NEW YORK, April 4, 2023 /PRNewswire-PRWeb/ -- The Mount Sinai Health System's esophagectomy program has received a three-star (excellent performance) overall composite score from the Society of Thoracic Surgeons (STS).

According to STS, only 13 institutions in the United States and Canada hold the three-star rating, which denotes the highest category of quality, for esophagectomy surgery. The esophagectomy overall performance score represents two domain scores in a single number: absence of both operative mortality and major morbidity.

Esophagectomy is the main surgical treatment for esophageal cancer. Mount Sinai's esophagectomies incorporate a surgical innovation by Raja Flores, MD, Chair of Thoracic Surgery at the Mount Sinai Health System, who pioneered a simple yet highly effective change in the surgical approach.

"I'm surprised and honored at the recognition our department has received from the STS," Dr. Flores said. "Surprised because it has been my hope that surgeons at other institutions would adopt our modification, which simply involves switching the juncture site between the stomach and the esophagus to promote better blood flow between the two organs." Dr. Flores described the revision in an article in the Journal of Surgical Oncology and created a video to demonstrate the technique.

The revised procedure is less invasive than conventional esophagectomy, causes less trauma, and reduces complications such as leaking or obstruction. It also decreases the average surgical time from seven to 2.5 hours, according to the journal article.

Many esophageal cancer patients have suffered for years from heartburn and acid reflux, and deal with the symptoms by taking antacids, Dr. Flores noted. Lou Martinez, an overnight custodian for the New York court system, was among them. One night several years ago, Mr. Martinez was having dinner at work and found that the food wouldn't go down; it stuck in his throat. Even water just sat there.

"We diagnosed him with esophageal cancer, and like many other patients, he was shocked that a common symptom like heartburn could lead to a serious condition like cancer," Dr. Flores recalled. Mr. Martinez, one of approximately 19,000 patients diagnosed with esophageal cancer annually in the United States, underwent the revised esophagectomy several years ago and continues to do well.

What drew Dr. Flores to thoracic surgery? "Actually, thoracic surgery chose me," he said. "I didn't know anything about the field until I was a fourth-year surgery resident in the '90s. I started seeing some patients who were a little rough around the edges, who suffered from self-inflicted exposures like alcohol addiction or smoking. I treated them at a time when esophagectomy was a dreaded procedure, when patients would have complications right and left. As I treated them, I realized I really love this field."

Incremental changes have made esophagectomy much safer and more effective since then, and Dr. Flores hopes his approach will continue to move the field forward. "It's not about whether you use a robot or laser or some other tool," he said. "Focusing on the fine points of an operation is what actually gets rid of the cancer and helps ensure that the patient will recover without a complication."

The STS star rating system is one of the most sophisticated and highly regarded overall measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs in the United States and Canada. The General Thoracic Surgery Database (GTSD) star ratings are derived by testing whether the participant's composite or domain score is significantly different from the overall STS average for esophagectomy for esophageal cancer performed by GTSD participants.

STS General Thoracic Surgery Public Reporting offers a comparison of GTSD and national outcomes, demonstrating the high performance of GTSD participants. The latest analysis of data for esophageal cancer resection covers a three-year period, from July 1, 2019, to June 30, 2022, and includes 101 participants.

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The Mount Sinai Health System's esophagectomy program has received a three-star overall composite score from the Society of Thoracic Surgeons.

Mount Sinai Achieves Highest Rating From Society of Thoracic Surgeons for Ground-Breaking Esophagectomy Program

Mount Sinai researchers have published results that show encouraging therapeutic options for patients with the blood cancer multiple myeloma after first-line treatment with bispecific antibodies fails. Bispecific antibodies are a type of antibody that can bind to two different antigens at the same time—they are meant to enhance the immune system’s destruction of tumor cells.

While new T cell-based immunotherapies, or “T-cell redirection” therapies, such as chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies have revolutionized cancer treatment, doctors still need to determine what second-line treatments (also known as salvage therapy) are effective after a patient relapses. In the August 26 online edition of 

, Mount Sinai researchers report that sequential use of different T-cell redirection therapies in these multiple myeloma patients is possible and could lead to good patient outcomes and survival.

In a retrospective analysis, researchers identified 58 multiple myeloma patients who participated in a bispecific antibodies clinical trial at Mount Sinai and underwent salvage therapy due to relapse. Patients were followed for an average of 30.5 months after the end of the trial and underwent an average of two salvage therapies over that period.

Nineteen patients received T-cell redirection therapy as a first salvage therapy, and the rest received a non-T-cell redirection therapy, such as chemotherapy. Thirty-two percent of patients who underwent T-cell redirection therapy as a first salvage therapy needed to undergo a second salvage therapy due to relapse or nonresponse to therapy. In a significant contrast, 79 percent of the patients treated with a non-T-cell redirection therapy needed to undergo a second salvage therapy. Some of this group of patients had T-cell redirection therapy as their second salvage therapy, resulting in a total of 28 patients who received T-cell redirection as either a first salvage therapy or second salvage therapy.

Depth and duration of response to the first bispecific antibodies treatment did not predict response to the second T-cell redirection therapy, indicating that even if patients did not respond to an initial T-cell redirection therapy, there may still be an option to effectively treat with a second course. The overall response rate of the 19 patients who transitioned from the initial bispecific antibodies to T-cell redirection therapy as a first salvage therapy was 84 percent, compared to 49 percent in those who received other types of therapies.

“As the clinical use and advancement of T-cell redirection therapies continue to grow, effective strategies are needed to manage outcomes for patients who relapse or are unresponsive to this initial treatment,” said senior author Samir Parekh, MD, Director of Translational Research in Myeloma, co-leader of the Cancer Clinical Investigation program at The Tisch Cancer Institute, and a member of the Icahn Genomics Institute at the Icahn School of Medicine at Mount Sinai. “This study shows patients relapsing after initial bispecific antibodies therapy can benefit from a second bispecific antibody or CAR-T cell therapy.”

Studies are underway to understand how T cells function after initial T-cell redirection therapy and how they are activated in sequential bispecific antibodies and CAR-T cell treatments. “Future clinical trials incorporating sequential combinations of T-cell redirection therapy will build upon these findings to further develop treatment guidelines and improve long-term outcomes for multiple myeloma patients,” Dr. Parekh said.

This work was supported by the National Cancer Institute (NCI) R01 CA244899 and CA252222.

T-cell redirection therapy has shown to be effective in patients unresponsive to initial bispecific antibody treatment.


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Mount Sinai Achieves Highest Rating From Society of Thoracic Surgeons for Ground-Breaking Esophagectomy Program

Mount Sinai Researchers Report Encouraging Immunotherapy Option for Relapsed Myeloma