bluuebunny/crossref_metadata_2025_split huggingface dataset:
557. AN EXPERIENCE OF LAPAROSCOPIC GASTRECTOMY AND FUNDOPLICATION FOR A PATIENT WITH NEUROENDOCRINE TUMOR AND LARGE HIATAL HERNIA WITH UPSIDE-DOWN STOMACH
Authors: Kamiya Satoshi , Furukawa Kenichiro , Nagata Masato , Koseki Yusuke , Fujiya Keiichi , Hikage Makoto , Tanizawa Yutaka , Terashima Masanori , Bando Etsuro 
Published: September 2022

Abstract
The case of a neuroendocrine tumor arising from an upside-down stomach due to a large hiatal hernia is rare but occasionally encountered in clinical practice. As we experienced such a case and successfully treated by simultaneous laparoscopic distal gastrectomy and hernia repair with fundoplication, we here report our experience.
A 79-year-old woman was referred to our hospital with suspicion of a stomach submucosal tumor. Detailed examination revealed the submucosal tumor in diameter of 20mm located on the middle third of stomach, and the pathology of biopsy showed the positivity for Chromogranin-A and Synaptophysin. CT scan also demonstrated the large hiatal hernia with prolapsing the almost whole stomach and transverse colon to the left thoracic cavity. We diagnosed that as Rindi classification type III neuroendocrine tumor and complex esophageal hiatal hernia, and we planned laparoscopic distal gastrectomy and hernia repair with fundoplication.
Laparoscopy showed the prolapse of almost whole stomach and colon through the esophageal hilum to left thoracic cavity. We pull them back to abdominal cavity and divided the hernia sac at the level of hilum. After distal gastrectomy, we managed to close the enlarged esophageal hilum without using artificial mesh by suturing the crus of diaphragm. We added the Toupet fundoplication to remnant stomach, and reconstructed the digestive tract by means of Roux-en-Y method. There were no findings of passage obstruction or regurgitation in the peroral contrast examination. The patient was discharged 7 days after surgery with good postoperative course.
Simultaneous laparoscopic gastrectomy and esophageal hiatus hernia repair was successfully performed. Enlarged esophageal hilum could be closed without using the artificial mesh even for the patient with an upside-down stomach, and Toupet fundoplication could be added for a small remnant stomach after distal gastrectomy. Therefore, our procedure was considered to be a safe and feasible minimally invasive surgery for such patients.
558. SURVIVAL IMPACT OF CLINICAL AND NONCLINICAL REASONS FOR DELAY TO ESOPHAGECTOMY AFTER NEOADJUVANT CROSS THERAPY
Authors: Dave Yatee , Kapcio Kevin , Linville Wendy , Strawderman Myla , Peyre Christian , Jones Carolyn , Lada Michal 
Published: September 2022

Abstract
The optimal time interval between completion of standard-of-care neoadjuvant CROSS chemoradiation and esophagectomy (CRT-S) in patients with esophageal cancer remains controversial. Precise reasons for prolongment of this interval are not well described, although studies have associated a prolonged CRT-S with variable survival outcomes. We aimed to evaluate whether specific reasons for delay to esophagectomy beyond the recommended period of 8 weeks post-chemoradiation are associated with differences in overall survival (OS).
A prospectively maintained database was reviewed for patients with esophageal cancer at a single academic institution who completed neoadjuvant CROSS therapy and underwent subsequent esophagectomy from 2012 to 2019. Patients were grouped by time interval of CRT-S into a no-delay group (≤56 days) and delay group (&gt;56 days). The delay group was then further stratified by clinical and nonclinical reasons for delay. Demographics, comorbidities and complications were compared. A multivariable Cox regression model was used to evaluate the impact of variables on OS from time of surgery. Survival outcomes were described using standard Kaplan-Meier curves.
Of 96 patients, 48 (50.5%) had delays, with 62.5% (n=30) being for nonclinical reasons. Post-operative complications were similar between the no-delay and delay subgroups, except that the clinical delay group had more unplanned intensive care unit admissions (p=0.032). The median CRT-S for the no-delay, overall delay, clinical delay, and nonclinical delay groups were 47, 71, 79, and 68 days, respectively. On multivariable analysis, nonclinical delay, male gender, pathologic complete response, and tumor location were independent predictors of improved survival. A nonclinical delay was associated with improved OS (p=0.010) while clinical delay was not significantly different (p=0.968) from the no-delay group.
Patients with delay to esophagectomy greater than 8 weeks for nonclinical reasons after completion of chemoradiation had improved survival compared to patients undergoing esophagectomy within 8 weeks or who had delayed surgery for clinical reasons. Delay for nonclinical reasons was not associated with increased rates of postoperative complications. Future studies regarding the optimal time interval between the completion of neoadjuvant chemoradiation and esophagectomy need to consider the specific reasons for delay to surgery.
575. MANUAL LAYER EMBEDDED ANASTOMOSIS: A NEW TECHNIQUE TO REDUCE ANASTOMOSIS LEAKAGE AFTER ESOPHAGECTOMY
Authors: He Xuedong , Han Yongtao , Peng Lin , Mao Tianqin , He Wenwu 
Published: September 2022

Abstract
The suturing after esophagectomy includes mechanical anastomosis and hand-sewn anastomosis. At present, various of anastomosis methods with potential anastomosis leakage, the optimal anastomosis methods still remain debates. This study described a new technique for creation of an anastomosis in thought to reduce the incidence of anastomosis leakage.
Between September 2020 to December 2021, the patients who received this new anastomosis technique enrolled into this retrospective study. The anastomosis method as follows. Firstly, the gastric conduit was shaped secondary to get adapt embedded length and anger. Secondary, the embedded posterior wall was sutured and layer sew anastomosis. And then, embedded the anastomosis after layer sew into gastric tube and suture the embedded anterior wall lastly. And the anastomosis was pushed into thorax from neck to ended this anastomosis procedure.
A total of 56 patients enrolled into this study comprised 51 males and 5 females with mean age of 65.4 years. Among of them 9 patients received neoadjuvant therapy. And all of them performed minimally invasive surgery by thoracoscope combined laparoscopic. The median intraoperative blood loss volume was 79.8ml (range 20-150ml). The median operate time was 331 minutes (range 220-465 minutes). The median postoperative feeding time was 6.3 days (range 3-8 days). All the patients without anastomosis leakage. The incidence of anastomotic stricture and the acid reflux ration were lower than the average of literature reports.
This new manual layered embedded esophagogastric anastomosis significantly reduce the incidence of anastomosis leakage and stricture, prevent the acid reflux. This technique has good short outcome and suitable for popularization and application.
580. EFFECTS OF NEOADJUVANT CHEMOTHERAPY ON PREOPERATIVE DISEASE SPECIFIC SYMPTOMS AND HEALTH RELATED QUALITY OF LIFE FOR PATIENTS WITH GASTROESOPHAGEAL CANCER
Authors: Holmén Anders , Klevebro Fredrik 
Published: September 2022

Abstract
Guidelines promotes neoadjuvant chemotherapy in treating gastroesophageal cancer, but little is known concerning effects on disease specific symptoms and health-related quality of life. We therefore wished to study how preoperative neoadjuvant chemotherapy might affect disease specific symptoms and preoperative health-related quality of life in patients with gastroesophageal cancer.
We performed a single center cohort study with prospectively collected data on patients with curative intended surgery due to gastroesophageal cancer between 2013 and 2020. Patients were asked to voluntarily assess their health-related quality of life prior to surgery and stratified with regards to neoadjuvant chemotherapy or surgery alone. Our primary endpoint was self-assessed health-related quality of life evaluated with validated quality of life questionnaires, transferred from a Likert scale to a 0-100 score according to scoring manuals. A multivariable adjusted model was constructed including for age, ASA-score, and clinical tumor T- and N-stage.
In total 361 patients were included of which 239 were treated with neoadjuvant chemotherapy. Patients that received neoadjuvant chemotherapy were in median 10 years younger and included more males (77 vs 65).
Patients treated with neoadjuvant chemotherapy reported better physical functioning (6.1, p=0.013), less pain (-10.9, p=0.004)), less insomnia (-12.6, p=0.004), and less trouble concerning eating restrictions (-11.9, p=0.005). Some symptoms were further reduced in patients with EC, such as dysphagia (-15.2, p=0.006), eating restrictions (-23.2, p= p&lt;0.001), and odynophagia (-18.0%, p=0.002). Patients with GC had better physical functioning (11.06, p=0.015) and less pain (14.9, p=0.017).
With exception of sense of taste and hair loss, neoadjuvant chemotherapy may improve preoperative Health Related Quality of Life in patients with gastroesophageal cancer. This is even more clear concerning nutritional aspects and is more pronounced for patients with esophageal cancer.
584. PREVALENCE AND SURGICAL TREATMENT OF TRUE SHORT ESOPHAGUS IN GERD AND HIATUS HERNIA
Authors: Lugaresi Marialuisa , Tassi Valentina , Daddi Niccolò , Bassi Francesco , Pilotti Vladimiro , Mattioli Sandro 
Published: September 2022

Abstract
Prevalence and surgical treatment of true short esophagus (TSE), defined as the intra operative position of the apex of the gastric folds (endoscopic cardia- EC) &lt;1.5 cm below the apex of the diaphragmatic hiatus after extend isolation of lower esophagus, are controversial. We report on 441 patients affected by GERD/HH, consecutively operated upon with three different minimally invasive surgical techniques, successively regularly followed up according to protocol, in the period 2004-2022.
The distance between the endoscopically-localized EC marked with clips by the surgeon and the apex of the diaphragmatic hiatus after maximal thoracic esophagus mobilization was measured during the laparoscopic procedure. A standard Nissen fundoplication (SN) was performed in cases with an abdominal length &gt;1.5 cm; in cases of TSE a laparoscopic-thoracoscopic Collis-Nissen (CN) or laparoscopic Stomach Around Stomach Fundoplication (SASF) in elderly patients was performed. The fundoplication superior margin was always fixed below the hiatus, over the EC. Patients’ symptoms, radiological and endoscopic data were pre/postoperatively recorded.
After intra-thoracic esophageal mobilization (median =9 cm), TSE was diagnosed in 30.38 % of 441 cases (31,8% in 311/2004-2017; 27,7% in 130/2017-2022). SN was performed in 69%, CN in 23% and SASF in 7%. On 441 cases regularly followed up with a median of 106 months, HH relapse was radiologically diagnosed in 3%, with excellent, good, fair, and poor outcomes respectively in 46.3%, 43.2%, 6.7%, and 3.8% of cases. No outcome significant differences among SN CN and SASF, were recorded.
In the period 2004-2022, prevalence of TSE was constant in a significant third of patients routinely submitted to GERD/HH surgery. In the presence of TSE, CN and SASF performed according to determined surgical principles may achieve results as satisfactory as those obtained with SN.
591. THE ROLE OF INTRAOPERATIVE HYPERSPECTRAL IMAGING (HSI) IN THE CASE OF USING COLON INTERPOSITION AFTER OESOPHAGECTOMY
Authors: Zimmermann Anne , Köhler Hannes , Gockel Ines , Moulla Yusef 
Published: September 2022

Abstract
Colon conduit is an alternative option for the reconstruction after oesophagectomy. The impact of using Hypersepctral Imaging (HSI) has been already proved in evaluating the perfusion of gastric conduit, but not in the case of using colon conduit. This is the first study described a new tool evaluating the perfusion of colon conduit and allowing us as esophageal surgeons to choose the appropriate side (left or right) of colon conduit and anastomosis site intraoperatively
In 10 patients, who underwent reconstruction with a long segment colon conduit after oesephagectomy from 01.01.2018 till 01.04.2022. HSI was recorded in 8 of these patients at the root and tip of colon conduit after clamping the colic middle vessels allowing us to evaluate the perfusion and the appropriate side of colon conduit (Figure 1)
Anastomosis Leakage (AL) grad I° was detected only in one patient (12.5%) of all included patients (n=8). There was no conduit necrosis in all of these patients. Re-anastomosis was necessary only in one patient. There were no need to conduit resection and esophageal diversion or to stent placement in all of included patients. Furthermore, there were no change of the selected side of colon conduit intraoperatively
HSI is a promising novel intraoperative imaging tool to evaluate the perfusion of colon conduit objectively, which helping us to make the right decision regarding the side of the colon conduit as well as the site of the anastomosis intraoperatively.
592. CLINICAL EVALUATION OF A HYPERSPECTRAL IMAGING SYSTEM FOR MINIMALLY INVASIVE SURGERY (HSI-MIS)
Authors: Thomaßen Madeleine T , Köhler Hannes , Maktabi Marianne , Pfahl Annekatrin , Chalopin Claire , Gockel Ines , Moulla Yusef 
Published: September 2022

Abstract
Hyperspectral Imaging (HSI) provides surgeons intraoperative colored images of abdominal organgs detecting the perfusion and oxygenation. Limiting factors such as missing colour video, camera size, and long acquisition times have been overcome in the first CE-certified HSI-System for Minimally-Invasive Surgery (HSI-MIS; TIVITA® Mini Endoscopy Edition, Diaspective Vision GmbH, Am Salzhaff, Germany). This system was evaluated in-vivo during surgery and compared with an HSI-System for Open Surgery (TIVITA® Tissue, Diaspective Vision GmbH, Am Salzhaff, Germany).
Hyperspectral imaging was performed with both the HSI-MIS and the HSI-System for Open Surgery at the Region of Interest. 19 patients undergoing gastroenterologic resections were included in the study. The images acquired with the HSI-MIS were registered onto the images from the open HSI system, and spectra, as well as parameter images, were pixel-wise compared. Violin plots were created for Tissue Oxygen Saturation (StO2), Near-Infrared Perfusion Index (NIR PI), Tissue Water Index (TWI) and Organ Hemoglobin Index (OHI). The raw data was analyzed using a partial least squares (PLS) and compared with the parameters as calculated by the original software
The MAE results for the in-vivo evaluation were: StO2: 17.4% ± 7.6%, NIR PI: 16.3 ± 9.4, OHI: 14.3 ± 4.5, and TWI: 18.3 ± 7.8. The results obtained by PLS were StO2: 11.1% ± 3.9% (improved by 36%), NIR PI: 9.5 ± 5.8 (improved by 42%), OHI: 10.7 ± 2.7 (improved by 25%) and TWI: 9.6 ± 4.3 (improved by 48%)
Laparoscopic hyperspectral imaging during minimally invasive procedures shows promising results. Parameter deviations might be attributable to technical differences and on how the parameters are calculated. The PLS method has shown significant improvement compared to the original calculation.
593. UPPER MEDIASTINAL LYMPHADENECTOMY IN PRONE POSITION TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Davakis Spyridon , Sakellariou Stratigoula , Stratigopoulou Panagiota , Ntoka Polyxeni , Giagkos Christos , Ziogas Dimitrios , Theochari Maria , Liakakos Theodoros , Charalabopoulos Alexandros 
Published: September 2022

Abstract
Minimally invasive esophagectomy (MIE) is a challenging procedure associated with high rate of complications and mortality. Routine lymphadenectomy includes 2-field lymphadenectomy for distal esophageal or esophago-gastric junction Siewert I-II cancers. SML refers to extended 2-field lymphadenectomy or total mediastinal lymphadenectomy. The exact benefits of superior mediastinal lymphadenectomy (SML) have long been debated with no clear evidence pertaining to improved outcomes.
N=150 consecutive patients underwent totally MIE under a surgical team from September 2016 to September 2020. SML included right paratracheal nodes and lymph nodes along the right recurrent laryngeal nerve throughout its mediastinal route (including the paratracheal-retrocaval compartment) in cases of extended 2-field lymphadenectomy, as well as left paratracheal nodes and lymph nodes along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Eligible patients underwent SML during 2-stage or 3-stage MIE.
N=20 consecutive cases were identified as eligible according to the inclusion criteria during the study period. 30- and 90- day mortality rates were 0. There were no anastomotic or chyle leaks noted. Pulmonary complications were observed in 16.5% of the patients. There was 1 right recurrent laryngeal nerve palsy noted. Median length of hospital stay was 9 days. Median number of resected lymph nodes was 45 (Range: 37-68), with median SML nodes count being 8 (Range: 2-25). Median follow up was 24 months.
The small sample size is immediately recognised as a limiting and influencing factor in the results of this study. However, MIOs with SML may provide some, although not comprehensive, benefit in oncological outcomes without adding any further significant morbidity. Larger studies are needed to assess the role SML can play in improving patient outcomes.
601. SINGLE-PORT VATS ESOPHAGECTOMY. SAFE AND FEASIBLE TECHNIQUE
Authors: Caronia Francesco Paolo , Russo Emanuele 
Published: September 2022

Abstract
Minimally invasive esophagectomy represents the gold standard for the treatment of esophageal carcinoma. The improvement of surgical techniques and the development of the single port vats for the thoracic time represent a safe and efficacy option. We show some technical aspects showing the feasibility of this approach and the potential troubles to face up.
We show a single port vats esophagectomy combined with full laparoscopy in a patient with esophageal adenocarcinoma and esophageal stent.
Patient discharged in 7post operative day. Course was uneventful.
The minimally invasive approach represents the gold standard for the treatment of esophageal carcinoma. Single port vats may be a feasible and safe option.
602. LONG-TERM OUTCOME OF COLON INTERPOSITION IN SEVERE CORROSIVE UPPER DIGESTIVE TRACT INJURY
Authors: Tharavej Chadin , Chobarporn Thitiporn 
Published: September 2022

Abstract
Long-term outcome of colonic interposition in patients with severe corrosive upper gastrointestinal tract injury is less known.
Patients diagnosed of severe corrosive upper digestive tract injury were included. Patients with full-thickness organ necrosis underwent emergent surgical resection without primary reconstruction. Subsequent esophageal reconstruction with substernal colonic interposition approximately 6 months after the ingestion was undertaken in physically and mentally fit patients. Esophageal dilatation program was applied as first line treatment in all patients with esophageal stricture at a median duration of 5 weeks after the injury. Esophageal replacement procedure was offered to the patients who had failed dilatation. Late complications, swallow function, nutritional autonomy and overall survival in patients who underwent colonic interposition were evaluated.
There were 70 patients undergoing colonic interposition. Of 70 patients, 50 (71%) had cervical pharyngo-colonic and 20 had cervical esophago-colonic anastomoses. There was one (1.4%) 90-day hospital mortality. Anastomosis leakage was 8%. At median follow up of 58 months, late deaths were observed in 6 patients causing by nesidioblastosis (2), resuicidal attempt (2) and intestinal volvulus (2). Adhesive small intestinal obstruction requiring laparotomy was observed in 7(10%). Nutritional autonomy was achieved in 55 of 60 (92%) patients. Strictures were developed in 10 (16%) and dumping syndrome in 20 (30%) patients. Five- and ten-year overall survival were 72% and 61%, respectively.
Colonic interposition in patients with severe corrosive upper digestive tract injury was safe and effective. Long-term survival, function and nutritional outcome are good regardless of the proximal level of cervical anastomosis. However, the late negative impact of the reconstructive procedure on metabolic derangement and small intestinal obstruction cannot be overemphasized.
628. THE BEST METHOD OF THE GASTRIC TUBE RECONSTRUCTION AFTER ESOPHAGECTOMY
Authors: Inoue Seiya , Yoshida Takahiro , Goto Masakazu , Fujiwara Satoshi , Toba Hiroaki , Takizawa Hiromitsu 
Published: September 2022

Abstract
As a postoperative complication of esophageal cancer, anastomotic leakage (AL) is a serious complication that affects not only the delay in the start of oral intake but also the prognosis. Anastomotic stenosis (AS) also has a significant effect on postoperative quality of life. The blood flow evaluation of gastric tube was introduced for the purpose of improving these, and then the anastomosis method was changed from hand-sewn to Collard's modified method.
Esophageal cancer patients who underwent gastric tube reconstruction as a radical operation for esophageal cancer during the period from January 2017 to November 2021 were included (n=120). The blood flow evaluation of gastric tube using the ICG was started in 2019, and the anastomosis method was changed from hand-sewn to Collard modified method from April 2021. These patients were divided into 3 groups and the surgical results were compared and examined. Group A (without blood flow evaluation, hand-sewn): 55 cases, Group B (with blood flow evaluation, hand-sewn): 42 cases, Group C (with blood flow evaluation, modified Collard method): 23 cases.
In the blood flow evaluation of gastric tube, the A and B groups were compared, and the AL incidence rate tended to be higher in the B group (A/B: 18.2%/33.3%, p=0.087). The incidence of AS was significantly higher in group B (A/B: 32.7%/66.7%, p=0.001). There was no difference in the incidence of AL between groups B and C (B/C: 33.3%/26.0%, p=0.586). The incidence of AS was significantly lower in group C (B/C: 66.7%/5.9%, p&lt;0.001). The incidence of AL was compared by anastomotic method, but no difference was observed (P = 0.444). In addition, there was no difference in postoperative complications.
It is considered that the modified Collard method could reduce AS because a constant anastomosis diameter could be maintained even when a difference in diameter between the esophagus and the gastric tube was observed during the anastomosis. However, both AL and AS have increased due to the evaluation of gastric tube blood flow, and it is necessary to review the blood flow evaluation method.