Current state of esophageal cancer surgery in China: a national database analysis

Abstract

BackgroundThe present standard of surgical treatment for esophageal cancer is country dependent. The aim of the present study was to investigate the basic aspects of surgical procedures performed for esophageal cancer, and provide information about the present state of esophageal cancer surgery in China.MethodsData were obtained from a database administered by the Chinese Ministry for Health. A total of 542 participating hospitals were divided into seven geographic areas, and 10% of hospitals in each area were randomly chosen for inclusion. All patients with esophageal cancer, who underwent esophagectomy in these participating hospitals from January 1 to December 31, 2015, were included in the present study. The clinical characteristics, stage of tumor at diagnosis, operation summary and outcomes, and histological findings of patients were extracted and analyzed.ResultsThe present study included 11,791 patients, and the average number of patients per hospital was 218. Squamous cell carcinoma was the most common pathological type, while the mid-esophagus was the most common location. Open procedures were performed in 63.8% of patients, while minimally invasive esophagectomy was performed in 36.2% of patients. Multiple approaches to transthoracic esophagectomy were utilized. Two-field lymphadenectomy was the most frequently performed (64.8%), followed by three-field lymphadenectomy (21.8%). Gastric tubes, thoracic duct ligation and postoperative enteral nutrition were implemented to minimize complications.ConclusionThe standard operative procedure and detailed technique for esophageal carcinoma surgery is presently being debated in China. This survey provides some basic information about the present state of esophageal cancer surgery countrywide.

High expression of collagen 1A2 promotes the proliferation and metastasis of esophageal cancer cells

“…Surgery, medical radiotherapy, chemotherapy, and emerging gene detection targeted therapy are used to treat ESCA (19). However, these treatments may result in some side effects, such as esophageal anastomotic leakage, anastomotic stenosis, infection, and other post-operative complications (20).…”

Pretreatment-assisted robot intrathoracic layered anastomosis: our exploration in Ivor-Lewis esophagectomy

“…At present, limited to the complexity of esophagogastric anastomosis (EGA), most MIE in China was performed via McKeown esophagectomy with cervical EGA (3,4). However, for patients with lower-thoracic esophageal cancer, esophagogastric junction cancer and even some mid-thoracic esophageal cancer, which accounted for more than 80% of the total cases in China (5), minimal invasive Ivor-Lewis esophagectomy (MIILE) with intrathoracic EGA would be a better choice because the anastomosis site was lower and closer to the gastroepiploic arterial arcade. Patients with intrathoracic EGA would get better functional results with less posteroperative complications (6,7).…”

The modern approach to esophagectomy—review of the shift towards minimally invasive surgery

“…Transhiatal esophagectomy involves incisions in the abdomen and neck with a cervical anastomosis. The McKeown technique tends to predominate in Asia due to recommendations of three field lymphadenectomy and higher rates of proximal squamous cell cancer vs. the West where more distal adenocarcinoma is more common and the Ivor-Lewis technique is preferred (3,4,13,14). MIE has been described as having either thoracoscopy with laparotomy, thoracotomy with laparoscopy, or thoracoscopy with laparoscopy, with the neck incision always performed in an open manner.…”