ObjectiveTo detect human papilloma virus (HPV)infection with fluorescent quantitative real-time polymerase chain reaction (FQ-PCR)in Minnan population, and explore the correlation between HPV infection and carcinogenesis of esophageal carcinoma (EC)of Minnan patients.
MethodsFQ-PCR was performed to examine HPV-6, HPV-11, HPV-16 and HPV-18 in 100 healthy Minnan people (healthy group, 66 males and 34 females with their age of 52.35±6.72 years)and 100 Minnan patients with squamous EC (EC group and tumor-adjacent normal tissue group, 64 males and 36 females with their age of 51.62±6.37 years)between October 2009 and December 2012.
ResultsThe incidences of HPV infection in 100 EC tissues, 100 tumor-adjacent normal tissues and 100 esophageal mucosa tissues of healthy people were 22/100, 8/100 and 6/100 respectively, which were statistically different (χ2=10.63, P < 0.01). Positive infection of HPV-6, HPV-11, HPV-16 and HPV-18 was observed in 11 cases, 11 cases, 14 cases and 15 cases in EC group respectively, 5 cases, 6 cases, 7 cases and 8 cases in tumor-adjacent normal tissue group respectively, and 5 cases, 5 cases, 6 cases and 6 cases in the healthy group respectively (P > 0.05). Positive HPV infection was observed in 1 patients with well differentiated squamous EC, 21 patients with moderately differentiated squamous EC and 5 patients with poorly differentiated squamous EC (P > 0.05).
ConclusionHPV infection may exist in tumor tissue of Minnan patients with squamous EC, and may be correlated with carcinogenesis and development of squamous EC.
Abstract： Objective To summarize the technical characteristics and experience on the surgical treatment of esophagobrochial fistula induced by esophageal carcinoma and explore the safe and effective operation procedures. Methods This report retrospective1y summarized 12 cases of esophagobronchial fistula induced by esophageal cancer between January 2007 and November 2010 in Tangdu Hospital, Fourth Military Medical University. There were 9 male patients and 3 female patients with their mean age of 51.24 years (ranging from 37 to 62 years). Four types of surgical procedures were performed to patients according to their respective conditions: (1) Esophagectomy ＋“tunnel”esophagogastrostomy ＋ pulmonary lobectomy (2 patients)； (2) Esophagectomy ＋ stapled esophagogastrostomy ＋ pulmonary lobectomy (5 patients)； (3) Esophagectomy ＋ colon interposition for esophagus ＋ pulmonary lobectomy (4 patients)； (4) Esophagectomy ＋ esophagogastrostomy ＋ left pneumonectomy (1 patient). Results Among those 12 cases presenting to our hospital, 2 patients died during the postoperative period and the overall morality was 16.67%(2/12). One patient died of acute congestive heart failure on the 4th postoperative day after esophagectomy, “tunnel”esophagogastrostomy and left lower lobectomy of the lung for esophageal carcinoma directly invading the left lower bronchus, and another patient died of severe infection and renal failure on the 11th postoperative day after esophagectomy, stapled esophagogastrostomy and left upper lobectomy of the lung for esophageal carcinoma directly invading the left upper bronchus. Four patients developed mild empyema and 1 patienthad bronchial fistula after surgery, who finally recovered and were discharged after treatment of antibiotics and drainage. The postoperative morbidity was 41.67%（5/12）. All surviving patients were followed up from 1 month to 3 years. During follow-up, there was one death, and the other patients were alive without any clinical events. Conclusion Individualized surgical procedure is a safe and effective therapeutic choice for patients with esophagobronchial fistula induced by esophageal carcinoma.
ObjectiveTo explore the clinical features and the prognostic factors of neuroendocrine carcinoma of the esophagus.
MethodsWe retrospectively analyzed clinical data of 41 cases of neuroendocrine carcinoma of the esophagus admitted in the First Affiliated Hospital of Nanjing Medical University between March 2008 and March 2014. There were 37 males and 4 females at a mean age of 61.1±7.9 years (ranged from 40 to 79 years). All patients underwent surgical resection and lymph node dissection.
ResultsNo severe complications occurred during the perioperative period, and no death occurred during the period of hospitalization.Thirteen patients received postoperative chemotherapy and radiotherapy. Eleven patients received simple postoperative chemotherapy. One patient received postoperative radiotherapy. The remaining 16 patients did not receive any special treatment. The patients were followed up for 6 to 61 (24.0±13.6)months. Twenty-two patients survived, the other 19 patients died. The 1-year, 2-year, 3-year, 4-year, and 5-year survival rate was 80.49%, 39.02%, 21.95%, 7.32%, and 4.88%, respectively. The median survival of single surgical treatment and postoperative comprehensive treatment was 12.0 months and 25.0 months, respectively. The median survival of T2-T4 and T1 was 20.0 months and 37.5 months, respectively. The difference was statistically different (P<0.05). Cox regression analysis showed that the depth of tumor invasion, postoperative adjuvant chemotherapy and radiotherapy were independent factors of prognosis (P<0.05).
ConclusionsNeuroendocrine carcinoma of the esophagus is rare and with a high degree of malignancy. It is expected to increase the long-term survival rate after surgical and postoperative comprehensive treatment.
Objective To summarize the clinical experience of surgical treatment for cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm), so as to enhance the surgery curative effect and reduce the occurrence of complications. Methods Clinical material of 142 patients with esophageal carcinoma in the neck and upper thorax in this hospital were retrospectively analyzed. Radical excision were taken for 122 patients, palliative excision were taken for 15 patients and exploration were taken for 5 patients, total excision rate was 96.5%. The main type of surgical reconstruction technique includes: simple replacement of esophagus with stomach, colon replacement of esophagus technique, jejunum replacement of esophagus, pectoral major muscleskin flap reconstruction; the right chestupper abdomenneck three incisions for the stomach replacement of esophagus technique, an entire throat excision+stomach replacement of esophagus, a tube stomach replacement of esophagus, left chestneck two incisions, stomach replacement of esophagus technique. Results There were 5 postoperative deaths, two of which died of pulmonary infection, one died of serious infection due to colon necrosis, one died of pulmonary infection due to esophagealtracheal fistula after palliative excision, one died of suffocation due to massive regurgitations. Tumor cells were discovered on the cancer edge of esophagus by pathology in 9 patients. Eight patients with carcinoma of the cervical and 21 patients with carcinoma of the upper thoracic esophagus were suffered from one or more kind of postoperative complications. Mainly complications consisted of the jejunum necrosis, the colon necrosis, the recurrent nerve damage, the lungs infection, the swallow function barrier, esophageal regurgitation. The total of 117(85.4%) survivals were followed up from 1 to 5 years, 20 patients were missed followup. The 1, 3, 5 years survival rate after surgical treatment were 72%,48% and 31% respectively. The 5 year survival rate of the patients in Ⅰ,Ⅱ,Ⅲ,Ⅳa stage were 82.3%, 61.2%, 25.0% and 5.0% respectively. Conclusion Further studies about operation mode, excision area, prevention for postoperative complication, preservation and reconstruction of normal function for patients suffering from the cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm) is still expected.
Abstract: Objective To explore the protection of pulmonary function by shortening the thoracic opening time inesophagectomy of esophageal carcinoma. Methods A retrospective review of the postoperative pulmonary function of 54 patients with upper esophageal cancer undergoing esophagectomy with triple incisions in Tongji Hospital from January 2007 to April 2010 was conducted. The patients were divided into two groups. Twentyeight patients including 25 males and 3 females aged at 58.9±8.2 years were in in the classic procedure group, accepting classical esophagectomy with triple incision approach. Among them, there were 26 patients with squamous carcinoma and 2 with adenocarcinoma. Twentysix patients including 22 males and 4 females aged at 54.7±9.4 years were in the improved procedure group, accepting improved esophagectomy with triple incision approach. Among them, 25 patients had squamous carcinoma and 1 had adenocarcinoma. We analyzed the difference of the thoracic opening time, onelung ventilation time during the operation, arterial oxygen pressure (PaO2), arterial carbon dioxide differential pressure(PaCO2), pulse oximeter saturation (SpO2), postoperative mechanical ventilation time, intensive care unit (ICU) stay time, postoperative oxygen support days, postoperative inhospital days, and the incidence of pulmonary infection and respiratory failure between the two groups. Results There was a statistical difference between the two groups in thoracic opening time (4.7±1.2 hours versus 2.6±0.8 hours, t=7.51, Plt;0.05) and onelung ventilation time (3.7±15 hours versus 23±0.8 hours, t=4.23, Plt;0.05). The PaO2 and SpO2 on the 1st day and the 3rd day after operation were significantly lower than those before operation in both the classic procedure group (on the 1st day after [CM(159mm]operation, PaO2: F=516.03, Plt;0.05; SpO2: F=129.63, Plt;0.05; on the 3rdday after operation, PaO2: F=213.99, Plt;005; SpO2: F=61.84, Plt;0.05) and the improved procedure group (on the 1st day after operation, PaO2: F=423.56, Plt;0.05; SpO2: F=184.24, Plt;0.05; on the 3st day after operation, PaO2: F=136.78, Plt;0.05). On the 1st day after operation, PaO2 and SpO2 in the improved procedure group were significantly higher than those in the classic procedure group (F=36.20, Plt;0.05; F=93.42, Plt;0.05), while PaCO2 in the improved procedure group was significantly lower than that in the classic procedure group (F=155.49, Plt;0.05). On the 3rd day after operation, PaO2 in the improved procedure group was significantly higher than that in the classic procedure group (F=29.23, Plt;0.05). The postoperative mechanical ventilation time and ICU stay time in the improved procedure group were significantly shorter than those in the classic procedure group (t=3.81, P=0.00; t=4.65, Plt;0.05). Conclusion Improved esophagectomy of carcinoma with triple incision approach can significantly shorten the thoracic opening time and onelung ventilation time during operation, which plays a good role in protecting pulmonary function and lowering the incidence of pulmonary complications.
Objective To explore the protective effect of early enteral nutrition on intestinal mucosa barrier in patients with esophageal carcinoma after operation. Methods Fifty six patients with esophageal carcinoma whose weight decreased more than 20% before operation in three months were divided into enteral nutrition group ( n =30) and parenteral nutrition group ( n =26). Plasma concentration of lipopolysaccharide(LPS), tumor necrosis factor (TNF), gastrin, glutamine, and ratio of lactulose and mannitol (L/M) were measured on the 1st, 4th, 8th day after operation respectively. Results Weight loss and infectious complication in enteral nutrition group were less than those in parenteral nutrition group after operation ( P lt;0.01, 0.05). On the 4th and 8th day after operation,the level of LPS,TNF, and L/M were lower in enteral nutrition group than those in parenteral nutrition group ( P lt;0 01), the values of gastrin and glutamine were higher in enteral nutrition group than those in parente...更多ral nutrition group ( P lt;0 01). Conclusion Enteral nutrition can protect the intestinal mucosa barrier and decrease infectious complication after operation.
ObjectiveTo explore the safety and feasibility of the modified and improved thoracoscopic surgery for esophageal cancer using the concept of "single-direction" thoracoscopic technique.MethodsThe clinical data of 65 patients undergoing this modified minimally invasive esophagectomy based on "single-direction" thoracoscopic system between June 2018 and April 2019 were retrospectively analyzed, including 54 males and 11 females aged 62.5±7.8 years.ResultsThe thoracoscopic operation time was 133.4±28.6 min, and intraoperative blood loss was 61.9±29.2 mL. No intraoperative blood transfusion was needed. One patient was transferred to open thoracotomy (due to severe pleural adhesion atresia). Major complications included anastomotic leak, pneumonia, chylothorax, incisional infection, recurrent laryngeal nerve paralysis and gastric emptying disorders, which were recovered by conservative treatment. No postoperative death occurred. The median number of lymph nodes and lymph node station harvested was 19 and 10, respectively. The median postoperative hospital stay was 10 days. The volume of chest drainage was 1 117.3±543.4 mL.ConclusionThe minimally invasive operation mode of esophageal cancer based on "single-direction" thoracoscopic system is safe and feasible, and has good field vision and smooth and simplified procedure.
Abstract: Objective To investigate the expression of inhibitor of apoptosis gene Livin and its relationship with expression of P53,Bcl-2 in esophageal carcinoma tissues. Methods The expression of Livin messenger ribonucleic acid (mRNA) in 36 esophageal carcinoma tissues and 18 paracancerous tissues were measured by reverse transcriptionpolymerase chain reaction (RT-PCR) combined with silver staining technique. The expression of Livin, P53 and Bcl-2 proteins were detected by immunohistochemical method (streptavidin-peroxidase). Results RT-PCR results: Livin mRNA positive expression of esophageal carcinoma tissues was more evident than that of paracancerous tissues, the expression of both variants was simultaneous basically. Immunohistochemical results: the Livin protein positive expression rate of esophageal carcinoma tissues was higher evidently than that of paracancerous tissues(Plt;0.01). Livin protein positive expression rate of external coat of esophagus invaded by carcinoma was higher than that of tunica muscularis esophagi invaded by carcinoma(Plt;0.05); Livin protein positive expression rate of lymph node metastasis was higher than that of normal lymph node (Plt;0.05). The expression of Livin protein was not related to the expression of P53 protein（χ2=1.00,P=0.505）,but it was positively related to the expression of Bcl-2 protein（χ2=10.60，P=0.003）. Conclusion Aberrant expression of Livin may be a new target for diagnosis and gene treatment of esophageal carcinoma.The aberrant expression of Livinand apoptosis related gene Bcl-2 may play synergetic roles in process of carcinogenesis of esophageal carcinoma.
ObjectiveTo compare clinical outcomes between triluminal-tube feeding combined with tubular stomach and traditional esophagectomy for the treatment of esophageal carcinoma (EC)in elderly patients.
MethodsA total of 196 elderly patients (>60 years)with EC who received esophagectomy in the Department of Cardiothoracic Surgery, Mianyang Central Hospital from January 2007 to January 2013 were enrolled in this study. According to different surgical methods, all the patients were divided into triluminal-tube feeding combined with tubular stomach group (group A)and traditional esophagectomy group (group B). There were 96 patients including 51 males and 45 females in group A with their age of 60-81 (66.21±7.32)years, and 100 patients including 54 males and 46 females in group B with their age of 60-82 (65.43±6.37)years. Clinical indexes were compared between the 2 groups.
ResultsRadical esophagectomy was successfully performed for all the patients. There was no statistical difference in operation time, intraoperative blood loss, postoperative incidence of chylothorax, recurrent laryngeal nerve paralysis, anastomotic leakage, anastomotic stricture or mortality between the 2 groups (P > 0.05). Time to first passage of flatus and postoperative length of hospital stay of group A were significantly shorter than those of group B, and the incidences of postoperative arrhythmias, pulmonary complications and thoracic-stomach syndrome of group A were significantly lower than those of group B (P < 0.05).
ConclusionTriluminal-tube feeding combined with tubular stomach can significantly reduce postoperative morbidity, shorten hospital stay and improve quality of life of elderly patients undergoing esophagectomy.
ObjectiveTo evaluate the metastasis feature and the dissecting value of cervicothoracic lymph node for middle esophageal squamous carcinoma.
MethodsA total of 303 patients admitted to the Rugao Boai Hospital(107 patients) and the Rugao People's Hospital (196 patients) received the stapled cervical esophagogastrostomy via different thoracic approach according to the admission order number between March 2005 and February 2013. There were 290 patients with Ro resections including 149 patients by Ivor-Lewis approach (an Ivor-Lewis group) and 141 patients by Sweet approach (a Sweet group). The data of lymph nodal dissection and PTNM stage and follow-up of the two groups were analyzed.
ResultsThe number of positive lymph nodes dissected from the cervicothoracic junction in the IvorLewis group was significantly greater than that in own upper abdomen (Z=3.12, P<0.05) and that in the cervicothoracic junctionin in the Sweet group (Z=3.30, P<0.05). The lymph node metastasis rate of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen(χ2=10.76, P<0.05)and that in the cervicothoracic junction in the Sweet group (χ2=7.34, P<0.05). The lymph node ratio (LNR) of the cervicothoracic junction in the Ivor-Lewis group was significantly higher than that in own upper abdomen (χ2=11.67, P<0.05) and that in the cervicothoracic junction in the Sweet group (χ2=5.99, P<0.05). The proportion of patients which PTNM were Ⅲa or Ⅲb as N＞N1 in the Ivor-Lewis group was significantly higher than that in the Sweet group(χ2=5.59, P<0.05). After surgery of 1 year, 3 years, 5 years, the rate of lymph node local recurrence and the total rate of tumor metastasis or recurrence in the Ivor-Lewis group were significantly lower than in the Sweet group (P<0.05). The survival rate in the Ivor-Lewis group was significantly greater than that in the Sweet group (P<0.05).
ConclusionThe cervicothoracic junction has a higher incidence of lymphatic metastasis, which transfer intensity is greater than that of upper abdomen. The extended cervicothoracic lymph node dissection should be indeed indispensible to increase of radical resection and the accuracy of PTNM stage and to improve the long term survival for middle esophageal carcinoma.
