ObjectiveTo explore the correlation of pretreatment systemic immune inflammation index (SII) with prognosis in esophageal cancer patients.MethodsWe searched the PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP, Chinese Biology Medicine, and Wanfang databases to identify eligible studies evaluating the relation between pretreatment SII and prognosis in patients with esophageal cancer from establishment of databases to December 2018. SII was defined as the absolute neutrophil count multiplied by the absolute platelet count divided by the absolute lymphocyte count. The primary endpoint was overall survival (OS), and the secondary endpoints were cancer-specific survival and disease-free survival. The Stata 12.0 software was applied for the meta-analysis, and the hazard ratio (HR) and 95% confidence interval (CI) were assessed.ResultsA total of six retrospective studies involving 2 376 esophageal cancer patients were included and all patients were from China or Japan. The results revealed that elevated pretreatment SII was significantly associated with poor OS in esophageal cancer [HR=1.50, 95%CI (1.15, 1.95), P=0.002]. Subgroup analyses of OS indicated that SII had a high prognostic value in patients who received surgery [HR=1.54, 95%CI (1.14, 2.08), P=0.005] and were diagnosed as esophageal squamous cell carcinoma [HR=1.50, 95%CI (1.11, 2.02), P=0.007]; however, no significant relation was observed between SII and prognosis in esophageal cancer patients who were treated with radiotherapy [HR=1.318, 95%CI (0.611, 2.841), P=0.482]. Furthermore, compared with neutrophil to lymphocyte ratio and platelet to lymphocyte ratio, SII showed a higher predictive value for the prognosis of esophageal cancer.ConclusionsPretreatment SII may serve as an independent risk factor for prognosis of Chinese and Japanese esophageal cancer patients, especially patients who were treated with surgery and with esophageal squamous cell carcinoma. However, more prospective studies with big samples from other countries or regions are still needed to verify our findings.
Objective To evaluate the effect of frailty on postoperative complications in elderly patients with esophageal cancer.Methods We enrolled the patients aged≥65 years and with esophageal cancer who underwent surgical treatment in Shanghai Chest Hospital in 2021. The modified frailty index (mFI) was calculated and the patients were divided into a non-frailty group and a frailty group. The primary outcomes were the incidence of postoperative pulmonary infection, arrhythmia, anastomotic fistula and chylothorax complications. Secondary outcomes were the time of extubation, the rate of unplanned re-intubation, the length of ICU stay, hospital stay, rate of readmission within 30 days after discharge and the mortality within 30 days after operation.Results Finally 607 patients were collected. There were 273 patients in the non-frailty group and 334 patients in the frailty group. The non-frailty group had lower rates of complications including pulmonary infection (5.5% vs. 13.5%), arrhythmia (3.7% vs. 9.3%), anastomotic fistula (2.9% vs. 7.5%), and shorter ICU stay [2.0 (0.0, 4.0) d vs. 4.0 (1.0, 6.0) d] and in-hospital stay [11.5 (9.5, 13.0) d vs. 13.0 (11.0, 18.0) d],lower rates of the readmission within 30 days (2.9% vs. 6.6%) and the mortality within 30 days (0.4% vs. 1.2%) compared with the frailty group (P<0.05).Conclusion Frail elderly patients with esophageal cancer have higher rates of postoperative complications. mFI can be used as an objective index to identify high-risk elderly patients with esophageal cancer.
目的 探討食管賁門癌術后非計劃二次手術的原因及有效的預防和治療措施。 方法 回顧性分析 2010 年 1 月至 2016 年 1 月在我院胸外科實施食管賁門癌手術 2 655 例患者的臨床資料，37 例（1.4%）患者因嚴重并發癥實施了非計劃二次手術，其中男 28 例、女 9 例，年齡 65（48～79）歲，總結該 37 例患者的臨床特征、二次手術的原因及治療方法。 結果 吻合口瘺 11 例：1 例行空腸造瘺，2 例行胸壁切口清創+胸腔置管引流術，3 例行頸部切口清創+上縱隔置管引流術，5 例行胸腔探查術（其中 3 例行瘺口修補術），1 例胸胃瘺行胸胃部分切除+食管頸部曠置+空腸造瘺術。乳糜胸 13 例，經胸行胸導管結扎術，其中 1 例右胸結扎失敗后再次經腹腔縫扎胸導管。胸腔出血 6 例行開胸探查止血，腹腔出血 2 例，分別經左胸及腹正中探查止血。1 例胸胃扭轉，行吻合口切除+胃-食管端端再次吻合術。1 例因雙側聲帶麻痹行氣管切開；1 例因肺大皰破裂氣胸行胸腔鏡下肺大皰切除術；1 例因腸梗阻行開腹探查粘連松解+空腸造瘺術。1 例胸內瘺患者因二次術后肺部感染死亡，其余患者均治愈出院。 結論 食管賁門癌術后二次手術的主要原因為吻合口瘺、乳糜胸及出血，提高首次手術質量是預防二次手術發生的關鍵，對需要行二次手術治療的嚴重并發癥，及時果斷的決定可避免病情進一步惡化和提高二次手術的效果。
ObjectiveTo explore the in vitro anti-tumor effect of clove extracts (CEs) on radioresistant esophageal cancer cell KYSER and its mechanism.MethodsEthanol extracts of clove bud were prepared. Gas chromatography was used to identify the main active components of CEs. In vitro cell culture method was used to observe the effect of CEs at different concentrations on KYSER cell growth. Methyl thiazolyl tetrazolium (MTT) method was used to detect the effect of different concentration CEs on KYSER’s survival and its’ manner. Transmission electron microscope (TEM) was used to observe the changes of KYSER’s organelle microstructure after CEs treated. Transwell chamber method was used to detect the impact of CEs on KYSER’s migration ability. The apoptosis rate and cell cycle distribution of KYSER treated by CEs were quantitatively determined by flow cytometry. Clone formation experiment was used to detect the clone formation ability of KYSER treaded by CEs.ResultsThe main components of CEs were eugenol, eugenol hydrocarbon, and eugenol acetate. In vitro cell culture showed that 0.4% CEs could inhibit KYSER growth. MTT assay showed that the concentration of CEs≥0.5% could inhibit the survival of KYSER in a dose-dependent manner. TEM assay showed that after treated by 0.5% CEs, KYSER’s microvilli became shorter and wider, ribosomes in the cytoplasm decreased, mitochondria atrophied, and a large number of autophagosomes were formed. Transwell migration assay showed that relative migration rates of KYSER after treated by 0.5% CEs and 0.6% CEs were (65±4)% and (41±3)%, respectively. Compared with the control group, the differences were statistically significant (P<0.001). Flow cytometry showed that the apoptosis rates of the control group, the 0.5% CEs treated group, and the 0.6% CEs treated group were (5.63±0.50)%, (11.77±0.42)%, and (19.44±0.19)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001). Flow cytometry showed that the G1 phase ratios of cells in the control group, the 0.5% CEs treatment group, and the 0.6% CEs treatment group were (61.99±1.20)%, (75.38±1.50)%, and (78.81±1.00)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001). The clonal formation experiment showed that after 24 h of CEs treatment, the clonal formation rates of the control group, the 0.5% CEs treatment group, and the 0.6% CEs treatment group were (80.5±1.0)%, (18.1±0.8)%, and (5.0±0.5)%, respectively, and the differences between the control group and the two CEs treated groups were statistically significant (P<0.001).ConclusionCEs can exert anti-tumor effect on radioresistant esophageal cancer cells by inducing autophagy and apoptosis, promoting cell cycle arrest, inhibiting cell energy metabolism, and inhibiting migration.
ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
ObjectiveTo investigate the safety and efficacy of 3D single-portal inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer.MethodsClinical data of 28 patients, including 25 males and 3 females, aged 51-76 years, with esophageal squamous cell carcinoma undergoing single-portal inflatable mediastinoscopic and laparoscopic esophagectomy from June 2018 to June 2019 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a 3D mediastinoscopic group (3D group, 10 patients) and a 2D mediastinoscopic group (2D group, 18 patients). The perioperative outcome of the two groups were compared.ResultsCompared with the 2D group, the 3D group had shorter operation time (P=0.017), more lymph nodes resected (P=0.005) and less estimated blood loss (P=0.015). There was no significant difference between the two groups in the main surgeon's vertigo and visual ghosting (P>0.05). The other aspects including the indwelling time, postoperative hospital stay, pulmonary infection, arrhythmia, anastomotic fistula, recurrent laryngeal nerve injury were not statistically significant between the two groups (P>0.05).ConclusionThe 3D inflatable mediastinoscopic and laparoscopic esophagectomy for esophageal cancer, which optimizes the surgical procedures of 2D, is safe and feasible, and is worthy of clinical promotion in the future.