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Oesophagus surgery

David Graham, Gideon Lipman, Vinay Sehgal, Laurence B Lovat
The landscape for patients with Barrett's oesophagus (BE) has changed significantly in the last decade. Research and new guidelines have helped gastroenterologists to better identify those patients with BE who are particularly at risk of developing oesophageal adenocarcinoma. In parallel, developments in endoscopic image enhancement technology and optical biopsy techniques have improved our ability to detect high-risk lesions. Once these lesions have been identified, the improvements in minimally invasive endoscopic therapies has meant that these patients can potentially be cured of early cancer and high-risk dysplastic lesions without the need for surgery, which still has a significant morbidity and mortality...
October 2016: Frontline Gastroenterology
Pravin Rathi, Pravir Gambhire
Abdomen is involved in 11% of patients with extra-pulmonary tuberculosis; The most common site of involvement is the ileocaecal region, other locations of involvement, in order of descending frequency, are the ascending colon, jejunum, appendix, duodenum, stomach, oesophagus, sigmoid colon, and rectum. Apart from the basic work up, Investigations like CT scan, EUS, Capsule endoscopy, Balloon enteroscopy, Ascitic fluid ADA, TB-PCR, GeneXpert, Laproscopy are being increasingly used to diagnose tuberculosis.Therapy with standard antituberculous drugs is usually highly effective for intestinal TB...
February 2016: Journal of the Association of Physicians of India
S M Lagarde, M Navidi, S S Gisbertz, H W M van Laarhoven, K Sumpter, S L Meijer, B Disep, A Immanuel, S M Griffin, M I van Berge Henegouwen
BACKGROUND: The significance of extracapsular lymph node involvement (LNI) is unclear in patients with oesophageal cancer who have undergone neoadjuvant treatment followed by oesophagectomy. The aim of this study was to assess the incidence and prognostic significance of extracapsular LNI in a large multicentre series of consecutive patients with oesophageal cancer treated by neoadjuvant chemotherapy or chemoradiotherapy and surgery. METHODS: Data from a consecutive series of patients treated at two European centres were analysed...
October 3, 2016: British Journal of Surgery
F Klevebro, M Lindblad, J Johansson, L Lundell, M Nilsson
BACKGROUND: Randomized trials have shown that neoadjuvant treatment improves survival in the curative treatment of oesophageal and gastro-oesophageal junction cancer. Results from population-based observational studies are, however, sparse and ambiguous. METHODS: This prospective population-based cohort study included all patients who had oesophagectomy for cancer in Sweden, excluding clinical T1 N0, recorded in the National Register for Oesophageal and Gastric Cancer, 2006-2014...
September 30, 2016: British Journal of Surgery
M C C M Hulshof, H W M van Laarhoven
Oesophageal cancer remains a malignancy with a poor prognosis. However, in the recent 10-15 years relevant progress has been made by the introduction of chemoradiotherapy (CRT) for tumours of the oesophagus or gastro-oesophageal junction. The addition of neo-adjuvant CRT to surgery has significantly improved survival and locoregional control, for both adenocarcinoma and squamous cell carcinoma. For irresectable or medically inoperable patients, definitive CRT has changed the treatment intent from palliative to curative...
August 2016: Best Practice & Research. Clinical Gastroenterology
Pedro David Delgado-López, Antonio Rodríguez-Salazar, Vicente Martín-Velasco, José Manuel Castilla-Díez, Javier Martín-Alonso, Ana Galacho-Harriero, Cecilia Gil-Polo, Elena Araus-Galdós
OBJECTIVE: To describe the specific surgical details and report the lessons learned with a series of patients suffering from spinal tumours that underwent total en bloc spondylectomy (TES). METHODS: A retrospective case series review is presented, together with an analysis of the clinical and technical variables, as well as the outcomes. RESULTS: A total of 10 patients underwent TES (2000-2016) for primary (osteosarcoma, chondrosarcoma, fibrosarcoma and chordoma) and secondary spinal tumours (lung, breast, thyroid, oesophagus, and meningioma metastases)...
September 14, 2016: Neurocirugía
Birgitte-Elise G Emken, Lars R Lundell, Lene Wallin, Helge E Myrvold, Cecilia Engström, Madeleine Montgomery, Anders R Malm, Tore Lind, Jan G Hatlebakk
OBJECTIVE: To compare the effect of anti-reflux surgery (ARS) versus proton pump inhibitor therapy on lower oesophageal sphincter (LOS) function and oesophageal acid exposure in patients with chronic gastro-oesophageal reflux disease (GORD) over a decade of follow-up. MATERIAL AND METHODS: In this randomised, prospective, multicentre study we compared LOS pressure profiles, as well as oesophageal exposure to acid, at baseline and at 1 and 10 years after randomisation to either open ARS (n = 137) or long-term treatment with omeprazole (OME) 20-60 mg daily (n = 108)...
September 3, 2016: Scandinavian Journal of Gastroenterology
Steven Dirven, Jacqueline Allen
PURPOSE OF REVIEW: Investigation and surgical manipulation of the larynx, pharynx, and oesophagus suffer from inherent challenges with access to the sites of interest. To reduce trauma and external scarring, visualization and minimally invasive interventions by the transnasal or transoral routes have become more prevalent. This article discusses engineering methods used to understand and overcome the mechanical constraints inside the airway and upper gastrointestinal tract, and examines the role that robotics and engineering are beginning to play in modelling of surgical interventions in this region...
August 31, 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
B L Powell
A 48-year-old woman was seen in a surgical outpatient clinic with a 2 year history of progressive dysphagia with occasional regurgitation, partially controlled with a proton pump inhibitor. Primary investigations of pH testing and gastroscopy were normal, although a barium swallow study revealed significant hold-up at the aortic arch impression and a posterior right-sided oesophageal impression suggestive of a right-sided aortic arch. A follow-up computed tomography angiogram discovered a vascular ring encircling the trachea and oesophagus, formed by a right-sided aortic arch with aberrant aortic branches, and a Kommerell's diverticulum...
August 23, 2016: Annals of the Royal College of Surgeons of England
E J Jongerius, D Boerma, K A Seldenrijk, S L Meijer, J J G Scheepers, F Smedts, S M Lagarde, O Balague Ponz, M I van Berge Henegouwen, J W van Sandick, S S Gisbertz
BACKGROUND: A complete omentectomy is recommended as part of radical (sub)total gastrectomy for gastric cancer, but there is little evidence to suggest any survival benefit. The aim of this study was to evaluate the incidence of, and risk factors for, metastases in the greater omentum in patients undergoing gastrectomy for gastric cancer. METHODS: This was a multicentre prospective cohort study (OMEGA trial) of consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy...
October 2016: British Journal of Surgery
L Backemar, A Wikman, T Djärv, A Johar, P Lagergren
BACKGROUND: Although health-related quality of life (HRQoL) recovers after surgery for oesophageal cancer in most long-term survivors, one in seven patients experiences a deterioration in HRQoL for reasons yet unknown. The aim of this study was to assess whether co-morbidities diagnosed after surgery influence recovery of HRQoL. METHODS: Patients who underwent surgery for cancer of the oesophagus or gastro-oesophageal junction in Sweden between 2001 and 2005 were included...
August 22, 2016: British Journal of Surgery
Atsushi Omura, Masato Yoshida, Yojiro Koda, Nobuhiko Mukohara
A 79-year-old moderately frail man with a history of graft replacement for descending thoracic aortic aneurysm and chronic kidney disease presented with the onset of haemoptysis. Computed tomography demonstrated aorto-oesophageal fistula secondary to aortic arch aneurysm rupture. Emergency surgery was performed through a median sternotomy. Cardiopulmonary bypass was established via femoral artery inflow and bicaval venous drainage. After establishing circulatory arrest, the aortic arch was excised. Resection of the aortic aneurysm and debridement were performed during antegrade cerebral perfusion and lower body perfusion from femoral artery inflow using balloon occlusion of the previous graft...
August 19, 2016: Interactive Cardiovascular and Thoracic Surgery
G Créhange, F Huguet, L Quero, T V N'Guyen, X Mirabel, T Lacornerie
Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation...
September 2016: Cancer Radiothérapie: Journal de la Société Française de Radiothérapie Oncologique
Tomasz Gil, Janusz Warmus, Janusz Włodarczyk, Zbigniew Grochowski, Krzysztof Bederski, Piotr Kocoń, Piotr Talar, Jarosław Kużdżał
INTRODUCTION: Iatrogenic tracheobronchial injuries are rare. AIM: To analyse the mechanism of injury, symptoms and treatment of these patients. MATERIAL AND METHODS: Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. RESULTS: There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48)...
June 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Anna Pellat, Marie Wislez, Magali Svrcek, Pascal Hammel, Pauline Afchain, Thierry André
Poorly differentiated neuroendocrine tumors are rare but their incidence is rising. High-grade neuroendocrine lung tumors, including small-cell lung cancer, are part of this group. Outside of the lung, they most often arise within the gastrointestinal tract (oesophagus, guts and pancreas) and are called neuroendocrine carcinomas. Due to their rarity, very little is known about neuroendocrine carcinomas of the pancreas and the gastrointestinal tract and few studies have been done. Therefore, most therapeutic recommendations are issued from studies on small-cell lung cancers...
August 6, 2016: Bulletin du Cancer
L J X Giesen, H M Kroon, R van Valen, N M S de Groot, C Kik, B P L Wijnhoven
BACKGROUND: An atrio-oesophageal fistula (AOF) is a rare but severe complication of radiofrequency ablation during video-assisted thoracoscopic pulmonary vein isolation (VATS-PVI). CASE DESCRIPTION: A 68-year-old man presented to the emergency department with reduced general well-being and a fever. Eight weeks prior he had undergone a VATS-PVI. Blood results revealed elevated inflammatory parameters, and blood cultures were positive for Streptococcus anginosus. A CT-scan demonstrated an air configuration in the left atrium...
2016: Nederlands Tijdschrift Voor Geneeskunde
Daniela Zanotti, Mohamed Elkalaawy, Majid Hashemi, Andrew Jenkinson, Marco Adamo
PURPOSE: Preoperative oesophago-gastro-duodenoscopy (p-OGD) is often routinely employed in patients undergoing bariatric surgery. The value of p-OGD is still unclear; however, since all bariatric procedures modify stomach anatomy differently with exclusion of the remnant in a majority of cases, the question arises whether there is a rational for including it routinely in the preoperative pathway. MATERIAL AND METHODS: To assess the current status of p-OGD in the UK, a survey was sent to the British Obesity & Metabolic Surgery Society members, regarding preoperative evaluation of patients, focusing on the role of p-OGD...
September 2016: Obesity Surgery
Alexander Huelsen, Ramadan Oumer, Anna Ashcroft, Ross H Roberts, Grant N Coulter, Steven J Kelly, Murray L Barclay
BACKGROUND: Idiopathic achalasia is a non-curable, primary motility disorder of the oesophagus. Most established long-term palliative treatment options are laparoscopic Heller myotomy (LHM) and endoscopic balloon dilatation (BD). AIM: We aimed to compare the outcome of both therapies and the risk of serious complications, defined as perforation or death, in a single-centre series. METHOD: In this retrospective study, patients with BD or LHM were identified from 1997-2010...
2016: New Zealand Medical Journal
Mikael Lund, Jon A Tsai, Magnus Nilsson, Reidar Winter, Lars Lundell, Sigridur Kalman
BACKGROUND: Neoadjuvant chemoradiotherapy might improve oncological outcome compared with chemotherapy after surgery for oesophagus or gastrooesophageal junction cancer. However, radiotherapy may induce cardiovascular side-effects that could increase the risk of perioperative adverse effects and postoperative morbidity. OBJECTIVES: The aim of this study was to compare the perioperative haemodynamics in patients undergoing oesophagectomy following neoadjuvant chemotherapy or chemoradiotherapy for cancer...
September 2016: European Journal of Anaesthesiology
R Lambertz, H Drinhaus, D Schedler, M Bludau, W Schröder, T Annecke
Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient...
June 2016: Der Anaesthesist
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