bluuebunny/crossref_metadata_2025_split huggingface dataset:
745. A CASE OF ESOPHAGEAL METASTATIC STRICTURE 9 YEARS AFTER BREAST CANCER SURGERY
Authors: Nakazato Hidetsugu , Nagamine Shinji , Tokizawa Hiromi , Tomiyama Takeshi , Tomori Takehiko , Nagayoshi Seiji , Miyagi Jun 
Published: September 2024

Abstract

Background
Oesophageal metastasis of breast cancer is relatively rare. In this report, we describe our experience of a case in which dysphagia was the main complaint, leading to the diagnosis of esophageal metastasis.

Method
A 63-year-old woman who had undergone partial mastectomy and sentinel lymph node removal in 20xx with a diagnosis of breast cancer presented 9 years after surgery with dysphagia. The postoperative pathological diagnosis of breast cancer was invasive ductal carcinoma, T2, N0, M0, ly1. She had previously received chemotherapy for recurrent bone metastases and mediastinal lymph node metastases 7 years post-operatively, and RT and chemotherapy for a diagnosis of SVC syndrome due to mediastinal lymph nodes 8 years post-operatively. In the present case, upper gastrointestinal endoscopy showed oesophageal stricture and biopsy showed ER+ and PgR- from oesophageal mucosa. Radiotherapy and chemotherapy were administered for the diagnosis of oesophageal metastasis of breast cancer, and the patient's symptoms improved.

Conclusion
In the case of oesophageal stricture with dysphagia after breast cancer surgery, it is essential to consider oesophageal metastases of breast cancer as a differential, although rare, in addition to benign and primary disease.
746. ESOPHAGECTOMY, WITH CHOLECYSTECTOMY HAS A HIGH INCIDENCE OF REFLUX ESOPHAGITIS AND GASTRIC TUBE ULCER
Authors: Hashimoto Naoki 
Published: September 2024

Abstract
The surgical methods for thoracic esophageal cancer was subtotal esophagectomy, with gastric pull up via retrosternal route, and cervical anastomosis. However, some cases were complicated by acute cholecystitis in the early postoperative period, and cholecystectomy was performed intraoperatively to prevent postoperative cholecystitis in some cases. The disruption of normal anti-reflux mechanisms including the lower esophageal sphincter, angle of His, and diaphragmatic muscle and the denervation of the vagus nerve are generally thought to be the main factors that interfere with gastric motor function. Furthermore, the pressure difference between thoracic (negative) and abdominal cavity (positive) is another factor that promotes reflux across the anastomosis.
Due to these factors, postoperative reflux esophagitis is frequently experienced. Furthermore, after cholecystectomy, due to loss of gallbladder reservoir function after cholecystectomy and decrease in antroduodenal motility, bile is not excreted by food intermittently but continuously, resulting in duodenogastric reflux. We investigated postoperative reflux esophagitis and gastric tube ulcers in cases with and without intraoperative cholecystectomy for the past three years. We investigated cholecystectomy with esophagectomy (n=65) and non-cholecystectomy with esophagectomy (n=101) in 166 cases of radical surgery for esophageal cancer in which 2-3 regions had been dissected in the past 3 years. As shown in Fig. 1, there are no differences in location, TNM, gender, and PPI administration .reflux esophagitis of the cervical esophagus is A:0 B:2 (3%), C:5 (8%), D:3 (5%) for chole(+), A:2 (2%), B:2 (2%), C:2 (2%), and D:2 (2%) for chole(-). Gastritis was Chole(+) superficial gastritis 14 (21%), metaplasia 4 (6%), chole(-) superficial gastritis 25 (25%), metaplasia 3 (2%). However, gastric tube ulcers occurred in 5 cases (7%) of Chole(+) and 1 case of perforation, while only 1 case (1%) of gastric tube ulcers occurred in Chole(-)..
(Conclusion) Esophagectomy, gastric pull up with cholecystectomy has a high incidence of reflux esophagitis in the neck and can also cause ulcers in the gastric tube. Therefore, care should be taken in postoperative follow-up.
754. PATHOLOGICAL RESPONSE PREDICTS EFFICACY OF ADJUVANT FLOT CHEMOTHERAPY IN GASTROESOPHAGEAL CANCER: AN INTERNATIONAL COHORT STUDY
Authors: Liu David , Hall Ms Katheryn , Wong Darren , Lee Margaret , Duong Cuong , Bright Tim , Aly Ahmad , Watson David ,   on behalf of all SPACE-FLOT investigators
Published: September 2024

Abstract

Background
Perioperative FLOT-based chemotherapy is the current standard of care for all patients with locally-advanced gastroesophageal cancer. However, many patients are unable to complete all planned adjuvant FLOT cycles due to treatment related toxicity and diminished performance status after radical surgery. Within this context, it is unclear whether adjuvant FLOT will improve oncological outcomes for patients with cancers that either don’t respond or respond exceptionally well to neoadjuvant FLOT. To facilitate clinical decision-making, we examined whether pathological response to neoadjuvant FLOT can guide its adjuvant use.

Methods
Prospectively collected data from 43 centres across 12 countries was analysed. Patients with non-metastatic gastroesophageal adenocarcinoma who received neoadjuvant FLOT followed by radical surgery between 2017-2022 were included. Pathological response was assessed using validated tumour regression grading (TRG) systems. All TRG were trichotomized into minimal responders (MR=worse TRG category), complete responders (CR=pathological complete response), and partial responders (PR=all TRG categories between MR and CR). Survival outcomes of patients who did and did not receive adjuvant FLOT within these cohorts were compared using Kaplan Meier and Cox regression analysis. These findings were validated using propensity score matched analysis.

Results
1887 patients (MR n=459, CR n=221, PR n=1207) were evaluated. The median follow-up was 25.5 months. In the MR group, there was no DFS (HR=1.03, 95%CI 0.78-1.36) or adjusted-OS (HR=0.96, 95%CI 0.70-1.30) difference between those who did (n=272) and did not (n=187) receive adjuvant FLOT. In the CR group, there was no DFS (HR=0.88, 95%CI 0.41-1.85) or OS (HR=0.69, 95%CI 0.31-1.54) difference between those who did (n=136) and did not (n=85) receive adjuvant FLOT. In the PR group (adjuvant FLOT n=847, no adjuvant FLOT n=360), adjuvant FLOT conferred a significant DFS (HR=0.68, 95%CI 0.55-0.86) and OS (HR=0.55, 95%CI 0.44-0.69) benefit.

Conclusions
Pathological response to neoadjuvant FLOT predicts therapeutic efficacy to adjuvant FLOT. Only partial responders benefit from adjuvant treatment. Our findings challenge the current doctrine that perioperative FLOT should be applied to all patients regardless of pathological tumour response.
762. A PROPOSAL FOR CERVICAL ANASTOMOTIC LEAKAGE CLASSIFICATION AFTER ESOPHAGECTOMY
Authors: Gonçalves Beatriz Pereira , Chumbinho Beatriz , Cabral Francisco , Ramos Paulo , Monteiro Cecília , Casaca Rui 
Published: September 2024

Abstract

Background
Anastomotic leak (AL), a potently life-threatening complication after esophagectomy, has a wide spectrum of presentation. There are also several treatment modalities but uncertainty about its clinical applicability remains, being mostly guided by personal experience and available resources.
Regarding cervical anastomosis, literature is especially scarce. Although classically it was managed conservatively with cervical wound drainage, 60-70% have an intrathoracic manifestation, which is not only associated with worst clinical severity, as it appears more difficult to manage.
In this study, we propose a new classification system for cervical esophago-gastric leak, based on its imaging presentation, with a standardized therapeutic approach.

Methods
Cervical AL classification and therapeutic protocol were developed through retrospective evaluation of a prospective database, including all patients submitted to esophagectomy with gastric conduit reconstruction and cervical anastomosis since the 1st January 2018 to the 31st March 2024, in an upper gastro-intestinal surgery unit, at a tertiary cancer center.
AL manifestation was classified according to imaging appearance on CT scan, reviewed by a dedicated radiologist.
Protocol was developed considering treatment patterns according to each manifestation and respective success rate.

Results
During this period, 253 esophagectomies were performed, 171 with cervical anastomosis and thus included to analysis. AL rate was 21.6%.
Four types of AL manifestation were identified: A – exclusive cervical manifestation (32.4%); B – mediastinal drainage without pleural involvement (8.1%); C – apical pleural collection (8.1%); D – pleural involvement (51.2%).
Based on these patterns, a standardized therapeutic algorithm was developed (figure 1): conservative treatment with cervical wound drainage for A, endoscopic therapy for B and C (first-line endoluminal esosponge®, stent as option) and for type D, in addition to endoscopic therapy, pleural drainage and empyema decortication in refractory cases.

Conclusion
Although well stablished and easy to apply, the Esophagectomy Complications Consensus Group (ECCG) classification for esophagectomy AL differentiates its severity, but does not guide its treatment. In this study, we identified four types of cervical AL manifestation, which we consider relevant to select the appropriate treatment modality. This protocol was recently adopted in our center and we pretend to evaluate its results in a short-term.
767. INFLUENCE OF NEOADJUVANT IMMUNOTHERAPY-CHEMOTHERAPY ON PERIOPERATIVE OUTCOMES IN LOCALLY ADVANCED ESOPHAGEAL ADENOCARCINOMA
Authors: Nevo Yehonatan , Tankel James , Zao Henry , Ramirez Jaime , Cools-Lartigue Jonathan , Muller Carmen , Alcindor Thierry , Ferri Lorenzo 
Published: September 2024

Abstract

Background
This study evaluates the perioperative outcomes of patients with locally advanced esophageal adenocarcinoma (EAC) who were treated with neoadjuvant immunotherapy (IO) and chemotherapy versus a matched cohort of patients that received neoadjuvant chemotherapy (NAC) alone.

Methods
A single center non-randomized phase II trial was undertaken in locally advanced (cT3-4 and/or N+) EAC and 49 patients completed neoadjuvant Avelumab + DCF (Docetaxel, Cisplatin, 5FU) and esophagectomy between 2/2018 and 2/2020. These patients were matched to contemporary patients (1/2018-6/2020) who met inclusion criteria but received neoadjuvant chemotherapy alone (NAC) with a comparable Docetaxel based. The postoperative outcomes were then compared between the two groups.

Results
Ninety-nine patients with locally advanced EAC underwent esophagectomy and meet enrolment criteria for this study. Of these patients, 50 received NAC alone 49 received IO+NAC. Baseline characteristics such as age, gender and clinical stage were comparable between groups.
Operative approach and rate of MIE (~60%) was similar in both groups. Overall and major complication rate were similar between groups (50 vs. 51%, p=0.91; 20 vs. 26%, p=0.44 respectively) with concordant rates of anastomotic leak (6 [12%] vs. 6 [12%], p=0.86) and respiratory complications (13 [26%] vs. 11 [22%], p=0.68) in NAC alone and IO+NAC group respectively. There were no significant differences in the LOS and 30- and 90-days mortality rates between the two groups.

Conclusion
The addition of immunotherapy to neoadjuvant chemotherapy for locally advanced esophageal adenocarcinoma does not appear to significantly alter perioperative short-term outcomes after esophagectomy
779. IMMUNE CHECKPOINT INHIBITOR WITH CHEMOTHERAPY (CISPLATIN+5FU) FOR ADVANCED ESOPHAGEAL CANCER
Authors: Narumiya Kosuke , Suda Hiroshi , Shimamoto Naoaki , Suzuki Tatunori , Muraishi Ryu , Okumura Yasuhiro , Okamura Yukiyasu 
Published: September 2024

Abstract

Background
First-line chemotherapy for advanced esophageal carcinoma results in poor outcomes. Compared with placebo plus chemotherapy, pembrolizumab plus chemotherapy improved overall survival in patients with previously untreated, advanced oesophageal squamous cell carcinoma according to the KEYNOTE-590. We studied 17patients for the unresectable esophageal cancer and gastroesophageal junction adenocarcinoma cases treated with pembrolizumab and chemotherapy at our hospital between November 2023 and May 2024.

Methods
17 patients with advanced carcinoma of the thoracic esophagus having either T4 tumor or distant lymph node metastasis were enrolled in this study. pembrolizumab 200mg/m2 and CDDP 80 mg/m2 was administered on days 1 and 5-FU 800 mg/m2 was administered on days 1-5 intravenously 3corse in 3-week cycles.

Results
Back ground: Averaged Age 76 (55-86), male: female =16:1, location (Ce: Ut: mt: Lt: Jz =1:1:6:6:3), strength 71mm (30-120), Stage (IVA: IVB= 7:10), Pathology (SCC: AD= 16:1), Times (3 courses completed: uncompleted: ongoing=9:3:5), Response PR:SD:PD: unknown=6:1:2:8, Toxicity: iRAE: liver dysfunction: Febrile neutropenia=4:2:6, The incidence of Grade 3 or higher adverse events was 3/15. One toxicity-related death occurred. We performed conversive esophagectomy for 2 patients. After chemotherapy: operation: radiation: observation: death:=2:2:10:3

Conclusion and discussion
Due to the small number of cases, it is unclear whether the treatment was safe in a single center. I would like to consider increasing the number of cases. We will show one toxicity-related death and two conversive operation.
787. THE CHALLENGE OF GASTRO-ESOPHAGEAL ONCOLOGICAL SURGERY AFTER BARIATRIC PROCEDURES: EXPERIENCE OF A REFERRAL HIGH-VOLUME UPPER GI SURGICAL CENTER
Authors: Cuce Federica , Belluomini Mario Antonio , Pallabazzer Giovanni , Gennai Andrea , Marini Paola , Solito Biagio , Santi Stefano 
Published: September 2024

Abstract

Background
The effectiveness of bariatric surgery for weight loss in morbidly obese patients has been well established and it's becoming more common as many surgeons are trained to perform them safely, even in older patients. Obesity is associated with reflux and hormonal imbalances that increase the risk of Barrett's esophagus, esophageal adenocarcinoma and gastric cancer.
Bariatric procedures alter gastric anatomy, vascularization and lymphatic drainage and render subsequent upper gastrointestinal surgery for malignancies a technical challenge, that will present more and more in the future.
We present laparoscopic sleeve gastrectomy, gastric bypass and gastric banding conversion to oncological respective surgeries.

Methods
We retrospectively reviewed the medical records of our referral high-volume center for upper gastrointestinal surgery and identified patients who underwent upper gastrointestinal oncologic surgery from January 1998 to May 2024. We selected all patients who had previously undergone bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic gastric bypass, gastric banding, or other less common procedures). Three patients met our criteria, and we recorded: demographic characteristics, surgical technique, oncologic surgical outcome, postoperative complications, long-term complications, and oncologic follow-up.

Results
A hybrid IvorLewis esophagectomy was performed years after a sleeve gastrectomy for distal esophageal adenocarcinoma. The sleeve was used for gastric pull-up, adequately vascularized by the right gastroepiploic artery as demonstrated by intraoperative indocyanine green.
A patient developed adenocarcinoma of the cardia after Roux-en-Y gastric bypass, infiltrating the gastric pouch, the gastric remnant and liver S2. After neoadjuvant chemotherapy, an open Ivor-Lewis esophagectomy was performed using the gastric remnant for a pull-up.
In a third patient, a locally advanced adenocarcinoma of the stomach developed after gastric banding. After neoadjuvant chemotherapy, an open total gastrectomy with Roux-en-Y esophagojejunostomy was performed.

Conclusion
We report three cases of successful esophago-gastric oncological surgery in patients with altered anatomy and vascularization due to previous bariatric surgery, without major postoperative complications or mortality. Oncologic benchmarks for both esophageal and gastric surgery were met as a high lymph node yield and oncologic margins were maintained.
Our heterogeneous series suggests that sleeve gastrectomy, gastric bypass, and gastric banding surgery can be successfully converted to resective surgeries after a metachronous neoplasia diagnosis in high-volume upper gastrointestinal centers.
These and similar modified reconstructive techniques are likely to be used in the future as metabolic surgery and esophago-gastric cancer are increasing.
790. RISK FACTORS FOR ESOPHAGEAL CANCER IN NORTHEAST INDIA: A MULTI-CENTRIC CASE-CONTROL STUDY
Authors: Harris Caleb , Mawlong Anisha , Tapkire Ritesh , Albert Sandra , Jagtap Vikas 
Published: September 2024

Abstract

Background
Northeast India has a high incidence of esophageal cancer(EC), with age-adjusted incidences ranging from 19 to 50 per 100,000 (in females and males respectively). This is over ten times the average incidence of EC in India. The local preparation of raw betel nut,‘kwai’, is integral to the culture, but its role has not been established. This study aimed to assess the role of betel nut, with or without tobacco as a causative agent for EC. The role of alcohol was also studied.

Methods
A multi-centric, matched case-control study was performed from October 2022 to March 2024 in three centres situated in the Northeast region of India. All cases of biopsy proven squamous EC, arising from the cricopharynx to the gastroesophageal junction were included, with matched controls (1:3 ratio) being patients visiting the hospital for minor ailments and healthy volunteers from the community. A validated questionnaire was administered by trained trial coordinators. The data was analysed using a conditional multivariate logistic regression which incorporated the individual matching of cases with 3 controls. A p-value of &lt; 0.05 was considered statistically significant.

Results
A total of 185 cases and 556 controls were matched for age (± 5 years), ethnicity, and gender. There was an increased risk of EC for those consuming betelnut with slaked lime [Calcium hydroxide Ca(OH)2] (Odds Ratio(OR) of 3.77 (Confidence Interval(CI) 1.30-10.92)); alcohol (OR 2.00 CI: 1.80-6.67) and tobacco (OR 3.47 CI:1.80-6.67). The risk was higher for those who swallowed the betel quid and juice as compared with those who spit it out (OR 4.01 CI: 2.24-6.73). The risk was increased in those consuming betelnut while hungry, instead of a meal (OR 10.40 CI 3.66-29.57). The risk was increased in those with no formal education (OR of 4.13 CI: 2.01-8.49). On adjusting with other risk factors (tobacco and alcohol), the risk was highest for betelnut with tobacco (OR 7.84 CI 2.12-29.90) and betelnut with alcohol (OR 2.84 CI 1.11-7.29). All these OR were statistically significant.

Conclusion
Consumption of betelnut with slaked lime increases the risk of EC. This risk is increased by the concomitant use of tobacco and alcohol.
794. RETROSPECTIVE ANALYSIS OF CLINICAL CHARACTERISTICS AND PROGNOSIS OF SYNCHRONOUS MULTIPLE PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Wenyi Liu , Yu Zhentao 
Published: September 2024

Abstract

Background
Multiple primary esophageal squamous cell carcinoma (MPESCC) is a rare and complex type of esophageal cancer, categorized into synchronous multiple primary esophageal squamous cell carcinoma (S-MPESCC) and metachronous multiple primary esophageal squamous cell carcinoma (M-MPESCC). Compared to solitary esophageal squamous cell carcinoma (SESCC), multiple primary esophageal squamous cell carcinoma (MPESCC) generally has a poorer prognosis, with significant differences in treatment strategies and survival outcomes. This study aims to explore the clinical characteristics and prognosis of S-MPESCC through a retrospective analysis of a large patient cohort.

Methods
This study retrospectively analyzed clinical data from 758 patients with esophageal squamous cell carcinoma (ESCC) who underwent surgical resection at two medical centers in China from January 2012 to December 2021. The S-MPESCC group included 68 patients, and the SESCC group included 690 patients. All patients underwent radical esophagectomy with systematic lymph node dissection. Preoperative and postoperative data were collected, including gender, age, family history, tumor staging, and lymph node metastasis.

Results
There were no significant differences in baseline characteristics, such as gender, age, and family history, between the S-MPESCC and SESCC groups. The lymph node metastasis rate was significantly higher in the S-MPESCC group compared to the SESCC group, especially in the upper mediastinal and abdominal regions (P&lt;0.05). Survival status was monitored through outpatient visits and telephone calls until December 2022. The results showed that the 3-year and 5-year survival rates of the S-MPESCC group were significantly lower than those of the SESCC group (P&lt; 0.05). Patients with a greater depth of primary tumor infiltration had poorer survival outcomes in the S-MPESCC group.

Conclusion
This study clarified the clinical characteristics and prognosis of S-MPESCC through a retrospective analysis of 758 ESCC patients. S-MPESCC patients had a significantly higher rate of lymph node metastasis and a poorer prognosis compared to SESCC patients. Future efforts should focus on optimizing treatment strategies to improve the prognosis and survival rates of patients with S-MPESCC.
799. OPTIMUM NUMBERS OF DISSECTED LYMPH NODES FOR ACCURATE NODAL STAGING IN CT1-2N0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Park Seong Yong , Park Boram , Yun Jae Kwang , Kim Hyeong Ryul , Kim Yong-Hee , Jeon Yeong Jeong , Lee Junghee , Cho Jong Ho , Kim Hong Kwan , Choi Yong Soo , Zo Jae Il , Shim Young Mog 
Published: September 2024

Abstract

Background
Patients with esophageal squamous cell carcinoma (ESCC) with lymph node metastasis may be misclassified as pN0 due to an inadequate lymph node dissection. The purpose of this study was to confirm that patients with cT1-2N0 ESCC are indeed pN0 and to propose an adequate number of lymph nodes for correct nodal staging.

Methods
A total of 1,855 patients who underwent upfront surgery for cT1-2N0 ESCC at two tertiary academic hospital in Korea between 1995 and 2019 were included in the study. The probability of false-negative lymphadenectomy and NSS (nodal staging score) was calculated to assess the probability of pN0 status.

Results
The mean age was 63.36 ± 8.01 years, with 1,726 (93.05%) male patients. The mean number of dissected lymph nodes was 34.69 ± 13.98. The clinical T stages were as follows: cTis & cT1a 354 (19.08%), cT1b 1,053 (56.77%), and cT2 448 (24.15%). Pathologic nodal upstaging occurred in 443 (23.91%); pN1 352 (19.0%), pN2 78 (4.21%), and pN3 13 (0.7%). By calculating the probability of false-negative lymphadenectomy, removing fewer than 33 lymph nodes was associated with a 20% risk of missing a positive lymph node, whereas removing 53 lymph nodes was associated with a 10% risk of missing a positive lymph node. The NSS, which reflects the probability that a patient with ypN0 status is actually free of occult nodal disease after surgery, increased as the number of dissected lymph nodes increased.

Conclusions
Extensive lymph node dissection is mandatory for accurate staging and reducing the risk of missing positive lymph nodes in early-stage ESCC. The survival benefits of extensive lymph node dissection need to be evaluated in further analysis.