bluuebunny/crossref_metadata_2025_split huggingface dataset:
362. DELAY IN SOLID GASTRIC EMPTYING IS ASSOCIATED WITH SILENT REGURGITATION EVENTS, PULMONARY MICROASPIRATION AND LARYNGOPHARYNGEAL REFLUX DISEASE
Authors: Khoma Oleksandr , Burton Leticia , Gooley Susanna , Weerasinghe Daminda , Falk Gregory , Van der Wall Hans 
Published: September 2024

Abstract

Background
Pulmonary micro-aspiration (PMA) is a feared complication of severe and sometimes silent gastroesophageal reflux disease (GORD). A novel scintigraphic test that shows refluxate contamination of the pharynx, upper and lower airways has recently been developed. This test and multiple observations allowed the development of a hypothesis that prolongation in solid gastric emptying (SGE) may be a more critical than delays in liquid gastric emptying (LGE) in micro-aspiration into the airways.

Methods
Standard LGE and SGE studies together with the novel microaspiration test were evaluated in paired studies in patients with medially resistant symptoms GORD to measure rates of micro-aspiration after each meal. Either water labelled with 99m Technetium Phytate for the LGE or a labelled egg sandwich for the solid meal was utilised. Major symptoms were noted and the cough and reflux severity index (CSI & RSI) obtained in all patients.

Results
A total of 131 patients were included in this study (59M/72F). The age range was 21 to 83 years with a mean of 52 years. Patients were in the overweight range for body mass index (BMI), with a mean of 26.8. Major symptoms were of bloating, nausea, belching and dyspepsia as well as cough, throat clearing and globus. Less than 20% complained of heartburn.
Results. SGE was abnormal in 92% (Mean 766 min) and LGE was abnormal in 53% (Mean 82 min). PMA was shown in 35% after the SGE and in 71% after the LGE. PMA positive patients were older. SGE and PMA were significantly correlated (p&lt;0.00) but not LGE. The only significant symptom in the PMA group was bloating. RSI was abnormal in 64% and CSI in 46%.

Conclusion
The majority of patients with PMA do not complain of heartburn. Bloating in patients with severe GORD should raise the possibility of gastroparesis and PMA. Prolonged SGE may be critical in the physiology of atypical reflux and present another treatment goal with addition of pyloroplasty to anti-reflux procedure of choice.
367. IMPACT OF NEOADJUVANT IMMUNOTHERAPY ON POSTOPERATIVE COMPLICATIONS IN RESECTABLE ESOPHAGEAL ADENOCARCINOMA
Authors: Scarton Alessia , Moletta Lucia , Capovilla Giovanni , Uzun Eren , De Pasqual Carlo Alberto , Hadzijusufovic Edin , Pierobon Elisa Sefora , Salvador Renato , Provenzano Luca , Zanchettin Gianpietro , Tagkalos Evangelos , Berthl Felix , Lang Hauke , Giacopuzzi Simone , Grimminger Peter P , Valmasoni Michele 
Published: September 2024

Abstract

Background
Several studies are ongoing on the use of immunotherapy in the neoadjuvant setting for esophageal and gastroesophageal junction cancer but it is unclear the effect of an increased activation of the immune system on surgery and the postoperative course.

Methods
This multicenter retrospective cohort study included data from 3 high-volume centers for upper-GI surgery. Only patients with esophageal adenocarcinoma who underwent neoadjuvant therapy and radical surgery between 2015 and 2022 were included. Clinical characteristics and the postoperative outcomes were compared between patients who received standard neoadjuvant therapy or chemotherapy plus immunotherapy. A 1-to-1 matched comparison was also performed.
The difference in overall survival (OS) and disease free survival (DFS) between the two groups was also evaluated.

Results
Overall, 563 patients were included and 21 received preoperative Pembrolizumab or Trastuzumab combined with at least a couple of chemotherapy drugs. The incidence of complications was 47% in the group with immunotherapy and 40.7% in the other group (p=0.53). The matched analysis confirmed no differences in rate of complications (p&gt;0.99), gravity of complications (p=0.17) and pulmonary complications (p&gt;0.99). Anastomotic leak rate was 4.7% in the immunotherapy group and 19% in the other one (p=0.34).
Overall survival and disease free survival were comparable (respectively p=0.4 and p=0.9) also after the matched analysis (respectively p=0.15 and p=0.52).

Conclusion
Neoadjuvant immunotherapy-based regimen does not affect the postoperative course, in particular it does not appear to aggravate the major complications of esophagectomy.
392. MACHINE LEARNING TO PREDICT LYMPH NODE METASTASIS IN T1 ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A MULTICENTER STUDY
Authors: Xu Wenyi , Liu Fangyi , Tang Han , Tan Lijie , Yin Hao 
Published: September 2024

Abstract

Background
Lymph node metastases (LNM) is a relatively uncommon but possible complication of T1 esophageal squamous cell carcinoma (ESCC). Existing models do poorly when it comes to quantifying this risk. As a branch of artificial intelligence, machine learning (ML) algorithms have developed and become more prominent. Up to now, no individualized ML prediction model aimed at predicting LNM in T1 esophageal squamous cell carcinoma patients is available. This study aimed to develop a machine learning model for LNM in patients with T1 esophageal squamous cell carcinoma.

Methods
Patients with T1 squamous cell carcinoma treated with surgery between January 2010 and September 2021 from 3 institutions were included. Machine-learning models were developed using data on patients’ age and sex, depth of tumor invasion, tumor size, tumor location, macroscopic tumor type, lymphatic and vascular invasion, and histologic grade. Elastic net regression (ELR), random forest (RF), extreme gradient boosting (XGB), and a combined (ensemble) model of these was generated. Use Area Under Curve (AUC) to evaluate the predictive ability of models. The contribution of each factor was calculated. To meet clinical needs, we designed the model as a user-friendly website.

Results
926 and 341 patients were included in the derivation and validation cohorts. The lymph node metastasis rate was 14.8%. The models all exhibited potent discriminating power. The elastic net regression model performed best with externally validated AUC of 0.803 (AUC 0.773 for RF, 0.791 for XGB, 0.799 for ensemble) whereas the NCCN guidelines identified patients with LNM with an AUC of 0.576 and logistic model with an AUC of 0. 670. The most important features were lymphatic and vascular invasion as well as depth of tumor invasion.

Conclusions
The model created utilizing machine learning approaches had excellent performance estimating the likelihood of LNM in T1 ESCC, which can help patients achieve personalized treatment options.
394. ESOPHAGEAL STENTING IN ESOPHAGEAL CANCER PATIENTS WITH PERFORATION AND FISTULA
Authors: Chaiyakul Monwadee , Sunpaweravong Somkiat , Ruangsin Sakchai , Laohawiriyakamol Supprerk 
Published: September 2024

Abstract

Background
Esophageal perforation and fistula to the respiratory system are serious problems in esophageal cancer patients. Esophageal self-expandable metal stent (SEMS) placement has become a popular treatment for this problem. This retrospective study aimed to evaluate the factors associated with clinical outcomes following the placement of a SEMS in esophageal cancer patients with perforation and fistula.

Methods
Data from 43 esophageal cancer patients with perforation and fistula who underwent esophageal SEMS placement at Prince of Songkla University Hospital between January 2008 and June 2023 were reviewed. Statistical analyses, including chi-square tests and Kaplan-Meier methods, were employed for comparisons and survival calculations.

Results
The SEMS location was the middle esophagus in 76.8% and 11.6% in each of the lower and upper esophagus. The disease was stage IV in 62.8% and stage III in 37.2%. 46.5% had a history of chemoradiotherapy. The perforation and fistula penetrated into the left bronchus in 39.5%, right bronchus 18.6%, trachea 16.3%, lung 14% and mediastinum 11.6%.
The SEMS technique was successful in all patients. The median stent patency was 38.5 days. Tumor overgrowth was the major cause of stent obstruction. The median overall survival was 40 days. Initial success of the SEMS placement was the only predictor of better survival.

Conclusion
Esophageal SEMS placement in esophageal cancer perforation and fistula cases is technically uncomplicated. Although these advanced esophageal cancer patients had a poor prognosis, the esophageal SEMS provided symptom relief and improved quality of life for their remaining time.
396. SHORT-TERM REVIEW: REAL-WORD EXPERIENCE OF PEMBROLIZUMAB AS FIRST-LINE CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yoshii Takako , Hara Hiroki , Takahashi Naoki , Matsushima Tomohiro , Inamoto Rin , Asayama Masako , Kumekawa Yosuke , Suzuki Yuko , Shimizu Satoshi 
Published: September 2024

Abstract

Background
In Japan, Pembrolizumab, combined with standard chemotherapy (fluorouracil and cisplatin), was approved for first-line treatment of esophageal squamous cell carcinoma (ESCC) in November 2021. In advanced ESCC cases, modifications like omitting cisplatin or adding the palliative radiotherapy for malignant stenosis are sometimes necessary. The real-world application of Pembrolizumab with chemotherapy (Pem+C) in these scenarios remains uncertain. This review presents an overview of Pem+C’s short-term clinical outcomes in practice.

Methods
We retrospectively studied nineteen patients treated with Pem+C as the first-line chemotherapy for advanced ESCC from Nov. 2021 to Dec.2023. Response evaluation was primarily based on RECIST v1.1. Clinical worsening factored into some progression disease (PD) assessments. Adverse events were graded using CTC-AE v5.0. Kaplan-Meier survival curves were calculated by SPSS, with data cutoff on Dec. 31. 2023.

Results
Median age was 70 (49-83 years), PS (0/1/2):0/8/1, TPS (1≤/1≤/NE):1/2/16. Disease Status (Recurrence [locoregional/distant metastasis] /metastatic):3 [2/1] /16. Sequence of treatments (Pem+C alone/ concurrent palliative radiotherapy (pRT) consisting of 30-40Gy/ maintenance after chemoradiotherapy ):10/5/4. Three received only fluorouracil as backbone chemotherapy due to frailty. Median follow-up time, overall survival (OS) and progression free survival (PFS) were 8.3, 14.4, and 6.5 months, respectively. Responses in evaluable eighteen (CR/PR/nonCRnonPD/SD/PD):2/8/1/3/4. No unexpected severe adverse events (≥Grade3) were found. Among limited cases, concurrent pRT didn’t increased life-threatening AE; however, neutropenia ≥G3 seemed to be slightly frequent (2/5). One patient’s survival exceeded 24.8 months.

Conclusion
Our real-world experience with Pem+C in advanced ESCC includes diverse approaches clinical practices. The outcomes, while prelimiary, compare favorably with existing literature, without significant inferiority. The safety data and success case in the concurrent pRT group are significant, though limited by the small number of cases and short observation period.
While further, more rigorous studies are necessary, adaptable Pem+C could be viable in practice.
420. MESH REINFORCEMENT IN HIATAL HERNIA REPAIR: CLINICAL RESULTS OF OUR EARLY EXPERIENCE
Authors: Kitsou Ms Eleni , Saliaris Konstantinos , Triantafyllou Tania , Karikis Ioannis , Katsila Sofia , Kakounis Konstantinos , Pachos Nikolaos , Xiromeritou Vasiliki , Theodorou Dimitrios 
Published: September 2024

Abstract

Background
Approximately one-third of the population develops diaphragmatic hernias among which only 10% are symptomatic. Restoration of the normal anatomy, hiatus closure and fundoplication are effective methods in the surgical treatment of diaphragmatic hernia repair. Placement of absorbable meshes to cover the hiatal closure emerges as a new, albeit controversial in the literature, technique for reinforcement. This study aims to assess the quality of life of patients diagnosed with hiatal hernia who underwent Nissen or Toupet fundoplication with absorbable biosynthetic mesh placement covering the suturing of the hiatus as an additional step during the laparoscopic or robotic hiatal hernia repair.

Methods
Data of all patients who underwent Nissen or Toupet fundoplication with absorbable mesh reinforcement at the hiatus between 2020-2023 at our specialised unit was collected and analysed. Thirteen patients who had completed their 6-month and 1-year postoperative follow-up, were interviewed. GERD score, PPI use and postoperative endoscopy were evaluated.

Results
Occasional use of PPI was reported by one patient, whereas those who had already undergone endoscopy of the upper gastrointestinal tract presented no signs of esophagitis, recurrence of hernia or Barrett esophagus. One patient reported symptom improvement after the operation with a GERD score of 13, while the rest of the patients had a GERD score of 0 (12/13).

Conclusion
The treatment of diaphragmatic hernias with Nissen or Toupet fundoplication using absorbable mesh reinforcement of the hiatus after closure with sutures seems to be an effective therapeutic method with a success rate over 90% in our case series provided that the rest of the surgical steps are identical between the cases through a well-established technique by our surgical team. However, further studies with larger number of patients and longer follow-up are mandatory aiming to further investigate the potential benefits when mesh reinforcement is applied.
427. THE ROLE OF CROSS-SECTIONAL IMAGING IN PATIENTS WITH PULMONARY MICRO ASPIRATION
Authors: Goonawardhana Dulani , Khoma Oleksandr , Falk Gregory , Van der Wall Hans 
Published: September 2024

Abstract

Background
There is increasing evidence of a strong relationship between pulmonary microaspiration of refluxate and pulmonary diseases such as bronchiectasis and lung fibrosis. This group has demonstrated the presence of co-location of pulmonary aspiration on modified reflux scintigraphy with lobar parenchymal lung changes on high resolution computed tomographic imaging of the lung (HRCT-L) in patients with typical and atypical reflux symptoms. There is, however, a cohort of patients who demonstrate evidence of reflux aspiration without evidence of parenchymal changes on HRCT-L. This study aims to demonstrate a group of patients with confirmed reflux micro-aspiration without corresponding changes in lung parenchyma on HRCT.

Methods
Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. Patients who underwent microaspiration studies and had normal HRCT-L for chest symptoms were included. The group was compared to patients with lung changes on HRCT-L corresponding with micro-aspiration studies.

Results
Inclusion criteria were met by 14 patients (86% female, 14% male). The mean age was 54 years (range: 36 – 81 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes on HRCT-L corresponding to site of reflux micro-aspiration on scitigraphy were demonstrated in 66 out of 80 patients listed in the database. Amongst patients with normal HRCT-L typical reflux symptoms were reported in 1 patient, atypical symptoms in 6 patients, both in 5 patients and 2 did not report symptoms. Most common presenting symptom was cough. There was no difference in symptomatology of patients with or without HRCT-L pulmonary parenchymal changes. Patients with pulmonary changes on HRCT were on average 13 years older than patients without CT changes (mean age 67, range 31-91).

Conclusion
HRCT-L is an important additional investigation in patient with reflux micro-aspiration detected on scintigraphy to identify patients with reflux related lung parenchymal changes. Younger age of patients with normal HRCT-L suggests that parenchymal changes may be developing as a result of prolonged exposure to reflux micro-aspiration over time.
457. EVALUATING THE ACCURACY OF CLINICAL SIEWERT CLASSIFICATION, A RETROSPECTIVE REVIEW OF 807 PATIENTS
Authors: Walmsley James , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Tham Ji Chung , Wheatley Tim , Chan David SY 
Published: September 2024

Abstract

Background
Adenocarcinoma of the gastro-esophageal junction (GEJ) is increasingly common in Western societies. GEJ tumours are typically categorized using the Siewert classification, which divides the tumours in to 3 types based on location relative to the GEJ. Studies have shown that there is improved survival with a proximal surgical resection such as esophagectomy for type 1 tumours while type 3 tumours have improved survival when managed as other gastric cancers with a total or extended total gastrectomy. This requires accurate clinical classification. This study aims to evaluate the accuracy of commonly used staging modalities in the clinical classification of GEJ tumours.

Methods
A review of 807 consecutive patients undergoing curative resection for GEJ cancer was performed. Patient data was obtained from a prospectively maintained database between February 2010 and April 2023. Siewert type was established clinically as part of the staging process. The standard staging modalities used for every patient included computerized tomography (CT) and endoscopy, with most patients also undergoing positron emission tomography (PET). Endoscopic ultra-sonography (EUS) and staging laparoscopy was also used selectively. Accuracy was determined by comparing clinical classification to pathological classification following surgery.

Results
807 patients were included [319 type 1, 401 type 2, 87 type 3]. Clinical classification was the same as pathological classification in 59.5% of cases [69.6% for type 1, 48.6% for type 2, 71.3% for type 3 (p&lt;0.001).
The use of different staging modalities for each sub-type is presented in table 1. For patients that underwent EUS, Siewert type was accurate in 59.4% of cases overall. The failure rate for EUS was 2.9%. For patients undergoing staging laparoscopy Siewert type was accurate in 69.3% and for patients that underwent PET, EUS and staging lap the accuracy was 74.4%.

Conclusion
Accurately determining Siewert type clinically is challenging. This is particularly relevant for type 2 tumours which had the least accurate comparison of clinical to pathological type. The use of additional modalities including EUS, and staging laparoscopy improves accuracy but may not be feasible in all patients.
464. OUTCOMES AFTER CURATIVE RESECTION FOR GASTRO-ESOPHAGEAL JUNCTION ADENOCARCINOMA
Authors: Walmsley James , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Tham Ji Chung , Wheatley Tim , Chan David SY 
Published: September 2024

Abstract

Background
Gastro-Esophageal Junction (GEJ) adenocarcinoma is becoming increasingly common in the west. Given the anatomical location of the junction there are several surgical approaches that can be used to treat these tumours, this is often guided by the sub-type of tumour, categorised using the Siewert classification. While overall survival for GEJ cancer tends to be poor compared with other solid organ cancers, changes in diagnosis and treatment have led to improvements in recent years. This study represents one of the largest retrospective reviews of its type to focus on the short- and long-term outcomes of patients undergoing curative resection for GEJ cancer.

Methods
Information was collected on 807 consecutive patients undergoing curative resection for gastro-esophageal junction adenocarcinoma between February 2010 and April 2023. The primary outcome was overall 5- and 10-year survival. Secondary outcomes included: disease free survival, survival based on surgical resection, 30- and 90-day mortality, post operative complications, oncology and pathology outcomes. For each outcome overall results and analysis comparing Siewert types was performed.

Results
807 patients were included [319 type I cancers (39.5%), 401 type II (50%) and 87 type III (10.8%)]. Type I and II were predominantly managed with Esophagectomy (Type I = 100%, Type II = 97.5%). For Type III tumours 49% had esophagectomy and 51% had either a total or extended total gastrectomy.
Siewert groups had comparable short-term outcomes, presented in table 1. Overall survival was 46% at 5 years and 37% at 10 years with no significant difference between Siewert types (p=0.24). Disease free survival was 55% at 5 years and 50% at 10 years with no significant difference between Siewert type (p=0.34).

Conclusion
The 3 Siewert classification subtypes of gastro-esophageal junction adenocarcinoma have similar short-term outcomes, overall and disease-free survival.
466. ROBOT-ASSISTED CERVICAL ESOPHAGECTOMY (RACE) FOR ESOPHAGEAL CANCER: THE FIRST TWO CASES OF AN ITALIAN HIGH-VOLUME CENTER
Authors: Turolo Cecilia , Voltarel Guerrino , Collizzolli Alice , Canepari Elia , Milazzo Martina , De Pasqual Carlo Alberto , Weindelmayer Jacopo , Giacopuzzi Simone 
Published: September 2024

Abstract

Background
Closed thorax esophagectomy is an alternative to conventional two or three-field esophagectomy in patients with esophageal cancer and pulmonary comorbidities, previous thoracic surgery or cervical tumor spread without thoracic involvement. We describe our first two cases of robotic trans-hiatal and trans-cervical esophagectomy.

Methods
We performed a robotic assisted abdominal D2 lymphadenectomy and trans-hiatal esophageal dissection until the tracheal carina with en bloc mediastinal lymphadenectomy. Then we did left cervicotomy and, using a gelPort, we continued robotic esophageal dissection in superior mediastinum until the carina, preserving left recurrent nerve. Subsequently, in abdomen, we completed esophageal dissection and gastric tubulization. After section of the esophagus we pulled up the gastric conduit and in one case we performed a esophago-gastric 23 mm termino-lateral mechanical circular anastomosis and in the other hypopharyngeal-gastric handsewn double layer anastomosis.

Results
One patient had distal esophageal adenocarcinoma and we chose RACE because of previous pleuritis. Pathology reported ypT2N1 (35 lymph nodes retrieved) with R0 resection. Post operative complications were cervical anastomotic leak, chylous ascites and atrial fibrillation treated conservatively; total length of stay (LOS) was 25 days. The second patient had cervical squamous cell carcinoma spreading to the neck without thoracic involvement. In addition to RACE, we performed tracheostomy after cervical lymphadenectomy. Pathology reported ypT0N0 (17 lymph nodes) with R0 resection. A post-operative Bernard Horner syndrome was noted; total LOS was 16 days.

Conclusion
Our first experience in performing RACE with the Da Vinci Xi robotic system shows that this can be a feasible procedure with adequate surgical and oncological outcomes. Further comparison studies are needed.