bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA05.01: SURGICAL MANAGEMENT OF ESOPHAGEAL SARCOMA: A MULTICENTER EUROPEAN EXPERIENCE
Authors: Mege Diane , Depypere Lieven , Piessen Guillaume , Slaman Annelijn E , Wijnhoven Bas P L , Hölscher Arnulf , Nilsson Magnus , Van Berge Henegouwen Mark I , Van Lanschot J Jan B , Schroeder Wolfgang , Thomas Pascal , Nafteux Philippe , D'Journo Xavier Benoit 
Published: September 2018

Abstract

Background
Esophageal sarcomas (ES) are rare and evidence in literature is scarce making their management difficult. The objective is to report surgical and oncological outcomes of ES in a large multicenter European cohort.

Methods
This is a retrospective multicenter study including all patients who underwent en-bloc esophagectomy for ES in 7 European tertiary referral centers between 1987 and 2016. The main outcomes and measures are pathological results, early and long-term outcomes.

Results
Among 10,936 esophageal resections for cancer, 21 (0.2%) patients with ES were identified. The majority of tumors was located in the middle (n = 7) and distal (n = 9) third of the esophagus. Neoadjuvant chemoradiotherapy was performed in 5 patients. All the patients underwent en-bloc transthoracic esophagectomy (19 open, 2 minimally invasive). Postoperative mortality occurred in 1 patient (5%). One patient received adjuvant chemotherapy. Definitive pathological results were carcinosarcoma (n = 7), leiomyosarcoma (n = 5), and other types of sarcoma (n = 9). Median tumor length was 5 cm [1–10]. Microscopic R1 resection was present in 1 patient (5%) and 7 patients (33%) were N + . Median follow-up was 16 (3–79) months in 20 of 21 patients (95%). One-, 3- and 5-year overall survival (OS) rates were 74%, 43% and 35%, respectively. One-, 3- and 5-years disease-free survival (DFS) rates were 58%, 40% and 33% respectively. Median overall survival (OS) was 33 months for patients with a tumor ≤ 5 cm and 13 months for patients with a tumor > 5 cm (P = 0.54). Median OS was 6 months in N + patients vs. 37 months for N0 patients (P = 0.06). At the end of the follow-up period, 9 patients had died from cancer recurrences (43%), 3 patients from other reasons (14%), 1 patient was still alive with recurrence (5%) and the 7 remaining patients were free of disease (33%). Recurrence was local (n = 3), metastatic (n = 3) or both (n = 4).

Conclusion
Carcinosarcoma and leiomyosarcoma were the most common ES histological sub-types. Tumor size and N + disease seemed prognosis factors. Transthoracic en-bloc esophagectomy with radical lymphadenectomy should be recommended to achieve complete resection. Long-term survival remained poor with a high local and distant recurrence rate.

Disclosure
All authors have declared no conflicts of interest.
RA05.03: THE INFLUENCE OF ANASTOMOSIS ON THE BLOOD SUPPLY OF STOMACH AND THE OPTIMIZATION OF WIDTH OF TUBULAR STOMACH IN END-TO-SIDE ESOPHAGEAL-GASTRIC ANASTOMOSIS
Authors: Hu Yang 
Published: September 2018

Abstract

Background
End-to-side esophageal-gastric anastomosis is the most commonly used method of anastomosis in esophagectomy. Narrow gastric tube, especially 3cm-wide one, is thought to improve the blood supply of stomach. But with the combine use of these two techniques, we found alimentary tract leakage became more common. The reason was obscure. Few have considered the influence of anastomosis-induced gastric wall defect on the blood supply of gastric tube (Figure 1). We carried out this research to prove this hypothesis and to find out method to resolve this problem.

Methods
Animal experiment and clinical cohort study have been carried out. Narrow gastric tube group (3cm wide) and baseball-bat-shaped gastric tube group (5cm in avascular area) were compared. In animal experiment, 3 pigs in each group. Impaired blood supply will slow down blood flow and cause metabolic acidosis. So blood gas analysis (with the blood collected in gastric wall distal or proximal to the anastomosis) and arteriography with methylene blue were performed. pH and BE(from blood gas analysis) and time required for methylene blue to reach the tip of gastric tube were used to evaluate the blood supply of these areas. In cohort study, 176 patients were enrolled with 24 in narrow gastric tube group and 152 in bat-like gastric tube group. The incidence of leakage was compared.

Results
In animal experiment, before anastomosis, no metabolic acidosis was found in both groups. But after anastomosis, methylene blue couldn’t reach the gastric wall distal to the anastomosis, and the blood gas analysis shows metabolic acidosis with the blood from the same area, only in narrow group, These indicated insufficient blood supply in this area. In the cohort study, the incidence of leakage was much higher in narrow group.

Conclusion
Anastomosis can influence the blood supply of the gastric tube distal to it. It's the reason of the increase of alimentary tract fistula incidence with the use of 3cm-wide narrow gastric tube. Widen the gastric avascular area is an effective way to prevent this. So for end-to-side anastomosis, 5cm-wide gastric tube is preferred, while narrower gastric tube is suitable for other mode of anastomosis which do not cause gastric wall defect

Disclosure
All authors have declared no conflicts of interest.
RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE
Authors: Lambert Joel , Caratella Sanya , Lawrence Eloise , Alkhaffaf Bilal 
Published: September 2018

Abstract

Background
Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications

Methods
From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention.

Results
224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260.

Conclusion
Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically.

Disclosure
All authors have declared no conflicts of interest.
RA05.05: STOMACH PRESERVED ILEOCOLIC INTERPOSITION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Ueno Masaki , Haruta Syuusuke , Tanaka Tsuyoshi , Okura Yu , Iizuka Toshiro , Udagawa Harushi 
Published: September 2018

Abstract

Background
A stomach is the first choice as an esophageal substitute after esophagectomy for cancer. In case with a history of gastrectomy, concurrent gastric disease, the ileo-colon is used as an esophageal substitute in our hospital. From 2007, as a method of preservation of the gastrointestinal function, we have provided the reconstruction of stomach preserved ileo-colic interposition.

Methods
1990–2017.12, 227 patients underwent colon interposition after esophagectomy with extended lymphadenectomy. Until 1997, we selected the colon graft based on colon vessel finding during surgery. From 1998, we assumed ileo-colon first choice. From 2007, we started stomach preserved ileo-colic interposition. Between 2007 and 2017, we performed this method in 108/142 colon interposition patients. We examined these 108 patients to know the recent result of ileo-colon interposition.

Results
An average of 108 patients is 61 years. The cases without preoperative treatment was 38 cases (35%). Endoscopic resection was done in 23 cases (21%). 38 received preoperative chemo and 9 CRT. Clinical TNM was I/II/III/IV = 62/20/24/2. We performed lymphadenectomy with three field in 70 and two in 38. Route of reconstruction was retrosternal in 99(92%), a posterior mediastinal in 8. Microvascular anastomosis was conducted in one. The anastomosis of all cases performed hand-sewn end-to-side anastomosis in neck. The incidence of postoperative morbidity is one patient had anastomotic minor leakage (1%), one had pneumonia to need intubation. 4 patients experienced bowel obstruction, 1 required surgery. Endoscopy had done 4–12 month later, there were no patients have reflux esophagitis or anastomotic stenosis. 12 patients had colon-gastric anastomotic ulcer. PPI was started. The weight rate of decline of the 12 months after surgery was an average of 9%. 32% patients have diarrhea.

Conclusion
Stomach preserved ileo-colic interposition after esophagectomy with extended lymphadenectomy is feasible and have a favorable outcome. Keep up long-term quality of life and decrease in complications after the long-term progress is expected.

Disclosure
All authors have declared no conflicts of interest.
RA05.08: OPTIMAL RADIATION DOSE IN THE NEOADJUVANT TREATMENT OF ESOPHAGEAL CANCER: A COMPARATIVE EUROPEAN STUDY
Authors: Mantziari Styliani , Allemann Pierre , Winiker Michael , Messier Marguerite , Demartines Nicolas , Piessen Guillaume , Schäfer Markus 
Published: September 2018

Abstract

Background
Current guidelines recommend the use of neoadjuvant chemo-radiation (NCR) for the treatment of locally advanced esophageal cancer, both types, adenocarcinoma (AC) and squamous cell carcinoma (SCC). So far, the optimal dose of radiotherapy to achieve a maximal tumor response within an acceptable toxicity is not yet determined. The aim of this study was to assess the impact of preoperative radiation dose on postoperative outcomes and long-term survival.

Methods
Consecutive patients operated in two European tertiary centers for AC or SCC, treated with NCR and surgery from 2000–2016 were assessed. Specific postoperative complications (i.e. anastomotic leakage, atrial fibrillation), histological tumor regression grade (TRG, Mandard score), overall and disease-free survival were compared among three patients groups: group A (41.4Gy), group B (45Gy), and group C (50.4Gy). The x2 or Fisher test were used for categorical variables and ANOVA for continuous variables. Survival analysis was done with the Kaplan-Meier method and log-rank test.

Results
There were 294 patients included; 41.5% (n = 122) had AC and 58.5% (n = 172) SCC. Overall, 9.2%/27 patients received 41Gy, 57.8%/170 patients 45Gy and 33%/97 patients received 50.4Gy. Carboplatin-Paclitaxel was the most frequently used chemotherapy for group A (62.9%), and 5FU-Cisplatin for groups B (69.4%) and C (51.5%). Postoperative anastomotic leakage was lower for group B (7.1%) compared to group A (22.2%) and C (13.4%) (P = 0.036), as was the occurrence of atrial fibrillation (11.8% group B, 33.3% group A and 19.6% group C, P = 0.013). Complete or excellent response (TRG 1–2) was significantly better for group B (58.2%), followed by group C (49.5%) and A (25.9%) patients (P = 0.012). Median overall survival was 48, 27 and 29 months for group A, B and C (P = 0.498), and median disease-free survival was 13, 27 and 18 months (P = 0.411), respectively.

Conclusion
Preoperative radiotherapy dose of 45Gy with 5FU-Cisplatin was associated with a better histological response and less postoperative adverse outcomes compared to 41Gy and 50.4Gy, with no significant differences in long-term recurrence and survival. The role of the type of chemotherapy and histological tumor type are important co-factors affecting outcome and must be further assessed.

Disclosure
All authors have declared no conflicts of interest.
RA06.02: DETECTION OF ALTERED BOLUS TRANSPORT THROUGH THE ESOPHAGUS AND ESOPHAGO-GASTRIC JUNCTION IN PATIENTS WITH HIATUS HERNIA AND DYSPHAGIA
Authors: Estremera-Arevalo Fermin , Dent John , Omari Taher , Myers Jennifer 
Published: September 2018

Abstract

Background
Dysphagia can occur in patients with a small hiatus hernia (HH). Whether this relates to a pressure-flow variation through the esophagus or esophago-gastric junction (EGJ) is unknown.

Methods
High-resolution impedance manometry (HRIM) performed off therapy in 210 reflux patients and 25 age-matched healthy volunteers, recorded 10 × 5mL saline and likewise viscous bolus swallows. Esophageal pressure flow analysis (PFA) with AIMplot v8.0 was undertaken for valid bolus swallows. HRIM EGJ-subtype and endoscopic + /- fluoroscopic imaging enabled HH diagnosis (2–5 cm, > 5 cm excluded). Dysphagia was scored for difficulty swallowing 9 food types (Dakkak and Bennett; 0 none to 45 severe). ANOVA assessed differences in biomechanics of controls and HH + /- patients and dysphagia (D + , > 10/45).

Results
To date, findings for 135 patients (74M 61F, BMI 28, 19–41) with 70 HH + positive were compared with the 65 HH- negative and 25 healthy controls (7M 18F, BMI 27, 19–37)—see Table.
In HH + there was increased resistance (intrabolus pressure) to bolus flow through the esophagus, while pressure during bolus clearance was lower. Further, a higher impedance ratio suggests less effective esophageal emptying, in addition to reduced EGJ outflow time. HH impairs transport of viscous and liquid swallows, affecting patients with HH + and troublesome dysphagia the most.

Conclusion
A small hiatus hernia alters biomechanics of bolus transport and hinders esophageal and esophago-gastric junction outflow, more so in patients with both dysphagia and hiatus hernia. These findings may relate to altered longitudinal muscle function associated with a short, flaccid esophagus when a hiatus hernia is present.

Disclosure
All authors have declared no conflicts of interest.
RA06.03: SURGICAL OUTCOMES OF GIANT HIATAL HERNIA REPAIR IN PATIENTS OVER THE AGE OF 80
Authors: Khoma Oleksandr , Mugino Miho , Falk Gregory 
Published: September 2018

Abstract

Background
Patients with giant hiatal herniae are often symptomatic and have significantly reduced quality of life (QoL). Laparoscopic fundoplication is an established treatment of giant hiatal hernia. Advanced age has been previously shown to be the most significant predictor of mortality and morbidity in hiatal hernia repair. Reported outcomes of laparoscopic fundoplication in patients over the age of 80 are limited to case reports and small case series.

Methods
Data was extracted from a prospectively populated single surgeon database of laparoscopic fundoplication procedures between 1995 and 2014. Patients who were operated for giant HH (> 30% of stomach in the chest) that were aged 80 or older at the time of surgery were included. Quality of life (QOL) data was collected pre-operatively, in early post-operative period (within 12 months) and late post-operative period (24 months or later). QOL data included gastro-intestinal quality of life index (GIQLI), Visick score, dysphagia score and overall satisfaction with surgery. Search of Ryerson index (was conducted to establish month and year of death and calculate post-operative life expectancy.

Results
Inclusion criteria were met by 89 patients. Average age was 84 (80–93). The proportion of herniated stomach was 70.9% on average (range 30–100%; SD 27.25), the hiatal defect was large in all patients. There was 1 perioperative death from myocardial infarction at 30 days after surgery. There were no other major complications (Clavien-Dindo Grade III-IV). Post-operative survival was an average of 74.5 months (SD 47.8; range 1–233). GIQLI was reduced pre-operatively (mean 91.8; SD 19.4). There was improvement in GIQLI scores on early (mean 101.45; SD 21.2) and late (mean 106.7; SD 19.2; P = 0.005) post-operative follow up. Pre-operative Visick scores (mean 2.92; SD 0.98) have improved significantly in early (mean 1.94; SD 0.97; P = 0.000) and late (mean 2.03; SD 0.99; P = 0.001) post-operative periods. During early post-operative follow up 97% of the patients were satisfied with overall outcome of their operation, whilst 3% were dissatisfied. Overall satisfaction scores remained high on late follow up (93.3% satisfied, 6.7% dissatisfied).

Conclusion
Findings of this study demonstrate that in carefully selected patients with giant HH surgery is safe and results in improved quality of life post operatively.

Disclosure
All authors have declared no conflicts of interest.
RA06.05: LAPAROSCOPIC GIANT PARAESOPHAGEAL HERNIA REPAIR: CT SCAN AND QUALITY OF LIFE TOOL EVALUATION OF SUCCESS
Authors: Hietaniemi Henriikka , Ilonen Ilkka , Kauppi Juha , Andersson Saana , Räsänen Jari 
Published: September 2018

Abstract

Background
Our objective was to analyze the results of laparoscopic giant paraesophageal hernia (GPEH) repair in tertiary hospital setting. The main endpoints were recurrence of the hernia, postoperative quality of life, symptoms and satisfaction with the operation. To assess radiographical recurrence we used computerized tomography imaging, which has not been used in previous studies.

Methods
We identified all non-emergent giant (more than 30% of stomach in the chest) esophageal hernia repairs in our hospital from medical records. The patients were sent standardized 15D health-related quality of life and Gastroesophageal reflux disease (GERD-HRQL) questionnaires. Patients who gave their consent were assigned to a non-contrast computerized tomography (CT)-study to assess radiographical recurrence.

Results
Altogether 165 patients were reviewed. 74% of the patients were female, with a mean age of 67. 1 patient (0.6%) had died perioperatively. Complications were reported in 28 patients (17%). 10 patients (6.1%) had to undergo reoperation within 30 days. 7 patients (5.9%) were dissatisfied with the operation. 66% had an excellent result on GERD-HRQL. 4 patients had a major recurrent hernia in CT, but the radiographic findings did not correlate with symptoms. The mean D15 score was 0853 for our patients and 0896 for the age-adjusted control population (P &lt; 0001).

Conclusion
The complication rate was comparable to previous studies. Perioperative mortality was low, significant radiographical recurrences were rare and only few patients were dissatisfied with the result. However the overall quality of life of the study group was slightly below age-adjusted population average.

Disclosure
All authors have declared no conflicts of interest.
RA07.02: IDENTIFYING TUMOR MARKERS IN ESOPHAGEAL ADENOCARCINOMA AND LYMPH NODE METASTASES FOR TARGETED FLUORESCENCE IMAGING
Authors: De Gouw Didi , Klarenbeek Bastiaan , Rijpkema Mark , Verrijp Kiek , Rovers Maroeska , Rosman Camiel , Van Der Post Chella 
Published: September 2018

Abstract

Background
Neoadjuvant chemoradiotherapy (nCRT) followed by resection of the tumor with two field lymphadenectomy is a standard treatment for esophageal cancer. After nCRT, however, in more than 70% of patients no lymph node metastases are found, suggesting extensive overtreatment. Tumor-targeted fluorescence imaging is a promising technique to detect lymph node metastases intra-operatively and guide personalized resection. The aim of this study is to identify potential viable tumor markers for fluorescence imaging of lymph node metastases in patients with esophageal adenocarcinoma (EAC).

Methods
Immunohistochemistry (IHC) was performed on tissue microarrays from EAC’s patients that underwent surgical resection between 2007 and 2016. Patients were subdivided in five groups, non-pretreated patients with and without metastatic lymph nodes, complete responders, partial responders and non-responders after nCRT. Five membranous markers, c-MET, CAIX, EGFR, EpCAM, HER2, and two cytoplasmic markers, VEGF-A and VEGF-A receptor were included. Tumor marker expression was scored on intensity (none (0), slight (1), moderate (2), strong (3)) and the percentage of positive cells (estimation). Threshold for positive detection rate was defined as an intensity of ≥ 2 in more than 10% the cells.

Results
EpCAM showed the highest expression in metastastic lymph nodes, with a median intensity of 3 (range 2–3) in > 70% of the tumor cells. Expression was found in 37 out of 39 EAC’s (95%). VEGF-A and CAIX expression was observed in 28 of 33 (85%) and 10 of 33 (30%) of metastatic lymph nodes and 34 of 39 (87%) and 17 of 39 (44%) in the primary EAC’s, respectively. For the other tumor biomarkers the detection rate ranged between 0 and 11% for metastatic lymph nodes and primary EAC’s. Only EpCAM and VEGF-A showed weak, non-specific staining in the fibrotic tissue.

Conclusion
High expression rates in primary EAC and metastatic lymph nodes were observed using immunohistochemical antibodies for EpCAM, VEGF-A and CA-IX, making these clinically relevant viable EAC tumor markers. A phase 1 dose finding study targeting VEGF-A by Bevacizumab-800-CW in patient with EAC is in preparation.

Disclosure
All authors have declared no conflicts of interest.