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Zhang Y, Wang J, Ren S, Jiao J, Ding Z, Yang H, Pan D, Li J, Zhang G, Li X, Zhao S. An integrated strategy for reducing anastomotic leakage in patients undergoing McKeown esophagectomy. Heliyon 2024; 10:e26430. [PMID: 38404844 PMCID: PMC10884487 DOI: 10.1016/j.heliyon.2024.e26430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Objective To describe our experience of reducing anastomotic leakage, a problem that has not been properly solved. Methods Starting in January 2020, we began implementing our integrated strategy (application of an esophageal diameter-approximated slender gastric tube, preservation of the fibrous tissue around the residual esophagus and thyroid inferior pole anastomosis) in consecutive patients undergoing esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube. Additionally, the blood supply at the site of the anastomosis was evaluated with a near-infrared fluorescence thoracoscope after the completion of esophagogastric anastomosis in the integrated strategy group. Results Of 570 patients who were reviewed, 119 (20.9%) underwent the integrated strategy, and 451 (79.1%) underwent the conventional strategy. The rate of anastomotic leakage was 2.5% in the integrated strategy group and 10.2% in the conventional strategy group (p = 0.008). In the integrated strategy group, the site of most of the anastomotic blood supply was the residual esophagus dominant (82.4%), followed by the gastroesophageal dual-dominant (12.6%) and the gastric tube dominant (5.0%). The reconstruction route was more likely to be orthotopic in the integrated strategy group than in the conventional strategy group (89.9% vs. 38.6%, p = 0.004). Gastric dilation was identified in 3.4% of the patients in the integrated strategy group and in 21.1% in the conventional strategy group. Conclusions Patients who underwent our proposed integrated strategy (Zhengzhou Strategy) during McKeown esophagectomy without a nasogastric tube or a nasal-jejunum feeding tube had a strikingly lower rate of anastomotic leakage and a relatively lower rate of postoperative complications, such as gastric tube dilation and delayed gastric emptying.
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Affiliation(s)
- Yan Zhang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Junya Wang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Shuang Ren
- Department of Oncology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jia Jiao
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Zheng Ding
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Hang Yang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Dabo Pan
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jindong Li
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Guoqing Zhang
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Xiangnan Li
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Song Zhao
- Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
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Kitadani J, Ojima T, Hayata K, Goda T, Takeuchi A, Tominaga S, Fukuda N, Nakai T, Nagano S, Kawai M. Impact of zero anastomotic leakage after esophagectomy followed by whole stomach reconstruction for esophageal cancer: prospective cohort study. Langenbecks Arch Surg 2023; 408:451. [PMID: 38030888 DOI: 10.1007/s00423-023-03191-x] [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: 09/27/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The stomach is the most common organ which is used for reconstruction after esophagectomy for esophageal cancer. It is controversial which is better narrow gastric tube reconstruction or whole stomach reconstruction to prevent anastomotic leakage. METHODS From August 2022 to March 2023, we started a prospective cohort study of whole stomach reconstruction after esophagectomy. Until then (from January 2018 to July 2022), narrow gastric tube reconstruction was performed as a standard reconstruction. RESULTS Narrow gastric tube reconstruction and whole stomach reconstruction were performed in 183 patients and 20 patients, respectively. The patient's characteristics were not significantly different between the narrow gastric tube group and the whole stomach group. In particular, for all patients in the whole stomach reconstruction group, retrosternal route and esophagogastrostomy by hand sewn were applied. There were no occurrences of AL through the continuous 20 cases in the whole stomach group, otherwise 42 (22.9%) patients in the narrow gastric group (P = 0.016). Postoperative hospital stays were significantly shorter in the whole stomach group than in the narrow gastric group (21 days vs. 28 days, P < .001). Blood perfusions were evaluated by indocyanine green for all cases, which had very good blood perfusion in all cases. Additionally, quantitative blood perfusion was examined by SPY-QP (Stryker, USA) for one case. Even the edge of the fornix showed more than 90% blood perfusion levels when the antrum was fixed as the reference point. CONCLUSION Whole stomach reconstruction with excellent blood perfusion is considered to be safe and has the possibility to prevent from occurring AL after esophagectomy for esophageal cancer patients.
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Affiliation(s)
- Junya Kitadani
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Toshiyasu Ojima
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Keiji Hayata
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Taro Goda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihiro Takeuchi
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shinta Tominaga
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Naoki Fukuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Tomoki Nakai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Shotaro Nagano
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Manabu Kawai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Brito M, Nunes G, Luz C, Oliveira G, Pinto Marques P, Fonseca J. Niti-S Esophageal Mega-Stent: An Emerging Endoscopic Tool with Different Applications in the Management of Surgical Anastomotic Leaks. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:45-51. [PMID: 37818399 PMCID: PMC10561319 DOI: 10.1159/000524420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/08/2022] [Indexed: 10/12/2023]
Abstract
Introduction Anastomotic leak (AL) is a dangerous complication in the early postoperative period after total gastrectomy or esophagectomy being associated with high mortality. Self-expandable metal stents (SEMS) play a significant role in AL management. Only one case report described the use of Mega-Stent in AL setting. The authors report a two-case series with different applications of a Niti-S esophageal Mega-Stent in AL management. Case Report Case 1 is a 67-year-old male who underwent an esophagectomy due to a squamous cell carcinoma of the distal esophagus. The early postoperative period was complicated with AL and gastropleural fistula. Initially, an OTSC was deployed in the dehiscence but failed to resolve AL. The esophageal Mega-Stent was further placed in-between the esophagus and the bulbus. Post-stenting contrast studies confirmed no further AL.Case 2 is an 86-year-old woman who underwent total gastrectomy with roux-en-y esophagojejunostomy due to a gastric adenocarcinoma, complicated with AL. A partially covered metal stent (PCMS) was placed to cover the anastomosis. Computed tomography confirmed leakage persistence and a second PCMS was deployed, resolving the AL. Several weeks later, both PCMSs presented ingrowth from granulation tissue. An esophageal Mega-Stent was placed (stent-in-stent technique) and 2 weeks later, all stents were removed, with no AL recurrence. Discussion/Conclusion SEMS placement for AL is a safe, well-established therapeutic technique. Limitations include stent migration and incomplete cover of large AL. Mega-Stent can be an emerging tool for endoscopic AL management.
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Affiliation(s)
- Mariana Brito
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Gonçalo Nunes
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
| | - Carlos Luz
- Department of Surgery, Hospital Garcia de Orta, Almada, Portugal
| | - Gabriel Oliveira
- Department of Surgery, Hospital Garcia de Orta, Almada, Portugal
| | | | - Jorge Fonseca
- Department of Gastroenterology, Hospital Garcia de Orta, Almada, Portugal
- PaMNEC – Grupo de Patologia Médica, Nutrição e Exercício Clínico, CiiEM, Centro de investigação interdisciplinar Egas Moniz, Monte da Caparica, Portugal
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Maier J, Kandulski A, Donlon NE, Werner JM, Mehrl A, Müller M, Doenecke A, Schlitt HJ, Hornung M, Weiss ARR. Endoscopic vacuum therapy significantly improves clinical outcomes of anastomotic leakages after 2-stage, 3-stage, and transhiatal esophagectomies. Langenbecks Arch Surg 2023; 408:90. [PMID: 36790506 PMCID: PMC9931828 DOI: 10.1007/s00423-023-02826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Anastomotic leakages after esophagectomies continue to constitute significant morbidity and mortality. Intrathoracic anastomoses pose a high risk for mediastinitis, sepsis, and death, if a leak is not addressed timely and appropriately. However, there are no standardized treatment recommendations or algorithms as for how to treat these leakages. METHODS The study included all patients at the University Hospital Regensburg, who developed an anastomotic leakage after esophagectomy with gastric pull-up reconstruction from 2007 to 2022. Patients receiving conventional treatment options for an anastomotic leakage (stents, drainage tubes, clips, etc.) were compared to patients receiving endoscopic vacuum-assisted closure (eVAC) therapy as their mainstay of treatment. Treatment failure was defined as cervical esophagostomy formation or death. RESULTS In total, 37 patients developed an anastomotic leakage after esophagectomy with a gastric pull-up reconstruction. Twenty patients were included into the non-eVAC cohort, whereas 17 patients were treated with eVAC. Treatment failure was observed in 50% of patients (n = 10) in the non-eVAC cohort and in 6% of patients (n = 1) in the eVAC cohort (p < 0.05). The 90-day mortality in the non-eVAC cohort was 15% (n = 3) compared to 6% (n = 1) in the eVAC cohort. Cervical esophagostomy formation was required in 40% of cases (n = 8) in the non-eVAC cohort, whereas no patient in the eVAC cohort underwent cervical esophagostomy formation. CONCLUSION eVAC therapy for leaking esophagogastric anastomoses appears to be superior to other treatment strategies as it significantly reduces morbidity and mortality. Therefore, we suggest eVAC as an essential component in the treatment algorithm for anastomotic leakages following esophagectomies, especially in patients with intrathoracic anastomoses.
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Affiliation(s)
- Jonas Maier
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Kandulski
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - N E Donlon
- Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - J M Werner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Mehrl
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - M Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Doenecke
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - M Hornung
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A R R Weiss
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Huang Y, Fu X, Fu S. Case report: Drainage tube penetrating anastomosis as a rare cause for long-term nonunion of esophagogastric anastomosis in neck. Front Surg 2023; 10:1140839. [PMID: 36911617 PMCID: PMC9992177 DOI: 10.3389/fsurg.2023.1140839] [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: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
Anastomotic leakage is a life-threatening complication for esophageal cancer patients who received McKeown esophagectomy. Cervical drainage tube penetrating anastomosis is a rare but noteworthy cause of long-term nonunion of esophagogastric anastomosis. Here we reported two cases of esophageal cancer patients who received McKeown esophagectomy. The first case acquired the anastomotic leakage on postoperative day (POD) 7, and lasted for 56 days. The cervical drainage tube was removed at POD 38, and the leakage healed in 25 days. The second case acquired the anastomotic leakage on POD 8 and lasted for 95 days. The cervical drainage tube was removed at POD 57, and the leakage healed in 46 days. The two cases demonstrated the duration-prolonging effect of drainage tube penetrating anastomosis, which should not be overlooked in clinical practice. We suggested paying attention to the duration of leakage, the drainage fluids amounts and characteristics, and the imaging manifestations to help diagnose. If the cervical drainage tube penetrated the anastomosis, the tube should be eliminated as soon.
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Affiliation(s)
- Yaochen Huang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengling Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xing H, Hu M, Wang Z, Jiang Y. Short-term outcomes of Ivor Lewis vs. McKeown esophagectomy: A meta-analysis. Front Surg 2022; 9:950108. [PMID: 36386496 PMCID: PMC9649905 DOI: 10.3389/fsurg.2022.950108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/26/2022] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The objective of this article is to assess the rate of anastomotic leak and other perioperative outcomes in patients undergoing esophagectomy with either thoracic or cervical anastomosis. METHODS This meta-analysis was conducted by searching relevant literature studies in Web of Science, Cochrane Library, PubMed, and Embase databases. Articles that included patients undergoing esophagectomy and compared perioperative outcomes of McKeown with Ivor Lewis procedures were included. The primary outcome parameter was anastomotic leak, and secondary outcome parameters were grade ≥2 anastomotic leak, chylothorax, recurrent laryngeal nerve injury, hospital length of stay, intensive care unit (ICU) length of stay, postoperative mortality rate, operative time, blood loss, R0 resection rate, and lymph nodes examined. RESULTS A total of eight studies, with 3,291 patients (1,857 Ivor Lewis procedure and 1,434 McKeown procedure) were eligible for analysis. Meta-analysis showed that Ivor Lewis procedure was associated with lower rate of anastomosis leak of all grades [risk ratio (RR), 0.67; 95% confidence interval (CI), 0.55-0.82; P = 0.0001], lower rate of recurrent laryngeal nerve injury (RR, 0.14; 95% CI, 0.08-0.25), and shorter length of hospital stay (weighted mean difference, 0.13; 95% CI, 0.04-0.22). Grade ≥2 anastomotic leak, chylothorax, ICU length of stay, postoperative mortality rate, operative time, blood loss, R0 resection rate, and lymph nodes examined were similar between the two groups. CONCLUSIONS Although all grades of anastomotic leak and recurrent laryngeal nerve injury are higher in the McKeown procedure, this meta-analysis supports similar short-term outcomes and oncological efficacy between Ivor Lewis and McKeown esophagectomy.
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Affiliation(s)
- Huajie Xing
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Mengyu Hu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhiqiang Wang
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Yuequan Jiang
- Department of Thoracic Oncology, Chongqing University Cancer Hospital, Chongqing, China
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Zhu X, Wu H, Liu C, Mei X. Covering the gastric tube with the mediastinal pleura during minimally invasive McKeown esophagectomy can reduce the incidence of anastomotic fistulae. Wideochir Inne Tech Maloinwazyjne 2021; 16:612-619. [PMID: 34691313 PMCID: PMC8512517 DOI: 10.5114/wiitm.2021.105155] [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: 10/20/2020] [Accepted: 12/22/2020] [Indexed: 12/08/2022] Open
Abstract
INTRODUCTION The rate of anastomotic leakage from intrathoracic esophagogastric anastomoses can be reduced by covering them with the mediastinal pleura. Whether anastomotic leakage can be reduced by covering the portion of the gastric tube in the upper mediastinum with the mediastinal pleura during minimally invasive McKeown esophagectomy (MIE McKeown) is unknown. AIM To evaluate the consequence of covering the mediastinal pleural during minimally invasive McKeown esophagectomy. MATERIAL AND METHODS Consecutive patients who underwent MIE McKeown between January 2015 and December 2019 were retrospectively analyzed. Participants for whom the portion of the gastric tube in the upper mediastinum was not covered with the mediastinal pleura were assigned to group A; otherwise, they were assigned to group B. Chi-square analysis and univariable and multivariable logistic analyses were used to compare the differences between the two groups and explore the risk factors for anastomotic fistulae. RESULTS A total of 267 patients with middle and lower esophageal cancer were included in this study (131 in group A and 136 in group B). Anastomotic leakage occurred in 5 patients (5/136) in group B compared with 13 patients (13/131) in group A (p = 0.042). Univariable and multivariable logistic analyses identified a gastric tube not covered with the mediastinal pleura as a risk factor for significantly greater anastomotic leakage (p = 0.042), but it was not an independent prognostic factor for anastomotic leakage (odds ratio = 0.585, 95% confidence interval: lower bound: 0.069, upper bound, 1.122). CONCLUSIONS This study provides preliminary evidence that covering the gastric tube with the mediastinal pleura during MIE McKeown can decrease the incidence of anastomotic leakage.
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Affiliation(s)
- Xiaodong Zhu
- Department of Thoracic Surgery, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hanran Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Changqing Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xinyu Mei
- Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Hou N, Xu X, Lv D, Lu Y, Li J, Cui P, Ma R, Luo X, Tang Y, Zheng Y. Tissue-engineered esophagus: recellular esophageal extracellular matrix based on perfusion-decellularized technique and mesenchymal stem cells. Biomed Mater 2021; 16. [PMID: 34384057 DOI: 10.1088/1748-605x/ac1d3d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
Perfusion-decellularization was an interesting technique to generate a natural extracellular matrix (ECM) with the complete three-dimensional anatomical structure and vascular system. In this study, the esophageal ECM (E-ECM) scaffold was successfully constructed by perfusion-decellularized technique through the vascular system for the first time. And the physicochemical and biological properties of the E-ECM scaffolds were evaluated. The bone marrow mesenchymal stem cells (BMSCs) were induced to differentiate into myocytesin vitro. E-ECM scaffolds reseeded with myocytes were implanted into the greater omenta to obtain recellular esophageal ECM (RE-ECM), a tissue-engineered esophagus. The results showed that the cells of the esophagi were completely and uniformly removed after perfusion. E-ECM scaffolds retained the original four-layer organizational structure and vascular system with excellent biocompatibility. And the E-ECM scaffolds had no significant difference in mechanical properties comparing with fresh esophagi,p> 0.05. Immunocytochemistry showed positive expression ofα-sarcomeric actin, suggesting that BMSCs had successfully differentiated into myocytes. Most importantly, we found that in the RE-ECM muscularis, the myocytes regenerated linearly and continuously and migrated to the deep, and the tissue vascularization was obvious. The cell survival rates at 1 week and 2 weeks were 98.5 ± 3.0% and 96.4 ± 4.6%, respectively. It was demonstrated that myocytes maintained the ability for proliferation and differentiation for at least 2 weeks, and the cell activity was satisfactory in the RE-ECM. It follows that the tissue-engineered esophagus based on perfusion-decellularized technique and mesenchymal stem cells has great potential in esophageal repair. It is proposed as a promising alternative for reconstruction of esophageal defects in the future.
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Affiliation(s)
- Nan Hou
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Xiaoli Xu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China.,Department of Otorhinolaryngology, University-Town Hospital, Chongqing Medical University, Chongqing Municipality, People's Republic of China
| | - Die Lv
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Yanqing Lu
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Jingzhi Li
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Pengcheng Cui
- Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Chinese People's Liberation Army Air Force Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Ruina Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Tangdu Hospital, Chinese People's Liberation Army Air Force Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Xiaoming Luo
- Department of Biomedical Science, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Ying Tang
- Department of Pathology, First Affiliated Hospital, Chengdu Medical College, Chengdu, Sichuan Province, People's Republic of China
| | - Yun Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Yu WQ, Gao HJ, Shi GD, Tang JY, Wang HF, Hu SY, Wei YC. Development and validation of a nomogram to predict anastomotic leakage after esophagectomy for esophageal carcinoma. J Thorac Dis 2021; 13:3549-3565. [PMID: 34277050 PMCID: PMC8264723 DOI: 10.21037/jtd-21-209] [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: 01/31/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022]
Abstract
Background This study aimed to identify variables associated with anastomotic leakage after esophagectomy and established a tool for anastomotic leakage prediction. Methods Twenty-six preoperative and postoperative variables were retrospectively collected from esophageal cancer patients who were treated with radical esophagectomy from January 2018 to June 2020 in the Affiliated Hospital of Qingdao University. SPSS Version 23.0 and Empower Stats software were used for establishing a nomogram after screening relevant variables by univariate and multivariate Logistic regression analyses. The established nomogram was identified by depicting the receiver operating characteristic (ROC) curves and calibration curve, which was verified by 1,000 bootstrap resamples method. Results A total of 604 eligible esophageal cancer patients were included, of which 51 (8.4%) patients had anastomotic leakage. Multivariate Logistic regression analysis showed that smoking, anastomotic location, anastomotic technique, prognostic nutritional index (PNI) and ASA score were independent risks of anastomotic leakage. The area under curve (AUC) of ROC in the established nomogram was 0.764 (95% CI, 0.69–0.83). The internal validation confirmed that the nomogram had a great discrimination ability (AUC =0.766). Depicted calibration curve demonstrated a well-fitted prediction and observation probability. In addition, the decision curve analysis concluded that the newly established nomogram is significant for clinical decision-making. Conclusions This nomogram provided the individual prediction of anastomotic leakage for esophageal cancer patients after surgery, which might benefit treatment results for patients and clinicians, as well as pre-and postoperative intervention strategy-making.
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Affiliation(s)
- Wen-Quan Yu
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Hui-Jiang Gao
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Guo-Dong Shi
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Jia-Yu Tang
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Hua-Feng Wang
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Shi-Yu Hu
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Yu-Cheng Wei
- Thoracic Surgeon, Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
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10
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Chen C, Jiang H. The assessment of intraoperative technique-related risk factors and the treatment of anastomotic leakage after esophagectomy: a narrative review. J Gastrointest Oncol 2021; 12:207-215. [PMID: 33708437 DOI: 10.21037/jgo-21-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Anastomotic leakage, including cervical anastomotic leakage and intrathoracic anastomotic leakage, is a serious complication of esophageal cancer and a leading cause of death after esophagectomy. In fact, anastomotic leakage after esophagectomy can be caused by numerous factors in the preoperative, intraoperative, and postoperative periods. Intraoperative technique-related risk factors, including surgical methods, anastomosis sites, anastomosis methods, the type of gastric tube, and reconstruction routes, are the key causes of its occurrence. Anastomotic leakage treatments include both surgical and non-surgical treatments, while surgical treatment has high risks, many complications, and high mortality. Actually, non-surgical methods including naso-leakage drainage, stent, negative pressure therapy, and so on, are also very critical in the treatment of anastomotic leakage. So, the selection of correct and appropriate treatment methods plays an important role in alleviating the suffering of patients, shortening hospitalization time, and reducing mortality. This study undertook a systematic review in which data in the PubMed database were searched and analyzed to assess the safety and efficacy of surgical technique-related factors in esophagectomy, and appropriate treatment of anastomotic leakage after esophagectomy. In conclusion, gastric tube, posterior mediastinal route and stapled anastomosis are safe among esophagectomy surgical techniques, and non-surgical treatment of anastomotic leakage such as naso-leakage drainage is feasible in the majority of cases.
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Affiliation(s)
- Chuangui Chen
- Department of Minimally Invasive Esophagus Surgery, Key Laboratory of Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hongjing Jiang
- Department of Minimally Invasive Esophagus Surgery, Key Laboratory of Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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11
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Famiglietti A, Lazar JF, Henderson H, Hamm M, Malouf S, Margolis M, Watson TJ, Khaitan PG. Management of anastomotic leaks after esophagectomy and gastric pull-up. J Thorac Dis 2020; 12:1022-1030. [PMID: 32274171 PMCID: PMC7139088 DOI: 10.21037/jtd.2020.01.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient’s clinical status and the surgeon’s preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - John F. Lazar
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hayley Henderson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Margaret Hamm
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Stefanie Malouf
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marc Margolis
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Thomas J. Watson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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12
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Verstegen MHP, Bouwense SAW, van Workum F, Ten Broek R, Siersema PD, Rovers M, Rosman C. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg 2019; 14:17. [PMID: 30988695 PMCID: PMC6449949 DOI: 10.1186/s13017-019-0235-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/14/2019] [Indexed: 01/28/2023] Open
Abstract
Background Anastomotic leakage (0-30%) after esophagectomy is a severe complication and is associated with considerable morbidity and mortality. The aim of this study was to determine which treatment for anastomotic leakage after esophagectomy have the best clinical outcome, based on the currently available literature. Methods A systematic literature search was performed in Medline, Embase, and Web of Science until April 2017. All studies reporting on the specific treatment of cervical or intrathoracic anastomotic leakage following esophagectomy with gastric tube reconstruction for esophageal or cardia cancer were included. The primary outcome parameter was postoperative mortality. Methodological quality was assessed by the Newcastle-Ottawa Quality Assessment Scale. Results Nineteen retrospective cohort studies including 273 patients were identified. Methodological quality of all studies was poor to moderate. Mortality rates of intrathoracic anastomotic leakages in the treatment groups were as follows: conservative (14%), endoscopic stent (8%), endoscopic drainage (8%), endoscopic vacuum-assisted closure system (0%), and surgery treatment group (50%). Mortality rates of cervical anastomotic leakages in the treatment groups were as follows: conservative (8%), endoscopic stent (29%), and endoscopic dilatation (0%). Discussion Due to small cohorts, heterogeneity between studies, and lack of data regarding leakage characteristics, no evidence supporting a specific treatment for anastomotic leakage after esophagectomy was found. A severity score based on leakage characteristics instead of treatment given is essential for determining the optimal treatment of anastomotic leakage. In the absence of robust evidence-based treatment guidelines, we suggest customized treatment depending on sequelae of the leak and clinical condition of the patient. PrDepartment of Surgery, Radboudumc, P.O.B. 9101/618 NLactical advices are provided. Trial registration Registration number PROSPERO: CRD42016032374.
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Affiliation(s)
- Moniek H P Verstegen
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Stefan A W Bouwense
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Frans van Workum
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Richard Ten Broek
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Peter D Siersema
- 2Gastroenterology and Hepatology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Maroeska Rovers
- 3Operating Rooms and Health Evidence, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Camiel Rosman
- 1Department of Surgery, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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13
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Abstract
Anastomotic leakage (AL) is one of the most critical and detrimental complications in esophageal surgery. Early diagnosis and timely therapeutic action are necessary if patients are to avoid AL-related problems. However, there is no gold standard or consensus for early diagnosis. In this review, we focus on summarizing the definition and types of AL and modalities for early diagnosis of AL after esophagectomy.
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Affiliation(s)
- Seok Whan Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Jae Jun Kim
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Deog Gon Cho
- Department of Thoracic and Cardiovascular Surgery, St. Vincent's Hospital, The Catholic University of Korea, College of Medicine, Suwon, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
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14
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Abstract
Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment.
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Affiliation(s)
- R van Hillegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - M F J Seesing
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - H J F Brenkman
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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15
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Gooszen JAH, Goense L, Gisbertz SS, Ruurda JP, van Hillegersberg R, van Berge Henegouwen MI. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer. Br J Surg 2018; 105:552-560. [PMID: 29412450 PMCID: PMC5900725 DOI: 10.1002/bjs.10728] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Background Studies comparing the anastomotic leak rate in patients with an intrathoracic versus a cervical anastomosis after oesophagectomy are equivocal. The aim of this study was to compare clinical outcome after oesophagectomy in patients with an intrathoracic or cervical anastomosis, and to identify predictors of anastomotic leakage in a nationwide audit. Methods Between January 2011 and December 2015, all consecutive patients who underwent oesophagectomy for cancer were identified from the Dutch Upper Gastrointestinal Cancer Audit. For the comparison between an intrathoracic and cervical anastomosis, propensity score matching was used to adjust for potential confounders. Multivariable logistic regression modelling with backward stepwise selection was used to determine independent predictors of anastomotic leakage. Results Some 3348 patients were included. After propensity score matching, 654 patients were included in both the cervical and intrathoracic anastomosis groups. An intrathoracic anastomosis was associated with a lower leak rate than a cervical anastomosis (17·0 versus 21·9 per cent; P = 0·025). The percentage of patients with recurrent nerve paresis was also lower (0·6 versus 7·0 per cent; P < 0·001) and an intrathoracic anastomosis was associated with a shorter median hospital stay (12 versus 14 days; P = 0·001). Multivariable analysis revealed that ASA fitness grade III or higher, chronic obstructive pulmonary disease, cardiac arrhythmia, diabetes mellitus and proximal oesophageal tumours were independent predictors of anastomotic leakage. Conclusion An intrathoracic oesophagogastric anastomosis was associated with a lower anastomotic leak rate, lower rate of recurrent nerve paresis and a shorter hospital stay. Risk factors for anastomotic leak were co‐morbidities and proximal tumours. Lower leak rates after intrathoracic anastomosis
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Affiliation(s)
- J A H Gooszen
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Centre, Utrecht, The Netherlands
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16
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Abstract
Esophagolymphadenectomy is the cornerstone of multimodality treatment for resectable esophageal cancer. The preferred surgical approach is transthoracic, with a two-field lymph node dissection and gastric conduit reconstruction. A minimally invasive approach has been shown to reduce postoperative complications and increase quality of life. Robot-assisted minimally invasive esophagectomy (RAMIE) was developed to facilitate this complex thoracoscopic procedure. RAMIE has been shown to be safe with good oncologic results and reduced morbidity. The use of RAMIE opens new indications for curative surgery in patients with T4b tumors, high mediastinal tumors, and lymph node metastases after neoadjuvant treatment.
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17
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Zhang Y, Zhang YX, Hu JW, Yao GY, Xue L, Fan H, Zhang YQ, Wang Q. Endoscopic naso-leakage drainage: a safe and effective method for the management of intrathoracic anastomotic leakage after esophagectomy. J Thorac Dis 2017; 9:3052-3061. [PMID: 29221279 DOI: 10.21037/jtd.2017.08.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Intrathoracic anastomotic leakage (IAL) remains a major complication of esophagectomy. Main non-surgical options of management include chest drainage and endoscope interventions. This study is aim to present our experience and assess the efficacy of endoscopic naso-leakage drainage (ENLD) in patients with IAL. Methods From June 2011 to January 2017, 67 patients who developed IAL after esophagectomy and managed by non-surgical approaches were analyzed retrospectively. IAL was confirmed by clinical presentations combined with the evidence of CT scan, radiography and endoscopy. Thirty-eight patients were treated by conventional chest drainage (CD group) and 29 patients underwent ENLD with or without chest drainage (ENLD group), while other treatments including enteral nutrition and antibiotics had no difference between the two groups. In ENLD group, a 12 Fr naso-leakage tube was placed through the leakage to the bottom of vomica under ultra-slim electronic gastroscope. The naso-leakage tube was then connected to a gastrointestinal decompression device for drainage and was also used for rinse. When the vomica diminished and the drainage was also clean, the naso-leakage tube could be pulled back gradually. Finally, healing of the leakage was confirmed endoscopically. Clinical records of the two groups were analyzed. Results In ENLD group, naso-leakage tubes were successfully placed under endoscope in all 29 patients without any procedure-related complications. In CD group, the mortality is 7.9% (three patients) and five patients (13.2%) developed to systemic inflammatory response syndrome (SIRS) due to insufficient drainage. While in ENLD group, there was only one patient (3.4%) developed to SIRS and no death was observed, but the difference was not statistically significant. When compared with the CD group, the ENLD group had a shorter healing course (44.2±18.3 vs. 60.5±27.7 days, P=0.008), duration of antibiotics usage (16.4±7.8 vs. 11.8±3.8 days, P<0.001) and duration of fever (4.3±2.2 vs. 9.5±8.6 days, P=0.002). Conclusions To our initial experience, ENLD is an ideal option with safety and efficacy in management of IAL after esophagectomy.
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Affiliation(s)
- Yi Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong-Xing Zhang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Wei Hu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guang-Yu Yao
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Liang Xue
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hong Fan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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18
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Comparison of Early and Late Complications in Three Esophagectomy Techniques. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Goense L, van Rossum PSN, Kandioler D, Ruurda JP, Goh KL, Luyer MD, Krasna MJ, van Hillegersberg R. Stage-directed individualized therapy in esophageal cancer. Ann N Y Acad Sci 2016; 1381:50-65. [PMID: 27384385 DOI: 10.1111/nyas.13113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/05/2016] [Indexed: 12/16/2022]
Abstract
Esophageal cancer is the eighth most common cancer worldwide, and the incidence of esophageal carcinoma is rapidly increasing. With the advent of new staging and treatment techniques, esophageal cancer can now be managed through various strategies. A good understanding of the advances and limitations of new staging techniques and how these can guide in individualizing treatment is important to improve outcomes for esophageal cancer patients. This paper outlines the recent progress in staging and treatment of esophageal cancer, with particularly attention to endoscopic techniques for early-stage esophageal cancer, multimodality treatment for locally advanced esophageal cancer, assessment of response to neoadjuvant treatment, and the role of cervical lymph node dissection. Furthermore, advances in robot-assisted surgical techniques and postoperative recovery protocols that may further improve outcomes after esophagectomy are discussed.
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Affiliation(s)
- Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter S N van Rossum
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daniela Kandioler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Khean-Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Mark J Krasna
- Meridian Cancer Care, Jersey Shore University Medical Center, Neptune, New Jersey
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