A nomogram to predict major complications in patients with early-stage non-small-cell lung cancer / 中华胸心血管外科杂志

Objective To develop an easy-to-use nomogram to assist clinicians in predicting major postoperative morbidity in those non-small-cell lung canccr patients who underwent VATS lobectomy.Methods A perspective multi-center study was developed to analyze the major postoperative complications of 612 non-small-cell lung cancer patients who underwent VATS lobectomy.Muhivariable logistic regression was used to model postoperative morbidity and built the nomogram to accurately predict the major complications.Results There were 606 (99％) survivors and 6 (1％) mortality.A total of 32 patients suffered from major complications.Using logistic regression to predict major complications,preoperative model for ASA score,age ≥70 years and operation time ＞ 150 nin were found to be the significant predictors(P ＜ 0.05) of morbidity and were included in our model.Conclusion We propose a nomogram to enable clinicians to better estimate morbidity in patients with VATS lobectomy.

Strengthen perioperative multimodality treatment in order to improve long-term outcomes of esophageal cancer / 中华胃肠外科杂志

Esophageal squamous cell carcinoma (ESCC) is one of the commonest malignancies in China. Surgery is the main treatment for ESCC. However, the long-term survival is very poor by surgery alone. Perioperative multimodality treatment, including locally and systemically administrated, preoperatively and postoperatively, has been and will be the standard treatment in terms of improving long-term survival. Base on decades of practice and clinical trials, it is believed that preoperative treatment is better than postoperative treatment, and that chemotherapy plus radiotherapy preoperatively is better than either chemotherapy or radiotherapy alone. Therefore, preoperative radiochemotherapy followed by surgery is the standard treatment and future direction for locally advanced ESCC.

Impact of early enteral nutrition on the intestinal motility of patients after esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the impact of early enteral nutrition (EN) on the intestinal motility of patients after esophagectomy.</p><p><b>METHODS</b>Thirty-five consecutive patients undergoing esophagectomy for esophageal cancer by a single surgical team from the Peking University Cancer Hospital from June 2011 to July 2011 were enrolled. Patients were randomly divided into EN group (n=20) and parenteral nutrition group (control group, n=15) within 24 h after esophagectomy procedure. Bowel sound recovery time was monitored by auscultation, and the gastrointestinal tract symptoms were recorded.</p><p><b>RESULTS</b>Bowel sound recovery time was (45.1±20.3) h in the EN group, and was (56.7±17.0) h in the control group (P=0.082). Gastrointestinal symptoms such as nausea, abdominal distension, diarrhea occurred in 4 patients in EN group and 3 patients in control group and were alleviated by lowering infusion speed and more off-bed ambulation, and no significant difference was seen between the two groups (P=1.000).</p><p><b>CONCLUSIONS</b>Early enteral nutrition in the patients after esophagectomy is safe and feasible. Early enteral nutrition does not delayed bowel function recovery or increase gastrointestinal symptoms.</p>

Research progress of prognostic protein biomarkers associated with esophagus squamous cell carcinoma / 中华胃肠外科杂志

Esophageal cancer (EC) is one of the common malignant tumors in China. Esophagectomy based on multi-disciplinary principle improves the quality of life and survival of esophageal cancer patients, but a lot of patients will suffer recurrence or metastasis after surgery. TNM stage is the most important factor which affects the prognosis of patients with esophageal cancer. Besides, there are other prognostic factors, such as abnormal expression of the proteins. Exploration of these proteins may provide new clues to improve prognosis in esophageal squamous cell cancer (ESCC). We reviewed the literatures related to abnormal protein expression in ESCC, and tried to elucidate the prognostic value and potential clinical application of these proteins in ESCC.

One hundred years of evolution of esophageal surgical approach and clinical significance / 中华胃肠外科杂志

Esophageal surgery has developed for almost 100 years. Esophagectomy can be performed via left, right thoracotomy, even via hiatus without thoracotomy due to its unique anatomic characteristics. Left thoracotomy was the initial approach in the world, and has still been performed by Chinese colleagues, but Ivor Lewis (right side thoracotomy) procedure is popular in western countries. Currently, esophagectomy by right thoracotomy has been accepted worldwide since its radical dissection for tumor. Therefore, video-assisted thoracoscopic esophagectomy based on right thoracotomy will be the mainstream surgery for esophageal cancer in the future since its minimal invasion and tumor dissection.

Application of enteral nutrition tube placement and feeding equipment / 中华胃肠外科杂志

Although considerable clinical problems were solved by parenteral nutrition since 1960s, because of the risk of infectious and metabolic complications and advance in feeding tube placement, feeding methods, and artificial ingredient nutrients, enteral nutrition from 400 years ago has been brought to attention again. This review article is aimed to illustrate the issues related to enteral tube feeding in esophageal surgery.

Efficacy analysis of comprehensive treatment in small cell esophageal carcinoma following resection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical outcome of patients with small cell esophageal carcinoma(SCEC).</p><p><b>METHODS</b>Clinical data of patients with esophageal carcinoma were retrospectively collected from March 2000 to March 2011 at the Thoracic Surgery Department of the Peking University Cancer Hospital. Data included tumor characteristics, staging, treatment, response, short-term outcome, and long-term survival.</p><p><b>RESULTS</b>A total of 546 patients with esophageal carcinoma were identified, among whom there were 15 patients with SCEC(2.7%). Fourteen cases received multimodality treatment based on operation and one underwent operation alone. Four patients had preoperative chemotherapy and 10 had postoperative chemotherapy. Four patients had postoperative radiation. After excluding one case of postoperative death within 3 months, the median overall survival was 14.3 months(range, 4 to 99 months), significantly worse than those with non-SCEC(42.2 months, P<0.05).</p><p><b>CONCLUSION</b>SCEC is rare and the outcomes are poor. It should be considered as a systematic disease.</p>

Outcome after surgery preserving pharynx and larynx for cervical esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term survival of multidisciplinary treatment based on thoracic surgery for cervical esophageal squamous cell carcinoma.</p><p><b>METHODS</b>The clinical characters and follow-up data of forty-one cervical esophageal cancer patients who accepted multidisciplinary treatment based on surgery with preservation of pharynx and larynx were retrospectively reviewed, and the long-term survival was compared with 480 non-cervical esophageal cancers who accepted surgery in the same period done by the same surgical team.</p><p><b>RESULTS</b>There were 28 males and 13 females with a mean age of 62 years old. In the cervical esophageal cancer group, 30 patients accepted neoadjuvant chemotherapy, 25 patients accepted adjuvant chemotherapy, and 21 patients accepted both. Six patients received postoperative radiation. Four patients underwent exploratory surgery alone, and 37 cases underwent radical surgery and cervical anastomosis. One case died during the perioperative period. The 1-, 3-, 5- and 8-year survival rates were 96.8%, 52.6%, 35.1%, and 35.1% in the 36 patients with cervical esophageal cancer who underwent radical surgery, and were 85.0%, 54.3%, 45.0%, and 36.7% respectively in the 457 non-cervical esophageal cancer patients. There was no significant difference between the cervical group and non-cervical group(P=0.91).</p><p><b>CONCLUSION</b>Cervical esophageal cancer should be treated in a multidisciplinary approach to obtain satisfactory long-term outcomes.</p>

Protection on intestinal mucosa barrier during perioperative period of esophageal cancer / 中华胃肠外科杂志

Intestinal mucosa plays important roles in digestion, absorption and substance exchange between organism and external environment. Meanwhile, it is the largest immune organ and mucosal barrier, including mechanical, biological and immune barrier. A variety of diseases, especially postoperative complications, are associated with the damage of mucosal barrier. Esophageal cancer surgery is complex and many perioperative factors, especially hypoperfusion and fasting, may affect the integrity of intestinal barrier. Understanding of the mechanism of intestinal barrier (mechanical, biological and immune barrier), the physiological function of probiotics, and the benefit of early enteral nutrition to intestinal barrier are important components to achieve fast recovery after surgery for esophageal cancer.

Multidisciplinary therapy for multi-focal esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the management strategies and outcome of treatment for multi-focal esophageal carcinoma.</p><p><b>METHODS</b>Twenty two patients with multi-focal esophageal carcinoma who underwent esophagectomy by a single surgeon team from March 2000 to March 2011 at the Beijing Cancer Hospital were reviewed retrospectively. The clinical and pathological characters were analyzed, and the outcome was compared with that of 471 patients with single esophageal carcinoma who received esophagectomy by the same surgeon team during the same period.</p><p><b>RESULTS</b>Eighteen out of 22 patients with multi-focal esophageal cancer underwent esophagectomy via transthoracic approach while 4 patients via transhiatal. Eight patients received neoadjuvant chemotherapy and 15 patients received adjuvant chemotherapy. Four hundred and seventy-one out of 471 patients with single esophageal cancer underwent esophagectomy via transthoracic approach while 60 patients via transhiatal. One hundred and fourty-eight patients received neoadjuvant chemotherapy and 267 patients received adjuvant chemotherapy. The 3-year survival of the 22 patients with multi-focal esophageal carcinoma was 41.9%, and the median survival time was 29.2 months. The 3-year survival of the 471 patients with single esophageal carcinoma was 54.7%, and the median survival time was 46.8 months. There was no significant difference in survival between the two groups(P=0.051).</p><p><b>CONCLUSIONS</b>The prognosis of patients with multi-focal occurrence esophageal carcinoma was poor. Extended esophageal resection may be beneficial to these patients with concurrent systemic chemotherapy.</p>

Long-term efficacy of transhiatal esophagectomy for esophageal carcinoma and esophagogastric junction cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term efficacy of transhiatal esophagectomy (THE) for esophageal carcinoma or esophagogastric junction cancer.</p><p><b>METHODS</b>Between March 2000 and December 2009, a total of 544 patients with either esophageal carcinoma or esophagogastric junction cancer underwent esophagectomy via THE (n=63) or other approaches (n=481) in Beijing cancer hospital institution. Procedures were performed by a single surgeon team. Long-term survival was compared between two groups.</p><p><b>RESULTS</b>The 1-year, 3-year, 5-year, and 8-year accumulative survival rates in THE group were 91.0%, 60.5%, 44.6%, and 44.6%, respectively, while those in non-THE group were 84.5%, 49.2%, 37.2%, and 28.7%, respectively. The THE group showed better long-term survival than the non-THE group, however the difference was not statistically significant.</p><p><b>CONCLUSION</b>THE is a safe alternative for esophageal carcinoma and esophagogastric junction cancer.</p>

Up-regulation of HOXA13 in esophageal squamous cell carcinoma of stage IIa and its effect on the prognosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of HOXA13 gene in stage-II(a esophageal squamous cell carcinoma(ESCC), and to evaluate its relationship with clinicopathological characteristics and prognosis.</p><p><b>METHODS</b>The expression of HOXA13 was examined by immunohistochemistry(IHC) in specimens from 39 patients with ESCC of stage-II(a, who underwent resection from 1995 to 2002. SPSS software was used to analyze the relationship between HOXA13 expression and clinicopathological characteristics and prognosis of patients.</p><p><b>RESULTS</b>The expression of HOXA13 protein was detected in ESCC tissue, and the positive rate was 61.5%. The median survival time of patients without HOXA13 expression(>72 months) was significantly longer than those with HOXA13 expression (24 months)( P=0.023). Multivariate analysis showed that HOXA13 expression was independent predictor of disease-free survival time of patients with ESCC.</p><p><b>CONCLUSION</b>The expression of HOXA13 can be detected in ESCC and is a negative independent predictor of disease-free survival, which implies that HOXA13 might play a role in ESSC, and may be used as a clinical tumor marker of ESCC.</p>

Evaluation of transhiatus esophagectomy for patients with esophageal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the transhiatus esophagectomy for patients with esophageal cancer.</p><p><b>METHODS</b>Clinicopathological data of 46 patients with esophageal cancer undergone transhiatus esophagectomy by single surgeon team from May 2000 to July 2007 were analyzed retrospectively.</p><p><b>RESULTS</b>These 46 patients included 44 esophageal squamous cell carcinomas,1 esophageal adenocarcinoma and 1 esophageal carcinoid. The lesions of 11 patients located at neck segment, 21 at upper segment, 5 at middle segment, and 9 at lower segment. All the patients were classified according to UICC TNM stage classification: 3 cases as stage 0, 6 cases as stage I, 17 cases as stage II a, 2 cases as stage II b, 16 cases as stage III. Six patients received preoperative chemotherapy and pathological complete response was seen in 2 cases. Reconstruction with stomach was performed in 42 cases and with colon interposition in 4 cases.All the tumors were resected, and there was no perioperative death. All the resected margins were pathologically clear. Postoperative complications occurred in 12 cases and were successfully treated, including 2 cases of hoarseness, 3 cases of cardiac arrhythmia,1 case of bilateral pleural effusion, and 6 cases of small anastomotic leakage at neck.</p><p><b>CONCLUSION</b>Transhiatus esophagectomy is an ideal choice in surgical treatment for patients with esophageal cancer, especially for the ones of aged, poor cardiac or pulmonary function, who can not afford the thoracotomy.</p>

Expression of 39 HOX genes in esophageal cancer cell lines / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify whether HOX genes can be used as markers of esophageal cancer.</p><p><b>METHODS</b>The expression of 39 HOX genes in esophageal cancer cell lines was examined. Specific primers were designed and RT- PCR was performed for each HOX gene members in above esophageal cancer cell lines, EC109 and CAES.</p><p><b>RESULTS</b>Fifteen out of 39 HOX genes were expressed in esophageal cancer cell lines. They were HOXA2, HOXA7, HOXA9, HOXA10, HOXA13, HOXB7, HOXB9, HOXC4, HOXC5, HOXC6, HOXC8, HOXC9, HOXD9, HOXD10, and HOXD13 respectively. Of them. Eleven genes were overlapped with the ones detected in human esophageal squamous cell carcinoma(ESCC) in our former study.</p><p><b>CONCLUSION</b>This study reconfirms our former that some HOX genes are deregulated expressed in ESCC, which provides more positive evidence for their roles in ESCC.</p>

Significance of multidisplinary surgery in chest wall resection and reconstruction for selected patients with breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical significance and survival benefits of chest wall resection and reconstruction (CWRR) by multidisciplinary surgery for selected patients with locally advanced or recurrent breast cancer in order to address the importance of collaboration between ablative (breast surgery or/and thoracic surgery) and reconstructive teams during CWRR.</p><p><b>METHODS</b>The data of 44 patients who underwent multidisciplinary CWRR at The University of Texas M. D. Anderson Cancer Center between March 2001 and June 2004 were retrospectively analyzed, which included the CWRR techniques used, patient characteristics and treatment outcomes. Survival of patients with primary, recurrent or metastatic disease, and that of those with curative or palliative resection were also compared.</p><p><b>RESULTS</b>All patients were female aged 34-83 years with primary (n=19), recurrent (n=15) or metastatic breast cancer (n=10). The surgery modes included curative resection(n=36) and palliative (n=8) with a mean defect size of skin: 218.4 cm2; of bony chest wall: 113.9 cm2 (n=15). Immediate reconstruction (n=43) with prosthesis (n=10) or without (n=34) for most of these patients. All of them required soft tissue coverage with pedicled flap (n=37) or free flap (n=13). The average hospital and ICU stay was 6.6 days and 3.4 days (n=8), respectively. The morbidity was acceptable and no 30-day mortality happened. Neither was there difference in median survival (44.7 m vs. 36.0 m, P = 0.752) nor in 1-, 2-, and 3-year survival rates between primary breast cancer (78.4%, 78.4%, 39.2%) and recurrent one (70.9%, 70.9%, 70.9%, P > 0.05). However, both median survival (16.0 m) and the 1-, 2-, and 3-year survival rates (30.0%, 15.0%, 0) in patients with metastasis were much poorer than that in those with primary breast cancer (P = 0.003) or recurrence(P =0. 018). The survival of patients underwent curative resection (36.0 m, 71.5%, 65.7%, 65.7%) were much longer than those with palliative resection (15.1 m, 35.1%, 23.4%, 7.8%, P = 0.018).</p><p><b>CONCLUSION</b>With full control of systemic and local disease by up-front multidisciplinary strategy, chest wall resection and reconstruction could improve long-term survival if curative resection achieved or the quality of life if palliative resection done for breast cancer patients with tumor invading the chest wall or local recurrence. Ablative and reconstructive surgeons should be included in surgery team in order to guarantee the possibility of extensive resection and effective reconstruction in a single stage with high safety, good survival and minimal morbidity.</p>