Diseases of the Esophagus最新文献

{"title":"745. A CASE OF ESOPHAGEAL METASTATIC STRICTURE 9 YEARS AFTER BREAST CANCER SURGERY","authors":"Hidetsugu Nakazato, Shinji Nagamine, Hiromi Tokizawa, Takeshi Tomiyama, Takehiko Tomori, Seiji Nagayoshi, Jun Miyagi","doi":"10.1093/dote/doae057.357","DOIUrl":"https://doi.org/10.1093/dote/doae057.357","url":null,"abstract":"Background Oesophageal metastasis of breast cancer is relatively rare. In this report, we describe our experience of a case in which dysphagia was the main complaint, leading to the diagnosis of esophageal metastasis. Method A 63-year-old woman who had undergone partial mastectomy and sentinel lymph node removal in 20xx with a diagnosis of breast cancer presented 9 years after surgery with dysphagia. The postoperative pathological diagnosis of breast cancer was invasive ductal carcinoma, T2, N0, M0, ly1. She had previously received chemotherapy for recurrent bone metastases and mediastinal lymph node metastases 7 years post-operatively, and RT and chemotherapy for a diagnosis of SVC syndrome due to mediastinal lymph nodes 8 years post-operatively. In the present case, upper gastrointestinal endoscopy showed oesophageal stricture and biopsy showed ER+ and PgR- from oesophageal mucosa. Radiotherapy and chemotherapy were administered for the diagnosis of oesophageal metastasis of breast cancer, and the patient's symptoms improved. Conclusion In the case of oesophageal stricture with dysphagia after breast cancer surgery, it is essential to consider oesophageal metastases of breast cancer as a differential, although rare, in addition to benign and primary disease.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"25 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226404","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":"641. COMPARISON OF SURGICAL TREATMENTS FOR GASTROESOPHAGEAL REFLUX IN SYSTEMIC SCLEROSIS","authors":"Sergio Szachnowicz, Lucas Ferros, Ilan Friedmann, Andre Duarte, Edno Bianchi, Francisco Seguro, Rubens Sallum, Ulysses Ribeiro Júnior","doi":"10.1093/dote/doae057.344","DOIUrl":"https://doi.org/10.1093/dote/doae057.344","url":null,"abstract":"Background This study proposes to compare the results of refractory gastroesophageal reflux disease (GERD) in patients with Systemic sclerosis, aiming to compare the results of different surgical approaches. Methods 44 patients are presented, followed between 2005 and 2024, diagnosed with Systemic Sclerosis and referred to our service. Just 7 patients were submitted to surgical treatment of GERD. Three different were done: partial fundoplication, Roux-en-Y gastroplasty, and Esophagectomy. Results Considering the 44 patients, just 15,9 % were operated. Two underwent partial fundoplication, 2 esophagectomies, and 3 gastric bypasses. The patients submitted to esophagectomy had delayed or incomplete esophagic emptying, and the patients who underwent gastric bypass, even with total aperistalsis showed good esophagic emptying during a barium swallow. Only patients without aperistalsis were offered partial fundoplication. We had no mortality, and the morbidity was 33% in gastric Bypass, with no morbidity in the fundoplication and esophagectomy group. The patients submitted to bypass presented better QOL and reflux control. Conclusion The surgical approach to the treatment of GERD in Systemic sclerosis is recommended just in selective cases and should be tailored concerning the clinical conditions and the esophagus emptying of each patient.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"177 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226408","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":"398. DYSPHAGIA OR REGURGITATION AND ITS CORRELATES AMONG UP TO 10-YEAR ESOPHAGEAL SQUAMOUS CELL CARCINOMA SURVIVORS","authors":"Yong Yuan, Jianfeng Zhou, Yixin Liu, Yushang Yang","doi":"10.1093/dote/doae057.153","DOIUrl":"https://doi.org/10.1093/dote/doae057.153","url":null,"abstract":"Background Dysphagia and regurgitation significantly impair the quality of life among survivors of esophageal squamous cell carcinoma (ESCC). Notably, the prevalence and associated factors of these symptoms in long-term survivors, particularly within Asian populations, remain underexplored. This study endeavors to bridge these critical knowledge gaps. Methods We evaluated the severity of dysphagia and regurgitation (mild, moderate, and severe), and their associations with clinical features and lifestyle factors among 512 10-year ESCC survivors who underwent ESCC radical surgery. Demographic, clinical, and lifestyle information was collected at study enrollment, which occurred 6 months post-surgery, and dysphagia and regurgitation was assessed at the 10-year post-surgery follow-up survey. Results In this study, 13.3% and 27.0% of participants reported dysphagia and regurgitation, respectively. Multivariable polytomous regression analysis revealed a significant association of dysphagia with upper thoracic esophageal carcinoma (mild dysphagia OR: 2.371, 95% CI: 1.051, 5.347) and postoperative radiotherapy and chemotherapy (mild dysphagia OR: 4.352, 95% CI: 2.168, 8.732; moderate/severe dysphagia OR: 3.651, 95% CI: 1.046, 12.745). An inverse relationship was observed between dysphagia and dietary quality as measured by the CHFP-2007 score (mild dysphagia OR: 0.458, 95% CI: 0.341, 0.615; moderate/severe dysphagia OR: 0.168, 95% CI: 0.089, 0.316). For regurgitation, positive associations were found with higher income level (mild regurgitation OR: 2.074, 95% CI: 1.020, 4.216), insomnia (moderate/severe regurgitation OR: 3.523, 95% CI: 1.127, 11.010), and use of Chinese patent medicine (mild regurgitation OR: 2.264, 95% CI: 1.279, 4.007). Conversely, age at surgery (moderate/severe dysphagia OR: 0.907, 95% CI: 0.848, 0.970) and higher dietary quality (mild dysphagia OR: 0.744, 95% CI: 0.606, 0.914; moderate/severe dysphagia OR: 0.406, 95% CI: 0.259, 0.634) showed protective effects against regurgitation. Conclusions The prevalence of dysphagia and regurgitation among long-term survivors of ESCC in China is high, underscoring a significant health concern. This study identifies critical correlates such as the tumor's anatomical site, the nature of postoperative interventions, dietary quality, socioeconomic standing, and concurrent health issues. These findings advocate for the integration of postoperative management approaches, including tailored dietary and lifestyle adjustments, aimed at mitigating these symptoms in long-term ESCC survivors.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"11 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226410","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":"261. CONVERSION ESOPHAGECTOMY FOR CT4B ESOPHAGEAL CANCER - MIE VS OPEN -","authors":"Koshiro Ishiyama, Daisuke Kurita, Jyunya Oguma, Hiroyuki Daiko","doi":"10.1093/dote/doae057.040","DOIUrl":"https://doi.org/10.1093/dote/doae057.040","url":null,"abstract":"Background and Aims The standard treatment for locally advanced unresectable esophageal cancer is definitive chemoradiotherapy (dCRT), however, after induction chemotherapy with a triplet chemotherapy regimen (docetaxel, cisplatin, and 5-FU: DCF) or dCRT, conversion surgery could be performed if esophageal cancer is considered resectable. Furthermore, minimally invasive surgery such as robot-assisted or thoracoscopic procedures are expected to improve the outcome of patients with advanced esophageal cancer. We investigated the feasibility of minimally invasive esophagectomy (MIE) in conversion surgery. Materials and Methods Sixty-six patients who underwent conversion thoracic esophagectomy for cT4b esophageal cancer from 2007 to 2023 were included. The short-term outcomes of 25 open esophagectomy group and 41 MIE group (8 robot-assisted and 33 thoracoscopic) were compared. Results No differences in age, gender, PS, tumor location, histology, cN, or cM were observed between the two groups. cT4b organs tended to be in the airway in the MIE group (airway 70.7% vs 44%, major vessels 19.5% vs 24%, both 9.7% vs 32%, p=0.04) and DCF therapy was significantly performed in the MIE group for induction therapy (DCF 87.8% vs 56%, dCRT 12.2% vs 44%, p<0.001). On the other hand, salvage surgery was significantly associated with open esophagectomy (24.3% vs. 52%, p=0.003). There was no difference in surgical outcomes regarding thoracic operation time (157 min vs. 180 min, p=0.09), whereas the total operation time was significantly shorter in the MIE group (392 min vs. 439 min, p=0.02). Blood loss was significantly lower in the MIE group (79 ml vs. 470 ml, p<0.001), and R0 resection rate did not differ (82.9% vs. 72%, p=0.357). There were no significant differences in postoperative complications including pneumonia (26.8% vs. 44%, p=0.183) and recurrent nerve palsy (21.9% vs. 36%, p=0.260), but anastomotic leakage was significantly lower in the MIE group (4.8% vs. 24%, p=0.04). There was no difference in median postoperative hospital stay (16 [11-20] vs. 16 [14-29] days), however, median ICU stay (3 [3-4] vs. 4 [3-4] days, p=0.03) and readmission within 1 month after discharge (2.4% vs. 16%, p=0.04) were significantly lower in the MIE group. In-hospital mortality was observed in 1 case in the MIE group and 3 in the open esophagectomy group. Conclusion Despite the bias associated with the transition of treatment modalities and surgical techniques, MIE may contribute to improved short-term outcomes in conversion surgery.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"117 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205203","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":"370. LOWER MEDIASTINUM DISSECTION IN THORACOSCOPIC ESOPHAGECTOMY","authors":"Beatriz Pereira Gonçalves, Maria do Carmo Girão, Beatriz Chumbinho, Leonor Ávila, Francisco Cabral, Paulo Ramos, Cecília Monteiro, Rui Casaca, Nuno Abecasis","doi":"10.1093/dote/doae057.129","DOIUrl":"https://doi.org/10.1093/dote/doae057.129","url":null,"abstract":"Background Thoracic esophagectomy is currently the preferred technique for the thoracic phase of transthoracic esophagectomy for esophageal cancer. Randomized controlled trials comparing this minimally invasive approach to the open one, demonstrated a lower rate of pulmonary complications rate, without worst long-term outcomes. Video-based learning of minimally invasive surgery is essential, especially in such a complex procedure like esophagectomy. However, resources are lacking. Therefore, we aim to conduct a video demonstration of lower mediastinum dissection of our standardized right thoracoscopy esophagectomy, in the prone position. Methods Surgery de-construction through video assessment is routinely performed in our upper gastrointestinal unit. It is fundamental for surgical training, as well as for technical skills improvement of experienced surgeons. Here we present a step-by-step approach of one of the key parts of our standardized thoracoscopic esophagectomy technique – the lower mediastinum dissection. Results Thoracoscopic esophagectomy is systematically performed in a prone position, using a bronchial blocker, 4 working ports and a pressure of 6 mmHg for pneumomediastinum. The first stage of thoracoscopic esophagectomy is the lower mediastinum dissection. Three main steps compose this procedure - posterior dissection, anterior dissection and main bronchus and carina dissection. This video offers a comprehensive overview of the key anatomical landmarks that require identification during the procedure, the sequential steps involved and the critical pitfalls. Conclusion Thoracoscopic esophagectomy for esophageal cancer should be performed in high-volume centers, in a standardized and systematic way. Video revision and procedure debriefing is essential not only for surgery learning and coaching, but also for outcome improvement. Sharing knowledge and experience through video-based presentations can contribute to development of this complex area of minimally invasive esophagectomy. https://drive.google.com/file/d/1vWJOTCey8wI6HQi0jAR8C_t3tUKVbrW1/view?usp=drive_link","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"9 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205239","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":"766. LASTING SYMPTOMS AFTER OESOPHAGEAL RESECTIONAL SURGERY (LASORS): MULTICENTRE VALIDATION COHORT STUDY","authors":"Heidi Paine, Swathikan Chidambaram, Khaled Dawas, Borzoueh Mohammadi, Yassar Qureshi, Robert O'Neill, Nick Dai, Bilal Alkhaffaf, Ravinder Vohra, Sheraz Rehan Markar","doi":"10.1093/dote/doae057.367","DOIUrl":"https://doi.org/10.1093/dote/doae057.367","url":null,"abstract":"Background As outcomes following curative-intent oesophageal cancer treatment improve, more patients are living with the long-term morbidity of cancer therapies, the symptoms of which are poorly recognised and understood. Existing symptomatology and quality-of-life tools are cumbersome and moreover are not designed specifically for evaluation of post-treatment survivorship. The LASER study and subsequent consultation process identified six key symptoms thought to predict poor health-related quality-of-life (HRQoL) as measured by validated European Organisation for Research and Treatment of Cancer (EORTC) tools. The current study aimed to validate this six-symptom LAsting Symptoms after Oesophageal Resection (LASOR) clinical tool, and assess its clinical utility. Methods In this multi-centre cohort study, patients who underwent oesophagectomy between January 2015 and June 2019 across the United Kingdom, and were disease-free at least one-year post-treatment, were asked to complete LASOR, EORTC-QLQ-C30 and QLQ-OG25 questionnaires. LASOR symptoms (low mood, reduced energy, thoracotomy pain, heartburn, diarrhoea, and bloating after eating) were evaluated using composite scores based on frequency and quality of life impact, and correlated with EORTC HRQoL scores. The ability of the LASOR tool to predict patients with poor HRQoL was validated using receiver operating characteristic (ROC) curve analysis. Patient acceptability of the tool was assessed using a separate questionnaire. Results 263 participants were included. 192 (73%) were males. Surgical technique included open (61%), hybrid (18%), and minimally-invasive (21%). 203 patients (77%) received neoadjuvant chemotherapy or chemoradiotherapy. 148 patients (56%) experienced a post-operative complication. Four LASOR symptoms were associated with significantly lower HRQoL: reduced energy (OR=2.13; 95% CI 1.20-2.87), low mood (OR=1.86; 95% CI 1.45–3.12), diarrhoea (OR=1.48; 95% CI 1.06–2.06), and bloating (OR=1.35; 95%CI 1.03-1.77). In combination, the LASOR symptoms produced an area under the ROC curve of 0.85 (sensitivity = 0.82, specificity = 0.73). Conclusion The six-symptom LASOR tool generated a reliable model for identification of patients with a poor HRQoL, with an overall diagnostic accuracy of over 80%. This is the first clinical symptom tool to be validated in the post-curative-treatment setting for patients with oesophageal cancer. The LASOR tool is straightforward to administer and highly acceptable to patients, and can be used to identify those at risk of high morbidity and poor quality of life in surveillance programmes. In turn, evidence-based survivorship services can be integrated into patient follow-up to alleviate the burden of cancer treatment on oesophagectomy patients.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"20 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205079","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":"554. SHORT TERM OUTCOMES OF ESOPHAGECTOMY FROM LOW VOLUME CANCER CENTRE IN INDIA","authors":"Rigved Nittala, Amita Sekhar Padhy","doi":"10.1093/dote/doae057.280","DOIUrl":"https://doi.org/10.1093/dote/doae057.280","url":null,"abstract":"This study evaluates short term outcomes of esophagectomy at a low volume cancer hospital in Visakhapatnam, India. Fifteen patients who underwent esophagectomy from 2020 to 2023 were analysed. The most common histology was squamous cell carcinoma. The mean age was 55 years and the majority were male. The common approaches used were open trans hiatal and transthoracic esophagectomy. The mean operative time was 9.5 hours and the mean hospital stay was 15.92 days. There were no perioperative deaths but complications included pulmonary issues, vocal cord paralysis, anastomotic leaks, chyle leaks and wound infections. Higher volume centres tend to have better outcomes after esophagectomy. However, factors other than volume like patient selection, ERAS (Enhanced Recovery After Surgery) protocols, specialized critical care and trained multidisciplinary teams also impact outcomes. At our centre, though a low volume hospital, proper patient selection, prehabilitation and a collaborative team approach helped achieve acceptable results. We recommend developing consensus on defining low and high-volume centres for esophagectomy in the Indian context, based on disease burden, resources and constraints. Overall, there is a lack of Indian data comparing outcomes between low and high-volume centres for esophagectomy.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"4 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205205","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":"536. TUMOR-INFORMED “LIQUID BIOPSY” FOR ESOPHAGEAL ADENOCARCINOMA FROM MATCHED CANCER ORGANOID CULTURE","authors":"Thaiane Rispoli, Premalatha Shathasivam, Niharikaa Aiyar, Jonathan Allen, Frances Alisson, Yvonne Bach, Eugenia Dakpo, Adam Sundby, Gavin Wilson, Jonathan Yeung","doi":"10.1093/dote/doae057.266","DOIUrl":"https://doi.org/10.1093/dote/doae057.266","url":null,"abstract":"Background The absence of recurrent mutations in esophageal adenocarcinoma (EAC) poses a challenge in detecting circulating tumor DNA (ctDNA) in plasma and may hinder the advancement of liquid biopsy methods. To address this, we cultured patient-derived EAC organoids (PDOs), speculating that they could serve as a guide for identifying ctDNA in the patient's blood samples. This approach aims to leverage organoids as a potential tool to overcome the complexity of identifying ctDNA in EAC, offering a promising avenue for refining liquid biopsy strategies in clinical practice. Methods PDOs were generated from EAC tumor tissue in Matrigel domes and expanded in suspension culture. To isolate mononucleosomes (147 bp), chromatin from PDOs was extracted and digested with micrococcal nuclease (MNase). Fragments larger than 147 bp were removed through size selection. MNase-sequencing was performed to generate a mutation map with preferential coverage of nucleosome-protected DNA for each sample. Matched whole genome sequencing of the tumor for each respective PDO sample was used as a control. Primers were designed for the identified mutations in nucleosome-protected DNA and used to amplify patient cfDNA for sequencing. Results DNA from five different PDOs were collected and MNase digested. MNase concentration and digestion time were optimized for each sample. MNase digestion produced mononucleosomes of approximately 147 bp for all samples. MNase-sequencing identified 24 mutations in peaks (mononucleosomes) in 24 genes, including known oncogenes. Among these were 16 missense, 2 frameshift, and 1 nonsense mutations, and 5 mutations in splice regions. To date, amplicons of expected size were detected by PCR for six genes using either total PDO DNA or normal cell-free DNA, confirming the detectability of these genes. PCR amplification using patient ctDNA and next-generation sequencing is ongoing. Conclusion These findings show that we are able to isolate and detect somatic mutations in nucleosomes from different PDOs, allowing us to generate a nucleosome SNV map for each sample. Preliminary data indicate these regions can be PCR amplified from normal cfDNA. Amplification and sequence verification of mutated regions from corresponding patient blood ctDNA is ongoing. The mapping of patient-specific variants will enable the development of targeted personalized PCR panels, aiding in recurrence prediction and enhancing drug screening accuracy. This advancement holds promise for early cancer detection and improving prognoses for individuals with EAC by addressing gaps in recurrence prediction.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205210","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":"785. MANAGEMENT OF ESOPHAGEAL CANCER WITH CONCURRENT CERVICAL NODE METASTASIS: A NATIONWIDE POPULATION-BASED COHORT STUDY","authors":"Maxime Sanders, Sylvia van der Horst, Teus Weijs, Stella Mook, Nadia Haj Mohammad, Jan Erik Freund, Jessie Elliot, Mark van Berge Henegouwen, Suzanne Gisbertz, Peter van Rossum, Hanneke van Laarhoven, Misha Luyer, Grard Nieuwenhuijzen, Bas Wijnhoven, Bianca Mostert, Rob Verhoeven, Jelle Ruurda, Richard van Hillegersberg","doi":"10.1093/dote/doae057.381","DOIUrl":"https://doi.org/10.1093/dote/doae057.381","url":null,"abstract":"Background In the Netherlands, the standard treatment of locally advanced, resectable esophageal cancer without metastasis is neoadjuvant chemoradiotherapy followed by esophagectomy. There is a small subset of patients that present with concurrent cervical lymph node metastasis (LNM). Historically this was seen as distant metastasis and surgical intervention has usually not been an option for these patients. The contemporary TNM classification now categorizes these lymph node stations as locoregional disease. Our current study aims to describe current treatment paradigms in the Netherlands for patients presenting with esophageal cancer and concurrent cervical LNM. Methods This population-based cohort study utilized data from the Netherlands Cancer Registry (NCR), encompassing patients with locally advanced thoracic esophageal or gastroesophageal junction cancer and concurrent cervical lymph node metastasis. Treatment modalities were categorized into five options: neoadjuvant therapy followed by surgery (Neo + S), definitive chemoradiotherapy (dCRT), chemotherapy with or without radiotherapy < 30 Gray (CT), radiotherapy (RT), and best supportive care (BSC). Overall survival (OS) was assessed using the Kaplan-Meier method and compared via the log-rank test. Hazard rates were computed using Cox proportional hazards regression, with adjustment for confounding achieved through inverse probability of treatment weighting (IPTW). Results Between 2015 and 2021, a cohort of 412 patients was identified from the NCR database. Median survival durations were observed as follows: 24.2 months for Neo + S, 18.0 months for dCRT, 14.5 months for CT, 7.0 months for RT, and 3.2 months for BSC (Figure). A comparison between the Neo + S group and dCRT demonstrated a significant improvement in survival (p=0.02). Further subdivision of the surgical group into neoadjuvant CRT or chemotherapy did not reveal a significant difference in survival (p=0.6). Utilizing IPTW to adjust for confounding factors, Neo + S maintained its survival advantage. Conclusion The retrospective cohort findings suggest that neoadjuvant therapy followed by surgery may represent the optimal approach for managing esophageal cancer patients with cervical LNMs Yet, it's vital to recognize the influence of confounding by indication, which statistical adjustments may not entirely rectify. Furthermore, immortal time bias notably skews results favorably toward surgery. Nevertheless, the results emphasize the importance of considering surgery as a viable option for these patients. These limitations underscore the critical need for a prospective study, prompting the launch of the NODE-II trial.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"30 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205270","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":"431. DISSECTION OF THE SUPRACARINAL MESOESOPHAGUS RECURRENTIAL LYMPHADENECTOMY AND RECURRENT NERVE DAMAGE","authors":"Pablo Guerrero, Fernando Mingol Navarro, Marcos Bruna Esteban, David Quevedo Cruz, Marta Nieto, Carmen Gutiérrez Sánchez, Cristina Martínez Chicote, Francisco Javier Vaqué Urbaneja","doi":"10.1093/dote/doae057.182","DOIUrl":"https://doi.org/10.1093/dote/doae057.182","url":null,"abstract":"Background Currently, an extended mediastinal lymphadenectomy is considered paramount for an accurate cancer staging as well as to improve the oncologic outcomes of patients with locally advanced esophageal cancer. Following the recently described supracarinal mesoesophagus (Cuesta et. al. 2023) allows a complete lymphadenectomy, including the left recurrential area. However, this dissection represents a considerable challenge and could be associated with significant complications. The aim of this study is to analyse if the extended lymphadenectomy guided by the anatomy of the superior mesoesophagus enables a more careful dissection of the recurrent nerves in order to avoid an injury of these structures. Methods We prospectively studied all patients in our centre with advanced esophageal cancer, from 2018 to 2023, who underwent esophagectomy and recurrent lymphadenectomy following the surgical plane of the supracarinal mesoesophagus (both unilateral and bilateral). All procedures were performed as curative intent by the same surgeon. We analysed all patients with recurrent nerve lesions and their severity, as well as their implication through the postoperative period and the treatment needed for their repair. In addition, we also studied the number of adenopathies included in the specimen, specifying those that belonged to the recurrential area and its positivity for tumoral cells. Results We included 40 patients in our study, 30 men and 10 women with an average age of 65 years. All of them received neoadyuvant therapy previous to the surgery (mostly CROSS and FLOT schemes). There were only 2 patients (5%) who suffered from permanent recurrent palsy, both needing surgical treatment for its correction. Two other patients had mild dysphonia that could be resolved with phoniatric rehabilitation. No fatal outcome occurred secondary to recurrent nerve injury. The median number of adenopathies resected in total was 35, while the median number of adenopathies corresponding to the recurrential area was 5. Conclusions In this study we have observed that, following the landmarks of the supracarinal mesoesophagus allows us to perform an extended mediastinal lymphadenectomy reducing the recurrent nerves injury down to only 5%. Even though a lesion of the recurrent nerves could imply a major influence on the quality of life, performing this dissection meticulously could improve the quality of cancer staging, overall and disease-free survival without significantly increasing the risk of recurrent nerve damage. For this reason, the proper knowledge of these anatomical planes of dissection may help improve lymphadenectomies without increasing or even reducing the rate of recurrent nerve injury.","PeriodicalId":11354,"journal":{"name":"Diseases of the Esophagus","volume":"9 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142226411","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}