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Rev. argent. cir ; 114(1): 20-25, mar. 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1376372


RESUMEN Antecedentes: en la última década ha comenzado a investigarse el uso de la captación de fluorescencia mediante luz infrarroja para la visualización de ganglios linfáticos en tumores de estómago y esófago. Objetivo: evaluar la factibilidad de la evaluación del drenaje linfático de cáncer de esófago mediante el uso de fluorescencia y verde de indocianina (ICG). Material y métodos: se realizó un estudio prospectivo que incluyó pacientes con tumores de la unión gastroesofágica resecables (estadios I, II y III). Antes de comenzar la cirugía se inyectaron por endoscopia 4 mL de ICG doblemente diluida en agua estéril (1,25 mg/mL = 5 mg) en la submucosa del esófago en los cuatro cuadrantes (1 mL por cuadrante) alrededor del tumor. Resultados: se incluyeron en total 6 pacientes. En todos ellos se logró identificar el drenaje linfático del tumor hacia la primera estación ganglionar: en 6/6 (100%), el drenaje linfático con fluorescencia se detectó en las estaciones ganglionares N°s 3 y 7 (curvatura menor y arteria gástrica izquierda). En ningún paciente se identificó fluorescencia en ganglios mediastinales. Conclusión: la visualización del drenaje linfático de tumores de la unión gastroesofágica mediante el uso de fluorescencia con ICG es factible.

ABSTRACT Background: Over the past decade, fluorescence imaging with infrared light has been used to visualize lymph nodes in tumors of the stomach and esophagus. Objective: The aim of our study was to evaluate the feasibility of evaluating lymphatic drainage in esophageal cancer using fluorescence and indocyanine green (ICG). Material and methods: We conducted a prospective study of patients with resectable tumors of the gastroesophageal junction (stage I, II and III). Before surgery, 4 mL of ICG double diluted in sterile water (1.25 mg/mL = 5 mg) were injected via endoscopy into the esophageal submucosa in the four quadrants (1 mL per quadrant) around the tumor. Results: A total of 6 patients were included. Lymphatic drainage from the tumor to the first lymph node station was identified in all patients: in 6/6 (100%), fluorescent lymphatic drainage was detected in nodal stations number 3 and 7 (lesser curvature and left gastric artery) Fluorescence was not identified in the mediastinal lymph nodes in any patient. Conclusion: Visualization of lymphatic drainage of gastroesophageal junction tumors to the lesser curvature nodes using fluorescence imaging is feasible.

Article in Chinese | WPRIM | ID: wpr-920832


@#The incidence of complications after radical resection of esophageal carcinoma is high up to about 20%-50%. The incidence of pneumonia, pleural effusion, tracheal intubation, anastomotic fistula and cardiac events is relatively high. Among them, pulmonary complications are the most common complications after esophageal cancer operation and cause the most perioperative deaths. Among the factors that influence the occurrence of postoperative complications of esophageal cancer, the amount of fluid infusion during and after the operation is closely related to the occurrence of postoperative complications. Moreover, in the environment of enhanced recovery after surgery (ERAS), it is more important to optimize the postoperative fluid management of esophageal cancer. Restricted fluid therapy plays a more and more important role in patients undergoing esophagectomy. This review integrated the relevant research results and discussed the advantages of the restricted fluid therapy compared with other fluid therapy, how to control the restricted infusion volume and infusion speed and how to monitor and evaluate the infusion process and the selection of infusion types, so as to provide reference for clinical practice test.

Article in Chinese | WPRIM | ID: wpr-920829


@#Surgery is a classic traditional method for the treatment of early-stage esophageal cancer, and it is also recognized as an effective first-choice method in the medical community. With the development of endoscopic technology, esophagus-preserving comprehensive treatment of esophageal cancer has almost the same or even better effects in some aspects in the treatment of early esophageal cancer than surgery. Many clinical guidelines have also recommended it as the first-choice treatment for early esophageal cancer. The room for surgical treatment of esophageal cancer has been further compressed. This article discusses the comprehensive treatment model of esophageal cancer from the perspective of thoracic surgery, aiming to find a new position of thoracic surgery in the treatment of esophageal cancer.

Article in Chinese | WPRIM | ID: wpr-920819


@#Objective    To assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. Methods    The medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. Results    The upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. Conclusion    The effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.

Article in Chinese | WPRIM | ID: wpr-920818


@#Objective    To explore the relationship between metformin use and the risk and prognosis of esophageal cancer in patients with diabetes. Methods    The PubMed, Web of Science, EMbase, VIP, WanFang and CNKI databases were searched by computer to identify relevant studies from inception to August 21, 2021. Newcastle-Ottawa scale (NOS) was used to evaluate research quality. The STATA 12.0 software was used to conduct the statistical analysis. Results    A total of 14 studies involving 5 605 218 participants were included finally. NOS of all researches were≥6 points. The pooled results indicated that metformin use could decrease the risk of esophageal cancer in diabetics (OR=0.84, 95%CI 0.71-1.00, P=0.045), and could also prolong the overall survival of diabetics with esophageal cancer (HR=0.89, 95%CI 0.80-0.99, P=0.025). Conclusion    Metformin use can not only decrease the risk of esophageal cancer in patients with diabetes, but also improve the prognosis of diabetics with esophageal cancer significantly. However, more prospective high-quality studies are still needed to verify the conclusion.

Article in Chinese | WPRIM | ID: wpr-920817


@#Objective    To systematically review risk factors for esophagogastric anastomotic leakage (EGAL) after  esophageal cancer surgery for adults to provide theoretical basis for clinical prevention and treatment. Methods    PubMed, Web of Science, The Cochrane Library, WanFang Data, VIP, CNKI and CBM were searched from inception to January 2020 to collect case control studies and cohort studies about risk factors for EGAL after esophageal cancer surgery. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, and then, meta-analysis was performed by using RevMan 5.3 software. Results    A total of 33 studies were included, including 19 case-control studies and 14 cohort studies, all of which had a Newcastle-Ottawa Scale (NOS)≥6. There were 26 636 patients, including 20 283 males and 6 353 females, and there were 9 587 patients in China and 17 049 patients abroad. The results of meta-analysis showed that the following factors could increase the risk for EGAL (P≤0.05), including patient factors (18): age, sex, body mass index (BMI), smoking history, smoking index (≥400), alcohol history, digestive tract ulcer, respiratory disease, lower ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), chronic obstructive pulmonary disease (COPD), coronary atherosclerosis, peripheral vascular disease, arrhythmia, diabetes, hypertension, cerebrovascular disease, celiac trunk calcification and descending aortic calcification; preoperative factors (6): abnormal liver function, renal insufficiency, American Society of Anesthesiologists (ASA) grading, neoadjuvant radiotherapy and preoperative albumin<35 g/L, preoperative lower albumin; intraoperative factors (7): retrosternal route, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, splenectomy; postoperative factors (5): respiratory failure, postoperative arrhythmia, use of fiberoptic bronchoscopy, pulmonary infection, deep venous thrombosis. Neoadjuvant chemotherapy could reduce the risk for postoperative EGAL (P<0.05). However, age≥60 years, upper gastrointestinal inflammation, diffusing capacity for carbon monoxide (DLCO%), thoracic surgery history, abdominal surgery history, glucocorticoid drugs history, neoadjuvant chemoradiotherapy, anastomotic embedding, end-to-end anastomosis, hand anastomosis, intraoperative blood loss and other factors were not significantly correlated with EGAL. Conclusion    Current evidence suggests that the risk factors for postoperative EGAL include age, sex, BMI, smoking index, alcohol history, peptic ulcer, FEV1/FVC, COPD, diabetes, ASA grading, neoadjuvant radiotherapy, preoperative albumin<35 g/L, cervical anastomosis, thoracoscopic surgery, operation time≥4.5 h, tubular stomach, upper segment tumor, intraoperative splenectomy, postoperative respiratory failure, postoperative arrhythmia and other risk factors. Neoadjuvant chemotherapy may be the protection factor for EGAL. Due to limited study quality, more high quality studies are needed to verify the conclusion.

Article in Chinese | WPRIM | ID: wpr-920816


@#Objective    To compare the short- and long-term efficacy of surgery and endoscopy in the treatment of early esophageal cancer by a systematic review and meta-analysis. Methods    We extracted data independently from The Cochrane Library, PubMed, EMbase, Web of Science for studies comparing surgery with endoscopy from 2010 to 2020. The primary outcomes including R0 resection rate, long-term overall survival (OS), disease-specific survival (DSS), major complications, recurrence, hospital stay and cost. Meta-analysis was performed using RevMan 5.3 and Engauge Digitizer was used to extract survival curves from relevant literature, and relevant data were calculated based on statistical methods. Results    A total of 17 studies involving 3 705 patients were included. It was found that patients in the surgery group had a higher R0 resection rate compared with the endoscopic group (OR=0.13, 95%CI 0.07 to 0.27, P<0.001, I2=6%). The total complications rate of resection of esophageal cancer was higher than that of the endoscopic group (OR=0.28, 95%CI 0.16 to 0.50, P<0.001, I2=68%). The length of hospitalization in the endoscopic group was obviously shorter than that in the surgery group (MD=–8.28, 95%CI –12.44 to –4.13, P<0.001, I2=96%). The distant recurrence rate (OR=0.58, 95%CI 0.24 to 1.41, P=0.230, I2=0%) and the local recurrence rate after resection (OR=1.74, 95%CI 0.66 to 4.59, P=0.260, I2=40%) in the endoscopic group was similar to those of the surgery group. There was no significant difference in 5 year-OS rate between the two groups (HR=0.86, 95%CI 0.67 to 1.11, P=0.25, I2=0%), which was subdivided into two groups: adenocarcinoma (HR=0.55, 95%CI 0.15 to 2.05, P=0.37, I2=0%) and squamous cell carcinoma (HR=0.68, 95%CI 0.46 to 1.01, P=0.06, I2=0%), showing that there was no difference between the two subgroups. There was no significant difference in the DSS rate (HR=0.72, 95%CI 0.49 to 1.05, P=0.090, I2=0%) between the two groups. The cost of the surgery group was significantly higher than that of the endoscopic group (MD=–12.97, 95%CI –18.02 to –7.92, P<0.001, I2=93%). Conclusion    The evidence shows that endotherapy may be an effective treatment for early esophageal neoplasm when considering the long-term outcomes whether it is squamous or adenocarcinoma, even though it is not as effective as surgery in the short-term efficacy.

Acta Pharmaceutica Sinica B ; (6): 1271-1287, 2022.
Article in English | WPRIM | ID: wpr-929375


As one of the hallmarks of cancer, metabolic reprogramming leads to cancer progression, and targeting glycolytic enzymes could be useful strategies for cancer therapy. By screening a small molecule library consisting of 1320 FDA-approved drugs, we found that penfluridol, an antipsychotic drug used to treat schizophrenia, could inhibit glycolysis and induce apoptosis in esophageal squamous cell carcinoma (ESCC). Gene profiling and Ingenuity Pathway Analysis suggested the important role of AMPK in action mechanism of penfluridol. By using drug affinity responsive target stability (DARTS) technology and proteomics, we identified phosphofructokinase, liver type (PFKL), a key enzyme in glycolysis, as a direct target of penfluridol. Penfluridol could not exhibit its anticancer property in PFKL-deficient cancer cells, illustrating that PFKL is essential for the bioactivity of penfluridol. High PFKL expression is correlated with advanced stages and poor survival of ESCC patients, and silencing of PFKL significantly suppressed tumor growth. Mechanistically, direct binding of penfluridol and PFKL inhibits glucose consumption, lactate and ATP production, leads to nuclear translocation of FOXO3a and subsequent transcriptional activation of BIM in an AMPK-dependent manner. Taken together, PFKL is a potential prognostic biomarker and therapeutic target in ESCC, and penfluridol may be a new therapeutic option for management of this lethal disease.

Acta Pharmaceutica Sinica B ; (6): 1054-1067, 2022.
Article in English | WPRIM | ID: wpr-929347


Esophageal cancer is one of the most lethal cancers worldwide because of its rapid progression and poor prognosis. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are two major subtypes of esophageal cancer. ESCC predominantly affects African and Asian populations, which is closely related to chronic smoking and alcohol consumption. EAC typically arises in Barrett's esophagus with a predilection for Western countries. While surgical operation and chemoradiotherapy have been applied to combat this deadly cancer, molecularly targeted therapy is still at the early stages. With the development of large-scale next-generation sequencing, various genomic alterations in ESCC and EAC have been revealed and their potential roles in the initiation and progression of esophageal cancer have been studied. Potential therapeutic targets have been identified and novel approaches have been developed to combat esophageal cancer. In this review, we comprehensively analyze the genomic alterations in EAC and ESCC and summarize the potential role of the genetic alterations in the development of esophageal cancer. Progresses in the therapeutics based on the different tissue types and molecular signatures have also been reviewed and discussed.

Article in Chinese | WPRIM | ID: wpr-927899


Objective: To investigate the effect of Xuanfu Daizhe decoction on the stemness of esophageal cancer cells. Methods: The BALB/c nude mice were randomly divided into the control group and experimental group, 5 mice in each group, which were continuously administered with normal saline and Xuanfu Daizhe decoction (9.89 g/kg) by gastrogavage, respectively. Human esophageal carcinoma cells ECA-109 (5×106) were subcutaneously injected into the mice on the 8th day. Tumor volume was measured twice a week. The mice were sacrificed 4 weeks after injection, and the tumor tissue and mouse serum were collected. The expressions of the major stemness-regulating transcription factors, i.e., NANOG, OCT4 and SOX2, were detected by RT-qPCR, Western Blot and immunohistochemistry. ECA-109 cells were treated with 10% fetal bovine serum and serum from the above two groups of mice for 48 hours respectively, and three replicate wells were set in each group, and the expressions of NANOG, OCT4, SOX2 and the levels of AKT and p-AKT were detected by RT-qPCR and Western Blot, respectively. ALDH activity in tumor cells was detected by flow cytometry; the number of spheroids of tumor cells was detected by the spheroidization experiment. Results: Compared with the control group, the growth and size of esophageal cancer tumors were significantly inhibited by Xuanfu Daizhe Decoction; the expressions of NANOG, OCT4, SOX2, the ALDH activity, the number of spheroids, and the levels of AKT and phosphorylated AKT (p-AKT) in esophageal cancer cells were significantly reduced by Xuanfu Daizhe Decoction both in vivo and in vitro. Conclusion: Xuanfu Daizhe Decoction inhibits the stemness of esophageal cancer cells, it may be a potentially effective drug for the treatment of esophageal cancer and provides a theoretical basis for the exploration of new effective drugs for the treatment of esophageal cancer.

Animals , Esophageal Neoplasms/pathology , Mice , Mice, Nude , Proto-Oncogene Proteins c-akt , Transcription Factors
China Pharmacy ; (12): 1448-1454, 2022.
Article in Chinese | WPRIM | ID: wpr-927191


OBJECTIVE To in vestigate inhibitory effect s of gallic acid (GA)on human esophageal cancer TE- 1 cells in vitro and its potential mechanism. METHODS The effects of GA on the proliferation of TE- 1 cells were determined by MTT assay after treated with GA for 24 h and 48 h. Cell fluorescence counting (CCK-F)method and inverted fluorescence microscope were used to observe the changes in the number and morphology of TE- 1 cells after treated with GA. The change of cell migration ability was detected by scratch test. The effects of GA on the colony-forming ability of TE- 1 cells were tested by plate colony formation experiment. Cell apoptosis was detected by flow cytometry. Fluorescence probe (DCFH-DA)method was used to observe reactive oxygen species (ROS)production. Western blot assay was used to detect the expression of caspase- 3,caspase-9,Bcl-2,Bcl-2 associated X protein (Bax),cyclin D 1 and cyclin D 3. RESULTS GA significantly reduced the proliferation ability of TE- 1 cells in time and concentration dependent manner. the IC 50 of GA to TE- 1 cells were (281.22±26.81)μmol/L(24 h)and(220.90±31.15) μ mol/L(48 h),respectively. Compared with control group ,the cells in the administration group showed shrinkage ,sparse arrangement and nuclear pyknosis ,and the number of cells decreased significantly. Compared with control group ,the cell migration ability and colony formation ability were decreased significantly in administration groups (P<0.01 or P<0.05). The apoptosis rates of TE- 1 cells were (6.21±0.32)%,(12.59±0.58)% and(15.41±0.41)% after treated with 100,300 and 500 μmol/L GA for 24 h,all of which were significantly higher than (5.29±0.28)% of control group (P<0.01 or P<0.05). Except for GA 100 μmol/L group,the level of ROS in other administration groups were significantly increased (P<0.01 or P<0.05). Compared with control group,the expressions of Bcl- 2(only GA 200 μmol/L group),Bax(except for GA 100 μmol/L),caspase-3 and caspase- 9(except for GA 100 μmol/L)were increased significantly (P<0.01 or P<0.05),while the protein expressions of Bcl- 2(except GA 100, 200 μmol/L group),cyclin D 1 and cyclin D 3 were significantly decreased (P<0.01 or P<0.05). CONCLUSIONS GA can inhibit the proliferation of esophageal cancer TE- 1 cells, restrict their migration ability and colony-forming ability ,and promote apoptosis. The mechanism may be related to the increase of ROS level ,up-regulation of the expressions of pro-apoptotic proteins caspase- 3,caspase-9 and Bax ,and down-regulation of the expressions of anti-apoptotic protein Bcl- 2,cyclin D1 and cyclin D 3.

Acta Pharmaceutica Sinica ; (12): 793-801, 2022.
Article in Chinese | WPRIM | ID: wpr-922901


Multicellular tumor spheroids (MCTS) can simulate the structure and metabolic characteristics of tumors in vivo, which is of great significance to study the metabolic phenotype of tumor cells and the mechanism of drug intervention. In this study, esophageal cancer MCTS were constructed, and MCTS frozen sections were prepared after treated with different formulations of paclitaxel (PTX) including common PTX injection, PTX liposome and albumin bound PTX. MCTS mass spectrometry imaging analysis method was established by using air flow assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI). The visualization of the permeation and enrichment process of PTX in MCTs after PTX treatment was realized, and the spatially resolved metabolomics of PTX injection group was studied. The results showed that the permeation and enrichment behavior of PTX in MCTs model were related to the formulations. The changes of endogenous metabolites in MCTs of esophageal cancer after treated with PTX injection had temporal and spatial characteristics. The metabolic changes of MCTS during the initial 0-4 hours were dominated by the down-regulation of middle-high polarity metabolites and some lipids in the central region of MCTS, while the metabolic changes of MCTS during 8-72 hours were mainly up-regulated by lipid metabolites in the peripheral region of MCTS. The combination of in vivo tumor-associated MCTs model with label free, highly sensitive and high coverage mass spectrometry imaging technology provided a new method and strategy for the study of pharmacometabolomics.

Rev. cuba. cir ; 60(3): e1074, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1347384


Introducción: El cáncer de esófago es una de las neoplasias más agresivas del tracto digestivo, presenta alta morbilidad y mortalidad a nivel mundial. Objetivo: Determinar las características clínico epidemiológicas de los pacientes con cáncer de esófago y su oportunidad del tratamiento. Métodos: Se realizó una investigación básica de tipo descriptiva y retrospectiva en los pacientes con cáncer de esófago hospitalizados en el Instituto Nacional de Oncología y Radiobiología durante el período enero 2016 - enero 2017. Se obtuvieron los datos necesarios de las historias clínicas individuales de los casos que cumplieron los criterios de inclusión. Se aplicaron frecuencias absolutas y porcentajes para permitir los análisis estadísticos de variables seleccionadas. Resultados: El diagnóstico en las edades entre 60 y 69 años fue más frecuente, con el 44,8 por ciento de los casos; el 73,7 por ciento eran hombres y el 52,3 por ciento de la raza negra. En el 71,0 por ciento se encontró antecedentes de esofagitis de reflujo; 78,9 por ciento eran fumadores y 52,6 por ciento bebedores abusivos. La disfagia fue el síntoma más común y el carcinoma epidermoide se presentó con mayor frecuencia alcanzándose el 82,1 por ciento de la muestra estudiada. La mayoría de los casos se diagnosticó en estadio III. Conclusiones: Esta neoplasia constituye un problema de salud en Cuba, se incrementa su incidencia en los últimos años. Se recomienda aplicar el programa de detección y diagnóstico precoz de la enfermedad(AU)

Introduction: Esophageal cancer is one of the most aggressive neoplasms of the digestive tract; it accounts for high morbidity and mortality worldwide. Objective: To determine the clinical-epidemiological characteristics of patients with esophageal cancer and their chances for treatment. Methods: A descriptive and retrospective basic research was carried out, during the period from January 2016 to January 2017, in patients with esophageal cancer hospitalized at the National Institute of Oncology and Radiobiology. The necessary data were obtained from the individual medical records of the cases. that met the inclusion criteria. Absolute frequencies and percentages were applied for the statistical analyses of the selected variables. Results: The diagnosis at ages between 60 and 69 years was more frequent, accounting for 44.8 percent of the cases. 73.7 percent were men and 52.3 percent were of black race. A history of reflux esophagitis was found in 71.0 percent. 78.9 percent were smokers and 52.6 percent were abusive drinkers. Dysphagia was the most common symptom, while squamous cell carcinoma presented more frequently, reaching 82.1 percent of the sample studied. Most of the cases were diagnosed in stage III. Conclusions: This neoplasm is a health concern in Cuba; its incidence has increased in recent years. It is recommended to apply the program of early diagnosis and detection of the disease(AU)

Humans , Male , Middle Aged , Aged , Esophageal Neoplasms/epidemiology , Carcinoma, Squamous Cell/therapy , Esophagitis, Peptic/drug therapy , Early Diagnosis , Medical Records , Epidemiology, Descriptive , Retrospective Studies , Treatment Adherence and Compliance
Rev. inf. cient ; 100(4): e3524, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289651


RESUMEN Introducción: El cáncer de esófago avanzado es una de las neoplasias más agresivas con una elevada morbilidad y mortalidad. Botsuana ocupa el duodécimo cuarto puesto mundial con respecto a las muertes ocasionadas por esta enfermedad. Objetivo: Determinar las características clínico-patológicas de los pacientes con cáncer esofágico avanzado en el Hospital Princess Marina de Gaborone, Botsuana. Método: Se realizó un estudio prospectivo-descriptivo donde se caracterizó clínica y patológicamente a 45 pacientes con el diagnóstico endoscópico e histológico de cáncer de esófago avanzado en el periodo de enero a septiembre de 2019. Resultados: Predominó el sexo masculino (86,7 %) y los pacientes mayores de 60 años (60,0 %). La disfagia, la anorexia y la pérdida de peso fueron los síntomas más frecuentes y prevalecieron los pacientes con un tiempo entre la aparición de los síntomas y el diagnóstico-endoscópico entre tres y seis meses; la dieta inadecuada, el etilismo crónico y el hábito de fumar fueron los factores de riesgo predominantes. La localización anatómica más frecuente fue el tercio medio (51,1 %), el tipo endoscópico predominante fue el vegetante (46,7 %) y la mayoría de los pacientes presentó el tipo histológico carcinoma epidermoide (95,6 %) bien diferenciado (84,4 %). Conclusiones: El estudio de las características clínico-patológicas de los pacientes con cáncer esofágico avanzado permite su correcta estadificación, siendo una herramienta útil en la valoración multidisciplinaria del tratamiento debido a su complejo manejo clínico e institucional.

ABSTRACT Introduction: Advanced esophageal cancer is one of the most aggressive neoplasms with high morbidity and mortality. Botswana ranks 14th in the world for deaths from this disease. Objective: To determine the clinicopathological characteristics of patients with advanced esophageal cancer at the Princess Marina Hospital in Gaborone, Botswana. Method: A prospective-descriptive study was carried out, where 45 patients with endoscopic and histological diagnosis of advanced esophageal cancer were characterized clinically and pathologically, from January to September 2019. Results: Males predominated (86.7%), and also patients older than 60 years (60.0%). Dysphagia, anorexia and weight loss were the most frequent symptoms, and prevailed patients with three to six months between the appearance of symptoms and endoscopic diagnosis; inadequate diet, chronic alcoholism, and smoking were the predominant risk factors. The most frequent anatomical location was the middle third (51.1%), the predominant endoscopic type was the vegetative (46.7%) and most of the patients presented the histological type squamous cell carcinoma (95.6%) well differentiated (84.4%). Conclusions: The study of the clinical-pathological characteristics of patients with advanced esophageal cancer allows its correct staging, being a useful tool in the multidisciplinary assessment of treatment due to its complex clinical and institutional management.

RESUMO Introdução: O câncer de esôfago avançado é uma das neoplasias mais agressivas com alta morbimortalidade. Botswana ocupa o 14º lugar no mundo em mortes por esta doença. Objetivo: determinar as características clínico-patológicas de pacientes com câncer de esôfago avançado no Hospital Princesa Marina em Gaborone, Botsuana. Método: Foi realizado estudo prospectivo-descritivo em que 45 pacientes com diagnóstico endoscópico e histológico de câncer de esôfago avançado foram caracterizados clínica e patologicamente de janeiro a setembro de 2019. Resultados: Predominou o sexo masculino (86,7%) e pacientes com mais de 60 anos ( 60,0%). Disfagia, anorexia e perda de peso foram os sintomas mais frequentes e prevaleceram os pacientes com tempo entre o aparecimento dos sintomas e o diagnóstico endoscópico entre três e seis meses; dieta inadequada, alcoolismo crônico e tabagismo foram os fatores de risco predominantes. A localização anatômica mais frequente foi o terço médio (51,1%), o tipo endoscópico predominante foi o vegetativo (46,7%) e a maioria dos pacientes apresentou o tipo histológico carcinoma espinocelular (95,6%) bem diferenciado (84,4%). Conclusões: O estudo das características clínico-patológicas dos pacientes com câncer de esôfago avançado permite seu correto estadiamento, sendo uma ferramenta útil na avaliação multidisciplinar do tratamento devido ao seu complexo manejo clínico e institucional.

Humans , Male , Adult , Middle Aged , Aged , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/pathology , Endoscopy/methods , Botswana , Epidemiology, Descriptive , Prospective Studies , Observational Study
Rev. cir. (Impr.) ; 73(4)ago. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388859


Resumen La acalasia es un trastorno motor primario de la musculatura lisa esofágica que se caracteriza por disfagia, pseudorregurgitación y baja de peso. El tratamiento puede ser endoscópico o quirúrgico. Sólo se conocen los resultados a largo plazo de la cirugía, mientras que los endoscópicos tienen aún un seguimiento muy corto y no permiten sacar conclusiones valederas. La acalasia es una lesión que tiene una probabilidad significativamente mayor de desarrollar un cáncer esofágico, ya sea de tipo epidermoide, por inflamación crónica y retención de comida en el esófago, o un adenocarcinoma, secundario a reflujo gastroesofágico, que aparece posterior a cualquier tratamiento. Las publicaciones muestran que alrededor de 3% a 4% de los pacientes presentan a largo plazo, sobre 10 a 15 años postratamiento, el desarrollo de un cáncer avanzado del esófago. Se concluye que es indispensable un seguimiento clínico y endoscópico en forma rutinaria a estos pacientes.

Achalasia is a primary motor disorder of the esophageal smooth muscle characterized by dysphagia, pseudoregurgitation, and weight loss. Treatment can be endoscopic or surgical. The long-term results are only known from surgery, while endoscopic results still have a very short follow-up and do not allow us to draw valid conclusions. Achalasia is a lesión that has a significantly higher probability of developing esophageal cancer, whether of the epidermoid type, due to chronic inflammation and food retention in the esophagus, or an adenocarcinoma, secondary to gastroesophageal reflux, which appears after any treatment. Publications show that about 3 to 4% of patients present in time, about 10 to 15 years after treatment, the development of advanced cancer of the esophagus. It is concluded that clinical and endoscopic follow-up is essential in these patients on a routine basis.

Arq. gastroenterol ; 58(2): 195-201, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1285325


ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence. OBJECTIVE: We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T). METHODS: Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events. RESULTS: A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001). CONCLUSION: ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms.

RESUMO CONTEXTO: A dissecção endoscópica submucosa (DES) no tratamento da neoplasia superficial do esôfago está associada a uma alta taxa de ressecção R0 em bloco e baixa taxa de recorrência. OBJETIVO: O objetivo deste estudo é comparar o desempenho e os resultados clínicos da DES com incisão circunferencial (DES-C) versus com DES com túnel submucoso (DES-TS). MÉTODOS: Estudo retrospectivo de banco de dados coletados prospectivamente de um centro especializado em DES, investigando pacientes consecutivos submetidos à DES por câncer de esôfago superficial, entre 2009 e 2018. DES-TS foi definida como a técnica de realizar primeiro incisões na mucosa seguida de tunelamento submucoso no sentido oral para anal. DES-C consistiu em completar uma incisão circunferencial seguida da dissecção submucosa. As principais variáveis do estudo incluíram taxas de ressecção em bloco e R0. Os resultados secundários incluíram características do procedimento, taxa de ressecção curativa, recorrência local e eventos adversos. RESULTADOS: Um total de 65 procedimentos (23 DES-TS e 42 DES-C) foram realizados para CCE de esôfago (40; 61,5%) e neoplasia associada ao EB (25; 38,5%). Não houve diferenças estatisticamente significativas entre os pacientes submetidos a DES-TS versus DES-C nas taxas de ressecção em bloco (91,3% vs 100%, P=0,12), R0 (65,2% vs 78,6%, P=0,24), taxas de ressecção curativa (65,2% vs 73,8%, P=0,47) e tempo médio do procedimento (118,7 min com vs 102,4 min, P=0,35). Os eventos adversos para DES-TS e DES-C foram os seguintes: sangramento (0 vs 2,4%; P=0,53), perfuração (4,3% vs 0; P=0,61), estenose esofágica (8,7% vs 9,5%; P=0,31). A recorrência local foi encontrada em 8,7% após DES-TS e 2,4% após DES-C (P=0,28) em um seguimento médio de 8 e 2,75 anos, respectivamente (P=0,001). CONCLUSÃO: DES-TS e DES-C demostram ser igualmente eficazes com perfil de segurança semelhante para o tratamento das neoplasias superficiais do esôfago.

Humans , Esophageal Neoplasms/surgery , Esophageal Stenosis , Endoscopic Mucosal Resection/adverse effects , Retrospective Studies , Treatment Outcome , Neoplasm Recurrence, Local
Rev. Fac. Med. UNAM ; 64(2): 22-25, mar.-abr. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1250778


Resumen El síndrome de Plummer-Vinson (Paterson-Brown-Kelly) es una entidad rara, caracterizada por disfagia, formación de membranas esofágicas y anemia por deficiencia de hierro. Presentamos el caso de una mujer de 46 años con antecedentes clínicos de anemia ferropénica de larga evolución, que posteriormente presentó disfagia y odinofagia. Se encontró una membrana subcricoidea que fue rota exitosamente con el endoscopio. Los médicos de primer contacto deben estar familiarizados de los síntomas del síndrome de Plummer- Vinson, y tenerlos en cuenta a la hora de abordar un paciente con la tríada clásica. Como el síndrome es una condición pre- cancerosa con alto potencial maligno, el diagnóstico precoz y tratamiento oportuno es de suma importancia.

Abstract Plummer-Vinson syndrome (Paterson-Brown-Kelly) is a rare entity, characterized by dysphagia, esophageal web formation, and iron deficiency anemia. We present the case of a 46-year-old woman with a clinical history of iron deficiency anemia who subsequently presents dysphagia and odynophagia. A subcricoid web that was successfully broken with the endoscope was found. First contact doctors should be familiar with the symptoms of Plummer-Vinson syndrome, and take them into account, when addressing a patient with the classic triad. Since the syndrome is a precancerous condition with high malignant potential, early diagnosis and treatment is of utmost importance for better prognosis.

Rev. argent. cir ; 113(1): 32-42, abr. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1288172


RESUMEN Antecedentes: tanto el adenocarcinoma gástrico (ACG) como el esofágico (ACE) son una de las princi pales causas de muerte por cáncer digestivo en el mundo, si bien la ecoendoscopia (EUS) ha demos trado ser una herramienta valiosa en la estadificación preoperatoria del ACG y ACE en casos seleccio nados. Objetivo: evaluar la utilidad de la EUS en la estadificación de ACG y ACE para seleccionar los pacientes candidatos a neoadyuvancia, comparándola con la etapa previa a la implementación de la EUS en un centro quirúrgico de la Argentina. Material y métodos: se incluyó una serie consecutiva de pacientes con ACE y ACG durante el período 2013- 2019. Se excluyeron pacientes con criterios de irresecabilidad y operados de urgencia. Se dividió la muestra en cuatro grupos: G1 y G2 ACE con y sin EUS, G3 y G4 ACG con y sin EUS, respectivamente. Se evaluaron variables clínicas, anatomopatológicas y de supervivencia en todos los grupos. Resultados: se incluyó un total de 89 pacientes, de los cuales 40 fueron por ACE, 30 pacientes perte necieron a G1 vs. 10 a G2. Se analizaron 49 pacientes con ACG, 20 pertenecieron a G3, mientras que 29 a G4. En los pacientes estadificados con EUS, en G1, 23 pacientes realizaron neoadyuvancia (76 %) versus 2 pacientes en G2 (20 %) p: ≤ 0,005. En G3 realizaron quimioterapia perioperatoria 8 pacientes (40 %), mientras que en G4, solo dos pacientes (7 %) p: ≤ 0,005. En cuanto al análisis de metástasis ganglionares (G+) en la anatomía patológica, tuvimos un aumento esperable en los pacientes no esta dificados con EUS en cáncer esofágico donde, en G1, el 30% tuvieron G+ versus 60% en G2 p: ≤ 0,005. En G3 y G4 se observó un 45 % de G+. Con un tiempo promedio de seguimiento de 36 meses (6-72), si bien no observamos una diferencia significativa en cuanto a supervivencia global ni recurrencia, observamos una tendencia a favor de los pacientes estadificados con EUS. Conclusión: la utilización de la EUS en la estadificación preoperatoria de ACG y ACE es importante. Aunque su uso puede ser un desafío en muchos centros de la Argentina, futuros esfuerzos son necesa rios para incluir) este estudio en casos seleccionados en la estadificación de tales pacientes.

ABSTRACT Background: Gastric adenocarcinoma (GAC) and esophageal adenocarcinoma (EAC) are one of the leading causes of mortality from gastrointestinal cancer worldwide. Endoscopic ultrasound (EUS) has proved to be a valuable tool for preoperative staging of GAC and EAC in selected cases. Objective: The aim of this study was to evaluate the usefulness of EUS for staging of EAC and GAC and selecting patients who are candidates for neoadjuvant therapy, as compared with the previous stage before the implementation of EUS, in a surgical center in Argentina. Material and methods: Consecutive patients with EAC and GAC between 2013-2019 were included. Patients with criteria of unresectable cancer or who underwent emergency surgery were excluded. The sample was divided into four groups G1 and G2 (EAC with and without EUS, respectively) and G3 and G4 (GAC with and without EUS, respectively). The clinical and anatomopathological variables and survival were evaluated in all the groups. Results: A total of 89 patients were included, 40 with EAC (30 in G1 and 10 in G2, and 49 with GAC, 20 in G3 and 29 in G4. Of the patients undergoing EUS staging in G1, 23 (75%) received neoadjuvant therapy vs. 2 patients in G2 (20%) (P ≤ 0.005). Eight patients (40%) in G3 and 2 (7%) in G4 received perioperative chemotherapy (P ≤ 0.005). Lymph node metastases were observed in 9 (30%) of surgical specimens of EAC in G1 and in 60% in G2 (P ≤ 0.005), and in 45% in G3 and G4. After a mean follow-up of 36 months (6-72), we observed a non-significant trend toward higher overall survival and disease-free survival in patients undergoing EUS staging. Conclusion: EUS for preoperative staging pf EAC and GAC is a useful tool. Although the use of EUS use may be a challenging task in many centers in Argentina, future efforts are needed to include this test in selected cases for staging patients with these types of cancers.

Article in Chinese | WPRIM | ID: wpr-873684


@#Periodontitis is closely related to many systemic diseases. Cancer of the digestive system is a common malignant tumor. Increasing evidence has shown that periodontitis is related to various digestive system cancers. This review summarizes the current research on the relationship between periodontitis and esophageal cancer, gastric cancer, and colorectal cancer and analyzes the possible mechanisms, including via microorganisms, immunity, inflammation, and genes. The content of periodontal pathogens and Helicobacter pylori in the mouth of patients with periodontitis is increased, with the secretion of many virulence factors and pathogenic enzymes and inhibition or evasion of the host’s non-specific immune function, making the digestive system organs connected to the oral cavity more vulnerable to cancer cell invasion. The plasma levels of interleukin-1β(IL-1β) , interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in patients with periodontitis and digestive system cancers are increased. These elevated factors promote the occurrence and development of cancer by activating endothelial cells, increasing the expression of adhesion molecules and inducing the production of matrix metalloproteinases. Additionally, formyl peptide receptors involved in the inflammatory response and NF-κB, as therapeutic targets of periodontitis, are associated with many cancers, but the mechanism is unclear. Periodontal health is considered a breakthrough point to provide a reference for the prevention and treatment of patients with these three common cancers of the digestive system.

Article in Chinese | WPRIM | ID: wpr-873631


@#Objective    To investigate the short-term follow-up results of inflatable mediastinoscopy combined with laparoscopy in the treatment of esophageal cancer. Methods    Clinical data of 102 patients with esophageal cancer who underwent minimally invasive esophagectomy were enrolled in our hospital from January 2017 to January 2019. Patients were divided into two groups according to different surgical methods, including a single-port inflatable mediastinoscopy combined with laparoscopy group (group A, n=59, 53 males and 6 females, aged 63.3±7.6 years, ranging from 45 to 75 years) and a video-assisted thoracoscopy combined with laparoscopy group (group B, n=43, 35 males and 8 females, aged 66.7±6.7 years, ranging from 50-82 years). The short-term follow-up results of the two groups were compared. Results    Compared with the group A, the rate of postoperative pulmonary complication of the group B was significantly lower (18.64% vs. 4.65%, P<0.05). There was no significant difference between the two groups in other postoperative complications (P>0.05). The 6-month, 1-year, and 2-year survival rates were 96.61%, 89.83%, and 73.33%, respectively in the group A, and were 95.35%, 93.02%, and 79.17%, respectively in the group B. There was no significant difference in short-term survival rate after operation (P>0.05). Conclusion    In the treatment of esophageal cancer, the incidence of pulmonary complications of inflatable mediastinoscopy combined with laparoscopy is lower than that of traditional video-assisted thoracoscopy combined with laparoscopy, and there is no significant difference in other postoperative complications or short-term survival rate between the two methods. Inflatable mediastinoscopy combined with laparoscopy for radical esophageal cancer is a relatively safe surgical method with good short-term curative effects, and long-term curative effects need to be further tested.