Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+endoscopic ultrasound+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve circulating tumor DNA and radiomics for risk stratification to advance precise organ-preserving strategies.
ObjectiveTo explore the safety and practicality of intestinal autotransplantation (IATx) combined with radical tumor resection in the treatment of intraperitoneal tumors involving vital blood vessels. MethodThe research progress on indications, preoperative evaluation, ex vivo organ preservation techniques, and mesenteric vascular reconstruction techniques for IATx from January 1996 to August 2023 both domestically and internationally was reviewed. ResultsThe IATx had become a feasible surgical option for the patients with intraperitoneal tumors involving vital blood vessels (more than 180° involving the root of the superior mesenteric artery). The related studies had identified that the intraperitoneal tumors involving vital blood vessels mainly originated from the pancreas, mesentery, and retroperitoneum. Establishing a multidisciplinary team for preoperative assessment of IATx could aid to establish a valuable diagnostic and treatment system. The keypoints of IATx mainly included IATx preparation (cutting and ligating mesenteric blood vessels), in vivo tumor resection, cryopreservation of intestine in vitro, vascular and gastrointestinal reconstruction after IATx, which was different viewpoints in the different literature, such as the selection of in vivo/in vitro tumor resection, mesenteric vascular reconstruction, and portal or vena cava drainage. However, there was a consensus that the optimal solution for ex vivo organ preservation technology was improved solutions relevant to UW. At present, the hot ischemia time of intestine graft was shortened, the incidence of postoperative intestinal graft loss was reduced, and the postoperative survival of patients was gradually extended. But there were still some unresolved complications, such as early graft loss, pancreatic leakage, delayed gastric emptying, postoperative bleeding, etc. ConclusionsIATx combined with tumor resection for intraperitoneal tumors involving vital blood vessels is feasible through carefully preoperative evaluation and surgical planning, which could provide a good clinical and prognostic result. But this operation requires higher technical requirements and might only be performed in centers with rich experience in intestinal transplantation.
Liver transplantation plays a pivotal role in the field of treating end-stage liver diseases. It is currently the only treatment method that can effectively save patients’ lives and has been fully verified as effective in clinical practice. However, the problem of postoperative infection has become one of the key factors impeding the favorable prognosis of patients. Among them, donor-derived infections, due to their uniqueness and complexity, are gradually becoming a research hotspot in both clinical and scientific research fields. Through a systematic and comprehensive analysis of a large number of existing studies, we deeply analyzed the overall current situation of infections after liver transplantation, clarified the specific types of donor-derived infections and their respective characteristics. On this basis, the potential risks of such infections were thoroughly explored, and preventive strategies such as the prophylactic use of antibiotics and vaccination were put forward in a targeted manner, aiming to improve the prognosis of patients after liver transplantation to the greatest extent and enhance the quality of life of patients.
The evidence base, technical specifications and clinical implementation conditions of organ preservation strategies after neoadjuvant therapy for esophageal cancer were systematically reviewed, to provide an integrated framework for precise clinical decision-making. Based on the SANO randomized controlled trial and a series of diagnostic accuracy studies, the evolution of active surveillance (AS), the performance of multimodal evaluation techniques, and the outcomes of salvage treatment after recurrence were summarized. The SANO trial demonstrated that patients with rigorously selected clinical complete response (cCR) who received AS had a 2-year overall survival rate of 74%, which was non-inferior to the immediate surgery group (71%; absolute difference 0%, 95%CI –7% to 7%). Thirty-one percent of patients successfully avoided esophagectomy by the end of follow-up. However, the 2-year disease-free survival rate was significantly lower in the AS group than that in the surgery group (74% vs. 92%). The locoregional recurrence rate was 48%, the 30-day mortality rate after salvage esophagectomy following definitive chemoradiotherapy reached 11%, which was 3.7-fold higher than that of elective surgery (RR=3.67, 95%CI 2.89-4.66); whereas in the SANO study, the 30-day mortality rate of salvage surgery after neoadjuvant chemoradiotherapy with active surveillance for recurrence was 4%, showing no significant difference compared with the 5% observed in the immediate surgery group. The false-negative rate of cCR assessment was 13.5%-19.2%, with a negative predictive value of only 68.7%, indicating that approximately one in three patients judged as cCR actually had residual disease. Current evidence with immature long-term survival data does not support AS as a routine recommendation. This strategy should be strictly limited to high-volume esophageal cancer centers, patients with esophageal squamous cell carcinoma, highly consistent multimodal evaluations, and fully informed and highly compliant patients. Future studies are needed to optimize risk stratification using biomarkers such as circulating tumor DNA, and to balance quality-of-life benefits and oncological safety through adaptive therapeutic strategies.
