bluuebunny/crossref_metadata_2025_split huggingface dataset:
236. INDOCYANINE GREEN TRACHEOBRONCHIAL FLUORESCENCE (ICG-TBF) VIA NEBULIZATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY -A NOVEL TECHNIQUE
Authors: Thammineedi Subramanyeshwar Rao 
Published: August 2023

Abstract

Keywords
ICG, fluorescence guided surgery, esophagectomy, ICG nebulization, ICG-TBF, tracheobronchial fluorescence.
Abstract

Background
Surgical manipulation of tracheobronchial complex is a contributing factor in pulmonary morbidity of esophagectomy. Accurate dissection between membranous trachea and bronchi with esophagus is essential. This study tests the feasibility of delivering indocyanine green (ICG) in an aerosol form to achieve tracheobronchial fluorescence (ICG-TBF).

Methods
Patients with esophageal and esophagogastric carcinoma undergoing minimally invasive esophagectomy (McKeowns type) were included. ICG was aersolized by nebulisation in supine position before thoracoscopy. ICG-TBF was observed with real time fluorescence enabled camera. Intraoperative and postoperative complications related to ICG were noted.

Results
37 patients were included in the study. ICG-TBF was identified in 94.6% (35/37) of patients with mean time to fluorescence identification of 13 minutes (1–43). There were no airway resections/injuries in the study. No intraoperative or postoperative complications attributable to ICG were observed. No 90 day postoperative mortality was seen.

Conclusions
ICG delivered in aerosol form was found to be safe and effective in achieving ICG-TGF. Further studies on effect of ICG-TBF in decreasing pulmonary complications of esophagectomy are needed.
248. SYSTEMIC INFLAMMATORY MARKERS AS PROGNOSTIC FACTORS IN ESOPHAGEAL CANCER: A MEXICAN PERSPECTIVE
Authors: Takahashi Alberto Mitsuo Leon , Basave Horacio Noe Lopez , Jones Daniel , Lino-Silva Leonardo Saul , Salcedo-Hernandez Rosa Angelica , Calderillo-Ruiz German , Diaz-Romero Maria Del Consuelo , Gomez-Hernandez Maria Fernanda , Gomez Angel Herrera 
Published: August 2023

Abstract

Background
Esophageal cancer (EC) represents the eighth most commonly diagnosed cancer, and sixth cause of cancer-related deaths worldwide. Several studies have demonstrated an association between systemic inflammation, anti-cancer immunity, and poor oncological outcomes in patients with EC. Biomarkers including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) may reflect the balance between pro-cancer inflammation and anti-cancer immune response and have prognostic implications in Mexican esophageal cancer patients.

Methods
A retrospective review of a prospectively collected database of all EC patients from 2011–2022 was performed. Baseline pre-treatment NLR, LMR and PLR was collected. The date of last follow-up or death was ascertained from medical records. ROC curves were used to calculate cut-off values for NLR and PLR, while the median-value was used for LMR. Serum albumin of &lt;3.5 g/dL was considered malnutrition. Kaplan–Meier (univariate) and Cox regression (multivariate) were performed to evaluate survival against prognostic factors.

Results
498 patients were included during the study period, 80.1% men and 19.9% women, median age 60 (±12.2) years old. Adenocarcinoma (49.8%) was the most common histological subtype, followed by squamous cell carcinoma (31.7%). Clinical stage included: I (3%), IIA-B (11.8%), III (37.6%), IVA (2.6%), and IVB (44.2%). Neoadjuvant chemoradiotherapy was the predominant initial therapy (50.4%), followed by chemotherapy (41.7%). ROC curves revealed the following cut-off value: 2.92 for NLR, 174 for IPL, and 3.5 for LMR. In the univariate analysis, four prognostic factors were significant for overall survival (NLR, PLR, LMR, albumin) (Table 1), while in the multivariate analysis only NLR and albumin remained independent factors for survival (Table 2).

Conclusion
In our population, low NLR and high albumin can be considered independent prognostic markers in patients with esophageal cancer. These common pretreatment biomarkers can serve to identify patients with good prognostic factors, contributing to an improved consent process and therapeutic decision making. Further research should focus on more accurate cut-off values for survival prognostication.
278. MEDIASTINOSCOPIC ESOPHAGECTOMY WITH INTRAOPERATIVE NERVE MONITORING FOR ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA; A SINGLE-CENTER INITIAL EXPERIENCE
Authors: Suzuki Akihiro , Yokoi Tadao , Matsubara Taketo , Mitsuoka Koichiro , Sanbonmatsu Mariko , Miyachi Yosuke , Taketa Takashi , Shimada Gen , Kaido Toshimi 
Published: August 2023

Abstract

Background
In recent years, adenocarcinoma of esophagogastric junction (EGJ) has been on the increase in Japan. Although laparoscopic resection by the transhiatal approach is commonly used, patients often have difficulty with mediastinal lymph node dissection and reconstruction after resection. Since 2020, we have been performing mediastinoscopic esophagectomy for EGJ adenocarcinoma patients with esophageal invasion exceeding 3 cm in length or with a large tumor diameter. We report on the short-term results of the surgery performed.

Methods
Of 15 patients with adenocarcinoma of the esophagogastric junction who underwent radical esophagectomy at our hospital during a 36-month period from January 2020 to December 2022, 5 patients underwent mediastinoscopic esophagectomy without thoracic incisions. Surgery consisted of mediastinoscopic and laparoscopic subtotal esophagectomy, mediastinal lymph node dissection, and posterior mediastinal gastric tube reconstruction with cervical anastomosis. In all cases, continuous left recurrent nerve monitoring was performed intraoperatively. Short-term surgical outcomes were evaluated in terms of age, gender, TNM classification, stage, preoperative complications, operation time, blood loss, tumor diameter, length of esophageal invasion, postoperative complications, and postoperative hospital stay.

Results
All five patients were male, with a mean age of 67.8 years. 4 of the 5 patients had preoperative complications. Tumor localization was Siewert classification type I in 4 patients and type II in 1. The average tumor length and esophageal invasion length was 44 ± 26 mm and 38 ± 11 mm respectively. The average operation time was 395 ± 29 minutes and blood loss was 38 ± 39 mL. Lymph node metastases was revealed in three patients. No postoperative anastomotic leakage or recurrent nerve palsy was observed. One patient developed postoperative aspiration pneumonia but was cured without reintubation.

Conclusion
Mediastinoscopic esophagectomy for EGJ adenocarcinoma was performed safely. RCTs conducted in Western countries reported that esophagectomy with cervical anastmosis is associated with higher rates of recurrent nerve palsy than esophagectomy by the transhiatal approach. The use of a mediastinoscope to visualize the recurrent nerve and the use of intraoperative nerve monitoring devices might reduce the frequency of recurrent nerve palsy.
283. 18F-FDG PET/MRI FOR RESTAGING ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY
Authors: Valkema Maria , Sablonière Quido de Lussanet , Valkema Roelf , Thomeer Maarten , Dwarkasing Roy , Harteveld Anita , Doukas Michail , Mostert Bianca , Zijden Charlène , Sluis Pieter , Lagarde Sjoerd , Wijnhoven Bas , Verburg Frederik , Lanschot Jan 
Published: August 2023

Abstract

Background
The accuracy of 18F-FDG PET/CT is insufficient to detect residual locoregional esophageal cancer after neoadjuvant chemoradiotherapy (nCRT). This feasibility study aims to investigate whether post-treatment 18F-FDG PET/MRI may potentially improve tumor detection.

Methods
This was a prospective, single center feasibility study. At 6–12 weeks after nCRT, patients underwent standard 18F-FDG PET/CT followed by PET/MRI, and completed a questionnaire to evaluate burden. Two teams of readers either assessed the 18F-FDG PET/CT or the 18F-FDG PET/MRI first; the other scan was assessed one month later. SULmax and ADCmean were measured at the primary tumor location. Histopathology of the surgical resection specimen served as reference standard for diagnostic accuracy calculations. When patients with clinically complete response continued active surveillance, response evaluations until nine months after nCRT served as proxy for ypT and ypN (i.e. ‘ycT’, ‘ycN’).

Results
In the 21 included patients (median age 70 [IQR 62–75], 16 males), disease recurrence was found in the primary tumor in 14 (67%) patients (of whom one ypM+, detected on both scans), and in locoregional lymph nodes in six patients (29%). Accuracy (team 1/team 2) to detect yp/ycT+ with 18F-FDG PET/MRI vs 18F-FDG PET/CT was 38/57% vs 76/61%. For ypN+, accuracy was 63/53% vs 63/42%, resp. Neither SULmax (both scans) nor ADCmean were discriminatory for yp/ycT+. Fourteen of 21 (67%) patients were willing to undergo a similar 18F-FDG PET/MRI examination in the future.

Conclusion
18F-FDG PET/MRI currently performs comparably to 18F-FDG PET/CT. Improvements in the scanning protocol, increasing reader experience, and performing serial scans might contribute to enhance accuracy of tumor detection after nCRT using 18F-FDG PET/MRI.
286. A BIBLIOMETRIC ANALYSIS OF NEOADJUVANT THERAPY FOR ESOPHAGEAL CANCER
Authors: Huang Yizhou , Zheng Bin , Chen Maohui , Zhang Shuliang , Zeng Taidui , Chen Chun 
Published: August 2023

Abstract

Background
The study aims to summarize publication characteristics of neoadjuvant therapy for esophageal cancer and create scientific maps to explore hotspots and emerging trends with bibliometric methods.

Method
The publications between 2013 and 2022 were retrieved from the Web of Science Core Collection (WoSCC) on March 4, 2023. Bibliometric tools including VOSviewer and CiteSpace were used for statistical analysis. Data on the trend of the annual output, countries/regions, institutions, journals, authors, subject categories, keywords, and co-cited references were presented in this study.

Results
A total of 1713 publications written by 9222 authors of 1696 institutions, 49 countries/regions in 287 journals were included in the bibliometric study. China was the most prolific country with 414 publications, and The United States was the country that cooperated most with other countries. Doki, yuichiro, van Hagen, p, annals of surgical oncology, j clin oncol, and sun yat sen univ were the top 1 productive author, co-cited author, productive journal, co-cited journal, and prolific institution, respectively. The top 4 most present keywords were esophageal cancer, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy, and chemotherapy. Furthermore, the clinical research hotspots involved in the immunotherapy of ESCC have received the most attention in recent years.

Conclusions
This study visually analyzed the development status and scientific trend of neoadjuvant therapy for esophageal cancer over the past decade. The results could guide scientists to comprehensively understand the existing research and determine future directions.

Keywords
Web of Science (WOS); esophageal cancer; bibliometric analysis.
309. SURGICAL TREATMENT FOR THE RECURRENT SITE OF ESOPHAGEAL CANCER AFTER ESOPHAGECTOMY
Authors: Okamoto Hiroshi , Taniyama Yusuke , Sato Chiaki , Ozawa Yohei , Ishida Hirotaka , Koseki Ken , Muranami Yuto , Kamei Takashi 
Published: August 2023

Abstract

Background
Although the outcome of patients with recurrent esophageal cancer following radical esophagectomy is extremely poor, long-term survival can be achieved with multimodal therapy, including surgical resection of the recurrent lesion. Developing a treatment strategy is a critical issue; therefore, we examined the indications and optimal timing for surgical treatment in patients with recurrence.

Methods
A total of 184 patients with recurrent esophageal cancer after radical esophagectomy were studied between 2001 and 2015, with a focus on surgical resection.

Results
The first recurrence site was the lymph nodes (124 cases; 67%) [neck (35; 19%), mediastinum (82; 45%), abdomen (35; 19%)], lung (36; 20%), liver (32; 17%), pleura (18; 10%), bone (13; 7%), etc. Second-line treatment following recurrence was surgery (8 cases), chemoradiotherapy (89 cases), chemotherapy (64 cases), and best supportive care (23 cases). Patients with single organ or solitary recurrence and recurrence more than 8 months after surgery had better prognoses. All the surgical cases had single-site recurrence (lung-3, cervical lymph nodes-3, colon-1, and brain-1). Good prognosis was expected for the patients with lung or cervical lymph node recurrence.

Conclusion
Surgical treatment for recurrent esophageal cancer following radical esophagectomy was considered beneficial for the recurrence of cervical lymph node or lung metastasis of solitary lesions at least 8 months after esophagectomy. Immune checkpoint inhibitors have recently been indicated for esophageal cancer and expected for improving prognosis, and the role of surgery in multidisciplinary treatment for metastatic recurrence needs repeated investigation.
321. ESD AND ELPS A NOVEL MINIMALLY INVASIVE TREATMENT FOR MULTI-EPISODE SUPERFICIAL ESOPHAGEAL SCC AND 2ND PRIMARY HYPOPHARYNGEAL SCC:A CASE REPORT
Authors: Maneesoi Siwaree , Swangsri Jirawat , Sureepong Paiboon 
Published: August 2023

Abstract

Background
Esophageal SCC is a common cancer worldwide. Major risk factors were tobacco and alcohol use. It’s also a cause of head and neck cancers, particularly hypopharyngeal SCC. ESD was established as standard procedure for curative early esophageal SCC. However, conventional ESD for hypopharyngeal lesions is technically difficult. This report describes a patient who had superficial hypopharyngeal SCC following multiple esophageal ESD sessions. This VDO presentation shows how to perform safe ELPS and achieve oncological purposes.

Methods
A 77-year-old Thai man. He had primary cervical esophageal SCC and 1 month after complete response from definite CCRT, he began presenting four other recurrent episodes of superficial esophageal SCC in the lower, middle, and two times of cervical regions over a 3-year period. ESD and APC were applied and showed a complete response. The last endoscopic finding also revealed of superficial hypopharyngeal SCC and ELPS was decided by the following step: curve laryngoscope placement, laryngeal packing, lesion identification and marking, submucosal injection, circumferential incision, submucosal dissection, and bleeding control. The specimen was removed transorally and sent for pathological examination.

Result
The operation was successful without complications. The patient was able to start a liquid diet on day 1 and a soft meal on second day post operation. He was discharged on 3rd day without any complications. The pathological report was moderated differentiate SCC with positive deep margin, so he was planned for further RT.

Conclusion
ELPS provided good visualization, which led to a sufficient working space for resection. The procedure was safe and feasible for superficial hypopharyngeal lesions and exhibited good oncological outcomes, preserving both swallowing and phonation functions.
331. IMPACT OF SARCOPENIA ON RECURRENCE OF ESOPHAGOGASTRIC ADENOCARCINOMA IN PATIENTS THAT HAVE UNDERGONE NEOADJUVANT CHEMOTHERAPY
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 is known to be associated with post-operative complications and increased mortality. Whether preoperative sarcopenia has an affect on disease recurrence has not been investigated for patients with esophageal adenocarcinoma undergoing neoadjuvant chemotherapy.

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 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 of 52.4 cm2 for men and 38.5 cm2 for women were used. Patients that had complete resection (R0) of were included in the analysis. A cox-regression model was used to investigate recurrence between those with sarcopenia and those without.

Results
133 patients were included in the analysis. Patients with sarcopenia before or after NAC were not more likely to develop disease recurrence than those patients without sarcopenia (Hazard ratio 1.08, 95% CI 0.97–1.17; p &gt; 0.05).

Conclusion
In this cohort of patients from a single high volume centre, sarcopenia status in EGA patients undergoing NAC and esophagectomy does not significantly impact the rate of disease recurrence.
345. ADJUVANT IMMUNOTHERAPY IN CURATIVE INTENT ESOPHAGEAL CANCER RESECTION PATIENTS
Authors: Kwak Hyunjee , Banks Kian , Hung Yun-Yi , Alcasid Nathan , Susai Cynthia , Velotta Jeffrey 
Published: August 2023

Abstract

Background
Despite ongoing therapeutic innovations, esophageal cancer remains a disease with one of the poorest survival rates with an overall 5 year survival of 20%. Recent clinical trials have demonstrated the role of adjuvant immunotherapy to improve patient survival. However, these therapies are often not completed in their entirety due to side effects or disease progression. We report our real world experience with immunotherapy and esophageal cancer within an integrated health care system.

Methods
All adult patients undergoing minimally invasive esophagectomy (MIE) in our large integrated health care system between September 1, 2017 and November 15, 2021 were reviewed. Patients with multiple cancers were excluded for a final patient cohort of 37 patients who received immunotherapy and 139 who did not. Patients who received immunotherapy were reviewed for the number of doses they received, if they were able to complete therapy, side effects, and disease progression. Baseline characteristics and outcomes, including 90 day and 1 year mortality, were compared between the two patient groups. Logistic regression was performed to identify factors that impacted survival.

Results
Of 37 patients who received immunotherapy, 17 received nivolumab, 17 received pembrolizumab, 11 received trastuzumab, 2 received ipilimumab, and 9 received combination. Only 5 patients successfully completed therapy. Therapy was terminated in 7 patients due to side effects, most commonly colitis. Furthermore, 18 patients stopped therapy due to disease progression, and 4 patients expired during treatment. There were no significant differences in 90 day or 1 year mortality between patients who received immunotherapy and those who did not. At a maximum of three year follow up, patients with late stage disease who received immunotherapy had a significantly worse survival.

Conclusion
Immunotherapy has been shown to have a promising impact on patient survival in esophageal cancer. However, outside of a clinical trial, there are numerous barriers to successful treatment in a real-world setting. At our regionalized center of excellence, we found that most patients are unable to complete immunotherapy treatment due to disease progression or side effects, and immunotherapy did not improve survival. Further work is required to tailor immunotherapy delivery to diverse patient populations.
382. CARDIAC REMODELING IN PATIENTS WITH ESOPHAGEAL CANCER-ASSOCIATED CACHEXIA
Authors: Cameron Miles E , Judge Sarah , Judge Andrew , Awad Ziad 
Published: August 2023

Abstract

Background
Cachexia is a debilitating wasting syndrome affecting 60% of patients with esophageal cancer, regardless of stage. While cachexia is usually characterized by skeletal muscle atrophy, systemic inflammation and aberrant endocrine signaling is thought to also precipitate cardiac atrophy and dysfunction. Indeed, cachectic patients often display clinical signs of heart failure. In this initial study, we sought to characterize the relationships between weight loss, body composition and parameters of cardiac structure and function.

Methods
We performed a retrospective review of patients that received esophagectomy between 2015 and 2020 at our facility. Male patients with pre-operative transthoracic echocardiogram studies and no prior history of cardiac disease were included. Body composition was measured using PET/CT scans. Patients were classified as having cachexia if having more than 8% loss in body mass in the six months before surgery. Appropriate t-tests and correlational analyses were performed after assessing normality. A p-value less than 0.05 was considered statistically significant.

Results
Mean age was 65.8 ± 7.54 years. Mean six-month weight loss was 13.2%, and 65.4% of patients were classified as having cachexia. Patients with cachexia tended to have lower left ventricular mass (135 ± 7.38 g v. 148 ± 7.53 g, p = 0.2) and significantly lower left atrial diameter (3.32 ± 0.441 cm v. 4.47 ± 0.515 cm, p = 0.0261). Curiously, pre-operative weight loss positively correlated with left ventricular internal diameter end systole (R = 0.4521, p = 0.0204) and negatively correlated with diastolic blood pressure (R = -0.4102, p = 0.0417). When compared to segmented PET/CT scans, patients with increased deposition of adipose to muscle—a sign of pathologic remodeling—also had decreased left atrial diameter (R = 0.6497, p = 0.0222).

Conclusions
Various measures of heart structure and function are altered in cachectic patients with esophageal cancer. Patients were more weight loss have reduced left atrial and increased left ventricular diameters. These findings suggest that cardiac structure may dynamically change in response to cachexia. In summary, there is a profound need to better characterize the pathology of cardiac atrophy and dysfunction in patients with cachexia.