bluuebunny/crossref_metadata_2025_split huggingface dataset:
484. UPFRONT SURGERY VERSUS PREOPERATIVE TREATMENT FOR PATIENTS AGED 80 YEARS OLDER WITH ESOPHAGEAL CANCER
Authors: Sakurai Toru , Utsunomiya Daichi , Kubo Kentaro , Kanematsu Kyohei , Kurita Daisuke , Ishiyama Koshiro , Oguma Junya , Daiko Hiroyuki 
Published: September 2022

Abstract
In recent years, with the aging of the population, there have been more opportunities to operate on very elderly esophageal cancer patients over the age of 80.
The safety of neoadjuvant chemotherapy has become the standard, but for very elderly patients is not clear. In our hospital, it is selected if general condition is acceptable. This time, we examined cases of very elderly esophageal cancer patients aged over 80 years performed esophagectomy at our hospital.
The subjects were 28 patients aged 80 years or older who underwent esophagectomy at our hospital for advanced esophageal cancer from January 2017 to December 2020.
A retrospective study was performed by dividing into the upfront surgery group (S) and the preoperative treatment group (Neo: neoadjuvant chemotherapy group, preoperative chemoradiation group, salvage surgery group).
The primary endpoints were recurrence rate and recurrence-free survival (month), and the secondary endpoints were preoperative adverse event incidence, R0 achievement rate, and perioperative complication rate in the preoperative treatment group.
Median age is 82 years (range: 80-89 years). S/Neo= 21/7 cases. Chemotherapy were DCF: 1 case, FOLFOX: 2 cases, FP: 2 cases, CDDP + VP: 1 case. Preoperative adverse event incidence of Grade 3 or higher was 14.2%. The R0 achievement rate was 90%/100% (S/Neo, p= 0.442; t-test). Perioperative complications rate of Clavien-Dindo IIIa or higher was 33.3%/71.4% (S/Neo, p= 0.083; t test). The recurrence rate was 57.1%/14.2% (S/Neo), which were significantly lower in the Neo than in the S(p= 0.049; Logistic regression model). The median recurrence-free survival was 13 months in the S and 10 months in the Neo.
It is necessary to select a treatment method that balances curative and postoperative QOL for the elderly based on organ function, tumor factors, social background, etc. Since it is difficult to use CDDP for very elderly patients, FOLFOX is the first choice at our hospital. Operation techniques such as less invasive mediastinoscopic and two-staged surgery are selected. From the results of this study, preoperative treatment may reduce the recurrence rate.
488. RADIOFREQUENCY ABLATION OF LOW-GRADE DYSPLASIA IS COST-EFFECTIVE FOR PATIENTS WITH LONG-SEGMENT BARRETT'S OESOPHAGUS
Authors: Vissapragada Ravi 
Published: September 2022

Abstract
Barrett’s oesophagus is a precursor to oesophageal adenocarcinoma (OAC), which can be lethal if found at late stages. Stages of Barrett's oesophagus are generally divided into non-dysplasia or dysplasia. There is little doubt that patients with high-grade dysplasia require endoscopic intervention, usually with ablative techniques. Endoscopic treatment of low-grade dysplasia (LGD) has been more controversial, however. Our main aim was to improve cost-effectiveness of LGD ablation using length of Barrett's oesophagus to select high-risk individuals.
A cost-utility analysis was undertaken using a Markov cohort model, which simulated progression and regression of non-dysplastic Barrett’s oesophagus (NDBE) to EAC (cycle length of 6 months, time horizon of 35 years). Health states included: NDBE, regression of metaplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), EAC, and death. Cost pertaining to investigations and treatments were sourced from local health network. Quality-adjusted life-year (QALY) data were taken from literature values. Initial estimates of transition probabilities between health states were derived from literature and calibrated to lifetime risk of HGD and OAC using standardised methodology. One-way and probabilistic sensitivity analysis were conducted.
Several strategies (39 total) were tested in this cost-utility analysis and were broadly divided into selective (length-based) or non-selective LGD ablation. In addition to LGD ablation, surveillance intervals for NDBE were altered to improve cost-effectiveness. In non-selective group of strategies, only 1 was found to be cost-effective, whereas 24 of 28 length-based LGD ablation strategies were found to be cost-effective (at a willingness to pay threshold of AU$50,000/QALY). Probabilistic analysis (1000 simulations) showed that exclusion of individuals with short segment Barrett's oesophagus (SSBE) from surveillance with ablation of LGD in long-segment Barrett's oesophagus (LSBE) was the most cost-effective strategy (AU$33,031/QALY).
Patients with long-segment Barrett's oesophagus are at significantly higher risk of progression to adenocarcinoma. Results of this study indicate reducing endoscopic surveillance for SSBE with routine surveillance for LSBE with ablation of LGD when detected is cost-effective in 100% of the simulations. Several studies in recent years have shown similar results. Thus ablation of LGD in Barrett's oesophagus requires serious consideration, especially for high-risk individuals.
498. MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER AND A HISTORY OF LIVER TRANSPLANTATION: A LITERATURE REVIEW AND CASE SERIES
Authors: Uzun Eren , Grimminger Peter 
Published: September 2022

Abstract
The survival after liver transplantation is continually improving. With evidence of an increased risk of de-novo malignancies after liver transplantation, it is urgent to improve the treatment of an esophageal cancer in patients with a history of liver transplantation. With this study we wanted to show a case series of totally minimally invasive Esophagectomy for patients with a history of liver transplantation, as well as an literature review.
We performed a systematic literature review according to the PRISMA guidance to identify the documented cases of an operative procedure in patients with a history of liver transplantation. Baseline characteristics, tumor stages as well as operative and postoperative management is compared with the case series of 2 cases operated minimally invasive in our center.
Seven studies were identified, with a total of 15 patients who underwent esophagectomy after liver transplantation. In 67% of the cases, including our two patients, alcohol associated liver cirrhosis was the indication for the liver transplantation. All reported cases proceed an open surgical approach for the Esophagectomy, except for 1 case with an open abdominal approach and a thoracoscopic chest procedure. The two cases in our center underwent a totally minimally invasive esophagectomy. The mean length of stay in the hospital was 21.5 days, compared to 8 and 14 days in our presented cases.
The importance of an optimal treatment of esophageal cancer after liver transplantation is evident. With this case series we showed that it is technically feasible to proceed a total minimally invasive Esophagectomy for patients with a history of liver transplantation in a curative intention. For a successful and radical treatment of malignancies after liver transplantation a multidisciplinary procedure is necessary.
503. TOTAL ESOPHAGECTOMY AND GASTRIC PULL UP FOR POST CORROSIVE ESOPHAGEAL STRICTURE: FEASIBLE IN MOST CASES WITH EXCELLENT OUTCOME
Authors: Ezz Reda , Sabry Karim 
Published: September 2022

Abstract
Post corrosive esophageal stricture represent a big national problem in Egypt because of bad culture of using (POTASH K2CO3) a highly corrosive substance for washing clothes with accidental (children) or sometimes suicidal (adult) swallow of this corrosive substance.
Extensive esophageal stricture resulted is the late consequence of such swallow with complete or partial dysphagia leading to severe malnutrition and death of many patients. Dilation was successful in mild cases and many other cases required surgery.
We present our new surgical strategy in managing 96 cases of post corrosive esophageal stricture including early feeding jejunostomy as well introduction of MI technique.
From January 2016 to January 2022 ,96 cases of failed dilation post corrosive esophageal stricture were included in the study. Three- fields total esophagectomy and gastric pull up with cervical stapled esophago-gastric anastomosis was the operation used for all cases. Pyloroplasty and feeding jejunostomy were done for all cases We followed the cases for development of any complications (leak, bleeding, respiratory problems and stricture).
Laparoscopy was used in 49 (51%) cases and was successfully completed in 42cases (86%). Right thoracotomy and left cervicotomy were used in all cases. Mean operative time was 368 minutes. Early complications were in the form of leak: cervical 12 cases (12.5%), from pyloroplasty 3 cases (3%). All cases managed conservatively. Only one pyloroplasty leak required exploration. Bleeding occurred in 5 cases (5%) and managed conservatively. Respiratory problems occurred in 37 cases (39%) requiring prolonged intubation in 3 cases (3%). Postoperative dysphagia was noted in 9 cases (9%) due to anastomotic stricture managed by dilation. No mortality recorded.
Our short- and long-term results of total esophagectomy and gastric pull up for post corrosive esophageal stricture are excellent with low morbidity and no mortality.
505. OUTCOMES AFTER ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY: REVIEW OF 1000 PATIENTS IN A SINGLE CENTER
Authors: Yang Yang , Li Chunguang , Li Zhigang 
Published: September 2022

Abstract
Robot-assisted minimally invasive esophagectomy (RAMIE), an increasingly adopted surgical approach, has been demonstrated with higher surgical efficiency and better lymph node dissection than thoracoscopic minimally invasive esophagectomy (MIE) in the Phase III RAMIE trial. We present the safety and feasibility of RAMIE for the surgical treatment in a large group of patients.
We reviewed 1000 consecutive patients undergoing RAMIE between November 2015 to March 2022 in our institution. Demographic data, intraoperative parameters, and postoperative outcomes including length of hospital stay, morbidity and mortality were assessed. The primary endpoint of the study was operative (30-day) mortality.
Squamous cell carcinoma accounted for 93.8% of all diseases. Most tumors were located in the mid-thoracic esophagus (46.3%) and clinically staged as T2 and T3 (87.4%). The proportion of preoperative therapy was 33.4% All patients received total robot-assisted thoracoscopic-laparoscopic esophagectomy, except for 49 planned hybrid surgery (thoracoscopy or laparotomy). The rate of conversion to open surgery was 3.2% and R0 resection was 96.8%. Overall postoperative complications occurred in 45.2% of patients (C-D grade III: 10.3%) including pulmonary complications (8.6%), anastomotic leakage (8.2%), and vocal cord paralysis (22.4%). Median length of hospital stay was 11 days and 30-day mortality was 0.5%.
RAMIE resulted in acceptable surgical results, postoperative outcomes and low mortality, which can be performed safely with good results in an experienced center.
506. MANAGEMENT OF POST INTUBATION TRACHEO-ESOPHAGEAL FISTULA. HOW, WHEN AND WHY TO FACE OFF A POTENTIALLY FATAL INJURY
Authors: Russo Emanuele , Caronia Francesco Paolo , Guggino Gianluca 
Published: September 2022

Abstract
Post-orotracheal intubation tracheal injuries are rare but potentially fatal events. The data in the literature show differences in incidence for single-lumen and double-lumen tube intubations. Esophageal involvement may evolve into mediastinitis with poor prognosis. Treatment depends on the location of the lesion, size, extent and the patient's status. Timing and multidisciplinary team evaluation is mandatory for best decision.
In a multi-centric observational study between January 2018 and December 2021 we observed 6 consecutive patients with iatrogenic post oro tracheal intubation tracheo-esophageal laceration underwent to multidisciplinary management.
4 patients were treated with end-to-end tracheal resection and anastomosis and closure of the esophageal fistula with cervicotomy access + interposed muscle flap without esophageal exclusion
1 patient was treated with tracheostomy and anterior fistula repair with cervicotomy access + esophageal exclusion
1 patient was treated conservatively for poor performance status. Surgical treatment was within 12 hours from diagnosis.
30-days mortality was observed in one case.
Post-orotracheal intubation tracheal injuries are rare but potentially fatal events. Fast and multidisciplinary decision with aggressive treatment are the goal to improve results and reduce mortality.
513. RISK FACTORS OF CERVICAL LYMPH NODE METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA AND ESTABLISHMENT OF RISK PREDICTION MODEL
Authors: Gong Taiqian 
Published: September 2022

Abstract
Cervical lymph node metastasis of esophageal squamous cell carcinoma (ESCC) is an important basis for lymph node dissection of ESCC. Now, there are still disputes about whether to perform two field lymph node dissection or three field lymph node dissection. Establishing prediction model by analysis big data could promote the accuracy of prediction of cervical lymph node metastasis in patients with ESCC which can help clinicians to select individualized surgical scheme for patients
The clinical data of 102 consecutive patients with ESCC who underwent radical esophagectomy and three-field lymph node dissection between September 2015 to December 2021 were retrospectively analyzed. They were divided into positive group and negative group according to cervical lymph node metastasis. The differences between the two groups were compared, and after the univariate analysis those who were statistically significant were included in multivariable logistic regression analysis to establish the risk prediction model and plot a nomogram by software R.
Among the 102 patients, univariate analysis (P&lt;0.2) indicated that cervical lymph node metastasis of ESCC was related to the distance from upper edge of the tumor to the incisors (P=0.085), vascular invasion (P= 0.141) and recurrent laryngeal nerve lymph nodes metastasis (P = 0.157). Multivariate logistic regression analysis showed that the distance from upper edge of the tumor to the incisors (P=0.153) and the vascular invasion (P=0.198) were independent risk factors. The AUC of ROC curve is 0.682 (95% confidence interval: 0.578-0.786) and the Youden index is 0.294, 95% CI (0.620, 0.742).
The prediction model includes two variables: the distance from upper edge of the tumor to the incisors and the vascular invasion. It plays a certain role in predicting the risk of cervical lymph node metastasis of ESCC, and can assist doctors in individualized treatment for patients with ESCC.
519. CLINICAL OUTCOMES OF ESOPHAGECTOMY IN ADVANCED AGE PATIENTS – A PROPENSITY SCORE MATCHING STUDY IN A LOCAL INSTITUTE
Authors: So Choi Kwan , Lam Chin Tou , Cheung Siu Hong , Chow Tam Lin 
Published: September 2022

Abstract
Esophagectomy for esophageal cancer is associated with high operative morbidity and mortality. While more patients diagnosed with esophageal cancer in advanced age, current study was to address the feasibility and safety of esophagectomy for advanced age patients.
Total 62 patients who underwent esophagectomy from 2017-2021 were recruited from local institute database. These patients were divided into 2 groups: group I (age &lt;70), group II (age ≥70). Propensity score matching (PSM) analysis was performed with patient baseline demographics, tumour characteristics, and operation details. After PSM, 19 patients on each arm were identified. Primary outcome was major surgical morbidity rate (Clavien-Dindo Grade ≥3). Secondary outcomes included perioperative parameters, length of hospital stay, short-term mortality and overall survival.
The perioperative outcomes included day to resume oral feeding and mobilization were similar between two groups. There was a trend toward higher rate of chest infection (5.3% vs 26.3%, p=0.180) in group II. The length of hospital stay was significantly longer in older age group as well (9 days vs. 13 days, p=0.032). Nevertheless, there was no statistically significant difference in major surgical morbidity rate (10.5% vs. 5.3%, p=1.000) and 30-day mortality rate (0% vs. 5.3%, p=1.000) between two groups.
Esophagectomy was safe and feasible in selected advanced age patients with good performance status. There was no increase in major surgical complication rate and short-term mortality.
oldage.xlsx (could not be inserted)
534. CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: DO WOMEN RESPOND BETTER THAN MEN?
Authors: Abdulrahman Maan , Abdulrahman Rand , Kumar Nitya , Corbally Martin , Walsh Thomas 
Published: September 2022

Abstract
The incidence of esophageal cancer is higher in men, with evidence that men present at a more advanced stage. Randomized trials of neoadjuvant treatments have hitherto not stratified for gender, but it is unclear whether the response to neoadjuvant chemoradiotherapy (NeoCR) and outcome is similar for both genders. The aim of this study is to compare presentation, response to treatment and survival of esophageal cancer between men and women.
A prospectively maintained database of 205 patients (143 males; 70%) diagnosed with esophageal carcinoma and treated with curative intent (definitive chemoradiotherapy, neo-adjuvant chemoradiotherapy followed by surgery or surveillance, or surgery alone), between 1998 and 2019 at one teaching hospital, was interrogated for impact of gender on response to treatment (complete versus incomplete clinical response) and survival.
Of 36 females who had NeoCR, 28 (78%) had a complete clinical response, compared to 52 of 116 males (45%). The complete pathological response rate was 21 of 36 (58.3%) of females compared to 31% of men (P&lt;0.001). Controlling for age, stage at diagnosis, and type of therapy, females survived significantly longer than males [HR 0.72 CI 0.53-0.98 (p=0.038)].
Our results suggest a gender difference in response to chemoradiotherapy, which is reflected in outcome and survival. It is suggested that future randomized trials of neoadjuvant and indeed adjuvant therapy stratify for gender which may impact on management guidelines.
541. DO WE NEED ANOTHER QUESTIONNAIRE FOR GASTRO-ESOPHAGEAL REFLUX DISEASE? PRELIMINARY ANALYSIS OF A NEW QUESTIONNAIRE
Authors: Zanoni Andrea , Marchetti PierPaolo , Torroni Lorena , Vesentini Roberta , Lauro Enrico , Casella Francesco , Guerzoni Giacomo , Alessandro Carrara , de Manzoni Giovanni , Verlato Giuseppe 
Published: September 2022

Abstract
Gastroesophageal reflux is a very frequent condition and different questionnaires to describe it have been proposed overtime. Nevertheless available questionnaires don’t allow to fully describe all different aspects of the disease.
The aim of this study was to validate a new questionnaire (RoRex) on gastroesophageal reflux disease.
The RoRex questionnaire was administered via web in two Italian centres, Rovereto and Verona, to patients attending specialized gastrointestinal surgical units, and to volunteers. Up to now, 54 patients and 50 volunteers participated in the study. Median age was 52 years (range 23-75 years) in patients and 47.5 years (range 25-80 years) in volunteers. Women were more prevalent than men in both groups (57% and 56% respectively).
The RoRex questionnaire comprises 15 questions, where symptoms are scored on a frequency base: no, sometimes, several times per week, every day. Information on smoking habits, alcohol use, diet was also collected.
The two groups largely differed as regards major symptoms. Regurgitation, heartburn, epigastric pain, retrosternal pain, laryngospasm were reported several times per week/every day in 50%, 39%, 30%, 22%, 23% of patients and 9%, 11%, 7%, 7%, 0% of volunteers.
Preliminary analysis showed a different pattern in principal components between patients and volunteers. The 1st component, comprising heartburn and epigastric/retrosternal pain, was similar in both groups. The 2nd component comprised reclage, peevish cough, hoarseness in patients, and postnasal drip, hoarseness, dysphagia in volunteers. The 3rd component included regurgitation/laryngospasm in the former and peevish cough/belching in the latter.
The new questionnaire, based on symptom frequency, allows to distinguish among major symptoms, i.e. heartburn/pain, upper airways irritation, and regurgitation in patients suffering from gastroesophageal reflux disease. These results, as well as the comparison of RoRex questionnaire with already validated ones and its usefulness as a screening tool in the general population, will be verified in larger samples.
545. THE NATURE, SEVERITY AND IMPACT OF CURATIVE OESOPHAGEAL RESECTION FOR OESOPHAGEAL CANCER ON SWALLOWING THROUGHOUT SURVIVORSHIP: PRELIMINARY FINDINGS
Authors: Gillman Anna , Reynolds John V , Hayes Michelle , Walshe Margaret , Regan Julie 
Published: September 2022

Abstract
Survivors of curative oesophageal resection for oesophageal cancer present with oropharyngeal and oesophageal dysphagia for many years following surgery. Few studies have explored the presentation of oropharyngeal dysphagia throughout survivorship or its impact on swallow-related quality of life (QoL). This prospective observational study investigated 1) the nature, severity and QoL impact of transhiatal, 2 stage and 3 stage surgeries on swallowing at least 12 months post-operatively, and 2) relevant surgical and clinical associations.
Seventeen adults were recruited from a national centre for oesophageal cancer, including 14 males, 3 females (mean age = 62.59+/-10.44 years), who were a mean of 35.12 months (+/- 23.03) post curative oesophageal resection. Participants were assessed using videofluoroscopy (rated via MBS Impairment Profile), the EORTC-QLQ-OES-18 and Reflux Swallow Index (RSI) between November 2021 and March 2022. The Functional Oral Intake Scale (FOIS) was used to evaluate oral intake status. Bivariate analysis was conducted to investigate associations between the surgical approach, time since surgery, presence of dysphagia, altered diet, reflux, and QOL.
Participants presented with reduced laryngeal elevation (100%), delayed pharyngeal swallow initiation (94.2%), reduced hyoid movement (88.2%), reduced UES opening (70.7%) and oesophageal retention (89%). Mean MBS Imp Total Oral and Pharyngeal Scores were 5.41+/-2.58 and 7.53+/-2.6 respectively. 3 participants penetrated food/fluids (PAS mean 1.24 +/-.56). Mean FOIS, RSI and EORTC scores were 6.53+/-.514, 8.47+/-10.17 and 37.59+/-9.17 respectively. Surgical approach was associated with altered diet (FOIS) (p = 0.039). Time since surgery was associated with pharyngeal dysphagia (Total Pharyngeal Score (p = 0.023)), QOL was associated with altered diet (p= 0.038), RSI (p &lt;0.001) and reduced anterior hyoid excursion (p= 0.046).
This preliminary study found that 1) all participants presented with an element of oropharyngeal dysphagia and 2) there are significant associations between surgical elements and oropharyngeal dysphagia, and between quality of life and altered diet, reflux, and hyoid movement. Further research and improved clinical practices are therefore required to minimise the severity of dysphagia experienced, to manage this chronic dysphagia throughout survivorship, and to ultimately reduce the impact it has on survivors.
556. MANAGEMENT OF INTRAOPERATIVE TRACHEAL TEAR DURING ESOPHAGECTOMY
Authors: Thammineedi Subramanyeshwar Rao , Shukla Srijan , Patnaik Sujit Chyau 
Published: September 2022

Abstract
Tracheal tears are serious complications of esophagectomy
With limited options available in a potentially unstable patient, timely management is a must
Using minimal access skills and endosuturing, an experienced surgeon can tackle this surgical emergency with primary repair
Adjunct step of omental wrapping can be added to buttress this repair
55 year gentleman with middle 1/3rd esophageal SCC post CROSS protocol neoadjuvant chemoradiation
Underwent thoracic dissection thoracoscopically with no events
During neck dissection, while looping the cervical esophagus, there is a sudden gush of air with fall in Oxygen saturation
Following is the video of how the surgical and anesthestic team handled the situation.