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@#<b>Objective</b> To compare the set up errors derived from different registration methods of the X-ray volume imaging (XVI) system for radiotherapy in the treatment of middle/lower-segment esophageal cancer, and to provide a reference for radiation treatment of esophageal cancer. <b>Methods</b> We randomly selected 63 patients with middle/lower-segment esophageal cancer, and obtained their reconstructed XVI images at the first therapy to perform automatic registration with gray-value and bone registration methods. We acquired and compared the three translation errors (along <i>x</i> [left to right], <i>y</i> [head to feet], and <i>z</i> [front to back] axes) and three rotation errors (around the <i>x</i>, <i>y</i>, and <i>z</i> axes) derived from the two registration methods. <b>Results</b> Gray-value registration had significantly smaller translation errors along the <i>x</i> and <i>z</i> axes than bone registration (<i>x</i> azes <i>t</i> = −2.78, <i>z</i> azes <i>t</i> = −2.15, <i>P</i> < 0.05), but there was no significant difference along the <i>y</i> axes (<i>P</i> > 0.05). The rotation errors around the three axes were all smaller than 1°, and were smaller with gray-value registration than with bone registration, but without significant differences (<i>P</i> > 0.05). <b>Conclusion</b> We recommend gray-value registration for radiotherapy in the treatment of middle/lower-segment esophageal cancer. Manual verification or fine-tuning is recommended after automatic registration in clinical practice. Besides translation errors, rotation errors should also be paid attention to.
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ObjectiveTo explore the mechanism of Qigesan （QGS） in intervening in the migration and invasion of esophageal carcinoma TE-1 cells. MethodMicroarray technology was used to screen differentially expressed genes （DEGs） in the normal group and the QGS group， and the ontological functions and signaling pathways of DEGs were analyzed. The thiazolyl tetrazolium （MTT） assay was used to detect the effect of QGS on the viability of TE-1 cells. In the subsequent experiments for verification， a blank group， a transforming growth factor-β1 （TGF-β1） group， a TGF-β1 + QGS group， and a TGF-β1 + SB431542 group were set up. The cell morphology in each experimental group was observed by microscopy. The migration and invasion abilities of cells were detected by wound healing assay， and the mRNA expression levels of E-Cadherin， vimentin， Smad2， and Smad7 were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）. The protein expression of E-Cadherin， vimentin， p-Smad2/3， Smad2/3， and Smad7 was detected by Western blot. ResultThere were 1 487 DEGs between the QGS group and the blank group， including 1 080 down-regulated ones （accounting for 72.63%） and 407 up-regulated ones. The down-regulated genes were mainly involved in biological processes such as cytoskeletal protein binding， ATP binding， adenylate nucleotide binding， and adenylate ribonucleotide binding， and the involved Kyoto Encyclopedia of Genes and Genomes （KEGG） pathways included TGF-β signaling pathway， cell cycle， extracellular matrix-receptor interaction protein， tumor pathways， and oocyte meiosis. The up-regulated genes were mainly involved in RNA binding， DNA binding， transcriptional regulator activity， transcriptional activator activity， and nucleotide binding， and the KEGG pathways involved mainly included mitogen-activated protein kinase （MAPK） signaling pathway， bladder cancer， renal cell carcinoma， cancer pathways， and p53 signaling pathway. Compared with the blank group， the inhibition rate of cell viability of TE-1 cells increased after QGS （20， 30， 40， 60， 80 mg·L-1） intervention for 12， 24， 36， 48， 60 h （P<0.05）， and the inhibition rate was time- and dose-dependent. Compared with the blank group， the TGF-β1 group showed lengthened cells with fibroblast phenotype. Compared with the TGF-β1 group， the TGF-β1 + QGS group showed shortened cells with normal morphology and epithelial phenotype. The cell morphology in the TGF-β1 + SB431542 group was similar to that of the TGF-β1 + QGS group. Compared with the blank group， the TGF-β1 group showed potentiated ability of cell migration and invasion （P<0.05）. Compared with the TGF-β1 group， the TGF-β1 + QGS group and the TGF-β1 + SB431542 group showed inhibited and weakened migration and invasion abilities of cells （P<0.05）. However， there was no significant difference in migration and invasion abilities between the TGF-β1 + QGS group and the TGF-β1 + SB431542 group. The mRNA expression levels of vimentin and Smad2 in the TGF-β1 group were higher （P<0.05）， and the mRNA expression levels of E-Cadherin and Smad7 were lower （P<0.05） than those in the blank group. Compared with the TGF-β1 group， the TGF-β1 + QGS group and the TGF-β1+ SB431542 group exhibited decreased expression levels of vimentin and Smad2 mRNA （P<0.05）， and elevated expression levels of E-Cadherin and Smad7 mRNA （P<0.05）. Compared with the blank group， the TGF-β1 group showed up-regulated protein expression levels of vimentin， p-Smad2/3， and Smad2/3 （P<0.05）， and reduced protein expression levels of E-Cadherin and Smad7 （P<0.05）. Compared with the TGF-β1 group， the TGF-β1 + QGS group and the TGF-β1 + SB431542 group displayed decreased protein expression levels of vimentin， p-Smad2/3， and Smad2/3 （P<0.05）， and increased protein expression levels of E-Cadherin and Smad7 （P<0.05）. ConclusionThe ethyl acetate extract of QGS inhibits the epithelial-mesenchymal transition （EMT） of TE-1 cells through the TGF-β1 pathway to reduce the migration and invasion of TE-1 cells.
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Introducción: La esofagectomía es uno de los procedimientos con más alta morbilidad posoperatoria en cirugía oncológica digestiva. Objetivo: Describir las complicaciones relacionadas con la esofagectomía subtotal programada según variables de interés. Métodos: Se realizó un estudio descriptivo y transversal en los Servicios de Cirugía General de los hospitales "Saturnino Lora" y "Juan Bruno Zayas" de Santiago de Cuba, desde 2010 hasta 2019. La población estuvo conformada por 81 pacientes, de la cual se reclutó una muestra aleatoria de 68 enfermos sometidos a esofagectomía subtotal programada por cáncer de esófago. Fueron investigadas las siguientes variables: presencia de complicaciones posoperatorias y tipo de técnica quirúrgica utilizada. Además, se clasificaron en grados según Dindo Clavien. Resultados: Todos los enfermos fueron operados por técnica abierta mediante esofagectomía subtotal programada, donde la resección mediante la técnica de Ivor-Lewis se realizó en el 69,2 por ciento. Para todas las técnicas quirúrgicas empleadas predominó la atelectasia (39,7 por ciento) como complicación posquirúrgica, y entre las infecciosas la neumonía en 30 enfermos (44,1 por ciento), mientras que para las complicaciones quirúrgicas no infecciosas el neumotórax fue mayormente incidente, para el 25,0 por ciento. El mayor número de complicaciones se ubicó en el grado II de Dindo Clavien. Conclusiones: La presencia de complicaciones posquirúrgicas de la enfermedad es notable, en correspondencia a lo reflejado por la literatura médica. Existió relación significativa entre la presencia del hábito de fumar, de enfermedad pulmonar obstructiva crónica y la de toracotomía con algunas de las complicaciones encontradas(AU)
Introduction: Esophagectomy is one of the procedures with the highest postoperative morbidity in digestive cancer surgery. Objective: To describe the complications related to scheduled subtotal esophagectomy according to variables of interest. Methods: A descriptive and cross-sectional study was carried out in the General Surgery Services at Saturnino Lora and Juan Bruno Zayas hospitals in Santiago de Cuba, from 2010 to 2019. The population consisted of 81 patients, out of which a random sample of 68 patients undergoing elective subtotal esophagectomy for esophageal cancer was selected. The variables investigated were presence of postoperative complications and type of surgical technique used. In addition, they were classified in grades according to Clavien-Dindo. Results: All the patients were operated by open technique by programmed subtotal esophagectomy, the resection by the Ivor-Lewis technique was performed in 69.2 percent. For all the surgical techniques used, atelectasis (39.7 percent) prevailed as a postsurgical complication, and among the infectious complications, pneumonia prevailed in 30 patients (44.1 percent), while for non-infectious surgical complications, pneumothorax was mostly incidental for 25.0 percent. The highest number of complications was in Clavien-Dindo grade II. Conclusions: The presence of post-surgical complications of the disease is notable, corresponding to what is reflected in the medical literature. There was significant relationship between the presence of smoking, chronic obstructive pulmonary disease and thoracotomy with some of the complications found(AU)
Subject(s)
Humans , Postoperative Complications , Esophageal Neoplasms/etiology , Esophagectomy/methods , Thoracotomy/adverse effects , Correspondence as Topic , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
RESUMEN Introducción: El cáncer de esófago es la octava neoplasia diagnosticada con más frecuencia a nivel mundial, con 456 mil nuevos casos al año. Objetivo: Caracterizar a pacientes con cáncer de esófago que se les realiza esofagectomía subtotal programada. Métodos: Se realizó un estudio observacional, descriptivo de una serie de casos en los servicios de cirugía general de los Hospitales Provincial "Saturnino Lora" y General "Juan B. Zayas" de Santiago de Cuba desde 2010 al 2019. El universo estuvo conformado por 81 pacientes con diagnóstico de cáncer de esófago, de los cuales se seleccionaron 68 por cumplir con los criterios de inclusión. Fueron investigadas variables epidemiológicas, clínicas y quirúrgicas. Se calcularon porcentajes, media aritmética y desviación estándar. Resultados: Se observó predominio de los hombres (88,2 %); dentro de los factores epidemiológicos hubo predominio del hábito alcohólico (75,0 %) y del tabaquismo (58,8 %), la disfagia fue el síntoma más frecuente (48 enfermos). Las lesiones tumorales localizadas en el tercio medio e inferior fueron las más frecuentes. Predominó el carcinoma epidermoide en 52 pacientes y la localización del tumor en el tercio medio esofágico. En cuanto al tipo de resección quirúrgica la más utilizada fue la de McKeown (87,2 %). Conclusión: El cáncer de esófago es más frecuente en varones de la tercera década de la vida, fumadores, consumidores de alcohol y con mal estado nutricional. El patrón histológico predominante es el carcinoma epidermoide vegetante. La esofagectomía transhiatal es la variante técnica más utilizada en su tratamiento quirúrgico.
ABSTRACT Introduction: Esophageal cancer is the eighth most frequently diagnosed neoplasm worldwide with 456 thousand new cases per year. Objective: To characterize patients with esophageal cancer who undergo programmed subtotal esophagectomy. Methods: An observational, descriptive study of a case series was carried out in the general surgery services of the Provincial Hospital "Saturnino Lora" and General "Juan B. Zayas" of Santiago de Cuba from 2010 to 2019. The universe was made up of 81 patients diagnosed with esophageal cancer, of which 68 were selected agreeing inclusion criteria. Epidemiological, clinical and surgical variables were investigated. Percentages, arithmetic mean and standard deviation were calculated. Results: A predominance of men was observed (88.2 %); among the epidemiological factors, there was a predominance of alcoholic habit (75.0 %) and smoking (58.8 %), dysphagia in 48 patients was the most frequent symptom. Tumor lesions located in the middle and lower third were the most frequent. Squamous cell carcinoma predominated in 52 patients and the tumor was located in the middle third of the esophagus. Regarding the type of surgical resection, the most used was that of McKeown (87.2 %). Conclusion: Esophageal cancer is more frequent in men in the third decade of life, smokers, chronic alcoholics and poor nutritional status. The predominant histological pattern is vegetative squamous cell carcinoma. Transhiatal esophagectomy is the most widely used technical variant in its surgical treatment.
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RESUMEN Introducción: El carcinoma epidermoide constituye la variedad más frecuente de cáncer esofágico. Se considera poco frecuente en la práctica clínica y su evolución es muy agresiva. Objetivo: Describir las manifestaciones clínicas y diagnóstico de un paciente con carcinoma epidermoide de esófago. Caso clínico: Paciente masculino de 46 años de edad, que comenzó con fiebre, tos y disfonía; apareció disfagia 20 días después. Se identificó un tumor por exámenes imagenológicos y se indicó biopsia con toma de muestra, mediante endoscopia superior, de manera que se confirmó la enfermedad. Conclusiones: El cáncer esofágico es una entidad infrecuente. Su síntoma cardinal, la disfagia, no se evidencia al inicio de la enfermedad y su diagnóstico se realiza a través de estudios imagenológicos e histológicos.
ABSTRACT Introduction: Squamous cell carcinoma constitutes the most frequent variety of esophageal cancer. It is considered rare in clinical practice and its evolution is very aggressive. Objective: To describe the clinical manifestations and diagnosis of a patient with squamous cell carcinoma of the esophagus. Clinical case: 46-year-old male patient, who began with fever, cough and dysphonia. Dysphagia developed 20 days later, the tumor was identified by imaging tests and a biopsy was indicated with sampling by upper endoscopy so that the disease was confirmed. Conclusions: Esophageal cancer is a rare entity. Its cardinal symptom, dysphagia, is not evident at the beginning of the disease and its diagnosis is made through imaging and histological studies.
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RESUMEN Antecedentes: en la última década ha comenzado a investigarse el uso de la captación de fluorescencia mediante luz infrarroja para la visualización de ganglios linfáticos en tumores de estómago y esófago. Objetivo: evaluar la factibilidad de la evaluación del drenaje linfático de cáncer de esófago mediante el uso de fluorescencia y verde de indocianina (ICG). Material y métodos: se realizó un estudio prospectivo que incluyó pacientes con tumores de la unión gastroesofágica resecables (estadios I, II y III). Antes de comenzar la cirugía se inyectaron por endoscopia 4 mL de ICG doblemente diluida en agua estéril (1,25 mg/mL = 5 mg) en la submucosa del esófago en los cuatro cuadrantes (1 mL por cuadrante) alrededor del tumor. Resultados: se incluyeron en total 6 pacientes. En todos ellos se logró identificar el drenaje linfático del tumor hacia la primera estación ganglionar: en 6/6 (100%), el drenaje linfático con fluorescencia se detectó en las estaciones ganglionares N°s 3 y 7 (curvatura menor y arteria gástrica izquierda). En ningún paciente se identificó fluorescencia en ganglios mediastinales. Conclusión: la visualización del drenaje linfático de tumores de la unión gastroesofágica mediante el uso de fluorescencia con ICG es factible.
ABSTRACT Background: Over the past decade, fluorescence imaging with infrared light has been used to visualize lymph nodes in tumors of the stomach and esophagus. Objective: The aim of our study was to evaluate the feasibility of evaluating lymphatic drainage in esophageal cancer using fluorescence and indocyanine green (ICG). Material and methods: We conducted a prospective study of patients with resectable tumors of the gastroesophageal junction (stage I, II and III). Before surgery, 4 mL of ICG double diluted in sterile water (1.25 mg/mL = 5 mg) were injected via endoscopy into the esophageal submucosa in the four quadrants (1 mL per quadrant) around the tumor. Results: A total of 6 patients were included. Lymphatic drainage from the tumor to the first lymph node station was identified in all patients: in 6/6 (100%), fluorescent lymphatic drainage was detected in nodal stations number 3 and 7 (lesser curvature and left gastric artery) Fluorescence was not identified in the mediastinal lymph nodes in any patient. Conclusion: Visualization of lymphatic drainage of gastroesophageal junction tumors to the lesser curvature nodes using fluorescence imaging is feasible.
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RESUMEN Introducción: El cáncer de esófago es una enfermedad descrita desde hace 2 000 años y en la actualidad ocupa el octavo lugar en incidencia a nivel mundial. Objetivo: Describir las características clínico-histológicas de los pacientes con cáncer esofágico del Hospital Nacional "Guido Valadares" de Timor Oriental. Método: Se realizó un estudio observacional-descriptivo y retrospectivo en 106 personas con diagnóstico endoscópico e histológico de cánceres esofágicos atendidos en la Unidad de Endoscopia del servicio de Gastroenterología de dicha institución, desde junio de 2016 hasta mayo de 2021. Se analizaron variables como: grupo etario, sexo y otros factores de riesgo (manifestaciones clínicas, tiempo de comienzo de los síntomas, localización, tipo endoscópico y tipo histológico). Resultados: El cáncer de esófago fue más frecuente en hombres de 60 y más años de edad (65,1 %). El tabaquismo y la ingestión de alcohol fueron los factores de riesgo predominantes con el 64,2 % y 57,5 %, respectivamente. La mayoría de los casos se diagnosticaron entre los 3 y 6 meses del inicio de los síntomas, la disfagia el principal motivo de consulta (98,1 %). Desde el punto de vista endoscópico predominó el tipo polipoide o vegetante localizados en el tercio medio esofágico (45,3 %), constituyendo el carcinoma de células escamosas el tipo histológico más frecuente. Conclusiones: El estudio de las características clínico-histológicas de los pacientes con cáncer esofágico permite un adecuado enfoque diagnóstico de esta enfermedad, así como el desarrollo de acciones de salud preventivas sobre los principales factores de riesgo identificados.
ABSTRACT Introduction: Esophageal cancer is a leading cause of cancer-related illness that has been described for two thousand years and currently set at the eighth place in incidence worldwide. Objective: To describe the clinical-histological features in patients with esophageal cancer at the Guido Valadares National Hospital in Timor-Leste. Method: An observational-descriptive and retrospective study was conducted in 106 patients with esophageal cancer related endoscopic and histological diagnosis. All of them attended in the Endoscopy Unit at the Gastroenterology service, from June 2016 to May 2021. Variables such as age group, sex and other risk factors like (clinical manifestations, the onset of symptom, location, endoscopic type and histological type) were analyzed. Results: Esophageal cancer was more frequent in male aged 60 and older (65.1%). Smoking and alcohol intake were the predominant risk factors (64.2% and 57.5%, respectively). Most of cases were diagnosed between 3 and 6 months after the onset of symptoms, with dysphagia as the main reason for consultation (98.1%). From the endoscopic point of view, polypoid mass or vegetating lesions found in the middle third of the esophagus predominated (45.3%), with squamous cell carcinoma as the most frequent histological type. Conclusions: Study of clinical-histological features in patients with esophageal cancer allows an adequate diagnostic approach to this illness, as well as the development of preventive health actions on the main risk factors identified.
RESUMO Introdução: O câncer de esôfago é uma doença descrita há 2.000 anos e atualmente ocupa o oitavo lugar em incidência mundial. Objetivo: Descrever as características clínico-histológicas dos pacientes com câncer de esôfago no Hospital Nacional "Guido Valadares" em Timor Leste. Método: Foi realizado um estudo observacional-descritivo e retrospectivo em 106 pessoas com diagnóstico endoscópico e histológico de câncer de esôfago atendidas na Unidade de Endoscopia do serviço de Gastroenterologia da referida instituição, no período de junho de 2016 a maio de 2021. Variáveis como: foram analisadas: faixa etária, sexo e outros fatores de risco (manifestações clínicas, tempo de início dos sintomas, localização, tipo endoscópico e tipo histológico). Resultados: O câncer de esôfago foi mais frequente em homens com 60 anos ou mais (65,1%). O tabagismo e o consumo de álcool foram os fatores de risco predominantes com 64,2% e 57,5%, respectivamente. A maioria dos casos foi diagnosticada entre 3 e 6 meses do início dos sintomas, sendo a disfagia o principal motivo de consulta (98,1%). Do ponto de vista endoscópico, predominou o tipo polipóide ou vegetativo localizado no terço médio do esôfago (45,3%), sendo o carcinoma espinocelular o tipo histológico mais frequente. Conclusões: O estudo das características clínico-histológicas de pacientes com câncer de esôfago permite uma adequada abordagem diagnóstica desta doença, bem como o desenvolvimento de ações preventivas de saúde sobre os principais fatores de risco identificados.
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RESUMEN Introducción: El cáncer de esófago es una enfermedad presente a escala mundial, sobre todo en naciones en vías de desarrollo. Se realizó una revisión bibliográfica en bases de datos biomédicas mediante el motor de búsqueda de información Google académico. Se seleccionaron 24 de 62 artículos; 22 (91,6 %) del último quinquenio, publicados en español e inglés, relacionados con el objetivo propuesto. Objetivo: Describir algunos aspectos del cáncer de esófago, con énfasis en los epidemiológicos, etiopatogénicos y del tratamiento quirúrgico. Desarrollo: El cáncer de esófago es más frecuente en varones, con proporción hombre/mujer de 6:1, aunque en poblaciones de alto riesgo la incidencia es igual en ambos sexos; aunque algunos refieren que la relación es de 3 a 10 hombres por cada mujer, en dependencia de la zona geográfica. Las áreas de alta frecuencia son: Asia, África Central y del Sur. El carcinoma epidermoide y el adenocarcinoma representan el 95,0 % de todos los tumores esofágicos. La esofagectomía abierta o mínimamente invasiva constituye el pilar básico del tratamiento quirúrgico. Conclusiones: En la etiología del cáncer de esófago, los factores moleculares, genéticos y ambientales juegan un papel importante. El diagnóstico en etapas avanzadas predomina debido a lo tardío de la aparición de los síntomas y a las insuficiencias en el cribaje. El tratamiento quirúrgico constituye un pilar fundamental para los tres primeros estadios de la enfermedad, acompañada o no de quimio-radioterapia adyuvante o de neoadyuvancia (en el estadio II).
ABSTRACT Introduction: Esophageal cancer is a disease present worldwide, especially in developing nations. A bibliographic review was carried out in biomedical databases using the Google Scholar search engine. 24 of 62 articles were selected; 22 (91.6 %) of the last five years, published in Spanish and English, related to the proposed objective. Objective: To describe some aspects of esophageal cancer, with emphasis on the epidemiological, etiopathogenic and surgical treatment. Development: Esophageal cancer is more common in men, with a male/female ratio of 6:1, although in high-risk populations the incidence is the same in both sexes; although some report that the ratio is between 3 and 10 men for every woman, depending on the geographical area. High frequency areas are: Asia, Central and South of Africa. Squamous cell carcinoma and adenocarcinoma represent 95.0 % of all esophageal tumors. Open or minimally invasive esophagectomy is the basic pillar of surgical treatment. Conclusions: In the etiology of esophageal cancer, molecular, genetic and environmental factors play an important role. Diagnosis in advanced stages predominates due to the late onset of symptoms and insufficient screening. Surgical treatment is a fundamental pillar for the first three stages of the disease, accompanied or not by adjuvant or neoadjuvant chemo-radiotherapy (in stage II).
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Objective:To investigate the effects of supplemental parenteral nutrition on postoperative nutritional status, immune function and inflammatory response in patients with esophageal cancer after operation.Methods:A prospective study was performed on 72 patients with esophageal cancer who visited the Department of Thoracic and Cardiovascular Surgery of the Affiliated Hospital of Putian University from June 2018 to June 2020. According to the random table of new drug data statistics and processing software, they were randomly divided into experimental group (supplementary parenteral nutrition group) and the control group (complete enteral nutrition group), with 36 cases in each group. The experimental group was given enteral nutrition (EN) from the first day after operation, and EN and parenteral nutrition (PN) was given on the 4th to 8th day after operation. In the control group, EN was started on the first day after operation. The changes of nutritional status, immune function and inflammatory indexes in the perioperative period were compared between the two groups. Mann-Whitney U test was used for measurement data that did not meet the normality standard, and t test was used to compare measurement data that met the normality standard between groups. Nutrition indicators, inflammatory indicators and immune indicators used repeated measures analysis of variance. For enumeration data, Mann-Whitney U test was used for hierarchical classification data, and χ 2 test was used for unordered multi-classification data. Results:On the 1st day after operation, the prealbumin concentration ((95.34±37.93) mg/L and (81.60±37.68) mg/L) in the experimental group and the control group was significantly higher than that before the operation ((144.86±46.79) mg/L and (130.39±50.91) mg/L), and the differences were statistically significant (all P<0.001), and there was no significant difference between the two groups (all P>0.05). Immunoglobulin (Ig) A ((0.48±0.39) g/L and (0.41±0.30) g/L), IgG ((4.21±3.44) g/L and (4.08±2.98) g/L), IgM( (0.32±0.26) g/L and (0.30±0.27) g/L) in the experimental group and the control group were compared with preoperative ((0.55±0.45) g/L and (0.47±0.39) g/L, (5.16±3.36) g/L and (5.48±3.30) g/L, (0.38±0.32) g/L and (0.35±0.30) g/L), and the difference was not statistically significant (all P>0.05), and there was no significant difference between the two groups (all P>0.05). In the experimental group and the control group, CD3 ((31.75±11.81) % and (28.03±9.30)%) were lower than those before operation ((40.86±12.50)% and (42.31±8.09)%), CD4 ((14.19±5.39)% and (16.06±9.08)%) were lower than those before operation ((21.69±8.54)% and (24.11±12.09)%), CD4/CD8 ((0.24±0.09) and (0.29±0.18)) were lower than those before operation ((0.42±0.16) and (0.50±0.28)), and CD8 ((59.03±8.14)% and (56.39±7.42)%) were lower than those before operation ((51.25±6.64)% and (49.14±6.53)%), the differences were statistically significant (all P<0.05). There was no significant difference in C3, C4 and C reactive protein (CRP) compared with preoperatively (all P>0.05), and there was no significant difference between the two groups (all P>0.05). On the 7th day after operation, the prealbumin concentration ((186.70±40.88) mg/L) in the experimental group was higher than that before operation and on the 1st day after operation, and the difference was statistically significant (all P<0.05), which was higher than that in the control group ((131.62±53.37) mg/L), the difference was statistically significant (all P<0.05); the prealbumin concentration in the control group ((131.62±53.37) mg/L) was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05). IgA ((0.88±0.42) g/L), IgG ((10.70±4.39) g/L) in the experimental group was higher than that before operation, and the difference was statistically significant (all P<0.05), and it was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05), lower than those in the control group ((0.59±0.44) g/L and (4.08±2.98) g/L), the difference was statistically significant (all P<0.05). In the test group, CD3 ((45.92±14.31)%), CD4 ((27.06±10.53)%), CD4/CD8 (0.66±0.33) increased and and CD8 (43.64±11.34%) decreased compared with the first day after operation, with statistically significant differences (all P<0.05). The elevated levels of CD4 and CD4/CD8 were statistically significant compared with the control group (all P<0.05). The CRP ((8.90±7.56) mg/L) in the experimental group on the 7th postoperative day was lower than that before operation and on the 1st postoperative day, and the difference was statistically significant (all P<0.05), which was lower than the control group ((16.24±13.53) mg/L), the difference was statistically significant (all P<0.05). The incidence of postoperative pulmonary infection (22.22% (8/36)), the incidence of anastomotic leakage (5.56% (2/36)), and the postoperative hospital stay ((14.17±4.79) d) in the experimental group were lower than those in the control group (44.44% (16/36), 25.00% (9/36), (18.47±6.34) d), the total hospitalization expenses in the experimental group ((71 261.94±11 503.50) yuan) were higher than those in the control group ((65 226.81±10 106.43) yuan), the difference was statistically significant (the statistical values were χ 2=4.00, χ 2=5.26, t=3.74, t=2.37; P values were 0.046, 0.022, <0.001 and 0.021, respectively). Conclusion:Supplemental parenteral nutrition for perioperative esophageal cancer patients can effectively maintain nutritional status, improve immune function, and reduce the inflammatory stress response.
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Objective:To investigate the clinicopathological features and prognosis of patients with gastric gastrointestinal stromal tumor (GIST) combined with digestive tract cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 1 163 patients with gastric GIST who were admitted to the Union Hospital admitted to Tongji Medical College of Huazhong University of Science and Technology from January 2002 to December 2021 were collected. There were 606 males and 557 females, aged 59(range,20?94)years. Of the 1 163 patients, 129 cases with gastric GIST combined with other digestive tract cancer were divided into the combined group, and 1 034 cases with only gastric GIST were divided into the non-combined group. Observation indicators: (1) clinicopathological features of patients; (2) surgical situations and postoperative complications; (3) follow-up and survival of patients; (4) analysis of prognosis associated affecting factors. Follow-up was conducted using outpatient examination, telephone and online interview to detect survival of patients up to January 2022. The overall survival time was defined as the time from surgery to the last tine of follow-up or the outcome events, such as death of patient, loss of follow-up, etc. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Com-parison of ordinal data was conducted using the non-parameter Mann-Whitney U test. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. The COX proportional hazard model was used for univariate and multivariate analyses. Results:(1) Clinicopathological features of patients. Of the 129 patients in the combined group, there were 81 cases combined with gastric cancer, 39 cases combined with esophageal cancer, 8 cases combined with colon cancer and 1 case combined with rectal cancer. Gender (male, female), cases with age ≤60 years or>60 years, cases without or with clinical symp-toms before surgery, cases with tumor diameter of gastric GIST as<2 cm, 2?5 cm, 5?10 cm,>10 cm, cases with mitotic index as <5/50× high power field, 5?10/50× high power field, >10/50× high power field, cases with cell proliferation index of Ki-67 as ≤5% or >5%, cases classified as extremely low risk, low risk, medium risk and high risk of the modified national institutes of health (NIH) risk classification, cases with or without tumor necrosis of the gastric GIST, cases without or with adjuvant imatinib therapy, cases with the expression of DOG-1 detected by immunohistochemical staining as positive or negative, cases with the expression of CD34 as positive or negative were 92, 37, 30, 99, 9, 120, 114, 10, 3, 2, 126, 1, 2, 122, 2, 112, 8, 5, 4, 129, 0, 121, 8, 118, 3, 117, 12 in the combined group, versus 514, 520, 585, 449, 194, 840, 383, 360,201, 90, 799, 155, 80, 851, 143, 337, 308, 192, 197, 960, 74, 769, 265, 850, 80, 990, 44 in the non-combined group, showing significant differences in the above indicators between the two groups ( χ2=21.46, 51.11, 11.06, Z=?10.27, ?5.34, χ2=15.94, Z=?10.61, χ2=9.86, 24.10, 5.52, 6.37, P<0.05). Of the 1 163 patients, there were 12 cases of the combined group suspected diagnosed as gastric GIST before surgery and 1 case of the combined group dia-gnosed as gastric GIST by gastroscopy and pathological examination before surgery. The rest of 1 150 patients were diagnosed as gastric GIST by intraoperative exploration or postoperative pathological examination. (2) Surgical situations and postoperative complications. Of the 129 patients in the combined group, 72 cases underwent open surgery and 57 cases underwent laparoscopic or thoracoscopic surgery including 3 cases converted to open surgery. Of the 1 034 patients in the non-combined group,207 cases underwent endoscopic surgery, 371 cases underwent open surgery, and 456 cases underwent laparoscopic or thoracoscopic surgery including 8 cases converted to open surgery. Incidence of postoperative complications was 10.078%(13/129) in the combined group, versus 2.321%(24/1 034) in the non-combined group, showing a significant difference between the two groups ( χ2=22.40, P<0.05). (3) Follow-up and survival of patients. Of the 1 163 patients, 1 046 cases were followed up for 44(range, 1?220)months, with the postoperative 5-year overall survival rate as 87.2%. The postoperative 5-year overall survival rate was 51.2% in the combined group, versus 91.4% in the non-combined group, showing a significant difference between the two groups ( χ2=169.07, P<0.05). (4) Analysis of prognosis associated affecting factors. Results of univariate analysis showed that gender, age, tumor diameter of gastric GIST as 2?5 cm, 5?10 cm and >10 cm, combined with other digestive tract cancer, mitotic index as >10/50× high power field and tumor necrosis of the gastric GIST were related factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST ( hazard ratio=2.16, 2.27, 0.46, 0.57, 1.75, 7.58, 2.70, 1.80, 95% confidence intervals as 1.52?3.07, 1.60?3.22, 0.29?0.71, 0.34?0.94, 1.11?2.77, 5.29?10.85, 1.67?4.38, 1.08?2.98, P<0.05). Results of multivariate analysis showed that gender, age, tumor diameter of gastric GIST, combined with other digestive tract cancer and mitotic index were independent factors affecting the post-operative 5-year overall survival rate of patients with gastric GIST ( hazard ratio=1.91, 1.82, 2.10, 7.11, 2.75, 95% confidence intervals as 1.33?2.75, 1.27?2.62, 1.14?3.87, 4.58?11.04, 1.50?5.03, P<0.05). Conclusions:The tumor diameter of gastric GIST is short in patients combined with other digestive tract cancer, and the risk grade of modified NIH risk classification is lower. Gender, age, tumor diameter of gastric GIST, combined with other digestive tract cancer and mitotic index are independent factors affecting the postoperative 5-year overall survival rate of patients with gastric GIST.
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Objective To investigate the diagnostic value of blue light imaging-bright (BLI-bright) and linked color imaging (LCI) for early esophageal cancer (EEC).Methods:Data of 63 consecutive patients with EEC who underwent gastroscopy under BLI-bright, LCI and white-light imaging (WLI) and endoscopic submucosal dissection (ESD) from May 2018 to August 2020 at Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine were analyzed retrospectively in the cohort study. Subjective visibility analysis was performed by 6 endoscopists who were divided into 2 groups (expert group and trainee group) with 3 endoscopists in each group. The main observation index was the visibility score (ranking score, RS). The objective color difference (Δ E) between lesions of EEC and surrounding mucosa under 3 modes were analyzed by using the L *a *b * color space. Results:The overall RS of 6 endoscopists under WLI mode (2.57±0.81) was significantly lower than that under LCI (3.25±0.67) ( t=9.71, P<0.001) and BLI-bright (3.18±0.67) ( t=9.31, P<0.001). In the expert group, the RS of WLI (2.71±0.80) was significantly lower than that of LCI (3.33±0.66) ( t=7.16, P<0.001) and BLI-bright (3.42±0.62) ( t=8.09, P<0.001). In the trainee group, the RS of WLI (2.40±0.90) was also significantly lower than that of LCI (3.15±0.83) ( t=9.62, P<0.001) and BLI-bright (2.89±0.92) ( t=5.69, P<0.001), and the RS of LCI was higher than that of BLI-bright ( t=4.07, P<0.001). The Δ E between lesions of EEC and surrounding mucosa under WLI (11.52±3.40) was significantly lower than that under LCI (16.64±4.70) ( t=7.10, P<0.001) and BLI-bright (15.72±3.84) ( t=7.88, P<0.001). Conclusion:BLI-bright and LCI can effectively improve EEC visibility and color difference between EEC and surrounding mucosa. Furthermore, LCI is more conducive to the detection of EEC for the trainees.
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ObjectiveEsophageal cancer is a common malignant tumor of the upper gastrointestinal tract， and has high incidence and mortality in China. Its incidence is increasing year by year， and survival rate is low， thus seriously threatening human life and health. To further explore the pathogenesis of esophageal cancer and its systematic and efficient diagnosis and treatment methods， the animal models of esophageal cancer was evaluated according to the animal model evaluation method previously established by our team based on the characteristics of its clinical symptoms of traditional Chinese and western medicine， and suggestions for model improvement were proposed. MethodThe existing animal models of esophageal cancer were summarized through China National Knowledge Infrastructure （CNKI） and Wanfang Data. The relevant indexes of the models were assigned， and their coincidence with the clinical diagnostic guidelines of traditional Chinese and western medicine for esophageal cancer was evaluated. ResultExcept the spontaneous animal model of esophageal cancer with high clinical coincidence adopted in few studies， the animal model induced by methylbenzylnitrosamine was in good agreement with the clinical data， which simulated the etiology and pathogenesis of esophageal cancer to a certain extent. The model partially reflected some indicators of clinical diagnosis in western medicine， and also indicated the body weight loss， purple nail and increased number of drinking in traditional Chinese medicine （TCM）. However， there was still a lack of differentiation of TCM syndromes. ConclusionOn the basis of the original model， the animal model induced by methylbenzylnitrosamine and the mouse model of xenogeneic gastric wall transplantation of human esophageal cancer cells were applied， which were intervened with the factors of phlegm and qi mutual obstruction syndrome， blood stasis and phlegm stagnation syndrome， Yin deficiency and internal heat syndrome and Qi deficiency and yang weakness syndrome， and were distinguished to reflect the performance of TCM syndrome. The animal model of esophageal cancer combined with TCM syndrome was thus obtained， which embodied the clinical symptoms of esophageal cancer in TCM， and the characteristics of the animal model combined with TCM syndrome， and simulated the clinical practice of traditional Chinese and western medicine， providing an accurate pathological model carrier for basic research.
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Esophageal cancer is a digestive tract malignancy with high morbidity and mortality and mainly occurs in males. The 5-year survival rate is lower than 20%. In China， the morbidity and mortality of esophageal cancer rank the first in the world， seriously threatening national health. The pathogenesis of esophageal cancer is diverse， which is generally considered as the consequence of environmental-genetic-gene interaction. In addition to genetic factors and regional characteristics， gene mutation， RNA interference， DNA damage repair， tumor microenvironment， dietary habit， chronic adverse stimulation， and inflammatory reaction are all involved in the occurrence and development of esophageal cancer. However， there is no unified and accurate conclusion. Clarifying the exact pathogenesis of esophageal cancer is of great significance for its early screening， diagnosis， prevention， treatment， and prognosis. Surgery， radiotherapy， and chemotherapy are the three effective methods for the treatment of esophageal cancer. However， due to the atypical early symptoms， most patients have missed the best operation period when diagnosed， resulting in poor clinical prognosis. Moreover， radiotherapy and chemotherapy will cause side effects such as loss of appetite， low immune function， esophagitis， pneumonia， and malnutrition， which is not conducive to the prognosis and treatment maintenance of patients. With definite efficacies on esophageal cancer， traditional Chinese medicine （TCM）， which is flexible and diverse in the treatment， can primarily or alternatively be involved in the treatment of esophageal cancer. TCM can eliminate postoperative complications and postoperative infections and relieve adverse gastrointestinal reactions， weakened immune function， and organ damage caused by radiotherapy and chemotherapy. It can enhance clinical efficacy and improve the quality of life of patients. Therefore， it is necessary to systematically summarize the clear pathogenesis or risk factors of esophageal cancer and review the clinical characteristics of TCM in the prevention and treatment of esophageal cancer to facilitate the early screening， diagnosis， and treatment of esophageal cancer and promote the application of TCM in the prevention and treatment of esophageal cancer and related adverse reactions.
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Esophageal cancer is a type of upper gastrointestinal malignant tumor with a high degree of malignancy， strong invasion ability， and poor prognosis， which belongs to the category of "dysphagia" in traditional Chinese medicine （TCM）. In addition to tumor resistance， Chinese herbal prescription plays a role in sensitization. In light of information in literature， the syndrome elements of esophageal cancer include Qi stagnation， phlegm， Qi deficiency， blood stasis， and Yin deficiency. After clinical differentiation， the syndromes of esophageal cancer are divided into phlegm and Qi obstruction， Qi and Yin deficiency， fluid deficiency and heat accumulation， Qi deficiency and phlegm dampness， combined phlegm and heat， combined phlegm and stasis， combined heat toxin and stasis， healthy Qi deficiency and toxin accumulation， et al. Dabanxiatang， Qigesan， Xuanfu Daizhetang， Liujunzitang， Shashen Maidongtang， and Tongyoutang are the common clinical prescriptions， where Qigesan， Liu Junzitang， and Tongyoutang have been proved by in vitro and in vivo experiments to exert anti-esophageal cancer effect by directly inhibiting tumor cell proliferation， promoting apoptosis， affecting tumor microenvironment， regulating cell energy metabolism， and inhibiting angiogenesis. In addition， an increasing number of studies have been conducted on anti-esophageal cancer effect of Chinese herbal prescription by targeting non-coding single-stranded microRNA. The specific mechanisms of Da Banxiatang， Shenzhe Peiqitang， Xiao Xianxiongtang， Renshen Banxiatang， and Liushenwan have been scarcely reported despite good clinical efficacy. Wuzhuyu Tang and Tongguansan recorded in ancient books have been rarely applied in modern times. Therefore， the present study reviewed the special drugs and prescriptions mentioned in ancient TCM classics， the commonly used Chinese herbal prescriptions in modern clinical practice， and experimental research progress， to promote treatment methods of Chinese herbal prescriptions against esophageal cancer.
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China has a high incidence of esophageal cancer，more than 90% of which are esophageal squamous cell carcinoma （ESCC）. Abnormal proliferation，migration and new microvessels of intraepithelial neoplasia cells are the important pathogenic links in the transformation from esophageal intraepithelial neoplasia （EIN） to ESCC. Studies on the progression of esophageal precancerous lesions into esophageal cancer mostly focus on environment and genetic susceptibility，such as inflammatory factors，abnormal vascular endothelial growth factor （VEGF） signaling pathway transduction，p53 gene mutation，and DNA methylation. Some pharmacology studies have confirmed that traditional Chinese medicine （TCM） can inhibit inflammatory factors，regulate abnormal signaling pathways and improve the microenvironment. A large number of patients with esophageal cancer have been found to be in advanced stage，and the 5-year survival rate is low even after active treatment. The quality of life of patients in advanced stage is worrying due to esophageal obstruction and lung infection，and therefore， early prevention is important. Early intervention in patients with esophageal precancerous lesions is in line with clinical needs and embodies the TCM theory of “treating disease before its onset.” The mechanism of action and clinical efficacy of TCM has been gradually confirmed and promoted， with certain clinical significance. To explore simple，economical and effective TCM intervention measures conforms to the clinical diagnosis and treatment standards and the modernization of TCM.
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@#<b>Objective</b> To investigate the dosimetric effect of truncated regions in computed tomography (CT) images on the targets and organs at risk in volumetric modulated arc therapy (VMAT) for middle thoracic esophageal cancer. <b>Methods</b> CT images of 15 patients with middle thoracic esophageal cancer were selected. Circle masks were used to make the volume of the truncated region account for 10%, 20%, 30%, and 40% of the arm volume, and the corresponding truncated CT images were obtained. The real CT was denoted as CT0. Two radiotherapy plans were made on CT0. One plan was VMAT_1F with full arcs, and the other one was VMAT_3F with arm avoidance. The plans were transplanted to four truncated CT, respectively, and the dosimetric differences between different plans were compared using Wilcoxon signed-rank test. <b>Results</b> Compared with VMAT_1F in CT0, <i>D</i><sub>mean</sub> and <i>V</i><sub>5</sub> of the lung decreased in VMAT_3F, but <i>D</i><sub>max</sub> of the spinal cord, <i>D</i><sub>mean</sub> of the heart, and <i>V</i><sub>20</sub> of the lung increased. In VMAT_3F, there was no statistically significant difference between the dosimetric parameters in the four truncated CT and those in CT0 (all <i>P</i> > 0.05). In VMAT_1F, except for homogeneity index and <i>D</i><sub>max</sub> of the spinal cord, the dosimetric parameters in four truncated CT were significantly different from those in CT0 (<i>P</i> < 0.05). The dosimetric difference increased with the increase in truncated region-to-volume ratio. <b>Conclusion</b> Complete CT data should be collected in clinical practice, and the radiation field avoiding the truncated regionshould be set if necessary to reduce the influence of the truncated region on dosimetry.
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Background Esophageal cancer is a common gastrointestinal tumor with a high incidence in China. Some studies suggest that intestinal flora is significantly related to the occurrence and development of tumors and other diseases. Traditional 16S rDNA sequencing technology only provides taxonomic resolution at genus level. Objective Based on PacBio single molecule real time (SMRT) sequencing technology to identify characteristic microbial biomarkers associated with esophageal cancer at the species level. Methods A total of 120 newly diagnosed cases of esophageal cancer were recruited and 60 healthy patients with matched sex and age were recruited as the control group. Fresh stool samples were collected from all subjects. Full-length 16S rDNA sequencing was performed on samples from 4 patients with esophageal cancer and 1:1 matched healthy controls using the third-generation sequencing PacBio SMRT technology, and the structural differences of intestinal flora were analyzed based on the sequencing results. Function prediction was performed by PICRUSt software. Large population samples were validated by screening different gut microbes by linear discriminant analysis and linear discriminant analysis effect size to identify esophageal cancer-associated gut microbes. Results Based on sequencing samples, the results of α diversity analysis showed that the Ace, Chao1, Simpson Diversity, and Shannon Wiener indices of the esophageal cancer group were higher than those of the healthy control group (P<0.05), and the results of β diversity showed that the scattered clusters of the esophageal cancer group and the healthy control group were separated, which meant that there were differences in the structure of intestinal flora between the two groups. It was found at the phylum level that the abundances of Proteobacteria, Bacteroidetes, and Firmicutes in the intestinal flora of the esophageal cancer group were increased. At the genus level, the relative abundances of Spirospira, Pasteurella, Roxella, and Bacteroides in the esophageal cancer group were increased. At the species level, there were 11 microbial species with increased relative abundances in the esophageal cancer group, including Enterobacter sp. E.20, Bacteroides ovatus V975, and Faecalibacterium prausnitzii, and the microbial species with decreased relative abundances in the esophageal cancer group were Ralstonia pickettii, Enterobacter unclassified, and Streptococcus salivarius JIM8777. The PICRUSt functional annotation found differences in alanine, aspartate and glutamate metabolism (map00250), peptidoglycan (map00550), one carbon pool by folate (map00670), thiamine metabolism (map00730), and biosynthesis of amino acids (map01230) between the two groups. The results of the population validation study showed that the abundances of Enterobacter sp E.20 and Bacteroides massilience in the esophageal cancer group were increased, the abundance of Streptococcus salivarius JIM8777 was decreased, and the differences between the two groups were statistically significant (P<0.05). By establishing receiver operating characteristic analysis for representative species level biomarkers, the area under curve (AUC) of combining Enterobacter sp E.20, Streptococcus salivarius JIM8777, and Bacteroides massilience was 0.779, higher than single diagnosis (AUC=0.610, 0.608, and 0.659, respectively). Conclusion There are significant differences in gut microbiota between the esophageal cancer group and the healthy control group. The combination of Enterobacter sp E.20, Streptococcus salivarius JIM8777, and Bacteroides Massilience has potential application value for the diagnosis of esophageal cancer.
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Objective:To investigate the independent risk factors for fever after endoscopic radiofrequency ablation (RFA).Methods:From January 2016 to April 2021, 51 patients with early esophageal cancer, who were treated with RFA in the Department of Gastroenterology, Changhai Hospital and whose lesion range exceeded 3/4 of the circumference of esophagus, were included in the case-control study. Patients were divided into fever group ( n=15) and non-fever group ( n=36) according to whether they had fever after operation. The general condition of patients, family history of gastrointestinal tumors, lesion length, lesion range, ablation energy and ablation times were mainly collected for univariate analysis. The variables with P<0.1 were further included in multivariate logistic regression analysis to explore the independent risk factors for fever after RFA. Results:Univariate analysis showed that the lesion length ( t=-3.89, P<0.001), lesion range ( χ2=11.52, P=0.001) and ablation energy ( P=0.001) were significantly different between the two groups. Pearson correlation showed that there was a significant positive correlation between lesion length and lesion circumference ( r=0.71, P<0.001), and the lesion range was determined by the lesion circumference length. Therefore, the two variables of lesion length and ablation energy were finally included in the logistic regression analysis. Logistic regression analysis showed that the risk of fever after RFA was 1.21 times as high as that before when the length of esophageal lesions increased by 1 centimeter (95% CI: 1.01-1.43, P=0.037). The risk of fever after RFA using 12 J ablation energy was 0.43 times as high as that using 10 J ablation energy (95% CI: 0.22-0.85, P=0.015). Conclusion:Lesion length and ablation energy are independent risk factors for fever after esophageal RFA. Patients with long segment early esophageal cancer and using low ablation energy are more likely to have fever after RFA.
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@#The incidence of complications after radical resection of esophageal carcinoma is high up to about 20%-50%. The incidence of pneumonia, pleural effusion, tracheal intubation, anastomotic fistula and cardiac events is relatively high. Among them, pulmonary complications are the most common complications after esophageal cancer operation and cause the most perioperative deaths. Among the factors that influence the occurrence of postoperative complications of esophageal cancer, the amount of fluid infusion during and after the operation is closely related to the occurrence of postoperative complications. Moreover, in the environment of enhanced recovery after surgery (ERAS), it is more important to optimize the postoperative fluid management of esophageal cancer. Restricted fluid therapy plays a more and more important role in patients undergoing esophagectomy. This review integrated the relevant research results and discussed the advantages of the restricted fluid therapy compared with other fluid therapy, how to control the restricted infusion volume and infusion speed and how to monitor and evaluate the infusion process and the selection of infusion types, so as to provide reference for clinical practice test.
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@#Surgery is a classic traditional method for the treatment of early-stage esophageal cancer, and it is also recognized as an effective first-choice method in the medical community. With the development of endoscopic technology, esophagus-preserving comprehensive treatment of esophageal cancer has almost the same or even better effects in some aspects in the treatment of early esophageal cancer than surgery. Many clinical guidelines have also recommended it as the first-choice treatment for early esophageal cancer. The room for surgical treatment of esophageal cancer has been further compressed. This article discusses the comprehensive treatment model of esophageal cancer from the perspective of thoracic surgery, aiming to find a new position of thoracic surgery in the treatment of esophageal cancer.