• Chemotherapy
• Esophageal cancer
• Geriatric oncology
• Physical fitness

• Humans
• Aged
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/therapy
• Female
• Male
• Prospective Studies
• Neoadjuvant Therapy/adverse effects
• Neoadjuvant Therapy/methods
• Physical Fitness/physiology
• Esophagectomy/methods
• Aged, 80 and over
• Walk Test

• 2023-younger-12 Japan Health Research Promotion Bureau

• Esophageal cancer
• Neoadjuvant therapy
• Physical activity
• Prehabilitation
• Tumor regression

• Humans
• Male
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/pathology
• Retrospective Studies
• Neoadjuvant Therapy/methods
• Aged
• Middle Aged
• Esophagectomy/methods
• Accelerometry/methods
• Exercise/physiology
• ROC Curve
• Neoplasm Staging
• Treatment Outcome

• Grant Number 24H02738 JSPS KAKENHI
• Okayama University

• Borderline resectable
• Colorectal liver metastasis
• Liver resection
• Neoadjuvant chemotherapy
• Surgical failure

• Humans
• Colorectal Neoplasms/pathology
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Liver Neoplasms/mortality
• Liver Neoplasms/drug therapy
• Male
• Risk Factors
• Female
• Neoadjuvant Therapy
• Retrospective Studies
• Middle Aged
• Aged
• Treatment Failure
• Survival Rate
• Hepatectomy
• Time Factors
• Prognosis
• Chemotherapy, Adjuvant
• Adult
• Cohort Studies
• Aged, 80 and over

• Comorbidity
• Elderly patient
• Esophageal cancer
• Nutritional risk
• Prognosis
• Radiotherapy

• gastrointestinal (upper)
• rehabilitation
• supportive care
• survivorship

• Humans
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/drug therapy
• Esophagectomy/adverse effects
• Male
• Aged
• Retrospective Studies
• Female
• Neoadjuvant Therapy
• Middle Aged
• Muscle, Skeletal
• Cohort Studies

• Esophageal cancer
• Neoadjuvant chemotherapy
• Older patients
• Performance status

• Humans
• Aged
• Neoadjuvant Therapy
• Esophagectomy/adverse effects
• Retrospective Studies
• Esophageal Neoplasms/surgery
• Prognosis

• charlson comorbidity index
• esophageal cancer
• photodynamic therapy
• talaporfin sodium

• Humans
• Photosensitizing Agents/therapeutic use
• Photochemotherapy/methods
• Salvage Therapy/methods
• Retrospective Studies
• Esophageal Neoplasms/drug therapy
• Comorbidity
• Treatment Outcome
• Porphyrins

• Humans
• Aged
• Middle Aged
• Retrospective Studies
• Comorbidity
• Lung
• Vital Capacity
• Esophageal Neoplasms/surgery

• comorbidity
• emphysema
• esophagectomy
• low attenuation area
• smoking

• Humans
• Retrospective Studies
• Esophagectomy
• Pulmonary Emphysema/diagnostic imaging
• Pulmonary Emphysema/surgery
• Tomography, X-Ray Computed
• Esophageal Neoplasms/diagnostic imaging
• Esophageal Neoplasms/surgery
• Prognosis
• Emphysema
• Risk Factors

• Male
• Humans
• Female
• Retrospective Studies
• Carotid Intima-Media Thickness
• Coronary Artery Disease
• Comorbidity
• Idiopathic Pulmonary Fibrosis/diagnostic imaging

• Esophageal cancer
• Esophageal surgery
• Geriatrics
• Neoadjuvant chemotherapy

• Male
• Female
• Humans
• Aged
• Neoadjuvant Therapy/adverse effects
• Retrospective Studies
• Esophageal Neoplasms/drug therapy
• Esophageal Neoplasms/complications
• Sarcopenia/complications
• Neutropenia

• Ejection fraction
• Elderly
• HFmrEF
• Heart failure
• Outcome

• Female
• Humans
• Male
• Stroke Volume
• Retrospective Studies
• Prognosis
• Universities
• Coronary Artery Disease
• Heart Failure
• Hospitals

• Prognosis
• Respiratory morbidity
• Thoracoscopic esophagectomy

• Humans
• Retrospective Studies
• Esophagectomy/adverse effects
• Neoplasm Recurrence, Local/surgery
• Esophageal Neoplasms/surgery
• Prognosis
• Morbidity
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Treatment Outcome
• Thoracoscopy

• Esophageal cancer
• Esophagectomy
• Overall survival
• Postoperative blood glucose
• Postoperative complications

The factors influencing the prognosis of patients with esophageal cancer vary among studies and are still poorly known.

To determine the factors associated with survival in patients with esophageal cancer.

This retrospective study included patients with esophageal cancer admitted between January 2017 and March 2020 at Heping Hospital Affiliated to Changzhi Medical College. All patients were treated according to the available guidelines. Follow-up was censored in October 2020. Univariable and multivariable Cox regression analyses were used to determine the independent risk factors for overall survival (OS).

In total, 307 patients were included. Their median age was 64 (range, 44-79) years, 63.5% were male, and the median disease course was 2 (0.1-36) months. The median tumor size was 3 (0-10) cm. Most patients were T3 (29.6%), N0 (70.0%). Most tumors were grade 2 (48.2%), and 87.3% were squamous cell carcinoma. The in-hospital mortality was 16.9%, the 30-day mortality was 19.9%, and the 90-day mortality was 25.4%. The cumulative OS rates at the last follow-up were 82.1% (95%CI: 67.7%-96.5%) for stage 0/I/II and 47.4% (95%CI: 16.5-78.6%) for stage III/IVA (P < 0.001). The multivariable analysis showed that creatinine levels (HR = 1.02, 95%CI: 1.00-1.03, P = 0.050), pTNM III/IVA (HR = 4.19, 95%CI: 2.19-8.01, P < 0.001), adjuvant radiotherapy and/or chemotherapy (HR = 0.23, 95%CI: 0.11-0.49), and the Comprehensive Complication Index (CCI) (HR = 1.02, 95%CI: 1.004-1.03, P = 0.011) were independently associated with OS.

The survival of patients with esophageal cancer is poor, especially those with pTNM III/IVA. pTNM stage III/IVA, CCI, and adjuvant therapy (radiotherapy and/or chemotherapy) are independently associated with OS.

• Esophageal cancer
• Survival
• Prognosis
• Factors
• Multivariable analysis

Accumulating evidence suggests a survival benefit after curative oesophageal cancer surgery in women compared with men. The aim of this study was to explore sex disparities in survival after surgery with curative intent in patients with oesophageal cancer.

This was a population-based cohort study, including all patients with oesophageal or gastric cancer who underwent surgery with a curative intent between 2006 and 2017 in Sweden. Female versus male mortality rate ratio (MRR) and excess mortality rate ratio (EMRR) were used as measures of survival. Two different parametric models were designed to account for potential confounders. Patients with gastric cancer were used as a comparison group as no differences in survival between sexes were expected among these patients.

A total of 1301 patients underwent resection for oesophageal adenocarcinoma and 305 patients for oesophageal squamous cell carcinoma. Women had a lower EMRR (0.76, 95 per cent c.i. 0.58 to 1.01, P = 0.056; 0.52, 95 per cent c.i. 0.32 to 0.84, P = 0.007 respectively) in both histological subtypes. The effect was more profound in early clinical stages, in patients receiving neoadjuvant treatment, and without postoperative complications. No sex-related difference was observed in survival of patients with gastric cancer.

Women undergoing resection for oesophageal carcinoma have better survival compared with men.

• Adenocarcinoma
• Cohort Studies
• Esophageal Neoplasms
• Female
• Humans
• Male
• Neoadjuvant Therapy
• Stomach Neoplasms/surgery

• China Scholarship Council
• Swedish Cancer Society

• Definitive chemoradiotherapy
• Esophageal carcinoma
• Neoadjuvant chemoradiotherapy
• Surgery
• Survival

Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques.

All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies.

Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011–2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008–2010 29.4% and lowest in 2017–2020 1.8%) and in 1-year survival rate (1987–1998 68.4% vs. 2017–2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen.

Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay.

• Esophageal cancer
• esophagectomy
• minimally invasive surgery

• Chemotherapy
• Hepatectomy
• Metastasis
• Neoadjuvant
• Retrospective

Endoscopic submucosal dissection (ESD) is a preferred treatment option for superficial esophageal squamous cell carcinoma (SESCC). However, only few studies compared long-term survival outcomes of ESD with surgery. This study compared the overall survival (OS), recurrence-free survival, and complication rates of ESD with those of surgery.

We reviewed patients who underwent ESD (n = 70) or surgery (n = 114) for SESCC at Seoul National University Hospital from 2011 to 2017. A propensity score-matched analysis was used to reduce selection bias. To increase the precision of our results interpretation, subgroups were analyzed according to the depth of tumor invasion.

In the matching study, the ESD group (n = 34) showed comparable survival outcomes with the surgery group (n = 34). The 5-year OS rates were 89.4% vs 87.8% for the ESD and the surgery groups, respectively; similarly, the 5-year recurrence-free survival rates were 90.9% and 91.6%, respectively. The ESD group showed a lower early major complication rate (2.9% [1 of 34] vs 23.5% [8 of 34], P < 0.001) and shorter hospital stay (median, 3.0 days vs 16.5 days, P < 0.001) than the surgery group. In the tumor in situ (Tis)-subgroup, ESD showed better OS than esophagectomy (P = 0.030). Between-group comparisons of survival outcomes in the T1a and T1b subgroups revealed no significant differences.

Long-term outcomes of ESD are comparable with surgery for patients with SESCC. For early major complications and duration of hospital stay, ESD was associated with better outcomes than radical surgery. These results support ESD as the preferred treatment option for SESCC.

The present study aimed to introduce a novel method of cervical esophagogastric anastomosis, so-called ‘modified one-piece mechanical anastomosis’ (MOMA) in McKeown esophagogastrectomy and to compare its feasibility, efficacy and safety with those of ‘conventionally double-layer hand-sewn anastomosis’ (CDHA). Between March 2016 and March 2018, 80 consecutive patients with thoracic esophageal squamous cell carcinoma undergoing McKeown esophagogastrectomy with a curative intent were included in the present study. Among them, 40 received MOMA and the other 40 received CDHA. Their medical records, including operation time, anastomotic time, estimated blood loss, postoperative complications within 30 days, as well as survival rate, were retrospectively reviewed, analyzed and compared. Total operation time, anastomotic time and estimated blood loss in the MOMA group were significantly decreased compared with those in the CDHA group (207.73±2.66 vs. 225.40±3.43 min; 10.95±0.44 vs. 23.03±0.47 min; 144.50±21.14 vs. 241.75±23.75 ml; all P<0.01). Anastomotic leakage was present in 1 patient in the CDHA group, but no patients in the MOMA group (P=1.000). Anastomotic stenosis was documented in 4 and 2 patients in the MOMA and CDHA group, respectively (P=0.392). The 30-day operative mortality was 0% and no significant difference was demonstrated in postoperative complications within groups (P>0.05). Furthermore, the disease-free and overall survival was compared by means of Kaplan-Meier survival estimates and log-rank tests and no statistical difference was determined (P=0.5114 and P=0.7875, respectively). McKeown esophagogastrectomy with MOMA may be a feasible, effective and reproducible alternative with relatively satisfactory postoperative outcomes for the treatment of TE-SCC, providing shorter operation and anastomosis times, and less estimated intraoperative blood loss.

• McKeown esophagogastrectomy
• conventionally double-layer hand-sewn anastomosis
• modified one-piece mechanical anastomosis
• thoracic esophageal squamous cell carcinoma

• Esophageal cancer
• Esophagectomy
• Malnutrition
• Risk stratification comorbidity
• Sarcopenia

An increasing number of older patients is undergoing curative, surgical treatment of esophageal cancer. Previous meta-analyses have shown that older patients suffered from more postoperative morbidity and mortality compared to younger patients, which may lead to patient selection based on age. However, only studies including patients that underwent open esophagectomy were included. Therefore, it remains unknown whether there is an association between age and outcome in patients undergoing minimally invasive esophagectomy.

To perform a systematic review on age and postoperative outcome in esophageal cancer patients undergoing esophagectomy.

Studies comparing older with younger patients with primary esophageal cancer undergoing curative esophagectomy were included. Meta-analysis of studies using a 75-year age threshold are presented in the manuscript, studies using other age thresholds in the Supplementary material. MEDLINE, Embase and the Cochrane Library were searched for articles published between 1995 and 2020. Risk of bias was assessed with the Newcastle-Ottawa Scale. Primary outcomes were anastomotic leak, pulmonary and cardiac complications, delirium, 30- and 90-d, and in-hospital mortality. Secondary outcomes included pneumonia and 5-year overall survival.

Seven studies (4847 patients) using an age threshold of 75 years were included for meta-analysis with 755 older and 4092 younger patients. Older patients (9.05%) had higher rates of 90-d mortality compared with younger patients (3.92%), (confidence interval = 1.10-5.56). In addition, older patients (9.45%) had higher rates of in-hospital mortality compared with younger patients (3.68%), (confidence interval = 1.01-5.91). In the subgroup of 2 studies with minimally invasive esophagectomy, older and younger patients had comparable 30-d, 90-d and in-hospital mortality rates.

Older patients undergoing curative esophagectomy for esophageal cancer have a higher postoperative mortality risk. Minimally invasive esophagectomy may be important for minimizing mortality in older patients.

• Elderly
• Minimally invasive esophagectomy
• Open esophagectomy
• Esophageal cancer
• Clinical outcome
• Perioperative mortality

Minimally invasive oesophagectomy (MIO) is reported to produce fewer respiratory complications than open oesophagectomy. This study assessed differences in postoperative complications between MIO and hybrid MIO (HMIO) employing thoracoscopy and laparotomy, along with the influence of co-morbidities on postoperative outcomes.

Patients with oesophageal cancer undergoing three-stage MIO or three-stage HMIO between 1999 and 2018 were identified from a prospectively developed database, which included patient demographics, co-morbidities, preoperative therapies, and cancer stage. The primary outcome was postoperative complications in the two groups. Secondary outcomes included duration of operation, blood transfusion requirement, duration of hospital stay, and overall survival.

There were 828 patients, of whom 722 had HMIO and 106 MIO, without significant baseline differences. Median duration of operation was longer for MIO (325 versus 289 min; P < 0.001), but with less blood loss (median 250 versus 300 ml; P < 0.001) and a shorter hospital stay (median 12 versus 13 days; P = 0.006). Respiratory complications were not associated with operative approach (31.1 versus 35.2 per cent for MIO and HMIO respectively; P = 0.426). Anastomotic leak rates (10.4 versus 10.2 per cent) and 90-day mortality (1.0 versus 1.7 per cent) did not differ. Cardiac co-morbidity was associated with more medical and surgical complications. Overall survival was associated with AJCC stage and co-morbidities, but not operative approach.

MIO had a small benefit in terms of blood loss and hospital stay, but not in operating time. Oncological outcomes were similar in the two groups. Postoperative complications were associated with pre-existing cardiorespiratory co-morbidities rather than operative approach.

• Endoscopic mucosal resection
• Esophagectomy
• Esophagus
• Prognosis
• Squamous cell carcinoma

• Charlson comorbidity index
• Comorbidity
• Mortality
• Shock
• Stress cardiomyopathy
• Takotsubo

Palliative therapy has been associated with improved overall survival (OS) in several tumor types. Not all patients with metastatic esophageal cancer receive palliative chemotherapy, and the roles of other palliative therapies in these patients are limited.

To investigate the impact of other palliative therapies in patients with metastatic esophageal cancer not receiving chemotherapy.

The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined chemotherapy and had known palliative therapy status [palliative therapies were defined as surgery, radiotherapy (RT), pain management, or any combination thereof] were included. Cases with unknown chemotherapy, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Cox proportional hazards regression models were employed to examine factors influencing survival.

Among 140234 esophageal cancer cases, we identified 1493 patients who did not receive chemotherapy and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. The majority (72.7%) did not receive other palliative therapies. On both univariate and multivariable analyses, there was no difference in OS between those receiving other palliative therapy (median 2.83 mo, 95%CI: 2.53-3.12) vs no palliative therapy (2.37 no, 95%CI: 2.2-2.56; multivariable P = 0.290). On univariate, but not multivariable analysis, treatment at an academic center was predictive of improved OS [Hazard ratio (HR) 0.90, 95%CI: 0.80-1.00; P = 0.047]. On multivariable analysis, female sex (HR 0.81, 95%CI: 0.71-0.92) and non-black, other race compared to white race (HR 0.72, 95%CI: 0.56-0.93) were associated with reduced mortality, while South geographic region relative to West region (HR 1.23, 95%CI: 1.04-1.46) and CCI of 1 relative to CCI of 0 (HR 1.17, 95%CI: 1.03-1.32) were associated with increased mortality. Higher histologic grade and T-stage were also associated with worse OS (P < 0.05).

Palliative therapies other than chemotherapy conferred a numerically higher, but not statistically significant difference in OS among patients with metastatic esophageal cancer not receiving chemotherapy. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative therapies other than chemotherapy in metastatic esophageal cancer and future studies are warranted.

• Esophageal cancer
• Metastatic
• Palliative
• Chemotherapy
• Radiotherapy
• Survival

气管支架被用于治疗各种良恶性气管疾病以及医源性操作引起的中央气道狭窄或气管瘘，其在迅速缓解症状方面具有较好的效果，但患者的长期生存仍有赖于对原发病的个体化治疗。因此，探索影响气管支架置入患者预后的相关危险因素，对于优化支架置入术以及改善患者的个体化临床管理具有帮助作用。

回顾性研究2014年1月-2017年6月在浙江大学附属第一医院胸外科接受支气管镜下气管支架置入治疗的66例患者，分析年龄、性别、基础Charlson合并症指数（Charlson comorbidity index, CCI）、支架植入操作时长等临床指标对患者预后的影响。

年龄、性别对患者预后没有显著影响，而CCI评分较高（P=0.045）和操作时间超过60 min（P=0.037）均为患者预后不良的独立危险因素，随后依据CCI评分和操作时长两个指标构建了患者预后的列线图预测模型，模型的受试者工作特征曲线（receiver operating characteristic curve, ROC）的曲线下面积为0.71，一致性指数为0.69。

对于接受气管支架置入的患者，其基础的CCI评分和支架置入操作的时长对其预后判断具有一定的临床价值。

• Airway stent
• Charlson comorbidity index
• Procedure duration
• Prognosis

• Charlson comorbidity index
• Elderly patients
• Gastric cancer
• Prognostic factors

• cancer survivors
• comorbidity
• survivorship

• esophageal squamous cell carcinoma
• prognosis
• programmed death-ligand 1
• radiotherapy

Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can cause severe adverse events, including neutropenia and febrile neutropenia. The feasibility of DCF therapy is a concern, particularly for elderly patients, patients with moderate organ disorders, and patients suffering from malnutrition caused by dysphagia or insufficient oral intake. We introduced a biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and outcome of an esophagectomy after bDCF therapy for patients with advanced esophageal squamous cell carcinoma.

Fifty-nine patients with esophageal carcinoma underwent an esophagectomy after DCF or bDCF therapy as primary chemotherapy. DCF was administered to 37 patients in the DCF group, whereas bDCF was administered to 22 patients in the bDCF group.

Patients in the bDCF group were significantly older than those in the DCF group (p = 0.016). Heart and pulmonary comorbidities were significantly more common in the bDCF than in the DCF group (p < 0.001 and p = 0.039, respectively). Grade 3 or 4 neutropenia was less frequent in the bDCF than in the DCF group (40.9 vs. 81.1%, p = 0.002). Anorexia was more frequent in the DCF group than in the bDCF group (18.9 vs. 0%, p = 0.030). The clinical response rate of the bDCF group was significantly higher than that of the DCF group (86.4 vs. 62.2%, p = 0.047). There was no significant between-group difference in the postoperative morbidity rate (bDCF 45.5% vs. DCF 32.4%) or in the histological therapeutic effect.

The results demonstrate that primary bDCF therapy for high-risk patients with advanced esophageal cancer is feasible and safe in both chemotherapeutic and perioperative periods without a reduction in the efficacy of DCF therapy.

• Biweekly DCF
• Esophageal cancer
• Esophagectomy
• Preoperative chemotherapy