Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 2

Kitagawa, Yuko; Ishihara, Ryu; Ishikawa, Hitoshi; Ito, Yoshiaki; Oyama, Takashi; Oyama, Tsuneo; Kato, Ken; Kato, Hiroyuki; Kawakubo, Hirofumi; Kawachi, Hiroshi; Kuribayashi, Shiko; Kono, Koji; Kojima, Takashi; Takeuchi, Hiroya; Tsushima, Takahiro; Toh, Yasushi; Nemoto, Kenji; Booka, Eisuke; Makino, Tomoki; Matsuda, Satoru; Matsubara, Hisahiro; Mano, Masayuki; Minashi, Keiko; Miyazaki, Tatsuya; Muto, Manabu; Yamaji, Taiki; Yamatsuji, Tomoki; Yoshida, Masahiro

doi:10.1007/s10388-023-00994-1

Cited by 54 publications

(17 citation statements)

References 103 publications

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“…We identified esophagectomy with 2-field (thoraco-abdominal) or 3-field (cervico-thoraco-abdominal) lymph node dissection, except transhiatal esophagectomy and 2-stage reconstruction, using the original Japanese procedure codes. Transhiatal esophagectomy was omitted because the procedure is considered only for esophagogastric junction adenocarcinoma with esophageal invasion measuring ≤4 cm in length and is uncommon for esophageal cancer in Japan 24 . The exclusion criteria were as follows: age below 18 years, missing data on body mass index, antibiotic use from the day of admission to the day before surgery, concomitant surgery for laryngeal or hypopharyngeal cancer, intestine reconstruction, general anesthesia on POD 1 (ie, other surgery on POD 1, or overnight anesthesia for esophagectomy), and discharge within POD 2.…”

Section: Methodsmentioning

confidence: 99%

“…Transhiatal esophagectomy was omitted because the procedure is considered only for esophagogastric junction adenocarcinoma with esophageal invasion measuring ≤ 4 cm in length and is uncommon for esophageal cancer in Japan. 24 The exclusion criteria were as follows: age below 18 years, missing data on body mass index, antibiotic use from the day of admission to the day before surgery, concomitant surgery for laryngeal or hypopharyngeal cancer, intestine reconstruction, general anesthesia on POD 1 (ie, other surgery on POD 1, or overnight anesthesia for esophagectomy), and discharge within POD 2. We also excluded patients who were administered both CEZ and ABPC/SBT on the day of surgery, those who used antibiotics other than CEZ or ABPC/SBT on the day of surgery, and those who did not continue CEZ or ABPC/SBT on POD 1.…”

Section: Study Protocolmentioning

confidence: 99%

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Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Hirano,

Konishi,

Kaneko

et al. 2023

Annals of Surgery

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Objective: To assess the effect of antimicrobial prophylaxis with ampicillin-sulbactam (ABPC/SBT) compared with cefazolin (CEZ) on the short-term outcomes after esophagectomy. Summary Background Data: CEZ is widely used for antimicrobial prophylaxis in esophagectomy without procedure-specific evidence, whereas ABPC/SBT is preferred in some hospitals to target both aerobic and anaerobic oral bacteria. Methods: Data of patients who underwent esophagectomy for cancer between July 2010 and March 2019 were extracted from a nationwide Japanese inpatient database. Overlap propensity score weighting was conducted to compare the short-term outcomes [including surgical site infection (SSI), anastomotic leakage, and respiratory failure] between antimicrobial prophylaxis with CEZ and ABPC/SBT, after adjusting for potential confounders. Sensitivity analyses were also performed using propensity score matching and instrumental variable analyses. Results: Among 17,772 eligible patients, 16,077 (90.5%) and 1695 (9.5%) patients were administered CEZ and ABPC/SBT, respectively. SSI, anastomotic leakage, and respiratory failure occurred in 2971 (16.7%), 2604 (14.7%), and 2754 patients (15.5%), respectively. After overlap weighting, ABPC/SBT was significantly associated with a reduction in SSI [odds ratio 0.51 (95% confidence interval 0.43–0.60)], anastomotic leakage [0.51 (0.43–0.61)], and respiratory failure [0.66 (0.57–0.77)]. ABPC/SBT was also associated with reduced respiratory complications, postoperative length of stay, and total hospitalization costs. The proportion of Clostridioides difficile colitis and noninfectious complications did not differ between the groups. Propensity score matching and instrumental variable analyses demonstrated equivalent results. Conclusions: The administration of ABPC/SBT as antimicrobial prophylaxis for esophagectomy was associated with better short-term postoperative outcomes compared to CEZ.

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Section: Methodsmentioning

confidence: 99%

Section: Study Protocolmentioning

confidence: 99%

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Hirano,

Konishi,

Kaneko

et al. 2023

Annals of Surgery

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“…Generally, among ER, esophagectomy, and chemoradiotherapy, the treatment strategies for patients in the categories of T1a-MM and T1b-SM1 are regarded as borderline. According to the guidelines for esophageal cancer in Japan[ 14 , 15 ], clinical T1a-MM and T1b-SM1 SESCC are relative indications for ER, and additional treatment after ER is recommended for SESCC patients with lymphovascular invasion (LVI) or submucosal invasion. However, even if ER is performed, if the histopathological diagnosis is tumor depth [pT1a-MM, and LVI (+) or pT1b-SM], radical resection or additional treatment such as chemoradiotherapy is recommended due to considering the risk of LNM.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

2024

World J Gastroenterol

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In this editorial, we comment on the article by Wang et al published in the recent issue of the World Journal of Gastroenterology in 2023. We focused on identifying risk factors for lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma (SESCC) patients and how to construct a simple and reliable clinical prediction model to assess the risk of LNM in SESCC patients, thereby helping to guide the selection of an appropriate treatment plan. The current standard treatment for SESCC is radical esophagectomy with lymph node dissection. However, esophagectomy is associated with considerable morbidity and mortality. Endoscopic resection (ER) offers a safer and less invasive alternative to surgical resection and can enable the patient's quality of life to be maintained while providing a satisfactory outcome. However, since ER is a localized treatment that does not allow for lymph node dissection, the risk of LNM in SESCC limits the effectiveness of ER. Understanding LNM status can aid in determining whether patients with SESCC can be cured by ER without the need for additional esophagectomy. Previous studies have shown that tumor size, macroscopic type of tumor, degree of differentiation, depth of tumor invasion, and lymphovascular invasion are factors associated with LNM in patients with SESCC. In addition, tumor budding is commonly associated with LNM, recurrence, and distant metastasis, but this topic has been less covered in previous studies. By comprehensively evaluating the above risk factors for LNM, useful evidence can be obtained for doctors to select appropriate treatments for SESCC patients.

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“…While adenocarcinoma is more prevalent in Western countries, ESCC is particularly common in Asian countries, including Japan and China, accounting for up to 90% of esophageal cancers in these regions [ 2 ]. The standard treatment for stage II and III ESCC varies by region, with neoadjuvant cytotoxic chemotherapy (CTx) followed by surgery being common in Japan, and chemoradiotherapy (CRT) followed by surgery being common in Western countries [ 3 , 4 , 5 ]. A comprehensive nationwide database in Japan, the National Clinical Database (NCD), highlighted a significant reduction in 90-day mortality rates for esophagectomies, dropping from 3.2% in 2011 to 1.5% in 2020.…”

Section: Introductionmentioning

confidence: 99%

Contrasting Roles of Programmed Death-Ligand 1 Expression in Tumor and Stroma in Prognosis of Esophageal Squamous Cell Carcinoma

Murakami,

Booka,

Furuhashi

et al. 2024

Cancers

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The assessment of programmed death-ligand 1 (PD-L1) expression in esophageal squamous cell carcinoma (ESCC) has become increasingly important with the rise of immune checkpoint inhibitors (ICIs). However, challenges persist, including subjective interpretation and the unclear significance of staining intensity, as well as contrasting roles in tumoral and stromal regions. Our study enhances the understanding of PD-L1 in ESCCs by analyzing its expression in tumors and stroma with H-scores, highlighting its distinct clinicopathological impacts. In a retrospective cohort of 194 ESCC specimens from surgical resection, we quantified PD-L1 expression in tumoral and stromal compartments using H-scores, analyzing whole slide images with digital pathology analysis software. Kaplan–Meier analysis demonstrated that higher PD-L1 expression is significantly associated with improved postoperative overall survival (OS) and recurrence-free survival (RFS) in both tumoral and stromal areas. Multivariable analysis identified high tumoral PD-L1 expression as an independent prognostic factor for prolonged OS and RFS (HR = 0.47, p = 0.007; HR = 0.54, p = 0.022, respectively). In a separate analysis, high stromal PD-L1 expression was found to correlate with less advanced pathological stages and a prolonged response to cytotoxic chemotherapy, with no similar correlation found for ICI treatment response. This study reveals PD-L1’s contrasting role in the ESCC tumor immune microenvironment, impacting prognosis, tumor stage, and treatment response.

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Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 2

Cited by 54 publications

References 103 publications

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Antimicrobial Prophylaxis with Ampicillin-sulbactam Compared with Cefazolin for Esophagectomy

Risk factors for lymph node metastasis in superficial esophageal squamous cell carcinoma

Contrasting Roles of Programmed Death-Ligand 1 Expression in Tumor and Stroma in Prognosis of Esophageal Squamous Cell Carcinoma

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