Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Objective To explore the effect of BCG-polysaccharide nucleic acid(BCG-PSN) on the numbers of Th3,Th2 and Th1 cells in peripheral blood mononuclear cell(PBMC) and airway inflammation status in patients with asthma.Methods Twenty-six patients with moderate persistent asthma were enrolled into the study and randomly divided into simple medication group(n=13,accepted Fluticasone/salmeterol alone) and combined medication group(n=13,accepted Fluticasone/salmeterol+BCG-PSN together).The numbers of Th3,Th1 and Th2 cells in PBMC, the serum levels of TGF-β,IFN-γ,IL-4 and IgE and the clinical effect and airway inflammation status were observed at three time points: before,1.5 months after and 3 months after treatment. Results (1)At 1.5 months after treatment,the Th1/Th2 number was significantly higher in the combined medication group than the simple medication group(1.20±0.57 vs 0.79±0.39,t= 2.129,P＜0.05),and the asthma control test scale(ACT) showed similar difference(18.31±1.75 vs.15.54±2.40,t=3.359,P＜0.01) between the two groups.(2)At 3 months after treatment,the Th1/Th2 number was significantly higher in the combined medication group than the simple medication group(1.73±0.74 vs1.16±0.48,t=2.327,P＜0.05),and the ACT also showed the same kind of difference(22.46±1.13 vs.20.23±2.59,t=2.851,P＜0.01) between the two groups.In addition,at this time point the PEF variability was significant lower in the combined medication group than the simple medication group([9.88±2.18]% vs.[12.05±2.74]%,t=2.235,P＜0.05).(3)We found no significant differences in the comparisons of the numbers of T helper cell subsets in PBMC ,the serum levels of cytokines and IgE,the numbers of inflammatory cells in induced sputum between the two groups(Ps＞0.05).(4)No correlation were found between Th3 cell numbers in PBMC and the serum levels of IgE in the two groups.Conclusion The combined use of Fluticasone/salmeterol and BCG-PSN can further correct the imbalance of Th1/Th2 cells,alleviate clinical symptom of asthma and airway hyper-responsiveness.The therapeutic efficacy improves along with the therapy period,better in the combined medication group than the simple medication group.BCG-PSN has no significant effects on the numbers of Th3 in PBMC in patients with asthma.