bluuebunny/crossref_metadata_2025_split huggingface dataset:
273. EVALUATION OF THE RESULTS OF ‘TUBELESS’ ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL CANCER WITHIN AN ERAS PROTOCOL
Authors: de Zadava Lissón Miriam Menéndez Jiménez , Esteban Marcos Bruna , Navarro Fernando Mingol , Urbaneja Francisco Javier Vaqué , Pardo Luis Hurtado , García Alberto Sánchez 
Published: September 2022

Abstract
Classically, esophagectomy used to routinely left chest drains, as well as decompressive nasogastric tube (NGT) and feeding jejunostomy, making the postoperative period slower and more uncomfortable for patients.
Our objective is to evaluate the results of not using tubes and drains (tubeless esophagectomy) in patients with esophageal cancer undergoing McKeown esophagectomy within an ERAS protocol in our center.
Retrospective, descriptive and comparative study of two consecutive groups undergoing McKeown esophagectomy. The first group (P) included 25 patients with tubes and drains (April 2018–August 2019) and the second group (T) 25 patients undergoing tubeless esophagectomy (July 2020–December 2021).
In group P all patients were left with thoracic drainage and jejunostomy and in selected cases abdominal drainage; no patient was left with NGT.
In group T (‘TUBELESS’) no drains or NGT were placed. No jejunostomy was performed except in those patients at high risk of malnutrition, and a phantom jejunostomy was used instead.
Both study groups are comparable in terms of epidemiological characteristics, etiology, preoperative tumor stage and neoadjuvant treatment.
In group P, 86% of the patients underwent or already had a jejunostomy, 100% of the patients were left with a left thoracic drain and 28% with an abdominal drain. None of the patients had a cervical drain or NGT.
In group T no cervical, abdominal or thoracic drain was placed, but 2 patients (8%) underwent a jejunostomy due to high risk of malnutrition.
Table 1 shows the postoperative results. There are no significant differences in 90-day mortality, readmission rate or anastomotic leakage.
Despite the widespread thought of the need for the use of chest drains after esophagectomy, abstention from their use, as well as abstention from the use of decompressive nasogastric tube and feeding jejunostomy (replacing it with the use of a ghost jejunostomy), does not increase morbimortality and improves the postoperative comfort of the patient, as well as the hospital stay.
275. PREOPERATIVE 3D-CT EVALUATION OF THE BRONCHIAL ARTERIES IN TRANSMEDIASTINAL RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Maeda Tomohito , Fujiwara Hitoshi , Konishi Hirotaka , Shiozaki Atsushi , Nishibeppu Keiji , Ohashi Takuma , Kubota Takeshi , Kiuchi Jun , Arita Tomohiro , Shimizu Hiroki , Yamamoto Yusuke , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Otsuji Eigo 
Published: September 2022

Abstract
Transmediastinal radical esophagectomy (TME) is the esophagectomy without thoracotomy that can achieve the mediastinal lymphadenectomy equivalent to transthoracic procedure. Understanding of surgical anatomy in the deep mediastinum near the aortic arch or tracheal bifurcation is essential for the safe procedure. The present study aims to evaluate the bronchial arteries (BAs) with preoperative 3D-CT for TME.
Seventy-nine patients with thoracic esophageal cancer undergoing TME were examined by preoperative 3D-CT to evaluate BA variations in the number, branching pattern, and mediastinal course. For the right BAs (RBAs) crossing the esophagus, the mediastinal courses in transcervical view were classified in relation to the esophagus and tracheobronchi, and compared with surgical findings.
A total of 107 RBAs (1.35/person) were confirmed on preoperative 3D-CT. Of these, 61 (57.0%) crossed the esophagus dorsally (type Ed), and the remaining 46 (43.0%) crossed the esophagus ventrally (type Ev). During the left transcervical procedure, all type Ed RBAs were identified and mostly preserved (57/61, 93.4%) whereas most type Ev RBAs were identified (39/46, 84.8%), but more than half were sacrificed (26/46, 56.5%) for lymphadenectomy. The blood loss during the transcervical procedure was 17.0 ± 55.8 mL. The total number of dissected mediastinal lymph nodes was 23.7 ± 9.3. There were no significant complications related to extensive lymphadenectomy.
Preoperative 3D-CT evaluation is useful to understand the mediastinal courses of BAs specific to the transcervical approach, which may allow BAs to be handled more carefully according to the type during surgery, contributing to a safer procedure in the deep mediastinum.
283. DOES PROTON PUMP INHIBITOR EXPOSURE INCREASE THE RISK OF DEVELOPING EOSINOPHILIC ESOPHAGITIS IN CHILDREN WITH ESOPHAGEAL ATRESIA?
Authors: Tang Tiffany , Leach Steven T , Krishnan Usha 
Published: September 2022

Abstract
Children with esophageal atresia (EA) receive proton pump inhibitors (PPIs) long-term due to gastroesophageal reflux disease susceptibility. They have also demonstrated greater susceptibility to eosinophilic esophagitis (EoE) compared to the general pediatric population. No studies have investigated EoE risk factors in EA. This study aimed to determine whether PPI exposure and early-life factors are associated with an increased risk for subsequent EoE development in children with EA.
A retrospective chart review was undertaken at a paediatric hospital in Sydney, Australia. The study cohort consisted of children with EA who had their repair and/or follow-up at this hospital between 1 January 2005 and 31 December 2020. Children with EA and EoE (cases) were matched (1:2) with those with only EA (controls), for sex, prematurity and presence of long-gap, to compare PPI exposure. Other early-life factors were analysed without matching, using simple and multivariable logistic regression.
Of the 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EA and EoE received PPI for significantly higher durations (p = 0.018) and at significantly higher cumulative doses (p = 0.017) than children with EA but no EoE. Food allergy (adjusted odds ratio [aOR], 10.515; 95% confidence interval [CI], 2.659–41.581), family history of atopy (aOR, 5.312; 95% CI, 1.575–17.911) and infantile antibiotic exposure (aOR, 1.048; 95% CI, 1.011–1.086) were also significantly associated with an increased risk of developing EoE in the EA cohort.
Longer durations of PPI exposure and exposure to higher cumulative doses of PPI were both associated with the subsequent development of EoE in children with EA. Other early life factors such as atopic family history, food allergy and infantile antibiotic exposure were also significantly associated with an increased risk of developing EoE in children with EA.
294. AN UNUSUAL CASE OF EPIPHRENIC DIVERTICULUM COEXISTING WITHIN ESOPHAGEAL LEIOMYOMA
Authors: Farooqui Marryam Riaz , Rauf Fatima , Bhatti Hamza Waqar , Javed Umer , Arshad Rabia , Hanif Muhammad 
Published: September 2022

Abstract
Oesophageal leiomyoma and epiphrenic diverticulum are two rare entities to be simultaneously occurring together. The preoperative diagnosis in such coexisting conditions is often difficult and leiomyoma is mostly an incidental finding. Till date there is no evidence of the pathogenesis that if the diverticulum causes leiomyoma or vice versa?: We report a case of 32-year-old male with no known co-morbids, previous history of accidental kerosine oil intake 7 months ago, with dysphagia and retrosternal burning pain since 4 weeks with no history of documented weight loss. General physical and systemic examinations were unremarkable.
Contrast studies showed left sided epiphrenic diverticulum. CECT was suggestive of traction diverticulum. Endoscopy showed a large diverticulum on left side of esophagous 38 cm from incisors. On laparoscopy a mass extending to GEJ was appreciated and patient underwent laparoscopy assisted transhiatal esophagectomy and esophagogastric anastomosis with feeding jejunostomy. Peroperatively a mass of 15 x 8 cm was arising from distal oesophagus histopathology of which came out to be a leiomyoma. On POD ‘0’ patient developed Rt sided pneumothorax for which chest intubation was done. Repeat contrast studies showed a patent anastomosisand patient was discharged home.
A careful history, thorough investigations, and surgeon’s awareness of possible synchronous disease processes helps in the management of such patients.
299. LEFT THORACOPHRENOTOMY OESOPHAGOGASTRECTOMY AS AN ALTERNATIVE APPROACH IN OESOPHAGEAL CANCER
Authors: Ammar Ahmed , Paul Melanie , El-Sharkawy Ahmed , Iftikhar Syed 
Published: September 2022

Abstract
The left thoracophrenotomy approach to oesophagectomy-also known as Sweet Oesophagectomy (SO)—for oesophageal cancer is performed by many centres worldwide but seldom used in the UK, owing to concerns over the extent of lymphadenectomy compared with the Ivor-Lewis oesophagectomy (ILO) approach. This study aims to compare the oncological and clinical outcomes following the Sweet approach with ILO.
A retrospective, single centre study was conducted, analysing all patient data following the SO approach and ILO for oesophageal cancer between August 2012 and March 2021.
Total number offered the Sweet and ILO were 72 and 197 patients respectively. 91.7% vs 80.2%, p = 0.071 were distal tumours. Median node count were 22 and 23 respectively, p = 0.980. The Sweet was associated with 69.4% circumferential, 94.4% proximal and 95.8% distal R0 resections compared with 72.6% (p = 0.365), 98% (p = 0.132) and 96% (p = 0.330) with ILO resection, respectively. Median operative time was 169 vs. 301 minutes for Sweet and ILO respectively, p &lt; 0.001. Overall complication rate was 29.2% with Sweet and 45.7% with ILO, p = 0.015, including, Anastomotic leaks 0 vs. 11, p = 0.041, return to theatre 1 vs. 22, p = 0.04. The 30-day, 90-day and 5-year survival was 100% vs. 99% (p = 0.391), 98.6% vs. 95.9% (p = 0.281) & 51.4% vs. 50.3% (p = 0.869), respectively.
The Sweet procedure was associated with comparable oncological efficacy and survival to ILO. Furthermore, was associated with significantly shorter operative time and lower complication rates, therefore should be considered in selected cases. Having a reduced hospital stay and operative time may be more favourable in more frail patients with distal and junctional oesophageal tumours.
303. A NOVEL ‘WATERFALL METHOD’ OF FILLING THE POSTERIOR MEDIASTINAL CAVITY AFTER ESOPHAGECTOMY USING OMENTAL FLAP IN RETROSTERNAL GASTRIC TUBE RECONSTRUCTION
Authors: Yasuda Takushi 
Published: September 2022

Abstract
Post-esophagectomized mediastinal dead space can cause not only mediastinal abscess in R2 resection, but also airway trouble in salvage surgery or combined resection of the airway system due to intra-thoracic great pressure fluctuations. Therefore, dead space filling is critical to prevent them. Dead space is filled with an omentum pulled up in posterior mediastinal route along with the gastric tube. However, it causes delayed gastric empty, considerably decreasing the patient’s quality of life (QOL).
We have developed a new technique to fill the dead space by dropping the omentum from the anterior to the posterior mediastinum after lifting it in the retrosternal route along with the gastric tube, and named it the waterfall method. When creating a gastric tube, the omentum is taken as many as possible, and is fixed to pull-up thread so that it is about 15 cm below the tip of the gastric tube. After lifting the gastric tube to the neck, pull the omental flap down through a small incision in the anterior mediastinal pleura and fill the mediastinal dead space.
Of 630 esophageal cancer patients who underwent surgery from January 2012 to March 2022, this new technique was adopted to 20 patients (mean age: 65Y, male/female: 16/4). The reason for adaptation was R2 resection in 7, salvage surgery in 4, combined resection of the airway system in 8 and other in 1. All patients underwent chemoradiation with more than 50 Gy or triplet chemotherapy preoperatively. Minor anastomotic leakage was observed in 2 and pneumonia and pneumothorax in 3 and 3, respectively. But no development of mediastinal abscess or airway fistula was observed, and no patient complained delayed gastric empty.
Our new technique to fill the post-esophagectomized mediastinal dead space by dropping an omental flap from the anterior to the posterior mediastinum was considered useful, safe and feasible to prevent the development of mediastinal abscess or airway fistula. Since there is no symptom of delayed gastric empty, it is considered to be one of the useful surgical procedures that can maintain the patient’s QOL as well as prevent postoperative complications.
306. THE ROLE OF ADJUVANT CHEMOTHERAPY AFTER NEOADJUVANT THERAPY FOLLOWED BY SURGERY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Park Seong Yong , Jeon Yeong Jeong , Lee Junghee , Cho Jong Ho , Choi Yong Soo , Zo Jae Il , Shim Young Mog , Kim Hong Kwan 
Published: September 2022

Abstract
This retrospective study was performed to investigate the efficacy of adjuvant chemotherapy after neoadjuvant therapy followed by surgery in esophageal squamous cell carcinoma (ESCC).
The data of 428 patients who received the neoadjuvant therapy and esophagectomy for ESCC between 2003 and 2018 were retrospectively reviewed. The 1:2 propensity score matching was performed to balance the patients’ characteristics. Eighty-three (19.4%) patients received the adjuvant chemotherapy, whereas 345 (80.6%) did not receive the adjuvant chemotherapy. The median follow-up period was 27.04 months (interquartile range: 15.85–62.04 months).

The patients who received the adjuvant chemotherapy showed better pulmonary function and ASA score, but there were no differences after propensity score matching. In matched patients, the adjuvant chemotherapy did not improve the OS, but subgroup analysis revealed that 5-year OS improved in ypT + N+ patients by adjuvant chemotherapy (20.2% vs. 27.7%, p = 0.012), whereas the benefit of adjuvant chemotherapy was no observed in ypT0N0, ypT + N0 and ypT0N+. Multivariable analysis showed that ypStage, ASA score and adjuvant chemotherapy (HR 0.462, p = 0.004) was associated with OS in ypT + N+ patients. The freedom from distant metastasis was significantly different according to the adjuvant chemotherapy (27.2% vs. 49.5%, p = 0.039).
Adjuvant chemotherapy after neoadjuvant therapy followed by surgery in ypT + N+ ESCC patients might improve the OS by reducing the distant metastasis. The consideration could be given to administration of adjuvant chemotherapy to ypT + N+ ESCC patients with tolerable conditions.
309. ASSESSMENT AND MANAGEMENT AFTER CORROSIVE INGESTION: WHEN IS SPECIALIST CENTRE REFERRAL NEEDED? A 10-YEAR UK EXPERIENCE
Authors: Di Maggio Francesco , Vergani Vittoria , Tomasi Ivan , Zhang Chuan , Gossage James , Botha Abrie , Baker Cara 
Published: September 2022

Abstract
Corrosive ingestion injuries are rare but clinically significant events, potentially associated with high morbidity and mortality. Low case-volumes limits guideline development. We report the largest UK cohort of patients admitted consecutively to a UGI tertiary referral centre after caustic ingestion, over a period of 10 years. Clinical presentation, diagnostics and treatment modalities as well as short and long-term outcomes were analysed, to produce evidence and the recommendation for centralization of management only of severe injuries.
All adults treated following corrosive ingestion between 2010 and 2020 were included. Eighty-one patients were included, with an average follow-up of 5 years. Blood results, imaging and endoscopic findings were reviewed. Patients were stratified based on endoscopic findings. Emergency and delayed management was analysed along with short and long-term outcomes. Predictive value of early outcome indicators was investigated.
Patients with injuries ≤ Zargar 2A had long-term outcomes similar to the ones with negative endoscopic findings.
All fifteen patients suffering injuries Zargar ≥2B required ITU and four died (26.6%). All deaths occurred within 50 days of ingestion, had Zargar grade ≥ 3 and airway involvement.
Five patients (33%) required emergency operations, two of which died.
All Zargar ≥2B injury survivors (n = 11) developed strictures and/or tracheo-esophageal fistulae (18%), required multiple admissions and prolonged nutritional support; five required delayed resections.
Zargar grade ≥ 2B, airway damage, and increased CRP on admission correlated with unfavourable outcomes.
Corrosive ingestion injuries up to Zargar 2A do not cause long-term sequelae and can be managed locally. Injuries.
&gt; 2B bear high mortality and will cause sequelae. Early identification of severe injuries and transfer to specialist centres with multidisciplinary ITU, OG, thoracic and ENT expertise is recommended.
313. RISK FACTORS FOR RECURRENCE IN ADVANCED ESOPHAGEAL CANCER PATIENTS WHO RECEIVED NEOADJUVANT CHEMOTHERAPY FOLLOWED BY ESOPHAGECTOMY
Authors: Muneoka Yusuke , Ichikawa Hiroshi , Usui Kenji , Kano Yosuke , Hirose Yuki , Miura Kohei , Tajima Yosuke , Ishikawa Takashi , Shimada Yoshifumi , Sakata Jun , Kosugi Shin-ichi , Wakai Toshifumi 
Published: September 2022

Abstract
Recently, nivolumab adjuvant therapy has become a new treatment option in Japan. However, who is the good candidate of this adjuvant therapy has not been fully investigated. The aim of this study was to clarify the risk factors for recurrence in advanced esophageal cancer patients who received neoadjuvant chemotherapy (NAC) followed by esophagectomy.
We retrospectively reviewed the records of 83 patients with advanced thoracic esophageal cancer who received NAC followed by esophagectomy between 2000 and 2018 (69 men and 14 women with a median age of 65 years). We evaluated relapse-free survival (RFS) and investigated the risk factors for recurrence by multivariate analysis.
The regimen of NAC was Cisplatin +5-FU (CF) in 74 patients, Docetaxel + Cisplatin +5-FU in six, and CF with radiotherapy in three. The median follow-up period after esophagectomy was 53 months. The 3-year RFS rate was 58.8%. Multivariate analyses revealed ypT3–4 (Hazard ratio, 3.71; 95% confidence interval, 1.67–8.29), lymphatic invasion (3.45; 1.62–7.39), and postoperative infectious complications (2.99; 1.47–6.07) were significant risk factors for recurrence. Moreover, the prognosis of the patient group with 2 or more risk factors was significantly worse than that of the patient group with 0–1 factor (The 3-year RFS rates, 75.2% vs. 23.1%; p &lt; 0.001).
ypT3–4, lymphatic invasion, and postoperative infectious complications were significant risk factors for recurrence after esophagectomy after neoadjuvant chemotherapy. The prognosis of the patient group with 2 or more these risk factors was significantly worse, therefore, it is considered to be a candidate for nivolumab adjuvant therapy.
317. ABSOLUTE LYMPH NODE YIELD AND LYMPH NODE RATIO ARE PREDICTORS OF SURVIVAL AND IMPORTANT QUALITY METRICS IN ESOPHAGEAL CANCER SURGERY
Authors: Bolger Jarlath , Tavakoli Iran , Espin-Garcia Osvaldo , Castro Pedro Perez , Marwah Anindita , Darling Gail , Yeung Jonathan 
Published: September 2022

Abstract
Surgical resection following neoadjuvant therapy remains the cornerstone of curative management of esophageal cancer. In spite of this, there remains uncertainty regarding the optimal radicality of lymphadenectomy, and whether increasing lymph node yields confer a true survival benefit. This study aims to assess the impact of lymph node (LN) yield and LN ratio on survival following surgery for esophageal cancer, in addition to identifying factors that may influence LN yield and radicality of resection.
All patients undergoing esophagectomy with curative intent from January 1, 2010 to December 31, 2020 were reviewed. Clinical and pathological variables were assessed, with univariable, multivariable, regression and survival analyses performed as appropriate. Cutpoint analysis was used to determine the optimal lymph node ratio.
397 patients underwent esophagectomy, with 288 having a minimally invasive operation (MIE). Stage (stage 3 HR: 1.64 (1.02–2.62), p = 0.04, stage 4 HR: 2.50 (1.43–5.01), p = 0.001), margin status (HR: 2.62 (1.57–4.36), p &lt; 0.001), LN yield &lt;15 (HR: 2.62 (1.57–4.36), p &lt; 0.001) and elevated LN ratio (HR: 8.42 (2.85–24.90, p &lt; 0.001) predicted survival. Patients undergoing MIE had higher LN yields compared with open (30.7 vs 25.3, p &lt; 0.001). Patients undergoing neoadjuvant chemoradiation had lower LN yields compared with those without neoadjuvant therapy and those with neoadjuvant chemotherapy (26.4 vs 30.6 vs 36.8 respectively, p &lt; 0.001). LN ratio &lt; 0.05 was associated with a survival benefit.
Lymphadenectomy is a cornerstone of resection of esophageal cancer. Low LN yield and high LN ratio are associated with reduced overall survival. Maintaining a LN yield &gt;15 should remain a key quality metric. A LN ratio of &lt;0.05 is associated with a significant survival benefit.
318. PRE-TREATMENT CRP AND ALBUMIN DETERMINES PROGNOSIS FOR UNRESECTABLE ADVANCED ESOPHAGEAL CANCER
Authors: Sohda Makoto 
Published: September 2022

Abstract
Nutritional disorders due to cancer-related weight loss, such as cancer-impaired food passage, are prominent in many cases in advanced oesophageal cancer. Here, we investigated the nutritional factors that most affect the therapeutic effect and prognosis of unresectable oesophageal cancer.
One hundred four patients diagnosed with cT4b oesophageal squamous cell carcinoma were included in this study. The values of C-reactive protein/albumin ratio, Glasgow Prognostic Score, prognostic nutritional index, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were calculated from the pre-treatment blood sampling results of the patients who received chemoradiotherapy, and the therapeutic effect and prognosis were analysed.
High- C-reactive protein/albumin group and Glasgow Prognostic Score 1 or 2 group showed significantly worse prognosis compared with the low- C-reactive protein/albumin group and Glasgow Prognostic Score 0 group in both disease-specific survival and overall survival.
Evaluation of pre-treatment CRP and albumin value in locally advanced oesophageal cancer leads to useful prognostic prediction.