Esophageal cancer is one of the common malignant tumors with high incidence and poor prognosis. Angiogenesis-related pathways play an important role in the occurrence and development of esophageal cancer. Vascular endothelial growth factor (VEGF) is the main mediator of angiogenesis. In addition to promoting angiogenesis and maintaining the survival of neovascularization, VEGF can also directly act on esophageal cancer cells and promote the occurrence and development of tumors. This article reviews the biology of VEGF and its effect on blood vessels, the expression of VEGF in esophageal cancer cells and its influencing factors, the role of VEGF in esophageal cancer cells, the immunomodulatory activity of VEGF and the clinical study of VEGF inhibitors. The purpose of this study is to provide a basis for more rational use of VEGF inhibitors in the treatment of esophageal cancer.
The incidence of complications after radical resection of esophageal carcinoma is high up to about 20%-50%. The incidence of pneumonia, pleural effusion, tracheal intubation, anastomotic fistula and cardiac events is relatively high. Among them, pulmonary complications are the most common complications after esophageal cancer operation and cause the most perioperative deaths. Among the factors that influence the occurrence of postoperative complications of esophageal cancer, the amount of fluid infusion during and after the operation is closely related to the occurrence of postoperative complications. Moreover, in the environment of enhanced recovery after surgery (ERAS), it is more important to optimize the postoperative fluid management of esophageal cancer. Restricted fluid therapy plays a more and more important role in patients undergoing esophagectomy. This review integrated the relevant research results and discussed the advantages of the restricted fluid therapy compared with other fluid therapy, how to control the restricted infusion volume and infusion speed and how to monitor and evaluate the infusion process and the selection of infusion types, so as to provide reference for clinical practice test.
Abstract： Objective To explore the value of serum Dickkopf-related protein 1 （DKK1）for the early diagnosis of esophageal cancer， and provide theoretical evidence for the diagnosis and treatment of esophageal cancer. Methods A total of 145 patients who were admitted to the Affiliated Hospital of Jiangnan University between October 2009 and April 2011 were included in this study and divided into four groups. There were 72 patients in the esophageal cancer group （54 males and 18 females with their median age of 60.4 years），13 patients in the precancerosis group （9 males and 4 females with their median age of 58.6 years），30 patients in the benign esophageal lesion group （23 males and 7 females with their median age of 56.4 years），and 30 healthy people in the volunteer group （19 males and 11 females with their median age of 58.6 years）. Serum DKK1 protein concentration was measured by enzyme linked immunosorbent assay （ELISA）. Receiver operating characteristics （ROC） curve was drawn to determine the cutoff level with optimal diagnostic accuracy. Results Serum DKK1 protein levels were significantly higher in the esophageal cancer group and precancerosis group than those in the volunteer group and benign esophageal lesion group ［（37.5±2.8） μg/L， （19.7±2.7） μg/L vs. （5.7±0.8） μg/L， （6.5±0.8） μg/L，t=47.391， P＜0.05］. There was no statistical difference in serum DKK1 protein level between the volunteer group and benign esophageal lesion group ［（6.5±0.8） μg/L vs. （5.7±0.8） μg/L， t=4.215，P=0.374］. When the level of serum DKK1 protein was 13.4 μg/L， the diagnostic sensitivity and specificity of esophageal cancer were 74.1% and 96.7%， respectively. Conclusion Overexpression of serum DKK1 protein could be related to the pathogenesis and progression of esophageal cancer. DKK1 protein may be a potential serologic biomarker for the early diagnosis of esophageal cancer.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Abstract:Objective To investigate the application value of fluorine-18 fluorodeoxyglucose （18F-FDG）- positron emission tomography （PET） in patients with esophageal cancer. Methods From October 1999 to December 2005, 52 patients with esophageal cancer （15 untreated and 37 treated patients） were imaged with 18F-FDG-PET.18F-FDG-PET scans were analyzed by visual method combined with semiquantitative analysis. 18F-FDG- PET results were compared with pathological results and follow-up survey. Results There were 15 untreated patients before 18F-FDG-PET scans, the primary tumors in 11 patients （T2 to T4 stage） were all 18F-FDG avid and primary site in 4 patients （T1 stage） showed nothing abnormal. The sensitivity of 18F-FDG-PET was 73.3% （11/ 15）. In diagnosing 16 resected enlarged lymph nodes beyond 1 cm in 8 operated patients. Six lymph nodes was malignant by 18F-FDG-PET scans before operation, there were 5 metastases lymph nodes and 1 tuberculosis nodes. 18F-FDG-PETrevealed distant metastases in 7 patients and corrected them from surgery candidates to late stage. In 37 treated patients 18F-FDG-PET confirmed 34 patients with recurrence and/or metastasis. Conclusion ^18F-FDG-PET has limited value in comfirming T and N stage in esophageal cancer. It shows much value in M stage and treatment guiding in patients with esophageal cancer.
Objective To investigate the current status of esophageal cancer surgery-related researches using bibliometric methodologies and identify the trend and hotspots. Methods The Chinese and English literature was collected from Web of Science and CNKI from inception of each database to April 1, 2022. VOSviewer 1.6.18 and CiteSpace 6.1 were applied to cluster the authors, institutions, and keywords. For social network and time series analysis, Excel, GraphPad, and R 4.0.3 were used to visualize the literature on esophageal cancer surgery. Results Finally, 19 566 English literature and 19 872 Chinese literature was included. The results demonstrated that the annual publishing of both Chinese and English literature increased over time, with English literature increasing rapidly and Chinese literature maintaining an average number of above 1 000 per year from 2011 to 2019. Researches were predominantly centered in Europe, the United States, Japan, South Korea, and China. China's researches in the field of surgical treatment in esophageal cancer lacked international collaboration, which began later than East Asian countries such as Japan and South Korea and had less influence. From the keyword perspective, previous researches on surgical treatment of esophageal cancer mostly focused on surgical techniques, complications, and comprehensive perioperative therapy. Both Chinese and English literature showed that the prevalence of keywords such as minimally invasive surgery, comprehensive treatment, and clinical trials increased dramatically during the recent years, indicating that these fields may represent the future directions and research trends. Conclusion Compared to East Asia countries, such as Japan and South Korea, Chinese esophageal cancer surgery-related researches are relatively lacking. The research direction and field are similar to those in developed countries such as the United States and Europe. Future attention may be focused on minimally invasive treatment, comprehensive treatment, and clinical trials associated with surgical treatment of esophageal cancer.
The incidence of esophageal cancer (EC)is high in China. In recent years, vascular tumor embolus (VTE)has become a common pathological finding after esophagectomy. Multiple studies show that VTE is the result of multiple contributing factors, and is correlated to patients' prognosis. Many researchers confirm that VTE is positively correlated with the risk of lymph node metastasis. Optimal treatment for VTE patients has not yet reached a consensus. Research progress of VTE in EC is reviewed.
Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. MethodsWe retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
Mini-invasive video-assisted thoracoscopic surgery (VATS) has been employed in diagnosis and treatment of esophageal diseases for about 10 years. The potential advantages of VATS over thoracotomy are reduction of chest pain just after the operation and in the long run, lower incidence of postoperative respiratory complications, and reduction of aesthetic sequelae. Thoracoscopic staging of esophageal cancer is to evaluate the invasion and metastasis of cancer, which is helpful for better selection of patients for appropriate treatment .Operation of esophageal cancer with VATS is prescribed mainly in the early stage of carcinoma, but it’s application is restricted due to the multiple sites of operation and complexity of procedures. VATS for benign esophageal diseases such as esophageal leiomyoma and achalasia is becoming the preferable choice of operation in qualified medical centers.