bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.118: THE EFFECTS OF THE HERBAL MEDICINE DAIKENCHUTO (TJ-100) AFTER ESOPHAGEAL CANCER RESECTION, OPEN-LABEL, RANDOMIZED CONTROLLED TRIAL
Authors: Tangoku Akira , Nishino Takeshi , Inoue Seiya , Yoshida Takahiro 
Published: September 2018

Abstract

Background
Daikenchuto (TJ-100), a traditional Japanese herbal medicine, is widely used in Japan. Its effects on gastrointestinal motility, microcirculation and its anti-inflammatory effect are known. The purpose of this prospective randomized controlled trial was to investigate the effect of TJ-100 after esophagectomy in esophageal cancer patients.

Methods
Forty patients to whom subtotal esophagectomy for esophageal cancer was planned at our institute from March 2011 to August 2013 were enrolled and divided into two groups at the point of determination of the operation schedule after informed consent: TJ-100 treated group (n = 20) and Control group (n = 20). The primary end-points were maintenance of the nutrition condition and the recovery of gastrointestinal function. The secondary end-points were the serum C-reactive protein (CRP) level and adrenomedullin level during the postoperative course, the incidence of postoperative complications, and the length of hospital stay after surgery.

Results
We examined 39 patients because one patient in TJ-100 group couldn’t perform a curative surgery. The mean age of the TJ-100 group patients was significantly older than that of the control group. The rate of body weight decrease at postoperative day 21 was significantly suppressed in the TJ-100 group (3.6% vs. 7.0%, P = 0.014), but the serum albumin levels were not significantly different between the groups. The recovery of gastrointestinal function regarding flatus, defecation, and oral intake showed no significant between the groups, but postoperative bowel ill symptoms tended to be rare in the TJ-100 group. There was no significant difference in hospital stay after surgery. The serum CRP levels at postoperative day 3 tended to be suppressed in the TJ-100 group (P = 0.126). The rate of increase in adrenomedullin levels tended to be high postoperatively in the TJ-100 group, but there was no significant difference.

Conclusion
TJ-100 treatment after esophagectomy prompts the recovery of gastrointestinal motility and minimizes body weight loss. Those effects might suppress the excess inflammatory reaction related to surgery

Disclosure
All authors have declared no conflicts of interest.
PS01.123: EPIDURAL ANALGESIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: EFFICACY AND COMPLICATION PROFILE
Authors: Kingma Berend , Visser Els , Marsman Marije , Ruurda Jelle , Van Hillegersberg Richard 
Published: September 2018

Abstract

Background
Adequate postoperative pain management is essential to facilitate uneventful recovery after esophagectomy. Although epidural analgesia is the gold standard, it is not satisfactory in all patients. The aim of this study was to describe the efficacy and complication profile of epidural analgesia after minimally invasive esophagectomy (MIE).

Methods
A total of 108 patients who underwent a robot-assisted (McKeown) MIE for esophageal cancer were included from a single center prospective database (2012–2015). The number of patients that could receive epidural analgesia, the sensory block range per day, the number of epidural top-ups, the need for escape pain mediation (i.e. intravenous opioids), the highest pain score per day (numeric rating scale, 0–10), and epidural-related complications were assessed until postoperative day (POD) 4.

Results
Epidural catheter placement was achieved in 101 patients (94%). A complete sensory block was found in 49% (POD1), 42% (POD 2), 20% (POD3), and 30% (POD4) of patients. An epidural top-up was performed in 26 patients (24%), which was successful in 22 patients. Escape pain medication in the form of intravenous opioids were given at least once in 49 out of 108 patients (45%) on POD 1, 2, 3, or 4. Overall median highest pain scores on the corresponding days were 2.0 (range 0–10), 3.5 (range 0–9), 3.0 (range 0–8), and 4.0 (range 0–9). Epidural related complications occurred in 20 patients (19%) and included catheter problems (n = 11), hypotension (n = 6), bradypnea (n = 2), and reversible tingling in the legs (n = 1).

Conclusion
In conclusion, epidural analgesia is insufficient and escape pain medication is necessary in nearly half of patients undergoing MIE.

Disclosure
All authors have declared no conflicts of interest.
PS01.129: A NEW ANIMAL TRAINING MODEL FOR MEDIASTINAL LYMPHADENECTOMY WITH A SINGLE-PORT MEDIASTINOSCOPIC CERVICAL APPROACH
Authors: Kikuchi Hirotoshi , Soneda Wataru , Kawata Sanshiro , Hirotsu Amane , Murakami Tomohiro , Matsumoto Tomohiro , Ozaki Yusuke , Hiramatsu Yoshihiro , Kamiya Kinji , Takeuchi Hiroya 
Published: September 2018

Abstract

Background
Single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer is a minimally invasive surgery and can be applied to patients with low pulmonary function. However, special skills are needed to safely perform this surgical procedure as a curative operation without complications such as recurrent laryngeal nerve paralysis. To date, no animal training models for this surgical procedure has not been established. In this study, we developed a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach.

Methods
A domestic pig was intubated, with a normal tracheal tube, and placed in a spine position. Because pigs do not have clavicles, skin incision was made on the cephalic side of the left forelimb. Anterior cervical muscles were cut and cephalic parts of thymus and left thyroid were resected to deploy the operation field. Esophagus and left recurrent laryngeal nerve were identified behind the trachea. A wound edge protector (Lap-Protector) and EZ Access was attached to the wound. An artificial pneumomediastinum was created using 5–6 mmHg of CO2 gas and three 5mm ports were inserted to EZ Access. Operator dissected connective tissues around esophagus and vessels mainly using a bipolar sealing device. At the right side of the esophagus, fat tissue with 106recL lymph nodes was dissected from tracheal wall. After dissection was reached to the carina level, esophagotracheal ligament was cut and dissection on the left side of esophagus was carried out to the level of aortic arch. By displacing the trachea to the front side, 109R, 107 and 109L lymph node were dissected.

Results
Because pig's tracheal cartilage is sub-circumferential, mobility of trachea is relatively poor, and risks of tracheal membranous portion damage are low. Although there are some anatomical differences between pigs and human, this animal training model reproduces surgical procedures of mediastinal lymphadenectomy in human such as forceps operation techniques in narrow fields and effects of artificial pneumomediastinum.

Conclusion
We established a new animal training model for mediastinal lymphadenectomy with a single-port mediastinoscopic cervical approach. This model reproduces surgical procedures in human and is useful for training surgeons who wish to start performing mediastinal lymphadenectomy by mediastinoscopic cervical approach.

Disclosure
All authors have declared no conflicts of interest.
PS01.130: VIDEO-ASSISTED THORACOSCOPE 3D AND 2D MODE COMPARATIVE ANALYSIS FOR ESOPHAGEAL CHEST SURGERY
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming 
Published: September 2018

Abstract

Background
To study the advantages and disadvantages of 3D and 2D thoracoscope in the thoracic surgery of esophageal carcinoma.

Methods
Retrospectively analyze esophageal cancer cases between July 2013 and July 2017 of the first affiliated hospital to Xiamen University, depending on the different mode of Video-Assisted Thoracoscopic, which can be divided into 3D-VATS group 353 cases (observation group) and 2D-VATS group 351 cases (control group). Comparing the difference in operation time, intraoperative bleeding, lymph node transmission, volume of the drain by the first 24 hours, total volume of the drain, chest tube time and postoperative complications.

Results
All the 704 patients with esophageal cancer were performed under the video-assisted thoracoscope. In terms of surgery time, 3D-VATS group (51.4 ± 13.3min) was shorter than 2D-VATS group (65.7 ± 9.1min), with statistical significance (t = -9.751, P = 0.013); on blood loss, 3D-VATS group (34.1 ± 10.5ml) was less than 2D-VATS group (50.2 ± 9.4ml) with statistical significance (t = -9.274, P = 0.009); about lymph nodes transmission, 3D-VATS group (16.8 ± 3.2) was more than 2D-VATS group (13.1 ± 3.7), with statistical significance (t = 5.213, P = 0.007); in volume of the drain by the first 24 hours, 3D-VATS group (171.2.15 ± 20.2ml) was less slightly than 2D-VATS group (180.3 ± 35.2ml), no statistical difference (t = -1.347, P = 0.281); about total volume of the drain, 3D-VATS group (530.2 ± 53.4ml) was less slightly than 2D-VATS group (553.8 ± 57.5ml), no statistical difference (t = -1.911, P = 0.093); on chest tube time, 3D-VATS group (4.2 ± 0.7d) was less slightly than 2D-VATS group (4.9 ± 1.1d), no statistical difference (t = -1.806, P = 0.069); Postoperative complications in two groups including the incidence of arrhythmia, pulmonary infection, anastomotic leakage and recurrent laryngeal nerve injury has no obvious difference (P > 0.05).

Conclusion
Video-assisted thoracoscopic surgery of esophagectomy under 3D-mode has certain advantages in operation time, intraoperative bleeding and lymph nodes transmission over 2D-mode. While in the item of volume of the drain by 24 hours, total volume of the drain, chest tube time and postoperative complications, they have no obvious difference.

Disclosure
All authors have declared no conflicts of interest.
PS01.132: RISK FACTORS OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH GASTRIC TUBE RECONSTRUCTION FOR THORACIC ESOPHAGEAL CANCER
Authors: Sugimoto Atsushi , Toyokawa Takahiro , Tamura Tatsuro , Sakurai Katsunobu , Kubo Naoshi , Tanaka Hiroaki , Yashiro Masakazu , Muguruma Kazuya , Hirakawa Kosei , Ohira Masaichi 
Published: September 2018

Abstract

Background
Anastomotic leakage is a major complication after esophagectomy. Recent studies reported that anastomotic leakage is associated with poor prognosis. We aimed to identify the risk factors of anastomotic leakage after esophagectomy for thoracic esophageal cancer.

Methods
We analyzed retrospectively consecutive patients who underwent esophagectomy with reconstruction using gastric tube by cervical anastomosis for thoracic esophageal cancer between January 2009 and December 2017. In the reconstruction, end-to side mechanical anastomosis with circular stapler through the posterior mediastinal route was preferred until 2014, and end-to end hand-sewn anastomosis through the retrosternal route was preferred from 2015. As inflammation-based and/or nutritional markers, prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), Controlling Nutritional Status (CONUT) score, and neutrophil lymphocyte ratio (NLR) were investigated. Receiver operator characteristic curve analyses were performed to set the cut-off value of continuous variables. Risk factors predicting anastomotic leakage were analyzed using logistic regression model.

Results
A total of 170 patients (144 males and 26 females) were evaluated. Median age was 65 years (59 − 70). Anastomotic leakage was observed in 21 patients (12.3%). A mechanical anastomosis with circular stapler (P = 0.047) and longer operative time (≧560 minutes) (P = 0.015) were identified as risk factors of anastomotic leakage in univariate analysis. Multivariate analysis including variables with P < 0.1 on univariate analyses identified lower PNI (< 45) (P = 0.044, OR 2.78, 95% CI: 1.02 − 7.56) and mechanical anastomosis with a circular stapler (P = 0.036, OR 3.30, 95% CI: 1.07 − 10.09) as independent risk factors.

Conclusion
Our findings suggested that preoperative lower PNI and mechanical anastomosis were independent risk factors of anastomotic leakage after esophagectomy. Further studies aimed at preoperative nutritional intervention and anastomotic technique are warranted.

Disclosure
All authors have declared no conflicts of interest.
PS01.142: THE IMPACT OF CERVICAL LYMPH NODE DISSECTION ON ACID AND DUODENOGASTROESOPHAGEAL REFLUX AFTER INTRATHORACIC ESOPHAGOGASTROSTOMY FOLLOWING TRANSTHORACIC ESOPHAGECTOMY
Authors: Fukaya Masahide , Miyata Kazushi , Itatsu Keita , Asai Soichiro , Yamazaki Kimitoshi , Ebata Tomoki , Nagino Masato 
Published: September 2018

Abstract

Background
The aim of this study was to evaluate the impact of cervical lymph node dissection on acid and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy.

Methods
Thirty one patients receiving transthoracic esophagectomy gastric tube reconstruction by intrathoracic esophagogastrostomy were subjected and divided into two groups: two field lymph node dissection group (the 2F group) and three field lymph node dissection group (the 3F group). All patients underwent 24h pH and bilirubin monitoring and gastrointestinal endoscopy one year after surgery. The results of 24h pH and bilirubin monitoring, endoscopic findings, and reflux symptoms, were compared between two groups.

Results
No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) of the 3F group (P = 0.023). DGER was observed in 2 patients (13%) of the 2F groups, whereas it was observed in 8 (53%) of the 3F group (P = 0.007). The percentage time of acid reflux in the 3F group was significant higher than that in the 2F group (median 0.8 vs 0%, P = 0.008). The percentage time of bile reflux in the 3F group was also significantly higher than that in the 2F group (median 2.600 vs 0%, P = 0.027). Four patients (25%) had reflux esophagitis in the 2F group, and nine patients (60%) had reflux esophagitis in the 3F group (P = 0.048).

Conclusion
Cervical lymph node dissection increases acid reflux and duodenogastroesophageal reflux, and can lead to the increase of the incidence of reflux esophagitis in patient with intrathoracic esophagogastrostomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.145: SIMULTANEOUS RESECTION FOR ESOPHAGEAL CANCERS WITH MULTIPLE PRIMARY CANCERS
Authors: Takeno Atsushi , Masuzawa Toru , Murakami Kohei , Kawai Kenji , Sakamoto Takuya , Naito Atsushi , Katsura Yoshiteru , Ohmura Yoshiaki , Kagawa Yoshinori , Takeda Yutaka , Murata Kohei 
Published: September 2018

Abstract

Background
Esophageal cancer is frequently associated with multiple primary cancers and they are sometimes found simultaneously. The aim of this retrospective study was to clarify the clinical outcome of simultaneous surgery for patients with esophageal squamous cell cancer with multiple primary cancers.

Methods
Clinicopathologic features and surgical outcomes were compared between 14 simultaneous resections (SR group) and 108 single esophagectomy (E group) among 122 patients who underwent esophagectomy for esophageal squamous cell cancer in 2005–2013.

Results
The most common site of multiple primary cancers was the stomach (6 patients; 43%), followed by the stomach (5 patients; 36%), the lung (4 patients; 29%), the tongue, the colon, and the duodenum (1 patient; 7%). The number of multiple primary cancers was double (12 patients; 86%), triple (1 patient; 7%), and quadruple (1 patient; 7%). The incidence of antecedent and subsequent cancers didn’t differ between two groups. The SR group increased blood loss and prolonged operation time. However, there were no differences in postoperative morbidity, mortality and hospital days between the two groups. The SR group had shorter overall survival than the E group (3 years MST 54% vs 74%, Log rank P = 0.056)

Conclusion
The presence of synchronous cancers complicates the surgical resection of esophageal cancer. Although simultaneous surgery for patients with esophageal squamous cell cancer with multiple primary cancers was found to be comparably safe, the overall survival was poor than the single esophagectomy group. Treatment strategy condidering multidisciplinary approach is needed to improve the survival.

Disclosure
All authors have declared no conflicts of interest.
PS01.148: UTILITY OF GASTROSTOMY VIA GASTRIC TUBE AFTER ESOPHAGEAL CANCER SURGERY
Authors: Matsumoto Yoshihisa 
Published: September 2018

Abstract

Background
Esophageal cancer patients often suffer from preoperative malnutrition. It is very important for them to improve their perioperative nutrition status. In our department, we have adopted jejunostomy after esophageal cancer surgery in almost all cases. However, sometimes we have experienced catheter related complications via jejunostomy. Recently, several studies reported that gastrostomy via gastric tube might reduce the catheter related complications. In this study, we compared gastrostomy with jejunostomy as postoperative results and catheter related complications.

Methods
From January 2010 to November 2016, we performed 215 consecutive esophagectomy for esophageal cancer. It was divided into 133 cases of gastrostomy group (group G) and 82 cases of jejunostomy group (group J). We analyzed clinicopathological factors (age, sex, tumor localization, tumor progression degree and preoperative chemotherapy), postoperative results (anastomotic leakage, respiratory complications, recurrent nerve palsy and postoperative hospital stay) and correlation of catheter related complications retrospectively.

Results
There were no significant differences between the two groups in clinicopathological factors and postoperative outcomes such as anastomotic leakage, recurrent nerve paralysis and postoperative hospital stay. Respiratory complications were occurred in 12 cases (8.0%)/25 cases (31.0%) (P < 0.001). Catheter related complications were occurred in 17 cases (5 in group G (3.0%), 12 in group J (9.8%) (P = 0.005) and it was significantly less in group G. The details of catheter related complications were classified into group G (duodenal perforation and dislocation) and group J (intestinal perforation, intestinal obstruction and intestinal fluid leakage).

Conclusion
The rate of catheter related complications after esophagectomy via gastrostomy in this study were lower than that via jejunostomy in previous reports. We suggest the route of enteral nutrition via gastric tube is more effective than that via jejunostomy with regard to catheter related complications.

Disclosure
All authors have declared no conflicts of interest.
PS01.165: HIGH BMI HAS NO IMPACT ON THE SURVIVAL OF CHINESE PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA TREATED WITH CURATIVE ESOPHAGECTOMY: A PROPENSITY SCORE-MATCHED STUDY
Authors: Deng Han-Yu , Lin Yidan 
Published: September 2018

Abstract

Background
Controversy still exists as to whether high BMI has any impact on the long-term survival of esophageal cancer patients treated with curative esophagectomy. Due to the rarity of esophageal adenocarcinoma in Chinese patients, its characteristics were rarely reported and the prognostic value of high BMI in Chinese esopaheagl adenocarcinoma patients has not been investigated yet. Therefore, we conducted this propensity score-matched study to explore the prognostic value of high BMI in Chinese patients with esophageal adenocarcinoma for the first time.

Methods
We retrospectively collected data of patients with lower thoracic esophageal adenocarcinoma who underwent curative esophagectomy in our department from January 2009 to December 2016. Patients were grouped into high BMI group (≥ 23 kg/m2) and normal BMI group (18.5–22.9 kg/m2) according to the Asian specific BMI cutoff value. Both Cox regression survival analysis and propensity score-matched analysis were applied.

Results
A total of 132 patients were included for analysis. Fifty-three patients were in the high BMI group while 79 patients were in the normal BMI group. There were no significant differences regarding age, gender, comorbidity, tumor differentiation, tumor site, lymphovascular invasion, or surgical approaches between the two groups. However, patients in the high BMI group had more stage III diseases but less rate of adjuvant therapy than patients in the normal group. For survival, there was no significant survival difference between patients with high BMI and those with normal BMI (5-year overall survival rate: 40.8%VS 48.1%; P = 0.398). In the multivariate analysis, high BMI was not found to be an independent prognostic factor of Chinese patients with esophageal adenocarcinoma (HR = 1.028, 95%CI: 0.621–1.667, P = 0.945). A total of 92 patients were included after propensity-score matched analysis, and all those baseline data were comparable between the two groups. However, there was still no significant difference of survival between patients with high BMI and those with normal BMI (5-year overall survival rate: 41.4%VS 43.3%; P = 0.760).

Conclusion
High BMI have no impact on survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy. Therefore, esophageal adenocarcinoma patients with high BMI should not be denied for curative esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.175: EVALUATION OF ASSOCIATIONS BETWEEN GASTRIC TUBE PREPARATION METHODS AND THE INCIDENCE OF CERVICAL ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER
Authors: Miyawaki Yutaka , Sato Hiroshi , Sakuramoto Sinich , Okamoto Koujun , Yamaguchi Shigeki , Koyama Isamu 
Published: September 2018

Abstract

Background
In esophageal reconstruction, the gastric tube (GT) is superior in elevation and handiness of the maneuver; therefore, GT is most often selected as a reconstruction conduit. Although some leakages from esophagogastric anastomoses are induced by ischemic or congested peripheral blood flow in the reconstruction conduits, the association between the GT and the incidence of anastomotic leakage (AL) is unclear.

Methods
Between February 2013 and September 2017, 188 consecutive patients who underwent an esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstructions using narrow gastric tubes (Gr.N) until May 2016, which is when we began preparing and using stretched GTs (Gr.S). We retrospectively evaluated the incidence of AL.

Results
AL occurred in 29 of 188 (15.4%) patients, and the frequency of AL occurrence in Gr.S was lower than that in Gr.N (P = 0.034). Sex, body mass index, Brinkman index, and presence of hypertension or anemia were significantly associated with AL (P = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). The multivariate logistic regression analysis suggested that the type of GT used and the Brinkman index were independent risk factors for AL (P = 0.016 and 0.020, respectively).

Conclusion
Our results demonstrated that the difference in the GT preparation method was an independent risk factor for AL after cervical esophagogastrostomy. We suggest that the method of GT preparation could contribute to a reduction of AL after esophagectomy.

Disclosure
All authors have declared no conflicts of interest.