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The blood supply of the right gastroepiploic artery after esophagectomy with gastric tube reconstruction is essential for avoiding anastomotic leakage. Near-infrared fluorescence (NIRF) imaging with indocyanine green is widely used to assess the blood supply because it can visualize it in real-time during navigation surgery. However, there is no established protocol for this modality. One reason for this lack of protocol is that NIRF provides subjective information. This study aimed to evaluate NIRF quantification. We conducted a literature review of risk factors for anastomotic leakage after esophagectomy, NIRF procedures, NIRF quantification, and new methods to compensate for NIRF limitations. Major methods for the quantification of NIRF include measuring the blood flow speed, visualization time, and fluorescence intensity. The cutoff value for the blood flow speed is 2.07 cm/s, and that for the visualization time is 30–90 s. Although the time-intensity curve provided patterns of change in the blood flow, it did not show an association with anastomotic leakage. However, to compensate for the limitations of NIRF, new devices have been reported that can assess tissue oxygenation perfusion, organ hemoglobin concentration, and microcirculation. [ABSTRACT FROM AUTHOR]

Background: In Japan, nivolumab administration is the standard treatment for patients with unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC) who are refractory or intolerant to fluoropyrimidines and platinum-based chemotherapy. We determined if inflammatory prognostic factors are useful in patients with ESCC treated with nivolumab monotherapy. Methods: The clinical data of patients with ESCC treated with nivolumab monotherapy as the second- or later-line treatment were retrospectively analyzed. Neutrophil/lymphocyte, platelet/lymphocyte, and C-reactive protein/albumin ratios (CAR); prognostic index; and prognostic nutritional index were investigated. Cut-off values for each factor were determined according to overall survival using time-dependent receiver operating characteristic curves. Results: During January 2017–June 2021, 93 consecutive patients with ESCC were enrolled from five institutions (median age, 70 years; male, 77%). With a median follow-up period of 9.1 (range, 1.0–34.7) months, the median overall and progression-free survival were 12.8 (95% confidence interval [CI], 9.0–16.6) and 4.0 (95% CI, 2.6–5.4) months, respectively. Of five inflammatory prognostic factors, the cut-off value for CAR was 0.62; prognosis was significantly longer in those with CAR < 0.62 (hazard ratio, 0.39; 95% CI, 0.22–0.67; p = 0.001). Conclusions: Inflammatory prognostic factors were useful in predicting prognosis for ESCC patients pretreated with nivolumab, especially for those with CAR < 0.62, suggesting that CAR adequately reflects prognosis. [ABSTRACT FROM AUTHOR]

Background: Less invasive esophagectomy using laparoscopic or thoracoscopic surgery has been reported to have the advantages in short-term recovery over the conventional open thoraco-abdominal approach. However, few reports directly compare laparoscopic gastric mobilization (LGM) and thoracotomy with laparotomy and thoracotomy. The aim of this study was to prove the clinical efficacy of LGM compared with open thoraco-abdominal esophagectomy (OE) in treating thoracic esophageal cancer. Patients and Methods: We retrospectively reviewed 92 consecutive patients who underwent esophagectomy by OE ( n=47) or LGM ( n=45) between 1999 and 2009 at Kochi Medical School (Kochi, Japan) to analyze the surgical outcomes. Results: Patients who underwent LGM had significantly lower operative blood loss (430 versus 1060 mL; P<.001), lower rate of postoperative infections (POIs) (33.3 versus 55.3%; P=.034), shorter length of intensive care unit stay (1 versus 3 days; P<.001), and hospital stay (35 versus 46 days; P=.003). Conclusions: LGM has clinical benefits compared with OE in reduced POIs and faster recovery for patients with esophageal cancer. [ABSTRACT FROM AUTHOR]

Background To investigate the impact of the preoperative patient-related factors on survival after esophagectomy in patients with esophageal cancer. Methods We retrospectively reviewed 140 patients with esophageal cancer who underwent esophagectomy. Preoperative comorbidities, nutritional and inflammation status including the neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS), and their pathological findings were analyzed to assess their relationships with prognosis. Results Univariate analysis demonstrated that a history of cardiovascular disease (CVD), a GPS of 1 or 2, lack of neo-adjuvant chemotherapy (NAC), no thoracoscopic esophagectomy, blood loss volume ≥ 255 ml, the number of lymph node metastasis (LNM) ≥ 2, lymphatic invasion, venous invasion, and residual cancer were associated with poor survival. Multivariate analysis revealed that a history of CVD (hazard ratio [HR], 2.129; 95% confidence interval [CI], 1.327–4.226; P  = 0.041), a GPS of 1 or 2 (HR, 3.232; 95% CI, 1.516–6.437; P  = 0.003), LNM ≥ 2 (HR, 3.133; 95% CI, 1.355–7.760; P  = 0.007), and pathological residual cancer (HR, 2.429; 95% CI, 1.050–5.105; P  = 0.039) were independently associated with poor survival, and NAC was associate with better survival (HR, 0.289; 95% CI, 0.118–0.667; P  = 0.003). Conclusion Preoperative patient-related factors including a history of CVD and a GPS of 1 or 2 were predictors of poor prognosis after esophagectomy in patients with esophageal cancer. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]