bluuebunny/crossref_metadata_2025_split huggingface dataset:
401. CLINICAL SIGNIFICANCE OF SIGNAL REGULATORY PROTEIN ALPHA AND CLUSTER OF DIFFERENTIATION 47 EXPRESSION IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Li Junpeng , Ozawa Yohei , Mozumi Takeru , Taniyama Yusuke , Sato Chiaki , Okamoto Hiroshi , Ishida Hirotaka , Kamei Takashi 
Published: September 2024

Abstract

Background
This study focuses on assessing the expression of Signal Regulatory Protein Alpha (SIRPα) and Cluster of Differentiation 47 (CD47) in Esophageal Squamous Cell Carcinoma (ESCC) and their impact on prognosis. Given the prominence of the CD47-SIRPα axis in cancer for inhibiting macrophage-mediated phagocytosis, this research aims to explore their role and significance in the development and treatment of ESCC.

Methods
In this study, 100 ESCC patients who underwent esophagectomy were included. Resected specimens were stained immunohistochemical staining for SIRPα and CD47. SIRPα expression was classified as high or low with cut-off value of 3%. CD47 expression was evaluated by Combined Positive Score (CPS) and Tumor Proportion Score (TPS) methods with setting a 10% threshold for high and low expression. The five-year survival rates were compared across groups over a median observation period of 61 months. This study reveals the correlation between these biomarkers and postoperative prognosis.

Results
Total 79 males and 21 females were included in this study and mean age was 68.7-year-old. The high SIRPα expression group (48 patients) revealed significantly worse 5-year overall survival rate than the low expression group (52 patients) (56.4 vs 82.8%, P=0.0098). For CD47, both evaluated by using CPS and TPS, the high expression group also showed significantly worse 5-year overall survival rate than its low group (48.8 vs 89.5%, P&lt;0.0001, and 48.4 vs 87.5%, P&lt;0.0001 respectively). Relapse free survival also showed significantly worse survival rate in high expression group of SIRPα and CD47.

Conclusion
The expression levels of SIRPα and CD47 serve as important biomarkers for predicting the prognosis of ESCC. They may influence prognosis by inhibiting macrophage-mediated tumor cell phagocytosis and modulating anti-tumor immune responses, offering new targets for ESCC treatment.
405. SELECTIVE ANTERIOR GASTROPEXY WITH OR WITHOUT FUNDOPLICATION FOR THE TREATMENT OF GRADE III/IV HIATAL HERNIA
Authors: Osterballe Lene , Aahlin Eirik Kjus , Alamili Mahdi , Storli Per Even , Goll Rasmus , Mortensen Kim Erlend 
Published: September 2024

Abstract

Background
The optimal approach to a paraoesophageal hernia (PEH) repair is unclear. Several steps during the procedure are still for discussion. Most surgeons dealing with PEH surgery agree on removal of the hernia sac from the mediastinum and a hiatoplasty with non-absorbable suture. Whether to perform an anti-reflux procedure or/and a gastropexy is unclear. Few studies exist on the subject but without clear favor of an anti-reflux procedure and/or a gastropexy.
The aim of this upcoming study is to test if the anti-reflux procedure is redundant for patients suffering from PEH with obstructive rather than regurgitation symptoms.

Methods
We are setting up a pragmatic, prospective, multicentre, two-armed study. Study beginning June 2024. Sample size calculation with 108 patients in each arm. Both arms will do hernia sac excision, closure of hiatus and gastropexy. One arm will in addition do an anti-reflux procedure. Our objectives are 1) To assess safety of anterior gastropexy with and without fundoplication regarding peri- and postoperative complications. 2) To compare efficacy of anterior gastropexy with and without fundoplication regarding symptom control and clinical recurrence. 3) To assess health related quality of life pre- and post-surgery in patients treated with the two strategies for PEH.

Results
Our primary outcome is disease specific and health related quality of life before surgery and 3-6-12 months after surgery. Secondary outcomes are per- and post-operative complications according to the clavien-dindo score and radiological status/recurrence 12 months after surgery.

Conclusion
The study will add on to existing knowledge about essential technical steps of PEH surgery. Do the patients benefit from a fundoplication or is this potentially complicating procedure redundant regarding long-term symptom control.
411. IMPACT OF FEEDING ADJUNCTS AND RADIOLOGICAL SARCOPENIA ON OUTCOMES IN NEO-ADJUVANT TREATED OESOPHAGEAL CANCER PATIENTS
Authors: Burns Flora Agnes , Convill James , Samake Maurice , Petrides George , Phillips Alexander 
Published: September 2024

Abstract

Introduction
Nutritional management plays a pivotal role in the care of patients with oesophageal cancer, particularly for those presenting with complete dysphagia, which poses a significant management challenge. Establishing adequate nutrition is not only a prerequisite for initiating neo-adjuvant treatment in cases of potentially curable disease but is also crucial for patient survival and quality of life. Additionally, emerging evidence suggests that sarcopenia, significantly predicts post-operative complications following oesophageal surgery. Our study aims to evaluate the impact of feeding adjuncts during neo-adjuvant treatment on outcomes, including post-operative complications, and to investigate the prevalence and implications of radiological sarcopenia in these patients.

Methods
Data from the Northern Oesophago-Gastric Cancer Unit database was used to identify patients diagnosed with oesophageal cancer and discussed at the multidisciplinary team (MDT) meetings from 2017 to 2021. The focus was on those deemed curable with planned neo-adjuvant treatment followed by surgery. Through MDT notes review, patients were identified that required feeding adjuncts prior to surgery. Demographics, tumour characteristics, treatment modalities, hospital stay length, complication rates, and survival outcomes were collected. Radiological sarcopenia was evaluated at initial staging and re-staging computed tomography (CT) scans.

Results
353 patients were included; 15 required pre-operative feeding adjuncts. This subgroup was predominantly male (73%), with a higher proportion having squamous cell carcinoma (SCC) (34% V 17%). Progression to surgery was lower in the adjunct group (73% V 87%, p=0.11). Post-operative hospital stay and one-year survival rates were comparable between groups. The adjunct group had a higher incidence of severe post-operative complications (50% Vs 28% Clavien-Dindo grade ≥3, p=0.08). Radiological sarcopenia was higher in the adjunct group (70% Vs 52%, p=0.18), with no cases of sarcopenia reversal after re-staging in the adjunct group, versus 9% in the non-adjunct group.

Conclusion
These findings highlight an association between complete dysphagia in patients with potentially curable oesophageal cancer and increased rates of post-operative complications and pre-operative radiological sarcopenia. Notably, these patients are more likely to be female and have SCC. The data underscore the critical need for diligent monitoring and nutritional support for patients requiring feeding adjuncts in the neo-adjuvant phase, emphasizing the broader implications of nutritional status on surgical outcomes and overall patient care in oesophageal cancer management.
413. LYMPH NODE MAJOR PATHOLOGIC RESPONSE IS A POTENTIAL PROGNOSTIC FACTOR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Xu Wenyi , Jiang Dongxian , Sun Tiantao , Tang Han , Tan Lijie 
Published: September 2024

Abstract

Background
Esophageal cancer ranks tenth in incidence and is the sixth most common cause of cancer-related deaths. Neoadjuvant chemoradiotherapy before and after surgery has been shown to improve ESCC patients' survival compared with surgery alone. However, the outcomes of nCRT are heterogeneous, and clinical or pathological methods that can predict nCRT responses have been extensively studied. There are currently no standard grading methods that assess the treatment response in lymph nodes after nCRT. We aimed to assess the clinicopathological relevance and determine the prognostic significance of lymph node major pathologic response (MPR) after nCRT in ESCC patients.

Methods
Patients who received nCRT for ESCC followed by surgery were retrospectively reviewed and classified into different lymph node stage (LNS) according to their pathological regression: LNS0 (no tumor cells in lymph node before nCRT); LNS1 (residual tumor cells in lymph node after nCRT≤50%; major pathologic response); LNS2 (residual tumor cells in lymph node after nCRT&gt;50%; not major pathologic response).

Results
In total, 187patients, comprising 91,49 and 47 patients with LNS stage of 0(no tumor cells in lymph node before nCRT),1(major pathologic response), or 2(not major pathologic response), respectively, were included. The result showed that the higher LNS stage was strongly associated with decreased overall survival (P&lt;0.001) and disease-free survival (P&lt;0.001), and increased recurrence risks (P=0.002). The cox regression showed MPR was significantly an independent prognostic factor of OS and DFS. Among 96 patients with clinically positive LNs,54patients (56.3%) showed discordance between the PT and LN pathological regression grades.

Conclusions
Residual tumor cells in lymph node after nCRT≤50% could be defined as lymph node major complete response. The Lymph node MPR can be an independent prognostic indicator of ESCC patients who received nCRT plus curative surgery.
417. POSTOPERATIVE CHYLE LEAK - LESS LIKELY IN OBESE PATIENTS AND ASSOCIATED WITH POSTOPERATIVE MORTALITY
Authors: Linder Gustav , Hedberg Jakob , Edholm David , Nilsson Magnus 
Published: September 2024

Abstract

Background
Esophagectomy can be complicated by postoperative chyle leak (PCL). PCL is a rare condition but accounts for considerable morbidity and can be challenging to manage. Predisposing factors and the impact of PCL on survival are not fully understood.
This study aimed to investigate risk factors for PCL in a national cohort and its associations, if any, with outcomes and survival.

Methods
All patients with esophageal cancer in the Swedish Registry for Esophageal and Gastric Cancer (NREV) who underwent esophagectomy between 2006 and 2018 with information on complications were included in this study. Risk factors and protective factors of PCL were explored with multivariable logistic regression and 90-day mortality was described. Adjusted and overall survival was studied with Cox-regression and the Kaplan-Meier method.

Results
The study included 1540 patients that underwent esophageal resection. 51 patients (3.3%) had PCL of which 32 (62.7%) were managed operatively. Median time in hospital increased with 14 days from 15 to 29 days in patients with PCL compared to patients without.
In multivariable logistic regression, overweight (BMI&gt;25) and obese (BMI&gt;30) patients were significantly less likely to suffer from postoperative chyle leak, OR 0.41 (0.19-0.88 95%CI) and OR 0.28 (0.08-0.97) respectively.
In patients with PCL, 90-day mortality was increased three-fold, 15.7% vs 5.0%, and median survival was six months shorter (28.8 vs 34.8 months) compared to patients without PCL.
Despite this, PCL was not significantly associated with poor overall survival in multivariable adjusted analysis, HR 1.12 (0.75-1.66 95%CI).

Conclusion
Postoperative chyle leak remains a serious complication following esophagectomy. This study finds a reduced risk of PCL in obese patients by unknown mechanisms that should be further explored. Even though short-term mortality is clearly affected by PCL this complication does not seem to impact long-term survival.
429. BARRETT'S ESOPHAGUS IN CHILDREN
Authors: Sosnova Sofya , Bataev Saidkhassan , Khaspekov Dmitry , Bataev Ali , Tsatsa Maxim 
Published: September 2024

Abstract

Background
In children, Barrett's esophagus (BE) is much less common than in adults and has its own characteristics. If in adult practice the treatment tactics are quite restrained, then in childhood they are, on the contrary, as radical as possible. Barrett's esophagus is a consequence of pathological gastroesophageal reflux disease, which is considered an obligate precancerous disease, which determines the relevance of research in this direction.

Material and research methods
345 children with GERD were examined over 10 years. BE was detected in 52 children, which accounted for 14% of cases. Of these, 20 children had peptic stricture of the esophagus. They were included in the 2nd group of the study. The first group - 32 children without peptic stenosis of the esophagus.
The treatment tactics for patients in the first group are fundoplication, after 3 months eradication of BE (electrodestruction or cryodestruction). In the second group - a course of bougienage, fundoplication, with destruction BE, or extirpation of the esophagus for extended peptic strictures of the esophagus.

Results
Of the 52 children, boys predominated (71%). The average age was 10.2 years
In all cases in the first group, antireflux surgery produced a positive result, although it did not affect the regression of metaplasia in the category of patients with an endoscopically negative form.
In all patients of the second group, a positive result was obtained, GER was stopped, stenosis and metaplasia of the esophagus were eliminated. Eradication of metaplasia in 45% (9 children) of cases was achieved by extirpation of the esophagus due to extensive peptic stenosis (4-6 cm), and in 55% (11 children) - postoperative endoscopic destruction BE.

Conclusions
BE detected in childhood is subject to eradication upon its detection, regardless of the absence of signs of high-grade dysplasia, which is more likely to occur in adulthood.
Patients with an endoscopically negative form of BE require clinical observation with morphological control once a year.
Extirpation of the esophagus with simultaneous coloesophagoplasty is indicated in children with peptic strictures (4-6 cm) that are not amenable to balloon dilatation against the background of fundoplication for 6 months or more.
432. POSTOPERATIVE SAFETY AND TOLERABILITY OF INTRAMUSCULAR OCTREOTIDE IN PATIENTS WITH GASTROESOPHAGEAL CANCER: AN OPEN-LABEL PHASE 2 PILOT STUDY
Authors: Holmén Anders , Lampi Maria , Klevebro Fredrik 
Published: September 2024

Abstract

Background
Dietary peptides are believed to contribute to persistent weight loss following gastrectomy or esophagectomy due to cancer. Previous studies have suggested that this effect might be partially mitigated by octreotide. This study aims to investigate the safety and tolerability of intramuscular Sandostatin® LAR depot 10mg, including the frequency and nature of adverse events. It serves as a pilot study for future research aiming to comprehensively assess its effects.

Methods
A prospective open-label phase-2 study was conducted from November 2021 to June 2023. Twenty patients (10 undergoing gastrectomy, 10 undergoing esophagectomy) were enrolled. Patients received three doses of intramuscular Sandostatin® LAR depot 10mg at 7 days, 1 month, and 2 months post-surgery. All patients were evaluated at 7 days, 1, 2, 3, and 6 months post-surgery.
The primary endpoint was safety, determined by the incidence and nature of adverse events, with no occurrence of serious or severe events defined as successful. Tolerability was defined as at the completion of the treatment protocol by at least 90% of patients.
Secondary endpoints included weight loss (percent from baseline), Health-Related Quality of Life (assessed via EORTC-QLQ-C30 and OG25 at baseline, 1, 2, 3, and 6 months post-surgery), and the proportion of subjects requiring enteral nutrition via jejunostomy.

Results
The study protocol was completed by 95% of participants. No serious or severe adverse events were reported. Median weight loss at 6 months was 11% (3 months: 7%, 2 months: 4%, 1 month: 5%). Mean and median Global Quality of Life (part of EORTC-QLQ-C30) remained unchanged at 6 months compared to baseline (mean: 67.6 vs. 67.2; median 66.7 [25-100] vs 70.8 [16.7-100]). The percentage of subjects requiring enteral nutrition was 40%, 30%, and 15% at 1, 2, and 3 months respectively.

Conclusion
This pilot study suggests that Sandostatin® LAR depot was well tolerated and safe, with no serious or severe adverse events observed. Weight loss, Health Related Quality of Life, and the proportion of subjects requiring enteral nutrition were consistent with expectations. Future studies should consider a double-blinded randomized controlled design preferably with dose-response assessment for more robust investigation.
442. POSTOPERATIVE ADJUVANT RADIOTHERAPY REDUCES LOCOREGIONAL RECURRENCE IN PATIENTS WITH BORDERLINE RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Zhang Guoqing , Mu Teng , Zhao Jia , Li Xiangnan 
Published: September 2024

Abstract

Background
borderline resectable esophageal squamous cell carcinoma (Br-ESCC) patients who underwent R0 resection had a significantly improved prognosis. However, local recurrence cannot be ignored. We sought to investigate the efficacy of postoperative adjuvant radiotherapy in reducing locoregional recurrence in patients with Br-ESCC.

Methods
we established a new resection status, Rbr+, which was defined as no clear boundary between the mass/scar and the outer aortic/tracheal membrane, no visible cancer remaining on the outer aortic/tracheal membrane, and a pathologically negative circumferential margin. patients with Br-ESCC who underwent curative esophagectomy at our center from January 2018 to December 2021 were eligible for this study. Patient characteristics, and perioperative variables were included in this study. univariable and multivariable analyses were performed to compare locoregional recurrence based on the logistic regression model. The Kaplan-Meier method and Cox proportional hazard model were used to compare overall and cause-specific survival.

Results
A total of 99 patients were included, among whom 27 (27.3%) had a locoregional recurrence. 71.7% (71/99) were classified as Rbr+ resection, and 28.3% (28/99) were classified as Rbr- resection. With a median postoperative follow-up of 55.3 months (range, 24.3-70.8 months), 25 patients out of 71 with Rbr+ resection suffered from local recurrence. However, 2 patients out of 28 with Rbr- resection suffered from locally recurrence. The locoregional recurrence was 25%(7/28) and 41.9%(18/43) in Rbr+ resection with and without postoperative adjuvant radiotherapy. While, the locoregional recurrence was 8.33%(1/12) and 6.25%(1/16) in Rbr- resection patients with and without postoperative adjuvant radiotherapy.

Conclusion
Rbr+ resection was independently associated with locoregional recurrence in patients with Br-ESCC. postoperative adjuvant radiotherapy was independently associated with overall and cause-specific survival in patients with Br-ESCC.
455. SHOULD THE DIAGNOSTIC THRESHOLD FOR PH MONITORING IN GASTROESOPHAGEAL REFLUX DISEASE DIFFER BETWEEN THE EAST AND THE WEST?
Authors: Wong Ian , Yam Ben Ka-Pan , Kwok Ryan Chun-Lok , Tsang Steven Ka-Chun , Wong Claudia Lai-Yin , Chan Desmond Kwan-Kit , Law Betty Tsz-Ting , Chan Fion Siu-Yin , Law Simon 
Published: September 2024

Abstract

Background
The Montreal definition's reliance on troublesome typical symptoms alone is inadequate for diagnosing 'actionable' Gastroesophageal Reflux Disease (GERD). Lyon consensus 2.0 updated conclusive evidence of GERD, incorporating Los Angeles grade B or above esophagitis and Acid Exposure Time (AET) exceeding 6% in ambulatory reflux monitoring. The Seoul Consensus 2020 presents varied opinions on applying the same standards to the Asian population. A meta-analysis determined the Asian upper limit of AET as 3.2%. This study aims to compare Lyon 1.0 and 2.0 consensus compositions and assess the sensitivity and specificity of different AET thresholds in predicting Grade B or above esophagitis.

Methods
Patients with refractory GERD symptoms or considering anti-reflux surgery underwent objective GERD workup, including 24-hour catheter-based or 96-hour wireless ambulatory pH monitoring, High-Resolution Manometry, and upper endoscopy. This retrospective cohort study analyzed patient data from 2011-2023, excluding those with prior anti-reflux surgery, bariatric surgery, or myotomy for achalasia. Patients were categorized based on Lyon Consensus 1.0 and 2.0 as 'Non-GERD,' 'Borderline GERD,' 'Borderline GERD with evidence,' and 'Conclusive GERD.' Sensitivity, specificity, and Area-Under-Curve (AUC) were calculated using AET thresholds of 3.2%, 4%, 6%, and 7.2% to predict Grade B or above esophagitis.

Results
Between July 2011 and August 2023, 257 patients underwent pH monitoring and were included in the analysis, with 247 (93.8%) being ethnic Chinese. The number of patients categorized as conclusive GERD was significantly higher in Lyon 2.0 (134, 52.1%) compared to Lyon 1.0 (109, 42.4%), p &lt; 0.001. Sensitivity and specificity for predicting Grade B or above esophagitis were as follows: AET 3.2% (83.3%, 48.8%), AET 4% (65.3%, 52.4%), AET 6% (73.8%, 66%), AET 7.2% (69.0, 72.1%). AET 7.2% demonstrated the highest AUC of 70.6% (Figure 1). Among patients classified as conclusive GERD, 67 (50%) underwent antireflux surgery.

Conclusion
Using the Asian threshold of AET 3.2% yields the highest sensitivity for detecting Grade B or above esophagitis. Additionally, the AUC is higher compared to using AET 4.0%. However, it is important to note that AET alone should not be the sole parameter for diagnosing actionable GERD, as even with the lowest AET threshold of 3.2%, 16.7% of patients with Grade B or above esophagitis would be missed.