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Summary This study aimed to investigate the survival impact of the number of lymph nodes dissection (LND) in patients receiving neoadjuvant chemotherapy (NCT) for esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed the clinical pathological data and survival of 407 ESCC patients who underwent esophagectomy after NCT between January 2015 and December 2016. The relationship between the number of LNDs and 5-year overall survival (OS) or disease-free survival (DFS) was plotted by using restricted cubic spline analysis. A Cox proportional hazards regression model was used to identify prognostic factors of OS and DFS. We observed an obvious non-linear relationship between LND and the hazard ratios (HRs) for OS (P = 0.0015) and DFS (P < 0.001) of all the patients. In the multivariate analysis of OS and DFS, the number of LNDs (greater than 28 and less than 46) had a significant protective effect on survival (OS: HR: 0.61, 95% CI: 0.42–0.88, P = 0.007; DFS: HR: 0.50, 95% CI: 0.36–0.70, P < 0.001). For patients with nodal metastases, it was also an independent prognostic factor for OS (HR, 0.56, 95% CI, 0.35–0.90, P = 0.017) and DFS (HR, 0.42, 95% CI, 0.28–0.65, P < 0.001). Some degree of lymphadenectomy after NCT was beneficial in improving 5-year OS and DFS for ESCC patients with nodal metastases. For patients with nodal negativity, more extended lymphadenectomy did not improve patient survival.

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Background:The feasibility and safety of en bloc robot-assisted minimally invasive oesophagectomy (RAMIE) need to be verified. Methods:Forty-seven patients who received conventional RAMIE and 31 who received modified en bloc RAMIE at Henan Cancer Hospital were included in the study cohort. We compared the perioperative outcomes of conventional RAMIE and modified en bloc RAMIE.Results: Compared with the conventional RAMIE group, the en bloc RAMIE group yielded a higher total number of lymph nodes (p = 0.001), especially thoracic lymph nodes (p = 0.025) and left recurrent laryngeal nerve (RLN) lymph nodes (p = 0.005).No notable differences were found in the rate of total complications (p = 0.663) or RLN injury (p = 0.891) between the two groups. The preoperative and postoperative serological indicators were comparable between the two groups.Conclusions: Modified en bloc RAMIE was safe and feasible for patients with oesophageal squamous cell carcinoma and improved lymph node dissection, especially thoracic and left RLN lymph node dissection.

Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE).Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identi ed for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0-34.7] vs. 0 [0-22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0-31.7] vs. 18.0 [0-25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien-Dindo CD ≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This nding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest Xray examination.

Neoadjuvant therapy follow by surgery is the standard treatment mode for patients with locally advanced esophageal squamous cell carcinoma (ESCC). This research aimed to investigated the potential of sonic hedgehog (Shh), glioma-associated oncogene homolog1 (Gli1) and Phospho-S6 (p-S6) to predict the response of ESCC to neoadjuvant chemotherapy. Firstly, the expressions of Shh, Gli1 and p-S6 in cancer tissues and normal tissues of 49 ESCC patients without neoadjuvant therapy were detected by immunohistochemistry. A total of 390 ESCC patients were included in the nest study, and 44 pairs of patients with or without neoadjuvant chemotherapy were matched after 1:1 propensity score matching to evaluate the effect of neoadjuvant chemotherapy on the expression of Shh, Gli1 and p-S6. The relationship between Shh, Gli1, and p-S6 expression and the outcomes of neoadjuvant chemotherapy was analyzed retrospectively. The expressions of Shh (positive/negative: 25/24 vs. 0/49, P﹤0.001), Gli1 (24/25 vs. 0/49, P﹤0.001) and p-S6 (16/33 vs. 0/49, P﹤0.001) in cancer tissues were significantly higher than those in normal tissues. Neoadjuvant chemotherapy did not change the expression of Shh (24/20 vs. 23/21, P=0.109), Gli1 (23/21 vs. 21/23, P=0.839) and p-S6 (10/34 vs. 15/29, P=0.383) in ESCC cancer tissues. Among them, the positive expression of Shh was associated with poor tumor regression grade (TRG2-3/TRG1: 23/1 vs. 12/8, P=0.003) and poor 5-year survival rate (44.7% vs. 65.8%, P=0.041). The expressions of Shh, Gli1 and p-S6 were increased significantly in ESCC and were not affected by neoadjuvant chemotherapy. Shh is a significant predictive indicator of ESCC response to neoadjuvant chemotherapy and prognosis.

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Purpose: This retrospective study evaluated the impact of nasogastric decompression (NGD) on gastric tube size to optimize the Enhanced Recovery After Surgery protocol after McKeown minimally invasive esophagectomy (MIE). Methods: Overall, 640 patients were divided into two groups according to nasogastric tube (NGT) placement intraoperatively. Using propensity score matching, 203 pairs of individuals were identified for gastric tube size comparisons on postoperative days (PODs) 1 and 5. Results: Gastric tubes were larger in the non-NGD group than the NGD group on POD 1 (vertical distance from the right edge of the gastric tube to the right edge of the thoracic vertebra, 22.2 [0–34.7] vs. 0 [0–22.5] mm, p <0.001). No difference was noted between the groups on POD 5 (18.5 [0–31.7] vs. 18.0 [0–25.4] mm, p =0.070). Univariate and multivariate analyses showed that non-NGD was an independent risk factor for gastric tube distention on POD 1. No difference in the incidence of complications (Clavien–Dindo（CD）≥2) (40 (23.0%) vs. 46 (19,8%), p =0.440), pneumonia (CD≥2) (29 [16.8%] vs. 30 [12.9%], p =0.280) or anastomotic leakage (CD≥3) (3 [1.7%] vs. 6 [2.6%], p =0.738) were noted between the without gastric tube distention group and with gastric tube distention group. Conclusion: Intraoperative NGT placement reduces gastric tube distention rates after McKeown MIE on POD 1, but the complications are similar to those of unconventional NGT placement. This finding is based on NGT placement or replacement at the appropriate time postoperatively through bedside chest X-ray examination.