bluuebunny/crossref_metadata_2025_split huggingface dataset:
FA02.05: PROGRESSION RATE OF BARRETT’S ESOPHAGUS FROM NATIONAL REGISTRY OF EXPERT CENTERS IS MUCH GREATER THAN ANTICIPATED FROM POPULATION STUDIES
Authors: O'Byrne Lisa , Verhage Roy , O'Brien Marie , O'Toole Dermot , Muldoon Cian , Buckley Martin , Murphy Tom , Reynolds Rob , Patchett Stephen , Kay Elaine , Azam Haleema , Ravi Narayanasamy , Reynolds John 
Published: September 2018

Abstract

Background
Barrett's Esophagus (BE) is well established as the main pathological precursor for esophageal adenocarcinoma (EAC). Progression to high grade dysplasia (HGD) or EAC varies widely between population based studies and specialized BE registries from high volume centers. No such data existed from the Republic of Ireland until 2011 when a multicenter registry was established involving three centers to more accurately determine the risk of progression to EAC in the Irish population.

Methods
A detailed clinical, endoscopic and pathological database includes 3397 patients from January 2008 to July 2017, with BE defined by the presence of specialized intestinal metaplasia (SIM). A prospective web based database was used to gather information from three designated esophageal centers with initial and follow up data abstracted by a data manager and overseen by a project manager.

Results
325 were excluded following a diagnosis of HGD or EAC at index biopsy, or being a tertiary referral, leaving 3072 with a median age of 61 and a 2.1:1 male to female ratio and a median follow up of 3 years, and 5024 person years. 127 (4%) cases progressed to HGD/EAC, 65 after one year of follow up. 55 (2%) developed EAC were identified, 30 of those within one year. The overall incidence HGD/EAC was 2.53% per year, 1.3% if the first year is excluded. The risk of progression to EAC alone was 1.09% per year, 0.5% excluding the first year. Low grade dysplasia (LGD) on index biopsy was associated with a progression rate of 11.7% per year, 4.2% with the first year excluded.

Conclusion
With strict data entry and pathologic quality assurance, progression rates for non-dysplastic BE was several fold higher than population studies, highlighting caution in abstracting from population data. True LGD, as evidenced in a recent report by Kestens et al.1 represent high risk disease, with most of the risk evident within the first year. Reference: 1. Kestens C, Offerhaus G, van Baal J, Siersema PD. Patients wtih Barrett's esophagus and persistent low-grade dysplasia have an increased risk for high- grade dysplasia and cancer. Clin Gastroenterol Hepatol. 2016;14:956–962

Disclosure
All authors have declared no conflicts of interest.
FA03.04: ACTIVE SURVEILLANCE VS SURGERY IN CLINICALLY COMPLETE RESPONDERS AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: A PROPENSITY-MATCHED STUDY
Authors: Van Der Wilk Berend , Neijenhuis Lisanne , Noordman B , Nieuwenhuijzen Grard A P , Sosef M N , Van Berge Henegouwen Mark I , Lagarde Sjoerd M , Wijnhoven Bas P L , Van Der Gaast Ate , Van Lanschot Jan B J 
Published: September 2018

Abstract

Background
Nearly one third of esophageal cancer patients show a pathologically complete response in their resection specimens after neoadjuvant chemoradiotherapy (nCRT) according to CROSS regimen. This raises questions whether all patients benefit from surgery or if active surveillance can be applied to patients with a clinically complete response (cCR) after nCRT. This retrospective-multicenter propensity matched study compared outcomes of patients with a cCR after nCRT undergoing active surveillance or standard surgery.

Methods
Patients that refused surgery after nCRT between 2012–2017 from 4 hospitals were included. For the standard surgery group, patients from the preSANO trial were enrolled. A cCR was defined as endoscopies with multiple (bite-on-bite) biopsies, EUS-FNA and PET-CT showing no residual disease 6 and 12 weeks after completion of nCRT. Optimal propensity-score matching generated a matched cohort (1:2) matched for age, comorbidities, cT, cN, histology of the tumor and biopsy type. For comparison of severity of complications according to Clavien-Dindo (CD) classification, a separate optimal propensity-score matching cohort was generated (1:2) for all patients in the active surveillance group that underwent surgery. Primary outcome was overall survival, secondary outcomes were rate of radically resected tumors, distant dissemination rate and rate of postoperative complications according to the CD-classification.

Results
75 patients were identified of whom 50 patients underwent standard surgery and 25 patients underwent active surveillance. 13 of 25 patients in the active surveillance group underwent surgery for locoregional recurrent disease. Median follow-up was 23.7 months for the standard surgery group and 18.8 months for the active surveillance group. There was no statistically significant difference between the groups in overall survival (HR = 0.48, 95%C.I. 0.10–2.2, P = 0.96). In both groups, all tumors were radically resected. There were no statistically significant differences in distant dissemination rate between the active surveillance and standard surgery group (16.0% versus 22.0%, P = 0.76) or in severity of complications (CD ≥ 3;46.2% versus 23.1%, P = 0.16).

Conclusion
There was no statistically significant difference in overall survival, distant dissemination rate and severity of complications between patients undergoing standard surgery or active surveillance after nCRT. However, since sample sizes were small, especially for the severity of complications, these results should be interpreted with caution.

Disclosure
All authors have declared no conflicts of interest.
FA04.01: TEN-YEAR FOLLOW-UP OF A MULTICENTRE, DOUBLE-BLIND RANDOMISED CONTROLLED TRIAL OF LAPAROSCOPIC NISSEN VS ANTERIOR 90° PARTIAL FUNDOPLICATION
Authors: Hopkins Roy , Irvine Tanya , Jamieson Glyn , Devitt Peter , Watson David 
Published: September 2018

Abstract

Background
Nissen fundoplications have been reported to have various side effects, which have led to modifications, including partial fundoplications such as anterior 90° wrap. Five-year follow up of randomised trials suggest less side effects following anterior 90° partial compared to Nissen fundoplication, although Nissen fundoplication achieved better reflux control. There is, however, limited longer-term outcome data for Nissen versus 90° anterior partial fundoplication. This study determined outcomes of previous randomised control trials at 10 + years follow-up.

Methods
From 1999 to 2003, 191 patients were enrolled in two randomised trials comparing anterior 90° partial versus Nissen fundoplication, with outcomes available for 155 (78%) at 10 years. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0–10), a validated dysphagia score (0–45), Visick score (1–5) and yes/no responses were used. The two trials were combined to evaluate long-term outcomes.

Results
Following anterior 90° fundoplication patients reported less dysphagia to liquids (0.8 vs 1.8, P = 0.032) and solids (2.0 vs 3.3, P = 0.015). Dysphagia assessed using the 0–45 scale was also less following anterior 90° fundoplication (7.6 vs 12.7, P = 0.023). There was no significant difference in heartburn scores (2.8 vs 1.9 P = 0.053), although more patients were consuming PPIs following anterior 90° fundoplication at 10 years (43.8% vs 20.0% P = 0.004). Overall satisfaction scores were similar for both groups (7.9 vs 7.5, P = 0.215), and the majority considered their original decision for surgery to be correct (78.1% vs. 84.6%, P = 0.387). Reoperation rates were similar (anterior 90° - 13.7% vs Nissen 10.8%, P = 0.796).

Conclusion
At 10 years follow up, both procedures achieved similar overall success rates as measured by global satisfaction measures, but with more dysphagia following Nissen fundoplication, versus a higher rate of PPI consumption after anterior 90° fundoplication. Heartburn symptom differences failed to reach statistical significance.

Disclosure
All authors have declared no conflicts of interest.
FA05.01: NON-ONCOLOGICAL PULMONARY MORTALITY IS ASSOCIATED WITH OESOPHAGECTOMY FOR CANCER
Authors: Antonowicz Stefan , Markar Sheraz , Wiggins Tom , Mackenzie Hugh , Askari Alan , Faiz Omar , Hanna George 
Published: September 2018

Abstract

Background
Improvements in oesophageal cancer care have meant ever more patients are being declared cured. Whether oesophagectomy itself causes long-term non-cancer mortality is not known. This study was conducted to assess the timing and frequency of non-cancer causes of death after oesophagectomy in the UK with a population-based survey.

Methods
Hospital Episode Statistics provides contemporaneous admission data for all inpatient National Health Service encounters since 2000. A linked database was constructed of all HES encounters with oesophagectomy treatment codes, with Office for National Statistics mortality data, which included cause and date of death. Minimum follow-up was to 5 years. Independent variables potentially predictive of cause of death were entered into logistic regression analyses.

Results
There were 7204 oesophagectomy patients for which linked mortality data was available. A total of 302 died within 90 days, and a further 5874 died of primary cancer recurrence. Of the remaining 908 non-index-cancer deaths, 238 (26.2%) died of respiratory causes, 210 (23.1%) died of other cancers, 158 (17.4%) died of cardiac diagnoses and 64 (7%) died of cerebrovascular diagnoses. Survival patterns for those dying of cardiac and primary cancer recurrence were similar, with 80% occurring within 2 years of surgery. Non-cancer respiratory mortality was a later occurrence, with 80% occurring by 6 years. A pre-operative pulmonary diagnosis was associated with pulmonary mortality (OR 2.66 95% C.I. 1.49–4.77, P < 0.001), and a pre-operative ischaemic heart disease diagnosis were associated with post-operative cardiac death (OR 2.28 95% C.I. 1.13–4.59, P = 0.021). Long-term respiratory mortality was associated with inpatient respiratory complications in the index encounter (OR 2.60 95% C.I. 1.36 to 4.98, P = 0.004). Comparison to mortality rates after colectomy for cancer revealed 2-fold increased risk of non-cancer pulmonary death after oesophagectomy.

Conclusion
Oesophagectomy may increase the risk of non-cancer respiratory death in oesophageal cancer survivorship, with implications for peri-operative pathways and follow-up programs. Further work is needed to test whether this is a consequence of reconstruction, peri-operative complications, or progression of pre-morbid diagnoses.

Disclosure
All authors have declared no conflicts of interest.
FA05.02: AN ANALYSIS OF SURVIVAL TRENDS IN 471 PATIENTS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Lada Michal , Peyre Christian , Wizorek Joseph , Watson Thomas , Peters Jeffrey , Jones Carolyn 
Published: September 2018

Abstract

Background
Five-year survival after the surgical treatment of esophageal cancer has traditionally been reported to be as low as 15%. More recently, the improvement of clinical staging involving PET/CT and the introduction of neoadjuvant chemo-radiation have each altered the survival outcomes of patients with this lethal disease. The impact of these factors on survival trends has not been well described in literature. The aim of this study was to analyze the survival trends after esophagectomy for esophageal adenocarcinoma at a high-volume center.

Methods
The study population consisted of 471 consecutive patients undergoing esophagectomy for esophageal adenocarcinoma at a university-based medical center between January 1, 2000 and July 31, 2017. Clinical variables were collected for three groups based on the date of esophagectomy and were compared (Group 1: 2000–2004, Group 2: 2005–2011, Group 3: 2012–2017). Survival was compared via the Kaplan-Meier (KM) method.

Results
The 471 patients had a median age of 64.0 years (range 27.0–86.2) and 395/471 (84%) were male. Dysphagia (282/471, 60%), heartburn (63/471, 13%) and chest pain (29/471, 6%) were the most common presenting symptoms. The majority of the patients underwent transhiatal esophagectomy (n = 279, 59.1%) and en-bloc esophagectomy (n = 85, 18.0%). Staging with PET/CT was utilized in 316/471 patients (67%) with 6% of Group 1, 76% of Group 2 and 100% of Group 3, P < 0.001. Neoadjuvant therapy was utilized in 44% of patients, 209/357 (0% of Group 1, 45% of Group 2 and 76% of Group 3, P < 0.001). The median survival for the entire cohort was 30.0 months (range 0.3–208.0) with 5-year KM survival of 30% for Group 1, 43% for Group 2 and 47% for Group 3, P < 0.001, Figure. When comparing Group 1 and Group 2, the 10-year KM survival improved from 23% to 37%, P < 0.001.

Conclusion
This analysis reveals an improvement in 5-year survival after esophagectomy from 30% to 47% over the past two decades. Similarly, 10-year survival has improved from 23% to 37%. The evolution of better clinical staging and advancements in neoadjuvant therapy likely played a vital role in these trends. In contrast to the earliest cohort, PET/CT is now routinely utilized in the staging of esophageal cancer. Further, other than those with early stage disease, all patients are currently evaluated for neoadjuvant chemo-radiation. Notably, the 5-year survival rate for the most recent cohort (2012–2017) approaches 50% and would likely be higher if patients with esophageal adenocarcinoma treated endoscopically were included. Improvements in staging and treatment paradigms for esophageal adenocarcinoma have resulted in significant progress towards cure.

Disclosure
All authors have declared no conflicts of interest.
FA05.03: EFFECT OF EPHEDRINE ON GASTRIC CONDUIT PERFUSION MEASURED BY LASER SPECKLE CONTRAST IMAGING (LSCO) AFTER ESOPHAGECTOMY: A PROSPECTIVE IN-VIVO COHORT STUDY
Authors: Jansen Sanne , De Bruin Daniel , Strackee Simon , Van Berge Henegouwen Mark I , Van Leeuwen Ton , Gisbertz Suzanne 
Published: September 2018

Abstract

Background
Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5–20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3–4%). Ephedrine is used widely in anesthesia to treat intra-operative hypotension and may improve perfusion by the increase of cardiac output (CO) and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by Laser Speckle Contrast Imaging (LSCI).

Methods
This prospective, observational, in-vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) towards decreased perfusion (fundus). Intra-patient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test.

Results
LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0·05) measured intra-patients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high.

Conclusion
This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux towards the fundus.

Disclosure
All authors have declared no conflicts of interest.
FA06.04: SURVIVAL BENEFIT OF MULTIMODAL LOCAL THERAPY FOR REPEAT RECURRENCE OF THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER THORACOSCOPIC ESOPHAGECTOMY
Authors: Ninomiya Itasu , Okamoto Koichi , Oyama Katsunobu , Kinoshita Jun , Fushida Sachio , Ohta Tetsuo 
Published: September 2018

Abstract

Background
This study was performed to clarify the optimal therapeutic strategy for recurrent disease after thoracoscopic esophagectomy (TE). We especially focused on the prognostic impact of multimodal local therapy for localized recurrence.

Methods
We investigated the prognosis of 49 patients who developed recurrence among 140 patients who underwent TE at Kanazawa University Hospital. The prognostic factors after recurrence were examined by univariate and multivariate analysis.

Results
The patterns of initial recurrence included hematological recurrence in 24 patients (17.1%), lymphatic recurrence in 26 (18.6%), pleural dissemination in 5 (3.6%), peritoneal dissemination in 2 (1.4%), and local recurrence in 4 (2.9%). Of these 49 recurrences, 26 (53.0%) were localized within 3 regions. As the treatment for initial recurrence, 34 patients (including all 26 patients with localized recurrence) underwent local therapy comprising surgery and radiation therapy. Among them, 23 (67.6%) showed disappearance of the targeted region or diminishment without regrowth indicating local therapy successful. Sixty-six local therapies were performed for repeated recurrence. In total, 49 (74.2%) of the 66 localized recurrences were successfully managed by multimodal local therapy. The 14 patients treated by surgery as the initial therapy showed the most favorable survival. The 23 patients who underwent successful local therapy showed better survival than the other patients (P < 0.001). An age of > 70 years and a noncurative initial TE were statistically significant negative variables for survival after recurrence by the univariate analysis. A recurrence pattern with liver metastasis, more than four lung metastases, and pleural metastasis were also statistically significant negative variables. Localized recurrence, performance of local therapy, successful local therapy, and performance of surgery as the initial therapy for recurrence were statistically significant positive variables. Multivariate analysis showed that successful local therapy at the recurrence site and a noncurative initial TE were the only statistically significant positive and negative independent variables, respectively.

Conclusion
The minimal invasiveness of TE might contribute the performance of multimodal local therapy after recurrence. Multimodal local therapy for repeat recurrence contributes the improvement of survival after recurrence.

Disclosure
All authors have declared no conflicts of interest.
FA07.01: COMPARISON OF PERIOPERATIVE OUTCOMES AFTER ESOPHAGEAL RESECTION OR BYPASS FOR CORROSIVE STRICTURES OF THE ESOPHAGUS: A RANDOMIZED CONTROL STUDY
Authors: Dash Nihar 
Published: September 2018

Abstract

Background
Esophageal resection following corrosive stricture is projected to be associated with higher morbidity and mortality in comparision to bypass in the esophagus. Therefore perioperative risk of resection should be weighed against the long term risk of bypassed esophagus.

Methods
All fit patients of corrosive esophageal strictures without fistula or perofration were included. Randomisation was done after induction inside operation theatre. Stomach was the prefered conduit in both the groups. Right colon was the next prefered one. All cases were followed up for 6 months. Intraoperative anaesthetic events, complications related to technique, post operative complications and parameters related to recovery were studied.

Results
58 patients were recruited. 8 of them were excluded because of various reasons. 21 patients with resection and 29 patients with bypass were included in the study. The physiochemical parameters were comparable. The resection group had significant more mediastenal dissection time. There was no difference in the operative time, blood loss, hospital stay, dysphagia, anastomotic leak, nerve injury and pulmonary complications. Only 1 out of 50 patient died in the bypass group. In 1 patient thoracotomy was done again in the bypass group.

Conclusion
From this interim analysis we conclude that both surgical options are comparable with respect to the perioperative outcomes. Since the patients are young and the there is definite risk of malignancy in the injured esophagus, resection procedure can be safely undertaken.

Disclosure
All authors have declared no conflicts of interest.
FA07.02: ESOPHAGEAL PERFORATION: A RETROSPECTIVE, SINGLE CENTER OUTCOMES
Authors: Kovacs Balazs , Masuda Takahiro , Bremner Ross , Smith Michael , Huang Jasmine , Hashimi Samad , Patel Chirag , Ahmed Shair , Mittal Sumeet 
Published: September 2018

Abstract

Background
Esophageal perforation (EP) though uncommon has high morbidity and mortality. Aim of this study is to evaluate the outcomes at a tertiary referral hospital.

Methods
After IRB approval patients with EP between May 2014 and Sept 2017 were identified. Retrospective chart review was done to collect data. Exclusion criteria were: age under 18, leak following esophageal resection and esophageal stenting in previous year. Pittsburgh esophageal perforation severity score (PS) was calculated for each patient.

Results
During study period 56 patients (70% men) with EP met inclusion and exclusion criteria with a mean age and BMI of 60 Yrs. 27.1 kg/m2 respectively. Most common causes were iatrogenic (43%) and Boerhaave's (21%). Nearly 3/4th patients presented to the hospital within 24h of onset. The site of perforation was thoracic (67.9%), cervical (16.1%) and abdominal (16.1%). Overall mortality within 1 month was 5.7% (3 cases) compared to predicted (5.8 cases, 10.4%) based on Pittsburgh score (P > 0.05). See Table 1 for PS at presentation, management and ICU stay.

Conclusion
In our single center experience the leading cause of EP are iatrogenic injury and Boerhaave's syndrome. PS correlated well with need for aggressive surgical intervention and length of ICU stay. Use of endoluminal stents was higher than previously reported. Stents with or without additional surgical intervention can be a viable option in a subset of patients.

Disclosure
All authors have declared no conflicts of interest.