Radical Surgery For Esophageal Carcinoma Research Articles

The relationship between preoperative anemia and length of hospital stay among patients undergoing radical surgery for esophageal carcinoma: a single-centre retrospective study

BackgroundAlthough it is unclear if preoperative anemia affects patients undergoing radical resection of esophageal cancer, it does increase the length of stay (LOS) for surgical patients. Accordingly, the purpose of this study was to investigate if, after adjusting for other covariates, anemia was independently associated with LOS in people undergoing radical resection of esophageal cancer.MethodsThe retrospective cohort study included 680 patients undergoing radical esophageal cancer surgery between January 2010 and December 2020. Preoperative anemia was the targeted independent variable, while LOS was the target independent variable. Demographics, comorbidities, laboratory tests, surgery and anesthesia, postoperative outcomes, and complications were collected. Multivariate linear analyses were performed for variables that might influence preoperative anemia and LOS selection. Subgroup analysis using hierarchical variables was then used to test the potential relationship.ResultsThe 647 individuals that were randomly chosen had an average age of 61.06 ± 8.16 years, and 77.43% of them were male. The prevalence of anemia was 36.6%. All patients recruited had an average length of stay (LOS) of 26.31 ± 13.19 days, 25.40 ± 11.44 days for patients who had no preoperative anemia, and 27.89 ± 15.66 days for patients who had preoperative anemia, p < 0.05. After adjusting for covariates, the results of fully adjusted linear regression revealed that preoperative anemia was significantly associated with LOS (β = 2.04, 95%CI (0.13, 3.96) ), p < 0.05. The results of the subgroup analysis were basically accurate and steady. Regardless of gender, same outcomes were seen when preoperative anemia was defined as a Hb level < 13 g/dL (β = 2.29, 95%CI (0.33, 4.25) ), p < 0.05. In addition, the LOS was shortened with the increase of preoperative hemoglobin (Hb) (β= -0.81, 95%CI (-1.46, -0.1) ), p < 0.05.ConclusionPreoperative anemia is typical in Chinese patients undergoing radical esophageal cancer resection and is independently associated with prolonged LOS.

Effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma

Objective To evaluate the effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma. Methods Seventy-two ASA Ⅰ or Ⅱ elderly patients of both sexes, aged 65-80 y, weighing 45-85 kg, scheduled for elective radical resection for esophageal cancer and were randomly divided into 3 groups (n=24) using a random number table: group A, group B and group C. After induction of anesthesia, the patients were intubated with double-lumen tube and one-lung ventilation was performed. During one-lung ventilation, the lung on the operated side was collapsed naturally in group A, positive pressure ventilation (fresh gas flow 2 L/min) was applied in the lung on the operated side in group B, and high-frequency jet ventilation (frequency 100 bpm, driving pressure 0.5 kg/cm2) was used in the lung on the operated side in group C. The blood samples were obtained before induction (T0), at the end of operation (T1), on 6 h (T2), 12 h (T3) and 24 h (T4) after operation for determination of plasma concentration of S100β protein, neuron-specific enolase (NSE), IL-6 and TNF-α. The Mini-Mental State Examination(MMSE) was used to test the cognitive function of the patients at T0, T4, 3 d (T5) and 7 d after operation (T6). Results Compared with the baseline value at T0, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group A and group B were increased at T1-T4, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were increased at T1-T3, the MMSE score in group A were decreased at T4-T6, the MMSE score in group B and group C were decreased at T4-T5(P<0.05). Compared with group A, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group B and group C were decreased at T1-T4, the MMSE score in group B and group C were increased at T4-T6(P<0.05). Compared with group B, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were decreased at T1-T4, the MMSE score in group C were increased at T4-T5(P<0.05). Conclusions Continuous positive ventilation and high-frequency jet ventilation of lung on operated side both can effectively improve early postoperative cognitive function, and the efficacy of high-frequency jet ventilation is better. Key words: Continuous positive airway pressure; High-frequency jet ventilation; Aged; Cognitive disorder

A clinical study of thoracic esophageal carcinoma metastasis into abdominal lymph nodes

Abstract Objective The aim of this study was to analyze the potential of thoracic esophageal carcinoma to metastasize into abdominal lymph nodes. Methods The data on abdominal lymph node metastasis in 164 patients who had undergone resection of thoracic esophageal carcinoma were analyzed retrospectively and grouped according to tumor position in the upper, middle, or lower thoracic esophagus. The difference in tumor infiltration depth, differentiation degree, pathological type, pathological stage, and the metastasis rate in abdominal lymph nodes among the three groups was evaluated and the correlation of abdominal lymph node metastasis with tumor infiltration depth, differentiation degree, and pathological type was analyzed. Results Clinical characteristics such as tumor infiltration depth, differentiation degree, pathological type, and pathological stage were not significantly different between the patients with upper, middle, and lower thoracic esophageal carcinomas. Although there was a difference in the metastasis rate in abdominal lymph nodes between the three groups (6.9%, 27.4%, and 39.6% for the upper, middle, and lower thoracic esophageal carcinomas, respectively), it was not statistically significant. There was also no association between the rate of abdominal lymph node metastasis and tumor infiltration depth, differentiation degree, and pathological type. Conclusion Esophageal carcinoma specifically metastasizes into lymph nodes. If the tumor infiltrates the upper thoracic submucosa, it could metastasize down to abdominal lymph nodes via the lymphatic capillary net. The majority of esophageal carcinomas were of T1b or higher pathological stage at the diagnosis, indicating infiltration of the submucosa. Thus, tumors of the early stage, high degree of differentiation, or position in the upper thoracic esophagus were not less prone to metastasis into abdominal lymph nodes. Therefore, routine abdominal lymph node dissection during radical surgery for esophageal carcinoma is necessary.

Effect of dexmedetomidine combined with continuous positive airway pressure on oxidative stress and inflammatory responses during one-lung ventilation in elderly patients undergoing radical surgery for esophageal carcinoma

Objective To evaluate the effect of dexmedetomidine combined with continuous positive airway pressure (CPAP) on the oxidative stress and inflammatory responses during one-lung ventilation (OLV) in the elderly patients undergoing radical surgery for esophageal carcinoma.Methods One hundred and twenty ASA physical status Ⅱ or Ⅲ patients,aged 65-80 yr,with body mass index 18-25 kg/m2,scheduled for radical surgery for esophageal carcinoma,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C),dexmedetomidine group (group D),CPAP group (group P) and dexmedetomidine combined with CPAP group (group DP).After induction of anesthesia,the patients were endotracheally intubated and then mechanically ventilated.At the beginning of skin incision,OLV was performed instead.In D and DP groups,a loading dose of dexmedetomidine 0.3 μg/kg was infused starting from 10 min before incision,followed by infusion at a rate of 0.3 μg·kg-1 ·h-1 untill the chest was closed.CPAP 2 cmH2O was used on the non-ventilated side during OLV in P and DP groups.Immediately before incision,at 90 min of OLV,at the end of operation and on 1 day after operation,venous blood samples were obtained for determination of the serum malondialdehyde (MDA),interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) concentrations.The development of complications was recorded at 1 and 7 days after operation.Results Compared with group C,the incidence of hyoxemia during operation and pulmonary atelectasis and infection after operation was significantly decreased in the other three groups,the incidence of hyoxemia and pulmonary atelectasis and infection after operation was decreased,and the serum concentrations of MDA,IL-6 and TNF-α were decreased in group DP (P ＜ 0.05).Compared with D and P groups,the serum concentrations of MDA,IL-6 and TNF-α were significantly decreased,and the incidence of pulmonary atelectasis and infection after operation was decreased in group DP (P ＜ 0.05).The incidence of hyoxemia during operation was significantly lower in group DP than in group D (P ＜ 0.05).Conclusion Dexmedetomidine combined with CPAP can alleviate the oxidative stress and inflammatory responses more effectively and is more helpful in improving prognosis than either alone during OLV in elderly patients. Key words: Dexmedetomidine ; Continuous positive airway pressure ; Respiration, artificial; Oxidative stress ; Inflammation ; Aged

Analysis of prognostic factors of esophageal and gastric cardiac carcinoma patients after radical surgery using Cox proportional hazard model-A random sampling study from the fourth hospital of Hebei Medical University during the period of 1996–2004

Objective To retrospectively analyze clinical data of patients from our hospital who underwent radical surgery for esophageal carcinoma and for adenocarcinoma of the gastric cardia, as well as to investigate prognostic factors affecting the long-term survival of the patients.

Recurrence Pattern of Squamous Cell Carcinoma in the Middle Thoracic Esophagus after Modified Ivor‐Lewis Esophagectomy

Despite increasingly radical surgery for esophageal carcinoma, many patients still develop tumor recurrence after operation. This study was designed to evaluate the recurrence pattern of squamous cell carcinoma in the middle thoracic esophagus after modified Ivor-Lewis esophagectomy. We retrospectively reviewed data of 196 patients who underwent modified Ivor-Lewis esophagectomy with two-field lymph node dissection from January 1997 to January 2001. Recurrence was classified as locoregional or hematogenous recurrence. Logistic regression analysis was performed to identify risk factors of postoperative recurrence. The overall 3-year and 5-year survival rates in all patients were 53% and 31%, respectively. Recurrence was recognized in 96 patients (48.9%) in the 3 years after operation. The median time to tumor recurrence was 12.2 months. The pattern of recurrence was locoregional in 52 patients (mainly mediastinal in 41, single cervical/supraclavicular in 8), hematogenous in 44 patients (simultaneous locoregional and hematogenous in 10; mainly liver, bone, or lung in 39). The locoregional recurrence rate was significantly lower in patients with postoperative radiotherapy than that in patients without postoperative radiotherapy (p = 0.02). Logistic regression analysis showed that T3 (p = 0.032), N1 (p = 0.003), and postoperative radiotherapy (p = 0.022) were independent risk factors for tumor locoregional recurrence. About one half of the patients would develop recurrent disease within 3 years after modified Ivor-Lewis esophagectomy with two-field lymph node dissection, and most of them had mediastinal lymph node, liver, bone, or lung metastasis. Postoperative radiotherapy was beneficial in the control of locoregional recurrence.

Serum Procalcitonin Levels Are Elevated in Esophageal Cancer Patients with Postoperative Infectious Complications

Background: The normal systemic inflammatory response to surgical stimuli often makes early diagnosis of postoperative infections difficult. Purpose: We investigated whether serum procalcitonin (PCT) levels may be a useful marker of bacterial infections in patients after invasive surgery. Subjects and Methods: The subjects were 40 patients who had undergone radical surgery for esophageal carcinoma by a right thoracoabdominal approach. Nine patients were diagnosed to have a postoperative infection during the first 7 days after surgery. Changes in serum PCT levels were compared between the group diagnosed to have postoperative infection (infection group) and the group without infection (noninfection group). Results: The postoperative serum PCT levels were significantly higher in the infection group than in the noninfection group (ANOVA: p < 0.01). Serum PCT peaked on postoperative day (POD) 5 in the infection group (8.7 ± 8.2 ng/ml, mean ± SD) and on POD 1 in the noninfection group (0.5 ± 0.5 ng/ml). No significant differences were found between the two groups in leukocyte count, serum CRP or cytokine levels. The receiver operating characteristics (ROC) curve was constructed for infection identification. The area under the ROC curve for peak postoperative PCT was 0.968, and at a cutoff value of 2.0 ng/ml, the sensitivity was 89% and the specificity was 93%. Conclusions: Serum PCT levels may be useful for the early diagnosis of postoperative infectious complications.

Metachronous gastric carcinoma from a gastric tube after radical surgery for esophageal carcinoma

Background Cases of metachronous gastric carcinoma arising from a gastric tube used for reconstruction have been increasing in long-term survivors of esophageal cancer in recent years. We investigated the characteristics of gastric tube carcinoma to determine the most appropriate approach to managing it. Methods Between 1980 and 1997, 508 patients underwent radical esophagectomy for esophageal carcinoma at Keio University Hospital. Reconstruction was performed with a gastric tube in 414 (81.5%) of them, and 8 of them developed a metachronous carcinoma in the gastric tube. The clinical and pathologic characteristics of the gastric tube carcinomas were evaluated in this study. Results Gastric cancer was detected during follow-up endoscopic examinations or in an upper gastrointestinal series in seven patients. All of the cancers were diagnosed as adenocarcinoma histopathologically. Endoscopic mucosal resection was performed in two patients, partial resection of the residual stomach was performed in three patients. One patient was treated by endoscopic mucosal resection as palliative therapy, since he had severe pulmonary emphysema. Total resection of the gastric tube was attempted in 2 advanced cases but was unsuccessful because of direct invasion of other organ by the cancer. The 5 patients who underwent curative resection are alive with no subsequent recurrence. Conclusions Since early diagnosis permits less invasive treatment and curative treatment is difficult in advanced cases, strict postoperative examinations are important after radical esophagectomy to ensure early detection of metachronous gastric carcinoma arising from gastric tubes used for reconstruction.

Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease.

Despite increasingly radical surgery for esophageal carcinoma, a large number of patients still experience recurrent disease soon after operation. The current study was undertaken to evaluate the pattern of recurrence after curative esophagectomy for cancer of the thoracic esophagus and to identify factors predictive of recurrent disease. A total of 439 consecutive patients discharged from the authors' institution following R0 resection between January 1982 and July 2002 were followed for evidence of recurrence over a mean interval of 37.3 (range, 1-207) months. Overall 1-, 3- and 5-years survival rates were 91%, 54%, and 41%, respectively. Some 230 patients (52.4%) developed proven recurrence, of whom 24 were alive and 206 were dead at the time of writing. The median time to recurrence was 12.0 (range, 6-96) months, with a median survival thereafter of 7.0 (range, 0-83) months. The pattern of recurrence was local in 12.1%, regional in 20.5% (cervical 3.6%, mediastinal 14.8%, and abdominal 2.1%), and distant in 19.8%, respectively. The overall pattern of dissemination was significantly different according to the histologic subtype (P = 0.021). One hundred five (45.7%) of all recurrences occurred within 12 months of surgery, with local, regional, and distant recurrence occurring at a median of 14.0 (range, 6-77), 13.5 (range, 6-73), and 11.0 (range, 6-96) months, respectively; A factor predictive of recurrent disease was histologic tumor depth invasion (P = 0.001). Depth of tumor invasion should be used to identify patients who will have recurrence within 12 months of operation, so that these patients may be either entered into trials of multimodality treatment or offered nonsurgical palliation.

Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients

Background Despite three decades of debate, no conclusion has been reached concerning the effectiveness of postoperative radiotherapy for resected esophageal carcinoma. From 1986 through 1997, a prospective randomized study was carried out with 495 patients in an attempt to define the value of this therapeutic modality. Methods A total of 495 patients with esophageal cancer who had undergone radical resection were randomized by the envelope method into a surgery-alone group (S) of 275 patients and a surgery plus radiotherapy group (S + R) of 220 patients. Radiation treatment was started 3 to 4 weeks after the operation. The portals encompassed the entire mediastinum and bilateral supraclavicular areas. A midplane dose of 50 to 60 Gy in 25 to 30 fractions was delivered over 5 to 6 weeks. Results The overall 5-year survival rate was 31.7% for the S group and 41.3% ( p = 0.4474) for the S + R group. The 5-year survival rates of patients who were lymph node positive were 14.7% and 29.2% ( p = 0.0698), respectively. Five-year survival rates of stage III patients were 13.1% and 35.1% ( p = 0.0027), respectively. Conclusions Postoperative prophylactic radiotherapy improved the 5-year survival rate in esophageal cancer patients with positive lymph node metastases and in patients with stage III disease compared with similar patients who did not receive radiation therapy. These results were almost significant for patients with positive lymph node metastases and highly significant for patients with stage III disease.