bluuebunny/crossref_metadata_2025_split huggingface dataset:
490. THE IMPACT OF ONE-LUNG VENTILATION ON POSTOPERATIVE COMPLICATIONS AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Battaglia Silvia , Turi Stefano , Puccetti Francesco , Lorenzo Cinelli , Lavinia Barbieri , Treppiedi Elio , Cossu Andrea , Elmore Ugo , Rosati Riccardo 
Published: September 2024

Abstract

Background
One of the most common issue after Ivor Lewis esophagectomy are pulmonary complications, affecting up to 27% of patients, leading to longer hospital stay and higher healthcare costs.
Traditionally, one-lung ventilation (OLV) with a double-lumen tube, is used during the thoracic phase of esophagectomy in order to provide a good surgical view by collapsing the right lung parenchyma. However, OLV has been proven to contribute to negative respiratory outcomes after surgery. On the other hand, a recent metanalysis showed that Two Lung Ventilation (TLV) is feasible throughout the two phases of the procedure, with good clinical, surgical and oncological results.

Methods
A consecutive series of patients undergoing minimally invasive Ivor Lewis esophagectomy (MIIL) between November 2022 and November 2023 in one high-volume center was retrospectively reviewed. Intraoperative ventilation characteristics were analyzed. Postoperative pulmonary complications were stratified according to Clavien Dindo classification and further divided into mild (&lt;3a) and severe (&gt;3b).
Descriptive statistics was used to analyze the study sample. Data was expressed as median and interquartile range (IQR) for non-normally distributed variables and as proportions for binary variables. Categorical variables are expressed as frequencies and analyzed by chi-square (χ2) tests. P-values of &lt; 0.05 defined statistical significance (two-sided).

Results
Of the 70 patients, 8 were excluded due to lack of data. 62 patients were further stratified into three groups considering the ratio between the durations of OLV and the thoracic phase (OLV/TP): group A less than 25% of OLV/TP, group B more than 25% but less than 75% and group C more than 75%.
No difference between the three groups was found in terms of pulmonary complications (χ2=1.6248, p-value=0.4437) whilst patients with a shorter OLV/TP showed a significant reduction in the incidence of severe respiratory complications(χ2= 8.2974, p-value 0.015785, p &lt; 0.05).

Conclusion
Taking into account the limits of the study (retrospective nature, single center study), our results show that the length of OLV may negatively affect postoperative pulmonary outcomes. These promising results justify the need to conduct a randomized controlled study that would be instrumental in reaching definitive conclusions.
505. USE OF INDOCYANINE GREEN FOR ASSESSMENT OF GASTROPLASTY VASCULARIZATION AFTER MCKEOWN ESOPHAGECTOMY
Authors: Lissón Miriam Menéndez Jiménez De Zadava , Navarro Fernando Mingol , Esteban Marcos Bruna , Urbaneja Javier Vaqué , Nieto Marta 
Published: September 2024

Abstract

Background
Anastomotic leakage is one of the most feared complications of esophagogastric surgery, conferring significant morbidity and mortality in these patients. It is known that inadequate vascularization of the gastroplasty is a major risk factor for anastomotic dehiscence. The aim of this study is to evaluate and demonstrate the utility of intraoperative use of indocyanine green (ICG) in patients undergoing esophagectomy and reconstruction with gastroplasty to assess the relationship between its vascularization and the presence of anastomotic leakage in the postoperative period.

Methods
Prospective, longitudinal, observational, and analytical study of 36 consecutive cases in which intraoperative ICG was used for patients undergoing McKeown esophagectomy and reconstruction with gastroplasty and cervical anastomosis from June 2021 to December 2023. The distance traveled by the ICG in a proximal direction from the pylorus at 30 and 90 seconds after its intravenous infusion was measured. An automatic baseline point or point of maximum fluorescence was also recorded and compared both in net value and in percentage at 30, 60, 90, and 120 seconds after the infusion of ICG with the theoretical zone of anastomosis construction (zone reaching the sternal manubrium after extending the graft over the sternum). Statistical analysis was performed using SPSS version 24.0.

Results
The rate of leaks and necrosis of the graft was 19.4% and 2.8%, respectively. There is a significant relationship (p&lt;0.05) between the rate of anastomotic dehiscence and the net value and percentage compared with the automatic baseline point of ICG at the anastomosis site and at the apex of the gastroplasty at 30, 60, 90, and 120 seconds. Using a ROC curve (figure 1) that analyzed the time it takes for ICG to reach the anastomosis, a cutoff point of 19.5 seconds was established, which gives ICG greater profitability as a diagnostic test with an AUC of 0.821 (0.642-1). The positive predictive value of this test is 0.36, and the negative predictive value is 1.

Conclusion
The use of indocyanine green appears to be a good method for identifying those anastomoses and gastroplasties that present a high risk of dehiscence and/or necrosis. The time it takes for ICG to reach the anastomosis, the speed at which it does so, as well as the quantitative value provided by the platform used, seem to be valid parameters for identifying high-risk cases. This would allow for the performance of additional measures to reduce the risk of dehiscence and/or necrosis. Randomized prospective studies with a larger sample size would be necessary.
514. ESOPHAGOGASTRIC ANASTOMOSIS STRICTURE AFTER A CERVICAL FISTULA: LONG TERM COMPLICATION AFTER THE MCKEOWN PROCEDURE STERNOTOMY APPROACH: ANASTOMOSIS RESECTION
Authors: Cruz David Quevedo , Navarro Fernando Mingol , Antolino Pablo Guerrero , Nieto Marta , de Zadava Lisson Miriam Menendez Jimenez , Esteban Marcos Bruna , Urbaneja Javier Vaque 
Published: September 2024

Abstract

Background
Anastomotic stricture after anastomotic leakage is a common long term complication after mckeown procedure. It can be resolved by endoscopic dilations on most occasions. However, if endoscopic aproach fail, we have to solve the estenosis with a surgery procedure.
This type of reintervention could be a really hard aproach due to an intense fibrosis and anatomical layer destructuring.
In this video, we show a initial cervical approach to do a anastomosis resection and reanastomosis. However, due to the intense fibrosis and the difficulty in dissecting the gastric plasty from the sternal table, the incision had to be extended and a partial sternotomy was performed. With this approach, we can see the gastric plasty, making the dissection. The we can perform a new esophagus gastric anastomosis safety.
In conclusion, partial sternotomy allows us to visualize the gastric plasty and perform the dissection safety making a tensión free anastomosis.
https://we.tl/t-6MTce26lI1
519. ROBOTIC HELLER DOR FOR SYMPTOMATIC ACHALASIA. A SINGLE TERTIARY CENTER EXPERIENCE
Authors: Sacco Michele , Bencivenga Maria , Casella Francesco , Cucè Federica , Weindelmayer Jacopo , de Manzoni Giovanni , Giacopuzzi Simone 
Published: September 2024

Abstract

Background
Minimally invasive Heller-Dor is the best therapeutic option for symptomatic achalasia.
The aim of this study is to describe the introduction of Robotic program for Heller-Dor procedure (RAHD) in a tertiary center evaluating clinical and surgical outcome.

Methods
We performed a retrospective analysis of patients diagnosed with symptomatic achalasia through clinical, endoscopic, and manometric workup, that were eligible for RAHD. We included all consecutive patients underwent RADH between September 2019 and December 2023 using the DaVinci Xi surgical system. Patients with previous endoscopic or surgical treatment for achalasia were excluded.

Results
Data from 44 patients were collected. Patients’ characteristics are summarized in table 1.
Most patients were in good clinical condition with an ASA score 1-2 and a CCI 1-2 in more than 80% of cases.
Mean Eckhardt score (ES) was 6 (SD 2.05). Most frequent symptom was dysphagia, present in all patients but with different severity.
Mean operating time was 184 minutes (SD 46).
Mucosal tear occurred in three cases and all were sutured immediately, an abdominal drain was placed only in the first case. A regular postoperative course was observed in all patients.
All patients underwent a post-op gastrografin esophagogram before starting a liquid diet; none revealed leakage or treatment failure.
Three patients (6,8 %) experienced Clavien-Dindo grade I complication, one hepatic hematoma, one pneumothorax, and one PONV. No severe complications were reported.
Maximum length of hospital stay was 4 days, mean 3.2 (SD 0.42).
All patients were discharged with a well-tolerated soft diet.
Mean ES at follow up was 0.58 (SD 0.7) at 1 months. After 6 months and 1 year, no patients reported recurrence of symptoms (ES &lt;3), but three patients reported symptomatic reflux (6,8%).

Conclusion
Our experience suggests that introduction of RAHD is safe and effective in the treatment of symptomatic achalasia in a tertiary center for Upper Gastrointestinal Surgery.
521. SHORT-TERM PROPHYLACTIC STENTING FOR HIGH-RISK ESOPHAGEAL ANASTOMOSIS: A CASE SERIES
Authors: Clements Hollie A , Zino Samer , Oglesby Stuart , Patil Pradeep V 
Published: September 2024

Abstract

Background
Anastomotic leak after esophagectomy is a cause of major morbidity, increases surgical mortality and can affect long-term survival outcomes. Early recognition and treatment of anastomotic leaks has greatly improved the rescue rates for this catastrophic complication. However, for some patients, successful rescue is not sufficient to prevent major morbidity and worse long-term outcomes. Prevention of esophageal anastomotic leaks would benefit these patients. Prophylactic stenting after esophagectomy can be one of the tools used in addition to all other factors that are implemented to improve surgical outcomes in this complex cohort of patients.

Methods
We present a series of seven patients who underwent esophagectomy for malignant disease at our institution. They had insertion of prophylactic esophageal stents at the time of esophagectomy due to a combination of patient factors and intraoperative complications. All anastomoses were carried out using the modified Orringer technique of linear stapled esophagogastric anastomosis. All patients underwent insertion of an 18mm diameter, fully covered EGIS (S&G Biotech, Korea) esophageal stent with antireflux valve. This was fixed to the esophagus / gastric tube using two 2-0 Vicryl Rapide (Polyglactin 910) sutures. The stents were removed endoscopically between postoperative day 14 and 28.

Results
None of the seven patients who underwent prophylactic esophageal stenting had any clinical or radiological evidence of anastomotic leak. In one patient, at the time of stent removal, a possible anastomotic defect was noted but it was not possible to enter the cavity. A new stent was inserted, and the patient was clinically observed. He remained clinically well throughout. Another patient developed a severe hospital acquired pneumonia requiring ventilatory support without evidence of anastomotic leak. Median length of stay was 13 days. There was no mortality within 90 days of surgery.

Conclusion
Short term prophylactic esophageal stenting is possible and safe. The technique of stent fixation and early removal helps to mitigate the risks of stent migration and erosion. In our small series, the stents were effective in preventing anastomotic leaks with no stent related complications. This provides optimism for patients and surgeons that morbidity from anastomotic leaks can be minimised, enabling patients to recover from surgery and proceed to adjuvant treatment if indicated. The safety profile of prophylactic esophageal stents should be investigated further and both short- term and long-term outcomes compared to current standards of care by randomised studies.
524. SURVIVAL AFTER CURATIVELY INTENDED TREATMENT OF ESOPHAGEAL CANCER IN THE NORDIC COUNTRIES
Authors: Norén Nora , Achiam Michael Patrick , Aahlin Eirik Kjus , Kauppila Joonas , Vidarsson Bjarni Geir , Klevebro Fredrik 
Published: September 2024

Abstract

Background
Esophageal cancer is the 6th leading cause of cancer related death and has a high impact on life quality. With the ambition to improve long-term survival multimodal treatment including chemotherapy, or combined chemoradiotherapy, followed by surgical resection has become the standard of care. The overall aim of this study is to demonstrate the current treatment of esophageal cancer and survival in the Nordic countries.

Methods
In this cohort study based on prospective national patient registers all patients with esophageal cancer treated with curative intent between 2015-2020 in Sweden, Denmark, Norway, Finland and Island were included. Primary endpoint is 1-year survival after curative treatment for esophageal cancer. Secondary outcome is to describe curative intended treatment for esophageal cancer in the Nordic countries.

Results
The results will describe baseline characteristics, curative treatment including details of the surgical and perioperative treatment, and survival stratified by country.

Conclusion
The conclusion will describe the current curative treatment of esophageal cancer in the Nordic countries.
553. CIRCULAR STAPLED CERVICAL ESOPHAGO-GASTROSTOMY, A VALUABLE OPTION AFTER TOTALLY MINIMALLY INVASIVE MCKEOWN ESOPHAGECTOMY?
Authors: Pansa Andrea , Giorgi Lorenzo , Di Benedetto Mattia , Alfieri Rita , Basato Silvia , Marano Salvatore , Castoro Carlo 
Published: September 2024

Abstract

Background
The optimal choice of anastomotic technique for cervical esophagogastric anastomosis after esophagectomy remains unclear. The incidence of cervical anastomotic leak after esophagectomy can be up to 30%, which is the highest among all types of gastrointestinal anastomosis. Anastomotic stricture is another complication that can decrease the postoperative quality of life with an incidence of 9.1–46.0%. Few studies directly compared circular stapled (CS) and hand sewn (HS) cervical esophago-gastric anastomosis, with mixed results. We aim to compare the two techniques in a pre-post cohort study.

Methods
Medical record of all patients that underwent minimally invasive subtotal esophagectomy and cervical esophago-gastrostomy in our institution from January 2018 to January 2024 were reviewed from a prospectively collected database. We routinely performed hand sawn anastomoses until February 2022, then switched to circular stapled, with the aim of reducing the incidence of anastomotic leaks. We compared clinical data of patients who received hand sewn cervical anastomosis and circular stapled anastomosis. Primary endpoints were anastomotic leaks and strictures.

Results
We identified 101 patients who met the inclusion criteria. HS anastomosis was performed in 67 patients, while 34 received CS anastomosis. Anastomotic leak rate was 22.4% in the HS group and 8.8% in the CS group (OR 0.34, p=0.092). Anastomotic stricture rate was 26.9% in the HS group and 14.7% in the CS group (OR 0.47, p=0.17). Median length of stay was 18 (IQR 15-22) days in the HS group and 13.5 (IQR 12-14.5) days in the CS group (p=0.001). Severe complication rate (CD&gt;2) was 16.4% in the HS group and 11.8% in the CS group (OR 0.68, p=0.53).

Conclusions
In our experience, the introduction of circular stapled cervical esophago-gastrostomy was feasible and safe, and resulted in a lower incidence of anastomotic leak and stricture compared to hand sewn anastomosis, though not statistically significant, possibly because of the small sample size. No difference in other major postoperative outcomes was observed. We found cervical CS anastomosis a reliable, reproducible and technically less demanding procedure, even for very high esophageal cancers. We believe that this anastomotic technique could spread even in Western countries where it has hardly ever been explored.
554. SHORT TERM OUTCOMES OF ESOPHAGECTOMY FROM LOW VOLUME CANCER CENTRE IN INDIA
Authors: Nittala Rigved , Padhy Amita Sekhar 
Published: September 2024

Abstract
This study evaluates short term outcomes of esophagectomy at a low volume cancer hospital in Visakhapatnam, India. Fifteen patients who underwent esophagectomy from 2020 to 2023 were analysed. The most common histology was squamous cell carcinoma. The mean age was 55 years and the majority were male. The common approaches used were open trans hiatal and transthoracic esophagectomy. The mean operative time was 9.5 hours and the mean hospital stay was 15.92 days. There were no perioperative deaths but complications included pulmonary issues, vocal cord paralysis, anastomotic leaks, chyle leaks and wound infections. Higher volume centres tend to have better outcomes after esophagectomy. However, factors other than volume like patient selection, ERAS (Enhanced Recovery After Surgery) protocols, specialized critical care and trained multidisciplinary teams also impact outcomes. At our centre, though a low volume hospital, proper patient selection, prehabilitation and a collaborative team approach helped achieve acceptable results. We recommend developing consensus on defining low and high-volume centres for esophagectomy in the Indian context, based on disease burden, resources and constraints. Overall, there is a lack of Indian data comparing outcomes between low and high-volume centres for esophagectomy.
564. PRONE POSITION THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS DURING 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER. SURGICAL TECHNIQUE
Authors: Davakis Spyridon , Liakakos Theodoros , Charalabopoulos Alexandros 
Published: September 2024

Abstract

Background
Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of this approach is the construction of esophago-gastric anastomosis. Herein, we aim to present our anastomotic technique on hand-sewn esophago-gastric anastomosis in prone position, utilizing 3D-assisted thoracoscopy.

Methods
This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers from the same surgical team, over a period of 6 years and more than 250 consecutive esophagectomies. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. The anastomosis was hand-sewn in prone position, in 2-layers, using barbed sutures, with utilization of 3D-assisted thoracoscopy. Thorough technique and key steps of this anastomotic technique are provided.

Results
Median operative time was 280 minutes while median suturing time for the esophago-gastric anastomosis was 45 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=6 patients (2%); n=5 were type I anastomotic leaks, requiring no intervention and n=1 was type II, which was treated with thoracoscopic lavage and chest drains followed by endoVAC therapy.

Conclusion
Formation of the esophago-gastric anastomosis is the rate limiting step of 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction utilizing mechanical staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced safely and effectively, offering all the advantages of manual anastomosis and significant reduction of devastating post-operative anastomotic leakage.
https://wetransfer.com/downloads/bdf3a3496197daf79ccf5b05f71ba64920240309175850/a4da3be742fd3199e102e553c8a4011e20240309175918/c14cc2
578. DUPILUMAB EFFICACY IN EOSINOPHILIC OESOPHAGITIS PATIENTS TREATED WITH PRIOR THERAPY AND INADEQUATE RESPONSE, INTOLERANCE, OR CONTRAINDICATION TO SWALLOWED TOPICAL CORTICOSTEROIDS
Authors: Cianferoni Antonella , Dellon Evan S , Schlag Christoph , Xia Changming , Durrani Sandy , Pela Tiffany , Radwan Amr , Jacob-Nara Juby A 
Published: September 2024

Abstract

Background
Improvements in histologic, symptomatic, and endoscopic aspects of eosinophilic oesophagitis (EoE) were observed in patients treated with dupilumab weekly (qw) enrolled in the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617), regardless of prior inadequate response, intolerance, and/or contraindication to swallowed topical corticosteroids (STC). Here we assess the efficacy of dupilumab qw versus placebo in this STC non-responsive/intolerant subgroup, stratifying further by those with/without history of food elimination diets, proton pump inhibitor (PPI) use at randomisation, or history of oesophageal dilation.

Methods
This analysis includes patients who received dupilumab 300 mg qw or placebo for 24 weeks in Part B and an additional 28 weeks dupilumab in Part C. Co-primary endpoints (Weeks 24 and 52) include: proportions of patients achieving peak eosinophil count (PEC) ≤6 eosinophils/high-power field (eos/hpf) and absolute change in Dysphagia Symptom Questionnaire (DSQ) score. Secondary endpoints assessed included proportions of patients achieving PEC ≤1 eos/hpf, &lt;15 eos/hpf, % change in PEC, and absolute change in Endoscopic Reference Score, and EoE-Histologic Scoring System grade/stage scores.

Results
Dupilumab 300 mg qw improved proportions of patients achieving co-primary endpoints, ≤6 eos/hpf and absolute change in DSQ score, and secondary endpoints, ≤1 eos/hpf and &lt;15 eos/hpf at Week 24 versus placebo, regardless of history of food elimination diets, PPI use at randomisation, or history of dilation (Table). Improvements were maintained or continued to improve at Week 52. A similar trend was observed for other secondary endpoints assessed. Placebo-treated patients who switched to dupilumab in Part C demonstrated similar efficacy to patients treated with dupilumab in Part B. Dupilumab safety was consistent with the known dupilumab safety profile.

Conclusion
Dupilumab qw demonstrated sustained improvements in histologic and symptomatic aspects of EoE up to 52 weeks in adults and adolescents with an inadequate response, intolerance, and/or contraindication to STC, regardless of history of food elimination diets, PPI use, or history of oesophageal dilation. Improvements in endoscopic aspects of EoE up to 52 weeks were also observed.