Results of Extended en bloc Esophagectomy in Treatment of Patients with Esophageal Cancer

2009 ◽  
pp. 97-105
Author(s):  
David I. Watson ◽  
Glyn G. Jamieson
Keyword(s):  
Esophageal Cancer ◽  
En Bloc

scholarly journals Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2

2019 ◽  
Vol 07 (06) ◽  
pp. E733-E742 ◽  
Author(s):  
Andres Mora ◽  
Kenro Kawada ◽  
Yasuaki Nakajima ◽  
Takuya Okada ◽  
Yutaka Tokairin ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Survival Rates ◽  
Early Esophageal Cancer ◽  
En Bloc ◽  
Term Survival ◽  
Long Term Survival ◽  
Submucosal Tumors ◽  
Submucosal Cancer

Abstract Background and study aims Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are promising therapeutic options for early esophageal cancer (EC). The factors that can affect mid- and long-term survival in patients with submucosal EC (SM1 and SM2) have not been described in the literature. We aim to describe clinicopathological outcomes and factors that can affect the mid- and long-term survival in patients with resected submucosal tumors. Patients and methods We performed a retrospective analysis of patients who underwent endoscopic resection (ER) for submucosal tumors over a 20-year period. The final study population included 119 cases with 137 lesions. Information was collected according to the Japanese Classification of Esophageal Cancer 11-edition and factors affecting survival for 2 and 5 years after ER were analyzed. Results EMR was performed in 99 cases (72.3 %), ESD in 38 cases (27.7 %). There were no significant complications. Two- and 5-year survival rates were 91 % and 82 %, respectively. Mean age was 67.22 years (± 9.49 years), mortality caused by EC occurred in 13 cases (11 %). Factors that had a significant impact on long-term survival were age > 65 years (P = 0.0026), number of resected specimens (P = 0.0031), presence of another progressive disease (not EC) (P ≤ 0.001), recurrence (P = 0.0002), and relation between histopathological positive vertical margin and recurrence (P = 0.0112). Conclusions ER is viable treatment for esophageal submucosal cancer, selection between ESD/EMR can depend on tumor size and patient condition, and en bloc ER is the recommended technique for submucosal tumors. Long-term survival factors were identified.

Successful En-Bloc Resection of Large Superficial Esophageal Cancer Using Sodium Hyaluronate and Small-Caliber-Tip Transparent Hood

2004 ◽  
Vol 59 (5) ◽  
pp. P257
Author(s):  
Makoto Nishimura ◽  
Hironori Yamamoto ◽  
Hiroto Kita ◽  
Keijiro Sunada ◽  
Kazunobu Hanatuka ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Sodium Hyaluronate ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Superficial Esophageal Cancer ◽  
En Bloc ◽  
Transparent Hood

Successful En-Bloc Resection of 6 Cases of Large Superficial Esophageal Cancer Using Sodium Hyaluronate and Needle-Knife

2006 ◽  
Vol 63 (5) ◽  
pp. AB136
Author(s):  
Makoto Nishimura ◽  
Hironori Yamamoto ◽  
Kentaro Sugano
Keyword(s):  
Esophageal Cancer ◽  
Sodium Hyaluronate ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Superficial Esophageal Cancer ◽  
En Bloc ◽  
Needle Knife

PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Chang Hyun Kim ◽  
Jin-Jo Kim
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Old Age ◽  
Single Incision ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Safe Procedure ◽  
En Bloc ◽  
Transhiatal Approach ◽  
The Mean

Abstract Background A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer Methods We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes. Results The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient. Conclusion TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve. Disclosure All authors have declared no conflicts of interest.

Staging and neoadjuvant therapy for esophageal cancer

2001 ◽  
Vol 58 (3) ◽  
pp. 165-173
Author(s):  
T. Benhidjeb ◽  
K. T. Moesta ◽  
P. M. Schlag
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Neoadjuvante Radiochemotherapie ◽  
En Bloc ◽  
Stadiengerechte Therapie ◽  
Diagnostische Laparoskopie ◽  
Stadium I

Eine stadiengerechte Therapie von Patienten mit Ösophaguskarzinom erfordert eine präoperative exakte Erfassung der Tumorausdehnung und eine präzise Stadieneinteilung. Die Endosonographie ist derzeit die sensitivste Technik für die Vorhersage der Tumorinfiltrationstiefe und des Lymphknotenstatus. Die Genauigkeit der Endosonographie kann durch Kombination mit der Computertomographie gesteigert werden. Die Abklärung von Fernmetastasen beinhaltet neben einer Röntgen-Thorax-Aufnahme in zwei Ebenen eine Sonographie des Halses und Abdomens sowie eine Computertomographie in Spiraltechnik von Hals/Thorax/Abdomen. Für den Nachweis kleinerer Metastasen und einer Peritonealkarzinose findet die diagnostische Laparoskopie mit laparoskopischem Ultraschall bei infracarinalen Tumorlokalisationen Bedeutung. Bei Patienten mit einem lokoregionär begrenzten Ösophaguskarzinom (Stadium I-IIB bzw. T1-T2/N0-N1/M0) ist die En-bloc-Ösophagektomie mit Lymphadenektomie die Therapie der ersten Wahl. Bei Patienten mit einem lokal fortgeschrittenen Ösophaguskarzinom (Stadium III bzw. T3-T4/N0-N1/M0) ist besonders bei supracarinaler Tumorlokalisation eine R0-Resektion nicht sicher möglich. Die neoadjuvante Radiochemotherapie führt bei einer signifikanten Anzahl von Patienten zum Downstaging des Primärtumors, Zunahme der R0-Resektionsrate, Reduktion der Lokalrezidivrate und Verlängerung des rezidivfreien Intervalls. Allerdings ist diese Vorbehandlung mit einem deutlichen Anstieg der operativen Morbidität und Mortalität assoziiert, so dass die Suche nach neuen Modalitäten kombinierter Behandlung (z.B. lokale Hyperthermie) und der Einsatz neuer zytostatischer Substanzen Aufgabe der Zukunft ist.

851 TRANSHIATAL ESOPHAGECTOMY: A SELECTIVE ROLE IN THE CURATIVE APPROACH TO ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Waqas Butt ◽  
Noel E Donlon ◽  
Jarlath C Bolger ◽  
Claire L Donohoe ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Early Stage ◽  
Pulmonary Complications ◽  
Transhiatal Esophagectomy ◽  
En Bloc ◽  
Curative Intent ◽  
Co Morbidity ◽  
Audit Reports ◽  
Effective Use

Abstract   Surgery remains central to the curative management of esophageal cancer. At this Center, based on evidence from the literature, transthoracic en bloc surgery (TTE) is standard, however transhiatal esophagectomy (THE) is considered for predicted early stage junctional (AEG) tumors, multifocal in situ cancer, or where age or respiratory co-morbidity suggests a high risk with TTE. This audit reports this experience over 19 years. Methods Data was acquired from our prospectively maintained database. Patients who underwent esophagectomy with curative intent and gastric tube reconstruction for mid/distal esophageal or esophagogastric junction cancer (cT1-4aN0-3 M0) from 2000 to 2018 were included. THE was compared with TTE for operative complications (ECCG-defined), and proxy markers of oncologic quality. Results 933 patients were included, 166 (18%) THE and 767 (82%) TTE. The median (range) age was 62(22–83) vs 67(36–86) in TTE and THE, with 43(6%) and 40(24%) over 75 respectively (p < 0.01). There were significantly (p < 0.01) more early tumors in the THE (58%) vs the TTE group(11%). 23% were > ASA 3 in THE vs 12% TTE (p < 0.01). Postoperative pulmonary complications (PPCs) were 11% and 18.3% in THE and TTE cohorts, respectively(p 0.03). In-hospital mortality was 1.2%vs3.4% in THE vs TTE (p = 0.21). Five-year survival was 67% and 40% in THE vs TTE, respectively. Conclusion These data are consistent with the safe and effective use of THE in selected cases. Notably, favourable major pulmonary morbidity and mortality rates for a higher risk cohort. We suggest that this approach may still be relevant in defined scenarios in an increasingly minimally invasive era.

scholarly journals Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Kenro Kawada ◽  
Tatsuyuki Kawano ◽  
Taro Sugimoto ◽  
Kazuya Yamaguchi ◽  
Yuudai Kawamura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Head And Neck ◽  
Anterior Wall ◽  
Transoral Surgery ◽  
Cervical Esophageal Cancer ◽  
En Bloc ◽  
Swallowing Function ◽  
Transnasal Endoscopy ◽  
Submucosal Dissection

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here.Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection.Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection.Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

scholarly journals Clinicopathological examination of ESD as salvage therapy for esophageal cancer after definitive chemo-radiation therapy

2018 ◽  
Vol 06 (04) ◽  
pp. E450-E461 ◽  
Author(s):  
Tomo Kagawa ◽  
Shigenao Ishikawa ◽  
Tomoki Inaba ◽  
Mariko Colvin ◽  
Junki Toyosawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Salvage Therapy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Maximum Diameter ◽  
Pathological Examination ◽  
Muscularis Mucosa ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims Salvage therapy for esophageal cancer following chemo-radiation therapy (CRT) has not been established. We aimed to evaluate endoscopic submucosal dissection (ESD) as a salvage therapy based on histopathological features of lesions. Patients and methods We compared 10 lesions in eight patients with local residual, recurrent, or metachronous esophageal squamous cell carcinoma treated by ESD after CRT (CRT group) and 59 lesions treated by ESD without CRT (non-CRT group) during the same period. Results The en bloc resection rate was 100 % while the complete resection rate was 80.0 % in the lesions after CRT, indicating no difference between the CRT and non-CRT groups. Pathological examination showed that fibrosis was more intense in the lamina propria mucosa, muscularis mucosa, and submucosa. The muscularis mucosa was thicker in both non-tumor and tumor sites in the CRT group compared to the non-CRT group. However, severe submucosal fibrosis was observed only in one lesion in the CRT group. The maximum diameter of the submucosal artery was significantly larger in the CRT group (P < 0.001). Conclusions Compared to the non-CRT group, the lesions in the CRT group were accompanied by fibrosis while the muscularis mucosa were thicker; however, severe fibrosis of the submucosa was rare. It is important to dissect the muscularis mucosa appropriately during ESD, which makes successful dissection of the submucosa possible. Attention should be paid to bleeding from large arteries.

En-bloc esophagectomy for esophageal cancer

2004 ◽  
Vol 188 (3) ◽  
pp. 254-260 ◽  
Author(s):  
Mitsuo Tachibana ◽  
Shoichi Kinugasa ◽  
Hiroshi Yoshimura ◽  
Muneaki Shibakita ◽  
Yasuhito Tonomoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
En Bloc

scholarly journals Successful en bloc resection of superficial esophageal cancer treated by endoscopic submucosal dissection with a splash needle

Endoscopy ◽  
2008 ◽  
Vol 40 (S 02) ◽  
pp. E81-E82 ◽  
Author(s):  
M. Fujishiro ◽  
S. Kodashima ◽  
O. Goto ◽  
S. Ono ◽  
Y. Muraki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Superficial Esophageal Cancer ◽  
En Bloc ◽  
Submucosal Dissection
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