Effect of erythromycin on electrical activity and gastric emptying of the intrathoracic stomach after esophagectomy for esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of erythromycin on electrical activity and emptying of the intrathoracic stomach after esophagectomy for esophageal cancer.</p><p><b>METHODS</b>Thirty patients undergoing esophagectomy for cancer and esophagogastrostomy above the aortic arch were divided into the study group (n=15) and the control group (n=15). Electrogastrography and radionuclide gastric emptying were examined for these patients before and 1, 3, 6, 12 months after surgery. Patients in the study group received erythromycin (0.25 g tid po) for 1 week before examination.</p><p><b>RESULTS</b>The wave amplitude (Uv), dominant frequency (CPM) and percentage of normal slow wave (%) of electrogastrogram decreased after surgery and returned to normal at the first postoperative month in the study group and the 12th postoperative month in the control group (P>0.05). Gastric emptying was significantly delayed after esophagectomy, and returned to normal one year after operation in the study group (P>0.05). However, gastric emptying remained abnormal in the control group (P<0.01).</p><p><b>CONCLUSIONS</b>Erythromycin improves electrical activity and emptying of the stomach after esophagectomy for cancer. Gastric emptying recovery later than the recovery of electrical activity, which may be related to gastric ischemia and edema.</p>

Antireflux anastomosis following resection of esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the antireflux effects of a modified Nissen fundoplication following esophagectomy for cancer.</p><p><b>METHODS</b>From March 2006 to March 2007, 70 patients with esophageal cancer were divided into two groups randomly. Esophagogastrostomy with a stapler only was perform in 35 patients as controls (group C), and a modified Nissen fundoplication was added after esophagogastrostomy with stapler in the other 35 patients as observed group (group O). There were 48 male and 22 female, ranging in age from 47 to 77 years (mean 60.1 years). The operative morbidity and mortality were recorded. Fourty-nine patients were followed at 3 months after surgery, and the questionnaire of life quality (EORTC QLQ C-30) was conducted in 24 patients in group C and 25 patients in group O. Thirty patients were examined with esophageal manometry, 24 h pH monitoring and gastroscopy. There were 16 patients in group C and 14 patients in group O.</p><p><b>RESULTS</b>There was no significant difference in postoperative morbidity between the two groups (P > 0.05). However, the scores of heart burn and regurgitation in the group O were less than in group C (P = 0.041 and 0.034 respectively), but there was no difference in scores of dysphagia between the two groups (P = 0.677). The pressure at the anastomotic site was higher than that in the stomach in group O (P = 0.032), but not in group C (P = 0.448). DeMeester score in group O was 53 ± 46, compared to 140 ± 103 in group C (P = 0.043). The score of esophagitis was 0.9 ± 0.8 in group O, which was lower than 1.6 ± 1.0 in group C (P = 0.041).</p><p><b>CONCLUSIONS</b>Addition of modified Nissen fundoplication after esophagectomy and esophagogastrostomy for cancer significantly increases the pressure at the anastomotic site, thus reduces the extent of gastroesophageal reflux, which leads to the reduction of the extent of reflux esophagitis and the improvement of the quality of life.</p>

Long-term outcome of antireflux surgery for gastroesophageal reflux disease / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the long-term outcomes of various antireflux procedures for gastroesophageal reflux disease (GERD).</p><p><b>METHODS</b>Between November 1988 and January 2004, 129 patients with GERD underwent antireflux procedures. Six kinds of antireflux procedures were performed including Nissen fundoplication, cardiac oblique invagination (COI) procedure, Belsey Mark IV, Toupet, Thal and Dor procedures. One hundred and sixteen patients were followed up. Esophageal manometry study was carried out in 95 patients preoperatively and 51 postoperatively. 24-hour esophageal pH monitoring were carried out in 56 patients preoperatively and 35 postoperatively. Esophagoscopy were performed in all patients before operation and 48 cases after operation.</p><p><b>RESULTS</b>Clinical symptom scores reduced significantly from 4.1 +/- 0.4 before surgery to 1.1 +/- 1.0 after surgery (t = 27.21, P < 0.01). The outcome of surgery showed excellent in 42 cases (36.2%), good in 60 (51.7%), fair in 7 (6.0%), poor in 7 (6.0%). The long-term follow-up showed excellent or good results in 87.9% of patients. There was no significant difference in Nissen fundoplication, COI procedure and Belsey Mark IV.</p><p><b>CONCLUSIONS</b>There are significant differences in symptom score, esophageal manometry, 24-hour esophageal pH monitoring and esophagoscopy pre- and post-operatively. There is no significant difference in Nissen fundoplication, COI procedure and Belsey Mark IV.</p>

Expression and prognostic significance of survivin and caspase-3 in esophageal squamous-cell carcinoma and their relationship with HSPs expression / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the prognostic significance of expression of survivin and caspase-3 in esophageal squamous-cell carcinoma (ESCC) and the relasionship with expression of heat shock proteins 27 and 70 (HSP27 and HSP70).</p><p><b>METHODS</b>Expressions of survivin and caspase-3 in 101 cases of ESCC were quantitatively detected with flow cytometry. Their expressions in long-term survival group (group A, >or= 5 years, 38 cases) were compared with those in the short-term survival group (group B, <or= 1 year, 63 cases). Their prognostic significance and clinocopathological characteristics were evaluated and their relationship with HSP27 and HSP70 expression was analyzed.</p><p><b>RESULTS</b>The mean fluorescence intensity (mFI) of survivin in group B was 6.79 +/- 2.11, which was significantly higher than that (5.00 +/- 0.77) in group A (P < 0.01). The mFI of caspase-3 in the two groups were similar (5.12 +/- 0.67 vs. 5.07 +/- 0.77, P > 0.05). The positive expression rate of survivin in group A was significantly lower than that in group B (31.6% vs 54.0%, P = 0.029). Compared with that in short-term survival group, the strong positive expression rate of caspase-3 in long-term survival group was significantly higher (47.6% vs. 68.4%, P = 0.042). Positive expression rate of caspase-3 showed decreasing tendency with increase in age. No significant differences in clinicopathologic features in relation to expression rate of caspase-3 other than tumor length. No correlation was observed between expression intensity of survivin and any clinicopathologic features. Logistic regression analysis indicated that survivin and caspase-3 expressions were of independent prognostic significance for ESCC. There was no association between survivin and caspase-3 expression and expression of HSP27 and HSP70.</p><p><b>CONCLUSION</b>The expressions of survivin and caspase-3 are two independent prognostic factors in ESCC. They do not correlate with HSP27 and HSP70 expression.</p>