bluuebunny/crossref_metadata_2025_split huggingface dataset:
422. MANAGEMENT OF ANASTOMOTIC LEAK AFTER TOTAL GASTRECTOMY WITH THE “RENDEZ-VOUS” HYBRID TECHNIQUE: PRESENTATION OF OUR APPROACH AND RESULTS
Authors: Katsila Sofia , Saliaris Konstantinos , Triantafyllou Alexandra , Theodorou Andreas , Kakounis Konstantinos , Linardoutsos Dimitrios , Smparounis Spyridon , Xiromeritou Vasiliki , Triantafyllou Tania , Theodorou Dimitrios 
Published: September 2024

Abstract

Background
Anastomotic dehiscence following total gastrectomy and Roux-en-Y reconstruction remains a demanding clinical scenario, associated with high morbidity and mortality rates. Management options focus on controlling systemic and local sepsis while allowing for proper anastomotic healing. Optimal treatment algorithm remains to be determined and therapeutic strategy is being individualized. The primary goal of the present study is to present the modified rendezvous stenting technique, a technique implemented in our department during reoperation for washout, in critically ill anastomotic leak patients.

Methods
We performed a retrospective descriptive analysis of severely ill patients suffering an anastomotic leak from an esophagojejunal anastomosis, who had been operated in our department during the last five years (01/2018-12/2023). All patients were operated on by the same surgical team and endoscopy was performed by the same endoscopist. Data regarding patients who had been subjected to the modified rendezvous technique were collected.

Results
Since 2018, five anastomotic leak patients underwent stenting over the anastomosis using the modified rendezvous technique during relaparotomy. Stenting was effective in controlling local contamination in 4 out of 5 patients (80%). One patient required repeat stent placement due to stent migration. Overall the 30 day mortality rate was 20% and no deaths directly attributed to the leak were observed. Stents remained in position for an average of 4.25 weeks.

Conclusion
Anastomotic stenting using the rendezvous technique is a safe and feasible technique. It can prove useful in controlling local abdominal contamination in severe anastomotic leak patients, while minimizing the risk of stent migration. Further implementation of the technique will allow for more reliable conclusions to be drawn, regarding the technique’s actual effectiveness.
423. ROBOTIC SURGERY FOR BENIGN ESOPHAGEAL DISEASE: PROMOSING OUTCOMES OF AN EARLY CASE SERIES
Authors: Saliaris Konstantinos , Karikis Ioannis , Varsos Panagiotis , Smparounis Spyridon , Linardoutsos Dimitrios , Katsila Ms Sofia , Pachos Nikolaos , Theodorou Andreas , Triantafyllou Tania , Theodorou Dimitrios 
Published: September 2024

Abstract

Background
Laparoscopic surgery is a well-established approach in the treatment of benign gastroesophageal junction (GEJ) disease. Robotic platforms have only recently been incorporated in surgery for esophageal motility disorders and their exact value remains to be determined. In the present study, we present our initial experience through a case series of patients with benign GEJ disease treated using the DaVinciXi robotic system in our department.

Methods
Patients undergoing surgery for benign GEJ disease during the last 5 years (01/2029-12/2023) were prospectively collected. Data regarding their perioperative and postoperative course was evaluated. All patients attended regular follow-up appointments. Patients with relapse or deterioration of their symptoms were referred for objective testing using high-resolution manometry or 24-h impedance pHmetry.

Results
12 patients with achalasia were subjected to robotic Heller myotomy and modified Dor fundoplication, 13 patients underwent hiatal hernia repair and 2 patients underwent Nissen fundoplication due to severe reflux. Median operative time was 110min (96-150) and no intraoperative or postoperative complications were observed. All patients demonstrated resolution of their symptoms, with a median postoperative Eckardt score of 2 for patients with achalasia and median GERD score of 1 for patients with GERD. 2 patients with achalasia were subjected to impedance manometry due to temporary symptom relapse, without any abnormal findings.

Conclusion
The incorporation of robotic platforms in the treatment of achalasia, reflux and hiatal repair is safe with excellent perioperative and postoperative functional results, when performed in a high-volume center. Further experience will demonstrate potential advantages and disadvantages of the method and will allow for reliable comparison to the laparoscopic approach.
425. PARACONDUIT HIATAL HERNIA FOLLOWING ESOPHAGECTOMY IN A PORTUGUESE TERTIARY CENTER
Authors: Ávila Leonor , Gonçalves Beatriz , Chumbinho Beatriz , Girão Carmo , Cabral Francisco , Ramos Paulo , Monteiro Cecília , Casaca Rui , Abecasis Nuno 
Published: September 2024

Abstract

Background
Esophageal Cancer is the seventh most common cancer worldwide with poor overall survival. As minimally invasive esophagectomy is becoming the new standard of care, an increased incidence of para-conduit hiatal hernias has been reported. Possible risk factors, other than those related to the operative approach have been suggested, such as location of the tumor. Histological type may also account for the increased incidence of hiatal hernias due to shift from esophageal squamous cell carcinomas to adenocarcinomas of the gastro-esophageal junction in Western world. We reviewed our center’s experience to determine whether the adoption of minimally invasive esophagectomy was associated with an increased incidence of para-conduit hernia.

Methods
A single-center, prospective database was used to retrospectively analyze consecutive patient who underwent esophagectomy between January 2007 and December 2023.

Results
Between January 2007 and December 2023, 497 patients were submitted to esophagectomy (Ivor-Lewis, McKeown or transhiatal) due to cancer (242 squamous cell carcinomas and 255 adenocarcinomas); 163 proximal esophageal cancers and 323 distal esophageal cancers.
An hiatal hernia was diagnosed in 11 (2.21%) of 497 included patients submitted to esophagectomy; 5 (3.25%) after 154 totally minimally invasive esophagectomies, 3 (11.11%) after 27 hybrid esophagectomies and 3 (0.95%) after 316 open esophagectomies. The median days to diagnosis of hiatal hernia was 199 (6-3881) days. Surgical treatment consisted of cruroplasty in 1 patient, crurorrhaphy in 6 patients, reduction of herniated contents in 4 patients. The tumor was located proximally in 1 patient whereas the remaining 10 were at distal esophagus or at gastro-esophageal junction. Regarding pathologic evaluation, 2 were squamous cell carcinomas (0.82%) and 9 adenocarcinomas (3.53%).

Conclusion
In our experience, the adoption of minimally invasive esophagectomy has been associated with an increase of symptomatic para-conduit hernia, in line with the reports of recent meta-analyses. The prevalence of paraconduit hiatal hernia was also increased in adenocarcinomas, revealing the shift in the histological type in Western world.
The true rate of herniation may be much higher, as our patients are not routinely submitted imaging diagnostic tests as part of their follow-up.
426. TAILORED MANAGEMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY IN A SPECIALISED UNIT IN THE ERA OF HYBRID AND ENDOSCOPIC NOVELTIES
Authors: Triantafyllou Alexandra , Theodoropoulos Charalampos , Varsos Panagiotis , Kitsou Eleni , Saliaris Konstantinos , Matthaiou Georgia , Katsila Sofia , Kakounis Konstantinos , Xiromeritou Vasiliki , Triantafyllou Tania , Theodorou Dimitrios 
Published: September 2024

Abstract

Tailored management of anastomotic leak after esophagectomy in a specialised unit in the era of hybrid and endoscopic novelties.
Triantafyllou Alexandra1, Theodoropoulos Charalampos2, Eleni Kitsou1, Saliaris Konstantinos1, Karikis Ioannis1, Pachos Nikolaos1, Katsila Sofia3, Kakounis Konstantinos3, Triantafyllou Tania1, Xiromeritou Vasiliki3, Theodorou Dimitrios1
1. 1st Propaedeutic Surgical Department, Hippocratio General Hospital of Athens, University of Athens, Greece
2. Surgical Department, Tzaneio Hospital, Greece
3. Department of Gastroenterology, Hippocratio General Hospital of Athens, Greece

Background
Anastomotic leak following esophagectomy remains one of the most dreadful complications with high rates of morbidity and mortality. This study aims to delineate the incidence, therapeutic strategies, and associated outcomes of esophagogastric anastomotic leak in our unit.

Methods
We retrospectively analyzed prospectively collected data of patients diagnosed with anastomotic leak following esophagectomy. The treatment modalities and the patient outcomes are presented.

Results
199 patients underwent esophagectomy between 2019 and 2023. Among them, 21 patients (10.6%) were diagnosed with anastomotic leakage. 17 out of these 21 patients (81.0%) were male, and the mean age was 58.6 years. 14 out of the 21 patients had cervical anastomosis (leak rate: 8.6%) and 7 patients intrathoracic anastomosis (leak rate: 18.9%). Significant reduction of the intrathoracic anastomotic leak rate was recorded within 2013 (0%) following revision of the anastomotic technique. No deaths were observed, and the average time to healing was 29.1 days. Endoscopic stenting was employed in 12 patients (57.1%), reoperation in 5 (23.8%), bedside wound exploration in 7 (4.8%) and one patient was treated conservatively. Besides stenting, 4 patients (19.0%) underwent percutaneous drainage procedures under radiological guidance.

Conclusions
Managing esophageal anastomotic leakage presents significant challenges. Optimal outcomes for anastomotic healing and patient survival are achieved through a multidisciplinary and individualised approach encompassing interventional radiology or endoscopy and/or reoperation in selected patients.
428. MIDDLE MEDIASTINAL LYMPHADENECTOMY IN MEDIASTINOSCOPIC ESOPHAGECTOMY FOR ESCC
Authors: Konishi Hirotaka , Fujiwara Hitoshi , Shiozaki Atsushi , Nishibeppu Keiji , Ohashi Takuma , Kubota Takeshi , Otsuji Eigo 
Published: September 2024

Abstract
(Introduction) In mediastinoscopic esophagectomy, it is necessary to secure a view of the deep middle mediastinum. Although tracheal carina lymph nodes can be stably dissected using a cervical approach, but they are dissected using a hiatal approach when it is difficult to secure the field of view. (Middle mediastinum dissection) It is important to at least peel off the tracheal membrane or azygos vein in order to reduce the risk of secondary injury in the hiatal approach, even if cervical approach is difficult. In that case, the attachment between the esophagus and subcarinal tissue should be maintained for the en-block dissection. In the hiatal approach, the dissection along the pericardial and aortic surface is continuous with the dissection layer in the cervical approach and left and right tracheal cartilage are exposed enough. In the left side, the dissection along the inferior pulmonary vein is connected to the dissection of No.109L lymph node. Then, in the right side, similarly dissect the subcarinal lymph nodes along the right bronchus (No.109R lymph node). At this time, it is important to carefully check the position of azygos vein to avoid injury. Finally, the lymph nodes at the apex of the tracheal carina are sufficiently cauterized and dissected. (Conclusion) When it is difficult to reach the subcarinal tissue in cervical approach due to body type or tumor factor, the hiatal approach is necessary for sufficient lymphadenectomy of the middle mediastinum. At that case, prior detachment of the tracheal membrane and azygos vein will be important to reduce the risk of secondary injuries. Maintaining the continuity between the esophagus and dissected tissue is also important for the stable field of view.
441. EXTENT AND BOUNDARIES OF LYMPH NODE STATIONS DURING MINIMALLY INVASIVE ESOPHAGECTOMY: A SURVEY AMONG DUTCH ESOPHAGEAL SURGEONS
Authors: van der Aa Dillen , Ketel Mirte , Henckens Sofie , van Berge Henegouwen Mark , Rosman Camiel , Klarenbeek Bastiaan , Gisbertz Suzanne 
Published: September 2024

Abstract

Background
The optimal extent of lymph node dissection (LND), and the anatomical boundaries per lymph node station (LNS) during minimally invasive esophagectomy (MIE) for esophageal cancer remains a topic of debate. This study investigated the opinion of Dutch esophageal cancer surgeons on their routine LND extent and anatomical boundaries per LNS, during MIE.

Methods
In April 2023, an English web-based cross-sectional survey was conducted. Within all 15 Dutch hospitals performing MIE, two MIE surgeons were asked to participate. The routine LND extent (quantity, specific LNS) for distal esophageal adenocarcinoma, (dis)agreement with the TIGER definition, and anatomical boundaries for each LNS in six directions were inquired.

Results
Twenty-four Dutch MIE surgeons completed the survey (80% response rate). Consensus on the routine LND extent (85% or more of the participating surgeons) included the left and right paracardial, left gastric artery, celiac trunk, proximal splenic artery, common hepatic artery, subcarinal middle mediastinal paraoesophageal, lower mediastinal paraoesophageal, pulmonary ligament and upper mediastinal paraoesophageal LNSs. Other LNS were not widely considered routine. Although, certain anatomical boundaries were consistent among surgeons, the majority varied, even when agreeing on the TIGER definition.

Conclusion
Significant variations in surgical practice among Dutch esophageal surgeons, regarding their routine extent of LND and anatomical boundaries of LNSs during MIE were demonstrated. Variation may impact clinical outcomes, hampers uniform treatment strategies, and hinders comparison of performance assessments. This study highlights the need for an international follow-up study towards one uniform defined LND during MIE for esophageal cancer.
449. CAN LARGE ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL SURGERY BE TREATED BY ENDOLUMINAL VACUUM-ASSISTED CLOSURE (EVAC THERAPY)?: A CASE REPORT
Authors: Momblan Dra Dulce , Farguell Jordi , Sendino Oriol , Turrado Victor , Cardin Dra Verena , Ibarzabal Dra Ainitze , Curell Dra Anna , Pera Miguel 
Published: September 2024

Abstract

Background
Anastomotic leakage after esophageal surgery is a deadly complication which approach is still under debate. The high morbimortality of the surgical approach has led to debate whether there are any alternative treatments. The appropriate strategy is based on many factors that include patient’s general conditions, size of anastomotic leakage and diagnosis delay. EVAC (Endoscopic vacuum assisted wound closure) is an emerging technique to treat these patients that can be placed either into the cavity or in the lumen under endoscopic guidance. It is then connected to a negative continuous pressure of 75-125mmhg and then reviewed after 3-4 days.

Methods
A 62-year-old man with esophageal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy, followed by a minimally invasive Mckeown esophagectomy. On the fourth postoperative day, inflammatory indexes increased, and a CT scan showed an anastomotic leakage. It was decided to perform an endoscopy that showed that the leakage was about 70% of the anastomosis opening to a wound cavity of 5cm with necrotic tissue and fibrosis. Due to the clinical stability of the patient, it was decided to treat the anastomotic leakage conservatively by EVAC therapy.

Results
To start the EVAC therapy a polyurethane sponge was placed in the cavity via an overtube during the first endoscopy. The patient underwent a total of 14 EVAC sessions over 85 days. As we performed the sessions, healthy granulation tissue appeared leading the leakage and the cavity size to progressively improve. After the 13th session, the endoscopic evaluation showed a healed anastomosis. A CT scan with oral contrast was performed showing leak resolution. The patient started oral intake and was discharged after four days.

Conclusions
Treatment of anastomotic leakage after esophagectomy is still challenging and presenting high morbidity. The appropriate strategy needs to be individualized. Although surgical reintervention was the classical approach for these patients, new strategies have appeared like the EVAC. It is a promising option to improve the outcome of patients with transmural leakages who would otherwise require surgery. It has demonstrated that it is a reliable, safe and effective treatment.
451. PREDICTIVE FACTORS FOR PNEUMONIA AND ANASTOMOTIC LEAK AFTER TRANSTHORACIC ESOPHAGECTOMY FOR CANCER AND FAILURE TO RESCUE ANALYSIS ON 1355 PATIENTS
Authors: Kemeter Melissa , Kemeter Melissa , Thumfart Lucas , Huettner Felix , Heger Patrick , Koch Oliver , Grechenig Michael , Emmanuel Klaus , Capovilla Giovanni , Riccio Federica , Salvador Renato , Valmasoni Michele , Latorre-Rodriguez Andres R , Mittal Sumeet , Hitzl Wolfgang , Diener Markus K , Dubecz Attila 
Published: September 2024

Abstract

Background
Pneumonia (PN) and anastomotic leak (AL) represent the most feared complications after transthoracic esophagectomy for cancer, the former more commonly observed after open and the latter after minimally-invasive (MI) procedures. Studies comparing these two complications with focus on predictive risk factors and procedure-related failure-to-rescue (FTR) are sparse. Aim of the study was to explore such aspects with a large multicentric dataset.

Methods
All patients who underwent an Ivor Lewis transthoracic esophagectomy for cancer between 2008 and 2022 in four tertiary centers were queried. Predictive risk factors for pneumonia, anastomotic leak and in-hospital mortality were analyzed with univariable models. FTR was defined as in-hospital death following a major complication. Patients were then classified and compared according to the type of operation [open, hybrid-laparoscopic, hybrid-robotic, standard minimally-invasive (MIE) or robotic minimally-invasive (RAMIE)]. Pneumonia and anastomotic leak associated FTR was calculated and compared across the groups. Machine-learning models (neuronal nets, support vector machines and random forests classifier) were applied to predict complications and FTR.

Results
In total, 1,355 patients were included. Significant (p&lt;0.05) predictors for PN (n=211, 15.6%) were ASA=4, preexisting cardiac and pulmonary conditions, conversion (thoracotomy), neoadjuvant therapy and age. Those for AL (n=160, 11.8%) were preexisting cardiac condition, conversion (thoracotomy) and operation time. Overall FTR-rate was 3.6%. Age&gt;65y, preexisting cardiac and pulmonary condition, AL, PN, postoperative bleeding, sepsis, pulmonary embolism, myocardial infarction, arrhythmia and need for blood transfusion were the risk factors significantly associated with in-hospital mortality. PN- and AL- associated FTR rates did not significantly differ among the different operation types (Figure 1). Machine-learning models were unable to predict complications or FTR properly.

Conclusions
Our study showed that there is a greater number of factors associated with pneumonia rather than anastomotic leak, probably making the prevention of this complication more challenging to achieve. However, pneumonia- and leak-associated FTR-rates did not significantly differ among the groups, demonstrating that the implementation of minimally-invasive procedures can be safely carried out, if experience is provided.
454. QUALITY OF LIFE AFTER ESOPHAGECTOMY WITH INTRATHORACIC VS CERVICAL ANASTOMOSIS: A NATIONWIDE COHORT STUDY
Authors: Matthée Eric , Ubels Sander , Verstegen Moniek , Hannink Gerjon , Klarenbeek Bastiaan , van Workum Frans , Rosman Camiel , Grutters Janneke PC 
Published: September 2024

Abstract

Background
Transthoracic esophagectomy with either intrathoracic or cervical anastomosis is considered standard of care in patients with mid to distal esophageal or gastroesophageal junction (GEJ) cancer. Patients after esophagectomy will experience a deterioration in health-related quality of life (HR-QoL) after esophageal cancer surgery. Whilst some reports describe long-lasting deterioration, other reports show recovery of HR-QoL comparable with the general population after 2 years. The aim of this study was to investigate the difference in HR-QoL in patients after a transthoracic esophagectomy with either intrathoracic- or cervical anastomosis in a nationwide database.

Methods
A nationwide cohort study was performed combining data from two registries: Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients after esophagectomy for mid/distal esophageal or GEJ cancer between 2015 and 2022 were included. HR-QoL was measured at baseline, 3, 6, 9, 12, 18, and 24 months postoperatively using EORTC QLQ-C30 and OG-25 questionnaires.
Linear mixed models were used to assess the mean score difference between patients with intrathoracic and cervical anastomosis. A difference of 10 points or more was considered clinically relevant. Adjustments were made for potential confounders (age, gender, ASA classification).

Results
Of the 4269 registered patients in the NCR, in 1274 patients at least one questionnaire was available. Of these patients 346 underwent an esophagectomy with cervical - and 928 with intrathoracic anastomosis. Patients after esophagectomy with cervical anastomosis reported statistically significant more problems in the following categories: dysphagia, couching, trouble eating with others and swallowing saliva during the first 3 months, choked when swallowing and trouble talking during the first 12 months postoperatively. In all other categories no significant difference was found. Only trouble talking at the 3-month time point was considered as a clinically relevant difference.

Conclusion
Although the intrathoracic anastomosis is associated with significantly better HR-QoL in several categories, only trouble talking at 3 months postoperatively was considered clinically relevant. Overall HR-QoL was comparable for esophageal cancer patients after an esophagectomy with either a cervical or intrathoracic anastomosis.
465. INNOVATION TO STANDARDIZATION OF THORACOLAPAROSCOPIC ESOPHAGECTOMY: CULMINATION OF THREE DECADES OF EXPERIENCE
Authors: Palanivelu C , Parthasarathi R , Ramesh N 
Published: September 2024

Abstract
Minimally invasive esophagectomy has seen a great deal of evolution over the last three decades. As one of the earliest adopters of minimally invasive approach for esophagectomy, we present our experience and the lessons we have learnt in over 1300 cases. We adopted the prone position and later modified to mid prone position for the thoracic phase of esophagectomy. This position has several advantages of better exposure due to gravity aided retraction of the lungs, clear operating field as blood trickles away as well as feasibility of rapid conversion to open thoracotomy in emergencies. A major transformation in our surgery was the technical modifications and the extent of mediastinal lymphadenectomy. With refinements in technique and greater understanding of the lymphatic spread, we evolved from standard to extended and even total mediastinal lymphadenectomy improving the oncological outcomes without increasing the operative morbidity. The mean total lymph node yield is over 35. Recurrent laryngeal nerve injury was noted in 7% of cases. The technique of anastomosis was also extensively modified from hand sewn to circular stapler to semi mechanical and finally fully mechanical side to side anastomosis using triangulation technique. The triangulation technique has led to significant reduction in leak rates to less than 5% and stricture formation (&lt;1%). Finally, our innovative railroading technique for specimen extraction through the neck is oncologically safe that avoids large incisions in the chest or abdomen. The 30 day mortality rate is less than 1%