Diagnosis and long-term results of surgical resection of early cardiac adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize therapeutic experience and the long-term results of early cardiac adenocarcinoma with surgical resection.</p><p><b>METHODS</b>Ninety cases were diagnosed with early cardiac adenocarcinoma during endoscopic screening in high incidence rate area of esophageal cancer from 1972 to 1997. All of the patients accepted surgical treatment. Cardiectomy included partial stomach and esophagus was performed through left thoracotomy in all patients. Esophagogastrostomy was carried out in the infra-aortic region and thoracoabdominal lymphatic dissection was performed in all cases.</p><p><b>RESULTS</b>The resection rate was 100%. One patient died in one month after the operation. Postoperative complications occurred in 4 cases (4.4%). Pathological examination of cancer specimens showed that 46 cases (51.1%) were intramucosal carcinoma without lymphatic metastasis and 44 cases (48.9%) were submucous infiltrating carcinoma with lymphatic metastasis in 5 (11.4%). The patients were followed-up to 2002, and the overall 5, 10, 15, 20 and 25 year survival rates were 91.9%, 83.6%, 69.6%, 49.8% and 16.6%, respectively.</p><p><b>CONCLUSIONS</b>Early diagnosis and early treatment may be the best approach for promoting the survival of the cardiac cancer. Surgical resection of early cardiac carcinoma provides excellent long-term survival.</p>

Surgical treatment of primary esophageal adenocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical treatment and clinical bio-characteristics of primary esophageal adenocarcinoma (PEAC).</p><p><b>METHODS</b>Clinical data of 43 cases with PEAC who had undergone operation from February 1980 to December 2000 in Linzhou City Esophageal Tumor Hospital were retrospectively analyzed.</p><p><b>RESULTS</b>Forty-three cases PEAC were reported in this study, which were 0.8% out of 5638 cases pathologically confirmed esophageal carcinoma treated during this period. Twelve cases (27.9%) were in the middle 1/3 of esophagus, thirty-one cases (72.1%) in the lower 1/3, which were significantly different from esophageal squamous cell carcinoma (ESCC). Fourteen cases were pure esophageal adenocarcinoma (32.6%), twenty-nine cases were adenosquamous cell carcinoma and adenoacanthoma cell carcinoma (67.4%). The ratio of lymph node metastasis of PEAC was higher than that of ESCC (65.1% vs. 31.6%, P < 0.001). The overall survival rates of 1, 3 and 5-year of PEAC were 81.4%, 46.5% and 28.2%, respectively, which were lower than those of ESCC (89.7%, 68.2% and 39.4%, respectively; chi 2 = 4.846, P = 0.028).</p><p><b>CONCLUSIONS</b>Compared with ESCC, PEAC, mainly located in the inferior 1/3 of esophagus, is a malignant disease with higher frequency of lymph node metastasis and poor prognosis. Surgical resection should be the first choice of treatment. Early diagnosis and early treatment as well as curative operation could improve prognosis. The long-term survival may be increased by adjunct multi-modality treatment.</p>

Surgical treatment of severe cicatricial anastomotic stricture after esophagectomy for esophageal and cardiac cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of the surgical procedure in the treatment of postoperative severe cicatricial anastomotic stricture for esophageal cancer and cardiac cancer.</p><p><b>METHODS</b>Twenty-four cases with severe anastomotic strictures and dysphagia after esophagectomy underwent second operation. The anastomosis was opened by two small transverse incisions about 1-2 mm above and below the anastomotic line. The esophageal and gastric walls were half opened. Then the circular cicatricial tissue was partially removed. The re-anastomosis was performed with a one layer, intermittent technique.</p><p><b>RESULTS</b>The second operations were successfully completed in 24 cases, cervical anastomotic leakage happened in 1 case and no operative mortality. All cases were followed up for 2-3 years. All patients can eat soft and common diet smoothly. No anastomotic strictures were found and the quality of life was significantly improved.</p><p><b>CONCLUSION</b>The second surgery with partial removal of the narrow cicatricial ring and reanastomosis for postoperative severe anastomotic stricture after esophagectomy is feasible, and the result is satisfactory.</p>