bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.246: SURGICAL OUTCOMES OF SURGICAL T4B THORACIC ESOPHAGEAL CANCER
Authors: Uemura Norihisa , Abe Tetsuya , Higaki Eiji , Hosoi Takahiro , An Byonggu 
Published: September 2018

Abstract

Background
Patients with surgical T4b (sT4b) thoracic esophageal cancer undergo exploratory thoracotomy or non-curative resection. However, in some cases, it is difficult to decide whether to perform exploratory thoracotomy without resection, or perform non-curative resection to the extent possible. The purpose of this retrospective study was to analyze surgical outcomes of sT4b thoracic esophageal cancer to clarify the optimal treatment strategy.

Methods
A total of 12 patients with sT4b thoracic esophageal cancer underwent exploratory thoracotomy (n = 7) or non-curative resection (n = 5) between January 2011 and December 2015. Of the seven patients who underwent exploratory thoracotomy, two underwent bypass surgery. In the five patients who underwent non-curative resection, gastric reconstruction was performed. Clinical data from these 12 patients were analyzed retrospectively.

Results
Compared to the seven patients who underwent exploratory thoracotomy (Ex group), the five patients who underwent non-curative resection (NC group) had a significantly longer period until the start of post-treatment (median, 23/57 (Ex/NC) days; P = 0.0027). No significant difference was observed in the postoperative survival period between the two groups (Median survival time (MST), 9/12 (Ex/NC) months; P = 0.55). In the prognostic factor analysis, patients with progressive disease (PD) responsiveness to preoperative treatment had a significantly poorer prognosis (MST, 13.5/5.5 (partial response-stable disease/PD) months; P = 0.01). On the other hand, patients with cStage 3 disease and who received postoperative chemoradiotherapy had a relatively good prognosis (cStage 3/4; MST 12.5/5.5 month, P = 0.09, postoperative chemoradiotherapy received/not received; MST 13/5 month, P = 0.11). The period until the start of post-treatment was not a prognostic factor.

Conclusion
Responsiveness to preoperative treatment was found to be a prognostic factor in patients with sT4b thoracic esophageal cancer. Thus, if patients show a poor response to preoperative treatment, R0 resection should be performed without exploratory thoracotomy. On the contrary, for patients with a good response to preoperative treatment, administration of post-operative chemoradiotherapy should be considered, while maintaining performance status without causing serious secondary injury.

Disclosure
All authors have declared no conflicts of interest.
RA01.03: HAND-SEWN INTRATHORACIC ESOPHAGO-GASTRIC ANASTOMOSIS IN 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER
Authors: Charalabopoulos Alexandros , Lawrence Justin , Kordzadeh Ali , Lorenzi Bruno 
Published: September 2018

Abstract

Description
This is a video of a hand-sewn 2-layer end-to-side intra-thoracic esophago-gastric anastomosis performed thoracoscopically during a totally minimally invasive 2-stage esophagectomy for cancer. The suture material used is the barbed V-Lock. We routine perform this anastomosis in all 2-stage minimally invasive esophagectomies in our Unit since 2016. We have performed about 50 consecutive esophagectomies with this anastomosis with < 3% leak rate.

Disclosure
All authors have declared no conflicts of interest.
RA01.05: MINIMALLY INVASIVE ESOPHAGECTOMY AND 3-FIELD LYMPH NODE DISSECTION (ESOPHAGEAL SUSPENSION METHOD)—FUJIAN MEDICAL UNIVERSITY UNION HOSPITAL EXPERIENCE
Authors: Zheng Bin , Zhang Shuliang , Zeng Taidui , Zheng Wei , Chen Chun 
Published: September 2018

Abstract

Description
We have modified our procedures of lymphadenectomy, with the purpose of radical lymph node dissection, because we believe that radical lymph node dissection along bilateral RLNs may be crucial for post-operative accurate staging, local control and better prognosis. Programmed lymphadenectomy includes several steps. Programmed extensive lymphadenectomy along right RLN included 3 steps: (1) Location of the right vagus nerve. (2) Loaction of the root of the right RLN. (3) Extensive lymphadenectomy. Programmed extensive lymphadenectomy along left RLN was conducted subsequently, which included 4 steps. (1) Esophageal suspension. (2) Lymph node rolling.(3) Location and identification of left RLN. (4) Extensive lymphadenectomy. During the whole procedure, we preferred to use blunt separation in the zones near the RLN, and preferred to use the ultrasound knife and scissors rather than electrical knife. The thoracic esophagus was not cut off during the procedure. After the thoracic procedures, we do the laparoscopic gastric dissociation and lymph node dissection. When metastasis to either RLN chains was confirmed by routine intra-operative frozen section, bilateral cervical lymphadenectomy was also performed. We divided the procedures into steps, which could have following advantages: more radical lymph node clearance with skeletonization of the nerves, reduced injuries due to definite location and identification of the nerves, more easier for surgeons to expose the surgical field and more easier for new-hands to master the procedures. Minimally invasive esophageactomy and thoracoscopic programmed extensive lymphadenectomy along the left and right RLNs in esophagectomy was feasible and safe. According to our study, programmed extensive lymphadenectomy yielded sufficient lymph nodes, with acceptable postoperative complications.

Disclosure
All authors have declared no conflicts of interest.
RA01.08: LAPAROSCOPIC ROUX-EN-Y GASTROJEJUNOSTOMY FOR GASTRIC CONDUIT OUTLET OBSTRUCTION FOLLOWING ESOPHAGECTOMY FOR CANCER
Authors: Bernardi Daniele , Porta Matteo , Asti Emanuele , Lazzari Veronica , Ceriani Chiara , Bonavina Luigi 
Published: September 2018

Abstract

Description
After Ivor Lewis esophagectomy, gastric outlet obstruction refractory to prokinetic therapy and/or endoscopic pyloric dilatation is a challenging clinical problem. Thoracoscopic implant of a gastric neurostimulator has been reported to be effective, but long-term results are lacking. The patient, a 57-year-old woman, underwent a Ivor Lewis esophagectomy for T1N0 adenocarcinoma in 2007. Postoperatively, the patient complained of persistent dysphagia, regurgitation, and 29-kg weight loss. A mechanical obstruction was ruled out by barium swallow study and upper gastrointestinal endoscopy. Several conservative attempts with prokinetic agents and endoscopic dilatations failed, and the patient was exclusively fed through jejunostomy until the thoracoscopic implant of a gastric neurostimulator in October 2015. The postoperative course was uneventful. At six-months follow-up, the patient was able to assume a soft diet and reported a weight gain of 3 kg, with a significant improvement of the total symptom score and gastric emptying scintigraphy. Nevertheless, this encouraging clinical benefit gradually disappeared after the first year of follow-up. At the beginning of 2017, the patient experienced persistent episodes of vomiting and returned to jejunostomy feeding. The video shows the technique of laparoscopic Roux-en-Y gastrojejunostomy. After adhesiolysis and transhiatal mobilization of the distal gastric conduit, a 50 cm long Roux-en-Y alimentary limb was fashioned and anastomosed to the antrum. Post-operative course was uneventful and a gastrographin swallow study showed a satisfactory emptying of the conduit. At the 3-month follow-up the patient was able to resume a soft oral diet. Laparoscopic Roux-en-Y gastrojejunostomy appears to be safe and effective in treating refractory gastric outlet obstruction following Ivor-Lewis esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
RA02.02: RANDOMISED OESOPHAGECTOMY: MINIMALLY INVASIVE OR OPEN: THE ROMIO STUDY
Authors: Berrisford Richard 
Published: September 2018

Abstract

Background
Oesophagectomy is the mainstay of curative treatment for oesophageal cancer; however, surgery is followed by a reduction in health-related quality of life (HRQL). Whether minimally invasive approaches improve HRQL is unknown and limited comparative evidence available. The ROMIO study is a pragmatic multi-centre randomised controlled trial (RCT) aiming to establish the clinical and cost effectiveness of laparoscopically-assisted (LAO) versus open oesophagectomy (OO) in patients with oesophageal cancer in terms of HRQL, complications and survival. It includes an exploratory study of totally minimally invasive oesophagectomy (TMIO).

Methods
Adult participants referred for primary oesophagectomy or oesophagectomy following re-staging after neoadjuvant chemotherapy or chemoradiotherapy for oesophageal or oesophago-gastric adenocarcinoma or squamous cell cancer are eligible. Consenting patients are randomised 1:1 to receive OO or LAO except in two centres where participants are randomised to LAO, OO or TMIO (1:1:1). The primary outcome is the EORTC QLQ-C30 physical function scale, assessed at 3, 6 and 12 weeks after randomisation. Secondary outcomes include hospital stay, blinded assessment of pain, surgical complications, other aspects of HRQL and survival to 24 months. Quality assurance of surgery is assessed with, i) surgeon entry criteria based on provision of two operative videos, ii) 7 standard intra-operative photographs, and, iii) histopathological assessment of the specimen. A qualitative intervention is being used to train surgeons to recruit and communicate clinical equipoise. 406 patients are required to examine whether the minimum clinically important difference on the QLQ-C30 physical function scale is detected, allowing for 5% of patients allocated to LAO to undergo OO and a proportion to be inoperable or not followed up (90% power, 5% significance). This will also detect a clinically important reduction in length of stay.

Results
Seven UK centres involving 33 surgeons are recruiting. 288 patients have been screened, of which 206(73%) are eligible and 117(56%) eligible randomised. 21 surgeons have submitted at least two videos for assessment. Of the 102 patients operated on, 1058 photographs have been returned from 85 different patients. Follow up is currently at 79% for all time points.

Conclusion
This RCT will provide evidence to inform decision-making and informed consent for oesophagectomy.

Disclosure
All authors have declared no conflicts of interest.
RA02.06: PREVENTION OF ATRIAL FIBRILLATION AND POSTOPERATIVE COMPLICATIONS USING LANDIOLOL HYDROCHLORIDE AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Ojima Toshiyasu , Nakamori Mikihito , Nakamura Masaki , Katsuda Masahiro , Hayata Keiji , Yamaue Hiroki 
Published: September 2018

Abstract

Background
The aim of this study was to evaluate if landiolol hydrochloride is effective and safe in the prevention of atrial fibrillation (AF) after esophagectomy and that the reduction of AF incidence would reduce other postoperative complications. No prospective data exist regarding the efficacy of landiolol in preventing new-onset AF and translating low morbidity in esophageal cancer patients after esophagectomy.

Methods
One hundred patients scheduled for transthoracic esophagectomy were enrolled in a randomized, double-blind, placebo-controlled trial between March 2013 and January 2016 in our institute. Enrolled patients were randomized with 1:1 parallel allocation ratio to either with or without landiolol prophylaxis. The primary endpoint was the occurrence of AF after esophagectomy. The secondary endpoints were incidence of postoperative complications, hemodynamics and inflammatory index.

Results
Postoperative AF occurred in 15 patients (30%) in the placebo group versus five patients (10%) in the landiolol group. The landiolol group showed a significantly lower incidence (P = 0.012). Overall incidence of postoperative complications was significantly lower in the landiolol group (P = 0.046). In the landiolol group, postoperative heart rate was effectively suppressed, while the decreased of blood pressure was not harmful. IL-6 level was significantly lower in the landiolol group after the administration (P < 0.01).

Conclusion
This is the first comparative trial that proved landiolol is indeed effective and safe in preventing AF after esophagectomy. We recommend that landiolol to be a part of the regimen for perioperative management of esophageal cancer patients undergoing transthoracic esophagectomy. Registration number: UMIN000010648 (http://www.umin.ac.jp/ctr/)

Disclosure
All authors have declared no conflicts of interest.
RA02.09: THE EFFECT OF PREOPERATIVE BREATHING EXERCISE IN PATIENTS UNDERGOING ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Takuya Hamakawa , Hirao Motohiro , Nishikawa Kazuhiro , Fujiwara Ayako , Maeda Sakae , Uemura Mamoru , Miyake Masakazu , Hama Naoki , Miyamoto Atsushi , Kato Takeshi , Takami Koji , Nakamori Shoji , Sekimoto Mitsugu 
Published: September 2018

Abstract

Background
Patients with esophageal cancer often have impaired respiratory function. Postoperative pulmonary complications frequently occur in patients undergoing esophagectomy. We instructed patients undergoing esophagectomy to do breathing exercise with Incentive Spirometer Coach 2 (Smiths medical) for at least two weeks before surgery, as well as smoking cessation.

Methods
We retrospectively reviewed medical records of 52 esophageal cancer patients who underwent spirometry both pre- and post- Coach 2 exercise between 2009 and 2017. We evaluated the change of respiratory function and postoperative complications. The influence of exercise was analyzed between patients who underwent neoadjuvant chemotherapy (NAC group, n = 36) and those treated without NAC (non-NAC group, n = 16).

Results
39 males and 13 females were included. Median age was 65 (45–82). Surgical procedures were 48 subtotal esophagectomy, 3 transhiatal esophagectomy, and 1 pharyngo-laryngo-esophagectomy. Vital capacity (VC) and forced expiratory volume in one second (FEV1.0) were significantly improved through exercise; 3405 to 3600ml (P = 0.021) and 2485 to 2555 ml (P = 0.008), respectively. NAC group included more advanced-staged cases but age and baseline respiratory function were not significantly different from non-NAC group. Interval between first and second spirometry was 31 days for non-NAC group, 69 days for NAC group. After exercise, non-NAC group showed significant improvement in VC (3135 to 3600ml, P = 0.006), FEV1.0 (2255 to 2565ml, P = 0.004), whereas NAC group showed little change in VC (3560 to 3630ml, P = 0.514), FEV1.0 (2585 to 2555ml, P = 0.514). Postoperative complication occurred in 27 of 52 cases. Postoperative pneumonia occurred in 7 (13.5%) in the present cohort, which was less frequent than 42% in the historical control cohort without breathing exercise.

Conclusion
Preoperative breathing exercise with Coach 2 improved respiratory function in patients without NAC. In patients with NAC, the effect of exercise was smaller than non-NAC group, still exercise might suppress the decrease of respiratory function during NAC. Breathing exercise may reduce postoperative pulmonary complications.

Disclosure
All authors have declared no conflicts of interest.
RA04.01: PRONE POSITION IN THORACOSCOPIC ESOPHAGECTOMY IMPROVES POSTOPERATIVE OXYGENATION AND REDUCES PULMONARY COMPLICATIONS
Authors: Kakeji Yoshihiro , Otsubo Dai , Takiguchi Gosuke , Oshikiri Taro , Nakamura Tetsu 
Published: September 2018

Abstract

Background
While thoracoscopic esophagectomy is a widely performed surgical procedure, only few studies regarding the influence of body position on changes in circulation and breathing, after the surgery, have been reported. This study aimed at evaluating the effect of body position, during surgery, on the postoperative breathing functions of the chest.

Methods
A total of 266 patients who underwent right-sided transthoracic esophagectomy for esophageal cancer from 2004 to 2012 were included in this study. Fifty-four of them underwent open thoracotomies in the left lateral decubitus position (Group O), 108 underwent thoracoscopic esophagectomy in the left lateral decubitus position (Group L) and 104 patients were treated by thoracoscopic esophagectomy in the prone position (Group P). Two patients in Group P, who presented with intra-operative bleeding and underwent thoracotomy, were subsequently excluded from the pulmonary function analysis.

Results
Two patients in Group P had to be changed from the prone position to the lateral decubitus position and underwent thoracotomy in order to control intra-operative bleeding. Despite the significantly longer chest operation period in Group P, total blood loss was significantly lower in this group when compared to Groups O and L. Furthermore, patients in Group P presented with significantly lower water balance during the perioperative period and markedly higher SpO2/FiO2 ratio after the surgery. The incidence of respiratory complications was significantly higher in Group O when compared to the other two groups; however, no significant differences were observed between the Groups L and P.

Conclusion
From a surgical point of view, artificial pneumothorax and gravity improves the operative field view in the prone position without any compression of the right lung, thereby resulting in no mechanical damage to the lungs. Prone position esophagectomy is a useful surgical technique, which appears to preserve the postoperative pulmonary function. The patients are able to endure the surgical procedure and present with less respiratory complications.

Disclosure
All authors have declared no conflicts of interest.
RA04.04: EVOLUTION FROM THORACOSCOPIC ESOPHAGECTOMY (MIE) TO ROBOTIC-ASSISTED (RAMIE): ANALYSIS OF EARLY AND LATE RESULTS 195 CASES
Authors: Sallum Rubens , Takeda Flavio , Santo Marco , Cecconello Ivan 
Published: September 2018

Abstract

Background
RAMIE by Transthoracic and Abdominal robotic approach (TT-r) or Transhiatal robotic (TH-r) are options and gained evidence among the major oncological procedures as well as lymph nodal dissection. The concept of esophagectomy and extensive lymphadenectomy with low morbidity boosted by the videothoracoscopic esophagectomy(MIE) is now focused on the new robotic approachs.

Methods
41 cases of RAMIE were studied. The TT-r approach (prone position- three arms and abdominal robotic) was performed in 37 and TH-r approach in 5 (most elderly AC patients - 75 to 86y.o.). Conversion to open or laparoscopic procedures, morbidity and mortality as well as the length of the lymphadenectomy were evaluated. These data were compared to the first 154 cases of MIE operated by the same surgical team in those early results. Also the late survival of the MIE group is presented.

Results
All RAMIE except 2 cases were Siewert I or II Adenocarcinoma, 34 post neoadjuvancy: MAGIC (7) or CROSS (27). There was no conversion to lap or open procedures. No patient received blood transfusion. One complication was observed: a partial rotation of gastroplasty in the thorax, that required thoracoscopic approach in the day 7. Mortality (90 days) was zero. Mean resected lymph nodes was 40 (22–76) and less in TH-r (23 × 43). In the MIE group, complications were: respiratory (26.2%), infectious (8.4%), cervical fistula (17.7%), vocal cord palsy (8.4%). 30 and 90 days mortality were one (0.93%) and 3 (2.8%). Mean dissected lymph nodes = 31.6 (± 14.3), 1:57 positives (± 3.21) and RAD 00:05 (± 0:09). The overall five-year survival was 69% (95% CI: 57% - 83%), 75% in stage 0/I/II and 42% in III/IV.

Conclusion
RAMIE with TT-r or TH-r technical proposals, seems to be safe without mortality. Lymph nodal achieved was equal to greater than the practiced through MIE and both higher than TH-r cases. No mortality or major complications were observed on elderly patients (mean 80.5yo.) submitted to TH-r Esophagectomy

Disclosure
All authors have declared no conflicts of interest.
RA04.05: PREVALENCE OF LYMPH-NODE METASTASIS IN T1B ESOPHAGEAL SQUAMOUS CELL CANCER: IMPLICATIONS FOR ADDITIONAL RADIOTHERAPY DESIGN FOLLOWING ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Liu Jun , Fu Xiaolong , Li Hongxuan , Cheng Yan , Li Zhigang 
Published: September 2018

Abstract

Background
Endoscopic submucosal dissection (ESD) can be used as a less invasive treatment option for early esophageal cancer. But how to prevent lymph node metastasis is essential in these patients. This study aimed to analyze prevalence of lymph nodes metastasis for T1b thoracic esophageal squamous cell carcinoma(TESCC) patients treated in Shanghai Chest Hospital(SCH) and to propose a clinical target volume (CTV) for additional radiotherapy Clinical Target Volume design following endoscopic submucosal dissection(ESD) in these patients.

Methods
From 2012 to 2017, consecutive patients with T1b TESCC patients who underwent complete resection in SCH were identified. The prevalence of lymph-node metastasis were assessed and evaluated whether these metastasis areas would be encompassed by our proposed CTV. We proposed lymph-node stations (JEOG) 101, 104, 105, 106, 107 for upper TESCC, lymph-node stations 106, 107, 108, 1, 2, 3, 7, 8, 9, 10 for middle TESCC, and lymph-node stations110, 112, 1, 2, 3, 7, 8, 9, 10 for lower TESCC.

Results
There were 240 patients (80.4% male) who met the inclusion criteria, with a mean age of 62 ± 7 years. Of the total, 27.1%(65/240) patients presented with lymph nodes metastasis. Single lymph-node and single station lymph-node metastasis among positive nodes patients were 63.1%(41/65) and 70.8%(46/65), respectively.Tumor length exceeding 20mm and poor tumor differentiation but not age, gender, tumor position and tumor thrombus were independently associated with the risk of nodal disease. Among positive nodes patients, 89.2% (58/65) lymph-node metastasis for T1b TESCC patients could be covered by proposed CTV.

Conclusion
Prevalence of lymph node metastasis is high in patients with T1b TESCC. It seemed additional radiotherapy after ESD for those patients with high risk factors is needed to prevent lymph node metastasis. Majority positive nodes area could be covered by our proposed CTV. However, the value of radiotherapy and the proposed CTV should be investigated in further prospective studies.

Disclosure
All authors have declared no conflicts of interest.
RA04.06: ESOPHAGECTOMY IN PATIENTS WITH EARLY STAGE ESOPHAGEAL CANCER AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Tschoner Andreas , Ziachehabi Alexander , Spaun Georg , Adelsgruber Peter , Schöfl Rainer , Függer Reinhold 
Published: September 2018

Abstract

Background
Early stage esophageal cancer has a low risk of lymph node metastasis. Therefore, an organ preserving endoscopic submucosal resection for tumors staged uT1 N0 has already been established. In case of non-curative dissection according to oncologic criteria esophagectomy has to be performed to achieve an oncologic resection.

Methods
Between 2010 and 2016 42 patients with early stage esophageal cancer underwent endoscopic submucosal dissections (ESD). We retrospectively evaluated the operative and pathologic outcome as well as disease free and overall survival in patients, who were operated on with esophagectomy because of non-curative endoscopic resection.

Results
5 of 42 (11.9%) had to be operated on: 3 patients with open abdominothoracal resektion with intrathoracal anastomosis, 1 patient with an open approach and a cervical anastomosis and 1 patient with an laparoscopic/thoracoscopic approach but open intrathoracic anastomosis. Reasons for ongoing resection were three times R1 endoscopic resection, one L1 infiltration and one sm1-infiltration in a squamous cell carcinoma. There was no perioperative mortality. One anastomotic leakage was treated interventionally, one thoracic surgical site infection conservatively. One anastomotic leakage had to be resected, put on a saliva fistula and reconstructed with a colonic interponate. No recurrence of cancer is observed so far.

Conclusion
Esophagectomy after non-curative ESD shows no evidence for a worse oncologic outcome. There is no higher peri- and postoperative risk. This legitimates our step-up approach.

Disclosure
All authors have declared no conflicts of interest.