China
Africa
Explore chapters and articles related to this topic
Esophageal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Jennifer Kahan, Carys Morgan, Kieran Foley, Thomas Crosby
Many surgeons, particularly in the United Kingdom, favor a two-stage radical transthoracic esophagectomy (Ivor Lewis approach). The stomach and coeliac nodes are mobilized via an abdominal incision, and the esophagus and mediastinal nodes via a right fifth interspace thoracotomy; the stomach and esophageal remnant are anastomosed. An alternative total thoracic, three-stage (McKeown) surgical approach can be adopted, when additional neck exploration and dissection are required.
Paraesophageal Hernia
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Despite best efforts, a sizeable proportion of hernias will recur. Radiologic recurrence must be distinguished from clinical recurrence. The majority of these patients can undergo a redo fundoplication with hiatal hernia repair, performed laparoscopically. A small number may require conversion to a Roux-en-Y esophagojejunostomy. In the patients with multiple recurrences and disabling symptoms, esophagectomy may be needed as a last resort.
Post-esophagectomy Colon Diaphragmatic Herniation
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Curtis S. Bergquist, Rishindra M. Reddy
The patient had a difficult postoperative recovery period after her transhiatal esophagectomy. The esophagectomy is a major operation for which patient selection is a crucial component. However, rigorous preoperative workup does not eliminate all complications. Failure to rescue has emerged as an area of interest and describes what happens to patients who suffer complications. Her stroke was recognized as early as was feasible, and appropriate consultants were involved immediately. No obvious event is found in the operative record to suggest why or when she had a stroke, but in retrospect, she was at baseline hypertensive. Systolic blood pressures of 100 and mean arterial pressures of greater than 60 were maintained during surgery and during the mediastinal dissection, but in retrospect, these may not have been high enough for this patient. Hypotension can occur with a tension pneumothorax, during displacement of the heart during posterior mediastinal dissection or in episodes of hemorrhage. Care was paid to the arterial line tracing while the surgeon’s hand is behind the heart to monitor for hypotension, but despite this, an ischemic event happened during her operation.
Effectiveness of Transthoracic Hybrid Minimally Invasive Esophagectomy: A Meta-Analysis
Published in Journal of Investigative Surgery, 2021
Zheng-Dao Wei, Han-Lu Zhang, Yu-Shang Yang, Long-Qi Chen
Pulmonary complications are another concern after esophagectomy. The development of pulmonary complications requires protracted stay in the hospital intensive-care unit. According to the available literature [54], patients who developed pneumonia following esophagectomy have a 20% risk of death. Furthermore, postoperative pneumonia has been shown to have a negative impact on long-term survival following esophagectomy [55]. Esophagectomy without thoracotomy achieved by the transhiatal or thoracoscopic procedure has also been proposed to improve postoperative pulmonary course [56]. The present meta-analysis showed that HMIE resulted in a lower incidence of pulmonary infections compared with OE, but an increased incidence of postoperative pneumonia compared with TMIE, which demonstrated the advantages of MIE. Further subgroup analysis showed that the incidence of postoperative pneumonia in the laparoscopic-thoracotomic subgroup (performed by laparoscopy) was lower than that in the OE group (not performed by laparoscopy). In addition, the incidence of postoperative pneumonia in the thoracoscopic-laparotomic subgroup (not performed by laparoscopy) was higher than that in the TMIE group (performed by laparoscopy). Therefore, the results for laparoscopy in esophagectomy in the present meta-analysis are encouraging.
Effect of direct oral feeding following minimally invasive esophagectomy on costs and quality of life
Published in Journal of Medical Economics, 2021
Madhuri Pattamatta, Laura F. C. Fransen, Annemarie C. P. Dolmans-Zwartjes, Grard A. P. Nieuwenhuijzen, Silvia M. A. A. Evers, Ewout A. Kouwenhoven, Marc J. van Det, Mickael Hiligsmann, Misha D. P. Luyer
Esophageal cancer is the sixth leading cause of cancer-related mortality and the eighth most common cancer worldwide1. The incidence of esophageal cancer in the Netherlands and other Western countries is increasing rapidly2–4. In the Netherlands, this is growing at a rate of roughly 400% in the recent years from 684 diagnoses in 1989 to 2,500 in 20185,6. A total of 2,536 new cases were identified in 20197. This is due to the increasing prevalence of known risk factors such as obesity, gastroesophageal reflux disease and smoking8,9. The Dutch healthcare costs for esophageal cancer care are expected to increase in the future with the increasing incidence and the improved neoadjuvant and surgical treatment10. Esophagectomy remains the cornerstone in esophageal cancer treatment. Postoperative complications following an esophagectomy are substantial and associated with a prolonged hospital stay, increased resource use and a reduced quality of life (QoL) 11,12.
The effect of early oral feeding after esophagectomy on the incidence of anastomotic leakage: an updated review
Published in Postgraduate Medicine, 2020
Chu Zhang, Miao Zhang, Longbo Gong, Wenbin Wu
Esophagectomy is still the standard treatment option for resectable esophageal cancer. As evidence for the optimal timing of oral intake is insufficient, widely varying feeding protocols have been practiced after esophagectomy. Nil by mouth is traditionally considered the standard of care during the first days after esophagectomy [22]. EOF has been shown to have positive outcomes in gastrointestinal surgery, but there is an increased risk of vomiting and aspiration pneumonia [23]. The potential increase of pulmonary complications due to aspiration, AL, and delayed gastric emptying are important arguments to EOF after esophagectomy, whereas the potential benefit of EOF after esophageal surgery remains elusive [24]. Based on the findings from the five RCTs in this review, EOF after esophagectomy does not increase the incidence or severity of postoperative ALs.