bluuebunny/crossref_metadata_2025_split huggingface dataset:
458. THORACOSCOPY VERSUS ENDOSCOPY IN THE TREATMENT OF ESOPHAGEAL LEIOMYOMA: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Zhang Shaoyuan , Geng Zihan , Yang Xinyu , Ren Changhao , Zhou Pinghong , Tan Lijie 
Published: September 2024

Abstract

Background
Esophageal leiomyoma, also called Esophageal Smooth Muscle Tumor (SMT), is one of the most common benign tumors of the esophagus. Surgical treatment is the most widely used method, including thoracic surgery such as thoracotomy, and VATS, and endoscopic surgery such as ESD and STER. We aimed to conduct a retrospective analysis of all esophageal leiomyoma surgeries in our center to assist decision-making in minimally invasive surgery for leiomyomas.

Methods
From January 2015 to September 2023 patients with pathologically diagnosed esophageal leiomyoma at our hospital were retrospectively enrolled. Those who had any pathological malignant component or lack of detailed clinical information were excluded. At the same time, a 1:1 propensity matching analysis was conducted for thoracoscopy and endoscopic surgery. The matching factors included age, gender, tumor location, and size and the caliper was set as 0.2.

Results
Finally, 1376 patients were included, of whom 153 underwent thoracic surgery and 1223 underwent endoscopic treatment. Endoscopic surgeries were mainly composed of ESD (54.5%) and STER (45.5%), with respective proportions, of which 2 cases used thoracoscopic-assisted endoscopic resection. In the surgical group, 131 patients, accounting for 85.6%, underwent thoracoscopic surgery, of which 65 patients (42.5%) used endoscopic-assisted examination during the operation. In terms of operation time, endoscopic resection was shorter than surgical surgery (44.9 ±39.7 versus 109.4 ± 67.9 min, p&lt;0.001). Similarly, for the postoperative hospitalization days, endoscopic resection was shorter than surgical surgery (2.0 [1.0, 3.0] versus 5.0 [3.0, 6.0] days, p&lt;0.001), we also found that the maximum diameter of surgical resection specimens was significantly larger than that of endoscopic surgery (1.3 [0.8, 2.5] versus 5.0 [3.5, 7.0] cm, p &lt;0.001). After PSM, the operation duration (p=0.031) and hospital stay (p&lt;0.001) were still statistically different between the surgical treatment group and the endoscopic group.

Conclusion
Most esophageal leiomyomas can be resected endoscopically, which can shorten the operation duration and hospital stay compared with thoracic surgery. When the maximum diameter of the tumor is too large or near important organs, thoracic surgery should be the first choice. In order to prevent possible esophageal mucosal damage, thoracoscopic surgery combined with intraoperative endoscopy examination is a safe and effective surgical treatment method.
459. DIAPHRAGMATIC RELAXING INCISION IN THE REPAIR OF DIAPHRAGMATIC HERNIA FOLLOWING OESOPHAGECTOMY: A RETROSPECTIVE STUDY
Authors: Bartz Sam , Sosef Meindert Nico , Belgers Drs Eric Henricus Johannes 
Published: September 2024

Abstract

Background
After oesophagectomy diaphragmatic hernia (DH) is a well-known long-term complication. Approximating the crura around the tubular stomach is often challenging, especially in cases with a wide hiatus. This study evaluates a surgical technique involving a relaxing incision.

Methods
This retrospective study included all post-oesophagectomy patients from 2016 to 2023 who underwent repair for diaphragmatic hernia. Primary outcome measures included incidence over time, postoperative complications, recurrence of DH, surgical technique, and length of hospital stay.

Results
13 patients were included, the relaxing incision was 12 times located on the left side and once on the right. All patients experienced symptoms and 81.3% of the patients were males. The median diameter of the hernia was 70 mm (range 65-100 mm), and the median of the surgical duration was 155 minutes. Complications occurred in 2 patients (2 times transient dysphagia). One recurrence was observed 13 months postoperatively, requiring reintervention. The median hospitalization length was 6 days, with 30.8% needing readmission. In Table 1 additional outcomes and characteristics are presented.

Conclusion
As far as known, this is the largest series of patients post-oesophagectomy in whom DH was repaired using a diaphragmatic relaxation incision. The relaxation incision proves to be a safe method for achieving an effective cruraplasty. It is essential for experienced laparoscopic surgeons to be aware of this technique when managing post-oesophagectomy patients.
460. THE ADDITIONAL VALUE OF CERVICAL ULTRASOUND IN THE DETECTION OF CERVICAL LYMPH NODE METASTASES IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Van Doesburg Jasmijn , Schuring N , Vries MHM , Duvivier KM , de Graaf P , Daams F , van Berge Henegouwen MI , Gisbertz SS 
Published: September 2024

Abstract

Background
Esophageal cancer patients with cervical lymph node metastases, staged according to the 8th edition of the American Joint Committee on Cancer (AJCC), are considered to have stage IV disease and are generally not eligible for treatment with curative intent. External cervical ultrasound (US) used to be standard in the diagnostic workup for detection of cervical lymph node metastases in the Netherlands, but is no longer included in the esophageal cancer guideline. This study aimed to assess the additional value of US over 18FDG PET-CT for the detection of cervical lymph node metastases in esophageal cancer patients, to reassure justified removal of cervical US from the guideline.

Methods
This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2014 and January 2021. Radiology and multidisciplinary team meeting reports were reviewed to identify patients with suspected cervical lymph node(s). Primary outcome was detection rate of cervical lymph node metastases on ultrasound and/or 18FDG PET-CT. Golden standard was etiology based on Fine Needle Aspiration (FNA).

Results
This study included 768 patients, with a median age of 66 years. Patients were predominantly male (75.0%) and the majority had an adenocarcinoma (71.9%). On 18FDG PET-CT, 77 patients had suspected cervical lymph nodes. Of those, 39 proved malignant. Seven malignant lymph nodes were missed on 18FDG PET-CT. 18FDG PET-CT had a positive predictive value (PPV) of 50.6%, a negative predictive value (NPV) of 99.0%, a sensitivity of 84.8% and a specificity of 94.7%. Based on US alone, 134 patients had suspected cervical lymph nodes. Of those, 45 proved malignant. One malignant lymph node was missed on US. US had a PVV of 33.6%, a NPV of 99.8%, a sensitivity of 97.8% and a specificity of 87.7%. In total, suspected cervical lymph nodes were documented in 151 patients (19.7%). FNA was conducted in 134 out of 151 patients. Of those, 46 proved malignant. No major complications after FNA were reported. For 21 patients, this resulted in stage migration and changed policy from curative intent to palliative.

Conclusion
Standard US increases the number of FNA conducted for benign cervical lymph nodes, as the positive predictive value is low (33.6%). However, it does have an additional value as it identifies 15% of cervical lymph node metastases that were not seen on 18FDG PET-CT.
467. DISTRIBUTION OF LYMPH NODE INVOLVEMENT IN PATIENTS WITH GASTRO-ESOPHAGEAL JUNCTION ADENOCARCINOMA
Authors: Walmsley James , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Tham Ji Chung , Wheatley Tim , Chan David SY 
Published: September 2024

Abstract

Background
Curative cancer surgery relies on understanding the lymphatic spread of the tumour to guide lymphadenectomy. The lymphatic involvement in patients with esophageal squamous cell carcinoma (SCC) has been evaluated extensively in large cohort studies from the East where SCC predominates, but the pattern of lymph node spread in gastro-esophageal junction (GEJ) adenocarcinoma is less clear. The primary aim of this study was to compare differences in the pattern of lymph node involvement according to the Siewert classification.

Methods
Consecutive patients who underwent curative resection for GEJ adenocarcinoma between February 2010 and April 2023 were analysed from a prospectively maintained database. Patient demographic data, neo-adjuvant treatment, operation type and histopathological report data were collected and analysed according to the pathological Siewert classification of GEJ cancer.

Results
807 patients who underwent curative surgery for GEJ adenocarcinoma were analysed. The median lymph node yield was 26 (5-81). Comparing positive para-esophageal node yields, Type I and II tumours were similar but both significantly higher than Type III. For positive para-gastric nodes, Type 2 and 3 tumours were similar but both significantly higher than type 1. The significance of these comparisons is presented in table 1. There were no differences comparing other specific nodal groups.
Evaluating the effect of node involvement on overall survival positive node status and positive hepatic artery nodes were found to be independent factors adversely affecting survival.

Conclusion
Siewert type I tumours have greater proximal lymph node involvement compared to type III tumours with higher proportions of positive para-esophageal nodes. Type III tumours on the other hand have higher proportions of para-gastric nodes. Type II tumours have similar para-esophageal node involvement to type 1 tumours and similar para-gastric involvement to type III tumours. Involvement of more specific nodal groups does not seem to vary between the sub types.
474. SELF EXPANDABLE METAL STENT AS A BRIDGE TO RESECTION IN ESOPHAGEAL CANCER – A NATIONAL REGISTER ANALYSIS ON MORTALITY
Authors: Persson Saga , Rouvelas Ioannis , Edholm David , Lindblad Mats , Nilsson Magnus , Klevebro Fredrik , Tsai Jon 
Published: September 2024

Abstract

Background
Patients with esophageal cancer commonly present with malnutrition and weight loss due to dysphagia.
Self Expandable Metal Stent (SEMS) have been used to relieve dysphagia and optimize nutrition prior to surgery and during neoadjuvant treatment. However, SEMS is associated with various complications and studies have further found a decreased survival in patients preoperatively treated with SEMS. The aim of the study was to investigate whether SEMS as a bridge to resection has an impact on mortality.

Methods
All patients with esophageal cancer in the Swedish National Register for Esophageal and Gastric cancer (NREV) between 2006 and 2018 were included.
Patient data, tumor and treatment characteristics were assessed. Resected patients who received SEMS preoperatively were compared to patients who did not receive SEMS with regard to patient, tumor and treatment characteristics. Overall survival was explored by multivariable Cox regression models and adjusted for age, ASA score, preoperative BMI, clinical T-stage and neoadjuvant chemo- or chemoradiotherapy. Primary outcome was mortality.

Results
In total, 1841 resected patients with esophageal cancer and curative intent were identified. Of these, 83 patients received SEMS as a bridge to resection. T-stage was more advanced in patients with SEMS than those without SEMS, but there was no difference in N-stage, ASA-score or preoperative BMI. Early mortality (&lt;90 days) and total mortality was higher in the SEMS group (12.4% vs 5.3%, p=0.002 and 77.1 % vs 58.2%, p&lt;0.001 respectively. Mean follow-up time was 45 months for the all included patients. SEMS was an independent predictor of earlier death in multivariable analysis (Hazard Ratio 1,710; CI 95% 1,27-2,23; p=&lt;0,001).

Conclusion
SEMS as a bridge to resection in the treatment of esophageal cancer seem to be associated with poor outcome with regard to both early and late mortality.
485. OMENTOPLASTY AS AN ADJUNCT IN ESOPHAGECTOMY
Authors: Thammineedi Subramanyeshwar Rao 
Published: September 2024

Abstract
This video highlights the role of Omentum as a patch on anterior aspect of stomach tube pulled up as an adjunt to repair. It can decrease the chance of air leak and potentially decrease the morbidity.
https://drive.google.com/file/d/1AJPKYbxXX8JsJgqbAEFidOv_9Zbeo568/view?usp=drive_link
487. A RARE CASE OF BRONCHOGENIC CYST ESOPHAGUS
Authors: Vijaya Kumar K , Ramesh K , Parthasarathi R , Palanivelu C 
Published: September 2024

Abstract

Introduction
Bronchogenic cyst is a relatively rare congenital malformation that develops from abnormal budding of the ventral foregut during the early stage of gestation. Histologically, the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands.

Case report
We present a 20 yrs male with chest discomfort during swallowing for 6 months. Evaluated with Upper GI scopy showed smooth mucosal elevation 30-35 cm from incisors. CECT Chest Showed features of Intramural cystic lesion of size 7x7cm.Patient was evaluated and taken up for surgery. Robotic Thoracoscopic cyst excison was done. Intraoperatively 7x7cm cystic lesion in lower esophagus infra carinally. Cyst has no communication with mucosa. Post operatively patient recovered well, Drin removed on 3 rd Post operative day and Patient was discharged on 4 th day. Histopathology showed the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands
https://1drv.ms/v/s!AklfEcoVwf9chCmLN-FSXBA2yV3B
494. DO WE NEED GENDER SPECIFIC GUIDELINES FOR ESOPHAGEAL CANCER MANAGEMENT?
Authors: Abdulrahman Maan , Abdulrahman Rand , Viani-Walsh Dylan , Hashem Jamal , Grogan Liam , O'Niell Brian , Kumar Nitya , Sorensen Jan , Walsh Thomas Noel 
Published: September 2024

Abstract

Background
The incidence of esophageal cancer is disproportionately greater in males, but trials of treatments are not gender stratified. It is unclear whether the response or outcome following neoadjuvant chemoradiotherapy (NCR) is gender specific. This study compared the presentation, response to NCR and outcome of female with male patients. (48)

Methods
A prospectively maintained database of 205 esophageal carcinoma patients treated with curative intent between 1998 and 2019 was interrogated for the impact of gender on presentation, response to NCR treatment and survival. (32 words)

Results
Of 205 patients, 59 (29%) females were significantly older than males [mean (SD) age 66.1 (10.8) v. 61.6 (11.2) (p=0.008)]. Sixty-six percent of females had squamous cell carcinoma (SCC) while 116 (79.5%) males had adenocarcinoma (AC) (&lt;0.001). Females with SCC had a mean age 66.7 years versus 58.9 years for males (p=0.006). Seventy-eight percent of females had a clinical complete response (cCR), versus 43.8% of males (P&lt;0.001). Sixty-nine percent of females with AC had a cCR versus 39% of males (p=0.04). Controlling for age, diagnostic stage and treatment type, females survived significantly longer than males [HR 0.71 CI 0.52-0.98 (p=0.035)]. (100 words)

Conclusion
This study found that females were on average a decade older with a significantly greater cCR rate, and a superior survival advantage compared to males. This suggests that randomized trials should stratify for gender. (35 words)
501. CLINICAL APPLICATION OF OESOPHAGEAL CELL COLLECTION DEVICE AND BIOMARKER TESTING IN SYMPTOMATIC REFLUX DISEASE: A NATIONAL RETROSPECTIVE COHORT STUDY
Authors: Chien Siobhan , Glen Paul , Bryce Gavin , Cruickshank Neil , Penman Ian , Robertson Kevin , Phull Perminder , Crumley Andrew , Gunjaca Ivan , Apollos Jeyakumar , Miller Michael , Fletcher Jonathan , Fullarton Grant 
Published: September 2024

Abstract

Background
Oesophageal cell collection device (OCCD) and biomarker testing was implemented nationally across Scotland in 2020 following the COVID-19 pandemic for symptomatic reflux patients referred to secondary care. Collected cells undergo biomarker testing for the presence of trefoil factor 3 (TFF3), an indicator of intestinal metaplasia (IM), in addition to atypia and p53. This national retrospective cohort study is the first to evaluate the clinical application of OCCD testing in symptomatic reflux patients and aims to assess whether OCCD and biomarker testing can safely be used as a triage tool for upper gastrointestinal (UGI) endoscopy in this cohort within secondary care.

Methods
Over a 32-month period, all patients undergoing OCCD testing with Cytosponge™ for investigation of reflux symptoms across 11 Scottish health boards were identified from prospectively maintained databases. In addition to OCCD testing, all patients also underwent clinical assessment either by UGI specialist nurses or consultants in secondary care. Individual patient records were interrogated to collect baseline demographics, OCCD test result and ongoing clinical management. Further analysis was performed on patients who subsequently underwent UGI endoscopy. All OCCD tests for Barrett’s surveillance were excluded from analysis.

Results
1385 OCCD tests were performed for reflux symptoms in 1305 patients. 1103/1385 tests (79.6%) were TFF3 negative: 912/1305 (69.9%) patients discharged with no additional investigations. 355/1305 patients (27.2%) subsequently underwent UGI endoscopy. When insufficient tests with missing biomarker data were excluded, 50/314 patients (15.9%) had biopsies demonstrating IM: biomarkers were significantly more likely to be positive in this group (35.5% vs. 3.2%, p&lt;0.001) (Table 1). 10/1103 patients with a TFF3 negative result (0.9%) had biopsies showing IM, dysplasia or malignancy. 1 patient had a TFF3 negative result but was diagnosed with oesophageal adenocarcinoma 27 months later.

Conclusion
OCCD and biomarker testing is effectively identifying those symptomatic reflux patients requiring further investigation with UGI endoscopy within the real-world setting. Biomarker testing is clearly aiding the diagnosis of Barrett’s oesophagus within this patient cohort. However, clinical assessment remains crucial to identify those with red flag symptoms and judicious follow-up of the discharged group will be critical to validate the ongoing use of OCCD testing in the long-term.
502. COMPARING NEOADJUVANT TREATMENTS REGARDING DYSPHAGIA AND WEIGHT CHANGES FOR PATIENTS WITH OESOPHAGEAL OR GASTRO OESOPHAGEAL CANCER
Authors: Ericson Jessica , Klevebro Fredrik , Sunde Berit 
Published: September 2024

Abstract

Background
Dysphagia is the main symptom for patients diagnosed with cancer in the oesophagus or gastro oesophageal junction (GOJ), but there are lack of recent studies confirming this. Several studies have reported relief of dysphagia during neoadjuvant treatment but there might also be side effects affecting nutritional status resulting in weight loss. We wanted to investigate if there are differences between the mainly used neoadjuvant treatments in Sweden today, namely CROSS, FLOT, and other treatments (OT), for example prolonged neoadjuvant treatment due to oligometastatic cancer. Aims of this study was to investigate dysphagia, weight changes, and main causes of healthcare referral.

Methods
All patients with cancer in the oesophagus or GEJ receiving neoadjuvant treatment followed by subsequent oesophagectomy at Karolinska University hospital in Stockholm, Sweden January 2017 to June 2022 were included in the study. Data were extracted from the local prospective database and the electronic medical records.
To grade the severity of dysphagia we used the five graded Ogilvie score. The weight as well as the dysphagia score was evaluated before oncological treatment and before surgery. The patients were divided into three groups, them receiving CROSS, FLOT and OT, respectively.

Results
There were 69 patients receiving CROSS, 68 receiving FLOT and 28 receiving OT.
The patients experienced relief of dysphagia in all groups, CROSS p&lt;0.001, FLOT p&lt;0.001 and OT p&lt;0.001.
Patients receiving CROSS lost 1.32 kg weight (-8.5 kg to 6.4 kg), while those receiving FLOT gained 0.08 kg (-5.5 kg to 11.1 kg) and OT lost 0.49 kg (-20 kg to 8 kg).
Dysphagia was the main symptom for patients diagnosed with oesophageal cancer or GEJ (65%), other causes (9%), followed by anaemia (8 %), reflux (6%), pain (6%) and au passant (5%).

Conclusion
All groups experienced statistically significant relief of dysphagia during the neoadjuvant treatments. There were small differences in weight changes between the treatment groups, although patients undergoing chemoradiotherapy treatment lost more weight compared to those only receiving chemotherapy. Main cause of referral is dysphagia.

Key words
Oesophageal cancer, neoadjuvant therapy, dysphagia, weight
506. CLINICAL OUTCOMES OF A NEW SURGICAL TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE: RETROSPECTIVE CHART REVIEW OF 28 PATIENTS FROM GERMANY
Authors: Elshafei Moustafa 
Published: September 2024

Abstract

Background
Gastroesophageal reflux disease (GERD) is a troublesome gastrointestinal ailment with significant prevalence worldwide. First-line treatment is attempted with proton pump inhibitor (PPI) therapy, but about 40% of patients experience irresponsiveness. Inadequate response, intolerance, or aversion to long-term therapy are indications for anti-reflux surgery. Fundoplication techniques, magnetic sphincter augmentation, and endoscopic techniques are existing surgical options, but are often associated with postoperative complications like dysphagia. The RefluxStop implant is an emerging technology that has demonstrated effectiveness in managing patients with chronic GERD. This report summarizes the clinical outcomes of 28 patients managed with RefluxStop at a German institution.

Methods
The RefluxStop procedure was performed on 28 patients with chronic GERD in a German center between July 2021 and November 2023. Data was obtained from a retrospective chart review to present the clinical outcomes following RefluxStop surgery, including GERD Health-Related Quality of Life (GERD-HRQL), PPI use, symptom resolution, patient satisfaction, and perioperative adverse events (AEs).

Results
Twenty-eight patients were followed for 14.1±4.7 months. Baseline patient characteristics are shown in Table 1. Median GERD-HRQL score decreased by 90% from a baseline of 40 (IQR 17) to 4 (IQR 5) at follow-up. PPI use decreased from 96.4% at baseline to 7.1% at follow-up. Almost 93% of reflux symptoms were eliminated. Only one patient (3.6%) was not satisfied with treatment. All patients with dysphagia at baseline (42.9%) experienced complete resolution. No reoperations or esophageal dilations were required. Seven patients experienced minor intraoperative AEs (e.g., neck emphysema) but none were procedure- or device-related.

Conclusion
This cohort of GERD patients in Germany demonstrated the safety and effectiveness of the RefluxStop procedure. Significant improvements in quality of life, PPI use, and reflux-related symptoms were observed without consequential safety concerns for over one year. Furthermore, this study corroborates the existing evidence of favorable postoperative safety outcomes associated with RefluxStop. Additional study is necessary to continue validation of this promising new treatment option.
513. ICG -TRACHEOBRONCHIAL FLUORESCENCE IN ESOPHAGEAL SURGERY
Authors: Thammineedi Subramanyeshwar Rao 
Published: September 2024

Abstract
ICG-Tracheobronchial Fluorescence is a useful technique to delineate the tracheo esophageal plane during Esophagectomy. Particularly beneficial for the less trained eye and in salvage settings.
https://drive.google.com/file/d/1BXHMcAmJsDkI4bp8YmQqv85etcVuUqKj/view?usp=drive_link