bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.188: NOVEL ESOPHAGEAL RECONSTRUCTION VIA TRANS-MEDIASTINAL ROUTE FROM POSTERIOR TO ANTERIOR MEDIASTINUM AFTER ESOPHAGECTOMY FOR GASTRECTOMIZED PATIENTS WITH HIGH RISKS
Authors: Yasuda Takushi , Shiraishi Osamu , Iwama Mitsuru , Kato Hiroaki , Hiraki Yoko , Yasuda Atsushi , Shinkai Masayuki , Kimura Yutaka , Imano Motohiro 
Published: September 2018

Abstract

Background
Elderly patients or those who have undergone surgery for head and neck cancer (HNC) have a potential risk of dysphagia, in addition, the latter has a considerable difficulty for surgery for the neck. Intrathoracic anastomosis is preferable to preserve swallowing function and reduce surgical risk, because the cervical procedure can be avoided. However, the stomach cannot be used as a substitute in gastrectomized patients; thus, securing graft blood supply is critical. Nevertheless, microvascular anastomosis cannot easily be added in procedures for intrathoracic posterior mediastinal reconstruction. We therefore designed a novel technique for esophageal reconstruction to enable both intrathoracic anastomosis and microvascular anastomosis simultaneously even in gastrectomized patients. The purpose of this study was to evaluate the usefulness and safety of this technique.

Methods
Esophagectomy with mediastinal lymphadenectomy is performed through a right thoracotomy in the left decubitus position, and temporary chest closure is done after the esophagus is divided at the upper mediastinum with safe margin. Next, the patient is placed in the left half side-lying position, and the jejunal or ileocolic graft for reconstruction is created after removal of the remnant stomach in the supine position. Then, after the patient's position is changed to the left decubitus one and rethoracotomy is performed, the graft is pulled up through the anterior mediastinum, and is then passed into the right thoracic cavity via a small hole made in the anterior mediastinal pleura. The graft is then finally anastomosed with the remnant esophagus in the upper posterior mediastinum. Thereafter, microvascular anastomosis is performed in the retrosternal space through the skin incision in the supine position. Finally, the continuity of alimentary tract is completed.

Results
This new reconstruction procedure was performed for 4 patients with no significant postoperative complications, good swallowing function postoperatively, and no retention of food in the graft. There was no in-hospital death.

Conclusion
This novel trans-mediastinal reconstruction technique is a possible option in terms of enabling intrathoracic anastomosis and addition of microvascular anastomosis for highly selected gastrectomized patients with advanced age or a past history of HNC surgery.

Disclosure
All authors have declared no conflicts of interest.
PS01.189: A STUDY ON THE UTILITY OF INTRAOPERATIVE NEUROSTIMULATION MONITORING SYSTEM FOR RECURRENT LARYNGEAL NERVE IN ESOPHAGECTOMY
Authors: Kawano Fumiaki , Takeno Shinsuke , Tashiro Kousei , Hamada Rouko , Miyazaki Yasuyuki , Munakata Syun , Hamada Takeomi , Wada Takashi , Nakamura Kunihide , Nanashima Atsushi 
Published: September 2018

Abstract

Background
Recurrent laryngeal nerve paralysis in esophagectomy is one of the most concerned complications. In recent years, intraoperative neurostimulation monitoring system (IONM) in thyroid surgery have been widespread for identification of recurrent laryngeal nerve and assessment of soundness. Therefore, IONM is often used during esophagectomy in Japan. In this study, we examined the efficacy of IONM in the patients undergoing esophagectomy.

Methods
Of 66 patients underwent esophagectomy since April 2015 until December 2017, IONM used in 27 patients in the surgery for the examination of recurrent nerve paralysis. We retrospectively reviewed these cases for intraoperative findings, neurostimulation monitoring findings and their outcomes.

Results
Of 27 patients, 25 were male and two were female, and the median age at operation was 66 years old. Although IONM was used in cervical lymph node dissection, there were no vocal cord responses in 5 patients (left side in 4 and right side in 1) with stimulation of the vagus nerve. Because all patients had no vocal cord paralysis due to stimulation of the cervical recurrent laryngeal nerve, it was diagnosed that there was the recurrent laryngeal nerve injury due to thoracic para recurrent nerve lymph node dissection. IONM was able to facilitate the identification and preservation of cervical recurrent nerve in all patients. Three out of 5 patients with no vocal cord response by IONM were confirmed recurrent laryngeal nerve paralysis in postoperative endoscope. In patients with vocal cord paralysis by IONM, it was possible to carefully performed postoperative management. On the other hand, in patients without paralysis, extubation on the operation day seemed possible without the concern for aspiration.

Conclusion
By using IONM in esophagectomy, we were able to evaluate the damage of the recurrent laryngeal nerve in real-time. Confirming the intraoperative recurrent nerve injuries is important for postoperative management or prediction of postoperative aspiration pneumonia. IONM in esophagectomy was useful not only in terms of surgical procedures but also in the evaluation of postoperative management.

Disclosure
All authors have declared no conflicts of interest.
PS01.190: FLEXIBLE GASTRIC TUBE: A NOBLE METHOD OF GASTRIC TUBE RECONSTRUCTION WITHOUT ANASTOMOTIC LEAKAGE
Authors: Nakajima Yasuaki , Kawada Kenro , Tokairin Yutaka , Hoshino Akihiro , Okada Takuya , Ryotokuji Tairo , Okuda Masafumi , Kume Yuichiro , Kawamura Yudai , Yamaguchi Kazuya , Kojima Kazuyuki , Kinugasa Yusuke 
Published: September 2018

Abstract

Background
Anastomotic leakage is one of the most frequent and severe morbidities after esophagectomy. For preventing anastomotic leakage, it is important to design a gastric tube with sufficient blood supply and to perform precise anastomosis at a well-conditioned site. We herein show our method of gastric tube reconstruction and evaluate the outcome.

Methods
Seven hundred and forty-six esophageal carcinoma patients who received subtotal esophagectomy with gastric tube reconstruction via the retrosternal route between 1994 and 2017 were enrolled in the present study. Although we previously used a greater curvature gastric tube with a 4 cm in diameter (narrow group), since 2000, a ‘flexible gastric tube,’ which was designed on an individual basis with the aim of preserving the vascular plexus in the center of the anterior and posterior stomach wall to the maximum possible extent in order to supply a sufficient amount of blood to the tip of the gastric tube was used (flexible group). Cervical esophagogastric end-to-side anastomosis using the circular stapler was performed during the whole period. The clinical outcomes were compared between the two groups.

Results
Anastomotic leakage was observed in 36 (4.8%) patients. While 24 of 155 (15.5%) patients showed anastomotic leakage in the narrow group, 12 of 591 (2.0%) patients showed anastomotic leakage in the flexible group and the clinical outcomes were significantly improved.

Conclusion
Our method of gastric tube reconstruction helped to improve the rate of anastomotic leakage after esophagectomy. At present, we are investigating the status of the blood flow using an ICG fluorescence method and by measuring the degree of oxygen saturation and hemoglobin using a new non-invasive monitoring tool during the operation. Postoperative assessments of the anastomotic site are performed using endoscopic examinations. We herein report the results of these assessments.

Disclosure
All authors have declared no conflicts of interest.
PS01.196: SHORT-TERM AND MEDIUM-TERM OUTCOMES IN PATIENTS OVER 70 DIAGNOSED WITH OESOPHAGEAL CANCER
Authors: Madhavan Anantha , Wyatt Nicola , Boreham Charlotte , Phillips Alexander , Michael Griffin S 
Published: September 2018

Abstract

Background
Oesophageal cancer incidence has increased over the last decade in the UK, particularly in older patients. Surgery, with or without perioperative chemotherapy, remains the gold standard treatment for patients with potentially curable disease. Currently, 41% of new cases of oesophageal cancer are in patients aged over 70. However, only 10% underwent surgery compared to 25% of those aged under 70. Concerns exist that advanced age may prejudice treatment decisions. The aim of our review is to evaluate the impact of age on outcomes in those undergoing planned curative treatment for oesophageal cancer.

Methods
A retrospective review of patients undergoing oesophagectomy for carcinoma between 2006 to 2016 at a single institution was performed. Patients were divided into two cohorts based on age at the time of diagnosis; under 70 years (Group A) and over 70 (Group B). Patients underwent a standardised staging protocol and treatment was decided by a multi-disciplinary team. Oesophagectomy was performed using a transthoracic approach with two field lymphadenectomy and perioperative chemo (radio) therapy used in those patients with locally advanced disease who were fit enough.

Results
There were 555 patients in Group A and 241 in Group B. Adenocarcinoma was the prevalent histological subtype in both cohorts: 76% (423) in Group A and 68% (165) in Group B. Median age at the time of diagnosis was 62 in Group A versus 74 in Group B. In Group A, 12% (18/343) did not receive neo-adjuvant treatment for locally advanced cancer versus 47% (101/212) in Group B (P < 0.001). Median hospital stay was longer in Group B (18 v 15 days P = 0.02). There was no significant difference in hospital mortality (Group A 1% vs Group B 2.4% P = 0.37) and major complication rate (Group A 14% vs Group B 20% P = 0.31). Two-year survival was 66% (adenocarcinoma) and 78% (SCC) in Group A compared to 60% (adenocarcinoma) and 64% (SCC) in Group B.

Conclusion
These results demonstrate that patients over 70 can be treated successfully with minimal additional risk to morbidity and mortality. However, these patients are more likely to be denied neoadjuvant treatment which may compromise their long-term outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.202: MANAGEMENT OF RESECTABLE ESOPHAGEAL AND GASTRIC (MIXED ADENO)NEUROENDOCRINE CARCINOMA: A NATIONWIDE COHORT STUDY
Authors: Van Der Veen A , Seesing Mfj , Wijnhoven Bas P L , Steur Wo , Van Berge Henegouwen Mark I , Rosman Camiel , Van Sandick Johanna , Mook Stella , Haj Mohammad Nadia , Hillegersberg Richard , Ruurda Jelle , Brosens Lodewijk 
Published: September 2018

Abstract

Background
Esophageal and gastric neuroendocrine- and mixed adenoneuroendocrine carcinomas (NEC, MANEC) are very rare. Optimal treatment strategies, the role of surgery and outcomes remain unclear. The aim of this study is to provide insight in accuracy of diagnosing, current treatment and survival in patients with resectable esophageal and gastric (MA)NEC.

Methods
All patients with esophageal or gastric (MA)NEC, who underwent surgical resection between 2006–2016, were identified from the Dutch national registry for histo- and cytopathology (PALGA). Patients with a neuroendocrine tumor lower than grade 3 were excluded. Data on patients, treatment and outcomes were retrieved from the patients record. Diagnosis by endoscopic biopsy was compared with diagnosis by resection specimen. Kaplan Meier survival analysis was performed.

Results
A total of 49 patients were identified in 25 hospitals, including 21 patients with esophageal (MA)NEC and 26 patients with gastric (MA)NEC on resection specimen. Biopsy diagnosis of (MA)NEC was correct in 23/27 patients. However, 20/47 patients with definitive diagnosis of (MA)NEC, were misdiagnosed on biopsy. Neoadjuvant therapy was administered in 13 (62%) esophageal (MA)NECs and 12 (46%) gastric (MA)NECs. Survival curves were similar with and without neoadjuvant therapy. One (4.8%) esophageal (MA)NEC and 4 (15%) gastric (MA)NECs died within 90 days postoperatively. For esophageal (MA)NEC the median overall survival (OS) after surgery was 37 months and 1-, 3- and 5-year OS were 71%, 50% and 35%, respectively. For gastric (MA)NEC, the median OS was 23 months and 1-, 3- and 5-year OS were 62%, 50% and 39%, respectively.

Conclusion
Localized esophageal and gastric (MA)NEC are often misdiagnosed on endoscopic biopsies. After resection, long-term survival was achieved in respectively 35% and 39% of patients.

Disclosure
All authors have declared no conflicts of interest.
PS01.206: ASSESSMENT OF THE GASTRIC CONDUIT RECONSTRUCTION USING INDOCYANINE GREEN FLUORESCENT IMAGING DURING ESOPHAGECTOMY
Authors: Yamabuki Takumi , Ohara Masanori , Kaneko Tsukasa , Fujiwara Aki , Takahashi Ryou , Komuro Kazuteru , Iwashiro Nozomu 
Published: September 2018

Abstract

Background
Recently, indocyanine green (ICG) fluorescent imaging has been applied as a real-time navigation tool in various surgical fields. We used ICG fluorescent imaging for gastric conduit reconstruction during esophagectomy.

Methods
A total of 92 consecutive patients with esophageal cancer who received gastric conduit reconstruction during esophagectomy from February 2011 to December 2017 were enrolled in the present study. We made gastric conduit with hand-assisted laparoscopic surgery (HALS) following esophagectomy. A gastric conduit with a width of 3cm was usually fashioned. After evaluation of the blood flow to the gastric conduit using ICG fluorescent imaging, anastomosis was done by circular stapler.

Results
The study group was comprised of 73 males and 19 females and the median age was 70 years (range 54–85 years). Nineteen patients received preoperative chemotherapy and eleven patients received preoperative chemo-radiotherapy. Forty-eight patients underwent thoracoscopic esophagectomy, nineteen patients underwent thoracotomy and twenty-five patients underwent laparoscope assisted transhiatal esophagectomy. In eighty-five patients, reconstruction was done via the posterior mediastinal route, while six patients ware treated by the retrosternal route, and the subcutaneous route was used in one patient. Cervical anastomosis was done in 84 patients and intrathoracic anastomosis was done in eight patients. The complications of the gastric conduit reconstruction were anastomotic leakage in one (1.1%) patient and stricture of the anastomosis site requiring esophageal dilatation in 26 (28.3%) patients. Periodic esophageal dilatation was done in 13 (14.1%) patients. There was one case of stricture of the gastric conduit, one case of bleeding of the gastric conduit and one case of fistula between the gastric conduit and the lung.

Conclusion
The gastric conduit reconstruction using ICG fluorescent imaging during esophagectomy may contribute to a reduction in the incidence of anastomotic leakage. However, further advancement of the relevant skills is required to improve the incidence of stricture of the anastomosis site.

Disclosure
All authors have declared no conflicts of interest.
PS01.211: IMPLEMENTATION OF A TOTALLY MINIMALLY INVASIVE OESOPHAGECTOMY PROGRAMME IN A UK SPECIALIST CENTRE: INITIAL EXPERIENCE AND OUTCOMES
Authors: Akitikori Temisanren , Lorenzi Bruno , Shanmuganathan Kanatheepan , Soile Oluwasunmisola , Hussain Aadil , Farhangmehr Neda , Sdralis Elias , Venkatesh Jayanthi Naga , Charalabopoulos Alexandros 
Published: September 2018

Abstract

Background
Totally minimally invasive oesophagectomy although challenging to perform has garnered popularity in the surgical treatment of oesophageal cancer. Advanced laparoscopic surgical skills are needed with the construction of the intra-thoracic anastomosis in the case of a 2-stage procedure being the rate-limiting step. We aim to report our initial experience and short-term outcomes of totally minimally invasive 3-stage and 2-stage oesophagectomies for cancer.

Methods
From January 2016 when the minimally invasive oesophagectomy programme was implemented in our Unit, to December 2017, 65 consecutive cases underwent either a 2-stage or a 3-stage oesophagectomy for cancer. In all cases a radical 2-field lymph node dissection was performed. All were performed in a prone position and in the 3-stage oesophagectomies, superior mediastinal lympadenectomy was additionally performed. In the 2-stage cases an end-to-side esophago-gastric anastomosis was constructed in two layers with barbed knotless suture (V-LocTM).

Results
Male: female was 4:1 with a mean age of 66.44 years (IQR, 43–82). n = 53 were 2-stage and 12 were 3-stage oesophagectomies. Thirty five (53.8%) had neoadjuvant chemotherapy and 30(46.2%) went straight to surgery. There were no open conversions. No feeding jejunostomies were placed routinely. Complete resection (R0) rate was 61.54% (40/65) with a mean lymph node harvest of 28 (IQR, 11–68). Five (7.6%) anastomotic leaks were diagnosed (4 in 2-stage and 1 in 3-stage oesophagectomies), with 1(1.5%) of them (in the 2-stage group) being subclinical requiring no intervention. Furthermore, 1(1.5%) chyle leak and 1(1.5%) gastric staple line leak were also observed. Pulmonary complications were reported in 13.8% of cases and cardiac complications arose in 1.5%. Seven (10.8%) anastomotic strictures were also noted that were treated with endoscopic balloon dilatation. Mean hospital stay was 13 days and 30-day mortality rate was 4.62%.

Conclusion
Implementation of a minimally invasive oesophagectomy program in our high-volume tertiary centre is yielding good initial results. Vast previous experience in the field is of paramount importance. Hand-sewn intrathoracic anastomosis during 2-stage procedures is feasible and with repetitively good outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS01.216: INTRODUCING MINIMAL INVASIVE OESOPHAGECTOMY AT A DEPARTMENT
Authors: Ainsworth Alan , Larsen Michael , Fristrup Claus 
Published: September 2018

Abstract

Background
Minimal invasive oesophagectomy has gained increasing popularity. This study reports the results of the first two years after introducing the technique at our department.

Methods
All procedures have been prospectively registered in a database. All patients were followed until death, 2 years after surgery, or end of the inclusion period.

Results
140 procedures were performed (23 November 2015 to 1 February 2018). There were 19 women and 121 men. Median age was 67 years (range 16–83 years). Pathologic T-and N-stage is shown in table 1. Patients were divided into the first 70 patients and the last 70 patients. The mean procedure time was 352 minutes for the ‘first patients’ and 331 minutes for the ‘last patients’ (P < 0.001). The risk for conversion to open surgery in the abdominal procedure was 6% for the ‘first patients’ and 9% for the ‘last patients’ (NS). For the thoracic procedure the corresponding figures were 11% and 6% (NS), respectively. Median length of postoperative stay was 9 days for both groups. The risk of anastomotic leakage was 16% (‘first patients’) and 11% (‘last patients’) (NS). However, in only 4% and 7%, respectively, endoscopic or surgical treatment was required. For all 140 patients, pulmonary complications were observed in 26 cases (18%) and cardiac complications were registered in 15 cases (11%).The 30 day mortality rate was 3% (131 patients) and the 1 year survival rate was 83% (53 patients). Table 1: Pathologic T-and N-stage

Conclusion
Minimal invasive oesophagectomy can be introduced at a department with acceptable short time morbidity.

Disclosure
All authors have declared no conflicts of interest.
PS01.222: HAS A MEDIASTINOSCOPE-ASSISTED ESOPHAGECTOMY CONTRIBUTE TO CURABILITY AND MINIMAL INVASIVE SURGERY?
Authors: Uchikado Yasuto , Omoto Itaru , Sasaki Ken , Okumura Hiroshi , Kita Yoshiaki , Owaki Tetsuhiro , Osako Yusaku , Arigami Takaaki , Yanagita Shigehiro , Ishigami Sumiya , Natsugoe Shoji 
Published: September 2018

Abstract

Background
In a mediastinoscope-assisted esophagectomy, it is unknown whether it contributes to minimally invasive surgery or curability. We examined the outcome of treatment of a mediastinoscope-assisted esophagectomy performed in our hospital.

Methods
From June 2014 to October 2017, 31 patients underwent a mediastinoscope-assisted esophagectomy. The examined items were clinicopathological factors, preoperative complications, preoperative treatment, bleeding volume, operation time, postoperative complications, and recurrence.

Results
There were 29 males, 2 females, and the average age 66 years. As preoperative treatment, 12 nontreatment, 4 chemotherapies, and 15 chemoradiotherapy (CRT) were performed. Preoperative complications were found in 27 cases, among which 13 cases were respiratory complications. The percentage of double cancers was also high, 8 cases with synchronous cancer, and 6 cases with metachronous cancer. Gastric cancer accounted for half in synchronous cancer, and in metachronous lung cancer was 4 cases. The reconstructed organs were 29 cases of stomach tube and 2 cases of colon. The reconstruction route was 17 cases in front of the chest wall and the chest wall anterior route was selected for the case of preoperative CRT significantly. The average bleeding volume was 316 ml, and the average operation time was 560 minutes. Pathological tumor depth T0/1a/1b/2/3 were each 2/11/6/7/4 cases. In the postoperative complications, 12 cases of temporary recurrent nephropathy, 5 cases of anastomotic suture failure, 3 cases of pulmonary complications. There were 6 cases (19.3%) of recurrence. Postoperative recurrence was associated with significant pathological tumor depth.

Conclusion
A mediastinoscope-assisted esophagectomy decreased postoperative pulmonary complications and there were not many recurrences after surgery. It seemed to contribute to minimally invasive surgery and curability.

Disclosure
All authors have declared no conflicts of interest.