Impact of the Rapid Recovery Concept on Complications and Patient Quality of Life in the Perioperative Nursing of Robot-Assisted Radical Oesophageal Cancer

Aim: This study evaluates the impact of Enhanced Recovery After Surgery (ERAS) nursing on postoperative complications and quality of life in patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE). Methods: A total of 150 patients who underwent RAMIE from January 2020 to January 2022 at our hospital were randomly assigned to either the observation group or the control group, with 75 patients in each. The control group received standard perioperative management and nursing care, while the observation group was treated with ERAS nursing strategies. Interventions continued until discharge, and outcomes such as postoperative complications, quality of life, and nutritional status were compared between the groups. Results: The observation group exhibited a significantly lower incidence of postoperative adverse reactions compared to the control group (P ionally, all dimension scores of the Short-Form 36 Health Survey (SF-36), including the total score, were higher in the observation group (P < 0.05). Furthermore, the Nutritional Risk Screening (NRS) scores for impaired nutritional status and disease severity, along with the total NRS score, were significantly lower in the observation group compared to the control group (P Conclusion: Implementing ERAS nursing in the perioperative care of patients undergoing RAMIE is associated with reduced postoperative complications and enhanced postoperative quality of life and nutritional status. .

Development and validation of a nomogram for predicting the probability of serious complication in esophageal cancer patients after esophagectomy

Background:Esophagectomy remains a procedure with one of the highest complication rates.This study aimed to develop and validate a model of nomogram for predicting the probability serious postoperative complications for the postoperative esophageal cancer(EC)patients.Methods:An observational study was conducted at Daping Hospital,China,encompassing 529 postoperative EC patients from December 2014 to November 2023.Weintegrated independent prognostic factors to craft a predictivemodel,specifically a nomogram,designed to forecast the risk of severe postoperative complications.Results:The incidence of serious complications for postoperative EC patients was 58.1%.A total of seven variables,including age,gender,bleeding volume during the operation(P=0.035),operating time(P=0.031),the Nutritional Risk Screening 2002(NRS 2002)score(P=0.027),the perioperative nutrition screen(PONS)score(P=0.018),and cystatin C levels(P<0.001),were applied to draw the nomogram of predicting serious complications after esophagectomy.The accuracy of predictive value for the model was quantified by Harrell’s C index at 0.690(95%confidence interval=0.596-0.785,P<0.001).Conclusion:We developed a nomogram system to demonstrate exceptional predictive capabilities for postoperative EC patients in forecasting the risk of serious complications.These results also emphasize the predictive value of the preoperative nutritional risk screening with NRS 2002 and PONS in EC patients undergoing esophagectomy.

Prognosis value of heat-shock proteins in esophageal and esophagogastric cancer:A systematic review and meta-analysis

BACKGROUND Heat shock proteins(HSPs)are molecular chaperones that play an important role in cellular protection against stress events and have been reported to be overex-pressed in many cancers.The prognostic significance of HSPs and their regulatory factors,such as heat shock factor 1(HSF1)and CHIP,are poorly understood.AIM To investigate the relationship between HSP expression and prognosis in esophageal and esophagogastric cancer.METHODS A systematic review was conducted in accordance with PRISMA recommend-ations(PROSPERO:CRD42022370653),on Embase,PubMed,Cochrane,and LILACS.Cohort,case-control,and cross-sectional studies of patients with eso-phagus or esophagogastric cancer were included.HSP-positive patients were compared with HSP-negative,and the endpoints analyzed were lymph node metastasis,tumor depth,distant metastasis,and overall survival(OS).HSPs were stratified according to the HSP family,and the summary risk difference(RD)was calculated using a random-effect model.RESULTS The final selection comprised 27 studies,including esophageal squamous cell carcinoma(21),esophagogastric adenocarcinoma(5),and mixed neoplasms(1).The pooled sample size was 3465 patients.HSP40 and 60 were associated with a higher 3-year OS[HSP40:RD=0.22;95%confidence interval(CI):0.09-0.35;HSP60:RD=0.33;95%CI:0.17-0.50],while HSF1 was associated with a poor 3-year OS(RD=-0.22;95%CI:-0.32 to-0.12).The other HSP families were not associated with long-term survival.HSF1 was associated with a higher probability of lymph node metastasis(RD=-0.16;95%CI:-0.29 to-0.04).HSP40 was associated with a lower probability of lymph node dissemination(RD=0.18;95%CI:0.03-0.33).The expression of other HSP families was not significantly related to tumor depth and lymph node or distant metastasis.CONCLUSION The expression levels of certain families of HSP,such as HSP40 and 60 and HSF1,are associated with long-term survival and lymph node dissemination in patients with esophageal and esophagogastric cancer.

Importance of early detection of esophageal cancer before the tumor progresses too much for effective treatment

This editorial comments on an article by Qu et al published in the World Journal of Gastrointestinal Oncology.It focuses on the importance of early detection of esophageal cancer,including recurrence or secondary malignancy after chemoradiotherapy(CRT).Endoscopic resection is the first choice for treatment for esophageal cancer remaining within the mucous membrane,while surgery or radical CRT are treatment options for advanced stages depending on the patient’s general condition and desire.Although these treatments are potentially curative,they are more invasive than endoscopic resection.Early-stage esophageal cancer is often asymptomatic and difficult to detect.Uniform periodic endoscopy is unrealistic.Although less burdensome tests exist,including liquid biopsy and urinary biomarkers,these have not yet been widely used in clinical practice.Early detection is important after radical CRT because the local recurrence rate is higher than that after surgery.However,endoscopic resection or photodynamic therapy is indicated if detected in the early stages,and positive results have been reported.Early detection of esophageal cancer is crucial.Endoscopy is the main diagnostic method;however,new and less burdensome methods should be established to ensure early treatment for patients with esophageal cancer.

Sporadic gastrinoma with refractory benign esophageal stricture:A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.

Endoscopic submucosal dissection for superficial esophageal neoplasms

Endoscopic submucosal dissection(ESD) is currently accepted as the major treatment modality for superficial neoplasms in the gastrointestinal tract including the esophagus.An important advantage of ESD is its effectiveness in resecting lesions regardless of their size and severity of fibrosis.Based on excellent outcomes for esophageal neoplasms with a small likelihood of lymph node metastasis,the number of ESD candidates has increased.On the other hand,ESD still requires highly skilled endoscopists due to technical difficulties.To avoid unnecessary complications including perforation and postoperative stricture,the indications for ESD require careful consideration and a full understanding of this modality.This article,in the highlight topic series,provides detailed information on the indication,procedure,outcome,complications and their prevention in ESD of superficial esophageal neoplasms.

Endoscopic submucosal tunnel dissection for largesuperficial esophageal squamous cell neoplasms

Endoscopic submucosal dissection(ESD)is a wellestablished treatment for superficial esophageal squamous cell neoplasms(SESCNs)with no risk of lymphatic metastasis.However,for large SESCNs,especially when exceeding two-thirds of the esophageal circumference,conventional ESD is time-consuming and has an increased risk of adverse events.Based on the submucosal tunnel conception,endoscopic submucosal tunnel dissection(ESTD)was first introduced by us to remove large SESCNs,with excellent results.Studies from different centers also reported favorable results.Compared with conventional ESD,ESTD has a more rapid dissection speed and R0 resection rate.Currently in China,ESTD for large SESCNs is an important part of the digestive endoscopic tunnel technique,as is peroral endoscopic myotomy for achalasia and submucosal tunnel endoscopic resection for submucosal tumors of the muscularis propria.However,not all patients with SESCNs are candidates for ESTD,and postoperative esophageal strictures should also be taken into consideration,especially for lesions with a circumference greater than three-quarters.In this article,we describe our experience,review the literature of ESTD,and provide detailed information on indications,standard procedures,outcomes,and complications of ESTD.

Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms

AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

Endoscopic resection is an effective treatment for noninvasive esophageal squamous cell neoplasms(ESCNs).Endoscopic mucosal resection(EMR)has been developed for small localized ESCNs as an alternative to surgical therapy because it shows similar effectiveness and is less invasive than esophagectomy.However,EMR is limited in resection size and therefore piecemeal resection is performed for large lesions,resulting in an imprecise histological evaluation and a high frequency of local recurrence.Endoscopic submucosal dissection(ESD)has been developed in Japan as one of the standard endoscopic resection techniques for ESCNs.ESD enables esophageal lesions,regardless of their size,to be removed en bloc and thus has a lower local recurrence rate than EMR.The development of new devices and the establishment of optimal strategies for esophageal ESD have resulted in fewer complications such as perforation than expected.However,esophageal stricture after ESD may occur when the resected area is larger than three-quarters of the esophageal lumen or particularly when it encompasses the entire circumference;such a stricture requires multiple sessions of endoscopic balloon dilatation.Recently,oral prednisolone has been reported to be useful in preventing post-ESD stricture.In addition,a combination of chemoradiotherapy(CRT)and ESD might be an alternative therapy for submucosal esophageal cancer that has a risk of lymph node metastasis because esophagectomy is extremely invasive;CRT has a higher local recurrence rate than esophagectomy but is less invasive.ESD is likely to play a central role in the treatment of superficial esophageal squamous cell neoplasms in the future.

Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife

AIM To determine short-and long-term outcomes of endoscopic submucosal dissection(ESD) using the stag beetle(SB) knife, a scissor-shaped device.METHODS Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3-and 5-year cumulative overall metachronous cancer rates were also assessed.RESULTS Eligible patients had dysplasia/intraepithelial neoplasia(22%) or early cancers(squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up(mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3-and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for noncurative resections. The 3-and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.CONCLUSION ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short-and long-term outcomes.

Risk factors for Mallory-Weiss Tear during endoscopic submucosal dissection of superficial esophageal neoplasms

BACKGROUND Adverse events during endoscopic submucosal dissection(ESD)of superficial esophageal neoplasms,such as perforation and bleeding,have been welldocumented.However,the Mallory-Weiss Tear(MWT)during esophageal ESD remains under investigation.AIM To investigate the incidence and risk factors of the MWT during esophageal ESD.METHODS From June 2014 to July 2017,patients with superficial esophageal neoplasms who received ESD in our institution were retrospectively analyzed.The clinicopathological characteristics of the patients were collected.Patients were divided into an MWT group and non-MWT group based on whether MWT occurred during ESD.The incidence of MWTs was determined,and the risk factors for MWT were then further explored.RESULTS A total of 337 patients with 373 lesions treated by ESD were analyzed.Twenty patients developed MWTs during ESD(5.4%).Multivariate analysis identified that female sex(OR=5.36,95%CI:1.47-19.50,P=0.011)and procedure time longer than 88.5 min(OR=3.953,95%CI:1.497-10.417,P=0.005)were independent risk factors for an MWT during ESD.The cutoff value of the procedure time for an MWT was 88.5 min(sensitivity,65.0%;specificity,70.8%).Seven of the MWT patients received endoscopic hemostasis.All patients recovered satisfactorily without surgery for the laceration.CONCLUSION The incidence of MWTs during esophageal ESD was much higher than expected.Although most cases have a benign course,fatal conditions may occur.We recommend inspection of the stomach during and after the ESD procedure for timely management in cases of bleeding MWTs or even perforation outside of the procedure region.

Combination of concurrent endoscopic submucosal dissection and modified peroral endoscopic myotomy for an achalasia patient with synchronous early esophageal neoplasms

with an increased risk for developing esophageal squamous cell carcinoma. In our paper, we introduced an achalasia patient combined with synchronous early esophageal neoplasms. We performed a combination of concurrent endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM). No complications other than postoperative pain that needed morphine treatment for two days had occurred. Dysphagia was significantly improved. Neither reflux nor cough occurred. The short-term efficacy and safety of our case is favorable and suggests that concurrent ESD and POEM could be a treatment option to such patients.

Nomogram for predicting early complications after distal gastrectomy

BACKGROUND Reducing or preventing postoperative morbidity in patients with gastric cancer(GC)is particularly important in perioperative treatment plans.AIM To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model.METHODS This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023.The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis.Based on the results obtained,a predictive nomogram was established.The nomogram was validated using internal and external(n=45)datasets.Its sensitivity and specificity were established by receiver operating characteristic curve analysis.Decision curve(DCA)analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability.RESULTS Multivariate logistic regression analysis showed that hypertension,diabetes,history of abdominal surgery,and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy.The modeling and validation sets showed that the area under the curve was 0.843[95%confidence interval(CI):0.746-0.940]and 0.877(95%CI:0.719-1.000),the sensitivity was 0.762 and 0.778,respectively,and the specificity was 0.809 and 0.944,respectively,indicating that the model had good sensitivity and specificity.The C-indexes of the modeling and validation datasets were 0.843(95%CI:0.746-0.940)and 0.877(95%CI:0.719-1.000),respectively.The calibration curve(Hosmer Lemeshow test:χ^(2)=7.33)showed that the model had good consistency.The results of the DCA analysis indicated that this model offered good clinical benefits.The accuracy of 10-fold cross-validation was 0.878,indicating that the model had good accuracy and stability.CONCLUSION The nomogram prediction model based on independent risk factors related to postoperative complications of distal gastrectomy can facilitate perioperative intervention for high-risk populations and reduce the incidence of postoperative complications.

Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy

AIM： To investigate the incidence of various types of postoperative pulmonary complications （POPCs） and to evaluate the significance of perioperative arterial blood gases in patients with esophageal cancer accompanied with chronic obstructive pulmonary disease （COPD） after esophagectomy. MEHTODS： Three hundred and fifty-eight patients were divided into POPC group and COPD group. We performed a retrospective review of the 358 consecutive patients after esophagectomy for esophageal cancer with or without COPD to assess the possible influence of COPD on postoperative pulmonary complications. We classified COPD into four grades according to percent-predicted forced expiratory volume in 1 s （FEV1） and analyzed the incidence rate of complications among the four grades. Perioperative arterial blood gases were tested in patients with or without pulmonary complications in COPD group and compared with POP（： group. RESULTS： Patients with COPD （29/86, 33.7%）had more pulmonary complications than those without COPD （36/272, 13.2%） （P〈0.001）. Pneumonia （15/29, 51.7%）, atelectasis （13/29, 44.8%）, prolonged 02 supplement （10/29, 34.5%）, and prolonged mechanical ventilation （8/29, 27.6%） were the major complications in COPD group. Moreover, patients with severe COPD （grade Ⅱ B, FEV1 〈 50% of predicted） had more POPCs than those with moderate（gradeⅡA,50%-80% of predicted） and mild （grade Ⅰ≥80% of predicted） COPD （P〈0.05）. PaO2 was decreased and PaCO2 was increased in patients with pulmonary complications in COPD group in the first postoperative week.CONCLUSION： The criteria of COPD are the critical predictor for pulmonary complications in esophageal cancer patients undergoing esophagectomy. Severity of COPD affects the incidence rate of the pulmonary complication,and percent-predicted FEV1 is a good predictive variable for pulmonary complication in patients-with COPD.Arterial blood gases are helpful in directing perioperative management.

Rare complication of percutaneous endoscopic gastrostomy: Ostomy metastasis of esophageal carcinoma

The authors present the case of a 55-year-old male with a stage Ⅲ(T4N1M0) squamous-cell esophageal carcinoma, who underwent percutaneous endoscopic gastrostomy(PEG). The pull method of tube placement was used. Five months after the procedure, the patient was referred to the hospital with a hard palpable tumour at the ostomy site. The hystologic exam revealed an abdominal wall metastasis of the esophageal cancer. The authors present this case because of the rarity of metastasis in ostomy after placement of PEG in patients with tumours located in the head and neck. In this particular context and judging by the rarity of situation, the clinical impact of this phenomenom is limited. Nevertheless, metastasis in ostomy site could be prevented by the push method, laparoscopy or laparotomy.

Stent type used does not impact complication rate or placement time but can decrease treatment cost for benign and malignant esophageal lesions

AIM: To evaluate if differences exist between selfexpanding esophageal metal stents(SEMS) and selfexpanding esophageal plastic stents(SEPS) when used for benign or malignant esophageal disorders with regard to safety, efficacy, clinical outcomes, placement ease and cost.METHODS: A retrospective analysis was performed to evaluate outcome in patients having SEPS/SEMS placed for malignant or benign esophageal conditions from January 2005 to April 2012. Inclusion criteria was completed SEMS/SEPS placement. Outcomes assessed included technical success of and time required for stent placement, procedure-related complications, need for repeat intervention, hospital stay, mortality and costs.RESULTS: Forty-three patients underwent stent placement for either benign/malignant esophagealdisease during the study period. Thirty patients had SEMS(25 male, mean age 59.6 years old) and 13 patients had SEPS(10 male, mean age 61.7 years old). Placement outcome as well as complication rate(SEPS 23.1%, SEMS 25.2%) and in-hospital mortality(SEPS 7.7%, SEMS 6.7%) after placement did not differ between stent types. Migration was the most frequent complication reported occurring equally between types(SEPS 66.7%, SEMS 57.1%). SEPS was less costly than SEMS, decreasing institutional cost by $255/stent.CONCLUSION: SEPS and SEMS have similar outcomes when used for benign or malignant esophageal conditions. However, SEPS use results in decreased costs without impacting care.

Clinical Application of Exclusive Right-Thoracic Approach in Surgery with or without Laparotomy for Mid-Upper Esophageal Cancer

OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure （Group A） from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure （Group B） from May 2001 to April 2007. RESULTS Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach （Belsey surgery）, and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy （modified IvorLewis surgery）. The complication rate was 15% （3/20） and 7.1% （1/14） respectively. The survival rate was 42.9% （5-year survival） and 38.7% （5-year survival） respectively for these two groups. CONCLUSION An exclusive right-thoracic approach （Belsey surgery） is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have midupper esophagus cancer.

Correlation between c-erbB-2 and P-glycoprotein Expression in Esophageal Carcinoma

Objective： To investigate the correlation between c-erbB-2 and multidrug resistance （MDR） and its clinical significance, Methods： Immunohistochemistry stain was used to examine the expression of c-erbB-2 and flow cytometry was used to detect the expression of P-glycoprotein （P-gp） in samples from 46 patients with esophageal carcinoma. Results： The positive expression rate of c-erbB-2 was 26.1% （12/46） in the 46 cases of esophageal carcinoma, of which 4 cases being low expression and 8 cases mediumhigh expression. The positive expression rate of P-gp was 60.9% （28/46） in the 46 cases of esophageal carcinoma, of which 6 cases being low expression, 13 cases medium expression and 9 cases high expression. Comparing c-erbB-2 with P-gp expression in different lymph node metastasis statuses showed that there was significant difference （P〈0.01） between P-gp expressions with lymph node metastasis （31.09%±5.33%） and without lymph node metastasis （8.04%±3.03%） when c-erbB-2 expression was positive. Comparing c-erbB-2 with P-gp expression in different TNM stages of esophageal carcinoma showed that there was significant difference （P〈0.01） between P-gp expressions in HI Ⅳ stage （33.68%±5.51%）and in Ⅱ stage patients （9.30%±2.78%） when c-erbB-2 expression was positive. The tumor＇s size and differentiation degree were not related to c-erbB-2 and P-gp expression. Conclusion： The high level of P-gp expression was related to the positive expression of c-erbB-2 with the lymph node metastasis in clinical Ⅲ-Ⅳ stage patients of esophageal carcinoma, suggesting that the double positive might lead to a poor prognosis. However, when the c-erbB-2 expression was negative, the lymph node metastasis and clinical staging were not related to the P-gp expression in esophageal carcinoma patients.

Epidemiology of esophageal cancer

Esophageal cancer(EsC)is one of the least studied and deadliest cancers worldwide because of its extremely aggressive nature and poor survival rate.It ranks sixth among all cancers in mortality.In retrospective studies of EsC,smoking,hot tea drinking,red meat consumption,poor oral health,low intake of fresh fruit and vegetables,and low socioeconomic status have been associated with a higher risk of esophageal squamous cell carcinoma.Barrett’s esophagus is clearly recognized as a risk factor for EsC,and dysplasia remains the only factor useful for identifying patients at increased risk,for the development of esophageal adenocarcinoma in clinical practice.Here,we investigated the epidemiologic patterns and causes of EsC.Using population based cancer data from the Surveillance,Epidemiology and End Results Program of the United States;we generated the most up-to-date stage distribution and 5-year relative survival by stage at diagnosis for 1998-2009.Special note should be given to the fact that esophageal cancer,mainly adenocarcinoma,is one of the very few cancers that is contributing to increasing death rates(20%)among males in the United States.To further explore the mechanism of development of EsC will hopefully decrease the incidence of EsC and improve outcomes.

Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma

AIM:To investigate the role of neoadjuvant chemoradiotherapy in prognosis and surgery for esophageal carcinoma by a meta-analysis.METHODS:PubMed and manual searches were done to identify all published randomized controlled trials(RCTs) that compared neoadjuvant chemoradiotherapy plus surgery(CRTS) with surgery alone(S) for esophageal cancer.According to the test of heterogeneity,a fi xed-effect model or a random effect model was used and the odds ratio(OR) was the principal measure of effects.RESULTS:Fourteen RCTs that included 1737 patients were selected with quality assessment ranging from A to C(Cochrane Reviewers' Handbook 4.2.2).OR(95% CI,P value),expressed as CRTS vs S(values>1 favor CRTS arm),was 1.19(0.94-1.48,P=0.28) for 1-year survival,1.33(1.07-1.65,P=0.69) for 2-year survival,1.76(1.42-2.19,P=0.11) for 3-year survival,1.41(1.06-1.87,P=0.11) for 4-year survival,1.64(1.28-2.12,P=0.40) for 5-year survival,0.82(0.39-1.73,P<0.0001) for rate of resection,1.53(1.33-2.84,P=0.007) for rate of complete resection,1.78(1.14-2.78,P=0.79) for operative mortality,1.12(0.89-2.48,P=0.503) for all treatment mortality,1.33(0.94-1.88,P=0.04) for the rate of adverse treatment,1.38(1.23-1.63,P=0.0002) for local-regional cancer recurrence,1.28(0.85-1.58,P=0.60) for distant cancer recurrence,and 1.27(0.86-1.65,P=0.19) for all cancer recurrence.A complete pathological response to chemoradiotherapy occurred in 10%-45.5% of patients.The 5-year survival benefi t was most pronounced when chemotherapy and radiotherapy were given concurrently(OR:1.45,95% CI:1.26-1.79,P=0.015) instead of sequentially(OR:0.85,95% CI:0.64-1.35,P=0.26).CONCLUSION:Compared with surgery alone,neoadjuvant chemoradiotherapy can improve the long-term survival and reduce local-regional cancer recurrence.Concurrent administration of neoadjuvant chemoradiotherapy was superior to sequential chemoradiotherapy.