bluuebunny/crossref_metadata_2025_split huggingface dataset:
262. EOSINOPHILIC ESOPHAGITIS: A SEVEN YEAR ANALYSIS OF EPIDEMIOLOGY IN A UNITED KINGDOM COUNTY
Authors: Sivarajan Sri , Arkle Thomas , Kotha Soumya , Ritchie Thomas , Gopaul Steven , Kumar Bhaskar 
Published: September 2024

Abstract

Background
Eosinophilic Esophagitis (EoE) is growing in incidence internationally. It is an immune-mediated disease that is characterised by esophageal mucosal eosinophilia and esophageal dysfunction. Awareness of EoE is also crucial for Esophagogastric surgeons as symptoms may mimic reflux disease or neoplasia, key considerations for an accurate differential diagnosis. Presently, there are no incidence estimates of EoE in the adult population in the UK. This study seeks to establish a cohort of EoE patients in Norfolk, a county in the East of England region, and to describe the incidence, characteristics, and diagnostic features of affected patients in both the adult and paediatric populations.

Methods
A retrospective analysis was performed of a prospectively maintained pathology database servicing a population of 761,000 persons in Norfolk. All newly diagnosed cases of EoE across a seven-year period between January 2017 and December 2023 were identified. Patients included for analysis had a histological diagnosis of EoE with &gt;15 eosinophils/hpf and symptoms of oesophageal dysfunction. Patient electronic health care records were reviewed for histology reports, endoscopic findings, and clinical history. The primary outcome was incidence of EoE within the county. Secondary outcomes assessed included: patient characteristics; allergy and atopy history; endoscopic features, biopsy protocol and referral indication.

Results
187 (median age 43 (4-85) years, Male: Female (126:61)) new cases of EoE were identified, of whom eight were in the paediatric age group of ≤16 years. The average annual incidence of EoE was 4.29 [95% CI 2.92, 5.66] and 0.89 [95% CI 0, 1.39] per 100,000 person/years in adult and paediatric groups respectively, with a significantly higher incidence in adults (RR 4.86 (95% CI [2.39 – 9.85] P&lt;0.005) (Figure 1). The most common referral indications for endoscopy were dysphagia (80.7%) and food bolus obstruction episodes (25.1%). The most common endoscopic feature of EoE was circular rings (49.2%).

Conclusion
This is the first study reporting incidence of EoE in the UK adult population. There was a significantly greater incidence of EoE in adults compared to the paediatric population. However, there was no significant change in incidence of EoE in either group over the study period. Incidence estimates identified are similar to those reported in other European populations. Importantly 18.2% of patients had normal appearance of oesophagus on endoscopy, which reinforces the need to take oesophageal biopsies where there is clinical suspicion. Ideally, prospective registry data is needed for a comprehensive characterisation of incidence and prevalence of EoE.
272. HOSPITAL VARIATION IN PALLIATIVE TREATMENT FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER: A NATIONWIDE POPULATION-BASED STUDY IN THE NETHERLANDS
Authors: Geerts Julie , Vissers Pauline , Mostert Bianca , Wijnhoven Bas , Haberkorn Brigitte , Rosman Camiel , Creemers Geert-Jan , Westdorp Harm , van der Sangen Maurice , Verhoeven Rob 
Published: September 2024

Abstract

Background
Palliative care for patients with esophageal (EC) includes a large variety of treatments and data on variation of palliative care across centers are unknown. This study aims to evaluate treatment variation at the hospital level for EC and GC patients in the Netherlands.

Methods
A nationwide retrospective cohort study was conducted using population-based data from the Netherlands Cancer Registry. Patients diagnosed with inoperable advanced (cT4B) or synchronous metastatic (cM1) EC between 2015-2022 were included. Probability of receiving potentially life-prolonging treatment (palliative resection, chemoradiotherapy or systemic treatment) according to hospital of diagnosis was analyzed using multilevel logistic regression analysis. Hospitals were categorized in tertiles according to this probability (high, medium, low) and overall survival (OS) was assessed using cox regression analysis.

Results
8,580 EC patients were included. Potentially life-prolonging treatment ranged from 23.5%-74.0% across hospitals of diagnosis (p&lt;0.0001). After adjustment for patient and tumor characteristics, the probability of receiving these treatments was associated with hospital of diagnosis (p&lt;0.0001). 13 of 79 hospitals demonstrated a significantly lower probability of giving potentially life-prolonging treatment. Patients diagnosed in hospitals with low probability of potentially life-prolonging treatment with had significantly worse OS than medium- (HR 0.85 (0.80-0.90) p&lt;0.0001) or high-probability hospitals (HR 0.77 (0.73-0.82) p&lt;0.0001).

Conclusion
This study shows substantial variation in palliative treatment for EC and GC care across Dutch hospitals, emphasizing the challenge of defining optimal treatment plans. Hospital of diagnosis was significantly associated with the probability of receiving potentially life-prolonging treatment and also with overall survival. These results suggest that appropriate selection of patients for treatment with potentially life-prolonging treatment leads to improved OS.
286. TREATMENT WITH CURATIVE INTENT FOR OLIGOMETASTATIC GASTROESOPHAGEAL CANCER-RESULTS OF A PROSPECTIVE MULTICENTER STUDY
Authors: Norén Nora , Rouvelas Ioannis , Nilsson Magnus , Lundell Lars , Szabo Eva , Edholm David , Hedberg Jakob , Smedh Ulrika , Hermansson Michael , Lindblad Mats , Klevebro Fredrik 
Published: September 2024

Abstract

Background
Oligometastatic gastroesophageal cancer is a clinical entity with no standard treatment recommendation. Treatment with curative intent has recently emerged as an option in selected patients in contrast to the traditional palliative treatment strategy. This prospective study aimed to assess the safety and efficacy of combined systemic and local treatment with curative intent for patients with oligometastatic gastroesophageal cancer.

Methods
In a multicenter collaborative study, consecutive patients with gastroesophageal cancer and metastases in the liver and/or extra-regional lymph nodes were screened for inclusion. Eligible patients were offered treatment with combined systemic and local therapy within the study. Primary endpoints were treatment safety and feasibility, secondary outcomes included postoperative mortality, treatment response, progression-free and overall survival. Subgroup analyses were stratified based on oligometastatic location.

Results
A total of 29/35 patients completed systemic and local treatment with surgical resection, liver ablation or definitive chemoradiotherapy. The majority of postoperative complications were mild-moderate, no patient died due to postoperative complications within 30 days of surgery. Median progression-free survival was 7.1 (interquartile range 4.3-12.4) months and median overall survival was 23.8 (interquartile range 12.3-33.0) months.

Conclusion
This study found combined systemic and local treatment to be a safe treatment option and to potentially improve long-term survival in strictly selected patients with oligometastatic gastroesophageal cancer.
293. OUTCOMES AFTER SURGICAL TREATMENT OF OESOPHAGOGASTRIC CANCER WITH SYNCHRONOUS LIVER METASTASES: A MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: van Hootegem Sander , De Pasqual Carlo , Giacopuzzi Simone , Van Daele Elke , Vanommeslaeghe Hanne , Moons Johnny , Nafteux Philippe , van der Sluis Pieter , Lagarde Sjoerd , Wijnhoven Bas 
Published: September 2024

Abstract

Background
Approximately 10-12% of patients with oesophageal and gastric cancer (OGC) present with oli-gometastatic metastases at diagnosis. It remains unclear if there is a role for radical surgery in these patients. We aimed to assess the outcomes of OGC patients who underwent simultaneous treatment for the primary tumour and synchronous liver metastases.

Methods
Patients with OGC who underwent surgical treatment between 2008 and 2020 for the primary tumour and up to five synchronous liver metastases aiming for complete tumour removal or ablation (i.e. no residual tumour) were identified from four institutional databases. The primary outcome was overall survival (OS), calculated with the Kaplan-Meier method. Secondary outcomes were disease-free survival and postoperative outcomes.

Results
Thirty-one patients were included with complete fol-low-up data in 30 patients. Twenty-six patients (84%) received neoadjuvant therapy followed by response evaluation. Median OS was 21 months [IQR 9-36] with a 2- and 5-year survival rates of 43% and 30%, respectively. While disease recurred in 80% of the patients (20 of 25 patients) after a radical resection, patients with a solitary liver metastasis had a median OS of 34 months. The number of liver metastases was a prognostic factor for OS (solitary metastasis aHR 0.330; p-value = 0.025). Thirty-day mortality was zero and complications occurred in 55% of the patients.

Conclusion
Long-term survival can be achieved in well-selected patients who undergo surgical resection of the primary tumour and local treatment of synchronous liver metastases. In particular, patients with a solitary liver metastasis seem to have a favourable prognosis.
303. VACUUM-STENT TREATMENT FOR TRANSMURAL DEFECTS IN THE UPPER GASTRO-INTESTINAL TRACT: CASE SERIES AND NEW INSIGHTS IN A TERTIARY REFERRAL CENTER
Authors: Pattynama Lisanne , Eshuis Wietse , Bergman Jacques , van Berge Henegouwen Mark , Pouw Roos 
Published: September 2024

Abstract

Background
Transmural defects in the upper gastro-intestinal (GI) tract are associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has recently been established as promising endoscopic treatment option for such defects and is most often applied using endoscopically placed vacuum-sponges. The vacuum-stent is a novel device to apply EVT, combining the advantages of negative pressure wound therapy and an intraluminal stent, allowing for oral intake.

Methods
The aim of this prospective cohort study is to describe the experiences of, and lessons learned by a tertiary referral center with EVT experience since 2018, regarding the vacuum-stent for transmural defects in the upper GI tract. All patients treated with a vacuum-stent between November 2022 and October 2023 were included. Outcome measures included successful defect closure, reasons of treatment failure, adverse events and strictures.

Results
31 patients were included. Baseline characteristics and outcomes are displayed in Table 1. Success rates of combined vacuum-stent and –sponge treatment and vacuum-stent treatment alone were respectively 83% and 78%. In this cohort, some notable reasons of failure were observed: a defect too close to the upper esophageal sphincter (UES), inadequate vacuum on the esophago-jejunal anastomosis, a carcinoma at a persisting perforated ulcer, and adverse events. Two adverse events occurred (6%): two patients developed a secondary defect at the site of the proximal vacuum-stent flange, of whom one had a cervical anastomosis with a narrow proximal esophagus and one Boerhaave syndrome. Three out of four patients with a severe structure had underwent a McKeown esophagectomy.

Conclusion
The vacuum-stent is a valuable treatment option for AL after Ivor Lewis esophagectomy, Boerhaave syndrome and iatrogenic defects with success rates of 78-83%. Treating cervical anastomotic leaks is not recommended by us, due to the narrow lumen of the proximal esophagus, the proximity of the UES and high risk of severe strictures. Furthermore, caution is recommended in case of a narrow esophagus. In our experience, vacuum-stent and –sponge treatment complement each other and might be indicated in different situations. Sharing experiences on the topic is important to assess the best techniques and indications, to be able to reach the full potential of the vacuum-stent and further increase the success rate.
311. PROGNOSTIC VALUE OF DIFFERENT CIRCUMFERENTIAL MARGIN SITES IN OESOPHAGEAL CANCER: A 10-YEAR COHORT STUDY
Authors: Elshaer Ahmed , Jones Sian , Mehta Samir , Hayden Jeremy , Cockbain AJ , Sarela Abeezar , Dexter Simon , Grabsch Heike 
Published: September 2024

Abstract

Background
There’s a growing interest towards the prognostic value of circumferential resection margin (CRM) involvement in oesophageal cancers. However, there is no sufficient data about the association of the site-specific CRM and survival. In this study, we analysed the influence of different involved CRM sites on survival.

Methods
This study included patients who had curative oesophagectomy for oesophageal cancer between 2010 till June 2021. Follow up till April 2022 was achieved. Patients with involved proximal or distal margins were excluded. The sites of CRM were defined anatomically to anterior (pericardial), posterior (aorta), lateral (pleurae). The outcomes between different CRM margins were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases.

Results
117 patients had CRM-positive after curative oesophagectomy during the study period. 33 cases had multi-involved CRM sites, while 84 patients had single involved CRM site. Posterior margins were the most common involved site 37/117 (31.6%). No differences in baseline pathological criteria (pT, pN stages and type of cancer) and neoadjuvant therapy. Positive anterior margins carried the worst overall (OS) and disease-free (DFS) survival compared to lateral and posterior margins (OS: 29 vs 41 vs 32 months respectively, p-value 0.37, DFS: 19.2 vs 32.1 vs 28.7 months respectively, p-value 0.39). Multi-involved CRM sites led to worse OS and DFS in comparison with single involved CRM site (OS: 19 vs 32 months respectively, p-value 0.008, DFS: 12.1 months vs 27.6 months respectively, p-value 0.05).

Conclusion
The site of involved CRM should be rigorously assessed in oesophagectomy specimens. The involved margin sites within CRM had different survival rates, with inferiority towards anterior resection margins. Larger studies are required to better evaluate the prognostic significance of various CRM sites.
315. SHORT-TERM RESULTS OF ROBOT-ASSISTED SURGERY FOR ESOPHAGEAL CANCER IN JAPAN 5 YEARS AFTER INSURANCE COVERAGE
Authors: Noma Kazuhiro , Matsumoto Hijiri , Kunitomo Tomoyoshi , Kawasaki Kento , Hashimoto Masashi , Kashima Hajime , Maeda Naoaki , Kikuchi Satoru , Tanabe Shunsuke , Fujiwara Toshiyoshi 
Published: September 2024

Abstract

Background
In Japan, robot-assisted surgery (RAMIE) for esophageal cancer surgery was covered by insurance in 2018, and its introduction has been rapidly progressing since then. In our department, RAMIE has been introduced and performed in 250 cases so far. In the process, we have improved the short-term results by introducing the standardization and NIM (neuromonitoring) according to the characteristics of RAMIE. In addition, we have recently expanded the use of RAMIE in advanced cancer patients due to its usefulness in stable operation. In this meeting, we will review the short- and mid-term results and discuss current issues.

Methods
We analyzed the short-term results of all 213 RAMIE cases performed at our department, and compared them with the short-term results of 51 post-standardization (late) MIE cases previously reported. The mid-term results to date were also reviewed.

Results
A total of 213 patients were included. 211, 222 mins thoracic operation time. 235, 190 ml blood loss in comparison to MIE (vs. RAMIE). Postoperative outcomes were similar: overall complications (&gt;Grade II) were 49, 54.9%, respiratory complications were 19.6, 23.9%, and recurrent nerve palsy was 15.7, 17.4%. Risk analysis demonstrated that paralysis in RAMIE was significantly related to prolonged thoracic operation time (p=0.021) and NIM (Odds=0.38, p=0.0447). In comparison between patients with early-stage and advanced cancer, pneumonia and anastomotic complications were not different. Prognosis was 81.7/64.2% (UICC 8th) for 3-year survival in cStage II/III patients.

Conclusion
RAMIE was considered to be highly useful for short-term and medium-term outcomes at this time.
328. NORMAN RUPERT BARRETT (1903 – 1979)
Authors: Tang Linda 
Published: September 2024

Abstract
Norman Rupert Barrett (1903 – 1979) was an Adelaide born thoracic surgeon. Barrett is most well-known for his contribution to ‘Barrett’s Oesophagus’. He was born into the Barrett Brothers malt producing family. He left Australia at the age of 10 and travelled throughout Europe and arrived in England in the wake of World War I. Following the Great War, Barrett sat his surgical examinations. Ironically, while the 21st century boasts well rounded surgeons and safe working hours, Barrett was at one point chastised for leaving the hospital grounds for a short walk while on call.
The origin of the term ‘Barrett’s Oesophagus’ may not be quite as you imagine. Barrett initially describes the oesophagus being lined with columnar epithelium but attributes this to a congenitally shortened oesophagus leading to part of the stomach entering the chest. Later on, it was described by Allison and Johnstone that this was, in fact, the oesophagus and proposed ulcers in this region better termed ‘Barrett’s ulcers’. Only several years later was this pathology accepted by Barrett. Now ‘Barret’s Oesophagus’ is well known to us as the term used to describe the adaptive metaplastic change of the squamous epithelium of the oesophagus to columnar epithelium from the stomach; it is the pathological waymark for endoscopists in the development of Oesophageal Cancer.
329. PREDICTION OF MEDIASTINAL LYMPH NODE METASTASIS IN SIEWERT TYPE I/II ESOPHAGOGASTRIC JUNCTION CANCER WITH ESOPHAGEAL INVASION
Authors: Shoji Yoshiaki , Tajima Kohei , Kanamori Kohei , Ogimi Mika , Ninomiya Yamato , Yamamoto Miho , Kazuno Akihito , Nabeshima Kazuhito , Nishi Takayuki , Koyanagi Kazuo 
Published: September 2024

Abstract

Background
Mediastinal lymph node dissection (LND) is a critical factor to decide the surgical strategy for Esophagogastric junction (EGJ) cancers. As a result of a prospective multicenter study in Japan, surgical algorithm including the extent of LND for EGJ cancers has recently been proposed according to the length of esophageal invasion. However, preoperative measure predicting upper mediastinal LN metastasis is still lacking, and the oncologic efficacy of mediastinal LND remain unknown.

Methods
The aim of this study was to identify preoperative factors predicting mediastinal LN metastasis, and we hypothesized that preoperative CT image would be of utility. Patients who underwent surgical treatment for Siewert Type I/II EGJ cancer with esophageal invasion with curative intent between 2000 and 2022 at the Tokai University Hospital were retrospectively reviewed.

Results
A total of 103 patients were enrolled. Among them, 55, 74, and 74 patients underwent upper, middle, and lower mediastinal LND, respectively. Upper/middle/lower mediastinal LN metastasis was observed in 14/13/23 of those patients, respectively, with lower thoracic paraesophageal LNs (29%), middle thoracic paraesophageal LNs (18%), and right recurrent nerve LNs (16%) being the three most common metastatic sites. Estimated invasion depth of the primary lesion≧cT3 (p≦0.007), tumor size≧4cm (p≦0.002), esophageal invasion length≧4cm (p≦0.007) and minor axis of the LN≧5mm by preoperative CT image (p&lt;0.001) were significant preoperative factors related to mediastinal LN metastasis.

Conclusion
Clinical T factor, tumor size, the size of mediastinal LN by CT image, as well as esophageal invasion length, were important preoperative factors to predict mediastinal LN metastasis, and those factors should be taken into consideration to decide the surgical strategy for EGJ cancers with esophageal invasion. Survival impact of mediastinal LND still remain unclear, and further accumulation of cases and prospective studies are awaited.
336. EFFICACY AND SAFETY OF PHOTODYNAMIC THERAPY FOR SECONDARY PRIMARY ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER CHEMORADIOTHERAPY OR RADIOTHERAPY FOR ANOTHER MALIGNANCY
Authors: Fujiwara Takahisa , Kadota Tomohiro , Yamashita Hiroki , Minakata Nobuhisa , Watanabe Takashi , Inaba Atsushi , Sunakawa Hironori , Nakajo Keiichiro , Shinmura Kensuke , Yano Tomonori 
Published: September 2024

Abstract

Background
Photodynamic therapy (PDT) using talaporfin sodium is known as the effective, safe, and less invasive treatment for local failure after chemoradiotherapy (CRT) or radiotherapy (RT) for esophageal squamous cell carcinoma (ESCC). The secondary primary ESCC sometimes occur at different site after CRT/RT for ESCC or other cancer, and PDT may be considered for such lesion if endoscopic resection and surgery are not suitable for patients. However, the actual therapeutic efficacy remains unclear. This study aims to evaluate the efficacy and safety of PDT using talaporfin sodium for untreated secondary primary ESCC with a history of CRT/RT for another malignancy.

Methods
This retrospective study enrolled the patients underwent PDT using talaporfin sodium for untreated secondary primary ESCC in the treatment field of prior CRT/RT for another malignancy at the National Cancer Center Hospital East from September 2016 to October 2021. The inclusion criteria of PDT in this study were as follow; 1) invasion depth limited within T2, 2) &lt;3/4 of the esophageal circumference, 3) absence of lymph node or distant metastasis, and 4) patient’s refusal or unsuitable physical condition for surgery. We evaluated the rate of local complete response (L-CR), incidence of adverse events, and clinical outcomes.

Results
Ten patients were enrolled in this study. Previous malignancy organ was hypopharynx (n=1), lung (n=2), and esophagus (n=7). All secondary primary ESCC were diagnosed as T1b. Finally, L-CR was achieved in 6 patients (L-CR rate: 60.0%). Among 6 patients with L-CR, one had local recurrence, one had lymph node recurrence, and the remaining four had no recurrence. During the median follow-up of 27.5 months, one patient with L-CR died from other diseases. Adverse events included grade ≤2 esophageal pain in 2 patients, photosensitivity and esophageal stricture in each one, and no esophageal perforation or treatment-related death.

Conclusion
As retreatment with RT is not available, PDT may be the treatment options for the secondary primary ESCC after CRT/RT for another malignancy.