Background The desirability of supraclavicular lymph node (LN) dissection, which is the cervical part of three-field LN dissection, has been discussed for a long time. In this study, we examine the ...pattern of supraclavicular LN metastasis in esophageal cancer, with a particular focus on the correlation between recurrent laryngeal nerve (RLN) LN and supraclavicular LN metastasis. Methods In all, 220 cases of R0 resected T1 to T3 squamous cell carcinomas were retrospectively examined. All of these patients underwent bilateral RLN LNs dissection; none received cancer treatment before surgery. Results Of 21 upper esophageal cancer cases, 33.3% of the patients had metastasis in the supraclavicular LN. Every patient in whom supraclavicular LN metastasis developed had metastasis in the RLN LN. Of 141 cases of middle esophageal cancer, 19.1% had metastasis in the supraclavicular LN. Among the patients whose RLN LN metastasized, 38.3% had metastasis in the supraclavicular LN. A similar correlation between RLN LN and supraclavicular LN metastasis was observed in lower esophageal cancer cases, especially in T3 cases. When considering cancers of the esophagus and patients who had metastasis in the supraclavicular LN, our data demonstrated that RLN LN metastasis did not always lead to metastasis on the same side of the supraclavicular LN. Conclusions The status of the RLN LN can be an indicator of supraclavicular LN dissection in upper esophageal cancer patients and advanced cases of middle and lower esophageal cancer patients. Bilateral supraclavicular LN dissection should be recommended even when only unilateral RLN LN metastasis occurs.
Recently, with the advances in diagnostic and therapeutic endoscopic techniques, there have been increasing reports of iatrogenic gastrointestinal perforation. The mortality rate of esophageal ...perforations is especially high, therefore, appropriate diagnosis and treatment are important, just as in cases of spontaneous esophageal rupture. We report a case of iatrogenic esophageal rupture during a hemostatic procedure for bleeding esophageal varices in a patient with liver cirrhosis, which was successfully treated by prompt surgical treatment, T-tube-based external drainage, and enteral nutrition. Attending surgeons may hesitate to opt for surgical treatment due to the high mortality and postsurgical complication rates in cases with cirrhosis of the liver, however, early surgical intervention before worsening of the patient's general condition may yield a favorable outcome.
Background
Prone thoracoscopic esophagectomy was introduced at our institution from 2012. This study describes our experiences of the main differences between thoracoscopic esophagectomy in the prone ...and traditional left lateral decubitus positions together with an analysis of the short-term surgical outcomes.
Method
In total, 87 patients undergoing thoracoscopic esophagectomy between January 2012 and October 2013 at Tohoku University Hospital were enrolled; of these, 54 and 33 patients were operated in the prone (Group P) and lateral decubitus (Group L) positions, respectively.
Results
The background of the patients was similar, and there was no in-hospital mortality. There were no significant differences between the groups in terms of whole surgical duration, thoracic duration, and number of dissected lymph nodes. Total blood loss and thoracic estimated blood loss were significantly lower in Group P than Group L. Furthermore, postoperative pulmonary complications, intensive care unit stay, and hospital stay were significantly lower in Group P.
Conclusion
Thoracoscopic esophagectomy in the prone position is feasible and safe. The prone position technique may be superior to conventional lateral decubitus position esophagectomy.
Background
Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence ...for cervical ESCC to preserve the larynx. Our department recently introduced dCRT concomitant with docetaxel, cisplatin, and 5-fluorouracil (DCF-R) for treating advanced cervical ESCC. This study aims to assess the safety and outcomes of DCF-R in patients with advanced cervical ESCC.
Methods
We retrospectively assessed 11 patients with advanced cervical ESCC (clinical stage: II–IV, including T4b and/or M1 lymph node) who received DCF-R as the first-line treatment between December 2010 and February 2015.
Results
Our patient cohort comprised 8 males and 3 females (median age 68 years; range 54–76 years). The pretreatment clinical stage included stage II (1), stage III (7), and stage IV (3) cases including 3 patients with T4b (2 trachea and 1 thyroid) and 3 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 1 patient. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Furthermore, grade 3 or more adverse events included leucopenia (91%), neutropenia (91%), febrile neutropenia (45%), and pharyngeal pain (55%). While the 2-year overall survival rate was 72%, the 2-year recurrent-free survival rate was 64%, respectively.
Conclusions
DCF-R treatment for advanced cervical esophageal cancer could be completed by the careful administration; although a strong blood toxicity might occur, this treatment may provide the chance to obtain favorable prognosis with larynx preservation.
Background
Evolution of thoracic endovascular aortic repair (TEVAR) appears to have influenced the pathogenesis and treatment strategy for aortoesophageal fistula (AEF). The purposes of this study ...are to evaluate our current surgical strategy for AEF and to provide insight to further improve the prognosis of such a devastating condition.
Methods and results
Between 2005 and 2013, we retrospectively reviewed the clinical charts of 10 patients requiring surgical treatment for AEF in Tohoku University Hospital. Four cases were primary and 6 were secondary. Initially, bridging TEVAR to control bleeding with concomitant subtotal esophagectomy and complete debridement of infected mediastinal tissue was performed. After a short interval, the patients underwent in situ aortic replacement with cryopreserved homografts or rifampicin-bonded Dacron grafts with omentopexy. Esophageal reconstruction was planned following general physical status improvement after 3–6 months. In-hospital mortality in the acute phase was 30 %. Although the completion of the staged strategy achieving successful esophageal reconstruction was possible in 5 patients, no local relapses of infection were observed in these patients. Overall survival at 1 and 5 year were 68.6 and 42.9 %, respectively.
Conclusions
The staged surgical treatment strategy for AEF consisted of prompt TEVAR to control bleeding with concomitant subtotal esophagectomy and subsequent in situ reconstruction of the aorta with an aortic homograft. This procedure enabled us to control local mediastinal infection with acceptable mortality. Avoiding delay in the diagnosis and initial treatment and resolving complications at each treatment step should further improve AEF treatment.
CD133 was recently reported to be a cancer stem cell marker and a prognostic marker for several tumors. However, few studies have investigated CD133 expression in esophageal squamous cell carcinoma ...(ESCC). Therefore, we examined whether CD133 could serve as a prognostic marker of ESCC and investigated the correlation between CD133 expression and the clinicopathological findings of ESCC patients and several markers.
We studied 86 ESCC patients who underwent curative surgery without neoadjuvant treatment at Tohoku University Hospital (Sendai, Japan) between January 2000 and December 2005. We analyzed tissue specimens by immunohistochemical staining for CD133, p53, p16, p27, murine double minute 2 (MDM2), Ki-67, and epidermal growth factor receptor (EGFR).
Pathological tumor depth and tumor stage were significantly more advanced among CD133-negative patients than among CD133-positive patients. A log-rank test showed that CD133 immunoreactivity was significantly correlated with the overall survival of the patients (P = 0.049). However, multivariate analysis showed that it was not significantly correlated (P = 0.078). Moreover, CD133 was significantly positively correlated with p27 immunoreactivity (P = 0.0013) and tended to be positively correlated with p16 immunoreactivity (P = 0.057). In addition, p16 immunoreactivity was correlated with smoking history (P = 0.018), pathological lymph node status (P = 0.033), and lymphatic invasion (P = 0.018).
This study indicated that CD133 immunoreactivity is a good predictor of prognosis in ESCC patients. In addition, CD133 may play a role in the regulation of tumor cell cycle through p27 and p16 in ESCC. At present, it thus remains controversial whether CD133 expression is a valid prognostic marker for ESCC. To elucidate this relationship, further investigations are required.
Poorly differentiated thyroid carcinoma (PDTC) is a newly recognized histological type of malignant thyroid tumor, accounting for about 2 - 13% of all thyroid carcinomas. PDTC is considered as a ...morphologically and biologically intermediate stage between well-differentiated thyroid carcinoma and anaplastic thyroid carcinoma. PDTC preferentially manifests bone metastases. We here established a cell line from a resected tumor specimen from a 70-year-old male patient with PDTC who presented with multiple bone metastases. This new thyroid tumor cell line was designated as DH-14-3 and was subsequently grown in culture for several years. DH-14-3 cells express thyroglobulin in the cytoplasm and thyroid transcription factor-1 in the nuclei, both proteins of which are specific markers for the thyroid gland. Importantly, triiodothyronine (T3) was detected in the cultured medium of DH-14-3 cells, in which, however, thyroxine (T4) was undetectable. Moreover, DH-14-3 cells secreted interleukin-8, transforming growth factor-β1, vascular endothelial growth factor, matrix metalloproteinase-1 and parathyroid hormone-related protein, all of which may be responsible for the aggressiveness or bone metastasis of PDTC. Thus, the production of these proteins may reflect the metastatic potential of this cell line. DH-14-3 cells also express CXC chemokine receptor-4 and epidermal growth factor receptor, and carry a missense mutation in the p53 tumor suppressor gene. In fact, transplantation of DH-14-3 cells into the back of nude mice resulted in the formation of tumors, thereby confirming the capability of tumorigenesis. DH-14-3 cells may be useful for investigating the biological features of PDTC and will contribute to the therapeutic study of thyroid cancer.
Purpose
To compare the surgical outcomes of ileostomy vs. transverse colostomy and investigate which is more suitable for a diverting stoma.
Methods
We assessed stoma-related complications and ...surgical outcomes, retrospectively, for 146 patients who underwent laparoscopic colorectal surgery with a temporary loop ileostomy or transverse colostomy. Complications after secondary stoma closure surgery were also analyzed.
Results
After the primary surgery, the incidence of prolapse was significantly higher in the transverse colostomy group, whereas high-output stoma and skin irritation were seen more frequently in the ileostomy group. The median interval to stoma closure was shorter in the ileostomy group than in the transverse colostomy group (144 vs. 196 days). After secondary closure surgery, the incidence of wound infection was significantly higher in the transverse colostomy group than in the ileostomy group. None of the patients in the ileostomy group had severe complications. The median postoperative hospital stay was significantly shorter in the ileostomy group than in the transverse colostomy group (10 vs. 13 days).
Conclusions
The findings of this study suggest that ileostomy should be the procedure of choice for short-term temporary diverting stoma, but that transverse colostomy is more appropriate for patients who require a long-term or permanent stoma.
A 60-year-old man diagnosed with esophageal cancer of the lower thoracic esophagus was referred for curative operation. Thoracoscopic esophagectomy with two-field lymph node dissection was performed ...without neoadjuvant therapy. Histopathological findings revealed three different components of carcinoma in the same tumor specimen: basaloid, adenocarcinomatous and squamous components. These different components of the tumor histological subtypes existed separately with clear borderline, but the histological transition among these components was partially appreciated. All of components were associated with different patterns in immunohistochemistry. The patient was well without recurrence 24 months after operation. It is well known that esophageal carcinoma have histological variety and variant types of esophageal carcinoma frequently colocalized with squamous component. However, the presence of three components which occupied the same proportion of the lesion in the superficial carcinoma has not been reported to the best of our knowledge. We finally interpreted this tumor as a composite tumor arising from squamous epithelium and differentiated into three different histologic phenotypes. Because of the various morphological features of esophageal carcinoma, detailed histopathological analysis of surgical specimens plays pivotal roles in obtaining their clinicopathological features.
An aberrant right subclavian artery (ARSA) is an anatomical abnormality that occurs at a frequency of 0.4–2 %. It is important to be aware of this abnormality when performing radical esophagectomy ...for esophageal cancer because many patients with an ARSA have a right nonrecurrent inferior laryngeal nerve (NRILN) and right thoracic duct. We report three cases of esophageal cancer with ARSA treated by thoracoscopic esophagectomy. Case 1 was a 59-year-old woman with a relapse of a thoracic esophageal cancer after definitive chemoradiotherapy (CRT). Case 2 was a 76-year-old man with upper thoracic esophageal cancer who had received no treatment before the surgery. Case 3 was a 69-year-old man with upper thoracic esophageal cancer pretreated with neoadjuvant CRT. It was possible to predict an ARSA by computed tomography and the right thoracic ducts by magnetic resonance imaging before surgery in all three cases. Thoracoscopic esophagectomy with two-field lymph node dissection was performed, and the NRILN and the right thoracic duct were detected and preserved in all three cases. Because of ARSA, the operative field is limited around the left recurrent nerve, so a careful procedure is needed to avoid nerve palsy.
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