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Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer
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Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (30 September 2024) | Viewed by 5231

Special Issue Editors

Prof. Dr. Dragos Valentin Predescu

E-Mail Website
Guest Editor
1. Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
2. Clinic of Esophageal and General Surgery, “Sf. Maria” Clinical Hospital, 011192 Bucharest, Romania
Interests: esophageal cancer; endoscopic diagnosis; endoscopic therapy; neoadjuvant therapies; surgical trends; palliative care
Dr. Mircea Manuc

E-Mail Website
Guest Editor
1. University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
2. Department of Gastroenterology, Clinic Fundeni Institute, 022328 Bucharest, Romania
Interests: esophageal cancer; endoscopic diagnosis; endoscopic therapy; neoadjuvant therapies; surgical trends; palliative care

Special Issue Information

Dear Colleagues,

The last decades have confirmed the emergence of esophageal cancer as a significant issue, justifying the statement that we are facing a true pandemic. The medical, diagnostic and therapeutic complexity of esophageal neoplastic pathology results from several unique characteristics, among which are the presence of two completely different histopathological forms (etiological, tumor behavior, therapeutic resources, research studies that are non-homogeneous in the selection of the statistical base, etc.), a complex, multidisciplinary diagnosis (gastroenterologist, radiologist-imager, pathologist) and the challenging management of therapeutic options. Therapeutic challenges arise from the difficulty of selecting a suitable solution for the patient and, on the other hand, from the complexity of this treatment (multimodal treatment, interventional gastroenterological, oncological and surgical).

Post-therapeutic results are modest and literature data on disease-free survival (DFS), progression-free survival (PFS) and overall survival (OS) confirm a not particularly spectacular improvement despite new diagnostic and therapeutic acquisitions. The natural question arises: what should be done and which direction should we take? The emergence of new diagnostic techniques, the possibility of screening for an early identification of neoplasia, the introduction of new oncologic attack schemes and non-surgical endoscopic maneuvers, as well as the introduction of minimally invasive surgical techniques, have opened up new resources for improving outcomes in the curative oncologic treatment and palliation of esophageal cancer.

Prof. Dr. Dragos Valentin Predescu
Dr. Mircea Manuc
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • esophageal cancer
  • endoscopic diagnosis
  • endoscopic therapy
  • neoadjuvant therapies
  • surgical trends
  • palliative care

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Published Papers (3 papers)

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15 pages, 2610 KiB  
Article
Comparative Analysis of Concurrent Chemoradiotherapy Versus Chemotherapy Alone as First-Line Palliative Treatments for Advanced Esophageal Squamous Cell Carcinoma
by Jirapat Wonglhow, Panu Wetwittayakhlang, Patrapim Sunpaweravong, Chirawadee Sathitruangsak and Arunee Dechaphunkul
J. Clin. Med. 2024, 13(21), 6353; https://doi.org/10.3390/jcm13216353 - 23 Oct 2024
Viewed by 1508
Abstract
Background: In advanced-stage esophageal squamous cell carcinoma (ESCC), treatment of both the primary tumor and metastatic sites is imperatively required. Consequently, an optimal treatment modality should effectively control both aspects. Therefore, the benefits of concurrent chemoradiotherapy (CCRT) in cases of advanced-stage ESCC [...] Read more.
Background: In advanced-stage esophageal squamous cell carcinoma (ESCC), treatment of both the primary tumor and metastatic sites is imperatively required. Consequently, an optimal treatment modality should effectively control both aspects. Therefore, the benefits of concurrent chemoradiotherapy (CCRT) in cases of advanced-stage ESCC should be evaluated. Methods: This retrospective study compared the efficacy and safety of CCRT versus chemotherapy alone for advanced-stage ESCC patients from January 2012 to December 2023 at a university hospital in Southern Thailand. Survival was assessed using the Kaplan–Meier approach, with comparisons being made by the log-rank test. A p-value of <0.05 indicated statistical significance. Results: From a total of 196 patients with stage IV ESCC, 117 (59.7%) received CCRT, while 79 (40.3%) received chemotherapy alone. The median overall survival (OS) time was 9.04 months for CCRT and 5.79 months for chemotherapy (hazard ratio, HR: 0.58 [0.43–0.78]). CCRT significantly improved OS time in stage IVA patients (HR: 0.52 [0.29–0.93]), but not in stage IVB patients (HR: 0.76 [0.51–1.11]). The median progression-free survival (PFS) time was 6.04 months for CCRT and 3.50 months for chemotherapy (HR 0.48 [0.35–0.65]). The objective response rates (ORRs) were 43.6% and 22.8%, respectively (p = 0.003). Hematological toxicities were more common with CCRT, along with mild cases of treatment-associated pneumonitis and dermatitis. Conclusions: Although palliative chemotherapy is the standard treatment for advanced-stage ESCC, CCRT provides significant benefits for patients with stage IVA ESCC, improving OS, PFS, and ORRs, despite there being a higher incidence of adverse events. Thus, CCRT should be considered for patients with stage IVA ESCC with a good performance status. Full article
(This article belongs to the Special Issue Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer)
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Other

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13 pages, 1224 KiB  
Systematic Review
Does Indocyanine Green Utilization during Esophagectomy Prevent Anastomotic Leaks? Systematic Review and Meta-Analysis
by Andrea Sozzi, Davide Bona, Marcus Yeow, Tamer A. A. M. Habeeb, Gianluca Bonitta, Michele Manara, Giuseppe Sangiorgio, Antonio Biondi, Luigi Bonavina and Alberto Aiolfi
J. Clin. Med. 2024, 13(16), 4899; https://doi.org/10.3390/jcm13164899 - 20 Aug 2024
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Abstract
Background: Indocyanine Green (ICG) is a promising technique for the assessment of gastric conduit and anastomosis perfusion during esophagectomy. ICG integration may be helpful in minimizing the risk of anastomotic leak (AL). Literature evidence is sparse, while the real effect of ICG assessment [...] Read more.
Background: Indocyanine Green (ICG) is a promising technique for the assessment of gastric conduit and anastomosis perfusion during esophagectomy. ICG integration may be helpful in minimizing the risk of anastomotic leak (AL). Literature evidence is sparse, while the real effect of ICG assessment on AL minimization remains unsolved. The aim of this systematic review and meta-analysis was to compare short-term outcomes between ICG-guided and non-ICG-guided (nICG) esophagogastric anastomosis during esophagectomy for cancer. Materials and Methods: PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried up to 25 April 2024. Studies that reported short-term outcomes for ICG versus non-ICG-guided (nICG) anastomosis in patients undergoing esophagectomy were considered. Primary outcome was AL. Risk ratio (RR) and standardized mean difference (SMD) were utilized as effect size measures, whereas to assess relative inference we used 95% confidence intervals (95% CI). Results: Overall, 1399 patients (11 observational studies) were included. Overall, 576 (41.2%) underwent ICG gastric conduit assessment. The patients’ ages ranged from 22 to 91 years, with 73% being male. The cumulative incidence of AL was 10.4% for ICG and 15.4% for nICG. Compared to nICG, ICG utilization was related to a reduced risk for postoperative AL (RR 0.48; 95% CI 0.23–0.99; p = 0.05). No differences were found in terms of pulmonary complications (RR 0.83), operative time (SMD −0.47), hospital length of stay (SMD −0.16), or 90-day mortality (RR 1.70). Conclusions: Our study seems to indicate a potential impact of ICG in reducing post-esophagectomy AL. However, because of limitations in the design of the included studies, allocation/reporting bias, variable definitions of AL, and heterogeneity in ICG use, caution is required to avoid potential overestimation of the ICG effect. Full article
(This article belongs to the Special Issue Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer)
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14 pages, 1862 KiB  
Systematic Review
Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis
by Alberto Aiolfi, Davide Bona, Matteo Calì, Michele Manara, Emanuele Rausa, Gianluca Bonitta, Moustafa Elshafei, Sheraz R. Markar and Luigi Bonavina
J. Clin. Med. 2024, 13(10), 2849; https://doi.org/10.3390/jcm13102849 - 12 May 2024
Cited by 5 | Viewed by 1763
Abstract
Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to [...] Read more.
Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall survival (OS). Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched through December 2023. The primary outcome was 5-year OS. The restricted mean survival time difference (RMSTD), hazard ratios (HRs), and 95% confidence intervals (CI) were used as pooled effect size measures. The GRADE methodology was used to summarize the certainty of the evidence. Results: Five studies (3291 patients) were included. TDL was reported in 54% patients. The patients’ age ranged from 49 to 69, 76% were males, and BMI ranged from 18 to 26. At the 5-year follow-up, the combined effect from the multivariate meta-analysis is -3.5 months (95% CI −6.1, −0.8) indicating that patients undergoing TDL lived 3.5 months less compared to those without TDL. TDL was associated with a significantly higher hazard for mortality at 12 months (HR 1.54, 95% CI 1.38–1.73), 24 months (HR 1.21, 95% CI 1.12–1.35), and 28 months (HR 1.14, 95% CI 1.02–1.28). TDL and noTDL seem comparable in terms of the postoperative risk for chylothorax (RR = 0.66; p = 0.35). Conclusions: In this study, concurrent TDL was associated with reduced 5-year OS after esophagectomy. This may suggest the need of a rigorous follow-up within the first two years of follow-up. Full article
(This article belongs to the Special Issue Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer)
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