Preoperative Chemotherapy Research Articles

Machine learning model predicting factors for incisional infection following right hemicolectomy for colon cancer

Background and aimColorectal cancer is a prevalent malignancy worldwide, and right hemicolectomy is a common surgical procedure for its treatment. However, postoperative incisional infections remain a significant complication, leading to prolonged hospital stays, increased healthcare costs, and patient discomfort. Therefore, this study aims to utilize machine learning models, including random forest, support vector machine, deep learning models, and traditional logistic regression, to predict factors associated with incisional infection following right hemicolectomy for colon cancer.MethodsClinical data were collected from 322 patients undergoing right hemicolectomy for colon cancer, including demographic information, preoperative chemotherapy status, body mass index (BMI), operative time, and other relevant variables. These data are divided into training and testing sets in a ratio of 7:3. Machine learning models, including random forest, support vector machine, and deep learning, were trained using the training set and evaluated using the testing set.ResultsThe deep learning model exhibited the highest performance in predicting incisional infection, followed by random forest and logistic regression models. Specifically, the deep learning model demonstrated higher area under the receiver operating characteristic curve (ROC-AUC) and F1 score compared to other models. These findings suggest the efficacy of machine learning models in predicting risk factors for incisional infection following right hemicolectomy for colon cancer.ConclusionsMachine learning models, particularly deep learning models, offer a promising approach for predicting the risk of incisional infection following right hemicolectomy for colon cancer. These models can provide valuable decision support for clinicians, facilitating personalized treatment strategies and improving patient outcomes.

MO50-7 Evaluation of preoperative chemotherapy and cancer genome therapy for intrahepatic cholangiocarcinoma in our hospital

MO50-7 Evaluation of preoperative chemotherapy and cancer genome therapy for intrahepatic cholangiocarcinoma in our hospital

Contribution of Immunoscore to Survival Prediction in Pancreatic Ductal Adenocarcinoma.

The presence of tumor-infiltrating lymphocytes (TILs) has been demonstrated as a prognostic factor in colorectal cancer after surgical resection of malignancy, but knowledge on their role in pancreatic cancer is lacking. The Immunoscore (IS) assesses TILs at the core of the tumor (CT) and invasive margin (IM) and is being evaluated as a new concept in tumor immunity. The aim of this study was to evaluate the relationship between IS and prognosis in PDAC. The IS was analyzed by immunohistochemistry using surgical tissue blocks from 131 patients with pancreatic ductal adenocarcinoma (PDAC) who underwent surgery to investigate the relationship between immune cell infiltration into the tumor and prognosis in PDAC. A high IS in both CT and IM of the tumor was significantly associated with prolonged overall survival (OS) (p<0.01) and relapse-free survival (RFS) (p<0.01). In multivariate logistic regression models adjusted for clinical pathology data, IS predicted survival and recurrence (p<0.01 and p<0.01, respectively). Moreover, in patients who received preoperative chemotherapy, a high IS was statistically significantly associated with longer OS and RFS (p<0.01 and p<0.01, respectively). The immunohistochemically assessed IS might be a useful prognostic marker for patients with PDAC who underwent primary tumor resection.

Oncological outcomes after radical prostatectomy of localized prostate cancer: stratified by magnetic resonance imaging and risk classification

BackgroundWe investigated whether combining T2-weighted magnetic resonance imaging (MRI) findings and clinical risk categories improves upon established prognostic indicators of oncological outcomes in prostate cancer. MethodsPatients who underwent radical prostatectomy, but not preoperative hormone therapy, radiotherapy, or chemotherapy, for localized prostate cancer at Seoul National University Bundang Hospital from October 2007 to April 2016 were included. MRIs were classified according to the Prostate Imaging-Reporting and Data System (PI-RADS). Patients were divided into the following five groups: 1, no focal suspicious lesion; 2, organ-confined suspicious lesion PI-RADS ≤3; 3, organ-confined suspicious lesion PI-RADS 4 or 5; 4, suspicious lesion with extraprostatic extension (EPE), no seminal vesicle invasion (SVI); 5, suspicious lesion with EPE and SVI. Risk classified according to the National Comprehensive Cancer Network (NCCN) and MRI findings were combined to analyze survival curves for biochemical recurrence (BCR)-free and metastasis-free survival. The area under a time-dependent receiver operating characteristic was analyzed for event prediction after 5 years. ResultsWe analyzed 1,290 patients. In multivariate Cox regression models, PI-RADS ≥4 (hazard ratio [HR] 2.33, P < 0.001), EPE (HR 1.46, P = 0.027), SVI (HR 5.03, P < 0.001) and NCCN high-risk (HR 2.33, 95% CI 1.66-3.26, P < 0.001) were associated with BCR. For metastasis, EPE (HR 2.33, P = 0.047), SVI (HR 13.08, P < 0.001) and NCCN high-risk (HR 2.78, P = 0.026) were independent risk factors. Depending on MRI group, BCR-free survival significantly decreased in NCCN intermediate-risk (P = 0.001) and high-risk (P < 0.001) groups, and metastasis-free survival decreased in the intermediate-risk group (P = 0.39) and significantly decreased in the high-risk (P < 0.001) group. Adding MRI group to NCCN risk classification significantly improved the predictive accuracy for BCR in comparison with NCCN risk classification alone (P = 0.042), but not for metastasis (P = 0.012). ConclusionCombining prostate MRI with NCCN risk classification improves the prediction value of BCR following radical prostatectomy for localized prostate cancer.

Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer.

Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.

Мультидисциплинарный подход в лечении рецидива рака прямой кишки с вовлечением мочевых путей

Aim. To evaluate immediate and long-term oncological results ofsurgical treatment of recurrent rectal cancer involving the urinary tractsystem to show the need for a multidisciplinary treatment approach for locally advanced recurrent rectal cancer. Material and methods. Retrospective cohort analysis with prospective supported database. Analyzed 14 cases: all patients with locally advanced rectal cancer recurrence involving urinary tract system were operated at the Clinic of Coloproctology and Minimally Invasive Surgery in 2013-2022. Results. The age of the patients was 51.6 ± 13.0 years, 6 men, 8 women. The greatest recurrence number was (88%) finded in group of primary colorectal cancer of the lower and middle parts of the rectum. In 57.2% observations patients received preoperative chemotherapy or combination with radiotherapy. Approximately 64% of primary operations were performed using an open approach. Recurrence of CRC with pT3-T4 invasion was diagnosed in 72% of cases. Metastatic damage of lymphatic nodes after primary surgery were identified in 57.2% of cases. In 2 observations primary surgery was performed with R2 resection margin, relapse in that cases was detected after 11 and 13 months. One histopathological report indicated R1 resection, relapse noted after 6 months. Adjuvant chemotherapy was performed in 10 cases (71.4%), in two cases (14.3%) – postoperative radiation therapy. Average time for recurrence detecting after primary operation was 16.5 [12-28] months. Advanced combined interventions including recurrence removal with colon resection, gynecological and urological stages (RR+CR+GR+UR) amounted to 36%, recurrence removal with resection colon and urological stage (RR+CR+UR) was performed in 43% of cases, recurrence removal without the colonic stage (RR+GR+UR and RR+UR) - 3 (21%) patients. Reconstructive surgery to restore urine derivation were performed in 12 (85.7%) cases. The average duration of the procedures was 412.5[205-490] minutes, intraoperative blood loss - 275 [150-400] ml. Early postoperative complications are classified as Clavien-Dindo III. One patient with SIRS was classified as a complication Clavien-Dindo IV. The duration of the postoperative period was 25.5 [14-30] days. Postoperative mortality was 0%. According pathohistological examination R1 resection was detected in 3 (21.4%) cases. Adjuvant chemotherapy was performed 8 (57.1%) patients, in 1 case (7.1%) combination with a course of radiotherapy. During the period 24 months after surgery the mortality rate was 14.3%, repeated relapses diagnosed in 3 (21.4%) patients, one was reoperated. Distant metastases was noted in 4 (28.6%) patients, of which in 1 case with repeated recurrence. Discussion. Our urogenital bacterial diversity analysisshowed that human testicular tissue is not a microbiologically sterile environment and also presented new data associated with testicular tissue and its possible relations with male infertility. Conclusion. The main treatment method for locally advanced rectal cancer recurrence involving the urinary tract system is surgical. Multidisciplinary approach with the involvement in the surgical team urologist oncologist made it possible to perform a one-stage radical intervention for locally advanced recurrence of rectal cancer with restoration of derivation urine without the need for subsequent reconstructive procedures on the urinary system. Keywords: rectal cancer, urinary tract, multidisciplinary approach, surgical treatment, recurrence.

Tolerability and Outcomes for Treatment of Older Myxoid Liposarcoma Population.

Myxoid liposarcoma predominantly affects young and middle-aged individuals, and little is known regarding treatment tolerability and outcomes in older patients. This study aims to better understand this older patient population. This single institution retrospective study included patients aged 70 years and older with localized (non-metastatic) myxoid liposarcoma. Sixteen patients were included. The median age was 75 years, and 9 (56%) were female. Fourteen (88%) were extremity tumors and two (12%) were trunk. The median tumor size was 10.4 cm (range, 3.6 to 28 cm). Five (31%) tumors had a round cell component. All patients had surgery. Fourteen (88%) had perioperative radiation, and three (19%) had perioperative chemotherapy. One patient had postoperative infection, and one patient had neutropenic fever from preoperative chemotherapy. The median follow up from surgery was 6.3 years. Eight (50%) patients died from MLPS. The median relapse-free survival and overall survival were 34 months and 75 months, respectively. Most older patients with localized MLPS received perioperative radiation therapy with surgery, and few serious toxicities were reported. Even with treatment, half of the patients relapsed.

Tumor-infiltrating immune cell profiles and changes associate with additional trastuzumab in preoperative chemotherapy for patients with HER2-positive gastric cancer

BackgroundHER2(+) gastric cancer (GC) can benefit from trastuzumab. However, the impact of additional trastuzumab in preoperative treatment on immune cells remains largely unknown.MethodsIn cohort I, immune cells were detected by immunohistochemistry in 1321 patients. Then 88 HER2(+) patients received preoperative therapy were collected as cohort II. Immune cell profiles and changes were analyzed in paired pre- and post-operative specimens using multiple immunohistochemistry staining.ResultsIn the treatment-naive GC patients (n = 1002), CD3+ and CD8+ T cell infiltration was significantly lower in the HER2(+) GC patients together with higher FoxP3+ T cells compared with HER2(−). However, FoxP3+ T and CD20+ B cell infiltration was significantly higher in HER2(+) GC after neoadjuvant chemotherapy (n = 319). The trastuzumab-exposed group had higher CD8+ T and lower FoxP3+ T cell infiltration and CD8+ T cell was even more significant in responders. Additionally, tertiary lymphoid structure (TLS) density increased in invasion margin of residual tumors. Patients with lower TLS in the tumor core or lower FoxP3+ T cells had better overall survival in the trastuzumab-exposed group.ConclusionAddition of trastuzumab modulates the immune microenvironment, suggesting the potential mechanism of the favorable outcome of anti-HER2 therapy and providing a theoretical rationale for the combinational immunotherapy in resectable HER2(+) GC patients.

Oncological outcomes in patients with residual triple-negative breast cancer after preoperative chemotherapy.

This study aimed to evaluate the clinical outcomes and prognostic implications of regional nodal irradiation (RNI) after neoadjuvant chemotherapy (NAC) in patients with residual triple-negative breast cancer (TNBC). We analyzed 152 patients with residual TNBC who underwent breast-conserving surgery after NAC between December 2008 and December 2017. Most patients (n = 133; 87.5%) received taxane-based chemotherapy. Adjuvant radiotherapy (RT) was administered at a total dose of 45-65 Gy in 15-30 fractions to the whole breast, with some patients also receiving RT to regional nodes. Survival was calculated using the Kaplan-Meier method, and prognostic factors influencing survival were analyzed using the Cox proportional-hazards model. During a median follow-up of 66 months (range, 9 to 179 months), the 5-year disease-free survival (DFS) rate was 68.0%. The 5-year locoregional recurrence-free survival, distant metastasis-free survival, and overall survival rates were 83.6%, 72.6%, and 78.7%, respectively. In the univariate analysis, the cN stage, ypT stage, ypN stage, axillary operation type, and RT field were associated with DFS. Multivariate analysis revealed that higher ypT stage (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.00-3.82; p = 0.049) and ypN stage (HR = 4.7; 95% CI 1.57-14.24; p = 0.006) were associated with inferior DFS. Among clinically node-positive patients, those who received RT to the breast only had a 5-year DFS of 73.7%, whereas those who received RNI achieved a DFS of 59.6% (p = 0.164). There were no differences between the DFS and RNI. In patients with residual TNBC, higher ypT and ypN stages were associated with poorer outcomes after NAC. RNI did not appear to improve DFS. More intensive treatments incorporating systemic therapy and RT should be considered for these patients.

Inspiratory Muscle Training Before Esophagectomy Increases Diaphragmatic Excursion: A Randomized Controlled Trial.

Inspiratory muscle training (IMT) has preventive effects against postoperative pulmonary complications (PPCs) after upper abdominal surgery. However, its impact on diaphragmatic function has not been evaluated. This study investigated the effect of preoperative IMT on diaphragmatic excursion (DE) and prevention of PPCs for patients with esophageal cancer. This study was an unblinded, parallel, randomized controlled trial. Patients with thoracic or abdominal esophageal cancer scheduled for esophagectomy were randomized into the incentive spirometry (IS) or IMT group. During preoperative neoadjuvant chemotherapy, IS or IMT intervention was performed. The inspiratory resistance of the IMT group was consistently set at 50% maximal inspiratory pressure. The primary outcome was the amount of change in DE evaluated with ultrasonography, and the secondary outcome was the incidence of Clavien-Dindo grade II or higher PPCs. This study recruited 42 patients. Among these patients 21 were randomized into the IS or IMT group, and 2 patients dropped out from the study. Finally, 40 patients were included in this analysis. The DE of the IMT group increased significantly after the intervention. The IMT group had significantly larger DE changes than the IS group. Of the 39 patients analyzed for postoperative outcome, 5 experienced gradeII PPCs. The IMT group had a lower incidence of PPCs than the IS group. Patients with thoracic and abdominal esophageal cancer scheduled for surgery who had preoperative IMT have increased DE, which may have an important role in prevention of PPCs.

Histopathological response to chemotherapy and survival of mucinous type gastric cancer.

Data on the clinicopathological characteristics of mucinous gastric cancer (muc-GC) are limited. This study compares the clinical outcome and response to chemotherapy between patients with resectable muc-GC, intestinal (int-GC) and diffuse (dif-GC) gastric cancer. Patients from the D1/D2 study or the CRITICS trial were included in exploratory surgery-alone (SAtest) or chemotherapy test (CTtest) cohorts. Real-world data from the Netherlands Cancer Registry on patients treated between with surgery-alone (SAvalidation), and receiving preoperative chemotherapy with or without postoperative treatment (CTvalidation) were used for validation. Histopathological subtypes were extracted from pathology reports filed in the Dutch Pathology Registry and correlated with tumor regression grade (TRG) and relative survival (RS). In SAtest (n = 549) and SAvalidation (n = 8062) cohorts, muc-GC patients had a five-year RS of 39% and 31%, similar to or slightly better than dif-GC (43% and 29%, p = .52 and p = .011), but worse than int-GC (55% and 42%, p = .11 and p < .001). In CTtest (n = 651) and CTvalidation (n = 2889) cohorts, muc-GC showed favorable TRG (38% and 44% (near-)complete response) compared to int-GC (26% and 35%) and dif-GC (10% and 28%, p < .001 and p = .005). The 5-year RS in CTtest and CTvalidation cohorts for muc-GC (53% and 48%) and int-GC (58% and 59%) was significantly better compared to dif-GC (35% and 38%, p = .004 and p < .001). Recognizing and incorporating muc-GC into treatment decision-making of resectable GC can lead to more personalized and effective approaches, given its favorable response to preoperative chemotherapy in relation to int-GC and dif-GC and its favorable prognostic outcomes in relation to dif-GC.

RAS mutation associated with short surgically controllable period in colorectal liver metastases: a retrospective study

BackgroundThe prognostic implications of the RAS status in colorectal cancer liver metastasis (CRLM) remain unclear. This study investigated the prognostic significance of RAS status after curative hepatectomy, focusing on surgical controllability.MethodsThis retrospective study included liver-only CRLM patients who underwent the first hepatectomy between 2015 and 2022 at the National Cancer Center Hospital. Recurrence-free survival (RFS), surgically controllable period (SCP), and overall survival (OS) were compared between RAS wild-type (RAS-wt) and mutant (RAS-mt) patients. Multivariate analyses were conducted to identify independent prognostic factors for each outcome and independent risk factors for less than 1 year SCP.ResultsA total of 150 patients were evaluated, comprising 63 patients with RAS-mt status. There was no significant difference in RFS between RAS-mt and RAS-wt (7.00 vs. 8.03 months, p = 0.48). RAS-mt patients exhibited worse SCP (11.80 vs.21.13 months, p < 0.001) and OS (44.03 vs. 70.03 months, p < 0.001) compared to RAS-wt. Multivariate analysis identified RAS-mt as an independent prognostic factor for both OS (hazard ratio [HR]: 3.37, p < 0.001) and SCP (HR: 2.20, p < 0.001), and as an independent risk factor for less than 1 year of SCP (odds ratio, 2.31; p = 0.03).ConclusionsCRLM with RAS mutations should be considered for strict surgical indications with preoperative chemotherapy and thorough examination, considering the possibility of short SCP.

Rhabdomyosarcoma of the Biliary Tract in Children: Analysis of Single Center Experience.

Rhabdomyosarcoma (RMS) of the biliary tract is a rare tumor in children, constituting 0.5-0.8% of all pediatric RMS. Still, it is the most common malignancy in this location in children. Due to its rarity and location, it may cause diagnostic and treatment difficulties. Above all, there are no therapeutic guidelines specific for this tumor location. The aim of the study was to present an analysis of our experience with the treatment of children with biliary tract rhabdomyosarcoma (RMS) and discuss clinical recommendations for this specific location published in the literature. A retrospective analysis of medical records of eight children with biliary tree RMS treated in one center between 1996-2022 was performed. Records of eight children, five boys and three girls aged 2 yrs 6 mo to 16 yrs 9 mo (median-6 yrs) were analyzed. All patients presented with jaundice as the first symptom. In two patients, initial diagnosis of a tumor was established. For the remaining six, the primary diagnoses were as follows: choledochal cyst-one, malformation of the biliary ducts-one, choledocholithiasis-one, cholangitis-three. In four patients, the extrahepatic bile ducts were involved; in four patients, both the intrahepatic and extrahepatic bile ducts were involved. Embryonal RMS was diagnosed in seven patients (three botryoides type). Alveolar RMS was found in one patient. Biopsy (three surgical, four during endoscopic retrograde cholangiopancreatography (ERCP)) was performed in seven patients. One child underwent primary partial tumor resection (R2). Seven patients received neoadjuvant chemotherapy, followed by delayed resection in five, including liver transplantation in one (five were R0). Two patients did not undergo surgery. Radiotherapy was administered in four patients (two in first-line treatment, two at relapse/progression). Six patients (75%) are alive with no evidence of disease, with follow-up ranging from 1.2 yrs to 27 yrs (median 11 yrs. and 4 mo.). Two patients died from disease, 2 y 9 mo and 3 y 7 mo from diagnosis. Children presenting with obstructive jaundice should be evaluated for biliary tract RMS. The treatment strategy should include biopsy and preoperative chemotherapy, followed by tumor resection and radiotherapy for residual disease and in case of relapse.

Ultra-radical surgery versus standard-radical surgery for the primary cytoreduction of advanced epithelial ovarian cancer; long-term tertiary center experiences

ObjectiveTo compare overall survival (OS) and morbidity outcomes in patients with advanced epithelial ovarian/tubal/peritoneal cancer undergoing standard-radical (SR) and ultra-radical (UR) surgical procedures based on NICE classification. Study DesignThis retrospective study analyzed data from 282 patients with 2014 FIGO stage III-IV epithelial ovarian cancer operated on between January 2006 and January 2019. The study compared OS, progression-free survival (PFS), and morbidity between SR and UR surgeries. Parameters influencing OS, including preoperative, postoperative, and post-adjuvant chemotherapy CA-125 values, surgical procedures, post-surgical residual tumor, histopathological grade, and FIGO surgical stage, were assessed. ResultsOut of 282 patients, 256 met the inclusion criteria. SR surgery was performed in 48 %, and UR surgery in 52 %. The mean preoperative CA-125 value was 1200 ± 1914.83, decreasing to 240.32 ± 373.87 postoperatively. The mean follow-up period was 63.01 ± 47.56 months. UR surgery correlated with significantly higher postoperative complications (p < 0.001), histopathological grade (p = 0.023), FIGO stage (p < 0.001), three-year death rates, and overall mortality rates (p = 0.035). FIGO stage and total metastatic lymph nodes emerged as independent prognostic factors for overall and PFS. ConclusionIn the treatment of epithelial ovarian cancer, evaluating the extent of the tumor before the surgery and showing maximal effort to minimize the residual tumor volume instead of applying UR procedures as the first choice seems to be the most important factor that can affect survival.

TUMOR IN HORSESHOE KIDNEYS: A CASE REPORT AND LITERATURE REVIEW

Objective: This study aims to report a renal tumor in a horseshoe kidney successfully treated with an open left nephrectomy. Case(s) Presentation: A 3 years old girl with a lump in the left abdomen and intermittent hematuria was referred to our hospital. Whole abdominal contrast CT scan showed the presence of a left renal mass in a horseshoe kidney that infiltrates the left renal artery and is attached to the spleen. The patient underwent preoperative chemotherapy followed by surgical resection. Discussion: In a horseshoe kidney, renal tumors are uncommon. The limited kidney mobilization and access to the renal hilum and the abnormal and highly variable vasculature make surgical treatment of a tumor in a horseshoe kidney extremely difficult. Conclusion: Open surgery continues to be the treatment of choice for horseshoe kidney tumors due to their anatomical complexity, particularly in cases where the tumor is difficult to eradicate. Keywords: Renal tumor, horseshoe kidney, surgical management.

205. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH TOTAL MEDIASTINAL LYMPHADENECTOMY FOR THORACIC ESOPHAGEAL CANCER: SHORT- AND LONG-TERM OUTCOMES IN 139 PATIENTS

Abstract Background The McKeown approach is a standard surgery for thoracic esophageal cancer in Japan, as lymph node dissection of upper mediastinum and neck is mandatory. The thoracoscopic approach allows access to the lymph node chain along the laryngeal nerves from the chest and led us to introduce minimally invasive Ivor Lewis esophagectomy (MIILE) with radical lymphadenectomy for middle and lower esophageal cancer. Although circular-stapled anastomosis is popular in MIILE, the frequency of anastomotic complications has been reported to be high. We introduced MIILE with linear-stapled anastomosis in 2010. Methods To evaluate the short- and long-term outcomes of MIILE with radial lymphadenectomy and linear stapled anastomosis, we performed a retrospective cohort study of 139 consecutive patients. The endpoints included overall complications, anastomotic leak rate, nutritional status at 12 months after MIILE, and 5-year overall survival, and disease-free survival. Surgical Procedure After laparoscopic gastric tube construction, thoracoscopic or robotic esophagectomy with total mediastinal lymphadenectomy was done in the prone position. ICG angiography was used to assess gastric tube viability and sacrifice the ischemic portion in recent cases. Esophago-gastric anastomosis was performed using a linear stapler. The opening was closed with interrupted sutures and covered with the omentum to secure the anastomosis. Results There was 122 male and 17 female patients with median age of 69 years. Preoperative diagnosis was stage I/II/III/IV in 44/46/37/12 patients. Pathology results were SCC in 108 cases. Tumor location was middle/lower/EGJ in 58/64/17 patients. Preoperative chemotherapy or CRT was administered in 77 patients. Median thoracic surgery time was 297 minutes and blood loss was 53 mL. Median hospital stay was 17 days. The short-term complication rate of grade IIIa or higher was 8.7%. Anastomotic leak occurred in 8 patients (5.8%), three of whom required intervention. No leakage occurred after introduction of intraoperative ICG angiography. 90-day mortality was 0.7%. With a median follow-up of 41 months, 5-year overall survival rate was 68.3% and disease-free survival rates was 56.7%. For the 65 SCC patients with clinical stage II/III disease, 5-year OS rate was 58.7%. During follow-up period, 2 patients (1.4%) required balloon dilatation due to anastomotic stenosis. At 12 months after MIILE, the mean weight loss was 11.6% and the mean albumin level was 3.9. Discussion Compared to benchmark complication rates reported by the international Esophagectomy Complication Consensus Group (ECCG), the overall complication rate (47% vs. 59%) was not significantly lower, but the anastomotic leak rate was significantly lower (5.8 vs. 11.4%). Overall survival, disease-free survival, and nutritional outcomes were similar to those reported in Japanese clinical trials. Conclusions MIILE with linear-stapled anastomosis is a safe procedure with a low rate of serious complications. Survival and nutritional outcomes were excellent. It may be recommended as a standard procedure for lower and middle esophageal cancer. https://www.dropbox.com/scl/fi/z6zyllnmie9qh3zhz2wd5/Okabe_ISDE.wmv?rlkey=4mig28fv5z2vhaui31tbk0mr9&amp;dl=0

Survival benefit of adjuvant chemotherapy based on molecular residual disease detection in resected colorectal liver metastases: subgroup analysis from CIRCULATE-Japan GALAXY

The prognostic role of circulating-tumor DNA (ctDNA)-based molecular residual disease (MRD) detection and its utility for postsurgical risk-stratification has been reported in colorectal cancer. In this study, we explored the use of ctDNA-based MRD detection in patients with colorectal liver metastases (CLM), for whom the survival benefit of adjuvant chemotherapy (ACT) after surgical resection remains unclear. Patients with CLM without extrahepatic disease from GALAXY study (UMIN000039205) were included. The disease-free survival (DFS) benefit of ACT was evaluated in MRD-positive and -negative groups after adjusting for age, gender, number and size of liver metastases, RAS status, and previous history of oxaliplatin for primary cancer. ctDNA was detected using a personalized, tumor-informed 16-plex mPCR-NGS assay. ctDNA-based MRD status was evaluated 2 to 10 weeks after curative surgery, before the start of ACT. Among 6,061 patients registered in GALAXY, 190 surgically resected CLM patients without any preoperative chemotherapy were included with a median follow-up of 24 (1-48) months. ctDNA positivity in the MRD window was 32.1% (61/190). ACT was administered to 25.1% (48/190) of patients. In the MRD-positive group, 24-month DFS was higher for patients treated with ACT (33.3% vs. not reached, adjusted HR: 0.07, P <0.0001); whereas no benefit of ACT was seen in the MRD-negative group (24-month DFS: 72.3% vs. 62.2%, adjusted HR: 0.68, P =0.371). Multivariate analysis showed that the size of liver metastases (HR: 3.94, P =0.031) was prognostic of DFS in the MRD-positive group. However, in the MRD-negative group, none of the clinicopathological factors were prognostic of DFS. Our data suggest that ACT may offer notable clinical benefits in MRD-positive patients with CLM. MRD status-based risk-stratification could be potentially incorporated in future clinical trials for CLM.

577. OUTCOMES OF SIMULTANEOUS RESECTION AND RECONSTRUCTION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA SYNCHRONOUSLY ASSOCIATED WITH HEAD AND NECK CANCER

Abstract In 1953, a study by Slaughter et al. on oral cancer proposed that field cancerization is the phenomenon of widespread carcinogenesis across multiple regions due to long-term exposure to common cancer-causing factors. Esophageal squamous cell carcinoma (ESCC) and head and neck cancer (HNC) share common risks, such as smoking and alcohol consumption, and are often observed synchronously. Therefore, treatment strategies based on tumor stages are important. In our hospital, for synchronous HNC and thoracic ESCC, local resection is indicated if the HNC is ≤T2, and resection with reconstruction is indicated if the HNC is ≥T3, and a one-stage operation for thoracic ESCC and HNC was generally performed. Here, we examined treatment strategies based on the results of simultaneous resection and reconstruction of synchronous thoracic ESCC and HNC in our hospital. A total of 174 patients with esophageal cancer underwent surgery at our hospital between January 2008 and December 2023. Among them, 16 (9%) had 18 lesions of synchronous HNC and nine patients (5%) underwent simultaneous resection and reconstruction. Patients with thoracic ESCC had Ut/Mt/Lt; 1/6/2; T-factor, T1/2/3; 5/2/2; N-factor, N0/1:6/3; and clinical stage, stage I/II; 2/6. For synchronous HNC, hypopharyngeal/oropharyngeal/laryngeal/cervical esophageal cancer; 5/2/1/2; T factor was T2/3/4; 1/6/3; N factor was N0/1/2c/3a/3b; 4/2/2/2/1/1; and clinical stage was stage II/III/IV; 1/5/4. Six patients underwent surgery after preoperative chemotherapy or chemoradiotherapy. Total pharyngo-laryngo-esophagectomy (TPLE) was performed using a thoracoscopic transthoracic approach in six patients, transhiatal approach in two, and mediastinoscopic approach in one. Regarding reconstruction, a gastric tube was used in nine patients, including eight patients in whom it was interposed with the free jejunal autograft. The median operative time was 929 min (590–1248 min) and median blood loss was 622 mL (213–1764 mL). Only patients with skin valve necrosis underwent reoperation; however, there were no hospital deaths, and the median postoperative hospital stay was 39 days (28–59 days). Recurrence was observed in four cases. All cases were considered to be due to HNC, and three were stage IV cases with advanced lymph node metastasis. Simultaneous resection and reconstruction for synchronous HNC and the thoracic esophagus is a highly invasive treatment that can be performed safely. Recurrence has been observed in advanced cases of HNC, and further development of multidisciplinary treatment, including preoperative chemotherapy, is necessary.

245. ESOPHAGECTOMY AFTER NEOADJUVANT CHEMOTHERAPY WITH AN INDICATION FOR CONVERSION SURGERY FOR HIGHLY ADVANCED ESOPHAGOGASTRIC JUNCTION ADENOCARCINOMA

Abstract Background There is currently no strong evidence for preoperative chemotherapy for advanced esophagogastric junction adenocarcinoma. Furthermore, no curative treatment strategy has been established for advanced junction adenocarcinoma, including Stage IV disease, with no indication for conversion surgery. Subjects and Methods In this study, we retrospectively reviewed nine patients with highly advanced esophagogastric junctional adenocarcinoma, including Stage IV adenocarcinoma, who underwent systemic chemotherapy followed by planned resection at our hospital. Results The participants included 6 males and 3 females, with median age of 64 (range: 45–72) years. Pretreatment stages III, IVA, and IVB, categorized based on UICC TNM classification (esophageal adenocarcinoma), were observed in 1, 4, and 4 cases, respectively, with 1 case of (#104) subclavian lymph node metastases, 1 case of (#16) abdominal para-aortic lymph node metastases, and 2 cases of liver metastases, including multiple lesions. All patients received S-1 plus oxaliplatin (SOX) therapy as preoperative chemotherapy (2–40 courses). Although we observed one patient with unresectable abdomen malingnancies, the others underwent R0 resection, six underwent esophagectomy (with three total gastrectomy and one liver resection), and two open (+ continuous right thoracotomy) lower esophagectomy + total gastrectomy. Pathological stages I, II, III, and IV were observed in two, one, four, and one patients, respectively. Postoperatively, stereotactic irradiation, chemotherapy, and immune checkpoint inhibitors were administered to the patients to treat recurrent brain and liver metastases, and the 1-year survival rate was found to be 71.4% with a median observation period of 17 (range: 0–61) months. Among them, downstage and pN0 cases were relatively promising. Conclusion Even in highly advanced cases, cases with promising prognoses with multidisciplinary treatment, including surgery, were observed. We hope that large-scale clinical trials, such as JCOG2203, will help clarifying the significance of this approach, and advancements in chemotherapy regimens are expected.

412. COMPARISON BETWEEN PREOPERATIVE MALNUTRITION, AND SARCOPENIA AND POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS

Abstract Background Typical indicators of malnutrition in cancer patients include BMI, CONUT, PNI, and prealbumin, while SMI and PMI are often used as indicators of skeletal muscle mass loss (sarcopenia). Although these indicators have been reported to be associated with surgical outcomes, their combination may be useful in determining the effectiveness of perioperative management because these are closely related during the perioperative period. Methods A total of 132 esophageal cancer patients who underwent esophagectomy between January 2021 and May 2023 were included in this study. Preoperative BMI, CONUT, PNI, prealbumin, SMI (measured by BIA), and PMI (measured by CT imaging) were extracted from clinical record. We also selected BMI and SMI as a new indicator for combined malnutrition and loss of skeletal muscle. Then, we investigated the association between these indicator and postoperative complications (pneumonia, suture failure, total CD Grade ≥II, total CD ≥IIIa), and length of hospital stay. Results The mean age of patients was 67.3 years, 107 were male and 25 were female. Preoperative chemotherapy was administered to 58 patients. Although associations with each single index were found for postoperative pneumonia and low BMI, low SMI, and low PMI, there was no significant association with anastomotic leakage or overall complications. On the other hand, low BMI+SMI was strongly correlated with postoperative pneumonia, overall Grade≥II, and Grade≥IIIa complications. In postoperative hospital stay, low BMI, low PNI, and low SMI as single indicators showed a significant increase in hospital stay, while low BMI+SMI showed further statistically significant increase. Conclusion In patients who underwent esophagectomy, single index for malnutrition and low skeletal muscle mass may be predictors of postoperative complications respectively. However, because perioperative management is inseparable from nutritional therapy and exercise therapy, composite index of BMI and SMI may be better predictor of therapeutic efficacy of perioperative nutrition and exercise therapy.