Antioxidants and cancers of the esophagus and gastric cardia

Antioxidant vitamins have attracted considerable attention in previous studies of esophageal squamous-cell carcinoma, but dietary studies of adenocarcinoma of the esophagus and gastric cardia remain sparse. Treating these tumors as distinct diseases, we studied intakes of vitamin C, beta-carotene and alpha-tocopherol in a nationwide population-based case-control study in Sweden, with 185, 165, and 258 cases of esophageal adenocarcinoma, esophageal squamous-cell carcinoma, and gastric cardia adenocarcinoma, respectively, and 815 controls. Subjects with a high parallel intake of vitamin C, beta-carotene, and alpha-tocopherol showed a 40-50% decreased risk of both histological types of esophageal cancer compared with subjects with a low parallel intake. Antioxidant intake was not associated with the risk of gastric cardia adenocarcinoma. Separately, vitamin C and beta-carotene reduced the risk of esophageal cancers more than alpha-tocopherol. We found that antioxidant intake is associated with similar risk reductions for both main histological types of esophageal cancer. Our findings indicate that antioxidants do not explain the diverging incidence rates of the 2 histological types of esophageal cancer. Moreover, our data suggest that inverse associations with esophageal squamous-cell carcinoma and adenocarcinoma may be stronger among subjects under presumed higher oxidative stress due to smoking or gastroesophageal reflux, respectively. Our results may be relevant for the implementation of focused, cost-effective preventive measures.     

管状胃在食管贲门癌手术中的临床应用

目的：评价管状胃技术在食管、贲门癌患者根治手术中的临床效果。方法：选取2007年5月-2010年12月我院胸外科收治的食管、贲门癌214例,按手术方法分为管状胃组和对照组,管状胃组：118例,男99例,女19例,年龄58.81±8.39岁（38-80岁）。其中食管癌104例于左颈部吻合49例,弓上吻合32例,弓下吻合23例;贲门癌根治14例。对照组：96例,男74例,女22例,年龄58.54±9.05岁（27-80岁）。食管癌89例于左颈部吻合8例,主动脉弓上吻合56例,弓下吻合25例;贲门癌根治7例。观察两组术后吻合口瘘发生率、手术时间、住院时间等。结果：两组均顺利完成手术。管状胃组发生吻合口瘘1例,残胃瘘7例;对照组发生吻合口瘘4例,残胃瘘1例;手术时间管状胃组与对照组（257.77±79.77 min vs 244.26±63.68 min,t=1.342,P=0.181）,吻合口瘘（P〉0.05）及残胃瘘（P〉0.05）差异无统计学意义,术后住院时间（14.90±5.65d vs 17.20±8.49d,t=2.279,P=0.024）,胸胃综合症发生率（P〈0.05）差异有统计学意义。结论：管状胃操作简单、安全,胸胃综合症并发症发生率较低,不增加手术时间,缩短了住院时间,可改善患者术后生活质量,具有较好的临床应用价值。     

Multimodality therapy for cancers of the esophagus and gastric cardia

The role of multimodal treatment in the management of esophageal cancer is controversial. There are conflicting results from studies on the effect of neoadjuvant and/or adjuvant treatment on long-term survival. Following a search of the Medline database, the authors examine the results of randomized studies on the various treatment protocols available and discuss future therapeutic improvements.     

Multimodality therapy for cancers of the esophagus and gastric cardia

The role of multimodal treatment in the management of esophageal cancer is controversial. There are conflicting results from studies on the effect of neoadjuvant and/or adjuvant treatment on long-term survival. Following a search of the Medline database, the authors examine the results of randomized studies on the various treatment protocols available and discuss future therapeutic improvements.     

Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus.

The authors studied the cigarette and alcohol use of 243 patients with adenocarcinoma of the cardia or lower esophagus, including 66 with Barrett's metaplasia (esophagocardia group). They compared results of that investigation with the cigarette and alcohol use of 303 patients with squamous carcinoma of the esophagus, a cancer in which an etiologic association is proven, and of 338 patients with stomach cancer not involving the cardia, a cancer in which there is little or no association with cigarettes or alcohol. Controlled for other variables, patients with squamous cancer used more cigarettes and alcohol than the other two groups. There was no significant difference in cigarette or alcohol use between patients with esophagocardia and stomach cancer or between those in the esophagocardia group with or without Barrett's metaplasia. Because cigarette and alcohol use was not greater in patients with esophagocardia than in those with stomach cancer, the authors do not think that such factors explain the increasing incidence of adenocarcinoma of the cardia or lower esophagus.     

Adenocarcinoma of the gastric cardia. Recurrence and survival after resection.

Between January 1, 1983, and December 31, 1988, operations were performed on 112 patients with adenocarcinoma of the gastric cardia. Resection of the primary tumor was performed in 93 patients. For these 93 patients, follow-up until July 1, 1989, averaged 24 months, during which time 59 patients died. Positive resection margins carried a greater risk for the development of a local recurrence but did not correlate with survival. The cumulative overall 5-year actuarial recurrence rate was 69%. The cumulative 5-year recurrence rate for metastases was 64% and for locoregional recurrence it was 36%. The overall 5-year survival rate was 24%. Differences in survival were observed between patients with carcinomas of the various subgroups of the 1987 TNM classification system (T1-T2 versus T3-T4, N0 versus N1-N2, M0 versus M1, Stages I-II versus Stages III-IV, Grades 1-2 versus Grades 3-4). In particular, lymph node status as correlated with histopathologic grade showed remarkable differences in survival: patients with no positive lymph nodes in the resection specimen and a Grade 1 or 2 tumor had a significantly better 5-year survival rate (53%) than the other subgroups (N0/Grades 3-4: 21%; N1-N2/Grades 1-2: 12%; N1-N2/Grades 3-4: 14%).     

Heredity and risk of cancer of the esophagus and gastric cardia.

The importance of genetic factors in the etiology of esophageal cancer is uncertain. We addressed the question of heredity in a population-based, nationwide case-control study conducted in Sweden during 1995 through 1997. The study involved 189 patients with esophageal adenocarcinoma, 262 with cardia adenocarcinoma, 167 with esophageal squamous cell carcinoma, and, for comparison, 820 control subjects. Familial occurrence of cancer was explored at face-to-face interviews. Logistic regression, with multivariate adjustment for potential confounders, was used to calculate odds ratios (ORs), which estimated relative risk. Occurrence of esophageal cancer among first-degree relatives did not increase the risk of adenocarcinoma or squamous cell carcinoma of the esophagus. Neither were there any significant associations with familial occurrence of gastric cancer or other gastrointestinal tumors. The risk of cardia adenocarcinoma was moderately increased among persons with first-degree relatives with gastric cancer (OR, 1.6; 95% confidence interval, 1.0-2.6). Familial occurrence of any cancer was not associated with increased risks of any of the three studied tumors. In conclusion, heredity does not seem to contribute importantly to the occurrence of esophageal cancer of any histological type. A weak association between familial gastric cancer and the risk of cardia cancer may represent a genetic link.     

贲门癌切除,回结肠代食管及胃,贲门重建术

After having studied both the advantages and disadvantages of various reconstructive operations, an improved reconstructive operation, i.e. ileo-colon replacement of esophagus, stomach and cardia was performed to avoid regurgitation esophagitis after cardiectomy in gastric cardiac cancer. Twenty patients underwent such reconstructive operation. Clinical observation and measurement of intraluminal pressure in the upper digestive tract before and after operation showed that this kind of operation gave satisfactory short-term results, not only avoiding the regurgitation, but increasing the radical resection rate, reducing the other postoperative complications and improving the diet quantity intake also. This reconstructive operation is better than the traditional routine method and worthy of extensive use. Preparations before, during and after the operation, cooperation in manipulation during the operation are described.     

A case-control study of cancer of the esophagus and gastric cardia in Linxian

A case-control study involving interviews with 1,244 patients (758 males and 486 females) with cancer of the esophagus or gastric cardia and 1,314 population-based controls (789 males, 525 females) was carried out in Linxian, a rural county in North Central China with one of the world's highest mortality rates for these tumors. Cancer risks tended to rise with increasing intake of wheat and corn, but no association was found with adult intake of pickled vegetables, the leading a priori suspect, and risks were not elevated among those consuming low quantities of fresh vegetables or fruits. Few differences in preparation or storage of food or water were detected, although cancer patients reported less fluid intake than controls. Few persons reported drinking alcoholic beverages. Smoking was reported by 61% of the male cases and was a mild risk factor, related more to cancer of the cardia than of the esophagus. The risk was increased by 70% among those whose parents had esophageal or stomach cancer, but only slightly among those whose spouses had such cancers, suggesting that exposure early in life and/or genetic effects may be involved.     

Adenocarcinoma arising from ectopic gastric mucosa in the cervical esophagus

Ectopic (heterotopic) gastric mucosa (EGM) of the upper esophagus, referred as inlet patch, is an asymptomatic benign lesion that is often detected during endoscopic examination. Although it is considered a source of adenocarcinoma in the upper esophagus, only 17 cases of adenocarcinoma have been reported previously. We report a rare case of adenocarcinoma arising in EGM of the cervical esophagus.     

Loss of heterozygosity and immunohistochemistry of adenocarcinomas of the esophagus and gastric cardia.

PURPOSE: Adenocarcinomas of the distal esophagus and gastric cardia are two tumors that have many features in common. They have similar prognoses, treatment modalities, and patterns of dissemination. The etiology is different, with gastroesophageal reflux disease playing a major role for esophageal adenocarcinoma, in contrast to adenocarcinoma of the gastric cardia. In the present study, we investigated several genetic and immunohistochemical features of adenocarcinomas of the distal esophagus and gastric cardia. EXPERIMENTAL DESIGN: Sixty-two resection specimens of either adenocarcinoma of the esophagus or adenocarcinoma of the gastric cardia were carefully selected. The genetic analysis included loss of heterozygosity of several tumor suppressor genes known to be involved in esophagogastric carcinogenesis. Immunohistochemical studies included the analysis of p53, c-Met, c-erbB-2, beta-catenin, and cyclooxygenase-2. In addition, a mutation analysis of the Tcf1 gene was done by direct sequencing. RESULTS: Patients with cardiac carcinoma had a significantly worse tumor stage and poorer differentiation on histology. Loss of heterozygosity analysis did not reveal significant differences between esophageal adenocarcinoma and cardiac adenocarcinoma. Immunohistochemical analysis revealed significantly more nuclear accumulation of beta-catenin and overexpression of cyclooxygenase-2 in patients with esophageal adenocarcinoma, compared with patients with cardiac carcinoma. No mutation was found in the Tcf1 gene in either tumor type. CONCLUSIONS: Although adenocarcinomas of the distal esophagus and gastric cardia have many features in common, we have found some evidence that they might form two different entities.     

Dietary intake of heterocyclic amines and cancers of the esophagus and gastric cardia.

The results of two epidemiological studies suggest that high intake of heterocyclic amines, which are formed on the surface of meats cooked at high temperatures, might be associated with increased risk of esophageal or cardia cancers. Our aim was to further investigate heterocyclic amine intake and risk of these cancers. We examined data from a nationwide, population-based, case-control study of risk factors for adenocarcinoma of the esophagus and gastric cardia and squamous cell carcinoma of the esophagus in Sweden, with 185, 258, and 165 cases, respectively, and 815 controls. Heterocyclic amine intake was estimated based on the frequency of consumption and degree of surface browning of commonly fried meats, and the consumption of pan juices. Statistically nonsignificant 50-70% higher risks of esophageal squamous cell carcinoma were observed among individuals in the highest quartile levels of 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline, and 2-amino-1methyl-6-phenylimidazo[4,5-b]pyridine relative to those in the lowest. Dose-risk trends were evident. Subjects reporting high intake of all three heterocyclic amines had an odds ratio of 2.4 (95% confidence interval, 1.2-4.8) relative to those with low intake of all three substances. In contrast, no association was found with risk of adenocarcinoma of the esophagus or gastric cardia. Heterocyclic amine intake might be associated with an increase in risk of squamous cell carcinoma of the esophagus. Given the dearth of epidemiological data regarding these cancers and the lack of established biological mechanisms, confirmatory data are needed.     

Adenocarcinoma of the oesophagus and gastric cardia: male preponderance in association with obesity

Recent evidence links obesity with the rising incidence of oesophageal adenocarcinoma. In Ireland between 1995 and 2004 the incidence of oesophageal adenocarcinoma increased by 38%, and this coincided with a 67% increase in the prevalence of obesity. In this study, a prospective case-control study was undertaken in 760 patients presenting to a tertiary centre between 1994 and 2004 diagnosed with cancer of the oesophagus, gastric cardia or stomach. Data were compared with 893 healthy controls. Multivariate logistic regression models were used to calculate the odds ratio (OR) of developing either cancer type according to quartiles of body mass index (BMI). Based on pre-illness BMI, 82% of patients who developed adenocarcinoma of the oesophagus were either overweight or obese compared with 59% of the healthy control population (P<0.001). A dose-dependent relationship existed between BMI and oesophageal adenocarcinoma in males. The adjusted odds ratio was 4.3 (95% CI: 2.3-7.9) among males in the highest BMI quartile compared with males in the lowest quartile (P<0.001 for trend). Using common cut-off points for BMI, the OR of adenocarcinoma of the lower oesophagus was 11.3 times higher (95% CI: 3.5-36.4) for individuals with a BMI >30 kg/m2 versus individuals with a BMI <22 kg/m2 (P<0.001 for trend). For adenocarcinoma of the gastric cardia, males in the top quartile of BMI had an OR of 3.5 (95% CI: 1.3-9.4) compared with the lowest quartile (P=0.03 for trend). A significant (P<0.001) inverse relationship between BMI and oesophageal SCC was observed. The odds ratio for adenocarcinoma of the oesophagus, the oesophago-gastric junction and gastric cardia rose significantly with increasing BMI. For tumours of the lower oesophagus, obesity increased the risk 10.9-fold. The increased risk is significant in males only.     

食管癌和贲门癌患者术后呼吸衰竭原因分析及防治

目的分析研究食管癌和贲门癌患者手术后发生呼吸衰竭的原因和治疗措施。方法应用SPSS统计软件Logistic回归分析及x^2检验,对114例呼吸衰竭患者的原因及死亡风险进行分析。结果因手术相关并发症引发的呼吸衰竭者40例（35．1％）,因严重呼吸道感染诱发的呼吸衰竭者43例（37．7％）,二者占全组的72．8％（83／114）。其他原因为麻醉清醒不完全或术中输液过量造成肺水肿、肺动脉栓塞、严重心律失常等。单因素和Logistic回归多因素分析发现,出现手术相关并发症者、术后并发症种类愈多者、术前肺功能差者、术前放疗者、术后第2天以后开始插管者、辅助呼吸时间愈长者、呼吸衰竭合并肺炎或‘肾衰者,其死亡危险性显著增加。其中前3者为显著独立致死因素,相对风险度分别为2．50,2．37和1．68;而与年龄、性别、手术治疗方式、术前合并疾病史、术前应用抗菌素等因素无显著相关性。结论食管癌和贲门癌患者术后发生呼吸衰竭多因手术相关的并发症和呼吸道感染所致。仔细谨慎的手术操作和术后防止严重并发症的发生,是避免食管癌和贲门癌术后发生呼吸衰竭的最重要措施。术后严密观察各项生命指征、及时插管或气管切开行机械通气辅助呼吸,是减少术后呼吸衰竭死亡的有效措施。     

治疗食管、贲门癌术后发生急性呼吸窘迫综合征的体会

 为探讨ARDS的防治措施, 本文分析了11例食管、贲门癌术后发生ARDS的发病特点及防治方法。 患者有长期慢性肺部疾患、高龄、高血压病者术后容易发生。 术中对肺组织的损伤及术中, 术后过量输液, 肺部感染及休克, 缺氧可能是术后发生ARDS的重要原因之一。 治疗应积极清除呼吸道分泌物, 辅助通气, 保持气道通畅, 控制肺部感染, 尤其是尽早行气管插管或气管切开为抢救成功的关键。 术前肺功能检查应结合临床来综合分析。     

Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia

BACKGROUND: The efficacy of endoscopic screening for chronic gastroesophageal reflux symptoms of heartburn and regurgitation in adult subjects depends on the sensitivity of this strategy for detecting Barrett esophagus in subjects before the development of adenocarcinoma of the esophagus or cardia. The aim of the current study was to determine what proportion of patients with cancer of the esophagus or cardia would have been candidates for a screening endoscopy before their cancer diagnosis based on the presence and duration of preceding reflux symptoms. METHODS: All patients with adenocarcinoma of the esophagus, adenocarcinoma of the cardia, or long-segment Barrett esophagus presenting for endoscopy at 4 tertiary care and 2 Veterans Affairs (VA) hospitals were given a previously validated questionnaire to determine their recall of common gastroesophageal reflux symptoms. RESULTS: The study population of 375 subjects consisted primarily of 294 (78%) white men. Only 67 of 110 patients (61%) with adenocarcinoma of the esophagus and 8 of 21 patients (38%) with adenocarcinoma of the cardia recalled symptoms of heartburn or regurgitation being present for >5 years before their diagnosis of cancer. Only 40 of 110 patients (36%) with adenocarcinoma of the esophagus and 5 of 21 patients (24%) with adenocarcinoma of the cardia recalled weekly symptoms being present for >5 years before their cancer diagnosis. Of the 244 patients with Barrett esophagus, 170 (70%) recalled heartburn or regurgitation for >5 years and 89 patients (37%) recalled weekly symptoms for >5 years. CONCLUSIONS: Current practice, which uses a screening strategy of performing endoscopy in patients with >5 years of heartburn or regurgitation, can detect Barrett epithelium in only a limited proportion of those patients at risk for developing adenocarcinoma of the esophagus or adenocarcinoma of the cardia.     

Results of surgical treatment in 6,123 cases of carcinoma of the esophagus and gastric cardia

Six thousand one hundred twenty-three cases of carcinoma of the esophagus and gastric cardia were treated surgically from 1965 to 1985. Overall resectability was 89.9%. Postoperative mortality was 3%, and incidence of postoperative complication, 10.3%. Follow-up rate was 91.3%, with 5 year survival of 36.8% (esophageal nearly twice that of gastric cardia), and 10 year survival of 17.2%. Factors affecting long-term survival were clinicopathologic staging and preoperative irradiation. Early discovery and timely treatment are the key to high resectability and improved long-term survival. More efficacious combined therapies are needed for the predominant late cases. We propose more radical resection because of the multifocal tendency of esophageal and extensive submucosal infiltration of cardia carcinoma. Continuing refinements of surgical technique helped to reduce postoperative leakage and structure.     

食管癌贲门癌切除术后应用机械进行粘膜吻合434例报告

目的探讨预防食管胃吻合口瘘和吻合口狭窄的方法。方法使用吻合器进行食管粘膜和胃粘膜吻合。结果４４２例中,手工吻合８例,机械吻合４３４例,吻合成功率为９８．２％,术中失误率为２．３％,术后并发症发生率为９．３％,死亡率１．４％,未发生食管胃吻合口瘘和吻合口狭窄。结论食管粘膜和胃粘膜机械吻合操作简单、可靠,即可缩短手术时间,有效地预防食管胃吻合口瘘和吻合口狭窄的发生,又可以切除足够长度的食管,降低切缘残癌的发生率,是食管癌和贲门癌切除术中食管胃吻合的理想方法。