bluuebunny/crossref_metadata_2025_split huggingface dataset:
386. SURGICAL SHORT-OUTCOMES IN ELDERLY PATIENTS WITH ESOPHAGEAL CANCER IN OUR INSTITUTION
Authors: Ishida Yoshinori , Kono Syugo , Hojo Yudai , Nakao Eiichiro , Nakamura Tatsuro , Kurahashi Yasunori , Shinohara Hisashi 
Published: September 2022

Abstract
With aging, patients with esophageal cancer would have several comobidity and decline of physiological function. It is difficult to fit the standerd treatment to the elderly patients with esopageal camcer. We review the data of elderly patients who underwent operation for esopageal cancer in our institution to evaluate the safety of surgery in this partucular population.
During January 2017 and December 2021, twenty three patients over 75-year-old underwent the operation with right thoracotomy, that is McKeown’s or Ivor-Lewis operation, for esophageal cancer or esophago-gastric junction cancer in our institution.
We retrospectively analyzed their preoperative assessment, concurrent disorders, surgical techniques used, postoperative course, and complications.
Average age of the patients was 79.5 years, and over 80 year-old patients were nine. Preoperative chemotherapy was done in 12 cases. Only 3 patients underwent esophagectomy with right thoracotomy and three-field lymph node dissection.
Postoperative complications occurred in 17 patients (74%). Mortality was one cases, because of severe respiratory failure. Anastomotic leakage was observed in nine patients. As other complications over Grade II in Clavien-Dindo (CD) classification, anastomotic stricture was 4, pneumonia was 3 cases. Recurrent nerve paralysis was observed in 6 patients in Grade I in CD classification.
It is difficult to decide treatment for esophageal cancer only at age. In elderly cases, it would require more ingenuity for anastomosis after esophagectomy.
387. REFUSING SURGERY AFTER NEOADJUVANT TREATMENT IN PATIENTS WITH ESOPHAGEAL CANCER: A PROPENSITY-SCORE MATCHED SURVIVAL ANALYSIS
Authors: Chi Chun-Ling , Gao Xing , Chao Yin-Kai 
Published: September 2022

Abstract
Neoadjuvant chemoradiotherapy (nCRT) followed by surgery is the recommended treatment for patients with locally advanced esophageal cancer. However, not all patients who started nCRT will undergo esophagectomy and refusal is one of the main reasons. Although an active-surveillance strategy in patients with a clinically complete response after nCRT is increasingly implemented in clinical practice, the evidence is still immature and refusing surgery still comes with uncertain risk and outcomes.
We aimed to study survival outcomes of patients with esophageal squamous cell carcinoma (ESCC) who underwent nCRT followed by surgery versus patients who refused surgery after nCRT. Two hundred thirty patients treated between 2012–2020 at Chang-Gung Memorial Hospital were assessed. To balance confounders that could interfere with patients’ decision, baseline characteristics, year of treatment, type of nCRT regimen, adverse events during nCRT, timing of response evaluation, and result of response evaluation (Figure 1) were subjected to propensity score matching (PSM). Thirty-three patients refused surgery and were matched with 66 (of 146) patients who underwent surgery.
Before PSM, the two groups had similar baseline characteristics. No significant differences were found in the choice of nCRT regimen nor the severity of adverse events during nCRT, except for the days between the end of nCRT and response evaluation, which was longer in the refusal group (31.7 ± 14.1 versus 37.4 ± 16.4, P = 0.047). Surprisingly, response evaluation results were also similar before PSM. Two patients refused surgery while having positive biopsies and 82% still had suspected nodal involvement on computerized or positron emission tomography scan. After PSM, 3-year overall survival was 59% versus 55% in the surgery and refusal group, respectively (P = 0.78).
Our findings suggest that patients who refused surgery have similar survival outcomes as patients receiving esophagectomy after nCRT. However, after refusal, 85% still received additional chemoradiotherapy, 52% had disease progression within 16 months and 12% received salvage surgery eventually. Refusing surgery based on patients’ values and belief does not necessarily lead to worse survival outcomes, but future clinical trials should focus on standardization of additional therapy and follow-up after refusal to avoid uncertain outcomes.
393. ENDOSCOPIC VACUUM THERAPY FOR PATIENTS WITH ESOPHAGEAL PERFORATION: A MULTI-CENTER RETROSPECTIVE COHORT STUDY
Authors: Luttikhold Joanna , Pattynama Lisanne MD , Seewald Stefan , Groth Stefan , Morell Bernhard , Ida Satoshi , Nilsson Magnus , Eshuis Wietse J , Pouw Roos E 
Published: September 2022

Abstract
Esophageal perforations are associated with high morbidity. Recently, endoscopic vacuum therapy (EVT) has been introduced as a novel treatment option for esophageal perforations. This technique has so far mainly been described for anastomotic leakage after upper gastrointestinal surgery. The aim of this study was to describe the initial experiences with EVT for treatment of esophageal perforations caused by Boerhaave syndrome or with an iatrogenic cause.
For this retrospective, multicenter cohort study, all patients primarily treated with EVT for an esophageal perforation at four hospitals in the Netherlands, Switzerland and Sweden between January 2018 and October 2021, were included. Data on patient characteristics, EVT and outcomes were analyzed. The primary endpoint was success rate of EVT, defined as closure of the defect, as assessed by endoscopy or CT-scan.

27 patients were included (Table 1). EVT succeeded in 24/27 patients (89%, 95%CI[71,98]) with 16/19 using EVT alone (84%, 95%CI[60,97]). In 8 patients an additional treatment modality was used. In 3 patients EVT failed: 2 (Boerhaave and unknown cause) deceased due to a pulmonary embolism and septic embolic stroke, and 1 (Boerhaave) underwent an additional esophagectomy. All had a ‘large’ perforation-size.
Median hospital stay was 18 days, with median 12 days EVT-duration and 1 sponge-exchange. Additional drainage was performed in 8 patients. EVT-associated complications occurred in 3 patients: 1 iatrogenic defect-expansion from the overtube and 2 hemorrhages, which spontaneously stopped.
EVT is a promising, possibly organ-preserving treatment for Boerhaave syndrome or iatrogenic esophageal perforation, with a success rate of 84–89%. More experience with the technique and indications for use will likely improve success rates in the future.
395. EXPRESSION OF MALAT1, MANCR, PSMA3-AS1 AND MIR-101 IN ESOPHAGEAL ADENOCARCINOMA PATIENTS: PRELIMINARY RESULTS OF A CASE–CONTROL STUDY
Authors: Syllaios Athanasios , Gazouli Maria , Sakellariou Stratigoula , Sougioultzis Stavros , Karavokyros Ioannis , Liakakos Theodoros , Schizas Dimitrios 
Published: September 2022

Abstract
Esophageal adenocarcinoma is a leading cause of cancer-related mortality. Ongoing research aims to elucidate the molecular mechanisms underlying the tumorigenesis and progression of esophageal adenocarcinoma and to identify novel therapeutic targets. The abnormal expression of lncRNAs and miRNAs may play an important role in various biological processes in cancer, including immune response, differentiation, angiogenesis, apoptosis, cell proliferation and autophagy.
A total of 50 patients who were operated for esophageal adenocarcinoma in our Department from January 2015 to December 2018, were enrolled in the study. Twenty-six healthy individuals that underwent upper gastrointestinal endoscopy were recruited as controls in the study. Total RNA was extracted from esophageal adenocarcinoma tumors, lymph nodes and healthy esophageal tissues using the reverse transcription and qRT-PCR. The expression of different lncRNAs (MALAT1, MANCR, PSMA3-AS1) and miRNA (miR-101) were determined by the 2-ΔΔct method and presented using Fold-Regulation.
MALAT1 expression was upregulated in esophageal adenocarcinoma tumors and positive lymph nodes compared to non-cancerous tissues (1.9 and 2.0 times higher than controls respectively). Higher expression of MANCR was also found in esophageal adenocarcinoma tissues and positive lymph nodes compared to controls (2.6 and 2.1 times respectively). MiR-101 was downregulated in esophageal adenocarcinoma tumors and positive lymph nodes compared to controls (16.0 and 7.8 times lower respectively). No significant difference was observed in PSMA3-AS1 expression between esophageal adenocarcinoma tumors or positive lymph nodes and relevant healthy tissues.
MALAT1 and MANCR are upregulated in esophageal adenocarcinoma patients while miR-101 is downregulated. Further research in lncRNAs, miRNAs and their interactions with oncogenic pathways may offer new options for the diagnosis, prognosis and therapy of esophageal adenocarcinoma patients.
396. LONG-TERM QUALITY OF LIFE AFTER MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER: A SINGLE CENTER EXPERIENCE
Authors: Jones Amy , Conroy Molly , Barney Megan , Shettig Abigale , Crafts Trevor , Qureshi Alia , Wood Stephanie 
Published: September 2022

Abstract
Esophageal cancer typically requires multimodal treatment, with neoadjuvant chemotherapy and radiation followed by esophagectomy, which has helped improve the 5-year survival of this disease. Short-term quality of life (QOL) has been previously evaluated in patients who have undergone esophagectomy. As survival rates improve and patients are living longer after having multimodal therapy, there exists a need to better understand how long-term QOL is impacted after esophagectomy.
A single-center cross-sectional QOL study was performed on a cohort of patients who underwent esophagectomy for esophageal cancer (2010–2017) with a post-operative survival period of at least four years. Patients who met inclusion criteria were contacted by phone in 2021–2022 to complete the European Organisation for Research and Treatment of Cancer (EORTC) OES-30 and OES-18 questionnaires, after standardization of interviews via a telephone script. Descriptive statistics were performed.
One hundred and fifty-five patients met inclusion criteria, and 64 (41.3%) completed the QOL questionnaires. Mean age was 64 years, the majority were white (98.4%) men (82.3%), and 82% underwent preoperative chemoradiation treatment. All patients underwent a minimally invasive surgical approach. At the time of QOL surveillance, the mean time from operation was 6.9 years. The median global QOL score in this population was 79.2 (Max 100). The population had median reported severity scores for dysphagia (100), reflux (33.3) trouble eating (16.7), and pain (11.1) (Max 100). A median score of 0 was found for all other esophageal symptom categories.
In patients surviving at least four years from esophagectomy for esophageal cancer, symptom severity scored highest for dysphagia. Elevated severity scores were also seen in descending order for reflux, difficulty eating, and pain. Despite these continued symptoms, long-term overall QOL remained high for this population after esophagectomy.
399. CURRENT PRACTICE IN ANTIREFLUX AND HIATAL HERNIA SURGERY: EXPLORATION OF THE BELGIAN FIELD
Authors: Depypere Lieven , Van Veer Hans , Nafteux Philippe , Coosemans Willy 
Published: September 2022

Abstract
In Belgium no publicly available information exists on the spread, quality, results nor follow-up of antireflux and hiatal hernia surgery, in contrast to the recently centralized esophageal cancer surgery. However, in some countries a plea is rising to perform this benign esophageal surgery in high volume centers. The aim of this study was to create a snap shot of the current practice in Belgium.
An online questionnaire was distributed among all members of the Royal Belgian Society for Surgery in autumn 2021. A total of 33 questions spread over four sections were asked, covering demographics, current practice (case load, case mix, indications for surgery, preoperative workup, patient information, average length of stay, follow up, quality of life (QOL)), operative techniques (approach, type of procedure, crural reinforcement) and future thoughts (opinion on the future of antireflux and hiatal hernia surgery in Belgium).
Twenty-four surgeons completed the questionnaire.
Surgical indications are discussed multidisciplinary and based on guidelines in 67%. Workup includes endoscopy, pH-monitoring and manometry in 100%. Barium swallow, impedance and gastric emptying tests were added in respectively 83%, 42% and 13%. Symptom or QOL scores were used in 17%. 81% are performed as primary surgery, 18% redo surgery and 1% resections. Laparoscopic procedures are reported in 99%: Nissen(−Rosetti) 79%, Toupet/Lind 15%, partial gastrectomy 5% and Collis gastroplasty 1%. Discharge is planned on POD1 in 42% and on POD2 in 54%. 50% performs follow-up &lt;1 year. Interest in further clinical research collaboration was expressed in 92%.
Antireflux and hiatal hernia surgery is not standardized in Belgium. There is an evident variety in clinical practice, but this questionnaire shows similarity amongst respondents regarding workup and surgical approach. Further research collaborations are possible in the future.
406. COMPARISON OF OUTCOMES BETWEEN SALVAGE OESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY WITH PLANNED OESOPHAGECTOMY AFTER NEOADJUVANT CHEMORADIOTHERAPY
Authors: Cooper Scott , Frankel Adam , Thomson Iain , Thomas Janine , Smithers Mark 
Published: September 2022

Abstract
Definitive chemoradiotherapy (dCRT) for oesophageal cancer is recommended in selected patients who are unfit for surgery, or where doctor and/or patient prefers to surgery. Salvage oesophagectomy after dCRT is reportedly a morbid procedure compared to oesophagectomy following neoadjuvant chemoradiotherapy (nCRT). If indications for dCRT expand, there will be a larger pool of patients requiring salvage oesophagectomy. We aimed to assess the post-operative clinical outcomes of patients who had dCRT compared with nCRT in our unit.
Data were obtained from a prospectively maintained database of patients receiving curative treatment for oesophageal cancer from January 2010 until February 2022. Patients receiving a salvage oesophagectomy after dCRT were compared to those receiving nCRT and planned oesophagectomy. An comparison of differences in group characteristics, post-operative outcomes and survival rates was made. Analysis was completed using t-test, chi-square, log rank and Kaplan–Meier methods.
216 patients had dCRT with 24 undergoing salvage oesophagectomy. 228 had nCRT followed by surgery. The salvage group had more SCC (47% versus 16%; p = 0.002), higher blood loss (434 versus 280 mL; p = 0.033) and more surgeon-rated technical problems (e.g. pleural adhesions or mediastinal fibrosis) (30% versus 11%; p = 0.010). Operative times were not significantly different (357 versus 330 minutes; p = 0.232). There was a trend towards higher complications in the dCRT group (83 versus 63%; p = 0.057). Operative mortality was 0% in both groups. As expected the median survival was worse in the dCRT group (26 versus 66 months; p = 0.040).
Patients selected to dCRT who require and are fit for salvage oesophagectomy have worse outcomes compared with those who have nCRT. However, this subgroup still have a modest potential for cancer survival. Our dataset adds to the existing literature and will help to counsel patients being considered for salvage oesophagectomy. The possible future increase in number of patients being offered dCRT makes improving the understanding of peri-operative and cancer-specific outcomes after salvage oesophagectomy a priority.
407. A STUDY OF OUTCOMES OF ESOPHAGEAL CANCER SURGERY FOR ELDERLY PATIENTS OVER 80 YEARS OF AGE
Authors: Shigeno Takashi , Fujita Takeo , Kajiyama Daisuke , Sato Kazuma , Fujiwara Naoto , Daiko Hiroyuki 
Published: September 2022

Abstract
According to the 2020 edition of the situation in Japan, the population aged 65 and over reached 35.89 million, accounting for 28.4% of the total population. Esophageal cancer is a common disease among the elderly, and it is expected that the number of encounters with elderly esophageal cancer patients will increase further in the future. We examined the outcomes of esophageal cancer surgery for elderly patients at our hospital.
Of 769 thoracic esophageal cancer resections performed at our hospital from 2015–2019, 53 (6.8%) patients aged 80 years or older were included.
The mean age was 82 (80–94) years, the male/female ratio was 45/8, tumor localization was Ut/Mt/Lt 5/23/25, and cStage (UICC 7th edition) was I/II/III/IV 12/8/30/3. The surgical technique was 1-stage resection/2-stage segmental resection/mediastinoscopy in 9/32/12 cases. Surgical complications were suture failure, recurrent nerve palsy, and pulmonary complications in 2/12/11 patients. The 3-year survival rate was 66.7%, and the 3-year recurrence-free survival rate was 62.1%. The 3-year survival rate was 66.7% and the 3-year recurrence-free survival rate was 62.1%.
Esophageal cancer surgery may be a treatment option for elderly patients who are able to tolerate surgery, even if they are over 80 years of age. Our hospital provides a multidisciplinary team intervention for patients over 70 years of age 3–4 weeks prior to surgery, during the perioperative period, and after discharge, which may be useful in reducing postoperative complications.
408. RISK FACTORS FOR PERMANENT RECURRENT LARYNGEAL NERVE PALSY AFTER MCKEOWN MINIMAL INVASIVE ESOPHAGECTOMY
Authors: Chao Yin-Kai , Kuo Chun-Ting 
Published: September 2022

Abstract
Recurrent laryngeal nerve (RLN) palsy, especially left side, is a common complication after 3-stage McKeown esophageal cancer surgery and is related to increased risk of respiratory complication. Although some risk factors have been identified on the development of RLN palsy, data on its long-term recovery and factors affecting the recovery was scarce. The present study aimed to assess these unresolved issues.
Patients who experienced left RLN palsy after McKeown minimally invasive esophagectomy (MIE) for esophageal carcinoma between 2008 and 2021 were selected from a prospective database. RLN palsy was defined based on postoperative fiberoptic laryngoscopy and was classified as permanent if recovery was not seen within 6 months. MIE was further classified as robot-assisted or conventional thoracoscopic approach.
Among the 85 patients who developed left RLN palsy after MIE, recovery was observed in 22 patients (i.e., permanent palsy rate: 75%). Multivariate logistic regression analysis revealed active smoker (unfavorable, OR [95%CI]:2.99 [1.06 ~ 8.41], p = 0.038) and the use of thoracoscopic approach (unfavorable, OR [95%CI]:3.52 [1.14 ~ 10.8], p = 0.028) as independent risk factors for permanent palsy. The permanent palsy rate was 33.3% in patients who were non- or ex-smoker and received robotic approach as opposed to 85.7% in those who were smokers and received conventional thoracoscopic appraoch (p &lt; 0.001).
Among the patients who developed left RLN palsy after McKeown MIE, only one-fourth could be fully recovered. RLN palsy occurred in patients who were smoker and received thoracoscopic approach were less likely to have spontaneous recover and might be candidates for early intervention.
409. RECONSTRUCTION OF A SEGMENTAL OESOPHAGEAL DEFECT WITH A TUBED RADIAL ARTERY FOREARM FREE FLAP GUIDED BY 3-DIMENSIONAL MODELLING
Authors: Leggett Brandon , Bas Onur , Wiper Jonathan , Wagels Michael , Frankel Adam 
Published: September 2022

Abstract
Segmental defects of the oesophagus are rare but complex. If the patient survives the initial insult, reconstructive techniques most commonly involve gastric pull-up or colonic interposition (1) however alternative techniques such as free flap reconstruction can be utilised if the former are unsuitable (2). The surgical field often is quite hostile in these cases, making pre-operative visualisation and planning critical in achieving a successful outcome. We describe our approach after a surgical complication in a 49-year-old man.
cT3N2M0 GOJ adenocarcinoma, pre-operative FLOT4, three-stage oesophagectomy complicated by anastomotic leak and tracheo-gastric fistula. Cervical oesophagostomy and venting gastrostomy (via laparotomy) was performed (severe illness precluded one-lung ventilation). He improved and was discharged, but a persistent fistula from the gastric conduit to his trachea remained. Reconstruction was planned by a multidisciplinary team using detailed 3D modelling. Via right thoracotomy, the gastric conduit was reduced into the abdomen and the tracheal defect was repaired with an intercostal muscle flap. A retrosternal colonic interposition restored gastrointestinal continuity. The superior 2 cm infarcted and was replaced by a dual-paddled tubular radial forearm free flap.
This complex surgical situation demonstrates how 3D visualisation of a segmental oesophageal defect can be extremely helpful in pre-operative planning. In particular, the precise anatomical location of the gastro-tracheal fistula and its relationship to the bony landmarks and surrounding vascular anatomy were critical in considering surgical access and reconstruction options. Whilst the literature describes applications of 3D visualisation for surgical planning in alternative contexts, there is minimal information of its use in upper gastrointestinal reconstruction. The use of 3D modelling and printing within the surgical context has frequently been associated with reduced operating times and improved medical outcomes (3).
This case adds to the previously documented advantages of 3D modelling in surgical planning but applies them to an area not well covered in the literature. Additionally, it demonstrates the utility of an infrequently used technique (RAFF) for reconstructing a segmental oesophageal defect. Further research into quantifying the outcomes following the implementation of 3D modelling in visualisation and surgical planning would be useful in encouraging its integration into mainstream surgical practice.
414. SHORT-TERM CLINICAL EFFECT OF ROBOT-ASSISTED ESOPHAGECTOMY WITH THORACIC DUCT RESECTION
Authors: Li Chunguang , Li Bin , Yang Yang , Li Zhigang 
Published: September 2022

Abstract
Whether extended robot-assisted esophagectomy with thoracic duct resection (RAE-TDR) has a favorable impact on esophageal cancer patients remains not well defined. This study aimed to analyze safety and efficiency of RAE-TDR.
From January 2019 to July 2020, 73 consecutive patients with TD-resected and 127 consecutive patients with TD-preserved were enrolled, who received standard RAE McKeown surgery. Perioperative related indicators, RFS and OS at 1-year were compared between the two groups.
Morbidity of Clavien–Dindo classification grade ≥ II or III were similar (p &gt; 0.05). The number of retrieved total lymph nodes and mediastinal nodes were significantly higher in the TD-resected group (29.0 ± 11.1 vs 25.1 ± 8.5, p = 0.006 and 2.3 ± 3.7 vs 1.7 ± 2.8, p = 0.002, respectively). Moreover, more metastatic TD-related lymph nodes were harvested in cT3–4 patients (2.3 ± 3.7 vs 1.7 ± 2.8，p = 0.21). The rate of LN recurrence and local recurrence were similar (6.8% vs 7.1%, p &gt; 0.99 and 1.4% vs 2.4%, p &gt; 0.99, respectively). OS and RFS at 1-year were equivalent regardless of the TD procedure in each stage (p &gt; 0.05). However, Hematogenous metastasis in TD-resected group was significantly elevated (17.8% vs 7.9%, p = 0.034).
RAE-TDR may help to improve total and metastatic LNs harvest, especially for patients with advanced ESCC without increasing adverse events intra- and post-operation. However, RAE-TDR does not bring about a decrease in local recurrence rate within short-term follow-up. We are not sure whether the increase in distant metastasis rate in the RAE-TDR group is associated with relevant immune system damage. Therefore, non-selective RAE-TDR resection is not routinely recommended.