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Su1618 Restaging PET-CT After Neoadjuvant Chemoradiotherapy Can Prevent Non-Curative Surgical Interventions in Esophageal Cancer Patients
18 (24%) for NAR, and 43 (58%) had a negative SI. For atypical symptoms, 6 (14%) had a positive SI for acid reflux, six (14%) had a positive SI for NAR, and 32 (72%) had a negative SI. Conclusion: Combined MII-pH shows that about 2/3rd of patients complaining of symptoms on PPI therapy do not have positive symptom index to either acidic and/or non-acidic reflux while remaining patients can have their symptoms attributable to reflux.
Su1620 Esophageal Cancer in the Young: A Population-Based Analysis of 1,095 Patients Attila Dubecz, Norbert Solymosi, Michael Schweigert, Jeffrey H. Peters, Hubert J. Stein BACKGROUND: Controversy exists about the clinical presentation and prognosis of young patients with gastrointestinal malignancies. The aim of this study was to evaluate populationbased demographics and survival of young patients with esophageal cancer in the United States. METHODS: We identified 1,095 patients under 40 years of age with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2008 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic variables and cancer-related survival were assessed and compared to all patients .40 years old (n= 65,930). Influence of available variables on survival was analyzed with logistic regression. RESULTS: Percentage of young patients with esophageal cancer is less than 2% and is declining since the 1990s. More than fifty percent are diagnosed in metastatic stage. Only 74% of patients with potentially resectable esophageal cancer underwent surgery. Median cancer-related survival (13 months vs. 11months) and five-year survival (22% vs. 18%) was significantly higher than in older patients. Multivariate-analysis identified surgical treatment (OR: 5.046) as the only as independent predictor of 5-year survival. Percentage of non-white patients, distal cancer and adenocarcinoma were significantly higher when compared to all patients. CONCLUSION: Most young patients with esophageal cancer are diagnosed in metastatic stage in the United States. Survival in patients under 40 years of age is better than in older patients. Patients undergoing surgical treatment for locoregional cancer have better survival.
Su1618 Restaging PET-CT After Neoadjuvant Chemoradiotherapy Can Prevent NonCurative Surgical Interventions in Esophageal Cancer Patients Martinus C. Anderegg, Roelof J. Bennink, Hanneke van Laarhoven, Jean H. Klinkenbijl, Maarten C. Hulshof, Jacques J. Bergman, Mark I. van Berge Henegouwen Background: Esophageal cancer is notorious for its rapid dissemination, both locally and to distant sites. Accurate staging at the time of diagnosis is of crucial importance to identify patients eligible for curative treatment. For the vast majority of these patients the preferred strategy consists of neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy. Given the aggressive nature of esophageal tumours, it is conceivable that in a significant portion of patients treated with nCRT, dissemination becomes manifest during this preoperative course (interval metastasis). Since metastatic disease is an absolute contraindication for esophagectomy, we added a post-neoadjuvant therapy PET-CT (restaging PET-CT) to the standard work-up of patients with potentially resectable esophageal carcinoma at initial presentation. Aim: Determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy in identifying patients with interval metastases preoperatively. Methods: From January 2011 until September 2012 all consecutive esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT (median interval 18 days). Staging at initial presentation consisted of endoscopy with biopsy, endoscopic ultrasonography, external ultrasonography of the neck and a thoracoabdominal CT scan. A PET scan was not part of the initial staging. Neoadjuvant therapy consisted of 5 cycles of carboplatin AUC 2, paclitaxel 50 mg/m2 and concurrent radiotherapy (41.4 Gy). If abnormalities on restaging PET-CT were suspect of metastases, histologic proof was acquired. This study was approved by the local ethics committee. Results: During the study period a total number of 280 new esophageal cancer patients were analysed at the outpatient clinic. Of these patients 148 underwent a restaging PETCT. The remaining 132 patients were considered ineligible for curative esophagectomy at initial presentation due to comorbidity, unresectable tumours or distant metastases (94 cases), refused to undergo surgery (12), were operated without nCRT (13) or did not complete nCRT in our centre (13). In 29 patients (19.6%) restaging PET-CT showed abnormalities suspicious for dissemination requiring additional imaging and/or biopsy, resulting in 16 cases of proven interval metastasis (10.8%) and a false-positive rate of 8.8% for restaging PET-CT. Of the patients without proven metastatic disease 116 patients have been operated at this time. In 4 of these 116 cases distant metastases were detected intraoperatively, leading to a false-negative rate of 3.4%. Conclusion: 10.8 percent of esophageal cancer patients develop detectable distant metastases during neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate restaging PET-CT as part of the standard workup of candidates for surgery.
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Background :The association of gastroesophageal reflux disease (GERD) and chronic pulmonary disorders has been a topic of great interest recently. However, little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). This study aims to evaluate in patients with COPD: (a) the prevalence and the sensitivity of symptoms to diagnose GERD; (b) the pattern of esophageal motility; and (c) the prevalence of distal and proximal GERD. Methods: A total of 50 patients with DPOC (as defined by age . 40 years with a FEV1/FVC below 88% of the predicted value after bronchodilator use, and no prior history of asthma) underwent symptomatic assessment, high-resolution manometry and dual probe esophageal pH monitoring. GERD was defined by a DeMeester score .14.7. Proximal reflux was defined by .= 1 episode of proximal reflux. Results: GERD was present in 21 (42%) of the total patients. GERD symptoms were referred by 20 (40%) patients more than once a month. Symptoms were not predictive of the presence of GERD (sensitivity 71%; specificity 83%). GERD symptoms presence, esophageal manometry and pHmonitoring according to the presence of distal GERD by pHmonitoring results are depicted in table 1. Conclusions: These data show that in patients with DPOC: 1) GERD is present in almost half of the patients; 2) symptoms were insensitive and nonspecific for diagnosing GERD; 3) a defective LES is not more common in patients with GERD leading to the hypothesis that the physiopathology for GERD may be linked to the transthoracic pressure gradient in this population; 4) in 95% of the patients with GERD, acid refluxed into the proximal esophagus. We conclude that patients with DPOC should be screened with pH monitoring for GERD.
Su1619 Conversion of Fundoplication to Roux-en-Y Gastric Bypass: Long-Term Results Daniel B. Leslie, Nikolaus F. Rasmus, Bridget M. Slusarek, Barbara K. Sampson, Henry Buchwald, Sayeed Ikramuddin Introduction: Conversion of Fundoplication to Roux-en-Y gastric bypass (RYGB) results in significant weight loss and resolution of co-morbid illness, especially gastrointestinal reflux disease (GERD). This procedure offers alternative therapy to patients with recalcitrant GERD following a failed fundoplication. To date, very little long-term data exists for this revisional procedure. Materials and Methods: Patients who underwent a conversion of fundoplication (Nissen or other) to RYGB between 2000 and 2011 at our academic medical center were identified. The department's bariatric surgery database was reviewed for weight loss, the presence of GERD symptoms and the use of GERD medications. A reflux and heartburn questionnaire was administered to assess impact on quality of life (GERD-HRQL) scores and to determine postoperative GERD symptoms. Results: Twenty eight patients (female/male = 24/4) underwent laparoscopic (n=17) or open (n=11) surgery by 3 different surgeons and mean weight follow-up (100%) was 3 ½ years. Average preoperative BMI and weight were 43.1 kg/m2 and 119 kg; 3 patients had BMI below 35 kg/m2. Average length of stay was 4 days. Post-revisional BMI, weight, and % excess weight loss were 32.0 kg/m2, 87 kg, and 61%. Resolution of type II diabetes mellitus, hypertension, and hyperlipidemia were noted in 67%, 33%, and 60% of patients, respectively. No major short-term complications occurred and there were no mortalities. At least 13 patients (46%) continued to use daily acid reduction medication treatment, and 7 patients reported ongoing GERD symptoms (25%). Indications for GERD therapy also include nonspecific abdominal pain, pre-RYGB history of Barrett's esophagitis, and documented gastrojejunal ulcer. On a ranked scale of no symptoms (0) to incapacitating symptoms (50), mean GERD-HRQL score was 9.5/ 50 following surgery. Conclusion: Conversion of fundoplication to RYGB is performed on patients with a lower than average BMI than our typical RYGB cohort and experience significant weight loss with improvement in comorbid disease. Complications are similar to larger cohorts of patients undergoing RYGB. Although ongoing therapy for acid reduction is common, improvements in GERD symptoms were noted.
GERD: gastroesophageal reflux disease LES: lower esophageal sphincter Su1622 Celiac Nodal Status As Determined by Laparoscopic Gastric Ischemic Preconditioning Is Prognostic in Locally-Advanced Esophageal Cancer and May Determine Necessity for Completion Esophagectomy Sabha Ganai, Michael B. Ujiki, Mark Talamonti, John G. Linn, Amy K. Yetasook, JoAnn Carbray, Marco Zahedi, Ki Wan Kim, John Howington Introduction: Laparoscopic gastric preconditioning has theoretical benefits of reducing conduit-related morbidity by allowing time for the stomach to adapt and/or demarcate to ischemic insults prior to staged esophagectomy and reconstruction. We hypothesized that focused pathological assessment of celiac lymph nodes during the conditioning interval could predict long-term outcomes after esophagectomy in patients with locally-advanced esophageal cancer. Methods: A single-institutional retrospective review was conducted between 10/2008 and 11/2012, identifying 34 patients with locally-advanced (clinical Stage IIB/III) esophageal cancer who completed staged esophagectomy after laparoscopic preconditioning. Median follow-up was 9 months. Results: Patients were 60±10 years old, 82% male, and had a BMI of 24±5 kg/m2. The median interval from preconditioning to esophagectomy was 7 days (interquartile range, IQR, 7-8). Preoperative staging was performed with EUS in 94% and PET in 100%, with 4 (12%) and 30 (88%) patients having clinical Stage IIB and III disease, respectively. Ninety-one percent of lesions were located in the distal esophagus, GE junction, and/or cardia. Histology comprised 30 (88%) adenocarcinomas, 3 (9%) squamous cell carcinomas, and 1 (3%) adenosquamous carcinoma. Ninety-seven percent of patients
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SSAT Abstracts
SSAT Abstracts
Prevalence of Gastroesophageal Reflux in Chronic Obstructive Pulmonary Disease Patients Henrique Abrahao, Fernando A. Herbella, Amilcar M. Bigatao, Jose R. Jardim, Luciana C. Silva, Fernando P. Vicentine, Marco G. Patti
Su1620 Esophageal Cancer in the Young: A Population-Based Analysis of 1,095 Patients Attila Dubecz, Norbert Solymosi, Michael Schweigert, Jeffrey H. Peters, Hubert J. Stein BACKGROUND: Controversy exists about the clinical presentation and prognosis of young patients with gastrointestinal malignancies. The aim of this study was to evaluate populationbased demographics and survival of young patients with esophageal cancer in the United States. METHODS: We identified 1,095 patients under 40 years of age with cancer of the esophagus and the gastric cardia diagnosed between 1973 and 2008 from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic variables and cancer-related survival were assessed and compared to all patients .40 years old (n= 65,930). Influence of available variables on survival was analyzed with logistic regression. RESULTS: Percentage of young patients with esophageal cancer is less than 2% and is declining since the 1990s. More than fifty percent are diagnosed in metastatic stage. Only 74% of patients with potentially resectable esophageal cancer underwent surgery. Median cancer-related survival (13 months vs. 11months) and five-year survival (22% vs. 18%) was significantly higher than in older patients. Multivariate-analysis identified surgical treatment (OR: 5.046) as the only as independent predictor of 5-year survival. Percentage of non-white patients, distal cancer and adenocarcinoma were significantly higher when compared to all patients. CONCLUSION: Most young patients with esophageal cancer are diagnosed in metastatic stage in the United States. Survival in patients under 40 years of age is better than in older patients. Patients undergoing surgical treatment for locoregional cancer have better survival.
Su1618 Restaging PET-CT After Neoadjuvant Chemoradiotherapy Can Prevent NonCurative Surgical Interventions in Esophageal Cancer Patients Martinus C. Anderegg, Roelof J. Bennink, Hanneke van Laarhoven, Jean H. Klinkenbijl, Maarten C. Hulshof, Jacques J. Bergman, Mark I. van Berge Henegouwen Background: Esophageal cancer is notorious for its rapid dissemination, both locally and to distant sites. Accurate staging at the time of diagnosis is of crucial importance to identify patients eligible for curative treatment. For the vast majority of these patients the preferred strategy consists of neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy. Given the aggressive nature of esophageal tumours, it is conceivable that in a significant portion of patients treated with nCRT, dissemination becomes manifest during this preoperative course (interval metastasis). Since metastatic disease is an absolute contraindication for esophagectomy, we added a post-neoadjuvant therapy PET-CT (restaging PET-CT) to the standard work-up of patients with potentially resectable esophageal carcinoma at initial presentation. Aim: Determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy in identifying patients with interval metastases preoperatively. Methods: From January 2011 until September 2012 all consecutive esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT (median interval 18 days). Staging at initial presentation consisted of endoscopy with biopsy, endoscopic ultrasonography, external ultrasonography of the neck and a thoracoabdominal CT scan. A PET scan was not part of the initial staging. Neoadjuvant therapy consisted of 5 cycles of carboplatin AUC 2, paclitaxel 50 mg/m2 and concurrent radiotherapy (41.4 Gy). If abnormalities on restaging PET-CT were suspect of metastases, histologic proof was acquired. This study was approved by the local ethics committee. Results: During the study period a total number of 280 new esophageal cancer patients were analysed at the outpatient clinic. Of these patients 148 underwent a restaging PETCT. The remaining 132 patients were considered ineligible for curative esophagectomy at initial presentation due to comorbidity, unresectable tumours or distant metastases (94 cases), refused to undergo surgery (12), were operated without nCRT (13) or did not complete nCRT in our centre (13). In 29 patients (19.6%) restaging PET-CT showed abnormalities suspicious for dissemination requiring additional imaging and/or biopsy, resulting in 16 cases of proven interval metastasis (10.8%) and a false-positive rate of 8.8% for restaging PET-CT. Of the patients without proven metastatic disease 116 patients have been operated at this time. In 4 of these 116 cases distant metastases were detected intraoperatively, leading to a false-negative rate of 3.4%. Conclusion: 10.8 percent of esophageal cancer patients develop detectable distant metastases during neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate restaging PET-CT as part of the standard workup of candidates for surgery.
Su1621
Background :The association of gastroesophageal reflux disease (GERD) and chronic pulmonary disorders has been a topic of great interest recently. However, little is known about GERD in the setting of chronic obstructive pulmonary disease (COPD). This study aims to evaluate in patients with COPD: (a) the prevalence and the sensitivity of symptoms to diagnose GERD; (b) the pattern of esophageal motility; and (c) the prevalence of distal and proximal GERD. Methods: A total of 50 patients with DPOC (as defined by age . 40 years with a FEV1/FVC below 88% of the predicted value after bronchodilator use, and no prior history of asthma) underwent symptomatic assessment, high-resolution manometry and dual probe esophageal pH monitoring. GERD was defined by a DeMeester score .14.7. Proximal reflux was defined by .= 1 episode of proximal reflux. Results: GERD was present in 21 (42%) of the total patients. GERD symptoms were referred by 20 (40%) patients more than once a month. Symptoms were not predictive of the presence of GERD (sensitivity 71%; specificity 83%). GERD symptoms presence, esophageal manometry and pHmonitoring according to the presence of distal GERD by pHmonitoring results are depicted in table 1. Conclusions: These data show that in patients with DPOC: 1) GERD is present in almost half of the patients; 2) symptoms were insensitive and nonspecific for diagnosing GERD; 3) a defective LES is not more common in patients with GERD leading to the hypothesis that the physiopathology for GERD may be linked to the transthoracic pressure gradient in this population; 4) in 95% of the patients with GERD, acid refluxed into the proximal esophagus. We conclude that patients with DPOC should be screened with pH monitoring for GERD.
Su1619 Conversion of Fundoplication to Roux-en-Y Gastric Bypass: Long-Term Results Daniel B. Leslie, Nikolaus F. Rasmus, Bridget M. Slusarek, Barbara K. Sampson, Henry Buchwald, Sayeed Ikramuddin Introduction: Conversion of Fundoplication to Roux-en-Y gastric bypass (RYGB) results in significant weight loss and resolution of co-morbid illness, especially gastrointestinal reflux disease (GERD). This procedure offers alternative therapy to patients with recalcitrant GERD following a failed fundoplication. To date, very little long-term data exists for this revisional procedure. Materials and Methods: Patients who underwent a conversion of fundoplication (Nissen or other) to RYGB between 2000 and 2011 at our academic medical center were identified. The department's bariatric surgery database was reviewed for weight loss, the presence of GERD symptoms and the use of GERD medications. A reflux and heartburn questionnaire was administered to assess impact on quality of life (GERD-HRQL) scores and to determine postoperative GERD symptoms. Results: Twenty eight patients (female/male = 24/4) underwent laparoscopic (n=17) or open (n=11) surgery by 3 different surgeons and mean weight follow-up (100%) was 3 ½ years. Average preoperative BMI and weight were 43.1 kg/m2 and 119 kg; 3 patients had BMI below 35 kg/m2. Average length of stay was 4 days. Post-revisional BMI, weight, and % excess weight loss were 32.0 kg/m2, 87 kg, and 61%. Resolution of type II diabetes mellitus, hypertension, and hyperlipidemia were noted in 67%, 33%, and 60% of patients, respectively. No major short-term complications occurred and there were no mortalities. At least 13 patients (46%) continued to use daily acid reduction medication treatment, and 7 patients reported ongoing GERD symptoms (25%). Indications for GERD therapy also include nonspecific abdominal pain, pre-RYGB history of Barrett's esophagitis, and documented gastrojejunal ulcer. On a ranked scale of no symptoms (0) to incapacitating symptoms (50), mean GERD-HRQL score was 9.5/ 50 following surgery. Conclusion: Conversion of fundoplication to RYGB is performed on patients with a lower than average BMI than our typical RYGB cohort and experience significant weight loss with improvement in comorbid disease. Complications are similar to larger cohorts of patients undergoing RYGB. Although ongoing therapy for acid reduction is common, improvements in GERD symptoms were noted.
GERD: gastroesophageal reflux disease LES: lower esophageal sphincter Su1622 Celiac Nodal Status As Determined by Laparoscopic Gastric Ischemic Preconditioning Is Prognostic in Locally-Advanced Esophageal Cancer and May Determine Necessity for Completion Esophagectomy Sabha Ganai, Michael B. Ujiki, Mark Talamonti, John G. Linn, Amy K. Yetasook, JoAnn Carbray, Marco Zahedi, Ki Wan Kim, John Howington Introduction: Laparoscopic gastric preconditioning has theoretical benefits of reducing conduit-related morbidity by allowing time for the stomach to adapt and/or demarcate to ischemic insults prior to staged esophagectomy and reconstruction. We hypothesized that focused pathological assessment of celiac lymph nodes during the conditioning interval could predict long-term outcomes after esophagectomy in patients with locally-advanced esophageal cancer. Methods: A single-institutional retrospective review was conducted between 10/2008 and 11/2012, identifying 34 patients with locally-advanced (clinical Stage IIB/III) esophageal cancer who completed staged esophagectomy after laparoscopic preconditioning. Median follow-up was 9 months. Results: Patients were 60±10 years old, 82% male, and had a BMI of 24±5 kg/m2. The median interval from preconditioning to esophagectomy was 7 days (interquartile range, IQR, 7-8). Preoperative staging was performed with EUS in 94% and PET in 100%, with 4 (12%) and 30 (88%) patients having clinical Stage IIB and III disease, respectively. Ninety-one percent of lesions were located in the distal esophagus, GE junction, and/or cardia. Histology comprised 30 (88%) adenocarcinomas, 3 (9%) squamous cell carcinomas, and 1 (3%) adenosquamous carcinoma. Ninety-seven percent of patients
S-1075
SSAT Abstracts
SSAT Abstracts
Prevalence of Gastroesophageal Reflux in Chronic Obstructive Pulmonary Disease Patients Henrique Abrahao, Fernando A. Herbella, Amilcar M. Bigatao, Jose R. Jardim, Luciana C. Silva, Fernando P. Vicentine, Marco G. Patti