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.

RA02.09: THE EFFECT OF PREOPERATIVE BREATHING EXERCISE IN PATIENTS UNDERGOING ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 22-22
Author(s):  
Hamakawa Takuya ◽  
Motohiro Hirao ◽  
Kazuhiro Nishikawa ◽  
Ayako Fujiwara ◽  
Sakae Maeda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Conflicts Of Interest ◽  
Forced Expiratory Volume ◽  
Pulmonary Complications ◽  
Transhiatal Esophagectomy ◽  
Postoperative Pulmonary Complications ◽  
Breathing Exercise ◽  
Subtotal Esophagectomy

Abstract Background Patients with esophageal cancer often have impaired respiratory function. Postoperative pulmonary complications frequently occur in patients undergoing esophagectomy. We instructed patients undergoing esophagectomy to do breathing exercise with Incentive Spirometer Coach 2 (Smiths medical) for at least two weeks before surgery, as well as smoking cessation. Methods We retrospectively reviewed medical records of 52 esophageal cancer patients who underwent spirometry both pre- and post- Coach 2 exercise between 2009 and 2017. We evaluated the change of respiratory function and postoperative complications. The influence of exercise was analyzed between patients who underwent neoadjuvant chemotherapy (NAC group, n = 36) and those treated without NAC (non-NAC group, n = 16). Results 39 males and 13 females were included. Median age was 65 (45–82). Surgical procedures were 48 subtotal esophagectomy, 3 transhiatal esophagectomy, and 1 pharyngo-laryngo-esophagectomy. Vital capacity (VC) and forced expiratory volume in one second (FEV1.0) were significantly improved through exercise; 3405 to 3600ml (P = 0.021) and 2485 to 2555 ml (P = 0.008), respectively. NAC group included more advanced-staged cases but age and baseline respiratory function were not significantly different from non-NAC group. Interval between first and second spirometry was 31 days for non-NAC group, 69 days for NAC group. After exercise, non-NAC group showed significant improvement in VC (3135 to 3600ml, P = 0.006), FEV1.0 (2255 to 2565ml, P = 0.004), whereas NAC group showed little change in VC (3560 to 3630ml, P = 0.514), FEV1.0 (2585 to 2555ml, P = 0.514). Postoperative complication occurred in 27 of 52 cases. Postoperative pneumonia occurred in 7 (13.5%) in the present cohort, which was less frequent than 42% in the historical control cohort without breathing exercise. Conclusion Preoperative breathing exercise with Coach 2 improved respiratory function in patients without NAC. In patients with NAC, the effect of exercise was smaller than non-NAC group, still exercise might suppress the decrease of respiratory function during NAC. Breathing exercise may reduce postoperative pulmonary complications. Disclosure All authors have declared no conflicts of interest.

Impact of comorbidity in the choice of curative treatment for esophageal cancer: A population-based study.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 131-131 ◽  
Author(s):  
Zohra Faiz ◽  
Margreet Van Putten ◽  
Rob H.A. Verhoeven ◽  
Johanna W. van Sandick ◽  
Grard A. P. Nieuwenhuijzen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Treatment Decision ◽  
Population Based ◽  
Curative Intent ◽  
Kaplan Meier ◽  
Co Morbidity ◽  
Study Support ◽  
The Impact

131 Background: Surgery after neoadjuvant chemoradiotherapy (nCRT) is the most common treatment with curative intent for esophageal cancer (EC) patients. Definitive chemoradiotherapy (dCRT) is an alternative for patients who are not eligible for resection because of comorbidity. The purpose of this retrospective study was to evaluate patient and tumor characteristics which are associated with the type of treatment. Methods: We selected all consecutive patients with a locally advanced EC (cT1 N + / T2-3N0-3M0-1a) who were treated with curative intent (nCRT, dCRT or surgery only) in the South East Netherlands between 1995 and 2013. For a proper assessment of the impact of co-morbidity, T4 tumors were excluded. The effect of co-morbidity on treatment decision and on survival was analyzed using a multivariable logistic regression and Kaplan-Meier method. Survival time was defined as time from 6 months after diagnosis until death or until January 1st 2015 for patients who were still alive. Results: Of the 1098 patients, surgery only was performed in 46%, nCRT in 28% and dCRT in 26%. Patients with ≥ 2 co-morbidities underwent more frequently dCRT (OR = 2.35; 95% CI: 1.45-3.86), or resection only (OR = 2.29; 95% CI: 1.41-3.69). Patients > 75 years (OR = 6.66; 95% CI: 3.48-12.77), patients with hypertension and diabetes (OR: 4.05;95% CI: 1.96-8.37-3.90) and patients with cardiovascular (mostly myocardial infarction) and pulmonary comorbidity (OR = 3:33; 95% CI: 1:51 to 7:34) underwent frequently more dCRT than nCRT. Patients with esophageal squamous cell carcinoma (ESCC) also had more frequently dCRT (OR = 2.27; 95% Cl: 1.38-3.73). Patients with an adenocarcinoma and ≥ 2 co-morbidities had favorable 3-year overall survival (OS) after nCRT compared with dCRT and surgery alone (p < 0.01). However, the 3-year OS after nCRT was similar after dCRT in ESCC patients with ≥ 2 co-morbidities (p = 0.75). Conclusions: The results of this study support the treatment with dCRT in patients with SCC of the esophagus, and with at least two co-morbidities, in particular, the combination of cardiovascular / pulmonary disorders and hypertension plus diabetes.

scholarly journals Pleural Solitary Fibrous Tumors—A Retrospective Study on 45 Patients

Medicina ◽  
2020 ◽  
Vol 56 (4) ◽  
pp. 185 ◽  
Author(s):  
Cornel Savu ◽  
Alexandru Melinte ◽  
Radu Posea ◽  
Niculae Galie ◽  
Irina Balescu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Ct Scan ◽  
Single Case ◽  
Postoperative Mortality ◽  
Diagnostic Methods ◽  
Chest Wall Resection ◽  
En Bloc ◽  
Curative Intent ◽  
Solitary Fibrous Tumors ◽  
Thoracic Ct

Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.

scholarly journals Safe and Effective Use of Ozone as Air and Surface Disinfectant in the Conjuncture of Covid-19

Gases ◽  
2020 ◽  
Vol 1 (1) ◽  
pp. 19-32
Author(s):  
Elena Grignani ◽  
Antonella Mansi ◽  
Renato Cabella ◽  
Paola Castellano ◽  
Angelo Tirabasso ◽  
...  
Keyword(s):  
Organic Molecules ◽  
Scientific Literature ◽  
Toxic Substance ◽  
Health And Safety ◽  
Emergency Situation ◽  
Ambient Air ◽  
Public Places ◽  
Safety Measures ◽  
Effective Use

The present paper extrapolates quantitative data for ozone virucidal activity on the basis of the available scientific literature data for a safe and effective use of ozone in the appropriate cases and to explore the safety measures developed under the stimulus of the current emergency situation. Ozone is a powerful oxidant reacting with organic molecules, and therefore has bactericidal, virucidal, and fungicidal actions. At the same time, it is a toxic substance, having adverse effects on health and safety. Its use is being proposed for the disinfection of workplaces’ and public places’ atmosphere, and for disposable masks and personal protective equipment disinfection for reuse, with particular reference to the COVID-19 pandemic outbreak. Ozone can be generated in situ by means of small, compact ozone generators, using dried ambient air as a precursor. It should be injected into the room that is to be disinfected until the desired ozone concentration is reached; after the time needed for the disinfection, its concentrations must be reduced to the levels required for the workers’ safety. The optimal use of ozone is for air and surface disinfection without human presence, using a concentration that is effective for the destruction of viruses, but not high enough to deteriorate materials.

scholarly journals 18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

2021 ◽  
Vol 20 ◽  
pp. 153303382110246
Author(s):  
Seokmo Lee ◽  
Yunseon Choi ◽  
Geumju Park ◽  
Sunmi Jo ◽  
Sun Seong Lee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Concurrent Chemoradiotherapy ◽  
Curative Intent ◽  
Squamous Cell Esophageal Cancer ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

scholarly journals Skeletal muscle PGC-1β signaling is sufficient to drive an endurance exercise phenotype and to counteract components of detraining in mice

2017 ◽  
Vol 312 (5) ◽  
pp. E394-E406 ◽  
Author(s):  
Samuel Lee ◽  
Teresa C. Leone ◽  
Lisa Rogosa ◽  
John Rumsey ◽  
Julio Ayala ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Exercise Training ◽  
Early Stage ◽  
Peroxisome Proliferator ◽  
Disuse Atrophy ◽  
Proof Of Concept ◽  
Peroxisome Proliferator Activated Receptor ◽  
Muscle Disuse ◽  
Training Response

Peroxisome proliferator-activated receptor-γ coactivator (PGC)-1α and -1β serve as master transcriptional regulators of muscle mitochondrial functional capacity and are capable of enhancing muscle endurance when overexpressed in mice. We sought to determine whether muscle-specific transgenic overexpression of PGC-1β affects the detraining response following endurance training. First, we established and validated a mouse exercise-training-detraining protocol. Second, using multiple physiological and gene expression end points, we found that PGC-1β overexpression in skeletal muscle of sedentary mice fully recapitulated the training response. Lastly, PGC-1β overexpression during the detraining period resulted in partial prevention of the detraining response. Specifically, an increase in the plateau at which O2 uptake (V̇o2) did not change from baseline with increasing treadmill speed [peak V̇o2 (ΔV̇o2max)] was maintained in trained mice with PGC-1β overexpression in muscle 6 wk after cessation of training. However, other detraining responses, including changes in running performance and in situ half relaxation time (a measure of contractility), were not affected by PGC-1β overexpression. We conclude that while activation of muscle PGC-1β is sufficient to drive the complete endurance phenotype in sedentary mice, it only partially prevents the detraining response following exercise training, suggesting that the process of endurance detraining involves mechanisms beyond the reversal of muscle autonomous mechanisms involved in endurance fitness. In addition, the protocol described here should be useful for assessing early-stage proof-of-concept interventions in preclinical models of muscle disuse atrophy.

In-situ observaton of the early stage of crystallization in undercooled Pd-Cu-Ni-P melt

2001 ◽  
Vol 44 (8-9) ◽  
pp. 1261-1267 ◽  
Author(s):  
Nobuyuki Nishiyama ◽  
Mitsuhide Matsushita ◽  
Akihisa Inoue
Keyword(s):  
Early Stage
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