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Bograd AJ, Molena D. Minimally invasive esophagectomy. Curr Probl Surg 2021; 58:100984. [PMID: 34629156 DOI: 10.1016/j.cpsurg.2021.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Daniela Molena
- Weill Cornell Medical College, New York, NY; Memorial Sloan Kettering Cancer Center, New York, NY.
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2
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de Vos-Geelen J, Geurts SME, van Putten M, Valkenburg-van Iersel LBJ, Grabsch HI, Haj Mohammad N, Hoebers FJP, Hoge CV, Jeene PM, de Jong EJM, van Laarhoven HWM, Rozema T, Slingerland M, Tjan-Heijnen VCG, Nieuwenhuijzen GAP, Lemmens VEPP. Trends in treatment and overall survival among patients with proximal esophageal cancer. World J Gastroenterol 2019; 25:6835-6846. [PMID: 31885424 PMCID: PMC6931002 DOI: 10.3748/wjg.v25.i47.6835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/04/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of proximal esophageal cancer differs from that of tumors located in the mid and lower part of the esophagus due to the close vicinity of vital structures. Non-surgical treatment options like radiotherapy and definitive chemoradiation (CRT) have been implemented. The trends in (non-)surgical treatment and its impact on overall survival (OS) in patients with proximal esophageal cancer are unclear, related to its rare disease status. To optimize treatment strategies and counseling of patients with proximal esophageal cancer, it is therefore essential to gain more insight through real-life studies.
AIM To establish trends in treatment and OS in patients with proximal esophageal cancer.
METHODS In this population-based study, patients with proximal esophageal cancer diagnosed between 1989 and 2014 were identified in the Netherlands Cancer Registry. The proximal esophagus consists of the cervical esophagus and the upper thoracic section, extending to 24 cm from the incisors. Trends in radiotherapy, chemotherapy, and surgery, and OS were assessed. Analyses were stratified by presence of distant metastasis. Multivariable Cox proportional hazards regression analyses was performed to assess the effect of period of diagnosis on OS, adjusted for patient, tumor, and treatment characteristics.
RESULTS In total, 2783 patients were included. Over the study period, the use of radiotherapy, resection, and CRT in non-metastatic disease changed from 53%, 23%, and 1% in 1989-1994 to 21%, 9%, and 49% in 2010-2014, respectively. In metastatic disease, the use of chemotherapy and radiotherapy increased over time. Median OS of the total population increased from 7.3 mo [95% confidence interval (CI): 6.4-8.1] in 1989-1994 to 9.5 mo (95%CI: 8.1-10.8) in 2010-2014 (logrank P < 0.001). In non-metastatic disease, 5-year OS rates improved from 5% (95%CI: 3%-7%) in 1989-1994 to 13% (95%CI: 9%-17%) in 2010-2014 (logrank P < 0.001). Multivariable regression analysis demonstrated a significant treatment effect over time on survival. In metastatic disease, median OS was 3.8 mo (95%CI: 2.5-5.1) in 1989-1994, and 5.1 mo (95%CI: 4.3-5.9) in 2010-2014 (logrank P = 0.26).
CONCLUSION OS significantly improved in non-metastatic proximal esophageal cancer, likely to be associated with an increased use of CRT. Patterns in metastatic disease did not change significantly over time.
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Affiliation(s)
- Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Sandra ME Geurts
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Margreet van Putten
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
| | - Liselot BJ Valkenburg-van Iersel
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Heike I Grabsch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James”s, University of Leeds, Leeds LS9 7TF, United Kingdom
| | - Nadia Haj Mohammad
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht 3584 CX, Netherlands
| | - Frank JP Hoebers
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6229 ET, Netherlands
| | - Chantal V Hoge
- Department of Internal Medicine, Division of Gastroenterology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Paul M Jeene
- Department of Radiotherapy, Radiotherapiegroep, Deventer 7416 SE, Netherlands
| | - Evelien JM de Jong
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Hanneke WM van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Tom Rozema
- Department of Radiotherapy, Insituut Verbeeten, Tilburg 5042 SB, Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Vivianne CG Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | | | - Valery EPP Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven 5612 HZ, Netherlands
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
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3
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Yamashita K, Mine S, Toihata T, Fukudome I, Okamura A, Yuda M, Hayami M, Imamura Y, Watanabe M. The usefulness of three-dimensional video-assisted thoracoscopic esophagectomy in esophageal cancer patients. Esophagus 2019; 16:272-277. [PMID: 30888533 DOI: 10.1007/s10388-019-00661-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The three-dimensional video-assisted (3D-VA) system is known to provide depth perception and the precise measurement of anatomical spaces, unlike the two-dimensional video-assisted (2D-VA) system. However, the advantages of the 3D-VA system in thoracoscopic esophagectomy remains unclear. METHODS We retrospectively analyzed data from 104 patients who underwent thoracoscopic esophagectomy for esophageal cancer from 2016 to 2017. We performed thoracic esophagectomy using either the 2D-VA or 3D-VA system during this period. Whenever the 3D-VA system was available in our surgical center, we performed 3D-VA thoracoscopic esophagectomy. Perioperative parameters, including operation times, blood loss, the number of dissected lymph nodes, postoperative complications, and the duration of postoperative hospital stays, were compared between the 2D-VA and 3D-VA system groups. RESULTS There were 51 and 53 patients in the 2D-VA and 3D-VA system groups, respectively. Preoperative parameters, including age, sex, tumor location, clinical stage and the distribution of preoperative treatment, were not significantly different between the groups. Although intraoperative blood loss did not differ between the two groups, operation times were significantly shorter in the 3D-VA system group than the 2D-VA system group (P = 0.023). The number of dissected mediastinal lymph nodes was similar in both groups. The incidences of postoperative complications, including pneumonia, recurrent nerve palsy, anastomotic leakages and chylothorax, were similar between the groups. The duration of postoperative hospital stays was also comparable between the groups. CONCLUSIONS An introduction of 3D-VA endoscopy into minimally invasive esophagectomies may contribute to the shortening of the duration of thoracoscopic procedures.
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Affiliation(s)
- Kotaro Yamashita
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ian Fukudome
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masami Yuda
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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4
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Nobel TB, Lavery JA, Barbetta A, Gennarelli RL, Lidor AO, Jones DR, Molena D. National guidelines may reduce socioeconomic disparities in treatment selection for esophageal cancer. Dis Esophagus 2019; 32:doy111. [PMID: 30496376 PMCID: PMC6514299 DOI: 10.1093/dote/doy111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The 2011 National Comprehensive Cancer Network guidelines first incorporated the results of the landmark CROSS trial, establishing induction therapy (chemotherapy ± radiation) and surgery as the treatment standard for locoregional esophageal cancer in the United States. The effect of guideline publication on socioeconomic status (SES) inequalities in cancer treatment selection remains unknown. Patients diagnosed with Stage II/III esophageal cancer between 2004 and 2013 who underwent curative treatment with definitive chemoradiation or multimodality treatment (induction and surgery) were identified from the Surveillance, Epidemiology and End Results (SEER)-Medicare registry. Clinicopathologic characteristics were compared between the two therapies. Multivariable regression analysis was used to adjust for known factors associated with treatment selection. An interaction term with respect to guideline publication and SES was included Of the 2,148 patients included, 1,478 (68.8%) received definitive chemoradiation and 670 (31.2%) induction and surgery. Guideline publication was associated with a 16.1% increase in patients receiving induction and surgery in the low SES group (21.4% preguideline publication vs. 37.5% after). In comparison, a 4.5% increase occurred during the same period in the high SES status group (31.8% vs. 36.3%). After adjusting for factors associated with treatment selection, guideline publication was associated with a 78% increase in likelihood of receiving induction and surgery among lower SES patients (odds ratio 1.78; 95% confidence interval (CI): 1.05,3.03). Following the new guideline publication, patients living in low SES areas were more likely to receive optimal treatment. Increased dissemination of guidelines may lead to increased adherence to evidence-based treatment standards.
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Affiliation(s)
- T B Nobel
- Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, New York
| | - J A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Barbetta
- Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R L Gennarelli
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A O Lidor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - D R Jones
- Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - D Molena
- Department of Surgery, Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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5
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Ruiz de Angulo D, Parrilla P. Surgical treatment for esophageal cancer: Are the questions finished or are the surgeons who are finished by the questions? Cir Esp 2017; 96:182-183. [PMID: 28918965 DOI: 10.1016/j.ciresp.2017.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Pascual Parrilla
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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6
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Miyazaki T, Sakai M, Sohda M, Kuwano H. [Thoracoscopic esophagectomy]. Kyobu Geka 2014; 67:773-777. [PMID: 25138955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In recent years, the number of facilities performing thoracoscopic surgery of the esophagus has increased. Thoracoscopic surgery has many advantages, such as a magnification effect, good lighting, and a wide field of view. Esophagectomy requires fine manipulation within a deep and narrow space. Thus, thoracoscopic surgery is suitable for the performance of esophagectomy. The body position during this procedure may be either prone or left lateral decubitus. Because there are advantages in both cases, the relative merits are controversial. The operation time is longer than that of open thoracotomy, but the amount of bleeding is small in most cases of thoracoscopic esophagectomy. There are also some reports that thoracoscopic esophagectomy is comparable with open esophagectomy in terms of radicality and quality of lymph node dissection, and the intensive care unit and hospital stay durations are shortened. Robot-assisted esophagectomy is a promising technology for the fine manipulations and high quality 3-dimensional visualization required in the performance of esophageal thoracoscopic surgery. Thoracoscopic esophagectomy will become more widespread and undergo further development in the future with the spread of robotic surgery and 3-dimensional endoscopic surgery.
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Affiliation(s)
- Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University, Maebashi, Japan
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7
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Tsubosa Y. [Current surgical treatment and perspectives for esophageal cancer]. Nihon Shokakibyo Gakkai Zasshi 2014; 111:269-275. [PMID: 24500316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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8
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Zhou PH, Shi Q, Zhong YS, Yao LQ. New progress in endoscopic treatment of esophageal diseases. World J Gastroenterol 2013; 19:6962-6968. [PMID: 24222940 PMCID: PMC3819532 DOI: 10.3748/wjg.v19.i41.6962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/11/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
The technique of endoscopic submucosal dissection (ESD), which was developed for en bloc resection of large lesions in the stomach, has been widely accepted for the treatment of the entire gastrointestinal tract. Many minimally invasive endoscopic therapies based on ESD have been developed recently. Endoscopic submucosal excavation, submucosal tunneling endoscopic resection and laparoscopic-endoscopic cooperative surgery have been used to remove submucosal tumors, especially tumors which originate from the muscularis propria of the digestive tract. Peroral endoscopic myotomy has recently been described as a scarless and less invasive surgical myotomy option for the treatment of achalasia. Patients benefit from minimally invasive endoscopic therapy. This article, in the highlight topic series, provides detailed information on the indications and treatments for esophageal diseases.
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9
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Abbas H, Rossidis G, Hochwald SN, Ben-David K. Robotic esophagectomy: new era of surgery. MINERVA CHIR 2013; 68:427-433. [PMID: 24101000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Esophagectomy is a surgical operation which requires technical expertise to decrease the morbidity and mortality frequently associated with this advance procedure. Various minimally invasive esophagectomy techniques have been developed to decrease the negative impact of esophageal resection. Recently, robotic assisted esophagectomies have been described with a wide variety in technique and outcome disparity. This article is a summation review of the current literature regarding the various techniques and surgical outcomes of robotic assisted esophagectomies.
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Affiliation(s)
- H Abbas
- Gastroesophageal Surgery, Department of Surgery University of Florida, Gainesville, FL, USA
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10
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Hofstetter W. Current and future options for treating esophageal cancer: a paradigm shift toward organ-sparing therapies. Tex Heart Inst J 2012; 39:846-847. [PMID: 23304031 PMCID: PMC3528248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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11
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Abstract
Beginning with the widespread introduction of laparoscopic cholecystectomy in late 1989, minimally invasive surgical technique has been refined in conjunction with the development of advanced instrumentation and have subsequently been applied to increasingly complicated disease processes. Esophageal surgeons have increasingly incorporated minimally invasive surgery into their practice since the first laparoscopic fundoplication was described by Dallemagne et al. in 1991. Esophagectomy is associated with significant morbidity and mortality even in highly experienced centers. Many esophageal surgeons have had a great deal of interest in minimally invasive esophagectomy (MIE), which has the potential advantages of being a less traumatic procedure with a resultant improvement in postoperative convalescence and fewer wound and cardiopulmonary complications compared to the open approaches. Throughout the 1990s, as confidence with laparoscopic surgery of the esophagogastric junction grew, MIE was initially attempted with hybrid operations combining traditional open surgery with minimally invasive approaches. Subsequently, a totally laparoscopic transhiatal approach was described; however, this approach was perceived to be very challenging and has not gained widespread acceptance. Approaches used at present depend on cancer stage, cancer location, body habitus, and pulmonary function. For localized cancer (T1N0) or HGD, we prefer laparoscopic inversion esophagectomy (retrograde or antigrade). This approach may also be used for patients at high risk for thoracotomy. For locally advanced cancer in the middle third of the esophagus or for proximal third esophageal cancer, we prefer 3-field MIE (abdomen, and chest with neck anastomosis). For locally advanced cancer in the distal esophagus, especially in patients with a short thick neck, we prefer thoracoscopic-laparoscopic (2-field) esophagectomy (TLE).
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Affiliation(s)
- Toshitaka Hoppo
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Shadyside Medical Center, Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232, USA
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12
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Mao YS, He J, Cheng GY. [Current status of surgical management of esophageal cancer in China and the future strategy]. Zhonghua Zhong Liu Za Zhi 2010; 32:401-404. [PMID: 20819477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kohn GP, Galanko JA, Meyers MO, Feins RH, Farrell TM. National trends in esophageal surgery--are outcomes as good as we believe? J Gastrointest Surg 2009; 13:1900-10; discussion 1910-2. [PMID: 19760305 DOI: 10.1007/s11605-009-1008-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Accepted: 08/25/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Positive volume-outcome relationships in esophagectomy have prompted support for regionalization of care; however, outcomes have not recently been analyzed. This study examines national trends in provision of esophagectomy and reassesses the volume-outcome relationship in light of changing practice patterns and training paradigms. METHODS The Nationwide Inpatient Sample was queried from 1998 to 2006. Quantification of patients' comorbidities was made using the Charlson Index. Using logistic regression modeling, institutions' annual case volumes were correlated with risk-adjusted outcomes over time, as well as presence or absence of fellowship and residency training programs. RESULTS A nationwide total of 57,676 esophagectomies were recorded. In-hospital unadjusted mortality fell from 12% to 7%. Adjusting for comorbidities, greater esophagectomy volume was associated with improvements in the incidence of most measured complications, though mortality increased once greater than 100 cases were performed. Hospitals supporting fellowship training or a surgical residency program did not have higher rates of mortality or total complications. CONCLUSIONS The current national mortality rate of 7% following esophagectomy is higher than is reported in most contemporary case series. A greater annual esophagectomy volume improves outcomes, but only up to a point. Current training paradigms are safe.
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Affiliation(s)
- Geoffrey Paul Kohn
- Department of Surgery, University of North Carolina, Chapel Hill, NC 27599-7081, USA.
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14
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Abstract
Extended lymph node dissection helps increase the curativeness of resection, the accuracy of surgical-pathological staging, and the prognosis of thoracic esophageal carcinoma. However, it is also associated with significantly increased surgical morbidity and has noticeable negative effects on the quality of life after surgery. Current trends for selective lymph node dissection based on clinical evidence may be helpful in reducing surgical risks while assuring the completeness of resection.
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Affiliation(s)
- Wen-Tao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, 241 Huaihai Road West, Shanghai, 200030, China.
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15
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Morita M, Yoshida R, Ikeda K, Egashira A, Oki E, Sadanaga N, Kakeji Y, Yamanaka T, Maehara Y. Advances in esophageal cancer surgery in Japan: an analysis of 1000 consecutive patients treated at a single institute. Surgery 2008; 143:499-508. [PMID: 18374047 DOI: 10.1016/j.surg.2007.12.007] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 12/07/2007] [Indexed: 12/14/2022]
Abstract
BACKGROUND In Japan, most esophageal cancers are squamous cell carcinomas, and the results of esophagectomy have improved remarkably in recent years. The object of this study was to evaluate advances in operative therapy for esophageal cancer in Japan. METHOD We evaluated mortality, morbidity, and prognosis in 1000 consecutive patients who underwent esophagectomy for esophageal cancer at a single institution in Japan. The patients were divided into 3 groups according to the period when esophagectomy was performed: Group I (n = 197), 1964-1980; group II (n = 432), 1981-1993; and group III (n = 371), 1993-2006. RESULTS The incidence of squamous cell carcinoma was 94%. The morbidity rates were 62%, 38%, and 33 %, in groups I, II, and III, respectively (P < 0.01, groups I vs II and III), and the in-hospital mortality rates were 14.2%, 5.1%, and 2.4%, respectively (P < 0.01, between each group). The 5-year overall survival rate was 30% (14%, 27%, and 46% in groups I, II, and III, respectively; P < 0.0001). Multivariate analysis revealed age, gender, depth of invasion, node metastasis, distant metastasis, curability, extent of lymphadenectomy, resectability, and the period when the operation was performed as independent prognostic factors. CONCLUSION Generally, esophagectomy has been performed safely without critical complications; however, the prognosis has improved remarkably with advances in surgical techniques and treatment modalities.
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Affiliation(s)
- Masaru Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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16
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Affiliation(s)
- D E Low
- Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, Washington 98111, USA.
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17
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Shiozaki H, Imamoto H, Shigeoka H. [Current status and evaluation of thoracoscopic esophagectomy for thoracic esophageal cancer]. Nihon Geka Gakkai Zasshi 2006; 107:73-6. [PMID: 16613207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The current status and evaluation of esophagectomy by thoracoscopic approach for thoracic esophageal cancer are described. The esophagectomy by thoracoscopic approach for thoracic esophageal cancer have been reported in some Instituts since 1996 in Japan. In 10 years, series consisting a large number of esophageal cancer patients have been treated with esophagectomy by thoracoscopic approach and evaluated about operative safety, curabirity and postoperative morbidity. Now, the establishment of training system is the most important subject to achieve the standardization of thoracoscopic esophagectomy for thoracic esophageal caner.
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Affiliation(s)
- Hitoshi Shiozaki
- Department of Surgery, Kinki University Medical School, Osaka, Japan
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18
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Novitsky YW, Paton BL, Kercher KW, Heniford BT. Current aspects of surgical management of GERD. Surg Technol Int 2006; 15:53-62. [PMID: 17029162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common pathologies treated by primary care physicians. Despite advances in antacid pharmacological treatments, many patients remain refractory to maximal medical therapy. In addition, many others are either unable to tolerate the side effects of the drugs or simply are unwilling to receive life-long daily medications. Laparoscopic Nissen fundoplication has evolved as the surgical procedure of choice for patients with GERD. Although the durability of surgical management has been questioned, experienced surgeons achieve long-term reflux cure rates of about 85% to 95%. Barrett's esophagus has recently been considered an additional indication for surgical therapy of reflux due to evidence of dysplasia regression following a 360 degrees fundoplication. However, the timing of surgical intervention and the exact procedure for patients with both short- and long-segment Barrett's esophagus remains debatable. Esophageal dysmotility in surgical patients with GERD has traditionally been approached by "tailoring" the degree of fundoplication. Recent evidence suggests that partial fundoplication may not be effective and that full fundoplication should still be employed. The degree of dysmotility prohibitive to a full 360 degrees fundoplication remains controversial and should be addressed with future randomized trials. Finally, patients with failed fundoplication represent a formidable diagnostic dilemma and a technical challenge. In experienced hands, these patients can still benefit from minimally-invasive restorative or "re-do" fundoplications with minimal perioperative morbidity and good long-term results.
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Affiliation(s)
- Yuri W Novitsky
- Division of Gastrointestinal and Minimally-invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Abstract
BACKGROUND Case-series reports from tertiary centers report improved outcomes for esophageal resection in recent years. The objective of the current study was to determine trends in short-term outcomes after esophageal resection in a representative sample of United States (US) hospitals. METHODS Observational study of all adult patients in the Nationwide Inpatient Sample who underwent esophageal resection from 1988 to 2000 (N = 8,657). Temporal trends of in-hospital mortality and prolonged length of stay were determined. Analyses were performed for all hospitals after stratifying by hospital volume. The proportion of patients having surgery at high volume hospitals was used to assess changes in referral patterns. RESULTS The overall mortality rate was 11.3% and revealed a modest but significant decline from 13.6% to 10.5% during the study period (p = 0.001). Low volume hospitals had markedly higher mortality rates and showed no improvement over time (15.3% vs 14.5%). In contrast, high volume hospitals indicated significant reduction in mortality over time (11.0% vs 7.5%, p = 0.003). Referral patterns changed over time with the proportion of esophageal resections performed at high volume hospitals increasing from 40% (1988 to 1991) to 57% (1997 to 2000). CONCLUSIONS The operative mortality rate for esophageal resection has declined over the past 13 years, particularly at high volume hospitals. Efforts should be made to understand the processes of care underlying this improvement.
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Affiliation(s)
- Justin B Dimick
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
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Abstract
Once considered an uncommon malignancy, primary esophageal adenocarcinoma has increased steadily in incidence over the past three decades. Despite advances in multimodality therapy, the prognosis for this tumor is generally poor. Surgical resection and reconstruction of the upper gastrointestinal tract is the current standard of care for localized esophageal cancer, but despite advances in perioperative care, still remains a relatively high-risk surgical procedure. Increasing numbers of reports published over the past decade have documented a clear volume-outcome relationship for several complex surgical procedures, and in particular for esophagectomy. The clinical implications of this association are reviewed in this section.
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Affiliation(s)
- Alan G Casson
- Department of Surgery, Division of Thoracic & Esophageal Surgery, Dalhousie University and the QE II Health Sciences Centre, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9.
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21
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Affiliation(s)
- D J Mathisen
- Department of Surgery, Massachusetts General Hospital, Boston 02114, USA
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Abstract
Despite the recent advances in the understanding of the pathophysiology of achalasia, aetiology remains obscure and this primary oesophageal motor disorder is still considered "idiopathic" in nature. As a consequence, the therapeutic approach remains palliative. Since there is little or no chance of improving the motor abnormalities of the oesophageal body, treatment of achalasia is aimed at symptomatic relief of functional lower oesophageal sphincter obstruction. Pharmacologic treatment induces only a limited and brief improvement. It may be used to treat early cases of achalasia without significant oesophageal dilatation and to manage patients exhibiting some but not all the characteristics of achalasia (e.g. transitional forms). In any event, drug therapy should be seen as a short-term measure and be considered as an alternative only in patients unfit to undergo pneumatic dilatation or surgery. Pneumatic dilatation and surgical myotomy (now increasingly carried out through a minimally invasive approach) remain, therefore, the two main approaches which guarantee long-lasting symptomatic relief. Unfortunately, both pneumatic dilatation and Heller cardiomyotomy are only palliative as neither reliably reverses oesophageal aperistalsis not corrects the incomplete postdeglutition relaxation of the lower oesophageal sphincter. They do, however, improve symptoms by lowering lower oesophageal sphincter pressure thus enhancing oesophageal emptying by gravity. Recently a third approach, consisting in perendoscopic injection of botulinum toxin into the lower oesophageal sphincter is gaining acceptance. Indeed, more endoscopists are finding this kind of treatment attractive because it does not carry the risk of perforation that can occur with pneumatic dilatation. However, since symptomatic improvement with botulinum toxin only lasts a few months, either repeated injections are required or the patient must be switched to other therapy. There may be, however, subsets of patients for whom BoTox injection is the preferred approach. They probably include elderly patients or patients with multiple medical problems who are poor candidates for more invasive procedures as well as those unwilling to have either surgery or pneumatic dilatation. Future approaches to achalasia may markedly change from the suggested algorithm depending on the long-term efficacy and safety as well as cost analysis of BoTox injection and of minimally invasive surgery.
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Affiliation(s)
- S Bruley des Varannes
- Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Nantes, France.
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23
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Peracchia A, Bonavina L, Via A, Incarbone R. Current trends in the surgical treatment of esophageal and cardia adenocarcinoma. J Exp Clin Cancer Res 1999; 18:289-94. [PMID: 10606171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Since adenocarcinoma of the esophagus and cardia is increasing at an alarming rate, major efforts are currently oriented to identify patients who may benefit from extensive resection. Between November 1992 and May 1998, 218 patients with histologically proven adenocarcinoma of the distal esophagus or cardia were referred to our Department. In six patients (10.2%) with Barrett's adenocarcinoma, cancer was discovered during endoscopic surveillance program for Barrett's metaplasia. Overall, one hundred-forty-seven patients (67%) underwent resection. Fifty-one underwent an extended mediastinal lymphadenectomy. Median cumulative survival was 25.9+/-3.1 months in patients undergoing resection, and 7+/-1.3 months in patients having palliation (p<0.01). Survival was significantly longer in patients with negative nodes than in those with lymph node metastases (54+/-12.9 versus 17+/-2.8 months, p<0.01). Six of the 51 patients (11.8%) undergoing extended lymphadenectomy had metastatic upper mediastinal nodes. Additional serial sections and immunohistochemistry were performed in 46 patients. In 6 of 18 patients (33.3%) with negative nodes at conventional hematoxylin-eosin examination, immunohistochemistry demonstrated micrometastases in the lesser curve, paracardial, peripancreatic, or lower mediastinal nodes. Early diagnosis remains the prerequisite for curative treatment of adenocarcinoma of the esophagus and cardia. When a curative resection is attempted, extended lymphadenectomy improves tumor staging and may prevent local recurrences. Serial sections and immunohistochemistry provide additional accuracy in the staging of the disease and may prove useful to select patients for adjuvant therapy.
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Affiliation(s)
- A Peracchia
- Dept. of General Surgery and Surgery Oncological, University of Milan, Ospedale Maggiore Policlinico I.R.C.C.S., Italy
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24
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25
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Affiliation(s)
- T Lerut
- Department of Thoracic Surgery, Catholic University Hospital Gasthuisberg, Leuven, Belgium
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26
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Affiliation(s)
- K Sugimachi
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Kariakin AM, Aliev SA, Ivanov MA. [Our experience and the outlook for the development of surgery in esophageal cancer]. Vestn Khir Im I I Grek 1997; 156:64-7. [PMID: 9324849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Results of resections and simultaneous plasty of the esophagus in 178 patients with the III and III-IV stages of the malignant process are analyzed. The overwhelming majority of the patients were elderly and senile people. The total intrahospital lethality was 14.1%, lethality due to incompetent anastomoses was 5.6%. A comparative evaluation of results of the Lewis operations and operations performed by the Savinykh-Kariakin method has shown that lethality in the first group of patients was 3.5 times higher than in the second group. Pulmonary and cardio-vascular complications as well as infectious complications were significantly more frequent after the intrapleural access and plasty of the esophagus. Less amount of such complications after the posteromedial plasty of the esophagus by the Savinykh-Kariakin method resulted in less total lethality (7.9%). The authors consider the better results of operative treatment to be related both with less traumatic method of resection and plasty of the esophagus and with the adequate control of possible complications and prophylactic measures.
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Davis EA, Heitmiller RF. Esophagectomy for benign disease: trends in surgical results and management. Ann Thorac Surg 1996; 62:369-72. [PMID: 8694593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Esophagectomy for benign disease is uncommon. METHODS From July 1987 to April 1995, 45 consecutive patients (30 men, 15 women; mean age, 50 years) were evaluated in whom the senior author (R.F.H.) performed an esophagectomy, esophageal reconstruction, or both. The study period was divided into two time intervals, July 1987 to January 1992 (time 1) and February 1992 to April 1995 (time 2). RESULTS Indications for operation included obstruction (23 patients, 51%), benign neoplasia (17.38%), and perforation (5 patients, 11%). A nonthoracotomy approach was used in 19 (42%) patients: 15 transhiatal and 4 substernal. Thoracotomies were performed in 26 (58%) patients through a left thoracoabdominal or multiincisional techniques. Morbidity occurred in 15 (33%) patients, and there was one operative death (2%). CONCLUSIONS Despite an operative morbidity of 33%, esophagectomy for benign disease may be performed with acceptably low mortality. We observed the following trends: (1) an increase in patients with benign neoplasia and a decline in patients with obstruction, (2) an increased use of transhiatal esophagectomy, (3) a decreased use of colon, an increased use of stomach for esophageal replacement; and (4) a decreased length of hospital stay.
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Affiliation(s)
- E A Davis
- Department of General Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Perniceni T, Gayet B. [Videosurgery and cancer of the esophagus: what is its future?]. Gastroenterol Clin Biol 1995; 19:173-5. [PMID: 7750706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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