Objective To investigate the effects of different levels of intra-abdominal pressure ( IAP) on respiration and hemodynamics in a porcine model of acute lung injury( ALI) .Methods A total of 8 domestic swine received mechanical ventilation. Following baseline observations, oleic acid 0. 1mL/kg in 20mL of normal saline was infused via internal jugular vein. Using a nitrogen gas pneumoperitongum, the IAP increased from0 to 15 and 25mmHg, and the groups were named IAP0 , IAP15 and IAP25 , respectively. During the experimental period, hemodynamic parameters including heart rate ( HR) , cardiac output ( CO) , mean arterial pressure( MAP) , central venous pressure( CVP) , intrathoracic blood volume index( ITBVI) and so on were obtained by using thermodilution technique of pulse induced continuous cardiac output( PiCCO) . The esophageal pressure( Pes) was dynamicly monitored by the esophageal catheter. Results Pes and peak airway pressure( Ppeak) increased and static lung compliance( Cstat) decreased significantly in IAP15 and IAP25 groups compared with IAP0 group( all P lt;0. 01) . Transpulmonary pressure( Ptp) showed a downward trend( P gt;0. 05) . PO2 and oxygenation index showed a downward trend while PCO2 showed a upward trend ( P gt;0. 05) . HR and CVP increased significantly, cardiac index( CI) and ITBV index decreased significantly ( all P lt;0. 05) ,MAP didn′t change significantly( P gt;0. 05) . The changes in Pes were negatively correlated with the changes in CI( r = - 0. 648, P = 0. 01) . Conclusion In the porcine model of ALI, Pes increases because of a rise in IAP which decreased pulmonary compliance and CI.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.
Objective To investigate the current status of esophageal cancer surgery-related researches using bibliometric methodologies and identify the trend and hotspots. Methods The Chinese and English literature was collected from Web of Science and CNKI from inception of each database to April 1, 2022. VOSviewer 1.6.18 and CiteSpace 6.1 were applied to cluster the authors, institutions, and keywords. For social network and time series analysis, Excel, GraphPad, and R 4.0.3 were used to visualize the literature on esophageal cancer surgery. Results Finally, 19 566 English literature and 19 872 Chinese literature was included. The results demonstrated that the annual publishing of both Chinese and English literature increased over time, with English literature increasing rapidly and Chinese literature maintaining an average number of above 1 000 per year from 2011 to 2019. Researches were predominantly centered in Europe, the United States, Japan, South Korea, and China. China's researches in the field of surgical treatment in esophageal cancer lacked international collaboration, which began later than East Asian countries such as Japan and South Korea and had less influence. From the keyword perspective, previous researches on surgical treatment of esophageal cancer mostly focused on surgical techniques, complications, and comprehensive perioperative therapy. Both Chinese and English literature showed that the prevalence of keywords such as minimally invasive surgery, comprehensive treatment, and clinical trials increased dramatically during the recent years, indicating that these fields may represent the future directions and research trends. Conclusion Compared to East Asia countries, such as Japan and South Korea, Chinese esophageal cancer surgery-related researches are relatively lacking. The research direction and field are similar to those in developed countries such as the United States and Europe. Future attention may be focused on minimally invasive treatment, comprehensive treatment, and clinical trials associated with surgical treatment of esophageal cancer.
Objective To compare the short-term efficacy of Ivor-Lewis via hand-sewn purse-string approach and purse-string forceps approach in minimally invasive esophagectomy for middle and lower esophageal cancer, and to discuss the safety and feasibility of hand-sewn purse-string anastomosis technique for minimally invasive Ivor-Lewis esophagectomy (MIILE). Methods The clinical data of 151 patients undergoing thoracoscopic and laparoscopic esophageal cancer surgery from January 2014 to January 2017 in our hospital were retrospectively analyzed. According to the different methods of purse string making, the patients were divided into a purse-string forceps group including 49 males and 16 females with a mean age of 67.98±7.07 years ranging from 51 to 80 years treated with forceps to make purse-string and a handcraft group including 61 males and 25 females with a mean age of 67.76±8.18 years ranging from 52 to 83 years using hand-sewn way. The perioperative data of two two groups were compared. Results The purse-string making time and postoperative total volume of chest drainage were less in the handcraft group than those in the purse-string forceps group (P<0.05). There was no significant difference between the two groups in hemorrhage during operation, the operation duration or postoperative hospital stay (P>0.05). There was also no statistical difference between the two groups in the rate of anastomotic or gastric tube fistula, anastomotic stenosis, pulmonary infection or incision infection (P>0.05). Conclusion In minimally invasive esophagectomy for middle-lower section, MIILE by hand-sewn purse-string is as safe as purse-string forceps, with no more complications, needing no professional equipments, and easy to learn, master and promote.
ObjectiveTo analyze the risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery, and to establish a risk prediction model for early prevention and treatment.MethodsClinical data of patients undergoing esophagectomy in our hospital from January 2013 to October 2020 were retrospectively analyzed. The independent risk factors for postoperative EGAL were analyzed by univariate and multivariate logistic regression analyses, and a clinical nomogram prediction model was established. According to whether EGAL occurred after operation, the patients were divided into an anastomotic fistula group and a non-anastomotic fistula group.ResultsA total of 303 patiens were enrolled, including 267 males and 36 females with a mean age of 62.30±7.36 years. The incidence rate of postoperative EGAL was 15.2% (46/303). The multivariate logistic regression analysis showed that high blood pressure, chronic bronchitis, peptic ulcer, operation way, the number of lymph node dissected, anastomotic way, the number of intraoperative chest drainage tube, tumor location, no-supplementing albumin in the first three days after operation, postoperative pulmonary infection, postoperative use of bronchoscope were the independent risk factors for EGAL after esophageal cancer surgery (P<0.05). A prognostic nomogram model was established based on these factors with the area under the receiver operating characteristic curve of 0.954 (95%CI 0.924-0.975), indicating a high predictive value.ConclusionThe clinical prediction model based on 11 perioperative risk factors in the study has a good evaluation efficacy and can promote the early detection, diagnosis and treatment of EGAL.
ObjectiveTo investigate the value of esophageal activity examination under X-ray fluoroscopy and chest CT in evaluating the resectability of upper thoracic esophageal cancer.MethodsA total of 221 upper thoracic esophageal carcinoma patients underwent radical operation between 2009 and 2015 in our hospital were enrolled, including 141 males and 80 females with a median age of 59 (47-79) years. Preoperative routine esophageal activity examination under X-ray fluoroscopy and chest enhanced CT were performed to determine whether the tumor had external invasion. The results of the two methods were compared with that observed during the operation.ResultsThe number of patients with esophageal activity score 1-6 was 70, 85, 32, 29, 2 and 3, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) of esophageal activity examination was 0.897 (95%CI 0.85-0.93, P<0.001), and the cut off value was >3. According to the ROC curve activity score, 4-6 points were considered as invasion, and 1-3 points were non-invasion. The sensitivity, specificity, accuracy and misdiagnosis rate of esophageal activity examination was 75.0%, 89.3%, 88.2%, 10.7%, respectively, and those of CT scan were 75.0%, 66.8%, 67.4%, 33.2%, respectively. Compared with CT scan, the specificity of esophageal activity examination was higher and the misdiagnosis rate was lower. Compared with the detection during the operation, 86.7% of patients with actual invasion of trachea and 85.7% of patients with actual invasion of other parts were in accordance with the esophageal activity examination results.ConclusionEsophageal activity examination under X-ray fluoroscopy can accurately predict the resectability of upper thoracic esophageal cancer, which is a useful supplement to chest CT examination, especially in the aspect of judging the relationship between lesions and the trachea.
ObjectiveTo compare medical cost and utilization efficiency of medical resources between manual layered anastomosis with mechanical stapling technique in esophagectomy. MethodsClinical data of 132 patients who underwent surgical resection of esophageal carcinoma in the Department of Thoracic Surgery of Gansu Tumor Hospital between January and October 2011 were respectively analyzed. According to different anastomotic techniques, all the patients were divided into a manual layered anastomosis group (including 40 males and 20 females with their age of 36-72 (49.3±7.6) years) and a mechanical stapling technique group (including 50 males and 22 females with their age of 30-79 (51.0±8.6) years). Demographic data, operation data, postoperative complications, direct and indirect medical cost, and constitution of direct medical cost were compared between the 2 groups. ResultsMedical cost of esophagectomy was 14 505.03± 1 523.37 yuan in the manual layered anastomosis group and 19 891.05±1 634.58 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Material cost was 2 242.00±751.08 yuan in the manual layered anastomosis group and 5 424.00±1 876.22 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Cost-effectiveness analysis showed that cost-effectiveness ratio in the manual layered anastomosis group was lower, thus this anastomotic technique was more reasonable. ConclusionMedical cost of manual layered anastomosis is lower than that of mechanical stapling technique in esophagectomy, as the utilization efficiency of medical resources of manual layered anastomosis is higher than that of mechanical stapling technique.
ObjectiveTo investigate the influence of enteral nutrition (EN) and total parenteral nutrition (TPN) on liver, kidney and gastrointestinal function in patients after esophagectomy. MethodsA total of 124 patients with esophageal cancer who underwent esophagectomy in the Affiliated Hospital of Guangdong Medical College from January 2012 to August 2013 were enrolled in this study. There were 71 male and 53 female patients with their average age of 59.7 years (range 31 to 85 years). All the patients were randomly divided into an experimental group and a control group. Postoperatively, patients in the experimental group received EN via nasogastric/nasointestinal tube, and patients in the control group received TPN. Preoperatively, 1, 3 and 7 days postoperatively, plasma alanine transaminase (ALT), aspartate transaminase (AST), indirect bilirubin (I_BIL), direct bilirubin (DB), total bilirubin (TB), total protein (TP) and albumin (ALB) were examined to evaluate liver function, blood urea nitrogen (BUN) and serum creatinine (Scr) were examined to evaluate renal function. Postoperative time to first audible bowel sounds, time to first flatus, and time to first stool were examined to evaluate gastrointestinal function. ResultsThere was no statistical difference in ALT, AST, I_BIL, DB or TB preoperatively and on the 1st postoperative day between the 2 groups (P > 0.05), but these parameters of the experimental group were significantly lower than those of the control group on the 3rd and 7th postoperative day (P < 0.05). There was no statistical difference in TP or ALB between the 2 groups (P > 0.05). There was no statistical difference in BUN or Scr preoperatively, on the 1st or 3rd postoperative day between the 2 groups (P > 0.05). BUN (4.94±1.07 mmol/L vs. 6.67± 2.88 mmol/L, P < 0.05) and Scr (52.50±12.46 μmol/L vs. 68.23±7.61 μmol/L, P < 0.05) of the experimental group were significantly lower than those of the control group on the 7th postoperative day. Postoperative time to first audible bowel sounds (42.00±1.68 hours vs. 50.00±1.54 hours), time to first flatus (64.15±10.35 hours vs. 70.64±14.73 hours) and time to first stool (4.20±1.50 days vs. 5.20 ±1.40 days) of the experimental group were significantly shorter than those of the control group (P < 0.05). ConclusionPostoperative EN can promote the recovery of gastrointestinal function, and has less influence on liver and kidney function, which is beneficial to postoperative recovery and morbidity reduction after esophagectomy.
Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.