Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy

BACKGROUND: Benign tracheo-neo-esophageal fistulas after esophagectomy are rare and treatment can be challenging. They can result from perioperative tracheal injury or various postoperative complications. METHODS: Charts of 6 patients with a benign tracheoneo-esophageal fistula after subtotal esophagectomy treated in this institution between July 1993 and August 1999 were analyzed. RESULTS: Three men and 3 women (median age 61 years) developed a fistula after subtotal esophagectomy. Symptoms varied from mild swallowing difficulties to aspiration pneumonia and mediastinitis. Two patients with mild symptoms were treated conservatively. In 1 patient a long fistula was partly excised through the neck. In 3 patients the gastric tube was excluded or excised, with surgical closure of the tracheal defect. The alimentary tract was reconstructed by colonic interposition. There were no major complications. After a median follow-up of 1.6 years, all fistulas were closed. All patients were capable of sufficient oral intake. CONCLUSIONS: A benign tracheo-neo-esophageal fistula after esophagectomy is a rare, but serious complication. Site and size of the fistula, together with the severity of symptoms, should dictate management.     

Long-term results after esophagectomy for squamous cell carcinoma of the esophagus associated with head and neck cancer.

BACKGROUND: Esophageal squamous cell carcinomas are frequently associated with head and neck cancers. The poor prognosis of each cancer, and their proximity, often limit the treatment options. This study was conducted to determine the characteristics and long-term outcome of such dual cancers. PATIENTS AND METHODS: We included 75 patients with esophageal carcinoma, of whom 25 had a synchronous head and neck malignancy. Curative treatment was possible in every case. The patients were divided into "solitary cancer" and "synchronous cancer" groups. RESULTS: The gender distribution, tumor location, and histological findings were similar in the two groups. Patients in the synchronous cancer group were younger than those in the solitary group (P < 0.0042). The operative mortality and pulmonary morbidity rates were not significantly different in the two groups. The rate of cervical anastomotic leaks was higher in the synchronous group (P < 0.05). The mean follow-up was 83 +/- 50 months. Five-year survival rates were not significantly different in the two groups (14.3% +/- 5.7% in the solitary group and 17.5% +/- 7.9% in the synchronous group). CONCLUSIONS: With aggressive treatment, the survival of patients with synchronous esophageal and head and neck cancers was similar to that of patients with isolated esophageal cancer.     

食管鳞癌切除术后切缘癌残留的影响因素及预后

目的 探讨食管鳞癌切除术后切缘癌残留的影响因素和预后,评价术后补救性治疗的价值.方法 回顾性总结中山大学肿瘤防治中心1997年1月至2003年6月连续收治的1074例行食管鳞癌切除术患者的临床与病理资料,分析肿瘤分化程度、部位、病变长度、切口选择、吻合位置、T分期、N分期与切缘癌残留发生率的关系,并通过生存分析探讨补救性治疗的方式.结果 本组44例（4.3%）出现切缘癌残留.食管端切缘癌残留在病变位于胸上段时发生率为6.5%;胃端切缘癌残留在病变位于胸下段时发生率为0.8%.切缘癌残留发生率随T分期和N分期的增加而升高（均P＜0.05）.Logistic回归分析显示,T分期和N分期是术后切缘癌残留发生的危险因素.切缘癌残留患者3年生存率为22.7%.生存时间（25.2±3.3）个月.术后行补救性治疗者20例（45.5%,其中行放疗18例,行联合放化疗2例）：另24例（54.5%）未行补救性治疗.术后行补救性治疗与未行补救性治疗患者的3年生存率分别为53.2%与7.8%（P=0.027）.结论 肿瘤浸润程度和淋巴结转移是食管鳞癌切除术后切缘癌残留发生的危险因素;术后行补救性治疗可明显提高生存率.     

Definitive chemoradiotherapy and salvage esophagectomy for squamous cell carcinoma of the esophagus

Surgical resection has widely accepted as the first-choice treatment for esophageal carcinoma in Japan, and it has improved the survival of patients with esophageal carcinoma during the past decades. However, the survival rate remains relatively poor compared with that of other gastrointestinal carcinomas. Physical handicaps after esophagectomy also cannot be ignored. Definitive chemoradiation has become an accepted treatment for esophageal carcinoma. Persistent or recurrent local disease is often the problem to be solved. In this case, selected patients with local failures can be salvaged by esophagectomy. In this paper we discuss recent improvements in definitive chemoradiotherapy and the definition of salvage esophagectomy. We also present our short-term results of a prospective phase II study of definitive chemoradiotherapy and salvage esophagectomy in patients with resectable squamous cell carcinoma of the esophagus.     

Total esophagectomy and descending colon bypass for squamous cell carcinoma of the esophagus

Twenty patients with carcinoma of the esophagus were treated with descending colon bypass and combined radiation and chemotherapy. The results obtained are described. In ten patients, total esophagectomy was also performed with a significant prolongation of life and well-being. The advantages as well as the disadvantages of using the descending colon for esophageal bypass are described. The merits of treating esophageal carcinoma in a sequence of stages, including use of the descending colon for bypass radiation therapy, and total esophagectomy are reviewed.     

Local treatment of penile squamous cell carcinoma

Treatment of primary tumour represents one of the main issues in the management of squamous cell carcinoma of the penis. Radical surgery assures the best results in terms of oncological radicality but causes important anatomical and functional limitations and a significant quality of life compromise. It is possible to suggest a penile-sparing treatment in the presence of small size and low stage tumours. The local recurrence rates seem higher than radical surgery and the functional and aesthetic results are not excellent in all cases. Moreover, radiotherapy seems to have a negligible percentage of local complications.     

Outcomes of active operation during intensive followup for second primary malignancy after esophagectomy for thoracic squamous cell esophageal carcinoma

BACKGROUND: Recent advances in the treatment of thoracic esophageal cancer have afforded it a better prognosis. As a consequence, increasing attention is being paid to the outcomes with postoperative monitoring for second primary malignancies after esophagectomy, but no recent study has focused on the longterm followup and outcomes in these patients. STUDY DESIGN: In 1989, we began intensive prospective screening and surveillance designed to detect cancers of the head and neck, lung, stomach, residual esophagus, and colon/rectum after esophagectomy. Between 1989 and 2001, 365 patients underwent esophagectomy for thoracic squamous cell esophageal carcinoma in our department. Of those, 200 were followed up as part of this program. Excluded were patients in whom esophageal cancer recurred, patients with other prior or simultaneous malignancies, and patients who died within a year of operation. Clinicopathologic profiles and treatment outcomes were determined for 33 patients who developed a second primary malignancy after esophagectomy. RESULTS: The interval between the primary esophageal cancer and the secondary carcinoma was 49 +/- 40 months (median, 48 months). The second primary malignancies were located in the stomach (30%), head and neck (24%), lung (24%), colon/rectum (9%), liver (6%), pancreas (3%), and blood (6%). Twenty-one patients (64%) were classified as stage 0, I, or II; 10 (30%) were stage III or IV. Overall, the 2-year, 3-year, and 5-year survival rates following diagnosis of a second primary malignancy were 58.0%, 58.0%, and 48.6%, respectively. Of the 19 patients (58%) in whom second primary malignancies were detected before symptoms developed, the 5-year survival rate was 70.7%, which was significantly greater than that among patients whose secondary malignancies were discovered after symptoms developed (17.1%). CONCLUSIONS: Good outcomes in the treatment of second primary malignancies after esophagectomy for thoracic squamous cell esophageal carcinoma can be obtained with longterm, intensive followup and active surgical intervention for detected malignancies.     

Outcomes of lymphadenectomy for lymph node recurrence after esophagectomy or definitive chemoradiotherapy for squamous cell carcinoma of the esophagus

Objective

The aim of this study was to determine the significance of lymphadenectomy for recurrence after treatment for esophageal squamous cell carcinoma.

Methods

Short- and long-term outcomes of 24 patients who underwent lymphadenectomy for recurrence in 3 hospitals between April 2004 and March 2013 were retrospectively analyzed. There were 17 cases with lymph node recurrence after esophagectomy (11 cervical, 4 mediastinal, and 2 abdominal node recurrences) and 7 cases with remnant or recurrent lymphatic diseases after definitive chemoradiotherapy (3 cervical, 1 mediastinal, and 3 abdominal node recurrences).

Results

Three minor complications were observed among 24 patients and the median postoperative hospital stay was 7 days. The 3-year progression-free and overall survivals of patients who underwent secondary lymphadenectomy for recurrence after esophagectomy were 51.5 and 75.5 %, respectively. The overall survival of patients with cervical node recurrence was significantly better than that of patients with mediastinal or abdominal node recurrence in this group (P = 0.0097). The median progression-free and overall survivals of patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy were 2 and 15 months, respectively. Although only 1 patient experienced local recurrence after secondary lymphadenectomy, locoregional failures occurred in 6 of 7 patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy.

Conclusion

Secondary or salvage lymphadenectomy can be performed safely in the selected patients. Secondary lymphadenectomy achieves locoregional disease control and results in a favorable long-term outcome, particularly for cervical node recurrence. Further large-scale cohort studies are needed to determine the prognostic significance of salvage lymphadenectomy after definitive chemoradiotherapy.     

pT1b期食管鳞状细胞癌开放手术与微创食管切除术后预后分析

目的 比较微创食管切除术与传统开放食管切除术对pT1b期食管鳞状细胞癌(ESCC)患者近远期疗效之间的差异.方法 回顾性分析2015 ～ 2018年于苏北人民医院胸外科行手术治疗并且术后病理确诊为pT1b期ESCC 162例患者的临床病理资料.根据手术方式分为微创手术(MIE)组和开放手术(OE)组.其中OE组共76例...     

Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus.

OBJECTIVE: This study evaluated the impact of aggressive surgery on survival in patients with carcinoma of the thoracic esophagus. SUMMARY BACKGROUND DATA: Prognostic value of lymph-node status for patients with esophageal carcinoma was emphasized, although it is currently under debate whether extensive lymph node dissection improves survival. METHODS: Two hundred ninety-five patients with thoracic esophageal carcinoma were admitted to Kagoshima University Hospital from December 1982 to December 1990. Esophagectomy was performed on 244 (82.7%) of these patients; 106 of whom underwent three-field lymphadenectomy (bilateral cervical, mediastinal, and abdominal regions) were analyzed regarding lymph-node status, tumor recurrence, and the effect of prognostic factors on survival using Cox's proportional hazards model. RESULTS: Hospital mortality and morbidity were 10.4% (11/106) and 65.1%, respectively. Seventy-eight patients (73.6%) had nodal involvement, including 49 patients with abdominal lymph-node metastases and 46 patients with recurrent nerve-node metastases. Five-year survival rates were 54.5% for 16 patients with a solitary nodal metastasis, 30.3% for stage III, 17.4% for stage IV, and 7.2% for 28 patients with six or more metastatic nodes. The most frequent sites of recurrence were the upper mediastinal region and the lung--its incidence increased significantly as the number of positive nodes increased. The most unfavorable prognostic factors included regional or recurrent nerve-node metastasis and patient age of more than 71 years. CONCLUSIONS: Three-field lymphadenectomy, including especially the removal of bilateral recurrent nerve nodes in the cervical region, is essential for improving the survival of patients with carcinoma of the upper two thirds of the thoracic esophagus.     

Revascularization using the short gastric vessels of the gastric tube after subtotal esophagectomy for intrathoracic esophageal carcinoma

BACKGROUND: Maintaining sufficient blood flow to the substitutive organ after esophagectomy is essential to decrease the risk of anastomotic leakage. STUDY DESIGN: Forty-one patients underwent subtotal esophagectomy for intrathoracic esophageal carcinoma and reconstruction using the gastric tube. Additional vascular anastomosis between the short gastric vessels and the vessels in the neck was performed in 15 patients. Tissue blood flow was measured by laser Doppler flowmetry before and after vascular anastomosis. The incidence of anastomotic leakage in the revascularization group was compared with that in the remaining 26 patients. RESULTS: Venous anastomosis was performed in 14 patients and arterial anastomosis in 9. There was a significant increase in tissue blood flow after venous anastomosis alone (mean percent increase: 36%; p < 0.01), and after arterial and venous anastomoses (mean percent increase: 108%; p < 0.01). No anastomotic leakage was observed in the revascularization group; six patients (23.1%) in the control group had leakage (p < 0.05). Patients in the revascularization group started taking a meal 10.0 +/- 0.4 days postoperatively, compared with 15.1 +/- 1.8 days in the control group (p < 0.05). CONCLUSIONS: Additional vascular anastomosis in esophageal reconstruction after subtotal esophagectomy achieved good results. This procedure can reduce the risk of anastomotic leakage and may be useful for esophageal reconstruction.     

Tumor angiogenesis as an independent prognostic factor after extended radical esophagectomy for invasive squamous cell carcinoma of the esophagus

BACKGROUND: Currently, there is only limited information regarding tumor angiogenesis and its clinical implications in cases of esophageal carcinoma. The purpose of this study was to clarify which clinicopathologic parameters correlate with tumor angiogenesis; furthermore, the study was conducted to evaluate whether tumor angiogenesis is an independent prognostic factor in cases of esophageal carcinoma. METHODS: Intratumoral microvessel density (MVD) and thymidine phosphorylase (dThdPase) expression were immunohistochemically studied after extended radical esophagectomy in 103 cases of esophageal carcinoma. RESULTS: Increased MVD significantly correlated with the depth of tumor invasion, the frequency of intramural metastasis, and the stage of tumor advancement (P <.05). dThdPase expression status significantly correlated with the size and depth of primary tumors (P <.02). A significant correlation was present between MVD and the expression status of dThdPase (P <.01). Furthermore, increased MVD correlated with increased tumor recurrence after esophagectomy and with poorer survival curves (P <.01 and P <.05, respectively). A multivariate analysis revealed MVD to be an independent predictor of unfavorable prognosis. CONCLUSIONS: Tumor angiogenesis expressed as MVD correlates with clinicopathologic parameters regarding tumor progression and is an independent prognostic indicator in patients undergoing extended radical esophagectomy for invasive esophageal carcinoma.     

Multiple urothelial recurrences of renal cell carcinoma after initial diagnostic ureteroscopy.

Urothelial recurrence of renal cell carcinoma after radical surgery is exceedingly rare. We report on a 48-year-old man who underwent upper urinary tract flexible endoscopy to define a filling defect, which was found to be a perforating renal cell carcinoma. After radical nephrectomy the patient had multiple recurrences on the urinary surfaces, ureter and urethra. Urothelial lesions were treated endoscopically. He remains free of tumor 42 months after the last treatment.     

Gastroduodenal artery-preserving pancreaticoduodenectomy after subtotal esophagectomy and gastric pull-up

Purpose  

Division of the gastroduodenal artery is commonly performed during pancreaticoduodenectomy for both malignant and benign disease. We describe here a technical modification of pylorus preserving pancreaticoduodenectomy with gastroduodenal artery preservation performed in a patient who previously underwent subtotal esophagectomy with gastric pull-up discussing advantages and drawbacks of the technique.