bluuebunny/crossref_metadata_2025_split huggingface dataset:
382. NUMBER OF LYMPH NODES RESECTED IS ASSOCIATED WITH OVERALL SURVIVAL IN PATHOLOGICALLY NODE-NEGATIVE ESOPHAGEAL CANCER
Authors: Bolger Jarlath , Darling Gail , Yeung Jonathan 
Published: September 2024

Abstract

Background
Lymphadenectomy is a key part of curative resection of esophageal cancer, with multiple quality assurance systems suggesting a minimum of 15 lymph nodes should be resected and subjected to pathological examination. Nevertheless, whether the absolute number of nodes resected is a surrogate marker for quality in surgery and staging, or has therapeutic benefit is debated. The aim of this study was to determine the impact of lymphadenectomy on survival in patients with resected pathologically node-negative disease (both treated and untreated with neoadjuvant therapy).

Methods
A review of our institutional prospectively maintained database was conducted from 2010-2020 inclusive. Inclusion criteria were patients undergoing esophagectomy for esophageal cancer aged 18+ who consented to data inclusion. Exclusion criteria were patients undergoing resection for benign disease, patients with Siewert III tumours undergoing gastrectomy or extended total gastrectomy, patients undergoing re-operative surgery, or patients where final pathology was not available. Univariable and multivariable analyses were performed as appropriate.

Results
195 patients (49%) had pathologically node negative disease, with median lymph node count of 25. 47% of patients were clinically node positive, but pathologically node negative following neoadjuvant therapy. On univariable survival analysis, number of nodes resected was a significant predictor of overall survival (HR 0.96, 0.93-0.98, p=0.001). On multivariable analysis, R status (HR 4.9, 1.2-21.1, p=0.03), number of nodes resected (HR 0.97, 0.94-0.99, p=0.02) and prior cN+ status (HR 2.28, 1.16-4.49, p=0.02) were predictors of overall survival. Patients with cN0, (y)pN0 disease had improved overall survival compared with cN+, (y)pN0 (median not reached vs 43.4 months, p=0.04).

Conclusion
Lymphadenectomy is a key part of resection of esophageal cancer. In pathologically node negative patients, the extent of lymphadenectomy remains a key predictor of overall survival. Conversion from clinically node positive to pathologically node negative disease is associated with worse outcomes compared to clinically and pathologically node negative disease. Even in early stage cancer, a thorough, multi-field lymphadenectomy should be encouraged.
407. MICRONUTRIENT INSUFFICIENCY AFTER SURGERY FOR OESOPHAGOGASTRIC NEOPLASMS: A PROSPECTIVE INTERVENTION STUDY CALLED THE VITAMIN STUDY
Authors: Van Der Velden Ariadne Lisa , Bartz Sam SI , Vermeer Thomas A , Bluijssen Kick JEM , van der Zijden Charlène J , Blonk Lotte , Boerma Evert-Jan G , Stoot Jan HMB , Gisbertz Suzanne S , Belgers Eric HJ , Wijnhoven Bas PL , Leers Mathie PG , Sosef Meindert N , Vijgen Guy HEJ 
Published: September 2024

Abstract

Background
Oesophageal and gastric cancer have major impact on nutritional status and quality of life (QoL). Preoperative malnutrition is reported in 42–80%. However, studies investigating postoperative nutritional status are scarce and postoperative identification and treatment of micronutritional deficiencies are currently lacking in (inter-)national guidelines. The aim of this study is to identify micronutrient deficiencies after surgery for oesophagogastric neoplasms and target them by supplementation.

Methods
This is a recently closed multicenter trial in the Netherlands. Patients receive a tailormade multivitamin supplement which differs per group and a calcium supplement. Baseline measurements consist of blood withdrawal, faecal elastase-1 (FE-1) analysis, QoL questionnaires and dietary behaviour. After 6 (T=1), 12 (T=2) and 24 (T=3) months from baseline, measurements are repeated, and a supplement questionnaire is added. The primary objective is micronutrient deficiency (yes/no). Secondary objectives include occurrence and symptoms of exocrine pancreas insufficiency (EPI) and QoL.

Results
Inclusion spanned from December 2021 to December 2023. Preliminary results from 95 patients are available, whereby 68 patients underwent oesophagectomy and 27 gastrectomy. Of these, 55 patients received 6 months of supplementation (T=1). At T=0, 77.0% had at least one micronutrient deficiency. Identified deficiencies are shown in table 1. Deficiencies were more common in patients undergoing gastrectomy compared to those undergoing oesophagectomy (88.0% vs. 72.1%). Reduced FE-1 (&lt;200 mg/kg) was found in 22.2% at baseline and 26.7% at T=1. 16.7% experienced EPI symptoms at baseline, which resolved at follow-up.

Conclusion
The most common micronutrient deficiencies decreased substantially after 6 months of supplementation. The follow-up extends until November 2024. Routine monitoring and supplementation could potentially be implemented in standard postoperative care for gastric and oesophageal cancer.
408. IS DYSPNOEA IN PARAOESOPHAGEAL HERNIA ONLY POST PRANDIAL? RELEVANCE TO THE POST TOOL DEVELOPMENT
Authors: Mugino Miho , Connell Louise , Paredes Steven , Khoma Oleksandr , Falk Gregory 
Published: September 2024

Abstract

Background
Paraoesophageal hernia (POH) presents with a unique symptomatology that may mimic respiratory and cardiovascular disease. Dyspnoea is increasingly recognised as a predominant symptom of POH. Post-prandial dyspnoea was included in a POH specific symptom reporting tool (POST). We have prospectively recorded the type of dyspnoea among patients with POH, and whether surgery improves dyspnoea.

Methods
Consecutive patients with POH managed in our service from 2009 to 2022 were identified. Preoperative dyspnoea was documented as 'post prandial' or 'with ordinary physical activity' on a symptom recording proforma. Post operative improvement in dyspnoea was evaluated.

Results
A total of 520 consecutive patients were diagnosed with POH between January 2009 to November 2022. 514 patients were included in the analysis; there were 383 females (75%) and mean age was 70. Improvement in dyspnoea was reported in 308 out of 355 (95%) patients. Pre-operative dyspnoea was categorised into activity induced (89%) and post-prandial (3%) or both (8%). Patients with both activity induced and post-prandial dyspnoea were 0.26 times less likely to report improvement in dyspnoea postoperatively than those with only activity induced dyspnoea (OR=0.26, 95% CI 0.07-0.94, P=0.041).

Conclusion
Symptom assessment of POH should include both post-prandial and activity induced dyspnoea, as both type of dyspnoea are associated with the presence of POH and is improved following surgical repair. There are multiple possible causes for dyspnoea including post prandial cardiac inflow obstruction, pulmonary aspiration, as well as anaemia (with or without iron deficiency) associated with the hernia. Any dyspnoea should be considered related to POH and therefore both post-prandial and activity induced dyspnoea should be included in diagnostic algorithm designed to evaluate POH.
440. QUANTIFICATION OF FLUORESCENCE ANGIOGRAPHY FOR ESOPHAGEAL PERFUSION ASSESSMENT: MEASURING AGREEMENT BETWEEN TWO SOFTWARE ALGORITHMS
Authors: Nijssen David J , Joosten Johanna J , Osterkamp Jens , van den Elzen Richard M , de Bruin Daniel Martijn , Svendsen Morten Bo Søndergaard , Dalsgaard Maria Winther , Gisbertz Suzanne S , Hompes Roel , Achiam Michael P , van Berge Henegouwen Mark I 
Published: September 2024

Abstract

Background
Indocyanine green fluorescence angiography (ICG-FA) may reduce perfusion related complications after esophagectomy with gastric conduit reconstruction. Software implementations for quantifying ICG-FA are emerging to overcome a subjective interpretation of the technology. Comparison between quantification algorithms is needed to judge its external validity. This study aimed to measure the agreement for esophageal perfusion assessment between two independently developed quantification software implementations.

Methods
This retrospective cohort analysis included standardized ICG-FA video recordings of patients who underwent esophagectomy with gastric conduit reconstruction between August 2020 until February 2022. Recordings were analysed by two quantification software implementations: AMS and CPH. The quantitative parameter used to measure visceral perfusion was the normalized maximum slope derived from fluorescence time curves. The agreement between AMS and CPH was evaluated in a Bland-Altman analysis. The relation between the intraoperative measurement of perfusion and the incidence of anastomotic leakage was determined for both software implementations.

Results
Seventy pre-anastomosis ICG-FA recordings were included in the study. The Bland-Altman analysis indicated a mean relative difference of +58.2% in the measurement of the normalized maximum slope when comparing the AMS software to CPH. The agreement between AMS and CPH deteriorated as the magnitude of the measured values increased, revealing a proportional (linear) bias (R2 = 0.512, p &lt; .001). Neither the AMS nor the CPH measurements of the normalized maximum slope held a significant relationship with the occurrence of anastomotic leakage (median of 0.081 versus 0.074, p = 0.32 and 0.041 vs 0.042, p = 0.51, respectively). Divergent approaches in maximum slope determination and raw signal filtering were identified as contributing factors to the differences in outcome.

Conclusion
This is the first study to demonstrate technical differences in software implementations that can lead to discrepancies in ICG-FA quantification in human clinical cases. The possible variation among software-based quantification methods should be considered when interpreting studies that report quantitative ICG-FA parameters and derived thresholds, as there may be a limited external validity.
478. OVERVIEW ON USE OF THE TRANSCERVICAL MEDIASTINOSCOPIC APPROACH FOR MINIMALLY INVASIVE TREATMENT OF ESOPHAGEAL CANCER: ESTABLISHMENT OF INTERNATIONAL COLLABORATIVE GROUP
Authors: Riccio Federica , Fujiwara Hitoshi , Klarenbeek Bastiaan R , Cuesta Miguel A 
Published: September 2024

Abstract

Background
Minimally invasive esophagectomy has emerged as a promising alternative to open surgery, demonstrating reduced postoperative complications and comparable oncological outcomes. Despite advancements, pulmonary complications and anastomotic leakages remain concerns. Since 2015, a novel technique combining single-port transcervical and trans-hiatal laparoscopic mediastinal dissection for esophageal resection was introduced. This procedure exhibits lower pulmonary complication rates compared to traditional approaches. However, its global adoption is limited, necessitating collaborative efforts to standardize techniques and outcomes. Following the IDEAL framework stage 2B (exploration), an international collaborative group for transcervical esophagectomy has been established, aiming to exchange insights, experiences, and lessons learned.

Methods
A cross-sectional survey involving 13 surgeons currently practicing transcervical esophagectomy was conducted, revealing variations in surgical approaches, indications, and outcomes.

Results
Surgeons from China, Germany, Japan, and The Netherlands participated. Indications for surgery varied, with less selectivity in higher-volume centers. Large tumors near the carina, bulky primary lesions or T4 tumors were identified as contraindications.
Different surgical approaches were reported, with the left transcervical and abdominal laparoscopic/robotic dissection being the most common. The mean operative time was about 382.2±117.9 minutes. The mean blood loss was of 100.2±71.1 milliliters.
Surgeons reported high rates of R0 resection and lymph node harvesting, as well as low rates of pulmonary complications (8.6±3.7) and anastomotic leaks (10.1±5.2); however, concerns persist regarding recurrent laryngeal nerve injuries (27.2±18.2).

Conclusion
Transcervical esophagectomy is gradually gaining recognition, with varying adoption rates. The collaborative group aims to align techniques, share experiences, and standardize the procedure. Challenges include differences in indications, surgical approaches, and outcomes, highlighting the need for ongoing discussion and research. Despite concerns about recurrent laryngeal nerve injuries, the procedure shows promise in reducing pulmonary complications.
The establishment this collaborative group signifies a crucial step toward global acceptance. By fostering collaboration, the group aims to enhance patient care, minimize learning-associated morbidity, and contribute to the continuous advancement of this surgical technique. Future efforts will focus on standardization, comparative studies, and training protocols.
489. EVALUATION OF THE ONCOLOGICAL QUALITY OF MINIMALLY INVASIVE TRANSCERVICAL OESOPHAGECTOMY (MICE) USING A CADAVERIC MODEL
Authors: Riccio Federica , Rossato Thomas Bevilaqua , Hutteman Merlijn , Rosman Camiel , Cuesta Miguel A , Klarenbeek Bastiaan R 
Published: September 2024

Abstract

Background
Nodal involvement is a well-known factor of poor prognosis for esophageal cancer, but the extent of the lymph node dissection, or the number of the dissected lymph nodes, remains controversial questions. Western guidelines (ESMO and NCCN) suggest accomplishing esophagectomy with en-bloc two-field lymphadenectomy.
Minimally Invasive transCervical oEsophagectomy (MICE) is a novel technique for the minimally invasive treatment of esophageal cancer. In the literature, the radicality of this procedure still remains unknown, as evidenced by studies conducted in Eastern countries.
This descriptive study explores feasibility of MICE in Western countries using a cadaveric model.

Methods
A cadaver study was conducted in a real operating room setting, with bilateral lung ventilation induced to replicate a real-life situation. Mediastinal dissection was carried out via single port left transcervical mediastinoscopy. Subsequently, a right thoracoscopy in prone position was performed to access the clearance of the fatty tissue at the anatomical boundaries of the lymph node stations. The finalization of the dissection of the lower mediastinum via transhiatal approach was not performed because it was not in the aim of the study.
The extent and the radicality of the dissection were evaluated by an independent external expert.

Results
Results indicated effectiveness of MICE in dissecting lymph nodes around the lower and middle esophagus, as well as at the subcarinal station. At the upper esophagus level, harvesting was complete on the left side but some residual tissue was found on the right-side at the right recurrent laryngeal nerve and on the right pleura, this result was attributed to technical difficulty.

Conclusion
The findings suggest that MICE is adequate in accomplish a complete dissection of lymph nodes around the mediastinal esophagus, including a complete subcarinal dissection, adhering to Western lymphadenectomy standards. Further descriptive study on cadaver will help to understand if a more extensive lymphadenectomy is achievable.
500. PRIMARY ESOPHAGEAL LYMPHOMA: UNDERSTANDING PROGNOSTIC FACTORS AND OUTCOMES
Authors: Mylonakis Adam , Dimitrakoudi Maria , Vasilatou Diamantina , Tsapralis Dimitrios , Vasiliadis Georgios , Koliakos Nikolaos , Sakarellos Panagiotis , Kapetanakis Emmanouil I , Schizas Dimitrios 
Published: September 2024

Abstract

Background
Primary Esophageal Lymphoma (PEL) represents a rare subtype of gastrointestinal lymphomas, posing unique diagnostic and therapeutic challenges. Given its rarity, comprehensive insights into its prognostic factors and outcomes remain limited. This study examines the epidemiology, treatment modalities, and outcomes of PEL, aiming to identify significant prognostic factors that influence patient survival.

Methods
A systematic review of the literature was conducted across PubMed/Medline and Scopus databases, focusing on cases of adult PEL. Data extraction included demographic information, treatment modality, and patient outcomes. Survival rates were calculated, and prognostic factors were analyzed through unifactorial analysis.

Results
Out of 56 studies, 69 cases of PEL were analyzed, with a male-to-female ratio of 2.8:1 and mean age of 55.5 years. Patients were predominantly treated with chemotherapy (52.1%) while 20% underwent surgical treatment. The mean survival reported was 49.3 months with one-, three-, and five-year survival rates of 84.5%, 72.3%, and 28.9%, respectively, exhibiting a less favorable prognosis compared to common lymphoma types. Survival analysis revealed that local lymphadenopathy had a significant impact on prognosis (p=0.008), while gender, age, treatment approach, and type of lymphoma were not significant determinants of survival. Immunocompromised status showed a marginally significant effect on survival (p= 0.053).

Discussion
The study highlights the less favorable prognosis of PEL compared to more common lymphomas, emphasizing the importance of recognizing patients with unfavorable prognostic factors such as local lymphadenopathy and immunocompromised status. The findings advocate for the establishment of an international patient registry to better understand and manage PEL, aiming to standardize diagnostic criteria and treatment strategies.
504. SENTINEL LYMPH NODE NAVIGATED SURGERY IN ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA USING INDOCYANINE GREEN AND FLUORESCENCE IMAGING
Authors: Jarosciakova Silvia , Snajdauf Martin , Pazdro Alexandr , Jakubov Filip , Lischke Robert , Harustiak Tomas 
Published: September 2024

Abstract

Background
Sentinel lymph node navigated surgery (SNNS) has been adopted for various cancers to reduce the negative impact of lymphadenectomy. Limited lymph node dissection using SNNS might be employed in the management of clinically lymph node negative early esophagogastric junction adenocarcinoma (EGJAC). However, it must be sure that sentinel lymph nodes (SLNs) reflect the patient's overall pN status. The aim of this study was to determine the feasibility and safety of SNNS using near-infrared fluorescence imaging and to obtain preliminary data about sensitivity of prediction of lymph node metastasis using SNNS.

Methods
Patients with cT1-2cN0 EGJAC without neoadjuvant therapy were prospectively included. One patient was enrolled after non-radical endoscopic resection of a high-risk pT1 tumor. Solution of indocyanine green (ICG) and 10% human serum albumin (ICG concentration 1,25mg/mL) was injected endoscopically into the submucosal layer at four quadrants (á 0.5mL) around the tumor or endoscopic resection scar just before the surgery. Subsequently, SLNs were identified and removed laparoscopically using fluorescence imaging. Then, esophagectomy or gastrectomy with radical lymphadenectomy were performed in all patients.

Results
A total of nine patients underwent SNNS followed by radical surgery. Histopathology revealed pT0pN0 in 1 patient, pT1bN0 in 3 patients, pT1bN3 in 1 patient, pT2pN1 in 2 patients, pT3pN0 in 1 patient and pT3pN2 in 1 patient. Overall, 62 SLNs were detected (median 7 SLNs per patient, range 1-16). Metastases in SLNs were found in four patients. All patients with pathologically positive lymph nodes had at least one SLN positive for metastasis. Sensitivity of prediction of pN positive status was 100%, false negative rate was 0%. There were no ICG-related adverse events or complications associated with SNNS procedure.

Conclusion
These results suggest that SNNS using ICG and fluorescence imaging in early EGJAC is feasible and safe. Our pilot data show promising diagnostic accuracy of predicting pathological lymph node status using SNNS. However, further studies with a larger number of patients are needed before introducing SNNS into clinical practice.
523. FIVE YEARS OF FLOT THERAPY. RANDOMIZED CONTROLLED TRIAL EVIDENCE IN PRACTICE
Authors: Findlay Alasdair , Singh Urvashi , Cockbain Andrew , Dexter Simon , Sarela Abeezar , Hayden Jeremy , Mehta Samir , Coe Peter 
Published: September 2024

Abstract

Introduction
The combination of 5-flurouracil, oxaliplatin, leucovorin and docetaxel (FLOT) is an effective chemotherapy regime in locally advanced, resectable gastro-oesophageal adenocarcinoma. Since the FLOT4-AIO randomised controlled trial demonstrated superiority over ECF/ECX it has been standard of care at many centres and European Society of Medical Oncology’s recommended perioperative regimen. After over five years of offering this treatment to patients we assessed how this evidence had translated into practice; identifying factors that predict dose reduction or incomplete therapy and overall survival.

Method
Patients who had the combination of neoadjuvant FLOT chemotherapy and oesophagectomy for adenocarcinoma of the oesophagus or gastro-oesophageal junction between February 2018 and September 2023 were identified from a prospectively collected database. Data on completion of chemotherapy, perioperative outcomes and long-term survival were collected. Pathological regression was assessed using Mandard tumour regression grade (TRG). The peri-operative, pathological, and long-term outcomes of patients who completed four cycles of neoadjuvant FLOT was compared with those who had reduced dose or early cessation. Statistical analysis used IBM SPSS, with Mann-Whitney U and Chi squared for variable analysis and univariate cox regression for survival.

Results
Eighty patients were included with a median age of 66 (47-79), 84% were male. Full dose completion was achieved by 57 (71%) patients, 20 (25%) had dose reduction and 7(8%) did not complete four cycles. Age, anaerobic threshold and VO2 max were not significantly different between those completing or not completing neoadjuvant chemotherapy (p=0.460, p=0.624, p=0.104 respectively); or requiring dose reductions (p=0.317, p=0.587, p=0.82). Median TRG across all three groups was 3. Median follow up was 55.4 months and mean overall survival was 53.4 months. No difference in survival was observed between those who completed or did not complete neoadjuvant FLOT (p=0.45).

Conclusion
Completion of neoadjuvant chemotherapy was lower in this cohort of patients than FLOT4-AIO. Rates of pathological complete response were similar. This translated into similar mean overall survival. Median survival was unable to be calculated as survival exceeds 50% at the time of our study. The use of FLOT has translated well into the routine neoadjuvant clinical setting with acceptable short- and long-term outcomes.