The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

World Journal of Surgery - Cervical anastomotic stricture after esophagectomy is a serious complication that adversely affects postoperative recovery, nutritional status and quality of life....     

T-Tube Management of a Major Leakage of the Cervical Esophagogastrostomy After Subtotal Esophagectomy: Report of Three Cases

A major leakage of the cervical esophagogastrostomy caused by necrosis of the esophageal substitute was successfully managed in three patients by inserting a T-tube. After partial necrosis of the gastric tube had been confirmed, a T-tube was inserted into the esophagus and the gastric tube through the reopened cervical wound. In one patient, a plastic esophageal prosthesis and subsequently, a covered self-expandable metallic stent were intubated over the fistula after T-tube removal to prevent salivary leakage and anastomotic stenosis. In the other two patients, the sump tube, which had been inserted through the gastrostomy for decompression during surgery, was replaced with a large chest drainage tube, the tip of which was positioned in the esophagus, after T-tube removal. The fistula was closed without severe stenosis, and oral feeding was resumed on postoperative days 71 and 64, respectively.     

食管癌切除食管胃颈部包套式机械吻合97例结果分析

目的探讨在食管胃颈部吻合术中使用机械吻合并吻合口包埋的作用。方法回顾性分析101例患者行食管癌切除食管胃颈部吻合术的临床资料,总结并分析手术情况和术后并发症情况。结果 97例使用管状吻合器机械吻合并包套吻合口,2例因胃长度不够采用手工吻合,1例因吻合后张力较大未行包套,1例抵钉座尺寸过大撕裂食管肌层需要另行缝合,手术完成率96.0%（97/101）。术后2例出现吻合口或胃出血（2.1%）,吻合口瘘4例（4.1%）,经过清创引流后痊愈;无其他机械吻合并发症。术后3月CT和上消化道造影提示吻合口狭窄（〈1.5 cm）2例,占2.1%,无〈1 cm病例。存在吞咽困难症状共4例（4.1%）,反流引发的反酸、口苦等口腔、咽部相关症状11例（11.3%）。结论管状吻合器胃腔内吻合安全、简便,宽松包套后有显著的抗反流作用。     

ASO Visual Abstract: Influence of Damaged Stomach on Anastomotic Leakage After Cervical Esophagogastrostomy for Patients with Esophageal Cancer

Annals of Surgical Oncology -     

Surgical Resection of Hypopharynx and Cervical Esophageal Cancer with a History of Esophagectomy for Thoracic Esophageal Cancer

Background

Cancer of the hypopharynx and cervical esophagus (PhCe cancer) frequently develops synchronously or metachronously with esophageal cancer. The surgical approach is usually difficult, especially in metachronous PhCe cancer after esophagectomy. The purpose of this study was to clarify the treatment outcomes of patients with metachronous PhCe cancer with a history of esophagectomy.

Methods

The subjects evaluated in this study were 14 patients with metachronous PhCe cancer who underwent pharyngo-laryngo-esophagectomy after subtotal esophagectomy and gastric tube pull-up for primary esophageal cancer.

Results

Definitive chemoradiotherapy (CRT; radiation dose >50 Gy) was performed for primary laryngeal (n = 1), pharyngeal (n = 2), esophageal (n = 1), and recurrent esophageal cancer (n = 2). For seven patients with metachronous PhCe cancer, induction CRT (radiation dose <40 Gy) was performed. In all 14 patients, pharyngo-laryngo-esophagectomy was followed by free jejunal graft interposition with reconstruction of the jejunal vessels. Although postoperative complications developed in four patients, no perioperative death or necrosis of the reconstructed free jejunum occurred. The 2- and 5-year overall survival rates were 84 and 50 %, respectively.

Conclusions

Pharyngo-laryngo-esophagectomy with free jejunal transfer is considered to be safe for metachronous PhCe cancer, even in patients with a history of CRT and esophagectomy.     

Hand-Sewn Cervical Anastomosis Versus Stapled Intrathoracic Anastomosis After Esophagectomy for Middle or Lower Thoracic Esophageal Cancer: A Prospective Randomized Controlled Study

Purpose The type of anastomosis and its outcome can affect postoperative morbidity, mortality, and quality of life after esophagectomy. We compared the outcomes of cervical hand-sewn anastomosis (CHS) and intrathoracic stapled anastomosis (ITS) performed after esophagectomy and gastric reconstruction. Methods Thirty-two patients with middle or lower thoracic esophageal cancer were prospectively randomized to undergo CHS (n = 18) or ITS (n = 14) after esophagectomy. We compared clinical data, postoperative symptoms, and long-term survival in the two groups. Results The rates of anastomotic leak and stricture in the CHS and ITS groups were 16.7% versus 7.1% and 0% versus 14.2%, respectively, which do not represent significant differences. The respective rates of recurrent laryngeal nerve palsy were 38.8% versus 7.1% (P < 0.05), and proximal esophageal resection was 15 mm longer (P < 0.05) in the CHS group. There were no significant differences in symptoms 6 months after surgery, or in the overall 5-year survival rates (72.2% and 85.7%, respectively). Conclusions The two methods of anastomosis yielded similar anastomotic outcomes. Although the incidence of recurrent laryngeal nerve injury was higher after CHS, and proximal esophageal resection was longer, this had little impact on postoperative symptoms and long-term survival.     

Linear Stapled Esophagogastrostomy is more Effective than Hand-Sewn or Circular Stapler in Prevention of Anastomotic Stricture: a Comparative Clinical Study

Objective  

The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture.     

Esophageal Position Affects Short-Term Outcomes After Minimally Invasive Esophagectomy: A Retrospective Multicenter Study

Background

Anatomical esophageal position may affect the short-term outcomes after minimally invasive esophagectomy (MIE). A previous single-institutional retrospective study suggested that the presence of a left-sided esophagus (LSE) made MIE more difficult and increased the incidence of postoperative complications.

Methods

The current study was a multicenter retrospective study of 303 patients with esophageal cancer who underwent MIE at six esophageal cancer high-volume centers in Kyushu, Japan, between April 2011 and August 2016. The patients were divided into the LSE (66 patients) and non-LSE groups (237 patients) based on the esophageal position on computed tomography images obtained with the patients in the supine position.

Results

Univariate analysis showed that patients with LSE were significantly older than those with non-LSE (69 ± 8 vs. 65 ± 9 years; P = 0.002), had a significantly greater incidence of cardiovascular comorbidity (65.2% vs. 47.7%; P = 0.013), and a significantly longer operating time (612 ± 112 vs. 579 ± 102 min; P = 0.025). Logistic regression analysis verified that LSE was an independent risk factor for the incidence of pneumonia (odds ratio 3.3, 95% confidence interval 1.254–8.695; P = 0.016).

Conclusions

The presence of a LSE can increase the procedural difficulty of MIE and the incidence of morbidity after MIE. Thus, careful attention must be paid to anatomical esophageal position before performing MIE.

     

Thyroid and Parathyroid Functions After Pharyngo-Laryngo-Esophagectomy for Cervical Esophageal Cancer

Annals of Surgical Oncology - Cervical esophageal cancer (CEC) patients whose larynx function cannot be preserved often undergo chemoradiotherapy, whereas those with residual or recurrent lesions...     

Improved Long-Term Survival After Esophagectomy for Esophageal Cancer: Influence of Epidemiologic Shift and Neoadjuvant Therapy

Background

The study was done to determine long-term outcomes of surgically treated esophageal cancer and to identify trends in epidemiology, oncological therapy, and oncological prognosis over the last two decades.

Methods

Overall survival in 304 patients undergoing esophagectomy was analyzed. Fifty-three percent had squamous cell carcinoma and 46 % had adenocarcinoma (AC). A total of 161 patients received neoadjuvant chemoradiation, 38 received neoadjuvant chemotherapy, and 105 were treated with surgery alone.

Results

Median survival (MS) increased significantly from 18.0 months (1988–1994) to 26.6 months (1995–2001) and to 59.3 months (2002–2011; p?<?0.001). The proportion of AC (22 vs 35 vs 65 %; p?<?0.001) and the proportion of patients treated with neoadjuvant therapy (neoT; 15.9 vs 85.3 vs 77.8 %; p?<?0.001) increased during the treatment period. After neoT, a beneficial outcome with a MS of 45.6 vs. 20.4 months (p?=?0.003) was found. Lymph node ratio [LNR; relative risk (RR), 5.4; p?<?0.001], response to neoT (RR, 1.6; p?<?0.004), and histological subtype (RR, 1.7; p?<?0.003) were identified as independent parameters of survival.

Conclusion

Since 1988, the outcome of surgically resected esophageal cancer strongly improved. Besides tumorbiological factors like histological type and LNR, the outcome is also affected by the increasing use of neoT towards favorable survival rates.     

单层或双层食管胃颈部吻合术治疗食管癌50例

目的比较两种吻合技术行食管胃颈部吻合的临床效果。方法因食管癌行食管次全切除、食管胃颈部吻合术共50例,其中采用双层吻合法34例,单层吻合法16例。结果双层吻合法的吻合口瘘发生率为23.5%（8/34）,单层吻合法的吻合口瘘的发生率为6.2%（1/16）。两组病人均无吻合口狭窄。结论总之,单层吻合法较双层吻合法减少了手术步骤,缩短了手术时间,减少了吻合口瘘的发生率,值得在食管癌切除术后颈部食管胃吻合中应用。     

Gastric Tube-Preserving Pancreatoduodenectomy After Esophagectomy and Reconstruction Using the Gastric Tube: Report of a Case

We herein present the case of an intraductal papillary mucinous tumor of the pancreas resected by a gastric tube-preserving pancreatoduodenectomy in a patient who underwent an esophagectomy and reconstruction using the gastric tube. To preserve the gastric tube, the gastroduodenal artery and right gastroepiploic vein must be successfully skeletonized and preserved. In the present case, the vascular anatomy was clarified not only two-dimensionally with the use of selective abdominal angiography, but also three-dimensionally with the use of helical computed tomography. After precisely identifying the location of the tumor in relation of the blood vessels, it was confirmed that a gastric tube-preserving pancreatoduodenectomy was feasible. A detailed analysis of the vascular anatomy should be carried out by helical computed tomography preoperatively. When the radicality of tumor resection is not compromised, a gastric tube-preserving pancreatoduodenectomy can be recommended, due to the fact that it is considered to be less invasive.     

A Simple Method for Breast Implant Placement Using a Drainage Tube

Silicone breast implants have been used for augmentation mammoplasty. In most cases, the surgery is performed for cosmetic purposes. Although the incision line must be of minimal length, it is difficult to replace silicone prosthesis in these patients by a minimal incision. A Drainage tube is a choice for draining the air and facilitates replacement of the prosthesis. The authors have used this method successfully for 13 cases. There were no complications. The described technique can be used for all augmentation mammoplasties using silicone breast implants.     

A Cost and Benefit Study of Esophagectomy for Patients with Esophageal Cancer

Introduction  

The incidence of esophageal cancer is increasing all over the world but the cost-and-benefit of esophagectomy for esophageal cancer patients was rarely studied. The aim of this study is to compare the cost-and-benefit of esophagectomy in different stages of esophageal cancer.     

Acute Cervical Epidural Hematoma,Screw Pullout,and Esophageal Perforation After Anterior Cervical Corpectomy Surgery: Report of a Case

To report a series of complications related to anterior cervical surgery in the same patient. There have been many reports of complications related to anterior cervical surgeries. These include cervical hematoma, instrumentation extrusion, or esophageal injury after anterior cervical decompression. However, there have been no reports of all these complications occurring in 1 patient. This is our report of a patient who experienced all 3 of these complications. The patient was a 73-year-old man suffering from cervical spondylotic myelopathy who was treated with C5 anterior cervical corpectomy and fusion with titanium mesh and bone graft. The patient successively experienced cervical hematoma, screw pullout, and esophageal perforation, and was treated accordingly. Although the patient suffered a series of complications after anterior cervical corpectomy, all the complications were treated successfully. It serves as a caution that a first complication such as hematoma in anterior cervical corpectomy with fusion should be given enough attention to prevent further complications.Key words: Anterior cervical corpectomy, Cervical spine, Esophageal perforation, Hematoma, Screw pulloutAnterior cervical corpectomy and decompression have long been used to manage various degenerative, traumatic, and neoplastic diseases of the cervical spine, as well as for infections, especially tuberculosis.^1,2 The surgical procedure has proved as safe and effective as other anterior cervical surgeries for improving nerve function, and in terms of infusion rate and complications.There have been many reports of complications related to anterior cervical surgeries. These include cervical hematoma, early-stage breathing infarction caused by respiratory tract involvement due to fixture extrusion and consequent rupture with esophageal damage, and in the late stage, esophageal fistula caused by ischemia.^3–19 However, there have been no reports of all these complications occurring in 1 patient. In the present case, the patient suffered all the above complications in succession.     

A New Method of Thermo-chemotherapy Using a Stent for Patients with Esophageal Cancer

Purpose Many patients with advanced esophageal cancer have a stent inserted in the esophagus, but very little else can be done. We devised a new method of delivering thermotherapy using an implant heating system (IHS) with a metallic stent. To our knowledge, there are no other reports of thermotherapy using metallic stents. We report our clinical results of treating patients with this new technique. Methods A metallic stent was placed in the esophagus and heated for thermotherapy. This was combined with simultaneous chemotherapy in 13 patients and radio-chemotherapy in 5 patients. Each thermotherapy session consisted of heating the stent to 50°C for 10 min. These 18 patients received a collective 52 sessions of thermotherapy. The tumor was excised after this treatment in 5 of these 18 patients. Results We evaluated 17 of the 18 patients, after the exclusion of 1 patient who underwent radio-chemotherapy before placement of the stent. There was 1 complete response (CR) and 12 partial responses (PR), accounting for 76%. The patient with a CR had no residual cancer cells detected by pathologic examination after surgical resection. Thermotherapy proved effective in 8 (89%) of 9 patients who received this treatment at least three times. It was effective in all (100%) patients who underwent concomitant radio-chemotherapy. Conclusions Our results show that thermotherapy using a stent can improve the effectiveness of combination therapy, suppress local tumor growth, and enhance quality of life over a long period.