Avaliação das complicações da esofagectomia de resgate na terapêutica cirúrgica do câncer de esôfago avançado

Abstract

-Background: Even though the esophageal cancer has innumerous treatment options its prognosis is still unsettled. Because esophagectomy is rarely curative, new and emerging therapies come to light such as isolated chemotherapy and radiotherapy or combined chemoradiation, followed or not by surgery. The rescue esophagectomy is an alternative for those patients with recurrent or advanced disease. Aim: To evaluate the results of the rescue esophagectomy in patients with esophageal cancer who had previously undergone chemoradiation and describe local and systemic complications of the procedure. Methods: Eighteen patients with unresectable esophageal squamous cell carcinoma were treated with chemoradiation followed by rescue esophagectomy. All of them presented the preoperative clinical conditions required to indicate the surgical procedure. Transthoracic esophagectomy with right side thoracotomy plus midline laparotomy was performed. Patients were evaluated with regard to any postoperative complications. Results: There were five patients with evidence of fistula at the level of the anastomosis, and four of them progressed satisfactorily. Postoperative dilation was needed in five out of eighteen patients due to stenosis of the esophagogastric suture line. Seven patients did develop pulmonary infection with a fatal outcome for two of them. Among the patients who were available for a five-year follow-up, there was a rate of 53.8% of disease-free survival. Conclusions -These patients presented an elevated morbidity of the procedure related to many factors such as the long period between chemoradiation and surgery, which leads to tissue injury resulting in anastomotic fistulas. Nevertheless, esophagectomy seems to be valuable in cases without any other therapeutic option. RESUMO -Racional:Apesar das inúmeras opções terapêuticas, o prognóstico da neoplasia maligna de esôfago continua sombrio. Devido à baixa taxa de cura da esofagectomia, foram desenvolvidas novas propostas de tratamento como a quimioterapia e radioterapia isoladas ou associadas, concomitante ou não à cirurgia, além da quimiorradiação exclusiva. A esofagectomia de regaste surge como opção terapêutica para aqueles pacientes com recorrência ou persistência da doença após tratamento clínico. Objetivo: Avaliar os resultados da esofagectomia de resgate em pacientes com câncer de esôfago submetidos previamente à quimiorradiação exclusiva, assim como descrever as complicações locais e sistêmicas. Método: Foram analisados retrospectivamente 18 pacientes com diagnóstico inicial de carcinoma epidermóide de esôfago irressecável, submetidos previamente à quimiorradioterapia. Após o tratamento oncológico eles foram examinados quanto às suas condições clínicas pré-operatórias. Foi realizada a esofagectomia por toracotomia direita e reconstrução do trânsito digestivo por cervicolaparotomia. Os mesmos foram avaliados no período pós-operatório tanto em relação às complicações locais e sistêmicas como em relação à qualidade de vida. Resultados: As complicações fora...

Perfil sociodemográfico e clínico de pacientes com neoplasia de esôfago e estômago em um hospital escola de São José do Rio Preto, SP

“…22 Um trabalho que incluiu pacientes com CE, de estô-mago e pâncreas encontrou um percentual de 2,7% de perda de peso, sendo que 64,4% dos pacientes relataram perda de peso não intencional. 23 A caquexia se caracteriza pela perda contínua de massa muscular e de gordura e está associada com a maioria dos cânceres em estágio avançado, principalmente gastrointestinal.…”

Critical analysis of palliative surgical therapy for advanced thoracic esophageal cancer

“…Thus, the method does not provide any quality of life, not contemplating the principles of an adequate palliative therapy. In addition, complications such as invariably aspiration bronchopneumonia, abdominal wall dehiscence, bleeding, digestive fistula with consequent mortality potential and low survival are frequently associated (5,22,23) Thus, the studies reported in the literature serve only as a historical review, since they are from the 1960s, 1970s and early 1980s, when the endoscopic methods presented today were not yet evident. Meniconi (22), in a literature review with 967 patients submitted to this type of procedure, reports complications ranging from 15 to 50%, with a mortality rate of up to 33% with survival time generally, not exceeding 90 days in most of the patients studied and without having rescued a satisfactory quality of life.…”

“…However, in recent years with the most appropriate postoperative care, with teams trained and accustomed to surgical procedures in the esophagus, there was a decrease in morbidity and mortality (14,15,19,23).…”

Immune-Related Long Non-coding RNA Signature and Clinical Nomogram to Evaluate Survival of Patients Suffering Esophageal Squamous Cell Carcinoma

“…There are two main histological types: esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), which differ in etiology, pathogenesis, and biological characteristics. Despite the rapid increase in the incidence of EAC in western countries, ESCC remains dominant in East Asia (Torre et al, 2015), with a poor 5-year overall survival (OS) rate and a high incidence of recurrence and metastasis (Aquino et al, 2013). Although the TNM staging system has been extensively employed as a factor indicating prognosis, due to the heterogeneity of ESCC, there still exist differences in the survival of patients at the same clinical stage.…”