scholarly journals The Effects of Protective Ventilation on the Production of Endogenous Melatonin and Prognosis in Patients Undergoing Esophageal Cancer Surgery: A Prospective Randomized Double-Blind Controlled Study

2020 ◽  
Author(s):  
Lixia Wang ◽  
Jun Li ◽  
Yuting Huang ◽  
Yan Zhu ◽  
Qiying Shen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Airway Pressure ◽  
Protective Ventilation ◽  
Cancer Surgery ◽  
Conventional Ventilation ◽  
Controlled Study ◽  
Lung Protective Ventilation ◽  
Inflammasome Activation ◽  
Esophageal Cancer Surgery ◽  
Endogenous Melatonin

Abstract Background: Exogenous melatonin exerts a similar effect to protective ventilation on attenuating ventilator-induced lung injury (VILI) by inhibiting NLRP3 inflammasome activation in mouse model. However, the effect of protective ventilation on the production of endogenous melatonin and prognosis in patients undergoing esophageal cancer surgery remains unknown. In this study, we aimed to reveal the effects of protective ventilation on the production of endogenous melatonin, interleukin (IL)-1β, IL-18 and major complications in patients undergoing esophageal cancer surgery. Methods: Eight-eight patients were randomized to receive “conventional” ventilation (Vt=10 mL/kg) or lung protective ventilation [Vt=5 mL/kg along with 5 cm of H2O positive end-expiratory pressure (PEEP)]. IL-1β, IL-18 and melatonin levels in bronchoalveolar lavage fluid (BALF) and serum were measured. Respiratory variables and outcomes were evaluated.Results: Lung protective ventilation decreased the peak airway pressure (Ppeak), plateau airway pressure (Pplat) and driving pressure (ΔP) compared with the “conventional” ventilation group. Lung protective ventilation inhibited polymorphonuclear (PMN) cells invasion into the BALF (P=0.000). Likewise, lung protective ventilation suppressed alveolar and serum IL-1β and IL-18 secretion after mechanical ventilation. Furthermore, lung protective ventilation resulted in a decrease in the inhibition of endogenous MT production compared to “conventional” ventilation (P=0.000). In addition, lung protective ventilation reduced the incidence of postoperative pulmonary complications (P=0.04) and the rate of major postoperative complications (P=0.023).Conclusions: Taken together, lung protective ventilation for esophageal cancer surgery suppressed the secretion of IL-1β, IL-18 and restored the endogenous melatonin level. Meanwhile, lung protective ventilation improved postoperative outcomes after esophageal cancer surgery.Trial registration: The Chinese Clinical Trial Registry, ChiCTR1900026190. Registered 25 September 2019, http://www.chictr.org.cn/edit.aspx?pid=34677&htm=4

scholarly journals The Effects of One-lung Ventilation on the Production of Endogenous Melatonin and NLRP3 Inflammasome-Related Inflammatory Cytokines in Patients Undergoing Laparoscopic Esophagectomy: A Prospective Randomized Double-Blind Controlled Study

2020 ◽  
Author(s):  
Lixia Wang ◽  
Jun Li ◽  
Yuting Huang ◽  
Yan Zhu ◽  
Qiying Shen ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
Nlrp3 Inflammasome ◽  
Airway Pressure ◽  
Lung Ventilation ◽  
Protective Ventilation ◽  
Conventional Ventilation ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
The Relationship ◽  
Endogenous Melatonin

Abstract Background: NLRP3 inflammasome has been confirmed to play a pivotal role in ventilator-induced lung injury (VILI), while exogenous melatonin can attenuate VILI by inhibiting NLRP3 inflammasome activation in mouse model. However, the relationship between endogenous melatonin and the NLRP3 inflammasome-related inflammatory cytokines in VILI induced by one-lung ventilation (OLV) remains unknown. In this study, we aimed to reveal the relationship between the NLRP3 inflammasome-related inflammatory cytokines: interleukin (IL)-1β, IL-18 and endogenous melatonin in OLV-induced VILI during esophageal cancer surgery.Methods: Twenty-eight patients were randomized to receive “conventional” ventilation (Vt=8 mL/kg) or lung protective ventilation (Vt=5 mL/kg along with 5 cm H 2 O positive end-expiratory pressure (PEEP)). Respiratory variables were evaluated. IL-1β, IL-18 and melatonin in bronchoalveolar lavage fluid (BALF) and plasma were measured.Results: we found that lung protective ventilation during OLV decreased peak airway pressure (Ppeak), plateau airway pressure (Pplat) and driving pressure (ΔP) compared with that in “conventional” ventilation group. Moreover, lung protective ventilation inhibited polymorphonuclear (PMN) cells invasion into BALF. Likewise, lung protective ventilation not only suppressed alveolar and plasma IL-1β secretion, but also reduced increased production of IL-18 in both BALF and plasma after OLV. Furthermore, we found that both alveolar and plasma endogenous melatonin levels in “conventional” ventilation group were lower than that in lung protection group.Conclusion: Taken together, the present study suggested that lung protective ventilation during OLV prevented VILI via suppressing NLRP3 inflammasome-related inflammatory cytokines secretion and restoring the level of endogenous melatonin in patients.Trial registration: the Chinese Clinical Trial Registry, ChiCTR1900026190. Registered 25 September 2019, http://www.chictr.org.cn/edit.aspx?pid=34677&htm=4

Risk stratification of anastomotic leakage using eGFR and FIB-4 index in patients undergoing esophageal cancer surgery

2021 ◽  
Author(s):  
Keita Takahashi ◽  
Katsunori Nishikawa ◽  
Yuichiro Tanishima ◽  
Yoshitaka Ishikawa ◽  
Takahiro Masuda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Risk Stratification ◽  
Anastomotic Leakage ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery

Volume and outcomes after esophageal cancer surgery: the experience of the Region of Lombardy—Italy

2013 ◽  
Vol 65 (4) ◽  
pp. 271-275 ◽  
Author(s):  
Uberto Fumagalli ◽  
Maurizio Bersani ◽  
Antonio Russo ◽  
Alessandra Melis ◽  
Stefano de Pascale ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery

Esophageal Cancer Surgery in Heart Transplant Patients

2005 ◽  
Vol 80 (4) ◽  
pp. 1510-1512 ◽  
Author(s):  
Burkhard H.A. von Rahden ◽  
Hubert J. Stein ◽  
Georg Schmidt ◽  
Holger Bartels ◽  
Matthias Overbeck ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Heart Transplant ◽  
Cancer Surgery ◽  
Transplant Patients ◽  
Esophageal Cancer Surgery

Enteral immuno-enhanced diets with arginine are safe and beneficial for patients early after esophageal cancer surgery

2008 ◽  
Vol 21 (7) ◽  
pp. 619-627 ◽  
Author(s):  
Satoshi Aiko ◽  
Yutaka Yoshizumi ◽  
Takamitsu Ishizuka ◽  
Takuya Horio ◽  
Takashi Sakano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery

scholarly journals Textbook outcome for esophageal cancer surgery: an international consensus-based update of a quality measure

2021 ◽  
Author(s):  
Marianne C Kalff ◽  
Mark I van Berge Henegouwen ◽  
Suzanne S Gisbertz
Keyword(s):  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Quality Measure ◽  
Resection Margins ◽  
International Consensus ◽  
Term Survival ◽  
Intraoperative Complication ◽  
Esophageal Cancer Surgery ◽  
Perioperative Course

Summary Textbook outcome for esophageal cancer surgery is a composite quality measure including 10 short-term surgical outcomes reflecting an uneventful perioperative course. Achieved textbook outcome is associated with improved long-term survival. This study aimed to update the original textbook outcome based on international consensus. Forty-five international expert esophageal cancer surgeons received a personal invitation to evaluate the 10 items in the original textbook outcome for esophageal cancer surgery and to rate 18 additional items divided over seven subcategories for their importance in the updated textbook outcome. Items were included in the updated textbook outcome if ≥80% of the respondents agreed on inclusion. In case multiple items within one subcategory reached ≥80% agreement, only the most inclusive item with the highest agreement rate was included. With a response rate of 80%, 36 expert esophageal cancer surgeons, from 34 hospitals, 16 countries, and 4 continents responded to this international survey. Based on the inclusion criteria, the updated quality indicator ‘textbook outcome for esophageal cancer surgery’ should consist of: tumor-negative resection margins, ≥20 lymph nodes retrieved and examined, no intraoperative complication, no complications Clavien–Dindo ≥III, no ICU/MCU readmission, no readmission related to the surgical procedure, no anastomotic leakage, no hospital stay ≥14 days, and no in-hospital mortality. This study resulted in an international consensus-based update of a quality measure, textbook outcome for esophageal cancer surgery. This updated textbook outcome should be implemented in quality assurance programs for centers performing esophageal cancer surgery, and could standardize quality measures used internationally.

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