The long-term outcome and prognostic analysis of surgically treated patients with trachea tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate and evaluate the clinical features, diagnostic methods, surgical management of trachea tumors in order to improve patients outcome.</p><p><b>METHODS</b>Clinical data of 32 patients with trachea tumors surgically treated from June 1986 to June 2005 were retrospectively analyzed. There were 22 male and 10 female patients. The age ranged from 14 to 63 years old with a median of 48 years old. The surgical procedures performed were resection and reconstruction of trachea in 10 cases, right or left pneumonectomy and carinal resection and reconstruction in 8 cases, right sleeve upper lobectomy, carinal resection and reconstruction of trachea and carina in 8 cases, and carina resection and reconstruction with tumor removal through tracheal windows 6 cases. The tracheal defect was repaired with a Teflon flap in two patients. Cardiopulmonary bypass was used in 2 patients during surgery.</p><p><b>RESULTS</b>The histological examination of resected lesions revealed squamous cell carcinoma in 19 cases, adenoid cystic carcinoma in 8 cases, adenocarcinoma in 2 cases, carcinoid in 2 cases, leiomyosarcoma in 1 case and adenoma in 1 case. One case had infection of thoracic cavity and 3 cases experienced temporary cardiac arrhythmia. There was no operative death. The follow-up periods were from 5 months to 3 years. The 1, 2 and 3 year survival rates were 93.7%, 59.4% and 50.0% respectively.</p><p><b>CONCLUSIONS</b>Squamous cell carcinoma adenoid cystic carcinoma are the most common in trachea tumors. Preoperative bronchoscope examination and chest CT scan can provide valuable diagnostic data. Proper choice of surgical procedure is important for improved patients' outcome.</p>

The patterns and prognostic factors of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the patterns of abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma and to evaluate the prognostic factors.</p><p><b>METHODS</b>Three hundred and sixty-eight patients with the middle thoracic esophageal squamous cell carcinoma from January 1998 to January 2003 were reviewed. There were 289 male and 79 female patients. The age ranged from 38 to 79 years, with a mean of 56 years. Preoperative clinical stage was stage I to III, and all patients underwent Ivor-Lewis esophagectomy with two-field lymphadenectomy. Follow-up was completed for all patients with a mean time of 68 months. Survival rate was calculated by Kaplan-Meier method. COX regression analysis was performed to identify risk prognostic factors.</p><p><b>RESULTS</b>Abdominal lymph node metastasis occurred in 58 (15.8%) patients, with 36.2% (21/58) of them being in stage T1 or T2. Skipping abdominal lymph node metastasis was recognized in 13.8% (8/58) patients, with all of them being in stage T1 or T2. The overall 5-year survival rate of patients with abdominal lymph node metastasis (10.3%) was lower than that of those with thoracic lymph node metastasis (18.3%). The prognosis of patients with distant abdominal lymph node metastasis was bad, and nobody could survive over 5 years.COX analysis showed that 5 or more positive nodes and distant abdominal node metastasis were independent risk factors of patients with abdominal lymph node metastasis.</p><p><b>CONCLUSIONS</b>Abdominal lymph node metastasis in patients with the middle thoracic esophageal squamous cell carcinoma occurs frequently, and the surgery favorable for extensive abdominal lymph node dissection should be selected. The prognosis of patients with abdominal lymph node metastasis is poor, especially those with more positive nodes and distant abdominal node metastasis.</p>

The local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage II A middle-third thoracic esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the local control of radiotherapy following Ivor-Lewis esophagectomy in the patients with stage IIA middle-third thoracic esophageal cancer.</p><p><b>METHODS</b>From June 1999 to June 2002, 125 patients with stage IIA squamous cell carcinoma of the middle-third thoracic esophagus were treated with Ivor-Lewis esophagectomy with two-fields lymphadenectomy. The survival rate was calculated by Kaplan-meier method and the difference of recurrence rate compared by chi(2) test.</p><p><b>RESULTS</b>The 3-year and 5-year survival rates were 58.4% and 43.2% in this group, respectively. Tumor recurrence occurred in 61 of the 125 patients (48.8%) within 3 years after operation. Of all cases of recurrence, 38 patients (30.4%) developed locoregional recurrence (including 5 patients with locoregional and hematogenous recurrence simultaneously). The locoregional recurrence rate of patients who received postoperative radiotherapy (20.3%) was significantly lower than that of both the group who received adjunctive chemotherapy (40.6%) and the group without adjunctive therapy (41.4%) (P < 0.05).</p><p><b>CONCLUSIONS</b>About half of the patients would develop recurrence disease within 3 years after Ivor-Lewis esophagectomy with two-fields lymph-adenectomy. Radiotherapy following Ivor-Lewis esophagectomy is an effective strategy to control local recurrence of the stage II A middle-third thoracic esophageal cancer.</p>

A study of correlation between early postoperative relapse with lymph node micrometastasis in patients with N0 esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the correlation between early postoperative tumor relapse with lymph node micrometastasis in the patients with pN(0) esophageal cancer.</p><p><b>METHODS</b>Using reverse transcriptase-polymerase chain reaction (RT-PCR), one hundred and sixty-six regional lymph nodes obtained from forty-three patients with esophagus cancer without invasion of the tumor confirmed by histopathologic analysis (pN(0)) were studied for further detecting mRNA of Mucin1 (MUC1) gene and determining nodal micrometastasis. All the patients underwent radical resection and regional lymph node dissection. Patients were followed up for one year to detect early tumor relapse. Difference in relapse was compared by chi(2) test.</p><p><b>RESULTS</b>MUC1 mRNA expression was identified for twenty-six lymph nodes (15.7%), in eighteen patients (42%) who were diagnosed as having nodal micrometastasis. TNM staging for these patients was up-regulated from stages I-II(A) to stages II(B)-III. Relapse disease was found in nine patients with lymph nodes micrometastasis and three patients without nodal micrometastasis (P < 0.05).</p><p><b>CONCLUSION</b>Early tumor relapse after radical surgery in the patients with pN(0) esophageal cancer might be correlated with nodal micrometastasis.</p>