Surgical Outcome of Colon Interposition in Esophageal Cancer Surgery: Analysis of Risk Factors for Conduit-Related Morbidity

2017 ◽  
Vol 66 (05) ◽  
pp. 384-389 ◽  
Author(s):  
Kanghoon Lee ◽  
Seung-Il Park ◽  
Dong Kim ◽  
Yong-Hee Kim ◽  
Se Choi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Graft Failure ◽  
Postoperative Morbidity ◽  
Neoadjuvant Chemoradiotherapy ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
Colon Interposition ◽  
Esophageal Reconstruction ◽  
Survival Duration ◽  
Complication Rates

Background We aimed to assess the feasibility, surgical outcomes, and conduit-related complications of colon interposition in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent colon interposition for esophageal reconstruction between June 2000 and June 2013 were retrospectively reviewed. Results A total of 67 consecutive patients (mean age, 62.2 ± 7.9 years) were enrolled. During this time period, 944 patients underwent esophageal reconstruction using gastric conduit. Twelve patients (17.9%) also received neoadjuvant chemoradiotherapy (nCRT). The median follow-up duration was 44 months (range, 1–168 months); median survival duration was 63 months (range, 1–168 months); and 3- and 5-year overall survival rates were 61.6 and 49.4%, respectively. A total of 43 patients (64.2%) experienced at least 1 postoperative morbidity. According to the Clavien–Dindo grading system, 36 patients (54%) experienced postoperative morbidity of higher than Grade III. Pulmonary complications were most commonly observed complications among the patients (18 patients, 26.9%). Anastomosis site leakage developed in 11 patients (16.4%), and 3 of these patients (6.0%) eventually experienced graft failure. On multivariate analysis, nCRT was determined as a significant risk factor for conduit-related complications (leakage, graft failure, fistula, and stricture). Conclusion Colon interposition is associated with relatively high complication rates, whereas nCRT is associated with conduit morbidity.

Multiple craniotomies in the management of multifocal and multicentric glioblastoma

2011 ◽  
Vol 114 (3) ◽  
pp. 576-584 ◽  
Author(s):  
Wael Hassaneen ◽  
Nicholas B. Levine ◽  
Dima Suki ◽  
Abhijit L. Salaskar ◽  
Alessandra de Moura Lima ◽  
...  
Keyword(s):  
Postoperative Morbidity ◽  
Extent Of Resection ◽  
Survival Duration ◽  
Karnofsky Performance Scale ◽  
Complication Rates ◽  
Group A ◽  
Group B ◽  
Performance Scale ◽  
Single Lesion

Object Multiple craniotomies have been performed for resection of multiple brain metastases in the same surgical session with satisfactory outcomes, but the role of this procedure in the management of multifocal and multicentric glioblastomas is undetermined, although it is not the standard approach at most centers. Methods The authors performed a retrospective analysis of data prospectively collected between 1993 and 2008 in 20 patients with multifocal or multicentric glioblastomas (Group A) who underwent resection of all lesions via multiple craniotomies during a single surgical session. Twenty patients who underwent resection of solitary glioblastoma (Group B) were selected to match Group A with respect to the preoperative Karnofsky Performance Scale (KPS) score, tumor functional grade, extent of resection, age at time of surgery, and year of surgery. Clinical and neurosurgical outcomes were evaluated. Results In Group A, the median age was 52 years (range 32–78 years); 70% of patients were male; the median preoperative KPS score was 80 (range 50–100); and 9 patients had multicentric glioblastomas and 11 had multifocal glioblastomas. Aggressive resection of all lesions in Group A was achieved via multiple craniotomies in the same session, with a median extent of resection of 100%. Groups A and B were comparable with respect to all the matching variables as well as the amount of tumor necrosis, number of cysts, and the use of intraoperative navigation. The overall median survival duration was 9.7 months in Group A and 10.5 months in Group B (p = 0.34). Group A and Group B (single craniotomy) had complication rates of 30% and 35% and 30-day mortality rates of 5% (1 patient) and 0%, respectively. Conclusions Aggressive resection of all lesions in selected patients with multifocal or multicentric glioblastomas resulted in a survival duration comparable with that of patients undergoing surgery for a single lesion, without an associated increase in postoperative morbidity. This finding may indicate that conventional wisdom of a minimal role for surgical treatment in glioblastoma should at least be questioned.

Effect of technologic advancements in radiotherapy on postoperative pulmonary complications after neoadjuvant chemoradiation in esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 110-110
Author(s):  
Bevan H. Myles ◽  
Caimiao Wei ◽  
Ritsuko Komaki ◽  
Ara A. Vaporciyan ◽  
Reza J. Mehran ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Pulmonary Complication ◽  
Neoadjuvant Chemoradiation ◽  
Pulmonary Complications ◽  
Complication Rates ◽  
Postoperative Pulmonary Complications ◽  
Radiation Technology ◽  
3D Crt

110 Background: Although 3D conformal radiation therapy (3D-CRT) is currently the de facto standard for the treatment of esophageal cancers, technologies such as Intensity Modulated Radiation Therapy (IMRT) or Proton Beam Therapy (PBT) are increasingly being used, but the evidence for the clinical benefits of these technologies are lacking. We hypothesized that radiation technology influences perioperative complications in esophageal cancer patients treated with neoadjuvant chemoradiation. Methods: We evaluated 423 patients (3D-CRT (n=208, 1998-2008), IMRT (n=165, 2004-2011), and PBT (n=50, 2006-2011)) treated with surgical resection after chemoradiation from 1998-2011 at M. D. Anderson Cancer Center. Postoperative complications (Pulmonary, GI, cardiac, wound healing) were recorded up to 30 days postoperatively. Kruskal-Wallis tests and Chi-square or Fisher’s exact tests assessed associations between continuous and categorical variables and the radiation technology, respectively. Logistic regression model tested the association between treatment technologies and complications adjusting for other significant patient characteristics. Results: While radiation modality was not significantly associated with postoperative GI (leak, ileus, fistula), cardiac (MI, AF, CHF), and wound complications, there was a significant reduction in postoperative pulmonary complications (ARDS, pleural effusion, respiratory insufficiency, pneumonia) for IMRT compared to 3D-CRT (OR 0.46, 95%CI 0.25, 0.83) and PBT compared to 3D-CRT (OR 0.26, 95%CI 0.09, 0.70), but not when IMRT was compared to PBT (OR 1.74, 95%CI 0.66, 4.61) after adjusting for preRT DLCO level. The median length of hospital stay was also significantly different between treatment modalities (12, 10, and 8 days for 3D-CRT, IMRT, and PBT, respectively, p<0.0001). There was no significant association between treatment year with pulmonary complication rates. Conclusions: Radiation technologies such as IMRT and PBT reduced postoperative pulmonary complication rates compared to 3D-CRT in esophageal cancer patients. This result needs to be confirmed in larger prospective studies.

scholarly journals TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY 3D HD FOR THORACIC ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY

2018 ◽  
Vol 5 (3) ◽  
pp. 133-146
Author(s):  
F. Achim ◽  
M. Gheorghe ◽  
A. Constantin ◽  
P. Hoara ◽  
C. Popa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Technology ◽  
Morbidity And Mortality ◽  
Esophageal Reconstruction ◽  
Thoracic Esophageal Cancer ◽  
Invasive Esophagectomy

Esophagectomy is a major surgical procedure with morbidity, and mortality related to the patient&#39;scondition, stage of the disease at the moment of diagnosis, complementary treatments and surgicalexperience of the surgeon. Minimally invasive esophagectomy (MIE) may lead to a reduction inperioperative morbidity and mortality with an acceptable quality of life and similar oncologic resultsto an open approach. We present an experience of the Center of Excellence in Esophageal Surgeryregarding totally MIE through thoracolaparoscopic modified McKeown triple approach, followedby esophageal reconstruction by gastric intrathoracic pull-up and cervical esophagogastricanastomosis and feeding jejunostomy in a patient with thoracic esophageal cancer who underwentpreoperative neoadjuvant chemoradiotherapy. The short-term outcomes of the totally minimallyinvasive esophagectomy procedure were very encouraging. The overall operative times were:thoracoscopic - 120 minutes, laparoscopic - 130 minutes and cervical - 50 minutes with a total of360 minutes. The intraoperative blood loss was 200 ml. The postoperative outcome was favorablewith early feeding on the jejunostomy. The control of cervical anastomosis was performed in the 6thday postoperative and the patient was discharged in the 10th day postoperative without anysymptomatology. At the first and third-month follow-up was not reported any postoperativecomplications. The totally minimally invasive approach using advanced technology of endoscopicsurgery allowed for this patient a simple postoperative evolution, no major complications and agood recovery after extensive surgery. The solid experience in open esophageal surgery ofUpper Gastro-Intestinal surgeons provides a fast learning curve of complex minimally invasivesurgical procedures with reduced perioperative morbidity. Long-term follow-up can confirm theresults from the literature regarding the survival, which is expected to be for these patients atleast equivalent with outcomes after open esophagectomy.

Perioperative morbidity and mortality after radical lymphadenectomy for operable esophageal cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15554-e15554
Author(s):  
C. S. Pramesh ◽  
R. C. Mistry
Keyword(s):  
Esophageal Cancer ◽  
Demographic Data ◽  
Postoperative Mortality ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Anastomotic Leaks ◽  
Prolonged Ventilation ◽  
Radical Lymphadenectomy

e15554 Background: The role of radical lymphadenectomy in localized resectable esophageal cancer is controversial. Radical lymphadenectomy confers more accurate staging, and improves locoregional control rates. However, there is no convincing evidence yet for a definite improvement in overall survival. Higher morbidity and mortality rates with radical lymphadenectomy are often quoted as reasons to avoid these procedures during esophageal resection. Methods: We retrieved data from October 2003 to December 2008 from a prospective surgical database maintained at a single tertiary cancer centre. Demographic data, operative details and postoperative morbidity and mortality were analysed. Postoperative complications analysed included need for prolonged ventilation, pulmonary complications, recurrent laryngeal nerve (RLN) paresis, cardiac ischemia and arrhythmias, and anastomotic leaks. Results: Six hundred and forty five patients (453 men, 192 women, mean age 53.6 years, range 19–76 years) were operated by transthoracic total esophagectomy for esophageal cancer between October 2003 and December 2007. Three hundred and ninety eight patients underwent two-field lymphadenectomy and 247 underwent three field radical lymphadenectomy. There was a higher incidence of prolonged ventilation (13.4% vs 6.6%, p=0.003), RLN paresis (61.4% vs 32.5%, p=0.000), and pulmonary complications (38.5% vs 24.4%, p=0.000) with radical three field lymphadenectomy compared to two field lymphadenectomy. The incidence of cardiac events (1.6% vs 2.6%, p=0.230), cardiac arrhythmias (5.8% vs 7.1%, p=0.640), anastomotic leaks (6.7% vs 8.2%, p=0.258) and postoperative mortality (5% vs 5.3%, p=0.80) were similar in the two groups. Conclusions: Radical three field lymphadenectomy increases pulmonary complication rates but has no impact on cardiac complications, anastomotic leaks, or operative mortality. No significant financial relationships to disclose.

Neoadjuvant chemoradiotherapy, chemotherapy, and radiotherapy do not significantly increase the incidence of anastomotic leakage after esophageal cancer surgery: a meta-analysis

2021 ◽  
Author(s):  
Zixian Jin ◽  
Jian Zhang ◽  
Dong Chen ◽  
Sikai Wu ◽  
Penglai Xue ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Randomized Controlled Trials ◽  
Anastomotic Leakage ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Significant Risk ◽  
Cancer Surgery ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Esophageal Cancer Surgery

Summary This study investigated whether neoadjuvant therapies, such as neoadjuvant chemoradiotherapy (NCRT), neoadjuvant chemotherapy (NCT), and neoadjuvant radiotherapy (NRT), would affect the incidence of anastomotic leakage (AL) after esophageal cancer surgery. Published randomized controlled trials were reviewed, and the incidence of AL after esophageal cancer was statistically analyzed in each study. Meta-analysis was performed using Revman and Stata software. A total of 17 randomized controlled trials with 2874 patients were reviewed showing that, in general, preoperative neoadjuvant therapies were not significant risk factors for AL after esophageal cancer surgery (relative risk [RR] = 0.82, 95% CI = 0.64–1.04). NCRT and NRT did not significantly increase the risk of postoperative AL in patients with esophageal cancer (RR = 0.81, 95% CI = 0.63–1.05; RR = 0.64, 95% CI = 0.14–2.97, respectively). Moreover, NCT has no significant correlation with the occurrence of AL (RR = 1.01, 95% CI = 0.57–1.80). NCRT, NCT, and NRT do not significantly increase the incidence of gastroesophageal AL after esophageal cancer surgery.

scholarly journals TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Martin Nnaji ◽  
Renol Koshy ◽  
Oliver Priest ◽  
Duncan Beardsmore ◽  
Vamshi Jagadesham ◽  
...  
Keyword(s):  
Pulmonary Complication ◽  
Enhanced Recovery ◽  
Significant Risk ◽  
Pulmonary Complications ◽  
High Flow ◽  
University Hospital ◽  
Complication Rates ◽  
Tertiary Referral Centre ◽  
Female Ratio ◽  
High Flow Oxygen

Abstract Introduction Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre. Methods We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery. Results Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery. Conclusion Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.

Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

2014 ◽  
Vol 28 (4) ◽  
pp. 358-364 ◽  
Author(s):  
Y. Hamai ◽  
J. Hihara ◽  
J. Taomoto ◽  
I. Yamakita ◽  
Y. Ibuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Morbidity ◽  
Neoadjuvant Chemoradiotherapy ◽  
Morbidity And Mortality
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