Esophagectomy for esophageal cancer used to be more invasive and complicated than other gastrointestinal surgeries, however, with the introduction of thoracoscopic surgery and robot-assisted surgery, it has become less invasive recently. The standard treatment for stage Ⅱ and Ⅲ thoracic esophageal cancer in Japan is preoperative chemotherapy (docetaxel + cisplatin + 5-FU) followed by surgery. In addition, guidelines now recommend salvage surgery after radical chemoradiotherapy, and the role of esophagectomy in the treatment of esophageal cancer has been significant. There are scattered reports that postoperative infectious complications after esophagectomy worsen long-term prognosis, and meta-analyses have also reported that postoperative infectious complications after esophagectomy worsen long-term prognosis. Efforts to reduce postoperative infectious complications after esophagectomy are important to improve the long-term prognosis of patients with esophageal cancer.

The study investigated the association between postoperative infectious complications and tumor recurrence in patients undergoing curative surgery for advanced esophageal cancer. The research was conducted at a single institution through a retrospective analysis. The study included 82 cases with Stage Ⅱ or Ⅲ cancer and a follow-up period of at least one year. Through univariate and multivariate analyses, risk factors for infectious complications and recurrence were identified. Serum albumin levels（Alb）showed a notable trend as a risk factor for infectious complications（Odds ratio 6.9, P＝0.07, 95％ confidence interval 0.82-66.95）, while a GPS（Glasgow Prognostic Score）of 1 or higher based on Alb levels was identified as a significant risk factor for recurrence（Hazard ratio 3.81, P＝0.04, 95％ confidence interval 1.04-24.91）. Although infectious complications occurred in patients with advanced esophageal cancer, the study did not find a significant association between these complications and tumor recurrence or metastasis. However, it is worth noting that improving nutritional status, as indicated by preoperative Alb levels, may contribute to reducing both infectious complications and the risk of recurrence. Comprehensive strategies should be considered to address these issues effectively.

The treatment strategy for obstructive colorectal cancer is shifting from conventional emergency surgery to primary resection after bowel decompression. The stent placement followed by elective surgery（bridge to surgery：BTS）has been shown to be safe and effective not only in the short-term, but also in the long-term outcomes, and is expected to expand further in the future. However, BTS strategy has less frequent risks of stent-related complications, such as perforation and postoperative complications. Although it is well known that perforation is a poor prognostic factor, the prognostic impact of postoperative complications is unknown. In our study, postoperative complications have a significant negative prognostic impact in BTS patients, but not in patients with transanal decompression tube, which is another method of decompression. In this article, we review the current status of perioperative complications and their countermeasures from the viewpoint of long-term outcomes in BTS strategy.

We investigated the prognostic impact of anastmotic leakage in laparoscopic surgery neoadjuvant chemotherapy（NAC）for advanced rectal cancer. We included 50 patients who underwent laparoscopic low anterior resection of the rectum after NAC at Nippon Medical School Hospital from 2012 to 2019．Eight patients (16%) occurred anastomotic leakage, and the 3-year recurrence free survival for such patients were significantly worse than that of patients without anastomotic leakage (12.5% vs. 76.9%, P＜ 0.01). In multivariate analysis, anastomotic leakage (HR: 7.49, 95% C.I. 2.43-23.09, P＜0.01) and positive lateral lymph nodes at initial presentation (HR: 3.05, 95% C.I. 1.02-9.14, P=0.05) were identified as significant poor prognostic factor. In addition, anastomotic leakage tended to be more common in patients with poor response to NAC (P=0.10). Therefore, it is important that we strive to reduce anastomotic leakage for improvement of the prognosis of the patient with receiving NAC.

Previous studies have shown increased recurrence and worse survival in patients with postoperative infection after colorectal cancer surgeries. However, other studies demonstrated no oncological impact in patients with postoperative infection. The impact of postoperative infection on recurrence-free survival was investigated in 638 patients undergoing surgery for pStage Ⅱ/Ⅲ colorectal cancer. The incidence of overall postoperative infection, incisional SSI, organ/space SSI, anastomotic leakage, and remote infection were 13.6％, 7.2％, 7.8％, 7.2％, and 1.6％, respectively. There were no significant differences in recurrence-free survival according to overall postoperative infection, incisional SSI, and remote infection between the present and absent groups. Patients with anastomotic leakage had a significantly poorer prognosis than those without it. On multivariate analysis, anastomotic leakage was an independent poor prognostic factor along with pT4 and pStage Ⅲ (anastomotic leakage；hazard ratio：2.02, 95％ confidence interval: 1.24-3.29, P＝0.005). The negative oncological impact of anastomotic leakage was shown in rectal cancer, but not in colon cancer. In the pStage Ⅲ patients, the induction rate of postoperative adjuvant chemotherapy was significantly lower in patients with anastomotic leakage (36.4％ vs. 70.3％). Further prevention of anastomotic leakage and optimization of adjuvant chemotherapy are important to improve the prognosis of colorectal cancer surgery.