bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA07.06: BASELINE FDG-PET/CT PARAMETERS AS PREDICTOR FOR RESIDUAL TUMOUR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN OESOPHAGEAL CANCER PATIENTS
Authors: Valkema Maria , Noordman B , Wijnhoven Bas P L , Spaander M C W , Lagarde Sjoerd M , Ruurda Jelle , Nieuwenhuijzen Grard A P , Van Berge Henegouwen M I , Sosef M N , Siersema P D , Van Lanschot J J B , Valkema R 
Published: September 2018

Abstract

Background
An optimal model for predicting pathologic response after neoadjuvant chemoradiotherapy (nCRT) in oesophageal cancer has not been defined yet. FDG-PET/CT is frequently used in response assessments. The aim of this side study of the preSANO trial (NL41732.078.13) was to investigate if the FDG-PET parameters SUVmax, total lesion glycolysis (TLG) and metabolic tumour volume (MTV) were predictive for residual tumour in the resected specimen of oesophageal cancer patients treated with nCRT.

Methods
Patients underwent FDG-PET/CT at baseline according to the European Association of Nuclear Medicine guidelines 1.0 (2.3MBq/kg F-18-FDG; scanning 60 ± 5min.). All parameters were corrected for lean body mass. MTV was defined as the volume within a 41% of SULmax ( = SUV/lean body mass) isocontour threshold at tumour and lymph nodes. TLG was calculated as SULmean x MTV. Logarithmic transformation was performed because of non-normal distribution of TLG and MTV. Baseline PET parameters were compared to tumour regression grade in the resection specimen (TRG3–4 = > 10% residual tumour vs. TRG1 = complete response). Peroperatively irresectable tumours were recoded as TRG4. Analyses were performed using an independent-samples T-test.

Results
From a total of 207 patients who underwent FDG-PET/CT before nCRT, 197 were included for analysis (5 were non-FDG avid, 5 had incomplete data). Histological type of tumour: adenocarcinoma (AC) n = 154, squamous cell carcinoma (SCC) n = 42, and one adenosquamous carcinoma. Thirty-seven patients (19%) had TRG1 and 41 patients (21%) had TRG3–4. In complete responders (TRG1), SULmax, TLG and MTV (mean ± SD) were 9.6 ± 5.8, 85.3 ± 85.5 and 13.0 ± 9.9, respectively. In patients with TRG3–4, SULmax, TLG and MTV were 9.4 ± 5.4145.8 ± 164.6 and 21.9 ± 16.2, respectively. SULmax was not significantly different between both groups (P = 0.8), but log(TLG) and log(MTV) (P = 0.008 and P = 0.001) were. In adenocarcinomas, log(TLG) did not differ between groups (P = 0.1).

Conclusion
Initial FDG tumour mass, expressed as MTV, (rather than SULmax) is the most contributing factor in predicting residual disease after nCRT in both SCC and AC. The effect is stronger in SCC. Therefore, baseline FDG tumour mass should be included in a prediction model, besides other clinical and tumour parameters.

Disclosure
All authors have declared no conflicts of interest.
RA07.07: THE ROLE OF 18F-FLUORODEOXYGLUCOSE POSITRON-EMISSION TOMOGRAPHY ON SURVIVAL OF PATIENTS FOLLOWING NEOADJUVANT CHEMOTHERAPY AND SURGERY FOR ESOPHAGEAL CANCER
Authors: Aoyama Junya , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Suda Koichi , Nakamura Rieko , Wada Norihito , Kitagawa Yuko 
Published: September 2018

Abstract

Background
The occurrence of lymph node metastases (LNMs) is a critical factor for postoperative survival in patients with esophageal cancer. Generally F-fluorodeoxyglucose positron-emission tomography (FDG-PET) has a low sensitivity and a relatively high rate of false-negative for detecting LNMs. However, the role of FDG-PET in predicting the outcome is still unclear. The aim of this study is to assess the role of FDG-PET in predicting survival in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) treated with neoadjuvant chemotherapy (NAC).

Methods
Seventy-three patients with TESCC received NAC followed by surgery, and underwent FDG-PET before NAC in our hospital between January 2012 and November 2016. The number of PET-positive lymph nodes (LNs) and the maximum standardized uptake value (SUVmax) of the LNs were prospectively evaluated. The results of FDG-PET were compared with the pathological results and the prognosis.

Results
15 patients had no PET-positive LNs, 23 had one, 15 had two and 20 patients had three or more positive LNs. A significantly high proportion of the PET-positive LNs ≧3 group had ≧3 pathological LNMs than the PET-positive LNs ≦2 group (70.0 vs. 22.6%, P < 0.001). The PET-positive LNs ≧3 group also had a significantly lower 3-year overall survival rate (47.9 vs. 71.9%, P = 0.018). Univariate Cox's proportional hazard regression analyses revealed the PET-positive LNs ≧3 status (Hazard ratio = 2.68 [1.14–6.28], P = 0.024) and the SUVmax of the LNs ≧8 status (Hazard ratio = 2.45 [1.06–5.65], P = 0.036) were significant prognostic factors. On the other hand, the SUVmax of the primary tumor was not a significant prognostic factor.

Conclusion
We identified the PET-positive LNs ≧3 status and the SUVmax of the LNs ≧8 status in patients with resectable TESCC before NAC as potential adverse prognostic factors for survival.

Disclosure
All authors have declared no conflicts of interest.
RA07.08: SURGICAL AND PATHOLOGICAL IMPACT OF THE NOVEL CLASSIFICATION OF AN ANATOMY OF BRONCHIAL ARTERIES IN PATIENTS WHO UNDERWENT ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Amada En , Kawakubo Hirofumi , Mayanagi Shuhei , Nakamura Rieko , Wada Norihito , Suda Koichi , Takeuchi Hiroya , Kitagawa Yuko 
Published: September 2018

Abstract

Background
The first systematic classification of an anatomy of bronchial arteries (BAs) is reported by Cauldwell E. W. in 1948. However, it is not suitable for recognizing anatomy of BAs for esophageal surgery since it does not contain information of relative position of BAs and esophagus. So, the aim of this study is to device a novel classification of BAswhich correlates with surgical and pathological factors of esophageal cancer.

Methods
Eighty-six patients that have undergone curative esophagectomy from April 2012 to March 2016 for esophageal cancer whose epicenter is located in midthoracic esophagus were enrolled. Dynamic-enhanced computed tomography imaging (dCT) and clinico-pathological factors were analyzed. The right (rt-) BA which runs along the right side of esophagus is defined as Median (M) type and rt-BA which runs along the left side of esophagus is defined as Lateral (L) type. Also, the BA which arises from right side of aortic arch and runs down aortopulmonary window is defined as Tracheal (T) type and the others are defined as Bronchial (B) type. We classified patients by combination of M/L type and T/B type.

Results
dCT was performed in 81 cases. The number of patients with type of MT, MB, LT and LB were 19, 46, 12 and 4, respectively. Existence of rt-2nd-BA is significantly frequent in LB type and existence of lt-2nd-BA is significantly frequent in M type (P < 0.001, P = 0.012, respectively). Also, rt and lt BA forms common trunk significantly frequent in patients with LT type (P = 0.012). As for pathological factors, 38 patients had pathological lymph node metastasis. Among these patients, MT type patients have significantly more metastasis-positive lymph nodes (mLN) in #107 (P = 0.006) and LT type patients have significantly more mLN nodes in #105 (P = 0.039). Also, we compared pretreatment diagnosis of metastasis positive LNs (pre-mLNs) and pathological metastasis positive LNs. And we found that false- falsenegative cases of pretreatment diagnosis are significantly frequent in M type on #105 and cases with absence of lt-2nd-BA on #106recR (P = 0.038, P = 0.018, respectively).

Conclusion
Classifying an anatomy of BAs by relative position to esophagus and their origin is possibly helpful in esophageal surgery.

Disclosure
All authors have declared no conflicts of interest.
RA08.02: RELATIONSHIP BETWEEN ABDOMINAL FAT DISTRIBUTION AND VASCULAR INVASION AMONG PATIENTS WITH EARLY ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yamamoto Yasunori , Ishiyama Akiyoshi , Namikawa Ken , Nakano Kaoru , Yamasaki Akira , Yoshimizu Shoichi , Yoshio Toshiyuki , Tsuchida Tomohiro , Fujisaki Junko , Okamura Akihiko , Watanabe Masayuki 
Published: September 2018

Abstract

Background
Excessive visceral fat might promote cancer development and progression because of metabolic disruption. A previous study has demonstrated that visceral obesity associated with lymphatic invasiveness and a poor response to preoperative treatment among patients who underwent esophagectomy for advanced esophageal squamous cell carcinoma (ESCC). This study aimed to clarify the impact of abdominal fat distribution on lymphatic and vessel invasion after endoscopic submucosal dissection (ESD) or esophagectomy for early ESCC (eESCC).

Methods
We enrolled the 106 patients who had undergone ESD or curative esophagectomy for pathological T1-muscularis mucosa (MM) and T1-submucosal layer (SM) lesions between January 2015 and December 2016. Using computed tomography volumetry, we measured areas of visceral (VFA) and subcutaneous (SFA) fat at the level of the umbilicus, and calculated the VFA/SFA ratio in each patient. We also measured body mass index (BMI). Lymphatic and vessel invasion by eESCC were compared with these parameters and between groups classified according to VFA/SFA ratios.

Results
Significantly more patients in the T1-MM group with high VFA/SFA had lymphatic invasion of eESCC compared with those who had low VFA/SFA (35.7% vs. 7.1%, P = 0.010). Metastatic lymph nodes were detected only in patients with high VFA/SFA who underwent esophagectomy. Values for BMI, VFA, and SFA were lower in patients with venous invasion than those without (BMI, 20 vs. 22.8, P = 0.076; VFA, 60.2 vs. 98.9 cm2, P = 0.042; SFA, 56.3 vs. 103.2 m2, P < 0.0001). In the T1-SM group, the SFA was lower in patients with lymphatic invasion than those without (74.4 vs. 115.2 m2, P = 0.010).

Conclusion
High VFA/SFA ratio was significantly associated with lymphatic invasion in patients with eESCC. Low values of BMI, VFA, and SFA was significantly associated with venous invasion in patients with eESCC. Abdominal fat distribution might influence lymphatic and vessel invasion by eESCC.

Disclosure
All authors have declared no conflicts of interest.
RA09.01: NORMAL LYMPH NODE APPEARANCE IN THE THORAX
Authors: Hansen Tomas , Nilsson Magnus , Lindholm Daniel , Sundström Johan , Hedberg Jakob 
Published: September 2018

Abstract

Background
Modern treatment of esophageal cancer is multimodal and highly dependent on detailed diagnostic assessment of clinical stage which includes nodal stage. Clinical appraisal of nodal stage requires knowledge of normal radiological appearance, information of which is scarce. We aimed to describe lymph node appearance on computed tomography (CT) investigations in a randomly selected cohort of healthy subjects.

Methods
In a sample of 426 healthy Swedish volunteers aged 50–64 years, CT scans were studied in detail concerning intrathoracic node stations relevant in clinical staging of esophageal cancer. With stratification for sex, the short axis of visible lymph nodes was measured and distribution of lymph node sizes was calculated as well as proportion of patients with visible nodes above 5 and 10 millimeters for each station. Probability of having any lymph node station above 5 and 10 millimeters was calculated with a logistic regression model adjusted for age and sex.

Results
In the 214 men (age 57.3 ± 4.1 years) and 212 women (57.8 ± 4.4years) included in the study, a total of 309 (72.5%) had a lymph node with a short axis of 5 mm or above was seen in one of the node stations investigated. When using 10 mm as a cutoff, nodes were visible in 29 (6.81%) patients. Men had three times higher odds of having any lymph node with short axis 5 mm or above (OR 3.03 95% CI 1.89–4.85, P < 0.001) as well as 10mm or above (OR 2.31 95% CI 1.02–5.23, P = 0.044) compared to women. Higher age was not associated with propensity for lymph nodes above 5 or 10 millimeters in this sample.

Conclusion
In a randomly selected cohort of patients between 50 and 64 years, almost ten percent of the men and four percent of the women had lymph nodes above ten millimeters, most frequently in the subcarinal station (station 107). More than half of the patients had nodes above five millimeters on computed tomography and men were much more prone to have this finding. The probability of finding lymph nodes in specific stations relevant of esophageal cancer is now described.

Disclosure
All authors have declared no conflicts of interest.
RA09.07: SURGICAL MANAGEMENT OF EARLY ESOPHAGEAL CANCER BASED ON LYMPH NODE METASTASIS RISK.
Authors: Duan Xiaofeng , Yu Zhentao 
Published: September 2018

Abstract

Background
Esophagectomy and lymph node dissection is still the main treatment for esophageal cancer. Endoscopic mucosal resection and submucosal dissection are increasingly becoming a treatment of choice to preserve the integrity of the esophagus and decrease the surgical trauma in early esophageal cancer. However, lymph node metastasos (LNM) risk is still a debate focus for the decision of treatment selection. Our objective was to evaluate the prevalence, pattern and risk factors of LNM in early stage esophageal cancer to improve surgical treatment allocation.

Methods
We identified patients with pathological T1 stage esophageal cancer who underwent esophagectomy and lymph node dissection. The pattern of LNM was analyzed and the risk factors related to LNM were assessed by univariate and multivariable logistic regression analysis.The nomogram model was used to estimate the individual risk of lymph node metastasis.

Results
In 143 patients, LNM rates were: all patients 17.5%, T1a 8.0%, and T1b 22.5% for T1b. Depth of tumor infiltration (P < 0.05), tumor size (P < 0.01), tumor location (P < 0.05), and tumor differentiation (P < 0.01) were independent risk factors related to LNM. These four parameters allowed the compilation of a nomogram to estimate the individual risk of LNM. Fig. Nomogram to estimate the individual risk of LNM. Each characteristic of the included parameters scores a specific number of points (points per parameter). The summarized total points score indicates the probability of LNM. For a middle esophageal cancer with middle differentiated (G2), 3 cm tumor (> 2.5cm) that invades the submucosa (pT1b), the calculated total scores is 129.5 = 87.5 + 21 + 0 + 21, hence the corresponding LNM risk is 20%.

Conclusion
T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. Nomograms that include factors can be used to predict individual LNM risk. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node dissection strategy.

Disclosure
All authors have declared no conflicts of interest.
RA10.02: A NOVEL ROLE FOR THE COMPLEMENT CASCADE IN CHEMORADIATION THERAPY RESISTANT OESOPHAGEAL ADENOCARCINOMA
Authors: Cannon Aoife , Lavin Danica , Byrne Róisín , Reynolds John , O'Sullivan Jacintha , Lynam-Lennon Niamh 
Published: September 2018

Abstract

Background
Resistance to chemoradiation therapy (CRT) in oesophageal adenocarcinoma (OAC) is an important clinical challenge. Elucidating underlying mechanisms of treatment resistance is crucial to improving survival rates.

Methods
OAC tumour biopsies were collected prior to neoadjuvant CRT. Tumour conditioned media was generated by culturing human explants for 24 h. Response to treatment was determined pathologically using the Mandard Grading System. C3, CFB and MCP-1 mRNA expression was assessed by qPCR. Secreted C3, C3a and MCP-1 were measured by ELISA. An isogenic model of radioresistant OAC was established by chronically irradiating OE33 cells with clinically-relevant doses of 2 Gy X-ray radiation. C5aR and C3aR expression was determined by flow cytometry.

Results
We demonstrate, for the first time, that the central factor of the complement cascade, complement component 3 (C3), is expressed in OAC tumours and is increased in pre-treatment OAC biopsies from patients (n = 13) who have a subsequent poor response to neoadjuvant CRT (P < 0.05). In addition, C3 is secreted from ex vivo human OAC tumour explants (n = 13) and correlates with levels of the monocyte chemoattractant MCP-1 (P < 0.008) and complement factor B (CFB) a component of the alternative pathway of complement activation (P < 0.0001). In vitro, radioresistant OE33 R cells had increased mRNA levels of C3 (P < 0.01), CFB (P < 0.05) and MCP-1 (P < 0.05) compared to radiosensitive OE33 P cells. OEE3 R cells expressed increased levels of secreted C3 and the anaphylatoxin C3a, compared to radiosensitive OE33P cells (both P < 0.001). Furthermore, we demonstrate for the first time that the anaphylatoxin receptor C5aR is expressed by OAC cells, suggesting that OAC cells can respond to complement anaphylatoxins.

Conclusion
This study highlights, for the first time, a novel role for the complement cascade in the resistance of OAC to CRT and highlights C3 as a novel predictive marker of response to CRT in OAC.

Disclosure
All authors have declared no conflicts of interest.
VS01.09: ROBOTIC MCKEOWN ESOPHAGECTOMY: LESSONS LEARNED AFTER 50 CASES
Authors: Sallum Rubens , Takeda Flavio , Santo Marco , Duarte Andre , Cecconello Ivan 
Published: September 2018

Abstract

Description
Authors show the lessons learned after 50 robotic esophagectomies: the new positioning of the 4 robotic arms in the thorax avoiding collisions, fixation of the arches of the azygos vein arch (after section) and retraction of the trachea allowing the dissection of the left recurrent nerve lymph nodal chain, especially within the aortic arch. Abdominal dissection and cervical anastomosis are also presented. The film end with the results compared to Thoracoscopic Esophagectomy

Disclosure
All authors have declared no conflicts of interest.
VS02.02: LAPAROSCOPIC TRANS-HIATAL REPAIR FOR BOERHAAVE’S SYNDROME: A CASE REPORT
Authors: Masui Hideyuki , Kobayashi Hiroyuki , Kondo Masato , Kaihara Satoshi , Hosotani Ryo 
Published: September 2018

Abstract

Description
Introduction Spontaneous esophageal rupture, also known as Boerhaave's syndrome, is an uncommon and potentially life-threatening condition that requires urgent surgical management. We report a case of spontaneous esophageal rupture that was successfully treated by primary closure and drainage laparoscopically. Case report The patient was a 49 year-old man with a history of liver cirrhosis. He experienced sudden-onset epigastric pain triggered by vomiting after drinking alcohol, and transported to our hospital. On admission, a thoracic CT scanning revealed mediastinal emphysema without pleural effusion. We diagnosed BS and performed an emergency operation. We chose laparoscopic trans-hiatal approach as it was thought to be minimally invasive compared with open thoracic surgery. Five trocars were placed in a similar way of gastric cancer surgery. We identified laceration on the left wall of the lower esophagus under assistance of intra-operative upper endoscopy, and conducted drainage and repair by primary closure with continuous barbed suture. Finally, an omental pedicle flap was applied for over sutured site. The operation time was 214 minutes and the amount of blood loss was 50 cc. In the post-operative course, intra-mediastinal abscess was observed and he required antibiotic therapy. However, the patient was discharged on the 16th post-operative day without a serious complication such as anastomotic leakage. Discussion Primary esophageal repair is the gold standard in Boerhaave's syndrome and the approach is usually left thoracotomy. However, if there is no perforation into the thoracic cavity as in our case, less invasive approach should be considered such as laparoscopic trans-hiatal approach. We could observe the lower esophagus completely under a good field of view in this approach. There are several treatments, and it should always be tailored to the patient's condition. Laparoscopic trans-hiatal approach is considered to be useful for the treatment of lower esophageal wall rupture. It is difficult to conduct a comparative study of the various methods that can be used to treat spontaneous esophageal rupture in cases that require emergent surgery, as the number of cases is limited. Therefore, the further accumulation of cases is necessary.

Disclosure
All authors have declared no conflicts of interest.
VS02.04: TOTAL THORACOSCOPIC ENUCLEATION FOR GIANT ESOPHAGEAL LEYOMIOMA: A CONSECUTIVE SERIES
Authors: Riva Pietro , Gentile Damiano , Da Roit Anna , Basato Silvia , Alfieri Rita , Marano Salvatore , Castoro Carlo 
Published: September 2018

Abstract

Description
Giant esophageal leiomyomas (GEL) are challenging benign conditions to treat in a total minimally invasive way. Here we show the management of a complete thoracoscopic enucleation (TE) of three giant esophageal masses in three different patients. Not only the size of these masses but mostly the position of them made the indication for TE borderline.

Methods
Every patient underwent a full diagnostic pre-op workup with CT scan, PET and EUS guided biopsies to rule out any malignancy.
In this video, we show a full thoracoscopic approach with the patient on the left flank in a semi-prone/prone position and under general anesthesia without lung exclusion. We use a 3 trocars approach and low pressure(8mmHg) CO2 insufflation during the whole procedure. The dissection of the mass is carefully performed to keep the whole mucosal layer undamaged and minimizing the incision in the muscular layer. Careful reconstruction of the muscular layer is a mandatory step at the end of the procedure. Azygos vein resection is performed depending on the mass location. We extract the mass in a bag by enlarging the incision of the inferior scapular trocar.
The integrity of the mucosal layer was constantly checked during the procedure either by direct endoscopic vision or by insufflation of air through a nasogastric tube.

Results
All the patients had an uneventful post-operative course, upper-GI series showed no leak, no stricture nor dilatation of the esophagus. On POD 4 a soft diet was administered.

Conclusions
Esophageal leiomyomas are a rare condition; the ones larger than 10cm are defined as GEL and they represent the 17% of the total. While, in advanced centers, Total TE for small leiomyomas is a standard of care, GELs are usually managed by open surgery, and in many cases, esophagectomy has to be performed. In our series of five consecutive GELs, located in the upper esophagus, TE proved to be safe and effective in all the patients.

Disclosure
All authors have declared no conflicts of interest.
VS02.08: VIDEO PRESENTATION ON LAPAROSCOPIC REPAIR OF INCARCERATED LEFT HIATAL HERNIA AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR DISTAL ESOPHAGEAL ADENOCARCINOMA
Authors: Myint Oo Aung 
Published: September 2018

Abstract

Description
63 years old Chinese gentleman with past medical history of ypT3 N0 adenocarcinoma of distal esophagus invovling the cardioesophageal junction status post neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy was presented to emergency department for severe epgiastric pain one and half year after surgery. Emergency CT scan showed the incarcerated hiatal hernia containing most of the small bowel mesentery, large portion of small bowel loops and part of trasnverse colon. There was a loop of small bowel which showed decreased enhancment and worrisome for ischemia. He underwent emergency diagnostic laparoscopy, laparoscopic reduction of hernia contents and repair of hiatal hernia. He resumed oral feeds and progressed to soft diet next day and discharged well on post operative day 3. This is the video showing the emergency repair of hiatal hernia in the pateient with previous minimally invasive esophagectomy for adenocarcinoma of distal esophagus.
To view this video please follow this link:
https://www.dropbox.com/sh/t9jvgk9w2y0nqhk/AABP9TcR0NDK9PcXjvV8TAWSa?dl=0

Disclosure
All authors have declared no conflicts of interest.