Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Neoadjuvant chemoradiotherapy (nCRT) and chemoimmunotherapy (nICT) are increasingly used for locally advanced esophageal squamous cell carcinoma. Although pathological complete response (pCR) is associated with favorable survival, nearly one third of pCR patients still experience recurrence. This study aimed to identify risk factors and recurrence patterns in this population. Methods We retrospectively reviewed 392 patients who achieved pCR after nCRT or nICT from two tertiary-referral centers between 1/2016 and 9/2023. Predictors and patterns of recurrence were evaluated using competing-risk models. Results The median follow-up time was 48.3 (interquartile range [IQR]: 41.9-60.7) months. A total of 61 patients (15.6%) developed disease recurrence with 37 after nCRT and 15 after nICT. The 2-year and 5-year cumulative incidence of recurrence in nCRT group was higher than that in the nICT group, showing 15% vs 8.9% and 23% vs 17%, respectively (P=0.032). Regarding specific sites of recurrence, nCRT group demonstrated a significantly increased cumulative incidence of distant recurrence than nICT group (P=0.002). After multivariable analysis, incomplete neoadjuvant therapy was independently predicting recurrence in nCRT group (adjusted hazard ratio[aHR] 2.86, P=0.005), whereas advanced cN stage (N2-3) was the only predictor significantly associated with relapse in nICT group (aHR 3.99, P=0.005). Conclusion Recurrence was not rare among patients who achieve pCR. Patterns of recurrence between nCRT and nICT were significantly differed, with higher incidence of distant recurrence found in nCRT. Factors predicting recurrence may alter in different modalities.

In response to the urban heat island effects and building energy demands in Singapore, this study proposes an agentic AI-enabled reasoning framework that integrates large language models (LLMs) with lightweight physics-based models. Through prompt customization, the LLMs interpret urban design tasks, extract relevant policies, and activate appropriate physics-based models for evaluation, forming a closed-loop reasoning-action process. These lightweight physics-based models leverage core thermal and airflow principles, streamlining conventional models to reduce computational time while predicting microclimate variables, such as building surface temperature, ground radiant heat, and airflow conditions, thereby enabling the estimation of thermal comfort indices, e.g., physiological equivalent temperature (PET), and building energy usage. This framework allows users to explore a variety of climate-resilient building surface strategies, e.g., green façades and cool paint applications, that improve thermal comfort while reducing wall heat gain and energy demand. By combining the autonomous reasoning capacity of LLMs with the rapid quantitative evaluation of lightweight physics-based models, the proposed system demonstrates potential for cross-disciplinary applications in sustainable urban design, indoor-outdoor environmental integration, and climate adaptation planning.

Abstract Topic Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies Background Esophageal squamous cell carcinoma (ESCC) with synchronous primary cancers in pharynx and larynx (SPC-PL) is rare and lacks standard-of-care treatment. This study examined tumor response and survival after neoadjuvant immuno-chemotherapy (nICT) in ESCC patients with SPC-PL. Methods This retrospective single-center study analyzed 21 patients with ESCC and SPC-PL who received nICT between 2020 and 2024. Treatment response was evaluated using clinical (endoscopic and radiological) and pathological criteria. Outcomes included response rates, overall survival (OS), and progression-free survival (PFS) and laryngeal preservation rates. Results The nICT regimen induced a clinical complete response (CR) in 71.4% (15/21) of SPC-PL lesions and a pathological CR in 38.5% (5/13) of resected esophageal specimens. With a median follow-up of 28.2 months, the 2-year OS and PFS rates were 75.9% and 44.1%, respectively. Laryngeal-preserving strategies were successfully implemented in 85.7% (6/7) of patients with locally advanced SPC-PL (cT2-3N0-2) who were conventional candidates for total laryngo-pharyngectomy. No significant difference in OS or PFS was observed compared to a concurrent surgical resection cohort (n=18). Conclusion nICT showed promising efficacy in treating ESCC patients with SPC-PL, providing high rates of tumor regression and laryngeal preservation. These results support nICT as an initial treatment option for ESCC patients with SPC-PL but further validation is needed.

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer Background Gastrointestinal complications related to gastric conduit reconstruction adversely affect quality of life (QoL) in patients undergoing esophagectomy for esophageal cancer (EC). We introduced a robot-assisted extended free jejunal interposition (EFJI) technique for intrathoracic esophageal cancer that preserves gastric and cardiac function (Figure 1A). This study aimed to compare perioperative outcomes and QoL between robot-assisted EFJI and McKeown esophagectomy in patients with upper thoracic esophageal cancer. Methods From February 2025 to August 2025, patients with upper thoracic esophageal cancer scheduled for robot-assisted EFJI or McKeown esophagectomy at our center were enrolled. Contrast-enhanced computed tomography confirmed the absence of metastasis to middle/lower mediastinal lymph nodes, abdominal lymph nodes, and distant organs. Surgical outcomes, complications, QoL, and oncologic survival were compared between the two groups. Results Ten patients underwent EFJI and 49 underwent McKeown esophagectomy. The EFJI group had longer operative time and greater intraoperative blood loss. However, complication rates (30.0% vs. 32.7%, Figure 1B) and length of hospital stay (10 vs. 9 days) were comparable between groups. Pain scores were significantly lower in the EFJI group at postoperative day 30 (2.2 vs. 13.3, p=0.032) and day 90 (2.2 vs. 11.1, p=0.031). Reflux scores were similar at day 30 (6.7 vs. 21.7) but significantly lower in the EFJI group at day 90 (5.0 vs. 32.5, p=0.011). Additionally, EFJI patients demonstrated lower symptom burden on the EORTC QLQ-OES18 at both 30 and 90 days postoperatively (Figure 1C), although no significant difference was observed in global QoL scores on the EORTC QLQ-C30 (Figure 1D). With a median follow-up of 6.8 months, one patient in each group developed local recurrence or distant metastasis, and recurrence-free survival rates were comparable. Conclusion Robot-assisted EFJI represents a safe reconstruction alternative following segmental resection of upper thoracic esophageal cancer and is associated with significantly reduced postoperative reflux compared with traditional McKeown esophagectomy.

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications Background This study compared the perioperative safety, quality of life and oncologic outcomes of the totally robot-assisted minimally invasive esophagectomy (ToRaMIE) technique with hybrid robot-assisted thoracoscopic and laparoscopic esophagectomy with an abdominal mini-incision (HyRaMIE). Methods The ToRaMIE procedure is performed as follows (Figure 1A). The thoracic esophagus is mobilized via a right thoracoscopic approach using the Da Vinci Xi robotic surgical system, with concurrent mediastinal lymph node dissection. Subsequently, the entire stomach is mobilized robotically via a robotic laparoscopic approach. The esophagus is transected at the esophagogastric junction using a linear stapler. A gastric conduit is created entirely intracorporeally and secured to the proximal stomach at the resection staple line. It is then delivered through a retrosternal tunnel to the left neck incision with robotic assistance. The cervical esophagus is mobilized through the left neck incision, and the thoracic esophagus along with the resected gastric tissue is removed. Finally, a stapled end-to-side esophagogastric anastomosis is created. Results From October 2024 to October 2025, 25 and 23 patients underwent ToRaMIE and HyRaMIE, respectively. Most patients had upper and middle thoracic esophageal tumors. No significant differences were observed between the two groups in terms of R0 rate, blood loss or the number of lymph nodes dissected, except for a longer operative time in the ToRaMIE group (271 vs. 248 min, p=0.045). The overall complication rates (28.0% vs. 30.4%, Figure 1B), postoperative pain scores (Figure 1C), and hospital stay duration (9.5 vs. 9.6 days) were similar between the groups. Furthermore, no significant difference was found in quality-of-life scores at 1 month (61.7 vs. 54.3) and 3 months (63.0 vs. 59.4) postoperatively (Figure 1D). At the latest follow-up, one patient in each group had developed distant metastasis, with comparable recurrence-free survival rates observed. Conclusion ToRaMIE is a safe procedure for thoracic esophageal cancer. Long-term survival is needed.

Background Esophageal squamous cell carcinoma (ESCC) with synchronous primary cancers in pharynx and larynx (SPC-PL) is rare and lacks a standard-of-care treatment. This study evaluated tumor response and survival after neoadjuvant immuno-chemotherapy (nICT) in ESCC patients with SPC-PL. Methods This retrospective, single-center study analyzed 21 patients with ESCC and SPC-PL who received nICT between 2020 and 2024. Treatment response was assessed using clinical (endoscopic and radiological) and pathological criteria. Outcomes included tumor response rates, overall survival (OS), progression-free survival (PFS) and laryngeal preservation rates. Results The nICT regimen induced a clinical complete response (CR) in 71.4% (15/21) of SPC-PL lesions and a pathological CR in 38.5% (5/13) of resected esophageal specimens. With a median follow-up of 28.2 months, the 2-year OS and PFS rates were 75.9% (95% confidence interval (CI): 59.5%-96.8%) and 44.1% (95% CI: 26.2%-74.2%), respectively. Among patients with locally advanced SPC-PL (cT2-3N0-2) who would traditionally have required total laryngo-pharyngectomy, laryngeal preservation was successfully achieved in 85.7% (6/7) after nICT. In an exploratory comparative analysis, no significant difference in OS or PFS was observed between the nICT cohort and a contemporaneous cohort treated with upfront resection (n = 18). Conclusion nICT showed promising efficacy in patients with ESCC and SPC-PL, achieving high rates of tumor regression and laryngeal preservation. These findings suggest that nICT may be a feasible initial treatment strategy for this population and support further validation in larger studies.

BACKGROUND:Robot-assisted minimally invasive oesophagectomy is used increasingly worldwide. However, no large-scale, multicentre, randomised controlled trial has compared long-term survival as the primary endpoint between robot-assisted oesophagectomy and conventional thoracoscopic oesophagectomy. We aimed to confirm the non-inferiority in overall survival of robot-assisted oesophagectomy over thoracoscopic oesophagectomy in patients with resectable oesophageal squamous cell carcinoma. METHODS:This multicentre, open-label, randomised, controlled, phase 3, non-inferiority trial (RAMIE) was conducted at six hospitals in China. Patients aged 18-75 years, with biopsy-proven squamous cell carcinoma, Eastern Cooperative Oncology Group scores of 0-2, and with tumour and nodal classifications of cT1-4a, N0-2, M0, or M1 (supraclavicular lymph nodes metastasis) were eligible. Patients were randomly assigned (1:1) using a computer-generated randomisation list and stratified by neoadjuvant therapy to robot-assisted oesophagectomy or thoracoscopic oesophagectomy, both with at least two-field lymphadenectomy. The primary endpoint was overall survival, analysed in the intention-to-treat population. The non-inferiority margin was 9% for 5-year overall survival (the upper limit of 95% CI of the hazard ratio [HR] was 1·33). Harms were assessed in the per-protocol population, defined as all eligible participants undergoing resection. This trial was registered with ClinicalTrials.gov, number NCT03094351 and is completed. FINDINGS:Between Aug 2, 2017, and Dec 23, 2019, 362 patients were randomly assigned (183 to robot-assisted oesophagectomy and 179 to thoracoscopic oesophagectomy. 309 (85%) of 362 patients were men and 53 (15%) were women. Two patients in each group did not undergo resection and were excluded from the per-protocol population. Median follow-up of the planned final analysis was 71·5 months (IQR 63·9-81·8). At 5 years, overall survival was 69·4% (95% CI 62·1-75·6) with robot-assisted oesophagectomy versus 56·2% (48·5-63·2) with thoracoscopic oesophagectomy (HR 0·71, 95% CI 0·51-0·97), confirming non-inferiority (one-sided pnon-inferiority=0·0001; exploratory analysis of p=0·032 for superiority). Intraoperative conversions to open surgery were similar between study groups (seven [4%] of 181 patients in the robot-assisted group vs six [3%] of 177 in the thoracoscopic group). Postoperative grade 3 or higher complications were comparable (22 [12%] of 181 patients in the robot-assisted group vs 18 [10%] of 177 in the thoracoscopic group). One treatment-related death occurred in each group. INTERPRETATION:In patients with resectable oesophageal squamous cell carcinoma, robot-assisted oesophagectomy was non-inferior, and seemed superior, to thoracoscopic oesophagectomy in terms of 5-year overall survival. FUNDING:National Clinical Key Specialty Construction Project, Shanghai Hospital Development Center, and the Program of Shanghai Academic/Technology Research Leader. TRANSLATION:For the Chinese translation of the abstract see Supplementary Materials section.

Cross-modal effects represent a crucial area of research in building environment. Post occupancy evaluation studies have confirmed that various domains significantly influence occupants' subjective perceptions. By integrating these two aspects, this study aims to analyze the complex cross-modal effects on occupants' satisfaction levels in residential environments. 2,402 questionnaires responses collected from residential environments were used to analyze the comprehensive effects among overall satisfaction and single-dimension satisfaction on ten aspects: thermal, acoustic, light, air quality, decoration, window view, infrastructure accessibility, green space accessibility, visual privacy, and acoustic privacy. By analyzing the combined effects of single dimensions on overall satisfaction, it was found that the influence of single-dimension satisfaction on overall satisfaction differs between the satisfied and dissatisfied sides. Dimensions not widely explored in the Indoor Environmental Quality field, such as indoor decoration, accessibility to infrastructure and green spaces, and window views, have a substantial impact on overall satisfaction. Interaction effects analysis revealed that people's perception of the environment is not dominated by any single dimension. When the overall environment is perceived as relatively satisfactory, improvements in any dimension are accompanied by increases in overall satisfaction. Conversely, when the overall environment is perceived as relatively unsatisfactory, deterioration in any dimension is accompanied by a decrease in overall satisfaction. This phenomenon may be attributed to the synchronicity of satisfaction across dimensions, a data characteristic reflected in the analysis of crossed effects. By analyzing the complex effects of multi-dimensional perception patterns, this study aims to enhance the understanding of the formation of overall satisfaction.

Understanding personalized thermal comfort is critical for creating comfortable indoor environments and achieving energy efficiency. Thermal history has a significant impact on human thermal adaptation, but it has received insufficient attention. Combining field investigation and statistical analysis, this study introduces the thermal neutral rate (TNR) and thermal comfort and acceptability rate (TCAR) to analyze the differences in thermal and humidity responses and adaptability among groups with different thermal histories in northern China. Results show that as subjects acclimatize to indoor environments, their thermal neutral temperature rises, and humid sensation votes approach 'neutral' conditions. Participants with no prior northern thermal history require up to 1 year to adapt to district heating environments, while adaptation to humid environments may take 2-3 years. The thermal neutral temperature of the un-adapted subjects was 18.0 degrees C, and post-adaptation, it varied within the range of 20.2-21.4 degrees C. For engineers designing indoor environments, maintaining temperatures within the range of 19.1-22.3 degrees C meets the comfort and acceptability requirements of participants with different thermal histories in the office. These findings provide evidence for understanding human thermal adaptation mechanisms and give recommended heating temperature ranges for comfortable indoor environments in office buildings in the severe cold zone.

The impacts of metabolic rate (activity level) on human thermal response have not been adequately addressed. Extensive data from the Chinese Thermal Comfort Database were utilized to classify subjects based on their activity levels, including resting, sitting, standing, and walking. Variations in thermal responses among people with different activities in real-life scenarios were analyzed. The thermal neutral temperatures and acceptable comfort ranges for these groups were established. Furthermore, the impact of activity on thermal responses for males and females was investigated. Results indicate that as the metabolic rate increases, subjects' thermal sensation vote gradually increases, while the comfort level decreases. The human thermal neutral temperatures with different activities were found to be 22.1 degrees C, 20.2 degrees C, 20.1 degrees C, and 18.9 degrees C, respectively. It was observed that males exhibit lower thermal neutral temperatures than females, with this gap narrowing as metabolic rate rise. Notably, for every 0.1 met increase in metabolic rate, the thermal neutral temperature decreases by approximately 0.3 degrees C. The acceptable temperature ranges for the four activity states were 15.7-31.0 degrees C, 13.9-29.7 degrees C, 16.0-27.0 degrees C, and 15.6-28.3 degrees C, respectively. As metabolic rate increase, the range narrows for subjects. The findings enhance the understanding of human thermal adaptation mechanisms, provide data support for personalized thermal comfort, and hold promise for reducing energy consumption in buildings.

The winter in severe cold area of China lasts as long as half a year, during which the outdoor temperature varies greatly. When people move between the indoor and outdoor, the sudden change of environment will affect human whole and local thermal responses. However, studies are scarce that aim at step change of large temperature differences in this area. A field study was conducted during different winter periods to explore the whole and local thermal responses to environmental step - changes, obtaining thermal response votes and skin temperature in real time. The results show that from early winter to the coldest period, the temperature difference between indoor and outdoor ranges from 15.3 degrees C to 24.5 degrees C. A larger temperature step leads to a longer stabilization time for physiological and psychological responses. There were significant differences in local thermal sensation and skin temperature in different parts. The thermal sensation of the calf could best reflect the whole thermal sensation, with correlation coefficients larger than 0.86. For the step change of cold environment, a model to predict the whole thermal sensation based on the local skin temperature of the calf was given, which has achieved a good prediction effect. Meanwhile, more sensitive changes in thermal comfort and lower thermal acceptability were observed from early winter to the coldest period, implying that people are not adapted to the sudden change.

OBJECTIVES:Intensive care unit (ICU) readmission has been proposed as a metric for quality of surgical care. The current study investigated potential factors and developed a prediction model for ICU readmission in patients following oesophagectomy for cancer. METHODS:A total of 3028 patients from January 2019 to December 2022 were retrospectively collated as training cohort, with 829 patients from January 2023 to August 2023 enrolled for validation, respectively. Univariable and multivariable analyses were performed to identify potential factors after which a nomogram based on results from multivariable analysis was constructed and validated. RESULTS:In the training cohort, the rate of ICU readmission was 3.6% (110/3028). Readmitted patients were associated with more reoperations, higher 90-day mortality and prolonged postoperative stay (all P < 0.001). Multivariable analysis demonstrated that older age ≥75 years, neoadjuvant therapy, preoperative albuminaemia, diffusing lung capacity for carbon monoxide (DLCO)%, longer operative duration and retention of endotracheal intubation when entering ICU were independently associated with ICU readmission. Based on these results, a nomogram for predicting readmission was constructed and validated. The Hosmer-Lemeshow test showed the model in the training cohort was well calibrated (χ2 = 5.259, P = 0.73) and area under the receiver operating characteristic curve was 0.739 (95% confidence interval 0.691-0.787). Moreover, the application of the nomogram in the validation cohort showed an improved area under the receiver of 0.780 (95% confidence interval 0.703-0.857). CONCLUSIONS:ICU readmission after oesophagectomy although uncommon (3.6%) was associated with prolonged hospitalization and significant mortality. A nomogram based on 6 variables may assist intensivists to early identifying patients at high risk of readmission.

Big environmental difference between the artificial indoor environments and the outdoor environments affects human comfort and physiological responses. This study examines the dynamic changes in human psychological and thermal responses to sudden, large temperature differences under three indoor conditions: slightly warm, neutral, and slightly cold. The similarities and differences between field studies and existing laboratory research were also analyzed. The results indicated that the indoor-outdoor temperature differences under slightly cold, neutral, and slightly warm conditions were 24.5 degrees C, 32.6 degrees C, and 39 degrees C. Environmental differences between indoor and outdoor conditions were influenced by various factors, including temperature, air speed and so on. Human thermal responses differed significantly among the three conditions (P < 0.01). Thermal sensation vote (TSV), thermal comfort vote (TCV), and skin temperature showed great changes after the environmental shift. Skin temperature fluctuated more during down-step, while heart rate and heart rate variability (HRV) exhibited greater changes during up-step in this test. In real-world scenarios, human thermal responses were influenced by temperature, air speed, and human behavior, resulting in deviations from laboratory findings. Furthermore, a time-dependent model for skin temperature and TSV was developed, revealing that thermal sensation changes more rapidly than skin temperature during abrupt shifts from cold to near-neutral environments.

BACKGROUND:Although definitive chemoradiotherapy (dCRT) remains the standard for cervical esophageal cancer (CEC), studies on surgical outcomes have reported conflicting results. This highlights the need for more data on surgical treatment for CEC. METHODS:This study reviewed 152 patients who underwent surgical treatment for CEC at a single center between May 2014 and May 2024. Patients were stratified by surgical procedure: laryngeal-preserving esophagectomy (LP) versus. total pharyngo-laryngo-esophagectomy (TPLE). Baseline data and perioperative outcomes were analyzed. Kaplan-Meier analysis and multivariable Cox regression were performed. RESULTS:Eighty-five patients underwent LP whereas 67 patients underwent TPLE. The median follow-up time was 24 months. Overall survival (OS) rate at 2-year for all patients was 58.9%, and a higher 2-year OS rate (71.2% vs. 43.5% and p = 0.035) was observed in the LP group compared to the TPLE group. The TPLE group had a higher R0 resection (negative resection margin) rate (75.3% vs. 89.6% and p = 0.024) but higher incidence of noncancer-related mortality (16.4% vs. 4.7% and p < 0.001) and 90-day mortality (7.5% vs. 0% and p = 0.010) compared to the LP group. Multivariable Cox regression analysis demonstrated that TPLE as an independent risk factor for OS (hazard ratio (HR), 1.872; 95% confidence interval [CI], 1.101-3.184; and p = 0.021). CONCLUSIONS:The survival outcomes of surgical treatment for CEC showed promising when compared to historical data of definitive chemoradiotherapy. Although the LP group had a lower R0 resection rate than the TPLE group, it demonstrated better survival rates and perioperative safety.

Background:Brain metastases (BMs) are associated with rapid progression and substantial morbidity. In recent years, the incidence of brain metastases from esophageal carcinoma (BMECs) has increased, despite remaining relatively rare. However, there is still a limited understanding of the diagnostic and therapeutic strategies for BMECs. A comprehensive understanding of BMEC is critical to inform timely neuroimaging surveillance and guide treatment. This systematic review and meta-analysis aimed to characterize the incidence, presentation and prognosis of BMECs. Methods:A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic search was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library until January 2025. Studies reporting incidence rates or survival data for histologically confirmed esophageal carcinoma with radiologically verified BMs were eligible. Two independent reviewers extracted data using standardized forms encompassing: (I) demographic variables; (II) primary tumor characteristics; and (III) metastatic parameters. Results:A total of 31 eligible studies met the inclusion criteria. The pooled incidence of BMECs was 2.84% [95% confidence interval (CI): 1.92-4.19%]. Notably, patients with adenocarcinoma exhibited a significantly higher incidence of BMECs compared to those with squamous cell carcinomas (SCCs) [5.34% (95% CI: 3.52-8.12%) vs. 1.45% (95% CI: 0.84-2.53%), P<0.001]. The pooled median overall survival (OS) following a BMEC diagnosis was 5.62 months (95% CI: 3.98-7.94). Furthermore, resection of BMs was significantly associated with improved OS [hazard ratio (HR): 0.45 (95% CI: 0.33-0.61), P<0.001], while multiple BMs [HR: 1.66 (95% CI: 1.27-2.16), P<0.001] and BMECs presenting with extracranial metastasis [HR: 1.52 (95% CI: 1.11-2.09), P=0.01] were significantly associated with worse OS. Conclusions:Comprehensive meta-analysis indicates BMEC as an uncommon but severe event in patients with esophageal carcinoma, demonstrating a poor prognosis of BMEC and a higher prevalence and incidence of BMs in adenocarcinoma. These findings support the regular use of brain imaging at staging and neuroimaging surveillance at follow-up in patients with esophageal carcinoma. Future research directions should focus on developing precise BM risk prediction tools and prospective studies to establish optimal treatment for BMECs.