Objective To assess the effectiveness and safety of nedaplatin combined with 5-fluorouracil (5-Fu) for advanced esophageal cancer. Methods Such databases as PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data were searched from the date of their establishment to May 4th, 2012 to collect the randomized controlled trials (RCTs) about nedaplatin combined with 5-Fu versus cisplatin combined with 5-Fu for advanced esophageal cancer. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the quality of the included studies. Then meta-analysis was conducted using RevMan 5.1 software. Results A total of 15 RCTs invloving 863 patients were included. The results of meta-analysis suggested that, compared with cisplatin combined with 5-Fu, nedaplatin combined with 5-Fu could improve short-term effects (RR=1.31, 95%CI 1.14 to 1.52, P=0.000 2) and reduce gastrointestinal reaction and renal function impairment, but it was associated with aggravated myelosuppression, increase of thrombocytopenia and leukopenia, and decrease of hemoglobin. There were no significant differences between the two groups in liver function impairment, diarrhea and peripheral neurovirulence. Conclusion Nedaplatin combined with 5-fluorouracil can increase short-term effects and reduce gastrointestinal reaction and renal function impairment. However, nedaplatin is associated with aggravated myelosuppression, so it should be applied in clinic with cautious. Nedaplatin combined with 5-fluorouracil can be used as a replacement chemotherapy regimen for advanced esophageal cancer, but the evidence about long-term effects and safety is still required. For the quality and quantity limitation of the included studies which decreases the level of evidence, so the conclusion of this systematic review only provides some references for clinical practice and research.
ObjectiveTo evaluate the impact of video-assisted thoracoscopic surgery (VATS) esophagectomy and routine operation on the short-term quality of life in patients with esophageal cancer. MethodsFrom January 2012 through January 2014, 157 esophageal cancer patients were classified into a VATS group (n=42) and a routine operation group (n=115) in our hospital. All patients in the two groups completed the Chinese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ)-C30 and QLQ-OES18 at one, six and 12 months after operation separately. ResultsAt the end of 6, 12 months after operation, the evaluation on global health status was higher in the VATS group(68.8±12.3 vs. 62.7±13.7, P<0.05; 76.2±10.4 vs. 68.6±8.8, P<0.05). At the end of 1, 6, 12 months after operation, the scores of symptom pain were less significantly in the VATS group than those in the routine operation group (P<0.05). One month after operation, the score of active ability in the VATS group was higher (P<0.05). At the end of 6, 12 months after operation, the score of emotional function and social role in the VATS group was higher (P<0.05). At the end of 12 months after operation, the score of role function and cognitive function in the VATS group was also higher (P<0.05). ConclusionVATS is of better effect on improving short-term quality of life of esophageal cancer patients compared with routine operation.
Objective To assess the value of vascular endothelial growth factor (VEGF) expression in the prognosis of esophageal cancer. Methods PubMed and EMbase were searched for collecting retrospective cohort studies on the correlation between VEGF expression and prognosis of esophageal cancer, and relevant articles were also retrieved from inception to June, 2012. Two reviewers independently screened the literature, extracted the data, and evaluated the quality. Then the meta-analysis was performed by using RevMan5.0 software, and the publication bias of literature was evaluated by means of Begg’s funnel plot and Egger’s method. Results Finally 10 cohort studies involving 811 patients were included. The meta-analysis showed that, patients with high level of VEGF had poor overall survival (HR=1.55, 95%CI 1.25 to 1.91). The results of subgroup analyses including VEGF subtype, critical value of VEGF and source of patient showed that: a) there was no correlation between patient’s prognosis and high level of VEGF-C; b) The high level of VEGF subtype in cancer tissue indicated a higher risk of death when the critical value was 10%, while it was not related to the prognosis when the critical value was 30%; and c) The high level of VEGF in cancer tissue was more valuable to predict the prognosis of esophageal cancer for Chinese patients rather than non-Chinese patients. Conclusion The level of VEGF’s expression in cancer tissue is valuable to predict the prognosis of esophageal cancer.
Objective To investigate the relationship between cyclooxygenase-2 (COX-2) gene polymorphism and genetic susceptibility to esophageal cancer. Methods The PubMed and EMbase databases were searched from the date of their establishment to January 1st, 2011 to collect the case-control studies on COX-2 polymorphism and susceptibility to esophageal cancer. For the population genotype distributions of both esophagus cancer group and control group, their odds ratios (ORs) and 95% confidence intervals (CIs) were taken as the effect indexes, either the fixed or random effect model was applied to conducted Meta-analysis in homozygote comparison, dominant and recessive genetic models, and the publication bias was assessed then. All statistical analyses were conducted with Stata11.0 software. Results A total of five case-control studies were included. The results of meta-analyses showed for the COX-2-765Ggt;C polymorphism, the CC+GC genotype was associated with the risk of esophageal cancer in a dominant genetic model (CC+GC vs. GG: OR=1.806, 95% CI 1.050 to 3.106); for the COX-2-1195Ggt;A polymorphism, the AA genotype was associated with the risk of esophageal cancer in homozygote comparison and recessive genetic models, the AA+GA genotype was associated with the risk of esophageal cancer in a dominant genetic model. Conclusion It is suggested that COX-2 polymorphism may be associated with genetic susceptibility to esophageal cancer.
Abstract： Objective To investigate the indications， surgical techniques and postoperative complication management of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospectively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy without thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010， including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 （48-81） years. There were 51 patients with upper thoracic esophageal cancer， 18 patients with middle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 （140-210） minutes， mean intraoperative blood loss was 150 （100 to 250） ml， and mean hospital stay was 15 （10-35） days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications， including 3 patients with anastomotic leakage at neck， 4 patients with recurrent laryngeal nerve injury， 5 patients with pleural effusion， 2 patients with pneumothorax， 3 patients with pneumonia， 3 patients with arrhythmia， 1 patient with chylothorax， 2 patients with incision infection， 2 patients with delayed gastric emptying， and 2 patients with anastomotic stenosis， who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years， and 8 patients were lost during follow-up. During follow-up， there were 94 patients who had lived for 1 year， 67 patients who had lived for 3 years， and 34 patients who had lived for 5 years postoperatively， and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thoracotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for patients with stageⅡor earlier esophageal cancer who can’t tolerate or aren’t suitable for transthoracic esophagectomy.
Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer （EC） who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 （58.8±6.6） years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 （305.0±40.7） minutes，including thoracoscopic operation time of 50-580 （105.0±38.4） minutes and laparoscopic operation time of 28-105 （54.0±8.6） minutes. Intraoperative blood loss was 20-440 （285.4±38.5） ml. The number of dissected lymph nodes was 6-39 （20.4±1.6） for each patient. Postoperative hospital stay was 7-93 （12.8±5.2） days. Sixty patients （30.6%） had postoperative complications，including 28 patients （14.3%） with pulmonary comp-lications，5 patients （2.5%） with chylothorax，5 patients （2.5%） with arrhythmias，15 patients （7.6%） with anastomotic fistula，10 patients （5.0%） with recurrent laryngeal nerve injury，and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.
Abstract： Objective To investigate the clinical application of tubular stomach in cervical esophageal reconstruction after esophagectomy for esophageal cancer. Methods A total of 850 patients with esophageal cancer who underwent esophagectomy through cervico-thoraco-abdominal（3-field）approach between January 2007 and January 2009 in North Jiangsu Hospital were allocated into the tubular stomach group（group A, n=425） and the whole stomach group （group B, n=425）by operation order. Group A included 287 male and 138 female patients with their average age of 58.2±11.5 years. Among them, 27 patients had upper esophageal cancer, 346 patients had middle esophageal cancer and 52 patients had lower esophageal cancer. Group B included 298 male and 127 female patients with their average age of 58.5±12.8 years. Among them, 33 patients had upper esophageal cancer, 338 patients had middle esophageal cancer, and 54 patients had lower esophageal cancer. Operation time, postoperative length of hospital stay and the incidence of anastomotic leakage, anastomotic stricture, intra-thoracic stomach syndrome and reflux esophagitis of the two groups were compared. Results All the patients recovered uneventfully with no in-hospital death. There was no statistical difference in operation time （175.0±12.8 min vs.171.0±10.5 min，t=1.702，P＞ 0.05）and postoperative length of hospital stay （16.0±8.5 d vs.16.3±8.8 d，t=1.773，P＞ 0.05） between the two groups. During follow-up of six months, the rates of anastomotic leakage（χ2=5.550，P＜ 0.05）, intra-thoracic stomach syndrome （χ2=10.500，P＜ 0.05）and reflux esophagitis（χ2=9.150，P＜ 0.05） of group A were significantly lower than those of group B. There was no significant difference in the incidence of anastomotic stricture （χ2=0.120，P＞ 0.05） between the two groups. Conclusion Tubular stomach is better than whole stomach for cervical esophageal reconstruction after esophagectomy for esophageal cancer since it is more physiologically and anatomically complied. It can decrease the incidence of anastomotic leakage, intra-thoracic stomach syndrome, reflux esophagitis and improve the postoperative quality of life.
Abstract: Objective To evaluate the feasibility and safety of combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis for the treatment of esophageal cancer. Methods We retrospectively analyzed clinical data of 40 patients with esophageal cancer who underwent esophagectomy in Beijing Chaoyang Hospital of Capital Medical University from March 2010 to March 2012. All the 40 patients were divided into 2 groups according to their different surgical approach， including 22 patients who underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis （minimally invasive surgery group） and 18 patients who underwent Ivor Lewis esophagectomy （open surgery group）. Operation time， intra-operative blood loss， lymph node dissection， postoperative morbidity， hospital stay and cost were compared between the two groups. Results The hospitalcost of minimally invasive surgery group was significantly higher than that of open surgery group ［（78 181.5±8 958.8） yuan vs. （61 717.2±35 159.4） yuan， Z=4.078，P=0.000］ . There was no statistical difference in operation time ［（292.0±74.8） min vs. （256.1±41.0） min， t=1.838，P=0.074］， intra-operative blood loss ［（447.7±597.0） ml vs. （305.6±125.9） ml， Z=0.401，P=0.688］， total number of dissected lymph nodes （230 vs. 215， t=1.714，P=0.095）， postoperative morbidity ［22.7% （5/22） vs. 33.3% （6/18）， χ2=0.559，P=0.498］， time to resume oral intake ［（8.5±3.5） d vs. （11.1±9.6） d，t=1.202，P=0.237］， and postoperative hospital stay ［（11.6±5.7） d vs. （13.3±9.4） d， t=0.680， P=0.501）］ between the two groups. The minimally invasive surgery group was further divided into two subgroups according to operation date， including 10 patients in the early stage subgroup and 12 patients in the later stage subgroup. The operation time of the later stage subgroup was significantly shorter than that of the early stage subgroup ［（262.9±64.9） min vs. （327.5±73.0） min， t=2.197， P=0.040］， but not statistically different from that of the open surgery group ［（262.9±64.9） min vs. （256.1 ±41.0） min， t=0.353， P=0.727］. Intra-operative blood loss of the later stage subgroup was significantly reduced compared with those of the early stage subgroup ［（220.8±149.9） ml vs. （720.0±808.0） ml， Z=3.279， P=0.001)］ and the open surgery group ［（220.8±149.9）ml vs. （305.6±125.9） ml， Z=2.089， P=0.037）］. Conclusion Combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis is a safe and effective surgical procedure for the treatment of esophageal cancer.
Abstract： Objective To explore the value of serum Dickkopf-related protein 1 （DKK1）for the early diagnosis of esophageal cancer， and provide theoretical evidence for the diagnosis and treatment of esophageal cancer. Methods A total of 145 patients who were admitted to the Affiliated Hospital of Jiangnan University between October 2009 and April 2011 were included in this study and divided into four groups. There were 72 patients in the esophageal cancer group （54 males and 18 females with their median age of 60.4 years），13 patients in the precancerosis group （9 males and 4 females with their median age of 58.6 years），30 patients in the benign esophageal lesion group （23 males and 7 females with their median age of 56.4 years），and 30 healthy people in the volunteer group （19 males and 11 females with their median age of 58.6 years）. Serum DKK1 protein concentration was measured by enzyme linked immunosorbent assay （ELISA）. Receiver operating characteristics （ROC） curve was drawn to determine the cutoff level with optimal diagnostic accuracy. Results Serum DKK1 protein levels were significantly higher in the esophageal cancer group and precancerosis group than those in the volunteer group and benign esophageal lesion group ［（37.5±2.8） μg/L， （19.7±2.7） μg/L vs. （5.7±0.8） μg/L， （6.5±0.8） μg/L，t=47.391， P＜0.05］. There was no statistical difference in serum DKK1 protein level between the volunteer group and benign esophageal lesion group ［（6.5±0.8） μg/L vs. （5.7±0.8） μg/L， t=4.215，P=0.374］. When the level of serum DKK1 protein was 13.4 μg/L， the diagnostic sensitivity and specificity of esophageal cancer were 74.1% and 96.7%， respectively. Conclusion Overexpression of serum DKK1 protein could be related to the pathogenesis and progression of esophageal cancer. DKK1 protein may be a potential serologic biomarker for the early diagnosis of esophageal cancer.
Abstract: Objective To determine the effects of early enteral nutrition (EEN) on postoperative recovery in elderly patients with esophageal cancer. Methods We included 100 elderly patients with esophageal cancer who were admitted at the PLA 100 Hospital between January 2006 and April 2010, and whose diagnoses were confirmed by pathological examination. The patients were divided into an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group, with 50 patients in each group. There were 32 males and 18 females with an average age of 72 years in the EEN group. There were 30 males and 20 females with an average age of 69 years in the PN group. We analyzed the effect of the nutrition administration method on bowel function recovery, hospital stay, complication rate, and nutritional status one week after surgery. Results The anal exhaust time (45.3±12.7 h vs. 73.6±11.7 h), time until anal defecation (80.5 h±15.6 h vs. 140.1±13.2 h), and hospital stay (13.0±1.8 d vs. 15.2±3.3 d) in the EEN group were all shorter than those in the PN group (Plt;0.05). The rates of lung infection, anastomotic leakage, and cardiac complications in the EEN group were significantly lower than those of the PN group (Plt;0.05). One week after the operation, the serum albumin (ALB), peripheral blood lymphocytes, transferrin, and 24 h urea nitrogen (BUN) in the EEN group were higher than those in the PN group (Plt;0.05). Conclusion Compared with parenteral nutrition, enteral nutrition can promote metabolic function in elderly patients after recovery, reduce morbidity, and promote recovery.