Comparison of neoadjuvant chemoimmunotherapy and neoadjuvant chemotherapy for resectable esophageal squamous cell carcinoma: a retrospective study with 3-year survival analysis.

BACKGROUND: Neoadjuvant chemoimmunotherapy (nCIT) for locally advanced esophageal squamous cell cancer (ESCC) has shown short-term benefits, but long-term survival outcomes are unclear. This study compares nCIT and neoadjuvant chemotherapy (nCT) in resectable ESCC. PATIENTS AND METHODS: A retrospective analysis was conducted on ESCC patients who underwent nCT or nCIT followed by esophagectomy. Propensity score matching (PSM) with a caliper of 0.02 was employed to minimize bias. The primary endpoints included disease-free survival (DFS) and overall survival (OS). RESULTS: A total of 131 comparable pairs of ESCC patients receiving nCT and nCIT were selected for the final analysis. The nCIT had higher rates of pathological complete response (pCR) and major pathological response (mPR) compared to nCT. Additionally, nCIT led to significant tumor down-staging, higher rates of R0 resection, and increased lymph node clearance during surgery. Patients who received nCIT exhibited improved disease-free survival (DFS) and overall survival (OS) at the 3-year follow-up. The incidence of distant and mixed relapses was lower in the nCIT group compared to the nCT group. However, the risk of locoregional relapse was comparable between the two groups. Subgroup analyses showed that the benefits of nCIT were generally observed across most patient subgroups. Interestingly, in patients without pCR or mPR, nCIT still demonstrated better survival benefits than nCT. CONCLUSION: nCIT demonstrated superior pathological response rates and improved 3-year DFS and OS compared to nCT alone in locally advanced ESCC, but long-term survival validation is needed.

Frequency and distribution pattern of lymph node metastasis after neoadjuvant chemoimmunotherapy for locally advanced esophageal squamous cell carcinoma.

BACKGROUND: Currently, neoadjuvant chemoimmunotherapy (NCIT) is widely used in the perioperative treatment of esophageal squamous cell carcinoma (ESCC). However, the patterns of lymph node metastasis following this novel treatment approach remain poorly understood. The aim of this study was to elucidate the distribution and frequency of postoperative lymph node metastasis (LNM) after NCIT. METHODS: We retrospectively analyzed cases from March 2020 to March 2023 in our hospital and selected patients who underwent NCIT followed by R0 resection for esophageal cancer. A total of 257 patients with clinical stage T3N0 or T1-3N + thoracic esophageal cancer were included. The distribution and frequency of metastatic lesions in each lymph node station were recorded according to the Japan Esophageal Society (JES) staging system. Additionally, we analyzed the patterns of lymph node metastasis based on the location of the thoracic tumor. RESULTS: Among the 257 patients, 110 (42.8%) had pathologically positive lymph nodes postoperatively. Common sites of lymph node metastasis included station 107 (12.8%), station 106recR (11.7%), and station 7 (12.5%). The lymph node stations with lower metastasis rates were station 105, station 106tbL, and station 111, each with a metastasis rate of 2.3%. In upper thoracic (Ut) cases, station 106recR (23.7%) was the most common site of lymph node metastasis, while in middle thoracic (Mt) cases, station 107 (16.7%) had the highest metastasis rate, and in lower thoracic (Lt) cases, station 7 (17.6%) had the highest metastasis rate. Lymph node metastasis (LNM) was more likely to occur in station 101R in Ut and Mt cases than in Lt cases (13.2% and 8.6%; p < 0.01). CONCLUSIONS: This study reveals the frequency and distribution patterns of lymph node metastasis following NCIT, highlighting the different patterns of lymph node metastasis based on tumor location. These findings can provide guidance for lymph node dissection during surgery.

The advantages of preoperative 3D reconstruction over 2D-CT in thoracoscopic segmentectomy.

Performing a pulmonary segmentectomy is a complex process, with precise localization of pulmonary nodules and recognition of intraoperative anatomical variations posing significant challenges. This study aims to assess the advantages of preoperative three-dimensional reconstruction (3D-RE) in thoracoscopic segmentectomy. The study, at Fujian Medical University Cancer Hospital, analyzed data from segmentectomy patients from January 2016 to February 2022. It compared 3D-RE and two-dimensional computed tomography (2D-CT) preoperative scans, focusing on perioperative complications within30 days to identify any differences. This investigation encompassed a total of 265 instances, with 148 belonging to the 3D-RE group and 117 aligned with the 2D-CT group. The 3D-RE group showed reduced intraoperative blood loss and shorter postoperative hospital stays (P < 0.001). They also had higher rates of lymph node sampling and combined subsegmentectomy and segmentectomy procedures (P < 0.01). Postoperative complications, particularly pneumonia and lung fistula, were lower in the 3D-RE group (P = 0.041). The rates of minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) were significantly higher in the 3D-RE group, while adenocarcinoma in situ (AIS) and benign cases were less common (P = 0.006). Surgical duration, chest tube duration, chest drainage volume, surgery complexity, and pathological diagnoses showed no significant differences between the groups. Utilization of preoperative 3D-RE holds potential to minimize both intraoperative and postoperative complications, thereby enhancing the safety and feasibility of undertaking segmentectomy procedures.

Neoadjuvant chemotherapy with or without camrelizumab in resectable esophageal squamous cell carcinoma: the randomized phase 3 ESCORT-NEO/NCCES01 trial.

Recent single-arm studies involving neoadjuvant camrelizumab, a PD-1 inhibitor, plus chemotherapy for resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC) have shown promising results. This multicenter, randomized, open-label phase 3 trial aimed to further assess the efficacy and safety of neoadjuvant camrelizumab plus chemotherapy followed by adjuvant camrelizumab, compared to neoadjuvant chemotherapy alone. A total of 391 patients with resectable thoracic LA-ESCC (T1b-3N1-3M0 or T3N0M0) were stratified by clinical stage (I/II, III or IVA) and randomized in a 1:1:1 ratio to undergo two cycles of neoadjuvant therapy. Treatments included camrelizumab, albumin-bound paclitaxel and cisplatin (Cam+nab-TP group; n = 132); camrelizumab, paclitaxel and cisplatin (Cam+TP group; n = 130); and paclitaxel with cisplatin (TP group; n = 129), followed by surgical resection. Both the Cam+nab-TP and Cam+TP groups also received adjuvant camrelizumab. The dual primary endpoints were the rate of pathological complete response (pCR), as evaluated by a blind independent review committee, and event-free survival (EFS), as assessed by investigators. This study reports the final analysis of pCR rates. In the intention-to-treat population, the Cam+nab-TP and Cam+TP groups exhibited significantly higher pCR rates of 28.0% and 15.4%, respectively, compared to 4.7% in the TP group (Cam+nab-TP versus TP: difference 23.5%, 95% confidence interval (CI) 15.1-32.0, P < 0.0001; Cam+TP versus TP: difference 10.9%, 95% CI 3.7-18.1, P = 0.0034). The study met its primary endpoint of pCR; however, EFS is not yet mature. The incidence of grade ≥3 treatment-related adverse events during neoadjuvant treatment was 34.1% for the Cam+nab-TP group, 29.2% for the Cam+TP group and 28.8% for the TP group; the postoperative complication rates were 34.2%, 38.8% and 32.0%, respectively. Neoadjuvant camrelizumab plus chemotherapy demonstrated superior pCR rates compared to chemotherapy alone for LA-ESCC, with a tolerable safety profile. Chinese Clinical Trial Registry identifier: ChiCTR2000040034 .

Conditional Survival of Patients with Limited-Stage Small Cell Lung Cancer After Surgery: A National Real-World Cohort Study.

BACKGROUND: The prognosis of limited-stage small cell lung cancer (LS-SCLC) after surgery usually is estimated at diagnosis, but how the prognosis actually evolves over time for patients who survived for a predefined time is unknown. METHODS: Data on patients with a diagnosis of LS-SCLC after surgery between 2004 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. The 5-year conditional cancer-specific survival (CCSS) and conditional overall survival (COS) were calculated. RESULTS: This study analyzed 997 patients (555 women, 55.7%) with a median age, of 67 years (interquartile range [IQR], 60-73 years). The 5-year CCSS and COS increased from 44.7% and 38.3%, respectively, at diagnosis to 83.7% and 67.9% at 5 years after diagnosis. Although there were large differences with different stages (stages I, II, and III) at diagnosis (respectively 59.5%, 28.4%; 28.1% for CCSS and 50.6%, 24.8%, and 23.6% for COS), the gap decreased with time, and the rates were similar after 5 years (respectively 85.0%, 80.3%, and 79.4% for CCSS; 65.6%, 56.9%, and 61.3% for COS). The 5-year conditional survival for the patients who received lobectomy was better than for those who received sublobectomy or pneumonectomy. Multivariable analyses showed that only age and resection type were independent predictors for CCSS and COS, respectively, throughout the period. CONCLUSION: Conditional survival estimates for LS-SCLC generally increased over time, with the most significant improvement in patients with advanced stage of disease. Resection type and old age represented extremely important determinants of prognosis after a lengthy event-free follow-up period.

The prognostic significance of right paratracheal lymph node dissection numbers in right upper lobe non-small cell lung cancer.

BACKGROUND: The number of dissected lymph nodes is closely related to the prognosis of patients with non-small cell lung cancer. This study explored the optimal number of right paratracheal lymph nodes dissected in right upper non-small cell lung cancer patients and its impact on prognosis. METHODS: Patients who underwent radical surgery for right upper lobe cancer between 2012 and 2017 were retrospectively enrolled. The optimal number of right paratracheal lymph nodes and the relationship between the number of dissected right paratracheal lymph nodes and the prognosis of right upper non-small cell lung cancer were analysed. RESULTS: A total of 241 patients were included. The optimal number of dissected right paratracheal lymph nodes was 6. The data were divided according to the number of dissected right paratracheal lymph nodes into groups RPLND + (≥ 6) and RPLND- (< 6). In the stage II and III patients, the 5-year overall survival rates were 39.0% and 48.2%, respectively (P = 0.033), and the 5-year recurrence-free survival rates were 32.8% and 41.8%, respectively (P = 0.043). Univariate and multivariate analyses revealed that among the stage II and III patients, ≥ 6 right paratracheal dissected lymph nodes was an independent prognostic factor for overall survival (HR = 0.53 95% CI 0.30-0.92 P = 0.025) and recurrence-free survival (HR = 1.94 95% CI 1.16-3.24 P = 0.011). CONCLUSIONS: Resection of 6 or more right paratracheal lymph nodes may be associated with an improved prognosis in patients with right upper non-small cell lung cancer, especially in patients with stage II or III disease.

Adjuvant Therapy-Free Strategy for Stage IB to IIIA Non-Small-Cell Lung Cancer Patients After Radical Resection Based on Longitudinal Undetectable Molecular Residual Disease: Prospective, Multicenter, Single-Arm Study (CTONG 2201).

BACKGROUND: The utility of circulating tumor DNA to monitor molecular residual disease (MRD) has been clinically confirmed to predict disease recurrence in non-small cell lung cancer (NSCLC) patients after radical resection. Patients with longitudinal undetectable MRD show a favorable prognosis and might not benefit from adjuvant therapy. PATIENTS AND METHODS: The CTONG 2201 trial is a prospective, multicenter, single-arm study (ClinicalTrials.gov identifier, NCT05457049), designed to evaluate the hypothesis that no adjuvant therapy is needed for patients with longitudinal undetectable MRD. Pathologically confirmed stage IB-IIIA NSCLC patients who have undergone radical resection will be screened. Only patients with 2 consecutive rounds of undetectable MRD will be enrolled (first at days 3-10, second at days 30 ± 7 after surgery), and admitted for imaging and MRD monitoring every 3 months without adjuvant therapy. The primary endpoint is the 2-year disease-free survival rate for those with longitudinal undetectable MRD. The recruitment phase began in August 2022 and 180 patients will be enrolled. CONCLUSIONS: This prospective trial will contribute data to confirm the negative predictive value of MRD on adjuvant therapy for NSCLC patients. CLINICAL TRIAL REGISTRATION: NCT05457049 (CTONG 2201).

The association between histological subtypes and lymph node metastasis and prognosis in early esophageal cancer: a population-based study.

BACKGROUND: There is still a lack of high-level clinical evidence and uniform conclusions on whether there are differences in lymph node metastasis (LNM) and prognosis between early esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC). METHODS: Patients with surgically resected, histologically diagnosed, pT1 EAC or ESCC in the Surveillance, Epidemiology and End Results registries database from 2004 to 2015 were included. Multivariable logistic regression, Cox regression, multivariate competing risk model, and propensity score matching were used to analyze association the histology and LNM or prognosis. RESULTS: A total of 570 early esophageal cancer patients were included. The LNM rates were 13.8% and 15.1% for EAC and ESCC ( P  = 0.757), respectively. Multivariate logistic regression analysis showed no significant association between histological type and LNM (odds ratio [OR], 1.209; 95% CI, 0.538-2.715; P  = 0.646). Moreover, the prognosis of early EAC and ESCC was shown to be comparable in both multivariate Cox regression (hazard ratio [HR], 1.483; 95% CI, 0.699-3.150; P  = 0.305) and the multivariate competing risk model (subdistribution HR, 1.451; 95% CI, 0.628-3.354; P  = 0.383). After propensity score matching, there were no significant differences between early EAC and ESCC in terms of LNM (10.6% vs.18.2%, P  = 0.215), 5-year CSS (89.8% [95% CI, 81.0%-98.6%] vs. 79.1% [95% CI, 67.9%-90.3%], P  = 0.102) and 5-year cumulative incidence of CSS (10.2% [95% CI, 1.4%-19.0%] vs. 79.1% [95% CI, 9.7%-32.1%], P  = 0.124). CONCLUSION: The risk of LNM and prognosis of early ESCC and EAC are comparable, so the treatment choice for early esophageal cancer does not depend on the histologic type.

Construction and validation of a risk-scoring model to predict lymph node metastasis in T1b-T2 esophageal cancer.

BACKGROUND: Lymph node status is an important factor in determining preoperative treatment strategies for stage T1b-T2 esophageal cancer (EC). Thus, the aim of this study was to investigate the risk factors for lymph node metastasis (LNM) in T1b-T2 EC and to establish and validate a risk-scoring model to guide the selection of optimal treatment options. METHODS: Patients who underwent upfront surgery for pT1b-T2 EC between January 2016 and December 2022 were analyzed. On the basis of the independent risk factors determined by multivariate logistic regression analysis, a risk-scoring model for the prediction of LNM was constructed and then validated. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminant ability of the model. RESULTS: The incidence of LNM was 33.5% (214/638) in our cohort, 33.4% (169/506) in the primary cohort and 34.1% (45/132) in the validation cohort. Multivariate analysis confirmed that primary site, tumor grade, tumor size, depth, and lymphovascular invasion were independent risk factors for LNM (all P < 0.05), and patients were grouped based on these factors. A 7-point risk-scoring model based on these variables had good predictive accuracy in both the primary cohort (AUC, 0.749; 95% confidence interval 0.709-0.786) and the validation cohort (AUC, 0.738; 95% confidence interval 0.655-0.811). CONCLUSION: A novel risk-scoring model for lymph node metastasis was established to guide the optimal treatment of patients with T1b-T2 EC.

Prognostic Factors and Outcomes in Elderly Esophagectomy Patients with Esophageal Cancer.

BACKGROUND: Choosing the appropriate treatment for elderly patients with esophageal cancer remains a contentious issue. While surgery is still a valid option, we aimed to identify predictors and outcomes in elderly esophagectomy patients with esophageal cancer. PATIENTS AND METHODS: We analyzed characteristics, surgical outcomes, survival rates, cause-specific mortality, and recurrence in 120 patients with stage I-IV esophageal cancer. Univariate and multivariate analyses were used to identify risk factors for event-free survival (EFS) and overall survival (OS). RESULTS: The median follow-up period was 31 months, with 5-year overall survival (OS) and event-free survival (EFS) rates standing at 45.2% and 41.5%, respectively. Notably, lower body mass index (BMI ≤ 22 kg/m2) and reduced preoperative albumin levels (pre-ALB < 40 g/L) led to a significant decrease in OS rates. Postoperative pulmonary complications resulted in higher in-hospital and 90-day mortality rates. After about 31 months post-surgery, the rate of cancer-specific deaths stabilized. The most common sites for distant metastasis were the lungs, supraclavicular lymph nodes, liver, and bone. The study identified lower BMI, lower pre-ALB levels, and postoperative pulmonary complications as independent risk factors for poorer EFS and OS outcomes. CONCLUSIONS: Esophagectomy remains a safe and feasible treatment for elderly patients, though the prevention of postoperative pulmonary infection is crucial. Factors such as lower BMI, lower pre-ALB levels, advanced tumor stage, postoperative pulmonary complications, and certain treatment modalities significantly influence the outcomes in elderly esophagectomy patients. These findings provide critical insights into the characteristics and outcomes of this patient population.

Single-Line Multi-Channel Flexible Stress Sensor Arrays.

Flexible stress sensor arrays, comprising multiple flexible stress sensor units, enable accurate quantification and analysis of spatial stress distribution. Nevertheless, the current implementation of flexible stress sensor arrays faces the challenge of excessive signal wires, resulting in reduced deformability, stability, reliability, and increased costs. The primary obstacle lies in the electric amplitude modulation nature of the sensor unit's signal (e.g., resistance and capacitance), allowing only one signal per wire. To overcome this challenge, the single-line multi-channel signal (SLMC) measurement has been developed, enabling simultaneous detection of multiple sensor signals through one or two signal wires, which effectively reduces the number of signal wires, thereby enhancing stability, deformability, and reliability. This review offers a general knowledge of SLMC measurement beginning with flexible stress sensors and their piezoresistive, capacitive, piezoelectric, and triboelectric sensing mechanisms. A further discussion is given on different arraying methods and their corresponding advantages and disadvantages. Finally, this review categorizes existing SLMC measurement methods into RLC series resonant sensing, transmission line sensing, ionic conductor sensing, triboelectric sensing, piezoresistive sensing, and distributed fiber optic sensing based on their mechanisms, describes the mechanisms and characteristics of each method and summarizes the research status of SLMC measurement.

High-dose chemotherapy sensitizes locally advanced esophageal squamous cell carcinoma to PD-1 blockade for a higher pathological complete response rate and survival.

BACKGROUND: PD-1 inhibitor and chemotherapy demonstrated durable antitumor activity with a manageable safety profile as the first-line treatment in patients with advanced esophageal squamous cell carcinoma (ESCC). The present study aimed to evaluate the efficacy of PD-1 inhibitors plus different dose intensity neoadjuvant chemotherapy in the treatment of locally advanced ESCC. METHODS: Patients with locally advanced but resectable thoracic ESCC, staged as T3 or T4a, N0-3, and M0 or M1 lymph node metastasis (confined to the supraclavicular lymph nodes), were enrolled in this study. The eligible patients received tislelizumab plus different dose intensity chemotherapy for a 21-day cycle with repeated 2-4 cycles before surgery. The primary endpoints are pathological complete response (pCR) and major pathological response (MPR), and the secondary endpoints are objective response rate (ORR), disease control rate (DCR), and disease-free survival (DFS). RESULTS: From November 2019 to February 2022, 122 cases received at least two cycles neoadjuvant chemoimmunotherapy and were evaluated by imaging examination. Subsequently, 99 patients underwent surgery and were evaluated by pathological evaluation. According to chemotherapy dose intensity, the patients were divided into three cohorts: cohort 1 (<80% dose intensity), cohort 2 (80-90% dose intensity), cohort 3 (90-100% dose intensity). All surgery patients underwent minimally invasive esophagectomy (MIE). The average pCR was identified in 22.22%; 16% had pCR in cohort 1, 17.65% had pCR in cohort 2, and 30.00% had pCR in cohort 3. MPR was observed in 9 (36.00%) patients in cohort 1, 18 (52.94%) patients in cohort 2, 22 (55.00%) patients in cohort 3. In univariable and multivariable analysis, dose intensity was significantly associated with MPR (p = 0.048) in patients who underwent esophagectomy. For surviving patients, the median follow-up was 13.76 months after esophagectomy. Compared to cohort 1, cohorts 2 and 3 had better DFS (p = 0.056). In addition, the prognosis of patients with MPR was better than that of patients without MPR (p = 0.014). CONCLUSIONS: The robust antitumor activity of neoadjuvant chemoimmunotherapy for locally advanced but resectable thoracic ESCC was confirmed. More than 80% of chemotherapy dose intensity combined with immunotherapy resulted in a high pCR rate and prolonged DFS.

Learning Hand Kinematics for Parkinson's Disease Assessment Using a Multimodal Sensor Glove.

Hand dysfunctions in Parkinson's disease include rigidity, muscle weakness, and tremor, which can severely affect the patient's daily life. Herein, a multimodal sensor glove is developed for quantifying the severity of Parkinson's disease symptoms in patients' hands while assessing the hands' multifunctionality. Toward signal processing, various algorithms are used to quantify and analyze each signal: Exponentially Weighted Average algorithm and Kalman filter are used to filter out noise, normalization to process bending signals, K-Means Cluster Analysis to classify muscle strength grades, and Back Propagation Neural Network to identify and classify tremor signals with an accuracy of 95.83%. Given the compelling features, the flexibility, muscle strength, and stability assessed by the glove and the clinical observations are proved to be highly consistent with Kappa values of 0.833, 0.867, and 0.937, respectively. The intraclass correlation coefficients obtained by reliability evaluation experiments for the three assessments are greater than 0.9, indicating that the system is reliable. The glove can be applied to assist in formulating targeted rehabilitation treatments and improve hand recovery efficiency.

Comparing a PD-L1 inhibitor plus chemotherapy to chemotherapy alone in neoadjuvant therapy for locally advanced ESCC: a randomized Phase II clinical trial : A randomized clinical trial of neoadjuvant therapy for ESCC.

BACKGROUND: A Phase II study was undertaken to evaluate the safety and efficacy of the neoadjuvant socazolimab, a novel PD-L1 inhibitor, in combination with nab-paclitaxel and cisplatin for locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: Sixty-four patients were randomly divided between the Socazolimab + nab-paclitaxel + cisplatin (TP) arm (n = 32) and the control arm (n = 32), receiving either socazolimab (5 mg/kg intravenously (IV), day 1) or a placebo with nab-paclitaxel (125 mg/m2 IV, day 1/8) and cisplatin (75 mg/m2 IV, day 1) repeated every 21 days for four cycles before surgery. The primary endpoint was major pathological response (MPR), and the secondary endpoints were pathological complete response (pCR), R0 resection rate, event-free survival (EFS), overall survival (OS), and safety. RESULTS: A total of 29 (90.6%) patients in each arm underwent surgery, and 29 (100%) and 28 (98.6%) patients underwent R0 resection in the Socazolimab + TP and Placebo + TP arms, respectively. The MPR rates were 69.0 and 62.1% (95% Confidence Interval (CI): 49.1-84.0% vs. 42.4-78.7%, P = 0.509), and the pCR rates were 41.4 and 27.6% (95% CI: 24.1-60.9% vs. 13.5-47.5%, P = 0.311) in the Socazolimab + TP and Placebo + TP arms, respectively. Significantly higher incidence rates of ypT0 (37.9% vs. 3.5%; P = 0.001) and T downstaging were observed in the Socazolimab + TP arm than in the Placebo + TP arm. The EFS and OS outcomes were not mature. CONCLUSIONS: The neoadjuvant socazolimab combined with chemotherapy demonstrated promising MPR and pCR rates and significant T downstaging in locally advanced ESCC without increasing surgical complication rates. TRIAL REGISTRATION: Registration name (on clinicaltrials.gov): A Study of Anti-PD-L1 Antibody in Neoadjuvant Chemotherapy of Esophageal Squamous Cell Carcinoma. REGISTRATION NUMBER: NCT04460066.

Minimally invasive versus open esophagectomy for resectable thoracic esophageal cancer (NST 1502): a multicenter prospective cohort study.

Background: Whether minimally invasive esophagectomy (MIE) is superior to open esophagectomy (OE) in the treatment of esophageal squamous cell carcinoma (ESCC) is still uncertain. Therefore, this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival. Methods: All hospitalized patients with cT1b-3N0-1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1, 2015 to December 31, 2018. The propensity score matching (PSM) was performed to minimize the selection bias. The basic clinicopathological characteristics and 3-year overall survival (OS) as well as disease-free survival (DFS) of two groups were compared by R version 3.6.2. Results: MIE were performed in 1,387 patients and OE in 335 patients. 335 cases in each group were finally matched by PSM, and no significant differences in the essential demographic characteristics were observed between the MIE and OE groups after PSM. Compared with OE, MIE had significantly less intraoperative bleeding, less total drainage volume, shorter postoperative hospital stay, and harvested significantly more lymph nodes (LNs) (all P < 0.001). There were no significant differences in the major postoperative complications and death rates between MIE and OE. The 3-year OS and DFS were 77.0% and 68.1% in the MIE group versus 69.3% and 60.9% in the OE group (OS: P = 0.03; DFS: P = 0.09), and the rates were 75.1% and 66.5% in the MIE group versus 66.9% and 58.6% in the OE group for stage cII patients (OS: P = 0.04, DFS: P = 0.09), respectively. Conclusions: Compared with OE, MIE is a safe and effective treatment approach with similar mortality and morbidity. It has the advantages in harvesting more LNs, improving postoperative recovery and survival of stage cII ESCC patients.

Right middle pulmonary vein classification by 3D-CT reconstruction and its clinical significance.

Background: A profound understanding of the type of right middle lobe (RML) vein return is crucial for thoracic surgeons to ensure safe anatomic lung resection. In this study, the type of venous return in the RML and its clinical significance were analyzed using the 3D computed tomography (3D-CT) reconstruction technique. Methods: This retrospective study analyzed the patients who underwent anatomical lobectomy or anatomical lung segment resection with preoperative 3D-CT reconstruction at the Department of Thoracic Oncology Surgery, Fujian Cancer Hospital from January 2020 to October 2022. The exclusion criteria were as follows: (I) blurred CT images and inadequate IQQA 3D reconstruction for clear visualization of bronchial and vascular subsegmental branches; (II) patients with a previous history of right middle lobectomy; (III) incomplete medical records. Results: This study included 608 eligible cases, 245 males (40.30%) and 363 females (59.70%), with an average age of 58.61 years. We identified four major types of RML venous return, including 407 cases (66.94%) of central vein type, 123 cases (20.23%) of isolated vein type, 11 cases (1.81%) of basal vein type, and 67 cases (11.02%) of combined vein type. Furthermore, the central venous type comprised four subtypes: 191 cases (27.3%) had one branch, 165 cases (27.14%) had two branches, 43 cases (7.07%) had three branches, and 8 cases (1.32%) had more than three branches. The combined venous type includes four subtypes: combination type A (n=37 cases, 6.09%), combination type B (n=7 cases, 1.15%), combination type C (n=21 cases, 3.45%), and combination type D (n=2 cases, 0.33%). Conclusions: Based on 3D-CT reconstruction, numerous types of venous return in the RML were found, highlighting the significance of 3D-CT reconstruction for thoracic surgeons. It plays a crucial role in understanding the type of RML venous return prior to surgery, providing invaluable information to ensure surgical safety and success.

A cross-sectional study: analysis of anatomical variation in the right upper lung intersegmental vein V2a based on a 3D reconstruction technique.

Background: This study aimed to summarize and analyze the anatomical structures of the right upper lung intersegmental vein V2a based on 3-dimensional (3D) reconstruction technology. Methods: We collected the enhanced computed tomography (CT) scans of 157 patients with pulmonary diseases, and reconstructed the right upper lung tissue structure through interactive qualitative and quantitative analysis (IQQA). According to the reconstruction results, the V2a of the right upper pulmonary intersegmental vein was returned to different veins for classification, and the subtypes were further subdivided according to the different vascular routes and the location of the pulmonary segmental bronchus. Results: Among 157 patients, there were 4 types of V2a according to the anatomical position of the veins. In type B (15 cases, 9.6%), V2a returned to the apical vein V1. In type C (2 cases, 1.3%), V2a did not exist, while in type D (1 case, 0.6%), V2a directly flowed into the right atrium. Type A is further divided into three subtypes (A1, A2, A3) according to the type of veins returned and the anatomical location of their confluence. In subtype A1 (110/139 cases, 79.1%), V2a returned to the posterior segment central vein. In subtype A2 (8/139 cases, 5.8%), V2a flowed from the B2 mediastinal surface down to the interlobular part of the posterior segmental vein. In subtype A3 (21/139 cases, 15.1%), V2a flowed between B1a and B2a and back to the central vein at the junction of the B2 and B3 bronchus. Type B is further divided into 3 subtypes (B1, B2, B3) according to the location of the apical posterior segmental bronchus. In B1 subtype (1/15 cases, 6.7%), V2a continued from the mediastinal surface of B1 back down to V1. In B2 subtype (7/15 cases, 46.7%), V2a continued from the medial side of the B1 lung back down to V1. In subtype B3 (7/15 cases, 46.7%), V2a flowed back into the central part of the posterior segmental vein. Conclusions: This study, supported by 3D reconstruction technology, preliminarily summarized the V2a typology and further refined the anatomical differences of each subtype.

Purse-indigitation mechanical anastomosis vs. traditional mechanical anastomosis undergoing McKeown esophagectomy: a retrospective comparative cohort study.

Background: Postoperative anastomosis-related complication rates remain high in patients undergoing McKeown esophagectomy with cervical anastomosis, and the optimal anastomotic technique remains under debate. We describe a new method of anastomosis, referred to as purse-indigitation mechanical anastomosis (PIMA) by reinforcing esophagogastric anastomosis, which can be performed after minimally invasive surgery. This study was designed to compare its feasibility, efficacy, and safety with those of traditional mechanical anastomosis (TMA). Methods: Between September 2020 and January 2022, 264 patients undergoing McKeown esophagectomy at a single center were included. Demographic data, including patient age, sex, diagnosis, neoadjuvant chemotherapy/radiation therapy in cases of malignancy, comorbidities, and operation time, anastomotic time, estimated blood loss, post­operative complications were collected. Their medical records were retrospectively reviewed, analyzed and compared between the PIMA and TMA cohorts. Results: The baseline comparability of the PIMA and TMA before the comparisons is no statistical difference. Univariable analysis revealed significantly decreased anastomotic leak rate with PIMA compared to TMA (4.10% vs. 11.59%, P=0.04). No significant difference was demonstrated in total operation time, estimated blood loss, postoperative hospital stay, or pulmonary complications between PIMA and TMA (243.94±21.98 vs. 238.70±28.45 min; 201.10±67.83 vs. 197.39±65.13 mL; 8.83±2.77 vs. 9.35±3.78 days; 8.21% vs. 11.59%; all P>0.05). The incidence of postoperative pulmonary complications (3.44% vs. 50%) was significantly associated with an increased rate of anastomotic leak [odds ratio (OR): 15.50; 95% confidence interval (CI): 4.81-43.71; P<0.01]. Conclusions: PIMA is feasible, safe to perform, and demonstrated a leak rate less than half that of TMA in this study. PIMA may represent a superior alternative to standard esophagogastric cervical anastomosis techniques. Larger sample size and long-term survival are required to fully evaluate PIMA.