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Query: UMLS:C0546837 (esophageal cancer)
 8,907 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Due to the increasing use of minimally invasive techniques, some authors have questioned the necessity to dissect the azygos vein as part of the en-bloc esophagectomy in patients with esophageal cancer. This study investigates the nodal clearance associated with resection of the azygos vein. Ninety-two patients with esophageal carcinoma were included in this prospective analysis. In all patients, a standard transthoracic en-bloc esophagectomy was performed including the resection of the azygos vein from the superior vena cava to the level of the diaphragm. After resection, the azygos vein with its adjacent connective tissue was separated from the tubular esophagus. The separated azygos vein specimen was histopathologically examined for the presence of lymph nodes (LN) and possible nodal metastasis. A total of 2,778 LN with a mean of 30.2 LN for each patient were resected. In 60 patients, 216 of 1,666 mediastinal LN (13.0%) were located along the azygos vein. Seven of 39 pN1 patients (17.9%) had LN metastases in the separated azygos vein specimen. In these seven patients, a total of 23 metastatic nodes were detected along the azygos vein. LN metastases along the azygos vein are too frequent to neglect their existence. Therefore, standard en-bloc esophagectomy including dissection of the azygos vein should not be abandoned irrespective of the surgical approach.
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PMID:The resection of the azygos vein--necessary or redundant extension of transthoracic esophagectomy? 1867 37

More extensive resection for esophageal cancer has been reported to improve survival in several series. We compared results from an unselected consecutive cohort of patients undergoing radical esophagectomy, including removal of all periesophageal tissue with a 2-field abdominal and mediastinal lymphadenectomy for esophageal and gastroesophageal malignancy. A prospective electronic database was reviewed for patients with esophageal malignancy undergoing an open esophagectomy between 1991 and 2004. Data were analyzed on an SPSS file (version 12.0, Chicago, IL, USA) using chi(2) or Fisher's exact test; odds ratio and 95% confidence interval; and the Kaplan-Meier method, log-rank test and Cox's proportional hazards regression for survival analysis. There were 178 patients with a median age of 65 years and a 70/30 male to female ratio. Median follow-up was 20.4 months. Pathology comprised adenocarcinoma in 64% of patients, squamous cell carcinoma 30%, and other malignancies 6%. Seventeen patients had neoadjuvant therapy. Hospital mortality was 3.3%. Complete resection was achieved in 87%. Local recurrence occurred at a median of 13 months in 6.7% of patients. Overall 5-year survival was 42%. For patients with invasive squamous cell carcinoma and adenocarcinoma the 5-year survival was 47% and 40.3%, respectively, and for patients without nodal involvement it was 71.5%, with one to four nodes involved, 23.5% and with >4 nodes, 5% (P < 0.001). Survival decreased with increasing direct tumor spread (P < 0.001) and pathological stage (P < 0.001). Esophageal resection with systematic 2-field lymphadenectomy can be performed with acceptable operative mortality and favorable survival.
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PMID:Does systematic 2-field lymphadenectomy for esophageal malignancy offer a survival advantage? Results from 178 consecutive patients. 1845 92

We aim to determine the effect of splenectomy on clinical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction (GEJ) after a curative intended resection. From January 1991 to July 2004, 210 patients underwent a potentially curative gastroesophageal resection with an extended nodal dissection. The study group was divided into: group I with splenectomy, consisting of 66 patients (31.4%), and group II without splenectomy, of 144 patients. Splenectomy was performed for oncological reasons. Medical records were reviewed retrospectively. Postoperative complications occurred in 27 patients (40.9%) in group I and in 68 patients (47.2%) in group II (P = 0.4). The overall mortality was not significantly different between both groups (P = 0.7). There was a higher administration of red blood cells during surgery (P < or = 0.001), increased operating room (OR) time (P < or = 0.001) and longer intensive care unit (ICU) stay (P = 0.01) in group I. Independent prognostic factors for survival were outcome of surgery, nodal metastases, gender, complications and ICU stay. Sepsis was a strong prognostic factor among the complications. The 1 and 2-year survival was significantly higher in group II; 75% and 67% (P = 0.032) compared to 69% and 56% (P = 0.017) in group I, respectively. However, the 5-year survival was not different in both groups (29% in group I and 60% in group II, P = 0.191). Splenectomy had no marked effect on mortality and morbidity after curative resection of esophageal cancer. Splenectomy had a significant increase in blood transfusions with prolonged OR time and ICU stay and decreased short-term survival.
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PMID:Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction. 1847 56

The purpose of the present study was to assess the contribution of simultaneous functional/anatomical imaging using integrated 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), compared with PET alone for the evaluation of initial lymph node staging in esophageal cancer. We studied 167 consecutive patients with thoracic esophageal squamous cell carcinoma (SCC) who had radical esophagectomy performed between January 1999 and April 2007. For individual nodal group evaluation, PET/CT showed 46.0% sensitivity (p<0.05 vs. PET), 99.4% specificity, 95.1% accuracy (p<0.05 vs. PET), 87.0% positive and 95.5% negative predictive values. PET showed 32.9% sensitivity, 98.9% specificity, 93.1% accuracy, 74.7% positive predictive value and 93.9% negative predictive value. Thus, the sensitivity and accuracy of PET/CT were significantly higher than those of PET. Comparisons between CT, PET and PET/CT in detecting lymph node metastasis by each region showed that PET/CT had a higher sensitivity in lower thoracic regions than PET and CT (p<0.05 vs. CT and PET). Lymph node staging (N0 vs. N1) was not significantly different, but staging per lymph nodal group was significantly better with PET/CT. Integrated PET/CT imaging with co-registration of anatomic and functional imaging data is useful in the initial lymph node staging of patients with operable esophageal cancer compared with PET alone.
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PMID:The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer. 1881 27

Esophageal cancer is one of the most difficult malignancies to cure, and identification of novel prognostic markers for patients with this disease is important. CD24 is a small highly glycosylated mucin-like protein. Several studies have shown that higher CD24 expression is significantly associated with shorter patient survival in various malignant tumors. However, the expression of CD24 and its clinicopathological significance in esophageal cancer remain largely unknown. Immunohistochemical analyses of CD24 and Ki-67 overexpression in 151 cases of esophageal squamous cell carcinoma were performed to examine the relationships of CD24 expression with clinicopathological parameters and patient survival. Five cell lines derived from esophageal cancer were subjected to Western blot analyses to evaluate CD24 expression. Immunohistochemically, CD24 expression was judged to be positive in 61 (40.4%) cases. CD24 expression was associated with lymph node metastasis (p = 0.005), pathologic stage (p = 0.018), number of nodal metastases (p = 0.003), lymphatic invasion (p = 0.002), venous invasion (p < 0.001), and Ki-67 labeling index (p < 0.001). The Pearson's correlation coefficient between the CD24 expression score and the Ki-67 labeling index was 0.404 (p < 0.001). CD24 expression was associated with disease-free survival (p < 0.001). A Cox multivariate regression analysis revealed that CD24 expression was an independent prognostic factor (p = 0.033). On Western blot analysis, CD24 was detected in all five cell lines. We conclude that overexpression of CD24, which was correlated with Ki-67 expression, is a novel independent prognostic marker for identifying patients with poor prognosis after curative resection of esophageal squamous cell carcinoma.
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PMID:CD24 expression is a novel prognostic factor in esophageal squamous cell carcinoma. 1905 Sep 62

Recent epidemiologic studies have shown a positive association between obesity and certain cancers. Our retrospective studies show that hypertriglyceridemia is an independent risk factor for the development of colonic adenoma and nodal metastasis in early gastric and esophageal cancer in men. High-fat condition may be favorable for the growth of malignant cells. Serum level of adiponectin is reduced in patients with advanced gastric cancer, which may be associated with the positive link between adiposity and cancer. In early gastric cancer, patients with undifferentiated type have lower fat volume than those with differentiated type. Adiposity appears to be closely related with various aspects in pathophysiology of gastrointestinal malignancy.
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PMID:Adiposity and gastrointestinal malignancy. 1915 87

The purpose of this study was to assess the value of diffusion-weighted magnetic resonance imaging (DWI) in detecting esophageal cancer and assessing lymph-node status, compared with histopathological results. DWI was prospectively performed in 24 consecutive patients with esophageal cancer, using the diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) sequence. DWIBS images were fused with T2-weighted images, and independently and blindly evaluated by three board-certified radiologists, regarding primary tumor detectability and lymph-node status. Apparent diffusion coefficients (ADCs) of the primary tumor and lymph nodes were also measured. Average primary tumor detection rate was 49.4%, average patient-based sensitivity and specificity for the detection of lymph-node metastasis were 77.8 and 55.6%, and average lymph-node group-based sensitivity and specificity were 39.4 and 92.6%. There were no interobserver differences among the three readers (P < 0.0001). Mean ADC of detected primary tumors was 1.26 +/- 0.29x10(-3) mm(2)/s. Mean ADC of metastatic lymph nodes (1.46 +/- 0.35x10(-3) mm(2)/s) was significantly higher (P < 0.0001) than that of nonmetastatic lymph nodes (1.15 +/- 0.24 mm(2)/s), but ADCs of both groups overlapped. In conclusion, this study suggests that DWI only has a limited role in detecting esophageal cancer and nodal staging.
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PMID:Diagnostic performance of diffusion-weighted magnetic resonance imaging in esophageal cancer. 1917 78

If the sentinel node (SN) concept is established in esophageal cancer, SN navigation surgery (SNNS) will be clinically useful. Individualized treatment will become possible, such as fewer lymphadenectomies in the upper mediastinal and cervical regions, SN sampling with endoscopic therapy, and targeted radiotherapy for SNs. Since the dye method is difficult to use for SN detection because of the complicated lymphatic flow in the esophagus and anthoracosis in the lymph nodes, the radioisotope method is used in esophageal cancer. When SNNS is introduced clinically, accurate diagnosis of nodal metastases, including micrometastases, will be essential. At present, there are few reports on the SN concept in esophageal cancer, and sufficient clinical evidence has not yet accumulated. In our experience, the detection rate was 93% in clinical NO patients with superficial esophageal cancer, and the accuracy rate was 100% for nodal metastases, including micrometastases. A clinical trial of SNNS has started in elderly patients with preoperative complications and in poor-risk patients. In the near future, a multicenter trial will be necessary to establish a standard for individualized therapy.
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PMID:[Sentinel node navigation surgery in esophageal cancer]. 1934 95

Several publications have showed that the number of metastatic lymph node (LN) should be taken into consideration in nodal category of esophageal cancer, but seldom considered extent of involved regional LNs. The aim of this study is to evaluate the significance of the extent of regional LN metastasis on survival in patients with esophageal cancer. A total of 245 thoracic esophageal cancer patients underwent transthoracic esophagectomy with standard lymphadenectomy between January 2000 and December 2006 were included in the study. Data including demographic factors, pathologic findings, LN parameters and survival outcomes were collected. The survival experience was depicted using Kaplan-Meier method. A multivariate Cox proportional hazard model was used to screen the significant prognostic factors. The univariate analysis to further explore the significant prognostic factor was done by log-rank test. After a median follow-up of 53.2 months, the 5-year survival rate was 46.3% for the entire cohort. Cox model regression indicated that the LN status and perigastric nodal status, aside from residual tumor status, histological tumor type and depth of invasion, were the independent prognostic factors. Patients without LN metastasis had better 5-year survival than those with positive nodes (64.2% vs. 18.9%, X2=35.875, P<0.001). However, For those patients with nodal involvement, there was no difference in 5-year survival between patients with involved nodes<3 and >or=3 (27.8% vs. 0%, X2=0.925, P=0.336). When considering the location of LN metastasis, patients could be further stratified according to whether the perigastric nodes were involved or not (37.5% vs. 10.0%, X2=4.295, P=0.038). In conclusion, involved LN number had no prognostic implication in nodal involved patients based on our data. Whereas, perigastric nodal involvement should be used to refine the N category (N0, no nodal metastasis, N1, non-perigastric node metastasis, N2, perigastric node metastasis) for the future esophageal cancer staging criteria.
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PMID:Prognostic significance of perigastric lymph nodes metastases on survival in patients with thoracic esophageal cancer. 1939 53

Multimodality treatment is increasingly used in the treatment for esophageal cancer. We determined the tumor regression grade after preoperative chemoradiation and correlated the effect of specific pathologic and clinical findings to overall survival. For this purpose esophageal biopsies and surgical specimens of 67 patients treated with neoadjuvant paclitaxel and carboplatin concurrent with radiotherapy were reviewed. Neoadjuvant chemoradiotherapy led to a significant downstaging. Complete tumor regression was found in 24% of the patients resulting in a trend towards better survival. It was found more frequently in poorly differentiated tumors. Patients with pre-treatment nodal involvement, assessed by endoscopic ultrasound, had a significantly worse survival compared to patients without. Contrastingly, this was not found for post-treatment nodal involvement, as determined by pathological examination, speculating that survival is more determined by (submicroscopic) distant disease, than by locoregional tumor cells.
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PMID:Pathological analysis after neoadjuvant chemoradiotherapy for esophageal carcinoma: the Rotterdam experience. 1940 81


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