DCF-resistant ESCC redevelops drug sensitivity when combined with calcium channel blockers due to ER stress response.

Background: Esophageal squamous cell carcinoma(ESCC) often develops resistance to standard chemotherapy regimens of docetaxel/cisplatin/5-fluorouracil(DCF) therapy. Strategies to overcome chemoresistance remain a significant clinical challenge.

Methods: DCF-resistant ESCC cell lines were established in the beginning through long-term exposure to chemotherapeutic agents.

Investigating the Synergistic Effects of Pembrolizumab and Chemotherapy in Gastric and Gastroesophageal Junction Cancer.

Purpose: Although immune checkpoint inhibitors (ICIs) and chemotherapy combinations have been approved for the treatment of gastric and gastroesophageal junction cancer (GC/GEJC), whether immunochemotherapy (ICT) offers advantages over the simple addition of individual monotherapies remains unclear. This study aimed to investigate whether ICT has a synergistic effect in patients with advanced GC/GEJC.

Materials And Methods: Reconstructed individual patient data were electronically extracted from the Kaplan-Meier curves of 3 randomized controlled trials comparing pembrolizumab (KEYNOTE-061, KEYNOTE-062, and KEYNOTE-859).

Comprehensive registry of esophageal cancer in Japan, 2016.

Background: The registration committee for esophageal cancer in the Japan Esophageal Society (JES) has collected the characteristics, treatments, and outcomes of patients who underwent any treatment in 2016 in Japan.

Methods: We analyzed data on patients who had visited the participating hospitals in 2016. We collected the data using the National Clinical Database with a web-based data collection system.

Impact of Artificial Intelligence on the Timing of Recurrent Laryngeal Nerve Recognition during Robot-Assisted Minimally Invasive Esophagectomy.

Background: As a first step to prevent recurrent laryngeal nerve (RLN) palsy, we have developed an artificial intelligence (AI)-based anatomical recognition system for critical anatomical structures in robot-assisted minimally invasive esophagectomy (RAMIE). In the present study, we investigated whether AI would enable surgeons to rapidly recognize the RLN.

Patients And Methods: Five surgical videos of RAMIE were used to validate the AI.

Real-time AI-based detection of excessive traction on the recurrent laryngeal nerve during robotic-assisted minimally invasive esophagectomy: a proof-of-concept study.

Recurrent laryngeal nerve (RLN) palsy often occurs due to excessive traction (ET) on the nerve during esophagectomy. Use of a nerve integrity monitor (NIM) sometimes can prevent RLN palsy, but it does not detect injury before it occurs. The aim of this proof-of-concept study was to use an artificial intelligence (AI) system for pre-injury detection of ET on the left RLN during robotic-assisted minimally invasive esophagectomy (RAMIE).

Development in Esophagectomy for Esophageal Cancer: The Current Standing Point of Robotic Surgery.

Despite advancements in multidisciplinary treatment, esophagectomy remains the primary curative treatment for esophageal cancer. Given that lymph node metastases can spread from the cervical to abdominal regions, three-field lymph node dissection has been established as a standard approach. However, this highly invasive procedure involves multiple anatomical regions-thoracic, abdominal, and cervical-leading to significant surgical burden.

Rationale and study design of multicomponent exercise intervention for frail older patients with acutely decompensated heart failure: Pilot of the randomized controlled trial J REHAB-HF trial.

Background: In Japan, a growing number of older adults with heart failure (HF) are experiencing physical frailty. Healthcare providers recommend multicomponent exercise program for frail patients; however, their effectiveness in older Japanese adults with HF, who differ physiologically from their Western counterparts, remains unclear. In this study, we will compare the feasibility and efficacy of a multicomponent exercise program with those of conventional exercise therapy as pilot study of the randomized controlled trial, Japanese REHAB-HF (J REHAB-HF) trial.

Impacts of COVID-19 pandemic on short-term outcomes of low anterior resection performed in hospitals with different surgical volumes.

Aim: To evaluate the impact of the coronavirus disease (COVID-19) pandemic on short-term outcomes of low anterior resection (LAR) across hospitals classified by surgical volume.

Methods: Data of patients who underwent elective LAR for rectal cancer between 2018 and 2022 were obtained from the National Clinical Database of Japan. Hospitals were categorized into high-, medium-, and low-volume groups.

Risk factors for pneumonia after endoscopic laryngopharyngeal surgery in cases with prior esophageal cancer treatment.

Background And Study Aims: Endoscopic laryngopharyngeal surgery is an effective treatment for superficial laryngopharyngeal cancer, particularly in cases with prior esophageal cancer treatment. Despite its frequent application, reports on the risk factors for postoperative complications are limited. This study aimed to identify the risk factors for pneumonia after endoscopic laryngopharyngeal surgery and to examine the variations in pneumonia incidence among the types of prior esophageal cancer treatment.

Analysis of surgical volume and short-term outcomes for upper gastrointestinal cancer post-COVID-19: Evidence from a nationwide Japanese database.

Aim: Previous studies indicated that short-term outcomes for gastroenterological surgeries did not worsen during the COVID-19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre- and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short-term outcomes.

Distribution of Lymph Node Metastasis and Prognosis in Duodenal Bulb Tumors: A Multicenter Retrospective Study.

Background: The optimal surgical procedure for primary duodenal cancer has not been established because of its low incidence. The purpose of this study was to examine the distribution of lymph node (LN) metastasis in duodenal bulb tumors. Specifically, in tumors with submucosal invasion, we aimed to evaluate the feasibility of distal gastrectomy with duodenal bulb resection combined with lymphadenectomy of regional gastric LNs.

Detection of pathologic complete response using deep neural network-based endoscopic evaluation in patients with esophageal cancer receiving neoadjuvant chemotherapy: a nationwide multicenter retrospective study from 46 Japanese esophageal centers.

Background: Detecting pathological complete response (pCR) preoperatively facilitated a non-surgical approach after neoadjuvant chemotherapy (NAC). We previously developed a deep neural network-based endoscopic evaluation to determine pCR preoperatively. Its quality warrants improvement with a larger data series for clinical application.

The difference of gas exchange pulmonary arterial capacitance with postural change between chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension.

Background: Pulmonary artery compliance (PAC), which could be estimated with gas exchange pulmonary arterial capacitance (GXcap), reflects the elasticity of the pulmonary vessels, and it is known that PAC is changed by pulmonary perfusion. GXcap could be measured using ventilatory gas analysis and is calculated using O pulse × peak end-tidal CO pressure. Moreover, it is known that pulmonary perfusion by postural changes is different between chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH).

A phase I/II trial evaluating the safety of increased-dose S- 1 with oxaliplatin and nivolumab in HER2-negative advanced gastric cancer.

Background: We developed and refined an S-1 dosage formula based on renal function, sex, and body surface area (BSA) to achieve the target area under the concentration-time curve of 5-fluorouracil in two prospective pharmacokinetic studies. The clinical validity of the refined formula (BBT formula) was evaluated using data from the two phase III trials of fist-line chemotherapy including S-1 for advanced gastric cancer, which demonstrated that overall survival and progression-free survival tended to be shorter in patients whose S-1 standard dose, based on BSA alone, was lower than that determined using the BBT formula.

Methods: Chemo-naïve patients with HER2-negative advanced gastric or gastroesophageal junction cancer, whose standard S-1 dose is lower than that determined using the BBT formula, receive S-1 at an increased dose based on the BBT formula plus oxaliplatin (130 mg/m) and nivolumab (360 mg/body).

Efficacy of aqueous olanexidine compared with alcohol-based chlorhexidine for surgical skin antisepsis regarding the incidence of surgical-site infections in clean-contaminated surgery: a randomized superiority trial.

Background: Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery.

Impact of the COVID-19 pandemic on the short-term outcomes after advanced liver resections performed in institutions certificated by Japanese Society of Hepato-Biliary-Pancreatic Surgery: Results from the Japanese National Clinical Database, 2018-2022.

Purpose: This study aimed to investigate the effects of the coronavirus disease 2019 pandemic on morbidity and mortality after advanced hepatectomy by surgical volume in Japan.

Methods: Data from patients who underwent advanced hepatectomy between 2018 and 2022 from the Japanese National Clinical Database were collected. The transition of the number of hepatectomies and changes in risk-adjusted mortality and major complication rates based on the type of institutions certified by the Japan Society of Hepato-Biliary-Pancreatic Surgery were investigated.

Changes in surgical versus nonsurgical treatments for gastrointestinal cancers during the COVID-19 pandemic: a nationwide analysis in Japan.

Purpose: To investigate the impact of the COVID-19 pandemic on the treatment landscape of gastrointestinal cancers in Japan, focusing on the use of nonsurgical treatments.

Methods: We conducted a retrospective cohort study using a nationwide insurance database and analyzed data for esophageal, gastric, colon, rectal, liver, and pancreatic cancers treated between July, 2019 and December, 2020. We calculated the surgical-to-nonsurgical-treatment ratio (SNR) for each type of cancer during the pandemic and defined April, 2020 as the pandemic onset.

Investigating the synergistic effects of immunochemotherapy in esophageal squamous cell carcinoma.

Background: Although combinations of immune-checkpoint inhibitors (ICI) with chemotherapy have been approved for esophageal squamous cell carcinoma (ESCC), it remains unclear whether immunochemotherapy (ICT) offers advantages over the simple addition of individual monotherapies. This study aimed to investigate whether ICT exhibits a synergistic effect in patients with advanced ESCC.

Methods: Reconstructed individual patient data of 3330 patients were electronically extracted from the Kaplan-Meier (KM) curves of eight randomized-controlled trials (ATTRACTION-3, CheckMate648, KEYNOTE-181, KEYNOTE-590, RATIONALE-302, RATIONALE-306, ESCORT, and ESCORT-1st).

Clinical value of preoperative circulating tumor DNA before surgery in patients with esophageal squamous cell carcinoma.

Introduction: A precise preoperative tumor monitoring method that reflects tumor burden during neoadjuvant treatment is required to guide individualized perioperative treatment strategies for esophageal squamous cell carcinoma (ESCC). This study examined the clinical significance of preoperative circulating tumor DNA (ctDNA) in the plasma of patients undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy.

Materials And Methods: Plasma samples were collected longitudinally for ctDNA analysis as well as genomic DNA from primary lesions from patients with histologically confirmed ESCC who received neoadjuvant chemotherapy (NAC) followed by subtotal esophagectomy.

Liquid Biopsy and Multidisciplinary Treatment for Esophageal Cancer.

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.