Diseases of the Esophagus最新文献

{"title":"816. BRONCHIAL INJURY AND REPAIR DURING MINIMALLY INVASIVE ESOPHAGECTOMY","authors":"Caleb Harris","doi":"10.1093/dote/doae057.409","DOIUrl":"https://doi.org/10.1093/dote/doae057.409","url":null,"abstract":"Background Video Assisted Thoracoscopy (VATS) is the preferred approach to Esophagectomy thanks to the improved short term outcomes without any compromise on the oncological outcomes. VATS Esophagectomy is technically difficult and has a steep learning curve, with several potential complications. Description This is the video of a patient with early esophageal cancer (T1N0M0) who underwent VATS esophagectomy in the semi-prone position with capnothorax. There was an inadvertent injury to the membranous wall of the left bronchus which was sutured using monofilament absorbable sutures. The omentum was wrapped around and sutured to the anterior wall of the stomach tube, which reinforced the sutures once it was pulled up into the thorax. Patient had an uneventful postoperative recovery. Importance This video, apart from stressing on the need for careful dissection around the bronchial tree, shows that such an injury can be managed with minimal invasive techniques. https://1drv.ms/v/s!AmL6SI2dDeQVh9AzGMuncYi8GT3nIQ?e=IcjfNd","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205242","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}

{"title":"564. PRONE POSITION THORACOSCOPIC HAND-SEWN ESOPHAGO-GASTRIC ANASTOMOSIS DURING 2-STAGE TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER. SURGICAL TECHNIQUE","authors":"Spyridon Davakis, Theodoros Liakakos, Alexandros Charalabopoulos","doi":"10.1093/dote/doae057.289","DOIUrl":"https://doi.org/10.1093/dote/doae057.289","url":null,"abstract":"Background Minimally invasive esophagectomy has been introduced in the 2000s in an effort to reduce post-operative pulmonary and cardiac complications. 2-stage totally minimally invasive esophagectomy combines laparoscopic abdominal phase followed by thoracoscopic thoracic phase. The rate limiting step of this approach is the construction of esophago-gastric anastomosis. Herein, we aim to present our anastomotic technique on hand-sewn esophago-gastric anastomosis in prone position, utilizing 3D-assisted thoracoscopy. Methods This is prospective analysis of consecutive patients that underwent 2-stage totally minimally invasive esophagectomy for esophageal and gastro-esophageal junction Siewert type I-II cancers from the same surgical team, over a period of 6 years and more than 250 consecutive esophagectomies. All operations were identical in terms of patient positioning, lymphadenectomy and type of anastomosis formed. The anastomosis was hand-sewn in prone position, in 2-layers, using barbed sutures, with utilization of 3D-assisted thoracoscopy. Thorough technique and key steps of this anastomotic technique are provided. Results Median operative time was 280 minutes while median suturing time for the esophago-gastric anastomosis was 45 minutes. Anastomosis was thoracoscopic, hand-sewn constructed in prone position in all cases. There was no conversion to open. Anastomotic leak complicated n=6 patients (2%); n=5 were type I anastomotic leaks, requiring no intervention and n=1 was type II, which was treated with thoracoscopic lavage and chest drains followed by endoVAC therapy. Conclusion Formation of the esophago-gastric anastomosis is the rate limiting step of 2-stage totally minimally invasive esophagectomy. Most surgeons prefer the construction utilizing mechanical staplers. Our anastomotic technique, present a safe and effective anastomosis, with favorable clinical outcomes. It can be reproduced safely and effectively, offering all the advantages of manual anastomosis and significant reduction of devastating post-operative anastomotic leakage. https://wetransfer.com/downloads/bdf3a3496197daf79ccf5b05f71ba64920240309175850/a4da3be742fd3199e102e553c8a4011e20240309175918/c14cc2","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205235","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}

{"title":"787. THE CHALLENGE OF GASTRO-ESOPHAGEAL ONCOLOGICAL SURGERY AFTER BARIATRIC PROCEDURES: EXPERIENCE OF A REFERRAL HIGH-VOLUME UPPER GI SURGICAL CENTER","authors":"Federica Cuce, Mario Antonio Belluomini, Giovanni Pallabazzer, Andrea Gennai, Paola Marini, Biagio Solito, Stefano Santi","doi":"10.1093/dote/doae057.383","DOIUrl":"https://doi.org/10.1093/dote/doae057.383","url":null,"abstract":"Background The effectiveness of bariatric surgery for weight loss in morbidly obese patients has been well established and it's becoming more common as many surgeons are trained to perform them safely, even in older patients. Obesity is associated with reflux and hormonal imbalances that increase the risk of Barrett's esophagus, esophageal adenocarcinoma and gastric cancer. Bariatric procedures alter gastric anatomy, vascularization and lymphatic drainage and render subsequent upper gastrointestinal surgery for malignancies a technical challenge, that will present more and more in the future. We present laparoscopic sleeve gastrectomy, gastric bypass and gastric banding conversion to oncological respective surgeries. Methods We retrospectively reviewed the medical records of our referral high-volume center for upper gastrointestinal surgery and identified patients who underwent upper gastrointestinal oncologic surgery from January 1998 to May 2024. We selected all patients who had previously undergone bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic gastric bypass, gastric banding, or other less common procedures). Three patients met our criteria, and we recorded: demographic characteristics, surgical technique, oncologic surgical outcome, postoperative complications, long-term complications, and oncologic follow-up. Results A hybrid IvorLewis esophagectomy was performed years after a sleeve gastrectomy for distal esophageal adenocarcinoma. The sleeve was used for gastric pull-up, adequately vascularized by the right gastroepiploic artery as demonstrated by intraoperative indocyanine green. A patient developed adenocarcinoma of the cardia after Roux-en-Y gastric bypass, infiltrating the gastric pouch, the gastric remnant and liver S2. After neoadjuvant chemotherapy, an open Ivor-Lewis esophagectomy was performed using the gastric remnant for a pull-up. In a third patient, a locally advanced adenocarcinoma of the stomach developed after gastric banding. After neoadjuvant chemotherapy, an open total gastrectomy with Roux-en-Y esophagojejunostomy was performed. Conclusion We report three cases of successful esophago-gastric oncological surgery in patients with altered anatomy and vascularization due to previous bariatric surgery, without major postoperative complications or mortality. Oncologic benchmarks for both esophageal and gastric surgery were met as a high lymph node yield and oncologic margins were maintained. Our heterogeneous series suggests that sleeve gastrectomy, gastric bypass, and gastric banding surgery can be successfully converted to resective surgeries after a metachronous neoplasia diagnosis in high-volume upper gastrointestinal centers. These and similar modified reconstructive techniques are likely to be used in the future as metabolic surgery and esophago-gastric cancer are increasing.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205206","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}

{"title":"424. EFFECT OF GUT MICROBIOTA ON THE RESPONSE TO NEOADJUVANT IMMUNOTHERAPY COMBINED WITH CHEMOTHERAPY IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA","authors":"Jianfeng Zhou","doi":"10.1093/dote/doae057.175","DOIUrl":"https://doi.org/10.1093/dote/doae057.175","url":null,"abstract":"Background To explore the impact of gut microbiota diversity on the efficacy of immunotherapy combined with chemotherapy in esophageal squamous cell carcinoma (ESCC) patients, aiming to identify microbial markers for predicting treatment outcomes. Methods In this study, we prospectively enrolled patients diagnosed with locally advanced esophageal squamous cell carcinoma who were scheduled to undergo neoadjuvant immunotherapy combined with chemotherapy; stool specimens were collected before the first cycle, the second cycle of immunotherapy, and at the time of preoperative disease evaluation. To examine the gut microbiota's composition and abundance, we employed the 16S rDNA sequencing technique. The sequencing data were preprocessed with FLASH and Uparse software, and species annotation was performed using the SSUrRNA database. Microbiota analysis was conducted using the R language, and group differences were assessed using appropriate statistical methods. Results In this study, 43 patients (totally 122 stool samples) with neoadjuvant immunotherapy combined with chemotherapy for esophageal squamous cell carcinoma were enrolled from December 2020 to January 2022. 16S rDNA sequencing results suggested that patients in the sensitive group had higher total fecal microbiota diversity than those in the drug-resistant group, and a notable variation in the structure of the microbiota was detected between the two groups. During treatment, the results did not show any significant statistical difference in the number of species (alpha diversity) in the sensitive group compared to the resistant group, although there was a trend towards a higher number of species in the pre-treatment sensitive group. As the treatment progressed, starting from the second cycle of treatment, the sensitive group had a higher alpha diversity than the resistant group. And we found that Bray-Curtis distance assessment of beta diversity showed that the difference between the sensitive and resistant groups also became more pronounced as treatment progressed. At the phylum level, the gut flora composition of the sensitive group remained relatively stable as treatment progressed, while the microbial diversity of the resistant group appeared to decrease. At the genus level, Bifidobacterium, Faecalibacterium, Akkermansia and Ruminococcus were more abundant in the immunotherapy-sensitive group; whereas Ligilactobacillus and Escherichia-Shigella was more rich in the immunotherapy-resistant group. The prediction model based on the baseline differences of gut microbiota in the two groups using a random forest method can be applied to predict the efficacy of immunotherapy for esophageal squamous cell carcinoma. Conclusion There are differences in species diversity and microbiota structure between the sensitive and resistant groups of esophageal squamous cell carcinoma patients receiving immunotherapy combined with chemotherapy, and the predictive model, which is based on the microbiota differ","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226405","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}

{"title":"433. UNRAVELLING THE MOLECULAR MECHANISMS BEHIND TUMOUR DIFFERENTIATION IN ESOPHAGEAL ADENOCARCINOMA","authors":"Gavin Wilson, Karanbir Brar, Frances Allison, Jonathan Allen, Yvonne Bach, James Cotton, Elliot Wakeam, Gail Darling, Elena Elimova, Sangeetha N Kalimuthu, Jonathan Yeung","doi":"10.1093/dote/doae057.184","DOIUrl":"https://doi.org/10.1093/dote/doae057.184","url":null,"abstract":"Background Esophageal adenocarcinoma tumors are divided into three grades based on the tumour’s histological differentiation: well, moderate and poor. Poorly differentiated tumours have a worse survival rate than moderate and well tumours. Understanding the molecular programs of this differentiation may lead to the identification of novel therapeutic interventions specific to tumour differentiation. We have utilized laser-capture microdissection to enrich tumour cells followed by gene expression profiling (RNA-seq) to identify gene expression programs and whole genome sequencing for differentiating specific mutations and copy number changes. Collectively, these results will enable us to unravel the molecular drivers of tumour differentiation. Methods Laser capture microdissection was applied to N=127 RNA-seq samples from N=74 patients and N=103 from N=81 patients from a mix of primary tumour biopsies, resections, and metastatic biopsies. Most samples have a matching RNA-seq and WGS sample. We used a standard pipeline to analyze the WGS data and produce somatic mutation, structural variant, and copy number calls. The gene expression data was segregated into two sets a test set consisting of N=74 samples and a test set of N=53 samples. Non-negative matrix factorization was used to identify eleven gene expression programs. Results Our testing RNA-seq cohort consisted of N=74 samples from N=74 patients with N=4 G1, N=26 G2, N=35 G3, and N=9 missing differentiation data. Our initial goal was to unravel the gene expression programs that correlate with tumour differentiation. Our non-negative matrix factorization analysis yielded 11 gene signatures, N=3 programs enriched in glandular gene expression, N=3 enriched in EMT pathways, N=2 with fibroblasts, and N=3 associated with immune / inflammation genes (not shown) (Figure 1). Moreover, the glandular signatures were associated with G1/G2 and the EMT and fibroblast signatures with G3. Moreover, the glandular 2 signature was associated with HER2 amplifications. Conclusion In this work we have begun to unravel the gene expression and genomic changes associated with tumour differentiation. We have found signatures enriched for both G1/G2 and G3 tumours and from these signatures we have observed gene expression heterogeneity within the different tumour differentiation categories. Moreover, the G3 tumours are enriched in fibroblasts despite our laser-capture microdissection. We are currently working on a classification model to predict tumor differentiation from these gene expression programs and are looking to further integrate our whole genome data to find additional genomic drivers.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205082","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}

{"title":"297. ASSESSING BLOOD-BASED BIOMARKERS IN OESOPHAGEAL CANCER PATIENTS RECEIVING NEOADJUVANT CHEMORADIOTHERAPY","authors":"Mohammed Al Azzawi, D O’Reilly, A Hill, J Crown, DM Collins, WB Robb","doi":"10.1093/dote/doae057.068","DOIUrl":"https://doi.org/10.1093/dote/doae057.068","url":null,"abstract":"Background Oesophageal cancer is the sixth most common cause of cancer-related deaths globally. It has a significant rate of mortality despite the multimodal approach to treatment. Neo-adjuvant chemoradiotherapy is standard of care but there is a clinical need for new therapies. HER2-targeted therapies and immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have emerged as treatment strategies of significant interest in recent years. This study focuses on exploring potential plasma-based biomarkers (growth factors, cytokines, soluble (s) PD-L1) in patients (pts) with oesophageal cancer receiving standard of care neo-adjuvant therapy and stratified based on HER2 expression and pathological complete response (pCR). Methods 50 pts with oesophageal cancer who are eligible for neoadjuvant therapy were recruited. Blood samples were taken pre-treatment, on the first day of the 2nd cycle and post-neoadjuvant treatment. Plasma was extracted within four hours of blood draw and stored at -800C. 20 matched pre- and post-treatment samples were included in this analysis. HER2 status (IHC 3+ (n=3), IHC 2+ (n=5), IHC 1+ (n=3), IHC 0 (n=6) was available for 17 pts. 3 pts achieved a pCR but no HER2 IHC data was available. The levels (pg/ml) of 21 analytes were assessed using the Human Growth Factor Luminex Performance Assay and a Luminex MagPix system. Changes were significant if p<0.05, paired student’s t test. Results Twenty-one biomarkers of response were assessed in the final analysis. Platelet-derived growth factor (PDGF)-AA and PDGF AA/BB displayed the highest concentration levels of the tested analytes but levels did not change pre-and post-treatment. GRO-b (CXCL2) and vascular endothelial growth factor (VEGF) displayed a numerical increase post-treatment but this did not prove significant (p<0.05). Tumour-necrosis factor-related apoptosis-inducing ligand (TRAIL) protein decreased significantly post-therapy (p=0.038). PD-L1 levels significantly increased in the post-treatment cycles (paired t-test p=0.0029), especially in pts with HER2+ status. TRAIL or sPD-L1 levels were not significantly different when categorised by HER2 IHC or pCR status. Conclusion The increase in sPD-L1 and reduction in TRAIL levels in the peripheral blood of oesophageal cancer patients following neoadjuvant therapy suggests treatment alters factors associated with immune-suppression and the induction of tumour cell death. Further investigation in a larger cohort is warranted.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205083","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}

{"title":"790. RISK FACTORS FOR ESOPHAGEAL CANCER IN NORTHEAST INDIA: A MULTI-CENTRIC CASE-CONTROL STUDY","authors":"Caleb Harris, Anisha Mawlong, Ritesh Tapkire, Sandra Albert, Vikas Jagtap","doi":"10.1093/dote/doae057.386","DOIUrl":"https://doi.org/10.1093/dote/doae057.386","url":null,"abstract":"Background Northeast India has a high incidence of esophageal cancer(EC), with age-adjusted incidences ranging from 19 to 50 per 100,000 (in females and males respectively). This is over ten times the average incidence of EC in India. The local preparation of raw betel nut,‘kwai’, is integral to the culture, but its role has not been established. This study aimed to assess the role of betel nut, with or without tobacco as a causative agent for EC. The role of alcohol was also studied. Methods A multi-centric, matched case-control study was performed from October 2022 to March 2024 in three centres situated in the Northeast region of India. All cases of biopsy proven squamous EC, arising from the cricopharynx to the gastroesophageal junction were included, with matched controls (1:3 ratio) being patients visiting the hospital for minor ailments and healthy volunteers from the community. A validated questionnaire was administered by trained trial coordinators. The data was analysed using a conditional multivariate logistic regression which incorporated the individual matching of cases with 3 controls. A p-value of < 0.05 was considered statistically significant. Results A total of 185 cases and 556 controls were matched for age (± 5 years), ethnicity, and gender. There was an increased risk of EC for those consuming betelnut with slaked lime [Calcium hydroxide Ca(OH)2] (Odds Ratio(OR) of 3.77 (Confidence Interval(CI) 1.30-10.92)); alcohol (OR 2.00 CI: 1.80-6.67) and tobacco (OR 3.47 CI:1.80-6.67). The risk was higher for those who swallowed the betel quid and juice as compared with those who spit it out (OR 4.01 CI: 2.24-6.73). The risk was increased in those consuming betelnut while hungry, instead of a meal (OR 10.40 CI 3.66-29.57). The risk was increased in those with no formal education (OR of 4.13 CI: 2.01-8.49). On adjusting with other risk factors (tobacco and alcohol), the risk was highest for betelnut with tobacco (OR 7.84 CI 2.12-29.90) and betelnut with alcohol (OR 2.84 CI 1.11-7.29). All these OR were statistically significant. Conclusion Consumption of betelnut with slaked lime increases the risk of EC. This risk is increased by the concomitant use of tobacco and alcohol.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205265","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}

{"title":"296. CLINICAL T1B-SM2-3N0M0 ESOPHAGEAL SQUAMOUS CELL CARCINOMA","authors":"Toshiro Iizuka, Eriko Noma","doi":"10.1093/dote/doae057.067","DOIUrl":"https://doi.org/10.1093/dote/doae057.067","url":null,"abstract":"Background With advancements in endoscopic techniques, safer and more reliable endoscopic resection of submucosal invasive lesions has become feasible. The evaluation of treatment outcomes for superficial esophageal carcinoma has typically been predicated on the depth of pathological diagnosis; however, there have been limited studies based on preoperative diagnosis. Given that treatment decisions in clinical practice are primarily guided by preoperative diagnosis, there is a heightened emphasis on studies grounded in preoperative assessments. This study aims to analyze the accuracy of preoperative diagnosis of T1b-SM2-3 N0M0, evaluate the accuracy of treatment selection and depth diagnosis, and assess long-term outcomes based on these determinations. Methods Thirty-eight patients diagnosed with T1b-SM2-3 N0M0 between April 2010 and December 2020 were included in the study. Depth diagnosis was determined through endoscopic evaluation utilizing white light, NBI, NBI magnification plus EUS, with lymph node metastasis diagnosis performed via CT imaging. Treatment decisions were made following patient consent, and long-term prognosis was assessed for each treatment modality. Results Initial treatment involved ESD in 14 patients, with an additional 5 patients undergoing additional treatment (ESD + AD) based on histological evaluation (surgery: 1, CRT: 4). Surgery or neoadjuvant chemotherapy (NAC) followed by surgery was performed in 15 patients, with CRT administered in 7. Among the 22 patients who did not receive NAC and whose histologic depth was evaluable, the accuracy rate of depth diagnosis was 64%, primarily attributable to overdiagnosis. In the 14 patients who underwent ESD excluding piecemeal resection, the negative rate of vertical margins was 93%. Five-year overall survival rates were as follows: ESD: 64.8%, ESD+AD: 75%, surgery: 86.2%, and CRT: 45.7%, with no statistically significant differences observed. The majority of deaths (83%) were attributed to other diseases or cancers, with only 2 deaths attributed to the primary disease. Conclusion ESD or surgery emerged as the preferred treatment modalities in the majority of cases, with relatively favorable long-term prognoses. Treatment decisions were influenced by comorbidities and other factors, potentially impacting long-term outcomes.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205078","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}

{"title":"306. TREATMENT OF ANASTOMOTIC LEAKS AFTER ESOPHAGECTOMY AND GASTRECTOMY FOR CANCER BY MEANS OF ENDOSCOPIC VACUUM THERAPY","authors":"Victor Turrado-Rodriguez, Oriol Sendino, Jordi Farguell Piulachs, Anna Curell Garcia, Ainitze Ibarzabal Olanl, Miguel Pera, Dulce Momblan Garcia","doi":"10.1093/dote/doae057.073","DOIUrl":"https://doi.org/10.1093/dote/doae057.073","url":null,"abstract":"Background Esophagectomy and gastrectomy are the cornerstones of the curative treatment of oesophageal and gastric cancer. In both techniques the risk of anastomotic leak (AL) is high, with rates of up to 21% after esophagectomy and up to 12% after gastrectomy. Mortality and morbidity are high after an AL occurs. Several treatment strategies have been developed for treatment of AL, including surgery, endoscopic stent and endoscopic vacuum therapy (EVT). The aim of this study is to analyse the treatment patterns of the patients with AL treated with EVT. Methods All patients diagnosed of gastric or oesophageal cancer with AL from January 2021 to January 2024 were included in a retrospective study. Baseline data, localization of the tumour, type of resection, type of anastomosis, total time with EVT, number of EVTs used per patient, hospital stay, Clavien-Dindo score and CCI were recorded. A descriptive analysis of the data is performed. Results All 18 patients with AL during the study period were treated with EVT. The tumour was located on the distal third of the oesophagus in 7 patients (38.9%), and stomach (27.8%). The median duration from surgery to the identification of AL was 5 days (IQR 4 – 9). The median duration of the EVT treatment was 18 days (IQR 13 – 23) with a median EVT replacement of 5.5 (IQR 4 – 7). 8 patients (44.4%) did not require ICU stay. Median time to resumption of oral intake was 34 days (IQR 26 –54). Success rate of the EVT therapy was 88.9%. Conclusions EVT is a useful tool for the treatment of AL in esophagogastric surgery. Even though the treatment may be long, it’s success rate in this series is 88.9% and it may avoid ICU stay in some cases. A close monitoring of this patients and the prompt use of additional techniques to assure source control is mandatory.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205080","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}

{"title":"503. HEALTH-RELATED QUALITY OF LIFE FOLLOWING CURATIVE INTENT TREATMENT FOR ESOPHAGEAL CANCER: IMPACT OF TREATMENT PATHWAY ON PATIENT-REPORTED OUTCOMES IN SURVIVORSHIP","authors":"Ellen Boyle, Nithiesh Loganathan, Jessie A Elliott, Christine Greene, Conor F Murphy, Noel E Donlon, Claire L Donohue, Narayanasamy Ravi, John V Reynolds","doi":"10.1093/dote/doae057.239","DOIUrl":"https://doi.org/10.1093/dote/doae057.239","url":null,"abstract":"Background Recent improvements in treatment modalities for esophageal cancer have resulted in improved survival outcomes, and optimisation of health-related quality of life (HR-QL) in survivorship is now an increasing focus. This study aimed to compare HR-QL in survivorship following treatment with definitive chemoradiation (dCRT), neoadjuvant chemoradiation and surgery (nCRT), neoadjuvant chemotherapy and surgery (nCT), and surgery only (S). Methods This was a cross-sectional study of patients who underwent oesophageal cancer treatment between 2010 and 2021. A multicomponent questionnaire was distributed to disease-free patients at least one year post completion of treatment. Scores were calculated according to the European Organisation for Research and Treatment of Cancer manual. A mean difference of ten points or more for symptom and function scales was considered clinically significant. One-way ANOVA was performed to detect statistically significant differences between treatment groups. Results Some 125 patients were included. Global HR-QL was similar between treatment groups (mean±SD, dCRT 67.4±20.9, nCRT 71.5±19.6, nCT 80.0±15.0, S 69.0±20.0, P=0.265). Analysis of functional scales found lower emotional functioning (S 71.1±25.5 vs dCRT 87.1±15.6, nCRT 79.6±19.5, nCT 88.9±26.3, P=0.028) and body image scores (S 71.8±29.2 vs dCRT 87.9±22.5, nCRT 83.3±27.8, nCT 91.1±19.8, P=0.056) among patients treated with surgery only. Dysphagia (P=0.034), trouble with coughing (P=0.014) and choking when swallowing (P=0.018) were increased following dCRT as compared with surgical treatment. Following surgical treatment, patients reported more diarrhoea as compared with dCRT (P=0.020), while dCRT was associated with increased constipation (P=0.004). Conclusion Overall HR-QL was similar between groups, but distinct patterns of symptoms were observed in different cohorts. Symptoms related to swallow function were more common in patients treated with dCRT, while patients who underwent surgery exhibited more diarrhoea, possibly reflective of increased dumping syndrome. Interestingly, patients who received surgery upfront reported lower scores for emotional functioning and body image in the long-term after treatment, as compared with other groups. Further research is needed to determine the differential psychological impact of major resectional upper GI surgery among patients presenting with early stage versus locally advanced disease.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226407","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}