bluuebunny/crossref_metadata_2025_split huggingface dataset:
213. A NEW MANOMETRIC TOOL TO EVALUATE THE EFFICACY OF LAPAROSCOPIC ANTIREFLUX SURGERY
Authors: Sozzi Marco , Siboni Stefano , Puricelli Michele , Milito Pamela , Lovece Andrea , Bernardi Daniele , Asti Emanuele 
Published: September 2024

Abstract

Background
High resolution manometry (HRM) has been proven able to describe the pathophysiological pathway leading to gastroesophageal reflux disease (GERD). Recently, a new manometric tool, the Milan Score (MS), has been introduced and validated to evaluate the risk of pathologic GERD, defined as Acid Exposure Time (AET) &gt;6% at pH-study. Aim of this study is to validate this score in the post-operative assessment after laparoscopic antireflux surgery (LARS).

Methods
All patients who underwent HRM after LARS between October 2020 and May 2023 were included. The MS was calculated assessing four manometric variables: esophagogastric junction (EGJ) type, EGJ contractile integral (EGJ-CI), ineffective esophageal motility (IEM) and response to the straight leg raise (SLR) manoeuvre. The MS was considered pathologic if ≥137 (risk of GERD ≥50%). The risk of GERD was categorized into six classes, according to the MS score. The MS was compared with validated questionnaires for reflux symptoms, including GERD Questionnaire (GERD-Q), GERD Health-Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI), and with postoperative endoscopy findings.

Results
A total of 160 patients were included (63% males, age: 53 years, time from surgery: 30 months). Surgical techniques included magnetic sphincter augmentation in 54% of patients, Toupet fundoplication in 29% and Nissen or Dor fundoplication in 17%. The proportion of patients with MS ≥137 among those with pathologic questionnaires was 73% for GERD-Q (p&lt;0.001), 75% for GERD-HRQL (p&lt;0.001) and 78% for RSI (p&lt;0.001). The rate of pathologic questionnaires increased for higher MSs. A MS ≥137 was related to recurrent hiatal hernia (23%, p=0.046) and esophagitis (21%, p=0.007) at endoscopy. Clinical and manometric outcomes were similar among different surgical techniques.

Conclusions
The MS is an efficient tool to assess the efficacy of LARS. Various surgical techniques have similar distribution in the different risk classes for GERD identified by MS, and similar clinical results. HRM with MS represent an easy and feasible assessment of surgical outcomes after LARS, providing an objective evaluation of the antireflux barrier after surgery.
220. SHORT-AND LONG-TERM OUTCOMES OF ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A PROPENSITY SCORE-MATCHED STUDY
Authors: Goto Hironobu , Koterazawa Yasufumi , Sawada Ryuichiro , Harada Hitoshi , Urakawa Naoki , Hasegawa Hiroshi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Oshikiri Taro , Kakeji Yoshihiro 
Published: September 2024

Abstract

Background
Conventional minimally invasive esophagectomy (C-MIE) for esophageal cancer has become widespread and standardized. In Japan, robot-assisted MIE (RAMIE) has been covered by national health insurance since 2018. However, the superiority of RAMIE over conventional MIE remains controversial. In this study, we will clarify the short-and long-term outcomes of RAMIE compared to C-MIE.

Methods
Short-term outcomes were compared using propensity score-matching (PSM) for C-MIE group (324 cases) and RAMIE group (101 cases) performed from 2010 to 2023. Long-term outcomes were compared using PSM for C-MIE group (313 cases) and RAMIE group (69 cases) up to 2021, when a minimum three-year observation period was available. Covariates for PSM were age, sex, tumor location, histological type, cT, cN, preoperative treatment, abdominal approach, and range of lymph node dissection.

Results
For short-term outcomes, 96 cases were included in each group after PSM. There were no significant differences in age, sex, tumor location, histological type, cT, cN, and preoperative treatment. Operative time was significantly longer in RAMIE group than in C-MIE group (overall procedure: 657 vs. 764 min, P&lt;0.001; thoracic prpcedure: 306 vs. 411 min, P&lt;0.001). Blood loss was significantly lower in RAMIE group than in C-MIE group (145 vs. 64 ml, P&lt;0.001). The rate of recurrent laryngeal nerve palsy (Clavien-Dindo classification, Grade II or higher) was significantly lower in RAMIE group than in C-MIE group (10% vs. 0%, P&lt;0.001). There were no significant differences in the rates of anastomotic leakage and postoperative pneumonia between both groups (P=0.159, 0.709). For long-term outcomes, 69 cases were included in each group after PSM. The 3-year overall survival rate was 70.8% in C-MIE group and 77.1% in RAMIE group, and the 3-year disease-free survival rate was 63.5% in C-MIE group and 58.8% in RAMIE group, both showing no significant difference (P=0.406, P=0.651).

Conclusions
RAMIE has the potential to reduce recurrent laryngeal nerve palsy compared to C-MIE and long-term outcomes for both procedures were comparable.
223. OUR SURGICAL TECHNIQUE OF TRACHEAL RESECTION AND ANTERIOR MEDIASTINAL TRACHEOSTOMY (AMT) IN THE MULTIDISCIPLINARY TREATMENT OF ESOPHAGEAL CANCER INVADING TRACHEA
Authors: Makino Tomoki , Momose Kota , Yamashita Kotaro , Tanaka Koji , Eguchi Hidetoshi , Doki Yuchiro 
Published: September 2024

Abstract
Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment and technically demanding. Herein, we introduce our surgical procedure of AMT and its tips to reduce postoperative complications. Briefly, in a supine position with cervical approach, the manubrium, the medial half of the clavicle, and the adjacent first and second ribs on both sides were removed to achieve an open cervico-thoracic view. After completion of tumor resection, AMT was performed; after encircling brachiocephalic artery and transected innominate vein if needed, the tracheal stoma was translocated from the left to right side of the brachiocephalic artery to avoid postoperative hemorrhage caused by tracheal compression. In a case of free-jejunum reconstruction, we usually harvest mesentery as much as possible to fill in the surrounding dead space in the upper mediastinum around trachea and major arteries to prevent infection (we also use the pectoral myocutaneous flap and omentum for this purpose). The tracheal stoma was finally created using interrupted stitched to attach the tracheal stump to the native chest skin.
https://photos.google.com/photo/AF1QipNDuxhBpSYDIDydLYD_0Vk917Kd13bG5t6ILtb6
227. CAUSES OF IN-HOSPITAL MORTALITY FOLLOWING TRANSTHORACIC ESOPHAGECTOMY FOR CANCER
Authors: Straatman Jennifer , Babic Benjamin , Klevebro Frederik , Fuchs Hans , Gisbertz Suzanne , Schmidt Thomas , Bruns Christiane , van Berge Henegouwen Mark , Nafteux Phillipe , Nilsson Magnus , Schröder Wolfgang 
Published: September 2024

Abstract

Background
Rates of peri-operative mortality following esophagectomy for cancer have markedly decreased over the last few decades, with a 90-day mortality rate below 5% considered a benchmark for quality of care. Although studies have focused on mortality rates, little is known about the causality. The aim of this study was to perform a multicenter, in-depth analysis of peri-operative mortality following esophagectomy for cancer.

Methods
Data was obtained multicenter, from prospective databases, between January 2010 – June 2020. All patients with a lethal postoperative course (Clavien-Dindo V) following elective transthoracic esophagectomy were included. Data collection included baseline characteristics, preoperative comorbidities, surgical procedures, postoperative complications and their management. In each participating center, two surgeons independently reassessed patient work-up and the management of intra-operative and postoperative complications to finally classify the management of each section as adequate, non-adequate or undetermined. Statistics encompassed descriptive analysis.

Results
One-hundred and twenty-one out of 3899 patients died in-hospital following oesophagectomy; a mortality rate of 3.1%. Patients deceased on a median of 32 days after surgery (IQR: 18-60). In preoperative work up: 24 patients (19.7%) had a Charlson-Comorbidity-Index (CCI) of 5 of higher; with cardiac comorbidity reported most often, in 39% of patients. Reassessment revealed work-up was not adequate in two patients (1.4%).
During surgery, 6 patients (4.6%) suffered complications, all managed adequately in reassessment. Following surgery, a total of 343 major complications were identified in the 121 patients (mean 2.4 ± 1.2) with anastomotic leakage (AL) reported most often, in 65 patients (53.7%). AL was reported as cause of death in 44 patients (36.5 %). In eight patients (6.6 %) postoperative management was reassessed to be non-adequate, in these cases recognition and initiation of treatment for AL (n=7) or conduit necrosis (n=1) was delayed.

Conclustion
In contrast to other published series, reassessment of this homogenous patient cohort with a lethal clinical course in expert centers revealed only a low rate of preventable mortality with respect to the preoperative patient selection and postoperative complication management. However, anastomotic leakage was identified to be the leading cause of death following esophagectomy contributing to a significantly prolonged clinical course and lethal outcome. As the development of surgical procedures with complex anastomotic techniques is inevitably associated with an increasing leakage rate expressed by prolonged learning curves, modification of complication management might be considered in order to reduce overall death rates.
242. BRD4 INHIBITION ENHANCES THE RADIOSENSITIVITY OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA THROUGH REGULATING ATF3-MEDIATED SERINE AND NUCLEOTIDE SYNTHESIS
Authors: Zhao Lei , Gao Tiantian , Zhang Zewei 
Published: September 2024

Abstract

Background
Radioresistance is a major culprit for radiotherapy failure in esophageal squamous cell carcinoma (ESCC). This study aimed to investigate the underlying mechanism of Brd4 in radiosensitivity of ESCC.

Methods
Brd2/3/4 proteins were assessed in radiosensitive and radioresistant ESCC tissues using IHC. A serial of functional experiments was performed to verify the significance of Brd4 in ESCC. RNA-seq and bioinformatics analyses were used to determine the potential downstream targets. The dual-luciferase reporter and ChIP assay were further examined the underlying regulatory mechanism among targets. Besides, we further verified the importance of ATF3-mediated serine and nucleotide metabolism in radiated ESCC cells.

Results
Brd4 is highly expressed in radio-resistant ESCC tissue. Knockdown of Brd4 led to increased DNA damage and cell apoptosis in irradiated ESCC cells. RNA-seq analyses exhibited that ATF3 was a potential downstream target of Brd4. The dual-luciferase reporter and ChIP assay demonstrated that Brd4 upregulated ATF3 expression via activation its promoter region. Besides, we found that ATF3 could facilitate the enzyme activities involved in serine and nucleotide biosynthesis pathway to promote radiation-induced DNA damage repair.

Conclusion
Brd4 facilitates ATF3 expression via binding to and activating ATF3 promoter region. Enhanced ATF3 further increases crucial enzymes activity in serine and nucleotide biosynthesis pathway to promote radiation-induced DNA damage repair. Targeting Brd4 is a promising treatment strategy to improve radiosensitivity in ESCC.
247. INVESTIGATION ON THE RECURRENCE AND PROGNOSIS WITH MM/SM1 OESOPHAGEAL SUPERFICIAL CANCER AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Toyokawa Tatsuya , Fujita Isao 
Published: September 2024

Abstract

Background
The therapeutic strategy for MM/SM1 oesophageal superficial cancer (OSC) after endoscopic submucosal dissection (ESD) still remains controversial, but there are some opinions that cut-end positive, vascular invasion positive, infiltrative growth pattern (INF) c, and poorly differentiated carcinoma are the risk factors for the recurrence of lymph-node (LN) or distal metastases.

Methods
This study aimed to investigate the recurrence and prognosis after ESD in patients with MM/SM1 OSC who do not have the risk factors. We performed ESD in 167 patients with OSC, and among these, we enrolled 15 patients with MM/SM1 OSC who did not have cut-end positive, vascular invasion positive, INF c, or poorly differentiated carcinoma in this study. The clinical background characteristics, endoscopic findings, additional therapy after ESD, recurrence, and prognosis of these patients were investigated.

Results
The median age of the patients, including 11 males and 4 females, was 69 years (range: 59–84). The mean follow-up duration was 75 months (range: 17-137). Of these, 3 patients had chronic obstructive pulmonary disease, 1 had cerebrovascular disease, and 1 had chronic heart failure. Regarding the lesion location, 2 patients had the lesion at Ut, 11 had at Mt, and 2 had at Lt. In 3 patients, the lesion occupied more than 3/4 of the lumen. We found 2 patients with elevated-type lesions, 10 with flat-type lesions, and 3 with depressed-type lesions. The mean long diameter of the lesions was 29 mm (range: 11-47). Regarding the lesion depth, there were 12 lesions in MM and 3 lesions in SM1. A total of 4 patients received additional radiation therapy, and the remaining 11 patients were followed up without additional therapy. The patients who received additional therapy did not have recurrences; however, 4 among the 11 patients without additional therapy manifested LN and lung metastases. Furthermore, 3 patients died because of the progression of oesophageal cancer, and another patient received chemotherapy.

Conclusion
In this study we showed that follow-up without additional therapy after ESD in patients with MM/SM1 OSC is unlikely to be acceptable despite not having risk factors. Therefore, we should urgently develop a treatment strategy for patients with MM/SM1 OSC after ESD.
249. OVERALL SURVIVAL OF PATIENTS WITH ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY: INSIGHTS FROM A RETROSPECTIVE STUDY
Authors: Van Der Zijden Charlène , Bouwman Anna , Mostert Bianca , Nuyttens Joost , van der Sluis Pieter , Spaander Manon , Mens Jan Willem , Homs Marjolein , van Doorn Leni , Wijnhoven Bas , Lagarde Sjoerd 
Published: September 2024

Abstract

Background
Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard of care for patients with locally advanced esophageal cancer. However, definitive chemoradiotherapy (dCRT) may be considered as an alternative for those with unresectable disease, cervical location of the tumor or if a non-surgical approach is preferred based on the patient's condition. Heterogeneity in indications for dCRT makes it challenging to draw generalized conclusions regarding outcomes and survival. The aim of this study was to evaluate overall survival (OS) and recurrence patterns in patients with specified homogeneous indications for dCRT.

Methods
Patients with esophageal cancer treated with dCRT (50.4 Gy radiotherapy concomitant with 6 cycles of carboplatin/paclitaxel) between 2012-2022 in a tertiary referral center were identified from our institutional database. Primary endpoint was OS calculated from date of diagnosis until date of death or last day of follow-up, using the Kaplan Meier method. Secondary endpoints included the proportion of patients that completed the dCRT regimen, 30- and 90-day mortality following dCRT and disease recurrence.

Results
162 patients were included, median follow-up was 74.6 months (IQR 46.2-99.3). The full dCRT regimen was completed by 116 (73.9%) patients. The 30- and 90-day mortality were 2.5% and 8.3%, respectively. The median OS was 23.7 months (95% CI 6.65-40.66) for cervical location of the tumor, 13.7 months (95% CI 7.92-29.8) for irresectable disease, 28.2 months (95% CI 12.10-44.22) for patients unfit for surgery and 20.6 months (95% CI 14.14-27.13) for those with preference for dCRT (p=0.15). Disease recurrence was observed in 74 patients (46%), located locoregional (46%), distant (19%) or both locoregional and distant (35%).

Conclusion(s)
Treatment with dCRT resulted in a 5-year OS of 35% and is associated with a high 90-day mortality. Disease recurrence was mostly locoregional located and was observed in 46% of patients. This emphasizes the critical necessity for enhanced treatment strategies centered on improving locoregional disease control.
253. CLINICAL USEFULNESS OF ENDOSCOPY, BARIUM FLUOROSCOPY, AND CHEST COMPUTED TOMOGRAPHY FOR THE CORRECT DIAGNOSIS OF ACHALASIA
Authors: Ishii Tadashi , Kamei Takashi , Nakano Toru , Koseki Ken 
Published: September 2024

Abstract

Background
The definite diagnosis of esophageal achalasia is established using manometry, which is per- formed in patients with suspected achalasia based on the findings of screening examinations, such as upper gastrointestinal endoscopy, chest computed tomography (CT), or a barium swallow test. However, the exact values of test characteristics in these supportive diagnostic examinations remain unclear.

Methods
We estimated the sensitivity and specificity of characteristic findings in the supportive diagnostic examinations for achalasia by comparing the data of a large number of achalasia patients and others with digestive symptoms.

Patients
Achalasia patients (n=119) and non-achalasia patients with suspected achalasia and repeated feelings of chest discomfort (n=37) who were treated in a single university hospital.

Results
Characteristic findings on chest CT (i.e. dilated esophagus, air-fluid level formation) and barium swallow tests were observed in more than 80% of achalasia patients but in less than 10% of non-achalasia patients. In contrast, conventional characteristic findings of upper gastrointestinal endoscopy (i.e. intra- esophageal food debris, feeling of resistance at the esophagogastric junction) were seen in only 40%-70% of achalasia patients. In particular, the feeling of resistance at the esophagogastric junction was observed by the examiner in only 30%-50% of patients.

Conclusion
Intra-esophageal food debris or resistance at the esophagogastric junction on upper gastrointestinal endoscopy will be positive in only about half of patients with achalasia. Other supportive diagnostic examinations, such as chest CT or barium fluoroscopy, should therefore be included in order to avoid overlooking the disease.
261. CONVERSION ESOPHAGECTOMY FOR CT4B ESOPHAGEAL CANCER - MIE VS OPEN -
Authors: Ishiyama Koshiro , Kurita Daisuke , Oguma Jyunya , Daiko Hiroyuki 
Published: September 2024

Abstract

Background and Aims
The standard treatment for locally advanced unresectable esophageal cancer is definitive chemoradiotherapy (dCRT), however, after induction chemotherapy with a triplet chemotherapy regimen (docetaxel, cisplatin, and 5-FU: DCF) or dCRT, conversion surgery could be performed if esophageal cancer is considered resectable. Furthermore, minimally invasive surgery such as robot-assisted or thoracoscopic procedures are expected to improve the outcome of patients with advanced esophageal cancer.
We investigated the feasibility of minimally invasive esophagectomy (MIE) in conversion surgery.

Materials and Methods
Sixty-six patients who underwent conversion thoracic esophagectomy for cT4b esophageal cancer from 2007 to 2023 were included. The short-term outcomes of 25 open esophagectomy group and 41 MIE group (8 robot-assisted and 33 thoracoscopic) were compared.

Results
No differences in age, gender, PS, tumor location, histology, cN, or cM were observed between the two groups. cT4b organs tended to be in the airway in the MIE group (airway 70.7% vs 44%, major vessels 19.5% vs 24%, both 9.7% vs 32%, p=0.04) and DCF therapy was significantly performed in the MIE group for induction therapy (DCF 87.8% vs 56%, dCRT 12.2% vs 44%, p&lt;0.001). On the other hand, salvage surgery was significantly associated with open esophagectomy (24.3% vs. 52%, p=0.003).
There was no difference in surgical outcomes regarding thoracic operation time (157 min vs. 180 min, p=0.09), whereas the total operation time was significantly shorter in the MIE group (392 min vs. 439 min, p=0.02). Blood loss was significantly lower in the MIE group (79 ml vs. 470 ml, p&lt;0.001), and R0 resection rate did not differ (82.9% vs. 72%, p=0.357).
There were no significant differences in postoperative complications including pneumonia (26.8% vs. 44%, p=0.183) and recurrent nerve palsy (21.9% vs. 36%, p=0.260), but anastomotic leakage was significantly lower in the MIE group (4.8% vs. 24%, p=0.04). There was no difference in median postoperative hospital stay (16 [11-20] vs. 16 [14-29] days), however, median ICU stay (3 [3-4] vs. 4 [3-4] days, p=0.03) and readmission within 1 month after discharge (2.4% vs. 16%, p=0.04) were significantly lower in the MIE group. In-hospital mortality was observed in 1 case in the MIE group and 3 in the open esophagectomy group.

Conclusion
Despite the bias associated with the transition of treatment modalities and surgical techniques, MIE may contribute to improved short-term outcomes in conversion surgery.
371. ENDOFLIP: THE FUTURE OF DYSPHAGIA DIAGNOSIS AND MANAGEMENT
Authors: Gonçalves Ana Raquel , Cardoso Pedro , Peixoto Armando , Macedo Guilherme , Santos Ana Luísa 
Published: September 2024

Abstract

Background
High-resolution manometry (HRM) is the gold standard for characterizing esophageal motility disorders, but it’s frequently associated with poor patient tolerance. A newer diagnostic tool, the Endoscopic Functional Lumen Imaging Probe (EndoFLIP), has emerged to assess esophagogastric junction (EGJ) distensibility and distension-mediated peristalsis. Also, for motility disorders such as EGJ outflow obstruction (EGJOO), HRM-isolated features aren’t enough for the diagnosis. The diagnosis also requires symptom correlation and additional investigations like EndoFLIP.

Methods
We conducted a single-center prospective cohort study for patients with dysphagia and inconclusive or intolerant to HRM. The inclusion criteria were patients with an elevated median integrated relaxation pressure (IRP) on HRM and patients with an inconclusive or intolerant to HRM. Patients with isolated IRP on HRM were included, as this isolated finding does not allow for the definitive diagnosis of EGJOO. These patients underwent EndoFLIP testing from January 2022 to February 2024 at a tertiary center.

Results
We performed EndoFLIP on 42 patients (50% male; 50% female), 23,8% with EGJOO diagnosis on HRM, 21,4% with inconclusive HRM, and 54,8% patients intolerant to HRM. Twenty-three patients intolerant to HRM underwent EndoFLIP, enabling diagnosis in all cases. Four patients were diagnosed with EGJOO, 6 with achalasia, and 4 with ineffective esophageal motility (IEM). On 88% of patients, the EndoFLIP allowed a correct diagnosis and treatment, with 29% undergoing endoscopic treatment during the same procedure. 9 patients with inconclusive HRM were diagnosed after EndoFLIP: 3 were diagnosed with EGJOO, 4 with IEM, and 3 with achalasia.
We report a significant discordance between EGJOO diagnosis on HRM and EndoFLIP results. 50% of patients diagnosed with EGJOO on HRM showed normal EndoFLIP results, with only 20% confirming the diagnosis, while 20% raised the possibility of the diagnosis being achalasia. 43,8% of patients diagnosed with EGJOO confirmed by EndoFLIP underwent endoscopic therapy with botulinum toxin or balloon dilation during the same procedure, resulting in clinical improvement for all patients.

Discussion
The discordance between HRM and EndoFLIP may arise from HRM's tendency to overdiagnose EJGOO, leading to unnecessary testing and treatments for EGJOO. Many EGJOO HRM diagnoses don't require therapy, as symptoms often resolve spontaneously or with dietary education, casting doubt on the isolated HRM finding's clinical significance. It's particularly beneficial for patients with inconclusive/intolerance to HRM, allowing correct diagnosis and treatment in cases of obstructive symptoms. These results support EndoFLIP as a screening tool for patients undergoing endoscopy, enabling better selection of those benefiting from subsequent HRM.