1
|
Onoda S, Tsukura K. Free jejunum transfers in oncologic reconstruction. SURGERY IN PRACTICE AND SCIENCE 2023; 14:100187. [PMID: 39845852 PMCID: PMC11749918 DOI: 10.1016/j.sipas.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 01/24/2025] Open
Abstract
Methods of pharyngoesophageal reconstruction include gastric pull-up, colon or jejunal interposition, and transfer of a free anterolateral thigh flap. The most popular method at our institution is transfer of a free jejunal graft. The free jejunum transfer was first described in 1957 by Seidenberg. The advantage of this procedure is a decreased risk of fistula, because the pharyngoesophagus is physiologically reconstructed with bowel-type reconstruction material. There are few reports about the operative methods of free jejunum transfer in detail and the operative methods vary greatly by institution. We performed free jejunum transfers for several hundred patients in the past and reported the characteristics and intraoperative and postoperative matters that require attention. Here, we summarize free jejunum transfer in oncologic reconstruction with relation to the points of safety, recipient vessels and microsurgical anastomosis, intestinal anastomosis and postoperative complications based on our experience and published reports.
Collapse
Affiliation(s)
- Satoshi Onoda
- Department of Plastic and Reconstructive Aesthetic Surgery, Toyama University Hospital, 2630, Sugitani, Toyama 930-0194, Japan
| | - Kahori Tsukura
- Department of Plastic and Reconstructive Aesthetic Surgery, Toyama University Hospital, 2630, Sugitani, Toyama 930-0194, Japan
| |
Collapse
|
2
|
Qi K, Lin G, Liu H, Zhang X, Chen Z, Li J. Comparison between radical surgery and chemoradiotherapy in patients with cervical esophageal cancer: a propensity score matched analysis. BMC Surg 2023; 23:119. [PMID: 37170089 PMCID: PMC10176790 DOI: 10.1186/s12893-023-02029-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The prognostic value of radical surgery (RS) and chemoradiotherapy (CRT) for cervical esophageal cancer (CEC) was estimated using the Surveillance, Epidemiology and End Results (SEER) database after 1:1 propensity score matching (PSM). METHODS This retrospective study used SEER data of CEC patients between 2004 and 2015. The prognostic effects on cancer-specific survival (CSS) were evaluated using multivariate cox regression analysis following radical surgery or CRT before and after PSM. The subgroup analysis of CSS is carried out according to T stages. RESULTS A total of 440 patients met the eligibility criteria. Three hundred and fifty-six(80.9%)patients underwent chemoradiotherapy, and eighty-four (19.1%) patients underwent radical surgery. There were significant differences between patients of radical surgery and CRT groups with regard to the tumor grade, histology and N stage. After PSM, 80 matched pairs (A total of 160 patients) were selected. Multivariable cox regression analysis revealed no difference in the CSS of patients that underwent either radical surgery or CRT before [hazard ratio (HR): 0.955, 95% CI: 0.704-1.295, P = 0.766] and after PSM (HR: 0.767, 95% CI: 0.512-1.149, P = 0.198). Subgroup analysis revealed no significant difference in CSS between patients with radical surgery and CRT groups for all T stages (T 1-4, all P > 0.05). CONCLUSIONS This analysis revealed that the prognostic outcomes in patients with cervical esophageal cancer were comparable between radical surgery and CRT.
Collapse
Affiliation(s)
- Kang Qi
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China.
| | - Gang Lin
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Haibo Liu
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Xining Zhang
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Zhimao Chen
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| | - Jian Li
- Department of Thoracic surgery, Peking University First Hospital, Xishiku str.8, 100034 Xicheng District, Beijing, China
| |
Collapse
|
3
|
Nakajima Y, Tachimori H, Miyawaki Y, Fujiwara N, Kawada K, Sato H, Miyata H, Sakuramoto S, Shimada H, Watanabe M, Kakeji Y, Doki Y, Kitagawa Y. A survey of the clinical outcomes of cervical esophageal carcinoma surgery focusing on the presence or absence of laryngectomy using the National Clinical Database in Japan. Esophagus 2022; 19:569-575. [PMID: 35902490 DOI: 10.1007/s10388-022-00944-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND One upside of cervical esophageal carcinoma is that radical surgery can be performed by laryngectomy, even for tumors with tracheal invasion. However, this approach drastically reduces the quality of life, such as by losing the vocal function. Cervical esophageal carcinoma is rare, and no comprehensive reports have described the current state of surgery. Using a Japanese nationwide web-based database, we analyzed the surgical outcomes of cervical esophageal carcinoma to evaluate the impact of larynx-preserving surgery. METHODS Based on the Japan National Clinical Database, 215 surgically treated cases of cervical esophageal carcinoma between January 1, 2018, and December 31, 2019, were enrolled. Clinical outcomes were compared between the larynx-preserved group and the laryngectomy group. RESULTS Ninety-four (43.7%) patients underwent larynx-preserving surgery. A total of 177 (82.3%) patients underwent free jejunum reconstruction. More T4b patients and more patients who underwent preoperative radiotherapy were in the laryngectomy group. There were no significant differences in the frequency and the severity of morbidities between the two groups. However, in the laryngectomy group, in-hospital death within 30 days after surgery was observed in 1 patient, and the postoperative hospital stay was significantly longer (P = 0.030). In the larynx-preserved group, recurrent nerve paralysis was observed in 24.5%. Re-operation (35.3%, P = 0.016), re-intubation (17.6%, P = 0.019) and tracheal necrosis (17.6%, P = 0.028) were significantly more frequent in patients who underwent pharyngolaryngectomy with total esophagectomy and gastric tube reconstruction than in others. CONCLUSION Larynx-preserving surgery was therefore considered to be feasible because it was equivalent to laryngectomy regarding the short-term surgical outcomes.
Collapse
Affiliation(s)
- Yasuaki Nakajima
- Department of Surgery, Edogawa Hospital, 2-24-18 Higashi-Koiwa, Edogawa-ku, Tokyo, 133-0052, Japan. .,The Japan Esophageal Society, Tokyo, Japan.
| | - Hisateru Tachimori
- Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan.,Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | - Naoto Fujiwara
- Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | - Kenro Kawada
- Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | - Hideaki Shimada
- Department of Gastroenterological Surgery and Clinical Oncology, Graduate School of Medicine, Toho University, Tokyo, Japan.,The Japan Esophageal Society, Tokyo, Japan
| | | | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| |
Collapse
|
4
|
Umezawa H, Umezawa M, Hokazono Y, Matsutani T, Ogawa R. Relationship between pharyngeal or esophageal reconstruction and esophageal pressure after swallowing. Cancer Rep (Hoboken) 2022; 6:e1619. [PMID: 35384372 PMCID: PMC9875660 DOI: 10.1002/cnr2.1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 01/23/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-resolution manometry, which measures esophageal luminal pressure changes after swallowing, could shed more light on food-transport dynamics after pharyngeal/esophageal reconstruction. This prospective cohort study assessed the influence of two head-and-neck and esophageal tumor-resection and reconstruction approaches on esophageal pressure. METHODS The cohort consisted of 17 patients who underwent esophageal/pharyngeal resection/reconstruction for cancer and then participated in postoperative high-resolution manometry. Five healthy controls also underwent manometry for comparison. RESULTS Partial pharyngectomy with patch grafts associated with smooth and continuous esophageal/pharyngeal movement. By contrast, surgery that removed the thoracic esophagus led to complete loss of peristalsis and poor food transport. CONCLUSIONS High-resolution manometry effectively characterized the changes in food-transport dynamics caused by pharyngeal/esophageal resection/reconstruction. These findings suggest that continuous and smooth movement of the pharynx and esophagus is important for swallowing and high resolution manometry could be useful in patients after pharyngeal/esophageal resection/reconstruction.
Collapse
Affiliation(s)
- Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | - Mariko Umezawa
- Department of GastroenterologyNippon Medical SchoolTokyoJapan
| | - Yu Hokazono
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| | | | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic SurgeryNippon Medical SchoolTokyoJapan
| |
Collapse
|
5
|
Analysis of various defects and reconstructive methods after invasive thyroid carcinoma resection. Auris Nasus Larynx 2022; 49:1027-1032. [DOI: 10.1016/j.anl.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022]
|
6
|
Abe S, Oguma J, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Saito Y, Daiko H. Novel hybrid endoscopy-assisted larynx-preserving esophagectomy for cervical esophageal cancer (with video). Jpn J Clin Oncol 2021; 51:1171-1175. [PMID: 33855445 DOI: 10.1093/jjco/hyab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
Hybrid endoscopy-assisted larynx-preserving esophagectomy is developed for cervical esophageal squamous cell carcinoma encroaching or extending above the upper esophageal sphincter. First, a cervical incision was surgically performed followed by cervical lymph node dissection. Second, the margin of cervical esophageal squamous cell carcinoma was endoscopically identified with iodine staining and marked endoscopically followed by semi-circumferential or circumferential endoscopic full-thickness excision around the lumen of the esophagus. The distal margin was surgically resected and reconstruction was performed. Among six consecutive patients with cervical esophageal squamous cell carcinoma undergoing hybrid endoscopy-assisted larynx-preserving esophagectomy, proximal surgical margin was histologically negative in five patients. During a median follow-up period of 15.5 months, all patients tolerated oral intake and were alive without evidence of recurrence. None of the patients experienced aspiration pneumonia, vocal disorder or postoperative anastomotic stricture. Hybrid endoscopy-assisted larynx-preserving esophagectomy could be a clinically feasible treatment for cervical esophageal squamous cell carcinoma providing accurate proximal resection margin with the benefit of laryngeal function preservation.
Collapse
Affiliation(s)
- Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Oguma
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Wang WP, Ma J, Lu Q, Han Y, Li XF, Jiang T, Zhao JB. Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction: A promising treatment for selected cervical esophageal squamous cell carcinoma. TURKISH JOURNAL OF GASTROENTEROLOGY 2021; 31:948-954. [PMID: 33626010 DOI: 10.5152/tjg.2020.19757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS There is no consensus on treatment for cervical esophageal squamous cell carcinoma (ESCC). Our aim is to evaluate the feasibility and outcome of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without tumor involvement of the larynx and hypopharynx. MATERIALS AND METHODS Retrospective analysis of patients with cervical ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the survival time for patients. RESULTS In total, 74 cervical ESCC patients were enrolled in the study. The mortality rate in 30 days was 8.1%, the total complication rate (at least one) was 47.3%, anastomosis leakage occurrence was 37.8%, mechanical ventilation ratewas12.2%, the rate of normal oral diet within 15 days was 71.6%, and the anastomosis recurrence rate in follow-up was 8.1%. Detailed analysis showed that the anastomosis leakage, pulmonary infection, laryngeal recurrent nerve injury, and chylothorax were the most common complications in surgical patients. Finally, the survival data showed that the median survival time was 31.83 months (95% CI=12.39-51.28 months) and the 3-year and 5-year survival rates were 49.1% and 35.5%, respectively. CONCLUSION Larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction might be a feasible and effective surgical alternative for the cervical ESCC patients whose tumor does not involve the larynx and hypopharynx.
Collapse
Affiliation(s)
- Wu-Ping Wang
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Jie Ma
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Qiang Lu
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Yong Han
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Xiao-Fei Li
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Tao Jiang
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| | - Jin-Bo Zhao
- Department of Thoracic Surgery, The second affiliated hospital of AFMU, Air Force Medical University, Xi'an, 710038, China
| |
Collapse
|
8
|
Watanabe A, Taniguchi M, Kimura Y, Kikkawa T, Hosokawa M. Larynx-preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery for cervical esophageal cancer invading pharynx. Dis Esophagus 2020; 33:5827017. [PMID: 32350502 DOI: 10.1093/dote/doaa020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022]
Abstract
Larynx preserving hybrid surgery with endoscopic laryngopharyngeal surgery and open surgery (HELPS) was created for resectable cervical esophageal cancer (CEC) invading the hypopharynx. This study aimed to verify the effectiveness and to evaluate the feasibility of the new HELPS treatment method. Between 2014 and 2018, 19 patients with CEC invading the hypopharynx were treated with HELPS. The postoperative complications and survival rates were reviewed. Postoperative recurrent laryngeal nerve paralysis occurred in four patients. All patients consumed food orally without a feeding tube at the time of the discharge. The median follow-up period was 27 months. The 2- and 3-year overall survival rates were 94.7 and 71.5%, respectively. HELPS, a new surgical treatment method that utilizes endoscopic surgery, is effective, feasible and beneficial for preserving the larynx in patients with CEC even if the tumor invaded the pharynx.
Collapse
Affiliation(s)
- Akihito Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Masanobu Taniguchi
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Yuki Kimura
- Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Tomohiro Kikkawa
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Masao Hosokawa
- Department of Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| |
Collapse
|
9
|
Relationship between the Incidence of Postoperative Fistula or Dysphagia and Resection Style, Gastric Tube Formation, and Irradiation following Free Jejunal Flap Transfer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2663. [PMID: 32309103 PMCID: PMC7159956 DOI: 10.1097/gox.0000000000002663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022]
Abstract
Background: The purpose of this study was to examine the relationship between the incidence of dysphagia or fistula formation in an anastomotic region and factors such as extent of resection, gastric tube formation, and irradiation among patients who underwent free jejunal flap transfer. Methods: We retrospectively examined 100 cases (88 men and 12 women; average age, 65.8 years; range, 46–88 years) in whom the evaluation of postoperative oral intake was possible after undergoing total pharyngo-laryngo-esophagectomy (TPLE) and free jejunal flap transfer. Chi-square test (with Fisher transformation, if necessary) was performed to analyze the relationship among resection styles (the resection margin extended to the oropharynx or to the cervical esophagus and gastric tube elevation), radiation therapy history, and incidence of dysphagia or fistula formation. Results: One hundred patients were analyzed, and complications such as postoperative fistula and dysphagia occurred in 8 (8.0%) and 20 patients (20.0%), respectively. However, no significant correlation was found between various resection factors and fistula formation or adverse events. At the reconstruction site, other complications such as postoperative lymphorrhea (7%), postoperative hematoma (4%), trachea necrosis (4%), cervical flap necrosis (1%), and thyroid necrosis (1%) occurred. These complications were managed by a cervical open wound and additional minor operation as needed. Conclusion: Thus, free jejunal transfer for TPLE is a good reconstruction technique with few complications and postoperative adverse events, regardless of the extent of resection and preoperative radiation therapy.
Collapse
|
10
|
Neoadjuvant Chemoradiotherapy and Larynx-Preserving Surgery for Cervical Esophageal Cancer. J Clin Med 2020; 9:jcm9020387. [PMID: 32024132 PMCID: PMC7073852 DOI: 10.3390/jcm9020387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 12/18/2022] Open
Abstract
Neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery is widely used for treating locally advanced esophageal cancer in the thorax. This study evaluated the feasibility of neoadjuvant CCRT as a larynx preservation strategy for treating cervical esophageal squamous cell carcinoma (SCC) by a multidisciplinary team. Fifteen patients with cervical esophageal SCC who received neoadjuvant CCRT and radical surgery at our institution were reviewed. All patients received CCRT using the intensity-modulated radiation therapy with 48 Gy to gross tumor and 43.2 Gy to regional lymphatic basin in 24 fractions. Side effects, clinical tumor responses, pathological responses, and surgical margin status were analyzed. Pathological T down-staging was noted in seven patients (46.7%); pathological complete response was achieved in three patients (20%). Fourteen patients (93.3%) had larynx preservation; eight patients (53.3%) achieved negative surgical margins. The 2-year overall survival, local relapse-free survival, and regional relapse-free survival were 50.6%, 62.2%, and 47.5%, respectively. Neoadjuvant CCRT and larynx-sparing surgery are feasible and tolerable in patients with cervical esophageal SCC. Prospectively designed studies for large patient groups and long-term follow-up results are needed for validating this multimodality therapy.
Collapse
|
11
|
Du XX, Yu R, Wang ZF, Du DC, Liu QY, Wang RM, Kang SR, Yang H. Outcomes and prognostic factors for patients with cervical esophageal cancer undergoing definitive radiotherapy or chemoradiotherapy. Bosn J Basic Med Sci 2019; 19:186-194. [PMID: 30877837 DOI: 10.17305/bjbms.2019.3873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022] Open
Abstract
Cervical esophageal cancer (CEC) is uncommon, accounting for less than 5% of all esophageal cancers. The management of CEC is controversial. This study investigated treatment outcomes and prognostic factors of survival in CEC patients undergoing definitive radiotherapy or concurrent chemoradiotherapy (CCRT). Ninety-one CEC patients were treated by intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiation therapy (3DCRT) between July 2007 and September 2017. The mean prescription dose was 64 Gy (range 54-70 Gy) delivered as 1.8-2.2 Gy per fraction per day, 5 days a week. Out of 91 patients, 34 received concurrent cisplatin-based chemotherapy (CT) including 18 patients who also received neoadjuvant CT. Overall survival (OS), locoregional failure-free survival (LRFFS), and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Prognostic factors of survival were determined in univariate (log-rank test) and multivariate (Cox proportional hazard model) analysis. Treatment-related toxicity was also assessed. Median follow-up time for all patients was 19 months. Two-year OS, LRFFS and PFS of all patients were 58.2%, 52.5% and 48.1%, respectively. Clinical stage was an independent prognostic factor for OS (HR = 2.35, 95% CI: 1.03-5.37, p = 0.042), LRFFS (HR = 3.84, 95% CI: 1.38-10.69, p = 0.011), and PFS (HR = 2.68, 95% CI: 1.11-6.45, p = 0.028). Hoarseness was an independent prognostic factor for OS (HR = 2.10, 95% CI: 1.05-4.19, p = 0.036). CCRT was independently associated with better LRFFS (HR = 0.33, 95% CI: 0.14-0.79, p = 0.012). 3DCRT and IMRT with concurrent CT is well-tolerated and may improve local tumor control in CEC patients. Advanced clinical stage and hoarseness are adverse prognostic factors for OS, LRFFS, and PFS in CEC.
Collapse
Affiliation(s)
- Xin-Xin Du
- Department of Radiotherapy, Inner Mongolia Cancer Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot; Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China; Research Group for Reproductive Medicine and IVF-Laboratory, Department of Obstetrics and Genecology, University of Cologne, Cologne, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Onoda S, Kinoshita M. Salvage Surgery for Jejunal Necrosis After a Free Jejunal Transfer. Ann Surg Oncol 2019; 26:2122-2126. [DOI: 10.1245/s10434-019-07348-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/18/2022]
|
13
|
Chen SB, Yang XH, Weng HR, Liu DT, Li H, Chen YP. Clinicopathological features and surgical treatment of cervical oesophageal cancer. Sci Rep 2017; 7:3272. [PMID: 28607370 PMCID: PMC5468278 DOI: 10.1038/s41598-017-03593-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023] Open
Abstract
Cervical oesophageal cancer (CEC) is a relatively uncommon malignancy. The biological behaviour and treatment have not been well studied. This retrospective study reviewed the clinicopathological features of 28 patients with CEC who underwent surgical resection to investigate the biological behaviour, treatment and prognosis of CEC. The long-term outcomes of these patients were compared with those of the CEC patients who received definitive chemoradiotherapy and those of thoracic or abdominal oesophageal cancer patients who underwent surgery. The study group contained 21 men and 7 women, ranging in age from 41 to 67 years (median: 56.5 years). The median survival time and the 1-, 3-, and 5-year overall survival rates were 25.0 months, 83.8%, 48.8%, and 41.9%, respectively. Only salvage surgery was found to affect the overall survival (P = 0.007). The long-term outcomes for CEC patients who underwent surgery were significantly better than those who received definitive chemoradiotherapy (P = 0.045) but were similar to those of thoracic or abdominal oesophageal cancer patients. In summary, CEC is an uncommon and aggressive malignancy. The malignant potential of CEC is similar to that of thoracic or abdominal oesophageal cancer. Surgical resection is an important therapeutic strategy and may be associated with better survival rates than definitive chemoradiotherapy.
Collapse
Affiliation(s)
- Shao-Bin Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xi-Hong Yang
- Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hong-Rui Weng
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Di-Tian Liu
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hua Li
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yu-Ping Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
| |
Collapse
|
14
|
Umezawa H, Nakao J, Matsutani T, Kuwahara H, Taga M, Ogawa R. Usefulness of the Clavien-Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1113. [PMID: 27975019 PMCID: PMC5142485 DOI: 10.1097/gox.0000000000001113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/12/2016] [Indexed: 02/03/2023]
Abstract
Background: The Clavien–Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer. Methods: All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012–December 2015 were identified. The postoperative complications were classified using the CD classification. Results: In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9–35) days after surgery. Conclusions: Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.
Collapse
Affiliation(s)
- Hiroki Umezawa
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Junichi Nakao
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Takeshi Matsutani
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Hiroaki Kuwahara
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Marie Taga
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery (H.U., J.N., H.K., M.T., R.O.) and Department of Surgery, Nippon Medical School Hospital, Tokyo, Japan
| |
Collapse
|
15
|
Makino T, Yamasaki M, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y. Short- and Long-Term Outcomes of Larynx-Preserving Surgery for Cervical Esophageal Cancer: Analysis of 100 Consecutive Cases. Ann Surg Oncol 2016; 23:858-865. [DOI: 10.1245/s10434-016-5511-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Indexed: 12/22/2022]
|
16
|
Neo-adjuvant therapy or definitive chemoradiotherapy can improve laryngeal preservation rates in patients with cervical esophageal cancer. A Japanese nationwide survey. Esophagus 2016. [DOI: 10.1007/s10388-016-0528-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
17
|
“Larynx-preserving surgery” for cervical esophageal carcinoma can preserve the vocal function and improve the clinical outcome. Esophagus 2016. [DOI: 10.1007/s10388-016-0547-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
18
|
Microvascular Reconstruction of Free Jejunal Graft in Larynx-preserving Esophagectomy for Cervical Esophageal Carcinoma. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e632. [PMID: 27257562 PMCID: PMC4874276 DOI: 10.1097/gox.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Losing the ability to speak severely affects the quality of life, and patients who have undergone laryngectomy tend to become depressed, which may lead to social withdrawal. Recently, with advancements in chemoradiotherapy and with alternative perspectives on postoperative quality of life, larynx preservation has been pursued; however, the selection of candidates and the optimal reconstructive procedure remain controversial. In this study, we retrospectively reviewed our experience with free jejunal graft for larynx-preserving cervical esophagectomy (LPCE), focusing on microvascular reconstruction. METHODS Seven patients underwent LPCE for cervical esophageal carcinoma, and defects were reconstructed by free jejunal transfer subsequently. We collected preoperative and postoperative data of the patients and assessed the importance of the procedure. RESULTS We mostly used the transverse cervical artery as the recipient, and a longer operative time was required, particularly for the regrowth cases. The operative field for microvascular anastomosis was more limited and deeper than those in the laryngectomy cases. Two graft necrosis cases were confirmed at postoperative day 9 or 15, and vessels contralateral from the graft were chosen as recipients in both patients. CONCLUSIONS Microvascular reconstruction for free jejunal graft in LPCE differed in several ways from the procedure combined with laryngectomy. Compression from the tracheal cartilage to the pedicle was suspected as the reason of the necrosis clinically and pathologically. Therefore, we should select recipient vessels from the ipsilateral side of the graft, and careful and extended monitoring of the flap should be considered to make this procedure successful.
Collapse
|
19
|
Hoeben A, Polak J, Van De Voorde L, Hoebers F, Grabsch HI, de Vos-Geelen J. Cervical esophageal cancer: a gap in cancer knowledge. Ann Oncol 2016; 27:1664-74. [PMID: 27117535 DOI: 10.1093/annonc/mdw183] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/20/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to provide an overview of the diagnosis, treatment options and treatment-related complications of cervical esophageal carcinoma (CEC) and to subsequently provide recommendations to improve quality of care. DESIGN Studies were identified in PubMed, EMBASE and Web of Science. A total of 107 publications fulfilled the inclusion criteria and were included. RESULTS CEC is uncommon, accounting for 2%-10% of all esophageal carcinomas. These tumors are often locally advanced at presentation and have a poor prognosis, with a 5-year overall survival of 30%. Tobacco and alcohol consumption seem to be the major risk factors for developing CEC. Surgery is usually not possible due to the very close relationship to other organs such as the larynx, trachea and thyroid gland. Therefore, the current standard of care is definitive chemoradiation (dCRT) with curative intent. Treatment regimens used to treat CEC are adapted by established regimens in lower esophageal squamous cell carcinoma and head and neck squamous cell carcinoma. However, dCRT may be accompanied by severe side-effects and complications. Several diagnostic and predictive markers have been studied, but currently, there is no other biomarker than clinical stage to determine patient management. Suggestions to improve patient outcomes are to determine the exact radiation dose needed for adequate locoregional control and to combine radiotherapy with optimal systemic therapy backbone. CONCLUSION CEC remains unchartered territory for many practising physicians and patients with CEC have a poor prognosis. To improve the outcome for CEC patients, future studies should focus on the identification of new diagnostic biomarkers or targets for radiosensitizers, amelioration of radiation schedules, optimal combination of chemotherapeutic agents and/or new therapeutic targets.
Collapse
Affiliation(s)
- A Hoeben
- Department of Internal Medicine, Division of Medical Oncology
| | - J Polak
- Department of Internal Medicine, Division of Medical Oncology
| | | | - F Hoebers
- Department of Radiation Oncology (MAASTRO Clinic)
| | - H I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Pathology & Tumour Biology, Leeds Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK
| | - J de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology
| |
Collapse
|
20
|
Grass GD, Cooper SL, Armeson K, Garrett-Mayer E, Sharma A. Cervical esophageal cancer: a population-based study. Head Neck 2014; 37:808-14. [PMID: 24616217 DOI: 10.1002/hed.23678] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/08/2014] [Accepted: 03/06/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to present our analysis of outcomes, prognostic factors, and treatment for cervical esophageal carcinoma using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A query of the SEER database from 1998 to 2008 was performed for patients with nonmetastatic adenocarcinoma or squamous cell carcinoma (SCC) of the cervical esophagus. Disease-specific survival (DSS) rates were calculated using Kaplan-Meier method, and predictive factors were analyzed by Cox proportional hazards regression. RESULTS We identified 362 patients; 92% of the patients had SCC, 16% received no definitive therapy, 5% received surgery, 71% received radiation therapy (RT), and 8% received both. Chemotherapy data were not available. Median DSS was 49 months for adenocarcinoma and 15 months for SCC. On multivariate analysis, histology (p = .02), RT (p < .001), and surgery plus RT (p < .001) were associated with DSS. CONCLUSION Survival in patients with cervical esophageal carcinoma remains poor. Further studies should define the use of RT, surgery, and chemotherapy.
Collapse
Affiliation(s)
- G Daniel Grass
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - S Lewis Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| | - Kent Armeson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Anand Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
21
|
Larynx-preserving limited resection and free jejunal graft for carcinoma of the cervical esophagus. World J Surg 2013; 37:551-7. [PMID: 23224075 DOI: 10.1007/s00268-012-1875-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is no generally accepted treatment strategy for cervical cancer. The aim of this study was to evaluate the safety and efficacy of larynx-preserving limited resection with free jejunal graft for cervical esophageal cancer. METHODS We retrospectively reviewed data of 58 patients with cervical esophageal cancer who underwent limited resection and free jejunal graft with or without laryngeal preservation. Among them, 45 patients received neoadjuvant treatment. RESULTS Larynx-preserving surgery was conducted in 33 of the 58 patients (56.9%). A higher proportion of patients who underwent laryngopharyngectomy with cervical esophagectomy (larynx-nonpreserving group) had cT4 tumors than those who underwent larynx-preserving cervical esophagectomy (larynx-preserving group) (72 vs. 12%). The overall incidence of postoperative complications was similar in the two groups (56 vs. 52%). The 5-year survival rate was 44.9% for the entire group. Laryngeal preservation did not reduce overall survival compared with the larynx-nonpreserving operation (5-year survival rate: 57.8 vs. 25.8%). Multivariate analysis identified the number of metastatic lymph nodes as the only independent prognostic factor. CONCLUSIONS The present study demonstrated that larynx-preserving limited resection with free jejunal graft is feasible. Also, this approach did not worsen the prognosis compared with the larynx-nonpreserving operation. Limited resection with free jejunal graft and laryngeal preservation is a promising treatment strategy for cervical esophageal cancer.
Collapse
|
22
|
de Manzoni G, Barbieri F, Zanoni A, Casella F. Surgical Treatment: Indications, Early and Long-term Results, and Disease Recurrence. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
The best salvage operation method after total necrosis of a free jejunal graft? Transfer of a second free jejunal graft. J Plast Reconstr Aesthet Surg 2011; 64:1030-4. [DOI: 10.1016/j.bjps.2011.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 01/29/2011] [Accepted: 02/04/2011] [Indexed: 11/20/2022]
|
24
|
Daiko H, Hayashi R, Sakuraba M, Ebihara M, Miyazaki M, Shinozaki T, Saikawa M, Zenda S, Kawashima M, Tahara M, Doi T, Ohtsu A. A Pilot Study of Post-operative Radiotherapy with Concurrent Chemotherapy for High-risk Squamous Cell Carcinoma of the Cervical Esophagus. Jpn J Clin Oncol 2011; 41:508-513. [DOI: 10.1093/jjco/hyr012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
25
|
Yoshida M, Furukawa T, Morikawa Y, Kitagawa Y, Kitajima M. The developments and achievements of endoscopic surgery, robotic surgery and function-preserving surgery. Jpn J Clin Oncol 2010; 40:863-9. [PMID: 20736221 DOI: 10.1093/jjco/hyq138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. 'Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital' may be a goal for us.
Collapse
Affiliation(s)
- Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan.
| | | | | | | | | |
Collapse
|