The informatization construction in medical field not only brings convenience to clinical doctors, but also creates huge data for clinical research. Taking the application of information technology in thoracic surgery as an example, we decide to talk about the establishment and application of esophageal cancer database based on standardized and structured electronic medical records. The aim, through the construction of database, is to improve clinical doctors’ management ability of esophageal cancer, to provide reference of the information construction to medical colleagues, and to promote the application of information in medicine.
ObjectiveTo explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.MethodsSeventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups.ResultsThere were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05).ConclusionIt is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. ResultsThe incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.
Esophageal cancer is an aggressive malignancy with high morbidity and poor prognosis. Symptoms of early esophageal cancer are insidious and difficult to detect, while advanced esophageal obstruction, lesion infiltration and metastasis seriously affect patients’ quality of life. Early detection and treatment can help to increase the survival chance of patients. Recently, artificial intelligence (AI) has shown remarkable success in diagnosis of esophageal cancer, highlighting the great potential of new AI-assisted diagnostic modalities. This paper aims to review recent progress of AI in the diagnosis of esophageal cancer and to prospect its clinical application.
ObjectiveTo investigate the effect of jejunostomy combined with Ivor-Lewis or McKeown operation on the treatment of middle and lower esophageal cancer.MethodsThe clinical data of 127 patients with middle and lower esophageal cancer admitted to our hospital from June 2018 to October 2019 were retrospectively analyzed, including 89 males and 38 females, aged 62.82±8.65 years. The patients were divided into an Ivor-Lewis group (IL group, 72 patients) and a McKeown group (MK group, 55 patients) according to surgical methods. Patients in the IL group received jejunostomy combined with Ivor-Lewis operation, and patients in the MK group received jejunostomy combined with McKeown operation. The operation time, postoperative bedside electrical impedance tomography (EIT) parameters, postoperative inflammatory factor levels, postoperative complications and rehabilitation of the two groups were compared.ResultsThe operation time (262.65±49.78 min vs. 303.04±60.13 min), postoperative eating time (10.54±2.22 d vs. 11.47±2.49 d) and postoperative hospital stay (14.78±2.47 d vs.15.72±2.36 d) in the IL group were significantly shorter than those in the MK group (P<0.05). The blood loss (156.13±52.43 mL vs. 158.87±48.47 mL) and the number of lymph node dissection (29.47±8.88 vs. 30.17±9.80) in the IL group were less than those in the MK group, but the differences were not statistically significant (P>0.05). The repeated measurement analysis of variance showed that the time point could significantly affect tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-8 levels (Ftime point=520.543, 272.379, 147.688, all P<0.05), but the surgical methods and the interactive effect of time point and surgical methods did not affect the levels of TNF-α, IL-6 and IL-8 (P>0.05). Postoperative bedside EIT image parameters were statistically different on the postoperative 1 d, 3 d, 5 d and 7 d between the two groups (P<0.05). Compared with the MK group, the incidences of recurrent laryngeal nerve injury, arrhythmia, pulmonary infection and atelectasis, anastomotic leakage, gastric wall necrosis and stump fistula, secondary thoracotomy and abdominal hemostasis, and intestinal obstruction were lower, but the differences were not statistically different (P>0.05). The recurrence rate of patients in the IL group within 6 months was lower than that in the MK group, but the difference was not statistically significant (8.33% vs. 9.09%, P>0.05).ConclusionJejunostomy combined with Ivor-Lewis or McKeown surgery have equivalent effects on patients with middle and lower esophageal cancer.
Objective To systematically evaluate the accuracy of endoscopy-based artificial intelligence (AI)-assisted diagnostic systems in the diagnosis of early-stage esophageal cancer and provide a scientific basis for its diagnostic value. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database were searched by computer to search for the relevant literature about endoscopy-based AI-assisted diagnostic systems for the diagnosis of early esophageal cancer from inception to March 2022. The QUADAS-2 was used for quality evaluation of included studies. Meta-analysis of the literature was carried out using Stata 16, Meta-Disc 1.4 and RevMan 5.4 softwares. A bivariate mixed effects regression model was utilized to calculate the combined diagnostic efficacy of the AI-assisted system and meta-regression analysis was conducted to explore the sources of heterogeneity. ResultsA total of 17 articles were included, which consisted of 13 retrospective cohort studies and 4 prospective cohort studies. The results of the quality evaluation using QUADAS-2 showed that all included literature was of high quality. The obtained meta-analysis results revealed that the AI-assisted system in the diagnosis of esophageal cancer presented a combined sensitivity of 0.94 (95%CI 0.91 to 0.96), a specificity of 0.85 (95%CI 0.74 to 0.92), a positive likelihood ratio of 6.28 (95%CI 3.48 to 11.33), a negative likelihood ratio of 0.07 (95%CI 0.05 to 0.11), a diagnostic odds ratio of 89 (95%CI 38 to 208) and an area under the curve of 0.96 (95%CI 0.94 to 0.98). ConclusionThe AI-assisted diagnostic system has a high diagnostic value for early stage esophageal cancer. However, most of the included studies were retrospective. Therefore, further high-quality prospective studies are needed for validation.
Objective To compare the outcome of tubular stomach and cervical esophagus laminated anastomosis and mechanical anastomosis. Methods A total of 128 patients with middle and upper esophageal cancer in our hospital from January 2013 to January 2016 were randomly divided into two groups, 64 patients in each group and all patients underwent esophagectomy. In the group A, there were 46 males and 18 females with age of 40–75 years, treated with tubular stomach and cervical esophagus layered anastomosis. There were 51 males and 13 females with age of 43–71 years in the group B receiving mechanical anastomosis. We observed the short-term and long-term efficacy as well as complications. Results In the group A, there was cervical anastomotic fistula in 1 patient, anastomotic stenosis in 2 patients and reflux esophagitis in 12 patients. In the group B, 1 patient suffered chylothorax, 8 patients cervical anastomotic fistula, 4 patients anastomotic stenosis and 14 patients reflux esophagitis. Conclusion Layered anastomosis can effectively reduce the incidence of anastomotic fistula and stenosis. Tubular stomach can effectively prevent and reduce the reflux esophagitis, and the high long-term quality of life will be achieved after the operation.
The incidence and mortality of esophageal cancer are high, with strong invasiveness and poor prognosis. In China, the number of morbidity and death accounts for about half of the world. The cause of the disease has not yet been clarified, and it is known to be related to many factors such as chronic damage to the upper digestive tract caused by poor diet and lifestyle, heredity and environment. With the continuous advancement of molecular biology technology, metagenomics and high-throughput sequencing began to be used as non-culture methods instead of traditional culture methods for micro-ecological analysis, and is becoming a research hotspot. Many studies have shown that the disturbance of upper digestive tract microecology may be one of the causes of esophageal cancer, which affects the occurrence and development of esophageal cancer through complex interactions with the body and various mechanisms. This paper reviews the research progress, which is of great significance to further clarify the value of upper gastrointestinal microecology in the pathogenesis, diagnosis and treatment of esophageal cancer.
[Abstract]Currently, there is no high-level evidence to support the benefit of postoperative adjuvant therapy for patients with resectable esophageal squamous carcinoma. By reviewing existing studies, this article analyzes the role of postoperative adjuvant therapy in resectable esophageal squamous carcinoma from four aspects, namely, the contradiction between the needs of clinical practice and the guidelines, the evolution of postoperative adjuvant therapy, the progress of the research on high-risk factors, and the outlook for the future, and elaborates on the high-risk factors that can be used as screening for postoperative adjuvant therapy. Thus, it provides reference for individualized and precise treatment of resectable esophageal squamous carcinoma.
Objective To systematically review the prognostic significance of extranodal extension in gastric cancer, esophageal cancer and gastroesophageal junction cancer. Methods We searched EMbase, The Cochrane Library (Issue 9, 2016), PubMed, CBM, CNKI, VIP and WanFang Data databases from inception to August 2016, to collect cohort studies about the prognostic significance of extranodal extension. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. Results A total of 16 studies involving 9 445 participants were included. The results of meta-analysis showed that for gastric cancer patients, the overall survival (OS) (HR=1.71, 95%CI 1.49 to 2.00,P<0.000 01), disease free survival (DFS) (HR=1.39, 95%CI 1.12 to 1.73,P=0.003) and cancer specific survival (HR=1.52, 95%CI 1.18 to 1.96,P=0.001) in ENE(+) group were lower than ENE(–) group. For esophageal cancer and gastroesophageal junction cancer patients, the overall survival (OS) (HR=1.84, 95%CI 1.49 to 2.27,P<0.000 01), disease free survival (DFS) (HR=2.18, 95%CI 1.70 to 2.81,P<0.000 01) and cancer specific survival (HR=1.73, 95%CI 1.19 to 2.52,P=0.004) in ENE(+) group were lower than ENE(–) group. Conclusion Current evidence indicates that ENE(+) was correlated with a poor prognosis in gastric cancer, esophageal cancer and gastroesophageal junction cancer patients. Due to the quantity and quality limitations of included studies, more high quality cohort studies are needed to verify the above conclusions.