Clinical value of measuring plasma D-dimer levels in patients with esophageal cancer.

BACKGROUND: Esophageal cancer represents a significant public health concern; however, reliable diagnostic and prognostic markers have not been established. This study aimed to investigate the clinical value of plasma D-dimer levels in patients with esophageal cancer. METHODS: Overall, 120 patients with esophageal cancer who underwent radical surgical resection at our department between January 2019 and 2020 were included (esophageal cancer group). Plasma D-dimer levels were measured preoperatively and on postoperative days 1 and 14. Additionally, 60 healthy participants (control group) with measured plasma D-dimer levels were included. The preoperative D-dimer levels and positive D-dimer test rates were compared between the groups. The 3-year survival rate in patients with esophageal cancer was calculated using the Kaplan-Meier method. RESULTS: Preoperative D-dimer concentration in the esophageal cancer group was (0.65 ± 0.859 µg/mL) significantly higher than that in the control group (0.32 ± 0.369 µg/mL). The positivity rate in the esophageal cancer group (35.0%, 42/120) was significantly higher than that in the control group (15%, 9/60). D-dimer concentrations were significantly higher 1 day postoperatively than preoperatively. Conversely, D-dimer concentrations were significantly lower 14 days postoperatively than preoperatively. Patients in the esophageal cancer group with plasma D-dimer concentrations ≤ 0.5 µg/mL had significantly higher 3-year survival rates than those with higher concentrations. In the logistic multivariate analysis, tumor pathological stage and preoperative plasma D-dimer levels were independent prognostic factors of 3-year survival rates in patients with esophageal cancer. CONCLUSION: Plasma D-dimer concentrations are clinically valuable in esophageal cancer diagnosis, postoperative recurrence monitoring, and prognosis prediction.

Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach.

Background: This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery. Methods: Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups. Results: There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008). Conclusion: Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.

Supplemental parenteral nutrition improves patient outcomes after esophageal cancer surgery: A single-center randomized controlled study.

BACKGROUND: We investigated the effect of supplemental parenteral nutrition comprising parenteral nutrition (PN) and enteral nutrition (EN) on the postoperative nutritional status, immune function, and inflammatory response of patients with esophageal cancer. METHODS: Seventy-two patients with esophageal cancer were divided into the experimental group (PN + EN group; n = 36) and control group (total EN [TEN] group; n = 36). In the PN + EN group, EN and PN were administered on postoperative days 4 to 8. In the TEN group, EN was initiated on postoperative days 1 to 8. Changes in the nutritional status, immune function, and inflammatory indices were compared between groups. RESULTS: Before surgery, the prealbumin (PA) values of both groups were lower than normal, and the C3, C4, and C-reactive protein (CRP) levels were above normal. The IgA, IgG, IgM, CD3, CD4, and CD4/CD8 levels were lower than normal, and the CD8 level was increased. On postoperative day 1, the PA levels of both groups decreased (P > .05), C3, C4, and CRP levels increased, and IgA, IgG, IgM, CD3, CD4, and CD4/CD8 decreased to values noted before surgery. On postoperative day 7, PA levels of the PN + EN group were significantly higher than those of the TEN group (P < .05). The CRP level of the PN + EN group was significantly lower than that of the TEN group (P < .05). IgA, IgG, and CD4 were significantly higher in the PN + EN group than in the TEN group (P < .05). CONCLUSION: Supplemental parenteral nutrition for perioperative esophageal cancer patients can maintain the optimal nutritional status, improve immune function, and reduce the inflammatory stress response.

Value of subcarinal lymph node dissection in esophageal cancer surgery: A case-control study.

We investigated the value of subcarinal lymph node dissection in esophageal cancer surgery. Altogether, 240 patients with esophageal cancer admitted to our department between June 2012 and January 2016 were prospectively assigned to an experimental group (subcarinal lymph node dissection group, n = 120 cases) and a control group (uncleaned group, n = 120 cases). The number of subcarinal lymph nodes and the rate of subcarinal lymph node metastasis were determined, and the factors influencing subcarinal lymph node metastasis were analyzed using logistic regression in the experimental group. The operation time, postoperative complications, intraoperative blood loss, postoperative hospital stay, total postoperative hospital cost, and 5-year survival rate were compared between the 2 groups. In the experimental group, an average of 6.03 subcarinal lymph nodes were dissected, and the lymph node metastasis rate was 18.33%. The subcarinal lymph node metastasis rate in the experimental group was related to the size of the subcarinal lymph nodes, depth of tumor invasion, and tumor location. The 5-year survival rate was higher in the experimental group than in the control group (44.2% vs 30.0%, χ2 = 6.407, P = .04). The subcarinal lymph node metastasis rate in patients with esophageal cancer is high. Patients with mid-thoracic esophageal cancers that infiltrate beyond the esophageal muscle layer with subcarinal lymph node size > 1.0 cm should undergo lymph node resection, despite increased operation time, incidence of postoperative pulmonary infection, hospitalization time, and total postoperative cost; lymph node resection may improve the 5-year survival rate.