Mortality and Morbidity Rates, Postoperative Course, Quality of Life, and Prognosis After Extended Radical Lymphadenectomy for Esophageal Cancer

Fujita, Hiromasa; Kakegawa, Teruo; Yamana, Hideaki; Shima, Ichiro; Toh, Yuji; Tomita, Yusuke; Fujii, Teruhiko; Yamasaki, Kokusi; Higaki, Kensaku; Noake, Toshihiro; Ishibashi, Nobuya; Mizutani, Kazuki

doi:10.1097/00000658-199311000-00008

Cited by 149 publications

(236 citation statements)

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“…In order to improve the prognosis, an extended radical esophagectomy with radical lymphadenectomy is often performed. However, transthoracic esophagectomy with lymphadenectomy is well known as one of the most stressful gastrointenstinal operations, which considerably increases the amount of surgical stress (9,10). As a result, the operative morbidity rate is still high, despite recent improvements in the peri-operative management (11).…”

Section: Introductionmentioning

confidence: 99%

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Frick

Justinger²,

Rubie³

et al. 2011

Oncol Rep

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Abstract. Pulmonary complications together with surgical complications are the most frequent causes for morbidity and mortality after thoracoabdominal esophagectomy. The con tinuous improvement of surgical techniques has led to a decrease in surgical complications, whereas up to 30% of the patients develop postoperative pulmonary complications such as acute lung injury (ALI) or even the more severe acute respiratory distress syndrome (ARDS), which are characterized by an acute inflammation in the lung parenchyma and the airspace. Evidence from several studies indicates that a complex network of inflammatory cytokines and mediators play a key role in mediation, amplification, and perpetuation of the process of lung injury and that the thoracotomy itself is a risk factor for developing ALI or ARDS. In this trial, the cytokine levels of IL6, IL8 and IL10 were measured and compared in 30 patients who had undergone an extended radical thoracoabdominal esophagectomy for esophageal cancer, via anterolateral thoracotomy (n=17) or posterolateral thoracotomy (n=13). Patients of both groups were similar in terms of age, sex and preoperative pulmonary function as well as in the anesthetic procedures they have undergone. All patients displayed significantly increased serum levels of IL6 and IL8 after thoracoabdominal esophagectomy. However, patients who were subjected to an anterolateral thoracotomy were reported with significantly higher serum levels of IL6 and IL8 compared to patients who had received a posterolateral thoracotomy. Thus, the choice of the thoracotomy method during the thoracoabdominal esophagectomy and the resultant cytokine levels may contribute to the occurrence of postoperative pulmonary complications and may have an impact on the extent and severity of the surgical stress.

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Section: Introductionmentioning

confidence: 99%

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Frick

Justinger²,

Rubie³

et al. 2011

Oncol Rep

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show abstract

Section: Introductionmentioning

confidence: 99%

“…1,2 However, extended lymphadenectomy increases operative morbidity, especially pulmonary complications. 2 Video-assisted thoracoscopic esophagectomy (VATS) has been developed to reduce the surgical insult. 3 VATS minimizes the reduction in vital capacity secondary to chest wall injury, and it provides survival results comparable to those obtained with open radical esophagectomy.…”

Section: Introductionmentioning

confidence: 99%

Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Ninomiya

Osugi

Fujimura

et al. 2008

Gen Thorac Cardiovasc Surg

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Objective. The attainment of proficiency in thoracoscopic radical esophagectomy for thoracic esophageal cancer requires much experience. We aimed to master this procedure safely with our regular surgical team members under the direction of an experienced surgeon. We evaluated the efficacy of instruction during the induction period and the significance of our results.Methods. We compared the results of 12 thoracic esophageal cancer patients who underwent thoracoscopic radical esophagectomy in our institution (group A) to those of the initial 17 patients who underwent the same operation at the director's institution (group B).Results. We were able to perform complete thoracoscopic radical esophagectomies without any direction after experiencing 10 cases that were performed under adequate direction. The number of dissected lymph nodes and the duration of the procedure were similar in the two groups: 34 (22.53) vs. 26 (9.55) nodes, P = 0.23; and 327.5 (110.2360) g, P = 0.0035. Postoperative pneumonia and atelectasis were observed in 25.0% of group A patients and in 17.6% of group B patients. The incidence of recurrent nerve palsy was 30.7% in group A and 11.7% in group B, but there was no statistically significant difference (P = 0.19). The morbidity rates in group A and group B were 41.6% and 29.4%, respectively (P = 0.694).Conclusion. Thoracoscopic radical esophagectomy can be mastered relatively quickly and safely under the direction of an experienced surgeon and a regular surgical team.

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“…In Western countries, the incidence of esophageal adenocarcinoma has been increasing, whereas in Japan no such tendency exists, and the majority of esophageal cancer is ESCC (18,19). Prognosis of esophageal cancer is relatively poor, despite the advances made in diagnosis and treatment (20,21). To improve the prognosis, it is essential to reveal the molecular mechanism for esophageal carcinogenesis and malignant progression.…”

Section: Introductionmentioning

confidence: 99%

Dysregulated expression of HOX and ParaHOX genes in human esophageal squamous cell carcinoma

et al. 2007

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Abstract. Homeobox genes function as master regulators in embryonic morphogenesis. We hypothesized that homeobox genes are essential to maintain tissue-or organ-specificity even in adult body and that the dysregulated expression of homeobox genes results in tumor development and progression. To better understand the roles of homeobox genes in development and progression of esophageal cancer, we analyzed the expression patterns of 39 HOX genes and 4 ParaHOX (CDX1, CDX2, CDX4 and PDX1) genes in esophageal squamous cell carcinoma (ESCC) and normal esophageal mucosa tissues. A total of 48 primary ESCC tissues and 7 normal esophageal mucosa tissues were resected from patients who underwent radical surgery without any preoperative chemotherapy or radiotherapy. The expression of HOX and ParaHOX genes were analyzed by a quantitative real-time RT-PCR method and immunohistochemistry. The expression levels of 24 HOX genes, CDX1, CDX2 and PDX1 were significantly higher in ESCC compared to normal mucosa (p<0.01, Mann-Whitney U test). The Immunohistochemical study revealed that HOXA5 and D9 proteins were more cytoplasmic in ESCC than normal mucosa cells. Our data indicate that the disordered expression of HOX and ParaHOX genes are involved in the development of ESCC or its malignancy.

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Mortality and Morbidity Rates, Postoperative Course, Quality of Life, and Prognosis After Extended Radical Lymphadenectomy for Esophageal Cancer

Cited by 149 publications

References 0 publications

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

Results of video-assisted thoracoscopic surgery for esophageal cancer during the induction period

Dysregulated expression of HOX and ParaHOX genes in human esophageal squamous cell carcinoma

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