bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.176: LINE-1 METHYLATION LEVEL AND LOCAL IMMUNE RESPONSE IN ESOPHAGEAL CANCER
Authors: Baba Yoshifumi , Yagi Taisuke , Kiyozumi Yuki , Hiyoshi Yukiharu , Iwatsuki Masaaki , Miyamoto Yuji , Yoshida Naoya , Baba Hideo 
Published: September 2018

Abstract

Background
In cancer cells, DNA methylation may be altered in two principle ways; global DNA hypomethylation and site-specific CpG island promoter hypermethylation. Since Long interspersed element-1 (LINE-1 or L1; a repetitive DNA retrotransposon) constitutes a substantial portion (approximately 17%) of the human genome, the extent of LINE-1 methylation is regarded as a surrogate marker of global DNA methylation. In previous studies, we demonstrated that LINE-1 hypomethylation was strongly associated with a poor prognosis in esophageal cancer, supporting its potential role as a prognostic marker (Ann Surg 2012). We also found that LINE-1-hypomethylated tumors showed highly frequent genomic gains at various loci containing candidate oncogenes such as CDK6 (Clin Cancer Res 2014). Given that immunotherapy, as represented by PD-1/PD-L1-targeting antibodies, has increasingly gained attention as a novel treatment strategy for esophageal cancer, better understanding of local immune response status in esophageal cancer is important. The aim of this study is to evaluate the relationship between LINE-1 methylation level and local immune response in esophageal cancer.

Methods
Using a non-biased database of 305 curatively resected esophageal cancers, we evaluated PD-L1 expression and TIL status (CD8 expression) by immunohistochemical analysis (Ann Surg 2017).

Results
TIL positivity was significantly correlated with longer overall survival (log-rank P < 0.0001). TIL-negative cases demonstrated significantly lower LINE-1 methylation level compared with TIL-positive cases (P = 0.012). This finding certainly supports that LINE-1 methylation level may influence the local immune response status.

Conclusion
PD-L1 expression was not related with LINE-1 methylation level. Further investigations in this field would provide deeper insights into esophageal tumor immunology and assist the development of new therapeutic strategies against esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.180: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OESOPHAGO-GASTRIC CANCER SURGERY: EVALUATION OF A SINGLE-CENTRE EXPERIENCE
Authors: Allen Sophie , Chakravartty Saurav , Timbrell David , Rockall Timothy , Prabhu Pradeep , Preston Shaun , Sultan Javed 
Published: September 2018

Abstract

Background
Cardiopulmonary exercise testing (CPEX) is an objective measure of functional capacity adapted to predict post-operative morbidity. CPEX may also identify optimisable cardio-respiratory comorbidity, prompting treatment modification or specialist referral. The role of CPEX in patient optimisation before oesophago-gastrectomy is yet to be evaluated. This study aims to assess the utility of CPEX in altering management and optimising patients prior to oesophago-gastrectomy.

Methods
All patients who underwent pre-operative CPEX testing and two phase oesophago-gastrectomy (January 2012 to January 2018) were included. All changes in patient management brought about by CPEX findings were evaluated. In addition, the role of validated risk-stratifying CPEX parameters (anaerobic threshold (AT), VO2 peak and FEV1) in predicting post-operative complications was assessed.

Results
236 patients underwent surgery. Median AT and VO2 peak were 11.95(7–24)ml/kg/min and 773(403–1552)ml/min/m2 respectively. 46% (109/236) of patients (VO2 peak > 800ml/min/m2) were graded ‘low risk’, 42% (99/236) ‘intermediate risk’ (VO2 peak = 600–800ml/min/m2), and 12% (28/236) ‘high risk’ (VO2 peak < 600ml/min/m2) for developing post-operative cardio-pulmonary complications. Based on CPEX findings, management plans were altered in 84 patients (36%). Cardiac comorbidity was identified in 55 patients (23%) with immediate alteration of cardiac medications in 9% (21/236) and another 11% (27/236) requiring specialist cardiology review. Medication for respiratory optimisation was initiated in 3% (7/236) and formal respiratory review sought in 5% (12/236). ‘Intermediate’ and ‘high risk’ patients had similar rates of overall complication (63% vs 63%, P = 1.00), cardio-pulmonary complication (48% vs 47%, P = 0.17), anastomotic leak (11% vs 15%, P = 0.33) and 90-day mortality (6% vs 4%, P = 0.40) compared with ‘low risk’ groups. CPEX variables (AT, VO2 peak, FEV1) did not predict complications, length of critical care or overall stay on Receiver Operating Characteristic curves (AUROC < 0.5) and multivariate logistic regression models.

Conclusion
CPEX findings changed management in 36% of patients, enabling optimisation before oesophago-gastrectomy. ‘Confounding by intention’ is a bias reducing the strength of association between test results and post-operative complications due to the propensity to medically intervene on the basis of the test findings. This study highlights the possibility that the high intervention rate may explain the poor correlation between test results and post-operative outcome.

Disclosure
All authors have declared no conflicts of interest.
PS02.187: RELATIONSHIP BETWEEN REGIONAL LYMPH NODE SIZE AND PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS
Authors: Kobayashi Teruyuki , Yamasaki Makoto , Tanaka Koji , Makino Tomoki , Miyazaki Yasuhiro , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
Surgery for esophageal cancer, in many cases performed after chemotherapy or chemoradiotherapy. Because treatment policy is determined by pretreatment evaluation, improvement of diagnosis accuracy is important. Commonly, metastatic diagnosis is performed by uniformly defining the size. We examined whether evaluation of N classification reflecting more prognosis can be done by examining lymph node metastasis criteria by area in CT.

Methods
We surveyed 300 cases of thoracic esophageal cancer (squamous cell carcinoma) who underwent surgery at our hospital from September 2010 to December 2014. We defined lymph node with a minor axis of 5 mm or more from CT (5 mm slice) before treatment as ‘visible node’. We changed the cut off of lymph node short diameter for each area to 5 mm, 10 mm and 15 mm, and those with long diameter/short diameter ratio less than 1.5 were designated as ‘metastasis’. We examined the optimal size of lymph node which reflect prognosis. We compared the correlation with the prognosis based on the N category of the 8th edition UICC TNM classification and the 11th edition Japanese Classification of Esophageal Cancer, using the cutoff of short diameter examined for each area.

Results
We evaluated the cut off of each area lymph node except paraesophageal, 15 mm in the cervical, 10 mm in the recurrent nerve, 15 mm in the upper trachea, 15 mm in the lower trachea, and 10 mm in the epigastric. Classification based on the N classification of the 8th edition UICC TNM classification, overall survival declined in the order of N categories.

Conclusion
From this result, it was suggested that diagnosis based on lymph node size in CT reflects prognosis by prescribing cut off for each site. From now on, it would be possible to raise the diagnostic accuracy of N classification further by subdivision of cut off and accumulation of the case.

Disclosure
All authors have declared no conflicts of interest.
PS02.201: EXPRESSION AND ROLE OF CLIC1 IN HUMAN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kobayashi Toshiyuki , Shiozaki Atsushi , Fujiwara Hitoshi , Konishi Hirotaka , Nako Yoshito , Kosuga Toshiyuki , Shoda Katsutoshi , Arita Tomohiro , Morimura Ryo , Murayama Yasutoshi , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Nakanishi Masayoshi , Okamoto Kazuma , Kishimoto Mitsuo , Otsuji Eigo 
Published: September 2018

Abstract

Background
Recent studies have reported important roles for chloride intracellular channel 1 (CLIC1) in various cancers; however, its involvement in esophageal squamous cell carcinoma (ESCC) remains unclear. The aim of the present study was to investigate the role of CLIC1 in human ESCC.

Methods
CLIC1 expression in human ESCC cell lines was analyzed by Western blotting. Knockdown experiments were conducted with CLIC1 siRNA, and their effects on cell proliferation, the cell cycle, apoptosis, migration, and invasion were analyzed. The gene expression profiles of cells were analyzed using a microarray analysis. An immunohistochemical analysis was performed on 61 primary tumor samples obtained from ESCC patients who underwent esophagectomy.

Results
ESCC cells strongly expressed CLIC1. The depletion of CLIC1 using siRNA inhibited cell proliferation, induced apoptosis, and promoted cell migration and invasion. The results of the microarray analysis revealed that the depletion of CLIC1 regulated apoptosis via the TLR2/JNK pathway. Immunohistochemistry showed that CLIC1 was present in the cytoplasm of carcinoma cells, and that the very strong or very weak expression of CLIC1 was an independent poor prognostic factor.

Conclusion
The present results suggest that the very strong expression of CLIC1 enhances tumor survival, while its very weak expression promotes cellular movement. The present study provides an insight into the role of CLIC1 as a switch among tumor behaviors in ESCC.

Disclosure
All authors have declared no conflicts of interest.
PS02.204: GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW
Authors: Gentile Damiano , Riva Pietro , Da Roit Anna , Basato Silvia , Marano Salvatore , Castoro Carlo 
Published: September 2018

Abstract

Background
Gastric conduit used for reconstruction after esophagectomy for esophageal cancer (EC) has the potential to develop a metachronous cancer known as gastric tube cancer (GTC). The aim of our study was to review literature and evaluate outcomes and possible treatment strategies for GTC.

Methods
A comprehensive systematic literature search was conducted using PubMed. No restriction was set for type of publication, number, age and sex of patients. Study language was limited to English. Characteristics of EC and its treatment and GTC and its treatment were analyzed.

Results
A total of 26 studies were analyzed, 10 retrospective analysis and 16 case reports, involving 170 patients, 17 patients (10%) were affected by multifocal GTC. 143 ECs (84,1%) were squamous cell carcinomas. In 95 patients (55,9%) a posterior-mediastinal reconstructive route was used at the time of esophagectomy for EC. Mean interval between esophagectomy and diagnosis of GTC was 67,18 months (4–236 months). 184 GTCs were metachronous lesions (98,4%). 164 GTCs were adenocarcinomas (98,2%). 84 GTCs were located in the lower part of the gastric tube. 88 patients were endoscopically treated. 63 patients underwent surgery. 30 total gastrectomies + limphoadenectomy with colon or jejunal interposition were performed. 27 subtotal gastrectomies and 6 wedge resections were performed. Main reported post-operative complications were: anastomotic leak, vocal cord palsy and respiratory failure. 19 patients were treated with chemoradiotherapy and palliative care. 68,2% of endoscopically treated patients, 63,5% of surgically resected patients and 5,2% of patients who underwent chemoradiotherapy were alive at a mean follow-up of 25,5 months. Feasibility of endoscopic resections in patients diagnosed with superficial GTC has been established. Surgical treatment represents the preferred treatment modality in operable patients with locally invasive tumor. Patients treated with conservative therapy have a scarce prognosis.

Conclusion
Yearly endoscopic follow-up is of paramount importance in patients who underwent esophagectomy for EC with gastric tube reconstruction. At least, a 10-year endoscopic surveillance is recommended.

Disclosure
All authors have declared no conflicts of interest.
PS02.205: MALIGNANCY DEVELOPING IN CORROSIVE INJURED ESOPHAGUS
Authors: Chandramohan Servarayan , Manickavasagam Kanagavel , Chinnathambi Madeshwaran , Jebaraj Abishai , Chandramohan Apsara , Varadharajan Visvarath 
Published: September 2018

Abstract

Background
Malignancy developing in a corrosive injured esophagus has been described in the literature. Though the possibility of malignancy developing in a corrosive esophagus is expected to be around 1000 fold no team has managed large numbers. The aim of this study is to analyse the pattern of presentation and problems encountered in managing these difficult patients.

Methods
13 patients with corrosive malignancy encountered between 1991 and 2016 were included in this study. Patients basic demographic profile, incidence, time interval between ingestion of corrosive and occurrence of malignancy, site of malignancy, symptoms at presentation, stage, management and survival were analysed.

Results
There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months.

Conclusion
There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient.. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months.

Disclosure
All authors have declared no conflicts of interest.
PS02.211: MALIGNANCY IN GASTRIC CONDUIT: ANALYSIS OF OUTCOME
Authors: Chandramohan Servarayan , Chinnathambi Madeshwaran , Varadharajan Visvarath , Manickavasagam Kanagavel , Jebaraj Abishai , Chandramohan Apsara 
Published: September 2018

Abstract

Background
Stomach is the best conduit available after esophageal resection for both benign and malignant esophageal disorders. Malignancy in the gastric conduit after esophageal resection is a rare occurrence with worst outcome.

Methods
13 cases of gastric conduit malignancy admitted in our institution from 2006 to 2016 were analysed. Malignancy in the conduit may be a second primary or a recurrence of the tumor bed or at anastamotic site. Indication for surgery, Demographic profile, Interval between occurrence and primary disease, site, type, stage and grade of malignancy, route of the conduit (retro sternal/posterior mediastinum), presence of pyloroplasty, post operative therapy and complications were analysed.

Results
The mean interval between primary esophageal malignancy and conduit cancer was 4.3 years. 6 cases represented the second primary, 4 represented anastamotic recurrence and 3 cases of bed recurrence. All cases were adenocarcinoma. Out of 13 patients 8 were advanced malignancy. Out this 8, one patient had conduit pulmonary fistula. Only feeding/stenting procedure and chemo/RT were done. In the remaining 5 patients wedge resection in 1patient and total conduit gastrectomy in 4 patients with colonic replacement were done. Comparing 2 cases of substernal with 2 cases of posterior mediastinal colonic conduit placement the post operative pulmonary complications are less and no need for delay in RT in substernal route. Median overall survival in non surgical patients was 6.2 months (range 4–11 months) and 1.9 months (range 6months -5.6 years) in surgical patients.(P = 0.003)

Conclusion
Colonic reconstruction and even partial resection is possible in the management of conduit malignancy after esophagectomy and even yields survival closer to primary gastric maligmancy. Placement of the conduit in the substernal route offers some advantage in treating the tumour bed with radiotherapy. Continuous postoperative monitoring after esophagectomy with the monotored surveillance program is needed to select appropriate cases for better results.

Disclosure
All authors have declared no conflicts of interest.
PS02.213: PREDICTING ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: THE VALUE OF C-REACTIVE PROTEIN. A NATIONWIDE REGISTER STUDY
Authors: Nilsson Erik , Johansson Jan , Falkenback Dan , Jeremiasen Martin , Åkesson Oskar , Hermansson Michael 
Published: September 2018

Abstract

Background
Anastomotic leakage (AL) after oesophageal surgery is a serious complication, leading to increased postoperative mortality. Early detection and treatment is essential. The aim of this study was to investigate if inflammatory serum parameters in the early postoperative course after oesophageal cancer surgery, could predict development of an AL.

Methods
All patients in Sweden with AL after thoraco-abdominal surgery for oesophageal or gastroesophageal junction cancer from 2006–01-01 to 2017–01-31 were collected from the Swedish National Registry for esophageal and gastric cancer (NREV). Two matched controls for each AL-patient were also selected from the registry. Pre-, per- and postoperative variables were collected from NREV. The following parameters were collected from patient charts: number of days from surgery to AL, diagnostic modality, method of treatment, serum levels of C-reactive protein (CRP), White blood cell count (WBC) and serum-Albumin taken on postoperative day 1 to 7 (POD1–7). Thoracic- and cervical anastomosis were analysed separately. Perioperative data and inflammatory markers were compared between controls and AL-patients. Receiver Operating Characteristic (ROC) curves was constructed to identify optimal cut-off values and a multivariate analysis was performed to identify independent risk factors.

Results
A total of 155 patients with AL and 307 controls (n = 462) were analysed. In patients with thoracic anastomosis median levels of CRP and WBC were significantly different on POD 2–7 and on POD 4–7 comparing AL-patients to controls. In patients with cervical anastomosis there was a significant difference in WBC levels on POD 1–7. ROC-curve analysis identified CRP on POD3 (cut-off 221) and POD4 (cut-off 203) as the best candidates for predicting AL in patients with a thoracic anastomosis, displaying an area under curve of 0.754 (Sensitivity 59%, Specificity 83%) and 0.731 (Sensitivity: 57%, Specificity 82%).

Conclusion
In this nation-wide register study we found that a model combining S-CRP levels on POD 3 and POD 4 after a thoraco-abdominal esophagectomy, could identify patients with increased risk of anastomotic leakage several days before it was diagnosed. However, since the sensitivity of this test is relatively low for predicting AL, it must be assessed in a larger clinical context.

Disclosure
All authors have declared no conflicts of interest.
PS02.221: THE SUCCESSFUL CONSERVATIVE MANAGEMENT OF CHYLOTHORAX WITH ETILEFRINE AND SOMATOSTACHIN ANALOG AFTER ESOPHAGECTOMY: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Yoshino Yutaro , Nakazato Hidetsugu , Tomiyama Takeshi , Nagamine Shinji , Tomori Takehiko , Inamine Susumu , Miyagi Jun , Nagayoshi Seiji , Omine Yasushi , Miyara Tetsuhiro 
Published: September 2018

Abstract

Background
Chylothorax is a severe complication after esophagectomy and is sometimes difficult to treat. Patients are treated with surgical and conservative therapies, including nutritional management.

Methods
Case: The patient was an 80-year-old man who had complained of dysphagia. Upper gastrointestinal endoscopy demonstrated a Borrmann type 2 tumor in the lower esophagus. Biopsy revealed squamous cell carcinoma. He was referred to our hospital after radiotherapy (40 Gy). The clinical stage, according to the UICC 7th edition, was cT3N1M0 cStage IIIA. Transthoracic esophagectomy with 2-field lymph node dissection was performed. The thoracic duct was observed. The postoperative chylothorax volume was < 1000 ml/day and required continuous drainage management.

Results
The single use of somatostatin analog failed to reduce the patient's chylothorax. Treatment with etilefrine and somatostachin analog led to the resolution of the patient's chylothorax.

Conclusion
The management of chylothorax with etilefrine and somatostachin analog may be a treatment option for patients with a low chylothorax volume or elderly patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.223: EFFECTIVENESS OF ETILEFRINE REGIMEN FOR CHYLOTHORAX AFTER ESOPHAGECTOMY WITH THORACIC DUCT RESECTION
Authors: Umino Ryosuke , Ohkura Yu , Ueno Masaki , Udagawa Harushi 
Published: September 2018

Abstract

Background
Management of postoperative chylothorax generally involves nutritional regimens as well as pharmacological and surgical therapies, but a clear consensus has yet to be reached. The aim of this study was to clarify the usefulness of an etilefrine regimen to broaden the medical treatment options for postoperative chylothorax after esophagectomy with resection of the thoracic duct.

Methods
A total of 371 consecutive patients with esophageal cancer were identified from a prospectively constructed database at the Department of Gastroenterological Surgery, Toranomon Hospital between January 2011 and February 2017. They were patients with squamous cell carcinoma or adenocarcinoma of the esophagus including Siewert type I, II tumor of the esophagogastric junction who underwent subtotal esophagectomy. Of these 371 patients, 19 patients who were diagnosed with chylothorax as a postoperative complication were enrolled in this study.

Results
Conservative treatment achieved cure in 16 patients among 19 patients. The duration of chylothorax tended to be longer in the no-etilefrine group (n = 5) than in the etilefrine group (n = 11) (27.8 vs. 11.6 days; P = 0.078). The 14 patients among 19 patients was resected the thoracic duct. Etilefrine was used in 12 of these 14 patients. Among these 12 patients, 3 required surgical treatment and the remaining 9 patients were cured with conservative treatment. The duration of chylothorax was shorter in the conservative treatment group than in the surgical treatment group (11.9 vs. 36.3 days; P = 0.052). And also, with the use of etilefrine as adjuvant therapy, cure was achieved in 9 patients (75%) without surgical intervention.

Conclusion
The findings of this study suggest the effectiveness of etilefrine in patients with chylothorax following esophagectomy. The drug was effective even in post-TDR chylothorax, an often intractable condition that is difficult to treat conservatively. However, when the effectiveness of etilefrine regimen is unexpectedly poor, it is important to switch from drug therapy to surgical treatment in the early stage of this complication.

Disclosure
All authors have declared no conflicts of interest.