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Mo1634 Rural Disparities in Esophageal Cancer Outcomes Based on Distance From Endoscopic Ultrasound (EUS)-Trained Gastroenterologists
Mo1633
for each county using 1991-2010 data from the Illinois State Cancer Registry. Age-adjusted mortality rates were calculated using SEER*STAT. Choropleth maps were created to illustrate Mortality-Incidence Ratios (MIRs) by Illinois county using ArcGIS. Mean GI density for each county was calculated from the US Area Health Resource File. Unique providers who perform EUS were identified and their locations geocoded for spatial analysis to calculate the shortest driving distance from each county centroid to the nearest EUS provider. USDA Economic Research Service rural-urban continuum codes (RUCC) and US census percent rurality data were used to designate county rurality and adjacency to metro counties. US Census Bureau county-based education, health insurance, income, and poverty data were used to determine socioeconomic deprivation levels. Chi-square, t-test, ANOVA, and Spearman's rho calculations were performed. Results: Access to GIs within a county was significantly influenced by county-level predictors including rurality, income, and educational status (p<0.05). No GIs were located in 65 out of 102 Illinois counties (64%) during the time interval analyzed, with a mean density of 1.0 per 100,000. There was a trend toward greater esophageal cancer incidence with increasing GI density (Spearman's rho=0.19; p=0.06). Median driving distance to the closest EUS provider was 28 miles in metro counties (n=36), 54 miles in rural counties adjacent to metro counties (n=33), and 98 miles in rural counties non-adjacent to metro counties (n=33; p<0.001). Distance to EUS-trained providers significantly correlated with both rurality and socioeconomic deprivation (p<0.001). Esophageal cancer MIR was positively correlated with RUCC (Spearman's rho=0.28; p=0.01) and EUS-provider distance (Spearman's rho=0.26; p=0.02). Conclusions: Higher MIR for esophageal cancer was observed in rural regions and was correlated with distance from EUS-trained providers. Outcomes may be influenced by the availability of specialist gastroenterologists, which may be a surrogate for a higher level of care. Further exploration of the impact of distance from high volume cancer centers and surgeons on rural cancer outcomes is warranted.
Sarcopenia Does Not Impact Morbidity or Survival in Patients With Resectable Esophageal Adenocarcinoma G Paul Wright, Jill K. Onesti, Chirag Patel, Andrea M. Wolf, Mathew H. Chung Introduction: Sarcopenia has been identified as a potential predictive variable for outcomes in selective surgical procedures and disease processes. The benefit of using sarcopenia for such purposes in oncologic surgery remains unclear. Methods: A retrospective review was conducted for all patients undergoing resection of esophageal adenocarcinoma with intention for cure at a single institution from 2006-2012. Lean psoas muscle area (LPMA) and LMPA/ BMI were calculated at the level of the L4 vertebral body using preoperative computed tomography correcting for muscle density. Patients were analyzed in tertiles based on these measurements. The primary outcome measures were anastomotic leak, 90-day morbidity (Clavien grade ≥ 3), and long-term overall survival. Multivariate analyses were performed for the primary outcome measures. A p value < 0.05 was considered significant. Results: One hundred six consecutive patients were identified and 100 patients had preoperative CT scans available for review. The mean patient age was 63±11 and 62% underwent neoadjuvant therapy. All surgical procedures were performed open and approaches included transhiatal (76%), Ivor-Lewis (11%), and three-field (13%) esophagectomy. The anastomotic leak rate was 10% and 90-day morbidity rate was 38%. Neither LPMA nor LPMA/BMI were significant predictors of anastomotic leak (LMPA - p=0.503; LPMA/BMI - p=0.268) or morbidity (LPMA - p=0.787; LPMA/BMI - p=0.528). Median overall survival was 2.8 years. Tertiles for LPMA (p=0.210) and LPMA/BMI (p=0.409) were not predictive of long-term survival (Fig. 1,2). Conclusion: Sarcopenia is not predictive of short term outcomes or longterm overall survival following esophagectomy for esophageal adenocarcinoma.
SSAT Abstracts
Fig 1. Overall Survival by LPMA tertile (first = lowest)
Choropleth map demonstrating Esophageal Cancer Mortality-Incidence Ratio (MIR) and Rurality by Illinois County. Unique providers with capabilities of performing Endoscopic Ultrasound (n=28) are designated as [H]. Twenty out of 23 (87%) Illinois counties with MIR greater than 1.02 were rural. Mo1635 Lymph-Node Dissection Along the Left Recurrent Laryngeal Nerve After Esophageal Stripping in VATS-E (Video-Assisted Thoracoscopic Surgery of Esophagus) and Safe Anastomotic Technique Hiroshi Makino, Hiroshi Yoshida, Hiroshi Maruyama, Eiji Uchida, Ichiro Akagi, Masao Miyashita
Fig 2. Overall Survival by LPMA/BMI tertiles (first=lowest)
Introduction Video assisted thoracoscopic surgery of the esophagus (VATS-E) in prone position is available because the lung moves below by the gravity, and a good operative field is obtained. A clear operative view of the middle and lower mediastinum has been obtained; however, the working space in the upper mediastinum is limited and lymph-node dissection along the left recurrent laryngeal nerve is difficult in prone position. We report to overcome the problem by our technique and safe anastomosis. Patients Eighty four patients (27 in left lateral and 57 in prone position), with esophageal squamous cell carcinomas underwent VATS-E, respectively. Methods (1) Lymph node dissection along the lt. recurrent laryngeal nerve At first the patients are fixed at semi-prone position because both prone and left lateral positions can be set by rotating. Three 5 mm ports and two 10 mm ports are used at the 3rd, 7th, 9th and 5 th, 7th intercostal space (ICS). The pneumothorax by maintaining CO2 insufflation pressure of 6 mmHg is made, and esophagectomy is performed in prone position. In the case of thoracotomy the patient will be rotated to the left lateral
Mo1634 Rural Disparities in Esophageal Cancer Outcomes Based on Distance From Endoscopic Ultrasound (EUS)-Trained Gastroenterologists James Regan, Whitney Zahnd, Bridget Kistner, Aman Ali, John D. Mellinger, Sabha Ganai Background: While centralization of esophagectomy has been advocated based on strong relationships of hospital and surgeon volume to mortality, rural disparities have not been explored for esophageal cancer outcomes. Opportunities are recognized for improvement in global systems related to esophageal cancer care including appropriate referral for surgical resection. This study explores the impact of rurality, gastroenterologist (GI) density and proximity to Endoscopic Ultrasound (EUS)-performing providers on outcomes for esophageal cancer in Illinois. Methods: Age-adjusted esophageal cancer incidence rates were calculated
S-1157
SSAT Abstracts
for each county using 1991-2010 data from the Illinois State Cancer Registry. Age-adjusted mortality rates were calculated using SEER*STAT. Choropleth maps were created to illustrate Mortality-Incidence Ratios (MIRs) by Illinois county using ArcGIS. Mean GI density for each county was calculated from the US Area Health Resource File. Unique providers who perform EUS were identified and their locations geocoded for spatial analysis to calculate the shortest driving distance from each county centroid to the nearest EUS provider. USDA Economic Research Service rural-urban continuum codes (RUCC) and US census percent rurality data were used to designate county rurality and adjacency to metro counties. US Census Bureau county-based education, health insurance, income, and poverty data were used to determine socioeconomic deprivation levels. Chi-square, t-test, ANOVA, and Spearman's rho calculations were performed. Results: Access to GIs within a county was significantly influenced by county-level predictors including rurality, income, and educational status (p<0.05). No GIs were located in 65 out of 102 Illinois counties (64%) during the time interval analyzed, with a mean density of 1.0 per 100,000. There was a trend toward greater esophageal cancer incidence with increasing GI density (Spearman's rho=0.19; p=0.06). Median driving distance to the closest EUS provider was 28 miles in metro counties (n=36), 54 miles in rural counties adjacent to metro counties (n=33), and 98 miles in rural counties non-adjacent to metro counties (n=33; p<0.001). Distance to EUS-trained providers significantly correlated with both rurality and socioeconomic deprivation (p<0.001). Esophageal cancer MIR was positively correlated with RUCC (Spearman's rho=0.28; p=0.01) and EUS-provider distance (Spearman's rho=0.26; p=0.02). Conclusions: Higher MIR for esophageal cancer was observed in rural regions and was correlated with distance from EUS-trained providers. Outcomes may be influenced by the availability of specialist gastroenterologists, which may be a surrogate for a higher level of care. Further exploration of the impact of distance from high volume cancer centers and surgeons on rural cancer outcomes is warranted.
Sarcopenia Does Not Impact Morbidity or Survival in Patients With Resectable Esophageal Adenocarcinoma G Paul Wright, Jill K. Onesti, Chirag Patel, Andrea M. Wolf, Mathew H. Chung Introduction: Sarcopenia has been identified as a potential predictive variable for outcomes in selective surgical procedures and disease processes. The benefit of using sarcopenia for such purposes in oncologic surgery remains unclear. Methods: A retrospective review was conducted for all patients undergoing resection of esophageal adenocarcinoma with intention for cure at a single institution from 2006-2012. Lean psoas muscle area (LPMA) and LMPA/ BMI were calculated at the level of the L4 vertebral body using preoperative computed tomography correcting for muscle density. Patients were analyzed in tertiles based on these measurements. The primary outcome measures were anastomotic leak, 90-day morbidity (Clavien grade ≥ 3), and long-term overall survival. Multivariate analyses were performed for the primary outcome measures. A p value < 0.05 was considered significant. Results: One hundred six consecutive patients were identified and 100 patients had preoperative CT scans available for review. The mean patient age was 63±11 and 62% underwent neoadjuvant therapy. All surgical procedures were performed open and approaches included transhiatal (76%), Ivor-Lewis (11%), and three-field (13%) esophagectomy. The anastomotic leak rate was 10% and 90-day morbidity rate was 38%. Neither LPMA nor LPMA/BMI were significant predictors of anastomotic leak (LMPA - p=0.503; LPMA/BMI - p=0.268) or morbidity (LPMA - p=0.787; LPMA/BMI - p=0.528). Median overall survival was 2.8 years. Tertiles for LPMA (p=0.210) and LPMA/BMI (p=0.409) were not predictive of long-term survival (Fig. 1,2). Conclusion: Sarcopenia is not predictive of short term outcomes or longterm overall survival following esophagectomy for esophageal adenocarcinoma.
SSAT Abstracts
Fig 1. Overall Survival by LPMA tertile (first = lowest)
Choropleth map demonstrating Esophageal Cancer Mortality-Incidence Ratio (MIR) and Rurality by Illinois County. Unique providers with capabilities of performing Endoscopic Ultrasound (n=28) are designated as [H]. Twenty out of 23 (87%) Illinois counties with MIR greater than 1.02 were rural. Mo1635 Lymph-Node Dissection Along the Left Recurrent Laryngeal Nerve After Esophageal Stripping in VATS-E (Video-Assisted Thoracoscopic Surgery of Esophagus) and Safe Anastomotic Technique Hiroshi Makino, Hiroshi Yoshida, Hiroshi Maruyama, Eiji Uchida, Ichiro Akagi, Masao Miyashita
Fig 2. Overall Survival by LPMA/BMI tertiles (first=lowest)
Introduction Video assisted thoracoscopic surgery of the esophagus (VATS-E) in prone position is available because the lung moves below by the gravity, and a good operative field is obtained. A clear operative view of the middle and lower mediastinum has been obtained; however, the working space in the upper mediastinum is limited and lymph-node dissection along the left recurrent laryngeal nerve is difficult in prone position. We report to overcome the problem by our technique and safe anastomosis. Patients Eighty four patients (27 in left lateral and 57 in prone position), with esophageal squamous cell carcinomas underwent VATS-E, respectively. Methods (1) Lymph node dissection along the lt. recurrent laryngeal nerve At first the patients are fixed at semi-prone position because both prone and left lateral positions can be set by rotating. Three 5 mm ports and two 10 mm ports are used at the 3rd, 7th, 9th and 5 th, 7th intercostal space (ICS). The pneumothorax by maintaining CO2 insufflation pressure of 6 mmHg is made, and esophagectomy is performed in prone position. In the case of thoracotomy the patient will be rotated to the left lateral
Mo1634 Rural Disparities in Esophageal Cancer Outcomes Based on Distance From Endoscopic Ultrasound (EUS)-Trained Gastroenterologists James Regan, Whitney Zahnd, Bridget Kistner, Aman Ali, John D. Mellinger, Sabha Ganai Background: While centralization of esophagectomy has been advocated based on strong relationships of hospital and surgeon volume to mortality, rural disparities have not been explored for esophageal cancer outcomes. Opportunities are recognized for improvement in global systems related to esophageal cancer care including appropriate referral for surgical resection. This study explores the impact of rurality, gastroenterologist (GI) density and proximity to Endoscopic Ultrasound (EUS)-performing providers on outcomes for esophageal cancer in Illinois. Methods: Age-adjusted esophageal cancer incidence rates were calculated
S-1157
SSAT Abstracts