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Background/aim: The docetaxel, 5-fluorouracil, and cisplatin (DCF) regimen is an effective form of chemotherapy for advanced esophageal cancer. However, the incidence of adverse events, such as febrile neutropenia (FN), is high. This study retrospectively examined whether pegfilgrastim treatment reduces FN development during DCF therapy., Patients and Methods: This study evaluated 52 patients who were diagnosed with esophageal cancer and underwent DCF therapy at Jikei Daisan Hospital, Tokyo, Japan, between 2016 and 2020. They were divided into non-pegfilgrastim and pegfilgrastim-treated groups, and side-effects of chemotherapy and cost-effectiveness of pegfilgrastim were examined., Results: Eighty-six cycles of DCF therapy were conducted (33 and 53 cycles, respectively). FN was observed in 20 (60.6%) and seven (13.2%) cases, respectively (p<0.001). The lowest absolute neutrophil count during chemotherapy was significantly lower in the non-pegfilgrastim group (p<0.001), and the number of days until improvement from nadir was significantly shorter in the pegfilgrastim group (9 vs. 11 days; p<0.001). No significant difference was found in the onset of grade 2 or more adverse events by Common Terminology Criteria for Adverse Events. However, renal dysfunction was significantly lower in the pegfilgrastim group (30.7% vs. 60.6%, p=0.038). Hospitalization costs were also significantly lower in this group (692,839 vs. 879,431 Japanese yen, p=0.028)., Conclusion: This study revealed the usefulness and cost-effectiveness of pegfilgrastim in prevention of FN in patients treated with DCF., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Despite recent progress in surgical techniques and perioperative management, postesophagectomy pneumonia remains the most common complication. Thus, it is important to identify the risk factors of postoperative pneumonia and to improve perioperative management. This study aimed to clarify risk factors for postoperative pneumonia and subsequently stratify the risk of pneumonia., Patients and Methods: A total of 154 patients who underwent subtotal esophagectomy were divided into two groups: patients without pneumonia and those with pneumonia. Their backgrounds and operative outcomes were compared. Furthermore, risk factors of postoperative pneumonia were evaluated using a logistic regression model., Results: Postoperative pneumonia developed in 18.8% (n=29) of the study cohort. In the multivariate analysis, the independent risk factors for postoperative pneumonia were forced expiratory volume at 1 s (FEV1) <1.98 l [p=0.011; odds ratio (OR)=3.960; 95% confidence interval (CI)=1.380-11.400], thoracotomy (p=0.043; OR=3.110; 95%CI=1.030-9.320), operative blood loss ≥390 ml (p=0.013; OR=3.900; 95%CI=1.340-11.400), and recurrent laryngeal nerve palsy (RLNP) (p=0.014; OR=3.740; 95%CI=1.310-10.700). Patients were also stratified into the following four groups as per the number of significant risk factors: the incidence of pneumonia in patients with no risk factor, one risk factor, two risk factors, three risk factors were 7.0% (5/71), 13.7% (7/51), 43.5% (10/23), and 77.7% (7/9), respectively., Conclusion: FEV1 <1.98 l, thoracotomy, operative blood loss ≥390 ml, and RLNP were independent risk factors of postoperative pneumonia. Additionally, patients could be stratified into four groups according to the incidence of pneumonia., (Copyright © 2022 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: There have been only sporadic reports on intraoperative nerve monitoring (IONM) during esophageal cancer surgery. We aimed to establish a strategy for the use of IONM during esophagectomy., Patients and Methods: Forty-one cases enrolled in this study. The IONM was performed before and after lymph node dissection in the thoracic cavity and cervical area. Occurrence of recurrent laryngeal nerve (RLN) palsy was assessed on the seventh postoperative day., Results: The identification of nerves using IONM was possible in all cases. The positive and negative predictive values of IOMN were 80% and 92%, respectively. Loss of response was observed during the thoracic procedure in 14 out of 16 cases, with the predominance of left RLN palsy (n=12)., Conclusion: In esophageal cancer surgery, identification of the RLN using IONM can be carried out safely, simply, and promptly. Using IONM systematically, the prediction of RLN palsy and detection of nerve injury point seems feasible., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)