Background: Surgical treatment of esophageal carcinoma is a main operation in term of both technique and anesthesiology. The Orringer technique is one of the treatments. Objectives: 1. To describe clinical and subclinical characteristics of the middle and lower-third esophageal carcinoma. 2. To assess preliminary results of Orringer technique in treating of the middle and lower-third esophageal carcinoma. Subjects and method: A prospective, descriptive, following by time study was conducted in the patients who were diagnosed the middle and lower third esophageal carcinoma and operated by Orringer technique at the Department of Digestive Surgery in Viet Duc Hospital from January/2000 to June/2006. Results: The subclinical symptoms included difficult swallow (98.5%), anorexia and loss weight (98.5%), pain in chest (23.5%), loss of voice (2.9%) and bloody vomiting (5.9%). For clinical symptoms, 54/68 patients (79.4%) had lesions in lower-third esophageal, 14/68 (20.6%) had lesions in the middle-third esophageal. The average length of the lesions was 6.23\xb12.22cm (95% CI=5.69-6.77). The average operation time was 273.38 \xb154.56 minutes (range: 140-420), which is much faster than those in esophagectomy via thoracotomy: Lewis-Santy technique (324 minutes) and Akiyama technique (480 minutes). Both intraoperative and post-operative complications of Orringer technique were less than those of esophagectomy via thoracotomy. Conclusion: In this study, the clinical and subclinical strongest characteristics of the patients with the middle-third esophageal carcinoma appear in the advanced period (III period and IV period (over 70%)). Orringer technique had faster operation time, less complications and lower mortality than those of esophagectomy via thoracotomy.
Esophageal Neoplasms/ surgery ; therapy

Esophageal Neoplasms ; diagnosis ; therapy ; Humans

Esophageal Neoplasms ; drug therapy ; Humans

The prevalence of esophageal cancer in China is significant. Surgery remains to be the mainstay treatment for esophageal cancer. Standardized surgical procedure and radical lymph node dissection is the base of multimodality treatment, which is also related to the success of the treatment and prognosis. At present, synchronized preoperative chemoradiation is recommended for operable esophageal cancer. Use of preoperative radiation is not associated with increased difficulty in performing surgery or increased complications. Preoperative chemotherapy alone is not recommended. NCCN recommends 5-fluorouracil-based adjuvant therapy administered synchronously with radiation. In China, postoperative synchronized chemoradiation is recommended for II(B-III) esophageal cancer. Large-scale, multi-center, prospective controlled clinical trials are warranted to determine the optimal combination of therapeutic alternatives to benefit patients the most.
Combined Modality Therapy ; Esophageal Neoplasms ; therapy ; Humans

Humans ; Esophageal Neoplasms/therapy* ; Stomach Neoplasms ; China

Surgery is the main treatment for resectable esophageal squamous cell carcinoma. However, for patients with locally advanced lesions, surgery-based comprehensive treatment is the best treatment strategy. According to the results of some randomized controlled clinical studies and meta-analysis, preoperative neoadjuvant therapy is recommended to improve the survival rate of patients. Neoadjuvant therapy includes neoadjuvant chemotherapy, chemoradiotherapy, targeted therapy and immunotherapy. Great progress has been made in neoadjuvant therapy, but there are still many clinical problems that need to be solved urgently, including the efficacy and safety of neoadjuvant therapy, the choice of neoadjuvant regimen and treatment cycle, the best combination and advantages of multimodal treatment, and the selection of responders to treatment, etc. This article provides a systematic review of the latest developments and existing controversies in neoadjuvant therapy for esophageal squamous cell carcinoma.
Chemoradiotherapy ; Combined Modality Therapy ; Esophageal Neoplasms/surgery* ; Esophageal Squamous Cell Carcinoma/therapy* ; Esophagectomy ; Humans ; Neoadjuvant Therapy

Treatment for patients with esophageal cancer remains unsatisfactory. Although surgery alone or chemoradiotherapy have been generally accepted as reasonable options for patients with locoregional esophageal cancer, 5-year survival rate of either management is about 20%. The limited success of single modality treatment using radiotherapy or surgery has led to the investigation of multimodality therapies, combining chemotherapy, radiotherapy, and surgery. However, the appropriateness of such therapies remains unanswered. A number of prospective randomized trials of trimodality therapy versus surgery alone suggest benefits of combined-modality therapy. Concurrent chemoradiotherapy is an alternative treatment in selected resectable cases to show potential benefits in survival and local control. Patients with complete response following neoadjuvant therapy have consistent, substantial benefits in survival. Pretreatment staging is necessary for standardization of patients undergoing treatment protocols and for outcome evaluation. Biologic markers can be used to predict response to therapy and might allow designation of treatment based on the individual tumor. In the future, clinical trials testing optimal integration of preoperative regimen including new drugs may impact on the prognosis of esophageal cancer.
Combined Modality Therapy ; English Abstract ; Esophageal Neoplasms/*therapy ; Humans

Esophageal Neoplasms ; therapy ; Humans ; Neoadjuvant Therapy ; Preoperative Care

Esophageal cancer has a poor overall prognosis and is frequently diagnosed at a late stage. Conventional treatment for metastatic esophageal cancer involves chemotherapy and radiation. Local disease control plays a significant role in improving survival. Endoscopic spray cryotherapy is a novel modality that involves freezing and thawing to produce local ablation of malignant tissue via ischemic mechanisms. Spray cryotherapy has been shown to be effective, particularly for early T-stage, superficial esophageal adenocarcinomas. We present the case of a 72-year-old-male with locally recurrent stage IV esophageal adenocarcinoma and long-term survival of 7 years to date, with concurrent chemoradiation and serial cryoablation. He remains asymptomatic and continues to undergo chemotherapy and sequential cryoablation. The findings highlight the long-term safety and efficacy of cryotherapy in combination with chemoradiation, and suggest that cryoablation may have an additive role in the treatment of advanced stage esophageal adenocarcinoma.
Adenocarcinoma* ; Cryosurgery* ; Cryotherapy ; Drug Therapy ; Esophageal Neoplasms ; Freezing ; Prognosis

OBJECTIVE: To investigate the effect of dexmedetomidine combined with pulmonary protective ventilation against lung injury in patients undergoing surgeries for esophageal cancer with one-lung ventilation (OLV). METHODS: Forty patients with undergoing surgery for esophageal cancer with OLV were randomly divided into pulmonary protective ventilation strategy group (F group) and dexmedetomidine combined with protective ventilation strategy group (DF group; =20). In F group, lung protective ventilation strategy during anesthesia was adopte, and in DF group, the patients received intravenous infusion of dexmedetomidine hydrochloride (0.3 μg · kg ·h) during the surgery starting at 10 min before anesthesia induction in addition to protective ventilation strategy. Brachial artery blood was sampled before ventilation (T), at 30 and 90 min after the start of OLV (T and T, respectively) and at the end of the surgery (T) for analysis of superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), arterial oxygenation pressure (PaO), oxygenation index (OI) and lung compliance (CL). RESULTS: At the time points of T, T and T, SOD level was significantly higher and IL-6 level was significantly lower in the DF group than in F group ( < 0.05). The patients in DF group showed significantly higher PaO, OI and CL index than those in F group at all the 3 time points. CONCLUSIONS Dexmedetomidine combined with pulmonary protective ventilation strategy can reduce perioperative lung injury in patients undergoing surgery for esophageal cancer with OLV by suppressing inflammation and oxidative stress to improve lung function and reduce adverse effects of the surgery.
Dexmedetomidine ; Esophageal Neoplasms ; therapy ; Humans ; Lung ; Malondialdehyde ; One-Lung Ventilation