Multifaceted surgical approach of combined thoracoretroperitoneal incision and midline abdominal incision for a secondary aortoenteric fistula.

BACKGROUND: We report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach. CASE PRESENTATION: A 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications. CONCLUSIONS: A one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.

Pretreatment Fibrinogen Level Is a Prognostic Factor for Esophageal Cancer Patients Who Receive Curative Treatment.

BACKGROUND/AIM: Pretreatment fibrinogen levels are a promising prognostic marker for some malignancies. The aim of the present study was to evaluate the clinical impact of fibrinogen levels before treatment in patients with esophageal cancer who underwent curative resection. PATIENTS AND METHODS: This study included 123 patients who underwent curative treatment for esophageal cancer between 2005 and 2020. The prognosis and clinicopathological parameters in the high fibrinogen and low fibrinogen groups were analyzed. RESULTS: Overall survival (OS) stratified by individual clinical factors was compared using the log-rank test, and a significant difference was observed when a pretreatment fibrinogen level of 400 g/dl was used as a cutoff value. The comparison of the patient background factors between the high fibrinogen (400 g/dl) and low fibrinogen (<400 g/dl) groups revealed significant differences in pathological T status and lymph node metastasis. In the low fibrinogen group, the OS rates at 3 and 5 years after surgery (71.4% and 58.1%, respectively) were significantly higher than those in the high fibrinogen group (38.3% and 32.4%, respectively). Univariate and multivariate analyses for OS showed that the fibrinogen level prior to treatment was a significant prognostic factor. Similar results were observed for recurrence-free survival. In addition, when the first recurrence site was compared, there were marginally significant differences in hematologic recurrence. CONCLUSION: Pretreatment fibrinogen levels are a significant risk factor in patients with esophageal cancer. Therefore, pretreatment fibrinogen levels are a promising prognostic factor for patients with esophageal cancer.