scholarly journals Anastomotic leakage following resection of the esophagus – Introduction of an endoscopic scoring system

2020 ◽  
Author(s):  
Jeannine Bachmann ◽  
Marcus Feith ◽  
Christoph Schlag ◽  
Mohamed Abdelhafez ◽  
Marc Martignoni ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Treatment Time ◽  
Malignant Tumors ◽  
Special Focus ◽  
High Morbidity ◽  
Endoscopic View ◽  
University Of Munich ◽  
Tracheobronchial System ◽  
Postoperative Leakage ◽  
Treatment Improvement

Abstract Background Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. MethodsPatients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. EndoscopyIn this retrospective analysis the focus is to describe different patterns of leakage of the anastomosis. Results We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of development of a fistula to the tracheobronchial system increased with higher grades of leakage. ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with special focus on prospective analysis.

scholarly journals Anastomotic Leakage Following Resection of the Esophagus – Introduction of an Endoscopic Scoring System

2021 ◽  
Author(s):  
Jeannine Bachmann ◽  
Marcus Feith ◽  
Christoph Schlag ◽  
Mohamed Abdelhafez ◽  
Marc Martignoni ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Treatment Time ◽  
Malignant Tumors ◽  
Special Focus ◽  
High Morbidity ◽  
Endoscopic View ◽  
University Of Munich ◽  
Tracheobronchial System ◽  
Postoperative Leakage ◽  
Treatment Improvement

Abstract Background Malignant tumors of the esophagus are the sixth leading cause of cancer-related deaths worldwide. Postoperative leakage of the esophago-gastrostomy leads to mediastinal sepsis, which is still associated with a high morbidity and mortality rate. The aim of this study was to describe the endoscopic view of the different severity grades of an anastomotic leakage. MethodsPatients Between June 2016 and September 2018, 144 patients were operated upon in the Department of Surgery, University of Munich, Germany. Among these patients, 34 (23.6%) presented with a leakage of the anastomosis. EndoscopyIn this retrospective analysis the focus is to describe different patterns of leakage of the anastomosis.Results We studied 34 patients in whom post-esophagectomy leakage of the anastomosis was detected and treated with an endoluminal vacuum sponge system. The leakage healed in 26 of 29 patients (success rate 89.7%). With increasing severity of leakage, the treatment time and the in-hospital mortality correspondingly increased. Furthermore, the incidence of development of a fistula to the tracheobronchial system increased with higher grades of leakage.ConclusionsExact descriptions of leakage are necessary to compare the cases and to prove post-treatment improvement. This is, to our knowledge, the first publication to present a leakage grading score in patients after esophagectomy including reconstruction with a gastric tube. This new grading system needs to be tested in further analyses, with special focus on prospective analysis.

Outcome of esophageal atresia: inborn versus outborn patients

2022 ◽  
Author(s):  
Denise Schlee ◽  
Till-Martin Theilen ◽  
Henning Fiegel ◽  
Martin Hutter ◽  
Udo Rolle
Keyword(s):  
Esophageal Atresia ◽  
Primary Anastomosis ◽  
Clinical Status ◽  
Special Focus ◽  
High Morbidity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Hospitalization Period ◽  
Volume Outcome ◽  
Centralized Care

Summary Esophageal atresia (EA) is a rare congenital disease which is usually not of the detected prenatally. Due to the lack of prenatal diagnosis, some newborns with EA are born outside of specialized centers. Nevertheless, centralized care of EA has been proposed, even if a clear volume–outcome association in EA management remains unconfirmed. Furthermore, whether outcomes differ between outborn and inborn patients with EA has not been systematically investigated. Therefore, this single-center, retrospective study aimed to investigate EA management and outcomes with a special focus on inborn versus outborn patients. The following data were extracted from the medical records of infants with EA from 2009 to 2019: EA type, associated anomalies, complications, and long-term outcome. Patients were allocated into inborn and outborn groups. Altogether, 57 patients were included. Five patients were excluded (referral before surgery, loss of data, death before surgery [n = 1], and incorrect diagnosis [diverticulum, n = 1]). Among all patients, the overall survival rate was 96%, with no mortalities among outborn patients. The overall hospitalization period was shorter for outborn patients. The median follow-up durations were 3.8 years and 3.2 years for inborn and outborn patients, respectively. Overall, 15% of patients underwent delayed primary anastomosis (long-gap atresia [n = 4] and other reasons [n = 4]). Early complications included three anastomotic leakages and one post-operative fistula; 28% of patients developed strictures, which required dilatation, and 38% of patients showed relevant gastroesophageal reflux, which required fundoplication, without any differences between the groups. The two groups had comparable low mortality and expected high morbidity with no significant differences in outcome. The outborn group showed nonsignificant trends toward lower morbidity and shorter hospitalization periods, which might be explained by the overall better clinical status.

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

2020 ◽  
Author(s):  
Chengcheng Christine Zhang ◽  
Lukas Liesenfeld ◽  
Rosa Klotz ◽  
Ronald Koschny ◽  
Christian Rupp ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Median Number ◽  
Adverse Event Rate ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Closure Rate ◽  
Endoscopic Vacuum Therapy

Abstract BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27,8 %) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n=10). Data from those who underwent treatment with EVT were included. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n=4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest. ConclusionsEVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.

scholarly journals Blood Aspergillus PCR: The Good, the Bad, and the Ugly

2020 ◽  
Vol 6 (1) ◽  
pp. 18
Author(s):  
Matthias Egger ◽  
Jeffrey D. Jenks ◽  
Martin Hoenigl ◽  
Juergen Prattes
Keyword(s):  
Diagnostic Tools ◽  
Diagnostic Process ◽  
Special Focus ◽  
High Morbidity ◽  
Potential Candidate ◽  
Diagnostic Quality ◽  
Invasive Fungal Diseases ◽  
Polymerase Chain ◽  
Additional Value

Invasive Aspergillosis (IA) is one of the most common invasive fungal diseases and is accompanied by high morbidity and mortality. In order to maximize patient outcomes and survival, early and rapid diagnosis has been shown to be pivotal. Hence, diagnostic tools aiding and improving the diagnostic process are ambitiously searched for. In this context, polymerase chain reaction (PCR) may represent a potential candidate. Its additional value and benefits in diagnosis have been demonstrated and are scientifically established. Nevertheless, standardized and widespread usage is sparse because several factors influence diagnostic quality and need to be considered in order to optimize diagnostic performance and outcome. In the following review, the current role of PCR in the diagnosis of IA is explored, with special focus on the strengths and limitations of PCR in different settings.

scholarly journals On the feasibility of the computational modelling of the endoluminal vacuum-assisted closure of an oesophageal anastomotic leakage

2018 ◽  
Vol 5 (2) ◽  
pp. 171289
Author(s):  
Ester Comellas ◽  
Facundo J. Bellomo ◽  
Iván Rosales ◽  
Luis F. del Castillo ◽  
Ricardo Sánchez ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Computational Analysis ◽  
Treatment Guidelines ◽  
Healing Process ◽  
Computational Modelling ◽  
High Morbidity ◽  
Suction Pressure ◽  
Vacuum Assisted Closure ◽  
Element Analysis ◽  
Basic Characteristics

Endoluminal vacuum-assisted closure (E-VAC) is a promising therapy to treat anastomotic leakages of the oesophagus and bowel which are associated with high morbidity and mortality rates. An open-pore polyurethane foam is introduced into the leakage cavity and connected to a device that applies a suction pressure to accelerate the closure of the defect. Computational analysis of this healing process can advance our understanding of the biomechanical mechanisms at play. To this aim, we use a dual-stage finite-element analysis in which (i) the structural problem addresses the cavity reduction caused by the suction and (ii) a new constitutive formulation models tissue healing via permanent deformations coupled to a stiffness increase. The numerical implementation in an in-house code is described and a qualitative example illustrates the basic characteristics of the model. The computational model successfully reproduces the generic closure of an anastomotic leakage cavity, supporting the hypothesis that suction pressure promotes healing by means of the aforementioned mechanisms. However, the current framework needs to be enriched with empirical data to help advance device designs and treatment guidelines. Nonetheless, this conceptual study confirms that computational analysis can reproduce E-VAC of anastomotic leakages and establishes the bases for better understanding the mechanobiology of anastomotic defect healing.

scholarly journals Construction and Characterization of Long Non-Coding RNA-Associated Networks to Reveal Potential Prognostic Biomarkers in Human Lung Adenocarcinoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Wenting Zhou ◽  
Chen Bai ◽  
Chaojun Long ◽  
Li Hu ◽  
Yanfei Zheng
Keyword(s):  
Lung Adenocarcinoma ◽  
Immune Cell ◽  
Malignant Tumors ◽  
Target Identification ◽  
Good Prognosis ◽  
Feedback Loops ◽  
High Morbidity ◽  
Scale Free ◽  
Prognostic Analysis ◽  
New Perspective

Lung adenocarcinoma (LUAD) is one type of the malignant tumors with high morbidity and mortality. The molecular mechanism of LUAD is still unclear. Studies demonstrate that lncRNAs play crucial roles in LUAD tumorigenesis and can be used as prognosis biomarkers. Thus, in this study, to identify more robust biomarkers of LUAD, we firstly constructed LUAD-related lncRNA-TF network and performed topological analyses for the network. Results showed that the network was a scale-free network, and some hub genes with high clinical values were identified, such as lncRNA RP11-173A16 and TF ZBTB37. Module analysis on the network revealed one close lncRNA module, which had good prognosis performance in LUAD. Furthermore, through integrating ceRNAs strategy and TF regulatory information, we identified some lncRNA-TF positive feedback loops. Prognostic analysis revealed that ELK4- and BDP1-related feedback loops were significant. Secondly, we constructed the lncRNA-m6A regulator network by merging all the high correlated lncRNA-m6A regulator pairs. Based on the network analysis results, some key m6A-related lncRNAs were identified, such as MIR497HG, FENDRR, and RP1-199J3. We also investigated the relationships between these lncRNAs and immune cell infiltration. Results showed that these m6A-related lncRNAs were high correlated with tumor immunity. All these results provide a new perspective for the diagnostic biomarker and therapeutic target identification of LUAD.

scholarly journals Endoscopic stenting for malignant tumors in the area of the bauginium fl ap

2020 ◽  
Vol 174 (5) ◽  
pp. 78-81
Author(s):  
A. S. Vodoleev ◽  
M. S. Burdyukov ◽  
S. S. Pirogov ◽  
E. S. Karpova ◽  
D. G. Sukhin ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Malignant Tumors ◽  
Clinical Success ◽  
Colonic Obstruction ◽  
Stent Migration ◽  
Endoscopic Stenting ◽  
High Morbidity ◽  
Right Colon ◽  
Long Distance ◽  
Ileocecal Region

Introduction. Stenting in the ileocecal region is not a routine procedure. Proximal colonic obstruction is generally managed with primary surgery, although there are no RCTs to support this assumption. Recent reports have shown that emergency right colon resection can be associated with high morbidity and mortality rates. We report about 8 cases of obstructive ileocecal cancer for palliative treatment. Case report. Four men and 4 women (mean age, 69 years; range, 62–82 years) were stenting for obstructive ileocecal cancer between September 2014 and December 2019. Emergency SEMS placement was attempted in the remaining 5 cases. An uncovered colonic stent (S&G Biotech; Boston Scientifi c) 22, 24, 25 mm in diameter, 6, 8or 9cm in length, was used. Clinical success is achieved in all cases. One patient was diagnosed with stent migration 4 weeks after stenting, and repeated stenting was performed. Five patients received chemotherapy after stenting, two patients refused further treatment. Discussion. Placing SEMS for ileocecal obstruction is technically challenging for the following reasons. The long distance from the anus, tortuosity of the bowel and angled anatomy of stricture make an ileocecal lesion difficult to reach endoscopically. SEMS can be an alternative to emergency surgery for obstruction due to right colon cancer. In our study, we had migration in 1 case, no perforations or stent ingrown were detected. Conclusion. Stenting for malignant tumors of the ileocecal region, complicated by intestinal obstruction is an eff ective and safe minimally invasive intervention, and can be used as an alternative to emergency surgery.

scholarly journals tRNA Metabolism and Lung Cancer: Beyond Translation

2021 ◽  
Vol 8 ◽  
Author(s):  
Meng Bian ◽  
Shiqiong Huang ◽  
Dongsheng Yu ◽  
Zheng Zhou
Keyword(s):  
Lung Cancer ◽  
Malignant Tumors ◽  
Protein Translation ◽  
Therapeutic Strategies ◽  
High Morbidity ◽  
Health It ◽  
Transfer Rnas ◽  
Trna Synthetases ◽  
Aminoacyl Trna Synthetases ◽  
New Ideas

Lung cancer, one of the most malignant tumors, has extremely high morbidity and mortality, posing a serious threat to global health. It is an urgent need to fully understand the pathogenesis of lung cancer and provide new ideas for its treatment. Interestingly, accumulating evidence has identified that transfer RNAs (tRNAs) and tRNA metabolism–associated enzymes not only participate in the protein translation but also play an important role in the occurrence and development of lung cancer. In this review, we summarize the different aspects of tRNA metabolism in lung cancer, such as tRNA transcription and mutation, tRNA molecules and derivatives, tRNA-modifying enzymes, and aminoacyl-tRNA synthetases (ARSs), aiming at a better understanding of the pathogenesis of lung cancer and providing new therapeutic strategies for it.

scholarly journals Surgical Management of Sinonasal Cancers: A Comprehensive Review

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3995
Author(s):  
Florian Chatelet ◽  
François Simon ◽  
Vincent Bedarida ◽  
Nicolas Le Clerc ◽  
Homa Adle-Biassette ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Special Focus ◽  
Sinonasal Cancer ◽  
Histologic Subtype ◽  
Tumor Pathology ◽  
Comprehensive Literature Review ◽  
Recent Developments ◽  
Oncological Results

Surgery plays an important role in the treatment of sinonasal cancer. Many surgical approaches have been described, including open, endoscopic, or combined approaches. The choice is based on several criteria: general criteria related to the oncological results and morbidity of each technique, specific criteria related to the tumor (tumor extensions, tumor pathology), the patient, or the surgeon himself. The aims of this review are (i) to provide a complete overview of the surgical techniques available for the management of sinonasal malignant tumors, with a special focus on recent developments in the field of transnasal endoscopic surgery; (ii) to summarize the criteria that lead to the choice of one technique over another. In particular, the oncological outcomes, the morbidity of the different techniques, and the specificities of each histologic subtype will be discussed based on a comprehensive literature review.

VS03.01: QUANTITATIVE IMAGING OF CHANGE IN MICROCIRCULATION BY SIDESTREAM DARK FIELD MICROSCOPY (SDF) AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 47-48
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
Suzanne Gisbertz
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Average Velocity ◽  
Venous Return ◽  
Conflicts Of Interest ◽  
Dark Field ◽  
Vessel Density ◽  
Flow Index ◽  
High Morbidity ◽  
Sidestream Dark Field

Abstract Description Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Transection of the left gastric and gastro-epiploic artery and veins results in compromised perfusion in the fundus area which can result in anastomotic dehiscence (5–20%), relating to high morbidity and mortality (3–4%). The main objective of this observational study is to evaluation gastric tube microcirculation with Sidestream Darkfield Microscopy (SDF). Method This study included 22 patients (October 2015 - June 2016). Intra-operative microscopic images of gastric tube microcirculation were obtained with SDF directly after reconstruction. Using software (AVA2.0), the following parameters were evaluated: average velocity (μm/sec), Microvascular Flow Index (MFI), Total Vessel Density (TVD), Perfusion Vessel Density (PVD), Proportion of Perfused Vessels (PPV) and the De Backer Score (DBS), to assess change in perfusion. Results SDF accurately visualized and evaluated microcirculation in all patients. A SDF-stabilizer was used to create stable images. The average velocity decreased significantly towards the fundus (P = 0.001). Also, MFI, PVD and PPV were significantly lower towards the fundus, compared to the base of the gastric tube (P = 0.0002). No differences in TVD and DBS were observed, which was associated to the observed vessel dilation in the fundus-area. This vessel dilation proposes that compromised venous return may play an important role in the development of necrosis and leakage. Three patients developed anastomotic leakage. Conclusion This is the first study presenting quantitative microcirculation imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV were accurate parameters to observe change in perfusion after reconstruction. Also, vessel dilation in the fundus suggests a role for venous return in the development of ischemia. Quantitative microcirculation with SDF could allow for intra-operative early risk stratification, and, potentially, can result in a reduction of anastomotic leakage. Disclosure All authors have declared no conflicts of interest.

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