bluuebunny/crossref_metadata_2025_split huggingface dataset:
194. THE IMPACT OF PREHABILITATION IN UPPER GASTROINTESTINAL (GI) CANCER UNDERWENT MAJOR SURGERY
Authors: Shariff Ramizah , Jahit Mohammad Shukri , Chee Tee Sze , Harith Abdul Aziz , Shahabuddin Nurul Hannan , Adibi Saiyidah Adila Mohd 
Published: September 2022

Abstract
Major upper gastrointestinal (GI) surgery always poses unique perioperative challenges and high post-surgical complications. Prehabilitation encompasses of exercise, nutrition and medical optimization prior to surgery. There is an emerging evidence to show prehabilitation plays a significant role in reducing morbidity and mortality associated with major upper GI surgery by improving patient’s functional status. Its role in improving postoperative outcomes such as length of stay (LOS) is less established.
An interventional study conducted among oesophageal and gastric cancer patients who undergone oesophagectomy and gastrectomy surgery. All the preoperative patients are assessed by dietician and nutrition therapy will be intiated based on ESPEN guideline. A standard set of physical and breathing exercise are adopted. Study characteristics, ECOG status, handgrip, peak flow meter and spirometry are obtained. Primary outcome is impact of prehabilitation on functional capacity. Secondary outcomes include post-operative length of stay and complications based on Clavien-Dindo classification.
Thirty one (31) patients who were recruited [gastrectomy (n = 21) and oesophagectomy (n = 10)]. Mean age was 59.2 ± 8.9 years. 21(67.7%)was male patients. Majority of the participants were SGA B (51.6%) with good ECOG status of 1(61.3%). Most of the diseases were in advanced stage [stage III (54.9%), stage IV (9.7%)].After prehabilitation, handgrip strength, peak flow meter and spirometry were significantly higher before surgery (20.9 vs 26.1, p = 0.002; 322.2 vs 419.3, p = 0.002; 77.4% vs 90.3%, p = 0.007 respectively). No significant difference in LOS and post operative complications were observed.
Prehabilitation was associated with significant increase in functional capacity after intervention. Hence prehabilitation should be strongly recommended among patient undergoing major upper GI surgery to accelerate recovery from cancer surgery. However, there is insufficient data to demonstrate its role in improving clinical outcomes, including LOS and post operative complications.
202. THE UTILITY OF TISSUE OXYGEN SATURATION DURING GASTRIC TUBE RECONSTRUCTION WITH CERVICAL ANASTOMOSIS FOR ESOPHAGECTOMY
Authors: Ishii Kenjiro , Tsubosa Yasuhiro , Haneda Ryoma , Inoue Masazumi , Mayanagi Shuhei 
Published: September 2022

Abstract
Background: One cause of anastomotic leakage after radical esophagectomy is blood flow insufficiency at the cervical anastomosis site. Therefore, evaluation of blood flow in the gastric tube is important in preventing anastomotic leakage. In this study, we focused on the repeated measurement of tissue oxygen saturation (rSO2) before and after raising the gastric tube to the cervical area and also at the actual anastomotic site in the gastric tube.
Methods: Eighteen patients were studied. rSO2 was measured at the tip (point pre 0) and 2, 4, and 6 cm on the distal side of the tip (point pre 1, pre 2, and pre 3) before the gastric tube was raised to the cervical site through the retrosternal route. After that, rSO2 was measured at the tip, 2 and 4 cm on the distal side of the tip (points post 0, post 1, and post 2), the actual anastomotic site (point AN). The relationship between rSO2 scores and the rate of anastomotic leakage was determined.
Results: The mean rSO2 at pre 0, pre 1, pre 2, and pre 3 were 48.9%, 52.3%, 54.8%, and 56.9%, respectively (p &lt; 0.05). The mean rSO2 at post 0, post 1, and post 2 were 47.8%, 50.5%, and 52.3%, respectively, and the rSO2 at point AN was 52.1%.
Anastomotic leakage was found in 6 patients. The rSO2 at points pre 0, pre 1, and pre 2, post 0 and point AN were significantly lower in patients with anastomosis leakage than those without it (p &lt; 0.05).
Conclusion: Tissue oxygen saturation monitoring was a useful indicator of blood flow insufficiency in the gastric tube during radical esophagectomy.
204. THE TUMOUR IMMUNE MICROENVIRONMENT IN OESOPHAGEAL ADENOCARCINOMA HAS PROGNOSTIC SIGNIFICANCE
Authors: Lonie James , Brosda Sandra , Aoude Lauren , Bonazzi Vanessa , Patel Kalpana , Lampe Guy , Koufariotis Lambros , Addala Venkateswar , Wood Scott , Thomas Janine , Walpole Euan , Mai Tao , Ackland Stephen , Martin Jarad , Burge Matthew , Finch Robert , Karapetis Christos , Shannon Jenny , Nott Louise , Bohmer Robert , Wilson Kate , Barnes Elizabeth , Zalcberg John , Smithers B Mark , Simes John , Price Timothy , Gebski Val , Watson David , Pearson John , Waddell Nic , Dolcetti Riccardo , Barbour Andrew 
Published: September 2022

Abstract
Oesophageal adenocarcinoma (OAC) is a deadly disease with an increasing incidence globally. Treatment outcomes with traditional therapy have largely plateaued and responses to immunotherapy are modest at best, necessitating the need for better biomarker driven selection. We aimed to unravel the tumour neoantigen landscape and immune microenvironment in OAC patients to aid improved patient selection and inform novel immunotherapy trials.
To characterise the tumour immune microenvironment and neoantigen landscape of OACs, we performed DNA sequencing (n = 117) and RNA sequencing (n = 115) on biopsies taken at pre-treatment endoscopy. Using expression-based computational methods we analysed transcriptomic data to profile infiltration levels of 28 immune cell populations and their functional orientation, as well as stromal signatures and immune checkpoint molecules. TCGA data was used for as a validation cohort. Tumour neoantigens were predicted using the pVAC-Seq pipeline.
Using an immune based classification based on the tumour microenvironment composition, we identified three distinct phenotypes; immune-enriched (IE), heterogeneously-infiltrated (HI), and immune-cold (IC). The IE group showed improved survival compared to both HI and IC, with HI showing the worst survival. The HI-group showed no difference in stromal scores to the IE group, but showed significantly decreased adaptive-immune cell infiltration, indicating that an immunosuppressive stromal compartment may be driving outcomes for these patients. No difference was seen in total or quality neoantigen load between groups, but high correlation with antigen processing machinery is seen.
Our analysis expands the knowledge of the relatively unknown tumour immune microenvironment of OAC. We have identified three immune TME-phenotypes with prognostic utility with current standard of care therapies; which may also act as potential immunotherapy biomarkers. This is being explored further in ongoing immune microenvironment research and will guide future translational studies.
211. STUDENT (CROWD SOURCED) ASSESSMENT OF LAPAROSCOPIC ASSISTED PERCUTANEOUS NEEDLE JEJUNOSTOMY PLACEMENT IS EQUIVALENT TO EXPERT ASSESSMENT, EXCEPT FOR PROCEDURE-SPECIFIC STEPS
Authors: Van Veer Hans , Van der Biest Femke , Corcoles Laurence , Van den Bergh Gert , Nafteux Philippe , Depypere Lieven 
Published: September 2022

Abstract
Objective and Structured Assessment of Technical Skills (OSATS) is an important and frequently used method to give feedback on surgical skills during surgical training. Feedback is usually given by qualified surgeons, but their availability is often limited. Aim of our study was to investigate whether OSATS performed by novice medical students and students trained in a laparoscopic jejunostomy simulation setup was equivalent to OSATS performed by experts in laparoscopic assisted percutaneous needle jejunostomy placement.
Fifty-six volunteers (32 inexperienced students, 12 trained students and 12 expert surgeons) were invited to participate. An instruction video with the procedure’s essential steps was displayed on an online survey platform. Thereafter five edited videos with essential steps of the procedure, performed by operators with a different level of expertise, were shown. Each video was followed by a standardized OSATS form, assessing nine different procedural aspects: fluency of the entire procedure, use of instruments, tissue respect, placement of stitches, tissue bridge between bowel and wall, submucosal needle tunneling, advancing the catheter, camera use and end result. Nonparametric statistics were used.
Thirty-seven (66%) volunteers—21 novice students (66%), 8 trained students (67%) and 8 surgeons (67%)—completed all five forms within 30 days. Median time to complete OSATS forms for novice students, trained students and experts was 22, 21 and 14.5 days respectively (p = 0.88). Median time needed per video was 825, 881 and 793 seconds respectively (p = 0.60). Average total scores per item showed no differences between novice students, trained and experts, except for items submucosal needle tunneling” (p = 0.0082) and advancing the catheter” (p = 0.0154) which both were rated higher by experts than by both groups of students.
Using standardized OSATS to evaluate laparoscopic assisted percutaneous needle jejunostomy placement, steps with common laparoscopic skills were rated equally by novice students, trained students and experts. These skills can be correctly evaluated without advanced training of the evaluator. Two procedure-specific items were rated differently by experts, compared to students. These procedure-specific items probably need more advanced training, explaining the different appreciation of the assessed manipulations by expert surgeons.
212. LAPARO-GASTROSCOPIC ESOPHAGECTOMY: A RETROSPECTIVE STUDY OF A PIONEER CASE SERIES
Authors: Shen Yaxing , Zhang Yiqun , Fang Yong , He Mengjiang , Fan Hong , Tan Lijie 
Published: September 2022

Abstract
Transcervical gastroscopic esophagectomy pioneered the gastroscope from intraluminal to extraluminal dissection for esophageal cancer. Its integration with laparoscopic gastric conduit formation, known as laparo-gastroscopic esophagectomy (LGE), was introduced an updated procedure of transhiatal esophagectomy. Herein, we report a case series to demonstrate its safety and efficacy.
We began performing LGE in July 2020, and herein we retrospectively reviewed the results of primary cohort performed from July 2020 to September 2021, in which endoscopic sentinel lymph node (SLN) navigation, an addition to the LGE procedure, was performed on patients 6 to 11. Patient clinical features, operative outcomes and complications were collected and analyzed. The follow-up results of the cohort was recorded.
LGE was successfully in 10 patients and 1 patient was excluded due to mucosal skip metastasis to cervical esophagus observed during SLN inspection. There were no intraoperative conversions or complications, and all patients tolerated the procedure well. Postoperatively, 2 patients developed pulmonary complications (One case of aspiration and 1 case of pleural effusion). SLNs were detected and removed in the last 4 cases, and frozen section examinations were negative. All patients were discharged within 10 days postoperatively, and no patient died at the latest follow-up in January 2022.
Based on the primary cohort that received LGE, the procedure shows promising surgical results, and the addition of SLN will further guarantee the oncological efficacy.
218. DYSPNOEA IMPROVES FOLLOWING REPAIR OF PARAOESOPHAGEAL HERNIA AND IS NOT NECESSARILY A CONTRAINDICATION TO SURGERY
Authors: Khoma Oleksandr , Wong Ngar Lok Joshua , Mugino Miho , Khoma Maite Jeanne , Van der Wall Hans , Falk Gregory L 
Published: September 2022

Abstract
Paraoesophageal hernias (PEH) are often symptomatic and can lead to life-threatening complications such as volvulus and ischemia. Recently dyspnoea was reported as most prevalent symptom of giant hiatus herniae. The aim of this study is to evaluate the effect of surgery on resolution of dyspnoea amongst patients with giant hiatus hernia defined as greater than 30% of the stomach above the diaphragm.
Data were extracted from a prospectively maintained single surgeon database containing records of patients undergoing composite hernia repair. Patients who underwent composite laparoscopic repair of giant paraoesophageal hernia between March 2009 and December 2015 and had documented dyspnoea were included. Inclusion criteria were met by 154 patients. Primary outcome of the analysis included preoperative and postoperative dyspnoea. Secondary outcomes included complications and post-operative symptoms.
The mean age at time of surgery was 71.2 years (range 49–93, SD 9.66). Surgery resulted in near complete resolution of dyspnoea (2.6% postoperatively, P-value &lt;0.001). Significant improvement was also noted in dysphagia, although not micro-aspiration.
Dyspnoea resolves following laparoscopic repair of giant paraoesophageal hernia. The presence of dyspnoea should be regarded as an indication rather than a barrier to surgery. We recommend all patients with giant hiatus hernia to be assessed by a specialist surgical service.
222. ARE GASTRIC MAPPING BIOPSIES NECESSARY TO DETERMINE THE DISTAL RESECTION MARGIN FOR SIGNET RING ADENOCARCINOMAS OF THE OESOPHAGO-GASTRIC JUNCTION?
Authors: Chaudhury Madhu , Singh Mohan , Ball Chris , Ward Jeremy , Shetty Vinutha Daya , Pursnani Kishore , Turner Paul 
Published: September 2022

Abstract
In our department patients with oesophago-gastric junctional adenocarcinomas with signet ring differentiation undergo a second endoscopy for gastric mapping biopsies to investigate the extent of tumour extension into the proximal stomach. This is due to the perceived aggressive morphology and to avoid a R1 (microscopic positive) resection at the distal margin. Our aim was to elucidate whether gastric mapping endoscopic biopsies are necessary prior to resection in signet ring adenocarcinomas of the oesophago-gastric junction (OGJ).
Patients with operable OGJ adenocarcinomas with signet ring morphology were retrospectively analysed from 2011–2021 from our databank of completed oesophagectomies at our upper gastrointestinal cancer surgical department. From 2014–2021, OGJ adenocarcinomas identified with signet ring differentiation were subjected to a second invasive endoscopy with gastric mapping biopsies to determine the distal ex-tent of microscopic invasion into the cardia and beyond. These were analysed to determine the histopathological yield from gastric mapping biopsies and the number of cases with a positive (R1) distal resection margin.
From 2014, 322 oesophagectomy cases were completed and these were analysed further. Of these, 21.7% (n = 70) were found pre-operatively to have signet ring differentiation and thus underwent a second gastric mapping endoscopy. Within the signet ring morphology cohort, only one patient (1.4%) was found to involve a R1 resection margin which necessitated a second operation involving gastric resection and colonic interposition.
Our results suggest that patients with signet ring adenocarcinoma of the OGJ do not need gastric mapping biopsies to determine the distal margin prior to resection. Although considered a more aggressive subtype of adenocarcinoma, radial infiltration from the tumour does not seem to affect conventional surgical oncological margins.
224. PURSUING ERAS POST-OESOPHAGECTOMY WITHOUT ENTERIC FEEDING TUBES: A 12 YEAR SINGLE CENTRE EXPERIENCE
Authors: Chaudhury Madhu , Shetty Vinutha Daya , Ward Jeremy , Ball Chris , Pursnani Kish , Turner Paul , Singh Mohan 
Published: September 2022

Abstract
Early feeding post oesophagectomy is encouraged. Surgical outcomes from different routes of feeding be it oral, via nasoenteral or jejunostomy tubes remains debatable due to ERAS protocol variations. We present our outcomes from our single regional centre where oesophagectomies are completed without the insertion of nasoenteric or feeding jejunostomy tubes, and therefore oral intake being the sole route of post-operative nutrition.
A retrospective study employed an electronic database of elective Ivor Lewis oesophagectomies from April 2009 to December 2021 at a tertiary upper gastrointestinal cancer centre in the United Kingdom. All patients without nasoenteric or jejunostomy tubes were included in the study, as this is the routine practice. Our practice involves a gradual increase in oral fluids from day 0 to 4, with supplementary intravenous fluid. We introduce a soft diet from the 5th post-operative day. We evaluated patient outcomes using the Clavien-Dindo grade (CDG). Primary outcomes were anastomotic leaks, length of stay, chyle leaks, and 30- and 90-day mortality.
578 Ivor Lewis oesophagectomies were peformed between 2009–2021 without any jejunostomies or nasoenteric tubes inserted. The median age was 63 years old (45–82) with M:F 1.8:1. The median length of stay (LOS) was 13 (3–148) days. Chyle leak was identified in 24 patients (4.2%) and of these 83.3% (n = 20) underwent surgical management with a mortality of 5% (n = 1). 16.7% (n = 4) chyle leaks were managed conservatively with a median LOS of 31 days (14–51), with no mortality. Anastomotic leaks were identified in 26 cases (4.5%), outcomes illustrated in the table. The 30- & 90-day mortality was 0.3% (n = 2) and 0.9% (n = 5).
While the best route of feeding post oesophagectomy remains contentious and variable, we have shown that surgical outcomes from performing oesophagectomies without the insertion of any enteric feeding tubes is feasible and safe. While this challenges conventional paradigm, we demonstrate early oral intake using a well-defined ERAS protocol poses no increased risk of surgical complications and negates the additional risks inherent from jejunal tubes and artificial feeding.
229. CARBON-13 BREATH TEST AS AN INVESTIGATIVE TOOL FOR DELAYED CONDUIT EMPTYING AFTER AN OESOPHAGECTOMY
Authors: Tham Ji Chung , Alcocer Bruno , Forbes Rosie , Ariyarathenam Arun , Humphreys Lee , Berrisford Richard , Wheatley Tim , Chan David , Lewis Stephen , Sanders Grant 
Published: September 2022

Abstract
The gold standard for diagnosing delayed conduit emptying (DCE) after an oesophagectomy is with scintigraphy. Current practice of using chest radiographs (CXR) and nasogastric tube (NG) output to diagnose DCE is useful clinically but is not as accurate as scintigraphy. A radiation-free procedure with higher accuracy that can be easily carried out at the bedside is needed. We proposal that the carbon-13 breath test is a viable option.
Oesophagectomy patients without pyloroplasty were recruited prospectively from 05/12/2017 to 31/12/2019 at a single centre. Age, gender, BMI, ASA grade, smoking status, and conduit size were used. DCE was diagnosed using parameters determined from CXRs and NG output described previously (1). At day 4/5/6, patients were fasted 6 hours prior to consumption of 100 mL of 193 kcal ice-cream laced with carbon-13 octanoic acid. Breath was captured at times 0, then every 30 minutes up to 4 hours and analysed using a gas spectrometer. Carbon-13 half-life excretion (t½) and estimated maximum excretion (tmax) was calculated using the formulas by Ghoos et al (2).
There were 65 patients with 24 DCE patients. Apart from gender (p = 0.015), there were no differences in demographics between DCE and non-DCE patients.
Differences were seen in both t½ and tmax. T½ was 3.04 hours [95%CI (2.91, 3.52)], and 3.54 hours [95%CI (3.41, 5.39)] in non-DCE, and DCE patients, respectively (p = 0.034). At time points 30, 60 and 90-minutes, Carbon-13 excretion were different, with p = 0.04, 0.015, and 0.034, respectively. Tmax was 1.68 hours [95%CI (1.45, 2.04)], and 2.15 hours [95%CI (1.98, 3.24)] in non-DCE, and DCE patients, respectively (p = 0.011).
This study has shown that the carbon-13 breath test is a viable tool to diagnose DCE. Further analysis and comparison with scintigraphy is required to validate the test. Although a gas spectrometer was used in this study to analyse patients’ breath, bedside testing devices are currently available and should be used in future studies.
231. A NOMOGRAM BASED ON BODY MASS INDEX CHANGES TO PREDICT PROGNOSIS AFTER CURATIVE RESECTION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Chen Long-Qi , Gu Yi-Min 
Published: September 2022

Abstract
This study aims to investigate the relationship between preoperative body mass index changes (∆BMI) and prognosis in patients with esophageal squamous cell carcinoma who underwent esophagectomy.
We identified 1883 patients with esophageal squamous cell carcinoma who underwent R0 resection in our department between January 2005 and December 2013. Patients were grouped into no decrease (∆BMI = 0) group and any decrease (∆BMI &gt; 0) group. The impact of ∆BMI on survival was investigated by using Kaplan–Meier curve and Cox regression modelling. A nomogram was constructed, and model performance was examined.

The ∆BMI &gt; 0 patients had worse 5-year overall survival rate than ∆BMI = 0 patients (26.8% vs 44.7% respectively, P &lt; 0.001). Preoperative ∆BMI was an independent prognostic factor in patients with esophageal squamous cell carcinoma (HR: 1.174, 95%CI: 1.014–1.358, P = 0.032). In subgroup analysis, major ∆BMI was associated with increased risk of poor prognosis when compared with minor ∆BMI (HR: 1.184, 95%CI: 1.031–1.359, P = 0.017). The prognostic nomogram presented good predictive ability with a C-index of 0.705 (Figure).
This study demonstrates that decreased body mass index had adverse impact on long-term survival in patients with esophageal squamous cell carcinoma who underwent curative esophagectomy. These results support application of nutrition support for the major ∆BMI group.