bluuebunny/crossref_metadata_2025_split huggingface dataset:
422. LAPAROSCOPIC TOUPET FUNDOPLICATION EVALUATION FOR GASTROESOPHAGEAL REFLUX DISEASE SHORT AND LONG-THERM FOLLOW-UP: A COHORT STUDY
Authors: Lisboa Fernando Freire , Oliveira Cruz Gabriel Carvalho , Souza Cordeiro Emerson Renê 
Published: August 2023

Abstract

Background
Gastroesophageal Reflux Disease (GERD) is one of the most important disorders of the gastrointestinal system, affecting 20% to 40% of the population of the United States of America. There are several surgical techniques for treating this disease, including the Toupet Fundoplication technique, which reduce the postoperative complications, like dysphagia, Gas Bloating Syndrome and incapacity to belch.

Methods
Prospective cohort study with 138 patients in two hospitals, one public and the other private, in the city of Natal, Brazil. All patients were evaluated postoperative as the following: 1) first week after the surgery were interviewed by the master surgeon; 2) fifty days after surgery were submitted to a Barium Swallow; 3) three months after the surgery the endoscopy was performed. The follow-up was carried out in relation to the symptom of postoperative dysphagia, ability to belch, feeling of fullness and gastroesophageal reflux.

Results
A total of 140 patients were observed, who were admitted for the Toupet Fundoplication procedure. Of this total, 74 patients were followed-up. 68 patients had improvement of symptoms related to esophageal disease and are clinically satisfied. 6 patients had recurrence of reflux symptoms. One patient still doesn’t belch. One patient had Gas Bloating Syndrome.

Conclusion
Toupet Fundoplication was a standard procedure in the study and achieved good results in 91,89% of the cases followed during follow-up of GERD control and relief symptoms with a minimal rate of adverse effects in the postoperative period.
430. MAPPING OF LYMPH NODE METASTASIS FROM ESCC AFTER NEOADJUVANT TREATMENT: A PROSPECTIVE ANALYSIS FROM A HIGH-VOLUME INSTITUTION IN CHINA
Authors: Zhang Hanlu , Chen Long-Qi , Wang Yun 
Published: August 2023

Abstract

Objective
The aim of the study was to describe the prevalence of lymph node metastases per lymph node station for esophageal squamous cell carcinoma (ESCC) after neoadjuvant treatment.

Methods
Clinicopathological variables of ESCC patients were retrieved from the prospective database of the Surgical Esophageal Cancer Patient Registry in West China Hospital, Sichuan University. Two-field lymphadenectomy was routinely performed and an extensive three-field lymphadenectomy was performed if cervical lymph nodes metastasis were suspected. Lymph node stations according to AJCC 8 were separately investigated. Percentage of patients with lymph node metastases was defined as number of patients with metastatic lymph nodes/number of patients with lymph node dissection of this station. Data is also separately analyzed according to pathological response of the primary tumor, pretreatment tumor length and tumor location.

Results
Between January 2019 and March 2023, 623 patients who underwent neoadjuvant therapy followed by transthoracic esophagectomy were enrolled (Table 1–1). Lymph node metastases were found in 215 patients (34.5%) and most frequently seen in lymph nodes along the right recurrent nerve (10.1%, 58/575), paracardial station (11.4%, 67/587) and lymph nodes along the left gastric artery (10.9%, 65/597). For patients with pretreatment tumor length &gt; 4 cm and non-PCR of primary tumor, the metastatic rate of right lower cervical paratracheal lymph nodes is 10.9% (10/92) and 10.6% (11/104), respectively (Table 1–2). For patients with an upper thoracic tumor, metastatic lymph nodes were most frequently seen along the right recurrent nerve (14.2%, 8/56). For patients with a middle thoracic tumor, metastatic lymph nodes were most frequently seen in the right lower cervical paratracheal lymph nodes (10.3%, 8/78), paracardial lymph nodes (10.2%, 29/285) and lymph nodes along the left gastric artery (10.4%, 30/289). For patients with a lower thoracic tumor, metastatic lymph nodes were most frequently seen in paracardial station (14.2%, 35/247) and lymph nodes along the left gastric artery (13.1%, 33/252) (Table 1–3).

Conclusion
The study accurately identified the distribution of lymph node metastases from ESCC after neoadjuvant treatment, which may contribute to guide the optimal extent of lymphadenectomy in the surgical treatment of ESCC patients after neoadjuvant treatment.
433. INTRAOPERATIVE ICG-IMAGING AS A TOOL TO ASSESS PERFUSION IN THE GASTRIC CONDUIT
Authors: Niska Karoliina 
Published: August 2023

Abstract

Background
In curative surgery for esophageal cancer a gastric conduit is often used to replace the resected esophagus. Anastomotic leakage (AL) is a serious complication. Sufficient perfusion in the gastric conduit is critical for the anastomosis. The aim of this pilot study was to investigate the feasibility of intraoperative indocyanine green (ICG) and near-infrared fluorescent imaging as a tool to assess perfusion of the gastric conduit in order to prevent postoperative AL.

Methods
Patients undergoing esophageal resection at Umeå University Hospital were invited to participate in this prospective study during 2017–2022. The surgery performed was open Ivor-Lewis esophagectomy. ICG was administered intraoperatively and video footage of the near-infrared fluorescence was recorded. The time from injection until visualized fluorescence in the gastric conduit was measured, as well as the intensity of the fluorescence in the gastric conduit. A loop of jejunum was used as control and the quotient between the measurement in the jejunal loop and in the gastric conduit was used for objective assessment.

Results
50 individuals were included. 46 patients had received neoadjuvant chemoradiotherapy and 3 had received chemotherapy only. 32 patients had video footages that were possible to assess as described above. Of these 11 had AL. No differences were demonstrated between patients with AL and those without, neither regarding time to fluorescence (p = 0.42), nor intensity (p = 0.72).

Conclusion
AL is a serious complication to esophageal surgery with a high incidence. Perfusion assessment of the gastric conduit using ICG has emerged as a promising technique to reduce AL. In this pilot study we developed two techniques to evaluate the perfusion in an objective manner, whilst none of these seem to be able to predict postoperative AL.
437. LAPAROSCOPIC RESECTION OF AN ESOPHAGEAL LEIOMYOMA WITH DOR FUNDOPLICATION
Authors: Katsoulis Iraklis , Tasis Nikos , Dafnis Andreas , Sarafi Aikaterini , Mpalampou Eleni , Kavalieratos George , Mitsaka Dimitra 
Published: August 2023

Abstract

Background
Leiomyomas are the most common benign esophageal tumors originating from the muscular layer. They are rare lesions that constitute less than 1% of esophageal neoplasms. In one-third of the patients leiomyomas occur at the level of the gastroesophageal junction. Minimally invasive surgery is considered today the treatment of choice with the laparoscopic approach used for distal tumors.

Methods
We present the case of a 79-year-old woman with an esophageal stromal tumor located above the gastroesophageal junction. The patient underwent a successful laparoscopic excision (enucleation) of the tumor. Subsequently a Dor fundoplication was performed in order to cover the muscular esophageal defect.

Results
The recovery from surgery was uneventful. The patient resumed liquid diet within 24 hours and was discharged from hospital on the 3d postoperative day. In one year follow-up, the patient is free of symptoms without stricture or evidence of esophagitis on endoscopy. Histology of the tumor was consistent with leiomyoma.

Conclusion
Distal esophageal leiomyomas can be safely and effectively treated with the laparoscopic approach.
444. SHOULD T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA BE SUBCLASSIFIED WITH RESPECT TO LYMPH NODE INVOLVEMENT AND SURVIVAL?
Authors: Gu Yi-Min , Chen Long-Qi 
Published: August 2023

Abstract

Background
Whether T2 esophageal squamous cell carcinoma should be subclassified into circular muscle (T2a) and longitudinal muscle (T2b) remains controversial. We aimed to investigate the effect of the depth of muscularis propria invasion on the incidence of lymph node involvement and patient survival outcomes in T2 esophageal squamous cell carcinoma.

Methods
We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. The pathological information of the depth of muscularis propria invasion was reassessed, and patients were grouped into the T2a group and T2b group. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan–Meier analysis and a Cox proportional hazard regression model.

Results
This study included a total of 750 patients from three institutes. The depth of muscularis propria invasion (OR: 3.95, 95% CI: 2.46–6.35; P &lt; 0.001) was correlated with lymph node metastases using logistic regression. T substage (OR: 1.37, 95% CI: 1.05–1.79; P &lt; 0.001) and N status (OR: 1.51, 95% CI: 1.05–2.17; P &lt; 0.001) were independent risk factors in multivariate Cox regression analysis. The T2a group had better overall survival (OR: 1.52, 95% CI: 1.19–1.94; P = 0.001) than the T2b group, specifically in T2N0 patients (OR: 1.38, 95% CI: 1.08–1.94; P = 0.035).

Conclusions
The depth of muscularis propria invasion should be subclassified to T2a and T2b with respect to lymph node involvement and survival outcomes in T2 esophageal squamous cell carcinoma.
448. PREDICTORS OF RECURRENT LARYNGEAL NERVE PALSY RECOVERY FOLLOWING ESOPHAGECTOMY
Authors: Li Ricardo , Wong Ian , Zhang Riki , Wong Claudia , Chan K K , Law Betty , Chan S Y , Law Simon 
Published: August 2023

Abstract

Background
Recurrent laryngeal nerve (RLN) palsy is a serious complication of esophagectomy that significantly impacts patients’ quality of life. This condition can be permanent or temporary, and identifying the factors associated with recovery can guide treatment options and manage patient expectations. We aimed to investigate the predictors associated with recovery from RLN palsy after esophagectomy.

Methods
We selected patients who underwent esophagectomy between 2003 and 2022, had a minimum survival and follow-up of 6 months, and experienced right, left, or bilateral RLN palsy from a prospectively managed database. Recovery was defined as restoration of vocal fold mobility within 6 months, irrespective of dysphonia symptoms while permanent injury was defined as persistent vocal cord palsy after six months. Univariate and multivariable logistic regression analyses were used to identify associations between variables and the likelihood of recovery.

Results
The overall RLN palsy rate was 14.5%. Ninety-five esophagectomy patients with RLN palsy were included. The mean age at operation was 64.4 years. Fifty-two patients (54.7%) recovered from vocal cord palsy. Sixty-four patients (67.4%) underwent minimally-invasive or video-assisted thoracoscopic esophagectomy. On multivariable analysis, patients who underwent neoadjuvant therapy (OR = 0.250, P = 0.012), vocal fold augmentation (OR = 0.283, P = 0.009), or reconstruction via the retrosternal route (OR = 0.326, P = 0.036) or right chest (OR = 0.088, P = 0.046) with reference to the orthotopic route, were less likely to recover from RLN palsy.

Conclusion
Neoadjuvant therapy, vocal fold augmentation and the route of esophageal reconstruction were significant predictors of recovery from RLN palsy after esophagectomy.
457. WHEN LAPAROSCOPIC MYOTOMY FAILS, COMPLEMENTARY PNEUMATIC DILATIONS REPRESENT AN EFFECTIVE AND SAFE OPTION
Authors: Costantini Andrea , Salvador Renato , Provenzano Luca , Capovilla Giovanni , Nicoletti Loredana , Forattini Francesca , Vittori Arianna , Nezi Giulia , Valmasoni Michele , Costantini Mario 
Published: August 2023

Abstract

Background
In the last 3 decades, laparoscopic Heller myotomy (LHM) has represented the treatment of choice for esophageal achalasia (EA), solving symptoms in most patients. Little is known about the fate of patients who relapsed after LHM, or about their most appropriate treatment. In this study we aimed at evaluating the results of complementary pneumatic dilations (CPD) after ineffective LHM.

Methods
We evaluated the patients with EA who underwent LHM plus Dor fundoplication (LHD) from 1992 to 2021 and were submitted to CPD for persistent or recurrent symptoms. The patients were followed clinically and with manometry, barium swallow and endoscopy when necessary. An Eckardt score (ES) &gt; 3 was used as threshold for failure both after LHD and after LHD + CPD.

Results
Out of 1420 patients undergoing LHD in the study period, 115 (8.1%) were considered failures and were offered CPD. Ten patients refused further treatment, in 5 CPD was not indicated for severe reflux esophagitis, 1 patient had surgery for a misshaped fundoplication and 1 last patient developed a cancer 2 years after LHD; that leaves 103 patients who underwent a median 2 CPD (IQR:1–3), at a median of 16 (IQR:8–36) months after surgery, with 3.0 to 4.0 cm Rigiflex dilator. No perforations were recorded. Only 6 patients were lost to follow up. The remaining 97 were followed for a median of 37 months (IQR:6–112) after the last CPD: 70 saw their symptoms healed, whereas 27 still complained of symptoms (ES &gt; 3). The only differences between the 2 groups were the ES before CPD, that was 3 (IQR:3–4) in the former and 4 (IQR:4–5) in the latter (p &lt; 0.05), and the number of required CPD, that was 2 (IQR:1–2) and 3 (IQR:1–3), respectively (p &lt; 0.05). All other parameters were similar between the 2 groups. Of the un-responding patients, 17 still require repeated CPD, 7 underwent re-myotomy, 1 POEM and 1 esophagectomy for end-stage disease.

Conclusion
CPD represent an effective and safe option to treat patients after a failed LHD: when the post-surgery ES consistently remains high, and the number of CPD exceeds 3, this may suggest the need for further invasive treatments.
473. PARACONDUIT HIATUS HERNIA AFTER OESOPHAGECTOMY: INCIDENCE, RISK FACTORS AND MANAGEMENT
Authors: Ahmed Rakesh , Elliott Jessie , Donohoe Claire L , Ravi Narayanasamy , Reynolds John V 
Published: August 2023

Abstract

Background
Hiatus hernia after oesophagectomy is an uncommon but serious complication of oesophageal cancer surgery. With improving long-term oncologic outcomes, post oesophagectomy hiatus hernia is an increasingly recognised entity in oesophageal cancer survivorship. The aim of this study was to assess the incidence of and risk factors for paraconduit hiatus hernia (PHH), and to describe management approaches in a tertiary referral centre.

Methods
All patients undergoing oesophagectomy for cancer from 2008 to 2022 were included. Early PHH was defined as occurring within 3 months of index surgery, with all other PHH defined as late PHH. Surveillance computed tomography scans were undertaken among all disease-free patients to 5-years postoperatively. Kaplan Meier and Cox proportional hazards regression models were used to determine independent risk factors for PHH.

Results
897 patients were studied. Early PHH occurred in 1.2%, and late PHH in 5.7% of patients. There was no late recurrence after early PHH. PHH was an asymptomatic radiologic finding in 45.5% of early and 84.3% of late cases. Median time to PHH was 15.7 months postoperatively. Nausea, abdominal pain and vomiting were the most common symptoms associated with PHH. Surgical intervention was required in 25.8% of cases, more commonly following early PHH (63.6%) as compared with late PHH (17.6%, P &lt; 0.01). Operative approach (P &lt; 0.001), extended resection of crura or diaphragm (P &lt; 0.001) and male sex (P = 0.037) were associated with increased risk of hiatus hernia.

Conclusion
Paraconduit hiatus hernia is an uncommon complication after oncologic oesophagectomy. Surgical intervention is often required for patients with PHH presenting in the first three months after surgery, but a majority of patients with asymptomatic late PHH may be managed expectantly.
487. CAMRELIZUMAB COMBINED WITH CHEMOTHERAPY OR APATINIB AS NEOADJUVANT THERAPY FOR LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PHASE 2 TRIAL
Authors: Meng Xiangrui , Qi Yu , Shan Zhengzheng , Yang Yang , Fan Qingxia , Wang Feng 
Published: August 2023

Abstract

Background
Increasing evidences prove the encouraging efficacy of neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC). However, the safety of chemotherapy is still unsatisfactory. Previous studies have confirmed the good efficacy and tolerance of camrelizumab (PD-1 inhibitor) combined with apatinib (angiogenesis inhibitor) in advanced ESCC. This trial is to assess the effectiveness and safety of camrelizumab plus chemotherapy or apatinib as neoadjuvant therapy for locally advanced ESCC. Here, we reported the results of cohort 2.

Methods
This is an open-label, non-randomized phase 2 trial of patients with stage cT2-4aN0–3 M0 ESCC. Eligible patients were 18–75 years old, had ECOG PS score of 0–1. Cohort 2 planned to enroll patients with 4 cycles of camrelizumab (200 mg Q2W) and apatinib (250 mg QD). Surgery was performed within 4–6 weeks after neoadjuvant therapy. The primary endpoint was major pathological response (MPR) rate. Secondary endpoints included pathological complete response (pCR) rate, R0 resection rate, disease-free survival, overall survival, and safety.

Results
Between Feb 2022 and May 2023, 21 patients were enrolled in cohort 2. 14 patients completed neoadjuvant therapy, the ORR was 50% and the DCR was 100%. 14 patients completed surgery and all patients (100%) reached R0 resection, 4 patients (4/14, 28.6%) reached MPR, 2 patients (2/14, 14.3%) reaching pCR, and 9 patients (9/14, 64.3%) had TNM downstaging. Any grade and grade ≥ 3 adverse events occurred in 84.2% and 9.5% of 21 patients, respectively. The most common AEs were thrombocytopenia (6/21, 28.6%) and increased alanine aminotransferase (6/21, 28.6%). No new safety signals or treatment-related deaths were observed.

Conclusions
Neoadjuvant camrelizumab in combination with apatinib in patients with locally advanced ESCC showed promising pathological response and downstaging effect with acceptable security. The study enrollment is ongoing, and further survival and safety data will be reported in the future.
488. LEFT BRONCHIAL ARTERY IN ESOPHAGEAL SURGERY
Authors: Thammineedi Subramanyeshwar Rao 
Published: August 2023

Abstract
Commonest cause of morbidity after esophagectomy is pulmonary. Tracheobronchial devascularization during surgery contributes to this morbidity and can potentially lead to mortality. This video shows that left bronchial arteries can be preserved like the right ones in an attempt to aid rapid recovery of patients.
This is the link to the video.
https://drive.google.com/file/d/11iWQ5KUTSoc9qCmViCUlGPF61iCvCnJk/view?usp=share_link.
Juke Stick: A Case of Pediatric Atraumatic Compartment Syndrome
Authors: Oswald Brandon , DeFeo Devin R , Jude Joseph W , Brillhart Dan , Borden Nathan 
Published: August 2023

ABSTRACT
Compartment syndrome is usually due to trauma but can also have atraumatic causes. It is defined as a compromise of neurovascular and muscle function that presents symptomatically with the six P’s: pain, pallor, paresthesia, paralysis, poikilothermia, and pulselessness. Diagnosis is confirmed by a delta pressure of &lt;30 mmHg (diastolic blood pressure minus the compartment pressure). This case details a 15-year-old male football player with atraumatic compartment syndrome in the lateral compartment of the right lower leg. Symptoms of swelling and pain began 2 weeks before presentation after the patient was “juked.” The patient’s symptoms improved after a week of rest but worsened when he returned to practice. In the emergency department, the patient was able to ambulate with pain and declined pain medication. Examination revealed severe tenderness, mildly decreased strength, decreased sensation, and edema in the lateral compartment via bedside ultrasound. Because of the concern for compartment syndrome, pressure was checked with a disposable manometer (Compass CT disposable pressure transducer) revealing a delta pressure of 26 mmHg. The patient consequently underwent fasciotomy, eventually returning to baseline function without deficits. Awareness of this atypical presentation of compartment syndrome will assist providers in making a critical diagnosis and preventing severe complications and disability. This case also demonstrates the potential of disposable pressure transducers for cost-effective and accurate diagnostic confirmation of compartment syndrome in the emergency department.
A prospective intervention study to identify drug-related emergency department visits comparing a standard care group and a pharmaceutical care group
Authors: Hellinger Benjamin J. , Gries André , Schiek Susanne , Remane Yvonne , Bertsche Thilo 
Published: August 2023

Background and importance
Adverse drug reactions impose a major burden. Those adverse drug reactions might lead to hospitalization but are often not correctly identified in the emergency department (ED). Clinical pharmacists, although not routinely implemented, can help identify adverse drug reactions.

Objective
The primary objective was to examine the drug association of ED visits in a pharmaceutical group with a clinical pharmacist integrated in the ED team compared with a standard group without additional support.

Design/setting/participants
This prospective intervention study was performed in the ED of a tertiary care university hospital in Leipzig, Germany. Patients who were ≥50 years old were included. From 1 March 2020 to May 31, 2020 patients were enrolled in the standard group. From 1 March 2021 to 31 May 2021, the pharmaceutical group was enrolled. The clinical pharmacist supported the ED team with patient´s detailed medication history and medication analysis. In both groups, patients were evaluated whether their ED visit was drug-related.

Outcome measures and analysis
The number of identified drug-related ED presentations were compared between the two groups. Interventions performed on adverse drug reaction management, causative drugs and patient characteristics were evaluated.

Main results
A total of 798 patients were enrolled in the standard group and 827 patients in the pharmaceutical group. Patients whose ED visit was drug-related had a median age of 77 years [(Q25–Q75) 63.5–83.5] and took 7 [(Q25–Q75) 5–8] drugs in standard group. In the pharmaceutical group median age was 78 years [(Q25–Q75) 66–83] and number of drugs taken was 9 [(Q25–Q75) 5.25–11]. 31 (3.9%) drug-related ED visits were identified in the standard group compared to 104 (12.6%) in the pharmaceutical group (OR 3.56; 95% CI 2.35–5.38). An intervention on the patient’s pharmacotherapy was performed in 16 drug-related ED visits in standard group compared to 77 in the pharmaceutical group.

Conclusion
In this study the implementation of a clinical pharmacist was associated with improved identification of drug-related ED visits. Discontinuations of causal medications and dose reductions were significantly higher in the pharmaceutical group compared to the standard care group.