bluuebunny/crossref_metadata_2025_split huggingface dataset:
362. AUTOMATED DETECTION OF UPPER MEDIASTINAL LYMPH NODES METASTASIS OF ESOPHAGEAL SQUAMOUS CANCER USING BERT ON COMPUTED TOMOGRAPHY
Authors: Ma Zhao , Li Yang , Li Xiangchun , Jiang Hongjing 
Published: August 2023

Abstract
Upper mediastinal lymph node (LN) metastasis is the extremely frequent metastasis lymph node site and dissection of this site of lymph node harbors a high risk of recurrent laryngeal nerve injury. Prediction of LN metastasis before dissection is necessary for personalized therapy. We developed a pre-training unsupervised deep learning model based on Bidirectional Encoder Representation from Transformers (BERT) to extract features from pre-operational CT images and detect patients with LN metastasis. A total of 3769 esophageal cancer patients from 2012 to 2020 with complete post-surgical pathology in our institute were included in this study, 823 of which had upper mediastinal LN metastasis. The extracted features of CT images were labeled with the LN metastasis status of the corresponding patients and then divided into training and validation groups (7:3) for training. In order to keep balancing of the positive and negative ratio in the test dataset, 800 patients were randomly selected from the validation group (1:1). The BERT-based pretrained learning model achieved a AUROC of 0.651 on detection of upper mediastinal LN metastasis. The specificity of this model could reach up to 0.732. Our model can be used to improve diagnostic ability of upper mediastinal LN metastasis before surgery.
373. THE PROGNOSTIC IMPACT OF TIME DELAYS IN OESOPHAGEAL CANCER SURGERY: 10-YEAR EXPERIENCE OF A HIGH-VOLUME CENTRE
Authors: Mcgregor Richard , Magnoli Matteo , Sayers Judith , Couper Graeme , Deans Chris , Lamb Peter , Skipworth Richard 
Published: August 2023

Abstract

Background
Over the last twenty years, treatment of oesophageal cancer has changed towards a multimodal approach to achieve better clinical outcomes. Detailed staging paradigms and neoadjuvant treatment have resulted in a longer time period before oesophagectomy, but literature on the prognostic impact of longer waiting times is scarce in this field. The aim of this study was to determine whether hospital (HD) or time to surgery (TTSD) delays adversely impact patient outcomes.

Methods
All patients who underwent oesophagectomy for oesophageal cancer between January 2009 and February 2020 at the Royal Infirmary of Edinburgh (RIE) were identified from a prospectively maintained database.
Two different time delays were considered. Hospital delay, defined as the time between date of diagnosis and start of treatment (i.e. neoadjuvant chemotherapy or straight to surgery). Time to surgery delay (time between the end of neoadjuvant regimen and surgery). The primary endpoint was to investigate whether hospital or time to surgery delay affected overall survival (OS). Secondary endpoints anaylsed whether hospital or time to surgery delays affected post-operative complication rate, 30 day mortality, or disease-free survival (DFS).

Results
A total of 512 patients were included for analysis over the 10 year study period. ‘Delayed treatment’ (DT) was calculated as greater than the median ‘hospital delay’, which was 56 days. ‘Early treatment’ (ET) was therefore defined as &lt;56 days. Similarly, median time to surgery was 35 days, and delay in time to surgery (DTTS) was defined as ≥35 days.
Kaplan–Meier survival analysis and the log rank tests did not find any significant difference in OS, DFS, post-operative complications, or 30 day mortality with either time delay. Further multivariate analyses showed that hospital and time to surgery delay, were not independent prognostic variables.

Conclusion
In our study group a hospital delay longer than 8 weeks did not impact on OS, DFS, or post-operative complications. Moreover, a time to surgery delay over 5 weeks appears safe, and did not impact overall survival.
375. RURAL PATIENTS HAVE A PROLONGED INPATIENT RECOVERY PROCESS AFTER ESOPHAGECTOMY COMPARED TO NON-RURAL PATIENTS AT A HIGH-VOLUME ESOPHAGEAL PROGRAM
Authors: Schroeder Julia , Lagisetty Kiran , Lynch William , Lin Jules , Chang Andrew , Orringer Mark , Reddy Rishindra 
Published: August 2023

Abstract

Background
Geographic access to care plays a large role in health disparities in esophageal cancer care, with rural individuals often travelling further to access complex healthcare services. We sought to characterize peri-operative outcomes in patients undergoing esophagectomy for loco-regional cancer at a single academic tertiary care center based on geographic home location. We hypothesize that rural patients will have worse peri-operative outcomes after esophagectomy, despite receiving care at the same high-volume hospital.

Methods
Prospectively collected data from patients with loco-regional esophageal cancer who underwent esophagectomy at a single academic medical center between 2003 to 2022 were analyzed based on county. The counties were aggregated into previously existing state-level ‘metropolitan’ versus ‘rural’ designations per the Rural Health Information Hub guidelines. Distance traveled by the patients were calculated using driving distance between the patient’s reported zip code and hospital address. Demographics, pre-operative treatment, surgical complications, post-operative outcomes, length of stay (LOS), and mortality of the two groups were analyzed using chi-squared, paired t-tests, and single-factor ANOVA.

Results
The cohort consisted of 1545 patients with 76.0% from metropolitan counties and 24.0% from rural counties. Patients were more likely to be male in both groups (p = 0.004), with no significant differences in pre-operative characteristics. Both groups had similar rates of pre-operative chemotherapy (p = 0.11) and pre-operative radiation (p = 0.58). Rural patients traveled greater distances for healthcare services compared to metropolitan patients (rural: 192.4 ± 101.2 miles; metropolitan: 63.4 ± 36.7 miles; p &lt; 0.001). Post-operatively rural patients had higher rates of pneumonia (p = 0.04) and more initial ICU visits (p &lt; 0.001). Rural patients had longer ICU LOS (p &lt; 0.001), but no difference in total hospital LOS (p = 0.28) or 30-day mortality (p = 0.35).

Conclusion
Rural patients tended to have a more complex inpatient recovery process after esophagectomy despite receiving surgery at the same high-volume institution and no differences in pre-operative characteristics (BMI, smoking history, and co-morbidities). It is unclear as to the reason for differences in pneumonia rates and ICU stays. Future studies should focus on the impact of rural location on disparities for individuals undergoing esophagectomy.
377. EARLY POSTOPERATIVE ORAL FEEDING IS SAFE FOLLOWING MAJOR UPPER GASTROINTESTINAL SURGERY (PROPENSITY SCORE MATCHING STUDY)
Authors: Papp Andras , Sindler Lili , Halvax Peter , Csontos Armand , Szako Lajos , Vereczkei Andras , Papp Csenge 
Published: August 2023

Abstract

Background
The traditional feeding method, which started 5–7 days after upper gastrointestinal (UGI) tumor resections is the widely accepted method worldwide. ERAS protocol is becoming more and more common, but there is still not enough evidence that early postoperative oral feeding is safe following major UGI surgery.
Patients and Methods: A propensity score matching study was conducted at the University of Pecs, Department of Surgery, Hungary between January 2020 and July 2022. The study included patients with UGI tumor resections where our early oral feeding (EOF) protocol were applied. Data were collected retrospectively and the EOF- group was compared with a control group, who have been cared for the traditional feeding method during this period.

Results
the study included 50 patients, 25 in the early oral feeding group, and 25 case-matched patients in the traditional oral feeding group. The start of the oral feeding was on day 2.09 in the EOF, and on day 5.52 in the LOF group. Statistically significant decreases were observed in the EOF group in the postoperative length of stay (8.875 days vs 12.06 days), first bowel movement, and length of postoperative intravenous fluid therapy. There were no significant differences in mortality, anastomosis insufficiency, anastomosis inflammation and stricture.

Conclusions
Our results confirmed, that in the EOF group the mortality and anastomosis leakages do not increase compared to the traditional feeding protocol. However EOF decreased the length of hospital stay resulted earlier recovery, and the quality of life was improved by starting early oral feeding.
378. GASTRIC FILLING IN NEOADJUVANT CHEMORADIOTHERAPY FOR OESOPHAGEAL CANCER
Authors: Hwang Yang , Chen Beini , Mai Tao , Lee Dominique , Thomson Iain , Smithers Mark , Frankel Adam 
Published: August 2023

Abstract

Background
Neoadjuvant Chemoradiotherapy (nCRT) for locally advanced oesophageal cancer improves survival. Currently, there is equipoise in the survival benefit of nCRT versus neoadjuvant chemotherapy. Excessive radiotherapy to the gastric conduit prior to surgery has long been a concern. Recent studies have linked radiation doses to the gastric fundus around 30 Gy to an increased risk of anastomotic leak. This study reviews a simple process aiming to reduce radiation dose to the gastric fundus.

Methods
This is a single-centre, retrospective analysis of 63 adult patients treated with nCRT (CROSS protocol) then oesophagectomy with a gastric conduit reconstruction. The Gastric Fill (GF) arm were given 500 mL of water prior to radiotherapy planning and treatment. The control group were consecutive patients prior to the implementation of the GF protocol. The fundus was mapped on radiotherapy software and planned to treat it like other organs at risk. Radiation dose to the fundus was recorded and compared between the two groups.

Results
The GF arm included 25 patients, with 38 patients in the control arm. Patients drank 350–800 mL of water prior to planning and treatment. There were no reported aspiration events. Radiotherapy techniques included VMAT and 3DCRT. All GF patients were treated with VMAT. There was a higher proportion of mid-oesophageal tumours in the control group (21% compared with 4%). The mean volume of gastric fundus in the GF group (mean = 215 cc, SD 144) was higher than the control group (mean = 155 cc, SD 100). The proportion of gastric fundus receiving &gt;30 Gy was lower in the GF group (mean = 10.9% SD = 16.0) compared with the control group (mean = 19.1% SD = 24.8).

Conclusion
Analysis did not show statistically significant difference between the groups, however, there was a trend suggesting radiation to the gastric fundus was reduced in the GF group. This study shows the feasibility of a simple and low risk intervention in reducing the radiation to the future gastric conduit. Further review with a larger cohort, and impact on anastomotic complications would be of interest for future review.
393. A RADIOMICS STRATEGY BASED ON CT INTRA-TUMORAL AND PERITUMORAL REGIONS FOR PREOPERATIVE PREDICTION OF NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER
Authors: Wang Yun , Li Zhiyang 
Published: August 2023

Abstract

Background
The standard treatment for esophageal cancer patients is neoadjuvant chemoradiotherapy followed by surgery. However, some of these patients do not achieve pathological complete response with this therapy, resulting in poor outcomes. The objective of this study is to develop a method for selecting patients who can achieve pathological complete response through pre-neoadjuvant therapy chest-enhanced CT scans.

Methods
The study enrolled 201 patients with esophageal cancer and divided them into a training set and a testing set in a 7:3 ratio. Radiomics features of intra-tumoral and peritumoral images were extracted from preoperative chest-enhanced CT scans of these patients. The features underwent dimensionality reduction in two steps, using Student’s t-test and least absolute shrinkage and selection operator. The selected intra-tumoral and peritumoral (including marginal and adjacent ROI) features were used to build models with four machine learning classifiers. The models with satisfactory accuracy and stability levels were considered to perform well. Finally, the performance of these well-performing models on the testing set was displayed using ROC curves.

Results
Among the 16 models, the best-performing models were the integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models. In the training set, the two models had average ROC AUCs of 0.906 and 0.918 respectively, with relative standard deviations (RSDs) of 6.26 and 6.89. In the testing set, the AUCs were 0.845 and 0.871, respectively. There was no significant difference in the ROC curves between the two models.

Conclusion
The addition of peritumoral radiomics features to the radiomics analysis may improve the predictive performance of pathological response for esophageal cancer patients to neoadjuvant chemoradiotherapy. The integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models developed in this study show potential for predicting pathological complete response in esophageal cancer patients and may help in selecting patients for neoadjuvant therapy.
395. SURGICAL PROCEDURE AND PERIOPERATIVE OUTCOME OF TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGOGASTRIC JUNCTION CANCER
Authors: Shiozaki Atsushi , Fujiwara Hitoshi , Konishi Hirotaka , Nishibeppu Keiji , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Otsuji Eigo 
Published: August 2023

Abstract

Background
We started performing mediastinal lymph node dissection by a laparoscopic transhiatal approach (LTHA) in 2009. To date, 548 patients had undergone our method during various esophageal surgical procedures, including esophagogastric junction cancer (EGJC). Furthermore, we started performing single-port mediastinoscopic cervical approach in 2014, and developed a simple technique for transmediastinal esophagectomy (TME) without thoracic approach (435 cases). Seventy five patients with EGJC were treated by TME.

Methods
Left single-port mediastinoscopic cervical approach was performed with pneumomediastinum. Mainly for advanced SCC, upper mediastinal lymph node dissection including recurrent laryngeal nerve LNs was performed with intraoperative monitoring using NIM system. Next, LTHA was performed for en bloc mediastinal lymph node dissection. The esophageal hiatus was opened, and working space was secured by Long Retractors. The posterior plane of the pericardium was extended. The posterior side of LNs was then separated. Finally, while lifting LNs like a membrane, they were resected from bilateral mediastinal pleura. Reconstruction with narrow gastric conduit was performed through substernal tract.

Results
Patients with EGJC performed TME were analyzed (n = 75, SCC/Adeno/Others = 37/35/3). Upper mediastinal lymph node metastasis was found in 13 cases (SCC/Adeno = 6/7), middle mediastinal lymph node metastasis was found in 10 cases (SCC/Adeno = 3/7), and all of them had advanced tumors. Their perioperative outcome was compared with those performed the right thoracotomy (n = 41). The operative time and bleeding were decreased by TME. The number of resected mediastinal lymph nodes, pR0 rate, and mediastinal recurrence in TME group were not inferior to the right thoracotomy group. In 93.3% of patients treated by TME, extubation was performed at 0 POD. Postoperative respiratory complication was decreased by TME (TME:6.7%, thoracotomy:17.1%).

Conclusions
This procedure, TME, resulted in a good surgical view, safe en-bloc mediastinal lymph node dissection, and the decrease of postoperative respiratory complications in patients with EGJC.
423. DYSPHAGIA AND RE-INTERVENTION AFTER MYOTOMY FOR ACHALASIA: A MATTER OF TECHNIQUE, OR A MATTER OF TIME?
Authors: Campagna Ryan , Pourak Kian , Bahar Piroz , Oh Eugene , Lagisetty Kiran , Orringer Mark , Lin Jules , Chang Andrew , Reddy Rishindra 
Published: August 2023

Abstract

Background
Achalasia is an incurable neurodegenerative disease of the esophagus. Palliative treatment includes disruption of the lower esophageal sphincter via multiple techniques, including open Heller myotomy (OHM), laparoscopic Heller myotomy (LHM), and per-oral esophageal myotomy (POEM). There is a paucity of data comparing long-term outcomes between OHM, LHM, and POEM. We sought to evaluate the relationship of these methods with clinical outcome parameters using our institution’s experience.

Methods
Patients greater than 3 years removed from myotomy for achalasia were studied. Post-operative Eckardt Symptom (ES) score and daily proton pump inhibitor (PPI) usage was recorded. Patients underwent timed barium esophagram (TBE) as clinically indicated. Retention was defined as a persistent column &gt;5 cm at 5 minutes. Post-operative interventions included Savary dilation, Botox injection, pneumatic dilation, surgical myotomy, and esophagectomy. Groups were stratified by surgery type (OHM, LHM, POEM) and by time since surgery (3–6 years, 6–10 years, &gt;10 years). A logistic regression analysis was performed examining the relationship of surgery type, time, symptomatic/objective outcomes, and post-operative interventions.

Results
172 patients had long-term data available. Mean follow up was 7.8 years (3.1–19.5 years). Nearly one-third of patients had a post-operative intervention (31%, 53/172). On regression analysis, OHM was associated with a higher risk of intervention (OR 9.4, p &lt; 0.05). Barium retention was significantly associated with LHM (OR 15.9, p &lt; 0.05) and the 3–6 year post-operative period (OR 11.1, p &lt; 0.05). PPI usage was not associated with surgery type, but was associated with the 3–6 year post-operative period (OR 3.2, p &lt; 0.05). There was no significant association of dysphagia with surgery type or time.

Conclusion
Post-operative barium retention and interventions are associated with specific myotomy techniques, but not time. PPI usage is associated with the early post-operative period, but not technique. Neither myotomy technique nor time alone are sufficient to predict risk of abnormal ES or dysphagia.
435. CIRCULAR-STAPLED ESOPHAGOGASTROSTOMY USING THE KEYHOLE PROCEDURE: TECHNICAL ASPECTS AND CLINICAL OUTCOMES
Authors: Tanaka Tsuyoshi , Goto Ai , Shibasaki Susumu , Suzuki Kazumitsu , Serizawa Akiko , Akimoto Shingo , Nakauchi Masaya , Inaba Kazuki , Uyama Ichiro , Suda Koichi 
Published: August 2023

Abstract

Background
The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes.

Methods
We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery.
Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS.

Results
Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p &lt; 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001).

Conclusions
The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.
447. PERIOPERATIVE OUTCOMES AFTER THORACOSCOPIC AND OPEN TRANSTHORACIC ESOPHAGECTOMY FOR CANCER
Authors: Pramesh C S , Karimundackal George , Jiwnani Sabita , Tiwari Virendra , Niyogi Devayani , Shetmahajan Madhavi , Ranganathan Priya , Parab Swapnil , Yadav Parveen , Purwar Pallavi , Ashok Apurva , Gopinath Srinivas , Mistry Rajesh 
Published: August 2023

Abstract

Background
Surgery for esophageal cancer is complex and associated with considerable postoperative morbidity. Several strategies have been attempted to decrease morbidity after esophageal resection including enhanced recovery programmes, concentration of surgery in high-volume centres, and minimally invasive surgical approaches. Randomized trials showing superior perioperative outcomes with thoracoscopic esophagectomy have sometimes not been replicated in real-world studies. We compared our short-term outcomes including postoperative complications, morbidity and mortality after thoracoscopic and open transthoracic esophagectomy for cancer.

Methods
We performed a retrospective analysis of a prospectively maintained database of esophageal resections for cancer at a tertiary referral cancer centre between Oct 2003 and Dec 2022. Consecutive patients undergoing either thoracoscopic or open transthoracic esophagectomy (TTE) with a cervical anastomosis were included in the study. Operative time, blood loss, lymph node yield, postoperative morbidity and mortality after surgery were compared between the two groups. Categorical data were analysed using the chi square test and numeric data using the Student t test. A p value of 0.05 was considered statistically significant and no adjustment was made for multiple comparisons.

Results
A total of 3328 patients were operated for esophageal cancer between 1st October 2003 and 31st Dec 2022. 897 patients who underwent thoracoscopic and 1591 patients who underwent open TTE were included in the study. Comparison between the two groups on the different variables are shown in the table. On multivariable logistic regression analysis, extended radical lymphadenectomy, higher modified risk score and open thoracic approach were significantly associated with increased postoperative morbidity.

Conclusion
Our series of thoracoscopic esophagectomy, one of the largest in the world, validates the results of randomized trials in the real-world setting, with significant reductions in operative blood loss, ICU stay, postoperative pulmonary complications, wound infections, and major morbidity. Thoracoscopic approach remained an independent determinant of decreased postoperative morbidity.