bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.104: INVESTIGATION OF FACTORS AFFECTING ENDOSCOPIC OBSERVATION FOR ESOPHAGOGASTRIC JUNCTION
Authors: Matsuo Yasumasa , Yasuda Hiroshi , Itoh Fumio 
Published: September 2018

Abstract

Background
Evaluation of the esophagogastric junction (EGJ) area is essential for detecting EGJ cancer including Barrett's adenocarcinoma. The aim of this study is to analyze the factors of difficulty in endoscopic EGJ evaluation.

Methods
Data were collected retrospectively from consecutive subjects who underwent esophagogastroduodenoscopy (EGD) for medical examination/health checkup in our institution between April 2013 and March 2014. The EGJ observed was assessed during both insertion and withdrawal of the EGD. The difficulty level of endoscopic EGJ evaluation was classified into two groups: an easy-evaluation (100% of the EGJ) and a difficult-evaluation (Not 100% of the EGJ) group. Midazolam was used as a sedative. We compared ages, genders, heights, weights, BMIs, coexisting heart and pulmonary diseases, gastric ulcers, sedations with midazolam and hiatal hernias between the two groups.

Results
The study included 692 patients (mean age 65.4 ± 12.4 years, 327 females). The easy-evaluation group comprised 575 cases (83.1%) and the difficult-evaluation group comprised 117 cases (16.9%). In the easy- and difficult-evaluation groups, the numbers of sedated cases were 348 (60.5%) and 96 (82.1%), the numbers of cases without esophageal hiatal hernia were 299 (52.0%) and 83 (70.9%), respectively. The cases that was sedated with midazolam and without esophageal hiatal hernia were identified as independent risk factors associated with difficulty in observation of the EGJ (for both factors, P < 0.001), and their odds ratios were 3.16 and 2.30, respectively. There were no other factors associated with difficulty in observation of the EGJ.

Conclusion
Sedation with midazolam and without esophageal hiatal hernia causes difficulty in endoscopic observation of the EGJ.

Disclosure
All authors have declared no conflicts of interest.
PS01.119: TO INVESTIGATE WHETHER BILATERAL MEDIASTINAL PLEURA SHOULD BE REMOVED IN I-IIA ESOPHAGEAL CANCER SURGERY
Authors: Yu Zhang 
Published: September 2018

Abstract

Background
For thoracic segment esophageal range, Some think resect double side mediastinal pleura. other think never resection has no difference, increased complications.

Methods
This study used a prospective, randomized controlled study method. 213 patients with I-IIIA esophageal cancer were randomly divided into two groups. one group of 106 patients were completely removed with bilateral mediastinal pleura. Another group of 107 patients had the mediastinal pleura in the implementation; Both groups performed a thoracic lymph node dissection. we observed the incidence of pleural effusion, pulmonary infection rate, chest infection rate, OS, thoracic metastatic tumor incidence, and the postoperative review PET- CT.

Results
Among the 106 patients, there were 11 cases of pleural metastasis, 8 cases of chest infection and 33 cases of pulmonary infection, thoracic drainage tube pulling time averaged 3.8 days. After surgery three months, six months, one year, two years, 47 cases PET-CT are positive. an average 5-year survival rate of 47.3%. In other group, 15 patients with pleural metastases, 5 patients with chest infection, 19 in the lungs, thoracic drainage tube pulling time averaged 3.4 days. After surgery three months, six months, one year, two years, 43 cases PET-CT are positive and an average 5-year survival rate of 46,8%..

Conclusion
This study is a prospective study on mediastinal pleural resection of esophageal cancer. Experimental conclusion found two groups of patients with pleural and pleural metastasis rate was not significant difference, and the chest cavity infection and pulmonary infection rate, less resection in patients with bilateral mediastinal pleura resection group is more, chest tube pull out two groups of almost the same time, there was no significant difference. Postoperative three months, six months, one year, two years PET-CT results, no significant difference in chest positive results. Patients with bilateral mediastinal pleural resection had a higher chest discomfort. In conclusion, it was concluded that there was no significant advantage in the surgical excision of bilateral mediastinal pleura in patients with esophageal cancer, and there were many complications. The sample size of this experiment is small, which is a single center study, and more large samples are needed.

Disclosure
All authors have declared no conflicts of interest.
PS01.120: INVESTIGATION OF NUTRITIONAL INDICATORS COMPARING RECONSTRUCTION ROUTE AFTER ESOPHAGECTOMY
Authors: Tokuhisa Akihiro , Kanekiyo Shinsuke , Takeda Shigeru , Nagano Hiroaki 
Published: September 2018

Abstract

Background
The gastric tube reconstruction route after esophagectomy is generally adopted posterior mediastinal or retrosternal route. Currently it is selected for each hospital or case. Preoperative and postoperative nutritional assessment, surgical complications and rate of survival are retrospectively compared between Posterior mediastinal routec(Group P) and Retrosternal route (Group R).

Methods
From January 2006 to December 2015, 198 patients with gastric tube reconstruction after esophagectomy (112 patients in Group P and 86 patients in Group R) were included. Propensity score was calculated and adjusted by multiple logistic regression analysis because bias of background factors occurs. 1) Surgical complications and survival rate, 2) CONUT score as a nutritional evaluation index before, 6 months and 12 months after surgery, 3) Endoscopic findings at 12 months after surgery were examined.

Results
In Group R, there were more advanced cases with thoracotomy than Group P. As a result of matching these factors as covariates using Propensity score, 27 groups were extracted in each group. 1) Surgical complications and survival rate: There was no difference in the incidence of complications such as arrhythmia, suture failure, pulmonary complications between the two groups. There was no difference between PFS and OS in the two groups. 2) Nutritional Evaluation Indicator: The patients who recognized malnutrition (CONUT score 3 or more) before surgery (group P 9.3% vs. group R 7.4%, P = 0.715), 6 months after surgery (18.0% vs 15.4%, P = 1.000), 12 months after surgery (8.6% vs 22.9%, P = 0.049), group P had good nutritional status for 12 months postoperatively. 3) Endoscopic findings: Anastomotic stenosis (group P 22.5% vs. group R 10.2%, P = 0.052) tended to be few in group R. The occurrence of reflux esophagitis and food residue stagnation was not different between both groups.

Conclusion
Although short-term benefits such as ease of response to postoperative recurrence and postoperative complications are considered to be in retrosternal reconstruction, as the results of esophageal cancer treatment outcome improve, longer term of nutrition etc is taken from the viewpoint. The posterior mediastinal route is the first choice in our department.

Disclosure
All authors have declared no conflicts of interest.
PS01.121: DISTRIBUTION OF MEDIASTINAL LYMPH NODE INVOLVEMENT IN ADENOCARCINOMA OF THE ESOPHAGOGASTRIC JUNCTION
Authors: Mine Shinji , Watanabe Masayuki , Imamura Yu , Okamura Akihiko , Yamashita Kotaro , Hayami Masaru , Yuda Masami , Fukudome Ian 
Published: September 2018

Abstract

Background
The distribution of mediastinal lymph node involvement is not clear in patients with adenocarcinoma of the esophagogastric junction (AEG). Based on our experiences with radical lymphadenectomy of upper mediastinum for esophageal squamous cell carcinoma, we applied this technique to patients with AEG. We retrospectively investigated it and compared it with that in patients who had lower esophageal squamous cell carcinoma (ESCC) with clinical invasion of the esophagogastric junction.

Methods
Sixty-four patients underwent esophagectomy via a right thoracotomy or a minimally invasive esophagectomy for Siewert type I tumor or type II with ≥ 3 cm esophageal invasion. The incidences of mediastinal lymph node involvements and the characteristics of patients with mediastinal nodal involvement were analyzed retrospectively. In addition, these outcomes were compared with 72 patients who had lower ESCC with clinical invasion of the esophagogastric junction.

Results
In 64 patients with AEG, mediastinal lymph node involvement was seen in 23 patients (36%). The incidences of upper, middle, lower mediastinal nodal involvement were 19%, 16%, and 22%, respectively. No significant differences were found for cStage, Siewert type, endoscopic tumor length, pT or pN status, residual tumor, or survival between patients with upper nodal involvement and those with middle or lower nodal involvement. The incidence of each mediastinal lymph node involvement was similar between AEG and lower ESCC patients.

Conclusion
Although our outcomes were based on limited data, the incidence of upper, middle, and lower mediastinal lymph node involvement might not be low, and its clinical characteristics were similar to those for middle or lower mediastinal nodal involvement in esophageal adenocarcinoma.

Disclosure
All authors have declared no conflicts of interest.
PS01.124: AN OPTIMAL SURGICAL APPROACH AND THE EXTENT OF LYMPH NODE DISSECTION FOR BARRETT’S ADENOCARCINOMA
Authors: Gokon Yusuke , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Okamoto Hiroshi , Takaya Kai , Maruyama Shota , Kamei Takashi 
Published: September 2018

Abstract

Background
An optimal surgical approach and the extent of lymph node dissection for Barrett's adenocarcinoma remain controversial. The standard surgical approach for Barrett's adenocarcinoma at our institution is performing thoracoscopic esophagectomy. Proximal gastrectomy is preferred in cases where distance between the proximal edge of the primary tumor and the esophagogastric junction is < 3 cm. However, some studies suggest a complete resection of Barrett's esophagus.

Methods
The clinicopathologic data of 36 patients with Barrett's adenocarcinoma who were admitted to our institution between 1994 and 2017 were retrospectively analyzed to assess the efficacy of lymph node dissection at each station using the index of estimated benefit from lymph node dissection (IEBLD).

Results
The tumor locations were found to be the middle thoracic, lower thoracic, and abdominal esophagus in 2 (5.6%), 17 (47.2%), and 17 (47.2%) cases, respectively. A total of 28 (77.8%), 6 (16.7%), and 2 (5.5%) patients underwent esophagectomy, proximal gastrectomy, and transhiatal esophagectomy, respectively. The overall lymph node metastasis rate was 41.6%. The IEBLD indexes of the middle/lower thoracic lymph and the abdominal lymph nodes were comparable, whereas those of the paraesophageal lymph nodes (#108 and 110) were relatively high. Conversely, the metastasis rates of the upper thoracic lymph nodes were 13.9%, with no IEBLD values. Cervical lymph node metastasis was not identified, and the significance of dissection was unclear. Stratified by the location of tumor, the ILBLD index of middle/lower thoracic lymph node was relatively high in Lt cases. Conversely, those of abdominal lymph nodes were high and those of middle thoracic lymph nodes were not identified in Ae cases. In proximal gastrectomy cases, the complete resection of Barrett's esophagus was not achieved in 2 (40%) cases with LSBE. Lymph node metastasis was identified in one case (#110). The recurrence-free survival rate was 100%.

Conclusion
The significance of upper thoracic lymph node dissection was unclear, whereas those of middle/lower thoracic lymph and the abdominal lymph nodes were comparable. The selection of an appropriate surgical approach at our institution was acceptable. The efficacy of complete resection of LSBE was not observed.

Disclosure
All authors have declared no conflicts of interest.
PS01.131: POSTOPERATIVE ANASTOMOTIC LEAKAGE AND PNEUMONIA FOLLOWING ESOPHAGECTOMY: A RETROSPECTIVE SINGLE-CENTER ANALYSIS
Authors: Herzberg Jonas , Strate Tim , Honarpisheh Human 
Published: September 2018

Abstract

Background
Anastomotic leakage and pneumonia following esophagectomy remain a significant clinical challenge and contribute to the postoperative outcome. Aim of this study was to investigate the relation between risk factors for the occurrence of leakage or pneumonia and the postoperative outcome and to identify further risk factors.

Methods
We analyzed 53 consecutive patients who underwent a surgical resection of the esophagus (distal esophagectomy and abdominothoracical esophagectomy) from January 2015 until August 2017. Patients demographics, perioperative parameters, and postoperative events were analyzed. Patient data were expressed as mean ± SD (range). P < 0.05 was considered statistically significant.

Results
Postoperative pneumonia and anastomotic leakage occurred in 15 (28%) and 8 (15%) patients, respectively. Median operative time was 330.7 (± 69.6) minutes, and median length of stay was 24.8 (± 10.6) days. 2 (3.8%) of the patients required blood transfusion due to intraoperative bleeding. BMI, ASA-score, and an intraoperative performed lymphadenectomy did not affect the occurrence of pneumonia or anastomotic leakage. Patients with anastomotic leakage stayed longer at the ICU. However, the overall hospitalization rate did not differ significantly. As an independent risk factor, we identified that hypoproteinaemia with a protein level ≤ 5 g/dl (p-value 0.036) leads to a significant higher occurrence of anastomotic leakage. We could not identify any risk factors with regards to postoperative pneumonia.

Conclusion
The prevalence of hypoproteinaemia in patients after esophagectomy was associated with a higher occurrence of postoperative anastomotic leakage. These results indicate the importance of the perioperative nutrition aiming for a balanced protein level irrespective of comorbidity and surgical procedure.

Disclosure
All authors have declared no conflicts of interest.
PS01.134: WHERE TO START? COMPARING INDUCTION CHEMORADIOTHERAPY AND UPFRONT SURGERY IN THE TREATMENT OF CLINICAL T2N0 ESOPHAGEAL CANCER
Authors: Agzarian John , Inra Matthew , Abdelsattar Zaid , Allen Mark , Blackmon Shanda , Cassivi Stephen , Nichols Iii Francis , Wigle Dennis , Shen K 
Published: September 2018

Abstract

Background
The purpose of this study was to evaluate the survival difference in clinical T2N0 esophageal cancer patients receiving neoadjuvant chemoradiotherapy (CRT) vs. upfront surgery.

Methods
Between 1/1/1995 to 12/31/2012, a prospectively maintained database was used to identify patients with cT2N0 esophageal adeno- and squamous cell carcinoma. Exclusion criteria included: lack of endoscopic esophageal ultrasonographic (EUS) staging, incomplete resection, and prior treatment with endoscopic mucosal or submucosal resection. Cox-proportional hazard ratios were used to compare the primary outcomes of overall (OS) and disease-free survival (DFS). Secondary outcomes included: rate of postoperative complications, rate of pathologic upstaging/response, and induction/adjuvant treatment completion rate. Pre-hoc subgroup analysis compared pathologically upstaged patients receiving upfront surgery followed by adjuvant chemotherapy to those treated with neoadjuvant CRT.

Results
A total of 161 cT2N0 esophageal cancer patients were identified based on EUS staging. Upfront surgery was offered to 134 patients (83%), with 27 patients (17%) receiving induction CRT. Univariate analysis did not demonstrate any significant baseline differences between the two groups. In the upfront surgery group, 53 (39.6%), 28 (20.9%) and 53 (39.6%) patients were pathologically down-staged, accurately staged and upstaged respectively. Upstaging was higher in the upfront surgery group (53/134, 39.6% vs. 4/27, 14.8%; P = 0.02), while 11/27 (40.7%) patients receiving neoadjuvant CRT demonstrated complete pathologic response. Of those eligible for adjuvant chemotherapy, only 21/55 (38.2%) received treatment. In the neoadjuvant CRT group, 51.9% completed all planned therapy, compared to 23.6% of patients treated with upfront surgery followed by adjuvant chemotherapy (P = 0.01). Cox proportional hazard ratio did not demonstrate an advantage to induction CRT in terms of OS (HR = 1.64, P = 0.43) or DFS (HR = 1.36, P = 0.69). In general, patients with pathologic upstaging had worse OS (HR = 2.73, P = 0.001) and DFS (HR = 4.18, P = 0.003).

Conclusion
EUS was only accurate in staging T2N0 patients in 20.9% of cases. While neoadjuvant CRT did not confer a survival advantage, these results likely reflect the low number of patients being referred for induction therapy. Neoadjuvant CRT was however associated with lower rates of pathologic upstaging and higher rates of treatment completion. Further research should evaluate the survival outcomes in pathologically upstaged cT2N0 patients not receiving neoadjuvant therapy.

Disclosure
All authors have declared no conflicts of interest.
PS01.137: CLINICAL IMPACT OF SURGICAL APGAR SCORE IN PREDICTING POSTOPERATIVE COMPLICATIONS AND LONG-TERM PROGNOSIS AFTER ESOPHAGECTOMY
Authors: Ishida Sonoko , Nakagawa Akio , Nakamura Tetsu , Oshikiri Taro , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Sumi Yasuo , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2018

Abstract

Background
Surgical Apgar Score (SAS) is a risk calculator, and is known to predict postoperative complications after surgery. Because it applies three intraoperative parameters, namely estimated blood loss, lowest mean arterial pressure, and lowest heart rate, actual surgical stress is reflected to its scoring system and many studies have reported its usefulness. And in recent years, close relationship between postoperative complications and long-term prognosis has been reported, but there are almost no studies about the relevance between risk calculator of complications and long-term prognosis.

Methods
A total of 400 patients who underwent esophagectomy for esophageal cancer between January 2007 and January 2017 at our institution were included in this study. Clinicopathological and intraoperative data to calculate SAS were collected from medical records, and a 10-point scoring system based on the original method was used to assign points. Complications classified as Clavien-Dindo grade III or higher were defined as postoperative complications. The relationship between SAS and postoperative complications and long-term prognosis was investigated.

Results
Postoperative complications occurred in 145 cases (36%). From ROC analysis, we set the SAS cut-off value to 5 points in this study. There were no significant differences in patient's background between the group of SAS ≤ 5 and > 5. Multivariate logistic regression analysis showed that hypertension (P = 0.049) and SAS ≤ 5 (P < 0.0001) were significant predictive factors for postoperative complications. In the prognostic analysis, log-rank analysis showed that patients with SAS ≤ 5 had a significantly poorer prognosis than those with SAS > 5 (P = 0.043), especially in clinical stage 2 or higher esophageal cancer (P = 0.027). In the multivariate analysis, SAS ≤ 5 was revealed to be a significantly poor prognostic factor in clinical stage 2 or higher esophageal cancer (P = 0.029).

Conclusion
The Surgical Apgar Score can predict postoperative complications, and is also useful to predict long-term prognosis after esophagectomy for esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS01.146: THE ANALYSIS OF THE SAFETY OF A MODIFIED LEFT RECURRENT LARYNGEAL LYMPH NODES DISSECTION IN THORACOSCOPIC ESOPHAGEAL CARCINOMA SURGERY
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming 
Published: September 2018

Abstract

Background
To explore the thoroughness and safety of a modified left recurrent laryngeal lymph nodes dissection in thoracoscopic esophageal carcinoma surgery.

Methods
Retrospectively analyzed the clinical data of 136 patients with the left recurrent laryngeal lymph nodes dissection from October 2015 to October 2017 in the First Hospital Affiliated to Xiamen University. 67 cases were divided to the traditional dissection group (double lumen endotracheal intubation, 90 ° lateral position) and 69 cases were classified to the modified dissection group (single cavity tracheal intubation, thoracic CO2 positive pressure ventilation, lateral prone position and esophageal suspension technology). Observed and compared the left laryngeal recurrent nerve lymph nodes cleaning and time, intraoperative complications including thoracic duct injury, tracheal injury, hoarseness and pneumonia.

Results
The cleaning time of the modified dissection group (23 + 8 min) was significantly less than that of the traditional cleaning group (32 plus or minus 5min) (P < 0.01). 5 patients occurred left laryngeal nerve injury in the modified dissection group, with statistically significance (P < 0.01), less than traditional dissection group of 12 patients. The modified dissection method improves the exposure of intraoperative field, the probability of thoracic duct and tracheal injury (1/69, 0/69) were lower than the traditional group (2/67, 1/67), but the difference was not statistically significant (P > 0.05). Moreover, there was no significant difference in lymph nodes metastasis and complications incidence rate (P > 0.05).

Conclusion
The modified dissection method, including single cavity tracheal intubation, thoracic CO2 positive pressure ventilation, lateral prone position and using esophageal suspension technology, can achieve good operation field exposure, the left recurrent laryngeal lymph nodes ‘the whole block’ cleaning, and the greatest degree protection of laryngeal recurrent nerve, thoracic duct, trachea and other organs damage. It is worthy of clinical popularization and application.

Disclosure
All authors have declared no conflicts of interest.
PS01.156: THE PATTERN OF LYMPH NODE METASTATIC AND ITS CLINICAL SIGNIFICANCE FOR THORACIC SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMATHE PATTERN OF LYMPH NODE METASTATIC AND ITS CLINICAL SIGNIFICANCE FOR THORACIC SUPERFICIAL ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Wang Shaohua , Chen Xiaofeng , Wang An 
Published: September 2018

Abstract

Background
The pattern of lymph node metastasis and surgical method in superficial esophageal squamous cell carcinoma (sESCC) remains to be established.

Methods
Clinical data of all patients from 2003 to 2015 who underwent curative esophagectomy for thoracic sESCC were collected based on a prospectively-maintained database. The pattern of lymph node metastasis was analyzed based on depth of tumor invasion and tumor location.

Results
The involved lymph node region was associated to the tumor location, however, upper mediastinal and perigastric region was the most vulnerable region. As for the depth of tumor invasion, the incidence of lymph node metastasis increased with the depth of tumor invasion going deeper. No lymph node involvement was found in tumors invading proper mucosa (M2), while the distribution of positive lymph nodes in tumors invading the deepest 1/3 submucosa was similar to that in advanced ESCC. Lymphatic invasion, tumor location and upper mediastinal lymph node involvement were independent predictors for cervical lymph node metastasis. For patients without lymphatic invasion, the positive predictive value of upper mediastinal lymph node metastasis for positive cervical lymph node was low (0∼25%), while the negative predictive value was very high, wherever the tumor located (93.8∼100%).

Conclusion
Tumors invading till proper mucosa was the best indication for endoscopic mucosa resection; Tumors invading the deepest 1/3 submucosa might benefit from neoadjuvant therapy; Mediastinal-abdominal lymphadenectomy was essential for sESCC. For those without lymphatic invasion, cervical lymphadenectomy might be avoided in case of negative upper mediastinal lymph node.

Disclosure
All authors have declared no conflicts of interest.