Maximum standardized uptake value on PET/CT in preoperative assessment of lymph node metastasis from thoracic esophageal squamous cell carcinoma / 癌症

The presence of lymph node metastasis is an important prognostic factor for patients with esophageal cancer. Accurate assessment of lymph nodes in thoracic esophageal carcinoma is essential for selecting appropriate treatment and forecasting disease progression. Positron emission tomography combined with computed tomography (PET/CT) is becoming an important tool in the workup of esophageal carcinoma. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) in assessing lymph node metastasis in esophageal squamous cell carcinoma (ESCC) prior to surgery. Fifty-nine surgical patients with pathologically confirmed thoracic ESCC were retrospectively studied. These patients underwent radical esophagectomy with pathologic evaluation of lymph nodes. They all had (18)F-FDG PET/CT scans in their preoperative staging procedures. None had a prior history of cancer. The pathologic status and PET/CT SUVmax of lymph nodes were collected to calculate the receiver operating characteristic (ROC) curve and to determine the best cutoff value of the PET/CT SUVmax to distinguish benign from malignant lymph nodes. Lymph node data from 27 others were used for the validation. A total of 323 lymph nodes including 39 metastatic lymph nodes were evaluated in the training cohort, and 117 lymph nodes including 32 metastatic lymph nodes were evaluated in the validation cohort. The cutoff point of the SUVmax for lymph nodes was 4.1, as calculated by ROC curve (sensitivity, 80%; specificity, 92%; accuracy, 90%). When this cutoff value was applied to the validation cohort, a sensitivity, a specificity, and an accuracy of 81%, 88%, and 86%, respectively, were obtained. These results suggest that the SUVmax of lymph nodes predicts malignancy. Indeed, when an SUVmax of 4.1 was used instead of 2.5, FDG-PET/CT was more accurate in assessing nodal metastasis.

Influence of preoperative chemoradiotherapy on pulmonary function and postoperative pulmonary complication in esophageal cancer patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the influence of preoperative chemoradiotherapy (CRT) on pulmonary function and postoperative pulmonary complications in esophageal cancer patients.</p><p><b>METHODS</b>Pulmonary function and postoperative pulmonary complications of 63 esophageal cancer patients undergoing preoperative CRT and operation in Cancer Center of Sun Yat-sen University between 2002 and 2013 were collected retrospectively. The influence of preoperative CRT on pulmonary functional indexes and postoperative pulmonary complications were analyzed.</p><p><b>RESULTS</b>After preoperative CRT, DLco% decreased significantly (83.7±17.7 vs. 96.4±17.8, P<0.01), while no obvious changes in other indexes were found. Postoperative pulmonary complication rate was 34.9% (22/63), including 19 cases of pneumonia and 3 cases of acute pulmonary injury/acute respiratory distress syndrome. Differences in postoperative pulmonary complication rates were not statistically significant between patients with DLco% <80 and those with DLco% ≥80 patients (29.7% vs. 41.7%, P>0.05), and between patients with DLco% decline ≥15% and those with DLco% decline <15% patients (31.6% vs. 37.8%, P>0.05).</p><p><b>CONCLUSION</b>Preoperative CRT can damage the diffusion function but not ventilation function of esophageal cancer patients, and does not increase the postoperative pulmonary complication rate.</p>

Analysis of learning process of video-assisted minimally invasive esophagectomy for thoracic esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the learning process of video-assisted minimally invasive esophagectomy (MIE).</p><p><b>METHODS</b>One hundred consecutive patients with thoracic esophageal carcinoma were treated by a same team of surgeons, and were divided into 3 groups in chronological order. The former two groups both consisted of 25 patients with thoracoscopy plus laparotomy. The remaining 50 patients were enrolled in the third group with thoracoscopy plus laparoscopy. Clinicopathological data including operative time, blood loss, protection of normal structures, complications, length of ICU stay, postoperative stay, and lymph nodes harvest, were collected and compared between groups.</p><p><b>RESULTS</b>Procedures were accomplished successfully in 96 patients. Only 4 cases were converted to open thoracotomy and none to laparotomy. The median operative time was 310 min and blood loss was 200 ml. The median number of lymph node harvest was 22. The overall complication rate was 50%. Comparison of first two groups revealed that significant differences existed in the preservation rate of arch of azygos vein (P=0.010), bronchial vessels (P=0.038), and exposure rate of thoracic part of left recurrent laryngeal nerve( P=0.048). Comparison of the former and latter 50 patients revealed that significant differences existed in thoracic operative time (P<0.001), blood loss (P=0.025), preservation rate of arch of azygos vein (P=0.001) and bronchial vessels (P<0.001), the number of lymph node harvest in thoracoscopy (P=0.022) and in left recurrent laryngeal nerve chain (P<0.001), and exposure rate of initiate part of left recurrent laryngeal nerve (P=0.002).</p><p><b>CONCLUSION</b>The learning curve of MIE is long and beginners should proceed step by step.</p>

Prognostic analysis of the patients with stage-III esophageal squamous cell carcinoma after radical esophagectomy / 癌症

<p><b>BACKGROUND AND OBJECTIVE</b>Most patients with esophageal carcinoma have disease in the locally late stage (stage III) when first diagnosed, with surgery as the first treatment of choice. This study analyzed the clinical data of patients with esophageal squamous carcinoma after radical esophagectomy and investigated prognostic factors.</p><p><b>METHODS</b>The data of 361 patients with esophageal squamous carcinoma who underwent radical esophagectomy and were hospitalized at Sun Yat-sen University Cancer Center between January 1997 and March 2004 were analyzed. The Kaplan-Meier method was used to analyze prognosis, log-rank test was used to compare the groups, and the Cox proportional hazards model was used for multivariate analysis.</p><p><b>RESULTS</b>The 1-, 2-, 3-, 4-, and 5-year survival rates were 67.7%, 40.6%, 27.5%, 23.4%, and 20.1%, respectively. Based on univariate analysis, the degree of invasion, rate of lymph node metastasis, number of metastatic regions, number of metastatic lymph nodes, postoperative complications, and duration of surgery were prognostic factors. Based on multivariate analysis, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent factors for the prognosis.</p><p><b>CONCLUSIONS</b>Of all clinical and pathologic factors, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent prognostic factors for the patients with stage-III esophageal squamous carcinoma after radical esophagectomy.</p>

Clinical evaluation of endoscopic ultrasonography and CT in the prediction of the resectability of esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the role of endoscopic ultrasonography (EUS) and CT in the prediction of the resectability of esophageal carcinoma.</p><p><b>METHODS</b>A retrospective study was carried out in 746 patients with esophageal carcinoma. These patients were divided into CT group (480 cases), EUS group (151 cases) and EUS+CT group (115 cases). Images of EUS and CT were double-blindly reviewed by radiologists. Relationship of EUS and CT images with surgical and pathological findings was examined.</p><p><b>RESULTS</b>Resection rates in the EUS group, CT group and EUS+CT group were 93.4%, 91.0% and 93.9%, respectively (chi(2)=1.551, P=0.484). Accuracy, sensitivity, specificity, positive predictive value and negative predictive value in the CT group were 81.7%, 87.4%, 23.3%, 92.0% and 15.4%, respectively; 94.7%, 98.6%, 40.0%, 95.9% and 66.7% in the EUS group; and 96.5%, 99.1%, 57.1%, 97.3% and 80.0% in the EUS+CT group, respectively. When assessing aortic invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 33.3%, 93.1%, 13.5% and 97.7%, in the CT group, respectively; 98.7%, 87.5%, 99.3%, 87.5% and 99.3% in the EUS group, respectively,and 98.3%, 85.7%, 99.1%, 85.7% and 99.1% in the EUS+CT group, respectively. In assessing tracheobronchial invasion, accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.3%, 20.8%, 95.0%, 17.9% and 95.8% in the CT group, respectively; 96.0%, 20.0%, 98.6%, 33.3% and 97.3% in the EUS group, respectively; and 98.3%, 66.7%, 99.1%, 66.7% and 99.1% in the EUS+CT group. Differences in assessing resectability were significant between CT group and EUS group (chi(2)=15.131, P=0.000), between CT group and EUS+CT group (chi(2)=15.662, P=0.000), and between EUS group and EUS+CT group (chi(2)=0.502, P=0.346). Differences in assessing aortic invasion were significant between CT group and EUS group (chi(2)=9.764, P=0.000), and between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between EUS group and EUS+CT group (chi(2)=0.076, P=0.581). Differences in assessing tracheobronchial invasion were significant between CT group and EUS+CT group (chi(2)=6.659, P=0.004), but were not significant between CT group and EUS group (chi(2)=3.729, P=0.034) and between EUS group and EUS+CT group (chi(2)=1.117, P=0.248).</p><p><b>CONCLUSIONS</b>EUS is a better procedure than CT in the prediction of the resectability and aortic invasion in esophageal carcinoma. There is limited value for EUS and CT in assessing tracheobronchial invasion. Combination of CT and EUS does not improve the prediction of resectability significantly.</p>