bluuebunny/crossref_metadata_2025_split huggingface dataset:
33. QUALITY PERFORMANCE INDICATORS FOR THE SURGICAL TREATMENT OF OESOPHAGEAL CANCER- A SYSTEMATIC REVIEW
Authors: Kulasegaran Suheelan , (Joanna) Wang Yijiao , Woodhouse Braden , Maccormick Andrew , Srinivasa Sanket , Koea Jonathan 
Published: August 2023

Abstract

Background
A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of oesophageal cancer (OC) with the aim of defining a set of QPIs that can be used in accreditation and allowing comparison of treatment and outcomes across jurisdictions, and provide a basis to develop quality improvement programs. These QPIs capture key components of patient care that are fundamental to the overall outcomes.

Methods
A systematic literature review was conducted by searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1st March 2022 included. Search terms utilised were Quality of health care OR Quality improvement OR Quality control OR Quality indicators OR Benchmark, AND Oesophagectomy OR Esophagectomy OR Oesophageal neoplasm OR Esophageal Neoplasm OR Adenocarcinoma OR Squamous Cell Cancer OR Oesophageal resection OR Esophageal Resection OR Oesophageal cancer OR Esophageal Cancer OR Ivor Lewis OR Oesophageal Surgery OR Esophageal Surgery.

Results
Twenty-five articles were included in the final analysis. The selected studies included editorials, retrospective review, prospective review, expert guidelines and consensus. For OC QPIs, process measures included multi-disciplinary meetings, access to perioperative multimodal diagnostic pathways, and surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay.

Conclusions
This systematic review summarises QPIs for the surgical management of OC. The data from this review will form the basis of a project to develop internationally agreed QPIs for OC resections.
39. HIGH PREOPERATIVE PLATELET TO LYMPHOCYTE RATIO IS ASSOCIATED WITH A GREATER RISK OF POSTOPERATIVE COMPLICATIONS AND RECURRENCES IN ESOPHAGEAL CANCER
Authors: Sasahara Masahiro , Kanda Mitsuro , Shimizu Dai , Takami Hideki , Inokawa Yoshikuni , Hattori Norifumi , Hayashi Masamichi , Tanaka Chie , Fujiwara Michitaka , Nakayama Goro , Kodera Yasuhiro 
Published: August 2023

Abstract

Background
Neoadjuvant treatment is currently the gold standard for advanced esophageal squamous cell carcinoma (ESCC). Several studies have examined the value of blood count-based indexes for predicting short- and long-term outcomes after esophagectomy for ESCC, but the relative predictive value of pretreatment, preoperative, and postoperative indexes has not yet been examined.

Methods
This study included 320 patients with thoracic ESCC who underwent subtotal esophagectomy after neoadjuvant chemotherapy or chemoradiotherapy at our institution. A total of 19 candidate blood parameters were measured before neoadjuvant treatment as well as preoperatively and postoperatively. The ability of the parameters to predict postoperative complications, overall survival (OS), and relapse-free survival (RFS) were assessed using receiver operating characteristic (ROC) curve analysis and Cox regression analysis.

Results
ROC curve analysis indicated that preoperative platelet to lymphocyte ratio (PLR) had the best predictive value with an optimal cutoff value of 166. Patients with high preoperative PLR (≥166) had significantly shorter OS and RFS and significantly higher incidences of hematogenous recurrence and postoperative pneumonia compared with patients with low preoperative PLR (&lt;166). In multivariate analysis, high preoperative PLR and high preoperative serum carcinoembryonic antigen level were independent predictors of poor prognosis.

Conclusion
Preoperative PLR is a good predictor of short- and long-term prognosis in patients with advanced ESCC who receive neoadjuvant treatment followed by radical resection.
144. OPTIMIZING MEDIASTINAL ACCESS FOR RADICAL ESOPHAGECTOMY: A BILATERAL CERVICAL AND TRANSHIATAL APPROACH TO RESECT ESOPHAGEAL CANCER
Authors: Xu Wei , Jiang Yuequan 
Published: August 2023

Abstract

Background
Major medical centers have gradually attempted and promoted esophagectomy via mediastinal approach. However, this operation is challenging and requires a high level of technical proficiency from surgeons because of the limited space and restricted visibility of the mediastinum. The current surgical method limits its application in patients with locally advanced esophageal cancer, which underscores an urgent need for optimization to facilitate its refinement and dissemination.

Methods
We have implemented the following enhancements to the surgical procedure: 1. The cervical level was chosen for transecting the esophagus, and then the proximal esophageal stump was pulled down and invaginated. 2. Bilateral cervical incisions were made, with a small 0.5 cm incision at the anterior edge of the right sternocleidomastoid muscle. 3. The position of abdominal surgical incisions was adjusted so that all incisions were located on the left side of the abdominal midline. 4. A portion of the left diaphragm was dissected. 5. During the superior mediastinum procedure, gauze was positioned within the expanded superior mediastinum.

Results
1. The surgical field was fully exposed, expanding the operative space for upper mediastinal surgery. 2. The difficulty of this surgery was reduced, and it was easier to expose both RLNs and completely remove the mediastinal lymph nodes. 3. The 106recR could be completely removed under endoscopy. 4. The thoracic duct could be fully exposed and freed. 5. During surgery, gauze is placed in the upper mediastinum to aid in hemostasis and improve visibility. 6. Even if the tumor was slightly larger or locally invaded surrounding tissues, it could be completely resected. 7.Complete resection of the esophageal mesorectum was successfully achieved.

Conclusion
Esophagectomy for esophageal cancer via bilateral cervical and transhiatal approach can achieve radical resection and can be applied to patients with locally advanced esophageal cancer. This surgical method expands the surgical indications, reduces the surgical difficulty for surgeons, and facilitates the promotion and popularization of the mediastinal approach surgery.
149. LAPAROSCOPIC HELLER CARDIO-MYOTOMY IS NOT ALWAYS A SAFE OPERATION
Authors: Ezz Reda 
Published: August 2023

Abstract

Background
Laparoscopic Heller cardio-myotomy is the standard surgical treatment of achalasia. Although POEM (Per-oral endoscopic myotomy) has gained wide acceptance among gastroenterologists, yet many surgeons are still loyal to this operation. One of the complications of the operation which could happen is esophageal or gastric perforation during the myotomy. Intra-operative detection of the perforation and meticulous repair is very important to prevent serious sequelae.

Methods
Between may 2021 and Jan 2023, 46 cases of achalasia (Type I and II) were treated by laparoscopic Heller cardio-myotomy and anti-reflux procedure (Dor or Toupet). Myotomy was performed using muscles splitting combined with either harmonic or hook diathermy. Intra-operative perforations were reported and were repaired in all cases and tested for absence of leakage. Post-operative follow up of cases having intraoperative perforations and its management were documented. For those having perforations postoperative gastrographin swallow and meal was done and oral fluids intake started second postoperative day.

Results
Perforations occurred in 11 cases (24%) and were repaired using 3 l0 suture: monofilament non-absorbable suture: prolene (polypropyelene, J&J MedTech) in 4 cases, monofilament absorbable suture monocryl (poliglecaprone 25, J&J MedTech) in 3 cases and vicryl (polyglactin 910, J&J MedTech) in 4 cases.
Smooth post-operative recovery was noted in 7 cases having perforations (64%). Four patients (36%) developed Leakage second postoperative day confirmed by investigations. All these cases were repaired with Vicryl. Endoscopic stent was inserted with improvement of the condition in 3 cases (75%). One patient required reoperations twice and expired in the 29th day postoperative from ARDS.

Conclusion
Although perforations could happen during laparoscopic Heller cardio-myotomy, it has a benign postoperative course in most cases. This doesn’t mean that it is a simple operation. Laparoscopic Heller cardio-myotomy should be done in highly specialized esophageal center because its complications could lead to death if badly managed.
151. INFLUENCE OF PERIOPERATIVE ANEMIA ON MORBIDITY AND MORTALITY OUTCOMES AFTER RADICAL ESOPHAGECTOMY
Authors: Guerrero-Antolino Pablo , Bruna Marcos , Vaqué Javier , García Nuria , Nieto Marta , Quevedo David , Menéndez Miriam , Navarro Fernando Mingol 
Published: August 2023

Abstract

Objectives

Methods
Retrospective and analytical study of patients who underwent radical esophagectomy for esophageal cancer performed in our institution from 2015 to 2021.
Several parameters related to anemia were measured: hemoglobin, ferritin, transferrin saturation and iron blood levels, as well as the need for perioperative blood transfusion. We analyzed, on the one hand, the incidence of complications in the immediate postoperative period. On the other hand, we assessed the results of overall survival and disease-free survival in relation to tumor disease.

Results
A total of 137 patients treated for esophageal neoplasia were included. The interventions performed were McKeown/Ivor-Lewis esophagectomy. Up to 106 (77,4%) patients received neoadjuvant therapy.
Patients who required transfusion in the perioperative period (35 patients; 26%) had a significantly lower mean survival (33 vs. 53 months). In addition, they presented higher rates of postoperative complications as well as a lower 5-year overall survival (Log Rank; p = 0.004). Patients with preoperative hemoglobin levels below 12 g/dL had a significantly higher recurrence rate (21% vs. 7%; p &lt; 0.05).
The anemic status was improved after the implementation of a multimodal prehabilitation protocol (12.1 g/dL versus 13 g/dL).

Conclusions
Radical esophagectomy is associated with high morbidity and mortality. Minimally invasive surgery has improved intra and postoperative outcomes. Despite this, the risk of intraoperative bleeding is not negligible. Therefore, it is essential for the patient to be in an optimal clinical and analytical status.
Multimodal prehabilitation could improve this status and the postoperative recovery. Studies with a larger number of patients and a longer follow-up will be necessary to evaluate the impact of this strategy.
167. NATIONAL TRENDS IN TECHNIQUE UTILIZATION FOR ESOPHAGECTOMY: DOES PRIMARY SURGEON SPECIALTY MATTER?
Authors: Dyas Adam , Mungo Benedetto , Stuart Christina , Mungo Alison , Mitchell John , Randhawa Simran , David Elizabeth , Stewart Camille , Mccarter Martin , Meguid Robert 
Published: August 2023

Abstract

Background
Cardiothoracic surgeons (CTS) and general surgeons (GS; including surgical oncologists) perform the vast majority of esophagectomies nationwide. We hypothesize that different clinical focus and training background could lead to different distribution in the use of open and minimally invasive surgery (MIS) techniques. Furthermore, we sought to explore whether specialty driven differences in surgical approach affect outcomes.

Methods
In a retrospective review of the ACS-NSQIP esophagectomy targeted participant user file (2016–2018), patients who underwent esophagectomy were sorted into CTS and GS cohorts. Perioperative characteristics and postoperative outcomes were compared using chi-square analysis or independent t-tests. Multivariate logistic regression controlling for perioperative variables was performed to generate risk adjusted odds ratios of postoperative outcomes by specialty.

Results
Of 3247 patients included, 1792 (55.2%) underwent esophagectomy by CTS and 1455 (44.5%) by GS as primary surgeon. CTS were more likely to use traditional MIS (p = 0.0004) or open approach (p &lt; 0.0001) and less likely to use robotic surgery (p = 0.04) or a hybrid robotic/traditional approach (p &lt; 0.0001) (Figure). CTS performed more Ivor Lewis esophagectomies and fewer transhiatal and McKeown esophagectomies (p &lt; 0.0001). After risk-adjustment, there were no differences in rates of post-esophagectomy complications or rate of positive margins between CTS and GS (all p &gt; 0.05). However, CTS were more likely to treat anastomotic leaks with surgery rather than other procedural interventions.

Conclusion
CTS and GS use MIS subtypes differently within esophagectomy. However, all risk adjusted differences in postoperative complications were driven by patient and operative characteristics rather than surgical subspecialty. Esophagectomy is being performed safely by surgeons with different clinical specialties and training pathway, with no differences in perioperative and oncologic outcomes.
173. FEASIBILITY AND POTENTIAL ADVANTAGE OF ROBOT-ASSISTED ESOPHAGECTOMY FOR CT4B ESOPHAGEAL CANCER
Authors: Makino Facs Tomoki , Momose Kota , Yamashita Kotaro , Tanaka Koji , Eguchi Hidetoshi , Doki Yuichiro 
Published: August 2023

Abstract

Background
Advantages of robot-assisted esophagectomy (RAMIE) includes operator-led stable surgical field with stereoscopic HD surgical vision and robotic instruments with EndoWrist technology. However, feasibility and potential benefit of RAMIE for cT4b thoracic esophageal cancer remain unclear.

Patients
A total of 16 cases with cT4b esophageal cancer treated with RAMIE between Feb, 2019 and April, 2023 were reviewed. Surgical technique and peri-operative factors in addition to short term outcome were evaluated in the present study.

Results
Background parameters of all 16 cases are as follows; median age = 70.5(42–81), gender (male/female) = 10/6, histology (SCC/Adenoca) =13/3, tumor location (Ut/Mt/Lt) = 4/6/6, invaded organs (Tr/Br/Ao/other) = 7/2/2/5, cN0/1/2/3 = 1/10/4/1, cM0/1 = 11/5, cStage3/4 = 11/5, and preoperative treatment (none/chemotherapy/CRT/both) = 0/9/6/1. In terms of surgical outcomes, median operation time/console time (thoracic procedure) were 506 (403–833)/253 (194–459) min while estimated blood loss was 116 (15–2090) ml. R0 resection was achieved in all cases without conversion to open procedure. Overall postoperative morbidity (Clavien-Dindo classification≧grade3) was 31.3% and the common morbidities were palsy of recurrent laryngeal nerve (n = 2) and anastomotic leakage (n = 2), followed by chylothorax (n = 1), pneumonia (n = 1), and non-occlusive mesenteric ischemia (n = 1). No hospital death (within 90 days) was identified and median postoperative hospital stay was 21 (14–142) days. Surgical videos of cT4b cases to show in our presentation include #1; Mt cT4 (Ao, ltPV) case previously treated with definitive CRT followed by immunotherapy where combined resection of aortic adventitia layer was performed by RAMIE and #2; Ut, cT4 (Tr, ltSCA) case previously treated with definitive CRT. We also discuss potential advantages of RAMIE over conventional approach together with protective measures to be taken in cT4b cases.

Conclusion
RAMIE for cT4b esophageal cancer seems to be feasible and might have potential advantage over conventional approach.
204. CORRELATION OF CIRCULATING T LYMPHOCYTES WITH RESPONSE TO NEOADJUVANT CHEMOIMMUNOTHERAPY IN OPERABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Li Kunzhi , Huang Yixuan , Yang Mu , Wang Kangning , Wei Xing , Zhou Qiang , Han Yongtao , Miao Yan , Fang Qiang 
Published: August 2023

Abstract

Background
There is growing evidence indicating that neoadjuvant chemotherapy combined immune-oncology therapy (neoCTIO) with anti-PD-1 antibodies is effective in esophageal squamous cell carcinoma (ESCC). However, the precise benefits remain unclear. This study aimed to explore whether the subsets and production of effector cytokines in circulating T lymphocytes were correlated with response to neoCTIO with toripalimab in operable ESCC.

Methods
ESCC patients staged cT2N1–2 M0 or cT3–4aN0-2 M0, with ECOG PS 0–1 status randomly received two cycles of different sequences of toripalimab plus chemotherapy (paclitaxel and carboplatin) on day 1 to 2 of each 21-day cycle. Minimally invasive esophagectomy (MIE) was performed 4–8 weeks after neoCTIO. Peripheral blood was collected before and after neoCTIO. Flow cytometry was used to detect the effector cytokines and subsets of CD8+ and CD4+ T lymphocytes. The primary endpoints were the advanced change of subsets, effector cytokines in T lymphocytes, and pathological complete response (pCR). The secondary endpoints included major pathological response (MPR) (NCT05044728).

Results
96.7% (32/33) patients received MIE with R0 resection. 18.8% (6/32) patients achieved pCR and 31.3% (10/32) patients achieved MPR. In the responders, CD8+ T lymphocytes showed higher IFNγ and TNFα coexpression compared to non-responders before neoCTIO (P = 0.010). The responders had higher frequency of effector subsets (P = 0.029) and lower naive subsets (P = 0.006) of CD8+ T lymphocytes than the non-responders before neoCTIO. No difference was found in the cell frequency of CD4+ T lymphocyte subsets between the responders and non-responders. There was no correlation between the change of subsets, effector cytokines in T lymphocytes and the sequence of neoCTIO.

Conclusion
NeoCTIO with toripalimab is effective in the treatment of ESCC. The baseline frequency of effector subsets and coexpression of IFNγ and TNFα in circulating CD8+ T lymphocytes have positive predictive value while the baseline frequency of Naive subsets is a negative biomarker. CD4+ T cell subsets have no correlation with the treatment response. The change of circulating CD8+ T lymphocytes is not affected by the sequence of neoCTIO.
219. ASSOCIATION BETWEEN VIDEO-BASED SURGICAL PERFORMANCE AND PATIENT OUTCOMES IN MINIMALLY INVASIVE ESOPHAGECTOMY IN THE NETHERLANDS
Authors: Ketel Mirte , Klarenbeek Bastiaan , Abma Inger , Det Marc , Esser Stijn , Law Simon , Steur Wobbe , Sosef Meindert , Wijnhoven Bas ,   MIE-CAT NL Collaboration Group, Hannink Gerjon , Rosman Camiel , Workum Frans 
Published: August 2023

Abstract

Background
Increasing evidence shows substantial variation in surgical performance measured by a (video-based) competency assessment tool (CAT). Moreover, suboptimal surgical performance has been associated with less favorable patient outcomes in complex minimal invasive procedures. It is likely this also applies for minimally invasive esophagectomy (MIE). In a previous study a CAT for MIE (MIE-CAT) was developed and validated. The present study investigated the association between surgical performance and postoperative outcomes of MIE in the Netherlands.

Methods
A nationwide observational video analysis study was performed. All fifteen Dutch hospitals performing MIE voluntarily submitted all patient outcomes from the 2020–2021 Dutch Upper-GI Clinical Audit registry, and two representative surgical videos from 2022. Surgical performance was assessed by 7 blinded and independent expert MIE surgeons with the MIE-CAT. Hospitals were divided into quartiles based on their performance score. Multilevel logistic regression, with clustering of patients within hospitals, was used to study associations between surgical performance and patient outcomes. Primary outcome was severe postoperative complications (Clavien-Dindo ≥3) within 30 days after surgery.

Results
Highest- (mean MIE-CAT 113.6, SD 5.5, n = 3) versus lowest-performance-quartile (mean 94.1, SD 5.9, n = 3) had more MIE experience (Pearson’s r = 0.74, 95%CI 0.32–0.92), larger volumes (Pearson’s r = 0.46, 95%CI -0.13-0.81) and favorable outcomes (Figure 1). Performance of highest- versus lowest-quartile was statically significantly associated with less complications (severe postoperative (RR, converted from OR, = 0.50, 95%CI 0.24–0.99), peroperative (RR = 0.21, 95%CI 0.04–0.94) and any postoperative (RR = 0.54, 95%CI 0.24–0.96)), less conversions (RR = 0.21, 95%CI 0.21–0.21) and a 11.5% absolute chance reduction of severe postoperative complications for an average patient. Increased anastomotic-phase performance was associated with less anastomotic leakage (RR = 0.14, 95%CI 0.06–0.31).

Conclusion
This Dutch nationwide study showed statistically significant and clinically relevant associations between surgical performance and outcomes of patients undergoing MIE. An average patient has a 11.5% absolute chance reduction of a severe postoperative complication when operated in a highest-performance quartile hospital, compared to a lowest-performance quartile hospital. These findings show that good surgical performance is an essential aspect for good clinical outcomes.
230. SURVIVAL OUTCOMES OF ROBOT-ASSISTED TRANS-MEDIASTIONAL ESOPHAGECTOMY IN PATIENTS WITH CT1N0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Yajima Shoh , Yagi Koichi , Aikou Susumu , Okumura Yasuhiro , Mitsui Takashi , Nishida Masato , Yamagata Yukinori , Yamashita Hiroharu , Nomura Sachiyo , Mori Kazuhiko , Seto Yasuyuki 
Published: August 2023

Abstract

Background
We have developed a robot-assisted trans-mediastinal esophagectomy (RATME) to reduce the surgical invasiveness of open trans-thoracic esophagectomy (oTTE). However, the long-term outcome of esophageal cancer patients who underwent RATME remains unclear.

Methods
Patients who underwent RATME or oTTE for clinical T1N0 esophageal squamous cell carcinoma were enrolled in this study. The clinicopathological and surgical details, overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS) were compared between the RATME and oTTE groups.

Results
Forty-three and 47 patients who underwent RATME and oTTE, respectively, were included in this analysis. The RATME group included more male patients and had a significantly lower comorbidity index. There was no significant difference in age, tumor location, preoperative ESD rates, and pathological TNM factors between the two groups. The RATME group showed a longer operation time, less blood loss, low incidence of pneumonia, and shorter hospital stays. The OS and DFS rates in the RATME tended to be higher than in the oTTE group; The 5-year OS rates were 88.4 vs 71.5%, and the 5-year DFS rates were 81.4 vs 62.8% (RATME vs oTTE group, p = 0.09 and p = 0.11). The CSS in both groups were equivalent; The 5-year CSS rates were 93.7 vs 92.4% in the RATME and oTTE groups respectively. The RATME group had significantly fewer deaths than the oTTE group (p = 0.032).

Conclusions
The RATME group tended to show better OS and DFS than the oTTE group. The OS of the RATME group was equivalent to that of the comprehensive registry data in Japan, indicating that RATME radicality is guaranteed.