Aims Endoscopic myotomy (POEM) was shown equally effective as laparoscopic Heller myotomy (LHM) in patients with achalasia at two years in a multicenter randomized trial. Postprocedural reflux esophagitis and treatment with acid inhibitors were more frequent after POEM. Here we report treatment success rate and analysis of post-procedural reflux at the five-year follow-up.
The aim of this study was to assess outcomes of endoscopic treatment in patients with 'high-risk' early esophageal cancer (EEC). 'High-risk' cancer was defined as any cancer with sm invasion or mucosal cancer with at least one of the following: poor differentiation, invasion to blood or lymphatic vessels and high tumor cell dissociation. The main outcome measurement was tumor-free survival.
The authors compare in a small group of patients the results of treatment of perforation of peptic gastroduodenal ulcers. Some patients were treated by suture using a miniinvasive approach and some by classical laparotomy. The first laparoscopic treatment of a perforated ulcer was made at the Third Surgical Clinic in July 1995. Since then up to February 1997 thus eight patients were treated. During the same period seven patients were treated by the classical approach. Comparison of the period of hospitalization, postoperative complications, consumption of analgesics and postoperative temperature in these almost identical groups revealed that the results are more favourable after laparoscopic sutures.
We prospectively investigated whether metabolic response assessed by 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (PET/CT) early in the course of neoadjuvant chemotherapy is predictive of survival in patients with adenocarcinoma of the esophagus and esophagogastric junction.PET/CT was performed before and in the third week after the initiation of the first cycle of neoadjuvant chemotherapy, which consisted of epirubicin, cisplatin, and 5-fluorouracil or capecitabine.The metabolic response was defined as a relative decrease in the peak standardized uptake value (SUL) of the tumor by ≥35% or total lesion glycolysis (TLG) by ≥66%.The associations of metabolic response with overall survival (OS) and disease-free survival (DFS) were investigated using Kaplan-Meier curves and multivariable Cox regression analysis.Among 126 recruited patients, the early metabolic response was assessed in 107 patients (90 of them underwent surgical resection).The five-year OS and DFS rates of all patients were 28% and 27%, respectively.No difference was found in OS (p=0.10 for SUL, p=0.08 for TLG) or DFS (p=0.50 for SUL, p=0.20 for TLG) between metabolic responders and non-responders.Post hoc analysis of the patients with a follow-up PET/CT within 16 days showed that metabolic response reflected by SUL predicted OS (p=0.03).We concluded that metabolic response assessed by PET/CT after the first cycle of neoadjuvant chemotherapy does not predict survival in patients with adenocarcinoma of the esophagus and esophagogastric junction.However, proper timing of the follow-up PET/CT may affect the prognostic ability of the early metabolic response.
Abstract Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.
Early diagnosis of sepsis and its differentiation from non-infective SIRS is very important. The links between inflammation and coagulation play an important role in the SIRS/sepsis process. We investigated hematological and biochemical parameters (including thromboelastography (TEG)) in patients after surgical resection of esophagus. The aim of our project was to find out whether there are any changes in these parameters that could help in differentiation between SIRS and sepsis.
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