Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: An Old Operation Revisited

Morita, Masaru; Nakanoko, Tomonori; Kubo, Nobuhide; Fujinaka, Yoshihiko; Ikeda, Keisuke; Egashira, Akinori; Saeki, Hiroshi; Uchiyama, Hideaki; Ohga, Takefumi; Kakeji, Yoshihiro; Shirabe, Ken; Ikeda, Tetsuo; Tsujitani, Shunichi; Maehara, Yoshihiko

doi:10.1245/s10434-011-1654-y

Cited by 37 publications

(27 citation statements)

References 29 publications

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“…Staged operations, that consist of an initial stage in which resection is performed and a secondary stage in which reconstruction is performed several weeks later, can reduce the surgical stress in high-risk operations. Staged operations were performed for high-risk patients with thoracic esophageal cancer (21) stomy and tube-jejunostomy; this was followed by reconstruction three weeks later (21). This staged operation was performed in cases of extremely invasive total pharyngolaryngo-esophagectomy by adopting pharyngostomy (22,23).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer

Morita

Egashira

Nakaji

et al. 2018

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Abstract. Background/Aim: The aim of this study was to clarify the treatment strategy for synchronous squamous cell carcinoma of the esophagus (ESCC) and head and neck cancer (HNC). Patients and MethodsThe multifocal development of squamous cell carcinoma (SCC) is frequently observed in the upper aerodigestive tract (UADT) including the head and neck region and the esophagus. The association of these cancers is observed both synchronously and metachronously (1). These cancers are highly aggressive and until relatively recently were usually associated with a dismal prognosis. Environmental factors such as cigarette smoking and alcohol drinking are closely related to the development of SCC of the UADT. Furthermore, we have reported that both heavy smoking and heavy drinking have synergistic effects on multi-centric carcinogenesis of the UADT (1, 2).Regarding the treatment strategy, surgical resection has been the gold standard of treatment for localized UADT cancer. However, this surgery is extremely invasive and is also associated with high rates of mortality and morbidity, especially in patients with esophageal cancer and pharyngeal cancer (3, 4). Patients with synchronous squamous cell carcinoma of the esophagus (ESCC) and head and neck cancer (HNC) often require for extremely complex and invasive surgical procedures in order to resect both lesions (5-7). The surgical procedures for synchronous double cancer therefore represent an important clinical problem.On the other hand, squamous cell carcinoma of the UADT is relatively sensitive to radiation and anticancer drugs such as 5-fluorouracil, cisplatin and paclitaxel (8-10). Definitive chemoradiotherapy is frequently indicated for ESCC while invasive esophagectomy is normally avoided (11). For patients with HNC, the preservation of the vocal function can be achieved if HNC is cured after definitive chemoradiotherapy (CRT). Definitive CRT for synchronous ESCC and HNC is controversial due to the larger radiation field and associated toxicity (12). In our institute, simultaneous definitive CRT has been applied in the treatment of synchronous ESCC and HNC (13,14). Another problem is that salvage treatment, which is frequently troublesome, may be indicated in cases with either residual or recurrent cancer after definitive CRT (4,11).In this study, we reviewed the clinical characteristics and treatment outcomes in 91 patients with synchronous ESCC and HNC, and paid special attention to simultaneous surgical resection and simultaneous CRT for both cancers. 909

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Section: Discussionmentioning

confidence: 99%

Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer

Morita

Egashira

Nakaji

et al. 2018

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“…Patients are at a higher risk of complications following coloplasty (8,24). Advanced age and prolonged duration of surgery together with diabetes, renal failure and poor general condition are reported to be important risk factors responsible for perioperative mortality following esophagectomy (8,9). In the current study, there were no mortalities subsequent to esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

“…None of the patients in the present study that underwent anastomosis on the neck after subtotal esophagectomy were positive for cancer within the resection margin. One-stage esophagectomy and coloplasty is a long surgery with a mean duration of 7.5 h, and has a higher mortality rate compared with the two-stage procedure (1,8,9,24).…”

Section: Discussionmentioning

confidence: 99%

“…Anterior interposition of the cervical esophagus may lead to additional damage of its blood supply and encourage the leakage as a result of ischemic necrosis. The interval between esophagectomy and reconstructive surgery has an obvious disadvantage for the patient in that it excludes early oral feeding, but two-stage esophagectomy is a relatively safe form of surgery that may reduce the risk of critical complications in high risk patients (8,9). Furthermore, in certain circumstances it creates the opportunity for the esophageal stump to recover from vessel injury and accumulate growth factors characteristic for the granulation stage of wound healing (10).…”

Section: Introductionmentioning

confidence: 99%

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Esophageal anastomosis - how the granulation phase of wound healing improves the incidence of anastomotic leakage

et al. 2016

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“…The time to reconstruction with a jejunal interposition can be as short as 24 hours to as long as six weeks after the initial operation. With proper planning these two stage strategies can lead to low morbidity in high risk patients that is comparable to the morbidity achieved with low risk patients undergoing standard esophagectomy (15).…”

Section: Two-stage Proceduresmentioning

confidence: 99%

Salvage esophagectomy for persistent or recurrent disease after definitive chemoradiation

Swisher¹,

Marks²,

Rice

2017

Ann. Cardiothorac. Surg.

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Locoregionally advanced esophageal cancer is treated by some oncologists with definitive chemoradiation. The optimal strategy to treat persistent or recurrent disease after definitive chemoradiation is controversial. We reviewed the literature to determine current treatment options and optimal approaches. Salvage esophagectomy of relapsed or recurrent esophageal cancer has traditionally been associated with increased risk. Modern literature, however, suggests that in specialized high volume centers the risk of salvage esophagectomy when accompanied with various risk-reducing approaches (anastomosis in non-radiated esophagus, omental transposition, selective use of alternative conduits and two stage procedures) is similar to planned esophagectomy after neoadjuvant chemoradiation. Long-term survival rates following salvage esophagectomy are also achievable and similar to planned esophagectomy. Since there are no other potentially curable treatment options, we recommend that all physiologically fit patients with locoregionally persistent or recurrent esophageal cancer after definitive chemoradiation be referred to a specialized high volume esophageal center for salvage esophagectomy.

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Two-Stage Operation for High-Risk Patients with Thoracic Esophageal Cancer: An Old Operation Revisited

Abstract: A two-stage operation is a safe operation that prevents the occurrence of critical postoperative complications, and it thus may be considered an important treatment strategy for high-risk patients with esophageal cancer.

Cited by 37 publications

References 29 publications

Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer

Treatment of Squamous Cell Carcinoma of the Esophagus Synchronously Associated with Head and Neck Cancer

Esophageal anastomosis - how the granulation phase of wound healing improves the incidence of anastomotic leakage

Salvage esophagectomy for persistent or recurrent disease after definitive chemoradiation

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