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OBJETIVO: evaluar la eficacia del tratamiento con radioterapia (RT) externa mediante radioterapia conformada tridimensional (RTC3D), radioterapia de intensidad modulada (RTIM), terapia con arcos volumétricos modulados (TAVM), y técnica HIBRIDO (RTIM/RTC-3D) en pacientes con diagnóstico de cancer de esófago (CE), localmente avanzado, que acudieron al Servicio de Radioterapia Dr. Enrique Gutiérrez, en el Centro Médico Docente la Trinidad. MÉTODO: se seleccionaron 29 pacientes durante el periodo 2006-2021 que cumplieran con los criterios de inclusión siendo tratados con Radioterapia externa y quimioterapia concurrente. RESULTADOS: Se evaluó una población de 29 pacientes, la mediana de edad fue de 67 años. Predomino el Adenocarcinoma (ADC) en un 58,6%. La técnica de tratamiento más utilizada fue la técnica HIBRIDO (RTIM/ RTC3D) en el 62,1% seguido de RTC3D 20,7%. 19 pacientes fueron a tratamiento concurrente y el esquema más utilizado fue capecitabina/ paclitaxel. Las complicaciones se evaluaron según la técnica siendo grado 3 gastrointestinales, con RTC3D. En relación a Sobrevida Global (SG) a los 2 años fue del 45,5% y a los 5 años de 22,7 %. La Sobrevida libre de progresión a distancia (SLPD) a los 2 años fue del 84.4.3% y a los 5 años del 60,2%; el 58,6% tuvo mejoría de los síntomas al momento de su evaluación final. CONCLUSIÓN: nuestros resultados demuestran que la administración de la Radioterapia en combinación con quimioterapia sigue siendo el tratamiento estándar para CE localmente avanzado, logrando una mejor calidad de vida para los pacientes, y una menor tasa de progresión a distancia.

The effectiveness of an elemental diet (ED) for preventing adverse events (AEs) during chemotherapy for patients with esophageal cancer (EC) remains unclear. The aim of this meta-analysis was to comprehensively assess the efficacy of ED for preventing AE in EC patients during chemotherapy. Medline (via PubMed), Embase, the Cochrane Library, and Web of Science were searched to retrieve prospective and randomized studies published before April 12, 2023. The odds ratio (OR) of each AE was calculated using Review Manger 5.4.1. The risk of bias was assessed, and a random effect model-based meta-analysis was used to analyze the available data. Four prospective and randomized studies involving 237 patients were identified after a systematic search. Regarding gastrointestinal toxicities, the findings indicated a trend toward a decrease in the risk of mucositis (OM) (OR = 0.54, 95 % CI: 0.25-1.14), constipation (OR = 0.87, 95 % CI: 0.49-1.53), and anorexia (OR = 0.99, 95 % CI: 0.32- 3.05), as well as an increasing trend in the risk of diarrhea (OR = 1.48, 95 % CI: 0.79-2.79), among patients treated with ED. However, none of these reached statistical significance. For hematological toxicities, the risk of all-grade neutropenia (OR = 0.28, 95 % CI: 0.14-0.57), grade = 2 leucopenia (OR = 0.43, 95 % CI: 0.22-0.84), grade = 2 neutropenia (OR = 0.34, 95 % CI: 0.17-0.67), and grade = 3 neutropenia (OR = 0.28, 95 % CI: 0.12-0.63) was significantly decreased. There is no firm evidence confirming the preventive effect of an ED against OM or diarrhea. However, an ED may potentially be helpful in preventing neutropenia and leucopenia. [ABSTRACT FROM AUTHOR]

Esophageal carcinoma during pregnancy is an extremely rare condition that presents unique challenges in terms of diagnosis and management. In this case study, we report on a 34-year-old pregnant woman from Somalia/Somaliland who presented with dysphagia and weight loss. She had previously been treated for gastroesophageal reflux disease, but her symptoms worsened over time. Upon examination, the patient exhibited cachexia, palpable cervical nodes, and basal crepitation upon admission. A CT scan of the neck revealed esophageal carcinoma with metastasis, while an ultrasonography confirmed the presence of a 24-week fetus. Due to the limited availability of chemotherapy and cancer treatment facilities, palliative care was initiated, unfortunately resulting in the unfortunate demise of both the patient and the fetus. This case highlights the significant impact of resource scarcity on disease management, as well as the ethical complexities involved in making decisions regarding palliative care for pregnant patients with cancer. It emphasizes the importance of timely diagnosis and the implementation of comprehensive, multidisciplinary approaches in addressing such rare occurrences. Resumen: El carcinoma de esófago durante el embarazo es una afección extremadamente rara que presenta desafíos únicos en términos de diagnóstico y tratamiento. En este estudio de caso, informamos sobre una mujer embarazada de 34 años de Somalia/Somalilandia que presentó disfagia y pérdida de peso. Anteriormente había sido tratada por enfermedad por reflujo gastroesofágico, pero sus síntomas empeoraron con el tiempo. Al ser examinado, el paciente presentaba caquexia, ganglios cervicales palpables y crepitación basal al ingreso. La tomografía computarizada de cuello reveló carcinoma de esófago con metástasis, mientras que la ecografía confirmó la presencia de un feto de 24 semanas. Debido a la limitada disponibilidad de instalaciones de quimioterapia y tratamiento del cáncer, se iniciaron los cuidados paliativos, lo que desafortunadamente resultó en la desafortunada muerte tanto de la paciente como del feto. Este caso pone de relieve el impacto significativo de la escasez de recursos en el manejo de la enfermedad, así como las complejidades éticas involucradas en la toma de decisiones con respecto a los cuidados paliativos para pacientes embarazadas con cáncer. Enfatiza la importancia del diagnóstico oportuno y la implementación de enfoques integrales y multidisciplinarios para abordar estos casos raros.

Background: Self-expanding metal prostheses improve dysphagia in patients with incurable esophageal cancer (EC). New stents have been introduced, and chemoradiotherapy has been implemented for EC, changing patients' risk profiles. It is unknown whether this has affected palliation with stents. Patients and methods: Retrospective study in three centers in Medellín-Colombia; patients undergoing placement of palliative esophageal prostheses for malignant dysphagia (1997-2022). Major and minor complications after implantation, the influence of oncological therapies, and survival were evaluated for 1997-2009 (n = 289) and 2010-2022 (n = 318). Results: 607 patients underwent esophageal prostheses; 296 (48.8%) became complicated. It was higher in the second period (52.5% vs. 48.1%), as were major complications (20.8% vs. 14.2%, p = 0.033), with no differences in minor complications (33.9% vs 31.8%, p = 0.765). Also, 190 (31.3%) patients presented with recurrent dysphagia, stable in both periods. Migration increased over time (from 13.1% to 18.2%, p = 0.09). The most common minor adverse event was pain, increasing over time (from 24.9% to 33.95%, p < 0.01), and associated factors were chemoradiotherapy, absence of fistula, and squamous cell carcinoma. Acid reflux decreased in the second group (p = 0.038). Twelve percent of patients required another intervention for feeding. Survival was not impacted by time and use of stents. Conclusions: Stents are an alternative in non-surgical malignant dysphagia, although recurrent dysphagia has not decreased over time. Minor stent-related complications are increasing in association with the implementation of chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Antecedentes: las prótesis metálicas autoexpandibles mejoran la disfagia en pacientes con cáncer esofágico (CE) incurable. En las últimas décadas se han introducido nuevos tipos de stents y se ha implementado la quimiorradioterapia para el CE, generando cambios en los perfiles de riesgo de los pacientes. Se desconoce si estos cambios han afectado la paliación con stents. Pacientes y métodos: estudio retrospectivo en tres centros de Medellín-Colombia; pacientes sometidos a colocación de prótesis esofágicas paliativas para disfagia maligna (1997-2022). Se evaluaron en dos períodos: 1997-2009 (n = 289) y 2010-2022 (n = 318), complicaciones mayores y menores después del implante, la influencia de las terapias oncológicas y la sobrevida. Resultados: se evaluaron 607 pacientes sometidos a prótesis esofágicas. 296 (48,8%) se complicaron, y fue mayor en el segundo periodo (52,5% frente a 48,1%), al igual que las complicaciones mayores (20,8% frente a 14,2%, p = 0,033), sin diferencias en complicaciones menores (33,9% frente a 31,8%, p = 0,765). 190 (31,3%) pacientes presentaron disfagia recurrente, estable en ambos períodos. La migración aumentó con el tiempo (de 13,1% a 18,2%, p = 0,09). El evento adverso menor más frecuente fue dolor, que aumentó con el tiempo (de 24,9% a 33,95%, p < 0,01), y los factores asociados fueron quimiorradioterapia, ausencia de fístula y carcinoma de células escamosas. El reflujo ácido disminuyó en el segundo grupo (p = 0,038). El 12% de pacientes requirieron otra intervención para alimentarse. No se impactó la sobrevida con el tiempo y uso de stents. Conclusiones: los stents son una alternativa en la disfagia maligna no quirúrgica, aunque la disfagia recurrente no ha disminuido con el tiempo. Las complicaciones menores relacionadas con el stent van en aumento, asociadas a la implementación de la quimiorradioterapia.

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Introduction: Morbidity and mortality continue being high worldwide as consequence of the esophagectomy programmed due to esophagus cancer. Objective: To identify the predictor factors of postsurgical and death complications, hospitalization and death causes in the studied population. Method: A cohort study of 81 patients with diagnosis of esophagus cancer was carried out. They were assisted in Saturnino Lora and Dr. Juan Bruno Zayas Alfonso hospitals in the province of Santiago de Cuba from January, 2010 to December, 2019, of which a random sample of 68 was chosen. To identify the prediction factors associated with the complications and mortality 2 cohorts of sick patients were defined: the exposed and those not exposed to interest factors, such as the thoracotomy realization, reinterventions, besides the infectious medical and surgical complications. The statistical method of Hosmer-Lemeshow was used with a significance level of α = 0,10. Results: If thoracotomy is carried out, the probability that infectious surgical complications are developed is 2.3 times more that if it is not carried out; also, the risk of dying due to this complications (p=0.024), in opposition to when they are not presented, ascends to 370.0 % (IC 90 %: 1.5–14.8). Conclusion: The thoracotomy realization is established as predictor factor of complications and the presence of reinterventions and infectious medical and surgical complications as death predictors in the programmed esophagectomy.

INTRODUCCIÓN: El cáncer de esófago (CE) es una enfermedad severa, sin embargo, hay un porcentaje de pacientes con enfermedad locorregional que son potencialmente curables. Hay algunos pacientes en los que está claro que la cirugía no es posible, y por lo tanto la quimiorradiación definitiva debe ser usada. Con la incorporación de técnicas de radioterapia de intensidad modulada (IMRT) es posible disminuir la dosis que reciben los órganos a riesgo. Esto es de suma importancia ya que en estudios publicados recientemente se demostró que la dosis cardíaca (V30

Introduction: The esophagus cancer is clinically manifested in advanced stages and presents great lethality. Objective: To characterize the patients operated on esophagus cancer according to epidemiological, clinical, diagnostic, histological and pathological variables. Methods: An observational, descriptive and cross-sectional study of 87 patients with esophagus cancer was carried out; they were operated in the General Surgery Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in the period 2014-2018. Results: This affection prevailed in patients from the male sex (94.2 %) between the 65 and 74 years (37.9 %); the most frequent histhologic type was the squamous cell carcinoma (89.6 %) and the localization in the mean third (49.4 %). The toxic habits that prevailed were nicotine addiction (87.4 %) and consumption of alcohol (75.8 %). The dysphagia and loss of weight showed in 73.5 and 66.6 % of the series, respectively. The diagnosis was carried out by means of images, such as esophagogram, chest, abdomen and pelvis contrast tomography, as well as by means of endoscopy and biopsy. Conclusions: It was demonstrated that men are the most affected and it is more frequent the diagnosis in those over 60 years. The link with the habit of smoking and consumption of alcohol was observed. The dysphagia is the most common and late symptom of the disease. The study of clinical, histological and pathological characteristics of patients with esophagus cancer allows an appropriate diagnostic approach of this affection, as well as the development of preventive health actions about the main identified risk factors. [ABSTRACT FROM AUTHOR]

Valorar la utilidad clínica de los criterios PERCIST y de los cambios en los parámetros cuantitativos de la PET/TC con [18F]FDG como factores pronósticos para la supervivencia libre de progresión y la supervivencia cáncer-específica en pacientes con cáncer de esófago tratados mediante quimiorradioterapia. Se valoraron retrospectivamente 50 pacientes (48 hombres) diagnosticados de cáncer de esófago durante un intervalo de 7,5 años. Se utilizaron los criterios PERCIST para valorar la respuesta a la neoadyuvancia. Asimismo, se determinaron las variaciones del SUV máximo, volumen metabólico tumoral y glucólisis tumoral total entre los estudios PET/TC pre- y postratamiento. Las curvas ROC, el método de Kaplan-Meier y el modelo de regresión de Cox se aplicaron para el análisis de factores pronósticos y curvas de supervivencia. El seguimiento medio fue de 26,8 meses, produciéndose 40 recurrencias-progresiones y 41 muertes. El análisis de supervivencia mostró curvas de supervivencia cáncer-específica con diferencias estadísticamente significativas en relación con los criterios PERCIST y la variación del volumen metabólico tumoral y la glucólisis tumoral total. Los criterios PERCIST fueron el único factor predictivo independiente en el análisis multivariante. Ni el SUV máximo ni el tamaño tumoral fueron predictores para ninguno de los criterios de evaluación. La aplicación de los criterios PERCIST, así como el cambio de volumen metabólico tumoral y glucólisis tumoral total de los estudios PET/TC demostraron ser factores pronósticos para la supervivencia cáncer-específica en pacientes de nuestro entorno tratados por cáncer de esófago. Los resultados podrían ayudar a personalizar el tratamiento. To assess the clinical utility of PERCIST criteria and changes in [18F]FDG PET/CT quantitative parameters as prognostic factors for progression-free survival and cancer-specific survival in patients with esophageal cancer treated by chemoradiotherapy. Fifty patients (48 men) diagnosed with esophageal cancer were retrospectively evaluated over a 7.5-year interval. PERCIST criteria were used to assess response to neoadjuvant therapy. Variations in the metabolic parameters maximum SUV, metabolic tumor volume and total lesion glycolysis between pre- and post-treatment PET/CT studies were also determined. ROC curves, Kaplan-Meier method and Cox regression model were used for the analysis of prognostic factors and survival curves. The average follow-up was 26.8 months, with 40 recurrences-progressions and 41 deaths. Survival analysis showed statistically significant differences in cancer-specific survival curves for PERCIST criteria and variation of metabolic tumor volume and total lesion glycolysis. PERCIST criteria were the only independent predictor in the multivariate analysis. Neither maximum SUV nor tumor size were predictors for any of the assessment criteria. Application of PERCIST criteria as well as change in metabolic tumor volume and total lesion glycolysis from PET/CT studies proved to be prognostic factors for cancer-specific survival in patients in our setting treated for esophageal cancer. The results could help to personalize treatment. [ABSTRACT FROM AUTHOR]

Introduction: The esophagus cancer is clinically manifested in advanced stages and presents great lethality. Objective: To characterize the patients operated on esophagus cancer according to epidemiological, clinical, diagnostic, histological and pathological variables. Methods: An observational, descriptive and cross-sectional study of 87 patients with esophagus cancer was carried out; they were operated in the General Surgery Service of Saturnino Lora Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in the period 2014-2018. Results: This affection prevailed in patients from the male sex (94.2 %) between the 65 and 74 years (37.9 %); the most frequent histhologic type was the squamous cell carcinoma (89.6 %) and the localization in the mean third (49.4 %). The toxic habits that prevailed were nicotine addiction (87.4 %) and consumption of alcohol (75.8 %). The dysphagia and loss of weight showed in 73.5 and 66.6 % of the series, respectively. The diagnosis was carried out by means of images, such as esophagogram, chest, abdomen and pelvis contrast tomography, as well as by means of endoscopy and biopsy. Conclusions: It was demonstrated that men are the most affected and it is more frequent the diagnosis in those over 60 years. The link with the habit of smoking and consumption of alcohol was observed. The dysphagia is the most common and late symptom of the disease. The study of clinical, histological and pathological characteristics of patients with esophagus cancer allows an appropriate diagnostic approach of this affection, as well as the development of preventive health actions about the main identified risk factors.

O câncer de esôfago é uma doença epidemiologicamente importante em nosso meio. O consumo de álcool, o tabagismo e o refluxo gastroesofágico estão entre os fatores de risco bem estabelecidos para o desenvolvimento de câncer. As condições prédeterminantes como o esôfago de Barrett, acalasia, estreitamento cáustico e lesões pré-malignas do esôfago apresentam um risco mais elevado para o câncer de esôfago. Estas lesões, portanto, merecem uma maior atenção. O diagnóstico precoce e o tratamento imediato podem permitir uma melhora na sobrevida e uma redução na morbidade e na mortalidade. Este trabalho apresenta algumas considerações a respeito das modalidades de tratamento de lesões precursoras e câncer superficial.

Determinar la utilidad de los parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos para la respuesta al tratamiento neoadyuvante, la supervivencia libre de progresión (SLP) y la supervivencia cáncer específica (SCE) en pacientes con carcinoma de células escamosas de esófago (CCE). Se valoraron retrospectivamente 30 pacientes (29 hombres) diagnosticados de CCE durante un intervalo de 6 años. Se determinaron los parámetros metabólicos SUV máximo (SUVmax), SUV medio (SUVmed), volumen metabólico tumoral (MTV) y glucólisis tumoral total (TLG) del estudio PET/TC al diagnóstico. Tras tratamiento con quimioterapia y/o radioterapia, se valoró la respuesta al tratamiento y la supervivencia de los pacientes. La comparación de parámetros entre grupos de respondedores y no respondedores se realizó mediante la prueba U de Mann-Whitney. Las curvas ROC y el método de Kaplan-Meier se utilizaron para el análisis de factores pronósticos y curvas de supervivencia. El seguimiento medio fue de 22,4 meses, produciéndose 22 recurrencias-progresiones y 25 fallecimientos. Se demostraron diferencias significativas entre respondedores y no respondedores con respecto al tamaño tumoral, el MTV y la TLG. El análisis de supervivencia halló diferencias significativas para SCE y SLP dependiendo de estos tres parámetros. Los parámetros metabólicos MTV y TLG, así como el tamaño tumoral, fueron factores pronósticos para la respuesta al tratamiento neoadyuvante, la SLP y la SCE en pacientes diagnosticados de CCE. Ni el SUVmax ni el SUVmed fueron predictores para ninguno de los criterios de evaluación. Los resultados permitirían personalizar el tratamiento de los pacientes. To determine the utility of 18F-FDG PET/CT quantitative parameters as prognostic factors for the response to neoadjuvant treatment, progression-free survival (PFS) and cancer-specific survival (CSS) in patients with esophageal squamous cell carcinoma (SCC). Thirty patients (29 men) diagnosed with SCC were retrospectively evaluated over a 6-year interval. Metabolic parameters were determined: maximum SUV (SUVmax), mean SUV (SUVmed), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) from baseline PET/CT study. After treatment with chemotherapy and/or radiotherapy, response to treatment and patient survival were assessed. The comparison of parameters between groups of responders and non-responders was carried out using a Mann-Whitney U test. ROC curves and the Kaplan-Meier method were used for analysis of prognostic factors and survival curves. The average follow-up was 22.4 months, with 22 recurrence-progressions and 25 deads. Significant differences were demonstrated between responders and non-responders with respect to tumor size, MTV and TLG. Survival analysis found significant differences for SCE and CSS depending on these three parameters. Metabolic parameters MTV and TLG, and tumor size were prognostic factors for neoadjuvant treatment response, PFS, and CSS in patients diagnosed with SCC. Neither SUVmax nor SUVmed were predictive for any of the evaluation criteria. Results could help to personalize patient treatment. [ABSTRACT FROM AUTHOR]

Introducción: El cáncer de esófago es una enfermedad presente a escala mundial, sobre todo en naciones en vías de desarrollo. Se realizó una revisión bibliográfica en bases de datos biomédicas mediante el motor de búsqueda de información Google académico. Se seleccionaron 24 de 62 artículos; 22 (91,6 %) del último quinquenio, publicados en español e inglés, relacionados con el objetivo propuesto. Objetivo: Describir algunos aspectos del cáncer de esófago, con énfasis en los epidemiológicos, etiopatogénicos y del tratamiento quirúrgico. Desarrollo: El cáncer de esófago es más frecuente en varones, con proporción hombre/mujer de 6:1, aunque en poblaciones de alto riesgo la incidencia es igual en ambos sexos; aunque algunos refieren que la relación es de 3 a 10 hombres por cada mujer, en dependencia de la zona geográfica. Las áreas de alta frecuencia son: Asia, África Central y del Sur. El carcinoma epidermoide y el adenocarcinoma representan el 95,0 % de todos los tumores esofágicos. La esofagectomía abierta o mínimamente invasiva constituye el pilar básico del tratamiento quirúrgico. Conclusiones: En la etiología del cáncer de esófago, los factores moleculares, genéticos y ambientales juegan un papel importante. El diagnóstico en etapas avanzadas predomina debido a lo tardío de la aparición de los síntomas y a las insuficiencias en el cribaje. El tratamiento quirúrgico constituye un pilar fundamental para los tres primeros estadios de la enfermedad, acompañada o no de quimio-radioterapia adyuvante o de neoadyuvancia (en el estadio II).

Introduction: Morbidity and mortality continue being high worldwide as consequence of the esophagectomy programmed due to esophagus cancer. Objective: To identify the predictor factors of postsurgical and death complications, hospitalization and death causes in the studied population. Method: A cohort study of 81 patients with diagnosis of esophagus cancer was carried out. They were assisted in Saturnino Lora and Dr. Juan Bruno Zayas Alfonso hospitals in the province of Santiago de Cuba from January, 2010 to December, 2019, of which a random sample of 68 was chosen. To identify the prediction factors associated with the complications and mortality 2 cohorts of sick patients were defined: the exposed and those not exposed to interest factors, such as the thoracotomy realization, reinterventions, besides the infectious medical and surgical complications. The statistical method of Hosmer-Lemeshow was used with a significance level of α = 0,10. Results: If thoracotomy is carried out, the probability that infectious surgical complications are developed is 2.3 times more that if it is not carried out; also, the risk of dying due to this complications (p=0.024), in opposition to when they are not presented, ascends to 370.0 % (IC 90 %: 1.5-14.8). Conclusion: The thoracotomy realization is established as predictor factor of complications and the presence of reinterventions and infectious medical and surgical complications as death predictors in the programmed esophagectomy. [ABSTRACT FROM AUTHOR]

Se presentan tres observaciones de pacientes portadores de cánceres de esófago, donde se realizó esófago artificial con tubo gástrico-peristáltico subcutáneo. Un paciente fallece al mes de operado, sobreviven dos pacientes: uno en tratamiento de su recidiva fistulosa de cuello y con metástasis reciente y otro con dos años de evolución, clínicamente bien, con buen resultado funcional del tubo gástrico. Se expone lo observado sobre vascularización de los tubos gástricos y sobre la longitud y ascenso logrado. La falla de

Presentado en sesión de 24 de octubre de 1956

Presentado en sesión de 20 de abril de 1955

Introducción: El cáncer de esófago es la octava neoplasia diagnosticada con más frecuencia a nivel mundial, con 456 mil nuevos casos al año. Objetivo: Caracterizar a pacientes con cáncer de esófago que se les realiza esofagectomía subtotal programada. Métodos: Se realizó un estudio observacional, descriptivo de una serie de casos en los servicios de cirugía general de los Hospitales Provincial "Saturnino Lora" y General "Juan B. Zayas" de Santiago de Cuba desde 2010 al 2019. El universo estuvo conformado por 81 pacientes con diagnóstico de cáncer de esófago, de los cuales se seleccionaron 68 por cumplir con los criterios de inclusión. Fueron investigadas variables epidemiológicas, clínicas y quirúrgicas. Se calcularon porcentajes, media aritmética y desviación estándar. Resultados: Se observó predominio de los hombres (88,2 %); dentro de los factores epidemiológicos hubo predominio del hábito alcohólico (75,0 %) y del tabaquismo (58,8 %), la disfagia fue el síntoma más frecuente (48 enfermos). Las lesiones tumorales localizadas en el tercio medio e inferior fueron las más frecuentes. Predominó el carcinoma epidermoide en 52 pacientes y la localización del tumor en el tercio medio esofágico. En cuanto al tipo de resección quirúrgica la más utilizada fue la de McKeown (87,2 %). Conclusión: El cáncer de esófago es más frecuente en varones de la tercera década de la vida, fumadores, consumidores de alcohol y con mal estado nutricional. El patrón histológico predominante es el carcinoma epidermoide vegetante. La esofagectomía transhiatal es la variante técnica más utilizada en su tratamiento quirúrgico.

Introducción: El carcinoma epidermoide constituye la variedad más frecuente de cáncer esofágico. Se considera poco frecuente en la práctica clínica y su evolución es muy agresiva. Objetivo: Describir las manifestaciones clínicas y diagnóstico de un paciente con carcinoma epidermoide de esófago. Caso clínico: Paciente masculino de 46 años de edad, que comenzó con fiebre, tos y disfonía; apareció disfagia 20 días después. Se identificó un tumor por exámenes imagenológicos y se indicó biopsia con toma de muestra, mediante endoscopia superior, de manera que se confirmó la enfermedad. Conclusiones: El cáncer esofágico es una entidad infrecuente. Su síntoma cardinal, la disfagia, no se evidencia al inicio de la enfermedad y su diagnóstico se realiza a través de estudios imagenológicos e histológicos.

Most of thoracotomies that are most frequently used in today's surgical practice were created in the operating rooms of the 20th century. In the search for different therapeutic options to treat cancerous and infectious conditions of the thoracic and mediastinal organs, the fathers of modern thoracic surgery created approaches that have stood the test of time and continue to be practiced, despite the enormous development of minimal access or video-assisted thoracic surgery. However, many surgeons are unaware of the events surrounding the birth of the main classical thoracotomies and, on the other hand, on more than a few occasions history has recognized as the fathers of some techniques those who do not really deserve that credit. In this third part of our review we continue to unravel the history of thoracic incisions, not all of which is well known. [ABSTRACT FROM AUTHOR]

Achalasia is a primary motor disorder of the esophageal smooth muscle characterized by dysphagia, pseudoregurgitation, and weight loss. Treatment can be endoscopic or surgical. The long-term results are only known from surgery, while endoscopic results still have a very short follow-up and do not allow us to draw valid conclusions. Achalasia is a lesion that has a significantly higher probability of developing esophageal cancer, whether of the epidermoid type, due to chronic inflammation and food retention in the esophagus, or an adenocarcinoma, secondary to gastroesophageal reflux, which appears after any treatment. Publications show that about 3 to 4% of patients present in time, about 10 to 15 years after treatment, the development of advanced cancer of the esophagus. It is concluded that clinical and endoscopic follow-up is essential in these patients on a routine basis. [ABSTRACT FROM AUTHOR]

The research aims to describe the temporal-spatial dynamics of deaths from esophageal cancer in the southern region of Brazil, from sex and age group, during the years 2007 to 2017, according to municipalities of residence. The research is a descriptive study, with a quantitative methodological approach. The annual temporal distribution of cases is continuous and the spatial distribution of mortality rates is concentrated in the mesoregions of the Northwest Rio-Grandense, Metropolitan Region of Porto Alegre and Centro Oriental Rio-Grandense for both sexes. Due to the higher male mortality, following the world and Brazilian trend, the mesoregions of the Northeast Rio-Grandense, Southwest Paranaense, North Central Paranaense and Western Catarinense present concentrations for this sex. Female deaths are concentrated in the 75-79 year age group and in the male deaths in the 60-64 year age group in Rio Grande do Sul. In Paraná and Santa Catarina, the peak of women's deaths is in the 65-69 age group and the of men is at 60-64 years old. This research updates the epidemiological profile of the region, which, when mentioned, did not go beyond the regional analysis, so it also deepens it. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal cancer is the sixth leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and potential benefits over esophagectomy for the treatment of esophageal cancer (EC). Aim: To report the results of ESD for EC in a high-volume center in Chile. Materials and Method: Retrospective descriptive study of patients who underwent ESD for EC at our center. Results: A total of 10 patients were treated with ESD for EC between 2010 and 2020. Eighty percent were male patients, the average age was 72 years (63-84). En bloc resection was achieved in all cases and there were no complications or mortality. All of the dissections were classified as R0 and 90% met curative standards. The mean follow-up was 38 months (3.5-123). Overall survival was 90%. Cancer-specific survival was 100% and recurrence-free survival was 100%. Discussion: The rate of morbidity and mortality of esophagectomy is high. ESD would be a safer technique, which allows R0 resections and eventually curation in selected patients with EC limited to the mucosa or submucosa. Conclusion: This is the first report of ESD for the treatment of EC in our country, it shows excellent oncologic results and safety of the procedure, comparable to those reported in the larger series published to date. [ABSTRACT FROM AUTHOR]

RESUMEN Introducción: El cáncer de esófago es una enfermedad muy frecuente con tasas de supervivencia desalentadoras, debido a su naturaleza extremadamente agresiva. Objetivo: Caracterizar clínica, epidemiológica y anatómicamente a los pacientes con cáncer de esófago. Método: Se realizó un estudio descriptivo de casos clínicos que acudieron al servicio de Gastroenterología del Hospital “Dr. Juan Bruno Zayas Alfonsoˮ, en el período comprendido entre junio -noviembre del año 2018. El universo de estudio estuvo conformado por el total de los pacientes de ambos sexos cuya cifra ascendió a 35. Resultados: El grupo de edad que predominó en ambos sexos fue el de 70 años y más, con 37,1 % entre los hombres y 17,1 % en las mujeres. Los hombres fueron los más afectados (68,6 %). La localización anatómica que prevaleció fue a nivel del tercio inferior en un 37,1 % entre los hombres y un 17,1 % entre las féminas. El 57,1 % resultó encontrarse bajo peso, en su mayoría presentaron el esófago de Barret como antecedente patológico personal, acompañado de odinofagia en el 88,6 % de los pacientes. Conclusiones: El estudio permitió caracterizar a los pacientes con cáncer de esófago según variables clínicas, epidemiológicas y anatómicas. Aparece con mayor frecuencia en las últimas décadas de la vida y en etapas avanzadas de la enfermedad, se localiza con mayor frecuencia en el tercio inferior y asociados a antecedentes patológicos personales.

Introducción: El tratamiento quirúrgico del cáncer de esófago sigue siendo un desafío a pesar de los avances en técnica quirúrgica, cuidados pre, post operatorios y complicaciones postoperatorias. Objetivo: Diagnosticar y dar el manejo actualizado en el tratamiento quirúrgico del cáncer de esófago en el hospital nacional Edgardo Rebagliati Martins - EsSalud. Métodos: Se seleccionaron los pacientes con diagnóstico de cáncer de esófago que ingresaron al servicio de cirugía, en el hospital nacional Edgardo Rebagliati Martins – EsSalud, durante el año 2017. Se incluyeron a pacientes de ambos sexos, a partir de 20 años de edad. Para la selección de la muestra se estratificó por edad y sexo de acuerdo al diagnóstico de cáncer de esófago. Resultados: Se diagnosticó 14 pacientes con cáncer de esófago, mediante la historia clínica, exámenes de laboratorio, endoscopia con biopsia, tomografía cervico toraco abdomino pélvica y radiografía esófago estomago duodeno contrastado. No se encontró ningún paciente menor a 40 años, predominó en el sexo masculino, en el grupo etareo entre los 61 y 80 años de edad, todos manifestaron disfagia, odinofagia y pérdida de peso, la complicación post operatoria más frecuente fue fistula de la anastomosis cervical. Conclusión: Se diagnosticaron 14 pacientes con cáncer de esófago, la esofagectomía y la restauración de la continuidad del tracto gastrointestinal son procedimientos complejos y desafiantes. Las fugas anastomóticas y las complicaciones pulmonares son las principales causas de morbimortalidad después de una esofagectomía.

Introduction: Background and aims: esophageal cancer (EC) is an important health problem worldwide with high morbidity and mortality. EC patients are likely to develop malnutrition. The aim of this study was to assess the feasibility and safety of endoscopic gastrostomy (PEG) feeding in EC cancer, and to identify risk factors associated with poor prognosis. Methods: a retrospective observational study was performed using records from EC patients referred for PEG. Age, gender, cancer histologic subtype, indication for gastrostomy, and mortality data were recorded. NRS 2002, body mass index (BMI), hemoglobin, serum albumin, transferrin and total cholesterol were collected at the day of PEG. An association between anthropometric, clinical and laboratorial data with patient survival was assessed. Results: data were obtained for forty-one EC patients (36 men and 5 women) aged 39-88 years (mean, 62 years). Gastrostomy was possible in all patients referred to PEG (27 patients selected for curative treatment and 14 patients for palliative nutrition). No major complications occurred. Mean survival after PEG was 18.1 months, and mortality rate at 3 months was 31.7 %. Most patients (34; 82.9 %) died under PEG feeding. Mean BMI was 21.3 kg/m2 and 14 patients (34.1 %) patients had low BMI. Serum albumin, transferrin and total cholesterol were low in 10 (24.4 %), 20 (48.8 %) and 18 (43.9 %) patients, respectively. Higher BMI (R = 0.30), serum albumin (R = 0.41) and transferrin (R = 0.47) tended to be positively correlated with survival (p < 0.005). Conclusions: PEG is a feasible and safe technique for enteral feeding in EC patients. Higher BMI, serum albumin and transferrin levels at admission predict a better outcome. Enteral feeding through PEG should be considered early in EC patients due to their higher risk of malnutrition, which is associated with shorter survival. [ABSTRACT FROM AUTHOR]

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Introduction and Aims: The outcomes of endoscopic submucosal dissection (ESD) in the esophagus have not been assessed in our country. Our primary aim was to analyze the effectiveness and safety of the technique., Material and Methods: Analysis of the prospectively maintained national registry of ESD. We included all superficial esophageal lesions removed by ESD in 17 hospitals (20 endoscopists) between January 2016 and December 2021. Subepithelial lesions were excluded. The primary outcome was curative resection. We conducted a survival analysis and used logistic regression analysis to assess predictors of non-curative resection., Results: A total of 102 ESD were performed on 96 patients. The technical success rate was 100% and the percentage of en-bloc resection was 98%. The percentage of R0 and curative resection was 77.5% (n=79; 95%CI: 68%-84%) and 63.7% (n=65; 95%CI: 54%-72%), respectively. The most frequent histology was Barrett-related neoplasia (n=55 [53.9%]). The main reason for non-curative resection was deep submucosal invasion (n=25). The centers with a lower volume of ESD obtained worse results in terms of curative resection. The rate of perforation, delayed bleeding and post-procedural stenosis were 5%, 5% and 15.7%, respectively. No patient died or required surgery due to an adverse effect. After a median follow-up of 14months, 20patients (20.8%) underwent surgery and/or chemoradiotherapy, and 9 patients died (mortality 9.4%)., Conclusions: In Spain, esophageal ESD is curative in approximately two out of three patients, with an acceptable risk of adverse events., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Introducción: la multifactorialidad del cancer humano es claramente reconocida. Últimamente se viene asociando virus de la familia del papiloma virus humano (HPV) como condicionante de carcinoma epidermoide de esofago. Caso clínico: describimosel primer casoa nivel de Latinoamérica de un cáncer de esófago con presencia de papilomavirus humano 16 en un trasplantado renal. La paciente de 59 años de edad fue sometida a un trasplante renal once años antes por un síndrome nefrótico de causa no determinada. Recibió inmunosupresores basados en ciclosporina, prednisona y micofenolato de manera initerrumpida. Tres meses antes del diagnóstico la paciente empieza a presentar de manera progresiva disfagia a sólidos asociada a baja ponderal. El estudio endoscópico alto demostró la presencia de una lesión proliferativa ulcerada en tercio medio de esófago. La biopsia esofágica demostró un carcinoma epidermoide. El estudio por PCR para papilomavirus humano subtipo 16 en el tejido tumoral mostró positividad.

Introducción: el cáncer de esófago se considera una entidad poco frecuente, con comportamiento agresivo y curso clínico progresivo. El objetivo de este trabajo es caracterizar clínico y patológicamente a los pacientes con cáncer esofágico diagnosticados en el hospital estudiado. Materiales y Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en 35 pacientes atendidos en el Servicio de Gastroenterología del Hospital Militar Docente “Dr. Mario Muñoz Monroy”, en la ciudad de Matanzas, desde enero del 2012 hasta diciembre del 2013, con el diagnóstico endoscópico e histológico de cáncer de esófago. Se analizaron variables como grupo etáreo, sexo, factores de riesgo, manifestaciones clínicas, tiempo de aparición de los síntomas, tipo endoscópico y tipo histológico que fueron representadas en tablas por frecuencias absolutas y relativas. Resultados: predominó el sexo masculino (85,7 %), con edades mayores de 60 años (88,6 %). La dieta inadecuada, la ingestión de alcohol y tabaquismo fueron factores de riesgo predominantes. La disfagia fue el principal motivo de consulta en dichos pacientes. Todos los casos se diagnosticaron entre los 3 y 6 meses del inicio de los síntomas. endoscópicamente predominó el tipo polipoide o vegetante (63,2 %). La mayoría de los casos estuvieron localizados en el tercio medio esofágico (34,2 %). El carcinoma de células escamosas fue el más frecuente histológicamente (52,6 %).

Endoesophageal brachytherapy is a useful technique for the palliative treatment of dysphagia in advanced oesophageal cancer. This technique offers good results on dysphagia control and quality of life. We report the case of a patient treated with this technique presenting complete response to the dysphagia. We describe endoesophageal brachyterapy technique and we comment on the literature.

Objective: Patients with head and neck squamous cell carcinoma (HNSCC) have an increased risk of second esophageal neoplasms. The aim of the present study is to evaluate the incidence, risk factors and prognosis of second esophageal neoplasms in patients with HNSCC., Methods: A retrospective study of 4711 patients with index tumor in the oral cavity, oropharynx, hypopharynx or larynx between 1985 and 2020 was conducted., Results: During the period analysed 149 patients (3.2%) had a second esophageal neoplasm. The incidence of second esophageal neoplasia was 0.42% per year and remained nearly constant throughout the follow-up period. According to the results of a multivariate study, the risk factors related to the appearance of second esophageal neoplasms were a history of high alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx. The 5-year disease-specific survival rate in patients with a second esophageal neoplasm, calculated from the diagnosis of this second neoplasm, was 10.5%., Conclusions: Patients with a HNSCC have an increased risk of developing of a second esophageal neoplasm. The risk factors associated with the appearance of a second esophageal neoplasm were severe alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx., (Copyright © 2023 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Sleeve gastrectomy has become the most performed bariatric surgery technique in the world. This bariatric technique has been related to the appearance of gastroesophageal reflux and recently with de novo Barrett's esophagus. It is not clear that this leads to an increased incidence of esophageal adenocarcinoma. In this review we analyze the current scientific literature to try to answer the true incidence of Barrett's esophagus and adenocarcinoma after sleeve gastrectomy, and whether these data should make us change the indications for this technique., (Copyright © 2023 AEC. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Post operative leaks of esophageal anastomosis after esophagectomy is a risky event associated with poor postoperative evolution. Its frequency and severity will depend mainly on surgical technical aspects. Objectives: To analyze the frequency, management and prognosis of leakage of esophageal anastomosis after esophagectomy for esophageal cancer. Material and Method: Analysis of our prospective oncologic database of patients with esophageal cancers submmitted to esofagectomy. Statistical analysis with Fisher's exact test. Results: 34 out of 37 esophageal cancer patients were included submitted to completely invasive mini esophagectomy. Cervical anastomosis was performed in 79.4% of patients, in the remaining 20.6%, a distal esophagectomy with intrathoracic anastomosis was performed. The leak rate was 38.2% (13/34), of these, 69.2% (9/13) correspond to grade Clavien - Dindo I - II complications. The leak rate was 54.5% (6/11) for retro-sternal gastric ascensus and 43.7% (7/16) for mediastinal route, without significative difference (p = 1.0). The reoperation rate was 11.7%, being a 100% secondary to mediastinal ascensus, 3 of them were submitted to thoracoscopic toilets and an innominate vein repair. Postoperative mortality rate was 5.8%, all concentrated in the group of patients with posterior mediastinal ascensus, but without statistical difference (p = 0.26). Conclusion: Leaks are frequent in patients operated on for esophageal cancer, especially after cervical esophago-gastro-anastomosis with anterior route for ascensus. However, retro-sternal ascensus did not require re-operations, nor postoperative mortality compared to gastric ascensus through posterior mediastinum. [ABSTRACT FROM AUTHOR]

Introduction: despite advances in surgical and adjuvant therapy, recurrence in esophageal cancer submitted to R0 surgery remains high. The aim is to define risk factors and recurrence patterns. Additionally, to show the management carried out and the outcome of patients showing recurrence. Material and methods: observational and prospective study that included 61 patients. Neoadjuvancy therapy was indicated on T3, T4 and N+ tumors and every lymph node dissection was performed in two fields. Recurrence is defined at distance, regional or local, when, recurrence is detected after six months. According to clinical features and the recurrences, a palliative, chemotherapeutic or surgical management was indicated. Results: there were 54 men and the mean age was 59.7 years. The most frequent stage was the IIA and 17 (27.9%) had positive lymph nodes. Thirty (49.2%) had showed recurrence with a median disease-free interval of 10.5 months. The pTNM, the absence of response to the neoadjuvancy and the presence of compromised lymph nodes were found to be risk factors for recurrence. Only the presence of compromised lymph nodes was significant in the multivariate analysis. After diagnosis of the recurrence, median survival was 7 months and 6 subjects survived beyond 1 year. Conclusions: we confirmed the high incidence of recurrence in esophageal cancer, where the presence of compromised lymph nodes is probably the main risk factor. After the diagnosis of a relapse the prognosis would be bad, however there would be a small subsidiary group for treatment where outcomes would be better.

Background: Determination of Basal Energy Expenditure (BEE) is essential for planning nutritional therapy in patients with esophageal cancer. Aims: The objective of this study was to determine BEE through indirect calorimetry (IC) in patients with squamous cell carcinoma of the esophagus (SCC). Methods: Cross-sectional study involving 30 patients admitted with a diagnosis of SCC who underwent IC before starting cancer therapy. The BEE was evaluated using IC and also estimated by means of the Harris-Benedict Equation (HBE). Nutritional assessment was conducted using anthropometric parameters (body mass index, arm circumference, triceps skinfold thickness, arm muscle circumference, and weight loss), biochemical parameters (albumin, transferrin and C-reactive protein) and tetrapolar bioimpedance to assess body composition (fat free mass). Additionally, lung capacity was measured and clinical staging of the cancer established by the TNM method. Results: The mean of the BEE for IC and Harris-Benedict Equation were 1421.8 ± 348.2 kcal/day and 1310.6 ± 215.1 kcal/day, respectively. No association was found between BEE measured by IC and clinical staging (p=0.255) or the Tiffeneau Index (p=0.946). There were no significant associations between BEE measured by IC and altered dosages of transferrin, albumin and C-reactive protein (p=0.364, 0.309 and 0.780 respectively). The factors most associated with BEE were BMI and fat free mass. Conclusion: The BEE of patients with SCC was underestimated when using the HBE, and the result overestimated when incorporating an injury factor with the HBE. Therefore, despite the practical difficulties of implementing IC, its use should be considered.

Como alternativa para reducir las complicaciones de la esofagectomía convencional, en los enfermos con cáncer, se ha propuesto la cirugía mínimamente invasiva. Se presentan 2 pacientes operados de esofagogastrectomía videoasistida, mediante movilización esofágica videotoracoscópica, esofagogastrectomía videolaparoscópica asistida y cervicotomía, uno en 2008 y el otro en 2009. Uno de ellos es un paciente masculino, de 45 años, con un carcinoma epidermoide del tercio inferior del esófago, operado sin accidente quirúrgico, y una fístula de la anastomosis cervical como única complicación; y el otro, un paciente masculino también, de 64 años con esófago de Barret y displasia severa/carcinoma intramucoso, no accidentes, se complica con neumonía derecha y fístula cervical. La esofagectomía mínimamente invasiva para el tratamiento del cáncer de esófago es técnicamente posible.The minimally invasive surgery has been proposed as alternative to reduce the complications of conventional esophagectomy in patients with cancer. This is the case of two patients operated on video-assisted esophagogastrectomy by means of video-thoracoscopy esophageal mobilization, assisted video-laparoscopy esophagogastrectomy and cervicotomy, one of them in 2008 and the other in 2009. A male patient aged 45 presenting with epidermoid carcinoma of the inferior third of esophagus, operated on sin surgical accident and also a fistula of the cervical anastomosis as the only explanation. A male patient aged 64 with Barrer't esophagus and severe dysplasia/ intramucosa carcinoma, non accidents who became complicated due to a right pneumonia and cervical fistula. The minimally invasive esophagectomy for treatment of esophagus cancer is technically possible.

INTRODUCCIÓN. En más del 75 % de los pacientes con cáncer de esófago, los procedimientos que se realizan son paliativos y existe un dilema ético sobre la forma de solucionar el problema fundamental: la alimentación. El objetivo de esta investigación fue señalar la importancia de las infiltraciones con alcohol absoluto para lograr la implantación de prótesis esofágicas artesanales por el método de tracción. MÉTODOS. Se realizó un estudio prospectivo y lineal con pacientes con cáncer de esófago irresecable, ingresados entre 1995 y 2009. Fueron evaluados 112 pacientes, de los cuales 65 fueron tratados con métodos paliativos. Se colocaron 55 prótesis esofágicas y en 10 de estos casos fue necesario canalizar previamente el tumor con infiltraciones de alcohol absoluto. RESULTADOS. Se consiguió pasar la sonda nasogástrica en el 90 % de los pacientes que necesitaron infiltraciones de alcohol absoluto. Fueron necesarias entre 1 y 2 sesiones, pero uno de los pacientes necesitó 3 sesiones de infiltración. No hubo complicaciones. CONCLUSIONES. La combinación de alcohol absoluto y prótesis permite eliminar la disfagia en el cáncer avanzado de esófago y cardias. Cuando existe estenosis total, el alcohol absoluto es un método adecuado para canalizar la estenosis tumoral de esófago antes de colocar la prótesis. En la mayoría de los casos son suficientes 1 o 2 sesiones de infiltración.INTRODUCTION. In more than 75% of patients presenting with esophageal cancer the procedures performed are of type palliative and there is a ethical dilemma on the way to solve the major problem: the feeding. The objective of present paper was to emphasize the significance of infiltrations with absolute alcohol to achieve the implantation of handmade esophageal prostheses using the traction method. METHODS. A linear and prospective study was performed in patients presenting with non-resectable esophageal cancer admitted between 1995 and 2009. A total of 112 patients were assessed with 65 of them treated using palliative methods. Fifty five esophageal prostheses were placed and in 10 of these cases it was necessary to tunnelled previously the tumor with absolute alcohol infiltrations. RESULTS. The nasogastric tube was passed in the 90% of patients needing infiltrations of absolute alcohol. One or two sessions were necessary but one of them need three sessions of infiltrations without complications. CONCLUSIONS. The combination of absolute alcohol and prosthesis allows to eliminate the dysphagia in cases of advanced cancer and cardias. When there is a total stenosis, the absolute alcohol is a appropriate method to canalize the esophageal tumoral stenosis before to place the prosthesis. In most of cases are enough 1 or 2 sessions of infiltrations.

Durante el período comprendido entre 1990 y 2006, 28 pacientes fueron sometidos a resección esofágica por cáncer en el Servicio de Cirugía de Tórax del Hospital Dr. Rafael Á. Calderón Guardia. La edad promedio fue de 65 años y la relación hombre mujer, de 6 a 1. El antecedente de tabaquismo se confirmó en un 80%, etilismo en un 75% y 8 pacientes eran conocidos portadores de esófago de Barret. Disfagia, dolor epigástrico y pérdida de peso fueron los síntomas más frecuentes; siendo la epigastralgia debida a otra patología digestiva coexistente, como reflujo o enfermedad péptica. Los pacientes clasificados como estadio IIb, III y IV recibieron terapia de inducción y aunque en 3 de estos no se encontró tumor residual en la pieza quirúrgica, en 2 casos quedó tumor adherido a la aorta. A 21 pacientes se les realizó esofagectomía total con ascenso gástrico y anastomosis cervical y a 7 esofagectomía parcial con ascenso gástrico al tórax en 5 y 2 esófago-yeyuno anastomosis, una intratorácica y otra abdominal. La complicación más frecuente fue la claudicación respiratoria por bronconeumonía, que se produjo en 7 pacientes y que fue mortal en 3. Dos de estos pacientes presentaron además fuga de anastomosis, una en el cuello y otra en el tórax. A largo plazo la complicación más frecuente fue estrechez de la anastomosis, que en los 7 casos se ha manejado con dilataciones. La mortalidad quirúrgica fue del 10.7% y en los 3 casos la bronconeumonía fue la causa principal. La supervivencia a 5 y 10 años fue del 31.5% y el 18%, respectivamente.Between 1990 and 2006, 28 patients had esophageal cancer resection at the Department of Thoracic Surgery of the Hospital Calderón Guardia of the Costa Rican Social Security System. The mean age was 65 years with a high male predominance of 6:1. Eighty percent of the patients were smokers, 75% drinkers and 8 patients had previous diagnosis of Barret’s esophagus. Dysphagia, epigastric pain and weight loss were the most frequent symptoms but the pain was related to preexisting peptic disease or esophagitis secondary to gastric reflux. Stage IIb, III and IV patients received neoadyuvant therapy. Three of these cases did not show residual tumor and 2 had residual aortic disease. Twenty one patients had total esophagectomy and 7 patiens had partial esophagectomies with gastric anastomosis in 5 and 2 esophagojejunostomies. Major complications were respiratory distress and bronchopneumonia in 7 patients, and anastomotic leak in 2. Thirty days mortality was 10.7%. The 3 patients died with bronconeumonía and one with cervical and other thoracic leak. Seven patients developed anastomotic strictures treated with dilatations. Survival at 5 and 10 years was 31.5% and 18% respectively.