bluuebunny/crossref_metadata_2025_split huggingface dataset:
232. EVALUATING THE CORRELATION BETWEEN CLINICAL AND PATHOLOGICAL TUMOUR AND NODAL STAGING IN OESOPHAGEAL CANCER –A 12 YEAR ANALYSIS
Authors: Chaudhury Madhu , Ball Chris , Shetty Vinutha Daya , Ward Jeremy , Pursnani Kish , Turner Paul , Singh Mohan 
Published: September 2022

Abstract
Oesophageal cancer is clinically staged using the TNM classification by modalities such as CT, PET-CT and endoscopic ultrasound. This is used to assess and guide oncological treatment in the form of neoadjuvant chemotherapy, radiotherapy and surgery. Following neoadjuvant therapy and/or surgery the resected specimen is analysed and given a final histological stage. The purpose of this study was to evaluate the accuracy and variation in pre-operative (radiological) stage from the final histopathological stage.
This retrospective study was conducted using an electronic database containing pre- and post-operative TNM staging information on all patients undergoing elective oesophagectomies from April 2009 to December 2021 at a single tertiary upper gastrointestinal cancer centre.
568 patients underwent Ivor Lewis oesophagectomies. The median age was 63 years old (45–82) with M:F 1.78:1. The median length of stay (LOS) was 13 (3–148) days. Results on table attached.
Based on our data, there is an observed significant down-staging amongst tumours with higher T and N stages from their predicted pre-operative stage to the final TNM stage allocated after histopathology review. This reflects the continued value of neoadjuvant chemo(radio)therapy. Early T1N0 tumours still appear challenging to accurately stage pre-operatively, hence adjuncts such as endoscopic ultrasound remain crucial in guiding management.
235. NEAR-INFRARED FLUORESCENCE IMAGING OF THORACIC DUCT IN MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Cheng Sida , Yang Feng , Li Hao , Zhou Jian , Zhao Xiaoyi , Zhou Zuli , Li Jianfeng , Li Yun 
Published: September 2022

Abstract
Chylothorax is a serious complication after esophagectomy and an important reason for reoperation and prolonged hospital stay. A clear localization of thoracic ducts (TDs) and the potential leakage site is an ideal strategy to prevent postoperative chylothorax. In order to explore the feasibility and safety of near-infrared fluorescence imaging (NIR-FI) with indocyanine green (ICG) to identify TDs and potential chyle leakage during video-assisted thoracoscopic esophagectomy, a prospective clinical trial was conducted.
We recruited 41 patients who underwent thoraco-laparoscopic minimally invasive esophagectomy for esophageal cancer in this prospective, single-arm clinical study between December 2020 and December 2021. The primary endpoint was the performance of NIR-FI in identifying TDs and chyle leakage. The ICG was injected subcutaneously into the right inguinal region 30 minutes before the thoracic operation, and it becomes fluorescent when excited by the light with a special wavelength in the NIR system. According to the intraoperative demands, surgeons can observe the position of the TDs under the real-time guidance of NIR-FI.
In 38 of 41 patients (92.7%) using NIR-FI, TDs were clearly visible in high contrast. The mean signal-to-background ratio (SBR) of all fluorescent TDs was 3.05 ± 1.56. Fluorescence imaging of TDs could be detected 0.5 hours after ICG injection and last up to 3 hours with an acceptable SBR value. The optimal observation time window is from about 1 to 2 hours after ICG injection. Under the guidance of real-time NIR-FI, three patients were found to have chylous leakage and the selective TD ligation were performed intraoperatively. No patient had postoperative chylothorax.
NIR-FI with ICG can provide highly sensitive and real-time assessment of TDs, as well as determine the source of chyle leakage, to prevent TD injury and direct selective TD ligation. It’s an effective navigation tool to minimize the incidence of chylothorax after minimally invasive esophagectomy.
242. ENDOSCOPIC MUCOSAL CONGESTIVE CHANGE ON POSTOPERATIVE DAY 1 AS A PREDICTIVE FACTOR OF POSTOPERATIVE ANASTOMOTIC STRICTURE
Authors: Fujiwara Naoto , Ito Sono , Shigeno Takashi , Kakuta Ryota , Shinohara Hajime , Shiobara Hiroyuki , Saito Katsumasa , Hoshino Akihiro , Okada Takuya , Kawada Kenro , Tokunaga Masanori , Kinugasa Yusuke 
Published: September 2022

Abstract
Anastomotic stricture is one of the crucial complications after the esophageal cancer surgery. Although anastomotic leakage is said to be a risk factor, anastomotic stricture can also occur without anastomotic leakage. From 2008, we have routinely conducted endoscopy on postoperative day 1, and evaluated the anastomotic site or mucosal condition of reconstructed organ. Among these data, we focused on the mucosal congestive change and examined the association with postoperative anastomotic stricture.
From 2010 to 2015, 203 esophageal cancer patients were conducted esophagectomy with retrosternal gastric tube reconstruction in Tokyo Medical and Dental University. Among them, 197 patients for which endoscopic data on postoperative day 1 were obtained were included in this study. Mucosal congestion was defined as blue or black color on endoscopic findings, and classified into four groups as absent, mild, moderate, and severe. Univariate and multivariate analysis were performed to clarify the relationship between the mucosal congestive change on endoscopic findings and occurrence of postoperative anastomotic stricture.
Among 197 patients, 60 patients (30.4%) experienced postoperative anastomotic stricture. Univariate and multivariate analysis revealed that the mucosal congestive change as moderate or severe was the independent risk factor for postoperative anastomotic stricture along with lower pathological Stage. Circular stapler size used for esophago-gastric anastomosis or postoperative anastomotic leakage were not independent risk factors for postoperative anastomotic stricture in this study.
It is said that congestive change induces secondary ischemia because of the high internal tissue pressure, and sometimes causes more severe damage than arterial ischemia. Our postoperative endoscopic evaluation method is useful to detect the risk of developing anastomotic stricture in early postoperative state. In such cases, management of postoperative fluid balance might be important to prevent postoperative anastomotic stricture, but it requires further investigation.
262. A STUDY OF METASTATIC LOCATION AND PROGNOSIS FOR ESOPHAGEAL CANCER WITH ONE OR TWO METASTATIC LYMPH NODES
Authors: Natsuki Seiji , Lee Shigeru , Tanaka Hiroaki , Mori Takuya , Deguchi Sota , Miki Yuichiro , Yoshii Mami , Tamura Tatsuro , Toyokawa Takahiro , Maeda Kiyoshi 
Published: September 2022

Abstract
Esophageal cancer has high frequency of lymph node (LN) metastasis and poor prognosis, and often relapse early even after radical esophagectomy. Extensive LN dissection has made it possible to grasp the detailed metastatic status and the relationship between LN metastasis and prognosis. It is necessary to study more about metastatic style and prognostic factors for minimalization of surgical invasion and individualization of treatment.
We analyzed about metastatic location, prognosis and recurrence for esophageal cancer cases with a few LN metastasis. We study 168 stageII, III esophageal cancer cases that underwent radical esophageal resection with regional LN dissection (D2 or more) from January 2015 to December 2017. Those cases included 37 or 29 cases with one or two LN metastasis.
The number of cases on each tumor location (Ce/Ut/Mt/Lt/Ae) were 4/19/80/55/10 cases. On LN dissection, D2 were 68 cases and D3 were 100 cases. In a comparison of survival rate, age (&lt;65/≧65), lymphatic invasion, the number of metastatic lymph node have significant difference. The 5-years overall survival rate of esophageal cancer with one or two metastatic LNs was each 82.9% or 65%. Most of a few LN metastasis cases have first group LN metastasis (11th Japanese Classification of Esophageal Cancer), for example No.106rec or abdominal LNs, but we didn’t sometimes detect them prior to surgery.
Esophageal cancer with a few metastatic lymph nodes had relatively good prognosis, and metastasis was likely to stay nearby the primary lesion. However, it is difficult to detect metastasis precisely prior to surgery, so developing the further technique of diagnosis and individualized treatment are expected in the future.
284. VALUE OF EXTENDED AND TOTAL MEDIASTINAL LYMPHADENECTOMY IN ESOPHAGEAL TUMORS
Authors: Pardo Luis Hurtado , Navarro Fernando Mingol , Esteban Marcos Bruna , Audí David Abelló , Jiménez Míriam Menéndez , Alonso Carla Pérez , Sánchez Marta Nieto , Urbaneja Javier Vaqué 
Published: September 2022

Abstract
The extent of lymphadenectomy in esophageal cancer surgery is a point of controversy at present, although the most recent evidence shows that survival is directly related to the number of nodes removed during surgery.
Descriptive study of patients with esophageal neoplasia who underwent esophagectomy with extended and total mediastinal lymphadenectomy by minimally invasive approach (right prone thoracoscopy, laparoscopy and left cervicotomy) in our center from January 2019 to December 2021. The data of patients included were retrospectively examined. Extended lymphadenectomy was indicated in patients with distal third adenocarcinoma type tumors while total lymphadenectomy was indicated in patient with squamous tumors and middle third adenocarcinoma. The primary endpoint was the incidence of affected lymph nodes in the upper mediastinum based on pathological examination. The secondary endpoint was to analyze the short-term outcomes.
A total of 45 patients were included (26.7% extended and 73.3% total mediastinal lymphadenectomy). The median number of removed nodes was 2 (IQR 4–1) and 2 (IQR 3–1) in the right and left recurrent area, respectively. Overall, the median incidence of recurrent lymph node metastases was 11.1%. Twenty percent of the patients with adenocarcinoma (100% distal third) and 0% of the patients with squamous cell carcinoma had positive recurrent nodes. Ninety-day mortality was 15.6%. With respect to postoperative complications such as recurrent laryngeal nerve paralysis was present in 24.4%. Anastomotic leakage was present in 20% (4.4% thoracic and 15.6% cervical).
Based on our results, extended and total lymphadenectomy increases both the overall number of lymph nodes removed and the number of affected nodes. This prevalence of positive recurrent nodes is not negligible. This greater radicality is associated with significant morbidity. The results of this study support the performance of extended lymphadenectomies also in distal third adenocarcinomas.
285. HOW TO DO IT? SUPRACARINAL APPROACH OF THE LEFT RECURRENT LARYNGEAL NERVE AREA FOR LYMPHADENECTOMY DURING THORACOSCOPIC ESOPHAGECTOMY
Authors: Pardo Luis Hurtado , Navarro Fernando Mingol , Esteban Marcos Bruna , Jiménez Míriam Menéndez , Alonso Carla Pérez , Sánchez Marta Nieto , Chicote Cristina Martínez , Urbaneja Javier Vaqué 
Published: September 2022

Abstract
It is important to know the anatomical relationships of the left recurrent laryngeal nerve during the total mediastinal lymphadenectomy. The objective of this procedure is to resect the lymph nodes located in this area without damaging the nerve. In order to approach the left recurrent laryngeal nerve (LRLN) area it is important to know different strategies to achieve this objective.
This video illustrates different ways of approaching the LRLN area during thoracoscopic esophagectomy.
The first approach illustrated, the esophagus is completely retracted to the right side. With this strategy it is possible to visualize the left paratracheal groove, and tissues and lymph nodes around LRLN are tented. The next approach consists of leaving the esophagus attached on its right and anterior side, creating an ample window, through which the LRLN area can be approached. Another approach involves section of the proximal esophagus. Once that the esophagus is dissected to the thoracic apex, it is divided proximal of the tumor with a stapler. Retraction of this stump creates an optimal view of the area.
Standardization of the supracarinal approach is necessary to improve dissection of the LRLN area and achieve a more adequate surgical resection with a low rates of complications.
293. STRATEGY FOR RECONSTRUCTION AFTER ESOPHAGECTOMY—AIMING FOR ESOPHAGO-GASTRIC ANASTOMOSIS WITHOUT LEAKAGE, NECROSIS, STENOSIS
Authors: Kurahashi Yasunori , Nakamura Tatsuro , Kono Shugo , Hojo Yudai , Nakao Eiichiro , Ishida Yoshinori , Shinohara Hisashi 
Published: September 2022

Abstract
The important points in esophagogastric anastomosis after esophagectomy are ensuring blood flow at the tip of the gastric tube and releasing tension at the anastomotic site. The biggest drawback of the retrosternal route is the narrow space behind the sternoclavicular joint at the thoracic inlet, which increases the risk of anastomotic leakage and stenosis.
We note the following three points during anastomosis. (1) Confirm the blood flow of the gastric tube using ICG fluorescence method, (2) Insert circular stapler from the side wall of the gastric tube and be careful not to put tension on the wall of the gastric tube. (3) Adjust the length of the residual esophagus so that the anastomotic site is not located behind the sternoclavicular joint that can cause anastomotic leakage and stenosis.
Of the 132 cases of subtotal esophagectomy for esophageal cancer performed in our department from January 2017 to March 2022, 94 cases underwent retrosternal reconstruction. There are 66 and 28 cases, respectively, before and after the procedure revision in November 2020. Improvement was observed in the incidence of anastomotic leakage which decreased from 43.9% to 10.7%, and the incidence of anastomotic stenosis which decreased from 34.8% to 17.9%.
It is suggested that securing blood flow at the tip of the gastric tube, releasing the tension at the anastomotic site, and adjusting the anastomotic site not to be located behind the sternoclavicular joint may reduce anastomotic leakage and stenosis in the retrosternal esophagogastric anastomosis after esophagectomy.
296. A BEGINNER’S THREE-YEAR LEARNING CURVE WITH ESOPHAGECTOMIES: A STUDY FROM A PERIPHERAL CANCER CENTRE IN NORTH-EAST INDIA
Authors: Das Gaurav 
Published: September 2022

Abstract
North-East India has a high incidence of esophageal cancer but lacks good infrastructure for cancer care delivery. I aim to present my experience with esophagectomies done in a cancer center of the region, as a beginner immediately after completion of broad specialty surgical oncology training. The objectives include estimation of 30-day morbidity and mortality rates and the short-term oncological outcomes including nodal yield and completeness of resection.
Retrospective observational study of a prospectively maintained database, during the study period from 1st November 2018 to 31st March 2022 (29 months). All patients had confirmed diagnosis of esophageal cancer and underwent esophagectomy by the same surgeon. They received neoadjuvant treatment as per institutional protocol. The results were presented with median values, range and percentages.
46 patients underwent esophagectomy; one had inoperable disease. Clinicopathological factors are in Table 1. 74.5% had neoadjuvant chemoradiation (NACRT). Minimally invasive trans-thoracic esophagectomy (67.4%) was favoured approach (conversion rate of 6%). 41.3% had ‘extended 2-field’ lymphadenectomy. 30-day mortality was 4.2% and morbidity included hoarseness of voice (17.4%), anastomotic leak (10.9%) and pneumonia (8.7%). Median nodal yield was 12 (range 4 to 48). Pathological complete response was noted in 44.1% of post-NACRT patients. Margin-negative resection was achieved in 91.3% patients. After median follow up of 20 months, 5 locoregional and 3 distant recurrences were noted. 76.6% patients are alive without disease.
Surgical audit is key at the beginning of a surgical career to gain insights into learning curve and areas of improvement include nodal yield and morbidity rates. The high margin negative resection rates are partly attributable to selection bias of a beginner.
300. RETROSPECTIVE STUDY FOR EVALUATING IMPACT OF NEOADJUVANT THERAPY USING CDDP +5-FU TOWARD ELDERLY ESOPHAGEAL CANCER PATIENTS
Authors: Ozawa Yohei , Taniyama Yusuke , Sato Chiaki , Okamoto Hiroshi , Fukutomi Toshiaki , Koseki Ken , Akaishi Ryujiro , Horie Yuta , Yamauchi Takuro , Kamei Takashi 
Published: September 2022

Abstract
A number of elderly esophageal cancer patients who have eligibility for radical esophagectomy are increasing. However, we have no clearly evidence of treating strategy for these population because mostly high evidential clinical studies doesn’t include over 75-year-old patients. In this study, we retrospectively assessed efficacy of neoadjuvant chemotherapy using CDDP +5-FU in over 75-year-old patient in our hospital.
We extracted total 105 over 75-year-old esophageal cancer patients who underwent radical esophagectomy from 2007 to 2020 in our hospital. We classified them Group A (surgery alone) and Group B (neo-FP(±RT) + surgery) and analyzed perioperative surgical risk, surgical outcomes, and adverse events or effectiveness for neoadjuvant therapy. Furthermore, long-term survival was assessed by using matched cohort from propensity score matching.
Preoperative risk score calculated by E-pass scoring system was significantly higher in group A while surgical score was similar between two groups. Among group B, 86% of patients were underwent neoadjuvant chemotherapy (NAC) and its completion rate was 78.9%. Number of the patients occurred adverse events during NAC were 8/7/12/3 in the G1/2/3/4 respectively. Postoperative complications decided by Clavien-Dindo classification weren’t seen significant difference between two groups. Postoperative in hospital days were significantly shorter in group A.
Survival analysis showed significantly worse overall survival and disease-free survival in group A in both all cohort and matched cohort.
The level of preoperative risk score was different between two different treatment strategies. Although this study has several limitations including low number population, difference of preoperative risk, and short follow up period, neoadjuvant therapy using FP may safety and effective treatment for elderly esophageal cancer patients.
302. PATIENT SPECIFIC AUGMENTED REALITY IN EXTENDED ROBOTIC ESOPHAGUS RESECTION FOR TYPE II GASTRO- ESOPHAGEAL JUNCTION ADENOCARCINOMA
Authors: Faiz Kaneshka , Faiz Zohra 
Published: September 2022

Abstract
For several procedures augmented reality (AR) allowed surgeons to work by the realtime visual feedback of the surgery field during lockdown by the COVID-19 pandemic. Integrating AR into medical practice could play a key role for the improvement of the learning curve and lower the costs. Also renovate the educational model with one consensus regarding the financing of medical specialist degree.
A global surgical model has not yet been achieved for type II adenocarcinoma of the gastro-esophageal junction (GEJ), while its incidence increases worldwide. Controversies exist about the type of resection. Minimally invasive surgery provides magnified anatomy that enables to perform dissection at the appropriate planes. This technique has made possible the standardization of surgery by ‘concentric-structured model’ for cancers arising in the middle part of esophagus. A patient specific model for GEJ will be conducted using the data of surgeries applied to the real anatomy with AR. The validity will be investigated, conforming the images.
Dutch single-center cohort study have demonstrated that after gastrectomy a positive margin was more common. While, esophagus resection provided a more complete lymph node dissection. The CARDIA trial has shown that one of the strongest independent prognostic factors is the presence of metastatic lymph nodes. Importantly, patients with positive upper mediastinal lymph nodes had a poorer prognosis. Related to this, German group have shown feasibility and superiority of a fully robotic surgery allowing a highly controlled lymph node dissection. Also, Korean study reported favorable outcomes of full four-arm robotic compared to robotic surgery combined with open abdominal surgery.
The increasing incidence of GEJ cancers, the different approaches and emerging new minimal invasive and robotic approach need a comprehensive anatomy concept of the type II GEJ. By having a global concept of surgical anatomy, surgery procedures can be performed consistently and standardized worldwide.
315. PATIENT-DERIVED ESOPHAGEAL ADENOCARCINOMA ORGANOIDS TREATED WITH CHEMOTHERAPEUTIC AGENTS MAY PREDICT TUMOR RESPONSE IN VIVO
Authors: Bolger Jarlath , Allen Jonathan , Radulovich Nikolina , Ng Christine , Allison Frances , Bach Yvonne , Akhter Akhi , Shathasivam Premalatha , Elimova Elena , Tsao Ming , Darling Gail , Yeung Jonathan 
Published: September 2022

Abstract
The current management of locally-advanced esophageal adenocarcinoma (EAC) includes neoadjuvant therapy; however, there are no robust markers that predict treatment response. While 25% of patients will have a complete pathological response, up to 40% will have little or no response. Identification of this non-responsive subgroup prior to treatment could allow personalization of induction regimens. This study aims to determine the feasibility of using patient-derived organoids (PDOs) generated from EAC to predict induction treatment response.
PDOs were generated from endoscopic biopsies taken pre-treatment in patients with locally advanced (LA) or metastatic (M) esophageal cancer. For those with LA disease, samples were also taken post-resection. PDOs were established, passaged, then treated with a drug panel of platinum-based drugs, taxane-based drugs, topoisomerase inhibitors and 5-flurouracil. Treatment response curves and growth metrics were mapped back to treatment response, based on pathological tumor regression grade in the LA group and clinical response based on cross-sectional imaging in the M group.
19 organoids from 7 LA tumors and 10 organoids from 8 M tumors were treated. For LA PDOs, there were significant correlations between cisplatin IC50 (p = 0.007), EC50 (p = 0.002) and TRG. There was a correlation between paclitaxel AUC and TRG (p = 0.02). There were no correlations with irinotecan or 5-FU drug metrics and TRG. For M PDOs, there was a correlation between cisplatin and clinical response for AUC (p = 0.04), and a trend for IC50 (p = 0.07). There were also correlations between paclitaxel and clinical response for IC50 (p = 0.04) and AUC (p = 0.01). There were no correlations with irinotecan or 5-FU.
Treatment responses of EAC PDOs treated in vitro with standard chemotherapeutic agents may predict clinical response in the corresponding patient’s tumor. A PDO model may form the basis for screening therapeutic agents in the neoadjuvant window, allowing the development of truly personalized neoadjuvant strategies.