bluuebunny/crossref_metadata_2025_split huggingface dataset:
275. SAFETY AND TREATMENT RESULTS OF SELF-EXPANDABLE METAL STENT (SEMS) PLACEMENT FOR ESOPHAGEAL DISEASE
Authors: Yamamoto Kei , Hirao Takafumi , Oka Yoshio 
Published: September 2024

Abstract

Background
Self-expandable metal stent (SEMS) placement for esophageal strictures and fistulas caused by malignant tumors has been reported from various institutions as a relatively minimally invasive and safe palliative treatment. SEMS placement is often selected for cancer-bearing patients whose general condition has already deteriorated, but there are many unknowns regarding the risks and benefits of placement.

Methods
We retrospectively examined swallowing scores, oral intake status, complications and prognosis for 41 cancer-bearing patients who underwent SEMS placement in our hospital from 2011 to 2023.

Results
There were 29 men and 12 women, with a median age of 77 years. The types of cancer were esophageal cancer / gastric cancer / lung cancer / others in 22/12/3/4 cases, respectively. The reason for stent placement was stricture / fistula in 39/2 cases. Stent placement was successful in 40 cases (97.6%), and complications were observed in 7 cases (17.1%), including bleeding, displacement, and aspiration pneumonia in 2, 3, and 2 cases, respectively. Three patients underwent second stent placement for restenosis, and the median time to restenosis was 57 days. After stent placement, dysphagia score improved in 30 cases (78.9%). After stent placement 35 patients (87.5%) chose palliative treatment and the median survival time (MST) was 1.7 months (0.2-10.8). Comparing patients with PS≦2 and PS≧3 using performance status (PS) at the time of stent placement, patients with PS≦2 significantly ate more after stent placement (median amount of oral intake; 80 % vs. 40%, p=0.037), and the survival period was longer (MST; 3.1 months vs. 1.3 months, p=0.0018). Univariate analysis on the risk of complications by stent placement showed that chemotherapy history, radiotherapy history, and pretreatment dysphagia score were not risk factors, but poor PS (≥3) was the only significant risk factor (Odds ratio: 12.5, 95% CI:1.3-117, p=0.027).

Conclusion
Esophageal stents are less invasive treatment than any other palliative methods, like esophageal bypass or radiation therapy for patients who strongly desire oral intake. However in patients with poor general condition the risk of complications is high and the survival period is not long, so it should be performed after fully explaining the risks and benefits.
279. NOVEL REFLUX MICROASPIRATION SCINTIGRAPHY ALLOWS EFFECTIVE PATIENT SELECTION FOR ANTIREFLUX SURGERY IN PROXIMAL REFLUX EVENTS
Authors: Khoma Oleksandr , Van der Wall Hans , Burton Leticia , Cooke Michelle , Falk Gregory 
Published: September 2024

Abstract

Background and Aims
There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GORD). The current suite of diagnostic tests principally assess reflux events in the oesophagus have problematic accuracy issues in the pharynx. A new scintigraphic technique has been developed and validated against 24-hour oesophageal monitoring with pH, impedance. It allows direct visualization of refluxate in the laryngopharynx and lungs. This was utilised to evaluate patients having laparoscopic fundoplication for severe proximal reflux resistant to maximal medical therapy. Scanning may allow succesful patient selection for antireflux surgery.

Methodology
Following Institutional Ethics approval, 50 patients were assessed by scintigraphy before and after laparoscopic fundoplication (LF) at a single nuclear medicine facility. Standardised Reflux Symptom Indices (RSI) were obtained from each patient before and after surgery. Patients were scanned after oral 99m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck and lungs. Background corrected time-activity curves were generated for the pharynx and upper oesophagus from which frequency of reflux was estimated by counting events with activities greater than 2 standard deviations above fitted values. Frequencies, Spearman correlation and the student’s t test were utilised for analysis.

Results
The study population (35F, 15M) had a mean age of 63.9 years (Range 21-86). All patients underwent LF. Mean BMI was 26.8 with 67% being over-weight or obese. All patients had proximal reflux events in the early dynamic study. SPECT/ CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 pre-operatively and in 36/50 and 20/50 post-operatively. The RSI, cough and throat clearing indices showed a significant fall post-operatively (p&lt; 0.001). The frequency of scintigraphic pharyngeal reflux events was reduced from a mean of 4.5 in 30 minutes to 2.9 (t=9.1, p=0.004).

Conclusion
The novel scintigraphic test detects oesophageal and extra-oesophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. Scintigraphy correlates well with symptoms of reflux in the oesophagus and extra-esophageal structures such as the laryngopharynx (chronic cough and throat clearing) and the response to LF albeit partial. PMA was significantly reduced.
283. MODIFIED FRAILTY INDEX AND CLINICAL FRAILTY SCALE TOOLS ARE NOT GOOD PREDICTORS OF SURVIVAL AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Ari Kaso , Sivarajan Sri , Shenoy Sachin , Patel Martyn , Kumar Bhaskar 
Published: September 2024

Abstract

Background
Assessing frailty in elderly patients is pivotal for preoperative risk stratification. Whilst the modified Frailty-Index (m-FI) and Clinical Frailty Scale (CFS) have been used to predict postoperative mortality and morbidity in various surgical contexts, their prognostic value for complications and overall survival following esophagectomy remains uncertain. Several studies have assessed pre-operative application of frailty indices and whether they have prognostic value for long-term postoperative outcomes, however, none have compared m-FI and CFS in patients undergoing esophagectomy. This study examines and compares m-FI and CFS with overall survival and post-operative complications in patients undergoing Minimally Invasive Esophagectomy (MIO).

Methods
We retrospectively analysed data from a prospectively maintained database, including patients aged ≥65 years undergoing MIO for esophageal cancer from January 2014 to December 2023, at a high-volume esophago-gastric tertiary centre. We compared the m-FI 11 and m-FI 5, CFS, all measuring frailty parameters in surgical patients. Frailty was defined as m-FI 11 ≥3, m-FI 5 ≥2, or CFS ≥4, based on the current literature evidence for application of these frailty assessment tools. Primary outcomes were 2- and 5-year all-cause mortality, with anastomotic leak, serious complications (Clavien-Dindo grade ≥IIIa) and average length of stay (LOS) as secondary outcomes.

Results
Among 174 patients (median age 72 years, range 65-85, male-to-female ratio 4:1), no significant associations were found between age, sex, TNM stage, and pre/post-op chemoradiotherapy within each scoring category. Neither tool showed significant associations for 2-, 5-year, and overall mortality (Table 1), nor for average length of stay. However, an m-FI 5 score ≥2 exhibited an odds ratio (OR) of 2.41 (95% CI 1.00–5.78, p = 0.049) for anastomotic leak, and a CFS score ≥4 had an OR of 2.46 (95% CI 1.02–5.90, p = 0.044) for serious complications.

Conclusion
In frail patients undergoing MIO, both the m-FI and CFS tools demonstrated no significant prognostic value for predicting overall survival. However, m-FI 5 ≥2 correlated significantly with anastomotic leaks, while CFS ≥4 correlated with serious complications. Relying on scoring tools for frailty assessment may inadvertently trivialise what is intended to be a multidimensional evaluation of health domains. Nevertheless, their utility in predicting complications should not be overlooked. We propose a more strategic use of frailty assessment tools to triage patients for comprehensive geriatric evaluation. This approach identifies patients at highest risk of complications and facilitates targeted prehabilitation for optimising outcomes.
289. OUTCOME OF CONVERSION SURGERY FOR ESOPHAGEAL CANCER WITH SYNCHRONOUS ABDOMINAL PARAAORTIC LYMPH NODE METASTASIS
Authors: Tanaka Koji , Sugimura Keijiro , Sugase Takahito , Momose Kota , Yamashita Kotaro , Kanemura Takeshi , Makino Tomoki , Shiraishi Osamu , Miyata Hiroshi , Yasuda Takushi , Yano Masahiko , Doki Yuichiro 
Published: September 2024

Abstract

Background and Purpose
Stage IVb esophageal cancer with distant metastasis has a poor prognosis with a 5-year survival rate of approximately 10%. Among distant metastases, the treatment strategy for esophageal cancer with metastasis to the #16 para-aortic lymph node has not been defined, and the significance of surgical resection is not clear.

Methods
Using the database of Osaka University and related institutions, we selected 41 cases of thoracic esophageal cancer with simultaneous #16 metastasis that underwent surgical resection between 2005 and 2021, and examined treatment outcomes.

Results
Patient background was median age 64 (43-76) years, gender M/F = 32/9, and primary site of occupancy Ut/Mt/Lt = 1/17/23. Tumor progression was cT factor T1/T2/T3/T4 =0/6/25/10, cN factor N0/N1/N2/N3 =0/13/19/9. Chemotherapy was administered as initial therapy in 38 patients, and CRT was administered in 3. Primary esophageal resection was performed in all 41 patients, and metastases were resected in 36 patients (88%). 38 patients (93%) were eligible for R0 resection. Pathologically, pT0-2/T3-4=22(54%)/19(46%), pN0/1/2-3 8(20%)/6(15%)/27(66%), and pN2 or higher were common. The 3-/5-year survival rate for all patients was 22.8%/19.0%. In all cases, pN0-1 had significantly better survival than pN2-3 (p=0.0252).

Conclusion
Conversion surgery for esophageal cancer with simultaneous #16 metastasis had a relatively good outcome, suggesting that the pN factor may be a prognostic factor.
290. EVALUATION OF THE POST-OPERATIVE GERD AND RESIDUAL CHEST PAIN AFTER POEM
Authors: Muranami Yuto , Sato Chiaki , Taniyama Yusuke , Okamoto Hiroshi , Ozawa Yohei , Ishida Hirotaka , Koseki Ken , Kamei Takashi 
Published: September 2024

Abstract

Background
Per-oral endoscopic myotomy (POEM) for esophageal achalasia has increasingly become a mainstream procedure worldwide, and its short and middle term efficacy and safety are more and more recognized. However, the long-term outcomes are still unclear and we sometimes experience the cases with severe post-operative GERD and residual chest pain.

Methods
We retrospectively reviewed 241 cases who were performed POEM in our center from Apr 2015 to Feb 2022 and evaluate their post-operative GERD and residual chest pain.

Results
Before POEM, 126 cases (54.8%) had chest pain. Residual chest pain 2 months after POEM was observed in 28 patients (23.1%). 78.2% had complete remission of chest pain after 1 year. Severe GERD (LA Grade C or D) 2 months and 1 year after POEM was observed in 5.1%, 8.2%, respectively. All of them except one patient were improved by PPIs. On univariable analysis, younger patients and pre-treatment were at risk for residual chest pain (p=0.02, p=0.04, respectively). Higher BMI was risk for severe GERD after 2 months (p=0.02), however it was not associate with that after 1 year (p=0.04).

Conclusion
Younger age and pre-treatment were at risk for residual chest pain after POEM and post-operative severe GERD was related to higher BMI, however almost all of them was controlled by PPIs. The number of cases was small, so it is necessary to accumulate more cases.
291. CLINICAL OUTCOMES OF IMMUNOCHEMOTHERAPY FOR UNRESECTABLE OR RECURRENT ESOPHAGEAL SQUAMOUS CELL CARCIONOMA
Authors: Nakajima Yasuaki , Ogiya Kazuo , Miura Shunsuke , Nakata Yutaka , Yamamoto Yudai , Iwata Noriko , Endo Haruhisa , Saeki Ichiro , Takahashi Sadao 
Published: September 2024

Abstract

Background/Aim
KEYNOTE-590 and CheckMate 648 study showed significantly feasible clinical outcomes in patients with advanced esophageal carcinoma. Herein, we report our clinical results of immunochemotherapy for unresectable and recurrent esophageal squamous cell carcinoma.

Patients and Methods
17 patients who received pembrolizumab plus 5-fluorouracil and cisplatin (IO+C) and 9 patients who received nivolumab plus ipilimumab (IO+IO) were enrolled.

Results
The median age of the IO+C group was 70 years, and all patients had unresectable disease. A median of 2 courses of treatment were performed, and the best overall response rate was 68.6% including CR in 2 patients, PR in 9 patients, SD in 4 patients, PD in 1 patient and NE in 1 patient. One-year progression-free survival rate (PFS) was 36.1% and one-year overall survival (OS) was 64.6%. Immune-related adverse events (irAE) included liver damage in 4 patients, skin damage in 4 patients, thyroid dysfunction in 2 patients and lung damage in 1 patient. The median age of the IO+IO group was 79 years, with 3 patients of unresectable disease and 6 patients of recurrence. A median of 2 courses of treatment were performed, and the best overall response rate was 71.4% including CR in 4 patients, PR in 1 patient, SD in 1 patient, PD in 1 patient, and NE in 2 patients. One-year PFS was 68.6% and one-year OS was 85.7%. irAE included liver damage in 3 patients, skin damage in 6 patients, thyroid dysfunction in 2 patients, rhabdomyolysis in 1 patient and hypopituitarism in 1 patient.

Discussion/Conclusion
Currently, in our institute, IO+C is the first choice for unresectable esophageal carcinoma, and IO+IO is selected for patients who are unresponsive or intolerant to FP, patients requiring outpatient treatment and patients with recurrent disease. Although long-term clinical outcomes will need to be examined, immunochemotherapy is very useful and it is necessary to examine the effective use of IO+C and IO+IO in the future.
295. SAFETY OF SURVEILLANCE GASTROSCOPY AND ENDOSCOPIC ULTRASONOGRAPHY IN THE OESOPHAGUS AFTER NEOADJUVANT CHEMORADIOTHERAPY: RESULTS FROM THE SANO COHORT
Authors: Gangaram Panday Sanjiv SG , Yean Low Kuan , Spaander Manon CW , Bisseling Tanya M , Curvers Wouter L , van Dieren Jolanda , Quispel Rutger , Oostenbrug Liekele , van der Linden Andries , Corporaal Sietske , Hol Lieke , Kouw Eva , van der Kraan Jolein , Hazen Wouter L , Honing Judith , van Lanschot Jan JB , Mostert Bianca , Nuyttens Joost J , Wijnhoven BasPL , van der Sluis Pieter C , Lagarde Sjoerd M 
Published: September 2024

Abstract

Background
An organ sparing strategy has been proposed for patients with oesophageal cancer and a clinically complete response after neoadjuvant chemoradiotherapy (nCRT). This active surveillance strategy involves (repeated) oesophagogastroduodenoscopy (OGD) with bite-on-bite biopsies and endoscopic ultrasonography (EUS). The preSANO trial and preliminary results of the SANO trial concluded that these procedures are safe to identify those with a clinically complete response. However, the safety of these procedures beyond that timeframe remains unknown. The aim of this study is to assess the safety of endoscopic procedures after nCRT, extending beyond three months.

Methods
This is a retrospective multicentre cohort study. All patients who participated in the pre-SANO and SANO studies were included. All were treated with CROSS nCRT for oesophageal cancer and underwent (repeated) endoscopic response evaluations (OGD with bite-on-bite biopsies and/or EUS with fine needle aspiration, as indicated). Primary outcome was serious adverse events (SAE) as defined by Central Committee on Research Involving Human Subjects (CCMO) associated with endoscopic procedures which include (but are not limited to) bleeding, infection and perforation. Secondary outcome included mechanical injury.

Results
A total of 919 patients underwent at least one endoscopic response evaluation. Some 2355 endoscopic procedures (61% OGD with EUS combined, 33% OGD and 6% EUS) were performed. Of these, 819 (35%) were performed more than three months after nCRT. SAEs were reported for five endoscopic procedures (0.2%) and included three cases of gastrointestinal bleeding after OGD with biopsies and two cases with infection secondary to the endoscopic procedures. No significant difference in SAEs was found between the procedures conducted before and more than three months after nCRT (2 vs. 3, OR 2.8, 95% CI, 0.3 – 33.7, P = 0.35).

Conclusion
OGD with biopsies and EUS are both procedures which can be safely performed after nCRT during an active surveillance strategy.
296. CLINICAL T1B-SM2-3N0M0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Iizuka Toshiro , Noma Eriko 
Published: September 2024

Abstract

Background
With advancements in endoscopic techniques, safer and more reliable endoscopic resection of submucosal invasive lesions has become feasible. The evaluation of treatment outcomes for superficial esophageal carcinoma has typically been predicated on the depth of pathological diagnosis; however, there have been limited studies based on preoperative diagnosis. Given that treatment decisions in clinical practice are primarily guided by preoperative diagnosis, there is a heightened emphasis on studies grounded in preoperative assessments. This study aims to analyze the accuracy of preoperative diagnosis of T1b-SM2-3 N0M0, evaluate the accuracy of treatment selection and depth diagnosis, and assess long-term outcomes based on these determinations.

Methods
Thirty-eight patients diagnosed with T1b-SM2-3 N0M0 between April 2010 and December 2020 were included in the study. Depth diagnosis was determined through endoscopic evaluation utilizing white light, NBI, NBI magnification plus EUS, with lymph node metastasis diagnosis performed via CT imaging. Treatment decisions were made following patient consent, and long-term prognosis was assessed for each treatment modality.

Results
Initial treatment involved ESD in 14 patients, with an additional 5 patients undergoing additional treatment (ESD + AD) based on histological evaluation (surgery: 1, CRT: 4). Surgery or neoadjuvant chemotherapy (NAC) followed by surgery was performed in 15 patients, with CRT administered in 7. Among the 22 patients who did not receive NAC and whose histologic depth was evaluable, the accuracy rate of depth diagnosis was 64%, primarily attributable to overdiagnosis. In the 14 patients who underwent ESD excluding piecemeal resection, the negative rate of vertical margins was 93%. Five-year overall survival rates were as follows: ESD: 64.8%, ESD+AD: 75%, surgery: 86.2%, and CRT: 45.7%, with no statistically significant differences observed. The majority of deaths (83%) were attributed to other diseases or cancers, with only 2 deaths attributed to the primary disease.

Conclusion
ESD or surgery emerged as the preferred treatment modalities in the majority of cases, with relatively favorable long-term prognoses. Treatment decisions were influenced by comorbidities and other factors, potentially impacting long-term outcomes.
297. ASSESSING BLOOD-BASED BIOMARKERS IN OESOPHAGEAL CANCER PATIENTS RECEIVING NEOADJUVANT CHEMORADIOTHERAPY
Authors: Al Azzawi Mohammed , O’Reilly D , Hill A , Crown J , Collins DM , Robb WB 
Published: September 2024

Abstract

Background
Oesophageal cancer is the sixth most common cause of cancer-related deaths globally. It has a significant rate of mortality despite the multimodal approach to treatment. Neo-adjuvant chemoradiotherapy is standard of care but there is a clinical need for new therapies. HER2-targeted therapies and immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have emerged as treatment strategies of significant interest in recent years. This study focuses on exploring potential plasma-based biomarkers (growth factors, cytokines, soluble (s) PD-L1) in patients (pts) with oesophageal cancer receiving standard of care neo-adjuvant therapy and stratified based on HER2 expression and pathological complete response (pCR).

Methods
50 pts with oesophageal cancer who are eligible for neoadjuvant therapy were recruited. Blood samples were taken pre-treatment, on the first day of the 2nd cycle and post-neoadjuvant treatment. Plasma was extracted within four hours of blood draw and stored at -800C. 20 matched pre- and post-treatment samples were included in this analysis. HER2 status (IHC 3+ (n=3), IHC 2+ (n=5), IHC 1+ (n=3), IHC 0 (n=6) was available for 17 pts. 3 pts achieved a pCR but no HER2 IHC data was available. The levels (pg/ml) of 21 analytes were assessed using the Human Growth Factor Luminex Performance Assay and a Luminex MagPix system. Changes were significant if p&lt;0.05, paired student’s t test.

Results
Twenty-one biomarkers of response were assessed in the final analysis. Platelet-derived growth factor (PDGF)-AA and PDGF AA/BB displayed the highest concentration levels of the tested analytes but levels did not change pre-and post-treatment. GRO-b (CXCL2) and vascular endothelial growth factor (VEGF) displayed a numerical increase post-treatment but this did not prove significant (p&lt;0.05). Tumour-necrosis factor-related apoptosis-inducing ligand (TRAIL) protein decreased significantly post-therapy (p=0.038). PD-L1 levels significantly increased in the post-treatment cycles (paired t-test p=0.0029), especially in pts with HER2+ status. TRAIL or sPD-L1 levels were not significantly different when categorised by HER2 IHC or pCR status.

Conclusion
The increase in sPD-L1 and reduction in TRAIL levels in the peripheral blood of oesophageal cancer patients following neoadjuvant therapy suggests treatment alters factors associated with immune-suppression and the induction of tumour cell death. Further investigation in a larger cohort is warranted.
306. TREATMENT OF ANASTOMOTIC LEAKS AFTER ESOPHAGECTOMY AND GASTRECTOMY FOR CANCER BY MEANS OF ENDOSCOPIC VACUUM THERAPY
Authors: Turrado-Rodriguez Victor , Sendino Oriol , Piulachs Jordi Farguell , Garcia Anna Curell , Olanl Ainitze Ibarzabal , Pera Miguel , Garcia Dulce Momblan 
Published: September 2024

Abstract

Background
Esophagectomy and gastrectomy are the cornerstones of the curative treatment of oesophageal and gastric cancer. In both techniques the risk of anastomotic leak (AL) is high, with rates of up to 21% after esophagectomy and up to 12% after gastrectomy. Mortality and morbidity are high after an AL occurs. Several treatment strategies have been developed for treatment of AL, including surgery, endoscopic stent and endoscopic vacuum therapy (EVT). The aim of this study is to analyse the treatment patterns of the patients with AL treated with EVT.

Methods
All patients diagnosed of gastric or oesophageal cancer with AL from January 2021 to January 2024 were included in a retrospective study. Baseline data, localization of the tumour, type of resection, type of anastomosis, total time with EVT, number of EVTs used per patient, hospital stay, Clavien-Dindo score and CCI were recorded. A descriptive analysis of the data is performed.

Results
All 18 patients with AL during the study period were treated with EVT. The tumour was located on the distal third of the oesophagus in 7 patients (38.9%), and stomach (27.8%). The median duration from surgery to the identification of AL was 5 days (IQR 4 – 9). The median duration of the EVT treatment was 18 days (IQR 13 – 23) with a median EVT replacement of 5.5 (IQR 4 – 7). 8 patients (44.4%) did not require ICU stay. Median time to resumption of oral intake was 34 days (IQR 26 –54). Success rate of the EVT therapy was 88.9%.

Conclusions
EVT is a useful tool for the treatment of AL in esophagogastric surgery. Even though the treatment may be long, it’s success rate in this series is 88.9% and it may avoid ICU stay in some cases. A close monitoring of this patients and the prompt use of additional techniques to assure source control is mandatory.