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Surgery continues to be the mainstay of esophageal cancer treatment. However, it is a big challenge for the surgical treatment of patients with both esophageal cancer and coronary artery disease (CAD).We reported, here, the first case series of esophageal cancer patients treated with simultaneous esophagectomy and off-pump coronary artery bypass grafting (CABG). From August 2010 to August 2012, 2154 esophageal or esophageal gastric junction (EGJ) cancer patients underwent surgical treatment in Tangdu Hospital, Xi'an, China. Among them, six patients with esophageal or EGJ esophageal gastric junction cancer complicated with CAD were given simultaneous esophagectomy and off-pump CABG, and were followed up until August 2014. Four patients were operated through left lateral thoracotomy and two patients were operated through median sternotomy plus upper midline laparotomy. All the patients survived the operation well and the postoperative morbidity rate was 67% (one anastomosis leakage, three cardiac arrhythmias). There was no postoperative mortality. The mean follow-up time was 34.5±7.8 months (range, 24-46 months). One patient died 36 months later due to tumor recurrence and all the other patients survived until the time to follow up. Simultaneous esophagectomy and off-pump CABG approachmight be a safe and effective procedure with good survival in selected patients with both esophageal cancer and CAD. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic values of using autoantibodies in sera to a panel of eight tumor-associated antigens ( TAAs) of P53, Koc, P62, C-myc, IMP1, Survivn, P16 and Cyclin B1 full-length recombinant proteins for early detection of patients with gastric cardia adenocarcinoma ( GCA) and high-risk subjects screening. Enzyme-linked immunosorbent assay was used to detect autoantibodies against the eight selected TAAs in 383 sera samples from four groups, including 140 subjects with normal gastric cardia epithelia ( NOR), 76 patients with chronic atrophic gastritis ( CAG), 79 patients with gastric cardia dysplasia ( DYS) and 88 patients with GCA. In addition, the expression of the eight antigens was analyzed in gastric cardia tissues by immunohistochemical method. The individual autoantibodies to six TAAs ( P53, P62, IMP1, Survivn P16 and Cyclin B1) were significantly higher in sera from patients with GCA than that in normal subjects ( P < 0.05). When autoantibody assay successively accumulated to seven TAAs ( P53, Koc, P62, C-myc, IMP1, Survivn and P16), a stepwise increased detection frequency of autoantibodies was found in the four sera groups (13% in NOR, 39% in CAG, 46% in DYS, and 64% in GCA, respectively), the risks to CAG, DYS and GCA steadily increased about 4.4-, 5.7- and 12.0-fold. The sensitivity and the specificity for autoantibodies against the seven TAAs in diagnosing GCA reached up to 64% and 87%, respectively. The area under the receiver operating characteristic curve for the seven anti- TAA autoantibodies was 0.73 (95% CI: 0.68-0.78) No more increase in sensitivity was found with the addition of new anti- TAA autoantibodies. A combination detection of autoantibodies to TAAs might be helpful to distinguish GCA patients from normal subjects and the patients with gastric cardia precancerous lesions. In addition, further studies in patients with GCA and precancerous lesions using enlarged TAA panels might improve the sensitivity and specificity of cancer detection and high-risk subjects screening. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the diagnostic values by detecting sera autoantibodies to eight tumor-associated antigens ( TAAs) of P53, IMP1, P16, cyclin B1, P62, C-myc, Survivn and Koc full-length recombinant proteins for the screening of high-risk subjects and early detection of esophageal squamous cell carcinoma ( ESCC). Enzyme-linked immunosorbent assay was used to detect autoantibodies against the eight selected TAAs in 567 sera samples from four groups, including 200 individuals with normal esophageal epithelia ( NOR), 214 patients with esophageal basal cell hyperplasia ( BCH), 65 patients with esophageal dysplasia ( DYS), and 88 patients with ESCC. In addition, the expression of the eight antigens in esophageal tissues was analyzed by immunohistochemistry. Statistically significant distribution differences were identified among the four groups for each of the individual autoantibodies to six TAAs ( P53, IMP1, P16, cyclin B1, P62, and C-myc); the detection rates of antoantibodies were positively correlated with the progression of ESCC. When autoantibody assay successively accumulated to six TAAs ( P53, IMP1, P16, cyclin B1, P62, and C-myc), a stepwise increased detection frequency of autoantibodies was found in the four sera groups (6% in NOR, 18% in BCH, 38% in DYS, and 64% in ESCC, respectively), the risks to BHC, DYS, and ESCC steadily increased about 3-, 9-, and 27-folds. The sensitivity and the specificity for autoantibodies against the six TAAs in diagnosing ESCC reached up to 64% and 94%, respectively. The area under the receiver operating characteristic curve for the six anti- TAA autoantibodies was 0.78 (95% confidence interval 0.74-0.83). No more increasing in sensitivity was found with the addition of new anti- TAA autoantibodies. A combination detection of autoantibodies to TAAs might distinguish ESCC patients from normal individuals and the patients with esophageal precancerous lesions. [ABSTRACT FROM AUTHOR]

It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the incidence of recurrent laryngeal nerve paralysis after esophagectomy was sought. A total of 115 patients diagnosed with esophageal cancer were enrolled in the thoracic section of the Tangdu Hospital of the Fourth Military Medical University from April 2008 to April 2009. Clinical parameters of patients, the morbidity, and the mortality following esophageal resection were recorded and compared. After the surgery, a 2-year follow up was completed. It was found that recurrent laryngeal nerve paralysis and postoperative pneumonia were more frequently diagnosed in the patients that did not receive continuous recurrent laryngeal nerve monitoring (6/61 vs. 0/54). Furthermore, positive mediastinal lymph nodes ( P = 0.015), total mediastinal lymph nodes ( P < 0.001), positive total lymph nodes ( P = 0.027), and total lymph nodes ( P < 0.001) were more often surgically removed in the patients with continuous recurrent laryngeal nerve monitoring. These patients also had a higher 2-year survival rate ( P = 0.038) after surgery. It was concluded that continuous intraoperative recurrent laryngeal nerve monitoring is technically safe and effectively identifies the recurrent laryngeal nerves. This may be a helpful method for decreasing the incidence of recurrent laryngeal nerve paralysis and postoperative pneumonia, and for improving the efficiency of lymphadenectomy. [ABSTRACT FROM AUTHOR]

A retrospective review of 18 patients treated for Boerhaave's syndrome in our center from 1954 to 2006 was undertaken. The patients were divided into two groups: group 1, the time delayed before treatment was less than 24 hours; group 2, the time delayed was more than 24 hours. The time interval between perforation and the onset of treatment in group 2 was from 50 hours to 30 days. Roentgenograms of the chest and esophagogram with a water-soluble contrast medium are able to reveal the perforation in most cases, and thoracentesis or thoracic drainage after swallow methylene blue may provide help as well. Surgical intervention was adopted in all three patients in group 1 and 12 in group 2, and conservative intervention in three in group 2. In group 1, two patients recovered uneventfully, the other one developed a postoperative respiratory infection, and he recovered after the infection was controlled. The mortality in group 2 was 33.3% (5/15), and the mortality in patients with conservative intervention was 100% (3/3). Five complications occurred after surgical intervention in group 2, including four fistulae and one incision infection. In conclusion, it may be appropriate to manage patients aggressively with primary repair and adequate mediastinal and pleural drainage when patients present late. Because of the syndrome's initial severity and a tendency to postoperative complications, patients should be closely monitored, and correct antibiotic therapy and adequate nutrition are very important in treatment. [ABSTRACT FROM AUTHOR]

SUMMARY. The level of transforming growth factor β1 (TGFβ1) and transforming growth factor βII receptor (TGFβRII) was determined immunohistochemically in normal tissues and tissues with different severities of lesions (basal cell hyperplasia, BCH; dysplasia, DYS; carcinoma in situ , CIS; and squamous cell carcinoma, SCC) from surgically resected human esophagi and esophageal biopsies of symptom-free subjects. The samples were from an area with high esophageal cancer incidence in northern China (Linzhou, formerly Linxian, and nearby county Huixian in Henan Province). Peroxidase immunostain (ABC) and conventional hematoxylin and eosin stain were used. The tissue sections were incubated with antibodies of TGFβ1 and TGFβRII overnight. The immunoreactivity was observed in cytoplasm of the esophageal specimen. From normal to BCH to DYS to CIS and to SCC, the positive immunostaining rates for TGFβ1 increased significantly (P < 0.05). A linear correlation between the positive immunostaining rates of TGFβ1 and the different lesions was observed (P < 0.05). From well- to moderately- and poorly differentiated SCC, the positive immunostaining rates for TGFβ1 decreased gradually, but the difference was not significant (P > 0.05). In contrast, with the lesions progressing from normal to BCH to DYS to CIS and to SCC, the positive immunostaining rates for TGFβRII decreased significantly (P < 0.05). From well- to moderately- and poorly differentiated SCC, the positive immunostaining rates for TGFβRII decreased significantly (P < 0.05). There was a linear correlation between the positive rates of TGFβRII and different lesions and SCC differentiation (P < 0.05). The present results indicated that the alterations of TGFβ1 and TGFβRII is a frequent event in esophageal multistage carcinogenesis, the absent or lower expression of TGFβRII may lead to the loss of cell proliferation control by TGFβ1 and the... [ABSTRACT FROM AUTHOR]

SUMMARY. The objective of this study was to characterize the histologic changes from endoscopic screening for early esophageal cancer (EC) on subjects at high-incidence area (HIA) and low-incidence area (LIA) in Henan, China, and to further compare the changes in p53 and proliferating cell nuclear antigen (PCNA) in the multistage of human esophageal carcinogenesis from these two populations. The detection rate of basal cell hyperplasia (BCH) and dysplasia (DYS) was higher in the subjects from HIA than in those from LIA. Out of the 1568 symptom-free subjects examined at HIA, 10 (0.6%) cases with early squamous cell carcinoma (SCC) were identified. Immunoreactivity of p53 and PCNA was observed in cell nuclei of esophageal biopsies and surgically resected esophageal cancer specimens both in HIA and LIA. With the lesions progressed from normal epithelium to BCH to DYS to SCC, the positive-immunostaining cells expanded from basal layer to superficial layer, and the number of positive cells/mm2 for p53 and PCNA increased, and was significantly higher in HIA than in LIA among the similar morphological lesions (P < 0.01). The number of p53 positive cells/mm2 in SCC from HIA was almost fivefold higher than SCC from LIA (P < 0.01). The remarkable difference was also observed between HIA and LIA in DYS and BCH. The present results indicate that p53 protein accumulation is an important early biomarker for identifying high-risk subjects for EC. [ABSTRACT FROM AUTHOR]

Neoadjuvant chemotherapy (NAC) significantly extends survival in advanced esophageal squamous cell carcinoma (ESCC), but the short-term outcomes for cT4 ESCC remain controversial. Many NAC regimens have been previously reported, although no study has reported a regimen of irinotecan and nedaplatin for cT4 potential resectable ESCC. We evaluated the short-term outcomes of NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC. A total of 51 patients with cT4 potentially resectable ESCC were eligible for this study. Twenty of these patients underwent NAC, and the other 31 patients underwent surgery alone. The toxicities and response of NAC were evaluated. The clinicopathologic characteristics, responses, toxicities, surgical outcomes, postoperative complications, and survival time between the two groups were analyzed. No significant differences were found in clinicopathologic characteristics between the groups (P  > 0.05). The response rate of NAC was 75% (15/20). The differences in the long-axis diameter of the tumor and cT stage between pre- and post-NAC were significant (P  < 0.05). Twenty-four toxic events occurred in 11 patients of the NAC group, and 20/24 of these were mild. The R0 resection rates in the NAC group and the surgery alone group were 85% and 64.5%, with no statistically significant difference (P  > 0.05). Differences in the pathological T stage and pathological tumor-node-metastasis (TNM) stage were significant (P  < 0.05). The overall survival (OS) time and mortality in the NAC group versus the surgery alone group were 31.57 ± 3.06 months versus 15.24 ± 1.46 months and 25% versus 61.3%, respectively. The differences in OS and mortality were significant (P  < 0.05). The NAC group and R0 resection were significant and independent predictors of positive prognosis. NAC with irinotecan and nedaplatin in a single cycle followed by esophagectomy on cT4 resectable ESCC as a new NAC is safe and effective. [ABSTRACT FROM AUTHOR]