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1.
J Surg Res ; 257: 267-277, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862055

RESUMO

BACKGROUND: MicroRNAs have been reported to play regulatory functions in various cancers, including esophageal cancer. The aim of this study was to investigate the effects of miR-140 on the progression of esophageal cancer and the underlying regulatory mechanism. METHODS: The levels of miR-140 and zinc finger E-box-binding homeobox 2 (ZEB2) messenger RNA in esophageal cancer tissues and cell lines were measured by quantitative real-time polymerase chain reaction. The protein levels of ZEB2, ß-catenin, c-Myc, and cyclinD1 were determined by Western blot. Cell proliferation and apoptosis were determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide assay and flow cytometry, respectively. Cell migration and invasion were assessed by transwell assay. In addition, the relationship between miR-140 and ZEB2 was predicted by TargetScan online database and confirmed by dual-luciferase reporter assay. The tumor xenograft model was used to verify the role of miR-140 in esophageal cancer progression in vivo. RESULTS: The expression of miR-140 was downregulated whereas ZEB2 expression was upregulated in esophageal cancer tissues compared with paracancerous normal tissues. Functionally, both miR-140 overexpression and ZEB2 knockdown inhibited proliferation, migration, and invasion and induced apoptosis in esophageal cancer cells. ZEB2 overexpression reversed the effects of miR-140 on proliferation, apoptosis, migration, and invasion of esophageal cancer cells. Mechanistically, ZEB2 was identified as a target of miR-140. Furthermore, miR-140 suppressed Wnt/ß-catenin pathway by regulating ZEB2 expression in esophageal cancer cells. MiR-140 inhibited tumor growth of esophageal cancer through repressing ZEB2 expression in vivo. CONCLUSIONS: Our results demonstrated that miR-140 inhibited esophageal cancer development by targeting ZEB2 through inactivating Wnt/ß-catenin pathway.


Assuntos
Neoplasias Esofágicas/genética , Regulação Neoplásica da Expressão Gênica , MicroRNAs/metabolismo , Via de Sinalização Wnt/genética , Homeobox 2 de Ligação a E-box com Dedos de Zinco/genética , Animais , Apoptose/genética , Linhagem Celular Tumoral , Movimento Celular/genética , Proliferação de Células/genética , Progressão da Doença , Regulação para Baixo , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Esôfago/patologia , Esôfago/cirurgia , Técnicas de Silenciamento de Genes , Humanos , Camundongos , Invasividade Neoplásica/genética , Estadiamento de Neoplasias , Estudos Retrospectivos , Regulação para Cima , Ensaios Antitumorais Modelo de Xenoenxerto , Homeobox 2 de Ligação a E-box com Dedos de Zinco/metabolismo
2.
J Surg Res ; 257: 433-441, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892142

RESUMO

BACKGROUND: Epidural analgesia (EA) is an appealing adjunct for esophageal and gastric cancer patients. It remains unclear whether EA usage affects postoperative outcomes. There are no national data on the trends of EA utilization for these procedures. This study aims to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to study the utilization and outcomes of EA in open upper GI tract cancer resections. MATERIALS AND METHODS: A retrospective review of NSQIP was performed for patients undergoing open elective esophagectomies and gastrectomies for nonmetastatic cancer between 2014 and 2017. An Armitage trend test was performed. The population was propensity matched and assessed. RESULTS: There were 4802 esophagectomies performed. Twenty-nine percent of patients received EA. Of 2599 gastrectomies, 18% of patients received EA. The recent trends of EA use for esophagectomies (EA range [26.9%, 30.3%] P = 0.6535) and gastrectomies (EA [16.9%, 18.4%], P = 0.7797) remain stable. Propensity matching was performed, and the groups with and without EA were compared. For esophagectomies, EA was associated with blood transfusions (EA 14% versus No EA 10.8%, P = 0.0156). For gastrectomies, EA was associated with longer length of stay (LOS) (EA median [IQR] 8 [7,11] versus No EA 7 [6,11], P = 0.0002). CONCLUSIONS: Despite the current opioid epidemic, the recent trends of EA for esophageal and gastric cancer patients remain stable. EA was associated with blood transfusions for esophagectomies and with a longer LOS for gastrectomies. Therefore, EA should be carefully considered, and its analgesic efficacy in this population should be investigated closely in future studies.


Assuntos
Analgesia Epidural/estatística & dados numéricos , Esofagectomia/estatística & dados numéricos , Gastrectomia/estatística & dados numéricos , Neoplasias/cirurgia , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Adulto Jovem
3.
J Surg Res ; 257: 554-571, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32927322

RESUMO

BACKGROUND: To evaluate the existing literature comparing cardiopulmonary complications after minimally invasive esophagectomy (MIE) with open esophagectomy (OE) and conduct a meta-analysis based on the relevant studies. METHODS: A systematic search for articles was performed in Medline, Embase, Wiley Online Library, and the Cochrane Library. The relative risks or odds ratios (ORs) were calculated by using fixed or random-effects models. The I2 and X2 tests were used to test for statistical heterogeneity. We performed a metaregression for the pulmonary complications with the adenocarcinoma proportion and tumor stage. Publication bias and small-study effects were assessed using Egger's test and Begg's funnel plot. RESULTS: A total of 30,850 participants were enrolled in the 63 studies evaluated in the meta-analysis. Arrhythmia, pulmonary embolism, pulmonary complications, gastric tip necrosis, anastomotic leakage, and vocal cord palsy were chosen as outcomes. The occurrence rate of arrhythmia was significantly lower in patients receiving MIE than in patients receiving OE (OR = 0.69; 95% CI = 0.53-0.89), with heterogeneity (I2 = 30.7%, P = 0.067). The incidence of pulmonary complications was significantly lower in patients receiving MIE (OR = 0.54, 95% CI = 0.45-0.63) but heterogeneity remained (I2 = 72.1%, P = 0.000). The risk of gastric tip necrosis (OR = 1.48, 95% CI = 1.07-2.05) after OE was lower than that after MIE. Anastomotic leakage, pulmonary embolism, and vocal cord palsy showed no significant differences between the two groups. CONCLUSIONS: MIE has advantages over OE, especially in reducing the incidence of arrhythmia and pulmonary complications. Thus, MIE can be recommended as the preferred alternative surgery method for resectable esophageal cancer.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Fístula Anastomótica/etiologia , Arritmias Cardíacas/etiologia , Neoplasias Esofágicas/complicações , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Embolia Pulmonar/etiologia , Paralisia das Pregas Vocais/etiologia
4.
Vasc Health Risk Manag ; 16: 497-505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33273819

RESUMO

Introduction: Ischemia is considered as the main reason for thoracic gastroesophageal anastomotic leaks after esophagectomy. Microcirculatory monitoring with laser Doppler flowmetry and visible light spectroscopy may provide valuable intraoperative real-time information about the gastric tube's tissue perfusion and circulation. Patients and Methods: Ten patients with esophageal cancer operated with minimally invasive esophagectomy participated in this single-center, prospective, observational pilot study. A single probe with laser Doppler flowmetry and visible light spectroscopy was used to perform transserosal microcirculation assessment of the gastric tube at predefined anatomical sites during different operation phases. Group comparison and changes were evaluated using the paired sample t-test. Results: A reduction in StO2 was found at all measuring sites after the gastric tube formation compared with the baseline measurements. The mean StO2 reduction from baseline to gastric tube formation and after anastomosis was 16% (range 4%-28%) and 42% (range, 35%-52%), respectively. A statistically significant increase in the rHb concentration, representing venous congestion, was detected at the most cranial part of the gastric tube (P = 0.04). Three patients developed anastomotic leaks. Conclusion: Intraoperative real-time laser Doppler flowmetry and visible light spectroscopy are feasible and may provide insight to microcirculatory changes in the gastric tube and at the anastomotic site. Patients with anastomotic leaks seem to have critical local tissue StO2 reduction and venous congestion that should be further evaluated in studies with larger sample sizes.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Fluxometria por Laser-Doppler , Microcirculação , Monitorização Intraoperatória/métodos , Estômago/irrigação sanguínea , Estômago/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Análise Espectral , Resultado do Tratamento
5.
PLoS One ; 15(11): e0242223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180871

RESUMO

BACKGROUND: Although proximal gastrectomy (PG) is a recognized surgical procedure for early proximal gastric cancer, total gastrectomy (TG) is sometimes selected due to concern about severe gastroesophageal reflux. Esophagogastrostomy by the double-flap technique (DFT) is an anti-reflux reconstruction after PG, and its short-term effectiveness has been reported. However, little is known about the long-term effects on nutritional status and quality of life (QOL). METHODS: Gastric cancer patients who underwent laparoscopy-assisted PG (LAPG) with DFT or laparoscopy-assisted TG (LATG) between April 2011 and March 2014 were retrospectively analyzed. Body weight (BW), body mass index (BMI), and prognostic nutritional index (PNI) were reviewed to assess nutritional status, and the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 was used to assess QOL. RESULTS: A total of 36 patients (LATG: 17, LAPG: 19) were enrolled. Four of 17 LATG patients (24%) were diagnosed with Stage ≥II after surgery, and half received S-1 adjuvant chemotherapy. BW and PNI were better maintained in LAPG than in LATG patients until 1-year follow-up. Seven of 16 LATG patients (44%) were categorized as "underweight (BMI<18.5 kg/m2)" at 1-year follow-up, compared to three of 18 LAPG patients (17%; p = 0.0836). The PGSAS-45 showed no significant difference in all QOL categories except for decreased BW (p = 0.0132). Multivariate analysis showed that LATG was the only potential risk factor for severe BW loss (odds ratio: 3.03, p = 0.0722). CONCLUSIONS: LAPG with DFT was superior to LATG in postoperative nutritional maintenance, and can be the first option for early proximal gastric cancer.


Assuntos
Estado Nutricional , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Índice de Massa Corporal , Esofagectomia , Feminino , Gastrectomia , Humanos , Estimativa de Kaplan-Meier , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Retalhos Cirúrgicos
7.
Rozhl Chir ; 99(10): 438-446, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242961

RESUMO

INTRODUCTION: Anastomotic leak (AL) is one of the most serious surgical complications after esophagectomy. Endoscopic, radiological and surgical methods are used in the treatment of AL. The aim of this study was to retrospectively evaluate our therapeutic procedures and results of AL treatment after Ivor Lewis esophagectomy (ILE). METHODS: Retrospective audit of all ILEs performed in the years 20052019. Evaluation of AL treatment results according to Esophagectomy Complication Consensus Group (ECCG) classification and according to the primary therapeutic procedure with a focus on the treatment with esophageal stent. RESULTS: Out of 817 patients with ILE, AL was detected in 80 patients (9.8%): ECCG type I 33 (41%), type II 23 (29%) and type III 24 (30%) patients. Some 33 patients (41%) were treated conservatively. Esophageal stents were used in 39 patients (49%), of which 18 (23%) had concomitant percutaneous drainage and 17 (21%) were reoperated. Reoperation without a stent insertion was performed in 7 patients (9%). Esophageal diversion with cervical esophagostomy was performed in a total of 16 patients (20%). Esophageal stent treatment was successful in 24/39 patients (62%). Airway fistula occurred in 4 patients treated with stent (10%). Endoscopic vacuum therapy was successfully used in three patients after stent failure. Eight patients (10%) died as a result of AL. Mortality of AL type I, II and III was 0%, 4% and 29%. CONCLUSION: Successful treatment of AL requires an individual and multidisciplinary approach. The primary effort should aim to preserve anastomosis using endoscopic and radiological methods. In case of insufficient clinical effect, we recommend not to hesitate with reoperation. If primary therapy fails, the life-saving procedure is a cervical esophagostomy.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
9.
Kyobu Geka ; 73(10): 870-875, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130782

RESUMO

According to the aging of society, elderly patients with esophageal cancer have been increasing in Japan. A multimodality treatment strategy is required to achieve long-term survival in patients with advanced-stage esophageal cancer. However, in elderly patients with impaired organ functions, the highly invasive treatment strategy is often difficult to be indicated. Esophagectomy remains the mainstay of treatment even in the elderly. Indication for esophagectomy in the elderly should be determined comprehensively, based on the physical status, life expectancy, tumor staging, and patients' desires. To predict the risk of postoperative complications, some scoring systems, such as estimation of physiology ability and surgical stress( E-PASS) and controlling nutritional status(CONUT), and the risk calculator provided by the National Clinical Database in Japan should be appropriately used. For patients with impaired organ functions, surgical procedures to reduce the surgical invasiveness, such as 2-stage operation, transhiatal esophagectomy, and mediastinoscopic esophagectomy, should be considered as an alternative to conventional transthoracic esophagectomy and reconstruction. Depending on the situations, preservation of the bronchial artery, thoracic duct, and azygos arch should be considered. A care bundle by a multidisciplinary perioperative management team may decrease postoperative morbidity and mortality rates in elderly patients undergoing esophagectomy.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Idoso , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Humanos , Japão , Mediastinoscopia , Estadiamento de Neoplasias , Complicações Pós-Operatórias
10.
Kyobu Geka ; 73(10): 883-886, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130784

RESUMO

Definitive chemo-radiotherapy (CRT) in locally advanced esophageal cancer is associated with a high rate of loco-regional recurrence. In this condition, salvage esophagectomy may be considered as a therapeutic option. Despite the survival benefits of this combined approach, salvage esophagectomy remains a highly invasive procedure that confers a significant rate of morbidity and mortality and can adversely affect long-term quality of life. So careful evaluation is needed before the decision of the indication for salvage surgery. In order to prevent postoperative morbidity or mortality in patients underwent salvage esophagectomy, modifications in the surgical procedures, including minification of lymph node dissection and conversion to 2-stage surgery, are needed. Especially, it was necessary to pay attention to preserve blood flow of trachea. As aspiration pneumonia is sometimes fatal in patients after salvage esophagectomy, care to avoid aspiration is needed. Respiratory care is also essential during the follow-up period as well as perioperative period in patients who underwent salvage esophagectomy. Although salvage esophagectomy is considered a high-risk surgery, if indication for surgery was appropriate, that could be the only way which could prolong survival of locally advanced esophageal cancer patients after CRT.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Recidiva Local de Neoplasia/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Terapia de Salvação
11.
Kyobu Geka ; 73(10): 887-891, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130785

RESUMO

Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility. When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis.


Assuntos
Neoplasias Esofágicas , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Jejuno/cirurgia , Retalhos Cirúrgicos
12.
Medicine (Baltimore) ; 99(41): e22263, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031267

RESUMO

BACKGROUND: Oesophageal cancer is one of the most common malignant tumors and has been identified as one of the leading causes of cancer death worldwide. Surgery is considered to be the optimal treatment for patients with resectable oesophageal cancer. Oesophagectomy for oesophageal cancer can significantly extend the survival period of patients and provide a potential opportunity for a cure. However, there is still controversy regarding application of neck anastomotic muscle flap embedded. This systematic review and meta-analysis will be performed to determine whether the application of neck anastomotic muscle flap embedded would benefit patients more. METHODS: We will search PubMed, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and Google Scholar databases for relevant clinical trials published in any language before October 1, 2020. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, tumor pathological stage, and ethnicity will be performed. INPLASY registration number: INPLASY202080059. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: As far as we know, this study will be the first meta-analysis to compare the efficacy of the application of neck anastomotic muscle flap embedded in 3-incision radical resection of oesophageal carcinoma. Due to the nature of the disease and intervention methods, RCTs may be inadequate, and we will carefully consider inclusion in high-quality, non-RCTs, but this may result in high heterogeneity and affect the reliability of the results.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Músculos do Pescoço/transplante , Projetos de Pesquisa , Retalhos Cirúrgicos , Anastomose Cirúrgica , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
13.
Khirurgiia (Mosk) ; (9): 5-13, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33029996

RESUMO

OBJECTIVE: To describe the methodology of laparothoracoscopic Ivor Lewis esophagectomy in surgical treatment of esophageal cancer and compare early outcomes of this procedure with conventional Ivor Lewis surgery. MATERIAL AND METHODS: There were 30 laparothoracoscopic Ivor Lewis esophagectomies followed by non-hardware esophageal-gastric intrapleural anastomosis for esophageal cancer. All procedures have been performed for the period 2016-2019 at the Moscow Regional Research and Clinical Institute (suturing of anastomosis was based on the method of professor A.S. Allakhverdyan). RESULTS: Laparothoracoscopic esophagectomy is characterized by higher surgery time by 136.57 min (p=0.012), less duration of anesthesia and mechanical ventilation by 77.5 min (p=0.042), postoperative ICU-stay by 2.25 hours (p=0.021), blood loss by 550 ml (p=0,000), duration of postoperative fasting by 2 days (p=0.034), hospital-stay by 8 days (p=0.021) compared to open esophagectomy. There were no significant between-group differences in the number of resected lymph nodes (p=0.142). Incidence of esophageal-gastric anastomosis failure is insignificantly higher in the OE group (χ2=1.89; p=0.075). Incidence of pulmonary complications (pneumonia, chylothorax, paresis of the vocal cords, pleural empyema) is less in the LTSE group (p<0.05). Cardiovascular morbidity is significantly lower in the LTSE group (p<0.05). A 30-day mortality rate was similar in both groups (χ2=2.56; p=0.0253). CONCLUSION: Early results of laparothoracoscopic Ivor Lewis esophagectomy are superior to the results of conventional Ivor Lewis surgery in surgical treatment of esophageal cancer.


Assuntos
Esofagectomia , Esôfago/cirurgia , Estômago , Anastomose Cirúrgica , Humanos , Moscou , Estudos Retrospectivos , Estômago/cirurgia
14.
Am Surg ; 86(10): 1411-1417, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33074734

RESUMO

INTRODUCTION: Anastomotic leak is a dreaded complication following esophagectomy. Conventional management for leaks includes invasive reoperation and even gastrointestinal diversion. OBJECTIVE: The aim of this study was to examine our contemporary outcome of using endoscopic esophageal stenting as primary therapy for management of anastomotic leak following minimally invasive esophagectomy (MIE). METHODS: We reviewed data on 11 patients who developed an esophageal leak following 111 MIE between January 2011 and December 2019. Of the 11 anastomotic leaks, 10 patients had an anastomotic disruption and underwent endoscopic esophageal stenting as primary therapy for management of leaks, while 1 patient had an anastomotic disruption complicated by an associated tracheoesophageal fistula that required surgical reoperation and subsequent colonic interposition. Main outcome measures focused on the 10 patients who were managed with endoscopic stenting, including length of hospital stay following leak management, need for thoracotomy or gastrointestinal diversion for leak, stent complications, and leak-associated mortality. RESULTS: Of the 10 patients who underwent endoscopic esophageal stenting as primary therapy for management of leaks, there were 8 males with a median age of 66 years. The median time to diagnosis of anastomotic leak was 10 days postoperatively. One of the ten patients also underwent percutaneous drain placement, while none of the patients required thoracotomy. Median duration of stent placement was 39 (range, 29-105) days. Median length of stay after stent placement was 10 (range, 4-43) days. The median number of stent exchange was 1 (range, 1-3) stent. Gastrointestinal continuity was maintained in all patients. The 90-day leak-associated mortality was 9.1% (1 of 11 patients). CONCLUSIONS: Endoscopic stenting is an effective primary therapy in the management of postesophagectomy leak and avoids the need for an invasive, reoperative thoracotomy or gastrointestinal diversion procedure.


Assuntos
Fístula Anastomótica/terapia , Esofagectomia , Esofagoscopia/métodos , Stents , Idoso , Anastomose Cirúrgica , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino
15.
Br J Anaesth ; 125(6): 953-961, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33092805

RESUMO

BACKGROUND: Transthoracic oesophagectomy is associated with major morbidity and mortality, which may be reduced by goal-directed therapy (GDT). The aim of this multicentre, RCT was to evaluate the impact of intraoperative GDT on major morbidity and mortality in patients undergoing transthoracic oesophagectomy. METHODS: Adult patients undergoing transthoracic oesophagectomy were randomised to receive either minimally invasive intraoperative GDT (stroke volume variation <8%, plus systolic BP maintained >90 mm Hg by pressors as necessary) or haemodynamic management left to the discretion of attending senior anaesthetists (control group; systolic BP >90 mm Hg alone). The primary outcome was the incidence of death or major complications (reoperation for bleeding, anastomotic leakage, pneumonia, reintubation, >48 h ventilation). A Cox proportional hazard model was used to examine whether the effects of GDT on morbidity and mortality were independent of other potential confounders. RESULTS: A total of 232 patients (80.6% male; age range: 36-83 yr) were randomised to either GDT (n=115) or to the control group (n=117). After surgery, major morbidity and mortality were less frequent in 22/115 (19.1%) subjects randomised to GDT, compared with 41/117 (35.0%) subjects assigned to the control group {absolute risk reduction: 15.9% (95% confidence interval [CI]: 4.7-27.2%); P=0.006}. GDT was also associated with fewer episodes of atrial fibrillation (odds ratio [OR]: 0.18 [95% CI: 0.05-0.65]), respiratory failure (OR: 0.27 [95% CI: 0.09-0.83]), use of mini-tracheotomy (OR: 0.29 [95% CI: 0.10-0.81]), and readmission to ICU (OR: 0.09 [95% CI: 0.01-0.67]). GDT was independently associated with morbidity and mortality (hazard ratio: 0.51 [95% CI: 0.30-0.87]; P=0.013). CONCLUSIONS: Intraoperative GDT may reduce major morbidity and mortality, and shorten hospital stay, after transthoracic oesophagectomy. CLINICAL TRIAL REGISTRATION: UMIN000018705.


Assuntos
Esofagectomia/mortalidade , Hidratação/mortalidade , Hidratação/métodos , Cuidados Intraoperatórios/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagectomia/métodos , Feminino , Humanos , Cuidados Intraoperatórios/mortalidade , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 1008-1012, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33054000

RESUMO

The incidence of adenocarcinoma of the esophagogastric junction (AEG) continues to rise. While many treatment modalities are available, surgery is still the basis of comprehensive treatment of AEG. Siewert type II AEG, is more controversial than the other two types in terms of lymph node metastasis, surgical approach, extent of resection, and digestive tract reconstruction. When the distance of the superior tumor margin is more than 3 cm proximal to the EGJ line is more than 3 cm, thorough mediastinal lymph node dissection should be performed through thoracic approach. Total gastrectomy is the treatment of choice for Siewert type II tumors. When the tumor stage is in an early stage, the length of the tumor is ≤4 cm, and esophageal involvement is less than 3 cm, transthoracic esophagectomy plus proximal gastrectomy is feasible. The digestive tract reconstruction can be based on the experience of the operator and patient's choice of conditions.


Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Junção Esofagogástrica , Neoplasias Gástricas , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Junção Esofagogástrica/cirurgia , Gastrectomia , Humanos , Neoplasias Gástricas/cirurgia
18.
Medicine (Baltimore) ; 99(40): e22479, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019440

RESUMO

RATIONALE: Late-onset anastomotic leak (AL) is an uncommon but potentially lethal complication after esophagectomy. PATIENT CONCERNS: A 74-year-old male patient was readmitted due to chest distress and chills about 3 months after initial esophagectomy for cancer. DIAGNOSES: The previous endoscopic biopsy revealed primary esophageal squamous cell carcinoma, and sweet esophagectomy with gastric conduit reconstruction was therefore performed. The patient developed AL 3 months after the surgery. INTERVENTIONS: Naso-leakage extraluminal drainage tube was utilized because the symptoms of the patient were aggravated 1 month after the chest tube drainage since his second admission for AL. OUTCOMES: Twenty-one days after naso-leakage extraluminal drainage, the computed tomography images showed the healing of the leakage. Then the patient was discharged from the hospital. LESSONS: Late-onset AL should be kept in mind when the patient complained of chest distress and fever during the follow up after esophagectomy. In addition, naso-leakage extraluminal drainage could be considered for the treatment of AL. Further trials for better evidence are warranted.


Assuntos
Fístula Anastomótica/etiologia , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Fístula Anastomótica/patologia , Esofagectomia/métodos , Humanos , Masculino , Complicações Pós-Operatórias/patologia
19.
BMC Surg ; 20(1): 197, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917177

RESUMO

BACKGROUND: Although considered complex and challenging, esophagectomy remains the best potentially curable treatment option for resectable esophageal and esophagogastric junction (AEG) carcinomas. The optimal surgical approach and technique as well as the extent of lymphadenectomy, particularly regarding quality of life and short- and long-term outcomes, are still a matter of debate. To lower perioperative morbidity, we combined the advantages of a one-cavity approach with extended lymph node dissection (usually achieved by only a two-cavity approach) and developed a modified single-cavity transhiatal approach for esophagectomy. METHODS: The aim of this study was to evaluate the outcome of an extended transhiatal esophageal resection with radical bilateral mediastinal en bloc lymphadenectomy (eTHE). A prospective database of 166 patients with resectable cancers of the esophagus (including adenocarcinomas of the AEG types I and II) were analyzed. Patients were treated between 2001 and 2017 with eTHE at a tertiary care university center. Relevant patient characteristics and outcome parameters were collected and analyzed. The primary endpoint was 5-year overall survival. Secondary outcomes included short-term morbidity, mortality, radicalness of en bloc resection and oncologic efficacy. RESULTS: The overall survival rates at 1, 3 and 5 years were 84, 70, and 61.0%, respectively. The in-hospital mortality rate after eTHE was 1.2%. Complications with a Clavien-Dindo score of III/IV occurred in 31 cases (18.6%). A total of 25 patients (15.1%) had a major pulmonary complication. The median hospital stay was 17 days (interquartile range (IQR) 12). Most patients (n = 144; 86.7%) received neoadjuvant treatment. The median number of lymph nodes resected was 25 (IQR 17). The R0 resection rate was 97%. CONCLUSION: In patients with esophageal cancer, eTHE without thoracotomy resulted in excellent long-term survival, an above average number of resected lymph nodes and an acceptable postoperative morbidity and mortality.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Estudos de Coortes , Feminino , Humanos , Excisão de Linfonodo , Masculino , Complicações Pós-Operatórias/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
20.
J Surg Oncol ; 122(8): 1616-1623, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32989770

RESUMO

OBJECTIVE: The aim was to compare leak rate between hand-sewn end-to-end anastomosis (ETE) and semi-mechanical anastomosis (SMA) after esophagectomy with gastric tube reconstruction. BACKGROUND DATA: The optimal surgical technique for creation of an anastomosis in the neck after esophagectomy is unclear. METHODS: Patients with esophageal cancer undergoing esophagectomy with gastric tube reconstruction and cervical anastomosis were eligible for participation after written informed consent. Patients were randomized in 1:1 ratio. Primary endpoint was anastomotic leak rate defined as external drainage of saliva from the site of the anastomosis or intra-thoracic manifestation of leak. Secondary endpoints included anastomotic stricture rate at one year follow up, number of endoscopic dilatations, dysphagia-score, hospital stay, morbidity, and mortality. Patients were blinded for intervention. RESULTS: Between August 2011 and July 2014, 174 patients with esophageal cancer underwent esophagectomy. Ninety-three patients were randomized to ETE (n = 44) or SMA (n = 49). Anastomotic leak occurred in 9 of 44 patients (20%) in the ETE group and 12 of 49 patients (24%) in the SMA group (absolute difference 4%, 95% CI -13% to +21%; p = .804). There was no significant difference in dysphagia at 1 year postoperatively (ETE 25% vs. SMA 20%; p = .628), in stricture rate (ETE 25% vs. 19% in SMA, p = .46), nor in median hospital stay (17 days in the ETE group, 13 days in the SMA group), morbidity (82% vs. 73%, p = .460) or mortality (0% vs. 4%, p = .175) between the groups.


Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/métodos , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/métodos , Tempo de Internação/estatística & dados numéricos , Grampeamento Cirúrgico/métodos , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/classificação , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Método Simples-Cego
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