIC ESOPHAGOGASTROSTOMY AT MINIMALLY INVASIVE ROBOT-ASSISTED IVOR-LEWIS ESOPHAGECTOMY FOR CANCER
Authors: Wang Wen-Ping , Chen Long-Qi , Zhang Han-Lu , Yang Yu-Shang , He Song-Lin , Wang Yun 
Published: September 2018

Abstract

Background
The intrathoracic esophagogastrostomy played important role in minimally invasive Ivor-Lewis esophagectomy for cancer. The methods of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy mostly included hand-sewn, and circular stapler (anvil placement via OrVil system or transthoracically), which were still technically challenging. In this study, we modified the techniques of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy for cancer, in order to seek to simplify this complicated intrathoracic procedure. Then retrospective comparison between robotic and thoracoscopic cohorts was conducted.

Methods
We modified techniques focused on the ‘side-insertion’ anvil placement and purse string suture of intrathoracic robot-assisted esophagogastric anastomosis. The consecutive records of patients who underwent minimally invasive Ivor-Lewis esophagectomy for cancer via robot-assistant and thoracoscopic procedures in our department between January 2015 and November 2017 were retrospectively analyzed.

Results
Totally 47 patients were enrolled including 20 patients (male: 17, female: 3) in robot-assisted group and 27 patients (male: 21, female: 6) in thoracoscopic group. There was no conversion to open thoracotomy in both two groups. Mean operation duration of robotic group was 412.5 ± 63.5 min, significantly higher than 363.0 ± 53.3 min in thoracoscopic group (P = 0.006). Estimated blood loss in robotic group was less than that in thoracoscopic group (107.5 ± 63.5ml vs. 188.9 ± 94.3ml, respectively, P = 0.002). One patient (5.0%) in robotic group and two patients(7.4%) in thoracoscopic group had anastomotic leak. No postoperative reoperation or mortality (in-hospital or within 30 days after surgery) occurred in both groups.

Conclusion
Robot-assisted Ivor-Lewis esophagectomy was safe and feasible. Our modified procedure highlighting the ‘side-insertion’ method could simplify the process of intrathoracic anvil placement and purse string suture for the robot-assisted esophagogastric anastomosis. Robot-assisted Ivor-Lewis esophagectomy was nearly equivalent to thoracoscopic Ivor-Lewis esophagectomy at short-term outcomes, except higher operation time and less blood loss.

Disclosure
All authors have declared no conflicts of interest.
PS01.230: THE THREE-DIMENSIONAL ANIMATION ILLUSTRATING THE UPPER MEDIASTINAL ANATOMY FOR VIDEO-ASSISTED TRANSCERVICAL APPROACH IN ESOPHAGEAL CANCER SURGERY
Authors: Shinohara Hisashi , Kurahashi Yasunori , Ozawa Rie , Nakanishi Yasutaka , Niwa Hirotaka , Ishida Yoshinori 
Published: September 2018

Abstract

Description
Video-assisted transcervical approach may be promising for the upper mediastinal lymphadenectomy in patients with esophageal cancer. However, it is difficult to recognize positioning of landmark organs, such as the bronchus, recurrent nerves, and major vessels, since the operating field is unfamiliar for most surgeons and any anatomical charts have failed to show. Using a technique of the computer graphics, we have created three-dimensional animation illustrating the upper mediastinal anatomy which includes stepwise positional change of such landmark organs depending on progress of the dissection of the esophagus. This animation clip will become a useful tool for education for surgeons who introduce transcervical approach in upper mediastinal lymphadenectomy in video-assisted esophageal cancer surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.232: SHORT-TERM OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: He Haiqi , Fu Junke , Zhang Guangjian 
Published: September 2018

Abstract

Background
Surgical resection with radical lymphadenectomy is a pivotal component in the multidisciplinary therapy of esophageal cancer. Minimally invasive esophagectomy was shown to be effective in reducing the morbidity and was adopted increasingly. As a novel minimally invasive technique, robot-assisted esophagectomy remains in the initial stage ofapplication. This study describes the single-institution experience of robotic esophagectomy.

Methods
Between March 2016 and October 2017, 20 consecutive patients underwent robot assisted esophagectomy at our institute. The thoracic and abdominal mobilization were all performed with the assistance of the robot. We retrospectively collected the operative data and postoperative outcomes.

Results
The majority of patients were male (80%), and the median age was 62 years. The average operative time was 342 minutes (range 280–440). The average blood loss was 112 ml (range 50–400). No patient experienced conversion to a thoracotomy or laparotomy. R0 resection was achieved in all patients, the mean number of dissected lymph nodes was 19 (range 8–32). No 90-day operative mortality was observed, and postoperative complications were present in 8 of 20 patients (40.0%). Pulmonary complications were the most common event and were observed in 3 patients. Two patients experienced an anastomotic leak.

Conclusion
Our study demonstrated that robot-assisted esophagectomy is a safe and technically feasible alternative to conventional thoraco-laparoscopic esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.235: THE METHOD AND THE SHORT OUTCOME OF MEDIASTINAL LYMPH NODES DISSECTION FOR ESOPHAGEAL CANCER USING A TRANS-BICERVICAL AND TRANSHIATAL APPROACH UNDER THE PNEUMOMEDIASTINUM
Authors: Tokairin Yutaka , Nakajima Yasuaki , Kawada Kenro , Hoshino Akihiro , Okada Takuya , Ryotokuji Tairo , Okuda Masafumi , Kume Yuichiro , Kawamura Yudai , Yamaguchi Kazuya , Nagai Kagami , Akiata Keiichi , Kinugasa Yusuke 
Published: September 2018

Abstract

Background
We previously reported the performance of mediastinoscopic esophagectomy with lymph node dissection (MELD) under pneumomediastinum using a transcervical and transhiatal approach as a method of radical esophagectomy. For more complete lymph node dissection, it is necessary to dissect via not only left cervical but also right cervical approach in pneumomediastinum. We herein report the dissection method for upper mediastinum using a cervico-pneumomediastinal approach including right cervical approach in pneumomediastinum and the short surgical outcome.

Methods
This method was applied to nine cases for esophageal cancer. The right recurrent nerve was first identified using an open approach. Pneumomediastinum was then initiated to allow for the 105 and 106recR lymph nodes to be completely dissected along the right mediastinal pleura, the right vagus nerve, the proximal portion of the azygos vein and the right bronchial artery. The left recurrent nerve (106recL) lymph nodes and 106tbL lymph nodes were dissected using a cross-over technique, as described previously.

Results
This operation using bilateral cervical approach in pneumomediastinum were performed for nine cases. The median operation time and bleeding is 606 minutes and 506 ml, respectively. The median post-operative stay is 15 days.

Conclusion
MELD is therefore considered to be a more minimally invasive and useful modality for radical esophagectomy than the thoracic approach, although the field of view is different from that of the thoracic approach.

Disclosure
All authors have declared no conflicts of interest.
PS01.237: SAFETY OF RECURRENT LARYNGEAL NERVE NODAL DISSECTION IN PATIENTS WITH ESOPHAGEAL CANCER WHO HAD UNDERGONE CHEMORADIOTHERAPY
Authors: Chao Yin-Kai , De Leon Ayala Ivan 
Published: September 2018

Abstract

Background
Lymph node dissection (LND) along the recurrent laryngeal nerve (RLN) is a challenging surgical procedure that carries a high risk of morbidity, especially in patients who had undergone chemoradiotherapy (CRT). Here, we retrospectively examined the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had been previously treated with CRT.

Methods
Patients with esophageal cancer who had undergone thoracoscopic esophagectomy with RLN LND were divided into two groups according to prior treatment with CRT or not (CRT group versus upfront surgery [US] group, respectively). Intergroup comparisons were made in terms of 1) number of dissected nodes, 2) rates of RLN palsy, and 3) rates of perioperative complications. The learning curve for the RLN LND procedure was investigated with the cumulative sum (CUSUM) method.

Results
A total of 103 patients with esophageal cancer were included in the study (CRT group: n = 65; US group: n = 38). No conversion to open thoracotomy was required in either group. Moreover, intraoperative blood loss and the need for blood transfusions were similar. The technical challenges of RLN LND after CRT were more evident when performed in the left side. Accordingly, complete skeletonization of the left RLN was achieved only for 66.2% of patients in the CRT group, a percentage significantly lower than that obtained in the US group (86.8%; P = 0.022). Similarly, the rate of postoperative RLN palsy in the left side was significantly higher in the CRT group than in the US group (32.6% vs. 9.1%, respectively, P = 0.015), albeit not resulting in higher pneumonia rates. CUSUM analysis revealed a steep learning curve for left RLN LND performed in patients who had undergone CRT. Significant fluctuations in RLN palsy rates were observed over time, suggesting that proficiency did not improve linearly with increasing surgical experience.

Conclusion
To our knowledge, this is the first study to specifically investigate the feasibility and safety of thoracoscopic RLN LND in patients with esophageal cancer who had undergone CRT. Our data indicate that RLN LND is feasible even after CRT, although the technical challenges to be faced are greater than in CRT-naïve patients.

Disclosure
All authors have declared no conflicts of interest.
PS01.238: MESENTERY-ORIENTED LYMPH NODES DISSECTION AND INTRA-OPERATIVE NEURAL MONITORING TO REDUCE THE POSTOPERATIVE RECURRENT LARYNGEAL NERVE PARALYSIS IN ESOPHAGECTOMY
Authors: Kobayashi Hiroyuki , Mizumoto Motoko , Kondo Masato , Kita Ryosuke , Masui Hideyuki , Kitano Shoichi , Kumata Yukiko , Matsubara Takaaki , Shiokawa Keiichi , Kaihara Satoshi , Hosotani Ryo 
Published: September 2018

Abstract

Description
Background: As the thoracic esophageal carcinoma has a high metastatic rate of upper mediastinal lymph nodes, especially along the recurrent laryngeal nerve (RLN), it is crucial to perform complete lymph nodes dissection along the RLN without complications. Although Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as the useful tool of visual nerve identification, the utilization of IONM during esophageal surgery has not become common. Here, we describe our procedures focusing on a lymphadenectomy along the RLN utilizing the IONM. Methods and Procedures: We first dissect ventral and dorsal side of the esophagus preserving the membranous structure (mesoesophagus), which contains tracheoesophageal artery, RLN and lymph nodes. We next identify the location of the RLN which runs in the mesoesophagus using IONM before visual contact. After that, we perform lymphadenectomy around the RLN preserving the nerve. To evaluate the efficacy of this method, we compared short term surgical outcome of our 36 consecutive cases (neural monitoring group; Nm) of esophagectomy in prone positioning with 56 of our historical cases (conventional method group; Cm). Results: In all 36 cases of Nm group, we could obtain the location information of the RLN before the visual contact. Although the operation time of thoracic part was significantly longer in Nm group compared to Cm group (281 min vs. 254 min each, P = 0.005), postoperative RLN paralysis according to postoperative laryngoscopy was seen in 3 cases (8.3%) after surgical operation in Nm group, which was significantly lower than that in the Cm group (18/56, 32.1%, P = 0.005). As a result, median postoperative hospital stay was significantly shorter in Nm group than Cm group (22 days vs. 39 days each, P = 0.0003). Conclusion: Mesentery-oriented lymph nodes dissection using IONM has substantial advantages to perform accurate and safe thoracoscopic esophagectomy. It could decrease the RLN paralysis and postoperative hospital stay after esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.239: MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN PATIENTS WITH AIDS: AN ENTITY ON THE RISE
Authors: Lorenzi Bruno , Farhangmehr Neda , Akitikori Temisanren , Shanmuganathan Kanatheepan , Soile Oluwasunmisola , Hussain Aadil , Sdralis Elias , Charalabopoulos Alexandros 
Published: September 2018

Abstract

Background
Recently it was reported by World Health Organization that over 36 million people are living with HIV globally; for the first time ever life expectancy in people with HIV exceeds the average. This is mainly due to the development of highly active antiretroviral medication that have turned AIDS from a life threatening disease to a chronic condition. HIV patients are as prone as the general population to developing esophageal cancer. We aim to describe our experience and factors for consideration whilst treating HIV patients with esophageal cancer.

Methods
In 2017, 77 cases were surgically treated for esophageal and gastroesophageal junction cancer in our tertiary referral centre. n = 2 (2.5%) were HIV positive. Their disease, demographic and surgical characteristics were analyzed and the outcomes are presented.

Results
A 62 and 65-year-old HIV male patients had 2-stage esophagectomy for gastro-esophageal junction adenocarcinoma. They both had similarities with locally advanced tumours and late presentation with dysphagia and > 10% total body weight loss. Clinical staging revealed T3N2M0 tumours in both cases. Viral load was low (< 40 copies/mL) and both had neoadjuvant chemotherapy as first line of treatment. Both had a 2-stage esophagectomy; one had laparoscopic-assisted and the other had totally minimally invasive. Histological staging was ypT3N1 and ypT3N3 respectively. Antiretroviral medications were in both started enterally on day 1; in the first case via a triple-lumen nasojejunal feeding tube and in the second via a single-lumen nasogastric tube. No feeding jejunostomies were placed. No immediate post-operative complications were noted. Length of stay was 14 and 8 days respectively.

Conclusion
AIDS patients with esophageal cancer can present late, with advanced tumors, as dysphagia is common due to fungal esophagitis and tends to be underestimated. Where indicated, this cohort of patients should receive full multimodality treatment, like the general population, as results are no different. Multidisciplinary approach with involvement of an HIV specialist doctor from the beginning of treatment planning is of paramount importance as optimization prior to surgery is commonly necessary. Antiretroviral medications are needed immediately post-operatively in all cases and a clear plan for enteral route administration should be in place.

Disclosure
All authors have declared no conflicts of interest.
PS01.240: ROBOTIC ESOPHAGECTOMY USING THE DA VINCI XI: INITIAL EXPERIENCE FROM A TERTIARY CANCER CENTRE
Authors: Jiwnani Sabita , Tantravahi Umasankar , Ingle Parag , Patil Vijayraj , Karimundackal George , S Pramesh C 
Published: September 2018

Abstract

Background
Esophagectomy is a daunting procedure with a steep learning curve. Minimally invasive esophagectomy is associated with reduced perioperative complications. However, most studies so far have evaluated thoracoscopic or laparoscopic approaches. We describe our initial experience with robotic esophagectomy using the da Vinci Xi system.

Methods
We performed a retrospective analysis of a prospectively maintained database of patients operated with radical intent for esophageal cancer between November 2014 and November 2017.

Results
Thirty-four of the 483 curative esophagectomies were performed robotically. We performed the thoracic part in the semi-prone position and the abdominal part in a supine position. The thoracic component of the procedure was completed robotically in all 34 patients. For the abdominal approach, 19(55.9%) patients underwent gastric mobilization by the robotic approach, 9(26.5%) by the laparoscopic approach, and 6(17.6%) by laporotomy. The median age was 51 years and 76.5% of the patients were male. 73.5% of the patients had T3 tumours and 52.9% of the patients did not have significant nodes (N0) on preoperative imaging by PET-CT. 70.6% of the patients received neoadjuvant chemotherapy and 2.9% of the patients received neoadjuvant chemoradiotherapy. Standard two field (infracarinal and abdominal) lymphadenectomy was performed in 88.2% and three field lymphadenectomy in 11.8%. The median blood loss was 275 ml, with 85% of patients having blood loss below 400ml. The total surgical time (including docking and changing patient position) was 390 min. No patient needed intra or post-operative blood transfusion. Median ICU and hospital stay were 0.6 days and 10 days respectively. Major morbidity (Clavin-Dindo score > 3A) occurred in 17.6% with one post-operative mortality (2.9%). Pulmonary complications were seen in 8.8% and anastomotic leak in 11.8%. The median lymph nodes retrieved were 18. At a median of 24-months follow-up, the disease free survival was 58%, and the overall survival was 70%.

Conclusion
Transthoracic total esophagectomy is safe and feasible through the robotic approach. Larger studies with longer follow-up are needed to establish robotic esophagectomy as a standard surgical option for patients with esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.243: THORACOSCOPIC IVOR LEWIS MIE WITH END-TO-SIDE INTRATHORACIC ESOPHAGOGASTROSTOMY BY USE OF CIRCULAR STAPLER: INITIAL EXPERIENCE AND COMPARISION WITH MCKEOWN MIE
Authors: Ziccarelli Antonio , Vecchiato Massimo , Concina Serena , Petri Roberto , Martino Antonio 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy (MIE) has been met with increased interest for the surgical treatment of esophageal cancer. One critical obstacle for the implementation of MIE has been the intrathoracic anastomosis. In this study, we describe a technique of Ivor Lewis MIE in prone position and we present the short-term outcomes of this procedure compared to the McKeown MIE.

Methods
A total of 53 consecutive patients with with an Adenocacinoma of the gastroesophageal junction (GEJ) or the distal esophagus esophageal who had undergone MIE were included in the analysis. The clinical outcomes were analized and compared between the 24 patients treated with thoracoscopic two field Ivor Lewis (IL) MIE with intrathoracic stapled End-to-side anastomosis and 29 patients treated with thoracoscopic three field McKeown (McK) MIE with cervical stapled End-to-side anastomosis. The main outcome was postoperative respiratory complications. The secondary outcomes included the length of the operation, blood transfusion, number of dissected lymph nodes, postoperative morbidities and mortality.

Results
No statistical difference was found between postoperative respiratory complications (p: 0, 475), operative time (p: 0395), Lymph node retrieved (p: 0864), blood transfusion (p: 0951), ICU stay (p: 0131), oral intake in days (p: 0592), post operative stay (p:0830), anastomotic leakage (p: 0669), overall morbidity (p:0400), mortality (p: 0267). Anastomotic stenosis were more frequent in the McKeown group (p: 0062).

Conclusion
The intrathoracic stapled end-to-side anastomosis technique seems to be feasible, safe, and easy to perform, associated with a limited postsurgical complication rate and a good functional outcome.

Disclosure
All authors have declared no conflicts of interest.
PS01.244: MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER WITH THE PATIENT IN PRONE POSITION: EXPERIENCE OF 156 CONSECUTIVE CASES IN A SINGLE CENTER
Authors: Ziccarelli Antonio , Vecchiato Massimo , Lirusso Chiara , Rosignoli Alessandro , Silvestro Roberto , Innocente Roberto , Petri Roberto , Martino Antonio 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome.

Methods
Between July 2005 and December 2017, 156 patients underwent minimally invasive esophagectomy in the prone position at the authors' institutionin. Was performed 132 three field McKeown MIE (84,6%) with circular stapled cervical anastomosis and 24 two field Ivor Lewis MIE (15,4%) with circular stapled intrathoracic anastomosis; For four patients (2,6%) the colon was used for cervical anastomosis, and two patients (1,3%) had previously undergone left pneumonectomy because of lung cancer. The preoperative indication was squamous cell carcinoma for 100 patients (64,1%) and adenocarcinoma for 53 patients (33,9%). In three cases (1,9%), the histology of the specimen showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 79 patients (50,6%)

Results
In 152 patients (97,4%) was performed esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. In four cases (2,6%) an early thoracotomic conversion was necessary due to the presence of lung adhesions such that made it impossible to establish the pneumothorax. The mean operative time was 255 min (range: 130–420 min). The median intensive care unit stay was 2 days (range: 0–77 day), and the median postoperative hospital stay was 15 days (range: 8–79 day). The mean number of procured lymph nodes was 16 (range: 0–56 Ln). The perioperative pulmonary morbidity rate was 22,4%, and the perioperative mortality rate was 2.6%. An anastomotic leakage occurred in 13 patients (8,3%).

Conclusion
Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques.This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results.

Disclosure
All authors have declared no conflicts of interest.