Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the...Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.展开更多
Objective：To evaluate the role of colonic interposition for reconstruction of the esophagus. Meth-ods: From April 1979 to October 1998, Thirty-one patients with benign esophageal stenosis and 15 patients with esophag...Objective：To evaluate the role of colonic interposition for reconstruction of the esophagus. Meth-ods: From April 1979 to October 1998, Thirty-one patients with benign esophageal stenosis and 15 patients with esophagus carcinoma received the colonic interposition for esophageal reconstruction. There were 5 pa-tients with the esophagus carcinoma after subtotal gastrectomy. Four of 5 cases received colonic interposition graft from the esophageal bed after the esophagus was pulled out without thoracotomy. Results: There was no perioperative death. All 31 cases of the benign esophageal stenosis got long term survival and normal life. The 3- and 5-year survival rates of patients with the carcinoma of the esophagus were 63. 6% and 40. 6% re-spectively. Conclusion: The colonic interposition graft is a choice for the patients with the cervical stenosis of the esophagus, especially for those already had subtotal gastrectomy. Using the left colonic artery as the sup-porting vessel and using the colon segment in an isoperistaltic position is the optimal choice. Improving the operative techniques and decreasing the complications are important for the extension use of this method.展开更多
文摘Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer(T2 or greater or node positive); however, a high rate of disease recurrence(systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment(preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy(radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.
文摘Objective：To evaluate the role of colonic interposition for reconstruction of the esophagus. Meth-ods: From April 1979 to October 1998, Thirty-one patients with benign esophageal stenosis and 15 patients with esophagus carcinoma received the colonic interposition for esophageal reconstruction. There were 5 pa-tients with the esophagus carcinoma after subtotal gastrectomy. Four of 5 cases received colonic interposition graft from the esophageal bed after the esophagus was pulled out without thoracotomy. Results: There was no perioperative death. All 31 cases of the benign esophageal stenosis got long term survival and normal life. The 3- and 5-year survival rates of patients with the carcinoma of the esophagus were 63. 6% and 40. 6% re-spectively. Conclusion: The colonic interposition graft is a choice for the patients with the cervical stenosis of the esophagus, especially for those already had subtotal gastrectomy. Using the left colonic artery as the sup-porting vessel and using the colon segment in an isoperistaltic position is the optimal choice. Improving the operative techniques and decreasing the complications are important for the extension use of this method.
