Esophageal cancer is a highly prevalent tumor species in Henan province, which brings heavy medical burden to families and society. Surgical treatment plays a dominant role in the treatment of non-advanced esophageal cancer. However, cancer cells in esophageal cancer lesions are highly invasive, postoperative recurrence and metastasis rates are pretty high. More effective systemic and comprehensive treatment is urgently needed to improve the prognosis. We invited 52 doctors in esophageal surgery, oncology, pathology, imaging, and radiation therapy of 32 hospitals at all levels in Henan province, to repeatedly negotiate and fully discuss in combination with evidence and clinical practice experience. Finally, “diagnosis and treatment pathway of neoadjuvant immunotherapy for esophageal cancer in Henan province” was formulated. In this treatment pathway, seven recommendations were proposed from seven perspectives including target population, patient evaluation, protocol selection, surgical timing, postoperative management, organ preservation, and general principles to offer reference for medical personnel related to esophageal cancer surgery.

Clinical staging is an important reference for treatment decisions and a key factor affecting the prognosis of patients. As one of the most important international staging criteria, the 12 th edition of classification of esophageal cancer of Japan Esophageal Society (JES) has been applied in clinical practice since 2022. Compared with the previous classification of esophageal cancer of JES, the N staging in 12 th edition of classification of esophageal cancer is defined as the number of lymph node metastases, rather than the station of the metastatic lymph nodes according to the tumor location. It is noteworthy that the 12 th edition of classification of esophageal cancer classifies supraclavicular lymph nodes as M1a stage, and M1a stage as well as N2-N3 stages are classified in the same clinical stage, which means that the Japanese scholars still believe that supraclavicular lymph node metastasis is not a contraindication to surgery for thoracic esophageal cancer. Compared with the esophageal cancer staging criteria jointly issued by the International Anti-Cancer Alliance and the American Cancer Federation, it is controversial that whether esophageal cancer patients with supraclavicular lymph node metastasis can receive surgical treatment. Since esophageal squamous cell carcinoma in China is the main pathological type as in Japan, a clear understanding and answer to the above question is of great significance in guiding the clinical diagnosis and treatment of esophageal cancer. The authors consult relevant literature and combine it with clinical practice to explore the controversy of supraclavicular lymph node metastasis in the treatment of esophageal cancer, aiming to provide reference for the accurate definition of metastatic lymph nodes in esophageal cancer, as well as the precise staging and optimal treatment mode for patients.

Clinical staging is an important reference for treatment decisions and a key factor affecting the prognosis of patients. As one of the most important international staging criteria, the 12 th edition of classification of esophageal cancer of Japan Esophageal Society (JES) has been applied in clinical practice since 2022. Compared with the previous classification of esophageal cancer of JES, the N staging in 12 th edition of classification of esophageal cancer is defined as the number of lymph node metastases, rather than the station of the metastatic lymph nodes according to the tumor location. It is noteworthy that the 12 th edition of classification of esophageal cancer classifies supraclavicular lymph nodes as M1a stage, and M1a stage as well as N2-N3 stages are classified in the same clinical stage, which means that the Japanese scholars still believe that supraclavicular lymph node metastasis is not a contraindication to surgery for thoracic esophageal cancer. Compared with the esophageal cancer staging criteria jointly issued by the International Anti-Cancer Alliance and the American Cancer Federation, it is controversial that whether esophageal cancer patients with supraclavicular lymph node metastasis can receive surgical treatment. Since esophageal squamous cell carcinoma in China is the main pathological type as in Japan, a clear understanding and answer to the above question is of great significance in guiding the clinical diagnosis and treatment of esophageal cancer. The authors consult relevant literature and combine it with clinical practice to explore the controversy of supraclavicular lymph node metastasis in the treatment of esophageal cancer, aiming to provide reference for the accurate definition of metastatic lymph nodes in esophageal cancer, as well as the precise staging and optimal treatment mode for patients.

Objective:To investigate the application value of computed tomography (CT) examination of lymph node short diameter in evaluating left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 628 patients with thoracic esophageal squamous cell carcinoma who were admitted to 2 medical centers (236 cases in the Sun Yat-sen University Cancer Center and 392 cases in the Affiliated Cancer Hospital of Zhengzhou University) from October 2009 to December 2016 were collected. There were 462 males and 166 females, aged from 38 to 85 years, with a median age of 62 years. Observation indicators: (1) operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node; (2) efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis; (3) determination of the optimal cut-off value; (4) examination results using different diagnostic criteria. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. The area under curve (AUC) of receiver operating characteristic curve (ROC) was used to estimate the efficiency of detection methods. The maximum value of Youden index corresponded to the optimal cut-off point. Results:(1) Operation status, dissection and metastasis of left recurrent laryngeal nerve lymph node: among the 628 patients, there were 572 cases undergoing two-field lymph node dissection while 56 cases undergoing three-field lymph node dissection, there were 408 cases undergoing minimally invasive surgery while 220 cases undergoing open surgery. Sixty of 628 patients had left recurrent laryngeal nerve lymph node metastasis. A total of 1 666 left recurrent laryngeal nerve lymph nodes were dissected from the 628 patients, among which 75 were metastatic lymph nodes, with a metastasis rate of 4.502%(75/1 666). (2) Efficacy of CT examination of the left recurrent laryngeal nerve lymph node short diameter in evaluating postoperative lymph node metastasis: the AUC of CT examination of the left recurrent laryngeal nerve lymph node short diameter in predicting postoperative lymph node metastasis was 0.854 (95% confidence interval as 0.792 to 0.916, P<0.05). (3) Determination of the optimal cut-off value: the Youden indices were 0.556, 0.384, 0.258, 0.063 and 0.003 respectively when using 5 mm, 6 mm, 7 mm, 8 mm, 9 mm or 10 mm as the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. The short diameter as 5 mm was the optimal cut-off value for CT examination of the left recurrent laryngeal nerve lymph node short diameter. (4) Examination results using different diagnostic criteria: the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, cases being missed diagnosis were respectively 66.3%, 92.3%, 89.5%, 46.3%, 96.0%, 20 and 5.0%, 99.8%, 90.7%, 75.0%, 90.9%, 57 when using short diameter ≥5 mm or ≥10 mm in CT examination of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma. Conclusions:CT examination of lymph node short diameter can be used to evaluate left recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma. The sensitivity, specificity and accuracy is preferable when using short diameter ≥5 mm in CT examina-tion of the left recurrent laryngeal nerve lymph node as the diagnostic criteria for left recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma.

Objective:To evaluate the therapeutic effects and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma.Methods:The clinical data of a total of 148 patients with locally advanced esophageal squamous cell carcinoma enrolled in the Affiliated Cancer Hospital of Zhengzhou University from 2007 to 2017 were retrospectively analyzed. The patients received 5-Fu/Cisplatin or Paclitaxel/Cisplatin for chemotherapies. The total treatment dose for the radiotherapy was delivered at 36-40Gy under conventional fractionation. Kaplan-Meier method was used to calculate survival rates, and Log-rank test and Cox model were performed for univariate analysis and multivariate analysis, respectively.Results:The overall survival (OS) rates of 1-, 3-and 5-year were 74%, 51% and 51%, respectively, with a median survival time (MST) of 72.4 months. The carcinoma/disease-free survival (DFS) rates for 1, 3, 5 years were 60%, 51%, 45%, respectively, with a median time of 60.1 months. The 1-, 3-and 5-year OS rates of the pCR group were 86%, 70%, 70%, the ones of which in the non-pCR group were 70%, 44%, 43%, respectively ( P=0.002). The 1-, 3-and 5-year DFS rates were 76%, 71%, 68% for the pCR group, and 53%, 43%, 37% for the non-pCR group, respectively ( P=0.002). In pN(-) group and pN(+ ) group, the 1-, 3-and 5-year OS rates were 83%, 56%, 55% and 50%, 38%, 38%( P=0.004), respectively. Further, the 1-, 3-and 5-year DFS rates were 66%, 56%, 51% for the pN(-) group, and 43%, 38%, 31% for the pN(+ ) group ( P=0.006), respectively. Multivariate analysis revealed that pCR and pN status were independent prognostic factors for OS and DFS ( P=0.012, 0.011 and P=0.025, 0.033). Conclusion:Neoadjuvant chemoradiotherapy demonstrated significant therapeutic effects in the treatment of locally advanced esophageal squamous cell carcinoma, while pCR and pN status served as independent prognostic factors.

Objective    To investigate the learning curve of non-tube and early oral feeding procedure following McKeown minimally invasive esophagectomy (MIE). Methods    We analyzed the clinical data of 38 patients (26 males, 12 females, aged 42–79 years) with esophageal cancer who received non-tube and early oral feeding procedure after surgery at the Affiliated Tumor Hospital, Zhengzhou University from November 2017 to August 2018. They suffered upper thoracic esophageal cancer (n=4), middle thoracic esophageal cancer (n=22) or lower thoracic esophageal cancer (n=12). Results    McKeown MIE was successfully performed on 38 patients. Oral feeding began 1.7 (1-4) days after surgery in the 38 patients with non-tube. Pneumonia/atelectasis occurred in 5 patients (13.1%), respiratory failure in 1 patient (2.6%), arrhythmia in 3 patients (7.9%), hoarseness in 5 patients (13.1%), anastomotic fistula in 1 patient (2.6%), cervical incision infection in 1 patient (2.6%), pneumomediastinum and infection in 1 patient (2.6%) and gastric emptying disorder in 2 patients (5.2%). No death was observed. After 26 patients with McKeown MIE were treated with enhanced recovery after surgery procedure, the operation time and complications could reach a relatively stable state and entered a plateau phase of learning curve. Conclusion    Non-tube and early oral feeding procedure following MIE is technically safe and feasible. It can shorten hospital stay, relieve the discomfort of placement of nasogastric and nutrition tube and may reduce the incidence of complications. The learning curve of non-tube and early oral feeding procedure following MIE is  about 26 cases.

Objective To determine the treatment outcome of nimotuzumab in combination with neoadjuvant concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 23 ESCC patients were enrolled.The preoperative strategies consisted of nimotuzumab (200 mg per week in week 1-5),concurrent chemotherapy by paclitaxel (45 mg/m2 per week in week 2-5) and cisplatin (20 mg/m2 per week in week 2-5) and radiotherapy by a total dose of 40 Gy (2.0 Gy/d,5 days per week in week 2-5).Esophagectomy was performed 4 weeks after the completion of preoperative therapies.Results All of the 23 patients enrolled completed the planned combined therapy method,and 22 patients underwent final surgery.The clinical response rate of nimotuzumab in combination with preoperative chemoradiotherapy was 96％.The most frequent Grade 1/2 toxicities observed were gastrointestinal reaction,bone marrow suppression,and esophagitis.The rate of radical resection was 100％,and the pathological complete response rate was 41％.The incidence rate of postoperative pulmonary infection,anastomotic leak,hoarseness,and arrhythmia were 14％,9％,4％,and 4％,respectively.No perioperative deaths occurred in our study.The 1-,3-,and 5-year overall survival (OS) rate for all the patients were 86％,52％ and 52％,respectively.The median survival time (MST) was 28.9 months.Postoperative pathologic results showed 15 patients with lymph node negative and 7 patients with lymph node positive.the 1-,3-,and 5-year OS for pN0 group were 100％,62％ and 62％,versus 57％,29％ and 29％ for pN+ group (P=0.033).The MST for pNo group was 42.6 months versus 14.2 months for pN + group.Conclusions The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy followed by surgery is safe and effective for locally advanced ESCC.Patients with lymph node negative after surgery have significantly improved long-term survival.

Objective To systemic evaluate postoperative pulmonary function between segmentectomy and lobectomy in patients with early stage non-small cell lung cancer.Methods Computer searched was performed up to September 2016 at the Cochrane Library,PubMed,EMBASE,CBM,CNKI,VIP and Wanfang database,collected postoperative pulmonary function between segmentectomy and lobectomy in Patients with early stage Non-Small Cell Lung Cancer.Study selection,data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.Results Eight studies included 308 segmentectomy and 386 lobectomy were identified for inclusion.FVC％ (MD =9.91,95％ CI:3.53-16.30,P =0.002),postoperation / preoperation FVC％ (MD =6.74,95％ CI:5.52-7.79,P ＜0.05),FEV1％ (MD =13.25,95％ CI:10.25-16.26,P ＜ 0.05),postoperation / preoperation FEV1％ (MD =7.18,95 ％ CI:5.88-8.48,P ＜ 0.05) showed significant difference.Conclusion Pulmonary function index was superior to lobectomy after segmentectomy in patients with early stage lung cancer,and segmentectomy resection was more beneficial to preserve lung function.

Objective To acknowledge the effect of T-lymphocyte subset on lymph node micrometastasis in esophageal cancer patients by the study of the correlation between T-lymphocyte subset and micrometastasis.Methods CD3+、CD4+、CD8+and CD4+/CD8+ were examined in esophageal cancer patients under thoracotomy by flow cytometry,and the micrometastasis were examined by immunohistochemistry in lymph node that were diagnosed as negative for metastases by routine histopathological analysis.Two groups were divided by with or without micro-metastasis,T-lymphocyte subset were compared with two groups.Results CD3+,CD4+ and CD4+/CD8+were significantly lower in group with micrometastasis than in group without micrometastasis,CD8+ was significantly higher in group with micrometagtasis than in group without micrometastasis.Conclusion T-lymphocyte subset is closely associmed with micrometastasis and low CD3+,CD4+ and high CD8+ T-lymphocyte is associated with poor cancer-specific survival.