bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.224: ESOPHAGEAL CANCER IN MALAYSIA: THE NEED FOR EARLY DETECTION!
Authors: Ying Khoo Hui , Voon Kelvin , How Teoh Keat , Yee Lim Shyang , Nagalingam Premnath , Aznan Shuhaili Mohamad , Rajan Reynu , Mohammed Taher Mustafa , Ritza Kosai Nik 
Published: September 2018

Abstract

Background
Esophageal cancer is one of the deadliest cancer in Malaysia. However, neither the incidence nor prevalence has been recorded nationally. We report our experience in dealing with esophageal cancer in Penang Hospital (PH) and Universiti Kebangsaan Malaysia Medical Center (UKMMC), two tertiary hospitals in Northern and Central region of Malaysia, respectively.

Methods
A review of 143 esophageal cancer that were diagnosed in PH and UKMMC in year 2014–2017.

Results
Among the 143 esophageal cancers, 60 cases were from HPP and 83 from UKMMC. The mean age at diagnosis was 62.5 ± 14.2. 67.4% were male patients. Esophageal cancer was commonest in Chinese ethnicity (41%), followed by Malay (29.9%), Indian (17.4%) and others (11.8%). Dysphagia was the commonest presenting symptom (84.6%) and the mean duration of symptoms were 14 weeks. Majority of the cancers were located at the cardioesophageal junction (38.6%), followed by lower third of esophagus (32.1%), mid esophagus (23%), upper third of esophagus (11.5%) and cervical esophagus (5.7%). More than 90% of patients presented with advanced disease, 35% and 55% of patients with stage 3 and stage 4 disease, respectively. Squamous cell carcinoma (45.8%) was the commonest histology type, slightly more than adenocarcinoma (45.1%). The rest were neuroendocrine tumour, gastrointestinal tumour and lymphoma. To date, surgery with curative intend were done in 44.1% of patients while the rest were managed with palliative treatment.

Conclusion
It is striking that majority of patients presented with late disease. Disease awareness campaign, early detection and multimodality treatment are crucial to improve outcomes of patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.225: PROGNOSTIC VALUE OF LYMPH NODE METASTASIS IN DIFFERENT SITES IN PATHOLOGICAL T3 ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS
Authors: Wang Ying-Jian , Li Kun-Kun , Liu Xue-Hai , Guo Wei 
Published: September 2018

Abstract

Background
The aim of this study was to evaluate the impact of different sites of lymph node metastasis in pathological T3 (pT3) esophageal squamous cell carcinoma patients (ESCC).

Methods
We retrospectively reviewed 300 consecutive ESCC patients who underwent radical minimally invasive esophagectomy (MIE) and two-field lymphadenectomy from 2010 to 2015. After exclusion, 111 cases were analyzed. Patients were divided into 3 groups (mediastinal metastasis, abdominal metastasis, and simultaneous metastasis) according to their lymph node metastatic sites. Disease-free survival (DFS) and disease-specific survival (DSS) were analyzed.

Results
The results showed that the incidence of lymph node metastasize to mediastinum, abdomen, and simultaneous was 55 (49.5%), 21(18.9%), 35(31.6%), respectively. Patients in simultaneous metastasis group had a higher cancer recurrence (log-rank test; P = 0.0341; Figure 1A) than mediastinum and abdomen metastasis group. Similarly, patients in simultaneous metastasis group had greater rate of cancer-related death (log-rank test; P = 0.0177; Figure 1B) than mediastinum and abdomen metastasis group. In the multivariate model, metastasis site was an independent risk factor in both DFS (P = 0.0402; HR, 1.4071; 95% CI, 1.0171–1.9466) and DSS (P = 0.0238; HR, 1.4342; 95% CI, 1.0507–1.9577).

Conclusion
Simultaneous mediastinal and abdominal lymph node metastasis is associate with a relatively poor prognosis in pT3 ESCC patients.

Disclosure
All authors have declared no conflicts of interest.
PS02.230: CLOSURE OF POSTESOPHAGECTOMY GASTROTRACHEAL FISTULA FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY THROUGH THE STOMACH CONDUIT OPENING
Authors: Lee Junhee , Yi Eunjue , Lee Sungho , Ho Chung Jae 
Published: September 2018

Abstract

Background
The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here.

Methods
A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0.

Results
The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28.

Conclusion
Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications.

Disclosure
All authors have declared no conflicts of interest.
PS02.238: POSTOPERATIVE PROGNOSTIC NUTRITIONAL INDEX CAN PREDICT A LONG-TERM PROGNOSIS OF ESOPHAGEAL CANCER
Authors: Takahashi Jun , Saito Masaaki , Obitsu Tamotsu , Ishioka Daisuke , Kiyozaki Hirokazu , Rikiyama Toshiki 
Published: September 2018

Abstract

Background
Recent reports indicate the nutritional and immune status often affect the long-term prognosis of patients with cancer. The preoperative prognostic nutritional index(PNI) is used as an evaluation of the perioperative nutritional status, and it is reported that the PNI level correlates with postoperative results. However, only a handful of reports have discussed the predictive prognostic potential of postoperative PNI. The aim of this study is to clarify the correlation of postoperative PNI level and long-term prognosis of patients with esophagus cancer who underwent esophagectomy.

Methods
A total of 29 patients with esophageal cancer who received neoadjuvant chemotherapy followed by radical esophagectomy from January 2011 to December 2014 were retrospectively reviewed. The calculation of PNI level is as follows: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (/mm3). The postoperative PNI level was measured three months after radical esophagectomy. The patients were stratified by postoperative PNI level by two groups using calculated cutoff level (PNI = 43.9) by receiver operating characteristic curve. The correlation of 3-year disease-free survival (DFS) and postoperative PNI level was evaluated.

Results
Of the total, 25 were male and 4 were female. The median age of patients was 68 years (31–79 years). Overall, patients received 1–2 cycles of preoperative chemotherapy with 5-FU and cisplatin. Of these 29 patients, 9 (31.0%) responded to chemotherapy (8 patients had a partial response and 1 had a complete response). The median postoperative PNI level was 47.2 (38.0–58.9). Univariate analyses showed that 3-year DFS was worse in patients with low postoperative PNI level (P = 0.017), advanced pathological stage (P = 0.029) and younger age (< 70 years) (P = 0.02). Multivariate analyses showed that low postoperative PNI level[hazard ratio (HR) 0.224, 95% confidence interval (CI) 0.060–0.83, P = 0.026] and advanced pathological stage (HR 3.197, 95% CI 1.13–9.06, P = 0.029) were independent predictors of 3-year DFS.

Conclusion
Our findings suggest that the postoperative PNI level may be a useful marker to predict a prognosis of patients with esophagus cancer. Nutrition intervention for undernourished patients after surgery may improve prognosis of patients with esophagus cancer.

Disclosure
All authors have declared no conflicts of interest.
RA01.07: SALVAGE ESOPHAGECTOMY IN SQUAMOUS CELL ESOPHAGEAL CARCINOMA: TECHNICAL SURGICAL ASPECTS OF A HIGH-RISK PROCEDURE
Authors: Takeda Flavio , Cecconello Ivan , Ribeiro Jr Ulysses , Mariano Rocha Julio , Catapreta Lucas , Duarte Andre , Sallum Rubens 
Published: September 2018

Abstract

Description
Background: The concept of salvage esophagectomy after definitive chemoradiotherapy treatment has traditionally been recognized as a feasible option, but due to the associated unfavorable morbidity and mortality profile, this indication has been limited. Methods: The experience of 27 cases of salvage esophagectomy were summarized in this VIDEO. The thoracic field performed in the prone position and abdominal field performed laparoscopically. Lessons learned concerning improvement of safety and lymphadenectomy are particularly shown Results: The cases of thoracic and abdominal robotic esophagectomy summarized in this VIDEO were squamous cell mid third esophageal carcinoma post definitive chemo- radiotherapy. It this video, we particularly show the relationship to left broncqueal side and the effects of scars in mediastinum after the high dose of radiotherapy. Discussion: Salvage esophagectomy is feasible, but it still needs an intensive care during surgery to avoid secondary lesions, such as air way tree, vascular and pleural injuries.

Disclosure
All authors have declared no conflicts of interest.
RA03.01: A POPULATION-BASED STUDY ON LYMPH NODE RETRIEVAL IN PATIENTS WITH ESOPHAGEAL CANCER: RESULTS FROM THE DUTCH UPPER GASTROINTESTINAL CANCER AUDIT
Authors: Van Der Werf Leonie , Dikken Johan , Van Berge Henegouwen Mark I , Lemmens Valery , Nieuwenhuijzen Grard A P , Wijnhoven Bas P L 
Published: September 2018

Abstract

Background
For esophageal cancer, the number of retrieved lymph nodes (LNs) is often used as a quality indicator. The aim of this study was to analyze the number of retrieved LNs in the Netherlands, to assess factors associated with LN yield and to explore the association with short-term outcomes.

Methods
For this retrospective national cohort study, patients with an esophageal carcinoma who underwent esophagectomy between 2011–2016 were included. Primary outcome was the number of retrieved LNs. Associations were tested with univariable and multivariable regression analysis for the association with ≥ 15 LNs.

Results
3970 patients were included. Between 2011–2016 the median number of LNs increased from 15 to 20. Factors independently associated with ≥ 15 LNs were: 0–10 kg preoperative weight loss (versus: unknown weight loss, odds ratio [95% confidence interval]: 0.71[0.57–0.88]), Charlson-score 0 (versus: Charlson-score 2: 0.76[0.63–0.92]), cN2-category (reference: cN0, 1.32[1.05–1.65]), no neoadjuvant therapy and neoadjuvant chemotherapy (reference: neoadjuvant chemoradiotherapy, 1.73[1.29–2.32], 2.15[1.54–3.01]), minimally invasive transthoracic (reference: open transthoracic, 1.46[1.15–1.85]), open transthoracic (versus open and minimally invasive transhiatal, 0.29[0.23–0.36] and 0.43[0.32–0.59], hospital volume of 26–50 or > 50 resections/year (reference: 0–25, 1.94[1.55–2.42], 3.01[2.36–3.83]) and year of surgery (reference: 2011, ORs: 1.48, 1.53, 2.28, 2.44, 2.54). There was no association of ≥ 15 LNs with short-term outcomes.

Conclusion
The number of LNs retrieved increased between 2011 and 2016. Weight loss, Charlson score, cN-category, neoadjuvant therapy, surgical approach, year of resection and hospital volume were all associated with increased LN yield. The retrieval of ≥ 15 LNs was not associated with increased postoperative morbidity/mortality.

Disclosure
All authors have declared no conflicts of interest.
RA03.02: ACUTE KIDNEY INJURY AFTER ESOPHAGEAL CANCER SURGERY: INCIDENCE, RISK FACTORS, AND IMPACT ON ONCOLOGIC OUTCOMES
Authors: Murphy Conor , Dunne Talulla , Elliott Jessie , King Sinead , Ravi Narayanasamy , Reynolds John 
Published: September 2018

Abstract

Background
Surgery remains the cornerstone of treatment for esophageal cancer. Esophagectomy serves as an exemplar of major operative trauma, yet there is a paucity of literature regarding postoperative renal outcomes. We aimed to study the incidence of acute kidney injury (AKI) after esophageal cancer surgery, and to determine independent risk factors for postoperative renal impairment.

Methods
Consecutive patients undergoing potentially curative surgery for esophageal cancer from 2006–2016 were studied. AKI was defined according to AKIN criteria. Complications were recorded prospectively and comprehensive complications index (CCI) was determined. Multivariate linear and logistic regression were performed to determine factors independently predictive of postoperative AKI.

Results
661 patients (72.9% male), a mean age of 63.5 ± 9.7 years, underwent surgery (2-stage esophagectomy, 307 [46.4%]; 3-stage esophagectomy, 117 [17.7%]; transhiatal esophagectomy, 112 [16.9%]; extended total gastrectomy, 122 [18.5%)], pharyngolaryngoesophagectomy, 3 [0.5%]), with a CCI of 21.3 ± 19.7 and an in-hospital mortality of 1.4%. Baseline prevalence of chronic kidney disease was 1.8%. Postoperative AKI occurred in 174 (26.3%) patients, with AKIN 1, 2 and 3 in 122 (18.5%), 41 (6.2%) and 11 (1.7%), respectively. Of these, 5 (2.9%) required renal replacement therapy during admission. Preoperatively, greater BMI (P = 0.02, OR 1.05 [95% CI 1.01–1.10]), male sex (P = 0.05, OR 1.68 [1.01–2.78]), age (P = 0.001, OR 1.04 [1.02–1.07]), hypertension (P = 0.005, OR 1.85 [1.20–2.84]), and transthoracic approach (P = 0.01, OR 1.82 [1.14–2.89]) independently predicted postoperative AKI. After surgery, while CCI was predictive of AKI on univariable analysis (P < 0.001 OR 1.03 [1.02–1.04]), atrial fibrillation (P = 0.001 OR 3.25 [1.57–6.72]) and prolonged intubation (P = 0.016 OR 3.61 [1.28–10.21]) were independently associated with AKI on multivariable logistic regression. On multivariable linear regression, neoadjuvant treatment (surgery only, 13.5 ± 35.8%; chemotherapy, 25.3 ± 42.2%; chemoradiation 18.7 ± 31.9%, P = 0.02), transthoracic approach (P = 0.006), and baseline BMI (P = 0.02) predicted postoperative %Δcreatinine. Postoperative AKI did not impact survival outcome on univariable or multivariable analysis.

Conclusion
Major AKI is rare after esophageal cancer surgery, with risk independently associated with increasing age, features of the metabolic syndrome, and postoperative morbidity.

Disclosure
All authors have declared no conflicts of interest.
RA03.03: THE IMPACT OF ENHANCED RECOVERY AFTER SURGERY (ERAS) ON PATIENTS UNDERGOING OESOPHAGECTOMY
Authors: Dent Barry , Sturrock Jillian , Mckenna Janine , Taylor Claire , Jaretzke Helen , Michael Griffin S , Immanuel Arul 
Published: September 2018

Abstract

Background
Enhanced recovery after surgery (ERAS) is defined as a multimodal care pathway designed to achieve early recovery for patients undergoing surgery. For patients undergoing oesophagectomy such pathways are complex and must involve a wide multi-disciplinary team. The importance of peri-operative nutrition is especially relevant in this patient group. We describe our experience of the impact of an ERAS pathway in a high volume oesophago-gastric unit on both short and medium term patient outcomes.

Methods
Consecutive patients undergoing open 2 phase subtotal oesophagectomy with two field lymphadenectomy in a 12 month period following the introduction of an ERAS pathway were included in the study. Outcomes were compared with consecutive patients undergoing the same procedure over a 12 month period prior to the introduction of the ERAS pathway. All patients were treated in a single UK unit. Adherence to the ERAS pathway was monitored by a dedicated ERAS coordinator. All data were collected prospectively. Statistical analysis was performed using the Mann-Whitney U test for continuous and Chi2 for categorical data.

Results
189 patients were included (97 pre-ERAS and 92 ERAS). There were no demographic differences between the patient groups. The rate of severe post-operative complications (Accordion score 3 + ) was identical between groups (29%). Median length of hospital stay was significantly reduced with ERAS (10 days v 14 days pre-ERAS (P < 0.001)) as was the total readmission rate (21% v 39% P = 0.006). Weight loss following surgery was significantly reduced with ERAS. At 2 weeks 1% of patients had lost over 10% of their pre-operative weight compared with 32% pre-ERAS (P < 0.001). A significant difference was maintained at 6 weeks (9% v 55%), 3 months (19% v 66%) and 6 months (35% v 71%).

Conclusion
Our results demonstrate the positive impact of ERAS for patients undergoing oesophagectomy. Despite no reduction in post-operative complication rates, both hospital stay and readmission rates were reduced, suggesting a positive impact of ERAS on patients’ response to complications. Far fewer patients were readmitted for nutritional reasons/failure to thrive following the introduction of ERAS. Implementing an ERAS pathway requires a dedicated multi-disciplinary team to provide the required peri-operative care both in the hospital and community.

Disclosure
All authors have declared no conflicts of interest.
RA03.06: IMPROVED SURVIVAL AFTER ESOPHAGECTOMY FOR ESOPHAGEAL OR GASTROESOPHAGEAL CANCER IN THE LAST 25 YEARS
Authors: Slaman Annelijn , Pirozollo Giovanni , Eshuis Wietse , Gisbertz Suzanne , Van Berge Henegouwen Mark I 
Published: September 2018

Abstract

Background
Many things have changed in treatment for patients who underwent esophagectomy for cancer in the last decades, such as neoadjuvant chemoradiotherapy and minimally invasive esophagectomy. This study was performed to evaluate developments in survival after esophagectomy for cancer over the last 25 years.

Methods
Patients who underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) carcinoma between January 1993 and February 2017 were selected from a prospectively maintained database of a tertiary referral center, guaranteeing minimum follow-up of 12 months at time of the analyses. Patients were divided in different groups according to year of esophagectomy: A) 1993–1997, B) 1998–2002, C) 2003–2007, D) 2008–2012, and E) 2013–2017. Follow-up was truncated at a maximum of 60 months. Survival outcomes were assessed by Kaplan Meier estimate, using log-rank tests to compare survival curves between groups.

Results
A total of 1503 patients were included. Median follow-up was 55.8 months (IQR 31.5–60.0). Median estimated overall survival for all patients was 36.4 months (95% CI 31.8–40.9) and improved from 26.1 months (95% CI 19.3–32.8, period A) to 46.1 months (95% CI 36.9–55.3) in period E (P = 0.001). Cumulative 1- and 3-years survival increased from 69.3% and 42.4% (period A) to 79.2% and 54.6% (period E, P < 0.05) respectively. The cumulative 5-years survival improved from 30.5% (period A) to 43.4% in period D (P = 0.007).

Conclusion
Survival after esophagectomy for cancer improved significantly in the last 25 years. Additional investigations should be performed to assess predictive factors for survival, in order to further improve survival.

Disclosure
All authors have declared no conflicts of interest.
RA04.03: MINIMALLY INVASIVE ESOPHAGECTOMY IN THE LEFT LATERAL DECUBITUS POSITION
Authors: Otsuka Koji , Goto Satoru , Ariyoshi Tomotake , Yamashita Takeshi , Motegi Kentaro , Kato Rei , Kohmoto Masahiro , Saito Akira , Date Hiromi , Yamazaki Kimiyasu , Aoki Takeshi , Murakami Masahiko 
Published: September 2018

Abstract

Background
We initially performed minimally invasive esophagectomy in a left lateral decubitus position through 5 ports in 1996, and we have now treated over 900 cases using this approach. This position has many benefits, but it also has some drawbacks. We were able to operate with good results after we introduced artificial pneumothorax with CO2 insufflation in 2010. We investigated the short- and long-term outcomes of thoracoscopic surgery for esophageal cancer in the left lateral decubitus position at our institution.

Methods
From 1996 to 2016, 807 esophageal cancer patients were treated with minimally invasive esophagectomy in the left lateral decubitus position at our hospital. We compared the 289 cases treated in the early period (1996–2005) and 518 cases treated in the late period (2006–2016), in which the procedure was standardized and operator training was established

Results
The completion rate of thoracoscopic surgery was 99.5%, with the procedure switched to thoracotomy in only 3 patients in whom hemorrhage occurred. The mean intrathoracic operative time was 205.0 min, mean intrathoracic blood loss was 127.3 mL, and mean number of dissected mediastinal lymph nodes was 24.7. The postoperative complications were pneumonia (8.5%), anastomotic leakage (7.5%), and recurrent nerve paralysis (7.8%). The 5-year overall survival rate was 69.5%. Comparison of 289 cases treated in the early period (1996–2005) and 518 cases treated in the late period (2006–2016), revealed significant differences in mean intrathoracic blood loss (174.0 vs. 94.2 mL); number of dissected mediastinal lymph nodes (20.0 vs. 28.4); postoperative hospital stay (33.4 vs. 20.0 days, all P < 0.001); and postoperative anastomotic leakage (13.9% vs. 1.6%, P < 0.0001). In recent operation, we do not have recurrent laryngeal nerve paralysis and hoarseness after we take care of the micro anatomical layer, stretch and thermal damage of recurrent laryngeal nerve when we dissect the lymph node.

Conclusion
These data indicate significant improvements in intrathoracic blood loss, number of dissected mediastinal lymph nodes, anastomotic leakage, and postoperative hospital stay, reflecting continued improvement of minimally invasive esophagectomy performed in the left lateral decubitus position at our institution.

Disclosure
All authors have declared no conflicts of interest.
RA05.02: PRELIMINARY STUDY ON SCOPE OF CERVICAL LYMPHADENECTOMY OF PATIENTS WITH ESOPHAGUS CARCINOMA UNDER THORACOSCOPE
Authors: Hong Peng 
Published: September 2018

Abstract

Background
Objective: To explore scope of cervical lymphadenectomy of patients with esophagus carcinoma under thoracoscope.

Methods
Select patients underwent routine bilateral cervical lymph node dissection under thoracoscope.The highest location of cervical lymphadenectomy was marked by titanium clip and recorded anatomic landmark around it.After surgery, CT scan of neck was contributed to estimate the location.

Results
The results: The upper boundary of lymph node dissection on right neck located on the upward side of the crosspoint of right inferior thyroid artery and right recurret laryngeal nerve, which was adjacent to the midpoint position between the upper pole and lower pole of right thyroid, the lower side of musculi omohyoideus and the plane of transverse cervical artery. The upper boundary of left scope of cervical lymphadenectomy was adjacent to the upper position of lower pole of left thyroid, which was about the same level as that of right titanium clip. Postoperative CT scan on neck and chest suggested that bilateral titanium clip was located on midpoint between the upper pole and lower pole of thyroid on the same side.

Conclusion
Bilateral cervical paraesophageal lymph nodes (101 group)under inferior thyroid artery could be finished by thracoscope for radical resection of esophageal carcinoma.But we still need more evidence to discover the difference between the 2.5 field lymph node dissection and the 3 field lymph node dissection.

Disclosure
All authors have declared no conflicts of interest.