bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.109: CLINICAL SIGNIFICANCE OF NEOADJUVANT CHEMOTHERAPY IN ESOPHAGEAL CANCER PATIENTS WITH SEVERE DYSPHAGIA
Authors: Kosugi Shin-Ichi , Nemoto Mariko , Ichikawa Hiroshi , Muneoka Yusuke , Kano Yosuke , Hanyu Takaaki , Ishikawa Takashi , Wakai Toshifumi 
Published: September 2018

Abstract

Background
Neoadjuvant chemotherapy (NAC) followed by curative resection is a standard treatment for resectable locally advanced esophageal cancer. However, clinical significance of NAC for patients with severe dysphasia due to esophageal stenosis was not fully validated.

Methods
Fifty patients with resectable locally advanced esophageal cancer who received cisplatin and 5-fluorouracil followed by curative resection between 2006 and 2005 in our institution were retrospectively reviewed. Twenty-one patients required nutritional support due to severe dysphasia before or during NAC (Group A) and the remaining 29 patients had no dysphagia (Group B). Clinicopathological characteristics, nutritional status, treatment-related adverse events, and survival were compared between the two groups.

Results
Seventeen patients received enteral feeding with transnasal tube and the remaining 4 patients (19%) received parenteral nutrition alone in group A. There were no significant differences in tumor characteristics between the two groups. Serum albumin levels of group A and B before NAC were 3.8 and 4.3 g/dL (P = 0.02), and those after NAC were 3.6 and 4.0 g/dL, respectively (P < 0.01). NAC completion rates of group A and B were 86% and 83% (P = 0.78) and grade 3 or higher leukocytopenia developed in 33% and 10%, respectively (P = 0.07). Postoperative pneumonia of grade 2 or higher according to the Clavien-Dindo classification occurred in 48% and 28%, respectively (P = 0.23). Five-year overall survival rates of group A and B were 45% and 71%, respectively (P = 0.04).

Conclusion
NAC could be safely completed in patients with severe dysphagia; however, those were likely to have treatment-related adverse events and poorer survival.

Disclosure
All authors have declared no conflicts of interest.
PS02.118: THE RESEARCH ABOUT SITE AND RISK FACTORS OF THE RECURRENCE AND METASTASIS AFTER POSTOPERATIVE RADIOTHERAPY IN ESOPHAGEAL
Authors: Li Jiancheng , Lin Yina 
Published: September 2018

Abstract

Background
To explore the risk factors of recurrence of postoperative esophageal cancer after radiotherapy, and analyze the regional and temporal regularity of this kind of recurrence.

Methods
Retrospective analysis the198 patients from Fujian Provincial Tumor Hospital Radiotherapy Department between January 2000 and December 2015 were collected of esophageal cancer after surgery, were treated with adjuvant postoperative radiotherapy, 198 patients were followed up for recurrence, To study the relationship between the observed indexes and the recurrence of esophageal cancer after radiotherapy. The recurrence site was divided into local recurrence and distant metastasis, and analysis of the relationship between the recurrence site and time, so as to take different treatment modalities for patients with different time periods.

Results
In 198 patients with recurrence and metastasis, 166 (84%) were found within 2 years.The patients whose metastasis and recurrence in 2 years, 43 cases (26%)had recurrence in the irradiation field, 85 cases (51%) had metastasis outside the irradiation field, 38 cases (23%) were both in and outside of the field. In 88 cases of recurrence within six months of the patients, only 18 cases (20%) recurrenced in the field, the recurrence rate was significantly lower than that of the outside the field. Multi-factor analysis results show that the lymph node metastasis and the start time of radiotherapy are the main risk factors affecting the recurrence, The postoperative pathological diagnosis in the control of N0, the risk of recurrence of N3 is 1.673 times of N0 (P = 0.036, HR = 1.673, 95%CI = 1.033 to 2.711); Less than 30 day recurrence risk is 2.482 times (P = 0.003, HR = 2.482, 95%CI = 1.364 to 4.520), more than 60 day recurrence risk is 1.42 times (P = 0.039, HR 1.42, 95%CI 1.019 to 1.979).

Conclusion
After radiotherapy after esophagectomy, 84% recurrence within 2 years, so should be closely followed up 2 years after the treatment, postoperative radiotherapy only control the radiation within the field of the recurrence rate within the next six months. Lymph node metastasis, radiation therapy, the start time is a risk factor for esophageal predicting recurrence after radiotherapy after surgery.

Disclosure
All authors have declared no conflicts of interest.
PS02.123: LYMPH NODE METASTASIS STATUS AFTER DIFFERENT STRATEGIES OF NEO-ADJUVANT THERAPIES FOR THE ESOPHAGEAL SQUAMOUS CELLS CARCINOMAS
Authors: Gong Lei , Tang Peng , Jiang Hongjing , Shang Xiaobin , Zhang Hongdian , Yu Zhentao 
Published: September 2018

Abstract

Background
Lymph node status is an essential prognostic factor for the long term survival of esophageal cancer patients. The impact of neo-adjuvant therpay on lymph node status remains unconcern, especially for squamous cells carcinomas. The study objectives were to retrospective analyzed the impact on the numbers and stations of metastasis of lymph nodes after the neo-adjuvant therapy.

Methods
Patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma at Tianjin Medical University Cancer Institute and Hospital from 2013 to 2017 were included in this study. Group 1 included the patients who were treated with surgery only (N = 120). Group 2 included the patients who received the neo-adjuvant chemoradiation (n = 77). Group 3 included the patients who received the neo-adjuvant chemotherapy (n = 117).

Results
In group 2, the pathological complete response (pCR) rate was 45.61%, partial response (PR) rate was 22.8%, and stable disease (SD) rate was 22.39%. In group 3, the pCR rate was 12.7%, PR rate was 27.8%, and SD rate was 59.5%. The lymph node metastasis rate at upper mediastinum was 22.39% in group 1, 17.54% in group 2, 35.90% in group 3. The lymph node metastasis rate at middle mediastinum was 19.40% in group 1, 1.75% in group 17.54% in group 3. There were no significant differences at other part of station.

Conclusion
There is still no standardized guideline for the treatment of esophageal squamous cells carcinomas. In our study, we retrospectively compared the effects of neo-adjuvant chemoradiation and chemotherapy on the status of lymph node metastasis. It is showed that there were less lymph node metastasis after the the neo-adjuvant therapy compared with the surgery alone group. But the group 2 had better pCR rates than the group 3. And after the chemoradiation, it also showed less lymph node metastasis on the upper and middle mediastinum. From the results of our study, we may draw a conclusion that neo-adjuvant chemoradiation would be a better choice for those patients who had multiple stations of lymph node metastasis. But we still need the prospective studies to verify our hypothesis.

Disclosure
All authors have declared no conflicts of interest.
PS02.124: NOVEL APPROACHES AND CONSIDERATIONS FOR IMMUNOTHERAPY IN OBESITY-ASSOCIATED OESOPHAGEAL ADENOCARCINOMA
Authors: Conroy Melissa , Galvin Karen , Dunne Margaret , Reynolds John , Lysaght Joanne 
Published: September 2018

Abstract

Background
Immunotherapies are transforming cancer treatment for inoperable and advanced disease. However, the incidence of obesity-associated cancers, including oesophageal adenocarcinoma (OAC) continue to increase. Treatment with immune-based therapies present a unique challenge for immunologists, as they need to enhance anti-tumour immunity without exacerbating pre-existing carcinogenic inflammation. Therefore, we examined the effect of PD-1 blockade in omentum and liver of OAC patients, sites of activated inflammatory T cells, which play a key role in obesity-associated inflammation. In addition, we examined novel ways to reduce the infiltration of inflammatory T cells to these sites in a bid to reduce adipose tissue inflammation.

Methods
Blood, omentum and liver samples were obtained from consenting OAC patients and treated with anti-PD-1 antibody. CD4+ and CD8+ T cell activation, cytokine expression and cytotoxic potential were assessed by flow cytometry. To identify potential chemokine pathways to alter T cell trafficking to the omentum and liver, chemokine receptor expression was examined, along with levels of secreted chemokines using flow cytometry and ELISAs. Pre-treatment of T cells with chemokine receptor antagonists was performed prior to chemotaxis assays using an in vitro transwell system.

Results
In addition to OAC tumour, omentum and liver were found to be enriched with substantial populations of PD-1 expressing T cells. Treatment of omental and hepatic T cells with anti-PD-1 did not enhance inflammatory cytokine expression or proliferation, but transiently increased CD107a expression by CD8+ T cells. MIP-1α, MIP-1β and IP-10 mediate T cell trafficking to the omentum and liver in OAC. OAC-derived T cells preferentially migrate to the adipose and liver tissue conditioned media of obese OAC patients and this can be significantly reduced using a MIP-1α receptor antagonist.

Conclusion
This study provides evidence that anti-PD-1 treatment is unlikely to exacerbate pre-existing T cell-mediated inflammation outside the tumour in obesity-associated cancers. Furthermore, novel CCR1 antagonists may be used to attenuate pathological inflammation in obesity. This dual targeting approach aims to enhance anti-tumour immunity through the use of immune checkpoint inhibitors, and has identified a novel immunotherapeutic approach to reduce obesity-associated inflammation by targeting key chemokine pathways. In vivo testing is required to determine the efficacy of this approach.

Disclosure
All authors have declared no conflicts of interest.
PS02.133: THE EFFICACY AND SAFETY OF S-1 MONOTHERAPY FOR RECURRENT OR METASTATIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA REFRACTORY OR INTOLERABLE TO PLATINUM PLUS 5-FU
Authors: Ito Takahiko , Honma Yoshitaka , Miyamoto Takahiro , Hirano Hidekazu , Shoji Hirokazu , Okita Natsuko , Iwasa Satoru , Takashima Atsuo , Kato Ken , Boku Narikazu 
Published: September 2018

Abstract

Background
Platinum plus 5-fluorouracil (FP) is recognized as the standard regimen of palliative chemotherapy for recurrent or metastatic esophageal squamous cell carcinoma (ESCC). Although taxane is widely selected for 2nd line regimen, other options are very limited. In Japan, S-1 is available for esophageal cancer. In this retrospective study, we evaluated the efficacy of S-1 monotherapy for recurrent or metastatic (advanced) ESCC refractory or intolerable to FP.

Methods
The subjects of this study were 11 patients with advanced ESCC who received S-1 after failure of FP. The endpoints evaluating efficacy were overall survival (OS), progression free survival (PFS), and overall response rate (ORR) in patients with target lesions (TLs).

Results
The characteristics of the subjects were: median age 69 years, PS (0/1) 5/6, number of prior chemotherapy regimens (1/2/3 ≥ ) 4/4/3. 9 patients were refractory and 2 were intolerant to prior FP. 9 patients had good control of the primary lesions. Only 2 patients received post-S-1 therapy. The median OS and PFS were 11.7and 3.0 months. Two of 9 patients with TLs, one refractory and the other intolerant to prior FP, achieved partial response (PR) while the remaining 7 patients showed progressive disease (ORR 22%). The other 2 patients without TLs showed nonCR/nonPD. Common treatment-related adverse events included grade 3 leukopenia for 1 patients (9.1%), but there were no serious cases.

Conclusion
ORR of 22% suggests modest activity of S-1 for advanced ESCC refractory or intolerable to platinum plus 5-FU (FP). However, more than half of the patients showed progressive disease. Future study exploring optimal patient selection for S-1 is warranted.

Disclosure
All authors have declared no conflicts of interest.
PS02.136: SURGICAL INTERVENTION FOR RECURRENT CANCER OF THE ESOPHAGUS
Authors: Muhinga Morris 
Published: September 2018

Abstract

Background

CASE REPORT ON SUCCESFUL SURGICAL INTERVENTION FOR RECURRENT CA OESOPHAGUS
45 year old female diagnosed with cancer of the oesophagus in 2013, CT Scan showed operable tumour. Patient underwent Ivor Lewis oesophagectomy. Histopatholgy showed pT2N0Mx(Stage IIA). Patient was followed up and was noted to be loosing weight in April 2016, upper GI Endoscopy showed recurrence of the tumour, at the intrathoracic stomach level.CT Scan revealed a tumour involving the stomach but no pulmonary nodules. In Multidisciplinary discussion it was agreed to offer patient surgical resection. At surgery the intrathoracic stomach was mobilised and resection done. Formal laparotomy was performed and the transverse colon prepared for colonic interposition at the cervical region. At the time of surgery the patient's weight was 38 kg, this increased to 45kg within the first 6 months after surgery. Patient underwent adjuvant chemotherapy and is doing well 2 years after the second surgery.

Methods
this is a case report.

Results
case report.

Conclusion
recurrence after esophagectomy is high and some patients can benefit from redo surgery.

Disclosure
All authors have declared no conflicts of interest.
PS02.143: OUTCOME OF SALVAGE ESOPHAGECTOMY OF ESOPHAGEAL CARCINOMA
Authors: Nishida Masato , Seto Yasuyuki , Yagi Koichi , Sugawara Kotaro 
Published: September 2018

Abstract

Background
Although the incidence of postoperative complications is higher than typical surgery, salvage esophagectomy for esophageal squmous cell cancer(ESCC) is expected to achieve good prognosis when it resutles in R0 resection.
At our hospital, definitive chemo radiotherapy(dCRT) consists of irradiation(50.4 Gy/28 Fr) with concurrent chemotherapy(Nedaplatin/TS-1, or 5FU continuous administration). Salvage surgery is performed 4 weeks after the end of dCRT in case of residual disease.

Methods
Among 55 patients of salvage surgery after dCRT in our hospital between 2006 and 2016, 47 patients underwent salvage esophagectomy. These cases are retrospectively reviewed in terms of factors related to short and long term outcome and survival.

Results
The clinical T factor was 4/2/116/25 in cT1/T2/T3/T4 respectively. Clinical evaluation after dCRT was non-CR/SD in 18 cases(38%), SD in 14 (30%), PDin 2(4.3%) and recurrence after CR in 13(28%). R0 resection rate was 75%. Postoperative complications occurred in 64%. The incidence of complications exceeding Clavien-Dindo class Grade3 were 45% and all in-hospital mortality was 8.5% (4 cases). Pathological therapeutic effects were Grade1a (30%) in 14 cases and Grade3 (32%) in 15. Pathologic lymphnode metastasis was detected in 4 cases among these 15.
The median overall survival (OS) time was 20.3 months and 3 year and 5 year OS rate were 39 and 22% respectively. Univariate analysis showed R1/2 cases, clinically positive lymphnode metastasis after dCRT, and pathological Grade 0/1/2 and pT3/4 was risk factors for overall survival rate. In multivariate analysis, R1/2 resected cases (HR 7.38, 95% CI 2.42–24.6, P < 0.01) were independent risk factor.

Conclusion
It is necessary to reduce the surgical insult of salvage esophagectomy with minimal invasive procedure and postoperative treatment.
Salvage esophagectomy is highly recommended as long as it achieves R0 resection resulting in good prognosis.

Disclosure
All authors have declared no conflicts of interest.
PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT
Authors: Taniguchi Yoshiki , Tanaka Koji , Miyazaki Yasuhiro , Makino Tomoki , Takahashi Tsuyoshi , Kurokawa Yukinori , Yamasaki Makoto , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection.

Methods
The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction.

Results
After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful.

Conclusion
There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice.

Disclosure
All authors have declared no conflicts of interest.
PS02.148: ENDOSCOPIC MANAGEMENT OF GASTRO-BRONCHIAL FISTULA FOLLOWING 2-STAGE OESOPHAGECTOMY USING OVER-THE-SCOPE-CLIP (OTSC): CASE SERIES
Authors: Ying Tan Chih , Arkar Kyaw Htet , Lorenzi Bruno , Charalampopoulos Alex , Venkatesh Jayanthi Naga , Tang Cheuk 
Published: September 2018

Abstract

Background
Post-oesophagectomy gastro-bronchial fistula (GBF) has significant morbidity and mortality. Management of GBF remains non-standardized due its rarity and limited available evidence. Re-operation and surgical repair has been the main approach. More recently, multimodal endoscopic treatment is gaining popularity as primary treatment option due to its relatively non-invasiveness, increasing evidence of success rate and reduced morbidity. We present a case series of GBF managed endoscopically using over-the-scope-clip (OTSC).

Methods
A dedicated, prospective and contemporaneous regional Upper GI cancer database was searched to identify GBF from January 2015 to December 2017. Clinical notes and investigation images of identified cases were analysed.

Results
Three patients developed post-oesophagectomy GBF during study period. Mean age of patients was 53. Mean time of GBF diagnosis was 233 days (range: 20–608). Two patients had endoscopic stent placement prior to OTSC application. Primary technical success was achieved in all patients. No adverse events were reported. Two patients had complete healing of GBF and mean healing time was 15 days (range: 6–24). One patient who had significant co-morbidities (peripheral arterial disease, diabetes, hepatitis C, rheumatoid arthritis and heavy smoker) developed persistent leak of GBF and died from cardiac event.

Conclusion
GBF and its surgical treatment are associated with a high morbidity and mortality. We present this case series where two out of three patients with GBF were successfully treated with this modality. Endoscopic therapy incorporating OTSC placement is a feasible option in management of post-oesophagectomy GBF. Further studies are required to understand and establish its role in treatment algorithm of post-oesophagectomy GBF.

Disclosure
All authors have declared no conflicts of interest.
PS02.149: COMBINED MULTI-MODALITY TREATMENT INCLUDING ONE-STAGE SURGERY FOR SYNCHRONOUS CANCER OF THE ESOPHAGUS AND PANCREATIC AMPULLA IN AN ELDERLY PATIENT
Authors: Decker Georges , Faber Bernard , Schalbar Claude , Foxius Alain , Groot Koerkamp Helene 
Published: September 2018

Abstract

Background
One-stage surgery for synchronous esophageal and pancreatic cancer has only very rarely been reported, mostly in younger patients. This is to our knowledge the first case of a completed multi-modality treatment (induction chemo-radiation, one-stage surgery and adjuvant chemotherapy) in an elderly patient.

Methods
Difficult case report.

Results
A 77 years old ASA-2 male patient, with a symptomatic 4 cm long adenocarcinoma of the gastro-esophageal junction, ycT3N0M0 and an adenocarcinoma of the ampulla of Vater (cT2N0M0, discovered by chance) underwent surgery after induction chemo-radiation (CROSS scheme). The patient previously had undergone a sigmoidectomy for perforated diverticulitis by median laparotomy. A one-stage radical subtotal esophagectomy was performed combined with a duodeno-pancreatectomy (Whipple) by laparotomy and right thoracotomy. The radical resection of the esophagus and pancreatic head with 2-field lymphadenectomy and total gastrectomy (due to resection of the gastro-duodenal artery) was done with intestinal reconstruction using a long segment right coloplasty with esophago-colic anastomosis in the right chest apex. Operative time was 710 minutes and blood loss 700 ml. Post-operative course was complicated by a small perforation of the proximal jejunum requiring reoperation for over-sewing at day 10 (Dindo-Clavien grade IIIA). Thereafter uneventfull recovery and post-operative hospital stay was 34 days until discharge to patient's home. Pathology: GEJ Adenocarcinoma ypT3N0M0, G2, R0 and adenocarcinoma of the ampulla of Vater with duodenal and peri-pancreatic fat invasion pT4N1M0, G2, R0. 2 lymph nodes were involved on the pancreatic specimen out of total 62 nodes (esophagectomy 40, duodeno-pancreatectomy 22). Adjuvant chemotherapy was administered for the locally advanced pancreatic cancer. Nocturnal nutritional supplements by jejunostomy were pursued during chemotherapy and the feeding jejunostomy was removed after full functional recovery 4 months postoperatively. Pancreatic enzyme supplementation was pursued. The patient has recovered his normal nutritional habits at 3 months and all preoperative physical activities at 6 months. 6 months follow-up CT-scan showed no recurrence.
Follow-up CT-scan after 1 year is suspicious for a solitary liver metastasis currently under investigation.

Conclusion
Combined multi-modality treatment for esophageal and pancreatic treatment is feasible in otherwhise fit elderly patients (> 75 years) with an acceptable functional and metabolic outcome.

Disclosure
All authors have declared no conflicts of interest.