bluuebunny/crossref_metadata_2025_split huggingface dataset:
376. THE IMPACT OF OVERALL SURVIVAL ON TWO-FIELD OR THREE-FIELD LYMPHADENECTOMY IN MIDDLE AND LOWER THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Li Kexun , Leng Xuefeng , Li Changding , Liu Kun , He Wenwu , Luo Xi , Wang Chenghao , Wang Qifeng , Wang Kangning , Liu Guangyuan , Zhou Qiang , Jiang Longlin , Li Haojun , Mao Tianqin , Du Kunyi , Fang Qiang , Xiao WenGuang , Han Yongtao , Peng Lin 
Published: September 2022

Abstract
More than 50% of esophageal cancer cases worldwide occur in China. Squamous cell carcinoma is the main subtype of esophageal cancer in East Asian. The manner of lymphadenectomy during surgery is related to the OS, but the effect of removed lymph node count for middle and lower thoracic esophageal squamous cell carcinoma (ESCC) in China is still controversial.
Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database) from Jan. 2010 to Dec. 2017. Patients were divided into two groups: For patients without suspicious tumor-positive cervical lymph nodes, 2-field systematic lymphadenectomy was performed and were belonged 2F group, while patients with suspicious tumor-positive cervical lymph nodes, 3-field systematic lymphadenectomy was performed and were put into 3F group. According to the quartile number of resected lymph nodes during operation. Four subgroups were designed for analysis in 2F group and 3F group, depending on the intensity of the lymphadenectomy.
After 60.0 months (95% CI 56.5–63.4) of median follow-up time. The median OS of 2F group patients was 46.9 months (95% CI 39.3–54.5), 3F group was 34.0 months (95% CI 26.1–42.0). The OS at 1, 3, and 5 years were 87%, 57%, and 46% in the 2F group. In the 3F group, the OS rates at 1, 3, and 5 years were 82%, 49%, and 41% (P = 0.029). According to the quartile number of RLNs, there were different survival outcomes in 3F sub-groups, while in the 2F groups, the OS between A/B/C/D group was not significantly different (Fig A & B).
ESCC patients with suspicious tumor-positive cervical lymph nodes have significantly worse OS than patients who without tumor-positive cervical lymph nodes. Different lymph nodes number removed in 3F patients could lead the entirely different survival outcomes. However, this still needs further large scale study to verify in China.
378. FLOT VS ECX: A COMPARISON OF TWO NEOADJUVANT CHEMOTHERAPY REGIMEN’S EFFECTS ON SARCOPENIA IN ESOPHAGOGASTRIC ADENOCARCINOMA PATIENTS
Authors: Convill James , Chmelo Jakub , Prasad Pooja , Brown Joshua , Petrides George , Phillips Alexander 
Published: September 2022

Abstract
Sarcopenia is defined as a loss of skeletal muscle mass and function. It is prevalent amongst patients with esophagogastric adenocarcinoma (EGA) and associated with adverse treatment outcomes. Neoadjuvant chemotherapy (NAC) may contribute to sarcopenia development. FLOT, although superior to ECX in terms of survival, has been reported to have higher toxicities. The aim of this study was to compare the effect of ECX and FLOT on sarcopenia and lean body mass (LBM) in EGA patients.
Patients diagnosed with EGA between January 2017 and December 2020 and undergoing ECX/FLOT NAC followed by esophagectomy from a single tertiary center in the UK had their pre- and post-NAC CT scans assessed for radiological sarcopenia. Skeletal muscle index (SMI) was calculated from muscle area measured on CT scans at the level of third lumbar vertebra. Previously published SMI cut off values for radiologically defined sarcopenia were used (52.4cm2/m2 for men and 38.5cm2/m2 for women). LBM (kg) was calculated using a previously published formula.
153 patients were included in the analysis. Sarcopenia increased from 77/153 (50.3%) pre-NAC to 98/153 (64.1%) post-NAC (p &lt; 0.005). There were 48/82 (58.5%) ECX and 29/65 (44.6%) FLOT patients sarcopenic pre-NAC. 60/82 (73.2%) ECX and 38/65 (58.5%) FLOT patients were sarcopenic post-NAC and pre-operatively. There was no statistically significant difference observed for development of sarcopenia after NAC between the two NAC regimens (p = 0.793). Similarly, LBM significantly decreased during NAC (p = 0.007), but this effect did not vary between NAC regimen (p = 0.917).
Radiological sarcopenia is highly prevalent in EGA patients and significantly increases during NAC. However, this study suggests that there is no difference in the degree of sarcopenia between ECX and FLOT NAC regimens. Impact of pre- and post-FLOT related sarcopenia on treatment outcomes needs to be established alongside strategies to treat this syndrome and prevent its further development.
384. A 10-YEAR EXPERIENCE WITH ANASTOMOTIC LEAKS IN UPPER GASTROINTESTINAL SURGERY
Authors: Law Jia Hao , Ng Charmaine Zhi-Mei , Lauw Sarah-Kei , So Jimmy Bok Yan , Kim Guo Wei , Shabbir Asim 
Published: September 2022

Abstract
Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge despite advancements in surgical techniques and investigation modalities. We seek to identify key clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries in our practice.
592 patients underwent UGI surgeries with an anastomosis in a single center between January 2011 and Jan 2021. The cohort comprises were 237 (40.0%) distal gastrectomies, 120 (20.3%) total gastrectomies, 104 (17.6%) Roux-en-y bariatric bypasses, 53 (9.0%) Ivor-Lewis esophagectomies, 41 (6.9%) proximal gastrectomies, 17 (2.8%) palliative gastro-jejunostomies and 20 (3.4%) Mckeown esophagectomies. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed.
The overall occurrence of AL was 6.4%. AL was highest in esophagectomies (13.7%) and total gastrectomies (10.0%). Clinical parameters associated with AL include HR &gt;120 BPM, desaturation, bilious or food contents in drain and leukocytosis. On multivariate analysis, HR &gt;120 BPM and leukocyte count &gt;19x1000000000/L were independent predictors of AL. Patients with high-risk anastomosis who had pre-emptive investigations, were more likely to be managed with antibiotics instead of requiring invasive therapy (p = 0.025). Methylene blue test, oral contrast study and Computed Tomography scan with intravenous and oral contrast had respective false negatives of 50.0%, 20.0% and 9.1%, while esophagogastroduodenoscopy had none.
Our study demonstrates that the presence of a triad including desaturation, tachycardia and leukocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed to exclude a AL. A practice of evaluating high risk anastomosis prior to feeding decreases need for surgical intervention and improves the chances of successful conservative treatment.
388. PREOPERATIVE TREATMENT AND THORACOSCOPIC ESOPHAGECTOMY FOR BORDERLINE RESECTABLE ESOPHAGEAL CANCER
Authors: Kawada Hironori 
Published: September 2022

Abstract
Preoperative DCF therapy is recommended for cStage II/III esophageal cancer based on the results of JCOG1109. However, there is no established treatment strategy for Borderline Resectable (BR) esophageal cancer that is suspected of invading vital organs. And the pros and cons of thoracoscopic surgery have not been clarified. We have been performing preoperative chemoradiotherapy (NACRT) followed by thoracoscopic subtotal esophagectomy for BR esophageal cancer. Details and short-term results are presented.
After 2 courses of FP therapy and 40 Gy total dose (2 Gy x 20 times) of fractionated conventional irradiation, patients underwent thoracoscopic subtotal esophagectomy with D2 dissection if T4 factor was considered to have been removed by CT evaluation.
From April 2017 to present, NACRT was performed in 25 BR esophageal cancer patients. Two of them were unresectable, and thoracoscopic subtotal esophagectomy was performed in 23 cases. All patients had squamous cell carcinoma. 4 patients had complications of Clavien-Dindo Grade III or higher. The median postoperative hospital stay was 23 days. Of the 23 cases that were resectable, R0 resection could be performed in 21 cases (91.3%). The pathological response of the primary tumor was Grade3 in 11 patients (47.8%), Grade2 in 5 (21.7%), and Grade1 in 7 (30.4%). Pathological-CR including regional lymph nodes was 7 cases (30.4%).
NACRT is effective for BR esophageal cancer, and thoracoscopic subtotal esophagectomy can be performed safely. We would like to continue to study the long-term results of NACRT with more cases in the future.
389. BENEFITS OF BILATERAL THORACOSCOPIC SURGERY IN THE PRONE POSITION FOR A LARGE ESOPHAGEAL TUMOR
Authors: Uemura Norihisa , Ishihara Makoto , Saeki Satomi , Ito Takaaki , Tsukahara Tetsuo , Tabata Koki , Yamashita Hiromasa , Takeuchi Mamiko , Arai Toshiyuki , Amemiya Takeshi 
Published: September 2022

Abstract
Esophageal gastrointestinal stromal tumors (GISTs) are relatively less symptomatic and may have a significantly large tumor diameter at diagnosis. Large esophageal tumors are difficult to resect because it is tough to maintain the surgical field in the narrow mediastinal region. In addition, because GIST has a risk of dissemination if the tumor collapses during surgery, it must be resected with as little force as possible.
We herein report a middle and lower thoracic esophageal GIST with a maximum lateral diameter of 12 cm that could be safely resected by a bilateral thoracoscopic approach in the prone position. The case was that of a 70-year-old man. Since his tumor diameter was large and the surrounding organs were severely compressed, it was deemed to be borderline resectable, and preoperative chemotherapy with imatinib was decided. However, administration of imatinib did not result in tumor shrinkage, and interstitial pneumonia occurred. Thus, the final decision was to resect it.
It was difficult to remove the left side of the tumor by normal thoracoscopic operation from the right side as the tumor was large. There was also the risk of the tumor collapsing due to unreasonable traction. Therefore, we selected a surgical procedure in which the left and right sides of the tumor were detached by bilateral thoracoscopic operation in the prone position and then the tumor was removed from the abdominal cavity by a transesophageal hiatal operation under laparotomy. Followed by gastric tube reconstruction by the posterior sternal route. The postoperative course was uneventful.
In this case, taking advantage of the thoracoscopic approach from both sides, the tumor could be safely resected without unreasonable traction. Furthermore, the prone position has the advantage that bilateral thoracoscopic operation is possible without changing the position. This technique could also be applied for the excision of esophageal cancer involving the left side.
392. A CASE REPORT AND REVIEW OF MANAGEMENT OF AORTOESOPHAGEAL FISTULA SECONDARY TO OESOPHAGEAL MALIGNANCIES
Authors: Pang Jolyn , Ng Ya-Lyn Annalisa , Wong Siang Yih Andrew 
Published: September 2022

Abstract
Aortoesophageal fistula (AOF) is a rare but life-threatening condition. We present a case of AOF secondary to oesophageal Squamous Cell Carcinoma (SCC) treated with Thoracic Endovascular Aortic Repair (TEVAR) and a literature review of cases of AOF secondary to oesophageal malignancies treated with TEVAR.
We performed a literature review of patients with oesophageal malignancies complicated by AOF who underwent endovascular stenting as treatment.
A total of 16 articles with 22 patients were found during the review. The majority (18 out of 22 patients, 82%) were male. 18 (82%) presented with haemorrhage and 9 (41%) presented with hypotension. Of the eight studies where location of oesophageal tumour was mentioned, 7 (88%) were in the mid-thoracic oesophagus. Survival at 6 months post-stenting was up to 45%.
Early recognition of AOF, effective resuscitation and early intervention is critical in survival of patients with AOF. TEVAR has been shown to have good outcomes with high technical success rate.
397. NEOADJUVANT CHEMORADIOTHERAPY VERSUS NEOADJUVANT CHEMOTHERAPY AND POSTOPERATIVE COMPLICATIONS AFTER ESOPHAGECTOMY FOR CANCER
Authors: Olafsdottir Halla , Dalqvist Emmy , Hamida Osama , Onjukka Eva , Klevebro Fredrik , Nilsson Magnus , Gagliardi Giovanna , von Döbeln Gabriella Alexandersson 
Published: September 2022

Abstract
Postoperative complications after esophagectomy are common. Neoadjuvant chemotherapy or chemoradiotherapy in addition to surgery is the standard treatment with curative intent for patients with locally advanced esophageal cancer. The aims of our study were to analyze if the addition of neoadjuvant radiotherapy to chemotherapy and surgery increases the rate and severity of postoperative complications and to evaluate if radiotherapy doses to the heart and lungs were associated with postoperative complications.
The study was based on a prospectively collected database of esophageal cancer patients that were operated on between October 2008 and March 2020. Patients treated with neoadjuvant chemoradiotherapy were compared to patients treated with neoadjuvant chemotherapy. All postoperative complications were graded according to the Clavien Dindo classification. The primary outcome was 30-day postoperative complications. Logistic regression was used to determine the effect of radiotherapy on complication rates. Several dose/volume parameters for the lungs and the heart were considered.
During the study period esophagectomy was performed on 275 patients after neoadjuvant treatment (93 after chemotherapy and 182 after chemoradiotherapy). The median total radiation dose was 41.4 Gy, the median lung dose was 6.2 Gy and the median dose to the heart was 20.3 Gy. Neoadjuvant chemoradiotherapy compared to chemotherapy showed no association with postoperative complications of a Clavien Dindo score of ≥2 or severe postoperative complications (Clavien Dindo ≥3b). Taxane-containing chemotherapy had a statistically significant association with postoperative complications (table 1). The radiotherapy dose to the heart and lungs had no significant association with postoperative complications.
In our cohort, the addition of preoperative radiotherapy to chemotherapy did not increase the rate of postoperative complications. However, an association between postoperative complications and taxane-containing chemotherapy regimens given with or without concomitant radiotherapy was noted.
400. RISK FACTORS OF DELAYED GASTRIC EMPTYING AFTER ESOPHAGECTOMY WITH GASTRIC INTERPOSITION: AN ANALYSIS OF 810 CASES
Authors: Yu Ming Ru , Leow Osbert Qi Yao , Chao Yin-Kai 
Published: September 2022

Abstract
Delayed gastric emptying (DGE) after esophagectomy is not uncommon and would significantly impair patient’s quality of life. Risk factors of DGE remained poorly understood. This study aimed to assess this unresolved issue.
We performed a retrospective study in patients with esophageal cancer who underwent esophagectomy and reconstructed with the gastric substitute between 2000 to 2020. DGE was defined as less than 50% emptying of the contrast medium within 10 minutes on postoperative esophagography. Multivariable logistic analysis was performed to identify patient-, tumor- and procedure-related factors that increase the risk of DGE.
Among 810 eligible patients, the incidence of DGE was 12.2%. Patients who developed DGE had higher incidence of pneumonia (23.2% vs. 10.7%, p &lt; 0.001), longer hospital stay (25.16vs.19.89 days, p &lt; 0.001), and higher rate of in-hospital mortality (4% vs. 1%, p = 0.014). Multivariate analysis identified pre-existing COPD (OR, 2.38; p = 0.004), whole stomach reconstruction (vs. gastric tube, OR, 6.96; p = 0.001) and posterior mediastinum route (vs. retrosternum, OR, 5.35; p = 0.002) as independent risk factors for DGE. The incidence of DGE was 0.6% in patients who received gastric tube reconstruction via retrosternum route as opposed to 20.6% who received whole stomach reconstruction via posterior mediastinum route.
DGE after esophagectomy is associated with increased morbidity and mortality. Type of gastric conduit and route of reconstruction played important roles in the development of DGE.
403. FRAILTY AS A PREDICTOR OF POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ESOPHAGECTOMY
Authors: Chowdhury Sheuli , Conroy Molly A , Johnson Alicia J , Qureshi Alia P , Wood Stephanie G 
Published: September 2022

Abstract
Careful selection and optimization of esophageal cancer patients for esophagectomy is necessary and has been shown to improve outcomes. Preoperative frailty measures, both objective and subjective, may predict postoperative outcomes after minimally invasive esophagectomy (MIE) and be applied to surgical decision-making and patient selection. We hypothesize that measures of increased frailty are associated with major complications after MIE for esophageal cancer.
This is a prospective cohort study of patients undergoing MIE for esophageal cancer in a US academic tertiary hospital over one year (2021). We tested preoperative frailty by measuring two-flight stair climb times, pulse change during stair climb, grip strength, and Edmonton Frail Scale (EFS) score. Postoperative complications in the first 30 days were classified based on Clavien-Dindo, with Grade III or above defined as a major complication (primary outcome). We calculated Spearman correlations among the four different frailty measures. We performed t-tests to compare frailty measures in patients with and without major complications.
Thirty-four patients were enrolled with a mean age of 64 (SD 11) and 79.4% male. EFS score, grip strength, and stair climb time were significantly correlated (p &lt; 0.05), as shown in Figure 1. There was a significant difference in EFS scores between groups with or without major complications (4.7 vs 3.0, p = 0.04, respectively), with a higher score representing increased frailty. Other frailty measures did not meet significance between groups for major complication, including stair climb time (difference of 11.0 s, 95% CI: −0.38-22.4) and grip strength (difference of 7.7 kg, 95% CI: −0.94-16.3). No difference was seen in pulse change by complication status.
A higher Edmonton Frail Scale score is associated with major postoperative complications following MIE. Patients with higher EFS score should be counseled on increased surgical risk of morbidity and prehabilitation should be considered. Other measures such as stair climb time and grip strength may support the preoperative frailty assessment in esophageal cancer patients, as they were highly correlative with each other.
411. MAJOR INTRAOPERATIVE COMPLICATIONS IN MINIMALLY INVASIVE ESOPHAGECTOMIES
Authors: Söderström Henna , Moons Johnny , Nafteux Philippe , Uzun Eren , Grimminger Peter , Luyer Misha DP , Nieuwenhuijzen Grard AP , Nilsson Magnus , Hayami Masaru , Degisors De Sebastien , Piessen Guillaume , Vanommeslaeghe Hanne , Van Daele Elke , Cheong Edward , Gutschow Christian A , Vetter Diana , Schuring Nannet , Gisbertz Suzanne , Räsänen Jari 
Published: September 2022

Abstract
Studies have shown minimally invasive esophagectomy (MIE) to be a feasible surgical technique in treating esophageal carcinoma, with equal oncological results as open surgery. The number of MIEs in Europe are increasing. Postoperative complications have been recently reviewed by a multicenter study that benchmarked MIE outcomes. There are no studies, to date, regarding major intraoperative complications during MIE and their effect on patient survival.
Data was gathered retrospectively from 10 European centers with a minimum MIE experience of 3 years and more than 20 procedures annually. All intention-to-treat, minimally invasive laparoscopic/thoracoscopic esophagectomies with gastric conduit reconstruction for esophageal- and GE junction cancers operated between 2003–2019 were reviewed. Major intraoperative complications were defined as loss of conduit, erroneous transection of vascular structures, significant injury to other organs including bowel, heart, liver or lung, splenectomy, major anesthesiologic complications including intubation injuries, arrhythmias, pulmonary embolism and myocardial infarction. We also included minor intraoperative events that led to additional repair or resection of vascular structures or airways.
Amongst 2862 MIE cases we identified 99 patients with 103 intraoperative complications. Of the 34 different complications the most common were vascular lesions during laparoscopy (n = 40). There were 20 splenic artery and -capsular injuries, 11 requiring splenectomy. Four losses of conduit due to gastroepiploic artery injury and five colon injuries were reported. Six tracheobronchial lesions needed repair, and 12 patients had significant lung parenchyma injuries. During thoracoscopy nine of the 13 cases with bleeding were converted and an additional 5 patients required postoperatively emergency re-intervention for thoracic bleeding. There were 2 on-table deaths. 10 of the 99 patients died in-hospital.
This study offers a good overview of the wide range of possible intraoperative complications. Knowing the pitfalls can help trainees, and experienced surgeons, avoid common complications. Unfortunately, this study does not offer us incidence, which would require a prospective trial. On-table deaths are exceedingly rare.
There is a possible underreporting of complications, an issue not avoided by implementing specific surveying criteria. Surgical registries need to capture intraoperative complications better in the future.
412. FEASIBILITY AND SAFETY OF MINIMALLY INVASIVE SURGERY FOR OESOPHAGEAL DUPLICATION CYST IN ADULTS– EXPERIENCE FROM AN OESOPHAGO-GASTRIC SURGERY UNIT
Authors: Surendran Suraj , Samuel Ashish , Paul Negine , Yacob Myla , Abraham Vijay , Gnanamuthu Roy , Samarasam Inian 
Published: September 2022

Abstract
Oesophageal duplication cyst (ODC) is a rare congenital anomaly of the foregut. The reports of ODCs presenting in adulthood is relatively rare. Surgical excision is the ideal treatment. Traditionally, the excision is performed via a thoracotomy with its resultant morbidity. Minimally invasive surgical (MIS) approaches are feasible and can potentially reduce the postoperative discomfort and reduce the hospital stay. We aimed to study the feasibility and safety of MIS for ODC in adults.
A retrospective review of all adult patients with ODCs treated in an oesophago-gastric surgery unit, between January 2015 and March 2022, was performed. All patients received MIS. The demographic, clinico-radiological, and operative details and outcomes were analysed.
Nine patients (Female 7; mean age, 36.2 ± 4.4 years) were included. Chest pain was the commonest symptom (44.0%). Oesophago-gastroscopy showed normal mucosa in all patients. Endoscopic-ultrasound was performed in all except one; no cysts had atypical features. The cysts were frequently located in the distal thoracic oesophagus (78%) and the median (range) cyst size was 6.3(3.9–13.5) cm. All patients received MIS (Thoracoscopy,8; Thoraco-laparoscopic, 1); no conversion to open surgery. The techniques resection techniques were enucleation (5), stapler-assisted resection (3) or partial excision (1). The 30-day morbidity was 22.2% (Staple line leakthoracoscopic repair, 1; pleural collectionimage-guided drainage, 1). The median (range) hospital stay was 7(3–25) days and there was no mortality.
MIS is feasible and safe for the management of adult ODCs and should be offered to patients, irrespective of the timing of its presentation or the location and size of the cyst.