bluuebunny/crossref_metadata_2025_split huggingface dataset:
622. EVALUATION OF THE PSOAS MUSCLE INDEX ON CLINICAL OUTCOMES IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA RECEIVING NEOADJUVANT CHEMOTHERAPY
Authors: Tanaka Ryo , Imai Yoshiro , Matsuo Kentaro , Honda Kotaro , Lee Sang-Woong 
Published: September 2022

Abstract
Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies. Muscle mass, defined as the psoas muscle index (PMI), is an important parameter of sarcopenia. However, the relationship between esophageal cancer and PMI has not been fully investigated, especially in patients receiving neoadjuvant therapy.
We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer.
We included 112 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and post-neoadjuvant chemotherapy psoas muscle index were evaluated for associations with postoperative complications, in addition to survival. Psoas muscle index (PMI) cutoffs were 6.0 cm2/m2 for men and 4.0 cm2/m2 for women. In this study, sarcopenia was defined based on the value of PMI.
63 patients (56.3%) were diagnosed with sarcopenia after receiving neoadjuvant chemotherapy (NAC). Patients with sarcopenia after NAC were significantly older than patients without sarcopenia. No significant difference was found in gender or ASA score. The rate of postoperative complication in the patients with sarcopenia was higher than that in the patients without sarcopenia (40.0% vs 24.5%; p=0.090). Especially, the rate of postoperative pneumonia in the patients with sarcopenia was significantly higher than that in the patients without sarcopenia (23.8% vs 6.1%; p=0.012).
Cross sectional measures of sarcopenia after neoadjuvant chemotherapy could predict postoperative complications in multidisciplinary treatments for esophageal cancer. It is important to maintain or improve nutritional status by intervention from the time of neoadjuvant chemotherapy.
631. OPERATIVE OUTCOMES OF ROBOTIC GASTROPEXY IN THE TREATMENT OF GIANT PARAESOPHAGEAL HERNIA IN PATIENTS WITH PREDOMINANTLY OBSTRUCTIVE SYMPTOMS
Authors: Habib Fahim , Luketich James , Pennathur Arjun , Copelli Susan , Schuchert Matthew , Sarkaria Inderpal 
Published: September 2022

Abstract
Our approach to the repair of giant paraesophageal hernia (GPEH) has undergone a paradigm shift. In cases with predominantly obstructive symptoms, following hernia repair, we have transitioned from a mandatory antireflux procedure to a comprehensive extended gastropexy. Further, we have successfully adopted the robotic platform, faithfully replicating the tenets of the operation that we previously refined using the laparoscopic approach. The objective of this study was to describe operative outcomes with this approach.
With IRB approval, we retrospectively analyzed prospectively collected data. Operative technique included complete mediastinal dissection of the hernia sac, reduction of contents, tension free return of the stomach to its normal intraabdominal position, preservation of the crural lining, and repair of the crura with nonabsorbable suture. For patients with predominantly obstructive symptoms and minimal reflux, in lieu of an antireflux procedure, we performed an extended gastropexy involving accentuation of the angle of His and placement of a series of horizontal mattress sutures between the greater curvature of the stomach along the line of the short gastric vessels and the diaphragm.
Between 2014 and 2021, 113 patients underwent robotic GPEH repair with gastropexy (median age 74.3 ± 9.05 years, 79.6% female, elective 78.7% vs. 21.2% urgent). Majority were Type III GPEH (75.2% vs 24.7% Type IV) and 22.3% had an organ-axial volvulus. Most common presenting symptoms were dysphagia (35.4%), vomiting (23.8%) and chest pain (17.7%). All operations were completed robotically. Cardinal tenets of GPEH repair were achieved in all cases. Average length of stay was 5.85 ± 5.18 days. Two patients (1.7%) died within 30 days, and 24.7% developed a postoperative complication, 13 (11.5%) were readmitted and 4 (3.5%) required reoperation.
In patients with a GPEH who have predominantly obstructive symptoms, a robotic approach that adheres to the principal tenets of GPEH repair with an extended gastropexy in lieu of an antireflux procedure appears to be feasible and safe. Further studies that evaluate functional outcome and long-term follow-up to assess durability appear to be warranted.
634. PERIOPERATIVE MORBIDITY AND MORTALITY AFTER STANDARD TWO-FIELD AND RADICAL THREE-FIELD ESOPHAGECTOMY – RESULTS FROM A RANDOMIZED TRIAL
Authors: Pramesh CS , Karimundackal George , Jiwnani Sabita , Shetmahajan Madhavi , Ranganathan Priya , Parab Swapnil , Niyogi Devayani , Tiwari Virendra , Mistry Rajesh , Badwe Rajendra 
Published: September 2022

Abstract
The role of radical lymphadenectomy in esophageal cancer is controversial. While standard two-field lymph node dissection (2FLND) is considered the standard of care, the role of prophylactic radical three-field lymph note dissection (3FLND) is debatable. We conducted a large randomized trial comparing oncological outcomes between 2FLND and 3FLND for operable esophageal cancer. Here, we report the perioperative complications in the trial.
Patients with operable esophageal squamous cell/adenocarcinoma between 18-75 years of age with no clinicoradiological supracarinal lymph node metastases were eligible. Patients were randomly allocated intraoperatively with allocation concealment (stratified by histology, T, N stage, level of growth, and neoadjuvant treatment) to 2FLND or 3FLND. Patients randomized to 2FLND underwent removal of all infracarinal mediastinal and D2 abdominal lymph nodes; patients randomized to 3FLND in addition had bilateral supracarinal mediastinal and lower cervical neck lymph node dissection. Intraoperative and postoperative details including perioperative complications were collected. Chi-square test was used for categorical and the Student t test for numeric variables.
A total of 700 patients were recruited between Jan 2005 and Dec 2019 (359 2FLND, 341 3FLND). Demographic data are presented in the Table. More patients undergoing 3FLND required prolonged ventilation (4.2 vs 12%, p&lt;0.001), had pulmonary complications (25.6 vs 38.1%, p&lt;0.001) and anastomotic leaks (11.7% vs 17.6%, p=0.03). There were no differences in cardiac complications (0.8 vs 2.6%, p=0.08), chyle leaks (3.1 vs 3.5%, p=0.83), major morbidity (CD score &gt;3a; 14.8% vs 19.4%, p=0.13) and mortality (4.5 vs 5.9%, p=0.4) in the two groups.
Pulmonary complications and anastomotic leaks occur more frequently with 3FLND than 2FLND while major morbidity and mortality were similar. Oncological outcomes will dictate whether 3FLND is beneficial in patients with operable esophageal cancer.
640. ESOPHAGECTOMY FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION ADENOCARCINOMA IN RYGB PATIENTS. A LITERATURE REVIEW ON OPERATIVE TECHNIQUES, SAFETY AND ONCOLOGIC OUTCOME
Authors: Diab Abdul-Rahman , DuCoin Christopher 
Published: September 2022

Abstract
Roux-en-Y gastric bypass (RYGB) surgery changes the anatomy of the gastrointestinal tract, and thus renders the surgical management of esophageal and gastroesophageal junction adenocarcinoma cases technically confusing. No consensus exists regarding the the optimal surgical technique in terms of safety and oncologic outcomes in these cases. The aim of this study is to compile and analyze the available operative/technical data in the literature on surgical management of esophageal and gastroesophageal junction adenocarcinoma in RYGB patients.
A literature review was performed in Cochrane Database, Embase, Medline, PubMed, and Scopus electronic databases to find all cases of esophagectomy for esophageal and gastroesophageal junction adenocarcinoma in RYGB patients. Keywords used were esophageal adenocarcinoma, esophagogastric junction adenocarcinoma, gastric bypass, bariatric surgery, esophagectomy, Ivor Lewis esophagectomy, transhiatal esophagectomy, and thoracoabdominal esophagectomy. All abstracts retrieved were screened, and for each one deemed relevant, the full text was obtained. Finally, 11 articles containing 17 cases were studied and analyzed. Extracted data included: Esophagectomy type, incision type, gastric pouch management, conduit used, Roux limb management, and most importantly complications and oncologic outcome.
Esophagectomy was Ivor Lewis, transhiatal, and thoracoabdominal in 58.82%, 23.53% and 17.65% respectively. Esophagectomy was open in 46.67%, and minimally invasive in 53.33%. Gastric pouch was reconnected to the excluded stomach in 14.29%, while it was resected in 85.71%. Gastric, colonic and jejunal conduits were used in 87.5%, 6.25% and 6.25% respectively. In 63.64%, the Roux limb (RL) was connected to the abdominal wall and a feeding jejunostomy was placed. In the remaining 36.36%, the RL was either totally resected, or its proximal end was anastomosed to the distal end of the biliopancreatic limb. No complications were reported.
No differences in oncologic outcome or safety were observed between open versus minimally invasive esophagectomy. Minimally invasive esophagectomy is safe and technically feasible with appropriate oncologic outcomes for esophageal and gastroesophageal junction adenocarcinoma patients with previous gastric bypass. Therefore open esophagectomy is not necessary. Post RYGB Esophageal and gastroesophageal junction adenocarcinoma might be underreported, and the number of cases will undoubtedly continue to increase in the coming years.
641. ALPORT SYNDROME WITH ESOPHAGEAL LEIOMYOMA TREATED WITH CONSERVATIVE DISTAL ROBOTIC MYOTOMY: AVOIDING ESOPHAGECTOMY?
Authors: Takeda Flavio Roberto , Sallum Rubens Antonio Aissar , Meira Jose Donizete , Gusbert Luis Gustavo , Nobre Karolyne Ernesto Luiz Lopes , Nobre Josean Victor Lopes Higino , Ribeiro Ulysses , Cecconello Ivan 
Published: September 2022

Abstract
Alport Syndrome manifests as dysmorphic hematuria associated or not with nephrotic syndrome, renal failure and visual and auditory impairment, in addition to family history. Leiomyoma is the most common benign neoplasm of the esophagus, but it is rare in childhood, and controversies persist as to the best option for its surgical treatment. We report the case of an 8-year-old female patient diagnosed with Alport syndrome and association with esophageal leiomyoma.
An 8-year-old female had 3 episodes of pneumonia related to bronchoaspiration. During childhood, he presented pictures of retrosternal pain related to dysphagia, which had worsened in intensity in the last 2 years. She had a hypothesis of achalasia, she underwent an Endoscopic Poem Myotomy. During the procedure, a mass was observed in the distal esophagus and a biopsy showed that it was an esophageal leiomyoma. Given the close association of this tumor with Alport Syndrome, biopsy confirmed the diagnosis. She was then submitted to robotic surgery for possible esophagectomy, however, only partial resection of the Leiomyoma was performed avoiding esophagectomy.
Due to young age and the morbidity of esophageactomy, only partial resection of the Leiomyoma was performed, with significant improvement in esophageal emptying for liquids and solids in the postoperative period and hospital discharge after 5 days. Considering leiomyomatosis a benign disease, partial resection was permitted since the histological aspects such as high rates of Ki67% and cellular morphological features were not found.
The case in question presented a diagnosis due to the severe manifestations that were provided by the esophageal leiomyoma in a patient with atypical epidemiological characteristics, such as age group and sex. The conservative surgical strategy was chosen due to the patient's age and the surgical result was satisfactory, being suggested in similar cases.
642. RESULTS COMPARING SAFE (SUPERCHARGED CERVICAL ANASTOMOSIS FOR ESOPHAGECTOMY AND GASTRIC PULL-UP) AND NON-SAFE PROCEDURE: PROPENSED MATCHED SCORE STUDY
Authors: Takeda Flavio Roberto , Sallum Rubens Antonio Aissar , Gusbert Luis Gustavo , Ribeiro Ulysses , Cecconello Ivan 
Published: September 2022

Abstract
Esophagectomy is a high-risk surgical procedure. Anastomotic leakage is the most feared complication and is likely related to diminished anastomotic perfusion. “Supercharged” microvascular anastomosis has been performed in select patients to supplement the blood supply to the graft and anastomosis, after esophagectomy. This study aimed to evaluate results after performing the supercharged cervical anastomosis for esophagectomy procedure.
This retrospective cohort study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma with or without SAFE procedure between 2009-2021. Demographic features were assessed such as gender, age, histological type, staging; complications were evaluated (anastomotic leakage, clinical and surgical complications); mortality and overall survival; all those setting was compared between groups after propensed matched score system (PMS). Univariable and multivariable analysis were done.
The study enrolled 421 patients, 71 with SAFE procedure and 350 without SAFE procedure. After PMS (1:1), 65 patients remained in each group. which included 100 (77.0%) men, with a mean age of 65.3 years. Univariable analysis showed SAFE procedure less occurrence of leakage HR 3.05 (1.32-5.34), less clinical complications HR 3.24 (1.56-5.67). In multivariable analysis, SAFE procedure was related to less occurrence of leakage HR 3.1 (2.43-4.32). Comparinfg both overall survival (3 ys), SAFE group had better results (SAFE 52.3%; non SAFE 31.2%)
The supercharged cervical anastomosis for esophagectomy procedure may be related to low occurrence of anastomotic leakage and improve overall survival.
643. PRACTICAL IMAGING REVIEW OF EXPECTED FINDINGS AND POSSIBLE COMPLICATIONS RELATED TO MULTIMODAL TREATMENT OF ESOPHAGEAL CANCER
Authors: Takeda Flavio Roberto , Oliveira Victor Rodrigues , de Paiva Magalhaes Daniel , Neves Yuri Costa Sarno , Sallum Rubens Antonio Aissar , Ribeiro Ulysses , Cecconello Ivan 
Published: September 2022

Abstract
Esophageal cancer has been a major health issue, representing the eighth most common cancer worldwide. In the last decades, esophageal cancer treatment has evolved rapidly and a multimodality approach has been increasingly used. Main treatment options for locally advanced tumors include surgery resection, neoadjuvant or definitive chemoradiotherapy and palliative endoscopic dilation/stenting. In that context, radiology plays an important role in the early identification and management of treatment related complications.
Retrospective analysis of the radiological exams of esophageal cancer patients in the ICESP (Cancer Institute of Sao Paulo) followed by selection of several cases (more than 300 cases) illustrating the expected findings and the main complications related to each treatment modality (surgical, endoscopic and radiotherapy-related).
Five main different complications were selected and the radiological findings were classified using the HARMS mnemonic: Hiatal hernia; Anastomotic fistula, Radiation-induced injury, Mediastinal and pleural-pulmonary abscess and stenting-related injuries. For each classification, several images were selected using the different methods of esophageal imaging - mainly upper gastrointestinal series and computed tomography.
After categorization it is possible to recognize and familiarize with post-treatment complications using the “HARMS” mnemonic. Therefore, we present a review for the radiologists describing what is important to report as well as a compilation of possible image findings that oncologists, surgeons and endoscopists must be aware of.
649. MODIFIED EN BLOC ESOPHAGECTOMY WITH TOTAL LYMPHADENECTOMY IN PATIENTS WITH RESIDUAL TUMOR AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Hsu Po-Kuei 
Published: September 2022

Abstract
The optimal type of esophagectomy and extent of mediastinal lymphadenectomy for patients who had received neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) remain debatable. We hypothesized that a more radical resection could be associated with better survival without adding morbidity.
Data of patients who received trimodal treatments (neoadjuvant chemoradiotherapy followed by surgery) for ESCC between 2016 and 2021 in a single center were analyzed. Modified en bloc esophagectomy (mEBE) is defined as removal of the esophagus tube en bloc with adjoining locoregional soft tissue and lymph nodes, using the concept of mesoesophagus. Total lymphadenectomy includes dissection of lymph nodes around bilateral recurrent laryngeal nerves. Outcomes after mEBE with total lymphadenectomy were compared to those after conventional esophagectomy (CE).
A total of 154 patients, including 42 and 112 receiving mEBE and CE, respectively, were included. Compared to CE, the mEBE was associated with a longer operative time (560 vs. 540 min, p&lt;0.001) and higher total resected lymph node (19 vs. 17, p=0.001); whereas the complication rates and length of stay were similar between two groups. There was no overall survival (OS) difference between mEBE and CE groups in patients with ypT0N0 stage. However, in patients with residual tumors (non-ypT0N0), the 3-year OS rates were 58.5% and 40.8% in mEBE and CE groups, respectively (p=0.010).
In patients with ESCC, mEBE with total lymphadenectomy after neoadjuvant chemoradiotherapy is safe without adding perioperative morbidity. Moreover, it is associated with better OS compared to CE, especially in patients who have residual tumor after neoadjuvant treatments.
651. LAPAROSCOPIC TOTAL FUNDOPLICATION IS SUPERIOR TO MEDICAL TREATMENT FOR REDUCING THE CANCER RISK IN BARRETT'S ESOPHAGUS: A LONG-TERM ANALYSIS
Authors: Szachnowicz Sergio , Duarte André Fonseca , Nasi Ary , da Rocha Julio Rafael Mariano , da Costa Bernal Seguro Francisco , Bianchi Edno Tales , Tustumi Francisco , de Moura Eduardo Hornoux Guimaraes , Sallum Rubens Antonio Aissar , Cecconello Ivan 
Published: September 2022

Abstract
Background: The present study aims to compare the effectiveness of surgical and medical therapy in reducing the risk of cancer in Barrett's esophagus in a long-term evaluation.
Methods: A prospective cohort was designed that compared Barrett's esophagus patients submitted to medical treatment with omeprazole or laparoscopic Nissen fundoplication. The groups were compared using propensity score matching paired by Barrett’s esophagus length. A total of 398 patients met inclusion criteria. There were 207 patients in the omeprazole group (Group A) and 191 in the total fundoplication group (Group B). After applying the propensity score matching paired by Barrett’s esophagus length, the Groups were 180 (Group A) and 190 (Group B).
Median follow-up was 80 months. Group B was significantly superior for controlling GERD symptoms, in promoting Barrett’s esophagus regression or blocking its progression. Also was more efficient in preventing the development of dysplasia and cancer. Logistic regression was performed for the outcomes of adenocarcinoma and dysplasia, using age and BMI as covariates. Even after regression analysis, Group B was still superior to Group A to prevent esophageal adenocarcinoma or dysplasia transformation (OR: 0.51; 95% CI: 0.27 to 0.97, for adenocarcinoma or any dysplasia; and OR: 0.26; 95% CI: 0.08 to 0.81, for adenocarcinoma or high-grade dysplasia).
Surgical treatment is superior to medical management, allowing for better symptom control, less need for reflux medication use, higher regression rate of the columnar epithelium and intestinal metaplasia, and lower risk for progression to dysplasia and cancer.
653. DOES MIE REDUCE PULMONARY COMPLICATIONS IN A REAL-WORLD SCENARIO?
Authors: Gopinath Srinivas Kodaganur , Jiwnani Sabita , Karimundackal George , Tiwari Virendrakumar , Niyogi Devayani , Ranganathan Priya , Pramesh CS 
Published: September 2022

Abstract
Pulmonary complications are a common cause of morbidity, and occurs in upto 30% after esophagectomy. Randomised trials have shown significant decrease in pulmonary complications after minimally invasive esophagectomy (MIE). We conducted a study to evaluate whether this was true in a real-world scenario.
We performed a retrospective analysis of a prospectively maintained database of patients undergoing esophagectomy. Data of consecutive patients undergoing MIE or open Mc-keown transthoracic esophagectomy (OE) between 2013 and 2021 were included. Categorical variables were compared by Pearson’s Χ2 test or Fisher’s exact test. Multivariate logistic regression analysis was performed to analyse the relation between pulmonary complications and potential related factors to identify independent predictors of pulmonary complications.
A total of 1046 patients underwent MIE or OE between 01/01/2013 and 31/12/2021. The mean age was 54.2+/-9.9 y; 413 (39.5%) were smokers; 862 (82.4%) patients underwent neo-adjuvant chemotherapy; 411 patients(41.1%) underwent MIE( 309- VATS, 102- Robotic) while the remaining 635 underwent OE. Overall, 354(33.8%) patients had pulmonary complications, of which 234(22.4%) were CD 3a and above. Pulmonary complications were reduced by 11.6% (171/635, 26.9% with OE vs 63/411, 15.3% with MIE; p=0.001)(). On multivariate analysis, age &gt; 60y, open surgery, FEV1,3-field lymphadenectomy and ASA grade(II and III) were found to be significant predictors of pulmonary complications (table 1)
Adoption of MIE results in fewer pulmonary complications in the real world; however, the large differences seen in randomised trials may not be replicable in a real-world scenario. Elderly patients, those with low FEV1 values, a higher ASA grade and those who have undergone a 3-field lymphadenectomy may develop significant pulmonary complications in spite of undergoing MIE.
656. EPIMIOLOGICAL ASPECTS OF PROGRESSION FROM BARRETT'S ESOPHAGUS IN DYSPLASIA AND ESOPHAGEAL ADENOCARCINOMA: LONG FOLLOW UP IN A HIGH VOLUME CENTER
Authors: Szachnowicz Sergio , Gallon Eduardo , Dardin Felipe Augusto , Duarte André Fonseca , Sallum Rubens Antonio Aissar , Cecconello Ivan 
Published: September 2022

Abstract
Barrett's Esophagus (BE) affects approximately 3 million people in Brazil and an increase in its incidence has been observed in recent years. Especially in scenarios with social and financial limitations, it is of fundamental importance to study the epidemiological factors related to a higher risk of progression from EB to dysplasia in our specific population to optimize these patients' follow-up.
A retrospective analysis of patients with BE with long follow-up at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, regarding epidemiological aspects associated with a higher incidence of BE progression to dysplasia and adenocarcinoma.
Statistical analyzes were performed to establish correlations between the variables sex, age, smoking, ethnicity, BMI, Barrett's extension and the presence of esophageal dysplasia and adenocarcinoma. We found that sex, smoking, ethnicity and Barrett's extent are variables that are related to a higher incidence of adenocarcinoma.
This study confirmed that males, smoking and white patients, besides patients with long Barrett's epythelium were associated with higher risk to develop dysplasia and adenocarcinoma.