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Lv Z, Yuan L, Mao Y, Ai S. Recurrent laryngeal nerve paralysis as a potential mediator of complications in esophagectomy following lymph node dissection. Dis Esophagus 2025; 38:doaf028. [PMID: 40411169 DOI: 10.1093/dote/doaf028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2024] [Revised: 11/17/2024] [Accepted: 03/31/2025] [Indexed: 05/26/2025]
Abstract
Complications from esophagectomy often interact with each other, with those related to recurrent laryngeal nerve (RLN) paralysis (RLNP) being particularly significant. Aggressive dissection of RLN lymph nodes (RLN-LNs) is considered a major contributing factor to RLNP. This study seeks to validate the hypothesis that RLNP acts as a mediator, not only resulting from RLN-LN dissection but also amplifying the likelihood of other postoperative complications. Data were retrospectively extracted from the Chinese 12th Five-Year Major Science and Technology Project on esophageal diseases, including a cohort of 1684 patients enrolled between 2015 and 2018. Both univariate and multivariate structural equation models were employed to validate the mediating role of RLNP in postoperative complications. Without causing RLNP, RLN-LN dissection directly increased the risk of chylothorax (odds ratio [OR] = 1.179, 95% confidence interval [CI] = 1.003-1.385) and decreased the risk of cardiac arrhythmia (OR = 0.919, 95% CI = 0.838-0.993). Meanwhile, through the mediating effect of RLNP, RLN-LN dissection indirectly led to complications requiring intensive care (OR = 1.043, 95% CI = 1.004-1.083) and conservative therapy (OR = 1.043, 95% CI = 0.996-1.092). RLNP serves as a critical mediator between RLN-LN dissection and subsequent postoperative complications requiring intensive care and conservative therapy. Recognizing that many of these complications are mediated by RLNP could help thoracic surgeons prioritize neural protection during RLN-LN dissection, potentially reducing the overall risk of multiple complications and alleviating the associated concerns.
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Affiliation(s)
- Zhuoheng Lv
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ligong Yuan
- Division of Life Sciences and Medicine, Department of Thoracic Surgery, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Siyuan Ai
- Department of Thoracic and Cardiovascular Surgery, Liangxiang Hospital, Beijing, China
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Mao Y, Liu S, Han Y, Guo S, Chen C, Gao S, Hao A, Duan H, Fang W, Zhang R, Yu Z, Fu X, Li X, Wang Q, Tan L, Li Z, Li Y, Zhang Z, Wei W, Fang Y, Fu D, Wei X, Yuan L, Muhammad S, He J. Three-field vs two-field lymphadenectomy in thoracic ESCC patients: a multicenter randomized study (NST 1503). JOURNAL OF THE NATIONAL CANCER CENTER 2025; 5:203-211. [PMID: 40265094 PMCID: PMC12010381 DOI: 10.1016/j.jncc.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/16/2024] [Accepted: 01/09/2025] [Indexed: 04/24/2025] Open
Abstract
Background 3-field lymph node dissection (3FL) frequently lead to much more perioperative complications than 2-field lymph node dissection (2FL). This study was designed as a non-inferiority trial to evaluate whether 3FL could be omitted without compromising overall survival (OS) and disease-free survival (DFS) in the patients with resectable thoracic esophageal squamous cell cancer (ESCC) and negative right recurrent laryngeal nerve lymph nodes (RRLN-LNs). Methods cT1b-3N0-1M0 thoracic ESCC patients were managed in 3 arms during open or minimally invasive McKeown esophagectomy according to the results of frozen section examination for RRLN-LNs: if positive, direct 3FL (RRLN[+]-3FL); if negative, 2FL (RRLN[-]-2FL) or 3FL (RRLN[-]-3FL) by randomization. Results Based on frozen section, of the 829 finally recruited patients, 121 (13.6 %) had positive RRLN-LNs and direct 3FL (RRLN[+]-3FL); 766 had negative RRLN-LNs and were randomized into the RRLN [-]-2FL (386 cases) or RRLN[-]-3FL (380 cases) group. The cervical LN metastasis rate in the RRLN[+]-3FL group (28.9 %) was significantly higher than that in the RRLN[-]-3FL group (8.3 %) (P<0.001). The 5-year OS and DFS were 72.2 % and 65.1 % in the RRLN[-]-3FL group and 68.8 % and 62.8 % in the RRLN[-]-2FL group (OS, P = 0.163; DFS, P = 0.378), versus 50.3 % and 41.2 % in the RRLN[+]-3FL group (both P<0.001), respectively. Conclusions Additional cervical lymphadenectomy can be avoided in the patients with middle or lower thoracic ESCC and negative RRLN-LNs by frozen section treated by upfront surgery.Trial Registration: ClinicalTrials.gov Identifier NCT02448953.
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Affiliation(s)
- Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuoyan Liu
- Department of Thoracic Surgery, Fujian Cancer Hospital, Fujian Medical University, Fuzhou, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Shiping Guo
- Department of Thoracic Surgery, Shanxi Cancer Hospital, Taiyuan, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Hospital, Fuzhou, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anlin Hao
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Hongbing Duan
- Department of Thoracic Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Renquan Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Zhentao Yu
- Department of Thoracic Surgery, Tianjin Cancer Hospital, Tianjin, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji University, Wuhan, China
| | - Xiaofei Li
- Department of Thoracic Surgery, The Fourth Military University Hospital, Xi'an, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China
| | - Zhirong Zhang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenqiang Wei
- National Central Cancer Registry, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Fang
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Donghong Fu
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Xudong Wei
- Department of Thoracic Surgery, Anyang Cancer Hospital, Anyang, China
| | - Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shan Muhammad
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hardy K, Chmelo J, Joel A, Navidi M, Fergie BH, Phillips AW. Histological prognosticators in neoadjuvant naive oesophageal cancer patients. Langenbecks Arch Surg 2023; 408:184. [PMID: 37156834 DOI: 10.1007/s00423-023-02927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Prognosis of oesophageal cancer is primarily based upon the TNM stage of the disease. However, even in those with similar TNM staging, survival can be varied. Additional histopathological factors including venous invasion (VI), lymphatic invasion (LI) and perineural invasion (PNI) have been identified as prognostic markers yet are not part of TNM classification. The aim of this study is to determine the prognostic importance of these factors and overall survival in patients with oesophageal or junctional cancer who underwent transthoracic oesophagectomy as the unimodality treatment. METHODS Data from patients who underwent transthoracic oesophagectomy for adenocarcinoma without neoadjuvant treatment were reviewed. Patients were treated with radical resection, with a curative intent using a transthoracic Ivor Lewis or three staged McKeown approach. RESULTS A total of 172 patients were included. Survival was poorer when VI, LI and PNI were present (p<0.001), with the estimated survival being significantly worse (p<0.001) when patients were stratified according to the number of factors present. Univariable analysis of factors revealed VI, LI and PNI were all associated with survival. Presence of LI was independently predictive of incorrect staging/upstaging in multivariable logistic regression analysis (OR 12.9 95% CI 3.6-46.6, p<0.001). CONCLUSION Histological factors of VI, LI and PNI are markers of aggressive disease and may have a role in prognostication and decision-making prior to treatment. The presence of LI as an independent marker of upstaging could be a potential indication for the use of neoadjuvant treatment in patients with early clinical disease.
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Affiliation(s)
- Kiera Hardy
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jakub Chmelo
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Abraham Joel
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maziar Navidi
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bridget H Fergie
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
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Toyoshima Y, Narumiya K, Kudo K, Egawa H, Hosoda K. Comparative analysis of the outcomes of gastrectomy vs. endoscopic mucosal resection or endoscopic submucosal dissection for the treatment of gastric tube cancer after esophagectomy. Glob Health Med 2023; 5:40-46. [PMID: 36865898 PMCID: PMC9974229 DOI: 10.35772/ghm.2022.01059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023]
Abstract
This study investigated the clinical characteristics of patients with gastric tube cancer following esophagectomy at our hospital, and to examine the outcomes of gastrectomy versus endoscopic submucosal dissection. Of 49 patients who underwent treatment for gastric tube cancer that developed 1 year or more after esophagectomy, 30 patients underwent subsequent gastrectomy (Group A), and 19 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) (Group B). The characteristics and outcomes of these two groups were compared. The interval between esophagectomy and diagnosis of gastric tube cancer ranged from 1 to 30 years. The most common location was the lesser curvature of the lower gastric tube. When the cancer was detected early, EMR or ESD was performed, and the cancer did not recur. In advanced tumors, gastrectomy was performed but the gastric tube was difficult to approach and lymph node dissection was difficult; two patients died as a result of the gastrectomy. In Group A, recurrence occurred most often as axillary lymph node, bone, or liver metastases; in Group B, no recurrence or metastases were observed. In addition to recurrence and metastasis, gastric tube cancer is often observed after esophagectomy. The present findings highlight the importance of early detection of gastric tube cancer after esophagectomy and that the EMR and ESD procedures are safe and have significantly fewer complications compared with gastrectomy. Follow-up examinations should be scheduled with consideration given to the most frequent sites of gastric tube cancer occurrence and the time elapsed since esophagectomy.
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Affiliation(s)
| | - Kosuke Narumiya
- Address correspondence to:Kosuke Narumiya, Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjuku-ku, Tokyo 162-8666, Japan. E-mail:
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Miao J, Cai M, Sun J, Gu Y, Du B. Protective effect of dexmedetomidine on lung injury during one-lung ventilation in elderly patients undergoing radical esophagectomy. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20827x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
| | | | | | - Yi Gu
- Nantong University, China
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Qu R, Tu D, Ping W, Fu X. The Impact of the Recurrent Laryngeal Nerve Injury on Prognosis After McKeown Esophagectomy for ESCC. Cancer Manag Res 2021; 13:1861-1868. [PMID: 33658850 PMCID: PMC7917328 DOI: 10.2147/cmar.s298228] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis. Methods Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed. Results RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI, patients with RNLI have longer operation time, more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN lymph node metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.
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Affiliation(s)
- Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Dehao Tu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wei Ping
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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Wada Y, Anbai A, Takagi N, Kumagai S, Okuyama E, Nanjo H, Sato Y, Motoyama S, Hashimoto M. Outcomes of Definitive Chemoradiotherapy for Stage IVa (T4b vs. N4) Esophageal Squamous Cell Carcinoma Based on the Japanese Classification System: A Retrospective Single-Center Study. Cancers (Basel) 2020; 13:E8. [PMID: 33375169 PMCID: PMC7792968 DOI: 10.3390/cancers13010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/17/2022] Open
Abstract
The differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 esophageal squamous cell carcinoma post chemoradiotherapy (CRT) is unclear. This study compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors. We retrospectively identified 66 patients with stage IVa esophageal squamous cell carcinoma who underwent definitive CRT at our center between January 2009 and March 2013. The treatment outcomes, i.e., progression patterns, prognostic factors, and toxicities based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events, were studied. The patients (56 men and 10 women) had a median age of 67 (range: 37-87) years. The T/N classifications were T4b non-N4 (28/66), non-T4b N4 (24/66), and T4b N4 (14/66). Objective response was achieved in 57 patients (86.4%, (95% confidence interval, 74.6-94.1%)). There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. We found no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal squamous cell carcinoma. Thus, it seems impractical to modify CRT regimens based on T/N factors.
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Affiliation(s)
- Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
| | - Akira Anbai
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
| | - Noriko Takagi
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
| | - Satoshi Kumagai
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
| | - Eriko Okuyama
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
| | - Hiroshi Nanjo
- Division of Clinical Pathology, Akita University Hospital, 1-1-1 Hondo, Akita 010-8545, Japan;
| | - Yusuke Sato
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita 010-8545, Japan; (Y.S.); (S.M.)
| | - Satoru Motoyama
- Esophageal Surgery, Akita University Hospital, 1-1-1 Hondo, Akita 010-8545, Japan; (Y.S.); (S.M.)
| | - Manabu Hashimoto
- Department of Radiology, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8545, Japan; (A.A.); (N.T.); (S.K.); (E.O.); (M.H.)
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Nusrath S, Saxena AR, Raju KVVN, Patnaik S, Subramanyeshwar Rao T, Bollineni N. The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review. Indian J Surg Oncol 2020; 11:538-548. [PMID: 33013140 DOI: 10.1007/s13193-020-01156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022] Open
Abstract
Lymph nodal metastasis is one of the most important prognostic factors determining survival in patients with carcinoma esophagus. Radical esophagectomy, with the resection of surrounding lymph nodes, is considered the prime treatment of carcinoma esophagus. An extensive lymphadenectomy improves the accuracy of staging and betters locoregional control, but its effect on survival is still not apparent and carries the disadvantage of increased morbidity. The extent of lymphadenectomy during esophagectomy also remains debatable, with many studies revealing contradictory results, especially in the era of neoadjuvant therapy. The pattern of distribution and the number of nodal metastasis are modified by neoadjuvant therapy. The paper reviews the existing evidence to determine whether increased lymph node yield improves oncological outcomes in patients undergoing esophagectomy with particular attention to those patients receiving neoadjuvant therapy.
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Affiliation(s)
- Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Ajesh Raj Saxena
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - K V V N Raju
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Sujith Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Naren Bollineni
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
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Askari A, Munster AB, Jambulingam P, Riaz A. Critical number of lymph node involvement in esophageal and gastric cancer and its impact on long-term survival-A single-center 8-year study. J Surg Oncol 2020; 122:1364-1372. [PMID: 32803769 DOI: 10.1002/jso.26145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nodal disease in esophageal and gastric cancer is associated with poor survival. OBJECTIVES To determine the critical level of lymph node involvement where survival becomes significantly compromised. METHODS Survival analyses using multivariable Cox regression and receiver operator characteristics (ROC) were undertaken to determine what number of positive lymph nodes were most sensitive and specific in predicting survival. RESULTS A total of 317 patients underwent esophagectomy (n = 190, 59.9%) and gastrectomy (n = 127, 40.1%) for adenocarcinoma. At multivariable analyses, four nodes positivity (irrespective of T-category) was associated with nearly a fivefold increased risk of mortality when compared to node-negative patients (hazard ratio [HR], 4.9; interquartile range 2.0-11.5; P < .001). A positive ratio of up to 50.0% was not associated with worse survival than having four nodes positive (HR, 4.6; 95% confidence interval, 2.6-8.1; P < .001). ROC analysis demonstrated four lymph nodes positive to have a sensitivity of 80.5%, a specificity of 60.1%, and an accuracy of 77.8 (P < .001). CONCLUSION The absolute number of nodes positive for cancer is more important than the proportion of positive nodes in predicting survival in esophageal/gastric cancer. Four positive lymph nodes are associated with a fivefold increase in mortality. Beyond this, increasing numbers of positive lymph nodes make no appreciable difference to survival.
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Affiliation(s)
- Alan Askari
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Alex B Munster
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Amjid Riaz
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
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Ku GY, Ilson DH. Cancer of the Esophagus. ABELOFF'S CLINICAL ONCOLOGY 2020:1174-1196.e6. [DOI: 10.1016/b978-0-323-47674-4.00071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Guan H, Yu Y, Ge H, Zhu S, Huang W, Li B. Implication of clinical target delineation for T1b/T2 thoracic esophageal squamous cell carcinoma based on the pattern of lymph node metastases. Future Oncol 2019; 15:3345-3355. [PMID: 31578872 DOI: 10.2217/fon-2019-0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to explore different patterns of lymph node metastases (LNM) in T1b and T2 thoracic esophageal squamous cell carcinoma (ESCC), and to further clarify its significance in radiotherapy target delineation. Materials & methods: Data of 1960 patients with T1b and T2 thoracic ESCC treated at different cancer centers were retrospectively analyzed. All patients underwent esophagectomy and lymphadenectomy. χ2 test and multivariate analysis were applied for analyzing clinicopathological factors related to LNM. Results: Age, location, tumor length, T stage and pathological grade were significantly associated with LNM (p < 0.01). For T1b ESCC, LNM rates in all sites were below 15%. For T2 upper thoracic ESCC, LNM rates were over 15% in upper mediastinal (15.8%). For T2 middle thoracic ESCC, LNM rates were middle mediastinal (17.2%) and abdominal (15.5%). For T2 lower thoracic ESCC, LNM rates were lower mediastinal (24.9%) and abdominal (22.5%). Subgroup analysis of T2 middle thoracic ESCC demonstrated that for patients older than 60 years, tumor length <4 cm and tumors were well differentiated. The LNM rates for abdominal were 11.9, 12.7 and 9.9%. Conclusion: Given the different patterns of LNM between T1b and T2 thoracic ESCC, target delineation should be adjusted accordingly.
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Affiliation(s)
- Hui Guan
- Department of Radiation Oncology, The Fourth People's Hospital of Jinan, Jinan 250031, PR China
| | - Yang Yu
- School of Medicine & Life Sciences, Shandong Academy of Medical Sciences, University of Jinan, Jinan 250031, PR China
| | - Hong Ge
- Department of Radiation Oncology, Henan Tumor Hospital, Zhengzhou 450008, PR China
| | - Shuchai Zhu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong 250117, PR China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong 250117, PR China
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The impact of cervical lymph node dissection on acid and duodenogastroesophageal reflux after intrathoracic esophagogastrostomy following transthoracic esophagectomy. Surg Today 2019; 49:1029-1034. [PMID: 31218418 DOI: 10.1007/s00595-019-01835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of cervical lymph node dissection on acid reflux and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy. METHODS Thirty-one patients receiving transthoracic esophagectomy with gastric tube reconstruction by intrathoracic esophagogastrostomy were divided into the following two groups: a two-field lymph node dissection group (2F group) and a three-field lymph node dissection group (3F group). All patients underwent 24-h pH and bilirubin monitoring and gastrointestinal endoscopy at 1 year after surgery. The 24-h pH and bilirubin monitoring results, endoscopic findings, and reflux symptoms were compared between the 2 groups. RESULTS No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) patients in the 3F group (p = 0.007). DGER was found in 2 patients (13%) in the 2F group and in 8 (53%) in the 3F group (p = 0.023). Four patients (25%) in the 2F group and 9 (60%) in the 3F group (p = 0.048) had reflux esophagitis. CONCLUSION Cervical lymph node dissection increases acid reflux and DGER and can lead to an increase in the incidence of reflux esophagitis in patients undergoing intrathoracic esophagogastrostomy.
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Hyperbilirubinemia predicts the infectious complications after esophagectomy for esophageal cancer. Ann Med Surg (Lond) 2019; 39:16-21. [PMID: 30899455 PMCID: PMC6402227 DOI: 10.1016/j.amsu.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/03/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023] Open
Abstract
Background Surgical stress and inflammation can cause hyperbilirubinemia, which sometimes occurs after esophagectomy for esophageal cancer (EC). The aim of this study was to elucidate the clinical significance of postoperative hyperbilirubinemia in the management of EC patients. Materials and methods We retrospectively reviewed records of 81 EC patients who underwent esophagectomy from 2009 to 2014. We compared the clinicopathological and perioperative factors, including the presence of hyperbilirubinemia (total bilirubin ≥1.5 mg/dL), between patients with postoperative infectious complications (PIC group) and those without (Non-PIC group). Results PIC developed in 52 patients (64.2%). There were significant differences in incidence of postoperative hyperbilirubinemia between the PIC group and the non-PIC group (34.6% vs. 3.4%, P = 0.002), as well as the approach of esophagectomy (P = 0.045), the surgical duration (469 vs. 389 min, P < 0.001), the amount of blood loss (420 vs. 300 mL, P = 0.018), the frequency of intraoperative blood transfusions (32.7% vs. 6.9%, P = 0.012) and the peak postoperative C-reactive protein level (17.3 vs. 8.6 mg/dL, P = 0.007). Multivariate analysis revealed hyperbilirubinemia was independently associated with the occurrence of PICs (odds ratio: 38.6, P = 0.010). The median time to the diagnosis of hyperbilirubinemia was significantly shorter than that of PICs (3.0 vs. 4.5 days, P = 0.025). Conclusions Postoperative hyperbilirubinemia was associated with the occurrence of PICs and frequently occurred before any PICs become apparent. More attention should be paid to the serum bilirubin level in the management after esophagectomy for EC.
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Key Words
- CI, confidence of interval
- CRP, C-reactive protein
- Complications
- EC, Esophageal cancer
- Esophageal cancer
- Esophagectomy
- Hyperbilirubinemia
- Infection
- LN, lymph node
- MIE, Minimally invasive transthoracic esophagectomy
- OE, open transthoracic esophagectomy
- OR, odds ratio
- PICs, postoperative infectious complications
- T-bil, total bilirubin
- THE, Transhiatal esophagectomy
- TNM, tumor-node-metastasis
- UICC, International Union Against Cancer
- WBC, white blood cell
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Plate JDJ, Peelen LM, Leenen LPH, Houwert RM, Hietbrink F. Joint management format at the mixed-surgical intermediate care unit: an interrupted time series analysis. Trauma Surg Acute Care Open 2018; 3:e000177. [PMID: 30402555 PMCID: PMC6203139 DOI: 10.1136/tsaco-2018-000177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/15/2018] [Indexed: 11/06/2022] Open
Abstract
Background The management format of the mixed-surgical intermediate care unit (IMCU) affects its performance. A format of combined supervision of surgeons with additional critical care certifications and admitting specialists, named the “joint format”, may herein be a promising new model of specialized critical care. This study aims to assess the performance of the joint management format. Methods This observational cohort study compared three IMCU management formats at the stand-alone, mixed-surgical IMCU of a tertiary referral hospital using interrupted time series analyses. All admissions from 2001 until 2015 were included. Predetermined criteria for performance (utilization, efficiency, and safety) were applied to three different management format periods: open (2001–2006), closed (2006–2011), and joint (2011–2015) formats. Results A total of 8894 admissions were analyzed. In terms of case load (utilization), there was an overall increase in the number of surgical patients (0.25%/year) (p<0.001), age (0.38/year) (p<0.001), and readmissions from the ward (0.16%/year) (p<0.001) and from the intensive care unit (ICU) (0.17%/year) (p=0.014). In terms of efficiency, the admission duration decreased (1.58 hours/year) (p<0.001). Transfer to the ICU within 24 hours, readmission within 24 hours from the ward, and unplanned mortality (eg, safety) did not change over time. Discussion At a time of increasingly complex case load, the joint format at the mixed-surgical IMCU is an efficient and safe management format in which the admitting specialist continues to provide specialized care. Specialty-specific supervision at IMCUs is a safe option which should be considered in healthcare policy decisions. Level of evidence Level IV.
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Affiliation(s)
- Joost D J Plate
- Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Linda M Peelen
- Departments of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Luke P H Leenen
- Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R Marijn Houwert
- Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Sakatoku Y, Fukaya M, Miyata K, Itatsu K, Nagino M. Clinical value of a prophylactic minitracheostomy after esophagectomy: analysis in patients at high risk for postoperative pulmonary complications. BMC Surg 2017; 17:120. [PMID: 29191187 PMCID: PMC5709936 DOI: 10.1186/s12893-017-0321-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the clinical value of a prophylactic minitracheostomy (PMT) in patients undergoing an esophagectomy for esophageal cancer and to clarify the indications for a PMT. METHODS Ninety-four patients who underwent right transthoracic esophagectomy for esophageal cancer between January 2009 and December 2013 were studied. Short surgical outcomes were retrospectively compared between 30 patients at high risk for postoperative pulmonary complications who underwent a PMT (PMT group) and 64 patients at standard risk without a PMT (non-PMT group). Furthermore, 12 patients who required a delayed minitracheostomy (DMT) due to postoperative sputum retention were reviewed in detail, and risk factors related to a DMT were also analyzed to assess the indications for a PMT. RESULTS Preoperative pulmonary function was lower in the PMT group than in the non-PMT group: FEV1.0 (2.41 vs. 2.68 L, p = 0.035), and the proportion of patients with FEV1.0% <60 (13.3% vs. 0%, p = 0.009). No between-group differences were observed in the proportion of patients who suffered from postoperative pneumonia, atelectasis, or re-intubation due to respiratory failure. Of the 12 patients with a DMT, 11 developed postoperative pneumonia, and three required re-intubation due to severe pneumonia. Multivariate analysis revealed FEV1.0% <70% and vocal cord palsy were independent risk factors related to a DMT. CONCLUSION A PMT for high-risk patients may prevent an increase in the incidence of postoperative pneumonia and re-intubation. The PMT indications should be expanded for patients with vocal cord palsy or mild obstructive respiratory disturbances.
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Affiliation(s)
- Yayoi Sakatoku
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Keita Itatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Kosugi SI, Ichikawa H, Hanyu T, Ishikawa T, Wakai T. Appropriate extent of lymphadenectomy for squamous cell carcinoma of the esophagogastric junction. Int J Surg 2017; 44:339-343. [PMID: 28709935 DOI: 10.1016/j.ijsu.2017.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 10/19/2022]
Abstract
AIM To investigate the appropriate extent of lymphadenectomy for squamous cell carcinoma (SCC) of the esophagogastric junction (ECJ). METHODS We retrospectively reviewed the cases of 52 patients with SCC of the ECJ who underwent extended mediastinal lymphadenectomy. We assessed potential risk factors for lymph node metastasis (LNM) in the upper/middle mediastinum by conducting univariate and multivariate analyses, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value. Survival rates were calculated using the Kaplan-Meier method, and the therapeutic value index of each nodal basin dissection was calculated by multiplying the frequency of metastasis at the basin and the 5-year overall survival rate of patients with metastasis at that basin. RESULTS Twenty patients (38%) had mediastinal LNM; 13 (25%) had metastasis in the upper/middle mediastinum, and 13 (25%) had metastasis in the lower mediastinum. Tumor length (P = 0.03) and pathological nodal status (P = 0.01) were independent risk factors for upper/middle mediastinal LNM. The optimal ROC cutoff value of tumor length was 54 mm. The 5-year overall survival rate of the patients with LNM in the upper/middle mediastinum was 46%. The therapeutic value index of upper/middle mediastinal lymphadenectomy was 11.6, which was inferior to that of perigastric lymphadenectomy at 17.3, but superior to that of lower mediastinal lymphadenectomy at 5.8. CONCLUSION An upper/middle mediastinal lymphadenectomy may be required for patients with tumors that are ≥54 mm long, and in those with suspected LNM.
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Affiliation(s)
- Shin-Ichi Kosugi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan.
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
| | - Takashi Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
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17
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Scholtemeijer MG, Seesing MFJ, Brenkman HJF, Janssen LM, van Hillegersberg R, Ruurda JP. Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes. J Thorac Dis 2017; 9:S868-S878. [PMID: 28815085 DOI: 10.21037/jtd.2017.06.92] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury caused by esophagectomy may lead to postoperative morbidity, however data on long-term recovery are scarce. The aim of this study was to evaluate the consequences of RLN palsy (RLNP) in terms of pulmonary morbidity and long-term functional recovery. METHODS Patients who underwent a 3-stage transthoracic (McKeown) or a transhiatal esophagectomy for esophageal carcinoma in the University Medical Center Utrecht (UMCU) between January 2004 and March 2016 were included from a prospective database. Multivariable analyses were conducted to assess the association between RLNP and pulmonary complications and hospital stay. Data regarding long-term recovery were summarized using descriptive statistics. RESULTS Out of the 451 included patients, 47 (10%) were diagnosed with RLNP. Of the patients with RLNP, 34 (7%) had a unilateral lesion, 8 (2%) had a bilateral lesion, and in 5 (1%) the location of the lesion was unknown. The incidence of RLNP was 3/127 (2%) in the transhiatal group, and 44/324 (14%) in the McKeown group. RLNP after McKeown esophagectomy was associated with a higher incidence of pulmonary complications (OR 2.391; 95% CI 1.222-4.679; P=0.011), as well as a longer hospital stay (+4 days) (P=0.001). Of the RLNP patients with more than 6 months follow up almost half recovered fully {median follow-up of 17.5 [7-135] months}. Of the remainder, six required a surgical intervention and the others had residual symptoms. CONCLUSIONS RLNP after McKeown esophagectomy is associated with an increased pulmonary complication rate, longer hospital stay, and a moderate long-term recovery. Further studies are necessary that examine technologies, which may reduce RLNP incidence and contribute to the early detection and treatment of RLNP.
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Affiliation(s)
- Martijn G Scholtemeijer
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hylke J F Brenkman
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luuk M Janssen
- Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jelle P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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Malpractice claims related to recurrent laryngeal nerve injury: Forensic remarks regarding 15 cases. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2016. [DOI: 10.1016/j.ejfs.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ichikawa H, Kosugi SI, Kanda T, Yajima K, Ishikawa T, Hanyu T, Muneoka Y, Otani T, Nagahashi M, Sakata J, Kobayashi T, Kameyama H, Wakai T. Surgical and long-term outcomes following oesophagectomy in oesophageal cancer patients with comorbidity. Int J Surg 2016; 36:212-218. [PMID: 27810380 DOI: 10.1016/j.ijsu.2016.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The elucidation of the clinical impact of comorbidities is important to optimize the treatment and follow-up strategy in oesophageal cancer. We aimed to clarify the surgical and long-term outcomes following oesophagectomy in oesophageal cancer patients with comorbidity. METHODS A total of 658 consecutive patients who underwent oesophagectomy for oesophageal cancer between 1985 and 2008 at our institution were enrolled. Based on the criteria of comorbidity as we defined it, we retrospectively reviewed and compared the surgical outcomes and survival between the comorbid (n = 251) and non-comorbid group (n = 407). RESULTS Postoperative morbidity and mortality were not significantly different between the two groups. The 5-year overall survival rate of the comorbid group was significantly lower (39.3% vs. 45.2%, adjusted HR = 1.31, 95% CI: 1.07-1.62) but the 5-year disease-specific survival rate was not significantly different between the comorbid and non-comorbid groups (53.9% vs. 53.1%, adjusted HR = 1.11, 95% CI: 0.86-1.42). The 5-year incidence rate of death from other diseases in the comorbid group was significantly higher than that in the non-comorbid group (26.7% vs. 14.8%, P < 0.01). The leading cause of death from other diseases was pneumonia. CONCLUSIONS Oesophagectomy in oesophageal cancer patients with comorbidity can be safely performed. However, the overall survival after oesophagectomy in these patients was unfavorable because of the high incidence of death from other diseases, especially pneumonia.
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Affiliation(s)
- Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Shin-Ichi Kosugi
- Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University, Medical and Dental Hospital, Niigata 949-7320, Japan.
| | - Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo-shi, Niigata 955-0055, Japan
| | - Kazuhito Yajima
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
| | - Takashi Ishikawa
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Yusuke Muneoka
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takahiro Otani
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan
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Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma. World J Surg 2016; 40:129-36. [PMID: 26464155 DOI: 10.1007/s00268-015-3261-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP. METHODS A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1–3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan–Meier method. RESULTS A total of 178 (59.5%) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1%) patients, right in 15 (8.4%), and left in 104 (58.4%)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.06–8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95% CI 1.78–19.80, P < 0.01). Cumulative recovery rate from RLNP was 61.7% at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months. CONCLUSIONS RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62% of affected nerves recovered within 12 months, great attention should be given when performing these procedures.
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Tominaga K, Doyama H, Nakanishi H, Yoshida N, Takeda Y, Ota R, Tsuji K, Matsunaga K, Tsuji S, Takemura K, Yamada S, Katayanagi K, Kurumaya H. Importance of colonoscopy in patients undergoing endoscopic resection for superficial esophageal squamous cell carcinoma. Ann Gastroenterol 2016; 29:318-24. [PMID: 27366032 PMCID: PMC4923817 DOI: 10.20524/aog.2016.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of the study was to clarify the frequency of colorectal neoplasm (CRN) complicating superficial esophageal squamous cell carcinoma (ESCC) and the need for colonoscopy. METHODS We retrospectively reviewed 101 patients who had undergone initial endoscopic resection (ER) for superficial ESCC. Control group participants were age- and sex-matched asymptomatic subjects screened at our hospital over the same period of time. Advanced adenoma was defined as an adenoma ≥10 mm, with villous features, or high-grade dysplasia. Advanced CRN referred to advanced adenoma or cancer. We measured the incidence of advanced CRN in superficial ESCC and controls, and we compared the characteristics of superficial ESCC patients with and without advanced CRN. RESULTS In the superficial ESCC group, advanced CRNs were found in 17 patients (16.8%). A history of smoking alone was found to be a significant risk factor of advanced CRN [odds ratio 6.02 (95% CI 1.30-27.8), P=0.005]. CONCLUSION The frequency of synchronous advanced CRN is high in superficial ESCC patients subjected to ER. Colonoscopy should be highly considered for most patients who undergo ER for superficial ESCC with a history of smoking, and is recommended even in superficial ESCC patients.
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Affiliation(s)
- Kei Tominaga
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Hisashi Doyama
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Naohiro Yoshida
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Yasuhito Takeda
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Ryosuke Ota
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kunihiro Tsuji
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kazuhiro Matsunaga
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Shigetsugu Tsuji
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kenichi Takemura
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Shinya Yamada
- Department of Gastroenterology (Kei Tominaga, Hisashi Doyama, Hiroyoshi Nakanishi, Naohiro Yoshida, Yasuhito Takeda, Ryosuke Ota, Kunihiro Tsuji, Kazuhiro Matsunaga, Shigetsugu Tsuji, Kenichi Takemura, Shinya Yamada)
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Kurumaya), Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology (Kazuyoshi Katayanagi, Hiroshi Kurumaya), Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Kleinberg L, Brock M, Gibson M. Management of Locally Advanced Adenocarcinoma of the Esophagus and Gastroesophageal Junction: Finally a Consensus. Curr Treat Options Oncol 2016; 16:35. [PMID: 26112428 DOI: 10.1007/s11864-015-0352-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Opinion statement: Adenocarcinoma of the esophagus is increasing in incidence in Western nations leading to increased interest in and opportunity to study optimal management. Randomized trials have now robustly demonstrated the preoperative therapy with chemoradiotherapy and chemotherapy alone improves survival outcome for the bulk of curable patients, those with locally advanced T1N1M0 and T2-3 N0-1 M0 disease. Evidence suggests but does not confirm that radiation-containing regimens are more beneficial. Clinical staging is designed to exclude patients with T1N0M0 disease who may be treated with surgery alone and those with metastatic disease who may not benefit from intensive local therapy. The approach to clinical staging includes endoscopy with ultrasound and fine needle aspirate to assess local and regional disease, supplemented by CT and PET scanning primarily to exclude metastatic disease. Minimally invasive approaches to esophagectomy may be used with the goal of reducing complications, but there is no evidence that mortality or ultimate outcome is improved.
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Affiliation(s)
- Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA,
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Kawamorita K, Tsubosa Y, Oka Y, Matsuda S, Takebayashi K, Niihara M, Okamura Y, Uesaka K. Acute necrotic pancreatitis after esophagectomy: a case report. Surg Case Rep 2016; 1:32. [PMID: 26943400 PMCID: PMC4747961 DOI: 10.1186/s40792-015-0033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/10/2015] [Indexed: 11/10/2022] Open
Abstract
Acute pancreatitis after esophagectomy is a very rare but fatal complication. This case report describes a 74-year-old man diagnosed with cT2N0M0, cStage IB esophageal squamous cell carcinoma (Union for International Cancer Control, seventh edition). On the basis of the patient's condition, it was decided that he should undergo esophagectomy without thoracotomy. The patient developed pyrexia 3 days after the operation. Chest and abdominal computed tomography revealed severe acute pancreatitis and gastric tube necrosis; therefore, gastrectomy was performed. Subsequent surgical exploration indicated pancreatic necrosis that was diagnosed as acute necrotic pancreatitis. Postoperative management of acute pancreatitis and the general condition of the patient were quite challenging, and rapid deterioration of the respiratory status was observed. The patient experienced multiple organ failure and died 57 days after the second surgery (60 days after the first surgery). This is a report of a patient with acute necrotic pancreatitis after esophagectomy.
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Affiliation(s)
- Keisuke Kawamorita
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yurika Oka
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Satoru Matsuda
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Katsushi Takebayashi
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Masahiro Niihara
- Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Li M, Zhang X, Zhao F, Luo Y, Kong L, Yu J. Involved-field radiotherapy for esophageal squamous cell carcinoma: theory and practice. Radiat Oncol 2016; 11:18. [PMID: 26846932 PMCID: PMC4743321 DOI: 10.1186/s13014-016-0589-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022] Open
Abstract
Esophageal carcinoma (EC) is characterized by a high rate of lymph node metastasis and its spread pattern is not always predictable. Chemoradiotherapy has an important role in the treatment of EC in both the inoperable and the pre-operative settings. However, regarding the target volume for radiation, different clinical practices exist. Theoretically, in addition to the clinical target volume administered to the gross lesion, it might seem logical to deliver a certain dose to the uninvolved regional lymph node area at risk for microscopic disease. However, in practice, it is difficult because of the intolerance of normal tissue to radiotherapy (RT), particularly if all regions containing the cervical, mediastinal, and upper abdominal nodes are covered. To date, the use of elective nodal irradiation (ENI) is still controversial in the field of radiotherapy. Some investigators use involved-field radiotherapy (IFRT) in order to reduce treatment-related toxicities. It is thought that micrometastases can be controlled, to some extent, by chemotherapy and the abscopal effects of radiation. It is the presence of overtly involved lymph nodes rather than the micrometastatic nodes negatively affects survival in patients with EC. In another hand, lymph nodes stationed near primary tumors also receive considerable incidental irradiation doses that may contribute to the elimination of subclinical lesions. These data indicate that an irradiation volume covering only the gross tumor is appropriate. When using ENI or IFRT, very few patients experience solitary regional node failure and out-of-field lymph node failure is not common. Primary tumor recurrence and distant metastases, rather than regional lymph node failure, affect the overall survival in patients with EC. The available evidence indicates that the use of ENI seems to prevent or delay regional nodal relapse rather than improve survival. In a word, these data suggest that IFRT is feasible in EC patients.
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Affiliation(s)
- Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China.
| | - Xiaoli Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China. .,Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
| | - Fen Zhao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China.
| | - Yijun Luo
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China.
| | - Li Kong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China.
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, Shandong Province, 250117, China.
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Miyata K, Fukaya M, Itatsu K, Abe T, Nagino M. Muscle sparing thoracotomy for esophageal cancer: a comparison with posterolateral thoracotomy. Surg Today 2015; 46:807-14. [PMID: 26311005 DOI: 10.1007/s00595-015-1240-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to investigate whether muscle sparing thoracotomy (MST) improved postoperative chest pain and an impairment of the postoperative pulmonary function in comparison with posterolateral thoracotomy (PLT). METHODS Twenty-four patients with esophageal cancer who underwent PLT from September 2006 to August 2008 and 30 patients who underwent MST from September 2008 to August 2010 were selected as subjects of this study. Postoperative acute and chronic chest pain and the recovery of the pulmonary function were retrospectively compared between the two groups. RESULTS The frequency of the additional use of analgesics was on days 3, 6, and 7 (mean 0.4 vs. 1.2, p = 0.027, 0.4 vs. 1.5, p = 0.007, and 0.2 vs. 1.2, p = 0.009, respectively) in the early postoperative period. The number of patients requiring analgesics at 1 and 3 months after surgery was significantly lower in the MST group than in the PLT group (13.3 vs. 58.3 %, p = 0.002, 10.0 vs. 50.0 %, p = 0.001, respectively). The postoperative vital capacity, expressed as a percentage of the preoperative value, 3 and 12 months after surgery was significantly higher in the MST group than in the PLT group (86.0 vs. 73.8 %, p = 0.028, 93.2 vs. 76.9 %, p = 0.002, respectively). CONCLUSION Compared with PLT, MST might, therefore, reduce postoperative chest pain and offer a better recovery of pulmonary function in patients with esophageal cancer.
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Affiliation(s)
- Kazushi Miyata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masahide Fukaya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Keita Itatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tetsuya Abe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Clinical predictors of aspiration after esophagectomy in esophageal cancer patients. Support Care Cancer 2015; 24:295-299. [DOI: 10.1007/s00520-015-2776-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 05/12/2015] [Indexed: 11/27/2022]
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Takemura M, Kaibe N, Takii M, Sasako M. Operative Benefits of Artificial Pneumothorax in Thoracoscopic Esophagectomy in the Left Lateral Decubitus Position for Esophageal Cancer. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ijcm.2015.612127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Lymphadenectomy as an essential part of the surgical treatment has been one of the most controversial aspects in the management of esophageal cancers. The purpose of this article was to review the evolution, the current role, and the optimal extent of lymphadenectomy for the treatment of esophageal cancers. Studies discussing the outcome of esophagectomy with lymph nodes dissection and comparing among different extent of lymphadenectomy were used in the analysis. Several studies including recently published articles reveal that additional radical lymphadenectomy may be beneficial in some patients with non-extreme esophageal cancer undergoing esophagectomy, whereas two-field lymph node dissection is suitable for distal esophageal cancers regardless of the histology of the tumor. Minimally invasive surgery and neoadjuvant therapy combined with radical surgery seem to show more benefit in selected cases, but further studies should be required to clearly demonstrate their efficacy and safety. The expertise and experience of the surgeons should also be taken into account in determining the success of these radical procedures.
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Affiliation(s)
- P Hiranyatheb
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Ma GW, Situ DR, Ma QL, Long H, Zhang LJ, Lin P, Rong TH. Three-field vs two-field lymph node dissection for esophageal cancer: A meta-analysis. World J Gastroenterol 2014; 20:18022-18030. [PMID: 25548502 PMCID: PMC4273154 DOI: 10.3748/wjg.v20.i47.18022] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 10/15/2014] [Accepted: 12/08/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effects of 3-field lymphadenectomy for esophageal carcinoma.
METHODS: We conducted a computerized literature search of the PubMed, Cochrane Controlled Trials Register, and EMBASE databases from their inception to present. Randomized controlled trials (RCTs) or observational epidemiological studies (cohort studies) that compared the survival rates and/or postoperative complications between 2-field lymphadenectomy (2FL) and 3-field lymphadenectomy (3FL) for esophageal carcinoma with R0 resection were included. Meta-analysis was conducted using published data on 3FL vs 2FL in esophageal carcinoma patients. End points were 1-, 3-, and 5-year overall survival rates and postoperative complications, including recurrent nerve palsy, anastomosis leak, pulmonary complications, and chylothorax. Subgroup analysis was performed on the involvement of recurrent laryngeal lymph nodes.
RESULTS: Two RCTs and 18 observational studies with over 7000 patients were included. There was a clear benefit for 3FL in the 1- (RR = 1.16; 95%CI: 1.09-1.24; P < 0.01), 3- (RR = 1.44; 95%CI: 1.19-1.75; P < 0.01), and 5-year overall survival rates (RR = 1.37; 95%CI: 1.18-1.59; P < 0.01). For postoperative complications, 3FL was associated with significantly more recurrent nerve palsy (RR = 1.43; 95%CI: 1.28-1.60; P = 0.02) and anastomosis leak (RR = 1.26; 95%CI: 1.05-1.52; P = 0.09). In contrast, there was no significant difference for pulmonary complications (RR = 0.93; 95%CI: 0.75-1.16, random-effects model; P = 0.27) or chylothorax (RR = 0.77; 95%CI: 0.32-1.85; P = 0.69).
CONCLUSION: This meta-analysis shows that 3FL improves overall survival rate but has more complications. Because of the high heterogeneity among outcomes, definite conclusions are difficult to draw.
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Ren Y, Su C, Zhou Y, Zhao X, Yang CL, Liu YY. Effect of bilateral supraclavicular postoperative radiotherapy in middle and lower thoracic esophageal carcinoma. World J Gastroenterol 2014; 20:17970-17975. [PMID: 25548496 PMCID: PMC4273148 DOI: 10.3748/wjg.v20.i47.17970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
METHODS: A total of 530 cases with middle and lower thoracic esophageal carcinoma in our hospital from January 2008 to April 2009 were selected and analyzed, of which 219 cases received right chest, upper abdominal incision Ivor-Lewis surgery and simultaneously underwent mediastinal and abdominal two-field lymphadenectomy. If regional lymph node metastasis occurred within the recurrent laryngeal nerve, the patients would receive bilateral supraclavicular radiotherapy (DT = 5000cGy) to be adopted at postoperative 4-5 wk (Group A) or cervical lymphadenectomy at postoperative 3-4 wk (Group B). If there were no regional lymph node metastases within the recurrent laryngeal nerve, the patients only underwent two-field, chest and abdomen, lymphadenectomy (Group C).
RESULTS: In 219 cases who underwent two-field lymphadenectomy, 91 cases were diagnosed with regional lymph node metastasis within the recurrent laryngeal nerve. Of them, 48 cases received cervical radiotherapy, and 43 cases underwent staging lymphadenectomy; 128 patients were not given the follow-up treatment of cervical radiotherapy because there was no regional lymph node metastasis within the recurrent laryngeal nerve. Five-year survival rates in group A and B were 47% and 50%, respectively, with no statistical difference between them, and the rate in group C was 58%.
CONCLUSION: For patients with middle and lower thoracic esophageal carcinoma combined with lymph node metastasis within the recurrent laryngeal nerve, cervical radiotherapy can be a substitute for surgery and provide benefit.
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31
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Paul S, Altorki N. Outcomes in the management of esophageal cancer. J Surg Oncol 2014; 110:599-610. [PMID: 25146593 DOI: 10.1002/jso.23759] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 12/25/2022]
Abstract
Esophageal cancer rates have continued to rise in the Western World. Esophageal cancer will be responsible for an estimated 15,450 deaths in the United States in 2014 alone. Esophageal resection with or without preoperative therapy remains the mainstay of treatment. Advances in surgical technique and perioperative care have improved short-term outcomes considerably by decreasing operative mortality. Despite these advances though, esophagectomy remains a procedure associated with considerable morbidity from a wide range of complications. Prompt recognition and treatment of complications can lower overall morbidity and mortality. Unfortunately, long-term outcomes remain poor as the vast majority of patients present with loco-regionally advanced or metastatic disease. Surgery by itself provides poor loco-regional control and fails to address micrometastatic disease. Neoadjuvant chemotherapy or chemoradiation provides a modest survival advantage compared to surgical resection alone. Future gains in understanding the molecular biology of esophageal cancer will hopefully lead to improved therapeutics and resultant outcomes.
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Affiliation(s)
- Subroto Paul
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY
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32
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Zhang W, Zhu H, Liu X, Wang Q, Zhang X, He J, Sun K, Liu X, Zhou Z, Xu N, Xiao Z. Epidermal Growth Factor Receptor Is a Prognosis Predictor in Patients With Esophageal Squamous Cell Carcinoma. Ann Thorac Surg 2014; 98:513-9. [DOI: 10.1016/j.athoracsur.2014.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 03/07/2014] [Accepted: 03/13/2014] [Indexed: 12/28/2022]
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Karimata H, Shimoji H, Nishimaki T. Clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer undergoing induction chemotherapy or chemoradiotherapy. Surg Today 2014; 45:479-86. [PMID: 25059344 DOI: 10.1007/s00595-014-0980-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/02/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE To identify clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer following induction chemotherapy or chemoradiotherapy. METHODS Of 48 patients with T4 esophageal cancer who underwent induction treatment, 30 underwent R0 esophagectomy. The factors predicting R0 resection and prognostic indicators were assessed in the 48 and 30 patients, respectively, using univariate and multivariate analyses. RESULTS In the univariate analyses, the primary tumor response, improvement of dysphagia, the post-induction therapy Glasgow Prognostic Score, an early tumor response and the post-induction therapy serum albumin and C-reactive protein levels were significantly correlated with R0 resection. Multivariate logistic regression analyses revealed that the response status and improvement of dysphagia were independent predictors of R0 resection. The univariate analyses identified a yp-T classification (yp-T0/1 vs. yp-T2/3/4), yp-nodal status and the number of pathologically positive nodes post-therapy (≤ 1 vs. ≥ 2) as significant prognostic factors. The multivariate analysis revealed that the number of pathologically positive nodes was the only significant independent prognostic indicator. CONCLUSION Patients showing an early tumor response to induction treatment and improvement of dysphagia may be appropriate candidates for esophagectomy, and individualized postoperative management strategies should be developed for patients with initially unresectable T4 esophageal cancer who have ≥ 2 positive nodes post-treatment.
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Affiliation(s)
- Hiroyuki Karimata
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Shimoji H, Karimata H, Nagahama M, Nishimaki T. Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg 2014; 37:2180-8. [PMID: 23649529 DOI: 10.1007/s00268-013-2074-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We hypothesized that the survival rate of patients undergoing R0 esophagectomy after induction chemotherapy or chemoradiotherapy for unresectable T4 esophageal cancer (URT4) would be similar to that of patients undergoing esophagectomy for immediately resectable esophageal cancer with no unfavorable prognostic factors (RNU). METHODS Between April 2002 and June 2012, 87 of 283 patients with esophageal cancer who presented at the University Hospital of the Ryukyus were enrolled in this prospective cohort study. Tumors were classified as RNU and URT4 in 44 and 43 of the 87 patients, respectively. Outcomes of treatment for URT4 patients were compared with those of RNU patients. RESULTS The R0 resection rate (61 %) and in-hospital mortality rate (20 %) of URT4 patients were significantly poorer than those of RNU patients (98 and 2.3 %, respectively), although the morbidity rate was similar in the two groups (63 and 52 %, respectively). The 5-year survival rate (35 %) of URT4 patients was significantly poorer than that of RNU patients (67 %) in the intention-to-treat analysis. However, no significant difference was noted between the two survival curves for cases of R0 resection (5-year survival rate, 60 % vs. 69 %). Multivariate analysis revealed R status as the only significant independent prognostic factor for URT4 patients (P < 0.001; hazard ratio = 8.279). CONCLUSIONS Satisfactory survival rates can be achieved if R0 resection is performed after induction treatment in patients with T4 esophageal cancer, although secondary radical esophagectomy is associated with a higher risk of in-hospital mortality.
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Affiliation(s)
- Hideaki Shimoji
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan.
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Chen JW, Xie JD, Ling YH, Li P, Yan SM, Xi SY, Luo RZ, Yun JP, Xie D, Cai MY. The prognostic effect of perineural invasion in esophageal squamous cell carcinoma. BMC Cancer 2014; 14:313. [PMID: 24886020 PMCID: PMC4016635 DOI: 10.1186/1471-2407-14-313] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/25/2014] [Indexed: 02/08/2023] Open
Abstract
Background Perineural invasion (PNI) is correlated with adverse survival in several malignancies, but its significance in esophageal squamous cell carcinoma (ESCC) remains to be clearly defined. The objective of this study was to determine the association between PNI status and clinical outcomes. Methods We retrospectively evaluated the PNI of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. The resulting data were analyzed using Spearman’s rank correlation, the Kaplan-Meier method, Cox proportional hazards regression modeling and Harrell’s concordance index (C-index). Results PNI was identified in 209 of the 433 (47.7%) cases of ESCC. The correlation analysis demonstrated that PNI in ESCC was significantly correlated with tumor differentiation, infiltration depth, pN classification and stage (P < 0.05). The five-year overall survival rate was 0.570 for PNI-negative tumors versus 0.326 for PNI-positive tumors. Patients with PNI-negative tumors exhibited a 1.7-fold increase in five-year recurrence-free survival compared with patients with PNI-positive tumors (0.531 v 0.305, respectively; P < 0.0001). In the subset of patients with node-negative disease, PNI was evaluated as a prognostic predictor as well (P < 0.05). In the multivariate analysis, PNI was an independent prognostic factor for overall survival (P = 0.027). The C-index estimate for the combined model (PNI, gender and pN status) was a significant improvement on the C-index estimate of the clinicopathologic model alone (0.739 v 0.706, respectively). Conclusions PNI can function as an independent prognostic factor of outcomes in ESCC patients, and the PNI status in primary ESCC specimens should be considered for therapy stratification.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mu-Yan Cai
- Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Zhu CM, Ling YH, Xi SY, Luo RZ, Chen JW, Yun JP, Xie D, Cai MY. Prognostic significance of the pN classification supplemented by vascular invasion for esophageal squamous cell carcinoma. PLoS One 2014; 9:e96129. [PMID: 24763284 PMCID: PMC3999115 DOI: 10.1371/journal.pone.0096129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/02/2014] [Indexed: 01/08/2023] Open
Abstract
Background The biological behavior and clinical outcome of esophageal squamous cell carcinoma (ESCC) are difficult to predict. Methodology/Principal Findings We investigate the prognostic impact of vascular invasion to establish a risk stratification model to predict recurrence and overall survival. We retrospectively evaluated the vascular invasion of 433 patients with ESCC treated with surgery between 2000 and 2007 at a single academic center. Those patients were assigned to a testing cohort and a validation cohort by random number generated in computer. The presence of vascular invasion was observed in 113 of 216 (52.3%) and 96 of 217 (44.2%) of ESCC in the training and validation cohorts, respectively. Further correlation analysis demonstrated that vascular invasion in ESCC was significantly correlated with more advanced pN classification and stage in both cohorts (P<0.05). Additionally, presence of vascular invasion in ESCC patients was associated closely with poor overall and recurrence-free survival as evidenced by univariate and multivariate analysis in both cohorts (P<0.05). In the subset of ESCC patients without lymph node metastasis, vascular invasion was evaluated as a prognostic predictor as well (P<0.05). More importantly, the combined prognostic model with pN classification supplemented by vascular invasion can significantly stratify the risk (low, intermediate and high) for overall survival and recurrence-free survival in both cohorts (P<0.05). The C-index to the combined model showed improved predictive ability when compared to the pN classification (0.785 vs 0.739 and 0.689 vs 0.650 for the training and validation cohorts, respectively; P<0.05). Conclusions/Significance The examination of vascular invasion could be used as an additional effective instrument in identifying those ESCC patients at increased risk of tumor progression. The proposed new prognostic model with the pN classification supplemented by vascular invasion might improve the ability to discriminate ESCC patients’ outcome.
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Affiliation(s)
- Chong-Mei Zhu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi-Hong Ling
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shao-Yan Xi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rong-Zhen Luo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jie-Wei Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing-Ping Yun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dan Xie
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mu-Yan Cai
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Kinjo T, Shimoji H, Nagahama M, Karimata H, Yoshimi N, Nishimaki T. Prognostic significance of simultaneous presence of histological and immunohistochemical metastasis to lymph nodes in patients with esophageal cancer. Ann Thorac Cardiovasc Surg 2014; 20:951-60. [PMID: 24583706 DOI: 10.5761/atcs.oa.13-00279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Presence of simultaneous pathological and immunohistochemical nodal metastasis (pNM and iNM, respectively) and/or other clinical factors may be reliable prognostic predictors of survival in esophageal cancer patients who have undergone multidisciplinary treatment. METHODS Univariate and multivariate analysis of the data collected from 77 patients who had undergone R0 esophagectomy was performed to determine the significance of presence of iNM or pNM, presence of simultaneous pNM, and other clinical factors as prognostic indicators in patients who had (n = 40) and had not (n = 37) undergone preoperative treatment. RESULTS Presence of pNM was found to be a significant prognostic predictor in patients who had undergone preoperative treatment, presence of iNM in patients who had not undergone preoperative treatment, and presence of simultaneous pNM and iNM in both patient groups. Multivariate analysis indicated that the sole prognostic predictor for patients who had undergone preoperative treatment was presence of simultaneous pNM and iNM while that of patients who had not undergone preoperative treatment was clinical T category. CONCLUSION Assessment of simultaneous presence of pNM and iNM may facilitate highly accurate prediction of survival in esophageal cancer patients undergoing R0 esophagectomy, regardless of whether they have undergone preoperative treatment.
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Affiliation(s)
- Tatsuya Kinjo
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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Kakuta T, Kosugi SI, Kanda T, Ishikawa T, Hanyu T, Suzuki T, Wakai T. Prognostic factors and causes of death in patients cured of esophageal cancer. Ann Surg Oncol 2014; 21:1749-55. [PMID: 24510184 DOI: 10.1245/s10434-014-3499-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of patients cured of esophageal cancer after esophagectomy is gradually increasing owing to advances in surgical techniques, perioperative management, and adjuvant therapies. This study assessed the clinical course and sought to identify the prognostic factors of these patients. METHODS A series of 220 consecutive patients who underwent esophagectomy and survived for more than 5 years with no relapse were enrolled. Survival analysis was performed using 25 variables including patient characteristics and operative and perioperative factors. Potential prognostic factors were identified by univariate and multivariate analyses, and the development of other primary cancers and the causes of death were retrospectively reviewed. RESULTS The overall 10-, 15-, and 20-year survival rates were 71.6, 50.1, and 32.2 %, respectively, with a median survival time of 180 months (range, 61-315 months). The negative independent prognostic factors identified were age at surgery [hazard ratio (HR), 1.05; P < .01], being male (HR, 2.62; P = .02), pulmonary comorbidities (HR, 2.03; P = .02), synchronous presence of other cancers (HR, 2.35; P < .01), colonic/jejunal interposition (HR, 1.76; P = .03), perioperative blood transfusion (HR, 1.92; P = .02), development of pulmonary complications (HR, 1.71; P = .02), and adjuvant radiotherapy (HR, 2.13; P = .01). Pulmonary diseases and other primary cancers were found to be the most common causes of death. CONCLUSIONS Careful follow-up including the surveillance of other primary cancers is required for long-term survivors of esophageal cancer after esophagectomy.
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Affiliation(s)
- Tomoyuki Kakuta
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Moris D, Mantonakis E, Makris M, Michalinos A, Vernadakis S. Hoarseness after thyroidectomy: blame the endocrine surgeon alone? Hormones (Athens) 2014; 13:5-15. [PMID: 24722123 DOI: 10.1007/bf03401316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. We reviewed the literature aiming to explore these potential surgical and non-surgical causes of hoarseness beyond thyroidectomy and the role of the endocrine surgeon. Is he/she alone to blame? METHODS/MATERIAL The MEDLINE/PubMed database was searched for publications with the medical subject heading "hoarseness" and keywords "thyroidectomy", "RLN", "VCD" or "intubation". We restricted our search till up to May 2013. RESULTS In our final review we included 80 articles and abstracts that were accessible and available in English. We demonstrated the incidence of hoarseness stemming from surgical and non-surgical causes and also highlighted the role of intubation as a potential cause of injury-related VCD. CONCLUSIONS Hoarseness is a relatively common complication of thyroidectomy, which can be attributed to many factors including surgeon's error or injuries during intubation as well as to other non-surgical causes. However, compared to procedures such as cervical spine surgery, mediastinal surgery, esophagectomy and endarterectomy, thyroidectomy would seem to be a procedure with a relatively low rate of recurrent laryngeal nerve palsies (RLNPs). It is often difficult to determine whether the degree of hoarseness after thyroidectomy should be attributed only the surgical procedure itself or to other causes, for example intubation and extubation maneuvers. The differential diagnosis of postoperative hoarseness requires the use of specific tools, such as stroboscopy and intra- and extralaryngeal electromyography, while methods like acoustic voice analysis, with estimation of maximum phonation time and phonation frequency range, can distinguish between objective and subjective deterioration in the voice. The importance of medical history should be also emphasized.
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Affiliation(s)
- Demetrios Moris
- First Department of Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Mantonakis
- First Department of Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Makris
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College of London, London, United Kingdom
| | - Adamantios Michalinos
- First Department of Surgery, "Laiko" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiridon Vernadakis
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Essen, Germany
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Shimoji H, Kinjo T, Karimata H, Nagahama M, Nishimaki T. Clinical and oncological effects of triplet chemotherapy followed by radical esophagectomy for resectable esophageal cancer associated with unfavorable prognostic factors. Surg Today 2013; 44:1273-81. [PMID: 23963503 DOI: 10.1007/s00595-013-0700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 07/04/2013] [Indexed: 12/16/2022]
Abstract
PURPOSES The purpose of this study was to evaluate the hypothesis that the survival of patients undergoing R0 resection after triplet chemotherapy for resectable esophageal cancer with unfavorable prognostic factors (Category 3) would be similar to that of patients undergoing esophagectomy for esophageal cancer without such factors (Category 1). METHODS Patients with Category 3 tumors were assigned to receive triplet chemotherapy consisting of 5-fluorouracil, doxorubicin and nedaplatin (FAN) followed by radical esophagectomy. The outcomes of the bimodality treatment for Category 3 patients (n = 25) were compared with those of Category 1 patients (n = 41) in a prospective cohort study. RESULTS Grade 3 or higher toxicity developed during chemotherapy in 32 % of the Category 3 patients, with no treatment-related deaths. No significant difference was detected in the surgery-related mortality and morbidity rates between the two groups. The recurrence-free survival was significantly worse in Category 3 than in Category 1 patients (p = 0.002), although the overall survival was not significantly different (p = 0.085) between the two groups in cases of R0 resection (5-year survival rates: 34.4 vs. 66.5 %). CONCLUSIONS Although FAN chemotherapy followed by radical esophagectomy can be safely performed, this treatment modality may not have sufficient power to cure Category 3 disease.
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Affiliation(s)
- Hideaki Shimoji
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan,
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Kosugi SI, Kawaguchi Y, Kanda T, Ishikawa T, Sakamoto K, Akaike H, Fujii H, Wakai T. Cervical lymph node dissection for clinically submucosal carcinoma of the thoracic esophagus. Ann Surg Oncol 2013; 20:4016-21. [PMID: 23892526 DOI: 10.1245/s10434-013-3141-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus. METHODS A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes. RESULTS A total of 40 patients (47%) were found to have pathological LN metastasis. Also, 13 patients (15%) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7%); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5%. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95% confidence interval 1.03-6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3. CONCLUSIONS We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.
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Affiliation(s)
- Shin-ichi Kosugi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan,
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Negative lymph-node count is associated with survival in patients with resected esophageal squamous cell carcinoma. Surgery 2013; 153:234-41. [DOI: 10.1016/j.surg.2012.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 08/03/2012] [Indexed: 12/13/2022]
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Miyasaka D, Okushiba S, Sasaki T, Ebihara Y, Kawada M, Kawarada Y, Kitashiro S, Katoh H, Miyamoto M, Shichinohe T, Hirano S. Clinical evaluation of the feasibility of minimally invasive surgery in esophageal cancer. Asian J Endosc Surg 2013; 6:26-32. [PMID: 23116427 DOI: 10.1111/j.1758-5910.2012.00158.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 06/10/2012] [Accepted: 08/05/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Open thoracotomy laparotomy with extended dissection for esophageal cancer is associated with problems such as delayed postoperative recovery and decreased quality of life. In contrast, in minimally invasive surgery, these problems can be improved. In the present study, we investigated the feasibility of minimally invasive surgery in esophageal cancer. METHODS In this retrospective study, we evaluated esophagectomy performed by the same surgeon in 98 patients with thoracic esophageal cancer. Open surgery was performed in 30 patients (open group), and minimally invasive surgery was performed in 68 patients (MIS group). We compared the invasiveness and radical cure of cancer by minimally invasive surgery with that of open surgery. RESULTS Comparison between the open and MIS groups showed that intraoperative blood loss, intraoperative and postoperative transfused blood volume, and surgical site infection rates were significantly lower in the MIS group. The duration of postoperative endotracheal intubation and hospital stay were significantly shorter in the MIS group. The histopathologic type was squamous cell carcinoma in 93.3% in the open group and 92.6% in the MIS group. The respective 3-year survival rates were 36.7% and 71.5%, and the respective 5-year survival rates were 26.7% and 61.5%. CONCLUSION Based on a historical control study at a single institution, we are unable to conclude that minimally invasive surgery is superior to open surgery. However, our results indicate that minimally invasive surgery is feasible as a surgical procedure in esophageal cancer.
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Affiliation(s)
- Daisuke Miyasaka
- Department of Surgery, KKR Sapporo Medical Center - Tonan Hospital, Sapporo, Japan
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Suda K, Ishida Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, Satoh S, Uyama I. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg 2012; 36:1608-1616. [PMID: 22392356 DOI: 10.1007/s00268-012-1538-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP. METHODS A single-institution nonrandomized prospective study was performed. The patients (n = 36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n = 16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n = 20, control group). These patients were observed for 30 days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration. RESULTS Robot assistance significantly reduced the incidence of vocal cord palsy (p = 0.018) and hoarseness (p = 0.015) and the time on the ventilator (p = 0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted group CONCLUSION Robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy is feasible and safe. This method shows promise in preventing RLNP.
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Affiliation(s)
- Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Aichi, Japan.
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Hanyu T, Kanda T, Yajima K, Tanabe Y, Komukai S, Kosugi SI, Suzuki T, Hatakeyama K. Community-acquired Pneumonia during Long-term Follow-up of Patients after Radical Esophagectomy for Esophageal Cancer: Analysis of Incidence and Associated Risk Factors. World J Surg 2011; 35:2454-62. [DOI: 10.1007/s00268-011-1226-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kanda T, Sato Y, Yajima K, Kosugi SI, Matsuki A, Ishikawa T, Bamba T, Umezu H, Suzuki T, Hatakeyama K. Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma. World J Gastrointest Oncol 2011; 3:75-8. [PMID: 21603033 PMCID: PMC3098435 DOI: 10.4251/wjgo.v3.i5.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 04/26/2011] [Accepted: 05/03/2011] [Indexed: 02/05/2023] Open
Abstract
Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma. We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum. A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital. Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage IIA) and mucosal signet-ring cell carcinoma of the gastric antrum (T1N0M0 Stage IA). Although the gastric tumor appeared to be an intramucosal carcinoma, its margin was obscure, so endoscopic en-bloc resection was considered inadequate. We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer. Following transthoracic esophagectomy with three-field lymph node dissection, the gastric carcinoma was removed by gastric antrectomy, which preserved the right gastroepiploic vessels, and a pedunculated short gastric tube was used as the esophageal substitute. Twenty-eight months after the surgery, the patient is well with no evidence of cancer recurrence. Because it minimizes surgical stress and organ sacrifice, gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.
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Affiliation(s)
- Tatsuo Kanda
- Tatsuo Kanda, Yu Sato, Kazuhito Yajima, Shin-ichi Kosugi, Atsushi Matsuki, Takashi Ishikawa, Takeo Bamba, Katsuyoshi Hatakeyama, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
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Kosugi SI, Kanda T, Yajima K, Ishikawa T, Hatakeyama K. Risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with three-field lymph node dissection. Ann Surg Oncol 2011; 18:2961-7. [PMID: 21499809 DOI: 10.1245/s10434-011-1712-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extended radical esophagectomy with three-field lymph node dissection (3-FLD) has offered significant survival benefit, but some patients still suffer from early recurrence and die within 1 year after surgery. The purpose of this study was to identify the risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with 3-FLD. METHODS A consecutive series of 276 patients who underwent extended radical esophagectomy with 3-FLD was retrospectively reviewed. Excluding patients who underwent incomplete resection or died of other diseases within 1 year, we compared the clinicopathological characteristics between 203 patients who survived more than 1 year (1-year survival group) and 27 who died of cancer recurrence within 1 year (early-death group) by univariate and multivariate analysis. RESULTS Sixty-six patients (32.5%) had recurrent disease in the 1-year survival group. Hematogenous recurrences were more frequent in the early-death group than in the 1-year survival group (41% vs. 26%, respectively, p = 0.0481). There was a significant difference in nodal status, number of metastatic nodes, pathological stage, vessel invasion, and intramural metastasis, and there was borderline significance in the difference of depth of invasion and histological type between the two groups by univariate analysis. Multivariate analysis demonstrated that intramural metastasis was an independent risk factor. CONCLUSIONS Patients with intramural metastasis have a significant risk of early death even after extended radical esophagectomy with 3-FLD; however, it remains unknown whether surgical intervention can play a significant role for these patients.
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Affiliation(s)
- Shin-Ichi Kosugi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.
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Clinical course and outcome after esophagectomy with three-field lymphadenectomy in esophageal cancer. Langenbecks Arch Surg 2010; 395:341-6. [PMID: 20361205 DOI: 10.1007/s00423-010-0592-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/07/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Esophagectomy with three-field lymphadenectomy has been performed for esophageal cancer. Detailed analysis of cause of death and mode of recurrence is required to determine the need for further adjuvant therapy and follow-up. MATERIALS AND METHODS A total of 208 patients who underwent esophagectomy through right thoracotomy with three-field lymphadenectomy were enrolled into the present study. Mode of first recurrence was divided into four groups: lymph node, hematogenous, mixed, and local recurrence. RESULTS Excluding 16 hospital deaths, the number of deaths and 5-year survival rates were 104 patients and 7.8% for cancer recurrence, 12 patients and 53.8% for second primary cancers in other organs, and 34 patients and 31.0% for causes of death unrelated to carcinoma. In the 104 patients with relapse, 5-year survival rate of patients was 14.3% with lymph node recurrence (n = 29), 9.1% with hematogenous recurrence (n = 32), 3.1% with mixed recurrence (n = 35), and 12.5% with local recurrence (n = 8). CONCLUSION To improve outcomes for esophagectomy with three-field lymphadenectomy, early detection of recurrent disease and regular examination of the entire body for secondary cancer is necessary.
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Sendler A. [Tumors of the upper gastro-intestinal tract]. Chirurg 2010; 81:103-6; 108-10. [PMID: 20076935 DOI: 10.1007/s00104-009-1813-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The appropriate extent of lymph node dissection in tumors of the upper gastro-intestinal tract continues to be debated. The basic tenet of surgical oncology that cancerous lymph nodes are indicators not governors of survival is under question and derives from the different theories of metastasis. Is the metastatic flow linear (indicators) or does it occur in parallel to tumorigenesis (governor)? If the latter theory is true there would be only a limited indication for lymphadenectomy (LA).Extended LA leads to an ameliorated staging of the N category. Following LA locoregional tumor control is significantly improved for esophageal and gastric cancer. In case of gastric cancer it is evident that there is a group of patients in which extended LA lead to improved long-term survival. This gain in prognosis affects patients in which lymph node metastasis is not or only slightly advanced. In locally advanced tumors there is no prognostic benefit. Patients who might benefit from the extended procedure cannot be assessed during preoperative staging. Therefore, the indications for the procedure should be liberally carried out by experienced hands and in experienced centers. According to randomized studies there is no indication for extended radical LA in pancreatic cancer.
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