Esophagectomy in esophageal cancer - is there an optimal approach?

INTRODUCTION: Esophageal cancer is a public health problem,with increasing incidence and postoperative morbidity over the past recent years. Although a number of new surgical techniques, including minimally invasive surgery, have been developed, mortality and morbidity have remained elevated.The element that seems to influence the early postoperative morbidity and mortality is the method of approach. MATERIAL AND METHODS: retrospective observational study which is carried out in the period 2003-2012 including esophageal neoplasm patients operated in the First Surgical Clinic -Hospital "Sf. Spiridon", Iasi. 140 patients were included, of which only 33 have received surgery with curative aim. SURGICAL TECHNIQUE: we consider 2 techniques in our study:transhiatal (TH) technique (without opening the chest)followed by esophagoplasty with cervical anastomosis and transthoracic esophagectomy (TT) with intrathoracic or cervical anastomosis. RESULTS: We performed 57.58 % (n = 19) of interventions by TT versus 42.42% (n = 14) by TH. The overall rate of postoperative morbidity rate was 78.8% (n = 26). Overall early postoperative mortality rate was 15.5% (n = 5) caused by pleuropulmonary sepsis (2 cases), lung emboli (1 case) and sepsis caused by anastomotic leak (2 cases). CONCLUSION: TT and TH esophagectomy have precise indications in esophageal surgery for malignancies, the mortality and morbidity rate being strongly influenced by the surgical approach.

Deep multilevel wet etching of fused silica glass microstructures in BOE solution.

Fused silica glass is a material of choice for micromechanical, microfluidic, and optical devices due to its chemical resistance, optical, electrical, and mechanical performance. Wet etching is the key method for fabricating of such microdevices. Protective mask integrity is a big challenge due extremely aggressive properties of etching solution. Here, we propose multilevel microstructures fabrication route based on fused silica deep etching through a stepped mask. First, we provide an analysis of a fused silica dissolution mechanism in buffered oxide etching (BOE) solution and calculate the main fluoride fractions like [Formula: see text], [Formula: see text], [Formula: see text] as a function of pH and NH4F:HF ratio. Then, we experimentally investigate the influence of BOE composition (1:1-14:1) on the mask resistance, etch rate and profile isotropy during deep etching through a metal/photoresist mask. Finally, we demonstrate a high-quality multilevel over-200 µm etching process with the rate up to 3 µm/min, which could be of a great interest for advanced microdevices with flexure suspensions, inertial masses, microchannels, and through-wafer holes.