bluuebunny/crossref_metadata_2025_split huggingface dataset:
536. PREVENTING ESOPHAGO-GASTRIC ANASTOMOTIC LEAKS; THE ROLE OF LOAD-BEARING SUTURES
Authors: Walsh Thomas 
Published: September 2022

Abstract
The leak rate of esophago-gastric anastomosis remains at 10 to 30% despite technological advances and robotic techniques. From the moment of recovery from anaesthesia, the anastomosis is subjected to incessant distraction by the diaphragm with each inspiratory effort. It was hypothesized that eliminating all possible tension on the anastomosis during the vulnerable healing phase, by employing tension-bearing sutures between conduit and pleura, would provide the greatest opportunity for success. This study evaluated such a strategy.
A prospectively maintained database of all esophagectomies performed over a 21-year period, was interrogated for the anastomotic leak rate following the introduction of a tension-elimination anastomotic technique. This consisted of securing the gastric conduit to the mediastinal pleura using load-bearing sutures inserted obliquely. When these were secured, the anastomosis became floppy, and remaining so throughout the vulnerable phase of healing, when collagenase digestion reduces anastomotic tensile strength by two-thirds. All patients had a contrast study performed between day 5 to 7 and all intra-hospital mortalities underwent autopsy to determine the cause of death. Clinical, radiological and autopsy leaks were recorded.
There were 145 intra-thoracic esophago-gastric anastomoses created in 143 patients (two patients required salvage re-resection for tumour recurrence); of which 77% were male, and 65.3% were for adenocarcinoma. Fifty-five percent were stapled and 45% were hand-sewn. There was only 1 confirmed leak during the study period and 1 patient died from a mediastinal haemorrhage, which at autopsy was considered to possibly be the result of sepsis as a result of an occult anastomotic leak.
The low anastomotic leak-rate is attributed to the protective effect of the load-bearing sutures; preventing any traction on the anastomosis, the most incessant source of which is the piston-like action of the diaphragm and the gripping of the diaphragmatic crura. It is intuitive that eliminating all tension during the most vulnerable phase of healing would also reduce any risk posed by minor impairments of blood supply or technical imperfections of anastomotic technique, facilitating anastomotic success.
542. A CASE REPORT OF METACHRONOUS CERVICAL ESOPHAGEAL CANCER 7 YEARS AFTER ESOPHAGECTOMY WITH MULTIDISCIPLINARY TREATMENT
Authors: Kato Daiki , Yamada Kazuhiko , Nohara Kyoko , Enomoto Naoki , Yagi Shusuke , Suyama Yuto , Aso Kenta , Akazawa Naoki , Yokoi Chizu , Kokudo Norihiro 
Published: September 2022

Abstract
Background: It is important to check for secondary cancer after esophagectomy. Especially, radiation or chemotherapy for recurrent esophageal cancer, were often performed, and it may be difficult to select treatment for metachronous cancer. We report a case of surgical resection for metachronous cervical esophageal cancer after 7 years for thoracic esophageal cancer with multidisciplinary treatment.
Method: A 73-year-old woman underwent right thoracotomy and intrathoracic anastomosis before preoperative chemotherapy for lower thoracic esophageal cancer cT3N3M1 (LN104R) 7 years ago. Final pathological finding was UICC-pT3N3M1 and postoperative additional irradiation was performed. Fifteen months after surgery, there was recurrence of LN112AoP, and definitive chemoradiation therapy was performed. The lesion maintained complete response. Seven years later, upper gastrointestinal endoscopy revealed residual cervical esophageal cancer, and the diagnosis was cT1b (SM) N0M0.
Result: Since re-CRT was difficult because of history of irradiation and CRT, we selected surgical cervical esophagectomy without thoracotomy. After partial excision of sternum to widen the view of the upper mediastinum, bilateral laryngeal recurrent nerves were preserved, and trachea and cervical esophagus were exposed. We resected cervical esophagectomy and reconstructed by pedicled jejunum with microvascular anastomosis. The stump of gastric conduit in the thoracic cavity was closed. The final pathology was UICC-pT1bN0M0.
Conclusion: There are some cases in which long-term survival can be obtained even for advanced esophageal cancer. It is important to check for secondary cancer after esophagectomy. Radiation therapy and chemotherapy are often used for recurrence of esophageal cancer. We experienced surgical resection for metachronous cervical esophageal cancer 7 years after multidisciplinary treatment for esophageal cancer.
546. THE IMPACT OF PREOPERATIVE DENTITION ON POSTOPERATIVE SPUTUM SURVEILLANCE CULTURE AND POSTOPERATIVE PNEUMONIA IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Enomoto Naoki , Yamada Kazuhiko , Kato Daiki , Yagi Shusuke , Nohara Kyoko , Kokudo Norihiro 
Published: September 2022

Abstract
Preoperative dental cleaning and treatment are increasingly performed as part of perioperative management, and postoperative pneumonia has been reported to be reduced by these dental interventions in patients with esophageal cancer.
However, few studies have surveyed the impact of dentition on postoperative sputum culture and pneumonia.
Fifty-five consecutive patients who underwent subtotal esophagectomy at Center Hospital of the National Center for Global Health and Medicine between November 2015 and August 2020 were included. Salvage cases, two-stage procedures, and cases with inadequate dental findings were excluded. The number of lost teeth was investigated, and the relationship between sputum surveillance cultures collected on the first to fourth day after surgery and the development of postoperative pneumonia was analyzed.
Postoperative sputum surveillance culture revealed pathogenic organisms in 31 (56%) patients. Candida species/P. aeruginosa/Klebsiella species/E. cloacae/S. maltophilia/S. pneumoniae/S. aureus were detected in 27/13/9/7/5/4/4/4%, respectively. Pathogenic organisms were detected significantly more frequently in cases with more than ten lost teeth (p&lt;0.01, odds ratio 6.42, 95% CI 1.58-26.1).
Twelve patients (22%) had postoperative pneumonia with Clavien-Dindo grade 2 or higher. Postoperative pneumonia occurred significantly more frequently in patients with more than ten lost teeth (p=0.03, odds ratio 4.62, 95% CI 1.20-17.8). Postoperative pneumonia occurred significantly more frequently in patients in whom pathogens were detected (p=0.046, odds ratio 5.75, 95% CI 1.12-29.4).
Patients with many lost teeth tended to have pathogens detected in early postoperative surveillance cultures before the onset of pneumonia and have more risk of developing postoperative pneumonia.
569. INCIDENCE AND ONCOLOGICAL IMPLICATIONS OF THYROID INCIDENTALOMAS IN ESOPHAGEAL CANCER PATIENTS
Authors: Van Doesburg Jasmijn , Kalff Marianne , Voeten Daan , Engelsman Anton , Jol Saskia , Daams Freek , Gisbertz Suzanne 
Published: September 2022

Abstract
Although thyroid incidentalomas are regularly encountered during imaging of esophageal cancer, their oncological significance remains unknown. The aim of this study was to describe the incidence and etiology of thyroid incidentalomas observed during the diagnostic workup of esophageal cancer patients.
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 thyroid incidentalomas. In case of thyroid incidentaloma, the 18FDG-PET/CT or CT was reassessed by a radiologist blinded for the original report. The primary outcome was the incidence and etiology of thyroid incidentalomas.
This study included 1,110 esophageal cancer patients, with a median age of 66 years. Most patients were male (77.2%) and had an adenocarcinoma (69.4%). Thyroid incidentalomas were reported in 115 patients (10.4%)/ In 23 (20.0%) patients, additional diagnostics were required to characterize the lesion and two thyroidal lesions proved malignant. One patient was diagnosed with an esophageal cancer metastasis and one patient with a primary thyroid carcinoma. Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of generalized disseminated esophageal disease and no longer eligible for curative treatment.
In this study, thyroid incidentalomas were regularly observed, although their oncological significance is limited. Therefore, further etiological examination of thyroidal incidentaloma should only be considered when clinical consequences are to be expected.
603. NEOADJUVANT DCF VERSUS CRT IN COMPLEX TREATMENT OF LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CELL CANCER
Authors: Akhmedov Parvin , Kononets Pavel , Abouhaidar Omar , Tryakin Alexey 
Published: September 2022

Abstract
Both neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy improve tumor resectability, lead to downstaging of tumor process and increase overall and disease-free survival rates. This study investigates the efficacy and outcomes after neoadjuvant chemotherapy with DCF regimen and chemoradiotherapy for patients with locally advanced esophageal squamous cell carcinoma.
We retrospectively analyzed the results of 130 patients from 2013 to 2018 who received preoperative DCF chemotherapy (docetaxel 70 mg/m2 on day 1, cisplatin 70 mg/m2 on day1, 5-FU 750 mg/m2 on days 1-5, total 4 courses) followed by surgery or chemoradiotherapy (paclitaxel 175 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, 5-FU 750 mg/m2 on days 1-5 and 46 Gy) followed by surgery. Surgery included both open and minimal invasive esophagectomy with regional lymphadenectomy. Data, surgical results, treatment related complications and long-term results were compared in two groups.
Patient characteristics did not differ between the two groups. Incidence of &gt; grade 2 complications were higher in the DCF group. Incidence of neutropenia was in 72.3% versus 30.7% in the CRT group, febrile neutropenia 18.4% and 7.7%, respectively. The R0 resections were similar (98.3%). Chylothorax was noted only in two patients in the CRT group (3.0%). Complete pathological response in the CRT group was in 35.3% versus 20.0% in the DCF group. 3-year overall survival in the DCF and CRT groups was 70.7% and 64.6%, and 3-year disease-free survival was 60.0% and 49.2%, respectively (p&lt;0,05).
Thus, 4 courses of DCF is not inferior compared to CRT in terms of survival rates and becomes an alternative to CRT in the complex treatment of locally advanced squamous cell carcinoma of the esophagus.
604. DOES MINIMALLY INVASIVE ESOPHAGECTOMY REDUCE POSTOPERATIVE PULMONARY COMPLICATIONS? AN INTERNATIONAL COHORT STUDY FROM THE OESOPHAGOGASTRIC ANASTOMOSIS AUDIT (OGAA)
Authors:   Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative
Published: September 2022

Abstract
There is limited data characterizing the external validity of randomised trials on MIE for esophageal cancers. This study aimed to characterise the global impact of minimally invasive esophagectomy (MIE) on postoperative pulmonary complications (PPC).
Patients undergoing open (OE, n=350), hybrid (HE, n=368), and MIE for esophageal cancers were identified from the Oesophagogastric Anastomosis Audit (OGAA). Primary outcome was PPC and secondary outcomes were anastomotic leaks (AL) and 90-day mortality.
PPC rates were lower after MIE compared to OE and HE (38% vs 39% vs 31%, p=0.002), even on adjusted analyses compared to OE (odds ratio (OR): 0.57, CI95%: 0.44 - 0.74).
On adjusted analyses, MIE was not associated with higher AL (OR: 2.05, CI95%: 1.26 - 3.34) and 90-day mortality (OR: 4.55, CI95%: 2.70 - 7.69) compared to OE. Stratified analyses demonstrated lower PPC rates after MIE compared to OE in patients operated in high volume centers and high-income countries.
In contrast to previous reports, global adoption of MIE is associated with reduced PPC with no compromise in AL or overall complications. Introduction of MIE in standardized fashion with guidance from expert, high-volume surgeons justify benefits of MIE.
605. NEOADJUVANT FLOT FOR LOCALLY ADVANCED ESOPHAGEAL CANCERS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Kamarajah Sivesh , Evans Richard , Griffiths Ewen 
Published: September 2022

Abstract
Whilst multimodality treatment is established as standard of care for locally advanced esophageal cancers the precise choice of oncological neoadjuvant treatment remains unclear. Uptake of FLOT is increasing, yet collective experience in patients with esophageal cancer is unclear. This study aimed to assess the effectiveness of FLOT as first-line treatment in this patient population.
A systematic review was performed using Embase, MEDLINE (OvidSP), Web of Science, Scopus, PubMed Publisher, Cochrane, and Google Scholar until 28st December 2021, for studies of treatment-naive patients of any age who received FLOT as first-line treatment of locally advanced esophageal or gastric cancer. The primary outcome was overall survival. Secondary outcomes were progression-free survival, rates of grade 3 or 4 adverse events; and oncological outcomes
This systematic review included six studies comprising 895 patients, of which 479 (54%) patients received FLOT. All studies included patients with distal or gastroesophageal junction esophageal and 441 (92%) had esophageal adenocarcinoma. Pooled overall survival at 1-year, 2-year and 3-year were 81.7% (CI95%: 71.1% - 88.9%), 59.2% (CI95%: 47.4% - 69.9%), and 49.8% (CI95%: 28.9 - 70.8%). Pooled recurrence rates from three studies were 22.6% (CI95%: 12.3% - 37.7%). Oncological outcomes were reported for margin-negative resections (overall: 94.1%, CI95%: 88.1% - 97.2%), complete pCR (overall: 15.2%, CI95%: 7.1% - 29.7%), major pathological response (overall: 41.6%, CI95%: 24.6% - 60.8%).
There is limited evidence on FLOT for patients with esophageal or gastroesophageal cancers, despite the increasing use of FLOT in clinical practice. Standardisation in reporting oncological and surgical outcomes following FLOT are needed and future research and randomised controlled trials comparing FLOT are required.
612. GENDER DIFFERENCES IN JAPANESE PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Manabe Noriaki , Nakamura Jun , Yamatsuji Tomoki , Fujiwara Yoshinori , Katsumata Ryo , Ayaki Maki , Fujita Minoru , Naomoto Yoshio , Haruma Ken 
Published: September 2022

Abstract
Esophageal squamous cell carcinoma (ESCC) is the seventh most common cancer and the sixth leading cause of cancer-related death worldwide, and has a male preponderance. The gender-based differences in clinical presentation and risk factor exposure are not fully studied. The aim of this study was to compare males and females with this disease.
We retrospectively investigated the clinical data of 503 consecutive patients with ESCC from April 2011 to December 2019. Data collected included patient demographics, clinical presentation, pathology and risk factor exposure. We analyzed the differences in clinical characteristics and risk factor exposure between males and females with ESCC.
Four hundred and sixty-nine patients with ESCC were included. The male to female ratio was 4.6:1. There was no significant difference in clinical presentation and pathology. There were significant differences between risk factor exposure between the two genders: smoking and alcohol consumption was an association in more than 90% of males but in less than 50% of females. The analysis including all patients showed no significant difference in survival rates, but when limited to patients with stage 3 or higher disease, survival rates were significantly higher in females (Figure).
Smoking and alcohol consumption, traditionally considered risk factors, are less associated with female patients with ESCC, and other environmental risk factors might be more involved in this gender.
619. THE STRATEGY OF THE SURGICAL TREATMENT FOR ESOPHAGEAL NEUROENDOCRINE CARCINOMA
Authors: Narumiya Kosuke , Kudo Kenji , Yagawa Yosuke , Maeda Shinsuke , Ogawa Kyohei , Toyoshima Yukinori , Ide Hiroko , Osugi Harushi , Hosoda Kei 
Published: September 2022

Abstract
Esophageal neuroendocrine carcinoma (ENEC) are rare and aggressive behavior with early dissemination and poor prognosis. According to previous reports, including case reports and reviews, the incidence of ENEC ranges from about 0.8–2.8%. Unfortunately, the rarity of this tumor has not yet permitted the prospective recruitment of patients in clinical trials, in order to establish the optimal therapy. The purpose of this study was to determine the optimal surgical treatment of ENEC.
The histological diagnosis of ENEC was determined by examination of surgically resected specimens in patients who underwent surgery. The patients were selected from a prospective study of Department of Surgery, Institute of Gastroenterology Tokyo Women’s Medical University from 1968 to 2021. We study 27 cases of ENEC who performed operation with lymph node dissection. We investigated (1) the patient characteristics, (2) pathological findings including immunohistochemical profiles, (3) recurrence pattern, and survival curves, (4) ki-67 index. This study was approved by the ethics committee of Tokyo Women’s Medical University in Tokyo Japan.
(1) gender (mail: female=23: 4), depth (T1: T2; T3: T4)=8: 3: 12: 4 Lymph node (N0: N1)=2: 25 (2) Immunohistochemistry of synaptophysin: chromogranin A: NCAM = 70.4%: 45%: 60% (3) recurrence pattern (liver: lung: Lymph node: bone: dissemination = 8: 6: 4: 2: 4) 50% survival rate (T1: T2-4= 19 months: 6.5 months) p=0.0202, numbers of lymph node (0-2: 3&lt; = 19 months: 4mnths)p&lt;0.001, (4) ki-67 index 82.23%(57.36%-98.71%)
Cases in which long-term survival was obtained by surgical treatment was T1 or 0-2 numbers of lymph node. Ki-67 index was more than 80%.
629. TRENDS AND ESOPHAGEAL FINDINGS IN UPPER ENDOSCOPY AT MNAZI MMOJA HOSPITAL, ZANZIBAR
Authors: Gubi Mariam , Said Sanaa , Amour Ahlam 
Published: September 2022

Abstract
The Zanzibar islands are a group of islands found off the coast of East Africa. The main referral hospital is based on Unguja Island and this is the only government hospital with gastroenterologists and endoscopy services. Many patients may go for long periods before gaining access to these services.
This paper aims to describe trends and esophageal findings in upper endoscopy as well as describe a case study of adenocarcinoma of the esophagus.
Data was collected retrospectively from January 2014 to December 2021. Records were reviewed to assess total number of endoscopies done as well as to determine the diagnosis of those with esophageal findings. The total number of endoscopies combines both upper and lower endoscopy. The following data were registered total number of endoscopies, cancer of esophagus, esophagitis, esophageal varieces as well as any other esophageal disorder diagnosis found.
A total of 2955 endoscopies were undertaken between January 2014 to December 2019. Of those 176 were found to have an esophageal abnormality although specific diagnosis was missing for records from the years 2015, 2016 and 2017.
The commonest disorder was esophagitis followed by esophageal cancer and varieces. Other disorders were much rarer and are placed under the category others which include submucosal tumors, Mallory-Weiss tears, esophageal strictures and fistula.
There has been a gradual increase in the number of endoscopies done over the period of 2014 to 2021. Despite previous beliefs, esophageal varieces and infectious causes were not the commonest finding. Esophagitis and esophageal cancer were common in our setting and causes should be determined.
647. A CASE OF ACUTE GASTRIC TUBE ULCER BLEEDING SAVED BY EMERGENCY SURGERY
Authors: Higashida Masaharu , Kubota Hisako , Endo Shunji , Fujiwara Yukinori , Yoshimatsu Kazuhiko , Ueno Tomio 
Published: September 2022

Abstract
Gastric tube ulcer is recognized as one of the complications after esophageal cancer surgery. When a ulcer bleeds, or penetrates to the pericardial space, or perforates, it often follows a fatal course due to its anatomical position and the complexity of surgical treatment. We report a case of persistent bleeding from a gastric tube ulcer after esophageal cancer operation, which was unable to treat endoscopically.
The case was a 67-year-old man. Thoracoscopic subtotal esophagectomy and posterior mediastinal route subtotal gastric reconstruction were performed for middle thoracic esophageal cancer. His fifth-year regular endoscopy revealed a gastric tube ulcer. As a cause of myalgia, the patient was prescribed NSAIDs every day by a nearby doctor. Initially, no bleeding was observed, and discontinuance of NSAIDs and conservative treatment with PPI was continued. However, five months later, sudden hematemesis was observed at night, and he was transferred to a nearby doctor. Emergency endoscopy revealed gastric tube ulcer bleeding. And he was transferred to our hospital in an emergency.
However, two days later, hematemesis and persistent ulcer hemorrhage were observed. Due to the difficulty of cauterizing to heartbeat, emergency surgery was performed. The first attempt was made to approach by a posterior mediastinal route, but it was difficult to confirm the ulcer and it was difficult to control bleeding without compression. Adding the thoracotomy, the ulcer was confirmed under direct vision. An ulcer defect was about 5 cm, bleeding was from the ulcer margin. Barbed suture closure and the omental patch were performed. The postoperative course was uneventful and discharged from the hospital 21 days after the operation.
We experienced a rare case of acute hemorrhagic gastric tube ulcer that was difficult to treat conservatively and was saved by emergency surgery. After reconstruction of esophageal cancer, there are complicated situations such as the route of the elevated gastric tube, the position of the ulcer, and the risk of perforation to the pericardial space. Prompt and accurate medical care is required.
The Limits of Human Rights Law: A Reply to Corina Heri
Authors: Zahar Alexander 
Published: September 2022

Abstract
In this reply to Corina Heri, I argue that her article confuses human rights violations associated with the impacts of climate change with a putative class of violations going to the causation of climate change. Because the latter class has no prospect of being realized, the scope of Heri’s argument is much narrower than she makes out. Human rights law is limited to impact cases. It adds nothing to climate change mitigation law.
PhaMMseqs: a new pipeline for constructing phage gene phamilies using MMseqs2
Authors: Gauthier Christian H , Cresawn Steven G , Hatfull Graham F 
Published: September 2022

Abstract
The diversity and mosaic architecture of phage genomes present challenges for whole-genome phylogenies and comparative genomics. There are no universally conserved core genes, ∼70% of phage genes are of unknown function, and phage genomes are replete with small (&lt;500 bp) open reading frames. Assembling sequence-related genes into “phamilies” (“phams”) based on amino acid sequence similarity simplifies comparative phage genomics and facilitates representations of phage genome mosaicism. With the rapid and substantial increase in the numbers of sequenced phage genomes, computationally efficient pham assembly is needed, together with strategies for including newly sequenced phage genomes. Here, we describe the Python package PhaMMseqs, which uses MMseqs2 for pham assembly, and we evaluate the key parameters for optimal pham assembly of sequence- and functionally related proteins. PhaMMseqs runs efficiently with only modest hardware requirements and integrates with the pdm_utils package for simple genome entry and export of datasets for evolutionary analyses and phage genome map construction.