bluuebunny/crossref_metadata_2025_split huggingface dataset:
235. A NOVEL TUMOR STAGING SYSTEM INCORPORATING CN STATUS FOR STRATIFYING EARLY STAGE ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS AFTER TRIMODAL THERAPY
Authors: Li Xiaokun , Yuan Yong , Shen Yi 
Published: September 2024

Abstract

Background
This study aims to assess the prognostic significance of cN status in early-stage esophageal squamous cell carcinoma (ESCC) patients following neoadjuvant chemoradiotherapy (nCRT) and develop a novel staging model for personalized survival prediction.

Methods
Patients with ESCC who underwent nCRT and esophagectomy were included. The Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were employed to evaluate the validity of various oncological staging systems. A reduction in AIC and BIC values indicates improved predictive capability and accuracy.

Results
We established a novel staging model by incorporating ypTNM stage and cN status, effectively stratifying ypI ESCC patients. Cox regression analysis showed that only cN status was an independent prognostic factor for both overall survival (p = 0.030) and disease-free survival (p = 0.019) in patients with stage ypI. The newly developed ypTNM-cN staging exhibited a superior alignment with overall survival trends compared to the AJCC 8th ypTNM staging, with a significantly lower AIC of 3143.014 versus 3149.950. This superiority was further supported by a BIC of 3146.605 compared to 3153.541. In terms of disease-free survival outcomes, the emerging ypTNM-cN staging, with AIC and BIC values of 3196.057 and 3199.648, respectively, outperformed the AJCC 8th ypTNM staging, which recorded values of 3203.853 and 3207.444.

Conclusion
We have devised a novel staging system based on ypTNM stage and cN status to accurately categorize patients with ypI stage. Our ypTNM-cN staging system offers valuable insights into the classification of ypI ESCC and demonstrates reliable classification efficacy for all ESCC patients following nCRT and surgery.
236. THE ROLE OF ADJUVANT THERAPY FOLLOWING NEOADJUVANT CHEMORADIOTHERAPY AND ESOPHAGECTOMY IN ESOPHAGEAL CANCER
Authors: Li Xiaokun , Yuan Yong 
Published: September 2024

Abstract

Background
The objective of this study was to assess the role of adjuvant therapy following neoadjuvant chemoradiotherapy and esophagectomy in esophageal squamous cell carcinoma (ESCC).

Methods
We conducted a retrospective analysis involving 506 ESCC patients who underwent trimodal therapy. The clinical significance of adjuvant therapy on overall survival and disease-free survival was evaluated using Kaplan–Meier curves with log-rank tests, the Cox regression model, and a forest plot displaying hazard ratios (HR) with 95% confidence intervals.

Results
Among the 506 patients who had clinically positive lymph nodes and no metastasis after neoadjuvant chemoradiotherapy and esophagectomy, those who received adjuvant therapy exhibited shorter post-resection overall survival (OS) and disease-free survival (DFS), with a statistically significant difference between the two groups (Log-Rank, OS: P = 0.002; DFS: P &lt; 0.001). Adjuvant therapy was not identified as an independent prognostic factor for OS (HR: 1.249; 95% CI: 0.869-1.796; P = 0.230), but it was a significantly unfavorable independent prognostic factor for DFS (HR: 1.868; 95% CI: 0.349-2.586; P &lt; 0.001).

Conclusion
Adjuvant therapy is associated with poorer overall survival (OS) and disease-free survival (DFS) outcomes in ESCC patients with ypTNM stage I and II on final pathology following neoadjuvant chemoradiotherapy and esophagectomy. However, there was no significant difference observed in patients with ypTNM stage III or IV. Therefore, it is not recommended to undergo postoperative adjuvant therapy for patients with ypTNM stage I and II ESCC. However, for patients with ypTNM stage III and IV ESCC, further research is needed to explore adjuvant treatment strategies.
246. EFFECT OF INTRAOPERATIVE NERVE MONITORING DURING MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Hsu Po-Kuei 
Published: September 2024

Abstract

Background
Recurrent laryngeal nerve (RLN) lymphadenectomy is a crucial step during esophagectomy. However, it is technically demanding and associated with a significant risk of RLN injury. Despite several studies demonstrating the feasibility of intraoperative nerve monitoring (IONM) during esophageal surgery, routine utilization of IONM during minimally invasive esophagectomy has not become common, and there is limited evidence to provide robust guidance. Here, we describe our experience with IONM during minimally invasive McKeown esophagectomy.

Methods
Data from 115 consecutive patients who underwent bilateral RLN lymphadenectomy during thoracoscopic McKeown esophagectomy for esophageal squamous cell carcinoma (ESCC) by a single surgeon between July 2017 and November 2023 were reviewed. The cohort was divided into three groups: Group 1 (initial 23 cases without IONM), Group 2 (middle 46 cases without IONM), and Group 3 (late 46 cases with IONM). We compared the number of resected lymph nodes and the incidence of vocal cord palsy (VCP) among the three groups.

Results
The mean number of resected right-side RLN lymph nodes was 1.21, 2.30, and 3.28 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 2 and 3 (p = 0.03, Kruskal-Wallis test). The mean number of resected left-side RLN lymph nodes was 1.13, 2.70, and 2.67 in Groups 1, 2, and 3, respectively. A significant difference was noted between Groups 1 and 2 (p = 0.009), but not between Groups 2 and 3. The incidence of VCP was 8.7%, 8.7%, and 10.9% in Groups 1, 2, and 3, respectively. Compared to Group 2, the utilization of IONM in Group 3 did not reduce the postoperative VCP rate (OR: 1.280, 95% CI: 0.321-5.107).

Conclusions
With increasing experience, the number of resected RLN lymph nodes significantly increased. However, the utilization of IONM did not further improve left-side RLN lymphadenectomy or reduce the VCP rate.
250. CHANGES IN AND CLINICAL UTILITY OF MAXIMUM PHONATION TIME AND REPETITIVE SALIVA SWALLOWING TEST SCORES AFTER ESOPHAGECTOMY
Authors: Maruyama Suguru , Higuchi Yudai , Saito Ryo , Tanaka Hiroto , Ichikawa Daisuke 
Published: September 2024

Abstract

Background
Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, intervention by speech-language pathologists (STs) has reported to be important for the prevention of postoperative pneumonia. In this study, we report on the perioperative swallowing rehabilitation led by STs at our hospital. In addition, we focused maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy.

Methods
ST intervention was started at the induction of preoperative chemotherapy, and pre-surgical swallowing rehabilitation including oral care, incentive spirometry, abdominal breathing, and breath-hold swallowing was started and continued after surgery. MPT is the longest speech duration after maximal inspiration, and RSST is the number of empty swallowing that can be repeated in 30 seconds. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between 2020 and 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia.

Results
The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. Meanwhile, there were no significant changes in perioperative RSST scores. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (OR: 12.6, 95%CI: 1.29–123, P = 0.03) in the multivariate analysis. Regarding the onset of postoperative pneumonia, the MPT on POD6 was significantly associated with late-onset pneumonia, but not with early pneumonia (P = 0.02 and P = 0.25, respectively).

Conclusion
The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia. Early resumption of oral intake after esophagectomy might be a risk factor of aspiration pneumonia since expectoration function is not restored, especially in patients with a low MPT on POD 6.
252. RIGHT GASTROEPIPLOIC ARTERY LENGTH DETERMINED ANASTOMOTIC LEAKRIGHT GASTROEPIPLOIC ARTERY LENGTH DETERMINED ANASTOMOTIC LEAKAGE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER-A PROSPECTIVE COHORT STUDY
Authors: Li Kun-Kun 
Published: September 2024

Abstract

Background
This prospective cohort study, conducted at a high-volume esophageal cancer center from July 2019 to July 2022, aimed to investigate the link between the right gastroepiploic artery (RGEA) length and anastomotic leakage (AL) rates following minimally invasive esophagectomy (MIE). Real-world data on stomach blood supply in the Chinese population were examined.

Materials and methods
A total of 516 cases were enrolled, categorized into two groups based on the Youden index-determined optimal cut-off value for the relative length of RGEA (length of RGEA/length of gastric conduit, 64.69%) through ROC analysis: Group SR (short RGEA) and Group LR (long RGEA). The primary observation parameter was the relationship between AL incidence and the ratio of direct blood supply from RGEA. Secondary parameters included the mean length of the right gastroepiploic artery, greater curvature, and the connection type between right and left gastroepiploic vessels. Patient data were prospectively recorded in electronic case report forms.

Results
The study revealed median lengths of 43.60 cm for greater curvature, 43.16 cm for the gastric conduit, and 26.75 cm for RGEA. AL, the most common postoperative complication, showed a significant difference between groups (16.88% vs. 8.84%, p = 0.01). Multivariable binary logistic regression identified Group SR and LR (Odds ratio: 2.651, 95% CI: 1.124–6.250, p = 0.03) and Neoadjuvant therapy (Odds ratio: 2.479, 95% CI: 1.374–4.473, p = 0.00) as independent predictors of AL.

Conclusions
The study emphasizes the crucial role of RGEA length in determining AL incidence in MIE for esophageal cancer. Preserving RGEA and fostering capillary arches between RGEA and LGEA are recommended strategies to mitigate AL risk.
254. QUANTIFYING PERIOPERATIVE RISKS FOR ANTIREFLUX AND HIATUS HERNIA SURGERY: A MULTICENTER COHORT STUDY OF 4301 PATIENTS
Authors: Liu David , Wong Darren , Goh Su Kah , Fayed Aly , Stevens Sean , Aly Ahmad , Bright Tim , Weinberg Laurence , Watson David 
Published: September 2024

Abstract

Background
Predicting perioperative risks for fundoplication and hiatus hernia repair will inform treatment decision-making, hospital resource allocation, and benchmarking. However, available risk calculators do not account for hernia anatomy or technical aspects of surgery in estimating perioperative risk. Using a comprehensive Australian cohort, we quantified the incidence and determined the independent predictors of intraoperative and postoperative complications associated with antireflux and hiatus hernia surgeries. Additionally, we performed an in-depth analysis to understand the complication profiles associated with each independent risk factor.

Methods
Retrospective analysis of all elective antireflux and hiatus hernia surgeries in 36 Australian hospitals over 10 years. Hierarchical multivariate logistic regression analyses were performed to determine the independent predictors of intraoperative and postoperative complications accounting for patient, surgical, anatomical, and perioperative factors.

Results
A total of 4301 surgeries were analyzed. Of these, 1569 (36.5%) were large/giant hernias and 292 (6.8%) were revisional procedures. The incidence rates of intra- and postoperative complications were 12.6% and 13.3%, respectively. The Charlson Comorbidity Index, hernia size, revisional surgery, and baseline anticoagulant usage independently predicted both intraoperative and postoperative complications. These risk factors were associated with their own complication profiles. Finally, using risk matrices, we visualized the cumulative impact of these four risk factors have on the development of intraoperative, overall postoperative, and major postoperative complications.

Conclusions
This study has improved our understanding of perioperative morbidity associated with antireflux and hiatus hernia surgery. Our findings group patients along a spectrum of perioperative risks that informs care at an individual and institutional level.
260. LOW BLOOD LEVEL OF TUMOR SUPPRESSOR MIR-3619 AS A TARGET OF NUCLEIC ACID THERAPY TO PIM-1 IN ESOPHAGEAL CANCER
Authors: Arakawa Hiroshi , Komatsu Shuhei , Kamiya Hajime , Ishida Rei , Nishibeppu Keiji , Kiuchi Jun , Imamura Taisuke , Ohashi Takuma , Konishi Hirotaka , Shiozaki Atsushi , Fujiwara Hitoshi , Otsuji Eigo 
Published: September 2024

Abstract

Background
Numerous studies have attempted to understand the molecular mechanisms of tumorigenesis and identify clinical biomarkers and molecular targets for esophageal squamous cell carcinoma (ESCC). However, there are still only a few biomarkers and targets. We focused on tumor suppressor micro-RNA (miR)s in the plasma of ESCC patients, and we investigated the usefulness of these tumor suppressor miRs as biomarkers and therapeutic agents for ESCC. Methods: Plasma samples of 94 ESCC patients and 86 healthy volunteers were analyzed in this study. Among the group of 2600 miRs candidates registered in miRbase, we selected 25 miRs candidates which are low expressed in ESCC tissues, have tumor suppressive functions, and unreported as a body fluid biomarker. We selected 5 miRs (miR-564/ 637/ 1182/ 3178/ 3619), whose signals were detectable in the blood of healthy volunteers by microarray analysis. By test-scale analysis using TaqMan assay and validation analysis, we identified miR-3619, which showed the most significant difference in ESCC patients compared to healthy volunteers (p &lt; 0.001). Results: 1) Prognostic analysis revealed that a low miR-3619 plasma level was significantly associated with advanced stage and recurrence rate, and was an independent factor predicting poor prognosis in ESCC patients (p = 0.028, HR = 2.09). 2) Overexpression of miR-3619 mimic inhibited the proliferation of ESCC cells, induced the accumulation of apoptosis or G1/S phase cells, and reduced the cell migration and invasion abilities compared with negative control mimic. 3) We tested PIM-1xas candidate putative target genes for miR-3619 using microRNA database. PIM-1 protein expression levels were decreased in miR-3619-5p transfectants compared with NC. 4) In vivo, subcutaneous injection of miR-3619 could significantly inhibit tumor growth in mice. Administration of miR-3619 did not cause any clinical adverse events or side effects in blood-based parameters reflecting organ disorders. Conclusion: These results suggest that depleted tumor-suppressor miR-3619 in plasma could be one of blood-based biomarkers for predicting malignant potential of ESCC.
370. LOWER MEDIASTINUM DISSECTION IN THORACOSCOPIC ESOPHAGECTOMY
Authors: Gonçalves Beatriz Pereira , do Carmo Girão Maria , Chumbinho Beatriz , Ávila Leonor , Cabral Francisco , Ramos Paulo , Monteiro Cecília , Casaca Rui , Abecasis Nuno 
Published: September 2024

Abstract

Background
Thoracic esophagectomy is currently the preferred technique for the thoracic phase of transthoracic esophagectomy for esophageal cancer. Randomized controlled trials comparing this minimally invasive approach to the open one, demonstrated a lower rate of pulmonary complications rate, without worst long-term outcomes.
Video-based learning of minimally invasive surgery is essential, especially in such a complex procedure like esophagectomy. However, resources are lacking.
Therefore, we aim to conduct a video demonstration of lower mediastinum dissection of our standardized right thoracoscopy esophagectomy, in the prone position.

Methods
Surgery de-construction through video assessment is routinely performed in our upper gastrointestinal unit. It is fundamental for surgical training, as well as for technical skills improvement of experienced surgeons. Here we present a step-by-step approach of one of the key parts of our standardized thoracoscopic esophagectomy technique – the lower mediastinum dissection.

Results
Thoracoscopic esophagectomy is systematically performed in a prone position, using a bronchial blocker, 4 working ports and a pressure of 6 mmHg for pneumomediastinum.
The first stage of thoracoscopic esophagectomy is the lower mediastinum dissection. Three main steps compose this procedure - posterior dissection, anterior dissection and main bronchus and carina dissection.
This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved and the critical pitfalls.

Conclusion
Thoracoscopic esophagectomy for esophageal cancer should be performed in high-volume centers, in a standardized and systematic way. Video revision and procedure debriefing is essential not only for surgery learning and coaching, but also for outcome improvement. Sharing knowledge and experience through video-based presentations can contribute to development of this complex area of minimally invasive esophagectomy.
https://drive.google.com/file/d/1vWJOTCey8wI6HQi0jAR8C_t3tUKVbrW1/view?usp=drive_link
375. ROLE OF RECURRENTIAL LYMPHADENECTOMY BY MINIMALLY INVASIVE APPROACH IN THE SURGICAL TREATMENT OF ESOPHAGEAL CANCER
Authors: Nieto Marta , Martínez Cristina , Hurtado Mister Luis , Quevedo Mister David , Guerrero Mister Pablo , Mingol Mister Fernando , Bruna Mister Marcos , Vaque Mister Javier 
Published: September 2024

Abstract

Background
Esophageal cancer is an aggressive tumor, which is normally diagnosed in more advanced stages. The anatomical characteristics of the esophagus allow rapid spread to neighboring structures, and the extensive lymphatic drainage network facilitates tumor spread even in early stages.
Lymphatic spread is the single most important prognostic factor and is a good predictor of disease-free survival.
The objective of this study is to present the esophageal neoplasms operated in our center in which we have performed a recurrent lymphadenectomy, describing the postoperative complications, the presence of lymph node metastases and their influence on the evolutionary course of the disease.

Methods
Retrospective, observational, descriptive and analytical study in which all patients operated on for esophageal neoplasia from January 2019 to January 2024 are included. All patients have been operated on by the same surgical team specialized in esophagogastric surgery. Quantitative variables are described as mean and standard deviation, and qualitative variables are described as absolute number and percentage. The univariate methods used are Pearson's X2 or Student's t for independent samples. A logistic regression has also been performed to study factors that influence in survival. The IBM SPSS Statistics 22 program was used to analyze the data.

Results
89 patients have been operated on, 70 three-stage esophagectomies and 16 two-stage. In 60,6% cases it was adenocarcinoma and 33,7% squamous cell histology.
Recurrent lymphadenectomy was performed in all of them, 31 expanded and 58 total. 6 patients with recurrent lymph nodes affected, 2 on the right side, 3 on the left and 1 bilateral.
15% patients with tumors &gt;T2 presented recurrent affected lymph nodes, increasing to 20% in adenocarcinomas.
20 recurrent nerve injuries, all of them transient except 3.
Statistically significant relationship has been found between the number of affected lymph nodes and disease-free survival time (p = 0.045).

Conclusion
Mediastinal and recurrent lymphadenectomy in esophageal cancer influences in the number of positive nodes obtained after surgery. This could determine a more advanced staging of the disease, which allows adaptation of the adjuvant treatment, influencing in the time free of disease. Most injuries caused by this type of lymphadenectomy can be managed with conservative treatment.
378. LAPAROSCOPIC PRIMARY CLOSURE OF ESOPHAGEAL RUPTURE CAUSED BY BALLOON DILATATION FOR ACHALASIA AND HELLER'S MYOTOMY WITH DOR FUNDOPLICATION
Authors: Kwon Oh Kyoung , Yang Jae Yeong , Park Ki Bum , Park Ji Yeon 
Published: September 2024

Abstract

Background
Achalasia is a Primary motor disorder of the esophagus cased by Insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Major clinical presentations are Dysphagia, regurgitation, and occasional chest pain with or without weight loss. One of most commonly performed conservative treatment is pneumatic dilatation and its most serious complication is esophageal perforation. In this presentation we will introduce a case of esophageal perforation caused by pneumatic dilatation for esophageal achalasia treated with laparoscopic primary closure of perforation and simultaneous Heller’s myotomy with Dor Fundoplication.

Methods
Esophageal perforation occurred during endoscopic pneumatic dilatation occurred in 61-year-old female patient with achalasia. Initially endoscopic clipping was performed but the patient showed leukocytosis, tachycardia and decreased oxygen saturation with dyspnea. Chest CT showed intraabdominal and mediastinal free air and defect in distal esophagus. Then the patient was referred for surgery. During laparoscopic exploration, 3cm mucosal and 6cm muscle tearing at distal esophagus 2cm proximal to the esophagogastric junction at 3 o’clock direction. After removal of endoscopic clips, primary closure of esophageal rupture in 2-layed method and simultaneous Heller’s Myotomy with Dor fundoplication at 12 o’clock direction was performed.

Results
The patient showed rapid recovery from septic condition. Nasogastric tube was removed 4 days after surgery. Upper GI series checked with gastrografin 5 days after surgery showed no leakage and no delayed passage in distal esophagus. Chest tube and abdominal drain were removed and the patient was discharged 10 days after surgery. There was no dysphagia and reflux during follow-up afterwards.

Conclusion
Primary closure for esophageal rupture occurred during balloon dilatation for achalasia and simultaneous Heller’s myotomy with Dor fundoplication by approaching the esophagus from a different direction were successfully performed reducing not only the risk of fulminant sepsis but also the burden of the surgery for achalasia that would be needed to be performed later.