The role of surgery in the management of oesophageal cancer

Wu, Peter; Posner, Mitchell C.

doi:10.1016/s1470-2045(03)01167-7

Cited by 227 publications

(155 citation statements)

References 68 publications

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“…Hence, modifying preoperative criteria can prevent complications after esophagectomy. The criteria include the equipped ICU, accurate anesthesia, protection after surgery, proper nutrition, and positive nitrogen balance before surgery (56)(57)(58). As stated, anesthesia should be strictly in accordance with the opinions of the American Society of Anesthesiologists (59,60).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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Background: Due to the high prevalence and mortality rates of esophageal cancer in some parts of the world and considering that in most patients, symptoms occur when cancer is advanced, this study aimed to compare early and late complications in three esophagectomy techniques for treatment of esophageal cancer. Methods: The present study was a descriptive research on 316 patients with esophageal cancer referring to Shohada Tajrish hospital, Tehran. The results were recorded in the research forms consisting of individual characteristics, symptoms and reasons for referring to the hospital. Findings were extracted after classification and evaluated using descriptive statistics. Results: Among 316 patients studied, 190 patients (60%) were male and 126 (40%) were female. The highest prevalence was between 40 and 60 years old. The most significant reason for referring to the hospital was dysphagia and weight loss. Among 260 patients, 72 patients (27.7%) underwent surgery by transthoracic (Ivor Lewis type) approach, 76 patients (29.2%) underwent surgery by threeincision approach (Mc Keown procedure), and 112 patients (43%) underwent surgery by Trans-Hiatal (Oringer). A total of 36 deaths occurred. 22 deaths occurred using Ivor-Lewis (61%), 10 deaths occurred using Mc Keown (27.7%) and 4 deaths occurred after Oringer (11.1%). In terms of prevalence of complications, the most common early complication was pleural effusion (11%) and the most common late complication was anastomotic stricture (17.8%). Conclusions:Complications occurred in all three surgeries. The most complications occurred using transthoracic (Ivor Lewis type) approach and the least complications occurred using Trans-Hiatal (Oringer).

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Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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“…3,6,7,14 The mortality rate of esophagectomy at experienced centers is less than 5% [15][16][17][18] but ranges from 9% to more than 12% after neoadjuvant chemoradiotherapy in some reports.…”

Section: Journal Of Clinical Oncology O R I G I N a L R E P O R T V Omentioning

confidence: 99%

Outcomes of Patients With Esophageal Cancer Staged With [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET): Can Postchemoradiotherapy FDG-PET Predict the Utility of Resection?

Monjazeb

Riedlinger

Aklilu

et al. 2010

JCO

118

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Purpose To determine whether [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) can delineate patients with esophageal cancer who may not benefit from esophagectomy after chemoradiotherapy. Patients and Methods We reviewed records of 163 patients with histologically confirmed stage I to IVA esophageal cancer receiving chemoradiotherapy with or without resection with curative intent. All patients received surgical evaluation. Initial and postchemoradiotherapy FDG-PET scans and prognostic/treatment variables were analyzed. FDG-PET complete response (PET-CR) after chemoradiotherapy was defined as standardized uptake value ≤ 3. Results Eighty-eight patients received trimodality therapy and 75 received chemoradiotherapy. Surgery was deferred primarily due to medical inoperability or unresectable/metastatic disease after chemoradiotherapy. A total of 105 patients were evaluable for postchemoradiotherapy FDG-PET response. Thirty-one percent achieved a PET-CR. PET-CR predicted for improved outcomes for chemoradiotherapy (2-year overall survival, 71% v 11%, P < .01; 2-year freedom from local failure [LFF], 75% v 28%, P < .01), but not trimodality therapy. On multivariate analysis of patients treated with chemoradiotherapy, PET-CR is the strongest independent prognostic variable (survival hazard ratio [HR], 9.82, P < .01; LFF HR, 14.13, P < .01). PET-CR predicted for improved outcomes regardless of histology, although patients with adenocarcinoma achieved a PET-CR less often. Conclusion Patients treated with trimodality therapy found no benefit with PET-CR, likely because FDG-PET residual disease was resected. Definitive chemoradiotherapy patients achieving PET-CR had excellent outcomes equivalent to trimodality therapy despite poorer baseline characteristics. Patients who achieve a PET-CR may not benefit from added resection given their excellent outcomes without resection. These results should be validated in a prospective trial of FDG-PET–directed therapy for esophageal cancer.

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“…Esophagectomy remains the gold standard in the curative intent treatment of resectable esophageal cancer, often in combination with neoadjuvant chemotherapy or chemoradiotherapy (1)(2)(3). However, esophagectomy is a complex invasive procedure requiring exploration of several body cavities for adequate radical lymphadenectomy and restoration of gastrointestinal continuity.…”

Section: Introductionmentioning

confidence: 99%

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

et al. 2017

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years, high morbidity rates are still recorded (5,6). In an effort to reduce the postoperative morbidity associated with open esophagectomy various minimally invasive esophagectomy (MIE) techniques have been introduced and developed during the recent years. MIE is believed to minimize the surgical trauma and subsequently the postoperative pain resulting in a faster mobilization and recovery with reduced postoperative complication rates and shorter hospital stay compared to the open procedure. During the last 20 years several studies have been published within the field demonstrating that MIE is a safe technique with an oncological outcome at least equal to open esophagectomy with regard to complete resection rate, number of lymph nodes harvested and postoperative survival (7-9). Moreover, there is an indication of shortterm benefits after MIE especially with regards to reduced pulmonary complications and improved health related quality of life compared to the open procedure (10,11).The aim of the current study was to present our 4.5-year experience of the gradual implementation of various MIE techniques in our tertiary referral center with special focus on the evolution of adaptive changes and refinements of our practice of the procedure over this period. Methods Our unitCenter of digestive diseases (CDD) at Karolinska University Hospital, Stockholm is one of the largest and most highly specialized centers in the Nordic countries. It is a tertiary referral center in Stockholm County with a catchment area of approximately 2,500,000 inhabitants. Furthermore, CDD receives referrals for patients with newly diagnosed esophageal and cardia cancer from neighboring counties with an additional population of 650,000. This results in an annual case volume of 40-60 esophageal and resections in the most recent years.The Unit engages three consultant surgeons (MN, ML, IR), with long laparoscopic experience within benign upper gastrointestinal (UGI) surgery as well as long previous experience in open esophageal cancer surgery. Karolinska, Stockholm. From 2009, one of the current consultant surgeons, IR, spent 3 years in a fellowship in UGI cancer surgery at Bristol Royal Infirmary, Bristol, UK with special focus in MIE. During these years he became confident in both the hybrid laparoscopic assisted esophagectomy (HLAE) technique including laparoscopic gastric mobilization and abdominal lymph node dissection followed by thoracotomy and intrathoracic anastomosis as well as with the minimal invasive McKeown (MIMK) technique, i.e., thoracolaparoscopy followed by cervical anastomosis by performing more than 70 cases. In the meantime, two other consultant surgeons (MN & ML) had the chance to visit another center with extensive In May 2012 and as a first test of transition to MIE, the first HLAE was performed safely with all consultants present. This was followed shortly by an additional procedure with satisfactory results and without any technical problems to be encountered. HLAE was chosen as the most feasible MIE in the beginning...

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The role of surgery in the management of oesophageal cancer

Cited by 227 publications

References 68 publications

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Outcomes of Patients With Esophageal Cancer Staged With [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET): Can Postchemoradiotherapy FDG-PET Predict the Utility of Resection?

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

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The role of surgery in the management of oesophageal cancer

Cited by 227 publications

References 68 publications

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Outcomes of Patients With Esophageal Cancer Staged With [18F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET): Can Postchemoradiotherapy FDG-PET Predict the Utility of Resection?

Implementation of minimally invasive esophagectomy in a tertiary referral center for esophageal cancer

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Outcomes of Patients With Esophageal Cancer Staged With [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography (FDG-PET): Can Postchemoradiotherapy FDG-PET Predict the Utility of Resection?