Three Elderly Patients With Lower Esophageal Cancer Successfully Treated By Transhiatal Esophagectomy Assisted by Mediastinoscopy

Abstract Purpose : Although a change in skeletal muscle mass index (SMI) 4 months after esophagectomy impacts prognosis, predictors of a change in SMI have not been revealed. The purpose of this exploratory retrospective study was to clarify the predictors of a change in SMI after curative esophagectomy in elderly patients with esophageal cancer.Methods : Fifty-four patients who underwent esophagectomy and perioperative rehabilitation from 2015 to 2018 were enrolled. Preoperative and postoperative SMI (cm 2 /m 2 ) were calculated using computed tomography images. The ratio change in SMI was calculated as follows: (postoperative SMI − preoperative SMI) ÷ preoperative SMI × 100%. Potential predictors of a change in SMI ratio were analyzed by multiple regression. Results : The mean ratio change in SMI 4 months after esophagectomy was −7.1% ± 9.4%. The ratio change in quadriceps muscle strength in the first month after surgery ([postoperative strength − preoperative strength] ÷ preoperative strength × 100%) (standardized β = .273, p = .038) and neoadjuvant chemotherapy (NAC) (standardized β = .398, p = .006) were predictors of the ratio change in SMI independent of age, sex, pathological stage, and preoperative SMI. Conclusion : Quadriceps muscle weakness in the first month after esophagectomy and NAC were predictors of the ratio change in SMI after esophagectomy. Continuous postoperative comprehensive rehabilitation and supportive care may inhibit loss of skeletal muscle mass.

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Stenting of the esophagus in the course of the malignant dysphagia in elderly patients

OBM Geriatrics ◽

10.21926/obm.geriatr.2102171 ◽

2020 ◽

Vol 05 (02) ◽

pp. 1-1

Author(s):

Janusz Włodarczyk ◽

◽

Alicja Włodarczyk ◽

Keyword(s):

Lung Cancer ◽

Esophageal Cancer ◽

Elderly Patients ◽

Clinical Management ◽

Survival Rates ◽

Palliative Therapy ◽

Esophageal Stenosis ◽

Safe Procedure ◽

Malignant Dysphagia ◽

Esophageal Stenting

Esophageal cancer is a disease with difficult clinical management, and palliative therapy is the only predominant treatment. This retrospective study analyses the results of clinical management of elderly patients (>75 years of age) who were treated with esophageal stenting for malignant dysphagia due to primary esophageal cancer, including squamous cell carcinoma (SCC), esophageal adenocarcinoma (EAC), as well as secondary esophageal malignant strictures due to non-small cell lung cancer (NSCLC). Patients with esophago-respiratory fistula (ERF) were also included in the study. This study included 166 patients aged 75–88 (mean age, 78) years. Nine (5.4%) patients had upper malignant esophageal stenosis, 48 (28.1%) had the middle, 43 (25.9%) in the lower part of the esophagus, 49 (29.5%) patients had EAC-related stenosis, and 17 (10.2%) patients reported lung cancer-related esophageal stenosis. Dysphagia was rated at 2.8 (range, 2–3) before stenting and at 1.2 (range, 1–2) after the stenting procedure. Seven (4%) patients experienced stenting migration, 12 (7.2%) had granulation tissue overgrowth and prosthesis obstruction, two (1.2%) developed respiratory failure, and one (0.6%) patient died. Twelve (7.2%) patients were treated for ERF with double-stenting, and three (1.8%) patients developed a secondary fistula after the stent implantation. The mean survival of patients with esophageal cancer and ERF was 101.8 days and 62.5 days, respectively. Esophageal stenting has proven a safe procedure in patients over 75 years of age. It has a low rate of stenting obstruction and migration. Patients with ERF are a particularly difficult group to treat, show very poor outcomes and short survival rates.

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Comparison of Short-term Outcome of Thoracoscopic-Laparoscopic Esophagectomy Versus Transhiatal Esophagectomy for Resectable Esophageal Cancer

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v11i1.31113 ◽

2021 ◽

Vol 11 (1) ◽

pp. 31113.1-31113.6

Author(s):

Touraj Asvadi Kermani ◽

◽

Seyed Ziaeddin Rasihashemi ◽

Hoseinpour Feyzi ◽

Moein Hoseinpour Feyzi ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Blood Loss ◽

Similar Rate ◽

Transhiatal Esophagectomy ◽

Term Outcome ◽

Laparoscopic Esophagectomy ◽

Resectable Esophageal ◽

Resectable Esophageal Cancer ◽

One Year

Background: Esophagectomy is performed in all patients with resectable esophageal cancer. Transthoracic-Laparoscopic Esophagectomy (TLE) is a minimally invasive method and considered to be the most appropriate method. In this study, we aim to evaluate and compare the perioperative outcome, and 1-year overall survival of TLE and Transhiatal Esophagectomy (THE) approaches. Methods: In this retrospective study, we reviewed the medical records of 108 patients with esophageal cancer undergoing TLE (n=44) or THE (n=64) between 2015 and 2018. The patients were followed for one year. The intraoperative and postoperative findings, as well as 1-year overall-survival, were compared between the two groups. Results: TLE compared to THE had a longer surgery duration (278.63±33.28 vs 223.28±33.99 min, P=0.001), a higher number of dissected lymph nodes (15.06±2.95 vs 10.21±2.58, P=0.001), less blood loss (345.45±178.76 vs 585.15±294.75 mL, P<0.001), and need for transfusion (20.5% vs 45.3%, P=0.006) during surgery as well as lower ICU stay (2.59±0.77 vs 3.90±0.83 days, P<0.001) and ward stay (8.77±0.96 vs 11.42±1.71 days, P<0.001). THE had somewhat higher complication than TLE, but with no significant differences. Conclusion: TLE had a similar rate of complication to THE approach, but with lower blood loss and lower ICU and hospital stay, it is a more appropriate method for esophagectomy.

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