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":" ","pages":""},"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/doad052.195
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":" ","pages":""},"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/doad052.225
Karoliina Niska
In curative surgery for esophageal cancer a gastric conduit is often used to replace the resected esophagus. Anastomotic leakage (AL) is a serious complication. Sufficient perfusion in the gastric conduit is critical for the anastomosis. The aim of this pilot study was to investigate the feasibility of intraoperative indocyanine green (ICG) and near-infrared fluorescent imaging as a tool to assess perfusion of the gastric conduit in order to prevent postoperative AL. Patients undergoing esophageal resection at Umeå University Hospital were invited to participate in this prospective study during 2017–2022. The surgery performed was open Ivor-Lewis esophagectomy. ICG was administered intraoperatively and video footage of the near-infrared fluorescence was recorded. The time from injection until visualized fluorescence in the gastric conduit was measured, as well as the intensity of the fluorescence in the gastric conduit. A loop of jejunum was used as control and the quotient between the measurement in the jejunal loop and in the gastric conduit was used for objective assessment. 50 individuals were included. 46 patients had received neoadjuvant chemoradiotherapy and 3 had received chemotherapy only. 32 patients had video footages that were possible to assess as described above. Of these 11 had AL. No differences were demonstrated between patients with AL and those without, neither regarding time to fluorescence (p = 0.42), nor intensity (p = 0.72). AL is a serious complication to esophageal surgery with a high incidence. Perfusion assessment of the gastric conduit using ICG has emerged as a promising technique to reduce AL. In this pilot study we developed two techniques to evaluate the perfusion in an objective manner, whilst none of these seem to be able to predict postoperative AL.
{"title":"433. INTRAOPERATIVE ICG-IMAGING AS A TOOL TO ASSESS PERFUSION IN THE GASTRIC CONDUIT","authors":"Karoliina Niska","doi":"10.1093/dote/doad052.225","DOIUrl":"https://doi.org/10.1093/dote/doad052.225","url":null,"abstract":"\u0000 \u0000 \u0000 In curative surgery for esophageal cancer a gastric conduit is often used to replace the resected esophagus. Anastomotic leakage (AL) is a serious complication. Sufficient perfusion in the gastric conduit is critical for the anastomosis. The aim of this pilot study was to investigate the feasibility of intraoperative indocyanine green (ICG) and near-infrared fluorescent imaging as a tool to assess perfusion of the gastric conduit in order to prevent postoperative AL.\u0000 \u0000 \u0000 \u0000 Patients undergoing esophageal resection at Umeå University Hospital were invited to participate in this prospective study during 2017–2022. The surgery performed was open Ivor-Lewis esophagectomy. ICG was administered intraoperatively and video footage of the near-infrared fluorescence was recorded. The time from injection until visualized fluorescence in the gastric conduit was measured, as well as the intensity of the fluorescence in the gastric conduit. A loop of jejunum was used as control and the quotient between the measurement in the jejunal loop and in the gastric conduit was used for objective assessment.\u0000 \u0000 \u0000 \u0000 50 individuals were included. 46 patients had received neoadjuvant chemoradiotherapy and 3 had received chemotherapy only. 32 patients had video footages that were possible to assess as described above. Of these 11 had AL. No differences were demonstrated between patients with AL and those without, neither regarding time to fluorescence (p = 0.42), nor intensity (p = 0.72).\u0000 \u0000 \u0000 \u0000 AL is a serious complication to esophageal surgery with a high incidence. Perfusion assessment of the gastric conduit using ICG has emerged as a promising technique to reduce AL. In this pilot study we developed two techniques to evaluate the perfusion in an objective manner, whilst none of these seem to be able to predict postoperative AL.\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":"46096285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.156
Sung Kwang Lee
Esophageal SMT is a rare disease, and most of them are benign. Esophageal schwannoma accounts for about 2% among esophageal SMT. Recently, F-18 FDG PET/CT has been widely used to confirm malignancy or to identify other metastatic lesions in cancer patients. However, even benign tumors often show an elevated SUV, and in the case of schwannomas, various values of SUV have been reported, which seems to limit differentiation from other malignant peripheral nerve sheath tumors. A 56-year-old female patient was incidentally found with extrinsic compressing mass at 22 cm from the incisor. An endoscopic ultrasonography and chest CT showed a 3.4 cm sized homogenous well-defined mass in upper esophagus, leiomyoma or gastrointestinal stromal tumor was suspected. SUV was elevated on PET-CT was performed to identify malignancy and metastatic lesions. When confirmed as malignant, additional surgery was planned, and enucleation was performed for primary diagnosis and treatment. The esophageal bulging was confirmed. After dividing the esophageal muscle, and underwent enucleation. In immunohistochemical staining, S-100 protein showed positive findings, which could be diagnosed as schwannoma. Due to the characteristics of esophageal SMT, FDG uptake may be observed on PET-CT, but if there is no evidence of metastasis, it is likely to proceed with treatment according to the benign disease. Then, if immunohistochemistry examination is diagnosed as malignancy, it would be desirable to apply additional stage surgery.
{"title":"342. VIDEO-ASSISTED THORACOSCOPIC ENUCLEATION OF BENIGN SCHWANNOMA MISDIAGNOSED AS MALIGNANT LESION ON F-18 FDG PET/CT IN ESOPHAGEAL SUBMUCOSAL TUMOR","authors":"Sung Kwang Lee","doi":"10.1093/dote/doad052.156","DOIUrl":"https://doi.org/10.1093/dote/doad052.156","url":null,"abstract":"\u0000 \u0000 \u0000 Esophageal SMT is a rare disease, and most of them are benign. Esophageal schwannoma accounts for about 2% among esophageal SMT.\u0000 Recently, F-18 FDG PET/CT has been widely used to confirm malignancy or to identify other metastatic lesions in cancer patients. However, even benign tumors often show an elevated SUV, and in the case of schwannomas, various values of SUV have been reported, which seems to limit differentiation from other malignant peripheral nerve sheath tumors.\u0000 \u0000 \u0000 \u0000 A 56-year-old female patient was incidentally found with extrinsic compressing mass at 22 cm from the incisor. An endoscopic ultrasonography and chest CT showed a 3.4 cm sized homogenous well-defined mass in upper esophagus, leiomyoma or gastrointestinal stromal tumor was suspected. SUV was elevated on PET-CT was performed to identify malignancy and metastatic lesions. When confirmed as malignant, additional surgery was planned, and enucleation was performed for primary diagnosis and treatment.\u0000 The esophageal bulging was confirmed. After dividing the esophageal muscle, and underwent enucleation. In immunohistochemical staining, S-100 protein showed positive findings, which could be diagnosed as schwannoma.\u0000 \u0000 \u0000 \u0000 Due to the characteristics of esophageal SMT, FDG uptake may be observed on PET-CT, but if there is no evidence of metastasis, it is likely to proceed with treatment according to the benign disease. Then, if immunohistochemistry examination is diagnosed as malignancy, it would be desirable to apply additional stage surgery.\u0000 \u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41793521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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":" ","pages":""},"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/doad052.273
Aria Sallakhi, Isabella Alexandra Baumgartl, J. Andresen, Hagar Khater, Georg Gibas, Amadea Medibach, Cordula Marolt, Wolfgang Radlspöck, J. Zacherl
According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase. Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12. Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up. A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.
{"title":"492. TYPES AND INCIDENCE OF POSTOPERATIVE ANEMIA AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY","authors":"Aria Sallakhi, Isabella Alexandra Baumgartl, J. Andresen, Hagar Khater, Georg Gibas, Amadea Medibach, Cordula Marolt, Wolfgang Radlspöck, J. Zacherl","doi":"10.1093/dote/doad052.273","DOIUrl":"https://doi.org/10.1093/dote/doad052.273","url":null,"abstract":"\u0000 According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase.\u0000 Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12.\u0000 Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up.\u0000 A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44275905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.198
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":" ","pages":""},"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/doad052.255
Rakesh Ahmed, J. Elliott, C. Donohoe, N. Ravi, J. Reynolds
Hiatus hernia after oesophagectomy is an uncommon but serious complication of oesophageal cancer surgery. With improving long-term oncologic outcomes, post oesophagectomy hiatus hernia is an increasingly recognised entity in oesophageal cancer survivorship. The aim of this study was to assess the incidence of and risk factors for paraconduit hiatus hernia (PHH), and to describe management approaches in a tertiary referral centre. All patients undergoing oesophagectomy for cancer from 2008 to 2022 were included. Early PHH was defined as occurring within 3 months of index surgery, with all other PHH defined as late PHH. Surveillance computed tomography scans were undertaken among all disease-free patients to 5-years postoperatively. Kaplan Meier and Cox proportional hazards regression models were used to determine independent risk factors for PHH. 897 patients were studied. Early PHH occurred in 1.2%, and late PHH in 5.7% of patients. There was no late recurrence after early PHH. PHH was an asymptomatic radiologic finding in 45.5% of early and 84.3% of late cases. Median time to PHH was 15.7 months postoperatively. Nausea, abdominal pain and vomiting were the most common symptoms associated with PHH. Surgical intervention was required in 25.8% of cases, more commonly following early PHH (63.6%) as compared with late PHH (17.6%, P < 0.01). Operative approach (P < 0.001), extended resection of crura or diaphragm (P < 0.001) and male sex (P = 0.037) were associated with increased risk of hiatus hernia. Paraconduit hiatus hernia is an uncommon complication after oncologic oesophagectomy. Surgical intervention is often required for patients with PHH presenting in the first three months after surgery, but a majority of patients with asymptomatic late PHH may be managed expectantly.
{"title":"473. PARACONDUIT HIATUS HERNIA AFTER OESOPHAGECTOMY: INCIDENCE, RISK FACTORS AND MANAGEMENT","authors":"Rakesh Ahmed, J. Elliott, C. Donohoe, N. Ravi, J. Reynolds","doi":"10.1093/dote/doad052.255","DOIUrl":"https://doi.org/10.1093/dote/doad052.255","url":null,"abstract":"\u0000 \u0000 \u0000 Hiatus hernia after oesophagectomy is an uncommon but serious complication of oesophageal cancer surgery. With improving long-term oncologic outcomes, post oesophagectomy hiatus hernia is an increasingly recognised entity in oesophageal cancer survivorship. The aim of this study was to assess the incidence of and risk factors for paraconduit hiatus hernia (PHH), and to describe management approaches in a tertiary referral centre.\u0000 \u0000 \u0000 \u0000 All patients undergoing oesophagectomy for cancer from 2008 to 2022 were included. Early PHH was defined as occurring within 3 months of index surgery, with all other PHH defined as late PHH. Surveillance computed tomography scans were undertaken among all disease-free patients to 5-years postoperatively. Kaplan Meier and Cox proportional hazards regression models were used to determine independent risk factors for PHH.\u0000 \u0000 \u0000 \u0000 897 patients were studied. Early PHH occurred in 1.2%, and late PHH in 5.7% of patients. There was no late recurrence after early PHH. PHH was an asymptomatic radiologic finding in 45.5% of early and 84.3% of late cases. Median time to PHH was 15.7 months postoperatively. Nausea, abdominal pain and vomiting were the most common symptoms associated with PHH. Surgical intervention was required in 25.8% of cases, more commonly following early PHH (63.6%) as compared with late PHH (17.6%, P < 0.01). Operative approach (P < 0.001), extended resection of crura or diaphragm (P < 0.001) and male sex (P = 0.037) were associated with increased risk of hiatus hernia.\u0000 \u0000 \u0000 \u0000 Paraconduit hiatus hernia is an uncommon complication after oncologic oesophagectomy. Surgical intervention is often required for patients with PHH presenting in the first three months after surgery, but a majority of patients with asymptomatic late PHH may be managed expectantly.\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":"43159544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.227
Tsuyoshi Tanaka, Ai Goto, S. Shibasaki, Kazumitsu Suzuki, A. Serizawa, Shingo Akimoto, M. Nakauchi, K. Inaba, I. Uyama, Koichi Suda
The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes. We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery. Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS. Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p < 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001). The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.
{"title":"435. CIRCULAR-STAPLED ESOPHAGOGASTROSTOMY USING THE KEYHOLE PROCEDURE: TECHNICAL ASPECTS AND CLINICAL OUTCOMES","authors":"Tsuyoshi Tanaka, Ai Goto, S. Shibasaki, Kazumitsu Suzuki, A. Serizawa, Shingo Akimoto, M. Nakauchi, K. Inaba, I. Uyama, Koichi Suda","doi":"10.1093/dote/doad052.227","DOIUrl":"https://doi.org/10.1093/dote/doad052.227","url":null,"abstract":"\u0000 \u0000 \u0000 The optimal reconstruction method after radical esophagectomy for esophageal cancer has been under debate. For avoiding an anastomotic stricture, we developed a novel method of circular-stapled esophagogastrostomy by employing the keyhole procedure, which uses a linear stapler (LS) to enlarge the anastomotic opening made with a circular stapler (CS). We report the technique and the clinical outcomes.\u0000 \u0000 \u0000 \u0000 We retrospectively reviewed 70 patients with esophageal cancer who underwent transthoracic esophagectomy and reconstruction via cervical CS-mediated anastomosis with or without the keyhole procedure between 2018 and 2020. The primary outcome was postoperative anastomotic stricture incidence within 180 days after surgery.\u0000 Surgical procedures: After a 3.5 cm-wide gastric conduit was created, the blood supply was examined via indocyanine green fluorescence imaging. Usually, anastomosis was made at the site which was dominated by the last branch of the right epiploic artery owing to Kocher’s maneuver. The CS was inserted through the anterior wall of the gastric conduit, and the end-to-side anastomosis was established on the greater curvature side of the gastric conduit. Then, a 45-mm long LS was used to create a keyhole over the circular staples, and the entry hole was closed with a 60-mm long LS.\u0000 \u0000 \u0000 \u0000 Among 70 patients, 22 underwent the keyhole procedure (CS + K group) and the remaining did not (CS group). A smaller CS was used in the CS + K group (p < 0.001). The incidence of anastomotic stricture was significantly different (CS vs. CS + K, 18.8 vs. 0%, p = 0.049), especially when a 21 or 23 mm CS was used (CS vs. CS + K, 50.0 vs. 0%, p = 0.005). The univariate analysis confirmed that CS ≤ 23 without a keyhole was a significant risk factor (p = 0.001).\u0000 \u0000 \u0000 \u0000 The keyhole procedure could be a simple and useful alternative technique that reduces the risk of stricture formation in the cervical esophagogastric anastomosis, especially when using the smaller-sized CS.\u0000","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43558434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-30DOI: 10.1093/dote/doad052.016
Ding-Qiang Chen, Junlan Cai, K. Weng, Zhinuan Hong
The comprehensive complication index (CCI) is a new index to comprehensively and systematically evaluate complication severity. The objective of this study was to evaluate the predictive ability of CCI on short—and long-term overall survival(OS) in patients with esophageal squamous cell carcinoma (ESCC) undergoing minimally invasive esophagectomy (MIE) based on a propensity Score Matching (PSM) analysis. A total of 356 patients treated with radical MIE from 2013 to 2017 were included, and the primary outcome was OS, and the secondary outcomes were postoperative hospital stay and hospital costs. Firstly, the optimla cut-off value of CCI was determined by X-tile. PSM was used to balance the baseline characteristics. Second, we compared postoperative hospital stay and hospital costs between high- and low-CCI group. Third, the Kaplan–Meier survival curve was used to analyze survival difference. Fourth, univariate and multivariate Cox analysis was used to explore the independent risk factors of OS. The CCI > 24.2 was defined as high-CCI group and CCI≦24.2 was defined as low-CCI group. The high-CCI group had more hospital costs and longer hospital stay than the low-CCI group both before and after PSM (p < 0.001). The K-M analysis indicated that patients with high CCI had worse prognosis both before and after PSM (before matching: P < 0.001; after matching: P = 0.04). CCI was determined as independent prognostic factor both before and after PSM (before PSM, P = 0.002; after PSM, P = 0.025). The CCI could quantify postoperative complications after esophagectomy. High CCI is associated with longer hospital stay and hospitalization costs, and is an independent risk factor for poor OS.
{"title":"41. HIGH COMPREHENSIVE COMPLICATION INDEX AFTER MINIMALLY INVASIVE ESOPHAGECTOMY ASSOCIATED WITH POOR SHORT-TERM AND LONG-TERM OUTCOME: A PROPENSITY SCORE MATCHING ANALYSIS","authors":"Ding-Qiang Chen, Junlan Cai, K. Weng, Zhinuan Hong","doi":"10.1093/dote/doad052.016","DOIUrl":"https://doi.org/10.1093/dote/doad052.016","url":null,"abstract":"\u0000 \u0000 \u0000 The comprehensive complication index (CCI) is a new index to comprehensively and systematically evaluate complication severity. The objective of this study was to evaluate the predictive ability of CCI on short—and long-term overall survival(OS) in patients with esophageal squamous cell carcinoma (ESCC) undergoing minimally invasive esophagectomy (MIE) based on a propensity Score Matching (PSM) analysis.\u0000 \u0000 \u0000 \u0000 A total of 356 patients treated with radical MIE from 2013 to 2017 were included, and the primary outcome was OS, and the secondary outcomes were postoperative hospital stay and hospital costs. Firstly, the optimla cut-off value of CCI was determined by X-tile. PSM was used to balance the baseline characteristics. Second, we compared postoperative hospital stay and hospital costs between high- and low-CCI group. Third, the Kaplan–Meier survival curve was used to analyze survival difference. Fourth, univariate and multivariate Cox analysis was used to explore the independent risk factors of OS.\u0000 \u0000 \u0000 \u0000 The CCI > 24.2 was defined as high-CCI group and CCI≦24.2 was defined as low-CCI group. The high-CCI group had more hospital costs and longer hospital stay than the low-CCI group both before and after PSM (p < 0.001). The K-M analysis indicated that patients with high CCI had worse prognosis both before and after PSM (before matching: P < 0.001; after matching: P = 0.04). CCI was determined as independent prognostic factor both before and after PSM (before PSM, P = 0.002; after PSM, P = 0.025).\u0000 \u0000 \u0000 \u0000 The CCI could quantify postoperative complications after esophagectomy. High CCI is associated with longer hospital stay and hospitalization costs, and is an independent risk factor for poor OS.\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":"45347583","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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