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Background The main purpose of this study was to compare the postoperative complications caused by surgical reconstruction via either retrosternal (RS) or prevertebral (PV) routes in thoracoscopic and laparoscopic esophagectomy patients. Materials and Methods We retrospectively screened the perioperative data in total 59 patients who underwent minimally invasive esophagectomy in time period from January 2016 to January 2018. All the patients were subgrouped into two cohorts according to the surgical routes being taken: the RS route group (28 patients) and the PV route group (31 patients). The perioperative data including operation and hospitalization time and surgical complications were comparatively analyzed. Results The surgical procedure in all patients was successful and no case of death occurred during perioperative stage in both groups. Notably, patients in the RS group had significantly lower propensity of pneumonia than patients in the PV group (p < 0.05). However, comparative analysis revealed almost an identical time for both operative process and postoperative hospitalization. And there was no statistical significance in the rate of anastomotic leakage and stricture as well as other complications (p > 0.05). Conclusion RS and PV paths are both safe and effective routes that yielded similar postoperative complications. Reconstruction after thoracoscopic and laparoscopic esophagectomy via the RS route had lower propensity of pneumonia than PV route. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effectiveness of two approaches of minimally invasive esophagectomy (MIE) in esophagectomy patients. Materials and Methods: We retrospectively screened the perioperative data in a total of 49 patients who underwent MIE. Among them, 30 patients underwent thoracoscopy combined with laparoscopy (Group A), while the rest received mediastinoscopy combined with laparoscopy (Group B). Clinical effectiveness and postoperative complications were comparatively analyzed. Results: The patients with mediastinoscopy showed a shorter average surgical time, less blood loss during surgery, diminished drainage volume in the first 3 days after surgery, and reduced hospitalization time, compared with the patients with thoracoscopic approach (P < .05). However, the mediastinoscopic route seems to render a higher incidence of postoperative hoarseness than thoracoscopy combined with laparoscopy (P < .05). In mediastinal lymph node dissection, the number of right recurrent laryngeal nerve lymph nodes (RLN LNs) in mediastinoscopic route was significantly less than that of thoracoscopy (P < .05). Conclusion: Mediastinoscopy was less invasive, with shorter surgical time, faster recovery, and better patient comfort, although it had certain limitations in the dissection of right RLN LNs. It is beneficial to patients with poor pulmonary function and no obvious mediastinal lymphadenectasis. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to explore the clinicopathological characteristics and operative therapeutic efficacy of thoracic esophageal cancer after gastrectomy and compare with those without gastrectomy.Methods: From January 2000 to June 2007, 28 esophageal cancer patients with a history of distal gastrectomy underwent subtotal esophagectomy. Vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Six hundred seventeen patients without a history of gastrectomy treated in the same period form the control group. After the operation, pathological characteristic, tumor staging, and survival statistics were analyzed.Results: Of those patients with esophageal cancer associated with gastric remnant, the majority were male. There was an average of 16.5 years for diagnosing esophageal cancer from the initial partial gastrectomy, 75% (21/28) of them were patients with Billroth I anastomosis. The proportion of lower-third tumors in patients after gastrectomy (12 of 28 patients, 43%) was significantly higher compared with that of the patients with intact stomachs (124 of 617 patients, 20%; P = 0.004). After surgical treatment, the overall 1-, 3-, and 5-year survival rates of gastrectomized and nongastrectomized patients were 100%, 35.00%, and 23.33% versus 98.93%, 59.42%, and 30.85% in stages I-II and 80.00%, 30.00%, and 0% versus 98.59%, 62.03%, and 21.03% in stages III-IV. The log rank test of equality of survival distribution for the gastrectomized vs nongastrectomized patients was not significant in stages I-II (P = 0.5692) but was significant in stages III-IV (P = 0.0166).Conclusions: The patients with partial gastrectomy for more than 5 years, having upper gastrointestinal symptoms, should be considered having the risk of esophageal cancer associated with gastric remnant. For patients with a history of distal gastrectomy, a vascularized pedicle colonic conduit was most commonly used for esophageal substitution. Surgical efficacy was similar with the no-gastrectomy group in early stages I-II of esophageal cancer associated with gastric remnant but was lower compared with the no-gastrectomy group in stages III-IV. So, early diagnosis and an aggressive surgical approach may be crucial to achieve better outcomes for esophageal cancer patients with gastrectomy. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present study was to analyze the risk multi-factors of postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma. Methods: A total of 756 operations for elderly patients (>65 years of age) with esophageal or cardiac carcinoma were performed in our department from January 1997 to December 2006. These included 197 cases (26.1%) of various types of cardiac arrhythmia after operation. Logistic regression was adopted to analyze the risk multi-factors of postoperative cardiac arrhythmia. Results: It showed that complications of other diseases before operation, selection of operation method, duration of anesthesia and operation, postoperative pain, anoxia, hypovolemia, acid-alkali disequilibrium, and electrolyte imbalance might be the risk factors of postoperative cardiac arrhythmia in elderly patients with esophageal or cardiac carcinoma, whereas minimally invasive endoscopic operation might be a protective factor. Conclusions: In order to decrease the risk factors leading to postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma, it was necessary to completely evaluate the functions of heart and lung, improve the nutrition and metabolism of heart muscle, conduct effective breathing exercises, and correct the existing cardiac arrhythmia of such patients before operation, and perform the minimally invasive operation, shorten operation duration, relieve pain efficiently during the perioperative period, and correct hypovolemia and acid-alkali disequilibrium and electrolyte imbalance. [ABSTRACT FROM AUTHOR]

Background: The prognosis of esophageal cancer is still dismal because of its high probability of metastasis that is likely related to the cellular process of epithelial–mesenchymal transition (EMT). Recent studies have shown a novel role of X-linked inhibitor of apoptosis protein (XIAP) in regulating the migration process of cancer cells and, therefore, linking to progression and poor prognosis of cancer. Methods: The expression of XIAP in esophageal squamous cell cancer (ESCC) tissues was determined by immunohistochemistry assay. Cell migration was analyzed by wound healing assay and Transwell assay. The expression of EMT markers (E-cadherin, N-cadherin and Vimentin) was revealed by immunofluorescence assay. Quantitative real‑time PCR analysis and Western blot analysis were used to detect the expression of XIAP and EMT markers as well as transforming growth factor-β (TGF-β) at mRNA and protein level, respectively. Results: We found that the expression of XIAP closely correlated to the probability of lymphatic metastasis in patients and that ESCC patients with the high XIAP expression were associated with worse overall survival (OS). Univariate and multivariate analysis also revealed XIAP as an independent prognostic factor for overall survival in ESCC patients. In both EC9706 and TE13 cell lines, knockdown of XIAP decreased the migration of cancer cells by inhibiting EMT process through regulating the TGF-β signaling pathway, pinpointing a regulatory role of XIAP in migratory process upon TGF-β activation. Conclusions: Taken together, our results suggest XIAP as a important prognostic and regulative factor in ESCC patients. XIAP may promote migration of esophageal cancer cells through the activation of TGF-β mediated EMT. [ABSTRACT FROM AUTHOR]