BACKGROUND:Tongue pressure is a predictor of postoperative aspiration. This study aimed to examine changes in tongue pressure during neoadjuvant chemotherapy (NAC), identify associated factors, and investigate whether these changes are related to other functional outcomes, including exercise capacity and muscle function. METHODS:This prospective, single-center, observational study enrolled 68 patients with esophageal cancer scheduled to undergo NAC. Patients were classified into marked reduction (n=17) and remaining (n=51) groups based on the rate of change in tongue pressure. Tongue pressure, muscle function, walking ability, and exercise capacity were evaluated before and after NAC. Multivariate logistic regression analysis was performed to identify the factors significantly associated with a marked reduction in tongue pressure. Spearman's correlation analysis was used to evaluate the relationships between the rate of change in tongue pressure and the rates of change in each functional parameter. RESULTS:Multivariable logistic regression analysis identified age and the number of days during NAC when oral intake was not possible as significant independent factors associated with a marked reduction in tongue pressure. Spearman's correlation analysis revealed no significant correlations between the rate of change in tongue pressure during NAC and the rates of change in handgrip strength, isometric knee extensor strength, 30-s chair stand test performance, quadriceps thickness, maximum inspiratory pressure, maximum expiratory pressure, 10-m walk test result, or 6-min walk distance. CONCLUSIONS:These findings underscore the importance of incorporating swallowing function, including tongue pressure, into prehabilitation programs.
Recently, the application of Intensity-Modulated Radiotherapy (IMRT) and changes in fractionation schedules have been increasingly introduced in radiotherapy practice for esophageal cancer. However, the extent of their adoption and prevalence in real-world clinical practice remains unclear. This study aimed to describe nationwide trends in radiotherapy for esophageal cancer using a large-scale health insurance claims database. Using the DeSC database, we identified patients newly diagnosed with esophageal cancer between April 2017 and March 2023. Patients treated with definitive radiotherapy (defined as 25–35 treatment days in patients without distant metastasis) were selected. We analyzed temporal trends in radiotherapy, regional differences, and the incidence of radiation pneumonitis. Among patients with an identified initial treatment, the proportion of radiotherapy declined from 28.6
The prevalence of gastroesophageal reflux disease (GERD) has increased worldwide, and metabolic syndrome (MS) was reported as a risk factor for its incidence. This study retrospectively evaluated the relationship between endoscopic GERD classification and MS-related parameters in a Japanese cohort. We reviewed the medical records of 3,635 adults who underwent upper gastrointestinal endoscopy as part of health checkups. Based on endoscopic findings, GERD was classified according to the Los Angeles (LA) system. Body mass index (BMI), waist circumference, blood pressure (BP), and laboratory parameters—including glucose, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides—were compared across the LA grade groups. The numbers of patients classified as LA grade N, M, A, B, C, and D were 2,557 (70.3
Phase III trials have established the efficacy of immune-based therapies for unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC). However, real-world evidence comparing regimens and clinically applicable prognostic biomarkers remains limited. We retrospectively evaluated 245 patients with unresectable advanced/recurrent ESCC treated with first-line 5-fluorouracil plus cisplatin combined with nivolumab or pembrolizumab (CF + ICI; n = 114), first-line ipilimumab plus nivolumab (Ipi + Nivo; n = 46), or nivolumab monotherapy as second-line or later treatment (Nivo; n = 85). Efficacy, safety, and survival outcomes were assessed, focusing on inflammation-based nutritional indices and multivariate prognostic modelling. The objective response rates were 56
Once an esophago–airway fistula develops during chemoradiotherapy for cT4b esophageal cancer, further curative treatment is often precluded. We describe a robotic technique for closure of a large esophago–left main bronchial fistula using a pedicled autologous pericardial patch reinforced with a latissimus dorsi muscle flap. A 66-year-old woman with squamous cell carcinoma of the middle to upper thoracic esophagus invading the left main bronchus developed a fistula after definitive chemoradiotherapy. After temporary airway stenting, salvage surgery was performed in the semi-prone position under single-lung ventilation and CO₂ pneumothorax. Following thoracic esophagectomy, a horseshoe-shaped pedicled pericardial patch was created robotically, flipped cranially, and sutured to the bronchial defect. A right latissimus dorsi muscle flap was then introduced into the right thoracic cavity through a second intercostal opening and robotically fixed over the repair. To our knowledge, this is the first report of this robotic technique.
