Immuno-Genomic Profiling of Biopsy Specimens Predicts Neoadjuvant Chemotherapy Response in Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the most aggressive cancers and is primarily treated with platinum-based neoadjuvant chemotherapy (NAC). Some ESCCs respond well to NAC. However, biomarkers to predict NAC sensitivity and their response mechanism in ESCC remain unclear. We perform whole-genome sequencing and RNA sequencing analysis of 141 ESCC biopsy specimens before NAC treatment to generate a machine-learning-based diagnostic model to predict NAC reactivity in ESCC and analyzed the association between immunogenomic features and NAC response. Neutrophil infiltration may play an important role in ESCC response to NAC. We also demonstrate that specific copy-number alterations and copy-number signatures in the ESCC genome are significantly associated with NAC response. The interactions between the tumor genome and immune features of ESCC are likely to be a good indicator of therapeutic capability and a therapeutic target for ESCC, and machine learning prediction for NAC response is useful

Long-term results of a randomized controlled trial comparing neoadjuvant Adriamycin, cisplatin, and 5-fluorouracil vs docetaxel, cisplatin, and 5-fluorouracil followed by surgery for esophageal cancer (OGSG1003)

Sugimura, K, Yamasaki, M, Yasuda, T, et al. Long‐term results of a randomized controlled trial comparing neoadjuvant Adriamycin, cisplatin, and 5‐fluorouracil vs docetaxel, cisplatin, and 5‐fluorouracil followed by surgery for esophageal cancer (OGSG1003). Ann. Gastroenterol. Surg. 2020; 00: 1– 8. https://doi.org/10.1002/ags3.12388

〈Review〉Optimal reconstruction methods with a gastric substitute after esophagectomy

[Abstract] The preferred organ for reconstruction after esophagectomy is the stomach, but the procedures vary even for a gastric pull-up reconstruction. In this article, I review the major reports on the most popular procedures, specifically in relation to the following three aspects ofthe surgeries and examine the optimal gastric reconstruction technique at present. Size of gastric substitute : Compared with whole-stomach (WS) reconstruction, gastric tube (GT) reconstruction tended to have comparable incidence of anastomotic leakage, less chest discomfort, and a lower incidence of reflux esophagitis. As for physiological function of the gastric substitute, opinions differed as to the value of each : the WS preserves the entire gastric wall vascular network and has a larger capacity, enabling the patient to take sufficient calories by eating more meals, while the smallervolume and lower compliance of the gastric tube wall provides a rapid increase in intragastric pressure that facilitates gastric emptying after　food intake and lowers compression of the lung　and heart, thereby minimizing the ability of　intrathoracic negative pressure to cause　duodenogastric reflux. In GT, longer length and　complete clearance of the lymph nodes between　the subcardia and gastric angle are also great　advantages for tension-free anastomosis and　curativity. This review suggests that the GT is　a superior esophageal substitute.　Reconstruction route : Comparing the posteriormediastinal (PM) and retrosternal (RS) routes, PM is shorter, which is an advantage for tension-free anastomosis, but is susceptible to intrathoracic negative pressure and carries a risk of secondary dysphagia due to locoregional recurrence. On the other hand, the RS route facilitates irradiation of locoregional recurrence with less fear of adverse effects on the gastric conduit. Some authors reported the RS route had a higher rate of anastomotic leakage, although this review finds the rate is likely to be similar between the two routes. At present, RS is recommended in the palliative setting.Level of anastomosis : Comparison of cervical anastomosis (CA) and thoracic anastomosis (TA) revealed that CS enabled a 1.5 to 2.5 cm longer resection of the proximal esophagus, which was reported to decrease the risk of anastomotic recurrence. However, recent studies showed comparable survival rates for CA and TA groups. No significant difference was observed in the anastomotic leakage rate between the two groups. Currently, esophageal reconstruction methods after esophagectomy should be determined on an individual basis, after careful consideration of the merits and risks of each procedure and technique

A novel technique for securing tracheal blood supply in salvage anterior mediastinal tracheostomy

Introduction: The only way for complete cure of advanced esophageal cancer with invasion to the mid-trachea is anterior mediastinal tracheostomy (AMT), which has a significantly high risk of fatal complications. The shorter tracheal stump is beneficial for good blood supply, but complicates to create a tracheostomy. Presentation of case: A 71-year-old patient with a history of advanced cervical esophageal cancer who was treated with definitive chemoradiotherapy 3 years earlier had local recurrence on the left side of the trachea despite salvage lymphadenectomy for solitary left paratracheal lymph node recurrence 1 year earlier. AMT involving a resection of nearly the whole trachea was needded for complete resection. However, the recurrenced tumor was localized on the tracheal left side. We designed the new surgical procedure to preserve a longer segment of the unaffected right tracheal wall by diagonal cut (3.6 cm longer than on the left side) while maintaining adequate blood flow by preserving the right lateral vascular pedicle in a state of connecting with the right lobe of the thyroid gland and the right tracheal stump. The postoperative course was uneventful, and at 1 year postoperatively, no tumor recurrence has been detected. Discussion: Preservation of the lateral vascular pedicle enables a longer tracheal stump by securing sufficient blood supply and a longer tracheal stump in AMT, even when unilateral, enables to create tracheostomy more surely, preventing fatal complications. Conclusion: This novel procedure should be considered in cases with tumor invasion extending into the lower mid-trachea that is limited to one side

A case of incisional hernia repair using Composix mesh prosthesis after antethoracic pedicled jejunal flap reconstruction following an esophagectomy

Abstract Background An incisional hernia in a case of antethoracic pedicled jejunal flap esophageal reconstruction after esophagectomy is a very rare occurrence, and this hernia was distinctive in that the reconstructed jejunum had passed through the hernial orifice; a standard surgical treatment for such a presentation has not been established. Herein, we describe a case of repair using mesh prosthesis for an atypical and distinctive incisional hernia after antethoracic pedicled jejunal flap esophageal reconstruction. Case presentation A 77-year-old woman with a history of subtotal esophagectomy who had undergone antethoracic pedicled jejunal flap reconstruction complained of epigastric prominence and discomfort without pain. On examination, she had an abdominal protrusion between the xiphoid process and the umbilicus that contained the small bowel. Computed tomography showed that the fenestration of the abdominal wall that was intentionally created for jejunum pull-up was dehisced in a region measuring 9 × 15 cm and the small intestine protruded through it into the subcutaneous space without strangulation. Because the hernial orifice was too large and the reconstructed jejunum was passing through the hernial orifice in this case, we applied a parastomal hernia repair method that was modified from the inguinal hernia repair using the Lichtenstein technique. After 3 years and 5 months following surgery, the patient has recovered without hernia recurrence or other complications. Conclusion We consider this to be the first case of repair using Composix mesh prosthesis for repair of an atypical and distinctive incisional hernia after an antethoracic pedicled jejunal flap reconstruction. This method seems to be useful and could potentially be widely adopted as the surgical treatment for this condition