Advances of immunotherapy-related biomarker in esophageal carcinoma / 中华胃肠外科杂志

Esophageal carcinoma is one of the most common malignant tumors in the world, with incidence and mortality rankings of 7th and 6th, respectively. In recent years, immunotherapy represented by immune checkpoint inhibitors of programmed death-1 and programmed death ligand 1 (PD-L1) has been introduced into clinical practice and has changed the treatment status of esophageal cancer. Although immunotherapy has provided long-term survival benefits for patients with advanced esophageal cancer and high pathological response rates in the neoadjuvant therapy, only a few of the patients have satisfactory therapeutic outcomes. Therefore, effective biomarkers for predicting immunotherapeutic effects are urgently needed to identify those patients who could benefit from immunotherapy. In this paper, we mainly discuss recent research advances of biomarkers related to the immunotherapy of esophageal cancer and the clinical application prospects of these biomarkers.

Optimization of perioperative treatment strategies for locally advanced esophageal squamous cell carcinoma from the perspective of tumor heterogeneity / 中华胃肠外科杂志

Recent advances in multimodality treatment offer excellent opportunities to rethink the paradigm of perioperative management for locally advanced esophageal squamous cell carcinoma. One treatment clearly doesn't fit all in terms of a broad disease spectrum. Individualized treatment of local control of bulky primary tumor burden (advanced T stage) or systemic control of nodal metastatic tumor burden (advanced N stage) is essential. Given that clinically applicable predictive biomarkers are still awaited, therapy selection guided by diverse phenotypes of tumor burden (T vs. N) is promising. Potential challenges regarding the use of immunotherapy may also boost this novel strategy in the future.

Oligometastatic and oligoprogressive esophageal squamous cell carcinoma:clarifying conceptions and surgery perspectives / 中华外科杂志

The oligometastatic and oligoprogressive state has been a hot issue in cancer research. Its indolent tumor behavior, representing a novel therapeutic opportunity, has been identified as a clinical subtype in several malignancies. However, the clinical implications of the oligometastatic and oligoprogressive state in esophageal squamous cell carcinoma (ESCC) have not been thoroughly elucidated. There are still controversies regarding the existence of the oligometastatic state in ESCC, if the solitary regional lymph node metastasis should be viewed as oligoprogressive disease after esophagectomy, and the role of surgery and radiotherapy in ESCC oligometastatic disease. Despite many exciting contributions to the literature on these, further exploration is warranted. Thus, fostering the advance of research and scientific knowledge on the biological and prognostic characteristics scrupulously would facilitate personalizing treatment strategy for better outcomes.

Comparison of thoraco-laparoscopic and open three-field subtotal esophagectomy for esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of thoraco-laparoscopic subtotal esophagectomy in the treatment of esophageal cancer.</p><p><b>METHODS</b>Clinical data of 98 patients with esophageal cancer who underwent thoraco-laparoscopic subtotal esophagectomy from March 2009 to October 2011 were retrospectively analyzed. One hundred and five patients were served as controls who underwent open three-field subtotal esophagectomy in the same period.</p><p><b>RESULTS</b>There were significant differences between thoraco-laparoscopic and open three-field subtotal esophagectomy in blood loss [(85.1±32.8) ml vs. (215.5±60.6) ml], length of stay [(12.7±3.5) d vs. (16.9±4.5) d]), pneumonia (4.1% vs. 12.4%, P<0.05), atelectasis (3.1% vs. 10.5%, P<0.05), pleural effusion (3.1% vs. 10.5%, P<0.05), acute respiratory distress (1.0% vs. 7.6%, P<0.05) and arrhythmia (4.1% vs. 12.4%, P<0.05). No significant differences were observed in the number of lymph node harvested, operative time, anastomotic leak, thoracic abscess, chyle chest, re-laparotomy, re-thoracotomy, vocal cord paralysis, renal failure, gastric emptying, and mortality (all P>0.05).</p><p><b>CONCLUSION</b>Thoraco-laparoscopic subtotal esophagectomy is technically feasible and safe and is associated with less blood loss, less cardiopulmonary complication, and shorter hospital stay.</p>