bluuebunny/crossref_metadata_2025_split huggingface dataset:
FA05.06: EXACT METASTATIC RATE OF CERVICAL NODES BY NON-SELECTIVE THREE-FIELD DISSECTION FOR THE THORACIC ESOPHAGEAL CARCINOMA
Authors: Tachimori Yuji , Koyanagi Kazuo , Daiko Hiroyuki 
Published: September 2018

Abstract

Background
Three-field dissection is usually adapted for selected patients with esophageal carcinoma. Exact metastatic rate of cervical lymph nodes for thoracic esophageal carcinoma remains speculation.

Methods
Three-field dissection was performed for 96% of patients who underwent radical esophagectomy for thoracic esophageal carcinoma during 2001–2010. Exact metastatic rate and survival after dissection of metastatic nodes were evaluated for assessment of efficacy of three-field dissection.

Results
During 2001 to 2010, 1075 patients underwent esophagectomy for thoracic esophageal carcinoma. Excluding 115 patients underwent salvage esophagectomy and 39 patients underwent R1–2 resection, 921 patients underwent radical esophagectomy. Three-field dissection was performed in 882 patients (96%) and avoided in 19 patients because of systemic morbidity. The incidence of clinically positive supraclavicular lymph nodes 6.7%. The incidence of pathologically positive supraclavicular lymph nodes 14.1%. According to tumor location, the incidence of pathologically positive supraclavicular lymph nodes was 18.3% for the upper thoracic tumor, 17.2% for the mid thoracic tumor, 8.4% for the lower thoracic tumor. According to cT category, the incidence of pathologically positive supraclavicular lymph nodes was 8.4% for cT1b tumor, 9.9% for cT2 tumor, 17.2% for cT3 tumor. Of 823 patients with clinically negative supraclavicular node, 82 patients (10%) had pathologically positive supraclavicular nodes. Of patients with clinically positive recurrent laryngeal nerve node, 27.1% of patiets had pathologically positive supraclavicular nodes. Over-all 5-year survival of patients with pathologically positive supraclavicular lymph node was 20.8% for the upper thoracic tumor, 31.5% for the mid thoracic tumor, 14.3% for the lower thoracic tumor.

Conclusion
Exact metastatic rate and survival after dissection of metastatic nodes for supraclavicular lymph node were evaluated for assessment of efficacy of three-field dissection for thoracic esophageal carcinoma. Of patients with clinically negative node, 10% of patients had pathologically positive supraclavicular nodes. High incidence of positive supraclavicular nodes in patients with clinically positive recurrent laryngeal nerve node indicated posibility of selection for three-field dissection. Overall 5-year survival of patients with pathologically positive supraclavicular lymph node was better than that of patients with organ metastasis reported previously.

Disclosure
All authors have declared no conflicts of interest.
FA06.01: CLINICAL EFFECT OF NEOADJUVANT CHEMOTHERAPY OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA FOR SUPERFICIAL PHARYNGEAL SQUAMOUS CELL CARCINOMA
Authors: Ishida Hiroki , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Nakamura Rieko , Suda Koichi , Wada Norihito , Kitagawa Yuko 
Published: September 2018

Abstract

Background
Esophageal squamous cell carcinoma (ESCC) is often synchronously accompanied by pharyngeal squamous cell carcinoma (PSCC). However, the treatment strategies for these cancers have not been established. Neoadjuvant chemotherapy is the standard treatment for advanced ESCC and is also effective for PSCC patients. However, few studies have focused on the efficacy of systemic chemotherapy for patients with superficial PSCC.

Methods
We retrospectively examined 22 cases of superficial PSCC that occurred in 14 patients with ESCC who received neoadjuvant therapy between January 2011 and June 2017.

Results
Of the 14 patients, 13 (93%) were male, and the median age was 63.5 years (range: 35–74 years). The clinical stage of ESCC was II for 7, III for 5, and IVB for 2 (AJCC 8th staging system). The PSCC origin included the oropharynx in 9 lesions (40.9%) and the hypopharynx in 13 lesions (59.1%). Macroscopic type was classified as protruding (type1 or 0-I) for 2, superficial elevated (0-IIa) for 5, superficial flat (0-IIb) for 13, and superficial depressed (0-IIc) for 2. The estimated depth of invasion was EP in 12 lesions, SEP in 8 lesions, and MP in 2 lesions. FP regimen was administered to 11 patients in 15 lesions and DCF to 3 patients in 7 lesions. One patient had concurrent chemoradiotherapy. Chemotherapy for PSCC resulted in CR in 10 lesions (45.4%). In CR, 9 of 10 lesions were of superficial flat type. All non-CR lesions also had tumor regression. In the CR patients, 5 lesions(50%) had local recurrence, and the median duration until recurrence was 4 months (range: 4 to 17 months). Endoscopic resection(ER) for PSCC was performed in the 13 lesions after esophagectomy. The median duration after diagnosis was 7 months (range: 3 to 20 months).

Conclusion
Systemic chemotherapy of ESCC has tumor regression potential for superficial flat-type PSCC with clinical tumor invasion in EP or SEP. Although chemotherapy for PSCC results in non-CR, additional ER is quite effective. Because half of the CR lesions had recurrence, strict follow-up and observation of the pharynx are reasonable options for patients with ESCC.

Disclosure
All authors have declared no conflicts of interest.
FA06.03: THE EFFECT OF LYMPH NODE HARVEST UPON MORTALITY FROM OESOPHAGECTOMY FOR OESOPHAGEAL ADENOCARCINOMA: NATIONAL POPULATION-BASED COHORT STUDY
Authors: Markar Sheraz , Varagunam Mira , Mackenzie Hugh , Brand Christian , Cromwell David , Maynard Nick , Hanna George 
Published: September 2018

Abstract

Background
In an era of increased utilisation of multimodality treatment for oesophageal adenocarcinoma the role of radical lymphadenectomy remains controversial. The objectives of this population-based cohort study were to evaluate the influence of lymph node harvest upon short- and long-term mortality following oesophagectomy for oesophageal adenocarcinoma, with subset analysis of patients receiving neoadjuvant therapy.

Methods
The UK National Oesophago-Gastric Cancer Audit (NOGCA) was used to identify suitable patients operated on between 1st April 2012 and 31st March 2016. Logistic regression of confounders was used to generate predicted mortality probabilities for utilisation in Risk-Adjusted Cumulative Sum (RA-CUSUM) analysis to identify the lymph node harvest change-points associated with changes in one-, two- and three-year mortality.

Results
Within the three-year study period, 3883 patients were included of these 2192 patients (56%) received neoadjuvant chemotherapy. For all patients there were non-significant change-points in 1-, 2-, and 3-year mortality at 19, 27 and 19 lymph nodes respectively. For patients receiving neoadjuvant therapy change-point analysis did show statistically significant reductions in 2-year mortality (44.9% before to 39.2% after 19 lymph nodes; P = 0.017) and 3-year mortality (55.0% before to 47.4% after 20 lymph nodes; P = 0.035). 30-day and 90-day mortality and anastomotic leak were not significantly by lymph node harvest of greater than 19 lymph nodes.

Conclusion
The results of this national population-based cohort study suggest that at least 20 lymph nodes should be harvested during oesophagectomy given the prognostic importance in oesophageal adenocarcinoma, and the benefits to improve pathological staging of the patient and appropriately allocate adjuvant therapy.

Disclosure
All authors have declared no conflicts of interest.
FA06.05: DETECTING RESIDUAL ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION BY ENDOSCOPIC BIOPSIES, EUS AND FDG-PET: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Eyck B , Noordman B , Onstenk B , Nieboer Daan , Spaander M C W , Valkema R , Lagarde Sjoerd M , Wijnhoven Bas P L , Van Lanschot J J B 
Published: September 2018

Abstract

Background
After curatively intended neoadjuvant chemoradiotherapy (nCRT) according to CROSS plus surgery for esophageal cancer, 29% of patients have a pathologic complete response. Active surveillance after nCRT, in which patients undergo frequent clinical examinations and where esophagectomy is only offered to those with a locoregional regrowth without distant metastases, has been proposed as novel treatment option. This study provides a systematic review and meta-analysis of the literature regarding the accuracy of endoscopic biopsies, endoscopic ultrasound (EUS) and 18F-FDG PET(-CT) for detecting residual disease after nCRT for esophageal cancer.

Methods
A systematic literature search in Embase, Medline, Cochrane and Web of Science was performed. Two reviewers independently collected studies on the diagnostic accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) for detecting residual disease after nCRT at the primary tumor site or in regional lymph nodes for potentially curable esophageal adenocarcinoma (AC) or squamous cell carcinoma (SCC). Histopathological examination of the resection specimen was the reference standard. Study quality was appraised with the QUADAS-2 tool. Sensitivity and specificity values were calculated and pooled using meta-analyses. Subgroup analyses were performed to investigate possible sources of heterogeneity.

Results
60 studies were included for qualitative analysis and 40 for quantitative analysis. For detecting residual disease at the primary tumor site, 11 studies evaluated endoscopic biopsies, 11 described EUS qualitatively, 14 evaluated PET qualitatively, 12 evaluated PET quantitatively, 6 of them using SUVmax and 6 of them using DSUVmax. Summary sensitivity values were 0.36 (95%CI 0.27–0.45), 0.97 (95%CI 0.94–0.98), 0.74 (95%CI 0.66–0.81), 0.68 (95%CI 0.61–0.74) and 0.68 (95%CI 0.54–0.79), respectively. Summary specificity values were 0.93 (95%CI 0.85–0.97), 0.09 (95%CI 0.04–0.19), 0.52 (95%CI 0.40–0.63), 0.70 (95%CI 0.61–0.78), 0.70 (95%CI 0.60–0.78) and respectively. For detecting residual malignant lymph nodes, 11 studies evaluated EUS with a summary sensitivity of 0.68 (95%CI 0.54–0.80) and a summary specificity of 0.58 (95%CI 0.45–0.70). Subgroup analyses demonstrated that sensitivity of endoscopic biopsy, PET DSUVmax and EUS for nodal was higher in SCC than in AC.

Conclusion
Current literature suggests insufficient accuracy of endoscopic biopsies, EUS and 18F-FDG PET(-CT) as individual modalities for detecting residual disease after nCRT for potentially curable esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
FA08.01: MORTALITY AND REFRAINMENT FROM ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS THAT STARTED NEOADJUVANT CHEMORADIOTHERAPY: A POPULATION-BASED COHORT STUDY
Authors: Borggreve Alicia , Van Rossum Peter , Mook Stella , Haj Mohammad Nadia , Hillegersberg Richard , Ruurda Jelle 
Published: September 2018

Abstract

Background
Esophagectomy functions as the cornerstone of the curative treatment for locally advanced esophageal cancer. The addition of neoadjuvant chemoradiotherapy (nCRT) to surgery improves survival, but can be accompanied by substantial toxicity on the other hand. This cohort study describes the consequences of nCRT for esophageal cancer in terms of mortality (during or after the course of nCRT) in real-world clinical practice, as well as the proportion of patients that do not proceed to planned esophagectomy after finishing nCRT.

Methods
All patients that started nCRT (carboplatin/paclitaxel with 41.4 Gy) for primary, locally advanced, esophageal cancer in 2015 were included from the nationwide population-based cancer registry. Outcome measurements were mortality during or within 90 days after neoadjuvant therapy (and before planned esophagectomy), as well as refrainment from planned esophagectomy after starting nCRT and the reasons for cancelled esophagectomy.

Results
Some 740 patients that started nCRT for esophageal cancer were included (Table 1). A total of 13 (1.8%) patients died during or within 90 days after nCRT (before planned esophagectomy). A total of 79 (10.7%) patients that started nCRT did not proceed to esophagectomy. The most frequently reported reasons for not proceeding to esophagectomy were tumor progression (4.6%, n = 34), performance status (2.7%, n = 20), and patients’ request (1.8%, n = 13).

Conclusion
In this population-based study, 1 in 10 (10.7%) patients that started nCRT for locally advanced esophageal cancer did not undergo esophagectomy. Further research should aim to investigate whether this patient group can be selected prior to treatment, and if interventions and counseling will result in a larger proportion of patients who will undergo surgery.

Disclosure
All authors have declared no conflicts of interest.
FA08.02: ENHANCED RECOVERY AFTER ESOPHAGECTOMY AND RECONSTRUCTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Chou Shah-Hwa , Liu Yu-Wei 
Published: September 2018

Abstract

Background
Enhanced recovery after surgery (ERAS) was originally designed and used in colorectal surgery. Recently there were some related reports of its implementation on esophageal cancer surgery, mainly adenocarcinoma. This study is to determine if ERAS can be effectively and safely applied to esophageal squamous cell carcinoma in Asian population.

Methods
In early 2012, our perioperative management protocol was reinvented and has been implemented thereafter. So two groups of patients were set up and compared. Group A is the patients operated on before 2012, managed by the old protocol. Group B is the patients managed under the new protocol. Their demographics, complications, hospital stay and charges were reviewed and analysed.

Results
Group A 65 patients. Group B 61 patients. The ventilator days, ICU stay and postoperative stay were statistically shorter in group B. There was no hospital mortality in either groups. No increase of complications was noted in group B. The hospital charges in group B were lower although statistically insignificant.

Conclusion
The new protocol of perioperative care is safe and effectively enhanced the postoperative recovery after esophagectomy and reconstruction for esophageal squamous cell carcinoma.
Table 1. Clinical protocol for group A and B
POD, post-operative day; ICU, intensive care unit; TPN, total parenteral nutrition; J-P drain, Jackson-Pratt drain; N/S, normal saline; CVC, central venous catheter; NG, nasogastric tube; OR, operating room; NPO, nil per os; IV, intravenous; PCA, patient control analgesia.

Disclosure
All authors have declared no conflicts of interest.
PS01.002: INTERSPHINCTERIC ESOPHAGEAL LENGTH IN ADULTS
Authors: Kovacs Balazs , Masuda Takahiro , Bremner Ross , Mittal Sumeet 
Published: September 2018

Abstract

Background
High Resolution Manometry (HRM) has replaced standard water perfused manometery as the gold standard for esophageal testing. While normal and abnormal parameters continue to be refined for HRM there is no literature related to manometric esophageal length in adult population using HRM. Aim of this study is to define normal range for esophageal length and variation with patient height.

Methods
An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent HRM between 11/01/2016 and 11/01/2017. Patients with history of previous esophageal surgery, hiatal hernia or major disorders of peristalsis were excluded. Inter-sphincteric esophageal length (cm) was measured from the lower border of UES to the upper border of LES during inhalation. Esophageal Length Index (ELI) was calculated by dividing the esophageal length by patient height.

Results
A total of1139 patients underwent HRM in the study period of which 235 patients met inclusion criteria and form the cohort for this study. Mean age was 57.3; BMI was 27.3. Median height was 166.6 cm, inter-sphincteric length was 22.4 cm. Mean ELI was 0.135 (+ 0.012), with 5th and 95th percentile range of 0.113 and 0.154 respectively (Figure 1).

Conclusion
Esophageal length and ELI varies in the normal population. An ELI of < 0.113 draws attention to possible short esophagus. It would be interesting to correlate these parameters with intra-abdominal esophageal length in patients undergoing hiatus hernia repair.

Disclosure
All authors have declared no conflicts of interest.
PS01.003: EVALUATION OF BOTH STANDARD AND NOVEL HRM METRICS OF THE UPPER ESOPHAGEAL SPHINCTER (UES) IN ACHALASIA AND REFLUX DISEASE. APPLICATION OF THE CONTRACTILE INTEGRAL IN THE UES
Authors: Triantafyllou Tania , Theodoropoulos Charalampos , Zografos Georgios , Theodorou Dimitrios 
Published: September 2018

Abstract

Background
The literature is still lacking thorough manometric analysis of the function of the Upper Esophageal Sphincter (UES) among patients with motility disorders. Assessment of the High Resolution Manometry (HRM) features of the UES may be the key in further understanding the manometric profile of achalasia and even predicting treatment outcome. Furthermore, the Contractile Integral (CI) may be a more representative measure of contractility of the UES too.

Methods
Achalasia patients (study group) and a control group of individuals underwent HRM. Resting pressure, residual pressure, UES length and the Landmark UES-CI corrected for respiration were analyzed and compared between the two groups. The UES-CI metric was calculated according to the method applied for the Distal Contractile Integral (DCI).

Results
24 achalasia patients and 24 subjects consisting the control group with mean age 55.2 and 56.1, respectively, were enrolled. Although the mean UES length was found significantly lower in our study group (3.2 vs. 4.3, P = 0), mean residual pressure was found significantly higher among the same group as compared to controls (12.5 vs. 3, P = 0.01). Interestingly, we found a trend towards lower values of the corrected UES-CI in achalasia compared to the control group (132 vs. 207.8, P = 0.08). The resting pressure did not differ between the two groups.

Conclusion
Increased residual pressure values of the UES in achalasia compared to control group is a reasonable finding that indicates that UES may also be affected by the neuronal damage in this disorder or that the pressurization phenomenon (mainly in achalasia type II) disrupts the function of the UES during swallowing. However, results on the UES-CI in resting phase cannot confirm the hypothesis of higher risk of aspiration among achalasia patients whose esophageal lumen is known to present with incomplete clearance and stasis.

Disclosure
All authors have declared no conflicts of interest.
PS01.009: COMPREHENSIVE CLASSIFICATION FOR ANTIREFLUX FUNCTION OF THE ESOPHAGOGASTRIC JUNCTION BASED ON HIGH-RESOLUTION MANOMETRY
Authors: Masuda Takahiro , Kovacs Balazs , Bremner Ross , Mittal Sumeet 
Published: September 2018

Abstract

Background
The anatomical configuration of the esophagogastric junction (EGJ) and the thoracoabdominal pressure gradient (TAPG) affect gastric content backflow into the esophagus. A comprehensive antireflux function assessment is needed to identify underlying derangements in patients with gastroesophageal reflux (GER). Herein we propose an objective scoring system for grading EGJ function.

Methods
We analyzed patients who underwent 24-hour pH study and high-resolution manometry in 2017 at our institution. We assessed three factors: EGJ morphology, lower esophageal sphincter pressure integral, and TAPG. Each factor was scored on a scale of 0–2, and a cumulative score was calculated (Table 1). Patients were divided into 3 groups based on cumulative score: 0, competent EGJ function (Grade I); 1–3, moderate incompetency (Grade II); 4–6, poor competency (Grade III).

Results
In total, 140 patients were studied. The mean age was 58.6 years, 75 patients (53.6%) were men, and the mean body mass index was 28.6 kg/m2. Fifty-one patients (36.4%) had an abnormal DeMeester score (ie, > 14.72). A significant, progressive increase was seen in number of reflux episodes (I-25.7, II-36.4, III-50.5, rs = 0.207, P = 0.015), total acid exposure time (I-1.0%, II-2.1%, III-5.0%, rs = 0.312, P < 0.001) and prevalence of abnormal pH score (I-13.0%, II-32.0%, III-57.1%, rs = 0.314, P < 0.001) from Grade I to III.

Conclusion
The proposed grading of the EGJ based on a cumulative score of individual parameters has a good correlation with GER.

Disclosure
All authors have declared no conflicts of interest.
PS01.013: CLINICAL SIGNIFICANCE OF ESOPHAGOGASTRODUODENOSCOPY IN PATIENTS WITH ESOPHAGEAL MOTILITY DISORDERS
Authors: Manabe Noriaki , Haruma Ken , Nakato Rui , Nakamura Jun , Murao Takahisa , Fujita Minoru , Suehiro Mitsuhiko , Kamada Tomoari , Shiotani Akiko , Kawamoto Hirofumi , Yamatsuji Tomoki , Naomoto Yoshio 
Published: September 2018

Abstract

Background
Although dysphagia is an indication for esophagogastroduodenoscopy (EGD) its causes include organic and non-organic disorders. There has been no study to investigate the clinical significance of EGD in patients with esophageal motility disorders (EMD). The first aim was to elucidate the detection ratio for EMD with EGD. The second aim was to clarify useful EGD parameters associated with them.

Methods
Participants included 372 patients who underwent EGD before high resolution manometry for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, spastic and non-occlusive contraction. The EGD finding was positive when at least one EGD finding was detected. HRM diagnoses were made based on the Chicago classification (v3.0).

Results
Of 372 participants, pseudoachalasia were diagnosed in 6 patients (1.61%), EMD in 250, and normal in 116. The detection ratio for each EMD by EGD is shown in Table 1. There were significant differences in the detection ratio among the three groups (81.1% in major, 50.0% in minor EMD and 15.5% in normal, P < 0.05). On multivariate analysis, resistance when passing through the EGJ (adjusted odds ratio (aOR): 3.99; 95% CI [1.26–12.66]), and non-occlusive contraction (aOR: 10.3; 95% CI [5.26–20.19]) were significantly associated with EMD.

Conclusion
The ratio of abnormal EGD findings was different in each EMD. Major EMD can be screened with EGD. Among several endoscopic parameters related with EMD, the non-occlusive contraction is most useful endoscopic parameter.

Disclosure
All authors have declared no conflicts of interest.