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Sato S, Nakatani E, Hawke P, Nagai E, Taki Y, Nishida M, Watanabe M, Ohata K, Kanemoto H, Oba N. Systemic inflammation score as a predictor of death within one year after esophagectomy. Esophagus 2024; 21:336-347. [PMID: 38625663 DOI: 10.1007/s10388-024-01059-7] [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: 01/20/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND After radical resection for esophageal cancer, death within 1 year of surgery can occur due both to recurrence and to other diseases, even after postoperative complications have been overcome. This study identified risk factors for early death within 1 year of esophagectomy for reasons other than death in hospital in patients undergoing esophagectomy for esophageal cancer or esophagogastric junction cancer. METHODS We reviewed 366 patients who underwent esophagectomy without adjuvant treatment between January 2009 and July 2022 for thoracic esophageal cancer or esophagogastric junction cancer. Patients who died within 1 year excluding in-hospital death were compared with those who did not. Multivariable logistic regression analysis was used to identify predictors of death within 1 year after surgery. RESULTS Death within 1 year occurred in 32 of 366 patients, 24 from primary disease and 8 from other diseases. Deaths within 1 year were significantly older than the other cases, had significantly lower % vital capacity (%VC), and occurred significantly more often in cases in advanced stages of disease. In a multivariable analysis, a systemic inflammation score (SIS) based on serum albumin level and lymphocyte-to-monocyte ratio was identified as an independent predictor of death within 1 year. As SIS increased, %VC decreased significantly, and CRP level and neutrophil-lymphocyte ratio increased significantly. There was no relationship between SIS and pN. Death within 1 year increased as SIS increased (p = 0.001 for trend). CONCLUSION SIS assessment undertaken before beginning esophageal cancer treatment is a useful predictor of death within 1 year of surgery.
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Affiliation(s)
- Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan.
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Philip Hawke
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Erina Nagai
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Yusuke Taki
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Masato Nishida
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Ko Ohata
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, Japan
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Inoue J, Morishita S, Okayama T, Suzuki K, Tanaka T, Nakano J, Fukushima T. Impact of quality of life on mortality risk in patients with esophageal cancer: a systematic review and meta-analysis. Esophagus 2024; 21:270-282. [PMID: 38772959 DOI: 10.1007/s10388-024-01064-w] [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: 02/27/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024]
Abstract
This systematic review and meta-analysis investigated the impact of quality of life (QoL) on mortality risk in patients with esophageal cancer. A literature search was conducted using the CINAHL, PubMed/MEDLINE, and Scopus databases for articles published from inception to December 2022. Observational studies that examined the association between QoL and mortality risk in patients with esophageal cancer were included. Subgroup analyses were performed for time points of QoL assessment and for types of treatment. Seven studies were included in the final analysis. Overall, global QoL was significantly associated with mortality risk (hazard ratio 1.02, 95% confidence interval 1.01-1.04; p < 0.00004). Among the QoL subscales of QoL, physical, emotional, role, cognitive, and social QoL were significantly associated with mortality risk. A subgroup analysis by timepoints of QoL assessment demonstrated that pre- and posttreatment global and physical, pretreatment role, and posttreatment cognitive QoL were significantly associated with mortality risk. Moreover, another subgroup analysis by types of treatment demonstrated that the role QoL in patients with surgery, and the global, physical, role, and social QoL in those with other treatments were significantly associated with mortality risk. These findings indicate that the assessment of QoL in patients with esophageal cancer before and after treatment not only provides information on patients' condition at the time of treatment but may also serve as an outcome for predicting life expectancy. Therefore, it is important to conduct regular QoL assessments and take a proactive approach to improve QoL based on the results of these assessments.
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Affiliation(s)
- Junichiro Inoue
- Division of Rehabilitation Medicine, Kobe University Hospital International Clinical Cancer Research Center, 1-5-1 Minatojimaminamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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3
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Ohsawa M, Hamai Y, Emi M, Ibuki Y, Kurokawa T, Yoshikawa T, Hirohata R, Kitasaki N, Okada M. The treatment efficacy and prognosis of each treatment in early postoperative recurrence of esophageal squamous cell carcinoma. Surg Today 2024; 54:53-63. [PMID: 37225930 DOI: 10.1007/s00595-023-02702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/17/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Various treatments are used for early postoperative recurrence of esophageal cancer, which has a poor prognosis. We evaluated the differences in outcomes and prognoses of each treatment modality between patients with early and late recurrence. METHODS Early and late recurrence were defined as recurrence within and after six postoperative months, respectively. Of the 351 patients with esophageal squamous cell carcinoma who underwent R0 resection esophagectomy, 98 experienced postoperative recurrence (early recurrence, n = 41; late recurrence, n = 57). We evaluated the characteristics of patients with early and late recurrence and compared their treatment responses and prognoses. RESULTS Regarding treatment responses for chemotherapy or immunotherapy, the objective response rate was not significantly different between the early- and late-recurrence groups. For chemoradiotherapy, the objective response rate was significantly lower in the early-recurrence group than in the late-recurrence group. The overall survival was significantly worse in the early-recurrence group than in the late-recurrence group. An analysis by treatment type showed that the early-recurrence group had significantly worse overall survival for chemoradiotherapy, surgery, and radiotherapy than the late-recurrence group. CONCLUSIONS Patients with early recurrence had particularly poor prognoses with worse post recurrence treatment efficacy than those with late recurrence. The differences in the treatment efficacy and prognosis were particularly pronounced for local therapy.
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Affiliation(s)
- Manato Ohsawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Yoichi Hamai
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan.
| | - Manabu Emi
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Yuta Ibuki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Tomoaki Kurokawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Toru Yoshikawa
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Ryosuke Hirohata
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Nao Kitasaki
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-Ku, Hiroshima City, Hiroshima, 734-0037, Japan
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4
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Matsui K, Kawakubo H, Matsuda S, Hirata Y, Irino T, Fukuda K, Nakamura R, Okita H, Kitagawa Y. Clinical predictors of early postoperative recurrence after radical esophagectomy for thoracic esophageal cancer. Esophagus 2023; 20:679-690. [PMID: 37222963 DOI: 10.1007/s10388-023-01014-y] [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: 01/20/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Esophagectomy for esophageal cancer has a high incidence rate of early postoperative recurrence and death. This study aimed to identify the clinical and pathological features in early recurrence cases and to confirm the usefulness of prediction using these factors for effective adjuvant therapy and postoperative surveillance. METHODS One hundred and twenty five patients who developed postoperative recurrence after undergoing radical esophagectomy for thoracic esophageal cancer were classified into two groups as follows: those with early recurrence at ≤ 6 months and those with nonearly recurrence at > 6 months after surgery. After identifying related factors of early recurrence, usefulness of these factors for prediction were examined in all patients with and without recurrence. RESULTS The analysis cohort consisted of 43 and 82 patients in the early and nonearly recurrence groups, respectively. In multivariate analysis, factors associated with early recurrence were higher initial levels of tumor markers (squamous cell carcinoma [SCC] ≥ 1.5 ng/ml in tumors, except for adenocarcinoma, and carcinoembryonic antigen [CEA] ≥ 5.0 ng/ml in adenocarcinoma) and higher venous invasion (v), i.e., ≥ 2 (p = 0.040 and p = 0.004, respectively). The usefulness of these two factors for recurrence prediction was confirmed in 378 patients, including 253 patients without recurrence. Patients with at least one of the two factors had significantly higher early recurrence rates than those without any factors in pStages II and III (odds ratio [OR], 6.333; p = 0016 and OR, 4.346; p = 0.008, respectively). CONCLUSIONS Early recurrence of thoracic esophageal cancer (i.e., during ≤ 6 months after esophagectomy) was associated with higher initial tumor marker levels and pathological findings of v ≥ 2. The combination of these two factors is useful as a simple and critical predictor of early postoperative recurrence.
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Affiliation(s)
- Kazuaki Matsui
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yuki Hirata
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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5
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Singh AK, Singhal BM, Yadav SK, Kewlani V. Impact of Different Histopathological Factors on Recurrence and Survival in Operated Carcinoma Esophagus. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2023. [DOI: 10.1055/s-0042-1758813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abstract
Background Even with radical surgery, a significant percentage of patients of esophageal cancer experience recurrent disease.
Aims The aim of the current study is to define the impact of different histopathological factors on the recurrence and survival in carcinoma esophagus following surgery.
Materials and Methods A retrospective review of 182 patients of esophageal carcinoma, operated between January 2011 and December 2016, was done. In our study, 92 patients underwent upfront surgery and 90 took neo-adjuvant/perioperative treatment before planned surgery. To compare the proportion between two groups, chi-square test was used and to compare the median between the two groups, Mann—Whitney U test was used. Factors affecting the survival were analyzed using the Kaplan–Meier survival curve to compare the median survival time across groups log rank (Mantel–Cox) test was used.
Results Out of 182 patients, 55 patients developed recurrences, in which 19 were loco-regional and 36 were systemic. Patients with lymph node-positive disease on final histopathology had more recurrence than lymph node-negative (39.74%, 31/78) versus (23%, 24/104), p = 0.01 (significant). Patients with features such as PNI-positive, poor differentiation, lymph node-positive, ENE, and higher stage disease had statistically significant, lower DFS and OS with p-value < 0.05. Patients with adenocarcinoma histology had more systemic recurrences and statistically significant lower DFS than SCC with p-value < 0.05.
Conclusions Systemic recurrences are more common. PNI, ENE, grade, lymph node-positive disease, and higher pathologic stage had statistically significant negative impact on both DFS and OS. On multivariate analysis, whereas ENE had an impact on DFS alone.
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Affiliation(s)
- Ashok Kumar Singh
- Department of Surgical Oncology, Kalyan Singh Superspeciality Cancer Institute, Lucknow, Uttar Pradesh, India
| | - Basant Mohan Singhal
- Department of Surgical Oncology, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
| | - Santosh Kumar Yadav
- General Surgery, Prasad Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vishal Kewlani
- Department of Surgical Oncology, Motilal Nehru Medical College, Allahabad, Uttar Pradesh, India
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6
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Yang Y, Zhang H, Li B, Shao J, Liu Z, Hua R, Li Z. Patterns of Recurrence After Robot-Assisted Minimally Invasive Esophagectomy in Esophageal Squamous Cell Carcinoma. Semin Thorac Cardiovasc Surg 2022; 35:615-624. [PMID: 35545203 DOI: 10.1053/j.semtcvs.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 01/08/2023]
Abstract
Robot-assisted minimally invasive esophagectomy (RAMIE) has been proven to be a feasible surgical approach for esophageal squamous cell carcinoma (ESCC). This study aimed to investigate the recurrence pattern and potential risk factors after RAMIE. Consecutive patients with ESCC who received RAMIE with McKeown technique at a single Esophageal Cancer Institute from November 2015 to September 2018 were retrospectively reviewed. Patients with available data, radical resection (R0), and a minimum 2-year follow-up period were eligible for the recurrence analysis. Risk factors of recurrence were examined by logistic regression analysis. R0 resection was achieved in 95.1% of patients (310/326). Of the 298 eligible patients with a median follow-up period of 30.6 months, recurrence was recognized in 95 patients (31.9%), with 4 (1.3%) local-only, 40 (13.4%) regional-only, 44 (14.8%) hematogenous-only and 7 (2.3%) combined recurrences. Cervical lymph nodes and lungs were the most frequent sites of regional and hematogenous recurrence, respectively. The median disease-free interval until recurrence was 12.1 (range 1.7-37.6) months and 83.2% of relapses occurred within 2 years after surgery. Multivariable analysis indicated that tumor in the upper esophagus, larger tumor length and positive lymph nodes as independent risk factors for recurrence. Hematogenous recurrence is the prevailing pattern after RAMIE for ESCC. For patients with advanced disease, neoadjuvant therapy is a key factor in reducing recurrence rather than surgical approaches.
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Affiliation(s)
- Yang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinchen Shao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhichao Liu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Hua
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China..
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7
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Murakami K, Yoshida N, Taniyama Y, Takahashi K, Toyozumi T, Uno T, Kamei T, Baba H, Matsubara H. Maximum standardized uptake value change rate before and after neoadjuvant chemotherapy can predict early recurrence in patients with locally advanced esophageal cancer: a multi-institutional cohort study of 220 patients in Japan. Esophagus 2022; 19:205-213. [PMID: 34993673 DOI: 10.1007/s10388-021-00896-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) followed by esophagectomy can improve the prognosis of locally advanced esophageal cancer (LAEC). However, LAEC reportedly recurred in 17-21% of patients within 6 months post surgery. Thus, current treatment strategies may be inadequate for LAECs with poor prognosis. Preoperative identification of patients with poor prognosis might aid in modification of treatment strategies. This study aimed to evaluate the usefulness of the maximum standardized uptake value change rate (ΔSUVmax) in predicting treatment effects on the primary lesion, prognosis, and LAEC recurrence. METHODS This study involved 220 esophageal cancer patients who underwent esophagectomy after NAC at three facilities in Japan. The optimal cut-off point for ΔSUVmax in predicting tumor regression grade (TRG) was calculated and used to assess the correlation between ΔSUVmax and postoperative survival. RESULTS The optimal cut-off point for ΔSUVmax was 0.5. The 5-year overall survival rate in patients with ΔSUVmax ≥ 0.5 was significantly higher than that in patients with ΔSUVmax < 0.5 (71.5% vs. 50.5%, P = 0.001). Multivariate analysis identified ΔSUVmax (hazards ratio, 0.496; P = 0.004) as an independent prognostic factor. Among 199 patients evaluated for recurrence, 24 (12.1%) showed recurrence within 6 months post surgery. Univariate analysis revealed ΔSUVmax as the only predictor for early recurrence (odds ratio, 0.222; P = 0.004). CONCLUSION ΔSUVmax before and after NAC is clinically useful as it could help predict TRG, survival outcome, and early recurrence within 6 months post esophagectomy and is easily obtainable in general clinical practice. We believe that it may also help determine suitable treatment strategies for LAEC.
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Affiliation(s)
- Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Taniyama
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kozue Takahashi
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Takashi Uno
- Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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8
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Kurogochi T, Honda M, Takahashi K, Okamura A, Imamura Y, Yamashita K, Kamiya S, Hayami M, Mine S, Watanabe M. Clinical features and risk factors for early recurrence after esophagectomy following neoadjuvant chemotherapy for esophageal cancer. Surg Today 2021; 52:660-667. [PMID: 34708307 DOI: 10.1007/s00595-021-02397-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to clarify the clinical features and outcomes of patients with recurrence after esophagectomy following neoadjuvant chemotherapy (NAC) related to the timing of recurrence. METHODS We reviewed 240 consecutive patients who underwent NAC followed by esophagectomy for clinical stage II/III esophageal squamous cell carcinoma between 2009 and 2014. We compared the clinical features and survival after recurrence among groups of patients stratified by the timing of recurrence diagnosis and identified the risk factors for early recurrence (ER). RESULTS Recurrence was identified within 1 year in 61 patients and after 1 year in 23 patients. Significant differences were observed between the patients with recurrence within 1 year (early recurrence; ER) and those with recurrence after 1 year (late recurrence; LR). The ER patients had more advanced tumors and higher pretreatment serum squamous cell antigen (SCC-Ag) levels and less experienced downstaging than patients without recurrence (no recurrence; NR). Overall survival was significantly worse for the ER patients than for the LR patients. Multivariate analysis revealed that cN2-3, increased serum SCC-Ag levels, and clinical response to NAC were independent predictors of ER. CONCLUSION The ER patients had distinctive clinical features from the LR and NR patients. Extensive lymph node metastasis, an elevated SCC-Ag, and inadequate response to NAC were identified as predictors of ER.
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Affiliation(s)
- Takanori Kurogochi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Michitaka Honda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Kamiya
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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9
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Xie Y, Wang D, Gao C, Hu J, Zhang M, Gao W, Shu S, Chai X. Effect of perioperative flurbiprofen axetil on long-term survival of patients with esophageal carcinoma who underwent thoracoscopic esophagectomy: A retrospective study. J Surg Oncol 2021; 124:540-550. [PMID: 34143443 PMCID: PMC8453976 DOI: 10.1002/jso.26553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives Nonsteroidal anti‐inflammatory drugs (NSAIDs) have an anti‐inflammatory response, but it remains unclear whether the perioperative use of flurbiprofen axetil can influence postoperative tumor recurrence and survival in esophageal carcinoma. We aimed to explore the effect of perioperative intravenous flurbiprofen axetil on recurrence‐free survival (RFS) and overall survival (OS) in patients with esophageal carcinoma who underwent thoracoscopic esophagectomy. Methods This retrospective study included patients who underwent surgery for esophageal carcinoma between December 2009 and May 2015 at the Department of Thoracic Surgery, Anhui Provincial Hospital. Patients were categorized into a non‐NSAIDs group (did not receive flurbiprofen axetil), single‐dose NSAIDs group (received a single dose of flurbiprofen axetil intravenously), and multiple‐dose NSAIDs group (received multiple doses of flurbiprofen). Results A total of 847 eligible patients were enrolled. Univariable and multivariable analyses revealed that the intraoperative use of flurbiprofen was associated with long‐term RFS (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.42–0.76, p = .001) and prolonged OS (HR: 0.49, 95% CI: 0.38–0.63, p = .001). Conclusions Perioperative flurbiprofen axetil therapy may be associated with prolonged RFS and OS in patients with esophageal carcinoma undergoing thoracoscopic esophagectomy.
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Affiliation(s)
- Yanhu Xie
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Di Wang
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Chen Gao
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Jicheng Hu
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Min Zhang
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Gao
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Shuhua Shu
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, China.,Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China, University of Science and Technology of China, Hefei, Anhui, China
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Hoshino S, Takeuchi M, Kawakubo H, Matsuda S, Mayanagi S, Irino T, Fukuda K, Nakamura R, Wada N, Kitagawa Y. Usefulness of Neutrophil to Lymphocyte Ratio at Recurrence for Predicting Long-Term Outcomes in Patients with Recurrent Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 28:3001-3008. [PMID: 33689078 DOI: 10.1245/s10434-021-09637-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/11/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although radical esophagectomy with multifield lymph node dissection is a promising treatment to achieve long-term survival for resectable esophageal cancer, survival after postoperative recurrence remains poor. To select the optimal treatment for patients with recurrent esophageal cancer, simple, objective indicators for predicting of long-term outcomes are needed. PATIENTS AND METHODS We conducted a single-institution, retrospective cohort study between 2004 and 2019, wherein 586 patients underwent transthoracic esophagectomy for primary esophageal squamous cell carcinoma. Of these, 133 patients with postoperative recurrence were included in this analysis. Several predictors of survival after recurrence were investigated. RESULTS Among all patients, the 1- and 3-year survival rates after recurrence were 48.0% and 23.1%, respectively. On multivariate analysis, the neutrophil to lymphocyte ratio (NLR) at recurrence was identified as a significant predictor of death after recurrence (hazard ratio 1.061; 95% confidence interval 1.002-1.125; p = 0.043). Time-dependent receiver operating characteristics curves showed that the area under the curve value of the NLR at recurrence was superior to the modified Glasgow Prognostic Score at recurrence in all terms. To simulate the clinical decision process, we set the cut-off NLR at recurrence for survival using survival classification and regression tree (CART) and defined the optimal cut-off value as 3.374. CONCLUSIONS NLR at recurrence was a significant indicator of survival after recurrence in patients with recurrent esophageal cancer. CART analysis was used to determine the optimal cut-off value for the prediction of survival, allowing the NLR to be used clinically to facilitate decision making.
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Affiliation(s)
- Shota Hoshino
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Irino
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazumasa Fukuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Rieko Nakamura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norihito Wada
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Wang F, Ge X, Wang Z, Weng Y, Yin R, You Q. Clinical significance and prognosis of supraclavicular lymph node metastasis in patients with thoracic esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:90. [PMID: 32175383 DOI: 10.21037/atm.2019.12.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Although most studies proved that thoracic esophageal cancer surgery with supraclavicular lymph nodes (SCLNs) metastasis could benefit, less than 30% of the 5-year survival rate remained controversy on its surgical treatment. In this study, we aimed to analyze the prognosis of SCLNs on the different segments of thoracic esophageal cancer, which will supply a reference for the treatment of this disease. Methods Retrospectively collected the clinical data of 163 patients with thoracic esophageal squamous cancer (ESCC) and compared the effects of SCLNs on prognosis in different segments. Results Patients with SCLNs metastasis had a worse prognosis than the negative group (P<0.001). In the upper thoracic group, there was no significant difference in OS between SCLNs positive group and negative group (P=0.077); however, in the middle and lower thoracic group, SCLNs positive group had a worse prognosis than the negative group (P<0.001) and lymph nodes positive in other sites (except for SCLNs) (P=0.039). Multivariate analysis found that SCLNs metastasis was an independent risk factor affecting the prognosis of ESCC in the middle and lower thoracic segments (P=0.007). Conclusions For patients with upper thoracic ESCC, SCLNs appear to be regional nodes. For the middle and lower thoracic ESCC, SCLNs should be defined as distant metastasis, and neoadjuvant therapy first may be an available therapy.
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Affiliation(s)
- Fudong Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China
| | - Xiaosong Ge
- Department of Cancer Center, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China
| | - Zhiqiang Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China
| | - Yuan Weng
- Department of Thoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China
| | - Rong Yin
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Qingjun You
- Department of Thoracic Surgery, The Affiliated Hospital of Jiangnan University, Wuxi 214062, China
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12
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Lee MK, Yost KJ, Pierson KE, Blackmon SH. Patient-reported outcome domains for the esophageal CONDUIT report card: a prospective trial to establish domains. Health Qual Life Outcomes 2018; 16:197. [PMID: 30305083 PMCID: PMC6180437 DOI: 10.1186/s12955-018-1023-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Health-related quality of life (QoL) deteriorates immediately after esophagectomy. Patients may benefit from periodic assessments to detect increased morbidity on the basis of subjective self-reports. Using input from patients and health care providers, we developed a brief prototype for the esophageal conduit questionnaire (Mayo Clinic Esophageal Conduit Outcomes Noting Dysphagia/Dumping, and Unknown outcomes with Intermittent symptoms over Time after esophageal reconstruction [CONDUIT] Report Card) and previously used it in comparative research. The present study aimed to expand its content and establish health-related QoL and symptom domains of a patient-reported postesophagectomy conduit evaluation tool. Methods We expanded tool content by selecting items measuring patient-reported symptoms from existing questionnaires or written de novo. A multidisciplinary group of clinician content-matter experts approved the draft tool, together with a designated patient advocate. The expanded tool was administered to patients postesophagectomy from March 1 to November 30, 2016. We established domains of conduit performance for score reporting through data analysis with exploratory factor analyses. We assessed psychometric properties such as dimensionality, internal consistency, and inter-item correlations in each domain and compared content coverage with other existing measures intended for this patient population. For data that were missing less than 50% of patient responses, the missing values were imputed. Results Five multi-item domains were established from data of 76 patients surveyed after esophagectomy; single items were used to assess stricture and conduit emptying. For every multi-item domain, dominance of 1 factor was present. Internal consistency reliability estimates for the domains were 0.87, 0.78, 0.75, 0.80, and 0.83 and average inter-item correlations were 0.40, 0.50, 0.40, 0.33, and 0.73 for dysphagia, reflux, dumping-gastrointestinal symptoms, dumping-hypoglycemia, and pain, respectively. Some items observed to have lower inter-item correlation were reworded or flagged for removal at future validation. For reflux and dumping-related hypoglycemia, additional items were written after these analyses. Conclusions The CONDUIT Report Card is a novel questionnaire for assessing QoL and symptoms of patients after esophageal reconstruction. It covers major symptoms of these patients and has good content validity and psychometric properties. The tool can be used to help direct patient care, guide intervention, and compare efficacy of different treatment options. Trial registration ClinicalTrials.gov identifier No. 02530983 on 8/18/2015.
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Affiliation(s)
- Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karlyn E Pierson
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Shanda H Blackmon
- Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Treatment Outcomes and Prognostic Factors After Recurrence of Esophageal Squamous Cell carcinoma. World J Surg 2017; 42:2190-2198. [DOI: 10.1007/s00268-017-4430-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mantziari S, Allemann P, Winiker M, Demartines N, Schäfer M. Locoregional Tumor Extension and Preoperative Smoking are Significant Risk Factors for Early Recurrence After Esophagectomy for Cancer. World J Surg 2017; 42:2209-2217. [DOI: 10.1007/s00268-017-4422-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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15
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Risk factors of early recurrence within 6 months after esophagectomy following neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma. Int J Clin Oncol 2016; 21:1071-1078. [DOI: 10.1007/s10147-016-0994-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/18/2016] [Indexed: 12/14/2022]
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16
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Low fat-containing elemental formula is effective for postoperative recovery and potentially useful for preventing chyle leak during postoperative early enteral nutrition after esophagectomy. Clin Nutr 2016; 35:1423-1428. [PMID: 27071696 DOI: 10.1016/j.clnu.2016.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/08/2016] [Accepted: 03/23/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. METHODS A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. RESULTS Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P < 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P < 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. CONCLUSIONS Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.
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Yu HM, Tang CW, Feng WM, Chen QQ, Xu YQ, Bao Y. Early Enteral Nutrition Versus Parenteral Nutrition After Resection of Esophageal Cancer: a Retrospective Analysis. Indian J Surg 2015; 79:13-18. [PMID: 28331260 DOI: 10.1007/s12262-015-1420-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/03/2015] [Indexed: 01/02/2023] Open
Abstract
This study aimed to compare the clinical outcomes and hospitalization cost between early enteral nutrition (EEN) and parenteral nutrition (PN) after resection of esophageal cancer. A total of 79 patients with esophageal cancer who underwent surgical treatment in our hospital from July 2010 to July 2013 were enrolled in this study. They were divided into EEN group (n = 39) and PN group (n = 40) based on the nutrition support modes. The clinical factors such as time to first fecal passage, postoperative albumin infusion, differences of serum albumin value, hospital stay, systematic inflammatory response syndrome (SIRS) duration, complications, initial hospitalization cost, and mortality were retrospectively compared. The EEN group had a significantly shorter hospital stay, lower initial hospitalization cost, earlier first fecal passage, and shorter duration of SIRS than PN group (P < 0.05). The dose of albumin infusion was significantly smaller in EEN group (P < 0.05) and the decreased value of serum albumin (Δalb) was more prominent in PN group compared with EEN group (P < 0.05). The percentage of patients having any postoperative complication was much higher in PN group than EEN group (P < 0.05), but there was no significant difference in in-hospital morbidity between two groups. Pneumonia was found significantly more frequent in PN group compared with EEN group (P < 0.05). Early EN started within 48 h after esophagectomy is safe, economic, and superior for reduction of postoperative complication, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.
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Affiliation(s)
- Huan Ming Yu
- Department of Thoracic Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
| | - Cheng Wu Tang
- Department of General Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
| | - Wen Ming Feng
- Department of General Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
| | - Qiu Qiang Chen
- Department of Thoracic Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
| | - Yong Qiang Xu
- Department of General Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
| | - Ying Bao
- Department of General Surgery, First People's Hospital Affiliated to Huzhou University Medical College, Huzhou, Zhejiang China
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Quality-of-life measures as predictors of post-esophagectomy survival of patients with esophageal cancer. Qual Life Res 2015; 25:465-475. [DOI: 10.1007/s11136-015-1094-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/26/2022]
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Stiles BM, Salzler GG, Nasar A, Paul S, Lee PC, Port JL, Altorki NK. Clinical predictors of early cancer-related mortality following neoadjuvant therapy and oesophagectomy. Eur J Cardiothorac Surg 2015; 48:455-60; discussion 460-1. [PMID: 25564218 DOI: 10.1093/ejcts/ezu479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/24/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although oesophagectomy can be curative for patients with oesophageal cancer (OC), it may be associated with high morbidity and decreased quality of life. Identifying risk factors for early systemic progression or death after oesophagectomy may help to guide treatment choices in at-risk patients. METHODS Patients undergoing oesophagectomy following neoadjuvant therapy for OC (November 1987 to January 2013) were reviewed, excluding deaths ≤3 months. Univariate predictors of death ≤1 year of operation were explored by logistic regression. Significant predictors (P ≤ 0.10) were included in a multivariate model. A risk factor index was created based on the number of significant risk factors in individual patients. RESULTS Of 581 patients, 238 had neoadjuvant chemotherapy or chemotherapy and radiation followed by oesophagectomy. Of these, 15% (n = 36) died ≤1 year following oesophagectomy and 69% of those from documented cancer recurrence. Clinical predictors of death ≤1 year by multivariate analysis included performance status >0 (HR 2.19; CI 1.02-4.69), poor (G3) tumour differentiation (HR 2.67; CI 1.14-6.21) and lack of clinical response (no response or progression versus complete and partial response) to neoadjuvant therapy (HR 2.77; CI 1.07-7.15). For patients with all factors evaluable (n = 167), variables were summed to derive a cumulative risk factor index, 0-3. An increased risk factor index (≥2) was highly associated with increased risk of death ≤1 year postoperatively (HR 4.84; CI 1.93-12.16), as well as with poor overall survival. CONCLUSIONS Clinically defined risk factors that predict early mortality following oesophagectomy include performance status, poor tumour differentiation and clinical response. In patients with at least two of these risk factors, 29% will die within 1 year of surgery. These patients should be identified and individual consideration given to less morbid surgical strategies or to alternative treatments.
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Affiliation(s)
- Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Gregory G Salzler
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Abu Nasar
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Subroto Paul
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Paul C Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
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Su XD, Zhang DK, Zhang X, Lin P, Long H, Rong TH. Prognostic factors in patients with recurrence after complete resection of esophageal squamous cell carcinoma. J Thorac Dis 2014; 6:949-57. [PMID: 25093092 DOI: 10.3978/j.issn.2072-1439.2014.07.14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/15/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recurrence following complete resection of esophageal squamous cell carcinoma (SCC) still remains common. The aim of this study was to investigate the prognostic factors in patients with recurrence after complete resection of esophageal SCC. METHODS The medical records of 190 patients with recurrent disease after complete resection of esophageal SCC were retrospectively reviewed. Recurrence pattern was classified as loco-regional recurrence and distant metastases. The Kaplan-Meier method was used for the survival analysis. Cox proportional hazards model was used for multivariate analysis. RESULTS Mediastinal nodal clearance area was the most common sites of loco-regional recurrence, whereas lung, liver and bone were the most common sites for distant metastases. The median survival after recurrence was 8 months. The 1, 3, 5-year post-recurrence survival rates were 45.9%, 10.6% and 6.4%, respectively. The overall 1, 3, 5-year survival rates were 76.6%, 27.3% and 12.3%, respectively. The independent prognostic factors included time of recurrence (≥12 months vs. <12 months, HR: 3.228, 95% CI: 2.233-4.668), pattern of recurrence (local-regional recurrence vs. distant metastases, HR: 1.690, 95% CI: 1.170-2.439), and treatment of recurrence [no treatment vs. treatment (radiotherapy or surgery or chemotherapy), HR: 0.642, 95% CI: 0.458-0.899]. CONCLUSIONS Our retrospective study showed that time of recurrence, pattern of recurrence and treatment of recurrence were independent prognostic factors in patients with recurrence after complete resection of esophageal SCC.
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Affiliation(s)
- Xiao-Dong Su
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
| | - Dong-Kun Zhang
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
| | - Xu Zhang
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
| | - Peng Lin
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
| | - Hao Long
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
| | - Tie-Hua Rong
- 1 Department of Thoracic Surgery, Cancer Center, Sun Yet Sen University, Guangzhou 510060, China ; 2 State Key Laboratory of Oncology in Southern China, Guangzhou 510060, China ; 3 Department of Thoracic Surgery, Guangdong Provincial Hospital, Guangzhou 510180, China
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The 30-Day Versus In-Hospital and 90-Day Mortality After Esophagectomy as Indicators for Quality of Care. Ann Surg 2014; 260:267-73. [DOI: 10.1097/sla.0000000000000482] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mine S, Sano T. Authors' reply: Proximal margin length with transhiatal gastrectomy for Siewert type II and III adenocarcinomas of the oesophagogastric junction (Br J Surg 2013; 100: 1050-1054). Br J Surg 2014; 101:735-6. [PMID: 24723024 DOI: 10.1002/bjs.9504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, 3-8-31, Ariake, Koto-ku, Tokyo, Japan.
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Is early enteral nutrition better for postoperative course in esophageal cancer patients? Nutrients 2013; 5:3461-9. [PMID: 24067386 PMCID: PMC3798914 DOI: 10.3390/nu5093461] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 12/28/2022] Open
Abstract
We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.
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