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Kim SE, Schlottmann F, Masrur MA. Management of Long-Segment Barrett's Esophagus. J Laparoendosc Adv Surg Tech A 2023; 33:1201-1210. [PMID: 37796531 DOI: 10.1089/lap.2023.0321] [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] [Indexed: 10/06/2023] Open
Abstract
Background: Gastroesophageal reflux disease is a common gastrointestinal disorder with one of its most feared complications being Barrett's esophagus (BE). Currently, most of the recommendations of BE management are driven by the level of dysplasia. However, the length of BE might also be related to the risk of dysplasia/malignant transformation. We aimed to determine the appropriate management of BE based on its length. Materials and Methods: A systematic literature review was conducted with searches made on PubMed, Embase, and Cochrane databases. Long-segment BE (LSBE) was defined as 3 cm or longer and short-segment BE (SSBE) as under 3 cm. Studies evaluating the behavior and management of SSBE and/or LSBE were included for analysis. Results: LSBE have greater risk of dysplasia or progression to esophageal adenocarcinoma compared to SSBE. Despite this greater risk, LSBE and SSBE are currently managed similarly based on the presence and degree of dysplasia. Endoscopic and ablative techniques may have higher level of success and less complications in SSBE, compared to LSBE. Decreasing time interval between surveillance may be a viable option for managing LSBE. Conclusions: Although many algorithms of monitoring and treatment of BE remain the same regardless of segment length, current evidence suggests that more aggressive management for LSBE might be needed due to its higher risk of malignant progression.
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Affiliation(s)
- Sarah E Kim
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Francisco Schlottmann
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Mario A Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Fernandes A, Li C, French D, Ellsmere J. Ten-year follow-up of endoscopic mucosal resection versus esophagectomy for esophageal intramucosal adenocarcinoma in the setting of Barrett's esophagus: a Canadian experience. Surg Endosc 2023; 37:8735-8741. [PMID: 37563345 DOI: 10.1007/s00464-023-10318-0] [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: 04/18/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) is an effective treatment for esophageal intramucosal adenocarcinoma (IMC), with similar recurrence and mortality rates versus esophagectomy in up to 5 years of follow-up. Long-term outcomes to 10 years have not been studied. This retrospective study investigates IMC eradication, recurrence, morbidity and mortality at 10 years following EMR versus esophagectomy in a single Canadian institution. METHODS Patients with IMC treated via esophagectomy or EMR from 2006 to 2015 were included. Post-EMR endoscopic follow-up occurred every 3 months for 1 year, every 6 months for 2 years and every 12 months thereafter. Categorical variables were expressed as percentages and continuous variables as mean with standard deviation or median and interquartile range. The student's t-test and Fischer's exact test were used for comparisons. Survival analysis utilized the Kaplan-Meier estimator and log-rank test. RESULTS Twenty-four patients were included. Patient and tumor characteristics were similar between groups. Median follow-up for EMR and esophagectomy were 85.2 months [IQR 64.8] and 126 months [IQR 54] respectively. A mean of 1.3 EMR (SD 1.1) were required for eradication, which was seen in 12 patients (12/14, 86%). No EMR-related complications occurred. Disease progression was seen in two patients (2/14, 14%); local recurrence was seen in 1 patient (1/14, 7%). Esophagectomy eradicated IMC in 10 patients (10/10, 100%); recurrence was seen in 2 (2/10, 20%, metastatic). Major, early esophagectomy-related morbidity affected 3 patients (3/10, 30%), and late morbidity was documented for 9 (9/10, 90%). Esophagectomy and EMR had similar recurrence rates (p = 0.554). Esophagectomy was associated with significantly more procedure-related morbidity (p < 0.001). There was no difference in mortality (p = 0.442) or disease-free survival (p = 0.512) between treatment groups. CONCLUSION EMR and esophagectomy for the treatment of IMC are associated with comparable recurrence rates and disease-free survival in 10-year follow-up. EMR is associated with significantly lower procedure-associated morbidity. EMR can be used to treat T1a distal esophageal adenocarcinoma with minimal procedure-related morbidity, and acceptable oncologic outcomes in long-term follow-up.
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Affiliation(s)
- Alisha Fernandes
- Division of General and Gastrointestinal Surgery, Department of Surgery, Dalhousie University, Room 8-23/4 Victoria Building, QEII-HSC, VG Site, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Chao Li
- Division of General Surgery, Department of Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Canada
| | - Daniel French
- Division of Thoracic Surgery, Department of Surgery, Dalhousie University, Halifax, Canada
| | - James Ellsmere
- Division of General and Gastrointestinal Surgery, Department of Surgery, Dalhousie University, Room 8-23/4 Victoria Building, QEII-HSC, VG Site, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada.
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Hu ZH, Li RX, Wang JT, Wang GJ, Deng XM, Zhu TY, Gao BL, Zhang YF. Thoracolaparoscopic esophagectomy for esophageal cancer with a cervical incision to extract specimen. Asian J Surg 2023; 46:348-353. [PMID: 35525693 DOI: 10.1016/j.asjsur.2022.04.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/24/2021] [Accepted: 04/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgical treatment is the most important and effective therapy for resectable esophageal cancer. Minimally invasive esophagectomy (MIE) can reduce surgical trauma. A neck incision can be performed for extraction of surgical specimen. This study was performed to investigate the safety and feasibility of neck incision to extract surgical specimen in thoracolaparoscopic esophagectomy for esophageal cancer. MATERIALS AND METHODS Thirty-four patients who experienced thoracolaparoscopic esophagectomy for esophageal cancer and a neck incision for extraction of surgical specimen were enrolled. The clinical, surgical and follow-up data were analyzed. RESULTS The procedure was successful in all patients (100%), with a neck incision to extract the surgical specimen. The median surgical time was 309 min, and the median blood loss was 186 ml, with the mean length of hospital stay of 11.5 days. Pulmonary complications occurred in 8 patients (23.5%). Anastomotic leakage occurred in 5 patients (14.7%), with one patient being treated conservatively to recover and four (11.8%) who received interventional drainage. One patient with interventional drainage died of severe infection, resulting in a 30-day surgical mortality of 2.9% (n = 1). Gastrointestinal complications happened in 5 patients (14.7%), including ileus in three patients and anastomotic stenosis in two patients. Follow-up was performed at a median time of 20 months (interquartile range, 14-32 months), with no death during this period. No recurrence was found in the first 12 months after radical resection. CONCLUSION The cervical incision to extract surgical specimen is safe and feasible with improved cosmetic effect in thoracolaparoscopic esophagectomy for esophageal cancer.
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Affiliation(s)
- Zhi-Hao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Rui-Xin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Jing-Tao Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Xiu-Mei Deng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Bu-Lang Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yun-Fei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Cheng Z, Zhang Z, Lin H, Meng Q, Xin L, Wang T, Wang W, Wang L. Focus on patients with early esophageal cancer-a prognostic nomogram. Transl Cancer Res 2020; 9:7469-7478. [PMID: 35117347 PMCID: PMC8797496 DOI: 10.21037/tcr-19-1645] [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: 08/25/2019] [Accepted: 03/03/2020] [Indexed: 11/21/2022]
Abstract
Background Esophageal cancer is a common cancer of the digestive system, with high morbidity and poor prognosis. However, while the prognosis of early esophageal cancer is relatively good, there is no effective model to accurately predict the prognosis of early esophageal cancer. The Aims of this study are to explore risk factors for the prognosis of early esophageal cancer and to establish a prediction nomogram for patients. Methods Surveillance, Epidemiology and End Results (SEER) Stat 8.3.5 was used to collect 2,351 cases of early esophageal cancer from 2004 to 2015 in the SEER database. Early esophageal cancer is defined as a lesion that is confined to the lamina propria and the muscularis mucosa. Prognostic factors were analyzed with the log-rank method and a Cox proportional hazard model by SPSS (v25.0). Independent prognostic factors were used to construct a nomogram with a Cox proportional hazard model. The C-index was used to evaluate the prediction effect of the nomogram. The internal validity of the nomogram was tested by discrimination and calibration using a bootstrap method with 1,000 resamplings. Results The median survival time was 30 months, and the 1-, 3-, and 5-year survival rates were 65.2%, 46.8%, and 41.6%, respectively. The male to female ratio was 3:1, and 85.33% of all patients were white. Univariate analysis showed that risk factors affecting patient prognosis included age (χ2=430.631, P<0.001), sex (χ2=48.1, P<0.001), marital status (χ2=107.597, P<0.001), race (χ2=58.928, P<0.001), primary site (χ2=98.675, P<0.001), tumor grade (χ2=116.421, P<0.001), surgery (χ2=1,259.33, P<0.001) and histologic type (χ2=231.062, P<0.001). Using multivariate analysis, we found that age (HR=1.787, 95% CI: 1.58–2.03), marital status (HR=0.774, 95% CI: 0.69–0.87), tumor grade (HR=1.241, 95% CI: 1.14–135), and surgery (HR=0.356, 95% CI: 0.33–0.39) were independent prognostic factors for patients with early esophageal cancer. We constructed the nomogram with the above independent factors, and the C-index value was 0.788. Conclusions This study obtained the latest epidemiological information on early esophageal cancer and determined that age, marital status, tumor grade and surgery were independent prognostic factors for early esophageal cancer. The nomogram developed with these factors could provide good prognosis prediction.
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Affiliation(s)
- Zhiyuan Cheng
- College of Basic Medical Sciences, Naval Medical University, Shanghai, China
| | - Zifan Zhang
- College of Basic Medical Sciences, Naval Medical University, Shanghai, China
| | - Han Lin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qianqian Meng
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Tianjiao Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Luowei Wang
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai, China
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Liu XY, Jiao CH, Zhao D, Chen Y, Zhang HM. Psychological impact of high-quality nursing care on patients with esophageal cancer during perioperative period: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e22270. [PMID: 33120731 PMCID: PMC7581172 DOI: 10.1097/md.0000000000022270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study is designed to systematically assess the psychological impact of high-quality nursing care (HQNC) on patients with esophageal cancer during perioperative period (ECPP). METHODS Several electronic databases will be searched to collect randomized controlled trials (RCTs) or case-control studies (CCSs) on HQNC in the management of ECPP from inception to present: Cochrane Library, PUBMED, EMBASE, SinoMed, Web of Science, WANGFANG, and China National Knowledge Infrastructure. We will not apply any language limitation to all literature searches. Two authors will independently perform literature selection, data extraction and literature quality evaluation. All disagreements will be resolved by a third author through discussion. Cochrane risk of bias tool will be employed to assess trial quality, and RevMan 5.3 software will be utilized to carry out statistical analysis. RESULTS This study will summarize the current evidence to appraise of the psychological impact of HQNC in the management of ECPP. CONCLUSION The findings of this study may help to explicit whether HQNC is effective on psychological problem in ECPP. It will also provide scientific evidence for the clinical practice and future researches. STUDY REGISTRATION INPLASY202080071.
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Affiliation(s)
| | - Chuan-hua Jiao
- Department of Dermatology, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Dan Zhao
- Department of Dermatology, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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Wirsching A, Boshier PR, Krishnamoorthi R, Larsen MC, Irani S, Ross AS, Low DE. Endoscopic therapy and surveillance versus esophagectomy for early esophageal adenocarcinoma: A review of early outcomes and cost analysis. Am J Surg 2019; 218:164-169. [PMID: 30635212 DOI: 10.1016/j.amjsurg.2018.12.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (cT1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early esophageal adenocarcinoma. METHODS Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015. RESULTS Age, BMI, and Charlson Comorbidity Scores were similar in patients undergoing endoscopic therapy (N = 20) and esophagectomy (N = 23). For patients undergoing endoscopic therapy a median of 6 endoscopic interventions, were performed per patient (range 2-18). Esophagectomy was associated with a median hospital stay of 9 (8-13) days and greater procedure specific morbidity compared to endoscopic therapy. Costs related to endoscopic therapy were significantly lower compared to esophagectomy ($22,640 vs. $53,849, P < 0.001). CONCLUSIONS Endoscopic treatment is associated with decreased morbidity and financial costs when compared to esophagectomy.
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Affiliation(s)
- Andrea Wirsching
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98111, USA.
| | - Piers R Boshier
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98111, USA.
| | - Rajesh Krishnamoorthi
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Ninth Ave, Seattle, WA, 98111, USA.
| | - Michael C Larsen
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Ninth Ave, Seattle, WA, 98111, USA.
| | - Shayan Irani
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Ninth Ave, Seattle, WA, 98111, USA.
| | - Andrew S Ross
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Ninth Ave, Seattle, WA, 98111, USA.
| | - Donald E Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98111, USA.
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7
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Qin J, Peng Y, Chen W, Ma H, Zheng Y, Li Y, Wang J. Comparative study of esophagectomy, endoscopic therapy, and radiotherapy for cT1N0M0 esophageal cancer in elderly patients: A SEER database analysis. Thorac Cancer 2019; 10:1511-1520. [PMID: 31199600 PMCID: PMC6610249 DOI: 10.1111/1759-7714.13080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The number of patients diagnosed with early stage disease (T1a or T1b) has been increasing. This study was conducted to investigate the effect of esophagectomy (ES), endoscopic therapy (ET), and radiotherapy (RT) on long-term survival in elderly patients with cT1N0M0 esophageal cancer. METHODS We searched the Surveillance, Epidemiology, and End Results (SEER) database to identify the records of elderly patients (≥ 75 years) with cT1N0M0 esophageal cancer between 2004 and 2014. Patient demographics and esophageal cancer parameters were compared among ES, ET, and RT groups. The Kaplan-Meier method and Cox proportional hazard modeling were used to compare long-term survival. RESULTS Data from 954 esophageal cancer patients (ES: n = 196; ET: n = 224; RT: n = 534) were identified. Multivariate Cox regression analysis showed that five-year survival in the ET and ES groups was significantly higher than in the RT group. After propensity score matching, we found no difference in five-year survival between ES and ET. CONCLUSION Using SEER data, we identified a significant survival advantage with the use of ES and ET compared to RT in patients with cT1N0M0 esophageal cancer aged > 75 years, while the long-term survival of patients after ET and ES was not significantly different.
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Affiliation(s)
- Jianjun Qin
- 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
| | - Yinjie Peng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Weipeng Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Haibo Ma
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- 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
| | - Jun Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Feczko AF, Louie BE. Endoscopic Resection in the Esophagus. Thorac Surg Clin 2018; 28:481-497. [PMID: 30268294 DOI: 10.1016/j.thorsurg.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The article is a review of the principles behind endoscopic resection of esophageal dysplasia and early cancers. The techniques of endoscopic mucosal resection and endoscopic submucosal dissection are reviewed, and the supporting literature compared. Endoscopic resection is compared with esophagectomy for the management of these lesions and current areas of controversy with regard to T1b lesions and gastroesophageal reflux following resection are addressed.
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Affiliation(s)
- Andrew F Feczko
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Avenue, Seattle, WA 98104, USA
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Avenue, Seattle, WA 98104, USA.
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Yu HX, Han CS, Xue JR, Han ZF, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert Rev Gastroenterol Hepatol 2018; 12:319-329. [PMID: 29451037 DOI: 10.1080/17474124.2018.1441711] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manifestations include gastric reflux, nausea, bloating, chest and epigastric discomfort, pharyngeal and esophageal expulsion and dysphagia. Weight loss and colorectal bleeding are severe symptoms. Areas covered: This review summarizes updated evidence of pathophysiology, risk factors, diagnosis and management of hiatal hernias. Laparoscopy and oesophagectomy procedures have been discussed as surgical procedures. Expert commentary: Endoscopy identifies untreatable gastric reflux; radiology is better for pre-operative assessments; manometry measures esophageal peristalsis, and CT scanning detects gastric volvulus and associated organ ruptures. Gastric reflux disease is mitigated using antacids and proton pump and histamine-2-receptor blockers. Severe abdominal penetration into chest cavity demands surgical approaches. Hence, esophagectomy has chances of post-operative morbidity, while minimally invasive laparoscopy entails fewer postoperative difficulties and better visualization of hernia and related vascular damages.
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Affiliation(s)
- Hai-Xiang Yu
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Chun-Shan Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Jin-Ru Xue
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Zhi-Feng Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Hua Xin
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
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