Digestive Reconstruction Research Articles

Isolated Intestinal Transplant for Chronic Intestinal Pseudo-Obstruction in Adults: Long-Term Outcome

BackgroundChronic intestinal pseudo-obstruction (CIPO) has been treated in adults by total parenteral nutrition (TPN) or, if complications arise, by multivisceral transplantation because the stomach is often involved. Eleven adults with CIPO were transplanted by intestinal graft in our center from 2000 to 2011. MethodsNine patients underwent isolated intestinal transplant and 2 patients had multivisceral transplant. Immunosuppression was represented by FK and steroids plus induction with alemtuzumab, daclizumab, or thymoglobulin. Average age at transplant was 33.5 years. We reported 1 graftectomy, followed by retransplantation. ResultsSeven patients are currently alive with working small bowel; cause of death was infection in the 4 remaining cases. In 9 isolated intestinal transplants, we performed different digestive reconstructions to allow gastric emptying. In 2 cases we were forced, after transplant, to perform ileostomy to improve intestinal motility. Graft and patient survival after 5 years are 60% and 70%, respectively, while after 10 years, 45% and 56%, respectively. ConclusionsAdults with CIPO and irreversible TPN complications benefit from isolated intestinal transplant with different surgical techniques to empty the native stomach: this strategy achieves good gastric emptying, with effective establishment of oral feeding and graft and patient survivals comparable to isolated intestinal transplant for short bowel syndrome.

Malone Antegrade Continence Enema in Patients with Perineal Colostomy After Rectal Resection.

The objective of this study was to evaluate the value of antegrade continence enema (Malone operation) in abdominoperineal resection (Miles' operation). Between January 2008 and May 2009, five cancer patients (two men and three women) underwent abdominoperineal resection and digestive reconstruction by perineal colostomy and Malone antegrade continence enema in our institution. Their functional results and quality of life were recorded. None of the patients died, but two had wound infections and one experienced urinary retention. Patients performed antegrade enema every 24h with 2,000mL of normal saline by themselves. The duration of the enema lasted for an average of approximately 35min, and fecal contamination was not detected at 24h. Patient satisfaction was determined to be 88%. Malone antegrade continence enema associated with abdominoperineal resection and perineal colostomy provided acceptable continence. It preserved the body image of the patients and resulted in a satisfactory quality of life. It is a potential alternative for patients who are not willing to have a permanent colostomy.

Difficulty and settlement of digestive reconstruction after laparoscopic gastrectomy for gastric cancer

Digestive reconstruction after gastrectomy is one of the key steps to the success of surgery. The surgical difficulty is greater for digestive reconstruction after laparoscopic-assisted gastrectomy (LAG). In order to reduce the incidence of postoperative complication and ensure a good quality of life for patients after gastrectomy, surgeons should have experience in open surgery and proper reconstruction technique and surgical instruments should be selected.

Life-threatening wirsungorrhagia

A 51-YEAR-OLD MAN with a medical history of alcoholic chronic pancreatitis and appendectomy was admitted to the emergency department with epigastric pain, melena, and rectorragia. The hemoglobin level was 4.3 g/dL without leukocytosis. The patient described a recent history of recurrent episodes of loss of consciousness and intermittent epigastric and periumbilical pain. Upper endoscopy revealed an active bleeding through the major papilla. Computed tomography of the abdominal revealed an hemorrhagic 42-mm cystic lesion in the pancreatic head with a dilated the Wirsung duct filled with hyperdense material (Fig 1, A and B). A celiac-mesenteric angiogram revealed a bleeding pseudoaneurysm of the anterior pancreaticoduodenal arcade directly communicating with a pancreatic pseudocyst. The celiac artery did not fill because of compression by the active median arcuate ligament (Fig 2, A and B). Liver arterial flow was maintained via retrograde flow through the pancreaticoduodenal arcades and the gastroduodenal artery. Embolization was deemed as not technically feasible because of the difficulty of selectively cannulating the feeding vessels of the pseudoaneurysm. During exploratory laparotomy, revascularization of the celiac territory with section of the median arcuate ligament was followed by a pancreaticoduodenectomy. Digestive reconstruction was performed by pancreaticogastrostomy, hepaticoojejeunostomy, and gastrojejunostomy. The postoperative course was uneventful. During

One-Hundred and Six Robot-Assisted Pancreatectomies

Context Laparoscopy has revolutionized abdominal surgery becoming the standard approach for many operations. The “da Vinci” surgical system overcomes most of the inherent technical limitations of laparoscopy. Objective We test whether the robotic approach can improve the outcome of pancreatic resections, which often require challenging dissection and complex digestive reconstructions. Methods One-hundred and six consecutive robotic pancreatic resections were performed between October 2008 and June 2012. There were 40 males and 66 females (62%), with a mean age of 57 years (range 21-80 years) and a mean BMI of 24.6 Kg/m 2 . Thirty-nine patients underwent pancreaticoduodenectomy (PD) (37%), 47 distal pancreatectomy (DP) (44%), 10 total pancreatectomy (10%), 7 tumor enucleation (6%) and 3 central pancreatectomy (3%). Since our activity spans over about a 4-year period, data were analyzed according to the time of surgery, to verify progress in the learning curve: 17 patients were operated on between October 2008 and September 2009, 22 patients between October 2009 and September 2010, 32 patients between October 2010 and September 2011 and 35 patients during the last 9 months (from October 2011 to June 2012). Results No patient was converted to laparoscopy or open surgery. Mean operative time (OT) was 442.8 minutes. In the first period OT was 512 min for PD and 420 for DP. The mean number of lymph nodes examined (LN) was 16.8; 31.2 for PD and 11.9 for DP. Pancreatic fistula (PF) occurred in 41% of the patients. In the second, OT was 596 min for PD and 402 for DP. The LN was 16.7; 27.2 for PD and 10.0 for DP. PF was amounted 36.3%. In the third, OT was 583 min for PD and 288 for DP. The LN was 28.7; 36.0 for PD and 19.1 for DP. PF was amounted 36.6%. In the fourth, OT was 590 min for PD and 250 for DP. The LN was 30; 32 for PD and 20 for DP. PF was amounted 35%. Fifty-six benign/low-grade tumors and 50 cancers were diagnosed. Surgical margins were all negative. Post-operative mortality was nil, morbidity was 56% and mean hospital stay was 16 days. Conclusions Robot-assisted pancreatic resections can be safely performed in selected patients. Despite the existence of a learning curve, experienced pancreatic surgeons are not expected to pay to robotics the same price that they would have been asked for by laparoscopy.

Comparative study on digestive reconstruction after tota1 gastrectomy

Objective To explore the type of the rational digestive reconstruction after total gastrectomy for gastric malignancy.Metlhods Three types of digestive reconstruction were performed after total gastrectomy in 121 cases with gastric carcinoma.The operating time,morbidity and mortality,digestive tract symptoms,nutritional status in 1 year after operation were compared.Results There were no signifioant differences among the three procedures in operative morbidity and mortality,postoperative food intake,nutritional status,incidences of diarrhea and dumping syndrome.Roux-en-Y esophajejunostomy and P-type esophajejunostomy had an advantage d anti-esophageal reflux,and are obviously superior to Lahey + Braun anastomosis.Roux-en-Y esophajejunostomy was simpler with shorter operating time and less complication.Condusion Roux-en-Y esophajejunostomy and P-type esophajejunostomy could be recommended as suitable methods for digestive reconstruction after total gastrectomy. Key words: Stomach neoplasms; Total gastrectomy; Digestive reconstruction

Intrathoracic supercharge technique for esophageal reconstruction using colon interposition via a retrosternal route

Currently, when the colon is used for reconstruction after esophagectomy, the supercharge technique is occasionally employed. At our institution, we perform esophagectomy using a procedure in which the laparoscopic transhiatal approach and digestive reconstruction precede the specimen resection. In addition, a retrosternal route is selected for reconstruction. We have devised an intrathoracic supercharge technique for this type of esophagectomy. Two patients whose stomachs were not available for reconstruction underwent subtotal esophagectomy with this supercharge technique. In these cases, the right-side colon was pulled up via a retrosternal route for reconstruction, and anastomoses were performed between the ileocolic artery and right internal thoracic artery, and between the ileocolic vein and superior vena cava, without microsurgery in the pleural space after removing the esophagus. This supercharge technique has the advantage of being less cumbersome, and we consider it to be suitable for esophageal reconstruction.

The effect of continuous jejunal interposition on gastrointestinal hormones after distal gastrectomy

The objective of our study was to determine the effect of continuous jejunal interposition on gastrointestinal hormones after distal gastrectomy, and lay a foundation for surgical management.Distal subtotal gastrectomy experimental model were established on 24 adult Beagle dogs. Digestive tract reconstruction of the dogs was randomly divided into continuous jejunal interposition group, Billroth II anastomosis group and isolated jejunum interposition group. The content of serum gastrin, plasma motilin and cholecystokinin after different digestive tract reconstructions was detected and compared by enzyme-linked immunosorbent assay. In the dogs which received continuous jejunal interposition, postoperative serum gastrin level was significantly lower than before surgery either in fasting or postprandial state (all p<0.05). The serum gastrin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). Furthermore, the postoperative plasma motilin and cholecystokinin levels were significantly higher than before surgery either in fasting or postprandial in dogs received continuous jejunal interposition (all p<0.05). The postoperative plasma motilin level of continuous jejunal interposition group was significantly higher than the other groups in postprandial state (all p<0.05), and was significantly higher than Billroth II -type anastomosis group in fasting state (p<0.05). However, the postoperative cholecystokinin level of continuous jejunal interposition group was significantly lower than the other groups (all p <0.05).Continuous jejunal interposition after distal gastrectomy could maintain the postoperative plasma motilin and serum gastrin in a relatively high level, while cholecystokinin in a low level.

Basic techniques for gastric cancer surgery

Surgery for gastric cancer is based on basic surgical techniques and modern theory of surgery.Accurate and safe surgical procedures are carried out based on application of scientific principles.The knowledge of gastric anatomy,physiology and pathophysiology is the basis of the gastric cancer surgery.The technical aspects of vascular control,lymph node dissection,digestive tract resection and reconstruction are important for the gastric cancer surgery.Full use of these techniques and mastery of the technology is an important guarantee for reducing surgical complications,improving the quality of life and longterm survival of gastric cancer patients. Key words: Gastric neoplasms; Surgical technique; Lymphadenectomy

Multivisceral transplantation in pigs: a model for research and training.

To present a model for research and training in multivisceral transplantation in pigs. Eight Large White pigs (four donors and four recipients) were operated. The multivisceral transplant with stomach, duodenum, pancreas, liver and intestine was performed similarly to transplantation in humans with a few differences, described below. Anastomoses were performed as follows: end-to-end from the supra-hepatic vena cava of the graft to the recipient juxta diaphragmatic vena cava; end-to-end from the infra-hepatic vena cava of the graft to the inferior (suprarenal) vena cava of the recipient; and end-to-side patch of the aorta of the graft to the infrarenal aorta of the recipient plus digestive reconstruction. The performance of the multivisceral transplantion was possible in all four animals. Reperfusions of the multivisceral graft led to a severe ischemia-reperfusion syndrome, despite flushing of the graft. The animals presented with hypotension and the need for high doses of vasoactive drugs, and all of them were sacrificed after discontinuing these drugs. Some alternatives to minimize the ischemia-reperfusion syndrome, such as the use of another vasoactive drug, use of a third pig merely for blood transfusion, presence of an anesthesia team in the operating room, and reduction of the graft, will be the next steps to enable experimental studies.

Reconstructive approaches of alimentary canal for subtotal gastrectomy

To explore the optimal technique of digestive tract reconstruction for radical proximal gastrectomy. The clinical data for 120 cases of proximal gastric cancer undergoing radical proximal gastrectomy at our hospital from 2000 to 2009 were analyzed retrospectively. They included three approaches of digestive tract reconstruction. The patients were divided into esophagogastric anterior wall anastomosis group (n = 50), jejunal interposition group (n = 26) and gastric tube group (n = 44). The quality of life was evaluated and compared among 3 groups. The rates of anastomotic fistula, anastomotic obstruction and the scores of heart burn and reflux esophagitis were higher in gastric tube group. And the increments of hemoglobin and body weight were less in gastric tube group than those in other groups (P < 0.05). The rates of gastric emptying in gastric tube group had no obvious differences with esophagogastric anterior wall anastomosis group at 120 min and 180 min (P > 0.05). And they were higher than those in jejunal interposition group (P < 0.05). There was no statistical difference in any parameter between esophagogastric anterior wall anastomosis and jejunal interposition groups (P > 0.05). The anastomosis of esophagogastric anterior wall is an ideal approach of digestive reconstruction for radical proximal gastrectomy. And it may improve the quality of life for surgical patients with proximal gastric cancer.

Gastroduodenal artery-preserving pancreaticoduodenectomy after subtotal esophagectomy and gastric pull-up

Division of the gastroduodenal artery is commonly performed during pancreaticoduodenectomy for both malignant and benign disease. We describe here a technical modification of pylorus preserving pancreaticoduodenectomy with gastroduodenal artery preservation performed in a patient who previously underwent subtotal esophagectomy with gastric pull-up discussing advantages and drawbacks of the technique. A 73-year-old man with a previous history of right nephrectomy and lower esophagectomy for cancer was referred to our center for the treatment of a 5-cm tumor of the pancreatic head. Following the preliminary steps of a standard pancreaticoduodenectomy, the gastroduodenal artery was isolated at its origin from the common hepatic artery. The entire length of the gastroduodenal artery was dissected after having sectioned the posterior-superior pancreaticoduodenal artery. The right gastroepiploic vessels were preserved along with the gastroduodenal artery. Digestive reconstruction was completed just as for pylorus-preserving pancreaticoduodenectomy. The preservation of the gastroduodenal artery along with the gastroepiloic vessels was safely performed with an operative time of 300min and minimal blood loss. Pathology showed a solitary 5-cm renal cell carcinoma metastasis. Gastroduodenal artery preserving pancreaticoduodenectomy can serve as an additional option in the armamentarium of a pancreatic surgeon. This technique constitutes an interesting technical option that ensures optimal vascular supply to the gastric remnant after previous esophagectomy. Its clinical application remains limited to selected indications and deserves further experience and comparison with standard techniques.

Experience in digestive reconstruction of P-type Roux-en-Y esophagojejunostomy following total gastrectomy in patients with gastric cancer

Objective To investigate an ideal way to reconstruct the digestive canal after total gastrectomy. Methods The clinical data of 87 cases with gastric cancer confirmed by pathology were retrospectively analyzed between May 2003 and Jan 2009, and every patient was subjected to P style of total gastrectomy and digestive canal reconstruction by using jejunum. The diet,symptoms and the body weight were observed. Results In the 87 cases, there was no death causalgia behind sternum. During the follow-up period in the patients with the survival time more than one year, the meal habit was recovered. No reflux symptom was found. The body weight increased in all patients. Conclusions P style operation in gastric cancer is easy and safe to perform. Reflux esophagitis and dumping syndrome seldom developed. Pjejunal ansa basically played the role in preservation and nutrition of stomach,so this was an ideal way to reconstruct the digestive canal after total gastrectomy. Key words: Stomach Neoplasms; Gastrectomy; Anastomosis,Roux-en-Y

Modified digestive reconstruction with midgut transposition after pylorus-preserving pancreaticoduodenectomy for pancreatic head tumor in childhood

We describe a new procedure of digestive reconstruction after pylorus-preserving pancreaticoduodenectomy in a 13-year-old girl presenting with a large solid and papillary epithelial neoplasm of the pancreatic head. A midgut transposition (like in a cure of midgut malrotation) was easily performed after tumor removal with minimal additional dissection. Bilio- and pancreaticodigestive anastomoses were performed on 2 separate Roux-en-Y loops, placed behind the postpyloric jejunal loop. Separate biliary and pancreatic conduits prevented both activation of pancreatic enzymes at the pancreatic duct anastomosis and reflux of pancreatic juice in the bile ducts. Midgut transposition avoided any traction or twist of the 3 isoperistaltic intestinal loops. Postoperative course was uneventful. This technique may be useful after pancreatic head resections in children and adolescents.

Role of duodenum in regulation of plasma ghrelin level and body mass index after subtotal gastrectomy

To investigate the role of duodenum in regulation of ghrelin and body mass index (BMI) and the correlation between ghrelin and BMI after subtotal gastrectomy. Forty-two patients with T(0-1)N(0-1)M(0) gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern, Billroth I group (n=23) and Billroth II group (n=19) respectively. Plasma ghrelin levels were determined by radioimmunoassay (RIA) before and at day 1, 7, 30 and 360 after gastrectomy,and BMIs were also measured. Two groups had identical postoperative trends in ghrelin alterations during the early stage, both dropping to nadir at day 1 (36.7% vs 35.7%), then markedly increasing at day 7 (51.0% vs 51.1%). At day 30, ghrelin level of Billroth I group was slightly higher than that of Billroth II group. At day 360, ghrelin level of Billroth I group recovered to 93.6%, approaching though lower than preoperative level and no significant difference was displayed, while ghrelin level of Billroth II group recovered only to 81.6% of preoperational level and significant difference existed (P=0.033). Compared with preoperative levels, ghrelin of two groups decreased by 6.9% and 18.4% while BMI by 3.3% and 6.4% respectively, liner regression correlations were revealed in both groups between decrease magnitudes(R(1)(2)=0.297,P=0.00;R(2)(2)=0.559,P<0.001). Anatomico-physiological duodenum compensatively promotes ghrelin recovery, accordingly enhances BMI after gastrectomy. Regarding patients with insufficient ghrelin secretion, ghrelin is positively correlated with BMI.

Perfusional evaluation of postesophagectomy gastroplasty with a radioisotopic study

Anastomotic fistula represents one of the frequent causes of postoperative morbidity and mortality following transhiatal esophageal resections. The main etiological factor is the ischemia of the gastric tube created for digestive transit reconstruction. Evidence suggests that per operative hypoperfusion can be maintained or even impaired after the surgery. Several methods have been employed in an attempt to assess the blood perfusion of the gastric flap, but they all pose limitations. However, there is a chronological relationship between perfusion assessments, which are almost exclusively performed per operatively, and the occurrence of a leak, which commonly appears several days after the surgery. The authors have developed a method of gastric perfusion evaluation by single photon emission computed tomography scintigraphy, which corrects that temporal matter, allowing the estimation of postoperative gastric perfusion. It is noninvasive, low cost, and may be applied by the time frame when most fistulas occur. High correlation between the event fistula and the low radiotracer uptake in the group of studied patients could be demonstrated. A role in the research of perfusion evaluation of different types of esophageal reconstruction is suggested.

Comparative Study on Three Types of Alimentary Reconstruction After Total Gastrectomy

BackgroundMore than 70 alimentary reconstruction procedures after total gastrectomy have been proposed to reduce the postoperative syndromes such as dumping syndrome, reflux esophagitis, and malnutrition. However, the optimal alimentary reconstruction method is still a matter of debate. The aim of the current study was to investigate the rationality of different alimentary tract reconstruction methods after total gastrectomy for gastric malignancy. MethodsThree types of digestive reconstruction methods were performed after total gastrectomy in 285 cases of gastric malignancy from May 1996 to December 2006, including Orr-type Roux-en-Y reconstruction (Orr-type), P-type Roux-en-Y reconstruction (P-type), and Moynihan-type reconstruction (Moynihan-type) methods. The operative time, early postoperative complications and mortality, food intake, alimentary symptoms, Visick scores, nutritional status at 1 and 3years after surgery, and cumulative survival at 1, 3, and 5years were comparatively analyzed. ResultsThere were no significant differences among the three methods in early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 3years (p > 0.05). The overall 1-, 3-, and 5-year cumulative survival rate were 75.30%, 39.86%, and 21.48%, respectively, without significant differences among the three groups (p > 0.05). However, the average operative time used in the Orr-type reconstruction method (2.9 ± 0.1h) was comparatively shorter than that used in the P-type (3.4 ± 0.2h) and the Moynihan-type (3.2 ± 0.1h). The incidences of reflux esophagitis after the gastric reconstruction with the Moynihan-type method at 1 and 3years (72% and 65%) were significantly higher than that with the Orr-type (3% and 0%) and P-type (5% and 0%; p < 0.01). Constituent ratio of Visick scores I–II of the Moynihan-type method at 1 and 3years (54% and 73%) were smaller than that of the Orr-type (94% and 96%) and the P-type (93% and 96%) methods (p < 0.01). ConclusionOrr-type Roux-en-Y reconstruction method can avoid reflux esophagitis, and the procedure is simpler than the other two methods. Therefore, Orr-type Roux-en-Y reconstruction can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer.

Role of the duodenum in regulation of plasma ghrelin levels and body mass index after subtotal gastrectomy

To investigate the role of the duodenum in the regulation of plasma ghrelin levels and body mass index (BMI), and the correlation between them after subtotal gastrectomy. Forty-two patients with T0-1N0-1M0 gastric cancer were divided into two groups after gastrectomy according to digestive reconstruction pattern, Billroth I group (n = 23) and Billroth II group (n = 19). Ghrelin levels were determined with radioimmunoassay (RIA) before and on d 1, 7, 30 and 360 after gastrectomy, and BMI was also measured. The two groups had identical postoperative trends in ghrelin alterations during the early stage, both decreasing sharply to a nadir on d 1 (36.7% vs 35.7%), then markedly increasing on d 7 (51.0% vs 51.1%). On d 30, ghrelin levels in the Billroth I group were slightly higher than those in the Billroth II group. However, those of the Billroth I group recovered to 93.6% on d 360, which approached, although lower than, the preoperative levels, and no statistically significant difference was observed. Those of the Billroth II group recovered to only 81.6% and manifested significant discrepancy with preoperative levels (P = 0.033). Compared with preoperative levels, ghrelin levels of the two groups decreased by 6.9% and 18.4% and BMI fell by 3.3% and 6.4%, respectively. The linear regression correlations were revealed in both groups between decrease of ghrelin level and BMI (R1(2) = 0.297, P = 0.007; R2(2) = 0.559, P < 0.001). Anatomically and physiologically, the duodenum compensatively promotes ghrelin recovery and accordingly enhances BMI after gastrectomy. Regarding patients with insufficient ghrelin secretion, ghrelin is positively associated with BMI.

Laparoscopic transhiatal esophago-gastrectomy after corrosive injury

Esophago-gastric necrosis is a surgical emergency associated with high morbidity and mortality. We report a laparoscopic transhiatal esophago-gastrectomy performed on a 43-year-old male, presenting two hours after hydrochloric acid ingestion. A gastroscopy showed several oral mucosal ulcers, a significant edema of the pharynx and larynx, a necrosis of the middle and lower esophagus and of the gastric fundus and antrum. A conservative strategy with intensive care observation was initially followed. After a change of clinical signs, chest-abdominal computed tomography was realized and a pneumoperitoneum with free fluid in the left subphrenic space and bilateral pleural effusions was in evidence. A laparoscopic exploration was proposed to the patient, and confirmed the presence of free peritoneal fluid and necrosis with perforation of the upper part of the stomach. A laparoscopic total gastrectomy with subtotal esophagectomy was performed; the procedure finished with an esophagostomy on the left side of the neck and a laparoscopic feeding jejunostomy (video). Total operative time was 235 minutes. After six months a digestive reconstruction with esophagocoloplasty by laparotomy and cervicotomy was easily realized thanks to the advantages (few adhesions, bloodless, and simple colic mobilization) of the previous minimally invasive surgery.

Significance of Immunohistochemical Expression of Estrogen Receptors α and β in Squamous Cell Carcinoma of the Esophagus

Possible significance of sex hormone estrogen as an antitumor therapeutic arm toward esophageal squamous cell carcinoma (ESCC) cells has been suggested. The aim of the current study was to clarify the clinicopathologic significance of an immunohistochemical expression of estrogen receptors alpha and beta (ER alpha and ER beta) in ESCC. Expression of ER alpha and ER beta were examined using an immunohistochemical methods in 73 paraffin-embedded sections collected from patients with ESCC who had been subjected to esophageal resection and digestive reconstruction without any preoperative induction therapy. Forty-seven (64.4%) ESCCs had a positive cytoplasmic expression of ER alpha and 21 (28.8%) ESCCs had a positive nuclear expression of ER beta. Univariate analysis showed that both positive ER alpha expression (P=0.0001) and negative ER beta expression (P=0.026) were unfavorable prognostic indicators in ESCC. Moreover, multivariate analysis showed that ER alpha-positive/ER beta-negative expression (P=0.003) and progression of tumor stage (P=0.014) were found to be independent unfavorable prognostic indicators in ESCCs. Immunohistochemical expression of ER alpha and ER beta were found to be observed in ESCC. Positive expression of ER alpha in addition to negative expression of ER beta proved to be an unfavorable independent prognostic indicator in ESCC.