An esophagogastric anastomotic leak, especially in the mediastinum or the chest, is a life-threatening complication of surgery for cancer of the esophagus. Of 617 patients who underwent esophageal resection and esophagogastric anastomosis between January 1980 and December 1989, 39 (6.32%) had anastomotic leakage; of these, 25 (64.10%) died. Various biologic parameters, operative techniques, and the management of leaks were analysed. Albumin concentration below 3 gm/dL (chi 2 = 3.9; P = 0.047), neoplastic permeation of the anastomotic cut margin (chi 2 = 4.7; P = 0.04), and cervical anastomosis (chi 2 = 12.32; P = 0.0004) were associated with a higher incidence of anastomotic leakage. Hemoglobin level, type of suture material used for the anastomosis, preoperative radiotherapy, and the experience of the operating surgeon under supervision were found to be statistically insignificant factors and did not influence anastomotic leakage. Mortality due to leak in the first postoperative week was 85% and was statistically significant as compared to the mortality occurring in the second postoperative week (chi 2 = 6.04; P = 0.013). Surgical or conservative management of the leak did not influence mortality (chi 2 = 1.2; P = 0.27). The salvage rates for cervical and intrathoracic anastomotic leakage were 80% and 29.4%, respectively. This difference is statistically significant (chi 2 = 29; P = 0.088).
Metastasis in chondroblastoma has been insufficiently stressed in the literature, unlike metastasis in giant cell tumors. The purpose of this case report is not only to document this uncommon event (the 12th case of lung metastasis) but also to emphasize that patients with chondroblastoma may have metastasis at presentation. Hence, all patients need to be evaluated regularly from the onset for possible lung metastasis so that deposits can be detected early for total resection.
Both surgery and radiotherapy can improve the quality of swallowing significantly for patients with operable esophageal carcinoma. Surgery is marginally superior to radiotherapy in improving the quality of swallowing. In this trial, survival in the surgery arm was significantly better than in the radiotherapy arm, although the small number of patients is a limitation.
Background. The impact of age and sex‐related changes in the endogenous hormonal milieu on survival after curative resection for esophageal epithelial cancer is explored. Adami et al. have suggested that the event of puberty has a favorable impact on survival after treatment of epithelial cancers.
Methods. The database consisted of 469 patients with esophageal cancer treated surgically with an intent to cure (without any gross residual disease at the end of the primary treatment) at Tata Memorial Hospital between 1980 and 1989.
Results. Life‐table analysis revealed a significantly better 5‐year survival for women younger than 49 years (35%, CI 24‐48) compared with men of the same age (16%, CI 8‐27) (P < 0.008). There was no difference in survival between men (17%, CI 12‐23) and women (26%, CI 16‐37) older than 49 years (P = 0.08). A Cox proportional hazard model showed sex to be the second most significant determinant of survival (P = 0.002) after lymph node metastasis (P < 0.0001).
Conclusion. The finding that the survival benefit is confined to women younger than 49 years is consistent with the hypothesis that the endocrine milieu in premenopausal women may prevent the establishment of micrometastases and thus improve the prognosis for esophageal epithelial cancer.
Results from historical controls are unreliable in detecting modest treatment benefits. Adjuvant chemotherapy in esophageal cancer should be tested within the tenets of randomized controlled trials with adequate-sample size to ascertain its efficacy.
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