Decision Making ; Esophageal Diseases ; diagnosis ; therapy ; Humans ; Physician's Role ; Thoracic Surgical Procedures

Intestinal mucosa plays important roles in digestion, absorption and substance exchange between organism and external environment. Meanwhile, it is the largest immune organ and mucosal barrier, including mechanical, biological and immune barrier. A variety of diseases, especially postoperative complications, are associated with the damage of mucosal barrier. Esophageal cancer surgery is complex and many perioperative factors, especially hypoperfusion and fasting, may affect the integrity of intestinal barrier. Understanding of the mechanism of intestinal barrier (mechanical, biological and immune barrier), the physiological function of probiotics, and the benefit of early enteral nutrition to intestinal barrier are important components to achieve fast recovery after surgery for esophageal cancer.
Enteral Nutrition ; Esophageal Neoplasms ; surgery ; therapy ; Humans ; Intestinal Mucosa ; Perioperative Period

Esophageal Neoplasms ; mortality ; surgery ; Humans ; Quality of Life ; Survival Analysis

Esophageal surgery has developed for almost 100 years. Esophagectomy can be performed via left, right thoracotomy, even via hiatus without thoracotomy due to its unique anatomic characteristics. Left thoracotomy was the initial approach in the world, and has still been performed by Chinese colleagues, but Ivor Lewis (right side thoracotomy) procedure is popular in western countries. Currently, esophagectomy by right thoracotomy has been accepted worldwide since its radical dissection for tumor. Therefore, video-assisted thoracoscopic esophagectomy based on right thoracotomy will be the mainstream surgery for esophageal cancer in the future since its minimal invasion and tumor dissection.
Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Thoracoscopy ; methods

Although considerable clinical problems were solved by parenteral nutrition since 1960s, because of the risk of infectious and metabolic complications and advance in feeding tube placement, feeding methods, and artificial ingredient nutrients, enteral nutrition from 400 years ago has been brought to attention again. This review article is aimed to illustrate the issues related to enteral tube feeding in esophageal surgery.
Enteral Nutrition ; instrumentation ; methods ; Humans

Esophageal squamous cell carcinoma (ESCC) is one of the commonest malignancies in China. Surgery is the main treatment for ESCC. However, the long-term survival is very poor by surgery alone. Perioperative multimodality treatment, including locally and systemically administrated, preoperatively and postoperatively, has been and will be the standard treatment in terms of improving long-term survival. Base on decades of practice and clinical trials, it is believed that preoperative treatment is better than postoperative treatment, and that chemotherapy plus radiotherapy preoperatively is better than either chemotherapy or radiotherapy alone. Therefore, preoperative radiochemotherapy followed by surgery is the standard treatment and future direction for locally advanced ESCC.
Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Humans ; Neoadjuvant Therapy ; Perioperative Care ; Radiotherapy, Adjuvant

Esophageal cancer (EC) is one of the common malignant tumors in China. Esophagectomy based on multi-disciplinary principle improves the quality of life and survival of esophageal cancer patients, but a lot of patients will suffer recurrence or metastasis after surgery. TNM stage is the most important factor which affects the prognosis of patients with esophageal cancer. Besides, there are other prognostic factors, such as abnormal expression of the proteins. Exploration of these proteins may provide new clues to improve prognosis in esophageal squamous cell cancer (ESCC). We reviewed the literatures related to abnormal protein expression in ESCC, and tried to elucidate the prognostic value and potential clinical application of these proteins in ESCC.
Biomarkers, Tumor ; metabolism ; Carcinoma, Squamous Cell ; metabolism ; Esophageal Neoplasms ; metabolism ; Humans ; Prognosis ; Proteins ; metabolism

OBJECTIVETo summarize the surgical outcome of patients with small cell esophageal carcinoma(SCEC).

METHODSClinical data of patients with esophageal carcinoma were retrospectively collected from March 2000 to March 2011 at the Thoracic Surgery Department of the Peking University Cancer Hospital. Data included tumor characteristics, staging, treatment, response, short-term outcome, and long-term survival.

RESULTSA total of 546 patients with esophageal carcinoma were identified, among whom there were 15 patients with SCEC(2.7%). Fourteen cases received multimodality treatment based on operation and one underwent operation alone. Four patients had preoperative chemotherapy and 10 had postoperative chemotherapy. Four patients had postoperative radiation. After excluding one case of postoperative death within 3 months, the median overall survival was 14.3 months(range, 4 to 99 months), significantly worse than those with non-SCEC(42.2 months, P<0.05).

CONCLUSIONSCEC is rare and the outcomes are poor. It should be considered as a systematic disease.

Adult ; Aged ; Carcinoma, Small Cell ; surgery ; therapy ; Combined Modality Therapy ; Esophageal Neoplasms ; surgery ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the clinical significance and survival benefits of chest wall resection and reconstruction (CWRR) by multidisciplinary surgery for selected patients with locally advanced or recurrent breast cancer in order to address the importance of collaboration between ablative (breast surgery or/and thoracic surgery) and reconstructive teams during CWRR.

METHODSThe data of 44 patients who underwent multidisciplinary CWRR at The University of Texas M. D. Anderson Cancer Center between March 2001 and June 2004 were retrospectively analyzed, which included the CWRR techniques used, patient characteristics and treatment outcomes. Survival of patients with primary, recurrent or metastatic disease, and that of those with curative or palliative resection were also compared.

RESULTSAll patients were female aged 34-83 years with primary (n=19), recurrent (n=15) or metastatic breast cancer (n=10). The surgery modes included curative resection(n=36) and palliative (n=8) with a mean defect size of skin: 218.4 cm2; of bony chest wall: 113.9 cm2 (n=15). Immediate reconstruction (n=43) with prosthesis (n=10) or without (n=34) for most of these patients. All of them required soft tissue coverage with pedicled flap (n=37) or free flap (n=13). The average hospital and ICU stay was 6.6 days and 3.4 days (n=8), respectively. The morbidity was acceptable and no 30-day mortality happened. Neither was there difference in median survival (44.7 m vs. 36.0 m, P = 0.752) nor in 1-, 2-, and 3-year survival rates between primary breast cancer (78.4%, 78.4%, 39.2%) and recurrent one (70.9%, 70.9%, 70.9%, P > 0.05). However, both median survival (16.0 m) and the 1-, 2-, and 3-year survival rates (30.0%, 15.0%, 0) in patients with metastasis were much poorer than that in those with primary breast cancer (P = 0.003) or recurrence(P =0. 018). The survival of patients underwent curative resection (36.0 m, 71.5%, 65.7%, 65.7%) were much longer than those with palliative resection (15.1 m, 35.1%, 23.4%, 7.8%, P = 0.018).

CONCLUSIONWith full control of systemic and local disease by up-front multidisciplinary strategy, chest wall resection and reconstruction could improve long-term survival if curative resection achieved or the quality of life if palliative resection done for breast cancer patients with tumor invading the chest wall or local recurrence. Ablative and reconstructive surgeons should be included in surgery team in order to guarantee the possibility of extensive resection and effective reconstruction in a single stage with high safety, good survival and minimal morbidity.

Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Mastectomy ; methods ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; surgery ; Neoplasm Staging ; Palliative Care ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Surgical Flaps ; Survival Analysis ; Thoracic Surgical Procedures ; Thoracic Wall ; pathology

OBJECTIVETo investigate the expression of HOXA13 gene in stage-II(a esophageal squamous cell carcinoma(ESCC), and to evaluate its relationship with clinicopathological characteristics and prognosis.

METHODSThe expression of HOXA13 was examined by immunohistochemistry(IHC) in specimens from 39 patients with ESCC of stage-II(a, who underwent resection from 1995 to 2002. SPSS software was used to analyze the relationship between HOXA13 expression and clinicopathological characteristics and prognosis of patients.

RESULTSThe expression of HOXA13 protein was detected in ESCC tissue, and the positive rate was 61.5%. The median survival time of patients without HOXA13 expression(>72 months) was significantly longer than those with HOXA13 expression (24 months)( P=0.023). Multivariate analysis showed that HOXA13 expression was independent predictor of disease-free survival time of patients with ESCC.

CONCLUSIONThe expression of HOXA13 can be detected in ESCC and is a negative independent predictor of disease-free survival, which implies that HOXA13 might play a role in ESSC, and may be used as a clinical tumor marker of ESCC.

Carcinoma, Squamous Cell ; metabolism ; pathology ; Esophageal Neoplasms ; metabolism ; pathology ; Female ; Homeodomain Proteins ; metabolism ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis