RA04.06: ESOPHAGECTOMY IN PATIENTS WITH EARLY STAGE ESOPHAGEAL CANCER AFTER NON-CURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 26-26
Author(s):  
Andreas Tschoner ◽  
Alexander Ziachehabi ◽  
Georg Spaun ◽  
Peter Adelsgruber ◽  
Rainer Schöfl ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Endoscopic Resection ◽  
Conflicts Of Interest ◽  
Early Stage ◽  
Oncologic Outcome ◽  
Open Approach ◽  
Thoracoscopic Approach ◽  
Postoperative Risk ◽  
Submucosal Resection

Abstract Background Early stage esophageal cancer has a low risk of lymph node metastasis. Therefore, an organ preserving endoscopic submucosal resection for tumors staged uT1 N0 has already been established. In case of non-curative dissection according to oncologic criteria esophagectomy has to be performed to achieve an oncologic resection. Methods Between 2010 and 2016 42 patients with early stage esophageal cancer underwent endoscopic submucosal dissections (ESD). We retrospectively evaluated the operative and pathologic outcome as well as disease free and overall survival in patients, who were operated on with esophagectomy because of non-curative endoscopic resection. Results 5 of 42 (11.9%) had to be operated on: 3 patients with open abdominothoracal resektion with intrathoracal anastomosis, 1 patient with an open approach and a cervical anastomosis and 1 patient with an laparoscopic/thoracoscopic approach but open intrathoracic anastomosis. Reasons for ongoing resection were three times R1 endoscopic resection, one L1 infiltration and one sm1-infiltration in a squamous cell carcinoma. There was no perioperative mortality. One anastomotic leakage was treated interventionally, one thoracic surgical site infection conservatively. One anastomotic leakage had to be resected, put on a saliva fistula and reconstructed with a colonic interponate. No recurrence of cancer is observed so far. Conclusion Esophagectomy after non-curative ESD shows no evidence for a worse oncologic outcome. There is no higher peri- and postoperative risk. This legitimates our step-up approach. Disclosure All authors have declared no conflicts of interest.

Utilization Trends and Volume-Outcomes Relationship of Endoscopic Resection for Early Stage Esophageal Cancer

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicole G. Jawitz ◽  
Vignesh Raman ◽  
Oliver K. Jawitz ◽  
Rahul A. Shimpi ◽  
Richard K. Wood ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Early Stage ◽  
Relationship Of

PS01.155: ANALYSIS ON THE INCIDENCE AND RISK FACTOR OF READMISSION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 93-93
Author(s):  
Seong Yong Park ◽  
Dae Joon Kim ◽  
Jee Won Suh ◽  
Go Eun Byun
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Anastomotic Stricture ◽  
Oral Intake ◽  
Vocal Cord Palsy ◽  
Jejunostomy Tube ◽  
The Mean ◽  
Secondary Hospital ◽  
Wound Problem

Abstract Background Esophageal complications consensus group (ECCG) recommended that readmissions to primary or secondary hospital within 30 days of discharge after esophagectomy can be an important quality outcome indicator for esophagectomy. This retrospective study was performed to investigate the frequencies and risk factors for readmission after esophagectomy. Methods We retrospectively reviewed 291 patients who received the esophagectomy and mediastinal lymphadenectomy for curative aim from January 2006 to June 2017. Results The mean age was 63.02 ± 8.02 years and male patients were 264 (90.7%). Thirty-nine (13.4%) patients readmit within 30 days after discharge. The mean readmission day after discharge was 14.76 ± 8.84. The common causes of readmission were anastomotic stricture requiring the ballooning (12, 30.7%), wound problem (7, 17.9%), pneumonia (6, 15.4%), and poor oral intake (4, 10.2%). Other causes of readmission were delayed gastric emptying (3), jejunostomy tube problem (2), ileus (2), pain (1), pneumothorax (1) and pleural effusion (1). On multivariate analysis, anastomotic leakage (odd ratio = 2.872, P = 0.022) were related to readmission, whereas age, pathologic stage, vocal cord palsy and neoadjuvant therapy were not related to readmission. In 30 patients with postoperative anastomotic leakage, the frequency of readmission due to wound problem (13.3% vs. 1.1%, P = 0.003) and anastomotic stricture (13.3% vs. 3.4%, P = 0.034) were significantly higher. Conclusion The incidence of readmission within 30 days after discharge was 13.4% and postoperative anastomotic leakage was related to the readmission, and it might be related to the wound problem and anastomotic stricture. Disclosure All authors have declared no conflicts of interest.

Endoscopic resection of early-stage esophageal cancer

1991 ◽  
Vol 5 (2) ◽  
pp. 59-62 ◽  
Author(s):  
Haruhiro Inoue ◽  
Mitsuo Endo ◽  
Kimiya Takeshita ◽  
Tatsuyuki Kawano ◽  
Narihide Goseki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Early Stage

Radiotherapy, including sentinel lymph node, to superficial cancer of esophagus.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 126-126 ◽  
Author(s):  
T. Kaburagi ◽  
H. Takeuchi ◽  
T. Oyama ◽  
R. Nakamura ◽  
T. Takahashi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Lymph Node Metastasis ◽  
Endoscopic Resection ◽  
Early Stage ◽  
Colloid Solution ◽  
Average Dose ◽  
Primary Tumors ◽  
Node Metastasis

126 Background: It is known that esophageal cancer frequently causes lymph node metastasis. Even if relatively early stage of esophageal cancer, reaching muscularis mucosae (T1a-MM: Japanese Classification of Esophageal Cancer) causes subclinical node metastasis to about 10%. So when radiation therapy (RT) is administered to these patients, field of irradiation should include the areas where subclinical node metastasis may exist. But the wider field of irradiation is, the more likely adeverse event is to occur. In this study, we examined utility of RT based on sentinel lymph node (SLN) theory. Methods: Before irradiation, Tc-99m tin colloid solution was endoscopically injected to the submucosal layer around the primary tumor and lymphoscintigraphy was examined to detect SLNs. And the irradiation field was planned as SLN regions were included. Patients with esophageal squamous cell carcinomas (ESCC) that reach cT1a-MM or cT1b and patients with ESCC who had underwent endoscopic resection and pathologically diagnosed pT1a-MM or pT1b were eligible if they had clinically no lymph node metastasis, no distant metastasis and no advanced cancer in other site. Between April 2001 and December 2009, 17 of these patients were received RT based on SLN theory. We retrospectively examined them. Results: Characteristics of the 17 pts were: median age; 67 (58-82), male/female; 15/2, T1a-MM/T1b-SM1/T1b-SM2; 4/2/11, definitive RT/adjuvant RT; 10/7, RT alone/concurrent chemoradiotherapy; 1/16. Average dose of irradiation was 57.0 ± 6.4Gy. Median follow-up is 81.4 months (7.9-127.2). Ten pts with definitive RT gained complete remission. Two minor local relapses of the primary tumors were observed. They underwent salvage endoscopic resection and survive without other relapse. There was no treatment related death. Grade 3 or 4 late toxicity was not observed. No significant financial relationships to disclose.

Endoscopic Resection and Ablation for Early-Stage Esophageal Cancer

2016 ◽  
Vol 26 (2) ◽  
pp. 173-176 ◽  
Author(s):  
Stephanie Worrell ◽  
Steven R. DeMeester
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Early Stage

PS02.075: USEFULNESS OF FDG-PET TO DECIDE THE INDICATION FOR ENDOSCOPIC RESECTION FOR SUPERFICIAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 141-141
Author(s):  
Masanobu Nakajima ◽  
Hiroto Muroi ◽  
Maiko Kikuchi ◽  
Yukiko Tani ◽  
Satoru Yamaguchi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Endoscopic Resection ◽  
Fdg Pet ◽  
Conflicts Of Interest ◽  
Standardized Uptake Value ◽  
Therapeutic Modality ◽  
Tumor Depth ◽  
Fdg Uptake ◽  
Superficial Cancer ◽  
The Relationship

Abstract Background 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a useful imaging modality to reflect the tumor activity. However, FDG-PET is mainly used for advanced cancer rather than superficial cancer. In this study, we investigate the relationship between the superficial tumor depth of esophageal cancer and FDG uptake, and discuss the possibility of using FDG-PET in making the decision for performing endoscopic resection. Methods From 2009 to 2017, 444 esophageal cancer patients underwent esophagectomy or Endoscopic submucosal dissection (ESD), and 195 were diagnosed with pathological superficial cancer. Among them, 146 patients were examined by FDG-PET before esophagectomy or ESD. For these 146 patients, the relationship between pathological tumor depth and FDG uptake was analyzed. Results Mean maximun standardized uptake value (SUV Max) in pT1a-EP/LPM was 1.362 ± 0.890, pT1a-MM/pT1b-SM1 was 2.453 ± 1.872, and pT1b-SM2/SM3 was 4.265 ± 3.233 (P < 0.0001). Among 51 pT1a-EP/LPM tumors, 10 (19.6%) showed positive detection of FDG. For pT1a-MM/pT1b-SM1 and pT1b-SM2/SM3, the detection rates were 52.9% (18/34) and 82.0% (50/61), respectively. The detection rate for pT1a-EP/LPM was significantly lower than for the other two groups (P < 0.0001). Among 10 FDG-PET positive patients, the reason for one lesionbeing PET positive could not be determined; however, nine of ten lesions had suitable reasons for the lesions being detected by PET and thus not being ER indication. PET diagnosis tends to be more accurate than endoscopic diagnosis (P = 0.0574) Conclusion Negative detection of superficial esophageal sqamous cell carcinoma by FGD-PET is useful for deciding the indication for ER. Furthermore, when FDG uptake is recognized, a therapeutic modality other than ER should be considered. Disclosure All authors have declared no conflicts of interest.

PS01.199: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL OF CIRCULAR STAPLING VERSUS TRIANGULATING STAPLING ESOPHAGOGASTRIC ANASTOMOSIS FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 106-106
Author(s):  
Masahiro Katsuda ◽  
Keiji Hayata ◽  
Mikihito Nakamori ◽  
Masaki Nakamura ◽  
Toshiyasu Ojima ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Anastomotic Stricture ◽  
Controlled Trial ◽  
University Hospital ◽  
Esophagogastric Anastomosis ◽  
Randomized Controlled ◽  
Cervical Esophagogastric Anastomosis

Abstract Background Several studies have reported that the triangulating stapling method decreases the incidence of anastomotic stricture after esophagectomy, but no randomized, controlled trial has confirmed the efficacy of the triangulating stapling method for cervical esophagogastrostomy. We compared triangulating stapling and circular stapling for cervical esophagogastric anastomosis regarding the decrease in anastomotic stricture after esophagectomy for thoracic esophageal cancer. Methods Between August 2010 and April 2014, 100 patients enrolled in this randomized, controlled trial at the Wakayama Medical University Hospital were allocated randomly to either the circular stapling group (n = 49) or the triangulating stapling group (n = 51). The primary end point was the incidence of anastomotic stricture within 12 months postoperatively. This randomized, controlled trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (UMIN000004848). Results There were no differences between the circular stapling and triangulating stapling groups in terms of clinical data. The amount of time required for esophagogastric anastomosis was slightly greater for the triangulating stapling group (22 minutes) than for the circular stapling group (18 minutes) (P = .028). Anastomotic stricture occurred in 8 patients (17%) in the circular stapling group and 9 patients (19%) in the triangulating stapling group (P = .935). The rate of anastomotic leakage was 11% for the circular stapling group and 2% for the triangulating stapling group (P = .073). Conclusion This RCT compared 2 techniques of cervical esophagogastric anastomosis after esophagectomy for esophageal cancer. This study is the first to compare these 2 methods in a randomized, controlled fashion.This study could not show that the triangulating stapling method was superior to the circular stapling method for cervical esophagogastrostomy to reduce anastomotic stricture. The triangulating stapling method, however, might have the potential to decrease the rate of anastomotic leakage; a large-scale RCT will be required to assess this question. Disclosure All authors have declared no conflicts of interest.

RA09.06: LONG-TERM OUTCOMES OF 650 ESOPHAGEAL CANCER PATIENTS WITH THORACOSCOPIC ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 41-41
Author(s):  
Takahiro Heishi ◽  
Hirotaka Ishida ◽  
Yu Onodera ◽  
Ken Ito ◽  
Takuro Konno ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Neoadjuvant Chemoradiotherapy ◽  
Thoracoscopic Esophagectomy ◽  
Stage Ii ◽  
Long Term Outcomes ◽  
Thoracoscopic Approach ◽  
Significant Difference

Abstract Background In 1996 Akaishi et al. reported the first thoracoscopic esophagectomy (TE) in Japan. Total 650 TEs for esophageal cancer have been performed in our institute by October 2016. There are many reports about the short-term outcomes of TE compared with open esophagectomy (OE), but the long-term outcomes of TE have been under debate. The aim of this study is to investigate the survival benefits of TE and to compare with OE and long-term outcomes which other previous reports showed. Methods A total 750 cases who underwent TE (N = 650) or OE (N = 100) between 1994 and 2015 in our hospital were included in this study. They were divided into four groups; surgery without any preoperative treatments (group S, N = 414), surgery after neoadjuvant chemotherapy (Group NAC, clinical stage II or III, N = 116), surgery after neoadjuvant chemoradiotherapy (Group NACRT, clinical stage II or III, N = 68) and salvage surgery after definitive chemoradiotherapy (Group SALV, N = 76). In group S, 100 patients received OE and 314 received TE. The other 3 groups (Group NAC, NACRT and SALV) received only TE. 3-year, 5-year overall survival (OS) and progression-free survival (PFS) rates for each group were analyzed and compared. Results In group S, the 5-year OS rate of TE was 63.4% and that of OE was 68.3%, there was no significant difference (Log-Rank test P = 0.41). Stage-specific OS rates of TE and OE were also compared and there was no significant difference. PFS rates of OE and TE showed the same tendency of OS. 5-year OS rate of group NAC was 63.5%. 3-year OS of group NACRT was 61.4%. 3-year and 5-year OS of group SALV were 41.4% and 34.0%. These results were the same or better than what the previous reports showed. Conclusion The long-term outcomes of TE were almost same as those of OE. The TE procedure resulted in similar or potentially better long-term outcomes in case of NAC, NACRT and SALV. It's acceptable to say thoracoscopic approach is the standard of esophagectomy. Disclosure All authors have declared no conflicts of interest.

PS01.210: VIDEO-ASSISTED SALVAGE ESOPHAGECTOMY: SHORT- AND LONG-TERM OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 109-109
Author(s):  
Toshiaki Shichinohe ◽  
Soichi Murakami ◽  
Yuma Ebihara ◽  
Yo Kurashima ◽  
Satoshi Hirano
Keyword(s):  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
Salvage Surgery ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Long Term Outcomes ◽  
Video Assisted ◽  
Salvage Esophagectomy ◽  
Short And Long Term

Abstract Background Salvage surgery is only one therapeutic option which enable to cure intractable esophageal cancer after definitive chemo-radiotherapy. Although video-assisted esophagectomy (VAE) is now widely accepted as a standard operation for primary esophageal cancer, the application of VAE to salvage surgery is still controversial since salvage surgery is known as high-risk operation. In this study, we investigated 27 cases of salvage surgery and assessed the feasibility of the operation by analyzing their short and long-term outcomes. Methods VAE was applied to 26 cases and laparoscopic lymphadenectomy was applied to 1 case. The procedure of the VAE included prone position esophagectomy (n = 8), esophagectomy by hand-assisted thoracoscopic surgery (n = 10) and mediastinoscope-assisted transhiatal esophagectomy (n = 5). Our current operative procedure after year 2010 is PPE. The fields of lymph node dissection for salvage esophagectomy have been limited to the stations that had metastasis before CRT and the lymphatic stations which newly recognized as suspected metastasis. Postoperative complications were defined according to the Clavien-Dindo classification. Results Video assisted surgery was applied to 96% of patients including one case of laparoscopic abdominal lymphadenectomy. One case required open surgery for suspicious of direct invasion of tumor. R0 rate of the operations was scored 78%. Postoperative complication rate defined as ≥ C-D II plus any grade of anastomotic leakage and recurrent laryngeal nerve palsy was 63%. The rate of anastomotic leakage, respiratory complication, and RLN palsy were 23%, 15%, and 12%, respectively. Operative death was 0%, whereas in-hospital mortality was 3.7%. Overall survival of esophagectomy cases showed 24% in 3-year and 8% in 5-year. According to subgroup analysis by pathological R status after operation, the survival outcomes of pR0 group (n = 20) reached 32% in 3-year and 10% in 5-year OS, whereas no patient reached 3-year survival in pR1/2 group (n = 6; P = 0.02). Conclusion Although salvage VAE should be applied in high-experienced institutions under the careful consideration of indication, it appears to be balanced operation for safety, and less invasiveness, as well as curability. Disclosure All authors have declared no conflicts of interest.

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