RNA-based liquid biopsies for better clinical management of Barrett’s esophagus and esophageal adenocarcinoma

In the past decades the incidence of esophageal adenocarcinoma (EAC) has increased dramatically in most Western populations. Due to the lack of symptoms EAC is often detected in a late stage, contributing to a poor 5-year survival rate. The potential of RNA (coding and miRNA) as circulating biomarker in blood has already been shown for many cancer entities but requires further investigation for EAC. In this study we will explore several RNA types in blood, including microRNA, messenger RNA, long non-coding RNA and circular RNA as a potential liquid biomarker to facilitate early diagnosis, prognosis and monitoring of esophageal adenocarcinoma We have been collecting blood and tissue samples from patients with non-dysplastic Barrett’s esophagus (NDBE), high-grade dysplasia (HGD) and EAC. Currently, our biobank includes >5000 samples from 120 patients. A proof-of-concept study was conducted including 17 patients from three groups (EAC, HGD and NDBE). For each patient, biopsies from diseased tissue and healthy tissue as well as blood were collected and analyzed using small RNA and total RNA sequencing. Gene expression analysis was performed to identify differentially expressed genes across the three groups. The highest number of significantly differentially expressed m(i)RNAs were present in the tissues of EAC versus NDBE patients, while these differences were much lower or even absent in the plasma samples. Moreover, we have identified between 1500 and 7500 unique circular RNAs in individual EAC cancer patients’ plasma, indicating promising opportunities for a blood-based liquid biomarker for BE and EAC. Currently, we are collecting additional samples to significantly increase the power of the differential expression study as well as to verify the results of our proof-of-concept study

The effect of time interval on esophagectomy after neoadjuvant treatment

"Esophagectomy timing after neoadjuvant therapy for distal esophageal adenocarcinoma" published in the Annals of Thoracic Surgery (doi: 10.1016/j.athoracsur.2015.09.044) states that 30- and 90-day mortality after esophagectomy for adenocarcinoma in patients with neoadjuvant chemoradiation, is significantly higher in patients with a postradiation interval of 9 weeks or more. The authors suggest that a "wait and see" approach after neoadjuvant therapy for esophageal adenocarcinoma may not be safe.status: publishe

Thoracic surgical training in Europe: what has changed recently?

Training in thoracic surgery (TS) traditionally varies amongst countries in Europe. The theoretical content of the training, the length of training, the amount of self-performed procedures to be done and the definition of training units all differ in European countries. However, in the past two decades, several initiatives were taken to harmonize TS training in Europe. The purpose of this paper is to highlight these initiatives and their impact on today's TS training in Europe.status: publishe

Extracapsular lymph node involvement after neoadjuvant chemoradiation in esophageal carcinoma: how to interpret?

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An unusual cause of "traumatic" hemothorax: perforation of the lung parenchyma by a bifid rib

Congenital anomalies of the ribs are relatively common, and they can be divided in numerical (for example cervical ribs) or structural abnormalities (for example bifid ribs). These anomalies are usually asymptomatic. Literature on symptomatic bifid ribs is limited. We present the case of a 36-year old male without any relevant medical history or medication who was referred to our center. After lifting a heavy object, he experienced sudden onset pain on the right anterior chest, with associated shortness of breath. Computed tomography of the chest showed a significant hemothorax on the right side, compression atelectasis of the right lower lobe, and an anomalous fifth right rib - described as a bifid rib. A VATS resection of the bifid rib was performed.The images of this case illustrate the unusual traumatic perforation of the lung caused by a bifid rib. The case illustrates that one might consider resection of an asymptomatic bifid rib when imaging suggests significant compression on the lung parenchyma.status: publishe

Traumatic rupture of splenic tissue 13 years after splenectomy. A case report

After splenectomy, two types of splenic tissue can remain in the human body: one type is the congenital accessory spleen, with its own vasculature and capsule. The other type is the acquired splenosis, caused by the spread of splenic tissue following splenic injury. The aim of this paper is to briefly review the literature dealing with spontaneous bleeding of splenic tissue, apart from the primary spleen, and to report a case showing the clinical and surgical importance of remaining splenic tissue after splenectomy.status: publishe

Large versus small bore feeding catheters after oesophagectomy: a retrospective comparative study of complications and indications for reintervention

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Long-term survival of surgical treatment of esophageal squamous cell carcinoma in Europe: the story of current practice in multimodal treatment

Squamous cell carcinoma is still the most common histological subtype of esophageal carcinoma in Europe, although its incidence is decreasing, while incidence of adenocarcinoma is rapidly increasing, especially in Western and Northern countries. Curative treatment is still surgery based, but unlike in most Asian countries, most patients receive multimodal treatment. Based on recent randomized trials, European guidelines mention neoadjuvant chemoradiation therapy followed by surgery or definitive chemoradiation followed by salvage resection when needed as treatment options in locally advanced esophageal squamous cell carcinoma patients. The trend towards more definitive chemoradiation can be explained by the possibility to have an organ-sparing treatment on one hand, but on the other hand also by the fact that most European esophageal surgeons are visceral surgeons who are less familiar with lymph node dissections in the upper mediastinum and neck. Nevertheless, surgical treatment with adequate lymph node dissection as part of a multimodal treatment still offers the best chances on long term survival with 5-year survival rates of up to more than 40 percent.status: Published onlin

The impact of coronavirus disease 2019 on the practice of thoracic oncology surgery: a survey of members of the European Society of Thoracic Surgeons (ESTS)

OBJECTIVES: There is widespread acknowledgement that coronavirus disease 2019 (COVID-19) has disrupted surgical services. The European Society of Thoracic Surgeons (ESTS) sent out a survey to assess what impact the COVID-19 pandemic has had on the practice of thoracic oncology surgery. METHODS: All ESTS members were invited (13-20 April 2020) to complete an online questionnaire of 26 questions, designed by the ESTS learning affairs committee. RESULTS: The response rate was 23.0% and the completeness rate was 91.2%. The number of treated COVID-positive cases per hospital varied from fewer than 20 cases (30.6%) to more than 200 cases (22.7%) per hospital. Most hospitals (89.1%) postponed surgical procedures. All hospitals performed patient screening with a nasopharyngeal swab, but only 6.7% routinely tested health care workers. A total of 20% of respondents reported that multidisciplinary meetings were completely cancelled and 66%, that multidisciplinary decisions were not different from normal practice. Trends were recognized in prioritizing surgical patients based on age (younger than 70), type of surgery (lobectomy or less), size of tumour (T1-2) and lymph node involvement (N1). Sixty-three percent of respondents reported that surgeons were involved in daily care of COVID-19-positive patients. Fifty-three percent mentioned that full personal protective equipment was available to them when treating a COVID-19-positive patient. CONCLUSIONS: The COVID-19 pandemic has created issues for the safety of health care workers, and surgeons have been forced to change their routine practice. However, there was no consensus about surgical priorities in lung cancer patients, demonstrating the need for the production of specific guidelines.status: publishe

PS02.128: SENSE OR NONSENSE OF A PALLIATIVE ESOPHAGECTOMY IN CASE OF UNEXPECTED OLIGOMETASTATIC DISEASE

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