bluuebunny/crossref_metadata_2025_split huggingface dataset:
231. ROBOT-ASSISTED TRANSMEDIASTINAL (TRANSCERVICAL & TRANSHIATAL) ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Seto Yasuyuki , Yagi Koichi , Yajima Sho , Okumura Yasuhiro , Miwa Yoshiyuki , Aikou Susumu , Yamagata Yukinori , Mitsui Takashi , Nishida Masato , Yoshimura Shuntaro , Mori Kazuhiko 
Published: August 2023

Abstract

Background
Esophagectomy is still main treatment mode for esophageal cancer, though it is known to be associated with severe surgical invasiveness resulting in high morbidity and mortality. Minimally invasive esophagectomy (MIE), which consisted of thoracoscopic and/or laparoscopic procedure, has been widely performed to diminish those disadvantages of open procedure. Recent reports, however, show insufficient effects of the conventional MIE. Therefore, additional improvements are needed to overcome those problems.

Methods
We developed the robot-assisted transmediastinal esophagectomy (RATME) in 2012 to prevent the postoperative complications. It is the combination of transcervical and transhiatal approach without one lung ventilation anesthesia and body change during surgery. Upper mediastinal lymphadenectomy along left recurrent laryngeal nerve (RLN) is perfomed by transcervical mediastinoscopic procedure under pneumo-mediastinum. Laparoscopic abdominal LN dissection is performed in parallel with the cervical procedure. Remnant lower and middle LN dissections, including subcarinal and main bronchus, are done using robotic procedure in which robotic arms are inserted through hiatus from abdomen. Finally, bilateral pleura can be preserved.

Results
To date, 275 RATMEs have been performed. Among them, post-operative pneumonia occurred in 33 cases (12%), and mortality is zero. Oncological outcomes, e.g., the numbers of harvested LNs, post-operative QOL, e.g., post-operative pulmonary function, were observed and reported to be better in RATME group as compared to open esophagectomy group. Survival after surgery is, also, not at all inferior.

Conclusion
RATME is a promising minimally invasive technique, overcoming the disadvantages of conventional procedures. For the patients with previous thoracic surgery, and/or impaired respiratory function who are unable to undergo transthoracic esophagectomy, RATME can offer a valuable alternative surgery as a radical treatment.
257. UPDATE OF THE INTRODUCTION OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), CLINICAL OUTCOMES OF THE LEARNING CURVE COHORT
Authors: Klarenbeek Bastiaan , Vercoulen Richard , Veenendaal Linde , Shiozaki Atsushi , Fujiwara Hitoshi , Rosman Camiel 
Published: August 2023

Abstract

Background
Surgical resection remains the cornerstone of curative treatment for patients with esophageal cancer. Transthoracic minimally invasive esophagectomies have reduced the occurrence of pulmonary complications, however it is still associated with significant morbidity. The Minimally Invasive transCervical Esophagectomy (MICE) is a novel surgical technique. To date this technique is not routinely performed in Western esophageal cancer patients. We aim to assess the safety and efficacy of the MICE procedure in Dutch patients with esophageal carcinoma. An update of the clinical outcomes of the learning curve cohort.

Methods
The MICE is a recently developed surgical technique in Japan. The procedure combines a laparoscopic transhiatal and single-port transcervical mediastinal dissection and aims to ensure a radical oncological resection with a reduction of pulmonary complications because a thoracotomy/scopy is avoided. Potential drawbacks may be an increased incidence of recurrent laryngeal nerve paresis (RLNP) and learning associated morbidity. A prospective pilot study was performed including consecutive patients undergoing MICE for esophageal cancer.

Results
Results will be updated up to August 2023, probably around 70 cases. A total of 50 patients were included in this study in Januari 2023 (male/female ratio 16:4, median age 71 years (IQR 52–85). Median operation time and blood loss was 350 minutes (IQR 326–360) and 100 mL (IQR 50–175). Conversion occurred in five patients (12%). Anastomotic leakage occurred in four patients (10%, 3 ECCG grade 1 and 1 ECCG grade 3). Pneumonia, pleural effusion and chyle leakage occurred in two (5%), five 12%) and two (5%) patients. Recurrent laryngeal nerve paralysis was seen in 22 patients (55%), at least 16 (73%) of which were only temporary. Median length-of-stay was 9 days (IQR 7–10).

Conclusion
MICE is a novel minimally invasive surgical technique which seems safe and effective to perform in Dutch patients with esophageal carcinoma. As expected, a higher incidence of RLNP was seen, but often only temporarily. Long-term safety and effectiveness will be prospectively evaluated in a larger population.
259. ROBOTIC ESOPHAGECTOMY AND THREE FIELD LYMPHADENECTOMY WITH INTRA-OPERATIVE RECURRENT LARYNGEAL NERVE MONITORING
Authors: Jiwnani Sabita , Gopinath Srinivas Kodaganur , Nadkarni Shravan , Tiwari Virendra , Niyogi Devayani , Pramesh C S 
Published: August 2023

Abstract

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Background
Surgery for esophageal malignancy is associated with significant morbidity and mortality, especially in cases requiring extensive lymphadenectomy. Recurrent laryngeal nerve (RLN) injury can result in hoarseness, aspiration, pneumonia, tracheostomy, and could even be life-threatening. A 33 year old lady with a lower thoracic esophageal squamous carcinoma with left trachea-esophageal groove nodes in the superior mediastinum underwent a Xi robotic esophagectomy and three field lymphadenectomy with intra-operative recurrent laryngeal nerve monitoring after neoadjuvant chemotherapy.

Methods
We used a bronchial blocker (COOPDECH bronchial blocker, Daiken-Iki Corporation, Japan) with a single-lumen electromyographic (EMG) endotracheal tube) (NIM EMG endotracheal tube, Medtronic Xomed, Jacksonville, FL, USA) for lung isolation along with capnothorax. Semiprone position with 3 robotic ports and an assistant port was utilised. Nerve monitoring provided an audiovisual waveform when either the vagus or the RLN was stimulated and transformed the laryngeal muscle activity into EMG signals. Grounding electrodes were placed on the patient’s shoulder or near the sternum. A prerequisite for adequate and effective nerve monitoring is the avoidance of neuromuscular blockers during anesthesia.

Results
Esophageal mobilisation was done in the standard fashion. The lymphadenectomy along the recurrent laryngeal nerves in the mediastinum and neck was guided by the nerve identification and stimulation utilising the long intra-thoracic nerve monitoring probes. In the mediastinum, the right recurrent laryngeal nerve was identified taking off from the right vagus along the lateral border of the trachea and looping around the right subclavian artery. The thoracic left recurrent nerve was identified in the aorto-pulmonary window as well along the left lateral border of the trachea in the trachea-esophageal groove where the metastatic lymph nodes were identified on radiology.

Conclusion
Minimally invasive esophagectomy is now the preferred modality for surgical extirpation of esophageal malignancies, with extensive lymphadenectomy used in appropriate cases. Interventions to reduce postoperative morbidity resulting from the dissection of nodes around the RLN need to be used. The use of IONM is associated with lower RLN palsy rates and superior lymph nodal yield and needs to be investigated with large-scale randomized studies for beneficial clinical outcomes.
262. DUPILUMAB REDUCED EOSINOPHIL COUNTS AND IMPROVED HISTOLOGY GRADE/STAGE SCORES IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: LIBERTY EOE TREET RESULTS
Authors: Collins Margaret , Dellon Evan S , Pela Tiffany , Aceves Seema S , Lucendo Alfredo J , Spergel Jonathan M , Sun Xian , Khodzhayev Angela , Radwan Amr , Jacob-Nara Juby 
Published: August 2023

Abstract

Background
In the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617) dupilumab 300 mg weekly (qw) demonstrated significant improvements in symptoms and eosinophil counts, and clinically meaningful improvement in endoscopic features vs placebo, in adults and adolescents with EoE. The objective of this analysis was to further assess the effect of dupilumab vs placebo on histologic aspects of disease in Parts A and B of LIBERTY EoE TREET.

Methods
Patients aged ≥12 years were randomized 1:1 to dupilumab 300 mg qw or placebo. Endpoints (at Week 24) were the proportion of patients achieving ≤1, ≤6, and &lt; 15 eosinophils per high-power field (eos/hpf), change from baseline in peak eosinophil count and Histologic Scoring System (HSS) scores, specifically the severity (grade) and extent (stage) of abnormality of the 8 components (basal zone hyperplasia [BZH], eosinophil inflammation [EI], eosinophil abscess [EA], eosinophil surface layering [ESL], dilated intercellular spaces [DIS], surface epithelial alteration [SEA], dyskeratotic epithelial cells [DEC], and lamina propria fibrosis [LPF]). P-values are nominal unless otherwise specified.

Results
Dupilumab significantly increased the proportion of patients achieving ≤1, ≤6, and &lt; 15 eos/hpf in Part A (P &lt; 0.0001, P &lt; 0.05, and P &lt; 0.0001, respectively) and Part B (all P &lt; 0.0001) vs placebo. Percent change in peak eosinophil count from baseline and HSS grade/stage scores were significantly improved with dupilumab vs placebo for Parts A and B (all P &lt; 0.0001) (Table). Significant improvements were observed for the histologic components BZH, EI, EA, ESL, SEA grade/stage scores (P &lt; 0.0001) in both Parts, DIS grade score in Part A (P &lt; 0.05), and DEC grade/stage scores in Part B (P &lt; 0.05); other components showed numeric improvements. Dupilumab was generally well tolerated.

Conclusions
Dupilumab 300 mg qw significantly decreased eosinophil counts and improved the severity and extent of histologic aspects of the disease as measured by HSS versus placebo in adults and adolescents with EoE up to 24 weeks, documenting a more global improvement in addition to eosinophil counts. Overall safety was consistent with the known dupilumab safety profile.
267. IDENTIFYING CANCER-ASSOCIATED FIBROBLAST POPULATIONS DRIVING THERAPY RESISTANCE IN GASTROESOPHAGEAL ADENOCARCINOMA
Authors: Tai Kulsum , Strasser Michael , Pal Sanjima , Bérubé Julie , Zeng Wotan , Kong Iris , Hoffman Adam , Tankel James , Bertos Nicholas , Sangwan Veena , Huang Sui , Ferri Lorenzo 
Published: August 2023

Abstract

Background
Peri-operative docetaxel-based triplet chemotherapy is the standard-of-care treatment for advanced gastroesophageal adenocarcinoma (GEA). However, most patients recur due to innate or acquired resistance. Although distinct populations of cancer-associated fibroblasts (CAFs) within the tumor microenvironment play important roles in conferring chemoresistance in other cancer types, this paradigm has not been extensively studied in GEA. We aim to characterize CAF heterogeneity in a well-annotated cohort of GEA patients, identifying potential biomarkers and targets to overcome chemoresistance.

Methods
Immunofluorescence and flow cytometry assays were performed to validate previously reported CAF markers from the literature in primary patient fibroblasts. To identify specific CAF markers for GEA, an atlas was developed using single-cell RNA sequencing (scRNA-seq) data obtained from 46 GEA patient samples, including 28 patients with longitudinal samples over the docetaxel-based triplet chemotherapy treatment trajectory. Differential and gene ontology analyses were performed to characterize distinct CAF subpopulations and identify dynamic CAF markers across treatment timepoints, while correlating with in-patient treatment response to chemotherapy. In parallel, tumor organoid-CAF co-cultures were established for subsequent in vitro drug testing with standard-of-care chemotherapy.

Results
CAF markers (VIM, FAP, PDPN, and S100A4) were found to be differentially expressed in fibroblasts isolated from good and poor pathological-response tumours. Analysis of scRNA-seq data reveals two main subpopulations of CAFs: myofibroblast CAFs (myCAFs) and inflammatory CAFs (iCAFs). Two markers, CCL20 and CHRDL1, were identified as differentially expressed between good and poor pathological responders in iCAFs, while nine markers, including ISG20 and C20orf27, were differentially expressed between clinical partial responders and poor responders. Dynamic CAF markers, including STAG2 and HAT1, were differentially expressed across treatment timepoints and were associated with pathological or clinical response.

Conclusions
GEA CAFs demonstrate extensive heterogeneity and comprise two major subpopulations. Several CAF markers were found to be associated with patient chemotherapy pathological or clinical response to chemotherapy, either in the chemonaïve setting or in the context of changes over the course of therapy. These putative biomarkers will be further validated and investigated, both in additional samples and in co-culture settings, to gain a better understanding of their clinical relevance and targeting potential.
280. FEASIBILITY OF ROBOTIC-ASSISTED SURGERY FOR BENIGN ESOPHAGEAL LESIONS: SINGLE-CENTER EXPERIENCE
Authors: Swangsri Jirawat , Patraithikul Premkamol , Parakonthun Thammawat , Methasate Asada 
Published: August 2023

Abstract

Background
Benign esophageal lesions are uncommon conditions compared to malignant cases. Thoracotomy is an extremely invasive procedure that can cause severe complications and delay recovery. Conventional VATS is limited in its approach to deep and narrow angles and difficult to manipulate due to abundance of vital structures that are always mobile in mediastinal area. Robotic-assisted surgery is a new challenge that aims to achieve minimally invasive procedures and improve postoperative outcomes for benign esophageal lesions.

Methods
We conducted a retrospective analysis of a single-center database from May 2012 to November 2022, including patients aged 20–75 years with diagnosed benign esophageal lesions such as esophageal leiomyoma and esophageal diverticulum who underwent robotic-assisted esophageal surgery using the Da Vinci Robotic surgery system. The operation was performed using either a transthoracic or transabdominal approach. Patient data, surgical procedures, interventions, and early outcomes (within 30 days post-operation) were collected and analyzed to assess postoperative variables. The study included 13 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay.

Results
The number of patients with each esophageal lesion was as follows: esophageal leiomyoma, 6 cases (46.1%); esophageal diverticulum, 3 cases (23.1%); and other benign lesions, 4 cases (30.8%). Robotics approaches were divided into 11 cases (84.6%) and 2 cases (15.4%) for transthoracic and transabdominal, respectively. The overall incidence of postoperative pulmonary complications was 5 cases (38.5%), with mild pulmonary infection occurred in 2 cases (15.4%). Other pulmonary complications occurred in the transthoracic approach due to patient characteristics related to underlying lung diseases, such as COPD and asthma. There was no evidence of 30 days mortality in our series.

Conclusion
Robotic-assisted surgery is feasible for benign esophageal surgery using both transthoracic and transabdominal approaches. Robotic devices can provide stabilization for both 3D camera views and instrument arms, particularly enhancing suturing ability. Robotic surgery is precise and maneuverable, with potential to perform intricate surgical procedures in tight angles and confined spaces such as the thoracic cavity and hiatal area. These factors can improve the overall operative outcome and enhance recovery due to minimally invasive access.
281. TOTAL LAPAROSCOPIC VERSUS OPEN GASTRIC PULL-UP FOLLOWING MINIMALLY INVASIVE THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Egami Yosuke , Sugimura Keijiro , Katsuyama Shinnsuke , Katsuyama Toru , Takeda Yutaka , Murata Kohei 
Published: August 2023

Abstract

Backgroud
The use of minimally invasive esophagectomy (MIE) as a treatment for patients with esophageal cancer has recently become more common worldwide. However, the laparoscopic approach for reconstruction and abdominal lymph node dissection has not fully investigated. The aim of the present study was to evaluate the technical feasibility of alimentary tract reconstruction with laparoscopically assisted gastric pull-up compared with open laparotomy gastric pull-up following minimally invasive thoracoscopic esophagectomy.

Methods
63 esophageal cancer patients who underwent minimally invasive thoracoscopic esophagectomy between 2011 and 2020 were included in the present study. For reconstruction, 25 patients underwent open laparotomy gastric pull-up (OLG) while 38 patients underwent laparoscopically assisted gastric pull-up (LAG). We compared the outcomes between the two groups.

Results
No significant difference was observed in physical and tumor status between the two groups. The mean operative time was significantly longer in LAG group (549 vs 621 min, p = 0.010) and blood loss was significantly lower in LAG (561 vs 134 mL, p &lt; 0.001). The mean number of harvested lymph nodes (47.2 vs 46.2, p = 0.840) were similar. The postoperative course showed lower incidences of overall complications (64% vs 32%, p = 0.011). No difference was observed in each complication between the two groups.

Conclusions
The findings suggest that laparoscopically assisted gastric pull-up is feasible and more effective in preventing postoperative complications.
288. POST-OPERATIVE COMPLICATIONS IN OBESE SARCOPENIC PATIENTS WITH ESOPHAGOGASTRIC ADENOCARCINOMA UNDERGOING 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 has been linked to mortality, various postoperative complications and the severity of these complications. Obesity has been linked with many health problems. Evidence has not been previously published regarding complication rates in obese, sarcopenic patients with esophagogastric 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. Obesity was defined as a BMI &gt;30 kg/m2. Post-operative complications were prospectively collected and classified using the Clavien-Dindo (CD) classification system. Patients were grouped as CD 0-I (no-mild complications) or CD II-V (moderate–severe complications).

Results
There were 191 patients included in the analysis. 25 patients post-NAC were both sarcopenic and obese. There was no significant difference between complication rates in the obese sarcopenic group vs the sarcopenic group.

Conclusion
EGA patients with obesity and sarcopenia post-NAC do not have a higher chance of developing complications than those patients with just sarcopenia.
296. FIBRIN SEALANT FOR THE PREVENTION OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: INTERIM REPORT OF A PROSPECTIVE, PHASE III, RANDOMIZED CONTROLLED STUDY
Authors: Wu Jia-Di , Zhao Zerui , Li Zhichao , Huang Weizhao , Wang Geng , Mao Teng , Lv Wenqiang , Peng Lin , Chen Jiyang 
Published: August 2023

Abstract

Purpose
Anastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy.

Methods
In this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5 mL Bioseal applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively.

Result
From February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively.

Conclusion
The application of Bioseal intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.
301. DIFFERENCES IN MULTIDISCIPLINARY CANCER CONFERENCES OF ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTIONAL CANCER REGARDING STAGING AND TREATMENT ALLOCATION—A MULTICENTER STUDY
Authors: Hannan Christine Jestin , Risso Solange León , Lindblad Mats , Loizou Louiza , Szabo Eva , Edholm David , Bartholomä Wolf Claus , Åkesson Oscar , Lindberg Fredrik , Strandberg Sara , Linder Gustav , Hedberg Jakob 
Published: August 2023

Abstract

Background
There are differences in esophageal cancer care across different regions in Sweden. According to Swedish national guidelines, all patients diagnosed with these tumors should be individually evaluated by regional multidisciplinary cancer conferences (MCCs) to be recommended the best possible treatment. The aim of the study was to investigate differences between the regional MCCs in Sweden regarding clinical staging and recommended treatment.

Method
Representatives for all six regional MCCs were invited to contribute with ten retrospective consecutive cases each. After anonymization radiological investigations were presented, along with the original case-specific medical history, anew at all participating regional MCCs. Each MCCs’ clinical Tumor Nodal Metastasis classification (cTNM) and treatment recommendation (curative, palliative or best supportive care) were compared between MCCs as well as with the original assessment.

Results
Five regional MCCs joined the study. Out of 50 available cases the majority were assessed anew in addition to the previous original assessment. There was not consensus among the regional MCCs regarding clinical T-stage in 42 cases (84%), clinical N-stage in 33 cases (66%), and for clinical M-stage in 16 cases (32%). In 37 cases (74%) a positron emission tomography-computed tomography (PET-CT) was available. Differences in appraisal of cTNM were not associated with PET-CT availability. The MCCs agreed on treatment recommendations in 26/50 cases (52%).

Discussion
The study shows differences, both in assessment of cTNM as well as treatment recommendations at different MCCs. A patient recommended curative treatment by one MCC could be suggested palliative care by another. To achieve more equal care for esophageal cancer patients in Sweden it is essential to increase consensus on cTNM and recommended treatment.