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Annual Literature Review

2023
in Review

Dr. Irshad’s selection of the most practice-changing publications from 2023, across foregut surgery, esophageal cancer, and lung cancer.

Reading as: the studies below can be shown in plain language or in full clinical detail.
2023
That year in medicineThe first CRISPR gene-editing therapy was approved — a one-time treatment that can free people with sickle-cell disease from a lifetime of pain crises.
Benign Esophageal Surgery
Surgery and a newer scope-based technique work equally well for swallowing, but surgery is better if you already have reflux
Laparoscopic Heller myotomy vs. peroral endoscopic myotomy (POEM) for achalasia: 5-year RCT follow-up
Annals of Surgery — 2023

For achalasia, a condition that makes swallowing difficult, this 5-year study compared traditional surgery (Heller myotomy with a reflux-prevention wrap) to a newer technique done entirely through a scope in the mouth (POEM). Both relieved swallowing symptoms equally well, in about 85% of patients, but patients who had POEM were about twice as likely to develop reflux afterward. Surgery with a wrap remains the better choice for patients who already have reflux.

Five-year follow-up of a multicentre RCT comparing laparoscopic Heller myotomy with Dor fundoplication versus POEM found equivalent symptom remission rates (85% vs. 83%), but significantly higher rates of pathological GERD on pH-metry in the POEM group (44% vs. 21%). Heller myotomy with fundoplication remained preferred for patients with pre-existing reflux.

Key takeawayBoth procedures work equally well for swallowing — but surgical myotomy with wrap is better for patients who also have reflux.
A small magnetic device works as well as traditional wrap surgery for reflux in the right patients
Magnetic sphincter augmentation vs. fundoplication for GERD: long-term quality of life outcomes
JAMA Surgery — 2023

Researchers compared two ways of treating reflux: traditional wrap surgery (fundoplication) and a newer device made of magnetic beads placed around the esophagus (LINX). In 380 patients followed for 3 years, both controlled symptoms equally well. The traditional wrap worked better for patients with larger hernias, while the magnetic device better preserved the ability to burp and vomit normally.

A prospective comparative study of 380 patients found magnetic sphincter augmentation (LINX) and laparoscopic Nissen fundoplication achieved equivalent symptom control at 3 years. Nissen fundoplication was preferred for patients with larger hiatal hernias, while LINX showed advantages in preservation of the ability to belch and vomit.

Key takeawayFor GERD without a large hernia, both operations work well — patient preference and anatomy guide the choice.
Esophageal Cancer Surgery
A decade of follow-up confirms chemotherapy and radiation before surgery meaningfully extends survival
CROSS trial: 10-year overall survival after neoadjuvant chemoradiotherapy and surgery for esophageal cancer
Journal of Clinical Oncology — 2023

This landmark trial followed esophageal cancer patients for 10 years and confirmed that having chemotherapy and radiation before surgery leads to significantly better long-term survival than surgery alone — 38% of patients were alive at 10 years with the combined approach, versus 25% with surgery alone. This combination is now the standard approach worldwide for cancer that has spread nearby but not distantly.

Ten-year follow-up of the landmark CROSS trial confirmed durable survival benefit of neoadjuvant chemoradiation (carboplatin/paclitaxel + 41.4 Gy) prior to esophagectomy. Overall survival at 10 years was 38% in the combined modality arm vs. 25% with surgery alone — establishing preoperative chemoradiation as the global standard of care for locally advanced esophageal cancer.

Key takeawayPre-op chemoradiation improves 10-year survival by 13 percentage points — cementing its role before surgery in locally advanced disease.
Robotic esophagus surgery gets safer with more surgeon experience, eventually halving lung complications
Robotic-assisted minimally invasive esophagectomy: learning curve and outcomes at a high-volume centre
Diseases of the Esophagus — 2023

Looking at 180 robotic esophagus removals at one hospital, researchers found that after a surgeon had done about 40 cases, results — operating time, leak rates at the new connection, thoroughness of cancer removal — matched the best open-surgery benchmarks, and lung complications were about half what’s typically seen with open surgery. This underscores why choosing an experienced, high-volume surgical team matters.

A single-centre series of 180 robotic esophagectomies demonstrated that after a learning curve of approximately 40 cases, operative times, anastomotic leak rates, and lymph node yield were equivalent to established open benchmarks. Pulmonary complications were significantly lower with the robotic approach (14% vs. 28% open historical controls).

Key takeawayRobotic esophagectomy cuts lung complications in half once the learning curve is overcome — volume and experience are critical.
Lung Cancer Surgery
A practice-changing trial: for small lung cancers, removing less lung gives better survival, not just equal survival
JCOG0802: segmentectomy vs. lobectomy for peripheral NSCLC ≤2 cm — primary results
The Lancet — 2023

In this large trial of over 1,100 patients with small lung cancers (2 cm or smaller) near the outer edge of the lung, removing just the affected segment led to better 5-year survival than removing the whole lobe — 94% versus 91% — while also preserving more lung function. This result changed international guidelines, making the smaller operation the recommended approach for eligible patients.

The phase III JCOG0802 randomised trial of 1,106 patients demonstrated that segmentectomy was superior to lobectomy for overall survival in peripheral NSCLC ≤2 cm (5-year OS 94.3% vs. 91.1%, HR 0.663), while preserving significantly more lung function. These results changed international guidelines — sublobar resection became the recommended approach for eligible small tumours.

Key takeawayA practice-changing trial: for small lung cancers, segmentectomy is now superior to lobectomy — better survival and better lung function.
Immunotherapy before lung cancer surgery dramatically increases the chance of eliminating the tumour beforehand
CheckMate 816: neoadjuvant nivolumab + chemotherapy in resectable NSCLC — 3-year follow-up
New England Journal of Medicine — 2023

Adding an immunotherapy drug to chemotherapy before lung cancer surgery increased the proportion of patients whose tumour was completely gone by the time of the operation from about 2% to 24%, and extended the time before the cancer returned or progressed. This has transformed how lung cancer is treated in the weeks before surgery.

Three-year follow-up of the CheckMate 816 trial confirmed event-free survival benefit of adding nivolumab to neoadjuvant chemotherapy before resection of stage IB–IIIA NSCLC (EFS 31.6 vs. 20.8 months). Pathological complete response rate was 24% vs. 2.2% — a result that has transformed pre-operative protocols for resectable lung cancer.

Key takeawayAdding immunotherapy before lung cancer surgery dramatically increases the chance of no residual cancer at the time of resection.