Carcinoma of the esophagus is the second most common cause of cancer-related-death in women,and fourth in men in China.The prevalence rate of adenocarcinoma of esophagus has increased in the western countries recently too.Unfortunately,the treatment result of esophageal cancer is very poor,and only 15%～20% of all esophageal cancer patients will be alive 5 years after diagnosis.With the development of radiologic techniques and molecular biology,the esophageal cancer patients are given on individualized treatment modality.This paper reviewed several interesting topics,including operation for esophageal cancer,new technologies for pre-operative staging,multidisciplinary treatment as well some data from the Shanghai Cancer Hospital.

The three-field lymphadenectomy for carcinoma of the esophagus remains debatable. There are several aspects that the debate focuses on. Firstly, should the positive cervical lymph nodes be considered a regional(N1) or a distant( M1) site of disease for tumors of esophagus? Secondly, can the extended lymphadenectomy prolong survival? Thirdly, the increase in the morbidity rates.

Objective To explore the feasibility and short-term efficacy of combined use of laparoscopic and thoracoscopic Ivor Lewis esophagectomy for the treatment of esophageal carcinoma.Methods A case of esophageal carcinoma was treated in our hospital in December 2007.Five trocars were used via laparoscopy to free the stomach and create a tube-like stomach.Afterwards,thoracoscopy was carried out via 4 trocars to remove the lesion and open the diaphragm,and then the tube-like stomach was pulled into the chest cavity and anastomosed to the chest wall.Results The operation time was 330 min,and the intraoperative blood loss was 200 ml.The lesion was removed completely with negative cutting edges.Postoperative pathological examination showed squamous cell carcinoma(stage T2N0M0).Follow-up was available for 3 months,during which no recurrence was found.Conclusion Laparoscopic and thoracoscopic Ivor Lewis esophagectomy is feasible and safe for the treatment of esophageal carcinoma.

Objective To evaluate the clinical value of CT scan in the diagnosis of tracheoesophageal groove lymph node (TEGLN) metastasis of thoracic esophageal carcinoma. Methods Forty-six patients with thoracic esophageal carcinoma underwent esophagectomy with three-field dissection (3FD) of the cervical, mediastinal, and abdominal lymph nodes. CT findings of TEGLN were compared with that of pathological findings. Results Among the 46 patients who underwent esophagectomy with 3FD, 14 (30%) were found to have TEGLN metastases. Of the 277 TEGLNs excised by operation, 16 were found to have metastases. Primary sites of the thoracic esophageal carcinoma with TEGLN metastasis in upper, middle, or lower portion were 66.67%, 22.86%, and 40%, respectively. The difference between each portion was not statistically significant. The thoracic esophageal carcinoma with TEGLN metastasis in T 1, T 2, T 3 and T 4 staging were 50.00%, 25.00%, 28.57%, and 100.00%, respectively. There was no statistically significant difference between each T staging. 18 TEGLNs were found in CT scans. The average diameter of them was 1cm (0.3～2.5 cm). Sensitivity and specificity of CT examination were 87.50% and 98.47%, respectively. Positive predict value and negative predict value were 77.78% and 99.23%, respectively. Conclusion In patient with thoracic esophageal carcinoma, nodules appeared in tracheoesophageal groove could be diagnosed as lymph nodal metastases. Low cervical and mediastinal CT scan should be a conventional examination, and it was the basis of the radiation therapy plan. Dissection of TEGLN was very important for patient of thoracic esophageal carcinoma, but if bilateral tracheoesophageal grooves were negative in CT scans, and bilateral internal jugular chain and bilateral superclavicular lymph node were both negative in clinical examination. 3FD dissection, which could increase the rate of operative complication, was not conventionally used.

Purpose:To explore the regularity of lymph node metastasis in thoracic esophageal carcinoma.Methods:From March 2000 to June 2001,100 patients with thoracic esophageal carcinoma underwent radical esophagectomy with three field lymphadenectomy. Dissection was done through a right lateral thoracotomy followed by repositioning and simultaneous laparotomy and neck incision. Results:The hospital mortality rate was 0%.Nodal metastases occurred in 54% (54/100) of patients. The rate of metastasis to neck, mediastinum and abdomen were 31%, 34% and 26%. Cervical nodal metastasis was not correlated with the depth of tumor penetration. There was a higher frequency in nodal metastasis near the bilateral recurrent laryngeal nerves than that in the bilateral supraclavicular region. Conclusions:①Neck, mediastinum and abdomen nodal metastases occurred frequenthy in thoracic esophageal carcinoma. ②Cervical nodal metastasis could occur in early stage of tumor infiltration.③Cervical lymphadenectomy was a very important factor for accurate staging of thoracic esophageal cancer.

Objective:To evaluate the feasibility and safety of laparoscopic jejunostomy with central venous catheterization set (CVC, Arrow International Inc., USA) during the operation of totally minimally invasive Ivor-Lewis esophagectomy (MIIE). Methods:The clinical data of 88 patients with esophageal squamous cell carcinoma who were admitted to the Fudan University Cancer Hospital from February 2013 to April 2014 were retrospectively analyzed. Among them, 48 patients with early mid-lower esophageal cancer un-derwent laparoscopic jejunostomy with CVC, and 40 patients accepted nasogastric tube nutrition. Short-term clinical outcomes were collected. Results:No significant difference in nutrition index was found between the two groups, but the rate of unplanned extubation in the laparoscopic jejunostomy with CVC group was less than that in the nasogastric tube nutrition group. Conclusion:Laparoscopic jejunostomy with CVC set is a safe and feasible technique. It is potentially accepted as an optional approach in MIIE for post-operative nutrition support.

Objective Totally MIIE with per-oral placement of anvil has been reported elsewhere,but MIIE with manual pursestring and per-thoracic port placement of anvil has been seldomly reported.The feasibility of the latter technique was proved in this study.Methods Patients with mid-lower thoracic esophageal cancer were prospectively treated with totally MIIE at Shanghai Cancer Center of Fudan University from Feberay 28,2013 to August 31,2013.Laproscopic intracorporeal construction of the gastric conduit and needle catheter J-tube were performed in the first stage of MIIE.In the second stage a hand sewn pursestring was made with endostitch system and the anvil of EEA stapler was inserted via the tenth inter costal port prior to the intrathoracic anastamosis.Short-term clinicopathologic outcomes were collected.Results 39 cases were treated with totally MIIE,media age 61 years,ranged 48-69 years,10 females and 29 males.There was 1 conversion to open surgery.The median duration of operation was 245 minutes.The median intraoperative blood loss was 210 ml.All the patients were margin negative and staged from pT1N0M0 to pT3N2M0.The average lymph node yields were 16.5 per patient.The median postoperative hospital stay was 7 days.There was no mortality.Perioperative morbidity occurred in 4 patients (10％).2 patients were complicated with late stage gastric paralysis which began 2 or 3 days after oral feeding and both recovered in 1 month.1 patient was with minor anastamotic leakage which was endoscopically demonstrated on the 14th day postoperatively and the patient recovered in 1 month post leakage.1 patient was complicated with severe pneumonitus and ARDS; the ICU stay of that case was 19 days and the recovered patient was discharged 27 days postoperatively.Conclusion MIIE with regular EEA stapler and intrathoracic anastamosis is feasible in patients with thoracic esophageal cancer.Prospective randomized clinical trials could be conducted to compare the open procedure and totally MIIE with regular EEA stapler.

Objective To analyze the metastatic rule of common hepatic artery lymph node of thoracic esophageal squamous cell carcinoma,and to investigate the strategies of common hepatic artery lymph node dissection.Methods The clinical data of 682 patients with esophageal squamous cell carcinoma who were admitted to the Cancer Hospital of Fudan University from May 2005 to December 2010 were retrospectively analyzed.The locoregional lymph node metastasis of thoracic esophageal squamous cell carcinoma,relationship between metastatic rates of common hepatic artery lymph node and clinicopathological factors and the postoperative complications were analyzed.The enumeration data were analyzed using the chi-square test.Results A total of 18 277 lymph nodes were dissected (27 lymph nodes per patient).The lymph node metastatic rate was 55.87％ (381/682),and the metastatic lymph node ratio was 7.87％ (1438/18 277).Lymph nodes adjacent to the cardia of stomach,laryngeal nerve,lesser curvature of stomach,cervical esophagus,left gastric artery had a higher metastatic rate,while common hepatic artery lymph node had a lower metastatic rate.All the common hepatic artery lymph node metastasis was accompanied with locoregional metastasis.A total of 1480 common hepatic artery lymph nodes were dissected (2 common hepatic artery lymph nodes per patient).Twenty-four patients had common hepatic artery lymph node metastasis,with the metastatic rate of 3.52％ (24/682) and the lymph node ratio of 2.16％ (32/1480).The common hepatic artery lymph node metastatic rates of upper,middle and lower esophageal squamous cell carcinoma were 2.33％ (1/43),3.76％ (16/425) and 3.27％ (7/217),with no significant difference (x2 =0.295,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients in T1,T2 and T3 stages were 2.35％ (2/85),5.46％ (10/183) and 2.90％ (12/414),with no significant difference (x2 =2.850,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with high,moderate and poor differentiated esophageal squamous cell carcinoma were 0(0/63),3.50％ (16/457) and 4.94％ (8/162),with no significant difference (x2=3.259,P ＞ 0.05).The common hepatic artery lymph node metastatic rates of patients with diameter of tumor under 3 cm,3-5 cm and above 5 cm were 2.59％ (6/232),3.02％ (11/364) and 8.14％ (7/86),with significant difference (x2 =6.267,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in N0,N1,N2,N3 stages were 0(0/301),2.53％ (5/198),5.65％ (7/124) and 20.34％ (12/56),with significant difference (x2 =62.368,P ＜ 0.05).The common hepatic artery lymph node metastatic rates of patients in stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 0(0/62),1.78％ (6/337),5.06％ (13/257) and 19.23％ (5/26),with significant difference (x2=25.959,P ＜0.05).Two hundred and twenty-eight patients had postoperative complications with the complication rate of 33.43％ (228/682).The incidence of anastomotic fistula was the highest,which was 11.58％(79/682).Conclusions The metastatic rates of common hepatic artery lymph node in thoracic esophageal squamous cell carcinoma is the lowest.For patients suffered from esophageal cancer in stage I or the tumor diameter under 5 cm,the dissection of common hepatic lymph node can be ommitted in surgery.

AIM: To establish hybrid mouse embryonic stem (ES) cell line from blastocysts of the (C57BL/6J?129/J) F1 mouse. METHODS: 3.5 days post-coitus (d.p.c.) blastocysts were cultured on mouse embryonic fibroblasts (MEFs) in the medium, after 3-4 days, Inner cell mass were picked up and disaggregated, then reseeded. After the ES-like colonies appeared, passaged them to give permanent ES cell lines. The pluripotent properties of ES cells obtained were analyzed by alkaline phosphatase (AKP) activity, expression of SSEA-1 and Oct-4, and their capacity to form teratoma. RESULTS: Two hybrid ES cell lines, SC1001, SC1002 were obtained from blastocysts of the (C57BL/6J?129/J) F1 genotype. Most of these ES cells had a normal karyotype and an XY sex chromosome composition. The pluripotent properties of the cell lines were analyzed on the basis of their alkaline phosphatase activity, expression of SSEA-1 and Oct-4, and their capacity to form teratoma in severe combined immunodeficiency (SCID) mice. CONCLUSION: Two hybrid mouse ES cell lines having pluripotent properties and capacity for long-term self renewal were generated from blastocysts of the (C57BL/6J?129/J) F1 genotype.

AIM: To establish hybrid mouse embryonic stem (ES) cell line from blastocysts of the (C57BL/6J × 129/J) F1 mouse. METHODS: 3.5 days post- coitus (d.p.c.) blastocysts were cultured on mouse embryonic fibroblasts (MEFs) in the medium, after 3 - 4 days, Inner cell mass were picked up and disaggregated, then reseeded. After the ES - like colonies appeared, passaged them to give permanent ES cell lines. The pluripotent propertes of ES cells obtained were analyzed by alkaline phosphatase (AKP) activity, expression of SSEA- 1 and Oct-4, and their capacity to form teratoma. RESULTS: Two hybrid ES cell lines, SC1001, SC1002 were obtained from blastocysts of the (C57BL/6J × 129/J) F1 genotype. Most of these ES cells had a normal karyotype and an XY sex chromosome composition. The pluripotent properties of the cell lines were analyzed on the basis of their alkaline phosphatase activity, expression of SSEA - 1 and Oct - 4, and their capacity to form teratoma in severe combined immunodeficiency (SCID) mice. CONCLUSION: Two hybrid mouse ES cell lines having pluripotent properties and capacity for long - term self renewal were generated from blastocysts of the ( C57BL/6J × 129/J) F1 genotype.