PS02.173: SURGICAL MANAGEMENT OF TRACHEOESOPHAGEAL FISTULAS IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 171-171
Author(s):  
Annelijn Slaman ◽  
Wietse Eshuis ◽  
Wim Van Boven ◽  
Suzanne Gisbertz ◽  
Mark I Van Berge Henegouwen
Keyword(s):  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Tracheoesophageal Fistula ◽  
Conflicts Of Interest ◽  
Muscle Flap ◽  
Severe Complication ◽  
Tertiary Referral ◽  
Muscle Flaps ◽  
Tracheal Defect ◽  
History Of

Abstract Background Tracheoesophageal fistula is a severe complication that can occur in patients who are treated for esophageal cancer. There is currently no consensus about the best surgical treatment. The aim of this study was to evaluate the results after surgical treatment of tracheoesophageal fistulas in patients with a history of esophageal cancer in a tertiary referral center. Methods Consecutive patients with a history of esophageal cancer who were surgically treated for tracheoesophageal fistulas between January 2010 and December 2017 were included. Primary outcome was success rate after surgical treatment. Surgical treatment was defined as successful if no combined (30-day or in-hospital) mortality and no recurrences occurred. Results Twenty patients underwent 26 surgical treatments for tracheoesophageal fistulas. Median age was 64 years (IQR 59–68). One patient developed a tracheoesophageal fistula elsewhere and was referred to our center. The incidence of tracheoesophageal fistulas following esophagectomy in our center was 1.9% (n = 13). Other tracheoesophageal fistulas were caused by traumatic intubation (n = 3) or definitive chemoradiation (n = 3). Surgery consisted of covering the tracheal defect with a muscle flap (n = 15), and/or pericardial patch (n = 11) or primary sutures (n = 5) possibly with resection of the reconstruction (n = 6). The median follow-up was 7.8 months (IQR 1.5–38.2). Treatment was successful in 60.0% of the patients (n = 12). Overall morbidity and combined (in-hospital and 30-day) mortality rates were 65.0% and 35.0%, respectively. In the last 5 patients the muscle flap was fixated to the tracheal defect and reinforced by bovine or autogenic pericardium in whom there was no mortality. Recurrences occurred in 7 patients (35.0%), but only 5 were physically eligible for secondary surgical treatment. The other patients died due to the recurrence. Patients with infectious cause of their tracheoesophageal fistula (n = 11) had more complications (7 versus 6 patients), higher mortality (5 versus 2 patients) and more recurrences (5 versus 2) than non-infectious tracheoesophageal fistulas. Conclusion Tracheoesophageal fistula is a severe complication and is associated with high mortality and recurrence rates. Surgical treatment should only be performed in tertiary referral centers. Using muscle flaps with reinforcement of pericardium might reduce the morbidity and mortality, but larger patient groups should be investigated. Disclosure All authors have declared no conflicts of interest.

PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 102-102
Author(s):  
Marco Antonio Guimaraes Filho ◽  
Flávio Sabino ◽  
Daniel Fernandes ◽  
Carlos Eduardo Pinto ◽  
Luis Felipe Pinto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
National Cancer Institute ◽  
Conflicts Of Interest ◽  
Morbidity Rate ◽  
Surgical Mortality ◽  
Surgical Morbidity ◽  
Hospitalization Time

Abstract Background Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed. Methods The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival. Results Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months. Conclusion Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care. Disclosure All authors have declared no conflicts of interest.

PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 131-131
Author(s):  
Daisuke Ishioka ◽  
Masaaki Saito ◽  
Jun Takahashi ◽  
Tamotsu Obitsu ◽  
Hirokazu Kiyozaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Standard Dose ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
History Of ◽  
Serum Crp

Abstract Background In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer. Methods A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated. Results At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT. Conclusion Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy. Disclosure All authors have declared no conflicts of interest.

P31 SURGICAL MANAGEMENT OF ACQUIRED TRACHEOESOPHAGEAL FISTULA CAUSED BY ESOPHAGEAL DIVERTICULUM

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Sun Yifeng ◽  
Hao Shuguang ◽  
Guo Xufeng ◽  
Yang Yu ◽  
Ye Bo ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Tracheoesophageal Fistula ◽  
Postoperative Morbidity ◽  
Main Bronchus ◽  
Muscle Flap ◽  
Esophageal Diverticulum ◽  
Serratus Anterior ◽  
Esophageal Diverticula ◽  
The Right

Abstract Aim To assess the safety and feasibility of surgical treatment for acquired tracheoesophageal fistula caused by esophageal diverticulum. Background & Methods There are rare studies of the treatment for acquired tracheoesophageal fistulas (TEFs) or bronchoesophageal fistulas (BEFs) caused by traction esophageal diverticula. Between Jan. 2014 and Apr. 2019, twelve patients were admitted to our department for TEF/BEF combined with esophageal diverticula. Clinical characteristics of the twelve patients were retrospectively reviewed. Results Among the 12 orifices in the airway side, there were two at the carina, three at the right main bronchus and seven at the right intermediate bronchus. All orifices in the esophagus side opened at the diverticula wall. All TEF/BEFs received surgical treatment. Firstly, the fistula tunnels were dissected easily. Then, interrupted sutures repaired the fistula orifices in the airway membrane. A limited diverticulectomy with the fistula resection was done in the esophagus. Separate layers of repair were performed for the defect in the esophagus. The serratus anterior muscle flap interposition was performed in all 12 cases. There were no postoperative morbidity and mortality. No recurrence fistula and symptomatic diverticula occurred. The airway and esophagus were unobstructed during the follow-up period. Conclusion Acquired TEF/BEFs caused by esophageal diverticula can be treated successfully by surgery. A limitated diverticulectomy is sufficient to ensure esophagus remodeling.

PS01.203: PREOPERATIVE PATIENT-RELATED FACTORS ASSOCIATED WITH PROGNOSIS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 107-107
Author(s):  
Hiroyuki Kitagawa ◽  
Jun Iwabu ◽  
Tsutomu Namikawa ◽  
Kazuhiro Hanazaki
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Poor Survival ◽  
Residual Cancer ◽  
Related Factors ◽  
History Of ◽  
The Impact ◽  
Preoperative Patient

Abstract Background To investigate the impact of the preoperative patient-related factors on survival after esophagectomy in patients with esophageal cancer. Methods We retrospectively reviewed 140 patients with esophageal cancer who underwent esophagectomy. Preoperative comorbidities, nutritional and inflammation status including the neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS), and their pathological findings were analyzed to assess their relationships with prognosis. Results Univariate analysis demonstrated that a history of cardiovascular disease (CVD), a GPS of 1 or 2, lack of neo-adjuvant chemotherapy (NAC), no thoracoscopic esophagectomy, blood loss volume ≥ 255 ml, the number of lymph node metastasis (LNM) ≥ 2, lymphatic invasion, venous invasion, and residual cancer were associated with poor survival. Multivariate analysis revealed that a history of CVD (hazard ratio [HR], 2.129; 95% confidence interval [CI], 1.327–4.226; P = 0.041), a GPS of 1 or 2 (HR, 3.232; 95% CI, 1.516–6.437; P = 0.003), LNM ≥ 2 (HR, 3.133; 95% CI, 1.355–7.760; P = 0.007), and pathological residual cancer (HR, 2.429; 95% CI, 1.050–5.105; P = 0.039) were independently associated with poor survival, and NAC was associate with better survival (HR, 0.289; 95% CI, 0.118–0.667; P = 0.003). Conclusion Preoperative patient-related factors including a history of CVD and a GPS of 1 or 2 were predictors of poor prognosis after esophagectomy in patients with esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Surgical treatment of multiple primary hypopharyngeal cancer and thoracic esophageal cancer: a report of 7 cases

2010 ◽  
Vol 30 (9) ◽  
pp. 998-1001
Author(s):  
Cai-yun ZHANG ◽  
Shi-cai CHEN ◽  
Hong-liang ZHENG ◽  
Zhi-gang LI ◽  
Min-hui ZHU ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Hypopharyngeal Cancer ◽  
Thoracic Esophageal Cancer ◽  
Multiple Primary

Subvalvular mitral aneurysm a rare pathology

2021 ◽  
pp. 1-2
Author(s):  
Odete R. Mingas ◽  
Ondina Fortunato ◽  
Sebastiana Gamboa
Keyword(s):  
Surgical Treatment ◽  
Left Ventricular ◽  
Left Ventricular Aneurysm ◽  
Ventricular Aneurysm ◽  
African Child ◽  
Cardiorespiratory Arrest ◽  
Previous Infection ◽  
History Of

Abstract We present a rare and challenging case of left ventricular aneurysm in an African child with no history of previous infection or trauma, admitted for surgical treatment, who presented non reversible cardiorespiratory arrest with cardiorespiratory resuscitation before surgery.

845 Progressive external ophthalmoplegia in sleep apnea presenting as floppy eyelid syndrome

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A329-A329
Author(s):  
Pratibha Anne ◽  
Rupa Koothirezhi ◽  
Ugorji Okorie ◽  
Minh Tam Ho ◽  
Brittany Monceaux ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Surgical Treatment ◽  
Sleep Apnea ◽  
Genetic Disorder ◽  
Deltoid Muscle ◽  
Progressive External Ophthalmoplegia ◽  
Ataxic Gait ◽  
Pressure Setting ◽  
Obstructive Sleep ◽  
History Of

Abstract Introduction Floppy eye lid syndrome (FES) is known to be associated with Obstructive sleep apnea (OSA) and chronic progressive external ophthalmoplegia (CPEO) is a rare genetic disorder with mitochondrial myopathy that may present with isolated eye lid ptosis in the initial stages. In a patient with loud snoring and obesity, treating obstructive sleep apnea may improve Floppy eyelid syndrome. Report of case(s) 52-year-old African – American male with past medical history of Hypertension, obesity, glaucoma, CPEO status bilateral blepharoplasty with failed surgical treatment. Patient was referred to Sleep medicine team to rule out Obstructive Sleep Apnea aa a cause of possible underlying FES and residual ptosis. On exam, patient was noted to have bilateral brow and eyelid ptosis and mild ataxic gait. MRI brain with and without contrast was unremarkable. Deltoid muscle biopsy was suggestive of possible congenital myopathy and mild denervation atrophy. Polysomnogram showed severe OSA with AHI of 74.1 per hour and patient was initiated on Auto CPAP at a pressure setting of 7–20 cm H2O. CPAP treatment improved snoring, OSA and subjective symptoms of excessive day time sleepiness but did not improve the residual ptosis. Conclusion Treatment of severe OSA in a patient previously diagnosed with CPEO and failed surgical treatment with bilateral blepharoplasty, did not alter the course of residual ptosis/ floppy eyelids even though his other sleep apnea symptoms have improved. Support (if any) 1. McNab AA. Floppy eyelid syndrome and obstructive sleep apnea. Ophthalmic Plast Reconstr Surg. 1997 Jun;13(2):98–114. doi: 10.1097/00002341-199706000-00005. PMID: 9185193.

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