Outcomes of Esophageal Cancer after Esophagectomy in the Era of Early Injection Laryngoplasty

(1) Background: severe weight loss was reported to be related to unilateral vocal fold paralysis (UVFP) after esophagectomy and could thus impair survival. Concomitant radical lymph node dissection along the recurrent laryngeal nerve during esophageal cancer surgery is controversial, as it might induce UVFP. Early intervention for esophagectomy-related UVFP by administering intracordal injections of temporal agents has recently become popular. This study investigated the survival outcomes of esophagectomy for esophageal squamous cell carcinoma (ESCC) after the introduction of early injection laryngoplasty (EIL). (2) Methods: a retrospective review of patients with ESCC after curative-intent esophagectomy was conducted in a tertiary referral medical center. The necessity of EIL with hyaluronic acid was comprehensively discussed for all symptomatic UVFP patients. The survival outcomes and related risk factors of ESCC were evaluated. (3) Results: among the cohort of 358 consecutive patients who underwent esophagectomy for ESCC, 42 (11.7%) showed postsurgical UVFP. Twenty-nine of them received office-based EIL. After EIL, the glottal gap area, maximum phonation time and voice outcome survey showed significant improvement at one, three and six months measurements. The number of lymph nodes in the resected specimen was higher in those with UVFP than in those without UVFP (30.1 ± 15.7 vs. 24.6 ± 12.7, p = 0.011). The Kaplan–Meier overall survival was significantly better in patients who had UVFP (p = 0.014), received neck anastomosis (p = 0.004), underwent endoscopic resection (p < 0.001) and had early-stage cancer (p < 0.001). Multivariate Cox logistic regression analysis showed two independent predictors of OS, showing that the primary stage and anastomosis type are the two independent predictors of OS. (4) Conclusion: EIL is effective in improving UVFP-related symptoms, thus providing compensatory and palliative measures to ensure the patient’s postsurgical quality of life. The emerging use of EIL might encourage cancer surgeons to radically dissect lymph nodes along the recurrent laryngeal nerve, thus changing the survival trend.

Clinical Characteristics and Nomogram for Adult Medullary Thyroid Carcinoma

Objectives: The present study aimed to investigate the clinical characteristics and independent prognostic factors in adult patients with medullary thyroid carcinoma (MTC), followed by construction of nomogram-based prognostic prediction model for adult MTC.Methods: Relevant subjects were retrieved from Surveillance, Epidemiology, and End Results (SEER) program from January 1, 2004 through December 31, 2014. According to the multivariate analysis, the 3- and 5-year cancer-specific survival (CSS) in MTC patients was predicted by constructing a nomogram. Results: In total, 1279 patients diagnosed with primary MTC were extracted from the SEER database. The 3-, 5-and 10-year CSS rates were 91.11%, 88.32%, and 81.63%, respectively. The Cox proportional hazards model revealed that advanced AJCC stage and elderly age were independent unfavorable prognostic factors, and that surgery and radical lymph node dissection were protective prognostic factors (all P＜0.05). In addition, radiotherapy was independently related to the decreased survival. The C-index of nomogram was 0.902 (95% CI: 0.878–0.926) for the internal validations. Calibration plot revealed satisfactory agreement between the actual findings and predicted outcomes.Conclusion: The nomogram could individually and precisely predict the CSS of MTC patients, which could be used to facilitate in individualized prognostic assessment evaluation and clinical decision-making.

RA01.05: MINIMALLY INVASIVE ESOPHAGECTOMY AND 3-FIELD LYMPH NODE DISSECTION (ESOPHAGEAL SUSPENSION METHOD)—FUJIAN MEDICAL UNIVERSITY UNION HOSPITAL EXPERIENCE

Description We have modified our procedures of lymphadenectomy, with the purpose of radical lymph node dissection, because we believe that radical lymph node dissection along bilateral RLNs may be crucial for post-operative accurate staging, local control and better prognosis. Programmed lymphadenectomy includes several steps. Programmed extensive lymphadenectomy along right RLN included 3 steps: (1) Location of the right vagus nerve. (2) Loaction of the root of the right RLN. (3) Extensive lymphadenectomy. Programmed extensive lymphadenectomy along left RLN was conducted subsequently, which included 4 steps. (1) Esophageal suspension. (2) Lymph node rolling.(3) Location and identification of left RLN. (4) Extensive lymphadenectomy. During the whole procedure, we preferred to use blunt separation in the zones near the RLN, and preferred to use the ultrasound knife and scissors rather than electrical knife. The thoracic esophagus was not cut off during the procedure. After the thoracic procedures, we do the laparoscopic gastric dissociation and lymph node dissection. When metastasis to either RLN chains was confirmed by routine intra-operative frozen section, bilateral cervical lymphadenectomy was also performed. We divided the procedures into steps, which could have following advantages: more radical lymph node clearance with skeletonization of the nerves, reduced injuries due to definite location and identification of the nerves, more easier for surgeons to expose the surgical field and more easier for new-hands to master the procedures. Minimally invasive esophageactomy and thoracoscopic programmed extensive lymphadenectomy along the left and right RLNs in esophagectomy was feasible and safe. According to our study, programmed extensive lymphadenectomy yielded sufficient lymph nodes, with acceptable postoperative complications. Disclosure All authors have declared no conflicts of interest.

Variations of Gastrocolic Trunk of Henle and Its Significance in Gastrocolic Surgery

Due to the increasing incidence of gastrointestinal (GI) tumors, more and more importance is attached to radical resection and patients’ survival, which requires adequate extent of resection and radical lymph node dissection. Blood vessels around the gastrointestinal tract, as anatomical landmarks for tumor resection and lymph node dissection, play a key role in the successful surgery and curative treatment of gastrointestinal tumors. In the isolation of subpyloric area or hepatic flexure of the colon for gastrectomy or right hemicolectomy, lymph node dissection and ligation are often performed at the head of the pancreas and superior mesenteric vein, during which even a minor inadvertent error may lead to unwanted bleeding. Among these blood vessels, the venous system composed of Henle’s trunk and its tributaries is the most complex, which has a direct influence on the outcome and postoperative recovery of the patients. There are many variations of Henle’s trunk, with complicated courses and various locations, attracting more and more researchers to study it and tried to analyze the influence of its variations on gastrointestinal surgeries. We characterized various variants and tributaries of Henle’s trunk using autopsy, vascular casting, 3D CT reconstruction, intraoperative anatomy, and Hisense CAS system and summarized and analyzed the tributaries of Henle’s trunk, to determine its influence on GI surgeries.