PS02.231: RELATIONSHIP BETWEEN CHANGE IN TONGUE PRESSURE AND PNEUMONIA AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 187-188
Author(s):  
Aya Yokoi ◽  
Daisuke Ekuni ◽  
Reiko Yamanaka ◽  
Manabu Morita
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Body Temperature ◽  
Conflicts Of Interest ◽  
Invasive Procedure ◽  
Portable Device ◽  
Postoperative Pneumonia ◽  
Tongue Pressure ◽  
White Blood Count ◽  
Swallowing Function

Abstract Background Esophagectomy for esophageal cancer is a highly invasive procedure with several serious postoperative complications, including pneumonia. It is commonly accepted that deteriorated swallowing function causes postoperative pneumonia. However, measurement to evaluate swallowing function related to postoperative pneumonia has not been developed. Recently, it became possible to measure tongue pressure using a non-invasive, easy and portable device. We hypothesized that tongue pressure relates to postoperative pneumonia. The aim of this study was to investigate the relationship between change in tongue pressure and pneumonia after esophagectomy among inpatients with esophageal cancer. Methods Fifty-eight inpatients (39 males and 19 females; 33–77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure was performed using a portable device before esophagectomy (baseline) and at postoperative 1 and 2 weeks. Repetitive saliva swallowing test (RSST) was also performed to evaluate swallowing function at the same time. Pneumonia was postoperatively diagnosed by the chest X-ray, white blood count, body temperature and purulent sputum. The data of general and oral conditions were collected from medical and dental records. Data also included sex, age, type of cancer, cancer stage (International Classification of Diseases for Oncology ICD-10 version 2015), type of operation (thoracotomy or thoracoscopy), type of preoperative chemotherapy, surgical duration, amount of bleeding during surgery, type of reconstruction, incidences of postoperative complications, intubation period, body temperature, blood chemical analysis, health behaviors and oral condition. Differences in parameters between the pneumonia (+ ) group (n = 10) and pneumonia (-) group (n = 48) were analyzed by Mann-Whitney U or Chi-square test. Level of significance was set at P < 0.05. Results Tongue pressure significantly decreased after esophagectomy (P < 0.05). The decrease in tongue pressure, age, amount of bleeding during surgery, length of fasting days, the ratio of thoracotomy and aspiration in the pneumonia (+ ) group were significantly greater than those in the pneumonia (-) group (P < 0.05). Conclusion The decrease in tongue pressure was related to the incidence of pneumonia after esophagectomy among inpatients with esophageal cancer. Disclosure All authors have declared no conflicts of interest.

PS02.125: NEOADJUVANT CHEMOTHERAPY PLUS SURGERY FOR NON-T4 CSTAGE II/III ESOPHAGEAL CANCER: A SINGLE INSTITUTION EXPERIENCE IN JAPAN

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 156-157
Author(s):  
Masahiko Ikebe ◽  
Mitsuhiko Ohta ◽  
Masahiko Sugiyama ◽  
Masaru Morita ◽  
Yasushi Toh
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Adverse Events ◽  
Standard Treatment ◽  
Conflicts Of Interest ◽  
Radical Surgery ◽  
Hospital Death ◽  
Number Of Patients ◽  
Grade 3

Abstract Background In Japan, following the results of JCOG 9907 trial, neoadjuvant chemotherapy (NAC) and radical surgery has been a standard treatment for Non-T4 cStage II/III esophageal cancer. Since 2009 we have also positioned NAC as standard treatment. We examined treatment outcomes and problems in our institute. Methods From 2009 to 2015, there were 64 patients with non-T4 stage II/III esophageal cancer treated with chemotherapy who are planned to undergo curative surgery. The standard NAC regimen consists of 2 courses of CDDP/5-FU (CF) therapy. As standard surgical procedure, subtotal esophagectomy, cervical anastomosis, three regional lymph node dissection were performed. Results The number of patients was 23/41 cases of cStage II/III respectively. 53 patients (88%) completed two courses of NAC. At the end of first course, NAC was terminated due to adverse events in 4 cases and due to the increasing tendency of tumors in 7 cases. NAC-induced adverse events of grade 3 or higher consists of myelosuppression in 27 cases (42%), appetite loss in 5 cases and so on. Surgery was performed in 61 cases (95%), of which R0 operation in 56 cases (88%), R1 operation in 3 cases and R2 operation in 2 cases. Three patients did not undergo surgery due to progressive disease. There were 7 cases (11%) of postoperative complications of Grade 3 or higher, but there was no in-hospital death. In the histological therapeutic effect, there were 5/41/7/4/3 cases for Grade 0/1a/1b/2/3, respectively. Three-year and five-year overall survival rate of all 64 patients were 68% and 47%. In 56 patients who underwent R0 surgery, they were 76% and 61% respectively. Conclusion From the viewpoint of adverse events and postoperative complications, NAC plus radical surgery for cStage II/III esophageal cancer could be performed safely. Considering that more than 60% of the patients belong to cStage III, this treatment strategy resulted in relatively favorable prognosis. Disclosure All authors have declared no conflicts of interest.

PS02.202: CLINICAL SIGNIFICANCE OF MEASUREMENT OF SKELETAL MUSCLE VOLUME AND SERUM NUTRITIONAL MARKERS IN ESOPHAGEAL CANCER PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 179-179
Author(s):  
Tomo Ishida ◽  
Tomoki Makino ◽  
Koji Tanaka ◽  
Makoto Yamasaki ◽  
Yasuhiro Miyazaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Lumbar Vertebra ◽  
Psoas Muscle ◽  
Prognostic Nutritional Index ◽  
Nutritional State ◽  
Postoperative Pneumonia ◽  
Cross Sectional ◽  
Term Survival ◽  
Neutrophil Lymphocyte Ratio

Abstract Background Some studies reported the association of muscle mass or nutritional state with development of postoperative morbidity. However, it remains unknown whether body composition or nutritional state influences upon clinical outcome in esophageal cancer (EC) patients undergoing surgery following neoadjuvant chemotherapy (NAC). Methods A total of 100 EC patients who undergone NAC followed by curative surgical resection in our hospital from 2011 to 2013 was analyzed. The cross-sectional area of psoas was measured by computed tomography at third lumbar vertebra and the Psoas Muscle Index [PMI: total psoas area at L3/(height × height)] was calculated. Pre- and post-NAC PMI in addition to prognostic nutritional index (PNI), modified Glasgow prognostic scale (mGPS), and neutrophil/lymphocyte ratio (N/L) as an inflammation or nutrition marker were evaluated in terms of their association with development of NAC adverse event, postoperative complications and long-term survival. Results The PMI significantly decreased during chemotherapy from 705.5 to 682.7 cm2/m2 (P = 0.0008). Pre-NAC PMI (low vs high group, cutoff: 6.36cm2/m2 for male, 3.92cm2/m2 for female) was significantly associated with serum albumin (3.5 vs 3.8g/dl P = 0.0064) and body mass index (19.6 vs 22.2kg/m2P < 0.001), and clinical response to NAC (response rate 66.7 vs 87.1% P = 0.02). Post-NAC PMI, meanwhile, correlated with development of postoperative pneumonia [Clavien-Dindo (C-D) classification grade > II] (35.0 vs 8.3% P = 0.0009) and expectoration disorder of sputum (C-D classification grade > III) (28.6 vs 10.5% P = 0.027) while neither pre- or post PMI were predictive of patient survival. Regarding serum nutritional markers, pre-NAC PNI and mGPS correlated with NAC-induced neutropenia [low vs high PNI (cutoff: 40): 100 vs 87% P = 0.019] and diarrhea (mGPS 0/1 vs 2: 27.4 vs 80.0% P = 0.017) while post-NAC mGPS (mGPS 0 vs 1/2) was predictive of development of postoperative pneumonia (11.5 vs 30.8%, P = 0.018) and expectoration disorder of sputum (10.7 vs 27.8%, P = 0.037), respectively. Notably, post-NAC mGPS (mGPS 0 vs 1/2: 76.4 vs 65.4%, P = 0.039) and N/L (N/L ≥ 2.5 vs < 2.5: 43.5 vs 82.1% P = 0.006) showed the significant association with 2-year overall survival. Conclusion Pre- and post-NAC PMI in addition to serum inflammation/nutrition markers might be clinically useful in predicting outcome of multidisciplinary treatments for EC patients. Disclosure All authors have declared no conflicts of interest.

RA02.01: COMPARISON OF THREE-FIELD VERSUS TWO-FIELD LYMPHADENECTOMY FOR THORACIC MIDDLE AND LOWER ESOPHAGEAL CANCER: POST-OPERATIVE RESULTS OF A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-20
Author(s):  
Bin Li ◽  
Jiaqing Xiang ◽  
Yawei Zhang ◽  
Jie Zhang ◽  
Yihua Sun ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Tumor Staging ◽  
Operating Time ◽  
Thoracic Esophageal Cancer ◽  
Term Survival

Abstract Background Patients with esophageal cancer can benefit from extended lymphadenectomy. However, the role of 3-field lymphadenectomy is unclear, and the extent of lymphadenectomy for thoracic esophageal cancer is still under discussion. Methods From June 2013 to November 2016, 400 patients with middle and lower thoracic esophageal cancer were randomly assigned to receive 3-field (3FL, n = 200) or the 2-field (2FL, n = 200) lymphadenectomy. The postoperative complications, according to the Clavien-Dindo classification, and lymph node metastasis were compared on the basis of intention-to-treat principle. Results Baseline characteristics were balanced between the 2 arms. There were 187 patients (93.5%) had squamous cell carcinoma in 3FL arm, and 192 (96.0%) in the 2FL arm, P = 0262. According to the pathological reports, T staging in the 2 arms were comparable, however more N3 patients in the 3FL arm (10.5%, 21/200) than that in the 2FL arm (10%, 5/200), P = 0040. Consequently, less TNM staging I patients in the 3FL arm (16.0%, 32/200) than that in the 2FL arm (25.5%, 51/200), P = 0.019. Operating time was significantly longer in the 3FL arm (median, 183 vs. 168 [2FL] minutes, P < 0.001). Six patients in the 3FL arm (3%, 6/200) had reintubation, whereas no reintubation in the 2 FL arm (0%, 0/200), P = 0.030. Other postoperative complications were comparable in the 2 arms. One patient in the 2-field arm died of chyloperitoneum. According to the Clavien-Dindo classification of surgical complications, the distribution of severity were similar between the 2 arms, P = 0.416. More lymph nodes were resected in the 3FL arm (Median, 37 vs. 24 [2FL], P < 0.001). Lymph nodes resected in the mediastinum and upper abdomen were comparable between the 2 arms. 44 patients (22%) in the 3FL arm had positive lymph nodes. Conclusion Compared with 2-field lymphadenectomy, 3-field lymphadenectomy doesn’t increase the surgical risks for patients with thoracic esophageal cancer. 3-field lymphadenectomy can be performed safely, removing unforeseen cervical positive lymph node, and offering more accurate tumor staging. Long-term survival analysis under protocol will clarify the role of 3-field lymphadenectomy for esophageal cancer. Disclosure All authors have declared no conflicts of interest.

RA02.06: PREVENTION OF ATRIAL FIBRILLATION AND POSTOPERATIVE COMPLICATIONS USING LANDIOLOL HYDROCHLORIDE AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 21-21
Author(s):  
Toshiyasu Ojima ◽  
Mikihito Nakamori ◽  
Masaki Nakamura ◽  
Masahiro Katsuda ◽  
Keiji Hayata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Cancer Patients ◽  
Conflicts Of Interest ◽  
Controlled Trial ◽  
Group Versus ◽  
Transthoracic Esophagectomy ◽  
Double Blind ◽  
Landiolol Hydrochloride

Abstract Background The aim of this study was to evaluate if landiolol hydrochloride is effective and safe in the prevention of atrial fibrillation (AF) after esophagectomy and that the reduction of AF incidence would reduce other postoperative complications. No prospective data exist regarding the efficacy of landiolol in preventing new-onset AF and translating low morbidity in esophageal cancer patients after esophagectomy. Methods One hundred patients scheduled for transthoracic esophagectomy were enrolled in a randomized, double-blind, placebo-controlled trial between March 2013 and January 2016 in our institute. Enrolled patients were randomized with 1:1 parallel allocation ratio to either with or without landiolol prophylaxis. The primary endpoint was the occurrence of AF after esophagectomy. The secondary endpoints were incidence of postoperative complications, hemodynamics and inflammatory index. Results Postoperative AF occurred in 15 patients (30%) in the placebo group versus five patients (10%) in the landiolol group. The landiolol group showed a significantly lower incidence (P = 0.012). Overall incidence of postoperative complications was significantly lower in the landiolol group (P = 0.046). In the landiolol group, postoperative heart rate was effectively suppressed, while the decreased of blood pressure was not harmful. IL-6 level was significantly lower in the landiolol group after the administration (P < 0.01). Conclusion This is the first comparative trial that proved landiolol is indeed effective and safe in preventing AF after esophagectomy. We recommend that landiolol to be a part of the regimen for perioperative management of esophageal cancer patients undergoing transthoracic esophagectomy. Registration number: UMIN000010648 (http://www.umin.ac.jp/ctr/) Disclosure All authors have declared no conflicts of interest.

PS02.134: COMPARISON OF PUSH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY WITH OPEN GASTROSTOMY IN ADVANCED ESOPHAGEAL CANCER PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 159-159
Author(s):  
Prasit Mahawongkajit
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Conflicts Of Interest ◽  
Invasive Procedure ◽  
Feeding Tube ◽  
Treatment Quality ◽  
Advanced Esophageal Cancer ◽  
Endoscopic Gastrostomy ◽  
Improve Patient

Abstract Background In esophageal cancer treatment, nutrition by feeding tube has been demonstrated to improve patient tolerance of treatment, quality of life, and long term outcomes. The open gastrostomy and percutaneous endoscopic gastrostomy (PEG) push technique are procedures that avoid cancer cells seeding and also improve patient nutritional status. The aim of this study is to compare the results of the push PEG and open gastrostomy in patients with advanced esophageal cancer. Methods A retrospective study was analyzed in the advanced esophageal cancer patients who indicated and received feeding support between January 2016 and December 2017. Results 28 patients in push PEG and 36 patients in open gastrostomy presented the following comparative data: mean operative duration time shorter in push PEG (11.9 min) than open gastrostomy (35.1 min), less blood loss in push PEG (0.8 mL) than open gastrostomy (5.6 mL), less pain score in push PEG (2.4) than open gastrostomy (5.9) and shorter hospitalization in push PEG (1.8 days) than open gastrostomy (2.6 days). Both groups showed no readmission or 30 day mortality. The adverse events of open gastrostomy demonstrated higher than push PEG group. Conclusion Both push PEG and open gastrostomy were the safe options for advanced esophageal cancer patients indicating for enteral nutrition and to avoid cancer cell seeding. The push PEG demonstrated the effective minimally invasive procedure, was safe and with fewer complications. Disclosure All authors have declared no conflicts of interest.

Swallowing Function-preserving Surgery for Thoracic Esophageal Cancer

2008 ◽  
Vol 59 (2) ◽  
pp. 213-213
Author(s):  
M. Yano ◽  
K. Takachi ◽  
K. Kishi ◽  
I. Miyashiro ◽  
S. Noura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Thoracic Esophageal Cancer ◽  
Swallowing Function

scholarly journals Longitudinal Changes of Tongue Thickness and Tongue Pressure in Neuromuscular Disorders

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
George Umemoto ◽  
Shinsuke Fujioka ◽  
Hajime Arahata ◽  
Nobutaka Sakae ◽  
Naokazu Sasagasako ◽  
...  
Keyword(s):  
Neuromuscular Disorders ◽  
The Other ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Longitudinal Changes ◽  
Swallowing Dysfunction ◽  
The Relationship ◽  
Lateral Sclerosis

Abstract Background Swallowing dysfunction is related to major cause of adverse events and an indicator of shorter survival among patients with neuromuscular disorders (NMD). It is critical to assess the swallowing function during disease progression, however, there are limited tools that can easily evaluate swallowing function without using videofluoroscopic or videoendoscopic examination. Here, we evaluated the longitudinal changes in tongue thickness (TT) and maximum tongue pressure (MTP) among patients with amyotrophic lateral sclerosis (ALS), myotonic dystrophy type 1 (DM1), and Duchenne muscular dystrophy (DMD). Methods Between 2010 and 2020, TT and MTP were measured from 21 ALS, 30 DM1, and 14 DMD patients (mean ages of 66.9, 44.5, and 21.4 years, respectively) at intervals of more than half a year. TT was measured, by ultrasonography, as the distance from the mylohyoid muscle raphe to the tongue dorsum, and MTP was determined by measuring the maximum compression on a small balloon when pressing the tongue against the palate. Then we examined the relationship between these evaluations and patient background and swallowing function. Results Mean follow-up periods were 24.0 months in the ALS group, 47.2 months in the DM1group, and 61.1 months in the DMD group. The DMD group demonstrated larger first TT than the other groups, while the DM1 group had lower first MTP than the ALS group. The ALS group showed a greater average monthly reduction in mean TT than the DM1 group and greater monthly reductions in mean body weight (BW) and MTP than the other groups. Significant differences between the first and last BW, TT, and MTP measures were found only in the ALS group. Conclusions This study suggests that ALS is associated with more rapid degeneration of tongue function over several years compared to DMD and DM1.

scholarly journals Relationship between Oral Hypofunction and Sarcopenia in Community-Dwelling Older Adults: The Otassha Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6666
Author(s):  
Yoshihiro Kugimiya ◽  
Masanori Iwasaki ◽  
Yuki Ohara ◽  
Keiko Motokawa ◽  
Ayako Edahiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Cross Sectional Study ◽  
Albumin Level ◽  
Community Dwelling ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Community Dwelling Older Adults ◽  
The Relationship

Oral hypofunction, resulting from a combined decrease in multiple oral functions, may affect systemic-condition deterioration; however, few studies have examined the association between oral hypofunction and general health among older adults. In this cross-sectional study, we examined the relationship between oral hypofunction and sarcopenia in community-dwelling older adults. We included 878 adults (268 men and 610 women, mean age 76.5 ± 8.3 years). Tongue coating index, oral moisture, occlusal force, oral diadochokinesis (/pa/,/ta/,/ka/), tongue pressure, mas-ticatory function, and swallowing function were evaluated as indicators of oral hypofunction. Grip strength, gait speed, and skeletal muscle mass index were measured as diagnostic sarcopenia parameters. The association between oral hypofunction and sarcopenia was examined via logistic regression using sarcopenia as the dependent variable. Oral hypofunction prevalence was 50.5% overall, 40.3% in men, and 54.9% in women. The prevalence of sarcopenia was 18.6% overall, 9.7% in men, and 22.5% in women. A logistic regression showed oral hypofunction, age, body mass index, higher-level functional capacity, and serum albumin level were significantly associated with sarcopenia. Sarcopenia occurred at an increased frequency in patients diagnosed with oral hypofunction (odds ratio: 1.59, 95% confidence interval: 1.02–2.47); accordingly, oral hypofunction appears to be significantly associated with sarcopenia.

scholarly journals Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

2017 ◽  
Vol 9 (2) ◽  
pp. 161-167 ◽  
Author(s):  
George Umemoto ◽  
Yoshio Tsuboi ◽  
Hirokazu Furuya ◽  
Takayasu Mishima ◽  
Shinsuke Fujioka ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Intake ◽  
Normal Diet ◽  
Oral Feeding ◽  
Tongue Pressure ◽  
Normal Range ◽  
Swallowing Function ◽  
Pharyngeal Pressure ◽  
Swallowing Dysfunction ◽  
The Impact

Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.

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