bluuebunny/crossref_metadata_2025_split huggingface dataset:
316. OMISSION OF ROUTINE PYLORIC PROCEDURES IN MINIMALLY INVASIVE ESOPHAGECTOMY: WHAT IS THE IMPACT ON PERI-OPERATIVE OUTCOMES?
Authors: Bolger Jarlath , Lau Harry , Yeung Jonathan , Darling Gail 
Published: September 2022

Abstract
Pyloroplasty or pyloromyotomy is often undertaken during esophagectomy to improve conduit function and potentially reduce complications. Minimally invasive esophagectomy (MIE) frequently omits a pyloric procedure. The impact on peri-operative outcomes and the need for subsequent interventions on the pylorus are unclear. This study assesses the requirements for endoscopic balloon dilation of the pylorus (EPD) following MIE.
Patients undergoing MIE from 2016–2020 were reviewed. Patients undergoing hybrid or open resection, or an intraoperative pyloric procedure were excluded. Demographic, clinical, and pathological data were reviewed. Data on the need for post-operative EPD in the short- and long-term settings were recorded. Univariable and multivariable analysis were performed as appropriate.
171 patients underwent MIE. There were no differences in age (p = 0.6), stage (p = 0.10) or ASA status (p = 0.52) between those requiring and not requiring EPD. Forty-three patients (25%) required EPD. Twenty-seven patients (16%) had EPD on their index admission. Seventy-five patients (43%) had a post-operative complication. There was a correlation between complications and the requirement for EPD both on the index admission (p &lt; 0.001) and subsequently (p &lt; 0.001). On multivariable analysis, there was no association between EPD and overall survival (p = 0.14). Eight patients (5%) required insertion of a feeding jejunostomy. Two patients underwent surgical pyloromyotomy for delayed gastric emptying.
Although pyloroplasty or pyloromyotomy can safely be excluded during MIE, a quarter of patients will require post-operative EPD procedures, for delayed gastric emptying or as part of management of post-operative complications. The impact of excluding pyloric procedures on gastric emptying requires further study.
319. SIGNIFICATIONS OF EXPRESSION OF TOLL-LIKE RECEPTORS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA CELLS
Authors: Sato Yusuke , Motoyama Satoru , Wakita Akiyuki , Nagaki Yushi , Fujita Hiromu , Kemuriyama Kohei , Sasamori Ryohei , Hayashi Kenjiro , Nozaki Syu , Minamiya Yoshihiro 
Published: September 2022

Abstract
Well known risk factors of Esophageal squamous cell carcinoma (ESCC) are habit of alcoholic drinking, smoking and poor diet. Moreover, recent reports showed that poor oral health is associated with upper aerodigestive tract malignancies including ESCC. We previously reported that among 232 ESCC patients who had preoperative assessment of oral function by dentist, about 70% of patients were diagnosed with periodontitis and about half of those patients were needed dental extraction.
Toll-like receptors (TLRs), a family of pattern recognition receptors, are able to recognize pathogen-associated molecular patterns (PAMPs) associated with a wide range of viruses, bacteria, fungi and parasites and thus play key roles in innate immune responses. Among these TLRs, TLR4 recognizes LPS, which construct the cell wall of gram-negative bacteria. Based on these findings, it is supposed that continuous exposure of LPS from gram-negative periodontal bacteria induces chronic inflammation caused by inflammatory cytokines from TLR4 signals, then carcinogenesis and progression of ESCC occurs.
Among these TLRs, TLR4 recognizes LPS, which construct the cell wall of gram-negative bacteria. We reported that ESCC patients who had higher TLR4 expression status in resected main tumor specimen showed significantly poor overall survival compared to lower patients after esophagectomy. (Sato Y, et al. Esophagus 2020) On the other hand, TLR3 recognizes dsRNA released form cell invading viruses. We previously reported that ESCC patients who had higher TLR3 expression status in resected main tumor specimen showed significantly better overall survival compared to lower patients after esophagectomy. (Sato Y, et al. Am J Surg. 2018).
Though TLR3 and TLR4 are in the same TLR family, those functional mechanism and relationships to prognosis in ESCC are totally different. Because TLR4 signaling is stimulatory on proliferative ability of ESCC, it is supposed that improvement of oral health inhibits carcinogenesis and progression of ESCC. On the other hand, because TLR3 signaling is suppressive, TLR3 agonist should be a possible candidate of therapeutic agent.
331. EFFECTIVENESS OF A SPECIALIZED AMINO ACID SUPPLEMENT CONTAINING CAHMB, L-ARGININE AND L-GLUTAMINE (ABOUND®) IN ESOPHAGEAL CANCER SURGERY
Authors: Takebayashi Katsushi , Kaida Sachiko , Yamaguchi Tsuyoshi , Otake Reiko , Miyake Toru , Kojima Masatsugu , Maehira Hiromitsu , Iida Hiroya , Tani Masaji 
Published: September 2022

Abstract
The wound healing effect of the specialized amino acid supplement containing CaHMB, L-arginine and L-glutamine (Abound®) has been reported. In this study, we evaluated the effectiveness of Abound® in patients with thoracic esophageal cancer in the perioperative period.
One hundred twenty-one patients who underwent esophagectomy for thoracic esophageal cancer between January 2013 and September 2021 were included. Among the 103 male and 18 female patients (median age 70 years, range 38-84 years) stage I disease was found in 41 patients, stage II in 17, stage III in 56, and stage IVa in 7. Postoperative infectious complications were evaluated between those patients who received Abound® for 7 days before surgery (n = 78) and those who did not (controls, n = 43).
The baseline characteristics between two groups were balanced. The postoperative infectious complications were follows: Anastomotic leakage occurred in 5 and 8 patients (6.4% vs 18.6%; p = 0.038) pneumonia occurred in 15 and 15 patients (19.2% vs 34.8%; p = 0.056), and wound infection occurred in 1 and 3 patients (1.2% vs 6.9%; p = 0.09) in the Abound® and control groups, respectively. The rate of anastomotic leakage was significantly lower in the Abound® group than that of control group. In anastomotic leakage cases, the treatment period was shorter in the Abound® group than that of control group: 18 (7-25) vs 25 (21-56) days; p = 0.033).
Abound® has the potential to reduce the incidence of infectious complications and shorten the treatment period for anastomotic leakage. Abound® may improve outcome following esophageal cancer surgery.
335. LONG TERM RISK FOR PROGRESSION TO NEOPLASIA FOR BARRETT’S ESOPHAGUS PATIENTS WITH VALIDATED LOW-GRADE DYSPLASIA OR INDEFINITE FOR DYSPLASIA
Authors: Elbe Peter , Öst Åke , Mellblom Lennart , Thorell Anders , Lundell Lars , Klevebro Fredrik , Lindblad Mats 
Published: September 2022

Abstract
Barrett’s esophagus (BE) with low-grade dysplasia (LGD) confirmed by two pathologists has a high risk of progression to high-grade dysplasia and cancer why ablation or more intense surveillance is recommended. Recent studies suggest that the progression risks for indefinite for dysplasia (IND) and LGD are similar, but the management guidelines are still different. We did a retrospective analysis to calculate the long-term risk for patients with verified LGD and IND.
All patients in the Ersta hospital BE-database in Stockholm who at least on one occasion during 1998 to 2012 were diagnosed with dysplasia. The first dysplastic specimen was re-evaluated by two highly experienced GI-pathologist. Clinical data was retrieved from the database and from patient medical records. Incidence rate (IR) was calculated for developing high-grade dysplasia (HGD) or cancer and IR ratio (IRR) was used as relative risk evaluation between the non-dysplastic Barrett’s Esophagus (NDBE) group and the LGD/IND groups and presented with 95% Confidence Intervals (CI).
Of 1180 patients with BE, 455 (39%) were diagnosed with dysplasia. 32 were excluded and 3 had HGD. Of the remaining 420 patients, 266 (63%) could be downgraded to NDBE, 82 (20%) were diagnosed as LGD and 71 (17%) as IND. Total follow-up was 4592 person years. The median follow-up time was 12 years. 34 patients developed neoplasia. The yearly IR for HGD or cancer among patients downgraded to NDBE was found to be 0,3% compared to 1,8% for LGD and 1,4% for IND. There was a five-fold increased risk of HGD or cancer among LGD/IND as compared to NDBE.
Patients with confirmed IND and LGD were found to have almost similarly elevated long-term risk for progression to neoplasia. Therefore, it seems reasonable that IND patients undergo the same surveillance regimen as non-treated LGD patients. Four patients (one with NDBE, two IND and one LGD) developed cancer more than 20 years after their initial BE diagnosis and therefore, it should be considered to keep BE patients in surveillance programs for a long period of time.
340. PROGNOSIS OF DIFFUSELY INFILTRATIVE ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Tamura Masahiro , Yoshimoto Yutaro , Yamauchi Suguru , Sugahara Yuuki , Yoshino Kohei , Ozaki Asako , Fujiwara Daisuke , Nasu Motomi , Hashiguchi Tadasuke , Hashimoto Takashi , Fukunaga Tetsu , Mine Shinji 
Published: September 2022

Abstract
Diffusely infiltrative esophageal squamous cell carcinoma is so rare that very few studies have been reported. Therefore, it has not been clear whether the survival of patients with this disease is poor or not. In this study, we retrospectively investigated our long-term results of radical esophagectomy for patients with diffusely infiltrative esophageal squamous cell carcinoma in our institution. In addition, we tried to detect prognostic factors of this disease if possible.
Data were retrospectively collected from medical records. Eligible patients underwent esophagectomy for esophageal squamous cell carcinoma with diffuse infiltration from 2002 to 2018 in our institution. Diagnosis of this disease was done in the conference of esophageal surgical team based on the findings of endoscopy and upper gastrointestinal series. Overall survival rates were calculated by the Kaplan–Meier method, and statistical significance was determined by the log-rank. P value of&lt;0.05 was considered statistically significant.
32 patients were selected in this study. Median age was 66 years old, cStage I/II/III/IV was 0/10/14/8 patients respectively, preoperative treatment was undergone for 11 patients. 5-year overall survival (OS) rate was 27.3% and 3-year OS rate was 37.5%.
5-year OS rate for each cStage II/III/IV was 48.0%, 14.3% 25.0%. Patients who underwent preoperative treatment seemed to have poor prognosis with statistically significant difference. Patients with clinical or pathlogical supraclavicular lymph node metastasis tended to have poor prognosis.
In this study, about 20% patients could obtain long-term survival. Therefore, surgical intervention could be one of the treatments for the patient with this disease. And also, we may take into account the postoperative treatment for the patient with poor prognostic factor.
346. CUTOFF VALUE OF THORACOABDOMINAL PRESSURE GRADIENT FOR GASTROESOPHAGEAL REFLUX DISEASE ON STARLET HIGH-RESOLUTION MANOMETRY
Authors: Masuda Takahiro , Tsuboi Kazuto , Hoshino Masato , Yamamoto SeRyung , Akimoto Shunsuke , Tanishima Yuichiro , Uno Kohei , Hara Keigo , Takahashi Keita , Sakashita Yuki , Fukushima Naoko , Takeuchi Hideyuki , Sato Kazuhide , Omura Nobuo , Yano Fumiaki , Eto Ken 
Published: September 2022

Abstract
Derangement of thoracoabdominal pressure gradient (TAPG) associates with gastroesophageal reflux disease (GERD). High-resolution esophageal manometry (HRM) is the gold standard to assess pathophysiology of GERD. Starlet HRM is widely used in Japan; however, TAPG values on Starlet HRM system have been unstudied. The aim of this study is to propose the cutoff value of TAPG to discriminate GERD on Starlet HRM system.
We included patients who underwent both Starlet HRM and 24-hour multichannel intraluminal impedance pH study (MII-pH) at our hospital between July 2018 and February 2022. Patients were divided into 3 groups; control group (both HRM and MII-pH were within normal limits), GERD group (acid exposure time [AET] ≥4.0% and/or DeMeester score ≥ 14.72), and non-pathological reflux group. Normal MII-pH values were defined according to our previous study using healthy Japanese volunteers (Yano, et al. Esophagus, 2017); AET &lt;2.5%, DeMeester score &lt; 11, and liquid reflux episodes &lt;80.0. TAPG and adjusted TAPG were analyzed (shown in Figure).
Total 102 patients met the study criteria (mean age 53.0 ± 16.0 years, 32 females). Thirty-four patients were categorized into the control group, 31 patients were into the GERD group, and 37 patients were into the non-pathological reflux group. In the control group, 5th and 95th percentiles of TAPG were − 3.4 and 24.3 mmHg, and those of adjusted TAPG were − 50.7 and 1.6 mmHg. TAPG poorly correlated with acid exposure time (AET) (rs = 0.287, p = 0.003); however, adjusted TAPG well-correlated with AET (rs = 0.505, p &lt; 0.001). ROC analysis showed that the estimated cutoff of adjusted TAPG was −11.1 mmHg (sensitivity 71.0%, specificity 71.8%, AUC 0.742, p &lt; 0.001).
Adjusted TAPG is associated with antireflux competency across the esophagogastric junction. Estimated cutoff value of adjusted TAPG was −11.1 mmHg in the study cohort. Further study is warrantied.
350. SALVAGE RADIATION THERAPY FOR OLIGO-RECURRENCES AFTER RADICAL TREATMENT OF ESOPHAGEAL CANCER
Authors: Mummudi Naveen , Srinivasan Shashank , Jiwnani Sabita , Tibdewal Anil , Karimundackal George , Pramesh CS , Agarwal Jai Prakash 
Published: September 2022

Abstract
Loco-regional recurrences following surgery or radical radiation therapy for esophageal cancers represent a significant clinical problem. We performed a retrospective study to assess the safety and efficacy of salvage radiation for oligo-recurrence after primary curative therapy for esophageal cancer.
Esophageal cancer patients treated with salvage radiotherapy between January 2011 and March 2020 at our institution were screened. Patients were included if they had undergone prior treatment for esophageal carcinoma with curative intent using either surgery or radiotherapy and had developed local/locoregional/isolated distant recurrences. Recurrences were diagnosed based on CT scan or/and FDG PET-CT scan. Treatment plan was discussed in a multi-disciplinary tumour board and patients were followed up as per institution policy. Survival rates were estimated using the Kaplan–Meier method and data was analyzed using IBM SPSS Statistics for Windows (Version 26.0. Armonk, NY: IBM Corp.)
Oligo-recurrence was diagnosed in 33 patients; thirty patients had loco-regional-recurrence (LRR), 3 had distant metastasis); 28 patients underwent surgery as initial treatment; 5 received definitive RT. Recurrence was detected at a median of 21 months. Of the 30 patients with LRR, 25 patients received chemo-radiation and 5 received RT alone. At a median follow-up of 18 months, 20 patients were alive and 61% had controlled disease. Overall survival at 1- & 2- year were 83% and 65% respectively. Concurrent chemotherapy administration and RT dose of &gt;56Gy were independent predictors for OS. No grade 3/4 acute or chronic toxicity were observed.
Salvage RT with or without concomitant chemotherapy for loco-regional recurrences after surgery for esophageal cancer is safe and effective. Advanced, modern RT techniques may reduce treatment related morbidity and improve outcomes.
355. CAMRELIZUMAB COMBINED WITH CHEMOTHERAPY OR APATINIB AS NEOADJUVANT THERAPY FOR LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PHASE 2 TRIAL
Authors: Qi Yu , Meng Xiangrui , Shan Zhengzheng , Fan Qingxia , Wang Feng 
Published: September 2022

Abstract
At present, esophageal squamous cell carcinoma (ESCC) has a dismal prognosis with huge unmet clinical needs. Chemotherapy or angiogenesis inhibitor showed synergistic effects with immunotherapy in preclinical and clinical studies. With the potential benefit of combining PD-1 inhibitor with chemotherapy or angiogenesis inhibitor, we conducted a phase 2 trial (NCT03917966) to assess the efficacy and safety of camrelizumab plus chemotherapy or apatinib as neoadjuvant therapy for locally advanced ESCC.
This is an open-label, non-randomized phase 2 trial of patients with stage cT2-4aN0-3 M0 ESCC. Cohort A enrolled patients who received 1 cycle of camrelizumab as induction therapy (200 mg Q3W) and 2 cycles of camrelizumab (200 mg Q2W) plus docetaxel and nedaplatin. Cohort B planned to enroll patients with 4 cycles of camrelizumab (200 mg Q2W) and apatinib (250 mg QD). Surgery was performed within 4–6 weeks after neoadjuvant therapy. The primary endpoint was major pathological response (MPR) rate. Secondary endpoints included pathological complete response (pCR) rate, R0 resection rate, disease-free survival, overall survival, and safety.
Between Feb 2020 and Oct 2021, 62 patients were enrolled in cohort A, with a median age of 66 years. As of Apr 20, 2022, 59 patients completed neoadjuvant therapy and 48 completed surgery. In the surgery set, all patients reached R0 resection, 37 (77.1%) reached MPR, 19 (39.6%) reached pCR, and 44 (91.7%) had TNM downstaging. Any grade and grade ≥ 3 adverse events occurred in 88.7% and 14.5% of 62 patients, respectively. No new safety signals or treatment-related deaths were observed. Cohort B started recently, and only 2 of 40 planned patients had been enrolled, thus were not analyzed.
Neoadjuvant camrelizumab in combination with chemotherapy in patients with locally advanced ESCC showed promising pathological response and downstaging effect with good tolerance. Another cohort of neoadjuvant camrelizumab plus apatinib for locally advanced ESCC is ongoing, which will be reported in the future.
369. GENOMIC ALTERATIONS AND SURVIVAL AFTER TREATMENT OF EAC BY SURGERY WITHOUT CHEMO- OR RADIOTHERAPY
Authors: Levert-Mignon Angelique , Trinh Anne , Falkenback Dan , Barnet Megan , Naeini Marjan , Grady John , McCabe Mark , Goldstein Leonard , Johansson Jan , Lord Reginald 
Published: September 2022

Abstract
Prognostic biomarkers for esophageal adenocarcinoma (EAC) remain elusive but may be helpful in treatment planning, as TNM staging often fails to accurately predict survival. Advanced stage patients are treated by peri-operative chemo/radiotherapy; biomarkers associated with survival are thus likely to represent both true prognostic markers as well as markers of response to chemo/radiotherapy. Here we present first-pass genomic findings for a cohort of optimally staged EAC patients treated by surgery alone.
DNA was extracted from fresh frozen EAC and matching normal squamous esophageal tissues obtained at esophagectomy from 65 consenting patients who did not receive any neo- or adjuvant chemo- or radiotherapy due to institutional preference at the time of tissue collection. Library preparation and sequencing for a targeted 600 cancer-associated gene panel designed using the Roche/NimbleGen EZ Choice Library NimbleDesign platform were conducted on Illumina-based platforms followed by analysis with an accredited bioinformatics pipeline. The panel design incorporated the entire coding region plus 10 bp of flanking intron of each gene.
Mean age 70 yrs; 88% male. All patients underwent an en bloc esophagectomy (mean 35 lymph nodes). TNM (7th ed.) stages were 61% Stage 3, 18% stage 2, 14% stage 1, 6% stage 4. At median 9.5 years follow-up, 20 (31%) patients remained alive. Copy number changes were common, reflecting chromosomal instability. Less than 8% of patients had high tumour mutational burden (&gt;10mut/MB), associated with mutations in DNA repair genes. Commonest somatic mutations included TP53 (HR: 0.43) and LRP1B (HR: 1.7). Pathways implicated included RTK signalling (PIK3CA, EGFR, KRAS), DNA damage (BRCA1, PALB2, MGMT) and histone remodelling (ARID1A, ARID2, KMT2D).
Peri-operative treatment means linking genomic changes independent of stage to clinical outcomes is difficult. Neoadjuvant and/or adjuvant treatment is now standard for T2–4 or node positive EAC. This cohort of 65 patients, most of whom had stage 3 disease and all of whom underwent optimal staging with en bloc esophagectomy, represents a unique opportunity to analyze characteristics of EAC without confounding by peri-operative treatment. An EAC-specific DNA sequencing panel approach offers potential for personalized therapy.
373. STRATEGIES ON OPTIMAL LYMPHADENECTOMY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A RETROSPECTIVE ANALYSIS OF 1517 CASES IN A SINGLE CANCER CENTER
Authors: Li Kexun , Leng Xue Feng , Du Kunyi , Liu Kun , He Wenwu , Wang Qifeng , Luo Xi , Wang Chenghao , Wang Kangning , Liu Guangyuan , Wei Xing , Li Haojun , Zhou Qiang , Li Zhiyu , Jiang Longlin , Zheng Kai , Li Changding , Mao Tianqin , Luo Xi , Fang Qiang , Xiao WenGuang , Han Yongtao , Peng Lin 
Published: September 2022

Abstract
The incidence and mortality of esophageal cancer are high-ranking in the world in cancer, it is the forth primary cause of cancer-related death and has the sixth highest incidence rate in China. Our purpose is to discuss the impact of the number of lymph nodes dissection in esophagectomy for esophageal squamous cell carcinoma to patients’ overall survival (OS), especially in the patients who have positive lymph nodes in recent years.
Data were from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database. We retrospective analyzed patients who underwent esophagectomy from Jan. 2010 to Dec. 2016. Patients were divided into two groups: Negative lymph nodes in the pathological results were assigned to N0 group, while patients with positive lymph nodes were divided into N+ group. The median number of resected lymph nodes (RLNs) during operation was 24, patients were assigned to group A/N0 and A/N+ according to RLNs number of 15–24, and number of RLNs more than 24 were assigned to group B/N0 and B/N+.
After 62.8 months of median follow-up time, 1517 patients who received esophagectomy were included. In the N+ group, the median overall survival (OS) of N+ A group was 27.8 months (95% CI 23.8–31.8) compared to N+ B group was 33.3 months (95% CI 28.2–38.5). The OS at 1, 3, and 5 years were 80%, 40%, and 30% in the N+ A group, and there were 82%, 48%, and 35% in the N+ B group, respectively (P = 0.038 &lt; 0.05). (HR 1.18, 95% CI 1.008–1.380, P = 0.038).
Increasing the harvest of number of lymph nodes during surgery more than 24 could improve the OS of esophageal squamous cell carcinoma patients. It is demonstrated patients without lymph metastasis have a better OS than those with lymph metastasis. When we reached dissection more than 15 lymph nodes, there will be no more benefits in OS for further harvest of lymph node numbers. Patients with different stages may be given different lymph nodes dissection strategies.