bluuebunny/crossref_metadata_2025_split huggingface dataset:
166. ROBOTIC-ASSISTED BILATERAL EPIPHRENIC DIVERTICULECTOMY WITH HELLER MYOTOMY AND DOR FUNDOPLICATION: A SURGICAL TECHNIQUE
Authors: Patraithikul Premkamol , Swangsri Jirawat 
Published: August 2023

Abstract

Background
Epiphrenic diverticula are rare esophageal diseases often associated with motility disorders such as achalasia. We present a case of bilateral epiphrenic diverticula in a patient with achalasia type III who presented with dysphagia. This video demonstrates the surgical technique of robotic-assisted bilateral epiphrenic diverticulectomy with Heller myotomy and Dor fundoplication, highlighting the six essential surgical steps.

Methods
A 72-year-old female presented with dysphagia for 3 years. An esophagogastroduodenoscopy revealed two epiphrenic diverticula without food content retention. A barium swallow revealed two epiphrenic diverticula, measuring 3.3 cm and 1.2 cm in diameter, on right and left side walls of distal esophagus, respectively. Esophageal manometry showed the lower esophageal sphincter (LES) pressure was 25.6 mmHg (normal &lt;15 mmHg). Subsequently, both the acid exposure time and the DeMeester score indicated normal levels of acid exposure. The patient underwent robotic-assisted surgery. The diverticulectomy was performed using stapling device under endoscopic guidance, followed by standard myotomy. Additionally, Dor fundoplication was performed to complete procedure.

Results
Postoperatively, the patient recovered well. An upper gastrointestinal study demonstrated an adequate myotomy without evidence of leak or residual epiphrenic diverticula. Further postoperative evaluation, including esophageal manometry, showed normal LES pressure of 12.8 mmHg, the postoperative acid exposure time of 0.0%, and the DeMeester score of 0.20, that indicating normal levels of acid exposure. The patient resumed a liquid diet on postoperative day 4 and a soft diet on postoperative day 7. Based on these results, the patient’s dysphagia was resolved, and there was an absence of gastroesophageal reflux symptoms.

Conclusion
Bilateral epiphrenic diverticula are extremely rare, and require complex procedure. Robotic-assisted surgery has the potential to enhance the facilitation of surgical treatment for this condition. The robotic tools are precise and maneuverable, making it possible to perform intricate surgical procedures in tight angles and confined spaces, such as the hiatal area. This technique offers several advantages over conventional laparoscopic surgery, and should therefore be considered for the treatment of bilateral epiphrenic diverticula.
180. ENHANCED RECOVERY PROTOCOL VERSUS CONVENTIONAL CARE IN ESOPHAGECTOMY PATIENTS WITH ESOPHAGEAL CARCINOMA: ADVANTAGES ON THE PATIENT-REPORTED OUTCOMES
Authors: Huang Yixuan , Xie Qin , Wang Kangning , Gong Ruoyan , Shi Qiuling , Han Yongtao , Fang Qiang 
Published: August 2023

Abstract

Background
The subjective metrics regarding quality of life are unclear in comparison of an enhanced recovery after surgery (ERAS) protocol with conventional care in esophagectomy patients with esophageal carcinoma, while the objective metrics are controversial. This study was to investigate the advantages of ERAS over conventional care on the Health-related Quality of Life (HRQoL) from patient-reported outcomes (PROs), and explore the key components of ERAS for benefit duration.

Methods
This was a single-center, retrospective study with prospective PROs data from esophagectomy patients with esophageal cancer between April 2019 and June 2021. The objective metrics included perioperative complications and postoperative length of stay (PLOS). PROs data were assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 quality of life questionnaire and the QLQ-OES18 esophageal cancer module from pre-surgery to six months after surgery. Mixed-effects models were used to longitudinally compare the HRQoL scores between the two programs.

Results
348 conventional care and 109 ERAS patients were analyzed. The ERAS group had less pneumonia, arrhythmia, and PLOS than the conventional group. The ERAS group outperformed the conventional group in six QLQ-C30 domains, especially physical functioning (p = 0.0115), role functioning (p = 0.0002), and fatigue (p = 0.0428). QLQ-OES18 revealed that the ERAS group had less dysphagia (p &lt; 0.0001), trouble talking (p = 0.0006) and better eating (p &lt; 0.0001) than the conventional group. The above advantages persisted three months after surgery. For cervical circular stapled anastomosis the initial items and duration of benefit were reduced in ERAS group than in conventional group.

Conclusion
The ERAS protocol has significant advantages over the conventional care in lowering postoperative symptom burden and improving HRQoL on PROs in esophagectomy patients with esophageal cancer, and the benefit persists up to three months after surgery. For the cervical anastomosis the optimal technique may be a key component of ERAS maintaining the items and duration of advantages on PROs.
196. MINIMALLY INVASIVE ESOPHAGECTOMY WITH AWARENESS OF THE THIN MEMBRANOUS DENSE CONNECTIVE TISSUES AROUND THE ESOPHAGUS
Authors: Tokairin Yutaka , Fukuda Akira , Iida Satoshi , Imai Kenichiro , Ganno Hideaki , Amagasa Hidetoshi , Shiobara Hiroyuki , Kawaguchi Machiko , Nagai Kagami , Kinugasa Yusuke 
Published: August 2023

Abstract

Background
We have clinically introduced the ‘mediastinoscopic esophagectomy with lymph node dissection’ (MELD) to esophagectomy for thoracic esophageal cancer, performed under pneumomediastinum via trans-bicervical and transhiatal approach since 2014. In parallel with this, we have been conducting histological studies of the thin membranous dense connective tissue (TMDCT) around the esophagus and utilizing the results during these surgeries to ensure a rational esophagectomy. Here, we describe the differences in the visibility of TMDCT between the two approaches for esophagectomy.

Methods
We retrospectively examined the visibility of TMDCT in surgical videos of trans-mediastinnal and trans-right thoracic approaches after 2015 to determine the characteristics of each approaches.

Results
The trans-mediastinal approach reaches the visceral sheath by entering just dorsal to the esophagus in the right neck, and the TMDCT is seen in a bubbled appearance. Unlike the right thoracic approach, the visceral sheath can be easily reached without a pleural incision. The adipose tissue including lymph nodes around the left recurrent laryngeal nerve (RLN) showed a clear dissection layer between the left subclavian artery, but the boundary between the lymph nodes around the left RLN and the aorta was unclear near the aortic arch, which was thought to be due to the lack of visceral sheath around No.106tbL. On the other hand, the trans-right thoracic approach showed a slightly shiny visceral sheath covering the surface of the thoracic duct on the dorsal side of the esophagus. In the left superior mediastinum, the left RLN and RLN lymph nodes were located on the organ side of the visceral sheath covering the esophagus and trachea. In right and left sides, the visceral sheath was obscured near the branch of the RLN from the vagus nerve, but the RLNs ran cranially on the medial side of the visceral sheaths.

Conclusion
We reported how the TMDCT is visualized with each surgical approach. The visceral sheath was visualized as a bubbly structure in the trans- mediastinal approach and as a slightly shiny areal structure in the trans-right thoracic approach. Recognition of the TMDCT around the esophagus was useful for safe and rational lymph nodes dissection regardless of the surgical approach.
198. MODELING CANCER CACHEXIA USING PATIENT TUMOR ORGANOID-DERIVED XENOGRAFTS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Lung Bryan Chee-chad , Yu Valen Zhuoyou , Wong Ian Yu-hong , Wong Claudia Lai-yin , Chan Desmond Kwan-kit , Chan Fion Siu-yin , Law Betty Tsz-ting , Lam Ka-on , Kwong Dora Lai-wan , Lo Anthony Wing-ip , Law Simon , Lung Maria Li 
Published: August 2023

Abstract

Background
Cancer cachexia is a metabolic and functional multifactorial body wasting syndrome and is one of the major causes of death in late-stage patients. Esophageal squamous cell carcinoma (ESCC) presents one of the highest morbidity and mortality rates due to cancer cachexia. However, there is limited effective and approved targeted treatment. Cancer cachexia animal models are highly limited, with few cancer types available as a pre-clinical drug testing platform and with none related to esophageal carcinoma.

Methods
We have developed a panel of ESCC patient-derived organoid xenograft (PDOX) mouse models based on our latest patient-derived organoid cultures from Hong Kong patients.

Results
Our PDOX mouse model displays cachexic phenotypes that traditional cell line-derived xenografts lack, including body wasting and functional signs. The slow-proliferating characteristic of the ESCC PDOX on mice allows development of cachexic conditions before the humane endpoint. Our comprehensive panel of PDOX lines allowed us to identify full spectrum and differential cachexia severities across mice bearing different PDOXs, indicating a heterogenous nature and allowing faithful mimicking of various patient conditions. Molecular analysis showed that several classic cachexia-related gene expressions were up-regulated in the isolated liver and inguinal adipose tissues of cachexic mice, along with elevated circulating Il-6 levels.

Conclusion
Our ESCC PDOX model potentially serves as a useful pre-clinical cachexia-targeted drug testing platform, providing more treatment options for ESCC patients for better disease management.

Acknowledgments
We acknowledge the Research Grants Council (Theme-based Research Scheme T12–701/17-R to MLL) and the Food and Health Bureau (Health and Medical Research Fund 06171566 to VZY) of the Hong Kong Special Administrative Region for funding support. We acknowledge DSMZ (German Collection of Microorganisms and Cell Culture) for the KYSE cell lines. We acknowledge the University of Hong Kong LKS Faculty of Medicine Centre for PanorOmic Sciences for providing imaging facilities.
210. BIORESORBABLE SYNTHETIC MESHES IN LARGE PARAESOPHAGEAL HERNIAS. TECHNIQUE OF APLICATION AND EARLY RESULTS
Authors: Brandalise Andre , Aranha Nilton Cesar , Lorenzetti Claudia , Brandalise Nelson Ary 
Published: August 2023

Abstract

Background
Large paraesophageal hernias (LPEH) are still a challenge faced by foregut surgeons. Surgical options are highly debated among specialists; esophageal lengthening procedures, diaphragmatic relaxing incisions, gastropexy and—mesh reinforcement. Severe complications related to synthetic meshes has led many surgeons to avoid this type of reinforcement.
However, newly developed synthetic bioresorbable meshes have been used as an alternative for hiatal reinforcement, lowering the rates of recurrence without the drawbacks of synthetic materials.

Methods
From April 2018 to February 2023, 65 patients underwent LPEH repair with hiatal augmentation with an inverted C-shape bioresorbable mesh. All surgeries were performed by two surgeons (AB and NCA). The meshes (Bio-A®—Gore® and Phasix ST®—BARD) were applied over crurorrhaphy, covering the anterior and posterior aspects of the hiatus and secured in place with sutures and cyanoacrylate. The choice of mesh was determined by the surgeon’s preference. Follow up visits were at 1, 6 and 12 months and yearly after that.

Results
There were 34 patients where Bio-A was used and 31 with Phasix. Median age (55,5 vs 54,8 years) didn’t differ between groups. LPEH were primary (PS) in 39 patients and recurrence from prior interventions (RS) in 26. Median age was higher in PS (58,6 vs 49,6 years). There were no intraoperative complications related to the use of mesh. The patients were discharged after 24–48 hours.
The average follow-up period was similar between PS and RS (10,1 vs 9,6 months).
There were three recurrences (2 Bio-A, 1 Phasix) in PS (7,6%) and seven (26,9%) in RS (2 Bio-A, 5 Phasix).
There weren’t complaints of prolonged dysphagia or need for dilatation.
Nine out of 10 recurrences are small. One large recurrence, required reintervention for acute volvulus after 1 year (RS group with Phasix).

Conclusion
bioresorbable meshes are safe to use as a reinforcement of hiatoplasty in LPEH. They can reduce recurrence and reoperation rates in PS at a short term follow-up. Large recurrent hiatal hernias still present as a major challenge and adjuvant techniques should be employed to further reduce recurrences.
225. PREDICTORS OF ANASTOMOTIC LEAK AMONG PATIENTS UNDERGOING ESOPHAGECTOMY: A RETROSPECTIVE COHORT OF 6669 PATIENTS
Authors: Jogiat Uzair , Verhoeff Kevin , Mocanu Valentin , Turner Simon , Bédard Eric 
Published: August 2023

Abstract

Background
Despite advances in operative techniques, anastomotic leak (AL) after esophagectomy remains a dreaded complication associated with a relatively high morbidity and mortality. Identification of patient and surgical factors associated with AL are useful for risk stratification to improve patient and procedure selection. Furthermore, an adequately powered analysis for the incidence of AL after minimally invasive esophagectomy is lacking.

Methods
The ACS-NSQIP database was used to extract patients who underwent esophagectomy between 2016 and 2021. Categorical variables were analyzed using chi-squared tests and continuous variables were evaluated using ANOVA tests. Using a hypothesis driven purposeful selection methodology, a multivariable logistic regression model was created with the primary outcome of interest being the odds of AL. Statistical analysis was completed with StataSE 17 (STATACorp, LP, College Station, TX). The primary outcome of interest was the effect of minimally invasive surgery on AL. Secondary outcomes were the effect of patient characteristics and surgeon specialty on AL.

Results
Of the 6669 esophagectomies, the leak rates were 14.6% (open; 360/2451), 13.4% (MIS-abdominal; 64/478), 21.1% (MIS-chest; 69/326), 14.3% (MIS-total; 369/2590), and 20.1% (Robotic; 166/824), respectively. On multivariate analysis, positive margin (OR 1.37, 95% CI 1.01–1.85, p = 0.043), MIS-chest (OR 1.40, 95% CI 1.01–1.96, p = 0.047), MIS-total (OR 0.95, 95% CI 0.78–1.15, p = 0.595), MIS-robotic (OR 1.37, 95% CI 1.07–1.77, p = 0.014), transhiatal esophagectomy (OR 1.28, 95% CI 1.01–1.62, p = 0.040), and three-hole esophagectomy (OR 1.38, 95% CI 1.12–1.77, p = 0.014) were surgical factors associated with increased odds of AL (Table 1).

Conclusion
Anastomoses that were performed by certain types of minimally invasive surgery and those performed in the cervical region were associated with increased odds of AL. Consideration of this increased risk needs to be weighed against the established benefits of minimally invasive surgery when selecting the appropriate procedure for each patient. Identifying patients who are high-risk for an AL pre-operatively may prevent delay in the diagnosis and treatment of ALs in this patient population.
227. RELATIONSHIP BETWEEN 90-DAY PROGNOSIS NUTRITIONAL INDEX AND INFLAMMATORY RESPONSE MARKERS AND LONG-TERM SURVIVAL IN ESOPHAGEAL CANCER
Authors: Xie Qin , Miao Yan 
Published: August 2023

Abstract

Background
The incidence rate of esophageal cancer in Asia is mainly squamous cell carcinoma, which is characterized by high mortality and poor prognosis. The prognosis of tumors is not only related to the biological characteristics of tumor cells, but also closely related to the nutritional status and inflammatory response of patients. The aim of this study is to investigate the relationship between nutritional index (PNI) and inflammatory response markers (NLR, LMR) at 90 days after surgery and long-term survival in patients with esophageal squamous cell carcinoma. To provide reference for accurately assessing the condition, identifying survival risks, and improving long-term prognosis.

Methods
The data of ESCC patients who underwent radical resection for esophageal cancer from April 2018 to November 2018 were extracted (n = 66). Calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and other indicators of patients at 90 days after operation. ROC was used to calculate the cut-off values of PNI, NLR, and LMR. KaplanMeier survival curve was used to analyze the relationship between different PNI, NLR, LMR levels and long-term survival of patients. All patients were followed up regularly after surgery, and the last follow-up time was April 2023.

Results
The best cut-off values of PNI, NLR, and LMR were 42.8, 3.27, and 4.76, respectively. Kaplan Meier survival analysis showed a correlation between postoperative PNI, NLR, LMR at 90 days and overall survival and disease-free survival. At 90 days after surgery, the OS (P = 0.007) and DFS (P = 0.038) of patients in the high PNI group (PNI ≥ 42.8) were better than those in the low PNI group; The OS (P = 0.002) and DFS (P = 0.048) of patients in the low NLR group (NLR &lt; 3.27) were better than those in the high NLR group; The OS (P = 0.001) and DFS (P = 0.039) of patients in the high LMR group (LMR ≥ 4.76) were better than those in the low LMR group.

Conclusions
PNI, NLR, and LMR are important predictors of OS and DFS in patients with esophageal squamous cell carcinoma after radical resection of esophagus. Patients with PNI ≥ 42.8, NLR&lt;3.27, and LMR ≥ 4.76 at 90 days after surgery have better OS and DFS.
237. PRE-NEOADJUVANT CHEMOTHERAPY SARCOPENIA IS PREDICTIVE OF MORTALITY IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS
Authors: Convill James , Samake Maurice , Sellars Hannah , Chmelo Jakub , Brown Joshua , Petrides George , Phillips Alexander 
Published: August 2023

Abstract

Background
Sarcopenia is defined as a loss of skeletal muscle mass and function. Preoperative sarcopenia amongst patients with esophageal cancer has been linked to mortality, various postoperative complications and the severity of these complications. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Whether sarcopenia is associated with neoadjuvant chemotherapy (NAC) for esophagogastric adenocarcinoma (EGA) and any link to mortality is not fully understood.

Methods
Patients diagnosed with EGA between January 2017 and December 2021 and undergoing NAC followed by esophagectomy from a single high-volume center had their pre-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). A cox-regression model was used to investigate mortality between those with sarcopenia and those without.

Results
There were 191 patients included in the analysis. Pre-NAC sarcopenia was associated with increased mortality (Hazard ratio 1.59, 1.00–2.54 p = 0.046). 5-year survival for sarcopenic and non-sarcopenic patients was 27.8% (17.1%, 45.2%) and 35.6% (21.3%, 59.5%), respectively. Median survival was 2.72 and 4.09 years, respectively.

Conclusion
EGA patients with sarcopenia pre-NAC have a significantly higher chance of mortality in the 5-years following their surgery. Strategies to treat sarcopenia and prevent its further development should be investigated with the aim to increase survival in this cohort.
238. ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS WITH SARCOPENIA BEFORE OR AFTER NEOADJUVANT CHEMOTHERAPY ARE MORE LIKELY TO HAVE LONGER POST-OPERATIVE INPATIENT STAYS
Authors: Convill James , Samake Maurice , Sellars Hannah , Chmelo Jakub , Brown Joshua , Petrides George , Phillips Alexander 
Published: August 2023

Abstract

Background
Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. The majority of this evidence comes from populations with squamous cell carcinoma or where neoadjuvant chemoradiotherapy was used. Protracted inpatient stays are directly associated with adverse events such as healthcare-associated infections and patient deconditioning and increase the economic burden on healthcare institutions.

Methods
Patients diagnosed with EGA between January 2017 and December 2021 and undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4 cm2 for men and 38.5 cm2 for women). Wilcoxon signed-rank test for non-parametric data was used to determine significance.

Results
191 patients were included in the analysis. The number of patients with sarcopenia increased from 96 to 123 following NAC. Sarcopenia before (p = 0.047) or after (p = 0.007) NAC was significantly associated with longer inpatient stays post-operatively. The median stay for patients with sarcopenia before or after NAC was 12 days compared to 9 for those without sarcopenia before or after NAC.

Conclusion
Radiological sarcopenia is highly prevalent in this cohort of patients and increases following NAC. This study demonstrates that sarcopenia before or after NAC in patients with EGA undergoing esophagectomy are likely to have longer inpatient stays following surgery. Peri-operative treatment to treat and reduce the incidence of sarcopenia should be trialed with the aim of improving post-operative outcomes in this cohort.
243. COMPARISON BETWEEN THE THERAPEUTIC AND PROPHYLACTIC LYMPHADENECTOMY OF THE SUPRACLAVICULAR AREA FOR PATIENTS WITH ESOPHAGEAL CANCER
Authors: Mine Shinji , Hashimoto Takashi , Orita Hajime , Nasu Motomi , Hashiguchi Tadasuke , Kaji Sanae , Fujiwara Daisuke , Yube Yukinori , Ozaki Asako , Yoshino Kohei , Sugahara Yuki , Kubota Akira , Egawa Hiroki , Fukunaga Tetsu 
Published: August 2023

Abstract

Backgrounds
Lymphadenectomy of the supraclavicular area (SCA) for patients with esophageal cancer has still remained controversial. Some previous studies showed that it could not improve survival. In this study, we retrospectively investigated the results of therapeutic and prophylactic lymphadenectomy around SCA for patient with esophageal cancer.

Methods
From 2010 to 2015, the patients who underwent esophagectomy with 3-fields lymphadenectomy were enrolled in this study. Patients with cervical esophageal cancer and with pN3 were excluded. Clinical nodal metastasis was decided on CT findings. Efficiency of index for lymphadenectomy (EI) was calculated with nodal incidence multiplied by 3-year relapse free survival (3yRFS).

Results
A total of 514 patients was enrolled in this study. Therapeutic lymphadenectomy was performed in 47 patients, and prophylactic lymphadenectomy was performed in 467 patients. In the therapeutic lymphadenectomy group, nodal metastasis was found in 17 patients (36.2%) and 3yRFS of these patients was 34.3%, and EI was 12.4. Meanwhile, in the prophylactic group, nodal metastasis was found in 14 (3.0%) and 3yRFS of these patients was 35.7%, and EI was 1.1. Of 514 patients, 138 received neo-adjuvant treatments. In the neo-adjuvant group, EI of the therapeutic lymphadenectomy was 21.5, and that of the prophylactic lymphadenectomy was 2.7. In the upfront surgery group, EI of the therapeutic lymphadenectomy was 0, and that of the prophylactic lymphadenectomy was 0.6.

Conclusion
The 3yRFS of the patients with pathological nodal metastasis in the SCA was relatively good. However, EI in the prophylactic group was very low due to very low incidence of the pathological nodal metastasis in the SCA. Clinical significance of prophylactic lymphadenectomy of SCA is not clear based on our data.