Development of less invasive surgical procedures for thoracic esophageal cancer

Okazumi, Shinichi; Ochiai, Takenori; Shimada, Hideaki; Matsubara, Hisahiro; Nabeya, Yoshihiro; Miyazawa, Yasumasa; Shiratori, Tooru; Aoki, Taito; Sugaya, Makoto

doi:10.1111/j.1442-2050.2004.00379.x

Cited by 15 publications

(23 citation statements)

References 21 publications

(40 reference statements)

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“…Several reports identifi ed improvements in anesthesia, surgical techniques and devices, and postoperative care as factors that have reduced postoperative morbidity and mortality [10][11][12]. These factors have contributed to improved survival rates in elderly patients with esophageal cancer.…”

Section: Survival In Elderly Patientsmentioning

confidence: 98%

Therapeutic management of elderly patients with esophageal cancer

et al. 2008

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Background. In an aging population, it is important to evaluate the therapeutic management of diseases. Esophagectomy is a reliable treatment for esophageal cancer, but it remains controversial for elderly patients as it could carry additional postoperative risks. Methods. Between April 1994 and March 2004, 418 patients with esophageal cancer were registered at our hospital. Clinicopathological factors and therapeutic outcomes for 65 patients aged over 75 years (elderly patients) and 353 patients aged under 75 years (nonelderly patients) were compared retrospectively. Results. In total, 19 patients aged over 75 years and 203 patients aged under 75 years underwent resection. The elderly patients were characterized by short operation times, surgery by transhiatal approach, organ reconstruction using the jejunum, fewer lymph nodes removed, and frequent comorbid disease. Curative resections were performed in 16 elderly patients (84.2%) and 173 nonelderly patients (85.2%). Postoperative morbidity did not differ between the two groups, but hospital death was more frequent in elderly patients. The overall survival time was signifi cantly higher for nonelderly patients. However, the disease-specifi c survival did not differ between the two groups. Nonsurgical treatments were administered to 46 elderly patients and 150 nonelderly patients; no signifi cant difference in survival was observed between the two groups. The overall survival times were not different between surgical treatment and nonsurgical treatment in the elderly group. Conclusions.Elderly patients obtained similar therapeutic benefi ts from esophagectomy as did nonelderly patients through careful management of comorbid disease and good perioperative care. Also, nonsurgical treatment is a useful treatment option for elderly patients. A well-designed randomized trial, of surgical versus nonsurgical treatment, should be conducted in the elderly to clarify this concern.

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Section: Survival In Elderly Patientsmentioning

confidence: 98%

Therapeutic management of elderly patients with esophageal cancer

et al. 2008

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“…For the improvement of long‐term survival, it is essential to minimize mortality by optimizing surgical techniques and perioperative care 17, 18, 19. In addition, severe infections, pulmonary complications, and liver dysfunction require extended intensive care and long hospital stays for some patients 9, 20.…”

Section: Introductionmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

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PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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“…The included studies reported on a variety of eight cancer types: pancreatic adenocarcinoma [19,28], non-small-cell lung cancer [20,23,34], ovarian [21], rectal [22,33], colorectal [25,31], endometrial [26], oesophageal [27,29,30,32], and breast cancer [24]. Sample sizes range from 37 [27] to 2628 [24] patients and the follow-up periods from six months to ten years. The glucocorticoid exposures ranged from a single administration of low dose dexamethasone to repetitive very high doses of methylprednisolone.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

Hølmich

Hasselager

Madsen

et al. 2019

Cancers

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The surgical stress response can accelerate clinical metastasis formation. Perioperative glucocorticoids might modulate this response and the metastatic process. We aimed to describe associations between perioperative glucocorticoids and long-term outcomes after cancer surgery. We searched four databases for eligible trials and performed meta-analyses on frequency and time-to-event data. We included sixteen studies that evaluated eight different cancer types. No association was found between perioperative glucocorticoids and recurrence in either the frequency meta-analysis, risk ratio (RR) 1.04, 95% confidence interval (CI) (0.87-1.25), or in the time-to-event meta-analysis, hazard ratio (HR) 1.18, 95% CI (0.78-1.79). Increased 1-year overall survival, RR 0.70, 95% (0.51-0.97), and disease-free survival, RR 0.77, 95% CI (0.60-0.97), was found for the glucocorticoid group, but five years after surgery, overall survival was reduced for the glucocorticoid group, RR 1.64, 95% CI (1.00-2.71). An exploratory subgroup analysis revealed decreased overall survival, HR 1.78, 95% CI (1.57-2.03), for patients undergoing colorectal cancer surgery while receiving glucocorticoids. Perioperative glucocorticoids were not associated with recurrence after cancer surgery. We found neither beneficial or deleterious associations between glucocorticoids and overall survival or disease-free survival. The available evidence remains heterogenous; low in quality and amount; and cancer-specific at present.Cancers 2020, 12, 76 2 of 22 such as glucocorticoids. Preliminary animal studies have investigated the effect of steroids on cancer progression and the results are not conclusive [6,7]. Some suggest that endogenous glucocorticoids released from prolonged stress response may hinder natural killer (NK) cell activity, which is essential in malignant defence, but the effect might not be as significant as the NK cell suppression mediated by stress related catecholamines [8]. On the other hand, the anti-inflammatory effects of glucocorticoids might prove beneficial in breaking the inflammatory cycle.Glucocorticoids are known to modulate the inflammatory stress response and are increasingly used in the perioperative period. Administration of low-dose perioperative dexamethasone is used for prevention of postoperative nausea and vomiting (PONV). Use of high dose glucocorticoids has been shown to have analgesic effects and may even decrease the risk of postoperative complications [9] without increasing short-term adverse events [10]. It appears that glucocorticoids are safe and beneficial for immediate postoperative outcomes. However, evaluation of safety and possible benefits on long-term oncologic outcomes remain to be shown. Furthermore, it has been recommended that the effect of adjunct medications for anaesthesia on oncological outcomes should be prioritized by researchers [11].In this study, we hypothesized that the use of perioperative glucocorticoids may impact long-term survival after cancer surgery. We aimed to describe the possible assoc...

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Development of less invasive surgical procedures for thoracic esophageal cancer

Cited by 15 publications

References 21 publications

Therapeutic management of elderly patients with esophageal cancer

Therapeutic management of elderly patients with esophageal cancer

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Long-Term Outcomes after Use of Perioperative Glucocorticoids in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analysis

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