bluuebunny/crossref_metadata_2025_split huggingface dataset:
359. NFE2L2 MUTATIONS ARE PREDICTIVE AND PROGNOSTIC OF TREATMENT OUTCOME IN RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS
Authors: Ko Josephine , Guo Chen , Lo Anthony Wing-Ip , Tao Lihua , Law Simon , Lam Ka-On , Kwong Dora Lai-Wan , Wong Ian Yu-Hong , Wong Claudia Lai-Yin , Chan Siu-Yin , Chan Kwan-Kit , Law Tsz-Ting , Leung Alvin Ka-Kiu , Wong Carissa Wing-Yan , Dai Wei , Lung Maria Li 
Published: August 2023

Abstract

Background
The poor prognosis of resectable esophageal squamous cell carcinoma (ESCC) poses an unmet need to identify genomic early predictive and prognostic biomarkers to improve treatment outcome and risk stratification.

Methods
Retrospective targeted sequencing was performed on 80 ESCC formalin-fixed, paraffin-embedded (FFPE) tumor specimens from 37 good responders and 43 poor responders receiving neoadjuvant treatment. Somatic mutations and copy number variations (CNVs) were detected in 130 cancer druggable genes with TOMA Os-seq. Kaplan Meier curve and COX regression analysis were used to estimate the risk of relapse and survival.

Results
Twelve patients (12/80, 15%) with hot spot NFE2L2 mutations occurred with significantly higher frequency in poor responders (p = 0.0003) and in patients with non-complete pathological response (p = 0.007) in resectable ESCC treated by chemo-radiotherapy (CRT). These patients also had poorer prognosis with higher risk of death (HR = 1.942, p = 0.039) and relapse (HR = 1.817, p = 0.063) by COX analysis. The independent prognostic role of hot spot NFE2L2 mutations was validated by the presence of recurrent plasma cell-free (ct)-DNA NFE2L2 mutations in an independent prospective cohort of resectable ESCC patients.

Conclusions
In summary, our study now demonstrates the clinical usefulness of hot spot NFE2L2 mutations, as a potential predictive and prognostic biomarker associated with pre-surgery CRT responses, and provides novel insights for future therapeutic options targeting the NRF signaling in resectable ESCC treated by neoadjuvant CRT. The novel prognostic role of hot spot NFE2L2 mutations may be useful markers to guide clinicians for treatment decisions in resectable ESCC patients following pre-surgery treatment.
366. SARCOPENIA DECIDED FROM LOWER PSOAS MUSCLE INDEX IS STRONGLY POOR PROGNOSTIC FACTOR FOR ELDERLY ESOPHAGEAL CANCER PATIENTS
Authors: Ozawa Yohei , Taniyama Yusuke , Sato Chiaki , Okamoto Hiroshi , Ishida Hirotaka , Koseki Ken , Kanabuchi Sawa , Muranami Yuto , Fusegawa Kazuki , Kamei Takashi 
Published: August 2023

Abstract

Background
Elderly esophageal cancer patients undergoing esophagectomy are increasing. Although esophageal cancer patients suffering sarcopenia are already well known to have poor prognosis, the impact of sarcopenia for each age group may differ, since older patients have a higher frequency of primary sarcopenia than younger patients.

Methods
To clarify the relationship between sarcopenia and surgical outcomes in elderly esophageal cancer patients, we measured the psoas muscle index (PMI) in 103 elderly esophageal cancer patients aged 75 years or older who underwent radical esophagectomy from 2007 to 2021. The patients were then classified into two groups, sarcopenia group and non-sarcopenia group, using the 25th percentile of PMI as a cut-off value, and the relationship with outcomes of surgery and neoadjuvant chemotherapy (NAC) was examined.

Results
The 103 patients included 83 males and 20 females. The sarcopenia group had significantly lower BMI, but there was no correlation with oncological factors such as tumor depth or lymph node metastasis. NAC (FP) was performed in 39 patients and there was no clear correlation between completion, efficacy, or adverse events and sarcopenia. Thoracoscopic esophagectomy was performed in 93 patients, and there was no clear correlation between short-term surgical outcomes and sarcopenia. However, the 5-year overall survival and 5-year disease free survival were significantly lower in the sarcopenia group, resulted sarcopenia was an independent poor prognostic factor.

Conclusion
In elderly esophageal cancer patients over 75-year-old who underwent radical esophagectomy, sarcopenia does not significantly affect short-term surgical outcomes, and NAC is possibly able to administer as in the non-sarcopenia group. However, the indication of surgery to sarcopenic patients should be carefully decided because they have worse long-term prognosis than non-sarcopenic patients.
387. VARIATIONS IN THORACIC DUCT ANATOMY HIGHLIGHTED BY FLUORESCENCE IMAGING
Authors: Thammineedi Subramanyeshwar Rao , Patnaik Sujit Chayau , Syed Nusrath , Shukla Srijan 
Published: August 2023

Abstract
Chyle leaks are seen even after preserving or electively clipping the thoracic duct during esophagectomy. One of the reasons for this is the variations in the course, calibre and anatomy of thoracic duct. ICG Fluorescence navigation can highlight these variations and aid in enhancing the safety of esophageal surgery. This video demonstrates some variations of thoracic duct seen by ICG Fluorescence. Google drive link of the same copied below.
https://drive.google.com/file/d/1J5d2CoBb6HkvH9iaPQWnZvJGjXPm4bQ8/view?usp=share_link.
389. DEVELOPING A PROGNOSTICALLY SIGNIFICANT MORPHOLOGICAL CLASSIFICATION SYSTEM FOR ESOPHAGEAL ADENOCARCINOMA
Authors: Cotton James , Zyla Roman , Allison Frances , Bach Yvonne , Allen Jonathan , Darling Gail , Elimova Elena , Wilson Gavin , Yeung Jonathan , Kalimuthu Sangeetha 
Published: August 2023

Abstract

Background
Histologically, esophageal adenocarcinoma is broadly divided into two morphological subtypes: intestinal and diffuse types, with the latter conferring a worse prognosis. However, the present classification system does not account for morphological heterogeneity and the clinical and prognostic implications of this heterogeneity remains uncertain. This study focuses on elucidating the clinical and prognostic significance of the various EAC morphological patterns.

Methods
We identified surgical resection cases conducted at a single center from 2008 to the present date. All tumour-containing slides were analyzed, and the percentages of each morphological pattern was calculated. The overall percentage of each morphology was determined by summing across all tumour slides per case. Cases were stratified by neoadjuvant treatment status.

Results
This study reviewed 106 surgical resection cases. Seventy cases (58 male, 12 female, 59.26 +/− 11.12 years) received neoadjuvant treatment prior to surgery, while 36 cases (29 male, 7 female, 66.36 +/− 11.85 years) did not. A similar average slide number was obtained from treated versus untreated cases (10.13 +/− 7.43 slides vs 9.14 +/− 8.57, p = 0.5391). Morphological heterogeneity (i.e., 3+ morphologies occupying &gt;10% of the tumor) was not different between treated and untreated cases (33% versus 24.2%, p = 0.35). Subgroup analysis revealed a significant increase in tumor morphological heterogeneity with poorer neoadjuvant treatment response (score 3) (p &lt; 0.05).

Conclusions
To our knowledge, this is the first study investigating the clinical and prognostic implications of the heterogeneous morphological patterns observed in EAC. Our results suggest that tumours with poor response to neoadjuvant therapy are more likely to exhibit significant morphological heterogeneity. We are currently exploring whether specific morphological patterns are linked to adverse prognosis and poor response to neoadjuvant therapy. These findings have the potential to guide clinical decision-making in EAC.
398. THE HYBRID INTRA-THORACIC OESOPHAGO-GASTRIC ANASTOMOSIS—CONTEMPORARY PERFORMANCE WITH LOW BENIGN ANASTOMOTIC STRICTURE FORMATION
Authors: Joglekar Shantanu , Huynh An , Zhou Warren , Chong Lynn , Sayed-Hassen Akhtar , Hii Michael , Cade Richard 
Published: August 2023

Abstract

Background
The intra-thoracic linear stapled semi-mechanical anastomosis is associated with reduced rates of benign anastomotic stricture when compared with circular stapled and end-to-end hand-sewn methods.
The hybrid anastomosis is a modification of this. The hand-sewn posterior wall, extended with a stapler firing provides the theoretical advantage of increased luminal patency. It has been published as a single surgeon experience from our institutions (1993–2011), with low leak rate and stricture rate of ten percent. These patients largely underwent upfront surgery.

Methods
We assessed the performance of this hybrid anastomotic technique amongst multiple surgeons, in a contemporary setting with high use of neoadjuvant therapy, compared with the end-to-end hand-sewn anastomosis.
Patients undergoing open Ivor Lewis oesophagectomy over a 6 year period were identified using the prospective oesophagectomy database across two public hospitals. Chart review was used to compile data on anastomotic technique, reflux symptoms, PPI use and endoscopic dilatations.

Results
There were 80 patients, with minimum 12 month and mean 24 months follow up. 60 patients underwent hybrid anastomosis and 20 hand-sewn. Four surgeons oversaw more than 10 anastomoses. 70% of patients received neoadjuvant treatment. Four anastomotic leaks required intervention (5%).
Benign stricture formation requiring endoscopic dilatation was more common in the hand-sewn group (35%) compared with the hybrid group (12%) (p = 0.0061). All strictures were identified within 12 months. On multi-variate analysis, anastomotic leak, neoadjuvant therapy, smoking, diabetes and vascular comorbidities did not predict stricture formation.
Symptomatic reflux approached 50% in both groups, despite 89% long term PPI adherence.

Conclusion
We demonstrate that the hybrid anastomosis continues to achieve low rates of benign anastomotic stricture amongst multiple surgeons, even in the era of neoadjuvant therapy. Symptomatic reflux remains common after oesophagectomy, so PPI should be used long-term. Outcomes for both anastomoses compare to published standards. These results are relevant to consider when modifying techniques for minimally invasive anastomosis.
400. CONSTRUCTION OF A MODULAR SYSTEM OF ‘INFLATABLE SINGLE-INCISION MEDIASTINOSCOPY ESOPHAGECTOMY’ BASED ON FASCIA ANATOMY
Authors: Liangzhan Lv , Xiangfeng Gan , Qingdong Cao 
Published: August 2023

Abstract

Background
We improved Inflatable Single-Incision Mediastinoscopy esophagectomy to implement the simultaneous laparoscopic esophagectomy with inflatablesingle-Incision mediastinoscope and lymphadenectomy along bilateral recurrent laryngeal nerves under mediastinoscopy through a single left-neck incision and formed the concept of modular treatment of inflatable mediastinoscopic esophagectomy based on fascial anatomy which we can achieve standardized add programmed esophageal dissociation, greatly shorten the learning curve, make it easier to popularize and promote, and help us to control the operation time and complications.

Methods
According to anatomy of the periesophageal fascia we summarized six surgical modules, respectively is: To make the neck incision, dissociate posterior and left esophagus, dissociate anterior and right esophagus, lymphadenectomy along left recurrent laryngeal nerves, lymphadenectomy along right recurrent laryngeal nerves, dissect the Subcarinal lymph nodes. The clinical data of patients undergoing esophagectomy with inflatable single-pore mediastinoscope from February 2020 to February 2021 in our hospital were summarized and analyzed, and compared with the data of minimally invasive thoracic esophagectomy, in order to verify the clinical application effect of this modular system.

Results
In the validation study of modularization in this subject, no perioperative death was found in the 44 patients and the R0 resection rate was 100% confirmed by postoperative pathology. The average operation time was 204.9 ± 45.4 minutes, mean intraoperative blood loss was 64.6 ± 45.5 mL, average number of lymph nodes removed was 19.5 ± 9.1, average length of hospital stay was 27.0 ± 18.17 days, postoperative anastomotic fistula (2.27%), anastomotic stenosis (13.64%), chylous leakage (0%), pleural effusion (4.55%), and pulmonary infection (9.09%), better than the control group. The incidence of postoperative hoarseness (18.19%) which needed to be improved.

Conclusion
This standardized and modular surgical procedure description based on fascia anatomy is proposed for the first time for the esophagectomy under inflatable mediastinoscope, and is an exploration of the construction of a modular system for this surgical procedure. This modular system enables us to achieve standardized, programmed and rapid esophageal dissociation, which has good clinical application value.
402. LYMPH NODE METASTASIS MAPPING IN T1–2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Tian Dong , Nan Jin-Zhu , Jiang Kai-Yuan , Zheng Xiang-Yun , Chen Long-Qi 
Published: August 2023

Abstract

Background
Lymph node metastasis (LNM) is a crucial factor in predicting the prognosis of patients with T1–2 esophageal squamous cell carcinoma (ESCC), but the extent of lymph node (LN) dissection remains controversial. This study aims to investigate the optimal extent of LN dissection for T1–2 ESCC by analyzing the metastasis rate, evaluating the prognostic value at each LN station, and identifying risk factors for the LN stations with high LNM rate.

Methods
Patients with pathological T1–2 ESCC who underwent esophagectomy with LN dissection were enrolled between January 2014 and December 2019. Kaplan–Meier and Cox proportional hazards model were used to analyze the influence of LN with different metastasis rates on prognosis, respectively. The logistic regression analysis was performed to identify risk factors for the LN stations with high LNM rate.

Results
In total, 386 patients with T1–2 ESCC were included with a median LN dissection number of 18.5 (range: 12–48). The LN stations with LNM rate over 5% were the station 8 (11.9%), 2 (10.9%), 17 (8.0%), 16 (7.3%), and 7 (5.2%), and patients with metastasis of these stations showed significantly worse OS (P &lt; 0.001). Moreover, the BMI (OR 0.45, 95%CI: 0.27–0.75, P &lt; 0.01), tumor differentiation (OR 1.66, 95%CI: 1.14–2.42, P &lt; 0.01), and T stage (OR 2.05, 95%CI: 1.21–3.47, P &lt; 0.01) were independent risk factors of the metastasis of stations with LNM rate over 5%.

Conclusions
The poor prognosis of the metastasis of LN stations with LNM rate over 5% (station 8, 2, 17, 16, and 7) in T1–2 ESCC suggests the necessity of dissection, especially for patients with lower BMI, poor tumor differentiation, and deeper infiltration.
403. END-STAGE ACHALASIA: FEASIBILITY OF CARDIOMYOTOMY WITH ANTERIOR 90-DEGREE FUNDOPLICATION AS TREATMENT
Authors: Basu Pallavi , Ng Annalisa , Wong Andrew 
Published: August 2023

Abstract
Achalasia is a primary motor disorder of the oesophagus. End-stage achalasia is characterised by a grossly dilated sigmoid-shaped oesophagus with food stasis leading to chronic inflammation. Despite treatment, approximately 5% of patients progress to this late stage, needing oesophagectomy. Current guidelines recommend oesophagectomy as the last resort after failure of first-line endoscopic treatment or cardiomyotomy. We review a case of a 70 years old female with end-stage achalasia who successfully underwent cardiomyotomy but required a looser wrap for oesophageal emptying.
Patient first presented in her 50s with dysphagia and Oesophago-Gastro-Duodenoscopy (OGD) showed a dilated oesophagus with food stasis and no contractions. Barium swallow confirmed the diagnosis of achalasia. She underwent pneumatic dilatations with minimal symptom improvement and eventually defaulted follow-up. Several years later she presented with haematemesis due to severe oesophagitis and Eckardt score of 7. Both OGD and CT scans showed a grossly dilated megaoesophagus. High-resolution manometry confirmed Type I achalasia with IRP (integrated relaxation pressure) 25.8 and complete absence of peristalsis. She was initiated on nasogastric feeding and was also diagnosed with pulmonary embolism (PE).
In view of PE and patient’s comorbidities, she was not fit for oesophagectomy. Peroral endoscopic myotomy (POEM) was also deemed challenging in the presence of severe, chronic oesophagitis and patient’s need for anticoagulation with potential difficulty in endoscopic haemostasis. She underwent laparoscopic cardiomyotomy with anterior 180-degree fundoplication. However, post-operation contrast swallow showed hold up of contrast despite intraoperative OGD showing smooth passage of scope through LES. Decision was made for revision of fundoplication to anterior 90-degree to further promote oesophageal emptying. Post-operation contrast swallow showed satisfactory drainage into stomach and patient tolerated post-fundoplication diet regime.
This case illustrates the role of cardiomyotomy as first-line in patients with end-stage achalasia who are not fit for oesophagectomy. However, an anterior 180-degree fundoplication may not allow adequate drainage from a megaoesophagus and a less tight wrap should be considered in such cases. Post-operation, reported Eckardt score of our patient was 1 with no reflux symptoms, indicating marked alleviation of symptoms. Thus, cardiomyotomy with a lesser 90-degree fundoplication is feasible as first-line treatment in end-stage achalasia.
413. MANAGEMENT OF AORTO-ESOPHAGEAL FIFISTULA SECONDARY AFTER THORACIC ENDOVASCULAR AORTIC REPAIR
Authors: Tang Shoujun , Zhou Haining , Zhong Chuan 
Published: August 2023

Abstract

Background
Aorto-esophageal fifistula (AEF) is rare with highly fatal conditions and occurs most frequently secondary as a result of oesophageal malignancies, aortic aneurysms, thoracic trauma, and other thoracic surgerys. We evaluated the incidence of AEF after thoracic endovascular aortic repair (TEVAR), and investigated their clinical features, determinants, therapeutic options and results. Raising awareness and vigilance of AEF and developing individualized diagnosis and treatment measures are the key to improve the prognosis.

Methods
We conducted a voluntary survey in three centres with a thoracic endovascular programme.

Results
Of the patients who underwent TEVAR between 2010 and 2020,11/423 developed AEF. Aortic pseudoaneurysm was associated with the development of AEF among indications to TEVAR (P &lt; 0.05). Besides, emergent and complicated procedures resulted in increased risk of AEF (P &lt; 0.05). Five patients were treated conservatively, all of whom died within 30 days. Six patients underwent AEF surgical treatment, with a perioperative mortality of 33% (2/6). At a mean follow-up of 18.7 + 13.6 months, overall survival was 33% (2/6).

Conclusion
The incidence of AEF after TEVAR is not negligible and long-term follow-up is required especially for patients submitted to emergent and complicated procedures. Both surgical and endovascular treatment of AEF are associated with high mortality. However, once AEF develops, conservative treatment does not appear to be an optimal management. Timely operation has positive correlation with increase of long-term survival rate of patients.
419. PROGNOSTIC RELEVANCE OF METABOLIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR ADENOCARCINOMA OF THE ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION
Authors: Harustiak Tomas , Zemanova Milada , Fencl Pavel , Lischke Robert 
Published: August 2023

Abstract

Background
The prognostic value of the metabolic response to neoadjuvant therapy in patients with adenocarcinoma of the esophagus and esophagogastric junction (EAC) remains controversial. The aim of our single-center prospective trial was to evaluate the association of metabolic tumor and nodal response, as measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), with disease-free survival (DFS) in patient with EAC treated with neoadjuvant chemotherapy (NAC) followed by surgery.

Methods
Following the PET response criteria in solid tumors (PERCIST 1.0), PET/CT was performed before and after the third cycle of triplet NAC (epirubicine, cisplatina and 5-fluorouracil or capecitabine). The relative changes of the maximum, peak and mean standardized uptake value (ΔSULmax, ΔSULpeak, ΔSULmean), metabolic tumor volume (ΔMTV) and total leasion glycolysis (ΔTLG) in the primary tumor and ΔSULmax in the regional lymph nodes were analyzed in terms of prediction of DFS using Cox regression analysis.

Results
Some 94 patients with surgical resection were included between 2009 and 2015. Of the tumor metabolic response parameters, only ΔTLG and ΔMTV were associated with survival. Stepwise cutoff analysis found ΔTLG≥45% best predicted DFS (HR 0.25, p = 0.0018). Persistens of FDG-avidity of lymph nodes after NAC was associated with worse DFS (HR 2.63, p &lt; 0.001). Multivariable analysis of preoperative variables (baseline characteristics and metabolic response) showed that only tumor ΔTLG≥45% and post-NAC nodal FDG-avidity were predictors of DFS. In the final multivariable model including postoperative variables, pN-stage and post-NAC nodal FDG-avidity remained the only independent variables associated with DFS.

Conclusion
ΔTLG is the most optimal metabolic parameter reflecting the response to NAC in the primary tumor, however it did not independently predict DFS after surgery. The complete metabolic response in the lymph nodes after NAC independently predicted the prognosis.
421. UNVEILING THE COMPLEXITY—DISSECTION OF 106 LYMPH NODES IN ESOPHAGEAL CANCER
Authors: Fonseca Filipa , Cabral Francisco , Ramos Paulo , Monteiro Cecília , Abecasis Nuno , Casaca Rui 
Published: August 2023

Abstract

https://drive.google.com/file/d/1mKXEdCEEyOmzHo0bWJoRs4qAUDpr3LAk/view

Background
Surgical resection with thoracic lymphadenectomy is currently the sole curative option for treating non-cervical esophageal cancer. While a minimally invasive approach can achieve an efficient lymphadenectomy with reduced morbidity, its intricate and complex technical nature has limited its routine utilization in many centers. We aim to present a step-by-step approach to thoracoscopic thoracic lymphadenectomy.

Methods
Our upper gastrointestinal unit has developed multiple training protocols to create an optimal learning environment that aims to enhance surgical comprehension. Video coaching is a fundamental component of this learning environment, effectively demonstrating and deconstructing intricate surgical procedures. In recognition of the importance of minimally invasive thoracic lymphadenectomy, we have developed a video that is now incorporated into our existing curriculum. The video coaching and debriefing process enables us to continuously refine and optimize our training protocols, ultimately reducing the learning curve.

Results
We present a video showcasing a systematic and minimally invasive approach to total thoracic lymphadenectomy. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved, and the critical pitfalls. Additionally, it provides valuable insights into the recognition of these landmarks and emphasizes the significance of 3D visualization of the ganglionic station for a better understanding of this procedure. Furthermore, the long-form video presentation will include additional correlation with the patient’s CT scans for a more in-depth comprehension of the procedure.

Conclusion
In high-volume centers that utilize a standardized technique, thoracoscopic total thoracic lymphadenectomy for esophageal cancer can be performed in a safe and reproducible manner with minimal morbidity. The use of a minimally invasive approach not only provides optimal anatomical visualization but also facilitates video revision and debriefing of the surgeries, ultimately improving the understanding of this complex surgical procedure.