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Cancer of the esophagus is an aggressive cancer with high mortality. Because of the esophagus's lack of serosa and its peculiar lymphatic drainage, esophageal cancer is diagnosed in advanced stages. The eighth edition of the TNM (2017) aims to standardize care for esophageal cancer throughout the world; it includes not only patients treated with esophagectomy alone, but also those receiving neoadjuvant chemotherapy and/or radiotherapy. One new development in the eighth edition is that it establishes separate classifications for different time periods, with pathologic stage groups for prior to treatment (cTNM), after esophagectomy (pTNM), and after neoadjuvant therapy (ypTNM). The combined use of endoscopic ultrasound, CT, PET-CT, and MRI provides the greatest accuracy in determining the clinical stage, and these techniques are essential for planning treatment and for evaluating the response to neoadjuvant treatment. Esophagectomy continues to be the main treatment; it is also the elective gastrointestinal surgery that has the highest mortality, and it carries the risk of multiple complications, including anastomotic leaks, pulmonary complications, technical complications, and functional complications.

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Objetivo: Evaluar el efecto de la aplicación intraoperatoria de mitomicina C (MMC) en la dacriocistorrinostomía (DCR) externa, sobre la evolución clínica y el tamaño de la osteotomía mediante tomografía computarizada helicoidal (TCH). Métodos: Se practicaron 17 DCR en 17 pacientes clasificados en dos grupos: grupo 1 o control (DCR sin MMC): 8 pacientes, y grupo 2 (DCR con MMC): 9 pacientes. La MMC intraoperatoria (0,2 mg/ml/2 minutos) se aplicó mediante hemosteta sobre la osteotomía. Los estudios con TCH se practicaron a las 24 horas, 1, 3 y 6 meses. Se valoró el grado de epífora y permeabilidad lagrimal. El cálculo del área de osteotomía fue obtenido mediante reconstrucción informatizada tridimensional y multiplanar de las TCH. Resultados: El seguimiento medio fue 10,47ñ4,1 meses (rango= 6-18 meses). La DCR con MMC resolvió la epífora en el 100 por ciento de los pacientes, versus 75 por ciento en el grupo control. En el grupo 2 el porcentaje de osteotomía permeable a los 6 meses, en comparación con el área de osteotomía inmediatamente tras la cirugía, fue 93,82ñ4,55 por ciento, frente al 64,81ñ9,68 por ciento en el grupo 1 (p<0,001). Existieron diferencias significativas desde el 1.er mes. Conclusiones: La MMC incrementa la tasa de éxitos de la DCR y reduce el cierre del área de la osteotomía (AU)

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PURPOSE: To study the effect of intraoperative mitomycin C (MMC) in external dacryocystorhinostomy (DCR), on the clinical evolution and osteotomy size with helical computed tomography (HCT). METHODS: A total of 17 patients who had undergone DCR were randomly assigned to either a control group (8 patients) or an MMC group (9 patients). Intraoperative MMC (0.2 mg/ml/2 minutes) was applied to the osteotomy site. HCT scans were performed within 24 hours after surgery and then at 1, 3 and 6 months. The epiphora grade and lacrimal drainage system irrigation were evaluated after surgery. A computer-aided three-dimensional and multiplanar reconstruction was used to calculate the surface area of the osteotomy site. RESULTS: The mean follow-up was 10.47+/-4.1 months (range= 6-18 months). All patients (100%) remain asymptomatic in the MMC group and 5 patients (75%) in the control group. In the MMC group the percentage of the remaining osteotomy size in comparision with the osteotomy size immediately after surgery at the end of the sixth postoperative month was 93.82+/-4.55%, whereas that of the control group was only 64.81+/-9.68% (p<0,001). Statistically significant differences were noted at 1, 3 and 6 months. CONCLUSIONS: Intraoperative MMC may increase the success rates over the traditional DCR procedure and is effective in reducing the closure rate of the osteotomy after DCR.

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