Radical Resection Of Esophageal Cancer Research Articles

Relationship between anesthesia factor and postoperative cellular immune function in patients undergoing radical resection for esophageal cancer: value of thoracic paravertebral block combined with general anesthesia

Objective To evaluate the cardioprotection induced by combination of dexmedetomidine and limb ischemic preconditioning in the patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 52-64 yr, weighing 51-78 kg, with New York Heart Association Ⅱ or Ⅲ, scheduled for elective CABG with CPB, were divided into 4 groups (n=20 each) using a random number table method: control group (group C), limb ischemic preconditioning group (group L), dexmedetomidine group (group D) and dexmedetomidine plus limb ischemic preconditioning group (group DL). Limb ischemic preconditioning was induced by 3 cycles of 5-min unilateral lower limb ischemia followed by 5-min reperfusion starting from 30 min before aortic clamping in L and DL groups. Dexmedetomidine was injected via the central vein in a loading dose of 1 μg/kg after induction of anesthesia, followed by an infusion of 0.4 μg·kg-1·h-1 until the end of operation in D and DL groups. Venous blood samples were obtained immediately before aortic clamping, at the end of CPB and at the end of operation for determination of plasma concentrations of cardiac troponin I (cTnI) by enzyme-linked immunosorbent assay. Myocardial tissues were obtained from the right auricle immediately before aortic clamping and at the end of CPB for determination of the expression of Bcl-2 and Bax (by immunohistochemistry) and apoptosis index (AI) (using TUNEL). The restoration of spontaneous heart beat was recorded. Bcl-2/Bax ratio was calculated. Results Compared with group C, the plasma cTnI concentrations were significantly decreased, the Bcl-2 expression was up-regulated, the Bcl-2/Bax ratio was increased, Bax expression was down-regulated, and AI was decreased in the other three groups (P<0.05). Compared with L and D groups, the plasma cTnI concentrations were significantly decreased, the Bcl-2 expression was up-regulated, the Bcl-2/Bax ratio was increased, Bax expression was down-regulated, and AI was decreased in group DL (P<0.05). The rate of restoration of spontaneous heart beat was significantly increased in group DL as compared with the other three groups (P<0.05). Conclusion Combination of dexmedetomidine and limb ischemic preconditioning can mitigate myocardial injury, it provides better efficacy than either alone, and the mechanism is related to inhibiting cell apoptosis in the patients undergoing CABG with CPB. Key words: Dexmedetomidine; Ischemic preconditioning; Cardiopulmonary bypass; Coronary artery bypass grafting; Myocardial injury

Efficacy of PCV-VG mode for lung protective ventilation in patients requiring one-lung ventilation during thoracoscopic surgery

Objective To evaluate the efficacy of pressure-controlled volume-guaranteed (PCV-VG) mode for lung protective ventilation in patients requiring one-lung ventilation (OLV) during thoracoscopic surgery. Methods Sixty patients, aged 50-70 yr, with body mass index of 18-26 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective radical resection of esophageal cancer performed via video-assisted thoracoscope under general anesthesia, were divided into 2 groups (n=30 each) using a random number table: volume-controlled ventilation group (group V) and PCV-VG group (group P). The ventilator settings were adjusted, with a tidal volume 10 ml/kg and respiratory rate 10-12 breaths/min during two-lung ventilation, and with a tidal volume 6 ml/kg and respiratory rate 12-16 breaths/min during OLV.The inspiratory/expiratory ratio was 1∶2, pressure restriction was 35 cmH2O, and 33% oxygen was inhaled at 2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg.Visual analog scale score was maintained ≤ 3 after operation.After admission to the operation room (T0) and at 1, 3 and 7 days after operation (T1-3), forced vital capacity (FVC), forced expiratory volume in first second (FEV1), and maximal mid-expiratory flow (MMEF) were measured, arterial blood samples were collected for blood gas analysis, arterial carbon dioxide partial pressure and arterial oxygen partial pressure (PaO2) were recorded, and alveolar-arterial oxygen tension difference (PA-aO2)was calculated.Clinical Pulmonary Infection Score was assessed at T1, T2 and T3.The chest tube removal time and length of postoperative hospital stay were recorded. Results Compared with the baseline at T0, FVC, FEV1, MMEF and PaO2 were significantly decreased, and PA-aO2 was increased at T1-3 in the two groups (P<0.05). Compared with group V, FVC, FEV1, MMEF and PaO2 were significantly increased, PA-aO2 and Clinical Pulmonary Infection Score were decreased, and the chest tube removal time and length of postoperative hospital stay were shortened at T1-3 in group P (P<0.05). Conclusion PCV-VG mode can achieve lung protective ventilation, which is helpful in improving outcomes in the patients requiring OLV during thoracoscopic surgery. Key words: Respiration, artificial; Thoracoscopy

Effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation in patients undergoing esophageal cancer resection

Objective To evaluate the effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation (OLV) in patients undergoing esophageal cancer resection. Methods Forty American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 25-65 yr, with body mass index of 18-25 kg/m2, scheduled for elective radical resection of esophageal cancer, were divided into 2 groups (n=20 each) using a random number table: dexmedetomidine group (group D) and control group (group C). Dexmedetomidine was infused intravenously in a loading dose of 0.6 μg/kg over 10 min before induction of anesthesia, followed by an infusion of 0.4 μg·kg-1·h-1 until 30 min before the end of operation in group D, and the equal volume of normal saline was given instead in group C. After intubation (T1), at 30, 60 and 90 min of OLV (T2-4), and at 30 min after restoration of two-lung ventilation (T5), blood samples were taken from the internal jugular vein.Broncho-alveolar lavage fluid (BALF) in ventilated lung was collected at T1-4.The concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6(IL) and IL-10 in plasma and BALF were determined by enzyme-linked immunosorbent assay. Results Compared with group C, the plasma concentrations of TNF-α at T5 and IL-6 at T4, 5 were significantly decreased, the plasma concentration of IL-10 was increased at T4, 5, and the concentration of TNF-α in BALF at T4 and concentration of IL-6 in BALF at T3, 4 were decreased, and the concentration of IL-10 in BALF was increased at T4 in group D (P<0.05). Conclusion Dexmedetomidine can significantly ameliorate the inflammatory responses in lung tissues during OLV, thus reducing systemic inflammatory responses in patients undergoing esophageal cancer resection. Key words: Dexmedetomidine; Respiration, artificial; Inflammation

Clinical value of the lung protective ventilation strategy in thoracoscopic and laparoscopic radical resection of esophageal cancer

Objective To explore the clinical value of the lung protective ventilation strategy in thoracoscopic and laparoscopic radical resection of esophageal cancer. Methods The prospective study was conducted. The clinicopathological data of 160 patients who underwent thoracoscopic and laparoscopic radical resection of esophageal cancer at the Tumor Hospital Affiliated to Xinjiang Medical University between June 2015 and June 2016 were collected. All the patients undergoing thoracoscopic and laparoscopic radical resection of esophageal cancer were allocated respectively into the experimental group and control group according to the random number table, and intraoperative single-lumen endotracheal tube intubation and continuous CO2 artificial pneumothorax was conducted. Patients in the experimental group received mechanical ventilation using lung protective ventilation strategy. Parameters of mechanical ventilation: tidal volume (VT) 6 mL/kg+ positive end expiratory pressure (PEEP) 5 cmH2O (1 cmH2O=0.098 kPa)+ plat pressure (Pplat)≤30 cmH2O+ recruitment maneuver (RM). Patients in the control group received the traditional ventilation (parameters of ventilation: VT=9 mL/kg). Observation indicators: observation points were at 10 minutes after tracheal intubation in general anesthesia (T1), at 1 hour after one-lung ventilation (T2), at the end of surgery (T3) and at 24 hours postoperatively (T4). (1) Comparison of parameters of respiratory mechanic: peak airway pressure (Ppeak), Pplat and resistance of airway (Raw) . (2) Comparison of the blood gas analysis: arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2) and pH. (3) Comparison of inflammatory reaction indexes: serum IL-6, IL-8, TNF-α and C-reactive protein. (4) Comparison of postoperative pulmonary complications: pulmonary infection, pulmonary atelectasis, pulmonary edema, bronchospasm, hypoxemia and acute respiratory distress syndrome (ARDS). Measurement data with normal distribution were represented as ±s. Comparisons between groups were evaluated with an independent sample t test. Comparisons of count data were done using the chi-square test. Ordinal data were analyzed using the Kruskal-Wallis test. Repeated measurement data were analyzed by the repeated measures ANOVA. Results All the 160 patients were screened for eligibility, 80 in each group. (1) Comparison of parameters of respiratory mechanic: Ppeak, Pplat and Raw from T1 to T3 were respectively from (18.5±3.4)mmHg (1 mmHg=0.133 kPa) to (22.5±4.6)mmHg, from (15.3±3.6)mmHg to (17.5±2.7)mmHg, from (15.1±1.8)cmH2O/(L·s) to (16.8±2.6)cmH2O/(L·s) in the experimental group and from (17.2±3.7)mmHg to (32.5±4.8)mmHg, from (15.1±3.8)mmHg to (21.5±4.5)mmHg, from (15.6±2.8)cmH2O/(L·s) to (19.5±4.0)cmH2O/(L·s) in the control group, with statistically significant differences in the changing trend between the 2 groups (F=10.35, 12.57, 18.63, P<0.05). (2) Comparison of the blood gas analysis: PaO2 from T1 to T4 was from (505±38)mmHg to (490±34)mmHg in the experimental group and from (523±35)mmHg to (460±43)mmHg in the control group, with a statistically significant difference between 2 groups (F=11.56, P<0.05). (3) Comparison of inflammatory reaction indexes: serum IL-6, IL-8, TNF-α and C-reactive protein from T1 to T4 were respectively from (157±35)ng/L to (213±48)ng/L, from (19.3±2.5)ng/L to (21.2±4.3)ng/L, from (158±35)ng/L to (293±46)ng/L, from (7.5±3.5)mg/L to (47.7±5.8)mg/L in the experimental group and from (162±33)ng/L to (326±45)ng/L, from (16.2±3.5)ng/L to (34.2±4.8)ng/L, from (156±35)ng/L to (393±48)ng/L, from (8.6±2.8)mg/L to (78.2±6.5)mg/L in the control group, with statistically significant differences in the changing trend between 2 groups (F=8.85, 10.45, 13.27, 19.68, P<0.05). (4) Comparison of postoperative pulmonary complica-tions: incidence of postoperative pulmonary complications in the experimental group and control group was respectively 17.5%(14/80) and 31.3%(25/80). Pulmonary infection, pulmonary atelectasis, pulmonary edema, bronchospasm, hypoxemia and ARDS were respectively detected in 7, 6, 5, 6, 10, 0 patients in the experimental group and 16, 13, 13, 14, 20, 2 patients in the control group, showing a statistically significant difference between 2 groups (χ2 =4.10, P<0.05). Conclusion Lung protective ventilation strategy can reduce Ppeak and Raw and improve oxygenation in thoracoscopic and laparoscopic radical resection of esophageal cancer, meanwhile, it can also reduce intra- and post-operative inflammatory reaction and postoperative complications. Key words: Esophageal neoplasms; Lung protective ventilation strategy; Pulmonary protection

A clinical study of salvage radiotherapy for supraclavicular lymph node metastasis in patients with esophageal cancer

Objective To evaluate the efficacy of salvage radiotherapy for supraclavicular lymph node metastasis (SLNM) after initial treatment in patients with esophageal cancer. Methods A total of 117 patients with SLNM after radical resection for esophageal cancer were enrolled as subjects from 2006 to 2012. All patients received three-dimensional radiotherapy with 1.8-2.0 Gy per cycle, 5 cycles a week. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. In all the patients, the 1-and 3-year overall survival (OS) rates were 38.5% and 14.1%, respectively. The 1-and 3-year OS rates were significantly higher in patients treated with salvage radiotherapy or radiochemotherapy (n=100) than in patients without any salvage treatment (n=17)(42% vs. 18%, P=0.008; 17% vs. 0%, P=0.008). The patients treated with radiochemotherapy (n=32) had significantly higher 1-and 3-year OS rates than those treated with radiotherapy alone (n=68)(59% vs. 34%, 36% vs. 11%, P=0.002) or without any salvage treatment (n=17)(59% vs. 18%, 36% vs. 0%, P=0.002). Patients without visceral metastasis (n=80) had significantly higher 1-and 3-year OS rates than those with visceral metastasis (n=37)(44% vs. 27%, P=0.002; 22% vs. 0%, P=0.002). Patients with supraclavicular doses of ≥60 Gy in salvage radiotherapy (n=75) had significantly higher 1-and 3-year OS rates than those with supraclavicular doses of<60 Gy in salvage radiotherapy (n=25)(75% vs. 25%, P=0.000; 24% vs. 8%, P=0.000). The multivariate analysis using the Cox model showed that supraclavicular doses of ≥60 Gy, mediastinal metastasis, visceral metastasis, and salvage treatment method were independent factors for survival (P=0.001, 0.015, 0.009, 0.025). Conclusions Salvage radiotherapy can improve the survival of patients with SLNM in esophageal cancer. Salvage radiotherapy or radiochemotherapy is highly recommended for patients with SLNM alone. A radiation dose of ≥60 Gy in salvage radiotherapy improves survival in patients. Key words: Esophagus neoplasms; Supracevicular lymph node metastasis; Salvage treatment; Prognosis

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

Few reports have reported the long-term outcome of esophageal cancer patients suffering from postoperative infectious complications. Here, we investigated the impact of postoperative infectious complications in patients who had undergone curative resection for esophageal cancer. The study population comprised 97 patients who underwent radical resection for esophageal cancer with curative intent between 2001 and 2008. Postoperative infectious complications were defined as surgical site infections and pneumonia. We compared clinical features, tumor histology, recurrence, and overall survival between patients with postoperative infections and those who did not. Of the 97 patients studied, 37 had postoperative infectious complications. The disease-free and overall survival rates of the entire cohort did not significantly differ between patients with and without postoperative infectious complications. Univariate analysis revealed that among patients with stage III esophageal cancer, those with postoperative infectious complications demonstrated significantly shorter disease-free survival than those without. Multivariate analysis demonstrated that postoperative infectious complications were independent prognostic indicators for disease-free survival of stage III esophageal cancer patients. Our findings suggest that postoperative infectious complications in stage III esophageal cancer patients have a negative impact on disease-free survival.

Lung protection of flurbiprofen axetil combined with protective mechanical ventilation in patients undergoing thoracic surgery

Objective To evaluate the lung protection of flurbiprofen axetil combined with protective mechanical ventilation in the patients undergoing thoracic surgery. Methods Sixty patients of both sexes, aged 25-64 yr, with body mass index of 18-29 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective radical resection of esophageal cancer under general anesthesia, were randomly divided into 4 groups(n=15 each)using a random number table: conventional mechanical ventilation(group CMV), flurbiprofen axetil combined with conventional mechanical ventilation group(group F+ CMV), protective mechanical ventilation group(group PMV), and flurbiprofen axetil combined with protective mechanical ventilation group(group F+ PMV). Volume-controlled ventilation was performed in the 4 groups.Conventional mechanical ventilation mode was as follows: tidal volume(VT)10 ml/kg and respiratory rate(RR)10-12 breaths/min during two-lung ventilation(TLV); VT 8 ml/kg and RR 15-18 breaths/min during one-lung ventilation(OLV). Protective mechanical ventilation mode was as follows: VT 6 ml/kg, positive end-expiratory pressure 5 cmH2O, RR 15-18 breaths/min(during OLV)or 10-12 breaths/min(during TLV), inspiratory/expiratory ratio 1∶2, fraction of inspired oxygen 100%, oxygen flow rate 1-2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-45 mmHg in the 4 groups.Flurbiprofen axetil 2 mg/kg was injected intravenously at 15 min before skin incision, and the patient-controlled intravenous analgesia(PCIA)was used after surgery.PCIA solution contained sufentanil 100 μg and flurbiprofen axetil 2 mg/kg in 100 ml of normal saline.The PCIA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h, and visual analogue scale score was maintained ≤3.Before induction of anesthesia(T0), at 15 min of TLV(T1), at 1 and 2 h of OLV(T2), at 2 h after OLV(T3), at the end of surgery(T4), and at 24 h after surgery(T5), blood samples were taken from the radial artery for determination of arterial oxygen partial pressure, and oxygenation index was calculated.The occurrence of abnormal pulmonary function was recorded during and after surgery.The parameters of pneumodynamics were recorded at T1-4.Central venous blood samples were taken at T0, 4, 5 to measure the concentrations of tumor necrosis factor-alpha, interleukin-6(IL-6), and IL-8 in serum. Results Compared with group CMV, arterial oxygen partial pressure, oxygenation index, and dynamic lung compliance were significantly increased, the peak airway pressure, airway plateau pressure and concentrations of tumor necrosis factor-alpha, IL-6, and IL-8 in serum were significantly decreased, and the incidence of abnormal pulmonary function after surgery was significantly decreased in the other 3 groups, especially in group F+ PMV(P<0.05). Conclusion Flurbiprofen axetil used before and after surgery has lung protection, and it produces better efficacy when combined with protective mechanical ventilation in the patients undergoing thoracic surgery. Key words: Cyclooxygenase inhibitors; Respiration, artificial; Respiratory distress syndrome, adult; Thoracotomy

Efficacy of paravertebral block for preemptive analgesia in elderly patients undergoing thoracotomy

Objective To evaluate the efficacy of paravertebral block for preemptive analgesia in elderly patients undergoing thoracotomy. Methods Sixty patients, aged 65-70 yr, with body mass index of 18-23 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective radical resection for esophageal cancer through a left thoracotomy, were randomly divided into total intravenous anesthesia group (group I) and total intravenous anesthesia combined with paravertebral block group (group B) with 30 patients in each group.Anesthesia was induced with iv infusion of dexmedetomidine 0.4 μg·kg-1·h-1, and iv injection of midazolam 0.04 mg/kg, propofol 2 mg/kg, sufentanil 0.5 μg/kg and rocuronium 0.8 mg/kg.In group B, paravertebral block was performed under the guidance of altrasound after induction of anesthesia, a paravertebral catheter was placed at T4-8 in the paravertebral space on the left side, and 0.5% ropivacaine 5 ml was injected via the catheter into the paravertebral space.Anesthesia was maintained with iv infusion of propofol 6-8 mg·kg-1·h-1 and remifentanil 0.1-0.3 μg·kg-1·min-1, and intermittent iv blouses of rocuronium.Patient-controlled intravenous analgesia (PCIA) was used after operation.PCIA solution contained sufentanil 2 μg/kg, dezocine 10 mg, and dexmedetomidine 100 μg in 100 ml of normal saline.The PCIA pump was set up with a 2 ml bolus dose, a 15 min lockout interval, and background infusion at a rate of 2 ml/h.Prince-Henry score was maintained ≤ 3 after operation.At 5 min before skin incision, 5 min after skin incision, and 5 min after thoracotomy, the mean arterial pressure and heart rate were recorded.The intraoperative consumption of anesthetics, the extubation time, SpO2 at 30 min after extubation, amount of drugs consumed per hour during PCIA, occurrence of postoperative pulmonary complications, patients who required intensive care unit admission, and postoperative recovery time were recorded. Results No cardiovascular events were found in the two groups.Compared with group I, the intraoperative consumption of propofol, remifentanil and rocuronium was significantly decreased, extubation time was shortened, the SpO2 at 30 min after extubation was increased, the amount of drugs consumed per hour during PCIA was reduced, the incidence of postoperative complications and the number of patients who required ICU admission were decreased, and the postoperative recovery time was shortened in group B (P<0.05). Conclusion Paravertebral block produces good efficacy for preemptive analgesia in elderly patients undergoing thoracotomy. Key words: Nerve block; Analgesia; Aged; Thoracotomy

Clinical value of preoperative serum carcinoembryonic antigen detection in the prediction of esophageal cancer lymph node metastasis

Objective To investigate the clinical value of preoperative serum carcinoembryonic antigen (CEA) detection in the prediction of esophageal cancer lymph node metastasis. Methods The clinical data of 111 patients with esophageal cancer who were admitted to the Chaoyang Hospital of Capital Medical University between December 2010 and January 2014 were retrospectively analyzed. Patients received preoperative serum CEA examination and enhanced CT of the chest. The surgical procedures were selected according to the condition of patients, including radical resection of esophageal cancer via left thoracic approach, transabdominal right thoracic approach (open and laparoscopic surgeries), cervico-thoracic-abdominal triple incision (open and laparoscopic surgeries) and transabdominal incision. The international standard was used for tumor location and TNM stage of esophageal cancer. The count data and comparison of ordinal data in the univariate analysis were analyzed using the chi-square test, Fisher exact probability and rank-sum test, respectively. The multivariate analysis was done using the stepwise logistic regression. The ROC curve was used for evaluating diagnostic value of serum CEA examination and enhanced CT of the chest. All the 111 patients were divided into 4 groups according to the interquartile range results of the CEA examination, and the lymph node metastasis rates of 4 groups were compared by the chi-square test. Results All the 111 patients underwent successful radical resection of esophageal cancer after preoperative serum CEA detection and enhanced CT of the chest, including 40 via left thoracic approach, 56 via transabdominal right thoracic approach, 8 via cervico-thoracic-abdominal triple incision and 7 via transabdominal incision. There were 3 patients with upper thoracic esophageal cancer, 52 with middle thoracic esophageal cancer, 36 with lower thoracic esophageal cancer and 20 with cancer of gastro-esophageal junction. The postoperative pathological type included 84 squamous cell carcinomas, 23 adenocarcinomas and 4 other carcinomas. There were 44 patients with negative lymph node metastases and 67 with positive lymph node metastases. The positive rate of elevated serum CEA in the 111 patients was 36.04%(40/111). Tumor location, pathological type and N stage of tumor were clinical pathological factors affecting the positive rate of serum CEA of patients (Z=6.815, 6.608, 16.928, P 4.21 μg/L by the stratified analysis, respectively, with a significant difference among the 4 groups (χ2=16.026, P<0.05). The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.687 (95% CI: 0.590-0.785) and 0.689 (95% CI: 0.591-0.788) by ROC curve, which were significantly different from the area under the guides (P<0.05). The areas under the curve of CEA level and enhanced CT of the chest for lymph node metastasis were 0.785 (95%CI: 0.697-0.873, P<0.05). Conclusions Serum CEA detection not only has certain predictive value for lymph node metastasis of esophageal cancer, but has a higher predictive value combined with enhanced CT of the chest. There is a risk of lymph node metastasis for patients with deep tumor invasion and elevated CEA level, and the range of lymph node dissection should be expanded. Key words: Esophageal neoplasms; Carcinoembryonic antigen; Lymph node metastasis

Late Recurrence After Radical Resection of Esophageal Cancer.

Approximately 10-20 % of esophageal cancer patients in whom recurrence is diagnosed experience late recurrence beyond 2 years after esophagectomy. However, the risk of late recurrence is still unclear. The aim of this study was to identify the risk factors of late recurrence for appropriate postoperative surveillance. A total of 447 patients underwent radical esophagectomy and reconstruction for esophageal cancer from 2005 to 2014. Patients who had recurrence beyond 2 years after esophagectomy were defined as the late recurrence group and the remaining patients with recurrence as the early recurrence group. A comparison of the clinicopathological factors and prognosis was performed between patients with early recurrence, late recurrence, and no recurrence. Recurrences were recognized in 117(26.2 %) of the 447 patients. Recurrence was diagnosed within 2 years after surgery in 103 patients (88.0 %) and after 2 years in 14 patients (12.0 %). Patients with late recurrence showed a favorable prognosis compared with those with early recurrence (P = 0.0131), and late recurrence was an independent factor associated with a favorable prognosis after recurrence (HR 0.199, P = 0.025). In the comparison between patients with late recurrence and those with no recurrence who had a minimal recurrence-free survival of 2 years, pathological lymph node metastasis at esophagectomy was found to be an independent predictor of late recurrence (HR 7.296, P = 0.043). Pathological lymph node metastasis at esophagectomy is a risk factor of late recurrence for esophageal cancer, and a close, lifelong follow-up is recommended for such patients.

Protective effects of lung protective ventilation on lungs in patients undergoing radical resection for esophageal cancer

Objective To evaluate the protective effects of lung protective ventilation on the lungs in patients undergoing radical resection for esophageal cancer. Methods Sixty-eight patients of both sexes, aged 40-64 yr, of ASA physical status Ⅰ or Ⅱ, with body mass index 17-40 kg/m2, scheduled for elective radical resection for esophageal cancer, were randomly divided into conventional ventilation group (CV group, n = 34) and protective ventilation group (PV group, n = 34) using a random number table.Double lumen tube was inserted after induction of anesthesia, an anesthesia machine was connected, and the patients were mechanically ventilated.In group CV, VT was set at 10 ml/kg during two-lung ventilation, and VT was set at 7 ml/kg, and I∶E was set at 1∶2 during one-lung ventilation.In group PV, VT was set at 7 ml/kg during two-lung ventilation, VT was set at 5 ml/kg, I∶E was set at 1∶2, and PEEP was set at 10 cmH2O during one-lung ventilation, and bilateral lung recruitment maneuver was performed every 45 min.Before induction of anesthesia, and at days 1, 3, and 5 after surgery, blood gas analysis was performed, and Clinical Pulmonary Infection Score was recorded.Before induction of anesthesia, and at 5 days after surgery, point-of-care testing for pulmonary function was performed, and percentages of maximum ventilatory volume (MVV%), forced vital capacity (FVC%), and forced expiratory volume in 1 second (FEV1%) were recorded, and FEV1/FVC was calculated.The development of respiratory failure, pulmonary atelectasis and incision infection was recorded within 5 min after surgery. Results Compared with group CV, MVV%, FVC%, FEV1% and FEV1/FVC were significantly increased, Clinical Pulmonary Infection Score was decreased at each time point after surgery, SaO2 and PaO2 were increased, and no significant changes were found in pulmonary atelectasis and incision infection in group PV. Conclusion Lung protective ventilation can effectively protect the lungs in the patients undergoing radical resection for esophageal cancer. Key words: Respiration, artificial; Esophageal neoplasms; Esophagectomy

食道癌術後再建胃管に発生した早期胃癌の１例

食道癌術後再建胃管に発生した早期胃癌の１例

Esophageal-gastric anastomosis in radical resection of esophageal cancer under thoracoscopy combined with laparoscopy.

To determine the feasibility of esophagogastric anastomosis in esophageal cancer radical resection under thoracoscopy combined with laparoscopy in terms of complications and operation time. Experimental study. Department of Thoracic Surgery, Affiliated with The First Hospital, Suzhou University, from June 2008 to June 2012. Clinical data of 136 patients operated for esophageal cancer by radical resection under thoracoscopy combined with laparoscopy was analyzed. Eighty one superior and middle segment esophageal carcinoma patients were operated through right thoracoscope, abdominoscope, and neck incision. The esophagogastric anastomosis was completed in the left side of neck by handiwork. Fifty five inferior segment esophageal carcinoma were operated through right thoracoscope, abdominoscope and the esophagogastric anastomosis was completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus. The operation time and the intra-operative blood loss in patients with intrathoracic mechanical anastomosis was significantly lower than that of cervical anastomosis. Other variables were not significantly different. The practicability of this method of anastomosis that completed with stapler in right thoracic cavity through superior belly incision and diaphragmatic hiatus had been well confirmed.

Effects of dexmedetomidine on cellular immune function during analgesia with morphine after radical resection for esophageal cancer

Objective To evaluate the effects of dexmedetomidine on the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.Methods Sixty patients of both sexes,of ASA physical status Ⅰ or Ⅱ,after radical resection for esophageal cancer under general anesthesia,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Patient-controlled intravenous analgesia (PCIA) was performed immediately after operation in the two groups.In group C,the PCIA solution (150 ml) contained morphine 0.48 mg/kg.In group Dex,the PCIA solution (150 ml) contained morphine 0.48 mg/kg and dexmedetomidine 1 μg/kg.The postoperative visual analogue scale (VAS) scores were maintained ≤ 3.The consumption of morphine was recorded within 24,48 and 72 h after operation.The adverse effects such as nausea,vomiting,pruritus,bradycardia,hypotension,oversedation and respiratory depression were also recorded after operation.Before induction of anesthesia (T0),immediately after extubation (T1),and at 24,48 and 72 h after operation (T2-4),venous blood samples were obtained for determination of the levels of T-lymphocyte subsets (CD3+,CD4+,CD8+) and natural killer (NK) cells by flow cytometry.CD4+/CD8+ ratio was calculated.Results Compared with group C,the consumption of morphine within 24,48 and 72 h after operation and incidence of nausea,vomiting and pruritus after operation were significantly decreased in group Dex.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly lower at T1-4 than at T0 in the two groups.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly higher at T1-4 in group Dex than in group C.Conclusion Dexmedetomidine can improve the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients. Key words: Dexmedetomidine ; Morphine ; Analgesia, patient-controlled ; Immunity, cellular

125I radioactive seeds implantation combined with postoperative chemotherapy in treatment of advanced esophageal squamous cell carcinoma

Objective To evaluate the safety and efficacy of 125I radioactive seeds implantation combined with postoperative chemotherapy as a treatment option for thoracic advanced esophageal squamous cell carcinoma(ESCC). Methods A prospective cohort study was carried out between 2000and 2005. According to preoperative CT staging criteria,298 patients in phase Ⅱ-Ⅲ of ESCC, who had were admitted to Oncology Center Surgery of Nanjing First Hospital Affiliated to Nanjing Medical University and Thoracic Surgery of YanCheng Oncology Hospital, were randomly divided into three groups: intraoperative 125I seeds implantation combined with postoperative chemotherapy (group A, 98cases), postoperative chemoradiotherapy (group B, 100 cases) and surgery alone (group C, 100cases). All patients received radical resection of esophageal cancer. According to pTNM staging criteria after operation, 233 patients in phase Ⅱb-Ⅲ of ESCC were finally enrolled in the study (78 in group A, 75 in group B, and 80 in group C). With 0. 5 m Ci of single seed, total activity of 5-11 mCi and matched peripheral dose in 60-70 Gy, 10-22 125I seeds were implanted into the target of patients in group A under direct vision in accordance with treatment planning system. The validation and quality assessment of radioactive seeds were demonstrated according to CT scan or X-ray imaging. The postoperative complications were observed. The local recurrence of the cancer was demonstrated using CT scan. The survival rate of patients was followed up for 1-,3-,5- and 10 years. Results The satisfied quality assessment of 125I seeds was observed. There was no displacement or loss of seed. The local recurrence in group A, B and C was 11. 5%, 13. 3% and 38. 8%, respectively, with statistical significance (P ＜ 0. 05). There was no significant difference among three groups with respect to complications and 1-year survival (P＞0. 05). However, the overall survival rate 3-, 5- and 10-years was 64.8%,37. 7% and 25. 1% in group A respectively; 63.3%, 36.9% and 24.9% in group Brespectively; 43. 6i%, 25.0%, and 12.6% in group C, respectively (all P＜0. 05). The 3-,5- and 10-year progression free survival rates were 63.5 %, 37.4 % and 15.1% in group A respectively; 62.5 %,36.6% and 14. 4% in group B respectively; 42.5%, 25.6% and 6.2% in group C respectively (all P＜0. 05). Conclusions It is a safe, effective and simple method for intraoperative 125I seeds implantation combined with postoperative chemotherapy in treatment of advanced ESCC, which may reduce the local recurrence and improve survival rates in patients with ESCC. Key words: Esophageal squamous cell carcinoma; Radioactive seed; 125I or 125I; Brachytherapy; Esophagectomy

Research in influence of pre-operative pain education on pain control after radical resection of esophageal cancer

目的 探讨术前疼痛知识教育对食管癌患者术后疼痛控制的认识、所采取的疼痛控制措施及疼痛控制效果的影响.方法 采用历史对照研究,2008年3-4月43例拟实施食管癌根治术的患者予常规护理(对照组),2008年6-7月39例拟实施食管癌根治术的患者在常规护理基础上接受经过系统疼痛控制培训的同组医护人员的疼痛教育(实验组).评估2组术后24 h镇痛需求和术后疼痛程度.结果 实验组镇痛需求明显高于对照组,术后疼痛程度明显低于对照组.结论 疼痛教育能转变医护人员和患者对疼痛的认识,能显著改善食管癌根治术后患者疼痛控制效果。

Circulating micrometastases of esophageal cancer detected by carcinoembryonic antigen mRNA reverse transcriptase-polymerase chain reaction: clinical implications

In some patients without distant metastases according to conventional preoperative investigations, relapse occurs in distant organs within a few years after radical resection of esophageal cancer. Various attempts have been made to detect micrometastases that are not found by conventional techniques. A quantitative real-time reverse-transcriptase polymerase chain reaction was used to detect messenger RNA for carcinoembryonic antigen in 147 blood samples from 49 patients scheduled for radical resection of esophageal cancer at Juntendo University Hospital between September 2003 and June 2004. The number of circulating cancer cells was assessed and the clinical significance of detecting such micrometastases was analyzed. Multivariate analysis showed that positivity of this assay was significantly associated with pT1 or pT2 disease and stage III or stage IV disease. Patients with more than 40-50 carcinoembryonic antigen mRNA copies among 10(4) normal cells on quantitative analysis had a higher recurrence rate. The number of tumor cells circulating in the blood may have more influence on the prognosis of esophageal cancer than the presence of tumor cells.

食道癌術後再建胃管に発生した未分化癌の１例

食道癌術後再建胃管に発生した未分化癌の１例

食道癌術後再建胃管癌の１例

食道癌根治術後6年目に発見された再建胃管癌の1例を経験した.症例は66歳, 男性.6年前に食道癌にて右開胸, 開腹, 胸部食道全摘術, 胸骨後経路による頸部食道胃管吻合術が施行された.今回, 嚥下障害を主訴に精査が行われ, 胃管下部に癌が発見された.手術は胸骨縦切開, 開腹による胃管全摘, 胸壁前にて右半結腸をもちいた再建術が行われたが, 心嚢, 縦隔胸膜に浸潤があり非治癒切除に終った.肉眼型はBorrmann4.組織学的には中分化型管状腺癌, 硬性型, 1群リンパ節転移陽性, stage IVであった.術後MTX, フトラフ-ルを用いた化学療法を施行, 9か月の現在健在である.自験1例を含め1990年までに報告された本邦における食道癌術後再建胃管癌47例を集計し, その臨床像について検討を行った.早期癌は12例と少なく, 予後は不良である.したがって, 術後の定期的な胃管造影, 内視鏡検査を積極的に行い, 胃管癌の早期発見に努める必要がある.

食道癌術後挙上胃管に発生した胃癌症例と本邦報告例の検討

食道癌術後挙上胃管に発生した胃癌症例と本邦報告例の検討