bluuebunny/crossref_metadata_2025_split huggingface dataset:
339. MANAGEMENT OF OESOPHAGO-PLEURAL FISTULAS WITH ENDOSCOPIC VACUUM THERAPY: A PROMISING APPROACH
Authors: Srikanth Diya , Ng Annalisa YL , Ching Siok Siong , Lin Jinlin , Wong Andrew SY , Lee June 
Published: September 2024

Abstract

Background
Boerhaave syndrome is a rare and serious condition requiring prompt management to prevent severe complications and improve patient outcomes. One significant complication is an oesophago-pleural fistula. These fistulas often result in aspiration pneumonia, empyema, and mediastinitis. Conventional management with surgery has high complication and mortality rates. Endoscopic vacuum therapy (EVT) is a less invasive technique for the management of oesophageal fistulas, involving endoscopic placement of a vacuum-assisted sponge within the oesophageal defect, promoting healing via continuous wound drainage and tissue granulation.

Methods
We report the case of a gentleman who initially presented with Boerhaave syndrome, was treated with open oesophageal repair, and was re-admitted 3 weeks later for an oesophago-pleural fistula with pleural collections. EVT was administered to the oesophageal defect twice weekly for 29 days and the effectiveness of therapy was monitored with serial oesophagogastroduodenoscopies, contrast studies, and computed tomography scans of the thorax to monitor the resolution of the pleural collections. During this period, the fistula defect showed gradual granulation tissue growth, resulting in full closure of the mucosal defect.

Results
The use of EVT has shown to result in successful closure of fistulas, resolution of sepsis with reduced need for surgical intervention, and shorter hospital stays. EVT combines coverage of the oesophageal defect and adequate drainage of the cavity behind the defect, often without the need for additional external drain placement. These findings highlight the role of EVT as a valuable adjunct in the management of oesophageal fistulas, particularly in cases requiring rescue therapy. Limitations of EVT include risk of bleeding, fistula formation/recurrence, need for frequent endoscopic interventions, stricture formation, and inability for oral intake due to occlusion of the gastrointestinal tract.

Conclusion
EVT represents a paradigm shift in the management of oesophageal fistulas, offering a less invasive alternative with the ability to promote wound healing, control sepsis, and reduce the need for high-risk redo oesophageal surgery. Further prospective studies and trials are needed to reach a consensus about its technical aspects, such as pressure settings and procedure intervals; as well as to evaluate its efficacy as a potential first-line treatment for oesophageal fistulas.
343. DIAGNOSTIC VALUE OF ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSESOPHAGEAL NEEDLE ASPIRATION (EBUS-TENA) IN LESIONS ADJACENT TO BOTH THE TRACHEA/BRONCHUS AND ESOPHAGUS
Authors: Zhou Haining , Tang Shoujun , Zhong Chuan 
Published: September 2024

Abstract

Objective
To investigate the clinical diagnostic value of endobronchial ultrasound-guided transesophageal needle aspiration (EBUS-TENA) in lesions adjacent to both the trachea/bronchus and esophagus

Methods
The clinical data of 12 patients who underwent EBUS-TENA from February 2019 to February 2022 were collected. The operative physicians and nurses worked closely with each other and meticulously cared the patients. The vital signs changes were observed and recorded, as well as intraoperative adverse events and the acquired specimens.

Results
All the 12 patients underwent surgery successfully, and hair-like tissue strips were obtained in each case. There were 8 cases of central lung cancer and 4 cases of mediastinal tumor. The preoperative vital signs scores showed no significant difference with the intraoperative and postoperative scores (P&gt;0.05). A few complications occurred, including 2 case of mild cough, 2 case of nausea and vomiting, with no symptoms of severe cough and dyspnea, haemorrhage, mediastinal infection, pneumothorax, mediastinal emphysema and other complications.

Conclusion
EBUS-TENA has significant effect in successfully obtaining pathological tissue specimens especially for lesions adjacent to both the trachea/bronchus and esophagus, improving disease positive diagnosis rate, reducing patients discomfort and the risk of surgery.
344. SURGICAL APPROACH FOR SPONTANEOUS ESOPHAGEAL RUPTURE: THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY
Authors: Tang Shoujun , Zhou Haining , Zhong Chuan 
Published: September 2024

Abstract

Objective
To explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate.

Methods
A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy.

Results
Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P &lt; 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P &gt; 0.05).

Conclusion
Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.
354. NEOADJUVANT CHEMORADIOTHERAPY FOLLOWED BY SURGERY VERSUS UPFRONT SURGERY FOR ESOPHAGEAL CANCER: LONG-TERM OUTCOMES IN A CROSS TRIAL STUDY CENTER
Authors: Carresi Agnese , Ponce Carmen Mestre , van der Aa Dillen C , Eshuis Wietse , van Berge Henegouwen Mark I , Gisbertz Suzanne S 
Published: September 2024

Abstract

Background
Since the publication of the CROSS-trial, showing improved survival following neoadjuvant chemoradiotherapy + surgery (CRT-S) compared to upfront surgery (U-S) for esophageal cancer, this neoadjuvant regimen has become standard care in the Netherlands. Given the relatively low R0 rate in the U-S arm (69%) and lymph node yield (LNY) in both arms (15 U-S, 18 CRT-S) observed in the CROSS-trial, the present study aimed to compare survival of patients who underwent CRT-S versus U-S in a tertiary referral center that participated in the CROSS-trial, within the era that the trial was performed.

Methods
This retrospective study included patients, who underwent an esophagectomy between 2004-2010, and met the CROSS-trial inclusion criteria. Primary outcome was 10-year overall survival (OS), and patients with CRT-S and U-S were compared. Secondary outcomes were R0-resection rate, LNY and positive LNY. Subgroup analyses were performed for histology (adenocarcinoma [AC] and squamous cell carcinoma [SCC] and for surgical approach (transthoracic [TTE] and transhiatal [THE] esophagectomy).

Results
We included 288 patients: 144 after CRT-S, 144 after U-S. 112 (39%) participated in the CROSS-trial. 10-year OS was not significantly better for CRT-S (40%) versus U-S (34%; p=0.183). In SSC, OS following CRT-S was 49% and after U-S 35% (p=0.228), versus 38% and 34% in AC (p=0.396). Following TTE, OS was better compared to THE in both CRT-S and U-S groups: 44% and 39% (p=0.369) versus 32% and 29% (p=0.590). R0-rates were 96% (CRT-S) and 86% (U-S). Median LNY was equal: 23. 55 (38%) and 100 (69%) patients had positive lymph nodes after respectively CRT-S and U-S.

Conclusion
This study showed that, with a radical TTE, comparable OS results can be achieved, and therefore CRT may not be indicated in all patients. Further analyses are necessary to identify patients who may benefit from the additional local treatment that CRT is (e.g SCC or involved circumferential resection margin). Additionally, surgical techniques have improved since the CROSS-trial, with less surgical trauma in minimally invasive esophagectomy. This may result in better outcomes for surgery nowadays, indicating the need for further studies in the current era.
359. INNOVATIVE USE OF WEERDA DIVERTICULOSCOPE FOR REMOVAL OF AN IMPACTED SHARP FOREIGN BODY IN THE CERVICAL OESOPHAGUS MIMICKING MALIGNANCY
Authors: Vaz Osborne Peter , Cardozo Arun , Chaudhury Madhu , Stockwell Robert , Turner Paul , Ward Jeremy , Pursnani Kishore , Shetty Vinutha Daya 
Published: September 2024

Abstract

Background
Chronically impacted sharp foreign bodies (FB) of the cervical or upper thoracic oesophagus can present a diagnostic dilemma. Fifty percent of sharp objects tend to lodge in the upper oesophagus and frequently cause perforation. A multidisciplinary approach is warranted. Eventually, surgery by cervical oesophagotomy/thoracotomy may be required. The Weerda diverticuloscope offers excellent endoscopic visibility and access to the lumen of the upper oesophagus allowing for removal of FBs and mitigating risks of a major surgical procedure.

Methods
We report an interesting case of a 27 year old gentleman being investigated for dysphagia. The patient notes were obtained from the electronic patient records. The radiological images were sourced from the picture archiving and communication system (PACS) and endoscopy from stored images. The patient was radiologically diagnosed as having T4 malignancy but consecutive biopsies suggested Actinomycosis. Patient thereafter recollected having a fist fight and losing his dentures. This triggered the use of the Weerda diverticuloscope, a bivalved rigid diverticuloscope (Karl Storz, Tuttlingen, Germany). It has a distal fibreoptic illumination that is designed for trans-oral stapling of pharyngeal pouches

Results
Under general anaesthesia, the Weerda diverticuloscope was introduced into the cervical oesophagus. The tips of the jaws positioned just proximal to the embedded dental prosthesis. The diverticuloscope was suspended for stabilisation in the same manner as for endoscopic stapling of a pharyngeal pouch and the jaws were distracted to allow endoscopic access. A 5mm rigid telescope was passed alongside a pair of heavy endoscopic scissors and the prosthesis was divided into 3 parts. The central intraluminal component was removed first using endoscopic forceps, followed by gentle disimpaction and extraction of the remaining two components embedded in the oesophageal wall.

Conclusion
Foreign bodies in the oesophagus rarely can mimic cancer or chronic granulomatous diseases. A multidisciplinary approach is occassionally recommended in their management. There have been a few published reports of the use of the Weerda diverticuloscope to remove upper oesophageal FBs successfully. It’s use, however, is not often considered routinely. We recommend the use of this technique at centres where expertise in endoscopic management of Zenker’s diverticula is available and when endoscopic retrieval has failed.
368. THE ROLE OF PG-SGA SCORE IN PREDICTING SHORT- TERM POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER SURGERY
Authors: Mylonakis Adam , Kozadinos Alexandros , Frountzas Maximos , Tsikrikou Ilianna , Kyriakidou Maria , Karanikki Eva , Lidoriki Irene , Toutouzas Konstantinos G , Theodorou Dimitrios , Schizas Dimitrios 
Published: September 2024

Abstract

Background
The preoperative nutritional status is increasingly recognized as a determinant of postoperative outcomes in esophageal cancer patients. This study examines the relationship between preoperative nutritional scores, particularly the Patient-Generated Subjective Global Assessment (PG-SGA), and the incidence of short-term postoperative complications.

Methods
A prospective cohort study was conducted on patients undergoing surgery for esophageal cancer across two Surgical Departments at University Hospitals in Athens, Greece. Preoperative nutritional status was assessed using the PG-SGA score. Patients were categorized based on the PG-SGA score into low to medium risk with score of 8 or less, and high risk with score of 9 or higher. Postoperative complications were classified according to the Clavien-Dindo system, and their association with nutritional status was statistically assessed.

Results
This study included 59 consecutive patients who underwent surgery for esophageal cancer with female-to-male ratio of 1:4.9 and a median age of 65.4 ± 10.4 years, 43 (72.9%) of whom had received neoadjuvant chemotherapy. Notable postoperative complications (Clavien- Dindo classification ≥III) occurred in 14 cases, including evisceration (n=1), hemorrhage (n=1), chyle leakage (n=1), anastomotic leak (n=8), pleural effusion requiring radiological intervention (n=2), and a persistent pneumothorax necessitating additional thoracic tube insertion (n=1). A statistically significant association was found between malnutrition, as indicated by the PG-SGA≥9, and the development of severe postoperative complications (Clavien- Dindo classification ≥III) (p = 0.034).

Conclusion
This study suggests that preoperative PG-SGA score is potentially significant predictors of short- term postoperative complications in esophageal cancer surgeries. Incorporating nutritional assessments into the preoperative evaluation may help identify high-risk patients and tailor perioperative care to improve surgical outcomes.
372. TREATMENT USING NIVO+CHEMO OR NIVO+IPI FOR UNRESECTABLE/RECURRENT ESOPHAGEAL SQUAMOUS CANCER IN OUR INSTITUTE
Authors: Ogata Takashi , Kanematsu Kyohei , Nagasawa Shinsuke , Morita Junya , Ohnuma Shizune , Tanabe Mie , Yamada Takanobu , Oshima Takashi , Furuta Mitsuhiro , Machida Nozomu 
Published: September 2024

Abstract

Introduction
Currently, regarding stage IVB esophageal cancer treatment, the esophageal cancer treatment guideline in JAPAN was revised in 2022 based on the results of two phase III trials, KN590 and CM648, and Nivolumab+Chemo and Nivolumab+Ipilimumab would be used as 1st line treatment.

Subject
NIVO+Chemo19NIVO+Ipilimumab (IPI)17
Before February 2024, a total of 160 cases of unresectable/recurrent esophageal squamous cell carcinoma have been treated using IO, IO+Chemo, and IO+IO at our institute. 19 cases were treated with NIVO+Chemo and 17 cases were treated with NIVO+IPI as the 1st line treatment. We examined the treatment backgrounds and outcomes of these subjects.

Result
Regarding patient characteristics, median age was 66/65 years in NIVO+Chemo group/NIVO+IPI group, male to female ratio was 18:1/15:2, PS0/1 was 14/5 cases in NIVO+Chemo, and 16/1 cases in NIVO+IPI. Pre-treatment status (primary unresectable/recurrent/other) were 13/5/1 in NIVO+Chemo, and 4/12/1 in NIVO+IPI. The presence/absence of post-treatment was 12/7 cases in NIVO+Chemo and 10/7 cases in NIVO+IPI. The presence/absence of irAEs was 5/14 cases in NIVO+Chemo, and 15/2 cases in NIVO+IPI. ORR was 52.6%, and median OS was 782 days, and median PFS was 190 days in NIVO+Chemo group, and 52.9%/544days/138days in NIVO+IPI group.

Consideration
Both the NIVO+Chemo and NIVO+IPI groups at our facility had longer OS and PFS than previously reported. In particular, the response rate of NIVO+IPI was as high as that of the NIVO+Chemo group, and this is thought to be since many cases of postoperative recurrence with small tumor volumes were enrolled in NIVO+IPI group. We believe that it is important to distinguish between IO/IO and IO/CHEMO as a treatment strategy for unresectable/recurrent esophageal squamous cell carcinoma.
409. TWO-STAGE OPERATIVE PROCEDURE FOR A BENIGN, COMPLICATED TRACHEOESOPHAGEAL FISTULA CAUSED BY FOREIGN BODY IMPACTION
Authors: Rajan Shiv , Kumar Vijay 
Published: September 2024

Abstract

Background
Benign Tracheoesophageal fistula (TOF) caused by foreign body impaction is a rare condition requiring technical expertise. There are choices available based on the individual patient's situation, including endoscopic management, local resection and defect closure, and, in rare cases, esophagectomy.

Methods
A 58-year-old male had a history of artificial tooth dislodgement that got impacted in the esophagus, resulting in dysphagia. Endoscopy showed an impacted denture with an underlying transmural esophageal perforation, closed with clips and an endoloop. Two weeks later, partially covered SEMS was placed. Failure to retrieve the SEMS after repeated attempts due to tissue ingrowths, he was referred for management. CECT showed a stent in situ with a small air-filled cavity left lateral to the tracheal bifurcation. Bronchoscopy revealed the compression of the posterior tracheal wall and the presence of an endoclip in the posterior wall of the left main bronchus (LMB).

Results
The patient was planned for a two-stage operation. In the first stage, esophagus was mobilized along with the stent and the fistulous tract was excised. The esophagus was divided at both ends in the thorax. Up to this part, the procedure was done with single-port VATS without CO2 and in the left semi-prone position with a bronchial blocker in the right main bronchus. The fistula with the LMB was closed with an intercostal muscle flap and a bovine pericardial patch with transient apnoea. During this part, we extended the incision in the fourth space to raise the flap. Cervical esophagostomy was matured, and a feeding jejunostomy was created. The postoperative phase was uneventful, and he was discharged on the 5th postoperative day. After 4 weeks, we did the second phase of surgery, where we made a 4 cm retrosternal gastric conduit and performed the hand-sewn anastomosis with the cervical esophagus, which was taken down from the skin. The patient had an uneventful postoperative course and was allowed to be taken orally on day five and discharged subsequently two days later.

Conclusions
TOF demands a multidisciplinary treatment strategy. Successful outcomes are determined by patient triage, delineation of the location and size of the defect, mediastinal contamination, and the availability of expertise.
430. PROGNOSTIC PATTERNS OF LYMPH NODES WITH COMPLETE TREATMENT RESPONSE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER NEOADJUVANT CHEMORADIOTHERAPY AND NEOADJUVANT CHEMOTHERAPY
Authors: Xu Wenyi , Jian Zitao , Jiao Heng , Tang Han , Tan Lijie 
Published: September 2024

Abstract

Background
The prognostic significance of lymph nodes with pathological complete treatment response (pcr-LN) has not been well investigated in esophageal squamous cell carcinoma (ESCC). We aimed to determine the prognostic impact of pcr-LNs in ESCC after either neoadjuvant chemoradiotherapy (nCRT) or neoadjuvant chemotherapy (nCT).

Methods
578 patients with ESCC from two medical facilities were analyzed retrospectively, with 303 patients receiving nCRT and 275 receiving nCT. Pcr-LNs were defined as LNs exhibiting regression changes, such as fibrosis, mucin lakes, keratinization, and giant cell responses but no evidence of living tumor cells. 5 LN status subgroups were identified based on the ypN category in 8th AJCC: ypN0/pcr-LN-, ypN0/pcr-LN+, ypN1, ypN2, and ypN3. The Kaplan-Meier approach was used to analyze the overall survival (OS), and subgroup findings were compared using the log-rank test. Multivariate analysis of OS was performed using a Cox proportional hazard model.

Results
45 patients were classified into ypN0/pcr-LN+ (7.8%), 33 in the nCRT group, and 12 in the nCT group (p = 0.006). Compared to the nCRT group, the nCT group underwent a more thorough LN dissection (LN (mean (SD)): nCRT, 21.05 (8.77); nCT, 26.08 (11.66); p = 0.001). Survival analysis of OS showed the subgroup ypN0/pcr-LN+ had a significantly worse prognosis than ypN0/pcr-LN- in the nCRT group (p = 0.047), but no difference was seen in the nCT group. Multivariable analysis revealed that ypN0/pcr-LN+ patients in the nCRT group had a greater risk of mortality than ypN0/pcr-LN- patients (p = 0.0487).

Conclusion
The nCRT group had a more noticeable complete treatment response in LNs than the nCT group. However, in comparison to the nCT group, the nodal downstaging with radiotherapy in the nCRT group may not translate into improved outcomes. More aggressive systemic therapy might be required to improve the overall survival in esophageal cancer patients receiving neoadjuvant treatment.
436. IDENTIFICATION OF M6A-RELATED SIGNATURE GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA BY MACHINE LEARNING METHOD
Authors: Chen Long-Qi , Shang Qi-Xin 
Published: September 2024

Abstract

Background
We aimed to construct and validate the esophageal squamous cell carcinoma (ESCC)-related m6A regulators by means of machine leaning.

Methods
We used ESCC RNA-seq data of 66 pairs of ESCC from West China Hospital of Sichuan University and the transcriptome data extracted from The Cancer Genome Atlas (TCGA)-ESCA database to find out the ESCC-related m6A regulators, during which, two machine learning approaches: RF (Random Forest) and SVM (Support Vector Machine) were employed to construct the model of ESCC-related m6A regulators. Calibration curves, clinical decision curves, and clinical impact curves (CIC) were used to evaluate the predictive ability and best-effort ability of the model. Finally, western blot and immunohistochemistry staining were used to assess the expression of prognostic ESCC-related m6A regulators.

Results
2 m6A regulators (YTHDF1 and HNRNPC) were found to be significantly increased in ESCC tissues after screening out through RF machine learning methods from our RNA-seq data and TCGA-ESCA database, respectively, and overlapping the results of the two clusters. A prognostic signature, consisting of YTHDF1 and HNRNPC, was constructed based on our RNA-seq data and validated on TCGA-ESCA database, which can serve as an independent prognostic predictor. Experimental validation including the western and immunohistochemistry staining were further successfully confirmed the results of bioinformatics analysis.

Conclusion
We constructed prognostic ESCC-related m6A regulators and validated the model in clinical ESCC cohort as well as in ESCC tissues, which provides reasonable evidence and valuable resources for prognostic stratification and the study of potential targets for ESCC.

Key words
m6A, RNA methylation, esophageal squamous cell carcinoma, machine learning, experimental validation