The definition,staging and optimal treatment of adenocarcinoma of esophagogastric junction (AEG) have long been in controversy.Surgery is still the primary treatment for resectable AEG,and surgical procedures depend on its classifications.However,the efficacy of surgery alone is barely satisfactory.Neoadjuvant chemoradiotherapy and perioperative chemotherapy can improve the survival of patients.Simplified 2 cm principle is presented in the 8th edition of American Joint Committee on Cancer for TNM staging system of esophageal cancer.In addition,the new edition provides clinical staging and pathologic staging after neoadjuvant therapy,improving the clinical practicability of new staging system.

Esophageal reconstruction is of great importance in the practice of esophagectomy,and esophagogastric anastomosis represents the most essential and key technical aspect of the operation,which largely determined patients' shortterm outcomes.A successful esophageal anastomosis should be no occurrences of postoperative early-stage anastomotic bleeding and leakage and later-stage anastomotic stenosis.The circular stapler,linear cut stapler and hand-sewn anastomosis are the most common anastomotic methods.Hand-sewn anastomosis is the most traditional and classical.Circular stapler has gained significant popularity for its simplicity and convenience.Linear cut stapler used for side-to-side anastomosis has the potential to reduce the risk of postoperative anastomotic stenosis via expanding inner diameter of anastomosis.Every anastomotic method has its advantages and disadvantages,and it cannot completely avoid occurrence of postoperative anastomotic complications.To have a better outcome,both surgeon's experiences and patient's individual conditions should be taken into consideration for the choice of anastomotic technique.

Objective To investigate the prognostic significance of the angiolymphatic invasion(ALI) in patients with esophageal squamous cancer(ESCC) who received radical resection.Methods A retrospective review was performed on 355 patients who underwent radical resection for ESCC in our hospital between June 2005 and December 2008.Clinicopathological features and overall survival rate were surveyed.Results Of all the patients included, these 46 ESCC patients with angiolymphatic(ALI group) invasion accounted for 13.3％.The 5-year overall survival rate was 20.3％ in patients of ALI group and 40.2％ in those of non-ALI group(P =0.001).The histological differentiation was poorer in the ALI group (P =0.008) as compared with non-ALI group.Univariate analysis showed that body mass index(BMI), ALI, T stage, N stage, and differentiation were associated with survival(P ＜ 0.05 for all).Multivariate analysis revealed that ALI, N stage, T stage and BMI were independent risk factors of prognosis.Conclusion This study highlights that ALI may facilitate the stratification of patients with a poor prognosis after radical resection for ESCC.

Objectives:To improve the surgical procedures and investigate the feasibility of the closed placement of nasojejunal tube during Ivor-Lewis esophagectomy. Methods:From January 2010 to December 2013, 85 patients (72 males and 13 females) with esophageal or gastric cardiac carcinoma underwent Ivor-Lewis esophagectomy in our department. Briefly, the general surgical proce-dures were performed as follows:1) stomach mobilization and enlargement of esophageal hiatus and pyloric sphincter digital fracture via laparotomy; 2) tubular stomach reconstruction, esophageal carcinoma resection, and intra-thoracic esophagogatrostomy via right posterolateral thoracotomy;and 3) forward closed placement of feeding tube through the nostrils and jejunum of patients under the guid-ance of a surgeon, who palpates the pylorus through the hiatus with the use of fingers. Results:No operative death or feeding tube-asso-ciated adverse event was observed. Among the 85 patients who have undergone Ivor-Lewis esophagectomy, feeding tube placement in-to the jejunum during surgery failed in 33 cases. The success rate of nasojejunal feeding tube placement was 61.2%(52/85). Twelve pa-tients with successful tube placement did not receive enteral feeding for several reasons and were thereby transferred to parenteral group. Significant differences were observed in terms of the nutritional cost and proportion between enteral feeding and parenteral groups (?1,469 ± 741 vs.?3,223 ± 917, P<0.001;3.4%vs. 7.2%, P<0.001). No differences in postoperative hospital stay and morbidi-ty were observed between the two groups (P>0.05). Conclusion:The novel forward closed placement of nasojejunal feeding tube dur-ing Ivor-Lewis esophagectomy provides a non-invasive, feasible, simple, and economical method for postoperative nutritional support. Surgeons could perform this novel technique successfully in practice.

Review the Notch signaling pathway in the status and prospects of Barrett's esophagus,for gastroesophageal reflux disease and prevention provide a new research direction of Barrett's esophagus.Notch impact cell fate and differentiation is an important signal pathway,may be lost on the in-depth study on clear Notch signaling pathways involved in Barrett esophagus specific molecular mechanism of im,for prevention,early diagnosis and treatment of Barrett esophagus provide new molecular targets.

Objective To summarize the experience of double layered anastomosis in thoracoscopic and laparoscopic esophagectomy,and to explore its impact on the postoperative anastomotic complications.Methods Patients with thoracoscopic and laparoscopic esophagectomy from September 2014 to Auguest 2015 were retrospectively included.The cervical anastomosis were conducted by hand-sewn double layered anastomosis on the posterior wall of the gastric remnant,with the anastomotic configuration of end-to-side.The patients' general information and postoperative complications were recorded and analyzed.Results 45 patients with esophageal squamous cell carcinoma were included.The major postoperative complications were gastric dilatation(6/45,13.3％),hoarseness(5/45,11.1％),anastomotic leak/gastric necrosis(2/45,4.4％),anastomotic stricture(0/45,0).All patients were discharged from hospital with no perioperative death.Conclusion Hand-sewn double layered anastomotic technique could be safely used in thoracoscopic and laparoscopic esophagectomy,which could assure the security of the anastomosis.The anastomotic complication rates for this technique are rare enough to be recommended,as compared with other anastomotic methods reported in the literatures.

Objective To summarize our results and experience in dealing with the postoperative intrathoracic gastro-air-way fistulae after esophagectomy for esophageal carcinoma.Methods From January 2010 through February 2012,1490 patients with esophageal carcinoma underwent esophagectomy in our department.The postoperative intrathoracic gastro-airway fistulae were documented in 10 patients,with a frequency of 0.67％.Five of them died.The possible etiology,clinical characters,treatment and prevention of this complication were reviewed.Results The location of the fistulate were 7 at left main bronchus,1 at right main bronchus,and 2 at distal trachea.After 2-3 weeks conservative treatment,1 patient underwent primary surgical repair and cured,1 refused any further intervention and sacrified,8 patients underwent endoscopic insertion of covered stent and only 3 healed.For the remaining 5 cases with failed stent therapy,2 died of severe aspiration and lung infection,3 had surgical repair,one of them successed and 2 died of aspiration and aortic rupture,respecively.Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheal/bronchial wall.Therefore,a meticulous closure and wapping of gastroplasty and appropriate isolation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae.The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option.Primary repaire is suggested and careful preoperative assessment is crucial.

The recently published AJCC Esophageal Cancer Staging System, 8^th Edition will be implemented on Januray 1, 2018, which was developed by Worldwide Esophageal Cancer Collaboration based on 22 654 esophageal cancer patients from 33 worldwide centers. The definition of T, N, M, G stage and regional lymph nodes were optimized in the 8^th edition. And the new "2 cm" principle has simplified the definition for the cancer of esophagogastric junction. In addition to pathologic staging, the 8^th edition also provided clinical staging and pathologic staging after neoadjuvant therapy, making the new esophageal cancer staging system more practicable and reasonable.

Esophagectomy is one of the most complex interventions in thoracic surgery.Traditional open esophagectomy requires large incision and is associated with many complications.Video-assisted thoracoscopic surgery (VATS) contributes to less complications and hospital stay,and uniportal VATS has more minimal advantages over multi-portal VATS.Due to the technical complexity of esophagectomy,uniportal VATS is highly difficult.Surgeons from Taiwan reported uniportal VATS esophagectomy for the first time in 2015,and this uniportal technique was also reported by surgeons from other institutions.Nowadays,uniportal VATS esophagectomy is still in its initial stage,skills are immature,and long-term,large sample,controlled studies are demanded.Here,authors reviewed the development,skills,short-term outcomes,current practice in West China Hospital,the advantages and challenges for unipotrtal VATS esophagectomy.

AJCC Esophageal Cancer Staging System, 8^th edition will be implemented on January 1, 2018. The N staging in 8^th edition of staging system remains following 7^th edition based on the number of metastatic nodes, except the limited revision of the regional lymph node map. N staging revision was reviewed from the simple definition of negative (N0) and positive (N1) lymph node(s) to the positive node number based proposal (7^th edition). The 7^th edition staging system, especially the N staging, were proved with more advantages on distinguishing disease progression and predicting prognosis of the esophageal cancer. On other hand, the disadvantages of 7^th edition N staging are discussed. The refined N staging based on the number of metastatic node station is introduced. The extent and station of metastatic node could better reflect the disease progression and prognosis according to our research. The controversy on N staging of esophagogastric junction cancer is discussed as well. Other reported N staging associated index including lymph node ratio, lymphatic vessel invasion and biomarkers are reviewed and evaluated.