bluuebunny/crossref_metadata_2025_split huggingface dataset:
453. THE EFFECTIVITY OF NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL ADENOCARCINOMA WITH PRESENCE OF EXTRACELLULAR MUCINE, SIGNET-RING CELLS OR POORLY COHESIVE CELLS
Authors: Valkema Maria Joanna , Vos AM , van der Post RS , Ooms AHAG , Oudijk L , Eyck BM , Lagarde SM , Wijnhoven BPL , Rosman C , van Lanschot JJB , Doukas M 
Published: September 2022

Abstract
Five-year overall survival of patients with locally advanced esophageal adenocarcinoma treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery is 40%. Better understanding of histopathological factors that influence treatment response is necessary to identify patients with expected poor prognosis. Aim of the study was to assess whether pre- and post-treatment presence of excessive (≥1%) extracellular mucus accumulation, signet-ring cells (SRC) and/or poorly cohesive cells were associated with poor response to nCRT, independent of tumor differentiation grade.
This was a retrospective cohort study. Patients included were diagnosed with an adenocarcinoma of the esophagus or GEJ, who underwent CROSS and were planned to undergo esophagectomy between 2001–2019 at two university hospitals. Percentages of the factors extracellular mucus, SRC and poorly cohesive cells were scored by experienced pathologists in pre-treatment biopsies and resection specimen slides relative to the primary tumor area. Multivariable logistic regression models and Cox proportional-hazards models were used to evaluate the histopathological factors in relation to tumor regression grade (TRG) 1–2 (&lt;10% tumor) vs TRG 3–4 (&gt;10% tumor), overall survival (OS) and disease-free survival (DFS).
Some 325 patients were included (median age 65 years, 280/325 (86%) male). In pre-treatment biopsies, ≥1% extracellular mucus was present in 66/325 (20%); ≥1% SRC 43/325 (13%); ≥1% poorly cohesive cells 126/325 (39%). In patients undergoing esophagectomy, 150/284 (53%) had TRG 3–4. Median OS in all patients was 44 months (95%CI: 36–62). Factors in pre-treatment biopsies were not associated with outcomes independent of differentiation grade. Only patients with ≥1% SRC in the resection specimen had poorer OS (Fig 1): HR for death 1.71, 95%CI: 1.06–2.76, adjusted for age, sex, pre-treatment pathological tumor and nodal stage (pre-pT/pre-pN), ypN and tumor differentiation grade.
Extracellular mucus accumulation, SRC and/or poorly cohesive cells in pre-treatment biopsies in patients with esophageal adenocarcinoma treated with nCRT are not associated with response to nCRT, OS or DFS. Their presence should not be a reason to refrain from CROSS nCRT. However, persistence of SRC in the resection specimen after nCRT is an indicator of poor prognosis.
455. ESOPHAGOGASTRIC JUNCTION CANCER: A DIFFICULT BORDER: A WORLDWIDE SURVEY ON ONCOLOGICAL AND SURGICAL APPROACH
Authors: Leone Barbara , De Pasqual Carlo Alberto , Gervasi Maria Clelia , Zenzaro Matteo , Turolo Cecilia , Weindelmayer Jacopo , Giacopuzzi Simone , de Manzoni Giovanni 
Published: September 2022

Abstract
The incidence of esophagogastric junctional adenocarcinoma (EGJ) has been steadily increasing over the last 30 years, especially in Western countries. Surgical and oncological treatment of these malignancies are still debated, in particular in case of true junctional cancer (Siewert type II tumors). The aim of the study is to compare different approaches to EGJ cancers in high volume centers around the world.
We administered a survey to 39 international opinion leaders, working in high volume centers, with a minimum of 50 gastrectomies and 20 esophagectomies performed as first operator. The survey was structured in the form of clinical case scenarios, created to focus on different peculiar issues in the management of Siewert type II tumors. The main fields of investigation were the oncological approach of these malignancies (i.e. choice and type of neoadjuvant treatment) and the preferred surgical strategy.
Our first finding was that almost 80% of responders would choose a neoadjuvant treatment even in cT2N0 patients, fearing probably the low accuracy of the clinical staging. Secondly, 60% of surgeons would prefer chemotherapy over chemoradiotherapy in locally advanced Siewert II tumors, regardless of histological subtype and nodal diffusion.
As for the surgical strategy, we reported a strong preference (75% of responders) for two-field esophagectomy, over three-field esophagectomy (11%) and total extended gastrectomy (14%). However, in case of signet-ring cell carcinoma, up to 20% of surgeons would prefer an extended total gastrectomy, to avoid a distal positive margin.
Our survey confirms that the management of Siewert type II tumors is greatly debated, even among experts of the field, and it needs to be tailored on the patient and tumor characteristics. Even so, we observed a trend towards the choice of chemo over chemoradiotherapy for any histological subtype. When operating on Siewert type II tumors, a thoracic approach is considered necessary by most of responders.
461. SURGICAL TREATMENT OF STAGE IV ESOPHAGEAL CANCER AFTER CCRT IMPROVES SURVIVAL
Authors: Wang Hu-lin Christina , Chen Ke-Cheng , Cheng Chia-Hsien , Wu Ming-Shiang , Lee Yi-Chia , Wang Hsiu-Po , Liou Jyh-Ming , Kuo Yu-Ting , Han Ming-Lun , Chen Chien-Chuan , Huang Pei-Ming , Hsu Hsao-Hsun , Chen Jin-Shing , Kuo Shuenn-Wen , Lin Mong-Wei , Liao Hsien-Chi , Wu I-Hui , Lin Chia-Chi , Hsu Chih-Hung , Huang Ta-Chen , Guo Jhe-Cyuan , Hsu Feng-Ming , Tsai Chiao-Ling , Lu Shao-Lun , Chiang Yun , Chang Yeun-Chung , Chen Jo-Yu , Huang Yu-Sen , Chen Mei-Chi , Yeh Li-Hao , Chiang Pin-Yi , Chang Yu-Chien , Tsai Yu-Dian , Lee Yee-Fan , Yeh Ruoh-Fang , Cheng Mei-Feng , Ko Kuan-Yin , Liu Chia-Ju , Chang Yih-Leong , Hsien Min-Shu , Lee Yi-Hsuan , Lin Fang-Miao , Kang Ya-Chun , Jin Yng-Jiun , Chen Yen-Tsz , Lee Jang-Ming 
Published: September 2022

Abstract
Treatment of stage IV esophageal cancer is traditionally palliative, but treatment response is usually poor. The role of surgery in the treatment of advanced esophageal cancer remains controversial. We sought to determine whether surgical treatment followed by neoadjuvant chemoradiation therapy might provide survival benefits for these patients.
A retrospective review of 163 esophageal cancer patients with M1 disease (distant organ metastasis) treated at a tertiary medical center hospital was performed from April 2002 to June 2021. Patient demographics and cancer staging, treatment, and disease recurrence, and time of follow up were included for analysis. Univariate and multivariate analysis was performed for overall survival and progression-free survival analysis. Propensity score matching based on patient age and tumor staging characteristics was also performed for analysis.
124 patients were treated by CCRT alone and 39 treated by CCRT plus surgery. 3-year and 5-year progression free survival was 17.7% and 8.9% for CCRT+surgery group vs 0.8% and 0.0% in CCRT only group. (p = 0.019) 3- and 5-year survival was 24.0% and 12.0% in CCRT plus surgery group compared to 2.8% and 1.4% for CCRT only group (p = 0.009). Propensity matching of 39 CCRT plus surgery patients and 78 CCRT-only patients showed similar results (17.5% & 8.5% PFS vs 1.3% & 0.0% for PFS, 24.0% and 12.0% vs 3.9% and 1.9% OS).
Surgical resection following CCRT treatment may improve progression-free survival and overall survival for selected patients of esophageal cancer with M1 disease. Surgical indication should be judicious, and further follow up studies should be performed.
463. OESOPHAGEAL PERFORATIONS: CAUSES, MANAGEMENT, AND OUTCOMES AT A SPECIALIST UPPER GASTROINTESTINAL UNIT OVER A TEN-YEAR PERIOD
Authors: Toi Teri , Lam Stephen , Kumar Bhaskar 
Published: September 2022

Abstract
Perforation of the oesophagus is a relatively rare but life-threatening condition, which requires early laparoscopic or surgical intervention. The aim of this work was to describe the causes, management and outcomes of emergency patients treated at a single high volume upper gastrointestinal specialist unit in the United Kingdom.
In this retrospective case series, we identified all patients who presented to a tertiary upper gastrointestinal surgery unit with a spontaneous or iatrogenic oesophageal perforation. Patient demographics, clinical management, and outcomes were identified by hand review of the medical notes.
Between March 2011 to July 2020, 58 patients were identified. The median age was 71 years (interquartile range 52 years to 83 years) and 64% were male. A total of 83% of patients had benign perforations, the rest being malignant. Management of all patients was supportive in 41%, endoscopic in 19% and surgical in 40%. In total 63% of spontaneous benign perforations were managed surgically, and only 6% endoscopically. The median length of hospital stay for all patients that survived more than 90 days was 13 days. The 90-day mortality rate for all patients was 42%.
Oesophageal perforations are a relatively rare but lethal disease, carrying a mortality. Whilst surgery has historically been the most common management of benign spontaneous perforations, endoscopic treatments are likely to become increasingly common in the future.
467. USEFUL ANASTOMOSIS AFTER ESOPHAGECTOMY USING ICG FLOW AND COLLARD MODIFIED METHOD
Authors: Yamada Kazuhiko , Nohara Kyoko , Enomoto Naoki , Yagi Shuyu , Kato Daiki , Aso Kenta , Hogo Tomoki , Suyama Yuto , Takemura Nobuyuki , Kiyomatsu Tomomichi , Kokudo Norihiro 
Published: September 2022

Abstract
Risk of anastomotic leakage after esophagectomy is reported comorbidity, surgical technique, and others. One of management to reduce AL is to measure indocyanine green (ICG) of gastric conduit. It may be more sensitive and useful than traditional method. Furthermore, by changing the anastomotic technique with modified Collard method, AL rate was reduced from 15% to 4% and anastomotic stenosis was also reduced. In this study, we examined some marker of stomach roll depiction by ICG.
We enrolled 52 cases for which ICG data were obtained from August 2019 to December 2021. The distance from stump of the stomach roll was measured by marking the line ICG 5mg stained after 30, 60 seconds We examined some data of arterial network between left and right gastroepiploic arteries, the depiction of gastric conduit, and intra andextramural vessels from the wall from the recorded images. We decided anastomotic line stained with ICG in 30 second.
We reconstructed gastric conduit with 42 stomach roll and 10 subtotal stomach. The distance of gastric conduit stained with ICG was Mean ± SD: 47 ± 19 mm (0-80 mm) at 30 seconds and 28 ± 17 mm (0-60 mm) at 60 seconds. Arterial network between left and right gastroepiploic artery: yes/no (8:43), whole gastric wall depiction: yes/no (24/28), extramural blood flow: yes/no (44/7). There was no necrosis of gastric conduit, AL rate was 3.8% (2/52), and anastomotic stenosis requiring endoscopic bougie was 2%. Ten cases of subtotal stomach had no AL and stenosis.
By using ICG, anastomotic line drawn in 30 second was shorter than 60 seconds and gastric conduit was shorter than traditional line. Determining good blood flow sites using ICG in gastric conduit and widening anastomotic caliber using modified Collard method may have reduced AL and stenosis. It is considered to be very simple procedure that does not depend on surgeon.
468. THE EFFECT OF ROUTINE ENDOSCOPIC SCREENING FOR SYNCHRONOUS ESOPHAGEAL NEOPLASIA IN PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA
Authors: Shimada Ayako , Hirano Yuki , Oyama Takashi , Tamura Takuya , Minagawa Takuya , Ishida Takashi , Tsuruta Masashi , Hoshimoto Sojun , Shinoda Masahiro , Itano Osamu 
Published: September 2022

Abstract
Esophageal squamous cell carcinoma (ESCC) and head and neck (H&N) cancer coincide in high frequency and early detection of synchronous cancer is inevitable for these patients. The aim of this study is to analyze the effect of routine endoscopic screening for synchronous esophageal cancer in patients with H&N cancer.
From April 2020 to March 2022, 35 patients with newly-diagnosed H&N cancer had routine screening endoscopy for synchronous esophageal cancer. All patients with H&N cancer were referred to our department prior to the treatment for H&N cancer.
The locations of H&N cancers were oral/oropharyngeal/hypopharyngeal/laryngeal/other H&N cancer; 9/6/9/9/2 respectively. Image-enhanced endoscopy using BLI (blue laser imaging) was performed in all patients. Lugol staining was used in 20 patients and multiple Lugol voiding lesions were detected in 9 patients. Among all patients, abnormal endoscopic findings in esophagus were detected in 15 patients (43%), and biopsy was performed in 11 patients (31%). Biopsy revealed SCC in 5 patients and atypical epithelium in 2 patients. Esophageal lesions were all found in early stage within indication of endoscopic treatment. 3 patients underwent endoscopic treatment after treatment of H&N cancer.
Routine endoscopic screening for patients with H&N cancer is effective in early detection of synchronous esophageal cancer with minimally invasive treatment for esophageal neoplasm. The treatment of chemotherapy for H&N cancer may be effective for esophageal lesions, therefore, careful surveillance is required during the treatment of H&N cancer. Routine endoscopy should be continued further for these patients for screening of metachronous cancer.
475. IMPACT OF SURGERY START TIME ON SHORT TERM OUTCOMES OF ELECTIVE ESOPHAGECTOMY FOR CANCER
Authors: Yang Tzu Yi , Chao Yin Kai 
Published: September 2022

Abstract
As the number of patients with esophageal cancer is increasing, it is expected to lead to an increased work for surgeons. However, surgeons would work less effectively with fatigue accumulation during the course of a normal workday. We examined the impact of surgery start time and work load on short-term outcomes of patients undergoing elective esophagectomy for caner.
This was a retrospective analysis of a single medical center dataset that included all patients (n = 614) who had undergone elective esophagectomy for cancer between 2010 and 2022. Patients were categorized according to the start times of surgery (AM group: 8am-1pm, n = 491; PM group: 1pm-5pm, n = 123). Post-operative outcomes and short-term survival were taken as primary end point.
The baseline characteristics of the AM and PM group were similar. The AM group had longer operation time (443.29±89.31 vs. 410±81.55, p &lt; 0.001). The rate of unplanned conversion to laparotomy from laparoscopy was higher in the PM group with borderline significance (0.2% vs. 0.7%, p= 0.08). Both of the oncological outcomes and the incidence of the postoperative complications were similar between two groups (all p &gt; 0.05). In short term survival, patients in the PM group had higher 180-day mortality (9.3% vs. 16.3%, p= 0.045).
Surgery start times might contribute to higher conversion rate in abdominal part of surgery. Otherwise, surgery start times and workload of surgeons during working time did not affect short-term outcomes of elective esophagectomy for cancer.
483. UTILITY OF ENDOLUMINAL FUNCTIONAL LUMEN IMAGING IN DIAGNOSIS OF ESOPHAGEAL DYSFUNCTION FOLLOWING BARIATRIC SURGERY
Authors: Yao Rebecca , Rapaka Babusai , Dayyeh Barham Abu 
Published: September 2022

Abstract
We present the case of a 46-year-old male with medically complicated class III obesity who presented with new-onset and persistent dysphagia after undergoing a successful laparoscopic Roux-en-Y gastric bypass surgery. An esophagogastroduodenoscopy was unrevealing, however, further workup with the endoluminal functional lumen imaging probe (EndoFLIP) device was suggestive of esophageal dysmotility with decreased distensibility index of the GE junction and absent/disorganized secondary esophageal peristalsis.
Thorough chart review was performed to elicit details of the case presentation. Further, a literature review was performed to supplement background knowledge and discussion.
We present a case of symptomatic esophageal dysphagia in a post-procedural bariatric surgery patient with normal EGD yet positive findings on functional lumen imaging, consistent with the newly described entity termed Post Obesity Surgery Esophageal Dysfunction (POSED). POSED is defined by aperistalsis and increased intragastric pressure seen after bariatric surgery. It is thought to occur due to a high-pressure gastric zone created in the noncompliant postoperative stomach after Roux-en-Y gastric bypass, or an increased esophageal afterload by a restrictive laparoscopic sleeve gastrectomy. No treatment guidelines exist, though options include botulinum toxin, dilation, and per-oral esophageal myotomy.
This case provides further insight into the role that functional lumen imaging has in the bariatric patient, as it may be able to more accurately detect patients who will develop esophageal dysmotility following bariatric surgery, or perhaps even those who may be predisposed prior to undergoing intervention for weight loss.
490. CORRELATION BETWEEN HISTOLOGICAL AND MOLECULAR ALTERATIONS WITH POOR SURVIVAL IN ESOPHAGEAL ADENOCARCINOMA
Authors: Bonora Elena , Mastracci Luca , Orsini Arianna , Bozzarelli Isotta , Isidori Federica , Tassi Valentina , Fiocca Roberto , Lugaresi Marialuisa , D'Errico Antonietta , Malvi Deborah , Spaggiari Paola , Tomezzoli Anna , Albarello Luca , Ristimäki Ari , Bottiglieri Luca , Krishnadath Kausilia , Rosati Riccardo , Romario Uberto Fumagalli , De Manzoni Giovanni , Räsänen Jari , Mattioli Sandro 
Published: September 2022

Abstract
The incidence of esophageal adenocarcinoma (EAC) has constantly risen in western countries over the past decades, often diagnosed at advanced stage and with a five-year survival around 20%1. In a previous study on EAC cases submitted to surgery (without neoadjuvant treatment) an algorithm (EACGSE classification)2 based on morphologic distinctions provided a significant prognostic impact. We aimed to evaluate the molecular basis underlying these differences, to improve patient management.
The EAC cohort classified according to EACGSE2 was included in the study. Genomic DNA was available from formalin fixed paraffin embedded surgical specimens for 207 cases. The cases were sequenced for 26 cancer-related genes (panel #226722257; IDT) with high coverage on NextSeq500 (Illumina). Data analysis was performed using a dedicated pipeline3. 245 cases were analyzed for SMAD4 immunostaining (IHC). Loss of SMAD4 immunostaining was reported as % of negative tumor cells (at least 35% of neoplastic cells).
TP53 was the most frequently altered gene (134/207 cases with at least one mutation). The presence of TP53 missense variants was associated to a poor cancer-specific survival (CSS) in the high-risk cases (glandular poorly differentiated, mucinous invasive, diffuse anaplastic, mixed) according to EACGSE2 (P=0.0005). A significant correlation was observed for TP53 truncative variants and loss of SMAD4 staining (P=0.008). Actually, SMAD4 loss was observed in 85/245 (35%) of all EAC cases analyzed via immunostaining. SMAD4 loss correlated with poor CCS (P=0.007) and disease-free survival (P=0.002) in EACGSE high-risk cases.
TP53 missense mutations correlated to poor outcomes (CSS) in high-risk cases, TP53 truncative mutations were associated to SMAD4 loss. SMAD4 loss itself resulted a frequent event in EAC and correlated with lower CCS and disease-free survival in high-risk cases. Therefore, we were able to correlate EAC histological classification, clinical outcomes and molecular phenotypes. Validation in independent samples is warranted to corroborate these findings.
References
1. Coleman et al. Gastroenterology2018;154:390–405.
2. Fiocca et al. Cancers 2021;13:5211.
3. Isidori et al. CTG 202011:e00202.
494. GIANT GASTROINTESTINAL STROMAL TUMOR OF THE ESOPHAGUS: REPORT OF TWO CASES
Authors: Sato Kota , Akuta Sohei , Yamazaki Shigeru 
Published: September 2022

Abstract
Gastrointestinal stromal tumor (GIST) accounts for 1-3% of all gastrointestinal tumors. Most of GIST occurs in the stomach and small intestine, but GIST from the esophagus is relatively rare at about 2-5%. Surgical resection is the treatment of choice, but no routine procedure has been established. We report two cases of esophageal GIST that underwent surgical resection.
[Case 1]
A 75-year-old woman. She was diagnosed with an 11 cm-sized submucosal tumor was found in the esophagus by upper gastrointestinal endoscopy. Histopathological examination showed that the tumor was GIST. The patient's postoperative course was uneventful and the patient was discharged home in good condition on the 22nd postoperative day.
[Case 2]
A 58-year-old man. He was diagnosed a 9 cm-sized elevated lesion in the by CECT. The tumor suspected esophageal cancer sarcoma, we underwent esophagectomy. Finally, histopathological examination revealed that the tumor was GIST. His postoperative course was uneventful and he was discharged on the 19th postoperative day.
[Case 1 result]
Postoperative adjuvant chemotherapy with imatinib was failed, but the follow-up period continued without recurrence.
[Case2 result]
Postoperative adjuvant chemotherapy with imatinib was introduced. Contrast-enhanced CT 6 months after surgery revealed multiple liver metastases. 2nd line chemotherapy with sunitinib is still ongoing.
[Discussion]
Surgical treatment is the first choice for esophageal GIST, but no standard surgical procedure has been established. In the past, esophagectomy similar to esophageal cancer was often performed, but thoracoscopic local resection may be selected in recent years. Even in the case of giant esophageal GIST as like this two cases, if the general condition is stable and preoperative treatment is possible, it is possible to choose to perform preoperative neoadjuvant chemotherapy.
500. DEVELOPMENT AND VALIDATION OF INTRAOPERATIVE RADIATION FIBROSIS SCORE (IRFS) IN PATIENTS UNDERGOING TRANSTHORACIC ESOPHAGECTOMY POST NEOADJUVANT CHEMORADIATION FOR ESOPHAGEAL CANCER
Authors: Shukla Srijan , Thammineedi Subramanyeshwar Rao , Patnaik Sujit Chyau 
Published: September 2022

Abstract
Esophagectomy performed for cancers of esophagus is a challenging surgery. Post radiation fibrosis makes identification of critical structures difficult. The exact relationship between radiation dose and timing of surgery to the intraoperative difficulty remains to be tested.
Surgical videos of transthoracic esophagectomy for carcinoma esophagus post neoadjuvant chemoradiation were reviewed and IRFS score was calculated based on three factors (esophageal pleural thickening, periesophageal planes, periadenitis). The IRFS score was then correlated with the radiation dose, interval between radiation completion and surgery, surgery duration, pathological response, major intraoperative complications and short term surgical outcomes.
Primary objective: Correlation of radiation dose and timing of surgery with the IRFS.
Secondary objectives: To study for correlation between surgery duration, pathological response, major intraoperative complications and short term surgical outcomes with IRFS
Surgical videos of 100 patients were analysed.
IRFS score which comprises of esophageal pleural thickening, periesophageal planes and periadenitis is a unique tool of assessing surgical difficulty which can be used to correlate radiation doses and interval to surgery. Further studies are required to validate it against post operative outcomes.