Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

Background

Few reports have reported the long-term outcome of esophageal cancer patients suffering from postoperative infectious complications. Here, we investigated the impact of postoperative infectious complications in patients who had undergone curative resection for esophageal cancer.

Methods

The study population comprised 97 patients who underwent radical resection for esophageal cancer with curative intent between 2001 and 2008. Postoperative infectious complications were defined as surgical site infections and pneumonia. We compared clinical features, tumor histology, recurrence, and overall survival between patients with postoperative infections and those who did not.

Results

Of the 97 patients studied, 37 had postoperative infectious complications. The disease-free and overall survival rates of the entire cohort did not significantly differ between patients with and without postoperative infectious complications. Univariate analysis revealed that among patients with stage III esophageal cancer, those with postoperative infectious complications demonstrated significantly shorter disease-free survival than those without. Multivariate analysis demonstrated that postoperative infectious complications were independent prognostic indicators for disease-free survival of stage III esophageal cancer patients.

Conclusions

Our findings suggest that postoperative infectious complications in stage III esophageal cancer patients have a negative impact on disease-free survival.

     

Superiority of 10-mm-wide Balloon over 8-mm-wide Balloon in Papillary Dilation for Bile Duct Stones: A Matched Cohort Study

Background/Aims:

Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy (EST) for common bile duct (CBD) stones. To date, 10- and 8-mm EPBD have not been fully compared.

Patients and Methods:

Patients who underwent EPBD for CBD stones at two Japanese tertiary care centers between May 1994 and January 2014 were identified. Matched pairs with 10- and 8-mm EPBD were generated. Short- and long-term outcomes were compared between the two groups.

Results:

A total of 869 patients were identified (61 and 808 patients for 10- and 8-mm EPBD, respectively), and 61 well-balanced pairs were generated. The rate of complete stone removal within a single session was higher in the 10-mm EPBD group than in the 8-mm EPBD group (69% vs. 44%, P < 0.001), and use of lithotripsy was less frequent in the 10-mm EPBD group (23% vs. 56%, P < 0.001). The rates of post-ERCP pancreatitis were similar between the 10- and 8-mm EPBD groups (11% vs. 8%). Cumulative biliary complication-free rates were not statistically different between the two groups: 88% [95% confidence interval (CI): 79–97%] and 94% (95% CI: 88–100%) at 1 year and 69% (95% CI: 56–85%) and 80% (95% CI: 69–93%) at 2 years in the 10- and 8-mm EPBD groups, respectively. In the 10-mm EPBD group, ascending cholangitis was not observed, and pneumobilia was found in 5% of cases during the follow-up period.

Conclusions:

EPBD using a 10-mm balloon for CBD stones is safe and more effective than 8-mm EPBD. The sphincter function is highly preserved after 10-mm EPBD.     

The sequential changes of serum acute phase reactants in response to antituberculous chemotherapy]

In order to evaluate the clinical effectiveness of response to antituberculous chemotherapy, we measured the serum levels such of acute phase reactants as C-reactive protein (CRP), alpha-1-acid glycoprotein (alpha 1-AG), haptoglobin, alpha-1-antitrypsin (alpha 1-AT) and sialic acid in 24 patients with pulmonary tuberculosis. Furthermore the relationship between these parameters and other biochemical indicators, such as serum immunoglobulins (IgG, IgA and IgM) and blood erythrocyte sedimentation rate (ESR) were observed. In the case studies of the eighteen prognostically cured patients, the serum levels of alpha 1-AG, haptoglobin, alpha 1-AT and sialic acid were significantly higher than those of healthy controls (P less than 0.01), and were significantly decreased to normal levels within three to five weeks after negative results for tubercule bacilli were obtained in the sputum cultures, while CRP, immunoglobulin and ESR showed a tendency to be lower than the healthy controls. In conclusion, alpha 1-AG, haptoglobin, alpha 1-AT and sialic acid are considered to be the sensitive biochemical indicators capable of being used to predict and monitor the clinical response to antituberculous chemotherapy.