bluuebunny/crossref_metadata_2025_split huggingface dataset:
508. OUTCOME OF NEOADJUVANT CHEMORADIOTHERAPY PLUS SURGERY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA IN EAST ASIA VERSUS WESTERN EUROPE
Authors: Eyck Ben , Gao Xing , Yang Yang , van der Wilk Berend , Wong Ian , Wijnhoven Bas , Liu J , Lagarde Sjoerd , Lam KO , Hulshof M , Li Zhi Gang , Law Simon , Chao Yin Kai , van Lanschot Jan 
Published: September 2022

Abstract
Patients with different ethnic and genetic backgrounds may respond differently to specific anticancer therapies. The present study aimed to assess whether patients with esophageal squamous cell carcinoma (ESCC) who are treated with neoadjuvant chemoradiotherapy (nCRT) according to the CROSS regimen in East Asia have an inferior response compared to patients treated in Western Europe.
Patients with ESCC who completed ≥80% of nCRT according to CROSS (five weekly cycles of carboplatin [AUC of 2 mg/mL/min] and paclitaxel [50 mg/m2] with concurrent 41.4 Gy radiotherapy in 23 daily fractions of 1.8 Gy) followed by esophagectomy between June 2012 and April 2020 were identified from Asian and Dutch databases. Primary endpoint was pathologically complete response (pCR), defined as ypT0N0. Asian and Dutch patients were compared with nearest-neighbor propensity score matching, adjusting for confounding factors: gender, Charlson comorbidity index, tumor location, cT and cN stage, interval from start of nCRT to surgery, and number of resected lymph nodes.
In total, 839 patients were included (Asian: 175, Dutch: 664). After matching, 154 remained in each group. Confounding factors were all significantly different before matching and 26% in the Asian versus 42% in the Dutch cohort had a pCR (p&lt;0.001), which became 27% versus 42% after matching (p=0.008), respectively. Both ypT and ypN stage were significantly higher in the Asian cohort. R0 resection rate was comparable (Asian: 92% vs. Dutch: 95% resp., p=0.29). Asian patients more often had a cervical anastomosis (p=0.001) and less complications including pulmonary complications (21%-38%, p=0.002), chyle leakage (2%-10%, p=0.006) and anastomotic leakage (10%-21% resp., p=0.02).
The present study shows that after adjusting for patient and tumor characteristics, East Asian patients with ESCC have a poorer response to nCRT according to the CROSS regimen than Western European patients. The poorer response did not seem to have a negative effect on surgical outcome. Future studies investigating anticancer therapy for esophageal cancer should take into account ethnic and genetic differences in response to these regimens.
509. FULLY ROBOTIC IVOR-LEWIS ESOPHAGEAL RESECTION (RAMIE) – TECHNICAL DETAILS OF THE RAMIE PROCEDURE IN THE ROBOT2 TRIAL
Authors: Grimminger Peter 
Published: September 2022

Abstract
Robotic-assisted surgery is increasing, especially in cancer surgery. Minimal-invasive esophagectomy (MIE) is commonly the standard operation procedure in high-volume centers. Also, the fully robotic minimally invasive esophagectomy is performed more and more frequent. Over the past 5 years we continuously improved our 4-arm RAMIE procedure.
At the moment we are comparing the two total minimal-invasive Ivor-Lewis techniques in a RCT (ROBOT-2 trial).
Since January 2017 we perform RAMIE procedures and we would like to demonstrate the further developed robotic technique of one case as an example how we perform Ivor-Lewis RAMIE after a learning case of over 250 RAMIE cases in our case observation center in Mainz Germany.
The overall advantages between RAMIE and MIE are under evaluation in our recruiting ROBOT-2 trial, of which we like to report the progress at ISDE 2022.
512. COMBINATIONAL TREATMENT USING ENDOSCOPIC DILATION AND ORAL PREDNISOLONE FOR REFRACTORY ANASTOMOTIC STRICTURE AFTER ESOPHAGECTOMY
Authors: Tetsuo Hanako , Kobayashi Shinichiro , Enjoji Takahiro , Maruya Yasuhiro , Kobayashi Kazuma , HIdaka Masaaki , Ito Shinichiro , Kanetaka Kengo , Eguchi Susumu 
Published: September 2022

Abstract
Anastomotic strictures are common complications after esophagectomy, and frequent dilatations to refractory strictures reduce patient’s QOL. Yamaguchi and colleagues have developed new treatments using oral prednisolone. They have shown the safety and potential efficacy to prevent esophageal strictures after ESD. However, the efficacy and safety of oral prednisolone is not evaluated to anastomotic stricture after esophagectomy.
The aim of this study is to examine the safety of oral steroids therapy for postoperative esophageal stenosis.
The subjects were patients who passed 28 days after the esophagectomy and recurred stenosis symptoms within 2 weeks after the dilatation, and who have undergone more than three or more dilations. Indication of oral steroids therapy was based on the definition of Kochman.
Oral prednisolone was started at 30 mg/day after dilations, tapered gradually, and then discontinued for 12 weeks.
The primary endpoint was safety evaluation.
Secondary endpoints included stenosis rate at 85 days after initiation of steroid therapy, dysphagia score, number of dilations, change in weight, and duration of dilation interval, and enterostomy use rate.
Five of six patients with refractory anastomotic strictures were enrolled.
The risk factor for the incidence of refractory stenosis was ischemic changes around the entire anastomosis.
The duration of hospital stay was significantly prolonged.
All the patients completed the therapy and no adverse events were observed.
There were two cases of re-strictures.
Dilation frequency was significantly reduced (4.4 ± 1.1 vs. 1.4 ± 1.9, P &lt; 0.01) and the intervals was significantly prolonged (11.9 ± 6.2 days vs. 60.5 ± 33.6 days, P = 0.02).
Dysphagia scores were significantly improved (3.2 ± 0.8 vs 0.2 ± 0.4, P &lt; 0.01).
The rate of enterostomy use was significantly reduced (80% vs 0%, P = 0.02).
Steroid therapy for esophageal stricture after esophagectomy may be safe and effective. Further studies are needed to evaluate the efficacy of steroid therapy in a large number of patients.
518. VATS ESOPHAGEAL DIVERTICULECTOMY WITH LAPAROSCOPIC HELLER MYOTOMY AND DOR FUNDOPLICATION
Authors: Cheung Siu Hong , Leung Yuen Yee , So Choi Kwan , Wong Tiffany Wing Ka , Lam Chin Tou 
Published: September 2022

Abstract
60years old lady presented with dysphagia.
Upper endoscopy found a large esophageal diverticulum at distal esophagus which was the likely cause of symptoms.
Diverticulectomy was suggested in view of its large size and symptoms.
Video assisted thoroscopic surgery was utilized in this case.
VATS staple esophageal diverticulectomy was performed in left semi prone position under one-lung ventilation. Subsequent laparoscopic cardial myotomy was performed in supine position, with Dor fundoplication performed at last.
Patient had uneventful recovery.
She was extubated after the operation.
Diet was resumed on post operative day 2.
Patient was discharged on post operative day 4.
No complication was observed and there was complete symptoms resolution.
left VATS esophageal diverticulectomy is feasible and safe.
523. RISK FACTORS ASSOCIATED WITH NOT RECEIVING ADJUVANT CHEMOTHERAPY FOR LOCALLY ADVANCED ESOPHAGOGASTRIC ADENOCARCINOMA
Authors: Chmelo Jakub , Brown Joshua , Prasad Pooja , Convill James , Phillips Alexander W 
Published: September 2022

Abstract
Perioperative chemotherapy is standard of care in the curative treatment of locally advanced esophagogastric adenocarcinoma in the UK. Previously used MAGIC triplet is becoming less frequently used in favor of superior FLOT quadruplet. There is however large number of patients who don't undergo adjuvant component of both of these perioperative regimens. This study aimed to investigate factors which are associated with not receiving adjuvant chemotherapy after neoadjuvant chemotherapy followed by surgical resection for esophagogastric adenocarcinoma.
All patient receiving neoadjuvant chemotherapy for esophagogastric adenocarcinoma followed by curative surgery during 2010 till 2019 were identified from prospectively maintained single institution database. Patients who died in-hospital or within 90 days of surgery were excluded from analyses. Risk factors which could be associated with receiving/not receiving adjuvant component were studied. Mann U Whitney and chi-square test were used as appropriate. Multivariable logistic regression was carried out to identify risk factors independently predictive of not receiving adjuvant chemotherapy.
Analyses included 624 patients of whom 273 received adjuvant chemotherapy (44%). This included ECX/ECF in 233 patients, EOX in 5 patients, FLOT in 22 patients and other/unknown regimens in 13 patients. Age, Charlson comorbidity index, return to theatre, severe postoperative complications (Clavien-Dindo grade III+) and R1 resection were associated with not receiving adjuvant chemotherapy (p 0.005, p 0.006, p 0.026, p 0.043, p 0.004 respectively). Statistically significant variables were entered into multivariable logistic regression model. Only R1 resection was independently associated with not receiving adjuvant component (OR 0.18, p 0.007).
This study confirms that only less than half of patients who undergo neoadjuvant chemotherapy followed by surgery with curative intent receive adjuvant chemotherapy. Reasons for this are multifactorial but age, comorbidities, severe complications and positive longitudinal margin might play important role. These results also highlight the importance of prevention, early detection and appropriate management of postoperative complications.
526. SALVAGE SURGERY FOR ESOPHAGEAL CANCER: IS IT TIME TO REFINE SURVEILLANCE CRITERIA?
Authors: Abdulrahman Rand , Abdulrahman Maan , Shamiya Khalid Adnan , Al-Khusaibi Mohamed , Picket Lianne , Monaghan Orla , O’Neill Brian , Grogan Liam , Kumar Nitya , Corbally Martin , Walsh Thomas Noel 
Published: September 2022

Abstract
There is no accepted surveillance strategy following curative oesophageal cancer management, with reinvestigation often relying on symptom development. Lack of a surveillance standard may impact on outcome and survival. We hypothesized that strict surveillance was more likely to detect curable recurrent disease. This study compared the outcome for salvage surgery for recurrent disease, detected on a strict surveillance program, with survival of patients that had undergone immediate surgery following an incomplete response to neoadjuvant chemoradiotherapy.
A prospective database of oesophageal carcinoma patients who were treated with curative intent (Surgery alone, Neoadjuvant Chemoradiotherapy (NeoCR) plus surgery, Definitive Chemoradiotherapy or Neoadjuvant Chemoradiotherapy with surveillance by choice), was interrogated for patients with recurrent disease amenable to salvage surgery. Surveillance for all consisted of 3-monthly endoscopy and 6-monthly CT scanning for 3 years, followed by 6-monthly endoscopy and yearly CT scanning to 5 years, and both yearly thereafter. If recurrence was diagnosed patients were restaged and, if suitable, underwent salvage surgery. Their outcome was compared with patients undergoing neoadjuvant chemoradiotherapy and having immediate surgery for an incomplete response.
Of 205 patients treated with curative intent, 18 (9%) underwent salvage surgery for locoregional recurrence. They had a median survival of 61.6 months (range 10.32 to 136.08) and a 3-year survival of 50%. This compares to 115 patients who underwent surgery following incomplete response to NeoCR, who had a median survival of 38.3 months (range 2.20 to 254.26) and a 3 year survival of 44%, which was statistically insignificant between the groups (p= 0.975). The overall mean survivals were 57.84 months and 57.9 months respectively.
Intensive surveillance identified a cohort of patients (9% of total) with recurrence amenable to salvage surgery and with outcomes non-inferior to immediate surgery following NeoCR. As most were asymptomatic, it is suggested that without surveillance the opportunity for curative intervention would have been lost. Even novel treatments will require detection of recurrence before disease becomes unmanageable. It is suggested that surveillance guidelines be updated to standardize interval endoscopy/imaging, as for other GI malignancies.
527. A RIGHT CERVICOTOMIC APPROACH TO RETRIEVE A DENTAL PROSTHESIS FROM THE ESOPHAGUS
Authors: Zanchetta Matteo , Monti Elisa , Latham Lorenzo , Costa Jessica , Marzorati Alessandro , Odeh Murad , Colombo Elisabetta Marta , Ietto Giuseppe , Inversini Davide , Iovino Domenico , Festi Luigi , Carcano Giulio 
Published: September 2022

Abstract
Foreign body (FB) ingestion in the upper gastrointestinal (GI) tract is a relatively common emergency presenting numerous diagnostic and therapeutic challenges. Adults most frequently ingest FBs accidentally while eating solid food. The esophagus accounts for 57% to 75% of all FBs impactions in GI tract. More than 80% FB pass spontaneously, around 10-20% require an endoscopic removal, and less than 1% have to be treated surgically, depending on the nature and location of the FB.
A 68 years old man presented to the Emergency Department complaining of a mild dysphagia since two days before. A laryngeal endoscopy showed edema of the right aryepiglottic fold; salivary stagnation hiding the pyriform sinus; edema of the right vocal cord; the airway caliber was adequate. A chest radiograph showed a dental prosthesis, probably ingested during a seizure, in the upper esophageal tract. The patient developed dyspnea and phonation difficulty due to neck swelling. An urgent CT scan showed signs of esophageal perforation and diffuse edema. A multidisciplinary equipe was assembled to properly treat the patient.
In the operating room, two attempts of retrieval with a flexible and a rigid endoscope failed because the dental prosthesis was stuck in the right pyriform sinus. After a careful evaluation of the FB location, the surgeon performed a right cervicotomy, uncommon when compared with the traditional left side approach to the neck, and retrieved it through an esophagotomy. A nasogastric tube was inserted and a paraesophageal 19 Ch drain in aspiration was placed in situ. Over time, no signs of esophageal leakages were detected post-operatively and eventually the patient was able to feed with solid foods without complications.
Any esophageal FB may cause potentially fatal injuries, therefore it must be retrieved within 12 to 24 hours. An endoscopic approach should be attempted first, with surgery being the extrema ratio. The surgical approach depends on the nature and location of the FB. A left cervical approach should not be regarded as dogmatic, and a right-sided approach, being equally safe and effective from a surgical point of view, could be appropriately chosen when clinically indicated.
529. ANALYSES OF CLINICAL FACTORS AFFECTING POSTOPERATIVE SYMPTOMS INCLUDING BODY WEIGHT LOSS, ORAL INTAKE, AND REFLUX AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Mine Shinji , Hashimoto Takashi 
Published: September 2022

Abstract
Some patients complain of serious postoperative digestive symptoms after esophagectomy. However, it has not been clear what clinical factors are related to these symptoms. In this study, we investigate the relationships between postoperative digestive symptoms (body weight loss, subjective oral intake, and reflux) and clinical factors.
Of 155 patients who underwent esophagectomy at our department from April 2019 to July 2021, 75 patients were eligible because they could be followed up at our outpatient clinic without relapse. Postoperative symptoms including body weight loss, oral intake ≥70%, and reflux were asked. Regarding clinical factors, age, sex, route of reconstruction, the width and the location of the gastric tube in CT images, and the location of pylorus ring in CT images were investigated retrospectively.
The median body weight loss was 10.5%. Oral intake ≥70% was found in 37/61. 24/50 patients complained of reflux. The mean body weight loss was 6.2% in the intrathoracic anastomosis, 10.5% in the posterior mediastinal route, and 12.6% in the retrosternal route (p=0.04). Oral intake ≥70% was found in 20/29 of the wide gastric tube group and 16/31 of the narrow gastric tube group (p=0.197). The group with oral intake ≥70% was likely to be younger (p&lt;0.01), and male is likely to have oral intake ≥70% (p=0.193). Regarding reflux, there were no difference in clinical factors.
Although this is a retrospective study and biases in each group are found, body weight loss is less found in the intrathorax anastomosis and in the duodenostomy group via a retrosternal route. Oral intake is likely to be more in younger patients, in male, and in patients with wider gastric tube. On the other hand, no clinical factors were found related to reflux.
535. ENDOSCOPIC AND THORACOSCOPIC MANAGEMENT OF OESOPHAGEAL PERFORATION
Authors: Kumar Bhaskar , Khanzada Zubair 
Published: September 2022

Abstract
This is a rare case of boerhaave’s syndrome associated with ischaemic small bowel in a young patient. A 45-year-old man, background of schizophrenia, alcohol excess and previous TIAs, presented to resus room in a peri-arrest condition secondary to sepsis. A CT scan confirmed gross mediastinitis with extensive right pleural contamination and an ischaemic segment of small bowel. An intercostal chest drain in resus was placed and drained enteric content from the oesophagus confirming the diagnosis.
The patient was immediately taken to operating theatre and a large distal oesophageal perforation was localized on OGD under GA. Using a novel technique, a guide wire was placed into the mediastinal cavity via the perforation. Over the guide wire, an exudrain was placed to act as an endovac (200mmHg wall suction) and a large bore NG tube placed into the stomach. A right sided VATs decortication and wash out and insertion of further chest drains was carried out, followed by laparotomy and resection of a 10cm segment of ischaemic small bowel.
Following a short critical care unit stay, the patient made a steady recovery free of any complications. In total, 3 endoscopies were performed post operatively to assess mediastinal healing. Psychotropic medications were delivered through an NJ tube. At 3 weeks, the patient showed complete healing of the oesophageal defect and had a stricture which needed dilatation.
Endoscopic negative pressure treatment can be combined with a minimally invasive thoracoscopic approach to the mediastinum to achieve success even in an unstable patient. Vigilance needs to be applied for concomitant pathology such as small bowel ischaemia, although rare, contributes to the risk associated with this serious condition.
538. A DECADE OF ESOPHAGEAL AND ESOPHAGO-GASTRIC JUNCTION CANCER EPIDEMIOLOGY IN NATIONAL CANCER INSTITUTE MEXICO
Authors: Takahashi Alberto Mitsuo Leon , Basave Horacio Noe Lopez , Silva Leonardo Saul Lino , Ruiz German Calderillo , Garcia Erika Betzabe Ruiz , del Consuelo Diaz Romero Maria , Martinez Marytere Herrera , Torres Cesar Alejandro Paleta , Castañeda Karla Fabiola Hernandez , Gomez Angel Herrera 
Published: September 2022

Abstract
In 2020, the incidence of esophageal cancer was 8th and mortality was 6th in the world. However, it´s not the top 10 in Mexico. Mexico is a developing country and has no national cancer registration. Moreover, Mexico is the 2nd largest obese country in the world, and obesity is one of the leading factors for adenocarcinoma. Therefore, we believe that the actual incidence of esophageal cancer in Mexico is likely to be higher.
Retrospective study of patients diagnosed as esophageal and esophago-gastric junction (EGJ) cancer from January 2011 to September 2021. We used the 8th edition (AJCC) to separate esophageal and esophago-gastric junction from gastric cancer and determine the clinical stage. Descriptive statistics were used and Mean Overall Survival (MOS) and Overall Survival (OS) were figured from the date of diagnosis to the date of death or the last follow-up. Kaplan-Meier was used to assess the patients' survival and the differences in subgroups were analyzed by the log-rank with SPSS ver.26.
617 patients were admitted during the period (496 were esophageal and 121 true EGJ). The ratio was men 500 (81%) to women 117 (19%) and the mean age was 60.7±12.3 y.o. (18-90). Main symptoms were solid dysphagia 466 (75.5%) and weight loss 508 (82.3%). The mean BMI was 23.8± 4.6(14.6-42.6). The main histology was intestinal adenocarcinoma 288 (46.7%) and then squamous cell carcinoma 214 (34.7%). Clinical stage IVB 325 (52.7%) and III 213 (34.5%) were the most frequent and 158 (25.6%) cases could not start treatment. The mean following was 11 (0-98) months, MOS was 19.1 (95%CI,16.4-21.9) months and OS was 30.8%. The 5-year SV by stage were I-100%, IIA-37%, IIB-16%, III-15%, IVA-B 6%.
This study shows epidemiology from National Cancer Institute in Mexico. Most patients were men in their 60s. The main histology was adenocarcinoma, yet we had many squamous cell carcinoma cases. Although Mexico is the second largest obese country in the world, our patients in the average were not obese. Unfortunately, most patients are diagnosed in advanced stage (IVB) and it might cause the poor prognosis of survival.
539. SURGICAL TECHNIQUES AND OUTCOMES OF GASTRIC CONDUIT RECONSTRUCTION FOLLOWING ESOPHAGECTOMY BY HAND-ASSISTED LAPAROSCOPIC SURGERY (HALS) FOR ESOPHAGEAL CANCER
Authors: Suzuoki Masato , Hiraoka Kei , Takahashi Ryo , Niwa Hiroki , Mizunuma Kenichi , Wada Hideyuki , Iwashiro Nozomu , Ohara Masanori 
Published: September 2022

Abstract
After esophagectomy with reconstruction using a gastric conduit for esophageal cancer, anastomotic leak can cause serious complications and has a significant impact on the postoperative course.
At our institution, gastric conduit reconstruction by hand-assisted laparoscopic surgery (HALS) is the first-line technique for reconstruction following esophagectomy due to its reliability and shortened operative time. In this study, we performed a retrospective review of the surgical outcomes.
We reviewed characteristics and perioperative outcomes of 124 patients who underwent esophagectomy with gastric conduit reconstruction for esophageal cancer by HALS from February 2011 to December 2021.
Surgical procedure: We created a gastric tube via the HALS incision. A 3-cm wide gastric tube was fashioned using the linear staplers. We mobilized and manually stretched the stomach to ensure the length of the gastric tube. Then the blood flow in the gastric tube was evaluated by ICG fluorescence method followed by esophagogastric anastomosis using a 25-mm circular stapler on the greater curvature side.
Among the 124 patients, there were 99 males and 25 females with a median age of 70 years (range, 46 – 85 years). Neoadjuvant therapy was performed in 50 patients. The median operative time was 259 minutes (135-454 minutes). Complications related to the gastric conduit reconstruction included anastomotic leak in two patients (1.6%) and anastomotic stricture requiring dilatation in 39 patients (31.5%), of whom 15 (12.1%) underwent repeat dilatation. Gastric tube stenosis, gastric tube hemorrhage, and gastric tube-to-pulmonary fistula were also observed in one case each.
In the present study, while the incidence of anastomotic leak was low (1.6%) in patients received HALS esophagectomy with gastric conduit reconstruction, almost one-third (31.5%) of the patients had anastomotic stricture and required dilatation.