Leiomyosarcoma (LMS) of the gastrointestinal tract is an extremely rare high-grade neoplasm with poor prognosis. For advanced LMS with distant metastasis, the decision as to the choice of the most appropriate therapeutic strategy, including chemotherapy and surgery, is difficult. Here, we present an unusual case of LMS of the sigmoid colon with liver metastases and gastric cancer. The survival of this patient was prolonged by a combined modality therapy involving chemotherapy and surgery.

Background: Patients across various cancers who develop immune-related adverse events (irAEs) post-immune checkpoint inhibitor (ICI) treatment tend to experience better tumor response and survival than those who do not. However, studies regarding this association in patients with esophageal squamous cell carcinoma (ESCC) are limited. Methods: We assessed the relationship of irAEs with tumor response and survival in 82 consecutive patients with unresectable advanced or recurrent ESCC treated with second- or later-line nivolumab, an anti-PD-1 antibody, monotherapy. Results: We observed irAEs in 24 (29.3%) patients, with the overall response and disease control rates in the irAE-positive group being significantly better than those in the irAE-negative group (both p < 0.0001). During the entire period and within 8 weeks of nivolumab initiation, progression-free and overall survivals (PFS and OS, respectively) were significantly better in patients with grade1/2 irAEs than in those without. Univariate and multivariate analyses indicated grade1/2 irAEs during the entire period and within 8 weeks as independent covariates for PFS (entire period: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.16–0.49, p < 0.001; within 8 weeks: HR 0.46, 95% CI 0.23–0.93, p = 0.03) and OS (entire period: HR 0.24, 95% CI 0.13–0.44, p < 0.001; within 8 weeks: HR 0.41, 95% CI 0.18–0.92, p = 0.03). Conclusions: Grade1/2 irAEs during the entire treatment period and within 8 weeks of nivolumab initiation were significantly associated with improved tumor response and survival in patients with advanced ESCC treated with nivolumab monotherapy. Therefore, mild irAEs may be predictive markers for the response and prognosis of ESCC following ICI treatment.

Background: An anti-reflux anastomosis “double-flap technique” was recently used to resolve severe reflux esophagitis after intrathoracic esophagogastrostomy performed following proximal gastrectomy and lower esophagectomy, for esophagogastric junction (EGJ) cancer. We describe thoracoscopic reconstruction procedure performed by using the “double-flap” technique, which involves the creation of seromuscular flap under direct vision. This case report aimed to report the usefulness of this intrathoracic anastomosis procedure, as it may be difficult to perform double-flap technique with intraperitoneal manipulation in EGJ cancer cases. Presentation of case: A 58-year-old man was diagnosed with Siewert type II EGJ cancer. We performed laparoscopic proximal gastrectomy, lower esophagectomy, and thoracoscopic esophagogastrostomy using the anti-reflux double-flap technique in the prone position. This was achieved after careful dissection in the plane between the muscular and submucosal layers prior to replacing the remnant stomach into the abdominal cavity. The postoperative course was uneventful, with no symptoms of esophageal reflux after 21 months of surgery, even without medications. Discussion: This procedure offers the advantage of minimal invasiveness and ensures adequate surgical margins when lower esophageal incisions are required. This minimally invasive procedure achieves anastomosis using the complete hand-sewn method to prevent reflux, under a good surgical field of view for dissection of the lower esophagus and mediastinal lymph nodes. Conclusions: This procedure is very useful due to its minimal invasiveness, ease of thoracic procedure, and prevention of reflux in patients with EGJ cancer. To our knowledge, this is the first report of thoracoscopic esophagogastrostomy performed using the double-flap technique for EGJ cancer.