ObjectiveTo investigate the correlation factors of cervical lymphatic metastasis in thoracic esophageal squamous cell carcinoma.Methods Data of 62 patients with thoracic esophageal squamous cell carcinoma were retrospectively analyzed.Factors associated with cervical lymphatic metastasis were analyzed by using x2 test and multivariate Logistic regression analysis.ResultsLymphatic metastasis was found in 36 cases (58.1％ ),of which metastasis in cervical lymph node was found in 15 cases(24.2％ ).A total of 1954 lymph nodes were excised,with an average of 31.5 per patient.Of all the lymph nodes,metastasis was found in 187 (9.6％) nodes.Logistic regression showed that tumor location,tumor length,thoracic lymphatic metastasis,the metastasis number of thoracic lymph nodes and thoracic lymphatic metastasis along recurrent laryngeal nerve were independent risk factors of cervical lymphatic metastasis [ OR:1.976 ( 1.436-2.538 ),P =0.035 ; 1.346(1.032-1.683),P =0.041;3.012( 1.572-6.825),P =0.012;2.023( 1.463-4.745),P =0.025 and2.254 ( 1.483-4.952 ),P =0.020,respectively ].Conclusion The independent risk factors of cervical lymphatic metastasis are foundation of selective 3-field lymph node dissection and their validities should be validated in further clinical trials.

Objective To investigate the relationship between programmed death 1 ( PD?1), programmed death receptor?1 ligand ( PD?L1 ) and clinical pathological parameters, early postoperative recurrence and metastasis in patients with esophageal squamous cell carcinoma.MethodsThe retrospectively analyze of Paraffin tissue specimens and clinical pathology data in 58 Patients undergoing radical esophageal squamous cell carcinoma surgery from January 2015 to January 2017 in the 910 hospital of PLA Joint Service Support force were performed.Expression of PD?1 and PD?L1 in esophageal squamous cell carcinoma and normal esophageal mucosa were detected by SP immunohistochemical staining.The positive expression rates of PD?1 and PD?L1 in normal esophageal mucosa and esophageal squamous cell carcinoma were compared.the relationship between PD?1 and PD?L1 and gender, age, family history, depth of tumor invasion, degree of differentiation, lymph node metastasis, and TNM staging were analyzed.Follow?up was performed by outpatient consultation and telephone consultation.The recurrence and metastasis of early postoperative (≤1 year) was analyzed.The PD?1 and PD?L1 in esophageal squamous cell carcinoma were analyzed in patients with recurrent metastasis and non?relapsing and metastasis.Results The positive expression rate of PD?1 in esophageal squamous cell carcinoma was 37.93%( 22／58 ), which was significantly higher than that in normal esophageal mucosa 15.52%( 9／58).The difference was statistically significant (χ2＝7.440,P＝0.006).The positive expression rate of PD?L1 in esophageal squamous cell carcinoma was 43.10%( 25／58), which was significantly higher than that of normal esophageal mucosa 18.97%(11／58).The difference was statistically significant (χ2＝7.894,P＝0.005).There was a difference in the positive expression rate of PD?L1 between different infiltration depth and TNM stage, P＜0.05.58 patients who underwent radical esophageal squamous cell carcinoma had been followed up for 6?12 months.A total of 14 patients had recurrence and metastasis,the incidence rate was 24.14%.The positive expression rate of PD?1 in the recurrence group was 42.86%(6／14),and that in the non?recurrent group was 36.36%(16／44).The difference was not statistically significant,(χ2＝0.190,P＞0.05).The positive expression rate of PD?L1 in the recurrence group was 71.43%(10／14),and that in the non?recurrent group was 34.09%(15／44).The difference was statistically significant,(χ2＝6.037,P＜0.05).Conclusion The expression of PD?1 and PD?L1 in cancer tissues of patients with esophageal squamous cell carcinoma is highly expressed.PD?L1 is closely related to the occurrence and progression of esophageal squamous cell carcinoma,and it is also an important index affecting early recurrence and metastasis.Which can be selected as a new target for early diagnosis and treatment.

Objective To explore the clinical efficacy of two procedures in thoracoscopic anterior mediastinal tumor resection. Methods A retrospective study was conducted on patients who underwent thoracoscopic anterior mediastinal tumor resection at the Department of Thoracic Surgery, the 910th Hospital of Joint Logistics Support Force from October 2016 to January 2024. Patients were divided into two groups according to the surgical approach: a modified approach group (bilateral intercostal ports+two subcostal ports) and a classic subxiphoid approach group (one subxiphoid port+two subcostal ports). Perioperative data and postoperative improvement of myasthenia gravis (MG) subgroup were compared between the two groups. Results A total of 55 patients were included, including 27 males and 28 females with a mean age of (49.4±15.1) years. There were 23 patients in the modified approach group and 32 patients in the classic subxiphoid approach group. The modified approach group had shorter operation time [(129.0±20.5) min vs. (148.9±16.7) min, P<0.001], less intraoperative blood loss [(63.0±16.6) mL vs. (75.0±10.8) mL, P<0.001], shorter postoperative drainage tube removal time [(3.1±0.4) d vs. (3.9±0.6) d, P<0.001] and shorter postoperative hospital stay [(4.2±0.4) d vs. (5.0±0.6) d, P<0.001), and lower proportion of intraoperative cardiac dysfunction [4 (17.4%) vs. 14 (43.8%), P=0.040]. There was no statistical difference in maximum diameter of tumor resected [(4.5±1.7) cm vs. (4.0±0.9) cm, P=0.193] and postoperative drainage volume [(396.4±121.5) mL vs. (399.9±161.3) mL, P=0.932]. There was 1 patient of perioperative collateral injury in the modified approach group (pericardial injury), and 6 patients in the classic subxiphoid approach group (1 patient of diaphragm injury, 1 patient of liver contusion, 4 patients of pericardial injury). There was no statistical difference in pain scores at 24 h, 48 h and 72 h after surgery (P>0.05). The postoperative improvement of MG symptoms in the modified approach group was better than that in the classic subxiphoid approach group at 1 year after surgery (complete stable remission rate: 77.8% vs. 50.0%; effective rate: 100.0% vs. 91.6%). No conversion to open chest surgery occurred in either group, and there were no postoperative rehospitalizations or deaths related to surgery within 30 days after surgery in both groups. Conclusion The modified approach is safe and controllable with more open surgical field and more reliable complete resection range than the classic subxiphoid approach group.