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Laparoscopic ischemic conditioning prior esophagectomy in selected patients: the ISCON trial. 选择性患者食管切除术前腹腔镜局部缺血预处理:ISCON试验。
Eline de Groot, Lars M Schiffmann, Arjen van der Veen, Alicia Borggreve, Pim de Jong, Daniel Pinto Dos Santos, Benjamin Babic, Hans Fuchs, Jelle Ruurda, Christiane Bruns, Richard van Hillegersberg, Wolfgang Schröder

Anastomotic leakage (AL) after esophagectomy is the most impactful complication after esophagectomy. Ischemic conditioning (ISCON) of the stomach >14 days prior to esophagectomy might reduce the incidence of AL. The current trial was conducted to prospectively investigate the safety and feasibility of laparoscopic ISCON in selected patients. This international multicenter feasibility trial included patients with esophageal cancer at high risk for AL with major calcifications of the thoracic aorta or a stenosis in the celiac trunk. Patients underwent laparoscopic ISCON by occlusion of the left gastric and the short gastric arteries followed by esophagectomy after an interval of 12-18 days. The primary endpoint was complications Clavien-Dindo ≥ grade 2 after ISCON and before esophagectomy. Between November 2019 and January 2022, 20 patients underwent laparoscopic ISCON followed by esophagectomy. Out of 20, 16 patients (80%) underwent neoadjuvant treatment. The median duration of the laparoscopic ISCON procedure was 45 minutes (range: 25-230). None of the patients developed intraoperative or postoperative complications after ISCON. Hospital stay after ISCON was median 2 days (range: 2-4 days). Esophagectomy was completed in all patients after a median of 14 days (range: 12-28). AL occurred in three patients (15%), and gastric tube necrosis occurred in one patient (5%). In hospital, the 30-day and 90-day mortalities were 0%. Laparoscopic ISCON of the gastric conduit is feasible and safe in selected esophageal cancer patients with an impaired vascular status. Further studies have to prove whether this innovative strategy aids to reduce the incidence of AL.

食管切除术后吻合口瘘(AL)是食管切除术最严重的并发症。食管切除术前14天以上的胃缺血预处理(ISCON)可能会降低AL的发生率。本试验旨在前瞻性研究腹腔镜ISCON在选定患者中的安全性和可行性。这项国际多中心可行性试验包括AL高危食管癌症患者,胸主动脉严重钙化或腹腔主干狭窄。患者通过阻断胃左动脉和胃短动脉进行腹腔镜ISCON,然后在间隔12-18天后进行食管切除术。主要终点是并发症Clavien-Dindo ≥ ISCON后和食管切除术前2级。2019年11月至2022年1月,20名患者接受了腹腔镜ISCON,随后进行了食管切除术。在20例患者中,16例(80%)接受了新辅助治疗。腹腔镜ISCON手术的中位持续时间为45分钟(范围:25-230)。ISCON后,没有患者出现术中或术后并发症。ISCON后的住院时间中位数为2天(范围:2-4天)。所有患者均在中位14天后完成食道切除术(范围:12-28)。AL发生在3例患者中(15%),而胃导管坏死发生在1例患者(5%)。在医院,30天和90天的死亡率为0%。腹腔镜胃导管ISCON对某些血管受损的食管癌症患者是可行和安全的。进一步的研究必须证明这种创新策略是否有助于降低AL的发病率。
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引用次数: 2
Treatment burden and cost-effectiveness analysis of the neoadjuvant CROSS regimen in esophageal squamous cell carcinoma: a multicenter retrospective study. 食管鳞状细胞癌新辅助CROSS方案的治疗负担和成本效益分析:一项多中心回顾性研究。
Xing Gao, Zhi-Hao Yang, Yi-Hsuan Cheng, Chun-Ling Chi, Tzu-Yi Yang, Kai-Hao Chuang, Chiao-En Wu, Joseph Jan-Baptist van Lanschot, Yu-Wen Wen, Yin-Kai Chao

High-quality evidence indicated that both neoadjuvant carboplatin/paclitaxel (CROSS) and cisplatin/5-fluorouracil (PF) regimens in combination with radiotherapy improve survival outcomes compared to surgery alone in patients with esophageal cancer. It is not yet known whether they may differ in terms of treatment burden and healthcare costs. A total of 232 Taiwanese patients with esophageal squamous cell carcinoma who had undergone neoadjuvant chemoradiotherapy (nCRT) with either the CROSS (n = 153) or the PF (n = 79) regimens were included. Hospital encounters and adverse events were assessed for determining treatment burden. Cost-effectiveness analysis was undertaken using the total costs incurred over 3 years in relation to overall survival (OS) and progression-free survival (PFS). Compared with PF, the CROSS regimen was associated with a lower treatment burden: shorter inpatient days on average (4.65 ± 10.05 vs. 15.14 ± 17.63 days; P < 0.001) and fewer admission requirements (70% of the patients were never admitted vs. 20% in the PF group; P < 0.001). Patients in the CROSS group experienced significantly less nausea, vomiting, and diarrhea. While the benefits observed in the CROSS group were associated with additional nCRT-related expenditures (1388 United States dollars [USD] of added cost per patient), this regimen remained cost-effective. At a willingness-to-pay threshold of 50,000 USD per life-year, the probability of the CROSS regimen to be more cost-effective than PF was 94.1% for PFS but decreased to 68.9% for OS. The use of the CROSS regimen for nCRT in patients with ESCC was associated with a lower treatment burden and was more cost-effective than PF.

高质量的证据表明,与单纯手术相比,新辅助卡铂/紫杉醇(CROSS)和顺铂/5-氟尿嘧啶(PF)方案联合放疗可改善癌症患者的生存结果。目前尚不清楚他们在治疗负担和医疗费用方面是否存在差异。共有232名台湾食管鳞状细胞癌患者接受了新辅助放化疗(nCRT) = 153)或PF(n = 79)方案。对医院遭遇和不良事件进行评估,以确定治疗负担。成本效益分析使用了3年内发生的与总生存期(OS)和无进展生存期(PFS)相关的总成本。与PF相比,CROSS方案的治疗负担较低:平均住院天数较短(4.65 ± 10.05对15.14 ± 17.63天;P
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引用次数: 0
Magnetic sphincter augmentation may limit access to magnetic resonance imaging. 磁性括约肌增强术可能会限制磁共振成像的使用。
Andrés R Latorre-Rodríguez, Emma Aschenbrenner, Sumeet K Mittal

Magnetic sphincter augmentation (MSA) is an alternative surgical treatment for gastroesophageal reflux disease; however, >1.5 T magnetic resonance imaging (MRI) is contraindicated for patients who have undergone MSA with the LINX Reflux Management System (Torax Medical, Inc. Shoreview, Minnesota, USA). This drawback can impose a barrier to access of MRI, and cases of surgical removal of the device to enable patients to undergo MRI have been reported. To evaluate access to MRI for patients with an MSA device, we conducted a structured telephone interview with all diagnostic imaging providers in Arizona in 2022. In 2022, only 54 of 110 (49.1%) locations that provide MRI services had at least one 1.5 T or lower MRI scanner. The rapid replacement of 1.5 T MRI scanners by more advanced technology may limit healthcare options and create an access barrier for patients with an MSA device.

磁括约肌增强术(MSA)是胃食管反流病的一种替代手术治疗方法;然而,对于使用LINX回流管理系统(Torax Medical,股份有限公司Shoreview,Minnesota,USA)进行MSA的患者,1.5 T以上的磁共振成像(MRI)是禁忌证。这一缺点可能会对MRI的使用造成障碍,并且已经报道了外科手术移除该装置以使患者能够接受MRI的情况。为了评估使用MSA设备的患者获得MRI的机会,我们于2022年对亚利桑那州的所有诊断成像提供商进行了结构化电话采访。2022年,在提供MRI服务的110个地点中,只有54个(49.1%)拥有至少一台1.5 T或更低的MRI扫描仪。更先进的技术快速取代1.5T MRI扫描仪可能会限制医疗保健的选择,并为使用MSA设备的患者创造一个进入障碍。
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引用次数: 0
Laparoscopic reconstruction in McKeown esophagectomy is a risk factor for postoperative diaphragmatic hernia. 麦基翁食管切除术中的腹腔镜重建是术后膈疝的危险因素。
Akihiro Takeuchi, Toshiyasu Ojima, Keiji Hayata, Junya Kitadani, Taro Goda, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai, Hiroki Yamaue, Manabu Kawai

Diaphragmatic hernia is a very rare but high-risk complication after esophagectomy. Although there are many studies on the Ivor Lewis esophagectomy procedure for diaphragmatic hernia, there are fewer studies on the McKeown procedure. The present study aimed to estimate the incidence of diaphragmatic hernia after esophagectomy, describing its presentation and management with the McKeown procedure. We retrospectively evaluated the 622 patients who underwent radical esophagectomy between January 2002 and December 2020 at the Wakayama Medical University Hospital. Statistical analyses were performed to evaluate risk factors for diaphragmatic hernia. Emergency surgery for postoperative diaphragmatic hernia was performed in nine of 622 patients (1.45%). Of these nine patients, one developed prolapse of the small intestine into the mediastinum (11.1%). The other eight patients underwent posterior mediastinal route reconstructions (88.9%), one of whom developed prolapse of the gastric conduit, and seven of whom developed transverse colon via the diaphragmatic hiatus. Laparoscopic surgery was identified in multivariate analysis as the only independent risk factor for diaphragmatic hernia (odd's ratio [OR] = 9.802, p = 0.034). In all seven cases of transverse colon prolapse into the thoracic cavity, the prolapsed organ had herniated from the left anterior part of gastric conduit. Laparoscopic surgery for esophageal cancer is a risk factor for diaphragmatic hernia. The left anterior surface of gastric conduit and diaphragmatic hiatus should be fixed firmly without compromising blood flow to the gastric conduit.

膈疝是食管切除术后一种非常罕见但高风险的并发症。尽管有许多关于Ivor-Lewis食管切除术治疗膈疝的研究,但关于McKeown手术的研究较少。本研究旨在评估食管切除术后膈疝的发生率,描述其表现和麦基翁手术的处理。我们对2002年1月至2020年12月在和歌山医科大学医院接受根治性食管切除术的622名患者进行了回顾性评估。进行统计分析以评估膈疝的危险因素。622名患者中有9名(1.45%)接受了术后膈疝的紧急手术。在这9名患者中,1名出现小肠脱垂进入纵隔(11.1%)。其他8名患者接受了后纵隔路径重建(88.9%),其中1名出现胃导管脱垂,其中7例经膈肌裂孔形成横结肠。在多变量分析中,腹腔镜手术被确定为膈疝的唯一独立危险因素(奇数比[OR] = 9.802,p = 0.034)。在所有7例横结肠脱垂进入胸腔的病例中,脱垂的器官都是从胃导管的左前部突出的。腹腔镜食管癌症手术是膈疝的危险因素。胃导管和膈肌裂孔的左前表面应牢固固定,而不影响胃导管的血流。
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引用次数: 0
Efficacy and safety of modified endoscopic submucosal tunnel dissection for superficial esophageal circumferential lesions. 改良内镜下黏膜下隧道剥离术治疗食管浅周病变的疗效和安全性。
Ye Tian, Chengjun Xue, Xiaomin Li, Jianan Bai, Zequan Xiao, Qibin He, Jingbao Kan, Guoqin Zhu, Qiyun Tang

To evaluate the efficacy and safety of intra-tunnel dissection using hemostatic forceps and needle-type device for patients with esophageal circumferential lesions (ECLs). Patients with ECLs were enrolled in the study and underwent endoscopic submucosal tunnel dissection (ESTD) or hemostatic forceps-based ESTD (ESFTD). All patients were divided into three subgroups according to longitudinal length of the lesions (LLLs): >8 cm, 4-8 cm and < 4 cm. The clinical data such as gender, age, length of lesions and operating time were collected. A total of 152 patients were included in this study and comprised 80 cases of ESFTD and 72 cases of ESTD. The procedure time was markedly shorter in the ESFTD group than in the ESTD group (P < 0.001). Moreover, ESFTD significantly increased the rate of complete resection and reduced specimen injury in LLLs >8 cm and 4-8 cm subgroup compared with ESTD (P < 0.001), but not in <4 cm subgroup (P > 0.05). The perforation and infection rate were similar in ESFTD and ESTD group (P > 0.05). However, ESFTD effectively decreased the muscular injury rate' the duration of chest pain and the time from endoscopic surgery to first occurrence of esophageal stenosis compared with ESTD group (P < 0.01). ESFTD has better efficacy and safety than ESTD in the treatment of ECLs, especially for large lesions. ESFTD could be recommended for patients with ECLs.

评价使用止血钳和针型装置进行食管周围病变(ECLs)隧道内剥离的有效性和安全性。ECL患者被纳入研究,并接受内镜下黏膜下隧道剥离术(ESTD)或基于止血钳的ESTD(ESFTD)。根据病变的纵向长度(LLL)将所有患者分为三个亚组:>8cm、4-8cm和<4cm。收集性别、年龄、病变长度和手术时间等临床数据。本研究共纳入152名患者,包括80例ESFTD和72例ESTD。ESFTD组的手术时间明显短于ESTD组(P<0.001)。此外,与ESTD相比,ESFTD显著提高了LLLs>8cm和4-8cm亚组的完全切除率并减少了标本损伤(P<001),但不在0.05。ESFTD和ESTD组的穿孔率和感染率相似(P>0.05)。然而,与ESTD组相比,ESFTD有效地降低了肌肉损伤率、胸痛持续时间和内镜手术至食管狭窄首次发生的时间(P<0.01)。ESFTD可推荐用于ECL患者。
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引用次数: 0
Results of the ARROW survey of anti-reflux practice in the United Kingdom. ARROW对英国抗反流实践的调查结果。
Robert Walker, Andrew Currie, Tom Wiggins, Sheraz R Markar, Natalie S Blencowe, Tim Underwood, Marianne Hollyman

Gastro-esophageal reflux disease (GERD) is a common, significant health burden. United Kingdom guidance states that surgery should be considered for patients with a diagnosis of GERD not suitable for long-term acid suppression. There is no consensus on many aspects of patient pathways and optimal surgical technique, and an absence of information on how patients are currently selected for surgery. Further detail on the delivery of anti-reflux surgery (ARS) is required. A United Kingdom-wide survey was designed to gather surgeon opinion regarding pre-, peri- and post-operative practice of ARS. Responses were received from 155 surgeons at 57 institutions. Most agreed that endoscopy (99%), 24-hour pH monitoring (83%) and esophageal manometry (83%) were essential investigations prior to surgery. Of 57 units, 30 (53%) had access to a multidisciplinary team to discuss cases; case-loads were higher in those units (median 50 vs. 30, P < 0.024). The most popular form of fundoplication was a Nissen posterior 360° (75% of surgeons), followed by a posterior 270° Toupet (48%). Only seven surgeons stated they had no upper limit of body mass index prior to surgery. A total of 46% of respondents maintain a database of their practice and less than a fifth routinely record quality of life scores before (19%) or after (14%) surgery. While there are areas of consensus, a lack of evidence to support workup, intervention and outcome evaluation is reflected in the variability of practice. ARS patients are not receiving the same level of evidence-based care as other patient groups.

胃食管反流病(GERD)是一种常见的、严重的健康负担。英国指南指出,对于诊断为胃食管反流病不适合长期抑酸的患者,应考虑进行手术治疗。在患者路径和最佳手术技术的许多方面没有达成共识,也缺乏关于目前如何选择患者进行手术的信息。需要提供更多关于抗反流手术(ARS)的细节。一项全英国范围的调查旨在收集外科医生对ARS术前、术中和术后实践的意见。收到了来自57个机构的155名外科医生的回复。大多数人同意内镜检查(99%)、24小时pH监测(83%)和食道测压(83%)是手术前的重要检查。在57个单位中,30个(53%)有机会与多学科小组讨论案件;这些单位的病例负荷更高(中位数为50比30,P
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引用次数: 0
Performance of a consensus-based algorithm for diagnosing anastomotic leak after minimally invasive esophagectomy for esophageal cancer. 基于共识的算法诊断癌症食管微创切除术后吻合口瘘的性能。
Jobbe Lemmens, Bastiaan Klarenbeek, Moniek Verstegen, Frans van Workum, Gerjon Hannink, Sander Ubels, Camiel Rosman

Anastomotic leak (AL) is a common and severe complication after esophagectomy. This study aimed to assess the performance of a consensus-based algorithm for diagnosing AL after minimally invasive esophagectomy. This study used data of the ICAN trial, a multicenter randomized clinical trial comparing cervical and intrathoracic anastomosis, in which a predefined diagnostic algorithm was used to guide diagnosing AL. The algorithm identified patients suspected of AL based on clinical signs, blood C-reactive protein (cut-off value 200 mg/L), and/or drain amylase (cut-off value 200 IU/L). Suspicion of AL prompted evaluation with contrast swallow computed tomography and/or endoscopy to confirm AL. Primary outcome measure was algorithm performance in terms of sensitivity, specificity, and positive and negative predictive values (PPV, NPV), respectively. AL was defined according to the definition of the Esophagectomy Complications Consensus Group. 245 patients were included, and 125 (51%) patients were suspected of AL. The algorithm had a sensitivity of 62% (95% confidence interval [CI]: 46-75), a specificity of 97% (95% CI: 89-100), and a PPV and NPV of 94% (95% CI: 79-99) and 77% (95% CI: 66-86), respectively, on initial assessment. Repeated assessment in 19 patients with persisting suspicion of AL despite negative or inconclusive initial assessment had a sensitivity of 100% (95% CI: 77-100). The algorithm showed poor performance because the low sensitivity indicates the inability of the algorithm to confirm AL on initial assessment. Repeated assessment using the algorithm was needed to confirm remaining leaks.

吻合口瘘(AL)是食管切除术后常见且严重的并发症。本研究旨在评估基于共识的算法在微创食管切除术后诊断AL的性能。本研究使用了ICAN试验的数据,ICAN试验是一项比较颈部和胸内吻合的多中心随机临床试验,其中使用预定义的诊断算法来指导AL的诊断。该算法根据临床症状、血液C反应蛋白(临界值200 mg/L)和/或引流淀粉酶(临界值200IU/L)来识别疑似AL的患者。对AL的怀疑促使用对比度吞咽计算机断层扫描和/或内窥镜检查进行评估,以确认AL。主要的结果衡量标准是算法的灵敏度、特异性以及阳性和阴性预测值(PPV、NPV)。AL根据食管切除术并发症共识组的定义进行定义。245名患者被纳入研究,125名(51%)患者被怀疑患有AL。该算法的敏感性为62%(95%置信区间[CI]:46-75),特异性为97%(95%CI:89-100),初步评估的PPV和NPV分别为94%(95%CI:79-99)和77%(95%CI:66-86)。尽管最初评估为阴性或不确定,但对19名持续怀疑AL的患者进行重复评估,其敏感性为100%(95%CI:77-100)。该算法表现出较差的性能,因为低灵敏度表明该算法无法在初始评估中确认AL。需要使用该算法进行反复评估,以确认剩余泄漏。
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引用次数: 0
Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer. 放疗对癌症食管自扩金属支架不良事件的影响。
Andressa A Machado, Bruno C Martins, Iatagan R Josino, André T C Chen, Carlos B C Hong, Alisson L D R Santos, Gustavo R A Lima, Martin A C Cordero, Adriana V Safatle-Ribeiro, Caterina Pennacchi, Carla C Gusmon, Gustavo A Paulo, Luciano Lenz, Marcelo S Lima, Elisa R Baba, Fábio S Kawaguti, Ricardo S Uemura, Rubens A A Sallum, Ulysses Ribeiro, Fauze Maluf-Filho

Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.

自膨胀金属支架(SEMS)被认为是缓解无法手术的食管肿瘤吞咽困难和瘘管的首选治疗方法。然而,接受或将接受放射治疗(RT)的患者使用SEMs的安全性尚不确定。本研究旨在评估RT对食管癌症SEMSs患者不良事件(AE)的影响。这是一项从2009年到2018年在癌症三级医院进行的回顾性研究。我们收集了有关RT、肿瘤的组织学类型、支架置入后的SEMSs和AE模型的信息。对323例恶性狭窄或瘘管患者进行了SEMs治疗。主要组织学类型为鳞状细胞癌(79.6%)。共插入282个部分覆盖和41个完全覆盖的SEMs。323名患者中,182人未接受RT,118人在放置SEMS前接受RT,23人在放置后接受RT。将支架置入前接受RT治疗的组与未接受RT治疗组进行比较,第一组出现严重疼痛的频率更高(9/118 7.6%对3/182 1.6%;P=0.02)。支架置入后接受RT的组发生全身AE的风险更高(13/23 56.5%对63/182 34.6%;P=0.019),向内生长/过度生长(6/23 26.1%对21/182 11.5%;P=0.045)和胃食管反流(2/23 8.7%对2/182 1.1%;P=0.034)。无法手术的食管肿瘤患者在支架置入前接受RT治疗可延长生存期,并增加严重胸痛的风险。对使用食管支架的患者进行RT治疗会增加轻微、不危及生命的AE的发生率。
{"title":"Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer.","authors":"Andressa A Machado,&nbsp;Bruno C Martins,&nbsp;Iatagan R Josino,&nbsp;André T C Chen,&nbsp;Carlos B C Hong,&nbsp;Alisson L D R Santos,&nbsp;Gustavo R A Lima,&nbsp;Martin A C Cordero,&nbsp;Adriana V Safatle-Ribeiro,&nbsp;Caterina Pennacchi,&nbsp;Carla C Gusmon,&nbsp;Gustavo A Paulo,&nbsp;Luciano Lenz,&nbsp;Marcelo S Lima,&nbsp;Elisa R Baba,&nbsp;Fábio S Kawaguti,&nbsp;Ricardo S Uemura,&nbsp;Rubens A A Sallum,&nbsp;Ulysses Ribeiro,&nbsp;Fauze Maluf-Filho","doi":"10.1093/dote/doad019","DOIUrl":"10.1093/dote/doad019","url":null,"abstract":"<p><p>Self-expanding metallic stents (SEMS) are considered the treatment of choice for the palliation of dysphagia and fistulas in inoperable esophageal neoplasms. However, the safety of SEMSs in patients who received or who will be submitted to radiotherapy (RT) is uncertain. The study aimed to evaluate the impact of RT on adverse events (AEs) in patients with esophageal cancer with SEMSs. This is a retrospective study conducted at a tertiary cancer hospital from 2009 to 2018. We collected information regarding RT, the histological type of the tumor, the model of SEMSs and AEs after stent placement. Three hundred twenty-three patients with malignant stenosis or fistula were treated with SEMSs. The predominant histological type was squamous cell carcinoma (79.6%). A total of 282 partially covered and 41 fully covered SEMSs were inserted. Of the 323 patients, 182 did not received RT, 118 received RT before SEMS placement and 23 after. Comparing the group that received RT before stent insertion with the group that did not, the first one presented a higher frequency of severe pain (9/118 7.6% vs. 3/182 1.6%; P = 0.02). The group treated with RT after stent placement had a higher risk of global AEs (13/23 56.5% vs. 63/182 34.6%; P = 0.019), ingrowth/overgrowth (6/23 26.1% vs. 21/182 11.5%; P = 0.045) and gastroesophageal reflux (2/23 8.7% vs. 2/182 1.1%; P = 0.034). Treatment with RT before stent placement in patients with inoperable esophageal neoplasm prolongs survival and is associated with an increased risk of severe chest pain. Treatment with RT of patients with an esophageal stent increases the frequency of minor, not life-threatening AEs.</p>","PeriodicalId":11255,"journal":{"name":"Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9279981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Maximum phonation time: an independent predictor of late-onset pneumonia after esophageal cancer surgery. 最长发声时间:食管癌症手术后迟发性肺炎的独立预测因素。
Kakeru Tawada, Eiji Higaki, Tetsuya Abe, Jun Takatsu, Hironori Fujieda, Takuya Nagao, Koji Komori, Seiji Ito, Masahiro Yoshida, Isao Oze, Yasuhiro Shimizu

Dysphagia after esophagectomy is a major risk factor for aspiration pneumonia, thus preoperative assessment of swallowing function is important. The maximum phonation time (MPT) is a simple indicator of phonatory function and also correlates with muscle strength associated with swallowing. This study aimed to determine whether preoperative MPT can predict postoperative aspiration pneumonia. The study included 409 consecutive patients who underwent esophagectomy for esophageal cancer between 2017 and 2021. Pneumonia detected by routine computed tomography on postoperative days 5-6 was defined as early-onset pneumonia, and pneumonia that developed later (most often aspiration pneumonia) was defined as late-onset pneumonia. The correlation between late-onset pneumonia and preoperative MPT was investigated. Patients were classified into short MPT (<15 seconds for males and <10 seconds for females, n = 156) and normal MPT groups (≥15 seconds for males and ≥10 seconds for females, n = 253). The short MPT group was significantly older, had a lower serum albumin level and vital capacity, and had a significantly higher incidence of late-onset pneumonia (18.6 vs. 6.7%, P < 0.001). Multivariate analysis showed that short MPT was an independent risk factor for late-onset pneumonia (odds ratio: 2.26, P = 0.026). The incidence of late-onset pneumonia was significantly higher in the short MPT group (15.6 vs. 4.7%, P = 0.004), even after propensity score matching adjusted for clinical characteristics. MPT is a useful predictor for late-onset pneumonia after esophagectomy.

食管切除术后吞咽困难是吸入性肺炎的主要危险因素,因此术前评估吞咽功能很重要。最大发声时间(MPT)是一个简单的发声功能指标,也与吞咽相关的肌肉力量相关。本研究旨在确定术前MPT是否可以预测术后吸入性肺炎。该研究包括2017年至2021年间连续409名因癌症接受食管切除术的患者。术后第5-6天通过常规计算机断层扫描检测到的肺炎被定义为早发性肺炎,随后发展的肺炎(最常见的是吸入性肺炎)被定义为晚发性肺炎。研究了迟发性肺炎与术前MPT的相关性。患者被分为短MPT(
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引用次数: 0
Multiple staging investigations may not change management in patients with high-grade dysplasia or early esophageal adenocarcinoma. 多分期研究可能不会改变高级别发育不良或早期食管腺癌患者的治疗方法。
A Reyhani, E Gimson, C Baker, M Kelly, N Maisey, J Meenan, M Subesinghe, M Hill, J Lagergren, J Gossage, S Zeki, J Dunn, A Davies

The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. This coincided with a transition period from esophagectomy to endoscopic mucosal resection (EMR) as the treatment of choice. Patients were staged with computed tomography (CT), endoscopic ultrasound (EUS) and 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography(PET)/CT. The aim of this study was to assess their accuracy and impact on clinical management. 297 patients with high-grade dysplasia or early adenocarcinoma were included (endoscopic therapy/EMR n = 184; esophagectomy n = 113 [of which a 'combined' group had surgery preceded by endoscopic therapy n = 23]). Staging accuracy was low (accurate staging EMR: CT 40.1%, EUS 29.6%, FDG-PET/CT 11.0%; Esophagectomy: CT 43.3%, EUS 59.7%, FDG-PET/CT 29.6%; Combined: CT 28.6%, EUS46.2%, FDG-PET/CT 30.0%). Staging inaccuracies across all groups that could have changed management by missing T2 disease were CT 12%, EUS 12% and FDG-PET/CT 1.6%. The sensitivity of all techniques for detecting nodal disease was low (CT 12.5%, EUS 12.5%, FDG-PET/CT0.0%). Overall, FDG-PET/CT and EUS changed decision-making in only 3.2% of patients with an early cancer on CT and low-risk histology. The accuracy of staging with EUS, CT and FDG-PET/CT in patients with high-grade dysplasia or early adenocarcinoma of the esophagus is low. EUS and FDG-PET/CT added relevant staging information over standard CT in very few cases, and therefore, these investigations should be used selectively. Factors predicting the need for esophagectomy are predominantly obtained from EMR histology rather than staging investigations.

对食管高度发育不良或早期腺癌进行多分期研究的临床价值尚不清楚。分析了2000年至2019年间接受早期食管癌症治疗的单中心前瞻性队列患者。这与食管切除术向内镜黏膜切除术(EMR)的过渡期相吻合。采用计算机断层扫描(CT)、内镜超声(EUS)和2-脱氧-2-[18F]氟代葡萄糖(FDG)正电子发射断层扫描(PET)/CT对患者进行分期。本研究的目的是评估其准确性和对临床管理的影响。297名患有高度发育不良或早期腺癌的患者被纳入研究(内镜治疗/EMR n=184;食管切除术n=113[其中“联合”组在内镜治疗之前进行了手术n=23])。分期准确率低(准确分期EMR:CT 40.1%,EUS 29.6%,FDG-PET/CT 11.0%;食管切除术:CT 43.3%,EUS 59.7%,FDG-PET/CT 29.6%;合并:CT 28.6%,EUS46.2%,FDG-PET/CT 30.0%)。所有可能因T2疾病缺失而改变管理的组的分期不准确率为CT 12%,EUS为12%,FDG-PET/CT为1.6%。所有检测淋巴结疾病的技术的敏感性均较低(CT为12.5%,EUS为12.5%,FDG-PET/CT0.0%)。总体而言,仅3.2%的早期癌症患者在CT和低风险组织学上改变了FDG-PET/CT和EUS的决策。EUS、CT和FDG-PET/CT在食管高度发育不良或早期腺癌患者中的分期准确性较低。在极少数情况下,EUS和FDG-PET/CT比标准CT增加了相关的分期信息,因此,这些研究应选择性使用。预测需要食管切除术的因素主要来自EMR组织学,而不是分期研究。
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Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
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