Postoperative Intensive Care Treatment after Esophageal Resection

The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhyth- mia, anastomotic leakage and mental disorders are the topics covered. Systemic in?ammatory reaction and sepsis is the linking topic between these speci?c complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers五笔字型计算机汉字输入技术leakage must be suspect in any septic episode. and amiodarone. Anastomotic Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly suc- cessful in the therapy of these leakages. Microbiological surveillance and speci?c antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.

Nomograms and prognosis for superficial esophageal squamous cell carcinoma

In recent years,endoscopic resection,particularly endoscopic submucosal dis-section,has become increasingly popular in treating non-metastatic superficial esophageal squamous cell carcinoma(ESCC).In this evolving paradigm,it is crucial to identify factors that predict higher rates of lymphatic invasion and poorer outcomes.Larger tumor size,deeper invasion,poorer differentiation,more infiltrative growth patterns(INF-c),higher-grade tumor budding,positive lymphovascular invasion,and certain biomarkers have been associated with lymph node metastasis and increased morbidity through retrospective reviews,leading to the construction of comprehensive nomograms for outcome prediction.If validated by future prospective studies,these nomograms would prove highly applicable in guiding the selection of treatment for superficial ESCC.

Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer:A metaanalysis

BACKGROUND The effectiveness of neoadjuvant therapy in esophageal cancer(EC)treatment is still a subject of debate.AIM To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy(nCRT)and neoadjuvant chemotherapy(nCT)for locally advanced EC(LAEC).METHODS A comprehensive search was conducted using multiple databases,including PubMed,EMBASE,MEDLINE,Science Direct,The Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Science and Technology Journal Database,and Chinese Biomedical Literature Database Article.Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected.RESULTS The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival.The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate(OSR)[odds ratio(OR)=0.95],complete response rate(OR=3.15),and R0 clearance rate(CR)(OR=2.25).However,nCT demonstrated a better 5-year OSR(OR=1.02)than nCRT.Moreover,when compared to nCRT,nCT showed reduced risks of cardiac complications(OR=1.15)and pulmonary complications(OR=1.30).CONCLUSION Overall,both nCRT and nCT were effective in terms of survival outcomes for LAEC.However,nCT exhibited better performance in terms of postoperative complications.

Benign esophageal stricture after thermal injury treated with esophagectomy and ileocolon interposition

Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pinhole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and qualityof-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients.

Multidisciplinary approach for patients with esophageal cancer

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage Ⅲ or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.

Esophageal Cancer Patients with Less Lymph Node Dissection May Have Better Prognosis

Background: China is a high incidence area of esophageal cancer. Esophageal squamous cell carcinoma recurrence and mortality rates are relatively high. Recent studies show that the recurrence rate remains very high even through the implementation of lymph node expanding dissection. Methods and Results: In order to study the relationship between lymph node dissection number and survival of the patients with esophageal squamous cell carcinoma, 407 cases of esophageal cancer are selected in the First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to June 2013. There were 15 cases without surgery, while the rest of the 392 patients were post-operation in follow-up. 54 patients were lost in follow-up, and the rate was 13.8%. Finally, there were 338 patients entered into our research. The median age was 58 (37 - 81), males accounted for 79%. The number of lymph node dissection is for a total of 2091, and a median of 5. Positive lymph nodes are 400, while the total positive rate is 19.1%. Conclusion: The number of lymph node dissection is divided into 3 groups that are 0 to 6, 7 to 11, 12 or more into three grades, and reduced number of lymph node dissection may prolong the survival (P < 0.05). The number of lymph node dissection should be as less as possible unless there is definitely positive lymph node metastasis.

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the GDFT group was lower than the control group (P < 0.05);theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1 (before one-lung ventilation), and the GDFT group was higher than the control group (P < 0.05). At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P < 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P < 0.05);the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P < 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body’s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.

Clinical evidence of neoadjuvant immunotherapy for resectable locally advanced esophageal carcinoma:A systematic review

Background:Immune checkpoint inhibitors(ICIs)as the neoadjuvant therapy for resectable locally advanced esophageal carcinoma(rlaEC)remains challenging given the poor reports of efficacy and safety.This study aimed to summarize reliable evidence for the preoperative neoadjuvant immunotherapy of rlaEc by analyzing all the published clinical trials on the ICIs as the neoadjuvant therapy for rlaEC.Methods:PubMed,Cochrane Library,Embase and ClinicalTrials.gov were searched from inception until June 1st,2023,for available reports to perform a meta-analysis.The primary endpoints were RO resection,objective response rate(ORR),pathological complete response(pCR)and major pathological response(MPR),as well as treatment-related adverse events(AEs)and postoperative complications.The Stata 14.0 software was employed to estimate pooled effect size.Results:A total of 18 single-arm clinical trials involving 625 patients met the inclusion criteria.Meta-analysis showed that,among these patients with rlaEC,the pooled R0 resection rate was 97.0%(95%CI:94.0%-99.0%),the p0oled ORR was 70.0%(95%CI:64.0%-76.0%),the p0oled pCR and MPR rate were 34.0%(95%CI:29.0%-39.0%)and 56.0%(95%CI:47.0%-65.0%)respectively.The incidence of main treatment-related AEs and postoperative complications was about 6%-45% and 8%-19% respectively.Conclusions:Patients with rlaEC were tolerated to neoadjuvant immunotherapy and it might be beneficial to improve efficacy.But this meta-analysis had limitations and the conclusions still needed to be validated by more rigorous phase II randomized controlled clinical trials.

Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report

BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.

RECONSTRUCTION OF ESOPHAGUS WITH WHOLE STOMACH THROUGH ESOPHAGEAL BED AFTER RESECTION OF THE UPPER ESOPHAGEAL CARCINOMA A REPORT OF 160 CASES

From September 1985 to December 1992, 160 cases of reconstruction of the esophagus with the whole stomach through the esophageal bed after resection of the upper esophageal carcinoma were performed with neither operative mortality nor intrathoracic complications. The leakage rate of the cervical anastomosis with Gambee's single layer method was 1.2%. The main steps of the operative procedure consisted of : (1) making a right thoracotomy for dissecting and removing the entire thoracic esophagus; (2) laparotomy for mobilizing the whole stomach, constricting it to tube shape and doing a pyloroplasty; and (3) pulling up the mobilized tube-like stomach through the posterior mediastinal space(i.e. the esophageal bed) out of the left neck incision and then the esophagogastrostomy with Gambee's single layer anastomosis was performed.