Background: The association between recurrence timing and prognosis in patients with locally advanced resectable esophageal cancer undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy remains unclear. This study aimed to clarify this association using multicenter prospective clinical trial data.
Methods: Among 162 patients enrolled in a NAC phase II study comparing the efficacy of cisplatin and fluorouracil plus docetaxel with cisplatin and fluorouracil plus adriamycin, 64 patients with recurrence after R0 resection were included in this study. We evaluated the association between recurrence timing and overall survival after recurrence (OSr), along with clinicopathological factors associated with recurrence timing and OSr.
Results: Among 64 patients, 46 (71.9%) and 59 (92.2%) experienced recurrence within 1 and 2 years after surgery, respectively. Groups based on recurrence timing, including ≤ 6, 6-12, and > 12 months, had median OSr of 3.6, 13.9, and 13.4 months, respectively. The prognosis was significantly poorer for patients with recurrence ≤ 6 months after surgery than for other patients (P < 0.001). Multivariate analysis revealed pathological lymph node staging as an independent factor associated with early recurrence (odds ratio: 3.46, 95% confidence interval: 1.47-8.02, P = 0.0045). On the other hand, multivariate analysis for factors associated with OSr revealed pT (hazard ratio [HR]: 1.91, 95%CI 1.26-2.88, P = 0.0022), early recurrence (HR: 6.88, 95%CI 2.68-17.6, P < 0.001), and treatment after recurrence, with both local treatment (HR: 0.47, 95%CI 0.22-0.98, P = 0.043) and chemotherapy (HR: 0.25, 95%CI 0.11-0.58, P = 0.0011) as independent prognostic factors.
Conclusion: Patients with advanced esophageal cancer experiencing recurrence within 6 months after esophagectomy following NAC have an extremely poor prognosis, suggesting that an advanced pN stage is associated with early recurrence.
{"title":"The impact of time to postoperative recurrence on the prognosis of patients with esophageal cancer post recurrence: exploratory analysis of OGSG 1003.","authors":"Soshi Hori, Makoto Yamasaki, Nobuyuki Yamamoto, Takashi Harino, Kota Momose, Kotaro Yamashita, Koji Tanaka, Keijiro Sugimura, Tomoki Makino, Atsushi Takeno, Osamu Shiraishi, Masaaki Motoori, Hiroshi Miyata, Yutaka Kimura, Motohiro Hirao, Takushi Yasuda, Masahiko Yano, Yuichiro Doki","doi":"10.1007/s10388-024-01070-y","DOIUrl":"10.1007/s10388-024-01070-y","url":null,"abstract":"<p><strong>Background: </strong>The association between recurrence timing and prognosis in patients with locally advanced resectable esophageal cancer undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy remains unclear. This study aimed to clarify this association using multicenter prospective clinical trial data.</p><p><strong>Methods: </strong>Among 162 patients enrolled in a NAC phase II study comparing the efficacy of cisplatin and fluorouracil plus docetaxel with cisplatin and fluorouracil plus adriamycin, 64 patients with recurrence after R0 resection were included in this study. We evaluated the association between recurrence timing and overall survival after recurrence (OSr), along with clinicopathological factors associated with recurrence timing and OSr.</p><p><strong>Results: </strong>Among 64 patients, 46 (71.9%) and 59 (92.2%) experienced recurrence within 1 and 2 years after surgery, respectively. Groups based on recurrence timing, including ≤ 6, 6-12, and > 12 months, had median OSr of 3.6, 13.9, and 13.4 months, respectively. The prognosis was significantly poorer for patients with recurrence ≤ 6 months after surgery than for other patients (P < 0.001). Multivariate analysis revealed pathological lymph node staging as an independent factor associated with early recurrence (odds ratio: 3.46, 95% confidence interval: 1.47-8.02, P = 0.0045). On the other hand, multivariate analysis for factors associated with OSr revealed pT (hazard ratio [HR]: 1.91, 95%CI 1.26-2.88, P = 0.0022), early recurrence (HR: 6.88, 95%CI 2.68-17.6, P < 0.001), and treatment after recurrence, with both local treatment (HR: 0.47, 95%CI 0.22-0.98, P = 0.043) and chemotherapy (HR: 0.25, 95%CI 0.11-0.58, P = 0.0011) as independent prognostic factors.</p><p><strong>Conclusion: </strong>Patients with advanced esophageal cancer experiencing recurrence within 6 months after esophagectomy following NAC have an extremely poor prognosis, suggesting that an advanced pN stage is associated with early recurrence.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"472-483"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Recently, the incidence of achalasia has been increasing, but its cause remains unknown. This study aimed to examine the initial symptoms and the course of symptoms and to find new insights into the cause and course of the disease.
Methods: Altogether, 136 patients diagnosed with achalasia by high-resolution manometry (HRM) were enrolled. Questionnaires and chart reviews were conducted to investigate the initial symptoms, time from onset to diagnosis, and comorbidities, as well as the relationship between HRM results, time to diagnosis, and symptom severity.
Results: In total, 67 of 136 patients responded to the questionnaire. The median ages of onset and diagnosis were 42 and 58 years, respectively. The median time from onset to diagnosis was 78.6 months, with 25 cases (37.3%) taking > 10 years to be diagnosed. The symptom onset was gradual and sudden in 52 (77.6%) and 11 (16.4%) patients, respectively. Of the 11 patients with acute onset, three (27.3%) developed anhidrosis at the same time. There was no correlation between the time from onset to diagnosis and esophageal dilatation, resting LES pressure, or mean integrated relaxation pressure (IRP). No correlation was also found between the degree of symptoms and resting LES pressure or IRP.
Conclusion: Esophageal achalasia can have acute or insidious onsets. This finding may help to elucidate the cause of achalasia.
{"title":"Two onset types of achalasia and the long-term course to diagnosis.","authors":"Akane Kurosugi, Tomoaki Matsumura, Michiko Sonoda, Tatsuya Kaneko, Satsuki Takahashi, Kenichiro Okimoto, Naoki Akizue, Yuhei Ohyama, Yukiyo Mamiya, Hayato Nakazawa, Ryosuke Horio, Chihiro Goto, Yuki Ohta, Takashi Taida, Atsuko Kikuchi, Mai Fujie, Kentaro Murakami, Masaya Uesato, Yoshihito Ozawa, Jun Kato, Hisahiro Matsubara, Naoya Kato","doi":"10.1007/s10388-024-01069-5","DOIUrl":"10.1007/s10388-024-01069-5","url":null,"abstract":"<p><strong>Background: </strong>Recently, the incidence of achalasia has been increasing, but its cause remains unknown. This study aimed to examine the initial symptoms and the course of symptoms and to find new insights into the cause and course of the disease.</p><p><strong>Methods: </strong>Altogether, 136 patients diagnosed with achalasia by high-resolution manometry (HRM) were enrolled. Questionnaires and chart reviews were conducted to investigate the initial symptoms, time from onset to diagnosis, and comorbidities, as well as the relationship between HRM results, time to diagnosis, and symptom severity.</p><p><strong>Results: </strong>In total, 67 of 136 patients responded to the questionnaire. The median ages of onset and diagnosis were 42 and 58 years, respectively. The median time from onset to diagnosis was 78.6 months, with 25 cases (37.3%) taking > 10 years to be diagnosed. The symptom onset was gradual and sudden in 52 (77.6%) and 11 (16.4%) patients, respectively. Of the 11 patients with acute onset, three (27.3%) developed anhidrosis at the same time. There was no correlation between the time from onset to diagnosis and esophageal dilatation, resting LES pressure, or mean integrated relaxation pressure (IRP). No correlation was also found between the degree of symptoms and resting LES pressure or IRP.</p><p><strong>Conclusion: </strong>Esophageal achalasia can have acute or insidious onsets. This finding may help to elucidate the cause of achalasia.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"546-551"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141283364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Programmed cell death-1 (PD-1) blockade improves survival in patients with advanced esophageal squamous cell carcinoma (ESCC). However, the efficacy of taxanes after exposure to PD-1 blockade remains unclear in patients with advanced ESCC.
Methods: We retrospectively analyzed the clinical outcomes of advanced ESCC patients treated with taxanes (paclitaxel or docetaxel) with/without prior exposure to PD-1 blockade (Exposed /Naïve group) at National Cancer Center Hospital from June 2016 to December 2020.
Results: Ninety-nine patients (Exposed group, n = 32; Naïve group, n = 67) were included. The objective response rate (ORR) of the Exposed group was significantly higher than that of the Naïve group (37.5% vs. 13.4%, p = 0.009). The median progression-free survival was similar between the Exposed and Naïve groups (3.8 vs. 2.8 months, HR 1.12, 95% CI 0.65-1.86, p = 0.66). PD-1 blockade exposure independently predicated higher ORR to taxanes in multivariate analysis. Grade ≥ 3 adverse events were comparable between the Exposed and Naïve groups (45.8% vs. 40.3%, p = 0.64).
Conclusions: Taxanes following PD-1 blockade in advanced ESCC showed a higher ORR but similar PFS compared to taxanes without prior PD-1 exposure.
背景:程序性细胞死亡-1(PD-1)阻断可提高晚期食管鳞状细胞癌(ESCC)患者的生存率。然而,晚期ESCC患者在接受PD-1阻断治疗后使用紫杉类药物的疗效仍不明确:我们回顾性分析了2016年6月至2020年12月期间国立癌症中心医院接受紫杉类药物(紫杉醇或多西他赛)治疗的晚期ESCC患者的临床结果,这些患者之前接受过/未接受过PD-1阻断剂治疗(暴露组/新药组):共纳入99名患者(暴露组,n = 32;新药组,n = 67)。暴露组的客观反应率(ORR)明显高于新药组(37.5% vs. 13.4%,P = 0.009)。暴露组和新药组的中位无进展生存期相似(3.8 个月 vs. 2.8 个月,HR 1.12,95% CI 0.65-1.86,p = 0.66)。在多变量分析中,PD-1阻断剂暴露可独立预测更高的紫杉类药物ORR。暴露组和新药组发生≥3级不良事件的比例相当(45.8% vs. 40.3%,p = 0.64):结论:在晚期ESCC中使用PD-1阻断后的紫杉类药物与未暴露PD-1的紫杉类药物相比,ORR更高,但PFS相似。
{"title":"Impact of taxanes after PD-1 blockade exposure in advanced esophageal squamous cell carcinoma.","authors":"Kazuhiro Shiraishi, Yuki Takeyasu, Shun Yamamoto, Kotoe Oshima, Hiroshi Imazeki, Hidekazu Hirano, Natsuko Okita, Hirokazu Shoji, Yoshitaka Honma, Satoru Iwasa, Atsuo Takasima, Ken Kato","doi":"10.1007/s10388-024-01085-5","DOIUrl":"10.1007/s10388-024-01085-5","url":null,"abstract":"<p><strong>Background: </strong>Programmed cell death-1 (PD-1) blockade improves survival in patients with advanced esophageal squamous cell carcinoma (ESCC). However, the efficacy of taxanes after exposure to PD-1 blockade remains unclear in patients with advanced ESCC.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical outcomes of advanced ESCC patients treated with taxanes (paclitaxel or docetaxel) with/without prior exposure to PD-1 blockade (Exposed /Naïve group) at National Cancer Center Hospital from June 2016 to December 2020.</p><p><strong>Results: </strong>Ninety-nine patients (Exposed group, n = 32; Naïve group, n = 67) were included. The objective response rate (ORR) of the Exposed group was significantly higher than that of the Naïve group (37.5% vs. 13.4%, p = 0.009). The median progression-free survival was similar between the Exposed and Naïve groups (3.8 vs. 2.8 months, HR 1.12, 95% CI 0.65-1.86, p = 0.66). PD-1 blockade exposure independently predicated higher ORR to taxanes in multivariate analysis. Grade ≥ 3 adverse events were comparable between the Exposed and Naïve groups (45.8% vs. 40.3%, p = 0.64).</p><p><strong>Conclusions: </strong>Taxanes following PD-1 blockade in advanced ESCC showed a higher ORR but similar PFS compared to taxanes without prior PD-1 exposure.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"539-545"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Per‑oral endoscopic myotomy (POEM) is the preferred endoscopic modality for managing achalasia cardia. However, there are no recommendations on the role of POEM in non‑achalasia esophageal dysmotility disorders (NAEMD), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and hypercontractile esophagus (HE). The present systematic review and meta-analysis aimed to assess the safety and efficacy of POEM in the treatment of NAEMD. MEDLINE, Embase, and Scopus were searched from inception to August 2023 for studies analyzing the outcome of POEM in NAEMD. Clinical success and adverse events were the main outcomes assessed. The event rates and their 95% confidence interval were calculated using a random effects model. A total of 11 studies with 271 patients were included in the final analysis. The pooled clinical success rate with POEM in NAEMD was 86.9% (82.9-90.9). On subgroup analysis, the pooled clinical success rates of POEM in DES and EGJOO were 97.8% (90.9-100.0) and 92.7% (86.3-95.1), which were significantly higher than in HE 81.2% (73.5-88.8). Data from limited studies showed that the pooled rate of improvement in dysphagia and chest pain was 88.5% (83.0-93.9) and 87.4% (80.5-94.4). The pooled incidence of overall AEs and serious AEs was 12.6% (5.7-19.5) and 0.3% (0.0-1.9), respectively. On follow-up, the pooled incidence of new-onset heartburn was 18.7% (11.1-26.2). POEM is a safe and efficacious treatment modality for the management of NAEMD with a lower clinical success in patients with HE. Further large-scale studies are required to validate the findings of the present analysis.
{"title":"Efficacy and safety of per-oral endoscopic myotomy in non-achalasia esophageal motility disorders: a systematic review and meta-analysis.","authors":"Rajesh Puri, Suprabhat Giri, Sarat Chandra Panigrahi, Bipadabhanjan Mallick, Preetam Nath, Zubin Dev Sharma, Bimal Kumar Sahu","doi":"10.1007/s10388-024-01076-6","DOIUrl":"10.1007/s10388-024-01076-6","url":null,"abstract":"<p><p>Per‑oral endoscopic myotomy (POEM) is the preferred endoscopic modality for managing achalasia cardia. However, there are no recommendations on the role of POEM in non‑achalasia esophageal dysmotility disorders (NAEMD), including esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), and hypercontractile esophagus (HE). The present systematic review and meta-analysis aimed to assess the safety and efficacy of POEM in the treatment of NAEMD. MEDLINE, Embase, and Scopus were searched from inception to August 2023 for studies analyzing the outcome of POEM in NAEMD. Clinical success and adverse events were the main outcomes assessed. The event rates and their 95% confidence interval were calculated using a random effects model. A total of 11 studies with 271 patients were included in the final analysis. The pooled clinical success rate with POEM in NAEMD was 86.9% (82.9-90.9). On subgroup analysis, the pooled clinical success rates of POEM in DES and EGJOO were 97.8% (90.9-100.0) and 92.7% (86.3-95.1), which were significantly higher than in HE 81.2% (73.5-88.8). Data from limited studies showed that the pooled rate of improvement in dysphagia and chest pain was 88.5% (83.0-93.9) and 87.4% (80.5-94.4). The pooled incidence of overall AEs and serious AEs was 12.6% (5.7-19.5) and 0.3% (0.0-1.9), respectively. On follow-up, the pooled incidence of new-onset heartburn was 18.7% (11.1-26.2). POEM is a safe and efficacious treatment modality for the management of NAEMD with a lower clinical success in patients with HE. Further large-scale studies are required to validate the findings of the present analysis.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"419-429"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Preoperative chemotherapy with 5-fluorouracil and cisplatin (FP) followed by surgery has been considered a standard treatment for patients with stage II/III esophageal squamous cell carcinoma (ESCC) based on the results of a phase III trial (JCOG9907) in Japan. Subsequently, the phase III NExT trial (JCOG1109) revealed the survival benefit of the neoadjuvant DCF regimen, which adds docetaxel to FP, and it became a standard treatment. However, the long-term results and prognostic factors of neoadjuvant DCF therapy in the real world are unknown.
Methods: We retrospectively investigated 50 patients with ESCC treated with neoadjuvant DCF therapy from July 2012 to December 2017 at The University of Tokyo Hospital.
Results: Median overall survival (OS) and progression-free survival (PFS) were 32.3 [95% confidence interval (CI) 21.0-NA] and 10.0 months (95% CI 6.3-15.6), respectively. Median OS [not reached (95% CI 31.5-NA) vs. 21.4 months (95% CI 13.5-33.0); p = 0.028] and PFS [83.3 months (95% CI 6.4-NA) vs. 7.4 months (95% CI 6.0-12.8] were significantly longer in patients with an objective response than in non-responders. Of 44 surgical cases, median PFS tended to be longer in pathological lymph node metastasis-negative patients. Conversely, survival did not differ according to cStage (II/III vs. IV) or the average relative dose intensity (ARDI, ≥ 85% vs. < 85%).
Discussion: The response to neoadjuvant DCF therapy could predict patient prognosis. Additionally, pN+ tended to increase the recurrence risk, whereas cStage and ARDI did not influence survival.
背景:根据日本一项III期试验(JCOG9907)的结果,术前使用5-氟尿嘧啶和顺铂(FP)化疗,然后进行手术,一直被认为是II/III期食管鳞状细胞癌(ESCC)患者的标准治疗方法。随后,III 期 NExT 试验(JCOG1109)揭示了在 FP 基础上增加多西他赛的新辅助 DCF 方案的生存获益,并将其作为标准治疗方法。然而,在现实世界中,新辅助 DCF 治疗的长期效果和预后因素尚不清楚:我们回顾性调查了2012年7月至2017年12月在东京大学医院接受新辅助DCF治疗的50例ESCC患者:中位总生存期(OS)和无进展生存期(PFS)分别为32.3个月[95%置信区间(CI)21.0-NA]和10.0个月(95% CI 6.3-15.6)。客观应答患者的中位OS[未达到(95% CI 31.5-NA)vs 21.4个月(95% CI 13.5-33.0);p = 0.028]和PFS[83.3个月(95% CI 6.4-NA)vs 7.4个月(95% CI 6.0-12.8)]明显长于无应答患者。在44例手术病例中,病理淋巴结转移阴性患者的中位生存期往往更长。相反,c分期(II/III期与IV期)或平均相对剂量强度(ARDI,≥85%与≥85%)对生存期没有影响。 讨论:对新辅助DCF治疗的反应可预测患者的预后。此外,pN+往往会增加复发风险,而c分期和ARDI并不影响生存率。
{"title":"Response to chemotherapy could predict the prognosis of esophageal squamous cell carcinoma treated with neoadjuvant docetaxel, cisplatin, and fluorouracil (DCF) followed by surgery: long-term results in a single institute.","authors":"Yasuyoshi Sato, Kazuhiko Mori, Shinichiro Atsumi, Kei Sakamoto, Shuichiro Oya, Asami Okamoto, Masayuki Urabe, Yoshiyuki Miwa, Shoh Yajima, Koichi Yagi, Sachiyo Nomura, Hiroharu Yamashita, Yasuyuki Seto","doi":"10.1007/s10388-024-01062-y","DOIUrl":"10.1007/s10388-024-01062-y","url":null,"abstract":"<p><strong>Background: </strong>Preoperative chemotherapy with 5-fluorouracil and cisplatin (FP) followed by surgery has been considered a standard treatment for patients with stage II/III esophageal squamous cell carcinoma (ESCC) based on the results of a phase III trial (JCOG9907) in Japan. Subsequently, the phase III NExT trial (JCOG1109) revealed the survival benefit of the neoadjuvant DCF regimen, which adds docetaxel to FP, and it became a standard treatment. However, the long-term results and prognostic factors of neoadjuvant DCF therapy in the real world are unknown.</p><p><strong>Methods: </strong>We retrospectively investigated 50 patients with ESCC treated with neoadjuvant DCF therapy from July 2012 to December 2017 at The University of Tokyo Hospital.</p><p><strong>Results: </strong>Median overall survival (OS) and progression-free survival (PFS) were 32.3 [95% confidence interval (CI) 21.0-NA] and 10.0 months (95% CI 6.3-15.6), respectively. Median OS [not reached (95% CI 31.5-NA) vs. 21.4 months (95% CI 13.5-33.0); p = 0.028] and PFS [83.3 months (95% CI 6.4-NA) vs. 7.4 months (95% CI 6.0-12.8] were significantly longer in patients with an objective response than in non-responders. Of 44 surgical cases, median PFS tended to be longer in pathological lymph node metastasis-negative patients. Conversely, survival did not differ according to cStage (II/III vs. IV) or the average relative dose intensity (ARDI, ≥ 85% vs. < 85%).</p><p><strong>Discussion: </strong>The response to neoadjuvant DCF therapy could predict patient prognosis. Additionally, pN+ tended to increase the recurrence risk, whereas cStage and ARDI did not influence survival.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"514-522"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.
Methods: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.
Results: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).
Conclusions: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.
{"title":"Esophagectomy for esophageal cancer in patients with a history of total pharyngolaryngectomy: a Japanese nationwide retrospective cohort study.","authors":"Akihiko Okamura, Masayuki Watanabe, Jun Okui, Kengo Kuriyama, Osamu Shiraishi, Takanori Kurogochi, Tetsuya Abe, Hiroshi Sato, Hiroshi Miyata, Yoshihiko Kawaguchi, Yusuke Sato, Hiroaki Nagano, Shinsuke Takeno, Masanobu Nakajima, Kentaro Matsuo, Kentaro Murakami, Katsushi Takebayashi, Sohei Matsumoto, Tomoyuki Okumura, Yoshihiro Kakeji, Koji Kono, Nobuhiko Oridate, Yasushi Toh, Hiroya Takeuchi, Yukio Katori","doi":"10.1007/s10388-024-01078-4","DOIUrl":"10.1007/s10388-024-01078-4","url":null,"abstract":"<p><strong>Background: </strong>Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.</p><p><strong>Methods: </strong>We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.</p><p><strong>Results: </strong>Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).</p><p><strong>Conclusions: </strong>In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":" ","pages":"438-446"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended.
Patients and methods
In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study.
Results
ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4 mm vs. 32.4 ± 9.9 mm, p < 0.01) and dissection speed was faster (10.5 ± 5.9 mm2/min vs. 7.5 ± 4.2 mm2/min, p < 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (p = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, p < 0.01), interruption due to body movement (0% vs 13%, p < 0.01), and acute adverse events (21.7% vs 33.5%, p = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (p = 0.018).
Conclusion
Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.
背景/目的与镇静相比,在全身麻醉下进行食管内镜黏膜下剥离术(ESD)可能为疑难病例提供更稳定的治疗。我们评估了与异丙酚镇静下相比,全身麻醉下进行的ESD的临床特征和结果,并讨论了推荐使用全身麻醉的病例。结果81例患者的92个病灶在全身麻醉下进行了ESD,184例患者的200个病灶在异丙酚镇静下进行了ESD。全身麻醉组与镇静组相比,肿瘤长轴直径更大(39.8 ± 14.4 mm vs. 32.4 ± 9.9 mm,p < 0.01),解剖速度更快(10.5 ± 5.9 mm2/min vs. 7.5 ± 4.2 mm2/min,p < 0.01)。在镇静组中,咽癌治疗史与较慢的解剖速度显著相关(p = 0.037)。镇静组出现低氧血症(0% vs 9.8%,p < 0.01)、因身体移动而中断手术(0% vs 13%,p < 0.01)和急性不良事件(21.7% vs 33.5%,p = 0.05)的频率较高。咽癌治疗史是导致急性不良事件的重要因素(p = 0.018)。结论对于难以在异丙酚镇静下进行稳定手术的患者来说,全身麻醉下食管ESD是一种治疗选择。特别是对于有咽癌治疗史的患者,ESD 更难在他们身上实施,而且他们发生急性不良事件的风险更高,因此可以考虑全身麻醉。
{"title":"Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended","authors":"Atsushi Goto, Koichi Hamabe, Shunsuke Ito, Shinichi Hashimoto, Jun Nishikawa, Taro Takami","doi":"10.1007/s10388-024-01086-4","DOIUrl":"https://doi.org/10.1007/s10388-024-01086-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background/aims</h3><p>Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended.</p><h3 data-test=\"abstract-sub-heading\">Patients and methods</h3><p>In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4 mm vs. 32.4 ± 9.9 mm, <i>p</i> < 0.01) and dissection speed was faster (10.5 ± 5.9 mm<sup>2</sup>/min vs. 7.5 ± 4.2 mm<sup>2</sup>/min, <i>p</i> < 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (<i>p</i> = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, <i>p</i> < 0.01), interruption due to body movement (0% vs 13%, <i>p</i> < 0.01), and acute adverse events (21.7% vs 33.5%, <i>p</i> = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (<i>p</i> = 0.018).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"42 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cervical esophagogastric anastomosis is conventionally performed using the McKeown esophagectomy. However, an optimal anastomotic technique has not yet been established. This study aimed to compare the clinical outcomes of triangular anastomosis (TA) and totally mechanical Collard anastomosis (TMCA) for cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.
Methods
In this matched- cohort study, 117 patients who underwent minimally invasive esophagectomy between 2019 and 2024 were divided into TA and TMCA groups. The TA technique was performed between September 2019 and December 2021, and the TMCA technique was performed between January 2022 and January 2024. We then compared the surgical outcomes and postoperative complications (pneumonia, recurrent laryngeal nerve palsy, anastomotic leakage, and stricture) between the two groups.
Results
Propensity score matching revealed that 40 patients were included in both the TA and TMCA groups. The rates of pneumonia, recurrent laryngeal nerve palsy, and anastomotic leakage were not significantly different between the two groups. However, the rate of anastomotic stricture was lower in the TMCA than in the TA group (2.5% vs. 27.5%, respectively, P = 0.003).
Conclusions
Compared with the TA technique, the TMCA technique reduced the rate of anastomotic stricture when performing cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.
背景传统上采用麦氏食管切除术进行颈食管胃吻合术。然而,最佳的吻合技术尚未确立。本研究旨在比较三角吻合术(TA)和完全机械科拉德吻合术(TMCA)在微创食管切除术中通过胸骨后途径进行胃导管重建的颈食管胃吻合术的临床效果。方法在这项匹配队列研究中,117 名在 2019 年至 2024 年期间接受微创食管切除术的患者被分为 TA 组和 TMCA 组。TA技术在2019年9月至2021年12月期间进行,TMCA技术在2022年1月至2024年1月期间进行。然后,我们比较了两组患者的手术效果和术后并发症(肺炎、喉返神经麻痹、吻合口漏和狭窄)。两组患者的肺炎、喉返神经麻痹和吻合口漏发生率无明显差异。结论与 TA 技术相比,TMCA 技术降低了经胸骨后途径进行微创食管切除术和胃导管重建术中颈食管胃吻合术的吻合口狭窄率。
{"title":"The totally mechanical Collard technique for cervical esophagogastric anastomosis reduces anastomotic stricture compared with triangular anastomosis in minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route: a propensity score-matched study","authors":"Hironobu Goto, Taro Oshikiri, Yasufumi Koterazawa, Ryuichiro Sawada, Taro Ikeda, Hitoshi Harada, Naoki Urakawa, Hiroshi Hasegawa, Shingo Kanaji, Kimihiro Yamashita, Takeru Matsuda, Yoshihiro Kakeji","doi":"10.1007/s10388-024-01088-2","DOIUrl":"https://doi.org/10.1007/s10388-024-01088-2","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Cervical esophagogastric anastomosis is conventionally performed using the McKeown esophagectomy. However, an optimal anastomotic technique has not yet been established. This study aimed to compare the clinical outcomes of triangular anastomosis (TA) and totally mechanical Collard anastomosis (TMCA) for cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>In this matched- cohort study, 117 patients who underwent minimally invasive esophagectomy between 2019 and 2024 were divided into TA and TMCA groups. The TA technique was performed between September 2019 and December 2021, and the TMCA technique was performed between January 2022 and January 2024. We then compared the surgical outcomes and postoperative complications (pneumonia, recurrent laryngeal nerve palsy, anastomotic leakage, and stricture) between the two groups.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Propensity score matching revealed that 40 patients were included in both the TA and TMCA groups. The rates of pneumonia, recurrent laryngeal nerve palsy, and anastomotic leakage were not significantly different between the two groups. However, the rate of anastomotic stricture was lower in the TMCA than in the TA group (2.5% vs. 27.5%, respectively, <i>P</i> = 0.003).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Compared with the TA technique, the TMCA technique reduced the rate of anastomotic stricture when performing cervical esophagogastric anastomosis during minimally invasive esophagectomy with gastric conduit reconstruction through the retrosternal route.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"209 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142252506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma.
Methods
The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan–Meier method and log-rank tests were used to compare both groups’ survival and local recurrence curves.
Results
After propensity score matching, the two groups showed no significant difference in en bloc resection rate (97.80% vs. 99.56%, p = 0.096), treatment time (64.75 min vs 61.33 min, p = 0.448), recurrence rate (3.30% vs. 2.20%, p = 0.458), and stricture rate (7.69% vs. 4.07%, p = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, p = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively.
Conclusions
Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars.
背景重复内镜黏膜下剥离术治疗食管鳞状细胞癌的近端复发具有挑战性。因此,本研究评估了重复内镜黏膜下剥离术治疗复发性食管鳞状细胞癌的有效性和安全性。经过倾向评分匹配后,比较了内镜粘膜下剥离术后瘢痕组(n = 91)和首次内镜粘膜下剥离术组(n = 910)的食管内镜粘膜下剥离术相关结果。采用卡普兰-梅耶法和对数秩检验比较两组患者的生存率和局部复发率曲线。80% vs. 99.56%,p = 0.096)、治疗时间(64.75 分钟 vs. 61.33 分钟,p = 0.448)、复发率(3.30% vs. 2.20%,p = 0.458)和狭窄率(7.69% vs. 4.07%,p = 0.110)无明显差异。然而,内镜粘膜下剥离术后疤痕组的穿孔率高于首次内镜粘膜下剥离术组(4.40% 对 1.10%,P = 0.031)。内镜下粘膜下剥离术后瘢痕组和首次内镜下粘膜下剥离术后瘢痕组的 5 年总生存率分别为 88.6% 和 89.0%。因此,重复内镜黏膜下剥离术可有效治疗靠近首次内镜黏膜下剥离术疤痕的食管鳞癌复发。
{"title":"Repeat endoscopic submucosal dissection close to the initial endoscopic submucosal dissection scar for superficial esophageal squamous cell carcinoma","authors":"Koki Matsuoka, Tsukasa Ishida, Tetsuya Yoshizaki, Yoshinobu Yamamoto, Mineo Iwatate, Yasuaki Kitamura, Tomoya Sako, Atsushi Ikeda, Takayuki Ose, Fumiaki Kawara, Ryusuke Ariyoshi, Yasushi Sano, Hirofumi Abe, Shinwa Tanaka, Toshitatsu Takao, Yoshinori Morita, Takashi Toyonaga, Toshio Shimokawa, Yuzo Kodama","doi":"10.1007/s10388-024-01074-8","DOIUrl":"https://doi.org/10.1007/s10388-024-01074-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Repeat endoscopic submucosal dissection for metachronous recurrence of esophageal squamous cell carcinoma close to previous endoscopic submucosal dissection scars is challenging. Therefore, this study evaluated the efficacy and safety of repeat endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The study included 1680 patients. After propensity score matching, esophageal endoscopic submucosal dissection-related outcomes were compared between the post-endoscopic submucosal dissection scar group (n = 91) and first endoscopic submucosal dissection group (n = 910). The Kaplan–Meier method and log-rank tests were used to compare both groups’ survival and local recurrence curves.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>After propensity score matching, the two groups showed no significant difference in <i>en bloc</i> resection rate (97.80% vs. 99.56%, <i>p</i> = 0.096), treatment time (64.75 min vs 61.33 min, <i>p</i> = 0.448), recurrence rate (3.30% vs. 2.20%, <i>p</i> = 0.458), and stricture rate (7.69% vs. 4.07%, <i>p</i> = 0.110). However, the perforation rate was higher in the post-endoscopic submucosal dissection scar group than in the first endoscopic submucosal dissection group (4.40% vs. 1.10%, <i>p</i> = 0.031). The 5-year overall survival rates in the post-endoscopic submucosal dissection scar and first endoscopic submucosal dissection groups were 88.6% and 89.0%, respectively.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Repeated esophageal endoscopic submucosal dissection for recurrent esophageal squamous cell carcinoma yielded satisfactory clinical outcomes and survival rates. Therefore, repeat endoscopic submucosal dissection may effectively treat esophageal squamous cell carcinoma recurrence close to the initial endoscopic submucosal dissection scars.</p>","PeriodicalId":11918,"journal":{"name":"Esophagus","volume":"25 1","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141770559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}