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  • 1
    Online Resource
    Online Resource
    Hazard Curves for Tumor Recurrence and Tumor-Related Death Following Esophagectomy for Esophageal Cancer
    MDPI AG ; 2020
    In:  Cancers Vol. 12, No. 8 ( 2020-07-27), p. 2066-
    Details
    In: Cancers, MDPI AG, Vol. 12, No. 8 ( 2020-07-27), p. 2066-
    Abstract: Background: The knowledge of both patterns and risk of relapse following resection for esophageal cancer is crucial for establishing appropriate surveillance schedules. The aim of this study was to evaluate the pattern of hazards for tumor recurrence and tumor-related death in the postoperative long-term follow-up after esophagectomy. Methods: Retrospective single-center analysis of 362 patients, with resected esophageal cancer. Multivariate Cox proportional hazard model was used. Results: A total of 192 (53%) had postoperative tumor recurrence. The relapse patterns of adenocarcinoma and squamous-cell carcinoma showed that each had a single peak, 12 months after surgery. After induction there was one peak at 5 months, the non-induced patients peaked 11 months, postoperatively. At 18 months, the recurrence hazard declined sharply in all cases. The hazard curves for tumor-related death were bimodal for adenocarcinoma, with two peaks at 6 and 22 months and one single peak for squamous-cell carcinoma at 18 months after surgery, showing pronounced decline later on. Conclusion: In curatively resected esophageal cancer, both tumor recurrence hazard and hazard for tumor-related death showed distinct, partly bimodal patterns. It could be justified to intensify the surveillance during the first two postoperative years by initiating a close-meshed follow-up to detect and treat tumor recurrence, as early as possible.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers12082066
    Language: English
    Publisher: MDPI AG
    Publication Date: 2020
    detail.hit.zdb_id: 2527080-1
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  • 2
    Online Resource
    Online Resource
    Persistent Head and Neck Cancer Following First-Line Treatment
    MDPI AG ; 2018
    In:  Cancers Vol. 10, No. 11 ( 2018-11-03), p. 421-
    Details
    In: Cancers, MDPI AG, Vol. 10, No. 11 ( 2018-11-03), p. 421-
    Abstract: Background: Following first-line treatment of head and neck cancer (HNC), persistent disease may require second-line treatment. Methods: All patients with HNC treated between 2008 and 2016 were included. Second-line treatment modalities and survival of patients were analyzed. Results: After first-line therapy, 175/741 patients had persistent disease. Of these, 112 were considered eligible for second-line treatment. Second-line treatment resulted in 50% complete response. Median overall survival of patients receiving second-line therapy was 24 (95% CI: 19 to 29) months; otherwise survival was 10 (9 to 11; p 〈 0.0001) months. Patients receiving second-line surgery had a median overall survival of 45 (28 to 62) months, patients receiving second-line radiotherapy had a median overall survival of 37 (0 to 79; p = 0.17) months, and patients receiving systemic therapy had a median overall survival of 13 (10 to 16; p 〈 0.001) months. Patients with persistent HNC in the neck had a better median survival (45 months; 16 to 74 months; p = 0.001) than patients with persistence at other sites. Conclusion: Early treatment response evaluation allows early initiation of second-line treatment and offers selected patients with persistent disease a realistic chance to achieve complete response after all. If possible, surgery or radiotherapy are preferable.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    URL: Article
    DOI: 10.3390/cancers10110421
    Language: English
    Publisher: MDPI AG
    Publication Date: 2018
    detail.hit.zdb_id: 2527080-1
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  • 3
    Online Resource
    Online Resource
    A nomogram illustrating the probability of anastomotic leakage following cervical esophagogastrostomy
    Springer Science and Business Media LLC ; 2021
    In:  Surgical Endoscopy Vol. 35, No. 11 ( 2021-11), p. 6123-6131
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 35, No. 11 ( 2021-11), p. 6123-6131
    Abstract: Early diagnosis of anastomotic dehiscence following cervical esophagogastrostomy may become difficult. Estimation of an individual probability could help to establish preventive and diagnostic measures. The predictive impact of epidemiological, surgery-related data and laboratory parameters on the development of anastomotic dehiscence was investigated in the immediate perioperative period. Methods Retrospective study in 412 patients with cervical esophagogastrostomy following esophagectomy. Epidemiological data, risk factors, underlying disease, pre-treatment- and surgery-related data, C-reactive protein and albumin levels pre-and post-operatively were evaluated. We applied univariable and multivariable logistic regression analysis and developed a nomogram for individual risk assessment. Results There were 345 male, 67 female patients, mean aged 61.5 years; 284 had orthotopic, 128 retrosternal gastric pull-up; 331 patients had carcinoma, 81 non-malignant disease. Mean duration of operation was 184 min; 235 patients had manual, 113 mechanical and 64 semi-mechanical suturing; 76 patients (18.5%) developed anastomotic dehiscence clinically evident at mean 11.4 days after surgery. In univariable testing young age, retrosternal conduit transposition, manual suturing, high body mass index, high ASA and high postoperative levels of C-reactive protein were predictors for anastomotic leakage. These six parameters which had yielded a p 〈 0.1 in the univariable analysis, were entered into a multivariable analysis and a nomogram allowing the determination of the patient’s individual risk was created. Conclusion By using the nomogram as a supportive measure in the perioperative management, the patient’s individual probability of developing an anastomotic leak could be quantified which may help to take preventive measures improving the outcome.
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-020-08107-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 1463171-4
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  • 4
    Online Resource
    Online Resource
    Stage-based treatment for thymoma in due consideration of thymectomy: a single-center experience and comparison with the literature
    Springer Science and Business Media LLC ; 2015
    In:  World Journal of Surgical Oncology Vol. 13, No. 1 ( 2015-12)
    Details
    In: World Journal of Surgical Oncology, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2015-12)
    Type of Medium: Online Resource
    ISSN: 1477-7819
    URL: Article
    DOI: 10.1186/s12957-015-0718-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 2118383-1
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  • 5
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    Online Resource
    Frequency and Consequences of Cervical Lymph Node Overstaging in Head and Neck Carcinoma
    MDPI AG ; 2022
    In:  Diagnostics Vol. 12, No. 6 ( 2022-06-02), p. 1377-
    Details
    In: Diagnostics, MDPI AG, Vol. 12, No. 6 ( 2022-06-02), p. 1377-
    Abstract: Clinical lymph node staging in head and neck carcinoma (HNC) is fraught with uncertainties. Established clinical algorithms are available for the problem of occult cervical metastases. Much less is known about clinical lymph node overstaging. We identified HNC patients clinically classified as lymph node positive (cN+), in whom surgical neck dissection (ND) specimens were histopathologically negative (pN0) and in addition the subgroup, in whom an originally planned postoperative radiotherapy (PORT) was omitted. We compared these patients with surgically treated patients with clinically and histopathologically negative neck (cN0/pN0), who had received selective ND. Using a fuzzy matching algorithm, we identified patients with closely similar patient and disease characteristics, who had received primary definitive radiotherapy (RT) with or without systemic therapy (RT ± ST). Of the 980 patients with HNC, 292 received a ND as part of primary treatment. In 128/292 patients with cN0 neck, ND was elective, and in 164 patients with clinically positive neck (cN+), ND was therapeutic. In 43/164 cN+ patients, ND was histopathologically negative (cN+/pN−). In 24 of these, initially planned PORT was omitted. Overall, survival did not differ from the cN0/pN0 and primary RT ± ST control groups. However, more RT ± ST patients had functional problems with nutrition (p = 0.002). Based on these data, it can be estimated that lymph node overstaging is 26% (95% CI: 20% to 34%). In 15% (95% CI: 10% to 21%) of surgically treated cN+ HNC patients, treatment can be de-escalated without the affection of survival.
    Type of Medium: Online Resource
    ISSN: 2075-4418
    URL: Article
    DOI: 10.3390/diagnostics12061377
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2662336-5
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  • 6
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    Individualized, multimodal palliative treatment of inoperable esophageal cancer: Clinical impact of photodynamic therapy resulting in prolonged survival
    Wiley ; 2012
    In:  Lasers in Surgery and Medicine Vol. 44, No. 3 ( 2012-03), p. 189-198
    Details
    In: Lasers in Surgery and Medicine, Wiley, Vol. 44, No. 3 ( 2012-03), p. 189-198
    Abstract: In esophageal carcinoma palliative treatment is often required due to advanced tumor stage or patient‐related factors. The main goal of our retrospective single center study was to evaluate the effect of an individualized multimodal palliative treatment, focusing on the efficacy of different treatment options. Materials and Methods Between 1999 and 2009, 640 patients suffering from esophageal carcinoma were referred to our division. Two hundred fifty out of those (39.1%) were treated with palliative intention by using a individualized, multimodal concept including endoscopic dilatation, photodynamic therapy (PDT), endoluminal brachytherapy, external radiation, chemotherapy, stenting, feeding tube, and palliative resection. Results There were 37 women (14.9%) and 211 men (85.1%). The treatment included PDT in 171 cases (in 118 as first measure), stenting in 124 (38), dilatation in 83 (24), endoluminal brachytherapy in 92 (20), feeding enterostomy in 40 (14), external radiation in 67 (23), chemotherapy in 57 (29), and palliative resection in 3 patients. The mean number of palliative treatments per patient was 2.6. Mean survival time for the collective was 34 months. Distant metastases and nodal positivity were connected with a significantly reduced survival. If PDT was used in the first place, median survival was 50.9 months compared to 17.3 months if other options were used as initial modality ( P  = 0.012). Conclusion By using an individualized multimodal approach, an acceptable mean survival time can be achieved in advanced esophageal cancer treated with palliative intention. PDT, if used as initial endoluminal treatment in patients without gross tumor infiltration into the mediastinum, the great vessels or the tracheo‐bronchial tree, enables a considerable beneficial effect in the palliative setting. Lasers Surg. Med. 44:189–198, 2012. © 2012 Wiley Periodicals, Inc.
    Type of Medium: Online Resource
    ISSN: 0196-8092 , 1096-9101
    URL: Issue
    URL: Article
    DOI: 10.1002/lsm.v44.3
    DOI: 10.1002/lsm.22006
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 1475539-7
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  • 7
    Online Resource
    Online Resource
    Self-Expanding Bifurcation Stent for Malignant Esophagotracheobronchial Fistula
    SAGE Publications ; 2009
    In:  Asian Cardiovascular and Thoracic Annals Vol. 17, No. 1 ( 2009-02), p. 79-81
    Details
    In: Asian Cardiovascular and Thoracic Annals, SAGE Publications, Vol. 17, No. 1 ( 2009-02), p. 79-81
    Abstract: A 60-year-old man with esophageal carcinoma in the upper 3rd underwent palliative treatment including photodynamic therapy, brachytherapy, external beam irradiation, and esophageal stenting. He developed a symptomatic malignant esophagotracheobronchial fistula that could not be closed by telescope-stenting in the esophagus. Implantation of a self-expanding, covered metal, tracheal bifurcation stent by flexible bronchoscopy resulted in immediate closure of the fistula with an uneventful recovery.
    Type of Medium: Online Resource
    ISSN: 0218-4923 , 1816-5370
    URL: Article
    DOI: 10.1177/0218492309102527
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2044527-1
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  • 8
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    Online Resource
    Acute effects of combined photodynamic therapy and hyperbaric oxygenation in lung cancer-A clinical pilot study : Photodynamic Therapy, Hyperbaric Oxygenation, and Lung Cancer
    Wiley ; 2001
    In:  Lasers in Surgery and Medicine Vol. 28, No. 5 ( 2001-06), p. 399-403
    Details
    In: Lasers in Surgery and Medicine, Wiley, Vol. 28, No. 5 ( 2001-06), p. 399-403
    Type of Medium: Online Resource
    ISSN: 0196-8092
    URL: Issue
    URL: Article
    DOI: 10.1002/lsm.v28:5
    DOI: 10.1002/lsm.1067
    Language: English
    Publisher: Wiley
    Publication Date: 2001
    detail.hit.zdb_id: 1475539-7
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  • 9
    Online Resource
    Online Resource
    PS01.034: GENDER AND BODY MASS INDEX HAVE AN INFLUENCE ON DELAYED GASTRIC EMPTYING FOLLOWING ESOPHAGECTOMY AND GASTRIC PULL-UP
    Oxford University Press (OUP) ; 2018
    In:  Diseases of the Esophagus Vol. 31, No. Supplement_1 ( 2018-09-01), p. 59-59
    Details
    In: Diseases of the Esophagus, Oxford University Press (OUP), Vol. 31, No. Supplement_1 ( 2018-09-01), p. 59-59
    Abstract: Delayed gastric emptying is a common feature after gastric pull-up for reconstruction following esophagectomy. Symptoms range from mild discomfort to life-threatening recurrent aspiration. Apart from the well-known and technically inevitable truncal vagotomy neither causative factors nor effective preventive measures have been clearly identified. Methods We did a retrospective study in 381 patients (317 males, 64 females; age: 22 -88 years; mean: 62,4 years), who underwent esophagectomy and gastric pull-up with cervical esophagogastrostomy between 1/2008 and 12/2017. During this period the surgical technique had been the same except that in the first phase no intervention at the pylorus had been done (N = 207), whereas in the second pyloromytomy (N = 97) and in the third (N = 110) intrapyloric injection of Botulinum-toxin was performed. Delayed gastric emptying was diagnosed by distension of the conduit with an air-fluid level on chest roentgenogram, and by symptoms and signs of regurgitation or vomiting in absence of other bowel obstruction. 122 patients had retrosternal pull-up due to transmural tumour growth or lymph-nodes, in 259 the orthotopic route was chosen. All patients were followed-up for at least three months after the operation. Results 56 patients (14,7%) developed delayed gastric emptying. Neither pyloromytomy nor injection of Botox had any effect as compared with the patients in the no-intervention period. The route of gastric pull-up had no influence either. In women (N = 15; 23,4%), however, delayed gastric emptying was significantly more frequent than in men (N = 41; 12,9%; P = 0.03). Moreover, the Body Mass Index (BMI) of patients with delayed gastric emptying (BMI = 26.6) was significantly higher than in those who had not (BMI = 24,7; P = 0.03). By multivariate analysis the influence of gender and BMI on the development of delayed gastric emptying remained significant. Conclusion The results of our single center retrospective analysis may show that both, gender and BMI might significantly influence the development of postoperative delayed gastric emptying after esophagectomy and reconstruction by gastric pull-up. For a better understanding and management of delayed gastric emptying prospective trials with larger numbers of patients are definitely needed. Disclosure All authors have declared no conflicts of interest.
    Type of Medium: Online Resource
    ISSN: 1120-8694 , 1442-2050
    URL: Article
    DOI: 10.1093/dote/doy089.PS01.034
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2004949-3
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  • 10
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    Online Resource
    As time goes by–developments in surgery for esophageal cancer in the new millennium
    Springer Science and Business Media LLC ; 2022
    In:  European Surgery Vol. 54, No. 3 ( 2022-06), p. 144-149
    Details
    In: European Surgery, Springer Science and Business Media LLC, Vol. 54, No. 3 ( 2022-06), p. 144-149
    Abstract: In the last two decades, both treatment options and epidemiological features of cancer have changed. We studied the influence of related parameters on the outcome of patients undergoing resection for esophageal carcinoma. Methods We analyzed 499 consecutive patients who underwent esophagectomy for carcinoma since January 2000, comparing 2000–2010 with 2011–2021 and examining changes over time. Results The percentage of men (87.9 vs. 86.9%; p  = 0.74) in the two groups was unchanged, whereas mean age increased significantly from 60.8 to 65.2 years ( p  = 0.000). There was a trend towards an increase of adenocarcinoma (gamma = 0.120, ASE = 0.055). Despite significantly increasing use of induction chemoradiotherapy ( p  = 0.000) from 7.14% in 2000 to 68.9% in 2021 the distribution of pT, pN stage, grading and the rate of positive lateral resection margins remained unchanged. When comparing the two periods, the overall 30-day mortality was 4.4 vs. 4.2% ( p  = 0.56), recurrence-free survival was 36.9 vs. 38% at 60 months and 33.9 vs. 36.4% at 120 months ( p  = 0.93). Tumor-associated survival was 41.1 vs. 45% at 60 months and 35.5 vs. 38.7% at 120 months ( p  = 0.78). None of the survival rates differed significantly. A multivariable analysis of year of surgery, age, sex, histological subtype, grading, pT, pN, lateral resection margin, and induction therapy showed that only higher pT ( p  = 0.01), positive pN ( p  = 0.000), positive lateral margin ( p  = 0.003), squamous cell carcinoma ( p  = 0.04) and higher grading ( p  = 0.026) had a statistically significant, independent, negative influence on prognosis. Conclusion Optimized noninvasive and invasive therapeutic modalities have produced only marginal improvement in the prognosis of esophageal cancer within the last two decades.
    Type of Medium: Online Resource
    ISSN: 1682-8631 , 1682-4016
    URL: Article
    DOI: 10.1007/s10353-022-00752-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2029279-X
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