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1.
Medicine (Baltimore) ; 100(11): e25138, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725995

RESUMO

BACKGROUND: Gastrointestinal complications and malnutrition are common problems that affect postoperative rehabilitation and survival of patients with esophageal cancer. Evidence has shown that probiotics have a positive effect on improving gastrointestinal complications and nutritional status of patients with esophageal cancer after surgery, but there is a lack of prospective studies on this topic. We designed this prospective randomized controlled trial to evaluate the effects of probiotics on gastrointestinal complications and nutritional status in patients with postoperative esophageal cancer. METHODS: This is a prospective, randomized, double-blind, placebo-controlled trial. It was approved by the Clinical Research Ethics Committee of our hospital. 192 patients will be randomly divided into probiotics group and the placebo group in a 1:1 ratio. After operation, probiotics and placebo will be given orally for 8 weeks. The indexes of nutritional status and incidence of digestive tract complications will be recorded and the data will be analyzed by SPSS 18.0 software. DISCUSSION: This study will evaluate the effect of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer. The results of this study will provide clinical basis for the use of probiotics in postoperative treatment of esophageal cancer. TRIAL REGISTRATION: OSF Registration number: D DOI 10.17605/OSF.IO/QHW86.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Gastroenteropatias/terapia , Desnutrição/terapia , Complicações Pós-Operatórias , Probióticos/uso terapêutico , Adulto , Método Duplo-Cego , Neoplasias Esofágicas/microbiologia , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/microbiologia , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/microbiologia , Pessoa de Meia-Idade , Estado Nutricional , Período Pós-Operatório , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
2.
Khirurgiia (Mosk) ; (2): 20-26, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570350

RESUMO

OBJECTIVE: To report our initial experience of robot-assisted McKeown esophagectomy with stapled cervical esophagogastrostomy. MATERIAL AND METHODS: There were 5 robot-assisted McKeown esophagectomies in patients with benign end-staged and malignant diseases of the esophagus for the period from October 2019 to February 2020. RESULTS: No conversions and intraoperative complications were observed. Mean surgery time was 406±48 min, total intraoperative blood loss - 108±45 ml. Four patients had minor complications (wound infection, atelectasis, pneumothorax) that required conservative treatment. We have controlled anastomosis in 2-3 postoperative days with water-soluble contrast, none patient had an anastomotic leakage. Mean hospital-stay was 5 days. Complete (R0) resection was accomplished in all patients with malignant neoplasms. CONCLUSIONS: Our first experience showed that robot-assisted McKeown esophagectomy is a safe and feasible surgical option for esophageal diseases. Robot-assisted interventions require advanced endoscopic surgical experience.


Assuntos
Neoplasias Esofágicas , Esofagectomia/métodos , Esôfago/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Estômago/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Cirurgia Bariátrica , Doenças do Esôfago/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Pescoço , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
4.
BMC Surg ; 21(1): 1, 2021 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-33388031

RESUMO

BACKGROUND: The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied. METHODS: A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90 mm Hg lasting more than 5 min, was recorded. Patients' 30 days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables. RESULT: A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54 years. The mean duration of the surgery was 208 min. Intraoperative mean low SBP was 80 mmHg while the lowest record was 55 mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26-6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22-9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14-1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP < 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p = 0.16) CONCLUSION: In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure < 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Hipotensão/etiologia , Anastomose Cirúrgica , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Feminino , Humanos , Hipotensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
5.
Anticancer Res ; 41(1): 453-458, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419843

RESUMO

BACKGROUND AND AIM: Anastomotic leakage, the most common major complication after esophagectomy, is an important early postoperative complication that results in reoperation, delayed discharge, and psychological and financial distress. The current study focused on gastric conduit blood flow and investigated the relationship between gastric conduit temperature and anastomotic leakage. PATIENTS AND METHODS: Between July 2015 and December 2017, a total of 51 patients aged 38 to 84 years who underwent esophagectomy followed by esophagogastric anastomosis with gastric conduit reconstruction were enrolled. Thermography was then used to measure the temperature of the intact stomach and gastric conduit before anastomosis. RESULTS: The temperature of the planned site of gastric conduit anastomosis was significantly inversely correlated with anastomotic leakage, with the receiver operator characteristic curve showing a cutoff point of 27.6°C for predicting anastomotic leakage. CONCLUSION: The temperature of the planned gastric tube anastomosis line should be kept at 27.6°C or higher to reduce anastomotic leakage.


Assuntos
Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/complicações , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos , Estômago/cirurgia , Termografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Temperatura Corporal , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Termografia/métodos
6.
BMC Surg ; 21(1): 42, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461529

RESUMO

BACKGROUND: Anastomotic leakage (AL) is a common and serious complication following esophagectomy. We aimed to provide an up-to-date review and critical appraisal of the efficacy and safety of all previous interventions aiming to reduce AL risk. METHODS: We searched MEDLINE and Embase from 1946 to January 2019 for randomized controlled trials (RCTs) evaluating interventions to minimize esophagogastric AL. Pooled risk ratios (RR) for AL were obtained using a random effects model. RESULTS: Two reviewers screened 441 abstracts and identified 17 RCTs eligible for inclusion; 11 studies were meta-analyzed. Omentoplasty significantly reduced the risk of AL by 78% [RR: 0.22; 95% CI: 0.10, 0.50] compared to conventional anastomosis (3 studies, n = 611 patients). Early removal of NG tube significantly reduced the risk of AL by 62% [RR: 0.38; 95% CI: 0.02, 0.65] compared to prolonged NG tube removal (2 studies, n = 293 patients); Stapled anastomosis did not significantly reduce the risk of AL [RR: 0.92; 95% CI: 0.45, 1.87] compared to hand-sewn anastomosis (6 studies, n = 1454 patients). The quality of evidence was high for omentoplasty (vs. conventional anastomosis), moderate for early NG tube removal (vs. prolonged NG tube removal), and very low for stapled anastomosis (vs. hand-sewn anastomosis). CONCLUSIONS: This is the first meta-analysis to summarize the graded quality of evidence for all RCT interventions designed to reduce the risk of AL following esophagectomy. Our findings demonstrated that omentoplasty significantly reduced the risk of AL with a high quality of evidence. Although early NG tube removal significantly reduced AL risk, there is a need for further research to strengthen the quality of evidence for this finding. Evidence profiles presented in our review may help inform the development of future clinical practice recommendations. Systematic review registration: CRD42019127181.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/prevenção & controle , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/patologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
J Thorac Cardiovasc Surg ; 161(3): 822-832.e6, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33451846

RESUMO

OBJECTIVES: To (1) measure 4 physiologic metrics before esophagectomy, (2) use these in an index to predict composite postoperative outcome after esophagectomy, and (3) compare predictive accuracy of this index to that of the Fried Frailty Index and Modified Frailty Index. METHODS: Grip strength (kilograms), 30-second chair sit-stands (number), 6-minute walk distance (meters), and normalized psoas muscle area (cm2/m) were measured for 77 consenting patients from January 1, 2018, to April 1, 2019. Imbalanced random forest classification estimated probability of a composite postoperative outcome, which included mortality, respiratory complications, anastomotic leak, delirium, length of stay ≥14 days, discharge to nursing facility, and readmission. G-mean error was used to compare predictive accuracy among indexes. RESULTS: Median grip strength was 38 kg (25th-75th percentiles, 31-44), number of sit-stands 11 (10-14), psoas muscle area to height ratio 6.9 cm2/m (6.0-8.2), and 6-minute walk distance 407 m (368-451). There was generally weak correlation between these metrics, with the highest between 30-second sit-stands and 6-minute walk distance (r = 0.57). Age, degree of patient-reported exhaustion, and the 4 objective metrics comprised the Esophageal Vitality Index, which had a lower G-mean error of 32% (31-33) than the Fried Frailty Index, 37% (37-38), and the Modified Frailty Index, 48% (47-48). CONCLUSIONS: The Esophageal Vitality Index, an objective, simple assessment consisting of grip strength, 30-second chair sit-stands, 6-minute walk, and psoas muscle area to height ratio outperformed commonly used frailty indexes in predicting postesophagectomy mortality and morbidity. The index provides a robust picture of patients' fitness for surgery beyond the qualitative "eyeball" test.


Assuntos
Técnicas de Apoio para a Decisão , Esofagectomia , Fragilidade/diagnóstico , Indicadores Básicos de Saúde , Idoso , Composição Corporal , Tomada de Decisão Clínica , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Tolerância ao Exercício , Feminino , Fragilidade/complicações , Fragilidade/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiopatologia , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Teste de Caminhada , Caminhada
8.
J Thorac Cardiovasc Surg ; 161(3): 836-843.e1, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33485662

RESUMO

OBJECTIVES: We sought to determine the safety and feasibility of esophagectomy after neoadjuvant immunotherapy and chemoradiotherapy in clinical trial patients with locally advanced esophageal cancer. METHODS: We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemoradiotherapy (n = 25) or chemoradiotherapy alone (n = 143) at our institution between 2017 and 2020. The primary end point was risk of 30-day major complications (Clavien-Dindo classification system grade ≥ 3), which was assessed between groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. Secondary end points were interval to surgery, 30-day readmission rate, and 30-day mortality. RESULTS: All included patients successfully completed neoadjuvant therapy and underwent esophagectomy with negative margins. Age, sex, performance status, clinical stage, histologic subtype, procedure type, and operative approach were similar between groups. Neoadjuvant immunotherapy was not associated with a statistically significantly increased risk of developing a major pulmonary (relative risk, 1.43; 95% confidence interval, 0.53-3.84; P = .5), anastomotic (relative risk, 1.34; 95% confidence interval, 0.45-3.94; P = .6), or other complication (relative risk, 1.29; 95% confidence interval, 0.26-6.28; P = .8). Median (interquartile range) interval to surgery was 54 days (47-61 days) in the immune checkpoint inhibitor group versus 53 days (47-66 days) in the control group (P = .6). Minimally invasive approaches were successful in 72% of cases, with only 1 conversion. Thirty-day mortality and readmission rates were 0% and 17%, respectively, in the immune checkpoint inhibitor group and 1.4% and 13%, respectively, in the control group. CONCLUSIONS: On the basis of our preliminary experience, esophagectomy appears to be safe and feasible following combined neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/terapia , Esofagectomia , Imunoterapia , Terapia Neoadjuvante , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Idoso , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/mortalidade , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase II como Assunto , Bases de Dados Factuais , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Esofagectomia/efeitos adversos , Esofagectomia/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/mortalidade , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Readmissão do Paciente , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
10.
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
11.
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
12.
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
14.
Rev. cir. (Impr.) ; 72(5): 427-433, oct. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1138734

RESUMO

Resumen Introducción: La esofagectomía presenta una alta morbilidad postoperatoria. Sin embargo, las definiciones de las complicaciones son variables. Un grupo multinacional (esophagectomy complications consensus group; ECCG) propuso definiciones estandarizadas. Objetivo: Evaluar las complicaciones postoperatorias en esofagectomía según las definiciones propuestas por el ECCG. Materiales y Método: Realizamos un estudio de cohorte retrospectivo, a partir de una base de datos prospectiva. Se incluyeron pacientes sometidos a una esofagectomía por cáncer entre 1996 y 2018 en un centro. Se aplicaron las definiciones de las complicaciones postoperatorias según el ECCG. Resultados: Se incluyeron 215 pacientes (Hombres 64%; edad 67 [31-82] años). Un 64% presentaban alguna comorbilidad. Existió un predominio de carcinoma escamoso con un 68%. La ubicación tumoral más frecuente fue el tercio inferior del esófago (48%). Se utilizó un abordaje abierto en 74% y mínimamente invasivo en 26%. La morbilidad postoperatoria total fue de 67%. Las complicaciones más frecuentes fueron las respiratorias alcanzando un 27%. En total, un 25% de los pacientes presentó una filtración de la anastomosis esofagogástrica, de las cuales un 24% fueron tipo II (no requirieron una reintervención quirúrgica). Se produjo una paresia de cuerda vocal en 7%, todas tipo I (no requirieron terapia específica). Se presentó una fístula quilosa en 2%, en 1% se trataron con nutrición parenteral (tipo II) y en 1% se realizó una reintervención (tipo III). Conclusión: La esofagectomía se asocia a una alta morbilidad. Las principales complicaciones son las respiratorias y las gastrointestinales. La utilización de las definiciones de consenso permite una estandarización y graduación de las complicaciones.


Introduction: Esophagectomy presents a high postoperative morbidity. However, the definitions used are variable. A multinational group (esophagectomy complications consensus group; ECCG) proposed standardized definitions. Aim: To evaluate postoperative complications in esophagectomy according to the definitions proposed by the ECCG. Materials and Method: We conducted a retrospective cohort study, based on a prospective database. Patients undergoing esophagectomy for cancer between 1996 and 2018 at one center were included. The definitions of postoperative complications according to the ECCG were applied. Results: We included 215 patients (64% men, age 67 [31-82] years). Sixty-four percent had some comorbidity. There was a predominance of squamous carcinoma with 68%. The most frequent tumor location was the lower third of the esophagus (48%). An open approach was used in 74% and minimally invasive in 26%. Total postoperative morbidity was 67%. The most frequent complications were respiratory complications, which reached 27%. The leakage of the esophagogastric anastomosis reached 25%, 24% were type II (did not require surgical reoperation). There was a vocal cord paresis in 7%, all were classified as type I (did not require specific therapy). A chylous fistula was presented in 2%, in 1% they were treated with parenteral nutrition (type II) and in 1% a reoperation was performed (type III). Conclusion: Esophagectomy is associated with a high morbidity. The main complications are respiratory and gastrointestinal. The use of consensus definitions allows standardization and grading of complications.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias , Neoplasias Esofágicas/epidemiologia , Esofagectomia/efeitos adversos , Estudos Retrospectivos , Estudos de Coortes , Morbidade
15.
Anticancer Res ; 40(10): 5343-5349, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988852

RESUMO

BACKGROUND/AIM: The present study aimed to examine the association of the controlling nutritional status (CONUT) score with outcomes in patients undergoing esophagectomy for esophageal cancer (EC). MATERIALS AND METHODS: A systematic literature review was carried out to investigate the impact of the CONUT score in EC. Next, meta-analysis of long-term outcomes was performed. RESULTS: The search found six eligible retrospective studies, and five studies with 952 patients were included in the meta-analysis. Meta-analysis found a significant association of the CONUT score with outcomes including overall survival [hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.75-3.60, p<0.001], cancer-specific survival (HR=2.60, 95%CI=1.53-4.41, p<0.001), and recurrence free survival (HR=2.08, 95%CI=1.39-3.12, p<0.001). CONCLUSION: The CONUT score may be an independent predictor associated with prognosis in patients undergoing esophagectomy for EC. However, further studies are needed to clarify the association of the CONUT score with postoperative outcomes in EC patients.


Assuntos
Neoplasias Esofágicas/metabolismo , Estado Nutricional/fisiologia , Complicações Pós-Operatórias/metabolismo , Intervalo Livre de Doença , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Modelos de Riscos Proporcionais
17.
Ann R Coll Surg Engl ; 102(9): e1-e3, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32735117

RESUMO

This case presents an unusually late complication of oesophagectomy 20-years post-surgery, with upper gastrointestinal bleeding. Further investigation revealed a gastric conduit ulcer eroding into the lower lobe of the right lung, forming a fistula with a basal branch of the right pulmonary artery. Upon successful embolisation, the HydroCoil® was visible on endoscopy. This case highlights the need for lifetime proton pump inhibitor cover post-oesophagectomy and demonstrates that when approaching uncommon presentations of common problems, careful consideration to treatment technique is essential.


Assuntos
Esofagectomia/efeitos adversos , Úlcera Péptica Hemorrágica/etiologia , Artéria Pulmonar , Úlcera Gástrica/etiologia , Idoso , Feminino , Gastroscopia , Humanos , Artéria Pulmonar/patologia , Úlcera Gástrica/diagnóstico
18.
Surgery ; 168(3): 558-566, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32611514

RESUMO

BACKGROUND: Although an anastomotic leak after esophagectomy is one of the most common postoperative complications, it is not well understood whether specific anatomic factors of the different route of reconstruction can predispose to the development of anastomotic leak after esophagectomy. This study aimed to clarify whether various factors related to the size of the thoracic inlet are independent predictors of anastomotic leak after esophagectomy. METHODS: We reviewed 248 patients who underwent esophagectomy with retrosternal reconstruction of the gastric conduit between January 2013 and March 2019. Various factors related to the size of the thoracic inlet were measured using computed tomography. Multivariate logistic regression was used to analyze the association between various measurements and anastomotic leak. RESULTS: Anastomotic leak occurred in 38 patients (15.3%). On univariate analysis, the thickness of the sternum, the thickness of the clavicle, the sternum-trachea distance, the ratio of the sternum-trachea distance/sternum-vertebral body distance, sex, body mass index, and method of anastomosis were statistically significantly associated with anastomotic leak. On multivariate analysis, the ratio of the sternum-trachea distance/sternum-vertebral body distance and the method of anastomosis were the independent risk factors for anastomotic leak. CONCLUSION: The ratio of the sternum-trachea distance/sternum-vertebral body distance is associated with cervical anastomotic leak after retrosternal gastric conduit reconstruction after esophagectomy. Measurement of the thoracic inlet space may contribute to preoperative planning, such as for the route of the conduit for reconstruction and anastomotic site.


Assuntos
Fístula Anastomótica/epidemiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/patologia , Esôfago/patologia , Esôfago/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Esterno , Estômago/cirurgia , Tomografia Computadorizada por Raios X
19.
Am Surg ; 86(6): 621-627, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683957

RESUMO

BACKGROUND: To identify the association between the width of the gastric conduit and the benign anastomotic stricture (BAS) after esophagectomy with end-to-side cervical anastomosis for esophageal cancer. METHODS: Patients with esophageal cancer who underwent esophagectomy between July 2013 and July 2014 were included in this study. The gastric conduit was used for reconstruction in all patients and end-to-side cervical anastomosis were performed using a circular stapler. The patients were divided into a narrow group (3-5 cm) and a wide group (>5 cm) based on the gastric conduit width. Univariate and multivariate logistic regressions were used to analyze the possible factors (patients' age, gender, preoperative comorbidities, neoadjuvant chemotherapy, gastric conduit width, anastomotic leakage) that could affect the incidence of BAS. RESULTS: Two-hundred and one patients were included in this study. The median follow-up period was 29 months (17-58 months). Seven cases (3.5%) showed anastomotic leakage in the postoperative period and 38 patients (18.9%) developed BAS; all within the first year of follow-up. In univariate analysis, the width of the gastric conduit was the only risk factor for the development of BAS (odds ratio [OR] = 3.36, P = .005). In multivariate logistic regression analysis, the wide group was an independent significant risk factor for the development of BAS developing compared with the narrow group (OR = 2.84, P = .02). CONCLUSIONS: A wide gastric conduit width (>5 cm) is an independent risk factor for the development of BAS after esophagectomy and stapled cervical end-to-side anastomosis for esophageal cancer.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Constrição Patológica/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Anastomose Cirúrgica/métodos , Esofagectomia/métodos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estômago/cirurgia
20.
Ann R Coll Surg Engl ; 102(9): 693-696, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32538118

RESUMO

INTRODUCTION: The incidence of delayed gastric emptying (DGE) following oesophagogastrectomy with gastric conduit reconstruction is reported to be between 1.7% and 50%. This variation is due to differing practices of intraoperative pylorus drainage procedures, which increase the risk of postoperative biliary reflux and dumping syndrome, resulting in significant morbidity. The aim of our study was to establish rates of DGE in people undergoing oesophagogastrectomy without routine intraoperative drainage procedures, and to evaluate outcomes of postoperative endoscopically administered Botulinum toxin into the pylorus (EBP) for people with DGE resistant to systemic pharmacological treatment. METHODS: All patients undergoing oesophagogastrectomy between 1 January 2016 and 31 March 2018 at our unit were included. No intraoperative pyloric drainage procedures were performed, and DGE resistant to systemic pharmacotherapy was managed with EBP. RESULTS: Ninety-seven patients were included. Postoperatively, 29 patients (30%) were diagnosed with DGE resistant to pharmacotherapy. Of these, 16 (16.5%) were diagnosed within 30 days of surgery. The median pre-procedure nasogastric tube aspirate was 780ml; following EBP, this fell to 125ml (p<0.001). Median delay from surgery to EBP in this cohort was 13 days (IQR 7-16 days). Six patients required a second course of EBP, with 100% successful resolution of DGE before discharge. There were no procedural complications. CONCLUSIONS: This is the largest series of patients without routine intraoperative drainage procedures. Only 30% of patients developed DGE resistant to pharmacotherapy, which was managed safely with EBP in the postoperative period, thus minimising the risk of biliary reflux in people who would otherwise be at risk following prophylactic pylorus drainage procedures.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Esofagectomia/efeitos adversos , Gastrectomia/efeitos adversos , Gastroparesia/tratamento farmacológico , Gastroscopia , Piloro/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Feminino , Gastrectomia/métodos , Gastroparesia/etiologia , Gastroscopia/métodos , Humanos , Masculino , Piloro/fisiopatologia , Neoplasias Gástricas/cirurgia
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