Objective To explore the predictive value of cardiopulmonary exercise test (CPET) combined with clinical indexes in the postoperative complications. Methods The clinical data and CPET data (including lung function) of patients undergoing radical esophagectomy in Xuzhou Central Hospital from January 2018 to March 2022 were collected. Univariate analysis and multivariate logistic regression analysis were used to analyze the meaningful evaluation index for the occurrence of postoperative complications. Results A total of 77 patients with esophageal cancer were included, including 59 (76.6%) males and 18 (23.4%) females aged 47-80 years. There were 42 (54.5%) patients in the non-complication group and 35 (45.5%) patients in the complication group. Univariate analysis results showed that the occurrence of postoperative complications was significantly correlated with age, body mass index (BMI), smoking index, tumor stage, the length of postoperative hospital stay, peak work rate (WRpeak), peak kilogram oxygen uptake (VO2peak/kg), the ventilatory equivalent for carbon dioxide slope (VE/VCO2 slope), forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) and maximum expiratory flow rate (MMEF) (P<0.05). The results of multivariate logistic regression analysis showed that BMI [OR=1.35, 95%CI (1.03, 1.77), P=0.031], peakVO2/kg [OR=0.64, 95%CI (0.45, 0.93), P=0.018], oxygen uptake-anaerobic threshold (ATVO2) [OR=0.66, 95%CI (0.44, 0.98), P=0.044] and VE/VCO2 slope [OR=1.49, 95%CI (1.10, 2.02), P=0.011] were the related indexes of complications after radical resection of esophageal cancer. The sensitivity of BMI, VO2peak/kg, ATVO2/kg and VE/VCO2 slope in predicting postoperative complications was 82.10%, and the specificity was 87.44%, 95%CI (0.744, 0.955). Conclusion BMI, VO2peak/kg, ATVO2/kg and VE/VCO2 slope can be used as predictors for postoperative complications of esophageal cancer.
Abstract: Objective To determine the effects of early enteral nutrition (EEN) on postoperative recovery in elderly patients with esophageal cancer. Methods We included 100 elderly patients with esophageal cancer who were admitted at the PLA 100 Hospital between January 2006 and April 2010, and whose diagnoses were confirmed by pathological examination. The patients were divided into an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group, with 50 patients in each group. There were 32 males and 18 females with an average age of 72 years in the EEN group. There were 30 males and 20 females with an average age of 69 years in the PN group. We analyzed the effect of the nutrition administration method on bowel function recovery, hospital stay, complication rate, and nutritional status one week after surgery. Results The anal exhaust time (45.3±12.7 h vs. 73.6±11.7 h), time until anal defecation (80.5 h±15.6 h vs. 140.1±13.2 h), and hospital stay (13.0±1.8 d vs. 15.2±3.3 d) in the EEN group were all shorter than those in the PN group (Plt;0.05). The rates of lung infection, anastomotic leakage, and cardiac complications in the EEN group were significantly lower than those of the PN group (Plt;0.05). One week after the operation, the serum albumin (ALB), peripheral blood lymphocytes, transferrin, and 24 h urea nitrogen (BUN) in the EEN group were higher than those in the PN group (Plt;0.05). Conclusion Compared with parenteral nutrition, enteral nutrition can promote metabolic function in elderly patients after recovery, reduce morbidity, and promote recovery.
Esophageal carcinoma surgery belongs to high risk subjects. Esophageal carcinoma radical resection and reconstruction is popular in the surgical field and one of the most challenging operations. How to understand, evaluate and treat risks, take corresponding measures, so as to reduce and avoid risks, has been the focus of clinical attention and research. we base on clinical work practices, review the relevant literatures, try to review the risk factors of Esophageal cancer surgery, evaluation methods, risk classification, and its preventive countermeasures for preliminary thinking and discussions, to provide a useful reference to development of a scientific, rational and practical Esophageal cancer surgery risk scoring system.
The lymphatic system is the main way of tumor metastasis and diffusion. Esophageal cancer is one of the typical cancers that are prone to metastasis through the lymphatic system. At present, an increasing number of studies show that the interaction between tumor cells and lymphatic endothelial cells is the first step in tumor lymphatic metastasis, but the underlying molecular mechanism is unclear. This article reviews the role and changes of tumor-related lymphatic vessels and lymphatic endothelial cells in the process of tumor lymphatic metastasis, which lays a foundation for further study of the specific molecular mechanism of esophageal cancer lymphatic metastasis and provides a new treatment direction for esophageal cancer patients.
Objective To investigate the application of enhanced recovery after surgery (ERAS) in da Vinci robotic McKeown surgery for esophageal cancer. Methods Clinical data of patients admitted to the First Hospital of Lanzhou University and undergoing da Vinci robotic McKeown surgery for esophageal cancer from 2017 to 2021 were retrospectively analyzed. According to the treatment, they were divided into two groups, a conventional group and an ERAS group. Patients in the conventional group were treated with the conventional perioperative treatment mode of thoracic surgery, and patients in the ERAS group were treated with accelerated rehabilitation surgical treatment mode. Relevant hospitalization indicators and postoperative complication rates were compared between the two groups. Results Finally 128 patients were collected, including 106 males and 22 females, with an average age of 61.91 years. There were 71 patients in the conventional group and 57 patients in the ERAS group. The postoperative pain index in the ERAS group was significantly lower than that in the conventional group (P<0.05), and the duration of postoperative analgesic pump used in the ERAS group was shorter than that in the conventional group (2.39±0.49 d vs. 3.13±0.63 d, P<0.001). There was no statistical difference in the incidence of postoperative related complications (gastroesophageal reflux, anastomotic stenosis, anastomotic fistula, arrhythmia, recurrent laryngeal nerve injury, chylothorax, anastomosis stomatitis or incisional infection) between the two groups (P>0.05), but the incidence of postoperative lung infection in the ERAS group was statistically lower (12.28% vs. 26.76%, P=0.043), and the volume of postoperative pleural effusion was statistically less compared with the conventional group (P<0.05). In the ERAS group, the surgery time (294.35±15.19 min vs. 322.79±59.09 min, P<0.001), postoperative exhaust time (1.44±0.39 d vs. 1.94±0.43 d, P<0.001), postoperative removal time of nasolasal tube (6.79±0.73 d vs. 8.21±0.86 d, P<0.001), hospital stay (19.88±3.36 d vs. 21.34±3.59 d, P=0.020), hospitalization costs (105 575.28±8 960.75 yuan vs. 137 894.64±19 518.60 yuan, P<0.001) were all lower or shorter than those of the conventional group. Postoperative activity was longer in the ERAS group than that in the conventional group (P<0.05), but there was no statistical difference in preoperative anesthesia time between the two groups (P=0.841). Conclusion The application of ERAS in da Vinci robotic McKeown surgery for esophageal cancer can effectively alleviate the physiological and psychological burden of patients, reduce the occurrence of postoperative related complications, effectively shorten the total hospital stay, save hospitalization costs, and reduce the economic burden of patients and society. Therefore, it can be promoted and applied in the clinic.
Objective To evaluate the effect of mechanical suture in surgery of esophageal carcinoma,Methods Five hundred and sixty-eight cases of esophagogastrostomy and esophagojejunostomy for esophageal and cardiac carcinoma were collected in our hospital between January, 1988 and December, 2002. They were devided into two groups according to the methods of anastomoses, the group by stapler and the group with hand. The incidence of postoperative complications in the two groups was compared. Results The time of esophagogastrostomy, the total operating time, and postoperative fasting time of group by stapler were shorter than those of group with hand （Plt;0. 01）, and there was no statistically difference in the median hospitalized time after operation for two groups. The anastomotic leakage, anastomotic stricture, anastomotic bleeding , incidence of postoperative complications in respiration and circulation and mortality rate of group by stapler were lowed than those of group with hand （2.1%, 1.4%,0%,2.8% and 0.7% vs.6.8%,4.3%,1.4%,16.5% and 2.9%）. There was no statistical difference in the postoperative gastro-esophageal reflux for two groups （P 〉 0.05 ）. Conclusion The median time of esophagogastrostomy and the median operating time by stapler are decreased and the incidence of postoperative complications is decreased.
