bluuebunny/crossref_metadata_2025_split huggingface dataset:
437. MEASUREMENT OF FUNCTIONAL, PSYCHOSOCIAL, AND QUALITY OF LIFE IMPACTS OF ROBOTIC VERSUS HYBRID OESOPHAGO-GASTRECTOMY
Authors: Paine Heidi , Rayner Charles , Tehranchi Sam , Luangsomboon Aphiwat , McGuire Ms Anna , Walker Robert , Madhavan Anantha , Singh Pritam , Preston Shaun R , Abbassi-Ghadi Nima 
Published: September 2024

Abstract

Background
Since the introduction of Robotic-Assisted Minimally-Invasive Oesophago-gastrectomy (RAMIO), comparisons to other surgical approaches have focussed primarily on peri-operative and oncological outcomes. Few studies have focused on quality-of-life measures once the patient has been discharged home. We sought to compare physical, psychosocial, sleep, pain and employment related measures at six weeks following discharge in patients undergoing RAMIO versus Hybrid Oesophago-gastrectomy.

Methods
We performed a prospective cohort study comparing RAMIO and Hybrid Oesophago-gastrectomy. Twenty-five consecutive patients on a curative surgical pathway were recruited to each group. Participants were contacted via telephone pre-operatively and six weeks post-operatively. Parameters studied were: physical activity, social activity, sleep, pain control, and employment. Psychological wellbeing was measured using the Hospital Anxiety and Depression Scale, and quality of life with the European Organisation for Research and Treatment of Cancer questionnaires C30 (all cancer patients) and OG25 (patients undergoing oesophago-gastric cancer treatment). Results were analysed using Chi Square and Mann-Whitney-U statistical tests.

Results
There were no differences in age, ASA, or anaerobic threshold between study groups. At six weeks the RAMIO group was more likely than Hybrid to have returned to pre-operative physical and social activity (physical 7/25 vs. 1/25, p=0.04, social 13/25 vs. 5/25, p=0.03). The RAMIO group stopped regular analgesia earlier, and required fewer opiates. Patients were more likely to return to work in the RAMIO group (7/15 vs. 1/12,p=0.04). The RAMIO group had fewer cases of depression (2 vs. 9, p=0.03), lower QLQ C30 and OG25 scores, and reported higher overall health and quality of life scores (p=0.001).

Conclusion
We have demonstrated an improvement in physical and social activity, a faster return to work, a reduction in analgesia requirements, lower rates of depression and improved health and quality of life, six weeks post-operatively when comparing RAMIO to Hybrid Oesophago-Gastrectomy.
This study has highlighted additional considerations for the selection of surgical modality in oesophago-gastrectomy beyond peri-operative outcomes. Further investigation across a larger sample size and longer time frame to quantify the full spectrum of potential benefits of robotic oesophago-gastric surgery is warranted.
447. SAFETY AND FEASIBILITY OF DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY
Authors: Guerrero Pablo , Navarro Fernando Mingol , Esteban Marcos Bruna , Cruz David Quevedo , Nieto Marta , Sánchez Carmen Gutiérrez , Chicote Cristina Martínez , Urbaneja Francisco Javier Vaqué 
Published: September 2024

Abstract

Background
Gastroesophageal reflux is a common adverse effect after oncological surgery for tumors of the gastroesophageal junction. Some of the reasons are the radicality of the intervention as well as the placement of the anastomosis inside the thoracic cavity, where there is a constant negative pressure. In recent years, multiple methods of digestive tract reconstruction have been developed in order to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, consisting of the creation of a seromuscular flap covering the anastomosis.

Methods
We designed a retrospective observational and descriptive study including all patients who underwent esophagogastric surgery and Kamikawa doble-flap reconstruction technique from January 2019 to January 2024. The operation conditions, postoperative recovery, postoperative complications (both short and mid-long term), and follow-up data were collected and analyzed. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part.

Results
We included a total of 10 patients in our series. All of them underwent an esophagogastric resection followed by a doble-flap reconstruction technique. Thoracoscopy in prone position was the approach used in most of the patients. In these cases, the doble flap was performed using the posterior wall of the gastric remnant. Half of the patients had no postoperative complications and the other half, mild ones. Postoperative manometry and pHmetry were only performed in 4 patients due to technical difficulties. In all these cases the tests showed no alterations. Despite this, one patient reported reflux, which was controlled with PPIs.

Conclusions
The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.
453. ROBOT ESOPHAGECTOMY WITH EXTENDED MEDIASTINAL LYMPH NODE DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Kawakubo Hirofumi 
Published: September 2024

Abstract

Background
Radical surgical resection may play role in prognosis improvement of the esophageal squamous cell carcinoma (ESCC) patients. Because esophagectomy with radical lymphadenectomy is highly invasive, we introduced thoracoscopic esophagectomy in 1999, and have performed over 600 cases. In 2009, we developed a hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection and reported good long-term outcomes especially in cT1bN0M0 ESCC patients. We reported 3y and 5y RFS was 96% and 96%, and 3y and 5y OS was 94% and 92% in those patients. We introduced robot-assisted esophagectomy (RMIE) using daVinci Xi system in June 2018 and have performed for 80 cases. We perform RMIE with the prone position instead of the hybrid position with same concept of thoracoscopic esophagectomy with extended LN dissection. Thanks to a three-dimensional magnified view, fully wristed dexterity and tremor filtration of da Vinci Xi system, the robotic system facilitates precise dissection especial for upper mediastinal lymph node dissection. We show safety introduction and technical pitfalls of robot-assisted esophagectomy with extended LN dissection. Methods: The patient is fixed on prone position. We use Monopolar curved scissors for superficial layer, bipolar cut for dissection with maryland bipolar forceps for deeper layer around Aorta and trachea, and Sharp dissection with Potts scissors around recurrent laryngeal nerves. After esophageal mobilization and mediastinal lymphadenectomy were completed, bilateral recurrent laryngeal nerve, bilateral subclavian artery, trachea, bilateral bronchus, aorta, left pulmonary artery and vein, left pleura, pericardium and hiatus are all skeletonized. Results: We could standardize surgical procedure in first 20 cases. Average operation time in the thoracic procedure is 234.4min and 190.2min in last 30 cases. Median blood loss is 0ml. Postoperative pneumonia and vocal cord palsy were occurred only 6 case in 80 cases. Conclusion: Robot assisted esophagectomy with extended LN dissection was safely introduced in our facility and it is feasible and beneficial for the lymph node dissection especially for lymph node dissection around the recurrent laryngeal nerve.
https://www.dropbox.com/scl/fi/w8na39w6bo9ivwwz7x2rh/Hirofumi-Kawakubo-ISDE-2024.mp4?rlkey=p9mvt7dotyeaj6xfwvud8vcmr&dl=0
497. ENDOFLIP AND BOTULIN TOXIN INJECTION: THERAPEUTIC MANAGEMENT IN ESOPHAGEAL AND GASTRIC MOTILITY DISORDERS
Authors: Cardoso Pedro , Gonçalves Ana Raquel , Peixoto Armando , Macedo Guilherme 
Published: September 2024

Abstract

Introduction
Esophageal motility disorders present diagnostic and therapeutic challenges, with dysphagia being a common symptom prompting evaluation. The Endolumenal Functional Lumen Imaging Probe (EndoFLIP) has recently gained recognition as a valuable tool for assessing esophageal function. This study aims to evaluate the utility of EndoFLIP in guiding therapeutic interventions, specifically focusing on botulinum toxin injections, among patients presenting with diverse esophageal disorders. Moreover, the study acknowledges the potential of EndoFLIP as a diagnostic adjunct during diagnostic upper gastrointestinal endoscopy in cases where therapeutic alternatives are limited or as therapeutic trial.

Methods
A retrospective analysis was conducted on 21 patients who underwent EndoFLIP assessment and subsequently received botulinum toxin injection at the same procedure. These patients were identified from records at a tertiary center, covering the period from January 2022 to February 2023. EndoFLIP procedures were analyzed, focusing on patient symptoms and indication for the procedure. Data regarding clinical symptoms, EndoFLIP findings, and therapeutic interventions were extracted and analyzed to assess the role of EndoFLIP in guiding treatment decisions for esophageal disorders. The used cutoffs for esophagogastric junction (EGJ) distensibility index were &lt; 2 mm2/mmHg and &lt; 10 mm2/mmHg for pyloric distensibility.

Results
All patients referred for esophageal motility evaluation with EndoFLIP presented with dysphagia as the primary symptom. Two patients presented with postprandial bloating, leading to further evaluation with impedance planimetry to assess pyloric distensibility, suspected to be due to diabetic gastroparesis. Following EndoFLIP assessment, a conclusive diagnosis was achieved in all patients: 10 patients were diagnosed with esophagogastric junction outflow obstruction, 1 patient with absent contractility, 7 patients with achalasia, and 1 patient with hypercontractile esophagus. Patients who underwent planimetry to evaluate pyloric distensibility both exhibited reduced distensibility index. Following treatment, 10 patients showed clinical improvement and 11 await clinical reassessment.

Conclusions
Regarding the evaluation of the EGJ distensibility index in patients with achalasia without indication for invasive treatment, the EndoFLIP emerges as a diagnostic tool that allows for immediate guidance if intervention is recommended. Likewise, patients with refractory gastroparesis and pylorospasm identified through EndoFLIP may benefit from toxin injection for future myotomy decision.
In conclusion, EndoFLIP serves as a valuable tool in diagnosing and guiding therapeutic interventions in patients with esophageal and gastric motility disorders. Further research is warranted to validate the role of EndoFLIP in optimizing treatment outcomes for esophageal disorders.
509. DOES SARCOPENIA AFFECT THE OUTCOME OF PATIENTS WITH ESOPHAGEAL CARCINOMA AFTER ESOPHAGECTOMY?
Authors: Merten Jennifer , Mora Nabila Gala Nacul , Hoelzen Jens Peter , Juratli Mazen , Pascher Andreas , Eichelmann Ann-Kathrin 
Published: September 2024

Abstract

Background
Sarcopenia is increasingly recognized as an independent predictor of clinical outcomes of cancer patients such as post-operative complications and prolonged hospital stays. Additionally, sarcopenia can also negatively impact overall survival because of reduced ability to tolerate treatments like neoadjuvant therapy and surgery. At particular risk among cancer patients is the esophageal cancer population because of tumor stenosis leading to dysphagia and impossibility of oral feeding in many patients. The purpose of the current study was to investigate the effect of preoperative sarcopenia on postoperative complications in patients undergoing esophagectomy for esophageal cancer.

Methods
This retrospective study includes all patients who underwent full-robotic abdominothoracic esophageal resection because of esophageal cancer at our institution between 06/2020 and 12/2022. The skeletal muscle index (SMI) was assessed using the preoperative computed tomographic staging scans by measuring the cross-sectional muscle area at the third lumbar vertebral level. Following cut off SMI values were used to define sarcopenia: men: 52,4 cm2/m2, women: 38,5 cm2/m2 according to Prado et al (Lancet Oncol, 2008). Recorded parameters included demographic data, neo-adjuvant treatment, histologic findings, postoperative course and overall- and disease-free survival.

Results
A total of 113 cases were included in this preliminary analysis. 97 patients (86%) were classified as having sarcopenia. Of these, 38 patients (40%) had a preoperatively or during esophageal resection implemented percutaneous endoscopic jejunostomy (PEJ) tube to ensure enteral nutrition. Despite age, groups were comparable regarding neoadjuvant treatment and histologic findings (mean age sarcopenic patients: 66y vs. 61y non-sarcopenic patients, p = 0.03). There was no difference in the incidence of occurrence of anastomotic leakage, pulmonary complications, need for re-operation, length of (ICU) stay and overall- and disease-free survival between sarcopenic and non-sarcopenic patients.

Conclusion
Incidence of sarcopenia is very high among esophageal cancer patients. In our study population, however, preoperative sarcopenia failed to predict complications or long-term outcome after esophagectomy for esophageal cancer. 40% of the sarcopenic patients received a PEJ. This relatively high proportion of implemented PEJ could have contributed to the observed comparable outcomes between sarcopenic and non-sarcopenic patients. This observation underlines the importance of prehabilitation and nutritional support for patients with preoperative sarcopenia.
566. SUPERIOR MEDISTINAL LYMPHADENECTOMY IN PRONE POSITION UTILIZING 3D-ASSISTED THORACOSCOPY. A NOVEL APPROACH
Authors: Davakis Spyridon , Mylonakis Adam , Kozadinos Alexandros , Nitsa Zoi , Sakarellos Panagiotis , Alexandrou Andreas , Charalabopoulos Alexandros 
Published: September 2024

Abstract

Introduction
Routine lymphadenectomy during esophagectomy includes 2-field lymphadenectomy for distal-esophageal or esophago-gastric junction adenocarcinoma. Superior mediastinal lymphadenectomy (SML) refers to extended 2-field lymphadenectomy (right or left para-tracheal nodes) or total mediastinal lymphadenectomy. The exact benefits of (SML) have long been debated, but with the evolution of prone position 3D-assisted thoracoscopy favorable outcomes can be achieved in the hand of experts.

Aim
This study aims to describe our surgical technique of 3D-assisted thoracoscopic SML during minimally invasive esophagectomy in prone position.

Material and Methods
SML included right paratracheal nodes and lymph nodes (LNs) along the right recurrent laryngeal nerve throughout its mediastinal route (including the paratracheal-retrocaval compartment) in cases of extended 2-field lymphadenectomy, as well as left paratracheal nodes and LNs along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy.

Results
Among the identified eligible cases (n=30), there was no mortality at 30- or 90-post-operative days. No anastomotic or chyle leaks were observed. Pulmonary complications occurred in 15% of patients; right recurrent laryngeal nerve palsy was noted in one patient (3.3%). The median number of resected LNs was 45, with a median count of 12 SML LNs.

Conclusions
Although limited by a small cohort sample, this study suggests that minimally invasive esophagectomy with SML may offer some benefits in terms of oncological outcomes without significant additional morbidity.
https://wetransfer.com/downloads/6329dbd1f817d7e492f8905291f946e120240309180637/42ee79017067b59a4a73138377d9d95620240309180649/f28a32
610. CROSS-BEDDED ANTI-REFLUX ANASTOMOSIS ACHIEVED LESS GASTROESOPHAGEAL REFLUX WITHOUT ADDITIONAL DYSPHAGIA COMPARED TO CONDITIONAL ANASTOMOSIS IN MCKEOWN ESOPHAGECTOMY
Authors: Wu Na , Wang Lei , Hu Yang 
Published: September 2024

Abstract

Background
Most esophageal cancer patients undergoing Mckeown esophagectomy had severe postoperative gastroesophageal reflux and poor quality of life. A novel anastomosis technique was invented to improve this situation. We conducted this study to investigate the incidence of gastroesophageal reflux, dysphagia, and quality of life (QoL) among patients with esophageal cancer undergoing non-intussuscepted anastomosis and cross-bedded anti-reflux (CAR) anastomosis during Mckeown esophagectomy.

Methods
Data from patients who underwent Mckeown esophagectomy for esophageal cancer from March 2022 to December 2022 were retrospectively analyzed. The incidence of gastroesophageal reflux, dysphagia, and QoL were measured. We enrolled 218 patients, including 155 patients undergoing non-intussuscepted anastomosis and 63 patients undergoing CAR anastomosis. Propensity score matching was used to provide a balanced cohort consisting of 63 paired cases. Patients’ demographics and clinical data were compared between the two arms.

Results
Before propensity score matching, there were no significant differences between the two arms in terms of sex, age, body mass index, or comorbidities. Neoadjuvant therapy was the only unbalanced variable. After propensity matching, baseline characteristics were all comparable between them. Anastomotic leakage occurred in 1 (1.6%) patient in the CAR anastomosis arm and in 2 (3.2%) in the non-intussuscepted anastomosis arm. No significant difference was observed in dysphagia severity (P=0.267). 45 (71.4%) patients in the non-intussuscepted anastomosis arm and 60 (95.2%) in the CAR anastomosis arm slept in the supine position (P=0.001). Gastroesophageal reflux was milder in the CAR anastomosis arm (P&lt;0.001). The CAR anastomosis arm was superior to the non-intussuscepted anastomosis arm in the social functioning domain (P=0.004) and financial difficulties domain (P=0.026) of QoL.

Conclusions
CAR anastomosis achieved sufficient control of gastroesophageal reflux without causing dysphagia. It also improved QoL compared with non-intussuscepted anastomosis.

https://1drv.ms/v/s!AmCqlJJZqDPDjRcLYFEgRSPHrUDY?e=1bEAyy
763. TEXTBOOK ONCOLOGIC OUTCOME FOLLOWING TRIMODALITY THERAPY FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Mitchell Kyle , Kassab Cynthia , Antonoff Mara , Mehran Reza , Rajaram Ravi , Rice David , Swisher Stephen , Vaporciyan Ara , Walsh Garrett , Hofstetter Wayne 
Published: September 2024

Abstract

Background
Although the concept of textbook oncologic outcome (TOO) as an emerging quality benchmark has been validated in the general surgical oncology literature, data regarding the frequency of achieving TOO and its impact on subsequent survival outcomes in patients with esophageal adenocarcinoma (EAC) who undergo trimodality therapy remain undefined.

Methods
Patients with adenocarcinoma of the esophagus/gastroesophageal junction (GEJ, Siewert I/II) who underwent neoadjuvant chemoradiation and esophagectomy at a single institution (2000-2022) were retrospectively identified. Patients undergoing salvage resection were excluded. TOO was defined according to a published consensus definition: length of stay (LOS) ≤14 days, R0, ≥20 resected lymph nodes, no anastomotic leak (any grade), no Clavien-Dindo (CD) grade ≥3 complications, no hospital or intensive care unit (ICU) readmission, and no reoperation. Multivariable logistic regression was used to identify clinicopathologic features associated with TOO. Multivariable Cox regression and landmark analyses were used to quantify the association between TOO and OS.

Results
Of 1138 patients, TOO was observed in 38.2% (435): 90.9% (1034) R0, 60.9% (693) ≥20 lymph nodes, 89.9% (1023) no anastomotic leak, and 98.4% (1120) no in-hospital mortality. Features independently associated with reduced odds of TOO included: cervical anastomosis (OR 0.50, P=0.001), preoperative delay ≥90 days after neoadjuvant therapy (OR 0.62, P=0.004), induction chemotherapy (OR 0.74, P=0.039), coronary artery disease (OR 0.67, P=0.043). Among patients who underwent esophagectomy &lt;90 days after neoadjuvant therapy and survived ≥30 days, TOO was independently associated with improved OS (HR 0.80, P=0.018). TOO remained associated with improved OS using 90-day (P=0.014) and 120-day (P=0.037) landmarks.

Conclusions
Although TOO is difficult to achieve following trimodality therapy for EAC, it is strongly associated with improved long-term overall survival. As such, further efforts are warranted to explore the utility of TOO as a quality benchmark in EAC patients and to validate its impact across varying practice settings.
783. ROBOTIC ASSISTED CISTERNA CHYLI EMBOLIZATION FOR ABDOMINAL CHYLE LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Denissen Laurens , Valk Jody , Jardinet Thomas , de Maat Michiel 
Published: September 2024

Abstract

Background
High output chyle leakage is a challenging complication following esophagectomy, carrying substantial morbidity and even mortality. Initial conservative management with parenteral feeding is commonly advised resulting in lengthy episodes of hospitalization and prolonged chest tube placement. Here, we present a case post Ivor-Lewis esophagectomy with high-output chyle leakage where we localized the leakage site to be at the cysterna chyli and subsequently treated it operatively combining robotics, fluorescence and embolization with glue.

Methods
A 74-year-old male underwent robotic-assisted minimally invasive Ivor Lewis esophagectomy for distal esophageal adenocarcinoma. Postoperatively, chylous fluid was drained from the chest up to 700-1300cc per day despite parenteral feeding. Lipiodol lymphangiography identified extravasation of contrast at the cysterna chyli and correct clipping of the thoracic duct. Due to failure of conservative management, on postoperative day 14, robotic-assisted exploration of the truncal region with intranodal injection of indocyanine green was performed.

Results
This innovative procedure revealed the leakage site medially of the coeliac trunc at the cysterna chyli. Lymphatic sealing was achieved via percutaneous endoluminal embolization using a microcatheter and Histoacryl® injections, resulting in an abrupt resolution of the leak and discharge with oral MCT diet on day 5 after reoperation.

Conclusion
This case demonstrated the feasibility and efficacy of an innovative multimodal technique combining the dexterity and fluorescence of robotic surgery with a laparoscopic application of an interventional radiology embolization technique. Because of the risk of venous emboli, we note that this technique should only be applied in cases of abdominal chyle leakage when the thoracic duct is interrupted.
https://www.dropbox.com/scl/fi/sktltdc1be41jfq4dk3lt/Video-Presentation-ISDE-2024-Robotic-Embolisation-Abdominal-Chyle-leakage-Def.mp4?rlkey=1wni1dpnjg4swiajcjdfa6isn&st=wx30jbi7&dl=0