RESUMEN
BACKGROUND: The purpose of the study is to examine if prolonged thromboprophylaxis decreases the risk of thrombosis after intended curative surgery for oesophageal cancer. Study results are expected to inform a guideline for thromboprophylaxis after oesophageal cancer surgery. The perspective is to reduce morbidity and mortality in this critically ill patient group. Thrombosis is the second-most common cause of cancer death after the cancer itself. The risk of thrombosis depends on the cancer type, and upper gastrointestinal cancers are considered high risk. This risk is further increased when patients undergo surgery. However, only few studies have investigated the peri- and postoperative coagulation profile in oesophageal cancer patients. Due to this lack of knowledge, prophylaxis is currently restricted to 5000 IU (international units) low-molecular weight heparin daily from surgery until discharge from hospital (approximately 10 days), whereas patients with gastric cancer receive 30 days of treatment. The present study examines whether a 30-day treatment is superior and safe, compared with the current standard treatment. METHODS: The study is a randomised controlled trial. Inclusion is ongoing, and we aim to include 100 patients. Blood samples are drawn before and after surgery, and the coagulation is extensively examined. The primary endpoint is the difference in plasma levels of prothrombin fragment 1 + 2 (F1 + 2) 30 days after surgery between the intervention and the standard group. Furthermore, patients are examined with ultrasound to screen for asymptomatic venous thrombotic events (VTE). Secondary endpoints are incidence of bleeding, symptomatic and asymptomatic VTE and mortality 30 days 1 one year after surgery. DISCUSSION: The study will provide valuable information on the perioperative coagulation profile and VTE risk of oesophageal cancer patients. The study seeks to aid in optimising the postoperative thromboprophylaxis, and the perspective is to reduce morbidity and mortality in this at-risk patient population. TRIALS REGISTRATION: The trial was prospectively registered at the EU Clinical Trials Register with ID 2021-001335-24 on 30 June 2021 and at ClinicalTrials.gov with study identifier NCT05067153.
Asunto(s)
Anticoagulantes , Neoplasias Esofágicas , Protrombina , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Anticoagulantes/uso terapéutico , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Esofagectomía/efectos adversos , Factores de Tiempo , Heparina de Bajo-Peso-Molecular/uso terapéutico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Fragmentos de Péptidos/sangre , Resultado del Tratamiento , Tromboembolia Venosa/prevención & control , Tromboembolia Venosa/etiología , Coagulación Sanguínea/efectos de los fármacos , Factores de Riesgo , Esquema de MedicaciónRESUMEN
BACKGROUND: The purpose of this retrospective study was to compare the safety and feasibility of single-intercostal totally minimally invasive Ivor Lewis esophagectomy (MIIE) with those of multiple-intercostal MIIE. METHODS: Between January 2016 and December 2022, clinical data were collected for 528 patients who successfully underwent totally minimally invasive esophagectomy. Among these patients, 294 underwent MIIE, with 200 undergoing the single-intercostal approach and 94 undergoing the multiple-intercostal approach. Propensity score matching (PSM) was applied to the cohort of 294 patients. Subsequently, perioperative outcomes and other pertinent clinical data were analyzed retrospectively. RESULTS: A total of 294 patients were subjected to PSM, and 89 groups of patient data (178 persons in total) were well balanced and included in the follow-up statistics. Compared to the multiple intercostal group, the single intercostal group had a shorter operative time (280 min vs. 310 min; p < 0.05). Moreover, there was no significant difference in the incidence of major perioperative complications (p > 0.05). The total number of lymph nodes sampled (25.30 vs. 27.55, p > 0.05) and recurrent laryngeal nerve lymph nodes sampled on the both sides (p > 0.05) did not significantly differ. The single intercostal group had lower postoperative long-term usage of morphine (0,0-60 vs. 20,20-130; p < 0.01), total temporary addition (10,0-30 vs. 20,20-40; p < 0.01) and temporary usage in the first 3 days after surgery (0,0-15 vs. 10,10-20; p < 0.01) than did the multicostal group.There were no significant differences in age, sex, tumor location or extent of lymphadenectomy or in the clinical factors between the single-intercostal group (p > 0.05). CONCLUSIONS: Both techniques can be used for the treatment of esophageal cancer. Compared to multiple intercostal MIIE, the feasibility of which has been proven internationally, the single intercostal technique can also be applied to patients of different age groups and sexes and with different tumor locations. It can provide surgeons with an additional surgical option. TRIAL REGISTRATION: This study was retrospectively registered by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine, and written informed consent was exempted from ethical review. The registration number was 20,230,326. The date of registration was 2023.03.26.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Humanos , Masculino , Femenino , Estudios Retrospectivos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Esofagectomía/métodos , Esofagectomía/efectos adversos , Persona de Mediana Edad , Anciano , Toracoscopía/métodos , Toracoscopía/efectos adversos , Tempo Operativo , Estudios de Factibilidad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Puntaje de Propensión , Escisión del Ganglio Linfático/métodos , Resultado del Tratamiento , AdultoRESUMEN
Postoperative hiatal hernia is a rare and specific complication after esophagectomy. This complication leads to emergency and affects mortality. Incidence of this complication has increased due to the great number of minimally invasive procedures over the past decades. In addition, chronic cough, preoperative hiatal hernia and transhiatal approach also increase the risk of recurrent hernias. Most post-esophagectomy hiatal hernias do not require emergency surgery. About 70% of patients have symptoms reducing the quality of life. About 25% of cases are asymptomatic and discovered incidentally during follow-up examinations. The role of surgery for asymptomatic post-esophagectomy hernias is a matter of debate because the risk of symptoms or complications is poorly predictable. Surgical treatment is the only radical method for symptomatic or complicated hernias. However, there is still no consensus regarding surgical approach and technique. Most surgeons prefer open surgery fearing severe adhesive process and other technical difficulties. Laparoscopic approach is widely accepted as the "gold standard" for primary hiatal hernia. However, minimally invasive access for post-esophagectomy hiatal hernias is not sufficiently studied and described in several case reports. Currently, it is very important to study the risk factors of hiatal hernias after esophagectomy. We present successful laparoscopic repair of hiatal hernia after hybrid McKeown esophagectomy.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Hernia Hiatal , Herniorrafia , Laparoscopía , Complicaciones Posoperatorias , Humanos , Hernia Hiatal/cirugía , Hernia Hiatal/etiología , Esofagectomía/efectos adversos , Esofagectomía/métodos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/etiología , Herniorrafia/métodos , Herniorrafia/efectos adversos , Neoplasias Esofágicas/cirugía , Masculino , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
Intrathoracic herniation of the gastric tube pulled up through the retrosternal route after oesophagectomy is relatively rare and usually can be managed by conservative treatment.We present two patients who needed reoperation for intrathoracic herniation of gastric tube after minimally invasive oesophagectomy for thoracic oesophageal cancer. Postoperatively, both patients showed herniation and acute twist of the gastric tube. Due to the twist of the gastric tube, one patient had ischaemic change of the proximal tip of the gastric tube, and the other patient showed delayed gastric emptying, both of which led to surgical repairs. In this case report, we discuss why the herniation of gastric tube from the retrosternal route occurs, how to decide to do reoperation and how to prevent this complication.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Complicaciones Posoperatorias , Reoperación , Humanos , Esofagectomía/efectos adversos , Reoperación/métodos , Masculino , Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/cirugía , Persona de Mediana Edad , Anciano , Hernia/etiología , Estómago/cirugía , FemeninoRESUMEN
BACKGROUND: Esophageal cancer is currently one of the high-risk malignant tumors worldwide, posing a serious threat to human health. This study aimed to analyse the causes of postoperative mortality and intrathoracic anastomotic leakage(IAL) after esophagectomy. METHODS: A retrospective analysis was conducted on 172 patients with esophageal cancer resection and focused on the preoperative and postoperative indicators. Cox regression analysis was performed to identify factors affected IAL and evaluated the potential factors on postoperative mortality. The Kaplan-Meier curve was applied to evaluate the effect of leakage on postoperative mortality after propensity score matching. RESULTS: Univariable and multivariable Cox regression analysis showed that infection and high BMI were significant risk factors for IAL, patients with BMI over 24 kg/m2 in IAL group was two times higher than that of the group without IAL (95% CI = 1.01-6.38; P = 0.048). When patients were infected, the hazard ratios(HRs) of anastomotic leakage was twice that of patients without infection (95% CI = 1.22-4.70; P = 0.011). On the other hand, IAL was a significant cause of postoperative mortality, the 40-day postoperative mortality rate in the leakage group was significantly higher than the non leakage group (28.95% in leakage group vs. 7.46% in non leakage group, P<0.01). After propensity score matching, IAL still significantly affected postoperative mortality. The total length of hospital stay of the leakage group was inevitably longer than that of the non leakage group (22.19 ± 10.79 vs. 15.27 ± 8.59). CONCLUSION: IAL was a significant cause of death in patients underwent esophageal cancer resection. Patients with high BMI over 24 kg/m2 and infection may be more prone to developing IAL after esophagectomy. IAL inevitably prolonged the length of hospital stay and increased postoperative mortality.
Asunto(s)
Fuga Anastomótica , Neoplasias Esofágicas , Esofagectomía , Humanos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Fuga Anastomótica/mortalidad , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Masculino , Femenino , Esofagectomía/efectos adversos , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Riesgo , Anciano , Puntaje de Propensión , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidadRESUMEN
To evaluate the efficacy and postoperative complications of endoscopic thoracoscopic and laparoscopic radical esophagectomy compared to open surgery in esophageal cancer treatment. This retrospective study included 103 esophageal cancer patients admitted from August 2018 to March 2022, divided into observation (endoscopic surgery) and control (open surgery) groups. We compared intraoperative parameters, postoperative outcomes, immune function, and one-year overall survival (OS). Intraoperative bleeding volume, the retention time of chest tube, postoperative fasting time, and hospital stay in the observation group were smaller than those in the control group (Pâ <â .05). The differences were not statistically significant (Pâ >â .05) when comparing operative time, the number of intraoperative blood transfusion cases, and the rate of operating room extubation in these 2 groups. The differences were not statistically significant when comparing the amount of resected lymph nodes and the positive rate of incisal edge in these 2 groups (Pâ >â .05). There was no statistically significant difference in the complication rates such as pneumonia, pleural effusion, pneumothorax, pulmonary embolism, anastomotic fistula, the leakage of thoracic duct, the injury of RLN and arrhythmia in these 2 groups (Pâ >â .05). At 7 days postoperatively, the CD4+ and CD4+/CD8+ in the observation group and the control group were smaller than the preoperative ones in their same groups, and they were larger in the observation group than those in the control group (Pâ <â .05); There was no statistically significant difference on the CD8+ in the observation group and the control group at 7 days postoperatively compared with the preoperative ones in their same groups (Pâ >â .05). The 1-year postoperative OS rate was 81.63% (40/49) in the observation group and 72.22% (39/54) in the control group, and the difference was not statistically significant when comparing the OS rates of these 2 groups (Pâ =â .238, HRâ =â 0.622, 95% CIâ =â 0.279-1.385). Endoscopic thoracoscopic and laparoscopic esophagectomy offers less invasive treatment with significant short-term benefits and better preservation of immune function in esophageal cancer patients, making it a safe and effective surgical option.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Laparoscopía , Complicaciones Posoperatorias , Toracoscopía , Humanos , Esofagectomía/métodos , Esofagectomía/efectos adversos , Neoplasias Esofágicas/cirugía , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Toracoscopía/métodos , Toracoscopía/efectos adversos , Anciano , Tempo Operativo , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricosRESUMEN
PURPOSE: This research aimed to clarify the metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma and to investigate appropriate strategies for lymph node dissection. METHODS: Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed. RESULTS: A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively. CONCLUSIONS: The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.
Asunto(s)
Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagectomía , Escisión del Ganglio Linfático , Ganglios Linfáticos , Metástasis Linfática , Nervio Laríngeo Recurrente , Humanos , Masculino , Femenino , Persona de Mediana Edad , Nervio Laríngeo Recurrente/patología , Estudios Retrospectivos , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas de Esófago/cirugía , Carcinoma de Células Escamosas de Esófago/patología , Carcinoma de Células Escamosas de Esófago/secundario , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Esofagectomía/efectos adversos , Esofagectomía/métodos , Anciano , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Terapia Neoadyuvante , Adulto , Factores de Riesgo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaAsunto(s)
Fístula Esofágica , Esofagectomía , Stents , Humanos , Esofagectomía/efectos adversos , Stents/efectos adversos , Masculino , Fístula Esofágica/etiología , Fístula Esofágica/cirugía , Fístula Esofágica/terapia , Neoplasias Esofágicas/cirugía , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/cirugía , Fuga Anastomótica/etiología , Fuga Anastomótica/terapia , Persona de Mediana Edad , Esofagoscopía/métodosRESUMEN
BACKGROUND: Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting. METHODS: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL. RESULTS: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference). CONCLUSIONS: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.
Asunto(s)
Fuga Anastomótica , Neoplasias Esofágicas , Esofagectomía , Laringectomía , Faringectomía , Humanos , Masculino , Esofagectomía/efectos adversos , Esofagectomía/métodos , Femenino , Neoplasias Esofágicas/cirugía , Estudios Retrospectivos , Laringectomía/efectos adversos , Laringectomía/métodos , Anciano , Persona de Mediana Edad , Japón/epidemiología , Faringectomía/métodos , Faringectomía/efectos adversos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Neoplasias Primarias Secundarias/epidemiología , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Neumonía/epidemiología , Neumonía/etiología , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Oesophageal squamous cell carcinoma (OSCC) poses a considerable health burden, particularly in regions such as East Asia. This study aims to investigate the long-term outcomes of OSCC patients who are smokers and drinkers. MATERIALS AND METHODS: In this retrospective analysis, data from Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database between January 2010 and December 2017 were examined. Patients were categorised into different groups based on their smoking and alcohol consumption history: None, Smoker, Non-Smoker, Smoke-Only, Drinker, Non-Drinker, Drinker-Only, and Both. Survival outcomes were compared between the groups using Kaplan-Meier analysis and propensity score matching (PSM). The primary outcome was overall survival (OS), measured from surgery to death or last follow-up in April 2022. RESULTS: The OS median was 45.4 months for all patients after oesophagectomy. Smokers had a significantly lower median OS of 36.6 months compared with Non-Smokers with 66.2 months (p<0.001). Similarly, Drinkers had a lower median OS of 34.4 months compared with Non-Drinkers with 52.0 months (p<0.001). PSM analysis confirmed the significant differences in OS between Smokers and Non-Smokers (p=0.002) and between Drinkers and Non-Drinkers (p=0.002). Subgroup analyses showed no significant differences in OS between Group Another and Group Both, Group Smoker-Only and Group Drinker-Only, and Group Drinker-Only and Group Both. (figure 4) CONCLUSION: Smoking and drinking were associated with significantly reduced OS in patients. However, no significant differences were found between the subgroups of patients who only smoked, only drank, or engaged in both habits.
Asunto(s)
Consumo de Bebidas Alcohólicas , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Esofagectomía , Puntaje de Propensión , Fumar , Humanos , Esofagectomía/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Carcinoma de Células Escamosas de Esófago/cirugía , Estudios Retrospectivos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Consumo de Bebidas Alcohólicas/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Fumar/efectos adversos , Fumar/epidemiología , Anciano , Fumadores/estadística & datos numéricos , China/epidemiología , Estimación de Kaplan-Meier , Resultado del TratamientoRESUMEN
BACKGROUND/AIM: Esophagectomy for esophageal carcinoma (EC) is known to lead to deterioration of respiratory function (RF) due to thoracotomy and mediastinal lymph node dissection. This study aimed to evaluate the impact of transmediastinal esophagectomy (TME) on pulmonary function. PATIENTS AND METHODS: We retrospectively analyzed the data of 102 patients with EC who underwent transthoracic esophagectomy (TTE) or TME and underwent RF tests within three months postoperatively at Kyoto Prefectural University of Medicine between 2014 and 2022. Perioperative pulmonary functions were evaluated based on vital capacity (VC) and forced expiratory volume in one second (FEV1.0). RESULTS: Among 102 patients undergoing esophagectomy, 12 (11.8%) patients were included in the TTE group, and the remaining 90 (88.2%) patients were included in the TME group. Neoadjuvant treatments were significantly more common in the TTE group (p=0.011), with more advanced tumor stages (p=0.017). The TME group had significantly lower estimated blood loss (p=0.015). RF after esophagectomy showed a decrease in VC, and VC of predicted (%VC). The decrease rate in VC, %VC, and FEV1.0 was significantly greater in the TTE group than in the TME group. CONCLUSION: TME is a surgical procedure with a less severe postoperative decline in RF than TTE.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Pruebas de Función Respiratoria , Estudios Retrospectivos , Periodo Posoperatorio , Complicaciones Posoperatorias/etiología , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
BACKGROUND: Frailty becomes more pronounced with advancing age, tightly intertwined with adverse clinical outcomes. Across diverse medical disciplines, frailty is now universally recognized as not only a risk factor but also a predictive indicator for unfavorable clinical prognosis. METHODS: This study was a retrospective cohort study that included clinical data from patients (aged ≥ 65 years) with esophageal cancer treated surgically at the First Affiliated Hospital of Anhui Medical University in 2021. For each patient, we calculated their 11-index modified frailty index(mFI-11) scores and categorized the patients into a frailty group (mFI-11hign) and a non-frailty group (mFI-11low) based on the optimal grouping cutoff value of 0.27 from a previous study. The primary study index was the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula, chylothorax, and electrolyte disturbance complications. Secondary study indicators included postoperative ICU stay, total hospitalization time, readmission rate within 30 days of discharge, and mortality within 30 days after surgery. We performed univariate and multivariate analyses to assess the association between mFI-11 and adverse outcomes as well as postoperative complications. RESULTS: Five hundred and fifteen patients were included, including 64.9% (334/515) in the non-frailty group and 35.1% (181/515) in the frailty group. Comparing postoperative complication rates between the two groups revealed lower incidences of postoperative anastomotic fistula (21.5% vs. 4.5%), chylothorax (16.0% vs. 2.1%), cardiac arrhythmia (61.9% vs. 9.9%), pulmonary infections (85.1% vs. 26.6%), and electrolyte disturbance (84.5% vs. 15.0%) in patients of the non-frailty group was lower than that in the frailty group (p < 0.05). mFI-11 showed better prognostic results in predicting postoperative complications. anastomotic fistula (area under the ROC curve AUROC = 0.707), chylothorax (area under the ROC curve AUROC = 0.744), pulmonary infection (area under the ROC curve AUROC = 0.767), arrhythmia (area under the ROC curve AUROC = 0.793), electrolyte disturbance (area under the ROC curve AUROC = 0.832), and admission to ICU (area under the ROC curve AUROC = 0.700). CONCLUSION: Preoperative frail elderly patients with esophageal cancer have a high rate of postoperative complications. mFI-11 can be used as an objective indicator for identifying elderly patients at risk for esophageal cancer.
Asunto(s)
Neoplasias Esofágicas , Complicaciones Posoperatorias , Humanos , Neoplasias Esofágicas/cirugía , Masculino , Femenino , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , China/epidemiología , Fragilidad/epidemiología , Fragilidad/diagnóstico , Anciano de 80 o más Años , Esofagectomía/efectos adversos , Factores de Riesgo , Evaluación Geriátrica/métodos , Pronóstico , Anciano Frágil , Pueblos del Este de AsiaRESUMEN
BACKGROUND: Minimally invasive esophagectomy is associated with decreased postoperative complications compared with open esophagectomy. However, the risks of complications for minimally invasive esophagectomy compared with open esophagectomy may be affected by operative time. The objectives of this study are to (1) compare the incidence of postoperative complications for minimally invasive esophagectomy and open esophagectomy and (2) evaluate the association of postoperative complications on operative approach and operative time. METHODS: A retrospective cohort analysis of patients who underwent an esophagectomy in the American College of Surgeons National Surgical Quality Improvement Program Procedure-Targeted Data File was performed from 2016 to 2020. For analysis, minimally invasive esophagectomy and open esophagectomy were stratified into tertiles of operative time. A bivariate analysis of postoperative complications comparing minimally invasive esophagectomy with open esophagectomy was performed. Multivariable Poisson regression models were estimated evaluating the association of the likelihood of postoperative complications with operative approach and operative time. RESULTS: In total, 8,574 patients who underwent esophagectomy were included: 5,369 patients underwent minimally invasive esophagectomy, and 3,205 patients underwent open esophagectomy. Median operative time was 402 minutes for minimally invasive esophagectomy and 321 minutes for open esophagectomy. The incidence of postoperative complications and 30-day mortality was lower in the minimally invasive esophagectomy group than the open esophagectomy group within the same tertiles of operative time. When we compared patients who underwent short open esophagectomy with those who underwent long minimally invasive esophagectomy, there were no significant differences in complications. CONCLUSION: There is no significant association of postoperative complications for short open esophagectomy compared with long minimally invasive esophagectomy. Patients should be selected for minimally invasive esophagectomy when there is appropriate surgeon experience and hospital resources.
Asunto(s)
Esofagectomía , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Incidencia , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/mortalidad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
BACKGROUND This study aimed to investigate the impact of EIT-guided yoga breathing training on postoperative pulmonary complications (PPCs) for esophageal cancer patients. MATERIAL AND METHODS Total of 62 patients underwent radical resections of esophageal cancer. Esophageal cancer patients were randomized to the standard care group, or the intervention group receiving an additional complete breathing exercise under the guidance of EIT in AICU. Following extubation after the esophagectomy, pulmonary functions were evaluated by EIT with center of ventilation (CoV), dependent silent spaces (DSS), and non-dependent silent spaces (NSS). RESULTS Sixty-one older esophageal cancer patients (31 in the Control group and 30 in the EIT group) were included in the final analysis. Forty-four patients experienced pulmonary complications after esophagectomy, 27 (87.1%) in the Control group and 17 (36.7%) in the EIT group (RR, 0.42 (95% CI: 0.26, 0.69). The most common pulmonary complication was pleural effusion, with an incidence of 30% in the EIT group and 74.2% in the Control group, with RR of 0.40 (95% CI: 0.23, 0.73). Time for the first pulmonary complication was significantly longer in the EIT group than in the Control group (hazard ratio, HR, 0.43; 95% CI 0.21 to 0.87; P=0.019). Patients in the EIT group had significantly higher scores in CoV, DSS, and NSS than in the Control group. CONCLUSIONS Guided by EIT, the addition of the postoperative breathing exercise to the standardized care during AICU could further improve pulmonary function, and reduce postoperative pulmonary complications after esophagectomy.
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Ejercicios Respiratorios , Neoplasias Esofágicas , Esofagectomía , Complicaciones Posoperatorias , Yoga , Humanos , Masculino , Esofagectomía/efectos adversos , Esofagectomía/métodos , Femenino , Ejercicios Respiratorios/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Persona de Mediana Edad , Neoplasias Esofágicas/cirugía , Anciano , Pruebas de Función Respiratoria , Pulmón/fisiopatologíaRESUMEN
BACKGROUND: Surgery for oesophageal squamous cell carcinoma involves dissecting lymph nodes along the recurrent laryngeal nerve. This is technically challenging and injury to the recurrent laryngeal nerve may lead to vocal cord palsy, which increases the risk of pulmonary complications. The aim of this study was to compare the efficacy and safety of robot-assisted oesophagectomy (RAO) versus video-assisted thoracoscopic oesophagectomy (VAO) for dissection of lymph nodes along the left RLN. METHODS: Patients with oesophageal squamous cell carcinoma who were scheduled for minimally invasive McKeown oesophagectomy were allocated randomly to RAO or VAO, stratified by centre. The primary endpoint was the success rate of left recurrent laryngeal nerve lymph node dissection. Success was defined as the removal of at least one lymph node without causing nerve damage lasting longer than 6 months. Secondary endpoints were perioperative and oncological outcomes. RESULTS: From June 2018 to March 2022, 212 patients from 3 centres in Asia were randomized, and 203 were included in the analysis (RAO group 103; VAO group 100). Successful left recurrent laryngeal nerve lymph node dissection was achieved in 88.3% of the RAO group and 69% of the VAO group (P < 0.001). The rate of removal of at least one lymph node according to pathology was 94.2% for the RAO and 86% for the VAO group (P = 0.051). At 1 week after surgery, the RAO group had a lower incidence of left recurrent laryngeal nerve palsy than the VAO group (20.4 versus 34%; P = 0.029); permanent recurrent laryngeal nerve palsy rates at 6 months were 5.8 and 20% respectively (P = 0.003). More mediastinal lymph nodes were dissected in the RAO group (median 16 (i.q.r. 12-22) versus 14 (10-20); P = 0.035). Postoperative complication rates were comparable between the two groups and there were no in-hospital deaths. CONCLUSION: In patients with oesophageal squamous cell carcinoma, RAO leads to more successful left recurrent laryngeal nerve lymph node dissection than VAO, including a lower rate of short- and long-term recurrent laryngeal nerve injury. Registration number: NCT03713749 (http://www.clinicaltrials.gov).
Oesophageal cancer often requires complex surgery. Recently, minimally invasive techniques like robot- and video-assisted surgery have emerged to improve outcomes. This study compared robot- and video-assisted surgery for oesophageal cancer, focusing on removing lymph nodes near a critical nerve. Patients with a specific oesophageal cancer type were assigned randomly to robot- or video-assisted surgery at three Asian hospitals. Robot-assisted surgery had a higher success rate in removing lymph nodes near the important nerve without permanent damage. It also had shorter operating times, more lymph nodes removed, and faster drain removal after surgery. In summary, for oesophageal cancer surgery, the robotic approach may provide better lymph node removal and less nerve injury than video-assisted techniques.
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Neoplasias Esofágicas , Esofagectomía , Escisión del Ganglio Linfático , Procedimientos Quirúrgicos Robotizados , Cirugía Torácica Asistida por Video , Humanos , Esofagectomía/métodos , Esofagectomía/efectos adversos , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Femenino , Persona de Mediana Edad , Cirugía Torácica Asistida por Video/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Neoplasias Esofágicas/cirugía , Escisión del Ganglio Linfático/métodos , Escisión del Ganglio Linfático/efectos adversos , Anciano , Carcinoma de Células Escamosas de Esófago/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Nervio Laríngeo Recurrente/cirugía , Traumatismos del Nervio Laríngeo Recurrente/etiología , AdultoRESUMEN
BACKGROUND: Enteral nutrition is the preferred mode of nutrition following esophagectomy. However, the preferred mode of enteral nutrition (feeding jejunostomy (FJ) vs. nasojejunal (NJ) tube) remains contentious. In this randomized controlled trial (RCT), we compared FJ with NJ tube feeding in terms of safety, feasibility, efficacy, and quality-of-life (QOL) parameters in Indian patients undergoing trans-hiatal esophagectomy (THE) for carcinoma esophagus. MATERIALS AND METHODS: This single-center, two-armed (FJ and NJ tube), non-inferiority RCT was conducted from March 2020 to January 2024. Forty-eight patients underwent THE with posterior-mediastinal-gastric pull-up and were randomized to NJ and FJ arms (24 in each group). The postoperative complications, catheter efficacy, and QOL parameters were compared between the two groups till the 6-week follow-up. RESULTS: In this RCT, we found no significant difference in the occurrence of catheter-related complications, postoperative complication rate, catheter efficacy, and visual analog pain scores between patients with NJ tube and FJ, following THE for esophageal cancer. There was a significantly better self-reported physical domain QOL score noted in the NJ group, both at the time of discharge (44.7 ± 6.2 vs 39.8 + 5.6; p value, 0.005) and at the 6-week follow-up (55.4 ± 5.2 vs 48.6 ± 4.5; p value, < 0.001). CONCLUSION: Based on the findings of our RCT, we conclude that both enteral access methods (NJ vs. FJ) exhibit comparable incidences of catheter-related complications. The use of NJ tube is a viable alternative to a surgical FJ, has the benefit of early removal, and saves the distress associated with a tube per abdomen.
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Nutrición Enteral , Neoplasias Esofágicas , Esofagectomía , Intubación Gastrointestinal , Yeyunostomía , Calidad de Vida , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Nutrición Enteral/métodos , Masculino , Yeyunostomía/métodos , Yeyunostomía/efectos adversos , Femenino , Persona de Mediana Edad , Intubación Gastrointestinal/métodos , Intubación Gastrointestinal/efectos adversos , Terapia Neoadyuvante/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , AncianoRESUMEN
BACKGROUND: Minimally invasive transcervical oesophagectomy is a surgical technique that offers radical oesophagectomy without the need for transthoracic access. The aim of this study was to evaluate the safety and feasibility of the minimally invasive transcervical oesophagectomy procedure and to report the refinement of this technique in a Western cohort. METHODS: A single-centre prospective cohort study was designed as an IDEAL stage 2A study. Patients with oesophageal cancer (cT1b-4a N0-3 M0) who were scheduled for oesophagectomy with curative intent were eligible for inclusion in the study. The main outcome parameter was the postoperative pulmonary complication rate and the secondary outcomes were the anastomotic leakage, recurrent laryngeal nerve palsy, and R0 resection rates, as well as the lymph node yield. RESULTS: In total, 75 patients underwent minimally invasive transcervical oesophagectomy between January 2021 and November 2023. Several modifications to the surgical technique were registered, evaluated, and implemented in the context of IDEAL stage 2A. A total of 12 patients (16%) had postoperative pulmonary complications, including pneumonia (4 patients) and pleural effusion with drainage or aspiration (8 patients). Recurrent laryngeal nerve palsy was observed in 33 of 75 patients (44%), with recovery in 30 of 33 patients (91%). A total of 5 of 75 patients (7%) had anastomotic leakage. The median number of resected lymph nodes was 29 (interquartile range 22-37) and the R0 resection rate was 96% (72 patients). CONCLUSION: Introducing minimally invasive transcervical oesophagectomy for oesophageal cancer in a Dutch institution is associated with a low rate of postoperative pulmonary complications and a high rate of temporary recurrent laryngeal nerve palsy.
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Neoplasias Esofágicas , Esofagectomía , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias , Humanos , Esofagectomía/métodos , Esofagectomía/efectos adversos , Neoplasias Esofágicas/cirugía , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios de Factibilidad , Estadificación de NeoplasiasRESUMEN
BACKGROUND: The aim of this study was to assess the risk factors for anastomotic stricture in esophageal cancer patients undergoing esophagectomy. Esophageal anastomotic stricture is the most common long-term complication for esophagectomy. The risk factors for esophageal anastomotic stricture still remain controversial. METHODS: MEDLINE, Cochrane Library, and EMBASE were searched to identify observational studies reporting the risk factors for esophageal anastomotic stricture after esophagectomy. A meta-analysis was conducted to investigate the impact of various risk factors on esophageal anastomotic stricture. The GRADE [Grading of Recommendations Assessment, Development and Evaluation] approach was used for quality assessment of evidence on outcome levels. RESULTS: This review included 14 studies evaluating 5987 patients.The meta-analysis found that anastomotic leakage (odds ratio [OR]: 2.75; 95% confidence interval[CI]:2.16-3.49), cardiovascular disease [OR:1.62; 95% CI: 1.22-2.16],diabete [OR: 1.62; 95% CI: 1.20-2.19] may be risk factors for esophageal anastomotic stricture.There were no association between neoadjuvant therapy [OR: 0.78; 95% CI:0.62-0.97], wide gastric conduit [OR:0.98; 95% CI: 0.37-2.56],mechanical anastomosis [OR: 0.84; 95% CI:0.47-1.48],colonic interposition[OR:0.20; 95% CI: 0.12-0.35],and transhiatal approach[OR:1.16; 95% CI:0.81-1.64],with the risk of esophageal anastomotic stricture. CONCLUSIONS: This meta-analysis provides some evidence that anastomotic leakage,cardiovascular disease and diabete may be associated with higher rates of esophageal anastomotic stricture.Knowledge about those risk factors may influence treatment and procedure-related decisions,and possibly reduce the anastomotic stricture rate.
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Anastomosis Quirúrgica , Neoplasias Esofágicas , Estenosis Esofágica , Esofagectomía , Humanos , Esofagectomía/efectos adversos , Factores de Riesgo , Estenosis Esofágica/etiología , Estenosis Esofágica/epidemiología , Anastomosis Quirúrgica/efectos adversos , Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Oportunidad RelativaRESUMEN
This state-of-the-art review explores the intricacies of anastomotic leaks following oesophagectomy and gastrectomy, crucial surgeries for globally increasing esophageal and gastric cancers. Despite advancements, anastomotic leaks occur in up to 30 % and 10 % of oesophagectomy and gastrectomy cases, respectively, leading to prolonged hospital stays, substantial impact upon short- and long-term health-related quality of life and greater mortality. Recognising factors contributing to leaks, including patient characteristics and surgical techniques, are vital for preoperative risk stratification. Diagnosis is challenging, involving clinical signs, biochemical markers, and various imaging modalities. Management strategies range from non-invasive approaches, including antibiotic therapy and nutritional support, to endoscopic interventions such as stent placement and emerging vacuum-assisted closure devices, and surgical interventions, necessitating timely recognition and tailored interventions. A step-up approach, beginning non-invasively and progressing based on treatment success, is more commonly advocated. This comprehensive review highlights the absence of standardised treatment algorithms, emphasizing the importance of individualised patient-specific management.
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Fuga Anastomótica , Esofagectomía , Gastrectomía , Humanos , Fuga Anastomótica/terapia , Fuga Anastomótica/etiología , Esofagectomía/efectos adversos , Gastrectomía/efectos adversos , Factores de Riesgo , Neoplasias Gástricas/cirugía , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/terapia , Tracto Gastrointestinal Superior/diagnóstico por imagen , StentsRESUMEN
BACKGROUND: Meta-analyses have primarily focused on the effects of exercise-based prehabilitation on postoperative outcomes and ignored the role of nutritional intervention. In this study, we filled this gap by investigating the effect of nutrition-based prehabilitation on the postoperative outcomes of patients who underwent esophagectomy and gastrectomy. METHODS: Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint. RESULTS: Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09). CONCLUSIONS: Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.