bluuebunny/crossref_metadata_2025_split huggingface dataset:
176. NON-REGIONAL LYMPHADENOPATHY IN PATIENTS WITH ESOPHAGEAL CANCER TREATED WITH CURATIVE INTENT: A PROPENSITY MATCHED ANALYSIS OF PATHOLOGICAL AND SURVIVAL OUTCOMES
Authors: Tankel James , Boukhili Neyla , Sakalla Rawan , Hijazi Talia , Spicer Jonathan , Assaleh Jamil , Alcindor Thierry , Najmeh Sara , Cools-Lartigue Jonathan , Ferri Lorenzo 
Published: August 2023

Abstract

Background
The management of patients with esophageal cancer and concurrent retroperitoneal or supraclavicular lymphadenopathy is controversial. Whilst these patients could be considered non-resectable, the survival benefit of neoadjuvant treatment followed by en bloc resection is not well described. The aim of this study was to explore the perioperative, pathological and survival outcomes of patients with esophageal cancer who presented with oligometastatic non-regional lymphadenopathy treated with neoadjuvant therapy and subsequent en bloc transthoracic esophagogastrectomy.

Methods
Between 01/2010 and 12/2022, a single center retrospective review of a prospectively maintained comprehensive esophageal cancer surgical database was performed. All patients with esophageal and junctional cancer with clinical non-regional (supraclavicular and retroperitoneal) lymphadenopathy were identified (Tany, Nany, M+). Only patients treated with neoadjuvant chemotherapy/chemoradiotherapy (nCT/nCRT) and extended en bloc transthoracic esophagogastrectomy including resection of the non-regional lymph node basin were included. Patients with gastric cancer and solid organ metastases were excluded. Propensity score matching was used to create a control group of clinically M- patients from same database to compare survival outcomes.

Results
Of the 46/1235 patients with non-regional lymphadenopathy, 39 met the inclusion criteria. Most had adenocarcinoma (35/39,89.7%) with retroperitoneal and supraclavicular lymphadenopathy in 26/39 (66.7%) and 16/39 (41.0%). nCRT and nCT was used in 5 and 34 patients respectively. Twenty-four received taxane based regimens and 24/39 (61.5%) adjuvant therapy. A trend towards improved overall survival was noted when comparing the study and control groups (27.0 vs 17.0 months, p = 0.065). However, cM+(retroperitoneal) had similar survival to the control group with both being higher than cM+(supraclavicular) (27.0 vs 21.0 vs 13.0 months, p = 0.039). Non-regional nodal basin sterilization occurred in 20/36 (55.6%) and was not associated with improved survival.

Conclusion
Whilst non-regional lymph node disease in the setting of esophageal cancer can be treated with neoadjuvant therapy and curative en bloc extended transthoracic resection, it seems that in terms of survival patients with retroperitoneal disease benefit the most. In this group of patients, equivalent survival to those with non-metastatic disease is achievable. Further understanding into those who would benefit from such a regimen is urgently needed.
178. OUTCOME OF DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL COMBINATION CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL CANCER
Authors: Tanaka Koji , Momose Kota , Yamashita Kotaro , Makino Tomoki , Saitoh Takuro , Yamamoto Kauyoshi , Takahashi Tsuyoshi , Kurokawa Yukinori , Eguchi Hidetoshi , Doki Yuichiro 
Published: August 2023

Abstract

Background
T4b esophageal cancer, chemoradiotherapy with 5FU plus cisplatin (FP-RT) is usually performed as a treatment option. However, its therapeutic efficacy has not been satisfactory, and there is still no certain opinion on its use, including induction therapy and surgical intervention. In recent years, favorable outcomes of radiation therapy with DCF (DCF-RT) have been reported, but there is no consensus. Therefore, we aimed to retrospectively analyze the outcomes of DCF-RT of our hospital.

Methods
We retrospectively analyzed the safety and efficacy of 61 patients treated with DCF-RT for cT4 esophageal cancer from March 2014 to December 2021. The regimens were (DTX: 30/m2 Day1, CDDP: 10 mg/m2 Day1–5, 5-FU: 400 mg/m2 Day1–5) 2 courses or (DTX: 35/m2 Day1, CDDP: 40 mg/m2 Day1, 5-FU: 400 mg/m2 Day1–5) 3 courses + RT (40-60Gy).

Results
The main location of tumor was Ce/Ut/Mt/Lt = 20/8/24/2 cases. Dose reduction was required in 19 cases (33%); CTCAE ver 4.0 Grade 3 or higher adverse events were leukopenia 53%, neutropenia 51%, febrile neutropenia 19%, anorexia 12%; no treatment-related deaths were observed. Clinical response was CR/PR/SD/PD = 3/42/9/3 patients, with a response rate of 79%. Clinically downstage from T4 was achieved in 42 patients (74%), and esophagectomy was performed in 51 patients (91%). 20 patients (38%) required combined resection of T4b organs and 48 patients (94%) achieved R0 resection. Pathological response was Grade 1/2/3/NA = 12/24/12/4, and overall survival (1Y/2Y/3Y) = 86/68/54% after CRT.
In summary, DCF-RT for T4 esophageal cancer seemed to be relatively safe and may contribute to long survial.
181. SAFETY AND TIME USAGE OF CIRCULAR STAPLED ANASTOMOSIS IN THE SHIFT FROM MIE TO RAMIE
Authors: Fasting Magnus , Førland Dag , Skagemo Caroline , Mala Tom 
Published: August 2023

Abstract

Background
Introducing new surgical techniques may increase the potential for adverse events. There is no consensus or evidence on the optimal anastomotic technique in esophageal resection. We used the circular stapled anastomosis (CSA) technique as standard in MIE, and continued this practice during the introduction of RAMIE. Here, we evaluate the early results of reconstruction during Iwor-Lewis esophagectomy using CSA after converting from MIE to RAMIE, with redspect to safety and time usage.

Methods
The first 27 RAMIEs were included, as well as an equal number of video recorded MIEs immediately preceeding the shift to RAMIE. Patient background and short-term outcomes were recorded prospectively. The duration of the reconstruction, i.e. the time from esophageal transection to transection of the blind limb of the gastric conduit was recorded from operative videos. Both MIE and RAMIE were performed in the prone position using single lumen tube intubation. The robot was not undocked during the reconstruction. Data was registered in a patient registry approved by the Institutional Data Protection Officer with written consent by all patients.

Results
27 RAMIEs and 29 MIEs were included. Patient demographics, comorbidity and tumor disease stages were similar between the two groups. There were video recordings of 26 cases in each group. There were no conversions to thoracotomy in either group. All reconstructions were completed using CSA. The median duration of the reconstruction was 40 (range: 26–85) minutes in the MIE group and 46 (35–76) minutes in the RAMIE group (p = 0.02). There were three anastomotic leaks in each group (RAMIE 11% and MIE 10%). One patient died within 90 days of surgery in the MIE group.

Conclusion
In this study, the use of CSA during RAMIE for the reconstruction in Iwor-Lewis esophagectomy was feasible with comparable anastomotic leak rate as after MIE. The average duration of reconstruction was 6 minutes longer in the RAMIE group.
187. PROGNOSTIC IMPACT OF LYMPH NODE HARVEST FOR PATIENTS WITH NODE-NEGATIVE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A LARGE-SCALE MULTICENTER STUDY
Authors: Shang Qi-Xin , Chen Long-Qi 
Published: August 2023

Abstract

Background
We examined the association between the number of resected lymph nodes and survival to determine the optimal lymphadenectomy for thoracic Esophageal Squamous Cell Carcinoma (ESCC) patients with negative lymph node.

Methods
We included 1836 patients from Chinese three high-volumed hospitals with corresponding clinicopathological characters such as gender, age, tumor location, tumor grade and TNM stage of patients. The median follow-up of included patients was 45.7 months (range, 1.03–117.3). X-Tile plot was used to identify the lowest number of lymphadenectomy. The multivariate model’s construction was in use of parameters with clinical significance for survival and a nomogram based on clinical variable with P &lt; 0.05 in Cox regression analysis. Both two models were validated using a cohort extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database between 1975 and 2016 (n = 951).

Results
More lymphadenectomy numbers were significantly associated with better survival in patients both in training cohort (Hazard ratio [HR] = 0.980; 95% Confidence Interval [CI]: 0.971, 0.988; P &lt; 0.001) and validation cohort (HR = 0.980; 95% CI: 0.968, 0.991; P = 0.001). Cut-off point analysis determined the lowest number of 9 for thoracic ESCC patients in N0 stage through training cohort (C-index: 0.623; Sensitivity: 80.7%; 1-Specificity: 72.5%) when compared with 10 in validation cohort (C-index: 0.643; Sensitivity: 78.2%; 1-Specificity: 63.0%). The cut-off points of 9 were examined in training cohort and validated in the divided cohort from validation cohort (all P &lt; 0.05). Meanwhile, nomograms for both cohorts were constructed and the calibration curves for both cohorts agreed well with the actual observations in terms of predicting 3-year and 5-year survival, respectively.

Conclusions
Larger number for lymphadenectomy was associated with better survival in thoracic ESCC patients in N0 stage. 9 was we got as the lowest number for lymphadenectomy in pN0 ESCC patients through this study, and our result should be confirmed further.
189. IDENTIFICATION OF M6A-RELATED SIGNATURE GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA BY MACHINE LEARNING METHOD
Authors: Shang Qi-Xin , Chen Long-Qi 
Published: August 2023

Abstract

Background
We aimed to construct and validate the esophageal squamous cell carcinoma (ESCC)-related m6A regulators by means of machine leaning.

Methods
We used ESCC RNA-seq data of 66 pairs of ESCC from West China Hospital of Sichuan University and the transcriptome data extracted from The Cancer Genome Atlas (TCGA)-ESCA database to find out the ESCC-related m6A regulators, during which, two machine learning approaches: RF (Random Forest) and SVM (Support Vector Machine) were employed to construct the model of ESCC-related m6A regulators. Calibration curves, clinical decision curves, and clinical impact curves (CIC) were used to evaluate the predictive ability and best-effort ability of the model. Finally, western blot and immunohistochemistry staining were used to assess the expression of prognostic ESCC-related m6A regulators.

Results
2 m6A regulators (YTHDF1 and HNRNPC) were found to be significantly increased in ESCC tissues after screening out through RF machine learning methods from our RNA-seq data and TCGA-ESCA database, respectively, and overlapping the results of the two clusters. A prognostic signature, consisting of YTHDF1 and HNRNPC, was constructed based on our RNA-seq data and validated on TCGA-ESCA database, which can serve as an independent prognostic predictor. Experimental validation including the western and immunohistochemistry staining were further successfully confirmed the results of bioinformatics analysis.

Conclusion
We constructed prognostic ESCC-related m6A regulators and validated the model in clinical ESCC cohort as well as in ESCC tissues, which provides reasonable evidence and valuable resources for prognostic stratification and the study of potential targets for ESCC.
200. COMPARISON OF SHORT-TERM OUTCOMES BETWEEN TRANSTHORACIC AND ROBOT-ASSISTED TRANSMEDIASTINAL RADICAL SURGERY FOR ESOPHAGEAL CANCER: A PROSPECTIVE STUDY
Authors: Yoshimura Shuntaro , Seto Yasuyuki 
Published: August 2023

Abstract

Background
The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.

Methods
Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.

Results
Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p &lt; 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p &lt; 0.0001 for all four measurements).

Conclusions
Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.
201. PREOPERATIVE HANDGRIP STRENGTH IS ASSOCIATED WITH POSTOPERATIVE PULMONARY COMPLICATIONS AFTER MAJOR ABDOMINAL SURGERY: A PROSPECTIVE MULTICENTRE INTERNATIONAL COHORT STUDY
Authors: Sellayah Renishka , Boden Ianthe 
Published: August 2023

Abstract

Background
Low muscle strength is a primary indicator of sarcopenia, defined by the European Working Group on Sarcopenia (EWGSOP2) and is related to postoperative complications after major surgery. Handgrip strength is easily measured preoperatively and is an alternative to skeletal muscle index assessments, which are time consuming and require specialised equipment. The current studies pertaining to handgrip and postoperative outcomes are largely retrospective, single-centre studies in populations dissimilar to Australian and New Zealand surgical patients.

Methods
Patient-level data from the Lung Infection Prevention Post Surgery—Major Abdominal—with Pre-Operative Physiotherapy study (ANZCTR 12613000664741), a randomised controlled trial conducted across three Australian and New Zealand tertiary hospitals (2013–2015) was utilised. Eligible patients were those listed for elective upper abdominal surgery. Maximum dominant handgrip was measured via standardised methods. Percentage of predicted handgrip was calculated using recognised normative values; &lt;85% predicted was set as signifying low handgrip strength. The association between &lt;85% of predicted handgrip and postoperative outcomes was analysed using multivariate regression modelling adjusted for covariate effects of age, gender, ASA, smoking status, and type of surgery.

Results
Of 432 participants (50% colorectal, 25% UGI/HPB) hand grip data was available for 379 (88%). Patients with low preoperative handgrip had a four-fold increased risk of developing a postoperative pulmonary complication (RR 3.95; 95% CI 1.09 to 14.2; p = 0.037) independent of other confounding variables. Handgrip had the strongest effect on postoperative pulmonary complications compared to age, gender, upper gastrointestinal, hepatobiliary surgery, ASA, and current smoking. There were consistent signals of a relationship between preoperative weak hand grip and MET calls, extraordinary physician ward consults, prolonged length of hospital stay (&gt;14 days), sub-acute stays, and longer time to independent mobilisation.

Conclusion
This is the first study of handgrip in Australian and New Zealand surgical patients. It prospectively validates previous findings that weak handgrip is related to worse postoperative outcomes, particularly respiratory. Intriguingly, handgrip had a stronger effect on pulmonary complications than upper GI or hepatobiliary surgery. Finally, given its ease of measurement, handgrip can be assessed at first clinical contact, increasing the time available for pre-habilitation.
205. LONGITUDINAL PATIENT-REPORTED OUTCOMES AFTER MINIMALLY INVASIVE MCKEOWN ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Nie Xin , Miao Yan , He Wenwu , Li Changding , Li Zhiyu , Han Yongtao , Wang Chenghao 
Published: August 2023

Abstract

Background
Surgery for esophageal squamous cell carcinoma (ESCC) is characterized by a poor prognosis and high complication rate, resulting in a heavy symptom burden and poor quality of life (QOL). Neoadjuvant therapy followed by surgery improved the postoperative survival of ESCC patients. This study was a longitudinal patient-reported outcomes (PROs) evaluation to compare the effects of neoadjuvant therapy followed by minimally invasive Mckeown esophagectomy and surgery without neoadjuvant therapy from the patient’s perspective.

Methods
We investigated ESCC patients who underwent minimally invasive Mckeown esophagectomy in a single centre. Longitudinal data on clinical characteristics and PROs were collected. The MD Anderson Symptom Inventory and the European Organization for Research and Treatment of Cancer (EORTC)‘s quality of life questionnaires were used to assess symptoms and QOL before and after surgery. Compared the PROs’ trajectories during the investigation.

Results
Overall, 244 eligible ESCC patients were enrolled, of which 78 (group A) underwent neoadjuvant therapy followed by surgery, and 166 (group B) underwent surgery without neoadjuvant therapy. On postoperative day 5, dry mouth (p = 0.035) was more evident in group A. In postoperative month 1, patients in group A reported more disturbed sleep (p = 0.012) and drowsy (p = 0.050). In the sixth month, patients in group A had more symptom burden of disturbed sleep (p = 0.038), distress (p = 0.005) and lack of appetite (p = 0.049), and had worse physical (p = 0.050), role (p = 0.003) and emotional (p = 0.020) functions. Twelve months after surgery, group A had a worse social function (p = 0.019).

Conclusion
The longitudinal changes in postoperative symptoms and QOL were about the same in both groups. But at some point, especially in the sixth month after surgery, patients who underwent neoadjuvant therapy followed by surgery had a heavier symptom burden and a poorer QOL.
212. ROBOT ASSISTED ESOPHAGECTOMY WITH EXTENDED MEDIASTINAL LYMPH NODE DISSECTION
Authors: Kawakubo Hirofumi , Matsuda Satoru , Takeuchi Masashi , Kitagawa Yuko 
Published: August 2023

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. 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 234.4 min and 195.6 min in last 30 cases. Median blood loss is 0 mL. Postoperative pneumonia and vocal cord palsy were occurred only 4 case in last 50 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.
217. IMPORTANCE OF PERFORMING BARIUM SWALLOW TEST FOR COLLECT DIAGNOSIS OF ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION INCLUDING ACHALASIA
Authors: Ishii Tadashi , Kamei Takashi 
Published: August 2023

Abstract

Background
The clinical manifestation of achalasia is nonspecific (weight loss, vomiting); particularly, making an early diagnosis is often difficult. It often remains unrecognized for a long period or can be initially misdiagnosed as an eating disorder, such as anorexia nervosa, whose main clinical features mimic achalasia. Additionally, several overlooked patients with esophagogastric junction outflow obstruction (EGJOO), including achalasia, are should be identified in the community population.

Methods
1. We collected data from 38 patients with achalasia and examined them for diagnostic factors that could lead to a delayed diagnosis.
2. The data of a cumulative total of 489,823 hospital visits at a tertiary medical center were collected. We selected patients with the given suspected diagnoses that could be misdiagnosed, and investigated the kind of imaging tests used in them. Among them, we selected patients with symptoms persisting for &gt;6 months, without a definitive diagnosis, and in whom upper endoscopy, but not barium swallow test, was performed. Subsequently, we performed barium swallow tests in these patients.

Results
1. The most important factor that caused a delay in the diagnosis of achalasia was non-performance of a chest CT scan or barium swallow test promptly at first physician contact.
2. We identified 39 people that could have been misdiagnosed, who had undergone upper endoscopy, but not barium swallow testing, with symptoms persisting for &gt;6 months and without a definitive diagnosis. Among them, 16 individuals agreed to undergo the barium swallow test. One of them was confirmed to suffer from EGJOO.

Conclusion
To avoid a delayed diagnosis of EGJOO, including achalasia, performing a barium swallow test promptly, in addition to routine endoscopy, appears to be extremely important. Furthermore, we successfully identified one patient with EGJOO from among the community population using an extraction algorithm.