OBJECTIVETo evaluate the influence of the number, station and field of metastatic lymph node on the prognosis of thoracic esophageal cancer and to investigate an ideal nodal staging method.

METHODSClinicopathological and follow-up data of the 204 patients who underwent thoracic esophagectomy from June 2001 to December 2009 were analyzed retrospectively and all the patients were re-staged according to the 7th edition of the AJCC TNM staging system. Log-rank test was applied to perform survival analysis according to lymph node metastasis staging(number, station, and field), Cox proportional hazard model was used to screen risk factors.

RESULTSThe follow-up rate was 93.1%(190/204). The median follow up time was 37.0(0-104) months. The overall and cancer-specific 5-year survival rates were 35.0% and 38.8%. When grouped according to the number of metastatic lymph node(0, 1-2, 3-6, ≥ 7), the 5-year survival rates of pN0, pN1, pN2 and pN3 were 47.8, 31.8%, 11.5% and 0 respectively(P=0.000). When grouped according to the number of stations of metastatic lymph node[N(0s), N(1s)(1 station LN metastasis), N(≥ 2s)(≥ 2 stations LN metastasis)], the 5-year survival rates of N(0s), N(1s), N(≥ 2s) were 47.8%, 31.5% and 11.3% respectively(P=0.000). When grouped according to the number of fields of metastatic lymph node, the 5-year survival rates of N0, 1 field, 2 fields and 3 fields involvement were 47.8%, 34.2%, 12.1% and 0 respectively(P=0.000). Cox regression showed that the number of stations [P=0.043, RR(95% CI)=1.540(1.013-2.342)], and the number of fields[P=0.010, RR(95%CI)=2.187(1.210-3.951)] of metastatic lymph node were the independent risk factors for survival.

CONCLUSIONSThe extent of metastatic lymph node is an independent risk factor for the prognosis of esophageal cancer patients. Revision of the current N-classification of TNM staging system according to the number of stations of metastatic lymph node may be more reasonable.

Aged ; Carcinoma, Squamous Cell ; mortality ; pathology ; Esophageal Neoplasms ; mortality ; pathology ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVE: To evaluate the sub-acute oral effect of titanium dioxide (TiO₂) nanoparticles on the oxidation/antioxidation biomarkers and inflammatory cytokines in blood, liver, intestine, and colon in rats. METHODS: Twenty four 4-week-old clean-grade Sprague Dawley (SD) rats were randomly devided into 4 groups by body weight (n=6, control, low, middle, and high), in which the rats were orally exposed to TiO₂ nanoparticles at doses of 0, 2, 10 and 50 mg/kg body weight/day for 28 consecutive days separately. Food intake, body weight and abnormal behaviors during the experiment were recorded. The rats were euthanized on the 29th day. The blood was collected via abdominal aortic method and centrifuged to collect the serum. Tissues from liver, intestine and colon were collected and homogenated. Then enzyme-linked immunosorbent assay (ELISA) and microwell plate methods were used to detect oxidation/antioxidation biomarkers including superoxide dismutase (SOD), glutathione (GSH), glutathione peroxidase (GSH-Px), total mercapto (T-SH), glutathione disulfide (GSSG), malomdialdehvde (MDA) and inflammatory cytokines including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the serum, liver, intestine and colon in the rats. RESULTS: Compared with the control group, no significant differences in body weight, food intake and organ coefficients were observed in all the three groups after TiO₂ gavage. No significant changes in GSH, GSH-Px, T-SH, and IL-6 were observed. Compared with the control group, significant increase of SOD activity in serum in high dose group, signi-ficant increase of GSSG concentration in intestine in middle and high dose group and significant increase of MDA concentration in liver in low and high dose group were observed. Compared with the control group, a significant increase of TNF-α in liver in middle and high dose group was observed. CONCLUSION TiO₂ nanoparticle can increase antioxidant enzymes activities in blood, increase oxidative biomarkers in liver and intestine, increase inflammatory cytokines in liver in rats after a 28-day sub-acute orally administration. Among blood, liver, intestine, and colon, liver is most sensitive to the toxicity induced by TiO₂ nanoparticles, followed by intestine, blood, and colon in sequence.
Animals ; Antioxidants ; Biomarkers ; Cytokines ; Nanoparticles ; Oxidative Stress ; Rats ; Rats, Sprague-Dawley ; Titanium

OBJECTIVETo analyze the differences in perioperative morbidity and lymph node dissection between minimally invasive esophageal carcinoma resection and open procedure.

METHODSFrom January to December 2011, 72 patients with esophageal cancer underwent surgery. Thirty-four patients underwent video-assisted esophagectomy, and 38 underwent open procedure. In the minimally invasive group, there were 7 thoraco-laparoscopic cases, 16 thoracoscopic cases, and 11 laparoscopic cases.

RESULTSThe early cases (T1-T2) were more common in the minimally invasive group than that in the open group [79.4%(27/34) vs. 55.3%(21/38), P<0.05]. The complication rate was 41.2%(11/34) in the open group and 42.1%(16/38) in the minimally invasive group, and the difference was not statistically significant (P>0.05). However, the functional complication in minimally invasive group was significantly lower than that in open group [2.9%(1/34) vs. 28.9%(11/38), P<0.01], while technical complications (anastomotic leak and recurrent laryngeal nerve injury) were significantly more common( 38.2% vs. 10.5%, P<0.05). Lymph node group number in minimally invasive group was comparable with the open group (9.1 vs. 11.2, P>0.05), but the number of node in minimally invasive group was significantly lower (13.5±5.9 vs. 17.8±5.2, P<0.05). When stratified by time period, early 17 cases were associated with similar technical complication rate with the late 17 cases (P>0.05), while thoracic lymph node group number, number of node, and positive node were improved in the late phase (all P>0.05).

CONCLUSIONSMinimally invasive esophagectomy reduces functional morbidity, while technical complication including anastomotic leak and recurrent laryngeal nerve injury may be increased. Endoscopic lymph node dissection may be comparable to open surgery.

Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; adverse effects ; Lymph Node Excision ; methods ; Male ; Middle Aged ; Morbidity ; Postoperative Complications ; Retrospective Studies ; Thoracoscopy ; adverse effects ; Treatment Outcome

OBJECTIVETo compare the differences in biological behavior and clinical features between adenocarcinoma of the esophagogastric junction (AEG) and lower thoracic esophageal squamous cell cancer (LESC), and to explore reasonable procedures for each cancer.

METHODSClinical data of 111 patients with AEG and 126 patients with LESC who underwent surgery from January 2004 to April 2012 were retrospectively reviewed. Data pertaining to resection rate, lymph node metastasis, and postoperative complication rate were analyzed.

RESULTSThe resection rate was 94.6% for AEG and 97.6% for LESC, and the difference was not statistically significant (P<0.05). The rate of lymph node metastasis in the mediastinum in patients with AEG was significantly lower [6.3%(7/111) vs. 32.5%(41/126), P<0.01], while the rate of lymph node metastasis in the abdomen was significantly higher [57.7%(64/111) vs. 34.1%(43/126), P<0.01]. The rate of lymph node metastasis in mediastinum of AEG was 12.5%(4/32) for Siewert I and 4.7%(3/64) for Siewert II, and there was no lymph node metastasis in Siewert III (n=15). For AEG patients who underwent trans-abdominal surgery, the rate of positive lymph node in the middle and lower mediastinum was significantly lower than trans-thoracic surgery [0/22 vs. 7.9% (7/89), P<0.05]. LESC via right thorax with two-field or three-field lymph node dissection was associated with a significantly higher rate of positive lymph node metastasis in the upper mediastinum than that of single incision via left thorax [17.9%(12/67) vs. 0/59, P<0.01]. The postoperative complication rates were 23.4%(26/111) and 27.0%(34/126) respectively, and the difference was not statistically significant(P>0.05).

CONCLUSIONSAEG and LESC show different lymph node metastasis pattern and should be operated differently. Lymphadenectomy in mid-lower mediastinum should be emphasized in Siewert I and Siewert II type cancers.

Adenocarcinoma ; surgery ; Aged ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Esophagogastric Junction ; pathology ; surgery ; Esophagus ; pathology ; surgery ; Female ; Humans ; Lymph Node Excision ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Most patients with esophageal cancer have advanced disease at presentation. The efficacy of surgical resection alone is often unsatisfactory in patients with stage III or more advanced cancer according to the seventh edition of UICC staging system for esophageal cancer. The systematic multidisciplinary treatment is important. Mounting evidence indicates that preoperative concurrent chemoradiotherapy is the most effective induction therapy to down-stage tumor and increase radical resection rate. For the esophageal squamous cell carcinoma patients with multi-stations and multi-fields lymph node metastasis, preoperative induction chemotherapy would be a viable option. For locally advanced cancers which have been surgically resected, postoperative adjuvant radiotherapy maybe helpful to improve local control for the insufficient surgical dissection. The role of adjuvant chemotherapy also needs further studies. Thoracic esophageal squamous cell carcinoma and lower esophageal adenocarcinoma which is common in western countries are different. We need more prospective clinical studies to establish our treatment modalities for esophageal cancer.
Carcinoma, Squamous Cell ; drug therapy ; radiotherapy ; surgery ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms ; drug therapy ; radiotherapy ; surgery ; Humans ; Prospective Studies ; Radiotherapy, Adjuvant

OBJECTIVETo evaluate THE clinical significance of the 2009 UICC staging system for thoracic esophageal squamous cell carcinoma.

METHODSTwo hundred and nine patients with thoracic esophageal squamous cell carcinoma undergone selective cervico-thoraco-abdominal lymphadenectomy were reviewed retrospectively and restaged according to the new 2009 UICC staging system. The relationship between individual stages and survival were analyzed accordingly.

RESULTSThe five-year overall and cause-specific survivals were 35.0% and 38.8%, respectively. Depth of invasion (T, P = 0.004), number of metastatic lymph nodes (N, P < 0.001), distant lymph node metastasis (M, P = 0.003), complete resection (R, P = 0.005) were significantly related to postoperative survival. On the other hand, location of primary tumor (L, P = 0.743) and histological grade (G, P = 0.653) were not significantly related to long-term prognosis. Upon stratification, the 5-year survival for T4a (32.0%) was significantly better than that of T4b (0, P < 0.001), but was similar to that of T3 (28.4%, P = 0.288). Patients without nodal involvement (47.8%, P < 0.001) and those with single station nodal disease (37.5%, P < 0.001) had significantly better survival than patients having 2 or more stations of lymph node metastasis (11.3%). Also patients without nodal involvement and those with metastasis confined to a single field (34.2%) had significantly better survival than patients having nodal diseases in 2 fields (12.1%) and 3 fields (0, P < 0.001). The 5-year survival for cervical metastasis after complete resection was 20.0%. Upon multivariate analysis, depth of tumor invasion (P = 0.001, RR = 1.635), numbers of metastatic nodal stations (P = 0.043, RR = 1.540) and fields (P = 0.010, RR = 2.187) were revealed as independent risk factors for long-term survival.

CONCLUSIONSThe new UICC staging system effectively predicts long-term prognosis for thoracic esophageal squamous cell carcinoma. Depth of tumor invasion and extent of lymph node involvement are two most important prognostic factors. To improve surgical outcomes, much effort is needed to increase the accuracy of preoperative staging and to include effective induction therapies into a multidisciplinary setting.

Carcinoma, Squamous Cell ; pathology ; surgery ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Female ; Follow-Up Studies ; Humans ; International Agencies ; Lymph Node Excision ; Lymph Nodes ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Retrospective Studies ; Survival Rate

OBJECTIVETo investigate the value of the intraoperative fine-needle aspiration cytology (IFNAC) in the diagnosis of pancreatic cancer.

METHODSThe IFNAC data of 70 pancreatic cancer patients were retrospectively reviewed. IFNAC had been done in our hospital only in a few patients before 2001, however, more and more patients have been examined by renovated method since 2002. But as the way of carrying out IFNAC improved by changing from the ordinary 10 ml syringe and 22 gauge needle (0.7 mm) before 2003 to 5 ml syringe and 25 gauge skin testing needle (0.5 mm), the panreas itself is properly exposed before IFNAC, the operator at frst fixes the suspected mass with his left hand and does the puncture with his right hand. Puncturing is done while the syringe is rotated, negative pressure is being kept at the same time. The needle is withdrawn under negative pressure, 6-8 syringe are used for each patient by puncturing at 6-8 points, then smears are made with the syringes. The whole process takes 20 min to accomplish.

RESULTSThe overall positive rate was 84.3%. The positive rate of the conventional IFNAC was 66.67%, while it was increased to 95.3% following the introduction of the renovated method (P = 0.002); No complication was observed in this series.

CONCLUSIONIntraoperative fine-needle aspiration cytology using 25 gauge skin testing needle and multi-point rotating maneuver during puncturing in the diagnosis of pancreatic cancer is safe and effective with few complications.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Biopsy, Fine-Needle ; Cytodiagnosis ; False Negative Reactions ; Female ; Humans ; Intraoperative Period ; Lymph Nodes ; pathology ; Male ; Middle Aged ; Pancreas ; pathology ; surgery ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery ; Predictive Value of Tests ; Retrospective Studies

OBJECTIVETo analyze the clinical and pathologic risk factors of early recurrence in patients with pathological N1 (pN1) stage esophageal squamous cell carcinoma after radical esophagectomy.

METHODSA retrospective study was carried out on 95 consecutive pN1 stage esophageal squamous cell carcinoma patients undergoing esophagectomy with lymphadenectomy by the same surgical team from January 2004 to December 2010 was performed. The Cox proportional hazards model was used to determine the independent risk factors for recurrence and metastasis within 3 years after the operation.

RESULTSRecurrence was identified in 52 patients (54.7%) within 3 years after operation. Local recurrence was found in 42 patients (44.2%), and distant metastasis in 10 patients (10.5%). The Cox multivariate analysis showed that pT3-4a stage (RR=3.604, P=0.027), positive lymph node metastasis in two stations (RR=4.834, P=0.009) or two fields (RR=5.689, P=0.003), and postoperative adjuvant chemotherapy (RR=1.594, P=0.048) were independent risk factors for postoperative recurrence.

CONCLUSIONSPostoperative adjuvant chemotherapy can decrease the probability of postoperative recurrence and metastasis of pN1 esophageal squamous cell carcinoma. As for patients who are identified as multi-station or multi-field lymph node metastasis, preoperative induced therapy maybe further improve treatment outcomes.

Carcinoma, Squamous Cell ; drug therapy ; pathology ; surgery ; Chemotherapy, Adjuvant ; Esophageal Neoplasms ; drug therapy ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; etiology ; Postoperative Period ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors

OBJECTIVEDue to its minimal-invasive approach, endovascular procedure had replaced surgery in treating Budd-Chiari syndrome (BCS). The interventional therapy was a safe and effective treatment in adults with BCS and the cure rate was high. However Budd-Chiari syndrome in children and adolescents is rare. Published literature on interventional procedure for Budd-Chiari syndrome in children and adolescents is scarce. The aim of the study was to present results of percutaneous transluminal angioplasty (PTA) and stents placement in children and adolescents with BCS and to evaluate the efficacy and safety in these patients of this approach.

METHODTwenty-five patients [16 boys and 9 girls; average age of (14.5 ± 3.4) years old; age ranged from 5 to 17 years] with Budd-Chiari syndrome who were hospitalized from December 1990 to August 2012 were presented. All of them were diagnosed by color Doppler ultrasound scan while 12 of them had magnetic resonance venography (MRV) scan. All of the patients had undergone angiographic examination. Four cases with membranous obstruction of the inferior vena cava (IVC) were treated with PTA. One case with segmental block of IVC was treated with PTA and stent placement. Five cases with membranous obstruction of IVC and hepatic vein (/and accessory hepatic vein) were treated with PTA. Among 8 cases with membranous obstruction of hepatic veins, 6 cases were treated with PTA and the others with PTA and stent placement. Among 4 cases with blocks of 3 hepatic veins (HVs), one was treated with PTA, one with PTA plus catheter thrombolysis plus PTA, one with PTA and stent placement and the other one was unsuccessful. Three cases with obstruction of HV and accessory HV (AHV) were treated with PTA. Totally, 24 patients were treated with interventional approach and followed up.

RESULTThe procedure was successful in 24 patients. The involved veins (hepatic veins or IVC) were patented after interventional procedure. The pressure of hepatic vein was (42.1 ± 4.2) cm H2O (37-50 cm H2O) (1 cm H2O = 0.098 kPa) before the interventional therapy, while it was (17.3 ± 3.3) cm H2O (14-26 cm H2O) after it. The pressure of IVC was (30.6 ± 2.9) cm H2O (26-36 cm H2O) before the interventional therapy, while it was (18.8 ± 4.2) cm H2O (15-26 cm H2O) after it. The symptoms and signs vanished instantly after interventional procedure. There were no procedure-related complications. The rate of overall initial cure was 96%. The patients were followed up for a mean of 25.8 months (range 6 months to 8 years). Seven cases developed restenosis after first procedure. Five of them were treated with PTA, one with PTA plus catheter thrombolysis plus PTA, one with PTA and stent placement. All of the involved veins were patented again. Clinical symptoms were relieved. There were no procedure-related complications as well.

CONCLUSIONThe interventional procedure in children and adolescents with BCS is the same as in adults. Radiological therapeutic intervention is efficacious and safe in children and adolescents with BCS.

Adolescent ; Angioplasty ; Budd-Chiari Syndrome ; diagnostic imaging ; surgery ; therapy ; Catheterization, Peripheral ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hepatic Veins ; diagnostic imaging ; surgery ; Humans ; Liver ; blood supply ; diagnostic imaging ; Male ; Phlebography ; methods ; Radiography, Interventional ; Retrospective Studies ; Stents ; Thrombolytic Therapy ; Treatment Outcome ; Vena Cava, Inferior ; diagnostic imaging ; surgery ; Venous Thrombosis ; therapy

Objective To observe the effects of total enteral nutrition ( TEN) and early combined parenteral nutrition ( PEN+TEN) in patients with esophageal cancer after operation .Methods The prospective,random, controlled clinical trial was adopted.One hundred patients receiving esophageal cancer operation were randomly assigned to the TEN group (50 cases) and the PEN+TEN group(50 cases).The differences in nutritional status, inflammatory response, immune status and postop-erative complications were compared in the two groups before and after operation.Results The levels of total serum protein, albumin or retinol binding protein were higher in the PEN group than the TEN group at the 10th day after operation, respective-ly[(60.1 ±6.2)g/L vs(55.3 ±9.3)g/L,(36.4 ±4.2)g/L vs(34.6 ±1.6)g/L,(43.3 ±5.9)g/L vs(34.9 ±3.3)g/L, P<0.05] .The levels of ESR or CRP were higher in PEN +TEN group than the TEN group at the 10th day after operation, re-spectively [(54.9 ±25.8)mm/h vs(31.8 ±14.2)mm/h,(30.9 ±13.2)g/L vs(15.8 ±6.1)g/L, P<0.01] .The levels of CD3+, CD4 +, or CD8 +were higher at the 10 th day after operation than at the day before surgery in TEN group [(59.6 ±9.8)％vs(68.3 ±4.4)％,(41.7 ±7.8)％vs(46.5 ±5.5)％,(23.2 ±5.5)％vs(20.0 ±2.7)％, P<0.05], but not in PEN+TEN group.The levels of IgA or IgG were significant higher in the TEN group than the PEN +TEN group at the 10th day after operation[(1.9 ±0.5)g/L vs(1.6 ±0.3)g/L,(11.9 ±3.3)g/L vs(9.4 ±2.2)g/L, P<0.01].Con-clusion The inflammatory reaction and immune function in TEN group are better than those in PEN +TEN group.Although the nutritional status is worse in the TEN group than that in the PEN group , but the rate of postoperative complications has not increased.