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14. IMPACTS OF ADDITIONAL CYCLES OF NEOADJUVANT IMMUNOCHEMOTHERAPY ON ESOPHAGECTOMY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA 14.新辅助免疫化疗对食管鳞状细胞癌食管切除术的影响
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.002
Long-Qi Chen, Y. Gu, Boyu Liu
The aim of this study is to explore the pathological characteristics and safety of esophagectomy after different cycles of neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC). We prospectively collected patients who underwent neoadjuvant immunochemotherapy combined with esophagectomy from two institutes between 2019 and 2022. The primary outcome was defined as pathological complete response (PCR), and the secondary outcomes were defined as the incidence of postoperative complications. The most commonly used checkpoint inhibitor was camrelizumab. A total of 152 enrolled patients underwent esophagectomy, with 9 of 119 patients (7.6%) in the 2-cycle group undergoing thoracotomy and 2 patients of 33 patients (6.1%) in the >2-cycle group converting to thoracotomy. Twenty-three patients in the 2-cycle group and 6 patients in the >2-cycle group achieved PCR, there was no statistically significant difference between the two groups (19.3% vs. 18.2%; P = 0.882). The N0 rate (57.1% vs. 51.5%; P = 0.565) and lymph node ratio (6% vs. 6%; P = 0.489) were similar between the two groups. The most common postoperative complication was pneumonia, there were no significant differences in postoperative complications between the two groups. This study indicated that although additional cycles of neoadjuvant immunochemotherapy had no significant effect on the feasibility and safety of esophagectomy, 2-cycle of treatment is enough when considering pathological complete response rate.
本研究的目的是探讨食管鳞状细胞癌(ESCC)新辅助免疫化疗不同周期后食管切除术的病理特征和安全性。我们前瞻性地收集了2019年至2022年间来自两个研究所的接受新辅助免疫化疗联合食管切除术的患者。主要结果定义为病理完全反应(PCR),次要结果定义为术后并发症的发生率。最常用的检查点抑制剂是卡雷珠单抗。共有152名入选患者接受了食管切除术,其中2周期组119名患者中有9名(7.6%)接受了开胸手术,>2周期组33名患者中的2名(6.1%)改为开胸手术。2周期组23例患者和>2周期组6例患者实现了PCR,两组之间没有统计学显著差异(19.3%对18.2%;P = N0发生率(57.1%对51.5%;P = 0.565)和淋巴结比率(6%对6%;P = 0.489)在两组之间相似。最常见的术后并发症是肺炎,两组术后并发症无显著差异。本研究表明,尽管新辅助免疫化疗的额外周期对食管切除术的可行性和安全性没有显著影响,但考虑到病理完全缓解率,2个周期的治疗就足够了。
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引用次数: 0
372. INVESTIGATION OF RISK FACTORS OF POSTOPERATIVE PNEUMONIA IN MEDIASTINOSCOPIC ESOPHAGECTOMY 372. 纵隔镜食管切除术术后肺炎的危险因素分析
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 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.
肺炎是食管切除术中常见的并发症。尽管纵隔镜食管切除术中肺炎的发生率较低,但肺炎的危险因素尚不清楚。对风险因素进行了调查。本研究回顾性分析了我院2016年至2021年收治的食管癌症纵隔镜下食管消泡术和胃导管重建术患者244例。术后肺炎被诊断为Clavien-Dindo 2级或更高级别。患者分为两组 = 21)和不带(n = 223)肺炎,以及背景、手术因素或组织病理学因素。术后肺炎21例(8.6%),术前白蛋白、PNI(<45)、PLR(>122)和手术出血(>134)与术后肺炎有显著相关性(p < 年龄和既往呼吸道疾病也与术后肺炎有关,但不显著。在多变量分析中,低PNI是术后肺炎的独立危险因素(p = 0.047,或 = 2.74)。术后肺炎与吻合口瘘或复发性神经麻痹等并发症无关。即使在术前呼吸功能障碍的患者中,也没有观察到与术后肺炎的相关性。据报道,PNI可作为术后并发症的预测指标。在本研究中,它也是术后肺炎的一个预测因素。癌症食管营养不良患者的早期营养干预可预防术后肺炎。低PNI可能是纵隔镜食管切除术后肺炎的一个预测因素。
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引用次数: 0
432. SINGLE-CELL RNA SEQUENCING OF MORPHOLOGICALLY-PURE PATIENT-DERIVED ORGANOIDS FROM ESOPHAGEAL ADENOCARCINOMA PATIENTS 432. 形态学纯化食管腺癌患者来源类器官的单细胞RNA测序
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.224
P. Shathasivam, Mansur M. Naeem, T. Rispoli, Niharikaa Aiyar, Akhi Akhter, G. Wilson, G. Darling, J. Yeung
We have successfully cultured esophageal adenocarcinoma (EAC) patient-derived organoids (PDOs) from endoscopic biopsies. These PDOs recapitulate the histological and molecular features of the originating tumour and frequently exhibit morphological heterogeneity within the same patient sample. The underlying biology of these morphologies and their relation to treatment response remains unknown. This study will examine the gene expression profile of morphologically pure organoids. EAC tissue samples collected from patients were processed and embedded into Matrigel to generate PDOs. Parental PDOs with heterogenous morphology were sorted to isolate clonal pure morphology organoids. Multiple clones were expanded and clones of different morphology were collected and dissociated to single cells for single-cell RNA sequencing. Multiple single morphology clones were grown from nine different mixed morphology parental PDOs, demonstrating that EAC organoids can be generated from single cells. Successful formation of organoids from single cells took between two to four weeks. The percentage of single cells successfully generating organoids was sample-dependent. Six clones of solid, cystic, budding or grape-like morphology from two PDOs have been expanded and dissociated to single cells for single-cell RNA sequencing. PDOs have emerged as a powerful tool to study drug response and personalize therapy. This study will examine the correlation of EAC organoid morphology with gene expression. Future directions will include the identification of morphology-dependent drug targets, enabling the development of more precise targeted drug screening for each patient.
我们已经成功地从内镜活检中培养了食管腺癌(EAC)患者来源的类器官(PDOs)。这些PDOs概括了原发肿瘤的组织学和分子特征,并且在同一患者样本中经常表现出形态学异质性。这些形态的潜在生物学及其与治疗反应的关系尚不清楚。本研究将检测形态学纯类器官的基因表达谱。从患者身上收集的EAC组织样本经过处理并嵌入到Matrigel中以生成pdo。对具有异质形态的亲本PDOs进行分类,分离克隆纯形态类器官。扩增多个克隆,收集不同形态的克隆,解离成单细胞,进行单细胞RNA测序。从9个不同的混合形态亲本pdo中培养出多个单一形态克隆,证明EAC类器官可以由单个细胞产生。从单个细胞成功形成类器官需要两到四周的时间。单细胞成功生成类器官的百分比依赖于样本。来自两个PDOs的六个固体、囊状、出芽或葡萄状形态的克隆已经扩增并解离到单细胞,用于单细胞RNA测序。pdo已经成为研究药物反应和个性化治疗的有力工具。本研究将探讨EAC类器官形态与基因表达的关系。未来的方向将包括识别形态依赖的药物靶点,从而为每位患者开发更精确的靶向药物筛选。
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引用次数: 0
177. BULKY LYMPHADENOPATHY IN ESOPHAGEAL CANCER: ASSESSING PATHOLOGICAL AND SURVIVAL OUTCOMES AFTER TREATMENT WITH CURATIVE INTENT 177. 食管癌的大体积淋巴结病:评估治疗后的病理和生存结果
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.043
J. Tankel, Yenothan Nevo, S. Najmeh, J. Spicer, C. Mueller, L. Ferri, J. Cools-Lartigue
Whilst pre-treatment bulky regional lymphadenopathy is associated with poor survival outcomes in gastric adenocarcinoma, the impact this may have on survival in the setting of esophageal adenocarcinoma has not been described. The aim of this study was to explore the relationship between bulky regional lymphadenopathy found at diagnosis and survival outcomes in patients with esophageal adenocarcinoma treated with neoadjuvant chemotherapy and en bloc esophagogastrectomy. A single center, retrospective review of a prospectively maintained upper GI cancer surgical database was performed between 01/2012 and 12/2020. Patients with adenocarcinoma of the esophagus/esophagogastric junction (cT2–3, Nany, M0) treated with neoadjuvant docetaxel based chemotherapy and transthoracic en bloc esophagogastrectomy were identified. Pretreatment CT scans were reviewed and patients stratified according to whether bulky periesophageal or periceliac lymph nodes were present. This was defined as periceliac or periesophageal lymphadenopathy >2 cm in its long axis. Once stratified by the presence of bulky lymphadenopathy, overall survival (OS) was compared and a Cox multivariate regression model calculated. Of the 975 patients identified, 225 met the inclusion criteria. cT3/4 and cN+ was found in 169/225 (75%) and 154/225 (73%) respectively. Forty-eight patients (21%) were allocated to the bulky lymphadenopathy group. Among them, ypT status was similar, ypN3 disease more common (18/48,38% vs 39/177,20%, p = 0.025) with a trend towards pathological complete response (5/48,10% vs 7/177,4%, p = 0.086). OS was worse among patients with bulky regional lymphadenopathy (32.6 vs 50 months, p = 0.012). Along with poor differentiation (HR 1.8,95% CI 1.0–2.9, p = 0.034) and ypN+ (HR 1.9,95% CI 1.1–3.6, p = 0.032), bulky lymphadenopathy was independently associated with an increased risk of death (HR 1.7,1.0–2.9,p = 0.048). Pre-treatment bulky regional lymphadenopathy is a poor prognostic sign despite multimodal treatment with docetaxel based systemic neoadjuvant therapy and en bloc resection. Identification of alternative treatment strategies may help improve survival outcomes among this specific group of patients.
虽然治疗前大面积区域性淋巴结病变与胃腺癌患者较差的生存结果相关,但尚未描述其对食管癌患者生存的影响。本研究的目的是探讨在新辅助化疗和整体食管胃切除术治疗的食管腺癌患者中,诊断时发现的大块区域淋巴结病与生存结局之间的关系。在2012年1月至2020年12月期间,对前瞻性维护的上消化道肿瘤手术数据库进行了单中心回顾性审查。食管/食管胃交界处腺癌(cT2-3, Nany, M0)患者接受新辅助多西紫杉醇化疗和经胸整体食管胃切除术。回顾了预处理CT扫描,并根据是否存在大块的食管周围或腹腔周围淋巴结对患者进行分层。定义为腹腔周围或食管周围淋巴结病,长轴长约2cm。一旦根据存在肿大淋巴结病进行分层,比较总生存期(OS)并计算Cox多元回归模型。在确定的975例患者中,225例符合纳入标准。cT3/4和cN+分别位于169/225(75%)和154/225(73%)。48例(21%)患者被分配到大体积淋巴结病组。其中,ypT状态相似,ypN3疾病更常见(18/48,38% vs 39/177,20%, p = 0.025),并有病理完全缓解的趋势(5/48,10% vs 7/177,4%, p = 0.086)。大面积局部淋巴结病变患者的OS更差(32.6 vs 50个月,p = 0.012)。随着分化差(HR 1.8,95% CI 1.0-2.9,p = 0.034)和ypN+ (HR 1.9,95% CI 1.1-3.6,p = 0.032),大体积淋巴结病与死亡风险增加独立相关(HR 1.7, 1.0-2.9,p = 0.048)。尽管多模式治疗以多西紫杉醇为基础的全身新辅助治疗和整体切除,但治疗前大面积局部淋巴结病是一个预后不良的迹象。确定替代治疗策略可能有助于改善这一特定患者群体的生存结果。
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引用次数: 0
25. THE ROLE OF ADJUVANT THERAPY FOR PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA UNDERGOING NEOADJUVANT THERAPY AND ESOPHAGECTOMY 25. 辅助治疗在食管腺癌新辅助治疗及食管切除术患者中的作用
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.009
Xiaokun Li, Yong Yuan, Yi Shen
The use of adjuvant therapy after neoadjuvant therapy followed by esophagectomy is controversial due to limited studies. The aim of this study was to investigate the role of adjuvant therapy for patients with esophageal adenocarcinoma (EAC) after neoadjuvant therapy and esophagectomy and to provide a basis for clinical decision-making. Patients who were diagnosed as EAC and underwent neoadjuvant therapy followed by surgery were included in this study. The data of the patients in training group are derived from Surveillance, Epidemiology, and End Results (SEER) database. Patients from two institutions (West China Hospital and Nanjing Jinling Hospital) were used to validate the results. A total of 3445 EAC patients were identified from the SEER database according to the eligibility criteria. No significant difference was found between adjuvnat therapy and non-adjuvant therapy group (5-year overall survival (OS): 35.7 and 37.2%, p = 0.920; 5-year cancer-specific survival (CSS): 39.5 and 43.2%, p = 0.520). Meanwhile, 130 patients were identified from West China Hospital (n = 84) and Jinling Hospital (n = 46). The results showed that patients undergoing adjuvant therapy group had a better OS than non-adjuvant therapy group (p = 0.031). On the basis of the SEER database, this study revealed no survival benefit of adjuvant therapy for patients with EAC after neoadjuvant therapy and surgery. However, the analysis results of patients from two institutions in China show that patients with EAC may benefit from adjuvant therapy after neoadjuvant therapy and esophagectomy.
由于研究有限,在食管切除术后使用新辅助治疗是有争议的。本研究旨在探讨食管腺癌(EAC)患者在新辅助治疗和食管切除术后的辅助治疗作用,为临床决策提供依据。本研究纳入了被诊断为EAC并在手术后接受新辅助治疗的患者。训练组患者的数据来源于监测、流行病学和最终结果(SEER)数据库。来自两个机构(华西医院和南京金陵医院)的患者被用来验证结果。根据资格标准,共从SEER数据库中确定了3445名EAC患者。佐剂治疗组和非佐剂治疗组之间没有发现显著差异(5年总生存率:35.7%和37.2%,p = 0.920;5年癌症特异性生存率(CSS)分别为39.5%和43.2%,p = 0.520) = 84)和金陵医院(n = 46)。结果表明,接受辅助治疗的患者OS优于非辅助治疗组(p = 0.031)。基于SEER数据库,本研究显示,辅助治疗对EAC患者在新辅助治疗和手术后的生存没有益处。然而,来自中国两个机构的患者分析结果表明,EAC患者在新辅助治疗和食管切除术后可能受益于辅助治疗。
{"title":"25. THE ROLE OF ADJUVANT THERAPY FOR PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA UNDERGOING NEOADJUVANT THERAPY AND ESOPHAGECTOMY","authors":"Xiaokun Li, Yong Yuan, Yi Shen","doi":"10.1093/dote/doad052.009","DOIUrl":"https://doi.org/10.1093/dote/doad052.009","url":null,"abstract":"\u0000 \u0000 \u0000 The use of adjuvant therapy after neoadjuvant therapy followed by esophagectomy is controversial due to limited studies. The aim of this study was to investigate the role of adjuvant therapy for patients with esophageal adenocarcinoma (EAC) after neoadjuvant therapy and esophagectomy and to provide a basis for clinical decision-making.\u0000 \u0000 \u0000 \u0000 Patients who were diagnosed as EAC and underwent neoadjuvant therapy followed by surgery were included in this study. The data of the patients in training group are derived from Surveillance, Epidemiology, and End Results (SEER) database. Patients from two institutions (West China Hospital and Nanjing Jinling Hospital) were used to validate the results.\u0000 \u0000 \u0000 \u0000 A total of 3445 EAC patients were identified from the SEER database according to the eligibility criteria. No significant difference was found between adjuvnat therapy and non-adjuvant therapy group (5-year overall survival (OS): 35.7 and 37.2%, p = 0.920; 5-year cancer-specific survival (CSS): 39.5 and 43.2%, p = 0.520). Meanwhile, 130 patients were identified from West China Hospital (n = 84) and Jinling Hospital (n = 46). The results showed that patients undergoing adjuvant therapy group had a better OS than non-adjuvant therapy group (p = 0.031).\u0000 \u0000 \u0000 \u0000 On the basis of the SEER database, this study revealed no survival benefit of adjuvant therapy for patients with EAC after neoadjuvant therapy and surgery. However, the analysis results of patients from two institutions in China show that patients with EAC may benefit from adjuvant therapy after neoadjuvant therapy and esophagectomy.\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":"46401766","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
328. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL CARCINOMA INVOLVING THE ENTIRE ESOPHAGUS: SHORT-TERM RESULTS 328. 内镜下粘膜下剥离治疗浅表性食管癌累及整个食道:近期结果
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.146
I. Toshiro, Eriko Noma, Yoshiaki Moriguchi
The treatment of superficial esophageal carcinoma involving the entire esophagus remains challenging due to the difficulty in accurate preoperative diagnosis and the complexity of the Endoscopic Submucosal Dissection (ESD) technique. The management of esophageal stricture following ESD also remains controversial. In this study, we analyzed the advantages and disadvantages of ESD for superficial whole circumferential esophageal carcinoma in our hospital, based on short-term results. We retrospectively analyzed 10 patients diagnosed with superficial esophageal carcinoma involving the entire circumference and treated with ESD from January 2021 to the present. We evaluated the accuracy of preoperative diagnosis, treatment-related complications of ESD, post-ESD stenosis, and adverse events associated with stenosis prophylaxis. Treatment Course: The primary treatment consisted of circumferential resection under general anesthesia followed by local injection of 120–320 mg of steroids into the ulcer after resection. Patients were started on a diet 2–3 days after surgery and initiated oral steroid therapy starting with 30 mg with PPI and Sulfamethoxazole Trimethoprim. The dose of steroids was gradually reduced by 5 mg every 3 weeks for a total of 18 weeks. The study included 7 males and 3 females with a mean age of 72.9 years. The lesions were located in Upper 1, Middle 5, and Lower 4. The average dissection time was 89.1 minutes, the mean length of endoscopic longitudinal mucosal defects was 70 mm, and the en bloc resection rate was 100%. The histological depth was EP/LPM 5, MM/SM 13, and SM2 or deeper 2. The accuracy of preoperative diagnosis was 80%, but all SM2 lesions were underdiagnosed as SM1. No ESD-related adverse events were observed in any case. Two patients with SM2 after ESD underwent additional surgery. Stenosis occurred in 25% of cases. Steroid-related events included drug-induced liver dysfunction in 4 cases, esophageal candida in 2 cases, pulmonary tuberculosis in 1 case, and delayed perforation in 1 case. ESD for superficial esophageal carcinoma involving the entire esophagus can be safely and effectively performed. Steroid administration may be useful for preventing post-ESD stenosis, but its management requires attention as it may cause adverse events.
由于术前难以准确诊断和内镜下粘膜剥离(ESD)技术的复杂性,累及整个食管的浅表性食管癌的治疗仍然具有挑战性。ESD术后食管狭窄的处理也存在争议。本研究结合近期疗效,分析我院浅表全周性食管癌ESD的优缺点。我们回顾性分析了10例自2021年1月至今诊断为累及整个周长的浅表性食管癌并接受ESD治疗的患者。我们评估了术前诊断的准确性、ESD的治疗相关并发症、ESD后狭窄以及与狭窄预防相关的不良事件。疗程:主要治疗方法为全麻环切,术后局部注射类固醇120 ~ 320 mg。患者在术后2-3天开始饮食,并开始口服类固醇治疗,起始剂量为30mg, PPI和磺胺甲恶唑甲氧苄啶。类固醇的剂量逐渐减少,每3周减少5mg,共18周。研究对象为男性7人,女性3人,平均年龄72.9岁。病变位于Upper 1, Middle 5和Lower 4。平均清扫时间89.1分钟,内镜下纵向粘膜缺损平均长度70 mm,整体切除率100%。组织学深度EP/LPM 5, MM/SM 13, SM2或更深2。术前诊断的准确率为80%,但所有SM2病变都被误诊为SM1。所有病例均未观察到与静电相关的不良事件。2例ESD后SM2患者接受了额外的手术。25%的病例发生狭窄。类固醇相关事件包括药物性肝功能障碍4例,食道念珠菌2例,肺结核1例,迟发性穿孔1例。累及整个食管的浅表性食管癌可安全有效地行ESD。类固醇可能有助于预防esd后狭窄,但其管理需要注意,因为它可能导致不良事件。
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引用次数: 0
44. LONG-TERM OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY FOR PATIENTS WITH ACHALASIA: A SINGLE-CENTRE STUDY 44. 贲门失弛缓症患者经口内窥镜肌切开术的长期疗效:一项单中心研究
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.017
M. Alotaibi, R. Bechara
and study aims: The short-term outcomes of Peroral endoscopic myotomy (POEM) for achalasia are well described, however, there is limited long-term data in the literature. This study aims to retrospectively assess the long-term outcomes of the POEM in a Canadian tertiary care centre. All patients who underwent POEM for treatment of Achalasia with minimum follow-up of at least 4 years at a tertiary care centre were enrolled in this study. The primary outcome of the study was clinical success defined as a post-POEM Eckardt score ≤ 3 at ≥48 months. Secondary outcomes included changes in body mass index (BMI), incidence of gastroesophageal reflux disease (GERD), adverse events and length of hospital stay. Thirty-eight patient (aged 53.9 ± 17.9) underwent POEM, with a median follow-up period of 61 months (48–79). The mean Eckardt score was significantly reduced from 7.7 ± 1.9 to 1.2 ± 0.6 (P < 0.001). All patients achieved post-POEM Eckardt scores of ≤3 at ≥48 months. BMI increased from 27.4 ± 6.5 pre-POEM to 29.4 ± 6.7 (P < 0.003) post-POEM. Twelve (31.5%) patients developed pathologic reflux. POEM is an effective and safe procedure for achalasia with durable long-term outcomes. Larger series with longer follow-up are required to confirm these results.
研究目的:经口内镜肌切开术(POEM)治疗贲门失弛缓症的短期疗效已有很好的描述,但文献中的长期数据有限。本研究旨在回顾性评估加拿大三级护理中心POEM的长期结果。所有在三级护理中心接受POEM治疗贲门失弛缓症的患者都被纳入本研究,随访时间至少为4年。该研究的主要结果是临床成功,定义为POEM后Eckardt评分 ≤ ≥48个月时为3例。次要结果包括体重指数(BMI)、胃食管反流病(GERD)发病率、不良事件和住院时间的变化。三十八名患者(年龄53.9岁 ± 17.9)接受了POEM,中位随访期为61个月(48-79)。Eckardt的平均得分从7.7显著降低 ± 1.9至1.2 ± 0.6(P < 0.001)。所有患者在POEM后的Eckardt评分≥48个月时均达到≤3。BMI从27.4增加 ± 6.5 POEM前至29.4 ± 6.7(P < 0.003)。12例(31.5%)患者出现病理性反流。POEM是治疗贲门失弛缓症的一种有效且安全的方法,具有持久的长期疗效。需要更大的系列和更长的随访时间来确认这些结果。
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引用次数: 0
16. THORACIC FRACTURES AND OTHER CHEST WALL ABNORMALITIES AFTER THORACOTOMY FOR ESOPHAGEAL CANCER: A RETROSPECTIVE COHORT STUDY 16. 食管癌开胸术后胸腔骨折及其他胸壁异常:一项回顾性队列研究
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 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.
食管癌开胸术后胸壁疼痛常被报道,但了解甚少。本研究的目的是:1)确定胸壁异常在术后影像学上的患病率;2)比较开胸相关胸骨折患者与未开胸相关胸骨折患者的并发症、长期疼痛和生活质量。本回顾性队列研究纳入了2010年1月1日至2020年12月31日期间接受开胸手术的食管癌患者。术后早期CT检查(6个月)。无病患者填写疼痛和生活质量问卷(SF-36和EORTC-QLQ-C30)。共纳入366例患者。与开胸术相关的肋骨骨折144例(39%),胸横突骨折4例(2%)。胸椎骨折患者更容易出现术后并发症(89%对74%,p = 0.002),尤其是肺炎(51%对39%,p = 0.032)。77名参与者(33名有胸椎骨折,44名无胸椎骨折)术后平均41个月(P25-P75 28-91)完成问卷调查。48名(63%)参与者报告了长期胸壁疼痛,但没有发现与胸部骨折相关(p = 0.637)。生活质量评分在有胸椎骨折和没有胸椎骨折的患者之间没有差异,并且大多与参考人群相当。食管癌开胸手术后,胸部(主要是肋骨)骨折很常见。胸椎骨折患者术后并发症的风险增加,尤其是肺炎,但与长期疼痛或生活质量下降的关系尚未得到证实。
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引用次数: 0
326. LONG-TERM OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY (MERAS) PROTOCOLS IN PERI-OPERATIVE MANAGEMENT OF MINIMALLY INVASIVE ESOPHAGECTOMY 改良术后恢复(MERAS)方案在微创食管切除术围术期管理中的长期疗效
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.144
Maohui Chen, B. Zheng, Yizhou Huang, Shuliang Zhang, T. Zeng, Chenhui Ning, Chun Chen
Enhanced recovery after surgery (ERAS) programs consists of a set of pre-, intra- and post-operative protocols to minimize perioperative burden, reduce postoperative complications and morbidity, optimize postoperative recovery, and shorten hospital stay. The rare studies available demonstrate positive results for long-term survival of ERAS in gastric, colon and rectal cancers, however, it is not clear whether the ERAS regimen can improve the long-term prognosis of esophageal cancer. Therefore, we conducted this study to compare post-operative morbidity, functional recovery, and length of hospital stay in patients undergoing esophagectomy following the implementation of modified ERAS (mERAS) protocols or conventional standard care (SC), and to determine the effect of the ERAS protocol after esophagectomy on long-term survival. Materials and methods: This retrospective clinical study was conducted from 1st June 2014 to 31st December 2016, included 229 consecutive patients with esophageal carcinoma who underwent esophagectomy. The mERAS protocols were implemented in our department of Fujian Medical University Union Hospital on 1st November 2015. After that time, all patients were treated according to the protocols (mERAS group). And before that time, all patients were treated with conventional standard care (SC group). We chose the cohort of patients, because the patients underwent surgery most recently prior to the patients in mERAS group. There was no significant difference between the two groups, with the exception of the percentage of patients who had cocomitant disease. The rate of cardiac diseases or hypertension in mERAS group was higher than that in SC group (24.4% vs. 13.8%). Incidence rate of anastomotic leakage was significantly lower in mERAS patients than in SC patients (0% vs. 13.8%, P = 0.000). Incidence rate of chylous leakage was significantly lower in mERAS patients than in SC patients (0.7% vs. 6.4%, P = 0.015). In patients with 5% preoperative weight loss, survival was better in the mERAS group than in the SC group. The advantage of ERAS concerns the surgeon, care team, the patient and the society as a whole. Our study indicated that implementation of mERAS protocols in patients undergoing minimally invasive esophagectomy could resulted in better postoperative recovery and reduced postoperative complications.
增强术后恢复(ERAS)计划包括一套术前、术中和术后方案,以最大限度地减少围手术期负担,减少术后并发症和发病率,优化术后恢复,缩短住院时间。现有的罕见研究表明,ERAS方案对胃癌、结肠癌和直肠癌的长期生存有积极的结果,但尚不清楚ERAS方案是否能改善癌症的长期预后。因此,我们进行了这项研究,以比较在实施改良ERAS(mERAS)方案或常规标准护理(SC)后接受食管切除术的患者的术后发病率、功能恢复和住院时间,并确定食管切除术后ERAS方案对长期生存的影响。材料和方法:这项回顾性临床研究于2014年6月1日至2016年12月31日进行,包括229名连续接受食管切除术的食管癌患者。mERAS方案于2015年11月1日在福建医科大学协和医院我科实施。在此之后,所有患者均按照方案进行治疗(mERAS组)。在此之前,所有患者均接受常规标准护理(SC组)。我们选择了患者队列,因为在mERAS组中,患者最近接受了手术。除了患有合并疾病的患者百分比外,两组之间没有显著差异。mERAS组心脏病或高血压发生率高于SC组(24.4%vs.13.8%),吻合口瘘发生率显著低于SC组(0%vs.13.8%,P = mERAS患者的乳糜渗漏发生率显著低于SC患者(0.7%对6.4%,P = 0.015)。在术前体重减轻5%的患者中,mERAS组的生存率高于SC组。ERAS的优势涉及外科医生、护理团队、患者和整个社会。我们的研究表明,在接受微创食管切除术的患者中实施mERAS方案可以带来更好的术后恢复和减少术后并发症。
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引用次数: 0
286. A BIBLIOMETRIC ANALYSIS OF NEOADJUVANT THERAPY FOR ESOPHAGEAL CANCER 286.食管癌新辅助治疗的文献计量学分析
IF 2.6 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-30 DOI: 10.1093/dote/doad052.117
Yizhou Huang, B. Zheng, Maohui Chen, Shuliang Zhang, T. Zeng, Chun Chen
The study aims to summarize publication characteristics of neoadjuvant therapy for esophageal cancer and create scientific maps to explore hotspots and emerging trends with bibliometric methods. The publications between 2013 and 2022 were retrieved from the Web of Science Core Collection (WoSCC) on March 4, 2023. Bibliometric tools including VOSviewer and CiteSpace were used for statistical analysis. Data on the trend of the annual output, countries/regions, institutions, journals, authors, subject categories, keywords, and co-cited references were presented in this study. A total of 1713 publications written by 9222 authors of 1696 institutions, 49 countries/regions in 287 journals were included in the bibliometric study. China was the most prolific country with 414 publications, and The United States was the country that cooperated most with other countries. Doki, yuichiro, van Hagen, p, annals of surgical oncology, j clin oncol, and sun yat sen univ were the top 1 productive author, co-cited author, productive journal, co-cited journal, and prolific institution, respectively. The top 4 most present keywords were esophageal cancer, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy, and chemotherapy. Furthermore, the clinical research hotspots involved in the immunotherapy of ESCC have received the most attention in recent years. This study visually analyzed the development status and scientific trend of neoadjuvant therapy for esophageal cancer over the past decade. The results could guide scientists to comprehensively understand the existing research and determine future directions. Web of Science (WOS); esophageal cancer; bibliometric analysis.
本研究旨在总结癌症新辅助治疗的出版特点,并创建科学地图,以文献计量方法探索热点和新趋势。2013年至2022年的出版物于2023年3月4日从网络科学核心收藏(WoSCC)中检索。包括VOSviewer和CiteSpace在内的文献计量工具用于统计分析。本研究提供了关于年度产出趋势、国家/地区、机构、期刊、作者、主题类别、关键词和共同引用参考文献的数据。文献计量学研究共收录了1713篇出版物,这些出版物由49个国家/地区的1696个机构的9222名作者在287种期刊上撰写。中国是最多产的国家,有414种出版物,美国是与其他国家合作最多的国家。Doki,yuichiro,van Hagen,p,《外科肿瘤学年鉴》,j clin oncol和sun yat-sen univ分别是第一大多产作者、共同引用作者、多产期刊、共同引用期刊和多产机构。最常见的四个关键词是食管癌症、新辅助放化疗、新辅助化疗和化疗。此外,近年来ESCC免疫治疗的临床研究热点也受到了极大的关注。本研究直观地分析了近十年来癌症新辅助治疗的发展现状和科学趋势。研究结果可以指导科学家全面了解现有研究并确定未来的方向。科学网;食管癌症;文献计量分析。
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引用次数: 0
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Diseases of the Esophagus
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