bluuebunny/crossref_metadata_2025_split huggingface dataset:
266. EXTENSION OF FDG-PET-BASED RADIOMIC MODELS ON IDENTIFICATION OF PATIENTS WITH RESIDUAL ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY
Authors: Valkema Maria Joanna , Beukinga Roelof , Chatterjee Avishek , Woodruff Henry , van Klaveren David , Noordzij Walter , Valkema Roelf , Bennink Roel , Roef Mark , Schreurs Wendy , Doukas Michail , Lagarde Sjoerd , Wijnhoven Bas , Lambin Philippe , Plukker John , van Lanschot Jan 
Published: September 2022

Abstract
For esophageal cancer patients, detection of residual tumor after neoadjuvant chemoradiotherapy (nCRT) is important for guiding treatment decisions regarding standard esophagectomy or active surveillance. Prediction models incorporating clinical variables and FDG-PET quantitative radiomic features have been previously developed in a single-center setting (‘development cohort’, Beukinga et al. 2018) to identify patients with residual tumor after nCRT. The aim was to improve generalizability by redeveloping the models (i.e. ‘model extension’) using a multicenter prospectively acquired cohort.
The development cohort was combined with a patient cohort collected from a prospective multicenter study in four Dutch institutes. Patients underwent nCRT according to the CROSS regimen followed by esophagectomy 6–14 weeks after nCRT between 2013–2019. Outcome was tumor regression grade (TRG) 1–2 (0–10% tumor) vs TRG 3–4 (&gt;10% tumor). FDG-PET/CT was performed 6–12 weeks after nCRT. Post-treatment FDG-PET-radiomic features were calculated from gross tumor volumes. Features were standardized per scanner. A bootstrapped least absolute shrinkage and selection (LASSO) model using clinical variables and radiomic features was developed and a model incorporating clinical variables was developed for reference.
Some 262 patients were included. Median age was 65 years (IQR 60–70), 158 of 262 were male (82%) and outcomes were 129/262 TRG 1–2 (49%) and 133/262 TRG 3–4 (51%). The extended LASSO model included seven radiomic features and the clinical variables cT stage and histology (internally validated AUC, 0.59). At a probability threshold to obtain 90% sensitivity for detection of TRG 3–4 (benchmark with bite-on-bite biopsies + fine-needle aspiration of suspected lymph nodes), specificity was 36% and accuracy 63%. A LASSO clinical reference model (including cT, sex, histology) achieved an internally validated AUC of 0.58 (Fig. 1).
The extended internally validated LASSO model incorporating post-treatment radiomic features and clinical variables yielded moderate discriminative ability. The improvement in predictive performance with this model compared with a model using only clinical variables was marginal. The application of radiomics to post-treatment FDG-PET/CT scans is of no help in decision-making in individual patients regarding the choice for active surveillance after nCRT.
274. AUTOMATED SURGICAL STEP RECOGNITION FOR ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY USING ARTIFICIAL INTELLIGENCE
Authors: Takeuchi Masashi , Kawakubo Hirofumi , Matsuda Satoru , Kitagawa Yuko 
Published: September 2022

Abstract
More robot-assisted minimally invasive esophagectomy (RAMIE) procedures have been performed owing to three-dimensional field of view, image stabilization, and flexible joint function, however, both the surgeon, and surgical team require proficiency. Therefore, assessing the surgical learning curve and determining the surgical difficulty are essential for reducing complications. This study aimed to establish an artificial intelligence (AI)-based automated surgical phase recognition system for RAMIE by analyzing robotic surgical videos and evaluate the learning curve.
This study enrolled 31 patients who underwent RAMIE. We annotated the videos into the following nine surgical phases, namely preparation, lower mediastinal dissection, upper mediastinal dissection, azygos vein division, subcarinal lymph node dissection (LND), right recurrent laryngeal nerve (RLN) LND, left RLN LND, esophageal transection, and post-dissection to completion of surgery to train the AI for automated phase recognition. We divided all patients into two groups, namely early period (20 patients) and late period (11 patients), after which the relationship between the surgical phase duration and learning curve was assessed.
Frames were extracted from each video at a rate of one frame per second (fps), with an average of 14517 ± 4770 frames per video, which were used to train and test the AI model. Four-fold cross validation was applied to evaluate the performance of the present model. The AI had an accuracy of 84%. The preparation (p = 0.012), post-dissection to completion of surgery (p = 0.003), and ‘no step’ (p &lt; 0.001) phases predicted by the AI were significant shorter in the late period than in the early period.
We established an automated surgical phase recognition system for RAMIE using deep learning. Specific phase durations were significantly associated with surgeons’ learning curve, and similar tendencies were observed on phase durations predicated by the AI. Our AI-based system can be useful for not only education or OR efficiency but also evaluating surgical skill.
288. ASSOCIATION BETWEEN ENDOGENOUS SUBTYPE CLASSIFICATION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND OUTCOME OF CHEMORADIOTHERAPY
Authors: Yano Tomonori , Amanuma Yusuke , Minashi Keiko , Komatsu Masayuki , Nagashima Kengo , Shimizu Juko , Ishihara Ryu , Watanabe Akinori , Yamatsuji Tomoki , Matsushima Kayoko , Doyama Hisashi , Ando Takayuki , Nishimura Yasumasa , Sasaki Hiroki , Muto Manabu 
Published: September 2022

Abstract
Chemoradiotherapy (CRT) is a treatment option for esophageal squamous cell carcinoma (ESCC) and prognosis of patients achieved complete response is good. However, we cannot predict the outcome of the CRT before treatment. In previous single center study, RNA expression analysis using biopsy samples of 274 ESCC patients before CRT identified endogenous subtype classification. E type (high expression of squamous epithelial markers) showed good prognosis and M2 type (high expression of mesenchymal markers) did poor prognosis.
We conducted a prospective multicenter study to confirm the association between molecular subtyping and outcome of CRT. From January 2015 to July 2016, we prospectively recruited 226 patients from 10 hospitals in Japan.
This study was approved by the institutional review board at each hospital, and we obtained written informed consent from all patients (UMIN000016141). Biopsy samples were obtained before treatment, and molecular subtyping was performed. Treatment was selected by each physician. Clinical outcome of the patients treated by CRT was investigated according to the molecular subtype.
Among 226 patients, two patients withdrew the content. We could identify the subtype classification in all 224 patients. Fifty-seven patients (25.4%) were classified to E type and 56 (25.0%) to M2 type. In 224 patients, 97 received treatment include CRT (77: CRT alone, 16: induction chemotherapy followed by CRT, 4: CRT followed by surgery). The proportion of patients alive at 5 years was 48.8% (95% CI 28.0-66.7%) in E type, and 29.8% (95% CI 12.4-49.6%) in M2 type. The patients in E type showed better prognosis although it was not significant statistically (HR 0.5; 95% CI 0.23-1.09; p = 0.08).
This prospective multicenter study could show the usefulness of molecular subtyping of ESCC to predict the outcome of CRT.
289. PRIMARY MONOPHASIC SYNOVIAL SARCOMA OF THE CERVICAL ESOPHAGUS CONFIRMED BY DETECTION OF THE SS18-SSX2 FUSION TRANSCRIPTS
Authors: Tada Nobuhiro , Sasaki Ken , Tsuruda Yusuke , Shimonosono Masataka , Noda Masahiro , Uchikado Yasuto , Okumura Hiroshi , Omoto Itaru , Natsugoe Shoji 
Published: September 2022

Abstract
Synovial sarcoma (SS) of the esophagus is extremely rare. Because of the microscopic features of SS, the monophasic type can easily be misdiagnosed as other spindle cell tumors. Here, we present the first case of a primary SS of the esophagus in the presence of SS18-SSX2 fusion transcripts.
A 47-year-old Japanese woman was initially diagnosed with thyroid papillary carcinoma in the left lobe and leiomyoma of the cervical esophagus and subsequently underwent left thyroid lobectomy and enucleation of the esophageal tumor. Four years after the first surgery, the esophageal tumor recurred. Endoscopic biopsy of the tumor revealed atypical cell proliferation with spindle cell features and mitoses. Immunohistochemistry showed focal positivity for bcl-2 and HHF35. Furthermore, the presence of SS18-SSX2 fusion transcripts was confirmed by reverse transcription-polymerase chain reaction analysis, using a paraffin-embedded tumor specimen. Therefore, the tumor was diagnosed as monophasic SS of the cervical esophagus.
We re evaluated the surgical specimen enucleated 3 years previously, which was initially diagnosed as leiomyoma, and the diagnosis of SS was confirmed. The patient underwent cervical esophagectomy with isolated jejunal interposition reconstruction. Three years after the second surgery, SS recurred in the distal anastomotic site between the jejunum and the esophagus, and the patient underwent thoracoscopic esophagectomy with gastric conduit reconstruction. The pathological grade of the lesion worsened with every recurrence.
Monophasic SS can be difficult to discriminate from other spindle cell tumors based on microscopy alone, and molecular analysis could be useful for confirming the precise diagnosis of monophasic SS.
290. ANALYTIC MORPHOMIC INDEX AND QUANTITATIVE GASTRIC PERFUSION ASSESSMENT FOR RISK STRATIFICATION OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY
Authors: Ishikawa Yoshitaka , Hider Ahmad , Zhang Peng , Askar Brandon , Haveric Arman , Brandser Andrew , Lagisetty Kiran , Wakeam Elliot , Lynch William , Enchakalody Binu , Sullivan June , Orringer Mark , Chang Andrew , Wang Stewart , Reddy Rishindra , Lin Jules 
Published: September 2022

Abstract
Sarcopenia, a reduction in muscle mass, has been considered a preoperative risk factor for complications after esophagectomy while impaired perfusion of the gastric conduit has been associated with anastomotic leaks. The aim of this study was to stratify patients by their risk of anastomotic leak following esophagectomy using morphomic factors and quantitative assessment of gastric conduit perfusion.
Patients who underwent an esophagectomy with a cervical anastomosis and gastric conduit from 2015–2021 were included. Preoperative CT scans were processed using semiautomated algorithms (MATLAB; MathWorks, MA). Indocyanine green perfusion was assessed intraoperatively (SPY elite; Stryker, MI). Sarcopenia was defined using skeletal muscle area (Martin’s criteria). Decreased subcutaneous fat, decreased bone mineral density, and impaired conduit perfusion were defined as below the cutoff value from the ROC curve. The morphomic index was determined using the number of decreased morphomic factors present (0–3). The Fisher exact test, the Mann–Whitney U test, and multivariable logistic regression were used to make statistical comparisons.
140 patients with both perfusion and morphomic data were evaluated (Leak n = 27; No leak n = 113). Decreased subcutaneous fat, decreased bone mineral density, and impaired gastric conduit perfusion were associated with an anastomotic leak (p = 0.041, 0.017, and 0.010). Neoadjuvant chemoradiation was significantly more common in the leak group (p = 0.048). On multivariable analysis, a higher morphomic Index and impaired gastric perfusion were risk factors for anastomotic leak. The incidence of anastomotic leaks with a high morphomic index (2 or 3) and impaired gastric perfusion was 40.6% compared to 9.4% with a low morphomic index and without impaired gastric perfusion (p = 0.006).
Impaired gastric conduit perfusion and decreased preoperative subcutaneous fat area, bone mineral density, and skeletal muscle area, likely surrogates for increased frailty and poor nutritional status, were associated with an increased risk of anastomotic leaks especially when multiple morphomic factors were simultaneously decreased. These findings may be useful in risk stratification and intraoperative decision making in patients undergoing esophagectomy.
295. BILATERAL VOCAL CORD PARALYSIS AFTER HYPOPHARYNGEAL CERVICAL ESOPHAGEAL ESD—AN UNRECOGNISED RARE COMPLICATION
Authors: Yip Hon Chi , Chiu Philip Wai Yan , Chan Jason Ying Kuen 
Published: September 2022

Abstract
This is a video showing ESD performed for recurrent early cervical esophageal squamous cell carcinoma in close proximity to the pharynx. The procedure was completed smoothly with en-bloc resection. However, patient developed vocal cord paralysis requiring temporary tracheostomy. It is postulated that vocal cord paralysis was caused by posterior cricoarytenoid muscle injury. This important muscle is the only laryngeal muscle that opens the vocal folds, and will lead to potential airway compromise if injured. There hasn’t been any report of vocal cord paralysis after cervical esophageal ESD, and this case illustrates that this potentially lethal complication should not be overlooked.
297. ESOPHAGECTOMY IN ELDERLY PATIENTS WITH ESOPHAGEAL CANCER: A FIVE-YEAR EXPERIENCE FROM A CANCER CENTRE IN NORTH-EAST INDIA
Authors: Das Gaurav , Talukdar Abhijit 
Published: September 2022

Abstract
North-East India has a high incidence of esophageal cancer. An elderly patient with esophageal cancer often has multiple comorbidities and compromised general condition and so, esophagectomy in this population is associated with more morbidity and mortality. Our objectives were to estimate the 30-day morbidity and mortality and estimate the disease-free and overall survival and recurrence patterns.
Retrospective, observational single institute study. We included all patients with age ≥ 60 years with a proven diagnosis of esophageal cancer and who underwent an esophagectomy during the study period from 1st January 2016 to 31st December 2020. Data was collected from patient’s records and the results were presented using median values, range and percentages.
There were 35 patients; median age was 65 years (range 60 to 76 years). Neoadjuvant chemotherapy (40.0%) was used more than chemoradiation (31.4%). Procedures included trans-thoracic esophagectomy (68.6%), trans-hiatal esophagectomy (25.7%) and left thoraco-abdominal approach (5.7%). 30-day mortality rate was 8.6% (aMI, COVID pneumonia and ARDS). 30-day morbidity rate was 40%, with pulmonary (25.7%), hoarseness of voice (17.1%), anastomotic leak (14.3%), wound infection (11.4%), symptomatic cardiac arrhythmias (5.7%) and septicaemia (2.9%) being part of the spectrum. 8.5% had locoregional recurrence and 5.7% had distant recurrence (peritoneum, bones and liver). Median overall survival was 33 months (range 9 to 43 months).
Esophagectomy in elderly patients carry a high risk of 30-day morbidity and mortality, but has acceptable overall survival.
298. COMPLIANCE FOR TRIMODALITY TREATMENT OF LOCALLY ADVANCED ESOPHAGEAL CANCER: EXPERIENCE FROM A CANCER CENTRE IN NORTH-EAST INDIA
Authors: Das Gaurav , Sarma Gautam , Roy Partha 
Published: September 2022

Abstract
Neoadjuvant chemoradiation (NACRT) is a standard approach for treatment of locally advanced esophageal cancer. In real-world scenario, there are several challenges to the completion of such treatment. We aim to estimate the completion rates of such treatment and also estimate the treatment response.
Retrospective, observation single-institute study. Study duration was from 1st June 2018 to 30th June 2021. Data was collected from patient’s records and results were presented in median values, range and percentages.
A total of 82 patients were planned for trimodality treatment in the Joint Tumour Board during the study period. The number of patients who completed the NACRT was 55 (67.1%). Of them, 11 (13.4%) defaulted by not undergoing esophagectomy and 4 patients (4.9%) had inoperable disease at surgery. A total of 42 patients (51.2% of intention to treat population) actually completed the trimodality treatment. Trans-thoracic esophagectomy was done in 35 and transhiatal esophagectomy in 7 patients. Complete pathological response of both the primary and the nodes (pCR) was noted in 12 patients (26.1%).
The compliance for trimodality treatment approach is a key area for improvement in esophageal cancer treatment and we need to decrease ‘drop outs’ due to temporary symptom relief, remoteness of residence, financial hurdles, treatment toxicity with an efficient system of care delivery.
301. LONG TERM RESULTS OF SINGLE AND MULTI-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY (MIE) FOR TREATING ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED STUDY
Authors: Chen Yung-Hsin , Lee Jang-Ming 
Published: September 2022

Abstract
Minimally invasive esophagectomy (MIE) is widely accepted as the standard treatment for esophageal cancer. It provides similar oncological outcomes with less pain and morbidity compared to open surgery. We first described MIE with single-incision both in the laparoscopic and thoracoscopic phase in 2015. Compared to multi-portal approach, short-term result showed comparable perioperative outcome with significantly reduced pain after surgery. With accumulated clinical experience, we compared our long-term follow-up result for single-incision MIE versus multi-incision MIE.
Patients with esophageal cancer, receiving MIE at our institute from 2008 to 2022 were included. 337 patients underwent single-incision MIE, while 467 patients received multi-incision MIE. Matching based on propensity scores produced 290 patients in each group.
The baseline characteristics between the two groups were similar after matching. Overall survival (OS) and progression free survival (PFS) were not compromised in single-incision MIE compared to multiple-incision MIE (5-year OS: 42.9% vs. 21.2%, p &lt; 0.001; 5-year PFS: 35.1% vs. 17.1%, p &lt; 0.001). The operation time was shorter (505.7 min vs. 562.4 min, p &lt; 0.001). Single-incision MIE had larger mean number of dissected lymph nodes (45.6 vs 37.4, p &lt; 0.001). There were no significant differences between the two groups in terms of short-term complications (single vs multi: 20.3% vs 15.9%, p = 0.196) and R1/2 rate (single vs multi: 11.5% vs 9.0%, p = 0.340).
Single-incision MIE is safe, feasible and effective for patients with esophageal cancer. Its long-term oncological outcomes are not compromised when compared to multiple-incision MIE, while its short-term perioperative outcomes are comparable to multi-incision approach. Three-dimensional imaging may play a role in higher quality oncological resection with more lymphatic clearance for single-incision MIE compared to multiple-incision MIE.
305. SURVIVAL DIFFERENCES ACCORDING TO THE PATHOLOGIC STATUS AFTER NEOADJUVANT THERAPY FOLLOWED BY SURGERY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Park Seong Yong , Jeon Yeong Jeong , Lee Junghee , Ho Jong , Choi Yong Soo , Zo Jae Il , Shim Young Mog , Kim Hong Kwan 
Published: September 2022

Abstract
This retrospective study was performed to investigate the survival differences according to the pathologic status after neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery in esophageal squamous cell carcinoma (ESCC).
The data of 507 patients who received the neoadjuvant CCRT and esophagectomy for ESCC between 2003 and 2018 were retrospectively reviewed. The mean age was 62.28 ± 8.07 and 473 (93.3%) were male patients. The median follow-up period was 29.24 months (interquartile range: 16.57–49.95 months). 144 (28.4%) patients showed pathologic complete response (ypCR) and 90 (17.8%) patients showed ypCR of primary lesion with residual metastatic lymph nodes (ypT0N+). 107 (33.5%) and 103 (20.3%) patients showed ypT + N+ and ypT + N0, respectively.
In patients with residual metastatic lymph nodes, the numbers of metastatic lymph nodes were 1(112, 22.1%), 2(49, 9.7%) and more than 3(100, 19.7%). The 5-year overall survivals (OS) of each group were 71.1%(ypCR), 47.9%(ypT + N0), 51.8%(ypT0N+) and 27.1%(ypT + N+); ypCR patients showed better survival than others and there were no survival differences in 5-year OS between ypT + N0 and ypT0N+ patients (p = 0.811). ypT + N+ patients showed more common locoregional and distant metastasis. The 5-year freedom from distant metastasis were different according to pathologic status; 83.1%(ypCR), 69.4%(ypT + N0), 59.1%(ypT0N+) and 44.6%(ypT + N+). The numbers of residual metastatic lymph nodes were related to the distant metastasis (HR1.083, p &lt; 0.001) ypCR offers long-term survival in patients without nodal metastases, but the survival significantly deteriorates with the presence of residual primary lesion and nodal metastases. Follow-up strategies and indication of additional postoperative therapy could be guided according to the pathologic status after neoadjuvant CCRT followed by surgery.
308. RIGHT TOP PULMONARY VEIN IS A VENOUS ANOMALY OF WHICH SURGEONS SHOULD BE AWARE IN SUBCARINAL DISSECTION FOR RADICAL ESOPHAGECTOMY
Authors: Sato Yuta , Tanaka Yoshihiro , Ohno Shinya , Endo Masahide , Yoshida Kazuhiro 
Published: September 2022

Abstract
A right top pulmonary vein (RTPV) that crosses behind the right bronchus, is a variation of the superior posterior pulmonary vein in the right upper lobe. Damage of this vessel can lead to intraoperative bleeding, congestion of the posterior segment of the right upper lobe, and cardiac tamponade. Subcarinal lymph node dissection is mandatory in radical esophagectomy for esophageal cancer, and the RTPV is an anomalous vessel of which surgeons should be aware.
A 70-year-old man underwent thoracoscopic esophagectomy for esophageal cancer (T3N1M0). An anomaly of the superior posterior pulmonary vein in the right lobe was recognized on preoperative computed tomography imaging. With simulation and intraoperative navigation using three-dimensional imaging (SYNAPSE VINCENT, Fuji Photo Film Co., Ltd, Tokyo, Japan) of the same view as that observed during the operation, radical subcarinal dissection could be performed with preservation of the RTPV.
Only 5 case reports have described the association of RTPV in esophagectomy. In review of the literature, the incidence of RTPV ranged from 0.28 to 9.3%, and its mean vascular diameter ranged from 7.0 mm to 2.2 mm, with the right superior pulmonary vein being a common inflow site. Our case in which the RTPV ran dorsal to the right main bronchus is very rare. In radical subcarinal dissection of esophagectomy in cases with RTPV, it is important to recognize the posterior pericardial plane and release the ventral fixation of these lymph nodes to free space for the back side.
Based on our review of the relevant literature, an RTPV larger than 4.5 mm should be noted in order to prevent injury and ligation should be avoided. The preoperative recognition of this abnormal vessel using 3D imaging was very useful for radical SCLN dissection during thoracoscopic esophagectomy.