bluuebunny/crossref_metadata_2025_split huggingface dataset:
517. INTERNATIONAL CONSENSUS AND CLINICAL CARE ALGORITHM FOR THE DIAGNOSIS AND TREATMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY
Authors: Stuart Sanne K , Lemmens Jobbe , Nieuwenhuijzen Grard AP , Evans Richard PT , Kamarajah Sivesh K , Wijnhoven Bas , Wong Ian YH , Griffiths Ewen A , Ubels Sander , Klarenbeek Bastiaan R , Rosman Camiel 
Published: September 2024

Abstract

Background
Anastomotic leak (AL) is a common and severe complication after esophagectomy. Guidelines for the management of AL are lacking due to limited evidence, in which case consensus can provide a sound base for guiding clinical practice. This study aimed to develop a consensus-based guideline and clinical algorithm on the diagnosis and treatment of AL after esophagectomy.

Methods
A three-stage modified Delphi study was performed. Stage 1 comprised a scoping systematic review to find available evidence and formulate statements. Methodological quality was assessed using the Newcastle-Ottawa scale. Stage 2 comprised a two-round Delphi survey, globally distributed to surgeons and gastro-enterologists experienced in diagnosing and treating AL. During stage 3, clinical recommendations were formulated by an international expert panel, based on the Delphi consensus and a strength was assigned following GRADE principals. A clinical care algorithm was developed based on these recommendations. This study was performed in collaboration with the ISDE Guidelines Committee.

Results
A total of 5.843 articles were screened, and 118 included to formulate Delphi statements. The Delphi survey was completed by 106 participants in the first round and 136 in the second. Consensus was achieved on 13 statements on diagnosis and 21 statements on treatment of AL. During the guideline development stage, 12 diagnostic recommendations were formulated covering screening, clinical signs, biochemical tests, and imaging for the diagnosis of AL. 15 recommendations were formulated regarding treatment strategies of AL and indications and techniques for supportive care, drainage and defect closure. A clinical care algorithm on diagnosis and treatment of AL was designed.

Conclusion
This study developed clinical recommendations based on consensus and available evidence, and designed a clinical care algorithm for the diagnosis and treatment of AL after esophagectomy. The developed recommendations and clinical care algorithm, may provide clinical support and aid standardized decision-making in clinical practice and potentially improve patient outcomes.
535. AUDITING THE PATIENTS OUTCOMES AFTER SURGERY FOR ESOPHAGEAL AND GASTRIC CARDIA CANCER WITHIN THE 18 YEARS PERIOD. SINGLE CENTER EXPERIENCE
Authors: Pazdro Alexandr , Snajdauf Martin , Faltova Hanka , Wolesky Jakub , Harustiak Tomas 
Published: September 2024

Abstract

Background
Malignant tumor of the esophagus and gastroesophageal junction is a long-term survival limiting disease. Although over the years there has been a significant shift in the quality of surgical care, oncological approach and treatment protocols, despite it is still disease with a very poor prognosis.

Methods
Evaluation of a retrospective database of consecutive patients at our surgical departement from 2005 to 2022. We divided these 18 years into three periods A (2005 – 2010), B (2011 – 2016) and C (2017 – 2022) in which we evaluated overall survival, morbidity, anastomotic complications, 30- and 90-day mortality and number of removed nodes. The difference in the number of patients with adneocarcinoma was between periods A and C, higher by almost 30%, squamous cell carcinoma without an increase.

Results
During the observed period, radical surgery was performed on 1252 patients, 881 patients with adenocarcinoma (70.37%) and 316 patients with squamous cell carcinoma (25.24%) and 4.39% (n=55) with another histological type.
The period A N=384 (2005 – 2010), period B N=405 (2011 – 2016) and C N=463 (2017 – 2022).
Between periods A and C, we recorded an increase in frequency of adenocarcinoma by almost 30%, squamous cell carcinoma without any increase.
62.3% of patients (N=780) underwent neoadjuvant oncological treatment. The indication for its performance was the clinical TNM classification (cT2 and more or cN+), histological type, general condition of the patient and as well patients age.
We indicated for chemoradiotherapy 271 patients (21.65%), CHT 491 (39.22%) RT only in 17 patients and 472 (37.7%) patients designated for surgery without any other treatment.
• 5-year survival in the entire group was 37.20% (Graph No 1) and median survival was 974 days for adenocarcinoma and 909 days for squamous cell carcinoma.
• 30-day mortality for the entire monitored period was 1.92% (24 out of 1252) and 90-day mortality was 5.27% (66 out of 1252).
• Other results are in the attached table.

Conclusion
During the observed period, it is clear that the quality indicators of surgical resection are improving, as well as the 30- and 90-day mortality, but this trend is not clearly manifested in the length of survival.
538. COMPARISON OF EARLY POSTOPERATIVE OUTCOMES OF CERVICAL ANASTOMOSIS TO HIGH INTRATHORACIC ANASTOMOSIS AMONG PATIENTS WITH UPPER THORACIC ESOPHAGEAL CANCER
Authors: Son Jeonga , Lee Genehee , Lee Junghee , Jeon Yeong Jeong , Park Seong-Yong , Cho Jong Ho , Choi Yong Soo , Kim Jingook , Kim Hong Kwan , Shim Young Mog 
Published: September 2024

Abstract

Background
For upper thoracic esophageal cancer, esophagectomy combined with cervical esophagogastrostomy (cervical anastomosis, CA) and three-field lymph node dissection (3FLND) has been proposed as the standard surgical approach. However, while CA provides sufficient length of proximal resection margins, it is associated with a higher incidence of postoperative complications such as anastomotic leaks, recurrent laryngeal nerve (RLN) injury, and increased mortality. As an alternative, high-intrathoracic esophagogastric anastomosis (high-ITA) with 3FLND has been performed. We aimed to evaluate the benefits and limitations of high-ITA compared to conventional CA in terms of early postoperative outcomes.

Methods
A total of 232 patients, who underwent curative esophagogastrostomy with 3FLND and either of high-intrathoracic anastomosis (high-ITA) or cervical anastomosis (CA) for upper thoracic esophageal cancer a tertiary hospital from January 2010 to December 2021. Collected data from medical records were analyzed retrospectively regarding morbidity and mortality rates. The primary end point was recurrence. Anastomotic leak, RLN palsy, hospital stay, and 90-day mortality and in-hospital mortality were evaluated using Chi-squared test, Fisher’s exact test, and T-test. The risk of mortality and recurrence were analyzed using Cox-proportional hazard regression with a median follow-up of 39.1(IQR 17.8, 80.2) months.

Results
Among the fifty patients with high-ITA and 182 patients with CA, the high-ITA group reported fewer anastomotic leaks (6.0% vs. 19.8%, p=0.02) and a shorter hospital stay (median 12days vs. 15 days, p&lt;0.001). No significant difference was observed in RLN palsy (6.0% vs. 13.7%, p=0.22) and the 90-day or in-hospital mortality rate (2.0% vs. 2.2%, p=1.0). The number of lymph nodes dissected (LND) was similar between the groups (47.4(±15.4) vs. 52.7(±18.3), p=0.06), and there was no difference in the risk of mortality and recurrence according to the high-ITA method (HR 0.9, 95% CI 0.6-1.6; HR 1.0, 95% CI 0.6-1.7) after adjustment for age, sex, and stage.

Conclusion
In the esophagogastrostomy with three-field lymph node dissection, performing high-intrathoracic anastomosis may reduce the incidence of anastomotic leaks and shorten the hospital stay without adversely affecting overall survival.
571. A PHASE I/II MULTICENTER STUDY EVALUATING THE EFFICACY AND SAFETY OF INDUCTION IMMUNOCHEMOTHERAPY FOLLOWED BY CONCURRENT IMMUNO-CHEMORADIOTHERAPY IN UNRESECTABLE LA-ESCC
Authors: Song Xinyun , Li Yue , Feng Wen , Cai Xuwei , Zhang Qin , Fu Xiaolong , Yu Wen 
Published: September 2024

Abstract

Background
Despite advances in radiotherapy techniques, the prognosis for patients undergoing definite chemoradiotherapy remains suboptimal. There exists an urgent and unmet need to enhance the efficacy of concurrent chemoradiotherapy for patients with unresectable Locally Advanced Esophageal Squamous Cell Carcinoma (LA-ESCC). Immunotherapy, when combined with chemotherapy, has emerged as the established first-line treatment for advanced esophageal cancer. Significant tumor shrinkage and reduced tumor residual observed after induction immunotherapy might provide the potential to enhance locoregional control of radiotherapy as well as better protection of critical organs and circulating lymphocytes.

Methods
We conducted a multicenter, phase I/II study aiming to assess the efficacy and safety of induction immunochemotherapy followed by immuno-chemoradiotherapy (ICRT) for unresectable LA-ESCC (SCR-ESCC-002, NCT06173986) (Figure 1). Eligible patients will initiate treatment with 2-3 cycles of immunochemotherapy. Within 4 weeks after completing the induction treatment, patients without disease progression will proceed to receive concurrent radiotherapy (45-50Gy in 25 fractions), weekly chemotherapy, and PD-1 inhibitor on day1,22. Following immuno-chemoradiotherapy, patients will continue with immunotherapy maintenance until disease progression or unacceptable toxicity, for a maximum duration of one year. The study's dual primary endpoints are progression-free survival and treatment completion rate.

Results
As of January 2024, 13 eligible patients were enrolled in our trial, with median follow-up of 7.8 months. Due to tumor shrinkage of induction immunochemotherapy, radiation doses to normal tissues were significantly reduced, particularly for the lungs, heart, and vertebrae. All 13 patients completed the planned induction treatment and radiotherapy, with 8 completing more than 4 weekly chemotherapies. During ICRT, 10 of 13 patients experienced grade 3-4 adverse events. These included lymphopenia (69.23%), myelosuppression (46.15%), hepatitis (7.69%), esophagitis (7.69%), and pneumonitis (7.69%). Nine patients achieved a complete response, and 3 partial response 4 weeks after ICRT according to RECIST v1.1.

Conclusion
Decreased radiation volumes due to tumor regression brought by induction immunochemotherapy diminish the occurrence of non-hematological adverse events during ICRT. Preliminary analysis suggests that this therapeutic modality exhibits favorable safety profiles and yields a superior clinical complete response rate compared to definitive chemoradiotherapy alone. The trial is presently enrolling participants, and the confirmation of efficacy and survival outcomes necessitates larger sample sizes and extended follow-up durations.
613. LAPAROSCOPIC MANAGEMENT OF TYPE IV HIATAL HERNIA WITH MESH AUGMENTATION CRUROPLASTY - EXPERIENCE AT A TERTIARY CARE CENTRE
Authors: Parthasarathi R , Ramesh N , Cumar Bharath , Palanivelu C 
Published: September 2024

Abstract

Background
Type IV para-esophageal hernias, which are characterized by herniation of other organs in addition to stomach, are rare - comprising only 2-5% of all para-esophageal hernias. They are associated with life-threatening complications such as strangulation or perforation of stomach. Laparoscopic treatment of these hernias requires excellent advanced laparoscopic suturing and dissecting skills. Although laparoscopic approach is now universally accepted, the role of mesh augmentation remains debated.

Methods
Case records of patients who underwent Laparoscopic mesh augmentation cruroplasty for Type IV hiatal hernia since 2012 were retrospectively analyzed.

Results
Out of 340 patients who underwent hiatal hernia repair, 7 patients (3males,
4females) fulfilled the selection criteria. Median age was 64(53-89) years. Median duration of symptoms was 2months (15days-6months). All patients complained of heartburn. Vomiting was present in 5(71%) patients; only 1(14%) patient had persistent vomiting with dysphagia.
Respiratory symptoms were present in 2(29%) patients. No patient had features of peritonitis or sepsis. One patient had undergone laparoscopic heller’s cardiomyotomy twice before. All patients underwent MDCT which confirmed type IV paraesophageal hernia.
Median operating time was 150(100-280) minutes. Median blood loss was 150(50-400) ml.
6(85%) patients had herniation of omentum in addition to stomach while 1 patient had herniation of omentum and transverse colon. No patient had ischemia/perforation of stomach. Median hiatal defect was 6(5-8) cm. Sac was excised completely in all cases following reduction of contents. Crural repair was done with1-0 polyester interrupted sutures.
In some patients, anterior cruciate ligament repair was done to avoid tenting of esophagus.
Rectangle shaped Composite mesh with key-hole slit in upper border was placed. Mesh was anchored with interrupted 1-0ethilon sutures. Fundoplication (Nissen’s/Toupet) was done in all patients, none required esophageal lengthening procedure.
Median post-operative stay was 5(2-8) days, median ICU stay was 1(0-4) days. Oral liquids were started on 2 nd (1-3) post-op day and solids on 4 th (2-5) day. 2(29%) patients had post- operative complications - atrial fibrillation and transient respiratory failure respectively.
Median follow-up was 14(1-40) months. No patient had symptomatic recurrence. OGDscopy at 6months was normal in 5 patients. No mesh related complication was observed.

Discussion
Wide hiatal defects were noted in all patients. This necessitated mesh augmentation of crural repair. Both short-term (morbidity, mortality) and long-term outcomes (recurrence, patient satisfaction) were excellent.
739. SIGNIFICANCE OF COX2 INHIBITOR FOR ESOPHAGEAL CANCER FROM THE CLINICAL AND EXPERIMENTAL ESTIMATE
Authors: Hashimoto Naoki 
Published: September 2024

Abstract
(Aims) We report experimental and clinical evidence that COX2 represent a potential molecular target for the treatment and prevention of esophageal cancer.
(Methods) (A)Experiment: Thirty 8-week male wistar rats were exposed to duodenal content esophageal reflux. All animal underwent an esophagoduodenal anastomosis (EDA) with total gastrectomy in order to produce chronic esophagitis. In ten rats the sham (Control). They were sacrified at 40th week. Their esophagi were examined for HE, COX2,PGE2, PCNA and total bile acids in the esophageal lumen was measured. (B)Clinical: The expression of COX2 was examined for 68 specimens of esophageal squamous cell carcinoma (SCC) and the correlation of COX2 expression with clinicopatholigic features was examined.
(Results) (A) After 40 weeks of reflux, columnar dysplasia, squamous cell carcinoma and adenocarcinoma were found. Total bile acid in the esophageal lumen was significantly increased in the EDA group compared with the sham operated rats. PCNA LI and esophageal tissue PGE2 were higher in dysplastic and cancer tissue than that of control. Overexpression of COX2 was shown in dysplastic and cancer tissue. COX2 may play an important role in esophageal cancer by duodenal content reflux.(B) COX2 immunoreactivity was weak in 27(40%) and strong in 41(60%) of the carcinomas. The proportion of poorly differentiated SCC among tumors with a strong expression of COX2 (34%) was significantly higher than among tumors with a weak expression of COX2 (19%, p=0.02). The depth of tumors (p=0.004), lymph node metastasis (p=0.0009) and the stage of the tumors (p=0.001) were advanced significantly more progressively in ECCS with a strong COX2 expression. Moreover, survival was significantly reduced (p=0.02) among patients with strong COX2 expression when compared with the COX2 weak group. This study showed that strong expression of COX2 was correlated with tumor progression and poor differentiation in ESCC. (Conclusion) In this experimental study, we demonstrate that bile reflux of duodenal contents induce COX2 and increase prostaglandin synthesis in dysplastic and cancer tissue. Our study suggests that COX2 may play a role in esophageal carcinoma development and progression, COX2 inhibitors may be potential targets for the prevention or treatment of esophageal carcinoma.
748. CAUSES, TREATMENT AND OUTCOMES OF CONDUIT NECROSIS FOLLOWING OESOPHAGECTOMY: A SINGLE CENTRE RETROSPECTIVE STUDY
Authors: Tankel James , Amin Samir , Katz Amit , Dehghani Mehrnoush , Sakalla Ms Rawan , Cools-Lartigue Jonathan , Spicer Jonathan , Najmeh Sara , Mueller Carmen , Ferri Lorenzo 
Published: September 2024

Abstract

Background
Conduit necrosis (CN) following esophagectomy is a poorly described entity associated with high morbidity and mortality. Identifying factors associated with CN would help stratify patients at risk of this devastating complication. Furthermore, describing the outcomes of various treatment options may aid in personalising treatment to maximise the chance of recovery. The aim of this study was to describe the causes, treatment and outcomes of CN following esophagectomy.

Methodology
Between 01/2006 and 12/2023, a single centre retrospective review of a prospectively maintained comprehensive oesophageal cancer surgical database was performed. Complications data from the online Canadian Thoracic Surgery Quality Improvement Program was also utilized. All patients with oesophageal and junctional cancer who underwent transthoracic en bloc surgical resection were included. Defined as circumferential ischaemia of the neo-esophageal conduit identified on postoperative endoscopy, patients with CN were identified. Clinical and demographic data of these patients was compared to those with no documented history of conduit complications. The treatment and outcomes of CN were also recorded.

Results
Anastomotic leak occurred in 146/1043 patients (14.0%), CN in 39 (3.7%) and tracheo-oesophageal fistula in 7 (0.7%). Compared to the 853 patients without conduit complications, CN was associated with BMI &gt;34.5kg/m2 (3/39 vs 15/853,p = 0.03), proximal lesions (5/39,12.9% vs 23/853,2.7%, p = 0.002) and McKeown oesophagogastrectomy (13/39,33.3% vs 125/853,14.7%, p=&lt;0.001). Initially, endoscopic treatment, anastomotic refashioning, taking down the conduit and oesophagostomy was used in 14, 13, 8 and 4 patients (35.9%,33.3%,20.5% and 10.3%) with success rates of 7/14(50.0%), 6/13(46.2%), 4/8(50.0%), and 3/4(75.0%) respectively. The 90-day mortality of CN was 10.9% and associated with a prolonged hospital admission (median 46 vs 12 days, p=&lt;0.001)

Conclusion
CN is an uncommon entity but associated with high morbidity, mortality and prolonged postoperative length of stay. Treatment decisions remain complex and whilst endoscopic management seems feasible, re-intervention is often required. Further understanding of how to improve salvage treatment in this unique cohort of patients is required.
770. CLOSURE OF OESOPHAGEAL DEFECTS USING THE VACSTENT DEVICE: INITIAL INSIGHTS FROM THE LARGEST UK CASE SERIES
Authors: Aslam Nasar , Gertner Julian , Maguire Joshua , Duku Margaret , Thorpe Sally , Mohammadi Borzoueh , Dawas Khaled , Ahmed Omer , Banks Matthew , Graham David , Qureshi Yassar , Sweis Rami , Sehgal Vinay 
Published: September 2024

Abstract

Introduction
Oesophageal defects are associated with poor morbidity and mortality and often require prolonged hospitalisation and artificial nutrition. Existing endoscopic treatment modalities exhibit limitations. Covered stents are associated with a migration rate of up to 50% and closure with endoscopic clips is limited to simple defects. Vacuum therapy is a well understood and established surgical therapy to promote wound healing. Endoscopic Vacuum Therapy (EVT) utilises these principles in the management of transmural oesophageal defects. The VACstent GITM (MicroTech) is a novel device which synergistically incorporates the advantages of a fully covered oesophageal stent while concurrently employing EVT. This approach seals the defect while mitigating against stent migration through the vacuum effect. Luminal patency is also maintained which helps to preserve nutritional independence. Accelerated healing and enhanced nutrition are thought to help reduce morbidity and enhance patient quality of life.

Methods
This single-centre prospective case series describes outcomes for patients with transmural oesophageal defects treated with the VACstent GITM device.
All procedures were performed with propofol sedation and fluoroscopic guidance. The VACstent GITM was exchanged every 5-7 days until endoscopic closure. A contrast study was used to confirm closure after which oral nutrition was restarted.
The primary outcome was clinical success, defined as the endoscopic and radiological evidence of defect closure. Secondary outcomes included number of stent exchanges, technical success, and the adverse event (AE) rate.

Results
The VACstent GITM device was used for seven patients between October 2023 and February 2024. Four patients had anastomotic leaks with three having iatrogenic perforations. The mean patient age was 60 (± 19.3) years with 57% of the patient cohort being male. The clinical success rate was 86% with a technical success rate of 100% and a median defect closure time of 13 (± 6.6) days. A median number of 1 stent exchanges was required. The median defect size was 8mm (± 6.2). There were no reported AEs. All patients were able to successfully come of artificial nutrition.

Conclusion
This case series illustrates the safety and efficacy of the VACstent for the treatment of a heterogenous group of oesophageal defects. To our knowledge this represents the largest series in a cohort of patients from the United Kingdom. Larger scale comparative studies incorporating a more diverse patient cohort will further clarify the potential of the VACstent device in reducing the necessity for major surgical interventions in this complex and challenging patient population. It will also help to refine future treatment algorithms for oesophageal defect management.
771. EVOLUTION OF THE SURGICAL MANAGEMENT OF OESOPHAGEAL PERFORATION
Authors: Johnson Mary Ann , Read Matthew 
Published: September 2024

Abstract

Background
Oesophageal perforations historically have been managed with open trans-thoracic operations. With the increasing experience of minimally invasive procedures, we have performed a case series of trans-hiatal repairs for oesophageal perforations. Our unit has maintained a prospective database of oesophageal perforations since 2014.

Methods
Retrospective review of outcomes of open trans-thoracic operation to laparoscopic trans-hiatal oesophageal perforation repairs.

Results
From 80 patients, our database demonstrates an evolution in the treatment of oesophageal perforations from open thoracotomy to either endoscopic intervention (20) or trans-hiatal repair (12).

Conclusion
Laparoscopic Trans-hiatal oesophageal Repair is comparable and feasible in carefully selected patients (a video recording of the repair will be part of the presentation)