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.
Abstract: Objective To explore the outcomes of videoassistedthoracoscopic surgery (VATS) in the treatment of esophageal leiomyoma. Me thods [WTBZ] We reviewed and analyzed the clinical data of 87 patients with esophageal leiomyoma treated with VATS in Changhai Hospital of Second Military Medical University between June 2002 and January 2009. [WTHZ]Results [WTBZ]Videoassisted thoracoscopic leiomyoma enucleations was performed in 80 patients, whilea conversion to minithoracotomy was required in 7 others. All procedures werecompleted smoothly and the postoperative recovery was uneventful, without mortality or severe complications. The patients were drinking liquids from postoperative day 1 and were eating a normal diet from day 3. All patients were pathologically diagnosed with leiomyoma after operation. Followups of 6 months to 6.5 years (mean: 3.8 years) found no recurrence. [WTHZ] Conclusion [WTBZ]Videoassisted thoracoscopic enucleation can be the first choice for esophageal leiomyomas derived from lamina propria. Patients with esophageal leiomyomas of diameter gt;1.0 cm should be treated with VATS .
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.
ObjectiveTo give an annual data report of surgical treatment of esophageal cancer in Shanghai Chest Hospital to provide reference for treatment and research on esophageal cancer.MethodsThe clinical data of 414 patients with esophageal cancer who underwent endoscopy (9 patients) and esophagectomy (405 patients) in Shanghai Chest Hospital in 2015 were reviewed, including 334 males and 80 females. Their tumor biological characteristics and short-term and long-term treatment results were analyzed.ResultsPatients in this group were predominantly aged 60 to 69 years (46.9%), and the tumor was mainly located in the middle thorax (50.7%). About 79.9% of the patients received trans-right thoracic esophagectomy, 44.4% received minimally invasive surgery; 388 (93.7%) patients accepted upfront esophagectomy without induction therapy, and 179 (43.2%) patients received postoperative adjuvant therapy. The R0 resection rate was 90.6%, and the 30- and 90-day mortality rates were 1.4% and 2.4%, respectively. The 4-year overall survival rate of the R0 resection patients was 65.7%.ConclusionSatisfactory long-term survival results can be obtained for thoracic esophageal cancer if R0 resection can be achieved by trans-right thoracic esophagectomy and extended lymphadenectomy combined with appropriate postoperative adjuvant treatment.
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.
Abstract： Objective To investigate diagnosis and treatment of concealed intrathoracic anastomotic leak of the esophagus. Methods We retrospectively analyzed the clinical data of 32 patients who presented with unexplained sepsis （temperature＞38 ℃ and elevated white blood cell count） after esophagectomy and intrathoracic anastomosis for esophageal carcinoma or gastric cardia carcinoma in Affiliated Hospital, Medical College of Qingdao University from January 2006 to December 2010. All the patients underwent oral water-soluble contrast esophagogram and oral water-soluble contrast computerized tomography of the chest. None of the patients had any sign of contrast leak in these diagnostic examinations, but their chest computerized tomography all showed peri-anastomotic bubble and encapsulated effusion. Fifteen patients were treated as concealed intrathoracic anastomotic leak of the esophagus, including fasting, broad spectrum antibiotic treatment, prolonged gastrointestinal decompression and enteral nutrition via naso-intestinal feeding tube. The other 17 patients were not treated as anastomotic leak of the esophagus and only received broad spectrum antibiotic treatment. Results None of the 15 patients who were treated as concealed intrathoracic anastomotic leak finally developed anastomotic leak proved by oral water-soluble contrast esophagogram and computerized tomography of the chest （0%, 0/15）. Among the 17 patients who were not treated as anastomotic leak, fourteen patients developed anastomotic leak later （82.4%, 14/17）, 2 patients died of aorto-esophageal fistula and 3 patients died of multiple organ dysfunction syndrome. Conclusion Peri-anastomotic bubble and irregular encapsulated effusion in oral water-soluble contrast esophagogram and computerized tomography of the chest should be considered as specific signs of concealed intrathoracic anastomotic leak of esophagus after esophagectomy and intrathoracic anastomosis. Patients with such signs should be treated as anastomotic leak.