Editorial
Editorial for the Inaugural Issue: Clinics in Surgery
Hiroyuki Kato
First Department of Surgery, Dokkyo Medical University, Japan
*Corresponding author: Hiroyuki Kato, First Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi Mibu-machi, Tochigi, 321-0293, Japan
Published: 28 Dec, 2016
Cite this article as: Kato H. Editorial for the Inaugural Issue:
Clinics in Surgery. Clin Surg. 2016; 1:
1269.
Keywords:
Surgery; Surgical case reports; Internal medicine
Editorial
I am honored to launch the inaugural issue of our new online publication Clinics in Surgery.
And I am delighted to be an editorial board member of the newly launched the Clinics in Surgery,
the peer-reviewed open access journal of the USA, aims to publish original research articles from all
areas of surgery, surgical case reports, internal medicine.
I hope that this journal will link one of the international academic medical communities. Here,
I address about current status of esophageal cancer as my contribution for publishing the inaugural
issue.
Esophageal cancer has proven to be one of the most difficult malignancies to cure, because of
its rapid progression and poor outcomes [1,2], and it is known as the sixth most common cause of
death from cancer in the world. During the past four decades, important changes have occurred
in the epidemiologic patterns of this disease. The most striking has been the dramatic rise in the
West of the incidence of adenocarcinoma of the lower esophagus and cardia, which has surpassed
squamous cell cancer as the predominant cell type [1]. In Asia, however, diagnosed esophageal
cancers are predominantly squamous cell in type and are mostly located in the middle third of the
esophagus. The risk factors for esophageal squamous cell carcinoma (ESCC) are alcohol drinking
and smoking. Furthermore World Health Organization prescribed that acetaldehyde associated
with alcoholic beverages is a Group 1 carcinogen. In addition, in relation to dietary factors, poor
nutritional status and vitamin deficiency due to inadequate intake of fruits and vegetables are also
reported as risk factors. By contrast, intake of green and yellow vegetables and fruits are reported as
preventive factors [3]. It is generally accepted that esophageal adenocarcinomas (EAC) is a direct
consequence of the condition known as Barrett’s esophagus (BE), a condition in which the stratified
epithelium is substituted by metaplastic columnar epithelium. The treatments for esophageal
carcinoma depend on its etiology and stage [2]. For mucosal cancer, endoscopic mucosal resection
and endoscopic submucosal dissection are standard treatments in Japan, on the other hand for
locally advanced cancer, esophagectomy remains the mainstay. The three most common techniques
for thoracic esophagectomy are the transhiatal approach, the Ivor Lewis esophagectomy, and the
McKeown technique in the world. Furthermore, minimally invasive esophagectomy (MIE) for the
management of esophageal cancer was first described by Cuschieri et al in 1992, and it has been
reported their experience with excellent results. The technique has currently been representing
the most popular. Neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is added, if the
tumor is more advanced. The theoretical advantages of adding chemotherapy to the treatment
of esophageal cancer are potential tumor down-staging prior to surgery, as well as targeting
micrometastasis and, thus, decreasing the risk of distant metastasis. Cisplatin- and 5-fluorouracilbased
regimes are generally used worldwide. On the other hand, triplet combination chemotherapy
is gradually spreading. Chemoradiotherapy is the standard for unresectable esophageal cancer and
could also be considered as an option for resectable tumors. Concurrent chemoradiotherapy should
be the standard of care in patients with medically or technically inoperable. Although neoadjuvant
chemoradiotherapy followed by surgery or salvage surgery after definitive chemoradiotherapy is a
practical treatment, judicious patient selection is crucial. Furthermore, molecularly-targeted drug
is genuinely expected in the worldwide. It is important to have a thorough understanding of these
therapeutic modalities to assist in this endeavor.
Ultimately, our new online journal Clinics in Surgery content will be published on a continuous
publication model again. I hope you will agree that this inaugural issue represents a distinguished
start for a journal that will feature the cutting-edge ideas of leading.
References
- Kato H, Fukuchi, Miyazaki T, Nakajima M, Tanaka N, Inose T, et al. Surgical treatment for esophageal cancer. Current issues. Dig Surg. 2007; 24: 88-95.
- Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg. 2013; 61: 330-335.
- Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, et al. Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015; 12: 1-30.