In this study, we investigated the diagnostic performance of magnifying endoscopy (ME) with third-generation narrow-band imaging (3G-NBI) for early gastric cancer (EGC), primarily in patients with Helicobacter pylori eradication. This was a post hoc analysis of a multicenter, randomized trial comparing 3G-NBI, texture and color enhancement imaging, and white-light imaging in gastric neoplasm (GN) detection. For all detected lesions, the endoscopic diagnosis of ME using 3G-NBI was compared with the pathological diagnosis. The primary analyses focused on the sensitivity and specificity of ME with 3G-NBI for EGC or non-EGC. The diagnostic performance was analyzed according to confidence level, macroscopic type, lesion size, and H. pylori infection status. This study included 901 patients; 228 suspected GN lesions in 187 patients were analyzed. The lesions were diagnosed with EGC in 62 (27 with high confidence) and non-EGC in 166 (91 with high confidence) patients using ME with 3G-NBI and pathologically diagnosed as EGC in 61 and non-EGC in 167 patients. The overall diagnostic performance was sensitivity and specificity of 70.5
BACKGROUND:Adjuvant nivolumab has become a standard treatment after curative resection for locally advanced esophageal cancer; however, postoperative recurrence remains common. The efficacy of immune checkpoint inhibitor (ICI)-based therapy for postoperative recurrence in patients treated with adjuvant nivolumab remains unclear. This study evaluated the clinical outcomes of first-line ICI-based therapy for postoperative recurrence, focusing on the impact of prior adjuvant nivolumab exposure. METHODS:This single-center retrospective study included 81 patients who developed postoperative recurrence after radical esophagectomy and subsequently received first-line ICI-based therapy. Propensity score matching (PSM) was performed to adjust for baseline differences. Treatment outcomes were assessed based on treatment response, progression-free survival, and overall survival (OS) after recurrence. RESULTS:Among the 81 patients, 27 had received adjuvant nivolumab and 54 had not. Treatment responses, including the proportion of patients achieving early tumor shrinkage ≥ 20%, were similar between patients with and without prior adjuvant nivolumab exposure. After PSM, no statistically significant differences were observed in treatment response. No significant differences were observed in progression-free survival (hazard ratio 1.4, 95% confidence interval 0.74-2.64, p = 0.298) or OS (hazard ratio 1.23, 95% confidence interval 0.61-2.50, p = 0.56). Two-year OS was 44% and 42.9% in the adjuvant and non-nivolumab groups, respectively. CONCLUSIONS:First-line ICI-based therapy for postoperative recurrence demonstrated no statistically significant differences in clinical outcomes irrespective of prior exposure to adjuvant nivolumab, suggesting that previous adjuvant immunotherapy does not preclude clinical benefit from subsequent ICI-based therapy at recurrence.
BACKGROUND:To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. METHODS:A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. RESULTS:Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. CONCLUSIONS:This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.
Fusion surgery, where laparoscopic techniques are purposefully integrated into robotic surgery, is a novel approach that can be used in colorectal surgery. However, a standard definition and practical guidance are lacking. Therefore, this study aimed to generate consensus to standardise the definition of fusion surgery and consequently raise awareness of fusion surgical approaches and their appropriate use cases. We conducted a two-round modified Delphi study with 17 colorectal surgeons from Asia–Pacific (5 Steering Committee [SC]; 12 Expert Panellists [EP]). Statements were drafted by the SC based on clinical experience, published literature and comments from the EP. The EP rated these statements anonymously on a 5-point Likert scale. A virtual expert meeting was held between voting rounds to discuss the statements. Consensus was predefined as ≥ 75
Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle. We aimed to evaluate the efficacy and safety of PAEM. This retrospective study included patients who underwent PAEM for lower rectal lesions between January 2017 and December 2024 at the Osaka International Cancer Institute. PAEM was performed intentionally after October 2023, whereas unintentional PAEM occurred during endoscopic submucosal dissection (ESD) prior to October 2023. Short-term outcomes were assessed, and negative vertical margin rates were compared between groups. Among 242 consecutive patients who underwent ESD for lower rectal lesions, PAEM was performed in 25 patients (unintentional PAEM, 13; intentional PAEM, 12). The median age was 66 years (range, 38–89 years), and 14 patients (56
