OBJECTIVE: To investigate the effect of thoraco-laparoscopic esophagectomy on postoperative immune function of patients with esophageal carcinoma. METHODS: Eighty-one patients undergoing radical esophagectomy in our hospital between January, 2017 and December, 2019 were enrolled in this study.According to the surgical approach, the patients were divided into endoscopic group (41 cases) and open surgery (3 incisions) group (40 cases).The immunological indicators (CD3 RESULTS: No death occurred in either of the group after the operation.On days 4 and 7 after the operation, CD3 CONCLUSIONS Thoraco-laparoscopic resection of esophageal cancer can reduce postoperative secretion of proinflammatory factors, alleviate inflammatory responses, and promote the recovery of immune functions to accelerate postoperative recovery of the patients.
Carcinoma, Squamous Cell/surgery* ; Esophageal Neoplasms/surgery* ; Esophagectomy ; Humans ; Laparoscopy ; Postoperative Complications ; Postoperative Period

OBJECTIVE: To explore the clinical characteristics and prognosis of multiple myeloma(MM) patients with secondary primary malignancies. METHODS: The clinical data of newly diagnosed MM patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2019 were retrospectively analyzed. The patients with secondary primary malignancies were retrieved, and their clinical features and prognosis were evaluated. RESULTS: A total of 1 935 patients with newly diagnosed MM were admitted in this period, with a median age of 62 (18-94) years old, of which 1 049 cases were hospitalized twice or more. There were eleven cases with secondary primary malignancies (the incidence rate was 1.05%), including three cases of hematological malignancies (2 cases of acute myelomonocytic leukemia and 1 case of acute promyelocytic leukemia) and eight cases of solid tumors (2 cases of lung adenocarcinoma, and 1 case each of endometrial cancer, esophageal squamous cell carcinoma, primary liver cancer, bladder cancer, cervical squamous cell carcinoma, and meningioma). The median age of onset was 57 years old. The median time between diagnosis of secondary primary malignancies and diagnosis of MM was 39.4 months. There were seven cases with primary or secondary plasma cell leukemia, the incidence rate was 0.67%, and the median age of onset was 52 years old. Compared with the randomized control group, the β2-microglobulin level in the secondary primary malignancies group was lower (P=0.028), and more patients were in stage I/II of ISS (P=0.029). Among the 11 patients with secondary primary malignancies, one survived, ten died, and the median survival time was 40 months. The median survival time of MM patients after the secondary primary malignancies was only seven months. All seven patients with primary or secondary plasma cell leukemia died, with a median survival time of 14 months. The median overall survival time of MM patients with secondary primary malignancies was longer than that of the patients with plasma cell leukemia (P=0.027). CONCLUSION The incidence rate of MM with secondary primary malignancies is 1.05%. MM patients with secondary primary malignancies have poor prognosis and short median survival time, but the median survival time is longer than that of patients with plasma cell leukemia.
Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Multiple Myeloma/complications* ; Leukemia, Plasma Cell ; Retrospective Studies ; Esophageal Neoplasms/complications* ; Esophageal Squamous Cell Carcinoma/complications* ; Prognosis ; Neoplasms, Second Primary

BACKGROUND: The Ivor-Lewis operation has been widely applied for treating thoracic esophageal cancer, but more acceptable results from three-field lymph node dissection have recently been reported. In this study the efficacy of the Ivor-Lewis operation was evaluated. MATERIAL AND METHOD: Among the 273 patients, who underwent operation for esophageal cancer between September 1994 and August 2004, we retrospectively studied 172 patients with esophageal squamous cell carcinoma and who had no other primary cancer and who underwent complete resection with an Ivor-Lewis operation. The postoperative complications, the short and long-term survival and the recurrence patterns were analyzed. RESULT: The postoperative staging was as follows: stage I in 40 cases, IIA in 48 cases, IIB in 18 cases, III in 55 cases, IVA in 5 cases and IVB in 6 cases. The operative mortality rate was 4% (7 of 172 pts). Postoperative complication occurred in 32 patients (18%) and tumor recurred in 55 patients (32%). The overall 5-year survival rate was 48%; it was 85.6% in stage I patients, 47.6% in IIA patients, 65% in IIB patients, 22.8% in III patients and 0% for those in IV (p<0.05). The 5-year survival rate according to the location of esophageal cancer was 26.5% for patients with tumor in the upper 1/3 of the esophagus and 52.4% for patients with tumor in the mid and lower 1/3 (p>0.05). CONCLUSION: The Ivor-Lewis operation is an acceptable surgical procedure for thoracic esophageal squamous cell carcinoma. Yet it is necessary to consider other surgical procedures, and especially three-field lymph node dissection for treating upper 1/3 esophageal cancer.
Carcinoma, Squamous Cell* ; Esophageal Neoplasms ; Esophagus ; Humans ; Lymph Node Excision ; Mortality ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: To remove the tumor and to restore continuity is very important in patients with esophageal cancer for cure of disease or palliation. To compare the outcome of Transhiatal Esophagectomy using Laparoscope (Lapa-THE), author`s modification of traditional tanshiatal esophagectomy, with that of transhiatal esophagectomy (THE). MATERIALS AND METHODS: The author performed THE in 10 cases with esophageal cancer and Lapa-THE in 5 cases with esophageal cancer from March 1992 to August 1996 in Department of Surgery, Pusan National University Hospital. RESULTS: Of all 15 cases with esophageal cancer, 6 cases were occurred at 6th decade and 3 cases were occurred at 7th decade. The ratio of male to female was 4:1. The all 5 cases with Lapa-THE were mid-thoracic esophageal cancers. Of 10 cases with THE, the cancer occurred 2 cases in mid-thoracic esophagus, 4 cases in lower-thoracic esophagus and 4 cases in cardia portin. According to pathological type, the 12 cases were squamous cell carcinoma, 2 cases were adenocarcinoma, and 1 case was small cell carcinoma. Of all 10 cases with THE, the postoperative death was occurred in 1 case due to graft necrosis, other postoperative complications were occured in 5 cases, stenosis of anastomotic site in 3 cases, wound infection in 1 case and pleural effusion in 1case. In the cases with Lapa-THE, stenosis was occurred in 1 case, wound infection in 1 case and there was no postoperative death. CONCLUSION: The Lapa-THE is comparable therapeutic technique with conventional THE for treatment of patient with esophsgeal cancer, especially it was useful in mid-thoracic esophageal cancer.
Adenocarcinoma ; Busan ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Cardia ; Constriction, Pathologic ; Esophageal Neoplasms* ; Esophagectomy* ; Esophagus ; Female ; Humans ; Laparoscopes* ; Male ; Necrosis ; Pleural Effusion ; Postoperative Complications ; Transplants ; Wound Infection

PURPOSE: We report on a novel method and outcomes of laparoscopic gastric tubing with pyloromyotomy. METHODS: The abdominal procedure includes laparoscopic gastric mobilization, celiac axis lymph node dissection, formation of the gastric tube, and pyloromyotomy. Between January 2009 and April 2013, our minimally invasive esophagectomy (MIE) was performed on 54 patients with esophageal cancer. The short-term outcomes, including postoperative complications, were analyzed. RESULTS: There were no cases of conversion to open surgery. Of 54 patients, 52 patients had squamous cell carcinoma (SCC) and two had adenocarcinoma. The total operative time was 349.8+/-77.4 minutes, of which 90.6+/-27.6 minutes was required for the abdominal procedure. The mean estimated operative blood loss during the abdominal procedure was 40.0+/-355.5 ml. The postoperative complication rate was 24.1%; three patients died of pneumonia. CONCLUSION: Laparoscopic gastric tubing with pyloromyotomy is a feasible and safe treatm ent option for patients with esophageal cancer.
Adenocarcinoma ; Axis, Cervical Vertebra ; Carcinoma, Squamous Cell ; Conversion to Open Surgery ; Esophageal Neoplasms* ; Esophagectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Operative Time ; Pneumonia ; Postoperative Complications

BACKGROUND: For resection of esophageal cancer, esophagogastrostomy caused serous multiple complications such as leakage of anastomosis site, stenosis, recurrence of cancer, etc. Especially, accoding to the anastomosis site of esophagogastrostomy, patients in post operation state was felt various subjective symptom, multiple complications and longer hospital periods, etc. Therefore, there was a demand for comparison and analysis of complication between cervical and thoracic esophagogastrostomy. MATERIAL AND METHOD: From January 1995 to May 1999, 55patients with esophageal cancer underwent cervical esophagogastrostomy(23patients) or thoracic esophagogastrostomy(32patients). Cancer was grouped according to the postoperative staging(I--5pt, II--27pt, III--23pt) by the AJCC classification and location: upper thoracic(3pt), middle(34pt) and lower(18pt). Cancer was mostly squamous cell carcinoma except 2 adenocarcinoma. Fifty five patients were male with average age of 59 years for cervical anastomosis and 55 years for thoracic anastomosis. The staple anastomosis was done in one cervical anastomosis patient and 23 thoracic anastomosis patients. RESULT: There was one mortality from cervical anastomosis and two from thoracic anastomosis. Fourty six complications(respiratory and digestive system, etc..) occurred in 15cervical anastomosis patients and 37 complication in 13thoracic anastomosis patients. In 23cervical esophagogastrostomy patients, 11patients had moderate to severe dysphagea during swallowing. However, only 2thoracic anastomosis patients experienced this dysphagea. The postoperative hospital stay was above 20days in 18 cervical anastomosis patients, and in 13thoracic anastomosis patients. CONCLUSION: Among esophageal tumor cases, respiratory, digestive, infection and other complications did occur after esophagogastric anastomosis. Particularly, mortality rate secondary to respiratory complication was high. Anastomotic leakage was more frequent in manual anastomosis than in staple anastomosis, and was also seen more frequently among cervical anastomosis than among thoracic anastomosis. In the cases of cervical anastomosis, the patients complained more of dysphagea while their hospital stays were significantly long.
Acyclovir* ; Adenocarcinoma ; Anastomotic Leak ; Carcinoma, Squamous Cell ; Classification ; Constriction, Pathologic ; Deglutition ; Digestive System ; Esophageal Neoplasms* ; Humans ; Length of Stay ; Male ; Mortality ; Postoperative Complications ; Recurrence

BACKGROUND: The incidence of cervical esophageal cancer is low compared with that of thoracic esophageal cancer, and the role of surgery for cervical esophageal cancer is limited compared with that of radiotherapy or chemotherapy. This study was carried out to determine the outcome of surgery for cervical esophageal cancer. MATERIAL AND METHOD: We analyzed retrospectively medical records of 43 patients who had undergone curative surgical resection for cervical esophageal cancer from January 1989 to December 2002. Follow-up loss was absent and the last follow-up was carried out in February 28, 2004. RESULT: The mean age was 60 years old and the male to female ratio was 40:3. Histologic types were squamous cell carcinoma 42 patients and malignant melanoma 1 patient. The methods used for esophageal reconstruction were gastric pull-up 32 patients, free jejunal graft 7 patients and colon interposition 4 patients. Postoperative complications occurred in 31 patients (72%), and operative mortality occurred in 7 patients (16%). Pathologic stages were I 3, IIa 14, IIb 1, III 19, and IVa 6 patients. Tumor recurrence occurred in 16 patients (44%), and the 3 and 5-year survival rates were 29.3% and 20.9%. CONCLUSION: The reported surgical results for cervical esophageal cancer showed somewhat high operative mortality, postoperative complication rates and recurrence rates and a low long-term survival rate. It is suggested that multimodality treatment including surgery is needed for the treatment of cervical esophageal cancer because radiotherapy or chemotherapy without surgery could not relieve dysphagia or resolve the tumor completely.
Carcinoma, Squamous Cell ; Colon ; Deglutition Disorders ; Esophageal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Medical Records ; Melanoma ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Survival Rate ; Transplants

BACKGROUND/AIMS: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs. METHODS: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated. RESULTS: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively. CONCLUSIONS: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.
Aged ; Carcinoma in Situ/pathology/*surgery ; Carcinoma, Squamous Cell/pathology/*surgery ; Cohort Studies ; Disease-Free Survival ; Dissection ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation ; Esophageal Stenosis ; Esophagoscopy ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mucous Membrane/pathology/*surgery ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/*pathology ; Operative Time ; *Postoperative Complications ; Postoperative Hemorrhage ; Retrospective Studies ; Treatment Outcome ; Tumor Burden

BACKGROUND AND OBJECTIVEMost patients with esophageal carcinoma have disease in the locally late stage (stage III) when first diagnosed, with surgery as the first treatment of choice. This study analyzed the clinical data of patients with esophageal squamous carcinoma after radical esophagectomy and investigated prognostic factors.

METHODSThe data of 361 patients with esophageal squamous carcinoma who underwent radical esophagectomy and were hospitalized at Sun Yat-sen University Cancer Center between January 1997 and March 2004 were analyzed. The Kaplan-Meier method was used to analyze prognosis, log-rank test was used to compare the groups, and the Cox proportional hazards model was used for multivariate analysis.

RESULTSThe 1-, 2-, 3-, 4-, and 5-year survival rates were 67.7%, 40.6%, 27.5%, 23.4%, and 20.1%, respectively. Based on univariate analysis, the degree of invasion, rate of lymph node metastasis, number of metastatic regions, number of metastatic lymph nodes, postoperative complications, and duration of surgery were prognostic factors. Based on multivariate analysis, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent factors for the prognosis.

CONCLUSIONSOf all clinical and pathologic factors, the degree of invasion, rate of lymph node metastasis, and postoperative complications were independent prognostic factors for the patients with stage-III esophageal squamous carcinoma after radical esophagectomy.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Postoperative Complications ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate

We retrospectively analyzed 54 patients with esophageal cancer treated surgically between 1992 and 1996. They composed of 51(94.4%)men, 3(5.6%)women, and the age ranged from 42 to 78, the mean was 58.7+/-8.37. Symptoms were varied with dysphagia(72.2%), epigastric discomfort(16.6%), chest pain (5.6%), and so on(5.6%). Transthoracic esophagectomy(TTE) with esophagogastrostomy was done in 36 case, TTE with esophagocologastrostomy in 4 case, and transhiatal esophagectomy(THE) with esophagogastrostomy in 14 case. The operative mortality was 12.9%(7/54); 6 underwent TTE with esophagogastrostomy, and 1 underwent TTE with esophagocologastrostomy. Postoperative complications were of anastomotic leakage in 7 case, wound infection in 10 case, anastomotic stricture in 9 case, vocal cord paralysis in 2 case, bronchial tearing in 1 case, and pneumothorax in 3 case. Locations of esophageal cancer were upper thoracic esophagus in 4 case, middle thoracic esophagus in 34 case and lower thoracic esophagus in 16 case. Histological types were adenocarcinoma in 1 case and squamous cell carcinoma in 53 case. During the follow-up period, 25 cases died. Cumulative survival rate was 52.7% in 1 year, 45.5% in 2 year, 45.5% in 3 year, 45.5% in 4 year, 45.5% in 5 year.
Adenocarcinoma ; Anastomotic Leak ; Carcinoma, Squamous Cell ; Chest Pain ; Constriction, Pathologic ; Esophageal Neoplasms* ; Esophagus ; Follow-Up Studies ; Humans ; Mortality ; Pneumothorax ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Vocal Cord Paralysis ; Wound Infection