bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.213: COMPARISON OF MANUAL VERSUS MECHANICAL INTRA-THORACIC ESOPHAGO-GASTRIC ANASTOMOSIS IN RADICAL 2-STAGE MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER
Authors: Charalabopoulos Alexandros , Farhangmehr Neda , Akitikori Temisanren , Shanmuganathan Kanatheepan , Soile Oluwasunmisola , Hussain Aadil , Tang Cheuk , Venkatesh Jayanthi Naga , Lorenzi Bruno 
Published: September 2018

Abstract

Background
While in open esophagectomy a plethora of studies comparing outcomes of mechanical (circular or linear stapler) versus hand-sewn intra-thoracic anastomosis have been published, little evidence exists regarding 2-stage minimally invasive esophagectomy; In the majority of published studies the mechanical anastomosis is favored. Construction of the intra-thoracic esophago-gastric anastomosis in minimally invasive esophagectomy is the procedure's rate limiting step. We aim to present our results of hand-sewn versus mechanical anastomosis in 2-stage minimally invasive esophagectomy.

Methods
Data of 113 consecutive patients over a 20-month period that underwent 2-stage minimally invasive esophagectomy for cancer in our institution were analyzed. Inclusion criteria included only 2-stage and only minimally invasive esophagectomies for cancer. 43 cases underwent fully minimally invasive esophagectomy and 70 had laparoscopic-assisted hybrid esophagectomy. A fully hand-sewn anastomosis with 3/0 v-lock barbed suture was formed in 38% of cases and a mechanical anastomosis with a 25mm or 28mm circular stapler was formed in 62% of cases. Comparison between anastomotic techniques was assessed through Chi-Square and Log-Rank analysis.

Results
Median age was 68(IQR,47–82) in manual anastomosis group and 65(IQR,31–81) in circular stapler group. Of the manual anastomosis group, 74% received neo-adjuvant treatment versus 20% of the mechanical anastomosis group. In the manual anastomosis group n = 3(6.97%) developed a leak; of these, n = 2 were stented and n = 1 was subclinical requiring no intervention. There was one sepsis-related death; 30-day mortality was 2.3%. In the mechanical anastomosis group n = 2(2,8%) developed anastomotic leak (one combined with tracheo-esophageal fistula) and both were stented and eventually resulted in mortality. 30-day mortality was 2.8%. No conduit necrosis was noticed. Anastomotic strictures requiring dilatation were seen in n = 4(9.3%) in the manual anastomosis group versus n = 5(7.1%) in the mechanical anastomosis group. No statistically significant difference was found between the groups in terms of leak (P = 0.312), stricture (P = 0.698) and mortality rate (P > 0.005). Median length of stay was 11 days (7–70) in the manual anastomosis group and 12 days (7–51) in mechanical anastomosis group.

Conclusion
Outcomes between manual and mechanical intra-thoracic anastomosis in minimally invasive esophagectomy show no difference within our study group. Both are equally safe and efficient, with surgeon's preference taking priority.

Disclosure
All authors have declared no conflicts of interest.
PS01.223: ‘ENERGY-LESS TECHNIQUE’ WITH MINI-CLIPS FOR RECURRENT LARYNGEAL NERVE LYMPH NODE DISSECTION IN PRONE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Saeki Hiroshi , Nakashima Yuichiro , Kubo Nobuhide , Hirose Kosuke , Sasaki Shun , Jogo Tomoko , Taniguchi Daisuke , Edahiro Keitaro , Korehisa Shotaro , Nakanishi Ryota , Ando Koji , Oki Eiji , Maehara Yoshihiko 
Published: September 2018

Abstract

Background
Esophagectomy with radical mediastinal lymph node dissection remains the standard option for the curative treatment of esophageal squamous cell carcinoma. However, meticulous lymph node dissection along the recurrent laryngeal nerve (RLN), often results in recurrent laryngeal nerve paralysis (RLNP), leading to postoperative laryngopharyngeal dysfunction. Recently, thoracoscopic radical esophagectomy has been performed as a minimally invasive surgery for esophageal cancer. Although thoracoscopic surgery appears to reduce the risk of postoperative pulmonary complications and permits earlier postoperative recovery, the issue of postoperative RLNP remains unresolved.

Methods
We had attempted to simply cut the vessels around RLN sharply with scissors without using energy device in order to prevent RLN paralysis. However, these procedures often result in minor bleeding. Then we introduced the use of mini-clips for hemostasis before cutting the vessels with scissors. In this study, we analyzed data from 64 patients with esophageal cancer who underwent thoracoscopic esophagectomy in prone position. The patients were divided into two groups according to the period of operation: before and after the introduction of energy-less techniques with mini-clips. Surgical results were compared between the 2 groups.

Results
With regard to RLNP, the incidence was 24.0% in the before group; this incidence went down to 5.1% in the after group, after the introduction of energy-less techniques with mini-clips (P = 0.0259). Moreover, length of hospital stay after surgery was significantly shortened, from 36.1 days to 22.0 days, after the introduction of energy-less techniques with mini-clips (P = 0.0075). There were two operators performing thoracoscopic esophagectomy at our institution: surgeon A, a senior doctor with a 22-year career; and surgeon B, a junior doctor with a 12-year career. We compared all surgical results and found that there were no differences between the two doctors.

Conclusion
Our energy-less technique with mini-clips in RLN lymph node dissection could keep the surgical field dry by preventing minor bleeding. This contributed both to prevent RLNP and to shorten the patient's hospital stay. This technique was also considered useful for standardizing procedures within our institution, because special skills were not needed.

Disclosure
All authors have declared no conflicts of interest.
PS01.231: EFFICACY OF ARTIFICIAL PNEUMOTHORAX WITH SINGLE-LUMEN TRACHEAL TUBE VENTILATION IN THORACOSCOPIC SUBTOTAL ESOPHAGECTOMY IN THE SEMI- PRONE POSITION
Authors: Saito Masaaki , Kiyozaki Hirokazu , Obitsu Tamotsu , Ishioka Daisuke , Takahashi Jun , Rikiyama Toshiki 
Published: September 2018

Abstract

Background
Thoracoscopic esophagectomy for esophageal cancer performed with single-lumen tracheal tube ventilation in the semi-prone position provides the advantages of easier anesthesia induction; easiness of left-sided recurrent laryngeal nerve lymph node dissection; and shortening of the transit time to laparotomy. The aim of this study was to clarify the surgical safety and anesthetic procedure associated with thoracoscopic esophagectomy with single-lumen tracheal tube ventilation by intraoperative monitoring of respiratory status and hemodynamic changes.

Methods
A total of 30 patients with esophageal cancer who underwent thoracoscopic subtotal esophagectomy at our institute from January 2014 to December 2017 were retrospectively reviewed. Cardiac index (CI), systemic vascular resistance index (SVRI), mean arterial pressure (MAP), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2), end-tidal carbon dioxide pressure (EtCO2), and tidal volume (TV) using FloTrac system were measured.

Results
There were no significant changes in CI, SVRI, and MAP during artificial pneumothorax. Conversely, PaCO2 and EtCO2 gradually increased during artificial pneumothorax (P < 0.05) and decreased to almost their original levels thereafter. Furthermore, progressive reduction in tidal volume was observed in four cases after anti- side pneumothorax due to the injury of the left pleura with lymph node dissection. The mean TV and mean PaO2 were 0.42 L and 229.0 mmHg during artificial pneumothorax, respectively.

Conclusion
There was no exaggerated circulatory or ventilatory depression during artificial pneumothorax in the semi-prone position. Artificial pneumothorax with single-lumen tracheal tube ventilation in thoracoscopic subtotal esophagectomy may be a reliable anesthetic procedure. However, further examinations in the future will be necessary to determine its safety.

Disclosure
All authors have declared no conflicts of interest.
PS02.017: EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING UPPER MEDIASTINAL LYMPH NODE DISSECTION IN THORACOSCOPIC RADICAL ESOPHAGECTOMY
Authors: Lee Shigeru , Fujiwara Yushi , Hashiba Ryoya , Gyobu Ken , Inazu Daiki , Naka Ryoko , Nishiyama Masaki , Osugi Harushi 
Published: September 2018

Abstract

Background
The development of minimally invasive surgery has yielded many benefits, therefore the number of patients undergoing thoracoscopic radical esophagectomy (TRE) for esophageal cancer has been increasing worldwide. However, in the Japanese nationwide web-based database report, the incidence of recurrent laryngeal nerve (RLN) paralysis and overall morbidity were significantly higher in the TRE group than in the open esophagectomy group. In recent years, intraoperative nerve monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centers. We tried to determine the feasibility and effectiveness of IONM of RLN during upper mediastinal lymph node dissection in TRE.

Methods
All 628 patients who underwent TRE in the left lateral decubitus position at Osaka City University Hospital between May 1995 and February 2018 were enrolled in the present study. We introduced IONM using NIM® (Medtronic) during TRE from October 2016 at our hospital. We divided retrospectively the patients into two groups: IONM group (TRE with IONM of RLN; n = 49) and No-IONM group (TRE without IONM of RLN; n = 579). Diagnosis of RLN paralysis was performed using laryngoscopy. The feasibility of IONM during TRE and the incidence of postoperative RLN paralysis were compared with those in No-IONM group.

Results
IONM could be performed for 46 patients (93.9%) in IONM group. Three patients (6.1%) could not keep single-lung ventilation using a single lumen tracheal tube with a bronchial blocker and needed to replace a tracheal tube by a double lumen tube during TRE. The incidence of postoperative RLN paralysis (CD≧ 1; CD; Clavien-Dindo classification of surgical complications) was 17.4% in IONM group and 30.2% in No- IONM group. There was a significant difference in the incidence of postoperative RLN paralysis (P < 0.05). Moreover, the right and bilateral paralysis of RLN after TRE did not occur in any patients in IONM group.

Conclusion
IONM of RLN during TRE is technically feasible. The introduction of standardized IONM of RLN during TRE is able to reduce the incidence of postoperative RLN paralysis.

Disclosure
All authors have declared no conflicts of interest.
PS02.021: TOTALLY LAPAROSCOPIC TRANSHIATAL ESOPHAGECTOMY FOR ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION: INDICATIONS, TECH. ASPECTS AND RESULTS, COMPARING TO OPEN ACCESS
Authors: Takeda Flavio , Sallum Rubens , Ribeiro Jr Ulysses , Mariano Rocha Julio , Duarte Andre , Cecconello Ivan 
Published: September 2018

Abstract

Background
Minimally invasive esophagectomy remains with high morbidity and mortality rates. The transhiatal technique has less surgical time, lower morbidity and an acceptable oncological surgical control for patients with adenocarcinoma of the esophagogastric junction (AGEJ), unfortunaly still infrequent by laparoscopy. The aim of this study is to present indications, technical aspects and results of the totally laparoscopic transhiatal esophagectomy (TLTE) comparing to open access (OA)

Methods
This study retrospectively reviewed esophageal cancer patients that were admitted at an oncology referral center between 2011 to 2016. The studied population was composed of 128 AEGJ, all of them characterized as Siewert I and II classification. Demographic, pathological and clinical characteristics were analyzed and compared to clinical stage and overall survival at 60 months, between TLTE and OA. Influence of prognostic variables was assessed by Cox regression.

Results
The mean age was 63,4 ys (55–80ys), 85,4% were male. The selection of this group of patients was related to good clinical condition, however most of T2-T3 tumors. 90 patients were submitted to OA and 38 to TLTE (p-value for Log-Rank 0.11). Average follow-up was 39.8 months. By univariate analysis, curative intention resection was related to only 22% of patients in 5 ys. By univariate Cox regression, only degree of cellular differentiation was related to poor clinical stage in TLTE (p-value = 0.05). Weight loss (kg), BMI variation (kg/m²) and percentage of weight loss from initial symptoms to the diagnosis of esophageal carcinoma are factors that predict indicate the TLTE. Considering only patients submitted to curative intent surgery, more than 21 node resection could reach a statistically significant improvement in survival rate by univariate analysis, but there were no difference between both groups.There was no mortality and morbidity rate about 7%. Comparing TLTE to OA there were no difference in survival and morbidity and mortality.

Conclusion
This is a preliminary study about low rate related to both access (TLTE and OA) in patients with AEGJ) with T2-T3 tumors, with low morbidity and no mortality series. TLTE is a safe and feasible alternative to the open approach, with decrease short-term morbidity with comparable oncological outcomes.

Disclosure
All authors have declared no conflicts of interest.
PS02.025: CHARACTERISTICS OF SUPERFICIAL BASALOID SQUAMOUS CELL CARCINOMA TREATED BY ENDOSCOPIC RESECTION
Authors: Oyama Tsuneo , Takahashi Akiko 
Published: September 2018

Abstract

Background
Basaloid squamous cell carcinoma (BSCC) is a rare esophageal carcinoma. And the characteristics especially in early stage is unknown.

Methods
The aim of this study is to clarify the characteristics of superficial BSCC. Thirteen patients (9 males and 4 females) with BSCC treated by endoscopic resection (12 ESD and 1 EMRC) from January 2000 to March 2017 were enrolled in this retrospective study. The median age was 67 (57–83). The median follow-up period was 24 (12–115) months. T1a-EP/LPM and T1a-MM/T1b-SM1 without lymph duct invasion (LDI) was followed up. T1a-MM/T1b-SM1 with LDI or T1b-SM2 were treated by additional treatment (AT).

Results
1. En-bloc resection and R0 resection rate was 100% and 100%, respectively. 2. Macroscopic type; 0-IIa, 0-IIb and 0-IIc was 4, 1 and 8, respectively. 3. The median tumor diameter was 27 (2–62) mm. 4. Invasion depth; T1a-LPM, T1a-MM/T1b-SM1, and T1b-SM2 was 3, 5 and 5, respectively. 5. Histological characteristics; All BSCC were covered by SCC or non-neoplastic squamous epithelium. 6. Endoscopic characteristics; SMT like appearance was found in 46% (6/13). Yellowish nodules were observed in 23% (3/13). This finding was observed, when BSCC exist superficial epithelial layer covered by thin non-neoplastic epithelium. 7. Prognosis A: T1a-LPM (N = 3). Two patients are alive without recurrence, and 1 patient died of other disease. B: T1a-MM/SM1 (N = 5). Two of 3 patients without LDI were followed up and alive. Remaining one patient wanted to be treated by CRT, and alive. Two patients had LVI, however they were followed up without AT because of patient's hope. One is alive, and another died of other disease. C: T1b-SM2 (N = 5). Two and one patients were treated by surgery and chemotherapy, respectively, and alive without recurrence. Remaining two patients were followed up without AT. One of 2 patients are alive without recurrence. Another patient dead of other disease.

Conclusion
1. All of BSCC were covered by SCC or non-neoplastic epithelium. 2. SMT like appearance and yellowish nodules under squamous cell epithelium were the characteristic endoscopic findings. 3. 40% of T1aMM/T1bSM1 had LDI. It's higher than that of SCC. Therefore, En-bloc resection is necessary for the detailed histological examination.

Disclosure
All authors have declared no conflicts of interest.
PS02.028: RESULTS OF ENDOSCOPIC VACCUM-ASSISTED CLOSURE THERAPY IN THE MANAGEMENT OF POSTOPERATIVE LEAKAGE AFTER ESOPHAGECTOMY
Authors: Hyun Jeon Jae , Kim Kwhanmien , Won Seong Yong , Cho Sukki , Jheon Sanghoon 
Published: September 2018

Abstract

Background
Postoperative leakage after esophagectomy is associated with significant life-threatening complications. Recently, endoscopic vacuum-assisted closure (E-VAC) has been introduced and successfully used as a new treatment option. The purpose of this study was to evaluate the safety and efficacy of the E-VAC for the management of postoperative leakage.

Methods
A total of 22 patients were treated with either intraluminal or intracavitary E-VAC therapy for the management of postoperative leakage from May 2012 to April 2018. The location of leakage was intrathoracic in 17 patients, and cervical in 5. The size of defects was small (< 1 cm) in 8 patients, moderate (1∼2 cm) in 6, and large (> 2 cm) in 5. Outcomes of E-VAC therapy were analyzed retrospectively.

Results
Complete closure of postoperative leakage was achieved in 19 of 22 patients. The location and size of defects did not affect the success of VAC therapy (all P < 0.05, respectively). The median duration of E-VAC application was 14 days (range 2∼103), and a median of 3 E-VAC systems (range, 1∼14) were used. In 19 patients who were successfully treated with E-VAC, oral feeding was possible on median 15 days after the first day of treatment. There was no mortality related with postoperative leakage.

Conclusion
E-VAC might be a well-tolerated and effective therapeutic option for the treatment of various postoperative leakage after esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS02.030: CLINICAL COURSE OF PATIENTS WITH COMPLETE RESPONSE BY CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGIEAL CANCER
Authors: Tamura Shigeyuki , Matsuyama Jin , Nagai Kenichi , Imamura Hiroki , Yagi Yuriko , Mokutani Yukako , Hashimoto Yasuji , Hirose Hajime , Kubota Masaru , Ide Yoshihito , Fukushima Yukio , Sasaki Yo 
Published: September 2018

Abstract

Background
Definitive chemoradiotherapy (dCRT) is one of the treatment strategies for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). In this report, we investigated the timing, pattern of recurrence, and prognosis in patients with LA-ESCC who achieved clinical complete response (cCR) following dCRT.

Methods
dCRT was performed for 71 patients with LA-ESCC from April 2006 and December 2017. We retrospectively examined the clinical records of 27 patients (38%) with ESCC who achieved cCR following dCRT assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). These patients were classified into two groups: 19 patients (Group A) who did not recognize recurrence thereafter and 8 cases (Group B) who were confirmed to have recurred until Deccember 2017. Clinicopathological features and clinical course for two groups were examined.

Results
Clinical stages before treatment were cT1/2/3/4 = 7/3/6/3 cases, cN0/1/2/3 = 8/3/6/2, cM0/1 = 18/1 and cStage I/II/III/IV = 6/4/6/3 in Group A, and cT1/2/3/4 = 1/3/2/2, cN0/1/2/3 = 1/2/4/1, cM0/1 = 8/0, cStage I/II/III/IV = 1/0/5/2 in Group B, respectively. Patients in Group B had more advanced cases than Group A. In group A, 16 out of 19 patients (84%) are still alive without recurrence and 3 have died because of hypopharyngial cancer, lung cancer, and senility, respectively. Double cancers were confirmed in 12 patients (63%) including 6 head and neck cancers. In Group B, the recurrences were confirmed at 7–26 months (Median: 12.5M) from the diagnosis of cCR. Six out of 8 patients (6/8:75%) had the recurrence of mediastinal lymph nodes. In Group B, 6 out of 8 cases (75%) confirmed death, and the period from recurrence to death was 5–18 months (median: 9.5M).

Conclusion
After cCR was obtained by dCRT, recurrence was observed in 8/27 cases (29.6%) in about 13 months. In patients with recurrence, 75% of patients had mediastinal lymph node recurrence and had poor prognosis of about 10 months. Also in patients without recurrence, double cancers were observed in 12/19 cases, suggesting the importance of surveillance for the purpose of 2nd primary cancer screening.

Disclosure
All authors have declared no conflicts of interest.
PS02.033: SIMULTANEOUS INTEGRATED BOOSTING RADIATION DOSE IN UNRESECTABLE THORACIC ESOPHAGEAL CANCER: LONG-TERM OUTCOMES OF A PHASE I/II TRIAL
Authors: Yu Wen , Fu Xiao-Long , Cai Xu-Wei , Feng Wen , Zhang Qin , Gao Lan-Ting 
Published: September 2018

Abstract

Background
To observe the long-term outcomes of a phase I/II trial (NCT01843049) of simultaneous integrated boost (SIB) for dose escalation in unresectable thoracic esophageal cancer.

Methods
Patients with esophageal squamous cell carcinoma were treated with escalating radiation dose of 4 levels defined as our previous works (Yu et al. Radiother Oncol 2015). A prescription dose of 62.5–64Gy was delivered to the gross tumor volume, with (Level 3 & 4) or without (Level 1 & 2) a SIB up to 70 Gy for the pre-treatment 50% SUVmax area of the primary tumor. Patients also received 2 cycles of chemotherapy of cisplatin and fluorouracil concurrently and 2 more cycles after radiotherapy.

Results
Dose escalation has been safely achieved up to Level 4 with tolerable acute toxicities as previously reported, so a phase II trial was further performed basing on Level 4. After a median follow-up duration of 21.8 (2.5–61.4) months for all 34 patients and 40.1 (13.4–61.4) months for 17 patients still alive, median overall survival time was 42.4 months for all and 18.8/42.4/not achieved (median follow-up duration, 57.6 months)/10.8 months for Level 1/2/3/4 (n = 5/10/5/14), respectively. Median progression-free survival time was 11.7 months for all and 12.2/26.4/10.1/10.8 months for Level 1/2/3/4, respectively. Eight deaths occurred within the 20 patients in Level 1, 2 and 3, including 6 due to local or regional progression, 1 liver metastasis and 1 acute esophageal hemorrhage. Nine out of the 14 patients of Level 4 died, including 5 because of severe late esophageal toxicities (perforation, fistula or hemorrhage), 1 radiation-induced pericardial effusion, 1 brain metastasis, 1 local failure and 1 non-cancer-related heart disease.

Conclusion
Severe late esophageal toxicities might have compromised long-term survival after dose of Level 4 was delivered despite of tolerable acute toxicities. Dose escalation should be carried out in an appropriate dose-fractionation window, otherwise increased toxicities might conceal the potential benefit of tumor control brought by high dose intensity. Larger numbers of patients should be enrolled into Level 3 for further assessment of treatment tolerance.

Disclosure
All authors have declared no conflicts of interest.