The ability to further stratify patients with esophageal carcinoma (EC) in the same stage into high-risk patients by the presence of lymphovascular invasion (LVI) may permit refinement of multi-modality therapy. However, the role of LVI in the prognosis of EC is not definite. A meta-analysis was conducted to investigate the relationship between LVI and EC prognosis. We searched PubMed, Embase, Web of Science, and Cochrane Library databases for studies on the association between LVI and prognosis of EC. Only studies with patient survival data related to LVI were included. The effect size for this analysis was the hazard ratio (HR) with 95% confidence intervals (CI) for overall survival (OS) and recurrence-free survival (RFS). Thirty-five studies with 9876 patients were included according to the defined inclusion and exclusion criteria. LVI was a poor indicator for the OS (HR = 1.64, 95% CI: 1.44–1.87, P < 0.001) and RFS (HR = 1.79, 95% CI: 1.38–2.34, P < 0.001). However, the heterogeneity was medium in OS (I² = 61.2%, P < 0.001) and extreme in RFS (I² = 77.5%, P < 0.001). In subgroup analysis, heterogeneity was originated from the staining method and proportion of early disease (stage (I + II)). We concluded that LVI was a poor prognostic indicator in patients with EC, especially in those studies with the IHC staining method and a high proportion of early disease (stage (I + II)).

OBJECTIVES: The objective of this study was to demonstrate the cumulative influence of simultaneous lymphatic and vascular invasion in thoracic oesophageal squamous carcinoma after radical operation. METHODS: A total of 598 cases with thoracic oesophageal squamous carcinoma that were cured by radical open oesophagectomy and extensive lymphadenectomy in the period of 2002 to 2014 were included. An association of the status of lymphovascular invasion with clinicopathological factors and a recurrent pattern was illustrated. Overall survival and disease-free survival were calculated, and the risk factors for decreased disease-free survival were determined with Kaplan–Meier subset analyses and Cox regression analysis. RESULTS: The status of lymphovascular invasion was significantly associated with tumour differentiation (P = 0.045) and the pathological tumour, node and metastasis stage (P < 0.001), which includes the tumour intramural invasive depth (T parameter) as well as regional (N parameter) and distant (M parameter) lymph node involvement. The 1-, 3- and 5-year overall survival and postoperative disease-free survival were significantly decreased by lymphatic or vascular invasion alone (P < 0.001) and were further decreased by simultaneous lymphatic and vascular invasion (P < 0.001). The independent risk factors that predicted reduced disease-free survival were the following: T parameter (P < 0.001, odds ratio: 1.436), N parameter (P < 0.001, odds ratio: 1.838) and the status of lymphovascular invasion (P < 0.001, odds ratio: 1.568). Simultaneous lymphatic and vascular invasion were significantly correlated with postoperative early recurrence (P = 0.037). CONCLUSIONS: Simultaneous lymphatic and vascular invasion independently has a more adverse effect on prognosis than lymphatic or vascular invasion alone. Differentiating between lymphatic and vascular invasion is recommended in order to further study the role of lymphovascular invasion in cancer staging and prognostication in multicentre prospective studies.

Background and objectives: The optimal therapeutic method for patients with superficial esophageal squamous cell carcinoma (sESCC) remains to be established. Methods: Clinical data of all the patients from 2002 to 2014 who underwent curative esophagectomy and three-field lymphadenectomy for thoracic sESCC were collected based on a prospectively-maintained database. The pattern of lymph node metastasis was analyzed based on the depth of tumor invasion, tumor location and surgical fields. Results: The involved lymph node region was associated to the tumor location, however, upper mediastinal and perigastric region was the most vulnerable region. The incidence of lymph node metastasis increased with the depth of tumor invasion. No lymph node involvement was found in tumors invading proper mucosa (M2), while the pattern of positive lymph nodes in tumors invading the deepest 1/3 submucosa was similar to that in advanced ESCC. Lymphatic invasion, tumor location and upper mediastinal lymph node involvement were independent predictors for cervical lymph node metastasis. For patients without lymphatic invasion, the positive predictive value of upper mediastinal lymph node metastasis for positive cervical lymph node was low (0 similar to 25%), while the negative predictive value was extremely high, wherever the tumor located (93.8 similar to 100%). Conclusions: Tumors invading till proper mucosa was the best indication for endoscopic mucosa resection. Mediastinal-abdominal lymphadenectomy was essential for sESCC invading beyond proper mucosa. For those without lymphatic invasion, cervical lymphadenectomy might be avoided in case of negative upper mediastinal lymph node.

Background: Lymphovascular invasion (LVI) is a factor correlated with a poor prognosis in oesophageal squamous cell carcinoma (ESCC). Lymphatic invasion (LI) and vascular invasion (VI) should be reported separately because they may indicate a difference in prognosis. The prognostic role of LI and VI in ESCC patients remains controversial. A meta-analysis was conducted to resolve this question. Methods: We searched the PubMed, EMBASE, Web of Science, Scopus and Cochrane Library databases for studies on the association between LI and VI and the prognosis of patients with ESCC. The PICOs (Participant, Intervention, Comparison, Outcome) strategy were selected for the systematic review and meta-analysis. The effect size (ES) was the hazard ratio (HR) or relative ratio (RR) with 95% confidence intervals (CI) for overall survival (OS) and recurrence-free survival (RFS). Results: A total of 27 studies with 5740 patients were included. We calculated the pooled results from univariate and multivariate analysis using the Cox proportional hazards method. The heterogeneity was acceptable in OS and RFS. According to the pooled results of multivariate analysis, both LI and VI were correlated with a worse OS. VI was a negative indicator for RFS, while the p value of VI was greater than 0.05. The prognostic role was weakened in subgroup analysis with studies using haematoxylin–eosin staining method. Conclusions: Both LI and VI were indicators of a worse OS outcome. LI was a more significant indicator in predicting a worse RFS. More larger sample studies with immunohistochemical staining and good designs are required to detect the prognostic value of separate LI and VI in ESCC.

Sleeve resection and reconstruction of the bronchial corner between the upper lobar bronchus and the intermediate bronchus is technique demanding. A 33-year-old Chinese man suffered from recurrence of low-grade malignant mucoepidermoid carcinoma located at the orifice of upper lobar bronchus with invasion to the main bronchus nearly 1 year after he had undergone an incomplete bronchoscopic resection. With detailed preoperative and intraoperative evaluation by computed tomography and bronchoscopy, a deeper wedge resection and bronchoplasty of the secondary carina was performed. The freedom from tumor cells at the cut-edges was guaranteed by frozen examination. The postoperative course was uneventful and the patient was free from recurrence for 18 months after the surgery. With an R0 resection, the procedure described in the present case report was feasible and relatively easy, thus an alternative to sleeve lobectomy or sleeve bronchial resection for small-size low-grade malignancy located at the orifice of upper lobar bronchus.