bluuebunny/crossref_metadata_2025_split huggingface dataset:
383. DEVELOPMENT OF PERSONALIZED ‘LIQUID BIOPSY’ FOR ESOPHAGEAL ADENOCARCINOMA FROM MATCHED ORGANOID CULTURE
Authors: Rispoli Thaiane , Shathasivam Premalatha , Aiyar Niharikaa , Allen Jonathan , Allison Frances , Bach Yvonne , Darling Gail , Wilson Gavin , Yeung Jonathan 
Published: August 2023

Abstract

Background
Recurrent mutations are not a hallmark of esophageal adenocarcinoma (EAC). This challenges the identification of circulating tumor DNA in the plasma and can limit the development of liquid biopsy strategies. We have cultured patient-derived EAC organoids and hypothesize that these can be used as a roadmap for the identification of circulating tumor DNA in the corresponding patient’s blood.

Methods
EAC tumor tissue from patients was processed to generate patient-derived organoids (PDOs) in Matrigel domes. Established PDOs were then scaled-up in suspension culture. To isolate mononucleosomes (147 bp), chromatin from these cells was extracted and digested with micrococcal nuclease (MNase). Right size selection was used to remove DNA larger than the targeted 147 bp. Next Generation Sequencing will be performed for nucleosome mapping and to generate a personlized SNV map. Using the SNV map, a personalized PCR panel will be developed to detect circulating tumor somatic variants in patient plasma cfDNA.

Results
DNA from three different PDOs were collected and MNase digested. MNase concentration and digestion time were optimized for each sample to avoid over digestion. MNase digestion resulted in mononucleosomes at approximately 147 bp for all three samples, as well as large DNA segments between 300 to 8000 bp. Right size selection resulted in isolation of 34 to 48 ng of the mononucleosome peak. These results indicate that MNase digestion was successful in generating nucleosomes of the desired size range and the selected nucleosomes were of high quality, as confirmed by the Bioanalyzer. Samples will be subjected to next-generation sequencing.

Conclusion
This study will determine nucleosome SNVs maps in circulating cell-free DNA from EAC patients to allow for generation of optimized targeted PCR panels, prediction of recurrence based on specific variants unique to each patient, and development of more precise drug screening. These advantages have the potential to fill a void in early cancer detection and the prediction of cancer recurrence, leading to improved prognoses for individuals diagnosed with EAC.
394. USEFULNESS OF INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING IN REDUCING RECURRENT LARYNGEAL NERVE PARALYSIS AFTER ROBOT-ASSISTED THORACOSCOPIC ESOPHAGECTOMY
Authors: Koyanagi Kazuo , Tajima Kohei , Kanamori Kohei , Ogimi Mika , Shoji Yoshiaki , Ninomiya Yamato , Yamamoto Miho , Kazuno Akihito , Nishi Takayuki , Nabeshima Kazuhito 
Published: August 2023

Abstract

Background
Robot-assisted thoracoscopic esophagectomy (RAMIE) is a precise and safe procedure with its advantages. On the other hand, RAMIE has several disadvantages. The lack of tactile function must be fully recognized, and surgical procedures must take the characteristics into account. We examined whether the findings obtained by intraoperative recurrent nerve monitoring (NIM) are useful in reducing recurrent laryngeal nerve paralysis (RLNP) after RAMIE.

Methods
Overall, 81 cases of RAMIE through February 2023 were included in the study. NIM was performed in 41 patients in the first term using a combination of continuous and intermittent methods (NIM group). In the subsequent 40 patients, NIM was not performed (non-NIM group) in order to confirm the learning effect of NIM and to shorten the operation time. RLNP was confirmed by a combination of symptoms and postoperative laryngoscopy. Clinical and oncological factors and short-term outcomes of the two groups were compared.

Results
All postoperative RLNP occurred on the left side. Six patients (14.6%) in the NIM group had Grade 1 or higher RLNP. The causes of RLNP were all found during thoracic manipulation; 4 cases of over-traction of RLN and 2 cases of crush injury by robotic forceps. There was a significant decrease in RLNP of Grade 2 or higher; 4 patients (9.7%) in the NIM group and 0 in the non-NIM group (p = 0.04). In the non-NIM group, there was a reduction in thoracic operative time, total operative time, and thoracic blood loss.

Conclusion
NIM made us aware of surgical maneuvers that cause RLNP after RAMIE. Although the proficiency of the RAMIE technique may have played a role in the reduction of RLNP in the later period, avoidance of risky surgical procedures due to the learning effect from the NIM was thought to have contributed to the decrease in RLNP.
397. LEFT PILLAR PINCHING TECHNIQUE FOR MINIMALLY INVASIVE REPAIR OF PARA-CONDUIT HERNIA
Authors: Joglekar Shantanu , Sane Saee , Liu David , Duong Cuong 
Published: August 2023

Abstract
Surgical repair of the para-conduit hernia provides an increasing challenge in the era of minimally invasive oesophagectomy. The key principles are preservation of the gastric conduit and its right gatro epiploic vascular arcade, and durable closure of the defect.
Of various methods, posterior crural repair is difficult without mobilising and risking and kinking the conduit, while anterior repair of a big defect requires the adjunct of a mesh which carries its own risks of infection or erosion. There is no consensus on the appropriate surgical technique.
We propose that the Left pillar of the hiatus be pinched to provide an effective repair. This is safe as dissection and suturing is well away from the conduit and arcade. We find the left pillar to be adequately mobile to allow repair, and the sutures sit in the tendinous portion of the left hemi diaphragm to provide durability.
We provide 2 videos to describe the key steps in this technique and demonstrate that this technique is effective in both small and large defects, and acute and chronic para-conduit hernia.
Link: https://1drv.ms/v/s!Anu-cyBTuGbsgbxtX8aLf2P1YEPl9g?e=fXz7Pm.
Please contact me, shantjog@gmail.com if this link does not work and I will explore an alternative method to share the video.
Many thanks.
408. COMPARISON OF THE SHORT-TERM EFFICACY OF THORACOSCOPY COMBINED WITH GASTROSCOPY AND TRADITIONAL THORACOTOMY IN THE TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE
Authors: Tang Shoujun , Zhou Haining , Zhong Chuan 
Published: August 2023

Abstract

Background
Early and thorough intrathoracic debridement，irrigation and catheter drainage are of great significance for the healing of esophageal rupture. This study aims to explore the surgical treatment of spontaneous esophageal rupture, reduce the trauma and improve the cure rate.

Methods
A total of 21 patients with spontaneous esophageal rupture were selected from June 2010 to June 2022. In the thoracoscopy combined with gastroscopy group, 12 patients were treated with thoracoscopic debridement, esophageal rupture repair, thoracic drainage with closed drainage tube, nasal drainage with gastroscope and nasal duodenal feeding tube placement. In the thoracotomy group, 9 patients performed scheduled thoracotomy.

Results
Compared with the thoracotomy group, the thoracoscopy combined with gastroscopy group had less incision pain, shorter operation time, less surgical bleeding, and lower incidence of incision infection, pulmonary infection and arrhythmia, with statistical significance (P &lt; 0.05), while the incidence of anastomotic fistula and mortality showed no statistical significance (P &gt; 0.05).

Conclusion
Spontaneous esophageal rupture is an emergency in thoracic surgery, and the combined operation of thoracoscopy and gastroscopy after early diagnosis has less trauma, faster recovery and good therapeutic effect.
411. SINGLE-PORT THORACOSCOPIC RESECTION FOR THE SPINDLE CELL TUMOR OF ESOPHAGUS
Authors: Zhou Haining , Tang Shoujun , Zhong Chuan 
Published: August 2023

Abstract

Backgroud
Single-port thoracoscopic for the huge spindle cell tumor of esophagusis is one of the most challenging surgeries. Here we reported a rare case of huge spindle cell tumor of esophagusis to explore the application of single-port thoracoscopic in esophageal resection.

Methods
A 61-year-old female was admitted due to swallow obstruction with breath tight for 1 month. The enhanced CT showed an irregular mass in the right posterior superior mediastinum close to the cephalic trunk, superior vena cava, right superior pulmonary artery and azygos vein, with tracheal and esophageal displacement. The differential diagnosis is potentially large, including lymphoma, lung cancer, bronchial cysts, esophageal tumors, etc. Ultimately we decided to use single-port thoracoscopic surgery for a biopsy or a complete resection of the tumor based on the intraoperative conditions.

Results
During the operation, we found that the tumor was located in the right posterior superior mediastinum and originated from the intrinsic muscular layer of the esophagus. The spindle cell tumor of esophagus resection by single-port thoracoscopic approach was carried out successfully. Pathological examination revealed esophageal leiomyoma.

Conclusion
The single-port thoracoscopic resection for the spindle cell tumor of esophagus is feasible and comprehensive.
438. NO ROBOT, NO PROBLEM. LAPAROSCOPIC TREATMENT OF LARGE HIATAL HERNIAS
Authors: Brandalise Andre , Aranha Nilton Cesar , Lorenzetti Claudia , Brandalise Nelson Ary 
Published: August 2023

Abstract
Large paraesophageal hernias are always a challenge to the surgeons. Robotic platforms add advantages to theses technically challenging surgical procedures, but it is not available in many parts of the world.
Laparoscopy is still the most common approach and we present a video of different tips and tricks and some key steps to achieve better results.
https://www.dropbox.com/s/lx6lqmzw9h6vn8b/Large%20Hernias%20ISDE.mov?dl=0.
451. ISOFORM SWITCHING EVENTS MAY PROVIDE NEW INSIGHT FOR THE IDENTIFICATION OF PROGNOSTIC AND THERAPEUTIC TARGETS IN ESOPHAGEAL ADENOCARCINOMA
Authors: Zhang Yun , Howard Connor , Israel Rachel , Vandenburg Bryce , Barnett Shari , Riethoven Jean-Jack , Clarke Jennifer , Lagisetty Kiran , Lin Jules , Reddy Rishindra , Chang Andrew , Kresty Laura A 
Published: August 2023

Abstract

Background
Esophageal adenocarcinoma (EAC) represents a growing health problem characterized by rising incidence and poor prognosis due to late-stage diagnosis coupled with treatment resistance. Although EAC is a cancer with a high mutational burden, it lacks highly prevalent oncogenic drivers that can be therapeutically targeted. Herein, we investigated whether isoform switching events, defined as a change of the dominant gene isoform, may offer prognostic or therapeutic value in EAC.

Methods
We conducted RNA-sequencing on RNA isolated from patients undergoing esophagectomy following a diagnosis of EAC or Barrett’s with high-grade dysplasia (BE.HGD). Isoform switching events between Barrett’s low-grade dysplasia (BE.LGD) and BE.HGD + EAC alone or in combination with TP53 mutation were identified using IsoformSwitchAnalyzeR. Patients were stratified into tertiles based on isoform expression level, followed by cancer-free survival analysis using the log-rank test. To evaluate whether mortality-linked isoforms influence cancer cell growth, viability, migration and response to standard chemotherapy (Paclitaxel and Carboplatin), isoform-specific siRNA knockdown experiments targeting TTLL12 and HM13 were performed in OE19 and OE33 EAC cell lines.

Results
Isoform switching events were identified in 71 genes comparing BE.LGD with BE.HGD + EAC, with 10 isoforms significantly associated with cancer-specific patient mortality. With the inclusion of TP53 mutation status, 67 genes were isoform-switched and 16 isoforms were significantly linked with cancer-specific mortality. Knockdown of TTLL12 and HM13 isoforms, two survival-linked isoforms, led to significant inhibition of cell viability and inhibition of cell migration in EAC cell lines. Moreover, combination treatment of isoform-specific siRNA and chemotherapeutic agents further decreased cell viability with synergistic effects observed in both cell lines suggesting a role for specific isoform switches in therapeutic sensitization.

Conclusions
Our research identified specific isoform switching events significantly linked to increased cancer mortality among EAC patients. Gene knockdown studies of two identified isoforms led to significant inhibition of EAC cell migration and viability with synergy observed when cells were treated with both siRNA and standard chemotherapeutic agents. In conclusion, identification of isoform switching events may provide fresh insight for the identification of prognostic markers and inform new potential therapeutic targets for EAC treatment or prevention.
453. TREATMENT AND SURVIVAL OF PATIENTS WITH A POSITIVE RESECTION MARGIN AFTER NEOADJUVANT CHEMORADIOTHERAPY AND ESOPHAGECTOMY
Authors: Zijden Charlène , Sluis Pieter , Mostert Bianca , Nuyttens Joost , Spaander Manon , Valkema Roelf , Ruurda Jelle , Wijnhoven Bas , Lagarde Sjoerd 
Published: August 2023

Abstract

Background
Esophagectomy after neoadjuvant chemoradiotherapy (nCRT) is associated with a tumor-positive resection margin in 4–9% of patients. Although survival in patients with a positive margin is decreased, Western guidelines do not recommend adjuvant systemic/local treatment after esophagectomy. The aim of this study was to assess whether patients underwent adjuvant therapy, regardless the lack of evidence from guidelines, and to evaluate the overall survival (OS) in patients that underwent esophagectomy and had a positive resection margin.

Methods
All patients diagnosed with resectable (cT2-4a/cTxN0–3/NxM0) esophageal or junctional cancer that underwent nCRT followed by esophagectomy between 2015 and 2021 were selected from the Netherlands’ Cancer Registry. Included were patients with a tumor-positive resection margin. The primary endpoint was the proportion of patients that started adjuvant treatment ≤16 weeks after esophagectomy, including chemotherapy, radiotherapy, immunotherapy or targeted therapy. Secondary outcome OS was calculated from date of surgery until date of death or last day of follow-up, using the Kaplan Meier method.

Results
Among the 300 included patients, 98.7% had a microscopically irradical resection (R1), while 1.3% had a macroscopically irradical resection (R2). The median age was 67 (interquartile range 60–72) years and WHO 0–1 (89.3%). Esophagectomy was performed open (8.3%), laparoscopically (57.7%) or robot-assisted (33%) and via transthoracic (89.7%) or transhiatal approach (8.7%). Some 71% of tumors had a partial response (Mandard category 1–3) or no pathological response (Mandard 4–5; 12.7%) to nCRT. One patient underwent external radiotherapy after esophagectomy. Twenty patients (7%) underwent adjuvant immunotherapy (nivolumab), despite their irradical resection. Median OS of all patients was 18.6 months (95% CI 14.7–22.4).

Conclusion
Real-world population level data showed that 7% of patients were treated with adjuvant immunotherapy, despite lack of evidence of the benefit thereof in patients with an irradical resection. This underlines the need for better neoadjuvant therapy leading to less irradical resections, as well as prospective studies evaluating adjuvant therapy in patients with an irradical resection.
456. PHYSICAL ACTIVITY AND FRAILTY AS PART OF HEALTH RELATED QUALITY OF LIFE ASSESSMENT IN ESOPHAGEAL CANCER SURVIVORS AFTER CURATIVE ESOPHAGECTOMY
Authors: Boyle Ellen , Elliott Jessie , Greene Christine , Murphy Conor , Donlon Noel , Donohoe Claire , Ravi Narayasamy , Reynolds John 
Published: August 2023

Abstract

Background
Survival rates for patients with esophageal cancer are improving, resulting in an increasing population of esophageal cancer survivors. Surgery is the mainstay of treatment but has a high risk of post-operative morbidity. This study aimed to characterise health related quality of life with a specific focus on physical activity and frailty assessment within an esophageal cancer survivor population.

Methods
This was a cross-sectional cohort study of patients who underwent esophageal cancer surgery between 2010 and 2015. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Linear and logistic regression analyses were utilised to determine the impact of treatment and pathologic variables on physical activity and frailty.

Results
On multivariable analysis, age was a significant predictor of level of physical activity (P = 0.001). Male sex, critical care length of stay and eating symptoms were independent predictors of frailty in both the PRISMA7 and SARCF tools (all P &lt; 0.001). Inpatient length of stay (P &lt; 0.001) and persistent eating symptoms following treatment (P &lt; 0.001) were both predictive of physical function following completion of treatment.

Conclusion
Curative esophagectomy can have significant effects on patients physical function, levels of physical activity and risk of frailty. Current methods of assessing health related quality of life in esophageal cancer survivorship may under-investigate the effects of curative esophagectomy on physical activity and frailty. Further research is warranted to investigate how patient pathways can be enhanced to minimise the long-term health-related quality of life impact of curative treatment.
460. INTRAEPITHELIAL EOSINOPHILS IN ACHALASIA PATIENTS ARE NOT UNCOMMON, BUT THEY SEEM NOT RELATED TO THE COURSE OF THE DISEASE
Authors: Costantini Andrea , Forattini Francesca , Ghisa Matteo , Angerilli Valentina , Provenzano Luca , Capovilla Giovanni , Vittori Arianna , Nezi Giulia , Costantini Mario , Valmasoni Michele , Fassan Matteo , Savarino Edoardo , Salvador Renato 
Published: August 2023

Abstract

Background
The presence of intraepithelial eosinophils (IE) was described in patients with esophageal motor disorders (EMD). Conversely, EMD and even achalasia were reported in patients with eosinophilic esophagitis (EoE). The purpose of this study was to further investigate this possible association.

Methods
From February to July 2022, patients with achalasia undergoing laparoscopic myotomy were evaluated. Patients who had previous treatment were excluded. Immediately before the operation, the patients underwent endoscopy with the addition of 4 biopsies from the proximal, middle and distal esophagus and from the Z line, respectively. Two additional samplings of the esophageal muscle were taken while performing the myotomy. The specimens were stained with H&E in order to highlight the presence of eosinophils and the number of IE eventually present in a high-power field (hpf) was recorded. Patients were re-evaluated 6 months after the operation.

Results
A total of 30 patients with a median age of 45.5 years were studied. Their preoperative ES was 6 (5–7) and the median duration of symptoms was 42 months (12–120); there were 18 stage I, 9 stage II, 2 stage III and only one stage IV, respectively; manometric subtype 1 was found in 7 patients, subtype 2 in 18 and subtype 3 in 5. There were no complications. All the patients had a good outcome and the median ES was 0 (0–1). IE were found in 6 patients (20%) [median 6/hpf (2–10)]. Only one patient met the pathologic criteria for EoE, whereas only one additional showed eosinophils in the muscular specimen. No differences in preoperative and postoperative data were found between patients with and without IE, but the maximum diameter of the gullet was narrower in the former than in the latter (3.24 cm vs 22.50 cm, respectively, p &lt; 0.05).

Conclusions
EoE and achalasia are 2 of the commonest causes of dysphagia and an association between them was recently hypothesized. Our study confirmed that IE are present in some patients with achalasia, but seldom meeting the criteria for EoE. Only a narrower esophagus was found in patients with IE as compared to those without, possibly reflecting an earlier stage of the disease.
478. ROBOTIC REPAIR OF EPIPHRENIC DIVERTICULUM
Authors: Bianchi Edno Tales , Szachnowicz Sergio , Cirlinas Alexandra , Sallum Rubens 
Published: August 2023

Abstract
We show a robotic repair of a epiphrenic diverticulum in a patient with a previous treatment 10 years ago by laparoscopic with diverticulectomy with a heller miotomy. This time we performed a complete ressection with a new miotomy in a thoracic aproach https://drive.google.com/file/d/1ancYQoy9csA1NjXhswGuDtkd1EjR0M7B/view?usp = sharing.
483. INTRAOPERATIVE EVALUATION OF HIATAL HERNIA SIZE AND CANDIDACY IN TIF ELIGIBLE PATIENTS
Authors: Harrison Madison , Stiles Erik , Hubka Michal 
Published: August 2023

Abstract

Background
Transoral incisionless fundoplication (TIF) is gaining prominence in treatment of gastroesophageal reflux disease (GERD) for patients with absent or small hiatal hernia. As TIF gains popularity, appropriate patient evaluation and selection is paramount in establishing anatomical candidacy hence successful outcome. We evaluated patients who were intended to be treated with TIF and underwent a standard evaluation but instead underwent robotic hiatal hernia repair. We compared their preoperative evaluation of hernia size with intraoperative findings.

Methods
A cohort of seventy-six patients from a single-center database from January 2020 to March 2023 were retrospectively analyzed. All were deemed candidates for TIF based on our inclusion criteria (pH confirmation of GERD, hiatal hernia &lt;2 cm) and underwent preoperative testing with endoscopy, esophagram, pH and manometry. Twenty-seven of these patients either were denied TIF by their insurance company or had personal preference for surgery (daVHH) over endoscopic intervention and underwent robotic assisted paraesophageal hernia repair. We examined intraoperative measurements of hiatal hernia size and EG junction anatomy and compared them to standard preoperative evaluation.

Results
On pre-operative endoscopy 23 patients were found to have no hiatal hernia, 20 were found to have a small hernia, 3 a medium hernia, and 1 a large hernia. Esophagram evaluation demonstrated no hiatal hernia in 17 patients and a small hernia in 23 patients. The average hiatal hernia size seen during manometry was 0.54 cm (0–2 cm) while the average hernia seen intra-operatively was 3.26 cm (1.5–4.8 cm). There was a significant difference between preoperative hernia size evaluated by manometry and intraoperative hernia size (p-value 0.04).

Conclusion
Standard preoperative evaluation of patients intended to be treated with TIF appears to have a tendency to underestimate the size of hiatal hernia and omits evaluation of paraesophageal anatomy. This can lead to poor patient selection of failure of this treatment modality. Addition of cross-sectional imaging to the evaluation of patients with small hiatal hernias can facilitate a more meaningful therapeutic decision making for endoscopic, surgical, and combination treatment options.