The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery.

INTRODUCTION: Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR). MATERIALS AND METHODS: This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A) and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B). Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery. RESULTS: The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC) and 28 patients had adenocarcinoma (ACC). There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT), or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected. CONCLUSION: The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer.

Esophageal diverticula: Analysis of 25 cases.

BACKGROUND: esophageal diverticula are classified as 2 types: true diverticula and pseudodiverticula. These disorders result in clinical manifestations such as dysphagia and esophageal reflux. In this study, we evaluated the results of surgical treatment for diverticula. METHODS: all patients suffering from symptomatic esophageal diverticulum, who underwent surgical treatment in Ghaem Hospital from 2000 to 2012 and were followed up for at least for one year, were included in the study. Age, sex, clinical manifestations, location, surgical approach, and mortality were evaluated. There were 25 patients (15 men and 10 women) with a mean age of 41 ± 8.3 years. RESULTS: the most common site of involvement was inferior (epiphrenic diverticulum). Barium swallow was diagnostic. After surgical treatment, complications occurred in 4 (16%) patients, comprising anastomosis site leakage, hoarseness, atelectasis, and wound infection; all were treated medically. There was no postoperative mortality. All patients experienced an improvement in symptoms during one year of follow-up. CONCLUSION: due to the good results and minimal complications postoperatively, surgical treatment is recommended for patients with symptomatic esophageal diverticulum.

Outcomes following surgery for complicated tuberculosis: analysis of 108 patients.

BACKGROUND: Both incidence and complications of pleuropulmonary tuberculosis (TB) have increased due to recent increase of immunocompromising conditions. The aim of this study was to assess surgical outcomes in patients suffering from complicated pleuropulmonary TB. METHODS: This study included 108 patients with pleuropulmonary TB who underwent surgery. Age, sex, surgical indications, operative techniques, complications, mortality, and morbidity were evaluated. RESULTS: Male-female ratio was 1:11 with mean age of 40 years; 72.2 and 27.8% of the patients underwent surgery due to parenchymal and pleural complications. In the parenchymal group, the most common indication was parenchymal destruction (27.7%) and the most common procedure was lobectomy (50.9%). Out of 20 sputum smear-positive patients, 15 had multidrug-resistant tuberculosis (MDR-TB) and 5 had smear-positive open cavity. Overall 13 of the MDR-TB group and all smear-positive open cavity group became sputum-negative after the surgery. There were 13 patients with undiagnosed masses, among whom 3 patients had adenocarcinoma. In the pleural group, the most common surgical indication was empyema (13.8%) and the most common procedure was decortication and pleurectomy (13.8%). In the bronchopleural fistula group (6.4%), patients showed good results after surgery. There were 19.4% of patients who showed postoperative complications. The most common complication was residual space (5.5%). The main factors leading to major postoperative complications included positive preoperative sputum smear and history of immunocompromising condition. Mortality rate was 2.7%. CONCLUSION: Considering the favorable results achieved by surgery in patients with pleuropulmonary TB, this treatment can be recommended for this group of patients.

Botulinum toxin for prevention of delayed gastric emptying after esophagectomy.

BACKGROUND: Esophageal cancer is among the most common gastrointestinal cancers for which the main treatment is surgery. This study was undertaken to analyze the results of Botox injection in preventing gastric stasis in these patients. PATIENTS AND METHODS: 60 patients with esophageal cancer in the middle and lower third parts were included in our study between 2010 and 2011, and were randomly divided into two groups. In group A, 30 patients underwent pyloroplasty, and in group B, injection of botulinum toxin into the pyloric sphincter muscle was used in 30 patients. RESULTS: The mean age of these patients was 61 ± 10.7 years and the male/female ratio was 33:27. Isotope scans 3 weeks after surgery showed that 5 patients in group A and 3 in group B had delayed gastric emptying; there was no significant difference between the 2 groups, and the success rate of Botox injection was 90%. CONCLUSION: Considering the fact that there was no significant difference between pyloroplasty and Botox injection on gastric emptying after surgery, and given the need to use less-aggressive techniques and facilitate greater use of endoscopic methods, botulinum toxin injection may be used instead of pyloroplasty as a simple, effective, and complication-free method to prevent delayed gastric emptying.

Pulmonary metastasectomy and repeat metastasectomy for soft-tissue sarcoma.

BACKGROUND: For patients with lung metastases from soft-tissue sarcoma, pulmonary metastasectomy is considered to be the only chance of possible cure. In this survey, we analyzed some potential prognostic factors affecting the outcome in these patients. PATIENTS AND METHODS: 34 patients who underwent pulmonary metastasectomy for soft-tissue sarcoma from April 1996 to April 2007, were enrolled in our study. The median follow-up period was 26 months. Survival curves, factors affecting the outcome, and treatment success rate were evaluated. RESULTS: Complete resection was achieved in 88.2% of patients. There was no perioperative mortality. The median overall survival and median disease-free survival were 42 and 27 months, respectively. Incomplete resection and bilateral lung metastases had significant adverse effects on overall survival. Shorter disease-free interval (<18 months) was a significant predictor of survival on multivariate analysis. Metastasectomy was attempted in 12 cases of whom 50% remained disease-free to the end of follow-up. CONCLUSION: Complete resection is the most important defining factor of success rate and survival. Patients with bilateral lung metastases or a shorter disease-free interval have significantly lower success rates. Repeat metastasectomy is curative in many patients.

The role of thoracoscopic debridement in the treatment of parapneumonic empyema.

AIM: To evaluate the efficacy of early video-assisted thoracoscopic debridement in patients with the fibropurulent phase of parapneumonic empyema. PATIENTS AND METHODS: 40 patients with parapneumonic empyema resistant to 2 weeks of antibiotic therapy, were randomly divided into 2 groups. In group 1 (20 patients), antibiotic therapy and irrigation was continued, and in group 2 (20 patients), video-assisted thoracoscopic debridement was performed. The 2 groups were compared in terms of therapeutic results. RESULTS: The male/female ratio was 29/11. Group 1 included 16 men and 4 women with a mean age of 54 years, and mean hospital stay was 41 days. Group 2 consisted of 14 men and 6 women with a mean age of 51 years, and mean hospital stay was 23 days. Considering the therapeutic results, 12 patients in group 1 were cured by antibiotic therapy and irrigation, whereas 8 required decortication and pleurectomy with thoracotomy. In group 2, 18 patients were cured by video-assisted thoracoscopic debridement, and 2 underwent thoracotomy and decortication due to intraoperative bleeding. A significant difference in therapeutic results was noted between the groups (p = 0.028). CONCLUSION: Video-assisted thoracoscopic debridement provides a high success rate and less invasive treatment for the early stages of empyema.