Gastric Tube Reconstruction by Laparoscopy-Assisted Surgery Attenuates Postoperative Systemic Inflammatory Response after Esophagectomy for Esophageal Cancer

Background  

Conventional open procedures have been supplanted in part by less invasive approaches, such as laparoscopic surgery developed for treating gastrointestinal malignancies. However, it is unclear whether laparoscopy-assisted gastric tube reconstruction (LAGT) can attenuate the postoperative systemic inflammatory response after esophagectomy for esophageal cancer.     

Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy

Background  

Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection.     

Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy

Background  

Perioperative nutrition remains a significant problem in patients undergoing neoadjuvant treatment for esophageal cancer. The aim of this study was to evaluate the effectiveness of esophageal stenting, feeding tube placement, or observation among esophageal cancer patients receiving neoadjuvant therapy.     

Pancreaticoduodenectomy with preservation of gastric tube blood flow after esophagectomy: Report of a case

INTRODUCTION

During pancreaticoduodenectomy (PD), the gastroduodenal artery (GDA) is commonly divided. In this study, we described the clinical features of PD in which the GDA was preserved in order to avoid gastric tube ischemia in a patient who had previously undergone esophagectomy.

PRESENTATION OF CASE

A 70-year-old man had previously undergone esophagectomy. Esophagectomy and gastric tube reconstruction were performed 10 years earlier due to superior thoracic esophageal cancer. The patient was referred to our hospital for the treatment of obstructive jaundice and was diagnosed with middle bile duct cancer. We performed PD and preserved the GDA. The postoperative course was uneventful, and the gastric tube continued functioning well.

DISCUSSION

In a patient with a prior esophagectomy and gastric tube reconstruction, the blood flow to the gastric tube is supplied only by the GDA via the right gastroepiploic artery (RGEA). Therefore, we carefully chose a technique that would preserve the GDA and avoid gastric tube ischemia. Oncologically, this procedure may be debatable because the efficiency of lymph node dissection along the GDA and RGEA may be compromised. PD involving GDA preservation in common bile duct (CBD) cancer may be acceptable because the CBD is behind the pancreatic head, and the CBD lymph flows into the para-aorta lymph nodes behind the pancreas.

CONCLUSION

This procedure is suitable for patients who have previously undergone esophagectomy and this procedure prevents digestive function disorders. Using this method, preoperative angiographic assessment and meticulous surgical technique may lead to successful outcomes.     

Laparoscopy-assisted proximal gastrectomy with gastric tube reconstruction for early gastric cancer

Background  

In this report, laparoscopy-assisted proximal gastrectomy (LAPG) and gastric tube reconstruction using a mini-loop retractor (MLR) is described for the treatment of early gastric cancer.     

Surgical treatment of esophagogastric dysfunction forty years after reverse gastric tube esophagoplasty for congenital esophageal anomaly

Background

In 1968, Burrington first described use of the reverse gastric tube esophagoplasty for esophageal replacement in children with esophageal atresia or acquired stenosis. There are few documented cases of long-term follow-up of these patients.

Case Report

We describe a 41-year-old female who presented with progressive dysphagia 40 years after reverse gastric tube for a congenital esophageal stenosis as an infant. Repeated endoscopic dilations were unsuccessful in relieving her symptoms, and she subsequently underwent a modified Ivor-Lewis esophagogastrectomy with resection of the reverse gastric tube and reconstruction using her remaining gastric remnant.

Conclusions

This report describes what we believe to be the longest recorded follow-up after reverse gastric tube esophagoplasty and highlights the potential for long-term complications after surgery for congenital anomalies.     

The lowest effective intracuff pressure of the esophagus obstruction tube to prevent reflux of gastric contents: a study on rabbits

Purpose

To determine the lowest effective cuff pressure of the esophageal obstruction tube to prevent reflux of gastric contents in rabbits.

Methods

Twenty-two New Zealand white rabbits (2.0–2.5 kg) were anesthetized. An esophageal obstruction tube, an esophageal observation tube, and a gastric tube were inserted into the esophagus and stomach, respectively. Normal saline containing methylene blue was injected into the stomach for an animal model of gastric contents reflux. Possible saline reflux was observed through the esophageal observation tube. It was considered “regurgitation” when the saline flowed out, and “no regurgitation” when the saline did not. When a “regurgitation” result was obtained in a particular rabbit, the intracuff pressure was increased by 10 cm H₂O in the following rabbit and vice versa. The trial was not terminated until six crossover points were observed from “no regurgitation” to “regurgitation.” A probit regression model was used to analyze the effective intracuff pressure of the esophagus obstruction tube after 50 % and 95 % of the rabbits showed no reflux.

Results

The lowest effective intracuff pressure to prevent reflux of gastric contents in 50 % of rabbits from the Dixon up-down method was 61.67 ± 8.16 cm H₂O. The intracuff pressures at which there was 50 % and 95 % probability of lack of gastric contents reflux from a probit regression model were 61.95 and 74.39 cm H₂O, respectively.

Conclusion

The insertion of an esophageal obstruction tube before endotracheal intubation can be an acceptable method for preventing the reflux of gastric contents in most rabbits under light anesthesia.     

Minimally invasive Ivor–Lewis esophagogastrectomy for gastric cardia cancer

Introduction  

Gastric cardia cancer with involvement of the esophagus may require an esophagogastrectomy to obtain negative tumor margins. Multiple studies have shown that minimally invasive esophagectomy is a safe approach for the treatment of esophageal cancer [1–3]. We describe the technique of a minimally invasive Ivor–Lewis esophagectomy in a 55-year-old patient with a gastric cardia tumor.     

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.     

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.     

Two novel endoscopic esophageal lengthening and reconstruction techniques

Background  

Esophageal reconstruction presents a significant clinical challenge in patients ranging from neonates with long-gap esophageal atresia to adults after esophageal resection. Both gastric and colonic replacement conduits carry significant morbidity. As emerging organ-sparring techniques become established for early stage esophageal tumors, less morbid reconstruction techniques are warranted. We present two novel endoscopic approaches for esophageal lengthening and reconstruction in a porcine model.     

Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed

Background  

The occurrence of esophageal dilation after laparoscopic adjustable silicone gastric banding (LASGB) had not been yet investigated systematically.     

Presentation and Survival of Operable Esophageal Cancer in Patients 55 Years of Age and Below

Background  

The increased incidence of esophageal cancer, especially in the younger age group, should encourage early diagnosis. The perceived rarity and poor prognostic outcome of esophageal cancer in this group is based on retrospective studies. The goal of this study was to review the presentation and survival of young patients with esophageal cancer.     

Differential Pathologic Variables and Outcomes across the Spectrum of Adenocarcinoma of the Esophagogastric Junction

Background  

Adenocarcinoma of the esophagogastric junction (AEG) as described by Siewert et al. is classified as one entity in the latest (7th Edition) American Joint Cancer Committee/International Union Against Cancer (AJCC/UICC) manual, compared with the previous mix of esophageal and gastric staging systems. The origin of AEG tumors, esophageal or gastric, and their biology remain controversial, particularly for AEG type II (cardia) tumors.     

Update on Staging and Surgical Treatment Options for Esophageal Cancer

Introduction  

Esophageal cancer remains a challenging clinical problem, with overall long-term survivorship consistently at a level of approximately 30%. The incidence of esophageal cancer is increasing worldwide, with the most dramatic increase being seen with respect to esophageal adenocarcinoma.     

Use of Multimodality Neoadjuvant Therapy for Esophageal Cancer in the United States: Assessment of 987 Hospitals

Background  

Consensus guidelines recommend neoadjuvant therapy in locally advanced esophageal cancer; however, whether this recommendation has been widely adopted is unknown. Therefore, we evaluated the utilization of neoadjuvant therapy in esophageal cancer and its association with outcomes in the United States.     

Feasibility study of sentinel lymph node biopsy in esophageal cancer with conservative lymphadenectomy

Introduction  

Lymphoscintigraphy and sentinel node mapping is established in breast cancer and melanoma but not in esophageal cancer, even though many centers have shown that occult tumor deposits in lymph nodes influence prognosis. We report our initial experience with lymphoscintigraphy and sentinel lymph node biopsy in patients undergoing resection for esophageal cancer.     

Mortality After Esophageal and Gastric Cancer Resection

Background

Contrasting findings on trends and determinants of operative mortality after surgery for esophageal and gastric cancer have been reported from population-based studies.

Methods

Discharge records of residents in the Veneto Region (northeastern Italy) with a diagnosis of esophageal or gastric cancer and intervention codes for esophagectomy or gastrectomy were extracted for the years 2000–2009. In-hospital, 30-day, 90-day, and perioperative (30-day?+?in-hospital) mortality were computed. The influence of patient and hospital variables on in-hospital mortality was assessed through multilevel models.

Results

Overall, 6,500 resections were performed in the period of 2000–2009, with a 10?% decline in the second half of the study period. In-hospital mortality was 4.6?% (5.3?% in 2000–2004 and 3.8?% in 2005–2009) and was higher for extended total gastrectomy and total esophagectomy. In 2005–2009 mortality declined for all resection types except extended total gastrectomy (8.0?%). For esophageal procedures, 30-day mortality was lower than in-hospital or perioperative mortality. A protective effect of procedural volume was found for esophageal but not for gastric resections; among gastric procedures, mortality was higher in male patients and in extended total gastrectomy patients.

Conclusions

Analyses of discharge records allowed investigation at a population level of time trends (downward mainly for esophageal resections) and determinants of perioperative mortality (hospital volume, gender, and procedure type).     

Simultaneous/Incidental Cholecystectomy During Gastric/Esophageal Resection: Systematic Analysis of Risks and Benefits

Background  

After esophageal/gastric resection with resulting truncal vagotomy, the incidence of gallstone formation seems to increase. The clinical relevance of gallstones and the role of simultaneous/incidental cholecystectomy in this setting are controversially discussed.     

Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Review of Meta-Analyses

Background  

Most randomized controlled trials (RCTs) that have compared neoadjuvant chemoradiation followed by surgery with surgery alone for locally advanced esophageal cancer have shown no difference in survival between the two treatments. Meta-analyses on neoadjuvant chemoradiation in esophageal cancer, however, are discordant.