bluuebunny/crossref_metadata_2025_split huggingface dataset:
543. THORACO-LAPAROSCOPIC EXCISION OF A FOREGUT DUPLICATION CYST WITH A PYLORO-DUODENAL COMMUNICATION
Authors: Surendran Suraj , Paul Negine , Yacob Myla , Chandran Sudhakar , Samarasam Inian 
Published: September 2022

Abstract
Foregut duplication cysts presents rarely in adults. Rarely, they can have an intraluminal communication. Traditionally, these cysts are excised via open surgical approaches.
This video case describes the Thoraco-laparoscopic management of a 34-year old female patient who was diagnosed with foregut duplication cyst with a pyloro-duodenal communication.
Successful excision of the foregut duplication cyst was achieved, through minimally invasive technique. Postoperatively, a right-sided pleural collection resulted, which was successfully managed with image-guided drainage. She is currently alive and asymptomatic at 1-year follow-up.
Minimally invasive surgery is feasible and safe in the management of foregut duplication cysts with luminal communication.
544. NON-EPSTEIN-BARR VIRUS ASSOCIATED LYMPHOEPITHELIOMA-LIKE CARCINOMA OF THE ESOPHAGUS WITH SURGICAL TREATMENT: A REPORT OF TWO CASES
Authors: Nakano Toru , Sawada Kentaro , Mitamura Atsushi , Suzuki Hideyuki , Sakurai Hiroto , Miura Tomoya , Takami Kazuhiro , Kondo Noriko , Yamamoto Kuniharu , Katayose Yu , Shibata Chikashi 
Published: September 2022

Abstract
Lymphoepithelioma-like carcinoma (LELC) can occur in many organs such as lung, stomach, skin, breast, bile ducts, esophagus, and other many organs. Esopahageal lymphoepithelioma-like carcinoma is an extremely rare disease. LELC has been reported to be associated with Epstein-Barr virus (EBV) in some organs, although there are many controversies. Here, we report a surgically treated two cases of non-Epstein-Barr virus associated LELC of the esophagus.
Case 1was a 46-year-old woman who was presented epigastralgia while eating. Upper gastrointestinal endoscopy showed a submucosal tumor in the lower esophagus. Biopsies were taken, and they identified atypical cells proliferating follicular manner and heavy infiltration of lymphocytes.
Case 2 was a 71-year-old man who was pointed out to have a tumor in the esophagus by barium examination and was referred to our hospital. Upper gastrointestinal endoscopy showed submucosal tumor was found 23-26 cm from the cut tooth. Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) was performed and diagnosed with LELC.
These patients underwent subtotal esophagectomy with lymphadenectomy and reconstruction with gastric tube.
Case1 was pathologically diagnosed with LELC, SM3, INFa, ly0, V0, pIM0, pPM0 (100mm), pDM0 (120mm), pRM0, pN0, cM0, pStageI, and case2 was diagnosed with LELC, ly1, V1, pIM0, pPM0, pDM0, pRM0, pN0, cM0, pStageI, according to the 10th edition of Japanese classification of Esophageal cancer. Immunohistochemical staining of the specimen from case 1 was positive for AE1/AE3, P40, p63, and negative for CD56 and chromogranin A. Immunohistochemical staining of the specimen from case 2 was positive for CK, EMA, P40, and negative forαSMA and desmin. EBV was not detected by EBER in situ hybridization in the specimen from both patients.
LELC is relatively common in salivary glands, thymus, lungs, stomach, skin, and cervix, and EBV that directly infects epithelial cells or infects lymphocytes infects epithelial cells and infects them. EBV infects epithelial cells and is thought to be associated with carcinogenesis of these organs. However, esophageal LELC is rare and it has been argued that EBV may not be involved. In these two cases, EBV was not detected in situ hybridization.
552. LAPAROSCOPIC RE DO FUNDOPLICATION
Authors: Ramakrishnan Parthasarathi , Balasubramanian Shankar , Natarajan Ramesh , Bharath Cumar M , Chinnusamy Palanivelu 
Published: September 2022

Abstract
Laparoscopic fundoplication though an effective form of therapy for patients with refractory gastroesophageal reflux disease, can fail due to poor patient selection or compromised surgical technique. Redo laparoscopic fundoplication is a challenging task prone to further failures.
Retrospective analysis of consecutive patients who underwent laparoscopic redo fundoplication in a tertiary care center between July 2015 and March 2022.
There were a total of 24 patients that underwent redo fundoplication during the study period. Wrap migration was noted in 8 (33.3%) patients while the wrap was too tight which led to dysphagia in 5 (20.8%) patients. Two patients had previously undergone laparoscopic redo fundoplication while one patient initially underwent open Nissen’s fundoplication. All the patients were managed successfully laparoscopically without any conversion. The median time interval between the first surgery and the redo operation was 8 months (3 months to 12 years). Symptomatic improvement was observed in 20 (83.3%) while 4 (16.7%) patients continued to have symptoms.
Laparoscopic redo fundoplication can yield satisfactory results in patients after initially failed anti reflux surgery when performed in experienced centers. Proper case selection and meticulous surgical technique to address the primary cause of failure is paramount.
561. VIDEO ASSISTED THORACOSCOPIC ESOPHAGECTOMY WITH ABERRANT VASCULAR ANATOMY
Authors: So Choi Kwan , Lam Chin Tou , Cheung Siu Hong , Chow Tam Lin 
Published: September 2022

Abstract
Aberrant right subclavian artery is an important vascular anomaly for upper mediastinal dissection in esophagectomy.
We encountered a patient with this aberrant vascular anatomy, which was identified in preoperative CT scan. Operative video was taken in the consent of patient and saved for further educational purpose.
This was a 67 years old male with advanced middle thoracic esophageal tumour. Biopsy confirmed squamous cell carcinoma. He underwent trimodality treatment after multidisciplinary team discussion. Neoadjuvant chemoradiotherapy was completed 6 weeks before the surgery.
The patient underwent minimally invasive McKwown esophagectomy with complete mediastinal dissection. The patient was put in semiprone position with bronchial block for one lung ventilation. The aberrant anatomy was successfully identified intraoperatively, and the operation was uneventful. The total operative time was 6 hours 39 mins and the total blood loss was 120ml. The patient ran an uneventful recovery and was discharged on postoperative D10.
To be able to acknowledge this unusual anatomy in preoperative imaging and clearly identify it intraoperatively are the keys to prevent inadvertent injury and massive bleeding.
562. PROGNOSTIC IMPACT OF CLINICOPATHOLOGICAL FEATURES FOLLOWING METASTECTOMY FOR METACHRONOUS PULMONARY METASTASIS FROM ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Prasad Pooja , Nevins Edward , Brown Joshua , Phillips Alexander W 
Published: September 2022

Abstract
Disease recurrence following treatment for esophageal cancer (EC) remains common despite incremental gains from receipt of neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive EC treatment. Clinicopathological features of the primary EC tumour have implications on the development of metastatic disease and overall survival. This systematic review sought to identify the prognostic impact of clinicopathological features of the primary esophageal tumour following treatment of metachronous pulmonary metastasis from EC.
A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the clinical and pathological features of the primary EC tumour among patients undergoing treatment for metachronous pulmonary metastasis were included. A random effects meta-analysis model was used to compare the impact of gender (male vs female), primary EC pathological T-stage (pT1/2 vs pT3/4) and pathological N-stage (N0 vs N1+), on 5-year survival following pulmonary metastectomy.
Seven non-randomised studies comprising 110 patients undergoing pulmonary metastectomy for metastatic EC were included. Gender did not have an impact upon 5-year survival (Risk Ratio (RR) =0.65; 95% confidence interval (CI):0.37-1.15; p=0.14). A lower primary EC T-stage (T1/2) was associated with improved 5-year survival following pulmonary metastectomy compared to advanced T-stages (T3/4), though this did not reach statistical significance (RR= 1.76; 95% CI:0.96-3.20; p=0.07). The absence of nodal disease (N0) in the primary EC tumour did not confer a survival benefit over those patients with nodal involvement disease (N1+) proceeding to pulmonary metastectomy (RR= 1.45; 95% CI:0.86-2.46; p=0.18).
Patient gender and pathological T- and n-stages of the primary tumour do not impact upon prognosis following metastectomy for metachronous pulmonary metastasis from EC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the treatment of the primary EC, limiting outcome assessment.
566. PROGNOSTIC SIGNIFICANCE OF TUMOUR BURDEN AND OPERATIVE TECHNIQUE FOR METACHRONOUS PULMONARY METASTASIS FROM ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Prasad Pooja , Nevins Edward , Brown Joshua , Chmelo Jakub , Phillips Alexander 
Published: September 2022

Abstract
Disease recurrence following treatment for esophageal cancer (EC) remains common despite incremental gains from neoadjuvant chemotherapy. The lung is a common site of distant metastasis following definitive EC treatment. Tumour burden influences the surgical approach utilised in the treatment of pulmonary metastasis from EC. In turn, this impacts patient prognosis. This systematic review sought to identify the impact of tumour burden and surgical approach on 5-year survival following metastectomy of metachronous pulmonary metastasis from EC.
A search of the major reference databases (PubMed, Medline, Cochrane) was performed with no time limits up to March 2022. Results were screened in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on the number of metastatic pulmonary tumours and operative techniques utilised were included. A random effects meta-analysis model was used to compare the impact of number of metastatic pulmonary deposits (single vs multiple), and operative approach (wedge vs anatomical resection) on the 5 year survival of patients following metastectomy for metachronous pulmonary metastasis from EC.
Seven non-randomised studies comprising 142 patients undergoing pulmonary metastectomy for metastatic EC were included. The number of metastatic deposits (single vs multiple) did not affect 5-year survival (Risk Ratio = 1.08; 95% confidence interval 0.58-2.02; p = 0.81). With respect to surgical technique, anatomical resection did not confer a survival benefit compared to wedge resection of pulmonary metastases from EC (Risk Ratio = 1.33; 95% Confidence Interval: 0.81 – 2.19; p = 0.26).
Tumour burden and surgical technique utilised does not impact upon the prognosis of patients undergoing pulmonary metastectomy for metastatic EC. However, current evidence from smaller non-randomised studies remains weak owing to variation in the clinicopathological features of the primary EC and pulmonary metastasis, limiting outcome assessment.
570. INCIDENCE AND ONCOLOGICAL IMPLICATION OF ADRENAL INCIDENTALOMAS IN ESOPHAGEAL CANCER PATIENTS
Authors: Van Doesburg Jasmijn , Voeten Daan , Kalff Marianne , Jol Saskia , van der Bergh Janneke , Engelsman Anton , Gisbertz Suzanne , Daams Freek 
Published: September 2022

Abstract
Adrenal incidentalomas are regularly encountered during imaging for esophageal cancer patients, but their oncological significance remains unknown. This study aimed to describe the incidence and etiology of adrenal incidentalomas observed during the diagnostic workup for esophageal cancer.
This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016. Radiology and multidisciplinary team meeting reports were reviewed for adrenal incidentalomas. In case of adrenal incidentaloma, the 18FDG-PET/CT was reassessed by a radiologist blinded for the original report. In case of a metachronous incidentaloma during follow-up, visibility on previous imaging was reassessed. Primary outcome was the incidence, etiology and oncological consequence of synchronous adrenal incidentalomas.
This study included 1,164 esophageal cancer patients, with a median age of 66 years. Patients were predominantly male (76.1%) and most had an adenocarcinoma (69.0%). Adrenal incidentalomas were documented in 138 patients (11.9%) during the diagnostic workup. At primary esophageal cancer workup, 22 incidentalomas proved malignant. However, follow-up showed seven malignant incidentalomas missed or inaccurately diagnosed as benign. In total, stage migration occurred in 15 of 22 (68.2%), but this number would have been higher if no incidentalomas were missed or inaccurately diagnosed.
The oncological impact of adrenal incidentalomas in patients with esophageal cancer is significant as a considerable part of incidentalomas changed treatment intent from curative to palliative. As stage migration is likely, pathological examination of a synchronous adrenal incidentaloma should be considered.
573. DOES CHEST PAIN AFFECT THE LONG TERM OTCOME OF SURGERY FOR ESOPHAGEAL ACHALASIA?
Authors: Tassi Valentina , Baldi Fabio , Lugaresi Marialuisa , Daddi Niccolò , Bassi Francesco , Pilotti Vladimiro , Mattioli Sandro 
Published: September 2022

Abstract
Literature supporting the adoption of POEM in place of the standard Heller myotomy in the presence of significant chest pain associated with typical symptoms like in case of Achalasia Type III according to the Chicago classification, generally reports on outcome data collected after short follow up periods. We aimed to assess behaviors of chest pain in the long term in a case series of patients submitted to the Heller-Dor operation.
Between 1978 and 2021,394 achalasia patients underwent the Heller-Dor operation. Chest pain was evaluated according to its frequency (0: absent; 1: occasional; 2: weekly; 3: daily): 81 preoperatively complained of chest pain (score 2-3) (CP group), 313 did not (score 0-1) (NCP group). Patients were followed up according to a timed protocol based on clinical assessment of dysphagia (D0 absent – D3 each meal), GERD symptoms (RS0 absent-RS3 each meal). Barium swallow and endoscopy (E0: normal, E1: mild esophagitis, E2-3: erosive/ulcerative esophagitis) were performed at each planned control. CP and NCP were compared.
CP group had shorter duration of dysphagia (p=0.03), smaller esophageal diameter and lower barium column (p&lt;0.05). At a median follow-up of 10 years for CP and 11 years for NCP (p=0.166), the frequency of dysphagia (p=0.05), GERD symptoms (p=0.3) and esophagitis (p=0.27) was similar in the two groups. Chest pain progressively attenuated in intensity and frequency.; median chest pain score preoperatively was 3, at follow-up it was 0 (p&lt;0.01). Clinical results obtained in CP patients (satisfactory D0–2, RS0–2, and E1 in 95%) were not inferior to those obtained in NCP patients (satisfactory in 93%) (p=0.05).
According to our single center case series, in the long term chest pain does not influence negatively HD outcome which is absolutely competitive with that generally reported for POEM and pneumatic dilation. Results presented in this study must be verified: as new randomized prospective studies would require a too long lag time, valid retrospective multi center studies should be performed.
574. MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: IMPROVING OUTCOMES WITH A SYSTEMATIC PROTOCOL
Authors: Cheng Shi Yu , Lim Jolene , Voon Kelvin 
Published: September 2022

Abstract
Minimally invasive esophagectomy (MIE) has the advantages of reduced post-op cardiopulmonary complications, faster recovery and better quality of life. MIE has been the standard approach for esophageal cancer in our center since year 2020. A systematic approach with prehabilitation and enhanced recovery after surgery is key in improving outcomes after MIE.
We herein report our protocol for MIE in esophageal cancer. A stepwise diagnostic, staging and multidisciplinary management pathway was adopted. All patients with histologically confirmed esophageal cancer were staged according to the 8th edition AJCC cancer staging with PET-CT scan. Patient assessment, comorbidity optimization and 3-axis prehabilitation were initiated on the first consultation. All cases were discussed in the multidisciplinary tumour board meeting and multimodality treatment approach was advocated. MIE was the standard surgical approach with selective ERAS pathway especially on goal directed fluid therapy, multimodality analgesia, timely extubation, early ambulation and enteral feeding.
A total of 10 patients underwent MIE between June 2020 to June 2021 with the MIE protocol. The mean age was 56.7. Adenocarcinoma was the commonest histology. All patients had neoadjuvant therapy due to locally advanced disease. 6 patients had McKeown MIE with either 3-field or total 2-field lymphadenectomy. The mean length of stay post-op was 8.3 days. The average post-op pain score was 2.3 and the mean time to ambulation post-op was 1.6 days. Post-operative complications were noted in 4 patients with only one being Clavien Dindo grade 3. There was no 90-day mortality post-op.
The early result of this systematic protocol with multidisciplinary approach, prehabilitation, MIE and selective ERAS pathway was promising. Evidence based practice with regular clinical audit are important in improving the quality of care and clinical outcomes.
577. FDG PT-CT METABOLIC TUMOUR AND NODAL RESPONSE AS A PREDICTOR OF PATHOLOGICAL RESPONSE AND SURVIVAL IN PATIENTS WITH OESOPHAGEAL ADENOCARCINOMA
Authors: Moore Jonathan , Subesinghe Manil , Santaolalla Aida , Green Michael , Deere Harriet , Van Hemelrijck Mieke , Lagergren Jesper , Chicklore Sugama , Maisey Nick , Kelly Mark , Gossage James A , Baker Cara R , Davies Andrew R 
Published: September 2022

Abstract
2-deoxy-2[18F]fluoro-D-glucose positron emission tomography-computed tomography (FDG-PET-CT) is routinely used for staging of oesophageal cancer and has an emerging role in assessing response to neoadjuvant therapy. The primary aim of this study was to evaluate the ability of FDG-PET-CT to predict pathological response in the primary tumour (pTR) and lymph nodes (pNR) in patients with oesophageal adenocarcinoma undergoing neoadjuvant chemotherapy before surgery. The secondary aim was to assess the prognostic effect of metabolic and pathological response.
Cohort study of 75 patients with locally advanced oesophageal or oesophago-gastric junctional adenocarcinoma who underwent FDG-PET-CT before and after neo-adjuvant chemotherapy, prior to surgical resection at a tertiary referral centre in the United Kingdom, between 2017-2020. Standardised uptake value (SUV) metrics related to the primary tumour and loco-regional lymph nodes were derived. pTR and pNR were evaluated using the Mandard classification. Receiver operator characteristic (ROC) analysis was performed and area under the curve (AUC) calculated to determine optimum SUVmax thresholds for metabolic response in the primary tumour (mTR) and lymph nodes (mNR). Survival was assessed using multivariable Cox regression.
ROC analysis demonstrated an optimum tumour SUVmax decrease of 51.2% for predicting pTR. A pragmatic 50% cut-off provided better prediction of pTR (AUC 0.714, sensitivity 73.5%, specificity 69.2%, p&lt;0.001) than PERCIST (30% reduction) and MUNICON (35% reduction) criteria. Using a 30% SUVmax threshold and excluding metabolically negative nodes, mNR demonstrated high sensitivity but low specificity (sensitivity 92.6%, specificity 57.1%, p=0.010) for predicting pNR. pTR, mTR, pNR and mNR were independent prognostic factors (pTR responder HR 0.10 95% CI 0.03-0.34; mTR responder HR 0.17 95% CI 0.06-0.48; pNR responder HR 0.17 95% CI 0.06-0.54; mNR responder HR 0.13 95% CI 0.02-0.66).
Metabolic response predicted pathological response in both the primary tumour and lymph nodes in this cohort of patients with locally advanced oesophageal adenocarcinoma treated with neo-adjuvant chemotherapy. Metabolic tumour response, pathological tumour response, metabolic nodal response and pathological nodal response were all independent prognostic factors for survival. Currently utilised metabolic response criteria may not be optimal for this tumour group.
578. ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING OESOPHAGECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Jethani Manish , Mistry Rajesh 
Published: September 2022

Abstract
Esophagectomy remains the main stay of treatment in localized esophageal carcinoma. Radical Esophagectomy is associated with high morbidity and mortality. To minimise peri and post-operative complications and accelerate recovery, concept of ERAS has been introduced. Standardized ERAS guidelines were lacking in esophagectomy patients until the ERAS society published their guidelines in late 2018.
This is a prospective observational study were ERAS protocol was followed for all patients undergoing esophagectomy during the study period (July 2020 to November 2021). Aim of the study was to compare the post-operative morbidity and mortality associated with ERAS protocol to published historical data from same institute. All patients undergoing esophagectomy for carcinoma of esophagus and GEJ were included and all the components of ERAS protocol as specified in the published guidelines were followed during the study.
Out of 52 patients, 36 underwent minimal invasive procedure and 15 had open surgery. Median age was 59.5 years. Average blood loss for thoracic part was 150 ml and 100ml for the abdominal. 37/52 (71.15%) were extubated and rest were electively ventilated till next morning. Median post-operative ICU stay was one day (1-2) and over all hospital stay was 10 days (9-12). Overall morbidity was 11/52 (21.15%) with major morbidity in 4/52 (7.69%); there was no mortality. 2/52 (3.84%) had anastomotic leak.
It was possible to follow the ERAS protocol for patients undergoing esophagectomy. The incidence of post-operative morbidity and mortality was no different from that seen in patients undergoing similar surgery before the implementation of ERAS protocol. The probable reason is many of the components of ERAS protocol were followed in our practice routinely. Notwithstanding our results, ERAS program is a collective responsibility and should be recommended in all patients undergoing esophagectomy to improve post-operative outcomes.