bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.172: ESOPHAGECTOMY FOR 70 YEARS OF AGE AND OLDER PATIENTS IN FUKUOKA HIGASHI NATIONAL MEDICAL CENTER
Authors: Ohga Takefumi , Kuma Sosei , Ezaki Takahiro 
Published: September 2018

Abstract

Background
The patients with esophageal cancer tend to be elder and men. The elderly patients have frequently dysfunction of critical organs. Surgical treatment for elderly esophageal cancer patients has been considered to be the most difficult and the operative indications remain controversial. Aim: The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 70 years of age) with esophageal cancer.

Methods
A total of 27 patients with esophageal cancer who underwent an esophagectomy in the Department of Surgery, National Fukuoka-Higashi Medical Center from 2005 to 2014 were divided into two groups according to age, namely, groups I (< 70 years, n = 18) and II (> or = 70 years, n = 9). In group II, surgery was only done in patients with PS0 or 1, as well as almost normal cardiac and pulmonary functions.

Results
The morbidity rates of group I and II were 66% and 33%, respectively. Pulmonary complications in each groups occurred in 12% and 0%, respectively. In group II, the mortality and 30-day mortality rates were 0.0% and 0.0%, respectively, and pulmonary complications did not occurred (0.0%). The average hospital stay period after the operation in group I and II were 55.5 days and 50.4 days, respectively. The hospital mortality retes in group I and II were 5.56% and 0.0%, respectively. The number of 3 years above survival persons is three (16.7%) and four (44.0%) in group I and II.

Conclusion
In the elderly, careful perioperative management is needed while paying special attention to pulmonary complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 70 years of age and older without any increased morbidity or mortality.

Disclosure
All authors have declared no conflicts of interest.
PS02.173: SURGICAL MANAGEMENT OF TRACHEOESOPHAGEAL FISTULAS IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Slaman Annelijn , Eshuis Wietse , Van Boven Wim , Gisbertz Suzanne , Van Berge Henegouwen Mark I 
Published: September 2018

Abstract

Background
Tracheoesophageal fistula is a severe complication that can occur in patients who are treated for esophageal cancer. There is currently no consensus about the best surgical treatment. The aim of this study was to evaluate the results after surgical treatment of tracheoesophageal fistulas in patients with a history of esophageal cancer in a tertiary referral center.

Methods
Consecutive patients with a history of esophageal cancer who were surgically treated for tracheoesophageal fistulas between January 2010 and December 2017 were included. Primary outcome was success rate after surgical treatment. Surgical treatment was defined as successful if no combined (30-day or in-hospital) mortality and no recurrences occurred.

Results
Twenty patients underwent 26 surgical treatments for tracheoesophageal fistulas. Median age was 64 years (IQR 59–68). One patient developed a tracheoesophageal fistula elsewhere and was referred to our center. The incidence of tracheoesophageal fistulas following esophagectomy in our center was 1.9% (n = 13). Other tracheoesophageal fistulas were caused by traumatic intubation (n = 3) or definitive chemoradiation (n = 3). Surgery consisted of covering the tracheal defect with a muscle flap (n = 15), and/or pericardial patch (n = 11) or primary sutures (n = 5) possibly with resection of the reconstruction (n = 6). The median follow-up was 7.8 months (IQR 1.5–38.2). Treatment was successful in 60.0% of the patients (n = 12). Overall morbidity and combined (in-hospital and 30-day) mortality rates were 65.0% and 35.0%, respectively. In the last 5 patients the muscle flap was fixated to the tracheal defect and reinforced by bovine or autogenic pericardium in whom there was no mortality. Recurrences occurred in 7 patients (35.0%), but only 5 were physically eligible for secondary surgical treatment. The other patients died due to the recurrence. Patients with infectious cause of their tracheoesophageal fistula (n = 11) had more complications (7 versus 6 patients), higher mortality (5 versus 2 patients) and more recurrences (5 versus 2) than non-infectious tracheoesophageal fistulas.

Conclusion
Tracheoesophageal fistula is a severe complication and is associated with high mortality and recurrence rates. Surgical treatment should only be performed in tertiary referral centers. Using muscle flaps with reinforcement of pericardium might reduce the morbidity and mortality, but larger patient groups should be investigated.

Disclosure
All authors have declared no conflicts of interest.
PS02.174: THE ACTION OF A NOVEL RADIOSENSITISER WITHIN THE OESOPHAGEAL ADENOCARCINOMA TUMOUR MICROENVIROMENT
Authors: Buckley Amy , Lynam-Lennon Niamh , Kennedy Susan , Cannon Aoife , O’Toole Dermott , Maher Stephen , Reynolds John , Ravi Narayanasamy , Kennedy Breandán , O'Sullivan Jacintha 
Published: September 2018

Abstract

Background
Oesophageal Cancer (OAC) is an aggressive disease with survival rates of ∼15-20%. Current therapeutic regimes focus on neo-adjuvant therapy (chemo-radiation) prior to surgery. Unfortunately, only 20–30% of patients show a beneficial response, with 70–80% of patients as non-responders. This major clinical challenge of treatment resistance reinforces the need for the identification of novel treatments which can act as radio-sensitisers in the neo-adjuvant setting.

Methods
Through a drug screening approach in-vivo, we have identified a novel anti-angiogenic and anti-metabolic compound, 11B_CC8 with radiosensitising activity. The ability of 11B_CC8 to act as an anti-metabolic agent under hypoxia was evaluated using the XFe24 Seahorse analyser and the Don Whitley i2 workstation. The ability of 11B_CC8 to radiosensitise our isogenic OAC cells under hypoxic conditions was assessed by clonogenic assay. The effect of 11B_CC8 on inflammatory, metabolic and angiogenic protein secretions from OAC treatment naïve tumour conditioned media (TCM) was evaluated by multiplex ELISA. Fresh treatment naïve patient biopsies were screened for their metabolic activity using the XFe24 seahorse analyser at baseline and post- treatment with 11B_CC8. The elucidation of the possible mechanism of action of 11B_CC8 was evaluated by Mass-Spectrometry.

Results
Our novel anti-angiogenic and anti-metabolic agent can enhance radiosensitivity in our isogenic model of OAC under both normoxic and hypoxic (0.5% O 2) conditions. 11B_CC8 significantly reduces oxygen consumption rate (OCR) under normoxic but not hypoxic conditions. Ex-vivo, 11B_CC8 significantly reduced the secretion of IL1β (P = 0.0117). Real-time ex-vivo metabolic rate analysis of our treatment naïve OAC biopsies showed significantly elevated OCR, when compared to Extracellular Acidification rate, a measure of glycolysis (P = 0.0059). Treatment with 11B_CC8 produced a reduction in OCR (P = 0.0039).

Conclusion
Our novel anti-angiogenic and anti-metabolic agent can enhance radiosensitivity in-vitro under both normoxic and hypoxic conditions. Ex-vivo, treatment naïve OAC human patient samples, 11B_CC8 can significantly reduce the secretion of IL1β and altered metabolic programming, specifically oxidative phosphorylation in human explants.

Disclosure
All authors have declared no conflicts of interest.
PS02.175: CLINICAL CHARACTERISTICS AND TREATMENT OF NEUROENDOCRINE CARCINOMA OF THE ESOPHAGUS
Authors: Morita Masaru , Kagawa Masaki , Nakaji Yu , Sugiyama Masahiko , Yoshida Daisuke , Ota Mitsuhiko , Ikebe Masahiko , Taguchi Ken-Ichi , Toh Yasushi 
Published: September 2018

Abstract

Background
Neuroendocrine carcinoma (NEC) of the esophagus is a rare and highly aggressive disease; however, an appropriate treatment strategy remains to be established, especially for surgical resection. The objective of this study is to clarify the clinical characteristics of NEC of the esophagus and to determine the optimal surgical strategy.

Methods
Nineteen patients who were immunohistochemically diagnosed with NEC of the esophagus from 1998 to 2017 were included in this study. The clinical features and therapeutic outcomes were examined.

Results

1. Clinical features
Sixteen of 19 patients showed protruding or localized type with or without ulceration. Only five patients were negative for both lymph node and organ metastasis and eight cases were positive for metastasis to distant organs and/or distant lymph nodes.

2. Surgical treatment
Five patients underwent esophagectomy. Four cases were classified as cStage I (cT1bN0M0); the other case was classified as cStage III (cT3N2M0). The preoperative diagnoses, based on the examination of biopsy specimens, were NEC (n = 2), SCC (n = 1), adenocarcinoma (n = 1), and carcinoma (n = 1). Subtotal and distal esophagostomy were performed in 3 and 2 patients, respectively. Salvage esophagectomy for recurrent disease was performed after definitive chemotherapy in one patient. Anastomotic leakage, which was conservatively healed, developed in one patient. Two patients with histologically-positive node metastasis died at 8 and 13 months, respectively, while another 3 patients (pT1bN0, n = 2; pT2N0, patient, n = 1) are currently alive without any recurrence, at 12, 45 and 72 months after esophagectomy, respectively.

3. Non-surgical treatment
Systemic chemotherapy was performed as the main treatment for 13 patients with advanced NEC. The regimens included cisplatin combined with irinotecan or etoposide (n = 10), cisplatin plus 5-fluorouracil (n = 2) and UFT plus irinotecan (n = 1). The MST was 13 months (range, 6–17 months).

Conclusion
The possibility of NEC should be kept in mind when we encounter protruded tumors of a distinctive shape. Consistent with previous reports, the prognosis of NEC of the esophagus is dismal, irrespective of the administration of systemic chemotherapy. However, surgical resection is considered to be a treatment option for cStage I/II NEC without node metastasis, as a long-term survival after esophagectomy was achieved by some patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.178: THE EFFECT OF INFLAMMATION AND NUTRITIONAL STATUS AND SARCOPENIA ON ESOPHAGEAL CANCER SURGERY
Authors: Soma Daisuke , Yamada Kazuhiko , Nohara Kyoko , Yamashita Satoshi , Wake Hitomi , Kokudo Norihiro 
Published: September 2018

Abstract

Background
An inflammation-based prognostic score, the modified Glasgow Prognostic Score (mGPS), has been established as a useful tool for predicting postoperative outcome in patients with cancer. Recently, depletion of skeletal muscle mass (sarcopenia) has been linked to poor outcome in several types of cancers. In this study investigated the relationship between these factors in patients with operable esopahgeal cancer.

Methods
Skeletal muscle mass was assessed in 87 patients who underwent esophagectomy from Jan. 2014 to Dec. 2016. The skeletal muscle tissue areas were measured by the ZioStation. The evaluated samples were slices of the third lumbar vertebrae (L3) in the inferior direction. The muscle area normalized by the square of the height (m2) is called the skeletal muscle index (SMI) (cm2/m2). The modified Glasgow prognostic score (mGPS) was measured using C-reactive protein (CRP) and albumin levels (mGPS 2: CRP > 1.0 mg/dL and albumin < 3.5 g/dL; mGPS 1: CRP > 1.0 mg/dL; mGPS 0: CRP ≤ 1.0 mg/dL). Patients were given mGPS- L group(mGPS0)or mGPS- H(mGPS1,2).

Results
The decrease of the skeletal muscle was higher in the mGPS2 than in the mGPS0. The rate of respiratory complications significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.01). For other complications the differences were not significant. Kaplan-Meier analysis and log-rank test revealed that Sarcopenia and mGPS-H predicted a higher risk of mortality (P = 0.0034 and 0.0001). Univariate analyses revealed that the mGPS, Stage and Sarcopenia were associated with mortality. Multivariate analyses using these 3 factors revealed that only mGPS (HR: 3.18; 95% CI: 1.70–8.70; P = 0.02) and Sarcopenia (HR: 3.39; 95% CI: 1.27–10.6; P = 0.01) were an independent risk factor of mortality.

Conclusion
The mGPS was closely related on the progression of sarcopenia, and both the mGPS-H and Sarcopenia were poor prognostic factor respectively.

Disclosure
All authors have declared no conflicts of interest.
PS02.179: NUTRITIONAL STATUS DIFFERENCES BETWEEN YOUNG AND ELDERLY PATIENTS UNDERGOING SURGERY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER
Authors: Lidoriki Irene , Schizas Dimitrios , Mpaili Efstratia , Michalinos Adamantios , Mpoura Maria , Kapelouzou Alkistis , Liakakos Theodore 
Published: September 2018

Abstract

Background
Esophageal cancer patients often suffer from malnutrition. Older people constitute a group of patients more susceptible to nutritional status deterioration. The aim of this study is to investigate the differences in nutritional status between elderly patients and patients younger than 65 years of age with esophageal and gastroesophageal junction cancer.

Methods
The study sample consisted of 73 patients with esophageal (n = 11) and gastroesophageal junction cancer (n = 62) who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and December 2017. Patients were divided into 2 groups according to their age, those younger than 65 years (n = 39) and those older than 65 years (n = 34). The preoperative assessment of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), laboratory tests, anthropometric measurements, handgrip strength, unintentional weight loss during the last six months and Skeletal Muscle Index (SMI) derived from analysis of CT scans.

Results
Malnutrition and sarcopenia were more prevalent in the group of older patients compared to the group of younger ones (73.5% vs 41%, P < 0.05 and 60% vs 35.3%, P < 0.05). PG-SGA was significantly higher in elderly patients (12.35 vs 8.23, P < 0.05), while SMI and handgrip strength were significantly lower in elderly patients (48.47 cm2/m2 vs 55.5 cm2/m2, P < 0.05 and 31 kg vs 39.1 kg, P < 0.05 respectively). Among the laboratory tests, albumin, hemoglobin and hematocrit were lower in the group of older patients (3.86 g/dL vs 4.15 g/dL, P < 0.05, 12.25 g/dL vs 13.17 g/dL, P < 0.05 and 36.5 vs 39.5, P < 0.05, respectively), whereas platelet-to-lymphocyte ratio was higher (205.4 vs 156.2, P < 0.05). Concerning anthropometric measurements, corrected mid arm muscle area and calf circumference were lower in older patients (42.15 cm2 vs 49.26 cm2, P < 0.05 and 34.86 cm vs 36.89 cm, P < 0.05, respectively), whereas no significant differences were observed in Body Mass Index values and unintentional weight loss between the two groups.

Conclusion
Geriatric patients with esophageal and gastroesophageal junction cancer have more compromised nutritional status compared to their younger counterparts. Preoperative nutritional assessment should be performed in all such patients in order to detect those who will benefit from perioperative nutritional support.

Disclosure
All authors have declared no conflicts of interest.
PS02.185: SIGNET RING OESOPHAGOGASTRIC ADENOCARCINOMAS HAVE POORER PROGNOSIS THAN MATCHED CONTROLS IN A MULTICENTRE STUDY
Authors: Khan Niall , Donohoe Claire , Phillips Alexander , Michael Griffin S , Reynolds John 
Published: September 2018

Abstract

Background
Controversy exists as to the relevance of the signet ring carcinoma (SRC) histological subtype of oesophagogastric adenocarcinoma to long-term prognosis. Some studies report a favourable prognosis while others report the contrary.

Methods
Retrospective analysis of outcomes of patients who underwent surgery with curative intent in two high volume centres (2000–15). Tumours were analysed according to location (oesophageal, junctional or stomach). Propensity score match (PSM) analysis was used to match patients with signet ring histology to those with oesophagogastric adenocarcinomas based on age, tumour location, use of neoadjuvant and adjuvant chemotherapy and pathological stage.

Results
A total of 2500 patients with oesophagogastric adenocarcinomas were treated, of whom 198 (7.9%) had signet ring histology. SRCs were more likely to have positive lymph nodes at pathological analysis (59% versus 50%, P = 0.009). Patients with oesophageal SRCs (n = 10) had a particularly poor prognosis with 23% 2 year survival and none alive at 5 years. The five year survival rate for patients with early SRC tumours (Stage 0/I/IIa) was 65% versus 85% for other early cancers (P < 0.003). PSM was used to match 195 of the SRC cases to 573 controls based on stage and treatment. Overall survival was significantly poorer in the SRC group (44.3 ± 8.6 versus 59.8 ± 8.5 months, 5 year OS 41% v 50%, P = 0.027).

Conclusion
Patients with the SRC variant of oesophagogastric cancer have a poorer prognosis. Genomic studies to identify the composition of such tumours as well as identify strategies to improve treatment for this subtype are warranted.

Disclosure
All authors have declared no conflicts of interest.
PS02.186: EUS-GUIDED FIDUCIAL MARKER INSERTION TO GUIDE RADIOTHERAPY IN ADVANCED ESOPHAGEAL CARCINOMA.
Authors: Chan Shannon , Teoh Anthony , Chi Yip Hon , Wong Vivien , Chiu Philip , Ng Enders 
Published: September 2018

Abstract

Background
The use of radiotherapy with or without concurrent chemotherapy is frequently required in treatment of advanced esophageal carcinomas. It can be given in an adjuvant, neoadjuvant or definitive setting. However, the margins of the tumor are often difficult to ascertain on computed tomography. Thus, EUS-guided fiducial marker insertion has an important role to aid the localization of the proximal and distal margins of the esophageal tumor. However, the optimal technique of the procedure is still uncertain.

Methods
This was a retrospective study of all patients who received EUS-guided fiducial marker insertion between March 2015 and October 2017. All patients suffering from esophageal carcinoma scheduled for radiotherapy underwent the procedure within one week of the scheduled appointment. Gold fiducial markers 5mm x 0.35mm (Visicoil, IBA Dosimetry, USA) were back loaded onto a 22-gauge needle (Vizishot, Olympus Medical, Japan) or (Expect, Boston Scientific, USA). The markers were placed under EUS guidance either intratumorally or in the normal submucosa just proximal and distal to the tumor.The submucosal planes were raised with diluted hyaluronic acid before insertion of the marker. Outcome parameters included tumor characteristics, early and late migration rates and tumor response rates.

Results
35 patients were included in the study. The mean (S.D.) age was 61.0 (9.9) years old. The mean (S.D.) length of the tumor were 7.2 (6.0) cm and and 86.2% of the patients had stage 3 disease. 27 patients had markers inserted by EBUS and 71.4% in the submucosa. When comparing fiducials that were placed in the submucosa versus intratumorally, significantly more fiducials had early (30% vs 0%, P = 0.004) and late migration (80% vs 0%, P < 0.001) in the intratumoral group. There were no differences in the stage of disease (P = 0.870), percentage of patients that completed radiotherapy (P = 0.063) and response rate (P = 0.197). There were no adverse effects in both groups.

Conclusion
In esophageal carcinomas planned for radiotherapy, EUS-guided fiducial markers should be placed in the submucosa just proximal and distal to the tumor instead of intratumorally. This may be able to increase the precision for radiotherapy.

Disclosure
All authors have declared no conflicts of interest.
PS02.188: EXPRESSION AND ROLE OF ANION EXCHANGER 2 IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Mitsuda Masato , Shiozaki Atsushi , Hikami Shoichiro , Shoda Katsutoshi , Arita Tomohiro , Kosuga Toshiyuki , Konishi Hirotaka , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Nakanishi Masayoshi , Fujiwara Hitoshi , Okamoto Kazuma , Otsuji Eigo 
Published: September 2018

Abstract

Background
Purpose: Recent studies have reported essential roles for various intracellular pH regulators in epithelial carcinogenesis and tumor progression. The aims of the present study were to investigate the role of anion exchanger 2 (AE2) in the regulation of tumor progression-related genes and the prognostic value of its expression in esophageal squamous cell carcinoma (ESCC).

Methods
In human ESCC cell lines, knockdown experiments were conducted using AE2 siRNA, and the effects on cellular movement and survival were analyzed. The gene expression profiles of cells were examined using a microarray analysis. An immunohistochemical analysis was performed on 61 primary tumor samples obtained from ESCC patients who underwent esophagectomy.

Results
AE2 was strongly expressed in KYSE170 and TE13 cells. The depletion of AE2 in these cells increased cell migration and inhibited the induction of apoptosis. The results of the microarray analysis revealed that various matrix metalloproteinase (MMP) signaling pathway-related genes, such as MMP1, MMP12, and TIMP4, were up- or down-regulated in AE2-depleted KYSE170 cells. Immunohistochemical staining showed that AE2 was primarily located in the cell membranes or cytoplasm of carcinoma cells, and its expression pattern at the invasive front (IF) of the tumor was related to the pT category. Prognostic analyses revealed that the low-grade expression of AE2 at the IF was associated with shorter postoperative survival.

Conclusion
s: The results of the present study suggest that reductions in AE2 in ESCC enhance cellular movement by affecting MMP signaling pathways and are related to a poor prognosis in patients with ESCC.

Disclosure
All authors have declared no conflicts of interest.