bluuebunny/crossref_metadata_2025_split huggingface dataset:
367. SPATIAL ORGANIZATION OF TUMOR-INFILTRATING LYMPHOCYTES PREDICTS PROGNOSIS OF PATIENTS WITH ESOPHAGEAL CANCER RECEIVING IMMUNOTHERAPY—A DEEP-LEARNING APPROACH
Authors: Huang Shujie , Wu Hansheng , Hong Liangli , Qiao Guibin 
Published: August 2023

Abstract

Background
Neoadjuvant immunotherapy plus chemotherapy has shown satisfying efficacy and manageable safety in locally advanced esophageal squamous cell carcinoma (ESCC) patients. Tumor-infiltrating lymphocytes (TILs) have been shown to be associated with the prognosis of various cancer types. It is unknown whether these TILs-associated characteristics can be adopted as a reliable prognostic biomarker for immunotherapy-based regimen. The current study aimed to assess the prognostic power of spatial organization of TILs in patients with advanced ESCC treated with immunochemotherapy.

Methods
In this retrospective, multicenter cohort study, pathologically confirmed locally advanced ESCC that was potentially resectable after neoadjuvant immunochemotherapy were included. Image segmentation was performed using UNet++ algorithm and H&E-stained nuclei were segmented using the StarDist deep-learning image segmentation. For the nuclei classification task, we choose to train and validate the classic convolutional neural network (CNN) Resnet50. We calculated tumor density and TiLs density in the tumor region (T_TiLs), TILs in the peritumoral region (P_TiLs) as well as TiLs density in the stromal region (S_TiLs). Based on the relative position relationship of tumor cells and lymphocytes, we subclassified the TILs spatial patterns into TILs-dominant, TILs-infiltrating, and TILs-circulating.

Results
Among the enrolled 86 patients, the male to female ratio approached 4:1. In this study, the mean IoU (mIoU) for nuclei segmentation is 0.9369 and the mean Dice coefficient is 0.9209. The areas under curve (AUC) for lymphocyte, tumor cell, and stromal cells classification are 0.92, 0.90 and 0.86, respectively. Through univariate analysis, TILs in tumor region (HR = 1.285, 95% CI: 1.042–1.586, p = 0.019), and TILs spatial organization (HR = 3.652, 95% CI: 1.216–10.967, p = 0.021) were identified as significant prognostic factors for OS. Multivariate analysis further revealed TILs in tumor region as the independent prognostic factor (HR = 1.248, 95% CI: 1.006–1.547, p = 0.044).

Discussion
The present study indicates that spatial organization and T_TILs are significant prognostic factors for ESCC patients receiving neoadjuvant immunochemotherapy. Future prospective studies with large sample size are needed to further validate the prognostic role of interaction between TILs spatial characteristic and distribution density in predicting overall survival.
372. INVESTIGATION OF RISK FACTORS OF POSTOPERATIVE PNEUMONIA IN MEDIASTINOSCOPIC ESOPHAGECTOMY
Authors: Konishi Hirotaka , Fujiwara Hitoshi , Shiozaki Atsushi , Nishibeppu Keiji , Ohashi Takuma , Kubota Takeshi , Otsuji Eigo 
Published: August 2023

Abstract

Background
Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated.

Methods
Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated.

Results
Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (&lt; 45), PLR (&gt; 122), and operative bleeding (&gt;134) were significantly related with post-operative pneumonia in the univariate analysis (p &lt; 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction.

Discussion
PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia.

Conclusion
Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.
374. RADIOGRAPHICALLY-DETERMINED FRAILTY IS ASSOCIATED WITH IMPAIRED GASTRIC CONDUIT PERFUSION DURING ESOPHAGECTOMY
Authors: Ishikawa Yoshitaka , Lin Jules , Brandser Andrew , Hider Ahmad , Askar Brandon , Lagisetty Kiran , Wakeam Elliot , Lynch William , Orringer Mark , Chang Andrew , Reddy Rishindra 
Published: August 2023

Abstract

Background
Frailty is considered a preoperative risk factor for complications after esophagectomy while impaired gastric conduit perfusion is associated with anastomotic leaks. Patients with impaired conduit perfusion may be candidates for gastric ischemic preconditioning, a surgical procedure performed prior to definitive esophagectomy to improve gastric conduit perfusion. The aim of this study was to investigate the association between radiographic determinants of frailty (morphomics) and gastric conduit perfusion assessed during esophagectomy.

Methods
Patients undergoing an esophagectomy with a cervical esophagogastric anastomosis (2015–2021) were included. Preoperative CT scans were processed using semiautomated algorithms (MATLAB; MathWorks, MA) to assess skeletal muscle (cross-sectional area, Martin’s criteria), subcutaneous fat (cross-sectional area, decreased when below the cut-off) and bone mineral density (decreased when below the cut-off). Indocyanine green perfusion was assessed intraoperatively (SPY Elite; Stryker, MI) and Ingress Index was calculated (standardized perfusion at the evaluated point). The morphomic index (MI), as an indicator of frailty, was determined using the number of decreased morphomic factors present (0–3). Multiple linear regression was used to analyze the data.

Results
One hundred and thirty-six patients were evaluated, with 25 patients developing anastomotic leaks (18.4%). Morphomic indices (MIs) of 2 or 3 were independently associated with reduced Ingress Index (p = 0.019 and 0.004, Table). In a sub-analysis for MI, MIs of 2 or 3 were associated with higher age (p = 0.029), lower BMI (p = 0.003), and cardiovascular disease (myocardial infarction, chronic heart failure, and vascular disease, p = 0.017). Other patient demographic factors including age, sex, and comorbidities did not affect Ingress Index.

Conclusion
Higher Morphomic Index (indicating lower than normal radiographic measures) were associated with impaired gastric conduit perfusion. More patients will be needed to investigate whether increased MI also is associated with development of anastomotic leaks. These findings may be useful in risk stratification and preoperative decision making in patients undergoing esophagectomy. Patients with MI of 2 or higher should be considered for gastric ischemic preconditioning.
391. PREHABILITATION DURING NACT IN ESOPHAGEAL CANCER CARE—A FEASIBILITY STUDY
Authors: St-Pierre Jade , Coca-Martinez Miquel , Drummond Kenneth , Minnella Enrico , Ferri Lorenzo , Scheede-Bergdahl Celena , Carli Franco 
Published: August 2023

Abstract

Background
Esophageal cancer bears a high disease burden with elevated morbidity and mortality. Treatment of esophageal adenocarcinoma (EAC) includes Neoadjuvant Chemotherapy (NACT) followed by surgical resection and subsequent adjuvant chemotherapy (ACT). This treatment triad effectively weakens already ill patients. Prehabilitation, a preoperative intervention designed to optimize patients through exercise, nutrition, and psychology, is understudied in this malignancy. Given limited prehabilitation resources at many hospitals, efficacy of home-based programs vs traditional supervised programs was investigated.

Methods
Patients diagnosed with EAC underwent a multimodal prehabilitation intervention and were blindly randomized to either supervised exercise or home-based exercise. The study was considered feasible if patients complied to 70% of the program. Compliance was measured by number of completed exercise sessions and adherence to nutritional advice and supplementation. Safety was measured by occurrence of adverse events. Cardiorespiratory fitness was measured by cardiopulmonary exercise testing (CPET). Functional capacity was measured by 6-minute walking test (6MWT), Sit-to-Stand and Hand Grip Strength. Quality of Life was measured by ESAS and FACT-E. All patients underwent assessment at baseline, preoperatively and 8 weeks postoperatively.

Results
44 patients were enrolled, supervised (n = 23) and home-based (n = 21). Average age was 64, BMI 27.9 kg/m2 and 68% underwent an Ivor Lewis esophagectomy. There were no significant differences between groups at baseline. Overall adherence to the program by the supervised group was 72% and 77% by the home-based group. Exercise allocation was not linked to adherence (p = 0.45). There were 2 non-serious adverse events recorded during this trial: one bout of syncope and one of light headedness during exercise. There is a relative maintenance or even improvement of cardiorespiratory fitness, functional capacity and QoL during NACT throughout the preoperative period.

Conclusion
Prehabilitation is an effective and safe intervention in esophageal cancer patients undergoing NACT. Home-based programs seem to provide similar benefits to supervised programs. This allows for wider implementation of prehabilitation in hospitals which do not have dedicated outpatient clinics for this purpose. Buffering functional decline during treatment is a triumph in a population that usually suffers. However, larger trials investigating prehab’s effect on post operative complications and QoL are needed.
401. THE ADJUVANT IMMUNOTHERAPY COMBINATIONS FOLLOWING ESOPHAGECTOMY FOR RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH NEOADJUVANT THERAPY
Authors: Tian Dong , Hu Wen-Long , Jiang Kai-Yuan , Tang Hong-Tao , Chen Long-Qi 
Published: August 2023

Abstract

Background
The potential benefits of postoperative adjuvant therapy for resectable esophageal squamous cell carcinoma (ESCC) following neoadjuvant therapy remain controversial. This study aims to evaluate the value of immunotherapy combinations as a potential adjuvant treatment for ESCC patients.

Methods
This retrospective study reviewed patients with ESCC who underwent neoadjuvant therapy following radical esophagectomy at West China Hospital, Sichuan University, between 2018 and 2021. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The survival curves and independent prognostic factors were analyzed using the Kaplan–Meier method and Cox proportional hazards model, respectively. In the patients who received postoperative adjuvant therapy, the survival curves of postoperative adjuvant therapy options, including immunotherapy combinations, chemotherapy (CT), and chemoradiotherapy (CRT), were compared.

Results
Of the total 482 patients, 141 (29.3%) received adjuvant therapy with 58, 58, and 25 cases receiving immunotherapy combinations, CT and CRT, respectively. Immunotherapy combinations demonstrated both a significantly better OS and DFS compared to CT or CRT, with a mean OS of 34 months vs. 29 months (95% confidence interval [CI] 27.633–34.503, P &lt; 0.05) and a mean DFS of 32 months vs. 24 months (95% CI 24.994–32.853, P &lt; 0.05), respectively. However, immunotherapy combinations were not identified as an independent prognostic factor for OS (hazard ratio [HR] 0.677, 95% CI 0.293–1.564, P = 0.361) and DFS (HR 0.470, 95% CI 0.208–1.064, P = 0.070).

Conclusion
Although adjuvant immunotherapy combinations prolong OS and DFS compared with CT and CRT in ESCC, they cannot independently predict prognosis. Therefore, the efficacy of immunotherapy combinations in adjuvant therapy still needs further exploration.
405. SHORT-TERM OUTCOMES OF ROBOT-ASSISTED ESOPHAGECTOMY
Authors: Kamei Takashi , Taniyama Yusuke , Okamoto Hiroshi , Sato Chiaki , Ozawa Yohei , Ishida Hirotaka 
Published: August 2023

Abstract

Background
Robot-assisted minimally invasive esophagectomy (RAMIE) has become widely performed in Japan, and the technique and short-term results have been accumulated. In our institute, we started with daVinci S in 2013, switched to Xi in 2018, and have experienced 110 cases so far.
Method; Technique and Devices: Semi-prone position with the left upper extremity placed under the body, 4 ports +1 assist port (Air Seal), double bipolar system—is the basic approach. The right upper extremity is placed so that it is attached to the head to provide axillary working space, and orthoglass to avoid direct compression of the right upper arm and robotic 4th arm. The range of motion of the 4th arm in the lower mediastinum is limited by the patient’s physique, so assistant forceps are used to assist as needed. Be willing to invert the camera to view the back of the operative field. Intraoperative recurrent nerve monitoring (NIM) was used in all cases.

Results
Five surgeons have performed RAMIE procedures. There have been no cases of conversion to thoracoscopic or open thoracotomy. The thoracic procedure time was significantly longer in RAMIE (299 min:274 min) than in thoracoscopic MIE. Blood loss tended to be less (17.1 mL: 44.0 mL). The incidence of recurrent nerve palsy (CD grade I or higher) was 44%:37%, that of pneumonia (CD grade II or higher) was 19%:18% and perioperative complications were similar between the two groups. Comparing the first half of the period when RAMIE was initiated with the second half, there was a significant decrease in the amount of bleeding, surgery time, and incidence of pneumonia, indicating an improvement in technique due to the number of experienced cases.

Conclusion
RAMIE can be performed safely, although no clear advantages can be demonstrated compared to thoracoscopic MIE at this time. RAMIE has clear advantages in terms of visual magnification of the dissected layer and stability of the surgical field, therefore, it is expected to reduce complications due to improved technique.
412. INTRAOPERATIVE APPLICATION OF ENDOFLIP FOR THE REPAIR OF HIATUS HERNIA AND FUNDOPLICATION
Authors: Tong Daniel 
Published: August 2023

Abstract

https://drive.google.com/file/d/1N3wVZ2UvO3eGBScjHMwtcJiCqfU0wUp1/view

Background
There is no objective measurement during repair of hiatus hernia and fundoplication intraoperatively. Whether the patient needs Nissen, Toupet or other fundoplication requires individual consideration. If the wrap repaired too tight, patient will develop dysphagia after surgery. If the wrap fold too loose, then the patient may experinced persistent reflux symptoms. This video demonstrate the application of EndoFlip intraoperatively to objectively measure the distensibility of the lower esophageal sphincter.

Method
Patient underwent laparoscopic hiatus hernia and fundoplication after symptoms assessment and confirmation of diagnosis. Intraoperatively, EndFlip probe was inserted and distensibility were measured as pre-dissection, post abdominal resection, post crural repair and after fundoplication. Tightness of fundoplication is adjusted aming at distenisbiliary index ranged 2–4.

Results
This study demonstrate the intraoperative aspproach for using EndoFlip as the tool to adjust the appropriate tightness on creating the wrap. Fpr this particular patient, before crus dissection, the distensibility index (DI) was 4.5, after crural dissection, DI was 5.5. After crural repair and Toupet fundoplication, the DI was 2.5. Post-operatively, patient had all the proton pump inhibitor stopped and enjoying good quality of life.

Conclusion
Objective intraoperative measurement during fundoplication is now available. Appropriate tightness of the wrap can be adjusted to avoidf post operative dysphagia or persistent reflus.
415. STEP-BY-STEP APPROACH TO CERVICAL LYMPHADENECTOMY 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/1sByes2_wNgSmb8DW9BjNQknjN7HCXtf1/view

Background
Cervical lymphadenectomy is an essential component of the treatment of esophageal cancer. Over the last six years, our upper gastrointestinal unit has carried out 180 esophagectomies, with 20% of them involving 3-field lymph node dissection. According to our unit’s protocol, the procedure is indicated for the following conditions: supraclavicular lymph node metastases, upper thoracic esophageal cancer, and recurrent nerve lymph node metastasis. We aim to present a step-by-step approach to cervical lymphadenectomy.

Methods
Our upper gastrointestinal unit has implemented several learning protocols that aim to design the most efficient and effective training environment. The primary objective is to enhance the learning process and surgical performance while maintaining quality standards. One of the essential components of this learning environment is video coaching, which provides a powerful tool for demonstrating and deconstructing surgical procedures. In recognition of the importance of cervical lymphadenectomy, we have developed a video that is incorporated into our unit’s existing curriculum.

Results
As an essential component of our comprehensive teaching protocol, we have included a video demonstrating the systematic approach to cervical lymphadenectomy. It offers a clear and concise overview of the anatomical landmarks that must be identified during the procedure, as well as the steps involved and the main pitfalls that must be avoided.

Conclusion
Our unit is committed to a phased and systematized approach to learning based on steps through the deconstruction of complex procedures. The unit’s structured teaching protocol allows the acquisition of competencies that enable the performance of cervical lymphadenectomy in an effective and efficient way, without compromising patient safety. We believe that our step-by-step approach to cervical lymphadenectomy will be a valuable resource for healthcare professionals working in our upper gastrointestinal unit.
431. RARE CASE OF CONTAINED ESOPHAGEAL PERFORATION IN LONG STANDING ACHALASIA CARDIA AND ITS SUCCESSFUL MANAGEMENT
Authors: Sachanandani Kanchan , Salvi Prashant , Thapar Pinky 
Published: August 2023

Abstract

Background
Esophageal perforation is the most feared complication after any intervention in achalasia cardia, especially after pneumatic dilation. We present a case of contained perforation after manometry in a long-standing case of achalasia cardia and its successful management.

Methods
A 64-year-old lady, known case of long-standing Rheumatoid arthritis on steroids and methotrexate, presented to us with complains of dysphagia to solids and liquids and 15 kgs weight loss in the past 3 years. On evaluation, she was dehydrated and cachexic. Upper GI endoscopy showed lot of food residue with erosions in body of esophagus and tight LES. Barium swallow showed sigmoid esophagus with typical bird beak appearance. Patient was admitted for hydration and nutritional optimization was done with nasojejunal feeding. She was further subjected to manometry to characterize the achalasia, which couldn’t be completed despite multiple forceful attempts. After 5 days, she was admitted for elective surgery. A CT scan of chest was done to evaluate the anatomy thoroughly before surgery, which showed contained mucosal perforation in lower esophagus on right side with minimal right pleural effusion. We planned for surgery next day.

Results
Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication was done with thoracoscopic lavage. Intra-operatively, upper GI endoscopy with minimal insufflation was done to confirm adequate cardiomyotomy and to look for the site of perforation. The perforation was not found. Hence, right thoracoscopy was done, which showed reactive pleural effusion without any food contents. Lavage was given and ICD was placed. Feeding jejunostomy was done laparoscopically. Patient was kept NBM for 7 days and JT feeds were started on POD 1 and gradually increased. ICD removed on POD 7. Oral gastrograffin contrast study was done on POD 8, which showed delayed passage at 5 minutes and no extravasation. Oral liquids were started and escalated gradually. Supplemental high protein nutrition was given through JT feeding. Patient was discharged on POD 15. At 1 month follow up, patient had 2 kgs weight gain and tolerated semisoft diet adequately.

Conclusion
Successful management of contained perforation in long standing achalasia cardia was achieved by targeting the source pathology in an already immunocompromised patient.
432. SINGLE-CELL RNA SEQUENCING OF MORPHOLOGICALLY-PURE PATIENT-DERIVED ORGANOIDS FROM ESOPHAGEAL ADENOCARCINOMA PATIENTS
Authors: Shathasivam Premalatha , Naeem Mansur , Rispoli Thaiane , Aiyar Niharikaa , Akhter Akhi , Wilson Gavin , Darling Gail , Yeung Jonathan 
Published: August 2023

Abstract

Background
We have successfully cultured esophageal adenocarcinoma (EAC) patient-derived organoids (PDOs) from endoscopic biopsies. These PDOs recapitulate the histological and molecular features of the originating tumour and frequently exhibit morphological heterogeneity within the same patient sample. The underlying biology of these morphologies and their relation to treatment response remains unknown. This study will examine the gene expression profile of morphologically pure organoids.

Methods
EAC tissue samples collected from patients were processed and embedded into Matrigel to generate PDOs. Parental PDOs with heterogenous morphology were sorted to isolate clonal pure morphology organoids. Multiple clones were expanded and clones of different morphology were collected and dissociated to single cells for single-cell RNA sequencing.

Results
Multiple single morphology clones were grown from nine different mixed morphology parental PDOs, demonstrating that EAC organoids can be generated from single cells. Successful formation of organoids from single cells took between two to four weeks. The percentage of single cells successfully generating organoids was sample-dependent. Six clones of solid, cystic, budding or grape-like morphology from two PDOs have been expanded and dissociated to single cells for single-cell RNA sequencing.

Conclusion
PDOs have emerged as a powerful tool to study drug response and personalize therapy. This study will examine the correlation of EAC organoid morphology with gene expression. Future directions will include the identification of morphology-dependent drug targets, enabling the development of more precise targeted drug screening for each patient.