ObjectiveTo investigate the feasibility of lung tissue flap repairing esophagus defect with an inner chitosan tube stentin in order to complete repairing and reconsruction of the esophagus defect.MethodsFifteen Japanese white rabbits were randomly divided into two groups， experiment group(n=10): esophagus defect was repaired with lung tissue flap having inner chitosan tube stent; control group(n=5): esophagus defect was repaired with lung tissue flap without inner chitosan tube stent; and then the gross and histological apearance in both groups were observed at 2, 4,8 weeks after operation, barium sulphate X-ray screen were observed at 10 weeks after operation.ResultsSix rabbits survived for over two weeks in experiment group, lung tissue flap healed with esophageal defect, squamous metaplasia were found on the surface of lung tissue flap in experiment group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and no narrow or reversed peristalsis, the peristalsis was good in experiment group.Four rabbits survived for two weeks and the lung tissue flap healed with esophageal defect, fibrous tissue hyperplasy on the surface of the lung tissue flap in control group. At 10 weeks after operation, barium sulphate examination found that barium was fluent through the esophageal and slight narrow or reversed peristalsis, the peristalsis was not good in control group, otherwise.ConclusionIt is a feasible method to repair the esophageal defect with lung tissue flap with the inner chitosan stent.
Objective-To apply self-pulmonary tissue flap to reconstruct esophagus directly or with alloy stent in this research. Methods Twenty-four dogs were divided into two groups, middle bronchus was ligated to prepare pulmonaryflap and incised, a 4 to 6 cm long and 1/2 to 2/3 perimeter defect was made in esophageal wall. Esophagus defect was repaired only with pulmonary flap (experimental group) and with pulmonary flap having self-expanded stent inside (control group). The gross appearance, histological apearance and barium X-ray films were observed at 2,4,6,8,10 and 12 weeks after operation. Results Two dogs died of anatomotic leak in experimental group, three dogs died of anatomotic leak and two dogs died of perforation of ulcer in control group. The growth of esophagus epithelium was observed from periphery area to central area after 8 to 10 weeks of operation. In pulmonary flap mass fibrous tissue proliferated and fibroblasts were active, but no necrosis occurred. Barium X-ray ofregenerated esophagus showed that mild stenosis and weakened peristalisis were observed in the middle of resophagus replacement, and that no obstruction, leakage, and dilation above anastomotic stoma occurred. Conclusion Pulmonary tissue flap can well support the mucosa crawl in the defect of esophagus. It is necessary to find a more suitable and satisfied stent for repairing segmental defect.
Reconstruction and repair of atresia or defect of the upper portion of esophagus is difficult. From November 1980 to December 1997, forth-five cases, consisting 35 males and 10 females, were treated with microsurgical technique. The 45 patients fell into the following groups as esophageal atresia of various causes in 21 cases, anastomotic fistula or stenosis following reconstruction of esophagus in 7 cases and late carcinoma of esophagus in 17 cases. The types of reconstruction consisted of transfer of free jejunum with its lower portion carrying a vascular pedicle in 24 cases, free transfer of jejunal graft in 15 cases, free vascularized jejunal graft in 2 cases and free vascularized tubular skin graft in 4 cases. After a follow-up of 6-19 months besides eight cases died from late esophageal carcinoma, thirty-seven cases were survived and could take food by mouth. All of the benign cases could return to work. In patients having late esophageal carcinoma, the operative procedure could improve the life quality and facilitate chemotherapy and radiotherapy.
Objective
To analyze the Podoplanin expression in patients with esophageal squamous cell carcinoma and to find out the relationship between Podoplanin expression and tumor embolus, lymph node metastasis, tumor differentiation as well as prognosis, and to provide clinical evidence for reducing the recurrence of esophageal squamous cell carcinoma and prolonging the disease-free survival and overall survival.
Methods
A retrospective analysis of 70 patients with esophageal squamous cell carcinoma in our hospital from June 2010 to June 2012 was conducted, including 39 males and 31 females, with a mean age of 63.6 years. Positive diagnosis of tumor thrombus was achieved in 35 patients and negative in 35 patients. Postoperative pathological specimens were examined and normal esophageal tissues (esophageal tissue more than 5 cm from the edge of the tumor) of patients were excised as a control group.
Results
The positive rate of Podoplanin was 34.2% in normal esophageal tissues and 62.8% in tumor tissues. The positive rate of Podoplanin expression was 77.1% and 48.6% in esophageal squamous cell carcinoma patients with or without tumor embolus, respectively. The positive rate of Podoplanin expression in tumor cells of patients with positive and negative lymph node metastasis was 71.9% and 23.1%, respectively (P<0.05). The mean disease-free survival of patients with Podoplanin expression-negative esophageal squamous cell carcinoma was 15.2 months, which was significantly longer than that of patients with Podoplanin expression-positive esophageal squamous cell carcinoma (P<0.05).
Conclusion
Podoplanin expression in the tumor cells and vessels can be an important reference index to the prognosis of patients with esophageal squamous cell carcinoma.
Objective To evaluate the effectiveness and safety of radiosensitizer metronidazole amino acidum natrium (CMNa) for esophagus carcinoma. Methods Databases including The Cochrane library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched from their establishment dates to Feb. 1st 2012 for randomized controlled trials (RCTs) of CMMa for esophagus carcinoma. Two reviewers independently screened literature and assessed the quality of the included studies and extracted data. Meta-analysis waw conducted using RevMan 5.1 software. Results A total of 17 RCTs involving 1 475 patients met the inclusion criteria. Results of meta-analyses showed that: a) As for short-term response, the total effectiveness of the experimental group given CMNa plus radiotherapy was higher than the control group given radiotherapy alone (OR=3.51, 95%CI 2.44 to 5.07, Plt;0.000 01). b) Significant differences were found in the quality of life, and one and two year survival rates (OR=2.90, 95%CI 1.91 to 4.39, Plt;0.000 01; OR=1.95, 95%CI 1.21 to 3.15, P=0.006). In accordance with the P-value of 0.05, there was a significant difference in three-year survival rate (OR=2.28, 95%CI 1.16 to 4.49, P=0.02). c) As for safety, no significant differences were found in radiation pneumonitis, radiation esophagitis, myelosuppression and mucous membrane reactions. Conclusion CMNa plus radiotherapy has beneficial effects in the treatment of esophagus carcinoma and improves 1, 2 and 3-year survival rates, but more RCTs on the quality of life and safety evaluation are needed.
Using gastric tube to replace the esophagus has been widely used in esophagectomy. This surgical method is gradually replacing the traditional stomach reconstruction. Its advantages in the incidence of postoperative complication, the quality of life and the long-time survival in clinic have proved to be true. Although using tubular stomach in esophagectomy has become the consensus of experts, some details still need some further discussing and this technique should be gradually improved in future. In this review, the superiority and the technical progress of gastric tube are introduced, and we predict the future of tubular stomach and discuss the existed problems.
ObjectiveTo investigate the short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer.
MethodsWe randomly allocated 52 patients with esophagus cancer who had preoperatively confirmed by CT on stage Ⅱ-Ⅲ B into an observation group and a control group with 26 patients in each group. There were 14 male and 12 female patients in the observation group at median age of 60 years (range:49-67 years). There were 16 male and 10 female patients in the control group with median age of 62 years (range:48-65 years).The control group received postoperative chemotherapy, and the observation group received postoperative chemotherapy combined with DC-CIK biotherapy. The combination of paclitaxel and cisplatin for four cycles was choosen as the chemotherapy regimen. Patients in the observation group were treated with DC-CIK biotherapy for 2 weeks after operation. At the fifth week they received the first cycle of chemotherapy. There was a course of biotherapy between two cycles of chemotherapy. The clinical efficacy, lymphocyte subtypes, and intracellular cytokines in peripheral blood of the patients, performance status (KPS) and adverse reactions were compared.
ResultsAll patients completed the therapy regimen successfully. In the observation group, the ratios of CD3+, CD4+, CD4+/CD8+, CD56+, and CD19+ increased, and the ratio of CD8+ decreased with significant differences (P<0.05).The biotherapy significantly increased interleukin 2 (IL-2), IL-12, interferon gamma (IFN-γ) and tumor necrosis fator (TNF)-α level (P<0.05). However, in the control group, there was no significant difference between post and pre-therapy in the levels of lymphocytes and cytokines. The effective rate of KPS was 76.92% in the observation group and 46.15% in the control group with a significant difference (P=0.023). No other adverse reactions except 3 patients with fever in the observation group were found.
ConclusionThe short-term curative efficacy of DC-CIK in comprehensive therapy of esophagus cancer is distinct. DC-CIK biotherapy can improve patients' immune functions and elevate their life quality, so it is likely to be an effective adoptive immunotherapy for esophagus cancer.
ObjectiveTo systematically review the efficacy of early enteral nutrition (EN) versus parenteral nutrition (PN) for esophagus cancer patients after esophagectomy.
MethodsThe following electronic databases as PubMed, EMbase, The Cochrane Library (Issue 6, 2016), Web of Science, CBM, WanFang Data and CNKI were searched from inception to June 2016 to collect randomized controlled trials (RCTs) on comparing early EN and PN for esophagus cancer patients after esophagectomy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of 14 RCTs involving 2 275 patients were included. The results of meta-analysis showed that, compared with the PN group, the early EN group could improve postoperative levels of albumin (MD=1.12, 95%CI 0.03 to 2.20, P=0.04) and transferrin (MD=10.08, 95%CI 5.41 to 14.76, P<0.000 1), decrease the incidences of pulmonary infection (OR=0.36, 95%CI 0.25 to 0.53, P<0.000 01) and anastomotic leakage (OR=0.57, 95%CI 0.36 to 0.92, P=0.02), but there was no significant difference in postoperative level of prealbumin between two groups (MD=10.04, 95%CI -0.31 to 20.39, P=0.06).
ConclusionThe early EN could improve the postoperative levels of albumin and transferrin, decrease the incidences of pulmonary infection and anastomotic leakage, but could not improve the postoperative prealbumin level.
ObjectiveTo systematically review efficacy and safety of docetaxel chemotherapy combine with 3-dimensional conformal radiation therapy (3D-CRT) in treatment of esophageal cancer.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI and WanFang Data were searched from inception to February 2017 to collect randomized controlled trials (RCTs) and quasi-randomized control trials (qRCTs) about docetaxel chemotherapy combine with 3D-CRT in treatment of esophageal cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 12.0 software.ResultsA total of 17 RCTs involving 1 353 patients were included. The results of meta-analysis showed that, compared with the radiotherapy alone, the docetaxel chemotherapy combine with 3D-CRT could improve effective rate (OR=1.25, 95%CI 1.07 to 1.47, P=0.003), 3-year survival rate (OR=1.91, 95%CI 1.19 to 3.06, P=0.006), but there were no significant differences in 1-year survival rate (OR=1.28, 95%CI 0.95 to 1.72, P=0.105), hematologic toxicities (OR=1.13, 95%CI 0.85 to 1.49, P=0.389) and gastrointestinal reactions (OR=1.19, 95%CI 0.90 to 1.57, P=0.181).ConclusionsCompared with radiotherapy alone, docetaxel chemotherapy combine with 3D-CRT can improve the effective rate, 3-year survival rate, but not increase the incidences of adverse effects. Due to limited quantity and quality of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results.
MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay.
ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications.
ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.
