bluuebunny/crossref_metadata_2025_split huggingface dataset:
481. STRONG SYMPTOMATIC IMPROVEMENT AT 1 YEAR AND BEYOND FOLLOWING REFLUXSTOP SURGERY FOR GASTRO-ESOPHAGEAL REFLUX DISEASE: A 40-PATIENT COHORTT
Authors: Lehmann Thorsten 
Published: September 2024

Abstract

Background
Despite well-established medical and surgical options for gastro-esophageal reflux disease (GERD), there remains a high unmet need for a treatment that improves symptoms without adverse effects. Symptoms of bloating, inability to belch or vomit, and dysphagia are among the more common side effects of standard anti-reflux surgery. RefluxStop is a novel device for the treatment of GERD that does not encircle the food passageway to avoid such side effects. The surgical technique is based on restoration of the normal anatomy of the gastroesophageal junction and maintaining the lower esophageal sphincter within the abdomen.

Methods
This study presents a case series of 40 patients who underwent RefluxStop surgery between July 2021 and November 2022 reaching at least 12 months of follow-up. A retrospective review of medical records was conducted. Baseline GERD Health-Related Quality of Life (GERD-HRQL) score was reported in addition to demographic and clinical characteristics. At follow-up, GERD-HRQL score, patient-reported GERD symptoms, and proton-pump inhibitor (PPI) use were reported. Peri-operative procedure-related and device-related adverse events (AEs) were recorded.

Results
Baseline patient characteristics are presented in Table 1. Mean follow-up was 14.5 (range 12-19) months. Mean GERD-HRQL score decreased dramatically from 19.5±3.8 at baseline to 1.1±2.2 at follow-up, reflecting a 91.9% improvement. At follow-up, reflux was reported as a symptom in only two patients (5%) (described as mild and occasional in one of them). None reported regurgitation or dysphagia. Only two patients (5%) reported bloating. The necessity for PPI therapy decreased from 97.5% (n=40) at baseline to 2.5% at follow-up. There were no intra-operative AEs or reoperations.

Conclusion
These data provide real-world evidence on the performance of RefluxStop in clinical practice. In this series of patients, the outcomes at 1 year and beyond indicate excellent effectiveness in reducing or eliminating GERD symptoms, as demonstrated by spontaneously reported symptoms and the validated, disease-specific, quality-of-life questionnaire. The discontinuation of PPI therapy is an additional indicator of effective symptomatic improvement. Importantly, this treatment did not induce dysphagia, a common consequence of established anti-reflux surgical techniques. RefluxStop is a promising option for patients with chronic GERD seeking definitive treatment while minimizing AEs.
484. DELTA-IRP AS A NEW HIGH-RESOLUTION MANOMETRY METRIC TO PREDICT THE POSITIVE OUTCOME OF LAPAROSCOPIC HELLER-DOR IN PATIENTS WITH ACHALASIA
Authors: Pittacolo Matteo , Costantini Andrea , Nezi Giulia , Provenzano Luca , Capovilla Giovanni , Vittori Arianna , Santangelo Matteo , Forattini Francesca , Nicoletti Loredana , Moletta Lucia , Costantini Mario , Valmasoni Michele , Savarino Edoardo V , Salvador Renato 
Published: September 2024

Abstract

Background
There is no consensus on the definition of failure after treatment in patients with esophageal achalasia. The Eckardt score (ES) is commonly used to define clinical outcome, but objective metrics based on high-resolution manometry (HRM) or other tools are lacking. Aim of this study was to identify any HRM objective parameters useful to predict a positive outcome after surgical treatment with laparoscopic Heller-Dor (LHD).

Methods
Patients who had undergone LHD between 2012 and 2022, with pre- and postoperative HRM at our Center, were enrolled. Patients were divided according to the outcome of treatment between success group (SG, symptom relief or resolution) and failure group (FG, ES&gt;3 or the need for additional treatment). Further to the traditional HRM metrics commonly evaluated, we also measured the difference between median values of pre- and postoperative Integrated Relaxation Pressure (∆-IRP). A ROC curve analysis was applied to assess the accuracy of each HRM parameter identified. Data are reported in Table 1.

Results
We enrolled 358 patients (F:M=177:187): 331 in the SG and 27 in the FG. The ∆-IRP was higher in SG [22mmHg (IQR:15-31)] than in FG [14.3mmHg (IQR:9.9-18.3), p=0.04]. The univariate analysis is showed in Table 1. At multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (p&lt;0.01). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.55 mmHg (sensibility 71%, specificity 70%).

Conclusions
Our data showed that the ∆-IRP with a threshold of 16.5 mmHg could represent a new objective tool to predict the positive outcome of LHD in patients with esophageal achalasia.
492. OUTCOMES OF ESOPHAGECTOMY IN THE ELDERLY- IS IT WORTH THE EFFORT?
Authors: Jiwnani Sabita , Karthik V , Baskaran D , Tiwari Virendra , Pramesh CS 
Published: September 2024

Abstract

Background
Esophageal cancer is the sixth most common cancer in India and most patients are diagnosed at locally or loco-regionally advanced stages. Multimodal management offers the best chance of cure, with surgery being the cornerstone. With improved life expectancy, elderly patients with esophageal cancer are being referred for surgery more frequently. Although recent studies have shown encouraging outcomes, increased post-operative complications are common. The aim of our study was to evaluate morbidity and survival in patients above 70 years undergoing curative surgery for esophageal cancer from 2011 to 2021 at our centre.

Methods
Of 2291 patients undergoing esophagectomy, 122 were above 70 years, ten were inoperable. Mean age was 73.3 years (70-84 years), with 78% males and 83% squamous cell carcinoma, most common location being lower-third (63.6%). Of the 110 patients, 80 (72.7%) received neoadjuvant treatment, 68(61.8%) were ASA grade II or more. McKneown’s approach was common, utilized in 55%, of which minimally invasive in 53%, with Ivor- Lewis, left thoraco-abdominal and transhiatal approaches in the rest. Mean blood loss was 350 ml, with mean operative time of 270 minutes and circumferential positivity rate of 12.7%.

Results
The mean ICU stay was 1 day, with the mean hospital stay being 13 days. Almost half (49%) had Clavien-Dindo grade III or higher morbidity, with pulmonary complications seen in 27%. Anastomotic leakage was seen in 20/110 (18%), with only 2 patients needing an intervention. 30-day mortality was 8.2%. Recurrences were seen in 21 patients, anastomotic and regional recurrences in 6, distant in 6, regional with distant in 9. The median recurrence free survival was 26 months with 3-year RFS of 43.7%. With a median follow-up of 25 months, median overall survival was 30 months and 3-year OS was 45.3%.

Conclusion
Despite higher post-operative morbidity and mortality, elderly patients have reasonable recurrence free and overall survival outcomes with curative surgery. With continuing refinements in prehabilitation, operative techniques, wider adoption of minimally invasive surgery, intra-operative management and post-operative care, early post-operative outcomes are likely to improve further. Elderly patients with resectable esophageal cancer should not be denied surgery.
503. HEALTH-RELATED QUALITY OF LIFE FOLLOWING CURATIVE INTENT TREATMENT FOR ESOPHAGEAL CANCER: IMPACT OF TREATMENT PATHWAY ON PATIENT-REPORTED OUTCOMES IN SURVIVORSHIP
Authors: Boyle Ellen , Loganathan Nithiesh , Elliott Jessie A , Greene Christine , Murphy Conor F , Donlon Noel E , Donohue Claire L , Ravi Narayanasamy , Reynolds John V 
Published: September 2024

Abstract

Background
Recent improvements in treatment modalities for esophageal cancer have resulted in improved survival outcomes, and optimisation of health-related quality of life (HR-QL) in survivorship is now an increasing focus. This study aimed to compare HR-QL in survivorship following treatment with definitive chemoradiation (dCRT), neoadjuvant chemoradiation and surgery (nCRT), neoadjuvant chemotherapy and surgery (nCT), and surgery only (S).

Methods
This was a cross-sectional study of patients who underwent oesophageal cancer treatment between 2010 and 2021. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Scores were calculated according to the European Organisation for Research and Treatment of Cancer manual. A mean difference of ten points or more for symptom and function scales was considered clinically significant. One-way ANOVA was performed to detect statistically significant differences between treatment groups.

Results
Some 125 patients were included. Global HR-QL was similar between treatment groups (mean±SD, dCRT 67.4±20.9, nCRT 71.5±19.6, nCT 80.0±15.0, S 69.0±20.0, P=0.265). Analysis of functional scales found lower emotional functioning (S 71.1±25.5 vs dCRT 87.1±15.6, nCRT 79.6±19.5, nCT 88.9±26.3, P=0.028) and body image scores (S 71.8±29.2 vs dCRT 87.9±22.5, nCRT 83.3±27.8, nCT 91.1±19.8, P=0.056) among patients treated with surgery only. Dysphagia (P=0.034), trouble with coughing (P=0.014) and choking when swallowing (P=0.018) were increased following dCRT as compared with surgical treatment. Following surgical treatment, patients reported more diarrhoea as compared with dCRT (P=0.020), while dCRT was associated with increased constipation (P=0.004).

Conclusion
Overall HR-QL was similar between groups, but distinct patterns of symptoms were observed in different cohorts. Symptoms related to swallow function were more common in patients treated with dCRT, while patients who underwent surgery exhibited more diarrhoea, possibly reflective of increased dumping syndrome. Interestingly, patients who received surgery upfront reported lower scores for emotional functioning and body image in the long-term after treatment, as compared with other groups. Further research is needed to determine the differential psychological impact of major resectional upper GI surgery among patients presenting with early stage versus locally advanced disease.
528. IMPACT OF SARCOPENIA AND MYOSTEATOSIS ON THE SURGICAL OUTCOME OF PATIENTS WITH ESOPHAGEAL CANCER
Authors: Scarton Alessia , Pierobon Elisa Sefora , Capovilla Giovanni , Moletta Lucia , Salvador Renato , Zanchettin Gianpietro , Provenzano Luca , Sartori Roberta , Zampieri Sandra , Corradin Simone , De Pasqual AnnaLaura , Sandri Marco , Valmasoni Michele 
Published: September 2024

Abstract

Background
Alterations in muscle mass, sarcopenia and myosteatosis might negatively affect the surgical outcome of patients with cancer. Body composition correlation with biochemical markers and impact on surgical outcome in esophageal cancers is yet to be fully determined.

Study design
Patients with esophageal and esophageal-gastric junction cancer undergoing resection with curative intent were enrolled in a prospective clinical trial from to 2019 to 2023. Patients were assessed at presentation for anthropometric measures, past medical history and biohumoral markers. Contrast-enhanced CT-scans were used to analyze body composition and to detect low lumbar skeletal muscle index (SMI) and low mean muscle attenuation. We investigated the association between the presence of sarcopenia and/or myosteatosis and malnutrition or systemic inflammatory state.

Results
We enrolled 130 esophagogastric cancer patients who underwent Ivor-Lewis esophagectomy. Postoperative morbidity was not significantly higher in the sarcopenic group compared to non-sarcopenic patients (p=0.35). Myosteatosis and albumin level weren’t associated with post-operative morbidity (p=0.11).
No differences in overall survival were found in patients with myosteatosis or sarcopenia compared to subjects with normal body composition (p=0.12 and p=0.16).

Conclusion
Our preliminary data shows no significant correlations between sarcopenia and myosteatosis and postoperative outcome and survival following esophagectomy for esophageal cancer. These findings from an high volume center suggest that factors other than these body composition parameters may play a more significant role in determining postoperative outcomes in patients undergoing esophagectomy. Further research is warranted to elucidate additional prognostic indicators and optimize patients care in this population.
532. OPERATIVE TRENDS AND CLINICAL OUTCOMES OF OPEN, LAPAROSCOPIC AND ROBOTIC APPROACHES TO HIATAL AND PARAOESOPHAGEAL HERNIAS-A STUDY OF 1834 PATIENTS
Authors: Ueda Goro , Low Donald , Stiles Erik , Sternbach Joel , Kuppusamy Madhan Kumar , Hubka Misho 
Published: September 2024

Abstract

Background
Indications for repair of hiatal and paraesophageal hernia (HH/PEH) repair evolved significantly over the past two decades, impacted by the increasing application of minimally invasive surgical (MIS) approaches. This transition underscores the importance of evaluating the operative trends and clinical outcomes associated with open (open), laparoscopic (lap), and robotic surgeries especially in cases of giant hernias (over 50% intrathoracic stomach). Understanding these dynamics is crucial, especially as MIS becomes increasingly prevalent in managing complex cases, including giant hernias. The aim of this study is to assess critical outcomes achieved during the evolution from open to lap to robotic HH/PEH repair in a high volume center.

Methods
This is a retrospective review of 1834 patients undergoing open (958), lap (390), and robot (486), consecutive HH/PEH repairs prospectively entered into an IRB approved database from 2000 to 2023 at a high-volume center.
Patient demographics, operative techniques, and top three most common presenting symptoms were studied overtime. Impact of operative technique, hernia type and size, operative outcomes including length of stay (LOS), radiographic recurrence (esophagram at 3 and 12 months), revisional surgery, on post-operative symptom resolution was evaluated.

Results
Annual volume increased overtime, with 418 repairs (78% robotic) in the last two years. Average hernia size decreased over the study period. The majority of patients (99.1%) presented with symptoms (Fig 1) and robotic repair had significantly better symptomatic resolution than open surgery (p&lt;0.05). This advantage persists with symptoms in giant hernias (p&lt;.001) LOS decreased over the study period (Fig 1). Overall radiographic recurrence (8.6%) and reoperative rate (2.4%) did not differ among operative techniques, however robotic repair had higher radiographic recurrence rate in case of giant hernia (18%, p&lt;.001).

Conclusion
The operative volume of HH/PEH repair has increased overtime associated with the increased application along with advancements in MIS and robotic operative techniques. Surgical interventions markedly ameliorate HH/PEH symptoms, with greater improvement observed in large hernia cases. Significant improvement in LOS and at least equivalent clinical results favors MIS, particularly robotic surgery. Although the incidence of anatomic recurrent hernia and reoperation is relatively low continued assessment of especially robotic operations to decrease this incidence further is warranted.
542. POST-ESOPHAGECTOMY PARACONDUIT HIATAL HERNIA DEVELOPMENT AND RECURRENCE
Authors: Singh Anupama , McAllister Miles A , Pezeshkian Fatemehsadat , Wee Jon O , Rochefort Matthew M , Swanson Scott J , Jaklitsch Michael T , Bueno Raphael , Wiener Daniel C , Shemmeri Ealaf 
Published: September 2024

Abstract

Background
Hiatal hernia post esophagectomy is a delayed postoperative complication. Historically, in open surgery, the incidence is rare. The increased utilization of minimally invasive methods has increased the incidence of hiatal hernias. Current literature is limited to case series. There is even less on frequency and management of re-recurrent cases. Our objectives were to identify the incidence of hiatal hernia post esophagectomy and the outcomes of the recurrent cases.

Methods
A retrospective analysis of prospective data at a single center was conducted on esophagectomies performed 2017 to 2022. Non-gastric conduit reconstructions were excluded. Baseline patient demographics including comorbidities, type of tumor, neoadjuvant therapy, surgical approach (open versus minimally invasive [MIE]), and conduit construction were recorded. Radiographic presence of non-gastric conduit abdominal contents was defined as hiatal hernia. Time of hiatal hernia occurrence, details of the repair and timing re-recurrence was recorded. Associated factors described in literature including baseline demographics, neoadjuvant therapy, operative technique, conduit diameter and use of pexy techniques were analyzed with univariate analysis. P&lt;0.05 was considered significant.

Results
A total of 565 esophagectomies met inclusion criteria, 78% (439/565) were MIE. Robotic-assisted comprised 33% (143/439) of the MIE cohort. A hiatal hernia was identified in 3% of patients (15/565). All had malignancy and were Ivor Lewis (11/15, 73%) or 3-hole (4/15, 27%). The majority had an MIE (13/15, 86%), one had open esophagectomy (6%), and one had hybrid (1/15, 6%). There was no difference in risk factors between the hernia and non-hernia groups. Median time to hernia was 5 months (IQR: 4, 12). All underwent repair. Recurrent hernia occurred in 33% of patients (5/15), all within the robotic-assisted MIE.

Conclusion
Hiatal hernia post esophagectomy occurred in 3% of cases, and most cases occurred within the MIE group. Recurrence of hernias occurred in robotic-assisted esophagectomy patients. Analysis of patient-specific factors such as prior hiatal hernia, body-mass index, neoadjuvant therapy, operative technique, conduit pexy technique all did not reveal significant correlation with hiatal hernia development. The recurrence of hiatal hernia all required redo repairs. Though we had no deaths in the hiatal hernia cohort, repeat surgeries affect morbidity in esophagectomy patients. Further analysis is needed to identify ways to minimize hernia recurrence in minimally invasive esophagectomy.
562. COMPARATIVE ANALYSIS OF THE OUTCOMES OF GASTRECTOMY VS. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE TREATMENT OF GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY
Authors: Narumiya Kosuke , Toyoshima Yukinori , Kudo Kenji , Hosoda Kei , Osugi Harushi , Ide Hiroko , Okamura Yukiyasu 
Published: September 2024

Abstract

Background
Although multimodal treatment and minimally invasive surgery for esophageal cancer have improved therapeutic outcomes for esophagectomy, this improvement has led to many reports of metachronous cancers following esophagectomy. After esophagectomy for esophageal cancer, the locations where metachronous cancers occur most frequently are the oropharynx, hypopharynx, and larynx, followed by the gastric tube. Due to a paucity of reports, much remains unknown about gastric tube cancer, such as the site of common occurrence, pattern of metastasis, treatment method. This study investigated the clinical characteristics of patients with gastric tube cancer and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection.

Methods
Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared.

Results
The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed.

Conclusion
In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.
567. EPIDEMIOLOGY OF BARRETT'S ESOPHAGUS IN ICELAND; INCIDENCE AND PROGRESSION TO NEOPLASM FROM A LARGE POPULATION-BASED STUDY
Authors: Namikawa Ken , Konráðsson Magnús , Fridgeirsson Hilmar , Sigmundsson Helgi , Jónasson Jón , Björnsson Einar 
Published: September 2024

Abstract

Background
Barrett’s esophagus (BE) is the known precursor to esophageal adenocarcinoma (EAC). Previous studies have demonstrated a wide variety of progression rate whereas no nationwide data regarding the progression has been reported. The aims of the study were to evaluate the prevalence of BE and neoplasms in BE, and progression to those in a large population based and nationwide.

Methods
This was a retrospective study and patients from 7 institutions who were identified through a database of centralized pathology laboratory in an expert center. Demographics and relevant clinicopathological features were obtained from medical records of patients with a pathologically confirmed BE by presence of intestinal metaplasia between 1990 and 2022.

Results
A total of 811 patients were identified with BE, 551 men (67.9%), male to female ratio 2.1:1, and with a median age at diagnosis of 63 years (IQR 53-73). At the time of BE diagnosis, the prevalence of neoplasm was 13.9%, (56 LGD, 14 HGD, and 43 EAC). Out of 56 LGD, 16.1% progressed to HGD (n=6) or EAC (n=3). Among 698 BE patients without neoplasm at the time of BE diagnosis, the cumulative incidence of neoplasm was 6.9% (29 LGD, 7 HGD, and 12 EAC) with median observation-period of 7 years (IQR: 4-9). In total, 161 cases of neoplasm (65.8% in long-segment, 34.2% in short-segment BE) were diagnosed in this BE cohort; 67.2% at time of BE diagnosis; and 32.8% without dysplasia at diagnosis progressed to neoplasm during follow-up.

Conclusion
In this large population-based study of patients with BE, around 14% were diagnosed as harboring neoplasm concomitantly with BE, which accounted for approximately 67% of all neoplasms. During the median follow-up of 7 years, about 7% of BE showed dysplastic or malignant progression.
570. ADRENAL METASTASES OF ESOPHAGEAL CANCER: SURGICAL MANAGEMENT OF SINGLE METASTASES
Authors: Lanz Laura Gomez , Palacios Jorge De Tomas , Lerma Maria Tudela , Jalon Jose Maria Monturiol , Sanchez Enrique Velasco 
Published: September 2024

Abstract

Background
Therapeutic possibilities of single metastases of esophageal carcinoma are evaluated.

Methods
We show the case of a patient diagnosed and treated for adenocarcinoma of the esophagus, who one year after surgery was diagnosed with a single adrenal metastasis.
The patient underwent chemotherapy treatment at the time of diagnosis of metastasis, after concluding the treatment and his disease remained stable, being the suprarenal the only site of recurrence, surgical treatment was proposed.

Results
the patient underwent a laparoscopic suprarenalectomy, with a 2 hour recovery, without complications and discharged on the third postoperative day.

Conclusion
surgical treatment of single metastases of esophageal cancer is possible and can make the patient free of disease.
In our center this option is proposed, when after diagnosis and after concluding chemotherapy treatment, the recurrence remains stable, there are no new lesions, and if this location is resectable.
In our center we have performed in the last year, two cases of adrenal metastasis of esophageal cancer.