Patrick J. McLaren

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios can Predict Treatment Response to Neoadjuvant Therapy in Esophageal Cancer.

IntroductionWe hypothesized that serum neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may predict pathologic complete response to neoadjuvant chemoradiotherapy in esophageal cancer patients. The ability to predict favorable treatment response to therapy may aid in determining optimal treatment regimens.Materials and MethodsA retrospective review of a prospective esophageal disease registry was conducted. Neutrophil-to-lymphocyte ratio was defined as the pre-chemoradiotherapy serum neutrophil count divided by lymphocyte count. Platelet-to-lymphocyte ratio was similarly defined. Logistic regression was applied to analyze these ratios and their effect on pathologic complete response. A Cox proportional-hazards model was used to analyze survival.ResultsSixty patients were included. Elevated neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were both negative predictors of pathologic complete response (odds ratio: 0.62; 95% confidence interval: 0.37–0.89, P = 0.037 and odds ratio: 0.91; 95% confidence interval: 0.82–0.98, P = 0.028, respectively). Only platelet-to-lymphocyte ratio was predictive of decreased overall survival (hazard ratio: 1.05, 95% confidence interval: 0.94–1.16, P = 0.40).ConclusionElevated neutrophil and platelet-to-lymphocyte ratios were significant predictors of a poor treatment response to neoadjuvant therapy. Only elevated platelet-to-lymphocyte ratio was predictive of worse overall survival. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios may offer a simple serum test to assess the likelihood of a pathologic complete response after neoadjuvant therapy in esophageal cancer.

Paraesophageal hernia repair outcomes using minimally invasive approaches

This study of inpatient admissions for paraesophageal hernia repair analyzes use of minimally invasive approaches and rates of intraoperative injury and in-hospital mortality.

Laparoscopic ischemic conditioning of the stomach increases neovascularization of the gastric conduit in patients undergoing esophagectomy for cancer

Gastric ischemic preconditioning has been proposed to improve blood flow and reduce the incidence of anastomotic complications following esophagectomy with gastric pull‐up. This study aimed to evaluate the effect of prolonged ischemic preconditioning on the degree of neovascularization in the distal gastric conduit at the time of esophagectomy.

Hiatal Hernia and Reflux Following Bariatric Surgery

There has been a boom in popularity of weight loss surgery in recent decades, and many different bariatric procedures have been developed. Current methods have demonstrated excellent weight loss and metabolic outcomes with very low major complication rates. However, all bariatric operations are associated with some degree of postoperative complications. Hiatal hernia, GERD, bile reflux, gastrogastric fistula, and band malfunction are just some of the complications that can occur following weight loss surgery. We discuss the different complication profiles associated with laparoscopic gastric banding, vertical sleeve gastrectomy, and Roux-en-y gastric bypass. Primary treatments for postoperative GERD are medical with proton pump inhibitors. Surgical and endoscopic treatment options exist for refractory cases, including conversion to gastric bypass, magnetic sphincter augmentation, and endoscopic radio-frequency ablation. Surgical revision may also be needed in cases of hiatal hernia, gastrogastric fistula, and gastric band malfunction.