China is one of the countries in the world with the highest rate of esophageal cancer. Early detection, accurate diagnosis, and treatment of esophageal cancer are critical for improving patients’ prognosis and survival. Machine learning technology has become widely used in cancer, which is benefited from the accumulation of medical images and advancement of artificial intelligence technology. Therefore, the learning model, image type, data type and application efficiency of current machine learning technology in esophageal cancer are summarized in this review. The major challenges are identified, and solutions are proposed in medical image machine learning for esophageal cancer. Machine learning's potential future directions in esophageal cancer diagnosis and treatment are discussed, with a focus on the possibility of establishing a link between medical images and molecular mechanisms. The general rules of machine learning application in the medical field are summarized and forecasted on this foundation. By drawing on the advanced achievements of machine learning in other cancers and focusing on interdisciplinary cooperation, esophageal cancer research will be effectively promoted.
ObjectiveTo review the lymph node metastasis pattern and its dissection value among adenocarcinoma of the esophagogastric junction (AEG) patients, in order to assist suitable individualized lymph node dissection strategies for diverse AEG patients. MethodsThe reports about lymph node metastasis and the value of dissection of AEG worldwide in recent years were retrieved and summarized. ResultsThe sites with higher lymph node metastasis rate of AEG included No.1, No.2, No.3, No.7 lymph nodes, etc. and sites with higher lymph node metastasis rate often benefit from dissection. Lymph node metastasis was related to factors such as tumor size and location, and lymph node dissection at individual sites is still controversial. ConclusionThe lymph node dissection range of AEG is highly controversial, especially for Siewert type Ⅱ AEG, which still requires prospective multicenter studies to prove.
In recent years, robot-assisted esophagectomy has become increasingly widespread, but the esophagogastric anastomosis step remains relatively complex and cumbersome. Currently, commonly used gastrointestinal reconstruction anastomosis techniques include end-to-end anastomosis, end-to-side anastomosis, and side-to-side anastomosis. Depending on the anastomosis method, they can be further divided into manual anastomosis and mechanical anastomosis, with common instruments including circular staplers and linear staplers. In esophageal cancer surgery, the choice of esophagogastric anastomosis technique is typically based on the tumor’s location and size as well as the surgeon’s preference. Each anastomosis technique has its advantages and disadvantages. With continuous improvements in anastomosis techniques and updates in stapling instruments, the incidence of complications after esophagogastric anastomosis has been effectively reduced. However, safely and efficiently completing gastrointestinal reconstruction during surgery remains a significant challenge. Scholars have made extensive explorations in this field, actively proposing and achieving various reconstruction methods, leading to significant progress. This article reviews the research progress of robot-assisted esophagogastric anastomosis techniques from both the anastomosis techniques and methods perspectives.
Objective
To analyze the clinical characteristics of patients treated with esophagectomy following endoscopic submucosal dissection (ESD) for early stage esophageal cancer or precancerosis and the reasons for esophagectomy.
Methods
We retrospectively analyzed the clinical data of 57 patients who were treated with esophagectomy following ESD in West China Hospital and Shanxian Hygeia Hospital from January 2012 through October 2016. There were 42 males and 15 females at age of 65.4 (52–77) years. There were 15 patients of upper thoracic lesions, the middle thoracic lesions in 34 patients, and the lower thoracic lesions in 8 patients.
Results
The reasons for esophagectomy included 3 patients with residual tumor, 8 patients with local recurrence, 37 patients with esophageal stricture, and 9 patients with dysphagia, although the diameter was larger than 1.0 cm. The pathology after esophagectomy revealed that tumor was found in 16 patients, including 3 patients with residual tumor and 8 with recurrent tumor confirmed before esophagectomy, and 5 patients with new-found recurrent tumor.
Conclusion
In the treatment of early stage esophageal cancer or precancerosis, the major reasons for esophagectomy following ESD include esophageal stricture, abnormal esophageal dynamics, local residual or recurrence.
ObjectiveTo analyze the effect of microecological preparation on digestive tract complications and nutritional status after esophageal cancer surgery.MethodsA total of 146 patients with esophageal cancer admitted to the Department of Thoracic Surgery, Renmin Hospital of Wuhan University from October 2017 to June 2019 were selected. There were 91 males and 55 females, aged 65 (61.9±8.2) years. They were randomly divided into two groups (an observation group and a control group, n=73 in each group) according to whether microecological preparation was given when they could take food one week after the surgery. Nutritional status and the incidence of gastrointestinal complications including anorexia, acid reflux, nausea, vomiting and diarrhea (≥3 times per day) in the first month after operation were compared between the two groups.ResultsThe incidence of anorexia, nausea, diarrhea (≥3 times per day), anastomotic fistula and stenosis in the observation group was lower and the index of nutritional status was higher than those in the control group within one month after the operation (all P<0.05). There was no statistically significant difference in acid reflux, vomiting, lung infection and incision infection between the two groups (all P>0.05).ConclusionMicroecological preparation can regulate gastrointestinal microecological balance, improve nutritional status, reduce the incidence of gastrointestinal complications and accelerate the postoperative rehabilitation.
ObjectiveTo investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.MethodsClinical data of 28 patients, including 25 males and 3 females, aged 51-76 years, with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group (3D group, 10 patients) and a 2D mediastinoscopic group (2D group, 18 patients). The perioperative outcome of the two groups were compared.ResultsCompared with the 2D group, the 3D group had shorter operation time (P=0.017), more lymph nodes resected (P=0.005) and less estimated blood loss (P=0.015). There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting (P>0.05). The other aspects including the indwelling time, postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic fistula, recurrent laryngeal nerve injury were not statistically significant between the two groups (P>0.05).ConclusionThe 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer, which optimizes the surgical procedures of 2D, is safe and feasible, and is worthy of clinical promotion in the future.
Objective To systematically review the prognostic significance of extranodal extension in gastric cancer, esophageal cancer and gastroesophageal junction cancer. Methods We searched EMbase, The Cochrane Library (Issue 9, 2016), PubMed, CBM, CNKI, VIP and WanFang Data databases from inception to August 2016, to collect cohort studies about the prognostic significance of extranodal extension. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 16 studies involving 9 445 participants were included. The results of meta-analysis showed that for gastric cancer patients, the overall survival (OS) (HR=1.71, 95%CI 1.49 to 2.00,P<0.000 01), disease free survival (DFS) (HR=1.39, 95%CI 1.12 to 1.73,P=0.003) and cancer specific survival (HR=1.52, 95%CI 1.18 to 1.96,P=0.001) in ENE(+) group were lower than ENE(–) group. For esophageal cancer and gastroesophageal junction cancer patients, the overall survival (OS) (HR=1.84, 95%CI 1.49 to 2.27,P<0.000 01), disease free survival (DFS) (HR=2.18, 95%CI 1.70 to 2.81,P<0.000 01) and cancer specific survival (HR=1.73, 95%CI 1.19 to 2.52,P=0.004) in ENE(+) group were lower than ENE(–) group. Conclusion Current evidence indicates that ENE(+) was correlated with a poor prognosis in gastric cancer, esophageal cancer and gastroesophageal junction cancer patients. Due to the quantity and quality limitations of included studies, more high quality cohort studies are needed to verify the above conclusions.
ObjectiveTo explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.MethodsSeventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups.ResultsThere were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05).ConclusionIt is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
ObjectiveTo explore the possible factors which influence the survival time of elderly patients with esophageal cancer.MethodsWe retrospectively analyzed the data of patients with esophageal cancer treated in the First Hospital of Lanzhou University, Gansu Province Tumor Hospital from January 2012 to October 2016. Kaplan-Meier method was used to estimate and analyze the single factor, survival curve with log-rank test. The Cox regression model was used for multivariate prognostic analysis．ResultsAccording to the inclusion and exclusion criteria, 302 patients were eventually collected, including 231 males and 71 females, with an average age of 66.0±6.0 years. The univariate analysis showed that age, tumor stage, tumor site, Karnosfsky performance satus (KPS) score, and treatment were prognostic factors (P<0.05). Multivariate analysis showed that the patient age and treatment were independent factors for overall survival (OS) and progress-free survival (PFS) (P<0.05). The OS and PFS of the patients with age≤70 years were better than those of the patients more than 70 years. Chemotherapy alone and surgery alone was better for survival situation than radiotherapy alone.ConclusionAge and treatment are independent prognostic factors in survival time of the elderly patients with esophageal cancer.
ObjectiveTo systematically review risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment.MethodsPubMed, Web of Science, The Cochrane Library, WanFang Data, VIP, CNKI and CBM were searched from inception to January 2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 33 studies were included, including 19 case-control studies and 14 cohort studies, all of which had a Newcastle-Ottawa Scale (NOS)≥6. There were 26 636 patients, including 20 283 males and 6 353 females, and there were 9 587 patients in China and 17 049 patients abroad. The results of meta-analysis showed that the following factors could increase the risk for EGAL (P≤0.05), including patient factors (18): age, sex, body mass index (BMI), smoking history, smoking index (≥400), alcohol history, digestive tract ulcer, respiratory disease, lower ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, peripheral vascular disease, arrhythmia, diabetes, hypertension, cerebrovascular disease, celiac trunk calcification and descending aortic calcification; preoperative factors (6): abnormal liver function, renal insufficiency, American Society of Anesthesiologists (ASA) grading, neoadjuvant radiotherapy and preoperative albumin<35 g/L, preoperative lower albumin; intraoperative factors (7): retrosternal route, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, splenectomy; postoperative factors (5): respiratory failure, postoperative arrhythmia, use of fiberoptic bronchoscopy, pulmonary infection, deep venous thrombosis. Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL (P<0.05). However, age≥60 years, upper gastrointestinal inflammation, diffusing capacity for carbon monoxide (DLCO%), thoracic surgery history, abdominal surgery history, glucocorticoid drugs history, neoadjuvant chemoradiotherapy, anastomotic embedding, end-to-end anastomosis, hand anastomosis, intraoperative blood loss and other factors were not significantly correlated with EGAL.ConclusionCurrent evidence suggests that the risk factors for postoperative EGAL include age, sex, BMI, smoking index, alcohol history, peptic ulcer, FEV1/FVC, COPD, diabetes, ASA grading, neoadjuvant radiotherapy, preoperative albumin<35 g/L, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, intraoperative splenectomy, postoperative respiratory failure, postoperative arrhythmia and other risk factors. Neoadjuvant chemotherapy may be the protection factor for EGAL. Due to limited study quality, more high quality studies are needed to verify the conclusion.
