Esophageal cancer surgery in Greece during the era of the financial crisis

Author(s):  
Dimitrios Schizas ◽  
Konstantinos S Mylonas ◽  
Natasha Hasemaki ◽  
Efstratia Mpaili ◽  
Vasileia Ntomi ◽  
...  

Summary The aim of this study is to describe outcomes of esophageal cancer surgery in a quaternary upper gastrointestinal (GI) center in Athens during the era of the Greek financial crisis. We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the University of Athens, during the period January 2004–June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. A total of 146 patients were identified. Nearly half of the patients (49.3%) underwent surgery during the last 4 years of the financial crisis (2015–2018). Mean age at the time of surgery was 62.3 ± 10.3 years, and patients did not present at older ages during the recession (P = 0.50). Most patients were stage III at the time of surgery both prior to the recession (35%) and during the financial crisis (39.8%, P = 0.17). Ivor–Lewis was the most commonly performed procedure (67.1%) across all eras (P = 0.06). Gastric conduit was the most common form of GI reconstruction (95.9%) following all types of surgery (P < 0.001). Pre-recession anastomoses were usually performed using a circular stapler (65%). Both during (88.1%) and following the recession (100%), the vast majority of anastomoses were hand-sewn. R0 resection was achieved in 142 (97.9%) patients. Anastomosis technique did not affect postoperative leak (P = 0.3) or morbidity rates (P = 0.1). Morbidity rates were not significantly different prior to (25%), during (46.9%), and after (62.5%) the financial crisis, P = 0.16. Utilization of neoadjuvant chemotherapy (26.9%, P = 0.90) or radiation (8.4%, P = 0.44) as well as adjuvant chemotherapy (54.8%, P = 0.85) and irradiation (13.7%, P = 0.49) was the same across all eras. Disease-free survival (DFS) and all-cause mortality rates were 41.2 and 47.3%, respectively. Median DFS and observed survival (OS) were 11.3 and 22.7 months, respectively. The financial crisis did not influence relapse (P = 0.17) and survival rates (P = 0.91). The establishment of capital controls also had no impact on recurrence (P = 0.18) and survival (P = 0.94). Austerity measures during the Greek financial crisis did not influence long-term esophageal cancer outcomes. Therefore, achieving international standards in esophagectomy may be possible in resource-limited countries when centralizing care.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Masazumi Sakaguchi ◽  
Hisahiro Hosogi ◽  
Yukinari Tokoro ◽  
Daisuke Yagi ◽  
Seiichiro Kanaya

Abstract   We reported the esophagus, trachea, recurrent laryngeal nerves (RLNs), and regional lymph nodes are contained in a common compartment, which we named mesotracheoesophagus. We believe complete resection of the mesotracheoesophagus is ‘mesenteric excision’ for esophageal cancer, which is the fundamental principle of intestinal cancer surgery. Since June 2011, we have performed minimal invasive esophagectomy (MIE) based on this concept. This study was aimed to evaluate outcomes of our MIE. Methods We performed a retrospective study of patients with esophageal cancer who underwent MIE at our hospital between June 2011 and March 2019. Procedure First, the dorsal side of the esophagus was dissected along a dissectable layer recognized outside the mesotracheoesophagus. After complete mobilization of the dorsal side of the esophagus, the trachea and RLNs were released from the mesotracheoesophagus and the rest of the fat tissue was dissected for radical LN dissection in the upper mediastinum. Results We identified consecutive 151 eligible patients. The median age was 68 year-old (IQR 35–83) and 117 patients were male. Tumor location was Ce:Ut:Mt:Lt:Ae = 1:12:67:58:13. Histologic cell-type was squamous cell carcinoma (SqCC):adenocarcinoma = 142:9. The clinical stage (TNM 8th edition) was I:II:III:IVa = 45:39:56:2 and I:IIB:III:IVA = 2:1:5:1 in patients with SqCC and in those with adenocarcinoma, respectively. R0 resection was performed in all patients. The Clavian-Dindo classification grade III and higher RLN paralysis rate was 7.3% and the pneumonia 5.3%. The mortality rate was 1.3%. Three-year disease free survival rate was 62.3%. Three-year overall survival rate was 71.7%. Conclusion The outcomes of mesenteric excision for esophageal cancer surgery were acceptable. Video https://www.dropbox.com/s/y1lm3uurr4t86vq/2020%20ISDE%20Abstract.mov?dl=0.


2018 ◽  
Vol 32 (7) ◽  
Author(s):  
F Klevebro ◽  
A Johar ◽  
J Lagergren ◽  
P Lagergren

SUMMARY Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001–2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86–1.87) or reoperation (OR 1.70; 95% CI 0.88–3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74–1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4056-4056
Author(s):  
A. L. Visbal ◽  
G. Darling ◽  
R. Wong ◽  
M. Guindi ◽  
J. Hornby ◽  
...  

4056 Background: Esophagectomy (E) for locally advanced esophageal cancer (LAEC) yields limited survival; this phase II trial assess feasibility and efficacy of induction chemo-radiotherapy followed by E. Methods: Patients (pts) with LAEC of the thoracic esophagus (TE) or gastroesophageal junction (GEJ), ECOG PS ≤ 2 and surgical candidates underwent POP I (65mg/m2) + C (30mg/m2) on weeks 1,2,4,5,7,8 + concurrent conformal radiotherapy (40Gy/20 fractions (F) during wk 4–7) and external beam boost (10Gy/5F on wk 8); E was performed on wk 12–16 after restaging. Pts receiving 75% of POP chemotherapy were eligible for pathologic (p) evaluation; planned sample size 36 nonM1A pts. Results: 52 pts enrolled from 11/02 to 12/05, mean age 60 yr (33–79), male:40, GEJ:TE/15:37; 37 adenocarcinoma, 13 SCC, 2 other; 13 pts were stage IIA, 7 IIB, 22 III, and 10 IVA. Toxicity during POP treatment included ANC (G3/4:36%), febrile neutropenia (9%), diarrhea (G3:9%), nausea (G3:6%), esophagitis (G3:2%) and anorexia (G3/4:15%); 3 pts stopped treatment due to toxicity, 2 withdrew, 2 progressed becoming non-operable, 1 died of a stroke and 1 from central line sepsis. Clinical response by RECIST was CR:2%, PR:30%, SD:62% and PD in 6%. Dysphagia improved or resolved in 34/47 pts (72%) during POP treatment. Of 43 evaluable pts, 41 underwent E, achieving R0 resection in 98% (1 refused E, 1 pending). Perioperative complications included anastomotic leak (23%), Afib (21%), pneumonia (21%), delirium (10%) and aspiration (10%); 1 pt died from aspiration. 7 pts (17%) achieved pCR, 2 of whom were pretreatment clinical stage IIA, 1 IIb and 4 III; downstaging occurred in 3/7 pts; 15 pts (36.6%) achieved minimal residual disease, 15 (36.6%) pPR, and 4 (9.8%) pSD. At a median (med) follow-up of 15.2 months (1.3–34.5m), 16/52 patients died (med & 2yr overall survival (OS) of 29 m & 66%). Of 41 resected pts, 17 recurred (med & 2yr disease free survival (DFS) of 20m & 46%) of whom 10 died of progression (med & 2-yr OS of 29m & 68.4%). 2yr DFS & OS was 83% & 86% in pCR vs 41% & 76% in non-pCR. Conclusion: In LAEC, induction I/C and radiotherapy followed by E is associated with 72% dysphagia improvement, a significant but manageable toxicity profile, and encouraging survival compared to historical controls. [Table: see text]


Author(s):  
Keita Takahashi ◽  
Katsunori Nishikawa ◽  
Yuichiro Tanishima ◽  
Yoshitaka Ishikawa ◽  
Takahiro Masuda ◽  
...  

2013 ◽  
Vol 65 (4) ◽  
pp. 271-275 ◽  
Author(s):  
Uberto Fumagalli ◽  
Maurizio Bersani ◽  
Antonio Russo ◽  
Alessandra Melis ◽  
Stefano de Pascale ◽  
...  

2005 ◽  
Vol 80 (4) ◽  
pp. 1510-1512 ◽  
Author(s):  
Burkhard H.A. von Rahden ◽  
Hubert J. Stein ◽  
Georg Schmidt ◽  
Holger Bartels ◽  
Matthias Overbeck ◽  
...  

2008 ◽  
Vol 21 (7) ◽  
pp. 619-627 ◽  
Author(s):  
Satoshi Aiko ◽  
Yutaka Yoshizumi ◽  
Takamitsu Ishizuka ◽  
Takuya Horio ◽  
Takashi Sakano ◽  
...  

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