bluuebunny/crossref_metadata_2025_split huggingface dataset:
100: IMPACT OF INCREASING LYMPH NODE YIELD ON THE NUMBER OF POSITIVE LYMPH NODES, MORBIDITY AND SURVIVAL IN ESOPHAGEAL CANCER SURGERY
Authors: Henckens S , Hagens E , Eshuis W , Meijer S , Van Berge Henegouwen M , Gisbertz S 
Published: April 2022

Abstract

Background and aim
Accurate determination of lymph node status after esophagectomy requires complete lymphadenectomy. Extended surgery might also lead to more postoperative morbidity. This study analyzed lymph node yield over time and investigated the influence of lymph node yield on the number of positive lymph nodes, postoperative morbidity and disease-free survival.

Methods
Patients who underwent transthoracic esophagectomy for esophageal adenocarcinoma between 2010 and 2018, were included. Lymph node yield was both analyzed as continuous variable and as categorical variable (&lt;15, 15–29 (reference category) and ≥ 30 nodes). The effect of lymph node yield on the number of positive lymph nodes, morbidity and disease-free survival was assessed in multivariable regression analyses.

Results
A total of 469 patients were included with a median follow-up of 20 months. The majority of the included patients received neoadjuvant chemo(radio)therapy (93.1%). The median lymph node yield increased from 25.0 lymph nodes (IQR 20–34) in 2010 to 36.0 lymph nodes (IQR 30–45) in 2018. Higher lymph node yield was significantly associated with more positive lymph nodes both as continuous variable (IRR 1.020, 95%CI 1.006–1.034), and as categorical variable with a threshold of ≥30 nodes (IRR 1.549, 95%CI 1.069–2.244). Lymph node yield was not associated with morbidity. Lymph node yield was not associated with disease-free survival when analyzed as a continuous variable (HR 0.996, 95%CI 0.984–1.008). There was also no difference in disease-free survival between patients with a lymph node yield of &lt;15 and 15–29 (reference) (HR 1.362, 95%CI 0.793–2.338), and between patients with a lymph node yield of 15–29 (reference) and ≥ 30 (HR 0.849, 95%CI 0.650–1.109).

Conclusion
A higher lymph node yield after esophagectomy was associated with a higher number of positive lymph nodes; a higher number of resected lymph nodes therefore improves staging. A higher lymph node yield did not result in increased morbidity and no association between lymph node yield and disease-free survival could be demonstrated in patients undergoing esophagectomy after neoadjuvant chemo(radio)therapy.
104: PERIOPERATIVE STRATEGIES IN ESOPHAGEAL CANCER RESECTION IN 12 NORDIC UNIVERSITY HOSPITALS
Authors: Achiam M P , Nilsson M , Åkesson O , Johansson J , Edholm D , Lindblad M , Szabo E , Sundbom M , Lindberg F , Bau Mortensen M , Kjus Aahlin E , Mala T , Johannessen H , Johnsen G , Kauppila J , Hedberg J 
Published: April 2022

Abstract

Background and aim
The Nordic countries have similar health care systems and registries simplifying epidemiological research. Differences in treatment traditions can, however, hamper the possibility to assess results and to harmonize control arms in joint randomized trials. In the process to set up a Nordic multi-center randomized trial regarding use of nasogastric tube (NG-tube) decompression after esophagectomy, we aimed to investigate perioperative routines in 12 University Hospitals in Sweden, Denmark, Norway and Finland.

Methods
All Nordic University Hospitals were contacted regarding a Nordic randomized controlled trial exploring effects and complications associated with the use of nasogastric tube use after esophagectomy for cancer. Those who chose to join the trial were sent a questionnaire regarding surgical and perioperative routines.

Results
Twelve centers with a combined catchment area of 16 million inhabitants and an annual volume of 400 esophagectomies joined the trial network. All but one used totally minimally invasive or hybrid surgical approach. All 12 centers reported routine use of NG-tube and 5 employed continuous suction. The NG-tube was removed between 3 and 7 days postoperatively. A routine pylorus drainage procedure was reported from two centers. Jejunostomy was used universally in 5 centers and selectively in 6 centers. One center did not use jejunostomy.

Conclusion
Differences in perioperative care after esophagectomy is apparent in the Nordic countries, highlighting the need for high-level evidence regarding these practices. A unified approach may facilitate clinical trial initiatives. There is a paucity of evidence regarding optimal NG-tube use after esophagectomy for cancer and a randomized trial investigating this issue is under way.
105: SURGICAL DISSECTION DOES NOT INCREASE FREE CANCER CELLS (FCC) IN PERITONEAL LAVAGE OF PATIENTS FOLLOWING D2 GASTRECTOMY
Authors: Geca K , Rawicz-Pruszynski K , Sedlak K , Mlak R , Polkowski W 
Published: April 2022

Abstract

Background and aim
Peritoneal free cancer cells (FCC) in patients with gastric cancer (GC) is poor prognostic factor. D2 gastrectomy dissection may induce exfoliated FCC spread from primary tumour or involved lymph nodes (LN). Conventional cytology for FCC detection has several limitations, and prophylactic use of extensive intraoperative peritoneal lavage (IPL) does not improve survival. A prospective single-arm observational study was conducted to verify whether D2 gastrectomy causes an increase of FCC in peritoneal lavage as in patients with GC following D2 gastrectomy.

Methods
Thirty GC patients underwent D2 gastrectomy, followed by objective quantitative measurements of CK19 mRNA level reflecting FCC with One-Step Nucleic Acid Amplification (OSNA) assay. The IPL with 3000 cc of saline was performed twice after: (1) gastrectomy with D2 lymphadenectomy; and (2) alimentary tract reconstruction. The IPL samples were analysed by initial cytology and four (1–4) consecutive OSNA assays (Figure 1). Three patients were excluded due to positive cytology in samples obtained after laparotomy.

Results
Initial OSNA measurement (1) revealed positive results (≥24.6 cCP/μl) in 7 (29.6%) patients. Subsequent OSNA measurements revealed a significant decrease in the FCC level after removal of the primary tumour with regional LNs (D2 gastrectomy) (1 vs 2; medians [95%CI]: 4.6 [1.1–18.5] vs. 0.00004 [0–0.2] cCP/μl; P = 0.0012). The first IPL induced non-significant increase in the FCCs (2 vs 3, medians [95%CI]: 0.00004 [0–0.2] vs 0 [0–0.5] cCP/μl; P = 0.3300), but the second IPL reversed it to normal levels (3 vs 4, medians [95%CI]: 0 [0–0.5] vs 0 [0–0] cCP/μl; P = 0.0.0574). At this point of operation, additional finding was a trend toward temporal increase of FCC in patients with LN involvement (pN1–3)(2 vs 3; medians [95%CI]: 0 [0–0.2] vs 0 [0–42.8] cCP/μl; P = 0.0674). One patient was still positive (FCC) at the end of operation as measured by OSNA (4).

Conclusion
D2 Gastrectomy does not induce increase in the peritoneal FCCs. Temporal intraoperative increase in peritoneal FCC after the IPL may be observed, especially in tumours with LN metastases. At least two consecutive IPLs (with min. 3000 mL of saline) are necessary to reverse temporal increase of peritoneal FCC.
108: FLUORESCENCE ANGIOGRAPHY IN COLONIC INTERPOSITION AS RECONSTRUCTION AFTER ESOPHAGEAL RESECTION
Authors: Joosten H , Gisbertz S , Eshuis W , Heineman D , Daams F , Van Berge Henegouwen M 
Published: April 2022

Abstract

Background and aim
Colonic interposition is an alternative for gastric conduit reconstruction after esophagectomy. Postoperative anastomotic leakage occurs in 15–30% of the patients and may partially be attributed to reduced blood supply to the colon and ileum after vascular ligation.
Fluorescence angiography (FA) can visualize tissue perfusion and guide the surgeon in selecting the anastomotic site. We aimed to give an overview of the postoperative outcomes and the first experiences of FA in colonic interposition.

Methods
This cohort study included all consecutive patients who underwent a colonic interposition between January 2015 and February 2021 in the Amsterdam UMC. Colonic interposition was performed for three different indications: inability to use the stomach because of previous gastric surgery or extensive tumour involvement, cancer recurrence in the gastric conduit requiring resection or because of complications after initial esophagectomy with failure and resection of the gastric conduit (i.e. ischaemia).
Since 2018 FA was performed prior to anastomotic reconstruction by administration of indocyanine green (ICG) injection (0.1 mg/kg/bolus). Imaging was performed by hand-held Spy-phi (Stryker, Kalamazoo, MI, U.S.A.).

Results
Twenty six patients were included(18 male, mean age 64), of whom thirteen (50%) underwent intra-operative FA assessment. Within the FA group two (15%) cervical anastomotic leakages occurred, whereas in the non FA group two anastomotic leakages and one graft necrosis (19%) occurred (P = 0.61). There was a change of management due to the FA assessment in two patients in the FA group (15%) which lead to a more extensive resection. In both cases no anastomotic leakage occurred. Mean ± SD operative time in the FA group versus the non FA group was 375 ± 87 versus 400 ± 112 minutes respectively (P = 0.56).

Conclusion
This is the first study that shows the potential role of FA enabling the surgeon to intra-operatively optimize perfusion in colonic interpositions. Further research is warranted to better elucidate this role.
130: PATTERN OF LYMPH NODE METASTASES IN GASTRIC CANCER—A SIDE-STUDY OF THE MULTICENTER LOGICA-TRIAL
Authors: De Jongh C , Triemstra L , Van Der Veen A , Brosens L , Luyer M , Stoot J , Ruurda J , Van Hillegersberg R 
Published: April 2022

Abstract

Background and aim
The relation between tumor characteristics and the pattern of lymph node (LN) metastases in gastric cancer is unclear, especially following neoadjuvant chemotherapy (NAC). Therefore, the aim of this study is to analyze the pattern of LN metastases of gastric cancer.

Methods
Individual LN stations were separately collected (no. 7–9, 11 and 12a) or clearly marked at the resection specimen (no. 1–6), and were analyzed for all patients included in the LOGICA-trial. The LOGICA-trial was a multicenter randomized trial comparing laparoscopic versus open gastrectomy in ten hospitals. Total and distal D2-gastrectomy were performed for resectable gastric cancer (cT1–4aN0–3bM0). The pattern of metastases per LN station was related to tumor location, cT-stage, Lauren classification and NAC-treatment. In addition, the distribution of LN metastases over the individual LN stations was assessed for four subgroups based on tumor location, cT-stage, Lauren classification and NAC-treatment, and several combinations of these characteristics.

Results
Between 2015–2018, 212 patients underwent D2-gastrectomy, of whom 158 (75%) received NAC. LN metastases were present in 121 patients (57%). Proximal tumors metastasized predominantly to proximal LN stations (no. 1, 2, 7 and 9; OR &gt; 1, P &lt; 0,05), and distal tumors to distal LN stations (no. 5, 6 and 8; OR &gt; 1, P &gt; 0,05). However, distal tumors still metastasized to proximal LN stations, and vice versa. Each individual LN station (no. 1–9, 11 and 12a) showed metastases, regardless of the tumor location, cT-stage, histological subtype and NAC-treatment, including station 12a for cT1N0-tumors. Although LN metastases were present more frequently in cT3–4- versus cT1–2-stage (59% versus 51%; P = 0,259) and in diffuse versus intestinal tumors (66% versus 52%; P = 0,048), the pattern of LN metastases was similar for these subgroups. A sensitivity analysis was performed with only the NAC-treated patients to test the robustness of these results, which showed a similar pattern of LN metastases after NAC.

Conclusion
Although the pattern of LN metastases is related to tumor location in gastric cancer, metastatic spread occurred in all LN stations (no. 1–9, 11 and 12a), regardless of the tumor location, cT-stage (including cT1N0-tumors), histological subtype and NAC-treatment. Therefore, all LN stations (including 12a; D2-lymphadenectomy) should be routinely dissected during gastrectomy.
146: THE NEED OF CDH1 GERMLINE MUTATION SCREENING IN PATIENTS WITH GASTRIC CANCER IN THE WEST
Authors: Alloggio M , Bencivenga M , Sacco M , Tomezzoli A , Tedaldi G , Torroni L , Verlato G , De Manzoni G 
Published: April 2022

Abstract

Background and aim
Although the international guidelines recommend the CDH1 germline mutations screening in patients at risk of carrying pathogenic mutations, few data exist about the compliance to systematic screening programs carried out in surgical centres.

Methods
In the present manuscript we report the results of CDH1 germline mutations screening, undertaken in patients with gastric cancer and their relatives at high volume surgical centre of Verona University from January 2011 to July 2020. In this study HDGC 2015 Guidelines criteria were used.

Results
During a 10 years period, we screened 72 subjects; among them, we found a pathogenic germline genetic alteration in 37 (51,4%). 15 patients underwent to surgery due to clinically detectable tumours or positive biopsies during endoscopic surveillance; of note the youngest case of early SRC tumours detected during endoscopy was aged 15 years old. 11 underwent prophylactic gastrectomy: 8 out of 11 (72,7%) presented neoplastic foci in the specimen. During surgical operation, 7 patients required an additional oesophageal resection due to the presence of gastric mucosa at the extemporary frozen section, despite the proximal section was made above the cardia.

Conclusion
Based on our experience, we can conclude that the CDH1 genetic screening should be absolutely offered to high-risk Western patients, in agreement with the international guidelines. Prophylactic total gastrectomy should be considered in selected cases also under 20 years of age.
190: ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND ROBOTIC SENTINEL NODE NAVIGATION SURGERY FOR EARLY GASTRIC CANCER: FIRST EXPERIENCE AND PRELIMINARY RESULTS
Authors: Bottari A , Fortuna L , Coratti F , Cianchi F , Staderini F 
Published: April 2022

Abstract

Background and aim
Early gastric cancer (EGC) is defined as a cancer limited to mucosa (T1a) and submucosa (T1b). The 5-year survival rates are respectively 96% and 83% for T1a and T1b. Despite endoscopic submucosal dissection (ESD) is considered the standard treatment for EGC, literature reports a quite considerable rate of lymph-node metastasis (2% to 18%). Combined surgical-endoscopic treatment can achieve accurate resection of EGC, solving the problem of lymphadenectomy which cannot be performed endoscopically. Near infrared (NIR) fluorescence imaging with indocyanine green (ICG) was recently introduced for lymphatic mapping in several tumors. The aim of the study is to evaluate the feasibility and safety of ESD in combination with robotic ICG guided sentinel node navigation surgery (SNNS).

Methods
ICG was endoscopically injected intraoperatively into the submucosal layer around the tumor. Intraoperative NIR imaging with ICG was carried out with a near-infrared camera system built into the robotic platform. The first lymph node which had taken up ICG appeared as a green spot and was identified as the sentinel node (SN). SN was then sent for extemporaneous histopathological examination. When ICG fluorescence extended to the second nodal stations a ICG guided robotic basin lymphadenectomy was performed. Basin lymph nodes were sent for definitive histopathological analysis. If no tumoral cells were identified in the SN, an ESD with standard technique was conducted. If the SN pathological examination revealed tumoral cells, a robotic radical resection and D2 lymphadenectomy was completed.

Results
Seven ESDs with SNNS and basin lymphadenectomy basin were performed. No gastric perforations or other intraoperative complications were registered. Mean operative time was 148.6 minutes. All the procedures histologically resulted in complete excisions. No lymph nodes metastasis was demonstrated in either the SN or the basin lymph nodes. A mean of 12 lymph-nodes was collected. Mean hospitalization time was 2.8 days.

Conclusion
In our preliminary experience, combined ESD and SNNS could be recommended as a safe and effective treatment for EGC in patients with potential risk of LN metastasis or in patients with multiple comorbidity in order to avoid more invasive organ resections.
201: THE YIELD OF DIAGNOSTIC LAPAROSCOPY WITH PERITONEAL LAVAGE IN GASTRIC ADENOCARCINOMA: A MULTICENTRE RETROSPECTIVE COHORT STUDY
Authors: Van Hootegem S J , De Pasqual C A , Van Der Wilk B J , Van Der Sluis P C , Phillips A W , Lagarde S M , Wijnhoven B P 
Published: April 2022

Abstract

Background and aim
Diagnostic laparoscopy (DL) with peritoneal lavage has been adopted as a standard staging procedure for patients with gastric cancer. Evaluating the effectiveness of DL is important given the ongoing improvement of diagnostic imaging. Studies on DL from Europe are scarce and mostly include a small number of patients. This multicentre retrospective cohort study assessed the yield of DL in patients with potentially curable gastric cancer.

Methods
Patients with adenocarcinoma of the stomach treated between January 2016 and December 2018 were identified from an institutional database from two high volume European Upper-GI surgical centres. Patients who underwent a diagnostic laparoscopy with peritoneal lavage for potentially curable disease after clinical staging with imaging (stage cT1-4 N0-3 M0) were included.

Results
Overall, in 78 of 327 included patients (23.8%) metastatic disease was diagnosed. Macroscopic metastases were seen in 32 of 327 (9.8%) patients, of which 26 were peritoneal lesions. Sixteen of these also had positive peritoneal cytology. A further 41 of 327 patients (12.5%) had positive peritoneal cytology in the absence of macroscopic metastases and five patients (1.5%) were deemed to have locally irresectable disease. Only one of the eighteen patients (6%) staged cT1–2 N0 had positive cytology and three of seven patients (43%) with stage cT1–2 N+ had macroscopic metastases.

Conclusion
Diagnostic laparoscopy should routinely be performed in all patients with gastric cancer including patients with cT1–2 disease.
205: ADJUNCTIVE SURVEILLANCE MODALITIES AND ONCOLOGIC OUTCOME: A REPORT FROM THE ENSURE STUDY
Authors: Elliott J A , Markar S R , Klevebro F , Johar A , Goense L , Lagergren P , Zaninotto G , Van Hillegersberg R , Van Berge Henegouwen M I , Nilsson M , Hanna G B , Reynolds J V 
Published: April 2022

Abstract

Background and aim
Established and emerging therapies for recurrent esophageal cancer may impact survival and health-related quality-of-life (HRQL), however surveillance protocols after primary curative treatment are inconsistent. Specifically, whether advantages exist for adjunctive surveillance modalities is unknown and was the focus of this study.

Methods
ENSURE was an international multicenter observational study of consecutive patients undergoing curative-intent surgery for esophageal and esophagogastric junction cancers (2009–2015) across 20 European and North American cancer centers (NCT03461341). The initial report from ENSURE assessed the impact of intensive imaging surveillance on the primary outcome measure of overall survival (OS); secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. In the present study, multivariable linear, logistic and Cox proportional hazards regression analyses were performed to determine the independent impact of adjunctive surveillance modalities on oncologic outcome.

Results
Results 4,682 patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy). Routine biochemistry, nutritional profiling, tumor markers, surveillance endoscopy and flexible nasolaryngoscopy were routinely assessed in 37, 33, 15, 19 and 7% of Centers, respectively. Routine biochemistry and tumour markers were associated with reduced risk of symptomatic recurrence, however neither modality was associated with survival benefit. Endoscopic surveillance was independently associated with increased probability of isolated local or anastomotic recurrence (OR1.49 [1.05–2.14]), and reduced probability of symptomatic recurrence (OR0.17 [0.12–0.25]), but not with improved OS. On subgroup analysis, endoscopic surveillance was associated with reduced symptomatic recurrence (OR0.19 [0.12–0.29]) and increased probability of tumour-directed therapy among patients with adenocarcinoma (OR1.65 [1.14–2.38]), but not those with SCC. Endoscopic surveillance was associated with improved OS (HR0.73 [0.55–0.98]) among patients with Barrett’s oesophagus, while flexible nasolaryngoscopy was associated with improved OS among patients with SCC (HR0.19 [0.05–0.80]). Nutritional surveillance was independently associated with increased tumor-directed therapy, improved HRQL (P = 0.015) and OS (HR0.89 [0.80–0.99]), while a multimodal surveillance approach was also associated with improved OS (HR0.83 [0.72–0.95]).

Conclusion
These data suggest that a multimodal and tailored surveillance approach may improve oncologic outcomes following curative-intent surgery for esophageal and esophagogastric junction cancer. These findings may inform guideline development and shared decision-making with patients.
206: COULD THE PITTSBURGH SEVERITY SCORE GUIDE THE TREATMENT OF ESOPHAGEAL PERFORATION? EXPERIENCE OF A SINGLE REFERRAL CENTER
Authors: Moletta L , Capovilla G , Pierobon E S , Provenzano L , Ciccioli E , Carrillo L , Valotto G , Zanchettin G , Salvador R , Costantini M , Merigliano S , Valmasoni M 
Published: April 2022

Abstract

Background and aim
Esophageal perforation (EP) is characterized by high morbidity and mortality. In recent years, non-operative management has proved to be successful in selected patients. However, there is a lack of data supporting the superiority of one approach over the others and there is no consensus on the treatment algorithm. The Pittsburgh Severity Score (PSS) is a scoring system based on clinical factors at the time of EP presentation, intended to guide treatment. The aim of the study is to verify PSS usefulness in stratifying EP severity and in guiding clinical decisions.

Methods
All patients referred to our Unit for EP between January 2005 and January 2020 were enrolled. Patients were stratified according to their PSS into 3 groups (PSS ≤ 2; 3–5 and &gt; 5): the postoperative outcomes were compared. The predictive value of the PSS was evaluated by simple linear and logistic regression for the following outcomes: need for surgery, complications, in-hospital mortality, ICU and hospital stay, time to refeeding and need for reintervention.

Results
Seventy-three patients were referred for EP (M/F: 46/27). Perforations were more frequently iatrogenic (41.1%) or spontaneous (37.0%). The median PSS was 4 (IQR 2–6). Surgery was required in 60.3% of cases. The median PSS was significantly lower in the conservative group (P &lt; 0.01). PSS was significantly associated with ICU admission, hospital stay, need for surgery and reintervention, post-perforation complications and mortality. After regression analysis, PSS was significantly predictive of post-perforation complications (P &lt; 0.01); in-hospital mortality (P = 0.01); ICU admission (P &lt; 0.01); need for surgical treatment (P &lt; 0.01) and need for reintervention (P = 0.02). The receiver-operator curve (ROC) analysis showed that a PSS ≥ 3 had good sensitivity and specificity for the main postoperative outcomes considered.

Conclusion
PSS is useful in stratifying patients in risk groups with different morbidity and mortality. It is also useful in guiding the therapeutic conduct, selecting patients for nonoperative management. Prospective studies are needed to confirm the role of the PSS in the treatment of esophageal perforation.