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  • 1
    Online Resource
    Online Resource
    Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis
    Oxford University Press (OUP) ; 2024
    In:  BJS Open Vol. 8, No. 2 ( 2024-03-01)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 8, No. 2 ( 2024-03-01)
    Abstract: Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study. Methods All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed. Results Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P & lt; 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms. Conclusion This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women.
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrae026
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
    detail.hit.zdb_id: 2902033-5
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  • 2
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    Partial stomach-partitioning gastrojejunostomy for gastric outlet obstruction: A cohort study based on consecutive case series from a single center
    Elsevier BV ; 2022
    In:  Asian Journal of Surgery Vol. 45, No. 1 ( 2022-01), p. 326-331
    Details
    In: Asian Journal of Surgery, Elsevier BV, Vol. 45, No. 1 ( 2022-01), p. 326-331
    Type of Medium: Online Resource
    ISSN: 1015-9584
    URL: Article
    DOI: 10.1016/j.asjsur.2021.05.047
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1068461-X
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  • 3
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    ERAS guidelines-driven upper gastrointestinal contrast study after esophagectomy
    Springer Science and Business Media LLC ; 2022
    In:  Surgical Endoscopy Vol. 36, No. 6 ( 2022-06), p. 4108-4114
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 36, No. 6 ( 2022-06), p. 4108-4114
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-021-08732-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 639039-0
    detail.hit.zdb_id: 1463171-4
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  • 4
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    The other explanation for dyspnea: giant paraesophageal hiatal hernia repair routinely improves pulmonary function
    Oxford University Press (OUP) ; 2019
    In:  Diseases of the Esophagus Vol. 32, No. 9 ( 2019-11-13)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 32, No. 9 ( 2019-11-13)
    Abstract: Paraesophageal hiatal hernias (PEHs) are most commonly associated with gastrointestinal symptoms; less widely appreciated is their potentially important influence on respiratory function. We hypothesize that surgical repair of PEH will significantly improve not only gastrointestinal symptoms, but also preoperative dyspnea and spirometry scores. A prospective Institutional Review Board-approved database was used to review all patients undergoing PEH repair from 2000 to 2016. Patients with pre- and postoperative pulmonary function tests assessed by spirometry were included. Postoperative changes in spirometry measurements were compared to PEH size as reflected by the percentage of intrathoracic stomach observed on preoperative contrast studies. Patients were stratified according to improvement in forced expiratory volume in 1 second (FEV1). Patients with 〉 12% (‘significant’) improvement in FEV1 after surgery were compared to the remaining patient population. In total, 299 patients met the inclusion criteria. Symptomatic improvement in respiratory function was noted in all patients after PEH repair. Age, gender, BMI, presenting symptoms, Charlson comorbidity index as well as preoperative comorbidities did not significantly impact the functional outcome. Spirometry results improved in 80% of the patients, 21% of whom showed an improvement of 〉 20% compared to the preoperative level. ‘Significant’ improvement in respiratory function was seen in 122 of 299 (41%) patients. Patients presenting with moderate and severe preoperative pulmonary obstruction demonstrated ‘significant’ improvement in FEV1 in 48% and 40% of cases, respectively. Large PEHs, characterized by a percentage of intrathoracic stomach 〉 75%, was strongly associated with ‘significant’ improvement in FEV1 (P = 0.001). PEHs can impact subjective and objective respiratory status and surgical repair can result in a significant improvement in dyspnea and pulmonary function score that is independent of preoperative pulmonary disease. Gastric herniation of more than 75% was associated with higher possibility for improvement of pulmonary function tests. Patients with persistent and unexplained dyspnea and coexistent PEH should be assessed by an experienced surgeon for consideration of elective repair.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doz032
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 639470-X
    detail.hit.zdb_id: 2004949-3
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  • 5
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    Online Resource
    P66 ENSURE: EUROPEAN INVESTIGATION OF SURVEILLANCE AFTER RESECTION FOR ESOPHAGEAL CANCER
    Oxford University Press (OUP) ; 2019
    In:  Diseases of the Esophagus Vol. 32, No. Supplement_2 ( 2019-11-23)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 32, No. Supplement_2 ( 2019-11-23)
    Abstract: To characterize oncologic surveillance protocols across European esophageal cancer centers and determine the independent impact of intensive surveillance on oncologic outcome. Background Emerging data demonstrate long-term survival after salvage interventions for local or oligometastatic recurrence after planned curative resection for esophageal cancer, providing rationale for postoperative surveillance. However, the impact of intensive surveillance on oncologic outcome and health-related quality of life (HRQOL) is unknown. Methods First, a survey of surveillance protocols across European esophageal cancer centres was undertaken (Phase 1). Then, an international multicentre study including consecutive patients who underwent surgery with curative intent for cTxNxM0 esophageal or junctional cancer from June 2009 to June 2015 was initiated (Phase 2). The estimated sample size of 4425, with 31% undergoing intensive surveillance, will provide 90% power to detect a 5% increase in 5-year overall survival (primary outcome measure). Secondary outcome measures include disease-free survival, incidence of oligometastatic recurrence, treatment strategies, and HRQOL. Subgroup analyses by age, histologic type and HER-2 status are planned. The study is registered on ClinicalTrials.gov (NCT03461341). Results For Phase 1, 27 centres across 13 European and North American countries participated. Centers undertook 52.3±17.1 esophageal cancer resections per year between 3.5±1.3 attending surgeons. The majority of centers utilized a standardized surveillance protocol for all patients (23, 85.2%). Routine laboratory investigations, nutritional profiling and tumor markers were assessed in 10 (37.0%), 9 (33.3%) and 4 (14.8%) of centers, respectively. 10 centers (37.0%) utilized routine postoperative surveillance computed tomography, of whom 3 (11.1%) also undertook routine postoperative PET-CT in follow-up. Surveillance endoscopy was performed in 7 centers (18.9%). Centers undertaking intensive imaging surveillance had fewer attending surgeons (P=0.036) but similar surgeon volume (P=0.832). Surveillance intensity was not associated with national health expenditure (P=0.733). For Phase 2, data for 4010 patients (31.1% intensive surveillance) from 18 centres across 9 European countries have been submitted to date, with results expected in September 2019. Conclusion The ENSURE study will provide the first appropriately powered evidence assessing the impact of postoperative surveillance strategies on oncologic outcome and HRQOL following potentially curative resection for esophageal cancer.
    Type of Medium: Online Resource
    ISSN: 1442-2050
    URL: Article
    DOI: 10.1093/dote/doz092.66
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2004949-3
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  • 6
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    P116 A PILOT STUDY ON ENERGY INTAKE AND TOTAL ENERGY EXPENDITURE, USING A MULTI SENSOR DEVICE, IN OESOPHAGEAL CANCER PATIENTS DURING THE ENTIRE COURSE OF MODERN MULTIMODALITY TREATMENT
    Oxford University Press (OUP) ; 2019
    In:  Diseases of the Esophagus Vol. 32, No. Supplement_2 ( 2019-11-23)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 32, No. Supplement_2 ( 2019-11-23)
    Abstract: The objective of the present pilot study was to address the feasibility and practical use of SenseWear Armband Mini® (SWA) as a possible valid method offering longitudinal, comprehensive and complete assessment of energy balance in oesophageal cancer patients submitted to modern multimodality therapy. Background and methods Assessment of malnutrition and its consequences are pivotal in the curative management of patients with oesophageal cancer. Twenty patients were recruited at diagnosis of oesophageal cancer, all amenable for curative treatment. The baseline measurement took place before start of neoadjuvant treatment and at three additional measurement periods: after the completion of neoadjuvant treatment, and at three and six months postoperatively. The patients carried the SWA for three consecutive days at each measurement period, allowing the measurement of free-living total energy expenditure (TEE) and physical activity level (PAL). Alongside, a three-day food diary was recorded, permitted the calculation of energy and protein intake. The body weigth was measured at all four occasions. Results Body weight steadily decreased during the preoperative phase. However, the greatest weight loss was observed during the first 3 months after surgery (mean=5.6 kg), where after it stabilised. The median energy intake of 1982 kcal (range: 910-3455) at baseline increased to 2210 kcal (range: 1718-3355, p=0.009) after the completion of the neoadjuvant treatment. At 3 months after oesophagectomy energy intake decreased to 1749 kcal (range: 1024-2707, p=0.101) and regained baseline levels first at 6 months postoperatively. The same trend was observed regarding protein intake. The TEE was 2262 kcal (range: 1595-3150) at baseline with no change after preoperative oncological treatment. A significant reduction in energy expenditure to 1975 kcal (range 1396-2336, p=0.005) was recorded at 3 months post oesophagectomy, which remained unchanged at six months after surgery. Conclusion There are significant obstacles in recording complete, comprehensive and repetitive data on energy balance during the entire course of modern multimodality treatment of oesophageal cancer patients. With the objective to achieve and maintain positive energy balance focus must be on the patients’ energy intake already at the time of diagnosis, throughout the neoadjuvant therapy phase but particularly during the first 3 postoperative months.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doz092.116
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 639470-X
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  • 7
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    Online Resource
    691 IS OPEN LEFT THORACO-ABDOMINAL ESOPHAGECTOMY A VIABLE OPTION IN THE ERA OF MINIMALLY INVASIVE ESOPHAGECTOMY?
    Oxford University Press (OUP) ; 2021
    In:  Diseases of the Esophagus Vol. 34, No. Supplement_1 ( 2021-09-17)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 34, No. Supplement_1 ( 2021-09-17)
    Abstract: Left thoracoabdominal esophagectomy (LTE) facilitates complete resection of esophageal cancer particularly for bulky tumors, but there are concerns that this approach is associated with significant morbidity. The aim of the current study was to evaluate short-term and oncological outcomes of left thoracoabdominal esophagectomy compared to minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction. Methods Prospectively entered esophagectomy databases from three high volume centers were reviewed for patients undergoing LTE or MIE 2012–2018. Patient demographics, tumour characteristics, operative outcomes, postoperative outcomes, and pathologic surrogates of oncologic efficacy (R0 resection rate, and number of resected lymph nodes) were compared. In total 844 patients were included in the study, LTE was applied in 654 (77.5%) patients, and MIE in 190 (22.5%) patients. Results LTE patients had more neoadjuvant treatment (LTE = 74.5%, MIE = 64.9%, P = 0.027). There was no difference in overall postoperative complications (LTE = 61.9%, MIE = 64.6%, P = 0.517), severe complications (Clavien Dindo & gt;IIIa (LTE = 26.6%, MIE 26.5%, P = 0.982), pneumonia (LTE = 29.8%, MIE = 26.3%, P = 0.349), anastomotic leak (LTE = 7.7%, MIE = 9.9%, P = 0.348), or in-hospital mortality (LTE = 1.5%, MIE = 2.1%, P = 0.584). Median length of stay was 11 days after LTE vs. 8 days after MIE (P  & lt; 0.001). R0 resection rate was 92.4% and 95.6% respectively (P = 0.144). Median number of resected lymph nodes was 25 for LTE and 28 for MIE (P = 0.017). LTE had more node positive resections (LTE = 57.6%, MIE = 44.0%, P = 0.001). Conclusion LTE was used for tumors with greater lymph node burden in patients that were more likely to have received neoadjuvant treatment compared to MIE. MIE was associated with significantly shorter length of hospital stay, however postoperative morbidity and Clavien-Dindo scores were equal to that of MIE in this cohort.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doab052.691
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 639470-X
    detail.hit.zdb_id: 2004949-3
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  • 8
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    Online Resource
    Management and outcomes in a consecutive series of patients with aero-digestive fistula at a tertiary gastro-esophageal surgery center
    Oxford University Press (OUP) ; 2024
    In:  Diseases of the Esophagus Vol. 37, No. 3 ( 2024-02-29)
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 37, No. 3 ( 2024-02-29)
    Abstract: Aerodigestive fistula (ADF) is defined as a pathological connection between the upper digestive tract and the airway. ADF is associated with high morbidity and mortality and management is often complex. A cohort study including all patients admitted with ADF 2004–2022 at a single tertiary esophageal surgery center was performed based on prospectively collected administrative data and retrospectively collected electronic patient chart data,. Patient demographics, performance status, comorbidity, fistula characteristics, management, and outcomes in terms of morbidity and mortality were assessed in patients with ADF of three distinct types: (i) tumor overgrowth-related, (ii) various benign etiologies, and (iii) post-esophagectomy. Sixty-one patients with ADF were included in the study, 33 (54.1%) tumor overgrowth-related, six (9.8%) benign and 22 (36.1%) post-esophagectomy. In the post-esophagectomy group 15 out of 22 (68.2%) patients were diagnosed with anastomotic leakage prior to ADF diagnosis. Self-expandable metallic stents (SEMS) were used for temporary fistula sealing in 59 out of 61 (96.7%) patients, of which most received stents in both the digestive tract and airway. Temporary fistula sealing with stents was successful enabling discharge from hospital in 47 out of 59 (79.7%) patients. Definitive ADF repair was performed in 16 (26.2%) patients, of which one (6.3%) died within 90-days and 15 could be discharged home with permanently sealed fistulas. ADF is a complex condition associated with high mortality, which often requires multiple advanced interventions. SEMS can be applied in the airway and simultaneously in the digestive tract to temporarily seal the ADF as bridge to definitive surgical repair.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doad068
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
    detail.hit.zdb_id: 639470-X
    detail.hit.zdb_id: 2004949-3
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  • 9
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    Lasting symptoms and long-term health-related quality of life after totally minimally invasive, hybrid and open Ivor Lewis esophagectomy
    Elsevier BV ; 2022
    In:  European Journal of Surgical Oncology Vol. 48, No. 3 ( 2022-03), p. 582-588
    Details
    In: European Journal of Surgical Oncology, Elsevier BV, Vol. 48, No. 3 ( 2022-03), p. 582-588
    Type of Medium: Online Resource
    ISSN: 0748-7983
    URL: Article
    DOI: 10.1016/j.ejso.2021.10.023
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2135606-3
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  • 10
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    ASO Author Reflections: The Impact of Minimally Invasive Surgery on the Completion Rate of the Perioperative Chemotherapy Protocol in Gastric Cancer
    Springer Science and Business Media LLC ; 2023
    In:  Annals of Surgical Oncology Vol. 30, No. 12 ( 2023-11), p. 7251-7252
    Details
    In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 30, No. 12 ( 2023-11), p. 7251-7252
    Type of Medium: Online Resource
    ISSN: 1068-9265 , 1534-4681
    URL: Article
    DOI: 10.1245/s10434-023-14023-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2074021-9
    detail.hit.zdb_id: 1200469-8
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