Objective To determine the effects of different anesthetic techniques on T-lymphocyte subsets in patients with esophageal carcinoma. Methods Forty patients were randomly assigned into general anesthesia group (group Ⅰ),or combined generae anesthesia with epidural anesthesia group(group Ⅱ). Peripheral blood CD3, CD4,CD8 were measured before induction ( T1 ), after anesthesia ( T2 ), end of operation ( T3 ), 1d ( T4 ), 3d ( T5 ) after surgery. Resolts CD3,CD4,CD8,CD4/CD8 decreased at T2 in the two groups. In group Ⅱ ,CD3,CD4,CD8,CD4/CD8 ratio almost returned to the baseline values at T4 ,while group Ⅰ did not. Conclusion Epidural anesthesia combined with general anesthesia can reduce depression of T-lymphocyte subsets induced by surgical trauma and anesthesia, and is the anesthetic tecnique of choice for cancer patients undergoing major operation.

OBJECTIVETo identify the risk factors of benign cervical anastomotic strictures after esophagectomy.

METHODSClinical data of 946 esophageal cancer patients undergoing esophagectomy with cervical anastomosis between 2003 and 2012 were analyzed retrospectively. Benign stricture was defined as dysphagia for which endoscopic dilation of the anastomosis was needed. Histologically proven malignant stricture was not regarded as benign stricture. χ(2) test and logistic regression model were used for univariate and multivariate analysis respectively.

RESULTSA total of 146 patients(16.5%) developed benign stricture during follow-up. Univariate analysis showed that the patients with cardiovascular disease (P=0.001), diabetes mellitus(P=0.041), gastric tube reconstruction(P=0.050), end-to-end anastomosis (P=0.013), or postoperative anastomotic leakage(P=0.008) had higher stricture rate. Multivariate analysis revealed that cardiovascular disease(P=0.004), gastric tube reconstruction (P=0.026), end-to-end anastomosis(P=0.043), and postoperative anastomotic leakage(P=0.001) were independently predictive factors for development of benign stricture.

CONCLUSIONSThe benign cervical stricture rate after esophagetomy with cervical gastric anastomosis is quite high. In order to prevent benign stricture formation, end-to-end anastomosis should be avoid. Blood pressure should be controlled for those with cardiovascular disease. Endoscopic dilation in an earlier stage postoperatively should be considered for those who develop anastomotic leakage.

Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; Constriction, Pathologic ; etiology ; Deglutition Disorders ; etiology ; Esophageal Neoplasms ; complications ; surgery ; Esophageal Stenosis ; etiology ; Esophagectomy ; adverse effects ; Follow-Up Studies ; Humans ; Postoperative Complications ; etiology ; Reconstructive Surgical Procedures ; adverse effects ; Retrospective Studies ; Risk Factors