Malignant Esophageal Tumors Research Articles

Experimental study on radiational characteristics and nursing care of a novel radioisotope 188Re memory alloy esophageal stent.

Radioactive esophageal stent, known for inhibiting tumor growth and delaying restenosis in malignant esophageal tumors, presents challenges due to potent radiation, leading to side effects. This study aims to support the clinical use of 188Re radioactive esophageal stent. The 188Re stent with 128MBq initial activity was placed in a biomimetic esophageal membrane. Radiation absorption doses were measured by thermoluminescence and calculated using mathematical software. Under simulated positioning, the stent was implanted in the esophagus of an experimental pig, followed by the feeding of Kangfuxin solution and nursing care (KFX-RT). Non-implanted and implanted-only pigs served as normal (CR) and experimental (RT) controls. Blood samples collected on days 7 and 21 were analyzed for inflammatory factors (TGF-β1, TNF-α, IL-6) using enzyme-linked immunosorbent assay. Esophageal tissue cells were assessed for deoxyribonucleic acid index (DI) and subdiploid content through flow cytometry. Absorbed doses at 0.5mm and 5mm reference points were 223.91cGy and 20.55cGy, respectively, with 92.64% absorbed within a 1mm thickness. Radiation dose significantly decreased at 6.5mm, with only 4.72% absorbed at depths ≥6.5mm. On days 7 and 21, levels of inflammatory factors, DI and subdiploid content were significantly increased in the KFX-RT and RT groups compared to the CR group, while all levels in the KFX-RT group were significantly lower than in the RT group. The 188Re esophageal stent exhibits high radiation absorption in superficial tissues and low absorption in deeper tissues. Kangfuxin solution combined with nursing care alleviates radiation-induced inflammatory damage.

Leiomyosarcoma of the esophagus, arising from lamina muscularis mucosae, in a combination with microinvasive squamous cell carcinoma-A case report.

Leiomyosarcoma of the esophagus is a very rare disease, accounting for less than 0.5% of malignant esophageal tumors. Esophageal leiomyosarcoma combined with squamous cell carcinoma is even rarer than solitary leiomyosarcoma. To our knowledge, there are less than ten cases of simultaneously diagnosed leiomyosarcoma and squamous cell carcinoma of the esophagus. A 66-year-old male was admitted to our hospital suffering from epigastric pain, asthenia, weight loss, and difficulties when feeding with solid food which had been present for 2 weeks. A computed tomography scan showed a large tumor tissue mass in the mid-to-distal part of the esophagus. The patient underwent robot-assisted surgery-an esophagectomy with esophagogastrostomy. Histologically, the tumor consisted of highly pleomorphic spindle cells with multiple atypical mitosis and necrotic areas. An immunohistochemical examination was performed to distinguish leiomyosarcoma from spindle cell squamous carcinoma or malignant GIST. Tumor cells stained diffusely positive for smooth muscle actin, but negative for p63, CD117, and CKAE1/AE3. Tumor invasion involved mucosa and submucosa, without tunica muscularis propria. Microinvasive well-differentiated squamous cell carcinoma was also noted in the mucosa at the borders between the tumor and the healthy part of the esophagus. The aim of the manuscript is to present an extremely rare case of combined polypoid leiomyosarcoma and microinvasive squamous cell carcinoma of the esophagus, cured by robot-assisted surgical intervention and to emphasize that such cases should be examined carefully, including additional diagnostic tests such as Immunohistochemistry (IHC) in order to define the correct diagnosis.

Pilot Trial on Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer: Feasibility and Impact on Anastomotic Leakage (TIGOAL-I).

To evaluate the feasibility, safety, and effectiveness of gastric conditioning using preoperative arterial embolization (PAE) before McKeown esophagectomy at a tertiary university hospital. Cervical anastomotic leakage (AL) is a common complication of esophagectomy. Limited clinical evidence suggests that gastric conditioning mitigates this risk. This pilot randomized clinical trial was conducted between April 2016 and October 2021 at a single-center tertiary hospital. Eligible patients with resectable malignant esophageal tumors, suitable for cervical esophagogastrostomy, were randomized into 2 groups: one receiving PAE and the other standard treatment. The primary endpoints were PAE-related complications and incidence of cervical AL. The study enrolled 40 eligible patients. PAE-related morbidity was 10%, with no Clavien-Dindo grade III complications. Cervical AL rates were similar between the groups (35% vs 25%, P = 0.49), even when conduit necrosis was included (35% vs 35%, P = 1). However, AL severity, including conduit necrosis, was higher in the control group according to the Clavien-Dindo ≥IIIb (5% vs 30%, P = 0.029) and Comprehensive Complication Index (20.9 vs 33.7, P = 0.01). No significant differences were found in other postoperative complications, such as pneumonia or postoperative mortality. PAE is a feasible and safe method for gastric conditioning before McKeown minimally invasive esophagectomy and shows promise for preventing severe AL. However, further studies are required to confirm its efficacy.

169. PROPENSITY SCORE MATCHING ANALYSIS OF THE EFFECT ON PROGNOSIS OF PROPHYLACTIC NECK DISSECTION FOR ESOPHAGEAL CANCER

Abstract Background There is still no definite evidence regarding the prognostic effect of #104 prophylactic dissection. Materials and Methods: We conducted a retrospective study of patients who underwent esophagectomy regarding the prognostic effect of #104 prophylactic dissection by propensity score matching analysis. Between 2012/1 and 2020/12, 302 patients with esophageal malignant tumors underwent radical subtotal esophagectomy via the right thoracic approach at our hospital. The histological types were limited to squamous cell carcinoma, adenocarcinoma, and basal cell carcinoma, and clinical (c)T4b (TNM 7th edition), cM1, cervical esophageal cancer, salvage surgery cases, R1/2 cases, and cases with synchronous advanced multiple cancers were excluded. This resulted in the analysis of the 220 cases comparing between the 3-filed and 2-filed dissection groups. R version 4.1.2 was used for statistical analysis. The predicted probability of #104 dissection was calculated by logistic regression model. Propensity score matching was performed to match patients between 2 groups according to age, tumor location, preoperative treatment, postoperative pneumonia, pathological (p)T factor, and pN factor by nearest neighbor method within caliper. P < 0.05 was considered statistically significant. Results Both DSS and DFS were significantly better in the 2-filed dissection group. Baseline characteristics showed that the 3-filed dissection group had significantly more patients of tumor location Mt and Ut, more squamous cell carcinoma as the histologic type, and more cases with preoperative treatment. In the 3-field dissection group, operative time was significantly longer and the postoperative complications was increased such as recurrent nerve palsy and cervical lymphatic leakage. Pathologic results showed higher grades of pT and pN. Four patients in the 3-field dissection group had p104 metastasis, and only 1 of these survived without recurrence. On the other hand, 5 patients of the 2-field dissection group had #104 as the first recurrence site, and 3 of these had simultaneous distant metastasis. There was no significant difference in DSS and DFS between groups after propensity score matching (DSS p = 0.852, DFS p = 0.768). Conclusions This retrospective study did not confirm a prognostic benefit of prophylactic dissection of the #104 region. This will be elucidated by results of the ongoing RCT, JCOG2013 trial.

Undifferentiated Carcinoma of Esophagus with SMARCA4 Deletion Expressing Synaptophysin: A Potential Diagnostic Pitfall.

Undifferentiated carcinoma of the esophagus is an entity that is included in WHO classification of digestive systems fifth edition (2018). The definition of this entity is a malignant esophageal epithelial tumor that lacks definite microscopic features of squamous, glandular, or neuroendocrine differentiation. It is a challenging diagnosis to make due to lack of diagnostic criteria. We report a case from a 45 years old man with a mass in the lower third of esophagus. Biopsy showed an epitheloid neoplasm with sheet like growth pattern and no glandular formation. The tumor cells had prominent nucleoli and indistinct cell borders. There were occasional rhabdoid cells. By immunostains, tumor cells were focally positive for pankeratin, keratin 7, synaptophysin, negative for CDX2 and p40, INSM1, chromogranin, and CD56. Background intestinal metaplasia (Barrett esophagus) was present. Next generation sequencing of the tumor revealed SMARCA4 deep deletion. The tumor showed loss of SMARCA4 by immunostain. This case demonstrates that undifferentiated carcinoma of the esophagus with SMARCA4 deletion can express synaptophysin. Awareness of this entity is important for the correct classification of this tumor.

A rare cause of dysphagia in children: Squamous cell carcinoma of the esophagus: A case report and review of literature

Globally, an estimated 572 000 cases occurred in 2018 of malignant tumors of the esophagus but in children and adolescents, this cancer is a rare disease. Through this case report, i tried to analyze the clinical, paraclinical, therapeutic and prognostic profile of squamous cell carcinoma of the esophagus in children. This 10 years old female school child is presented with a complaint of worsening of difficulty of swallowing of 01 week duration. She had Symptoms complex of TB for the last 3 months. FNAC from right axillary, bilateral inguinal LNs, discrete with pus oozing sinus tract about 2x2 cm Microscopy shows caseous necrotic material= suggestive of TB. SAM (NE) + Severe Pneumonia + R/O Diss TB (Lung, LN) + Tungiasis was considered and anti TB was started but the patient was deteriorating. After one month course in the hospital the patient condition was deteriorating, the dysphagia become worsened. CHEST CT SCAN of the child was taken and the Finding: there is multifocal coalescing tree in bud opacity in posterior segment of the right upper lobe and superior segment of the lower lobe on the same side. There is consolidation with bronchiectasis changes on the left lower lobe. Multiple enlarged Para tracheal, sub carinal and Para esophageal nodes noted. There is circumferential wall thickening of the mid and part of proximal esophagus with no fat plane from the enlarged adjacent nodes. Calcified right axillary nodes visualized. the Impression was Bilateral pulmonary opacities with mediastinal LAPs (likely 2ry to TB) + circumferential wall thickening of mid and part of proximal esophagus DDx: Esophageal malignant mass with mediastinal nodal deposits and aspiration pneumonia- so needs clinical correlation and endoscopic study. Esophageal biopsy was taken and section shows nests and single cells of malignant squamous cells having high N/C ratio hyper chromatic nucleo and dense eosinophilic cytoplasm along with keratin pearls along with monocular infiltration and atypical mitosis invading in to desmoplastic stroma. Conclusion: Squamous cell carcinoma The child was transferred to oncology ward for chemotherapy and radiotherapy after one week of ward stay the patient passed away. Malignant esophageal tumors in children and adolescents are extremely rare conditions. The ingestion of caustic products and smoking are currently the most well-known risk factors for this disease, factors not found in our patient. Dysphagia is the main clinical sign of squamous cell carcinoma of the esophagus. Thus, in the event of dysphagia in children or adolescents, a mediastinal process should be considered, and a paraclinical assessment should be carried out. Since squamous cell carcinoma of the esophagus is a rare malignant tumor in children, the interest of this case report is to underline the importance of evoking a malignant esophageal process in children who present a notion of dysphagia to solids then to liquids, associated with an alteration of the general condition and anemia.

A revamped MIC-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk

BackgroundThe purpose of this study was to investigate the effect of our revamped MIE-McKeown operation on postoperative gastrointestinal function recovery.MethodsThis revamped MIE-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk and with the tubular stomach buried throughout esophageal bed and azygos arch, has been implemented from July 2020 to July 2021 by the same medical team of Gaozhou People's Hospital thoracic surgery for 13 times. Preoperative clinical data, main intraoperative indicators and postoperative complications were observed.ResultsAll patients had esophageal malignant tumors at the level of middle and lower thoracic non-azygous venous arch, with preoperative clinical stage CT1-2N0M0 stage i-ii. V-vst test was performed on the 7th postoperative day, and 10 patients were found to have no loss of safety/efficacy. There were 2 cases with impaired efficacy and no impaired safety, 1 case with impaired safety. There were 1 cases of pulmonary infection, 1 cases of anastomotic fistula combined with pleural and gastric fistula, 2 cases of hoarseness, 2 cases of arrhythmia, 10 cases of swallowing function were grade i, 2 cases of swallowing function were grade iii, 1 case of swallowing function was grade iv in watian drinking water test one month after operation.ConclusionsMerit of this revamped MIE-McKeown operation is well preserving the integrity of azygos arch of vagus nerve and bronchial artery, and it is technically safe and feasible. No postoperative mechanical obstruction of thoracostomach, huge thoracostomach and gastrointestinal dysfunction occurs.

Potential benefits of one‑time gastroscopy in search for precancerous conditions.

Precancerous conditions for esophageal (EA) and gastric adenocarcinoma (GA) are Barrett's esophagus (BE) and atrophic gastritis (AG), respectively. Their surveillance is crucial for the detection of early lesions. The study aimed to assess whether one‑timeesophagogastroduodenoscopy (EGD) in search for precancerous conditions would be effective in the population with low‑to‑moderate esophageal and gastric cancer risk. A total of 5984 individuals who underwent diagnostic EGD in 3 endoscopic centers, from March 2018 to October 2019, were analyzed to assess the age of occurrence of precancerous conditions and cancers. Age distribution of the patients with malignant gastric and esophageal tumors registered in the national cancer registry from 2014 to 2017 was analyzed. In comparison with individuals below 40 years old, the risk of EA and GA diagnosis increased at the age of 60 to 64 years (odds ratio [OR], 12.1; 95% CI, 1.5-98.6), gastric and esophageal dysplasia at the age of 55 to 59 years (OR, 3.6; 95% CI, 1.3-9.7), and BE and AG at the age of 40 to 44 years (OR, 1.6; 95% CI, 1.04-2.4). The number of procedures per 1 cancer that could be potentially avoided was 236, 235, 290, 360, 394, and 344 for the age groups of 40-44 years, 45-49 years, 50-54 years, 55-59 years, 60-64 years, and 65-69 years, respectively. The assessed potential benefit‑to‑harm ratio was 47, 38, 31, 28, and 32 for the age groups of 40-49 years, 50-54 years, 55-59 years, 60-64 years, and 65-69 years, respectively. One‑time EGD in search for precancerous conditions could be potentially applicable in individuals between 40 and 69 years of age.

S1635 Gender-Related Difference on Demographics and Comorbidities of Gastroparesis

Introduction: Gastroparesis is known to be more prevalent in females than males, even though the pathophysiology behind it remains unclear. There is lack of gender specific comparison of gastroparesis in terms of demographics and comorbidities. The aim of the study was to compare the demographics and comorbidities of gastroparesis between female and male patients. Methods: Patients who had completed a gastric emptying study and diagnosed with gastroparesis were identified using a nationwide database, IBM Explorys (1999-2022). The following conditions were excluded: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, chemotherapy, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. Patients were subdivided into males and females. Demographic information, clinical symptoms and comorbidities were collected. Chi-square tests were performed to compare categorical data. Odds Ratios with a 95% confidence interval were reported. Results: A total of 17,570 patients were identified with gastroparesis, of which 13,090 (75%) patients were females and 4,390 (25%) patients were males. Females and males demonstrated similar trend in the distribution of ethnicity: most patients were White (76.6 vs 74.0%), followed by African American (13.0 vs 14.4%) and other races respectively (Table). There was a higher percentage of females than males in the younger age group: age 20-29 (F vs M: 5.3 vs 4.3%) and age 30-39 (F vs M: 13.8 vs 11.4%) respectively. Male patients with GP had a higher prevalence of diabetes mellitus (M vs F: 52.8 vs 42.8%) and other comorbidities, such as: hypertension (64.0 vs 54.5%), hyperlipidemia (57.2 vs 50.1%), chronic kidney disease (24.1 vs 15.8 %), coronary artery disease (26.4 vs 16.6 %) and smoking (16.6 vs 13.8%) (All P value < 0.0001) (Figure). Female patients had a higher prevalence of anxiety (F vs M: 41.3 vs 27.1%), depression (45.8 vs 31.7%), autoimmune conditions (13.8 vs 5.0%) and morbid obesity (15.6 vs 11.6%) (All P value < 0.0001). Conclusion: Female and male patients with gastroparesis demonstrate similar ethnic distribution. There is a higher percentage of female patients than males in the younger age group. However, female and male patients demonstrate different comorbidities.Figure 1.: Comparison of Comorbidities Between Female and Male patients with Gastroparesis. Table 1. - Comparison of Demographics and Comorbidities Between Female and Male Patients with Gastroparesis Female (N=13090) % Male (N=4390) % OR P Age 20-29 690 5.3% 190 4.3% 1.04-1.45 0.0135 30-39 1810 13.8% 500 11.4% 1.12-1.39 < 0.0001 40-49 2370 18.1% 740 16.9% 1.00-1.19 0.0612 50-59 2710 20.7% 1060 24.1% 0.76-0.89 < 0.0001 60-69 2810 21.5% 970 22.1% 0.89-1.05 0.3811 70-79 2000 15.3% 720 16.4% 0.84-1.01 0.0760 80-89 930 7.1% 290 6.6% 0.94-1.24 0.2618 90 above 260 2.0% 80 1.8% 0.85-1.41 0.4963 Race Caucasian 10030 76.6% 3250 74.0% 1.06-1.24 0.0005 African American 1700 13.0% 630 14.4% 0.81-0.98 0.0215 Asian 110 0.8% 50 1.1% 0.06-0.09 < 0.0001 Hispanic/Latino 120 0.9% 40 0.9% 0.70-1.44 0.9733 Unknown/Other 1130 8.6% 420 9.6% 0.79-1.00 0.0595 Comorbidities DM 5600 42.8% 2320 52.8% 0.62-0.71 < 0.0001 HTN 7130 54.5% 2810 64.0% 0.63-0.72 < 0.0001 HLD 6560 50.1% 2510 57.2% 0.70-0.81 < 0.0001 CKD 2070 15.8% 1060 24.1% 0.54-0.64 < 0.0001 CAD 2170 16.6% 1160 26.4% 0.51-0.60 < 0.0001 Smoking 1810 13.8% 730 16.6% 0.73-0.88 < 0.0001 Anxiety 5410 41.3% 1190 27.1% 1.76-2.04 < 0.0001 Depression 6000 45.8% 1390 31.7% 1.70-1.96 < 0.0001 Autoimmune disease 1800 13.8% 220 5.0% 2.62-3.49 < 0.0001 Morbid obesity 2040 15.6% 510 11.6% 1.27-1.56 < 0.0001

S582 Gastroparesis Is Associated With More Concurrent Gastrointestinal Symptoms and Motility Disorders Than Functional Dyspepsia

Introduction: Gastroparesis (GP) and functional dyspepsia (FD) present with overlapping upper gastrointestinal (GI) symptoms, such as: nausea, vomiting, early satiety, postprandial fullness, epigastric pain, and bloating. Other gastrointestinal motility disorders may be concurrent in patients with GP. The goal of study was to compare the presence of GI symptoms and other motility disorders in patients with GP and FD. Methods: A retrospective cohort study was performed on IBM Explorys (1999-2022), which contains de-identified healthcare information from more than 64 million patients across the United States. Adult patients who have completed gastric emptying study were selected, and subsequently divided into GP and FD cohorts. GP cohort consists of patients with a diagnosis of gastroparesis, with exclusion criteria: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. FD cohort was similarly constructed with additional exclusion criteria: gastroparesis, gastrointestinal ulcer, brain neoplasm and pancreatitis. The presence of GERD, IBS, GI symptoms and common GI medications were collected. Odds ratios (ORs) with 95% confidence interval were used to compare the cohorts. Results: GP and FD cohort consisted of 17,570 and 60,230 patients respectively (Table). There was a higher prevalence of concurrent motility disorders in patients with GP than FD, including GERD and IBS (65.1 vs 50.9%, 18.6 vs 13.3%). Patients with GP tend to present with more upper and lower GI symptoms than FD, including nausea (65.1 vs 46.3%), vomiting (53.0 vs 33.3%), epigastric pain (36.9 vs 27.2%), heartburn (8.6 vs 7.5%), diarrhea (34.6 vs 23.3%) and constipation (37.2 vs 21.8%) (P< 0.0001) (Figure). However, there was no difference in terms of early satiety and bloating when comparing the two groups. Acid reducing medications, anti-nausea medications and prokinetic agents were more commonly prescribed for patients with GP than FD, including proton pump inhibitors (PPIs), H2 receptor antagonists (H2RA), Metoclopramides and Ondansetron (p< 0.0001). Conclusion: GP is associated with more concurrent GI symptoms and motility disorders compared with FD. Acid reducing medications, anti-nausea and prokinetic medications are more commonly prescribed for patients with GP.Figure 1.: Comparison of GI symptoms between gastroparesis and functional dyspepsia Table 1. - Comparison of GI motility disorders, symptoms and medications between gastroparesis and functional dyspepsia GP (N=17570) % FD (N=60230) % OR P GI diseases GERD 11430 65.1% 30650 50.9% 1.74-1.86 < 0.0001 IBS 3260 18.6% 8030 13.3% 1.42-1.55 < 0.0001 Symptoms Upper GI symptoms Nausea 11430 65.1% 27910 46.3% 2.08-2.23 < 0.0001 Vomiting 9310 53.0% 20060 33.3% 2.18-2.34 < 0.0001 Early satiety 1660 9.5% 5780 9.6% 0.93-1.04 0.5556 Epigastric pain 6490 36.9% 16380 27.2% 1.51-1.62 < 0.0001 Heartburn 1510 8.6% 4500 7.5% 1.10-1.24 < 0.0001 Lower GI symptoms Diarrhea 6070 34.6% 14050 23.3% 1.67-1.80 < 0.0001 Constipation 6540 37.2% 13110 21.8% 2.06-2.21 < 0.0001 Bloating 60 0.3% 170 0.3% 0.90-1.63 0.2039 Medications PPI 13680 77.9% 35430 58.8% 2.37-2.56 < 0.0001 H2RA 7710 43.9% 18310 30.4% 1.73-1.85 < 0.0001 Metoclopramide 8630 49.1% 12490 20.7% 3.56-3.82 < 0.0001 Ondansetron 12570 71.5% 31330 52.0% 2.24-2.41 < 0.0001

Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors

Objective: To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT). Methods: A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results: A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment. Conclusion: ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

Risk model for mortality associated with esophagectomy via a thoracic approach based on data from the Japanese National Clinical Database on malignant esophageal tumors.

Postoperative complications after esophagectomy can be severe or fatal and impact the patient's postoperative quality of life and long-term outcomes. The aim of the present study was to develop the best possible model for predicting mortality and complications based on the Japanese Nationwide Clinical Database (NCD). Data registered in the NCD, on 32,779 patients who underwent esophagectomy via a thoracic approach for malignant esophageal tumor between January, 2012 and December, 2017, were used to create a risk model. The 30-day mortality rate after esophagectomy was 1.0%, and the operative mortality rate was 2.3%. Postoperative complications included pneumonia (13.8%), anastomotic leakage (13.2%), recurrent laryngeal nerve palsy (11.1%), atelectasis (4.9%), and chylothorax (2.5%). Postoperative artificial respiration for over 48h was required by 7.8% of the patients. Unplanned intubation within 30 postoperative days was performed in 6.2% of the patients. C-indices evaluated using the test data were 0.694 for 30-day mortality and 0.712 for operative mortality. We developed a good risk model for predicting 30-day mortality and operative mortality after esophagectomy based on the NCD. This risk model will be useful for the preoperative prediction of 30-day mortality and operative mortality, obtaining informed consent, and deciding on the optimal surgical procedure for patients with preoperative risks for mortality.

Is there a relationship between two different anesthetic methods and postoperative length of stay during radical resection of malignant esophageal tumors in China?: a retrospective cohort study

BackgroundData providing a relationship between the anesthetic method and postoperative length of stay (PLOS) is limited. We aimed to investigate whether general anesthesia alone or combined with epidural anesthesia might affect perioperative risk factors and PLOS for patients undergoing radical resection of malignant esophageal tumors.MethodsThe study retrospectively analyzed the clinical data of 680 patients who underwent a radical esophageal malignant tumor resection in a Chinese hospital from January 01, 2010, to December 31, 2020. The primary outcome measure was PLOS, and the secondary outcome was perioperative risk-related parameters that affect PLOS. The independent variable was the type of anesthesia: general anesthesia (GA) or combined epidural-general anesthesia (E-GA). The dependent variable was PLOS. We conducted univariate and multivariate logistic regression and propensity score matching to compare the relationships of GA and E-GA with PLOS and identify the perioperative risk factors for PLOS. In this cohort study, the confounders included sociodemographic data, preoperative chemotherapy, coexisting diseases, laboratory parameters, intraoperative variables, and postoperative complications.ResultsIn all patients, the average PLOS was 19.85 ± 12.60 days. There was no significant difference in PLOS between the GA group and the E-GA group either before or after propensity score matching (20.01 days ± 14.90 days vs. 19.79 days ± 11.57 days, P = 0.094, 18.09 ± 9.71 days vs. 19.39 ± 10.75 days, P = 0.145). The significant risk factors for increased PLOS were lung infection (β = 3.35, 95% confidence interval (CI): 1.54–5.52), anastomotic leakage (β = 25.73, 95% CI: 22.11–29.34), and surgical site infection (β = 9.39, 95% CI: 4.10-14.68) by multivariate regression analysis. Subgroup analysis revealed a stronger association between PLOS and vasoactive drug use, blood transfusions, and open esophagectomy. The results remained essentially the same (stable and reliable) after subgroup analysis.ConclusionsAlthough there is no significant association between the type of anesthesia(GA or E-GA) and PLOS for patients undergoing radical esophageal malignant tumor resection, an association between PLOS and lung infection, anastomotic leakage, and surgical site infection was determined by multivariate regression analysis. A larger sample future study design may verify our results.

Candida Cardiac Tamponade Secondary to Oesophageal-Pericardial Fistula: A Rare Presentation of Oesophageal Squamous Cell Carcinoma.

Candida is a rare cause of purulent pericarditis. Oesophago-pericardial fistula is an uncommon and potentially life-threatening complication of both benign and malignant oesophageal tumours. Here we report the case of 40-year-old woman who presented with symptoms and signs suggestive of acute pericarditis complicated by cardiac tamponade which required acute management with paracentesis. Pericardial fluid analysis was positive for Candida albicans. Oesophagogastroduodenoscopy was performed and revealed a small fistula in the proximal oesophagus extending into the retrocardiac space. Multiple biopsy specimens of the fistula site and oesophageal stricture were obtained. Histopathological findings were consistent with poorly differentiated squamous cell carcinoma of the oesophagus complicated by fistulation to the retrocardiac space.LEARNING POINTSPurulent pericarditis with atypical organisms should raise the suspicion of oesophago-pericardial fistula.Oesophago-pericardial fistula in oesophageal squamous cell carcinoma is rare and associated with high mortality and a poor prognosis.This is one of the few cases where a gastro-pericardial fistula has been diagnosed by endoscopy.

КЛИНИЧЕСКИЙ СЛУЧАЙ ЛЕЧЕНИЯ РАКА ПИЩЕВОДА IV СТАДИИ

In 2018 in Russian Federation more than 500 thousand new cases of cancer were found, including 8000 cases with malignant tumors of esophagus and more than 30 % of patients have the IV stage.&#x0D; Esophageal cancer takes the 6-th place in death causes connected to cancer in the world and it is still one of the main global problems in medical care. Oncologists face the problem of the most difficult choice in treatment tactics for spread stages of disease. In this situation it is recommended to provide combined treatment (surgery, neoadjuvant and adjuvant chemotherapy). &#x0D; Definitive radiotherapy or chemoradiotherapy (without surgery) is used for patients with unrespectable esophageal tumor. &#x0D; In this article we present clinical case of successful treatment of a patient with metastatic esophageal cancer. The patient got chemoradiotherapy in 2017 and after control checkup in November 2019 remission was registered. After provided treatment stopping of pain syndrome and dysphagia, food passage through esophagus was restored. The patient notes good life quality, he is physically active and socially adapted.

100 TOTAL LYMPHOCYTES COUNT (TLC) PREDICTS THE OVERALL SURVIVAL AFTER CHEMORADIOTHERAPY IN ESOPHAGEAL CARCINOMA PATIENTS

Abstract Lymphocytes play a critical role in the host immune system, and a decrease in number of lymphocytes, caused by malnutritional status and chemoradiotherapy (CRT) leads to immunosuppression. Immunosuppression could enhance the cancer development and progression. Previous studies demonstrated that lymphopenia was associated with worse prognosis in the pancreatic, lung, head and neck, and rectal cancer, but little is known about esophageal cancer. Methods There were 298 patients of esophageal malignant tumors, who had been initially treated with chemoradiotherapy (CRT) between January, 2007 and December, 2018. The total lymphocyte counts (TLC) before CRT and the nadir value during 6 weeks after CRT along with other clinical and treatment characteristics of these 298 patients, were retrospectively evaluated in relevance with the overall survival (OS) after CRT. Results The median TLC before and after CRT were 1469 (range 456–4710)/mm3 and 354 (range 21–1500)/mm3, respectively. When the patients were stratified with the threshold value of 1500/mm3 of pretreatment TLC, the Log-Rank test showed significant difference in OS between these 2 groups (OS 48.7% vs 36.6%, p = 0.011). In addition, the CTCAE grade of lymphopenia exceeding 3 after CRT was associated with worse OS even in the group with pretreatment TLC level more than 1500/mm3. The multivariate analysis showed that the significant prognostic factors of OS were cN, cM, additional esophagectomy and pretreatment TLC. Conclusion The decease of pretreatment TLC was significantly associated with worse OS when the patients of esophageal cancer were initially treated with CRT.

Primary Esophageal Lymphoma: Clinical Experience in Diagnosis and Treatment.

Primary esophageal lymphoma is a rare malignant tumor, which is often misdiagnosed. To improve the diagnosis and treatment of this disease, we presented one case admitted at our institution and a literature review of primary esophageal lymphoma cases, including the clinical data, features of imaging, endoscopy and pathology, treatment, and prognosis. The symptoms were non-specific. Under endoscopy, most of the lesions were located in the middle and lower segment of the esophagus, behaving as ulcers, polyps, or submucosal masses, always accompanying with esophageal stricture. The diagnosis of primary esophageal lymphoma was highly dependent on pathological and immunohistochemical examination, hence stacked sampling was suggested to improve the positive rate of mucosal biopsy. Combination of chemotherapy and radiotherapy may be the first choice of treatment, surgical and endoscopic resections may be an alternative solution as well. The therapeutic effect and prognosis were slightly better than those of other esophageal malignant tumors.

A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis

Minimally invasive esophagectomy (MIE) is increasingly performed to expect lower complication rate compared to open esophagectomy. Studies of minimally invasive Ivor Lewis esophagectomy (MIILE) with circular staplers have reported better outcomes compared to MIE with cervical anastomosis, but frequent anastomotic complications have also been reported. MIILE with linear staplers is a promising alternative, but the long-term functional and oncological outcomes are uncertain. To evaluate the functional and oncological outcomes of MIILE with linear stapled anastomosis, a retrospective cohort study was performed in 104 patients who underwent MIILE with linear stapled anastomosis for esophageal malignant tumors. The primary endpoints were the overall complication and anastomotic leak rates. The secondary endpoints were late complications, overall and disease-free survival, and nutritional status at 6 and 12months after MIILE. Anastomotic leak occurred in 4 patients (3.8%). The short-term complication rate of grade IIIb or higher was 6.7%. During a median 57-month follow-up period, anastomotic stricture occurred in one patient, 7 required hiatal hernia repair, and 2 underwent conduit revision surgery. The 5-year overall survival and disease-free survival rates were 69.3% and 59.5%, respectively. Status of reflux esophagitis at the time of most recent evaluation was grade N/A/B/C/D in 52/10/10/13/8 among 93 patients who had follow-up endoscopy. The mean body weight loss at 6 and 12months after MIILE was 11.3 and 11.8% with maintenance of the serum albumin level. MIILE with linear stapled anastomosis is a safe procedure with a low anastomotic complication rate and favorable long-term functional and survival outcomes.

Kissing tumors; the concurrent diagnosis of leiomyosarcoma and squamous cell carcinoma of the esophagus

BackgroundEsophageal leiomyosarcoma (LMS) is a rare tumor that constitutes less than 1% of all malignant esophageal tumors. Concurrent occurrence of esophageal leiomyosarcoma with squamous cell carcinoma (SCC) is even rarer than isolated leiomyosarcoma.Case presentationIn this report, we present a case of concurrent leiomyosarcoma and SCC in a 64-year-old woman presenting with vomiting and solid dysphagia, which has not been properly diagnosed following several referrals and diagnostic modalities. At last Exploratory laparotomy with gastric pull-up was performed in addition to radical laryngectomy with partial resection of the esophagus and subtotal thyroidectomy. Pathologic evaluation of the surgical specimen showed concurrent LMS (5.2 × 4.5 × 3 cm) and SCC (1.5 × 0.6 × 0.6 cm) at the same anatomical level in the proximal esophagus.ConclusionsThis study proposes the importance of using ancillary diagnostic tests such as immunohistochemistry (IHC) to diagnose less common cases such as concurrent LMS and SCC.

Technical features of esophageal stent deployment

To work out the optimal technique of endoscopic stenting of the esophagus (ESE) using various delivery devices (DD); to analyze immediate and long-term results of stenting depending on the type of DD. ESE results were studied in 83 patients. Group 1 included 41 patients with implantation of metal stents delivered on a knitted tubular casing (21 stents with proximal opening and 20 stents with distal opening). Group 2 consisted of 42 patients who underwent ESE using a DD in the form of a contracting outer shell. In the 1st group, DD «stumbling» in 6 cases (14.6%) required additional tubular hollow rigid conductor. In the 2nd group, there was no need for additional conductor (p=0.011). Intraoperative stent repositioning after its initial installation was required in 7 cases (17.1%) of the 1st group and 16 cases (38.1%) of the 2nd group (p=0.033). Higher likelihood of stent repositioning was observed in distal stent opening. Technical success rate was 100% in both groups. Clinical success rate was 100% in the 1st group and 97.6% in the 2nd group (p>0.05). Incidence of early and long-term postoperative complications was similar (p>0.05). ESE with various DDs is safe and effective in patients with malignant unresectable esophageal tumors and symptoms of dysphagia. However, certain features of stent installation should be considered. In our opinion, DD with proximal disclosure is more convenient due to better visual positioning of stent.