bluuebunny/crossref_metadata_2025_split huggingface dataset:
375. PATTERNS OF RECURRENT DISEASE AFTER NEOADJUVANT CHEMORADIOTHERAPY AND ESOPHAGEAL CANCER SURGERY WITH CURATIVE INTENT
Authors: Schuring Nannet , Stam WT , Plat VD , Kalff MC , Hulshof MCCM , van Laarhoven HWM , Derks S , van der Peet DL , van Berge Henegouwen MI , Daams F , Gisbertz SS 
Published: September 2022

Abstract
Recurrence is frequently observed in patients after esophageal cancer surgery and post-recurrence survival is dismal. Neoadjuvant chemoradiotherapy (nCRTx) followed by esophagectomy is the gold standard of care for resectable esophageal tumors in The Netherlands. This study investigated the recurrence patterns and survival in patients after nCRTx and esophagectomy.
This retrospective cohort study included data from a prospectively maintained database of patients with recurrent disease after nCRTx followed by esophagectomy in the Amsterdam UMC between 01-01-2010 and 31-12-2018. Post-recurrence treatment and survival were investigated for patients specified for tumor histology (adenocarcinoma [AC] or squamous cell carcinoma [SCC]) and by recurrence site (loco-regional, distant, or combined loco-regional and distant).
In total, 340 of the 803 patients included (42.3%) after nCRTx and esophagectomy developed a recurrent disease at a median of 49 and 51 weeks postoperatively, for patients with an AC or SCC, respectively. Fifty patients had loco-regional (14.7%, AC:11.2%/n = 31, SCC:32.2%/n = 19), 167 patients distant (49.1%, AC:52.3%/n = 145, SCC:33.9%/n = 20) and 122 patients had combined recurrences (35.9%, AC:36.5%/n = 101, SCC:33.9%/n = 20). Post-recurrence survival was superior for AC patients with loco-regional (33 weeks, 95%CI:7.3-58.7) compared to AC patients with distant (12 weeks, 95%CI 6.9-17.1) or combined recurrences (18 weeks, 95%CI:9.3-26.7). AC patients with loco-regional recurrences receiving curative intent treatment had the longest survival (87 weeks, 95%CI:6.9-167.4).
Most esophageal cancer recurrences after curatively intended treatment were located at distant or combined loco-regional and distant sites, with limited survival prospects. A subgroup of patients with loco-regional recurrence can be treated with curative intent and has prolonged survival. How to identify these patients needs to be investigated, as they may benefit from close postoperative surveillance.
390. ACUTE NUTRITIONAL AND FUNCTIONAL STATUS CHANGES IN PATIENTS UNDERGOING ESOPHAGECTOMY FOR CANCER
Authors: Lidoriki Irene , Syllaios Athanasios , Mylonas Konstantinos , Michalinos Adamantios , Gazouli Maria , Karavokyros Ioannis , Liakakos Theodoros , Schizas Dimitrios 
Published: September 2022

Abstract
Nutritional status of esophageal cancer patients who undergo esophagectomy is significantly exacerbated postoperatively. The aim of this study is to investigate changes in nutritional status and muscle function between preoperative period and the time of hospital discharge in cancer patients undergoing esophagectomy.
The study sample consisted of 70 patients with esophageal (n = 13) and gastroesophageal junction cancer (n = 57) who were admitted for surgery in our Department between September 2015 and February 2020. Out of them, 52 patients underwent Ivor-Lewis esophagectomy, while 18 patients underwent McKewon esophagectomy. The preoperative evaluation of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), while the preoperative assessment of muscle function was based on Handgrip Strength (HG). Weight loss and anthropometric measurements were also recorded. Patients’ follow-up was done at the time of hospital discharge.
Patients’ mean length of stay was 17.7 ± 12.5 days. Mean postoperative involuntary weight loss was 6% ± 3%. HG dominant hand was significantly lower at the time of discharge (−3.02 ± 3.80 kg, p &lt; 0.001) compared to preoperative levels. Moreover, a significant change was observed for PG-SGA score (+2.61 ± 1.73) indicating greater rates of impaired nutritional status. There was a significant reduction in BMI (−3.7 ± 2.47 kg/m2, p &lt; 0.001) and in arm circumference values (−0.8 ± 0.03 cm, p &lt; 0.05), whereas no statistically significant alterations were observed in triceps skinfold measurements postoperatively (−0.007 ± 0.49, p = 0.368).
Esophageal cancer patients who undergo esophagectomy exhibit overt deterioration of nutritional and functional status during the postoperative course. Timely nutritional interventions are of great significance in order to avoid patients underfeeding and improve patients’ postoperative outcome.
405. TRANSTHORACIC VERSUS TRANSMEDIASTINAL ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CANCER: PROPENSITY SCORE-MATCHED COHORT ANALYSIS
Authors: Katsurahara Keita , Fujiwara Hitoshi , Shiozaki Atsushi , Konishi Hirotaka , Kubota Takeshi , Ohashi Takuma , Otsuji Eigo 
Published: September 2022

Abstract
Transthoracic esophagectomy (TTE) has been the standard procedure for esophageal squamous cell carcinoma (ESCC). In our institution, we performed transmediastinal esophagectomy (TME) as a radical operation for ESCC from 2013. In this study, we compared the short-term and long-term outcome of TME and conventional TTE using propensity score matching analysis.
We performed a retrospective cohort study including 223 patients who underwent esophagectomy with gastric tube reconstruction for ESCC between January 2009 and December 2017. Of these, 115 patents underwent TME and 108 patients underwent TTE. Propensity score was calculated using logistic regression analysis and one-to-one patient pairs were matched using propensity score matching.
72 patients in the TME group and TTE group were extracted by propensity score matching. The incidence of postoperative pneumonia was significantly lower in the TME group (9.7% vs 33.3%, P = 0.0004). Three-year overall survival rate was relatively better in the TME group than in the TTE group (75.0% vs 62.6%, P = 0.165). And Three-year recurrence-free survival rate also tended to be better in the TME group than in the TTE group (55.2% vs 48.5%, P = 0.373).
TME reduce postoperative pneumonia and may improve long-term prognosis in ESCC patients.
417. ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY WITH UPPER MEDIASTINAL LYMPHADENECTOMY
Authors: Tsunoda Shigeru , Nishigori Tatsuto , Hisamori Shigeo , Maekawa Hisatsugu , Hoshino Nobuaki , Hanada Keita , Yoshida Shinya , Nishiyama Kazuhiro , Obama Kazutaka 
Published: September 2022

Abstract
We started robot-assisted minimally invasive esophagectomy (RAMIE) in 2012 using da Vinci S. After the reimbursement in the national insurance system in 2018, RAMIE has been indicated as an institutional standard surgery simply depending on the da Vinci availability. Our early series of 45 RAMIEs showed significantly less postoperative morbidity (p = 0.03) mainly due to less pulmonary complication (p = 0.006) compared to conventional minimally invasive esophagectomy using propensity score matching (Ann Surg Oncol. 2020).
This study aims to retrospectively evaluate the feasibility of RAMIE and to demonstrate our standardized RAMIE with updated data.
Our surgical technique is as follows. A patient is placed in a prone position with both lung ventilation with 8-10 mmHg artificial pneumothorax. In the upper mediastinum, the thoracic duct is usually preserved unless there is tumor invasion. Then, the tracheoesophageal arteries flowing into the visceral sheath over the recurrent laryngeal nerve (RLN) are divided first and RLN is isolated laterally. Then, the lymphatic tissue is dissected from the trachea. This procedure is identical on both sides of RLN nodal dissection.
By January 2022, 89 RAMIEs (S: 6 cases and Xi: 83 cases) were performed. Thoracic operation time was 348 min and console time was 296 min. Intraoperative blood loss was 80 g and the number of harvested thoracic nodes is 23. There was no conversion from RAMIE to MIE nor to open procedure. Overall severe postoperative morbidity (Clavien-Dindo Grade 3 or higher) was 17% (15/89) and clinically relevant postoperative recurrent laryngeal nerve palsy (Clavien-Dindo Grade 2 or higher) was 10% (9/89). There was no postoperative mortality.
RAMIE was safe and feasible.
420. IDENTIFICATION AND CLASSIFICATION OF TUMOR CELLS IN PATIENTS WITH BARRETT’S CARCINOMA BY HYPERSPECTRAL IMAGING (HSI)
Authors: Maktabi Marianne , Wichmann Yannis , Köhler Hannes , Chalopin Claire , Jansen-Winkeln Boris , Gockel Ines , Thieme René 
Published: September 2022

Abstract
Hyperspectral imaging (HSI), as recently applied in medicine, is a novel technology combining imaging with spectroscopy. It might be used to identify, classify and discriminate malignant and non-malignant cells of histopathologic specimens. HSI allows the determination of a spectrum between the visual and near-infrared light (500-1000 nm).
After surgical resection, specimens (n = 96) of Barrett’s cancer were fixed in 4% formaldehyde and slices were conducted (3 μm), which were stained with hematoxylin and eosin (HE). Differences in the absorbance of squamous epithelium and esophageal adenocarcinoma (EAC) cells were determined at eosin’s and hematoxylin’s maximal absorption of 530 nm and 590 nm. A classification algorithm, which combines a multilayer perceptron (MLP) with a Gaussian filter and data reduction based on principal component analysis (PCA) was used for discrimination.
For the first time in literature, we were able to analyze esophageal adenocarcinoma, tumor stroma and squamous epithelium cells by HSI. For both, the squamous epithelium and the esophageal adenocarcinoma cells, the intragroup variances were quite low. A set of 20 specimens was used in a testing phase, which showed MLP by using reflectance data to provide the best results. Leave-one-patient-out-cross validation for all 96 specimens showed an accuracy of 77% with a sensitivity of 87% and a specificity of 72% for EAC determination and visualization.
Squamous epithelium and EAC cells show specific spectral alterations due to their HE-staining, when measured by HSI. However, the training algorithms need further validation to foster a semi-automatic decision-making process in histopathological tumor cell identification.
424. ROBOT-ASSISTED AND CONVENTIONAL MINIMALLY INVASIVE ESOPHAGECTOMY ARE ASSOCIATED WITH BETTER POSTOPERATIVE RESULTS COMPARED TO HYBRID AND OPEN TRANSTHORACIC ESOPHAGECTOMY
Authors: Tagkalos Evangelos , Van der Sluis Pieter C , Babic Benjamin , Berlth Felix , Lang Hauke , Grimminger Peter P 
Published: September 2022

Abstract
Currently 4 surgical techniques are performed for transthoracic esophagectomy (open esophagectomy (OE), hybrid esophagectomy (HE), conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE). Aim of this study was to compare these 4 different esophagectomy approaches regarding postoperative complications and short term oncologic outcomes.
Between 2008 and 2019, consecutive patients who underwent esophagectomy with gastric conduit reconstruction were included in this single center study. The primary outcome of this study was the incidence of postoperative complications. Overall 422 patients (OE (n = 107), HE (n = 101), MIE (n = 91) and RAMIE (n = 123)) were evaluated.
Uncomplicated postoperative course was observed in 27% (OE), 34% (HE), 53% (MIE), and 63% (RAMIE) of patients (p &lt; 0.001). Pulmonary complications were observed in 57% (OE), 44% (HE), 28% (MIE), and 21% (RAMIE) of patients (p &lt; 0.001). Cardiac complications were present in 25% (OE), 23% (HE), 9% (MIE), and 11% (RAMIE) of patients (p &lt; 0.001). MIE and RAMIE were associated with fewer wound infections (p &lt; 0.001). Median hospital stay was shorter for MIE and RAMIE went compared to OE and HE (p &lt; 0.001). The lymph nodes yield differ significantly between the techniques (p &lt; 0.001).
Total minimally invasive esophagectomy (MIE, RAMIE) was associated with a lower overall, pulmonary, cardiac and wound complication rate as well as a shorter hospital stay compared to open or hybrid approach (OE, HE). RAMIE resulted in higher lymph node harvest than MIE.
432. A CASE OF ADVANCED ESOPHAGEAL CARCINOSARCOMA DIAGNOSED LATE DUE TO SEVERE STENOSIS AFTER CHEMORADIOTHERAPY
Authors: Higashimoto Iku , Taniyama Yusuke , Sato Chiaki , Okamoto Hiroshi , Koseki Ken , Ozawa Yohei , Ishida Hirotaka , Kamei Takashi 
Published: September 2022

Abstract
Radiochemotherapy (CRT) is one of the curative treatment options next to surgery in the treatment of esophageal squamous cell carcinoma. However, CRT may cause esophageal stenosis or obstruction during the healing process. Therefore, in such cases, follow up of early recurrence detection becomes an issue for those patients.
We report a case of severe stenosis after CRT, in which recurrence could not detected until advanced cancer developed on the anal side of stenosis.
The case is a 73-year-old male. He was diagnosed with upper thoracic esophageal cancer (T4N2M0StageIVa) and had undergone radical chemoradiotherapy 5 years ago. The treatment effect achieved a complete response, but the primary tumor site caused severe esophageal stenosis. Therefore, biannual CT follow up had been done instead of endoscopic follow up. During follow-up, CT revealed a new neoplastic lesion in the lower thoracic esophagus, and endoscopy inserted through a gastrostomy revealed a bulky tumor on the anorectal side of the stenotic lesion. Biopsy revealed carcinosarcoma and robot-assisted thoracoscopic esophagectomy was performed.
Malignant neoplasms can be developed not only the same site of primary tumor after CRT. Especially in case of carcinosarcoma, detection would be delayed because of rapid growing. But when the severe esophageal stenosis occurred after CRT, the examination of anal side become difficult. Therefore, it is necessary to observe by frequent CT or PET examination, or endoscopy from gastrostomy for early detection of recurrence or newly malignant neoplasm.
435. A DIAGNOSTIC PITFALL; SMALL CELL CARCINOMA-LIKE FEATURES IN BASALOID SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS
Authors: Ishida Hirotaka , Kasajima Atsuko , Yamauchi Takuro , Kato Nobufumi , Koseki Ken , Ozawa Yohei , Okamoto Hiroshi , Sato Chiaki , Taniyama Yusuke , Fujishima Fumiyoshi , Kamei Takashi , Sasano Hironobu 
Published: September 2022

Abstract
Esophageal basaloid squamous cell carcinoma may resemble small cell carcinoma biopsy specimens and cause difficulties in pathology diagnosis. We aimed to explore the pathological features of basaloid squamous cell carcinomas in biopsy specimens that mimic small cell carcinoma and to clarify their diagnostic and prognostic features. This study will contribute to draw attention to an important pitfall in pathology diagnosis in endoscopic biopsy specimens of the esophagus.
Thirty biopsy specimens of esophageal basaloid squamous cell carcinoma were reviewed and compared with 13 matched surgical specimens. A small cell carcinoma-like feature was defined as, when at least one of the three following findings was observed: 1) diffuse growth pattern, 2) nuclear molding and 3) nuclear crush artifact. Immunohistochemistry of synaptophysin, chromogranin A, CD56 (neuroendocrine markers) and p16 were performed in all cases.
Small cell carcinoma-like features, such as diffuse growth, nuclear molding, or nuclear crush artifact, were identified in 80% (24/30) of the biopsies and in 77% (10/13) of the surgery specimens, but in a proportionally much smaller area in the surgical specimens than in the biopsy samples. The presence of a small cell carcinoma-like feature had no impact on patients´ outcome. Immunohistochemically, synaptophysin and chromogranin A were consistently negative, while CD56 was expressed in 42% (10/24) basaloid squamous cell carcinomas with small cell carcinoma-like features. p16, a highly sensitive marker for small cell carcinoma, was also expressed in 8% (2/24).
In conclusion, small cell carcinoma-like features are frequent and conspicuous in biopsies, which may probably be caused by exogenous factors such as friction and external pressure that occur in biopsy procedure and in the tumor environment. Small cell carcinoma-like features may lead to a misinterpretation of a true small cell carcinoma, if CD56 is an only neuroendocrine marker expressed. p16 expression may be also detected in basaloid squamous cell carcinoma.
439. CAN THORACOSCOPIC ESOPHAGECTOMY IN CONVERSION SURGERY FOR LOCALLY ADVANCED UNRESECTABLE ESOPHAGEAL CANCER BE FEASIBLE?
Authors: Abe Tetsuya , Higaki Eiji , Fujieda Hironori 
Published: September 2022

Abstract
Conversion surgery (CS) after preoperative treatment has been reported to provide an improved prognosis for locally advanced unresectable esophageal cancer (LAUEC). The standard procedure of CS for LAUEC is transthoracic esophagectomy. However, few reports have been described on the safety and usefulness of conversion thoracoscopic esophagectomy.
We retrospectively analyzed the surgical outcomes of 26 patients who underwent transthoracic esophagectomy (open group) and 27 patients who underwent thoracoscopic esophagectomy (VATS group) between 2011 and 2019 after preoperative therapy for LAUEC.
Both groups had no significant differences in patient characteristics, excluding more females in VATS group. Median blood loss was significantly lower in VATS group. The two groups did not significantly differ in median operative time, R0 resection rate, any postoperative complications or hospital stay. No in-hospital deaths were observed in either group. The 3-year PFS rate was 62% in open group compared to 64% in VATS group, and the 3-year OS rate was 69% in the open chest group compared to 71% in the VATS group, which were comparable between the groups.
Thoracoscopic conversion surgery can be as safe and feasible as transthoracic thoracotomy in CS for LAUEC.
472. ROUTINE PLACEMENT OF FEEDING TUBES SHOULD BE AVOIDED IN ESOPHAGEAL CANCER PATIENTS UNDERGOING SURGERY
Authors: Shi Ge , Malthaner Richard , Nayak Rahul , Fortin Dalilah , Inculet Richard , Qiabi Mehdi 
Published: September 2022

Abstract
Perioperative nutritional optimization of patients undergoing esophagectomy for cancer is important as this population is prone to malnutrition associated with poor outcomes. Nutritional supplementation has been achieved via enteral nutrition through percutaneous feeding tubes such as gastrostomy tubes (G-tubes) and jejunostomy tubes (J-tubes). These are not benign and are associated with adverse events including infections, dislodgement, increased healthcare visits, among others. We aim to determine factors associated with adverse outcomes after feeding tube placement.
Patients who underwent esophagectomy for carcinoma and had at least one feeding tube placed from November, 2017 to October, 2021 at a single institution were retrospectively reviewed. Subgroup analyses were performed testing for revelant chracteristics. Wilcoxon rank sum test was used to analyze non-parametric continuous data, and Chi-Square and Fisher's exact test for categorical variables. Univeriate and multivariate logistical regression analyses were conducted evaluating outcomes of interests. The primary outcome was the overall rate of tube-related complications.
136 patients were included with 201 feeding tubes placed. The rate of adverse events related to feeding tubes was 39%. Of these, 11% were wound infections, 16% required procedural intervention, 11% visited the Emergency Department due to feeding tube-related complications. Smoking history was a significant risk factor for complications compared to never-smokers (44% vs. 24%, p=0.011). Females had increased complications compared to males (58% vs. 35%, p=0.010). Comorbid patients (Charlson Comorbidity Index 5-6) were more likely to suffer from tube-related complications (OR=4.47, p=0.038). There were no significant differences seen in complications rates comparing G- and J-tubes (32% vs. 43%, p=0.11).
There is significant morbidity related to feeding tubes. The risk profile of these tubes should be carefully discussed. Routine use of feeding tubes in esophagectomy patients should be avoided.
473. SAFETY AND USEFULNESS OF LARYNX- PRESERVING HIGH-LEVEL CERVICAL ANASTOMOSIS FOR CERVICAL ESOPHAGEAL CANCER
Authors: Fujieda Hironori , Abe Tetsuya , Higaki Eiji , Shimizu Yasuhiro 
Published: September 2022

Abstract
In cases of cervical esophageal cancer, total Pharyngo-Laryngo-Esophagectomy is often performed when the oral edge of the primary tumor is less than 2 cm from the esophageal entrance. In our hospital, we provide neo-adjuvant chemotherapy for cervical esophageal cancer and perform larynx-preserving esophagectomy whenever possible. The aim of this study was to evaluate the safety and efficacy of larynx- preserving high-level cervical anastomosis for cervical esophageal cancer.
41 patients underwent larynx- preserving esophagectomy for cervicothoracic esophageal cancer between January 2009 and September 2021 at our hospital were included. The distance from the oral edge of the primary tumor to the esophageal entrance was measured by esophagography and endoscopy. Patients with the distance of 2 cm or less were classified as the high cervical anastomosis group (H group: n=23), and patients with the distance of 2.1 cm or more were classified as the low cervical anastomosis group (L group: n=18). We compared the short-term and long-term results between the H and L groups.
There were no differences between H and L groups in terms of patient characteristics, such as clinical depth of tumor invasion, grading of lymph node metastasis, frequency neo-adjuvant chemotherapy. The incidence of postoperative complications was similar in the two groups such as pneumonia, anastomotic leakage, anastomotic stenosis, recurrent nerve palsy. In histopathological examination, the rate of positive proximal resection margin was significantly higher in H group. (34.8 vs 5.6%(P=0.028). 3-year recurrence-free survival rate and 3-year survival rate were similar in the two groups. The anastomotic recurrence rates did not differ between the two groups. (5.0 vs 5.9% (P=0.715))
In the H group, the rate of positive proximal resection margin was significantly higher. However, there was no difference in the anastomotic recurrence rate and the 3-year survival rate between the two groups. Therefore, we believe that larynx- preserving high-level cervical anastomosis is useful to maintain QOL in cervical esophageal cancer patients with the oral edge of the primary tumor is less than 2 cm from the esophageal entrance.