Perioperative nutrition support for esophageal cancer complicated with diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy between perioperative enteral and parenteral nutrition support for esophageal cancer patients complicated with diabetes mellitus.</p><p><b>METHODS</b>Thirty esophageal cancer patients complicated with diabetes mellitus between September and November 2012 were prospectively enrolled in this trial. According to random number table, 30 cases were randomly divided into enteral group (n=15) and parenteral group (n=15). During the period between 3 days before operation and 8 days after operation, patients received enteral nutrition (AnSure) and parenteral nutrition support respectively. The daily dynamic monitoring of blood glucose was performed. Nutritional indexes (albumin and prealbumin) were evaluated 1-day before operation and 8-day after operation. Postoperative recovery time of gastrointestinal function and complications associated with nutritional support were observed. The cost of nutritional support was calculated.</p><p><b>RESULTS</b>Patients in the two groups achieved satisfactory perioperative blood glucose control. Finger tip blood glucose was 5.0-9.0 mmol/L before meal, 7.0-10.0 mmol/L 2-hour after meal, and 4.0-8.0 mmol/L at 10 PM and 3 AM. No hypoglycemia (<3.5 mmol/L) was found in all the patients. The time to first flatus after surgery was (62.4±15.7) in the enteral group, significantly earlier than (90.8±22.4) h in the parenteral group (P<0.01). Postoperative nutritional indices and associated complications were not significantly different between two groups (all P>0.05). Cost in the enteral group was significantly lower than that in the parenteral group [(650.8±45.8) RMB vs. (3016.5±152.6) RMB, P<0.01].</p><p><b>CONCLUSION</b>Perioperative nutrition support can effectively control blood glucose and improve perioperative nutritional status simultaneously for esophageal cancer patients with diabetes mellitus. Compared with parenteral nutrition, enteral nutrition can accelerate the recovery of gastric bowel function and reduce the cost of nutritional support.</p>

Effect of PC cell-derived growth factor RNA interference on biological behavior of esophageal squamous carcinoma cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of PC cell-derived growth factor (PCDGF) RNA interference on esophageal squamous carcinoma cells Eca-109 in vitro.</p><p><b>METHODS</b>The PCDGF-shRNA expression vector was transfected into the Eca-109 cells by liposome. After transfection, the mRNA and protein expressions of PCDGF were detected by RT-PCR and Western-blot respectively. Cell Counting Kit-8 (CCK-8) assay and Boyden chamber method were performed to measure the cell proliferation and invasion ability respectively.</p><p><b>RESULTS</b>The expression levels of PCDGF mRNA and protein were both decreased in Eca-109 cells transfected with PCDGF-shRNA expression vector (transfection group). Twenty-four, 48 and 72 h after transfection, the cells proliferation in the transfection group was inhibited, and the inhibition rate was 20.4%, 21.1% and 20.9% respectively. The cell proliferation activity in the transfection group was significantly lower than that in the non-transfection group, liposome group and negative vector group (all P<0.05). The number of cell migration in the non-transfection group,negative vector group, liposome group and transfection group was 118.8±12.0, 100.8±9.0, 114.3±4.7, and 53.5±16.3 respectively. The differences were statistically significant between the transfection group and the other 3 groups (all P<0.05).</p><p><b>CONCLUSIONS</b>PCDGF RNA interference can inhibit the proliferation and invasion abilities of esophageal squamous carcinoma cells in vitro. PCDGF gene may be the new target of gene therapy.</p>

Clinical application of minimally invasive esophagectomy for esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of minimally invasive esophagectomy (MIE) for esophageal carcinoma.</p><p><b>METHODS</b>Clinical data of 298 esophageal carcinoma cases who were treated by MIE in the Fujian Provincial Cancer Hospital from June 2008 to April 2012 were retrospectively reviewed.</p><p><b>RESULTS</b>All the patients underwent MIE successfully except one conversion to open surgery. The mean operative time was (242.3±58.7) min. The postoperative length of hospital stay was (17.4±9.8) d. The number of harvested lymph nodes of total, the mediastinum, the abdomen and the cervix was 27.5±12.2, 10.7±5.7, 13.3±7.8, and 7.7±8.1, respectively. Postoperative complication rate was 29.9%, including pneumonia (n=41), recurrent laryngeal nerve injury (n=25), anastomotic leak (n=9), wound infection (n=7), and others (n=7). After follow up of 2 to 47 months, 3 patients were found to develop anastomotic stricture. There were no recurrence, metastasis, or death.</p><p><b>CONCLUSION</b>Minimally invasive esophagectomy is a safe, feasible, effective and minimally invasive surgical technique.</p>

Study of different enteral nutrition formulation treatment after esophagectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficiency of different early enteral nutrition (EN) with Ensure, Nutrison, and Peptison in postoperative patients with esophageal carcinoma.</p><p><b>METHODS</b>A total of 45 postoperative patients with esophageal carcinoma were randomly divided into three groups using random digit table: Ensure group (n=15), Nutrition group (n=15), and Peptison group (n=15). Enteral nutrition was given using nasogastric tube from the 2nd postoperative day for 8 days. Albumin and prealbumin were detected on the day before surgery and postoperative day 9 after fasting. The time to gastrointestinal tract function recovery, complications, and the cost of enteral nutrition were compared among the three groups.</p><p><b>RESULTS</b>There were no significant differences in postoperative nutrition indices(albumin and prealbumin) and EN-related complications among the three groups(all P>0.05). The time to gastrointestinal tract function recovery in Ensure group [(52.4±15.7) h] and Nutrison group [(50.8±12.4) h] was less than that in Peptison group [(60.3±16.8) h] (P<0.05). The expense of Ensure group [(443.3±45.8) RMB] was obviously less than that of Nutrison group[(639.5±52.6) RMB] and Peptison group [(990.5±95.5) RMB](both P<0.01).</p><p><b>CONCLUSIONS</b>Ensure, Nutrison and Peptison can be used for postoperative early enteral nutrition in patients with esophageal carcinoma, and the efficacy and complication are comparable. The cost of Ensure is the lowest.</p>

Analysis of lymph node metastases in early esophageal carcinoma and treatment regimens / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the incidence of lymph node metastasis (LNM) in early esophageal carcinoma and the techniques of dissection.</p><p><b>METHODS</b>Standard three-field dissection was performed in patients with small superficial esophageal carcinoma detected by endoscopy from 1993 - 2007. The lymph node metastases in different regions were identified by histopathology. The survival rate of the cases was analyzed.</p><p><b>RESULTS</b>A total of 149 patients with early esophageal carcinoma were identified by postoperative pathological examination. The overall lymph node metastasis (LNM) rate was 22.8%, and the degree of LNM was 2.4% in all fields. Most lymph node metastases from upper thoracic esophageal carcinoma were found in cervical and the right upper mediastinal nodes. The LNM from middle thoracic esophageal carcinoma were approximately equal in the cervical, mediastinal, and abdominal lymph nodes, and abdominal lymph node metastasis predominated in lower thoracic esophageal carcinoma. The metastatic rate of LNM adjacent to the right recurrent laryngeaal nerve was the highest (44.1%). Significant differences were shown among the rates of LNM in relation to different macroscopic pattern, depth of invasion and differentiation of tumor (P < 0.01), but not to the longitudinal length of tumor (P > 0.05). The overall 5-year survival rate was 77.9%. It was 87.0% in patients without LNM, and 47.1% in those with LNM.</p><p><b>CONCLUSION</b>Lymph node metastasis in early esophageal carcinoma is in a high frequency. Patients with tumor invasion into the mucosa or lamina propria but without lymph node metastasis may undergo a local operation such as endoscopic mucosectomy and have a good prognosis. Patients with tumor invasion into the muscularis mucosae or submucosa should be treated with radical surgery with three-field lymphadenectomy, especially, to dissect the lymph nodes adjacent to the recurrent laryngeal nerve.</p>