ABSTRACT
Objective Early diagnosis and effective treatment are the key to reduce the mortality and improve the prognosis of anastomotic leakage which involved many disciplines after esophageal cancer surgery. The aim of the study is to investigate the value of multidisciplinary which combined diagnosis and treatments in anastomotic leakage after esophageal cancer operations. Methods A total of 82 patients with anastomotic leakage after esophageal cancer surgery in our hospital from June 2013 to June 2018 . 43 patients from June 2013 to December 2015 were included in the control group. 39 patients with anastomotic leakage from January 2016 to June 2018 were used as the observation group. Patients in the control group were given routine diagnosis and treatment, while the observation group was given a multidisciplinary (thoracic surgery, imaging, general surgery, nutrition,etc.) joint diagnosis and treatment model. Observe general data, prognosis, and fistula healing time. Results The proportion of occultation in the observation group was significantly higher than that in the control group(38.5% vs 18.6%), and the difference was statistically significant (P<0.05). The healing time of anastomotic leakage was lower in the observation group[(17.24±3.62)d] than in the control group[(33.85±4.85)d](P<0.05). Conclusion Multidisciplinary combined diagnosis and treatment can improve the incidence of occult sputum and reduce the healing time of anastomotic leakage. It is worthy of clinical promotion.
ABSTRACT
Objective At present, there are few studies about the learning curve of da Vinci robot system for surgical treatment of esophageal cancer. This study aimed to evaluate the surgical outcomes of Da Vinci robotic surgical system for radical surgery in esophageal cancer and explore the learning curve characteristics of thoracic surgeon.Methods Clinical data of 60 consecutive cases who received Da Vinci robot-assisted radical esophagectomy between January 2011 and December 2015 in Nanjing General Hospital were reviewed retrospectively. The cases were divided into 3 groups according to the operation period: group A (operation time: January 2011 to January 2013), group B (operation time: February 2013 to February 2014) and group C (operation time: March 2014 to December 2015). There were 20 cases in each group. The docking time, thoracic cavity anatomical separation time, total operation time and complication were compared. The learning curve of robotic surgery system were analyzedResults The operations of 60 patients were successfully completed without any transfer to thoracotomy or laparotomy. There was no statistically significant difference in the incidence of complications between the 3 groups (P>0.05). With the increase in the number of surgical cases, the total operation time of group A (\[450.7±99.1\]min), group B (\[299.7±57.1\]min) and group C (\[248.5±71.5\]min) was gradually reduced. The difference was statistically significant (P0.05) . There were significant differences in total operation time among the three groups(P<0.05).After 20 cases, the fitting curve appeared turning angle, and then the curve began to slow down. Combined with the total operation time, pleural and abdominal cavity anatomical separation time and robotic docking time, it can be seen that the learning curve of Da Vinci robot-assisted radical robotic surgery in esophageal cancer was 20 cases.Conclusion After 20 cases of study, the thoracic surgeon can master the Da Vinci robotic surgical system for the radical surgery of esophageal cancer.
ABSTRACT
Objective: To observe the efficacy of preoperative prehabilitation on nutritional status and body composition of patients with esophageal cancer after operation. Methods: A total of 100 patients with esophageal cancer were randomly divided into the study group A and the control group B. The study group received prehabilitation from the day they adimitted to hospital and the control group received common preoperative preparation. The preoperative baseline data and postoperative indicators including levels of serum albumin, prealbumin, transferrin were recorded the day admitted to hospital and the 1, 3, 7, 30th day after surgery. Record the prognosis of the patients (albumin supplementation, incidence of postoperative complications, ICU monitoring time, total cost of hospitalization). And the body composition was examined on the day admitted to hospital and the 7, 30th day after surgery with BIA. Results: The level of serum albumin, prealbumin, transferrin and body composition were no statistically significant difference between the study group and the control group. Compared with the control group, the level of prealbumin were significantly higher in the study group on the 1, 3, 7, 30th day after surgery. The level of serum albumin, transferrin were also significantly higher in study group on the 3, 7, 30th day after surgery. The body composition was no significant difference between the two groups on the 7th day postoperatively. However, the loss of body composition such as skeletal muscle, body water, intracellular water, protein level and body cell volume were less in the study group compared with the control group on the 30th day after surgery. The incidence of postoperative complications in the prehabilitation group, ICU monitoring time, and hospitalization costs were significantly less than those in the control group. Conclusion: Prehabilitation intervention can obviously improve the nutritional status and the prognosis of the patients with esophageal cancer, and reduce the loss degree of their body composition.