UEG Week Virtual 2020 Congress Review - 11

UEG Week Congress Review

Scientific Programme Highlights
Survival benefits of minimallyinvasive oesophagectomy
confirmed
A large, population-based study
conducted using data from Sweden and
Finland has confirmed that minimallyinvasive oesophagectomy (MIO) improves
5-year survival compared with open
oesophagectomy (OO) in the treatment of
oesphageal cancer. The survival benefit
identified in the study was greater after
total MIO than after hybrid MIO.
Minimally-invasive oesophagectomy is being
performed more frequently for the treatment of
oesophageal cancer, with a recent meta-analysis
suggesting an 18% lower 5-year all-cause mortality
after MOI compared with OO.1 "The problem with
this systemic review was that most included studies
were small single-centre studies failing to adjust for
confounding factors, hence, only producing crude
estimates," said Eivind Gottlieb-Vedi from Karolinska
Institute and University Hospital in Stockholm,
Sweden.
To overcome these shortcomings, Gottlieb-Vedi and
colleagues designed a population-based cohort study
using data from almost all patients who underwent
elective oesophagectomy for oesophageal cancer
in Sweden (between 2011 and 2015) and Finland
(between 2010 and 2016). Detailed clinical information
was obtained from the medical records of each
individual identified, with follow-up data obtained
from cause of death registries. Multivariable Cox
regression was used to evaluate risk of all-cause
5-year mortality, adjusting for age, sex, comorbidities,
pathological tumour stage, histological tumour type,
neoadjuvant chemo(radio)therapy, country, and
annual hospital volume of oesophagectomy. A total of
794 OOs and 470 MIOs were analysed.

Gut microbiome instability linked to host
phenotypic changes
Long-term changes in the composition and genetic profile of the gut
microbiome have been linked with host phenotypic changes associated
with disease. The population-based Dutch Lifelines-DEEP cohort contains
>300 individuals who have been followed for 4 years and who have been
extensively phenotyped for lifestyle, clinical, and physiological factors,
with metagenomic sequencing of faecal samples performed twice in that
time. "This unique dataset allows us to investigate the long-term stability
of the gut microbiome composition and genetic make-up," explained
Lianmin Chen from the University Medical Center in Groningen, the
Netherlands.
Chen and co-workers have analysed data from this unique cohort (n=338;
age 22-84 years; 44% male) and found substantial changes in microbial
compositional stability over 4 years, with 60% of microbiome species
(n=157) and 40% of pathways (n=343) significantly altered during that time
(false discovery rate [FDR]-adjusted p<0.05 for both analyses). Microbial
abundance changes were associated with host metabolic changes linked
with disease with, for example, fungal flavin biosynthesis pathway
abundance changes being associated with changes in host plasma HbA1c
levels.
The team also analysed microbial genetic stability in this cohort by
assessing single nucleotide polymorphisms (SNPs) in different species
4 years apart. They found that some of the most genetically unstable
microbes (e.g. Ruminococcus torques, Streptococcus parasanguinis,
Faecalbacterium prausnitzii) were also associated with host phenotypic
changes related to disease. They reported that the gut microbiome
showed higher compositional and genomic variability over time betweenindividuals than within-individuals. Further analysis by the group
suggested that specific sets of genetically stable microbes could uniquely
distinguish their hosts with an accuracy of 82%, thus, serving as the host's
microbial 'fingerprint'.

Minimally-invasive oesophagectomy was associated
with an 18% decreased risk of all-cause 5-year
mortality compared with OO (adjusted [a] HR 0.82;
95% CI 0.67-1.00; p=0.048). The HR of all-cause 5-year
mortality was lower after total MIO compared with
OO (aHR 0.77; 95% CI 0.60-0.98) than after hybrid
MIO compared with OO (aHR 0.87; 95% CI 0.68-1.11).
Possible mechanisms proposed by the investigators
for the improved survival with MIO compared with OO
were a lower frequency of complications and faster
recovery.
1. Gottlieb-Vedi, E, et al. Ann Surg 2019;270(6):1005-1017.

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