The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.

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Introduction: Up to 32% of patients with esophageal cancer show a pathological complete response (ypCR) after neoadjuvant therapy. To prevent overtreatment, the indication to perform esophagectomy in these patients should be reconsidered. Implementing an organ-preserving strategy for patients with ypCR requires an accurate assessment of residual disease after neoadjuvant treatment. The aim of this study was to systematically review the effectiveness of imaging techniques used for detection of ypCR after neoadjuvant therapy but before resection in patients with esophageal cancer.

PurposeToday, 40 to 66 % of elective procedures in abdominal surgery are reoperations. Reoperations show increased operative time and risk for intraoperative and postoperative complications, mainly due to the need to perform adhesiolysis. It is important to understand which patients will require repeat surgery for optimal utilization and implementation of anti-adhesive strategies. Our aim is to assess the incidence and identify risk factors for repeat abdominal surgery.MethodsThis is the long-term follow-up of a prospective cohort study (Laparotomy or Laparoscopy and Adhesions (LAPAD) study; clinicaltrials.gov NCT01236625). Patients undergoing elective abdominal surgery were included. Primary outcome was future repeat abdominal surgery and was defined as any operation where the peritoneal cavity is reopened. Multivariable logistic regression analysis was used to identify risk factors.ResultsSix hundred four (88 %) out of 715 patients were included; median duration of follow-up was 46 months. One hundred sixty (27 %) patients required repeat abdominal surgery and underwent a total of 234 operations. The indication for repeat surgery was malignant disease recurrence in 49 (21 %), incisional hernia in 41 (18 %), and indications unrelated to the index surgery in 58 (25 %) operations. Older age (OR 0.98; p 0.002) and esophageal malignancy (OR 0.21; p 0.034) significantly reduced the risk of undergoing repeat abdominal surgery. Female sex (OR 1.53; p 0.046) and hepatic malignancy as indication for surgery (OR 2.08; p 0.049) significantly increased the risk of requiring repeat abdominal surgery.ConclusionsOne in four patients will require repeat surgery within 4 years after elective abdominal surgery. Lower age, female sex, and hepatic malignancy are significant risk factors for requiring repeat abdominal surgery.

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