Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.258
E. T. Bianchi, Paulo Cardoso, S. Szachnowicz, A. Nasi, F. Tustumi, F. Seguro, A. Duarte, R. Sallum
Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics. Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them. Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285). 48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14). The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.
{"title":"476. PATIENTS WITH TRACHEOSTOMY HAVE HIGHER INCIDENCE OF ESOPHAGEAL REFLUX AND DON’T PRESENT TYPICAL SYMPTOMS","authors":"E. T. Bianchi, Paulo Cardoso, S. Szachnowicz, A. Nasi, F. Tustumi, F. Seguro, A. Duarte, R. Sallum","doi":"10.1093/dote/doad052.258","DOIUrl":"https://doi.org/10.1093/dote/doad052.258","url":null,"abstract":"\u0000 \u0000 \u0000 Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD.\u0000 With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased.\u0000 Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics.\u0000 \u0000 \u0000 \u0000 Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination.\u0000 Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.\u0000 \u0000 \u0000 \u0000 Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux.\u0000 In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285).\u0000 48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14).\u0000 \u0000 \u0000 \u0000 The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41529199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.154
Y. Chen, Jang-Ming Lee
For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes. Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model. The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1). For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS. For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes. Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.
{"title":"340. LONG-TERM ONCOLOGIC OUTCOMES OF ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION AND SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY","authors":"Y. Chen, Jang-Ming Lee","doi":"10.1093/dote/doad052.154","DOIUrl":"https://doi.org/10.1093/dote/doad052.154","url":null,"abstract":"\u0000 \u0000 \u0000 For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes.\u0000 Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model.\u0000 \u0000 \u0000 \u0000 The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1).\u0000 For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS.\u0000 \u0000 \u0000 \u0000 For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes.\u0000 Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41555852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.124
Jiadi Wu, Zerui Zhao, Zhichao Li, Weizhao Huang, Geng Wang, Teng Mao, Wenqiang Lv, Lin Peng, Jiyang Chen
Anastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy. In this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5 mL Bioseal applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively. From February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively. The application of Bioseal intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.
吻合口渗漏（AL）是食管或食管胃交界癌症（EC或EJC）患者食管切除术后最严重的并发症之一。纤维蛋白封闭剂（FS）的应用可能有利于降低AL的发生率。本研究旨在评估FS预防McKeown食管切除术患者AL的安全性和有效性。在这项多中心、前瞻性、随机对照试验中，我们计划招募360名18-75岁的可切除EC或EJC患者，当参与者人数达到180人时进行中期分析。FS组患者接受McKeown食管切除术，在颈部吻合处应用2.5 mL Bioseal，而对照组患者仅接受手术。主要终点是术后前3个月内宫颈AL的发生率。从2019年2月到2021年11月，招募了180名患者，其中FS组89名，对照组91名。两组AL的发生率无统计学差异[FS组为6.7%（6/89），对照组为14.3%（13/91），P = 并发症具有可比性（P = 0.76）。术后未发生与FS相关的不良事件或死亡。术中应用Bioseal是可行的，不会增加并发症的风险，其预防AL的有效性需要在患者登记完成后重新验证。
{"title":"296. FIBRIN SEALANT FOR THE PREVENTION OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: INTERIM REPORT OF A PROSPECTIVE, PHASE III, RANDOMIZED CONTROLLED STUDY","authors":"Jiadi Wu, Zerui Zhao, Zhichao Li, Weizhao Huang, Geng Wang, Teng Mao, Wenqiang Lv, Lin Peng, Jiyang Chen","doi":"10.1093/dote/doad052.124","DOIUrl":"https://doi.org/10.1093/dote/doad052.124","url":null,"abstract":"\u0000 \u0000 \u0000 Anastomotic leakage (AL) is one of the most pernicious complications after esophagectomy for patients with esophageal or esophagogastric junction cancer (EC or EJC). The application of fibrin sealant (FS) may be advantageous for reducing the incidence of AL. This study aims to evaluate the safety and effectiveness of FS in preventing AL in patients undergoing McKeown esophagectomy.\u0000 \u0000 \u0000 \u0000 In this multicenter, prospective, randomized controlled trial, we planned to recruit 360 patients aged 18–75 years with resectable EC or EJC and the interim analysis was performed when the number of participants reaches 180. Patients assigned to the FS group received McKeown esophagectomy with 2.5 mL Bioseal applied to the cervical anastomosis, while patients in the control group received surgery alone. The primary endpoint was the incidence of cervical AL within the first 3 months postoperatively.\u0000 \u0000 \u0000 \u0000 From February 2019 to November 2021, 180 patients were recruited, with 89 in the FS group and 91 in the control group. There was no statistically difference between the incidence of AL between the two groups [6.7% (6/89) in the FS vs. 14.3% (13/91) in the control group, P = 0.16]. Complications was comparable (P = 0.76) between the FS group (42 of 89, 47.2%) and the control group (45 of 91, 49.5%). No adverse events related to FS or deaths occurred postoperatively.\u0000 \u0000 \u0000 \u0000 The application of Bioseal intraoperatively is feasible and does not increase the risk of complications, and its effectiveness for the prevention of AL needs to be revalidated after the completion of patient enrollment.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41679463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.162
Hui-Jiang Gao, Xiangyang Yu, Shixin Hu, Chu-Jiang Huang, De-Long Du, Xin Yu, Zhen-Tao Yu, Kai Ma
Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal cancer. However, it is currently unknown if fully mechanical stapled side-to-side anastomosis for Ivor Lewis TMIE could be preferred for patients in whom both procedures are oncologically feasible. The study was performed in 2 high-volume China esophageal cancer centers between Feb 2015 through Dec 2022. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing Ivor Lewis TMIE were included. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reoperations, length of stay, mortality, and overall survival (OS). 147 patients were included in this study. The incidence of anastomotic leakage requiring reintervention or reoperation was 12.9% after fully mechanical stapled side-to-side versus 11.8% after circular end-to-side anastomosis (P = 0.852). Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture (5.7% vs 17.1%, p = 0.032). Pulmonary complications (20.0% vs 23.7%), recurrent laryngeal nerve palsy (7.1% vs 5.3%), chyle leakage (10.0 vs 7.9%), atrial fibrillation (12.9 vs 13.2) and median hospital length of stay (12 vs 11 days) were comparable between the two arms (all P > 0.05). R0 resection rate was similar between the groups. Overall survival was comparable between the two arms (hazard ratio [HR], 0.81, 95% CI, 0.62–1.21, P = 0.208). The cumulative 5-year OS was 44.3% in the fully mechanical stapled side-to-side anastomosis arm, as compared with 39.5% in the circular end-to-side anastomosis arm. Compared to circular end-to-side anastomosis in patients in whom both procedures are oncologically feasible, there was no significant difference in the incidence of anastomotic leakage and other postoperative morbidity and OS with a fully mechanical stapled side-to-side anastomostic Ivor Lewis esophagectomy. Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture.
全微创食管切除术(TMIE)越来越多地应用于食管癌患者的治疗。然而，目前尚不清楚，对于两种手术方法在肿瘤上都可行的患者来说，Ivor Lewis TMIE的全机械侧对侧吻合是否更可取。该研究于2015年2月至2022年12月在中国两个高容量食管癌中心进行。前瞻性收集食管癌位于食管远端或胃食管交界处的连续患者进行Ivor Lewis TMIE。主要结局参数为吻合口漏，需要再干预或再手术。次要结局参数为手术特征、病理结果、并发症、再手术、住院时间、死亡率和总生存期(OS)。147例患者纳入本研究。全机械侧侧吻合术吻合口瘘发生率为12.9%，圆端侧吻合术吻合口瘘发生率为11.8% (P = 0.852)。全机械侧对侧Ivor Lewis食管切除术与较低的吻合口狭窄发生率显著相关(5.7% vs 17.1%， p = 0.032)。肺部并发症(20.0% vs 23.7%)、喉返神经麻痹(7.1% vs 5.3%)、乳糜漏(10.0 vs 7.9%)、心房颤动(12.9 vs 13.2)和住院时间中位数(12 vs 11天)在两组之间具有可比性(均P < 0.05)。两组间R0切除率相似。两组的总生存率相当(风险比[HR]， 0.81, 95% CI, 0.62-1.21, P = 0.208)。全机械端侧吻合臂累计5年OS为44.3%，圆形端侧吻合臂累计5年OS为39.5%。与圆端侧吻合相比，两种方法在肿瘤上都可行的患者，全机械侧对侧吻合Ivor Lewis食管切除术在吻合口漏发生率和其他术后发病率及OS方面无显著差异。全机械侧对侧Ivor Lewis食管切除术与较低的吻合口狭窄发生率显著相关。
{"title":"349. TOTALLY MECHANICAL STAPLED SIDE-TO-SIDE VERSUS CIRCULAR END-TO-SIDE ANASTOMOSIS FOR MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY: A MULTICENTER ANALYSIS","authors":"Hui-Jiang Gao, Xiangyang Yu, Shixin Hu, Chu-Jiang Huang, De-Long Du, Xin Yu, Zhen-Tao Yu, Kai Ma","doi":"10.1093/dote/doad052.162","DOIUrl":"https://doi.org/10.1093/dote/doad052.162","url":null,"abstract":"\u0000 \u0000 \u0000 Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal cancer. However, it is currently unknown if fully mechanical stapled side-to-side anastomosis for Ivor Lewis TMIE could be preferred for patients in whom both procedures are oncologically feasible.\u0000 \u0000 \u0000 \u0000 The study was performed in 2 high-volume China esophageal cancer centers between Feb 2015 through Dec 2022. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing Ivor Lewis TMIE were included. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reoperations, length of stay, mortality, and overall survival (OS).\u0000 \u0000 \u0000 \u0000 147 patients were included in this study. The incidence of anastomotic leakage requiring reintervention or reoperation was 12.9% after fully mechanical stapled side-to-side versus 11.8% after circular end-to-side anastomosis (P = 0.852). Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture (5.7% vs 17.1%, p = 0.032). Pulmonary complications (20.0% vs 23.7%), recurrent laryngeal nerve palsy (7.1% vs 5.3%), chyle leakage (10.0 vs 7.9%), atrial fibrillation (12.9 vs 13.2) and median hospital length of stay (12 vs 11 days) were comparable between the two arms (all P > 0.05). R0 resection rate was similar between the groups. Overall survival was comparable between the two arms (hazard ratio [HR], 0.81, 95% CI, 0.62–1.21, P = 0.208). The cumulative 5-year OS was 44.3% in the fully mechanical stapled side-to-side anastomosis arm, as compared with 39.5% in the circular end-to-side anastomosis arm.\u0000 \u0000 \u0000 \u0000 Compared to circular end-to-side anastomosis in patients in whom both procedures are oncologically feasible, there was no significant difference in the incidence of anastomotic leakage and other postoperative morbidity and OS with a fully mechanical stapled side-to-side anastomostic Ivor Lewis esophagectomy. Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43793889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.061
Shuntaro Yoshimura, Y. Seto
The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer. Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy. Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements). Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.
{"title":"200. COMPARISON OF SHORT-TERM OUTCOMES BETWEEN TRANSTHORACIC AND ROBOT-ASSISTED TRANSMEDIASTINAL RADICAL SURGERY FOR ESOPHAGEAL CANCER: A PROSPECTIVE STUDY","authors":"Shuntaro Yoshimura, Y. Seto","doi":"10.1093/dote/doad052.061","DOIUrl":"https://doi.org/10.1093/dote/doad052.061","url":null,"abstract":"\u0000 \u0000 \u0000 The present study aimed to assess the lower invasiveness of robot-assisted transmediastinal radical esophagectomy by prospectively comparing this procedure with transthoracic esophagectomy in terms of perioperative outcomes, serum cytokine levels, and respiratory function after surgery for esophageal cancer.\u0000 \u0000 \u0000 \u0000 Patients who underwent a robot-assisted transmediastinal esophagectomy or transthoracic esophagectomy between April 2015 and March 2017 were included. The perioperative outcomes, preoperative and postoperative serum IL-6, IL-8, and IL-10 levels, and respiratory function measured preoperatively and at 6 months postoperatively were compared in patients with a robot-assisted transmediastinal esophagectomy and those with a transthoracic esophagectomy.\u0000 \u0000 \u0000 \u0000 Sixty patients with esophageal cancer were enrolled. The transmediastinal esophagectomy group had a significantly lower incidence of postoperative pneumonia (p = 0.002) and a significantly shorter postoperative hospital stay (p < 0.0002). The serum IL-6 levels on postoperative days 1, 3, 5, and 7 were significantly lower in the transmediastinal esophagectomy group (p = 0.005, 0.0007, 0.022, 0.020, respectively). In the latter group, the serum IL-8 level was significantly lower immediately after surgery and on postoperative day 1 (p = 0.003, 0.001, respectively) while the serum IL-10 level was significantly lower immediately after surgery (p = 0.041). The reduction in vital capacity, percent vital capacity, forced vital capacity, and forced expiratory volume at 1.0 s 6 months after surgery was significantly greater in the transthoracic esophagectomy group (p < 0.0001 for all four measurements).\u0000 \u0000 \u0000 \u0000 Although further, large-scale studies are needed to confirm our findings, robot-assisted transmediastinal esophagectomy may confer short-term benefits in radical surgery for esophageal cancer.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43891424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.104
E. Dellon, M. Rothenberg, M. Collins, I. Hirano, M. Chehade, A. Bredenoord, A. Lucendo, J. Spergel, Xian Sun, J. Hamilton, E. Mortensen, Lila G. Glotfelty, A. Shabbir
In Parts A and B of the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617), dupilumab 300 mg weekly (DPL qw) vs placebo (PBO) demonstrated significant efficacy and acceptable safety up to 24 weeks in adults and adolescents with eosinophilic esophagitis (EoE). Patients who completed Parts A and B entered Part C and received DPL qw to 52 weeks. Here we present 52-week results from patients who completed Part B and continued to Part C. Of 80 DPL qw patients in Part B, 74 continued DPL qw in Part C (DPL/DPL). Of 79 PBO pts in Part B, 37 patients received DPL qw in Part C (PBO/DPL). Part B co-primary endpoints were proportion of patients achieving peak esophageal intraepithelial eosinophil (eos) count ≤6 eos/high- power field (hpf) and absolute change from Part B baseline in Dysphagia Symptom Score (DSQ) score at Week 24. Key secondary endpoints are listed in the Table. In Part C, all co-primary and secondary endpoints were assessed at Week 52 as secondary endpoints. Safety was also assessed. At Week 52, 84.6% of DPL/DPL and 67.6% of PBO/DPL patients achieved peak eos count ≤6 eos/hpf; mean (SD) absolute change from Part B baseline in DSQ score was −30.26 (15.39) for DPL/DPL and − 27.25 (11.46) for PBO/DPL patients. At Week 52, 100% of DPL/DPL and 78.4% of PBO/DPL patients achieved peak eos count <15 eos/hpf, 30.8% of DPL/DPL and 16.2% of PBO/DPL patients achieved peak eos count ≤1 eos/hpf, and compared to Part B baseline, peak eos count, EREFS, and HSS grade and stage scores were reduced (Table). DPL demonstrated an acceptable safety profile. DPL qw demonstrated persistent improvements in clinical, symptomatic, histologic, and endoscopic features of EoE up to 52 weeks and had an acceptable safety profile. PBO patients from Part B who received DPL in Part C showed similar efficacy to dupilumab qw patients of Part B.
{"title":"263. DUPILUMAB EFFICACY AND SAFETY TO 52 WEEKS IN ADULT AND ADOLESCENT PATIENTS WITH EOSINOPHILIC ESOPHAGITIS: RESULTS FROM LIBERTY EOE TREET","authors":"E. Dellon, M. Rothenberg, M. Collins, I. Hirano, M. Chehade, A. Bredenoord, A. Lucendo, J. Spergel, Xian Sun, J. Hamilton, E. Mortensen, Lila G. Glotfelty, A. Shabbir","doi":"10.1093/dote/doad052.104","DOIUrl":"https://doi.org/10.1093/dote/doad052.104","url":null,"abstract":"\u0000 \u0000 \u0000 In Parts A and B of the 3-part, phase 3 LIBERTY EoE TREET study (NCT03633617), dupilumab 300 mg weekly (DPL qw) vs placebo (PBO) demonstrated significant efficacy and acceptable safety up to 24 weeks in adults and adolescents with eosinophilic esophagitis (EoE). Patients who completed Parts A and B entered Part C and received DPL qw to 52 weeks. Here we present 52-week results from patients who completed Part B and continued to Part C.\u0000 \u0000 \u0000 \u0000 Of 80 DPL qw patients in Part B, 74 continued DPL qw in Part C (DPL/DPL). Of 79 PBO pts in Part B, 37 patients received DPL qw in Part C (PBO/DPL). Part B co-primary endpoints were proportion of patients achieving peak esophageal intraepithelial eosinophil (eos) count ≤6 eos/high- power field (hpf) and absolute change from Part B baseline in Dysphagia Symptom Score (DSQ) score at Week 24. Key secondary endpoints are listed in the Table. In Part C, all co-primary and secondary endpoints were assessed at Week 52 as secondary endpoints. Safety was also assessed.\u0000 \u0000 \u0000 \u0000 At Week 52, 84.6% of DPL/DPL and 67.6% of PBO/DPL patients achieved peak eos count ≤6 eos/hpf; mean (SD) absolute change from Part B baseline in DSQ score was −30.26 (15.39) for DPL/DPL and − 27.25 (11.46) for PBO/DPL patients. At Week 52, 100% of DPL/DPL and 78.4% of PBO/DPL patients achieved peak eos count <15 eos/hpf, 30.8% of DPL/DPL and 16.2% of PBO/DPL patients achieved peak eos count ≤1 eos/hpf, and compared to Part B baseline, peak eos count, EREFS, and HSS grade and stage scores were reduced (Table). DPL demonstrated an acceptable safety profile.\u0000 \u0000 \u0000 \u0000 DPL qw demonstrated persistent improvements in clinical, symptomatic, histologic, and endoscopic features of EoE up to 52 weeks and had an acceptable safety profile. PBO patients from Part B who received DPL in Part C showed similar efficacy to dupilumab qw patients of Part B.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44457490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.108
B. Klarenbeek, L. Veenendaal, C. Rosman
The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used. MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’. In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team. The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.
{"title":"269. CURRENT STATUS OF THE INTRODUCTION PROCESS OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), TYPICALLY IDEAL 2A STRUGGLES","authors":"B. Klarenbeek, L. Veenendaal, C. Rosman","doi":"10.1093/dote/doad052.108","DOIUrl":"https://doi.org/10.1093/dote/doad052.108","url":null,"abstract":"\u0000 \u0000 \u0000 The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used.\u0000 \u0000 \u0000 \u0000 MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’.\u0000 \u0000 \u0000 \u0000 In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team.\u0000 \u0000 \u0000 \u0000 The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43006615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.253
M. Menéndez, M. Bruna, J. Vaqué, Nuria García Del Olmo, Fernando Mingol Navarro, M.L. Nieto
Classically, esophageal neoplasms have had a poor survival, considering those T4b tumors that infiltrate the aorta, airways or vertebrae to be unresectable despite not having distant disease. With the advancement of surgical techniques, the improvement of neoadjuvant/adjuvant systemic treatments and the multidisciplinary approach to this pathology, these barriers of unresectability are gradually being broken. This is a 68-year-old patient, a 1-pack-a-day smoker, who presented squamous cell carcinoma 30 cm from the dental arch treated with chemoradiotherapy according to the CROSS scheme. After surgery at another center, there is suspicion of infiltration of the descending aorta, for which he was referred to our center. The case is discussed in a multidisciplinary committee and a decision is made to place TEVAR in the first stage and surgical resection of the lesion in a second stage. The patient underwent surgery performing a three-stage esophagectomy (McKeown) using prone thoracoscopy without selective intubation, through which a regulated esophagectomy was performed with total lymphadenectomy and en bloc resection along with the anterior wall of the descending aorta where there was suspicion of tumor infiltration, exposing the aortic prosthesis (Photo 2). The prosthesis is covered to isolate it from possible sources of infection with a patch of pericardium fixed with loose sutures to the aortic wall and biological glue. It was reconstructed using a mediastinal gastroplasty with cervical circular mechanical anastomosis. Postoperative period marked by cervical leakage that was resolved by conservative treatment. Resection using a minimally invasive approach of an aortic patch in cases of suspected tumor infiltration in esophageal neoplasms without systemic disease may be a safe therapeutic option as long as it is performed in centers specialized in complex esophageal resections and with a multidisciplinary team that also involves cardiac surgeons. The oncological prognosis must be evaluated in the long term, but achieving R0 resections should not be worse than in locally advanced resectable tumors.
{"title":"471. MINIMALLY INVASIVE ESOPHAGECTOMY WITH RESECTION OF THE DESCENDING AORTA DUE TO SUSPECTED TUMOR INFILTRATION","authors":"M. Menéndez, M. Bruna, J. Vaqué, Nuria García Del Olmo, Fernando Mingol Navarro, M.L. Nieto","doi":"10.1093/dote/doad052.253","DOIUrl":"https://doi.org/10.1093/dote/doad052.253","url":null,"abstract":"\u0000 \u0000 \u0000 Classically, esophageal neoplasms have had a poor survival, considering those T4b tumors that infiltrate the aorta, airways or vertebrae to be unresectable despite not having distant disease. With the advancement of surgical techniques, the improvement of neoadjuvant/adjuvant systemic treatments and the multidisciplinary approach to this pathology, these barriers of unresectability are gradually being broken.\u0000 \u0000 \u0000 \u0000 This is a 68-year-old patient, a 1-pack-a-day smoker, who presented squamous cell carcinoma 30 cm from the dental arch treated with chemoradiotherapy according to the CROSS scheme. After surgery at another center, there is suspicion of infiltration of the descending aorta, for which he was referred to our center.\u0000 The case is discussed in a multidisciplinary committee and a decision is made to place TEVAR in the first stage and surgical resection of the lesion in a second stage.\u0000 \u0000 \u0000 \u0000 The patient underwent surgery performing a three-stage esophagectomy (McKeown) using prone thoracoscopy without selective intubation, through which a regulated esophagectomy was performed with total lymphadenectomy and en bloc resection along with the anterior wall of the descending aorta where there was suspicion of tumor infiltration, exposing the aortic prosthesis (Photo 2). The prosthesis is covered to isolate it from possible sources of infection with a patch of pericardium fixed with loose sutures to the aortic wall and biological glue. It was reconstructed using a mediastinal gastroplasty with cervical circular mechanical anastomosis. Postoperative period marked by cervical leakage that was resolved by conservative treatment.\u0000 \u0000 \u0000 \u0000 Resection using a minimally invasive approach of an aortic patch in cases of suspected tumor infiltration in esophageal neoplasms without systemic disease may be a safe therapeutic option as long as it is performed in centers specialized in complex esophageal resections and with a multidisciplinary team that also involves cardiac surgeons. The oncological prognosis must be evaluated in the long term, but achieving R0 resections should not be worse than in locally advanced resectable tumors.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45887682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.226
Charles Rayner, S. Allen, Tadd Seymour, S. Preston, A. Frampton, D. Bartlett, N. Annels, N. Abbassi‐Ghadi
The immune system is highly responsive and positively adapts to exercise. A single bout of exercise results in the mobilisation of highly functional effector CD8+ T cells and NK-cells into the circulation. Murine cancer models have shown that exercise reduces tumour burden by increasing the frequency of tumour-infiltrating lymphocytes (TILs). There are no studies assessing the impact of an exercise programme on the levels of TILs in patients’ solid tumours in any cancer. We recently completed a 16-week randomised prehabilitation exercise program (NCT02950324) in esophageal cancer patients before esophagogastric cancer resection. Exercise training was a low-to-moderate intensity twice supervised, thrice home-based weekly program. Tumour specimens obtained at the time of resection were formalin fixed paraffin embedded (FFPE) for multispectral immunohistochemical analysis. Tumour tissues were stained with primary antibodies for CD68, CD57, CD8, CD4, FoxP3, Granzyme B, PDL1 and pancytokeratin. Cell populations and spatial relationships were analysed using the Phenoimager HT (Akoya Biosciences) and QuPath. Although our exercise program was ~33% of the physical activity guidelines for cancer patients, physical fitness and well-being were maintained rather than significantly reduced in the intervention group compared to the control group. Multispectral analysis observed that 3.2% ± 1.1% of cells in the tumours were CD8+ T cells compared to 1.4% ± 0.5% in the control group (p < 0.001). Furthermore, we observed positive associations between increased frequencies of CD8 + TILs (Fig 1C: r = 0.562, p = 0.016), Granzyme B+/CD8 + TILs (r = 0.637, p = 0.003) and larger increases in exercise induced aerobic capacity. This data suggests that the more exercise can increase aerobic fitness, the greater the likelihood of increasing functional TILs. New approaches to improve outcomes following surgery for esophageal adenocarcinoma are required. One such approach is immunotherapy. However, immunotherapy is relatively ineffective in esophageal adenocarcinoma due to the lack of CD8+ T cells and NK cells in the tumours. Increasing TILs through exercise programmes that are designed to focus on maintaining or improving aerobic capacity may improve patients’ response to immunotherapy and positively impact prognosis and survival.
{"title":"434. INCREASING TUMOUR INFILTRATING LYMPHOCYTES THROUGH EXERCISE ALONE—A PILOT RCT IN ESOPHAGEAL ADENOCARCINOMA","authors":"Charles Rayner, S. Allen, Tadd Seymour, S. Preston, A. Frampton, D. Bartlett, N. Annels, N. Abbassi‐Ghadi","doi":"10.1093/dote/doad052.226","DOIUrl":"https://doi.org/10.1093/dote/doad052.226","url":null,"abstract":"\u0000 \u0000 \u0000 The immune system is highly responsive and positively adapts to exercise. A single bout of exercise results in the mobilisation of highly functional effector CD8+ T cells and NK-cells into the circulation. Murine cancer models have shown that exercise reduces tumour burden by increasing the frequency of tumour-infiltrating lymphocytes (TILs). There are no studies assessing the impact of an exercise programme on the levels of TILs in patients’ solid tumours in any cancer.\u0000 \u0000 \u0000 \u0000 We recently completed a 16-week randomised prehabilitation exercise program (NCT02950324) in esophageal cancer patients before esophagogastric cancer resection. Exercise training was a low-to-moderate intensity twice supervised, thrice home-based weekly program. Tumour specimens obtained at the time of resection were formalin fixed paraffin embedded (FFPE) for multispectral immunohistochemical analysis. Tumour tissues were stained with primary antibodies for CD68, CD57, CD8, CD4, FoxP3, Granzyme B, PDL1 and pancytokeratin. Cell populations and spatial relationships were analysed using the Phenoimager HT (Akoya Biosciences) and QuPath.\u0000 \u0000 \u0000 \u0000 Although our exercise program was ~33% of the physical activity guidelines for cancer patients, physical fitness and well-being were maintained rather than significantly reduced in the intervention group compared to the control group. Multispectral analysis observed that 3.2% ± 1.1% of cells in the tumours were CD8+ T cells compared to 1.4% ± 0.5% in the control group (p < 0.001). Furthermore, we observed positive associations between increased frequencies of CD8 + TILs (Fig 1C: r = 0.562, p = 0.016), Granzyme B+/CD8 + TILs (r = 0.637, p = 0.003) and larger increases in exercise induced aerobic capacity. This data suggests that the more exercise can increase aerobic fitness, the greater the likelihood of increasing functional TILs.\u0000 \u0000 \u0000 \u0000 New approaches to improve outcomes following surgery for esophageal adenocarcinoma are required. One such approach is immunotherapy. However, immunotherapy is relatively ineffective in esophageal adenocarcinoma due to the lack of CD8+ T cells and NK cells in the tumours. Increasing TILs through exercise programmes that are designed to focus on maintaining or improving aerobic capacity may improve patients’ response to immunotherapy and positively impact prognosis and survival.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45893850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.003
Y. Gu, Wen-ping Wang, Long-Qi Chen
To investigate the effect of artificial capnothorax on circulating tumor cells and survival after minimally invasive esophagectomy for esophageal cancer. This prospective, multicenter, randomized controlled trial was conducted in a tertiary hospital in China. Between August 2019 and January 2020, 110 patients with resectable esophageal cancer were randomized to undergo non-capnothorax esophagectomy (n = 55) or capnothorax procedures. The analysis was based on the intention-to-treat principle. The final follow-up occurred in November 2022. The main outcomes were changes in folate receptor-positive circulating tumor cells, 3-year overall survival, and disease-free survival rates. A total of 110 patients were included in the intention-to-treat analysis. After surgery, the incidence of patients with incremental changes in FR + CTC levels was 18.6% (8/43) in the capnothorax group and 2.7% (1/37) in the non-capnothorax group (P = 0.033) (mean changes, −3.9 ± 3.4 [FU/3 mL] vs −2.4 ± 2.9 [FU/3 mL], respectively; P = 0.039). There were significant differences in the 3-year overall survival rate (81.6% [95%, 72.4–92.0] vs 65.2% [95%, 59.3–78.8]; P = 0.002) and disease-free survival rate (81.6% [95%, 72.4–93.0] vs 61.6% [95%, 50.1–75.7]; P = 0.015) between the two groups. Multivariate analysis indicated that the artificial pneumothorax approach was a prognostic factor for overall survival (HR: 2.347, 95% CI: 1.053–5.235; P = 0.037) and disease-free survival (HR: 1.325, 95% CI: 1.210–1.451; P < 0.001). Artificial capnothorax during surgery resulted in increased dissemination of circulating tumor cells and worse survival outcomes in patients with esophageal cancer. Esophagectomy under non-capnothorax should be a recommended procedure.
{"title":"15. EFFECT OF ARTIFICIAL CAPNOTHORAX VS NON-CAPNOTHORAX DURING THORACOSCOPIC ESOPHAGECTOMY ON CIRCULATING TUMOR CELLS AND SURVIVAL IN ESOPHAGEAL CANCER","authors":"Y. Gu, Wen-ping Wang, Long-Qi Chen","doi":"10.1093/dote/doad052.003","DOIUrl":"https://doi.org/10.1093/dote/doad052.003","url":null,"abstract":"\u0000 \u0000 \u0000 To investigate the effect of artificial capnothorax on circulating tumor cells and survival after minimally invasive esophagectomy for esophageal cancer.\u0000 \u0000 \u0000 \u0000 This prospective, multicenter, randomized controlled trial was conducted in a tertiary hospital in China. Between August 2019 and January 2020, 110 patients with resectable esophageal cancer were randomized to undergo non-capnothorax esophagectomy (n = 55) or capnothorax procedures. The analysis was based on the intention-to-treat principle. The final follow-up occurred in November 2022. The main outcomes were changes in folate receptor-positive circulating tumor cells, 3-year overall survival, and disease-free survival rates.\u0000 \u0000 \u0000 \u0000 A total of 110 patients were included in the intention-to-treat analysis. After surgery, the incidence of patients with incremental changes in FR + CTC levels was 18.6% (8/43) in the capnothorax group and 2.7% (1/37) in the non-capnothorax group (P = 0.033) (mean changes, −3.9 ± 3.4 [FU/3 mL] vs −2.4 ± 2.9 [FU/3 mL], respectively; P = 0.039). There were significant differences in the 3-year overall survival rate (81.6% [95%, 72.4–92.0] vs 65.2% [95%, 59.3–78.8]; P = 0.002) and disease-free survival rate (81.6% [95%, 72.4–93.0] vs 61.6% [95%, 50.1–75.7]; P = 0.015) between the two groups. Multivariate analysis indicated that the artificial pneumothorax approach was a prognostic factor for overall survival (HR: 2.347, 95% CI: 1.053–5.235; P = 0.037) and disease-free survival (HR: 1.325, 95% CI: 1.210–1.451; P < 0.001).\u0000 \u0000 \u0000 \u0000 Artificial capnothorax during surgery resulted in increased dissemination of circulating tumor cells and worse survival outcomes in patients with esophageal cancer. Esophagectomy under non-capnothorax should be a recommended procedure.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45969575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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