bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.140: OUTCOMES OF SALVAGE SURGERY IN PATIENTS WITH RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY
Authors: Slaman Annelijn , Eshuis Wietse , Draaisma Werner , Gisbertz Suzanne , Bergman Jacques , Van Laarhoven Hanneke , Meijer Sybren , Hulshof Maarten , Van Berge Henegouwen Mark I 
Published: September 2018

Abstract

Background
Definitive chemoradiotherapy for esophageal cancer can be a treatment option in selected patients. In patients with locoregional recurrence after definitive chemoradiotherapy, additional curative esophagectomy may be possible, but evidence for this ‘salvage’ esophagectomy is limited. The aim of this study was to evaluate clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy.

Methods
A prospectively maintained database was used to select patients who underwent esophagectomy for locoregional recurrent cancer of the esophagus or gastroesophageal junction after dCRTx (‘salvage esophagectomy’) and patients who underwent curative esophagectomy following neoadjuvant chemoradiotherapy (‘nCRTx esophagectomy’) between January 2013 and January 2018. Patients underwent salvage resection without direct reconstruction (2-stage salvage procedure) or with a direct reconstruction. Perioperative outcomes of salvage esophagectomy were compared to nCRTX esophagectomy. Oncologic outcomes were evaluated using the Kaplan-Meier method.

Results
A total of 16 patients underwent salvage esophagectomy and 330 patients underwent nCRTx esophagectomy during the study period. Direct reconstruction was performed in 3 patients (13.3%) of the salvage group versus 328 patients (99.1%) who underwent nCRTx esophagectomy (P < 0.001). R0-resection rate was higher after esophagectomy following nCRTx than after salvage surgery (97.0% versus 68.8% respectively, P < 0.001). Difference in morbidity did not reach statistical significance (58.8% versus 81.3% respectively, P = 0.115). The combined (30-day and in-hospital) mortality and 90-day mortality were significantly higher after salvage esophagectomy (2.4% versus 31.1% and 4.7% versus 42.9%, both P < 0.001). Median follow-up of all surviving patients was 21.4 months (IQR, 10.0–36.2). The overall survival in the salvage group had a median of 4.3 months (95% CI, 0–10.0) versus a median of 43.7 months (95% CI, 33.9–53.5) in the nCRTx esophagectomy group. The cumulative 1-year and 3-year survival of the salvage group were 42.2% and 28.1%. Within 5 years after surgery all patients in the salvage esophagectomy group had died.

Conclusion
Definitive chemoradiotherapy followed by esophagectomy for esophageal carcinomas is associated with a high proportion of R1 resections and high mortality rates. It is recommended to evaluate these results in larger patient cohorts. Salvage resections should only be performed in strongly selected patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.141: RESULTS AND PROSPECTS OF SALVAGE SURGERY AFTER DEFINITIVE CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Nabeya Yoshihiro , Hoshino Isamu , Nagata Matsuo , Takiguchi Nobuhiro , Ikeda Atsushi , Soda Hiroaki , Tonooka Toru , Gunji Hisashi , Yoshizumi Arihito , Imazeki Hiroshi , Minashi Keiko , Hironaka Shuichi 
Published: September 2018

Abstract

Background
Salvage surgery for esophageal cancer (squamous cell carcinoma) patients with locoregional failure after definitive chemoradiotherapy (dCRT) is high risk, and no surgical consensus has been established. We evaluated our 2 procedures of salvage surgery for failure which was confirmed by GS, CT, and PET: [SE] esophagectomy followed by reconstruction for patients ≤ 80 yo, without cT4 at the initial presentation, and whose recurrent/residual tumor can be removed as a R0 resection, and [SL] dissection of only metastatic abdominal lymph nodes for patients without any other failure.

Methods
All patients received dCRT ≥ 50 Gy followed by salvage surgery. In 17 patients who underwent SE from 2009 to 2014, prophylactic dissection of cervical or 106 tbL nodes was often omitted, poststernal route was preferred, LigasureTM was routinely used, and aggressive nutritional intervention with enteral nutrition was perioperatively supplied. In SL for 5 patients until 2016, No. 3 and 7 nodes were removed.

Results
[SE] Sixteen patients received R0 resection. Postoperative complications were noted in 6 patients (35%), and pleural effusion was the most common (24%). However, neither anastomotic leakage nor in-hospital death developed. Median overall survival (OS) time is 44 months, and provisional 5-year OS rate is 41%. While 7 patients died of esophageal caner, one died from another caner and 3 died from other illness. Tentative 5-year disease-free survival (DFS) rate is 54%. Between cases with relapse after CR and cases with residual tumor, no significant difference was found in postoperative recurrence (2/8 vs. 5/9, P = 0.33) and survival (provisional 5-year OS rate: 50 vs. 33%, P = 0.45/provisional 5-year DFS rate: 70 vs. 40%, P = 0.22), while the relapsed patients after CR showed a little better outcome. [SL] Three patients have no relapse for 60/36/18 months after SL. One developed bone metastasis in 54 months after SL. One patient developed repeated abdominal recurrence and underwent SL again.

Conclusion
SE can be safely performed with strict planning, secure surgery and appropriate perioperative care. SL can also be beneficial as a less invasive salvage surgery to selected patients. Strict decision-making and appropriate postoperative follow-up method with attention to other diseases should be established based on further studies.

Disclosure
All authors have declared no conflicts of interest.
PS02.144: ESOPHAGOPLASTY WITH FREE JEJUNUM FLAP AFTER COLON-ESOPHAGUS CONDUIT ISCHEMIA
Authors: Papp Andras , Vereczkei Andras , Pavlovics Gabor , Horvath Ors 
Published: September 2018

Abstract

Background
Colon interposition is mainly used as a second line treatment, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign and congenital diseases in patients with long-life expectancy. Colon provides extended conduit length, reliable blood supply and low incidence of reflux. However, the early and late postoperative ischemic complication rate is 5–15%.

Methods
Colon ischemia can frequently cause anastomosis complications, which can be safely treated with dilation or surgery. The most serious but rare complication is the acute conduit necrosis. More severe cases of necrosis require conduit take down with proximal esophageal diversion and placement of an enteral feeding tube. An uncommon complication is the colonic stricture due to chronic ischemia, which can be treated with conservative methods such as dilation and stenting. Surgery is indicated since the impaired deglutition can compromise the quality of life. Supercharged or free jejunal interposition is a suitable alternative conduit for esophageal replacement in patients with otherwise limited delayed reconstructive options. Good functional outcomes can be achieved despite the formidable technical challenges in this group of patients.

Results
In three such cases, we could successfully use a free jejunal flap for reconstruction; the replacement type was different, using substernal, presternal and sternotomy routes. The arterial blood supply was provided by the internal mammary artery. Saphenous graft was used to interconnect to external jugular or innominate vein to reestablish the venous drainage. All three patients survived without further complication.

Conclusion
Overall, it can be stated that free jejunal graft transplantation can be used to resolve complicated cases that cannot be reconstructed with any other methods and jejunum offers a good swallowing function and quality of life.

Disclosure
All authors have declared no conflicts of interest.
PS02.145: TREATMENT FOR CHYLOTHORAX AFTER THORACIC ESOPHAGECTOMY
Authors: Kanabuchi Sawa , Taniyama Yusuke , Sakurai Tadashi , Heishi Takahiro , Sato Chiaki , Takaya Kai , Okamoto Hiroshi , Maruyama Shota , Kamei Takashi 
Published: September 2018

Abstract

Background
Chylothorax is relatively rare complication in esophagus cancer surgery. But once it happens, appropriate treatment is absolutely essential to avoid another severe complication. We report our treatment results of chylothorax after thoracoscopic esophagectomy and represent the appropriate treatment strategy for this complication.

Methods
We examined 468 patients who underwent thoracoscopic esophagectomy for esophageal cancer from January 2009 to November 2017. Thoracic duct was mostly preserved except the case which had cancer invasion. Also, MRI scan was performed in all cases to detect the location of thoracic duct preoperatively. When the surgical approach was planned for chylothorax after esophagectomy, 250ml of 20% soybean oil was administrated through jejunostomy tube 30 minutes prior to the surgery. Thoracic duct is usually detected at the inferior mediastinum by thoracoscopy and applies ligation or clipping. Treatment effect can be checked during the surgery by interruption of soybean oil leakage which was easily recognized before ligation.

Results
Postoperative chylothorax was detected in seven out of 468 cases (1.50%). Thoracic duct had been preserved in all of those seven cases. Among them, two cases improved just by drainage and five needed to undergo thoracoscopic thoracic duct ligature. The mean amount of daily thoracic drainage was 1106 ml in the ligation group whereas 565 ml in the conservative treatment group. The median hospitalization days after surgery among ligation and conservative group was 33.5 and 25days, the median day until oral intake was 21 and 13 days, the median days until thoracic drain removal was 10.5 and 9 days, respectively.

Conclusion
In the case of chylothorax after esophagectomy, early oral intake and short hospitalization was possible by performing thoracoscopic thoracic duct ligature, especially in the case which had large amount of pleural effusion drainage. MRI was useful equipment to detect the variant of thoracic duct and to perform thoracoscopic thoracic duct ligature safely.

Disclosure
All authors have declared no conflicts of interest.
PS02.156: IMPROVING COMPLIANCE WITH ENHANCED RECOVERY PROTOCOLS IN OESOPHAGO-GASTRIC CANCER SURGERY: A COLLABORATIVE QUALITY IMPROVEMENT PROJECT
Authors: Doganay Emre , Halliday Laura , Barber Susan , Mccormack Orla , Moorthy Krishna 
Published: September 2018

Abstract

Background
Compliance with enhanced recovery programmes (ERPs) in oesophago-gastric (OG) surgery is challenging due to high rates of complications. Higher compliance is associated with better outcomes; however compliance is difficult to assess due to variable reporting and lack of standardisation of descriptors within an ERP. This study aims to understand variability in ERPs across two OG cancer centres and analyse impact of cross-site engagement and collaborative quality improvement (QI) on ERP compliance.

Methods
The collaborative QI project consisted of workshops and meetings that involved presentations and assessment of variations across ERPs, with prospective recording of ERP compliance at each site and cross-site feedback of results. Compliance and outcomes for 2016 were compared with 2017 to assess impact of QI initiative.

Results
At site A, overall mobilisation improved from 25% to 28% (P = 0.448) and oral intake from 19% to 56% (P = 0.002). There were no improvements in NGT (65% to 54%) and drain removal (69% to 53%). At site B, mobilisation improved from 51% to 68% (P = 0.097), NGT removal from 37% to 51% (P = 0.196), and drain removal from 15% to 32% (P = 0.412). There was no improvement in oral intake (47% to 34%). At site A, all complications reduced from 56% to 46% (P = 0.401), pneumonia from 47% to 22% (P = 0.024), and grade 3 complications from 22% to 15% (P = 0.605). At site B, all complications reduced from 58% to 54% (P = 0.697), pneumonia from 46% to 37% (P = 0.353), and grade 3 complications from 23% to 20% (P = 0.678). At site A, the median length of hospital stay reduced from 11 days to 9 days (P = 0.024), with no improvement at site B (12 to 14 days).

Conclusion
Engagement between clinical teams across the two sites resulted in improvement in postoperative outcomes. Compliance with individual ERP elements was observed across a few domains. Challenges encountered in this project included a lack of standardised definitions of ERP descriptors, variability in measures and variations in the individual elements within each ERP.

Disclosure
All authors have declared no conflicts of interest.
PS02.161: METABOLIC MARKERS OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA: A SYSTEMATIC REVIEW AND POOLED ANALYSIS
Authors: Mei Goh Yan , Boshier Piers , Antonowicz Stefan , Hanna George 
Published: September 2018

Abstract

Background
Oesophageal squamous cell carcinoma (ESCC) is a major global health burden associated with poor survival. Patients suffering from this condition typically present at an advanced stage due to non-specific early symptoms. An increasing emphasis on early detection has led to the investigation of novel biomarkers of ESCC. This systematic review aims to define existing biomarkers of ESCC and to identify perturbations in associated metabolic pathways.

Methods
A systematic online literature search (1946–January 2018) was performed to identify studies reporting metabolic biomarkers of ESCC. Pooled point estimate of the hierarchal summary ROC curve of analysed metabolites was performed using bivariate meta-analyses. Conduct of this review was in accordance with the recommendations of the Cochrane Library and MOOSE guidelines.

Results
An online search identified 628 potential relevant studies, of which eight (including a total 508 patients) met inclusion criteria. All publications represented phase-I biomarker discovery studies. Methods used to assess metabolites in patients with ESCC included liquid chromatography-mass spectrometry (n = 6), gas chromatography-mass spectrometry (n = 1) and 1H-nuclear magnetic resonance (n = 1). Sample types utilised were plasma (n = 5), tissue (n = 2) and urine (n = 1). A total of 1670 metabolites were identified as being associated with ESCC. Key metabolic pathways involved included tricarboxylic acid cycle and in pathways of oxidative stress. Metabolites identified increased in ESCC are breakdown products of fatty acid synthesis and glycerophospholipid metabolism e.g.: palmitic acid, oleic acid, LysoPC(24:0), LysoPC(18:2), L-carnitine, branched chain amino acids e.g.: valine, leucine, isoleucine and phenylalanine. Metabolites decreased in ESCC are breakdown products of amino acid metabolism e.g: glutamine, carbohydrates e.g.: glucose and organic acids e.g.: α-ketoglutaric acid oxime. Pooled analysis of findings from five studies showed an area under the receiver-operating characteristic analysis curve of 0.96, sensitivity 88.0% (95% CI 80.8%-92.7%) and specificity 93.5% (95% CI 96.9%- 86.8%).

Conclusion
This is the first review to define metabolic biomarkers associated with ESCC. Significant variability in identified metabolites is evidence of the broad range of analytical techniques employed and the diversity of metabolic pathways associated with this disease. Notwithstanding, findings provide important insight in to those metabolites associated with ESCC and provide a basis for future studies.

Disclosure
All authors have declared no conflicts of interest.
PS02.162: THREE-YEAR OVERALL SURVIVAL UPDATE FROM PHASE II STUDY OF CHEMOSELECTION WITH DCF AND SUBSEQUENT CONVERSION SURGERY FOR LOCALLY ADVANCED UNRESECTABLE ESOPHAGEAL CANCER
Authors: Yokota Tomoya , Kato Ken , Hamamoto Yasuo , Tsubosa Yasuhiro , Ogawa Hirofumi , Ito Yoshinori , Hara Hiroki , Ura Takashi , Kojima Takashi , Chin Keisho , Hironaka Shuichi , Kii Takayuki , Kojima Yasushi , Akutsu Yasunori , Matsushita Hisayuki , Kawakami Kentaro , Mori Keita , Nagai Yushi , Asami Chika , Kitagawa Yuko 
Published: September 2018

Abstract

Background
A multicenter phase II trial revealed that docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (IC) and subsequent conversion surgery (CS) was tolerable and effective in patients with locally advanced unresectable esophageal cancer (LAUEC) (Br J Cancer 2016;115:1328–1334). Here, we report updated 3-year analyses to further characterize the impact of DCF-IC followed by CS.

Methods
Esophageal cancer patients with clinical T4 disease and/or unresectable supraclavicular lymph node metastasis were eligible. The treatment starts with 3 cycles of DCF-IC, followed by CS if resectable, or by concurrent radiation plus chemotherapy with 5-fluorouracil and cisplatin (CF-RT) if not resectable. This updated analysis represents 3-year overall survival (OS), 3-year progression free survival (PFS), location of relapse, and subsequent therapy.

Results
As of October 11, 2017, 25 patients were dead. The median follow-up period in patients surviving without death was 39.3 months (95%CI: 38.7 - 41.7months). The estimated 1-year OS was 66.7% and lower limit of 95% confidence interval was 54.6%. The estimated 3-year OS was 46.6% (95% CI; 34.2 - 63.5%). The OS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6% (95%CI: 38.1 - 67.3%) and the estimated 3-year PFS was 39.6% (95%CI: 27.7 - 56.6%). The PFS for patients who underwent R0 resection (n = 19) was significantly longer than those who did not undergo R0 resection (3-year PFS: 61.3% vs. 25%). The recurrence or progression in primary site was observed in 31% of non R0 group. There was no significant difference in the rates of distant metastasis between the two groups (non R0 group vs. R0 group; 21% vs. 16%). The subsequent therapy after protocol therapy included chemotherapy (n = 18), radiotherapy (n = 11), and surgery (n = 5).

Conclusion
This longer follow up of DCF-IC followed by CS strategy for patients with LAUEC revealed promising OS and PFS. Based on this phase 2 trial, JCOG1510, a prospective randomized controlled trial to compare chemoselection with DCF-IC followed by CS versus CF-RT as a standard treatment is in preparation for LAUEC.

Disclosure
All authors have declared no conflicts of interest.
PS02.163: A CASE OF SEPARATION SURGERY WITH DRAINAGE TUBE-LESS (DRESS) ESOPHAGOSTOMY FOR ADVANCED CANCER WITH A RESPIRATORY FISTULA
Authors: Tanoue Yukinori , Takeno Shinsuke , Kawano Fumiaki , Tashiro Kousei , Hamada Rouko , Miyazaki Yasuyuki , Nanashima Atsushi 
Published: September 2018

Abstract

Background
Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported.

Methods
Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery).

Results
Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free.

Conclusion
Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed.

Disclosure
All authors have declared no conflicts of interest.
PS02.167: IMPACT OF POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOPHAGUS FOR CARCINOMA ON LONG-TERM SURVIVAL
Authors: Snajdauf Martin , Harustiak Tomas , Pazdro Alexandr , Lischke Robert 
Published: September 2018

Abstract

Background
Esophagectomy with 2–3 field lymph node dissection is one of the most invasive surgical treatment for malignancy and is still associated with a high mortality and morbidity despite improvements in surgical techniques and postoperative management. The impact of postoperative complications on perioperative morbidity is widely accepted. But the impact of postoperative complications on long-term survival remains controversial.

Methods
A retrospective analysis was performed on patient who underwent transthoracic esophagectomy with intrathoracic anastomosis for esophageal cancer between January 2005 and December 2012 in our department (415 patients). We excluded non-radical resections (R1, R2 – 27 patients, 6.5%) and patients who died within 90 day after operation (20 patients, 4.8%). Data on gender, BMI, histologic diagnosis, tumor staging, neoadjuvant treatment, comorbidities, technical complications and postoperative medical complications were reviewed. Considered postoperative complications were anastomotic leak, empyema, chyle leak, pneumonia, ARDS, cardiac arrhythmia, wound infection and urinary tract infection. We analysed separately extrapolated serious complications Clavien Dindo 3–4 and their possible impact on overall survival. Prognostic factors were assessed by multivariate analysis.

Results
Total number of analysed patients was 363. The median follow up was 8.5 years. From the baseline characteristics, the presence of atrial fibrillation (P = 0.0157, HR 2.376) and hypertension (P = 0.0093, HR 1.488), higher staging pT3–4 (0.0146, HR 1.437) and presence of lymph node metastasis pN + (P < 0.001, HR 2.263) had a negative impact on overall survival. Among the postoperative complications, only chyle leak (P = 0.0327, HR 4.023) had a negative prognostic factor on overall survival.

Conclusion
In this single institution series, among the postoperative complications only chylothorax affect negatively the overall survival. Accurate ligation of resected thoracic duct stumps to minimize chyle leak is important to improve outcomes. The influence of others postoperative complications wasn’t significant. We assume important to exclude postoperative mortality from analysis to prevent bias.

Disclosure
All authors have declared no conflicts of interest.