Management Of Esophageal Cancer Research Articles

Changes in the recent three decades and survey on the current status of surgical treatment for esophageal cancer in China.

To review the changes and survey on status quo of the surgical treatment for esophageal cancer in China. The differences in diagnosis and treatment for esophageal cancer among hospitals in different regions across China were also investigated. We sent questionnaires to 46 hospitals across China, investigating the volume of esophageal cancer surgeries, surgical procedures, and perioperative management under the guidance of esophageal surgery chiefs. A total of 46 questionnaires were sent out and collected. The survey results showed that in the past 5 years, the volume of surgeries for esophageal cancer remained stable by 23.9% of those hospitals, increased by 30.4%, and decreased by 45.7%. Of those patients treated by surgery, 19.1% were in the early stages, and 80.9% were in locally advanced stages. In terms of surgical procedures, 73.4% of the patients were treated by minimally invasive surgery and 85.7% of esophageal substitutes were a gastric conduit, 93.1% of the substitutes were pulled to the neck through the esophageal bed. For the lymph node dissection, 78.5% of the patients had a complete two-field lymph node dissection including the para-recurrent laryngeal nerve lymph nodes. Of the patients with neoadjuvant therapy, 53.5% received chemotherapy or chemotherapy plus immunotherapy (47.0%), and 43.5% had chemoradiation. Currently, in China, minimally invasive surgery-oriented multimodality treatment, including complete two-field lymph node dissection, has become the standard approach for esophageal cancer management. Over the past decade, this standardized approach has significantly improved prognosis compared to previous decades.

The Role of Immunotherapy in the Management of Esophageal Cancer in Patients Treated with Neoadjuvant Chemoradiation: An Analysis of the National Cancer Database.

The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation. Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan-Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model. In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer.

Efficacy and safety of neoadjuvant immunotherapy combined with chemotherapy for resectable esophageal cancer: a systematic review and meta-analysis.

Esophageal cancer is often overlooked in its early stages, with approximately 70% of patients being diagnosed at a locally advanced or late stage. Surgical treatment and chemotherapy are the mainstays of esophageal cancer management. However, for locally advanced esophageal cancer, both surgery alone and chemotherapy alone have high rates of recurrence and metastasis. The objective of the research was to investigate the security and therapeutic efficacy of neoadjuvant immunochemotherapy (NICT) in the treatment of resectable, locally advanced esophageal squamous cell carcinoma (ESCC). We conducted a literature search on PubMed, Embase, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), China Biomedical Literature Database, and Wanfang for studies published before November 2023 that investigated on the clinical effectiveness and safety of neoadjuvant immunotherapy in resectable ESCC. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used for assessment, and Stata 17.0 was utilized for meta-analysis and sensitivity analysis. A total of 13 retrospective cohort studies involving 1,276 patients were included in this analysis. The NICT group showed a higher pathological complete response (pCR) rate [odds ratio (OR) =5.72; 95% confidence interval (CI), 3.40-9.63]. The major pathologic response (MPR) rate, objective response rate (ORR), R0 resection rate, and 1-year overall survival (OS) in the NICT group were better than those in the neoadjuvant chemotherapy (NCT) group (OR =3.70, 95% CI: 2.32-5.91; OR =2.22, 95% CI: 1.44-3.40; OR =2.63, 95% CI: 1.58-4.38; OR =10.08, 95% CI: 4.32-23.56). However, the NICT group also showed a drawback in terms of adverse reactions and postoperative complications. The incidence of rash (OR =4.69, 95% CI: 1.42-15.49) and pleural effusion (OR =3.99, 95% CI: 1.75-9.07) was significantly higher in the NCT group compared to the NICT group. The subgroup analysis indicates that the use of camrelizumab is associated with an increased incidence of rash. Additionally, performing a left thoracic esophagectomy and esophagogastric thoracic procedure significantly improved the R0 resection rate. Neoadjuvant immunotherapy has shown promising efficacy in patients with locally advanced ESCC; however, it is linked to a higher occurrence of adverse events. Therefore, its use in clinical practice should be carefully considered.

Substitute or coexistence? mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer - a meta-analysis of perioperative outcomes and long-term survival.

Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC). The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for refining surgical strategies and enhancing patient outcomes in this field. Adhering to PRISMA guidelines, we systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until March 1, 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5.4, with heterogeneity dictating the use of fixed or random-effects models. Totally 21 relevant studies were finally included. MAE was associated with significantly shorter operation times ((MD=-59.58min, 95% CI: -82.90, -36.26) and less intraoperative blood loss (MD=-68.34mL, 95% CI: -130.45, -6.23). However, MAE resulted in fewer lymph nodes being dissected (MD=-3.50, 95% CI: -6.23, -0.78). Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE significantly reduced pulmonary complications (OR=0.59, 95% CI: 0.44, 0.81) but increased the incidence of recurrent laryngeal nerve injury (OR=1.84, 95% CI: 1.30, 2.60). No significant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference (HR=1.05, 95% CI: 0.71-1.54). MAE offers advantages in reducing operation time, blood loss, and specific postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct benefits and limitations. These findings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor specifics.

Alarmin S100A8 imparts chemoresistance of esophageal cancer by reprogramming cancer-associated fibroblasts

Chemotherapy remains the first-line treatment for advanced esophageal cancer. However, durable benefits are achieved by only a limited subset of individuals due to the elusive chemoresistance. Here, we utilize patient-derived xenografts (PDXs) from esophageal squamous-cell carcinoma to investigate chemoresistance mechanisms in preclinical settings. We observe that activated cancer-associated fibroblasts (CAFs) are enriched in the tumor microenvironment of PDXs resistant to chemotherapy. Mechanistically, we reveal that cancer-cell-derived S100A8 triggers the intracellular RhoA-ROCK-MLC2-MRTF-A pathway by binding to the CD147 receptor of CAFs, inducing CAF polarization and leading to chemoresistance. Therapeutically, we demonstrate that blocking the S100A8-CD147 pathway can improve chemotherapy efficiency. Prognostically, we found the S100A8 levels in peripheral blood can serve as an indicator of chemotherapy responsiveness. Collectively, our study offers a comprehensive understanding of the molecular mechanisms underlying chemoresistance in esophageal cancer and highlights the potential value of S100A8 in the clinical management of esophageal cancer.

Investigating the Prognostic Significance of Immune-Nutritional Indices in Esophageal Cancer Patients Following Esophagectomy

Background: Esophageal cancer remains one of the most challenging malignancies to treat, with survival rates significantly influenced by various hematological and nutritional markers. Understanding these markers is critical in optimizing treatment approaches and improving patient outcomes. Objective: This study aimed to investigate the prognostic significance of several markers, including Mean Corpuscular Volume (MCV), Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), C-Reactive Protein (CRP), Albumin, Total Lymphocyte Count (TLC), CRP Albumin ratio (CAR), and the Prognostic Nutritional Index (PNI), in patients with esophageal cancer undergoing esophagectomy. Methods: A prospective observational study was conducted involving 43 patients diagnosed with esophageal carcinoma at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Data collection included patient demographics, tumor characteristics, and laboratory results obtained from the Hospital Information and Management Security System (HIMSS). Statistical analysis was performed using SPSS version 25, with Kaplan–Meier survival curves and log-rank tests assessing the impact of hematological and nutritional markers on survival outcomes. Results: The majority of patients presented with advanced disease (Stage III and IV) and tumor sizes ranging from 5 to 10 cm. Mean survival times and statistical comparisons were analyzed, but no significant differences in survival based on the markers were observed. For example, patients with low and high PNI values did not show significant differences in survival (Log-rank test p-value = 0.382). Conclusion: The study did not demonstrate significant prognostic differences based on the evaluated hematological and nutritional markers. However, it highlights the importance of considering these factors in the overall management of esophageal cancer, suggesting further research with larger sample sizes and diverse populations is necessary.

The efficacy and safety of snare traction-assisted endoscopic submucosal dissection for circumferential superficial esophageal cancer.

This study aims to investigate the efficacy and safety of snare traction-assisted endoscopic submucosal dissection (ESD) for the management of circumferential superficial esophageal cancer. A total of 68 patients who underwent ESD for circumferential superficial esophageal cancer were included in this study. All the patients were divided into two groups based on whether the snare traction was used or not; the snare traction group (S-ESD, group n = 35) and the control group (C-ESD, group n = 33). There was no significant difference in the size of the resected area between the groups [21.98 (18.30, 27.00) cm2 vs 24.00 (15.28, 30.72) cm2, P = 0.976]. The snare traction group had a shorter dissection time [92.00 (74.00, 121.00) min vs 110.00 (92.50, 137.00) min, P = 0.017] and a faster resection speed [0.28 ± 0.13 cm2/min vs 0.22 ± 0.11cm2/min, P = 0.040] compared to the control group. There were no statistically significant differences between the two groups in terms of hospital stay, cost, en bloc resection rate, R0 resection rate, curative resection rate, bleeding rate, perforation rate, stricture rate, and recurrence rate (P > 0.05). Snare traction-assisted ESD is a safe and efficient approach for the treatment of circumferential superficial esophageal cancer. Its advantages includes shorter procedure so the anesthesia requirement, clear operative filed view, improved mucosal dissection efficiency, simple, and easily accessible equipment.

Endoscopic submucosal dissection (ESD) outcomes in T1B esophageal cancer: a retrospective study.

The role of submucosal endoscopic dissection (ESD) in management of invasive esophageal cancer (EC) remains unclear. In this case series, we evaluate the clinical and technical outcomes of patients who underwent ESD with pathologically staged T1b EC. This retrospective study included patients who underwent ESD between December 2016 and April 2023 with pathologically staged T1b EC. Patient demographics, tumor characteristics, and ESD technical outcomes were analyzed. Patients were followed to determine disease-free survival and tumor recurrence rates. Sixteen patients with a total of 17 pathologically staged T1b ECs were included in this case series with a median follow-up time of 28months [range 3-75]. ESD had high en-bloc (100%) and R0 (82.3%) resection rates. 16/17 patients (94.1%) were discharged the same day, and there were no immediate perioperative complications. 4/17 patients (23.5%) had curative ESD resections with no tumor recurrence. Among those with non-curative resections (n = 13), 5 patients had ESD only, 6 had ESD+surgery, and 2 underwent ESD+chemoradiation. In the ESD only group, 2/5 patients (40%) had tumor recurrence. In the ESD+surgery group, one patient died from a surgical complication, and 1/5 (20%) had tumor recurrence at follow-up. There was no tumor recurrence among patients who had ESD+chemoradiation. ESD is safe with high en-bloc and R0 resection rates in T1b EC. Recurrence rates are low but patients need close monitoring. Larger-scale studies are needed to determine the long-term clinical efficacy of ESD in T1b EC.

Impact of FAPI-46/dual-tracer PET/CT imaging on radiotherapeutic management in esophageal cancer

BackgroundFibroblast activation protein (FAP) is expressed in the tumor microenvironment (TME) of various cancers. In our analysis, we describe the impact of dual-tracer imaging with Gallium-68-radiolabeled inhibitors of FAP (FAPI-46-PET/CT) and fluorodeoxy-D-glucose (FDG-PET/CT) on the radiotherapeutic management of primary esophageal cancer (EC).Methods32 patients with EC, who are scheduled for chemoradiation, received FDG and FAPI-46 PET/CT on the same day (dual-tracer protocol, 71%) or on two separate days (29%) We compared functional tumor volumes (FTVs), gross tumor volumes (GTVs) and tumor stages before and after PET-imaging. Changes in treatment were categorized as “minor” (adaption of radiation field) or “major” (change of treatment regimen). Immunohistochemistry (IHC) staining for FAP was performed in all patients with available tissue.ResultsPrimary tumor was detected in all FAPI-46/dual-tracer scans and in 30/32 (93%) of FDG scans. Compared to the initial staging CT scan, 12/32 patients (38%) were upstaged in nodal status after the combination of FDG and FAPI-46 PET scans. Two lymph node metastases were only visible in FAPI-46/dual-tracer. New distant metastasis was observed in 2/32 (6%) patients following FAPI-4 -PET/CT. Our findings led to larger RT fields (“minor change”) in 5/32 patients (16%) and changed treatment regimen (“major change”) in 3/32 patients after FAPI-46/dual-tracer PET/CT. GTVs were larger in FAPI-46/dual-tracer scans compared to FDG-PET/CT (mean 99.0 vs. 80.3 ml, respectively (p < 0.001)) with similar results for nuclear medical FTVs. IHC revealed heterogenous FAP-expression in all specimens (mean H-score: 36.3 (SD 24.6)) without correlation between FAP expression in IHC and FAPI tracer uptake in PET/CT.ConclusionWe report first data on the use of PET with FAPI-46 for patients with EC, who are scheduled to receive RT. Tumor uptake was high and not depending on FAP expression in TME. Further, FAPI-46/dual-tracer PET had relevant impact on management in this setting. Our data calls for prospective evaluation of FAPI-46/dual-tracer PET to improve clinical outcomes of EC.

Comparisons of short-term outcomes between robot-assisted, video-assisted, and open esophagectomy for resectable esophageal cancer after neoadjuvant treatment: a retrospective study.

Robot-assisted esophagectomy (RAE), video-assisted minimally invasive esophagectomy (VAMIE), and open esophagectomy (OE) all have significant roles in the management of esophageal cancer (EC). Few studies have compared efficacy and safety between RAE, VAMIE, and OE for resectable EC after neoadjuvant treatment. Therefore, this study aimed to explore the short-term outcomes between RAE, VAMIE, and OE for resectable EC after neoadjuvant treatment. Ninety-eight patients were consecutively enrolled who underwent esophagectomy. A retrospective study was performed including 98 consecutive patients treated from January 2021 to August 2022 who received neoadjuvant treatment (including immunochemotherapy and chemoradiotherapy) followed by RAE, VAMIE or OE. Evaluated endpoints in the present study consisted of pathological outcomes, intraoperative and postoperative outcomes, as well as postoperative complications. No significant differences were seen in the operating time, blood loss, length of intensive care unit (ICU) stay, R0 resection, and number of dissected lymph nodes between the three RAE, VAMIE, or OE groups. The achievement rate of right recurrent laryngeal nerve (RLN) lymph node removal (P=0.01) and the total cost (P<0.001) were higher in RAE. The postoperative hospital stay of OE was longer than the other two groups (P<0.05). There were no significant differences in postoperative complications. Compared to VAMIE, no clear benefit exists for RAE in the treatment of resectable EC after neoadjuvant therapy. OE resulted in a longer hospital stay. Although the rate of successful right RLN node removal was higher with RAE, the clinical relevance for this is yet unclear.

Correlation between morphological parameters and dosimetric parameters of the heart and spinal cord in the intermediate- and advanced-stage esophageal cancer.

Radiation therapy plays a pivotal role as the primary adjuvant treatment for esophageal cancer (EPC), emphasizing the critical importance of carefully balancing radiation doses to the target area and organs at risk in the radiotherapeutic management of esophageal cancer. This study aimed to explore the correlation between morphological parameters and dosimetric parameters of the heart and spinal cord in intermediate- and advanced-stage esophagus cancer to provide a reference for clinical treatment. A total of 105 patients with intermediate- and advanced-stage EPC, who received treatment in our hospital from 2019 to 2021, were included. The morphological parameters were calculated by imaging. Intensity-modulated radiation therapy plan was executed at Raystation4.7. The PTV-G stood for the externally expanded planning target volume (PTV) of the gross tumor volume (GTV) and PTV-C for the externally expanded volume of the clinical target volume (CTV). The prescription dose of PTV-G and PTV-C was set as 60Gy/30F and 54Gy/30F, respectively. The linear regression model was used to analyze the correlation between morphologic parameters of EPC and dosimetric parameters of the heart and spinal cord. In 105 cases, the total lung length was correlated with the spinal cord maximum dose (D2 ). The heart mean doses (Dmean ) and heart V40 (the relative volume that receives 40 Gy or more) was correlated with PTV-G volume, PTV-G length; In middle- and upper-segment EPC cases, only the total lung volume was correlated with the spinal cord Dmean , spinal cord D2 , heart Dmean , and heart V40 ; In middle-stage EPC cases, the heart Dmean was correlated with the PTV-G volume, PTV-G length. The total lung length was correlated with the spinal cord D2 ; In middle- and lower-segment EPC, only the PTV-G volume and PTV-G length were correlated with the heart Dmean . All the aforementioned values were statistically significant. Combined with the unsegmented tumor and different locations, the organ at risk dose was comprehensively considered.

A Meta-Analysis and Review of Radiation Dose Escalation in Definitive Radiation Therapy between Squamous Cell Carcinoma and Adenocarcinoma of Esophageal Cancer

Esophageal cancer, ranked as the eighth most prevalent cancer globally, is characterized by a low survival rate and poor prognosis. Concurrent chemoradiation therapy (CCRT) is the standard therapy in the non-surgical treatment of localized carcinoma of the esophagus. Nevertheless, the radiation doses employed in CCRT remain notably lower compared to the curative definite chemoradiation therapy utilized in the management of other carcinomas. In order to increase the local control rates and enhance the treatment outcomes, several clinical trials have used high-dose radiation to analyze the effect of dose escalation. Despite the integration of technically advanced RT schemes such as intensity-modulated radiation therapy (IMRT), the results of these trials have failed to demonstrate a significant improvement in overall survival or local progression-free survival. In this review, we investigated previous clinical trials to determine the ineffectiveness of radiation dose escalation in the context of CCRT for esophageal cancer. We aim to clarify the factors contributing to the limited efficacy of escalated radiation doses in improving patient outcomes. Furthermore, we delve into recent research endeavors, exploring prospective radiation dose modifications being altered based on the histological characteristics of the carcinoma. The exploration of these recent studies not only sheds light on potential refinements to the existing treatment protocols but also seeks to identify novel approaches that may pave the way for more efficacious and personalized therapeutic strategies for esophageal cancer management.

CRP-albumin-lymphocyte (CALLY) Index Is an Independent Prognostic Factor for the Esophageal Cancer Patients Who Received Curative Treatment.

Perioperative inflammation and the nutritional status affect both short- and long-term oncological outcomes in various malignancies. We clarified the clinical impacts of the CRP-albumin-lymphocyte (CALLY) index in patients with esophageal cancer who received curative treatment. The present study included 180 patients who underwent curative treatment for esophageal cancer between 2005 and 2020. The prognosis and clinicopathological parameters were compared between a high-fibrinogen group and a low-fibrinogen group. The 3- and 5-year overall survival rates were 50.0% and 42.6%, respectively, in the CALLY index-low group, and 75.9% and 66.6% in the CALLY index-high group. The differences between the two groups were statistically significant (p<0.001). Univariate and multivariate analyses demonstrated that the CALLY index was an independent prognostic factor [hazard ratio=2.310, 95% confidence interval=1.416-3.767, p<0.001]. Similar results were observed in recurrence-free survival. When comparing the details of postoperative surgical complications, there was a significant difference in the incidence of anastomotic leakage. The incidence of anastomotic leakage was 40.2% in the CALLY index-low group, while it was 27.5% in the CALLY index-high group (p=0.030). The pretreatment CALLY index is one of the independent prognostic factors for esophageal cancer. The CALLY index might become a promising biomarker for the treatment and management of esophageal cancer.

Impact of the COVID-19 pandemic on esophageal cancer resource allocation: a systematic review.

The coronavirus disease 2019 (COVID-19) pandemic challenged global infrastructure. Healthcare systems were forced to reallocate resources toward the frontlines. In this systematic review, we analyze the impact of resource reallocation during the COVID-19 pandemic on the diagnosis, management, and outcomes of esophageal cancer (EC) patients. PubMed and Embase were systematically searched for articles investigating the impact of the COVID-19 pandemic on EC patients. Of the 1,722 manuscripts initially screened, 23 met the inclusion criteria. Heterogeneity of data and outcomes reporting prohibited aggregate analysis. Reduced detection of EC and considerable variability in disease stage at presentation were noted during the COVID-19 pandemic. EC patients experienced delays in diagnostic and preoperative staging investigations but surgical resection was not associated with greater short-term morbidity or mortality. Modeling the impact of pandemic-related delays in EC care predicts significant reductions in survival with associated economic losses in the coming years. Amidst resource scarcity during the COVID-19 pandemic, the multidisciplinary management of patients with EC was affected at multiple stages in the care pathway. Although the complete ramifications of reductions in EC diagnosis and delays in care remain unclear, EC surgery was able to safely continue as a result of collaboration between centers, strict adherence to COVID-19 protective measures, and reallocation of healthcare resources towards the same. Ultimately, when healthcare systems are pushed to the brink, the downstream consequences of resource reallocation require judicious analysis to optimize overall patient outcomes.

Endoscopic management of superficial esophageal cancers in 2024

Endoscopic management of superficial esophageal cancers in 2024

Complex Resections: Management of Cervical Squamous Cell Carcinoma

Cervical esophageal cancers are rare and generally treated with definitive chemoradiation rather than trimodality therapy due to the need for pharyngolaryngectomy and esophagectomy. However, surgery remains indicated to salvage residual or recurrent disease. We review the management of cervical esophageal cancer and present a case series of complex surgical resection.

Evolution of Treatment Outcomes and Prognostic Factors in Esophageal Cancer Surgery: A Retrospective Analysis of 1500 Consecutive Esophagostomies.

To clarify the surgical outcomes of esophagectomy in Japan and comprehensively evaluate trends over time. It is important to analyze data from a large number of consecutive patients from a single institution. We evaluated the treatment outcomes, complications, and prognosis of 1500 consecutive patients who underwent esophagectomy during 5 periods: group A (n = 284), 1964-1984; group B (n = 345), 1985-1993; group C (n = 253), 1994-2002; group D (n = 297), 2003-2012; and group E (n = 321), 2013-March 2020. The incidences of squamous cell carcinoma and adenocarcinoma were 93.8% and 3.3%, respectively. The proportion of adenocarcinoma cases has gradually increased over time. The in-hospital mortality rates for groups A, B, C, D, and E were 12%, 4.6%, 1.2%, 2.9%, and 1.5%, respectively. Group A had a significantly higher mortality rate than the other groups (P < 0.0001). Three-year survival rates were 22.2%, 47.8%, 53.4%, 69.9%, and 72.6% in groups A-E, respectively, 5-year survival rates were 17.2%, 41.3%, 49.2%, 63.9%, and 68.4%, respectively (P < 0.0001, group A vs groups D and E). The prognosis improved over time. Multivariate analysis revealed that depth of invasion, lymph node metastasis, the extent of lymph node resection, curative resection, pulmonary complications, and anastomotic leakage were significant independent prognostic factors. However, for recent surgeries (groups D and E), only the depth of invasion, lymph node metastasis, and curative resection were significant independent prognostic factors. Valuable changes in background and prognostic factors occurred over time. These findings will help optimize esophageal cancer management and improve patient outcomes.

OGC P45 Complications in patients undergoing robotic-assisted oesophagectomy at a single centre

Abstract Background Robotic-assisted oesophagectomy is increasingly being utilised in the management of oesophageal cancer. The implementation into practice comes with an inevitable learning curve and it is important to ensure that this does not occur at the expense of poor patient outcomes. This study looks at the complications rates from the implementation of a robotics program at a single centre. Methods A retrospective review of a prospectively maintained database of oesophageal cancer patients treated at a single centre was undertaken. The robotic oesophagectomy program commenced October 2019 and all patients undergoing oesophagectomy to June 2023 were identified. Demographics, operative variables, oncological outcomes, and complications were analysed. Type of operation was robotic when at least one phase was robot-assisted, minimally invasive (MIO) when one phase was thoracosopic or laparoscopic and open when both were open. CUSUM analysis was used to determine the effect of a change in anastomotic technique due to a real time observation of an increase in anastomotic leak rate. Results 229 patients underwent oesophagectomy; 67 robotic, 40 MIO and 122 open. Clinical stage, demographics, and CPEX parameters were similar. There were slightly fewer complications in the robotic group overall (robotic 71.6%, MIO 72.5%, Open 74.2%); this was not statistically significant. There were significantly more anastomotic leaks in the robotic group (19.4%) compared to open (12.9%) which was noted in real time and led to a change in anastomotic technique with CUSUM analysis after this showed a diminished anastomotic leak rate (0/9 cases). Chyle leak occurred in 6% of robotic and 4% of open cases, which was not significantly different. Conclusions We found that the outcomes following robotic oesophagectomy were mostly comparable to conventional techniques. Whilst we found no difference in overall complications, there was a significantly higher anastomotic leak rate observed and identified which led to a change in anastomotic technique. Early results from this indicates a significant reduction in anastomotic leakage. It is crucial that all centres adopting the robotic platform closely monitor outcomes in real-time.

OGC P55 The learning curve in robotic-assisted thoracic phase of oesophagectomy

Abstract Background Robotic oesophagectomy has gained increasing prominence in the management of oesophageal cancer, offering potential benefits over open procedures including improved visualisation, enhanced dexterity, and reduced surgical trauma. The adoption of this technique, however, requires navigating a learning curve. As oesophagectomy typically involves two stages, a staggered approach to training and implementation of robotic assistance can be employed. This approach enables surgeons to focus on mastering each phase individually, whilst allowing the completion of the procedure using an established technique. This study investigates the learning curve associated with the thoracic phase during oesophagectomy for a single high-volume surgeon. Methods A prospectively maintained database was used to retrospectively analyse the thoracic phases of the first 40 robotic-assisted oesophagectomies and compare them to 20 open thoracic phase procedures. These cases were sequentially performed by an experienced surgeon at a UK high-volume upper GI tertiary referral centre who had already achieved competence for the robotic abdominal phase. Operating time, blood loss, nodal count, R0 rate and length of stay were reviewed to determine the number of cases required to reach parity with the open procedure. Results There were no significant differences between the two regarding median age, BMI or anaerobic threshold. Operation time (210 vs. 247 minutes) and one lung ventilation time (175 minutes vs. 235 minutes) were significantly longer with robotic surgery, but reported blood loss was significantly less with robotic surgery (350 vs. 100ml) and there was no difference in median node count (34 vs. 35), R0 rate (95 vs. 95%) or length of stay (10 vs. 9 days). No Parameter differences were seen between early cases and later cases. Conclusions The findings of this study demonstrates that although operative time was longer there were comparable outcomes between the robotic and open thoracic phases of oesophagectomy for a single high-volume surgeon. Although progressive improvement in parameters for the robotic-assisted chest phase would be expected as the surgeon acclimated to the procedure, no such changes seen in this dataset. This may indicate that the learning curve in the thoracic phase is flattened in those who have already achieved competence in the robotically-assisted abdominal phase.

Management of esophageal cancer in patients with a right aortic arch or double aortic arch: a case series of 34 cases.

Few cases describing patients with a right aortic arch (RAA) or double aortic arch (DAA) and esophageal cancer (EC) have been reported. We analyzed RAA and DAA cases treated with esophagectomy in our center's database and reported in English-language studies until April 1, 2023. Our study assessed the malformation characteristics and surgical details of EC patients with RAA and DAA. We extracted data of 24 EC patients with RAAs and 10 EC patients with DAAs. In both groups, the patients were more likely to be Japanese and male, to have squamous cell carcinoma and to have tumors located in the upper thoracic esophagus or middle thoracic esophagus. Left thoracotomy was commonly applied for RAA patients. For DAA patients, the proportions of left-sided and right-sided approaches were similar. Esophagectomy under video-assisted thoracoscopic surgery (VATS) in RAA or DAA patients had been performed on a routine basis in recent years. There were two anastomotic leakages in each group. Specifically, Kommerell diverticulum rupture occurred in 1 RAA patient; gastric tube dilation occurred in 1 DAA patient; and recurrent laryngeal nerve (RLN) injury occurred in 2 RAA patients. The postoperative course was uneventful for most patients in both cohorts. Esophageal carcinoma is rarely seen in patients with an RAA or DAA. To adequately dissect superior mediastinal LNs, an auxiliary incision (such as sternotomy), the left door open method or a preceding cervical procedure should be used appropriately. Esophagectomy, whether via thoracotomy or thoracoscopic surgery, can be performed safely for both RAA and DAA.