Esophageal Cancer Surgery Research Articles

Microbial contamination of percutaneous endoscopic gastrostomy tube and nasogastric tube with drug-resistant bacteria.

Enteral nutrition is used in patients with stroke, head-and-neck or esophageal cancer surgery, or repeated aspiration pneumonia. Japanese enteral nutrition guidelines recommend percutaneous endoscopic gastrostomy tube (PEG) for long-term use of >4 weeks and nasogastric tube (NGT) for short-term use of <4 weeks. Catheters may be contaminated with microorganisms because enteral feeding products passed through them daily, but there are few reports on catheter contamination in Japan and no reports on the duration of catheter use. There are also reports that enteral feeding is a risk factor for the appearance of drug-resistant bacteria. Therefore, this study aimed to determine whether microorganisms could be isolated from enteral feeding catheters and determine the percentage of drug-resistant bacteria. Forty-six PEGs and 59 NGTs were collected at Showa University Hospital and Showa University Fujigaoka Rehabilitation Hospital from May 2019 to March 2020. Microorganisms were cultured by incubating 20 mL pass/wash solution of sterile purified water on BHI agar medium (37°C) for 24-72 h. The strains were isolated and cultured, then frozen (80°C) and stored. Antimicrobial susceptibility was determined by broth microdilution method. Microorganisms were detected in 37 PEGs and 57 NGTs (p = 0.007). Bacteria were detected in 27 PEGs and 53 NGTs (p < 0.001), and yeasts were detected in 29 PEGs and 28 NGTs (p = 0.112). Drug-resistant bacteria were isolated from 19.6% (9 of 46) in PEGs and 23.7% (14 of 59) in NGTs. PEGs and NGTs were contaminated with microorganisms, and drug-resistant bacteria were isolated. This study provides a rationale for future appropriate use in enteral feeding catheters.

Exploration of symptom cluster patterns and their trajectory in esophageal cancer surgery patients.

To investigate symptom burden and symptom cluster trajectories in patients undergoing surgery for esophageal cancer. A convenience sample of 210 patients who underwent thoracoscopic surgery for esophageal cancer was included from July to December 2023. The symptoms of the patients were evaluated at the following time points: preoperatively (T0), 1-3 days postoperatively (T1), 7 days postoperatively (T2), 1 month postoperatively (T3), and 3 months postoperatively (T4). This was done via the Chinese version of the MD Anderson Symptom Scale and the Supplementary Questionnaire for Perioperative Esophageal Cancer Symptoms. Exploratory factor analysis was used to identify symptom clusters, and latent class growth modeling was used to analyze the trajectories of each different symptom cluster. Exploratory factor analysis revealed the presence of four symptom clusters: mood-related symptom clusters (worst at T1, T2, and T4), gastrointestinal symptom clusters (worst at T0), fatigue-related symptom clusters (worst at T3), and surgery-related symptom clusters, with cumulative variance contribution rates of 64.34%, 62.29%, 68.23%, 70.29%, and 63.82%, respectively. The latent category growth model identified the existence of 2-3 distinct trajectories in each symptom cluster. This study identified 4 distinct symptom clusters in patients undergoing esophageal cancer surgery. The mood-related and gastrointestinal symptom clusters exhibited worsening and recurrence within 7 days post-surgery, necessitating particular attention. A subset of patients in the fatigue-related symptom cluster showed a tendency for continued exacerbation, emphasizing the need for long-term monitoring. Furthermore, symptom management strategies can be prioritized based on the severity of the symptom clusters.

Surrogacy between pathological complete response and overall survival: An individual patient data analysis of eight RCTs on neoadjuvant treatment plus surgery for esophageal cancer.

498 Background: Overall survival (OS) is the gold standard endpoint of treatment efficacy but requires an extended follow-up period. This study aimed to determine the validity of pathological complete response (pCR) as a surrogate endpoint for OS. Methods: The individual-level surrogacy between categorical outcome and OS was assessed using Kendall correlation coefficient, τ. Because no method has been reported to estimate τ between categorical variables and OS, we proposed the new method using an inverse probability of censoring weighting (IPCW) estimator adjusted for tied data that occur when applied to categorical outcomes. To evaluate the validity of this new method, we conducted simulations to compare its estimation accuracy with existing methods. A systematic review for all phase III RCTs comparing therapies in perioperative settings for resectable advanced esophageal and gastroesophageal junction cancer was performed and individual patient data (IPD) were requested from all included trials. Finally, surrogacy between pCR and OS was assessed using our proposed method. Results: Across all scenarios with varying τ values, sample sizes, and censoring proportions, the proposed method showed the lowest bias compared to the existing statistical methods. In total, 23 eligible trials were identified and IPD were available from eight RCTs (JCOG1109, JCOG9907, JCOG9204, FFCD9901, FFCD9102, SAKK75/08, CROSS, and KOK), including 1688 patients who received neoadjuvant therapy. For trial-level analysis, pCR showed a strong correlation with a determination of correlation of 0.65 when limited to neoadjuvant chemotherapy (NAC) trials. For individual-level analysis, in patients who received NAC, the hazard ratio (HR) for OS of pCR was 0.25 (95% CI: 0.13 - 0.47), and τ between OS and pCR was 0.225. While in patients who received neoadjuvant chemoradiotherapy (NACRT), the HR was 0.54 (95% CI: 0.45 - 0.66), and τ was 0.189. Additionally, τ between OS and pathological grade (pGrade), OS and tumor regression grade (TRG) was 0.196 and 0.143, respectively. As a reference, hypothetical data showed that in order to achieve a τ of 0.8 between pCR and OS, it is necessary to be able to clearly identify the prognosis to the extent that an HR of 0.09 (95% CI: 0.08 - 0.11) can be obtained. Conclusions: While pCR is sensitive enough to stratify prognosis and exhibit strong trial-level surrogacy, no individual-level surrogacy was demonstrated, making them insufficient to replace OS. It should be noted that there are substantial differences in prognostic stratification and potential use of pCR as primary endpoints in clinical trials.

A Case of Non-Anastomotic Tracheo-Thoracic Gastric Fistula.

Tracheo-thoracic gastric fistula (TTGF) is a rare but serious complication following oesophageal cancer surgery, involving an abnormal connection between the thoracic gastric cavity and the bronchial tree. We report a case of TTGF that developed 3 years post-esophagectomy, identified through bronchoscopy. The patient was treated using a multidisciplinary approach, which included the placement of a bronchial covered stent, insertion of a jejunostomy feeding tube, and gastrointestinal decompression. The intervention resulted in a marked improvement in the patient's respiratory distress and fever, leading to a successful discharge. This case highlights the necessity for individualised treatment strategies for TTGF and underscores the crucial role of multidisciplinary management in enhancing patient outcomes.

Robot-assisted esophagectomy with extended mediastinal lymph node dissection: The learning curve and surgical outcomes.

457 Background: We have performed thoracoscopic surgery (TMIE) and robot-assisted surgery (RAMIE) for esophageal cancer with extensive mediastinal lymph node dissection, including resection of the sympathetic nerve layers and the thoracic duct. We studied the learning curve, short-term results, and mid-to-long-term outcomes of RAMIE for esophageal cancer at our institution. Methods: We compared surgical times at different stages of the procedure. For mid to long-term outcomes, we analyzed 360 cases of TMIE/RAMIE performed between January 2009 and June 2022, comparing the incidence of postoperative complications, recurrence-free survival, and patterns of recurrence between RAMIE and TMIE. Recurrent laryngeal nerve palsy (C-D I) was evaluated using postoperative endoscopy or contrast swallowing tests to assess even mild paralysis. Results: The average console time in the thoracic procedure was 234.4 minutes, with Group A (294.5 minutes, range: 211-397 minutes) showing significantly longer times compared to Group B (190.5 minutes, range: 130-257 minutes). Blood loss was almost 0ml in 10 cases (50%) in Group A and 25 cases (62.5%) in Group B. Postoperative complications included pneumonia in 5 cases (8.3%) and recurrent laryngeal nerve palsy (C-D III) in 5 cases (8.3%), with no significant difference between the groups. However, surgical time for lymph node dissection around the recurrent laryngeal nerve was significantly shorter in Group B compared to Group A. Long-term analysis included 326 TMIE and 34 RAMIE cases. Mild recurrent laryngeal nerve palsy (&gt;C-D I) was observed in 92 cases (28%) of TMIE and 7 cases (21%) of RAMIE, showing a lower tendency in the RAMIE group (p=0.338). Pneumonia (&gt;C-D II) occurred in 57 cases (18%) in the TMIE group and 3 cases (9%) in the RAMIE group, with a relatively lower incidence in the RAMIE group (p=0.178). For patients with cT1N0M0 who did not receive preoperative chemotherapy, the 3-year recurrence-free survival rates were 95% for TMIE and 93% for RAMIE. Conclusions: RAMIE demonstrated a significant reduction in operative time due to the standardization of the procedure, particularly in the dissection of recurrent laryngeal nerve lymph nodes and other upper mediastinal maneuvers. RAMIE also showed a potential reduction in the incidence of recurrent laryngeal nerve palsy and pneumonia compared to TMIE. In terms of long-term outcomes, RAMIE maintained local control similar to TMIE, with further improvements in safety expected.

Postesophagectomy hiatal hernia: an uncommon complication after total minimally invasive surgery for esophageal cancer

Postesophagectomy hiatal hernia: an uncommon complication after total minimally invasive surgery for esophageal cancer

Individualized symptom experience and predictors in cancer patients after oesophagectomy: A latent profile analysis.

In the care for oesophageal cancer, symptom assessment was mainly carried out from the perspective of the total score using scales, which ignored individual differences in symptom experience among patients. To provide personalized symptom management, individual differences among patients with oesophageal cancer warranted further investigation. The objective was to identify the different symptom profiles of patients after oesophagectomy and examine the risk factors affecting the symptom profiles. It was a descriptive study with cross-sectional design. A total of 258 participants were recruited. Latent profile analysis was used to identify different profile of symptoms, and multiple logistic regression was used to identify risk factors. Three distinct profiles were identified: the "complex symptoms group" (32.6%), the "throat symptoms group" (25.2%), and the "single fatigue group" (42.2%). Patients with higher prognostic nutritional index (OR=0.797), higher resilience scale score (OR=0.907), living in city or town (OR=0.396), and stage II cancer (OR=0.413) were more likely to be classified as "single fatigue group". Patients with higher prognostic nutritional index (OR=1.233) and cervical anastomosis (OR=4.586) tended to be classified as the "throat symptoms group". Unemployed patients (OR=0.204) tended to belong to the "complex symptoms group," whereas patients with higher prognostic nutritional index were less likely to be in the "complex symptoms group." Individual differences existed in the symptom experience of patients undergoing surgery for oesophageal cancer. Precise symptom management programs should be designed and implemented according to the individualized characteristics of the patient's symptom experience to promote patients' recovery.

Progress on aspiration assessment methods for patients after esophageal cancer surgery in early: A review.

Esophageal cancer is a relatively common malignant tumor of the digestive tract. Patients with esophageal cancer show a high incidence of aspiration after surgery, which has a serious impact on their prognosis and rehabilitation. Nevertheless, while existing and past endeavors have concentrated on enhancing the diagnostic and therapeutic strategies for esophageal cancer, the necessity of preventing pneumonia caused by postoperative aspiration remains to be adequately addressed. We compiled the presently published literature and offer the latest developments on the causes of postoperative aspiration in patients with esophageal cancer, screening methods, and swallowing assessment tools. Relevant published papers were collected through a search of the China national knowledge infrastructure, Ovid EMBASE, Web of Science, Cochrane, and PubMed databases. There are various methods for assessing swallowing function after surgery for esophageal cancer. Clinically, it is necessary to select appropriate assessment tools for the swallowing function. Research indicates that the application of risk prediction models can better assess aspiration in patients after esophageal cancer surgery, bridge gaps in qualitative analysis, and alter the clinical outcomes of patients. Predictive models for dysphagia screening in patients after esophagectomy have significant clinical advantages and exhibit good clinical applicability.

Successful staged surgery for advanced esophageal cancer after conversion pancreatoduodenectomy with pancreaticogastrostomy.

Complex surgery during initial cancer treatment can limit surgical options when planning management of a secondary malignancy. Subtotal esophagectomy and pancreatoduodenectomy are the most invasive and difficult procedures in gastroenterological surgery. Surgical cases in which subtotal esophagectomy was performed after pancreatoduodenectomy with pancreaticogastrostomy are extremely rare and challenging procedures due to the resulting complicated anatomical changes. A 60-year-old man with a history of conversion pancreatoduodenectomy with pancreaticogastrostomy for advanced pancreatic head cancer was diagnosed as having advanced thoracic esophageal squamous cell carcinoma. After neoadjuvant chemotherapy, we chose a two-staged surgery with thoracoscopic subtotal esophagectomy. Following percutaneous endoscopic gastrostomy, we performed subtotal esophagectomy, systematic lymph-node dissection, and esophagostomy as the first-stage operation. Fifty-six days later, we performed gastrointestinal reconstruction with pedicle jejunum and microvascular anastomosis by the percutaneous route as the second-stage operation. Postoperatively, the patient was relieved without major complications, and the tumors were amenable to curative pathologic resection. The greatest advantages of staged surgery are to reduce surgical invasiveness and to circumvent the lower rate of curability. Our procedure reported here may be recommended as an option for staged resection and reconstruction in patients with advanced esophageal cancer after pancreatoduodenectomy with pancreaticogastrostomy.

The comparison of uniportal versus multiportal video-assisted thoracic surgery for esophageal cancer: a propensity-weighted analysis.

The utilization of uniportal video-assisted thoracoscopic surgery (VATS) has become prevalent, notwithstanding, there are few studies exploring its application specifically in esophagectomy. A retrospective analysis was conducted on data collected from patients diagnosed with clinical stage T1-3/N0/M0 thoracic esophageal cancer, who underwent surgery between January 2017 and December 2020. To evaluate the outcomes, an analysis was conducted utilizing the inverse probability of treatment weighting (IPTW) method. This study identified 55 patients who underwent uniportal VATS and 212 patients who underwent multiportal VATS. Postoperative complications classified as Clavien-Dindo grades 1-2 occurred less frequently after uniportal than multiportal VATS in both unadjusted and IPTW-adjusted analyses (10.1% versus 28.8%, respectively; P = 0.018). Upon IPTW analysis, it indicated that the rate of pneumonia (grades 1-2) in the uniportal VATS group was 7.3%, notably lower than the corresponding rate of 23.2% observed in the multiportal VATS group (P = 0.037). Patients in uniportal VATS group had a shorter postoperative length of stay comparing with those in multiportal VATS group (9 versus 10days, P = 0.006 after IPTW). The visual analog scale (VAS) was administered within 7days following surgery and scores were significantly lower in uniportal VATS group (P < 0.001). No surgery-related mortality was observed in uniportal VATS group. The survival benefit observed between two groups was comparable before (P = 0.320) and after IPTW analysis (P = 0.824), indicating no significant difference. The utilization of uniportal VATS for esophagectomy demonstrated a reduced occurrence of postoperative complications, accompanied by mitigated postoperative pain, thereby presenting as a viable and practical approach for treating esophageal cancer patients.

Health economic evaluation of minimally invasive surgery in treatment of digestive tract cancers: a Meta-analysis

Objective: To compare minimally invasive surgery with traditional open surgery, analyze the current application status of health economic evaluations in the treatment of digestive tract cancers, such as esophageal cancer, gastric cancer, and colorectal cancer by minimally invasive surgery and provide evidence for the rational selection of clinical treatment, alleviation of disease-related economic burdens, and rational allocation of healthcare resources. Methods: By using five databases, i.e. China National Knowledge Infrastructure, Wanfang data, Chinese Biomedical Literature Database, PubMed, and Embase, a database was established to retrieve all the papers about health economic studies of minimally invasive surgery for esophageal cancer, gastric cancer, and colorectal cancer published until December 31, 2023. Literature was analyzed by using software NoteExpress 3.8, and data were processed using Excel 2021. The quality of included papers was evaluated using the CHEERS 2022 checklist, and Meta-analysis was conducted by using software Stata 17.0. Results: A total of 10 919 relevant papers were retrieved, and 59 studies were included. Only 14 studies (23.7%) used standard health economic evaluation methods. Meta-analysis results revealed no significant differences in direct medical expenditure and total expenditure between minimally invasive surgery and open surgery. However, the expenditure for minimally invasive surgery exhibited a significant increase [mean difference (MD)=5 973.12 yuan, P<0.001], while hospital stay and indirect expenditure significantly decreased (MD: -4.85 days and -733.79 yuan, P<0.001). In China, for gastric cancer, the direct medical expenditure of endoscopic surgery was lower than that of open surgery (MD=-33 000.00 yuan) with no significant difference (P<0.001). In colorectal cancer cases, the direct medical and surgical expenditures for laparoscopic surgery were higher than those for open surgery (MD: 4 277.94 yuan and 4 267.80 yuan, P<0.001), while the indirect and total medical expenditures decreased (MD: -768.34 yuan and -159.10 yuan). Hospital stays in patients who had minimally invasive surgery for all three types of cancer were shorter than those who had open surgery (P<0.001). Conclusions: In the treatment of gastrointestinal cancer, compared with open surgery, minimally invasive surgery shows higher expenditure, but has advantages, such as shorter hospital stay and lower indirect expenditure, and there were no significant differences in direct medical and total expenditures between the two approaches. When conducting health economic evaluation, factors such as postoperative complications, hospital stay, and patient's economic status should be considered for their impact on total medical expenditure. It is necessary to pay attention to the application of health economic evaluations in healthcare decision-making.

Assessment of the extent of lymphadenectomy in esophageal cancer surgery in the observational tiger study: [TIGER-SQA] study protocol

The distribution pattern of esophageal cancer lymph node metastases and consequently the lymph node stations that should be resected are currently being investigated in the international distribution of lymph node metastases in esophageal carcinoma (TIGER) study. This observational study has no specific entry criteria, resulting in significant variation among participating centers regarding the extent of lymphatic tissue clearance during surgery. To ensure reliable interpretation of the TIGER study results, this study aims to develop an intraoperative metric (surgical quality assessment tool) to examine the extent of lymphadenectomy. This multicenter prospective study assesses the extent of lymphadenectomy during esophagectomies performed within the TIGER study. After consensus on the applicability of surgical quality assessment in observational studies (phase 1), a short photo/video of the thoracic, abdominal, and [if applicable] cervical area will be captured after lymphadenectomy (phase 2). Those images will be rated by expert surgeons using a structured assessment tool (phase 3), and an automatic artificial intelligence (AI)-based quality assessment will be developed (phase 4). The variability in lymphadenectomy will be adjusted when analyzing TIGER study outcomes. Technique standardization by surgical quality assurance (SQA) reduces variation in trial outcomes. This cannot be applied to the TIGER study because of its observational nature, although surgical heterogeneity might influence TIGER study outcomes. To monitor surgical performance within observational studies, surgical quality assessment can be applied, although this has not been done yet. This study will ensure a reliable interpretation of TIGER study results and could be used as a benchmark for quality assessment in future surgical studies.

Salvage Radiotherapy for Loco-regional Recurrence of Esophageal Cancer Following Surgery.

There is few evidence regarding the optimal salvage treatment options for loco-reginal recurrence of esophageal cancer. This study aimed to evaluate the clinical outcomes of salvage radiotherapy (RT) in patients with loco-regional recurrence (LRR) after surgery for esophageal cancer. We retrospectively reviewed 147 esophageal cancer patients who received salvage RT for loco-regional recurrence between 1996 and December 2019. A total dose of 60 Gy in 20 fractions was used for RT alone and 60-70 Gy in 30-35 fractions for concurrent chemoradiotherapy (CCRT). The patients' median age was 65 years (range, 41 to 86 years). The median disease-free interval was 13.5 months (1.0 to 97.4 months). After a median 18.8 months follow-up, the 2-year overall survival (OS) and progression-free survival (PFS) rates were 38.1% and 25.9%, respectively. The median OS and PFS were 18.8 and 8.4 months, respectively. The CCRT could not improve OS compared to RT (p=0.336), but there was a trend of better PFS in the CCRT group. Regarding toxicities, the rate of grade 3 or higher toxicity was 10.9% occurring in 16 patients, and it was higher in patients who received CCRT than in the RT alone group (19.6% vs. 6.3%, p=0.023). Salvage RT alone as well as CCRT could be effective in patients with locoregionally recurrent esophageal cancer.

Pre-fabricated Thigh Flaps for Total Thoracic Esophageal Defects after Failed Jejunum Grafting in Esophageal Cancer Surgery

Pre-fabricated Thigh Flaps for Total Thoracic Esophageal Defects after Failed Jejunum Grafting in Esophageal Cancer Surgery

Case-mix adjustment for between-hospital comparisons in oesophageal and gastric cancer surgery

Case-mix adjustment for between-hospital comparisons in oesophageal and gastric cancer surgery

Robotic esophagectomy with function-preserving radical mediastinal lymphadenectomy for esophageal cancer.

Radical lymphadenectomy is the critical component of surgery for esophageal cancer. However, lymphadenectomy significantly contributes to postoperative morbidity, particularly in terms of pulmonary complications following esophagectomy. Function-preserving mediastinal lymphadenectomy seeks to balance the procedure's necessary radicality and optimal functional outcomes. This approach emphasizes the preservation of the thoracic duct, tracheobronchial vascularity, and the pulmonary and recurrent laryngeal branches of the vagus nerve. Preservation of the thoracic duct is facilitated by indocyanine green fluorescence. Compared to the conventional technique of thoracic duct identification using anatomical landmarks, indocyanine green fluorescence lymphangiography offers real-time feedback, making it particularly advantageous in cases with complex anatomy or when the thoracic duct is challenging to visualize using conventional methods. Preservation of pulmonary branches of the right vagus during subcarinal lymphadenectomy and left recurrent laryngeal nerve during left paratracheal node dissection are technically challenging. The description of two types of left recurrent laryngeal nerve node dissection and technical tips for nerve function preservation are outlined in this review. Intraoperative neuromonitoring is a useful adjunct for nerve-sparing mediastinal lymphadenectomy. As ischemia to the respiratory tract impairs respiratory protective mechanisms, preservation of the tracheobronchial blood supply is critical. Preoperative imaging to detect bronchial artery anatomical variations and intraoperative assessment of perfusion using laser doppler flowmetry and indocyanine green fluorescence angiography are useful strategies to minimize tracheobronchial ischemia. Function-preserving mediastinal lymphadenectomy has the potential to improve short- and long-term outcomes after esophagectomy for esophageal cancer.

Effect of Preoperative Body Composition on Postoperative Anastomotic Leakage in Oncological Ivor Lewis Esophagectomy—A Retrospective Cohort Study

Background: Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery. Methods: In this cohort study, we analyzed patients’ body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo–Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients. Results: From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = −0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%). Conclusions: Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans.

Gastric conduit in patients with previous endoscopic resection of the stomach for esophageal squamous cell carcinoma.

This study investigated the clinical outcomes of gastric conduits for esophageal reconstruction in esophageal squamous cell carcinoma (ESCC) patients who had previously undergone endoscopic resection of the stomach. From January 2006 to April 2023, a total of 1964 patients underwent surgery for esophageal cancer at our institution. After initially excluding 125 of these cases due to a histology other than ESCC, we identified 147 patients in the remaining population who had previously undergone a gastric endoscopic resection, among which 56 patients (67.0 ± 6.5years) were included in the present study cohort. A gastric conduit event was defined as any new lesions at the gastric conduit. The diagnoses of a previous gastric lesion included early gastric cancer (EGC) in 32 patients (57.1%), adenoma in 23 patients (41.1%), and dysplasia in 1 (1.8%) patient. The endoscopic procedures involved an endoscopic submucosal dissection (ESD) in 36 patients (64.3%) and an endoscopic mucosal resection in 20 patients (35.7%). The 10-year event-free survival rate for the gastric conduit was 43.7%. Five patients were diagnosed with metachronous gastric neoplasm (EGC in two and adenoma in three patients). Endoscopic procedures were available for all five cases, but one patient with a metachronous EGC required a colon interposition with a total gastrectomy. In ESCC patients who have undergone an endoscopic resection of their gastric lesions, subsequent esophageal reconstruction with a gastric conduit could be a viable option if followed by regular endoscopic surveillance for the early detection and endoscopic curability of any lesions.

Professor Valeriy Ivanovich Kazansky (1894–1978) (on the 130th anniversary of his birth)

A prominent Russian surgeon, talented scientist and teacher, one of the founders of the development of thoracic surgery in the USSR, Honored Scientist of the RSFSR (1965), Doctor of Medical Sciences, Professor Valery Ivanovich Kazansky was born on October 14, 1894 in the village of Turgenevo, Tula Governorate, into a priest’s family. After graduating from the Tula Gymnasium with a medal, he entered the Imperial Military Medical Academy, which he graduated from in 1919. For two years, he served as a military doctor in the Red Army on the Eastern Front. After demobilization, he worked in the People’s Commissariat of Public Health, from 1925 to 1934, he headed the Surgical Department at the Hospital in Turtkul, and then in Chardzhou (Turkmenistan). In 1935, V. I. Kazansky transferred to work at the 2nd Moscow Medical Institute in the Clinic of Professor S. I. Spasokukotsky and simultaneously headed the Surgical Clinic of the Central Institute of Blood Transfusion (until 1947). In 1938, he defended his doctoral dissertation “Spontaneous non-tuberculous pyopneumothorax and its treatment”. During the Great Patriotic War, V. I. Kazansky was the consultant to the Northwestern and Western Fronts on blood transfusion issues, worked as the Professor-consultant at the Hospital of the Ministry of Railways, which specifically admitted victims with gunshot wounds to the chest. At the same time, from 1943, he served as the chief surgeon of the Moscow Department of Health, and from 1946 to the end of 1952, he held the position of chief oncologist of the USSR Ministry of Health. In 1953, he was elected the head of the Surgery Department of the Central Institute for Advanced Medical Training. For 30 years, V. I. Kazansky studied the problem of treating patients with esophageal cancer and for numerous works, including three monographs, he was awarded the N. N. Burdenko Prize. In 1973, the fundamental monograph “Surgery of Esophageal Cancer” was published. Valery Ivanovich was the author and co-author of about 200 scientific works, including 10 monographs, under his supervision 32 candidate and 8 doctoral dissertations were defended. Professor V. I. Kazansky died on March 30, 1978 and was buried in Moscow at the Nikolo-Arkhangelskoye Cemetery.

Outcomes of Salvage Surgery for Esophageal Carcinoma: A Nationwide Cohort Study from the Dutch Upper GI Cancer Audit.

Salvage esophagectomy is more complex and associated with higher postoperative morbidity and mortality than standard resection. This study aimed to investigate short-term outcomes and theinfluence of hospital volume on these outcomes of salvage surgery for esophageal cancer. The study enrolled all patients undergoing esophagectomy for esophageal cancer registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) between 2012 and 2022. The patients were classified as salvage or non-salvage by registering surgeons. Salvage surgery is defined in the DUCA as surgery after definitive chemoradiotherapy. Postoperative mortality (30-day/in-hospital) and morbidity were compared between the salvage and non-salvage patients using multilevel logistic regression analyses. Hospital variation in the use of salvage esophagectomy was investigated using funnel plots. The influence of hospital volume (≤ 40 to > 40 cases) and salvage volume (< 6 to ≥ 6 cases) on outcomes for salvage patients were investigated. Using backward elimination, relevant baseline characteristics influencing salvage outcomes were identified. Between 2012 and 2022, 7749 patients underwent esophagectomy, 251 (3%) of whom underwent salvage resection, varying from 0 to 8% between centers. Severe complications (43% vs 28%; odds ratio [OR], 1.81; 95 % confidence interval [CI], 1.40-2.34) and 30-day/in-hospital mortality (11% vs 3%; OR, 3.65; 95% CI, 2.38-5.61) were higher after salvage surgery than after non-salvage surgery. Salvage patients treated in high-volume centers had a lower risk of 30-day/in-hospital mortality than those treated in low-volume centers (9% vs 19%; OR, 0.42; 95% CI, 0.18-0.99), with no relation between salvage volume and outcome. Male sex, older age (> 75 years), and squamous cell carcinoma were associated with worse short-term outcomes of salvage surgery. Salvage surgery is associated with worse short-term outcomes than non-salvage esophagectomy. Outcomes after salvage surgery were favorable in high-volume esophagectomy centers.