Analysis of fistula formation of T4 esophageal cancer patients treated by chemoradiotherapy

Background & Aims: The development of an esophagorespiratory fistula (ERF) in patients with esophagealcancer (EC) is associated with poor prognosis. We observed a high rate of vocal fold paralysis (VFP) in patientswith ERF. Data on prevalence and complications of VFP in ERF are lacking. The present study investigated theincidence of VFP in patients with malignant ERF and examined possible risk factors and the impact on survival.Methods: We performed a retrospective case-control study of 46 institutional cases of EC patients with ERFin a time period of eleven years. Patients were matched to 92 randomly selected controls (EC patients withoutERF) in a 1:2 fashion for tumor localization and histology. Demographics, clinical characteristics, recurrence,treatment modalities as well as survival were analyzed.Results: Esophageal cancer patients with ERF developed more often VFP than EC patients without ERF (59%vs. 21%; p=0.02; odds ratio (OR) 4.9). Esophageal cancer patients with ERF had a more pronounced weightloss (7.1 vs. 11.5 kg; P = 0.008), as well as higher rates of esophageal (p=<0.001; OR 22.9) and tracheal stenting(p=<0.001; OR 76.8). Proximal tumor growth (p=0.004; OR 7.9), fistula formation to the trachea (p=<0.001;OR 17.2) and recurrent disease (p=0.04, OR 4.7) was associated with VFP development in EC patients withERF. Vocal fold paralysis in ERF did not adversely affect five-year survival.Conclusions: Vocal fold paralysis is a common complication in more than half of the patients with ERF inEC. It is associated with proximal tumor growth, fistula formation to the trachea and disease recurrence, butdoes not influence survival.

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Vocal Fold Paralysis is a Common Complication in Esophageal Cancer Patients with Esophagorespiratory Fistula

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-580 ◽

2020 ◽

Vol 29 (1) ◽

pp. 11-17

Author(s):

Gregor Paul ◽

Fabian Echterdiek ◽

Wolfram Bohle ◽

Wolfram Zoller

Keyword(s):

Esophageal Cancer ◽

Tumor Growth ◽

Cancer Patients ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

High Rate ◽

Treatment Modalities ◽

Fistula Formation ◽

Common Complication ◽

The Impact

Background and Aims: The development of an esophagorespiratory fistula (ERF) in patients with esophageal cancer (EC) is associated with poor prognosis. We observed a high rate of vocal fold paralysis (VFP) in patients with ERF. Data on prevalence and complications of VFP in ERF are lacking. The present study investigated the incidence of VFP in patients with malignant ERF and examined possible risk factors and the impact on survival. Methods: We performed a retrospective case-control study of 46 institutional cases of EC patients with ERF in a time period of eleven years. Patients were matched to 92 randomly selected controls (EC patients without ERF) in a 1:2 fashion for tumor localization and histology. Demographics, clinical characteristics, recurrence, treatment modalities as well as survival were analyzed. Results: Esophageal cancer patients with ERF developed more often VFP than EC patients without ERF (59% vs. 21%; p=0.02; odds ratio (OR) 4.9). Esophageal cancer patients with ERF had a more pronounced weight loss (7.1 vs. 11.5 kg; P = 0.008), as well as higher rates of esophageal (p=<0.001; OR 22.9) and tracheal stenting (p=<0.001; OR 76.8). Proximal tumor growth (p=0.004; OR 7.9), fistula formation to the trachea (p=<0.001; OR 17.2) and recurrent disease (p=0.04, OR 4.7) was associated with VFP development in EC patients with ERF. Vocal fold paralysis in ERF did not adversely affect five-year survival. Conclusions: Vocal fold paralysis is a common complication in more than half of the patients with ERF in EC. It is associated with proximal tumor growth, fistula formation to the trachea and disease recurrence, but does not influence survival.

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T4 esophageal cancer treated with radical resection

Panminerva Medica ◽

10.23736/s0031-0808.19.03622-x ◽

2020 ◽

Vol 61 (4) ◽

Author(s):

Hai Zhong ◽

Qianjun Li ◽

Wenhui Gao ◽

Xiang Li ◽

Junhua Zhang ◽

...

Keyword(s):

Esophageal Cancer ◽

Radical Resection ◽

T4 Esophageal Cancer

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Self-expandable Metallic Stent Insertion for Nonresectable Esophageal Cancer Patients.

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.52.75 ◽

2001 ◽

Vol 52 (2) ◽

pp. 75-81

Author(s):

Hideo Shimada ◽

Osamu Chino ◽

Takayuki Nishi ◽

Hikaru Tanaka ◽

Yoshifumi Kise ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Stent Insertion ◽

Metallic Stent ◽

Expandable Metallic Stent

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IMRT With Carboplatin Versus IMRT With Carboplatin and Fluorouracil for Eldly Esophageal Cancer Patients

Case Medical Research ◽

10.31525/ct1-nct03910634 ◽

2019 ◽

Author(s):

Keyword(s):

Esophageal Cancer ◽

Cancer Patients

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Faculty of 1000 evaluation for Immunonutrition improves functional capacities in head and neck and esophageal cancer patients undergoing radiochemotherapy: a randomized clinical trial.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718033455.793482713 ◽

2013 ◽

Author(s):

Tim Underwood ◽

Fergus Noble

Keyword(s):

Clinical Trial ◽

Esophageal Cancer ◽

Head And Neck ◽

Randomized Clinical Trial ◽

Cancer Patients ◽

Functional Capacities

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Neutrophil/lymphocyte Ratio after Flow Citometry Periferic Blood Cell Detection - Predictive Marker of Anastomotic Fistula in Colorectal Cancer Surgery

Revista de Chimie ◽

10.37358/rc.20.6.8195 ◽

2020 ◽

Vol 71 (6) ◽

pp. 295-306

Author(s):

Dumitru Radulescu ◽

Vlad Dumitru Baleanu ◽

Andrei Nicolaescu ◽

Marius Lazar ◽

Marius Bica ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Rectal Surgery ◽

Predictive Marker ◽

Fistula Formation ◽

Cell Detection ◽

Colon And Rectal Surgery ◽

Optimal Value ◽

Anastomotic Fistula ◽

Colorectal Cancer Patients

Anastomotic fistula is a dreadful complication of colon and rectal surgery that can put life into danger, being common after colorectal surgery. The preoperative lymphocyte neutrophil ratio (NLR) is known as a prognostic marker for colorectal cancer patients. The existence of a predictive marker of anastomotic fistula in colorectal cancer patients is not fully undestood, so we proposed to investigate the utility of preoperative NLR as a predictor of anastomotic fistula formation. This study the Neutrophils and lymphocytes were detected from periferic blood using flow citometry. We retrospectively evaluated 161 patients with colorectal cancer, who were treated curatively, in which at least one anastomosis was performed, comparing NLR values between patients who had fistula and those with normal healing, then comparing the group with low NLR, with the group with increased NLR, after finding the optimal value of NLR using the ROC curve.The optimal value of the NLR after establishing the cutoff value was 3.07. Between the low NLR group (n=134) and the high NLR group (n=27), were observed statistically significant differences in fistula (p [0.001) and death (p=0.001). The odds ratio for failure in the group with increased NLR was 10.37, which means that patients with NLR]3.54 have a chance of developing anastomotic fistula greater than 10.37 comparable to patients with lower NLR. We suggest the preoperative use of NLR can be used as a predictive marker of anastomotic fistula than can increase the quality of preoperative preparation and therefore the establishment of the optimal surgical technique that can lead to anastomotic fistula risk decrease.

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