bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical outcomes and learning curve analysis of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with 3D laparoscopic gastrectomy.
Authors: Chen Lin , Li Jiyang , Guo Xin , Xi Hongqing , Gao Yunhe , Cui Jianxin , Qiao Zhi , Zhang Kecheng , Liang Wenquan , Wei Bo , Xie Tianyu 
Published: January 2019

162 Background: There is a lack of supporting evidence regarding the safety, efficacy and surgeon acceptance of robotic versus three-dimensional (3D) laparoscopic surgery for patients with gastric cancer (GC). Methods: An ambispective cohort study was conducted. We compared short-term surgical outcomes including financial cost between robotic and 3D laparoscopic gastrectomy for all GC patients and the GC patients treated by Prof. Chen’s team. The Cumulative Sum (CUSUM) method was developed and used to analyze the learning curves of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen. Results: From August 2011 to June 2017, a total of 517 patients were enrolled for treatment with either robotic (n=408 including n=73 performed by Prof. Chen) or 3D laparoscopic (n=109 including n=71 performed by Prof. Chen) gastrectomy. There were no significant differences between the two operation methods regarding the clinical pathological characteristics, except for smoking habit (p < 0.001). In analysis of all the 517 patients, robotic group had shorter operative time (208 min vs 228 min, p=0.004), less time to first flatus (3 days vs 4 days, p=0.025), longer time to remove drainage and nasogastric tube (12 days vs 9 days, p=0.001, 6 days vs. 4 days, p=0.001, respectively), and more postoperative complications (21.3% vs. 9.2%, p=0.003). While we compared these short-term outcomes of robotic and 3D laparoscopic gastrectomy performed by Prof. Chen, only number of lymph node dissections (robotic 27 vs. 3D 33, p=0.038) and time to remove nasogastric tube (robotic 5 days vs. 3D 3 days, p < 0.001) were significantly different. CUSUM analysis showed that operative time reached a stable state after around 21 cases in robotic gastrectomy and 19 cases in 3D laparoscopic gastrectomy. The cost-effectiveness analysis showed that robotic gastrectomy had significantly higher total cost than 3D laparoscopic gastrectomy (robotic = RMB 124907 vs. 3D-laparoscopic = RMB 94395; p < 0.001). Conclusions: With comparable surgical outcomes, higher surgeon acceptance and less financial cost, 3D laparoscope is a highly recommended minimal invasive surgical method for GC patients.
Management of metastatic gastric and esophageal cancer in older adults.
Authors: Yokom Daniel , Natori Akina , Sim Hao-Wen , Chan Bryan Anthony , Moignard Stephanie , Sun Peiran , Lim Charles Henry , Jiang Di Maria , Ma Lucy Xiaolu , Darling Gail Elizabeth , Swallow Carol Jane , Brierley James D. , Wong Rebecca , Liu Geoffrey , Chen Eric Xueyu , Knox Jennifer J. , Alibhai Shabbir M.H. , Jang Raymond Woo-Jun , Elimova Elena 
Published: January 2019

163 Background: Older adults are under-represented or excluded from pivotal trials of palliative chemotherapy for metastatic gastric and esophageal (GE) cancers. Little is known about how older patients are treated in the real world. The objective of this study was to examine the impact of age on treatment and survival. Methods: Patients aged ≥65 years were identified from a retrospective database of patients with metastatic GE cancer (Princess Margaret Cancer Centre; 2011-2016). The impact of age ≥75 years (old-old) versus (vs.) 65-74 years (young-old) on treatment and survival was assessed using multivariable logistic and Cox proportional hazard regression models, respectively, adjusted for known prognostic factors including sex, comorbidity, primary site, histology, grade, stage at initial diagnosis, metastatic sites, and chemotherapy use. Results: Of 183 patients, median age was 72 (range 65-92) years; 31% were old-old. Old-old patients were less likely to be treated with any chemotherapy (12.3% vs. 45.2% young-old; adjusted odds ratio = 0.12 (95% confidence interval (CI) 0.05-0.31)). With a median follow-up of 5.7 months, 135 (74%) had died during follow-up; median overall survival (OS) was 5.2 months (mo) for the old-old vs. 8.4 mo (young-old). There was no significant difference in survival between the two groups after adjustment for known prognostic factors (old-old vs. young-old: univariable hazard ratio (HR) 1.75 (95% CI 1.2-2.5); adjusted HR 1.1 (95% CI 0.7-1.7). Treatment with any chemotherapy was associated with an improvement in survival: adjusted HR 0.34 (95%CI 0.22-0.52). Conclusions: In this single-centre study of older adults with metastatic GE cancer, there was an overall low rate of treatment with chemotherapy; those ≥75 were rarely treated. After accounting for known prognostic factors, there was no observed difference in survival between patients ≥75 and those 65 to 74. Comprehensive geriatric assessment may improve treatment selection in the older population. [Table: see text]
Screening for cancer-associated dysphagia: The development of two rapid tools for use in observational studies and routine care.
Authors: Borean Michael , Shani Kishan , Brown M. Catherine , Chen Judy , Liang Mindy , Karkada Joel , Kooner Simranjit , Doherty Mark K. , O'Kane Grainne M. , Jang Raymond Woo-Jun , Elimova Elena , Wong Rebecca , Darling Gail Elizabeth , Xu Wei , Howell Doris , Liu Geoffrey 
Published: January 2019

164 Background: Dysphagia as a cancer symptom can be associated with significant morbidity. We developed dysphagia screener tools for use in observational studies (Phase 1) and routine symptom monitoring in clinical care (Phase 2). Methods: Various dysphagia or odynophagia screening questions, selected after an expert panel reviewed content, criterion, and construct validity, were compared to either FACT-E Swallowing Index Cut-Off Values (SICV) or to questions adapted from the Patient Reported Outcomes for Common Terminology Criteria for Adverse Events (PRO-CTCAE). Sensitivity, specificity and patient acceptability were assessed. Results: In developing a tool for observational studies (Phase 1; n = 178 esophageal cancer patients), the screening question, “How are you currently eating?” had the highest sensitivities and specificities against various SICV cut-offs, with the best optimal cut-off associated with the clinical outcome of weight loss (80% sensitivity, 75% specificity). When developing a rapid screening tool for routine symptom monitoring (Phase 2; 255 head and neck, gastro-esophageal, and patients undergoing thoracic radiation), a single question screener (“Do you experience any difficulty or pain upon swallowing?”) versus a PRO-CTCAE-like gold standard generated sensitivities between 86-94% and specificities between 93-100%. The screening question (+/- follow-up questions where indicated) had a median completion time of under 2 minutes, and > 90% of patients were happy to complete the survey on an electronic tablet, did not feel that survey completion made their clinic visit more difficult, and did not find the questions upsetting or distressful. Conclusions: Two screener tools (for prospective observational studies “How are you currently eating?”, and for routine clinical monitoring “Do you experience any difficulty or pain upon swallowing?”) can effectively screen dysphagia symptoms without increasing cancer outpatient clinic burden.
Morbidity and mortality outcomes after esophagectomy following chemoradiation using a standardized operative technique.
Authors: Ha Jinny Suk , Fraser Charles , Zhou Xun , Hansaraj Natasha , Burrows Whitney , Broderick Stephen , Battafarano Richard James 
Published: January 2019

166 Background: Esophagogastrectomy following neoadjuvant chemo-radiation therapy for the treatment of locally advanced esophageal cancer is associated with significant morbidity and mortality. We hypothesized that the avoidance of neck anastomoses unless absolutely necessary to achieve negative margins and standardization of the anastomotic technique among surgeons would significantly decrease perioperative morbidity and potential mortality and improve oncologic outcomes for these patients. Methods: A HIPAA-compliant, prospectively maintained data base was retrospectively analyzed on 115 patients who underwent esophagogastrectomy following chemo-RT from 2007-2017 performed via a laparotomy and right thoracotomy using a standardized anastomotic technique. These procedures were performed by 5 different attending surgeons at 2 different academic medical centers. Peri-operative morbidity was assessed by standard measures and post-operative survival was assessed using Kaplan-Meyer survival. Results: There was 1 anastomotic leak and 1 mortality at 30 and 90 days. The overall 5-year survival was 40%. Major morbidity, defined as re-operation for bleeding, anastomotic leak, pneumonia, reintubation, chyle leak, and initial mechanical ventilation > 48 hours was 26% (30/113). Conclusions: Low anastomotic complication rates are associated with decreased perioperative morbidity and prolonged oncologic survival when compared to historical controls.
Laparoscopy and endoscopy cooperative surgery for gastric tumor.
Authors: Hiroki Ozawa , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Goto Osamu , Nakamura Rieko , Suda Koichi , Wada Norihito , Yahagi Naohisa , Kitagawa Yuko 
Published: January 2019

168 Background: Laparoscopic wedge resection is widely performed for managing gastric submucosal tumors (SMTs) that measure ≤5 cm in diameter. Laparoscopy and endoscopy cooperative surgery (LECS) is performed to ensure a sufficient margin while avoiding deformation or stenosis. Methods: We conducted a retrospective review of the data of 76 patients who underwent LECS for SMTs or early gastric cancers at our institution between April 2012 and July 2017. While Non-exposed Endoscopic Wall-inversion Surgery (NEWS) was performed for tumors with a major axis diameter of ≤5 cm and minor axis diameter of ≤3 cm, for other tumors, we adopted classical LECS or used the combination of laparoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET). Results: The tumor was located in the upper-/middle-/lower-third of the stomach in 49/20/7 cases. The mean operation time was 201.7 ± 66.2 min, and the mean blood loss was 4.7 ± 12.8 ml. The mean tumor size was 28.6 ± 11.6 mm. The histological tumor types included GIST (n = 38), leiomyoma (n = 14), schwannoma (n = 6), early gastric cancer (n = 8) and others (n = 10). The surgical procedure consisted of classical LECS/CLEAN-NET/NEWS in 17/15/44 cases; all early gastric cancers were treated by NEWS. The mean length of postoperative hospital stay was 8.7 ± 3.9 days. The mean serum levels of C-reactive protein on POD1 and POD3 were 3.2 ± 1.9 and 4.4 ± 3.4 mg/dl, respectively. The postoperative complications were anastomotic stenosis (n = 1), delayed gastric emptying (n = 3), pneumonia (>Grade II by the Clavien-Dindo classification) (n = 1) and exacerbation of GERD (>Grade II by the Clavien-Dindo classification) (n = 3). In the patient group that developed complications, the postoperative resumption of water intake was later, and the postoperative hospital stay was longer as compared to the group without complications (p = 0.04, 0.028). No relationship was observed between the likelihood of development of complications and the tumor location. Conclusions: Use of minimally invasive surgical procedures such as LECS could minimize the extent of gastric resection without deformation, stenosis. We consider that for surgical complications the LECS approach can be employed, regardless of the tumor location.
The prognostic role of neutrophil-to-lymphocyte ratio trends during therapy in esophageal cancer.
Authors: Al Lawati Yaseen , Ramirez-Garcialuna Jose Luis , Molina Franjola Juan Carlos , Pham Donavan , Skothos Elena , Mueller Carmen L. , Spicer Jonathan D. , Alcindor Thierry , Ferri Lorenzo 
Published: January 2019

17 Background: Neutrophil-to-lymphocyte ratio (NLR) has been identified as a biomarker for a number of malignancies, with higher ratios being associated with poorer oncologic outcomes. Rather than purely an indicator of advanced disease there is emerging evidence that neutrophils are directly implicated in facilitating cancer progression, and thus alterations and trends of neutrophil counts and NLR during different phases of treatment may reflect a change in oncologic outcome that is as important, or more so, as the absolute count or NLR at baseline. The aim of this study is to investigate the prognostic role of neutrophil-to-lymphocyte ratio trends during the treatment trajectory of patients with esophageal adenocarcinoma. Methods: This is a retrospective study of patients who underwent esophagectomy for esophageal adenocarcinoma between 2005-2016. NLR was measured at three time points: baseline, during neoadjuvant chemotherapy (NAC), and in the late postoperative period. Primary outcomes were overall (OS) and disease-free survival (DFS). Results: 333 patients met our inclusion criteria. Mean age was 65.6 years and 82% of patients were males. The majority of patients had locally advanced disease; 75% had clinical T3 disease and 59% had clinical N-positive disease. NAC was administered in 65.6% of patients. Increasing NLR trends between baseline and late postoperative periods was associated with worse OS (3-year OS 56.1% vs. 71.9%, p=0.045). Patients in the high NLR group before and after treatment did worse than those who moved from high to low groups (3-year OS 42.8% vs. 69.2%, p=<0.0001, 3-year DFS 32.3% vs. 61.8%, p=0.0001). High NLR at baseline and in the postoperative stage is associated with worse OS (3-year OS: 57% vs. 75.7% for baseline and 44.1% vs. 74.9% for postoperative NLR; p=0.0038 and <0.0001, respectively) and DFS (3-year DFS: 52.4% vs. 60.9% for baseline and 34.9% vs. 59.9% for postoperative NLR; p=0.03 and <0.0001, respectively). Patients with complete pathological response to NAC had lower mean baseline NLR (3.2 vs. 4.9 p=0.009). Conclusions: Changes in NLR during treatment may provide a clearer picture about survival outcomes and the role of neutrophils in cancer progression.
Intraperitoneal chemotherapy for gastric cancer with peritoneal dissemination: A single center retrospective analysis of 82 cases.
Authors: Yoshida Masahiro , Tsuji Yasushi , Oiwa Syutaro , Takayama Toshizo , Okamura Naoka , Sugiyama Junko , Sumiyoshi Tetsuya , Hirayama Michiaki , Kondo Hitoshi , Okushiba Syunichi 
Published: January 2019

170 Background: The prognosis of gastric cancer with peritoneal metastases remains dismal. Ishigami et al. have recently published a phase III study (PHOENIX-GC) aimed at clinical efficacy of intraperitoneal paclitaxel (PTX), which established intraperitoneal chemotherapy as a decent option for gastric cancer with peritoneal dissemination. According to this report, we have used various regimens of intraperitoneal chemotherapy, adjusted mainly based on previous treatments. Methods: Data from 82 patients with gastric cancer with peritoneal metastases who underwent intraperitoneal chemotherapy in our institute from February 2012 to July 2017 were retrospectively analyzed. The progression free survival (PFS), the overall survival (OS) and the 1-year survival rate were stratified by prior treatments. Results: Of the 82 patients, 38 (46.3%) were chemotherapy-naïve. The intraperitoneal regimens were assigned mainly according to the prior treatment: intraperitoneal PTX plus S-1/PTX was the most frequent (39 cases), followed by intraperitoneal PTX plus intravenous PTX (17 cases), intraperitoneal PTX only (6 cases), and the rest. The median PFS for the chemotherapy-naïve group and the previously treated group was 6.9 and 4.1 months, and the median OS was 12.8 and 7.9 months, and the 1-year survival rate was 72.2% and 34.4%, respectively. 10 patients (12.2%) achieved conversion surgery after confirmed complete response in the peritoneal metastases. Among these 10 patients, the median survival time is 22.7 months (7.6+-47.7). Adverse events were also analyzed for each regimen, as for intraperitoneal PTX plus S-1/PTX, leukopenia, neutropenia and anemia occurred frequently. All regimens were comprehensively tolerable, and there were no treatment-related deaths. Conclusions: Intraperitoneal chemotherapy is a promising and feasible option for gastric cancer with peritoneal dissemination. There were several cases with long-term prognosis where conversion surgery was achieved.
Results of neoadjuvant chemoradiotherapy with docetaxel, cisplatin, and 5-fuluorouracil for advanced esophageal cancer.
Authors: Emi Manabu , Hamai Yoichi , Ibuki Yuta , Okada Morihito 
Published: January 2019

171 Background: We previously reported a phase I study of neoadjuvant chemoradiotherapy (CRT ) with docetaxel, cisplatin, and 5-fuluorouracil (DCF) for advanced esophageal cancer. After that, we continued to conduct neoadjuvant CRT with DCF as phase II study and here, we report the results of this study including phase I. Methods: We performed neoadjuvant CRT with DCF chemotherapy and concurrent radiation therapy (40Gy including irradiation field) in patients with advanced esophageal squamous cell carcinoma. Dose of chemotherapy were as follows: docetaxel 25mg/m2 (level 1 n=17), or 30mg/m2 (level 2 n=4) on day 1,15,29 and 43 and cisplatin 70mg/m2 on day 1,29 and 5-fuluorouracil on day 1-4 and 29-32. The tumors were resected during weeks 10-13. Results: From Dec 2009 to Aug 2012, 21patients were enrolled and 19 patients underwent thoracic surgery. There were 17 male and four female subjects of ages ranging from 38 to 72 years (median, 61 years). Of these, 6 patients had stage IIIA esophageal cancer and two had stage IIIB esophageal cancer. All the patients had squamous cell carcinoma. Pathological complete response of primary tumor was achieved in 12 patients (63%) and complete pathological response of both primary tumor and lymph node was seen in eight patients (42%). During CRT, the most common grade 3/4 non-hematological toxicity were anorexia (29%) and esophagitis (29%). During CRT, septic shock caused by infection via catheter was observed and re-operation was performed in one patient with reconstructed gastric tube necrosis.One patient developed recurrent gastric tube ulcer in the anastomotic part 4years after esophagectomy. 10 patients are alive more than 5 years and 5-year overall survival is 47.6% and three of them were level II cases. Conclusions: This preoperative CRT regimen using triplets result in favorite prognosis, but treatment plan should be reconsidered because of relative high toxicity. Because high complete response rate of primary tumor were observed and long-term survival has been obtained at a high rate in the case of level II, we planned new phase I/II study of CRT with DCF without preventive irradiation field. Clinical trial information: R000002555.
Phase Ib/II trial of durvalumab and chemoradiation (CRT) with carboplatin/paclitaxel for esophageal and gastroesophageal junction (GEJ) adenocarcinoma.
Authors: Greally Megan , Molena Daniela , Sihag Smita , Wu Abraham Jing-Ching , Shah Pari M. , Fein Carly , Capanu Marinela , Kelsen David Paul , Janjigian Yelena Yuriy , Ilson David H. , Ku Geoffrey Yuyat 
Published: January 2019

172 Background: Pre-op CRT with carboplatin (C)/paclitaxel (P) and radiation (RT) for locally advanced esophageal cancer is a standard of care, based on the CROSS trial (NEJM 2012;366:2074). However, outcomes remain poor. Early data suggest activity of durvalumab (D) in GEJ/gastric cancer [Ann Oncol 25:iv361-372; 2014]. In a pilot study, we assessed safety of D + C/P + RT as pre-op therapy. Methods: Patients (Pts) had TanyN+ or T3-4NanyM0 esophageal and Siewert Type I/II GEJ adenocarcinoma staged by EUS, PET/CT and CT. Pts received D 1500mg x 1 dose and 4 weeks later C AUC2 and P 50mg/m2 weekly x 5 with RT (1.8Gy daily fractions to 50.4Gy). Pts also received D 1,500mg at first dose of C/P and RT. PET/CT was repeated 21-27 days post D and 4-6 weeks post CRT. Esophagectomy was planned 6-8 weeks after CRT. Pts who had R0 resections received adjuvant D 1,500mg 4 weekly x 6 doses. Initially, 6 patients were treated and followed for 30 days after surgery to assess for unacceptable toxicities. Results: 6 pts were enrolled: 3 Siewert I (50%), 2 Siewert II (33%), 1 esophageal (17%); 5 T3N1-2, 1 T4aN1. 5 pts (83%) underwent sx. 1 pt was retrospectively assessed to have metastases after induction D and taken off-study. Pathologic response was 60% in 2 pts, 90% in 1 pt, 80% in 1 pt and 40% in 1 pt; no complete response was seen. Significant grade 3/4 toxicity observed during D and CRT was neutropenia in 1 pt (17%). Adverse events (AEs) of any grade in ≥20%: lymphopenia (5 pts), thrombocytopenia (5 pts), leucopenia (4 pts), fatigue (3 pts), anemia (3 pts), neutropenia (3 pts) and abdominal pain (2 pts). Immune-related AEs were hypothyroidism (grade 2; 1 pt) and nephritis (grade 2; 1 pt). Surgical complications: 2 esophageal strictures, 1 pneumonia and 1 anastomotic leak with airway fistula, successfully treated with a stent. Immune correlative analyses from tumor blocks and whole blood are ongoing and will be reported in the poster. Conclusions: The addition of D to pre-op CRT in esophageal and GEJ adenocarcinoma appears feasible and safe. We observed no unacceptable toxicity. The study is being modified to incorporate use of induction chemo and PET (based on CALGB 80803 results) and expanded to a multicenter setting. Clinical trial information: NCT02962063.
A dose-escalation study of docetaxel, oxaliplatin and S-1 (DOS) as a first-line therapy for patients with unresectable metastatic gastric cancer.
Authors: Sato Yasushi , Sagawa Tamotsu , Takahashi Yasuo , Ohnuma Hiroyuki , Hamaguchi Kyoko , Hirakawa Masahiro , Fujikawa Koshi , Okamoto Koichi , Miyamoto Hiroshi , Muguruma Naoki , Takayama Tetsuji 
Published: January 2019

174 Background: Although the triplet regimen of docetaxel/cisplatin/S-1 (DCS) has shown promising activity and conversion rate in patients with unresectable metastatic gastric cancer (UMGC) in Japan, it was accompanied by severe adverse events. Recent studies suggested that oxaliplatin was almost as active, and relatively less toxic, than cisplatin in combination regimens for UMGC and can therefore replace cisplatin. The aim of this study was to determine the maximum tolerated dose (MTD), dose-limiting toxicities (DLTs), recommended dose (RD), and preliminary efficacy of docetaxel/oxaliplatin/S-1 (DOS) instead of DCS in patients with UMGC. Methods: Previously untreated 16 patients with histologically proven UMGC were enrolled. Docetaxel and oxaliplatin were administered intravenously on day 8. S-1 was administered orally twice a day on days 1-14. Each cycle was repeated every 3 weeks. DLTs were evaluated during the first cycle of treatment. Three dose-escalations of DOS were used in this study namely, level 1 (50/100/80 mg/m2), level 2 (50/130/80 mg/m2), and level 3 (60/130/80 mg/m2). Results: Among the six patients, one patient each experienced DLTs (febrile neutropenia and diarrhea) at level 1 and 2 doses, respectively. While two more patients experienced DLTs (febrile neutropenia and diarrhea) after administration of level 3 doses. Therefore, two additional patients were enrolled into the study at level 2. However, both these patients subsequently exhibited DLTs (febrile neutropenia and diarrhea). Therefore, we concluded that the MTD and RD with this regimen were level 2 and level 1, respectively, and that the DLT were grade 3 diarrhea and febrile neutropenia. The overall response rate was 78% (7/9) of the patients with measurable lesions, consisting of two complete response and five partial responses. Five patients underwent conversion surgery. Conclusions: The RD of the 3-weekly DOS regimen in patients with UMGC was docetaxel at 50 mg/m2 and oxaliplatin at 100 mg/m2 on day 8 and S-1 at 80 mg/m2 on days 1-14. The efficacy and ease of administration make the regimen a promising alternative to DCS. A phase II study using this RD regimen is currently underway. Clinical trial information: 000015849.