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Activated Smad signaling might be associated with a high potential for peritoneal recurrence in CY1P0 patients. Borrmann's macroscopic criteria and p-Smad2 expression are useful markers for surgeons selecting advanced gastric cancer patients with CY1P0 for gastrectomy.

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Traumatic perforation of the esophagus due to blunt trauma is very rare. Due to the rarity of this condition and its nonspecific presentation, diagnosis and treatment tends to be delayed, which leads to a high mortality rate. A female in her thirties fell flat on her chest on water while doing water sport. She developed neck and chest pain 5 days after the accident. The chest CT on the 6th day showed mediastinal emphysema and a right pyothorax. The abscess was drained and she underwent a tracheotomy, but she didn't recover as expected. Esophagoscopy on the 9th day showed pin hole ruptures in the upper intrathoracic esophagus. An emergency operation revealed the outer membrane of the esophagus had unexpectedly deteriorated, and the infection had spread to the cervical esophagus. So, a subtotal esophagectomy and two-stage reconstruction were performed. She had complications with an ascending infection of the pharynx which was drained. She was discharged 11days after the subtotal esophagectomy in good condition but with a tracheotomy. She had gastric tube reconstruction about 3 months afterwards. Thoracic esophageal perforation after blunt trauma can lead to delayed presentation, so aggressive and expeditious detection and treatment is needed.