bluuebunny/crossref_metadata_2025_split huggingface dataset:
380. GROWTH CHARACTERISTICS OF ESOPHAGEAL PATIENT DERIVED ORGANOIDS REFLECT CLINICOPATHOLOGIC VARIABLES
Authors: Bolger Jarlath , Allen Jonathan , Shathasivam Premalatha , Radulovich Nikolina , Ng Christine , Wilson Gavin , Tsao Ming-Sound , Elimova Elena , Darling Gail , Yeung Jonathan 
Published: September 2024

Abstract

Background
Esophageal patient derived organoids (PDOs) are three-dimensional cell culture models derived from esophageal cancer tissue. We have previously shown that PDOs recapitulate the genetic and morphologic characteristics of the primary tumour, and that PDOs may predict patient responses to neoadjuvant regimens and potentially allow personalisation perioperative therapies. Nevertheless, up to 30% of tissue samples fail to establish organoids in vivo, although the reasons for this are unclear. This study interrogates the clinical characteristics of biopsies that establish or fail to establish PDOs.

Methods
Esophageal adenocarcinomas from locally advanced (LA) or metastatic (M) disease were biopsied at initial endoscopy, following surgical resection, or image-guided biopsy of metastatic disease (n=75 total). Following a standardised protocol, cells were dissociated and seeded for organoid culture. Organoids are considered ‘established’ after passage 4. Samples were discarded if there was obvious contamination (n=9) or if there were no obvious tumour cells (n=6). Clinicopathologic variables for successfully established or unsuccessfully established were compared for both LA and M disease. Statistical analysis was performed to interrogate characteristics associated with successfully establishing organoids.

Results
There were significant differences between successful and unsuccessful organoids. Organoids were more likely to be established from endoscopic biopsies (p=0.002). Samples pre-treated with neoadjuvant chemoradiation or chemotherapy were less likely to grow (p=0.02). Samples from poorly differentiated tumours were less likely to grow compared with well and moderately differentiated tumours (p=0.05). Tumour stage, lymphovascular invasion, perineural invasion, MSI status and HER-2 status were not associated with growth characteristics.

Conclusion
Growth characteristics of esophageal adenocarcinoma PDOs correlate with clinicopathologic characteristics. Samples from patients who have undergone chemotherapy or chemoradiation, and poorly differentiated tumours are less likely to establish in vitro models. Understanding the altered in vitro growth patterns is key to translating use of organoids into clinical practice.
389. WILL SYNCHRONOUS ESOPHAGEAL AND LUNG RESECTION INCREASE THE INCIDENCE OF ANASTOMOTIC LEAKS? A MULTICENTER RETROSPECTIVE STUDY
Authors: Chen Long-Qi , Liu Yixin , Yang YuShang 
Published: September 2024

Abstract

Background
Reports on combined resection for synchronous lung lesions and esophageal cancer (CRLE) cases are rare and mostly individual cases. Furthermore, the feasibility of CRLE has always been a controversial topic. In the current study, we retrospectively analyzed the feasibility of CRLE and established an individualized prediction model for esophageal anastomotic leaks after CRLE by performing a multicenter retrospective study.

Methods
Patients who underwent esophagectomy between January 2009 and June 2021 were extracted from a 4-centre retrospectively maintained database, and those with CRLE at the same setting were matched in a 1:2 propensity score matched (PSM) ratio to esophagectomy alone (EA) patients. A nomogram was then established based on the variables involved in multivariate logistic regression analysis. Internal validation of the nomogram was conducted utilizing Bootstrap resampling. Decision and clinical impact curve analysis were computed to assess the practical clinical utility of the nomogram. A prognosis analysis for CRLE and EA patients by Kaplan-Meier curves was conducted.

Results
Of the 7152 esophagectomies, 216 cases of CRLE were eligible, and 1:2 ratio PSM EA patients were matched. The incidence of anastomotic leaks following CRLE increased significantly (P=0.035). The results of the multivariate analysis indicated the leaks varied according to the type of lung resection (anatomic &gt; wedge resection, P=0.016) and site of resected lobe (upper &gt; middle/low lobe; P=0.027), and a nomogram was established to predict the occurrence of leaks accurately (AUC=0.786). Although no statistically significant difference in overall survival (OS) was observed in the CRLE group (P=0.070), a trend toward lower survival rates was noted. Further analysis revealed that combined upper lobe anatomic resection was significantly associated with reduced OS (P=0.027).

Conclusion
Our study confirms that CRLE is feasible but comes with a significantly increased risk of anastomotic leaks and a concerning trend of reduced survival, particularly when upper lobe anatomic resections are performed. These findings highlight the need for careful patient selection and surgical planning when considering CRLE.
395. SUPERIOR PERFORMANCE OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY OVER THORACOSCOPIC APPROACH: A MULTI-INSTITUTIONAL STUDY ON SHORT-TERM OUTCOMES
Authors: Chao Yin-Kai , Lee Jui-Ying , Huang Wen-Chien , Lee Jang-Ming , Tseng Yau-Lin , Lu Hung-I , Tiffany Jian Ying Lye 
Published: September 2024

Abstract

Background
Robot-assisted minimally invasive esophagectomy (RAMIE) and conventional minimally invasive esophagectomy (CMIE) are superior to open techniques. However, few studies have directly compared the outcomes of these two approaches.

Methods
A retrospective study was conducted on a dataset from six medical centers, encompassing patients with esophageal squamous cell carcinoma (ESCC) who underwent minimally invasive esophagectomy between 2015 and 2022. Perioperative outcomes were compared after applying inverse probability of treatment weighting (IPTW).

Results
The study included 577 patients (RAMIE, 206; CMIE, 371). After applying IPTW, RAMIE was found to yield a higher number of mediastinal nodes compared to CMIE (14.86 versus 12.66, p=0.017). RAMIE was notably effective in retrieving upper mediastinal left RLN nodes, averaging 1.97 nodes versus 1.14 nodes harvested by CMIE (p&lt;0.001). This was coupled by a significant decrease in nerve palsy rates (13.9% versus 22.8%, p=0.020). A significantly larger percentage of patients in the RAMIE group had an uncomplicated postoperative course (51.8% versus 34%, p&lt;0.001). RAMIE also led to a reduction in pneumonia rates (8.6% versus 15.2%, p=0.041) and was linked to a shorter length of stay (LOS; 16.64 versus 21.14 days, p=0.007). The advantage of RAMIE in reducing LOS was especially pronounced in patients with a high Charlson comorbidity index (mean difference, 8.46 days; p=0.0069) and those who underwent preoperative therapy (mean difference, 5.63 days; p&lt;0.001).

Conclusion
In ESCC, the use of RAMIE led to fewer pneumonia and faster recovery compared to CMIE. Additionally, RAMIE significantly improved the feasibility and safety of performing LND along the RLN.
397. TREATMENT OUTCOMES OF IMMUNE CHECKPOINT INHIBITORS AS PRIMARY THERAPY FOR UNRESECTABLE OR RECURRENT ESOPHAGEAL CANCER
Authors: Kanamori Kohei , Tajima Kohei , Ogimi Mika , Ninomiya Yamato , Shoji Yoshiaki , Yamamoto Miho , Kazuno Akihito , Nabeshima Kazuhito , Nishi Takayuki , Koyanagi Kazuo 
Published: September 2024

Abstract

Background
For the primary treatment of unresectable or recurrent esophageal cancer, combination therapy with immune checkpoint inhibitors (ICI) such as pembrolizumab (Pem) with CF (cisplatin and 5-fluorouracil), nivolumab (Nivo) with CF, and Nivo with ipilimumab (Ipi) has been shown the significantly improve prognosis compared to standard CF therapy in international collaborative phase III trials. As a result, these ICIs have been approved as primary treatment agents in Japan, with treatment guidelines strongly recommending therapies including ICIs. We evaluated the treatment outcomes at our institute and discussed their utility.

Methods
We examined the treatment outcomes of 26 esophageal cancer patients who underwent primary treatment with Pem+CF, Nivo+CF, or Nivo+Ipi from January 2018 to January 2023. The median observation period was 7.0 months.

Results
There were 20 male and 6 female patients, with a median age of 69 years. Histologically, there were 24 cases of squamous cell carcinoma and 2 cases of adenocarcinoma. Of the 26 patients, 9 were postoperative recurrences and 17 were unresectable diseases. They were treated with Pem+CF (12 cases), Nivo+CF (7 cases), or Nivo+Ipi (7 cases) as primary therapy. The initial response was complete response (CR) in 1 case, partial response (PR) in 14 cases, stable disease (SD) in 2 cases, and progressive disease (PD) in 9 cases, resulting in an overall response rate of 57.6%. The median progression-free survival was 5.0 months, and the median overall survival was 15.2 months. There was no significant difference in prognosis according to the regimens. Grade 3 or higher adverse events included neutropenia in 3 cases, pituitary insufficiency in 1 case, and adrenal insufficiency in 1 case. One case with lung metastasis and two cases with para-aortic lymph node metastasis showed disappearance of metastatic lesions after chemotherapy including ICIs, leading to conversion esophagectomy. One case had anastomotic failure, but no other postoperative complications were observed. All patients are currently under observation without recurrence.

Conclusion
ICIs for unresectable or recurrent esophageal cancer showed a prolongation of prognosis in real-world clinical practice, suggesting their significance as part of a multimodal treatment approach including conversion surgery.
398. DYSPHAGIA OR REGURGITATION AND ITS CORRELATES AMONG UP TO 10-YEAR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURVIVORS
Authors: Yuan Yong , Zhou Jianfeng , Liu Yixin , Yang Yushang 
Published: September 2024

Abstract

Background
Dysphagia and regurgitation significantly impair the quality of life among survivors of esophageal squamous cell carcinoma (ESCC). Notably, the prevalence and associated factors of these symptoms in long-term survivors, particularly within Asian populations, remain underexplored. This study endeavors to bridge these critical knowledge gaps.

Methods
We evaluated the severity of dysphagia and regurgitation (mild, moderate, and severe), and their associations with clinical features and lifestyle factors among 512 10-year ESCC survivors who underwent ESCC radical surgery. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-surgery, and dysphagia and regurgitation was assessed at the 10-year post-surgery follow-up survey.
Results In this study, 13.3% and 27.0% of participants reported dysphagia and regurgitation, respectively. Multivariable polytomous regression analysis revealed a significant association of dysphagia with upper thoracic esophageal carcinoma (mild dysphagia OR: 2.371, 95% CI: 1.051, 5.347) and postoperative radiotherapy and chemotherapy (mild dysphagia OR: 4.352, 95% CI: 2.168, 8.732; moderate/severe dysphagia OR: 3.651, 95% CI: 1.046, 12.745). An inverse relationship was observed between dysphagia and dietary quality as measured by the CHFP-2007 score (mild dysphagia OR: 0.458, 95% CI: 0.341, 0.615; moderate/severe dysphagia OR: 0.168, 95% CI: 0.089, 0.316). For regurgitation, positive associations were found with higher income level (mild regurgitation OR: 2.074, 95% CI: 1.020, 4.216), insomnia (moderate/severe regurgitation OR: 3.523, 95% CI: 1.127, 11.010), and use of Chinese patent medicine (mild regurgitation OR: 2.264, 95% CI: 1.279, 4.007). Conversely, age at surgery (moderate/severe dysphagia OR: 0.907, 95% CI: 0.848, 0.970) and higher dietary quality (mild dysphagia OR: 0.744, 95% CI: 0.606, 0.914; moderate/severe dysphagia OR: 0.406, 95% CI: 0.259, 0.634) showed protective effects against regurgitation.

Conclusions
The prevalence of dysphagia and regurgitation among long-term survivors of ESCC in China is high, underscoring a significant health concern. This study identifies critical correlates such as the tumor's anatomical site, the nature of postoperative interventions, dietary quality, socioeconomic standing, and concurrent health issues. These findings advocate for the integration of postoperative management approaches, including tailored dietary and lifestyle adjustments, aimed at mitigating these symptoms in long-term ESCC survivors.
399. LYMPH NODE METASTATIC PATTERNS AND SENTINEL LYMPH NODES FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER DIFFERENT NEOADJUVANT REGIMENS
Authors: Yin Hao , Huang Xu , Jiao Heng , Tang Han , Tan Lijie 
Published: September 2024

Abstract

Background
This study aimed to outline lymph node metastasis patterns in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT), comparing regimens, assessing prognosis impact, and identifying potential sentinel lymph node stations for future individualized dissection.

Methods
Involving 578 ESCC patients undergoing nCRT (n=303) or nCT (n=275) followed by esophagectomy (2010-2022), we conducted propensity score matching, analyzing 171 pairs. Nodal metastasis patterns and station positivity associations with survival were assessed through univariate and multivariate models, adjusting for clinical factors.

Results
Among 171 nCRT patients, 36.8% had nodal metastases, 22.8% single-station, 8.2% two-station, and 5.8% ≥3-station occurrences. Specific station positivity correlated with poorer survival. The nCRT group had fewer nodal metastases (36.8% vs 50.3%), common sites being left gastric, right recurrent laryngeal nerve, and paraesophageal region. Increased nodal stations and positive nodes correlated with worse prognosis. In nCRT, mentioned areas were prognostic; in nCT, only left gastric nodal metastases were prognostic. Single and multi-station rates were similar, but nCT had more multi-station disease. For sentinel lymph nodes, positivity in left gastric, paraesophageal, right recurrent laryngeal nerve for nCRT, and subcarinal, left recurrent laryngeal nerve, paratracheal, left gastric, paraesophageal right recurrent laryngeal nerve for nCT, may indicate complex metastasis.

Conclusions
Over one-third of ESCC patients had post nCRT metastatic lymph nodes. Though nCRT reduced metastasis rates, survival outcomes didn't improve, emphasizing thorough lymph node dissection based on metastasis patterns.
400. MODIFICATION OF THE LESSER CURVATURE INCISION ENHANCES GASTRIC CONDUIT BLOOD FLOW AND DECREASE ANASTOMOTIC LEAKAGE RISK AFTER ESOPHAGECTOMY
Authors: Ninomiya Yamato , Zhao Hongbo , Tajima Kohei , Kanamori Kohei , Ogimi Mika , Shoji Yohiaki , Yamamoto Miho , Kazuno Akihito , Nabeshima Kazuhito , Nishi Takayuki , Koyanagi Kazuo 
Published: September 2024

Abstract

Background
We conducted this study to investigate the effectiveness of a modified incision line on the lesser curvature for gastric conduit formation during esophagectomy in enhancing the perfusion of the gastric conduit, as determined by indocyanine green (ICG) fluorescence imaging, and reducing the incidence of anastomotic leakage.

Methods
A total of 272 patients who underwent esophagectomy at our institution between June 2014 and August 2022 were enrolled in the study. The patients were divided into two groups in accordance with the type of cutline on the lesser curvature: the Conventional group, consisting of patients operated on until 2018 (Conventional group; n = 141), in which the traditional cutline (5.0 cm from the pylorus in routine) was adopted, and the Current group, consisting of patients operated on from 2019 until date (Current group; n = 131), in which a modified cutline on the lesser curvature was adopted, that allowed preservation of the entire right gastric artery was adopted (hereinafter, modified cutline) was adopted. Gastric conduit perfusion during the surgery was assessed by intraoperative ICG fluorescence imaging, and the clinical outcomes after esophagectomy were also evaluated.

Results
All patients underwent esophagectomy with regional lymph node dissection and gastric conduit reconstruction via the retrosternal route. The distance from the pylorus to the cutline was significantly longer in the Current group as compared with the Conv group (median: 9.0 cm vs. 5.0 cm, p &lt; 0.001). The blood flow speed in the gastric conduit wall assessed by ICG fluorescence imaging was significantly higher in the Current group than that in the Conventional group (median: 2.81 cm/sec vs. 2.54 cm/sec, p = 0.001). Furthermore, the incidence of anastomotic leakage was significantly lower (p = 0.024) and the hospital stay significantly shorter (p &lt; 0.001) in the Current group as compared with the Conventional group. Logistic regression analysis using the data of the entire cohort identified the blood flow velocity in the gastric conduit wall as the only variable that was significantly (negatively) associated with anastomotic leakage.

Conclusions
ICG fluorescence imaging is a feasible, reliable method for intraoperative assessment of gastric conduit perfusion. Use of the modified lesser curvature cutline could enhance gastric conduit perfusion, promote blood circulation around the anastomosis and ultimately reduce the risk of anastomotic leakage after esophagectomy.
402. BRAIN METASTASES FROM ESOPHAGEAL CANCER AFTER MULTIMODAL TREATMENT: EARLY DETECTION AND AGGRESSIVE LOCAL TREATMENT CAN LEAD TO BETTER OUTCOMES
Authors: Turolo Cecilia , Voltarel Guerrino , Collizzolli Alice , Milazzo Martina , De Pasqual Carlo Alberto , Giacopuzzi Simone , Weindelmayer Jacopo 
Published: September 2024

Abstract

Background
International guidelines do not recommend imaging investigations to rule out the presence of BM (brain metastases) during clinical staging or follow-up in patients with oesophageal cancer. Patients with single or up to three BM can be considered oligometastatic: in our study we analysed patients with BM focusing on the management and outcomes of BM.

Methods
We retrospectively identified patients who underwent surgical resection for oesophageal adenocarcinoma or squamous cell carcinoma from 2006 to 2022 in our Upper GI division and subsequently developed brain metastasis (BM). Starting from January 2018, a brain CT scan was added to the routine follow-up procedures in our centre. We divided patients in two groups based on the treatment received for BM: local therapy group treated with surgery and/or stereotactic body radiation therapy/stereotactic radiosurgery (SBRT/SRS) versus no local therapy group treated with chemotherapy or whole brain radiotherapy (WBRT).

Results
34 patients developed BM (three didn’t receive treatment); 23 patients in local therapy versus 8 in no local therapy group. Median overall survival (OS, from BM diagnosis to patient’s death or last follow-up) in local therapy group was 14.52 months whereas in no-local therapy 3.41 months, p&lt;0.001. At univariable analysis predictors of OS were pathological stage, pathological response, GI-GPA score, number of metastases, treatment. In multivariable analysis, only pathological stage was statistically significative. We diagnosed 17 BM recurrence before 2018 (17 patients of 355, 4,7%) and 17 after 2018 with introduction of routine brain CT (17 of 217, 7.8%).

Conclusion
BM from oesophageal cancer benefit from local aggressive treatment in terms of overall survival and to apply a local treatment is necessary that BM are diagnosed early. The introduction of brain CT scan during follow up may have improved the detection rate of BM and therefore in our opinion routine brain CT scan could be necessary.
406. EXPLORING THE OPTIMAL TIMING OF MINIMALLY INVASIVE SURGERY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER NEOADJUVANT CHEMORADIOTHERAPY
Authors: Xu Wenyi , Liu Fangyi , Xu Wenyi , Tang Han , Tan Lijie 
Published: September 2024

Abstract

Background
Neoadjuvant chemoradiotherapy has gradually become a first-line treatment for esophageal squamous cell carcinoma patients. After the completion of neoadjuvant chemoradiotherapy, patients usually undergo minimally invasive surgery to ensure complete removal of the tumor and lymphatic tissue. However, the optimal interval between neoadjuvant chemoradiotherapy and minimally invasive surgery is still an unknown factor, and whether it affects postoperative disease-free survival (DFS) and overall survival (OS) of patients remains unknown. Therefore, the main purpose of this study is to explore the specific impact of the interval between neoadjuvant chemoradiotherapy and minimally invasive surgery on patients, and to find the optimal interval time.

Methods
Patients who underwent neoadjuvant chemoradiotherapy and minimally invasive surgery from two institutions between October 2012 and September 2022 were included in this study. The time interval is defined as the days between the last time a patient receives neoadjuvant chemoradiotherapy and the execution of surgery. Determine the optimal interval truncation point using the surv_cutpoint function in the survminer package. The main research result is the OS and DFS of different interval groups. A multivariate Cox regression model was established to determine the main factors affecting Patient's OS. Construct a nomogram based on selected factors to meet clinical needs.

Results
252 patients were included in the study. The average interval between patients undergoing neoadjuvant chemoradiotherapy and minimally invasive surgery is 59 days. The earliest interval for patients to undergo surgery is 28 days. Determine the optimal interval of 46 days based on the survminer package and divide the patients into two groups. The five-year OS rates for the short interval group and the long interval group were 82.6% and 61.0% (P = 0.023). The five-year DFS rates for the two groups were 67.6% and 48.2% (P=0.068). Multivariate Cox regression shows that the time interval, patient's sex, tumor differentiation, ypT, and ypN are the main factors affecting overall survival.

Conclusions
The interval between neoadjuvant chemoradiotherapy and minimally invasive surgery has a certain impact on patient survival, and it is recommended to undergo surgery between 28 and 46 days to improve patient prognosis and survival.