Radical surgical treatment of Barrett's esophagus

In the light of modern scientific knowledge, pathogenesis of Barrette's esophagus (BE) is presented as an integral neoplastic process. Indications to operation and policy of radical surgical treatment in BE, including in combined esophageal diseases (burn and peptic strictures, reflux esophagitis, short esophagus) were developed. From 1990 to 2000 radical operations were performed in 14 patients (11 males, 3 females) with BE. Mean age was 54.1 years. About 80% patients had clinical signs of reflux esophagitis at the moment of hospitalization. In all the patients the diagnosis of BE was verified in microscopic examination of operative material. 4 patients with cylindrical metaplasia associated with ulcers and esophageal peptic strictures were operated, 3 patients--with epithelium dysplasia, 7 patients--with adenocarcinoma. All the patients underwent extirpation of thoracic portion of esophagus with one-stage plasty with isoperistaltic gastric tube, supplemented with mediastinal and abdominal lymphodissection in cancer. Affection of the regional lymph nodes was revealed in 43% patients with esophageal adenocarcinoma. 50% patients had complications in postoperative period. There were no cases of hospital lethality. The expansion of indications for early surgical treatment of BE at the stage of meta-, and dysplasia, before adenocarcinoma development, is thought valid.     

Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease

PurposeThe purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease.Materials and methodsThis retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4 cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates.ResultsAmong 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3 ± 14.9 [SD]; age range: 15–81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2 ± 10.8 [SD]; age range: 33–80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P < 0.0001), with more extra-thoracic localisation (P = 0.015) and bilateral tumour burden (P = 0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P = 0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P = 0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P > 0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P = 0.07). Tumour size > 2 cm was associated with a significantly higher local tumor progression in the RFA group (P = 0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR = 2 days; range: 2–12 days) than in the surgery group (median of 9 days; IQR = 2 days; range: 6–21 days) (P < 0.01).ConclusionRFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4 cm in diameter without associated pleural involvement or thoracic lymphadenopathy.     

射频消融与手术切除治疗小肝癌的Meta分析

目的：比较经皮射频消融与手术切除治疗小肝癌的疗效。方法：计算机检索文献,对纳入研究的方法及质量进行评价,并用RevMan 4.2.10版软件进行统计分析。结果：共纳入9个随机对照研究,Meta分析结果表明,两种治疗方法的1年总生存率差异无统计学意义,1、3年无瘤生存率、1年复发率手术组占优势。术后主要并发症及总住院时间,经皮射频消融组要优于手术组,差异有统计学意义（P〈0.05）。结论：经皮热射频消融治疗小肝癌短期内总体疗效差异不大,但是远期看来,手术组的生存率较高,复发率要低于射频组。     

Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates

OBJECTIVE: Treatment options for patients with non-small cell lung cancer who are not surgical candidates or who refuse operation are limited. Radiofrequency ablation represents a potential less invasive option for these patients. Our initial experience with radiofrequency ablation for peripheral, primary non-small cell lung cancer is reported. METHODS: We treated 21 tumors in 18 patients. Median age was 75 (range 58-86) years. Cancer stages were I (n = 9), II (n = 2), III (n = 3), and IV (n = 4). Patients with stage IV disease included 3 with recurrence after previous lobectomies and 1 with a synchronous liver metastasis also treated with radiofrequency ablation. Median tumor diameter was 2.8 cm (range 1.2-4.5 cm). Radiofrequency ablation was delivered by minithoracotomy in 2 cases and by a computed tomography-guided percutaneous approach in 16 patients. Computed tomographic and positron emission tomographic scans were used to evaluate recurrence and radiographic response in ablated nodules. RESULTS: One postoperative death occurred from pneumonia after open radiofrequency ablation. Median hospital stay was 2.5 days. A chest tube or pigtail catheter was required in 7 patients (38.9%) for procedure-related pneumothoraces. At a median follow-up of 14 months, 15 patients (83.3%) were alive. Local progression occurred in 8 nodules (38.1%). Mean and median progression-free intervals were 16.8 and 18 months, respectively. For stage I cancers, mean progression-free interval was 17.6 months. Median progression-free interval was not reached. CONCLUSION: This study demonstrates the feasibility of radiofrequency ablation for small, peripheral non-small cell lung cancer tumors. Local control is comparable to, if not better than, that provided by radiotherapy. Radiofrequency ablation should continue to be evaluated by thoracic surgeons as a noninvasive therapy for the high-risk patient with non-small cell lung cancer.     

Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett's esophagus

OBJECTIVE: To compare the results of medical treatment and antireflux surgery in patients with Barrett's esophagus (BE). SUMMARY BACKGROUND DATA: The treatment of choice in BE is still controversial. Some clinical studies suggest that surgery could be more effective than medical treatment in preventing BE from progressing to dysplasia and adenocarcinoma. However, data from prospective comparative studies are necessary to answer this question. METHODS: One hundred one patients were included in a randomized prospective study, 43 with medical treatment and 58 with antireflux surgery. All patients underwent clinical, endoscopic, and histologic assessment. Functional studies were performed in all the operated patients and in a subgroup of patients receiving medical treatment. The median follow-up was 5 years (range 1-18) in the medical treatment group and 6 years (range 1-18) in the surgical treatment group. RESULTS: Satisfactory clinical results (excellent to good) were achieved in 39 of the 43 patients (91%) undergoing medical treatment and in 53 of the 58 patients (91%) following antireflux surgery. The persistence of added inflammatory lesions was significantly higher in the medical treatment group. The metaplastic segment did not disappear in any case. Postoperative functional studies showed a significant decrease in the median percentage of total time with pH below 4, although 9 of the 58 patients (15%) showed pathologic rates of acid reflux. High-grade dysplasia appeared in 2 of the 43 patients (5%) in the medical treatment group and in 2 of the 58 patients (3%) in the surgical treatment group. In the latter, both patients presented with clinical and pH-metric recurrence. There was no case of malignancy after successful antireflux surgery. CONCLUSIONS: These results show that there are no differences between the two types of treatment with respect to preventing BE from progressing to dysplasia and adenocarcinoma. However, successful antireflux surgery proved to be more efficient than medical treatment in this sense, perhaps because it completely controls acid and biliopancreatic reflux to the esophagus.     

Endoscopic ablation of Barrett's esophagus using argon plasma coagulation (APC) following surgical laparoscopic fundoplication

BACKGROUND: Barrett's esopagus (BE) is considered a risk factor for the development of esophageal carcinoma. Recently, partial restoration of squamous mucosa after ablation of BE with endoscopic techniques has been described. METHODS: From November 1996 to November 1999, 23 patients with histologically proven BE have been treated by endoscopic argon plasma coagulation (APC) following suppression of gastro-esophageal reflux by laparoscopic fundoplication. Histological follow-up after completed ablation ranged from 16 to 45 months (mean, 31.9 months). RESULTS: Histologically, complete squamous reepithelialization was observed in 20/23 patients, whereas a regrowth of a mixed squamous and gastric type mucosa was observed in 1 patient. Small islands of intestinal metaplasia were observed under the neosquamous epithelium in two patients (9%) during follow-up. CONCLUSION: The success rate of APC ablation following laparoscopic antireflux surgery in our series may be as high as 91%. Nevertheless, small islands of intestinal metaplasia under the new squamous epithelium may persist in some patients. In these circumstances, the authors recommend that endoscopic ablation of BE should be confined to controlled clinical trials.     

The importance of symptom assessment in the surgical treatment of gastroesophageal reflux disease and Barrett's esophagus

The "art" and science of symptom assessment in the evaluation of patients with gastroesophageal reflux disease has been under emphasized. In fact, it is critical to judgements regarding surgical versus non-surgical therapy and is much more difficult than meets the eye. Many symptoms thought to be secondary to gastroesophageal reflux are not, and some, such as asthma cough and chest pain, which are commonly thought secondary to other causes, are indeed symptoms of reflux. Diagnostic studies are helpful but far from perfect, ultimately requiring the clinician's expert judgement as the key factor in determining a successful outcome. The following outlines both an approach to the assessment of symptoms and when possible, clinical studies shedding light on their cause and interpretation.     

射频消融联合经皮椎体成形术治疗脊柱转移瘤

目的探讨射频消融(RFA)联合经皮椎体成形术(PVP)治疗脊柱转移瘤的临床疗效。方法将62例脊柱转移瘤患者按治疗方法不同分为对照组(行单纯PVP治疗,30例)和观察组(行RFA联合PVP治疗,32例)。比较两组疼痛VAS评分、ODI、KPS评分、骨水泥渗漏率。结果患者均获得随访,时间3~12个月。两组术后各时间点VAS评分、ODI、KPS评分均明显优于术前(P<0.05);术后7 d及1、3个月VAS评分及ODI观察组均明显低于对照组(P<0.05);骨水泥渗漏率观察组明显低于对照组(P<0.05)。结论RFA联合PVP较单纯PVP治疗脊柱转移瘤能更有效地缓解患者疼痛、减轻其功能障碍并降低骨水泥的渗漏率。     

Radiofrequency thermal ablation: a potential treatment for hydropic fetuses with a large chest mass

BACKGROUND/PURPOSE: Physiological changes secondary to a rapidly enlarging fetal chest mass can lead to nonimmune hydrops, which is a predictor of impending fetal demise. Currently, open fetal surgery is offered for specific patients with hydrops before 32 weeks' gestation. The authors asked if a less-invasive technique, radiofrequency thermal ablation (RTA), could be applied safely to the destruction of fetal lung tissue. METHODS: Time-dated pregnant ewes at 120 to 125 days' gestation (term, 140 to 145 days) underwent RTA through a hysterotomy (n = 3) or in a transuterine fashion under ultrasound guidance (n = 4). The probe is a 15-gauge needle with a maximal 2-cm deployment sphere at its tip. By varying the intensity and duration of treatment, the power settings were optimized to create a defined area of ablation with minimal surrounding tissue injury. Five of the 6 fetal lambs were killed acutely, and 1 was followed up for 1 week with frequent ultrasound examinations. RESULTS: Gross examination of the animals killed acutely showed a consistent area of ablation using 10 watts of applied power for 3 minutes. Direct coagulation necrosis lesions ranged from 1x1 cm to 2x2 cm in size depending on the extent of the probe deployment. One animal was followed up for 1 week and showed no major adverse physiological effects. CONCLUSION: Radiofrequency thermal ablation can be performed safely in this fetal sheep model to create a controlled area of lung tissue ablation.     

Barrett食管的危险因素及治疗进展

食管腺癌发病率的增长速度居各种食管恶性肿瘤的第2位,目前认为Barrett食管是食管腺癌的一种癌前病变.Barrett食管的发病率与社会经济状况密切相关,在生活水平较高的发达国家,与Barrett食管相关的食管腺癌发病率迅速增长.Barrett食管的危险因素包括胃食管反流病、白人或西班牙裔种族、男性、年龄、吸烟、肥胖等.Barrett食管的治疗主要包括药物治疗、内镜治疗及外科手术治疗,但对Barrett食管有效的化学预防目前仍需进一步的临床随机试验加以阐明.     

射频消融治疗肝脏肿瘤的初步观察

目的探讨射频消融治疗肝脏肿瘤的近期疗效、不良反应及其安全性。方法对我科2004年12月~2005年6月收治的肝脏肿瘤29例的临床资料进行回顾性分析,以治疗后症状是否减轻、病变区范围是否缩小和CT增强扫描时病变区是否有强化来评价治疗效果。结果本组29例均完成治疗。术后1~5个月随访,症状消失13例,症状减轻14例;CT检查证实瘤体体积缩小29%~87%,平均为57%。结论射频消融治疗肝脏肿瘤具有微创、有效、简单、安全和可重复等优点,是局部治疗肝脏肿瘤的有效方法之一。