Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.130
A. Ishiyama, Chika Fukuyama, Hiroyuki Yamamoto, Y. Ikenoyama, K. Namikawa, Y. Tokai, T. Yoshio, J. Fujisaki
In Japan, alcohol consumption, smoking, and genetic an aldehyde dehydrogenase 2 polymorphisms are risk factors for most esophageal squamous cell carcinomas(ESCC). However, only a limited number of cases have been observed without these risk factors in daily practice. This study aimed to evaluate the endoscopic findings of 31 lesions in 29 patients with ESCC who underwent endoscopic submucosal dissection (ESD) at our hospital without a history of habitual alcohol consumption or smoking (hereafter referred to as ‘risk factors’). Patients and Methods: We retrospectively examined the endoscopic findings, final diagnoses, and patient and lesion backgrounds of 31 lesions from 29 patients of ESCC without risk factors who underwent ESD from January 2017 to December 2022 at our hospital. A total of 27 women and two men, median age 72 (44–87) years, were included; 10 patients were on proton pump inhibitors, 12 patients had a history of cancer, and 12 patients had a family history of cancer in the first degree. Additionally, three patients had multiple heterochronic lesions, one patient had a speckled esophagus, and two patients had grade B gastroesophageal reflux disease according to the revised Los Angeles classification. Occupied site; Ut/Mt/Lt = 4/24/3, circumferential; anterior/posterior/left/right wall = 0/16/10/5, macroscopic type; 0-IIa/0-IIb/0-IIc/mixed type = 4/10/15/2, median lesion length 17(5–45) mm, wall depth; EP/LPM/MM/SM1 = 11/18/1/1/1, all vascular invasions were negative. A total of 22 lesions had white-tone mucosa on their surface, suggesting superficial keratinization or hyperkeratinization. The lesions were diverse in shape. Additionally, seven lesions were observed which tended to run longitudinally with long axial lengths, all located on the posterior wall of Mt, and white adherent material was observed in six lesions. Iodine staining was performed in 30 lesions, all of which were unstained, and six of them had indistinct borders with inflammatory changes in the background. A total of three patients had synchronous/heterochronic multiple esophageal cancers. The white adherents running longitudinally in the posterior wall of the Mt and its white tone in patients with no risk factors suggest the possibility of previously unrecognized lesions and the need for close endoscopic examination, along with iodine staining and biopsy.
{"title":"307. A REVIEW OF 31 SUPERFICIAL ESOPHAGEAL CANCER CASES WITHOUT HISTORY OF HABITUAL DRINKING OR SMOKING OBSERVED IN OUR HOSPITAL","authors":"A. Ishiyama, Chika Fukuyama, Hiroyuki Yamamoto, Y. Ikenoyama, K. Namikawa, Y. Tokai, T. Yoshio, J. Fujisaki","doi":"10.1093/dote/doad052.130","DOIUrl":"https://doi.org/10.1093/dote/doad052.130","url":null,"abstract":"\u0000 \u0000 \u0000 In Japan, alcohol consumption, smoking, and genetic an aldehyde dehydrogenase 2 polymorphisms are risk factors for most esophageal squamous cell carcinomas(ESCC). However, only a limited number of cases have been observed without these risk factors in daily practice.\u0000 \u0000 \u0000 \u0000 This study aimed to evaluate the endoscopic findings of 31 lesions in 29 patients with ESCC who underwent endoscopic submucosal dissection (ESD) at our hospital without a history of habitual alcohol consumption or smoking (hereafter referred to as ‘risk factors’).\u0000 Patients and Methods: We retrospectively examined the endoscopic findings, final diagnoses, and patient and lesion backgrounds of 31 lesions from 29 patients of ESCC without risk factors who underwent ESD from January 2017 to December 2022 at our hospital.\u0000 \u0000 \u0000 \u0000 A total of 27 women and two men, median age 72 (44–87) years, were included; 10 patients were on proton pump inhibitors, 12 patients had a history of cancer, and 12 patients had a family history of cancer in the first degree. Additionally, three patients had multiple heterochronic lesions, one patient had a speckled esophagus, and two patients had grade B gastroesophageal reflux disease according to the revised Los Angeles classification. Occupied site; Ut/Mt/Lt = 4/24/3, circumferential; anterior/posterior/left/right wall = 0/16/10/5, macroscopic type; 0-IIa/0-IIb/0-IIc/mixed type = 4/10/15/2, median lesion length 17(5–45) mm, wall depth; EP/LPM/MM/SM1 = 11/18/1/1/1, all vascular invasions were negative. A total of 22 lesions had white-tone mucosa on their surface, suggesting superficial keratinization or hyperkeratinization. The lesions were diverse in shape. Additionally, seven lesions were observed which tended to run longitudinally with long axial lengths, all located on the posterior wall of Mt, and white adherent material was observed in six lesions. Iodine staining was performed in 30 lesions, all of which were unstained, and six of them had indistinct borders with inflammatory changes in the background. A total of three patients had synchronous/heterochronic multiple esophageal cancers.\u0000 \u0000 \u0000 \u0000 The white adherents running longitudinally in the posterior wall of the Mt and its white tone in patients with no risk factors suggest the possibility of previously unrecognized lesions and the need for close endoscopic examination, along with iodine staining and biopsy.\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":"41997461","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/doad052.258
E. T. Bianchi, Paulo Cardoso, S. Szachnowicz, A. Nasi, F. Tustumi, F. Seguro, A. Duarte, R. Sallum
Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics. Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them. Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285). 48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14). The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.
{"title":"476. PATIENTS WITH TRACHEOSTOMY HAVE HIGHER INCIDENCE OF ESOPHAGEAL REFLUX AND DON’T PRESENT TYPICAL SYMPTOMS","authors":"E. T. Bianchi, Paulo Cardoso, S. Szachnowicz, A. Nasi, F. Tustumi, F. Seguro, A. Duarte, R. Sallum","doi":"10.1093/dote/doad052.258","DOIUrl":"https://doi.org/10.1093/dote/doad052.258","url":null,"abstract":"\u0000 \u0000 \u0000 Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD.\u0000 With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased.\u0000 Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics.\u0000 \u0000 \u0000 \u0000 Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination.\u0000 Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.\u0000 \u0000 \u0000 \u0000 Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux.\u0000 In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285).\u0000 48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14).\u0000 \u0000 \u0000 \u0000 The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":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":"41529199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.154
Y. Chen, Jang-Ming Lee
For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes. Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model. The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1). For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS. For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes. Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.
{"title":"340. LONG-TERM ONCOLOGIC OUTCOMES OF ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION AND SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY","authors":"Y. Chen, Jang-Ming Lee","doi":"10.1093/dote/doad052.154","DOIUrl":"https://doi.org/10.1093/dote/doad052.154","url":null,"abstract":"\u0000 \u0000 \u0000 For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes.\u0000 Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model.\u0000 \u0000 \u0000 \u0000 The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1).\u0000 For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS.\u0000 \u0000 \u0000 \u0000 For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes.\u0000 Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":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":"41555852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.195
Yun Wang, Zhiyang Li
The standard treatment for esophageal cancer patients is neoadjuvant chemoradiotherapy followed by surgery. However, some of these patients do not achieve pathological complete response with this therapy, resulting in poor outcomes. The objective of this study is to develop a method for selecting patients who can achieve pathological complete response through pre-neoadjuvant therapy chest-enhanced CT scans. The study enrolled 201 patients with esophageal cancer and divided them into a training set and a testing set in a 7:3 ratio. Radiomics features of intra-tumoral and peritumoral images were extracted from preoperative chest-enhanced CT scans of these patients. The features underwent dimensionality reduction in two steps, using Student’s t-test and least absolute shrinkage and selection operator. The selected intra-tumoral and peritumoral (including marginal and adjacent ROI) features were used to build models with four machine learning classifiers. The models with satisfactory accuracy and stability levels were considered to perform well. Finally, the performance of these well-performing models on the testing set was displayed using ROC curves. Among the 16 models, the best-performing models were the integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models. In the training set, the two models had average ROC AUCs of 0.906 and 0.918 respectively, with relative standard deviations (RSDs) of 6.26 and 6.89. In the testing set, the AUCs were 0.845 and 0.871, respectively. There was no significant difference in the ROC curves between the two models. The addition of peritumoral radiomics features to the radiomics analysis may improve the predictive performance of pathological response for esophageal cancer patients to neoadjuvant chemoradiotherapy. The integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models developed in this study show potential for predicting pathological complete response in esophageal cancer patients and may help in selecting patients for neoadjuvant therapy.
{"title":"393. A RADIOMICS STRATEGY BASED ON CT INTRA-TUMORAL AND PERITUMORAL REGIONS FOR PREOPERATIVE PREDICTION OF NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER","authors":"Yun Wang, Zhiyang Li","doi":"10.1093/dote/doad052.195","DOIUrl":"https://doi.org/10.1093/dote/doad052.195","url":null,"abstract":"\u0000 \u0000 \u0000 The standard treatment for esophageal cancer patients is neoadjuvant chemoradiotherapy followed by surgery. However, some of these patients do not achieve pathological complete response with this therapy, resulting in poor outcomes. The objective of this study is to develop a method for selecting patients who can achieve pathological complete response through pre-neoadjuvant therapy chest-enhanced CT scans.\u0000 \u0000 \u0000 \u0000 The study enrolled 201 patients with esophageal cancer and divided them into a training set and a testing set in a 7:3 ratio. Radiomics features of intra-tumoral and peritumoral images were extracted from preoperative chest-enhanced CT scans of these patients. The features underwent dimensionality reduction in two steps, using Student’s t-test and least absolute shrinkage and selection operator. The selected intra-tumoral and peritumoral (including marginal and adjacent ROI) features were used to build models with four machine learning classifiers. The models with satisfactory accuracy and stability levels were considered to perform well. Finally, the performance of these well-performing models on the testing set was displayed using ROC curves.\u0000 \u0000 \u0000 \u0000 Among the 16 models, the best-performing models were the integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models. In the training set, the two models had average ROC AUCs of 0.906 and 0.918 respectively, with relative standard deviations (RSDs) of 6.26 and 6.89. In the testing set, the AUCs were 0.845 and 0.871, respectively. There was no significant difference in the ROC curves between the two models.\u0000 \u0000 \u0000 \u0000 The addition of peritumoral radiomics features to the radiomics analysis may improve the predictive performance of pathological response for esophageal cancer patients to neoadjuvant chemoradiotherapy. The integrated (intra-tumoral and peritumoral features) -XGBoost and integrated-random forest models developed in this study show potential for predicting pathological complete response in esophageal cancer patients and may help in selecting patients for neoadjuvant therapy.\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":"49585981","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/doad052.221
P. Elbe, Isabella Ekheden, M. Vujasinovic, J. Maret-Ouda, E. Marsk, M. Thuresson, B. Roelstraete, W. Ye, J. Ludvigsson
Pharyngeal squamous cell carcinoma is a known risk factor for later squamous cell carcinoma of the esophagus. We investigated whether the risk of esophageal carcinoma is high enough to justify routine gastroscopy surveillance in a northern European population. If the risk among patients with pharyngeal carcinoma corresponds to the risk among patients with Barretts esophagus of developing adenocarcinoma, it could justify surveillance. Histopathology data from pharyngeal and esophageal biopsies obtained 1980–2016 in Sweden’s 28 pathology departments were linked to national population-based healthcare registers. We calculated a subdistribution hazard ratio (HR) comparing the risk of esophageal cancer and death in patients with pharyngeal carcinoma to a matched general population. In total 1399 patients with pharyngeal cancer were identified. 344 were excluded due to age under 18 years, previous esophageal cancer, death or cancer within 6 months of diagnosis. Thus, 1055 patients remained. Median follow up time was 5,1 years. 78% were men and median age at diagnosis of pharyngeal cancer was 64 years. Four (0.38%) patients developed esophageal squamous cell carcinoma during follow-up, equal to 1 in 263 patients (HR = 14,32; 95%CI = 1,55-132,30). 855 of the patients (81%) died during follow-up (HR = 7,65; 95% = 6,82-8,59). The yearly risk of developing esophageal squamous cell carcinoma was 0,07%, which is lower than the risk among patients with Barretts esophagus. Therefore, we find no support for long-term endoscopic surveillance among patients with pharyngeal cancer.
{"title":"428. PHARYNGEAL SQUAMOUS CELL CARCINOMA AND RISK OF LATER ESOPHAGEAL SQUAMOUS CELL CARCINOMA","authors":"P. Elbe, Isabella Ekheden, M. Vujasinovic, J. Maret-Ouda, E. Marsk, M. Thuresson, B. Roelstraete, W. Ye, J. Ludvigsson","doi":"10.1093/dote/doad052.221","DOIUrl":"https://doi.org/10.1093/dote/doad052.221","url":null,"abstract":"Pharyngeal squamous cell carcinoma is a known risk factor for later squamous cell carcinoma of the esophagus. We investigated whether the risk of esophageal carcinoma is high enough to justify routine gastroscopy surveillance in a northern European population. If the risk among patients with pharyngeal carcinoma corresponds to the risk among patients with Barretts esophagus of developing adenocarcinoma, it could justify surveillance.\u0000 \u0000 \u0000 \u0000 Histopathology data from pharyngeal and esophageal biopsies obtained 1980–2016 in Sweden’s 28 pathology departments were linked to national population-based healthcare registers. We calculated a subdistribution hazard ratio (HR) comparing the risk of esophageal cancer and death in patients with pharyngeal carcinoma to a matched general population.\u0000 \u0000 \u0000 \u0000 In total 1399 patients with pharyngeal cancer were identified. 344 were excluded due to age under 18 years, previous esophageal cancer, death or cancer within 6 months of diagnosis. Thus, 1055 patients remained. Median follow up time was 5,1 years. 78% were men and median age at diagnosis of pharyngeal cancer was 64 years. Four (0.38%) patients developed esophageal squamous cell carcinoma during follow-up, equal to 1 in 263 patients (HR = 14,32; 95%CI = 1,55-132,30). 855 of the patients (81%) died during follow-up (HR = 7,65; 95% = 6,82-8,59).\u0000 \u0000 \u0000 \u0000 The yearly risk of developing esophageal squamous cell carcinoma was 0,07%, which is lower than the risk among patients with Barretts esophagus. Therefore, we find no support for long-term endoscopic surveillance among patients with pharyngeal cancer.","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":"42717454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.108
B. Klarenbeek, L. Veenendaal, C. Rosman
The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used. MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’. In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team. The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.
{"title":"269. CURRENT STATUS OF THE INTRODUCTION PROCESS OF MINIMALLY INVASIVE TRANSCERVICAL ESOPHAGECTOMY (MICE), TYPICALLY IDEAL 2A STRUGGLES","authors":"B. Klarenbeek, L. Veenendaal, C. Rosman","doi":"10.1093/dote/doad052.108","DOIUrl":"https://doi.org/10.1093/dote/doad052.108","url":null,"abstract":"\u0000 \u0000 \u0000 The introduction of a novel complex surgical technique is a challenging process and can be associated with a long learning curve and learning-associated morbidity. In order to introduce Minimally Invasive transCervical Esophagectomy (MICE) in a safe way, the IDEAL framework was a used.\u0000 \u0000 \u0000 \u0000 MICE is an innovative surgical technique, combining a single-port transcervical mediastinal dissection with a laparoscopic transhiatal esophagectomy. MICE could reduce pulmonary complications and the consequences of anastomotic leakage, without compromising oncological radicality. Our five-step approach of the ‘pre-clinical stage 0’ made the IDEAL framework more applicable as a practical guideline and led to a safe ‘first-in-human procedure, IDEAL stage 1’. Currently we are prospectively collecting data of a single-center Radboudumc cohort, going through the learning curve and finetuning the surgical technique, which is typical for IDEAL stage 2A ‘Development’.\u0000 \u0000 \u0000 \u0000 In another abstract, the clinical outcomes of our single-center Radboudumc learning curve cohort will be presented. By the time of the 2023 ISDE conference, around 70 cases will be included. As a result of technical difficulties during the learning curve and succinct evaluation with peers and patients, several changes to the MICE procedure have been made, like: indications, cervical incision, continuous NIM, sequence of abdominal/cervical approach, camera system, extraction and reconstruction, conversion, surgical team.\u0000 \u0000 \u0000 \u0000 The surgical technique of MICE evolved during the collection of a singe-centre Radboudumc learning curve cohort. These changes are typical for the ‘IDEAL development stage 2A’, thorough evaluation of these changes might help limiting learning associated morbidity.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":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":"43006615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.198
S. Joglekar, Saee Sane, David Liu, C. Duong
Surgical repair of the para-conduit hernia provides an increasing challenge in the era of minimally invasive oesophagectomy. The key principles are preservation of the gastric conduit and its right gatro epiploic vascular arcade, and durable closure of the defect. Of various methods, posterior crural repair is difficult without mobilising and risking and kinking the conduit, while anterior repair of a big defect requires the adjunct of a mesh which carries its own risks of infection or erosion. There is no consensus on the appropriate surgical technique. We propose that the Left pillar of the hiatus be pinched to provide an effective repair. This is safe as dissection and suturing is well away from the conduit and arcade. We find the left pillar to be adequately mobile to allow repair, and the sutures sit in the tendinous portion of the left hemi diaphragm to provide durability. We provide 2 videos to describe the key steps in this technique and demonstrate that this technique is effective in both small and large defects, and acute and chronic para-conduit hernia. Link: https://1drv.ms/v/s!Anu-cyBTuGbsgbxtX8aLf2P1YEPl9g?e=fXz7Pm. Please contact me, shantjog@gmail.com if this link does not work and I will explore an alternative method to share the video. Many thanks.
在微创食管切除术时代，导管旁疝的手术修复提出了越来越大的挑战。关键原则是保留胃导管及其右门大网膜血管拱廊，并持久关闭缺损。在各种方法中，后路的脚部修复是很困难的，不需要动员、冒险和扭曲导管，而前路修复一个大的缺陷需要补片，这有感染或侵蚀的风险。对于合适的手术技术尚无共识。我们建议将裂孔的左支柱夹紧以提供有效的修复。这是安全的，因为解剖和缝合远离导管和拱廊。我们发现左支柱足够灵活，可以进行修复，缝合线位于左半隔膜的肌腱部分，提供耐用性。我们提供了两个视频来描述该技术的关键步骤，并证明该技术对大小缺陷以及急性和慢性导管旁疝都是有效的。链接:https://1drv.ms/v/s ! Anu-cyBTuGbsgbxtX8aLf2P1YEPl9g ? e = fXz7Pm。请联系我，shantjog@gmail.com如果这个链接不起作用，我会探索另一种方法来分享视频。多谢。
{"title":"397. LEFT PILLAR PINCHING TECHNIQUE FOR MINIMALLY INVASIVE REPAIR OF PARA-CONDUIT HERNIA","authors":"S. Joglekar, Saee Sane, David Liu, C. Duong","doi":"10.1093/dote/doad052.198","DOIUrl":"https://doi.org/10.1093/dote/doad052.198","url":null,"abstract":"\u0000 Surgical repair of the para-conduit hernia provides an increasing challenge in the era of minimally invasive oesophagectomy. The key principles are preservation of the gastric conduit and its right gatro epiploic vascular arcade, and durable closure of the defect.\u0000 Of various methods, posterior crural repair is difficult without mobilising and risking and kinking the conduit, while anterior repair of a big defect requires the adjunct of a mesh which carries its own risks of infection or erosion. There is no consensus on the appropriate surgical technique.\u0000 We propose that the Left pillar of the hiatus be pinched to provide an effective repair. This is safe as dissection and suturing is well away from the conduit and arcade. We find the left pillar to be adequately mobile to allow repair, and the sutures sit in the tendinous portion of the left hemi diaphragm to provide durability.\u0000 We provide 2 videos to describe the key steps in this technique and demonstrate that this technique is effective in both small and large defects, and acute and chronic para-conduit hernia.\u0000 Link: https://1drv.ms/v/s!Anu-cyBTuGbsgbxtX8aLf2P1YEPl9g?e=fXz7Pm.\u0000 Please contact me, shantjog@gmail.com if this link does not work and I will explore an alternative method to share the video.\u0000 Many thanks.","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":"43036445","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/doad052.144
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.
{"title":"326. LONG-TERM OUTCOMES OF MODIFIED ENHANCED RECOVERY AFTER SURGERY (MERAS) PROTOCOLS IN PERI-OPERATIVE MANAGEMENT OF MINIMALLY INVASIVE ESOPHAGECTOMY","authors":"Maohui Chen, B. Zheng, Yizhou Huang, Shuliang Zhang, T. Zeng, Chenhui Ning, Chun Chen","doi":"10.1093/dote/doad052.144","DOIUrl":"https://doi.org/10.1093/dote/doad052.144","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"47642912","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/doad052.146
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.
{"title":"328. ENDOSCOPIC SUBMUCOSAL DISSECTION FOR SUPERFICIAL ESOPHAGEAL CARCINOMA INVOLVING THE ENTIRE ESOPHAGUS: SHORT-TERM RESULTS","authors":"I. Toshiro, Eriko Noma, Yoshiaki Moriguchi","doi":"10.1093/dote/doad052.146","DOIUrl":"https://doi.org/10.1093/dote/doad052.146","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"47897449","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/doad052.002
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.
{"title":"14. IMPACTS OF ADDITIONAL CYCLES OF NEOADJUVANT IMMUNOCHEMOTHERAPY ON ESOPHAGECTOMY IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA","authors":"Long-Qi Chen, Y. Gu, Boyu Liu","doi":"10.1093/dote/doad052.002","DOIUrl":"https://doi.org/10.1093/dote/doad052.002","url":null,"abstract":"\u0000 \u0000 \u0000 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).\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"49189387","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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