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Objective·To investigate factors affecting the prognosis of aged esophageal cancer patients after esophagectomy.Methods·Clinical data of 103 aged patients (≥ 80 years old) undergoing esophageetomy were collected.Effects of age,sex,clinical manifestations,pre-operative diseases,post-operative complications,T stage,lymph node metastasis,maximum diameter and location of the tumor,and surgical methods on the post-operative survival were analyzed.Results·1,3,and 5 years survival rates of 103 patients were 63.2％,15.9％,and 2.7％,respectively.Kaplan-Meier survival curve analysis indicated that the post-operative survival was significantly higher in patients with T1 and T2 stages than in patients with T3 stage.The 3 and 5 y survival rates of patients with T 1 stage were 50％ and 25％,respectively.Results of Cox regression multivariate analysis showed that T stage,maximum diameter of tumor,postoperative complications,and lymph node metastasis were independent factors affecting the post-operative survival.Conclusion·Esophageal cancer patients aged over 80 years with smaller tumor diameters,less postoperative complications,and negative lymph node metastasis have a longer post-operative survival period.Esophagectomy for patients with earlier stages (T1 and T2) can achieve an ideal post-operative survival period.
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Objective To explore the improving safety measures of colon interposition after esophagectomy .Methods From January 2003 to December 2014, 65 cases of colon interposition after esophagectomy were performed, and some improve-ments were made in the methods and procedures .Mainly including: Preoperative evaluation to first operation; Selection of co-lon segment; Simplify vascular anatomy;Cervical anastomosis was replaced by intrathoracic anastomosis;Modified anastomosis sequence; Strengthen preoperative preparation.Results There were no perioperative deaths.Only 2 patients with cervical fis-tula, due to malnutrition automatically discharged.The rate of anastomotic leakage on neck were 27.77%(10/36) and 6.89%(2/29) in the chest.2 cases were completed intestinal obstruction after jejunostomy , 1 cases of volvulus and 1 cases of intus-susception confirmed by reoperation.Conclusion Colon interposition after esophagectomy is a very important way of surgery. The operation process is complex, but as long as mastering the point of surgery, improving the surgical procedures, the good effect can be obtained and greatly improve the safety of the operation .
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<p><b>OBJECTIVE</b>To explore the methods and means of surgical treatment for cervical esophageal cancer in order to get the best efficacy.</p><p><b>METHODS</b>Retrospective investigation and analysis were carried out in 137 patients with cervical esophageal cancer undergoing operation in our hospital from January 2005 to December 2013. According to lesion locations, these cases were divided into two groups: larynx preservation group(Group A) and laryngectomy group(Group B). Surgery options of Group A included inversion esophagectomy without thoracotomy, three-incision esophagectomy, end to end anastomosis of cervical esophagus after local resection. Group B included gastric-pharyngeal anastomosis, pharyn-esophagus plasty, colon replacement of the esophagus or jejunal interposition. All the patients received postoperative adjuvant therapy.</p><p><b>RESULTS</b>There were no perioperative deaths. The main postoperative complications included anastomotic fistula in 20 cases(14.6%), postoperative massive bleeding after inversion esophagectomy in 3 cases, chylothorax in 1 case, anastomotic stenosis in 9 cases, severe gastroesophageal reflux in 6 cases and serious aspiration pneumonia in 2 cases. All these patients had complete resolution of disease with good postoperative quality of life. The 1-year, 3-year and 5-year survival were 73.7%, 48.4% and 26.8% respectively. The most important causes of postoperative death included local recurrence, cervical or mediastinal lymph node metastases, cachexia and multiple organic metastasis.</p><p><b>CONCLUSION</b>It is critical to select reasonable methods of operations to reduce postoperative complications and to receive proper adjuvant therapy.</p>
Subject(s)
Humans , Anastomosis, Surgical , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Lymphatic Metastasis , Neck , Pathology , Postoperative Complications , Quality of Life , Retrospective StudiesABSTRACT
Objective To investigate the feasibility of treatment mode of end-to-end anastomosis of esophagus(EAS) af ter partial resection for early-stage cervical esophageal carcinoma(ECEA).Methods 7 patients were substantially confirmed as squsmous cell carcinoma of cervical esophagus by endoscopy,the nearest distance of the lesion from the incisors was 17cm,and the furthest was 20 cm,the maximum extent was 2.5 cm,and the minimum was 1 cm.None of them with longitudinal muscularis invasion.Confirmed by PET/CT or chest enhancement CT examination preoperatively,intrathoracic and cervical lymphatic metastasis was excluded,cT1 -2 N0 M0.Incisal margin length was not less than 1 cm,the maximum was 5 cm and the minimum was 3 cm.Meanwhile,the cervical lymph node should be dissected,and the average number was 6.43 per case.After surgery,all the patients were fixed by plaster slab to release the tension of anastomosis.Postoperative adjuvant radiotherapy or chemotherapy was received.Results None of the patients had severe postoperative complications,and the average hospital stay was 14.5 days.All the patients are alive,the longest follow-up lasts for 3 years and 4 months,all of them can take normal food,without anastomotic stenosis.Conclusion Treatment mode of EAS after partial resection for ECEA significantly decrease the operative damage,apparently improve the patient's quality of life(QOL),so that the patients can better receive adjuvant treatment subsequently; it is a feasible and effective method for cervical esophageal carcinoma at the early stage.