bluuebunny/crossref_metadata_2025_split huggingface dataset:
48: LAPAROSCOPIC HELLER DOR IS AN EFFECTIVE TREATMENT FOR ESOPHAGEAL-GASTRIC JUNCTION OUTFLOW OBSTRUCTION
Authors: Provenzano L , Salvador R , Nezi G , Capovilla G , Nicoletti L , Pierobon E S , Moletta L , Valmasoni M , Merigliano S , Costantini M 
Published: April 2022

Abstract

Background and aim
Esophago-gastric junction outflow obstruction (EGJOO) is a relatively new clinical entity revealed by high-resolution manometry (HRM) that can have two different etiologies, i.e. idiopathic or secondary (esophageal strictures, eosinophilic esophagitis, giant hiatal hernia, prior fundoplication or bariatric surgery, malignancy). Treatment of EGJOO currently mirrors that of achalasia, but this is based only on few studies with small case series. The aim of this study was to assess the outcome of laparoscopic Heller-Dor (LHD) in patients with EGJOO, as compared with patients with esophageal achalasia.

Methods
Between 2016–2019, all patients with a diagnosis of idiopathic EGJOO and referred to our Centre for dysphagia or food regurgitation were prospectively collected. Naïve EGJOO patients were first given medical treatment with Ca2+ channel blockers for 6 months. Then patients were ‘restaged’: patients without clinical improvement and/or whose integrated relaxation pressure (IRP) had not decreased were scheduled for LHD. EGJOO patients who had already been treated elsewhere with botox injections, pneumatic dilations or Ca2+ channel blockers were scheduled upfront for LHD. Patients with EGJOO who underwent LHD were compared with patients with radiological stage I achalasia. The achalasia group was further analyzed by subgrouping the patients based on the manometric-pattern. Treatment failure was defined as the persistence or reoccurrence of a Eckardt score &gt; 3 or the need for retreatment.

Results
During the study period, 150 patients were enrolled: 25 EGJOO patients and 125 radiological stage I achalasia (25 pattern I, 74 pattern II, and 26 pattern III). The median follow-up was 24 months (IQR: 34–16). Treatment was successful in 96% of patients in the EGJOO group and in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (P = 0.50). Six-month post-operative HRM showed a reduction in the LES resting pressure and IRP for all patients in all 4 groups (P &lt; 0.001).

Conclusion
This is the first comparative study based on prospective data collection to assess the outcome of LHD in patients with EGJOO. LHD emerged as an effective treatment for EGJOO, with an excellent success rate, comparable with the procedure’s efficacy in treating early-stage achalasia.
60: CAN PREHABILITATION PREVENT DEVELOPMENT OF SARCOPENIA DURING NEOADJUVANT CHEMOTHERAPY FOR OESOPHAGOGASTRIC ADENOCARCINOMA?
Authors: Chmelo J , Navidi M , Phillips A W , Greystoke A , Sinclair R C 
Published: April 2022

Abstract

Background and aim
Sarcopenia characterised as a loss of muscle mass and function is prevalent in cancer populations. It is known to occur in patients receiving neoadjuvant treatment and is associated with poorer outcomes. Thus, minimizing sarcopenia may lead to improved patient prognosis. It has been suggested that exercise can reverse and prevent sarcopenia. Little is known as to whether prehabilitation as an intervention to enhance patients’ functional capacity prior to surgery can lead to sarcopenia prevention.

Methods
Patients enrolled into a prospective prehabilitation study (ChemoFit) during neoadjuvant chemotherapy (NAC) for oesophagogastric adenocarcinoma (OGA) had their radiological sarcopenia measured before and after neoadjuvant chemotherapy (NAC). Radiological sarcopenia and lean body mass (LBM) were measured from computed tomography scans at the level of the L3 vertebra. ChemoFit patients were compared with an historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their radiological sarcopenia evaluated prospectively prior to and after NAC for OGA.

Results
The group characteristics are described in the table. Radiological sarcopenia was present prior to NAC in 17/36 (47%) which increased to 26/36 (72%) after NAC amongst ChemoFit patients. Sarcopenia prior to NAC in the NO-PREHAB cohort was 12/28 (43%) which increased to 16/28 (57%) post NAC. Intergroup difference (P = 0.291). Median (IQR) ∆LBM at two time points was in ChemoFit −2.6 kg (−5.2; −0.6) and in NO-PREHAB -3.1 kg (−4.7; −1.0) (P = 0.730).

Conclusion
Radiological sarcopenia increased in both groups during NAC for OGA. Prehabilitation did not prevent this from happening. Other strategies must be explored in order to mitigate against sarcopenia.
94: HEALTH RELATED QUALITY OF LIFE OF PATIENTS WITH ESOPHAGEAL CANCER FOLLOWING ESOPHAGECTOMY TREATED WITH NEOADJUVANT CHEMORADIOTHERAPY OR CHEMOTHERAPY: A EUROPEAN MULTICENTER STUDY
Authors: Schuring N , Markar S , Hagens E , Jezerskyte E , Sprangers M , Johar A , Gisbertz S , Van Berge Henegouwen M 
Published: April 2022

Abstract

Background and aim
Curative treatment for patients with esophageal cancer consists of neoadjuvant treatment followed by an esophagectomy. Different neoadjuvant strategies exist; perioperative chemotherapy (pCT) and neoadjuvant chemoradiotherapy (nCRT). Both strategies improve the 5-year overall survival rate, however, whether differences exist in long-term health related Quality of Life (HR-QoL) has not been studied. The aim of this study is to compare HR-QoL between perioperative chemotherapy and neoadjuvant chemoradiotherapy in esophagectomy for cancer patients.

Methods
Disease-free patients following esophagectomy for cancer in one of the participating LASER study centers between 2010 and 2016, following neoadjuvant treatment with chemoradiotherapy or chemotherapy, were extracted for analysis from the LASER study database. Included patients completed the LASER, EORTC-QLQ-C30 and QLQ-OG25 questionnaires at least one year following surgery. Primary outcome was to assess long-term HR-QoL between patients treated with pCT or nCRT, using univariable and multivariable logistic regression analysis.

Results
Among the 565 included patients, 349 (61.8%) received neoadjuvant chemoradiotherapy, and 216 (38.2%) patient were perioperatively treated with chemotherapy. The mean age was 63.7 years (± SD 8.6) with a mean time since surgery of 4.3 (± 1.7) years. After multivariable analysis patients treated with pCT reported worse outcomes on the ‘Social Functioning’ domain (∆means 4.56 P-value&lt;0.05) and more symptomatology on the domains ‘Insomnia’ (∆means 5.65 P-value&lt;0.05) and ‘Diarrhea’ (∆means 5.93 P-value&lt;0.05) of the QLQ-C30, and more symptomatology on the domains ‘Reflux’ (∆means 7.40 P-value&lt;0.05), ‘Odynophagia’(∆means 4.66 P-value&lt;0.05) and ‘Pain and discomfort’(∆means 4.34 P-value&lt;0.05) of the QLQ-OG25. No statistically significant differences were observed for the LASER key symptoms. None of the observed differences in mean scores of HR-QoL domains were clinically relevant (∆means≠ ≥ 10 points).

Conclusion
Some differences in favor of nCRT were observed in long-term HR-QoL domains for patients following esophagectomy for cancer. However, none of the observed differences was clinically relevant (∆means≠ ≥ 10 points). HR-QoL is unhelpful when deciding on neoadjuvant strategy.
102: EFFECT OF A MULTIMODAL PREHABILITATION PROGRAM ON POSTOPERATIVE RECOVERY AND MORBIDITY IN PATIENTS UNDERGOING A MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Janssen H , Fransen L , Heesakkers F , Dolmans-Zwartjes A , Moorthy K , Nieuwenhuijzen G , Luyer M 
Published: April 2022

Abstract

Background and aim
Despite recent advancements in perioperative care, postoperative morbidity following an esophagectomy remains substantial. Studies in other major abdominal surgery, have shown that prehabilitation can improve short-term outcomes. This single-center cohort study investigated the effect of prehabilitation in patients undergoing minimally invasive Ivor-Lewis esophagectomy (MIE-IL).

Methods
Data were collected on consecutive patients receiving a standardized ERAS program that included direct start of oral feeding following MIE-IL (from postoperative day one), between October 2015 and February 2020. The intervention group comprised patients enrolled in the PREPARE prehabilitation program that was implemented in 2018 as the standard care pathway for all patients. The control group comprised a retrospective cohort prior to implementation of PREPARE. Postoperative outcomes included (functional) recovery, length of hospital stay (LOHS), cardiopulmonary complications (CPC) and other predefined outcomes.

Results
The PREPARE group comprised 52 patients and control group 43 patients. Median time to functional recovery was 6 vs. 7 days (P = 0.074) and LOHS 7 vs. 8 days (P = 0.039) in the PREPARE and control group, respectively. Hospital readmission rate was 9.6% vs. 14.3% (P = 0.484). Although thirty-day overall postoperative complication rate did not differ statistically significantly (P = 0.106), a clinically relevant reduction of 17% was observed in PREPARE patients. Similarly, CPC rate was 14% lower in the PREPARE group (P = 0.190). Anastomotic leakage rate was similar (9.6% vs 14.0%; P = 0.511). Despite no difference in severity (Clavien-Dindo) of complications (P = 0.311), ICU readmission rate was lower in PREPARE patients (3.8% vs. 16.3%, P = 0.039). In the PREPARE group wherein maximum oxygen uptake capacity (VO2max) was assessed preoperatively during a Steep Ramp Test, VO2max was lower at baseline in patients diagnosed with postoperative complications (P = 0.011). There were no data on VO2max in the control group.

Conclusion
Prehabilitating patients prior to a MIE-IL led to a shorter LOHS and reduced ICU readmission rate. Additionally, a clinically relevant improvement in (functional) recovery and reduction in postoperative morbidity was observed in patients that were prehabilitated.
103: EARLY OUTCOMES OF ROBOTIC GASTRECTOMY COMPARED WITH OPEN GASTRECTOMY FOR GASTRIC CANCER WITH DESCRIPTION OF THE ROBOTIC TECHNIQUE
Authors: Jung M K , Biasco B , Chevallay M , Wassmer C H , Toso C , Mönig S P 
Published: April 2022

Abstract

Background and aim
Minimally invasive gastrectomy for gastric cancer shows slower adoption in Western countries, probably due to more advanced stages and a more frequently proximal localization, which requires a total gastrectomy. We aimed to assess the perioperative outcomes in early and locoregional advanced gastric cancer.

Methods
We retrospectively reviewed a prospectively collected database. A total of 51 patients who underwent oncologic total gastrectomy or subtotal gastrectomy by robotic or open approach of stage pT1-T4a, pN0–3 were identified from June 2016 until June 2020. Nine patients were operated on robotically, and 42 patients by laparotomy.

Results
The age of the patients in the robotic group was comparable to that of the open group (64.7 ± 9.2 versus 62.8 ± 12.9, P = 0.685). Endoscopic tumor size was smaller in the robotic group (24.3 ± 10.4 mm versus 43.1 ± 27.0 mm, P = 0.081). Blood loss was significantly smaller with the robotic approach (185 ± 180 mL versus 425 ± 257 mL, P = 0.038). Pathologic tumor stage included stages pT1–pT4b in the open group, while stages pT1–pT3 were operated by robotic approach. Fewer tumors were localized in the upper body in the robotic group (0, 0%) than in the open group (12, 28.6%). The length of the proximal margin was comparable in the two groups (104.29 ± 50.29 versus 86.88 ± 64.66, P = 0.516). The mean number of retrieved lymph nodes was comparable in the robotic group and the open group (42.89 ± 12.119 versus 43.22 ± 20.271, P = 0.963). The mean number of metastatic nodes was significantly lower in the robotic group (0.33 ± 0.707 versus 7.02 ± 14.313, P = 0.171). Diffuse-type cancers were significantly more frequent in the robotic group (3 (33.3%) versus 3 (8.6%), P = 0.040). Significantly fewer high-grade complications (Clavien&gt;3a) appeared in the robotic group (0 (0%) versus 2 (4.8%), P = 0.019). Length of hospital stay was comparable in the two groups.

Conclusion
The gold standard of oncologic gastrectomy is still the open approach. The minimally invasive approach must show comparable pathohistological results in regards to lymph node harvest and proximal tumor margins to be accepted in future European guidelines.
106: DOUBLE TRACT RECONSTRUCTION VS POSTERIOR ESOPHAGO-GASTROSTOMY WITH PARTIAL NEO-FUNDOPLICATION AFTER PROXIMAL GASTRECTOMY IN ADVANCED GASTRIC CANCER
Authors: Sedlak K , Rawicz-Pruszynski K , Geca K , Mlak R , Polskowski W 
Published: April 2022

Abstract

Background and aim
There is an upward shift in the incidence and localization of gastric cancer (GC). Proximal gastrectomy (PG) has been advocated as an alternative operation for the upper third GC that may be performed as a function-preserving procedure with various new reconstruction techniques. Uneventful postoperative course is currently measured using well-defined textbook outcome (TO), which represents a composite of surgical quality metrics. The aim of this report was to compare the TO of the two reconstruction methods following PG: double tract reconstruction (DTR) and posterior esophago-gastrostomy with partial neo-fundoplication (EGF).

Methods
TO was defined as (1) radical resection according to the surgeons’ assessment at the end of the operation, (2) no intraoperative complications, (3) negative resection margins, (4) harvest of min. 15 lymph nodes (5) no severe postoperative complications, (6) no re-interventions, (7) no readmission to intensive care unit, (8) no prolonged hospital stay, (9) no hospital readmission and (10) no postoperative mortality. Some 44 patients were eligible for analysis.

Results
The DTR and EGF were performed in 21 and 23 patients, respectively. Detailed results of TO in DTR and EGF are shown in Table 1. Patients reconstructed with DTR had a nearly six-fold increased chance of achieving the TO compared to patients with EGF (OR = 5.80; P = 0.0090). Comparison of both reconstruction methods demonstrated no statistically significant differences in terms of postoperative complications and CCI score, and overall survival.

Conclusion
TO is more likely to be achieved in DTR than in EGF. Randomized controlled trials are warranted to indicate the preferred reconstruction technique after PG.
109: THE IGREENGO STUDY. CLINICAL ROLE OF INDOCYANINE GREEN IMAGING FLUORESCENCE IN SURGICAL TREATMENT OF ADVANCED GASTRIC CANCER. STUDY PROTOCOL
Authors: Lombardi P M , Mazzola M , Nicastro V , De Martini P , Gualtierotti M , Ferrari G C 
Published: April 2022

Abstract

Background and aim
Near infra-red/indocyanine green imaging fluorescence (NIR/ICG) technology is showing promising results in several fields of surgical oncology. However, the clinical value of NIR/ICG technology in the surgical treatment of advanced gastric cancer (AGC) is not clearly established. Indeed, although lymphadenectomy is one of the main steps in curative-intent surgery for gastric cancer and lymph node status is the most important prognostic factor for survival, several questions have risen in literature on considering the overall number of harvested lymph nodes as the best indicator of the NIR/ICG technology clinical value. At present, no data exist regarding the ability of NIR/ICG technology to modify the surgical conduct at the moment of lymphadenectomy.

Methods
This is the ‘iGreenGO’ (indocyanine Green Gastric Observation) study protocol: an international, prospective, multicentre study. Study population will be a cohort of Western patients undergoing preoperative upper gastrointestinal endoscopy with submucosal peritumoral ICG injection followed by curative-intent minimally invasive gastrectomy with D2 lymphadenectomy for locally AGC. High-volume western academic and non-academic hospitals will be allowed to participate in the study. The primary endpoint will be the ‘change of the surgical conduct’ (CSC) at the moment of intraoperative NIR/ICG technology activation after completing a D2 lymphadenectomy ‘with the naked eye’. Key secondary endpoints will be the identification of preoperative clinical variables potentially associated with CSC, the number of additional LNs retrieved and pTNM stage migration using NIR/ICG technology, abdominal fluorescence location according to patient’s and tumor’s characteristics.

Results
The sample size was calculated by considering the estimated incidence of intraoperative change of the surgical conduct when using NIR/ICG technology. Data from the literature indirectly suggest an approximate rate of such event around 17%. A sample size of 350 patients will be necessary to obtain a measurement with an estimated precision of 4% with a confidence level of 1-alfa = 95%.

Conclusion
The iGreenGO study will be the first western study to investigate the intraoperative clinical role of NIR/ICG technology in surgical treatment of AGC in a large cohort of Western patients. Results from the present study can further clarify the role of the NIR/ICG technology in helping the surgeon during lymphadenectomy for AGC.
113: THE PARA-OESOPHAGEAL HERNIA SYMPTOM TOOL (POST): A MODIFIED DELPHI CONSENSUS STUDY
Authors: Puri A , Patel N , Sounderajah V , Ferri L , Griffiths E , Low D , Maynard N , Mueller C , Pera M , Van Berge Henegouwen M , Zaninotto G , Hanna G , Markar S 
Published: April 2022

Abstract

Background and aim
Patients with a para-oesophageal hernia (POH) report a range of symptoms and quality of life (QOL) issues. Clinicians often utilise existing health-related quality of life tools to identify patients eligible for surgical management and to evaluate the benefit of surgical intervention. However, the most commonly used tools for this purpose are not disease specific. Therefore, crucial POH-specific symptoms which impact QOL may not be captured. To address this, a modified Delphi consensus study was undertaken to establish a HRQOL instrument specific to POH.

Methods
A two-round modified Delphi consensus study was conducted with a group of international experts. Participants were identified through their authorship in landmark POH studies and the professional networks of the study investigators. Before the Delphi process, a scoping survey was undertaken to generate a list of candidate items. Participants were asked to rate the items’ importance in assessing patients with POH using a 5-point Likert scale. The a priori threshold for inclusion was 80% for scores of 4 or 5. If consensus was not achieved, the item was carried through to the next round.

Results
The candidate list of items consisted of 64 symptoms, refined to 20 for inclusion within the first modified Delphi round. Four symptoms; ‘difficulty getting solid foods down’, ‘chest pain after meals’, ‘difficulty getting liquids down’ and ‘shortness of breath only after meals’, reached consensus threshold of 80% in the first round and additionally, ‘early feeling of fullness after eating’, reached consensus in the second. A total of 26 participants took part in the first and 24 in the second round. These five symptoms form the initial version of the Para-Oesophageal Hernia Symptom Tool (POST).

Conclusion
POST is the first tool that aims to capture POH-specific symptoms that impact HRQOL. Prior to clinical use, this tool will be presented in international patient workshops to assess its construct validity. Thereafter, we aim to assess the content validity of the tool through a longitudinal study in a cohort of patients with undergoing POH repair. This tool aims to serve as a decision-support tool for clinicians when evaluating the risk–benefit of surgical intervention in this cohort of patients.
123: SEVERE LYMPHOPENIA ACQUIRED DURING CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: INCIDENCE AND EXTERNAL VALIDATION OF A PREDICTION MODEL
Authors: Kroese T , Jairan J , Ruurda J , Lin S , Mohan R , Mook S , Haitjema S , Hoefer I , Haj Mohammad N , Van Hillegersberg R , Van Rossum P 
Published: April 2022

Abstract

Background and aim
The incidence of grade 4 lymphopenia in patients treated with chemoradiotherapy (CRT) according to Chemoradiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) regimen is unclear. The primary aim was to determine the incidence of grade 4 lymphopenia during CROSS for esophageal cancer. Secondary aims were to externally validate a prediction model for grade 4 lymphopenia and compare overall survival between patients with and without grade 4 lymphopenia.

Methods
Patients who underwent CRT for esophageal cancer between 2014 and 2019 were eligible for inclusion. Patients with a planned radiation dose of 41.4 Gy (CROSS) or 50.4 Gy (‘extended-CROSS’) and concurrent carboplatin and paclitaxel were included. The primary outcome was the incidence of grade 4 lymphopenia during CRT defined according to Common Terminology Criteria for Adverse Events version 5.0 (i.e. lymphocyte count nadir &lt;0.2 μL). The secondary outcome measures were the prediction model’s external performance (i.e. discrimination and calibration). Overall survival for patients with versus without grade 4 lymphopenia was compared using Kaplan–Meier analysis.

Results
A total of 219 patients were included of whom 176 patients (80%) underwent CROSS and 43 patients (20%) extended-CROSS. The incidence of grade 4 lymphopenia was 11% in CROSS and 33% in extended-CROSS (P &lt; 0.001). External discrimination yielded a c-statistic of 0.80 (95% confidence interval: 0.70–0.89). External calibration of the model was poor in CROSS but fair in extended-CROSS. Adjusted calibration using intercept correction (adjusted for the lower a-priori risk for grade 4 lymphopenia in CROSS) showed fair agreement between the observed and predicted risk for grade 4 lymphopenia. Median overall survival in patients with versus without grade 4 lymphopenia was 12.7 versus 42.5 months (P = 0.045).

Conclusion
The incidence of grade 4 lymphopenia is significantly higher in esophageal cancer patients receiving extended-CROSS compared to those receiving CROSS. The prediction model demonstrated good external performance in the setting of the CROSS-regimen and could be used to identify patients at high-risk for grade 4 lymphopenia who might be eligible for lymphopenia–mitigating strategies.