bluuebunny/crossref_metadata_2025_split huggingface dataset:
42: THE LAPAROSCOPIC HELLER-DOR IS AN EFFECTIVE LONG-TERM TREATMENT FOR END-STAGE ACHALASIA
Authors: Nezi G , Forattini F , Riccio F , Vittori A , Provenzano L , Capovilla G , Nicoletti L , Moletta L , Pierobon E S , Zanchettin G , Valmasoni M , Merigliano S , Costantini M , Salvador R 
Published: April 2022

Abstract

Background and aim
Laparoscopic Heller-Dor (LHD) is an effective treatment for esophageal achalasia, with good long-term results in more than 85–90% of patients. It remains controversial whether LHD is also indicated in the end-stage disease when the esophagus has a sigmoid shape. The aim of this study was to evaluate the outcome of LHD in patients with end-stage achalasia, as compared to patients with megaesophagus but without a sigmoid shape.

Methods
From 1992 to 2020, patients with a radiological diagnosis of sigmoid-shaped esophagus (radiological stage IV achalasia: group SE) and patients with straight, larger than 6 cm in diameter esophagus (radiological stage III achalasia: group NSE), both treated with LHD, were compared. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score &gt; 3, or the need for retreatment.

Results
During the study period, 164 such patients were observed: 73 patients in the SE group and 91 in the NSE group. The patients’ demographic and clinical parameters are summarised in Table 1. The median follow-up was 67 months (IQR: 24–106). No intra or postoperative mortality was recorded. There were 7 mucosal lesions: 2 in the SE group and 5 in the NSE group (P = 0.45). A positive outcome was obtained in 73% of patients in the SE group, as compared to 90% in the NSE group (P = 0.007, Table 2). All the patients whose surgery failed subsequently underwent one or more endoscopic pneumatic dilations. The overall success rate of the combination of LHD and endoscopic dilations was 83.6% in the SE group and all patients in the NSE group. The persisting failures had additional treatments: 4 patients a redo-myotomy, one each a botox injection, POEM and only one patient had an esophagectomy; the remaining 5 patients refused additional treatments. Postoperative 24-hour pH-monitoring was abnormal in 16.6% in SE group and 8.3% in NSE group (P = 0.33).

Conclusion
In end-stage achalasia patients, LHD may still achieve good results by relieving symptoms in more than 70% of patients. Therefore, LHD may still be the first surgical option to be offered to these patients before esophagectomy.
55: COMPETENCY ASSESSMENT TOOL FOR MINIMALLY INVASIVE ESOPHAGECTOMY: DEVELOPMENT AND PRELIMINARY CONSTRUCT VALIDITY AND RELIABILITY RESULTS
Authors: Ketel M , Hannink G , Eddahchouri Y , Klarenbeek B ,   Collaboration Group M, Van Workum F , Rosman C 
Published: April 2022

Abstract

Background and aim
Performance of the surgical team is essential for patient outcome. Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure and implementation is associated with a substantial learning curve. A validated, procedure specific and scientifically robust competency assessment tool (CAT) could provide structured feedback and can be a tool to improve patient outcome. The aim is to develop a MIE-CAT and assess construct validity, intra-observer reliability and inter-observer reliability.

Methods
Based on defined key steps from a Delphi study and refinement with a core group of MIE experts to establish content validity and obtain user agreement, the MIE-CAT was developed. Eighteen independent and blinded international MIE experts (&gt; 120 MIEs performed) followed an online workshop to train in using the MIE-CAT and assessed Ivor Lewis MIE videos that were performed from 2010–2020 by four MIE surgeons from the Esophageal Center East Netherlands. To analyze construct validity, 32 videos were divided into four groups (novice, intermediate, advanced and expert) based on the surgical team’s experience. For intra-rater and inter-rater reliability, the same video was scored twice by the same and different experts.

Results
The MIE-CAT consists of eight procedural phases, starting with the mobilization of the greater curvature and ending with creation of the intrathoracic anastomosis. Each phase contains four domains (exposure, execution, adverse events and end-product quality) and are scored with a 1–4 Likert scale. A total of 72 video assessments were used for analysis. Substantial performance variation between the MIE-CAT scores was seen (median 98 [IQR, 84–113.4]; range = 47–126). Median MIE-CAT scores were 79.5 [IQR 74–96.3], 91 [87.5–107], 101 [84.8–108] and 101 [95.5–108.3] for respectively the novice, intermediate, advanced and expert group (Figure 1). Significant differences between the average MIE-CAT scores of the experience groups were found with a Kruskal Wallis (P = 0.002). Good intra-rater reliability was observed (ICC, 0.71, 95% CI [0.35, 0.89) and moderate inter-rater reliability was observed (ICC, 0.54, 95% CI [0.10, 0.87).

Conclusion
A specific competency assessment tool to score the MIE performance, the MIE-CAT, was developed. It has the potential to be used for surgical training, safe implementation, performance improvement and research purposes.
116: INFLUENCE OF BODY COMPOSITE MEASURES ON CHYLE LEAK AFTER OESOPHAGECTOMY
Authors: Halle-Smith J , Subramanya M , Ghoneim A , Almonib A , Tan B 
Published: April 2022

Abstract

Background and aim
Chyle leak is an infrequent but potentially serious complication of oesophagectomy. Sarcopenia is an increasingly recognised prognostic factor in oesophageal cancer surgery. The aim of this study was to identify the influence of body composition and related factors on chyle leak following oesophagectomy.

Methods
Patients who developed chyle leak after oesophagectomy between January 2006–December 2020 were identified retrospectively from a prospectively collected and maintained dataset. A control group of patients undergoing oesophagectomy during the same time period was also collected. Relationships between chyle leak and demographics, operative factors and body composition measures were investigated as primary outcomes. Risk factors for severe chyle leak, defined as need for reintervention or greater than 1 litre of output per day, were evaluated as a secondary outcome.

Results
There were 26 patients who developed a chyle leak following an oesophagectomy. On univariate analysis, preoperative body mass index (BMI) (P = 0.001), subcutaneous fat index (P = 0.001) and total fat index (P = 0.004) were significantly associated with chyle leak. On multivariate analysis, a lower preoperative subcutaneous fat index was a significant independent predictor of chyle leak (P = 0.001). Sarcopenia was not found to be a significant predictor of developing chyle leaks. No significant predictors of severe chyle leak were identified.

Conclusion
A reduced preoperative body fat composition is a risk factor for chyle leak after oesophagectomy. Sarcopenia doesn’t predict either the occurrence or severity of chyle leak. This emphasises the importance of physiological and nutritional optimisation before oesophagectomy.
126: CLINICAL RELEVANCE OF THE TUMOUR LOCATION-MODIFIED LAURÉN CLASSIFICATION SYSTEM OF GASTRIC CANCER IN A WESTERN POPULATION
Authors: Jonathan M , Davies A , Santaollala A , Van Hemelrijk M , Maisey N , Lagergren J , Gossage J , Kelly M , Baker C 
Published: April 2022

Abstract

Background and aim
The Tumour Location-Modified Laurén Classification (MLC) system of gastric cancer combines Laurén histological subtype and anatomical tumour location. It divides tumours into proximal non-diffuse (PND), distal non-diffuse (DND) and diffuse type. The optimum classification of patients with Laurén mixed tumours within this system is not clear, having been grouped with both diffuse and non-diffuse type in previous studies. The clinical relevance of the MLC has not previously been examined in a Western population.

Methods
Cohort study including 404 patients who underwent gastrectomy for gastric adenocarcinoma between 2005–2020. Receiver operating characteristic (ROC) curve analysis was performed to establish the optimal categorisation of Laurén mixed tumours within the MLC when used to predict survival. Survival analysis was performed using Kaplan–Meier and Cox regression.

Results
ROC curve analysis demonstrated higher area under the curve (AUC) for predicting overall survival when Laurén mixed tumours were grouped with non-diffuse rather than diffuse type (0.583 vs 0.569). This classification was therefore used for survival analysis. Distal non-diffuse tumours had the best 5-year survival (64.7% DND vs 56.1% PND vs 45.1% diffuse, P = 0.006) and were least likely to have recurrence (27.0% DND vs 34.3% PND vs 48.3% diffuse, P = 0.001). Multivariable analysis demonstrated the MLC was an independent prognostic factor for survival (PND HR 1.64, 95% CI 1.16–2.32, Diffuse HR 2.20, 95% CI 1.56–3.09).

Conclusion
The MLC was an independent marker for predicting survival in this Western cohort of patients with gastric adenocarcinoma. Patients with proximal non-diffuse and diffuse tumours had worse survival than those with distal non-diffuse tumours.

Table
https://secure.sem-2000.it/semUpload/OLC/file/9203828791100911681076702/94279_Table.jpg.
133: QUALITY OF RECOVERY AFTER SUBTOTAL GASTRECTOMY USING QOR-40
Authors: Feenstra M , Küçükçelebi S , Van Berge Henegouwen M , Hollmann M , Gisbertz S , Daams F , Albersen J , Ten Hoope W , Hermanides J , Eshuis W 
Published: April 2022

Abstract

Background and aim
Gastric cancer surgery highly impacts postoperative quality of life. The Quality of Recovery-40 (QoR-40) is a validated 40-item patient questionnaire, designed to evaluate the quality of recovery after anesthesia. QoR-40 is subcategorized in five dimensions; physical comfort, physical independence, psychological support, emotional state and pain. The aim of this study was to evaluate the quality of recovery after subtotal gastrectomy using the QoR-40 questionnaire and to establish a reference standard for the QoR-40 after gastrectomy to be used in future studies.

Methods
This prospective observational study included all patients undergoing subtotal gastrectomy between January 2020 and December 2020 in the Amsterdam UMC. Primary endpoint was the quality of recovery on day three after surgery, using the Dutch QoR-40. Secondary endpoint was the occurrence of poor quality of recovery (PQR), defined as impairment in 2 or more dimensions, or impairment in the global QoR-40.

Results
27 Patients were included in this study, the median total score of the QoR-40 questionnaire was 184 [IQR 176–192]. Eight patients had a PQR, of whom four patients (50.0%) developed postoperative complications. Furthermore, two patients without PQR developed complications (7.4%). Impairment occurred mainly in dimensions physical comfort, physical independence and emotional state.

Conclusion
This study presents a reference standard for quality of recovery based on the QoR-40 questionnaire in patients undergoing subtotal gastrectomy. PQR may be related to postoperative complications. Future studies should focus on enhancing physical comfort, physical independence and emotional state to improve patient reported quality of recovery.
137: LAPAROSCOPIC DISTAL GASTRECTOMY: JUST AN OPTION OR THE NEW GOLD STANDARD FOR ELDERLY PATIENTS?
Authors: Viganò J , Palmieri F , Peri A , Fugazzola P , De Stefano F , Sargenti B , Pietrabissa A 
Published: April 2022

Abstract

Background and aim
The application of laparoscopy in elderly patients with gastric cancer is controversial, especially in Western population. The aim of the study is to evaluate the feasibility of a laparoscopic approach and compare short-term outcomes with results obtained using traditional open surgery.

Methods
Data concerning 52 elderly patients (≥70 years), who underwent distal gastrectomy at our institution from January 2017 to August 2020, were retrospectively analyzed. We divided the population into two cohorts according to the surgical technique (laparoscopic or open surgery) and we compared the short-term outcomes. The open and laparoscopic cohorts were compared in terms of demographics, ASA score, pTNM stage, the pathological pattern according to Lauren classification, time of surgery, selected type of gastrointestinal reconstruction, the extension of lymphadenectomy and number of lymph nodes resected, postoperative complications classified according to modified Clavien-Dindo system, length of stay (LOS), postoperative mortality within 30 days. Univariate and multivariate analyses were performed for length of stay, including age, sex, duration of surgery, BMI, technique, tumor localization, grading, reconstruction, ASA, Lauren stage, extension of lymphadenectomy, TNM stage, and neoadjuvant chemotherapy as variables.

Results
Demographics, pathological characteristics and surgical outcomes were comparable in both cohorts, except for the length of hospital stay (LOS) that was significative longer in the open cohort (12,31 vs 8,42 P = 0.02). Number of harvested lymph nodes and complete resection (R0) rate were similar, leading to comparable oncological results. Based on the univariate analysis, in addition to the approach, ASA score was another factor significantly associated to LOS (ASA 2 8,4 ± 2,1 days vs ASA 3 13,5 ± 7,8 days). A multiple regression was run to predict LOS from ASA and surgical approach. The multiple regression model statistically significantly predicted LOS, F(3,44) = 6,906, P &lt; 0,002. The surgical approach showed a certain trend to significance in predicting LOS, P = 0,09.

Conclusion
Laparoscopic distal gastrectomy is effective and safe in elderly patients with similar short-term outcomes compared to open distal gastrectomy. The main advantage of laparoscopic technique is a shorter length of hospital stay.
148: LAPAROSCOPIC FUNDOPLICATION FOR PARA-ESOPHAGEAL HERNIA REPAIR IMPROVES RESPIRATORY FUNCTION IN PATIENTS PRESENTING WITH DYSPNEA: A PROSPECTIVE COHORT STUDY
Authors: Bouriez D , Belaroussi Y , Boubaddi M , Martre P , Berger P , Gronnier C 
Published: April 2022

Abstract

Background and aim
Dyspnea in patients with a para-esophageal hernia (PEH) occurs in 7 to 32% of cases and is very disabling, especially in the elderly and its origin is poorly defined. The present study aims to assess the impact of laparoscopic fundoplication (LF) on dyspnea and respiratory function.

Methods
Dyspnea assessment through dyspnea visual analogic scale (DVAS) and modified medical research council score and pulmonary function test (PFT) with plethysmography were performed before and 2 months after LF in all consecutive patients undergoing LF for PEH from January 2019 to May 2021.

Results
All 43 patients included had pre-and postoperative dyspnea assessments and pulmonary PFT. Patients’ median age was 70 years (range 63–73.5 years), 37 (86%) were women, the median percentage of the intrathoracic stomach was 59.9% (range 44.2%–83.0%), the median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significantly (5.6 [4.7–6.7] vs 3.0 [2.3–4.4] P &lt; 0.001), and 37 (86%) patients had a clinically significant decrease inMMRC. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery respectively on average by +11.2% (SD 17.9), +5.0% (SD 13.9), and + 10.7% (SD 14.6).
Subgroup analysis highlighted patients with low preoperative FEV1 were more susceptible to improve it. No correlation was identified between improvement in dyspnea and FEV1. Also, no correlation was identified between the percentage of intrathoracic stomach and dyspnea or PFT parameters improvement.

Conclusion
PEH repair improves dyspnea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnea. Patients with a low preoperative FEV1 are more likely to improve it after LF.
160: PATIENT-TAILORED ALGORITHM FOR POSTERIOR CRUROPLASTY: TECHNIQUE DESCRIPTION AND COMPARISON WITH HIATAL SURFACE AREA
Authors: Sozzi A , Aiolfi A , Lombardo F , Cavalli M , Campanelli G , Bona D 
Published: April 2022

Abstract

Background and aim
Different surgical techniques have been described for laparoscopic crural approximation, ranging from simple suture to mesh reinforced repair. Nowadays, the choice of the most appropriate surgical strategy is left to surgeon experience and lacks of standardization. Our objective is to describe a patient-tailored decisional algorithm based on intraoperative findings and measurements (Table 1). In addition, we aimed to compare this technique with the previously described Hiatal Surface Area (HSA) method.

Methods
Prospective single-center cohort study (November 2015–June 2021). Perioperative outcomes, timing of recurrence, and quality of life were analysed.

Results
Overall, 104 patients were included. Overall, 78 (75.0%) patients underwent simple suture repair (= &lt; 5points) while crural mesh [Phasix ST®-Bard] repair as used in 26 (25.0%) patients (Figure 1). Our patient-tailored algorithm was compared to HSA method in 30 patients, with 93.3% of concordance. Toupet fundoplication was fashioned in all patients. No intraoperative complications occurred. The median postoperative stay was 1.8 days (range 1–7). The overall postoperative complication rate was 3.8%. The median follow-up was 29 months (range 1–58) with 95 patients having a minimum follow-up of 6 months. No mesh-related complication occurred. Recurrent hernia was diagnosed in three patients (2.9%) all managed with PPI. Compared to baseline, the median GERD-HRQL (P = 0.003) was significantly improved.

Conclusion
The application of a ‘patient-tailored’ decisional algorithm is safe and seems effective in the medium-term follow-up. The use of this algorithm may improve procedure reproducibility and standardization. The comparison with the HSA showed a high concordance, even though our algorithm is simpler and more manageable.

Table
https://secure.sem-2000.it/semUpload/OLC/file/9203828791100911681076702/94476_Table.jpg.
198: ROBOTIC ASSISTED TRANS CERVICAL ESOPHAGECTOMY (RACE PROCEDURE): DESCRIPTION OF THE SURGICAL TECHNIQUE AND PRELIMINARY RESULTS
Authors: Capovilla G , Tagkalos E , Berlth F , Froiio C , Hadzijusufovic E , Mann C , Staubitz J , Uzun E , Lang H , Grimminger P P 
Published: April 2022

Abstract

Background and aim
A combined trans-hiatal and transcervical approach to perform esophagectomy has been described in the literature for patients who are not candidates for a transthoracic approach. In this context, the technical limitations of conventional laparoscopy might be overcome by the application of robotic systems such as the DaVinci Xi. We aimed at describing the technical details and the feasibility of our technique for the robotic-assisted trans-cervical esophagectomy (RACE) and a preliminary case series.

Methods
In the abdominal phase the DaVinci Xi is docked using the standard 5-trocar configuration used for Ivor-Lewis esophagectomy. After gastric mobilization, tubulization and D2 lymphadenectomy, the dissection is advanced trans-hiatally until the tracheal carina. Infra-tracheal lymph-node dissection is normally feasible from the abdomen. A left cervical incision and neck lymph node dissection are performed, the esophagus is encircled. The robot is docked at the neck using a gel port with a 3-trocar configuration and an assistant-trocar for suction. The upper mediastinal preparation starts by dissecting the esophagus from the mediastinal pleura bilaterally, the pars membranacea anteriorly and the aortic arch proceeding caudally. Dissection of the left recurrent laryngeal nerve (l-RLN) lymph nodes can be achieved; care should be taken to avoid nerve injuries. Proceeding caudally, the tracheal dissection is advanced to the left bronchus. The azygos vein is encountered at the right tracheobronchial angle. Dissection of bronchial lymph nodes is performed bilaterally, the plane is connected to the previous abdominal plane. After retrieval of the specimen an end-to-side circular stapled anastomosis is performed at the neck.

Results
The procedure was completed in 4 patients with mid-esophageal squamous cell carcinoma who were not candidate for a trans-thoracic approach due to cardio-pulmonary comorbidities. Median hospital stay was 14 (9–18) days, median ICU stay was 4 (1–6) days. Left vocal cord palsy requiring rehabilitation therapy occurred in 2 patients (50%). No postoperative mortality was recorded. R0 resection was achieved in all patients with a median of 19 (15–22) retrieved lymph nodes.

Conclusion
RACE using the robotic system is feasible and provides an adequate surgical radicality. The procedure is safe, although the rate of RLN injury is higher.
Polymicrobial interaction in biofilm: mechanistic insights
Authors: Kulshrestha Anmol , Gupta Pratima 
Published: April 2022

Abstract
Polymicrobial biofilm (PMBF) formation during multispecies infection is a serious threat growing worldwide. According to CDC, microbial biofilm infection covers more than 65% of total infection. In many diseases, their natural habitat does not have one causative agent because most of the species exist in coaggregation (such as in cystic fibrosis, otitis media, and dental caries) leading to PMBF. PMBF is a big problem in bacterio-fungal and interspecies bacterial diseases that developed during chronic illness and created a major health burden globally. This review focused on various aspects of PMBFs such as why they are forming PMBF arrangements, the significance of studying these biofilms, and the interaction between causative microbes. Also, we reviewed how these interactions and polymicrobial formations make biofilms more recalcitrant toward treatment. Understanding the mechanistic process behind these biofilm formations gives an insight into specific molecules, proteins responsible for their polymicrobial nature, which is likely to be very helpful in antimicrobial research.
Neem-Based Insecticides Deter Oviposition Activity in Spotted Wing Drosophila (Diptera: Drosophilidae) in Sweet Cherries
Authors: Gyawaly Sudan , Rijal Jhalendra 
Published: April 2022

Abstract
Spotted wing drosophila, Drosophila suzukii (Matsumura), is an important invasive insect pest in the United States. Spotted wing drosophila females have serrated ovipositor that enables them to deposit eggs inside healthy, ripening softskinned fruits. In many berry and fruit crops, spotted wing drosophila is primarily controlled using synthetic insecticides in the organophosphate, pyrethroid, and spinosyn groups. However, alternative, reduced-risk insecticides with short residuals are necessary to minimize the possibilities of insecticide resistance and address other negative effects of synthetic insecticides. Neem-based products as alternative plant-based insecticides have antifeedant, repellent, antiovipository, and molting interference effects on insects and have been shown to affect the oviposition activities of some tephritid flies. We conducted laboratory studies to evaluate the oviposition deterrent activities of selected neem-based insecticides that contain either azadirachtin, or CHENO, or a combination of both, on spotted wing drosophila using sweet cherry in California. The results of the study showed that some of the neem oil products could reduce the degree of spotted wing drosophila oviposition by half compared with the control.