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Western European Variation in the Organization of Esophageal Cancer Surgical Care 西欧食管癌外科治疗组织的差异
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-27 DOI: 10.1093/dote/doae033
Maurits R Visser, Daan M Voeten, Suzanne S Gisbertz, Jelle P Ruurda, Michael P Achiam, Magnus Nilsson, Sheraz R Markar, Manuel Pera, Riccardo Rosati, Guillaume Piessen, Philippe Nafteux, Christian A Gutschow, Peter P Grimminger, Jari V Räsänen, John V Reynolds, Hans-Olaf Johannessen, Pedro Vieira, Michael Weitzendorfer, Aristotelis Kechagias, Mark I van Berge Henegouwen, Richard van Hillegersberg
Reasons for structural and outcome differences in esophageal cancer surgery in Western Europe remain unclear. This questionnaire study aimed to identify differences in the organization of esophageal cancer surgical care in Western Europe. A cross-sectional international questionnaire study was conducted among upper gastrointestinal (GI) surgeons from Western Europe. One surgeon per country was selected based on scientific output and active membership in the European Society for Diseases of the Esophagus or (inter)national upper GI committee. The questionnaire consisted of 51 structured questions on the structural organization of esophageal cancer surgery, surgical training, and clinical audit processes. Between October 2021 and October 2022, 16 surgeons from 16 European countries participated in this study. In 5 countries (31%), a volume threshold was present ranging from 10 to 26 annual esophagectomies, in 7 (44%) care was centralized in designated centers, and in 4 (25%) no centralizing regulations were present. The number of centers performing esophageal cancer surgery per country differed from 4 to 400, representing 0.5–4.9 centers per million inhabitants. In 4 countries (25%), esophageal cancer surgery was part of general surgical training and 8 (50%) reported the availability of upper GI surgery fellowships. A national audit for upper GI surgery was present in 8 (50%) countries. If available, all countries use the audit to monitor the quality of care. Substantial differences exist in the organization and centralization of esophageal cancer surgical care in Western Europe. The exchange of experience in the organizational aspects of care could further improve the results of esophageal cancer surgical care in Europe.
西欧食管癌手术结构和结果存在差异的原因尚不清楚。这项问卷调查研究旨在确定西欧食管癌手术治疗组织方面的差异。我们对西欧的上消化道(GI)外科医生进行了一项横断面国际问卷调查。根据科研成果和欧洲食管疾病学会或(国家间)上消化道委员会的活跃成员资格,每个国家选出一名外科医生。问卷由 51 个结构化问题组成,内容涉及食管癌手术的结构组织、手术培训和临床审核流程。2021 年 10 月至 2022 年 10 月期间,来自 16 个欧洲国家的 16 名外科医生参与了这项研究。有 5 个国家(31%)规定了年食管切除术量阈值,从 10 例到 26 例不等;有 7 个国家(44%)在指定中心集中进行治疗;有 4 个国家(25%)没有集中规定。每个国家进行食管癌手术的中心数量从 4 到 400 不等,即每百万居民有 0.5 到 4.9 个中心。在 4 个国家(25%),食管癌手术是普通外科培训的一部分,8 个国家(50%)报告有上消化道外科奖学金。有 8 个国家(50%)对上消化道手术进行了国家审计。如果有的话,所有国家都使用审计来监控医疗质量。西欧国家在食道癌外科治疗的组织和集中化方面存在很大差异。交流医疗组织方面的经验可进一步提高欧洲食管癌手术治疗的效果。
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引用次数: 0
Metabolic dysfunction-associated steatotic liver disease and risk of esophageal cancer in patients with diabetes mellitus: a nationwide cohort study 代谢功能障碍相关脂肪性肝病与糖尿病患者罹患食管癌的风险:一项全国性队列研究
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-04-08 DOI: 10.1093/dote/doae029
Yeong Jeong Jeon, Kyungdo Han, Seung Woo Lee, Ji Eun Lee, Junhee Park, In Young Cho, Jong Ho Cho, Dong Wook Shin
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes and a developing several cancers including esophageal cancer (EC). However, the association between MASLD and EC in diabetic patients has not been investigated. Therefore, we aimed to investigate the relation between MASLD and developing EC in diabetic patients. This was a population-based retrospective cohort study of data from the Korean National Health Insurance Service (NHIS). A total of 1,904,468 subjects diagnosed with diabetes who underwent NHIS-provided health checkups from 2009 to 2012 were included. We constructed a Cox proportional hazard model for the association of fatty liver index (FLI) and the risk of EC stratified by potential confounders. Over a mean follow-up duration of 6.9 years, the incidence of EC was higher in the high (≥60) FLI group compared to the low (<30) FLI group (14.4 vs. 13.7 event per 100,000 person-years). The risk of EC correlated with the degree of FLI, particularly in older (P = 0.002), female (P = 0.033), non-smoking (P = 0.002), and non-drinking patients (P = 0.025). Among obese patients, the risk of EC was not associated with FLI; however, the risk of EC was higher in the high FLI group in non-obese patients. Lean MASLD patients had the highest risk of EC (adjusted hazard ratio 1.78; 95% confidence interval, 1.5–2.13). MASLD was associated with an increased risk of EC in diabetic patients, and lean MASLD has the highest risk. Further studies are required to determine the causal relationship between MASLD and EC.
代谢功能障碍相关性脂肪性肝病(MASLD)与 2 型糖尿病和包括食管癌在内的多种癌症的发病密切相关。然而,糖尿病患者的代谢功能障碍相关性脂肪性肝病与食管癌之间的关系尚未得到研究。因此,我们旨在研究糖尿病患者的MASLD与食管癌之间的关系。这是一项基于人群的回顾性队列研究,研究数据来自韩国国民健康保险服务(NHIS)。共纳入了1,904,468名确诊为糖尿病的受试者,这些受试者在2009年至2012年期间接受了NHIS提供的健康检查。我们针对脂肪肝指数(FLI)与EC风险之间的关系构建了一个Cox比例危险模型,并对潜在的混杂因素进行了分层。在平均6.9年的随访期间,高(≥60)脂肪肝指数组与低(<30)脂肪肝指数组相比,EC发病率更高(每10万人年14.4例与13.7例)。心肌梗死的风险与FLI程度相关,尤其是年龄较大(P = 0.002)、女性(P = 0.033)、不吸烟(P = 0.002)和不饮酒(P = 0.025)的患者。在肥胖患者中,发生心肌梗死的风险与FLI无关;但在非肥胖患者中,高FLI组发生心肌梗死的风险较高。瘦型MASLD患者的EC风险最高(调整后危险比为1.78;95%置信区间为1.5-2.13)。MASLD与糖尿病患者发生心肌梗死的风险增加有关,而瘦型MASLD的风险最高。要确定MASLD与EC之间的因果关系,还需要进一步研究。
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引用次数: 0
Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0? 芝加哥 3.0 人体测量诊断与芝加哥 4.0 是否一致?
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-20 DOI: 10.1093/dote/doad071
Angélica Tobón, Albis C Hani, Cristiam D Pulgarin, Andres F Ardila, Oscar M Muñoz, Julian A Sierra, Daniel Cisternas
Summary There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland–Altman scatter plots, and Lin’s correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.
摘要 有关使用芝加哥 3.0(CCv3.0)和芝加哥 4.0(CCv4.0)方案解释高分辨率测压(HRM)所获结果的一致性程度的信息很少,目的是确定最后一个方案中包含的新吞咽动作所提供的价值。这是一项诊断测试研究,通过CCv3.0和CCv4.0协议在接受高分辨率测压的患者中获得的结果之间的一致性来评估一致性。一致性通过卡帕检验进行评估。使用Bland-Altman散点图和Lin相关-一致性系数(CCC)来评估仰卧位和坐位吞咽或固体吞咽时测量的IRP之间的一致性。共纳入 132 名患者(65% 为女性,年龄为 53±17 岁)。最常见的 HRM 适应症是吞咽困难(46.1%)。I 型是最常见的胃食管交界处类型。最常见的 CCv4.0 诊断是食管运动正常(68.9%)、贲门失弛缓症(15.5%)和食管运动无效(IEM;5.3%)。结果之间的一致性很高(Kappa 0.77 ± 0.05),总一致性为 87.9%。12.1%的患者出现了诊断重新分类,从CCv3.0的IEM到CCv4.0的正常食管运动。同样,仰卧位与坐位测量的 IRP(CCC0.92)和固体吞咽(CCC0.96)之间的一致性也很高。总之,与 CCv3.0 相比,CCv4.0 协议具有很高的一致性。在大多数测压诊断中,对接受激发试验的患者没有重新分类。然而,CCv4.0 更严格的标准能更好地对 IEM 患者进行重新分类。
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引用次数: 0
Management and outcomes in a consecutive series of patients with aero-digestive fistula at a tertiary gastro-esophageal surgery center 一家三级胃食管外科中心连续收治的一系列消化道瘘患者的管理和治疗效果
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-15 DOI: 10.1093/dote/doad068
Fahad Murad, Fredrik Klevebro, Gert Henriksson, Ioannis Rouvelas, Mats Lindblad, Magnus Nilsson
Summary Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair.
摘要 消化道瘘(ADF)是指上消化道与气道之间的病理连接。ADF 与高发病率和高死亡率有关,其治疗通常比较复杂。根据前瞻性收集的管理数据和回顾性收集的电子病历数据,对一家三级食管外科中心 2004-2022 年收治的所有 ADF 患者进行了一项队列研究。研究评估了三种不同类型的 ADF 患者的人口统计学特征、表现状态、合并症、瘘管特征、管理以及发病率和死亡率方面的结果:(i) 肿瘤过度生长相关,(ii) 各种良性病因,(iii) 食管切除术后。研究共纳入 61 例 ADF 患者,其中 33 例(54.1%)与肿瘤过度生长有关,6 例(9.8%)为良性病因,22 例(36.1%)为食道切除术后病因。在食管切除术后组中,22 位患者中有 15 位(68.2%)在确诊 ADF 之前已被诊断为吻合口漏。61名患者中有59名(96.7%)使用了自膨胀金属支架(SEMS)进行临时瘘管封堵,其中大多数患者在消化道和气道都使用了支架。在 59 名患者中,有 47 名(79.7%)成功使用支架临时封堵了瘘管,并顺利出院。16名患者(26.2%)接受了ADF最终修复手术,其中1名患者(6.3%)在90天内死亡,15名患者的瘘管被永久封堵,可以出院回家。ADF 是一种复杂的疾病,死亡率很高,通常需要多种先进的干预措施。SEMS 可用于气道,同时也可用于消化道,以暂时封闭 ADF,作为最终手术修复的桥梁。
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引用次数: 0
Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker’s diverticulum: a systematic review and meta-analysis 矢车菊刀(SB刀)治疗禅克氏憩室的有效性和安全性:系统综述和荟萃分析
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-12-15 DOI: 10.1093/dote/doad069
Dushyant Singh Dahiya, Smit Deliwala, Saurabh Chandan, Daryl Ramai, Hassam Ali, Lena L Kassab, Antonio Facciorusso, Gursimran S Kochhar
Summary Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.
摘要 雄甲虫刀(SB 刀)越来越多地被用于 Zenker 胃憩室切除术(ZD)。我们的研究评估了 SB 刀治疗 ZD 的有效性和安全性。我们检索了 Ovid EBM reviews、Ovid Embase、Ovid Medline、ClinicalTrials.gov、Scopus 和 Web of Science,以确定使用 SB 刀治疗 ZD 的研究。采用随机效应模型计算汇总比例(PP)。使用I2统计量评估异质性。最终分析共纳入了 7 项研究,268 名患者。吞咽困难和反胃是最常见的临床症状。ZD的平均大小为2.8 ± 0.7厘米,有28名患者(共148名)曾接受过治疗。技术成功率为98%(95% CI:92.3-99.5;I20),平均手术时间为26.2±8.3分钟。首次随访时的临床反应PP为87.9%(95% CI:81.6-92.3;I219),指数手术后复发的PP为13.5%(95% CI:9.6-18.6;I22)。在最终随访中,临床缓解率为96.2%(95% CI:91-98.4;I230.6),而手术失败率为3.6%(95% CI:1.6-8.1;I20)。使用 SB 刀时未发现严重不良事件(AE)。然而,术中和术后AEs的PP分别为13.2% (95% CI: 9.6-17.8; I20) 和9.3% (95% CI: 5.7-14.9; I2 < 20.9)。SB刀对Zenker氏憩室切除术非常安全有效,失败率仅为3.6%。
{"title":"Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker’s diverticulum: a systematic review and meta-analysis","authors":"Dushyant Singh Dahiya, Smit Deliwala, Saurabh Chandan, Daryl Ramai, Hassam Ali, Lena L Kassab, Antonio Facciorusso, Gursimran S Kochhar","doi":"10.1093/dote/doad069","DOIUrl":"https://doi.org/10.1093/dote/doad069","url":null,"abstract":"Summary Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker’s Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov, Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker’s Diverticulectomy with a failure rate of only 3.6%.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"35 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690132","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}
引用次数: 0
337. PREDICTION OF PULMONARY METASTASIS IN ESOPHAGEAL CARCINOMA PATIENTS WITH INDETERMINATE 337. 不确定食管癌患者肺转移的预测
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.151
Maohui Chen, Zheng Bin, Hongjin Wang, Yizhou Huang, Shuliang Zhang, Zeng Taidui, Chen Chun
Indeterminate pulmonary nodules (IPNs) are common after surgery for esophageal cancer. The paucity of data on postoperative IPNs for esophageal cancer causes a clinical dilemma. The aim of this study was to identify the characteristics and clinical significance of IPNs after radical esophagectomy for metastatic esophageal cancer and determine the risk factors for pulmonary metastasis and construct a risk score model to standardize the appropriate time to either follow up or treat the patient. All consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between 2013 and 2016 were included in this retrospective study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and develop risk score models. A total of 816 patients were enrolled in the study. During a median follow-up period of 45 months, IPNs were detected in 221 (27.1%) patients, of whom 66 (29.9%) were diagnosed with pulmonary metastases. The following five variables maintained prognostic significance after multivariate analyses: the pathologic N category, number of IPNs, shape of IPNs, time of detection of IPNs, and size of IPNs. The Pulmonary Metastasis Prediction Model (PMPM) scale ranges from 0 to 15 points and patients with higher scores have a higher probability of pulmonary metastases. After validated, the PMPM scale showed good discrimination with an AUC of 0.939. A PMPM scale for IPNs in patients who underwent esophagectomy for ESCC may be clinically useful for diagnostic and therapeutic decision-making.
不确定的肺结节(ipn)是食管癌术后常见的。食管癌术后ipn数据的缺乏导致了临床困境。本研究旨在探讨转移性食管癌根治性食管切除术后IPNs的特点及临床意义,确定肺转移的危险因素,构建风险评分模型,以规范患者随访或治疗的合适时间。2013年至2016年间连续接受根治性手术的食管鳞状细胞癌(ESCC)患者纳入本回顾性研究。进行单因素和多因素logistic回归分析,确定独立风险因素并建立风险评分模型。共有816名患者参加了这项研究。在中位随访45个月期间,221例(27.1%)患者检测到ipn,其中66例(29.9%)被诊断为肺转移。经多因素分析,病理N类型、IPNs数量、IPNs形状、IPNs检测时间、IPNs大小等5个变量对预后具有重要意义。肺转移预测模型(Pulmonary Metastasis Prediction Model, PMPM)评分范围为0 ~ 15分,得分越高的患者发生肺转移的可能性越大。经验证,PMPM量表鉴别效果良好,AUC为0.939。ESCC食管切除术患者ipn的PMPM量表可能对诊断和治疗决策有临床价值。
{"title":"337. PREDICTION OF PULMONARY METASTASIS IN ESOPHAGEAL CARCINOMA PATIENTS WITH INDETERMINATE","authors":"Maohui Chen, Zheng Bin, Hongjin Wang, Yizhou Huang, Shuliang Zhang, Zeng Taidui, Chen Chun","doi":"10.1093/dote/doad052.151","DOIUrl":"https://doi.org/10.1093/dote/doad052.151","url":null,"abstract":"\u0000 \u0000 \u0000 Indeterminate pulmonary nodules (IPNs) are common after surgery for esophageal cancer. The paucity of data on postoperative IPNs for esophageal cancer causes a clinical dilemma.\u0000 \u0000 \u0000 \u0000 The aim of this study was to identify the characteristics and clinical significance of IPNs after radical esophagectomy for metastatic esophageal cancer and determine the risk factors for pulmonary metastasis and construct a risk score model to standardize the appropriate time to either follow up or treat the patient.\u0000 \u0000 \u0000 \u0000 All consecutive patients with esophageal squamous cell carcinoma (ESCC) who underwent radical surgery between 2013 and 2016 were included in this retrospective study. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and develop risk score models.\u0000 \u0000 \u0000 \u0000 A total of 816 patients were enrolled in the study. During a median follow-up period of 45 months, IPNs were detected in 221 (27.1%) patients, of whom 66 (29.9%) were diagnosed with pulmonary metastases. The following five variables maintained prognostic significance after multivariate analyses: the pathologic N category, number of IPNs, shape of IPNs, time of detection of IPNs, and size of IPNs. The Pulmonary Metastasis Prediction Model (PMPM) scale ranges from 0 to 15 points and patients with higher scores have a higher probability of pulmonary metastases. After validated, the PMPM scale showed good discrimination with an AUC of 0.939.\u0000 \u0000 \u0000 \u0000 A PMPM scale for IPNs in patients who underwent esophagectomy for ESCC may be clinically useful for diagnostic and therapeutic decision-making.\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":"47995604","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}
引用次数: 0
444. SHOULD T2 ESOPHAGEAL SQUAMOUS CELL CARCINOMA BE SUBCLASSIFIED WITH RESPECT TO LYMPH NODE INVOLVEMENT AND SURVIVAL? 444. t2食管鳞状细胞癌是否应该根据淋巴结累及和生存率进行亚分类?
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.234
Y. Gu, Long-Qi Chen
Whether T2 esophageal squamous cell carcinoma should be subclassified into circular muscle (T2a) and longitudinal muscle (T2b) remains controversial. We aimed to investigate the effect of the depth of muscularis propria invasion on the incidence of lymph node involvement and patient survival outcomes in T2 esophageal squamous cell carcinoma. We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. The pathological information of the depth of muscularis propria invasion was reassessed, and patients were grouped into the T2a group and T2b group. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan–Meier analysis and a Cox proportional hazard regression model. This study included a total of 750 patients from three institutes. The depth of muscularis propria invasion (OR: 3.95, 95% CI: 2.46–6.35; P < 0.001) was correlated with lymph node metastases using logistic regression. T substage (OR: 1.37, 95% CI: 1.05–1.79; P < 0.001) and N status (OR: 1.51, 95% CI: 1.05–2.17; P < 0.001) were independent risk factors in multivariate Cox regression analysis. The T2a group had better overall survival (OR: 1.52, 95% CI: 1.19–1.94; P = 0.001) than the T2b group, specifically in T2N0 patients (OR: 1.38, 95% CI: 1.08–1.94; P = 0.035). The depth of muscularis propria invasion should be subclassified to T2a and T2b with respect to lymph node involvement and survival outcomes in T2 esophageal squamous cell carcinoma.
T2食管鳞状细胞癌是否应分为环肌(T2a)和纵肌(T2b)仍有争议。我们旨在研究固有肌层浸润深度对T2食管鳞状细胞癌淋巴结转移发生率和患者生存结果的影响。我们确定了2009年1月至2017年6月接受一期手术的pT2食管鳞状细胞癌患者。对固有肌层侵犯深度的病理信息进行重新评估,并将患者分为T2a组和T2b组。二元逻辑回归用于确定淋巴结转移的危险因素。使用Kaplan–Meier分析和Cox比例风险回归模型研究了固有肌层侵犯深度对生存率的影响。这项研究共包括来自三个研究所的750名患者。固有肌层侵犯深度(OR:3.95,95%CI:2.46–6.35;P < 0.001)与淋巴结转移相关。T亚阶段(OR:1.37,95%CI:1.05–1.79;P < 0.001)和N状态(OR:1.51,95%CI:1.05–2.17;P < 0.001)是多变量Cox回归分析中的独立危险因素。T2a组的总生存率较好(OR:1.52,95%CI:1.19-1.94;P = 0.001),特别是在T2N0患者中(OR:1.38,95%CI:1.08-1.94;P = 0.035)。就T2食管鳞状细胞癌的淋巴结受累和生存结果而言,固有肌层侵犯的深度应分为T2a和T2b。
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引用次数: 0
264. A RETROSPECTIVE CHART REVIEW OF 85 PATIENTS UNDERGOING THE REFLUXSTOP PROCEDURE TO MANAGE GASTROESOPHAGEAL REFLUX DISEASE: SAFETY AND EFFICACY 264. 85例接受反流阻滞治疗胃食管反流病的患者的回顾性图表回顾:安全性和有效性
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.105
Thorsten Lehmann, M. Simkus, C. Oehler
RefluxStop is a novel surgical device that manages gastroesophageal reflux disease (GERD) by restoring the normal structure of the antireflux barrier. This is accomplished by reinstating the acute angle of His and anchoring the gastroesophageal sphincter adequately in the intraabdominal cavity. This study reports the safety and efficacy of 79 patients in the postoperative period. A retrospective chart review was performed on 79 patients that underwent the RefluxStop procedure at a single institution between July 2021 and November 2022 to manage GERD symptoms after informed consent was obtained. Measures were evaluated to assess the feasibility, safety, and clinical outcomes during the follow-up period. 79 patients (age 49.8 ± 14 years), 46 of which were male, had a mean BMI of 25.8 ± 4.5. Associated conditions noted included esophagitis (45.6%), Barrett’s esophagus (17.7%), and hiatal hernia (57%). Hiatal hernias were large in 35% of cases, with an overall average size of 2.9 cm. Baseline symptoms included general GERD symptoms (35.4%), heartburn (29.1%), cough (13.9%), regurgitation (11.4%), retrosternal burning (10.1%), hoarseness (5.1%), abdominal pain or pressure (3.8%), nausea (2.5%), and others. Baseline GERD health-related quality of life (GERD-HRQL) score was 21.5 ± 5.2 and patients were receiving proton pump inhibitors (PPIs) for a mean of 4.7 ± 6.8 years. After surgery (10.7 ± 3.1 months), all subjects experienced significant improvement in GERD-related symptoms including dysphagia. Only 2.5% of patients required use of PPIs and no subjects required postoperative esophageal dilatation or reoperation. Additionally, there were no severe perioperative complications. Postoperatively, the mean GERD-HRQL score was significantly reduced to 1.6 ± 3.2 (92.6% improvement). This study adds to a growing body of evidence that the RefluxStop procedure is safe and effective in management of GERD patients. Notably, a considerable improvement in PPI usage and health-related quality of life parameters were appreciated. Additional studies are required to further validate the role of this procedure in disease management.
RefluxStop是一种新型的外科设备,通过恢复抗反流屏障的正常结构来治疗胃食管反流病(GERD)。这是通过恢复His的锐角并将胃食管括约肌充分固定在腹腔内来实现的。本研究报告了79例患者术后的安全性和有效性。对2021年7月至2022年11月期间在一家机构接受RefluxStop手术的79名患者进行了回顾性图表审查,以在获得知情同意后控制GERD症状。在随访期间,评估措施的可行性、安全性和临床结果。79名患者(年龄49.8 ± 14岁),其中46人为男性,平均BMI为25.8 ± 4.5注意到的相关疾病包括食管炎(45.6%)、巴雷特食管(17.7%)和裂孔疝(57%)。35%的病例中疝很大,总体平均大小为2.9厘米。基线症状包括一般胃食管反流症状(35.4%)、烧心(29.1%)、咳嗽(13.9%)、反流(11.4%)、胸骨后灼热(10.1%)、声音嘶哑(5.1%)、腹痛或压力(3.8%)、恶心(2.5%)等。GERD健康相关生活质量(GERD-HRQL)基线评分为21.5 ± 5.2,患者接受质子泵抑制剂(PPIs)治疗的平均时间为4.7 ± 6.8年。手术后(10.7 ± 3.1个月),所有受试者GERD相关症状(包括吞咽困难)均有显著改善。只有2.5%的患者需要使用PPIs,没有受试者需要术后食管扩张或再次手术。此外,没有严重的围手术期并发症。术后,GERD-HRQL平均评分显著降低至1.6 ± 3.2(改善92.6%)。这项研究增加了越来越多的证据,证明RefluxStop程序在GERD患者的管理中是安全有效的。值得注意的是,PPI的使用和与健康相关的生活质量参数得到了显著改善。还需要更多的研究来进一步验证这一程序在疾病管理中的作用。
{"title":"264. A RETROSPECTIVE CHART REVIEW OF 85 PATIENTS UNDERGOING THE REFLUXSTOP PROCEDURE TO MANAGE GASTROESOPHAGEAL REFLUX DISEASE: SAFETY AND EFFICACY","authors":"Thorsten Lehmann, M. Simkus, C. Oehler","doi":"10.1093/dote/doad052.105","DOIUrl":"https://doi.org/10.1093/dote/doad052.105","url":null,"abstract":"\u0000 \u0000 \u0000 RefluxStop is a novel surgical device that manages gastroesophageal reflux disease (GERD) by restoring the normal structure of the antireflux barrier. This is accomplished by reinstating the acute angle of His and anchoring the gastroesophageal sphincter adequately in the intraabdominal cavity. This study reports the safety and efficacy of 79 patients in the postoperative period.\u0000 \u0000 \u0000 \u0000 A retrospective chart review was performed on 79 patients that underwent the RefluxStop procedure at a single institution between July 2021 and November 2022 to manage GERD symptoms after informed consent was obtained. Measures were evaluated to assess the feasibility, safety, and clinical outcomes during the follow-up period.\u0000 \u0000 \u0000 \u0000 79 patients (age 49.8 ± 14 years), 46 of which were male, had a mean BMI of 25.8 ± 4.5. Associated conditions noted included esophagitis (45.6%), Barrett’s esophagus (17.7%), and hiatal hernia (57%). Hiatal hernias were large in 35% of cases, with an overall average size of 2.9 cm. Baseline symptoms included general GERD symptoms (35.4%), heartburn (29.1%), cough (13.9%), regurgitation (11.4%), retrosternal burning (10.1%), hoarseness (5.1%), abdominal pain or pressure (3.8%), nausea (2.5%), and others. Baseline GERD health-related quality of life (GERD-HRQL) score was 21.5 ± 5.2 and patients were receiving proton pump inhibitors (PPIs) for a mean of 4.7 ± 6.8 years. After surgery (10.7 ± 3.1 months), all subjects experienced significant improvement in GERD-related symptoms including dysphagia. Only 2.5% of patients required use of PPIs and no subjects required postoperative esophageal dilatation or reoperation. Additionally, there were no severe perioperative complications. Postoperatively, the mean GERD-HRQL score was significantly reduced to 1.6 ± 3.2 (92.6% improvement).\u0000 \u0000 \u0000 \u0000 This study adds to a growing body of evidence that the RefluxStop procedure is safe and effective in management of GERD patients. Notably, a considerable improvement in PPI usage and health-related quality of life parameters were appreciated. Additional studies are required to further validate the role of this procedure in disease management.\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":"45230552","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}
引用次数: 0
474. MANOMETRIC IDENTIKIT OF A FUNCTIONING AND EFFECTIVE FUNDOPLICATION IN THE HIGH-RESOLUTION MANOMETRY ERA 474. 在高分辨率测压时代,一种功能有效的测压方法
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.256
Matteo Santangelo, G. Capovilla, A. Vittori, F. Forattini, L. Provenzano, L. Nicoletti, Andrea Costantini, L. Moletta, M. Valmasoni, M. Costantini, E. Savarino, R. Salvador
Assessing patients following Laparoscopic Fundoplication (LF) can be challenging. Functional information provided by pathophysiological testing—which can shed light on the cause of recurrent symptoms—could be key to clinical decision making. The value of performing High-Resolution Manometry (HRM) after LF is still unclear and debated. We sought to establish the HRM parameters indicative of a functioning fundoplication, and whether HRM could distinguish it from a tight or defective one. We studied patients with gastroesophageal reflux disease (GERD) who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication between 2010–2022. HRM and pH monitoring were performed before and 6 months after surgery. LF failure was defined as GerdQ score ≥ 8 and abnormal 24 h-pH study or just abnormal 24 h-pH study. The study population was divided into 5 groups: LN and LT patients with normal pH monitoring (LNpH- and LTpH-, respectively); LN and LT patients with pathological pH monitoring (LNpH+ and LTpH+ groups, respectively); and patients with postoperative severe dysphagia (Dysphagia group). The novel Hiatal Morphology (HM) classification was applied, envisaging 3 subtypes: HM1 (normal morphology); HM2 (intrathoracic fundoplication); and HM3 (slipped fundoplication). We recruited 132 patients: 46 in the LNpH- group, 51 in the LTpH- group, 15 in the LNpH+ group, 7 in the LTpH+ group, and 5 in the Dysphagia group (Figure 1). Eight patients with GerdQ score ≥ 8 and normal 24 h-pH findings were excluded. At univariate analysis, postoperative lower esophageal sphincter (LES) basal pressure (p = 0.011), total and abdominal LES length (p = 0.014, p < 0.001) were correlated with LF failure. At multivariate analysis, postoperative abdominal LES length (p = 0.001) and HM2 (p < 0.001) were independently associated with surgical failure. Integrated relaxation pressure (IRP) was significantly higher in the Dysphagia group than in the LNpH- group. This study generated reference HRM values for an effective LF and confirms that using HRM to assess the abdominal portion of the neo-sphincter and abnormal hiatal morphology (HM2) improves the clinical assessment of recurrent symptoms. HRM can distinguish patients with a well-functioning wrap from those developing recurrent GERD due to an ineffective wrap. Postoperative IRP also correlated significantly with the onset of dysphagia after surgery.
评估腹腔镜胃底折叠术(LF)后的患者可能具有挑战性。病理生理学测试提供的功能信息——可以揭示复发症状的原因——可能是临床决策的关键。LF术后进行高分辨率测压(HRM)的价值仍不清楚,也存在争议。我们试图建立指示功能性胃底折叠的HRM参数,以及HRM是否可以将其与紧密型或有缺陷型区分开来。我们研究了2010-2022年间接受腹腔镜Nissen(LN)或Toupet(LT)胃底折叠术的胃食管反流病(GERD)患者。术前和术后6个月进行HRM和pH监测。LF失败定义为GerdQ评分 ≥ 8和异常的24-h-pH研究或只是异常的24-h-pH研究。研究人群分为5组:LN和LT患者,pH监测正常(分别为LNpH-和LTpH-);进行病理pH监测的LN和LT患者(分别为LNpH+和LTpH+组);以及术后严重吞咽困难的患者(吞咽困难组)。应用新的Hiatal形态学(HM)分类,设想了3个亚型:HM1(正常形态学);HM2(胸内胃底折叠术);和HM3(滑底折叠术)。我们招募了132名患者:LNpH-组46名,LTpH-组51名,LNpH+组15名,LTpH+组7名,吞咽困难组5名(图1)。GerdQ评分的8名患者 ≥ 8和正常24小时pH的结果被排除在外。在单因素分析中,术后食管下括约肌(LES)基础压(p = 0.011)、总LES长度和腹部LES长度(p = 0.014,p < 0.001)与LF衰竭相关。在多变量分析中,术后腹部LES长度(p = 0.001)和HM2(p < 0.001)与手术失败独立相关。吞咽困难组的综合舒张压(IRP)明显高于LNpH组。这项研究产生了有效LF的参考HRM值,并证实使用HRM评估新括约肌腹部和异常裂孔形态(HM2)可以改善对复发症状的临床评估。HRM可以区分功能良好包裹的患者和因包裹无效而复发的GERD患者。术后IRP也与术后吞咽困难的发生显著相关。
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引用次数: 0
32. QUALITY PERFORMANCE INDICATOR COMPLIANCE FOR THE TREATMENT OF OESOPHAGEAL ADENOCARCINOMA IN NEW ZEALAND 32.新西兰食管腺癌治疗的质量-性能指标依从性
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 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。
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Diseases of the Esophagus
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