bluuebunny/crossref_metadata_2025_split huggingface dataset:
586. CIRCUMFERENTIAL HIATAL DISSECTION DURING MINIMALLY INVASIVE ESOPHAGECTOMY CLINICAL AND ONCOLOGICAL OUTCOMES
Authors: Davakis Spyridon , Sdralis Ilias , Sakellariou Stratigoula , Ziogas Dimitrios , Theochari Maria , Stratigopoulou Panagiota , Ntoka Polyxeni , Liakakos Theodoros , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Circumferential resection margin involvement is an independent prognostic factor in patients with adenocarcinoma of the distal esophagus and esophago-gastric junction. However, there is currently no consensus on the extent and the technique of hiatal dissection. Herein, we aim to present our technique of circumferential hiatal dissection during 2-stage totally minimally invasive esophagectomy for adenocarcinoma of the distal esophagus and esophago-gastric junction with its related histopathological results.
A prospective study of 200 consecutive patients undergoing 2-stage totally minimally invasive esophagectomy over a period of 60 months was conducted. Dissection of the hiatus included peri-esophageal surrounding tissues in a cylindrical fashion maximizing the distance from the esophageal wall. Crural muscle fibers and pleura bilaterally, pericardial fat anteriorly and pre-aortic tissue posteriorly were excised en bloc. Histopathological results particularly focused on involvement of the circumferential resection margin.
Complete histological clearance (R0) was achieved in 96% (n=192) according to the criteria of the College of American Pathologists and in 95% (n=190) according to those of the Royal College of Pathologists. In pT3 tumors (n=102), the circumferential resection margin was negative in 97 patients (95%) according to the College of American Pathologists, and in 95 (93%) according to the Royal College of Pathologists.
Adoption of this safe and reproducible technique might reduce the incidence of circumferential resection margin involvement and improve pathological outcomes. In addition, there may be positive implications for training and quality control.
587. ROLE OF THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS IN 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY. REPORT OF 200 CONSECUTIVE CASES
Authors: Davakis Spyridon , Liakakos Theodoros , Sakellariou Stratigoula , Ziogas Dimitrios , Theochari Maria , Ntoka Polyxeni , Stratigopoulou Panagiota , Mpaili Efstatia , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Esophagectomy is the mainstay of treatment of esophageal and gastro-esophageal junction cancer. Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of the procedure is the construction of esophago-gastric anastomosis. We aim to present our technique and results on hand-sewn thoracoscopic esophago-gastric anastomosis in prone position.
This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. Study included adult patients with no upper age limit (&gt;18 years); all hybrid esophagectomies, esophagectomies for malignancy and emergency operations were excluded from the study. The anastomosis was manually facilitated thoracoscopic in prone position, in 2-layers, using barbed sutures. Primary endpoints were anastomotic leakage and anastomotic stricture rate. Secondary endpoints were 30- and 90-day mortality rates.
During a 5-years-period, n=200 consecutive patients underwent 2-stage totally minimally invasive esophagectomy for cancer. Most patients were males. Median age was 65.5 years. Median operative time was 280 minutes while median suturing time for the anastomosis was 50 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=5 patients (2.5%); n=4 were type I anastomotic leaks and n=1 was type I, which was treated with chest drainage. Anastomotic stricture was presented in n=13 patients (6.5%). 30-day mortality rate was 1% and 90-day mortality rate was 2.5%.
Formation of the esophago-gastric anastomosis is one of the most challenging aspects during 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction using circular or linear staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced and established in the hand of experts, offering all the advantages of manual anastomosis and reduction of devastating post-operative anastomotic leakage, which still complicates stapled constructed anastomosis with significant incidence.
589. HOW COULD PATIENTS SUPPORT SURGEONS? ANALYSIS OF PATIENT'S SKILLS BEFORE AND AFTER OESOPHAGOGASTRIC SURGERY AND IMPACT ON QUALITY OF LIFE
Authors: Alfieri Rita , Turchi Gian Piero , Pinto Eleonora , Fabbian Alessandro , Marano Salvatore , Cavarzan Marco , Riva Marta Silvia Dalla , Da Roit Anna , Orru Luisa , Pilati Pierluigi , Castoro Carlo 
Published: September 2022

Abstract
The role of hospital case volume and surgeon expertise in improving results after esophagectomy is well known. However, health-professionals expertise and hospital volume are not enough. Prehabilitation trials outlined that patient involvement is mandatory to improve adherence to therapeutic programs.
This study aims to identify what are patient’s modalities of dealing with postoperative course, supporting surgical outcomes with a psychological intervention and to evaluate his effect in the medium-term postoperative period.
Literature analysis was conducted to identify specific patient’s skills supporting the postoperative course. Sixteen peculiar dimensions were identified, considering four patients skills applied to clinical, daily activities, family and work areas. Patients textual data were collected by a sixteen-questions interview. Methodology for the Analysis of Computerized Text Data was used to identify discursive repertoires used by esophageal cancer patients. These textual data let construct a closed-ended questionnaire used to assess patient’s skills in the early postoperative course.
A psychological intervention aimed at enhancing competencies was conducted. Skills were re-assessed and quality of life (QOL) data were collected 9-months after intervention.
In this study 28 consecutive gastroesophageal cancer patients were enrolled within a larger group of patients undergone major surgery for gastrointestinal tumours. Low/medium/high levels were detected for each of the four skills. Wilcoxon signed-rank test showed that three of the four skills levels increased after the supportive intervention.
Analysis revealed no differences in relation to diagnosis, oncological treatment and demographic variables. Compared to other patients, skills levels showed no differences in gastroesophageal patients. Furthermore, quality of life at 9-months after esophagectomy was comparable to date reported in current literature in the medium-long term period after surgery for digestive tract cancer.
In these preliminary data, even with poorer prognosis, gastroesophageal patients deal with major surgery side effects using the same skills levels used by other gastrointestinal cancer patients.
Results show that skills evaluation during hospital stay can reveal the lacking modalities of dealing with the postoperative problems due to patients’ wrong beliefs about surgical results and physical recovery. When aimed at improving surgical outcomes and based on surgeon’s indications, even patients can support surgical outcomes.
590. GERD AND BARRETT`S ESOPHAGUS IN BARIATRIC SURGERY
Authors: Moulla Yusef , Feisthammel Jürgen , Blüher Matthias , Gockel Ines , Dietrich Arne 
Published: September 2022

Abstract
The role of preoperative Gastroscopy in obesity surgery in detecting a lot of abnormalities of Upper-GI such as GERD and BE`s has been already proved in our pervious study. The Development of GERD and BE`s after bariatric surgery still controversy in the bariatric surgery. The Aim of this study is to evaluate the development of GERD and BE`s in patients underwent bariatric surgery including LGB and LSG
In our single center prospectively-established database of obese patients, who u nderwent bariatric surgery from 01/2012 to 12/2019, we retrospectively compare the preoperative endoscopic finding of patients with BE`s to these findings after 1-2 years and 3-5 years after the bariatric surgery. The regression of BE’s was defined based on the endoscopic findings as a 1 cm down grade of Prague classification circumferential (C) as well as maximum extent (M) or complete regression of BE’s, histologically as a conversion of intestinal metaplasia to squamous epithelium or conversion of dysplastic dysplasia to intestinal metaplasia
Among 914 bariatric patients, we found 119 patients (13%) with BE`s. A control gastroscopy could be performed in 74 BE`s Patients. 37 patients received a control gastroscopy after 1-2 years and 47 patient after 3-5 years. The surgical procedure was the only significant factor for the development of GERD and BE`s after bariatric surgery (P&lt; 0.05). Progression of GERD after LGB was detected only in one patient (4.2%, n=54) and in 10 patients (50%, n=10) after LSG in patients. Furthermore, the progression of BE`s after LGB in 4 patient (7.4%, n=54) and in 6 patients (30%, n=20) after LSG
Laparoscopic gastric bypass should be considered in obese patients with GERD or BE`s. Therefore, detecting of GERD and BE`s prior to bariatric surgery may has an obvious impact on decision making regarding the suitable surgical bariatric procedure
594. TOTALLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY VERSUS HYBRID 2-STAGE ESOPHAGECTOMY. A SINGLE CENTER EXPERIENCE
Authors: Davakis Spyridon , Liakakos Theodoros , Mpaili Efstratia , Ziogas Dimitrios , Theochari Maria , Ntoka Polyxeni , Stratigopoulou Panagiota , Giagkos Christos , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Totally minimally invasive 2-stage esophagectomy (TMIE) eliminates the thoracotomy associated with hybrid 2-stage minimally invasive esophagectomy (hybrid-MIE). This has an important role in minimizing post-operative respiratory complications. There is ongoing growing evidence in published literature of improved clinical and oncological outcomes in totally MIE comparing to hybrid MIE, due to enhanced optics and extend of lymphadenectomy as well as to shorter length of hospital stay and surgical trauma associated to thoracoscopy.
This is a retrospective analysis of consecutive patients that underwent 2-stage minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers. TMIE combines a laparoscopic and thoracoscopic approach while hybrid-MIE includes laparoscopic open thoracotomic phase. Study included adult patients with no upper age limit (&gt;18 years). All esophagectomies for benign disease, as well as emergency operations were excluded from the study. Primary endpoints were 30- and 90-day mortality rate, anastomotic leak, anastomotic stricture, pulmonary complications, and length of hospital stay. Secondary endpoints were overall survival and progression-free survival rates respectively.
During an 8-year-period, 150 patients underwent hybrid-MIE, while 200 underwent TMIE. Operative-time was shorter in the hybrid-MIE group (320 vs 280 min). Anastomotic leak was significantly reduced in the TMIE group comparing to the hybrid-MIE group (2.5% vs 9.5%). Respiratory complications were reduced in the TMIE group (10 vs 25%). Median LOS was similar (7 vs 7.5 days). Median number of resected-lymph nodes was increased in the TMIE group (28 vs 35 lymph nodes). OS survival rate was 60 versus 51 months and PFS was 52 vs 43 months in the TMIE and hybrid-MIE groups respectively.
In general, TMIE was associated with moderately lower morbidity compared to hybrid-MIE, but randomized controlled evidence is lacking. The higher anastomotic leakage rate, higher rate of pulmonary complications and lower lymph node count that was found after hybrid-MIE in comparative analysis, indicate that TMIE can significantly improve clinical outcomes of patients undergoing esophagectomy. The findings of this study should be considered carefully by surgeons when moving from hybrid-MIE to TMIE.
607. COMPARISON OF RECURRENCE PATTERNS AND SURVIVAL AFTER NEOADJUVANT CHEMORADIOTHERAPY VS. CHEMOTHERAPY FOR ESOPHAGEAL CANCER, A MULTI-CENTER EUROPEAN COHORT STUDY
Authors: Klevebro Fredrik , Elliott Jessie , Montziari Styliani , Markar Sheraz R , Goense Lucas , Johar Asif , Lagergren Pernilla , Zanninotto Giovanni , van Hillegersberg Richard , van Berge Henegouwen Mark , Nilsson Magnus , Hanna George , Schäfer Marcus , Reynolds John 
Published: September 2022

Abstract
Curative treatment for esophageal cancer requires local and systemic disease control. Neoadjuvant treatment increases long-term survival, but the evidence to date is insufficient to determine if neoadjuvant chemoradiotherapy (nCRT) with focus on local control or neoadjuvant chemotherapy (nCT) with focus on systemic control, is more beneficial. In this analysis of the ENSURE study we aimed to compare recurrence patterns and survival between nCRT and nCT in a large multicenter European cohort study.
All patients treated with neoadjuvant therapy and esophagectomy for cancer from 2009-2015 in the ENSURE study (NCT03461341) were included. Univariable and multivariable logistic regression and Cox proportional hazard models were used to compare recurrence pattern, diseases-free, and overall survival. Results are shown as odds ratios (OR), hazard ratios (HR) and 95% confidence intervals (CI). The multivariable model was pre-specified and included age, sex, clinical tumor stage, and tumor histology. In total 3267/4682 (69.8%) patients were treated with neoadjuvant therapy and were included in the study. nCRT was given to 1798 (55.0%) patients, and nCT was given to 1496 (45.0%) patients.
Median age for nCRT was 63 vs. 64 for nCRT, 65.5% in the nCRT group had adenocarcinoma vs. 81.4% in the nCT group. In the nCRT group 38.7% of patients had tumor stage III-IV compared to 61.3% in the nCT group. Multivariable adjusted OR for local recurrence comparing nCRT to nCT was 1.31 (95% CI: 1.08-1.59), distant recurrence OR 1.87 (95% CI: 1.57-2.22), and combined recurrence 1.49 (95% CI: 1.26-1.76). Adjusted HR for disease specific survival comparing nCRT to nCT was 1.38 (95% CI: 1.24-1.55), disease free survival: 1.39 (95% CI: 1.25-1.54), and for overall survival: 1.44 (95% CI: 1.30-1.60).
The results of the study show significantly increased risk for recurrent disease and decreased survival after nCRT compared to nCT for esophageal cancer. nCRT is administered with a lower total dose of chemotherapy compared to nCT. Radiotherapy is given for local control, which is also achieved with adequate lymphadenectomy. The results indicate that effective systemic treatment with nCT might be beneficial compared to nCRT in curative intended treatment of esophageal cancer.
608. INCIDENCE AND IMPACT OF PREOPERATIVE HIATAL HERNIA IN PATIENTS WITH ESOPHAGEAL CARCINOMA UNDERGOING CURATIVE SURGICAL RESECTION
Authors: Solomon Daniel , Zaslavsky Adi , Varon Danielle , Israeli Tal , Amlinsky Yelena , Tamir Shlomit , Kashtan Hanoch 
Published: September 2022

Abstract
Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were previously described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy in a population of patients undergoing predominantly cervical anastomosis.
Patients who underwent esophagectomy 2012-2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias &gt;3 cm were included in the HH group.
Overall, 66 patients (33%) had HH &gt;3 cm. The control group included 12 patients (6%) with &lt;3 cm HH and 106 (53%) without HH. Patients with HH had higher Charlson Comorbidity Index (CCI) (p=0.017). Location of anastomosis was similar among cohorts (cervical anastomosis 82.2% vs 92.4%, p=0.113). HH patients had higher incidence of atrial dysrhythmia (16.7% vs 5.1% p=0.015). Rates of R0 resections were similar (95.8% vs 93.9%, p=0.724). Subgroup analysis on adenocarcinoma patients confirmed higher rates of signet ring cell features among HH patients (28.6% vs 12.3%, p=0.034). HH was not associated with poor disease free survival (p=0.274).
Patients with preoperative HH had higher CCI, higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.
609. MINIMALLY INVASIVE CERVICAL ESOPHAGECTOMY (MICE): FIRST RESULTS OF A DUTCH PILOT STUDY
Authors: van Veenendaal LM , Vercoulen RJMT , Shiozaki A , Fujiwara H , Rosman C , Klarenbeek BR 
Published: September 2022

Abstract
Surgical resection remains the cornerstone of curative treatment for patients with esophageal cancer. Transthoracic minimally invasive esophagectomies have reduced the occurrence of pulmonary complications, however it is still associated with significant morbidity. The Minimally Invasive Cervical Esophagectomy (MICE) is a novel surgical technique. To date this technique is not routinely performed in European esophageal cancer patients. We aim to assess the safety and efficacy of the MICE procedure in Dutch patients with esophageal carcinoma.
The MICE is a recently developed surgical technique in Japan. The procedure combines a laparoscopic transhiatal and single-port transcervical mediastinal dissection and aims to ensure a radical oncological resection with a reduction of pulmonary complications because a thoracotomy/scopy is avoided. A prospective pilot study was performed including consecutive patients undergoing MICE for esophageal cancer.
Twenty patients were included. The male/female ratio was 16:4 with a median age of 71 years (IQR 52-85). Median operation time and blood loss was 350 minutes (IQR 326-360) and 100 ml (IQR 50-175). Conversion occurred in five patients (20%). Recurrent laryngeal nerve paralysis was seen in seven patients (35%), at least six of which were temporary. Anastomotic leakage occurred in three patients (15%, 2 ECCG grade 1 and 1 ECCG grade 3). Pneumonia, chyle leakage and hemothorax all occurred once in different patients (Clavien-Dindo grade 2, 4 and 3a, respectively). The median length-of-stay was 10 days (IQR 7-10).
MICE is a novel minimally invasive surgical technique which seems safe and effective to perform in Dutch patients with esophageal carcinoma. As expected, a higher incidence of RLNP was seen, in most cases only temporarily. Long-term safety and effectiveness will be prospectively evaluated in a larger population.
610. NOVEL HYBRID TECHNIQUES FOR DELAYED RECONSTRUCTION OF THE CERVICAL PART OF A LEFT COLON INTERPOSITION: A CASE REPORT
Authors: Maurice Karim , El Samadoni Ayman , Khalil Ashraf Abolfotooh , Elsharkawy Omar Ahmed , El-Refaie Yehia , El-Kady Mohamed Nabil , El-Sabbagh Omar , Hamour Dina , Milad Nader , Mashhour Shady , Safwat Yehia M , Amin Ayman A 
Published: September 2022

Abstract
Conduit necrosis following colon interposition for esophageal replacement is a devastating complication with a high morbidity and mortality rates. Survivors often face a challenging journey of complex reconstructive procedures. A multi-disciplinary approach is paramount to tailor the management according to the patient's anatomy, nutritional and psychological status, conduit alternatives and routes. This case report provides a series of novel reconstructive techniques, each of which could be helpful for esophageal surgeons facing such difficult situation.
A 36 years old female, with a history of corrosive ingestion at the age of 5 years, who was subjected to series of regular dilatation since then, presented with a tight stricture not passing a wire. She underwent a subcutaneous isoperistaltic left colon interposition. The postoperative course was complicated with necrosis of the cervical part of the graft with infection of the subcutaneous tunnel. Resection was done with esophagostomy and colostomy in the neck. The patient survived the acute stage, feeding was established through the colostomy opening in the neck. Delayed reconstruction was planned 6 months later.
The skin between the two openings in the neck was considered posterior wall of the conduit, and transaxillary pedicled thoracodorsal artery perforator flap (TDAP) was used to reconstruct the anterior wall (1,2). Partial flap loss occurred (3). Debridment and gastrostomy were done. The result was two gaps on both ends of the flap (3). The food regurgitated upwards from the gastrostomy. An antireflux stent was placed inside the flap to bridge the defects and allow oral intake (4). The TDAP-colon side was closed using a local flap from TDAP and skin graft (5,6). The esophageal side was closed primary and covered by a supraclavicular flap (7-12).
Management of graft failure should focus on controlling sepsis and nutrition. Attempts should be made to preserve any surviving part of the conduit as long as it doesn’t add to sepsis. A combination of Myocutaneous flaps could be used to replace the cervical part of the conduit as TDAP and supraclavicular flaps. Stent could be used successfully to bridge a failure in a skin flap. Finally, a dedicated team is paramount for a successful outcome.
614. SIGNIFICANCE OF LAPAROSCOPIC SURGERY IN OPEN THORACOTOMY ESOPHAGECTOMY
Authors: Ikebe Masahiko , Tsutsumi Takashi , Inokuchi Shoich , Takayama Hiroomi , Yasuda Kazuhiro , Bandoh Toshio , Utsunomiya Toru 
Published: September 2022

Abstract
The usefulness of laparoscopic surgery in esophageal cancer surgery has been reported in the MIRO trial, but there are few reports of laparoscopic surgery in esophageal subtotal resection, which is the standard surgical procedure in Japan. Furthermore, chest procedures are often performed by thoracoscopic surgery, making it difficult to evaluate laparoscopic operations. This time, we retrospectively examined the usefulness of laparoscopic procedure in right thoracotomy surgery.
From 2007 to 2019, 135 patients with esophageal cancer who underwent thoracotomy and subtotal esophagectomy and were reconstructed by gastric tube (post-sternal route, cervical anastomosis) were included. In the laparoscopic group (Lap group), gastric mobilization and perigastric lymph node dissection were performed under 5-port. The stomach was pulled out of the abdominal cavity with a small laparotomy of 4-5 cm to prepare a gastric tube. In the case of open surgery (Open group), epigastric midline incision (15-20 cm) was performed up to the navel.
There were 67 cases in the Lap group and 68 cases in the Open group. There was no difference in thoracotomy time between the two groups. In the Lap group, the amount of bleeding was significantly less than in the Open group (289g vs 376g), and the operation time was longer. Lung complications of Clavien-Dindo classification Grade 2 or higher were significantly less in the Lap group (10% vs 24%). There was no difference between the two groups in anastomotic insufficiency and recurrent laryngeal nerve palsy. The number of dissected lymph nodes was significantly higher in the Lap group.
Laparoscopic abdominal manipulation in open esophageal cancer surgery was useful in reducing pulmonary complications.