bluuebunny/crossref_metadata_2025_split huggingface dataset:
300. ENDOSCOPIC FOLLOW-UP OF RADICALLY RESECTED SUBMUCOSAL ESOPHAGEAL ADENOCARCINOMA: PRELIMINARY RESULTS OF AN ONGOING PROSPECTIVE, INTERNATIONAL, MULTICENTER COHORT REGISTRY (PREFER TRIAL)
Authors: Pouw Roos , Nieuwenhuis Esther , Jansen Marnix , Koch Arjun , Spaander Manon , Nagengast Wouter , Westerhof Jessie , Bisschops Raf , De Hertogh Gert , Neuhaus Horst , Beyna Torsten , Bourke Michael , Weusten Bas , Alkhalaf Alaa , Pech Oliver , Seewald Stefan , Haidry Rehan , Schoon Erik , Schlag Christoph , De Wulf Dominiek , Houben Martin , Messman Helmut , Dewint Pieter , Ortiz Jacobo , Meijer Sybren , Bergman Jacques , Pouw Roos 
Published: August 2023

Abstract

Introduction
Current guidelines advise esophagectomy for submucosal esophageal adenocarcinoma (T1b EAC). Data from retrospective studies suggest that endoscopic follow-up (FU) may be a valid alternative in patients without signs of lymph node metastases (LNM) at baseline. Our aim is to evaluate the safety of a watchful waiting strategy with regular endoscopic FU as an alternative in patients treated endoscopically for T1b EAC (NCT03222635).

Methods
This study, conducted at 19 hospitals in Europe and Australia, aims to include 141 patients with 5-year FU. After endoscopic resection of T1b EAC (R0), patients are re-staged with endoscopic ultrasound (EUS) and CT/PET. Patients (N0M0) undergo strict endoscopic FU with gastroscopy and EUS. CT/PET is repeated after 1 year. The cohort is divided into ‘high-risk’ (submucosal invasion ≥500um, a/o poorly/undifferentiated tumor (G3–4), a/o lymphovascular invasion (LVI+)) and ‘low-risk’ (risk features absent). Outcome parameters are 5-year disease specific survival, overall survival, rates of LNM and local recurrence.

Results
134 patients (112 men, median age 69) underwent median FU of 22 (IQR 11–35) months: 87 high-risk and 47 low-risk. 6 patients (4% [95%CI 0.2–8.8]) were diagnosed with LNM after median FU of 8 (IQR 5–16) months. 2/6 underwent neoadjuvant chemo(radio)therapy with esophagectomy (ypT0N1M0, ypT0N0M0), 1/6 underwent esophagectomy only (pT0N2M0), 3/6 underwent selective surgical LN resection.
7 patients (5% [95%CI 0.8–9.6] were diagnosed with an intra-luminal tumor recurrence not eligible for endoscopic re-treatment after median FU of 7 (IQR 6–15) months. 2/7 underwent esophagectomy (pT1bN0M0, pTisN0M0), 1/7 had neoadjuvant chemoradiotherapy and esophagectomy (ypT1aN0M0), 3/7 underwent (chemo)radiotherapy only, of which 1 patient eventually died as result of stenosing EAC, 1/7 refused additional treatment.
No distant metastases were diagnosed. Five patients died of an EAC-unrelated cause. Five patients discontinued FU due to old age. Two patients were lost to FU.

Conclusion
The preliminary analysis from our ongoing prospective study suggest that in patients with radically removed high- or low-risk T1b EAC, without LNM at baseline, a strict endoscopic follow-up protocol is feasible and the window for curative therapy remains open for those patients who develop LNM (4%) or a local intra-luminal recurrence (5%) during FU. Most patients demonstrate uneventful FU.
326. LONG-TERM OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY (MERAS) PROTOCOLS IN PERI-OPERATIVE MANAGEMENT OF MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Chen Maohui , Zheng Bin , Huang Yizhou , Zhang Shuliang , Zeng Taidui , Ning Chenhui , Chen Chun 
Published: August 2023

Abstract

Introduction
Enhanced recovery after surgery (ERAS) programs consists of a set of pre-, intra- and post-operative protocols to minimize perioperative burden, reduce postoperative complications and morbidity, optimize postoperative recovery, and shorten hospital stay. The rare studies available demonstrate positive results for long-term survival of ERAS in gastric, colon and rectal cancers, however, it is not clear whether the ERAS regimen can improve the long-term prognosis of esophageal cancer. Therefore, we conducted this study to compare post-operative morbidity, functional recovery, and length of hospital stay in patients undergoing esophagectomy following the implementation of modified ERAS (mERAS) protocols or conventional standard care (SC), and to determine the effect of the ERAS protocol after esophagectomy on long-term survival.
Materials and methods: This retrospective clinical study was conducted from 1st June 2014 to 31st December 2016, included 229 consecutive patients with esophageal carcinoma who underwent esophagectomy. The mERAS protocols were implemented in our department of Fujian Medical University Union Hospital on 1st November 2015. After that time, all patients were treated according to the protocols (mERAS group). And before that time, all patients were treated with conventional standard care (SC group). We chose the cohort of patients, because the patients underwent surgery most recently prior to the patients in mERAS group.

Results
There was no significant difference between the two groups, with the exception of the percentage of patients who had cocomitant disease. The rate of cardiac diseases or hypertension in mERAS group was higher than that in SC group (24.4% vs. 13.8%). Incidence rate of anastomotic leakage was significantly lower in mERAS patients than in SC patients (0% vs. 13.8%, P = 0.000). Incidence rate of chylous leakage was significantly lower in mERAS patients than in SC patients (0.7% vs. 6.4%, P = 0.015). In patients with 5% preoperative weight loss, survival was better in the mERAS group than in the SC group.

Conclusion
The advantage of ERAS concerns the surgeon, care team, the patient and the society as a whole. Our study indicated that implementation of mERAS protocols in patients undergoing minimally invasive esophagectomy could resulted in better postoperative recovery and reduced postoperative complications.
332. NO NEED FOR A SPONGE! ENDOLUMINAL VACUUM THERAPY WITH A SIMPLE FENESTRATED SURGICAL DRAIN FOR MANAGEMENT OF BENIGN OESOPHAGEAL PERFORATIONS
Authors: Sivarajan Sri , Kulasegaran Suheelan , Kumar Bhaskar 
Published: August 2023

Abstract

Background
Conventional endoluminal vacuum therapy (EVT) uses a sponge and can be an effective technique for management of benign esophageal perforations. We describe a unique method of positioning a simple fenestrated surgical drain with applied vacuum suction at or through the site of perforation. We aimed to see whether this was a safe and effective management approach for benign esophageal perforations whilst reducing the frequency and need for general anaesthetic (GA) based endoscopic exchanges.

Methods
A retrospective case-series was performed on consecutive patients with benign esophageal perforations from 2019 to 2023 at a tertiary hospital in the United Kingdom. Included patients had undergone initial management of benign esophageal perforation with EVT and fenestrated surgical drain. The drain was either placed in an intraluminal or intracavitary position depending on the size of perforation. Primary outcome assessed was complete epithelialisation of the fistulous orifice with EVT. Secondary outcomes included: 90-day mortality, Length of Stay (LOS), re-operation, complications, percentage of EVT procedures under GA, duration of EVT and interval between endoscopic exchanges.

Results
Seven patients met inclusion criteria (median age: 66 (23–79) years). In four instances aetiology of perforation was iatrogenic from gastroscopic procedures with remaining cases due to Boerhaave’s syndrome, foreign body ingestion and benign ulceration. Six patients achieved full healing of perforation with EVT, with one patient requiring oesophageal stenting. There was 0%, 90-day mortality and two patients underwent re-operation for thoracic drainage procedures. Median LOS was 22 days and mean duration of EVT was 14 days. Patients underwent on average 2.6 gastroscopies during admission, 75% of which were performed without GA. The mean interval between EVT repositioning/exchange was 8 days.

Conclusion
EVT with a surgical drain achieved complete healing in all but one case of benign esophageal perforation. In contrast to EVT with sponge it can be performed without GA and with a longer duration between drain exchanges and gastroscopies. Additionally, as the same drain can be used for the duration of therapy it may reduce material cost. Further studies should perform prospective and direct comparisons with alternative EVT strategies for benign esophageal perforations.
340. LONG-TERM ONCOLOGIC OUTCOMES OF ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION AND SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Chen Yung-Hsin , Lee Jang-Ming 
Published: August 2023

Abstract

Purpose
For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes.
Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model.

Results
The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1).
For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 &gt; 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved&gt;40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS.

Conclusion
For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes.
Risk factors, such as age &gt; 65, FEV1 ≤ 80%, pathological cancer staging &gt;2, clinical cancer staging &gt;2 and positive resection margin were independently predictive of poor OS.
347. LASER CAPTURE MICRODISSECTION AND WHOLE GENOME SEQUENCING OF ESOPHAGEAL ADENOCARCINOMA SAMPLES WITH MINIMAL TUMOUR
Authors: Wilson Gavin , Cotton James , Liang Sheng-Beng , Allison Frances , Bach Yvonne , Allen Jonathan , Darling Gail , Elimova Elena , Kalimuthu Sangeetha , Yeung Jonathan 
Published: August 2023

Abstract

Background
Esophageal adenocarcinoma (EAC) samples, particularly biopsies, can have low tumour cellularity, which limits their use for sequencing. Previous studies have focused on untreated resection specimens with high cellularity (i.e. TCGA requiring 60% cellularity on histology). Laser capture microdissection (LCM) is a method to enrich tumour cells from histological specimens and has been successfully used in other samples. We hypothesize that LCM can enrich for tumour from biopsies and resection specimens with very low cellularity.

Methods
Biopsy and resection EAC specimens were subjected to laser capture microdissection and whole genome sequencing (N = 49 biopsies and N = 15 resections) as part of the MOCHA trial (NCT04219137). LCM samples were reviewed by a board-certified pathologist to quantify tumour cellularity prior to LCM. Matched germline DNA was extracted from patient blood. Samples were processed using an in-house pipeline to call somatic single nucleotide variants (SNVs), insertions, deletions, copy number changes, and structural variants. Post LCM tumour cellularity was estimated from the WGS data.

Results
We had slightly higher WGS tumour cellularity for biopsies (66.2% +/− 16.8) and resections (71.3% +/− 18.0) than TCGA (58.1% +/− 17.5), while our histological cellularity was much lower than TCGA’s 60% cutoff at 32.2% +/− 24.5 for biopsies and 31.0% +/− 22.7 for resections. Overall, our LCM strategy led to an increase of 35.4 +/− 25.1% for cellularity by WGS compared to the histology. Finally, we observed a similar tumour ploidy and SNV composition as TCGA, which further verified that our tumour enrichment strategy was successful.

Conclusion
We have successfully applied an LCM strategy to enrich for tumour cells from low cellularity specimens. For example, we have successfully enriched for tumour cells from specimens with as low as 1% histological cellularity. We are currently exploring the results of this dataset including clinical correlations, changes in potential driver mutations from biopsy to resection, and comparing our results to treatment response.
349. TOTALLY MECHANICAL STAPLED SIDE-TO-SIDE VERSUS CIRCULAR END-TO-SIDE ANASTOMOSIS FOR MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY: A MULTICENTER ANALYSIS
Authors: Gao Hui-jiang , Yu Xiang-Yang , Hu Shi-Yu , Huang Chu-Jiang , Du De-Long , Yu Xin , Yu Zhen-Tao , Ma Kai 
Published: August 2023

Abstract

Background
Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal cancer. However, it is currently unknown if fully mechanical stapled side-to-side anastomosis for Ivor Lewis TMIE could be preferred for patients in whom both procedures are oncologically feasible.

Methods
The study was performed in 2 high-volume China esophageal cancer centers between Feb 2015 through Dec 2022. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing Ivor Lewis TMIE were included. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reoperations, length of stay, mortality, and overall survival (OS).

Results
147 patients were included in this study. The incidence of anastomotic leakage requiring reintervention or reoperation was 12.9% after fully mechanical stapled side-to-side versus 11.8% after circular end-to-side anastomosis (P = 0.852). Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture (5.7% vs 17.1%, p = 0.032). Pulmonary complications (20.0% vs 23.7%), recurrent laryngeal nerve palsy (7.1% vs 5.3%), chyle leakage (10.0 vs 7.9%), atrial fibrillation (12.9 vs 13.2) and median hospital length of stay (12 vs 11 days) were comparable between the two arms (all P &gt; 0.05). R0 resection rate was similar between the groups. Overall survival was comparable between the two arms (hazard ratio [HR], 0.81, 95% CI, 0.62–1.21, P = 0.208). The cumulative 5-year OS was 44.3% in the fully mechanical stapled side-to-side anastomosis arm, as compared with 39.5% in the circular end-to-side anastomosis arm.

Conclusion
Compared to circular end-to-side anastomosis in patients in whom both procedures are oncologically feasible, there was no significant difference in the incidence of anastomotic leakage and other postoperative morbidity and OS with a fully mechanical stapled side-to-side anastomostic Ivor Lewis esophagectomy. Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture.
361. THE IMPACT OF A PROGRAM TO IMPROVE PREOPERATIVE NUTRITION AND REHABILITATION FOR ESOPHAGEAL CANCER PATIENTS
Authors: Nakano Toru , Koyama Kaori , Sawada Kentaro , Mitamura Atsushi , Miura Tomoya , Kitamura Yo , Sato Yoshihiro , Sakurai Hiroto , Takami Kazuhiro , Nagao Munetaka , Kondo Noriko , Yamamoto Kuniharu , Tsujinaka Shingo , Katayose Yo , Shibata Chikashi 
Published: August 2023

Abstract

Background
Improvement of the preoperative inflammation, nutrition, and other systemic conditions may reduce surgical complications and improve the prognosis of cancer. The usefulness of preoperative nutritional therapy and rehabilitation has recently been discussed. We created a novel program of preoperative rehabilitation and nutritional support to improve postoperative outcomes. We examined the nutritional status and blood electrolyte predisposition before and after this program.

Methods
Thirty five patients who underwent esophagectomy for esophageal cancer. These patients performed muscle strengthening exercise and received jelly beverage containing branched-chain amino acids immediately after rehabilitation and immune-modulating liquid diets for 7 consecutive days before surgery. Nutritional guidance was provided by a dietitian, who set a daily energy target of 30 kcal/kg and a protein target of 1.2 g/kg. Upper and lower limb strength training was performed with a physical therapist. Blood biochemical data on nutrition such as serum Alb, PreAlb, CRP, levels were compared after preoperative support.

Results
Thirty five patients who underwent esophagectomy for esophageal cancer in this period and evaluate their blood and serum samples. The average age of the patients was 66 years, 29 men and 6 women. Serum Alb level was 4.01 ± 0.4 g/dl before admission and 3.74 ± 0.35 g/dl the day before surgery (p = 0.04), and serum transthyretin level was unchanged from 28.9 ± 5.5 mg/dl to 26.1 ± 4.75 mg/dl. Serum CRP level tended to decrease from O.23 ± 0.528 mg/dl before admission to 0.14 ± 0.23 mg/dl the day before surgery. Other index of nutritional status did not change significantly before or after the program.
Improvements in preoperative inflammation and nutrition are expected to decrease surgical complications and contribute to cancer prognosis. Our study and intervention in the present study may have decreased inflammation, although it was not a clear objective improvement in nutritional status. The short duration of the intervention may have prevented a significant difference. A less prolonged hospitalization is not realistic and the most effective nutritional rehabilitation intervention should be devised in the future.
368. UNIPORTAL VATS MCKEOWN ESOPHAGECTOMY FOR LOWER THIRD ESOPHAGEAL SQUAMOUS CELL CANCER
Authors: Rajan Shiv , Kumar Vijay 
Published: August 2023

Abstract

https://wetransfer.com/downloads/bc83bc97967d74f093629397fd7b5ed720230505000919/8c1e7aa0e8a6b089152303025bfbfd7120230505000947/ff511d

Background
Minimally invasive esophagectomy has become the standard surgical procedure for the carcinoma esophagus worldwide. It is performed with multiport VATS or robotically. Uniport VATS technique has gained a recent popularity among thoracic surgeons for resecting lung cancers. Here we describe our technique of performing uniportal McKeown esophagectomy in semi prone position without using carbon dioxide.

Methods
The surgery was performed on a middle aged male patient who was diagnosed with a locally advanced squamous cell cancer of lower third of the esophagus. Multidisciplinary meeting planned three cycles of Docetaxel, cisplatin and 5 fluorouracil regimen and subsequent surgery was planned after patient had a partial response.

Results
The thoracic phase was performed by uniport VATS and abdominal phase was performed by standard multiport technique. Neck anastomosis was performed with linear stapler in side to side manner. Total time of the surgery was 280 minutes. Intraoperative and postoperative period was uneventful. Patient was discharged home on ninth postoperative day on oral diet.

Conclusion
Uniportal VATS McKeown Esophagectomy is a feasible and safe technique with all short term advantages of minimally invasive approach. The coaxial ergonomics together with the semi prone positioning, allows the best surgical maneuvering.
376. DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY
Authors: Chicote Cristina Martínez , Navarro Fernando Mingol , Tamarit Mireia Navasquillo , Sánchez Carmen Gutiérrez , Guerrero-Antolino Pablo , Andrés Beatriz Castro , Olmo Nuria García , Esteban Marcos Bruna , Urbaneja Francisco Javier Vaqué 
Published: August 2023

Abstract

Background
Gastroesophageal reflux is a frequent adverse effect after oncological surgery of the gastroesophageal junction because of the radicality of the intervention and the placement of the anastomosis inside the thoracic cavity. Different surgical techniques have been developed that seek to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, which consists of the creation of a seromuscular flap surrounding the anastomosis.

Methods
Retrospective observational and descriptive study including all patients in whom this technique has been performed from January 2019 to January 2023. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part.

Results
A total of 8 patients were operated. In 2 cases the anastomosis was performed by laparotomy, 1 by laparoscopy, 4 by right thoracoscopy and 1 by left thoracoscopy. Half of the patients had no postoperative complications and the other half had mild ones. Manometry and pHmetry were requested of all patients after 6 months but only performed in 2 due to technical difficulties. In both cases the tests showed no alterations, but one of the patients reported reflux controlled with PPIs. Other suffered from occasional dysphagia and was being treated with periodic endoscopic dilatations.

Conclusions
The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.