RA02.07: A TWO-STAGE OPERATION USING A FREE JEJUNAL FLAP FOR GASTRECTOMIZED ESOPHAGEAL CANCER

Abstract Background The stomach is not available as a reconstruction organ in previously and synchronously gastrectomized esophageal cancer patients. In these patients, a pedicled jejunum or colon is mainly used for the reconstruction organ instead of the stomach, however, its reconstruction procedure is different among the institutes. In our department, a two-stage operation using a free jejunal flap (FJF) is performed when the stomach is unavailable. Methods A two-stage operation using a FJF for gastrcectomized esophageal cancer performed between 2010 and 2016 were retrospectively analyzed to evaluate a safety and feasibility of our operation. Results A two-stage operation using a FJF was performed for 30 cases, 19 for previously gastrectomized cases, and 11 for synchronous cases, respectively. Among 30 cases, thoracic and cervical esophageal cancer cases were 25 and 5, respectively. For 25 cases of the thoracic esophageal cancer, a subtotal esophagectomy, making a cervical esophagostomy and a jejunal tube placement was performed at the first stage, a reconstruction through the subcutaneous route using a FJF with vascular anastomoses by plastic surgeons was performed at the second stage. Median operation time of first and 2nd stage was 334 and 503 minutes, respectively. An internal thoracic artery was used for a recipient artery in all cases. In 4 of 5 cases of cervical esophageal cancer, a subtotal esophagectomy, esophago-jejuno anastomosis, making a jejunostoma using a FJF was performed at the first stage, the reconstruction of the anal side of a jejunostoma was performed by using a pedicled intestine at the second stage. Median operation time of first and second stage was 640 and 260 minutes, respectively. Clavien-Dindo grade IIIb or IV postoperative complication was seen in 3 cases (10%) after the first stage, 3 cases (10%) after the second stage. Necrosis of a FJF and anastomotic leakage was seen in 0 (0%) and 5 cases (17%), respectively. Conclusion A two-stage operation using a FJF needs plastic surgeon's cooperation, but is considered to be safe and feasible operation when a stomach is not available. Disclosure All authors have declared no conflicts of interest.

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A two-stage operation for thoracic esophageal cancer: esophagectomy and subsequent reconstruction by a free jejunal flap

Surgery Today ◽

10.1007/s00595-013-0797-9 ◽

2013 ◽

Vol 44 (2) ◽

pp. 395-398 ◽

Cited By ~ 7

Author(s):

Yasuhiro Okumura ◽

Kazuhiko Mori ◽

Yukinori Yamagata ◽

Takashi Fukuda ◽

Ikuo Wada ◽

...

Keyword(s):

Esophageal Cancer ◽

Two Stage ◽

Thoracic Esophageal Cancer ◽

Free Jejunal Flap

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PS01.220: COMPARISON OF SHORT-TERM OUTCOMES BETWEEN RAMIE AND VAMIE IN TREATMENT MIDDLE THORACIC ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.220 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 112-112

Author(s):

Yidan Lin ◽

Hanyu Deng

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Operation Time ◽

Short Term ◽

Thoracic Esophageal Cancer ◽

Comparable Rate ◽

Invasive Esophagectomy

Abstract Background Whether robot-assisted minimally invasive esophagectomy (RAMIE) has any advantages over video-assisted minimally invasive esophagectomy (VAMIE) remains controversial. In this study, we tried to compare the short-term outcomes of RAMIE with that of VAMIE in treating middle thoracic esophageal cancer from a single medical center. Methods Consecutive patients undergoing RAMIE or VAMIE for middle thoracic esophageal cancer from April 2016 to April 2017 were prospectively included for analysis. Baseline data and pathological findings as well as short-term outcomes of these two group (RAMIE group and VAMIE group) patients were collected and compared. A total of 84 patients (RAMIE group: 42 patients, VAMIE group: 42 patients) were included for analysis. Results The baseline characteristics between the two groups were comparable. RAMIE yielded significantly larger numbers of total dissected lymph nodes (21.9 and 17.8, respectively; P = 0.042) and right recurrent laryngeal nerve (RLN) lymph nodes (2.1 and 1.2, respectively; P = 0.033) as well as abdominal lymph nodes (10.8 and 7.7, respectively; P = 0.041) than VAMIE. Even though RAMIE may consume more overall operation time, it could significant decrease total blood loss compared to VAMIE (97 and 161 ml, respectively; P = 0.015). Postoperatively, no difference of the risk of major complications or hospital stay was observed between the two groups. Conclusion RAMIE had significant advantage of lymphadenectomy especially for dissecting RLN lymph nodes over VAMIE with comparable rate of postoperative complications. Further randomized controlled trials are badly needed to confirm and update our conclusions. Disclosure All authors have declared no conflicts of interest.

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A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy

10.21203/rs.3.rs-899484/v1 ◽

2021 ◽

Author(s):

Shao-Wei Dong ◽

Chia-Chang Wu ◽

Chu-Tung Lin ◽

Kuan-Chou Chen ◽

Chen-Hsun Ho

Keyword(s):

Percutaneous Nephrolithotomy ◽

Operation Time ◽

Ultrasound Guided ◽

Stone Size ◽

Second Stage ◽

Tract Dilation ◽

Median Operation Time ◽

Hemoglobin Drop ◽

Pleural Injury ◽

Free Status

Abstract Background To evaluate the safety and the efficacy of a radiation-free 2-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy (PCNL). Methods From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator. Results The median age was 62.0 [IQR 11.0] years, and 11 (61.1%) were male. The median stone size was 3.3 [3.6] cm2, and stone laterality was almost equal over both sides. Successful tract establishment on the first attempt without fluoroscopy was achieved in 18 (94.7%) operations. The median tract establishment time was 10.4 [4.9] mins, and the median operation time was 67.0 [52.2] mins. The median hemoglobin drop was 1.0 [1.1] g/dL, and none required blood transfusion. Three (15.8%) developed fever. Pleural injury occurred in two (10.5%) operations (both had supracostal puncture), and one required drainage with pigtail. Stone-free status was achieved in 15 (77.8%) operations at 3 months postoperatively. Conclusions Herein we present a radiation-free 2-step tract dilation technique, which is characterized by ureteroscopic check of the partially dilated tract in between the first dilation with serial fascial dilators and the second dilation with balloon. Our data suggest that it is a safe and effective method.

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Development of fistula between esophagogastric anastomotic site and cartilage portion of trachea after subtotal esophagectomy for cervical esophageal cancer: a case report

Surgical Case Reports ◽

10.1186/s40792-016-0238-2 ◽

2016 ◽

Vol 2 (1) ◽

Cited By ~ 3

Author(s):

Daisuke Taniguchi ◽

Hiroshi Saeki ◽

Yuichiro Nakashima ◽

Ryosuke Tsutsumi ◽

Sho Nishimura ◽

...

Keyword(s):

Esophageal Cancer ◽

Case Report ◽

Anastomotic Site ◽

Cervical Esophageal Cancer ◽

Subtotal Esophagectomy ◽

And Cartilage

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PS02.131: PATTERN OF LYMPHATIC METASTASIS OF CERVICAL ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.131 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 158-158

Author(s):

Jiancheng Li ◽

Xiuling Shi

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Mediastinal Lymph Node ◽

Radical Resection ◽

Cervical Esophageal Cancer ◽

Cervical Lymph Nodes ◽

Node Metastasis

Abstract Background Cervical esophageal cancer were rarely surgeryed Analysis and discussion of lymph node metastasis of cervical esophageal cancer Methods From July 2008 to June 2017, 10 cases of successful esophagectomy of cervical esophageal cance in our hospital underwent radical resection. Surgical dissection range was the neck and the upper mediastinum. A total of 231 lymph nodes were dissected. The lymph nodes were summarized and grouped in different ways, and analyzed the law of lymph node metastasis. Results 7 cases of esophageal cancer, lymph node metastasis occurred, and the rate of lymph node metastasis was 70% (7/10), of which 1 case was T1b stage. 17 lymph node metastases, the degree of lymph node metastasis was 7.36% (17/231), including 4 esophageal lymph nodes, 12 cervical lymph nodes and 1 upper right mediastinal lymph node. Conclusion Cervical esophageal cancer lymph node metastasis can spread occur early metastasis, and the metastasis site were mainly in neck.. Disclosure All authors have declared no conflicts of interest.

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

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra02.09 ◽

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.

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PS01.141: TREATMENT STRATEGY FOR THORACIC ESOPHAGEAL CARCINOMA COMPLICATED WITH HEAD AND NECK CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.141 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 89-90

Author(s):

Masato Maeda ◽

Keisuke Kawamorita ◽

Ryohei Koreyasu ◽

Shou Ueda ◽

Tomoyasu Takayanagi ◽

...

Keyword(s):

Quality Of Life ◽

Esophageal Cancer ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Conflicts Of Interest ◽

Hypopharyngeal Cancer ◽

Thoracic Esophageal Cancer ◽

Subtotal Esophagectomy

Abstract Background The frequency of complication of head and neck cancer to thoracic esophageal cancer is high, and treatment methods and their order will be determined from the viewpoints of curability and quality of life. Methods We review the course of three cases we experienced and give some consideration. Results [Case 1] A 68-year-old man with cT2N0M0 Mt esophageal cancer and cT2N0M hypopharyngeal cancer. Two courses of DCF (DOC + CDDP + 5 FU) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy with three fields lymph nodes dissection, one course of DCF was added, and CRT (60 Gy/30 fr) combined with weekly CBDCA was administered to the neck. The case is alive without recurrence for 5 years and 9 months from the start of treatment. [Case 2] A 72-year-old man with cT2N0M0 Mt esophageal cancer and cT3N2bM0 hypopharyngeal cancer. Three courses of TCS (DOC + CBDCA + TS-1) made the hypopharyngeal lesion CR. After thoracoscopic subtotal esophagectomy, CRT (60 Gy) combined with biweekly CDDP was administered to the neck. The case is alive without recurrence for 5 years and 7 months. [Case 3] A 63-year-old man with LtMt multiple esophageal cancer (4 lesions, cT3N2M0) and cT2N1M0 hypopharyngeal cancer, and cT1bN0M0 gastric cancer. Though the hypopharyngeal cancer remained in PR after 2 courses of DCF, aiming at larynx preservation, thoracoscopic subtotal esophagectomy was performed, and gastric lesion was excised at the time of creating the stomach tube. After the operation, CRT (70 Gy) combined with weekly CBDCA made the hypopharyngeal lesion CR. Another cancer was demonstrated in the residual esophagus in 1 year and 3 months and surgical resection of the residual esophagus and the larynx with reconstruction with free jejunal transplantation was performed. The case is alive without recurrence for 2 years and 5 months after reoperation. Conclusion Salvage surgery may be necessary for metachronous multiple cancer cases, non-CR cases, and local recurrence cases as in case 3. We think that we can aim at compatibility of curability and maintenance of quality of life by treatment method which aims at preservation of larynx, combining with chemoradiotherapy and esophagectomy. Disclosure All authors have declared no conflicts of interest.

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