A tertiary care prospective of epidemiology and etiopathogenesis of esophageal carcinoma from Northern India

Background: Esophageal cancer is considered to be a one of the most lethal malignancy. Indian population have seen a lot of changes in the epidemiology of this deadly cancer. However very few studies have been done from northern India regarding the epidemiology and etiopathogenesis of this disease. Majority of esophageal cancers (about 90%) are either squamous cell or Adenocarcinoma. Any factor that causes chronic irritation and inflammation of the esophageal mucosa appears to increase the incidence of the esophageal. The aim of the study was to perform an epidemiological study and determine the various factors that are implicated in the pathogenesis of carcinoma esophagus.Methods: This study was conducted in the department of general surgery, Government Medical College, Jammu, as an observational prospective study. It took into account the patients from 2015 to 2020. A total of 23 patients of carcinoma oesophagus who presented to Outdoor patient wing of department of surgery were included in the study. After detailed history, examination and investigations, the various variables were extracted and data was processed.Results: In this study, the majority of people were from rural areas in their seventh decade of life with males: female ratio of 3:1. The majority of people complained of dysphagia and weight loss. The site of tumor was Gastroesophageal junction.Conclusions: This study emphasised the need of health education in our population, especially in young adults to lessen the risk factors for carcinoma esophagus.

Acute massive gastric dilatation as a result of closed-loop obstruction of stomach: an unusual and rare phenomenon

Acute massive gastric dilatation (AMGD) is a rare event which is usually underdiagnosed. It can occur due to multiple etiologies, including medical and surgical, or as a postoperative complication. We report a rare case of AMGD as a result of closed-loop obstruction of the stomach following feeding jejunostomy in a patient with carcinoma oesophagus. A high index of suspicion, early diagnosis and prompt management is the key to the successful treatment. To the best of our knowledge, this is the second case report of a closed-loop obstruction of the stomach leading to AMGD in published literature.

Dosimetric impact of positron emission tomography-based gross tumour volume (GTV) delineation over conventional CT-based GTV delineation for carcinoma oesophagus

Aim: The aim of the study was to find the dosimetric impact of positron emission tomography (PET)-based gross tumour volume (GTV) delineation over computed tomography (CT)-based GTV delineation for carcinoma oesophagus. Methods: Fifteen patients with carcinoma oesophagus were retrospectively selected. Two sets of GTVs in CT plain images were generated, one with the help of intravenous and oral contrast (GTV CT) and the other with only using PET uptake with the standardised uptake value (simple way of determining the activity in PET) (SUV) > 2.5 (GTV PET). Corresponding PTVs were generated. For all patients, rapid arc plans were generated. Changes in target volumes and critical structure doses were evaluated. The Wilcoxon signed-rank test was used for statistical analysis, and p value < 0.05 was assumed as statistically significant. Results: Mean reduction in GTV was 5.76 ± 19.35 cc. Mean reduction in PTV 45 Gy was 42.40 ± 76.39 cc. Mean reduction in heart mean dose was 1.53 ± 2.16 Gy. Mean reductions in left lung V20% and V10% were 2.43 ± 4.28 and 3.25 ± 5.09 Gy, respectively. Mean reductions in right lung V20% and V10% were 3.11 ± 4.91 and 2.80 ± 4.51 Gy, respectively. Mean reduction in total lung mean dose was 1.00 ± 1.19 Gy. Finding: PET-based GTV contouring reduces the treatment volume and critical structure doses significantly over CT-based GTV contouring for carcinoma oesophagus.

Prognostic role of serum C-reactive protein in carcinoma oesophagus

Background: Oesophageal cancer (EC) is the eighth most common cancer around the world. EC incidence and mortality are affected by geography. Eastern Asia, eastern and southern Africa has the highest rates, whereas Europe and North America show lower rates.Methods: The study was conducted on 30 cases of EC diagnosed in Sri Guru Ram Das Institute of Medical Sciences and Research, Sri Amritsar. The study was carried during period starting from January 2017 to June 2018. Serum C - reactive protein levels measurement was made in addition to the other routine investigations.Results: The sample consisted of 30 patients presenting with EC. Total number of males was 7 (23.33%) and there were 23 (76.66%) females. It was found in present study that the most common age group presenting with oesophageal cancer was 41-60 years followed by 61-80 years. It was also observed in the present study that majority of patients 15 (50%) were housewives. It was also observed that 17 (56.67%) of patients had more than 6 mg/l level of preoperative C-reactive proteins. Among the poorly differentiated histological grade patients 14 (73.68%) had high level of C-reactive proteins. Moreover hospital stay was also more among the patients having high pre-operative levels of C-reactive proteins (CRPs).Conclusions: The prognosis for patients with preoperative serum elevation of CRP was significantly more unfavourable than that for patients without serum CRP elevation.

Thoracoscopic ligation of the thoracic duct for a massive chylothorax following a thoracolaparoscopic oesophagectomy

Chyle leak is an uncommon yet solemn complication following several head, face and neck surgeries, especially malignancies. Thoracic duct injury usually has an insidious onset and a long course of response and improvement rendering the patient nutritionally debilitated and immunocompromised. Hence, the prompt identification and treatment of a chyle leak is essential for an optimal surgical outcome. Here, we present an interesting case report of a chylothorax, as a postoperative sequela in a 70-year-old male with carcinoma oesophagus who underwent a Thoracolaparoscopic oesophagectomy. He was managed by a thoracoscopic ligation of the thoracic duct, which not only negated the need for a major thoracic procedure, but also provided a good surgical outcome.

PS01.163: EVALUATION OF A TECHNIQUE OF SINGLE LAYER CONTINUOUS ESOPHAGOGASTRIC ANASTOMOSIS USING POLIGLECAPRONE 25

Background Methods This was a prospective study on patients who underwent esophagectomy for carcinoma oesophagus from May 2016 to August 2017. The patients who expired in immediate post operative period were excluded from study for evaluation of anastomotic leak and those patients who could not be followed up for at least six months were also excluded from study for evaluation of development of post operative stricture. End to side anastomosis was placed on the anterior surface of stomach using two suture lengths of 2–0 polyglecaprone 25. Anastomosis was done in single continuous layer with full thickness bites. At the end the stomach conduit was tucked to prevertebral fascia by a single stitch. During post operative period, Jejunal feeding was started on 2nd post operative day. Ryle's tube was removed on 5th post operative day and clear liquids were started. Gastrograffin study was done only if clinical suspicion of leak was there on day 7. Semisolid puree diet was started on day 7 and neck drain was removed on day 10. Patients were followed up for six months and specifically asked for symptoms of dysphagia.Symptoms of dysphagia were recorded and graded on the basis of Mellow-Pinkas scoring system. Results Mckeowns esophagectomy was performed in 18 patients, transhiatal in 8 patients and Ivor Lewis in 1 patient. Average time taken for anastomosis was 17 min. Anastomotic leak was seen in four patients(14.81%) and all leaks could be managed conservatively. Only two patients(7.40%) presented with dysphagia which required dilatations. The cost of suture used was least as compared to other techniques. Conclusion Anastomotic leak rate of the present technique was found to be comparable to other techniques whereas the post operative stricture formation was significantly less. Poliglecaprone 25 looses all its tensile strength by third week and this may be the reason for low stricture rates. We conclude that Esophagogastic anastomosis with a single layer continuous technique using 2–0 poliglicaprone 25 gives good results having comparable leak rates to other techniques. The rate of anastomotic stricture formation is quite low as compared to other techniques.The anastomosis takes less than seventeen minutes and is quite cost effective. Disclosure All authors have declared no conflicts of interest.