Poster Round

Prince of Wales Hospital, Hong Kong SAR

Aim: This is the first retrospective review of local statistics and outcomes of rigid bronchoscopy airway stenting, and aims to provide insights regarding the disease spectrum, stent usage, complications and survival.

Methods: Records are reviewed for patients who underwent first episode of airway stenting via rigid bronchoscopy between January 2016 and July 2020 done in Prince of Wales Hospital.

Results: 28 patients with a mean of 63.6 years old satisfy the inclusion criteria. Majority are malignancies, including 13 lung cancers (44.8%), 6 esophageal cancers, 2 thyroid cancers and 3 others. Other pathologies include 3 tuberculosis and 1 huge goitre. 19 cases (65.5%) were done in emergency setting for acute airway obstruction (stridor, desaturation, impending respiratory arrest), and the rest a hospital admission from pneumonia and multi-organ failure. Nearly all the rest (25 patients) reported significant improvement and are discharged home without oxygen, except for 2 others with early stent migration which necessitates stent revision. Complications include pneumothorax requiring chest drain insertion (17.2%), pneumonia (13.8%), sputum retention requiring bronchoscopic toileting (6.9%) and dysphagia/feeding tube insertion (17.2%). Long term complications include stent revision due to stent migration (13.8%) or granulation/tumour overgrowth (17.2%). 20 patients (68.9%) died at the time of review, the mean survival is significantly shorter for malignancies (108 days) than for non-malignant obstruction (714 days) (P < .05).

Conclusions: The great majority of airway stenting were performed in emergency/urgent setting to relieve malignant airway obstruction. It is primarily palliative, offering an extra 3.6 months of survival, although also associated with moderate risk of complications (55.2%).

Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR

Aim: Teaching operative surgery in OT is increasingly challenging in undergraduate curriculum with concerns of infection control, intraoperative disruptions and reducing exposure. With less graduates entering surgical profession, better methods of teaching operative surgery are warranted to arouse their interests. Live surgery transmission is popular amongst professional knowledge exchange. This study evaluates applicability of live surgery transmission to teach medical students (MS)on operative surgery.

Methods: This was a cross-sectional study on 6 classes of final year MS from a 6-year undergraduate program in Hong Kong. During the 5-week general surgical clerkship, 3 sessions of general surgical operations were transmitted real-time to classroom. Each 3-hour session was composed of case presentation, topic review by MS and operation illustration by senior surgeon. Post-teaching questionnaire (6-point Likert scale) evaluated 4 aspects - learning experiences on live surgery transmission, willingness for similar sessions, interest arousal and overall satisfaction.

Results: 159 teaching sessions of live surgery transmission were conducted over the 6-year study period and 2592 (96.0%) MS responded to the survey. None had intraoperative disruptions. 98.2% agreed that it could enhanced their understanding of the subject (32.0% strongly agree), 97.2% agreed better understanding of surgical anatomy (37.2% strongly agree), and 97.2% agreed that topic review by MS was useful (33.2% strongly agree). 79.0% wished for more similar sessions. A significant majority (96.6%) agreed it deepened their interests on surgery. 98.0% were satisfied with the sessions.

Conclusions: Remote transmission of live surgery were highly accepted by MS in learning operative surgery. It could enhance their learning experiences and arouse their interests on surgery while avoiding intraoperative disruptions.

Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong SAR

Aim: The study aims to document the visual outcome of 11 patients who suffered from optic nerve compression by meningioma at the orbital apex/juxtasellar region, all of which presented initially with visual impairment and subsequently underwent tumour excision with clinoidectomy.

Methods: 11 cases were identified from the pool of patients who underwent clinoidectomy from 2013-2020 in our centre. Location of tumour based on intra-op findings, visual acuity of bilateral eyes immediately pre-op, on post-op day 1 and on their first clinic follow up has been documented. Visual acuity of the symptomatic eye corresponding to the tumour location is analysed.

Results: Most patients’ visual acuity improved after clinoidectomy and tumour excision.

Conclusions: This cohort with clinoidectomy performed is associated with visual improvement.

United Christian Hospital, Hong Kong SAR

Aim: The incidence of cutaneous squamous cell carcinoma (cSCC) in the Chinese population is low but on a steady rising trend. There is a lack of reporting of the long-term outcome cSCC of this population in the literature.

Methods: Patients with head and neck cSCC were identified from the database of a regional hospital over 20 years. Five-year overall survival and its prognostic risk factors were analysed using Cox proportional hazard regression.

Results: Seventy-three patients were identified (33 men, 40 female). The median age was 84. Median follow-up duration was 44 months. The most common location of tumour was the cheek. Sixty-four patients underwent wide excision. Recurrences was found in 10 patients (13.7%). Median overall survival was 47 months. The 5-year overall survival rate was 39.9%. Survivals did not differ significantly among the T-stages of the eighth edition American Joint Committee on Cancer (AJCC) Tumour, Nodal and Metastasis (TNM) staging. Both age at or older than 75 years old (42 vs 70 months, P = .045) and higher grade of differentiation (2 vs 44 vs 70 months, P = .012) were significant prognostic factor on univariate analysis, but no significant independent factors were identified on multivariate analysis.

Conclusions: The 5-year overall survival in this cohort which consisted of mostly octogenarians and advanced stages of head and neck cSCC is low. Further studies on the Chinese population with regards to the long-term survival outcome is warranted.

Division of Urology, Department of Surgery, Princess Margaret Hospital, Hong Kong SAR

Aim: Enhanced recovery after surgery (ERAS) is the multidisciplinary approach to improve patients’ outcomes after major surgeries. We aim to investigate the impact of ERAS on robotic-assisted laparoscopic radical cystectomy in our center since its implementation in December, 2017.

Methods: Between December 2017 and June 2020, a total of 31 patients underwent robotic-assisted laparoscopic radical cystectomy under the ERAS program. The outcomes of these patients were retrospectively compared to the cohort of 12 patients whose robotic surgery was performed before implementation of ERAS. Patient characteristics, peri-operative parameters and outcomes were reviewed.

Results: Patients in both cohorts were matched with respect to age, sex, American Society of Anesthesiologists Classification, neoadjuvant treatment, tumor and nodal staging. Patients under the ERAS program had less blood loss (566 vs 1179 mL, P = .008) and their peri-operative transfusion rate was lower (22.6 vs 66.7%, P = .015). They had shorter time to first flatus (3.48 vs 4.50 days, P = .013). The mean operative time was similar (445 vs 485 minutes, P = .254). There were no patients requiring re-operation in the ERAS program (0 vs 3; P = .018). The median length of stay was shorter (15 vs 16.5 days, P = .201) and 30-day complication rate was lower (32.3 vs 41.7%, P = .723), but they were not statistically significant.

Conclusions: Implementation of ERAS for robotic-assisted laparoscopic radical cystectomy in our center has improved outcomes. Additional benefits were conferred to the robotic approach. Multi-institutional prospective studies are eagerly awaited.

Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR

Aim: Primary mesenchymal tumors in the perineum are rarely presented and most general surgeons are not familiar with the management. As the close proximity of perineal tumor to anorectal region, these patients are usually referred to colorectal surgeons for resectability. We would like to present our experience in managing these rare tumors in a tertiary referral center.

Methods: All medical records of patients presented with perineal mass were retrospectively reviewed in Division of Colorectal Surgery, Queen Mary Hospital.

Results: Five female and two male patients (median age 44) were identified and all had pressure symptom from the perineal mass, including constipation. MRI pelvis were performed in all patients and median size of 91.4 mm (range 66-158) were noted. According to radiological features, three patients had transperineal resection without preoperative pathological diagnosis (two epidermal cyst and one tailgut cyst). Of the four patients with transperineal biopsy, three patients had spindle cell tumors and one had sarcoma. Two of three patients with spindle cell tumors underwent en-bloc resection (one aggressive angiomyxoma and one solitary fibrous fibroma). The other patient with spindle cell tumor also suggestive of aggressive angiomyxoma and will have operation after neoadjuvant hormonal therapy. The patient with sarcoma was initially suspected to be anorectal abscess but confirmed to be alveolar rhambdomyosarcoma. As the patient refused abdominoperineal resection, chemoradiation was given but patient died of distant metastases at 34 months after diagnosis.

Conclusions: Perineal mesenchymal tumors are rare in clinical presentation and preoperative MRI pelvis is essential investigation to guide subsequent management.

Queen Elizabeth Hospital, Hong Kong SAR

Aim: In recent years, there has been a shift into non-operative management of splenic trauma for most patients. At our unit, we follow a protocol for splenic injury which was established in September 2012. The primary aim of this study is to investigate whether this protocol has allowed for more non-operative management of splenic traumas. The secondary aim is to identify risk factors for failing non-operative management.

Methods: We conducted a retrospective cohort study of all adult patients with splenic trauma who were admitted into the Queen Elizabeth Hospital between 1 January 2008 and 31 December 2018. 74 patients were included.

Results: There was an increase in percentage of patients managed conservatively after the protocol establishment (71.4%) compared with before (43.8%) (P = .016). Pre-protocol and post-protocol rates of failure of conservative management (P = .71) and in-patient death (P = .84) were similar. Units of red cells transfused in the first 72 hours (P = .85), and length of stay were also similar between the two groups.

Risk factors for failure of conservative management include high ISS score (P = .003), higher number of red cell transfused within the first 72 hours of admission, high energy trauma (P = .018), and ASA grading of 3 to 5 (P = .002).

Conclusions: The protocol increases the percentage of conservative management of the spleen and does not result in a higher percentage of failure. The protocol can be safely applied to preserve more spleens. We should be vigilant for patients at high risk for failure of conservative management.

Department of Surgery, Queen Mary Hospital, Hong Kong SAR

Aim: This is a systematic review of randomised controlled trials comparing the use of axillary reverse mapping (ARM) with conventional technique for axillary lymph node dissection in breast cancer surgery. The primary objective is to compare the post-operative lymphoedema rate in the respective study and control groups. Secondary objectives focus on the oncological safety of axillary reverse mapping quantified by intra-operative identification of ARM nodal metastasis and detection of axillary recurrence in the subsequent follow up period.

Methods: This review is written in line with the PRISMA protocol. Articles were retrieved from online journal databases with keywords “axillary reverse mapping”, “axillary lymph node dissection” and “randomised controlled trial”.

Results: 5 randomised controlled trials matching the aim of this review were included upon screening of 73 publications. There were findings of a lower post-operative lymphoedema rate in study group patients across all 5 RCTs, with statistical significance reached among larger studies. Oncological safety remains a highly-debatable topic with surgeon expertise and discretion required for intra-operative identification and removal of suspicious ARM nodes to achieve axillary clearance. Limitations include skewing of patient distribution towards lower tumour staging and lack of reporting of adjuvant therapy which may influence development of lymphoedema. Median follow up was at most 37 months for which late-onset lymphoedema and axillary recurrence rate may be under-reported.

Conclusions: Axillary reverse mapping is a feasible technique in the prevention of lymphoedema in axillary lymph node dissection with further large-scale randomised controlled trials and longer duration of follow up recommended.

Prince of Wales Hospital, Hong Kong SAR

Aim: To audit accuracy and adequacy of initial burns assessment, management and documentation before transferral of patient.

Methods: Retrospective audit with the referral forms of patients transferred from other hospitals to Prince of Wales Hospital (PWH) between 2015 and 2018. Information concerning burn injury, burn percentage, initial resuscitation were collected and compared to the final assessment after reaching PWH.

Results: 250 referral forms were reviewed - only 91.2% of the forms documented the patients’ total surface burn area (TBSA). 63 patients were documented as major burns before transferral but only 29 turned out to be major burns after assessment at PWH. There was a trend of overestimation of the TBSA at initial assessment (mean + 7.1%). 2 cases of major burns were initially underestimated as minor burns. Among those 63 cases classified as major burns before transferral, 51 (81.0%) have fluid resuscitation and only 26 (41.7%) inserted foley. For patients who sustained facial burns, 11 (28.9%) were intubated before transfer; 4 (10.5%) were escorted by staff who can assess and secure the airway during transfer; 22 (57.9%) of them had no airway intervention or assessment before transfer.

Conclusions: Majority of referrals had proper documentation, but there is still room for improvement. There is discrepancy in the accuracy of assessment including initially labelling patient as minor burns which subsequently turned out to be major burns, rendering initial resuscitation insufficient. Efforts in ensuring that the form is adequately filled before transfer and improving initial assessment is crucial to improve burns management and outcome.

Department of Urology, Queen Mary Hospital, Hong Kong SAR

Aim: To report the clinical outcomes of cadaveric renal transplantation using grafts from expanded criteria donors (ECD).

Methods: From 2005, 201 renal transplants were performed using cadaveric donor grafts, 42 from ECD and 159 from standard criteria donors (SCD). The demographics, perioperative and late outcomes of these two groups of recipients were studied.

Results: Recipients receiving ECD grafts were older (P < .001). The cold and warm ischemic times, operative duration and estimated blood loss were similar between the groups. There was a trend towards more surgical complications in the recipients receiving ECD grafts (14% vs 9%, P = .206). Grafts from SCD donors survived significantly longer than ECD grafts (mean survival 163 vs 120 months, P = .032). The mean graft failure-free survival in the ECD group was significantly worse than that in the SCD group (74 vs 137 months, P < .001). ECD graft recipients also had significantly inferior overall survival at 1 and 5 years compared SCD counterparts.

Conclusions: Expanding donor criteria is one solution to the burgeoning crisis of organ supply but it was associated with a trend towards more surgical complications, shorter graft survival and higher mortality rates. Our results provided important local reference for recipients, nephrologists and urologists in the use of ECD grafts.

Queen Mary Hospital, Hong Kong SAR

Objectives: It studies the survival outcomes of curative resection and palliative treatment of cutaneous scalp angiosarcoma in a Hong Kong tertiary institution to define the prognosis of different treatment modalities. Survival benefit of adjuvant radiotherapy was reviewed.

Methods: Data were collected from 1987 to 2019 at Queen Mary Hospital and Kwong Wah Hospital, Hong Kong. Biopsy proven cutaneous scalp angiosarcoma patients were included. Kaplan-Meier method is used to compare the overall survival of the three groups: (a) curative resection, (b) palliative radiotherapy, (c) palliative chemoirradiation.

Results: Fifty-one patients were retrieved, among them forty-two were male. Median age was 77 (range, 40-90) years. Surgical margin was achieved with an average of 3 cm. Median survival of all patients was 20.37 months. Overall survival of all patients at 1, 3, 5-year were 65.7%, 24.3%, 12.2% respectively. Overall survival of surgical group at 1, 3, 5-year are 77.9%, 53.6% and 19.1%, mean time to recurrence was 6.73 months. The 1, 3-year overall survival were 50%, 10% respectively in palliative radiotherapy group. The 1-year overall survival of palliative chemoirradiation group was 50% and there was no 3/5-year survivor. Patients who received adjuvant radiotherapy after curative resection had a statistically significant longer survival than those without adjuvant radiotherapy, the median survival were 33.8 and 8.2 months respectively (P = .001). Majority of the patients subsequently also developed locoregional recurrence and lung metastasis.

Conclusions: Overall survival is poor in head and neck cutaneous angiosarcoma. Aggressive resection with adjuvant radiotherapy has the best treatment outcome.

Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR

Aim: To audit the result of magtrace with blue dye in breast carcinoma patients.

Methods: Retrospective study comparing the result of using magtrace vs patent blue as tracer for identification of SLN on the same patient with breast carcinoma. Mastectomy patients in pyneh who were indicated for SLN biopsy but had difficulty in accessing the nuclear medicine department were recruited. Primary outcome is the LN detection rate. secondary outcomes include concordance rate, positive SLN rate, and metastatic SLN concordance rate.

Results: Between June 2019 and April 21, 2020 patients received magtrace injection preoperatively for SLN biopsy, and they also have patent blue injection immediately after GA. All were females, age mean 66 (range 44-92 years old), majority were IDC (66.7%) and T2 (58.8%). 65 LN (3.1/patient) were stained with magtrace and 32 LN (1.5/patients) were stained blue (P value = .007). The detection rate is 100% (21/21) and 95.2% (20/21) in magtrace and blue dye arms, respectively. 4 (20%) patients required axillary dissection due to positive SLN, which 2 are magtrace stained only and 2 are both magtrace and patent blue stained. The metastatic concordance rate was 50%.

Conclusions: SPIO for mastectomy patient had significantly high SLN detection rate, increased number of SLN harvest, higher positive SLN harvested, but low metastatic concordance when compared with patent blue. It will be a promising agent for centers with deficient nuclear medicine service. More case recruitment and longer followup will be required to look for axillary LN recurrence.

Department of Surgery, Queen Elizabeth Hospital, Hong Kong SAR

Aim: Overt small bowel bleeding is a surgical emergency. In cases of failed non-operative treatment or life-threatening bleeding, laparotomy and intra-operative enteroscopy (IOE) remains a last resort. However, data is lacking on the role and efficacy of IOE.

Methods: 25 patients between age 28 and 88 requiring IOE from January 2004 to December 2018 in Queen Elizabeth Hospital in Hong Kong were retrospectively reviewed. Their demographics, risks factors and outcomes were analyzed.

Results: Pre-operatively, 72% of patients had unstable hemodynamics with a median hemoglobin drop of 5.5 g/dL. 32% patients had catheter angiogram but failed hemostasis due to no contrast extravasation seen (24%) or failed embolization (8%). IOE helped identify bleeding in 92% of cases and guided small bowel resection. Pathology review showed NSAIDs-related or other ulcers (52%); vascular lesions including angiodysplasia, Dieulafoy's lesion etc. (24%); diverticulum (12%); Crohn's disease (4%), tuberculosis (4%) and Peutz-Jehger syndrome (4%). 19 patients (76%) had resolution of bleeding. 2 recurrent bleeding required re-operation with benign ulcers identified; 4 were conservatively managed. 1 patient complicated with entero-cutaneous fistula requiring re-operation. 30-day mortality was 24%. Pre-op hemodynamics, hemoglobin drop, use of anti-coagulants/anti-platelets and pathology has no statistical correlation with recurrent bleeding. Recurrent bleeding results in higher morbidity (P = .011) but does not affect mortality. Age > 80 is risk factor for mortality (P = .038).

Conclusions: Ulcers, vascular anomalies and diverticulum are the most common causes of overt small bowel bleeding in the emergency setting. IOE has high diagnostic yield and remains a life-saving tool in treatment of such pathologies.

Pok Oi Hospital, Hong Kong SAR

Aim: MBC is uncommon. Local data on this disease is limited. This study aims to review outcomes of MBC patients and to compare with that of females.

Methods: MBC patients in a single institution in HK from 2010 to 2019 were reviewed. Case control study was performed by matching based on age at diagnosis, year of diagnosis and stage. Overall survival (OS) and disease-free survival (DFS) were calculated using Kaplan-Meier analysis. Log rank test was performed to detect any differences.

Results: 21 MBC patients were identified. The median age at diagnosis was 69. 20 (95.2%) patients were diagnosed stage I-III disease. 17 (81.0%) patients underwent surgery. 8 (38.1%) and 9 (42.9%) patients received adjuvant chemotherapy and radiotherapy while 14 (66.7%) and 1 (4.76%) patients received hormonal and targeted therapy. 34 patients were eligible for comparison after excluding cases with no match (17 male M,17 female F). Mean follow up time was 42.4 ± 27.6 months (M) and 38.8 ± 28.9 months (F). OS was 78.7 ± 12.2 months (M) and 65.2 ± 10.1 months (F) (P = .583). DFS was 97.0 ± 9.20 months (M) 84.2 ± 6.98 months (F) (P = .677). The 3-year survival rates were 55.6% (M) and 56.3% (F) (P = .892). 5-year survival rates were 39.7% (M) and 40.4% (F) (P = .677).

Conclusions: The OS and DFS of MBC patients are comparable to their female counterparts. More evidence from prospective trials involving larger population and longer follow up period is required to confirm the results.

Department of Surgery, Kwong Wah Hospital, Hong Kong SAR

Aim: This report aims at studying whether the watch-and-wait strategy is applicable in patients with complete clinical response after NCRT and thus to avoid radical surgery.

Methods: Neoadjuvant chemoradiotherapy (NCRT) is used for locally advanced rectal cancer and about 15% to 20% can achieve pathological complete response. Habr-Gama has advocated watch-and-wait strategy for patients with complete clinical response after NCRT to avoid postoperative morbidity and functional disorders after radical surgery. A 69-year-old Chinese woman presented with per-rectal bleeding. Colonoscopy found a tumor at distal rectum and computer tomography scan showed no distant metastasis. Magnetic resonance imaging (MRI) staging was T4a, N2a, EMVI−, CRM+.

Results: The above-said patient underwent NCRT, the total dose of radiotherapy was 50.4 Gy, which was given in a fractionated manner (1.8 Gy × 28 Fr over 6 weeks). Intravenous fluorouracil was given concurrently with radiotherapy. Two months after the completion of NCRT, MRI restaging was mrTRG1/2 with possible total tumor regression, yN0, CRM−, EMVI− and endoscopy showed a scar only at the tumor site with biopsy showed no malignancy. Condition of complete clinical response was explained to patient, she opted for watch-and-wait strategy rather than surgery. We then performed regular endoscopy and MRI monitoring for her. She has kept the clinical complete response for 2 years till now since the completion of NRCT.

Conclusions: In patients with complete clinical response, the watch-and-wait strategy is a viable option to achieve organ preservation and spare surgical morbidities.

Division of Breast Surgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR

Aim: Treatment of elderly patients with operable breast cancer requires a multi-disciplinary approach to match the medical needs specific to the geriatric population. We investigated the clinical and pathological determinants in an elderly population with localized breast cancer to identify the prognostic factors for survival.

Methods: Chinese patients aged 70 and above with non-metastatic breast cancer treated between 2008 and 2017 at a University-affiliated tertiary breast centre were reviewed. Clinical-pathological factors as well as patients’ premorbidity predicting overall survival were analysed using univariate and multivariate cox proportional hazard model.

Results: 347 patients fulfilled the inclusion criteria for analysis. Our cohort had a median overall survival of 10.7 years. When stratified by TNM staging, overall survival was 11.29, 10.13, and 4.36 years for stage I, II and III respectively. Univariate analysis identified advanced age, high Charlson Comorbidity Index, American Society of Anesthesiologists score of 3, dependent functional status, larger tumor size, advanced lymph node status, histological high grade, and those who underwent primary endocrine therapy alone to be associated with increased risk of mortality. Multivariate analysis showed that only Charlson Comorbidity Index had a significant effect on survival probabilities, after adjusting for other variables. Those patients with more comorbidities (higher Charlson Comorbidity Index) predicted increased risk of death compared with those without comorbidities in this elderly cohort (HR = 3.411; 95% CI 1.515-7.681, P = .003).

Conclusions: Fragility determines survival outcomes in older breast cancer patients. There is a need for comprehensive geriatric assessment in personalizing treatment options in this population to optimise survival outcomes.

Department of Surgery, Queen Mary Hospital, Hong Kong SAR

Aim: Cyclooxygenase-2 (COX-2) over-expression was reported to be associated with resistance to chemoradiation. Use of COX-2 inhibitor can potentially enhance the effect of neoadjuvant chemoradiotherapy. This study aims to investigate whether using COX-2 inhibitor in esophageal squamous cell carcinoma (ESCC) would improve the overall survival and tumor response rate.

Methods: Patients with potentially resectable ESCC (T1-3, N0-1, M0 disease, AJCC sixth edition) diagnosed in QMH from 2002 to 2019 were retrospectively reviewed. Neoadjuvant chemoirradiation with PFRT (Cisplatin-5FU-based) or CROSS (Carboplatin-paclitaxel-based) regime were used. Patients on PFRT were recruited to additional use of Celecoxib. Patients were stratified into three subgroups (PFRT+Celecoxib, PFRT and CROSS) for analysis. PFRT and CROSS group was matched to PFRT+Celecoxib group in 1:1 caliper respectively with propensity score matching. Primary outcome was overall survival. Secondary outcomes were resection rate and pathological complete response (pCR) rate.

Results: 322 patients were identified including 45, 168 and 109 patients treated with PFRT+Celecoxib, PFRT and CROSS respectively. Propensity score-matched analysis was performed leaving 42 patients in each group. PFRT+ Celecoxib has longer median overall survival (53.9 ± 14.2 months) compared to PFRT (27 ± 5.4 months) and CROSS (14.6 ± 3.7 months), though it was statistically insignificant (P = .091). More patients in PFRT+ Celecoxib and PFRT group proceeded with esophagectomy compared to CROSS group (88.1% vs 81% vs 66.7%, P = .051). Similar pCR rates were found between three groups (P = .295).

Conclusions: Use of COX-2 inhibitor in combination with neoadjuvant PFRT may improve overall survival and tumor resection rate in patients with locally advanced ESCC. Further randomized study with larger sample size is warranted.