Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
ObjectiveTo explore the clinical features and the prognostic factors of neuroendocrine carcinoma of the esophagus. MethodsWe retrospectively analyzed clinical data of 41 cases of neuroendocrine carcinoma of the esophagus admitted in the First Affiliated Hospital of Nanjing Medical University between March 2008 and March 2014. There were 37 males and 4 females at a mean age of 61.1±7.9 years (ranged from 40 to 79 years). All patients underwent surgical resection and lymph node dissection. ResultsNo severe complications occurred during the perioperative period, and no death occurred during the period of hospitalization.Thirteen patients received postoperative chemotherapy and radiotherapy. Eleven patients received simple postoperative chemotherapy. One patient received postoperative radiotherapy. The remaining 16 patients did not receive any special treatment. The patients were followed up for 6 to 61 (24.0±13.6)months. Twenty-two patients survived, the other 19 patients died. The 1-year, 2-year, 3-year, 4-year, and 5-year survival rate was 80.49%, 39.02%, 21.95%, 7.32%, and 4.88%, respectively. The median survival of single surgical treatment and postoperative comprehensive treatment was 12.0 months and 25.0 months, respectively. The median survival of T2-T4 and T1 was 20.0 months and 37.5 months, respectively. The difference was statistically different (P<0.05). Cox regression analysis showed that the depth of tumor invasion, postoperative adjuvant chemotherapy and radiotherapy were independent factors of prognosis (P<0.05). ConclusionsNeuroendocrine carcinoma of the esophagus is rare and with a high degree of malignancy. It is expected to increase the long-term survival rate after surgical and postoperative comprehensive treatment.
ObjectiveTo explore the effects of modified telescopic embedding anastomosis in surgical treatment of esophageal and cardiac carcinoma. MethodsWe retrospectively analyzed the clinical data of 160 patients with esophageal or cardiac cancer undergoing surgery in our group from January 2014 through May 2015. There were 119 males and 41 females with a mean age of 61.6±7.1 years. Sixty-four patients received Sweet esophagectomy and 96 patients underwent minimally invasive Mckeown esophagectomy, and all the patients received end to side mechanical anastomosis. The patients were divided into a modified group and a traditional group according to the embedding types. There were 34 males and 12 females aged 61.7±6.4 years in the modified group undergoing modified telescopic embedding. There were 85 males and 29 females aged 62.2±7.5 years in the traditional group undergoing traditional interrupted horizontal mattress suture embedding. The anastomostic time and postoperative complications were compared between the two groups. ResultsCompared with the traditional group, obviously lower incidence of anastomotic fistula (0.0% vs. 12.3%, χ2=4.478, P=0.013), shorter anastomosis time (28.9±2.9 min vs. 30.0±3.1 min, t=-1.983, P=0.049), but a higher incidence of anastomotic stenosis (30.4% vs. 3.5%, χ2=23.799, P=0.000) in the modified group were found. There were no significant differences in the incidences of pulmonary complications, cardiovascular complications, laryngeal recurrent nerve injury, or perioperative mortality between the two groups (P>0.05). ConclusionModified telescopic embedding anastomosis is safe and feasible in surgical treatment of esophageal and cardiac carcinoma, and can effectively reduce the incidence of anastomotic fistula.
Nowadays, the popularization of endoscopic technology makes a substantial increase in the diagnosis rate of esophageal multiple primary carcinoma. However, the multiple primary carcinoma combined with esophageal cancer, lung cancer and cardiac cancer is relatively rare. This paper reported a 64-year-old male with multiple primary cancer who received one-stage complex radical surgery, including radical resection of esophageal cancer, lung cancer and cardiac cancer. After the operation, the patient presented chylothorax and conservative treatment was ineffective. Then we preformed ligation of thoracic duct through single-portal thoracoscope. The patient recovered successfully after surgery and the follow-up results showed well.
ObjectiveTo investigate the high risk factors for perioperative atrial fibrillation (AF) and its effect on the postoperative short term outcome in esophageal carcinoma patients. MethodsSixty three patients with AF after esophagectomy (AF group) and 126 patients without AF after esophagectomy in control group were analyzed by χ 2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups.ResultsThe rates of age above 65 (χ 2=7.02, P lt;0.01), male sex (χ 2=4.06, P lt;0.05), history of cardiac disease (χ 2=6 03, P lt;0.05), history of chronic obstructive pulmonary disease (COPD, χ 2=29.14, P lt;0 01), postoperative thoracic gastric dilatation ( P lt;0.01), and postoperative lower oxygen saturation ( P lt;0.01) in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10.65±0.87 d in patients developing AF group and 9.98±0.96 d in control group ( P gt;0.05). No difference was observed between two groups with regard to mortality ( P gt;0.05).ConclusionAF occurs more frequently after esophagectomy in aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.
Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer （EC） who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 （58.8±6.6） years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 （305.0±40.7） minutes，including thoracoscopic operation time of 50-580 （105.0±38.4） minutes and laparoscopic operation time of 28-105 （54.0±8.6） minutes. Intraoperative blood loss was 20-440 （285.4±38.5） ml. The number of dissected lymph nodes was 6-39 （20.4±1.6） for each patient. Postoperative hospital stay was 7-93 （12.8±5.2） days. Sixty patients （30.6%） had postoperative complications，including 28 patients （14.3%） with pulmonary comp-lications，5 patients （2.5%） with chylothorax，5 patients （2.5%） with arrhythmias，15 patients （7.6%） with anastomotic fistula，10 patients （5.0%） with recurrent laryngeal nerve injury，and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.
Objective To investigate the expression and clinical significance of CXCR4 in esophageal squamous cell carcinoma (ESCC). Methods Databases including PubMed, EMbase, Web of Science, CBM, VIP, CNKI and WanFang Data were searched from inception to April 2012, and the relevant references were also retrieved to collect relevant case-control studies. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the quality of the included studies. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 5 case-control studies involving 493 ESCC tissues and 136 normal esophageal tissues were included. The results of the meta-analyses showed that, as for the positive rate of CXCR4 expression, it was higher in ESCC tissues rather than normal esophageal tissues (OR=12.03, 95%CI 6.76 to 21.44, Plt;0.000 01), in ESCC tissues with lymph node metastasis rather than those without lymph node metastasis (OR=4.35, 95%CI 2.48 to 7.62, Plt;0.000 01), as well as in moderate and low differentiated ESCC tissues rather than high differentiated ESCC tissues (OR=0.51, 95%CI 0.32 to 0.81, P=0.004); but no significant difference was found between the clinical stage I-II and clinical stage III-IV ESCC tissues. Conclusion The presently limited evidence shows CXCR4 expression is associated with ESCC, lymph node metastasis and degree of cell differentiation, indicating that CXCR4 may take a role in the whole course of carcinogenesis of ESCC. But the relationship between CXCR4 expression and clinical stage of ESCC is still unclear, which needs to be further proved by more large-scale, well-designed and high quality case-control studies.
Objective To improve esophageal lymph node staging and investgate an ideal esophageal lymph node metastasis staging method. Methods The clinical pathological data and followup data of the 236patients who had undergone thoracic esophagectomy with at least 6 lymph nodes (LN) removed from January 1985 to December 1989 were analyzed retrospectively. Cox proportional hazard model was used to screen risk factors, and Logrank test was applied to perform survival analysis according to lymph node metastasis staging (number, distance and extent). Results The 10-year follow-up rate was 92.3%（218/236）. The overall 1-year, 5-year and 10-year survival rates were 80.2%, 43.1% and 34.2% respectively. One hundred and twelve (47.4%) patients had LN metastasis, and their 5-year survival rates were lower than that of patients without LN metastasis (14.8% vs. 66.6%; χ2=77.18, P=0.000). Cox regression analysis showed that besides depth of invasion, differentiation grade and LN metastasis, the number, distance and extent of LN metastasis were the independent risk factors which could influence prognosis. A further analysis was given via univariate Logrank test. When grouped according to the number of LN metastasis, there were significant differences in overall survival rates (χ2=96.00,P=0.000), but no significant difference was found in survival rates between N2 and N3 group(Pgt;0.05). When grouped according to the distance of LN metastasis, there were significant differences in overall survival rates (χ2=79.29, P=0.000), but no significant difference was found in survival rates among S1, S2 and S3 group(Pgt;0.05). When grouped according to the extent of LN metastasis (0, 1, and ≥2 fields), there were significant differences in overall survival rates (χ2=87.47, P=0.000), and so were the survival rates among groups (χ2=5.14, P=0.023). Conclusion Revising the current Nclassification of TNM staging of esophageal cancer according to the extent of LN metastasis(0, 1, and ≥2 fields) is more reasonable, and can reflect the prognosis of patients with esophageal cancer after esophagectomy better.
Abstract: Objective To discuss the probable pathogenesis, clinical manifestations, diagnostic and treatment methods, and prognosis of intramural esophageal dissection (IED), in order to improve diagnostic and therapeutic levels for IED. Methods We retrospectively analyzed the clinical data of one patient suffering from circumferential intramural dissection of whole thoracic esophagus with inflammation of false lumen and localized esophageal perforation treated in the First People’s Hospital Affiliated to Shanghai Jiaotong University in February 2010. The 56 years female underwent right exploratory thoracotomy through a standard posterolateral incision in the fifth intercostal space with the whole diseased esophagus resected and the stomach anastomosed through retrosternal tunnel to the cervical intact esophagus in the left neck. Case reports with integral clinical data in recent 10 years’ literature were reviewed through PubMed searching system with the keyword being intramural esophageal dissection or intramural esophageal hematoma. Results The patient was finally cured by whole thoracic esophagectomy and discharged at postoperative day 14. Halfyear followup result was satisfactory. Thirteen cases with integral clinical data were reviewed. The major manifestations were mainly chest and dorsal pain, odynophagia and dysphagia, and occasional hematemesis. Diagnosis was mainly based on esophagography, endoscope and CT. Twelve patients were cured or remitted after conservative therapy, endoscopic therapy or surgical therapy. One patient died after surgical exploration. Conclusions IED is arare disease, and esophagography, endoscope and CT are important diagnostic methods. IED is widely regarded as benign process which responds to conservative managements and endoscopic treatments. However, in some severe cases, we suppose that removal of the diseased esophagus is more reliable.