Nutritional Status and the Outcomes of Endoscopic Stenting in Benign and Malignant Diseases of Esophagus

BACKGROUND

Endoscopic stenting (ES) is a widely known method for palliative dysphagia treatment in esophageal strictures. Esophageal cancer is often associated with advanced malnutrition, which may increase the risk of complications of the procedure. The aim of this study was to evaluate complication rates and the impact of nutritional status on the outcomes of ES.

PATIENTS AND METHODS

A single-center retrospective study was conducted at Copernicus Hospital in Gdańsk, Poland. Adult patients who underwent endoscopic stenting between February 2014 and December 2018 were included. The influence of patient characteristics (age, sex, indications for esophageal stenting, and location of stenosis) and nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) on complication rates and survival were analyzed.

RESULTS

Eighty-one patients (69% men) were enrolled in the study. In 69%, the indication for ES was malignancy (mainly esophageal cancer). The median dysphagia score significantly decreased from 2.8 to 0.6 after the procedure (p < 0.001). Complications were observed in 27% (n = 22) of the patients. Early complications were bleeding (2.5%), stent unexpansion (2.5%), and stent migration during the procedure (3.7%). There were no early fatal complications of the procedure. Late complications included: stent migration (6.2%), tissue overgrowth (6.2%), food impaction (2.2%), fistula formation (3.7%), bleeding (3.7%), and stent malposition (1.2%). A total of 76% of the participants scored ≥ 3 points in nutritional screening (NRS2002) and 70% were diagnosed with severe malnutrition (GLIM -stage 2). A stent diameter of < 2.2 cm compared with ≥ 2.2 was associated with a higher rate of migrations (15.5% vs. 2.5%). The median survival time in the malignant group was 90 days. Histopathological diagnosis and patients' nutritional status (BMI, NRS 2002, GLIM, and dysphagia score) had no significant effect on complication rates and survival after esophageal stent insertion.

CONCLUSIONS

Endoscopic stenting is a relatively safe procedure for the palliative treatment of esophageal strictures. Severe malnutrition, although common, does not affect the outcomes of the procedure.

Risk factors and conservative therapy outcomes of anastomotic leakage after gastrectomy: Experience of 3,926 patients from a single gastric surgical unit

Background

Anastomotic leakage (AL) after gastrectomy is one of the severest postoperative complications and is related to increasing mortality. In addition, no consensus guidelines about strategies of AL treatment have been established. This large cohort study aimed to inspect the risk factors and efficacy of the conservative treatment for AL in patients with gastric cancer.

Methods

We reviewed the clinicopathological data of 3,926 gastric cancer patients undergoing gastrectomy between 2014 and 2021. Results contained the rate, risk factors, and conservative therapy outcomes of AL.

Results

In total, 80 patients (2.03%, 80/3,926) were diagnosed with AL, and esophagojejunostomy was the most frequent AL site (73.8%, 59/80). Among them, one patient (2.5%, 1/80) died. Multivariate analysis indicated that low albumin concentration (P = 0.001), presence of diabetes (P = 0.025), laparoscopic method (P &lt; 0.001), total gastrectomy (P = 0.003), and proximal gastrectomy (P = 0.002) were predicting factors for AL. The closure rate for the conservative treatment of AL in the first month after AL diagnosis was 83.54% (66/79), and the median time from leakage diagnosis to the closure of leakage was 17 days (interquartile range 11–26 days). Low level of plasma albumin (P = 0.004) was associated with late leakage closures. In terms of 5-year overall survival, no significant difference was observed between patients with and without AL.

Conclusion

The incidence of AL after gastrectomy is associated with low albumin concentration, diabetes, the laparoscopic method, and extent of resection. The conservative treatment is relatively safe and effective for the AL management in patients after gastric cancer surgery.

Foreign Body Aspiration Mimicking an Endobronchial Neoplasm: A Case Report and Review of the Literature

Foreign body aspiration (FBA) is infrequently encountered in the adult population, with major risk factors including advancing age, intoxication, and disorders of the central nervous system. Here, we present a case of FBA in an adult undergoing routine lung cancer screening to review imaging findings and highlight potential pitfalls for the practicing radiologist. A low-dose chest computed tomography (CT) scan was performed for lung cancer screening in a 57-year-old male with a one-month history of worsening dyspnea and cough. An endobronchial lesion was identified in the right bronchus intermedius. A follow-up 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) revealed hypermetabolic activity in the region of interest, raising concern for malignancy. Bronchoscopy was performed, revealing a nodular mass adjacent to a foreign body in the bronchus intermedius. Histopathologic analysis of the tissue sample revealed the presence of an aspirated foreign body with squamous metaplasia of the respiratory epithelium. Adult FBA is an uncommon clinical entity that may be incidentally observed on a screening chest CT. Relevant multimodality imaging findings are discussed here, along with a review of the accompanying pathologic changes seen with chronic airway impaction.

Thoracotomy in Children: Review from a Low-Income Country

Background

Thoracotomy is indicated for several congenital and acquired disorders in children. It is among the surgical procedures which require a well-trained and dedicated surgical, anesthesia and critical care team which can be difficult to assemble in a low-income country setup. As the pattern and outcome of thoracotomy in children remained unreported from such setting, this study aims to shed light on this matter.

Methodology

A descriptive cross-sectional review was conducted. Children who have undergone thoracotomy for non-cardiac pathologies were included in the study. Demographic and clinical data were collected by chart review. Frequencies and percentages were used to describe categorical variables while mean, median, standard deviation and interquartile range were calculated for continuous variables.

Results

A total of 68 patients were operated on in the study period, out of which 44 (64.7%) were males. The mean ages of the children at the time of diagnosis and procedure were 4.05 ± 3.9 years and 4.14 ± 4.03 years, respectively. The most common indication for thoracotomy was pulmonary hydatid cyst (17; 25%) followed by congenital lobar emphysema (11; 16.2%). Muscle sparing posterolateral thoracotomy was the most common approach in 66 (97.1%) patients. The analgesic medications that were used in the post-operative period were paracetamol, diclofenac, ibuprofen, tramadol and morphine. Combined analgesics were administered in two-thirds of the patients while a single analgesic was used in the rest of the children. No regional blocks were administered post operatively as pediatric size catheters were not available. The morbidity and mortality rates were found to be 11.8% and 8.8%, respectively.

Conclusion

The most common indication for thoracotomy in this study was pulmonary hydatid cyst. The provision of post-thoracotomy analgesia in our institution is suboptimal as evidenced by no use of regional blocks and poor practice of administering multimodal analgesia. Thoracotomy was associated with fairly high morbidity and mortality.

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.

Diagnosis and Management of Barrett's Esophagus

Barrett's esophagus is a metaplastic change of esophageal mucosa, which can be characterized by its salmon-colored lining and the presence of columnar epithelium with goblet cells. It is a well-established precancerous state of esophageal adenocarcinoma, a tumor with very poor survival rates, which incidence is rapidly growing. Despite numerous research, the debate about its diagnosis and management is still ongoing. This article aims to provide an overview of the current recommendations and new discoveries regarding the subject.

Mistakes and complications in the diagnosis and treatment of children with organic foreign body aspiration

The reason for the publication of this article was the increase in the number of children with long-standing organic foreign bodies in the respiratory tract, the late diagnosis of which causes severe complications. The article presents the three most significant cases from the general series, when the diagnosis and treatment tactics at the stages of treatment were associated with errors both at the prehospital stage and in the hospital. In the first clinical case, as it turned out, the child had aspired multiple foreign bodies. The first bronchoscopy revealed one solid foreign body. Due to severe fibrinous-purulent endobronchitis and contact bleeding, the bronchoscopy procedure was aborted. However, after 10 days, the child independently coughed up the second seed, which was a surprise to us. Control bronchoscopy after 3 weeks revealed no foreign bodies. In the second clinical observation, a child developed bronchiectasis due to a long stay of a foreign body in the respiratory tract. The third case demonstrates the diagnosis and treatment tactics in a child with a foreign body against the background of a coronavirus infection. In the first and third cases, the results of treatment were satisfactory. In the second case, a long stay of peanuts in the respiratory tract led to bronchiectasis in the lower lobe of the left lung, which required its removal. In the follow-up, there are no complaints, the child grows and develops according to age. The study analyzes the mistakes made at the stages of diagnosis and treatment of children with foreign bodies in the respiratory tract.Conclusion. Young children with long-term and atypically current respiratory diseases, dubious and even normal radiological picture with the absence of comprehensive information on the anamnesis of diseases should alert the doctor to the possibility of aspiration of a foreign body in the respiratory tract and serve as the basis for performing bronchoscopy.

Utility of fluoroscopic oesophagography in the setting of spontaneous and blunt traumatic pneumomediastinum

AIM

To determine the incidence of positive fluoroscopic oesophagography in patients presenting with spontaneous or blunt traumatic pneumomediastinum.

MATERIALS AND METHODS

Retrospective chart review was performed on patients who underwent fluoroscopic oesophagography for spontaneous or blunt traumatic pneumomediastinum between 2001-2019. Patients were excluded for history of oesophageal surgery, penetrating trauma, oesophageal cancer, or tracheal/oesophageal instrumentation.

RESULTS

Two hundred and fifty-two patients met the inclusion criteria; 170 presented with spontaneous pneumomediastinum and 82 presented with blunt traumatic pneumomediastinum. Fluoroscopic oesophagography was positive in eight patients with spontaneous pneumomediastinum, for a positivity rate of 4.7% (8/170). There was one false-negative case in a patient who presented with spontaneous pneumomediastinum and was found to have a non-full-thickness oesophageal injury on endoscopy. Fluoroscopic oesophagography was negative in all patients with blunt traumatic pneumomediastinum (0/82). The sensitivity and specificity of fluoroscopic oesophagography were 88.9% (8/9) and 100% (243/243), respectively. Oesophageal injury was more common in patients with spontaneous pneumomediastinum and a pleural effusion (5/11, 45.4%) than in patients with spontaneous pneumomediastinum and no pleural effusion (4/159, 2.5%, p<0.001).

CONCLUSION

The present findings do not support routine oesophagography in patients with blunt traumatic pneumomediastinum. Conversely, a positivity rate of 4.7% in patients with spontaneous pneumomediastinum suggests oesophagography may be warranted in this population, particularly if an associated pleural effusion is present.

On-site treatment of avalanche victims: Scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom)

INTRODUCTION

The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims.

METHODS

ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system.

RESULTS

We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%).

CONCLUSIONS AND RECOMMENDATIONS

For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.

Complication rates in rigid vs. flexible endoscopic foreign body removal in children

While foreign body aspiration remains a frequent and preventable cause of morbidity and mortality in children, recommendations on the appropriate removal technique do often not match the lived practice and expertise of the performing examiners. As there is a scarcity of data regarding success and complication rates of the procedure, the aim of this study was to set up a classification system for procedure-related complications, prospectively record and analyze them. Specialists in the field of foreign body removal contributed cases anonymously. Information regarding procedural details of the bronchoscopy, type, and severity of complications as well as patient characteristics were classified and recorded. Correlations were calculated using Pearson's Chi Square test. A total of 314 rigid and 178 flexible bronchoscopies were compared. Complications were categorized and their severity was defined by the anesthesiologist's assessment of whether to interrupt or terminate the procedure. The overall complication rate was similar in rigid vs. flexible bronchoscopy (19.1% vs. 24.2%, p = 0.232), while respiratory complications occurred significantly less frequent during rigid bronchoscopy (9.2% vs. 16.3%, p = 0.025). This is the largest pediatric case collection recording and comparing complications between rigid and flexible foreign body removal. The higher rate of respiratory complications in flexible bronchoscopy has been shown for the first time and validates some of the concerns about its use for foreign body removal. Flexible bronchoscopy is a safe procedure when extended respiratory monitoring and the possibility of an immediate switch to a secured airway are assured.

Hydatid Disease: A Pictorial Review of Uncommon Locations

Hydatid disease is a zoonotic infection caused primarily by the tapeworm parasite, Echinococcus granulosus. It is considered an endemic disease in the Mediterranean region.  In about 90% of cases, hydatid cysts are found in the liver and lungs; however, any other organ in the body may be affected, particularly in endemic areas. When encountering cystic lesions in these areas, the physician should always keep hydatid disease as a possible diagnosis in mind. To avoid life-threatening conditions such as anaphylactic shock or pressure effect on vital organs, timely diagnosis, and proper management are critical. When a rare site is involved, hydatid disease should be diagnosed using a combination of serologic assays and imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). These imaging modalities can also be used to determine the extent of the disease and assess possible complications. Here, we present a pictorial review of typical imaging manifestations of hydatid cysts in unusual sites. Being aware of these imaging features will assist physicians in making an accurate, timely diagnosis and subsequently, providing optimal management.

Endoscopic vacuum therapy significantly improves clinical outcomes of anastomotic leakages after 2-stage, 3-stage, and transhiatal esophagectomies

BACKGROUND

Anastomotic leakages after esophagectomies continue to constitute significant morbidity and mortality. Intrathoracic anastomoses pose a high risk for mediastinitis, sepsis, and death, if a leak is not addressed timely and appropriately. However, there are no standardized treatment recommendations or algorithms as for how to treat these leakages.

METHODS

The study included all patients at the University Hospital Regensburg, who developed an anastomotic leakage after esophagectomy with gastric pull-up reconstruction from 2007 to 2022. Patients receiving conventional treatment options for an anastomotic leakage (stents, drainage tubes, clips, etc.) were compared to patients receiving endoscopic vacuum-assisted closure (eVAC) therapy as their mainstay of treatment. Treatment failure was defined as cervical esophagostomy formation or death.

RESULTS

In total, 37 patients developed an anastomotic leakage after esophagectomy with a gastric pull-up reconstruction. Twenty patients were included into the non-eVAC cohort, whereas 17 patients were treated with eVAC. Treatment failure was observed in 50% of patients (n = 10) in the non-eVAC cohort and in 6% of patients (n = 1) in the eVAC cohort (p < 0.05). The 90-day mortality in the non-eVAC cohort was 15% (n = 3) compared to 6% (n = 1) in the eVAC cohort. Cervical esophagostomy formation was required in 40% of cases (n = 8) in the non-eVAC cohort, whereas no patient in the eVAC cohort underwent cervical esophagostomy formation.

CONCLUSION

eVAC therapy for leaking esophagogastric anastomoses appears to be superior to other treatment strategies as it significantly reduces morbidity and mortality. Therefore, we suggest eVAC as an essential component in the treatment algorithm for anastomotic leakages following esophagectomies, especially in patients with intrathoracic anastomoses.

Sarcopenia and Patient's Body Composition: New Morphometric Tools to Predict Clinical Outcome After Ivor Lewis Esophagectomy: a Multicenter Study

BACKGROUND

The impact of preoperative body composition as independent predictor of prognosis for esophageal cancer patients after esophagectomy is still unclear. The aim of the study was to explore such a relationship.

METHODS

This is a multicenter retrospective study from a prospectively maintained database. We enrolled consecutive patients who underwent Ivor-Lewis esophagectomy in four Italian high-volume centers from May 2014. Body composition parameters including total abdominal muscle area (TAMA), visceral fat area (VFA), and subcutaneous fat area (SFA) were determined based on CT images. Perioperative variables were systematically collected.

RESULTS

After exclusions, 223 patients were enrolled and 24.2% had anastomotic leak (AL). Sixty-eight percent of patients were sarcopenic and were found to be more vulnerable in terms of postoperative 90-day mortality (p = 0.028). VFA/TAMA and VFA/SFA ratios demonstrated a linear correlation with the Clavien-Dindo classification (R = 0.311 and 0.239, respectively); patients with anastomotic leak (AL) had significantly higher VFA/TAMA (3.56 ± 1.86 vs. 2.75 ± 1.83, p = 0.003) and VFA/SFA (1.18 ± 0.68 vs. 0.87 ± 0.54, p = 0.002) ratios. No significant correlation was found between preoperative BMI and subsequent AL development (p = 0.159). Charlson comorbidity index correlated significantly with AL (p = 0.008): these patients had a significantly higher index (≥ 5).

CONCLUSION

Analytical morphometric assessment represents a useful non-invasive tool for preoperative risk stratification. The concurrent association of sarcopenia and visceral obesity seems to be the best predictor of AL, far better than simple BMI evaluation, and potentially modifiable if targeted with prehabilitation programs.

Long-term retainment of a foreign body in the esophagus in an adult: a case report

Ingestion of a foreign body (FB) is a common emergency encountered in otorhinolaryngology. In most cases, FBs pass through the digestive tract spontaneously without any serious consequences, but some of them require nonsurgical interventions, and more severe cases require surgical interventions. The types of FBs ingested may differ in different countries and regions. In adults, bones, fish bones, and dental prostheses are most commonly found in the esophagus, and most of the FBs are retained in the esophagus less than 1 month. To the best of our knowledge, this is the first report of an unusual FB (a beer bottle cap) that was stuck in the upper esophagus for longer than 4 months. The main complaints of the patient were a sore throat and FB sensation, and an FB was diagnosed by a chest radiograph and computed tomography of the esophagus. He then had rigid endoscopic removal of the FB performed under anesthesia with propofol sedation. During a 3-month follow-up, the patient was asymptomatic and no esophageal stricture was observed. Impaction of FBs in the gastrointestinal tract can lead to severe adverse events. Therefore, early detection and timely management of FBs are important.

Esophageal emergencies

The esophagus is a deeply located organ which traverses the neck, the thorax, and the abdomen and is surrounded at each level by vital organs. Because of its positioning injuries to the esophagus are rare. Their common denominator is the risk of the organ perforation leading to spillage of digestive contents in surrounding spaces, severe sepsis and eventually death. Most frequent esophageal emergencies are related to the ingestion of foreign bodies or caustic agents, to iatrogenic or spontaneous esophageal perforation and external esophageal trauma. Early diagnosis and appropriate management are the keys of successful outcomes.

A population-based investigation: How to identify high-risk T1-2N0 esophageal cancer patients?

Purpose

Newly diagnosed T1-2N0 esophageal cancer (EC) is generally deemed as early local disease, with distant metastases (DM) easily overlooked. This retrospective study aimed to describe the metastatic patterns, identify risk factors and established a risk prediction model for DM in T1-2N0 EC patients.

Methods

A total of 4623 T1-2N0 EC patients were identified in the Surveillance, Epidemiology and End Results (SEER) database from 2004 to 2018. Multivariable logistic regression was used to identify risk factors for DM. A nomogram was developed for presentation of the final model.

Results

Of 4623 T1-2N0 patients, 4062 (87.9%) had M0 disease and 561 (12.1%) had M1 disease. The most common metastatic site was liver (n = 156, 47.3%), followed by lung (n = 89, 27.0%), bone (n = 70, 21.2%) and brain (n = 15, 4.5%). Variables independently associated with DM included age at diagnosis, gender, tumor grade, primary site, tumor size and T stage. A nomogram based on the variables had a good predictive accuracy (area under the curve: 0.750). Independent risk factors for bone metastases (BoM), brain metastases (BrM), liver metastases (LiM) and lung metastases (LuM) were identified, respectively.

Conclusions

We identified independent predictive factors for DM, as well as for BoM, BrM, LiM and LuM. Above all, a practical and convenient nomogram with a great accuracy to predict DM probability for T1-2N0 EC patients was established.

Primary costal hydatid cyst resembling urolithiasis: A case report

INTRODUCTION

Hydatid disease (HD) is a zoonotic infection caused by echinococcus granulosus tapeworms. HD accounts for approximately one million cases worldwide. HD is more prevalent in endemic areas, such as the Mediterranean region.

PRESENTATION OF CASE

A middle-aged male patient presented with right flank pain for years. His vital signs and physical examination were unremarkable. The whole-body bone scan revealed an area along the sixth rib's posterior arch with increased metabolic activity and CT and MRI were compatible with a hydatid cyst. The cyst was surgically resected and irrigation of the area with hypertonic saline was done. Medical treatment with albendazole was initiated and the patient had no complications.

DISCUSSION

Bone involvement is an uncommon finding in HD and involvement of the ribs is even more scarce. Surgical resection complemented with medical treatment is the preferred approach.

CONCLUSION

In the Mediterranean and middle eastern regions, high infection rates with E. granulosis are evident hence, uncommon manifestations of the disease should be regarded. Although renal stones are far more prevalent when in endemic areas of HD, the physician should also consider skeletal HD as a differential diagnosis.

Thymic lipofibroadenomas: Three case reports

BACKGROUND

Thymic lipofibroadenomas are extremely rare. In this study, we investigated the clinicopathological characteristics of thymic lipofibroadenomas.

CASE SUMMARY

This study included three patients with thymic lipofibroadenomas. We retrospectively analyzed the patient data to determine the clinicopathological characteristics of thymic lipofibroadenomas. The study included one man and two women [mean age, 43 (33-59) years]. All patients were non-smokers and presented with well-defined anterior mediastinal tumors. The cut surfaces of the tumors were solid, with a mixture of yellow and white areas. Microscopic evaluation of resected specimens showed scattered cord-like structures of epithelial cells embedded within abundant fibrotic and hyaline stroma admixed with variable quantities of adipose tissue. One patient showed hyperplastic thymic tissue in a part of the tumor.

CONCLUSION

Thymic lipofibroadenomas are an extremely rare type of benign thymic tumor. Surgical removal of lipofibroadenomas is usually curative.

Unilateral Pulmonary Agenesis about a Case Revealed by an Acute Respiratory Infection in a Young Infant

Pulmonary agenesis is a rare congenital anomaly of unknown cause, consisting of a complete absence of the lung parenchyma, bronchi, and vascularization. It may or not be associated with other malformations. The authors report a case of right pulmonary agenesis diagnosed in a four-month-old infant who had no previous pathological history and was growing well. The circumstance of discovery was respiratory distress during an infectious episode. The diagnosis was suspected on a standard chest X-ray and confirmed on a chest CT scan. There are no other associated defects. The evolution was good after antibiotic therapy. While bilateral pulmonary agenesis is incompatible with life, the unilateral form may remain unrecognized until adulthood. The prognosis depends mainly on the importance of the associated malformations.

A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors

OBJECTIVE

To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills.

METHODS

A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed.

RESULTS

All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min (p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p < 0.05).

CONCLUSIONS

Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.

A Case Report of Esophageal Perforation: Complications of Orogastric Tube Placement

Orogastric tube (OGT) insertion is a routine procedure in medical care. It is often inserted in patients after endotracheal intubation. OGT insertion is often a blind procedure. Misplacement of the tube can cause a variety of complications and can sometimes be life-threatening. We present the case of a 71-year-old male patient who experienced a rare proximal esophageal perforation as a complication of blind insertion of the OGT; he required OGT insertion after receiving endotracheal intubation for hypoxic respiratory failure secondary to COVID-19 infection. The esophageal perforation was revealed on a post-procedural roentgenogram and confirmed by a subsequent computed tomography of the chest. Given the small size of the perforation and the absence of clinical instability, conservative management was pursued leading to improvement of the mediastinitis. Although the complications of OGT insertion are uncommon, their consequences can be potentially serious and require a high degree of suspicion.

Mucoepidermoid carcinoma of the esophagus with MAML2 gene rearrangement: Case report and literature review

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy but rarely occurs in the esophagus. It is easily confused with adenosquamous carcinoma and squamous cell carcinoma (SCC) with mucus-secreting components. MAML2 gene rearrangement detected by fluorescence in situ hybridization (FISH), RT-PCR or next-generation sequencing (NGS) can aid in the diagnosis. We present a case of esophageal MEC with MAML2 gene rearrangement detected by FISH. To the best of our knowledge, this is the first report of an esophageal MEC with MAML2 gene rearrangement. We also reveal that esophageal MEC patients were reported to have a higher risk of recurrence and death than SCC patients in previous literature. However, all the cases were diagnosed using previous diagnostic criteria and not confirmed by MAML2 gene rearrangement detection, and most of them might not be true MECs.

CT Imaging Findings of Pulmonary Alveolar Echinococcosis

Alveolar echinococcosis is a parasitic infection caused by Echinococcus multilocularis in the metacestode stage. The disease involves the liver in almost all cases, and additionally, lung involvement is accompanied in approximately 13% of the cases. Due to the low incidence of pulmonary alveolar echinococci, there are few case reports of lung involvement in the literature. In this study, computed tomography (CT) findings related to pulmonary involvement in alveolar echinococcosis cases, which have increased worldwide in recent years, were evaluated.

Parasitic lung diseases

Parasitic lung diseases are caused by a number of parasites as a result of transient passage in the lung or as a result of an immunologic reaction. The clinical presentation may be in the form of focal or cystic lesions, pleural effusion or diffuse pulmonary infiltrates. With increasing globalisation, it is important to consider parasitic infections in the differential diagnosis of lung diseases. This is particularly important since early identification and prompt therapy result in full cure of these conditions. In this review, we summarise the most common parasitic lung diseases.

Surgical approaches to mediastinal cysts: clinical practice review

The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.

What is the impact of a large cyst size on the radiological diagnosis of pulmonary hydatid cyst in children?

Anamnesis, physical examination, and laboratory investigation of patients admitted to the clinic provide non-specific findings for pulmonary hydatid cysts. Obtaining an accurate diagnosis of this cystic lesion is only possible by radiological examination. An uncomplicated intact simple cyst in an early phase could be easily and precisely diagnosed by chest roentgenogram and computed tomography scan of the thorax. Complicated late cases may have confusing and challenging atypical radiological signs. In this case report, we report a giant pulmonary hydatid cyst (13 x 8 x 12 cm) with atypical radiological findings in a 4-year-old girl who was hospitalized with fever and cough and was treated with oral antibiotics for pneumonia.

Stem-cell therapy via gastroscopy improves the outcome of esophageal anastomotic leakage

Background

Esophageal anastomotic leakage (EAL) is a severe complication usually occurring after esophagectomy. Although there are various therapeutic methods for EAL treatment, they have not achieved satisfactory results. A previous study showed that the combination of mesenchymal stem cells (MSCs) and fibrin scaffold (FS) can treat EAL. This study aimed to evaluate the efficacy of the injection of MSCs and FS through a new engraftment gastroscope for EAL treatment.

Methods

Twelve adult pigs were randomly divided into the MSCs group (n = 6) and control group (n = 6). A stomach tube was then inserted through the leakage to construct the EAL model, which was removed after one week. The combination of MSCs and FS was autografted at the EAL site for pigs in the MSCs group using the tailor-made gastroscope while only FS was autografted for the pigs in the control group. Local status of EAL was evaluated using gastroscopy. Histological analyses and western blot (WB) were used to assess the gross specimens of esophagi around EALs.

Results

Gastroscopy showed a higher closure rate and a lower infection rate in the MSCs group than in the control group. However, the mortality was not significantly different between the two groups. HE staining showed a severe inflammatory response with dispersive infiltration of inflammatory cells and unhealed leakage in the control group. However, the infiltration of inflammatory cells was not altered in the MSCs group, and the leakage was completely healed. WB analyses showed that Myogenin and α-SMA expressions were significantly higher in the MSCs group than in the control group.

Conclusion

A porcine model of EAL was successfully developed by accessing the transplantation site through the esophagus. Further data revealed that the implantation of MSCs in FS via the novel engraftment gastroscope can promote the repair and occlusion of EAL. Therefore, the proposed method is a promising strategy for EAL treatment.

Treatment of anastomotic leak after esophagectomy: insights of an international case vignette survey and expert discussions

Anastomotic leak (AL) is a severe complication after esophagectomy. Clinical presentation of AL is diverse and there is large practice variation regarding treatment of AL. This study aimed to explore different AL treatment strategies and their underlying rationale. This mixed-methods study consisted of an international survey among upper gastro-intestinal (GI) surgeons and focus groups with expert upper GI surgeons. The survey included 10 case vignettes and data sources were integrated after separate analysis. The survey was completed by 188 respondents (completion rate 69%) and 6 focus groups were conducted with 20 international experts. Prevention of mortality was the most important goal of primary treatment. Goals of secondary treatment were to promote tissue healing, return to oral feeding and safe hospital discharge. There was substantial variation in the preferred treatment principles (e.g. drainage or defect closure) and modalities (e.g. stent or endoVAC) within different presentations of AL. Patients with local symptoms were treated by supportive means only or by non-surgical drainage and/or defect closure. Drainage was routinely performed in patients with intrathoracic collections and often combined with defect closure. Patients with conduit necrosis were predominantly treated by resection and reconstruction of the anastomosis or by esophageal diversion. This mixed-methods study shows that overall treatment strategies for AL are determined by vitality of the conduit and presence of intrathoracic collections. There is large variation in preferred treatment principles and modalities. Future research may investigate optimal treatment for specific AL presentations and aim to develop consensus-based treatment guidelines for AL after esophagectomy.

The emerging role of epigenetic regulation in the progression of silicosis

Silicosis is one of the most severe occupational diseases worldwide and is characterized by silicon nodules and diffuse pulmonary fibrosis. However, specific treatments for silicosis are still lacking at present. Therefore, elucidating the pathogenesis of silicosis plays a significant guiding role for its treatment and prevention. The occurrence and development of silicosis are accompanied by many regulatory mechanisms, including epigenetic regulation. The main epigenetic regulatory mechanisms of silicosis include DNA methylation, non-coding RNA (ncRNA), and histone modifications. In recent years, the expression and regulation of genes related to silicosis have been explored at epigenetic level to reveal its pathogenesis further, and the identification of aberrant epigenetic markers provides new biomarkers for prediction and diagnosis of silicosis. Here, we summarize the studies on the role of epigenetic changes in the pathogenesis of silicosis to give some clues for finding specific therapeutic targets for silicosis.

Inhalational lung diseases

The term inhalational lung disease comprises a group of entities that develop secondary to the active aspiration of particles. Most are occupational lung diseases. Inhalational lung diseases are classified as occupational diseases (pneumoconiosis, chemical pneumonitis), hypersensitivity pneumonitis, and electronic-cigarette-associated lung diseases. The radiologic findings often consist of nonspecific interstitial patterns that can be difficult to interpret. Therefore, radiologists' experience and multidisciplinary teamwork are key to ensure correct evaluation. The role of the radiologist is fundamental in preventive measures as well as in diagnosis and management, having an important impact on patients' overall health. It is crucial to take into account patients' possible exposure to particles both at work and at home.

Serum insulin-like growth factor binding protein-3 as a potential biomarker for diagnosis and prognosis of oesophageal squamous cell carcinoma

BACKGROUND

Insulin-like growth factor binding protein-3 (IGFBP3) has been reported to be related to the risk of some cancers. Here we focussed on serum IGFBP3 as a possible biomarker of diagnosis and prognosis for oesophageal squamous carcinoma (ESCC).

METHODS

Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum IGFBP3 level in the training cohort including 136 ESCC patients and 119 normal controls and the validation cohort with 55 ESCC patients and 42 normal controls. The receiver operating characteristics curve (ROC) was used to assess the diagnosis value. Cox proportional hazards model was applied to select factors for survival nomogram construction.

RESULTS

Serum IGFBP3 levels were significantly lower in early-stage ESCC or ESCC patients than those in normal controls (p < .05). The specificity and sensitivity of serum IGFBP3 for the diagnosis of ESCC were 95.80% and 50.00%, respectively, with the area under the ROC curve (AUC) of 0.788 in the training cohort. Similar results were observed in the validation cohort (88.10%, 38.18%, and 0.710). Importantly, serum IGFBP3 could also differentiate early-stage ESCC from controls (95.80%, 52.54%, 0.777 and 88.10%, 36.36%, 0.695 in training and validation cohorts, respectively). Furthermore, Cox multivariate analysis revealed that serum IGFBP3 was an independent prognostic risk factor (HR = 2.599, p = .002). Lower serum IGFBP3 level was correlated with reduced overall survival (p < .05). Nomogram based on serum IGFBP3, TNM stage, and tumour size improved the prognostic prediction of ESCC with a concordance index of 0.715.

CONCLUSION

We demonstrated that serum IGFBP3 was a potential biomarker of diagnosis and prognosis for ESCC. Meanwhile, the nomogram might help predict the prognosis of ESCC. Key MessageSerum IGFBP3 showed early diagnostic value in oesophageal squamous cell carcinoma with independent cohort validation. Moreover, serum IGFBP3 was identified as an independent prognostic risk factor, which was used to construct a nomogram with improved prognosis ability in oesophageal squamous cell carcinoma.

The Etiology, Diagnosis, and Management of Esophageal Perforation

BACKGROUND

Esophageal perforation is a serious and potentially life-threatening medical emergency. Given multiple etiologies and varying clinical presentations of the perforated esophagus, the diagnosis is commonly delayed, complicating expeditious and optimal intervention.

METHODS

We thoroughly reviewed the latest literature on the subject and herein describe the various treatment strategies in varying settings.

RESULTS

Treatment depends on multiple factors including the cause and location of the perforation, the time interval between the inciting event and presentation to the managing clinician, the overall medical stability of the patient, comorbidities including pre-existent esophageal pathology or prior foregut operations, and both the location and extent of extra-esophageal fluid collections. Because of these various considerations, determining the best diagnostic and therapeutic approach requires considerable clinical experience and judgment on the part of the physician. Management principles include (1) adequate fluid resuscitation; (2) expeditious administration of appropriate broad-spectrum antibiotics; (3) repair, occlusion, exclusion, diversion, or exteriorization of the perforation site; (4) drainage of extraluminal fluid collections; (5) relief of distal obstruction; and (6) nutritional support.

CONCLUSIONS

For decades, operative intervention has been the mainstay of therapy for esophageal perforation. More recently, endoscopic therapies, including stenting, clipping, suturing, or endoscopic vacuum therapy, have been introduced, expanding the clinician's therapeutic armamentarium while supplanting surgical approaches in many cases. With further experience and introduction of novel therapies, the management of esophageal perforation undoubtedly will continue to evolve.

Self-Expanding Metallic Stents for Palliation of Esophageal Cancer: A Single Center Experience From Saudi Arabia

BACKGROUND

Self-expanding metallic stents (SEMSs) are increasingly used as a non-surgical alternative for the palliation of advanced esophageal cancer (EC). However, there is a scarcity of real-life experience with the use of these stents exclusively in EC. The aim of this study is to evaluate the efficacy of SEMS in inoperable ECs in the western region of Saudi Arabia.

METHODS

A retrospective review of SEMS placed in a tertiary referral hospital for histologically proven inoperable EC from 2016 to 2019. Demographics data, procedure success, complication, re-intervention, and mortality were analyzed.

RESULTS

Forty-eight SEMS placed in 35 patients for palliation of dysphagia. The median age of patients was 68 years (range 31-95). 69% (24) patients have a lower third of EC and the rest have a middle third. SEMSs were placed successfully in all cases with symptomatic improvement. No major stent-related complication was seen. 28% (13) patients required re-intervention with additional SEMS placement, nine of which were for tissue in growth and four for distal migration. Median survival was 114 days (range 30-498). Most of the complications seen in fully covered SEMS compared to the partially covered 50% (8/16) vs 17% (5/30), respectively, p = 0.04. Chemo and/or radiotherapy were given to 51% (18) of the patients without any significant benefit on survival (p = 0.79) or re-intervention rate (p = 0.47) compared to those who did not.

CONCLUSION

SEMS is effective in palliating dysphagia in inoperable EC without major complications. Rates of tumors in growth and migration were comparable to other studies. SEMS provides long-term palliation.

All Microbiological Aspects of SARS-CoV-2 Virus

The COVID-19 disease, caused by SARS-CoV-2 virus, which was first seen in Wuhan (China) on December 31, 2019, rapidly spread to cities, countries, and continents and was noted in history as the first pandemic caused by coronaviruses. According to the World Health Organization reports, more than 645 million confirmed SARS-CoV-2-positive cases and more than 6.5 million confirmed deaths were noted all over the world during the pandemic (between December 2020 and December 2022). Although SARS-CoV-2 is a virus belonging to the coronavirus family, our knowledge of the pathogenesis and immune response of SARS-CoV-2 is still limited. Approximately 10 years (2012) after the Middle East Respiratory Syndrome (MERS-CoV) (nearly 2200 confirmed cases and 791 confirmed deaths) and 20 years (2002-2004) after the SARS-CoV epidemic (29 different countries, nearly 8000 confirmed cases, and 774 confirmed deaths), the current COVID-19 pandemic is a reminder of how new pathogens can emerge and spread rapidly, eventually causing serious public health problems. Further research is needed to establish animal models for SARSCoV-2 to investigate replication, transmission dynamics, and pathogenesis in humans in order to develop effective antiviral treatments and vaccines.

Endoscopic resection in the treatment of intramural esophageal bronchogenic cysts: A retrospective analysis of 17 cases

BACKGROUND

Intramural esophageal bronchogenic cysts (EBCs) are rare congenital malformations. Differences in reports on the clinical features of intramural EBCs and some controversies about the treatment strategy for intramural EBCs exist.

OBJECTIVES

To investigate the clinical characteristics of intramural EBCs and evaluate the safety and efficacy of endoscopic resection.

METHODS

The clinical and endoscopic features, endoscopic resection treatment, postoperative adverse events, and follow-up results of 17 patients with intramural EBCs were retrospectively studied.

RESULTS

Intramural EBCs exhibited male predominance with a male/female ratio of 58.8% (10/7) and were predominantly found in the distal esophagus. Approximately 94.1% of patients presented with gastrointestinal symptoms. All lesions were protruding masses covered by intact mucosal epithelium. The morphologies of intramural EBCs were diverse under white light endoscopy. On endoscopic ultrasonography, intramural EBCs presented as homogeneous or inhomogeneous hypoechoic or anechoic lesions. Eleven lesions originated from the muscularis propria, which underwent submucosal tunnel endoscopic resection (STER), and six lesions were from the submucosa, which underwent endoscopic submucosal dissection (ESD). Approximately 88.2% of patients underwent complete endoscopic resection. No serious pneumothorax, bleeding, pleural effusion, esophagotracheal fistula, or other adverse events occurred in all patients after endoscopic resection, and no cyst recurrence, metastasis, or esophageal scar stenosis was observed during the follow-up period.

CONCLUSIONS

Intramural EBCs can be treated by digestive endoscopic surgery. STER and ESD are safe, effective, and minimally invasive resection methods.

Pulmonary Hydatid Cyst in Children and Adults: Diagnosis and Management

Hydatid cyst disease induced by Echinococcus granulosus is a parasitic disease known since ancient times. Today, it continues to be seen in many countries and creates serious problems. The lung is the second most frequently affected organ by hydatid cysts after the liver. Lung involvement is more prevalent in children than adults, and the growth of the cyst is faster in children. Hydatid cysts are mostly seen in the right lower lobe of the lung. Common symptoms are chest pain, cough, and shortness of breath, with the most diagnostic symptom being the expectoration of cyst fluid or membranes. In endemic areas, the diagnosis of hydatid cysts can usually be made easily by clinical findings, serology tests, and radiological findings. When the hydatid cyst ruptures and becomes complicated, it is clinically and radiologically confused with many diseases, especially lung cancer. Surgery is accepted as primary treatment of lung hydatid cysts all over the world. The surgical approach is related to several factors such as the size of the cyst, whether it is intact or complicated, unilateral or bilateral, solitary or multiple, and the presence of destruction of the lung parenchyma. Although it is stated by some surgeons that capitonnage is not required, the most frequently applied surgical technique is cystotomy and capitonnage. Pulmonary resection should be avoided as much as possible, particularly in children. Albendazole or mebendazole treatment in pulmonary hydatid cyst is generally used after surgery and to prevent recurrences.

Diagnostic and Management Perspectives in Alveolar Echinococcosis: Review of Literature

Alveolar echinococcosis is a life-threatening zoonotic disease caused by Echinococcus multilocularis. The disease usually primarily involves the liver and shows tumor-like growth. Early diagnosis of alveolar echinococcosis is difficult because the disease is usually asymptomatic in the early stages. Untreated cases are fatal and result in death within 10 years of liver involvement. In the diagnosis of alveolar echinococcosis, the patient's medical history, radiological imaging findings, and serological and histopathological tests are used together. Radiological imaging methods are very important for early diagnosis and differential diagnosis of the disease. In this article, we wanted to review the diagnosis and treatment of alveolar echinococcosis and emphasize the importance of keeping it in mind, especially in cystic lesions of the liver, and the importance of early diagnosis of the disease.

Thymic lipofibroadenoma of the anterior mediastinum: A rare case report

BACKGROUND

Lipofibroadenoma is an extremely rare thymic tumor, and the anterior mediastinum is the most common site.

CASE SUMMARY

A 21-year-old male was admitted with fever without obvious cause for 2 months. After admission, the patient's highest temperature was 38.3°C, accompanied by diarrhea. Physical examination showed coarse breath sounds in both lungs. Chest enhanced computed tomography (CT) showed a mass of mixed density shadow on the left side of the anterior mediastinum with a size of approximately 9.2 cm × 5 cm × 2.1 cm and a clear boundary mixed with a low fat density shadow. Mediastinal tumors were removed under general anesthesia by video-assisted thoracoscopic surgery. Macroscopically, a clear boundary was shown between the tumor and the remaining thymus. Microscopically, the tumor contained a large amount of mature adipose and fibrous tissue with scattered cord-like epithelial tissue and a small number of lymphocytes scattered in the stroma. The tumor lacked thymic bodies. The neoplastic epithelial cells were oval or polygonal and arranged in fissures, the nuclei were uniform in size and mild in shape, and mitosis was rare. Epithelial cells were positive for AE1/AE3 and CK19, lymphocytes were positive for CD3 and CD20, and fat and fibrous tissue were positive for S-100 and vimentin, respectively. The Ki67 labeling index was less than 5%. Based on histological features and immunophenotype, thymic lipofibroadenoma was diagnosed. The patient was followed up 1 year after the operation, and no recurrence or residual lesions were found on the X-ray re-examination.

CONCLUSION

Lipofibroadenoma is a benign thymic tumor, and thymectomy is regarded as the best treatment. The biological behavior of thymic lipofibroadenoma is good, and the recurrence rate is low.

Mediastinal Thoracic Duct Cyst Infection after Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report

A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.

Quantitative CT analysis to predict esophageal fistula in patients with advanced esophageal cancer treated by chemotherapy or chemoradiotherapy

Background

Esophageal fistula is one of the most serious complications of chemotherapy or chemoradiotherapy (CRT) for advanced esophageal cancer. This study aimed to evaluate the performance of quantitative computed tomography (CT) analysis and to establish a practical imaging model for predicting esophageal fistula in esophageal cancer patients treated with chemotherapy or chemoradiotherapy.

Methods

This study retrospectively enrolled 204 esophageal cancer patients (54 patients with fistula, 150 patients without fistula) and all patients were allocated to the primary and validation cohorts according to the time of inclusion in a 1:1 ratio. Ulcer depth, tumor thickness and length, and minimum and maximum enhanced CT values of esophageal cancer were measured in pretreatment CT imaging. Logistic regression analysis was used to evaluate the associations of CT quantitative measurements with esophageal fistula. Receiver operating characteristic curve (ROC) analysis was also used.

Results

Logistic regression analysis showed that independent predictors of esophageal fistula included tumor thickness [odds ratio (OR) = 1.167; p = 0.037], the ratio of ulcer depth to adjacent tumor thickness (OR = 164.947; p < 0.001), and the ratio of minimum to maximum enhanced CT value (OR = 0.006; p = 0.039) in the primary cohort at baseline CT imaging. These predictors were used to establish a predictive model for predicting esophageal fistula, with areas under the receiver operating characteristic curves (AUCs) of 0.946 and 0.841 in the primary and validation cohorts, respectively. The quantitative analysis combined with T stage for predicting esophageal fistula had AUCs of 0.953 and 0.917 in primary and validation cohorts, respectively.

Conclusion

Quantitative pretreatment CT analysis has excellent performance for predicting fistula formation in esophageal cancer patients who treated by chemotherapy or chemoradiotherapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40644-022-00490-2.

The risk and prognostic factors for liver metastases in esophageal cancer patients: A large-cohort based study

BACKGROUND

This retrospective study aimed to explore risk factors for liver metastases (LiM) in patients with esophageal cancer (EC) and to identify prognostic factors in patients initially diagnosed with LiM.

METHODS

A total of 28 654 EC patients were retrieved from the Surveillance, Epidemiology and End Results (SEER) database from 2010 to 2018. A multivariate logistic regression model was utilized to identify risk factors for LiM. A Cox regression model was used to identify prognostic factors for patients with LiM.

RESULTS

Of 28 654 EC patients, 4062 (14.2%) had LiM at diagnosis. The median overall survival (OS) for patients with and without LiM was 6.00 (95% CI: 5.70-6.30) months and 15.00 (95% CI: 14.64-15.36) months, respectively. Variables significantly associated with LiM included gender, age, tumor site, histology, tumor grade, tumor size, clinical T stage, clinical N stage, bone metastases (BoM), brain metastases (BrM) and lung metastases (LuM). Variables independently predicting survival for EC patients with LiM were age, histology, tumor grade, BoM, BrM, LuM, and chemotherapy. A risk prediction model and two survival prediction models were then constructed revealing satisfactory predictive accuracy.

CONCLUSIONS

Based on the largest known cohort of EC, independent predictors of LiM and prognostic indicators of survival for patients with LiM were identified. Two models for predicting survival as well as a risk prediction model were developed with robust predictive accuracy.