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1.
Chirurgia (Bucur) ; 117(2): 143-153, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535775

RESUMO

Regardless of the reconstruction surgery used, the fundamental concepts of visceral reconstruction are based on the vascular support needed for the substituting graft. The vascular factor is the main element of any reconstruction technique, as an underlying condition for the visceral material stretch and, along with other factor, for the suture safety. In the case of the stomach, a consistent vascular flow and the minimal vascular anatomy variations are the first theoretical argument. A second argument is based on the intraparietal vascular network features allowing for supplementing visceral perfusion as the blood flow is stopped in one or more pediculi. Graft hypoperfusion is, however, a potential cause of failure, and the most frequently invoked complication is, therefore, a high risk of anastomosis fistulae. A series of modern techniques - arteriography data for the pre-operative vascular reconstruction or Doppler laser fluorometry intraoperative assessments, graft oximetry, laser speckle (spot) scan or the use of indocyanine green staining (ICG) - represent methods of early determination of the gastric graft perfusion/microperfusion quality used in reducing such risks. The doubts regarding the gastric perfusion mandate the use of vascular augmentation techniques. If such techniques are not used, the final outcome is uncertain and difficult to correct.


Assuntos
Esofagectomia , Esofagoplastia , Esofagectomia/métodos , Humanos , Verde de Indocianina , Estômago/irrigação sanguínea , Estômago/cirurgia , Resultado do Tratamento
2.
Chirurgia (Bucur) ; 117(2): 175-179, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535778

RESUMO

Introduction: Anastomotic fistulas after surgery for esophageal cancer, remain a challenge for both the surgeon and the gastroenterologist. The aim of the study is to highlight the role of esophageal stenting in the management of leaks after esophagectomy for malignancies. Materials and Methods: We reviewed the available literature on the endoscopic treatment of esophageal anastomotic leaks, especially articles on endoscopic stenting in the management of this complication. Pubmed and ClinicalKey databases were searched using keywords such as esophageal anastomotic leaks, fully covered self-expanding metal stents, esophageal neoplasm. The relevant literature has been reviewed and included in the article. Results and Conclusions: The insertion of self-expanding stents in the fistulas of the esophageal anastomosis, represents an efficient method of treatment both for the closure of the fistula and in the control of sepsis. The morbidity and mortality associated with this method of treatment may be significant.


Assuntos
Doenças do Esôfago , Neoplasias Esofágicas , Neoplasias Gástricas , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Doenças do Esôfago/complicações , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Estudos Retrospectivos , Stents/efeitos adversos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
3.
Chirurgia (Bucur) ; 117(2): 198-203, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535781

RESUMO

Introduction: There is an immune response after major surgery and inflammatory complications following complex surgery have a direct impact on morbidity and mortality. Currently, we do not have clinical tools to predict in which subset of patients a major complication will occur. The aim of this study was to evaluate the immediate dynamics of C-reactive protein (CRP), presepsin and procalcitonin in patients in which esophagectomy was performed either through video assisted thoracic surgery (VATS) or open approach. Methods: We conducted a prospective study on 27 patients with a mean age of 61.48 +-6.80 years, 13 patients with VATS and 14 with open approach, most of the patients were on stage III esophageal cancer (81%) and in all cases neoadjuvant treatment was performed. Results: There were increased levels of CRP, presepsin and procalcitonin after both arms of the study with significantly higher values for the open approach and with the same dynamic curves. In 3 cases there were extremely elevated levels of procalcitonin in the absence of a septic complication, in all cases a major complication occurred. Conclusion: Video assisted thoracoscopic esophageal mobilization induces a less immune response, even with the association of laparotomy. An elevated postoperative procalcitonin level can be an early indicator of a major postoperative complication.


Assuntos
Neoplasias Esofágicas , Pró-Calcitonina , Idoso , Proteína C-Reativa , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Receptores de Lipopolissacarídeos , Pessoa de Meia-Idade , Fragmentos de Peptídeos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracoscopia/efeitos adversos , Resultado do Tratamento
4.
Chirurgia (Bucur) ; 117(2): 230-236, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535786

RESUMO

Chylothorax is a rare complication, especially after esophageal cancer surgery. It may occur mainly in the thoracic stage of esophagectomy. The management of chylothorax is usually conservative, surgical reoperation with thoracic duct ligation being reserved for those cases refractory to that treatment. We discuss issues of diagnosis and therapeutic attitude, as evidenced by the literature, although a general consensus has not been established, most likely due to the low frequency of this complication. We emphasize the minimally invasive thoracoscopic approach, as it has been applied for two cases with this type of complication. A high rate of suspicion for thoracic duct injury should be maintained in all patients after esophageal surgery, with any pleural effusion entering the differential diagnosis of chylothorax.


Assuntos
Quilotórax , Neoplasias Esofágicas , Quilotórax/diagnóstico , Quilotórax/etiologia , Quilotórax/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Ligadura , Complicações Pós-Operatórias , Resultado do Tratamento
5.
Medicine (Baltimore) ; 101(17): e29201, 2022 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-35512077

RESUMO

ABSTRACT: The impact of serum prealbumin in patients with esophageal carcinoma after undergoing esophagectomy remains unclear, we speculated that serum prealbumin is associated with anastomotic leak (AL) after surgery, low serum prealbumin level may lead to AL. The aim of the study was to evaluate the relationship between serum prealbumin levels and AL after esophagectomy, to explore the value of serum prealbumin as an early predictor of AL after esophagectomy.Between January 2014 and December 2018, 255 patients were enrolled in this study, their basic characteristics and perioperative serum prealbumin levels were retrospectively analyzed. Statistical analysis by t test, nonparametric test and logistic regression were used to analyze data for patients with and without AL. Based on a receiver operator characteristic curve, a cut-off value for serum prealbumin levels as a predictor of AL was determined.Among the 255 patients, 18 patients were diagnosed with AL. The overall AL rate was 7.0% (18/255) including 12 cases of intrathoracic AL and 6 cases of cervical AL. By univariate analysis, we identified postoperative serum prealbumin level as a risk factor for AL (P < .001). Multivariate analysis also demonstrated postoperative serum prealbumin level (P = .028) to be an independent risk factor for AL. The best cut-off value of postoperative serum prealbumin level was 131 mg/L for predicting AL, with 83.3% sensitivity and 72.2% specificity.Postoperative serum prealbumin level was significantly associated with AL. it may help the early prediction of postoperative AL.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Neoplasias Esofágicas/complicações , Esofagectomia/efeitos adversos , Humanos , Pré-Albumina/análise , Estudos Retrospectivos
6.
World J Surg Oncol ; 20(1): 143, 2022 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-35509082

RESUMO

BACKGROUND: Esophageal adenosquamous carcinoma (EASC) is a rare disease. The biological behavior and treatment of this malignancy are not well studied. METHODS: Data from 56 patients with EASC who underwent esophagectomy were retrospectively analyzed and compared with 5028 patients with esophageal squamous cell carcinoma (ESCC). The impact of clinicopathological factors on the survival of patients with EASC was analyzed. The survival differences between patients with EASC and ESCC were also compared. RESULTS: There were 43 males and 13 females with a mean age of 59.7 ± 1.3 years (range, 39-79 years). Only 1 of the 43 patients who received preoperative esophagoscopic biopsy was diagnosed with EASC. The median survival time for patients with EASC was 32.0 months, and the 1-, 3-, and 5-year overall survival rates were 78.3%, 46.1%, and 29.6%, respectively. Resection margin, pN category, and adjuvant chemotherapy were found to be independent predictors. After 1:1 propensity score matching, the 5-year overall survival rate of 29.6% for patients with EASC was similar to that of 42.5% for patients with ESCC (P = 0.179). CONCLUSIONS: EASC is a rare disease and is easily misdiagnosed by esophagoscopic biopsy. The prognosis of EASC was similar to that of ESCC. Postoperative adjuvant chemotherapy may improve the survival of patients with EASC after esophagectomy.


Assuntos
Carcinoma Adenoescamoso , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Carcinoma Adenoescamoso/patologia , Carcinoma Adenoescamoso/cirurgia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Doenças Raras/patologia , Estudos Retrospectivos , Taxa de Sobrevida
7.
BMC Surg ; 22(1): 171, 2022 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-35545769

RESUMO

BACKGROUND: Treatment for regional lymph node recurrence after initial treatment for esophageal squamous cell carcinoma (ESCC) differs among institutions. Though some retrospective cohort studies have shown that lymphadenectomy for cervical lymph node recurrence is safe and leads to long-term survival, the efficacy remains unclear. In this study, we investigated the long-term outcomes of patients who underwent lymphadenectomy for regional recurrence after treatment for ESCC. PATIENTS AND METHODS: We retrieved 20 cases in which lymphadenectomy was performed for lymph node recurrence after initial treatment for ESCC in our hospital from January 2003 to December 2016. Initial treatments included esophagectomy, endoscopic resection (ER) and chemoradiotherapy/chemotherapy (CRT/CT). Overall survival (OS) and recurrence-free survival (RFS) after lymphadenectomy were calculated by the Kaplan-Meier method. We also used a univariate analysis with a Cox proportional hazards model to determine factors influencing the long-term outcomes. RESULTS: The five-year OS and RFS of patients who underwent secondary lymphadenectomy for recurrence after initial treatment were 50.0% and 26.7%, respectively. The five-year overall survival rates of patients who received esophagectomy, ER and CRT/CT as initial treatments, were 40.0%, 75.0% and 50.0%, respectively. The five-year OS rates of patients with Stage I and Stage II-IVB at initial treatments were 83.3% and 33.3%, respectively. CONCLUSIONS: Lymphadenectomy for regional recurrence after initial treatment for ESCC is effective to some degree. Patients with regional recurrence after initial treatment for Stage I ESCC have a good prognosis; thus, lymphadenectomy should be considered for these cases.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento
8.
Chirurgia (Bucur) ; 117(2): 164-174, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35535777

RESUMO

PURPOSE: The transition from open esophagectomy to Ivor Lewis to minimally invasive surgery has been gradual through hybrid approaches. The aim of this study was to present a comparison of the current variants of minimally invasive Ivor Lewis esophagectomy. Methods: A systematic literature search was performed to analyze the technical features of minimally invasive Ivor Lewis esophagectomy and their postoperative results. The research was performed in the PubMed and Medscape databases with the keywords Ivor Lewis minimally invasive esophagectomy, gastric tube, esogastric anastomosis, and the selection of articles was performed taking into account the technical variance used and the results obtained. Results: The research of the data in the literature shows that there is currently a consensus of the essential steps in the Ivor Lewis technique, but their performance allows the use of different options, each surgeon taking into account primarily their own experience and existing facilities in each hospital. Although, over time, there have been multiple transformations of some steps in the basic technique, currently there are still conflicting opinions on certain aspects of the surgical technique, all of which are motivated by research undertaken to improve postoperative results. Conclusions: Ivor Lewis Minimally invasive esophagectomy further raises debatable issues on the practical way to perform the essential steps of the technique; their clarification could lead to finding the optimal option.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Laparoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
9.
J Cardiothorac Surg ; 17(1): 81, 2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461251

RESUMO

BACKGROUND: Aberrant right subclavian artery (ARSA) accompanied by non-recurrent inferior laryngeal nerve (NRILN) is a rare anomaly. In cases of thoracic esophageal carcinoma associated with ARSA and NRILN, surgeons must take extra care not to injury these vessels and nerves. We believe semi-prone thoracoscopic esophagectomy to be a surgical approach that can safely deal with such an anomaly. CASE PRESENTATION: A 70-year-old man complained of feelings of chest constriction. Endoscopic examination revealed an esophageal tumor and computed tomography showed an ARSA. We performed semi-prone thoracoscopic esophagectomy for case with ARSA and NRILN. We identified these anomalies during esophagectomy, and we could complete surgery without injury these vessels and nerves. The patient had an uneventful recovery and discharged 22 days after surgery. CONCLUSIONS: Semi-prone thoracoscopic esophagectomy for esophageal carcinoma can be performed safely with a wide operative field, and is an excellent procedure for dissecting esophageal carcinoma in patients with ARSA and NRILN.


Assuntos
Carcinoma , Neoplasias Esofágicas , Idoso , Carcinoma/cirurgia , Anormalidades Cardiovasculares , Neoplasias Esofágicas/patologia , Esofagectomia/métodos , Humanos , Excisão de Linfonodo , Masculino , Nervo Laríngeo Recorrente/patologia , Nervo Laríngeo Recorrente/cirurgia , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
10.
Ann Card Anaesth ; 25(2): 214-216, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35417974

RESUMO

Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left-sided double-lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances.


Assuntos
Esofagectomia , Ventilação Monopulmonar , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Humanos , Intubação Intratraqueal/métodos , Pulmão , Ventilação Monopulmonar/métodos
12.
BJS Open ; 6(2)2022 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-35451010

RESUMO

BACKGROUND: Anastomotic leakage (AL) after oesophagectomy and oesophageal perforations are associated with significant morbidity and mortality. Minimally invasive endoscopy is often used as first-line treatment, particularly endoluminal vacuum therapy (EVT). The aim was to assess the performance of the first commercially available endoluminal vacuum device (Eso-Sponge®) in the management of AL and perforation of the upper gastrointestinal tract (GIT). METHODS: The Eso-Sponge® registry was designed in 2014 as a prospective, observational, national, multicentre registry. Patients were recruited with either AL or perforation within the upper GIT. Data were collected with a standardized form and transferred into a web-based platform. Twenty hospitals were enrolled at the beginning of the study (registration number NCT02662777; http://www.clinicaltrials.gov). The primary endpoint was successful closure of the oesophageal defect. RESULTS: Eleven out of 20 centres recruited patients. A total of 102 patients were included in this interim analysis; 69 patients with AL and 33 with a perforation were treated by EVT. In the AL group, a closure of 91 per cent was observed and 76 per cent was observed in the perforation group. The occurrence of mediastinitis (P = 0.002) and the location of the defect (P = 0.008) were identified as significant predictors of defect closure. CONCLUSIONS: The Eso-Sponge® registry offers the opportunity to collate data on EVT with a uniform, commercially available product to improve standardization. Our data show that EVT with the Eso-Sponge® is an option for the management of AL and perforation within the upper GIT.


Assuntos
Fístula Anastomótica , Tratamento de Ferimentos com Pressão Negativa , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Endoscopia Gastrointestinal , Esofagectomia/efeitos adversos , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Estudos Prospectivos , Sistema de Registros
13.
Cir Esp (Engl Ed) ; 100(4): 229-233, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35431165

RESUMO

INTRODUCTION: Esophageal cancer represents the eighth neoplasm worldwide. The therapeutic approach is interdisciplinary, with surgery being the most effective option. Several techniques have been proposed to perform esophagogastrostomy after esophagectomy, among them mechanical triangular esophagogastrostomy (MT), with a little experience published in the Western literature on the latter. The objective of this study is to describe the technical aspects and initial results of MT anastomosis. METHODS: A retrospective review of the patients who underwent esophagectomy according to the McKeown technique was performed, those in which MT anastomosis was implemented, between October 2017 and March 2020 in our hospital. RESULTS: 14 patients were included, with a mean age of 63 years. The mean operative time was 436 min (360-581), being diagnosed of anastomotic leak (AL) 3 of the 14 patients (21.4%), as well as 3 patients presented anastomotic stenosis (AS). The median stay was 20 days, without any death in the series. DISCUSSION: Multiple publications suggest the superiority in terms of AL and AS of the mechanical triangular anastomosis, which was also observed in our series, in which despite the small sample, a rapid improvement was observed in the indicators after the first cases. Therefore, this type of anastomosis may be a safe option for performing esophagogastric anastomosis after esophagectomy, being necessary more definitive conclusive studies.


Assuntos
Neoplasias Esofágicas , Esofagoplastia , Anastomose Cirúrgica/métodos , Fístula Anastomótica/cirurgia , Constrição Patológica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Pessoa de Meia-Idade
15.
J Am Coll Surg ; 234(5): 910-917, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426405

RESUMO

BACKGROUND: A biologic, degradable extracellular matrix (ECM) has been shown to support esophageal tissue remodeling, which could reduce the risk of anastomotic leak following total gastrectomy and esophagectomy. We evaluated the safety and efficacy of reinforcing the anastomosis with ECM in reducing anastomotic leak as compared to a matched cohort. STUDY DESIGN: In this single-center, nonrandomized phase II trial, gastric or esophageal adenocarcinoma patients undergoing total gastrectomy or esophagectomy were recruited from November 2013 through December 2018. ECM was surgically wrapped circumferentially around the anastomosis. Anastomotic leak was assessed clinically and by contrast study and defined as clinically significant if requiring invasive treatment (grade 3 or higher). Anastomotic stenosis, other adverse events, symptoms, and dysphagia score were collected by standardized forms at regular follow-up visits at approximately postoperative days (POD) 21 and 90. Patients receiving ECM were compared to a cohort matched for surgery type and age. RESULTS: ECM placement was not feasible in 9 of 75 patients (12%), resulting in 66 patients receiving ECM. Total gastrectomy was performed in 50 patients (76%) and esophagectomy in 16 (24%). Clinically significant anastomotic leak was diagnosed in 6 of 66 patients (9.1%) (3/50 [6.0%] after gastrectomy, 3/16 [18.8%] after esophagectomy); this rate did not differ from that in the matched cohort (p = 0.57). Stenosis requiring invasive treatment occurred in 8 patients (12.5%), and 10 patients (15.6%) reported not being able to eat a normal diet at POD 90. No adverse events related to ECM were reported. CONCLUSIONS: Esophageal anastomotic reinforcement after total gastrectomy or esophagectomy with a biologic, degradable ECM was mostly feasible and safe, but was not associated with a statistically significant decrease in anastomotic leak.


Assuntos
Anastomose Cirúrgica , Neoplasias Esofágicas , Esofagectomia , Gastrectomia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Constrição Patológica/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Matriz Extracelular , Gastrectomia/efeitos adversos , Humanos
16.
Ther Umsch ; 79(3-4): 181-187, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35440190

RESUMO

Minimally Invasive Esophagectomy for Esophageal Cancer Abstract. Oncological esophagectomy with gastric pull up and intrathoracic represents the standard surgical procedure in the curative treatment of malignant tumors of the esophagus and the esophagogastric junction. The procedure, as two or three body cavities are accessed, has a natural level of invasiveness, which suggests lowering the surgical trauma using minimally invasive surgery (MIS). Because of the complexity of the surgical procedure, minimally invasive esophagectomy is an operation with relevant surgical learning curve. As of now, two principally different minimally invasive techniques for esophageal resection are established in clinical routine in specialized centers, the conventional laparoscopy/thoracoscopy based method and the robotic approach. Benefits of minimally invasive esophagectomy are reduced pulmonary complications and reduced postoperative pain. The surgical radicality of both minimally invasive techniques is at least comparable to the open approach and combined MIS/open approach, long-term survival outcomes from randomized controlled trials are pending. The robotic surgical technology has evolved dramatically over the last decade and oncological esophagectomy offers meaningful opportunity for application. Due to further technological progress, robotic surgery is expected to play an even more important role in the future. Focusing on the direct comparison of conventional minimally invasive esophagectomy and robotic-assisted esophagectomy, the randomized ROBOT-2 trial will reveal important evidence.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Toracoscopia/métodos , Resultado do Tratamento
18.
Front Immunol ; 13: 848881, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35371089

RESUMO

Background: Immunotherapy has become a pillar of advanced solid tumors treatment. Patients are more likely to benefit from neoadjuvant immunotherapy compared with traditional neoadjuvant therapy. However, the safety and efficacy of neoadjuvant immunotherapy for the treatment of locally advanced, surgically resectable Esophageal squamous cell carcinoma (ESCC) remain unknown. Method: ESCC patients who received neoadjuvant treatment following minimally invasive esophagogastrostomy were enrolled from June 2020 to September 2021. The characteristics of neoadjuvant treatment and surgery were investigated to determine the safety and efficacy of the neoadjuvant combination of chemotherapy and immunotherapy (NCI). Results: A total of 149 patients were included in the study. Patient ratio was 40:109 between NCI and neoadjuvant chemotherapy plus radiotherapy (NCR) groups. No significant difference was found in terms of pathological characteristics, including ypN stage, ypTNM stage, differentiation, lymphovascular invasion, perineural invasion, pathological complete regression and tumor regression score, and these parameters were not correlated with NCI or NCR (all p>0.05). Regarding to the operation, the NCI group had less blood loss (49.25 ± 13.47 vs. 57.02 ± 47.26, p<0.001), and shorter operation time (247.75 ± 28.28 vs. 285.83 ± 52.43, p<0.001) than the NCR group. Additionally, the NCI group demonstrated a lower rate of overall perioperative complications (p=0.003) and grade >2 perioperative complications (p=0.042) than the NCR group. Conclusion: Overall, the findings reported here indicate NCI could result in better outcome and less complications to locally advanced ESCC patients compared with NCR therapy. As a novel therapeutic option, the efficacy and safety of NCI appears to be feasible and safe, while long-term survival data is still needed.


Assuntos
Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/patologia , Carcinoma de Células Escamosas do Esôfago/terapia , Esofagectomia/efeitos adversos , Humanos , Imunoterapia , Terapia Neoadjuvante/efeitos adversos
19.
Ther Umsch ; 79(3-4): 201-207, 2022 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-35440188

RESUMO

Complications and Management of Complications After Resection and Reconstruction of the Esophagus Abstract. A curative therapy of advanced esophagus carcinoma is primarily made possible by radical esophagectomy with lymphadenectomy. Impressive advances in the surgical techniques of esophageal surgery through minimally invasive and robotic oesophagectomy have been made in the last two decades. The perioperative management with prehabilitation, PDK application, early mobilization and early food intake also contributed significantly to a reduction in complications. However, esophageal surgery is fraught with complications. Anastomotic leakage is the most common technical-surgical complication. The rate is approximately 10-16%, independent of the technique and procedure. In addition to an experienced, subtle, atraumatic and rapid surgical technique, early detection (clinical, endoscopic, radiological) and adequate, interdisciplinary management of perioperative complications in resecting esophageal surgery are the key to increasing the safety of these complex interventions. The treatment of the complications includes conservative, interventional and surgical measures. In the last few decades, there has been a radical change from once exclusively surgical revisions with a high degree of invasiveness and a poor outcome to today's mostly conservative-interventional management with little patient burden and - in centers with the appropriate expertise - good results.


Assuntos
Neoplasias Esofágicas , Laparoscopia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
20.
PLoS One ; 17(3): e0265093, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263385

RESUMO

BACKGROUND: Concomitant liver cirrhosis is a crucial risk factor for major surgeries. However, only few data are available concerning cirrhotic patients requiring esophagectomy for malignant disease. METHODS: From a prospectively maintained database of esophageal cancer patients, who underwent curative esophagectomy between 01/2012 and 01/2016, patients with concomitant liver cirrhosis (liver-cirrhotic patients, LCP) were compared to non-liver-cirrhotic patients (NLCP). RESULTS: Of 170 patients, 14 cirrhotic patients with predominately low MELD scores (≤ 9, 64.3%) were identified. Perioperative outcome was significantly worse for LCP, as proofed by 30-day (57.1% vs. 7.7, p<0.001) and 90-day mortality (64.3% vs. 9.6%, p<0.001), anastomotic leakage rate (64.3 vs. 22.3%, p = 0.002) and sepsis (57.1 vs. 21.5%, p = 0.006). Even after adjustment for age, gender, comorbidities, and surgical approach, LCP revealed higher odds for 30-day and 90-day mortality compared to NLCP. Moreover, 5-year survival analysis showed a significantly poorer long-term outcome of LCP (p = 0.023). For risk stratification, none of the common cirrhosis scores proved prognostic impact, whereas components as Bilirubin (auROC 94.4%), INR (auROC = 90.0%), and preoperative ascites (p = 0.038) correlated significantly with the perioperative outcome. CONCLUSION: Curative esophagectomy for cirrhotic patients is associated with a dismal prognosis and should be evaluated critically. While MELD and Child score failed to predict perioperative mortality, Bilirubin and INR proofed excellent prognostic capacity in this cohort.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Bilirrubina , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
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