bluuebunny/crossref_metadata_2025_split huggingface dataset:
603. GASTROINTESTINAL SYMPTOMS, AND SYMPTOMS OF DELAYED GASTRIC CONDUIT EMPTYING, ONE YEAR AFTER DIAGNOSIS OF CANCER IN THE ESOPHAGUS
Authors: Konradsson Magnus , Klevebro Fredrik , Nilsson Magnus 
Published: September 2024

Abstract

Background
Improved survival after esophagectomy for esophageal cancer emphasises persistent symptoms related to the surgically altered anatomy. The Swedish national registry of esophageal and gastric cancer collects patient reported EORTC questionnaires OG25 and C30 12 months after diagnosis. These questionnaires adress gastrointestinal symptoms and specifically symptoms of delayed gastric conduit emptying (DGCE) according to diagnostic criteria defined in an international Delphi consensus. The aim of this study is to describe gastrointestinal symptoms, and symptoms of DGCE in a large cohort of patients, 12 months after diagnosis and esophagectomy for cancer with correlation to potential risk factors for DGCE.

Methods
Data for all cases that underwent esophagectomy with gastric conduit reconstruction during 2009-2018 was analysed. Baseline data was compared between responders and non-responders to the EORTC questionnaires to address responder bias. Frequency and severity of gastrointestinal symptoms was documented. An algorithm was created to identify cases reporting symptoms consistent with DGCE according to the symptom based part of the diagnostic criteria. Odds-ratios and 95% confidence intervals were calculated for univariate analysis for correlation to baseline data and risk factors and logistic regression used for multivariable analysis, using STATA v 16.1.

Results
Totally 484 (51,2%) responded the questionnaires. Responders were similar to non-pesponders regarding age, sex and ASA score. Early satiety was most commonly reported (44%), followed by concerns of low body weight, long time completing meals, enjoying meals and appetite. 147 patients (30.4%) reported symptoms compatible with DGCE. Patients with DGCE had a mean score of 3.79 (CI=3.57-4.0) for overall health compared to 5,13 (CI=5.0-5.26) non-DGCE patients. DGCE symptom patients had a mean score of 3.77 (CI=3.54-4.01) for overall quality of life compared to 5,22 (CI=5.08-5.36) for non-DGCE patients.

Conclusion
Almost one third of patients who had an esophagectomy with a gastric conduit reconstruction for esophageal cancer had symptoms compatible with DGCE after one year. Patients reporting symptoms of DGCE rated markedly lower for overall quality of life and overall health compared to patients without DGCE symptoms. This this study suggests that DGCE is a major quantitative and qualitative problem after esophagectomy.
605. MITOCHONDRIAL METABOLISM IN UPPER GI ADENOCARCINOMA DETERMINES PATIENT SURVIVAL
Authors: Shang Ersong , Smith Anna , Reynolds Martin , Matly Amna , Edwards Joanne , Phillips Alexander W , Greaves Laura 
Published: September 2024

Abstract

Background
Mitochondrial oxidative phosphorylation (OXPHOS) is responsible for meeting the vast majority of cellular energy demands. Ever since the description of aerobic glycolysis by Warburg in 1927, it has been recognised that cancers have dysfunctional metabolism. Clinically, this Warburg effect is the basis of FDG-PET imaging, increased FDG uptake represents increased tumour glycolysis and translates to worse upper GI adenocarcinoma outcomes. The cause of OXPHOS disruption in upper GI adenocarcinoma is poorly understood, its impact on potential therapeutic strategies is yet to be explored. This is particularly pertinent in upper GI adenocarcinomas as despite recent improvements, 5-year survival remains alarmingly low.

Method
Oesophageal and gastric adenocarcinoma samples collected in the UK from 175 patients (89 oesophageal adenocarcinoma, 86 gastric adenocarcinoma, 131 male, 44 female, median age=65, IQR=12) who underwent radical resection with curative intent between 1995 and 2009. Quantitative immunofluorescence were used to determine expressions of OXPHOS Complex I and IV at a single cell level. Patients were divided into high vs. low expressors of Complex I and IV using K-means clustering to allow for subsequent subgroup analysis.

Result
Survival analysis demonstrated significantly worse outcomes for low expressors as compared to high expressors of Complex I at 5 years post-op (5-year survival probability low expressors=0.440, 95%CI=0.358-0.539, high expressors=0.629, 95%CI=0.515-0.769, P-value=0.048). Similarly comparison of Complex IV expression also demonstrates disadvantageous survival for Complex IV low expressors (5-year survival probability low expressors=0.432, 95%CI=0.346-0.538, high expressors=0.603, 95%CI=0.499-0.729, P-value=0.042).
The low expressors of Complex I and IV encompassed significantly more Stage III disease as per AJCC 7th edition.
The low vs. high expression Complex I and IV groups are similarly matched for baseline patient characteristics.

Conclusion
These results demonstrate reduced capacity to carry out OXPHOS in oesophageal and gastric adenocarcinoma is characteristic of more advanced cancer and results in worse patient outcomes. Further work is needed to determine if OXPHOS status impacts on neo-adjuvant therapy response and how to exploit OXPHOS deficiency therapeutically in oesophageal and gastric adenocarcinomas.
The limitations of this preliminary work include small sample size and tissue derived from historic patients over a long period of time, during which treatment and outcomes for upper GI cancer have significantly changed.
609. LONG-TERM OUTCOMES OF SALVAGE SURGERY AFTER PROTON BEAM THERAPY FOR ESOPHAGEAL SQUAMOUS CELL CANCER
Authors: Toshiyama Satoshi , Honda Michitaka , Yamamoto Ryuya , Kawamura Hidetaka , Takagawa Yoshiaki , Murakami Masao , Teranishi Yasushi 
Published: September 2024

Abstract

Background
Proton beam therapy (PBT) for esophageal cancer is a promising option for local control, reducing adverse events. The salvage surgery is sometimes performed for residual or recurrent lesion after PBT, however the long-term outcome has not been known for lack of previous reports.

Methods
Of 374 patients treated with radical PBT for squamous cell carcinoma of the thoracic esophagus at our institution from 2009 to 2018, we selected cases in which salvage surgery was performed. Salvage surgery was defined as surgical resection of recurrent primary tumor and/or lymph node metastases. The primary outcome was overall survival, and secondary outcomes and postoperative complications were investigated.

Results
Nineteen patients in whom salvage surgery was performed were included. Median age was 66 (55-80) years, male: female: 16:3, clinical stage at initial presentation was I:II:III = 3:6:10, and median time from PBT to relapse was 23.8 months. Esophagectomy were performed in 12 patients, and lymphadenectomy for recurrent lymph node were performed in 7 patients. During a median observation period of 26.5 months postoperatively, 14 cases were confirmed to have died of primary disease, and the median overall survival from salvage surgery was 38.3 months. 8/14 (57.1%) patients had Grade 3 or higher postoperative complications, and no operative mortality was observed.

Conclusion
We showed the long and short-term outcome of salvage surgery after PBT for esophageal squamous cell carcinoma. Although the risk of postoperative complications was high, some cases of long-term survival after salvage esophagectomy were observed.
624. LONG-TERM OUTCOME OF NEOADJUVANT CHEMOTHERAPY FOLLOWED BY ESOPHAGECTOMY VERSUS DEFINITIVE PROTON BEAM THERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Honda Michitaka , Toshiyama Satoshi , Takagawa Yoshiaki , Murakami Masao , Yamamoto Ryuya , Teranishi Yasushi 
Published: September 2024

Abstract

Background
Proton beam therapy (PBT) for esophageal squamous cell carcinoma (ESCC) is a promising curable treatment to avoid surgery, however the long-term outcomes have not enough been reported. Herein, we compared the survival outcomes of PBT with those of esophagectomy after neoadjuvant chemotherapy, which is the standard of care in Japan.

Methods
Patients with thoracic ESCC, clinical stage II or III, who underwent neoadjuvant chemotherapy plus radical resection and proton beam therapy between 2011 and 2020 were identified from database of our institute. The chemotherapy regimen was 5FU, CDDP (CF) with/without docetaxel. PBT was defined as irradiation of 50 GyE or more to the primary tumor, prophylactic irradiation, and concurrent chemotherapy (CF). Patients with other severe diseases and patients who could not be followed up were excluded. To adjust confounding factors, propensity score matching was performed; covariates included T and N-factor, age, gender, time of treatment and site of tumor. We retrospectively evaluated overall survival time of the surgery and PBT groups as primary outcome in this study.

Results
244 patients were selected from the database. Median age was 71 years, 209 were male, 102 had esophagectomy after chemotherapy, and 142 had PBT. After propensity score matching, 46 patients in each group were selected by propensity score matching. Median survival was 42.8:44.6 months in the surgery and PBT groups, respectively (p=0.784). There were no treatment-related deaths, and Grade 3 or higher adverse events occurred in 8 and 8 patients (p=1.00), respectively.

Conclusion
PBT for stages II and III ESCC was comparable to neoadjuvant chemotherapy followed by surgery in long-term outcomes and adverse events.
627. LEFT THORACOSCOPIC PRIMARY REPAIR OF ESOPHAGEAL PERFORATION SECONDARY TO BOERHAAVE SYNDROME
Authors: Oo Aung Myint , Yeo Charleen , Tan Ryan Jun-Yi 
Published: September 2024

Abstract

Background
With the advancement of the minimally invasive surgical techniques, more and more acute surgical conditions including esophageal perforations can be performed safely using minimally invasive surgical approach.

Methods
A middle aged male patient presented to our department with 3 days history of epigastric pain and vomiting. He was febrile on admission and investigation revealed the left sided esophageal perforation due to Boerhaave Syndrome with left sided pleural effusion. He underwent left thoracoscopic primary repair of esophageal perforation and wash out successfully. This is the video of the thoracoscopic primary repair of the perforation. Patient was put in the right lateral semi prone position, the area of perforation was identified by careful dissection of the pleura and repaired was performed in 2 layers. The pleura cavity was washed out with warm saline and underwater sealed chest tube drain was inserted.

Results
Post operatively patient was transferred to surgical intensive care unit for 1 day. Patient was kept nil by mouth with parenteral nutrition for 7 days. Contrast study was performed on post operative day 7 and started oral feeding when there was no evidence of leakage. Patient recovered and discharged well.

Conclusion
Thoracoscopic primary repair with wash out of spontaneous esophageal perforation secondary to Boerrhave Syndrome is challenging however it is safe and can be performed successfully.
https://drive.google.com/file/d/1JTfJLV-ngUBwzMybGV4FL8EEQB-ysj9O/view
630. ENDOSCOPIC MANAGEMENT OF DELAYED-GASTRIC-EMPTYING AFTER ESOPHAGECTOMY IN A TERTIARY REFERRAL CENTER: COMPARISON BETWEEN DIFFERENT ENDOSCOPIC PROCEDURES
Authors: Battaglia Silvia , Giuseppe Dell'Anna , Mandarino Francesco Vito , Puccetti Francesco , Cossu Andrea , Barbieri Lavinia , Barchi Alberto , Azzolini Francesco , Fanti Lorella , Fanizza Jacopo , Elmore Ugo , Fuccio Lorenzo , Annese Vito , Rosati Riccardo , Danese Silvio 
Published: September 2024

Abstract

Background
Delayed Gastric Emptying (DGE) after Esophagectomy with a gastric conduit is a complication that occurs in 15-39% of patients. It is associated with short and long-term complications and with a poor quality of life. Intra-Pyloric Injection of Botulinum Toxin (BT), Pyloric Pneumatic Dilation (PD), and combination of these two techniques (BTPD) in the same session, represent the main endoscopic procedures, but comparative data are currently unavailable.

Methods
We retrospectively analyzed prospectively collected data on all consecutive patients with DGE after esophagectomy endoscopically treated from December 2018 to November 2023. DGE was classified based on the onset time (early/late), and the Gastric Outlet Obstruction Score (GOOS) was used for clinical staging. All BT patients received 200UI of toxin, while those PD patients have been dilated up to 20mm. Technical success (TS) was defined as the completion of the procedure, clinical success (CS) as achieving a GOOS of ≥2, and recurrence as the need for endoscopic/surgical treatment in patients who achieved CS. Adverse events (AEs) were classified using the AGREE classification.

Results
34 patients (82.4% male, 94.1% Ivor-Lewis, divided as follow: 13 (38.2%)BTPD-group, 12 (35.3%)BT-group and 9(26.5%)PD-group. Median follow-up was of 170 days (IQR 67-604), with no differences between the three groups. No statistically significant differences were found in the baseline characteristics among the three groups (e.g.surgical pyloromyotomy, neoadjuvant treatments). Despite identical TS (100%), BT-group exhibited a higher rate of clinical failure (25%) compared to the other groups (p=0.03). No difference in the recurrence rate was observed between the three groups (p=0.47). Dysfunction analysis showed that BTPD-group was characterized by a significatively shorter median time to refeeding of 1 day (IQR 1) compared to the other two groups (log-rank test p=0.0051). No AEs procedures related were recorded.

Conclusions
Our study reveals that BT is associated with a considerable rate of clinical failure, and that the combined BTPD treatment may offer a more rapid clinical success, maintaining an equivalent safety profile. Further prospective studies are needed to validate these findings.
637. UPFRONT SURGERY IN ESOPHAGEAL CANCER: ACCURACY OF PREOPERATIVE CLINICAL STAGING
Authors: Wallner Eva , Rudisch Björn , Farmaki Filitsa , Avramovska Irina , Kemeter Melissa , Giulini Luca , Diener Markus , Erhardt-Kreutzer Christina , Weitzendorfer Michael , Emmanuel Klaus , Koch Oliver 
Published: September 2024

Abstract

Background
Treatment of locally limited esophageal cancer is still a frequently discussed topic. Especially, the inaccuracy of clinical staging in lymph node-negative T2-carcinomas has to be considered further in the treatment pathway. Aim of this study was to evaluate the accuracy of clinical staging in patients treated with esophagectomy without neoadjuvant treatment.

Methods
We conducted a retrospective multicenter analysis at the departments of surgery from two university clinics. All patients between January 2016 and December 2023, who underwent an esophagectomy because of an esophageal adenocarcinoma or squamous cell carcinoma without neoadjuvant treatment were included. Advanced tumor stage, T staging greater than T2, was defined as exclusion criteria.

Results
Fifty-three patients after upfront esophagectomy were included in the analysis.
In 40 (75%) patients a gastroesophageal junction adenocarcinoma was diagnosed, and 13 (25%) patients were treated because of a squamous cell carcinoma of the esophagus.
Clinical T staging was T1 or T2 and all lymph node stages were included.
The endosonographic preoperative staging of invasion depth was accurate in 32 (60%) patients in comparison to the histopathological staging. In 7 (13%) cases the T-values were upstaged one level and in 5 (9%) cases one level downstaged after resection.
The endosonographic preoperative staging of nodal spread was accurate in 32 (60%) patients. Furthermore, in 7 (13%) cases node status was upstaged and in 5 (9%) patients downstaged.
Nine (17%) patients did not undergo a sufficient endosonographic staging, mainly due to prior endoscopic submucosal dissection or stenosis. In these patients, clinical lymph node staging was accurate in 4 patients.

Conclusion
Preoperative staging using endoscopic ultrasound and computed tomography is not accurate enough in a high number of patients, therefore we are seeking to identify other predictive factors underlying advanced stage esophageal cancer.
644. CUSTOMIZING A LARGE LANGUAGE MODEL TO PROVIDE CLINICALLY TAILORED ADVICE FOR EMERGENCY ESOPHAGEAL IMPACTIONS
Authors: Huo Bright , Hanna Nader 
Published: September 2024

Abstract

Background
There is interest in applying Large Language Models (LLMsclinically, but they are not trained for medical purposes. Equally, the development of LLMsrequires significant time and financial resources. Customizing an existing LLM for clinical purposes may overcome these limitations and would be of interest to clinicians, patients, hospital managers, and government/policy makers.

Methods
Thirty patient cases with nonbony esophageal impactions were developed using guidance from UpToDate. Standardized prompts were engineered for physicians as the end user. The customization tool was applied to ChatGPT-4.0 to create the Esophageal Impaction Tool (GPT-EIT), which provides advice for managing patients with esophageal impactions. Both GPT-EIT and the generic ChatGPT-4.0 models were queried February 28th, 2024. Their performance was evaluated based on guidelines for the removal of foreign bodies from the European Society of Gastrointestinal Endoscopy. Outcome data was presented using descriptive statistics in the form of counts and percentages.

Results
The GPT-EIT provided accurate recommendations for 30/30 (100.0%) cases. Each case was managed appropriately, recommending that stable patients received endoscopy within 24 hours, while patients with drooling were recognized as a surgical emergency and advice was given to provide endoscopy within 2 hours, but no more than 6 hours. GPT-EIT also advised to consider the appropriateness of treatment for patients presenting at 97 years of age based on their comorbidities and health status. The generic ChatGPT-4.0 model produced accurate guidance for 14/30 (46.7%) of cases. Patients with signs of significant obstruction would not have received timely endoscopy (Table 1).

Conclusions
ChatGPT can be customized to overcome limitations with its training dataset to develop clinically relevant, accurate advice for esophageal impactions. Clinicians, patients, hospital managers, and policymakers should take note that this methodology may be applied for other clinical purposes to avoid limitations related to resource constraints with developing LLMsfrom scratch.
645. CLINICAL SIGNIFICANCE OF LOCAL TREATMENT FOR RECURRENCE WITHIN THE SURGICAL FIELD AFTER RADICAL ESOPHAGECTOMY
Authors: Kanamori Jun 
Published: September 2024

Abstract

Background
In recent years, more aggressive multidisciplinary treatment and minimally invasive approaches with meticulous lymph node dissection have become the standard in esophageal cancer surgery, but recurrence cases within the surgical field after radical resection are unfortunately frequently observed. We will compare the clinicopathological characteristics of the cases of intra-sugical field recurrence with those of extra-surgical and both intra- and extra-surgical field recurrence and discuss their significance in light of the results of local treatment for intra-surgical field recurrence.

Subjects
The study included 130 cases of intra-surgical field recurrence among 490 esophageal cancer patients who underwent radical subtotal esophagectomy and cervical anastomosis (Mckeown-esophagectomy) with right thoracic approach between January 2013 and April 2019.

Results
The 130 cases of recurrence were categorized as intra-surgical field recurrence (Group I)/extra-surgical field (Group O)/intra- and extra-surgical field (Group I+O): 19/86/25. Preoperative factors: Tumor localization tended to be more common in Ut in group I (p=0.078), but there were no other differences such as cStage or preoperative treatment. Intraoperative/postoperative factors: I+O group had significantly more blood loss (p=0.045), but there were no other differences in the range of lymph node dissected field, number of dissected lymph nodes, combined resection of the thoracic duct, postoperative complications, hospital stay, or histological therapeutic effect. 19 patients in group I had 17 patients (89.5%) who received initial local treatment (surgery/CRT/RT: 4/7/6). The response rate (R0 resection or CR+PR) was 58.8%. Compared to cervical and upper mediastinal lymph node recurrence, the response rate to initial local treatment tended to be lower in patients with middle and lower mediastinal lymph node and anastomotic recurrence (80%/43%, p=0.145).

Discussion
Intra-surgical field recurrence after radical resection tended to be more common in the primary site of Ut. Recurrence in the upper mediastinal lymph nodes in the cervical region shows a relatively high response rate to local treatment, and long-term recurrence-free ("cure") is achieved. On the other hand, mid and lower mediastinal lymph node and anastomotic recurrences have a low response rate to local treatment and should be complemented with more systemic treatment, such as sequential ICI to initial treatment.
740. RABEPRAZOLE PROTECTS REFLUX ESOPHAGITIS DUE TO BILE IN RAT MODEL
Authors: Hashimoto Naoki 
Published: September 2024

Abstract

Aims
we studied the effect of proton pump inhibitor(PPI)(Rabeprazole) therapy on esophageal bile reflux in esophagitis after total gastrectomy. (Methodology) Sixteen 8-week old male Wistar rats were underwent total gastrectomy and esophagoduodenostomy to induce esophageal reflux of biliary and pancreatic juice. In 5 rats the sham operation induced a midline laparatomy alone (Sham). One week following surgery, they were treated with saline (Control) (n=8) PPI (Rabeprazole)(n=8)(30mg/kg/day) ip for 2 weeks. 3 weeks after operation, all rats were killed and the esophagus was evaluated histologically. Esophageal injury was evaluated by macroscopic, microscopic findings and expression of COX2 and PGE2. We performed the measurement of bile acid in the esophageal lumen and common bile duct.

Results
At 3 weeks after surgery, duodenal reflux induced esophageal erosions and ulcer formation. The macroscopic ulcer score and microscopic ulcer length were significantly reduced by PPI. The enhanced expression of COX2 and PGE2 in the control group was also markedly inhibited in the PPI group. Really, there is no difference between control group and PPI group in bile acid concentration from the common bile duct. PPI does not inhibit the secretion of bile acid from the common bile duct. But, the bile acid activity in the esophageal lumen was significantly increased in the control group, and this increase was significantly inhibited in the PPI group.

Conclusion
These results indicate that bile acid, which is inhibited by Rabeprazole, plays an important role in the mucosal damage induced by duodenal reflux.
741. EXPRESSION OF COX2 AND P53 IN RAT ESOPHAGEAL CANCER INDUCED BY REFLUX OF DUODENAL CONTENTS
Authors: Hashimoto Naoki 
Published: September 2024

Abstract
Aim. Reflux of duodenal contents can induce mucosal injury, stimulate cell proliferation, and promote tumorigenesis. We examined the expression of COX2 and p53 in rat esophageal lesions induced by duodenal content reflux. Methods. Thirty 8-week-old male Wistar rats were exposed to duodenal content esophageal reflux. All animals underwent an esophagoduodenal anastomosis (EDA) with total gastrectomy in order to produce chronic esophagitis. Ten rats were the sham. Control. They were sacrificed at the 40th week. Their esophagi were examined for HE, COX2, p53, and proliferating cell nuclear antigen (PCNA). Results. After 40 weeks of reflux, dysplasia, squamous cell carcinoma (SCC), and adenocarcinoma (ADC) were found. PCNA labeling index was higher in dysplastic and cancer tissue than that in normal. Overexpression of COX2 was shown in ADC and SCC. Wild-type p53 accumulation was found in ADC, and not in SCC. Conclusion. Reflux of duodenal contents into the esophagus led to ADC and SCC in rats. COX2 may play an important role in esophageal cancer by duodenal content reflux. Our present results suggest an association between wild-type p53 accumulation and COX2 expression in ADC, with no such relation seen in SCC.