BackgroundEsophageal adenocarcinoma (EAC) is the most common kind of esophageal cancer. Age at diagnosis of advanced EAC is greater. Studies about practice patterns for elderly EAC patients with distant metastasis (DM) in stage IVB are limited. This retrospective, population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) to evaluate 855 elderly EAC patients with DM in stage IVB from 2010 to 2015.Methods855 elderly EAC patients with DM in stage IVB between 2010 and 2015 were included in this study. Univariate and multivariate Cox-regression and Kaplan-Meier analyses were used to assess prognosis. These patients were classified to bone-only, brain-only, lung-only, liver-only, and multiple (patients with two or more organs in metastasis)-site group according to the site of metastasis. Overall survival (OS), cancer-specific survival (CSS), median survival time (MST), and survival rate (SR) were evaluated to analyze the survival outcomes.ResultsThe most common metastasis site was the liver among the single-organ metastasis population, followed by lung, bone, and brain. Compared with the bone-only group, the multiple-site group was associated with worst OS (HR: 1.037, 95% CI: 0.811–1.327, p = 0.770) and CSS (HR: 1.052, 95% CI: 0.816–1.357, p = 0.695). The multiple-site group also had the lowest MST in the population (MST: 2 months in OS and 3 months in CSS) and SR (6-month SR: 27.1% in OS, 29.9% in CSS, 1-year SR: 10.7% in OS, 12.0% in CSS, 3-year SR: 2.5% in OS, 2.8% in CSS). Compared to untreated patients (N) in the total population, other patients who were treated with surgery (S), radiotherapy (R), and chemotherapy (C) are beneficial for the prognosis (OS and CSS: p < 0.001).ConclusionThis population-based study was conducted to ascertain metastasis patterns and survival outcomes of EAC patients with DM in stage IVB. Elderly patients with multiple-site metastasis exhibited the worst OS and CSS among all the populations, and patients with bone-only metastasis had the worst OS and CSS among single-organ metastasis populations. Active treatment is beneficial for elderly EAC patients with DM in stage IVB, especially chemotherapy. This study also shows that more than one third of the patients had not received any therapy.

Background Esophageal squamous cell carcinoma (ESCC) has been listed among the most common esophageal cancers (ECs). Patients are generally relatively old in terms of their age at diagnosis of ESCC. A retrospective, population-based study appraising 537 elderly ESCC patients who suffered distant metastasis (DM) in stage IVB from 2010 to 2016 was performed. To this end, data pertaining to Surveillance, Epidemiology, and End Results (SEER) were adopted. Methods A total of 537 elderly patients with IVB-stage ESCC suffering DM treated from 2010 to 2016 were taken as subjects. Prognosis was determined by using Kaplan-Meier analysis, as well as univariate and multivariate Cox regression. In accordance with sites of metastasis, these patients were classified into five groups: bone-, lung-, brain-, liver-only, and multiple-site (metastases to two or more organs) groups. In order to assess the prognosis, the cancer-specific survival (CSS), median survival time (MST), overall survival (OS), and survival rate (SR) were examined. Results The lung was found to be the organ most vulnerable to metastasis in the population with single-organ metastasis, and liver, bone and brain followed in descending rank order. Relative to the group only having bone metastasis, the multiple-site group had the lowest CSS (HR: 1.067; 95% CI: 0.767–1.485; P=0.700) and OS (HR: 1.051; 95% CI: 0.759–1.454; P=0.766). The MST (MST: both 2 months in CSS and OS) and SR (6-month SR: 28.2% in CSS, 27.7% in OS; 1-year SR: 7.5% in CSS, 6.7% in OS; 3-year SR: 2.5% in CSS, 1.5% in OS) were also found to be the lowest for the multiple-site group among the total population. These patients benefited from treatment with chemotherapy (C), radiotherapy (R), and surgery (S), as evinced by the prognosis (CSS and OS: P<0.001), in comparisons with untreated patients (N) in the total population. The S or/and R + C resulted in no statistically significant differences to C alone (CSS: P=0.593; OS: P=0.510) in terms of the prognostic results, which indicated that C alone can have almost the same prognostic effect as multimodal therapy. Conclusions Population-based research was used to determine patterns of metastasis and survival outcomes of elderly patients with IVB-stage ESCC suffering DM. The worst CSS and OS were found in patients with multiple-site metastasis across all groups. The treatment is an independent prognostic factor affecting prognosis. Chemotherapy plays a vital role in prognosis. Active therapies are beneficial to elderly patients with IVB-stage ESCC suffering DM, particularly chemotherapy.

BACKGROUND Complex aberration in lung is rare, which may increase risk of vascular injury and cause ligation of wrong pulmonary vein or bronchus by mistake during lung surgery, and result in sever complication like pulmonary congestion or atelectasis. CASE SUMMARY A 44-year-old female was admitted for a ground glass nodule (24 mm in diameter) in her right upper lobe. Video-assisted thoracoscopic (VATS) right upper lobectomy with lymph nodes dissection was performed. During operation, we simultaneously identified extremely rare aberrations of right preeparterial bronchus, right upper lobe vein behind pulmonary artery and right middle lobe vein drained into left atrium in this patient. The patient was well recovered and discharged at the postoperative-day 4. CONCLUSION Preoperatively, three-dimensional reconstruction can help to identify inconspicuous variation of pulmonary vessels and bronchus effectively. During lung surgery, if anatomic aberration is suspected, careful dissection of vessels and bronchus will help to confirm whether there is an aberration or not.

BackgroundThough robotic Ivor Lewis esophagectomy has been increasingly applied, intrathoracic esophagogastrostomy is still a technical barrier. In this retrospective study, we introduced a double-docking technique for intrathoracic esophagogastrostomy to optimize surgical exposure and facilitate intrathoracic anastomosis. Moreover, we compared the clinical outcomes between the double-docking technique and anastomosis with a single-docking procedure in robotic Ivor Lewis esophagectomy.MethodsFrom March 2017 to September 2020, the clinical data of 68 patients who underwent robotic Ivor Lewis esophagectomy were reviewed, including 23 patients who underwent the double-docking technique (double-docking group) and 45 patients who underwent single-docking robotic esophagectomy (single-docking group). All patients were diagnosed with esophageal cancer or gastro-esophageal junction by biopsy before surgery. The technical details of the double-docking technique are described in this article.ResultsThere was no difference in the patient demographics data between the two groups. The median surgical time in the double-docking group was slightly shorter than in the classic group without statistical difference (380 vs. 395 min, p = 0.368). In the double-docking group, the median blood loss was 90 mL, the median number of lymph nodes harvested was 17, and the R0 resection rates were 100% (23/23). There were no differences in the surgical outcomes between the two groups.ConclusionsBased on our experience, the double-docking technique provides good surgical exposure when fashioning anastomosis, and such a technique does not increase the surgical time. Therefore, we believe that the double-docking technique is a safe and effective method for intrathoracic esophagogastrostomy while providing good exposure and ensuring the convenience and reliability of intrathoracic anastomosis.