Postoperative malnutrition remains a severe problem after oesophageal cancer resection, even in long-term disease-free survivors. Overweight and obese patients are the segment population most exposed to this postoperative malnutrition, suggesting that such surgery could have substantial bariatric effect. A special vigilance programme on the nutritional status of this sub-group of patients should be the rule.

Neoadjuvant radiochemotherapy for elderly patients (age above 70 years) with esophageal adenocarcinoma did not seem to increase postoperative morbidity or mortality, nor was there any difference in quality of life, nor any effect on survival, no matter what the age of the patient.

Our experience confirms that selection of candidates for redo GERD surgery is a challenging issue. A transthoracic approach seems to produce better results and lower rates of complications.

Colon interposition has been used since the beginning of the 20(th) century as a substitute for esophageal replacement. Colon interposition is mainly chosen as a second line treatment when the stomach cannot be used, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign diseases in young patients with long-life expectancy. During the surgery the vascularization of the colon must be carefully assessed, as well as the type of the graft (right or left colon), the length of the graft, the surgical approach and the route of the reconstruction. Early complications such as graft necrosis or anastomotic leaks, and late complications such as redundancy depend on the quality of the initial surgery. Despite a complex and time-consuming procedure requiring at least three or four digestive anastomoses, reported long term functional outcomes of colon interposition are good, with an acceptable operative risk. Thus, in very selected indications, colon interposition could be seen as a valuable alternative for esophageal replacement when stomach cannot be considered. This review aims at briefly defining "when" and "how" to perform a coloplasty through demonstrative videos.

Malnutrition is common 1 year after esophageal cancer surgery. However, the prognostic impact of this malnutrition on long-term outcome has been poorly reported. This study aims at determining the potential effect on disease-free survival (DFS) of weight loss observed at 1 year in disease-free survivors after curative esophageal resection. From a prospective single-institution database, 304 patients having undergone a transthoracic esophagectomy with two-field lymphadenectomy and gastric reconstruction between 1996 to 2008 were identified. Patients who died during the postoperative course (n= 24), patients who died within the first postoperative year (n= 12), patients who presented with an early recurrence within the first postoperative year (n= 20), and those who were lost to follow-up (n= 22) were excluded from the study, as well as those for whom the follow-up was shorter than 1 year (n= 21). The remaining 205 patients constituted a homogeneous group of 1-year disease-free survivors after full postoperative work-up and formed the material of the present study. Body weight (BW) values were collected before any treatment at the onset of symptoms (initial BW) and 1 year after esophagectomy. A 1-year weight loss (1-YWL) exceeding 10% of the initial BW defined an important malnutrition. Impact of the 1-YWL ≥ or <10% of the initial BW on DFS was investigated. Logistic regression was performed to identify factors affecting DFS. The mean initial BW was 69.1 ± 12 kg, corresponding to a mean body mass index (BMI) of 23.8 ± 3 kg/m(2) . Preoperatively, 32 (15%) patients were in the underweight category (BMI < 20 kg/m2), 110 (54%) were in normal (BMI = 20-24 kg/m2), and 63 (31%) were in the overweight category (BMI ≥ 25 kg/m2). Mean 1-year BW was 63.5 ± 12 kg. 1-YWL was <10% of the initial BW in 92 patients (45%) and ≥ 10% in 113 patients (55%). Accordingly, 5-year DFS rates were 66% (median: 80 months) and 48% (median: 51 months), respectively (P= 0.005). On multivariate analysis, only three independent variables affected the DFS significantly: clinical N stage (cN) status (P= 0.007; odds ratio: 1.99, 1.2-3.3), incomplete resection (P= 0.008, OR: 3.6, 1.3-9.3), and 1-YWL ≥ 10% (P= 0.004, OR: 2.1: 1.2-3.4). 1-YWL of or exceeding 10% of the initial BW in 1-year disease-free survivors has a negative prognostic impact on DFS after esophagectomy for cancer. This information offers another view on the objectives of the perioperative nutritional care of these patients. Special vigilance program on the nutritional status in post-esophagectomy patients should be the rule.

No abstract

L'ingestion de corps étranger de l'œsophage est un motif fréquent de consultation aux urgences pédiatriques. Cependant le phénomène peut se retrouver à tous les âges. Les auteurs décrivent les caractéristiques cliniques, paracliniques et thérapeutiques des corps étrangers enclavés dans l'œsophage pris en charge à l'hôpital du Mali. Il s'agit d'une étude prospective, menée entre janvier 2011 et décembre 2014 incluant tous les cas d'ingestion de corps étrangers enclavés dans l'œsophage. Au total 36 patients ont été pris en charge par des moyens endoscopiques ou chirurgicaux. L'âge moyen était de 6 ans (extrêmes: 14 mois- 62 ans). Le sexe masculin était dominant avec un sexe ratio de 1,75. Les corps étrangers étaient bloqués dans le rétrécissement crico-pharyngien dans 69,45% des cas suivi du rétrécissement aortique dans 22,22% des cas. Le délai d'extraction du corps étranger en moyenne était de 7 heures 30. La fibroscopie rigide a permis l'extraction du corps étranger dans 88,89% des cas. Une chirurgie par thoracotomie a permis d'extraire le corps étranger dans 5,55%. Les corps étrangers de l'œsophage peuvent se retrouver à tout âge mais restent plus fréquent chez l'enfant. L'extraction endoscopique est la man'uvre la plus réalisée mais la chirurgie pour extraction d'un corps étranger bloqué dans l'œsophage bien que rare reste le dernier recours à cause souvent de leur nature et de la survenue des complications. Le meilleur moyen pour lutter contre ces accidents reste la prévention.

Epiphrenic diverticula are defined as the herniation of the mucosa and submucosa through the muscular layers of the oesophageal wall in its lower third. An increased intraluminal pressure associated with an oesophageal motility disorder is usually present in the pathophysiology of the disease. Surgical treatment is indicated mostly in symptomatic patients. The current surgical treatment consists in: (i) removing the diverticulum; (ii) relieving the functional distal obstruction with an oesophageal myotomy including the lower oesophageal sphincter; and (iii) preventing an associated reflux by the addition of a non-obstructive partial fundoplication. Minimally invasive techniques have been reported, but traditional open procedures remain the treatment of choice of the disease.