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Abe T, Higaki E, Hosoi T, Nagao T, Bando H, Kadowaki S, Muro K, Tanaka T, Tajika M, Niwa Y, Shimizu Y. Long-Term Outcome of Patients with Locally Advanced Clinically Unresectable Esophageal Cancer Undergoing Conversion Surgery after Induction Chemotherapy with Docetaxel Plus Cisplatin and 5-Fluorouracil. Ann Surg Oncol 2020; 28:712-721. [PMID: 32761331 DOI: 10.1245/s10434-020-08865-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although definitive chemoradiotherapy (CRT) is recommended for patients with locally advanced unresectable esophageal cancer, the outcome is unsatisfactory. We previously demonstrated the safety and efficacy of induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil (DCF) and subsequent conversion surgery (CS) for patients with locally advanced unresectable esophageal cancer. However, whether or not induction DCF chemotherapy and subsequent CS improve the long-term outcomes of patients with locally advanced unresectable esophageal cancer is unclear. METHODS A total of 177 consecutive patients with locally advanced unresectable esophageal cancer without distant metastasis were included in this study. Of these, 55 patients received DCF induction chemotherapy, of whom 36 underwent CS. We divided these 36 patients into two groups according to clinical response, which was analyzed retrospectively. RESULTS The toxicities related to DCF chemotherapy were manageable. The response rate to induction DCF chemotherapy was 67%. R0 resection was achieved in 81% of the 36 patients who underwent subsequent CS. No serious postoperative complications were observed. Histopathological CR was achieved in 17% of the 36 patients, and the 3- and 5-year survival rates after CS were 61% and 54%, respectively. The outcomes of the patients who obtained good clinical response was better than the outcomes of patients who did not. CONCLUSIONS Induction DCF chemotherapy and subsequent CS show acceptable toxicity and offer the chance of long-term survival in patients with locally advanced clinically unresectable esophageal cancer.
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Affiliation(s)
- Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
| | - Eiji Higaki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Takahiro Hosoi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Takuya Nagao
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Hideaki Bando
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Shigenori Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Yasumasa Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
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Suen HC, Smith CW. Combined esophagectomy and carinal pneumonectomy. J Thorac Dis 2018; 10:S1845-S1849. [PMID: 30026970 DOI: 10.21037/jtd.2018.05.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hon Chi Suen
- Department of Cardiothoracic Surgery, Mercy Hospital Jefferson, Festus, MO 63028, USA
| | - Cody Wayne Smith
- Department of Cardiothoracic Surgery, Mercy Hospital Jefferson, Festus, MO 63028, USA
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Tanoue Y, Takeno S, Kawano F, Tashiro K, Hamada R, Miyazaki Y, Nanashima A. A case of separation surgery with drainage tube-less (DRESS) esophagostomy for advanced cancer with a respiratory fistula. Int J Surg Case Rep 2018; 44:24-28. [PMID: 29462754 PMCID: PMC5832673 DOI: 10.1016/j.ijscr.2018.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/12/2018] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. PRESENTATION OF CASE A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. DISCUSSION Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. CONCLUSION Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT.
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Affiliation(s)
- Yukinori Tanoue
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan.
| | - Shinsuke Takeno
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan.
| | - Fumiaki Kawano
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Kousei Tashiro
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Rouko Hamada
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Yasuyuki Miyazaki
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
| | - Atsushi Nanashima
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kihara 5200, Kiyotake, Miyazaki, 8891692, Japan
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Park S, Lee HJ, Kang CH, Kim YT. Successful Management of Airway Emergency in a Patient with Esophageal Cancer. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Igaki H, Kato H, Tachimori Y, Nakanishi Y, Shimoda T. Surgery for clinical T3 carcinomas of the upper thoracic oesophagus and the need for new strategies. Br J Surg 2005; 92:1235-40. [PMID: 15997441 DOI: 10.1002/bjs.5081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Patients with T3 carcinomas have a dismal prognosis, even after complete resection of the primary tumour and metastatic nodes. This study focused on the clinicopathological characteristics and outcomes after surgical resection of clinical T3 carcinomas of the upper thoracic oesophagus.
Methods
Between January 1988 and February 2000, 888 consecutive patients underwent surgical removal of carcinomas of the thoracic oesophagus or oesophagogastric junction at the National Cancer Centre Hospital, Japan. The case records of 51 consecutive patients with clinical T3 tumours of the upper thoracic oesophagus were analysed retrospectively.
Results
No patient received preoperative therapy. Complications occurred in 41 (80 per cent). In-hospital and 30-day postoperative mortality rates were 10 and 4 per cent respectively. Gross residual primary tumour or metastasis in regional nodes invading adjacent structures was noted in 14 patients (27 per cent) and incomplete resection including microscopic residual tumour in 23 (45 per cent). Overall 3- and 5-year survival rates were 20 and 12 per cent; median survival was 13·1 months.
Conclusion
Surgical resection of clinical T3 carcinomas of the upper thoracic oesophagus is associated with a high postoperative complication rate, incomplete resection and unsatisfactory outcome. Reconsideration of the surgical treatment strategy for these tumours is needed.
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Affiliation(s)
- H Igaki
- Division of Oesophageal Surgery, Department of Surgery, National Cancer Centre Hospital, Tsukiji, Tokyo, Japan.
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Igaki H, Kato H, Tachimori Y, Nakanishi Y. Prognostic evaluation of patients with clinical T1 and T2 squamous cell carcinomas of the thoracic esophagus after 3-field lymph node dissection. Surgery 2003; 133:368-74. [PMID: 12717353 DOI: 10.1067/msy.2003.76] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinicopathologic characteristics and outcomes with clinical T1 and T2 squamous cell carcinomas requiring surgical resection have not been well investigated. The purpose of this study was to evaluate results for patients undergoing 3-field lymph node dissection and to elucidate predictors of survival. METHODS From January 1988 to January 1998, 336 patients with carcinomas of the thoracic esophagus underwent transthoracic esophagectomy with 3-field lymph node dissection. Of these, 325 (97%) patients had squamous cell carcinomas. A total of 139 (41%) with clinical T1 and T2 tumors were retrospectively analyzed based on the prospectively established database. RESULTS Among the 139 patients with clinical T1 and T2 squamous cell carcinomas, 90 (65%) had T1 and 49 (35%) had T2 tumors. The operative morbidity, and 30-day and in hospital mortality rates were 70%, 0%, and 2%, respectively. Macroscopic and microscopic complete resection of the primary tumor and removal of metastatic nodes were accomplished in 90% of the cases. The overall 1-, 3-, and 5-year survival rates were 88%, 72%, and 61%. Significant prognostic factors, determined by multivariate analysis, were number of lymph node metastases, pathologic T status, and completeness of resection. Number of lymph node metastases most strongly affected survival. Eighty-six percent of patients with 5 or more metastatic nodes occurred recurrence of disease. CONCLUSION Esophagectomy with 3-field lymph node dissection accomplishes a high feasibility of complete resection of primary tumor and removal of metastatic nodes in patients with clinical T1 and T2 squamous cell carcinomas. Five or more metastatic nodes can be considered as an indicator of systemic disease with a high likelihood of distant organ metastasis. This variable must be taken into consideration for deciding clinical disease stage and treatment strategy.
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Affiliation(s)
- Hiroyasu Igaki
- Department of Surgery and Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Manshanden CG, Hulscher JB, Hovius M, Fockens P, van Lanschot JJ, Obertop H. Limited resection for carcinoma of the upper thoracic oesophagus is not a realistic option. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:561-6. [PMID: 11034806 DOI: 10.1053/ejso.2000.0947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS Due to its anatomical position, carcinoma of the proximal oesophagus results in early invasion of adjoining structures, often precluding (radical) resection. We performed a retrospective study to compare the potentially curative and palliative treatment results in patients with proximal (i.e. at or above the carina) vs distal oesophageal carcinoma. METHODS Over a 3-year period 30 patients with proximal and 145 patients with distal oesophageal cancer underwent surgery. RESULTS Microscopically radical resection was achieved in 11/30 patients (43%) with a proximal tumour and in 96/145 patients (66%) with a distal tumour (P=0.007). Three-year survival was 13.8%vs 44.3% respectively; localization was an independent prognostic factor. Recurrent upper aero-digestive tract symptoms developed in 38% of the patients with a proximal tumour and in 19% of the patients with distal carcinoma (P<0.05). DISCUSSION Carcinoma of the proximal oesophagus has a worse prognosis than more distal carcinomas. Definite cure is exceptional; many patients are ineffectively palliated. In patients with proximal oesophageal carcinoma surgery should not be performed outside clinical trials testing multimodality treatment.
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Affiliation(s)
- C G Manshanden
- Department of Surgery, Academic Medical Center at the University of Amsterdam, The Netherlands
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Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg 1998; 187:238-45. [PMID: 9740180 DOI: 10.1016/s1072-7515(98)00159-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The clinical significance of lymph node involvement along the recurrent laryngeal nerves in cancer of the thoracic esophagus is still controversial. Although these lymph nodes are anatomically located in a well-defined compartment (proximal mesoesophagus), appropriate procedures for dissecting them are not well established. STUDY DESIGN We retrospectively investigated clinical results over the past 10 years in 276 patients who underwent systematic dissection of cervical, mediastinal, and upper abdominal lymph nodes. We routinely performed the cervical procedure before thoracotomy for total dissection of the proximal mesoesophagus and to minimize the operative risk. RESULTS All macroscopically recognizable lesions were resected in 94% of the patients. The hospital mortality rate was 2.5%. Recurrent nerve palsy developed in 59 patients, but it was successfully managed without prolonged hoarseness in 50 of them. The recurrent nerve node group was most frequently involved (frequency of 25% in superficial cancer, 57% in non-superficial cancer). Supradiaphragmatic lymph node involvement was limited to the recurrent nerve nodes in 25% of the patients with positive supradiaphragmatic node. The 5-year survival rate in patients with positive recurrent nerve nodes was 34%. CONCLUSIONS Dissection of the recurrent nerve lymph nodes is essential for curative esophagectomy even in the early phase of cancer invasion. Our cervicothoracic approach for total dissection of the proximal mesoesophagus yielded acceptable outcomes.
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Affiliation(s)
- T Matsubara
- Department of Surgery, Cancer Institute Hospital, Tokyo, Japan
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Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Surgical treatment for carcinoma of the thoracic esophagus with major involvement in the neck or upper mediastinum. J Surg Oncol 1998; 67:6-10. [PMID: 9457249 DOI: 10.1002/(sici)1096-9098(199801)67:1<6::aid-jso2>3.0.co;2-f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES In carcinoma of the thoracic esophagus, most surgeons consider that esophagectomy is contraindicated in patients with clinical evidence of major extraesophageal involvement in the lower neck or peritracheal regions. However, metastases to these regions are commonly found even in early phases of carcinoma invasion. With recent progress in preoperative assessment, operative technique and adjuvant therapy, esophagectomy could possibly benefit appropriately selected patients. METHODS We retrospectively analyzed results in 42 patients who had major involvement in the neck or upper mediastinum and who underwent esophagectomy with systematic lymph node dissection. We operated upon patients unless lesions were assessed as definitely unresectable. Preoperatively, 32 had enlarged peritracheal nodes greater than 15 mm in diameter on computed tomography, 18 had hard unmobile tumors in the lower neck, 9 had recurrent laryngeal nerve palsy, and 10 had findings suggestive of tracheal invasion. Preoperative radiotherapy and/or chemotherapy was given to 32 low-risk patients. RESULTS The hospital mortality rate was 4%. Bowel reconstruction was completed in all cases. No macroscopically recognizable lesion remained after operation in 35 patients. Eight patients were alive 5 years after esophagectomy, including 2 who had had tracheal invasion and 1 with recurrent nerve palsy. The cumulative 5-year survival was 38%. CONCLUSIONS Evidence of major involvement of the neck and/or upper mediastinum does not always contraindicate resection. Aggressive esophagectomy combined with perioperative adjuvant therapy yielded acceptable palliation and occasional cure in cases with technically resectable lesions.
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Affiliation(s)
- T Matsubara
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
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Abstract
Repair options for tracheal defects secondary to tumor or trauma have been unsatisfactory for emergent cases. We report a case in which the tracheobronchial tree was entered during resection of carcinoma of the esophagus and emergently repaired with a Goretex graft. The patient did well for 22 months after esophagectomy, at which time the graft was found to be infected and was removed. The patient continues to remain free of tumor 4 years after initial resection.
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Affiliation(s)
- K W Millikan
- Department of General Surgery, Rush Medical College, Chicago, Illinois, USA
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Abstract
The management of patients with high-grade dysplasia in Barrett's esophagus is complex and controversial with regard to electing continued endoscopic biopsy surveillance until an early adenocarcinoma is detected or proceeding with partial esophagogastrectomy. Clinical recommendations to patients for either option should be individualized and based on several parameters reflecting patient and clinician factors. Available data on interpretational variation in the diagnosis of dysplasia; limitation of diagnostic errors with the use of a rigorous, systematic endoscopic biopsy protocol; new information on the apparent benign natural history of high-grade dysplasia in some patients; and the morbidity and mortality of esophageal resection all suggest that recommendation for continued endoscopic biopsy surveillance is an appropriate clinical practice in selected patients. Ongoing research investigations on high-grade dysplasia in Barrett's esophagus aim to reduce the potential for diagnostic errors, simplify cancer surveillance, and develop therapeutic interventions that are safer than but as effective as surgery.
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Affiliation(s)
- D S Levine
- Department of Medicine, University of Washington, Seattle, USA
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