bluuebunny/crossref_metadata_2025_split huggingface dataset:
646. MCKEOWN VS IVOR-LEWIS ESOPHAGECTOMY FOR PATIENTS WITH A HISTORY OF TOTAL PHARYNGOLARYNGECTOMY: A COMPARISON STUDY
Authors: Kuriyama Kengo , Kanamori Jun , Terayama Masayoshi , Watanabe Masayuki 
Published: September 2024

Abstract

Background
Oncologic esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. There are two different esophagectomy procedures: total esophagectomy with cervical anastomosis (McKeown) and subtotal esophagectomy with intrathoracic anastomosis (Ivor-Lewis). Differences in outcomes between McKeown and Ivor-Lewis esophagectomies for patients with this history remain unclear.

Patients and Methods
We retrospectively reviewed 36 patients with a history of TPL who underwent oncologic esophagectomy and compared the clinical outcomes between the procedures.

Results
Twelve (33.3%) and 24 (66.7%) patients underwent McKeown and Ivor-Lewis esophagectomies, respectively. McKeown esophagectomy was more frequently performed for the supracarinal tumors (P = 0.002). Other baseline characteristics, including the history of radiation therapy, were comparable between the groups. Postoperatively, the incidences of pneumonia and anastomotic leakage were higher in the McKeown group than in the Ivor-Lewis group (P = 0.029 and P &lt; 0.001, respectively). Neither tracheal necrosis nor remnant esophageal necrosis was observed. The overall and recurrence-free survival rates were comparable between the groups (P = 0.494 and P = 0.813, respectively).

Conclusion
When performing esophagectomy for patients with a history of TPL, if it is oncologically acceptable and technically available, Ivor-Lewis is preferable over McKeown esophagectomy for avoiding postoperative complications.
749. GENDER DIFFERENCE IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Hashimoto Naoki 
Published: September 2024

Abstract
In Japan, esophageal cancer is often more common in men, with a lower incidence in women than in men, accounting for 12% of the total number of cancers. In Japan and the West, SCC is involved in alcohol and tobacco. These habits are characteristically more common among men. Women are more likely to be diagnosed at an earlier stage than men. Therefore, we examined the prognosis, stage, and pathology of 145 men and 30 women who underwent radical surgery for esophageal cancer over the past 5 years. (Result) p stage is male: stage 0:7(5%), stage 1:35(25%), stage II: 58(40%), stage III:35(25%), stage IV:10(7%) female: Stage 0: 2 (7%), Stage 1: 12 (40%), Stage II: 6 (20%), Stage III: 9 (30%), Stage IV: 1 (3%). Significantly more men had advanced cancer. No difference was observed regarding Ly and V. Although there were no differences in location and histology, depth of invasion and lympho node metastasis were significantly enhanced in males. (table 1) Kaplanmier survival rate after 5 years was significantly better for women than for men. (Fig 1).(Conclusion) Compared to men, women had less advanced cancer at the time of discovery and a better 5-year survival rate.
759. P02.04 PARAVERTEBRAL VERSUS EPIDURAL ANALGESIA IN MINIMALLY INVASIVE ESOPHAGEAL RESECTION (PEPMEN): A RANDOMIZED CONTROLLED MULTICENTER TRIAL
Authors: Feenstra Minke , Kooij Cezanne , Eshuis Wietse , de Groot Eline , Hermanides Jeroen , Kingma B Feike , Gisbertz Suzanne , Ruurda Jelle , Daams Freek , Marsman Marije , van den Bosch Oscar , ten Hoope Werner , Goense Lucas , Luyer Misha , Nieuwenhuijzen Grard , Scholten Harm , Buise Marc , van Det Marc , Kouwenhoven Ewout , van der Meer Franciscus , Frederix Geert , Hollmann Markus , Cheong Edward , van Berge Henegouwen Mark , van Hillegersberg Richard 
Published: September 2024

Abstract

Background
Thoracic epidural analgesia has been the mainstay for pain control in esophageal cancer patients undergoing minimally invasive esophagectomy (MIE). Although effective epidural analgesia potentially contributes to achieving enhanced recovery after surgery (ERAS) goals in patients undergoing MIE, it can have counterproductive side effects such as hypotension, urinary retention and reduced mobility. Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.

Methods
This open randomized controlled superiority trial was conducted across four Dutch centers. A total of 192 patients with esophageal cancer, scheduled for elective transthoracic MIE with intrathoracic anastomosis, were included and randomized to receive either epidural analgesia or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included the quality of life, postoperative pain, opioid consumption, need for inotropic/vasopressor medication, duration of admission, mobilization, complications, readmission, and mortality.

Results
From December 2019 to February 2023, 94 patients were assigned to epidural and 98 to paravertebral analgesia. QoR-40 score on POD3 did not differ between groups (mean difference 3.7; P=.268). The epidural group had higher QoR-40 scores on POD1 and 2 (mean difference 7.7; P=.018, mean difference 7.3; P=.020) and lower pain scores (1 versus 2; P=&lt;.001, 1 versus 2; P=.033). More patients in the epidural group required vasopressor-medication on POD1 (38.3% versus 13.3%; P&lt;.001). In the paravertebral group, the urinary catheter was removed one day earlier (P=&lt;.001). No significant differences in complications or length of stay were observed.

Conclusion
This multicenter randomized controlled clinical trial did not show superiority of paravertebral analgesia over epidural analgesia in quality of recovery on the third day after minimally invasive esophagectomy. These results, however, support the safety of paravertebral analgesia as a viable alternative to epidural analgesia, enabling the provision of both techniques to patients in clinical practice.
766. LASTING SYMPTOMS AFTER OESOPHAGEAL RESECTIONAL SURGERY (LASORS): MULTICENTRE VALIDATION COHORT STUDY
Authors: Paine Heidi , Chidambaram Swathikan , Dawas Khaled , Mohammadi Borzoueh , Qureshi Yassar , O'Neill Robert , Dai Nick , Alkhaffaf Bilal , Vohra Ravinder , Markar Sheraz Rehan 
Published: September 2024

Abstract

Background
As outcomes following curative-intent oesophageal cancer treatment improve, more patients are living with the long-term morbidity of cancer therapies, the symptoms of which are poorly recognised and understood. Existing symptomatology and quality-of-life tools are cumbersome and moreover are not designed specifically for evaluation of post-treatment survivorship.
The LASER study and subsequent consultation process identified six key symptoms thought to predict poor health-related quality-of-life (HRQoL) as measured by validated European Organisation for Research and Treatment of Cancer (EORTC) tools. The current study aimed to validate this six-symptom LAsting Symptoms after Oesophageal Resection (LASOR) clinical tool, and assess its clinical utility.

Methods
In this multi-centre cohort study, patients who underwent oesophagectomy between January 2015 and June 2019 across the United Kingdom, and were disease-free at least one-year post-treatment, were asked to complete LASOR, EORTC-QLQ-C30 and QLQ-OG25 questionnaires. LASOR symptoms (low mood, reduced energy, thoracotomy pain, heartburn, diarrhoea, and bloating after eating) were evaluated using composite scores based on frequency and quality of life impact, and correlated with EORTC HRQoL scores. The ability of the LASOR tool to predict patients with poor HRQoL was validated using receiver operating characteristic (ROC) curve analysis. Patient acceptability of the tool was assessed using a separate questionnaire.

Results
263 participants were included. 192 (73%) were males. Surgical technique included open (61%), hybrid (18%), and minimally-invasive (21%). 203 patients (77%) received neoadjuvant chemotherapy or chemoradiotherapy. 148 patients (56%) experienced a post-operative complication. Four LASOR symptoms were associated with significantly lower HRQoL: reduced energy (OR=2.13; 95% CI 1.20-2.87), low mood (OR=1.86; 95% CI 1.45–3.12), diarrhoea (OR=1.48; 95% CI 1.06–2.06), and bloating (OR=1.35; 95%CI 1.03-1.77). In combination, the LASOR symptoms produced an area under the ROC curve of 0.85 (sensitivity = 0.82, specificity = 0.73).

Conclusion
The six-symptom LASOR tool generated a reliable model for identification of patients with a poor HRQoL, with an overall diagnostic accuracy of over 80%. This is the first clinical symptom tool to be validated in the post-curative-treatment setting for patients with oesophageal cancer. The LASOR tool is straightforward to administer and highly acceptable to patients, and can be used to identify those at risk of high morbidity and poor quality of life in surveillance programmes. In turn, evidence-based survivorship services can be integrated into patient follow-up to alleviate the burden of cancer treatment on oesophagectomy patients.
772. EVALUATING OUTCOMES OF LES OBSTRUCTION AND REFLUX IN PATIENTS UNDERGOING PERORAL ENDOSCOPIC MYOTOMY GUIDED BY THE 16CM IMPEDANCE PLANIMETRY CATHETER
Authors: Nguyen Anh , Podgaetz Eitan , Sampson-Ansah Mahalia , Bhatt Anjali , Mendoza Roseann , Ellison Ashton , Reddy Chanakyaram A , Spechler Stuart J , Konda Vani JA 
Published: September 2024

Abstract

Background
Peroral endoscopic myotomy (POEM) is a standard treatment option in achalasia. The endoluminal functional lumen imaging probe (FLIP) system utilizes impedance planimetry to measure diameter and distensibility at the esophagogastric junction (EGJ) in real-time. Most reports of the intraoperative FLIP experience focus on the 8 cm balloon, but the 16 cm balloon catheter also provides topographical assessments in addition to EGJ metrics. The aim of this study is to determine the clinical outcomes after a tailored myotomy using the 16 cm balloon during POEM.

Methods
We conducted a retrospective review of consecutive patients who underwent POEM with intraoperative FLIP with the 16 cm balloon catheter between January 2020 and September 2023. Operative reports were reviewed, and data including FLIP metrics and topographical assessments and myotomy length, which was guided by FLIP panometry, were recorded. Clinical parameters for lower esophageal sphincter (LES) obstruction (defined by FLIP-EGJ metrics, BEDQ/Eckardt scores and/or need for LES re-intervention) and reflux (defined by GERD-HRQL/RSI scores, +pH testing, LA B/C/D reflux esophagitis, PPI use and/or need for anti-reflux surgery) were collected during the 6-36 month follow up time period.

Results
Of 100 patients (57 female, mean 56.1y), 82 had Achalasia, 15 EGJOO, and 3 hypercontractile esophagus. Myotomy length was tailored (mean 8.2cm, range 3 – 15) by FLIP, and 10% had a short myotomy (≤4cm). Among 16 patients with previous Heller, the myotomy targeted contractile activity proximal to the previous myotomy in 10 cases. On follow up of 71 patients (median time 14mo), clinical outcomes are noted in Table 1. Obstructive symptoms and FLIP metrics showed significant improvement. Repeat myotomy was required in 5.6%. While reflux symptom scores improved, 37.5% had abnormal %AET, 4.7% had reflux esophagitis, and 7.0% required anti-reflux surgery.

Conclusion
A tailored myotomy with guidance of a 16 cm FLIP catheter to assess EGJ metrics and topographical assessments during POEM appears to be safe and effective at 6-36 month follow up. A tailored myotomy allows for a shorter myotomy than traditional surgical lengths and can be extended to capture residual disease noted with the 16 cm FLIP catheter in patients with previous surgery. Use of the 16 cm balloon during POEM results in overall low rates of LES re-intervention and post-myotomy reflux.
777. COMBINED OESOPHAGEAL AND AIRWAY STENTING FOR MALIGNANT OESOPHAGEAL STRICTURES: THE UK’S LARGEST TERTIARY CENTRE EXPERIENCE AND DEVELOPMENT OF A NOVEL ALGORITHM
Authors: Gertner Julian , Mullin Monica , Shea Ms Rosalind , Aslam Nasar , Banks Matthew , Ahmad Omer , Sweis Rami , Graham David , Navani Neal , Thakrar Ricky , Sehgal Vinay 
Published: September 2024

Abstract

Background
Malignant oesophageal strictures can cause airway compromise and fistula formation. Combined oesophageal and airway stenting is a potential treatment yet no guidelines exist. This study aims to describe the outcomes of same-session oesophageal and airway endoscopic stenting for malignant strictures and propose an algorithm for intervention.

Methods
A retrospective study on patients undergoing same-session gastroenterology (GI) and respiratory endoscopy at University College London Hospital, 2019-2023. All procedures were with anaesthetic-led propofol sedation. Endoscopic decision making was based on pre-procedure multidisciplinary team meeting (MDM) and intra-procedure clinical assessment. Data collected included malignancy type, luminal narrowing, complications, and mortality.

Results
26 patients were identified. Mean age was 63 years. Cancer type was oesophageal (81%) or lung (19%). The most common referral indication was dysphagia (42%); airway compromise was often seen on imaging (65%). Stent insertion was oesophageal only (35%), airway only (19%) and dual (27%). Airway stenting was common (80%) if airway stenosis was &gt;50%. No airway stenting occurred if stenosis was &lt;50%. After oesophageal stenting, repeat bronchoscopy showed increased airway stenosis in 4 patients (25%). The only intraoperative complication was one oesophageal perforation. New tracheooesophageal fistula was the most common post-intervention complication (15%). Median time from malignancy diagnosis to death was 7.9 weeks.

Conclusion
We present the first algorithm (Figure 1) for endoscopic stenting in patients with malignant oesophageal stricture and airway involvement. We suggest upper GI and respiratory MDM to plan same-session endoscopy with decision-making framed by patient-centred goals given their poor prognosis.
778. ROBOTIC-ASSISTED EPIPHRENIC DIVERTICULECTOMY: 9 YEAR EXPERIENCE OF A TERTIARY CENTER
Authors: Cuce Federica , Pallabazzer Giovanni , Belluomini Mario Antonio , Gennai Andrea , Solito Biagio , Marini Paola , Santi Stefani 
Published: September 2024

Abstract

Background
Epiphrenic esophageal diverticula are rare and often associated with esophageal motor disorders. Surgery is reserved for larger diverticula with symptoms that significantly impair quality of life. When possible, a transhiatal approach can reduce pulmonary complications by preserving pleural integrity; more proximal diverticular openings require a combined transthoracic and abdominal approach to achieve complete excision.
Robotic surgery assists in precise dissection and preservation of delicate mediastinal structures. Currently, few reports are available on larger patient cohorts of robotic diverticulectomy.
We describe all consecutive cases of robotic-assisted epiphrenic diverticulectomy performed at a high-volume tertiary center, since robotic surgery became available in 2015.

Methods
A retrospective chart review was conducted and, for all consecutive diverticulectomy cases, surgical techniques, patient characteristics and short and long-term outcomes were recorded. All patients underwent preoperative EGDS and esophagogram.
Diverticulectomy was always accompanied by esophagogastric Heller myotomy (&gt;7 cm) and Dor fundoplication with the Xi DaVinci system was performed. One to two SIGNA linear stapler firings were used for diverticular resection.
Symptoms, demographic data, and short and long-term surgical outcomes were recorded, including morbidity and mortality and post-operative symptoms.

Results
Four cases required both an abdominal and intrathoracic approach, none was converted. Intraoperative complications included one occurrence of splenic bleeding controlled by hemostatic. Intraoperative blood loss was negligible. In two cases an esophageal leiomyoma was found incidentally and excised. The only postoperative complication was trocar-related abdominal wall bleeding that led to reintervention for cauterization; mortality was zero. All patients underwent a post-op esophagogram, negative for leaks or strictures, and resumed soft feeding within 7 days.
All reported substantial symptom relief at six months. At one year, one patient reported reflux, and two reported dysphagia recurrence without evident structures or recurrences.

Conclusion
Robotic-assisted diverticulectomy is safe and effective for epiphrenic diverticula.
The abdominal approach allows for a thorough esophageal myotomy associated with a For antireflux procedure to reduce recurrences of the disease and long-term dysphagia. In some cases a transthoracic approach is also needed, when employed by experienced upper GI surgeons it doesn't significantly affect surgical outcomes. Quality of life improves after surgery, although symptomatic reflux might occur. Further prospective or experimental studies are needed to evaluate short and long-term outcomes of the robotic approach compared to other surgical approaches.
784. NO SUPPORT FOR IMMEDIATE POSTOPERATIVE REMOVAL OF NASOGASTRIC TUBE AFTER ESOPHAGECTOMY, RESULTS FROM A NORDIC MULTICENTER RANDOMIZED CONTROLLED TRIAL
Authors: Hedberg Jakob , Kauppila Joonas , Aahlin Eirik Kjus , Edholm David , Johnsen Gjermund , Johansson Jan , Lagergren Pernilla , Lindblad Mats , Lindberg Fredrik , Helminen Olli , Löfdahl Per , Førland Dag Tidemann , Vikhammer Mads , Svendsen Lars Bo , Sundbom Magnus , Szabo Eva , Åkesson Oscar , Nilsson Magnus , Achiam Michael , Mala Tom 
Published: September 2024

Abstract

Background
Esophagectomy is central in curative treatment of esophageal and gastroesophageal junctional cancer. Postoperative nasogastric (NG) tube for drainage of the gastric conduit is routine in most centers. The NG tube is typically associated with significant discomfort for the patients and may have risks of its own. Immediate postoperative removal of the NG tube has been suggested and deemed safe in several smaller trials. We hypothesized that immediate postoperative removal of the NG tube is non-inferior to keeping the NG-tube in place for 5 days postoperatively, with regard to anastomotic leak and other early outcomes.

Methods
Esophagectomy patients with a gastric conduit reconstruction were included in a multicenter, randomized controlled trial between February 2022 and March 2024. A 1:1 randomization stratified for center, age and anastomotic site (thorax/neck) was performed between immediate postoperative removal of NG tube (intervention) and 5 days of NG tube use (control). All patients underwent chest CT postoperative day 7. Anastomotic leak was the primary endpoint and a non-inferiority threshold of -9% difference in proportion of anastomotic leak, including 95% confidence interval, was set. Secondary endpoints included overall complications, pneumonia, length of stay as well as days in high dependency ward.

Results
Intention to treat analyses were performed on 444 patients whereof 215 were randomized to immediate NG-tube removal and 229 to control. Mean age was 67 years and neck anastomosis was performed in 78 patients (18%). 47 patients (22 %) had leak in the no NG tube group compared to 35 (15%) in the control group. Non-inferiority could not be established with a difference leak proportion to the advantage of NG tube use of 6.6% (95% CI: 13.8%-(-0.7%)). Overall complications (Clavien-Dindo &gt;2) occurred in 94 patients (44%) in the experimental group and 91 patients (40%) in the control group. Overall 30d mortality was 1.1%.

Conclusion
In this randomized controlled multicenter trial, the by far largest to be performed so far, we could not establish non-inferiority for abstaining from postoperative NG tube use after esophagectomy with regards to anastomotic leak, and therefore support NG tube use. The somewhat high proportion of leak could be partly due to meticulous complication registration, including CT with peroral contrast on day seven in all patients. Use of postoperative decompression of the gastric conduit with an NG tube should be encouraged.
785. MANAGEMENT OF ESOPHAGEAL CANCER WITH CONCURRENT CERVICAL NODE METASTASIS: A NATIONWIDE POPULATION-BASED COHORT STUDY
Authors: Sanders Maxime , van der Horst Sylvia , Weijs Teus , Mook Stella , Mohammad Nadia Haj , Freund Jan Erik , Elliot Jessie , van Berge Henegouwen Mark , Gisbertz Suzanne , van Rossum Peter , van Laarhoven Hanneke , Luyer Misha , Nieuwenhuijzen Grard , Wijnhoven Bas , Mostert Bianca , Verhoeven Rob , Ruurda Jelle , van Hillegersberg Richard 
Published: September 2024

Abstract

Background
In the Netherlands, the standard treatment of locally advanced, resectable esophageal cancer without metastasis is neoadjuvant chemoradiotherapy followed by esophagectomy. There is a small subset of patients that present with concurrent cervical lymph node metastasis (LNM). Historically this was seen as distant metastasis and surgical intervention has usually not been an option for these patients. The contemporary TNM classification now categorizes these lymph node stations as locoregional disease. Our current study aims to describe current treatment paradigms in the Netherlands for patients presenting with esophageal cancer and concurrent cervical LNM.

Methods
This population-based cohort study utilized data from the Netherlands Cancer Registry (NCR), encompassing patients with locally advanced thoracic esophageal or gastroesophageal junction cancer and concurrent cervical lymph node metastasis. Treatment modalities were categorized into five options: neoadjuvant therapy followed by surgery (Neo + S), definitive chemoradiotherapy (dCRT), chemotherapy with or without radiotherapy &lt; 30 Gray (CT), radiotherapy (RT), and best supportive care (BSC).
Overall survival (OS) was assessed using the Kaplan-Meier method and compared via the log-rank test. Hazard rates were computed using Cox proportional hazards regression, with adjustment for confounding achieved through inverse probability of treatment weighting (IPTW).

Results
Between 2015 and 2021, a cohort of 412 patients was identified from the NCR database. Median survival durations were observed as follows: 24.2 months for Neo + S, 18.0 months for dCRT, 14.5 months for CT, 7.0 months for RT, and 3.2 months for BSC (Figure). A comparison between the Neo + S group and dCRT demonstrated a significant improvement in survival (p=0.02). Further subdivision of the surgical group into neoadjuvant CRT or chemotherapy did not reveal a significant difference in survival (p=0.6). Utilizing IPTW to adjust for confounding factors, Neo + S maintained its survival advantage.

Conclusion
The retrospective cohort findings suggest that neoadjuvant therapy followed by surgery may represent the optimal approach for managing esophageal cancer patients with cervical LNMs Yet, it's vital to recognize the influence of confounding by indication, which statistical adjustments may not entirely rectify. Furthermore, immortal time bias notably skews results favorably toward surgery. Nevertheless, the results emphasize the importance of considering surgery as a viable option for these patients. These limitations underscore the critical need for a prospective study, prompting the launch of the NODE-II trial.