The Influence of Technical Complications on Postoperative Outcome and Survival After Esophagectomy

Ferri, Lorenzo; Law, Simon; Wong, Kam-Ho; Kwok, Ka–Fai; Wong, John W.

doi:10.1245/aso.2006.04.040

Cited by 74 publications

(71 citation statements)

References 43 publications

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“…6,10,45 Moreover, there is mounting evidence that states of systemic inflammation can accelerate the progression of metastatic tumor development. [23][24][25]38,39 The present data demonstrate that these two phenomena are inter-related, and that activated neutrophils represent a third cellular participant in this process. In this study, a physiologically relevant in vivo model of the early stages of hematogenous metastasis was developed using fluorescence intravital microscopy to monitor the trafficking of tumor cells in the liver vasculature.…”

Section: Discussionmentioning

confidence: 74%

“…21,22 Several reports from clinical series have raised the possibility that inflammatory consequences resulting from postsurgical complications may influence cancer recurrence. [23][24][25] Evidence from studies of other malignancies such as colorectal carcinoma have shown that proinflammatory cytokines such as TNFa and IL-1b increase tumor cell adhesion to endothelial cells in vitro and in vivo, largely by upregulating the expression of cell adhesion molecules such as selectins on the endothelial surface. 26 In addition, soluble inflammatory mediators have been shown to increase the expression of selectin ligands on cancer cells.…”

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confidence: 99%

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Systemic inflammation increases cancer cell adhesion to hepatic sinusoids by neutrophil mediated mechanisms

McDonald

Spicer

Giannais

et al. 2009

Intl Journal of Cancer

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204

163

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Interactions between endothelial selectins and selectin ligands expressed on tumor cells have been implicated in the binding of circulating metastatic cancer cells to the vascular endothelium during extravasation. Moreover, there is mounting evidence that inflammatory environments can accelerate the progression of metastasis by neutrophil mediated mechanisms. In this study, a physiologically relevant in vivo model of early metastasis coupled with intravital microscopy was used to visualize the trafficking of tumor cells within the liver vasculature in real time. Using GFPlabeled Lewis lung carcinoma subline H-59 cells, we show here that disrupting the interactions between endothelial selectins and tumor cell selectin ligands diminished tumor cell recruitment to the liver. Furthermore, systemic inflammation induced by intravenous injection of lipopolysaccharide significantly enhanced the metastatic potential of these lung carcinoma cells by increasing their propensity to adhere to the liver sinusoidal endothelium. Confocal microscopy revealed frequent colocalization of cancer cells with neutrophils and neutrophil depletion in vivo significantly attenuated the lipopolysaccharide-induced increase in H-59 cell adhesion. Although direct selectin-selectin ligand interactions contributed significantly to tumor cell adhesion to sinusoidal endothelial cells, we show here that in addition, interactions between adherent neutrophils within the inflamed sinusoids and circulating tumor cells may further increase tumor cell arrest in the liver. ' 2009 UICC Key words: cancer; metastasis; lung; rodent; adhesion molecules; e-selectin; neutrophil; sialyl Lewis X Lung cancer is the leading cause of cancer-related deaths worldwide. 1 A high proportion of patients harbor metastasis to regional lymph nodes upon presentation, and over half of all patients who undergo curative intent surgical resection of the lung will develop metastatic recurrence. 2 The liver is a common site of metastasis for lung cancer, with autopsy studies showing hepatic metastases in over 50% of lung cancer patients. 3 The hematogenous dissemination of cancer cells from a primary tumor to distant organs involves a cascade of sequential steps (reviewed in Refs. 4,5). The adhesion of circulating tumor cells to the vascular endothelium of distant organs is a key step in the metastatic cascade that may determine the organ tropism and extent of metastasis. Interactions between endothelial selectins and tumor cell selectin ligands have been implicated in the metastatic process. [5][6][7][8] Selectins are a family of transmembrane glycoproteins possessing an extracellular lectin domain that binds to carbohydrate moieties present on their ligands. 9 The three known selectins that function as cell adhesion molecules are expressed on the surface of endothelial cells (E-selectin and P-selectin), platelets (P-selectin) and leukocytes (L-selectin). E-selectin has been shown to contribute to the metastatic spread of multiple cancers, including lung and colon carcinoma, and m...

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Section: Discussionmentioning

confidence: 74%

mentioning

confidence: 99%

Systemic inflammation increases cancer cell adhesion to hepatic sinusoids by neutrophil mediated mechanisms

McDonald

Spicer

Giannais

et al. 2009

Intl Journal of Cancer

Self Cite

204

163

View full text Add to dashboard Cite

show abstract

“…Together, the combination of acute systemic inflammatory stimuli with high numbers of CTCs presents a fertile ground for the initiation of metastasis (3). The clinical evidence linking postoperative complications and high CTC numbers to poor oncologic outcomes is abundant (30)(31)(32)(33)(34). This study contends that neutrophils, as key effectors of the acute systemic inflammatory reaction, play a functional role to promote the implantation of CTCs and, thus, facilitate metastatic spread to distant organs such as the liver.…”

Section: Introductionmentioning

confidence: 98%

Neutrophils Promote Liver Metastasis via Mac-1–Mediated Interactions with Circulating Tumor Cells

et al. 2012

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Although circulating neutrophils are associated with distant metastasis and poor outcome in a number of epithelial malignancies, it remains unclear whether neutrophils play an active causal role in the metastatic cascade. Using in vivo models of metastasis, we found that neutrophils promote cancer cell adhesion within liver sinusoids and, thereby, influence metastasis. Neutrophil depletion before cancer cell inoculation resulted in a decreased number of gross metastases in an intrasplenic model of liver metastasis. This effect was reversed when inflamed neutrophils were co-inoculated with cancer cells. In addition, early adhesion within liver sinusoids was inhibited in the absence of neutrophils and partially restored with a short perfusion of isolated activated neutrophils. Intravital microscopy showed that cancer cells adhered directly on top of arrested neutrophils, indicating that neutrophils may act as a bridge to facilitate interactions between cancer cells and the liver parenchyma. The adhesion of lipopolysaccharide-activated neutrophils to cancer cells was mediated by neutrophil Mac-1/ICAM-1. Our findings, therefore, show a novel role for neutrophils in the early adhesive steps of liver metastasis. Cancer Res; 72(16);

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“…A correta dissecção do estômago associada ou não à manobra de Kocher permite a confecção de um tubo gástrico de dimensões capazes de atingir a região cervical, conferindo condições ótimas para anastomose segura 29,31,60 . A preferên-cia pela região cervical deve-se ao fato da benignidade das fístulas neste plano anatômico 20,21,22 . No mesmo nível de importância, é prioritário o manejo adequado do paciente no período perioperatório, evitando a hipotensão e seu impacto negativo na perfusão sistêmica e oxigenação tecidual, sendo relevante a manutenção de adequado volume intravascular e evitando o uso de drogas vasopressoras 22 .…”

Section: Tabela 1 -Dados Dos Dois Grupos Do Estudounclassified

“…Curiosamente, outras séries inferem que a mortalidade a longo prazo não foi afetada pelo índice de intercorrências técnicas 3,5,21 .…”

Section: Tabela 1 -Dados Dos Dois Grupos Do Estudounclassified

Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?

Fontes¹,

Kruse²,

Waechter³

et al. 2008

ABCD, arq. bras. cir. dig.

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INTRODUÇÃOA esofagectomia é procedimento cirúrgico complexo e tradicionalmente associado à morbidade significativa, tendo como principal indicação o tratamento da doença maligna. Neste caso, apesar dos progressos em outras modalidades terapêuticas, a esofagectomia persiste como tratamento de escolha em pacientes com tumores potencialmente ressecáveis, tanto com intento curativo quanto paliativo. Entretanto, na afecção maligna, cerca de 75% dos pacientes já apresentam doença avançada no momento do diagnóstico 24,25,59,62 . O câncer de esôfago figura entre os tumores sólidos mais letais, sendo referido universalmente como a sexta causa de morte dentre as neoplasias. Conforme estimativa do Instituto Nacional do Câncer -INCA, no Brasil são previstos registros de cerca de 10640 casos no ano de 2008.Atualmente, a seleção apurada de pacientes, associada ao aperfeiçoamento da anestesiologia, do rigor técnico e do manejo pré e pós-operatório em unidades de terapia intensiva resultaram em melhora significativa nas taxas de morbi-mortalidade destes pacientes 5,46,62 . Da mesma forma, a literatura evidencia que os bons resultados em procedimentos cirúrgicos complexos como a esofagectomia são volume dependentes 11,39,43,57 , com taxas de mortalidade hospitalar em serviços de excelência inferiores a 5% 62 .Após ressecção cirúrgica com intuito curativo, taxas de sobrevida em cinco anos são referidas entre 10 e 40% na maioria dos serviços de excelência. Já no Japão, Akiyama, entre outros, há muito refere resultados mais alentadores em cinco anos1. Por outro lado, visto o prognóstico reservado em nosso meio, é imperiosa a manutenção da qualidade de vida destes pacientes, concentrando esforços na prevenção de complicações que possam causar morbidade. Dentre estas, a mais temida é a deiscência da anastomose cervical, que é o calcanhar de Aquiles desta operação, com manifestações que oscilam entre a ocorrência benigna de sinus ou fístula até apresentações graves como mediastinite e óbito.Este estudo tem o objetivo de apresentar nova alternativa técnica de anastomose cervical visando diminuir a ocorrência de deiscência e consequentemente melhorar os resultados finais das esofagectomias (4):158-63 RESUMO -Racional -O câncer de esôfago é a sexta causa de morte relacionada à neoplasia no Brasil, e a esofagectomia quando factível é um dos pilares do tratamento, tanto com intento curativo quanto paliativo. A fístula cervical é complicação comum do procedimento e tem incidência entre 0,8 e 47, 6%. Objetivo -Testar a eficiência de uma alternativa técnica para a diminuição desta ocorrência. Métodos -Análise prospectiva de 126 pacientes alocados em dois grupos de acordo com a técnica utilizada para a anastomose esofagogástrica cervical. O grupo A, composto por 96 pacientes, teve a anastomose cervical realizada em dois planos, camadas mucosa com sutura contínua de fio categute cromado 3-0 ou caprofyl 3-0 e seromuscular com pontos separados de seda 3-0 agulhada, de forma tradicional, após ressecção prévia das extremidades redundantes do esôfa...

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The Influence of Technical Complications on Postoperative Outcome and Survival After Esophagectomy

Abstract: Although immediate postoperative outcome and hospital mortality rates were increased, no effect on long-term survival was seen in patients with complications related to errors in surgical technique.

Cited by 74 publications

References 43 publications

Systemic inflammation increases cancer cell adhesion to hepatic sinusoids by neutrophil mediated mechanisms

Systemic inflammation increases cancer cell adhesion to hepatic sinusoids by neutrophil mediated mechanisms

Neutrophils Promote Liver Metastasis via Mac-1–Mediated Interactions with Circulating Tumor Cells

Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?

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