Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.012
Yijiao (Joanna) Wang, S. Kulasegaran, S. Srinivasa, J. Koea, A. MacCormick
Oesophageal adenocarcinoma (OAC) is a lethal condition. The management is typically multifaceted with oesophagectomy being the cornerstone of treatment. Quality performance indicators (QPIs) are objective measurements of aspects of patient’s care that affect clinical outcomes. We look to measure a set of clinically relevant QPIs that can be used to capture key aspects of patient management at our institution. all patients with OAC treated from 2010 to 2015, and 2020 to 2021 at Te Whatu Ora Waitemata were included. Patients with secondary metastases to the oesophagus or gastric cancer with extension to the oesophagus were excluded. Electronic data in the form of clinic letters, operation notes, histology and radiology reports were reviewed. QPI adherence was collected in binary form. QPIs with consistently high compliance rates include radiological staging and histological diagnosis, perioperative dietitian involvement, explanations of disease and treatment intent, and pathology report documentation. QPIs demonstrating significant change and improvement across the two groups include endoscopic resection (60.0% of patients with T1 disease in 2010 to 88.9% in 2020 group), multimodality treatment (majority ECF and ECX perioperative chemotherapy in 2010 to majority FLOT chemotherapy in 2020 group) and minimally invasive approach (30.4% hybrid in 2010 compared to 72.4% hybrid in 2020). QPIs from the systematic review were readily measurable and were variably implemented in clinical practice. Areas requiring improvement were identified however relevance to real-world clinical outcomes require further focus of investigation.
食管腺癌（OAC）是一种致死性疾病。治疗通常是多方面的，食道切除术是治疗的基石。质量绩效指标（QPI）是对影响临床结果的患者护理方面的客观测量。我们希望测量一组临床相关的QPI，这些QPI可用于捕捉我们机构患者管理的关键方面。包括2010年至2015年和2020年至2021年在Te Whatu Ora Waitemata接受治疗的所有OAC患者。食管继发性转移或癌症延伸至食管的患者被排除在外。对临床信函、手术记录、组织学和放射学报告等形式的电子数据进行了审查。QPI依从性以二元形式收集。一贯高依从性的QPI包括放射学分期和组织学诊断、围手术期营养师参与、疾病和治疗意图的解释以及病理学报告文件。两组的QPI显示出显著的变化和改善，包括内镜切除术（2010年T1疾病患者的比例为60.0%，2020年为88.9%）、多模式治疗（2010年多数为ECF和ECX围手术期化疗，2020年多数为FLOT化疗）和微创方法（2010年30.4%为混合，2020年72.4%为混合）。系统综述中的QPI易于测量，在临床实践中也有不同的实施方式。确定了需要改进的领域，但与现实世界临床结果的相关性需要进一步关注调查。
{"title":"32. QUALITY PERFORMANCE INDICATOR COMPLIANCE FOR THE TREATMENT OF OESOPHAGEAL ADENOCARCINOMA IN NEW ZEALAND","authors":"Yijiao (Joanna) Wang, S. Kulasegaran, S. Srinivasa, J. Koea, A. MacCormick","doi":"10.1093/dote/doad052.012","DOIUrl":"https://doi.org/10.1093/dote/doad052.012","url":null,"abstract":"\u0000 \u0000 \u0000 Oesophageal adenocarcinoma (OAC) is a lethal condition. The management is typically multifaceted with oesophagectomy being the cornerstone of treatment. Quality performance indicators (QPIs) are objective measurements of aspects of patient’s care that affect clinical outcomes. We look to measure a set of clinically relevant QPIs that can be used to capture key aspects of patient management at our institution.\u0000 \u0000 \u0000 \u0000 all patients with OAC treated from 2010 to 2015, and 2020 to 2021 at Te Whatu Ora Waitemata were included. Patients with secondary metastases to the oesophagus or gastric cancer with extension to the oesophagus were excluded. Electronic data in the form of clinic letters, operation notes, histology and radiology reports were reviewed. QPI adherence was collected in binary form.\u0000 \u0000 \u0000 \u0000 QPIs with consistently high compliance rates include radiological staging and histological diagnosis, perioperative dietitian involvement, explanations of disease and treatment intent, and pathology report documentation. QPIs demonstrating significant change and improvement across the two groups include endoscopic resection (60.0% of patients with T1 disease in 2010 to 88.9% in 2020 group), multimodality treatment (majority ECF and ECX perioperative chemotherapy in 2010 to majority FLOT chemotherapy in 2020 group) and minimally invasive approach (30.4% hybrid in 2010 compared to 72.4% hybrid in 2020).\u0000 \u0000 \u0000 \u0000 QPIs from the systematic review were readily measurable and were variably implemented in clinical practice. Areas requiring improvement were identified however relevance to real-world clinical outcomes require further focus of investigation.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44003006","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/doad052.177
H. Konishi, H. Fujiwara, A. Shiozaki, Keiji Nishibeppu, Takuma Ohashi, T. Kubota, E. Otsuji
Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated. Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated. Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (< 45), PLR (> 122), and operative bleeding (>134) were significantly related with post-operative pneumonia in the univariate analysis (p < 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction. PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia. Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.
{"title":"372. INVESTIGATION OF RISK FACTORS OF POSTOPERATIVE PNEUMONIA IN MEDIASTINOSCOPIC ESOPHAGECTOMY","authors":"H. Konishi, H. Fujiwara, A. Shiozaki, Keiji Nishibeppu, Takuma Ohashi, T. Kubota, E. Otsuji","doi":"10.1093/dote/doad052.177","DOIUrl":"https://doi.org/10.1093/dote/doad052.177","url":null,"abstract":"\u0000 \u0000 \u0000 Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated.\u0000 \u0000 \u0000 \u0000 Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated.\u0000 \u0000 \u0000 \u0000 Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (< 45), PLR (> 122), and operative bleeding (>134) were significantly related with post-operative pneumonia in the univariate analysis (p < 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction.\u0000 \u0000 \u0000 \u0000 PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia.\u0000 \u0000 \u0000 \u0000 Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43525297","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/doad052.273
Aria Sallakhi, Isabella Alexandra Baumgartl, J. Andresen, Hagar Khater, Georg Gibas, Amadea Medibach, Cordula Marolt, Wolfgang Radlspöck, J. Zacherl
According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase. Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12. Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up. A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.
{"title":"492. TYPES AND INCIDENCE OF POSTOPERATIVE ANEMIA AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY","authors":"Aria Sallakhi, Isabella Alexandra Baumgartl, J. Andresen, Hagar Khater, Georg Gibas, Amadea Medibach, Cordula Marolt, Wolfgang Radlspöck, J. Zacherl","doi":"10.1093/dote/doad052.273","DOIUrl":"https://doi.org/10.1093/dote/doad052.273","url":null,"abstract":"\u0000 According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase.\u0000 Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12.\u0000 Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up.\u0000 A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44275905","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":null,"pages":null},"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/doad052.227
Tsuyoshi Tanaka, Ai Goto, S. Shibasaki, Kazumitsu Suzuki, A. Serizawa, Shingo Akimoto, M. Nakauchi, K. Inaba, I. Uyama, Koichi Suda
The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes. We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery. Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS. Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p < 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001). The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.
{"title":"435. CIRCULAR-STAPLED ESOPHAGOGASTROSTOMY USING THE KEYHOLE PROCEDURE: TECHNICAL ASPECTS AND CLINICAL OUTCOMES","authors":"Tsuyoshi Tanaka, Ai Goto, S. Shibasaki, Kazumitsu Suzuki, A. Serizawa, Shingo Akimoto, M. Nakauchi, K. Inaba, I. Uyama, Koichi Suda","doi":"10.1093/dote/doad052.227","DOIUrl":"https://doi.org/10.1093/dote/doad052.227","url":null,"abstract":"\u0000 \u0000 \u0000 The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes.\u0000 \u0000 \u0000 \u0000 We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery.\u0000 Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS.\u0000 \u0000 \u0000 \u0000 Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p < 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001).\u0000 \u0000 \u0000 \u0000 The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43558434","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":null,"pages":null},"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":null,"pages":null},"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/doad052.004
Suzanne F M van Wijck, Athiná Barza, J. Vermeulen, B. Eyck, B. J. van der Wilk, E. van der Harst, M. Verhofstad, S. Lagarde, E. V. van Lieshout, Charlène Zijden, M. Wijffels
Chest wall pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. The aims of this study were 1) to determine the prevalence of chest wall abnormalities on postoperative imaging; and 2) to compare complications, long-term pain, and quality of life in patients with versus without thoracotomy-related thoracic fractures. This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 1 January 2010 and 31 December 2020. An early postoperative CT (<1 month) and/or late CT (>6 months) had to be available. Disease-free patients were asked to complete questionnaires on pain and quality of life (SF-36 and EORTC-QLQ-C30). A total of 366 patients were included. Thoracotomy-related rib fractures were seen in 144 (39%) patients and thoracic transverse process fractures in 4 (2%). Patients with thoracic fractures more often developed postoperative complications (89% versus 74%, p = 0.002), especially pneumonia (51% versus 39%, p = 0.032). Seventy-seven participants (33 with thoracic fractures, 44 without) completed questionnaires median 41 (P25-P75 28–91) months postoperatively. Long-term chest wall pain was reported by 48 (63%) participants but no association with thoracic fractures was found (p = 0.637). Quality of life scores did not differ between patients with versus without thoracic fractures and were mostly comparable with their reference populations. Thoracic (mainly rib) fractures are prevalent following a thoracotomy for esophageal cancer. Patients with thoracic fractures have an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or decreased quality of life was not confirmed.
{"title":"16. THORACIC FRACTURES AND OTHER CHEST WALL ABNORMALITIES AFTER THORACOTOMY FOR ESOPHAGEAL CANCER: A RETROSPECTIVE COHORT STUDY","authors":"Suzanne F M van Wijck, Athiná Barza, J. Vermeulen, B. Eyck, B. J. van der Wilk, E. van der Harst, M. Verhofstad, S. Lagarde, E. V. van Lieshout, Charlène Zijden, M. Wijffels","doi":"10.1093/dote/doad052.004","DOIUrl":"https://doi.org/10.1093/dote/doad052.004","url":null,"abstract":"\u0000 \u0000 \u0000 Chest wall pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. The aims of this study were 1) to determine the prevalence of chest wall abnormalities on postoperative imaging; and 2) to compare complications, long-term pain, and quality of life in patients with versus without thoracotomy-related thoracic fractures.\u0000 \u0000 \u0000 \u0000 This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 1 January 2010 and 31 December 2020. An early postoperative CT (<1 month) and/or late CT (>6 months) had to be available. Disease-free patients were asked to complete questionnaires on pain and quality of life (SF-36 and EORTC-QLQ-C30).\u0000 \u0000 \u0000 \u0000 A total of 366 patients were included. Thoracotomy-related rib fractures were seen in 144 (39%) patients and thoracic transverse process fractures in 4 (2%). Patients with thoracic fractures more often developed postoperative complications (89% versus 74%, p = 0.002), especially pneumonia (51% versus 39%, p = 0.032). Seventy-seven participants (33 with thoracic fractures, 44 without) completed questionnaires median 41 (P25-P75 28–91) months postoperatively. Long-term chest wall pain was reported by 48 (63%) participants but no association with thoracic fractures was found (p = 0.637). Quality of life scores did not differ between patients with versus without thoracic fractures and were mostly comparable with their reference populations.\u0000 \u0000 \u0000 \u0000 Thoracic (mainly rib) fractures are prevalent following a thoracotomy for esophageal cancer. Patients with thoracic fractures have an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or decreased quality of life was not confirmed.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47198660","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":null,"pages":null},"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/doad052.156
Sung Kwang Lee
Esophageal SMT is a rare disease, and most of them are benign. Esophageal schwannoma accounts for about 2% among esophageal SMT. Recently, F-18 FDG PET/CT has been widely used to confirm malignancy or to identify other metastatic lesions in cancer patients. However, even benign tumors often show an elevated SUV, and in the case of schwannomas, various values of SUV have been reported, which seems to limit differentiation from other malignant peripheral nerve sheath tumors. A 56-year-old female patient was incidentally found with extrinsic compressing mass at 22 cm from the incisor. An endoscopic ultrasonography and chest CT showed a 3.4 cm sized homogenous well-defined mass in upper esophagus, leiomyoma or gastrointestinal stromal tumor was suspected. SUV was elevated on PET-CT was performed to identify malignancy and metastatic lesions. When confirmed as malignant, additional surgery was planned, and enucleation was performed for primary diagnosis and treatment. The esophageal bulging was confirmed. After dividing the esophageal muscle, and underwent enucleation. In immunohistochemical staining, S-100 protein showed positive findings, which could be diagnosed as schwannoma. Due to the characteristics of esophageal SMT, FDG uptake may be observed on PET-CT, but if there is no evidence of metastasis, it is likely to proceed with treatment according to the benign disease. Then, if immunohistochemistry examination is diagnosed as malignancy, it would be desirable to apply additional stage surgery.
{"title":"342. VIDEO-ASSISTED THORACOSCOPIC ENUCLEATION OF BENIGN SCHWANNOMA MISDIAGNOSED AS MALIGNANT LESION ON F-18 FDG PET/CT IN ESOPHAGEAL SUBMUCOSAL TUMOR","authors":"Sung Kwang Lee","doi":"10.1093/dote/doad052.156","DOIUrl":"https://doi.org/10.1093/dote/doad052.156","url":null,"abstract":"\u0000 \u0000 \u0000 Esophageal SMT is a rare disease, and most of them are benign. Esophageal schwannoma accounts for about 2% among esophageal SMT.\u0000 Recently, F-18 FDG PET/CT has been widely used to confirm malignancy or to identify other metastatic lesions in cancer patients. However, even benign tumors often show an elevated SUV, and in the case of schwannomas, various values of SUV have been reported, which seems to limit differentiation from other malignant peripheral nerve sheath tumors.\u0000 \u0000 \u0000 \u0000 A 56-year-old female patient was incidentally found with extrinsic compressing mass at 22 cm from the incisor. An endoscopic ultrasonography and chest CT showed a 3.4 cm sized homogenous well-defined mass in upper esophagus, leiomyoma or gastrointestinal stromal tumor was suspected. SUV was elevated on PET-CT was performed to identify malignancy and metastatic lesions. When confirmed as malignant, additional surgery was planned, and enucleation was performed for primary diagnosis and treatment.\u0000 The esophageal bulging was confirmed. After dividing the esophageal muscle, and underwent enucleation. In immunohistochemical staining, S-100 protein showed positive findings, which could be diagnosed as schwannoma.\u0000 \u0000 \u0000 \u0000 Due to the characteristics of esophageal SMT, FDG uptake may be observed on PET-CT, but if there is no evidence of metastasis, it is likely to proceed with treatment according to the benign disease. Then, if immunohistochemistry examination is diagnosed as malignancy, it would be desirable to apply additional stage surgery.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41793521","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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