Combined resection for synchronous lung lesions and esophageal cancer should be compared with staged surgery

We have read with great interest a paper titled ‘ Will synchronous esophageal and lung resection increase the incidence of anastomotic leaks? A multicenter retrospective study ’ published in the International Journal of Surgery by Liu et al . [1] . In this study, the authors conducted a large, multicenter cohort study and utilized propensity score matching (PSM) to adjust for confounding factors. The study not only compared the incidence of anastomotic leaks but also analyzed the trend of survival. The authors suggest that staged surgery might be a more suitable option. While Liu and colleagues have conducted a well-matched and meaningful study, there are certain points that require further discussion.


Dear Editor,
We have read with great interest a paper titled 'Will synchronous esophageal and lung resection increase the incidence of anastomotic leaks?A multicenter retrospective study' published in the International Journal of Surgery by Liu et al. [1] .In this study, the authors conducted a large, multicenter cohort study and utilized propensity score matching (PSM) to adjust for confounding factors.The study not only compared the incidence of anastomotic leaks but also analyzed the trend of survival.The authors suggest that staged surgery might be a more suitable option.While Liu and colleagues have conducted a well-matched and meaningful study, there are certain points that require further discussion.
Firstly, the authors The authors conducted a cohort study comparing the combined resection for synchronous lung lesions and esophageal cancer (CRLE) group with the esophagectomy alone group [1] .However, it is important to note that the study did not compare the CRLE group with the staged surgery group.In our opinion, it is crucial to consider the impact of lung resection, particularly in patients with malignant tumors, on survival outcomes.Additionally, the authors did not specify whether the recurrence pattern observed was related to lung malignancy or esophageal cancer.
Secondly, the significance of preoperative therapy in patients with T2/T3N0-1 esophageal squamous cell carcinoma has been recognized in the CROSS study.This finding was further emphasized in the NEOCRTEC5010 study and is also mentioned in current guidelines [2][3][4][5] .However, the study included 258/125 patients with T3 or T4 stages and all patients with more than N1 stages but only 12.5% receive preoperative therapy.
Then, Table 2 provided information on lung resection characteristics in 216 patients.However, only 204 patients (41 + 61 + 35 + 9 + 58) were included in the analysis of lung lesion location.All 216 patients were included in the analysis of lung lesion type.It is perplexing that they were unable to determine the location of the tumor, but were able to distinguish all the pathological results.
Lastly, numerous studies have consistently found that lymphadenectomy of esophageal cancer has a significant impact on patient survival.This impact is determined not only by the number of lymph nodes but also by the location of the tumor and lymph nodes [6,7] .It is important to note that lung cancer and esophageal cancer have different lymph node reflux modes [8,9] , which means that the lymph nodes that need to be removed may also differ in clinical results [10,11] .These differences could potentially influence survival outcomes.
In summary, although this study holds significant clinical significance, it requires further refinement and discussion of the relevant details to improve the comprehensiveness of the conclusions.It is essential to address these points and delve into the complexities of treatment strategies and surgical considerations in synchronous esophageal and lung lesions.This will be crucial for advancing clinical practice and optimizing outcomes for patients with these challenging conditions.necessary resources to conduct this research.We are also immensely grateful to Kunming Medical University for their academic guidance and collaboration throughout this study.Our heartfelt appreciation goes to all the medical staff and healthcare professionals in the Department of Thoracic Surgery at Yunnan Cancer Hospital.Their dedication, expertise, and tireless efforts have been instrumental in the success of this research.We extend our sincere thanks to the research staff in the Department of Thoracic Surgery at Yunnan Cancer Hospital.Their diligent work and valuable contributions have been essential in advancing our understanding of thoracic oncology.We would like to express our special gratitude to Professor Lianhua Ye from the Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University.Professor Ye's guidance, mentorship, and unwavering support have been invaluable throughout this research journey.We also extend our deep appreciation to Professor Yongchun Zhou from the Molecular Diagnosis Center, Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, Yunnan, and the Cancer Center Office, Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, Yunnan.Professor Zhou's expertise and insights have greatly enriched this study.We would also like to extend our sincere gratitude to Professor Yujie Lei, the director of the Scientific Research Department at Yunnan Cancer Hospital.Professor Lei's guidance and assistance throughout the research process have been invaluable.Her expertise and insights have greatly enhanced the quality of this study.Professor Lei not only provided academic guidance but also offered crucial support in coordinating and managing research resources, ensuring the smooth progress of the research.We are thankful to the administrative staff at Yunnan Cancer Hospital for their significant contributions to logistics and administrative support.We express our sincerest gratitude to all the individuals and institutions that have provided support and assistance for this research.Your contributions have had a profound impact on advancing scientific research and medical practice in the field of thoracic oncology.We will continue our efforts to improve the diagnosis, treatment, and quality of life for patients with thoracic tumors, making greater contributions to the cause of human health.