Diseases of the Esophagus最新文献

{"title":"Effects of immunoenteric nutrition versus general enteral nutrition on prognosis in patients with squamous cell carcinoma undergoing radical esophagectomy post neoadjuvant chemotherapy.","authors":"Guanghui Zhu, Xiaobin Song, Qin Wang, Zheng Zhang, Maotian Xu, Fei Xu, Jing Luo, Chi Zhang, Yi Shen","doi":"10.1093/dote/doaf027","DOIUrl":"https://doi.org/10.1093/dote/doaf027","url":null,"abstract":"<p><p>Malnutrition is a common complication among patients with esophageal cancer, significantly increasing the risk of postoperative complications and mortality. Multiple studies have shown that immunoenteric nutrition (IEN) can reduce postoperative infectious complications in patients with esophageal cancer. However, its prognostic impact on patients undergoing radical surgery following neoadjuvant therapy remains unclear. This study aimed to compare the prognostic effects of IEN versus standard enteral nutrition (EN) in patients with esophageal squamous cell carcinoma (ESCC) following radical esophageal cancer surgery after neoadjuvant therapy. This retrospective study included 197 patients with ESCC who underwent radical esophagectomy following neoadjuvant therapy between 2016 and 2022. Of these, 133 patients received postoperative standard EN, while 64 patients received IEN. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoints included the incidence of postoperative complications and changes in relevant blood markers before and after surgery. No significant differences were observed in postoperative hospitalization duration or complications between the two groups. Postoperative C-reactive protein and immunoglobulin M levels were significantly lower in the IEN group compared to the EN group (P = 0.018 and 0.042). Kaplan-Meier survival curves were plotted for 1, 2, 3, and 5 years to compare the effects of IEN and EN on OS and PFS. The log-rank test revealed the following survival rates: 90.6% versus 77.2% (1-year PFS, P = 0.023); 95.3% versus 82.7% (1-year OS, P = 0.015); 71.9% versus 56.7% (2-year PFS, P = 0.035); 76.6% versus 62.4% (2-year OS, P = 0.03); 54.6% versus 41.7% (3-year PFS, P = 0.064); 61.4% versus 49.3% (3-year OS, P = 0.08); 39.4% versus 30.7% (5-year PFS, P = 0.093); and 41.5% versus 32.6% (5-year OS, P = 0.104). Univariate and multivariate analyses identified several independent predictors of 2-year PFS and OS. For 2-year PFS, the independent predictors included body mass index (P = 0.005), ypTNM stage (Pathologic TNM-staging after neoadjuvant therapy) (P = 0.045), ypT stage (Pathologic T-staging after neoadjuvant therapy) (P = 0.030), ypN stage (Pathologic N-staging after neoadjuvant therapy) (P = 0.007), tumor differentiation (P = 0.031), and type of EN (P = 0.004). For 2-year OS, the independent predictors were age (P = 0.015), body mass index (P = 0.004), ypTNM stage (P = 0.013), ypT stage (P = 0.010), ypN stage (P = 0.009), tumor differentiation (P = 0.026), and type of EN (P = 0.001). In patients with ESCC undergoing esophagectomy after neoadjuvant therapy, postoperative IEN accelerates the resolution of the inflammatory state and improves short-term survival, though its long-term benefits remain uncertain. Furthermore, IEN does not significantly affect the postoperative hospitalization duration or the incidence of complications.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact on Barrett's dysplasia yield following the introduction of capsule sponge testing versus traditional endoscopic surveillance.","authors":"Siobhan Chien, Paul Glen","doi":"10.1093/dote/doaf033","DOIUrl":"https://doi.org/10.1093/dote/doaf033","url":null,"abstract":"<p><strong>Background: </strong>Capsule sponge testing for Barrett's surveillance is emerging as an innovative technology to aid endoscopic surveillance programs but has yet to be compared to traditional endoscopy in clinical practice. This study aims to establish the impact of the introduction of capsule sponge testing on dysplasia detection rates.</p><p><strong>Methods: </strong>Over a 5-year period, data were collected for all patients undergoing endoscopy and capsule sponge testing for Barrett's surveillance in a single health board. The 2-year periods pre- and post-implementation of capsule sponge testing were compared to assess dysplasia yield. Patients undergoing surveillance over the 2-year period 1 January 2021 to 31 December 2022 were dichotomized into two groups: capsule sponge test (±subsequent endoscopy) versus endoscopic surveillance only, to compare endoscopic biopsy results.</p><p><strong>Results: </strong>Barrett's surveillance was performed in 1568 patients between 1 January 2018 and 31 December 2019 (pre-intervention group) versus 1791 patients between 1 January 2021 and 31 December 2022 (implementation group). In the implementation group, 871 patients underwent traditional endoscopy versus 920 patients undergoing capsule sponge testing (with 157 patients [17.1%] proceeding to endoscopy after capsule sponge test). There were no significant differences in the rates of high grade dysplasia (HGD), intramucosal cancer (IMC), or invasive cancer diagnosed between the groups. However, yield of indefinite for dysplasia and low grade dysplasia (LGD) cases was higher in the endoscopic surveillance cohort.</p><p><strong>Conclusions: </strong>Capsule sponge testing is non-inferior to traditional endoscopic surveillance for detecting HGD, IMC, and cancer. Further follow-up is required to ensure early dysplasia is diagnosed appropriately in those undergoing capsule sponge testing for Barrett's surveillance.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the SANO trial really move us toward organ preservation for esophageal cancer?","authors":"Sheraz R Markar, Mark Van Berge Henegouwen, Christiane Bruns, Lorenzo Ferri, Richard van Hillegersberg, Wayne Hofstetter, Magnus Nilsson","doi":"10.1093/dote/doaf049","DOIUrl":"https://doi.org/10.1093/dote/doaf049","url":null,"abstract":"","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computing lifetime incidence of esophageal adenocarcinoma and age-specific prevalence of Barrett's esophagus.","authors":"Ravi Vissapragada, Norma B Bulamu, David C Whiteman, Tim Bright, Jonathan Karnon, David I Watson","doi":"10.1093/dote/doaf038","DOIUrl":"10.1093/dote/doaf038","url":null,"abstract":"<p><p>Barrett's esophagus is the precursor to esophageal adenocarcinoma. Esophageal adenocarcinoma detected from endoscopic surveillance programs accounts for <10% of all cases, suggesting majority of patients with Barrett's esophagus are likely unaccounted for. Previous observational studies have estimated the observed prevalence of Barrett's esophagus to be approximately 1%, but others suggest may be an underestimate. The aim of this study was twofold: (i) calculate lifetime risk of esophageal adenocarcinoma and (ii) estimate overall and age-specific prevalence of Barrett's esophagus. A tree cohort model was created for progression to esophageal adenocarcinoma from birth to death (100 years) for USA and Australian population. Lifetime risk of esophageal cancer and adenocarcinoma were necessary for calculating Barrett's esophagus prevalence. The model incorporated age- and sex-specific incidence data from national cancer registries: the Australian Institute of Health and Welfare and the Surveillance, Epidemiology, and End Results database for the USA. The model was calibrated using an optimization algorithm, which matched progression rates from Barrett's esophagus to esophageal adenocarcinoma with known national cancer data. A Monte Carlo simulation, with 10,000 iterations, was conducted to derive error margins. Estimates of age-specific and overall prevalence of Barrett's esophagus in the population were generated through a similar process. Results: The lifetime risk of esophageal cancer and adenocarcinoma in USA non-Hispanic White population was 0.56% and 0.36%, respectively, while it was somewhat higher at 0.81% and 0.61% (range 0.57%-0.65%) in the Australian population. Estimated overall prevalence of Barrett's esophagus was ~3% (±0.3%) and ~ 5.4% (±0.6%) in USA White and Australian populations (male and female). Prevalence for age brackets was estimated at 0.06% (±0.02%), 1.6% (±0.7%), 3.2% (±1.3%), 8% (±3%), and 12% (±4%) for USA, and 0.05% (±0.02%), 0.9% (±0.5%), 2.8% (±1.2%), 7% (±3%), and 12% (±4%) for Australian population for ages 0-29, 30-44, 45-59, 60-74, and 75+, respectively. Observed estimates of Barrett's esophagus prevalence are likely lower than projected overall prevalence. This study also presents age-specific prevalence estimates of Barrett's esophagus, which are key in developing screening programs for esophageal adenocarcinoma.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of delayed gastric conduit emptying after esophagectomy: a retrospective single-center study.","authors":"Andreas Damtoft, Jens Osterkamp, August A Olsen, Pieter De Heer, Michael Patrick Achiam","doi":"10.1093/dote/doaf040","DOIUrl":"https://doi.org/10.1093/dote/doaf040","url":null,"abstract":"<p><p>Delayed gastric conduit emptying (DGCE) after esophagectomy is a major cause of morbidity and reduced quality of life. The reported incidence varies greatly (2.2-47%), partly due to a lack of consensus on the definition of DGCE. Recently, an international expert consensus proposed diagnostic criteria for Early-DGCE (E-DGCE) and Late-DGCE (L-DGCE) alongside a symptom severity score. Using these criteria, we investigated the incidence and predictors of DGCE in a large cohort. All patients undergoing esophagectomy with pyloroplasty at Rigshospitalet, Denmark, between 2016 and 2021 were reviewed. E- and L-DGCE were defined using the proposed criteria (5-14 days and > 14 days after surgery, respectively). Specialist nurses followed patients for up 2 years at predefined intervals. About 387 patients were included. The incidence of E-DGCE was 174/387 (45%), and 155/387 (40%) patients presented with L-DGCE at least once during follow-up. The highest prevalence of L-DGCE (19.6%) was identified at postoperative day 28 (POD28) but decreased to 2.9% at the 2-year follow-up. A BMI of ≥30 was a predictor of E-DGCE (P = 0.004) and L-DGCE at POD28 (P = 0.01). No association between E-DGCE and L-DGCE was identified. Using the proposed criteria, the incidence of E-DGCE and prevalence of L-DGCE at POD28 was high. The prevalence of L-DGCE was dynamic but decreased greatly during follow-up. Future prospective studies with multiple follow-ups are needed to validate our findings and the usefulness of the criteria in a clinical setting.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of prophylactic cruroplasty on the incidence of hiatal herniation after robot-assisted minimally invasive esophagectomy (RAMIE).","authors":"Cezanne D Kooij, Eline M de Groot, Lucas Goense, B Feike Kingma, Hylke J F Brenkman, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1093/dote/doaf041","DOIUrl":"https://doi.org/10.1093/dote/doaf041","url":null,"abstract":"<p><strong>Background: </strong>Hiatal herniation (HH) following esophagectomy can cause severe complications and affect functional outcomes. This study assessed whether prophylactic cruroplasty during robot-assisted minimally invasive esophagectomy (RAMIE) reduces HH incidence.</p><p><strong>Methods: </strong>Patients undergoing curative RAMIE with cervical anastomosis for esophageal cancer at a high-volume center were included. Cruroplasty became routine in 2017 unless the hiatus was narrow. The primary outcome was HH incidence with versus without cruroplasty. Median follow-up was calculated using the reverse Kaplan-Meier method. Kaplan-Meier curves assessed HH-free survival and cumulative incidences up to 4 years, considering the time-dependent nature of HH. The log-rank test compared groups. Multivariable Cox regression evaluated the association between cruroplasty and HH, with hazard ratios (HR) and 95%-confidence interval (95%CI).</p><p><strong>Results: </strong>Between 2003 and 2023, 366 patients underwent RAMIE with cervical anastomosis. Median follow was 81 months (95%CI 71-91). In the cruroplasty group, 5 (5%) developed a HH (2 symptomatic, 3 asymptomatic), while 23 (9%) of patients without cruroplasty developed a HH (5 acute, 8 symptomatic, 10 asymptomatic). Most HHs were detected within 2 years (71%; n = 20). The 4-year cumulative incidence was 5.7% with cruroplasty and 11.1% without (P = 0.289). Imaging was performed in 77 of 101 patients (76%) with cruroplasty and 228 of 265 patients (86%) without cruroplasty. Cox regression revealed no significant association between cruroplasty and HH (HR 0.652, 95%CI 0.244-1.740).</p><p><strong>Conclusion: </strong>Prophylactic cruroplasty may reduce HH in RAMIE with cervical anastomose, though it cannot always prevent HH. Further research is warranted to confirm these findings and evaluate its role in other types of esophagectomy.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent laryngeal nerve paralysis as a potential mediator of complications in esophagectomy following lymph node dissection.","authors":"Zhuoheng Lv, Ligong Yuan, Yousheng Mao, Siyuan Ai","doi":"10.1093/dote/doaf028","DOIUrl":"https://doi.org/10.1093/dote/doaf028","url":null,"abstract":"<p><p>Complications from esophagectomy often interact with each other, with those related to recurrent laryngeal nerve (RLN) paralysis (RLNP) being particularly significant. Aggressive dissection of RLN lymph nodes (RLN-LNs) is considered a major contributing factor to RLNP. This study seeks to validate the hypothesis that RLNP acts as a mediator, not only resulting from RLN-LN dissection but also amplifying the likelihood of other postoperative complications. Data were retrospectively extracted from the Chinese 12th Five-Year Major Science and Technology Project on esophageal diseases, including a cohort of 1684 patients enrolled between 2015 and 2018. Both univariate and multivariate structural equation models were employed to validate the mediating role of RLNP in postoperative complications. Without causing RLNP, RLN-LN dissection directly increased the risk of chylothorax (odds ratio [OR] = 1.179, 95% confidence interval [CI] = 1.003-1.385) and decreased the risk of cardiac arrhythmia (OR = 0.919, 95% CI = 0.838-0.993). Meanwhile, through the mediating effect of RLNP, RLN-LN dissection indirectly led to complications requiring intensive care (OR = 1.043, 95% CI = 1.004-1.083) and conservative therapy (OR = 1.043, 95% CI = 0.996-1.092). RLNP serves as a critical mediator between RLN-LN dissection and subsequent postoperative complications requiring intensive care and conservative therapy. Recognizing that many of these complications are mediated by RLNP could help thoracic surgeons prioritize neural protection during RLN-LN dissection, potentially reducing the overall risk of multiple complications and alleviating the associated concerns.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of overall survival in esophageal cancer patients with pathologic complete response after neoadjuvant therapy and surgery.","authors":"Timothy R Harris, Ahmed Abdalla Ahmed Elkamel, Kevin Wang, Mazin Abdalgadir, Shamele Battan-Wraith, Chiu-Hsieh Hsu, Jonathan Rice, Praveen Sridhar, Stephanie G Worrell","doi":"10.1093/dote/doaf043","DOIUrl":"https://doi.org/10.1093/dote/doaf043","url":null,"abstract":"<p><p>Esophageal cancer recurrence occurs even in those who have a pathologic complete response (pCR) following neoadjuvant therapy and esophagectomy. The purpose of this study is to identify predictors of overall survival in patients with pCR. Using the National Cancer Database, a retrospective analysis of all adult patients with ypT0N0 esophageal cancer following neoadjuvant chemotherapy and radiation between 2012 and 2020 was performed. The variables analyzed were age, gender, ethnicity, insurance, Charlson-Deyo comorbidity score, clinical stage, and facility type. Cox proportional hazards regression was used to identify predictors of overall survival. Wilcoxon rank sum and chi-square tests were used for continuous and categorical variables, respectively, with a significance level of P < 0.05. There were 2767 patients that met the inclusion criteria, with the mean age of 63; 78% were male and 92% were White. Median survival was 6.6 years (95% confidence interval [CI]: 6.21-7.12). In multivariable analysis, older age (hazard ratio [HR] 2.7 per year, P < 0.0001), male gender (HR 3.3, P = 0.02), Charlson-Deyo score ≥ 2 (HR 3.9, P = 0.01), and advanced clinical stage (Stage IV vs. Stage I, HR 21.93, P < 0.001) predicted worse overall survival. Among patients who achieved pCR, advanced age, male gender, comorbidities, and clinical stage significantly influenced survival. Tumor- and treatment-related factors that impacted overall survival are advanced clinical stage and treatment at community facilities. These findings suggest that patients with advanced-stage esophageal cancer who achieve pCR remain at higher risk for recurrence and future studies should investigate this population further.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between recurrent laryngeal nerve diameter and postoperative palsy following robot-assisted minimally invasive esophagectomy.","authors":"Tiffany Jian-Ying Lye, Chien-Hung Chiu, Yin-Kai Chao","doi":"10.1093/dote/doaf048","DOIUrl":"https://doi.org/10.1093/dote/doaf048","url":null,"abstract":"<p><p>Recurrent laryngeal nerve palsy (RLNP) is a significant complication following upper mediastinal lymphadenectomy during esophagectomy. In this retrospective study, we investigated the association between recurrent laryngeal nerve (RLN) diameter and the risk of RLNP following robot-assisted minimally invasive esophagectomy (RAMIE). We analyzed consecutive patients with esophageal cancer who underwent RAMIE between January 2015 and March 2024. The left RLN diameter was measured from intraoperative digital recordings using validated image processing software. Patients were categorized into thick and thin nerve groups based on the median RLN diameter. Rates of immediate and permanent RLNP (defined as persisting beyond 6 months) were compared between groups. Multivariable analysis was performed to adjust for potential confounders. Among 149 patients, the median left RLN diameter was 1.5 mm. Immediate RLNP rates did not differ significantly between thick (n = 67) and thin (n = 82) nerve groups (19.5% vs. 11.9%, P = 0.265). However, recovery of vocal cord function was significantly more frequent in patients with thick nerves compared with those with thin nerves (87.5% vs. 43.8%, respectively), resulting in a higher permanent RLNP rate in the thin nerve group (11% vs. 1.5%, P = 0.023). Multivariable analysis identified thin RLN as the sole independent risk factor for permanent RLNP (odds ratio: 9.22, 95% confidence interval: 1.09-78.1, P = 0.041). Patients with thin left RLNs exhibit a significantly increased risk of permanent RLNP following RAMIE. Intraoperative RLN diameter assessment may inform surgical decisions and improve postoperative management strategies.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of recurrent laryngeal nerve lymph node metastatic status in thoracic esophageal squamous cell carcinoma.","authors":"Pengjie Yang, Bing Xue, Tianlai Liu, Lin Qi, Qiang Guo, Ting Yang, Mengfei Sun, Yongjun Yu, Bater Han, Yong Li","doi":"10.1093/dote/doaf052","DOIUrl":"https://doi.org/10.1093/dote/doaf052","url":null,"abstract":"<p><p>Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy with poor prognosis, and lymph node metastasis significantly influences patient outcomes. This retrospective study analyzed 189 thoracic ESCC patients who underwent radical esophagectomy (2019-2021) to evaluate the prognostic role of recurrent laryngeal nerve lymph node metastasis (RLN LNM). Patients with RLN LNM showed significantly worse overall survival (OS, P = 0.01) and disease-free survival (DFS, P = 0.046) than those without metastasis, with a 50.53% higher mortality risk and 37.83% higher recurrence risk. Subgroup analysis revealed no survival differences between left- and right-sided RLN LNM (P>0.05), while bilateral RLN LNM trended toward poorer outcomes but without statistical significance. Patients with RLN LNM plus extranodal metastases had markedly reduced OS (P = 0.0014) and DFS (P = 0.0008) compared to isolated RLN LNM. RLN LNM significantly predicted poor prognosis in lower thoracic ESCC (OS: P = 0.0027; DFS: P = 0.037) but not in upper or middle thoracic tumors. Multivariate Cox regression identified RLN LNM, perineural invasion, lymphovascular invasion, and neoadjuvant chemoradiotherapy with immunotherapy as independent risk factors for OS. These findings highlight RLN LNM as a critical prognostic indicator, particularly for lower thoracic ESCC, and emphasize the importance of integrating RLN LNM status into treatment strategies and staging systems.</p>","PeriodicalId":54277,"journal":{"name":"Diseases of the Esophagus","volume":"38 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}