Prognostic impact of micrometastasis in patients with esophageal cancer.

Squamous cell carcinoma (SCC) of the esophagus and adenocarcinoma of the esophago-gastric junction (AEG) are diseases with poor prognosis. Despite radical surgery having been carried out, many patients are at risk of cancer recurrence, especially with the presence of metastases in the lymph nodes. The study involved 60 patients suffering from SCC and AEG who had lymph nodes surgically removed between 2012 and 2018. Only lymph nodes with N0 status were subjected to immunohistochemistry examination. Histopathological criteria were used for the diagnosis of micrometastases (MM), defined as tumor cells or cell clusters of 0.2-2 mm diameter in the lymph node and tumor cell microinvolvement defined as free-floating neoplastic cells or cell clusters within the sub-capsular sinus or intramedullary sinuses of the lymph node. A total of 1130 lymph nodes were removed during surgery, with an average of 22 lymph nodes per patient (range 8-58). Micrometastases were found in 7 (11.66%) patients: 6 (10.0%) with AEG and 1 (1.66%) with SCC, representing a statistically significant difference p = 0.017. Multivariate analysis of the study group did not confirm the dependence of the MM on the T features ( p = 0.7) or G ( p = 0.5). In a Cox regression analysis, MM were not a risk factor for death, HR: 2.57 (0.95; 7.00), p = 0.064. There was no difference in overall survival for patients with MM (N (+)) and those without (N0), p = 0.055, but there was a statistically significant difference in time of relapse between patients with and without MM ( p = 0.049). Patients with the N (+) status are at high risk of cancer recurrence, and therefore we believe that complementary treatment should be considered in this group.

Alleviation of malignant dysphagia in inoperable lung cancer.

BACKGROUND: Due to the close anatomical relationship between the esophagus and the bronchial tree, lung cancer can cause malignant dysphagia. Patients with this complication may require palliation through esophageal and/or bronchial tree restoration. METHODS: Between the years 2008 and 2018, malignant dysphagia was diagnosed in 84 lung cancer patients. Their response to esophageal and/or bronchial tree stenting was studied retrospectively. Patients were stratified into three groups: esophageal compression without obstruction of the bronchi (Group I, n=64), esophageal compression and bronchial obstruction without fistulas (Group II, n=12), and dysphagia and esophagotracheal fistula (Group III, n=8). Group I had one stent implanted, whilst in Groups II and III, two stents were introduced. Both self-expanding stents and silicone Y stents were utilized. Prior to intervention and during the follow-up period, patients were assessed for degree of dysphagia and dyspnea, quality of life, and survival. RESULTS: Following endoprosthetic restoration, dysphagia score improved in all patient groups with reductions in Group I (2.68 vs. 1.2, P=0.0001), in Group II (2.76 vs. 1.3, P=0.0001), and in Group III (2.74 vs. 1.3, P=0.0001). There was no dyspnea recorded in Group I before an intervention, however it was present and reduced in Group II (2.86 vs. 0.4, P=0.001) and Group III (2.89 vs. 0.5, P=0.0001) following intervention. Quality of life was improved for all patient groups, with an increase in Karnofsky performance scale in Group I (56 vs. 72, P=0.0001), Group II (56 vs. 70, P=0.0001) and Group III (53 vs. 67, P=0.0001). Three patients (3.6%) developed respiratory failure and 1 patient (0.8%) died. Two patients (2.4%), following esophageal stenting, required bronchial tree stenting. Dysphagia occurred in 5 patients (6.0%) due to granuloma formation. In these cases, the stents were removed and re-stenting was carried out. In 3 of the patients (3.6%) the stents were removed due to migration and re-stenting was performed. CONCLUSIONS: Patients with malignant dysphagia due to lung cancer may require esophageal stenting as well as bronchial tree stenting. This treatment offers improvements in dysphagia and dyspnea scores, as well as in quality of life, and allows for the implementation of oncological treatments.

Surgical treatment of thoracic esophageal diverticula.

Introduction: Thoracic esophageal diverticulum (TED) is a rare benign disease associated with motility disorders of the esophagus. Surgical management is usually the definitive treatment, with traditional excision of the diverticulum via thoracotomy and minimally invasive techniques being comparable and associated with a mortality rate of between 0 and 10%. Aim: To present the results of surgical treatment of patients with thoracic diverticula of the esophagus in a 20-year period. Material and methods: The study presents a retrospective analysis of the results of surgical management of patients with the thoracic esophageal diverticulum. All patients underwent open transthoracic diverticulum resection with myotomy. Patients were evaluated for the degree of dysphagia before and after surgery, associated complications and overall comfort after surgical treatment. Results: Twenty-six patients due to diverticula of the thoracic part of the esophagus underwent surgical treatment. Resection of the diverticulum with esophagomyotomy was performed in 23 (88.5%) patients, anti-reflux surgery was performed in 7 (26.9%) and in 3 (11.5%) patients with achalasia, the diverticulum was left unresected. Among the patients operated on, 2 (7.7%) patients developed a fistula, and both required mechanical ventilation. In 1 patient the fistula closed spontaneously, and the other patient required esophageal resection and colon reconstruction. Two patients required emergency treatment due to mediastinitis. There was no mortality in the perioperative period of hospital stay. Conclusions: Treatment of thoracic diverticula is a difficult clinical problem. Postoperative complications pose a direct threat to the patient's life. Esophageal diverticula is characterized by good long-term functional results.

Treatment of Esophago-Airway Fistula after Esophageal Resection.

(1) Background: Esophago-airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material and Methods: We present a retrospective analysis of a group of 22 patients treated for an esophago-airway fistula between 2012 and 2022, with 21 cases after esophageal resection and one during the course of Hodgkin's disease. (3) Results: Twenty-two patients were treated for an esophago-airway fistula. Among them, a tracheobronchial fistula occurred in 21 (95.4%) patients during the postoperative period, while 1 (4.5%) was treated for Hodgkin's disease. Of these cases, 17 (70.7%) patients underwent esophageal diversion with various treatments, including intercostal flap in most cases, greater omentum in one (4.5%), latissimus dorsi muscle in two (9%), and greater pectoral muscle in one (4.5%). Esophageal stenting was performed in two patients (9.0%), and one (4.5%) was treated conservatively. Unfortunately, one patient (4.5%) died after being treated with bronchial stenting, and two (9.5%) experienced a recurrence of the fistula. (4) Conclusions: The occurrence of an esophago-airway fistula after esophagectomy is a rare but life-threatening complication with an uncertain prognosis that results in several serious perioperative sequelae.

Diagnosis and management of gastrointestinal chemical burns and post-burn oesophageal stenosis.

Post-burn oesophageal stenosis occurs as a result of accidental or intentional ingestion of a corrosive substance. Global estimates indicate tens of thousands of acid or lye ingestion cases per year. In some cases patients in the early post-burn phase require urgent surgical intervention. Endoscopy, along with chest and abdominal computed tomography, form the basis of diagnosis. The need for emergency oesophageal or gastric resection is associated with a high mortality rate of up to 60%. Post-burn oesophageal stenosis is a challenging clinical problem that requires coordinated multispecialty treatment. The treatment of post-burn stenosis may be with endoscopic techniques or reconstructive surgery. Surgical reconstruction is performed once the scar has definitively formed. The extent of the injury, anatomical conditions, previous surgery and the team's expertise determine the optimum reconstructive method. In this article, we present the current knowledge on the diagnosis and treatment of oesophageal burns.

Surgical treatment of cervical oesophageal diverticula.

AIM OF THE STUDY: The aim of our study is to present the results of surgical treatment of patients with cervical diverticula of the oesophagus in a period of 20 years. MATERIAL AND METHODS: A retrospective analysis of 65 patients treated between 2000 and 2020. Patients with symptoms such as dysphagia, vomiting, chocking, recurrent respiratory tract inflammation, as well as patients with diverticular recurrence or poor outcome of primary surgery, were qualified for surgical resection of the oesophageal diverticulum with myotomy using an open technique. Patients were evaluated for the degree of dysphagia before and after surgery, associated perioperative complications, and overall comfort after surgical treatment. RESULTS: Sixty-five patients underwent surgical treatment, 7(10.7%) of whom were treated for diverticular recurrence or poor outcome of primary treatment. The predominant symptom was dysphagia, which was found in 55(84.6%) patients, increasing over 6 to 48 months with a mean of 17.6 months. The size of the diverticulum ranged from 2 to 6 cm with a mean of 4.8 cm. One patient (1.5%) who experienced the suture line leak was treated conservatively and the fistula healed. Another patient had permanent vocal cord damage, and 1(1.5%) patient had transient damage. The surgical outcome was very good in 48 patients, good in 15 patients, and poor in 2 patients. No postoperative death occurred. CONCLUSIONS: The technique of open resection with myotomy continues to be an effective method of treating cervical diverticula. It has a zero-mortality rate, low perioperative complication rate, good functional outcome, and low recurrence rate.

Comparison of Suction Versus Nonsuction Drainage After Lung Resections: A Prospective Randomized Trial.

BACKGROUND: Sufficiently large, prospective randomized trials comparing suction drainage and nonsuction drainage are lacking. The aim of the present study was to compare the effects of suction drainage and nonsuction drainage on the postoperative course in patients who have undergone lung resection. METHODS: This prospective, randomized trial included patients undergoing different types of lung resections. On the day of surgery, suction drainage at -20 cm H2O was used. On the morning of the first postoperative day, patients, in whom the pulmonary parenchyma was fully reexpanded, were randomized in the ratio of 1:1. Patients assigned to group A continued with suction drainage, while those assigned to group B underwent nonsuction drainage. RESULTS: The study included 254 patients, with 127 patients in each group. The drainage volumes were 1098.8 mL and 814.4 mL in groups A and B, respectively (p = 0.0014). The times to chest tube removal were 5.61 days and 4.49 days in groups A and B, respectively (p = 0.0014). Prolonged air leakage occurred in 5.55% of patients in group A and in 0.7% of patients in group B (p = 0.032), and asymptomatic residual air spaces were noted in 0.8% of patients in group A and 9.4% of patients in group B (p = 0.0018). CONCLUSIONS: Nonsuction drainage is more effective than suction drainage with regard to drainage volume, drainage duration, and incidence of persistent air leakage. However, it is associated with a higher incidence of asymptomatic residual air spaces.