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1.
Background
Surgical treatment of advanced hypopharyngeal tumors is still a surgical challenge. We report a case of a hypopharyngeal tumor treated with a pharyngolaryngo-esophagectomy (PLE) and laparoscopic gastric tubulization and interposition.Methods
A 56-year-old man presented with a relapsing hypopharynx carcinoma, after primary chemoradiation therapy. Preoperative workup showed a stage IV cancer with esophageal invasion and multiple cervical lymph node metastases. Surgical treatment consisted of a cervical phase, with larynx, pharynx, and esophagus dissection, radical lymph node dissection, homolateral hemithyroidectomy and definitive tracheostomy, and an abdominal phase with a 4-trocar laparoscopy. The gastrocolic ligament was opened, and short gastric and left gastric vessels were divided preserving an accessory left hepatic artery. Gastric tailoring was carried out with 45-mm linear staplers. The hiatus was opened and the esophagus dissected free with Ultracision (Ethicon Endo-Surgery, Cincinnati, OH) to the tracheal bifurcation. The upper esophagus was bluntly mobilized by finger and sponge stick dissection. The gastric tube was pulled up, and the anastomosis between the stomach and the tongue base was performed with a 2-layer interrupted hand-sewn technique.Results
Total operative time was 390?min (abdominal time 180?min). Estimated blood loss was 400?cc. The number of dissected cervical lymph nodes was 32. Oral feeding was started after 10?days, and the patient was discharged after 14?days. Stage of disease was pT4N1M0 G3 R0.Conclusions
Laparoscopic surgery allows a minimally invasive gastric tailoring and tubulization and transhiatal esophageal dissection and represents a valuable alternative for intestinal reconstruction after PLE.CT scan showing a large hypopharynx carcinoma involving cervical lymph nodes and cervical esophagus 相似文献
2.
Shah-Hwa Chou Hsien-Pin Li Jui-Ying Lee Meei-Feng Huang Chia-Hua Lee Ka-Wo Lee 《World journal of surgery》2010,34(8):1832-1839
Background
The prognosis and quality of life (QOL) for those with cervical esophageal cancer is extremely poor, and chemoradiotherapy remains the mainstay treatment. During the past few years, our surgical teams has implemented a more aggressive and radical resection: total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach. This study compares the results of chemoradiotherapy and that of the aforementioned surgical approach. 相似文献3.
Hiroshi Miyata Makoto Yamasaki Tsuyoshi Takahashi Yukinori Kurokawa Kiyokazu Nakajima Shuji Takiguchi Masaki Mori Yuichiro Doki 《World journal of surgery》2013,37(3):551-557
Background
There is no generally accepted treatment strategy for cervical cancer. The aim of this study was to evaluate the safety and efficacy of larynx-preserving limited resection with free jejunal graft for cervical esophageal cancer.Methods
We retrospectively reviewed data of 58 patients with cervical esophageal cancer who underwent limited resection and free jejunal graft with or without laryngeal preservation. Among them, 45 patients received neoadjuvant treatment.Results
Larynx-preserving surgery was conducted in 33 of the 58 patients (56.9 %). A higher proportion of patients who underwent laryngopharyngectomy with cervical esophagectomy (larynx-nonpreserving group) had cT4 tumors than those who underwent larynx-preserving cervical esophagectomy (larynx-preserving group) (72 vs. 12 %). The overall incidence of postoperative complications was similar in the two groups (56 vs. 52 %). The 5-year survival rate was 44.9 % for the entire group. Laryngeal preservation did not reduce overall survival compared with the larynx-nonpreserving operation (5-year survival rate: 57.8 vs. 25.8 %). Multivariate analysis identified the number of metastatic lymph nodes as the only independent prognostic factor.Conclusions
The present study demonstrated that larynx-preserving limited resection with free jejunal graft is feasible. Also, this approach did not worsen the prognosis compared with the larynx-nonpreserving operation. Limited resection with free jejunal graft and laryngeal preservation is a promising treatment strategy for cervical esophageal cancer. 相似文献4.
Jeongmin Choi Sang Gyun Kim Joo Sung Kim Hyun Chae Jung In Sung Song 《Surgical endoscopy》2010,24(6):1380-1386
Background
Endoscopic ultrasonography (EUS) has been a useful method for the accurate staging of esophageal cancer. This study aimed to compare the diagnostic performance of EUS, positron emission tomography (PET), and computed tomography (CT) in the locoregional staging of resectable esophageal cancer. 相似文献5.
Purpose
To review relevant data for the management of esophageal perforation after anterior cervical surgery.Methods
A case of delayed esophageal perforation after anterior cervical surgery has been presented and the relevant literature between 1958 and 2014 was reviewed. A total of 57 papers regarding esophageal perforation following anterior cervical surgery were found and utilized in this review.Results
The treatment options for esophageal perforation after anterior cervical surgery were discussed and a novel management algorithm was proposed.Conclusion
Following anterior cervical surgery, patients should be closely followed up in the postoperative period for risk of esophageal perforation. Development of symptoms like dysphagia, pneumonia, fever, odynophagia, hoarseness, weight loss, and breathing difficulty in patients with a history of previous anterior cervical surgery should alert us for a possible esophageal injury. Review of the literature revealed that conservative treatment is advocated for early and small esophageal perforations. Surgical treatment may be considered for large esophageal defects.6.
Surveillance and treatment for second primary cancer in the gastric tube after radical esophagectomy
Takeo Bamba Shin-ichi Kosugi Manabu Takeuchi Masaaki Kobayashi Tatsuo Kanda Atsushi Matsuki Katsuyoshi Hatakeyama 《Surgical endoscopy》2010,24(6):1310-1317
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. 相似文献7.
Background
Minimally invasive esophagectomy (MIE) is a feasible technique that has been shown to be safe for the treatment of esophageal cancer. Chylothorax remains a challenging and potentially life-threatening postoperative complication of MIE. In this retrospective series, we evaluated the results of preventive intraoperative thoracic duct ligation in patients who underwent video-assisted thoracoscopic esophagectomy for cancer. 相似文献8.
Florian Lordick Arnulf H. Hölscher Karen Haustermans Christian Wittekind 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(2):177-187
Background
The treatment of localized esophageal cancer has been debated controversially over the past decades. Neoadjuvant treatment was used empirically, but evidence was limited due to the lack of high-quality confirmatory studies. Meanwhile, data have become much clearer due to recently published well-conducted randomized controlled trials and meta-analyses.Methods
Neoadjuvant and perioperative platinum fluoropyrimidine-based combination chemotherapy has now an established role in the treatment of stage II and stage III esophageal adenocarcinoma and cancer of the esophago-gastric junction. Neoadjuvant chemoradiation is now the standard of care for treating stage II and stage III esophageal squamous cell cancer and can also be considered for treating esophageal adenocarcinoma.Results
Patients with esophageal squamous cell cancer treated with definitive chemoradiation achieve comparable long-term survival compared with surgery. Short-term mortality is less with chemoradiation alone, but local tumor control is significantly better with surgery.Conclusion
This expert review article outlines current data and literature and delineates recommendable treatment guidelines for localized esophageal cancer. 相似文献9.
Matthew Bower MD Whitney Jones MD Ben Vessels MD Charles Scoggins MD MBA Robert Martin MD PhD 《Annals of surgical oncology》2009,16(11):3161-3168
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. 相似文献10.
Masaru Morita MD PhD FACS Hiroshi Saeki MD PhD FACS Shuhei Ito MD PhD Keisuke Ikeda MD Nami Yamashita MD PhD Koji Ando MD PhD Yukiharu Hiyoshi MD PhD Satoshi Ida MD PhD Eriko Tokunaga MD PhD Hideaki Uchiyama MD PhD Eiji Oki MD PhD FACS Tetsuo Ikeda MD PhD Sei Yoshida MD Torahiko Nakashima MD PhD Yoshihiko Maehara MD PhD FACS 《Annals of surgical oncology》2014,21(5):1671-1677
Purpose
Total pharyngo-laryngo-esophagectomy (PLE) is highly invasive, and the subsequent reconstruction is difficult. The purpose of this study was to clarify the techniques that can decrease the surgical stress and allow for safe reconstruction after this operation.Methods
The surgical method and clinical outcomes of total PLE were reviewed in 12 patients with either cervicothoracic esophageal cancer or double cancer of the esophagus and pharynx. Microscopic venous anastomosis was principally performed, and arterial anastomosis was added, if needed.Results
A narrow gastric tube was used in ten patients, including two patients who underwent free jejunal interposition, while the colon was used as the main reconstructed organ in two other patients. Staged operations were performed in three high-risk patients. All six patients treated after 2010 were able to undergo thoracoscopic and/or laparoscopic surgery. No critical postoperative complications developed, although minor anastomotic leakage developed in two patients who were successfully treated conservatively.Conclusion
When performing PLE, it is important to decrease the surgical stress and ensure a reliable reconstruction by adopting techniques that are appropriate for each case, such as thoracoscopic and laparoscopic surgery, staged operations, microvascular anastomosis, and muscular flaps. 相似文献11.
Ryan P. Merkow Karl Y. Bilimoria Martin D. McCarter Warren B. Chow Clifford Y. Ko David J. Bentrem 《Annals of surgical oncology》2012,19(2):357-364
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. 相似文献12.
Mark van Heijl Mirjam A. G. Sprangers Angela G. E. M. de Boer Sjoerd M. Lagarde Hans B. Reitsma Olivier R. C. Busch Hugo W. Tilanus Jan J. B. van Lanschot Mark I. van Berge Henegouwen 《Annals of surgical oncology》2010,17(1):23-30
Background
In patients with esophageal cancer, evidence for prognostic significance of preoperative quality of life (QoL) is limited, while the prognostic significance of postoperative QoL has not been investigated at all. 相似文献13.
Dittrick GW Weber JM Shridhar R Hoffe S Melis M Almhanna K Barthel J McLoughlin J Karl RC Meredith KL 《Annals of surgical oncology》2012,19(5):1678-1684
Background
Neoadjuvant chemoradiation (NCRT) has become the preferred treatment for patients with locally advanced esophageal cancer. Survival often is correlated to degree of pathologic response; however, outcomes in patients who are found to be pathologic nonresponders (pNR) remain uninvestigated. This study was designed to evaluate survival in pNR to NCRT compared with patients treated with primary esophagectomy (PE). 相似文献14.
Chou-Chin Lan Hsian-He Hsu Chin-Pyng Wu Shih-Chun Lee Chung-Kan Peng Hung Chang 《The Journal of surgical research》2014
Background
Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) cause substantial morbidity and mortality despite improvements in the understanding of lung injury and advances in treatment. Recruitment maneuver (RM) with high sustained airway pressures is proposed as an adjunct to mechanical ventilation to maintain alveolar patency. In addition, RM has been advocated to improve pulmonary gas exchange. However, many factors may influence responses to RM and the effect of pleural effusion (PLE) is unknown.Method
There were four groups in this study (n = 6 in each group). Group A was the control group, group B was the PLE group, group C was ARDS with RM, and group D was ARDS with PLE and RM. RM was performed in groups C and D, consisting of a peak pressure of 45 cm H2O with positive end-expiratory pressure of 35 cm H2O sustained for 1 min. Arterial blood gas, systemic and pulmonary hemodynamics, lung water, and respiratory mechanics were measured throughout.Result
After the induction of ALI/ARDS, there were significant decreases in partial pressure of oxygen in arterial blood, mean arterial pressure, systemic vascular resistance, and lung compliance. There were also significant increases in the alveolar–arterial O2 tension difference, partial pressure of arterial carbon dioxide, mean pulmonary arterial pressure, pulmonary vascular resistance, and lung water. The RM improved oxygenation, which was attenuated by PLE.Conclusions
ALI/ARDS leads to poor oxygenation and hemodynamics. RM results in improved oxygenation, but this improvement is attenuated by PLE. 相似文献15.
Omloo JM van Heijl M Hoekstra OS van Berge Henegouwen MI van Lanschot JJ Sloof GW 《Annals of surgical oncology》2011,18(12):3338-3352
Background
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used extensively to explore whether FDG Uptake can be used to provide prognostic information for esophageal cancer patients. The aim of the present review is to evaluate the literature available to date concerning the potential prognostic value of FDG uptake in esophageal cancer patients, in terms of absolute pretreatment values and of decrease in FDG uptake during or after neoadjuvant therapy. 相似文献16.
Oki E Morita M Toh Y Kimura Y Ohgaki K Sadanaga N Egashira A Kakeji Y Tsujitani S Maehara Y 《Surgery today》2011,41(7):966-969
Purpose
Metachronous gastric carcinoma arising in a gastric tube used for esophageal reconstruction has been occasionally encountered in long-term survivors of esophageal cancer. This study investigated 10 cases of gastric tube cancer in order to clarify the characteristics and the outcome of these patients. 相似文献17.
Background
An elevation in the neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with a poorer prognosis in patients with various tumors. The aim of this retrospective study was to clarify the correlation of the pretherapeutic NLR with the prognostic value of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with advanced esophageal cancer. 相似文献18.
Hui MK Chan KW Luk JM Lee NP Chung Y Cheung LC Srivastava G Tsao SW Tang JC Law S 《World journal of surgery》2012,36(1):90-97
Abstract
Esophageal cancer is a deadly cancer with esophageal squamous cell carcinoma (ESCC) as the major type. Until now there has been a lack of reliable prognostic markers for this malignancy. This study aims to investigate the clinical correlation between Forkhead box M1 (FoxM1) and patients’ parameters in ESCC. 相似文献19.
Satoshi Ida MD PhD Masaru Morita MD PhD FACS Yukiharu Hiyoshi MD PhD Keisuke Ikeda MD Koji Ando MD PhD Yasue Kimura MD PhD Hiroshi Saeki MD PhD Eiji Oki MD PhD Tetsuya Kusumoto MD PhD Sei Yoshida MD PhD Torahiko Nakashima MD PhD Masayuki Watanabe MD PhD FACS Hideo Baba MD PhD FACS Yoshihiko Maehara MD PhD FACS 《Annals of surgical oncology》2014,21(4):1175-1181
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. 相似文献20.