Esophageal anastomotic leak does not affect ability to receive adjuvant treatment.

BACKGROUND: Esophageal anastomotic leak is associated with high morbidity and mortality and potentially lethal if not recognized promptly and treated aggressively. While many studies have attempted to delineate the surgical techniques associated with lower rates of anastomotic leak, few have attempted to determine its long term effects on adjuvant therapy and patient quality of life. METHODS: We reviewed our prospective 350 patient esophageal-gastric database and found 194 esophageal anastomoses performed from 1994 to 2013. Leaks were classified based on timing, severity, and location. We then compared their postoperative courses of adjuvant treatment, morbidity/mortality, and quality of life measured by Karnofsky performance status and EORTC score. Statistical correlations were calculated with χ(2) , T-test, Kaplain-Meier, ANOVA, and Cox Regression analyses as appropriate. RESULTS: Of 194 patients receiving esophageal anastomoses for cancer, 35 (18%) developed clinically diagnosed anastomotic leak 27 from esophagogastric and 8 from esophagojejunal. These groups were similar in preoperative history, preoperative staging, and type of tumor. Type of operation and variations in operative technique did not significantly affect leak rate. Patients with a leak were more likely to require intraoperative transfusion (47.1% vs. 24.1%, P = 0.013). As expected, they had a greater prevalence of perioperative complications to include pneumonia (38.6% vs. 16.3%, P = 0.001), pulmonary embolus (11.3% vs. 4.3%, P = 0.043), ileus (11.4% vs. 1.6%, P = 0.006%), empyema (11.4% vs. 0%, P > 0.001), and catheter related blood stream infections (8.6% vs. 0%, P = 0.001). Despite this increase in perioperative morbidity, there was no statistically significant difference in 90 day peri-operative mortality (2.8% vs. 2.3%) with similar ability to receive adjuvant therapy (38.6% vs. 48.0%, P = 0.303), quality of life scores (93.2 vs. 93.1, P = 0.9), and survival at 12 months (93% vs. 94%, P = 0.3). CONCLUSION: Anastomotic leak after oncologic resection does not preclude adjuvant therapy and, when managed appropriately, does not affect long term performance status or survival.

The incidence of prostate cancer-trends in two ethnic groups in Trinidad: a nine year study - abstract

Data on prostate cancer patients were obtained from the Pathology Department, General Hospital, San Fernando (before 1993) and, after 1993, prospectively collected for all admissions to that hospital for all patients with prostate cancer. Additonal data was collected from the hospital theatre registers and medical records. 365 prostate patients' data over the nine year period 1987-1995 were analysed for tends in the disease. In the population served by the hospital there are equal numbers of East Indians and Africans in the age range > 60 years. There was a rapid rise in the incidence of prostate cancer in males > 60 years starting in 1993, when PSA became widely available. This rise was maintained and seen mainly in the African population though there was a lesser rise among the East Indians. In most years, prostate cancer was more frequent in African than East Indian men. These data emphasize the value of PSA in detecting prostate cancer in both races but there is need for more education and systematic screening programmes to detect the asymptomatic male who can be offered curative therapy. The significantly higher frequency of prostate cancer in Africans (87.2 percent) than East Indians (12.8 percent) may be associated with differences with genetic and dietary factors and not with environment which is the same for both races. (AU))