bluuebunny/crossref_metadata_2025_split huggingface dataset:
18. REFLUX OF DUODENAL CONTENTS INDUCES ESOPHAGEAL CARCINOGENESIS (SCC, ADC)
Authors: Hashimoto Naoki 
Published: September 2022

Abstract
The incidence of esophageal cancer patients who have undergone distal gastrectomy is increasing recently. Distal gastrectomy is a good model for studying the clinical effects of duodenal content reflux.
It is known that reflux of duodenal contents can induce mucosal injury, stimulate cell proliferation, and promote tumorigenesis. We examined the expression of COX2 and P53 in rat esophageal lesions induced by duodenal contents reflux after total gasytrectomy.
Thirty 8 week old male wistar rats were exposed to duodenal content esophageal reflux. All animal underwent an esophagoduodenal anastomosis(EDA) with total gastrectomy in order to produce chronic esophagitis. Ten rats were the sham (Control). They were sacrified at the 40th week. Their esophagi were examined for HE, COX2,P53 and Proliferating cell nuclear antigen (PCNA).
After 40 weeks of reflux, dysplasia(100%), squamous cell carcinoma(SCC)(40%) and adenocarcinoma (ADC) (30%)were found. PCNA Labeling index was higher in dysplastic and cancer tissue than that of normal. Overexpression of COX2 were shown in ADC and SCC. Wild type p53 accumulation were found in ADC, not in SCC. Moreover, SCC developed in places distant from the anastomosis compared to ADC. As compared with ADC, SCC is less frequently inflammatory.
This means that histological features may depend on the volume of reflux contents; small amounts of reflux causes SCC and a large volume of reflux causes ADC.
Reflux of duodenal contents into the esophagus led to ADC and SCC in rat. Small amounts of reflux causes SCC and a large volume of reflux causes ADC.
COX2 may play an important role in esophageal cancer by duodenal content reflux. Our present results suggest an association between wild type P53 accumulation and COX2 expression in ADC, with no such relation seen in SCC.
137. THE COMPARISON OF SHORT-TERM OUTCOMES BETWEEN NEOADJUVANT CHEMOTHERAPY COMBINED WITH IMMUNOTHERAPY AND NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CANCER
Authors: Xiao Xin , Yuan Yong 
Published: September 2022

Abstract
To evaluate the short-term outcomes of neoadjuvant chemotherapy combined with immunotherapy followed by esophagectomy for locally advanced esophageal squamous cell carcinoma.
Patients receiving neoadjuvant chemotherapy combined with immunotherapy (NACI group) or chemoradiotherapy (NACR group) at our center between September 2019 and September 2021 were identified. The primary outcomes were tumor regression score (TRS), pathological complete regression (pCR), overall survival (OS), progression-free survival (PFS) and pathological downstaging. Secondary outcomes were toxic effects and postoperative complications. The propensity score matching for enrolled patients was performed.
Data of 149 patients were analyzed. All included patients received minimally invasive esophagectomy, with only 3 conversion to open surgery. With regard toTRS, 25 (45.5%), 61 (64.9%) patients were scored 0 and 1 in the NACI and NACR groups, respectively (p = 0.020). Of note, 17 (30.9%) patients in the NACI group achieved pCR (ypT0N0), while 48 (51.1%) patients in NACR group achieved pCR (P = 0.026). Neoadjuvant chemoradiotherapy was associated with higher risk of postoperative pneumonia (p = 0.034). The 1-year cumulative progression-free survival rate was 85.4% and 75.4% in the NACI and NACR groups respectively (p = 0.147).
We found that neoadjuvant immunotherapy combined with chemotherapy compared with neoadjuvant chemoradiotherapy was associated with lower pneumonia rate and was safe and feasible for locally advanced ESCC. However, the tumor regression score and the pathological complete response rate of patients treated with neoadjuvant immunotherapy was lower than those of patients treated with neoadjuvant chemoradiotherapy. The short-term follow-up results were comparable between two treatment modalities.
138. TIMELY VERSUS DELAYED ESOPHAGECTOMY AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR LOCALLY ADVANCED ESOPHAGEAL SQUAMOUS CANCER
Authors: Xiao Xin , Yuan Yong 
Published: September 2022

Abstract
The optimal time interval from neoadjuvant therapy to surgery for esophageal cancer still remains unclear and controversial. Our aims were to investigate if prolonged time to surgery would have an impact on pathological complete response (pCR) rates and postoperative complications, and affect the survival for locally advanced esophageal squamous cancer (ESCC).
Patients with locally advanced ESCC receiving neoadjuvant chemoradiotherapy followed by esophagectomy between June 2017 and December 2020 were prospectively enrolled and retrospectively analyzed. Patients were divided into two groups, timely and delayed surgery groups, namely, group A (&lt; 10 weeks) and group B (≥ 10 weeks). We further classified the patients according to interval quartiles and 3-week groups. We measured the tumor regression score (TRS), pathological complete regression (pCR), clinical complete regression (cCR), overall survival (OS), progression-free survival (PFS) and postoperative complications as the analytical outcomes for this study.
A total of 40 patients (34.5%) in the timely surgery group (n = 116) and 54 patients (50.0%) in the delayed surgery group (n = 108) achieved pCR (P = 0.019). The postoperative complications and survival for two groups were similar. However, for patients with a non-cCR, delayed surgery was associated with poor survival (P = 0.035) and cancer progression (P = 0.036). For the second step of analysis, using linear-by-linear association chi-square test, the pCR rates were significantly difference across 4 groups and were increased along with time interval (P = 0.006). Results for 3-week intervals were similar (P = 0.009).
Patients with prolonged time interval (up to 12 weeks) from neoadjuvant chemoradiation to surgery have higher pCR rates without an impact on operative morbidity. For patients who have a non-cCR to neoadjuvant chemoradiation, delayed surgery was associated with poor survival and surgery should be performed within 10 weeks after neoadjuvant chemoradiation.
176. THE SURGICAL OUTCOMES OF LAPAROSCOPIC HELLER CARDIOMYOTOMY AND DOR FUNDOPLICATION FOR ACHALASIA
Authors: Lim Kheng Tian 
Published: September 2022

Abstract
Esophageal cardiomyotomy is the main component of treatment in achalasia which can be performed endoscopically or by surgery. Laparoscopic esophageal cardiomyotomy for achalasia is associated with reduced early postoperative morbidity compared to open surgery whilst laparoscopic anterior fundoplication is associated with reduced postoperative reflux symptoms. Proton Pump Inhibitor (PPI) is usually prescribed for postoperative acid reflux symptoms. The outcomes of laparoscopic Heller cardiomytomy and Dor fundoplication (LHCDF) from our unit were analyzed.
Consecutive cases of achalasia who underwent LHCDF were identified from electronic medical records from June 2016 to December 2021. The preoperative assessment included esophagogastroduodenoscopy (EGD), oral contrast swallow (OCS), esophageal high-resolution manometry (HRM) and occasionally a computed tomography scan. Objective symptoms evaluation using Eckardt score was performed before and after surgery. Long myotomy was performed with 7 cm on esophageal and 2 cm on gastric side followed by 3-stitches on each side of Dor fundoplication. Intraoperative EGD and postoperative OCS was routinely performed. The surgical outcomes of LHCDF were analyzed.
There were 11 cases of LHCDF with the mean age of 50 ± 5 years and M:F ratio 4:7. HRM confirmed 1 Type-I and 8 Type-II achalasia. The mean preoperative Eckardt score was 7.2 ± 0.5 and postoperative score of 0.5 ± 0.2. The mean duration of operation was 206 ± 7 minutes. There were no surgery-related complications, readmission, or mortality. The mean length of stay was 3 ± 0.5 days. Postoperative PPI use for acid reflux symptoms was 19% (n = 2). EGD at 1 year showed 1 esophagitis. The mean duration of clinic follow up was 24.6 ± 5.4 months.
LHCDF achieved good symptoms relief and surgical outcomes in patients with symptomatic achalasia. In this small cohort and short-term follow up, the majority of post-LHCDF patients did not require PPI for acid reflux symptoms and none required endoscopic or surgical reintervention.
225. TREATMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY (TENTACLE– ESOPHAGUS) STUDY: EFFICACY OF DIFFERENT INITIAL TREATMENT STRATEGIES FOR ANASTOMOTIC LEAK
Authors: Ubels Sander , Verstegen Moniek , Bouwense Stefan , Hannink Gerjon , Siersema Peter , Klarenbeek Bastiaan , van Workum Frans , Rosman Camiel ,   on Behalf of the TENTACLE - Esophagus Collaborative Group
Published: September 2022

Abstract
Anastomotic leak (AL) is a common and severe complication after esophagectomy. The presentation of AL is diverse and various treatments are available. However, it is unknown which treatment strategy for which type of leak is most effective. We aimed to investigate the effectiveness of different primary treatments of AL after esophagectomy.
TENTACLE—Esophagus is an international retrospective cohort study in 71 centers from 20 countries, which included patients with anastomotic leak after esophagectomy between 2011 and 2019. Detailed data were collected regarding leak characteristics and treatment. Primary outcome was 90-day mortality. Different leak types were defined, i.e., local symptoms (i.e., no intrathoracic fluid collections and well-perfused conduit), intrathoracic fluid collections and conduit ischemia/necrosis. Efficacy of different primary treatment strategies were assessed for these leak types, adjusted for case-mix and leak severity. The full study protocol is accessible at www.tentaclestudy.com.
In total, 1509 patients with AL were included and overall 90-day mortality was 11.7%. Of all patients, 482 patients had only local symptoms, 725 patients had intrathoracic fluid collections and 148 patients had conduit ischemia/necrosis. Primary treatment strategies included supportive treatment only (n = 335), drainage (n = 590), defect closure (n = 67), drainage & defect closure (n = 289) and surgical resection of the conduit & esophageal diversion (n = 57). The efficacy of different primary leak treatment strategies is currently being assessed. Results on the efficacy of primary treatment strategies for AL will be ready for presentation at the ISDE meeting.
This is the largest study on effectiveness of AL treatments. The final results on efficacy of primary leak treatments will be available for presentation at the ISDE meeting in Tokyo and can offer guidance in clinical practice to determine the preferred primary treatment strategy in patients with anastomotic leak after esophagectomy.
360. DIAGNOSIS OF RECURRENT LARYNGEAL NERVE PARALYSIS BY EVALUATING MOVEMENT OF THE VOCAL CORDS USING ULTRASONOGRAPHY AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Leng Xuefeng , Teng Xiangnan , Xu Shanling , Peng Lin , Xiao WenGuang , Fang Qiang , Han Yongtao , Zhu Yi 
Published: September 2022

Abstract
Development of thoracoscopic surgical skills and concepts in minimally invasive esophagectomy (MIE) and robotic-assisted (MIE) have provided us with a more wider anatomical understanding of lymphadenectomy and the relationship between lymph node dissection and recurrent laryngeal nerve paralysis (RLNP). However, RLNP correlates to postoperative complications even in prognosis. Early warning and novel diagnosis are urgent in the management of esophageal cancer patients.
Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy after extubating of trachea cannula at department of critical care medicine. Further ultrasonography combined endoscopy evaluation and verification were performed on day 5–7 before hospital discharge.
RLNP occurred in 4 of the 20 patients’ cohort (20%). All of 20 patients were finished ultrasonography combined endoscopy evaluation. The diagnostic accuracy of RLNP by ultrasonography compared to endoscopy had a sensitivity of 100.0% (4/4), a specificity of 87.5% (14/16). The positive predictive value was 66.7% (4/6), negative predictive value was 100.0% (14/14), a false positive rate of 33.3% (2/6), and a false negative rate of 0% (0/14).
Ultrasonography is a quite non-invasive and effective measure to diagnose and evaluate RLNP after esophagectomy compared to traditional examination of endoscopy. It also has a perspective future in evaluation for the recovery status of RLNP.
458. Multimodal analgesia after oesophagectomy provides clinically equivalent pain control for open and thoracoscopic approaches
Authors: Chung Jordan Ng Cheong , Barry James , Chmelo Jakub , Navidi Maziar , Phillips Alexander 
Published: September 2022

Abstract
Adequate pain control is an important consideration to ensure patients can mobilise after surgery and to reduce pulmonary complications. This is frequently provided by a thoracic epidural, however there has been increasing use of multimodal analgesia. Minimally invasive approaches in esophagectomy may also reduce post-operative pain. The aim of this study was to compare pain control in patients after Ivor Lewis esophagectomy with thoracoscopic (TE) vs open approach using multimodal analgesia.
Consecutive patients undergoing thoracoscopic or open esophagectomy for cancer between January 2015 and December 2019 were evaluated. All patients received multimodal analgesia (intrathecal diamorphine, paravertebral and rectus sheath catheters). Pain scores (at rest and on movement, graded from 0 to 10) were collected and compared between two cohorts. Length of stay and complications were also compared between the two groups.
This study included 161 patients; 114 (70.8%) underwent an open esophagectomy and 47 (29.2%) underwent a thoracoscopic chest phase. Mean pain scores were significantly lower for TE only on postoperative days (POD) 0 on movement (open 2.81 versus TE 1.50, p = 0.026) and POD 3 at rest (open 1.00 versus TE 0.60, p = 0.030). Postoperative stay was comparable between groups (9 versus 8 days). There was no significant difference in the overall complication rate (64.0% versus 57.4%, p = 0.433), pulmonary complications (27.7% versus 35.1% p = 0.461) and 30-day mortality (2.6% versus 0%, p = 0.262).
These results may suggest that a minimally invasive thoracoscopic approach does not provide additional analgesic benefit in comparison to open approach when multimodal analgesia is used. A clinically meaningful difference (score difference 0.9-1.6) was achieved only on POD 0. Importantly, in this cohort the open approach was not associated with inferior short-term postoperative outcomes. Future randomised controlled trials comparing minimally invasive techniques should consider employing multimodal analgesia in their design.
465. RELATIONSHIP BETWEEN THE PERIOPERATIVE NUTRITION, INFLAMMATION AND PROGNOSIS IN RESECTABLE ESOPHAGEAL CANCER PATIENTS, POSSIBLE SIGNIFICANCE OF NUTRITIONAL INTERVENTION
Authors: Fujiwara Yoshinori , Endo Shunji , Higashida Masaharu , Kubota Hisako , Yoshimatsu Kazuhiko , Ueno Tomio 
Published: September 2022

Abstract
Inversed relationship between inflammatory response and nutrition were reported, and preoperative mGPS score has been proposed as a useful prognostic biomarkers in several malignancies. It has been reported that the postoperative inflammatory responses may cause cancer recurrence and metastasis. In the present study, we investigated the treatment strategy from perioperative inflammatory reaction and nutritional status in patients with resectable esophageal cancer.
110 esophageal cancer patients (Squamous cell carcinoma, Stage I / II / III / IV: 44/17/39/20) were evaluated. The preoperative mGPS score was evaluated on a scale of 0 to 2. The cut-off value of albumin, CRP were 3.5g/dl, 0.14mg/dl, respectively. As the postoperative CRP, CRPmax and the area under the CRP curve (CRP (7), CRP (14)) for 7 days and 14 days after the operation, and ROC curve was used to set at optimal cut-off value of these parameters. Outcome was RFS (Recurrence Free Survival) and identified prognostic factors were determined by Cox multivariate analysis.
1, Preoperative albumin value was significantly lower in high CRP (&gt; 0.14mg / dl) (p &lt;0.05)). 2, Preoperative mGPS score 0 was better RFS than in the other groups(p&lt;0.05).3, Univariate analysis showed that mGPS, albumin, and CRP were prognostic factors for RFS, but Cox analysis showed mGPS was not prognostic factor. 4, The cut-off value of CRP (7) and CRP (14) were 59.9, 115.3, respectively. CRP (7) was prognostic factor for RFS in univariate analysis, but Cox analysis showed that only pStage and tumor locations were significant prognostic factors, high CRP (7) was tended to be poor prognostic (p = 0.089).
Clinical Stages, tumor locations were most important prognostic factors in resectable esophageal cancer patients. However, preoperative nutritional intervention may improve the prognosis of patients with esophageal cancer if preoperative CRP values can be suppressed. Suppressing the inflammatory reaction one week after surgery may improve the prognosis of patients with esophageal cancer.
520. EFFICACY AND SAFETY OF NEOADJUVANT CHEMOTHERAPY AND IMMUNOTHERAPY IN LOCALLY RESECTABLE ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Gong Taiqian , Gong Taiqian , Song Weian , Lu Jing , Liu Junqiang , Fan Boshi , Zhao Jiahua , Chen Siyu 
Published: September 2022

Abstract
Compared with neoadjuvant chemotherapy, concurrent chemoradiotherapy can significantly increase pCR rate and improve overall survival of Locally Advanced ESCC. However, the major pattern of failure is distant metastasis, and the increased risk of adverse events and surgery. Adding PD-1 inhibitor to the chemotherapy have shown significant clinical benefits and become the standard of care for first-line treatment of ESCC. We investigate the efficacy and safety of neoadjuvant PD-1 blockade combined with chemotherapy in real world.
We performed a retrospective, single institution review of all resectable locally advanced ESCC patients who received neoadjuvant sintilimab combined with chemotherapy and completed surgery in the sixth medical center of PLA general hospital from December 2019 to February 2022. The primary outcome was pCR rate in both the primary tumor and lymph nodes. Secondary outcomes were R0 resection rate, MPR rate, tumor downstaging rate, surgical complications, and treatment-related adverse events (TRAEs).
37 Patients aged between 47 to 76 years old (median age, 62) were collected. 3(8.1%) were diagnosed with stage II ESCC, 30(81.1%) with stage III, and 7(18.9%) with stage IVA (AJCC 8th). 30(81.1%) were male. 31 patients received 2 cycles and 6 patients received 3 cycles. 5(13.5%) patients obtained pCR. 7(18.9%) patients obtained pCR in primary tumor. 36(97.3%) patients obtained R0 resection. MPR (PCR included) was achieved in 18 (48.6%) patients. 28(75.7%) patients achieved clinical downstaging, and 64.9 (%) achieved pathological downstaging. Grade 3-4 TRAEs occurred in 7(18.9%) patients, and grade 3-4 surgical complications occurred in 1(2.7%) patient.
These real-world data revealed that neoadjuvant sintilimab plus chemotherapy could provide benefits with good tolerability for resectable locally advanced ESCC, and warrants further exploration in prospective clinical studies.
522. CAN PREHABILITATION IMPROVE HEALTH-RELATED QUALITY OF LIFE OF PATIENTS DURING NEOADJUVANT CHEMOTHERAPY FOR ESOPHAGOGASTRIC ADENOCARCINOMA?
Authors: Chmelo Jakub , Navidi Maziar , Sinclair Rhona CF , Greystoke Alastair , Phillips Alexander W 
Published: September 2022

Abstract
Prehabilitation is designed to improve patients’ functional capacity prior to operation in order to better withstand stress of surgery and therefore improve patients’ postoperative outcomes. It is not known whether prehabilitation of patients with esophagogastric adenocarcinoma (EGA) can also improve patients’ centred outcomes. The aim of this study was to assess whether prehabilitation can lead to better health-related quality of life (HRQoL) during neoadjuvant chemotherapy (NAC) treatment for EGA.
Patients enrolled into a prospective home-based prehabilitation study (ChemoFit) during NAC for EGA had their HRQoL measured using validated EORTC QLQ-C30 and QLQ-OG25 questionnaires prior NAC and prior to surgery (post-NAC). ChemoFit patients were compared with historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their HRQoL assessed in the same way during identical time points. Prehabilitation consisted of daily aerobic sessions with step-count target and daily strengthening exercises, under weekly telephone supervision. Mann U Whitney test was used for statistical comparison.
There were 31 patients in ChemoFit group and 24 patients in NO-PREHAB cohort. Statistically significant intergroup differences were observed for scores of global quality of life (mean score difference ChemoFit +12.9 vs NO-PREHAB -2.4, p=0.003), physical functioning (+5.8 vs -4.9, p=0.002), role functioning (1.6 vs -13.5, p=0.022) and for symptoms of fatigue (-6.6 vs 9.7, p=0.008) and nausea/vomiting (-10.2 vs 0.7, p=0.030).
Patients prehabilitated within ChemoFit study achieved better scores in several HRQoL scales including global quality of life in comparison to historical cohort which did not undergo prehabilitation. These results suggest that prehabilitation of patients with EGA might lead to improvement of their HRQoL prior to operation. It is unknown whether this difference would persist after operation. It is desirable to confirm these findings within randomised controlled trial setting.
571. ESOPHAGEAL PERFORATION AFTER LOBECTOMY: PADLOCK CLIP TO THE RESCUE
Authors: Cheng Shi Yu , Lim Jolene , Voon Kelvin 
Published: September 2022

Abstract
Esophageal perforation or fistula is a devastating condition with diagnostic and therapeutic challenges. It is associated with high morbidity and mortality due to its rapid progression to mediastinitis or peritonitis, septic shock and multiorgan failure. Iatrogenic perforation is the commonest in this era.
We hereby report a case of esophagopulmonary fistula following a right lower lobectomy which was successfully treated with endoscopic clipping. A 52-year-old man presented with productive cough and weigh loss for 2 weeks. Initial workup in another center revealed right lung lower lobe lesion and a right lower lobectomy was done. Saliva and food particle were noted in chest drain on post-operative day 2 due to esophageal perforation.
Re-thoracotomy, washout and esophageal repair was done. An open window thoracostomy was created for further drainage and parenteral nutrition was initiated. Histology of the lobectomy specimen revealed actinomycosis of right lung. However, there was persistent leak from the esophagus with suspicion of esophagopulmonary fistula. He was then transferred to our center for further treatment. OGDS revealed a 5mm defect at right lateral wall mid thoracic esophagus, about 28cm from incisor, with healthy and supple surrounding mucosa. Contrast study revealed esophagopulmonary fistula. Esophageal defect was successfully closed with over-the-scope padlock clip (Steris). Repeat contrast study 1 week later revealed resolution of fistula.
Sepsis and source control, nutritional support with restoration of gastrointestinal tract intergrity are key steps in the management of esophageal perforation. Endoscopic treatment is efficacious, less invasive, and with the advantage of organ preservation. Endoscopic clipping is safe and effective in selected group of patients with esophageal perforation or fistula.