Background/Objectives: Esophageal cancer (EC) remains highly lethal. The standard management of locally advanced disease includes neoadjuvant chemoradiotherapy (nCRT) followed by surgery. However, the role of esophagectomy in patients achieving clinical complete response (cCR) after nCRT remains uncertain. Methods: We conducted a retrospective study at the Davidoff Cancer Center, Rabin Medical Center (2013–2023). Patients with thoracic EC (adenocarcinoma and squamous cell carcinoma) stage cT2–4a, N+, M0 who received nCRT (cisplatin/5-FU or CROSS regimen with 41.4–50.4 Gy) were included. Patients with cCR, defined by negative biopsies, endoscopic ultrasound, and PET-CT, were managed with surgery or surveillance. Survival was analyzed using Kaplan–Meier and Cox regression. Results: Of 252 patients treated with nCRT, 118 achieved cCR. Seventy underwent surgery, with 47% (33 patients) achieving pathological complete response (pCR), and 48 were managed with surveillance. Five-year overall survival (OS) was 48% with surveillance and 49% with surgery; disease-free survival (DFS) was 36% vs. 43%. No significant differences were observed in OS (HR = 0.75, 95% CI 0.47–1.26) or DFS (HR = 0.88, 95% CI 0.55–1.41). In patients ≤70 years, surgery conferred an OS and DFS benefit (HR = 0.44, p = 0.03). No benefit was observed in patients >70 years, where outcomes trended against surgery. On multivariable analysis, older age (p = 0.005) and female sex (p = 0.007) were independent predictors of OS. Conclusions: In younger patients (≤70 years), surgery yielded significant survival benefit, supporting its role as the preferred treatment. In patients >70 years, surveillance produced comparable or superior outcomes, suggesting deferral of surgery may avoid morbidity without compromising survival. Age-specific tailoring of management is essential.

Background/Objectives : Phosphodiesterase type 5 inhibitors (PDE5Is) are used to treat erectile dysfunction, as they increase blood flow to the penis during sexual stimulation, supporting erection maintenance. There is limited evidence that their use increases survival in various types of cancer. As treatment for rectal cancer often results in erectile dysfunction, many patients take PDE5Is. This study assessed the association between PDE5I use and survival in rectal cancer patients. Methods : Utilizing data from Clalit Health Services in Israel, the analysis included 1,552 patients, with 256 users of PDE5Is. Survival differences were evaluated using non-parametric tests, Cox proportional hazards models, and propensity score matching to control for confounding variables. Results : PDE5I use was found to be significantly associated with improved survival, with a hazard ratio of 0.455 (p<0.001). The survival benefit persisted after adjusting for covariates and implementing matching procedures. Conclusions : These findings suggest a potential protective effect of PDE5I use on survival in rectal cancer patients, warranting further investigation into underlying mechanisms and clinical implications.

Phosphodiesterase type 5 inhibitors (PDE5I) are used to treat erectile dysfunction, as they increase blood flow to the penis during sexual stimulation, supporting erection maintenance. There is limited evidence that their use increases survival in various types of cancer. As treatment for rectal cancer often results in erectile dysfunction, many patients take PDE5Is. This study assessed the association between PDE5I use and survival in rectal cancer patients. Utilizing data from Clalit Health Services in Israel, the analysis included 1,552 patients, with 256 users of PDE5Is. Survival differences were evaluated using non-parametric tests, Cox proportional hazards models, and propensity score matching to control for confounding variables. Results indicated that PDE5I use was significantly associated with improved survival, with a hazard ratio of 0.455 (p< 0.001). The survival benefit persisted after adjusting for covariates and implementing matching procedures. These findings suggest a potential protective effect of PDE5I use on survival in rectal cancer patients, warranting further investigation into underlying mechanisms and clinical implications.