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Objective:To analyze the short-and long-term outcomes of elderly patients after esophagectomy by comparing preopera-tive comorbidities, postoperative complications, and survival rates among different age groups. Methods:We retrospectively reviewed the data of 253 patients who underwent esophagectomy from January to December 2010 in The First Affiliated Hospital of University of Science and Technology of China. Eighty-eight (34.8％) patients were aged<60 years (group A), 145 (57.3％) were aged 60-75 years (group B), and 20 (7.9％) were aged≥75 years (group C). The short-and long-term outcomes of the patients were analyzed. Results:There were significant differences in three group of patients with hypertension before operation (P<0.05). There were statistically sig-nificant differences among all complications, major complications, pulmonary infection, arrhythmia, and respiratory insufficiency (P<0.05), except for anastomotic leakage and other complications (P>0.05). The mean follow-up was 50.7 months. The median overall sur-vival and 1-, 3-, and 5-year overall survival rates were 68 months and 98.9％, 86.8％, and 69％, respectively, for group A;61 months and 93.1％, 76.1％, and 51％, respectively, for group B;and 32 months and 63.3％, 46％, and 28.8％, respectively, for group C (P<0.001). The median progression-free survival (PFS) and 1-, 3-, and 5-year PFS rates were 60 months and 98.86％, 85.2％, and 45.5％, respectively, for group A;43 months and 87.6％, 53.1％, and 26.9％, respectively, for group B;and 11 months and 30％, 20％, and 10％, respectively, for group C (P<0.001). The differences in survival rates between groups A and B, A and C, and B and C were statistically significant (P<0.001). The multivariate analysis showed that age and TNM stage IV were independent risk factors for overall survival and PFS (P<0.05). Conclusions:The long-term survival rate decreases significantly in elderly patients with esophageal cancer. In addition, age and advanced pathological stage of tumor are independent risk factors for long-term outcomes.
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Objective Compare the effect of thoracic and abdominal mediastinal tube placement on pain and comfort in patients with minimally invasive esophageal cancer and nursing care. Methods 108 patients with squamous cell carcinoma of the thoracic esophagus were selected from December 2016 to May 2017. The patients were divided into chest group and abdominal group according to the random number comparison table, each with 54 cases. All patients underwent minimally invasive radical resection of esophageal carcinoma. The mediastinum drainage tube was placed at different locations of the chest and abdomen after operation. The duration of intubation, total drainage volume, number of dressing change before and after extubation, degree of pain and comfort after surgery were recorded, drainage tube failure and the incidence of related complication were compared between the two groups. Results There was no significant difference in duration of intubation, total drainage volume, drainage tube failure and the incidence of related complication between Patients with mediastinal tubes placed through the chest and abdomen(P>0.05). The times of dressing change before and after extubation in the abdominal group were (2.8 ± 1.0), (1.9 ± 0.6) times, those in the chest group were (4.5 ± 1.2), (3.6 ± 1.1) times, there were significant difference between the two groups (t=7.841, 9.377, P<0.01). The NRS and VAS score at 1-4 days and extubation in the abdominal group were significantly lower than those in the chest group, the abdominal group were (3.2±1.0), (2.7±0.8), (2.3±0.7), (1.9±0.7), (1.5±0.6) points and (3.7±0.8), (3.4±1.4), (3.0± 0.7), (2.6±1.0), (2.6±1.0) points, the chest group were (3.7±1.3), (3.3±1.1), (2.8±0.8), (2.3±0.8), (2.3±0.7) points and (5.0±0.9), (4.3±1.4), (4.1±1.3), (3.3±1.2), (3.6±1.0) points, there were significant difference between the two groups (t=2.443-7.247, P<0.01 or 0.05). Conclusions Intraoperative abdominal minimally invasive radical mediastinal tube placed esophageal cancer, can significantly relieve pain and improve patient comfort, reduce the frequency of dressing change before and after extubation, not only quickly improve the rehabilitation of patients, but also can avoid the waste of medical resources, it is worthy of clinical promotion.
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Introducción: las resecciones esofágicas son técnicas complejas que se han ido perfeccionando con el tiempo con el objetivo de disminuir la morbilidad y mortalidad en los pacientes con afecciones de esófago. Objetivo: identificar el comportamiento de los pacientes que fueron sometidos a resecciones esofágicas por enfermedades benignas y malignas. Métodos: se realizó un estudio descriptivo y retrospectivo de pacientes con resecciones esofágicas en el Hospital Provincial Universitario Carlos Manuel de Céspedes, en el período de enero de 2010 hasta diciembre de 2013. La muestra estuvo conformada por 24 pacientes. Resultados: el grupo de edad más afectado fue el de 60 a 69 años y el sexo masculino; la técnica de resección usual: la transhiatal, los tumores constituyeron la principal causa de resección, la yeyunostomía como vía alimentaria, se utilizó el estómago casi total, con piloroplastia como forma de reemplazar el esófago, se utilizó un solo plano de sutura en las anastomosis. La fístula cervical fue la complicación más frecuente, el neumotórax y la bronconeumonía fueron la principal causa de reintervención y muerte respectivamente. Conclusiones: las resecciones esofágicas se efectúan con mayor frecuencia a edad avanzada de la vida, generalmente a individuos con neoplasias e induce a gran número de complicaciones, las infecciones respiratorias son las más graves. La esofagectomía transhiatal, utilizando el estómago casi total y la yeyunostomía como vía alimentaria alternativa y transitoria son ventajosas para este tipo de pacientes, pues la mayoría de las complicaciones resuelven con medidas conservadoras y procedimientos quirúrgicos de menor complejidad(AU)
Introduction: the esophageal resection is a complex technique that have been improving in order to decrease the morbidity and mortality rates in the patient who suffer esophageal illness. Objective: to identify the behavior of patients with esophageal resection. Methods: a retrospective and descriptive study was conducted in order to identify the behavior of patients with esophageal resections in Carlos Manuel de Cespedes hospital in the period from January 2010 to December 2013. The sample consisted of 24 patients. Results: the most affected age group was 60 to 69 years and male sex; the usual resection technique was transhiatal; the tumors were the main cause of resection, the jejunostomy as feeding pathway, using the almost the whole stomach, with pyloroplasty replacing the esophagus, one layer suture in anastomosis. The cervical fistula was the most frequent complication whereas pneumothorax and bronchopneumonia were the main causes of re-operation and death respectively. Conclusions: the esophageal resections are performed more often in aged patients, usually in individuals with malignancies, and are associated with many complications, being the respiratory infections the most severe ones. The transhiatal esophagectomy using almost the complete stomach and jejunostomy are advantages for this type of patients, since most of the complications can be resolved with conservative measures and less complex surgical procedures(AU)
Subject(s)
Humans , Male , Aged , Esophageal Fistula/therapy , Esophageal Neoplasms/surgery , Esophagectomy/methods , Esophagoscopy/methods , Epidemiology, Descriptive , Retrospective StudiesABSTRACT
Introducción: el cáncer de esófago es una de las neoplasias más agresivas del tracto digestivo. La cirugía es el método fundamental de tratamiento, con una alta frecuencia de complicaciones. Objetivo: caracterizar el cáncer de esófago en pacientes intervenidos quirúrgicamente. Método: se realizó un estudio descriptivo, longitudinal y con carácter prospectivo, en el Hospital "Dr. Carlos J. Finlay", entre enero de 2002 y diciembre de 2012. Universo de 62 pacientes. Se incluyeron pacientes con cáncer de esófago sometidos a resección. Las variables cualitativas se describieron estadísticamente mediante cifras frecuenciales y porcentuales. Resultados: el 82.3% perteneció al sexo masculino. El tercio inferior del esófago fue el más afectado en 42.2%. La variedad histológica que predominó fue el adenocarcioma en 59.7%. La mayoría de los pacientes se diagnosticaron en estadio IIb (41.9 %). La técnica quirúrgica más empleada fue la de Ivor Lewis (58.1%) y la sutura que más se realizó fue la mecánica. La estenosis de la anastomosis fue la complicación más frecuente en 12.9% y apareció solo cuando se realizó la sutura manual de la anastomosis. El tipo de sutura más utilizada fue la manual en 17.4%. La sobrevida postoperatoria fue de 17.7% a los 5 años. Conclusiones: predominaron los pacientes mayores de 60 años y pertenecientes al sexo masculino. La localización más frecuente fue en tercio inferior, con predominio del adenocarcinoma. La mayoría fueron diagnosticados en estadio IIb. La estenosis posquirúrgica fue la complicación más frecuente. La sobrevida postoperatoria fue aceptable.
Introduction: the esophagus cancer is one of the most aggressive neoplasias in the digestive tract. The surgery is the fundamental method of treatment, with a high frequency of complications. Objective: to characterize the esophagus cancer in patients intervened surgically. Method: it was done a descriptive, longitudinal study and of prospective character, in the "Dr. Carlos J. Finlay", between January of 2002 and December of 2012. The universe of the study was 62 patients. It was included patients with resection of esophagus cancer and in which the author of this paper participated on the operation. The qualitative variables were described statistically by means of frequencies and percentages. Results: 82.3% belonged to the masculine sex. The inferior third of the esophagus was the more affected in 42.2%. The histological variety that prevailed was the adenocarcioma in 59.7%. Most of the patients were diagnosed in IIb stage (41.9%). The surgical technique more carried out was Ivor Lewis (58.1%) and the type of suture was the mechanical. The stenosis of the anastomosis was the most frequent complication in 12.9% and it was appear only in cases with manual suture of the anastomosis. The type suture more used was the manual in the 17. 4%. The postoperative overlife was 17.7% at five years. Conclusions: most of patients were older than 60 years and men. The most frequent localization was in inferior third, with prevalence of the adenocarcinoma. Most was diagnosed in IIB stage. The postsurgical stenosis was the most frequent complication. The postoperative overlife was acceptable.
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Objective To evaluate the modularized operative process during video-assisted thoracoscopic esophagectomy for esophageal cancer.Methods The clinical data of 45 patients with esophageal cancer who were admitted to the Daping Hospital from December 2011 to December 2012 were retrospectively analyzed.The influence of modularized operative process on the intra-and post-operative condition and short-term complications after videoassisted thoracoscopic esophagectomy + esophagogastric anastomosis were analyzed to investigate the efficacy and value of modularized operative process.Patients received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma or thoracoscopic resection of esophageal carcinoma + gastric mobilization.Thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection were done according to the modularized operative process:(1) Pulmonary ligament mobilization and groups 8L and 9 lymph nodes dissection.(2) Mobilization of the esophagus under the arcus venae azygos.(3) Mobilization of esophagus above the arcus venae azygos.(4) Transection of the arcus venae azygos.(5) Complete removal of thorax esophgus.(6) Ligation of thoracic duct.(7) Dissection of groups 4,5,7,10 and 2L lymph nodes.All the patients were followed up via phone call or mail till February 2013.Patients received thoracoabdominal computed tomography and gastrofiberscopy to detect tumor recurrence or metastasis every 3 months within the first year after the operation,and they were re-examinated every half year at 1 year later.Results Of the 45 patients,29 received video-assisted thoracoscopic and laparoscopic resection of esophageal carcinoma and 16 received video-assisted thoracoscopic resection of esophageal carcinoma + gastric mobilization.The length of the tumor was (4.2 ± 2.5) cm.The numbers of patients in AJCC T1,T2,T3 and T4 stages were 7,14,15 and 9,and the number of patients with AJCC N0,N1,N2,N3 stages were 23,13,7,2,respectively.The intrathoracic operation time,total operation time,volume of intraoperative blood loss,number of lymph node resected and postoperative duration of hospital stay were (72 ± 13)minutes,(249 ± 39) minutes,(183 ± 62) ml,27 ± 7,(18 ± 7) days,respectively.Two patients were transferred to open surgery.No patient died postoperatively,and 11 complications were detected after the operation.Six patients were complicated with cervical anastomotic fistula,4 with anastomotic stricture and 3 with hoarseness.Forty-five patients were followed for 1.5-14.0 months with the median follow-up time of 8 months.One patient died of upper gastrointestinal hemorrhage at postoperative month 12,and 1 died of multi-organ dysfunction syndrome at postoperative month 8.The remaining 43 patients survived.Conclusions The modularized operative process for thoraeoscopic esophagectomy is safe and effective,its short-term efficacy is satisfactory.
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PURPOSE: A positive esophageal margin is encountered in a total gastrectomy not infrequently. The aim of this retrospective review was to evaluate whether a positive esophageal margin predisposes a patient to loco-regional recurrence and whether it has an independent impact on long-term survival. MATENRIALS AND METHODS: A retrospective review of 224 total gastrectomies for adenocarcinomas was undertaken. The Chi- square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and independent prognostic significance was evaluated using the Cox regression method. RESULTS: The prevalence of esophageal margin involvement was 3.6% (8/224). Univariate analysis showed that advanced stage (stage III/IV), tumor size (> or =5 cm), tumor site (whole or upper one-third of the stomach), macroscopic type (Borrmann type 4), esophageal invasion, esophageal margin involvement, lymphatic invasion, and venous invasion affected survival. Multivariate analysis demonstrated that TNM stage, venous invasion, and esophageal margin involvement were the only significant factors influencing the prognosis. All patients with a positive esophageal margin died with metastasis before local recurrence became a problem. A macroscopic proximal distance of more than 6 cm of esophagus was needed to be free of tumors, excluding one exceptional case which involved 15 cm of esophagus. CONCLUSION: All of the patients with a positive proximal resection margin after a total gastrectomy had advanced disease with a poor prognosis, but they were not predisposed to anastomotic recurrence. Early detection and extended, but reasonable, surgical resection of curable lesions are mandatory to improve the prognosis.