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Objective To determine the treatment outcome and prognosis after resection of esophageal cancer.Methods 312 patients who developed recurrence after curative resection for squamous cell cancer of the thoracic esophagus were analyzed retrospectively.Results Recurrence was found after a mean period of 17.8 months(range 2～56 months).Recurrence pattern was catagorized into lymphatic,hematogerous,mixed and anastomotic.The number of patients in each recurrence group was 188,42,60,22.312 patients were enveloped into a noadjuant treatment group(NT,68),a radiotherapy alone group(RT,110),a chemotherapt group(CT,72) and a radiotherapy combined chemothepapy(CRT+CT,32).The 0.5-,1-,2-and 3-year overall survival rates for NT were 63.5%,35.2%,16.3% and 13.1%;For CT were 65.7%,52.3%,11.9% and 9.2%;For RT were 75.6%,49.2%,32.2% and 14.2%,respectively.Compared with CT there were significant differences in survival for patients receiving RT alone or combined with CT(P0.05).Multivariate analysis showed that depth of tumor invasion,lymph node metastasis,operative procedure and different regimens of therapy were significant prognostic factors.Conclusion Esophagectomy with cervical anastomasis is recommened for esophageal carcinoma,additional cervical lymphadenectomy is benefical in a few patients.Radiotherapy or combined with chemotherapy to be effective in prolonging the survival of patietns with recurrenes after esophageal resection for cancer.Investigation for more effective drugs and regimens of chemotherapy need to be taken.
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Objective To evaluate the function of residual esophagus and stomach after subtotal esophagectomy and cervical gastroesophagostomy for esophageal carcinoma. Methods Manometry was performed in 21 patients who underwent cervical anastomosis after subtotal esophageal resection. The data was compared with normal subjects. Results The mean value of pharyngeal resting pressure was (1.20?2.03) mmHg(1mmHg=0.133kPa), and that of contraction pressure was (72.37?16.95) mmHg. The resting pressure of upper esophageal sphincter (UES) was (28.20?15.60) mmHg, and closing pressure was (107.10?28.43) mmHg. The resting pressure of residual esophagus was (15.98?11.10) mmHg, and contraction pressure was (48.45?18.37) mmHg. The resting pressure of stomach was (3.53?3.30) mmHg. Incidence of primary wave of esophagus was (57.14?34.50)%. The resting pressure of residual esophagus was much higher than that of normal group (P
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The resected specimens of esophageal adenocarcinoma from 73 patients were studied pathohistologically. The results demonstrated stage I in 1 cases; stage IIA 37; stage HB 8 and stage III 27. The incidence of postoperative complications and operative mortality were 4.1% and 1.4% respectively. The overall 5 year survival rate was 28. 3%. The authors pointed out that patients with primary esophageal adenocarcinoma should be operated on early. Even the late stage patients should also be treated surgically, because the esophageal adenocarcinoma is neither sensative to chemotherapy, nor radiotherapy.
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This paper presents the experience of surgical treatment of 32 patients with esophageal stricture caused by corrosive burn. The modes of surgical treatment in this series included: instrumental dilatation in 11 cases, reconstruction with resection of strictured esophagus in 19 (pharyngogas-trostomy in 6, cervical esophagogastrostomy in 12 and colon interposition in 1) and reoperation for esophageal restenosis in 2, There was no operative morality. All patients were fol- lowed-up and 94% of them resumed their normal diet post-operatively. The author recommend that dilatation can be applied to patients with localized esophageal stricture or slight annular stricture, and should done early. Resection of the esophageal stricture and esophagal reconstruction can be used in patients with extensive or severe stricture. There are many ways to esophageal reconstruction. The optimal one should meet the following requirements: isoperistaltic segment without tension and rich in blood supply, it should be easy to perform and result in no restenosis.