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

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

OBJECTIVETo study the impact of preoperative fasting plasma glucose(FPG) on postoperative morbidity and outcome following surgical resection of esophageal squamous cell carcinoma (ESCC), and to analyze the risk factor of postoperative complication in ESCC.

METHODSClinicopathological data of 314 ESCC patients undergoing esophagectomy in our center between January 2011 and December 2012 were retrospectively collected. Patients were divided into two groups according to their preoperative FBG: normal FPG group (FPG<6.1 mmol/L, 252 cases) and high FBG group (FPG≥6.1 mmol/L, 62 cases, including 14 diabetes cases). Clinicopathological data and postoperative morbidity were analyzed and compared between two groups. Multivariate logistic regression analysis was used to evaluate risk factors for postoperative complications.

RESULTSThere were 278 male and 36 female patients with a median age of 59 years (range 42-83 years). As compared to normal FPG group, high FBG group had higher ratio of female [22.6%(14/62) vs. 8.7%(22/252), P=0.000], older median age (66 years vs. 59 years, P=0.010), lower ratio of smoking and alcohol drinking [48.4%(30/62) vs. 73.8%(186/252), 38.7%(24/62) vs. 69.0%(174/252), both P=0.000], higher ratio of comorbid diabetes and hypertension [51.6%(32/62) vs. 15.1%(38/252), 16.1%(10/62) vs. 1.6%(4/252), both P=0.000]. Pathology results showed 206 patients in normal FPG group (81.7%, 206/252) were moderate-poor differentiation, which was obviously lower than 93.5%(58/62) in high FPG group(P=0.023). Patients of two groups completed their operations successfully. Perioperative overall complication morbidity was 24.2%(76/314), and the most common was lung lesions (24 cases of pneumonia, 10 cases of respiratory failure), then was anastomotic leakage (28 cases) and incision infection (18 cases). Differences in overall and other complication morbidity were not significant between two groups (all P>0.05). Multivariate logistic regression analysis revealed that operation time was an independent risk factor of postoperative complications (P=0.047), anastomosis site was an independent risk factor of anastomotic leakage (P=0.036), and FPG was not a risk factor of postoperative complications(respectively, P=0.683, P=0.836, P=0.784, P=0.637).

CONCLUSIONSPreoperative control of FBG does not increase the postoperative complication morbidity. Shortening operation time and choosing appropriate surgical procedure are important to decrease postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking ; adverse effects ; Anastomotic Leak ; etiology ; Blood Glucose ; physiology ; Carcinoma, Squamous Cell ; complications ; surgery ; Comorbidity ; Diabetes Complications ; epidemiology ; Diabetes Mellitus ; Esophageal Neoplasms ; complications ; surgery ; Esophagectomy ; adverse effects ; Female ; Humans ; Hypertension ; complications ; Male ; Middle Aged ; Operative Time ; Pneumonia ; epidemiology ; etiology ; Postoperative Complications ; epidemiology ; Respiratory Insufficiency ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors ; Smoking ; adverse effects ; Surgical Wound Infection ; epidemiology ; Treatment Outcome

OBJECTIVETo compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma.

METHODSClinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation (Sweet group) and 287 patients of Ivor-Lewis operation(Ivor-lewis group). Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups.

RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure (20.8 vs.19.3, P=0.030). Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower[(3.2%(33/1 021) vs. 8.0%(23/287), P=0.000]. Sweet group had a significantly lower rate of delayed gastric emptying[1.9%(19/1 021) vs. 5.2%(15/287), P=0.002] and significantly shorter hospital stay (14.7 days vs. 17.2 days, P=0.029). With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group (54.0% vs. 56.9%, P=0.873). Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageI( and stageIII( patients (P>0.05), while the 5-year survival rate of stageII( patients in Sweet group was significantly lower than that in Ivor-Lewis group (56.4%% vs. 70.4%, P=0.039).

CONCLUSIONSFor patients with middle-lower esophageal squamous cell carcinoma, Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice, especially for stageI( and stageIII( patients, while it requires thorough considerations for stageII( patients.

Anastomotic Leak ; Antineoplastic Protocols ; Carcinoma, Squamous Cell ; mortality ; surgery ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; statistics & numerical data ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; statistics & numerical data ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Surgical Wound Infection ; etiology ; Survival Rate ; Treatment Outcome

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

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

PURPOSE: After esophagectomy and gastric reconstruction for esophageal cancer, patients suffer from various symptoms that can detract from quality of life. Endoscopy is a useful diagnostic tool for evaluating patients after esophagectomy. This observational study was performed to investigate the correlation between symptoms and endoscopic findings one year after esophageal surgery and to assess the clinical usefulness of one-year endoscopic follow-up. MATERIALS AND METHODS: From 2001 to 2008, 162 patients who underwent esophagectomy with gastric reconstruction were endoscopically examined one year after operation. RESULTS: Patients suffered from the following symptoms: nocturnal cough (n=10), regurgitation (n=7), cervical heartburn (n=3), lump sensation (n=2), dysphagia (n=20) and odynophagia (n=22). Eighty-five (52.5%) patients had abnormal findings on endoscopic examination. Twelve (7.4%) patients had reflux esophagitis, and 37 (22.8%) patients had an anastomotic stricture. Only stricture-related symptoms were correlated with the finding of anastomotic strictures (p<0.001). Two patients had recurrences at the anastomotic sites, and four patients had regional lymph node recurrences with gastric conduit invasion visualized by endoscopy. Newly-developed malignancies in the esophageal remnant or hypopharynx that were not detected by clinical symptoms and imaging studies were reported in two patients. CONCLUSION: One year after esophagectomy, endoscopic findings were not correlated with clinical symptoms, except those related to stricture. Routine endoscopic follow-up is a useful tool for identifying latent functional and oncological lesions.
Anastomosis, Surgical ; Carcinoma, Squamous Cell/pathology/*surgery ; Esophageal Neoplasms/pathology/*surgery ; Esophagectomy/*adverse effects ; Follow-Up Studies ; Humans ; Neoplasm Recurrence, Local/diagnosis/epidemiology ; Postoperative Complications/*diagnosis/epidemiology ; Reconstructive Surgical Procedures ; Retrospective Studies

OBJECTIVETo explore the safety and effectiveness of artificial pneumothorax in semi-prone position applied to video-assisted thoracoscopic resection of esophageal cancer.

METHODSThe clinical data of 59 patients with esophageal cancer, who underwent thoracoscopic resection of esophageal cancer during April 2010 to April 2011, were reviewed and analyzed retrospectively to evaluate the operation time, lymph node dissection and metastatic nodes, post-operative complications, and comparison of the pre- and post-operative TNM staging. There were 9 cases of the upper thoracic esophagus, 44 of the thoracic segment esophagus, and 6 of the lower thoracic segment esophagus. One case of esophageal adenocarcinoma and 1 case of esophageal small cell carcinoma were treated by 2 cycles of neoadjuvant chemotherapy. The patients were in semi-prone position, and an artificial pneunothorax was created with injection of CO2 (at a pressure of 6 - 8 mmHg) via the trocar. The entire thoracic esophagus was dissociated, mediastinal lymph nodes dissected by thoracoscopy, stomach dissociated, abdominal lymph nodes were dissected through abdominal incision, and esophagogastric anastomosis was performed.

RESULTSAmong the 59 patients, 51 patients completed the thoracoscopic surgery, and 8 were converted to thoracotomy, due to azygos arch bleeding in two cases, membranous tracheal perforation in one case, inferior vena cava bleeding in one case, bronchial artery bleeding in one case, and dense pleural adhesions in three cases. The average operation time of the thoracoscopic surgery was 220.3 (180 - 330) min, and the average operation time for the operation in the thoracic part was 96.6 (80 - 120) min. The average blood loss was 220.8 (100 - 300) ml, the postoperative chest tube was placed for 2 to 4 days (average 3.2), postoperative drainage volume was: 60 - 300 ml (201.6 ml in average) in the 1st day, 30 - 280 ml in the 2nd day, and 0 - 160 ml in the 3rd day. The length of hospital stay was 11.5 days (9 - 14 d). No mortality, anastomotic fistula, and chylothorax occurred in our patient group. One case of arrhythmia, two cases of transient hoarseness, and two cases of pulmonary infection were all improved under symptomatic treatment. The overall complication rate was 9.8% (5/51). 714 lymph nodes were dissected in the 51 patient-group, with an average 14 lymph nodes per patient, including 512 chest lymph nodes (10 on average). The pathology report showed right recurrent laryngeal nerve lymph node metastasis in 6 cases, left recurrent laryngeal nerve lymph node metastasis in 3 cases, subcarinal lymph node metastasis in 2 cases, lesion lymph node metastasis in 1 case, and esophagogastric junction lymph node metastasis in 1 case.

CONCLUSIONSVideo-assisted thoracoscopic surgery (VATS) conducted in semi-prone position combined with artificial pneumothorax for the treatment of esophageal cancer is technically feasible and safe, as effective as open thoracic surgery, not only to maintain the intact thorax, significantly lighter postoperative pain, and reduces perioperative complication, but also better wound appearance. The operation is welcomed by patients and meets the requirements of the development of esophageal surgery, and it is a quite ideal treatment of early and intermediate stage esophageal cancer.

Adenocarcinoma ; pathology ; surgery ; Aged ; Carcinoma, Small Cell ; pathology ; surgery ; Carcinoma, Squamous Cell ; pathology ; surgery ; Drainage ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Operative Time ; Pneumothorax, Artificial ; Postoperative Complications ; Prone Position ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy

Esophageal cancer is a common cancer worldwide and has a poor prognosis. The incidence of esophageal squamous cell cancer has been decreasing, whereas the incidence of esophageal adenocarcinoma has been increasing rapidly, particularly in Western men. Squamous cell cancer continues to be the major type of esophageal cancer in Asia, and the main risk factors include tobacco smoking, alcohol consumption, hot beverage drinking, and poor nutrition. In contrast, esophageal adenocarcinoma predominately affects the whites, and the risk factors include smoking, obesity, and gastroesophageal reflux disease. In addition, Asians and Caucasians may have different susceptibilities to esophageal cancer due to different heritage backgrounds. However, comparison studies between these two populations are limited and need to be addressed in the near future. Ethnic differences should be taken into account in preventive and clinical practices.
Adenocarcinoma ; ethnology ; etiology ; genetics ; Alcohol Drinking ; adverse effects ; Asia ; epidemiology ; Asian Continental Ancestry Group ; genetics ; Carcinoma, Squamous Cell ; ethnology ; etiology ; genetics ; Esophageal Neoplasms ; ethnology ; etiology ; genetics ; European Continental Ancestry Group ; genetics ; Gastroesophageal Reflux ; complications ; Genetic Predisposition to Disease ; Humans ; Incidence ; Obesity ; complications ; Polymorphism, Single Nucleotide ; Risk Factors ; Smoking ; adverse effects ; United States ; epidemiology

BACKGROUND/AIMS: The aim of this non-randomized study was to determine the role of photodynamic therapy (PDT) in a multimodal approach for the palliation of advanced esophageal carcinoma. METHODS: Twenty consecutive patients with obstructing esophageal cancer were enrolled in this study. Each subject had dysphagia, and nine could not swallow fluid. External beam radiotherapy or a self-expandable metal stent was used following PDT for dysphagia due to recurrence of the malignancy. RESULTS: At 4 weeks post-PDT, a significant improvement in the dysphagia score was observed in 90% of patients, from 2.75 +/- 0.91 to 1.05 +/- 0.83 (p < 0.05). Patients with recurrent dysphagia underwent stent insertion at an average of 63 days (range, 37 to 90). The rate of major complications was 10%. Two esophageal strictures occurred, which were treated by placement of a modified expandable stent across the stricture. The median survival in these cases was 7.0 +/- 0.6 months. One patient that was treated with PDT and radiotherapy is alive and showed a complete tumor response. CONCLUSIONS: PDT as a multimodality treatment is safe and effective for relieving malignant esophageal obstruction with minimal complications.
Adenocarcinoma/complications/mortality/*therapy ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Squamous Cell/complications/mortality/*therapy ; Deglutition Disorders/etiology/*therapy ; Esophageal Neoplasms/complications/mortality/*therapy ; Esophageal Stenosis/etiology/*therapy ; Esophagoscopy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Metals ; Middle Aged ; *Neoplasm Recurrence, Local ; Palliative Care ; *Photochemotherapy/adverse effects ; Prospective Studies ; Prosthesis Design ; Radiotherapy, Adjuvant ; Stents ; Time Factors ; Treatment Outcome