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BackgroundCancer-related fatigue (CRF) is the most distressing symptom in the overall cancer population. For patients with esophageal cancer, CRF may even be harder to predict and control due to its complicated and prolonged treatment. Moreover, communication difficulties due to disease progression or treatment may further diminish esophageal cancer patients’ ability to communicate about CRF. However, little research has addressed the trajectory and associating factors of CRF in this population, especially during the active treatment phase. The purpose of this study was (1) to evaluate and compare the level of CRF at three time points, namely before treatment, a month after concurrent chemoradiotherapy (CCRT), and a week after surgery, and (2) to identify associated factors of CRF.MethodsThis prospective cohort study used a questionnaire to evaluate esophageal cancer patients’ CRF at three time points. Repeated measures ANOVA and linear regression were used to analyze the data.ResultsThis study included 73 participants. The severity of all CRF aspects intensified significantly over the course of treatment, reaching the highest level after surgery (P < 0.001). Worries of physician invalidation at baseline (P < 0.05) and marital status associated with CRF after CCRT and after surgery.ConclusionsThis is the first study to demonstrate the relationship between CRF and physician invalidation. Clinicians must be aware of the intensifying trend of CRF and provide timely intervention when caring for patients with esophageal cancer during cancer treatment. Reducing the worries of physician invalidation may alleviate CRF.

BackgroundAdvanced esophageal cancer invading the aorta is considered unsuitable for surgery with definitive chemotherapy or chemoradiation as the treatments of choice. In the current study, we evaluated the long-term clinical impact of combining thoracic endovascular aortic repair (TEVAR) with multimodality treatment in caring for such patients.MethodsWe evaluated 48 patients who had advanced esophageal cancer with aortic invasion. The oncological outcome, including overall survival (OS) and progression-free survival (PFS), after multimodality treatment with or without TEVAR is evaluated for these patients.ResultsOverall, 25/48 patients (52.1%) received a TEVAR procedure. There was no significant difference in OS (p = 0.223) between patients who did or did not receive TEVAR; however, patients who received TEVAR had significantly less local tumor recurrence (p = 0.020) and longer PFS (p = 0.019). This impact was most evident in patients who received both TEVAR and esophagectomy, with an incremental increase in hazard ratio (HR) for disease progression of 2.89 (95% confidence interval [CI] 0.86–9.96) and 4.37 (95% CI 1.33–14.33) observed under multivariable analysis, respectively, in comparison with patients who underwent only one or neither of these procedures (p = 0.005 for trend test).ConclusionTEVAR is a feasible procedure for esophageal cancers invading the aorta and can be used for curative-intent resection to improve local tumor control and PFS.

Background Uniportal robotic-assisted thoracic surgery (URATS) has been increasingly adopted in some centers; however, its global acceptance and clinical impact remain uncertain. This study compared the perioperative outcomes of URATS and multiportal robotic-assisted thoracic surgery (MRATS) pulmonary resections. Methods Eighteen patients who underwent URATS pulmonary resection between February 2023 and April 2024 were compared with 54 patients who underwent MRATS pulmonary resection between February 2016 and February 2023. Propensity score matching, incorporating age, sex, frailty index, clinical tumor size, nodal stage, operative side, prior treatment, and surgical procedure, was performed to reduce confounding. Perioperative outcomes were analyzed in 18 matched patient pairs. Results The URATS group had significantly lower analgesic requirements intraoperatively (12.5 [10.5–13.1] vs. 19 [12.3–21.5] mg; P =  0.02) and on the operative day (1.0 [0–3.1] vs. 4.2 [2.0–6.3] mg; P  = 0.005). They also had shorter intensive care unit stay (0 [0–0] vs. 1 [0–2] day; P  = 0.03) and postoperative hospital stay (4 [2–7] vs. 7 [5–11] days; P  = 0.003). However, the docking time was longer in the URATS group than in the MRATS group (11 [8–15] vs. 7 [5–8] min, P  = 0.006). Conclusion URATS appears to be a feasible approach. Lower analgesic requirements in the immediate postoperative period and shorter hospital stays may indicate improved postoperative recovery compared with MRATS.

Objective Drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies is safe and feasible in terms of early postoperative outcomes. However, the quality of surgery in the long term remains uncertain. This study aimed to investigate the perioperative outcomes, 3-year overall, and disease-free survival rates of patients who underwent minimally invasive anatomical lung resection surgery with the drainless technique for pulmonary malignancies. Methods Fifty-eight patients who underwent drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies (36 -lobectomy; 22 -segmentectomy) between November 2017 and June 2022 by a single surgeon were enrolled. Patients’ characteristics and perioperative, early postoperative, and long-term data were collected. The lymph node dissection stations and number, resection margin, 3-year overall and disease-free survival rates were assessed. Results The median age was 64 years. Forty-four patients were females (76%) and forty-seven patients were non-smokers (81%). The median five-factor modified frailty index was 1. Most patients had primary lung cancer; four (7%), 43 (74%), seven (12%), and three (5%) had stage 0, I, II, and III, respectively. The median lymph node dissection stations was four, and the number was 17. The resection margin was free in 98% of the cases. The 3-year overall survival rate was 98.3% in all patients, and 97.2% and 100% in the lobectomy and segmentectomy subgroups, respectively. The 3-year disease-free survival rate was 85.3% in all patients and 80.5% and 92.9% in the lobectomy and segmentectomy subgroups, respectively. Conclusion The drainless technique is safe and feasible for minimally invasive anatomical lung resection surgery for pulmonary malignancies in terms of early postoperative and long-term outcomes. However, further randomized controlled studies are warranted.

Background For advanced esophageal cancer, the clinical significance of pretreatment nodal status (cN) as determined by different examinations remains unclear. Patients and methods Patients with esophageal squamous cell carcinoma who underwent neoadjuvant chemoradiation and surgery were analyzed in this study. Pretreatment cN status assessed by CT, EUS, and PET/CT and clinicopathological features were used to evaluate tumor recurrence and long-term survival. Results Two hundred and twenty-two patients were identified in this study. Pretreatment PET/CT cN0 [odds ratio (OR) cN0 versus cN+, 5.316, p  < 0.001] and pretreatment CT cN0 (OR 1.957, p  = 0.032) both independently predicted ypN0. Pretreatment PET/CT cN0 was also associated with a lower recurrence rate and longer survival across the entire study group. Among patients with ypN0, pretreatment PET/CT cN+ indicated poor disease-free survival [hazard ratio (HR) 2.777, p  = 0.001] and overall survival (HR 2.211, p  = 0.034) compared with pretreatment PET/CT cN0, which predicted a favorable prognosis. Conclusions Data from the current study suggest that pretreatment lymph node status as assessed by PET/CT is strongly correlated with survival outcomes after neoadjuvant chemoradiation and surgery in patients with esophageal squamous cell carcinoma. ypN0 patients can achieve better survival outcomes when pretreatment cN0 is assessed by PET/CT.

Background Esophageal cancer (EC) presents a significant public health challenge globally, particularly in regions with high alcohol consumption. Its etiology is multifactorial, involving both genetic predispositions and lifestyle factors. Methods This study aimed to develop a personalized risk prediction model for EC by integrating genetic polymorphisms (rs671 and rs1229984) with virtually generated alcohol consumption data, utilizing advanced artificial intelligence and machine learning techniques. We analyzed data from 86,845 individuals, including 763 diagnosed EC patients, sourced from the Taiwan Biobank. Eight machine learning models were employed: Bayesian Network, Decision Tree, Ensemble, Gradient Boosting, Logistic Regression, LASSO, Random Forest, and Support Vector Machines (SVM). A unique aspect of our approach was the virtual generation of alcohol consumption data, allowing us to evaluate risk profiles under both consuming and non-consuming scenarios. Results Our analysis revealed that individuals with the genotypes rs671 = AG and rs1229984 = CC exhibited the highest probabilities of developing EC, with values ranging from 0.2041 to 0.9181. Notably, abstaining from alcohol could decrease their risk by approximately 16.29–49.58%. The Ensemble model demonstrated exceptional performance, achieving an area under the curve (AUC) of 0.9577 and a sensitivity of 0.9211. This transition from consumption to abstinence indicated a potential risk reduction of nearly 50% for individuals with high-risk genotypes. Conclusion Overall, our findings highlight the importance of integrating virtually generated alcohol data for more precise personalized risk assessments for EC.

To investigate the association between genetic polymorphisms of growth factor-related genes and prognosis in patients with advanced esophageal squamous cell carcinoma (ESCC). A total of 334 ESCC patients with advanced tumor stages (stages IIB, III and IV) were enrolled in the study. The genotypes of 14 candidate single nucleotide polymorphisms (SNPs) involved in growth factor-related functions were analyzed using iPLEX Gold technology from the genomic DNA of peripheral leukocytes, and were correlated with the clinical outcome of patients. Serum levels of growth factors were examined by enzyme-linked immunosorbent assay (ELISA). The genetic polymorphisms of EGF:rs4444903, EGF:rs2237051 and VEGF:rs2010963 showed significant associations with overall survival (OS) of advanced ESCC patients (A/A+ A/G vs. GG, [HR = 0.77, 95% CI = 0.60-0.99, P = 0.039 for rs4444903; A/G+ G/G vs. A/A, [HR = 0.74, 95% CI = 0.58-0.95, P = 0.019 for rs2237051; G/G+G/C vs. C/C, [HR] inves = 0.69, 95% CI = 0.50-0.95, P = 0.023 for rs2010963). EGFR:rs2227983 and 3 SNPs of PIK3CA also showed borderline significant correlation with OS of advanced ESCC patients (P = 0.058 for rs2227983; P = 0.069, 0.091 and 0.067 for rs6443624, rs7651265 and rs7621329 of PIK3CA respectively). According to cumulative effect analysis of multiple SNPs, patients carrying 4 unfavorable genotypes exhibited more than a 3-fold increased risk of mortality. Finally, both EGF and VEGF expression levels significantly associated with patient mortality. The genetic variants and expression levels of EGF and VEGF can serve as prognostic predictors in patients with advanced ESCC, and thus provide more information for optimizing personalized therapies for patients with ESCC.

Pleural spread is difficult to treat in malignancies, especially in lung cancer and thymoma. Monotherapy with surgery fails to have a better survival benefit than palliative chemotherapy, the currently accepted treatment. Photodynamic therapy utilizes a photosensitizer to target the tumor site, and the tumor is exposed to light after performing a pleurectomy and tumor resection. However, the benefits of this procedure to lung cancer or thymoma patients are unknown. We retrospectively reviewed the clinical characteristics and treatment outcomes of patients with lung cancer or thymoma with pleural seeding who underwent pleural photodynamic therapy and surgery between 2005 and 2013. Eighteen patients enrolled in this study. The mean patient age was 52.9 ± 12.2 years. Lung cancer was the inciting cancer of pleural dissemination in 10 patients (55.6%), and thymoma in 8 (44.4%). There was no procedure-related mortality. Using Kaplan-Meier survival analysis, the 3-year survival rate and the 5-year survival rate were 68.9% and 57.4%, respectively. We compared the PDT lung cancer patients with those receiving chemotherapy or target therapy (n = 51) and found that the PDT group had better survival than non-PDT patients (mean survival time: 39.0 versus 17.6 months; P = .047). With proper patient selection, radical surgical resection combined with intrapleural photodynamic therapy for pleural spread in patients with non-small cell lung cancer or thymoma is feasible and may provide a survival benefit.

Importance: While minimally invasive esophagectomy is currently accepted as an effective treatment for patients with esophageal cancer, the long-term survival outcomes of single-incision minimally invasive esophagectomy in these patients are still unknown, particularly when compared to those of the more invasive multi-incision minimally invasive esophagectomy. Objective: To determine the long-term oncological outcomes of single-incision minimally invasive esophagectomy in patients with esophageal cancer and to compare these outcomes with those of multi-incision minimally invasive esophagectomy. Design: This was a prospective, randomized, and propensity score-matched study wherein we analyzed patients who underwent treatment from February 2005 to May 2022. Setting: Our study was carried out by a single surgical team in a tertiary medical center. Participants: We analyzed 348 patients with esophageal cancer who underwent single-incision minimally invasive esophagectomy and 469 who underwent multi-incision minimally invasive esophagectomy. Main Outcomes and Measures: We aimed to determine the long-term survival outcomes of single-incision minimally invasive esophagectomy and compare these to those of multi-incision minimally invasive esophagectomy in our study population, and further conducted a propensity score-matching (n = 251 in each arm) study. Results: The disease progression-free (DFS) and overall survival (OS) rates of patients who underwent single-incision minimally invasive esophagectomy (SIMIE) was significantly better than that of those who underwent by multi-incision minimally invasive esophagectomy (MIMIE) (p = 0.024 for OS and p = 0.027 for PFS). This trend of difference was observed in the subsequent propensity-score matching analysis (p = 0.009 and 0.016 for OS and PFS, respectively). Conclusions and Relevance: The single-incision technique applied in minimally invasive esophagectomy to treat esophageal cancer is feasible without compromising the patient’s long-term oncological outcome, as opposed to that applied using multi-incision minimally invasive esophagectomy.