Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh ...repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.
Background
Because esophageal carcinosarcoma (ECS) is rare, a treatment strategy similar to that employed in esophageal cancer is usually applied. However, the clinicopathological features and the ...treatment effects of preoperative chemotherapy or chemoradiotherapy (CT/CRT) are not well known.
Methods
We retrospectively evaluated clinical and pathological characteristics of consecutive patients with pathologically confirmed ECS who underwent esophagectomy from 1996 to 2011 in our institution, and assessed their pathological response to preoperative CT/CRT in surgically resected specimens.
Results
We identified 19 patients with a final diagnosis of ECS who had then undergone curative surgery. In 6 of these, the preoperative pathological diagnosis by biopsy had been squamous cell carcinoma. In 7 of 13 patients treated by surgery alone, clinical T factors were overdiagnosed compared with pathological findings. Of patients who received preoperative CT (5-fluorouracil plus cisplatin) with (
n
= 2) and without (
n
= 4) concurrent RT (41.4–50.4 Gy), two had a partial response, in three, the disease remained stable, and one patient had progressive disease. Histopathological evaluation showed a limited pathological response in the sarcomatous component. Median overall survival of patients with and without preoperative treatment was 28.0 and 47.2 months, respectively HR = 1.55 (95% CI 0.36–6.56), and median relapse free survival was 13.4 months versus not achieved HR = 2.06 (95% CI 0.54–7.76).
Conclusion
The problems associated with clinical T stage diagnosis as well as the lack of evidence for an effect of preoperative treatment, especially on the sarcomatous component, mean that treatment strategies for ECS should be considered with care.
Surgical samples have long been used as important subjects for cancer research. In accordance with an increase of neoadjuvant therapy, biopsy samples have recently become imperative for cancer ...transcriptome. On the other hand, both biopsy and surgical samples are available for expression profiling for predicting clinical outcome by adjuvant therapy; however, it is still unclear whether surgical sample expression profiles are useful for prediction via biopsy samples, because little has been done about comparative gene expression profiling between the two kinds of samples.
A total of 166 samples (77 biopsy and 89 surgical) of normal and malignant lesions of the esophagus were analyzed by microarrays. Gene expression profiles were compared between biopsy and surgical samples. Artificially induced epithelial-mesenchymal transition (aiEMT) was found in the surgical samples, and also occurred in mouse esophageal epithelial cell layers under an ischemic condition. Identification of clinically significant subgroups was thought to be disrupted by the disorder of the expression profile through this aiEMT.
This study will evoke the fundamental misinterpretation including underestimation of the prognostic evaluation power of markers by overestimation of EMT IN past cancer research, and will furnish some advice for the near future as follows: 1) Understanding how long the tissues were under an ischemic condition. 2) Prevalence of biopsy samples for in vivo expression profiling with low biases on basic and clinical research. 3) Checking cancer cell contents and normal- or necrotic-tissue contamination in biopsy samples for prevalence.
This study investigated the incidence, diagnosis, treatment, and risk factors for nonmalignant airway erosion after subtotal esophagectomy for thoracic esophageal carcinoma.
Clinical data from all ...patients with thoracic esophageal carcinoma who underwent right transthoracic subtotal esophagectomy from 2000 to 2012 at our institution were retrospectively reviewed, and the clinical course and outcome of those who developed airway erosion were investigated in detail. Risk factors for airway erosion were calculated by multivariate analysis.
Of 1,091 patients enrolled, 15 patients (1.4%) developed nonmalignant airway erosion, which occurred at postoperative day (POD) 7 to 92 (median, 24). Anastomotic leakage or gastric-tube necrosis was detected prior to airway erosion in 14 cases (93.3%). Endoscopic and surgical therapy was administrated to 3 patients. Airway erosion was cured in 9 patients (60.0%). Five patients died from airway erosion directly (mortality, 33.3%). Alimentary leakage or necrosis (p<0.001), preoperative radiotherapy (p=0.004), and reconstruction through the posterior mediastinal route (p=0.051) were independent risk factors for airway erosion development.
Airway erosion is a fatal complication after subtotal esophagectomy. Preoperative radiotherapy dramatically increases the risk of developing airway erosion and reduces the probability of spontaneous healing. Aggressive treatment of alimentary leakage or necrosis and reconstruction through the anterior route help to decrease the risk of airway erosion, especially in high-risk patients.
Abstract
Background
A Mediastinal abscess can cause sepsis and make a patient sever condition. Early drainage treatment is required. We report a case which EUS-guided drainage was effective for a ...mediastinal abscess.
Methods
A 75-year-old man with T3 upper thoracic esophageal squamous cell carcinoma received preoperative chemotherapy. On day 9 the patient had fever and nuchal swelling. CT scan revealed a mediastinal abscess adjacent to the upper esophagus and the right paratracheal region extending to a retropharyngeal abscess. There was no clinical improvement with antibiotic therapy. On day 12 EUS-guided trans-esophageal drainage for the mediastinal abscess was performed.
Results
The echoendoscope was positioned within the upper esophagus, and the mediastinal collection was well visualized endosonographically. The mediastinal abscess was punctured and a pigtail catheter was placed. The retropharyngeal abscess was drainaged by pharyngeal incision. A repeated CT scan confirmed resolution of the abscess. On day 25 upper endoscopy was performed to remove the pigtail catheter. A small perforated hall was identified in the center of the esophageal tumor decreased after chemotherapy. The patients underwent esophagectomy after recovery.
Conclusion
EUS-guided trans-esophageal drainage was useful for a mediastinal abscess.
Disclosure
All authors have declared no conflicts of interest.
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