Ichiko Yamakita

Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

We compared the surgical outcomes between 114 patients who did not receive neoadjuvant therapy (group 1) and 92 others who received neoadjuvant chemoradiotherapy (nCRT) (group 2), and assessed the preoperative and surgical factors that influence postoperative morbidity to determine the impact of nCRT on morbidity and mortality after esophagectomy via cervical, right transthoracic, and abdominal approaches. The overall postoperative morbidity rates were 44.7% and 55.4% in groups 1 and 2, respectively (P = 0.13). Rates of anastomotic leak (8.8% vs. 16.3%; P = 0.10), pneumonia (9.6% vs. 13.0%; P = 0.44), recurrent nerve palsy (15.8% vs. 10.9%; P = 0.31), and all other complications did not significantly differ between the groups. Multivariable analysis revealed cervical lymph node dissection (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01-3.84; P = 0.047) as the sole independent covariate for overall morbidity. Furthermore, a history of cardiovascular disease (OR, 2.90; 95% CI, 1.03-8.24; P = 0.045), the retrosternal reconstruction route (OR, 15.15; 95% CI, 3.56-62.50; P = 0.0002), and a longer surgical duration (OR, 1.01; 95% CI, 1.002-1.02; P = 0.01) were independent covariates for anastomotic leakage, and advanced age (OR, 1.08; 95% CI, 1.01-1.15; P = 0.02) and lower body mass index (OR, 1.16; 95% CI, 1.01-1.33; P = 0.04) were independent covariates for pneumonia. However, whether or not patients received nCRT was irrelevant. We found that nCRT is safe for three-incision esophagectomy and it does not increase the incidence of postoperative morbidity and mortality relative to esophagectomy alone.

Preoperative prediction of a pathologic complete response of esophageal squamous cell carcinoma to neoadjuvant chemoradiotherapy

Background: The accurate prediction of a pathologic complete response (ypT0N0M [LYM] 0 ypStage 0) before operation is essential for selecting appropriate strategies for treating esophageal cancer after neoadjuvant chemoradiotherapy. Methods: We reviewed 130 consecutive patients with esophageal squamous cell carcinoma who were evaluated preoperatively using upper gastrointestinal endoscopy, computed tomography, and 18F‐fluorodeoxyglucose‐positron emission tomography after neoadjuvant chemoradiotherapy and subsequently underwent esophagectomy. Our aim was to determine the diagnostic abilities of computed tomography, 18F‐fluorodeoxyglucose‐positron emission tomography, and endoscopy to predict preoperatively a pathologic complete response of the primary site of the locally advanced esophageal squamous cell carcinoma and associated lymph nodes to trimodal neoadjuvant chemoradiotherapy. Associations between clinical complete response (ycT0N0M [LYM] 0 ycStage 0) and pathologic complete response were investigated preoperatively. Results: Twenty‐nine (22.3%) and 43 (33.1%) patients, respectively, achieved clinical complete response and pathologic complete response, which were associated (P = .001). The sensitivity and specificity, as well as the positive and negative predictive values of clinical complete response to define pathologic complete response were 39.5%, 86.2%, 58.6%, and 74.3%, respectively. Univariate and multivariate analyses selected clinical complete response as the sole independent preoperative predictor of pathologic complete response (clinical complete responses versus non–clinical complete responses: odds ratio: 0.26, 95% confidence interval, 0.10–0.65, P = .004). Recurrence‐free and overall survival (OS) rates were better in patients with than in those without clinical complete response (5‐year recurrence‐free and overall survival: 69.0% vs 41.4% and 75.9% vs 45.0%, respectively, both P = .02). Furthermore, clinical complete response was an independent preoperative predictor of recurrence‐free survival (clinical complete response versus nonclinical complete response: hazard ratio: 2.20, 95% confidence interval, 1.08–4.45, P = .03). Conclusion: Although pathologic complete response was predictable preoperatively to some extent, the accuracy was somewhat low. Considerable caution should be exercised when selecting the watch‐and‐wait approach with operation as needed and omitting planned operative intervention even for patients who achieve clinical complete response after neoadjuvant chemoradiotherapy.

Splenic hamartoma associated with thrombocytopenia: A case report

Highlights • Few cases of splenic hamartomas associated with thrombocytopenia have been reported.• Imaging findings in splenic hamartomas are non-specific, variable, and making definitive preoperative diagnosis difficult.• Surgery is necessary for diagnosis when malignancy cannot be ruled out.• Surgery may also improve symptoms of hypersplenism, including thrombocytopenia.

Impact of Interval Between Neoadjuvant Chemoradiation and Surgery Upon Morbidity and Survival of Patients with Squamous Cell Carcinoma of Thoracic Esophagus

Background/Aim: The present study aimed to determine the effects of intervals between neoadjuvant chemoradiotherapy (nCRT) and esophagectomy on therapeutic outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Patients and Methods: We analyzed data from 134 consecutive patients who were diagnosed with locally advanced ESCC of the thoracic esophagus and were treated by nCRT followed by esophagectomy between September 2003 and September 2015. We assigned the patients to groups A and B according to whether they underwent esophagectomy ≤8 or >8 weeks after nCRT. Results: The two groups were comparable in terms of age, gender, performance status, comorbidities, tumor location, clinical stage, R0 resection rates and pathological responses to nCRT. The incidences of pneumonia and respiratory failure were significantly higher in group B (p=0.03, p=0.009, respectively). Recurrence-free (RFS) and overall (OS) survival rates did not significantly differ between the two groups. However, RFS was significantly poorer among patients with R0 resection (p=0.04) and those of cStages III and IV (p=0.009) in group B. Conclusion: Esophagectomy should proceed within eight weeks after nCRT from the viewpoints of respiratory morbidity and impact of RFS on patients with R0 resection.

Role of FDG-PET/CT in prediction of pathological tumor response and survival after trimodality therapy for esophageal squamous cell carcinoma

Trimodality therapy has frequently been applied to patients with locally advanced esophageal cancer. However, to preoperatively predict the response to neoadjuvant therapy and prognosis is difficult.