ObjectiveTo investigate the predictive value of prognostic nutritional index (PNI) in complications after thoracoscopy-assisted radical resection of esophageal cancer.MethodsWe collected the clinical data of patients who underwent thoracoscopy-assisted esophagectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2020. The predictive value of PNI for postoperative complications was evaluated by establishing receiver operating characteristic (ROC) curve and the optimal cut-off point was determined. The patients were divided into a high PNI group and a low PNI group according to the cut-off point. The differences of baseline data and perioperative complications-related indicators between the two groups were compared and analyzed. Univariate and multivariate analyses were used to investigate the influence of PNI and other related indexes on postoperative complications.ResultsA total of 116 patients were enrolled in this study, including 75 males and 41 females, aged 65 (58-69) years. The area under ROC curve was 0.647, and the optimal cut-off point was 51.9. According to the cut-off point, there were 45 patients in the high PNI group and 71 patients in the low PNI group. The overall complication rate (χ2=10.437, P=0.001) and the incidence of postoperative pulmonary infection (χ2=10.811, P=0.001) were statistically different between the two groups. The results of univariate analysis showed that the duration of ventilator use (Z=–3.136, P=0.002), serum albumin value (t=2.961, P=0.004), and PNI value (χ2=10.437, P=0.001) were the possible risk factors for postoperative complications after thoracoscopy-assisted esophagectomy. The results of multivariate analysis suggested that the duration of ventilator use (OR=1.015, P=0.002) and the history of drinking (OR=5.231, P=0.013) were independent risk factors for postoperative complications, and high PNI was the protective factor for postoperative complications (OR=0.243, P=0.047).ConclusionPNI index has a certain value in predicting postoperative complications, which can quantify the preoperative nutritional and immune status of patients. Drinking history and duration of ventilator use are independent risk factors for postoperative complications of thoracoscopy-assisted esophagectomy, and high PNI is a protective factor for postoperative complications.
Objective To determine if laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising enables better perioperative and medium-term outcome than Ivor-Lewis cervical stapled esophagogastrostomy via thorax for middle esophageal carcinoma without intumescent lymphnode of neck. Methods The perioperative and medium-term outcome of a series of 55 patients underwent Ivor-Lewis cervical stapled esophagogas-trostomy via thorax between April 2010 and December 2012 were as a historic cohort (group A, 36 males, 19 females at age of 65±8 years). And 46 patients underwent laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising between January 2013 and March 2015 were as a prospective cohort (group B, 31males, 15 females at age of 66±7 years). Perioperative indexes, lymphadenectomy, and result at end of one year following up were compared. Results Compared with group A, there was shorter thoracic operation time (t=5.94, P < 0.05), shorter time of restored anus exhaust (t=2.08, P < 0.05), less pulmonary complication (χ2=3.08, P < 0.05) and less total perioperative complications (χ2=4.30, P < 0.05), shorter postoperative hospital stay (t=3.20, P < 0.05) in the group B. While no statistically significant difference was found between the two group in postoperative morbidity of circulation or digestive and associated with surgical techniques (all P>0.05), lymph node metastasis rate of cervico-thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.03, 0.15, 0.08, all P>0.05), lymph node ratio (LNR) of cervical thoracic (include cervical paraesophageal) or mediastinum or abdominal cavity (χ2=0.01,0.71, 0.01, all P>0.05), recurrence rate of tumour (χ2=0.04, P>0.05), or survival rate (χ2=0.13, P>0.05) one year after the surgery. Conclusion Laparoscopic assisted Ivor-Lewis cervical stapled esophagogastrostomy via a minor subaxillary incising is a more rational surgery of cervicothoracic and cervical paraesophageal lymph nodes dissection via intrathoracic instead of cervical approach for middle esophageal carcinoma.
Objective To investigate the feasibility, safety, and short-term efficacy of minimally invasive McKeown esophagectomy (MIME) in patients with locally advanced thoracic esophageal squamous cell carcinoma (TESCC) after neoadjuvant immunotherapy. Methods The clinical data of the patients with locally advanced TESCC in the First Affiliated Hospital of University of Science and Technology of China from July 2022 to March 2023 were restrospectively analyzed. They were divided into a neoadjuvant immunotherapy (NI) group and a non-neoadjuvant immunotherapy (NNI) group according to different preoperative neoadjuvant therapy. The perioperative clinical data and 3-month follow-up data were compared between the two groups. Results A total of 47 patients were collected, including 31 males and 16 females with a mean age of (67.57±7.64) years. There were 29 patients in the NI group and 18 patients in the NNI group. There were no statistical differences in baseline data, perioperative complications, short-term complications, surgical time, intraoperative bleeding, postoperative adjuvant therapy, metastasis/recurrence within 3 months, R0 resection rate, postoperative pathological staging decline, or College of American Pathologists (CAP) tumor regression grade between the two groups (P＞0.05). Conclusion Neoadjuvant immunotherapy combined with minimally invasive McKeown esophagectomy can be safely and effectively performed for patients with locally advanced TESCC without increasing operation time, intraoperative blood loss and perioperative complications.
ObjectiveTo explore the effect of body mass index (BMI) on therapeutic effect and surgical risk of esophagectomy. MethodsWe retrospectively collected the data of 494 patients who underwent esophagectomy in West China hospital of Sichuan University between March 2014 and March 2015. According to BMI, all patients were allocated to three groups: an obesity group (BMI≥25 kg/m2) of 74 patients, a normal weight group (18.5 kg/m2≤BMI < 25 kg/m2) of 345 patients, and a low weight group (BMI < 18.5 kg/m2) of 75 patients. ResultsThere were no statistical differences in the intraoperative blood loss (213.33±55.10 ml vs. 218.90±60.76 ml vs. 217.30±61.10 ml), operation time (197.07±52.47 min vs. 208.35±96.84 min vs. 182.84±63.06 min), incidence of postoperative complication (38.7% (29/75) vs. 43.2% (149/345) vs. 39.2% (29/74), the number of resected lymphnodes (l16.18±6.64 vs. 16.68 ±8.48 vs. 8.48±8.26), and the number of the metastatic lymphnodes (1.42±2.53 vs. 1.32±2.51 vs. 2.45±4.08) among the low weight group, the normal weight group, and the obesity group. ConclusionObesity and low weight do not increase the surgical risk and influence the surgical outcome. Therefore, obesity and low weight should not interfere with the operative choice of patients with esophageal cancer.
目的探讨残胃代食管治疗胃大部切除术后食管癌的手术方法及效果 方法回顾分析我院1996年2月至2012年7月手术治疗14例胃大部切除术后食管癌患者的临床资料。其中男13例，女1例，年龄57.2（49～65）岁；5例行弓上吻合，9例行弓下吻合。 结果手术时间（2.3+0.4）h，术中失血量（270.0+60.0）ml；术后禁饮食时间（7.3+1.8）d，住院时间（13.7+3.1）d，无吻合口瘘和围术期死亡；术后并发症发生率为28.57%（4/14），以肺部炎症和心律失常为主。术后1年、3年和5年生存率分别为85.7%、50.0%和21.4%。 结论残胃代食管，将残胃连同脾脏、胰尾移至胸腔，行食管残胃吻合术，适用于治疗胃大部切除术后中下段食管癌，具有一定的优越性。
Objective To explore the feasibility，safety and clinical applicability of combined complete thoracoscopicand laparoscopic esophagectomy for the treatment of esophageal carcinoma. Methods Clinical data of 34 patients with esophageal carcinoma who underwent combined complete thoracoscopic and laparoscopic esophagectomy in the Departmentof Thoracic Surgery of our hospital from January 2012 to June 2013 were analyzed retrospectively. There were 33 males and1 female with their age of 63 （41-76） years. Results One patient received conversion to laparotomy and 1 patient diedpostoperatively. Mean operation time was 362.1 （300-560） minutes，including 90.6 （60-220） minutes for thoracoscopicprocedure in 34 patients and 61.1 （45-85） minutes for laparoscopic procedure in 33 patients. Mean intraoperative blood loss was 206.5 （100-500） ml. Average number of dissected lymph nodes was 18.0 （13-31） for each patient with positivemetastatic rate of 44.1% （15/34）. Postoperative pathological diagnosis was squamous cell carcinoma in 33 patients and smallcell carcinoma in 1 patient. Postoperative pathological staging was stageⅠB in 1 patient，stageⅡA in 1 patient，stageⅡB in 15 patients，stageⅢA in 11 patients，stageⅢB in 3 patients and stageⅢC in 3 patients. Postoperative hospital stay was 15.2 （6-35） days. Two patients received bedside bronchoscopic sputum suction. Postoperative complications occurred in32.4% （11/34） of all patients，including pulmonary infection in 4 patients （11.8%），respiratory failure in 2 patients （5.9%），chylothorax in 1 patient （2.9%），cervical anastomotic leak in 4 patients （11.8%） and hoarseness in 2 patients （5.9%）. We followed up 33 patients for 1-16 months. Two died，Two were lost. The other 29 patients survived. Conclusion Combined complete thoracoscopic and laparoscopic esophagectomy is a minimally invasive，feasible and safe surgical procedure for the treatment of esophageal carcinoma with quick postoperative recovery，and is worthy of furtherclinical application.