Combination of preoperative pulmonary and nutritional preparation for esophagectomy

Abstract Purpose: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. Methods: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. Results: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). Conclusion: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.

Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period

Objective: During the perioperative period, oral ingestion is changed considerably in esophagectomy patients. The aim of this study was to investigate oral environment modifications in patients undergoing esophageal cancer treatments due to changes in dietary intake and swallowing functions. Material and Methods: Thirty patients who underwent operation for removal of esophageal cancer in Tokushima University Hospital were enrolled in this study. Results: It was found that 1) the flow rate of resting saliva decreased significantly at postoperative period by deprived feeding for one week, although it did not recover several days after oral ingestion began, 2) the accumulation of dental plaque and the number of mutans streptococci in saliva decreased significantly after operation, while both increased relatively quick when oral ingestion began, and 3) the swallowing function decreased significantly in the postoperative period. Conclusions: These results suggest that dental professionals should emphasize the importance of oral health care and provide instructions on plaque control to patients during the perioperative period of esophageal cancer treatment.

Tubo gástrico con conservación anatómica y funcional del píloro / Gastric tube with anatomical and functional conservation of the pylorus

INTRODUCCIÓN. No existe consenso en cuanto a la realización de un procedimiento de drenaje gástrico cuando se ha realizado una esofagectomía subtotal y se ha sustituido el esófago por el estómago tubulizado y desnervado. Es el objetivo de este estudio evaluar el resultado obtenido en pacientes a quienes se practicó esofagectomía subtotal y sustitución del órgano con estómago tubulizado sin aplicar drenaje gástrico (piloroplastia). MÉTODOS. Se analizaron 16 pacientes tratados con este procedimiento entre enero de 2002 y septiembre de 2005. Las variables estudiadas fueron la técnica quirúrgica empleada, las complicaciones posoperatorias y la presencia de síntomas de retención gástrica o de reflujo duodenogástrico, al alta y durante el seguimiento hasta los 6 meses. RESULTADOS. La resección por la técnica de McKeown se realizó en el 50 por ciento de los casos, mientras que el acceso transhiatal se practicó en el 43,8 por ciento y la técnica de Ivor Lewis en el 6,2 por ciento. Siete pacientes (43,8 por ciento) sufrieron complicaciones, principalmente por fístula esofagogástrica cervical (6 casos). El último de ellos presentó atelectasia y bronconeumonía bilateral que lo llevaron a la muerte. En el seguimiento a los 6 meses no se encontraron síntomas de reflujo alcalino ni de dificultad a la evacuación del estómago. CONCLUSIONES. No se demostró la presencia de retención gástrica o reflujo duodenogástrico en este estudio. No obstante, sería recomendable la realización de un estudio aleatorio que compare los resultados obtenidos en pacientes a quienes se practica un procedimiento de drenaje gástrico y en aquellos en quienes se mantienen intactas la fisiología y la anatomía del píloro desnervado(AU)

INTRODUCTION. There is no consensus as to the carrying out of a procedure of gastric drainage when a subtotal esophagectomy has been performed and the stomach has been replaced by the tubulised denervated esophagus. It is the aim of this study to evaluate the result obtained in patients who underwent subtotal esophagectomy and replacement of the organ by tubulised stomach without applying gastric drainage (pyroloplasty). METHODS. 16 patients treated with this procedure from January 2002 to September 2005 were analyzed. The studied variables were the surgical technique used, the postoperative complications and the presence of symptoms. RESULTS. The resection by McKeown's technique was performed in 50 percent of the cases, whereas the transhiatal access was carried out in 43.8 percent and Ivor Lewis' technique in 6.2 percent. Seven patients (43.8 percent) suffered complications, mainly due to esophagogastric cervical fistula (6 cases). The last of them presented atelactasia and bilateral bronchopneumonia that caused his death. At the six months of follow-up, there were neither symptoms of alkaline reflux nor of difficulty to evacuate the stomach. CONCLUSIONS. The presence of gastric retention or duodenogastric reflux was not proved in this study. However, it is recommendable to conduct a randomized study to compare the results obtained in patients that underwent a procedure of gastric drainage with those whose physiology and anatomy of the denervated pylorus are intact(AU)

Metanálise sobre o uso de glicocorticóides pré-operatório para redução do risco de complicações após esofagectomia por carcinoma do esôfago / Use of preoperative glucocorticoid to risk reduction of complications after esophagectomy by esophagus carcinoma: meta-analysis

JUSTIFICATIVA E OBJETIVOS: O emprego de glicocorticóides tem sido proposto para reduzir a morbidade após intervenções cirúrgicas, porém, não é largamente utilizado antes da ressecção do esôfago porque não existem conhecimentos suficientes sobre a sua eficácia. O objetivo do trabalho foi verificar os efeitos da administração pré-operatória de glicocorticóides, em pacientes submetidos à esofagectomia por carcinoma de esôfago. MÉTODO: As fontes utilizadas foram: Medline, Embase, Cancerlit, Scielo, Base de Dados de Ensaios Clínicos Controlados da Colaboração Cochrane e busca manual de referências. O término da pesquisa ocorreu em dezembro de 2005. Foram pesquisados estudos aleatórios de pacientes com carcinoma esofágico, em que se compararam glicocorticóides com placebo, administrados antes das esofagectomias. Os dados foram coletados pelos mesmos revisores e a qualidade dos estudos foi avaliada usando-se o escore de Jadad. A metanálise foi realizada utilizando-se a razão de chances - odds ratio- (intervalos de confiança - IC - de 95 por cento) entre tratamento e placebo e um modelo de risco relativo baseado no teorema de Bayes. RESULTADOS: Quatro estudos envolvendo 169 pacientes foram localizados. Não ocorreram diferenças na mortalidade pós-operatória e nas incidências de deiscência de anastomose e insuficiências renal e hepática entre glicocorticóides e placebo. Houve decréscimo na incidência de complicações respiratórias pós-operatórias (95 por cento IC = 0,09-0,46) , sepse (95 por cento IC = 0,10-0,81) e no total de complicações pós-operatórias (95 por cento IC = 0,06-0,23) no grupo tratado com glicocorticóides. CONCLUSÕES: A administração pré-operatória de glicocorticóides foi associada com um decréscimo nas complicações pós-operatórias.

BACKGROUND AND OBJECTIVES: Preoperative glucocorticoid administration has been proposed for reducing postoperative morbidity. This is not widely used before esophageal resection because of incomplete knowledge regarding its effectiveness. The aim here was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. METHODS: Studies were identified by searching the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CancerLit, SCIELO and Cochrane Library, and by manual searching from relevant articles. The last search for clinical trials for this systematic review was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were extracted by the reviewer, and the trial quality was assessed using Jadad scoring. Odds ratio with 95 percent confidence limits and bayesian relative risk were used to assess the significance of the difference between the treatment arms. RESULTS: Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95 percent CI = 0.09-0.46), sepsis (95 percent CI = 0.10-0.81), and total postoperative complications (95 percent CI = 0.06-0.23) with preoperative glucocorticoid administration. CONCLUSIONS: Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.