bluuebunny/crossref_metadata_2025_split huggingface dataset:
323. LONG-TERM SURVIVAL OUTCOME OF PATIENTS WITH EARLY ESOPHAGEAL CANCER AFTER ESD (ENDOSCOPIC SUBMUCOSAL DISSECTION) AND ESOPHAGECTOMY
Authors: Lin Yu-fu , Lee Jang-Ming , Lin M Mong-Wei , Huang Pei-Ming , Chen Ke-Cheng , Kuo Shuenn-Wen 
Published: September 2024

Abstract

Endoscopic submucosal dissection (ESD) has been gradually accepted as an effective treatment option for patients with early esophageal cancer. However, its long-term outcome is limited in literature.

Method
This study compare the overall survival for the patients with early esophageal cancer (T1N0M0) treated with ESD and esophagectomy. The tumor staging was confirmed with EUS, PET and CT imaging. The indication of ESD was T1aN0M0 in clinical staging studies. Three-field lymph node dissection with intrathoracic (Ivor Lewis) or cervical esophagogastrostomy (McKeown) was performed for the patients undergoing esophagectomy under thoracoscopic (minimally invasive esophagectomy) laparoscopic approaches.

Result
There were 82 patients enrolled in the study including 22 and 60 undergoing esophagectomy and ESD respectively. There is no difference of overall survival in 3 and 5 years with 89.1 % and 81.8 % for patients after ESD, 78.1 % and 78.1 % after esophagectomy (P=0.6)

Conclusion
For early esophageal cancer with T1aN0M0, ESD can provide an equivalent long-term survival outcome as compared to that with esophagectomy with three-field lymph node dissection.
326. SPONTANEOUS OESOPHAGEAL PERFORATION TREATED WITH OESOPHAGEAL STENT
Authors: Tang Linda , Lee Francis , Gaszynski Rafael , Kwon Sebastionus , Devadas Michael 
Published: September 2024

Abstract
We present the case of a 66-year-old male with spontaneous oesophageal perforation treated with oesophageal stenting. This patient reports sudden onset severe anterior chest pain after coughing and haematemesis with a background medical history of Type II DM, ESRF on Haemodialysis, Hypertension, OSA and takes prophylactic Aspirin. Endoscopy reveals multiple areas of oesophageal perforation in the proximal, middle, and distal oesophagus as well as a haematoma extending the entire length of the oesophagus to the COJ. This was treated with insertion of a WallFlex™ Fully Covered Oesophageal Stent as the patient was unsuitable for surgery. The result was re-epithelialisation of the entire oesophagus and complete resolution of the perforation at the mid-oesophagus.
Dutch physician Boerhaave first described spontaneous oesophageal perforation in 1724. Commonly, these were treated surgically with associated high morbidity and mortality. Advances in endoscopic and stent technology has given clinicians a greater armamentarium to treat patients especially in the frail end elderly population. These advances include choices such as stent covers, biodegradable and removable stents, and anti-reflux valves. Complications with oesophageal stents such as fistula formation, stent migration and retrosternal pain are often associated with the length of placement. The choice of a fully covered retrievable oesophageal stent in our case provided reconstitution of oesophageal lumen and minimisation of mediastinal sepsis.
With the progress in stent technology, we believe there will be greater use of endoscopic oesophageal stenting for oesophageal perforations bridges the gap between operative and non-operative management.
327. INCIDENCE OF GASTRIC BAND REMOVAL: A REVIEW OF THE LITERATURE
Authors: Tang Linda , Devadas Michael 
Published: September 2024

Abstract

Purpose
In the wake of the global obesity epidemic, bariatric surgery has become critical to prevent the complications of obesity and reduce the impact across health care systems. Laparoscopic Gastric Band insertion was at one point the most performed bariatric operation for obesity. In Australia, due to the limited publicly funded bariatric units, LAGB insertion is often performed in the private health sector. However, the post operative course for many of these patients who underwent LAGB has been fraught with complications often resulting in presentation to emergency, explantation of the LAGB and further surgical intervention. and is considered unfavourable in management of obesity.

Methodology
We performed a search of medical subject headings within PubMed, Medline and Embase for the terms ‘Gastric Band*’, ‘remov*’, ‘explant*. Following removal of duplicates, a total of 46 articles detailing the incidence of gastric band removals. Studies were included if they included discrete cohorts of patients who have undergone LAGB insertion, reported data on incidence of removal and median follow up &gt;3 years.

Results
Results of the literature review will be discussed.

Conclusion
While it is considered unfavourable as a surgical option for management of obesity, public hospitals continue to absorb many patients who have undergone this procedure placing stress on an already stretched system. The incidence of LAGB varies in the literature. The authors would like to provide an updated review of the literature to determine the incidence of LAGB to better inform patients and health care providers.
332. OUTCOMES OF SALVAGE SURGERY FOR ESOPHAGEAL CARCINOMA: A NATIONWIDE COHORT STUDY
Authors: Visser Maurits , Voeten Daan , Gisbertz Suzanne , Ruurda Jelle , van Hillegersberg Richard , van Berge Henegouwen Mark 
Published: September 2024

Abstract

Background
Compared to a standard resection, salvage esophagectomy is a more complex procedure and associated with increased postoperative morbidity and mortality. This study aimed to investigate short-term outcomes of salvage surgery for esophageal carcinoma and the influence of hospital volume and baseline characteristics on outcomes.

Methods
All patients undergoing esophagectomy for esophageal cancer registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) between 2012-2022 in the Netherlands were included. Patients were classified as salvage or non-salvage by registering surgeons. The definition was: surgery after definitive chemoradiotherapy. Postoperative mortality (30-day/-in-hospital) and morbidity were compared between salvage and non-salvage patients using multilevel logistic regression analyses. Hospital variation in the use of salvage esophagectomy was investigated using funnel plots. The influence of annual hospital volume (&lt;40-&gt;40) and annual salvage volume (&lt;6-&gt;6) on outcomes of salvage patients were investigated. Using backward elimination, relevant baseline characteristics influencing outcomes after salvage surgery were identified.

Results
Between 2012-2022, 7,749 patients underwent esophagectomy, of whom 251 (3%) underwent salvage resection, varying from 0%-8% of esophagectomies between centers. Salvage surgery was associated with an increased risk of 30-day/in-hospital mortality (11% vs. 3%; OR:3.65; 95%CI:2.38-5.61) and severe complications (43% vs. 28%; OR:1.81; 95%CI:1.40-2.34). Salvage patients treated in high-volume esophagectomy centers (&gt;40) had a decreased risk of 30-day/in-hospital mortality compared to low-volume centers (9% vs. 19%; OR:0.42; 95%CI:0.18-0.99), with no relation found between annual salvage volume and outcome. Certain baseline characteristics, foremost men, elderly (&gt;75 years) and squamous cell carcinomas, were associated with worse short-term outcomes of salvage surgery.

Conclusion
Salvage surgery for esophageal carcinoma is infrequently but increasingly performed in the Netherlands, with wide hospital variation in its use. Salvage surgery is associated with worse short-term outcomes when compared with non-salvage esophagectomy. Outcomes after salvage surgery were favorable in high-volume esophagectomy centers, suggesting a volume-outcome relationship for salvage surgery.
335. IMPACT OF POSTOPERATIVE COMPLICATIONS ON LONG-TERM OUTCOMES AFTER ESOPHAGECTOMY
Authors: Saito Ryo , Maruyama Suguru , Kawaguchi Yoshihiko , Akaike Hidenori , Shoda Katsutoshi , Higuchi Yudai , Tanaka Hiroto , Ichikawa Daisuke 
Published: September 2024

Abstract

Background
Recently, it has been reported that postoperative complications after esophagectomy not only prolong hospital stay and reduce quality of life, but also have impact on the long-term outcomes. However, this still remains controversial. Here, we aimed to evaluate the prognostic impact of postoperative complications after esophagectomy, focusing on the type and severity of complications. In addition, we examined the impact of postoperative pneumonia on long-term prognosis stratified by the presence of COPD.

Methods
In total, 254 consecutive patients who underwent esophagectomy for esophageal cancer between 2009 and 2021 were eligible. We examined the association between postoperative complications and long-term outcomes. Severe postoperative complications can be defined as C-D III-V in this study.

Results
Postoperative complications occurred in 150 out of 254 cases (59.1%). Patients with postoperative pneumonia and anastomotic leakage had significantly lower OS, CSS and RFS rates compared to those without, whereas other complications were not associated with long-term outcomes. Regarding severity, non-severe complications did not affect long-term prognosis, whereas patients with severe complications significantly lower OS, CSS, and RFS rates (P &lt; 0.01). In addition, patients without COPD who developed postoperative pneumonia had significantly lower long-term outcomes (P &lt; 0.01). However, in patients with COPD, no survival difference between patients with and without postoperative pneumonia was observed.

Conclusion
Severe postoperative pneumonia and anastomotic leakage were found to strongly influence the long-term outcomes. Meanwhile, postoperative pneumonia may have a minimal impact on long-term outcomes in COPD patients.
340. THE IMPACT OF OBESITY ON SURGICAL OUTCOMES AFTER ESOPHAGECTOMY FOR CANCER IN SWEDEN
Authors: Skogar Martin , Lindblad Mats , Enblad Malin , Linder Gustav 
Published: September 2024

Abstract

Background
Global obesity rates continue to rise and are closely linked to an increase in esophageal adenocarcinoma. While obesity is associated with an increased risk of postoperative complications, its influence on long-term survival is less clear. Some studies suggest that obese patients have poorer outcomes due to higher comorbidity rates, while others indicate comparable or even better survival, possibly due to better nutritional reserves.
This study aims to investigate whether obesity affects the survival and risk of postoperative complications in a national cohort of esophageal cancer patients.

Methods
This retrospective population-based register study included all individuals who underwent esophageal resection between 2006 and 2018 in Sweden. Data were extracted from the national quality registry for esophageal and gastric cancer (NREV). The cohort was grouped based on body mass index (BMI) into underweight (BMI &lt; 20), normal (BMI 20-25), overweight (BMI 25-30), and obese (BMI &gt; 30). Kaplan-Meier was used for survival analysis, and logistic regression and Cox regression were used for adjusted analyses (adjusting for sex, age, marital status, education level, Charlson comorbidity index score, histopathology, disease stage, and year of diagnosis).

Results
In total, 1742 individuals (79.9% males, mean age 66) were included, of whom 242 (13.9%) were obese. Obese individuals had more comorbidities at surgery, more commonly had adenocarcinoma, and underwent surgery more frequently in the later time period. The risk of surgical complications (e.g., anastomotic leak, bleeding) for obese individuals was not increased compared to those with normal weight (OR: 0.83 [0.56-1.21]), but an increased risk of non-surgical complications (e.g., pneumonia, cardiopulmonary events) was observed (OR: 1.78 [1.22-2.60]). The risk of death of any cause was decreased in obese individuals compared to those with normal weight (HR: 0.74 [0.58-0.95]), resulting in superior overall survival.

Conclusion
Despite the presence of more comorbidities among obese individuals undergoing esophagectomy, their risk of surgical complications remained comparable to those with normal weight. However, obese individuals exhibited a heightened susceptibility to other postoperative complications. Surprisingly, obese individuals demonstrated an improved overall survival at 5 years compared to those with normal weight.
347. THE EFFICACY OF CONVERSION SURGERY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH INVASION OF OTHER ORGANS
Authors: Ho Keiso , Kawakubo Hirofumi , Takeuchi Masashi , Matsuda Satoru , Fukuda Kazumasa , Nakamura Rieko , Kitagawa Yuko 
Published: September 2024

Abstract

Background
There are cases of advanced unresectable esophageal squamous cell carcinoma (ESCC) with invasion of other organs that can be successfully treated with chemoradiotherapy and systemic chemotherapy, enabling surgical resection. We actively perform conversion surgery for ESCC with invasion of other organs after definitive chemoradiotherapy or systemic chemotherapy.

Methods
The patients who underwent conversion therapy in our hospital for ESCC between 2012 and 2022 at participating institutions were retrospectively reviewed. We evaluated patient backgrounds, treatment outcomes, and overall survival (OS) were evaluated. 31 patients were enrolled. 14 conversion cases were performed after chemoradiotherapy, 17 cases were after chemotherapy. All 17 patients received systemic chemotherapy with DCF (Docetaxel + Cisplatin + 5-FU), and all 14 definitive chemoradiotherapy was administered at least 50 Gy.

Results
There were 24 males and 7 females with a median age of 67 (47-75) years. Involved organs were trachea in 24 cases, aorta in 6 cases, and pulmonary vein in 1 case. 19 patients underwent open esophagectomy, 11 thoracoscopic, and 1 robot-assisted. 14 patients had complications of Clavien-Dindo grade 3, mainly pneumonia, leakage, and recurrent laryngeal nerve palsy. 22 (71%) were performed R0 resection. Recurrence was observed in 20 patients (65%). Overall, 3-year PFS was 22% and 3-year OS was 39%. 3-year OS in patients with R0 resection was 49% while 12.5% in patients with R1 and 2 resection.

Conclusion
This study showed that conversion therapy could be relatively safely for ESCC patients with organ invasion responded to initial chemotherapy and chemoradiotherapy. Especially in cases R0 resection was performed, good prognosis was obtained.
348. MANAGEMENT OF AORTO-ESOPHAGEAL FIFISTULA SECONDARY AFTER THORACIC ENDOVASCULAR AORTIC REPAIR
Authors: Zhou Haining , Tang Shoujun , Zhong Chuan 
Published: September 2024

Abstract

Background
Aorto-esophageal fifistula (AEF) is rare with highly fatal conditions and occurs most frequently secondary as a result of oesophageal malignancies, aortic aneurysms, thoracic trauma, and other thoracic surgerys. We evaluated the incidence of AEF after thoracic endovascular aortic repair (TEVAR), and investigated their clinical features, determinants, therapeutic options and results. Raising awareness and vigilance of AEF and developing individualized diagnosis and treatment measures are the key to improve the prognosis.

Methods
We conducted a voluntary survey in three centres with a thoracic endovascular programme.

Results
Of the patients who underwent TEVAR between 2010 and 2020,11/423 developed AEF. Aortic pseudoaneurysm was associated with the development of AEF among indications to TEVAR (P&lt;0.05). Besides, emergent and complicated procedures resulted in increased risk of AEF (P&lt;0.05). Five patients were treated conservatively, all of whom died within 30 days. Six patients underwent AEF surgical treatment, with a perioperative mortality of 33% (2/6). At a mean follow-up of 18.7+13.6 months, overall survival was 33% (2/6).

Conclusion
The incidence of AEF after TEVAR is not negligible and long-term follow-up is required especially for patients submitted to emergent and complicated procedures. Both surgical and endovascular treatment of AEF are associated with high mortality. However, once AEF develops, conservative treatment does not appear to be an optimal management. Timely operation has positive correlation with increase of long-term survival rate of patients.
351. CONVERSION SURGERY FOR PATIENTS WITH ESOPHAGEAL CANCER AFTER ICI TREATMENT
Authors: Momose Kota , Yamashita Kotaro , Saito Takuro , Tanaka Koji , Makino Tomoki , Yamamoto Kazuyoshi , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Eguchi Hidetoshi , Doki Yuichiro 
Published: September 2024

Abstract

Background
As more and more immuno checkpoint inhibitor (ICI) agents are used in clinical practice for the treatment of esophageal cancer these days, we are becoming more likely to see a patient with initially unresectable but currently resectable tumor through the treatment with ICIs. Little is known about such conversion surgery for esophageal cancer. So, we here report our experiences.

Subjects and Methods
The patients who underwent esophageal cancer surgery after the treatment with ICI from 2020 to 2023 who had initially been diagnosed as unresectable were enrolled. Electronic medical records were retrospectively reviewed to collect clinicopathological findings.

Result
There were 15 eligible cases; 12 male and 3 female, median age 70 (51-81). Histology was SCC in all cases; 7 primary, 7 recurrent and 1 residual tumors. Involved distant metastatic organ was lymph node in 4 cases, liver in 4 cases, and lung in 1 case. Involved recurrent organ was lymph node in all the 7 recurrent cases. Clinical response to ICI treatment was detected in 12 cases (PD in 3 cases). R0 resection was achieved in 14 cases and pCR was detected in 3 cases. No irAE-suspected event was detected in all cases during postoperative course.

Conclusion
Since the patients' background, number and duration of the ICI treatment, treatment history before the conversion surgery were miscellaneous, it is still hard to lead conclusive statement on the conversion surgery for esophageal cancer after ICI treatment. So, it is necessary to keep going to experience conversion surgery cases for esophageal cancer to assess its efficacy.
357. OUTCOMES OF TWO-COURSE NEOADJUVANT CHEMOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL ON ADVANCED ESOPHAGEAL CANCER: A SINGLE INSTITUTION STUDY
Authors: Hashimoto Masashi , Noma Kazuhiro , Kawasaki Kento , Kunitomo Tomoyoshi , Maeda Naoaki , Tanabe Shunsuke , Fujiwara Toshiyoshi 
Published: September 2024

Abstract

Background
The CROSS trial established neoadjuvant chemoradiotherapy (CRT) as a cornerstone in treating esophageal cancer, making it the standard approach worldwide. However, in Japan, the JCOG1109 trial, a three-arm study, redefined the standard by showing the superiority of neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) over the conventional cisplatin and 5-fluorouracil (CF) regimen. Notably, it found no significant difference between neoadjuvant CRT with CF and CF. This trial adopted a 3-week cycle of 3 courses for the DCF regimen. Nonetheless, subsequent findings by Makino et al. suggested no difference in outcomes between 2-course and 3-course DCF regimens. This report presents the results of a 2-course neoadjuvant DCF regimen at our institution.

Method
This study included esophageal cancer patients who underwent esophagectomy after a 2-course NAC-DCF regimen at Okayama University Hospital from January 2014 to December 2019. Eligible participants were 20 to 80 years old, with a performance status of 0–1, histologically confirmed esophageal squamous cell carcinoma (ESCC), and adequate organ function. The stages ranged from cT1-4a N0-3 M0. We evaluated recurrence patterns, overall survival (OS), and recurrence-free survival (RFS) using the Kaplan-Meier method and explored histopathological factors associated with RFS through COX regression analysis.

Results
Out of 209 cases, 63 were eligible. The median follow-up was 71 months, with 17 instances of recurrence observed, categorized as lymphatic (6 cases), hematinic (3 cases), local (2 cases), dissemination (2 cases), and multiple (4 cases). The 5-year RFS was 64.5%, and the 5-year OS was 65.8%. Univariate analysis identified pathological T, N, Stage, and chemotherapy response grade as significant factors related to RFS, with multivariate analysis highlighting pathological N as an independent factor. Kaplan-Meier analysis demonstrated significant survival differences across N stages, particularly between N1 and N2.

Conclusion
Our findings from the 2-course neoadjuvant DCF regimen highlight pathological N stage as a crucial independent predictor of recurrence in ESCC patients treated with NAC-DCF. Specifically, patients above N2 exhibited notably poorer prognoses, underscoring the need for adjuvant treatment strategies.
358. IMPLICATIONS ON OVERALL SURVIVAL FROM POSITIVE CIRCUMFERENTIAL RESECTION MARGINS IN OESOPHAGEAL CANCER PATIENTS AT A TERTIARY REFERRAL CENTRE IN ENGLAND
Authors: Vaz Osborne Peter , Nair Beena , Ibison Frances , Sarantitis Ioannis , Singh Mohan , Turner Paul , Ward Jeremy , Pursnani Kishore , Shetty Vinutha Daya 
Published: September 2024

Abstract

Background
The oesophagogastric (OG) tertiary referral centre at our Trust was established in March 2009.It caters to a catchment population of approximately 1.6 million. Oesophageal cancer is a morbid disease contributing to 18% of cancer mortalities worldwide. Involvement of circumferential resection margin (CRM) is an indicator of poor prognosis. The aim was to calculate the microscopic positive resection rate in patients undergoing resections for oesophageal cancers, assess disease free survival (DFS) and overall survival (OS) in this cohort.

Methods
Patients undergoing oesophageal resections for cancer at our OG unit who satisfied the inclusion criteria - age&gt;18, operation with curative intent, adenocarcinoma and squamous cell cancer with a microscopic positive resection margin (R1) were included. Data was collected from the electronic patient record (Quadramed). Retrospective analysis was performed using MS Excel and IBM SPSS statistics Ver 27.

Results
A total of 640 oesophageal cancer resections performed between April 2009 - March 2023, who satisfied the inclusion criteria were included. Median age at surgery was 66 years. The R1 rate was 40% in our cohort (R0:R1 =380:260). Male to female ratio in the R1 cohort was 4:1. 98% (255 patients) had T3/T4 disease. 47.7% (124 patients developed recurrence. Of these, 83.8% (104 patients) developed distant metastasis and 16.2 %(20 patients) had locoregional metastasis. Median time to recurrence was 12 months and disease-free survival was also12 months. The OS at one year of 81% (140/260) was comparable to national data.

Conclusion
We conclude that locally advanced tumour staged T3 and above is the most likely cause for higher rate of CRM positivity. Other factors that could contribute is the lack of serosal layer in the oesophagus and the practise of ex situ removal of nodes from the main specimen in theatre which could potentially lead to stripping of the adventitia thus making the CRM falsely R1 during pathological staging. The R1 status however does not seem to affect the overall survival rate.