bluuebunny/crossref_metadata_2025_split huggingface dataset:
590. RESOLUTION OF SYMPTOMS AFTER OESOPHAGO-GASTRIC CANCER RESECTION (RESTORED)–STANDARDISING GASTROINTESTINAL SYMPTOMS AND CONDITIONS AFTER SURGERY: A MULTI-DISCIPLINARY EXPERT DELPHI STUDY
Authors: Byrne Ben , Low Donald , Andreyev Jervoise , Blazeby Jane , Markar Sheraz , Avery Kerry , Griffiths Ewen , Cockbain Andy , Nilsson Magnus , Moss Charlotte , Van Hemelrijck Mieke , Acheampong Kobby , Evans Orla , Dunn Jason , Zeki Sebastian , Taylor Joanna , Gossage James , Huddy Fiona , Davies Andrew 
Published: September 2024

Abstract

Background
Oesophago-gastric cancer surgery negatively affects quality of life with a high post-operative symptom burden. Several conditions that may be diagnosed and treated after surgery are recognised. However, consensus regarding their definition and management is lacking. We aimed to develop consensus regarding the definition, investigation and management of the common symptoms and conditions, and triggers to consider disease recurrence, as a foundation for improving management and quality of life in these patients.

Design
Modified 2-round Delphi consensus study of a multidisciplinary expert panel.

Results
86/127(67.7%) and 77/100(77.0%) responses were received in rounds 1 and 2. Consensus was achieved in defining 26 symptoms. For 10 conditions (anastomotic stricture, acid reflux, non-acid reflux, biliary gastritis, delayed gastric emptying, dumping syndrome, exocrine pancreatic insufficiency, bile acid diarrhoea, small intestinal bacterial overgrowth and carbohydrate malabsorption), definitions, diagnostic criteria, first and second-line investigation and first-line treatments were agreed. Consensus was not reached for third line investigation of some conditions, nor for second, third or fourth-line treatments for others. 12 of 14(85.7%) symptoms were agreed as triggers to consider cancer recurrence, during the early (&lt; 1 year) and late (&gt; 1 year) post-operative periods.

Conclusion
Expert consensus regarding symptoms, conditions and triggers to consider investigation for recurrence after oesophago-gastric cancer surgery was achieved. This will allow standardisation and timely diagnosis and treatment of post-operative conditions, reducing variation in care. It will facilitate comparative, prospective research to establish the incidence and response to treatment of these conditions, helping develop robust evidence to optimise patients’ quality of life.
593. DEEP LEARNING-BASED PROGNOSTIC MODEL INTEGRATING TUMOR-INFILTRATING LYMPHOCYTES FOR ESOPHAGEAL CANCER: A MULTICENTER RETROSPECTIVE COHORT STUDY
Authors: Huang Shujie , Xu Haijie , Su Yongjian , Lin Xirui , Zijie Li , Wang Sichao , Gao Zhen , Dong Yuejiao , Chen Zhuofeng , Qiao Guibin , Wu Hansheng , Hong Liangli 
Published: September 2024

Abstract

Background
Tumor-infiltrating lymphocytes (TILs) have been proven to be important prognostic factors for various tumors. However, their prognostic significance within the context of esophageal squamous cell carcinoma (ESCC) remains inadequately explored. This study aims to assess the prognostic potential of TILs in ESCC using deep learning (DL) methods.

Materials and Methods
We retrospectively enrolled 626 pathologically confirmed ESCC patients from two research centers. Their digital whole-slide imaging (WSI) and corresponding clinical information were collected. Subsequently, the DL method was employed to identify the tumor margin and TILs within the WSI. Tissue was divided into intra-tumor, peritumoral and stromal regions based on their distance from the tumor margin. TILs were counted in each region. Optimal cut-off values of TILs were determined using the X-tile software. To mitigate selection bias and intergroup heterogeneity, a propensity score matching (PSM) analysis was employed. Survival analysis was performed using Kaplan-Meier curves and the log-rank test. The Cox proportional hazards regression model was used to identify independent prognostic factors.

Results
We classified patients based on the cell counts and cut-off values of intra-tumor-infiltrating lymphocytes (I-TILs) and peritumoral infiltrating lymphocytes (P-TILs). Patients with high I-TILs & P-TILs were defined as those whose counts of both I-TILs and P-TILs exceeded the determined cut-off value. Patients with high I-TILs & P-TILs showed significantly better overall survival (OS, P = 0.0092) and recurrence-free survival (RFS, P = 0.0088) than patients with low I-TILs & P-TILs after PSM. Multivariable Cox proportional hazards regression further supported this conclusion and recognized I-TILs & P-TILs as an independent prognostic factor (P = 0.0136, hazard ratio = 0.63 for OS; P = 0.0098, hazard ratio = 0.63 for RFS).

Conclusion
In the present study, we identified the quantitative distribution of TILs in ESCC patients with the help of the DL method. We established that I-TILs & P-TILs serve as independent prognostic factors for these patients. Further study should focus on the lymphocyte subgroups and make better use of the spatial information to improve the predictive efficacy of TILs.
616. POST-ESOPHAGECTOMY REHABILITATION IS ASSOCIATED WITH EARLY IMPROVEMENTS IN PHYSICAL FITNESS AND SARCOPENIA: PRELIMINARY RESULTS FROM THE FITNESS AFTER OESOPHAGECTOMY (FARO) TRIAL
Authors: Prasad Pooja , Aure Ms Crystal Mira , Macdonald Jillian , Daly Jeremy , Wahed Shajahan , Greystoke Alastair , Phillips Alexander 
Published: September 2024

Abstract

Introduction
Curative treatment of gastro-esophageal cancer encompasses surgery and peri-operative chemo(radio)therapy. Advancements in oncological treatment and surgical techniques have resulted in incremental prognostic gains with increasing focus on survivorship and optimising quality of life (QoL). Despite enhanced recovery pathways, patients receive no assistance to improve physical functioning and QoL in the post-esophagectomy recovery period. Post-operative rehabilitation has demonstrated improvement in physical fitness and psychosocial wellbeing among other cancer subtypes. The aim of this study was to determine the impact of a patient-directed, home-based rehabilitation programme upon physical functioning in the early recovery phase following an esophagectomy.

Methods
The Fitness AfteR Oesophagectomy (FARO) study was a prospective, single-centre, parallel-group, open-label, two-arm, pragmatic randomised controlled external pilot trial. Patients were randomised to receive post-operative rehabilitation (alongside routine care- REHAB) or standard clinical care (NO-REHAB) alone in a 1:1 ratio. The rehabilitation intervention encompassed a 12-week home-based programme with weekly step-count targets, completion of resistance exercises and dietary monitoring. Cardiorespiratory fitness was determined by the 6-minute walk test (6MWT) and the functional impact of sarcopenia was assessed by the hand-grip strength (HGS). Outcomes were measured at baseline and 6 weeks post-esophagectomy. Between-group differences were analysed using linear mixed effects models.

Results
A total of 60 patients were included and randomised to REHAB (n=31) or NO-REHAB (n=29). A total of 29 patients in the REHAB group (93.5%) completed the rehabilitation programme with a 100% adherence rate. At 6 weeks post-esophagectomy, there was statistically significant improvements in the functional impact of sarcopenia as denoted by improvements in HGS in REHAB versus the NO-REHAB cohorts (mean difference= 4.237; 95% c.i 0.80-7.70; p=0.017). Cardiopulmonary fitness, as determined by the 6MWT, was comparable between cohorts with no statistically significant intergroup differences at 6 weeks (mean difference= 62.008; 95% c.i -5.85-129.91; p=0.073).

Conclusion
Post-operative rehabilitative interventions result in improvements in physical functioning in the early recovery phase following an esophagectomy. Further analysis from the FARO trial will determine if rehabilitation restores and improves QoL and recovery of cardiopulmonary fitness into survivorship.
634. SURGICAL OUTCOMES OF ESOPHAGEAL CANCER PATIENTS BASED ON PRIOR COVID DIAGNOSIS
Authors: Conrad Hope , Wang Kevin , Hamidi Mohammad , Hsu Chiu-Hsieh , Worrell Stephanie 
Published: September 2024

Abstract

Background
Since the Covid pandemic, many studies have been performed to determine the impact of Covid on surgical outcomes. Many researchers have found that prior Covid diagnosis puts surgical patients at higher risk of complication and mortality. The aim of this study is to determine if esophageal cancer patients undergoing esophagectomy are at higher risk based on previous Covid status.

Methods
The National Cancer Database (NCDB) was queried for all patients who underwent esophagectomy for cancer in 2020. This study was limited to the 2020 database as this was the year that Covid status was added to the NCDB registry. Patients with a Covid history and without a Covid history were compared. Only patients with complete Covid information were included in this study. Peri-operative outcomes including hospital length of stay and 30-day readmission were compared between groups. Wilcoxon rank-sum tests were performed to compare continuous variables between groups and Chi-square/Fisher’s exact tests were performed to compare categorical variables between groups.

Results
A total of 2387 patients met inclusion criteria, of which 114 (5%) had prior diagnosis of Covid and 2273 (95%) did not have prior Covid. There were no significant differences regarding basic demographics, including age, gender, neoadjuvant therapy, or pathologic staging. Both groups had similar rates of minimally invasive techniques and conversions to open surgery. There was no difference regarding 30-day readmission, however, the Covid group had a statistically longer hospital length of stay, 9 days (IQR 6-15) vs 8 days (IQR 1-11), p=0.007. On logistic regression, Covid was an independent predictor of increased overall length of stay (p=0.045).

Conclusion
Despite previous evidence that Covid patients may experience more surgical complications than their non-Covid counterparts, this NCDB study of esophageal patients undergoing esophagectomy demonstrated similar baseline demographics and outcomes with the only significant difference being longer hospital length of stay. Further research is necessary to determine risk of previous Covid diagnosis in surgical outcomes.
640. EPIPHRENIC DIVERTICULECTOMY WITH HELLER MYOTOMY AND DOR FUNDOPLICATION
Authors: Gutman Ya'ara , Braun Josef , Jacobi Harel , Goldes Yuri , Nevo Yehonatan 
Published: September 2024

Abstract
The attached video demonstrates epiphrenic diverticulectomy with Heller myotomy and Dor fundoplication, in a symptomatic 62 years old female patient with regurgitation and achalasia.
The video offers a unique insight into the complexities of treating this uncommon condition. In this case, a laparoscopic transhiatal approach was used. The video shows the key steps of the surgery, including challenges posed by the diverticulum's unusual location (left side of the esophagus), necessitating the careful opening of the left crura for optimal visualization and safe resection. We believe this teaching case not only sheds light on the intricacies of managing epiphrenic diverticulum but also underscores the importance of tailored approaches in addressing atypical presentations.
https://www.dropbox.com/scl/fi/jutvx1akf32nlgf8o57bp/epiphrenic-diverticuluectomy.mp4?rlkey=nmscb8y1k84g9cnfmzohtgjvp&dl=0
680. P02.06 MATTERHORN PCR BY REGION
Authors: Janjigian Yelena Y , Al-Batran Salah-Eddin , Wainberg Zev A , Van Cutsem Eric , Molena Daniela , Muro Kei , Hyung Woo Jin , Wyrwicz Lucjan , Oh Do-Youn , Omori Takeshi , Moehler Markus , Garrido Marcelo , Oliveira Sulene CS , Liberman Moishe , Oliden Victor Castro , Bilici Mehmet , Kurland John F , Xynos Ioannis , Mann Helen , Tabernero Josep 
Published: September 2024

Abstract

Background
FLOT was established as a perioperative therapy for GC/GEJC following the Phase 2/3 FLOT4 study conducted in Germany, with a pCR rate of 16% (Al-Batran et al, Lancet Oncol 2016). The global MATTERHORN study (NCT04592913) showed a statistically significant improvement in pCR with perioperative D+FLOT vs placebo (P) + FLOT in GC/GEJC at first interim analysis (Janjigian et al, ESMO Congress 2023). Subgroup analyses by region and country were completed to assess pCR rates with FLOT and benefit of D+FLOT across the global study population.

Methods
Participants (pts) with resectable GC/GEJC were randomized 1:1 to D 1500 mg or P every 4 weeks (Q4W) on Day 1 plus FLOT Q2W on Days 1 and 15 for 4 cycles (2 doses of D or P and 4 doses of FLOT pre- and post-operative), followed by D 1500 mg or P on Day 1 Q4W for 10 further cycles. Randomization was stratified by Asia vs non-Asia. pCR (Modified Ryan; central review) was assessed in prespecified (Asia) and post hoc regional subgroups, including 6 countries with the highest numbers of randomized pts.

Results
Of 948 pts randomized globally, 180 (19%) were in Asia. pCR outcomes with FLOT in Asia were consistent with global outcomes. pCR rates were improved with D+FLOT vs P+FLOT in all regions (Asia, Europe, North America and South America; Table), despite some imbalances in baseline characteristics and numerical differences in pCR rates by geographic location. The pCR rate with P+FLOT in the German subgroup (13%; 95% CI, 6.1–23.0) was similar to that with FLOT in the FLOT4 study. Improvement in pCR with D+FLOT vs P+FLOT was observed across subgroups by country. Similar trends across regional subgroups were observed for combined complete and near-complete response rate.

Conclusions
In MATTERHORN, pCR was consistently improved with the addition of D to perioperative FLOT in GC/GEJC across geographic regions. The study is ongoing for the primary objective of event-free survival.
764. PREDICTING AGE-SPECIFIC PREVALENCE OF BARRETT'S OESOPHAGUS IN AUSTRALIAN AND UNITED STATES
Authors: Vissapragada Ravi , Bulamu Norma , Whiteman David , Bright Tim , Yazbeck Roger , Karnon Jonathan , Watson David 
Published: September 2024

Abstract

Background
Barrett’s esophagus is the precursor to esophageal adenocarcinoma (EAC). EAC detected from endoscopic surveillance programs accounts for &lt;10% of all EAC, suggesting a large number of patients with Barrett’s esophagus are likely unaccounted for. Several studies have estimated the observed prevalence of Barrett’s esophagus to be approximately 1%, but this may be an underestimate. The aim of this study is to use population incidence of EAC and rate of progression from Barrett’s esophagus from large cohort studies to estimate a realistic prevalence of Barrett’s esophagus.

Methods
A simple tree cohort model was created for progression to EAC from birth to death (100 years) for American and Australian population. Lifetime risk of esophageal cancer and adenocarcinoma were endpoints. This was then used to back-calculate age-specific and overall prevalence of Barrett’s esophagus using an optimisation algorithm.

Results
Lifetime risk of esophageal cancer and adenocarcinoma in US Whites is 0.56% and 0.36% respectively, while in Australian population is slightly higher at 0.81% and 0.61% (range 0.57% - 0.65%). Estimated overall prevalence of Barrett’s esophagus is ~3% (±0.3%) and ~5.4% (±0.6%) in US White and Australian populations, while in males is 5.3% (±0.6%) and 7.4% (±0.3%), respectively. Female cohorts were seen to have lower chance of developing esophageal cancer, adenocarcinoma, and Barrett’s esophagus.

Conclusion
Cohort studies of Barrett’s esophagus are likely to underestimate its prevalence of this silent disease. Computational models based on progression from Barrett’s esophagus to EAC accounting for undetected disease reveal higher estimates, which can help in future screening options.
780. NEOADJUVANT IMMUNOTHERAPY COMBINED WITH CHEMORADIOTHERAPY VS NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CARCINOMA (CSTAGEII-III): A MULTI-CENTER PROSPECTIVE RANDOMIZED CLINICAL TRIAL (ICROSS)
Authors: Jiao Heng 
Published: September 2024

Abstract

Background
The role of neoadjuvant immunotherapy combined with chemoradiation in the treatment of esophageal cancer is not yet fully understood. This study aims to compare the efficacy and safety of neoadjuvant immunotherapy combined with chemoradiation versus traditional neoadjuvant chemoradiation in treating locally advanced esophageal squamous cell carcinoma (stages cII-III).

Methods
This prospective randomized controlled trial included histologically confirmed patients with potentially resectable esophageal squamous cell carcinoma (stages cII-cIII). Patients were randomly assigned to two groups: the treatment group (Arm A) received BGB-A317 (200mg IV) combined with the CROSS regimen of chemotherapy and radiation, while the control group (Arm B) received only the CROSS chemotherapy and radiation regimen. All patients underwent surgery followed by a five-year follow-up. The primary endpoints included pathological complete response rate (pCR), tumor regression grades, and lymph node clearance.

Results
The study enrolled 67 patients (52 males, 15 females) aged between 18-75 years. Tumor locations were as follows: upper segment in 16 cases, middle segment in 45 cases, and lower segment in 6 cases. A total of 64 patients were included in the analysis. There were no significant differences between the two groups in terms of pCR rates (Arm A 41.4% vs. Arm B 30.8%, p=0.414), tumor regression grades, Surgical time (221.09 ± 37.54 minutes vs. 227.05 ± 50.28 minutes, p=0.593), Estimated blood loss (182.73 ± 337.41 ml vs. 90.47 ± 66.36 ml, p=0.109), and postoperative hospital stay (9.31 ± 4.12 days vs. 8.42 ± 1.16 days, p=0.555). However, the treatment group had significantly more lymph nodes retrieved during surgery compared to the control group (26.86 ± 7.96 vs. 20.85 ± 9.68, p=0.020). The safety profiles were similar between the groups with no significant adverse events observed.

Conclusion
For patients with locally advanced esophageal squamous cell carcinoma, neoadjuvant immunotherapy combined with chemoradiation is comparable in efficacy and safety to neoadjuvant chemoradiation alone and may facilitate more effective lymph node clearance. Although these preliminary results are encouraging, further long-term follow-up and larger-scale studies are needed to validate these clinical findings once the study is complete.
797. A COMPARATIVE ANALYSIS ON THE EFFECTIVENESS OF DIFFERENT TREATMENT MODALITIES FOR ESOPHAGEAL CARCINOMA; A SYSTEMATIC REVIEW
Authors: Rashmi WA , Ridmi WA , Lakpriya WAY , Jayaratne JPDS 
Published: September 2024

Abstract

Background
Esophageal carcinoma; sixth most common cancer worldwide, presents a significant clinical challenge due to its aggressive nature and often late-stage diagnosis, resulting in poor prognosis and limited treatment options. Various treatment modalities, including surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy, are utilized in clinical practice. However, the optimal treatment strategy remains uncertain, as the comparative effectiveness of these modalities is not well-defined. Past studies have provided conflicting evidence, necessitating a comprehensive evaluation to guide clinical decision-making. Therefore, this systematic review aims to compare the efficacy and safety of different treatment modalities for esophageal carcinoma, with the objective of informing evidence-based treatment approaches and improving patient outcomes.

Methods
Total 350 publications from PubMed, EMBASE, Cochrane, Google Scholar and Semantic Scholar databases were identified on the effectiveness of different treatment modalities for esophageal carcinoma between 2000 and 2024. Following deduplication, two independent reviewers initially screened the articles for eligibility with titles and abstracts, and then, with complete articles. Bias assessment using GRADE guidelines for observational studies was done. Non-English studies, case-series/case-reports/essays/book-chapters/conference-abstracts/editorials/thesis/dissertations and studies without full-texts were excluded.

Results
Overall, the effectiveness of each treatment modality for esophageal carcinoma depends on various factors, including tumor stage, histology, patient characteristics, and treatment regimen. Combination approaches, such as chemoradiotherapy or multimodal therapy, are often used to maximize treatment efficacy and improve patient outcomes.

Conclusion
Multidisciplinary collaboration, personalized treatment approach, integration of novel therapies, such as immunotherapy and targeted therapy, into standard treatment regimens, survivorship care and advocate for further research to identify optimal treatment sequencing, identify predictive biomarkers of treatment response, and explore novel therapeutic targets to improve outcomes for patients with esophageal carcinoma is recommended.
801. ROBOTIC ASSISTED LAPAROSCOPIC GIANT PARA-OESOPHAGEAL HERNIA REPAIR: 5-YEAR EXPERIENCE
Authors: Siriwardana Priyantha , Sathian Vishnu , Qamruddin Mohammad , Lorenzi Bruno , Kadirkamanathan Sritharan 
Published: September 2024

Abstract

Background
Prior to laparoscopic era, giant paraesophageal hernia repair (GPEHR) was considered a relatively morbid operation requiring thoracotomy or laparotomy or both. GPEHR has been shown to be amenable to laparoscopic approach with low morbidity and mortality. We presented the outcome of over 200 cases of laparoscopic GPEHR (LGPEHR) with long-term follow- up over 20 years at DDW 2022. We have been performing robotic-assisted laparoscopic giant paraesophageal hernia repair (RAL-GPEHR) since 2018 and present our results.

Methods
We did a retrospective analysis of prospectively collected data of RAL- GPEHR using the DaVinci Xi between December 2018 and March 2024. All operating data are electronically recorded automatically by DaVinci Xi system for each surgeon/console user. Demographic data, clinical presentation, pre-operative assessment, and testing including haemoglobin (Hb), respiratory function {Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 Second (FEV1)} as well as quality-of-life (QoL) with SF-36 questioners (including general health, physical, emotional, and social components), length of hospital stay (LOS), morbidity, mortality and follow up outcomes (Clinical, Hb, radiological, respiratory and QoL) were recorded.

Results
Twenty patients underwent RAL-GPEHR with 15(75%) having crural repair plus gastropexy and 5(25%) patients having additional Toupet fundoplication. Fourteen (70%) were females. Data is presented in Table 1. Presenting symptoms were dyspnoea, reflux, post-prandial pain, and dysphagia with 7(35%) anaemic. Eight (40%) were ASA III and 12(60%) ASA II. Thirteen (65%) were Type III-GPEH, 4(20%)-Type IV, one-Type II (5%) and 2(10%) recurrent GPEH. Blood loss was minimal with no intra-operative complications or conversions to open. One (5%) had post-operative chest infection. Symptoms improved in all post-operatively with improvement of Hb, FVC, FEV1 and QoL. Radiological recurrence occurred in one (5%) but remains asymptomatic.

Conclusions
This report represents our initial experience of a small number of patients undergoing RAL-GPEHR which has proved to be feasible and safe. A long-term follow- up with a large series of patients is required to compare long-term outcomes especially symptomatic recurrences and QoL.