Esophageal

Various nutritional and inflammatory biomarkers have been reported to be associated with cancer prognosis, but most studies have focused on conditions before neoadjuvant chemotherapy (nCT). Developing real- time biomarkers reflecting changes in systemic conditions during nCT is important. We established a novel biomarker, represented as the albumin to derived neutrophil-to-lymphocyte ratio (Alb-dNLR ratio), and calculated the change in Alb-dNLR ratio ( (cid:4) Alb-dNLR) during nCT. We aimed to evaluate whether (cid:4) Alb-dNLR is associated with prognosis in ESCC patients. We investigated 172 patients who underwent nCT before esophagectomy between April 2010 and March 2018. dNLR was calculated as the ratio of neutrophil count to (white blood cell count—neutrophil count), Alb-dNLR ratio was calculated by dividing serum albumin level by dNLR, and (cid:4) Alb-dNLR was evaluated by dividing the post-Alb-dNLR ratio by the pre-Alb- dNLR ratio. Patients were divided into ‘high’ and ‘low’ groups according to (cid:4) Alb-dNLR. Thirty-nine patients (22.7%) had a low (cid:4) Alb-dNLR ( ≤ 0.8). The 5-year overall survival (OS) rates in patients with low and high (cid:4) Alb-dNLR were 38.1% and 53.6%, respectively (p=0.0072). Multivariate analyses demonstrated that estimated blood loss (p=0.044), pathological T stage (p=0.0005), pathological N stage (p=0.017), and (cid:4) Alb-dNLR (p=0.005) were independent prognostic factors for OS. Alb-dNLR is a useful prognostic factor for OS in patients with ESCC receiving nCT. Extended lymphadenectomy during esophagectomy for esophageal cancer may increase survival, but also increase morbidity. This study analyses changes in lymph node yield over time in a tertiary referral center, and investigates the influence of lymph node yield after transthoracic esophagectomy for esophageal adenocarcinoma on the number of positive lymph nodes, pathological N-stage, complications and survival. Consecutive patients undergoing transthoracic esophagectomy with gastric conduit reconstruction for esophageal adenocarcinoma between January 2010 and December 2020 were prospectively recorded (follow-up until Jan- uary 2022). Lymph node yield was analyzed as continuous and dichotomous variable ( ≤ 30 vs. ≥ 31 nodes). The effect of lymph node yield on number of positive lymph nodes, complications, disease-free and overall survival was assessed in multivariable regression analyses.

Incidence of Hematemosis

Effect on Esophageal Bleeding
Oporobility and Hepatic Function Clinical Aspects of the Therapy of Esophageal Bleeding.

Kiyoshi Inokuchi
Professor of Department of Surgery, Kyusyu University School of Medicine, Fukuoka,

Japan
Based on 246 experiences of portal hypertension patient, clinical and pathological features as well as surgical therapy for esophageal bleeding were discussed.
(1) Incidence of esophageal bleeding was varying according to the kinds of original disease: 11% in Banti's syrwIrome, 25% in cirrhosis of the liver and schistosomiasis japonica respectively, and 61% in prehepatic portal block.It was also found that patients with liver cirrhosis is prone to make massive hematemesis in bleeding episode.
(2) Autopsy examination of the cirrhotics revealed that the varices with irregularly thickened wall ruptured often, while those with simple dilatation with no thickening scarecely ruptured.This finding may suggest that the mechanical weakness of the varices is the major factor leading to the rupture.
(3) Here varying incidence in the the type of cirrhosis of Japanese and western patients should be mentioned.Portal cirrhosis, which responds well to medical treatment, is the most common type found in American patients.
In Japanese patients, on the other hand, postnecrotic and Laennec cirrhosis are the types of highest incidence.
Then, if the direct portacaval shunt is performed on cirrhotic patients with such poor liver function, portal blood avoids hepatic circulation and a hepatic an-oxia may be more frequently encountered.Taking into account such a special circumstance of the Japanese patients, the most elective therapy has been worked out as follows.
In emergent cases, as a rule, shunt operation is contraindicated, and the transperitoneal proximal gastrectomy is recommendable.It is not seldom that the site of bleeding is not in the esophagus, but in the stomach.It should also be noticki that the stomach ulcer appears more often in the cirrhotic patients as compared in the controlled group.
Concerning the interval operation, referring to our experiences involving splenectomy alone, splenectomy with dissection of the gastric coronary vein, and shunt operations, it was concluded that thc most reliable method for eliminating esophageal bleeding is to make a shunt between the portal and systemic circulation.And, I have pointed out to introduce a concept "Controlled Shunting" which materially implies a shunt that is so constructed that it does not impair hepatic circulation and at the same time achieves adequate decompression to prevent esophageal bleeding.In this sense, direct portacaval shunt does not meet the purpose.For realizing this concept, a new method of splenorenal anastomosis has been devised.The principle of the new technique is that the juncture angle between splenic vein and renal vein is made acute by utilizing an autogenous vein graft taken up from an anatomic bifurcation of the iliac vein.It has been proved that patency of the anastomosis was nearly 90%, and operative as well as fallow-up mortality is very low, and satisfactory results for esophageal bleeding were obtained.