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Background: Routine chest X-rays (CXR) are often performed following the removal of chest drains placed during oesophagectomy. CXRs are costly and inconvenient for the patient, often being performed out of working hours. The aim of this study was to evaluate whether routine CXR is necessary following drain removal or if CXRs should only be performed when indicated by the clinical status of the patient.Methods: This was a retrospective study of oesophagectomies performed at a single high volume centre. Routine post chest drain removal CXRs were analyzed and compared to baseline post-operative CXRs. The clinical status of the patient before and after chest drain removal was recorded.Results: 188 patients were identified. 111/188 (59%) had a pleural effusion or pneumothorax on their baseline post-operative CXR. Abnormal findings on post drain removal CXR were common with 72/188 (38.3%) patients having a new or worse pleural effusion or pneumothorax. Only, 5.6% (11/188) of these patients actually developed clinical signs after chest drain removal. Of these, only 2.1% (4/188) required chest drain re-insertion. No patients underwent intervention without showing clinical deterioration. No re-intervention was prompted by CXR finding alone.Conclusions: Routine CXR following chest drain removal is unnecessary. It is safe to only perform CXRs on patients who develop clinical signs.
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The aim of present study was to evaluate the linkage disequilibrium (LD) of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphism of TP53 and their haplotypes association with oesophageal cancer risk in patients from Punjab, northwest India. A total of 466 samples, including 233 oesophageal cancer patients and 233 healthy individuals were analysed. Data analysis revealed the gender specific association. In female group, arginine–proline (RP) genotype (P = 0.08) and P allele (P = 0.07) of p.R72P polymorphism was marginally associated with increased risk of oesophageal cancer. A1A2 genotype (P = 0.06) and A2 allele (P = 0.07) of PIN3 Ins16bp polymorphism was marginally associated with decreased risk of oesophageal cancer in male group. A1A2–GA genotype combination (P = 0.04) of PIN3 and r.13494g[a polymorphisms was significantly associated with decreased risk of oesophageal cancer in male group. In female group, PP–GA genotype combination (P = 0.02) of p.R72P and r.13494g[a polymorphisms and RP–A1A1–GG genotype combination (P = 0.04) of p.R72P, PIN3 and r.13494g[a polymorphisms was significantly associated with increased risk of oesophageal cancer. We observed moderate LD between two intronic polymorphisms PIN3 Ins16bp and r.13494g[a (D0 = 0.90; r 2 = 0.68). Haplotype analysis revealed that none of the haplotype combination was associated with oesophageal cancer risk when both the genders were considered. Stratification on the basis of gender showed that P-A2-P-A-A haplotype of p.R72P, PIN3 Ins16bp, p.P47S, p.R213R and r.13494g[a polymorphisms was marginally associated with reduced oesophageal cancer risk in male group (P = 0.08). Replication of these findings in independent cohorts may be insightful for the role of TP53 in oesophageal cancer pathogenesis.
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The relationship between the long noncoding RNA (lncRNA) expression and oesophageal cancer prognosis has been widely studied, but less consensus has been reached. We conducted this study to evaluate the relationship between the expression of lncRNAs and the prognosis and clinical pathology of oesophageal cancer. We conducted a systematic search of PubMed, EMBASE and Cochrane Library until 25 January 2019. Studies that evaluated the associations of a specific lncRNA with survival and/or clinicopathology of oesophageal cancer were included. Pooled hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs) were calculated using fixed or random-effect models. Sensitivity analysis was used to verify the stability of results. Publication bias was detected using Begg tests and adjusted utilizing the trim-and-fill method if a bias existed. A total of 51 studies comprising 6510 patients and regarding 41 lncRNAs were included in the present systematic review and meta-analysis. The results showed that dysregulation of lncRNAs was associated with overall survival, disease-free survival, and progression-free survival. The expression of lncRNAs was related to some certain clinicopathological parameters of oesophageal cancer, including tumour size, T classification, lymph node metastasis, tumour node metastasis (TNM) stage and differentiation. Among these findings, lncRNA AK001796, CASC9, HOTAIR, MALAT1 and UCA1 were identified and were expected to be ideal biomarkers for the prognosis and clinicopathology of oesophageal cancer. Although significant publication bias was observed in some studies, the results were not changed after adjustment using the trim-and-fill method. Abnormal lncRNA-expression profiles could serve as a promising indicator for prognostic evaluation of patients with oesophageal cancer. The combination of these lncRNAs will contribute to clinical decision-making in the future.
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Background: Oesophageal cancer is a common gastrointestinal malignancy in our country and transhiatal oesopahgectomy is popular choice of surgery for lower oesophageal cancers. This study aims at identifying the feasibility and effectiveness of this surgery in our setting.Methods: This prospective study was performed in Department of Surgery, SDM College of Medical Sciences and Hospital, Dharwad, India. It included a total of 10 cases operated during the study period. Various pre-operative, intra-operative and post-operative parameters were observed and results tabulated.Results: In our study dysphagia (90%) was the most common presenting complaint and tobacco, either smoked (40%) or chewed (40%) formed a common risk factor. Lower oesophageal growths (80%) were more common than mid oesophageal (20%). The preferred incision was midline (80%) and average duration of surgery was 351min and average blood loss was estimated to be 521 ml. There was one mortality and a R0 resection in 90% of the cases with 10% positive for local lymphnodal malignant spread.Conclusions: Our statistics are not very different to the studies compared, and we believe they will only improve. We propose transhiatal oesophagectomy to be a practical and affective tool in a surgeon’s armamentarium, which certainly can be a formidable treatment modality in sub-carinal oesophageal cancer.
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@#Alpha-fetoprotein (AFP)-producing carcinoma which microscopically mimics hepatocellular carcinoma (HCC) is a rare entity known as hepatoid adenocarcinoma (HC). They usually arise in the stomach, while oesophageal origin is only occasionally encountered. This tumour is highly aggressive and is associated with a poor prognosis. They frequently metastasise to the liver, thus giving rise to diagnostic difficulty, especially in cases where simultaneous oesophageal and liver mass are present. We reported a case of oesophageal hepatoid carcinoma with multiple liver metastasis, that was associated with an increased serum AFP. The distinction between HCC and HC is important because HC is more aggressive and has a poorer prognosis with limited therapeutic options. An extensive diagnostic work-up which include a thorough clinical history, radiological investigations (computed tomography or magnetic resonance imaging) as well as tissue biopsy supported by a panel of immunohistochemical markers are necessary to aid in the diagnosis of HC.
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Background & objectives: Insidious symptomatology, late clinical presentation and poor prognosis of oesophageal cancer (EC) highlight the pressing need for novel non-invasive biomarkers for early tumour diagnosis and better prognosis. The present study was carried out to evaluate the clinical significance of circulating and tissue miR-144 expression in oesophageal cancer. Methods: Clinical significance of miR-144 expression was evaluated in preneoplastic (12) and neoplastic (35) oesophageal cancer tissues as well as matched distant non-malignant tissues using real-time PCR (qPCR). Circulating levels of miR-144 were also analyzed in serum samples of EC patients as well as normal individuals to determine the diagnostic potential of miR-144. Further, targets of miR-144 were predicted using bioinformatic tools and their gene ontology (GO) terms were assigned. Results: Real-time PCR analysis revealed significant upregulation of miR-144 in 29 of 35 (83%) EC tissues as compared to matched distant non-malignant tissues (P=0.010). All the dysplastic tissues showed upregulation of miR-144 as compared to their matched distant non-malignant tissues. Relative levels of circulating miR-144 in serum significantly distinguished EC patients from normal controls (P=0.015; AUC = 0.731) with high sensitivity of 94.7 per cent. Bioinformatically predicted target, PUR-aplha (PURA) was found to be significantly (P=0.018) downregulated in 81 per cent (26/32) EC patients and its expression was found to be significantly and negatively correlated with miR-144 expression at mRNA level. Interpretation & conclusions: Our findings showed significant upregulation of miR-144 in serum samples of EC patients indicating its potential as minimally invasive marker. Further studies need to be done to understand the role of miR-144 in the pathogenesis of EC.
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Background: Carcinoma of the oesophagus is amongst the top ten cancers worldwide. It shows marked variation in incidence, types and outcome in the various regions of the world. Adenocarcinoma is the main variant worldwide whereas squamous cell carcinoma appears more common in developing countries. Aim of our Study: We mean to ascertain the hospital incidence and epidemiology of patients presenting with histologically confirmed oesophageal cancer. Patients and Methods: This is a retrospective study spanning from January 2008 to December 2014. It is an evaluation and audit of our management of patients with histologically confirmed cases of oesophageal cancer. Results: A total of 42 cases were enrolled in the study. The male: female ratio was 2.2:1. The mean age was 60.1 years, with the mean male age being 62.3 yrs and female 55.1 yrs. All patients presented with dysphagia and 92.9% had some weight loss, with 31% presenting with cachexia. A greater percentage of patients (83.3%) were from the Niger Delta area, residing at the riverine areas. 54.8% were documented to use local gin. The greater percentage (85.7) of patients presented with stage 4 disease. The histological type were squamous cell carcinoma occurring in 85.7% of patients and 14.3% being adenocarcinoma. The tumour was mainly located in the mid portion of the oesophagus 59.5% and 35.7% were located at the lower oesophagus and gastro-oesophageal junction with only 4.8% at the upper thoracic and cervical oesophagus. All had oesophagoscopy and biopsy done either in the endoscopy suite (awake or conscious sedation) or in the theater. Oesophageal intubation was only feasible in 7patients (16.7%) with only 3(7%) patients having oesophagectomy with gastric pull-up. Conclusion: Oesophageal carcinoma is usually squamous and in the middle third of the thoracic oesophagus. Most patients present late with palliation being the only feasible treatment.
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Objective To investigate the effects of silencing STMN1 by siRNA on the sensitivity of oesophageal cancer cells Eca-109 to paclitaxel .Methods The STMN1 siRNA(siSTMN1) or scramble siRNA(SCR) were transient transfected into Eca-109 cells .The mRNA and protein levels of STMN1 were detected by qPCR and Western blot in the Eca-109 cells of different groups .In vitro paclitaxel sensitivity of siSTMN1 and SCR transfected Eca-109 cell lines was tested by MTT assay and colony formation as-say .Hoechst 33258 nuclear staining were used to investigate the effect of silencing STMN 1 on the sensitivity of SCR ,siSTMN1 transfected Eca-109 cells and nontreated counterparts under paclitaxel induced apoptosis .Results The transient transfection cell lines were successfully established .Both protein and mRNA levels of STMN1 were effectively down-regulated in the siSTMN1 transfected Eca-109 cells .Down-regulation of STMN1 significantly enhanced the sensitivity of Eca-109 cells in response to paclitaxel (P<0 .01) .In addition ,the siSTMN1 transfected Eca-109 cells displayed significant apoptosis as assessed by Hoechst nuclear stai-ning(P<0 .01) .Conclusion Silencing STMN1 by siRNA could enhance the sensitivity of oesophageal cancer cells Eca-109 to paclitaxel .
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Clinical data from 278 patients with oesophageal carcinoma admitted to Songklanagarind Hospital, Songkla, Thailand between February 1982 and December 1992 were analysed to evaluated the effects on survival of various tumours and surgical techniques. There were 217 males and 61 females, average age 62.4 years (range 30-85 years), mean length of tumour 5.8 cm. (range 5-13.5 cm.). 216 cases were squamous cell carcinoma 14 cases a denocarcinoma, and 7 cases others. There were 4 techniques for surgical resection: 182 cases were operated on by modified Lewis-Tanner method, 40 cases by transmittal blunt resection, 29 cases by 3-stage technique and 27 cases by pharyngo-laryngo-oesophagectomy. Three-year, five-year, and ten-year survival rates from this report were 17.9%, 12.6% and 4.2% respectively. Respected patients stage 3 and 4, with albumin level equal to or less than 3 gm%, FEV1 equal to or less than 70% and anastomotic leakage were significantly associated with lower survival rates. No statistical significance among the techniques of surgical resection was noted.