bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.231: RELATIONSHIP BETWEEN CHANGE IN TONGUE PRESSURE AND PNEUMONIA AFTER ESOPHAGECTOMY
Authors: Yokoi Aya , Ekuni Daisuke , Yamanaka Reiko , Morita Manabu 
Published: September 2018

Abstract

Background
Esophagectomy for esophageal cancer is a highly invasive procedure with several serious postoperative complications, including pneumonia. It is commonly accepted that deteriorated swallowing function causes postoperative pneumonia. However, measurement to evaluate swallowing function related to postoperative pneumonia has not been developed. Recently, it became possible to measure tongue pressure using a non-invasive, easy and portable device. We hypothesized that tongue pressure relates to postoperative pneumonia. The aim of this study was to investigate the relationship between change in tongue pressure and pneumonia after esophagectomy among inpatients with esophageal cancer.

Methods
Fifty-eight inpatients (39 males and 19 females; 33–77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure was performed using a portable device before esophagectomy (baseline) and at postoperative 1 and 2 weeks. Repetitive saliva swallowing test (RSST) was also performed to evaluate swallowing function at the same time. Pneumonia was postoperatively diagnosed by the chest X-ray, white blood count, body temperature and purulent sputum. The data of general and oral conditions were collected from medical and dental records. Data also included sex, age, type of cancer, cancer stage (International Classification of Diseases for Oncology ICD-10 version 2015), type of operation (thoracotomy or thoracoscopy), type of preoperative chemotherapy, surgical duration, amount of bleeding during surgery, type of reconstruction, incidences of postoperative complications, intubation period, body temperature, blood chemical analysis, health behaviors and oral condition. Differences in parameters between the pneumonia (+ ) group (n = 10) and pneumonia (-) group (n = 48) were analyzed by Mann-Whitney U or Chi-square test. Level of significance was set at P < 0.05.

Results
Tongue pressure significantly decreased after esophagectomy (P < 0.05). The decrease in tongue pressure, age, amount of bleeding during surgery, length of fasting days, the ratio of thoracotomy and aspiration in the pneumonia (+ ) group were significantly greater than those in the pneumonia (-) group (P < 0.05).

Conclusion
The decrease in tongue pressure was related to the incidence of pneumonia after esophagectomy among inpatients with esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.232: BASALOID CARCINOMA OF THE ESOPHAGUS: MULTIMODAL APPROACH
Authors: De Vega Marta , Miliani Carlos , Rodriguez Vitoria Juan , Antonio Martinez-Piñeiro Juan , Pereira Fernando 
Published: September 2018

Abstract

Background
Basaloid cell carcinoma of the esophagus (BSCCE) is a rare (0.07–4%) poorly-differentiated variety of squamous cell carcinoma (SCC), more aggressive and with a worse prognosis than typical SCC. There are no published studies on the best therapeutic option for these tumors or on of the effectiveness of Neoadjuvant chemoradiotherapie; so there is no standard treatment. We describe the characteristics and the therapeutic strategy applied to a patient with an avanced basaloid squamous cell carcinoma of the distal esophagus.

Methods
A 70-year-old woman with dysphagia and severe malnutrition was diagnosed with locally advanced esophageal cáncer of lower esophagus The biopsy indicated moderately differentiated basaloid cell carcinoma. The clinical diagnosis was cT4NxM0, We decided multimodal treatment with curative intent: Neoadjuvant chemoradiotherapie at a dose of 41.4 Gy and concomitant carboplatin and pacliotaxel 5 cycles (CROSS scheme) plus surgery.

Results
PET-TAC post-neoadjuvant re-evaluation showed partial morphological response (reduction of tumor metabolism in 34.7%). 6 weeks after radiochemotherapy we performed a three fields total esophagectomy. Postoperative course without incidents. The pathological diagnosis was BASALOID cell CARCINOMA located in distal esophagus of 10 cm long with 30% tumor residual; it affects gastro-oesophageal junction. Stage TNM 7th ed: ypT3 N0 (0/17) L0V1R0 Our patient is fine and without evidence of recurrence after 15 meses.

Conclusion
Basal squamous cell carcinoma is more common in men around 60 years old, being rare in older women. They are located more frequently in the middle than in lower esophagus. They are tumors of poor prognosis (poorly differentiated, locally advanced and with an aggressive biological behavior that predisposes to early metastasis) although the latest publications relate the prognosis especially with the stage of the tumor. There are no published data about the use of Neoadjuvant treatment for these tumors. We have carried out a multimodal treatment (Cross scheme) followed by surgery with clinical, radiological (PET-TAC) and pathological response (30% of residual tumor in the piece) CONCLUSION The multimodal treatment with Cross scheme and surgery was useful in patients with Basaloid tumor of the esophagus can be considered for patients with this type of tumor.

Disclosure
All authors have declared no conflicts of interest.
PS02.235: POOR ORAL HEALTH INCREASES RISK OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA: THE FOLLOW-UP STUDY OF THE LINXIAN NUTRITION INTERVENTION TRIAL
Authors: Yu Pei , Zhang Su , Wang Ming , Liang He , Fan Hu , Qiao Lin , Taylor Philip 
Published: September 2018

Abstract

Background
Several studies have suggested an association between poor oral health and esophageal squamous cell carcinoma (ESCC). We conduct this study to further examine the association between oral hygiene and ESCC risk in Linxian, the high risk area of China.

Methods
We recruit 29,553 healthy and 3318 esophageal squamous dysplasia participants aged between 40 and 69 in 1985 and then followed up until April, 2015. Basic characteristics were collected and oral related diseases were examined by trained doctors. Cox regression models were used to calculate hazard rations (HRs) and 95% confidence intervals (CIs).

Results
In general group, 2577 participants’ dead for ESCC and the cumulative rate of ESCC death was 12.9%. Teeth loss more than 20, before age of 40, bleeding of teeth, chapped lips, oral leukoplakia were significantly associated with risk of death from ESCC, and with 1.28 (95% CI: 1.18–1.38), 1.12 (95% CI: 1.03–1.23), 1.28 (95% CI: 1.13–1.45), 1.14 (95% CI: 1.04–1.25), 1.23 (95% CI: 1.12–1.35) fold increased risk of death from ESCC respectively in models adjusted for potential confounders. In dysplasia group, 540 participants’ dead for ESCC and the cumulative rate was 24.7%. Those who loss teeth more than 20, before age of 40, bleeding of teeth, have 1.24 (95% CI: 1.02–1.51), 1.25 (95%CI: 1.02–1.52), 1.35(95%CI: 1.06–1.70) fold increased risk after adjustment. Association between chapped lips and ESCC death was not found.

Conclusion
Severe teeth loss, early age teeth loss and teeth bleeding were associated with ESCC death and excess risk increased as dysplasia occurred. Chapped lips loss association with ESCC death in dysplasia group, it may reveals that it react before dysplasia change. Further studies are warranted to find the mechanism association and improvements of protecting oral health should be done.

Disclosure
All authors have declared no conflicts of interest.
PS02.241: SINGLE CELL RNA SEQUENCING REVEALS THE HETEROGENEITY OF NON-CANCER CELL POPULATIONS WITHIN THE ECOSYSTEM OF ESOPHAGEAL ADENOCARCINOMA
Authors: Walker Robert , Secrier Maria , Harrington Jack , Parker Rachel , Kelly Jamie , Byrne James , West Jonathan , Rose-Zerilli Mat , Underwood Tim 
Published: September 2018

Abstract

Background
Esophageal adenocarcinoma (EAC) develops in a complex ecosystem that defines tumour evolution, response to treatment and patient outcomes. We have shown that high levels of cancer associated fibroblast (CAF) in the tumour microenvironment (TME) predicts poor outcome and is inversely related to tumour infiltrating lymphocyte (TILs) abundance. Bulk sequencing studies lack the resolution to dissect the phenotypic and functional heterogeneity and cell-cell interactions of the TME. We have applied single cell RNA sequencing to 12 EAC patients to address this challenge.

Methods
A total of 24 single-cell suspensions were prepared from resected specimens and paired normal tissue. Single cells and barcoded mRNA-binding micro-particles were combined in droplets containing cell lysis buffer using a custom-built microfluidic platform. Captured mRNA with a cell barcode and unique molecular identifier was reverse transcribed, amplified and sequenced. SEURAT (v2.1, R-package) was used to identify highly-variable genes and perform cell clustering.

Results
Analysis of 6859 of the highest quality cells using the 4167 most variable genes revealed 46 clusters which were divided into 12 broad populations. Antigen Presenting Cells (n = 189), B Cells (n = 265), Cancer Cells (n = 1449), Endothelial Cells (321), Fibroblasts (1690), Mast Cells (n = 184), Monocytes/Macrophages (n = 254), Plasma Cells (n = 208), Smooth Muscle, (n = 115), Squamous Epithelium (n = 751), T Cells (n = 1433). Analysis of publicly available bulk RNAseq datasets (TCGA) of EAC showed that tumours that were ‘hot’ for a CAF gene signature were ‘cold’ for a T-Cell signature. Subset analysis of the fibroblasts from tumour samples that were enriched for the same CAF signature revealed 3 subtly different clusters. One of these sub-populations differentially expressed genes associated with the Gene Ontology terms GO:00,40011 (locomotion) GO:0,006928 (movement of cell or subcellular component) and GO:00,48870 (cell motility). The two tumours with the highest ratio of this type of CAF to T-Cells were both found to have distant metastasis at resection.

Conclusion
EAC CAFs are a heterogeneous population with distinct biological functions which may have different implications for prognosis. These early results suggest that we are able to identify candidate biological processes that may describe the mechanisms through which CAFs and TILs influence outcome.

Disclosure
All authors have declared no conflicts of interest.
PS02.243: THE EFFECT OF PREHABILITATION ON SARCOPENIA DEVELOPMENT DURING NEOADJUVANT CHEMOTHERAPY FOR OESOPHAGOGASTRIC CANCER: A RANDOMISED CONTROLLED TRIAL
Authors: Allen Sophie , White Daniel , Rockall Timothy , Preston Shaun , Sultan Javed 
Published: September 2018

Abstract

Background
Neoadjuvant chemotherapy (NAC) and surgery improves 5-year survival in patients with oesophagogastric (OG) cancer. NAC induces loss of skeletal muscle mass and function, leading to the development of sarcopenia (defined as > 5% skeletal muscle (SM) loss in patients with a BMI of > 20kg/m2). This is a poor prognostic indicator of outcome. We assess whether a prehabilitation programme (during NAC) results in a reduced rate of SM loss compared with ‘standard care’.

Methods
A single-centre, randomised controlled trial was conducted in patients undergoing NAC for OG cancer. Patients were assigned to a 15-week prehabilitation programme comprising twice weekly supervised aerobic and resistance training and a thrice weekly home exercise plan (Prehab), or standard care (Control). Patients underwent CT imaging at baseline (week 0) and following NAC (week 10). Analysis was performed using Tomovision SliceOmatic software, with a single slice at the third lumbar vertebra. Height provided the skeletal muscle index (SMI, cm2/m2). Hand grip strength (HGS) using an analogue dynamometer at weeks 0 and 10 supplied functional outcome.

Results
Since December 2016, 46 patients have been recruited, with a 15% drop-out rate (7/46). All patients received NAC. To date, complete dataset is available for 29 subjects (Prehab n = 16; Control n = 13). Groups were matched for baseline demographics, SMI and HGS (P = ns): Mean SMI 53.71 ± 10.15cm2/m2 and HGS 46 ± 11.13kg at baseline. There was a weak correlation between baseline HGS and SMI (0.58). No difference was observed in the rate of sarcopenia development during NAC (Prehab 68.75% (11/16) vs. Control 69.23% (9/13); P = 0.98), however there was a non-significant trend towards a smaller amount of skeletal muscle loss in Prehab subjects compared with Controls (-3.02 ± 3.22 cm2/m2 vs. -5.28 ± 3.00cm2/m2; P = 0.38). Similarly, NAC induced a trend towards lesser decline in mean HGS in the Prehab group versus Controls (-1.07 ± 1.28 kg vs. -2.08 ± 3.84kg; P = 0.25). A greater mean visceral fat loss was seen in the Prehab subjects compared with Controls (-16.04 vs -7.95; P = 0.02).

Conclusion
Interim analysis demonstrates a trend towards preservation of muscle mass and HGS, and significantly more visceral fat loss in patients receiving prehabilitation during NAC. Trial completion is warranted. The full dataset will be available by June 2018.

Disclosure
All authors have declared no conflicts of interest.
PS02.244: PEDICLED FLAPS IN ESOPHAGEAL SURGERY: WHERE THORACIC-, PLASTIC- AND ENT- SURGEONS MEET
Authors: Gschwandtner Elisabeth , Lindenmann Jörg , Fink-Neuböck Nicole , Fediuk Melanie , Porubsky Christian , Swatek Paul , Maier Alfred , Spendel Stephan , Schintler Michael , Thurnher Dietmar , Smolle-Jüttner Freyja-Maria 
Published: September 2018

Abstract

Background
Esophageal, esophago-hypopharyngeal and esophago-tracheobronchial fistulae or strictures arising either de novo or following therapeutic interventions constitute serious therapeutic challenges. If conservative measures fail, pedicled muscular or myocutaneous flaps are life-saving assets.

Methods
During the last 10 years we treated 13 patients (11 males, 2 females; mean age: 59; range: 44–82y) with complex esophageal/hypopharyngeal problems by using pedicled muscle flaps.

Results
All had but one case of lye ingestion had underlying malignant disease, all but two of the latter had had chemo- and or radiotherapy. At the time of the intervention eight patients were in a critical, septic condition. There were 5 esophago-tracheal, 2 esophago-bifurcational, one esophago-colo-bronchial, and one hypopharyngo-tracheal fistula, as well as one pharyngo-cutaneous fistula all following resection/reconstruction and/or attempts of surgical closure. One patient had stricture following external irradiation, another one anastomotic stricture. We applied a total of 17 pedicled flaps: 10 pectoralis major flaps (7 of them myocutaneous, three split flaps), 5 deltoideo-pectoral myocutaneous flaps and 2 sternocleidomastoideus flaps. In 11 patients additional intermittent stenting was used. In 6 patients the respective condition healed, 4 patients could be discharged but had minor recurrent fistulae that could be handled conservatively, in three cases persisting sepsis and multiorgan failure could not be overcome.

Conclusion
Muscle flaps can be life-saving in large fistulae of the esophagus and the hypopharynx and are useful for refractory cervical stenosis. In presence of multiorgan dysfunction, however, healing of flaps however initially vital, is often impaired.

Disclosure
All authors have declared no conflicts of interest.
RA01.02: THORACIC DUCT LIGATION DURING THORACOSCOPIC RADICAL ESOPHAGECTOMY
Authors: Perwaiz Azhar , Singh Amanjeet , Chaudhary Adarsh 
Published: September 2018

Abstract

Description
What is this video? This video is about ligation of thoracic duct during thoracoscopic radical esophagectomy for carcinoma esophagus with focus on where to search for thoracic duct during medistinal dissection. Why this video is unique? Routine ligation of thoracic duct during radical esophagectomy does not assure against post operative chyle leak but is can reduce incidence of clinically signifiant chyle leaks and need of invasive procedure to manage it. The video aims for post graduates teaching and for beginners and can be a usefull guide to search for thoracic duct while planning thoracic duct ligation for chyle leak. Note- the video uploaded is not in high definition as the permissible limit donot allow > 120mb

Disclosure
All authors have declared no conflicts of interest.
RA01.04: A METHOD FOR TOTALLY MEDIASTINOSCOPIC TRANSHIATAL MIDDLE AND LOWER MEDIASTINAL LYMPH NODE DISSECTION FOR ESOPHAGEAL CANCER
Authors: Hoshino Akihiro , Nakajima Yasuaki , Kawada Kenro , Tokairin Yutaka , Okada Takuya , Ryotokuji Tairo , Kume Yuichiro , Yamaguchi Kazuya , Kinugasa Yusuke 
Published: September 2018

Abstract

Description
Thoracoscopic esophagectomy for esophageal cancer is performed via different approaches at each hospital. In order to reduce the thoracoscopic operative time, we perform mediastinal lymph node dissection via the cervical and transhiatal approach whenever possible before thoracoscopic approach. Recently totally mediastinoscopic transhiatal middle and lower lymph node dissection has been performed, and we will report the method involving constant esophageal traction and esophageal transection in the mediastinum. The mediastinal operational field obtains a clear view by transecting the esophagus on the cranial side. Futhermore, towing the thread sutured the transected esophagus to outside the abdominal cavity makes it possible to achieve good visualization of the mediastinum using the assistant's two retractors. The median total operative time was 507 minutes, and the median thoracoscopic operative time after transhiatal approach was 105 minutes. It is possible to safely perform totally mediastinoscopic middle and lower lymph node dissection with this method.

Disclosure
All authors have declared no conflicts of interest.
RA02.01: COMPARISON OF THREE-FIELD VERSUS TWO-FIELD LYMPHADENECTOMY FOR THORACIC MIDDLE AND LOWER ESOPHAGEAL CANCER: POST-OPERATIVE RESULTS OF A RANDOMIZED CONTROLLED TRIAL
Authors: Li Bin , Xiang Jiaqing , Zhang Yawei , Zhang Jie , Sun Yihua , Hu Hong , Miao Longshegn , Ma Longfei , Luo Xiaoyang , Ye Ting , Zhang Yiliang , Shao Longlong , Li Hang , Zhang Yang , Chen Haiquan 
Published: September 2018

Abstract

Background
Patients with esophageal cancer can benefit from extended lymphadenectomy. However, the role of 3-field lymphadenectomy is unclear, and the extent of lymphadenectomy for thoracic esophageal cancer is still under discussion.

Methods
From June 2013 to November 2016, 400 patients with middle and lower thoracic esophageal cancer were randomly assigned to receive 3-field (3FL, n = 200) or the 2-field (2FL, n = 200) lymphadenectomy. The postoperative complications, according to the Clavien-Dindo classification, and lymph node metastasis were compared on the basis of intention-to-treat principle.

Results
Baseline characteristics were balanced between the 2 arms. There were 187 patients (93.5%) had squamous cell carcinoma in 3FL arm, and 192 (96.0%) in the 2FL arm, P = 0262. According to the pathological reports, T staging in the 2 arms were comparable, however more N3 patients in the 3FL arm (10.5%, 21/200) than that in the 2FL arm (10%, 5/200), P = 0040. Consequently, less TNM staging I patients in the 3FL arm (16.0%, 32/200) than that in the 2FL arm (25.5%, 51/200), P = 0.019. Operating time was significantly longer in the 3FL arm (median, 183 vs. 168 [2FL] minutes, P < 0.001). Six patients in the 3FL arm (3%, 6/200) had reintubation, whereas no reintubation in the 2 FL arm (0%, 0/200), P = 0.030. Other postoperative complications were comparable in the 2 arms. One patient in the 2-field arm died of chyloperitoneum. According to the Clavien-Dindo classification of surgical complications, the distribution of severity were similar between the 2 arms, P = 0.416. More lymph nodes were resected in the 3FL arm (Median, 37 vs. 24 [2FL], P < 0.001). Lymph nodes resected in the mediastinum and upper abdomen were comparable between the 2 arms. 44 patients (22%) in the 3FL arm had positive lymph nodes.

Conclusion
Compared with 2-field lymphadenectomy, 3-field lymphadenectomy doesn’t increase the surgical risks for patients with thoracic esophageal cancer. 3-field lymphadenectomy can be performed safely, removing unforeseen cervical positive lymph node, and offering more accurate tumor staging. Long-term survival analysis under protocol will clarify the role of 3-field lymphadenectomy for esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
RA02.04: UTILIZATION OF ENHANCED RECOVERY AFTER SURGERY (ERAS) PROTOCOL IN PATIENTS UNDERGOING ESOPHAGEAL RESECTION: META-ANALYSIS OF RANDOMIZED TRIALS
Authors: Triantafyllou Tania , Singhal Saurabh , Olson Michael , Bhirud Deepak 
Published: September 2018

Abstract

Background
ERAS protocol for esophageal surgeries has gained recognition in the past decade with reported benefits of shortened hospital stay, quick recovery of function, improved quality of life, lower morbidity, and reduced overall cost. A meta-analysis was conducted to establish weighted-pooled analysis of current literature comparing ERAS protocol against standard management following esophageal resection.

Methods
A systematic search of literature databases was completed from January-1990 to January-2018 using predetermined keywords. Inclusion criteria were randomized controlled trials (RCTs) with sample size of > 30 patients in each arm and with overlapping ERAS protocols. Primary outcome variables were mean hospital stay (days), mean time to passage of flatus (hours), bowel motion (days), and rate of anastomotic leak. Secondary outcome variables were cardiac arrhythmia, pulmonary complications and overall morbidity. Mean difference (MD) for continuous variables and Odds ratio (OR) or Risk Difference (RD) for dichotomous variables with 95% confidence interval (CI) were calculated. Between-study heterogeneity was assessed by the I2 statistics and χ2 Q-test. Random effect model was used for substantial heterogeneity (I2 > 40% or P < 0.10) and otherwise, fixed effect model was used.

Results
Three RCTs were identified with a total of 358 patients (179 in each group). Hospital stay [MD = 4.47(95%CI = 2.39–6.55; P < 0.00001; I2 = 98%)] and time to passage of first flatus [MD = 20.56(95%CI  = 1.05–40.07; P  < 0.00001; I2 = 99%)] were reported by all three studies and pooled analysis favored ERAS group with substantial heterogeneity. Time to first bowel motion significantly favored the ERAS group with the least heterogeneity [MD = 1.36(95%CI = 0.94–1.78; P = 0.63; I2 = 0%)]. All dichotomous variables showed minimal between-study heterogeneity. ERAS group showed better outcome with regards to overall morbidity [RD = 0.10(95%CI = 0.03–0.18; P = 0.45; I2 = 0%)], pulmonary complications [OR = 0.26(95%CI = 0.10–0.63; P = 0.91; I2 = 0%)] and rate of anastomotic leak [OR = 0.12(95% CI = 0.01–0.94; P = 0.47; I2 = 0%)]. There was no difference between the two groups for cardiac arrhythmias [OR = 0.77(95% CI = 0.19–3.18; P = 0.32; I2 = 0%)]. Other outcome variables of interest, including quality of life, patient satisfaction, hospital cost, and in-hospital or 30-day mortality were inadequately reported by studies to be amenable to pooled analysis.

Conclusion
ERAS protocol shows significant improvement in post-operative recovery and lower complication rates as compared with standard management, without any increase in anastomotic leak rate. However, variability and discrepancy in protocols followed by different institutions is noteworthy. Establishment of standardized ERAS protocols is warranted.

Disclosure
All authors have declared no conflicts of interest.