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      Impact of body mass index on perioperative and oncological outcomes in elderly patients undergoing minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma


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          The association between elevated body mass index (BMI) and perioperative and oncological outcomes among elderly patients undergoing minimally invasive McKeown esophagectomy (MIE) remains unclear.


          We performed a single‐center retrospective analysis of 526 consecutive patients aged 65 years or older who underwent MIE for esophageal squamous cell carcinoma (SCC) between January 2016 and December 2019. Two groups were stratified by BMI: normal (18.5 ≤ BMI < 24 kg/m 2) and elevated groups (BMI ≥ 24 kg/m 2). A 1:1 propensity score matching (PSM) analysis was used to compare perioperative and oncological outcomes between the two groups.


          A total of 480 elderly patients were eventually enrolled, with a mean age of 70.2 years (range: 65–87), and 185 patients were eligible for elevated BMI, with a mean BMI of 26.3 ± 1.9 kg/m 2. Compared with the normal BMI group, the elevated BMI group had prolonged operation time (261.7 ± 57.2 vs. 278.9 ± 62.7 mins, p = 0.002) and increased incidence of intraoperative hypoxemia (12.2% vs. 21.6%, p = 0.006). The differences in intraoperative estimated blood loss, transfusion, new‐onset arrhythmia, and conversion rates and postoperative outcomes regarding pulmonary and surgical complications, intensive care unit and 30‐day readmissions, the length of hospital stay, and oncological outcomes regarding R0 dissection, and the number of dissected lymph nodes between two groups were comparable. After a 1:1 PSM analysis, there was no significant difference in both perioperative and oncological outcomes between two groups.


          Among elderly patients undergoing MIE for esophageal SCC, there was insufficient evidence to demonstrate that elevated BMI could increase perioperative and oncological adverse outcomes.


          After a 1:1 PSM analysis, there was insufficient evidence that elevated BMI increased perioperative and oncological outcomes among elderly patients undergoing MIE for esophageal SCC.

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          An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies

          The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
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            Mechanisms, Pathophysiology, and Management of Obesity

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              Oesophageal cancer

              Oesophageal cancer is a clinically challenging disease that requires a multidisciplinary approach. Extensive treatment might be associated with a considerable decline in health-related quality of life and yet still a poor prognosis. In recent decades, prognosis has gradually improved in many countries. Endoscopic procedures have increasingly been used in the treatment of premalignant and early oesophageal tumours. Neoadjuvant therapy with chemotherapy or chemoradiotherapy has supplemented surgery as standard treatment of locally advanced oesophageal cancer. Surgery has become more standardised and centralised. Several therapeutic alternatives are available for palliative treatment. This Seminar aims to provide insights into the current clinical management, ongoing controversies, and future needs in oesophageal cancer.

                Author and article information

                Cancer Med
                Cancer Med
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                21 March 2022
                August 2022
                : 11
                : 15 ( doiID: 10.1002/cam4.v11.15 )
                : 2913-2922
                [ 1 ] Department of Anesthesiology, Shanghai Chest Hospital Shanghai Jiao Tong University Shanghai China
                [ 2 ] Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine Shanghai Jiao Tong University Shanghai China
                Author notes
                [*] [* ] Correspondence

                Hongwei Zhu and Jingxiang Wu, Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai 200030, China.

                Email: zhuhongwei06@ 123456163.com and wjx1132xk@ 123456163.com

                Author information
                CAM44660 CAM4-2021-12-5172.R1
                © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                : 13 February 2022
                : 08 December 2021
                : 19 February 2022
                Page count
                Figures: 3, Tables: 6, Pages: 10, Words: 3738
                Funded by: National Natural Science Foundation of China , doi 10.13039/501100001809;
                Award ID: 82071233
                Funded by: Shanghai Shen Kang Hospital Development Center Project
                Award ID: SHDC2020CR4063
                Funded by: Shanghai Chest Hospital , doi 10.13039/501100008837;
                Research Article
                RESEARCH ARTICLES
                Clinical Cancer Research
                Custom metadata
                August 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.7 mode:remove_FC converted:08.08.2022

                Oncology & Radiotherapy
                elderly,mckeown,minimally invasive esophagectomy,outcomes,scc
                Oncology & Radiotherapy
                elderly, mckeown, minimally invasive esophagectomy, outcomes, scc


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