bluuebunny/crossref_metadata_2025_split huggingface dataset:
280. MANOMETRIC FINDINGS IN PATIENTS WITH GIANT HIATAL HERNIA: OESOPHAGEAL PHYSIOLOGY APPEARS TO IMPROVE WITH SURGERY
Authors: Khoma Oleksandr , Raichurkar Pratik , Falk Gregory 
Published: September 2024

Abstract

Background
High resolution manometry (HRM) is a gold standard test of oesophageal physiology. The use of HRM in patients with giant hiatus hernia (GHH) is limited by historical technical challenges as well as unclear clinical implications of the findings. The aim of this study is to demonstrate feasibility of HRM in patients with GHH and study effect of surgery on oesophageal physiology of patients undergoing GHH repair.

Methods
Data was extracted from a prospectively populated database of patients with giant (&gt;30% stomach above diaphragm) hiatus hernias. All patients that underwent HRM before and after surgery were included. Manometric findings before and after surgery were analysed and compared. Patient symptoms were correlated with manometric findings.

Results
Inclusion criteria were met by 30 patients: 83% female, average age 74 (range 51-86), 93% had type III hernia containing on average 55% of stomach. All operations but one were performed laparoscopically. Pre-operatively average LOS length was 1.89cm which improved significantly to 2.19cm after surgery (p&lt;0.05). Nine patients had ineffective oesophageal motility on index study which normalised post operatively in 4 patients. Lower oesophageal sphincter integrated relaxation pressure (IRP) increased post-operatively from 9.07mmHg to 11.52mmHg (p&lt;0.05). Distal contractility improved post-operatively, however this was not significant. Most common presenting symptoms were dyspnoea, anaemia, retrosternal pain, and dysphagia. There was no association between dysphagia and manometric findings before or after surgery.

Conclusion
This study provides an insight into HRM findings in patients with GHH before and after surgery. Majority of the physiological parameters improved with surgery. There was no correlation of symptom of dysphagia with manometric findings.
281. PROTEOMIC, TRANSCRIPTOMIC AND GENOMIC ANALYSIS OF ESOPHAGEAL ADENOCARCINOMA UNCOVERS CANDIDATE THERAPEUTIC TARGETS AND CANCER-SELECTIVE POST-TRANSCRIPTIONAL REGULATION
Authors: O'Neill Rob , Mayordomo Marcos , Mitulovic Goran , Al Shboul Sofian , Bedran Georges , Faktor Jakub , Hernychova Lenka , Uhrik Lukas , Gomez-Herranz Maria , Kocikowski Mikolaj , Save Vicki , Vojtesek Borivoj , Arends Mark , OCCAMS The , Hupp Ted , Alfaro Javier 
Published: September 2024

Abstract

Background
Addressing the poor prognosis associated with esophageal adenocarcinoma (EAC) has been hindered by the absence of biomarkers for early disease detection and therapeutic targets. Despite extensive research on the somatic mutations associated with EAC, the impact of genomic aberrations on protein expression and cancer phenotype remains unclear.

Methods
We conducted a quantitative proteomic analysis using tumour tissue and patient-matched adjacent normal esophageal and gastric tissues from 23 patients undergoing resection for EAC. We further examined the relationship between transcript and protein levels using patient-matched whole transcriptome RNA sequencing and proteomic data from 7 patients and integrated these findings with data from a cohort of 264 EAC patients with RNA sequencing and 454 patients with whole-genome sequencing, as well as external published datasets.

Results
We quantified protein expression from 5897 genes in EAC and normal tissues. Several potential biomarkers showing selective expression in EAC, such as the transmembrane protein GPA33, were identified. We validated the EAC-specific expression of GPA33 in an external cohort of 115 patients, suggesting its utility as a diagnostic and therapeutic target. Additionally, integrated analysis of protein and RNA expression in EAC and normal tissues revealed genes with discordant protein and RNA levels, indicating post-transcriptional regulation of protein expression. These outlier genes, including SLC25A30, TAOK2, and AGMAT, exhibited rare somatic mutations, suggesting post-transcriptional mechanisms driving this EAC-specific phenotype. AGMAT, as an example, was found to be overexpressed at the protein level in EAC compared to adjacent normal tissues, with a proposed EAC-selective, post-transcriptional mechanism regulating protein abundance.

Conclusion
Through quantitative proteomic analysis, we identified GPA33 as a candidate EAC biomarker. Integrated analysis of the proteome, transcriptome, and genome in EAC uncovered genes with tumor-selective post-transcriptional regulation of protein expression, offering potential exploitable vulnerabilities for therapeutic intervention.
294. LEARNING CURVE OF MINIMALLY INVASIVE ESOPHAGECTOMY: OUR SERIES, SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS
Authors: Riccio Federica , Pierobon Elisa Sefora , Bellaio Luca , Scarton Alessia Scarton , De Pasqual Anna Laura , Zuin Irene Sole , Pittacolo Matteo , Moletta Lucia , Zanchettin Gianpietro , Capovilla Giovanni , Salvador Renato , Provenzano Luca , Valmasoni Michele 
Published: September 2024

Abstract

Background
Minimally invasive esophagectomy has demonstrated non-inferiority in terms of surgical and oncologic outcomes compared with open esophagectomy, with better short-term outcomes. The learning curve of this procedure is protracted before a plateau of ideal results is reached. The purpose of this study is to evaluate the safety and efficacy of implementing a totally minimally invasive esophagectomy program for cancer in a high-volume center and the impact of the learning curve on perioperative and oncologic outcomes.

Methods
This is a retrospective non-randomized control study. The study includes 199 patients who underwent surgery from June 2018 to October 2022. Patients undergoing MIE were assigned to the “MIE group” (n=61), while those undergoing Open Esophagectomy to the “OE group” (n=138). By comparing the perioperative and oncological outcomes between the two groups, we assessed the safety and efficacy of the MIE. Subsequently, the MIE group was divided into two subgroups: Early Experience (“EE”) and Late Experience (“LE”) group. By comparing the perioperative surgical outcomes between these two groups we evaluated the presence and the impact of a learning curve.

Results
Although longer surgical duration (p&lt;0.001), MIE did not compromise surgical radicality (same rate of R0, p=0.345 and higher number of lymph node yields p&lt;0.001). We observed a learning curve effect on postoperative outcomes, with decreasing complication rates (61% vs. 36.7%, p=0.054), and shorter ICU stay (1.6 ± 2.4 vs. 0.6 ± 1.5, p=0.049) and faster recovery in the LE group (19.6 ± 19.8 vs. 12.2 ± 5.9, p=0.055). Analysis of CUSUM plots reveals a decrease in total ICU and recovery starting with patient number 25. A meta-analysis confirms a trend towards lower anastomotic leak rates as the learning curve progresses.

Conclusion
The findings of this study support the safety and efficacy of implementing a totally MIE program for cancer in a high-volume center. The outcomes are not impaired by the learning curve effect and meet current standards. Comparing the outcomes of the early experience with those of the late experience, we discovered improving trends in postoperative complication and recovery rates. In our high-volume center's experience, improving these outcomes has required 25 to 30 cases.
299. SURGICAL STRATEGY FOR THE TREATMENT OF AORTOESOPHAGEAL FISTULA
Authors: Adachi Yukari , Goto Hironobu , Koterazawa Yasufumi , Sawada Ruichiro , Harada Hitoshi , Urakawa Naoki , Hasegawa Hiroshi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Takeru , Oshikiri Taro , Kakeji Yoshihiro 
Published: September 2024

Abstract

Background
The number of thoracic endovascular aortic repair (TEVER) and artificial vessel replacement for thoracic aortic aneurysms is increasing. Aortoesophageal fistula (AEF) is one of the problems with long-term outcomes, and management of AEF needs immediate control of hemorrhage and infection. Bleeding control can be performed with artificial vessel replacement, but postoperative graft infection is inevitable in AEF. For infection control, removal of the diseased esophagus should be performed. In this study, we will clarify the surgical outcomes of esophagectomy for AEF.

Material and Methods
We evaluated 22 patients who underwent artificial vascular replacement and esophagectomy for AEF from 2007 to 2023 at Kobe University Hospital, retrospectively. The surgical approaches for esophagectomy were left open thoracotomy, median sternotomy or minimally invasive esophagectomy (MIE).

Results
In this study, all patients underwent simultaneous artificial vascular replacement and esophagectomy. According to the surgical approaches, 15 patients underwent left open thoracotomy, 6 patients underwent median sternotomy and 1 patient underwent left open thoracotomy + MIE. The male to female ratio was 15:7, and the median age was 72 (38-85) years. According to the type of reconstruction, 11 patients underwent pediculated jejunum reconstruction and 1 patient underwent ileocolic reconstruction. 12 patients (54.5%) were able to undergo reconstruction, 10 patients (45.5%) were not undergo reconstruction. 4 patients (18.2%) of died in the hospital.

Conclusion
Esophagectomy simultaneous with artificial vascular replacement could be a feasible treatment for AEF.
304. OUTCOMES OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY BEFORE AND AFTER IMPLEMENTATION OF ENDOSCOPIC VACUUM THERAPY IN A TERTIARY REFERRAL CENTER
Authors: Pattynama Lisanne , Pouw Roos , Gisbertz Suzanne , Daams Freek , Bergman Jacques , van Berge Henegouwen Mark , Eshuis Wietse 
Published: September 2024

Abstract

Background
Anastomotic leakage (AL) after esophagectomy is associated with severe morbidity and a high mortality. Endoscopic vacuum therapy (EVT) has recently been established as a promising endoscopic treatment option for AL, with success rates of higher than 80%. The aim of this study was to compare outcomes of AL after esophagectomy, before and after implementation of EVT.

Methods
For this cohort study, consecutive patients with AL after transthoracic esophagectomy with gastric conduit reconstruction with cervical or thoracic anastomosis from two different time periods (before the implementation phase of EVT [2013–2017, pre-EVT], and after [2020–2023, EVT]) were included. Data was collected from a prospectively maintained database. Outcome measures included initial treatment modality, re-operation, intensive care unit (ICU) admission, hospital stay, and complications, classified according to Clavien-Dindo.

Results
100 patients with AL were included, with 50 patients in the pre-EVT group and 50 patients in the EVT group. In the pre-EVT group, initial treatment of AL consisted of conservative therapy (n=20, 40%), endoscopic stenting (n=13, 26%), endoscopic drainage (n=6, 12%) or surgery (n=11, 22%). In the EVT group, initial treatment of AL consisted of conservative therapy (n=5, 10%), surgery (n=2, 4%) or EVT (n=43, 86%). Other baseline characteristics showed no differences. The EVT group had a significantly lower initial surgical treatment rate compared to the pre-EVT group (respectively 2 [4%] vs. 11 [22%], p=0.03). Furthermore, the EVT group had a significantly lower ICU admission rate than the pre-EVT group (respectively 16 [32%] vs. 35 [70%], p&lt;0.001). Clavien-Dindo classification differed significantly between the two groups (p = 0.033), with less Grade IIIa and more Grade IVa in the pre-EVT group, compared to the EVT group. Reoperations occurred in 17 patients (34%) in the pre-EVT group and 9 (18%) in the EVT group, which was not statistically significant. No statistically significant difference was observed in length of hospital stay.

Conclusion
The implementation of EVT as treatment option for AL after esophagectomy in this tertiary referral center may have led to a lower ICU admission rate. Taking this into consideration, EVT may be associated with long term health benefits for the patient and reduced healthcare costs.
312. THE VALUE OF DETECTING THE GASTRIC TUBE PRESSURE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: A PROSPECTIVE, UNCONTROLLED EXPLORATORY STUDY
Authors: Wei Xiufeng , Chen Xiankai , Xu Lei , Kang Xiaozheng , Qi Shu , Luo Peng , Wang Ziyi , Qin Jianjun , Wang Zhen , Zhang Ruixiang , Li Yin 
Published: September 2024

Abstract

Background
With the increasing popularity of minimally invasive esophagectomy(MIE), the incidence of postoperative gastric conduit dilation has also shown an increasing trend. The main purpose of this study is to explore the relationship between postoperative tubular gastric dilation and internal gastric tube pressure.

Methods
In a prospective cohort study from November 2023 to February 2024, 54 patients undergoing MIE were enrolled. Based on postoperative chest X-ray, patients were categorized into acute gastric conduit dilation (Acd) and non-acute dilation (Non-Acd) groups. Gastric tube pressure, including static pressures(SP), peak pressures(PP), and median pressures (MP), was measured postoperatively. Acute gastric dilation was defined as the gastric tube occupying over 40% of the hemithorax on X-ray. We compared the incidence of postoperative complications, surgery-related mortality, readmission rates, and hospital stay durations.

Results
Of the patients, 19 experienced acute gastric dilation, while 35 did not. The Acd group showed significantly higher SP, PP, and MP (p&lt;0.01). Univariate analysis identified SP, PP, MP, and upper mediastinal pleura reconstruction as risk factors for acute gastric dilation, with SP being a key predictor in multivariate analysis. Patients in the Acd group had longer hospital stays (median 13 days vs. 8 days for Non-Acd). No significant differences were noted in postoperative complications, surgery-related mortality or readmission rates.

Conclusion
Acute gastric conduit dilation post-MIE is linked to increased gastric tube pressure. Monitoring this pressure is both safe and feasible, offering insights into reducing acute gastric dilation through surgical improvements such as mediastinal pleura reconstruction.
314. TRANSORAL ANTEGRADE T-TUBE INSERTION FOR MANAGEMENT OF OESOPHAGEAL LEAKS FOLLOWING MINIMAL INVASIVE OESOPHAGECTOMY
Authors: Fong Kang Ler , Lyn Tiffany , Lee Zhen Jin , Tan Nan Guang , Lim Chin Hong , Lim Eugene Kee Wee , Eng Alvin Kim Hock , Chan Weng Hoong , Ong Hock Soo , Wong Wai Keong , Tan Jeremy Tian Hui 
Published: September 2024

Abstract

Introduction
Oesophageal leaks following minimal invasive oesophagectomy (MIE) present significant challenges to upper GI surgeons, with reported rates ranging from 11% to 21%. Management strategies include: conservative, endoscopic, and surgical interventions. These vary based on patient clinical status and institution. Here, we propose a hybrid approach involving thoracoscopic washout coupled with antegrade T-tube insertion via gastroscopy for managing these complex leaks.

Methods
We describe the case of a 66-year-old male who underwent MIE via the McKeown approach for Siewert 1 Gastro-oesophageal adenocarcinoma. His neoadjuvant chemotherapy had been interrupted by a complex ischiorectal abscess and thus a decision was made to proceed for surgery. The surgery proceeded with a cervical anastomosis using a linear stapled technique and closure with 3.0 PDS. Postoperatively, the patient deteriorated on day 2, necessitating intubation due to decreased oxygen saturation. The chest tube output looked slightly bile stained. A subsequent CT scan revealed mediastinal fluid accumulation, prompting urgent intervention.

Results
Diagnostic thoracoscopy revealed contamination of the right chest and posterior mediastinum, necessitating extensive washout. A 2cm necrotic patch and perforation were identified on the gastric side of the oesophago-gastric anastomosis. Intraoperative gastroscopy localized the leak with a positive air bubble test. A Maryland forceps was passed through the defect to confirm the defect. Subsequently, a guidewire was passed antegrade into the cavity using the gastroscope. Decision was made to purse-string the defect (around the guidewire) using 3.0 PDS and the T-tube was exchanged transorally via the guidewire into the cavity and exteriorized through a 5mm port to the skin. Existing large-bore chest and Blake drains were retained, and a feeding jejunostomy was established.

Conclusion
This hybrid management approach, combining endoscopy and thoracoscopic washout with T-tube insertion, offers an alternative for addressing complex anastomotic leaks following MIE. By avoiding resection and diversion, this technique potentially reduces morbidity. Follow-up scans demonstrated resolution of the leak allowing the patient to be discharged.
https://1drv.ms/v/s!Aghd8kXfo8oQlX6QyliVLgRDmIu-?e=EGN5YD
318. EFFICACY OF PROPHYLACTIC STEROID THERAPY OF INJECTION AND ADMINISTRATION AGAINST STRICTURE FOR SUBENTIRE CIRCUMFERENTIAL DEFECT AFTER ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION
Authors: Kadota Tomohiro , Sasabe Maasa , Yamashita Hiroki , Inaba Atsushi , Sunakawa Hironori , Nakajo Keiichiro , Shinmura Kensuke , Yano Tomonori 
Published: September 2024

Abstract

Background
Esophageal stricture is a major problem after endoscopic submucosal dissection (ESD) for large superficial esophageal squamous cell carcinomas (SESCC). Local triamcinolone injection (LTI) has been reported as the standard prophylactic treatment against stricture, however, it showed that its efficacy was insufficient for subentire circumferential mucosal defect after ESD in the subgroup analysis of randomized controlled trial (JCOG1217). On the other hand, the usefulness of oral prednisolone administration (OPA) has also been reported. Thus, we aimed to compare the efficacy of LTI with combination of LTI and OPA in patients with subentire circumferential mucosal defect after esophageal ESD.

Methods
This retrospective study enrolled the patients with mucosal defect after ESD larger than 7/8th circumference and not spreading entire who treated with LTI or combination of LTI and OPA between July 2010 to January 2020. Triamcinolone acetonide (50-100 mg) was injected into ulcer bed immediately after ESD, and oral prednisolone (30 mg daily, tapered gradually for 8 weeks) was administrated. We defined as an esophageal stricture in case the endoscope could not pass through the stricture, and then endoscopic balloon dilation (EBD) was required. We evaluated stricture-free survival (SFS), and the number and duration of EBD.

Results
A total of 42 patients in the LTI group and 26 in the combination group were enrolled. The median longitudinal extension of the lesions was 4.5 cm (range; 2-7) in the LTI group and 4 cm (2-7) in the combination group. Finally, 18 patients (42.9%) in the LTI group and 7 (26.9%) in the combination group developed esophageal stricture, and 12-week SFS was 64.3% and 76.9%. The median number and duration of required ESD were 6 (2-10) in the LTI group and 4 (2-9) in the combination group, and 88 days (15-288) and 66 days (22-176).

Conclusion
The steroid combination therapy of local triamcinolone injection and oral prednisolone administration showed the effective outcomes comparing with local triamcinolone injection alone for subentire circumferential mucosal defect after esophageal ESD. Thus, this combination therapy can be the most promising treatment and should be compared in the randomized controlled trail with large sample size.
319. EXTENSIVE LYMPHADENECTOMY MAY IMPROVE SURVIVAL IN NODE NEGATIVE OESOPHAGEAL CANCER
Authors: Khoma Oleksandr , Paredes Steven , Park Jin-soo , Kennedy Catherine , Falk Gregory 
Published: September 2024

Abstract

Background
Lymph node metastases are a major prognostic factor in survival of patients with oesophageal cancer.
The number of lymph nodes removed during oesophagectomy has been previously proven to be associated with improved survival. The aim of this study was to examine the effect of lymph node harvest on survival specifically in pathologically node negative (pN0) patients with oesophageal cancer.

Methods
Data were extracted from a prospectively populated single-surgeon database of oesophageal resections for cancer. All consecutive patients with pN0 were included. Patient-specific risk adjusted analysis of overall and disease-free survival was performed to identify the number of lymph nodes associated with improved survival.

Results
Inclusion criteria were met by 137 patients (49 squamous cell carcinoma and 88 adenocarcinoma). Adjusted for cancer stage, tumour (histological type, degree of differentiation, lympho-vascular invasion, neo-adjuvant therapy) and patient related factors (age, sex), increased lymph node number was associated with significant improvement in overall (P = 0.045) and disease free (P = 0.030) survival. Lymph node count ≥ 17 was associated with improved overall and disease-free survival.

Conclusion
In this cohort of patients with pathologically node-negative oesophageal cancer, lymph node count of 17 or above was associated with significantly improved survival.
322. IMPACT OF POSTOPERATIVE NUTRITIONAL SUPPORT MODES ON CLINICAL AND PATIENT-REPORTED OUTCOMES IN ENHANCED RECOVERY AFTER ESOPHAGECTOMY FOR CANCER
Authors: Wang Kangning , Xie Qin , Huang Yixuan , Wei Xing , Shi Qiulin , Zhou Qiang , Leng Xuefeng , Miao Yan , Han Yongtao , Fang Qiang 
Published: September 2024

Abstract

Background
Enhanced Recovery After Surgery (ERAS) for esophagectomy has been demonstrated to be safe and effective. However, there is significant variation in the nutritional support treatment modes during the perioperative period. We have recently developed a novel ERAS nutritional support mode. In this study, we compared this new mode with the previous ERAS nutritional support treatment mode to assess their impact on clinical and Patient-Reported Outcomes (PROs), aiming to develop an optimal approach.

Methods
We enrolled 357 patients who underwent esophagectomy for esophageal thoracic cancer or esophagogastric junction cancer from June 2021 to August 2023. Two different ERAS nutritional support treatment protocols were used postoperatively: the control group previously received enteral nutrition by nasojejunal tube + parenteral nutrition + early oral diet after surgery, while the study group currently received parenteral nutrition + early oral diet. We compared the two groups in terms of clinical observation indicators, hematological analysis, serum protein changes and clinical outcomes. The comparison of quality of life on PROs was assessed using the MD Anderson Symptom Inventory. Symptom changes were analyzed using a mixed-effects model.

Results
A total of 324 patients successfully completed the ERAS nutritional support protocols. The success rates were 91% in the control group and 90.2% in the study group, with no statistically significant difference (p&gt;0.05). The incidence of complications did not significantly differ between the two groups (p&gt;0.05). Compared to the control group (n=223), the study group (n=101) significantly shortened the chest drain time (6.2±2.6 days vs. 6.6±1.5 days, p&lt;0.05) and elevated the levels of serum total protein and albumin on the 4th postoperative day (53±5 g/L vs. 51±4 g/L, 30±2 g/L vs. 28±2 g/L, p&lt;0.05). There were no statistically significant differences in the first flatus time, first defecation time, infusion time and postoperative hospital stay between the two groups (p&gt;0.05). The comparison of hematological analysis, serum protein changes, changes in body weight during the perioperative period and 30-day readmission rate showed no statistically significant differences (p&gt;0.05). In the MD Anderson Symptom Inventory, the study group had significantly better scores in sadness, dry mouth, enjoyment of life, and general activity dimensions compared to the control group (p=0.013, p&lt;0.001, p=0.045, p=0.008).

Conclusion
Based on the similar rehabilitation outcomes, the simplified ERAS nutritional support treatment mode without postoperative enteral nutrition by nasojejunal tube is more optimized because it is physiological sound and significantly improves quality of life on PROs.