Comparative efficacy and safety between endoscopic submucosal dissection,surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer

BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.

Atrial fibrillation after surgery for esophageal carcinoma:Clinical and prognostic significance

瞄准：回顾地评估临床的关联，起作用的仙子冒因素，不同药理学预防的结果，和短期的预示的价值的风险在在为食道的癌的外科以后的伊朗的银币纤维性颤动(AF ) 。方法：在为与没有在食管切除术以后的 AF 的 126 个病人比较的食道的癌的外科在一样期间预定以后，我们回顾地与 AF 学习了 63 个病人。手术后的 AF 发生与可能涉及它的出现和短期的幸存的不同临床的因素有关。结果：一种强壮的关系被观察在之间心脏病的 AF 和手术后的组织缺氧，长期的妨碍的肺的疾病(COPD ) 的历史，手术后的胸的, 胸廓胃的膨胀，比 65 年旧的年龄，男性别和历史。没有差别关于医院停留的短期的死亡和长度在二个组之间被观察。结论：AF 在年老、男的病人更经常发生在食管切除术以后。贡献手术后的 AF 的另外的因素是 COPD 和心脏病的历史，手术后的组织缺氧和胸的, 胸廓胃的膨胀。

Increased N-terminal pro-brain natriuretic peptide level predicts atrial fibrillation after surgery for esophageal carcinoma

AIM: To evaluate the value of plasma N-terminal pro- brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. METHODS: NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge. RESULTS: Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 ± 12.2 years vs 63.4 ± 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 ± 18.3 pg/mL vs 396.1 ± 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008).CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.

Effect of enteral immunonutrition after radical surgery for esophageal carcinoma on anti-tumor immune response and intestinal mucosal barrier function

Objective:To study the effect of enteral immunonutrition after radical surgery for esophageal carcinoma on anti-tumor immune response and intestinal mucosal barrier function.Methods:A total of102 patients who received radical surgery for esophageal carcinoma in our hospital between May 2013 and December 2016 were selected and randomly divided into observation group and control group who received postoperative enteral immunonutrition and routine enteral nutrition respectively. 1 d before operation as well as 1 d and 7 d after operation, peripheral blood immune cell marker expression and serum intestinal mucosal barrier injury marker levels were detected.Results:1 d after operation, peripheral blood T-bet, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of both groups of patients were significantly lower than those 1d before operation while peripheral blood GATA-3 and Foxp3 fluorescence intensity as well as serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly higher than those 1d before operation;peripheral blood T-bet, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of observation group 7 d after operation were significantly higher than those 1 d after operation while peripheral blood GATA-3 and Foxp3 fluorescence intensity as well as serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly lower than those 1 d after operation;peripheral blood T-bet, GATA-3, Foxp3, NKG2D, NKp30, NKp44 and NKp46 fluorescence intensity of control group 7 d after operation were not significant different from those 1 d after operation, and serum DAO, Occludin, ZO-1 and claudin-1 levels were significantly lower than those 1d after operation.Conclusion: Enteral immunonutrition after radical surgery for esophageal carcinoma can enhance the anti-tumor immune response and improve the intestinal mucosal barrier function.

Evaluation of the 7^(th) edition of the TNM classification in patients with resected esophageal squamous cell carcinoma

AIM:To evaluate the prognostic factors and tumor stages of the 7th edition TNM classification for esophageal cancer.METHODS:In total,1033 patients with esophageal squamous cell carcinoma(ESCC)who underwent surgical resection with or without(neo)adjuvant therapy between January 2003 and June 2012 at the Thoracic Surgery DepartmentⅡof the Beijing Cancer Hospital,Beijing,China were included in this study.The following eligibility criteria were applied:(1)squamous cell carcinoma of the esophagus or gastroesophageal junction identified by histopathological examination;(2)treatment with esophagectomy plus lymphadenectomy with curative intent;and(3)complete pathologic reports and follow-up data.Patients who underwent non-curative(R1)resection and patients who died in hospital were excluded.Patients who received(neo)adjuvant therapy were also included in thisanalysis.All patients were restaged using the 7th edition of the Union for International Cancer Control and the American Joint Committee on Cancer TNM staging systems.Univariate and multivariate analyses were performed to identify the prognostic factors for survival.Survival curves were plotted using the Kaplan-Meier method,and the log-rank test was used to evaluate differences between the subgroups.RESULTS:Of the 1033 patients,273 patients received(neo)adjuvant therapy,and 760 patients were treated with surgery alone.The median follow-up time was 51.6mo(range:5-112 mo)and the overall 5-year survival rate was 36.4%.Gender,"p T"and"p N"descriptors,(neo)adjuvant therapy,and the 7th edition TNM stage grouping were independent prognostic factors in the univariate and multivariate analyses.However,neither histologic grade nor cancer location were independent prognostic factors in the univariate and multivariate analyses.The 5-year stage-based survival rates were as follows:ⅠA,84.9%;ⅠB,70.9%;ⅡA,56.2%;ⅡB,43.3%;ⅢA,37.9%;ⅢB,23.3%;ⅢC,12.9%andⅣ,3.4%.There were significant differences between each adjacent staging classification.Moreover,there were significant differences between each adjacent p N and p M subgroup.According to the p T descriptor,there were significant differences between each adjacent subgroup except between p T3 and p T4(P=0.405).However,there was no significant difference between each adjacent histologic grade subgroup and between each adjacent cancer location subgroup.CONCLUSION:The 7th edition is considered to be valid for patients with resected ESCC.However,the histologic grade and cancer location were not prognostic factors for ESCC.

Successful treatment of esophageal metastasis from hepatocellular carcinoma using the da Vinci robotic surgical system

A 59-year-old man with metastatic an esophageal tumor from hepatocellular carcinoma(HCC) presented with progressive dysphagia.He had undergone liver transplantation for HCC three and a half years prevously.At presentation,his radiological and endoscopic examinations suggested a submucosal tumor in the lower esophagus,causing a luminal stricture.We performed complete resection of the esophageal metastases and esophagogastrostomy reconstruction using the da Vinci robotic system.Recovery was uneventful and he was been doing well 2 mo after surgery.α-fetoprotein level decreased from 510 ng/mL to 30 ng/mL postoperatively.During the follow-up period,he developed a recurrent esophageal stricture at the anastomosis site and this was successfully treated by endoscopic esophageal dilatation.

SURGICAL TREATMENT OF PRIMARY ESOPHAGEAL SMALLCELL CARCINOMA

Objective: To study the clinical biocharacteristics of primary esophageal small-cell carcinoma (PESC) and factors influencing prognosis and to find rational indications for combination therapy. Methods: To analyze the clinical materials of 47 patients who had undergone an operation with PESC and to compare it with those patients with esophageal squamous-cell carcinoma (ESCC) or primary esophageal adenocarcinoma (PEAC). Results: The overall resectability, morbidity and 30-day mortality rates of PESC were 93.6%, 17.0% and 2.1% respectively, similar to those of ESCC or PEAC. TNM staging and lymph node metastasis were the major determinants influencing long-term survival. Tumor length, depth of tumor invasion and type of operation had little influence on long-term prognosis. The 5-year survival rate of PESC was 7.5%, which was much lower than that of ESCC and PEAC (P<0.01). Among the 42 deceased patents, one died of anastomotic leakage and the others died of remote metastasis and recurrence. Adjuvant chemotherapy did not help improve the patients’ long-term survival. Conclusions: Compared with ESCC and PEAC, PESC is the most malignant type with early lymphatic and hematogenous metastases and poor prognosis. Lymph node metastasis is the major factor influencing the prognosis. Patients in stage 0, I and II a of PESC are indicated for surgical resection, while those in stage II b, III or IV should be managed with non-surgical combined therapy.

SURGICAL TREATMENT OF PRIMARY ESOPHAGEALADENOCARCINOMA

Objective: To study the biocharacteristics of primary esophageal adenocarcinoma (PEAC) and factors influencing patients’ prognosis and to find rational surgical indications and combined therapy. Methods: To analyze the clinical material of 106 patients with PEAC and compared with that of patients with esophageal squamous-cell carcinoma (ESCC). Results: The overall resectability, morbidity and 30-day mortality rates of PEAC were 92.5%, 23.5% and 2.8% respectively, similar to those of ESCC. The TNM staging, lymph node metastasis, extraesophageal invasion and the nature of operation were major determinants influencing long-term prognosis. The 5-year survival rate of PEAC was 21.0%, which was lower than that of ESCC (P<0.01). Metastasis or recurrence remained to be the cause of death in 82.4% of patients who lived longer than 5 years, which was higher than that of ESCC (P<0.01). Adjuvant radiation did not influence survival of the patients with lymph node metastasis, but appeared helpful to the patients with no lymph node metastasis. Conclusion: compared with ESCC, PEAC is a malignant disease with poor prognosis. Surgical resection is the first and chief choice of treatment. Surgical indications include patients in stage 0, I, II and some in stage III and even in stage IV of PEAC. Early detection, early diagnosis and early treatment as well as radical operation could improve prognosis. Adjuvant radiotherapy appears helpful only to the patients without lymph node metastasis.

Pre- and Post-Surgical Health-Related Quality of Life Evaluation of Esophageal Carcinoma Patients

For patients with esophageal carcinoma (ESCA), health-related quality of life (HRQoL) has now become an essential feature. To examine the quality of life of preoperative and postoperative ESCA patients, we used the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ C-30) and the Quality of Life Questionnaire Oesophageal 18 (QLQ-OES18). Using the EORTC QLQ-C30 and the QLQ-OES18 questionnaire, the analysis of the quality of life scores of 246 patients with oesophageal cancer who were operated on at the Sun Yat-sen University Cancer Centre during the period 2013 to 2015 was carried out. Differences between pre- and post-surgical EORTC QLQ C-30 and QLQ-OES18 scores were examined using the Student’s t-test. Patients’ global health status (QoL) decreased significantly one month after the operation but gradually recovered within a year. In terms of the role function, the emotional function, the cognitive function, and the perception and function variants, EORTC QLQ-C30 and QLQ-OES18 scores increased statistically significantly, as did clinical signs variables such as exhaustion, nausea, vomiting, pain, sleeplessness, decreased appetite, stomach pain, and economic hardship. After surgery, there was an improvement in functional and symptom domains in esophageal carcinoma patients. EORTC QLQ-C30 and QLQ-OES18 can be used to assess the HRQoL before and after surgical procedures.

Pattern of Lymphatic Metastasis and Influencing Factors in Thoracic Esophageal Carcinoma

OBJECTIVE To explore the regular patterns of lymphaticmetastasis in thoracic esophageal carcinoma (TEC) and the factorsinfluencing these patterns.METHODS Data of 229 TEC patients who underwent radicalesophagectomy and thoracoabdominal 2-field lymphadenectomywere reviewed.Within this patient population,a total of 2458lymph nodes were dissected during surgery.The distributionof the nodular metastasis rates (NMR) in various diseasedregions in the esophageal carcinoma (EC) patients as wellas factors influencing metastases such as the depth of tumorinfiltration,tumor size,tumor morphology,and degree of tumordifferentiation were analyzed.RESULTS i) Lymphatic metastasis (LM) occurred in 102 ECcases,and the lymphatic metastasis rate (LMR) was 44.5%(102/229).The NMR was 9.5% (258/2458).ii) The NMRs were19.0%,6.7%,9.8% and 12.2% in the superior,middle and inferiormediastinum,and abdominal cavity,respectively,in patientswith EC in the superior thoracic segment;26.1%,7.4%,11.8% and11.9% in the same sites of the mediastinum,respectively,in thosewith middle thoracic-segment EC;and 0%,1.6%,5.3%,and 10.0%,respectively,in the same sites in those with inferior thoracic EC.iii) The LMRs of the EC patients in stage-T1,T2,T3 and T4 were28.6%,43.8%,47.6% and 31.3%,respectively,and the NMRs of thepatients were 7.9%,10.8%,10.7% and 10.8%,respectively.Therewere no significant differences between the LMR and the NMR ofthe EC patients in stage T1 to T4 (X^2=2.733,P=0.435 and X^2=0.686,P=0.876).iv) The LMR of the patients with the length of tumor≤3 cm,>3 cm and≤5 cm,and>5 crn were 45.2%,43.4% and 46.2%,respectively,and the NMR according to the same range of thetumor size above were 9.1%,11.6% and 11.7%,respectively.Therewere no significant differences between the groups (X^2=0.094,P=0.954 and X^2=3.933,P=0.140).v) The NMRs of the medullary,ulcerative,fungoid and sclerotic-type EC were 14.0%,9.6%,4.3%and 18.3%,respectively (X^2=19.292,P=0.000),among which theNMR of the fungoid-type EC was the lowest.The LMRs were42.5% and 75.0%,respectively in the cases with squamous cellcarcinoma (SqCC) and poorly differentiated SqCC (X^2=4.852,P=0.028),and the NMRs were 9.5% and 18.6% correspondingly inthe 2 groups (X^2=11.323,P=0.001).LM was commonly seen in thecases with poorly differentiated tumors.CONCLUSION Lymph node metastases of TEC spreads widelyand can involve many regions.Metastasis can even be found inearly stages of EC.Morphologic type and the degree of tumordifferentiation are the main factors affecting the LM.

Endoscopic and surgical resection of T1a/T1b esophageal neoplasms: A systematic review

AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P < 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P<0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). CONCLUSION: Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma insitu component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstaysof current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.

达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术的1例手术护理配合体会

本文总结了1例达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术的手术护理配合体会,包括护理人员应提前做好术前访视和规划,参与多学科会诊,术中加强手术患者转换体位、手术体位用物管理,重视手术体位压力性损伤的预防,做好机器人手臂器械和急救器械的管理等,从而促进达芬奇机器人辅助下食管癌三切口根治术联合右肾盂癌根治术顺利完成。

局部晚期食管鳞状细胞癌患者新辅助免疫治疗联合化疗后行根治性手术的术后病理学缓解程度及影响因素分析

背景与目的:局部晚期食管鳞状细胞癌(locally advanced esophageal squamous cell carcinoma,LAESCC)患者新辅助免疫治疗联合化疗(neoadjuvant immunotherapy combined with chemotherapy,nICT)后行根治性手术治疗具有较好的有效性和安全性,能够提高患者的病理学完全缓解(pathological complete remission,pCR)率、主要病理学缓解(main pathologic response,MPR)率及R0切除率。新辅助治疗后达到pCR/MPR的患者预后明显优于未达到pCR/MPR的患者,因此寻找pCR/MPR的预测因素有助于筛选联合治疗的优势人群。本研究旨在探讨nICT前后的临床资料对LAESCC患者nICT后行根治性手术的不同病理学缓解程度的预测价值并观察其安全性。方法:收集2019年1月—2023年6月于川北医学院附属医院在nICT后行根治性手术的LAESCC患者。收集所有患者的临床资料以及新辅助治疗前后患者的部分血液、炎症和营养学指标,根据新辅助治疗后的不同病理学缓解程度进行分组,通过多组比较方差分析及LSD-t事后检验探索对不同病理学缓解程度具有影响的因素,收集并记录患者新辅助治疗期间的不良反应及最终的手术情况。本研究已获得川北医学院附属医院医学伦理委员会批准(伦理审查编号:2024009)。结果:共收集到62例nICT后行根治性手术的LAESCC患者,新辅助治疗期间只有1例患者出现了4级的骨髓抑制表现,其余患者的不良反应均≤2级;手术的R0切除率为98.39%。本研究与川北医学院附属医院既往LAESCC新辅助化疗后行根治性手术治疗的研究相比,在手术时间、术中出血量、术后住院时间及手术并发症等方面未见明显差异。术后的病理学检查结果显示,pCR率为22.58%(14/62),MPR率为40.32%(25/62)。根据术后不同的肿瘤退缩分级(tumor regression grade,TRG),分为TRG1、TRG2和TRG3~4组,3组患者在新辅助治疗前的血小板分布宽度(platelet distribution width,PDW)及新辅助治疗后术前的中性粒细胞-淋巴细胞比值(neutrophil-tolymphocyte ratio,NLR)差异有统计学意义(P<0.05)。进一步对3组患者在新辅助治疗前的PDW及新辅助治疗后术前的NLR分别进行组内两两比较,发现TRG2组的PDW及NLR均低于TRG3~4组,差异有统计学意义(P<0.05)。结论:LAESCC患者nICT后行根治性手术可以获得较高的R0切除率、pCR率及MPR率且安全性可靠,新辅助治疗前患者的PDW越低、新辅助治疗后术前患者的NLR越低预示着越好的病理学缓解效果。

路径式呼吸功能训练在食管癌根治术后加速康复外科中的应用效果

目的分析路径式呼吸功能训练在食管癌根治术后加速康复外科(ERAS)中的应用效果。方法选取2020年1月至2022年12月河南省胸科医院80例接受食管癌根治的患者,依照随机法划分成研究组(40例)和常规组(40例),常规组接受ERAS引导下的常规干预,研究组在此基础上联合路径式呼吸功能训练。对比两组术后恢复状况、肺功能[最大通气量(MVV)、第一秒用力呼气容积(FEV_(1))]、血气指标[动脉二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、疼痛程度[视觉模拟评分(VAS)]、并发症发生率。结果与常规组相比,研究组住院时间、术后输液时间、胸管留置时间较短(P<0.05);与常规组相比,干预后研究组MVV、FEV_(1)水平较高(P<0.05);与常规组相比,干预后研究组PaCO_(2)、PaO_(2)水平较高(P<0.05);与常规组相比,术后24、48、72 h研究组VAS评分较低(P<0.05);研究组并发症发生率较常规组低(P<0.05)。结论路径式呼吸功能训练应用于食管癌根治术后ERAS中能缩短术后恢复时间,改善肺功能和血气指标,并能缓解疼痛、降低并发症发生率。

Fast track clinical pathway implications in esophagogastrectomy

AIM:To investigate the feasibility of fast track clinical pathway for esophageal tumor resections. METHODS:One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied.Fast track clinical pathway included analgesia control,fluid infusion volume control,early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine,and full liquid diet 5 d after operation. RESULTS:Among 114 patients(84 men and 30 women),26 patients underwent fast track surgery,including 17 patients over 65 years old and 9 under 65(P=0.014);18 patients who had preoperative complications could not bear fast track surgery(P< 0.001).No significant differences in tolerance of fast track surgery were attributed to differences in gender,differentiated degree or stage of tumor,pathological type of tumor,or operative incision.The median length of hospital stay was 7 d(5-28 d),4%patients were readmitted to hospital within 30 d of discharge.Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION:The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results.Median length of hospital stay has been reduced to 7 d.

不同挽救治疗方式对根治性放疗后局部复发食管鳞癌患者的生存影响

目的比较食管鳞癌根治性放疗后局部复发患者接受不同挽救治疗方式的生存结果。方法收集2012年6月—2016年10月在我院住院治疗并符合入组条件的局部复发食管鳞癌患者共124例,根据患者接受挽救治疗方式的不同,将患者分入挽救性手术组63例和挽救性放疗组61例,分析患者接受不同挽救性治疗后的局部控制率、长期生存率和不良反应。结果挽救性手术组与挽救性放疗组患者1、3、5年生存率分别是57.1%,23.8%,9.5%和52.5%,14.8%,4.9%,差异无统计学意义(P>0.05),1、3、5年局部控制率分别是46.0%、15.9%、4.8%和23.0%、8.2%、1.6%,接受挽救性手术的患者有更好的局部控制率(P<0.05)。COX回归分析显示复发间隔时间(RFS≦24月,RFS>24月)是独立的预后因素。两组患者常见的不良反应均是消化道反应和血液学毒性,多为1~2级,挽救性放疗组的治疗相关严重毒性发生率比挽救性手术组低。结论挽救放疗可为根治性放疗后局部复发食管鳞癌患者带来与挽救性手术相似的长期生存,治疗相关严重毒性发生率比挽救性手术低。

根治手术治疗pT_(2-3)N_(0-1)M_(0)期胸段食管鳞癌的临床预后分析

目的探讨pT_(2-3)N_(0-1)M_(0)期胸段食管鳞癌患者根治术后的预后生存状况及影响因素。方法选取2017年1月—2019年11月于新疆医科大学第一附属医院行根治手术治疗的138例pT2-3N0-1M0期胸段食管鳞癌患者,回顾性整理分析所有患者临床及随访资料。患者在手术治疗后1年内需3~6个月复查1次,之后6~12个月复查1次,3年后复查改为每年1次。全组患者术后随访至2022年12月。统计患者治疗后局部复发、淋巴结转移、生存等预后情况,使用Logistic回归分析影响pT2-3N0-1M0期胸段食管鳞癌患者预后的因素。结果138例患者中129例患者完成随访,随访率为93.48%;术后3年内预后不良患者78例,预后良好患者51例,预后不良率为60.47%。不同预后患者的年龄、性别构成、肿瘤位置、术后是否辅助化疗及组织学分化程度比较,差异均无统计学意义(P>0.05);预后不良组pT_(3)期、p N_(1)期、合并脉管瘤栓、肿瘤直径>3 cm患者所占比例高于预后良好组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,pT_(3)期、p N_(1)期、合并脉管瘤栓以及肿瘤直径>3 cm是影响食管鳞癌患者预后不良的危险因素(P<0.05)。结论pT2-3N0-1M0期食管鳞癌患者预后情况与pT和pN分期、合并脉管瘤栓情况、肿瘤直径密切相关。pT_(3)期、pN_(1)期、合并脉管瘤栓以及肿瘤直径>3 cm是影响食管鳞癌患者预后不良的危险因素。临床上对于存在上述危险因素的患者需予以重视,并早期进行干预,以降低预后不良的发生风险。

食管部分断离法在腹腔镜辅助全胃切除术食管-空肠吻合中的应用

目的总结食管部分断离法在上部胃癌腹腔镜辅助全胃切除术食管-空肠吻合中的手术经验,评价其临床效果及安全性。方法回顾性分析新乡医学院第一附属医院普外科行腹腔镜辅助全胃切除术+食管-空肠Roux-en-Y重建手术治疗的28例胃癌患者临床资料。应用食管部分断离法完成圆形吻合器抵钉座包埋。观察患者手术时间、食管-空肠吻合重建时间、术中出血量、淋巴结清扫数目、术后排气时间、术后住院时间以及吻合口瘘、发热、术后出血、切口感染、吻合口狭窄等术后并发症发生情况。结果28例患者均顺利完成腹腔镜辅助全胃切除术+食管-空肠Roux-en-Y手术。手术时间(193±42)min,食管-空肠吻合重建时间(26.2±4.3)min,术中出血量为(109±32)ml,淋巴结清扫数目(28.1±7.2)枚;术后并发症发生率为14.3%(4/28),其中发热2例、术后肠道动力不足2例;术后排气时间为(3.4±0.8)d,术后住院时间(10.4±1.1)d。所有患者均未发生腹部切口感染、术后出血、吻合口瘘、吻合口狭窄。结论食管部分断离法在上部胃癌腹腔镜辅助全胃切除术食管-空肠吻合中应用,吻合操作简单,且安全可行。

食管鳞状细胞癌全身治疗背景下外科手术遇到的挑战

外科手术一直是局部晚期食管鳞状细胞癌治疗中不可或缺的一部分,从最早的单纯手术治疗发展到如今以手术为主的多学科综合治疗,不同分期食管癌外科手术指征和目的也在不断变化和发展。延长生存、提高生活质量是食管癌治疗的主要目标,外科手术的实施也必须遵循该原则。因此,早期食管癌局部治疗的重点已从如何完成更好的根治性手术转变为保留器官治疗,包括内镜下治疗、放化疗等,尽可能推迟器官切除的时间;而对于既往边界/不可切除食管癌,在如今更好的全身治疗策略下,也获得了更多转化后手术的机会。在化疗、免疫治疗、放射治疗等综合治疗模式下,我们应当重新思考不同分期食管癌患者手术的时机、目的与范围,更好、更恰当地施行外科手术,最大限度地提高局部治疗的效果。