ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly.</p><p><b>METHODS</b>From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions(Sweet procedure, n=116). Intraoperative and postoperative parameters were compared.</p><p><b>RESULTS</b>The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively(P>0.05). The time required for opening the thorax was(47.2 ± 5.2) min and (105.4 ± 9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7% and 6.9%(P=0.049). The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3%, respectively. The overall complication rates were 22.4% and 34.5%(P=0.004). The perioperative mortalities were 1.7% and 3.4%(P>0.05). The postoperative ambulation time was (4.0 ± 2.0)d and (4.8 ± 3.7)d(P=0.046). The postoperative time in hospital was (11.5 ± 4.7)d and (13.7 ± 7.8)d(P=0.008).</p><p><b>CONCLUSIONS</b>Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Esophageal Neoplasms , Pathology , General Surgery , Esophagectomy , Methods , Esophagus , Pathology , Prospective Studies , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate whether dendritic cells pulsed with whole tumor lysates (WTL) could in vitro elicit antitumor T cell responses in patients with non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>Monocyte-derived immature DCs (imDCs) generated in the presence of human recombinant granulocyte-macrophage colony stimulating factor and interleukin-4 from peripheral blood mononuclear cell of NSCLC patients, and then were induced to mature by pulsing autologous WTL (DCs/WTL) or by the addition of TNF-alpha(TNF/DCs). FACS and MLR assay were used to monitor their phenotypic changes and capacity to stimulate allogeneic and autologous T cell proliferation. DCs/WTL activated with TNF-alpha (* DCs/WTL) were cocultured in vitro with autologous T cells for eliciting antitumor CTLs. T cell mediated antitumor responses were measured by IFN-gamma enzyme-linked immunospot (ELISPOT) assay for WTL-specific IFN-gamma releasing T cells and by lactate dehydrogenase release (LDH) assay for lysis of autologous tumor cells, respectively.</p><p><b>RESULTS</b>When monocytes-derived imDCs from the patients with NSCLC (n = 10) were pulsed with autologous WTL for a day at 30 microg total protein of WTL per 10(6) DCs/ml, this led to up-regulation of CD1a, CD83 and CD86 as well as HLA-DR, and also led to marked stimulation of allogeneic T cell proliferating activity, which was comparable to that of TNF/DCs. However, their capacity of stimulating autologous T cell proliferation in vitro was significantly more potent than those of TNF/DCs (P < 0.05). The numbers of WTL-specific IFN-gamma releasing T cells in 1/3 cultures after one week exposure to * DCs/WTL was increased significantly compared with those pulsing with TNF/DCs plus IL-2 or IL-2 alone (P = 0.05). T cells derived by priming of non-adherent PBMCs with * DCs/WTL after 14 days in vitro stimulation were significantly more responsive to autologous tumor cells compared with LAK (n = 3, P < 0.05), but its cytotoxicity against K562 cells was also comparable to LAK cells.</p><p><b>CONCLUSION</b>Monocyte-derived DCs from NSCLC patients could serve as functional APC. The * DCs/WTL may effectively elicit T cell-mediated antitumor response in vitro and enhance NK killing activity.</p>