bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.084: BOERHAAVE SYNDROME: CONTINUING CHALLENGE TO TREATMENT
Authors: Chandramohan Servarayan , Varadharajan Visvarath , Chinnathambi Madeshwaran , Manickavasagam Kanagavel , Chandramohan Apsara 
Published: September 2018

Abstract

Background
Boerhaave syndrome produces an extremely severe clinical profile due to extravasation of digestive secretions and food into the mediastinum and pleural space. Diagnosis is often delayed, since it is a rare disease and is usually confused with other equally serious pathologies. These factors contribute to its high mortality rate. We present a case which was previously treated in three different institutions and finally referred to our department.

Methods
81 year old gentleman was diagnosed as Boerhaave syndrome on 23rd Jan 2017. He had treatment in three different institutions: right ICD in first center: feeding jejunostomy and venting gastrostomy in second center: over the scope clipping and hemoclip in third center. As he continued to have persistent leak of enteral contents and purulent discharge in ICD, he was referred to our department for further management, two months after the intial insult.

Results
Patient was optimised for surgery and transhiatal esophagectomy with esophago gastric anastomosis was done in our department. Operative findings: Abdomen entered through midline incision, hiatal peritoneum incised, gastro esophageal junction encircled and esophagus mobilised. It revealed purulent discharge from right hemithorax and a 4cm esophageal perforation along right lateral aspect of esophagus above GE junction.About 120ml of foul smelling pus drained. Considering unhealthy esophageal tissue, long rent and failed endotherapy it was decided to do transhiatal esophagectomy. Previous gastrostomy site closed in 2 layers with 3–0 PDS. Through left anterior sternomastoid incision cervical esophagus mobilised and transected at low neck level and the specimen was removed through the hiatus. A gastric tube was made with linear staples and brought into neck through posterior mediastenum by camera sheath technique. Esophago-gastric anastamosis completed with posterior stapled and anterior hand sewn technique. Post op period was uneventful.

Conclusion
Early diagnosis and appropriate therapeutic strategies can reduce the mortality rate of Boerhaave's syndrome. Early intervention reduces the morbidity and mortality. The mortality increases with increasing time post insult. our patient who had undergone multiple theraputic modalities in three different centers was succesfully managed with trans hiatal esophagectomy in our department.

Disclosure
All authors have declared no conflicts of interest.
PS01.095: BENIGN ESOPHAGEAL STRICTURE: A RECAP OF OUR EXPERIENCE
Authors: How Teoh Keat , Voon Kelvin , Yee Lim Shyang , Nagalingam Premnath 
Published: September 2018

Abstract

Background
Caustic injury remains the commonest cause of benign esophageal strictures in Asia. Others include gastroesophageal reflux, iatrogenic, radiation, autoimmune or idiopathic causes. Treatment goals are relief of dysphagia and prevention of recurrence. This study aims to evaluate the experience with benign esophageal stricture in Penang Hospital, a tertiary hospital in Northern region of Malaysia.

Methods
A retrospective review of 12 patients with benign esophageal strictures between year 2012 - 2017.

Results
The mean age was 53.5 and two thirds were female. Half of these patients were of Chinese ethnicity while the other half were Indian. The commonest cause was caustic ingestion (41.7%), followed by reflux stricture (25%) and anastomotic stricture (25%). There was one case of dystrophic epidermolysis bullosa. More than half of the patients had complex and multiple strictures. 41.7% of patients had proximal strictures that were located within 20cm from the incisors. Endoscopic dilatation was the first line treatment with either Savary Gilliard or balloon dilators. A total of 97 dilatation sessions were done with a mean dilatation frequency of 2.3 ± 1.5 times for anastomotic strictures, 8 ± 8.2 times for reflux strictures and 8.0 ± 6.6 times for corrosive strictures. The mean dilatation interval was 2.5 ± 1.2 weeks. 58.3% of patients had successful endoscopic treatment. The success rate was higher in non-corrosive stricture (83% vs 40%). There was one dilatation related complication in which the patient had pneumomediastinum without overt mediastinitis. This however, resolved with conservative management. 41.7% of patients had refractory strictures that failed endoscopic dilatation. Surgery including esophagectomy (40%), revision of anastomosis (20%) and gastrostomy (40%) were done for this group of patients. Proximal strictures, complex strictures and multiple strictures were associated with failed endoscopic dilatation (P < 0.05).

Conclusion
Endoscopic dilatation is the first line treatment for benign esophageal strictures. Surgery is reserved for refractory strictures with failed endoscopic treatment. Predictor scoring systems for refractory stricture and individualized approaches are the key to success.

Disclosure
All authors have declared no conflicts of interest.
PS01.106: PSEUDODIVERTICULOSIS-RELATED ESOPHAGEAL MASS WITH INTENSE FDG UPTAKE
Authors: Sawada Ryuichiro , Oshikiri Taro , Nakamura Tetsu , Miura Yukiko , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Matsuda Yoshiko , Yamashita Kimihiro , Matsuda Takeru , Sumi Yasuo , Suzuki Satoshi , Kakeji Yoshihiro 
Published: September 2018

Abstract

Background
Esophageal intramural pseudodiverticulosis (EIPD) is rare condition. The usual symptom is dysphagia mainly due to benign stenosis, and other variety of symptoms and complications have been reported. Only few articles have shown EIPD leading to esophageal mass formation like malignancy. Here, we report EIPD related to esophageal mass with increased up take of 18F-fluorodeoxyglucose followed by esophagectomy.

Methods
A 48-year-old man presented with dysphagia caused by esophageal stricture. Esophagoscopy showed a protruding submucosal lesion and lumen stenosis in lower third of esophagus. The esophageal mucosa was intact, but one small hole was observed. Positron emission tomography-computed tomography showed the FDG-avid lesion in the lower esophagus. In addition to symptom persistence, possibility of malignancy offered him surgical resection. In the prone position, minimally invasive esophagectomy with gastric tube reconstruction was performed.

Results
The pathology of the surgical specimen showed that many cystic spaces lined by stratified squamous epithelium were present in the submucosa and partially in the muscularis propria. There was mucosal depression connecting with the cystic spaces, and submucosa was thickened with fibrosis. The dilated spaces formed flask-shaped lesion and intramural tracking parallel to the esophageal lumen. Based on these findings, esophageal intramural pseudodiverticulosis with no evidence of malignancy was diagnosed. The postoperative course was uneventful, and the patient was discharged 18 days after operation.

Conclusion
EIPD can result in inflammatory mass formation with high up take of FDG and the cavities can protrude into muscularis propria. The present report can be helpful in the assessment of PET-positive tumor. We should consider EIPD in unknown mass in the thoracic esophagus. Early diagnosis followed by conservative therapy may allow adequate control without surgery. The pathogenesis of EIPD remains to be fully clarified, and additional studies will be needed to elucidate the mechanism.

Disclosure
All authors have declared no conflicts of interest.
PS01.109: A RARE TUMOR OF THE CERVICAL ESOPHAGUS: SCHWANNOMA
Authors: Aydin Yener , Eroglu Atila , Ulas Ali , Keskin Hilmi , Ozmen Sevilay 
Published: September 2018

Abstract

Background
Schwannomas esophagus is very rarely seen. In this study, a schwannoma case with cervical esophagus was presented.

Methods
A 26-year-old female presented with dysphagia. In esophageal ultrasonography, a homogeneous, hypoechoic, and smooth-sided lesion originating from the proximal esophagus muscularis propria was detected. MRI revealed a well-defined mass lesion located in the cervical esophagus.

Results
The left cervical incision was performed and the lesion was enucleated. After the enucleation, saline was inserted into the enucleated area, and air was injected into the nasogastric tube to investigate the possibility of mucosal injuries. The esophageal muscle layers were then primarily closed with absorbable sutures. Frozen section examination was benign. Postoperative histopathological evaluation was assessed as accordance with schwannoma (Figure). Oral diet was started on the 3th postoperative day. There were no complications postoperatively. The patient was discharged on the 5th postoperative day.

Conclusion
The vast majority of esophageal tumors are cancer. Benign esophagial tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. Esophageal schwannoma is very rare and difficult to diagnose by endoscopy and imaging methods. In these cases, surgery provides both definitive diagnosis and treatment.

Disclosure
All authors have declared no conflicts of interest.
PS01.122: LONG-TERM QUALITY OF LIFE IN PATIENTS AFTER MCKEOWN VERSUS IVOR LEWIS ESOPHAGECTOMY
Authors: Jezerskyte Egle , Gisbertz Suzanne , Van Berge Henegouwen Mark I , Saadeh Luca , Scarpa Marco 
Published: September 2018

Abstract

Background
Treatment of distal esophageal and gastroesophageal junction (GEJ) cancers is challenging. The therapy for these cancers mainly consist of (neo)adjuvant chemo(radio)therapy and surgery. There are different surgical approaches possible for these patients: transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). However, there is no evidence which is the preferred approach in terms of oncology, morbidity and quality of life. The aim of this study was to investigate the difference in the long-term quality of life in patients undergoing McKeown (McK) versus Ivor Lewis (IL) esophagectomy in a tertiary referral center.

Methods
Consecutive patients after either McK or IL for distal oesophagus, GEJ or proximal gastric carcinoma were asked to fill in EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires to evaluate quality of life during the period of January 2014 – December 2017. EORTC QLQ-INFO25 quality of life questionnaire was used to evaluate information needs of patients in both groups. All answers with a long follow up (> 1 year) after surgery were analysed.

Results
In the McK group 62 and in the IL group 110 patients were included. Median follow up was 3 years for McK and 2 years for IL. Median age was 62,4 years. Cognitive functioning was significantly better in the IL group (P = 0.038). Complaints of dyspnoe (P = 0.004) and dysphagia (P = 0.028) were significantly higher in the McK group. Patients after IL had significantly less trouble with eating with others (P = 0.003), trouble with taste (P = 0.032), chocking when swallowing (P = 0.022) and trouble with talking (P = 0.038). There was no significant difference in global health status or physical, role, social or emotional functioning. Furthermore there was no difference in symptoms of nausea, fatigue, pain, discomfort or information scores between McK and IL groups.

Conclusion
After a follow up of > 1 year no differences in global health status or physical, role, social or emotional functioning scales between McK and IL esophagectomy were found. However, significant differences in some symptom scales and cognitive functioning were observed in favor of IL. These findings should be taken into consideration when deciding between a McK and IL esophagectomy in patients where both procedures are feasible.

Disclosure
All authors have declared no conflicts of interest.
PS01.141: TREATMENT STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA COMPLICATED WITH HEAD AND NECK CANCER
Authors: Maeda Masato , Kawamorita Keisuke , Koreyasu Ryohei , Ueda Shou , Takayanagi Tomoyasu , Kobayashi Toshiki , Hashomoto Yosuke , Fujimoto Yasuhiro , Yonezawa Kei , Miyashita Tadashi 
Published: September 2018

Abstract

Background
The frequency of complication of head and neck cancer to thoracic esophageal cancer is high, and treatment methods and their order will be determined from the viewpoints of curability and quality of life.

Methods
We review the course of three cases we experienced and give some consideration.

Results
[Case 1] A 68-year-old man with cT2N0M0 Mt esophageal cancer and cT2N0M hypopharyngeal cancer. Two courses of DCF (DOC + CDDP + 5 FU) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy with three fields lymph nodes dissection, one course of DCF was added, and CRT (60 Gy/30 fr) combined with weekly CBDCA was administered to the neck. The case is alive without recurrence for 5 years and 9 months from the start of treatment. [Case 2] A 72-year-old man with cT2N0M0 Mt esophageal cancer and cT3N2bM0 hypopharyngeal cancer. Three courses of TCS (DOC + CBDCA + TS-1) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy, CRT (60 Gy) combined with biweekly CDDP was administered to the neck. The case is alive without recurrence for 5 years and 7 months. [Case 3] A 63-year-old man with LtMt multiple esophageal cancer (4 lesions, cT3N2M0) and cT2N1M0 hypopharyngeal cancer, and cT1bN0M0 gastric cancer. Though the hypopharyngeal cancer remained in PR after 2 courses of DCF, aiming at larynx preservation, thoracoscopic subtotal esophagectomy was performed, and gastric lesion was excised at the time of creating the stomach tube. After the operation, CRT (70 Gy) combined with weekly CBDCA made the hypopharyngeal lesion CR. Another cancer was demonstrated in the residual esophagus in 1 year and 3 months and surgical resection of the residual esophagus and the larynx with reconstruction with free jejunal transplantation was performed. The case is alive without recurrence for 2 years and 5 months after reoperation.

Conclusion
Salvage surgery may be necessary for metachronous multiple cancer cases, non-CR cases, and local recurrence cases as in case 3. We think that we can aim at compatibility of curability and maintenance of quality of life by treatment method which aims at preservation of larynx, combining with chemoradiotherapy and esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS01.143: ANALYSIS OF THORACOSCOPE, LAPAROSCOPY COMBINED WITH TOTAL LARYNGECTOMY IN TREATMENT OF CERVICAL ESOPHAGEAL CARCINOMA OPERATION
Authors: Jiang Jie , Yu Xiuyi , Geng Guojun , Liu Hongming 
Published: September 2018

Abstract

Background
To investigate the feasibility and efficacy of cervical esophageal carcinoma operation through thoracoscope, laparoscopy combined with total laryngectomy.

Methods
Retrospect and analyze the data of 53 patients with cervical esophageal carcinoma undergone surgical treatment in Department of Thoracic Surgery, First Hospital Affiliated to Xiamen University from May.2010 to May.2017. Operation procedure: separate esophagus under thoracoscope, rebuild gastric tube, resect full throat, perform tracheostoma permanently, apply gastric-pharyngeal anastomosis.

Results
Thoracic operation time was 50 ∼ 65 min, average 57 min; abdominal operation time was 46 ∼ 62 min, average 54 min; neck surgery time was 117 ∼ 137 min, average 125 min. The amount of intraoperative bleeding was 78∼ 260 ml, average 180 ml. The postoperative hospital stay was 7 ∼ 15d, average 10d. All the cases were squamous cell carcinoma, 6 cases of high differentiated squamous cell carcinoma, 31 cases of squamous cell carcinoma, 10 cases of middle-low differentiated squamous cell carcinoma, 6 cases of low differentiated squamous cell carcinoma. All the resection edges had been proved no residual tumor left by pathological examination. In 53 cases, lymph node metastasis occurred in 48 cases, anastomotic fistula occurred in 1 cases, 2 cases of pulmonary infection, 1 cases of gastric emptying and 1 case anastomotic stenosis happed, and there is no death case. All the patients were followed up from 1 months to 5 years, the 1st, 3rd, 5th year survival rate was 83.8%, 51.2% and 23.1% respectively.

Conclusion
Cervical esophageal carcinoma operation treatment should be taken actively, Gastric pharyngeal anastomosis is an effective mean to treat cervical esophageal carcinoma.

Disclosure
All authors have declared no conflicts of interest.
PS01.152: BODY TEMPERATURE IN THORACOSCOPIC ESOPHAGECTOMY AND AIR CONDITIONING SYSTEM OF OPERATION ROOM
Authors: Usuki Hisashi , Kishino Takayoshi , Fujiwara Masao , Okano Keiichi , Suzuki Yasuyuki 
Published: September 2018

Abstract

Background
It is well known that the perioperative hypothermia often cause the perioperative complications. In this study the hypothermia during the thoracoscopic esophagectomy and the relationship between the hypothermia and the air conditioning system of operation room were evaluated.

Methods
The subject of this study was 58 patients with esophageal cancer. Fifty of them were male and the others were female and the age was 65.2 + -8.4 years old. Forty three of 58 patients underwent the surgery in the old operation rooms (Group A) and 15 of them underwent it in the operation rooms with new air condirioning system (Group B). The 18 measuring points were picked up for each patient, which were from 10 to 180 minutes after start. The body temperatures were measured every 10 minutes after starting anesthesia. The temperature difference comparing with the starting point of surgery and the frequency of hypothermic state were evaluated. ‘Hypothermic state’ was defined that the temperature reduce more than 0.3 centigrade in comparison with the temperature at the starting point of surgery in this study.

Results
< 1 > The body temperature reduced early 60 minutes and then rose slowly. It reduce 0.22 + -0.35 centigrade at 60 minutes after starting surgery in comparison with the starting point of surgery. < 2–1 > The temperature of the patients in Group A reduced 0.24 + -0.03 centigrade and 0.32 + -0.09 centigrade at 30 and 60 minutes after starting surgery. But, the temperature of the patients in Group B reduced only 0.05 + -0.01 centigrade at 30 minutes after starting surgery and the temperature recovered at 60 minutes. These differences were statistically significant. < 2–2 > The total measuring points were 774 points in Group A and 270 points in Group B. The hypothermic state was observed 353 measuring points (45.6%) in Group A, and only 8 points (3.0%) in Group B. This difference was statistically significant.

Conclusion
The new operation rooms, in which the temperature of the air flow for the patients and that for surgeons can be set separately, is useful for keeping the body temperature of the patients adequately.

Disclosure
All authors have declared no conflicts of interest.
PS01.153: MEDIASTINOSCOPIC ESOPHAGECTOMY FOR THE PATIENT OF ESOPHAGEAL CARCINOMA WITH CHRONIC OBSTRUCTIVE LUNG DISEASE(COPD)
Authors: Ohara Masanori , Yamabuki Takumi 
Published: September 2018

Abstract

Background
Respiratory failure is one of fatal postoperative complication after esophagectomy. The patient with COPD is tendency to contraindication of esophagectomy. Thoracoscopic esophagectomy preserve respiratory function comparing with open esophagectomy. We suppose to preserve more respiratory function with mediasinoscopic esophagectomy.

Methods
77-year-old male. He had home oxygen therapy(HOT) by 1 liter oxygen per minute. Diagnosis was lower esophageal carcinoma with metastasis of upper mediastinum and cardiac lymphnode. We performed mediasinoscopic esophagectomy with lymphnode dissection.

Results
Pathological findings revealed adenocarcinoma with metastasis of cardiac and bilateral laringial nerve lymphnode. He recovered after one week mecanical ventilation. He discharged after rehabilitation.

Conclusion
The patient with COPD has high risk of esophagectomy. However, we suppose mediastinoscopic esophagectomy is one of the hopeful option incase of sufficient informed consent.

Disclosure
All authors have declared no conflicts of interest.
PS01.162: IS THERE A DIFFERENCE IN SURVIVAL BETWEEN YOUNGER AND OLDER GASTRIC CANCER (INCLUDING AEG II AND AEG III) PATIENTS AFTER GASTRECTOMY?
Authors: Babic Benjamin , Matthias Corvinus Florian , Hadjijusufovic Edin , Tagkalos Evangelos , Lang Hauke , Grimminger Peter 
Published: September 2018

Abstract

Background
The incidence of gastric cancer decreases in the western world, however, it remains one of the most common diseases (1). There is just little data from Europe comparing the outcome of young and elderly gastric cancer patients. This study compares, depending on the age of 266 patients, the outcome of 266 consecutive gastrectomy cases due to gastric cancer

Methods
266 consecutive patients with gastric cancer received a gastrectomy between 2008–2016 at our comprehensive cancer centre. The mean age of the patients in this study was 64 years old (21- 93 years). All patients were followed up regarding survival. The patients were separated in 6 different groups, depending on the age at the time of operation. The different groups were re-analysed and compared to each other regarding median and 5-year survival.

Results
In this collective the 5-year survival rate for all patients was 43%. There were more diffuse type adenocarcinomas in Patients < 40 years. In younger patients the tumour was staged in an advanced stadium compared to the elderly patients group. There is a significantly higher 5-year survival rate for younger patients after gastrectomy. There is no significant difference, when separating patient groups in to decades of age.

Conclusion
Young patients have a higher 5-year survival rate after gastrectomy compared to old patients. However, comparing patients from chronologic age in decades, the significance is not reproducible. Therefore gastrectomy or subtotal gastrectomy is the determining therapeutic approach for gastric cancer with an acceptable outcome in both young and elderly patients. Older patients might have an lower 5 year survival rate not only due to the cancer or the surgical therapy itself, it is related to comorbidities and a lower rate in neoadjuvant therapy as well

Disclosure
All authors have declared no conflicts of interest.