Radical Resection Of Esophageal Carcinoma Research Articles

Preliminary Evaluation of Postoperative Radiotherapy between Small T-Shaped Field and All Regional Lymph Nodes Field in Thoracic Esophageal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> The optimal extent of clinical target volume (CTV) for postoperative radiotherapy in complete resection thoracic esophageal squamous cell carcinoma (ESCC) patients remains controversial. This study aimed to evaluate the preliminary results of postoperative radiotherapy with standard all regional lymph nodes field and adjusted small T-shaped field. <h3>Materials/Methods</h3> A total of 75 thoracic ESCC patients were enrolled from April 2017 to March 2021, retrospectively. Among them were 63 males and 12 females, with an average age of 64.28 (range, 49-82) years. All patients received intensity-modulated radiotherapy (IMRT) at a dose of 45-50.4Gy/25-28F after radical resection of esophageal carcinoma, of which 39 cases were small T-shaped field (including bilateral supraclavicular lymph nodes, upper and middle mediastinal lymph nodes, small T group),36 cases were all regional lymph nodes field (including tumor bed, bilateral supraclavicular lymph nodes, all mediastinal lymph nodes, left gastric lymph nodes and celiac lymph nodes, control group). 24 cases (32%) received concurrent chemotherapy and 57 cases (76%) received adjuvant chemotherapy. The median follow-up period was 31(range, 15-57) months. <h3>Results</h3> At the end of follow-up period, 7 (17.9%) cases had locoregional recurrence (LRR) and 8(20.5%) had distant metastasis (DM) in small T group, while 9 (25%) cases had LRR and 9 (25%) had DM in control group. There was no significant difference in LRR rate (p=0.456) and DM rate (p=0.643) between the two groups. There was also no significant difference in the total OS rate between the two groups (p=0.146). In terms of radiotherapy parameters, in small T group, the median values of V5, V20 and average dose of the lungs were 37.31%, 16.43% and 8.11Gy, respectively. The median value of the maximum dose of spinal cord was 29.95Gy. For the heart, the median value of the average dose and V30 were 5.13Gy and 2.64%. And the median value of V40 of the stomach was 34.32%. In control group, the median values of V5, V20 and average dose of the lungs were 53.49%, 22.08% and 11.41Gy. The median value of the maximum dose of spinal cord was 36Gy. For the heart, the median value of the average dose and V30 were 27.52Gy and 37.39%. And the median value of V40 of the stomach was 63%. All of the above parameters in small T group were significantly lower than those in control group (p<0.05). In addition, we observed grade 2 radiation pneumonitis and grade 2 radiation esophagitis in both groups:9 cases of radiation pneumonia with grade 2 or above in control group and only 1 case in small T group (p<0.001). There were 15 cases of radiation esophagitis with grade 2 or above in control group and 6 cases in small T group (p=0.024). <h3>Conclusion</h3> In conclusion, radiotherapy with small T-shaped field might be a feasible and efficacious postoperative approach for ESCC patients.

124. LONGITUDINAL STUDY OF POSTOPERATIVE SYMPTOMS AND QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Patients with esophageal squamous cell carcinoma have a variety of symptoms after surgery, which will affect the normal performance of various functions of patients for a long time, affect the quality of life of patients, and even affect the survival time of patients. In the past, we paid more attention to patients’ symptoms and quality of life at a single time point after surgery, which lacked continuity and long-term nature. In this study, 244 patients with esophageal squamous cell carcinoma who received thoracoscopic radical resection of esophageal carcinoma in Sichuan Tumor Hospital from April to December 2019 were selected by convenience sampling method. Adopt Chinese VERSION MD Anderson Symptom Inventory, European Organization for Research and teatment of cancer quality of life Questionnaire, EORTC QLQ-C30 and QLQ-OES18 were used to investigate the patients at 10 time points one year after surgery, and Pearson correlation analysis was used to analyze the correlation between postoperative symptoms and quality of life. Postoperative role and emotional function of the patients recovered to the baseline level 1 month after surgery, cognitive and social function recovered to the baseline level 3 months after surgery, and physical function and overall health status did not recover to the baseline level 1 year after surgery. Sleep restlessness, distress, drowsiness, and dry mouth recovered to baseline 3 months after surgery, while pain and fatigue did not recover to baseline 1 year after surgery. One year after surgery, the main symptoms were negatively correlated with body, role, emotion, cognition, social function and overall health status (P &amp;lt; 0.05). laparoscopic thoracic esophageal cancer radical surgery in patients with esophageal squamous cell carcinomas there were different degree of symptoms within one year after surgery, and multiple symptoms one year after surgery still exists, the serious influence the patient’s quality of life, health care workers should pay attention to the symptoms of patients with postoperative longitudinal change characteristic, value assessment and management of patients with symptoms, improve patient quality of life after surgery.

Safety analysis of early oral feeding after esophagectomy in patients complicated with diabetes

ObjectiveTo evaluate the safety of early oral feeding in patients with type II diabetes after radical resection of esophageal carcinoma.MethodsThe clinical data of 121 patients with type II diabetes who underwent radical resection of esophageal carcinoma in the department of cardiothoracic surgery of Jinling Hospital from January 2016 to December 2018 were retrospectively analyzed. According to the median time (7 days) of the first oral feeding after surgery, the patients were divided into early oral feeding group (EOF, feeding within 7 days after surgery, 67 cases) and late oral feeding group (LOF, feeding after 7 days, 54 cases). Postoperative blood glucose level, incidence of complications, nutritional and immune indexes, inflammatory indexes, normalized T12-SMA (the postoperative/preoperative ratio of vertical spinal muscle cross-sectional area at the 12th thoracic vertebra level) and QLQ-C30 (Quality Of Life Questionnaire) scores were recorded and compared in the two groups.ResultsThere was no statistical difference in preoperative nutritional index and postoperative complication rates between the EOF and LOF group (p > 0.05). The postoperative nutritional index (ALB, PA, TRF, Hb) and immune index (IgA, IgG, IgM) of the EOF group were higher than those of the LOF group (p < 0.05), and the inflammatory indicators (CRP, IL-6) of the EOF group were significantly lower than those of the LOF group (p < 0.05). Moreover, postoperative T12-SMA variation and QLQ-C30 scores of the EOF group were higher than those in LOF group (p < 0.05).ConclusionsEarly oral feeding is safe and feasible for patients with type II diabetes after radical resection of esophageal cancer, and it can improve short-term nutritional status and postoperative life quality of the patients.

Lead to elevate the temperature and speed of emergency rescue and nursing care of common carotid artery rupture and massive hemorrhage after operation of typical esophageal cancer

Objective: Objective To explore the first aid and nursing of patients with anastomotic fistula after radical resection of esophagus carcinoma complicated with major carotid hemorrhage.Methods: The clinical data of anastomotic fistula complicated with carotid artery rupture and massive hemorrhage after radical resection of typical esophageal carcinoma were analyzed and summarized.Results:Through the close cooperation of medical care, the rescue was successful.Conclusion:Earlier prevention observation, raising first aid consciousness and actively cooperating with doctors can improve the success rate of rescue.

Effects of combined ultrasound-guided erector spinae plane block and patient controlled intravenous analgesia on postoperative pain in patients undergoing radical resection of esophageal carcinoma

Objective To observe the effects of one time erector spinae plane block (ESPB) combined with patient controlled intravenous analgesia(PCIA) on postoperative pain and satisfactory extent of patients undergoing radical resection of esophageal carcinoma by thoracotomy operation. Methods Forty patients[20 males and 20 females, American Society of Anesthesiologists (ASA) status Ⅰ or Ⅱ], scheduled for radical resection of esophageal carcinoma by open chest surgery, were randomly assigned into two groups: ESPB combined with PCIA group(group EP) and PCIA only group (group IA). ESPB was performed in group EP before anesthesia induction. The effect was evaluated by detecting the area of block after 20 min. The patients in both group used PCIA after surgery. Visual Analogue Scale (VAS) scores were recorded at 1, 6, 12, 24 h and 48 h after operation both in the resting and the coughing state. The times of pressing analgesic pump, the total volume of analgesic drugs infused by analgesic pump, the frequency and extent of adverse reaction and satisfactory extent of patients were recorded as well. Results Twenty min after EPSB, pain sense of patients in group EP was successfully blocked in the skin area innervated by spinal nerve between T3 to T9. The VAS scores both at rest and during coughing in group EP were lower than those in group IA(P<0.05). The times of pressing analgesic pump and the volume of infused analgesic drugs were significantly less in group EP than the times and volume in group IA (P<0.05). Meanwhile, the frequencies of nausea and vomiting in group EP were significantly lower than those in group IA (P<0.05). Also, the degree of satisfaction in group EP was significantly higher than the degree in group IA(P<0.05). Conclusions For radical resection of esophageal carcinoma by thoracotomy, ESPB combined with PCIA is a more effective method for postoperative analgesia than PCIA only. Also, the gross satisfactory extent is significantly higher in group EP than that in group IA. Less adverse effects were observed in patients of group EP. Key words: Erector spinae plane block; Patient controlled intravenous analgesia; Radical resection of esophageal carcinoma; Analgesic effect; Degree of satisfaction

Total mesoesophagus excision by thoracoscopy and laparoscopy in the radical resection of esophageal carcinoma.

Esophageal carcinoma is a malignant tumor with a high incidence in China. Surgical treatment is the main treatment method. Endoscopic-assisted radical resections of esophageal carcinoma have shown promising results with shorter operation times, less intraoperative blood loss, and thorough lymph node dissection (1). Our team is skilled in the total mesoesophageal excision (TME) based on thoracoscopy and laparoscopy in the radical resection of thoracic esophageal carcinoma (2).

Study on safety of adjuvant radiotherapy concurrent with weekly chemotherapy for stage ⅡB-ⅣA esophageal carcinoma after radical resection

Objective: To evaluate the tolerability and short-term efficacy of chemo-radiotherapy in 125 patients with stage ⅡB-ⅣA esophageal carcinoma after radical resection. Methods: We retrospectively evaluated the rate of completion, toxicity and survival of patients undergoing adjuvant concurrent chemo-radiotherapy after radical resection of esophageal carcinoma from January 2004 to December 2014 in our institution. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model. Results: 122 patients received more than 50 Gy dose (97.6%). A total of 52 patients received more than 5 weeks chemo-radiotherapy (41.6%), while 73 patients underwent only 1-4 weeks (58.4%). The median following up was 48.4 months. 8 patients lost follow up (6.4%). The 1-year and 3-year overall survival rate were 91.6% and 57.0%, respectively, with a median survival time of 64.4 months. The 1-year and 3-year disease free survival rate were 73.2% and 54.3%, respectively, with a median disease free survival time of 59.1 months. The most common acute complications associated with chemo-radiotherapy were myelosuppression, radiation esophagitis and radiation dermatitis, the majority of which were Grade 1-2. Of the 125 patients, there were 59 cases of recurrence, including 23 cases with local regional recurrence, 26 cases with hematogenous metastasis, and 8 cases with mixed recurrence. Univariate analysis showed that the numbers of concurrent chemotherapy was associated with the overall survival (P=0.006). But receiving more than 5 weeks was not the prognostic factor compared to 1 to 4 weeks chemotherapy (P=0.231). Multivariate analysis showed that only the numbers of concurrent chemotherapy was an independent prognostic factor (P=0.010). Conclusions: Postoperative radiotherapy concurrent with weekly chemotherapy could improve the overall survival and decrease the recurrence for stage ⅡB-ⅣA esophageal carcinoma after radical resection. However, the completion rate of chemotherapy was low, so it was necessary to explore reasonable regimens to improve the completion rate and carry out prospective randomized controlled trial.

Single-Port Inflatable Mediastinoscopy Combined With Laparoscopic-Assisted Small Incision Surgery for Radical Esophagectomy Is an Effective and Safe Treatment for Esophageal Cancer

BackgroundWe previously developed a novel non-trans thoracic esophagectomy, the single-port inflatable mediastinoscopy combined with laparoscopy for the radical esophagectomy of esophageal cancer. The purpose of this study was to report its therapeutic efficacy and safety. MethodsFrom May 2016 to August 2017, we have completed 80 cases of radical resection of esophageal carcinoma using this novel surgical technique. The intraoperative findings and postoperative complications were reported. ResultsThe operation was successfully performed in all patients except for one patient switched from laparoscopic-assisted operation to open surgery. The mean operation duration was 191.4 ± 27 min, and the mean intraoperative blood loss was 147.3±28.9 mL. The mean number of removed lymph node was 21.9 ± 4.1. Five patients (6.4%) who had preoperative type I respiratory failure needed to stay in the intensive care unit for 24 h postoperatively. Postoperative complications included anastomotic leakage (8.9%), anastomotic stricture (21.25%), pleural effusion (9%), and hoarseness postoperative hoarseness (18.8%). The incidence of hoarseness at 3 months postoperation was reduced to 3.8%. All the complications were Clavien-Dindo grades I–III. There were no perioperative death and postoperative cardiopulmonary complications. ConclusionThese results showed that the single-port inflatable mediastinoscopy combined with laparoscopy is feasible for radical esophagectomy and possesses good therapeutic efficacy and safety.

The curative effect of neoadjuvant radiotherapy and chemotherapy combined with surgery for middle and late esophageal squamous cell carcinoma

Objective To understand the efficacy of neoadjuvant radiotherapy and chemotherapy combined with surgery in the treatment of middle segment esophageal squamous cell carcinoma. Methods 100 cases of mesoesophageal squamous cell carcinoma admitted from July 2011 to August 2013 were randomly divided into study group and control group, with 50 cases per group. The study group’s neoadjuvant radiotherapy and chemotherapy program was 2 Gy, which was performed with 6 to 8 targets for tongue titration intensity radiotherapy, once a day, 5 times a week, with a total dose of 40 Gy. TP regimen was administered synchronously on the 1st to 4th and 25th to 28th days after radiotherapy. The radical resection of esophageal carcinoma with two incisions in right chest and upper abdomen was performed 3 to 5 weeks after the end of radiotherapy and chemotherapy. Surgical complications, pathologic factors and 1, 3, 5-year survival rates were observed. Results In terms of postoperative complications, the incidence of pulmonary infection in the study group was higher than that in the control group (χ2=5.263, P=0.022). The incidence of anastomotic leakage in the study group was higher than that in the control group, with no statistical difference (χ2=0.344, P=0.558). The rate of recurrent laryngeal nerve injury in the study group was lower than that in the control group, with no statistical difference (χ2=1.042, P=0.307). The total incidence of postoperative complications in the study group was higher than that in the control group, with no statistical difference (χ2=3.326, P=0.068). In terms of pathological remission rate, the study group was significantly superior to the control group, with statistically significant differences (χ2=32.750, P=0.001). In terms of postoperative survival rate, the 1-year survival rate in the study group was higher than that in the control group, with no statistical difference (χ2=3.475, P=0.062). Survival rates of 3 years (χ2=5.769, P=0.016), and 5 years (χ2=4.762, P=0.029). were statistically higher in the survival study group than in the control group. Conclusion Neoadjuvant radiotherapy and chemotherapy combined with surgery can significantly prolong 3-year and 5-year survival rates in patients with middle thoracic esophageal squamous cell carcinoma. Key words: Esophageal squamous carcinoma; Neoadjuvant radiotherapy and chemotherapy; Surgical treatment

Attention should be paid to the lymph node dissection after neoadjuvant therapy: interpretation of Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition)

At present, no consensus has been reached on the methods of dissection of lymph nodes in radical resection of esophageal carcinoma, especially the number and range of lymph node dissection after neoadjuvant therapy, and the sensitivity of the number of lymph node dissection to the pathological N stage after neoadjuvant therapy is low. Therefore, the significance of lymph node dissection needs to be further confirmed. The dissection of the chest lymph nodes is necessary, regardless of the method of lymph node dissection. According to the American Joint Commission for Cancer (AJCC)/Union for International Cancer Control (UICC) and the Japan Esophagus Society (JES) standards, Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition) puts forward the Chinese standard of the thoracic lymph node grouping of esophageal carcinoma in order to meet the practical needs of Chinese patients. Key words: Esophageal neoplasms; Thoracic surgical procedures; Lymph node excision; Neoadjuvant therapy

VS03.07: RADICAL OPERATION OF ESOPHAGEAL CANCER UNDER 3D THORACOSCOPY

Abstract Description The main steps of radical resection of esophageal carcinoma under 3D thoracoscope. Disclosure All authors have declared no conflicts of interest.

Application value of the fusiform tube stomach in the digestive tract reconstruction after thoracoscopic and laparoscopic radical resection of esophageal carcinoma

Objective To explore the application value of the fusiform tube stomach in the digestive tract reconstruction after thoracoscopic and laparoscopic radical resection of esophageal carcinoma. Methods The retrospective cohort study was conducted. The clinicopathological data of 96 patients with thoracic esophageal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University between November 2016 and May 2017 were collected. All the patients underwent thoracoscopic and laparoscopic radical resection of esophageal carcinoma, 45 using thin tubular stomach and 51 using fusiform tube stomach for digestive tract reconstruction were respectively allocated into the tubular stomach group and fusiform stomach group. Observation indicators: (1) intra- and post-operative situations; (2) postoperative complications; (3) detection of gastric hemodynamics; (4) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survival up to November 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the rank sum test. Ordinal data and categorical variables were respectively done using the independent-sample Wilcoxon rank-sum test and chi-square test. Paired experimental data were analyzed by the Friedman test and Wilcoxon test. Results (1) Intra- and post-operative situations: 96 patients underwent successful thoracoscopic and laparoscopic radical resection of esophageal carcinoma. The number of closers, time of postoperative mediastinal tube removal, thoracic stomach anteroposterior diameter by postoperative CT examination, number of slices at maximal width of thoracic stomach by postoperative CT examination and duration of hospital stay were respectively 4 (range, 3-5), 14 days (range, 11-45 days), 28.35 mm (range, 9.96-75.70 mm), 0.56 (range, 0.33-2.13), 16 days (range, 12-62 days) in the tubular stomach group and 4 (range, 2-4), 12 days (range, 10-16 days), 45.80 mm (range, 17.36-89.77 mm), 1.10 (range, 0.47-2.15), 14 days (range, 12-61 days) in the fusiform stomach group, with statistically significant differences between groups (Z=4.525, 4.240, -3.796, -4.604, 2.154, P 0.05). Conclusion Compared with the thin tubular stomach, the fusiform tube stomach can reduce the incidences of postoperative fistula and pulmonary complications and shorten duration of hospital stay after the thoracoscopic and laparoscopic radical resection of esophageal carcinoma, and hemodynamics of the fusiform tube stomach is superior to that of thin tubular stomach. Key words: Esophageal neoplasms; Radical resection; Thoracoscopy; Laparoscopy; Fusiform tube stomach; Complications

Application of total mesoesophageal excision combined with sanye lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy

Objective To evaluate the clinical efficacy of total mesoesophageal excision and sanye lymph node dissection in the radical resection of esophageal carcinoma under thoracoscopy and laparoscopy, and to investigate its safety and feasibility, and to find a more reasonable and effective surgical treatment of esophageal carcinoma. Methods One hundred and twenty-six cases of esophageal cancer who underwent the minimally invasive surgery under thoracoscopy and laparoscopy for esophageal cancer in Central Hospital of Hengyang from October 2015 to September 2017 were retrospectively analyzed.Among them, Sixty-four patients accepted total mesoesophageal excision and sanye lymph node dissection under thoracoscopy and laparoscopy (observation group), Sixty-two cases accepted with conventional esophagectomy under thoracoscopy and laparoscopy (control group). The operation time, blood loss, indwelling time of thoracic drainage tube, postoperative drainage volume, postoperative hospitalization time, number of lymph node dissection, lymph node metastasis degree, perioperative complications of the two groups were analyzed and compared.The number of lymph node dissection and lymph node metastasis degree in different regions were compared between the two groups.The number of recurrence and death were recorded in the two groups. Results Compared with the control group, the operation time was longer in the observation group((264.9±32.9) min vs.(233.5±30.4) min, t=-5.56, P 0.05). The number of lymph nodes in the observation group was significantly higher than that in the control group ((32.7±15.5) pieces vs.(20.9±11.2) pieces, t=-4.93, P 0.05). Left and right recurrent laryngeal nerve, thoracic esophagus, celiac artery lymph node dissection of the number of observation group was higher than that of the control group ((4.7±3.2) pieces vs.(1.5±1.4) pieces, t=-7.25; (6.0±2.7) pieces vs.(3.1±1.7) pieces, t=-7.12; (5.7±2.4) pieces vs.(3.2±1.9) pieces, t=-6.48; P 0.05). There were no deaths in the two groups. Conclusion Total mesoesophageal excision and three-field lymph node dissection in radical resection of esophageal carcinoma under thoracoscopy and laparoscopy is safe and feasible, the recent effect does not increase the surgical complications, but its long-term effect need a lot of long-term follow-up.A relatively thorough cleaning of the esophageal mesentery and its lymph nodes can minimize the tumor in the subendothelial micrometastasis, and is beneficial for the prognosis of patients with esophageal cancer. Key words: Esophageal carcinoma; Esophageal mesentery; Sanye lymph node dissection; Thoracoscopy and laparoscopy; Micrometastasis

Investigate the effect of thoracic and abdominal mediastinal drainage tube on the pain and comfort of minimally invasive esophageal cancer patients and nursing care

Objective Compare the effect of thoracic and abdominal mediastinal tube placement on pain and comfort in patients with minimally invasive esophageal cancer and nursing care. Methods 108 patients with squamous cell carcinoma of the thoracic esophagus were selected from December 2016 to May 2017. The patients were divided into chest group and abdominal group according to the random number comparison table, each with 54 cases. All patients underwent minimally invasive radical resection of esophageal carcinoma. The mediastinum drainage tube was placed at different locations of the chest and abdomen after operation. The duration of intubation, total drainage volume, number of dressing change before and after extubation, degree of pain and comfort after surgery were recorded, drainage tube failure and the incidence of related complication were compared between the two groups. Results There was no significant difference in duration of intubation, total drainage volume, drainage tube failure and the incidence of related complication between Patients with mediastinal tubes placed through the chest and abdomen (P>0.05) . The times of dressing change before and after extubation in the abdominal group were (2.8 ± 1.0), (1.9 ± 0.6) times, those in the chest group were (4.5 ± 1.2), (3.6 ± 1.1) times, there were significant difference between the two groups (t=7.841, 9.377, P<0.01). The NRS and VAS score at 1-4 days and extubation in the abdominal group were significantly lower than those in the chest group, the abdominal group were (3.2±1.0), (2.7±0.8), (2.3±0.7), (1.9±0.7), (1.5±0.6) points and (3.7±0.8), (3.4±1.4), (3.0±0.7), (2.6±1.0), (2.6±1.0) points, the chest group were (3.7±1.3), (3.3±1.1), (2.8±0.8), (2.3±0.8), (2.3±0.7) points and (5.0±0.9), (4.3±1.4), (4.1±1.3), (3.3±1.2), (3.6±1.0) points, there were significant difference between the two groups (t=2.443-7.247, P<0.01 or 0.05). Conclusions Intraoperative abdominal minimally invasive radical mediastinal tube placed esophageal cancer, can significantly relieve pain and improve patient comfort, reduce the frequency of dressing change before and after extubation, not only quickly improve the rehabilitation of patients, but also can avoid the waste of medical resources, it is worthy of clinical promotion. Key words: Esophageal resection; Accelerated rehabilitation surgery; Mediastinum drainage; Comfort nursing

Clinic features and prognostic analysis for T1 esophagus cancer

Objective: To investigate relationship between the clinicopathological features and prognosis of T1 esophageal carcinoma. Methods: Data from 212 T1 primary esophageal cancer patients, who underwent radical surgery in The Fourth Hospital of Hebei Medical University from Jan 2001 to Dec 2009 were enrolled. There were 148 males and 64 females. There were 91 patients with stage pT1a and 121 patients with stage pT1b. Results: The survival of the 212 patients was 27~108 months, and the median survival was 80.8 months. The 1, 3, and 5 year survival rates of patients with stage T1a were 100%, 97.8% and 94.5%, respectively, and the median survival was 86.8 months. The 1, 3, and 5 year survival rates of patients with stage T1b were 100%, 95.9% and 74.4%, respectively, and the median survival was 76.2 months. The rate of lymph node metastasis in 121 patients with stage T1b was 26.4% (32/121). The lymph node metastasis rates in patients with stage sm1, sm2 and sm3 were 11.6% (3/26), 15.0% (6/40) and 41.8% (23/55), respectively. There was no significant difference in lymph node metastasis between stage sm1 patients and stage sm2 patients (P=0.973). Lymph node metastasis rates in patients with stage sm3 were higher than those in stage sm1 and sm2 (P<0.05). Conclusion: Radical resection of esophageal carcinoma with peripheral lymph node dissection is recommended for patients with T1b esophageal carcinoma.

Effects of aggressive warming on intraoperative temperature and cardiac troponin I in patients undergoing radical resection of esophageal carcinoma

Objective To observe the effects of aggressive warming on intraoperative temperature and cardiac troponin I (cTnI) in patients undergoing radical resection of esophageal carcinoma. Methods Ninety patients undergoing elective radical resection for esophageal carcinoma, aged 45-75 y, ASA Ⅰ or Ⅱ, and random stratification were performed according to the type of operation, then divided into aggressive warming group and routine group. All the patients were covered with the warming blanket at the lower extremities and abdomen. Fluid warming was used in both groups. Separately, aggressive warming group used the forced-air warming right after the patients entering the room to keep a final target core temperature≥36 ℃. However, in the routine group, intraoperative forced-air warming was used only when patient's core temperature decreased to less than 35 ℃ by turning off the warmer when the temperature reached 35.2 ℃ and switched to routine method. Nasopharyngeal temperatures of patients in two groups were recorded at 5 min after induction of anesthesia (T1), the beginning of the operation (T2), 60 min (T3), 120 min (T4), 180 min (T5) after incision and the end of operation(T6). Serum cTnI levels in the two groups were measured at 5 min after induction, 12, 24 h and 48 h after operation. The changes of temperature and serum cTnI were compared between two groups. Postoperative adverse events such as arrhythmia(including atrial fibrillation, supraventricular tachycardia, frequent ventricular premature), anastomotic fistula and lung abscess were also recorded. Results The core temperature in aggressive warming group was above 36 ℃ all the time, while in routine group, the temperature dropped to below 36 ℃ at the time point of T3, and was kept around 35 ℃ during the intraoperative period after T3. Eight patients in routine group experienced a period of hypothermia with the temperature <35 ℃ and used the rescue warming up. The concentrations of serum cTnI in aggressive warming group were significantly lower than those in the routine group at 24, 48 h after operation (P<0.05). The ratio of patients with postoperative serum cTnI elevation in aggressive warming group was significantly lower than that in routine group(14.3% vs 34.9%, P<0.05). Aggressive warming group also had lower rate of arrhythmia and anastomotic fistula (P<0.05) . Conclusions Aggressive warming can avoid the occurrence of hypothermia during the radical resection of esophageal carcinoma and prevent the elevation of serum troponin I after operation. Key words: Esophageal carcinoma; Radical resection; Body temperature protection; Troponin I

Clinical research of lymph node metastasis on the middle and lower segment of 108 patients with esophageal squamous cell carcinoma of Mongolian nationality

Objective To investigate the lymph node metastasis on the middle and lower segment of esophageal squamous cell carcinoma, understand the factors influencing lymph node metastasis, to further provide the theory evidence for the lymph node dissection on the middle and lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality. Methods A retrospective study was made in 108 Mongolian patients suffered from the middle and lower segment of esophageal squamous cell carcinoma who accepted radical resection of esophageal carcinoma by three incisions of right chest or combined with right thoracic laparoscopic in three incisions. Results A total of 4 914 lymph nodes were dissected, with an averaged clean of (45.5±6.0)lymph nodes for each case.80.6% of patients(87/108) were found lymph node metastasis.A total of 624 lymph nodes(624/4 914, 12.7%) existed metastasis.The rates of superior, middle and inferior mediastimum metastasis for middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 20.6%, 57.4% and 39.7%, respectively, while the rates of superior, middle and inferior mediastimum metastasis for lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality were 17.5%, 47.5% and 47.5%, respectively.There was no statistically significant difference between the two groups(P>0.05). The rate of lymph node peritoneal metastasis of lower segment of esophageal squamous cell carcinoma patients of Mongolian nationality was higher than that of middle segment of esophageal squamous cell carcinoma patients of Mongolian nationality(62.5% vs.16.2%, χ2=24.320, P 0.05). Conclusion The rate of lymph node metastasis on both the middle and lower segment of esophageal squamous cell carcinoma is high.The mediastinum lymph nodes needs to be emphatically cleaned.Abdominal lymph nodes cleaning of lower segment of esophageal squamous cell carcinoma can't be overlooked.Among the Mongolian patients, the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus, carina and recurrent laryngeal nerve, while the cleaning key of lymph node on the middle segment of esophageal squamous cell carcinoma are para esophagus, cardia side and carina.The deeper the tumor infiltration is, the lower the differentiation degree is, with cancer embolus in vessels, nerve invasion, the higher rate of the lymphatic metastasis. Key words: Esophageal neoplasms; Lymphatic metastasis; Mongolian nationality

The effects of NF-κB signal pathway on the process of anastomotic stricture after the radical resection of esophageal carcinoma

The aim of this article is to identify the relationship between the nuclear factor κB (NF-κB) signal pathway expression and the anastomotic stricture. It particularly focuses on the expression of p65, bcl-2, and cIAP-1 in the anastomotic stricture formation after radical resection of esophageal cancer. A total of 82 esophageal squamous carcinoma patients who had undergone esophagectomy by Ivor Lewis procedure were enrolled in the study. Tissues were collected from the patients who developed the anastomotic stricture after the operation, while para anastomotic tissues served as the control. The protein expression of p65, bcl-2, and cIAP-1 was analyzed by immunohistochemistry and western blot analyses, while the messenger RNA (mRNA) levels of p65, bcl-2, and cIAP-1 were evaluated by reverse transcription polymerase chain reaction (RT-PCR). The results showed that lower expression of p65, bcl-2, and cIAP-1 proteins was observed in the para anastomotic tissue; in the esophageal stricture’s tissue, the expression of these proteins was significantly higher ( P &lt; 0.05). The mRNA levels of P56, bcl-2, and cIAP-1 in the stricture tissue were remarkably increased ( P &lt; 0.05) compared with the para anastomotic tissues, and the mRNA levels in the sample of grade 3 dysphagia were higher ( P &lt; 0.05) than the levels of grade 1 and 2. In the normal esophageal epithelial cell of stricture patients was upregulated compared with that of no stricture patients. We can confirm that the anastomotic stricture has the relationship with the NF-κB signal pathway. The bcl-2 and cIAP-1, located downstream of NF-κB signal pathway, could be a new preventive and therapeutic target for the anastomotic stricture.

Nursing of a patient with AIDS after radical resection of esophageal carcinoma

Nursing of a patient with AIDS after radical resection of esophageal carcinoma

Abstract PR291

Background & Objectives: To evaluate the effect of oxycodone versus sufentanil on quality of recovery during early period after radical resection of esophageal carcinoma performed via video-assisted thoracoscope and laparoscope. Materials & Methods: before the end of surgery, oxycodone 0.05mg/kg was injected intravenously in group O, sufentanil 0.1 μg/kg was injected intravenously in group S. Patient-controlled intravenous analgesia (PCIA) was then used for postoperative analgesia at the end of surgery(lasting for 48h). PCIA solution contained oxycodone 0.75mg/kg in 100 ml of normal saline in group O. PCIA solution contained sufentanil 0.2μg/kg in 100 ml of normal saline in group S. The PCIA pump was set with 2 ml bolus dose, 15 min lockout interval and background infusion rate of 2 ml/h. At 6, 24, 48h after surgery, numeric rating scale (NRS) was used to assess the intensity of pain. When NRS scores ≥4, tromadol 1.5mg/kg injected intravenously was used as rescue analgesic. The global QoR-40 aggregate score were compared between the two groups. The requirement for rescue analgesics was recorded. The occurrence of nausea and vomiting was recorded. (the time of bowel function return, urocatheter tube removal, nasogastric tube removal after surgery) were recorded. Results: Compared with group S, group O produced better physical comfort scores(P<0.001), they also had more active, greater physical independence scores and had less pain 72 h after surgery(P<0.05), the global QoR-40 scores were significant increased (P<0.001). Compared with group S, the incidence of nausea and vomiting was significantly lower in group O (P<0.05). Compared with group S, the time of bowel function return, urocatheter tube removal, nasogastric tube removal after surgery were shorter in group O (P<0.05). Conclusion: Compared with sufentanil, oxycodone can improve the quality of recovery during the early period after radical resection of middle esophageal carcinoma performed via video-assisted thoracoscope and laparoscope. Disclosure of Interest: None declared