bluuebunny/crossref_metadata_2025_split huggingface dataset:
245. CONVERSION SURGERY AFTER DEINITIVE CHEMORADIOTHERAPY FOR THORACIC ESOPHAGEAL CANCER
Authors: Sato Hiroshi , Miyawaki Yutaka , Lee Seigi , Sakuramoto Shinichi 
Published: August 2023

Abstract

Background
Definitive chemoradiotherapy (dCRT) is an important treatment option for cStage III/IVa esophageal cancer. In our hospital, dCRT is the treatment of choice for cT4b. In this study, we investigated the technique, prognosis, and postoperative complications of salvage surgery after dCRT, with the aim of gaining knowledge to achieve both cure and safety.

Methods
The study included 36 patients who underwent conversion surgery after dCRT for thoracic esophageal cancer with suspected invasion of other organs between April 2012 and June 2021. The median age was 68 years (38–80 years). cT4b invasive organs were trachea and left main bronchus in 21 cases, aorta in 11 cases, and other organs in 4 cases. Thoracoscopic esophagectomy was performed in 13 patients. Reconstruction of the gastrointestinal tract via the posterior sternal route was the basic procedure.

Resluts
There was one case of death in hospital (3%). Postoperative complications (Clavien-Dindo Grade II or higher) were observed in 17 patients (47%), including pneumonia in 9 patients (25%) and suture failure in 5 patients (14%). The median postoperative hospital stay was 17 days. The incidence of postoperative pneumonia was lower in patients with higher preoperative serum Alb and preoperative PNI. The median recurrence-free survival was 14 months. Histopathologically, 7 patients (19%) showed cancerous remnants, and the prognosis was poor in patients with remnant disease, aortic invasion, or preoperative lymph node metastasis.

Conclusion
Perioperative outcomes were considered acceptable. Down staging is likely to be achieved after dCRT, but preoperative nutritional status should be improved. The prognosis is poor in patients with aortic invasion or lymph node metastasis, and the indication for chemoradiation should be carefully considered. Postoperative adjuvant therapy is an issue for the future.
247. TARGETING HAUS7/GAMMA-TUBULIN INTERACTION WITH HTIP1 SUPPRESSES TUMORIGENESIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Cai Ziqing , Lee Pui Yue Nikki , Wong Yu Hong Ian , Law Ying Kit Simon 
Published: August 2023

Abstract

Background
Uncontrolled cell division is a hallmark of cancer, making targeting deregulated cell cycle molecules with prognostic significance a promising approach to combat tumorigenesis. Our research focuses on HAUS7, a molecule highly relevant to esophageal squamous cell carcinoma (ESCC), and its interaction with gamma-tubulin. We designed a novel peptide, HTIP1, to target this interaction and suppress tumorigenesis.

Methods
We investigated the clinical relevance of HAUS7 upregulation in ESCC cohorts, studied its physiological microtubule-regulating and tumorigenic functions in vitro and/or in vivo, and employed a multidisciplinary approach to decode the mechanism underlying HAUS7 suppression. HTIP1 was designed by structure modelling and docking simulation. Its properties, cancer selectivity, anti-tumor efficacy, off-target effect and mechanisms of action were comprehensively evaluated. Patient-derived tumor xenograft models were used to provide additional preclinical evidence.

Results
Our results show that HAUS7 is the most essential HAUS member for regulating microtubule dynamics in ESCC, and its overexpression is correlated with aggressive tumor phenotypes and poor prognosis. Mechanistically, HAUS7 suppression releases gamma-tubulin, which upon phosphorylation, seizes LMAN1 and together they re-localize to the nucleus. The removal of LMAN1 from its innate location triggers endoplasmic reticulum stress and apoptosis. We designed HTIP1 to perturb HAUS7/gamma-tubulin interaction, which demonstrated anti-tumor effects similar to HAUS7 suppression, with high tumor specificity, negligible off-target effects, and more potency than relevant compounds.

Conclusions
Our findings provide a new strategy to counter tumorigenesis and pave the way for the development of a new drug targeting the HAUS7/gamma-tubulin interaction.
250. ASSOCIATION OF SLING-FIBER PRESERVATION POEM AND POST-POEM GERD SYMPTOMS: A NORTH AMERICAN SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Fujiyoshi Yusuke , Fujiyoshi Mary Raina Angeli , Khalaf Kareem , Gimpaya Nikko , Pawlak Katarzyna , Seleq Samir , Lamba Mehul , Li Suqing , Grover Samir , Mosko Jeffrey , May Gary , Teshima Christopher 
Published: August 2023

Abstract

Background
Peroral endoscopic myotomy (POEM) is standard treatment for achalasia. Gastroesophageal reflux disease (GERD) after POEM has been a limiting factor with this procedure. Preservation of the sling fiber during POEM was reported to reduce post-POEM GERD in Japan, but there are no reports of this technique in a western population. As such, we investigated the association of sling-fiber preservation during POEM and post-POEM GERD symptoms at our institution, which is a large therapeutic endoscopy referral center in Canada.

Methods
This is a retrospective, single-center study of patients who underwent POEM from October 2017 to January 2023 at our center. The initial cohort of patients were treated by conventional POEM until June 2021, after which a second cohort underwent POEM with sling-fiber preservation, as the techniques advanced. The primary outcome was the rate of positive GERD symptoms after POEM. The secondary outcomes were procedure time, gastric myotomy length, clinical success rate (Eckard score of less than 3), adverse events rate and use of PPI at follow-up.

Results
148 POEM cases (52.5 ± 15.6 y/o, female: 61(43%)) were included in this study. There was no significant difference in patient characteristics between the groups. The mean procedure time (108.6 ± 34.5 vs 109.1 ± 45.7 min, P = 0.93) and rate of adverse events (21% vs 14%, P = 0.36) were similar between the traditional and modified groups. In the sling fiber preservation group, gastric myotomy length was significantly longer (2.2 ± 0.7 vs 1.6 ± 0.8 cm, P &lt; 0.05) yet the GERD symptom rate at follow-up was significantly lower (22% vs 41%, P &lt; 0.05), although PPI use was similar (57% vs 50%, P = 0.47). Finally, the clinical success rate was similar between groups (88% vs 84%, P = 0.6).

Conclusions
Sling fiber preservation during POEM is safe and reduces post-POEM GERD symptoms, despite the longer gastric myotomy length. As such, sling fiber preservation may be a useful solution to reduce post-POEM GERD in western populations.
274. ROBOTIC-ASSISTED THORACOSCOPIC ESOPHAGECTOMY WITH MEDIASTINAL LYMPH NODE DISSECTION: DOES IT FEASIBLE FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURGERY?
Authors: Swangsri Jirawat , Patraithikul Premkamol , Parakonthun Thammawat , Methasate Asada 
Published: August 2023

Abstract

Background
Esophageal cancer is sixth leading cause of cancer-related mortality globally in 2020. Esophageal squamous cell carcinoma is one of most aggressive and need extensive operative treatment for radical and oncologic purpose. Conventional thoracotomy is highly invasive, conventional video-assisted is quite technical difficulty related with deep and narrow angle of exposure. Robotic-assisted procedure is new challenging to beat this limitation. This is descriptive report of initial robotic-assisted experiences regard to feasibility, safety and oncologic outcome.

Methods
We conducted a retrospective analysis of a single-center database from March 2012 to February 2023, including patients aged 45–85 years with resectable lesions of the esophageal squamous cell carcinoma who underwent robotic-assisted thoracoscopic esophagectomy using the Da Vinci Robotic surgery system. Patient data, surgical procedures, interventions, and early outcomes (within 30 days postoperation) were collected and analyzed to assess postoperative variables and adequacy of cancer clearance. The study included 12 patients, and the primary outcome was the incidence of pulmonary complications during the hospital stay.

Results
The overall incidence of postoperative pulmonary complications was 4cases (33.3%), with mild pulmonary infection occurring in 2cases (16.7%) without 30-day mortality in robotic-assisted thoracoscopic esophagectomy. The median admission period were 2 days and 15 days for ICU and hospital stay, respectively. The median time for the thoracic phase of operation was 210 minutes (150-445 minutes), and the median blood loss volume was 55 mL (20–300 mL). Pathological results showed that overall proximal and distal margins were uninvolved by tumor, and the median number of lymph nodes retrieval in the thoracic region was 22.5lymph nodes (14-73lymph nodes). 41.7% of patients were classified in pathological stage I.

Conclusion
Robotic-assisted thoracoscopic esophagectomy has shown promising early postoperative outcomes, low blood loss volume, short ICU and hospital stay, a low rate of pulmonary complications and including adequate lymph node retrieval and pathological results. These findings support the feasibility and safety of robotic-assisted thoracoscopic esophagectomy, which enhance postoperative recovery and improve surgical outcomes for the treatment of esophageal squamous cell carcinoma.
292. SPECIFIC METHYLATION MARKERS ASSOCIATED WITH CHANGES IN GENE EXPRESSION DISTINGUISH EAC AND SUB-TYPES OF BE PATIENTS
Authors: Dehkordi Nastaran Riahi , Higareda-Almaraz Juan Carlos , Kunej Urban , Chersicola Marko , Kruusmaa Kristi 
Published: August 2023

Abstract

Background
Esophageal adenocarcinoma (EAC) is one of the most deadly tumors in the world, owing to its aggressive nature and late detection. Barrett’s esophagus (BE), a premalignant condition, is the only known precursor of EAC. We focused on finding epigenetic changes such as differentially methylated regions within EAC and BE patients to demonstrate their biological significance in relation to patient stratification and early detection.

Methods
A differential methylation analysis pipeline was used to identify significant CpGs between 23 EAC, 62 BE, 49 normal squamous (SQ) and 7 fundus samples (GSE81334). These CpGs of interest were validated in the second dataset from an independent cohort (GSE104707) and the TCGA ESCA project dataset. RNASeq and methylation datasets from TCGA were integrated to find overlapping biomarkers that may reveal biological control of methylation. We further performed GO and pathway analysis of differentially methylated CpGs and cnetplot, correlating the obtained CpGs with affected genes and Gene Ontologies and pathways.

Results
We identified and validated 505 differentially methylated CpGs. Using the obtained markers, we were able to separate the normal samples from the EAC samples. BE samples were divided into 2 distinct sub-classes clustering either with normal or EAC, indicating potential for early patient stratification. With the integrated analysis of differentially methylated probes and gene expression, 108 regions were identified to be correlated, indicating epigenetic control of the regions. GO enrichment analysis revealed these regions to belong to biological processes related to cancer development. Further integration of mutation signatures revealed this signal to be independent of known alterations.
Conclusion(s): Methylation based clustering reveals markers showing distinct biological signals in BE and EAC patients and provides methylation status of distinct BE and EAC subtypes. Identified biomarkers show their relevance in early cancer detection and may exhibit strong potential in BE prognosis and better patients’ stratification. Characterization of these subtypes could aid in choosing more appropriate management strategies and better outcomes and improved survival of the patients.
302. IMPACT OF ERAS BENCHMARK ACHIEVEMENTS AND HYBRID ROBOTIC ASSISTED ESOPHAGECTOMY ON RECOVERY AND READMISSION IN AN ERAS CENTER OVER TIME
Authors: Stiles Erik , Harrison Madison , Qaraqe Taha , Sternbach Joel , Low Donald , Hubka Michal 
Published: August 2023

Abstract

Background
Early recovery after surgery (ERAS) guidelines have provided an effective recovery approach for esophagectomy. Adherence to ERAS benchmarks leads to improvements in accelerated recovery over time. We evaluated differences in ERAS clinical benchmark achievements in patients undergoing hybrid robotic assisted esophagectomy (hRAMIE) and the impact on length of hospital stay (LOS). We also examined the overall performance of our ERAS program and impact of operative technique on recovery and readmissions over time.

Methods
A single-center prospective database of esophageal cancer patients was retrospectively analyzed between January 2020 and December 2022. All consecutive patients underwent hRAMIE within a standardized ERAS pathway. Impact of individual ERAS benchmark achievements on postoperative outcomes were evaluated according to LOS groups: accelerated (≤6 days, AR), targeted (7–8 days, TR), and delayed recovery (≥9 days, DR). Ability to achieve AR and readmission rates were compared with previous esophagectomy patient cohorts and institutional published data. Data were tested for normality with Shapiro–Wilk testing. Continuous variables were compared via ANOVA or Kruskal-Wallis testing. Categorical variables were compared via Fisher testing.

Results
Sixty-four patients underwent hRAMIE with a median LOS 5.5 days. AR, TR, and DR was achieved by 75.0%, 18.8%, and 6.3% patients, respectively. AR outperformed the other groups in ICU stay (p = 0.0046), transition to PO medications (p &lt; 0.0001), and chest tube removal (p = 0.0002). Complications (48.4%) were more frequent among the TR and DR groups (p = 0.0051). 30-day readmission rate of 9.4% did not differ among the recovery groups (AR 6.2%, TR 25.0%, DR 0%, p = 0.114). 90-day mortality was 4.7% and disproportionately impacted the DR group (p = 0.0203). AR increased overtime without impacting readmission rate compared to previous cohorts in our ERAS center (Figure 1).

Conclusion
Within a common ERAS pathway at a single center, adherence to recovery benchmarks in patients undergoing hRAMIE multiplies the impact of ERAS and evolving operative technique on accelerated recovery across time. Improvements in AR can be achieved without affecting readmission rates. Routine audit of achievements of ERAS benchmarks is necessary to maintain post-esophagectomy outcomes in a time of changing health care resources.
315. LAPAROSCOPIC GASTRIC PULL-UP WITH GASTROJEJUNOSTOMY AS AN ALTERNATIVE TO COLON-TRANSPOSITION FOR CORROSIVE STRICTURE INVOLVING OESOPHAGUS AND ANTROPYLORIC REGION OF STOMACH
Authors: Dolma Tenzin 
Published: August 2023

Abstract

Background
Various gastrointestinal segments are used for replacement of the scarred oesophagus following corrosive ingestion. Colon is preferred if scarring involves both the oesophagus and the stomach, however, in some patients only the antral part of the stomach maybe involved (in addition to the oesophagus), and a gastric pull-up with a roux en Y gastrojejunostomy may also be feasible.

Methods
Retrospective analysis of corrosive strictures managed surgically between 2020–2023. The short and long-term outcomes of laparoscopic gastric pull-up with roux en Y gastrojejunostomy (LGPU-GJ) were compared with colonic pull-up.

Results
During the study period, 45 patients underwent surgical management for corrosive injury to the oesophagus and stomach. Of these, 7 patients underwent a LGPU-GJ (group A) and 20 patients underwent a colonic pull-up (Group B) and formed the study group. The mean operative time and blood loss was (195.7 ± 55 and 322 ± 63 min, p = 0.001; 48.5 ± 24 and 108 ± 30.8 mL p &lt; 0.001) in Group A and B respectively. One patient in Group A had a gastric staple line leak which was managed with intercostal drainage and antibiotics, 3 patients in Group B had cervical anastomotic leak which was managed conservatively. There was no mortality.
Over a median followup of 18 months, 2 patients in Group A and 7 in Group B required at least one session at endoscopic anastomotic dilatation. There were no significant reflux symptoms reported and all patients were able to tolerate a standard Indian diet.

Conclusion
In a select group of patients with concomitant oesophageal and isolated gastric antral stricture a laparoscopic gastric pull-up with roux en Y gastrojejunostomy may be a feasible alternative to the more complex colonic pull-up with shorter operative times, less blood loss and equivalent outcomes.
319. A SUCCESSFUL CASE OF VACUUM-STENT TREATMENT FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH COMPLICATED POST-SURGICAL COURSE
Authors: Pattynama Lisanne , Eshuis Wietse J , Pouw Roos 
Published: August 2023

Abstract

Background
Anastomotic leakage after esophagectomy is associated with severe morbidity. Endoscopic vacuum therapy (EVT) has gained a greater role in endoscopic treatment of these defects and is most often applied using endoscopically placed vacuum-sponges. Recently, the vacuum-stent was introduced as a new device to apply EVT, combining the benefits of negative pressure wound therapy and an intraluminal stent, while allowing for oral intake of a soft diet.

Methods
This video describes a patient with anastomotic leakage after esophagectomy with complicated post-surgical course, successfully treated with a vacuum-stent, including the technical aspects of the technique. First, a guidewire was placed and the vacuum-stent was advanced over the guidewire and introduced into the esophagus. The vacuum-stent was placed over the defect and deployed using the distal release system. Lastly, the vacuum-stent was connected to a vacuum pump, which was set to a pressure of -125 mmHg on the day of placement and -75 mmHg from the second day on. Generally, the vacuum-stent was removed after 7 days. If the defect persisted, another vacuum-stent was placed.
Case/Results: A 65-year-old female had undergone a minimally invasive esophagectomy with gastric conduit reconstruction and intrathoracic anastomosis. Post-surgically, the patient had dysphagia due to an elongated gastric conduit, only improving after stent placement. However, this caused a stent-induced broncho-esophageal fistula and was no definite treatment. Therefore, she underwent surgery to close the fistula with a bovine patch and gastric conduit re-construction. A prophylactic vacuum-sponge was placed, but 8 days post-surgery, endoscopy showed a dislocated sponge and dehiscence of the complete anastomosis. A vacuum-stent was placed. After 3 vacuum-stents in 20 days, the defect had closed endoscopically, which was confirmed by CT-scan with oral contrast.

Conclusions
The vacuum-stent seems to be a safe and possibly organ-saving treatment option for anastomotic leakage after esophagectomy.
Link to video: https://we.tl/t-eOVEhUiwge
320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA
Authors: Nezi Giulia , Forattini Francesca , Provenzano Luca , Capovilla Giovanni , Vittori Arianna , Nicoletti Loredana , Moletta Lucia , Pierobon Elisa Sefora , Costantini Andrea , Valmasoni Michele , Costantini Mario , Salvador Renato 
Published: August 2023

Abstract

Background
Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we aimed to compare the final outcome of the pull-down technique (PDLHD) with the results of classical myotomy (CLHD) in patients with end-stage achalasia.

Methods
From 1995–2022, patients with a radiological diagnosis of end-stage achalasia undergoing laparoscopic myotomy were enrolled in the study.
Symptoms were quantified using the Eckardt score. Barium-swallow, endoscopy and manometry were performed before and after the treatment. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score &gt; 3, or the need for retreatment.

Results
Of the 94 patients with end-stage achalasia (M:F = 52:42), 60 patients were treated with CLHD, and 34 patients with PDLHD.
The surgical procedures were completed laparoscopically in all patients. During follow-up, two patients (2.1%) developed squamous cell carcinoma (SCC), both in the CLHD group.
All patients in both groups had an improvement in their Eckardt score after surgery, and the failure rates were 27.6% (16/58) after CLHD and 5.9% (2/34) after PDLHD (p &lt; 0.01).
Amongst the patients who underwent complete post-operative follow-up, an abnormal acid exposure was detected in 2 patients after PDLH, and in 6 after CLHD (p = n.s.).

Conclusions
Taken into account the intrinsic limitations of the study (different time window, and different follow-up), the results of this study indicate that performing the pull-down technique during Laparoscopic Heller-Dor improves the final outcome in end-stage achalasia patients.
355. DEVELOPMENT OF A CUSTOM RELATIONAL DATABASE FOR INTEGRATING CLINICAL AND RESEARCH DATA FOR THE STUDY FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Allen Jonathan , Allison Frances , Ghany Rasheed , Akhter Akhi , Rispoli Thaiane , Aiyar Niharikaa , Shathasivam Premalatha , Darling Gail , Wilson Gavin , Yeung Jonathan 
Published: August 2023

Abstract

Background
With the advent of next-generation sequencing, digital pathology, and other high-dimensional data sources used in modern research, improved data management is required to maintain organization and relationship to the corresponding patient and their outcomes. The complexity of the data often limits interpretation by clinicians not highly versed in its analysis. Conversely, data scientists may not be able to interpret the data in the correct clinical context. We describe here a relational database and custom tools which coordinates clinical, organoid, and genomic data in the study of esophageal adenocarcinoma.

Methods
Database architecture was designed with pillars of clinical data and outcome, organoid culture data, and next-generation sequencing data. Data dictionaries were composed for all tables in the database architecture. Oracle Database was utilized and populated with datasets formatted to adhere to data dictionaries. Application Express was used to develop web applications for users to enter, query, and analyze data. Automatic nightly backups, robust login security, and tiers of access protect confidential data against system failures, human error, and data theft. Custom tools with graphical user interfaces were developed for survival curve generation and organoid drug-screening results, to facilitate clinician use.

Results
This database now encompasses over 21 data tables comprising clinical, surgical, recurrence, treatment response, tissue sample storage, organoid research, and genomic data. Data scientists can link omic data directly to patient clinical data and clinician researchers can rapidly obtain patient and organoid survival data for covariates of choice using a graphical user interface.

Conclusion
Proper data management requires a substantial initial investment in designing of database architecture, deployment of software and servers, formatting of data, and the creation of front-end user applications. The investment is well worth the cost, however, as a centralized database allows for rapid querying of data that would otherwise be scattered or require individualized analysis for each project. This also facilitates the interactions between data scientists and clinician researchers.