Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma.

BACKGROUND: : Endoscopic ultrasonography (EUS) is considered to be the best locoregional staging technique for cancer of the oesophagus. This study evaluated the relationship between preoperative EUS findings, completeness of surgical resection and survival. METHODS: : Between January 1995 and July 2002, 150 patients who underwent EUS for staging of tumours of the oesophagus were analysed prospectively. All underwent surgical resection with curative intent without neoadjuvant treatment. RESULTS: : Patient survival was significantly related to tumour (EUS T), node (EUS N) and Union Internacional Contra la Cancrum classification (EUS UICC) stage according to sonographic findings (P = 0.003, P = 0.009 and P = 0.004 respectively), and the presence of stenosis determined by EUS (P = 0.004). EUS T stage was a prognostic factor for survival (relative risk 1.7 (95 per cent confidence interval (c.i.) 1.1 to 3.0); P = 0.046). Complete surgical resection (R0) was also significantly related to EUS T, N and UICC classification (P < 0.001). EUS UICC stage was a factor predictive of R0 resection (relative risk 2.6 (95 per cent c.i. 1.4 to 4.8); P = 0.003). CONCLUSION: : R0 resection and survival of patients with tumours of the oesophagus were strongly related to endosonographic findings. These results support the proposal that EUS should be performed in all patients with oesophageal cancer, not only for staging patients before therapy but also to determine prognosis.

[Prospective study of early predictive factors of permanent hypocalcemia after bilateral thyroidectomy]. / Etude prospective des facteurs prédictifs précoces de la survenue d'hypocalcémie définitive après thyroïdectomie bilatérale.

AIM OF THE STUDY: The aim of this prospective cohort study was to identify the early criteria potentially predictive for outcome of permanent hypocalcemia after thyroidectomy. PATIENTS AND METHODS: Serum calcium (Ca) et phosphorus (Ph) were measured daily until discharge in 2035 consecutive patients undergoing bilateral thyroidectomy. In all patients experiencing postoperative hypocalcemia, defined as a Ca < 8.0 mg/dl on two consecutive days, parathyroid hormone was measured prior initiation of calcium therapy et discharge (early PTH), et blood sample was also obtained 7 to 14 days after discharge for Ca et Ph measurements (delayed Ca et Ph). These patients were then followed up until complete resolution of hypocalcemia or at least one year. Those still needing substitutive therapy to maintain normocalcemia one year after surgery were considered to have permanent hypocalcemia. Correlation of outcome with clinical characteristics, postoperative Ca et Ph levels, early PTH, et delayed Ca et Ph were examined with univariate analysis et multivariate logistic regression. RESULTS: Postoperative hypocalcemia occurred in 153 patients (7.5%) and spontaneously recovered in all but 7 patients (0.3%). Delayed Ca, and delayed Ph were found to be predictive for outcome of hypocalcemia by univariate analysis (p < 0.01). Relative risk to develop permanent hypocalcemia was 15 for patients with early PTH < 12 pg/ml, 52 when delayed Ph was > 4.0 mg/dl, and 121 when delayed Ca was < 8.0 mg/dl. None of the 113 patients with delayed Ca > or = 8.0 mg/dl and delayed Ph < or = 4.0 mg/dl developed permanent hypocalcemia, in contrast to 1 out of 31 patients (3%) with delayed Ca > 8.0 mg/dl or delayed Ph > 4.0 mg/dl, and 6 out of 9 patients (66%) with delayed Ca < 8.0 mg/dl and delayed Ph > 4.0 mg/dl. Both delayed Ca and delayed Ph appeared as independent factors predicting outcome of hypocalcemia at one year with multivariate logistic regression analysis. CONCLUSION: Delayed serum calcium and phosphorus levels, when measured one week after starting calcium therapy but prior to administration of any vitamin D analogs, accurately predict outcome of hypocalcemia after thyroidectomy. Patients with delayed Ca under 8.0 mg/dl and/or delayed Ph above 4.0 mg/dl are at high risk to develop permanent hypocalcemia.