Abstract Robot assisted minimally invasive esophagectomy (RAMIE) has been reported to be potential advantages in previous reports. Here we demonstrate the difference between these two minimally invasive procedures and investigated the surgical results of RAMIE in comparison with MIE using propensity matched-cohort. Methods We investigated 154 cases of thoracic esophagectomy conducted between 2020/1 to 2021/1. Among these cases, we analyzed 30 cases of RAMIE in comparison with 30 cases of matched-cohort which conducted conventional thoracoscopic esophagectomy (MIE) in the prone. Then we evaluated the surgical results between two groups. Results There were no differences in age (69.2 vs 69.1 yo), gender (M:F = 24:6 vs 24:6), cStage (Stage I,II,III,IV:6,3,14,7 vs 8,3,14,5), and preoperative chemotherapy (70% vs 66.7%) between RAMIE and matched-cohort MIE. There was statistically significant difference in total time of thoracic phase (233.1 vs 173.3 min; p < 0.01). There were no significant differences in postoperative events in RAMIE vs MIE (Clavien-Dindo Grade 1≧; Recurrent laryngeal nerve paralysis (RLNP) (16.7 vs 20.0%; p = 0.19). However, after the learning curve archived, seldom cases were diagnosed postoperative RLNP in RAMIE cases in comparison with MIE (p = 0.06). Conclusion We demonstrated the formalization of our procedure and surgical results of RAMIE. There were no significant differences in postoperative events between two groups. However RLNP was lower after the learning peak. Incidence of RLNP could be reduced in RAMIE.
Hoarseness is one of the classical symptoms in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), and it results from recurrent laryngeal nerve palsy, which is caused by nodal metastasis along the recurrent laryngeal nerve or by main tumors. We reviewed the short-term and long-term results of esophagectomy for patients with locally advanced ESCC and hoarseness at diagnosis.Patients who initially presented with hoarseness from recurrent laryngeal nerve palsy between 2009 and 2018 and underwent esophagectomy for thoracic ESCC were eligible for this study. Pharyngolaryngectomy or cervical ESCC were exclusionary.A total of 15 patients were eligible, and 14 underwent resection of the recurrent laryngeal nerves. The remaining patient had nerve-sparing surgery. Nine patients (60%) had post-operative complications ≥ Clavien-Dindo class II and, pulmonary complications were most common. Two patients (13%) died in the hospital. The 5-year overall survival rate for all patients was 16%. Age (≤ 65 years), cT1/T2 tumor, and remarkably good response to neoadjuvant treatment were likely related to longer survival; however, these relationships were not statistically significant.Esophagectomy for ESCC patients who are diagnosed with recurrent laryngeal nerve paralysis at initial presentation could be a treatment option if the patient is relatively young, has a cT1/T2 tumor, or shows a remarkably good response to neoadjuvant treatment. However, clinicians should be aware of the possibility of postoperative pulmonary complications, which were frequently observed with the procedure.
After the severe accident at the Fukushima-1 Nuclear Power Plant in March 2011, radioactive contamination of food has become a matter of serious concern in Japan. There is considerable information about radioactive iodine and cesium, but little is known about uranium contamination. We determined uranium content in spinach by the Japanese official method (Manual on Radiation Measurement of Food in Emergency Situations). In the preliminary study, we confirmed that the use of a microwave digestion system for preparing the test solution of spinach could shorten the testing time and give acceptable results. The manual recommends the use of two elements (Tl and Bi) as internal standards for measurement of uranium by ICP-MS. We found that Tl was more suitable than Bi to quantify trace amounts of uranium in spinach. However, it was necessary to determine Tl or Bi concentrations in the sample before analysis, since some samples of spinach contained significant amounts of these elements. The uranium contents of 9 spinach samples bought in April and May 2011 were less than 10 μg/kg, which are very low compared to the provisional regulatory limit in Japan.
An interlaboratory study was performed to evaluate the equivalence between an official method and a modified method of evaporation residue test using heptane as a food-simulating solvent for oily or fatty foods, based on the Japanese Food Sanitation Law for food contact products. Twenty-three laboratories participated, and tested the evaporation residues of nine test solutions as blind duplicates. In the official method, heating for evaporation was done with a water bath. In the modified method, a hot plate was used for evaporation, and/or a vacuum concentration procedure was skipped. In most laboratories, the test solutions were heated until just prior to dryness, and then allowed to dry under residual heat. Statistical analysis revealed that there was no significant difference between the two methods. Accordingly, the modified method provides performance equal to the official method, and is available as an alternative method. Furthermore, an interlaboratory study was performed to evaluate and compare two leaching solutions (95% ethanol and isooctane) used as food-simulating solvents for oily or fatty foods in the EU. The results demonstrated that there was no significant difference between heptane and these two leaching solutions.
Abstract Diffusely infiltrative esophageal squamous cell carcinoma is so rare that very few studies have been reported. Therefore, it has not been clear whether the survival of patients with this disease is poor or not. In this study, we retrospectively investigated our long-term results of radical esophagectomy for patients with diffusely infiltrative esophageal squamous cell carcinoma in our institution. In addition, we tried to detect prognostic factors of this disease if possible. Data were retrospectively collected from medical records. Eligible patients underwent esophagectomy for esophageal squamous cell carcinoma with diffuse infiltration from 2002 to 2018 in our institution. Diagnosis of this disease was done in the conference of esophageal surgical team based on the findings of endoscopy and upper gastrointestinal series. Overall survival rates were calculated by the Kaplan–Meier method, and statistical significance was determined by the log-rank. P value of<0.05 was considered statistically significant. 32 patients were selected in this study. Median age was 66 years old, cStage I/II/III/IV was 0/10/14/8 patients respectively, preoperative treatment was undergone for 11 patients. 5-year overall survival (OS) rate was 27.3% and 3-year OS rate was 37.5%. 5-year OS rate for each cStage II/III/IV was 48.0%, 14.3% 25.0%. Patients who underwent preoperative treatment seemed to have poor prognosis with statistically significant difference. Patients with clinical or pathlogical supraclavicular lymph node metastasis tended to have poor prognosis. In this study, about 20% patients could obtain long-term survival. Therefore, surgical intervention could be one of the treatments for the patient with this disease. And also, we may take into account the postoperative treatment for the patient with poor prognostic factor.
