RESUMEN
Although a 74-year-old man with gastric cancer with pyloric stenosis(cT4aN[+]M0, Stage â ¢)had undergone surgery, he was diagnosed with peritoneum dissemination. He received bypass surgery, and an intraperitoneal access port was implanted in his subcutaneous space. Postoperatively, he received 4 courses of SOX therapy. In treatment effect, the primary tumor showed no change, and ascites developed. Therefore, we changed the chemotherapy regimen in intravenous and intraperitoneal paclitaxel combined with S-1 therapy. After starting this regimen, the primary tumor decreased in size, and the pyloric stenosis improved. Currently, the patient is alive without recurrence for 5 years and 8 months after intravenous and intraperitoneal paclitaxel combined with S-1 therapy and receiving this treatment regularly.
Asunto(s)
Neoplasias Peritoneales , Estenosis Pilórica , Neoplasias Gástricas , Masculino , Humanos , Anciano , Paclitaxel , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Peritoneo/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Estenosis Pilórica/etiología , Estenosis Pilórica/cirugíaRESUMEN
PURPOSE: The objective of this study was to compare the effects of two types of enteral supplements, an antioxidant-enriched enteral nutrition (AeEN) and an immune-enhancing enteral nutrition (IeEN), on the nutrition, immunoinflammatory response, antioxidant capacity and clinical outcomes in patients after esophagectomy for cancer. METHODS: Patients (n = 20) undergoing esophagectomy for cancer were randomized in this single-center, open-label study. Two types of enteral supplements were used for 5 days before surgery and 7 days after surgery. The circulating levels of nutritional markers, immunoinflammatory markers, oxidative stress markers, and the antioxidant capacity were compared throughout the perioperative period, and the patients' clinical outcomes were also compared. RESULTS: The circulating levels of nutritional markers decreased after surgery, but the changes were not significantly different between the AeEN group and the IeEN group throughout the perioperative period. Surgery increased the immunoinflammatory markers, and the levels were not significantly different between the groups after surgery. Surgery also increased the levels of oxidative stress markers, but there were no significant differences between the groups throughout the study period. CONCLUSIONS: The results of this pilot study suggest that AeEN and IeEN have a similar effect on nutrition, the immunoinflammatory response, antioxidant capacity and clinical outcomes after esophagectomy for cancer. These findings, therefore, warrant further studies on a larger scale.
Asunto(s)
Antioxidantes/administración & dosificación , Arginina/administración & dosificación , Suplementos Dietéticos , Nutrición Enteral , Neoplasias Esofágicas/fisiopatología , Neoplasias Esofágicas/cirugía , Esofagectomía , Ácidos Grasos Omega-3/administración & dosificación , Estado Nutricional , Anciano , Neoplasias Esofágicas/inmunología , Esofagectomía/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nucleótidos/administración & dosificación , Evaluación Nutricional , Estrés Oxidativo , Atención Perioperativa , Proyectos Piloto , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: There are controversies regarding the extent of lymphadenectomy necessary during the course of esophagectomy for submucosal esophageal cancer. The purpose of this study was to examine the long-term outcomes after esophagectomy with extended lymphadenectomy in patients with submucosal esophageal cancer and to investigate the prognostic factors in these patients. MATERIALS: A prospectively maintained database identified 105 previously untreated patients with submucosal esophageal cancer who underwent transthoracic esophagectomy with three-field or two-field lymphadenectomy. Median follow-up was 101 months. RESULTS: All patients received R0 resection. Ninety-eight patients had squamous cell carcinoma, and seven had adenocarcinoma. Lymph node metastasis was present in 38 patients (36.2%), of whom 9 patients (23.7%) had positive cervical nodes. Thirty-five patients (33.3%) had other primary malignancies. The overall 5- and 10-year survival rates were 74.4 and 57.4%, respectively. The cause of death was recurrent disease in 16 patients, other malignancy in 12, and noncancer-related disease in 18. Univariate analyses demonstrated that other primary malignancy (P = 0.0041), poor differentiation (P = 0.0203), and angiolymphatic invasion (P = 0.0347) significantly affected overall survival. There was no difference in survival between patients with lymph node metastasis and those without (P = 0.9809). Multivariate analysis found other primary malignancy to be the only independent prognostic factor (hazards ratio, 2.295; 95% confidence interval, 1.201-4.386; P = 0.0119). CONCLUSIONS: Esophagectomy with extended lymphadenectomy for submucosal esophageal cancer results in 57.4% survival at 10 years. Other primary malignancy is the only independent predictor affecting long-term survival. Patients should be examined rigorously for other primary malignancy as well as recurrent disease during long-term follow-up.
Asunto(s)
Adenocarcinoma/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Escisión del Ganglio Linfático , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adulto , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Neoplasias Esofágicas/mortalidad , Neoplasias Esofágicas/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND: Photodynamic therapy (PDT) has been found to be safe and effective in patients with small early esophageal squamous cell carcinoma (SCC). However, its efficacy for widespread superficial SCC has not yet been confirmed. OBJECTIVE: To assess the long-term survival, complications, and recurrence of PDT for large superficial esophageal SCC. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENTS: A total of 38 patients with superficial SCC of the esophagus. All patients had a large unifocal lesion or multifocal lesions that were too large to be resected endoscopically. In addition, all patients were physiologically unfit for esophagectomy or had refused surgery. INTERVENTIONS: PDT with porfimer sodium. MAIN OUTCOME MEASUREMENTS: Clinical follow-up, long-term survival, complications, and recurrence were evaluated. RESULTS: Thirty-one patients (82%) had mucosal cancer (T1m), and 7 (18%) had submucosal cancer (T1sm). No patient had lymph node involvement. Nineteen patients had other primary malignancies. Complete remission was achieved in 33 (87%). At the time of writing, 28 patients (74%) were alive without recurrence. After a median follow-up period of 64 months (range, 7-125 months) after PDT, the overall 5-year survival rate was 76%. There was no treatment-related mortality. LIMITATIONS: Retrospective study with a small number of patients. CONCLUSIONS: This long-term follow-up study revealed that PDT was a potentially curative treatment for large superficial esophageal SCC. PDT might be a reasonable alternative to esophagectomy or to endoscopic resection for patients with superficial SCC of the esophagus without lymph node metastasis.
Asunto(s)
Carcinoma de Células Escamosas/tratamiento farmacológico , Éter de Dihematoporfirina/uso terapéutico , Neoplasias Esofágicas/tratamiento farmacológico , Fotoquimioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Supervivencia sin Enfermedad , Neoplasias Esofágicas/patología , Esofagoscopía , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
We report the case of a 50-year-old man with a double aortic arch who underwent esophagectomy for cancer in the middle thoracic esophagus at clinical Stage IIA (T3N0M0), based on the TNM classification (UICC 2002). The patient underwent esophagectomy with three-field lymphadenectomy following neoadjuvant chemotherapy. In such a case, it is important to recognize the anatomy in the upper mediastinum, especially the relationship between the right and left aortic arch, and the recurrent laryngeal nerves using computed tomography (CT) and three-dimensional CT. At first, we performed a cervical lymphadenectomy in order to isolate the bilateral recurrent laryngeal nerves, then mediastinal lymphadenectomy through a right thoracotomy. However, we could not confirm the bilateral recurrent laryngeal nerves during mediastinal lymphadenectomy, and were thus unable to resect them. The postoperative course was uneventful. The patient died of multiple liver metastasis 4 years after the surgery, with no evidence of recurrence in any lymph node.
Asunto(s)
Aorta Torácica/anomalías , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Magnetic compression anastomosis (MCA) is a revolutionary, minimally invasive method of performing choledochoenterostomy or choledochocholedochostomy without using surgical techniques in patients with biliary stricture or obstruction. Herein, we describe a case series of MCA for severe biliary stricture or obstruction, which could not be treated with conventional therapies. PATIENTS AND METHODS: Two patients with biliary obstruction were treated using MCA for choledochocholedochostomy and choledochoenterostomy at Tokyo Medical University Hospital and Tokyo Medical University Hachioji Medical Center. Endoscopically, a samarium-cobalt (Sm-Co) rare-earth magnet was placed at the superior site of obstruction through the percutaneous transhepatic biliary drainage route and another Sm-Co magnet was placed at the inferior site of obstruction. A comprehensive computer-aided literature search for MCA was performed up to September 2009 by using MEDLINE and EMBASE. RESULTS: MCA techniques enabled complete anastomosis in both cases without procedure-related complications. CONCLUSIONS: The MCA technique is a revolutionary method of performing choledochocholedochostomy and choledochoenterostomy interventionally in patients with biliary obstruction, for whom the conventional endoscopic procedure is not available, or in candidates who are deemed unsuitable for surgery.