303 LONG-TERM SURVIVAL AND PULMONARY COMPLICATIONS IN MEDIASTINOSCOPIC ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Hirotaka Konishi
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Cancer Progression ◽  
Pulmonary Complication ◽  
Pulmonary Complications ◽  
Recurrent Nerve ◽  
Radical Esophagectomy ◽  
Term Survival ◽  
Nerve Paralysis

Abstract   The radical esophagectomy for esophageal cancer is an invasive therapy due to a long one-lung ventilation. The mediastinoscopic esophagectomy in consideration of pulmonary complications became eligible for Japanese health insurance. Methods Radical esophagectomies (R0/1, gastric tube reconstruction) by thoracotomy/thoracoscopy (groupT) or mediastinoscopy (groupM) were performed for 118/58 or 225 patients with esophageal cancer. The long-term therapeutic results of mediastinoscopic radical esophagectomy are investigated. Results In clinicopathological features, younger and lower PS patients, neoadjuvant chemotherapy, advanced cases, or R1 resection were more frequent in groupT (p < 0.01). Pulmonary complication was not significantly different in both groups (15.5 vs 11.0%, p = 0.19), whereas the any complications, including the recurrent nerve paralysis, were significantly frequent in groupM. The 5-years overall survival was better in group M (53.0% vs 68.2%, p = 0.04), but it may be because of the difference of cancer progression. In the subgroup analysis, the overall survival rate was similar in each clinical stage. The survival of patients with pulmonary complication was significantly worse in groupT. Conclusion The survival of patients underwent trans-mediastinoscopic radical esophagectomy was not different from that with conventional esophagectomy. The influence of pulmonary complications on survival may be lower in mediastinoscopic esophagectomy.

RA04.02: THE COMPLICATIONS AND LONG-TERM SURVIVAL IN TRANS-MEDIASTINAL RADICAL ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 25-25
Author(s):  
Hirotaka Konishi ◽  
Hitoshi Fujiwara ◽  
Atsushi Shiozaki ◽  
Katsutoshi Shoda ◽  
Toshiyuki Kosuga ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Pulmonary Complication ◽  
Disease Stage ◽  
Recurrent Nerve ◽  
Radical Esophagectomy ◽  
Term Survival ◽  
Nerve Paralysis

Abstract Background (Bachground) The radical esophagectomy for esophageal cancer is an invasive therapy for a long one-lung ventilation. We have been stylized trans-mediastinal radical esophagectomy in order to relieve the pulmonary complications. Methods (Candidates) The radical esophagectomy (R0/1, gastric tube reconstruction) by thoracotomy/thoracoscopy (groupT) or mediastinoscopy (groupM) were performed for 120/58 or 131 esophageal cancer patients. The long-term therapeutic results of trans-mediastinal radical esophagectomy and complications (Clavien-Dindo classification≧ 2) are investigated. Results (Results) In clinicopathological features, neoadjuvant therapy, cStage III/IV advanced cases, or R1 resection was significant in groupT (P < 0.01). The frequency of anastomotic leakage and recurrent nerve paralysis were not different in both group (P = 0.94, 0.69, respectively), whereas pulmonary complication was significantly decreased (25.2 vs 10.9%, P = 0.003). Any complications were slightly frequent in groupT than in group M (32.4 vs 29.5%, P = 0.59). The 5-years overall survival was slightly better in group M than in group T due to the effects of disease stage (53.5% vs 63.4%, P = 0.19). In the subgroup analysis, the overall survival rate was similar in each clinical stage. Conclusion (Discussion) The trans-mediastinal radical esophagectomy was effective for the relief of pulmonary complication, and was not inferior to the esophagectomy by thoracotomy or thoracoscopy in the prognosis. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals Impact of Smoking Status on Perioperative Morbidity, Mortality, and Long-Term Survival Following Transthoracic Esophagectomy for Esophageal Cancer

2021 ◽  
Author(s):  
Sivesh K. Kamarajah ◽  
Anantha Madhavan ◽  
Jakub Chmelo ◽  
Maziar Navidi ◽  
Shajahan Wahed ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Smoking Status ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Transthoracic Esophagectomy ◽  
Anastomotic Leaks ◽  
Term Survival ◽  
Long Term Survival ◽  
Perioperative Morbidity

Abstract Introduction Esophagectomy is a key component in the curative treatment of esophageal cancer. Little is understood about the impact of smoking status on perioperative morbidity and mortality and the long-term outcome of patients following esophagectomy. Objective This study aimed to evaluate morbidity and mortality according to smoking status in patients undergoing esophagectomy for esophageal cancer. Methods Consecutive patients undergoing two-stage transthoracic esophagectomy (TTE) for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between January 1997 and December 2016 at the Northern Oesophagogastric Unit were included from a prospectively maintained database. The main explanatory variable was smoking status, defined as current smoker, ex-smoker, and non-smoker. The primary outcome was overall survival (OS), while secondary outcomes included perioperative complications (overall, anastomotic leaks, and pulmonary complications) and survival (cancer-specific survival [CSS], recurrence-free survival [RFS]). Results During the study period, 1168 patients underwent esophagectomy for cancer. Of these, 24% (n = 282) were current smokers and only 30% (n = 356) had never smoked. The median OS of current smokers was significantly shorter than ex-smokers and non-smokers (median 36 vs. 42 vs. 48 months; p = 0.015). However, on adjusted analysis, there was no significant difference in long-term OS between smoking status in the entire cohort. The overall complication rates were significantly higher with current smokers compared with ex-smokers or non-smokers (73% vs. 66% vs. 62%; p = 0.018), and there were no significant differences in anastomotic leaks and pulmonary complications between the groups. On subgroup analysis by receipt of neoadjuvant therapy and tumor histology, smoking status did not impact long-term survival in adjusted multivariable analyses. Conclusion Although smoking is associated with higher rates of short-term perioperative morbidity, it does not affect long-term OS, CSS, and RFS following esophagectomy for esophageal cancer. Therefore, implementation of perioperative pathways to optimize patients may help reduce the risk of complications.

Nomogram predicting long-term survival probability of thoracic esophageal squamous cell carcinoma after radical esophagectomy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4094-4094
Author(s):  
Weimin Mao ◽  
Xinming Zhou ◽  
Qixun Chen ◽  
Youhua Jiang ◽  
Xun Yang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Regression Model ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Radical Esophagectomy ◽  
Term Survival

4094 Background: Nomograms have been widely and successfully used for numerous cancers to obtain reliable prognostic information for each individual patient.To date, however, no studies have conducted survival estimates using nomograms for esophageal squamous-cell carcinoma (ESCC) in Chinese population.The purpose of this study is to develop a nomogram to predict the long-term survival probabilities in patients diagnosed with ESCC after radical esophagectomy. Methods: This study involves a dataset containing 1923 patients who underwent radical esophagectomy for ESCC at Zhejiang Cancer Hospital in Hangzhou, China. Among them, 1,578 patients with no missing data were used to build a prognostic nomogram based on Cox proportional hazard regression model. A multivariate survival analysis using Cox regression model was applied to identify significant variables with P-values <0.05. On the basis of the predictive model with the identified variables, a nomogram was constructed for predicting five-year and ten-year overall survival probabilities. The prediction model was internally validated using bootstrap resampling, assessing its optimism-corrected discrimination and calibration. Results: The median of overall survival times of 1578 ESCC patients was 35.6 months, and the 5-year and 10-year survival rate was 32% and 20%, respectively. The multivariate Cox model identified alcohol, tumor length, surgical approach, number of surgical removed lymph node, ratio of metastatic lymph nodes, region of lymph nodes dissection, depth of invasion, differentiation of tumor, postoperative complications as covariates significantly associated with survival. Across the 100 bootstrap replicates, the median optimism-corrected summary C-index for predicting survival was 0.713 (SE=0.011). Conclusions: A nomogram predicting 5- and 10-year overall survival after radical esophagectomy for ESCC in Chinese population was constructed and validated based on nine significant variables. The nomogram can be applied in daily clinical practice for individualized survival prediction of ESCC patients after potentially curative esophagectomy.

O45 THE ASSOCIATION OF PERIOPERATIVE QUALITY-OF-CARE PARAMETERS (TEXTBOOK OUTCOME) WITH LONG TERM OUTCOME AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
M C Kalff ◽  
I Vesseur ◽  
W Eshuis ◽  
D Heineman ◽  
F Daams ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Cox Regression ◽  
Neoadjuvant Treatment ◽  
Recurrence Rates ◽  
Term Survival ◽  
Long Term Outcome ◽  
Asa Score

Abstract Aim The objectives of this study were to confirm the association of textbook outcome (TO) and overall long-term survival after esophagectomy for esophageal cancer, to investigate the relationship of TO and recurrence rates and to identify clinicopathological predictors for not achieving TO. Background & Methods Despite current improvements in the multimodal treatment of esophageal cancer, surgery remains the key component. Therefore, it is essential to optimize the surgical procedure and to pursue the highest surgical quality. TO is a composite measure of ten perioperative parameters reflecting the quality of surgical care concerning esophagectomy. All patients with esophageal cancer who underwent a transthoracic or transhiatal esophagectomy with curative intent in two tertiary referral centers in The Netherlands between 2007-2016 were included. Patients with a carcinoma in situ, patients undergoing salvage or emergency procedure and patients that applied for opt-out were excluded. Clinicopathological predictors for not achieving TO were identified using univariate and multivariate logistic regression. Survival was compared using Kaplan-Meier life-table estimates and cox regression. Results In total, 1057 patients were included. Over time, the percentage of patients who achieved TO increased from 28.9% in 2007 to 37.5% in 2016. BMI under 18.5, ASA score above one and age above 65 years were associated with a worse TO rate (OR 2.72 [1.02-7.24], ASA 2 OR 1.57 [1.13-2.17] and ASA 3+4 OR 2.33 [1.56-3.48], OR 1.387 [1.06-1.81], respectively), whereas neoadjuvant treatment predicted a better TO rate (OR 0.58 [0.41-0.81]). The median overall survival was 53 months (95% CI 42 – 63) for patients with TO and 35 months (95% CI 29 – 41) for patients without TO; resulting in an overall survival benefit of 18 months (HR 0.759, 95% CI 0.636 – 0.906, P = 0.002). The recurrence rates between TO and no-TO differed, but was not statistically significant (47.1% vs 42.8%, P = 0.177). Conclusion BMI less than 18.5, ASA-score higher than one and age older than 65 were characteristics associated with not achieving TO. Neoadjuvant therapy was associated with a better TO rate. Achieved TO resulted in a better overall five-year survival indicating the importance of pursuing TO.

scholarly journals Favourable long-term survival of patients with esophageal cancer treated with extended transhiatal esophagectomy combined with en bloc lymphadenectomy: results from a retrospective observational cohort study

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dino Kröll ◽  
Yves Michael Borbély ◽  
Bastian Dislich ◽  
Tobias Haltmeier ◽  
Thomas Malinka ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Tertiary Care ◽  
Neoadjuvant Treatment ◽  
R0 Resection ◽  
En Bloc ◽  
Term Survival ◽  
Long Term Survival

Abstract Background Although considered complex and challenging, esophagectomy remains the best potentially curable treatment option for resectable esophageal and esophagogastric junction (AEG) carcinomas. The optimal surgical approach and technique as well as the extent of lymphadenectomy, particularly regarding quality of life and short- and long-term outcomes, are still a matter of debate. To lower perioperative morbidity, we combined the advantages of a one-cavity approach with extended lymph node dissection (usually achieved by only a two-cavity approach) and developed a modified single-cavity transhiatal approach for esophagectomy. Methods The aim of this study was to evaluate the outcome of an extended transhiatal esophageal resection with radical bilateral mediastinal en bloc lymphadenectomy (eTHE). A prospective database of 166 patients with resectable cancers of the esophagus (including adenocarcinomas of the AEG types I and II) were analyzed. Patients were treated between 2001 and 2017 with eTHE at a tertiary care university center. Relevant patient characteristics and outcome parameters were collected and analyzed. The primary endpoint was 5-year overall survival. Secondary outcomes included short-term morbidity, mortality, radicalness of en bloc resection and oncologic efficacy. Results The overall survival rates at 1, 3 and 5 years were 84, 70, and 61.0%, respectively. The in-hospital mortality rate after eTHE was 1.2%. Complications with a Clavien-Dindo score of III/IV occurred in 31 cases (18.6%). A total of 25 patients (15.1%) had a major pulmonary complication. The median hospital stay was 17 days (interquartile range (IQR) 12). Most patients (n = 144; 86.7%) received neoadjuvant treatment. The median number of lymph nodes resected was 25 (IQR 17). The R0 resection rate was 97%. Conclusion In patients with esophageal cancer, eTHE without thoracotomy resulted in excellent long-term survival, an above average number of resected lymph nodes and an acceptable postoperative morbidity and mortality.

P80 LONG-TERM OUTCOMES OF CLINICAL AND PATHOLOGICAL-STAGED T3N3 ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
S K Kamarajah ◽  
N Newton ◽  
M Navidi ◽  
S Wahed ◽  
A Immanuel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
Stage Migration ◽  
Pathological Stage ◽  
Term Survival ◽  
The Impact

Abstract Objective The aim of this study was to determine the outcomes of patients with T3N3 esophageal cancers and determine differences between the clinical stage and pathological stage. Background Locally advanced esophageal cancer is associated with poor long-term survival. Pre-treatment and post-treatment stage may differ due to the effect of neoadjuvant therapy and inaccuracies in staging. Multimodality staging followed by discussion at an MDT is considered the gold standard. Despite this, patients can be under-staged or over-staged leading to inadequate or unnecessary treatment associated with high levels of morbidity. Methods Consecutive patients from a single unit between 2010 - 2018 were included with either clinical (cT3N3) or pathological (pT3N3) esophageal cancer. Outcomes were compared between patients that underwent transthoracic esophagectomy and radical two field lymphadenectomy with or without neoadjuvant treatment and those patients staged cT3N3 treated non-surgically (NSR). Demographics, clinical and pathological stage, histological information and outcomes were recorded. Patients were staged using the TNM 8. Results This study included 156 patients, of which 63 had non-surgical treatment, only 3 of these had radical treatment. Of the remaining 93 patients who underwent esophagectomy, 34 were cT3N3, 54 were pT3N3 and five were unchanged before and after treatment. Median overall survival (OS) for surgical cT3N3 patients was significantly longer than pT3N3 and NSR (median: NR vs 19 vs 8 months, p<0.001). Twenty-seven patients with cT3N3 had lower staging following treatment whilst 3 had a higher stage. Conclusion T3N3 disease carries a poor prognosis. Within this cohort cT3N3 disease treated surgically has a high 5-year overall survival suggesting possible over-staging and stage migration due to neoadjuvant therapy. To contrast this those not having surgery have a dismal prognosis. The impact of neoadjuvant treatment cannot be predicted and, current staging modalities may be inaccurate. Clinical stage should be used with caution when counselling patients regarding management and prognosis.

PS02.248: ASSESSMENT OF BODY COMPOSITION AND SARCOPENIA IN PATIENTS WITH ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 193-194
Author(s):  
Piers R Boshier ◽  
Rachel Heneghan ◽  
Sheraz R Markar ◽  
Vickie E Baracos ◽  
Donald E Low
Keyword(s):  
Systematic Review ◽  
Esophageal Cancer ◽  
Body Composition ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Pulmonary Complications ◽  
Current Evidence ◽  
Term Survival ◽  
Potential Implication

Abstract Background There has recently been increased interest in the assessment of body composition in patients with esophageal cancer for the purpose of nutritional evaluation and prognostication. This systematic review and meta-analysis intends to summarize and critically evaluate the current literature concerning the assessment of body composition in patients with esophageal cancer and to assess its potential implication upon early and late outcomes. Methods A systematic literature search (up to August-2017) was conducted for studies describing the assessment of body composition in patients with esophageal and gastroesophageal junctional cancer. Meta-analysis of postoperative outcomes including long-term survival was performed using random effects models. Results C Twenty-nine studies reported the assessment of body composition in 3193 patients. Methods used to assess body composition in patients with esophageal cancer included: computerized tomography (n = 18 studies); bioelectrical impedance analysis (n = 10), and; dual-energy x-ray absorptiometry (n = 1). Significant variability was observed in regard to study design and the criteria used to define individual parameters of body composition. Sarcopenic patients had a higher incidence of postoperative pulmonary complications (7 studies, OR 2.03, 95%-CI 1.32 to 3.11, P = 0.001) after esophagectomy. Meta-analysis of six studies presenting long-term outcomes after esophagectomy identified significantly worse survival in patients who were sarcopenic (HR 1.70, 95%-CI 1.33 to 2.17, P < 0.0001; Figure 1). Conclusion The assessment of body composition has the potential to become a clinically useful tool that could support decision-making in patients with esophageal cancer. Current evidence is however weakened by inconsistencies in methods of assessing and reporting body composition in this patient group. Disclosure All authors have declared no conflicts of interest.

Clinical outcome and long-term survival following radical esophagectomy in the elderly

2001 ◽  
Vol 120 (5) ◽  
pp. A747-A748
Author(s):  
S DRESNER ◽  
A IMMMANUEL ◽  
P LAMB ◽  
S GRIFFIN
Keyword(s):  
Clinical Outcome ◽  
The Elderly ◽  
Radical Esophagectomy ◽  
Term Survival ◽  
Long Term Survival
Sign in / Sign up

Export Citation Format

Share Document