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Wang G, Tao S, Sun X, Wang J, Li T, Chen Z, Liu C, Xie M. Comparative study of acute and chronic pain after inflatable videoasisted MediastinoscopicTranshiatal esophagectomy and minimally invasive McKeown Esophagectomy:A propensity score matching analysis. Heliyon 2024; 10:e33477. [PMID: 39035516 PMCID: PMC11259877 DOI: 10.1016/j.heliyon.2024.e33477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 06/21/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
Objective The short-term quality of life of patients can be enhanced by performing Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy (IVMTE). Nevertheless, there is limited research on how it impacts postoperative acute and chronic pain in individuals diagnosed with esophageal cancer.Hence, this research aimed to examine the impact of IVMTE and minimally invasive Mckeown esophagectomy (MIME) on the occurrence of acute and chronic pain following surgery in individuals diagnosed with esophageal cancer. Methods A retrospective, propensity score matching analysis was adopted. In total, 133 patients with esophageal cancer who underwent IVMTE and MIME between January 2020 and December 2021 were part of the study. Among them, 38 patients underwent IVMTE and 95 patients underwent MIME. Following the propensity score matching analysis, 36 patients were included in each group. Patients' postoperative pain was evaluated using the numerical rating scale (NRS). Results The IVMTE group (Group A) had significantly reduced operation time and intraoperative blood loss compared to the MIME group (Group B) (P < 0.05). NRS scores on the 1st, 2nd, 3rd, and 7th days after surgery, as well as on the 3rd and 6th months post-surgery, were notably reduced in the IVMTE group (Group A) compared to the MIME group (Group B) (P < 0.05). Univariate and multivariate analysis showed that chronic pain occurred postoperative 3rd months was related to the operation methods (P < 0.05). Univariate analysis showed that chronic pain occurred postoperative 6th months was related to the operation time, postoperative 14th days NRS scores and operation methods (P < 0.05). Multivariate analysis showed that chronic pain occurred postoperative 6th months was related to the operation methods (P < 0.05). Conclusion The results showed that the operation methods were the main risk factors for postoperative chronic pain. The compared with MIME, IVMTE can further reduce the acute and chronic pain of patients with esophageal cancer.
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Affiliation(s)
| | | | - Xiaohui Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Jun Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Tian Li
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Zhengwei Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Changqing Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Mingran Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
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Stiles ZE, Hagerty BL, Brady M, Mukherjee S, Hochwald SN, Kukar M. Contemporary outcomes for resected type 1-3 gastroesophageal junction adenocarcinoma: a single-center experience. J Gastrointest Surg 2024; 28:634-639. [PMID: 38704200 DOI: 10.1016/j.gassur.2024.01.040] [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: 01/09/2024] [Accepted: 01/26/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Surgical resection remains the mainstay of treatment for tumors of the gastroesophageal junction (GEJ). However, contemporary analyses of the Western experience for GEJ adenocarcinoma are sparsely reported. METHODS Patients with GEJ adenocarcinoma undergoing resection between 2012 and 2022 at a single institution were grouped based on Siewert subtype and analyzed. Pathologic and treatment related variables were assessed with relation to outcomes. RESULTS A total of 302 patients underwent resection: 161 (53.3%) with type I, 116 (38.4%) with type II, and 25 (8.3%) with type III tumors. Most patients received neoadjuvant therapy (86.4%); 86% of cases were performed in a minimally invasive fashion. Anastomotic leak occurred in 6.0% and 30-day mortality in only 0.7%. The rate of grade 3+ morbidity was lower for the last 5 years of the study than for the first 5 years (27.5% vs 49.3%, P < .001), as was median length of stay (7 vs 8 days, P < .001). There was a significantly greater number of signet ring type tumors among type III tumors (44.0%) than type I/II tumors (11.2/12.9%, P < .001). Otherwise, there was no difference in the distribution of pathologic features among Siewert subtypes. Notably, there was a significant difference in 3-year overall survival based on Siewert classification: type I 60.0%, type II 77.2%, and type III 86.3% (P = .011). Siewert type I remained independently associated with worse survival on multivariable analysis (hazard ratio, 4.5; P = .023). CONCLUSIONS In this large, single-institutional series, operative outcomes for patients with resected GEJ adenocarcinoma improved over time. On multivariable analysis, type I tumors were an independent predictor of poor survival.
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Affiliation(s)
- Zachary E Stiles
- Division of Surgical Oncology, Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Brendan L Hagerty
- Division of Surgical Oncology, Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Maureen Brady
- Division of Surgical Oncology, Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Sarbajit Mukherjee
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States
| | - Steven N Hochwald
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Cancer Center, Miami Beach, Florida, United States
| | - Moshim Kukar
- Division of Surgical Oncology, Department of Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States.
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Yan Z, Xu X, Guo B, Wang P, Niu L, Gao Z, Yuan Y, Li F, He M. A approach of gastric conduit via the anterior of pulmonary hilum route during minimally invasive McKeown esophagectomy. J Cardiothorac Surg 2024; 19:232. [PMID: 38627783 PMCID: PMC11020892 DOI: 10.1186/s13019-024-02718-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The gastric conduit is the most commonly used replacement organ for reconstruction after minimally invasive McKeown esophagectomy. Although the optimal route of gastric conduit remains controversial, the posterior mediastinal route is physiologically preferable but is not without disadvantages. Here, we report the safety and efficacy of a method of gastric conduit reconstruction via the anterior of the pulmonary hilum route. METHODS We have used the anterior of the pulmonary hilum route since 2021. This procedure involves pulling the gastric conduit up through a substernal tunnel between the right thoracic cavity and the abdominal cavity and passing it into the neck via the anterior of the pulmonary hilum route. In this retrospective study, we compared the clinical outcomes between 20 patients who underwent this procedure and 20 patients who underwent the posterior mediastinal route from 2021 to 2022. RESULTS No mortality was reported in either group. No significant differences were observed between the two groups in duration of surgery, blood loss, incidence of postoperative complications, and postoperative hospital stay. As a result of the anterior of the pulmonary hilum route, the primary tumor bed and lymph node drainage area were effectively bypassed, which facilitates postoperative adjuvant radiotherapy or chemoradiotherapy. The distance of the gastric conduit accompanying the airway was significantly shorter in the anterior of the pulmonary hilum route group. CONCLUSIONS Our method is considered to be a safe and useful technique for the reconstruction of gastric conduit.
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Affiliation(s)
- Zhaoyang Yan
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Xinjian Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Bin Guo
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Pengzeng Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Linpeng Niu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Zhanjie Gao
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Yusen Yuan
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China
| | - Fei Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China.
| | - Ming He
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Hebei Provincial Key Laboratory of Tumor Microenvironment and Drug Resistance, Shijiazhuang, Hebei Province, China.
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Stiles ZE, Brady M, Hochwald SN, Kukar M. Relevance of Subcarinal Lymph Node Dissection for Gastroesophageal Junction Adenocarcinoma. J Surg Res 2023; 290:2-8. [PMID: 37156029 DOI: 10.1016/j.jss.2023.03.047] [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: 05/11/2022] [Revised: 02/20/2023] [Accepted: 03/16/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Reported rates of subcarinal lymph node (LN) metastases for esophageal carcinoma vary from 20% to 25% and the relevance of subcarinal lymph node dissection (LND) for gastroesophageal junction (GEJ) adenocarcinoma is poorly defined. This study aimed to evaluate rates of subcarinal LN metastasis in GEJ carcinoma and determine their prognostic significance. METHODS Patients with GEJ adenocarcinoma undergoing robotic minimally invasive esophagectomy from 2019 to 2021 were retrospectively assessed within a prospectively maintained database. Baseline characteristics and outcomes were examined with attention to subcarinal LND and LN metastases. RESULTS Among 53 consecutive patients, the median age was 62, 83.0% were male, and all had Siewert type I/II tumors (49.1% and 50.9%, respectively). Most patients (79.2%) received neoadjuvant therapy. Three patients had subcarinal LN metastases (5.7%) and all had Siewert type I tumors. Two had clinical evidence of LN metastases preoperatively and all three additionally had non-subcarinal nodal disease. A greater proportion of patients with subcarinal LN disease had more advanced (T3) tumors compared to patients without subcarinal metastases (100.0% versus 26.0%; P = 0.025). No patient with subcarinal nodal metastases remained disease free at 3 y after surgery. CONCLUSIONS In this consecutive series of patients with GEJ adenocarcinoma undergoing minimally invasive esophagectomy, subcarinal LN metastases were found only in patients with type I tumors and were noted in just 5.7% of patients, which is lower than historical controls. Subcarinal nodal disease was associated with more advanced primary tumors. Further study is warranted to determine the relevance of routine subcarinal LND, especially for type 2 tumors.
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Affiliation(s)
- Zachary E Stiles
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Maureen Brady
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Steven N Hochwald
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Moshim Kukar
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.
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Ma X, Ge H, Zhang X, Li S. Survival experience of patients undergoing oesophagectomy during the recovery period: A meta-synthesis of qualitative studies. J Clin Nurs 2023; 32:5579-5595. [PMID: 36802111 DOI: 10.1111/jocn.16648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 02/20/2023]
Abstract
AIMS AND OBJECTIVE To systematically review and synthesise existing qualitative research evidence describing the survival experience of patients undergoing oesophagectomy during recovery. BACKGROUND Patients with oesophageal cancer undergoing surgical treatment have severe physical and psychological burdens during the recovery period. Qualitative studies on the survival experience of patients undergoing oesophagectomy are increasing annually, but there is no integration of qualitative evidence. DESIGN A systematic review and synthesis of qualitative studies were conducted following the ENTREQ. METHODS Five English (CINAHL, Embase, PubMed, Web of Science and Cochrane Library) and three Chinese (Wanfang, CNKI and VIP) databases were searched for literature on the survival of patients undergoing oesophagectomy during the recovery period from its establishment in April 2022. The quality of the literature was evaluated by the 'Qualitative Research Quality Evaluation Criteria for the JBI Evidence-Based Health Care Centre in Australia', and the data were synthesised by the thematic synthesis method of Thomas and Harden. RESULTS A total of 18 studies were included, and four themes were identified: physical and mental dual challenges, impaired social functioning, efforts to return to normal life, lack of knowledge and skills in post-discharge care, and thirst for external support. CONCLUSIONS Future research should focus on the problem of reduced social interaction during the recovery of patients with oesophageal cancer, formulating individualised exercise intervention programs and establishing a sound social support system. RELEVANCE TO CLINICAL PRACTICE The results of this study provide evidence-based support for nurses to carry out targeted interventions and reference methods for patients with oesophageal cancer to rebuild their lives. NO PATIENT OR PUBLIC CONTRIBUTION The report was a systematic review and did not involve a population study.
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Affiliation(s)
- Xuanxuan Ma
- School of Nursing, Anhui Medical University, Hefei, China
| | - Hui Ge
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Shuwen Li
- School of Nursing, Anhui Medical University, Hefei, China
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Wang X, Liu Y, Lu Y, Chen S, Xing Y, Yang H, Wang X, Zhang Y, Pan T, Li J, Wang M, Zhang N, Liang M, Zhou F. Clinical impact of Fn-induced high expression of KIR2DL1 in CD8 T lymphocytes in oesophageal squamous cell carcinoma. Ann Med 2022; 54:51-62. [PMID: 34935568 PMCID: PMC8725851 DOI: 10.1080/07853890.2021.2016942] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To analyze the correlation between the inducing effect of Fusobacterium nucleatum (Fn) on the surface expression of the inhibitory receptor KIR2DL1 on CD8+ T cells in oesophageal squamous cell carcinoma (ESCC) and the clinicopathological features and survival prognosis and to explore its clinical significance. METHODS The inducing effect of Fn on CD8+ T cell surface inhibitory receptor KIR2DL1 expression was analyzed in a coculture system of human CD8+ T cells and ESCC cells infected with Fn. Fn infection and the expression of KIR2DL1 on CD8+ T cells were detected by RNAscope and immunohistochemistry in ESCC tissues, and the correlations between the inducing effect of Fn on KIR2DL1 expression on CD8+ T cells and clinicopathological features were analyzed. COX regression was used to analyze the influence of each factor on the prognosis of ESCC. Survival curves were plotted by the Kaplan-Meier method, and the effect of KIR2DL1 induction on survival time was analyzed by the log-rank test. RESULTS In the coculture system, KIR2DL1 expression on the surface of CD8+ T cells increased with increasing Fn infection time. In ESCC tissues, Fn infection was significantly correlated with high KIR2DL1 expression on CD8+ T cells. The Fn + CD8+KIR2DL1 positive patients were predominantly males who were smokers and alcohol drinkers. Moreover, patients with Fn infection were characterized by poor tumour differentiation, advanced clinical stage, and a short survival time. Meanwhile, Fn + CD8+KIR2DL1 positive group was independent risk factor affecting the prognosis of ESCC patients. CONCLUSIONS Long-term drinking and smoking lead to an extremely unhealthy oral environment in which Fn infection and colonization are more likely to occur, thus inducing high expression of KIR2DL1 on the surface of CD8+ T cells, which can weaken the antitumour immune response and promote the malignant progression of ESCC.HIGHLIGHTSFn induced high expression of KIR2DL1 CD8+ T cells in a time-dependent manner.Fn can reduce the response of tumour cells to CDDP.The inducing effect of Fn on CD8+ T cell surface KIR2DL1 expression was significantly associated with the poor prognosis of ESCC patients.
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Affiliation(s)
- Xiaopeng Wang
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China.,The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yiwen Liu
- College of Clinical Medicine, Laboratory of Molecular Biology of the First Affiliated Hospital, Cancer Institute of Henan University of Science and Technology, Henan Key Laboratory of Cancer Epigenetics, Luoyang, Henan, China
| | - Yannan Lu
- Graduate School of Dalian Medical University, Dalian, Liaoning, China
| | - Simo Chen
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Yaoping Xing
- The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Haijun Yang
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China
| | - Xiaojun Wang
- Basic Medical School of Henan University of Science and Technology, Luoyang, Henan, China
| | - Yaowen Zhang
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China
| | - Tao Pan
- Department of Lymphoma & Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Junkuo Li
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China
| | - Min Wang
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China.,The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Ning Zhang
- College of Clinical Medicine, Laboratory of Molecular Biology of the First Affiliated Hospital, Cancer Institute of Henan University of Science and Technology, Henan Key Laboratory of Cancer Epigenetics, Luoyang, Henan, China
| | - Mengxia Liang
- College of Clinical Medicine, Laboratory of Molecular Biology of the First Affiliated Hospital, Cancer Institute of Henan University of Science and Technology, Henan Key Laboratory of Cancer Epigenetics, Luoyang, Henan, China
| | - Fuyou Zhou
- Anyang Tumor Hospital (The Fourth Affiliated Hospital of Henan University of Science and Technology), Anyang, Henan, China.,The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.,College of Clinical Medicine, Laboratory of Molecular Biology of the First Affiliated Hospital, Cancer Institute of Henan University of Science and Technology, Henan Key Laboratory of Cancer Epigenetics, Luoyang, Henan, China
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Takahashi H, Peng J, Brady M, Roche C, Catalfamo K, Attwood K, Yendamuri S, Demmy TL, Hochwald SN, Kukar M. Acute gastric conduit dilation after minimally invasive esophagectomy: a 10-year experience. Dis Esophagus 2022; 35:6596996. [PMID: 35649395 DOI: 10.1093/dote/doac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/11/2022] [Accepted: 05/16/2021] [Indexed: 12/11/2022]
Abstract
Despite decreasing overall morbidity with minimally invasive esophagectomy (MIE), conduit functional outcomes related to delayed emptying remain challenging, especially in the immediate postoperative setting. Yet, this problem has not been described well in the literature. Utilizing a single institutional prospective database, 254 patients who underwent MIEs between 2012 and 2020 were identified. Gastric conduit dilation was defined as a conduit occupying >40% of the hemithorax on the postoperative chest X-ray. Sixty-seven patients (26.4%) demonstrated acute conduit dilation. There was a higher incidence of conduit dilation in the patients who underwent Ivor Lewis esophagectomy compared to those with a neck anastomosis (67.2% vs. 47.1%; P = 0.03). Patients with dilated conduits required more esophagogastroduodenoscopies (EGD) (P < 0.001), conduit-related reoperations within 180 days (P < 0.001), and 90-day readmissions (P = 0.01). Furthermore, in 37 patients (25.5%) undergoing Ivor Lewis esophagectomy, we returned to the abdomen after intrathoracic anastomosis to reduce redundant conduit and pexy the conduit to the crura. While conduit dilation rates were similar, those who had intraabdominal gastropexy required EGD significantly less and trended toward a lower incidence of conduit-related reoperations (5.6% vs. 2.7%). Multivariable analysis also demonstrated that conduit dilation was an independent predictor for delayed gastric conduit emptying symptoms, EGD within 90 days, conduit-related reoperation within 180 days, and 30-day as well as 90-day readmission. Patients undergoing MIE with acute gastric conduit dilation require more endoscopic interventions and reoperations.
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Affiliation(s)
- Hideo Takahashi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - June Peng
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maureen Brady
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Charles Roche
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kayla Catalfamo
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Steven N Hochwald
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Moshim Kukar
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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A New Risk Factor for Cervical Anastomotic Leakage-Role of The Relative Gastric Length in the Surgical Treatment of Esophageal Cancer. World J Surg 2022; 46:2235-2242. [PMID: 35616719 DOI: 10.1007/s00268-022-06579-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Blood supply is especially weak near the gastric fundus. Making the anastomosis in this area would increase the risk of anastomotic leakage (AL). In cervical anastomosis, the gastric conduit needs to travel through the thorax. Therefore, the relative length between the stomach and the thorax is an essential factor in deciding if the poorly supplied area could be removed. This study was to explore if a small relative gastric length was a risk of cervical AL. If all other conditions are equal, could intrathoracic anastomosis be a better choice? METHODS Patients who underwent esophagectomy with a preoperative barium swallow in West China Hospital between 2014 and 2017 were included. The length of the greater curvature and the thorax were obtained from the barium esophagogram. The ratio between the length of the greater curvature and the thorax was the relative gastric length calculated from the greater curvature (RGL-G). RESULTS A total of 782 patients were enrolled in the final analysis. The cervical AL group had a significantly higher ratio of patients with an RGL-G less than 1.3 (26.7% vs. 8.9%, p = 0.003). The multivariate logistic regression proved that RGL-G less than 1.3 was a risk factor for cervical anastomotic leakage (p = 0.012). Correspondingly, RGL-G less than 1.3 was not a risk factor (6.3% vs. 14.3%, p = 0.289) in the intrathoracic anastomosis group. CONCLUSIONS RGL-G less than 1.3 was a new risk factor for cervical AL, but it would not be a problem for intrathoracic anastomosis.
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Tong C, Liu Y, Wu J. Development and validation of a novel nomogram for postoperative pulmonary complications following minimally invasive esophageal cancer surgery. Updates Surg 2021; 74:1375-1382. [PMID: 34689289 DOI: 10.1007/s13304-021-01196-z] [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: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022]
Abstract
Postoperative pulmonary complications (PPCs) are the most common complications following minimally invasive esophagectomy (MIE) and can be associated with adverse outcomes. This study aims to construct a nomogram based on clinical factors to predict PPCs and investigate related early outcomes. Clinical data of 969 consecutive patients receiving MIE were retrospectively collected. Univariate and multivariate analysis were performed to select independent predictors. Using independent predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal verification. Early outcomes of PPCs were analyzed. The incidence of PPCs following MIE was 39.6% (384 out of 969). In multivariate analysis, older age (Odds ratio (OR) 1.034, P < 0.001), higher body mass index (OR 0.993, P = 0.003), heavy smoking (OR 1.396, P = 0.027), FEV1/FVC < 105% (OR 1.958, P < 0.001), chemoradiotherapy (OR 0.653, P = 0.039), estimated blood loss ≥ 400 mL (OR 2.582, P = 0.018), general anesthesia (vs Combined thoracic paravertebral blockade, OR 1.578, P = 0.014), operative time ≥ 240 min (OR 1.388, P = 0.027), squamous cell carcinoma (OR 2.099, P = 0.036) and conversion to thoracotomy (OR 2.820, P = 0.026) were independent predictors for PPCs. These ten independent predictors were used to develop a nomogram, with concordance index (C index) value of 0.662 and good calibration. After internal validation, similarly good calibration and discrimination (C index, 0.654; 95% CI 0.614-0.690) were observed. Patients developing PPCs had higher rates of anastomotic leakage, reoperation, ICU and 30-day readmissions, and prolonged ICU and hospital stays (P < 0.05). Our study identified ten predictors for PPCs, which were associated with poor early outcomes. The proposed nomogram can be a useful tool to identify patients at high risk of PPCs after MIE.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai, China.,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Liu
- Statistical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jingxiang Wu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No. 241 Huaihai Rd. West, Shanghai, China.
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Lu Y, Xu C, Wang H, Song T, Wu S, Liang X, Xu H. Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma. Front Med (Lausanne) 2021; 8:714619. [PMID: 34631736 PMCID: PMC8492900 DOI: 10.3389/fmed.2021.714619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose: To investigate the survival outcomes, prognostic factors and treatment modalities of stage I-III cervical esophageal carcinoma (CEC) patients using data from the Surveillance, Epidemiology, and End Results (SEER) database from the period 2004–2016. Methods: Patients with a histopathologic diagnosis of CEC were included. The primary endpoint was overall survival (OS). Univariate and multivariate analyses of OS were performed using Cox proportional hazards models, and OS was compared using the Kaplan-Meier method and log-rank test. Results: A total of 347 patients in the SEER database were enrolled. The median OS was 14.0 months, with a 5-year OS rate of 20.9%. The parameters that were found to significantly correlate with OS in the multivariate analysis were age at diagnosis [P < 0.001, hazard ratio (HR) = 1.832], sex [P < 0.001, HR= 1.867], histology [P = 0.001, HR = 0.366], surgery at the primary site [P = 0.021, HR = 0.553], radiotherapy (RT, P = 0.017, HR = 0.637) and chemotherapy (CT, P < 0.001, HR = 0.444). Comparison among the three treatment modalities demonstrated that a triple therapy regimen consisting of surgery, RT and CT was associated with a longer survival time than the other two treatment modalities before and after propensity score matching (PSM). However, triple therapy showed no significant survival benefit over double therapy (P = 0.496 before PSM and P = 0.184 after PSM). Conclusions: The survival of patients with CEC remains poor. Surgery, RT and CT were all strongly correlated with OS. We recommend a triple therapy regimen for select CEC patients based on the findings of the current study, although this recommendation should be further confirmed by prospective studies with large sample sizes.
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Affiliation(s)
- Yanwei Lu
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Chenwang Xu
- Department of Applied Physics, Hangzhou Medical College, Hangzhou, China
| | - Haitao Wang
- Department of Thoracic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Tao Song
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Shixiu Wu
- Department of Radiation Oncology, The Second Affiliated & Yuying Children's Hospital Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Liang
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hong'en Xu
- Department of Radiation Oncology, Oncology Center of Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
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11
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Ye H, Wang X, Li X, Gan X, Zhong H, Wu X, Cao Q. Effect of single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy on respiration and circulation. J Cardiothorac Surg 2021; 16:288. [PMID: 34627298 PMCID: PMC8502305 DOI: 10.1186/s13019-021-01671-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE We previously developed a new surgical method, namely, single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy. The purpose of this study was to evaluate the effect of carbon dioxide inflation on respiration and circulation using this approach. METHODS From April 2018 to October 2020, 105 patients underwent this novel surgical approach. The changes in respiratory and circulatory functions were reported when the mediastinal pressure and pneumoperitoneum pressure were 10 and 12 mmHg, respectively. Data on blood loss, operative time, and postoperative complications were also collected. RESULTS 104 patients completed the operation successfully, except for 1 patient who was converted to thoracotomy because of intraoperative injury. During the operation, respectively, the heart rate, mean arterial pressure, central venous pressure, peak airway pressure, end-expiratory partial pressure of carbon dioxide and partial pressure of carbon dioxide increased in an admissibility range. The pH and oxygenation index decreased 1 h after inflation, but these values were all within a safe and acceptable range and restored to the baseline level after CO2 elimination. Postoperative complications included anastomotic fistula (8.6%), pleural effusion that needed to be treated (8.6%), chylothorax (0.9%), pneumonia (7.6%), arrhythmia (3.8%) and postoperative hoarseness (18.2%). There were no cases of perioperative death. CONCLUSIONS When the inflation pressure in the mediastinum and abdomen was 10 mmHg and 12 mmHg, respectively, the inflation of carbon dioxide from single-port inflatable mediastinoscopy simultaneous laparoscopic-assisted radical esophagectomy did not cause serious changes in respiratory and circulatory function or increase perioperative complications.
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Affiliation(s)
- Haibo Ye
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
- Department of Anesthesia, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiaojin Wang
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiaojian Li
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiangfeng Gan
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Hongcheng Zhong
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China
| | - Xiangwen Wu
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China.
| | - Qingdong Cao
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Road, Xiangzhou District, Zhuhai, 519000, Guangdong, China.
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12
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Fehrenbach U, Wuensch T, Gabriel P, Segger L, Yamaguchi T, Auer TA, Beetz NL, Denecke C, Kröll D, Raakow J, Knitter S, Chopra S, Thuss-Patience P, Pratschke J, Hamm B, Biebl M, Geisel D. CT Body Composition of Sarcopenia and Sarcopenic Obesity: Predictors of Postoperative Complications and Survival in Patients with Locally Advanced Esophageal Adenocarcinoma. Cancers (Basel) 2021; 13:cancers13122921. [PMID: 34208070 PMCID: PMC8230687 DOI: 10.3390/cancers13122921] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To assess the impact of body composition imaging biomarkers in computed tomography (CT) on the perioperative morbidity and survival after surgery of patients with esophageal cancer (EC). METHODS Eighty-five patients who underwent esophagectomy for locally advanced EC after neoadjuvant therapy between 2014 and 2019 were retrospectively enrolled. Pre- and postoperative CT scans were used to assess the body composition imaging biomarkers (visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA) and volume (PMV), total abdominal muscle area (TAMA)). Sarcopenia was defined as lumbar skeletal muscle index (LSMI) ≤38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men. Patients with a body mass index (BMI) of ≥30 were considered obese. These imaging biomarkers were correlated with major complications, anastomotic leakage, postoperative pneumonia, duration of postoperative hospitalization, disease-free survival (DFS), and overall survival (OS). RESULTS Preoperatively, sarcopenia was identified in 58 patients (68.2%), and sarcopenic obesity was present in 7 patients (8.2%). Sarcopenic patients were found to have an elevated risk for the occurrence of major complications (OR: 2.587, p = 0.048) and prolonged hospitalization (32 d vs. 19 d, p = 0.040). Patients with sarcopenic obesity had a significantly higher risk for postoperative pneumonia (OR: 6.364 p = 0.018) and a longer postoperative hospital stay (71 d vs. 24 d, p = 0.021). Neither sarcopenia nor sarcopenic obesity was an independent risk factor for the occurrence of anastomotic leakage (p > 0.05). Low preoperative muscle biomarkers (PMA and PMV) and their decrease (ΔPMV and ΔTAMA) during the follow-up period significantly correlated with shorter DFS and OS (p = 0.005 to 0.048). CONCLUSION CT body composition imaging biomarkers can identify high-risk patients with locally advanced esophageal cancer undergoing surgery. Sarcopenic patients have a higher risk of major complications, and patients with sarcopenic obesity are more prone to postoperative pneumonia. Sarcopenia and sarcopenic obesity are both subsequently associated with a prolonged hospitalization. Low preoperative muscle mass and its decrease during the postoperative follow-up are associated with lower DFS and OS.
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Affiliation(s)
- Uli Fehrenbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
- Correspondence: ; Tel.: +49-(0)30-450-557-001; Fax: +49-(0)30-450-755-7901
| | - Tilo Wuensch
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Pia Gabriel
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
| | - Laura Segger
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
| | - Takeru Yamaguchi
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 6500017, Japan;
| | - Timo Alexander Auer
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
- Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Nick Lasse Beetz
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
| | - Christian Denecke
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Dino Kröll
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Jonas Raakow
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Sebastian Knitter
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Sascha Chopra
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Peter Thuss-Patience
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Bernd Hamm
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (T.W.); (C.D.); (D.K.); (J.R.); (S.K.); (S.C.); (J.P.); (M.B.)
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (P.G.); (L.S.); (T.A.A.); (N.L.B.); (B.H.); (D.G.)
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Lee NR, Meng RY, Rah SY, Jin H, Ray N, Kim SH, Park BH, Kim SM. Reactive Oxygen Species-Mediated Autophagy by Ursolic Acid Inhibits Growth and Metastasis of Esophageal Cancer Cells. Int J Mol Sci 2020; 21:E9409. [PMID: 33321911 PMCID: PMC7764507 DOI: 10.3390/ijms21249409] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022] Open
Abstract
Ursolic acid (UA) possesses various pharmacological activities, such as antitumorigenic and anti-inflammatory effects. In the present study, we investigated the mechanisms underlying the effects of UA against esophageal squamous cell carcinoma (ESCC) (TE-8 cells and TE-12 cells). The cell viability assay showed that UA decreased the viability of ESCC in a dose-dependent manner. In the soft agar colony formation assay, the colony numbers and size were reduced in a dose-dependent manner after UA treatment. UA caused the accumulation of vacuoles and LC3 puncta, a marker of autophagosome, in a dose-dependent manner. Autophagy induction was confirmed by measuring the expression levels of LC3 and p62 protein in ESCC cells. UA increased LC3-II protein levels and decreased p62 levels in ESCC cells. When autophagy was hampered using 3-methyladenine (3-MA), the effect of UA on cell viability was reversed. UA also significantly inhibited protein kinase B (Akt) activation and increased p-Akt expression in a dose-dependent manner in ESCC cells. Accumulated LC3 puncta by UA was reversed after wortmannin treatment. LC3-II protein levels were also decreased after treatment with Akt inhibitor and wortmannin. Moreover, UA treatment increased cellular reactive oxygen species (ROS) levels in ESCC in a time- and dose-dependent manner. Diphenyleneiodonium (an ROS production inhibitor) blocked the ROS and UA induced accumulation of LC3-II levels in ESCC cells, suggesting that UA-induced cell death and autophagy are mediated by ROS. Therefore, our data indicate that UA inhibits the growth of ESCC cells by inducing ROS-dependent autophagy.
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Affiliation(s)
- Na-Ri Lee
- Division of Hematology and Oncology, Jeonbuk National University Medical School, Jeonju 54907, Korea;
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine, Biomedical Research Institute of Jeonbuk National University Medical School, Jeonju 54907, Korea
| | - Ruo Yu Meng
- Department of Physiology and Institute of Medical Science, Jeonbuk National University Medical School, Jeonju 54907, Korea; (R.Y.M.); (N.R.)
| | - So-Young Rah
- Department of Biochemistry, Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.-Y.R.); (B.H.P.)
| | - Hua Jin
- School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, China;
| | - Navin Ray
- Department of Physiology and Institute of Medical Science, Jeonbuk National University Medical School, Jeonju 54907, Korea; (R.Y.M.); (N.R.)
| | - Seong-Hun Kim
- Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju 54907, Korea;
| | - Byung Hyun Park
- Department of Biochemistry, Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.-Y.R.); (B.H.P.)
| | - Soo Mi Kim
- Department of Physiology and Institute of Medical Science, Jeonbuk National University Medical School, Jeonju 54907, Korea; (R.Y.M.); (N.R.)
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Guo L, Zhao Q, Wang K, Zhao D, Ye X, Li T. A Case-Control Study on the Therapeutic Effect of Mediastinoscope-Assisted and Thoracoscope-Assisted Esophagectomy. Surg Innov 2020; 28:316-322. [PMID: 32909910 DOI: 10.1177/1553350620958265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To compare the clinical efficacies of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Materials and Methods. Seventy-six patients with esophageal cancer who underwent minimally invasive esophagectomy at the General Hospital of Ningxia Medical University between June 2015 and January 2019 were retrospectively evaluated. Among them, 28 patients underwent mediastinoscope-assisted transhiatal esophagectomy (MATHE), and 48 received thoracoscope-assisted transthoracic esophagectomy (TATTE). The perioperative clinical data and follow-up data of the 2 groups were compared. Results. All operations were successful in both groups. MATHE was favorable in terms of operation time, intraoperative blood loss, drainage volume 3 days after surgery, postoperative hospital stay, and hypoproteinemia (P < .05). Lymph node dissections were less than those in the TATTE (P < .05). No significant differences in long-term postoperative complications and survival rate were found between the 2 groups (P > .05). Conclusion. MATHE has the advantages of minimal trauma, shorter operation time, less intraoperative blood loss, and faster recovery. More adequate tumor clearance in terms of lymph node dissection can be achieved with TATTE. However, the comparison of survival rates between the 2 groups is similar.
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Affiliation(s)
- Li Guo
- 105002Graduate School of Ningxia Medical University, Ningxia, China
| | - Qian Zhao
- Department of Nuclear Medicine, 74747The General Hospital of Ningxia Medical University, Ningxia, China
| | - Kairui Wang
- 105002Graduate School of Ningxia Medical University, Ningxia, China
| | - Duowen Zhao
- 105002Graduate School of Ningxia Medical University, Ningxia, China
| | - Xiaofeng Ye
- Department of Surgical Oncology, Tumor Hospital, 74747The General Hospital of Ningxia Medical University, Ningxia, China
| | - Tao Li
- Department of Surgical Oncology, Tumor Hospital, 74747The General Hospital of Ningxia Medical University, Ningxia, China
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15
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Caso R, Wee JO. Esophagogastric Anastomotic Techniques for Minimally Invasive and Robotic Ivor Lewis Operations. ACTA ACUST UNITED AC 2020. [DOI: 10.1053/j.optechstcvs.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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