bluuebunny/crossref_metadata_2025_split huggingface dataset:
481. QUANTITATIVE ESTIMATION OF GASTRIC CONDUIT PERFUSION TO SELECT ESOPHAGECTOMY PATIENTS AT HIGH RISK OF IMPAIRED PERFUSION
Authors: Ishikawa Yoshitaka , Zhao Lili , Chang Andrew , Lin Jules , Orringer Mark , Lynch William , Lagisetty Kiran , Wakeam Elliot , Reddy Rishindra 
Published: September 2022

Abstract
Impaired gastric conduit perfusion is considered the most important factor of anastomotic leaks following esophagectomy. Gastric ischemic preconditioning (GIP) can improve conduit perfusion and may reduce anastomotic leaks; however, it remains unclear which patients could benefit from preconditioning. The aim of this study is to create a paradigm to select patients at high risk of impaired perfusion who may benefit from GIP.
Patients undergoing an esophagectomy with gastric conduit reconstruction and indocyanine green fluorescence angiography from July 2015 to December 2021 (Cohort 1), as well as all patients receiving an esophagectomy from 2003 to 2021 (Cohort 2) were reviewed. Analyzed variables for Cohort 1 included patient pre-operative demographics and ingress index (quantitative assessment of blood perfusion). Multiple linear regression model for conduit perfusion was used to select significant preoperative factors and to build a formula to estimate conduit perfusion. The formula was applied to Cohort 2 to estimate the percentage of patients who could receive GIP prior to esophagectomy.
349 patients were in Cohort 1, and 1965 in Cohort 2. There was a significant correlation with older age and low body mass index (BMI) and impaired conduit perfusion. Other factors, such as heart disease, diabetes, and prior chemoradiation did not correlate (Table). Using only two variables “age” and “BMI”, we determined how many could have poor conduit perfusion, defined as a low ingress index of &lt;40 (the median value from the Cohort 1). When applying the formula to Cohort 2, we estimated that 26.7% (525) of patients would be at risk for low perfusion and for anastomotic leaks.
Using BMI and age, we are able to risk stratify patients who are likely to have low perfusion in their gastric conduits (Figure, higher risk in red). We feel that this group will be the most likely to benefit from pre-esophagectomy gastric ischemic conditioning.
486. ENDOSCOPIC VACUUM THERAPY FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGEAL RESECTION—A RETROSPECTIVE SINGLE-CENTER ANALYSIS
Authors: Herzberg Jonas , Strate Tim , Guraya Salman Yousuf , Honarpisheh Human 
Published: September 2022

Abstract
Esophagectomy still comes with a high rate of anastomotic leakage resulting in a persisting high postoperative mortality. Endoscopic vacuum therapy (EVT) is an upcoming technique for the treatment of anastomotic leakages. We aimed to evaluate our experience with the efficacy of EVT for anastomotic leakages after esophagectomy for cancer.
We retrospectively analyzed all 96 patients who had undergone Ivor-Lewis resection for esophageal malignancy from January 2015 until December 2021 for the need of EVT within the same hospital stay. Patients demographics, perioperative parameters, treatment efficacy and success were analyzed. Patient data were expressed as mean ± standard deviation.
We included fourteen patients treated with EVT following Ivor-Lewis resection for esophageal malignancy within the same hospital stay. 12 EVTs were due to anastomotic leakage whereas two procedures were performed prophylactically. We started the EVT 10.71 ± 8.04 days after surgery with a mean duration of 13.86 ± 7.39 days and a mean number of 4.36 ± 2.37 endoscopies per patient. Successful treatment was achieved in 10 patients (71.4%), one patient needed an esophageal stenting and an additional surgery for re-anastomosis was needed in 3 patients (21.4%).
EVT can prevent re-operation in a high proportion of patients with anastomotic leakage and therefore provides a good non-surgical option for these patients. The periinterventional risk and possible complications of repetitive endoscopies should be analyzed in larger studies.
495. UNIPORTAL VATS MCKEOWN ESOPHAGECTOMY: 4-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER
Authors: Rajan Shiv , Kumar Vijay 
Published: September 2022

Abstract
A multidisciplinary approach is a cornerstone for the management of the carcinoma esophagus. Minimally Invasive Surgery (Total or hybrid) is essential for better postoperative outcomes. VATS assisted McKeown MIE is a well-established procedure. With the introduction of the uniportal VATS technique in lung surgeries, there is an increasing interest to replicate this in MIE too. Here we appraise our initial experience with the uniportal VATS (uVATS) MIE for the locally advanced squamous cell esophageal cancer.
This is a retrospective observational study. The cohort of carcinoma esophagus patients who underwent surgery from January 2018 to February 2022 in the department of surgical oncology was studied. Demographic data, clinical, treatment details, postoperative complications and short term oncological outcomes of patients who underwent the uVATS technique in semi-prone position were analyzed.
Total 32 (49.2%) patients underwent uVATS Mckeown esophagectomy. The majority of the patients had SCC (63%). All patients received NACT+/-RT. Each underwent extended mediastinal lymphadenectomy except two patients who had additional cervical lymphadenectomy. The mean thoracic phase time was 112+/- 25 min & blood loss was 115 +/- 20 ml. The median thoracic nodes dissected was 15 (8-36), postoperative pain score was 4 and hospitalization duration was 9 (8-12) days. Two patients had pneumonia and 2 had other complications. There was no 30-day mortality. After the median follow-up of 26.8 months, the OS & DFS was 93% & 86% respectively.
uVATS in a semi-prone position with fourth intercostals space access incision is a feasible and safe technique. It has all the advantages of MIE techniques over open surgery. The coaxial operating axis provides the best manipulation zone for operating without the need for CO2. Conversion to thoracotomy is quick if required. We believe it has a short learning curve than multiport VATS. More studies are needed to generate data for the uVATS technique in future.
497. INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY VERSUS VISUAL ASSESSMENT FOR GASTRIC CONDUIT PERFUSION ASSESSMENT IN PATIENTS UNDERGOING ESOPHAGECTOMY: A RANDOMIZED CONTROLLED STUDY
Authors: Thammineedi Subramanyeshwar Rao , Syed Nusrath , Patnaik Sujit Chyau 
Published: September 2022

Abstract
Esophago-gastric anastomosis leakage is one of most feared complication after esophagectomy accountable for major postoperative morbidity and mortality. The high rate of anastomotic complications is due the tenuous perfusion of gastric conduit. This prospective randomized control trial compares the efficacy of intraoperative indocyanine green fluorescence angiography (ICG-FA) against visual assessment (VA) in evaluating the perfusion of gastric conduit and proximal esophageal stump in patients undergoing esophagectomy for cancer.
Fifty eight consecutive patients who underwent esophagectomy for carcinoma middle, lower third esophagus or gastro-esophageal junction from January 2020 till September 2021 were enrolled. Amongst them 30 patients were randomized to non ICG arm where the perfusion of gastric conduit and esophageal stump was evaluated by visual assessment (VA) based on inspection of the color, the palpation of warmth, pulse, and bleeding from the edges and 28 patients to ICG arm underwent initial appraisal of gastric conduit and esophageal stump perfusion was done by visual assessment followed by ICG-FA. Correlation coefficient was evaluated by Pearson’s R coefficient.
Both the groups were similar in demographic parameters. The anastomotic leak was significantly lower in ICG arm [4 % vs 8/28 (27 %) p 0.0261]. Most of the leaks were minor type 1. When visual assessment was compared with ICG assessment, 80% of the vascularized conduits on VA showed good perfusion on ICG-FA. 39% of gastric conduit which seemed to be dusky on VA had good vascularity on ICG-FA. Kappa value was 0.256 p 0.097 i.e., a fair agreement between ICG and visual assessment in evaluating vascularity of gastric conduit was fair.
VA of the gastric conduit perfusion can underrate perfusion and hence can jeopardize removal of the devitalized part. ICG fluorescence imaging is an accurate and promising means to ascertain the vascularity of gastric conduit during an esophagectomy. But its utility needs to be validated in larger randomized trials.
507. ENHANCED RECOVERY AFTER SURGERY FOR VIDEO-ASSISTED THORACOSCOPIC (VATS) ESOPHAGECTOMY- A PROPENSITY SCORE MATCHING ANALYSIS IN A LOCAL INSTITUTE
Authors: So Choi Kwan , Lam Chin Tou , Cheung Siu Hong , Chow Tam Lin 
Published: September 2022

Abstract
Enhanced recovery after surgery (ERAS) has been implemented in esophagectomy. In our center, a specific and structured ERAS program for esophagectomy was initiated since 2017. In this study, we reviewed the feasibility and value of ERAS program in patients undergoing VATS esophagectomy when compared to a historical cohort.
Total 81 Patients who underwent VATS esophagectomy from 2014-2021 were recruited and divided into “ERAS” and “non-ERAS” groups. Propensity score matching
(PSM) analysis was performed with patient baseline dermographics, tumour characteristics, and operation details. After PSM, 21 patients on each arm were identified. The primary outcome was hospital stay. The secondary outcomes included various perioperative outcome measures, complications, short-term mortality and overall survival.
ERAS group had shorter hospital stay (10 days vs. 23 days, p=0.026), while the readmission rate remained low (4.8%). There were statistically significant improvement in perioperative outcomes including less total parental nutrition use, faster resumption of oral feeding, earlier removal of foley and chest drain, and earlier mobilization. There was no difference in anastomotic leakage rate. Less chest complications was observed in ERAS group. Overall there was less significant morbidities in ERAS group (≥Grade III, 9.5% vs. 43%, p=0.009). While short-term mortality was similar, ERAS group had a trend towards better overall survival rate. (37.7 months vs. 15.6 months, p=0.287).
The implementation of ERAS protocol in esophagectomy was feasible. It resulted in a shorter hospital stay with improving perioperative outcomes. Its impact on long term overall survival necessitated further ongoing study.
ERAS table.xlsx (could not be inserted).
515. EXOCRINE PANCREATIC FUNCTION IN PATIENTS AFTER ESOPHAGECTOMY; IS TREATMENT WITH PANCREATIC ENZYMES NECESSARY?
Authors: Blonk Lotte , Wierdsma NJ , Kazemier G , Gisbertz SS , van Berge Henegouwen MI , van der Peet DL , Straatman J 
Published: September 2022

Abstract
Symptoms of malabsorption, such as diarrhea, steatorrhea, or unintended weight loss, are often reported by patients after esophagectomy for cancer. The etiology of these symptoms is hypothesized to be multifactorial, with exocrine pancreatic insufficiency being described as one of the possible contributing causes. Symptoms of malabsorption are therefore often treated with pancreatic enzymes. This study aimed to measure the exocrine pancreatic function to determine whether there is an indication for pancreatic enzymes after esophagectomy.
This prospective study included patients after esophagectomy for cancer in a stable postoperative situation (≥6 months after surgery) without signs of recurrent disease. Patients with and without pancreatic enzymes or symptoms of malabsorption were included. Exocrine pancreatic function was measured by fecal elastase-1 (FE-1) and fecal fat excretion. Three-day stool collections were performed to measure mean daily fecal fat excretion (g/d). Combined with a four-day (weighted) nutritional diary, to determine the mean daily fat intake (g/d), the percentage of fat absorption was calculated. Patients who were already treated with pancreatic enzymes stopped at least two days before stool collection.
This study included 38 patients after esophagectomy for cancer. Exocrine pancreatic function was measured after a median postoperative follow-up of 20 months (range 6-45). Low FE-1 (&lt;200 μg/g) levels were found in seven patients (18%). Of these patients, one patient also had fat malabsorption (fat absorption &lt;85%). Prior to participation in this study, 11 patients (28%) already received treated with pancreatic enzymes because of symptoms of malabsorption. In one of these patients (9%) low FE-1 levels were found and in three patients (27%) fat malabsorption was diagnosed.
These preliminary results indicate that, based on FE-1 levels, the secretion of pancreatic enzymes after esophagectomy is only impaired in a subgroup of patients. Most often this did not lead to malabsorption of fat. Based on these results routine prescription of pancreatic enzymes is not recommended in patients after esophagectomy, however a trial prescription can be considered in patients suffering from gastrointestinal complaints of malabsorption.
530. LAPAROSCOPIC REPAIR OF ESOPHAGEAL PERFORATION
Authors: Lim Xin Yan , Lee June 
Published: September 2022

Abstract
Esophageal perforation is associated with high morbidity and mortality. Early detection and treatment are vital as delays substantially increases mortality risk. Management options include surgical repair, drainage, diversion, endoscopic stenting/clipping and conservative management. Treatment of choice depends on etiology, location and duration between perforation and detection. Surgical repair remains as the mainstay of treatment if perforation is diagnosed &lt;24 hours. However, for perforation detected &gt; 24 hours, management is controversial with many advocating non-operative therapy.
We present the case of a 68-year-old gentleman who underwent laparoscopic repair of an iatrogenic esophageal perforation. He first presented with dysphagia secondary to esophageal peptic stricture, initial biopsy showing no signs of malignancy. Patient underwent serial endoscopic dilatations, which was complicated with an iatrogenic esophageal perforation during his second dilatation. He underwent an urgent laparoscopic distal esophagectomy and proximal gastrectomy to resect the diseased part of the esophagus- intraoperatively noted a 1cm perforation over distal esophagus. A double tract reconstruction was then performed to restore continuity of the gastrointestinal tract and reduce gastric reflux to the esophagus.
Patient was started on clear feeds on post-operative day 1 with gradual escalation of feeding to soft diet on post-operative day 4. His post-operative recovery was largely uneventful and he was discharged on post-operative day 7. Histological examination however returned as a pT3N1a moderately differentiated oesophageal squamous cell carcinoma. A PET-CT scan and repeat gastroscopy done showed no residual or distant disease. His condition was discussed in multidisciplinary meeting and patient then underwent definitive chemotherapy and radiotherapy.
Although early recognition, detection and treatment of esophageal perforation are important for good outcomes, delays in diagnosis and treatment are usually due to rarity of this condition and lack of familiarity with management. Our video aims to showcase the surgical repair of a distal esophageal perforation and reconstruction in a minimally invasive fashion. Aim of surgery should include repair of perforation, cleaning up contamination, restoring gastrointestinal continuity and resolution of any underlying etiology.
547. THORACOLAPAROSCOPIC MANAGEMENT OF ESOPHAGEAL PERFORATIONS
Authors: Ramakrishnan Parthasarathi , Balasubramanian Shankar , Natarajan Ramesh , Bharath Cumar M , Keerthiraj K , Chinnusamy Palanivelu 
Published: September 2022

Abstract
Esophageal perforation carries a high morbidity and even mortality when not promptly treated. The rarity of the condition makes it challenging to diagnose and optimally manage it. We report our experience in managing such patients using minimally invasive approach.
Six consecutive patients with esophageal perforation who were managed using thoracoscopic or laparoscopic approach between 2015 and 2022 were included in the study.
The underlying etiology was spontaneous perforation in two patients, swallowed denture in two patients, ingested meat bone in one patient and iatrogenic perforation in one patient. The mean time between diagnosis and surgery was 48 hours. After mediastinal toileting the perforation was sutured with PDS 2-0. Covered metal stent was placed and fixed using PDS 2-0. The mean operating time was 180 minutes. The mean ICU stay was 2 days and the mean hospital stay was 10 days. Stent migration was seen in two patients which were retrieved laparoscopically. There was no in-hospital or 90- day mortality.
Esophageal perforations can be safely managed by minimally invasive approaches with acceptable morbidity in selected patients in high volume centres.
548. THORACOLAPAROSCOPIC EXCISION OF ESOPHAGEAL DUPLICATION CYST
Authors: Ramakrishnan Parthasarathi , Balasubramanian Shankar , Natarajan Ramesh , Bharath Cumar M , Keerthiraj K , Chinnusamy Palanivelu 
Published: September 2022

Abstract
Esophageal duplication cysts are rare developmental anomalies. The prevalence is estimated at 1 in 8200 live births. In adults they are usually an asymptomatic incidental radiographic or endoscopic finding. Definitive diagnosis requires surgical excision and histological examination.
Retrospective review of five consecutive patients with esophageal duplication cyst who were managed thoracolaparoscopically between January 2020 and March 2022 in a tertiary care teaching hospital.
Four patients underwent thoracoscopic excision while one patient underwent transhiatal excision. The longitudinal muscle layer of the esophagus was opened. The proximal and distal limits of the lesion were delineated and then excised. The lesion was excised using endoGIA stapler in one patient where the lesion was tethered to the mucosa. The overlying layers were sutured. The size of the largest lesion was 9.2 cm x 5.8 cm. The median operating time was 150 minutes (90 to 220 minutes). The median hospital stay was 5 days (5-7 days). The post operative recovery was uneventful in all the patients.
Esophageal duplication cysts can be safely managed with minimal morbidity by minimally invasive approaches even when the lesion is large.
549. LAPAROSCOPIC CARDIOPLASTY FOR FAILED PRIMARY TREATMENT OF ACHALASIA
Authors: Ezz Reda , Sabry Karim 
Published: September 2022

Abstract
Treatment of primary achalasia includes many modalities. All of these procedures have an associated failure rate. The resulting fibrosis from these methods of treatment (dilation, POEM or Heller's myotomy) makes re-Heller’s more difficult and less effective especially if associated with esophageal body aperistalsis suggesting esophagectomy to be the only surgical option. Cardioplasty whether open or Laparoscopic (LSC) may be an acceptable option after failure of these primary treatment (dilation, POEM or Heller's myotomy).
Patients with recurrent achalasia following failed primary treatments, were managed by cardioplasty either open or LSC. All patients were thoroughly investigated by upper endoscopy, dye study and manometry to confirm the failure of primary treatment and the need for redo surgery. Postoperative contrast swallows were done for all patients before discharge as well as manometry. We followed patient clinically and by investigations (dye study and manometry) to check the result of cardioplasty.
From May 2019 to April 2022, we operated 23 patients having failed primary achalasia treatment: 3 cases open (13%) and 20 cases (87%) by laparoscopy. Mean operative time was (62 min). Mean hospital stay was 2.6 days. Rapid esophageal emptying by dye studies was noted on all cases. LES pressure decreased in all patients (mean 11 mmhg). No anastomotic leak. During the follow up period, all patients were free from dysphagia. Four patients (17%) had developed heartburn and regurgitation controlled by medical treatment. No mortality recorded.
Laparoscopic cardioplasty is a feasible and effective option to treat patients for resistant achalasia with failed primary treatment (dilation, Heller’ myotomy and POEM) avoiding the high morbidity and mortality esophagectomy.
563. MAGNETIC DETECTION OF ESOPHAGEAL SENTINEL LYMPH NODES – A PROOF OF CONCEPT STUDY IN A PORCINE MODEL
Authors: Felinska Eleni , Billeter Adrian , Chen Zi-Wei , Willuth Estelle , Wise Philip Anthony , Nickel Felix , Müller-Stich Beat 
Published: September 2022

Abstract
Superparamagnetic iron oxide particles (SPIONs) have been used to mark sentinel lymph nodes in breast and prostate cancer surgery. Their suitability for other tumor entities remains unclear. In esophageal surgery, the future focus may shift to tailored lymph node resection to reduce the extent of surgery and to minimize perioperative complications. Still, there are very few tracers available to detect draining lymph nodes. In this study, we investigated the suitability of SPIONs for this issue.
Seven male piglets underwent surgery and SPIONs were injected into the esophageal wall. The distribution of the tracer into the adjacent local lymph nodes was investigated by a magnetometer over 120 minutes. Then, the specimens were harvested and examined histologically.
SPIONs were detected in all cases in the draining lymph nodes within the first 5 minutes after injection reaching a positive magnetic signal at 2160 ± 422 (magnetic count). The maximum was reached after 15 minutes at the magnetic count of 4880 ± 554.
The histological specimen confirmed the presence of the tracer in the esophageal wall and in the draining lymph nodes.
SPIONs are suitable for the detection of esophageal lymph nodes and should be evaluated in the clinical setting.
565. MOVING FROM OPEN ESOPHAGECTOMY TO MINIMALLY INVASIVE ESOPHAGECTOMY: A PARADIGM SHIFT IN AN UPPER GASTROINTESTINAL CENTER
Authors: Cheng Shi Yu , Lim Jolene , Voon Kelvin 
Published: September 2022

Abstract
Esophagectomy is a complex procedure that is traditionally associated with high morbidities. Minimally invasive esophagectomy (MIE) has the benefits of reduced post-op complications and improved quality of life in comparison to open esophagectomy (OE). This study aimed to compare the outcomes of MIE vs OE since the advocation of MIE as the standard approach in an upper gastrointestinal center.
A retrospective review of prospectively collected data from the institutional online databank. OE was the main approach for esophageal cancer between year 2015 to 2017, while MIE was the standard approach in 2020 to 2021. Patient’s demography, tumour’s characteristics, operative approach, perioperative outcomes such as operation time, blood loss, post-op length of hospital stay, number of lymph node yield, post-op morbidities and mortality were compared between the OE (Jan 2015 – Dec 2017) and the MIE (Jan 2020 – Dec 2021) group. 28 patients were included in this study, 15 in the OE group while 13 in the MIE group.
Mean age was similar in both groups (60.4vs59.4). 46.7% were of squamous cell carcinoma in the OE group vs 76.9% of adenocarcinoma in the MIE group. Ivor-Lewis approach was more common in the OE group (53.3%vs38.5%). MIE was associated with shorter mean operative time (489.38minutes vs 526minutes), less blood loss (110ml vs 250ml), shorter length of stay post-op (10.38days vs 24.67days) and higher number of lymph node yield (44vs31.67). Post-op morbidity was lower in MIE (30.7%vs73.3%) with Clavien-dindo grade-III and above complication rate of 7.69% vs 26.67%. 90-day mortality was 0 in the MIE vs 1 in the OE group.
MIE was associated with shorter operative time, higher number of lymph node yield, reduced post-op morbidity, mortality and shorter post-operative hospital stay in patients with esophageal cancer. The encouraging results marked the paradigm shift from OE to MIE in our center.