Esophagus最新文献

Background: Surveillance endoscopy is recommended after endoscopic resection of esophageal squamous cell carcinomas (ESCCs). However, surveillance endoscopy sometimes detects advanced subsequent ESCCs with invasion of the muscularis mucosa (MM) or deeper. We aimed to clarify the clinicopathological features of these advanced subsequent ESCCs.

Methods: This single-center retrospective study identified subsequent ESCCs detected during surveillance endoscopy. ESCCs that invaded the MM or deeper and were detected within 24 months after the previous endoscopy were defined as post-endoscopy esophageal advanced lesions (PEEALs), while the first ESCC detected in the patient was defined as the primary lesion. Study 1 compared the clinicopathological characteristics of PEEALs versus non-advanced lesions. Study 2 compared the endoscopic features of pT1a-MM PEEALs versus pT1a-MM primary lesions.

Results: A total of 307 subsequent ESCCs were analyzed in Study 1. Of these, 20 were PEEALs and 287 were non-advanced lesions (pT1a-EP/LPM). The median intervals from the previous endoscopy for PEEALs and non-advanced lesions were 6.1 months and 6.7 months, respectively (P = 0.283). The morphological feature of marginal elevation was seen in 60% of PEEALs. In Study 2, 15 pT1a-MM PEEALs were compared with 149 pT1a-MM primary lesions. Compared with primary lesions, pT1a-MM PEEALs were smaller (median 10 mm vs. 30 mm, P < 0.001) and had a higher prevalence of marginal elevation morphology (53.3% vs. 10.1%, P < 0.001).

Conclusions: The specific feature of PEEALs was marginal elevation. Surveillance endoscopy with careful observation for these lesions is recommended after endoscopic resection of ESCCs.

Background:  The occurrence of a gastrointestinal-airway fistula after esophageal cancer surgery is a serious and fatal complication that can cause severe respiratory complications. It is a pathological condition requiring prompt intervention to avoid a fatal course. Conventionally, highly invasive surgical treatment has been selected for the treatment for gastrointestinal-airway fistula, but its difficulty and mortality risk cannot be neglected. Esophageal stent placement is useful as a nonoperative management for gastrointestinal-airway fistulas, but the success rate of fistula closure is not that high. Hence, an effective method that can solve technical problems to avoid intervention-related complications and increases the success rate of fistula closure by stent placement needs to be developed. We have achieved better results with our unique ingenuity for the management of esophageal stent placement; thus, we aimed to describe the details of the management methods.

Methods: Our technique used in stent placement included endoscopic insertion of the self-expandable metallic stent and the fixation of the stent with a nylon thread and a transnasal catheter on the face. With this ingenuity, it becomes possible to reduce stent migration, and an easy and quick adjustment of its position in case of stent migration can be possible.

Results: We have experienced successfully cured cases with our novel technique [five of seven cases (71.4%)] with a minimum indwelling period.

Conclusions: Our technique is feasible for use in the management of gastrointestinal-airway fistula after esophageal cancer surgery.

Background: Barrett's esophagus (BE) is a known precursor of esophageal adenocarcinoma (EAC). EAC is comparatively rare in Japan compared to Western countries, where BE management guidelines have been well established based on robust evidence. This study evaluated for gaps between evidence-based medicine (EBM) and real-world clinical practice for BE management in Japan and examined endoscopist adherence to Japanese and Western guidelines.

Methods: A nationwide survey consisting of 19 questions was conducted among Japanese endoscopists to assess their diagnostic and surveillance practices for BE. Descriptive statistics and multivariate logistic regression analysis were employed to interpret key data.

Results: Responses from 804 endoscopists revealed significant differences between Western guidelines and Japanese practices. Local adherence to standardized inspection times was 7.6%, and 30.7% of endoscopists used the Prague classification. Biopsies for BE diagnosis and random biopsies following the Seattle protocol were rarely performed. For long-segment BE, 51.4% of respondents reported using magnifying endoscopy. Regarding ultra-short-segment BE (USSBE), opinions were divided on whether it should be diagnosed as BE and if patients should be informed of its diagnosis. Approximately 40% of respondents advocated annual surveillance for USSBE, with a general tendency to recommend closer follow-up regardless of BE length as compared with Western guidelines.

Conclusions: This survey highlighted several incongruities between EBM and real-world practices for BE, as well as differences between Western and Japanese approaches. Bridging these gaps will require generating more Japan-specific evidence, refining guidelines, and then promoting their dissemination to harmonize best BE practices with international standards and Japanese clinical settings.

Background: Advancements in esophageal cancer treatment have not substantially reduced the high recurrence rate and poor survival outcomes following esophagectomy; however, patients with oligometastasis may benefit from aggressive local treatments.

Methods: We performed curative esophagectomy in 714 patients with esophageal squamous cell carcinoma between 2007 and 2022. In total, 206 patients with recurrent lesions were enrolled in this study. Oligometastasis was defined as ≤ 5 lesions in a single organ or lymph node station. Treatments included surgery, chemoradiotherapy (CRT), chemotherapy, and radiotherapy. Disease-specific survival (DSS) was defined as the time from the initial recurrence to disease-related death or the last observation.

Results: Among the patients, 109 had oligometastasis, most commonly in the lymph nodes (N = 84), followed by the lung (N = 8) and liver (N = 7). The DSS rate in patients with oligometastasis (5-year DSS: 37.5%) was significantly higher than that in patients with multiple metastases (3.3%) (P < 0.001). Metastatic lesions are more likely to be oligometastatic when a disease-free interval (DFI) is prolonged. In the oligometastasis cohort, surgery or CRT was associated with significantly improved survival outcomes, particularly among patients with a DFI of less than 9 months. The selection of treatment modalities was significantly influenced by the patient's performance status (PS), with better PS being associated with a greater likelihood of receiving surgery or CRT.

Conclusion: Aggressive local treatment should be considered for oligometastasis after esophagectomy to improve long-term survival. A good PS after esophagectomy is crucial for the effective treatment of oligometastatic lesions.

Purpose: This study evaluates the outcomes of transhiatal colon bypass, with or without esophagectomy, as a surgical intervention for esophageal replacement in pediatric patients with severe corrosive esophageal strictures, focusing on safety, complications, and long-term functional outcomes.

Materials and methods: A retrospective analysis was conducted on pediatric patients who underwent transhiatal colon bypass between 2016 and 2019. The study included cases both with and without simultaneous esophagectomy. Standardized follow-up protocols were used to monitor complications, mortality, and long-term outcomes.

Results: Ten pediatric patients were included, with seven undergoing esophagectomy as part of the transhiatal colon bypass. The esophagectomy group had a significantly longer operative time (6.0 ± 0.7 h vs. 5.0 ± 0.4 h, p = 0.02). Intraoperative complications included vagus nerve injury (2 cases) and one intraoperative death. Postoperative issues included pneumonia (2 cases) and anastomotic leaks (2 cases). Long-term complications included anastomotic strictures and one case of intestinal obstruction. Despite these complications, both groups showed normal growth and good functional outcomes, with no significant differences in manometric results (p = 1.00).

Conclusion: Transhiatal colon bypass is a safe and effective option for esophageal replacement in pediatric patients with corrosive esophageal strictures. While esophagectomy increases surgical complexity and risks, it may be necessary in cases where the native esophagus poses long-term risks. Intraoperative assessment is crucial in deciding whether to include esophagectomy.

Background: Preoperative treatment has become widely recognized for improving survival in patients with esophageal cancer. The present study aimed to compare the prognosis between patients with pathological node-negative status treated with surgery alone (SA-pN0) and those who were clinically node-positive but converted to ypN0 following neoadjuvant chemotherapy (NAC-ypN0) in cases of advanced thoracic esophageal squamous cell carcinoma (ESCC).

Methods: This retrospective analysis used a multicenter database of 4849 consecutive patients who underwent treatment for esophageal cancer. Patients with clinical T2 or more advanced ESCC who underwent standard subtotal esophagectomy between 1990 and 2017 were included. The NAC-ypN0 group was compared with the SA-pN0 group in terms of patient characteristics, recurrence patterns, and survival outcomes using propensity score-matched analysis.

Results: In total, 109 patients were classified as NAC-ypN0 and 137 as SA-pN0. Propensity score matching resulted in the selection of 87 patients per group. Compared with the SA-pN0 group, the NAC-ypN0 group had a significantly more advanced clinical TNM stage and underwent significantly more three-field lymphadenectomies. Pathological findings showed downstaging of the pT stage in the NAC-ypN0 group, resulting in an equivalent distribution between the two groups. Additionally, the NAC-ypN0 group had significantly lower rates of lymphatic invasion (33% vs. 56%) and venous invasion (21% vs. 52%). Recurrence rates (21% vs. 22%) and survival outcomes (5-year overall survival: 83.9% vs. 76.1%, P = 0.110) were comparable between the two groups.

Conclusions: The NAC-ypN0 group demonstrated reduced lymphovascular invasion and showed a prognosis comparable to that of the SA-pN0 group.

Background: Detecting pathological complete response (pCR) preoperatively facilitated a non-surgical approach after neoadjuvant chemotherapy (NAC). We previously developed a deep neural network-based endoscopic evaluation to determine pCR preoperatively. Its quality warrants improvement with a larger data series for clinical application.

Methods: This study retrospectively reviewed patients with esophageal squamous cell carcinoma (ESCC) receiving NAC at 46 Japanese esophageal centers certified by the Japan Esophageal Society. Endoscopic images after NAC were collected with clinicopathological factors and long-term outcomes. We randomly selected the same number of patients with Grades 0-1a and Grades 1b-2 based on those with pCR (Grade 3). A deep neural network was used for endoscopic image analyses. A test data set, consisting of 100 photos, was utilized for validation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the deep neural network-based model and experienced physicians were calculated.

Results: The study enrolled 1041 patients, including 354 (33%) patients with pCR, the same number of histological non-responders (Grade 0-1a/1b-2, 352 [33%]/368 [34%]). The median values of sensitivity, specificity, PPV, NPV, and accuracy for pCR detection were 80%, 90%, 89%, 82%, and 85%, respectively. The patients with pCR preoperatively demonstrated significantly better overall survival and recurrence-free survival.

Conclusions: This large-scale study revealed that the deep neural network-based endoscopic evaluation after NAC identified pCR with feasible accuracy. The current artificial intelligence technology may guide an individualized treatment strategy, including a non-surgical approach, in patients with ESCC through prospective studies with careful external validation.

Background and purpose: It remains unclear whether the lymph-node ratio (LNR) is a relevant factor for the risk of recurrence following neoadjuvant chemotherapy (nCT) with docetaxel, cisplatin, and 5-fluorouracil (DCF), which is a new standard of care for locally advanced esophageal squamous cell carcinoma (ESCC) in Japan. This study aimed to evaluate the clinical utility of LNR as a risk factor for recurrence.

Materials and methods: We retrospectively analyzed 75 patients who underwent nCT-DCF followed by curative surgery for resectable ESCC. The cut-off for the LNR was determined using receiver-operating characteristic curve analysis for recurrence.

Results: A higher LNR was observed in 34 (45.3%) patients. At a median follow-up of 19.2 months, the median disease-free survival (DFS)/recurrence-free survival (RFS) rate was not reached in patients with a lower LNR and was 8.0 months in those with a higher LNR (P < 0.01). The estimated 1-year DFS/RFS rate was 47.8% and 100% for patients with a higher LNR and lower LNR, respectively. LNR remained a risk factor, even when stratified by non-pathological complete response, the presence of positive ypN, or ypStage III. In those with a higher LNR, the median DFS/RFS was 18.3 versus 8.0 months with and without adjuvant nivolumab treatment, respectively.

Conclusions: Higher LNR indicates a more aggressive phenotype with worse DFS/RFS rates and increased recurrence following nCT-DCF treatment and curative surgery for ESCC.

Background: Minimally invasive esophagectomy for esophageal cancer has become increasingly common to reduce postoperative pneumonia. However, the usefulness of pure laparoscopic abdominal manipulation without an upper abdominal incision remains unclear.

Methods: We evaluated the utility of pure laparoscopic surgery (LAP) vs. hand-assisted laparoscopic surgery (HALS) in esophagectomy. A total of 344 consecutive patients who underwent curative esophagectomy for esophageal cancer from 2019 to 2023 were enrolled; 235 patients were treated with HALS and 109 with LAP. The peri- and postoperative outcomes were compared between the two groups using a propensity score-matched analysis.

Results: Propensity score matching was used to compare 92 patients each in the HALS and LAP groups. Clinicopathological characteristics did not differ between the two groups. The incidence of postoperative pneumonia was significantly higher in the HALS group than in the LAP group (30% vs. 11%, respectively; P = 0.001). Multivariate logistic analysis showed that HALS was independently associated with postoperative pneumonia (odds ratio 3.82, P = 0.002), along with older age and male sex.

Conclusions: LAP may reduce the incidence of postoperative pneumonia in esophageal cancer patients who undergo esophagectomy.

Esophageal squamous cell carcinoma (ESCC) is a prevalent and highly lethal malignancy in Asia. Recent advancements in immune checkpoint inhibitors (ICIs) have markedly transformed the systemic therapy landscape for ESCC. Anti-PD-1-based combination with chemotherapy or with ipilimumab, an anti-CTLA-4 antibody, have been established as the new standard first-line treatments for patients with advanced ESCC. Moreover, anti-PD-1 monotherapy has demonstrated improved efficacy and survival compared with second-line chemotherapy in previously treated patients with ESCC. Novel ICIs targeting other immune checkpoints also show potential for enhancing anticancer therapy in advanced ESCC.The TIGIT/PVR pathway represents a new immune checkpoint. Preclinical studies have indicated that the dual blockade of TIGIT and PD-1 can enhance antitumor immune responses. Clinical trials have reported that combining anti-TIGIT with anti-PD-1/PD-L1 antibodies elicited clinical responses in patients with advanced ESCC. In the first-line systemic therapy setting, combinations of dual ICIs targeting TIGIT and PD-1/PD-L1 plus platinum-based chemotherapy have demonstrated acceptable toxicity profiles and promising antitumor activity in several phase II trials and one phase III study. However, the role of adding an anti-TIGIT antibody to the current standard of anti-PD-1/PD-L1 plus platinum-based chemotherapy in first-line therapy for advanced ESCC remains to be fully determined, necessitating further clinical trials. Ongoing studies are also investigating the role of anti-TIGIT, with or without anti-PD-1/PD-L1, in locoregional ESCC. Additional research is essential to optimize the potential of anti-TIGIT therapy in ESCC and other malignancies by identifying predictive biomarkers, determining optimal antibody types, and gaining key mechanistic insights.