bluuebunny/crossref_metadata_2025_split huggingface dataset:
474. ESOPHAGEAL CANCER SURGERY AND ITS CHALLENGES: A STEP AHEAD WITH THE INTRODUCTION OF ROBOT-ASSISTED SURGERY
Authors: Noma Kazuhiro , Hashimoto Masashi , Maeda Naoaki , Tanabe Shunsuke , Shirakawa Yasuhiro , Fujiwara Toshiyoshi 
Published: September 2022

Abstract
We introduced robot-assisted thoracoscopic surgery for esophageal cancer surgery in 2018 and have performed 143 cases so far. Compared with thoracoscopic surgery, robot-assisted surgery is overwhelmingly more stable and precise, however there are concerns about the safety because there is no sensation from the forceps. Here, we will show a video of a standardized procedure utilizing the characteristics of da Vinci and its application to advanced cancer, and discuss the safe use of da Vinci.
We compared the short-term outcomes of pretreatment cStage ≤ II (n=40) and cStage ≥ III (n=53) in a total of 93 single-operator cases out of 143 da Vinci esophageal operations performed at our department since 2018.
For all patients, thoracoscopic time: mean 227 minutes, blood loss: 185 ml, recurrent nerve palsy: 15 patients (16.1%), postoperative hospital stay: 29.4 days, R0 surgery achievement rate: 96.8%. By stage (cStage ≤ II vs. ≥ III), thoracoscopic time: 211 vs. 240 minutes (p&lt;0.05), blood loss: 171 vs. 195 ml (p=0.5), paralysis: 22.5 vs. 11.3% (p=0.17), postoperative hospital stay: 27.4 vs. 30.8 days (p=0.2). Although thoracoscopic time was significantly longer in the advanced cancer group, there was no difference in blood loss or hospital stay between the two groups, and paralysis was less common.
We focused on the effectiveness of robot-assisted thoracoscopic esophageal surgery for advanced cancer. Although robot-assisted surgery tends to take a relatively long time, we believe that it can be performed safely and effectively even for advanced cancer by careful surgical manipulation.
478. ENDOSCOPIC RESECTION OF A HUGE ESOPHAGEAL LIPOSARCOMA WITH LIGASURE INSTRUMENT
Authors: Su Ying-Chieh , Fong Yao , Chen Chao-Kun 
Published: September 2022

Abstract
Esophageal liposarcoma is a very rare pedunculated tumor of esophagus. It may cause progressive dysphagia due to mass effect and sudden death due to tumor suffocation. Surgical resection is challenging due to peduncle usually located at the superior esophageal sphincter region. We introduce a novel approach method that can transect the tumor peduncle safe and easy.
Review of the chart of Chimei Medical Center.
One 70 year old man with progressive dysphagia for 5 months and body weight loss over 8 KGs. A huge tip necrotic pedunculated tumor was found with endoscopy. Cut off the tumor peduncle with ligasure instrument under endoscopic guide was performed and the tumor was removed successfully. No tumor recurrence was found in 2 years.
Esophageal liposarcoma is a rare low grade malignancy of esophagus. Ligasure cut off the tumor peduncle can make a clear cut margin and avoid perforation or stenosis of esophagus.
480. OUTCOMES OF ADJUVANT LOCAL TREATMENT AFTER ESOPHAGEAL SURGERY WITH POSITIVE RESECTION MARGIN IN INTRATHORACIC ANASTOMOSIS
Authors: Son Jongbae , Jeon Yeong Jeong , Lee Junghee , Park Seong Yong , Cho Jong Ho , Kim Hong Kwan , Choi Yong Soo , Shim Young Mog 
Published: September 2022

Abstract
Esophageal cancer is aggressive diseases requiring surgery as an essential part of treatment. To achieve increased overall survival, complete resection (R0) is preferred. In some case, however, we encounter positive resection margin (R1).
Further resection will be required, but sometimes it is difficult to do additional procedure because of various reasons, especially the highest location of anastomosis.
Hypothesis of study is that R1 resection with adjuvant local therapy shows comparable result with R0 resection in intrathoracic anastomosis
From 2000 to 2017, total 2723 patients received the esophagectomy and mediastinal lymph node dissection for esophageal cancer. R0 resection was 1701, and R1 resection was 76 patients. Patients who received distal esophagectomy (n=56) and lack of information about adjuvant therapy (n=24) were excluded
Because of differences in some variables, we conducted 2:1 propensity score matching to reduce differences between groups.
Comparison of R1 resection group with adjuvant local therapy to R0 resection group is conducted
Overall survival (OS) and recurrence free survival (RFS) were estimated with Kaplan-Meier method.
76 patients were identified with R1 resection. Of those patients, 30 patients showed positive proximal resection margin from frozen section during surgery.
When compared to R0 resection group (including patients with adjuvant treatment), OS and RFS were statistically lower in R1 resection group (p=0.03 and 0.023, respectively)
When comparing R1 with adjuvant local treatment group to R0 resection group, there were no statistical differences in both OS and RFS.(p=0.13 and 0.22, respectively)

In R1 resection group, adjuvant local treatment group show favorable result compared to non-local treatment group, but there were no statistical differences in OS and RFS.(p=0.26 and 0.17, respectively)
R1 resection with proper adjuvant local treatment enable us to achieve comparable result with R0 resection group in intrathoracic anastomosis
When anastomosis is made at the highest level of thorax (i.e. thoracic inlet level), it is not easy to perform additional intrathoracic resection.
If it is difficult to do further resection when resection margin is positive, adjuvant local treatment after surgery can be one reasonable option to improve patient’s survival or minimize disease recurrence
487. THE OUTCOME OF NIVOLUMAB THERAPY FOR PLATINUM-RESISTANT UNRESECTABLE ADVANCED OR RECURRENT ESOPHAGEAL CANCER
Authors: Kanamori Kohei , Tajima Kohei , Yatabe Kentaro , Shoji Yoshiaki , Yamamoto Miho , Kazuno Akihito , Koyanagi Kazuo 
Published: September 2022

Abstract
In a phase III study, nivolumab treatment significantly prolonged survival compared with taxanes in patients with unresectable advanced or recurrent esophageal cancer who had become intolerant to first-line chemotherapy with 5-FU and platinum-based agents. We will report our experience and results of treatment with nivolumab at our hospital.
The subjects were 46 patients treated with nivolumab for unresectable advanced or recurrent esophageal cancer at our hospital from January 2019 to December 2021. Clinical factors and treatment effects were investigated.
The initial response was PR in 12 cases, SD in 18 cases, PD in 12 cases, and unevaluable in 4 cases. Median duration of nivolumab treatment was 3 months (1-18 months). Adverse effects grade 3 were found in 9 cases and grade 2 in 9 cases. Nivolumab was discontinued in 5 cases (10.8%) due to adverse effects.
Compared between cases who discontinued nivolumab within 2 months due to ineffectiveness or adverse effects and those who were able to continue for more than 2 months, overall survival was significantly prolonged in the latter group (median OS: 23.8 vs. 36.8 months, p=0.05).
In patients with unresectable advanced or recurrent esophageal cancer who responded to nivolumab, it was suggested that the drug may improve prognosis. The incidence of unsustainable adverse effects is relatively high, and it is important to control adverse effects.
496. THE OUTCOMES OF NIVOLUMAB FOR ESOPHAGEAL CANCER RECURRENT PATIENTS AFTER NAC-DCF THERAPY
Authors: Hashimoto Masashi , Noma Kazuhiro , Maeda Naoaki , Tanabe Shunsuke , Shirakawa Yasuhiro , Fujiwara Toshiyoshi 
Published: September 2022

Abstract
Cancer immune therapy is the most prominent topic in esophageal cancer. The attraction-3 trial showed that nivolumab was associated with a significant improvement in overall survival versus chemotherapy. This trial was well designed, including patients unresectable, after surgery, and after chemoradiotherapy. However, there are few reports limited to the recurrence after surgery. Here we report the outcome of Nivolumab for the recurrence after surgery with docetaxel, cisplatin, and 5-FU neoadjuvant chemotherapy (NAC-DCF).
The subjects were esophageal cancer recurrent patients after NAC-DCF, except for the cases performed only best supportive care, in Okayama University Hospital between January 2014 and October 2021, excepted the cases performed only best supportive care. We assessed their background characteristics, treatment details, immune-related adverse events (irAE), and overall survival (OS).
17 patients received therapies, including Nivolumab (Nivo). 41 patients received other chemotherapies (Control). There was no significant difference in gender (Nivo: male 88%, Control male 80%), age (Nivo: 68.1±8.9, Control: 65.1±5.6), and the period from surgery to recurrence (Nivo: 5.7±3.8 months, Control: 6.1±3.7 months). The Median overall survivals were 27±7.0 months and 18±2.5 months (P=0.055, Log Rank test). The major irAEs were reported in 4 cases (ACTH deficiency: 1 event, enterocolitis: 1 event, liver dysfunction: 2 events).
Nivolumab improved the outcomes of recurrent patients after NAC-DCF with a bit of tendency.
499. ICG GUIDED THORACIC DUCT CLIPPING FOR CHYLE LEAKS
Authors: Shukla Srijan , Thammineedi Subramanyeshwar Rao , Patnaik Sujit Chyau 
Published: September 2022

Abstract
Chylothorax and chyle leaks in neck are serious complications resulting from trauma or iatrogenic causes.
Early and accurate clipping of thoracic duct is potentially life saving.
ICG can be injected in groin node under USG guidance for fast visualisation and correct clipping of thoracic duct.
On table confirmation and documentation of no lymph flow beyond the clip is feasible.
2.5 mg indocyanine green in injected intranodal via ultrasound guidance.
Near infrared camera is utilised to view fluorescence imaging overlayed over thoracoscopic camera vision.
Groin intranodal injection of ICG yields brilliantly fluorescent illumination of thoracic duct which is especially useful in cases of chyle leaks.
Documentation of correct identification and post clipping termination of lymph flow beyond clip is feasible.
ICG intranodal injection yields excellent visualisation of thoracic duct which is useful in management of chyle leaks.
501. CONVERSATION WITH TISSUE IN UPPER MEDIASTINAL LYMPH NODE DISSECTION PROCEDURES FOR ESOPHAGEAL CANCER
Authors: Shirakawa Yasuhiro , Katsura Yuki , Hashimoto Masashi , Maeda Naoaki , Tanabe Shunsuke , Noma Kazuhiro , Fujiwara Toshiyoshi 
Published: September 2022

Abstract
Advances in the optical instrument for endoscopic surgery have enabled the anatomical recognition of minute membranes and layers previously invisible in open surgery. Those have allowed surgeons to take the benefits of conversing with the tissue. Furthermore, the recent introduction of robot-assisted surgery has made it possible to dissect with fidelity and safety according to the layers envisaged by the surgeon. Furthermore, we are increasingly having conversations with the tissues during the surgery.
Especially in the upper mediastinal lymph node dissection in esophageal cancer surgery, recognizing the delicate anatomy of the membranes and layers is an important technique. We have performed more than 600 thoracoscopic esophageal cancer surgeries in the prone position and more than 100 robot-assisted esophageal cancer surgeries. In our experience, we have tried to formulate the en bloc superior mediastinal lymph node dissection by applying the concept of microanatomy such as a visceral sheath, vascular sheath, and the meso-esophagus surrounded by a visceral sheath.
We have established a technique to detach the visceral sheath from the surrounding organs, release the trachea to reveal the meso-esophagus, and dissect the lymphatic chain in en-bloc while rescuing only the recurrent nerve. The spread of the visceral sheath is not symmetrical. On the left side, it is recognized as a firm membrane up to the aortic arch, but on the right side, it seems to disappear at the cervicothoracic border. This left-right difference is understandable considering the difference in the development of the primitive aortic arch on each side during fetal heart development.
In this study, we report on the technique and outcomes of upper mediastinal lymph node dissection based on the concept of the microanatomy of membranes and layers, which was developed through conversations with tissues in thoracoscopic esophageal cancer surgery, and its application to robot-assisted surgery.
502. CORRELATION OF LYMPH NODE SIZE WITH METASTATIC INVOLVEMENT IN PATIENTS WITH OESOPHAGEAL CANCER
Authors: Dutt Koel , Walmsley James , Jayasurya Philip , Bracey Tim , Ariyarathenam Arun , Berrisford Richard , Humphreys Martyn Lee , Sanders Grant , Wheatley Tim , Chan David SY 
Published: September 2022

Abstract
Accurate assessment of lymph node involvement is vital in the staging and prognostication of oesophagogastric cancers. Radiological lymph node size is an established criterion for metastatic involvement. Enlarged lymph nodes are generally interpreted as metastatic. However, there is little data on the correlation between lymph node size and metastatic infiltration confirmed on histopathology. This study aims to correlate lymph node size in oeosphageal cancer resection specimens with frequency of metastatic involvement.
Regional lymph nodes from oesophagectomy specimens of 32 consecutive patients who had pathologically confirmed N1 disease were analysed from May 2019 to May 2021. The number of positive and negative lymph nodes for each patient were counted. The largest diameter of each positive and negative lymph node was measured. The frequency of metastatic involvement was then calculated and correlated to lymph node size.
A total of 956 lymph nodes from 32 patients were analysed. Median age was 73.5 (48-80) years, there were 28 male and 4 female patients and 30 of them had adenocarcinoma with the remaining 2 reported as squamous cell carcinoma. Of 956 nodes, 94 (9.8%) were found to have metastatic involvement. The median size for the positive lymph nodes was 4.16 mm compared to 3.15 mm for the negative nodes (p=0.20). Ninety two percent of involved nodes were less than 10 mm diameter. Ninety four percent of the reactive nodes also measured less than 10mm (p=0.347).
There was no significant difference in size between metastatic and reactive lymph nodes with the majority of nodes with metastatic infiltration in oesophageal cancer resection specimens measuring less than 10 mm in diameter. Lymph node size is not a reliable indicator of metastatic involvement in patients with oesophageal cancer.
504. LONG-TERM PROGNOSIS AND CAUSES OF DEATH IN CLINICAL STAGE I ESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGECTOMY
Authors: Niihara Masahiro , Yamashita Keishi , Higuchi Tadashi , Chuman Motohiro , Washio Marie , Sakuraya Mikiko , Hiki Naoki 
Published: September 2022

Abstract
For patients with clinical stage (cStage) I esophageal cancer that were not indicated for endoscopic resection, esophagectomy was the standard treatment if surgery was desired. The long-term prognosis after surgical resection of cStage I esophageal cancer was 86.5% of the 5-year survival rate in the results of the JCOG0502 study. The aim of this study was to review the long-term survival the causes of death in cStage I esophageal cancer patients after esophagectomy.
Between January 2004 to February 2021, 138 patients underwent radical esophagectomy for the treatment of cStage I esophageal cancer in our institution. These cases also included non-curative resection cases after endoscopic resection. The patient cohort contained 116 (84 %) males, and 22 (16 %) patients. The median age was 68.5 years (range, 49–82). We estimated long-term overall and cancer-specific cumulative mortality for these patients. In addition, we analyzed the deaths from other causes. The median follow-up period was 52 months.
The 5-year survival rates and cancer-specific survival rate were 82.8% and 87.3%, respectively. There were two surgery-related deaths. Other-cause deaths were observed in 19 patients. The causes were other cancers in 7 patients, respiratory diseases (pneumonia, acute exacerbation of COPD) in 4 patients, heart failure in 1 patient, and unknown in 7 patients. The breakdown of other cancers was cervical esophageal cancer in 1 patient, hypopharyngeal cancer in 3 patients, lung cancer in 2 patients, and malignant lymphoma in 1 patient. Of the 4 patients who were caused by respiratory disease, 3 had recurrent laryngeal nerve palsy as postoperative complication.
The long-term prognosis of cStage I esophageal cancer patients after esophagectomy in our institution was comparable to that of other clinical trials. Head and neck cancer and lung cancer accounted for the majority of deaths due to other causes. In addition, most of the cases caused by respiratory disease had postoperative recurrent laryngeal nerve palsy. It was considered that attention should be paid to aspiration even during outpatient follow-up.
516. MICRONUTRIENT DEFICIENCIES AFTER GASTROESOPHAGEAL CANCER SURGERY
Authors: Blonk Lotte , Gooszen JAH , Fakkert R , Eshuis WJ , Rietveld S , Straatman J , Gisbertz SS , van Berge Henegouwen MI 
Published: September 2022

Abstract
Due to inadequate dietary intake and altered digestion and absorption of nutrients, patients after gastroesophageal cancer surgery are at high risk of becoming malnourished and to develop deficiencies in micronutrients. The goal of this study was to determine the prevalence of specific micronutrient deficiencies during follow-up.
This single center prospective study included patients who underwent resection for esophageal or gastric cancer and were still alive at follow-up between January 2016 and December 2017. All patients in this study were guided by a dietician and dietary supplements or tube feeding was prescribed in case of inadequate dietary intake. Blood samples were examined for possible deficiencies in calcium, ferritin, folic acid, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin D, vitamin E, and zinc. Primary endpoint of this study was the prevalence of specific micronutrient deficiencies.
149 patients after esophagectomy and 32 after gastrectomy were included. After esophagectomy early postoperative deficiencies (&lt;12 months after surgery, measurements performed in 68 patients) and late postoperative deficiencies (≥12 months after surgery, measurements performed in 81 patients) were seen in vitamin D (35.8% and 25.0%) and zinc (22.6% and 16.7%). After gastrectomy vitamin D (47.4%), zinc (29.4%), vitamin B1 (15.8%) and ferritin (15.8%) were found to be deficient &lt;12 months after surgery (measurements performed in 19 patients). Vitamin D (46.2%), zinc (16.7%), vitamin A (15.4%), and ferritin (15.4%) were deficient in the late postoperative period (measurements performed in 13 patients).
This single center prospective study showed that, despite active nutritional guidance, deficiencies in vitamin D, vitamin B1, vitamin A, zinc, and ferritin are prevalent following gastroesophageal resection for cancer and should therefore be routinely checked during follow-up and prophylactic supplementation to prevent deficiencies is indicated.
532. INDOCYANINE GREEN FLUORESCENCE DETECTED THE IMPAIRED BLOOD FLOW IN THE GASTRIC CONDUIT WITH ULCER SCARS: A PROSPECTIVE PRELIMINARY STUDY
Authors: Ichikawa Hiroshi , Muneoka Yusuke , Usui Kenji , Kano Yosuke , Ishikawa Takashi , Hirose Yuki , Miura Kohei , Tajima Yosuke , Shimada Yoshifumi , Sakata Jun , Kosugi Shin-ichi , Wakai Toshifumi 
Published: September 2022

Abstract
We previously identified the presence of peptic or endoscopic submucosal dissection (ESD) ulcer scars in the stomach as a risk factor for anastomotic leakage of esophagogastric anastomosis after esophagectomy. In this study, we investigated the association between peptic or ESD ulcer scars and blood flow at the gastric conduit using indocyanine green (ICG) fluorescence imaging.
We prospectively enrolled 17 patients who underwent cervical esophagogastric anastomosis after esophagectomy for thoracic esophageal cancer (15 men and 2 women with a median age of 70 years). Blood flow in the wall of gastric conduit was evaluated using ICG fluorescence imaging detected by a near-infrared camera system during the operation. The flow velocity of ICG fluorescence in the gastric wall was calculated by dividing the distance (cm) by moving time of ICG fluorescence (second) from the pylorus to the point of final branch of the right gastroepiploic artery.
In 17 patients, four had peptic or ESD ulcer scars in the stomach. One patient with ESD ulcer scars in the lesser curvature side resected during the creation of conduit was included in 13 without ulcer scars. The median flow velocity was significantly lower in patients with ulcer scars than that in patients without ulcer scars (1.15 cm/s vs. 2.17 cm/s, P &lt; 0.01). Anastomotic leakage was occurred only in two patients; one had ESD ulcer scar in the greater curvature side with the velocity of 1.17 cm/s, and one had no ulcer scars with the velocity of 1.67 cm/s.
Peptic or ESD ulcer scars were associated with the impaired blood flow in the wall of gastric conduit. Intraoperative ICG fluorescence imaging is a promising modality to evaluate the risk of anastomotic leakage after esophagectomy.
533. OUTCOMES OF RADIOFREQUENCY ABLATION TO TREAT BARRETT’S OESOPHAGUS: AN IRISH MULTICENTRE STUDY
Authors: Kyle Eimear , Donohoe Claire 
Published: September 2022

Abstract
The standard two-step approach of endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) has shown to be both safe and effective in achieving complete eradication of intestinal metaplasia (CEIM). Despite confidence in the regimen, the long-term sustainability of CEIM has not been well-described, nor has the ideal number of RFA sessions and frequency and length of surveillance. This study used the RIBBON database in Ireland to analyse these factors.
Analysis was performed on 398 eligible patients who underwent at least one session of RFA to treat BE from 2009 to 2021 in major centres across Ireland. Patients included had a minimum of 12 months follow-up (FU), with a total 1433.76 patient-years of FU analysed. CEIM was defined as histological and endoscopic absence of BE at post-RFA FU.
Patient outcomes were categorised according to recurrence status at FU: sustained CEIM, primary recurrence, treatment failure and unknown outcomes. They were also grouped according to the extent of dysplasia using the Vienna Grading System.
Of the 398 patients, 78.14% were male, the mean age at diagnosis was 61.55 years, mean length of Barrett’s segment was 5.36cm, and baseline dysplasia was 19.3% intramucosal carcinoma (IMC), 19% high-grade dysplasia (HGD), 23.3% low-grade dysplasia (LGD) and 37.1% non-dysplastic BE (NBDE). Of these patients, 321 (80.65%) achieved CEIM, at similar proportions. Of those, 67 (20.87%) experienced recurrence over 404.97 patient-years of FU. Further recurrence following subsequent treatment was rare (6 cases). The most common type of recurrence was NDBE (95.64%), and dysplastic recurrence was uncommon (4.36%). The mean time to recurrence was 647.21 days.
The results of this study showed that CEIM was achieved by RFA in the majority of cases, with dysplastic recurrence occurring at a very low rate, equating to significantly reduced disease progression.
There was a significant difference between the mean number of treatments for those who achieved sustained CEIM (4.15) and those who experienced recurrence (3.29). It is clear that some adjustments to the existing treatment and surveillance regimen could result in improvements in outcome.