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Competing Interests: Disclosures: An Intuitive Robotic Clinical Research Grant was provided in 2018 to support the setup of the registry for a duration of 1 year. No funding was requested nor received for the current study.

Background: Robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted in centers worldwide, with ongoing refinements to enhance results. This study aims to assess the current state of RAMIE worldwide and to identify potential areas for improvement., Methods: This descriptive study analyzed prospective data from esophageal cancer patients who underwent transthoracic RAMIE in Upper GI International Robotic Association (UGIRA) centers. Main endpoints included textbook outcome rate, surgical techniques, and perioperative outcomes. Analyses were performed separately for intrathoracic (Ivor-Lewis) and cervical anastomosis (McKeown), divided into three time cohorts (2016-2018, 2019-2020, 2021-2023). A sensitivity analysis was conducted with cases after the learning curve (> 70 cases)., Results: Across 28 UGIRA centers, 2012 Ivor-Lewis and 1180 McKeown procedures were performed. Over the time cohorts, textbook outcome rates were 39%, 48%, and 49% for Ivor-Lewis, and 49%, 63%, and 61% for McKeown procedures, respectively. Fully robotic procedures accounted for 66%, 51%, and 60% of Ivor-Lewis procedures, and 53%, 81%, and 66% of McKeown procedures. Lymph node yield showed 27, 30, and 30 nodes in Ivor-Lewis procedures, and 26, 26, and 34 nodes in McKeown procedures. Furthermore, high mediastinal lymphadenectomy was performed in 65%, 43%, and 37%, and 70%, 48%, and 64% of Ivor-Lewis and McKeown procedures, respectively. Anastomotic leakage rates were 22%, 22%, and 16% in Ivor-Lewis cases, and 14%, 12%, and 11% in McKeown cases. Hospital stay was 13, 14, and 13 days for Ivor-Lewis procedures, and 12, 9, and 11 days for McKeown procedures. In Ivor-Lewis and McKeown, respectively, the sensitivity analysis revealed textbook outcome rates of 43%, 54%, and 51%, and 47%, 64%, and 64%; anastomotic leakage rates of 28%, 18%, and 15%, and 13%, 11%, and 10%; and hospital stay of 11, 12, and 12 days, and 10, 9, and 9 days., Conclusions: This study demonstrates favorable outcomes over time in achieving textbook outcome after RAMIE. Areas for improvement include a reduction of anastomotic leakage and shortening of hospital stay., Competing Interests: Disclosure: Mark van Berge Henegouwen: Consulting or advisory role: Viatris, Johnson & Johnson, BBraun, Stryker, Medtronic. Philippe Rouanet, Anne Mourregot, Gijs van Boxel, Marc van Det, Ewout A. Kouwenhoven: Consulting or advisory role: Intuitive Surgical. Peter Grimminger: Consulting or advisory role: Intuitive Surgical, Medicaroid. Guillaume Piessen: Consulting or advisory role: BMS, Nestlé, Astellas Pharma, Daiichi; travel or accommodation: Medtronic, MSD. Inderpal Sarkaria: Teaching, consulting, research grants, co-founder and/or advisory: CMR, Intuitive, Medtronic, Stryker, OTL, Activ Surgical, AMSI, VAIM, Oncolys. Takahiro Kinoshita: Honorarium for lectures for Intuitive Surgical. Jelle Ruurda: Consulting or advisory role: Intuitive Surgical, Medtronic. Richard van Hillegersberg: Consulting or advisory role: Intuitive Surgical, Medtronic, Olympus. Cas de Jongh: Research grant in 2018 for a period of 1 year to make a start with establishing the UGIRA Esophageal Registry, provided by Intuitive (this is mentioned in the manuscript). Philip Chiu: Cornerstone Robotics Co. Ltd; serves as a Board member with stock options. Nicholas Carter: Proctor for Intuitive Surgical teaching robotic surgery to other hospitals. Christiane Bruns: Advisory board, Medtronic; oral presentations, AstraZeneca; grant support, Sirtex; Editorial Board, MedUpdate; research grant, Stryker. James Luketich: Owns stock in Intuitive Surgical but this represents <5% of his investments and does not influence his research. Suzanne Gisbertz: J&J (money paid to institution, not to her personally); Medicaroid (money paid to institution, not to her personally); Olympus (money paid to institution, not to her personally). Cezanne D. Kooij, B. Feike Kingma, Yin-Kai Chao, Arul Immanuel, Tom Mala, Hecheng Li, Hans F. Fuchs, Simone Giacopuzzi, Jörg C. Kalff, Jens-Peter Hölzen, Mazen A. Juratli, Frank Benedix, Eric Lorenz, Jan-Hendrik Egberts, Jan W. Haveman, Boudewijn van Etten, Beat P. Müller, Felix Berlth, Jan W. van den Berg, Marco Milone, Rubens A.A. Sallum, Matthias Brüwer, Tomas Harustiak, Takeo Fujita, Hiroyuki Daiko, and Zhigang Li have declared no conflicts of interest that may be relevant to the contents of this study., (© 2024. The Author(s).)

Background: The best multimodal approach for resectable locally advanced esophageal adenocarcinoma is unclear. An important question is whether perioperative chemotherapy is preferable to preoperative chemoradiotherapy., Methods: In this phase 3, multicenter, randomized trial, we assigned in a 1:1 ratio patients with resectable esophageal adenocarcinoma to receive perioperative chemotherapy with FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus surgery or preoperative chemoradiotherapy (radiotherapy at a dose of 41.4 Gy and carboplatin and paclitaxel) plus surgery. Eligibility criteria included a primary tumor with a clinical stage of cT1 cN+, cT2-4a cN+, or cT2-4a cN0 disease, in which T indicates the size and extent of the tumor (higher numbers indicate a more advanced tumor), and N indicates the presence (N+) or absence (N0) of cancer spread to the lymph nodes, without evidence of metastatic spread. The primary end point was overall survival., Results: From February 2016 through April 2020, we assigned 221 patients to the FLOT group and 217 patients to the preoperative-chemoradiotherapy group. With a median follow-up of 55 months, overall survival at 3 years was 57.4% (95% confidence interval [CI], 50.1 to 64.0) in the FLOT group and 50.7% (95% CI, 43.5 to 57.5) in the preoperative-chemoradiotherapy group (hazard ratio for death, 0.70; 95% CI, 0.53 to 0.92; P = 0.01). Progression-free survival at 3 years was 51.6% (95% CI, 44.3 to 58.4) in the FLOT group and 35.0% (95% CI, 28.4 to 41.7) in the preoperative-chemoradiotherapy group (hazard ratio for disease progression or death, 0.66; 95% CI, 0.51 to 0.85). Among the patients who started the assigned treatment, grade 3 or higher adverse events were observed in 120 of 207 patients (58.0%) in the FLOT group and in 98 of 196 patients (50.0%) in the preoperative-chemoradiotherapy group. Serious adverse events were observed in 98 of 207 patients (47.3%) in the FLOT group and in 82 of 196 patients (41.8%) in the preoperative-chemoradiotherapy group. Mortality at 90 days after surgery was 3.1% in the FLOT group and 5.6% in the preoperative-chemoradiotherapy group., Conclusions: Perioperative chemotherapy with FLOT led to improved survival among patients with resectable esophageal adenocarcinoma as compared with preoperative chemoradiotherapy. (Funded by the German Research Foundation; ESOPEC ClinicalTrials.gov number, NCT02509286.)., (Copyright © 2025 Massachusetts Medical Society.)

Simple Summary: Multidisciplinary treatment, including surgery, chemotherapy, or chemoradiotherapy, which are individualized based on the tumor progression, is used for esophageal cancer (EC) management. A novel testing modality for monitoring tumor burden throughout treatment is required to perform this individualized treatment. Liquid biopsy has recently become popular because conventional tests, such as upper gastrointestinal endoscopy and computed tomography (CT), are insufficient to evaluate minimal residual diseases. It requires taking a small body fluid sample and testing it for circulating tumor DNA (ctDNA), microRNA (miRNA), or circulating tumor cells (CTCs). Liquid biopsy may help predict EC prognosis and recurrence, stratify high-risk populations, and determine cases with complete responses to preoperative treatment. Additionally, it may determine the suitability for postoperative chemotherapy and conversion surgery. The potential of liquid biopsy to enhance treatment decisions will drive further EC treatment advancements. Esophageal cancer (EC) is one of the leading causes of cancer-related deaths globally. Surgery is the standard treatment for resectable EC after preoperative chemoradiotherapy or chemotherapy, followed by postoperative adjuvant chemotherapy in certain cases. Upper gastrointestinal endoscopy and computed tomography (CT) are predominantly performed to evaluate the efficacy of these treatments, but their sensitivity and accuracy for evaluating minimal residual disease remain unsatisfactory, thereby requiring the development of alternative methods. In recent years, interest has been increasing in using liquid biopsy to assess treatment responses. Liquid biopsy is a noninvasive technology for detecting cell components in the blood and other body fluids. It involves collecting a small sample of body fluid, which is then analyzed for the presence of components, including circulating tumor DNA (ctDNA), microRNA (miRNA), or circulating tumor cells (CTCs). Further, ctDNA and miRNA are analyzed with various techniques, including digital polymerase chain reaction (dPCR) and next-generation sequencing (NGS). CTCs are isolated by determining surface antigens using immunomagnetic techniques or by filtering the blood according to cell size and rigidity. Several studies indicate that investigating these materials helps predict EC prognosis and recurrence and possibly stratifies high-risk groups. Liquid biopsy may also apply to the selection of cases that have achieved a complete response through preoperative treatment to prevent surgery and preserve the esophagus, as well as identifying the suitability of postoperative chemotherapy and the timing of conversion surgery for unresectable EC. The potential of liquid biopsy to enhance treatment decisions will further advance EC treatment. [ABSTRACT FROM AUTHOR]

Esophageal adenocarcinoma (EAC) is an aggressive gastrointestinal (GI) malignancy with increasing incidence. Despite the recent progress in targeted therapies and surgical approaches, the survival rates of esophageal adenocarcinoma patients remain poor. The Dickkopf (DKK) proteins are secretory proteins known mainly as antagonists of the Wnt/β-catenin signaling pathway, which is considered an oncogene. However, it has been shown that in several GI cancers, including esophageal cancer, DKK1 may act as an oncogene itself through Wnt-independent signaling pathways. LRP5\6 and Kremen1/2 (Krm1/2) are transmembrane receptors to which the DKK proteins are mainly known to bind. CKAP4 (cytoskeleton-associated protein 4) is a novel receptor of DKK1, and the DKK1-CKAP4 pathway seems to be crucial in the role of DKK1 as an oncogene. The aim of this review is to feature the essential role of DKK1 and its receptors in carcinogenesis with a focus on EAC in an era of urgent need for specific biomarkers along with improved targeted therapies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the impact of primary tumor resection (PTR) on the prognosis of four common primary tumors with liver metastases, and to develop a prognostic model to visualize the PTR benefit rate of patients with liver metastases., Materials and Methods: Patients diagnosed with colorectal cancer liver metastases (CRLM), pancreatic cancer liver metastases (PLM), gastric cancer liver metastases (GLM), and breast cancer liver metastases (BLM) between 2004 and 2015 were retrospectively reviewed from the Surveillance, Epidemiology, and End Results (SEER) database and assigned to either the surgery or non-surgery groups. A 1:1 propensity score matching (PSM) was performed. Surgical patients who survived longer than the median cancer-specific survival (CSS) time for non-surgery patients constituted the benefit group. Logistic regression was conducted to explore the independent factors affecting surgical benefit, and a nomogram was established., Results: A total of 21,928 patients with liver metastases were included. After PSM for surgery and non-surgery patients, we found that PTR had a significant impact on the overall survival (OS) and CSS of CRLM, PLM, and BLM patients. In CRLM patients, age (p < 0.001), primary site (p = 0.006), grade (p = 0.009), N stage (p = 0.034), and histology (p = 0.006) affected the surgical benefit. In BLM patients, the independent factors were age (p = 0.002), race (p = 0.020), and radiotherapy (p = 0.043). And in PLM patients, chemotherapy was an independent factor associated with a survival benefit from PTR., Conclusion: PTR improved OS and CSS in patients with CRLM, PLM, and BLM. A predictive model was established to identify suitable candidates for PTR in CRLM patients., Competing Interests: Ethics Approval and Consent to Participate: All participants from our center signed written informed consent. The study protocol conformed to the ethical guidelines of the Declaration of Helsinki and was approved by the Ethical Committee at Shanghai East Hospital. Disclosure: Lin-Lin Liu, Yu-Kun Lin, and Zuo-Lin Xiang declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024. The Author(s).)

Background: Appendiceal epithelial tumors are rare and encompass a broad set of adenocarcinoma histologies, including mucinous (mAC), colonic-type (cAC), and goblet cell (GCA) adenocarcinomas. It has previously been reported that nodal disease predicted recurrence in patients with nonmetastatic appendiceal adenocarcinomas, supporting diagnostic laparoscopy with right hemicolectomy for staging and assessment for risk of recurrence. In this update, we sought to identify predictors of nodal disease on initial diagnostic pathology in nonmetastatic adenocarcinomas., Methods: Patients with nonmetastatic appendiceal adenocarcinoma at a single institution from 1994 to 2020 were included. Clinicopathologic characteristics that predict recurrence and lymph node metastasis were analyzed. Workup included staging laparoscopy with right hemicolectomy, seriel imaging and biochemical monitoring., Results: A total of 147 patients with mAC (18%), cAC (22%), and GCAs (59%) were included. After median follow-up of 53 months, 23 (16%) patients recurred, most commonly in the peritoneal cavity (17/23, 74%). Recurrence rates were higher among node-positive patients (59% vs. 5%, P < 0.001). Nodal disease was more common in mAC (27%) and cAC (37%) than in GCA (11%); however, adenocarcinoma grade was not associated with nodal involvement., Conclusions: Nodal metastasis was more common in mAC and cAC compared with GCA and was the only significant predictor of recurrence in appendix cancer., Competing Interests: Disclosures: All listed authors have no relevant disclosure. This work did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors., (© 2024. Society of Surgical Oncology.)

This study aimed to compare mucinous carcinoma and adenocarcinoma of the appendix in terms of survival and investigate the risk factors influencing survival. The data for this study were retrieved from the SEER database (SEER Research Plus 17 registries). Patients diagnosed with appendix cancer between 2004 and 2019 were included. Demographic data, such as age, gender, marital status, and year of diagnosis, along with oncological variables like stage, surgery, chemotherapy, radiotherapy, and survival time, were extracted from the SEER database. Pathological subtypes were classified as adenocarcinoma (AC) and mucinous adenocarcinoma (MAC) based on the College of American Pathologists guidelines. Patients with other pathological subtypes or missing data were excluded from the study. This study included 4524 patients, with 2118 (46.8%) classified as AC and 2406 (53.2%) as MAC. There was no significant difference in mean age between AC and MAC groups (63.22 ± 14.30 vs. 59.46 ± 14.07, p = 0.483). AC was more common in males, while MAC was more prevalent in females (46.8% vs. 53.2%; 55.6% vs. 44.4%, p < 0.001, respectively). Married status was high in both groups (p = 0.001). While no difference was found in white race distribution, the black race was more prevalent in the AC group (57.1% vs. 42.9%, p < 0.001). Grade 1 tumors were more frequent in the AC group, whereas Grades 2 and 3 were more common in the MAC group (p < 0.001). Stages 1, 2, and 3 were more prevalent in the AC group, while the majority of MAC cases were at Stage 4. Surgery rates were higher in the AC group (98.6% vs. 96.4%, p < 0.001). Chemotherapy was used more frequently in the MAC group (50.9% vs. 40.6%, p < 0.001), while radiotherapy rates were similar in both groups (p = 0.498). The mean follow-up period was 55.70 ± 47.2 months. Five- and ten-year survival rates for the MAC group were 64.4% and 50.2%, respectively, higher than the AC group's rates of 54.2% and 39.7% (p < 0.001). The overall risk of mortality was 1.4 times higher in the AC group compared to the MAC group (p < 0.001, HR: 1.377 [CI 95% 1.259-1.507]). While adenocarcinomas and mucinous adenocarcinomas have similar incidences, non-metastatic adenocarcinomas were more frequently observed. In contrast, mucinous adenocarcinomas often exhibited distant metastases. Nevertheless, the survival rate was higher in mucinous adenocarcinomas., Competing Interests: Declarations. Conflict of interest: The authors declare that no funds, grants, or other support was received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. Ethical approval: The study complied with the Declaration of Helsinki. Research involving human participants and/or animals: This article does not contain any studies directly involving human participants, as it is a review of data already collected in SEER database. Informed consent: For this type of study, formal consent is not required., (© 2025. The Author(s).)

The prognosis for esophageal cancer is determined in particular by the depth of infiltration (T stage) and lymph node metastasis (N status). In patients with locally advanced tumors, surgical resection is the current standard. The extent of the lymphadenectomy depends on the localization of the tumor, analogous to the choice of surgical technique. For adequate tumor staging and achievement of pN0 status, seven lymph nodes without tumor metastases are necessary by definition but the current guidelines recommend 20 lymph nodes as a benchmark in an expert consensus. Despite the importance of the lymph node status for the prognosis of the patient and the already standardized use of targeted imaging of sentinel lymph nodes in other oncological disciplines, there is neither a validated method nor sufficient evidence for the benefit of lymph node mapping in esophageal cancer. The discussion about the prognostic advantage of lymphadenectomy is particularly interesting in T1 early stage cancer. Due to the technical advances of interventional endoscopy in recent years, organ preservation using endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) has not only become possible but also safe to carry out and thus established as the standard with better functional results; however, if one or more risk factors are present, endoscopic ablation is no longer defined as curative and should be supplemented by further treatment, usually non-organ-preserving resection. The step from organ-preserving interventional treatment with a low complication rate to a surgical procedure with significant mortality and morbidity as well as functional limitations seems immense and requires optimization, especially in view of the technical developments of surgery in recent years. This can either aim to identify the risk of lymph node metastases more precisely or to minimize the morbidity/mortality and functional limitations of additive treatment procedures. Approaches to this are currently the subject of research and have already been safely applied in individual pilot projects., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: D.T. Krauss, T. Schmidt, C.J. Bruns und H.F. Fuchs geben an, dass kein Interessenkonflikt besteht. Dem Beitrag liegen keine Studien an Menschen oder Tieren zugrunde., (© 2025. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Introduction: The role of concurrent pyloroplasty with esophagectomy is unclear. Available literature on the impact of pyloroplasty during esophagectomy on complications and weight loss is varied. Data on the need for further pyloric intervention are scarce. Our study compares the clinical outcomes after esophagectomy with or without pyloroplasty and investigates the role of post-operative pyloric dilatation., Methods: Consecutive patients (n = 207) undergoing Ivor Lewis esophagectomy performed by two surgeons at our institution were included. Data on patient demographics, mortality rate, anastomotic leak, respiratory complications (Clavien-Dindo grade ≥ 3), anastomotic stricture rate, and percentage weight loss at 1 and 2 year post-operatively were evaluated. For weight analysis at 1 and 2 year post-operatively, patients were excluded if they had been diagnosed with recurrence or died prior to the 1 or 2 year timepoints., Results: Ninety-two patients did not have a pyloroplasty, and 115 patients had a pyloroplasty. There were no complications resulting from pyloroplasty. There was no significant demographic difference between the groups except for age. Mortality rate, anastomotic leak, respiratory complications, anastomotic stricture rate, and percentage weight loss at 1 and 2 years were statistically similar between the two groups. However, 14.1% of patients without pyloroplasty required post-operative endoscopic pyloric balloon dilatation to treat respiratory complications or gastroparesis. Subgroup analysis of patients without pyloroplasty indicated that patients requiring dilatation had greater weight loss at 1 year (15.8% vs 9.4%, p = 0.02) and higher respiratory complications rate (27.3% vs 4.7%, p = 0.038)., Conclusions: Overall results from our study that pyloroplasty during Ivor Lewis esophagectomy is safe and useful to prevent the need for post-operative pyloric dilatation., Competing Interests: Declarations. Disclosures: Doran, Digby, Green, Kelty, and Tamhankar have no conflicts of interests or financial ties to disclose., (© 2024. The Author(s).)

Over the past several years, there has been a trend of decreasing screening or diagnostic fluoroscopic examinations ordered by clinical teams, particularly double contrast gastrointestinal studies. The underlying reason is due to increasing number of endoscopic procedures performed by Gastroenterology and Urology and usage of other imaging modalities, which are either more sensitive and/or offer the ability to obtain tissue for confirmation. Many fluoroscopic studies are now tailored toward patients who have undergone gastrointestinal or genitourinary oncologic surgeries, providing both functional and anatomic information, which are important tools for patient management. Some of these surgeries are very complex and an understanding of the postoperative anatomy and potential pitfalls is important to accurately evaluate for complications. The purpose of this article is to describe techniques and indications for common post-operative fluoroscopic procedures in gastrointestinal and genitourinary oncology while reviewing normal appearances. Complications, with emphasis on postoperative leaks, will be highlighted. Familiarity with the various types of gastrointestinal surgeries and urinary diversion techniques and knowledge of the expected postsurgical appearance is essential for achieving an accurate and prompt diagnosis of complications to allow for adequate treatment and management., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

MicroRNA (miR)-106b-5p is highly expressed in colon cancer; however, data on its expression levels in left-sided colon cancer (LCC) vs. right-sided colon cancer (RCC) is lacking. The present study aimed to assess the differences in miR-106b-5p expression in stage II LCC and RCC, as well as its relationship with patient prognosis. From August 2018 to February 2020, 40 specimens of primary stage II colon cancer were collected from Huizhou First Hospital (Huizhou, China), which included 20 cases of LCC and 20 cases of RCC. The miR-106b-5p expression levels in cancer tissues were compared with normal adjacent tissues, as well as between LCC and RCC tissues, and survival outcomes were assessed. miR-106b-5p expression was significantly higher in stage II LCC tissues compared with RCC tissues. However, no significant difference in 5-year survival was observed between the two groups. Notably, 5-year survival was significantly lower in the high miR-106b-5p expression group compared with the low expression group among patients with RCC. By contrast, there were no survival differences between the high and low miR-106b-5p expression groups in LCC. Multivariate analysis indicated that miR-106b-5p expression was an independent prognostic factor for patients with RCC. In conclusion, miR-106b-5p expression was significantly upregulated in colon cancer tissues, with higher expression levels demonstrated in LCC compared with RCC. High miR-106b-5p expression in RCC was identified as an independent prognostic factor, whilst its expression in LCC did not show a significant association with prognosis. [ABSTRACT FROM AUTHOR]