Esophageal Surgery Research Papers - Academia.edu (original) (raw)

Emphysematous aortitis is a form of septic aortitis. It is a rare disease with a high mortality rate, necessitating prompt diagnosis and aggressive treatment. We present the computed tomography features of emphysematous aortitis leading... more

- by and +1
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- Esophageal Disorders, Aortic Disease, Aortic Dissection, Esophageal Surgery

Objectives: We report an early, single-institution experience of Robot-Assisted Minimally Invasive McKeown Esophagectomy (RAMIME) using a four-arm platform. The technique details, rationale, complications, and pitfalls during procedure development are discussed.
Methods: This was a retrospective observational study.
Results: Nine of the 11 patients (median age: 57 years [range: 45-83]) had a complete (R0) resection; 10 were given induction treatment combined with chemoradiation. The median operative time was 795 min (range: 635-975). The median thoracoscopic console time was 270 min (range: 135-330). The median laparoscopic console time was 160 min (range: 150-260 min). The median blood loss was 300 cm3 (range: 100-650), and the median length of hospital stay was 18 days (range: 14-36). The median number of lymph nodes harvested was 28 (range: 9-39). No patients were converted to open procedures. Four patients had major complications; one died of liver failure on postoperative day 16; and none had clinically significant anastomotic leaks.
Conclusions: RAMIME is feasible. With good understanding of the robotic concepts and a good robotic team, RAMIME is worth trying. In addition to its well-known benefits, RAMIME permits replacing one human assistant.

SUMMARY. The right length of the myotomy on the gastric side for esophageal achalasia is still a debated issue. We aimed to investigate the final outcome after classic myotomy (CM) as compared with a longer myotomy on the gastric side (LM) in two cohorts of achalasia patients. Forty-four achalasia patients who underwent laparoscopic Heller–Dor were considered; patients with a sigmoid-shaped esophagus were excluded. Symptoms were scored using a detailed questionnaire for dysphagia, regurgitation, and chest pain. Barium swallow, endoscopy, and esophageal manometry were performed before and 6 months after the surgical treatment; 24-hour pH-monitoring was also performed 6 months after the procedure. CM was defined as a gastric myotomy length in the range of 1.5–2.0 cm, while LM was 2.5–3 cm in length. The surgical treatment (CM or LM) was adopted in two consecutive cohorts. Treatment failure was defined as a postoperative symptom score >10th percentile of the preoperative score (i.e. >8). Of the 44 patients representing the study population, 20 had CM and 24 had LM. The patients' demographic and clinical parameters (age, sex, symptom score, duration of symptoms, esophageal diameter, and manometric pattern) were similar in the two groups. The median follow up was 24 months (interquartile range 12–39). One patient in each group was classified as a treatment failure. After the treatment, there was a significant decrease in both groups' symptom score, and resting and residual pressure (P < 0.01), with no statistically significant differences between the two groups in terms of postoperative symptom score, resting and residual pressure, or total and abdominal lower esophageal sphincter length and esophageal diameter. Extending the length of the myotomy on the gastric side does not seem to change the final outcome of the laparoscopic Heller–Dor procedure.

- by Renato Salvador
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- Esophageal Disorders, Esophagus, Achalasia, Esophageal Surgery

Background: The in vitro interactions of esophageal smooth muscle cells (SMCs) with synthetic absorbable polymers were tested and artifi cial muscle tissues harvested from subcutaneous implantation were examined. Material/Methods: Esophageal tissue samples from adult and fetal (25-day gestational age) rabbits were cut into small pieces and cultured in Dulbecco's Modifi ed Eagle Medium supplemented with 10% fetal bovine serum. Growing cells were identifi ed as SMCs by immunostaining for anti-actin and anti-myosin antibodies. Equal volumes of agar gel and medium were mixed and used for 3-D culture. 5×10 5 cells and 1 mg polyglycolic acid (PGA) and poly-lactide-co-glycolide acid (PLGA) fi bers were seeded in six-well tissue culture plates. On days 2 and 7 growing cells were counted by a hemocytometer and cell-polymer interactions were evaluated with light microscopy. Adult and fetal SMCs were seeded onto the PGA and PLGA scaffolds, cultivated for two weeks, and implanted subcutaneously on the backs of the rabbits. Cell-polymer implants were retrieved after four weeks and muscle formation was evaluated histologically and immunohistochemically. Results: Growing cells stained positive for actin and myosin proteins. Cell-polymer interactions were poor after 24 hours, whereas intensive attachment to the fi bers was detected 48 hours following cultivation. Both fi ber materials supported cell proliferation. PLGA scaffolds improved muscle formation more effi ciently than PGA, and fetal and adult SMCs showed similar mass quality. Conclusions: Scaffolds are important as cell-carrying vehicles, and material-cell interactions should be tested before application. A 3-D culture prepared with agar gel and medium is practical for testing material toxicity.

- by Haluk B Guvenc
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- Tissue Engineering, Polymers, Biopolymers, Esophagus

Background A new high-resolution manometry (HRM) parameter, the integrated relaxation pressure (IRP), has been proposed for the assessment of esophageal-gastric junction (EGJ) relaxation. Our aim was to assess the effect of Heller myotomy on IRP in achalasia patients. Methods We prospectively collected data on achalasia patients who underwent HRM between 2009–2014. Barium swallow was used to assess esophageal diameter and shape. Manometric diagnoses were performed by using the Chicago Classification v3. All patients with a confirmed diagnosis of achalasia were treated surgically with Heller Myotomy Results One hundred thirty-nine consecutive achalasia patients (M:F=72:67) represented the study population. All the patients had 100 % simultaneous waves but 11 had an IRP<15 mmHg. At median follow-up of 28 months, the median of IRP was significantly lower after surgery (27.4 [IQR 20.4–35] vs 7.1 [IQR 4.4–9.8]; p<0.001), and so were the lower esophageal sphincter (LES) resting pressure (27 [IQR 18–33] vs 6 [IQR 3–11]; p<0.001). At univariate analysis, IRP correlated with the gender, LES resting residual pressure, and dysphagia score. Conclusions This is the first study to have examined the role of IRP in achalasia, and how it changes after surgical treatment. An increased preoperative IRP correlated directly with a more severe dysphagia. The IRP was restored to normal by Heller myotomy.

- by Renato Salvador
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- Esophageal Disorders, Lower Esophageal Sphincter, Esophagus, Achalasia

SUMMARY. Diffuse esophageal spasm (DES) is a rare primary motility disorder of unknown cause, that can be found in patients complaining of chest pain and dysphagia and in whom ischemic heart disease and GERD have been excluded. The manometric hallmark of DES is the presence of simultaneous contractions in the distal esophagus alternating with a normal peristalsis. Even at specialized esophageal motility laboratories, DES is considered an uncommon diagnosis. In this review, the authors discuss the clinical and diagnostic aspects of this disease, as well as the possible therapeutic options (medical, endoscopic or surgical therapy). Surgery (esophageal myotomy performed through a thoracotomy or with a thoracoscopic access) seems to have a better outcome than medical or endoscopic treatment, and it is considered " the last resource " in these patients. However, satisfactory results are reported, from highly skilled centers, in only about 70% of treated cases, certainly inferior to those achieved in other esophageal disorders. The role of surgery in this disease requires therefore further study, even if controlled trials are probably difficult to perform, due to the rarity of the disease. KEY WORDS: diffuse esophageal spasm, esophageal motility, motility disorders, surgical therapy.

- by Renato Salvador
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- Esophageal Disorders, Esophagus, Esophageal Surgery

Background. The most dangerous complication following esophagogastrectomy for esophageal cancer is anastomotic leakage. Surgical interventions described did not have a major impact in reducing the risk of occurrence. On the other hand, pleural tenting has been used for more than a decade by thoracic surgeons to prevent prolonged air leak after formal upper lobectomy with excellent results.

- by Christos Asteriou
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- Esophageal Surgery
- by Christos Asteriou
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- Esophageal Surgery

Introduction: Esophagomediastinal fistula is an abnormal communication between the esophagus and the mediastinum. It is either congenital or acquired. In adults, esophageal fistulas are usually acquired lesions. They can occur as a complication of intrathoracic malignancies (60%), prolonged tracheal intubation, esophageal instrumentation (including endoscopy and esophageal tube placement), postoperative complications, rarely in infections or trauma. Case presentation: We report a case of a 78-year-old Albanian male presenting with severe dysphagia, GERD, vomiting, weight loss and asthenia, who was diagnosed with: 1/3 of distal esophagus stenosis. The patient underwent esophageal stenosis resection surgery et esophagogastric anastomosis et pyloroplasty. Postoperative anastomotic leakage of 250 cc occurred into the mediastinum, in the 6-th post operative day. The patient underwent endoscopic treatment of the fistula, using esophageal stent placement. Results: The stent was well tolerated and the patient was able to ingest liquids and soft food with improvement of respiratory signs. Four weeks later, after stent removal, a chest X-ray with oral contrast was performed and confirmed the fistula was obliterated. The patient was discharged home on an oral diet. He was asymptomatic at 6 months of follow-up with improved quality of life and body weight. Discussion: We report a case of esophagomediastinal fistula after esophagogastric anastomosis. This complication was successfully treated with endoscopic treatment repair using stent. In our patient stent placement was immediately effective to obliterate the fistula. This endoscopic management allows for rapid discharge from the hospital and avoids the need to repeat the open surgery.

- by Klaudia Stajka
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- Fistula, Medicine, Laparoscopic Surgery, General Surgery

- by Nikolaos Barbetakis and +1
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- Statistical Significance, Pleural Diseases, Follow-up studies, Esophageal Cancer

The hemoglobin, albumin, lymphocyte and platelet (HALP) score has been confirmed as a prognostic factor in several types of cancers. The current study aimed to assess the prognostic value of preoperative HALP score, an inflammatory and nutritional based score, in predicting cancer-specific survival (CSS) in resectable patients undergoing curative resection for esophageal squamous cell carcinoma (ESCC). The clinical data of 355 consecutive patients with ESCC who underwent curative resection were retrospectively conducted and analyzed. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value for preoperative HALP. The areas under the curve (AUC) for preoperative HALP and other variables were calculated and compared. Cox regression analyses and Kaplan–Meier methods were used to identify the factors associated with CSS. According to the ROC curve, the optimal cut-off value for preoperative HALP was 31.8. The 5-year CSS for preoperative HALP low (≤31.8) and high (>31.8) was 15.1% and 47.5%, respectively (p < 0.001). Preoperative HALP had reliable abilities to predict CSS in resectable ESCC patients in any stage or gender, according to the subgroup analysis based on the patients’ cancer stage and gender. Multivariate analyses confirmed that preoperative HALP was an independent prognostic score regarding CSS in patients with resectable ESCC (p < 0.001). This study confirmed that the postoperative HALP score could be regarded as a potential independent prognostic factor for CSS in patients with resectable ESCC.

- by BJBMS Journal
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- Cancer, Esophageal Cancer, Esophageal Surgery
- by Nikolaos Barbetakis and +1
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- Treatment Outcome, Stents, Endoscopy, Survival Rate
- by JOSE MIGUEL ALVEAR
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- Esophageal Disorders, Oesophageal Atresia, Esophageal Surgery

preventing postoperative chylothorax following esophagogastrectomy vessel-sealing system is effective for TM eComment: The use of the LigaSure

- by Christos Asteriou
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- Esophageal Surgery

Esophageal cancer is the sixth leading cause of cancer death and remains one of the least survivable cancers. Esophageal cancers show wide variations in incidence in different population, suggesting that environmental or lifestyle risk factors could be controlled to reduce risk of these diseases. There are two major histopathologic types (squamous cell carcinoma and adenocarcinoma) of esophageal epithelial malignancy. Recently, the rate of adenocarcinoma is increasing in developed countries: in the United States, 50% or more is adenocarcinoma and, in about 70%, the increase especially in a white male serves as adenocarcinoma. Esophageal adenocarcinoma develops in the lower esophagus. In contrast, in Japan, the increase in adenocarcinoma is not clear and most (90%) of esophageal cancers are squamous cell carcinoma. Such squamous cell carcinoma occurs onto the middle part esophagus mostly, and 60% or more of the whole esophagus cancer also develops in the middle and upper parts. These differences also influence the treatment results. The scope of this article is to discuss carcinogenesis in the esophagus by giving an overview about its histopathological characteristics and molecular mechanisms.

- by Scientific Research Publishing
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- Cancer, Cancer Research, Esophageal Cancer, Esophageal Surgery

The esophageal perforation remains a potentially devastating condition. Rapid diagnosis and therapy provide the best chance for survival; however, delay in diagnosis is common, resulting in substantial morbidity and mortality. This article discusses the diagnosis and Surgical Management for this potentially lethal Gastrointestinal condition.

- by Burkan Nasr
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- Esophageal Surgery
- by Christos Asteriou
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- Esophageal Surgery

Background: Leiomyomas of esophagus, although rare, are the most frequent benign tumors of esophagus. Aim of this study is the presentation of 7 patients with esophageal leiomyomas who underwent surgical treatment during a 9-year period.

- by Christos Asteriou
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- Esophageal Surgery