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.
目的 探讨食管贲门癌术后非计划二次手术的原因及有效的预防和治疗措施。 方法 回顾性分析 2010 年 1 月至 2016 年 1 月在我院胸外科实施食管贲门癌手术 2 655 例患者的临床资料，37 例（1.4%）患者因严重并发症实施了非计划二次手术，其中男 28 例、女 9 例，年龄 65（48～79）岁，总结该 37 例患者的临床特征、二次手术的原因及治疗方法。 结果 吻合口瘘 11 例：1 例行空肠造瘘，2 例行胸壁切口清创+胸腔置管引流术，3 例行颈部切口清创+上纵隔置管引流术，5 例行胸腔探查术（其中 3 例行瘘口修补术），1 例胸胃瘘行胸胃部分切除+食管颈部旷置+空肠造瘘术。乳糜胸 13 例，经胸行胸导管结扎术，其中 1 例右胸结扎失败后再次经腹腔缝扎胸导管。胸腔出血 6 例行开胸探查止血，腹腔出血 2 例，分别经左胸及腹正中探查止血。1 例胸胃扭转，行吻合口切除+胃-食管端端再次吻合术。1 例因双侧声带麻痹行气管切开；1 例因肺大疱破裂气胸行胸腔镜下肺大疱切除术；1 例因肠梗阻行开腹探查粘连松解+空肠造瘘术。1 例胸内瘘患者因二次术后肺部感染死亡，其余患者均治愈出院。 结论 食管贲门癌术后二次手术的主要原因为吻合口瘘、乳糜胸及出血，提高首次手术质量是预防二次手术发生的关键，对需要行二次手术治疗的严重并发症，及时果断的决定可避免病情进一步恶化和提高二次手术的效果。
目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0.6%（2/316），吻合口狭窄发生率为5.7%（18/316），对照组吻合口瘘发生率为1.6%（3/186），吻合口狭窄发生率为4.3%（8/186），均有显著性差异（P＜0.05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P＞0.05）。行机械吻合手术时间明显缩短，有统计学意义（P＜0.05）。实验组肺部感染发生率0.3%（1/316），无肺不张，对照组肺部感染发生率1.6%（3/186），肺不张0.5%（1/186），其差异有统计学意义（P＜0.05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。
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.