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Sivakumar J, Alnimri F, Liu DS, Duong CP. Comprehensive review of therapeutic procedures for delayed gastric conduit emptying after esophagectomy. J Gastrointest Surg 2025; 29:102046. [PMID: 40180211 DOI: 10.1016/j.gassur.2025.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/11/2025] [Accepted: 03/30/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Delayed gastric conduit emptying (DGCE) is a common functional complication after esophagectomy that significantly impairs the quality of life. Despite its clinical burden, standardized management protocols are lacking, and treatment approaches often rely on individual surgeon preference. This review aimed to evaluate the evidence on procedural interventions for established late DGCE to inform clinical decision-making. METHODS A systematic review was conducted across 5 databases, identifying 26 studies on DGCE interventions. Studies were assessed for quality using the Newcastle-Ottawa Scale, emphasizing the inclusion criteria that focused on procedural efficacy and outcome reporting. RESULTS A total of 26 studies encompassing diverse treatment modalities were included. Endoscopic approaches, such as botulinum toxin injection and balloon dilatation, have emerged as preferred first-line interventions, with success rates ranging from 50.0% to 100.0%. A hybrid approach combining both modalities demonstrated enhanced efficacy and lower recurrence, with success rates reaching 100.0%. Gastric peroral endoscopic myotomy showed promise for treatment-resistant DGCE, with experienced centers reporting success in 77.2% of refractory cases. Surgical options for gastric conduit revision were reserved for cases of DGCE with structural abnormalities, although the surgical options were associated with higher risks and complications. Significant heterogeneity in outcome definitions and reporting limited the comparability between studies. CONCLUSION This comprehensive evaluation provides valuable insights to assist clinicians in navigating current management strategies for DGCE. High-quality comparative studies are essential to refine treatment protocols and improve long-term patient outcomes.
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Affiliation(s)
- Jonathan Sivakumar
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Feras Alnimri
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - David S Liu
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia; Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia and Procedural Medicine, Austin Health, Heidelberg, Australia; Victorian Interventional Research and Trials Unit, Department of Surgery, Austin Precinct, The University of Melbourne, Heidelberg, Australia
| | - Cuong Phu Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia
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Mulisa G, Abebe T, Gutema B, Mahmuda J, Khan MAA, Gheit T, Herceg Z, Talukdar FR. Exploring Oesophageal Cancer in Ethiopia: Elevated Incidence in Females and Younger Cases. Cancer Rep (Hoboken) 2024; 7:e70048. [PMID: 39665274 PMCID: PMC11635477 DOI: 10.1002/cnr2.70048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/23/2024] [Accepted: 10/04/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND Oesophageal cancer is a public health concern in Ethiopia. Identifying the incidence and demographic profile of the two histological subtypes: oesophageal squamous cell carcinoma (ESCC) and oesophageal adenocarcinoma (EAC) are the key steps in recognizing the disease burden and potential aetiopathological associations. AIM The aim of this study is to identify the age and gender-specific incidence patterns of the most common subtype of oesophageal cancer in a high-incidence area of Ethiopia. METHODS A retrospective cross-sectional study from a high-incidence oesophageal cancer district in Ethiopia identified 630 cases from the pathology registry of nine hospitals. The patient records were carefully reviewed and data on age, gender, tumour location and histological types was systematically compiled. The patient data were retrieved and descriptive statistics were used to generate results. RESULTS ESCC subtype, accounted for constituting 500 (79.437%) cases. A gender disparity was observed, with 62.80% of cases occurring in females and 37.20% in males. This distribution of higher female ESCC incidences aligns with previous findings indicating a regional consistency and probable aetiological factor. Furthermore, ESCC incidence peaked at 40-50 years in females, highlighting an age-related incidence trend. EAC was observed in 67 (51.5%) females and 63 (48.5%) males showing similar prevalence. Spatial analysis revealed that the majority of ESCC cases were located in the lower oesophagus, followed by the middle part, with fewer instances in the upper oesophagus. CONCLUSION This study from Ethiopia identified ESCC as the predominant subtype, with a marked female predominance and age-related gender disparities. EAC with a lesser proportion identified with consistent spatial distribution patterns in both genders provide valuable insights into the epidemiological landscape of this disease. These findings emphasize the urgency of targeted research to uncover the underlying factors.
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Affiliation(s)
- Girma Mulisa
- Department of Microbiology, Immunology & ParasitologyAddis Ababa UniversityAddis AbabaAddis AbabaEthiopia
- Department of Biomedical ScienceAdama Hospital Medical CollegeAdamaEthiopia
| | - Tamrat Abebe
- Department of Microbiology, Immunology & ParasitologyAddis Ababa UniversityAddis AbabaAddis AbabaEthiopia
| | - Bekele Gutema
- Department of Medical Laboratory ScienceArsi UniversityAsellaEthiopia
| | | | - Md. Al Amin Khan
- Shahjalal University of Science and TechnologySylhetBangladesh
- Toxicology Society of BangladeshBangladesh
| | - Tarik Gheit
- International Agency for Research on CancerLyonFrance
| | - Zdenko Herceg
- International Agency for Research on CancerLyonFrance
| | - Fazlur Rahman Talukdar
- International Agency for Research on CancerLyonFrance
- Cancer Research UK Cambridge Institute, Li ka Shing Centre, University of CambridgeCambridgeUK
- Cancer Research UK Cambridge Centre, University of Cambridge, Li ka Shing CentreCambridgeUK
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Orabi A, Chillarge G, Di Mauro D, Veeramootoo D, Njere I, Manzelli A, Wajed S. Survival outcomes fifteen years after minimally invasive esophagectomy. Discov Oncol 2024; 15:708. [PMID: 39585588 PMCID: PMC11589040 DOI: 10.1007/s12672-024-01567-z] [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: 06/18/2024] [Accepted: 11/11/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Minimally invasive esophagectomy (MIO) offers a less traumatic resection for cancer patients resulting in improved quality of life. Concerns about the oncological efficacy of the procedure and potential impact on survival may have limited its wider adoption. This study reports survival outcomes fifteen years after patients underwent a total MIO for esophageal cancer. METHODS A single-centre analysis of survival outcomes was conducted on all patients who underwent MIO between 2004 and 2010 and had completed at least 15-years follow-up. Actual overall survival (OS) and disease-free survival (DFS) were evaluated with the Kaplan-Meier method. The pattern of association of patient factors with survival was assessed with the Cox regression analysis. RESULTS A total of 121 patients underwent resection, with 4 (3.3%) in-patient deaths. With a median follow-up time of 15.2 years, the median OS was 41 months. At 15-years there were 20 survivors (17.1%), with numbers at 10 and 5 years being 34 (29.1%) and 45 (38.5%) respectively. Median DFS was 27 months, with 19 (16.2%) patient disease free at 15 years, and 32 (27.4%) and 38 (32.5%) at 10 and 5 years respectively. Predictors of poor survival were the intracorporeal fashioning of the gastric conduit, perioperative blood transfusions, advanced disease stage and recurrence. CONCLUSIONS Long term survival outcomes following MIO support its increasing recognition as the standard of care as for curative resection in esophageal cancer.
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Affiliation(s)
- Amira Orabi
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Gauri Chillarge
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Davide Di Mauro
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK.
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | | | - Ikechukwu Njere
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Antonio Manzelli
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
| | - Shahjehan Wajed
- Department of Upper GI Surgery, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX25DW, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Bona D, Manara M, Bonitta G, Guerrazzi G, Guraj J, Lombardo F, Biondi A, Cavalli M, Bruni PG, Campanelli G, Bonavina L, Aiolfi A. Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis. Cancers (Basel) 2024; 16:1468. [PMID: 38672550 PMCID: PMC11048031 DOI: 10.3390/cancers16081468] [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: 03/11/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Severe postoperative complications (SPCs) may occur after curative esophagectomy for cancer and are associated with prolonged hospital stay, augmented costs, and increased in-hospital mortality. However, the effect of SPCs on survival after esophagectomy is uncertain. AIM To assess the impact of severe postoperative complications (SPCs) on long-term survival following curative esophagectomy for cancer, we conducted a systematic search of PubMed, MEDLINE, Scopus, and Web of Science databases up to December 2023. The included studies examined the relationship between SPCs and survival outcomes, defining SPCs as Clavien-Dindo grade > 3. The primary outcome measure was long-term overall survival (OS). We used restricted mean survival time difference (RMSTD) and 95% confidence intervals (CIs) to calculate pooled effect sizes. Additionally, we applied the GRADE methodology to evaluate the certainty of the evidence. RESULTS Ten studies (2181 patients) were included. SPCs were reported in 651 (29.8%) patients. The RMSTD overall survival analysis shows that at 60-month follow-up, patients experiencing SPCs lived for 8.6 months (95% Cis -12.5, -4.7; p < 0.001) less, on average, compared with no-SPC patients. No differences were found for 60-month follow-up disease-free survival (-4.6 months, 95% CIs -11.9, 1.9; p = 0.17) and cancer-specific survival (-6.8 months, 95% CIs -11.9, 1.7; p = 0.21). The GRADE certainty of this evidence ranged from low to very low. CONCLUSIONS This study suggests a statistically significant detrimental effect of SPCs on OS in patients undergoing curative esophagectomy for cancer. Also, a clinical trend toward reduced CSS and DFS was perceived.
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Affiliation(s)
- Davide Bona
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Michele Manara
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Guglielmo Guerrazzi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Juxhin Guraj
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, 95131 Catania, Italy;
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Piero Giovanni Bruni
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi—Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20157 Milan, Italy; (D.B.); (M.M.); (G.B.); (G.G.)
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