bluuebunny/crossref_metadata_2025_split huggingface dataset:
580. ESTABLISHMENT OF A RAT MODEL OF GASTROESOPHAGEAL REFLUX DISEASE INDUCED CHRONIC MICROASPIRATION
Authors: Masuda Takahiro , Kawamura Akira , Kurogochi Takanori , Shimoda Masayuki , Sakashita Yuki , Omura Nobuo , Yano Fumiaki , Eto Ken 
Published: September 2024

Abstract

Background
Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder in Japan, the world’s first super-aging society. Occult microaspiration due to GERD can cause respiratory infections especially in frail elderly individuals. The aim of the study was to establish an experimental in vivo model of GERD induced chronic microaspiration.

Methods
GERD was induced in 8-week-old male Wistar rats. A 2-cm midline incision was made in the upper abdomen. The border between the forestomach and the glandular portion (limiting ridge) was ligated with a 2–0 silk tie, and the duodenum near the pyloric ring was covered with a 2-mm-wide piece of an 18-Fr Nélaton catheter. CT scan and histopathological evaluation of the bilateral lungs were performed at 3 weeks after surgery.

Results
The 3-week survival rate was 80% (n=4/5). CT scan showed diffuse dilatation of the esophagus due to the reflux of gastric contents; however, there was no consolidation in the lungs similar to the healthy control. Based on macroscopic evaluation, the lungs had multiple spotted redness. Histopathological evaluation of hematoxylin and eosin staining showed multiple spotted aspiration pneumonia with peribronchiolar inflammatory cells, granuloma formation, goblet cell hyperplasia.

Conclusions
This model mimics human occult chronic microaspiration due to GERD, and may be useful in the investigation of drug efficacy and the evaluation for pathophysiology of GERD induced pulmonary disorders.
594. THE IMPACT OF PATIENT CHARACTERISTICS AND NEOADJUVANT TREATMENT ON THE TUMOUR MICRO-ENVIRONMENT OF ESOPHAGEAL CANCER
Authors: Fasquelle François , Teixeira-Farinha Hugo , Sempoux Christine , Worreth Sandrine , Piazzon Nathalie , Schäfer Markus , Mantziari Styliani 
Published: September 2024

Abstract

Background
Esophageal cancer remains associated with poor prognosis, as even with the current standards of multimodal treatment and oncologic surgery many patients show no response to treatment, or suffer early recurrence after surgery. In the current era of precision medicine, a better understanding of the tumor microenvironment (TME) is needed to identify patients with unfavourable biology, but also to illustrate the physiopathology of host reaction to treatment. The aim of this monocentric translational study was to analyse the biomolecular characteristics of esophageal cancer in relation to key clinicopathologic parameters, and in particular to the response to neoadjuvant treatment.

Methods
A series of patients operated for esophageal cancer with curative intent between 01.2009 and 12.2021 were included in this study. Clinicopathological data were collected, and initial biopsies and surgical specimens were reassessed by a senior GI pathologist. The immune infiltrate markers CD3, CD8, CD163, CD68, PDL1and FOXP3 were recorded as cell counts/high power field. The CPS score was used for PD-L1 quantification, whereas the Mandard regression grade (TRG) assessed pathologic response to neoadjuvant treatment (NAT). Continuous variables were compared with the Mann-Whitney-U and ANOVA tests, and categorical ones with the Chi-2 test. Significance threshold was set at p&lt;0.05.

Results
Overall, 68 patients (82.4% males, mean age 62.4□9.4 years, 79.4% adenocarcinoma) were included. TME in smokers had lower M2-like (CD163+, p=0.009) and total macrophages (CD68+, p=0.001), but similar CD163/68 ratio and T-cells as non-smokers. Adenocarcinoma histology compared to squamous cell, showed higher M2-like macrophages (p=0.023), mean CPS score (p=0.038) and T-cell infiltration (p=0.006). NAT increased macrophages and cytotoxic T-cells, and decreased Treg/FoxP3 cells in the TME. Chemotherapy, compared to chemoradiation, was associated with higher T-cell TME infiltration. Good responders to NAT (TRG1-2) had similar initial TME characteristics as poor responders, but they displayed lower macrophage count upon final histology (p=0.003).

Conclusions
In the present series, active smoking was related to attenuated, whereas adenocarcinoma histology to enhanced M2-like macrophage infiltration of esophageal cancer TME. Neoadjuvant treatment, and especially chemotherapy, recruited macrophages and T-cells in the TME. None of the biomarkers derived from the initial biopsies were associated with response to NAT, although an increased macrophage count upon final histology was related to poor response. The present study provides valuable insight to the TME composition of esophageal cancer. However, further studies are needed to assess the exact functional role of TME elements, and specifically macrophages, and their impact on clinical outcomes.
599. ASSESSMENT OF BREATHING MECHANICS IN OESOPHAGEAL CANCER SURVIVORS USING A 3D-MOTION CAPTURE SYSTEM
Authors: Tukanova Karina , Banger Matthew , McGregor Alison , Hanna George , Markar Sheraz 
Published: September 2024

Abstract

Background
Traditional open surgery is characterised by an intercostal incision. The associated ribcage injury may precipitate the development of post-thoracotomy-related pain, with impaired respiratory muscle contraction, leading to compromised coughing and decreased lung volumes. These changes in breathing mechanics may precipitate pulmonary complications, occurring in up to 40% of the patients. There is however no data available on the long-term breathing function and its implications on the health-related quality of life following oesophagectomy.
This proof-of-concept study aimed to objectively measure breathing movements using a 3D-motion capture system and to understand the impact of surgery on breathing patterns in oesophageal cancer survivors.

Methods
Oesophageal cancer survivors who were disease-free for at least 1 year postoperatively and healthy controls were included. Participants completed quality-of-life (QoL) questionnaires, including EORTC QLQ-C30, -OG25 and LASORS. Eighty-nine retroreflective markers were affixed to the participants' trunks to measure respiratory movements via the Vicon motion capture system during handheld spirometry performance. The highest spirometry value was recorded for the slow inspiratory (SIVC) and forced expiratory vital capacity (FEVC). Concurrent movement data was obtained from adjacent surface markers connected to the midpoint, allowing evaluation of the total volumetric movement of the trunk, and thoracic and abdominal contributions.

Results
Eighteen patients (median age 68) and 22 controls (median age 29) were included. Patients exhibited a significantly reduced SIVC alongside decreased chest movement contribution (median 2.4519 litres IQR 0.9270) compared to controls (median 3.1492 litres, IQR 1.8381) (p=0.013). Meanwhile, patients also had significantly lower FEVC with lower abdominal movement (median 1.5134 litres, IQR 0.7852) compared to controls (median 2.1263 litres, IQR 0.8740) (p=0.039).
The QoL amongst patients was significantly worse for half of the EORTC domains, including physical functioning, fatigue, dyspnoea, pain and discomfort, and coughing (p&lt;0.05). Additionally, the QoL of patients was consistently lower across all LASOR domains (p&lt;0.05).

Conclusion
Current data showed lower spirometry parameters and breathing movements amongst oesophageal cancer survivors, suggestive of impaired breathing mechanics. Specifically, chest expansion was compromised during slow inhalation, while abdominal contraction was reduced during forced exhalation. These findings suggest restrictive changes in breathing mechanics
600. DETECTION OF ANASTOMOTIC LEAK THROUGH THE VALUE OF DRAIN FLUID AMYLASE
Authors: Ting Ying Che , Hsu Po Kuei 
Published: September 2024

Abstract

Background
Anastomotic leak in cervical anastomosis after esophagectomy has consistently been a serious problem. Esophagram has long been utilized to make sure the integrity of anastomosis before starting oral diet. However, the diagnostic accuracy is limited. Drin fluid amylase collected from the cervical anastomotic site is another useful method for its conveniency in specimen collection and the numerical value. But the clinical interpretation varied. The aim of the study was to share the experience in our facility regarding the diagnostic value of esophagram and drain fluid amylase exam.

Methods
A total of 116 patients with esophageal cancer were reviewed. All patients received open or minimally invasive Mckeown esophagectomy with cervical anastomosis, with or without a neoadjuvant chemoradiotherapy. For the prediction of leak, esophagram and drain fluid amylase were utilized. Esophagram was arranged on the 7th post operative day. And drain fluid amylase was collected twice on the 3rd and the 7th post operative day. We assumed that presence of an elevating trend of the drain fluid amylase level, and the amylase level on the 7th post operative day being more than 80 IU/L, would suggest an anastomotic leak.

Results
For the entire cohort, the leakage rate was 18.9% (22/116). 67 patients and 48 patients received esophagram exam and drain fluid amylase testing, respectively. The sensitivity and specificity for esophagram were 28.6% and 95%, respectively. The positive and negative predictive values were 40% and 91.9%, respectively. The diagnostic accuracy was 88.1%. The diagnostic value of testing drain fluid amylase by using our criteria yielded a sensitivity and specificity of 75% and 95%, respectively. The positive and negative predictive values were 75% and 95%, respectively. The diagnostic accuracy was 91.7%.

Conclusion
Comparing with esophagram, testing the drain fluid amylase provided an easier and more accurate way to predict the possible anastomotic leak. The criteria for prediction of leak by using drain fluid amylase were presence of an elevating trend (amylase on POD7 / POD3 &gt;1) and the amylase level on the 7th post operative day being more than 80 IU/L.
611. THE UTILITY OF H ANASTOMOSIS IN INFLATABLE MEDIASTINOSCOPE-ASSISTED TRANSHIATAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Wu Na , Hu Yang 
Published: September 2024

Abstract

Objectives
In this article we present a novel technique to improve the outcome of mediastinoscope-assisted transhiatal esophagectomy (MATHE).

Methods
H anastomosis is derived from intussusceptive anastomosis, which reinforced the barrier from the alimentary canal cavity to the mediastinum and fromed an one-direction valve to preventing gastroesophageal reflux. H anastomosis improved the blood supply of gastric tube by reduce the thickness of intussuscepted tissue to adapt to the narrow esophageal bed in MATHE.

Results
Anastomotic leakage, gastroesophageal reflux and dysphagia were well controlled.

Conclusions
The good outcomes of H anastomosis in MATHE need further validation.
https://1drv.ms/v/s!AmCqlJJZqDPDjRjAwgLApB_mkRVp?e=diumNA
615. ROBOTIC REDO LAPAROSCOPIC HELLER’S CARDIOMYOTOMY
Authors: Parthasarathi R , Ramesh N , Cumar Bharath , Palanivelu C 
Published: September 2024

Abstract

Introduction
Robotic Heller’s cardiomyotomy is the preferred treatment option for achalasia cardia. However, following Heller’s cardiomyotomy up to 20% of patients experience dysphagia and regurgitation in the long term. The ideal management option for such patients needs to be determined.

Surgical Steps
The procedure is carried out with patient in supine position, legs abducted with the knees in slightly flexed position in reverse Trendelenburg position of approximately 30°.The pneumoperitoneum is created by closed Veress needle technique. After Relasing Adhesions, the gastrohepatic ligament is divided and the right crus is identified and retrocardiac window is formed; proximal short gastric vessels are divided for posterior wrap. The esophagus is separated by blunt dissection from the crus, the peritoneum and phrenoesophageal membrane are divided and the left crus is identified. If an anterior partial fundoplication is planned as antireflux procedure, the mobilization is limited to the lateral and anterior aspects. The anterior vagus nerve is identified and should be dissected and lifted away from the distal esophagus and proximal stomach in order to facilitate transhiatal dissection, myotomy and also to prevent injury to the esophagus and vagal trunks. Dissection is continued cranially around the esophagus for a distance of about 2–3 cm onto the dilated segment of the esophagus in the posterior mediastinum. If posterior partial wrap (Toupet) is planned, esophagogastric dissection is performed posteriorly from both crura and median arcuate ligament to get tension free wrap. Fundus of the stomach is dissected off the diaphragm and if needed two or three short gastric vessels are divided. Posterior vagal trunk is dissected along with esophagus.

Conclusion
Redo Robotic Heller’s cardiomyotomy can safely be performed with good symptomatic relief for patients who present with recurrent symptoms following Heller’s cardiomyotomy. Long term follow-up with larger sample size is needed to confirm these findings.
https://drive.google.com/file/d/1uFgx0Aal92o5FE-Ndp-tAsCg01NJ6Crm/view?usp=sharing
618. A COMPARISON OF HEALTH-RELATED QUALITY OF LIFE AT ONE YEAR FOLLOWING MINIMALLY INVASIVE VERSUS OPEN ESOPHAGECTOMY
Authors: Prasad Pooja , Brown Joshua , Cross Andrea , Wahed Shajahan , Phillips Alexander 
Published: September 2024

Abstract

Introduction
Minimally invasive esophagectomy (MIE) is being increasingly adopted in the surgical management of esophagogastric cancer. While equivalent clinical and oncological outcomes have been demonstrated in comparison with open resections, differences in health-related quality of life (HR-QOL) between the 2 modalities into survivorship remains unclear. The aim of this study was to determine the differences in HR-QOL between MIE and open esophagectomies (OE) at 1 year post-resection.

Methods
Consecutive patients undergoing an esophagectomy at a single, U.K based tertiary referral centre for esophagogastric cancer between January 2018 – December 2022 were evaluated. MIE was defined as utilisation of laparoscopic, thoracoscopic or robotic access for at least one phase of an esophagectomy. HR-QOL at 1 year following surgery was measured using the validated European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and esophagogastric cancer module (QLQ-OG25) and compared between groups.

Results
A total of 28 patients undergoing MIE and 25 patients undergoing OE were included. No statistical difference was noted in mean global HR-QOL between the OE and MIE cohorts at 1 year (69.33±19.50 vs 64.88±22.05; p=0.66). No statistically significant intergroup differences between OE versus MIE were observed at 1 year in physical functioning (82.67±16.89 vs 79.05±24.39; p=0.97) or role functioning (73.33±29.27 vs 67.86±32.37; p=0.60) domains. Similarly, no difference was observed in symptoms of nausea/vomiting (10.67±18.17 vs 8.93±14.69; p=0.56), pain (29.33±25.56 vs 26.79±33.44; p=0.26) or fatigue (29.78±25.40 vs 37.70±30.44; p=0.44).

Conclusion
HR-QOL remains comparable between MIE and OE at 1 year. Patient-reported outcomes must be assessed in the long-term to determine if minimally invasive approaches confer HR-QOL improvements well into survivorship.
619. ASSOCIATION OF PROLONGED ONE LUNG VENTILATION TIME WITH PERIOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGOGASTRIC CANCER RESECTION
Authors: Prasad Pooja , Brown Joshua , Cross Andrea , Wahed Shajahan , Phillips Alexander 
Published: September 2024

Abstract

Introduction
Esophagectomy for esophagogastric cancer is associated with high rates of peri-operative morbidity and mortality. Little is known of the impact of one lung ventilatory (OLV) times during the thoracic phase of an esophagectomy upon perioperative outcomes. The aim of this study was to determine the impact of OLV upon post-operative complications following esophagogastric cancer resection.

Methods
Consecutive patients undergoing an esophagectomy at a single, U.K tertiary referral centre for esophagogastric cancer between January 2015–January 2022 were evaluated. OLV time was defined as the number of minutes there was iatrogenic occlusion of one of the main bronchi such that all ventilatory requirements were performed by one lung. Previously published OLV times were used to determine if the duration was standard (&lt;150 minutes) or prolonged (&gt;=150 minutes). Post-operative complications were prospectively evaluated and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as either CD 0-I (none-minor complications) or CD II-V (moderate–severe complications including post-operative mortality).

Results
There were 361 patients included in the final analysis. OLV times of &lt;150 minutes were recorded in 101 patients and &gt;=150 minutes were recorded in 260 patients. Both groups were comparable in terms of development of CDII-V complications with no statistically significant intergroup differences (91/101 vs 241/260; p=0.075). Notably, 41/91 (45.1%) of patients with an OLV time &lt;150 minutes developed a pulmonary complication versus 100/241 (41.5%) with prolonged OLV times.

Conclusion
Pulmonary and other peri-operative complications remain a considerable burden in the recovery of patients following esophagogastric cancer resection, independant of OLV times. Strategies to mitigate this are need in order to reduce peri-operative morbidity and improve overall quality of life into survivorship.
626. DO CALCIUM CHANNEL BLOCKERS AFFECT CLINICAL OUTCOMES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH HYPERTENSION? A MULTICENTER RETROSPECTIVE STUDY
Authors: Zhou Jianfeng 
Published: September 2024

Abstract

Background
Esophageal squamous cell carcinoma (ESCC), prevalent globally, especially in Asia, is primarily treated with esophagectomy. Concurrently, hypertension, managed often with calcium channel blockers (CCBs), is widespread. The influence of CCBs on post-esophagectomy outcomes in hypertensive ESCC patients is yet to be fully understood. This study seeks to elucidate CCBs' impact on these patients to improve clinical management and drug selection.

Methods
Patients who underwent esophagectomy between December 2008 and Nov 2022 were extracted from a 4-centre prospectively maintained database, and those with hypertension were categorized based on whether they have been taking CCBs for an extended period (more than 1 year). Survival was analyzed using the log-rank test and multivariable Cox regression analysis.

Results
Of the 7954 esophagectomies, 348 cases of hypertensive ESCC patients were eligible. 37% (129 out of 348) of the patients with hypertensive ESCC patients had been on long-term CCB therapy. In univariate analysis, ESCC patients with hypertension who were treated with CCBs had a better OS than those who were not. Multivariate analysis results indicated that postoperative T stage and N stage are independent risk factors for the OS of ESCC patients with hypertension, while the use of CCBs is an independent protective factor for their OS. Additionally, a nomogram was established to accurately predict the occurrence of adverse outcomes.

Conclusion
This study finds that long-term CCB use improves OS in hypertensive ESCC patients post-esophagectomy, highlighting the recommendation of CCB therapy in managing hypertensive ESCC patients post-surgery.
632. CAN CARDIOPULMONARY EXERCISE TESTING PREDICT NEOADJUVANT CHEMOTHERAPY TOXICITY IN OESOPHAGEAL ADENOCARCINOMA PATIENTS?
Authors: Dayanamby Abbienaya , Chmelo Jakub , Bradshaw Alexander , Sinclair Rhona , Phillips Alexander W 
Published: September 2024

Abstract

Background
Cardiopulmonary exercise testing (CPET) is a method of assessing cardiopulmonary fitness. In the context of surgery, it is used to risk-stratify patients, allowing targeted prehabilitation to optimise comorbidities and fitness prior to surgery, and triage patients to the appropriate level of care after the operation. Various CPET-derived variables have been shown to be associated with short- and long-term outcomes after various surgery. In patients post-oesophagectomy, these variables are predictive of long-term survival. This study aimed to assess the use of this tool to predict neoadjuvant chemotherapy (NAC) related complications in patients receiving neoadjuvant FLOT prior to oesophagectomy.

Methods
All patients who underwent routine CPET during the staging process prior to NAC with FLOT and oesophagectomy in a single high-volume centre between September 2018 and January 2023 were included. Data were extracted from the unit’s contemporaneously maintained database. The Mann-Whitney U test was used to compare CPET variables in patients who completed NAC with FLOT fully versus those who did not finish NAC with FLOT due to acute chemotherapy toxicities.

Results
There were 129 patients who received neoadjuvant FLOT and had routine CPET performed during the defined study period. Six of those patients (4.7%) did not complete neoadjuvant chemotherapy due to acute chemotherapy toxicities but progressed to surgery. The median anaerobic threshold, VO2 peak, and VE/VCO2 among those who completed NAC were 14.2 ml/kg/min, 20.3 ml/kg/min, and 28, respectively, compared to 13.4 ml/kg/min, 19.7 ml/kg/min, and 31 in those who did not complete NAC (p=0.595, p=0.695, and p=0.160, respectively).

Conclusion
Although patients who received all four cycles of NAC with FLOT prior to oesophagectomy demonstrated CPET values indicating better base-line fitness than those who had to discontinue NAC due to acute chemotherapy toxicity, these differences did not reach the level of statistical significance. This study, therefore, did not demonstrate any predictive value of CPET in assessing the risk of incomplete NAC treatment prior to oesophagectomy.
639. WHICH FACTORS LEAD PATIENTS WITH BENIGN ESOPHAGEAL STRICTURES FOR SURGICAL TREATMENT BESIDES ENDOSCOPIC TREATMENT?
Authors: Szachnowicz Sergio , Friedmann Ilan , Ferros Lucas Sousa Maia , Duarte Andre Fonseca , Bianchi Edno Tales , Seguro Francisco CBC , Sallum Rubens AA , Júnior Ulysses Ribeiro 
Published: September 2024

Abstract

Background
This work proposes to evaluate patients with benign esophageal strictures, excluding caustic strictures, about their etiologies and poor prognostic factors for the success of endoscopic treatment.

Methods
It was evaluated in our service 38 patients, from 1992 to 2023, with benign esophageal strictures not related to caustic strictures. We could follow-up 24 patients from 7 months and 384 months (average of 136 months). Four died during the follow- up. We could analyze these following outcomes: clinical symptoms, surgical indications, age, gender, alcohol abuse, smoking, length of stricture, number of endoscopic dilation and stricture etiology.

Results
Concerning the 24 patients with follow-up, 4 had esophagectomy; 10 underwent endoscopic treatment with fundoplication and 10 were treated with endoscopic and medical treatment. Both groups, endoscopic and medical treatment, and endoscopic treatment with fundoplication had 4 patients that continued symptomatic (40%). The number of endoscopic dilations range from 1 to 101 (average 18) in each patient. The etiology of 38 patients with benign esophageal strictures were:
35 gastroesophageal reflux disease (13 Barrett´s esophagus); one with infectious esophagitis; one eosinophilic esophagitis and another due to esophageal varicose sclerosis. The prognostic factors to surgical treatment will be analyzed by statistical analysis.

Conclusion
From our data, it is possible to conclude that the endoscopic treatment is effective to manage the majority of benign esophageal strictures, even in association with fundoplication. Moreover, the main etiology was gastroesophageal reflux disease. Only few patients have developed indication to esophagectomy.