Introduction: Textbook outcome (TBO) is a composite measure of a number of peri-operative and clinical outcomes in oesophagogastric malignancy. It has previously been shown that TBOs are associated with improved overall survival in both oesophageal and gastric cancer. The influence of a minimally invasive approach (MIA) on TBO is not well defined. The purpose of this study is to validate TBO in our population, examine the influence of a MIA on achieving a TBO, and the impact of TBO on long-term survival. Methods: 269 patients undergoing oesophagectomy and 258 patients undergoing subtotal or total gastrectomy were included in this study. Demographic, clinical and pathological differences between patients with and without a TBO were compared using univariable and multivariable analysis. Overall survival for those with and without a TBO was examined. The influence of MIA on overall survival and TBO was determined using Cox proportional hazard models. Results: Patients undergoing oesophagectomy and gastrectomy were significantly more likely to achieve a TBO when MIA was used (p ¼ 0.01 and 0.001 respectively). When MIA is included as an outcome measure patients achieving a TBO show improved overall survival in both oesophageal and gastric cancer. MIA, clear resection margins and no unplanned admission to critical care are the strongest predictors of overall survival from the putative bundle of TBO parameters. Conclusion: Minimally invasive surgery is associated with improved TBO. Completion of a minimally invasive approach should be considered for inclusion as a textbook parameter.

No abstract

Patients with lower extremity peripheral vascular disease who underwent revascularization with either endovascular intervention or surgery had significantly lower composite rates of acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, or cardiovascular death after 3 years if they received rivaroxaban (Xarelto) 2.5 mg twice daily plus aspirin (17%) than if they received placebo and aspirin (20%). Major bleeding occurred in approximately 3% of patients in the rivaroxaban group vs 2% in the control group (P ¼ .07) according to one classification and in 6% of patients in the rivaroxaban group vs 4% in the control group (P ¼ .007) according to a different classification.Conclusion: Rivaroxaban at a dose of 2.5 mg twice daily plus aspirin was associated with a significantly lower incidence of the composite outcome of acute limb ischemia, major amputation, myocardial infarction, ischemic stroke, or cardiovascular death than aspirin alone. Major Study design: Retrospective analysis from the Global Registry for Endovascular Aortic Treatment (GREAT) between August 2010 and October 2016Key findings: Of 3758 patients (3220 male, 538 female) who received Gore Excluder stent grafts (W. L. Gore & Associates, Flagstaff, Ariz) and underwent endovascular infrarenal abdominal aortic aneurysm repair (EVAR), women had shorter, more angulated necks and more reintervention for device-related issues than men did but not more endoleaks.

Patients with esophageal or gastroesophageal junction (GEJ) cancer who fail to respond to chemoradiotherapy have a poor clinical prognosis. Recent clinical trials have investigated the use of immune checkpoint inhibitors in these patients. The use of programmed cell death protein 1 (PD-1) inhibitors has emerged as exciting therapeutic options in the curative and palliative setting of other solid tumors. We assessed the efficacy and safety of PD-1 inhibitors in esophageal and GEJ cancers. This systematic review was performed in accordance with the PRISMA guidelines. A comprehensive electronic literature search from the EMBASE, Pubmed, Scopus, MEDLINE, and Google Scholar databases was conducted up to 25 July 2021. This review identified 11 eligible studies reporting outcomes of 3451 patients treated with PD-1 blockade compared with 2286 patients treated with either a placebo or the standard regimen of chemotherapy. Clinically significant improvements in median overall survival have been demonstrated in advanced and metastatic esophageal and GEJ cancer while maintaining acceptable safety profiles. Promising survival data have also recently emerged from PD-1 blockade in the adjuvant setting. PD-1 blockade in esophageal and GEJ cancer has delivered impressive survival benefit while remaining well tolerated. Its use in the adjuvant setting will further advance treatment options, and more advancements in this area of therapy are highly anticipated. However, further characterization of the PD-1/programmed death ligand-1 pathway and elucidation of biomarkers to predict response are required to optimize patient selection.