bluuebunny/crossref_metadata_2025_split huggingface dataset:
527. SURGERY FOLLOWING ENDOSCOPIC RESECTION OF EARLY OESOPHAGO-GASTRIC CANCER AT ONE LARGE TERTIARY UNIT: A RETROSPECTIVE AUDIT
Authors: Khan Sharib , Boag Katie , Michel Martin , Sood Ruchit , Rembraken Bjorn , Coe Peter O 
Published: September 2024

Abstract

Background
Endoscopic resection (ER) is a therapeutic option for early oesophago-gastric (OG) cancer. It is recommended as primary treatment for T1a cancers and as an option in T1b cancers. Following ER, surgery is recommended if high-risk features are identified on post-operative pathology. The aim of this retrospective audit is to evaluate the outcomes of patients who underwent curative intent surgery following ER in a tertiary centre in the United Kingdom, to inform patient selection.

Methods
Data were retrospectively collected from 2015-2020 at one large tertiary referral centre. Patients were included if they underwent EMR for T1 oesophageal or gastric cancer. Patient demographics, information regarding referral and diagnosis, histology, staging, treatment and outcomes were recorded. Patients were offered surgical resection after EMR after discussion at a multidisciplinary team meeting. Data were analysed descriptively.

Results
186 patients underwent ER. Seventeen subsequently underwent curative surgery (Females, n=4), see Table 1 for further details. 41% experienced Clavien-Dindo complications Grade I-V.
Final histology were: 24% no residual cancer, 35% T1a, 24% T1b, 18% T2. The final stage was upgraded in 29%, 47% had the same grade or downgraded. Lymph node metastases were found in 24% of cases. In patients with no residual cancer after oesophagectomy: two had malignant deep margins on ER histology (T1b), one was recommended surgery, and one underwent chemo-radiation. Two patients had clear margins on ER (T1a m1), one had poorly differentiated histology and proceeded to surgery, the other underwent surveillance. Both patients who did not initially undergo surgery had recurrence (8 and 48 months).

Conclusion
Almost 10% of patients underwent surgery following ER. Despite selection criteria following international guidelines, 25% of those who underwent major surgery had no residual cancer following ER although a similar portion had positive lymph nodes. Morbidity and mortality following OG cancer remains significant and further work is required to better identify patients for surveillance following ER.
534. EVALUATION OF SURGICAL OUTCOMES IN ROBOTIC-ASSISTED ESOPHAGECTOMY
Authors: Takabe Yuya , Okabe Hiroshi , Sunagawa Hideki 
Published: September 2024

Abstract

Background
The adoption of robotic surgery for the treatment of esophageal cancer is on the rise, with reports indicating favorable short-term outcomes. This study aims to evaluate the performance of robotic-assisted esophagectomies at our hospital.

Methods
We conducted a retrospective analysis of perioperative outcomes in patients who underwent robotic-assisted esophagectomies. Cases requiring a two-stage operation were excluded.

Results
A total of 64 cases were evaluated, with a median age of 72.0 years (range 46-83). Histological types included SCC/AC/ASC/Other: 49/10/1/4 cases. Clinical stages were 0/I/II/III/IVA/IVB: 1/20/11/27/4/1 cases, respectively. Postoperative complications, classified as Clavien-Dindo (CD) Grade II or higher, occurred in 24 cases (37.5%), which included respiratory complications (pneumonia, atelectasis, pneumothorax) in 7 cases (10.9%), anastomotic leakage in 7 cases (10.9%), recurrent laryngeal nerve palsy in 3 cases (4.7%), anastomotic stricture in 2 cases (3.1%), wound infection in 2 cases, gastric conduit necrosis in 1 case (1.5%), cervical lymphorrhea in 1 case, tracheoesophageal fistula in 1 case, and other complications in 3 cases.

Conclusion
Robotic-assisted esophagectomies have demonstrated favorable short-term outcomes when compared with prior reports. Further studies are warranted to elucidate the reduction of complications and to determine long-term outcomes.
546. ESOPHAGEAL FUNCTION TESTS BEFORE AND AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY FOR SEVERE OBESITY
Authors: Masuda Takahiro , Uno Kohei , Watanabe Atsushi , Tsuboi Kazuto , Hoshino Masato , Takahashi Keita , Sakashita Yuki , Fukushima Naoko , Takeuchi Hideyuki , Sato Kazuhide , Omura Nobuo , Yano Fumiaki , Eto Ken 
Published: September 2024

Abstract

Background
Gastroesophageal reflux disease is common in patients with severe obesity. However, changes in esophageal motility and gastroesophageal reflux in patients undergoing sleeve gastrectomy have not been well-studied. In this study, we evaluated the effects of sleeve gastrectomy on esophageal function.

Methods
All patients undergoing laparoscopic sleeve gastrectomy (LSG) at our institution are entered into a prospectively maintained database. We queried this database to identify patients who underwent pre- and post-LSG esophageal function tests (ie, high-resolution manometry [HRM] and 24-hour pH monitoring). Post-operative was esophageal function tests done at 12 months after surgery.

Results
A total of 44 patients underwent LSG between Jul. 2018 and Dec. 2022, of which 11 patients underwent both pre and post-LSG esophageal function tests. The study cohort had a mean age of 65.4 years with 5 males. BMI was significantly decreased after LSG (40.0 vs. 27.4 kg/m2，p=0.004). Manometric hiatal hernia was increased post-LSG (0% vs. 45.5% [n=5/11]), though this difference did not reach statistical significance (p=0.063). Esophagogastric junction contractile integral (EGJ-CI), thoraco-abdominal pressure gradient, and distal contractile integral (DCI) were similar between the two groups (p=0.155, p=0.154, and p=0.131, respectively). Post-LSG 24-hour pH monitoring showed higher acid exposure time (0.4% vs. 11.2%, p=0.005) and DeMeester score (3.5 vs. 33.2, p=0.003).

Conclusions
Gastroesophageal reflux was significantly exacerbated post-LSG, although esophageal motility and EGJ pressures were preserved after LSG. This may indicate that the change in EGJ morphology and disruption of the angle of His have an important role in mechanism of LSG-related GERD.
557. POTENTIAL THERAPEUTIC TARGETS OF TRPV2 AND SLC12A2 IN ESOPHAGEAL ADENOCARCINOMA CANCER STEM CELLS
Authors: Nakamichi Naosuke , Shiozaki Atsushi , Inoue Hiroyuki , Kosuga Toshiyuki , Shimizu Hiroki , Kudou Michihiro , Ohashi Takuma , Arita Tomohiro , Konishi Hirotaka , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Fujiwara Hitoshi , Otsuji Eigo 
Published: September 2024

Abstract

Background
Cancer stem cells (CSCs) are resistant to current anticancer drugs and radiation. The membrane transporters have recently been reported to play crucial roles for Esophageal adenocarcinoma (EA) CSCs. The aim of our study was to investigate ion channel expression profiles in esophageal adenocarcinoma CSCs (EACSCs) and to examine these potential as therapeutic targets.

Methods
Using the EA cell line OE33, cells with strong ALDH1A1 activity, a CSC marker, were isolated by flow cytometry. The characteristics of CSCs for the separated cells were verified by sphere formation assay, the expression of CSC markers on real-time reverse transcription-polymerase chain reaction and western blotting, and anti-cancer agent sensitivity assay. Gene expression profiles in EACSCs were examined by a microarray analysis. The transporters, high expression in CSC, were examined the anti-tumor effect of these inhibitors.

Results
Separated cells formed spheres in low-adhesion plates. The expressions of CSC markers were higher in CSCs than in non-CSCs. The CSCs also exhibited resistance to cisplatin and redifferentiation potential. The microarray analysis showed that the expression of transient receptor potential vanilloid 2 (TRPV2) and solute carrier family 12 member 2 (SLC12A2), which related to ion channels, were upregulated in CSCs. The cytotoxicities of tranilast and furosemide, which were TRPV2 and SLC12A2 inhibitors respectively, were added to cisplatin.

Conclusions
We revealed that TRPV2 and SLC12A2 are highly expressed in EACSCs and have potential as therapeutic targets for EA.
561. COMMONALITY AND VARIATION IN PERIOPERATIVE ESOPHAGEAL CANCER MANAGEMENT IN HIGH VOLUME EUROPEAN CENTERS
Authors: Jones Daniel , Seely Andrew , Grimminger Peter , Reynolds John , Rosati Riccardo , Hanna George , Nilsson Magnus , Markar Sheraz , van Hillegersberg Richard , van Berge Henegouwen Mark , Gisbertz Suzanne 
Published: September 2024

Abstract

Background
Esophageal cancer is a leading cause of cancer related death worldwide. For patients with locally advanced, non-metastatic, esophageal cancer (EC), surgical resection remains an essential pillar. The multitude of surgical options have driven innovation, however, lack standardization and at times high-quality data-driven practices. A surgeon-level in-depth interview and questionnaire was created to understand the perioperative care pathways and intraoperative techniques used by high-volume European EC centres to gain insight into commonality and variation of current practice.

Methods
Eight (8) expert upper gastrointestinal surgeons were invited to participate in an in-depth interview and questionnaire. The focus included preoperative care pathways for esophageal adenocarcinoma of the distal esophagus/GE junction, technical aspects of esophageal resection (Ivor-Lewis) and postoperative pathways. The involvement of allied health, dedicated research programs, multidisciplinary cancer conference (MCC), follow up protocols and management of T4b EC was also assessed.

Results
The response rate was 100% (8/8). Majority of respondents indicated a country-level regionalization of EC care. The number of centres performing esophageal resection varied from 4 – &gt;100. Average number of esophagectomies/year ranged from 60-150. All centres presented EC patients at MCC, had dedicated research programs, and participated in National and International EC databases. Chemoradiotherapy was the predominate neoadjuvant treatment for GEJ cancers. Pretreatment clinical staging varied, with all centres having different, but pre-defined, preoperative and postoperative pathways. Intraoperative techniques including conduit preparation, feeding tube use, pyloric intervention, thoracic duct ligation and anastomotic technique varied substantially. There was no consensus regarding follow up or management of T4b EC.

Conclusion
The perioperative pathways and technical aspects of esophageal resection shared some commonalities however also differed substantially across high-volume EC centres in Europe. Multicenter, pragmatic randomized controlled trials (RCTs) are needed to better delineate which techniques should be included as standard of care, and which should be abandoned.
565. LAPAROSCOPIC TREATMENT OF HIATAL HERNIAS COMBINED WITH MODIFIED TOUPET FUNDOPLICATION. SURGICAL TECHNIQUE
Authors: Davakis Spyridon , Nitsa Zoi , Mylonakis Adam , Georgios Korovesis , Andreas Alexandrou , Charalabopoulos Alexandros 
Published: September 2024

Abstract

Introduction
Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias.

Aim
This study aims to describe our surgical technique of laparoscopic repair in hiatal hernias, including sliding, paraesophageal and mixed types.

Material and Methods
A total of 65 consecutive patients underwent laparoscopic hiatal hernia repair by the same surgical team within 4 years.

Results
Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac en bloc, 3 cm of intra-abdominal esophageal length, crural closure and an effective anti-reflux procedure as our modified Toupet fundoplication.

Conclusions
Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have significant reflux disease, an operative repair is required. A minimally invasive approach is safe and can provide excellent outcomes in the hand of experts.
https://we.tl/t-KgcOuSyEMt
575. PATHOLOGIC RESPONSE AND RESIDUAL LYMPH NODE PATTERNS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS UNDERGOING NEOADJUVANT IMMUNOCHEMOTHERAPY COMPARED TO NEOADJUVANT CHEMORADIOTHERAPY
Authors: Song Xinyun , Li Yue , Liu Jun , Lin Lin , Zhang Qin , Yu Wen , Fu Xiaolong 
Published: September 2024

Abstract

Background
Concurrent chemoradiotherapy is the cornerstone treatment for locally advanced esophageal cancer. Immunochemotherapy, established as the standard treatment for advanced esophageal cancer, concurrently exhibits excellent short-term efficacy in the neoadjuvant stage. Combining concurrent chemoradiotherapy with immunochemotherapy may enhance control over primary tumor and metastatic lymph nodes, potentially improving patients’ outcomes and survival. Therefore, comparing the pros and cons of these two treatment modalities in controlling primary lesions and lymph node metastasis is crucial for guiding clinical treatment.

Methods
Our study enrolled a total of 137 patients with esophageal squamous cell carcinoma (ESCC) who underwent neoadjuvant immunochemotherapy (NICT) and 151 ESCC patients who underwent neoadjuvant chemoradiotherapy (NCRT) between January 2019 and March 2022. We documented baseline patient characteristics, including clinical TNM stage, tumor location, and clinical metastatic lymph nodes, as well as pathologic outcomes such as pathological stage, pathologic complete response (pCR), tumor regression grade (TRG), and pathological metastatic lymph nodes. To balance baseline patient characteristics, we employed inverse probability of treatment weighting (IPTW) to adjust for confounding in different neoadjuvant treatment groups.

Results
After balancing baseline characteristics, there was no statistically significant difference in pathologic outcomes, including pCR rate, major pathologic response rate, TRG, yp-TNM stage, and R0 resection rate between NCRT and NICT. However, patients with clinical N2-3 stage (OR 2.66; 95% CI 1.05 to 6.79) or lower thoracic esophageal tumors (OR 2.31; 95% CI 1.05 to 5.04) had a higher chance of achieving pCR after NICT compared to NCRT. For patients undergoing NICT, the ypN0 rates for clinically N0 patients were 100.0% (5/5), while only 65.0% (13/20) of clinical N0 patients achieved ypN0 in the NCRT group. Even after adjusting for differences in clinical stage, tumor location, and baseline lymph node metastasis rates in various locations, the NICT group still demonstrated a lower rate of abdominal lymph node metastasis during surgery (p=0.030).

Conclusion
In comparison to concurrent chemoradiotherapy, immunochemotherapy exhibits comparable overall disease control for primary lesions and lymph node metastasis. Notably, patients with clinical N2-3 and lower thoracic esophageal cancer may derive greater benefits from NICT. The potential of immunochemotherapy in enhancing the effectiveness of chemoradiotherapy is evident in its ability to improve the control of occult metastatic lymph nodes and reduce abdominal lymph node metastasis.
577. OUTCOMES OF SIMULTANEOUS RESECTION AND RECONSTRUCTION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA SYNCHRONOUSLY ASSOCIATED WITH HEAD AND NECK CANCER
Authors: Kishino Takayoshi , Feng Dongping , Mastukawa Hiroyuki , Nishiura Bunpei , Kondo Akihiro , Ando Yasuhisa , Suto Hironobu , Asano Eisuke , Oshima Minoru , Kumamoto Kensuke , Okano Keiichi 
Published: September 2024

Abstract
In 1953, a study by Slaughter et al. on oral cancer proposed that field cancerization is the phenomenon of widespread carcinogenesis across multiple regions due to long-term exposure to common cancer-causing factors. Esophageal squamous cell carcinoma (ESCC) and head and neck cancer (HNC) share common risks, such as smoking and alcohol consumption, and are often observed synchronously. Therefore, treatment strategies based on tumor stages are important. In our hospital, for synchronous HNC and thoracic ESCC, local resection is indicated if the HNC is ≤T2, and resection with reconstruction is indicated if the HNC is ≥T3, and a one-stage operation for thoracic ESCC and HNC was generally performed. Here, we examined treatment strategies based on the results of simultaneous resection and reconstruction of synchronous thoracic ESCC and HNC in our hospital.
A total of 174 patients with esophageal cancer underwent surgery at our hospital between January 2008 and December 2023. Among them, 16 (9%) had 18 lesions of synchronous HNC and nine patients (5%) underwent simultaneous resection and reconstruction. Patients with thoracic ESCC had Ut/Mt/Lt; 1/6/2; T-factor, T1/2/3; 5/2/2; N-factor, N0/1:6/3; and clinical stage, stage I/II; 2/6. For synchronous HNC, hypopharyngeal/oropharyngeal/laryngeal/cervical esophageal cancer; 5/2/1/2; T factor was T2/3/4; 1/6/3; N factor was N0/1/2c/3a/3b; 4/2/2/2/1/1; and clinical stage was stage II/III/IV; 1/5/4. Six patients underwent surgery after preoperative chemotherapy or chemoradiotherapy. Total pharyngo-laryngo-esophagectomy (TPLE) was performed using a thoracoscopic transthoracic approach in six patients, transhiatal approach in two, and mediastinoscopic approach in one. Regarding reconstruction, a gastric tube was used in nine patients, including eight patients in whom it was interposed with the free jejunal autograft. The median operative time was 929 min (590–1248 min) and median blood loss was 622 mL (213–1764 mL). Only patients with skin valve necrosis underwent reoperation; however, there were no hospital deaths, and the median postoperative hospital stay was 39 days (28–59 days). Recurrence was observed in four cases. All cases were considered to be due to HNC, and three were stage IV cases with advanced lymph node metastasis.
Simultaneous resection and reconstruction for synchronous HNC and the thoracic esophagus is a highly invasive treatment that can be performed safely. Recurrence has been observed in advanced cases of HNC, and further development of multidisciplinary treatment, including preoperative chemotherapy, is necessary.
585. COMPREHENSIVE RISK SCORE OF THE E-PASS SERVES A PROGNOSTIC INDICATOR FOR PATIENTS AFTER NEOADJUVANT THERAPY AND CURATIVE ESOPHAGEAL CANCER SURGERY
Authors: Liu Yixin , Zhou Jianfeng , Yang YuShang , Chen Longqi 
Published: September 2024

Abstract

Background
Neoadjuvant chemoradiotherapy (nCRT) and curative surgery have been recommended as the standard treatments for locally advanced esophageal cancer. In addition, the comprehensive risk score (CRS) of the physiological ability and surgical stress (E-PASS) scoring system, incorporating both clinical and surgical factors, has proven effective in predicting postoperative complications and mortality. However, the impact of E-PASS scoring system on the prognosis of esophageal cancer remains uncertain. This study aimed to evaluate the comprehensive risk score of E-PASS scoring system for predicting the short- and long-term outcomes of patients treated with nCRT and esophageal cancer surgery.

Methods
Patients with esophageal cancer who underwent curative resection between 2010 and 2022 were retrospectively enrolled in this study. The cohort was divided into the low and high CRS groups. The CRS cutoff value was determined using the Youden index applied to overall survival (OS) curves. Prognostic value was assessed through Cox regression and Kaplan–Meier analyses.

Results
In total, 814 patients were enrolled, including 556 and 258 patients with low and high CRS, respectively. ROC curve analysis determined that the CRS was a highly specific and sensitive predictive tool for postoperative complication occurrence and severity (AUC=0.889 and 0.838, respectively). When the cutoff value was established using the Youden index applied to overall OS curves, multivariate analysis demonstrated that the CRS was an independent prognostic factor for OS (HR: 1.48; 95% CI 1.14–1.92, P=0.003) and recurrence-free survival (HR: 1.44; 95% CI 1.13–1.82, P=0.002), irrespective of esophageal cancer stage and tumor regression scores.

Conclusion
The E-PASS scoring system emerges as a visible predictor of short- and long-term outcomes in patients with esophageal cancer undergoing nCRT and curative surgery.
588. EFFICACY OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A NATIONWIDE INPATIENT COHORT STUDY
Authors: Shigeno Takashi , Okuno Keisuke , Ogo Taichi , Fujiwara Hisashi , Tanioka Toshiro , Kawada Kenro , Haruki Shigeo , Tokunaga Masanori , Fushimi Kiyohide , Kinugasa Yusuke 
Published: September 2024

Abstract

Background
Lymphadenectomy around the recurrent laryngeal nerve (RLN) is an essential part of curative surgery for esophageal cancer. The rate of lymph node metastasis around the RLN is extremely high, and postoperative RLN palsy could lead to a poor prognosis in patients with esophageal cancer. Although several single-center studies have shown that intraoperative nerve monitoring (IONM) can avoid RLN palsy, this has not been confirmed in a large-scale multicenter study. This study was performed to evaluate whether intraoperative nerve monitoring IONM can reduce postoperative RLN palsy during minimally invasive esophagectomy (MIE) for esophageal cancer using a national database.

Methods
We retrieved data of patients with esophageal cancer who underwent MIE involving thoracoscopic or robotic esophagectomy with IONM (502 patients) and without IONM (4,353 patients) at 348 hospitals from April 2020 to March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the frequency of postoperative RLN palsy and respiratory complications between the IONM (+) group and IONM (−) group using propensity score-matching (PSM) analysis. The propensity score was estimated using multivariable logistic regression models including age, sex, Body Mass Index, Brinkman index, Activities of Daily Living, comorbidities at admission, clinical TNM classification, approach of MIE, and hospital case volume with reference to previous studies of IONM.

Results
After PSM, the standardized bias was &lt;10% for all covariates, which indicated improved balance in the covariates between the matched pairs. With 1-to-1 matching, 501 pairs (1,002 cases) were created between the IONM (+) and (−) groups. The postoperative RLN palsy rate was significantly lower in the IONM (+) than (−) group (odds ratio, 0.24; 95% confidence interval [CI], 0.13–0.46). The respiratory complication rate was also significantly lower in the IONM (+) than (−) group (odds ratio, 0.66; 95% CI, 0.45–0.97). The anesthesia time was significantly longer in the IONM (+) group (regression coefficient, 60.1 minutes; 95% CI, 44.2–76.9). The length of postoperative hospitalization tended to be shorter in the IONM (+) than (−) group (regression coefficient, −1.39 days; 95% CI, −3.91 to 1.14).

Conclusion
This nationwide cohort study showed that IONM during MIE for esophageal cancer can reduce postoperative RLN palsy and respiratory complications.