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":" ","pages":""},"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}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.177
H. Konishi, H. Fujiwara, A. Shiozaki, Keiji Nishibeppu, Takuma Ohashi, T. Kubota, E. Otsuji
Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated. Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated. Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (< 45), PLR (> 122), and operative bleeding (>134) were significantly related with post-operative pneumonia in the univariate analysis (p < 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction. PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia. Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.
{"title":"372. INVESTIGATION OF RISK FACTORS OF POSTOPERATIVE PNEUMONIA IN MEDIASTINOSCOPIC ESOPHAGECTOMY","authors":"H. Konishi, H. Fujiwara, A. Shiozaki, Keiji Nishibeppu, Takuma Ohashi, T. Kubota, E. Otsuji","doi":"10.1093/dote/doad052.177","DOIUrl":"https://doi.org/10.1093/dote/doad052.177","url":null,"abstract":"\u0000 \u0000 \u0000 Pneumonia is a usual complication in esophagectomy. Although frequency of pneumonia in mediastinoscopic esophagectomy is low, risk factors for pneumonia are unclear. The risk factors are investigated.\u0000 \u0000 \u0000 \u0000 Two hundred and forty-four patients with mediastinoscopic esphagectomy and gastric tube reconstruction for esophageal cancer from 2016 to 2021 in our hospital were retrospectively considered in the present study. Postoperative pneumonia was diagnosed as Clavien-Dindo grade 2 or higher. Patients were divided into two groups with (n = 21) and without (n = 223) pneumonia, and background, surgical factors, or histopathological factors were investigated.\u0000 \u0000 \u0000 \u0000 Post-operative pneumonia was observed in 21 patients (8.6%), and pre-operative albumin, PNI (< 45), PLR (> 122), and operative bleeding (>134) were significantly related with post-operative pneumonia in the univariate analysis (p < 0.05). Age and previous respiratory disease were also tended to be related with post-operative pneumonia, but not significant. Low PNI was an independent risk factor of post-operative pneumonia in the multivariate analysis (p = 0.047, OR = 2.74). Post-operative pneumonia was not related to the complications, such as anastomosis leakage or recurrent nerve paralysis. No correlation with postoperative pneumonia was observed even in patients with preoperative respiratory dysfunction.\u0000 \u0000 \u0000 \u0000 PNI has been reported to be useful as a predictor of postoperative complications. In the present study, it was also a predictor factor of postoperative pneumonia. Early nutritional intervention for undernourished esophageal cancer patients may prevent postoperative pneumonia.\u0000 \u0000 \u0000 \u0000 Low PNI can be a predictive factor of postoperative pneumonia in the mediastinoscopic esophagectomy.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43525297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.224
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.
{"title":"432. SINGLE-CELL RNA SEQUENCING OF MORPHOLOGICALLY-PURE PATIENT-DERIVED ORGANOIDS FROM ESOPHAGEAL ADENOCARCINOMA PATIENTS","authors":"P. Shathasivam, Mansur M. Naeem, T. Rispoli, Niharikaa Aiyar, Akhi Akhter, G. Wilson, G. Darling, J. Yeung","doi":"10.1093/dote/doad052.224","DOIUrl":"https://doi.org/10.1093/dote/doad052.224","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"48681934","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/doad052.043
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。
{"title":"177. BULKY LYMPHADENOPATHY IN ESOPHAGEAL CANCER: ASSESSING PATHOLOGICAL AND SURVIVAL OUTCOMES AFTER TREATMENT WITH CURATIVE INTENT","authors":"J. Tankel, Yenothan Nevo, S. Najmeh, J. Spicer, C. Mueller, L. Ferri, J. Cools-Lartigue","doi":"10.1093/dote/doad052.043","DOIUrl":"https://doi.org/10.1093/dote/doad052.043","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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).\u0000 \u0000 \u0000 \u0000 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.\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":"48703315","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/doad052.009
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.
{"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}
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":" ","pages":""},"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/doad052.017
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.
{"title":"44. LONG-TERM OUTCOMES OF PERORAL ENDOSCOPIC MYOTOMY FOR PATIENTS WITH ACHALASIA: A SINGLE-CENTRE STUDY","authors":"M. Alotaibi, R. Bechara","doi":"10.1093/dote/doad052.017","DOIUrl":"https://doi.org/10.1093/dote/doad052.017","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\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":"48397974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.004
Suzanne F M van Wijck, Athiná Barza, J. Vermeulen, B. Eyck, B. J. van der Wilk, E. van der Harst, M. Verhofstad, S. Lagarde, E. V. van Lieshout, Charlène Zijden, M. Wijffels
Chest wall pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. The aims of this study were 1) to determine the prevalence of chest wall abnormalities on postoperative imaging; and 2) to compare complications, long-term pain, and quality of life in patients with versus without thoracotomy-related thoracic fractures. This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 1 January 2010 and 31 December 2020. An early postoperative CT (<1 month) and/or late CT (>6 months) had to be available. Disease-free patients were asked to complete questionnaires on pain and quality of life (SF-36 and EORTC-QLQ-C30). A total of 366 patients were included. Thoracotomy-related rib fractures were seen in 144 (39%) patients and thoracic transverse process fractures in 4 (2%). Patients with thoracic fractures more often developed postoperative complications (89% versus 74%, p = 0.002), especially pneumonia (51% versus 39%, p = 0.032). Seventy-seven participants (33 with thoracic fractures, 44 without) completed questionnaires median 41 (P25-P75 28–91) months postoperatively. Long-term chest wall pain was reported by 48 (63%) participants but no association with thoracic fractures was found (p = 0.637). Quality of life scores did not differ between patients with versus without thoracic fractures and were mostly comparable with their reference populations. Thoracic (mainly rib) fractures are prevalent following a thoracotomy for esophageal cancer. Patients with thoracic fractures have an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or decreased quality of life was not confirmed.
{"title":"16. THORACIC FRACTURES AND OTHER CHEST WALL ABNORMALITIES AFTER THORACOTOMY FOR ESOPHAGEAL CANCER: A RETROSPECTIVE COHORT STUDY","authors":"Suzanne F M van Wijck, Athiná Barza, J. Vermeulen, B. Eyck, B. J. van der Wilk, E. van der Harst, M. Verhofstad, S. Lagarde, E. V. van Lieshout, Charlène Zijden, M. Wijffels","doi":"10.1093/dote/doad052.004","DOIUrl":"https://doi.org/10.1093/dote/doad052.004","url":null,"abstract":"\u0000 \u0000 \u0000 Chest wall pain following a thoracotomy for esophageal cancer is frequently reported but poorly understood. The aims of this study were 1) to determine the prevalence of chest wall abnormalities on postoperative imaging; and 2) to compare complications, long-term pain, and quality of life in patients with versus without thoracotomy-related thoracic fractures.\u0000 \u0000 \u0000 \u0000 This retrospective cohort study enrolled patients with esophageal cancer who underwent a thoracotomy between 1 January 2010 and 31 December 2020. An early postoperative CT (<1 month) and/or late CT (>6 months) had to be available. Disease-free patients were asked to complete questionnaires on pain and quality of life (SF-36 and EORTC-QLQ-C30).\u0000 \u0000 \u0000 \u0000 A total of 366 patients were included. Thoracotomy-related rib fractures were seen in 144 (39%) patients and thoracic transverse process fractures in 4 (2%). Patients with thoracic fractures more often developed postoperative complications (89% versus 74%, p = 0.002), especially pneumonia (51% versus 39%, p = 0.032). Seventy-seven participants (33 with thoracic fractures, 44 without) completed questionnaires median 41 (P25-P75 28–91) months postoperatively. Long-term chest wall pain was reported by 48 (63%) participants but no association with thoracic fractures was found (p = 0.637). Quality of life scores did not differ between patients with versus without thoracic fractures and were mostly comparable with their reference populations.\u0000 \u0000 \u0000 \u0000 Thoracic (mainly rib) fractures are prevalent following a thoracotomy for esophageal cancer. Patients with thoracic fractures have an increased risk of postoperative complications, especially pneumonia, but an association with long-term pain or decreased quality of life was not confirmed.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47198660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.144
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":" ","pages":""},"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/doad052.117
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.
{"title":"286. A BIBLIOMETRIC ANALYSIS OF NEOADJUVANT THERAPY FOR ESOPHAGEAL CANCER","authors":"Yizhou Huang, B. Zheng, Maohui Chen, Shuliang Zhang, T. Zeng, Chun Chen","doi":"10.1093/dote/doad052.117","DOIUrl":"https://doi.org/10.1093/dote/doad052.117","url":null,"abstract":"\u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 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.\u0000 \u0000 \u0000 \u0000 Web of Science (WOS); esophageal cancer; bibliometric analysis.\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":"49439682","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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