Epithelial bone marrow cells in patients with advanced esophageal squamous cell carcinoma.

The aim of the current study was to examine epithelial cells in the bone marrow and peripheral blood of patients with various stages of esophageal squamous cell cancer prior to surgical treatment and to analyze the prognostic significance of these carcinoma cells deposits to the stage of the disease and applied surgical therapy. Thirty-two patients (25 men and 7 women), and 5 healthy bone marrow donors serving as controls were studied. Bone marrow samples were evaluated by light microscopy and examined by flow cytofluorometry. Cells were phenotypically analyzed for the antigens CD45- and CD18+ and/or EMA+. Results are presented as the number of cells revealing the investigated phenotype per 10 (5)analyzed cells. CD18 was expressed in the bone marrow cells of 15 of the 32 (47%) patients and EMA in 20/32 (62%), but not in peripheral blood. In 13 of the 32 pts (41%), co-expression of CD18 and EMA was observed. Patients with the proportion of marrow erythroblasts below 15% had higher numbers of CD18+ and EMA+ cells and there was a negative correlation between the number of erythroblasts and EMA+ cells (r=0.54, p=0.01). In patients with esophageal cancer and anemia, the number of EMA+ cells was higher (p=0.05) and the percentage of erythropoietic cells in the bone marrow was lower (p=0.01). In conclusion, flow cytofluorometry using anti-cytokeratin and anti-EMA antibodies may be useful in evaluating microdeposits of esophageal squamous cells in bone marrow. A dysfunctioning erythropoietic system causing anemia can be a first signal for the presence of malignant cell microdeposits in the marrow of patients with esophageal carcinoma.

Surgical treatment of patients with multiple carcinomas.

BACKGROUND: Primary multiple carcinomas are not observed very frequently. Research has been focused mainly on such issues as the frequency of occurrence of primary multiple carcinomas, the identification of high-risk groups, early diagnosis, treatment methods, and prognosis. The purpose of this article is to present our own experience in the surgical treatment of patients with multiple cancers. MATERIAL AND METHODS: The paper presents 13 patients of both sexes with primary multiple carcinomas. Four of these patients were diagnosed with synchronous carcinomas, the remaining patients with metachronous. The malignant tumors were variously localized. In the group with synchronous carcinomas, the malignant tumors were located in esophagus, stomach and rectum, pancreas and right ovary, esophagus and palatine tonsil. In the group with metachronous carcinomas, another cancer was diagnosed 12 months to 24 years after the treatment of the first carcinoma was completed. The other cancers were located in esophagus, stomach, pancreas, lung, and the skin of the cheek. Nine patients were qualified for surgical treatment on the basis of the preoperative TNM classification. Various surgical procedures were used. In cases of synchronous multiple carcinomas one-stage operations were preferred. RESULTS: Significant postoperative complications were noted in 2 cases. In the first case, a recto-sigmoid anastomotic leak resulted in increased circulatory and renal insufficiency, leading to the patient's decease. In the second case, a massive gastric hemorrhage after ileocoloesophagoplasty led to respiratory insufficiency, which was the cause of the patient's decease. Two patients died within 12 months after surgical treatment. In the first case cancer recurrence was the cause of death; in the second, myocardial infarction. Long-term follow-up was focused on 5 patients with no cancer recurrence during the period from 12 months to 4 years after surgical treatment. CONCLUSIONS: The results of this study suggest that patients who have had a first cancer successfully treated are at higher risk of developing a subsequent cancer, and that regular follow-up with thorough examination in patients successfully treated for cancer may lead to the early detection of a subsequent cancer when it is still at a curable stage.

[Comparative evaluation of postoperative complication in the reconstructive surgery of the esophagus]. / Porównawcza ocena wczesnych powiklan pooperacyjnych po zabiegach wytwórczych przelyku.

The paper presents 78 patients with stenosis of the middle thoracic segment of the esophagus. The substitute, being pedunculated intestinal graft, was brought to the neck through the retrosternal space. Early post-operative complications occurred in 8.9% of patients. Post-operative mortality rate was 7.6%. The most dangerous complication after esophageal plastic surgery is blood supply insufficiency. It was observed in 2 cases. Other complications included anastomotic leaks and respiratory distress syndrome. The authors emphasize that frequency of post-operative complications and mortality are related with the patient general condition and extent of the surgery.

[Iatrogenic esophageal injuries]. / Jatrogenne uszkodzenia przelyku.

Own experience regarding treatment of 25 iatrogenic oesophageal lesion are discussed. Diagnosis was established mainly by x-ray examination with the water soluble contrast and plain chest x-ray. One patient was treated conservatively. 24 were operated. All patients received antibiotics intravenously and for local mouth rinse. Operations consists of chest drainage and exclusion of oesophagus from food passage by gastrostomy. Treatment in all cases resulted in healing of oesophageal lesion.

[Iatrogenic injuries of the cardia antireflux system]. / Jatrogenne uszkodzenia mechanizmu antyrefluksowego wpustu.

Among presented 18 patients with iatrogenic injury of the cardia antireflux system, 5 were females and 13 males aged 35-62 years of life. 13 cases were operated before for cardiospasmus, 5 had gastric resection B2 for duodenal ulcer. In consequence all the patients presented stricture of the thoracic lower and abdomen part of oesophagus. 16 patients required reoperations, 2 had dilatation. In 2 cases stricture were located in middle and lower part of oesophagus. In 4 cases in abdominal and supradiaphragmatic part of oesophagus, in 5 cases in abdominal part of oesophagus, and in 7 cases in the cardia. 11 patients required one corrective surgery, 4-two operations, and 1-three operations. As a final procedure: in 2 cases artificial oesophagus was formed with intestinal graft, in 8 cases the cicatrical part of the oesophagus was excised and replaced by a pedunculated graft by Merendino method, in 3 cases esophagogastric anastomosis were done using Heyrowsky method, in 2 cases bypass was made from pedunculated part of jejunum which connect the part of oesophagus above the narrowing with the prepyloric part of the stomach by the own method, in 1 case intrathoracic esophagogastric anastomosis was performed. The best results were obtained by oesophagogastric bypass.

[Gastroesophageal reflux after reconstruction of the esophagus with colon interposition]. / Refluks zoladkowo-przelykowy po zabiegach wytwórczych przelyku z jelita grubego.

In this study 113 cases were analysed; in which colon interposition was used for the reconstruction od the esophagus. The function od the esophageal grafts was evaluated 2 to 36 years after the reconstruction. Massive reflux was observed mainly when the anastomosis had been made to the gastric fundus. Reflux to isoperistaltic grafts was found in 21% of cases in children and in 27% od cases in adults, whereas for antiperistaltic grafts is was found in 33% od cases in children and in 61% od cases in adults. 4 children and 7 adult patients required a a reoperation.

[Pleural hernia of an esophageal graft--late postoperative complication]. / Przepukliny oplucnowe sztucznych przelyków--odlegle powiklania pooperacyjne.

Pleural hernia of the oesophageal substitute from pedicled intestinal segment is one of the late postoperative complications. 13 cases of patients with oesophagus reconstructed because of lye ingestion stenosis are presented. Problems concerning diagnosis and treatment of pleural hernia are analysed. Eight patients with minor symptoms were treated conservatively. Five patients were operated, two of them from acute necrosis of the substitute. Necrosis was caused by incarceration of the bowel and torsion of the mesentery. Elective operative treatment consisted of reduction of hernia sac contents, closing of the hernia orifice, chest drainage and temporary gastronomy. In patient operated as an emergency cases necrotic part of substitute was removed. This resulted in oesophageal exclusion in the neck, creating gastronomy. Chest drainage was also performed.

Operative procedure in early carcinoma of the thoracic part of the esophagus.

The authors present four patients with early carcinoma of the thoracic part of the esophagus. In all patients, "blind" esophagectomy was performed without thoractomy. Simultaneously salivary fistula on the neck and gastrostomy was formed. During the second stage of the procedure a retrosternal esophagus was formed out of pedunculated intestinal grafts. No serious postoperative complications were noted. According to the authors, the above-mentioned procedure should be limited to early cases of carcinoma of the thoracic part of the esophagus. The post-operative follow up of the cases was up to four years.

[Benign esophageal tumors]. / Lagodne guzy przelyku.

The authors present seven cases of benign oesophageal tumours treated in hospital in the years 1972-1990. Among the treated patients were six men and one woman, aged from 30 to 70 years. In four patients the tumour was situated in the middle part of the thoracic segment, and in three cases in the lower part of the supradiaphragmatic segment of the oesophagus. The diagnosis od benign oesophageal tumour was made on the basis of X-ray examination, oesophagoscopy, and histopathological examination. Five patients were treated surgically. In two patients the access to the tumour was from the right pleural cavity, and in three other cases--from the abdominal cavity. The result of histopathological examination of the removed tumours was as follows: in two patients--benign polyps, in one patient--mature teratoma, in one female patient--myxofibroma, and in one case--fibromyoma. In all patients operated on complete cure was achieved.