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Thorax Mar 1968In the treatment of instrumental perforation of the obstructed thoracic oesophagus, relief of obstruction is one of the prerequisites of success. In some cases it is...
In the treatment of instrumental perforation of the obstructed thoracic oesophagus, relief of obstruction is one of the prerequisites of success. In some cases it is better to resect both the perforation and the original lesion rather than to rely on repair and drainage. The salient features of 19 cases of emergency oesophagectomy collected from the literature have been tabulated, and three new examples are here reported. The results are encouraging. The operation usually performed for malignant cases is a one-stage oesophagogastrectomy with oesophagogastrostomy; a two-stage procedure is recommended for benign lower-end strictures. The lacerated oesophagus and the stricture are resected at the emergency operation, and the fundus of the stomach, advanced into the chest, is anastomosed to the oesophagus. The whole of the stomach is thereby preserved for the elective reconstruction which constitutes the second stage.
Topics: Aged; Carcinoma, Squamous Cell; Esophageal Diseases; Esophageal Neoplasms; Esophageal Perforation; Esophagoscopy; Esophagus; Female; Gastrectomy; Gastrostomy; Humans; Male; Middle Aged
PubMed: 5654080
DOI: 10.1136/thx.23.2.204 -
Ultrasound in Obstetrics & Gynecology :... Dec 2019To evaluate the feasibility of antenatal direct visualization of normal and abnormal fetal esophagus using three-dimensional ultrasound (3D-US) with Crystal Vue... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the feasibility of antenatal direct visualization of normal and abnormal fetal esophagus using three-dimensional ultrasound (3D-US) with Crystal Vue rendering technology.
METHODS
Between February and April 2018, 3D-US volumes were collected from a non-consecutive series of singleton pregnancies, referred for clinically indicated detailed prenatal ultrasound at 19-28 weeks' gestation to one of two fetal medicine units in Italy. 3D volumes were acquired from a midsagittal section of the fetal thorax and upper abdomen with the fetus lying in supine position. Postprocessing with multiplanar mode was applied to orientate the volume and identify the esophagus. The region of interest was angled by approximately 30° to the spine and its thickness was adjusted in order to optimize visualization of the intrathoracic and intra-abdominal course of the esophagus. Crystal Vue software was used for image rendering of the fetal trunk in the coronal plane. Postnatal follow-up was available in all cases.
RESULTS
During the study period, 91 pregnancies met the inclusion criteria and were recruited. The study cohort included two pregnancies with suspicion of esophageal atresia due to suboptimal visualization of the stomach. Of the 89 cases with normal stomach on two-dimensional (2D) imaging, 3D-US with Crystal Vue rendering technology allowed direct evaluation of the whole course of the esophagus in 74 (83.1%). In the two cases with small or absent stomach bubble on 2D imaging, esophageal atresia was demonstrated antenatally on 3D Crystal Vue imaging and was confirmed postnatally. The mean time required for offline postprocessing and visualization of the esophageal anatomy was 4 min.
CONCLUSIONS
Using 3D-US with Crystal Vue rendering, it is possible to visualize antenatally the normal fetal esophagus and demonstrate presence of esophageal atresia. This should facilitate prenatal counseling and management of cases with suspected esophageal atresia. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Esophageal Atresia; Esophagus; Female; Fetus; Humans; Imaging, Three-Dimensional; Italy; Observational Studies as Topic; Pregnancy; Pregnancy Trimester, Second; Prenatal Diagnosis; Software; Stomach; Ultrasonography, Prenatal
PubMed: 30672651
DOI: 10.1002/uog.20221 -
Digestive Surgery 2011Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cervical anastomosis and thoracic anastomosis are used for gastric tube reconstruction after esophagectomy for cancer. This systematic review was conducted in order to identify randomized trials that compare cervical with thoracic anastomosis.
METHODS
A literature search for randomized trials was performed in the following databases: Medline, Embase and the Cochrane Library.
RESULTS
A total of 4 trials were included. All studies had a small sample size and were of moderate quality. One trial was excluded from the meta-analysis. The following outcomes were significantly associated with a cervical anastomosis: recurrent laryngeal nerve trauma (OR: 7.14; 95% CI: 1.75-29.14; p = 0.006) and anastomotic leakage (OR: 3.43; 95% CI: 1.09-10.78; p = 0.03). None of the following outcomes were associated with the location of the anastomosis: pulmonary complications (OR: 0.86; 95% CI: 0.13-5.59; p = 0.87), perioperative mortality (OR: 1.24; 95% CI: 0.35-4.41; p = 0.74), benign stricture formation (OR: 0.79; 95% CI: 0.17-3.87; p = 0.79) or tumor recurrence (OR: 2.01; 95% CI: 0.68-5.91; p = 0.21).
CONCLUSION
Cervical anastomosis could be associated with a higher leak rate and recurrent nerve trauma. However, the currently available randomized evidence is limited. Further randomized trials are needed to provide sufficient evidence for the preferred location of the anastomosis after esophagectomy.
Topics: Anastomosis, Surgical; Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Stomach
PubMed: 21293129
DOI: 10.1159/000322014 -
Polski Przeglad Chirurgiczny Sep 2021The aim of our study is to present the results of surgical treatment of patients with cervical diverticula of the oesophagus in a period of 20 years.
AIM OF THE STUDY
The aim of our study is to present the results of surgical treatment of patients with cervical diverticula of the oesophagus in a period of 20 years.
MATERIAL AND METHODS
A retrospective analysis of 65 patients treated between 2000 and 2020. Patients with symptoms such as dysphagia, vomiting, chocking, recurrent respiratory tract inflammation, as well as patients with diverticular recurrence or poor outcome of primary surgery, were qualified for surgical resection of the oesophageal diverticulum with myotomy using an open technique. Patients were evaluated for the degree of dysphagia before and after surgery, associated perioperative complications, and overall comfort after surgical treatment.
RESULTS
Sixty-five patients underwent surgical treatment, 7(10.7%) of whom were treated for diverticular recurrence or poor outcome of primary treatment. The predominant symptom was dysphagia, which was found in 55(84.6%) patients, increasing over 6 to 48 months with a mean of 17.6 months. The size of the diverticulum ranged from 2 to 6 cm with a mean of 4.8 cm. One patient (1.5%) who experienced the suture line leak was treated conservatively and the fistula healed. Another patient had permanent vocal cord damage, and 1(1.5%) patient had transient damage. The surgical outcome was very good in 48 patients, good in 15 patients, and poor in 2 patients. No postoperative death occurred.
CONCLUSIONS
The technique of open resection with myotomy continues to be an effective method of treating cervical diverticula. It has a zero-mortality rate, low perioperative complication rate, good functional outcome, and low recurrence rate.
Topics: Diverticulum, Esophageal; Esophagus; Humans; Neck; Postoperative Complications; Retrospective Studies; Treatment Outcome; Zenker Diverticulum
PubMed: 35195070
DOI: 10.5604/01.3001.0015.3190 -
Thorax Jun 1985
Topics: Bronchopulmonary Sequestration; Esophagus; Humans; Lung; Lung Diseases; Tracheoesophageal Fistula
PubMed: 4023999
DOI: 10.1136/thx.40.6.401 -
Thorax Mar 1980
Topics: Barium Sulfate; Esophageal Diseases; Esophagoscopy; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Pressure; Radiography
PubMed: 7385087
DOI: 10.1136/thx.35.3.161 -
PloS One 2018Cardiac toxicity after definitive chemoradiotherapy for esophageal cancer is a critical issue. To reduce irradiation doses to organs at risk, individual internal margins...
INTRODUCTION
Cardiac toxicity after definitive chemoradiotherapy for esophageal cancer is a critical issue. To reduce irradiation doses to organs at risk, individual internal margins need to be identified and minimized. The purpose of this study was to quantify esophageal motion using fiducial makers based on four-dimensional computed tomography, and to evaluate the inter-CBCT session marker displacement using breath-hold.
MATERIALS AND METHODS
Sixteen patients with early stage esophageal cancer, who received endoscopy-guided metallic marker placement for treatment planning, were included; there were 35 markers in total, with 9, 15, and 11 markers in the upper thoracic, middle thoracic, and lower thoracic/esophagogastric junction regions, respectively. We defined fiducial marker motion as motion of the centroidal point of the markers. Respiratory esophageal motion during free-breathing was defined as the amplitude of individual marker motion between the consecutive breathing and end-expiration phases, derived from four-dimensional computed tomography. The inter-CBCT session marker displacement using breath-hold was defined as the amplitudes of marker motion between the first and each cone beam computed tomography image. Marker motion was analyzed in the three regions (upper thoracic, middle thoracic, and lower thoracic/esophagogastric junction) and in three orthogonal directions (right-left; anterior-posterior; and superior-inferior).
RESULTS
Respiratory esophageal motion during free-breathing resulted in median absolute maximum amplitudes (interquartile range), in right-left, anterior-posterior, and superior-inferior directions, of 1.7 (1.4) mm, 2.0 (1.5) mm, and 3.6 (4.1) mm, respectively, in the upper thoracic region, 0.8 (1.1) mm, 1.4 (1.2) mm, and 4.8 (3.6) mm, respectively, in the middle thoracic region, and 1.8 (0.8) mm, 1.9 (2.0) mm, and 8.0 (4.5) mm, respectively, in the lower thoracic/esophagogastric region. The inter-CBCT session marker displacement using breath-hold resulted in median absolute maximum amplitudes (interquartile range), in right-left, anterior-posterior, and superior-inferior directions, of 1.3 (1.0) mm, 1.1 (0.7) mm, and 3.3 (1.8) mm, respectively, in the upper thoracic region, 0.7 (0.7) mm, 1.1 (0.4) mm, and 3.4 (1.4) mm, respectively, in the middle thoracic region, and 2.0 (0.8) mm, 2.6 (2.2) mm, and 3.5 (1.8) mm, respectively, in the lower thoracic/esophagogastric region.
CONCLUSIONS
During free-breathing, esophageal motion in the superior-inferior direction in all sites was large, compared to the other directions, and amplitudes showed substantial inter-individual variability. The breath-hold technique is feasible for minimizing esophageal displacement during radiotherapy in patients with esophageal cancer.
Topics: Aged; Aged, 80 and over; Cone-Beam Computed Tomography; Esophageal Neoplasms; Esophagogastric Junction; Esophagus; Female; Fiducial Markers; Four-Dimensional Computed Tomography; Humans; Male; Middle Aged; Neoplasm Staging; Radiotherapy Planning, Computer-Assisted; Respiration
PubMed: 29889910
DOI: 10.1371/journal.pone.0198844 -
Medical Physics Oct 2018This report presents the methods and results of the Thoracic Auto-Segmentation Challenge organized at the 2017 Annual Meeting of American Association of Physicists in...
PURPOSE
This report presents the methods and results of the Thoracic Auto-Segmentation Challenge organized at the 2017 Annual Meeting of American Association of Physicists in Medicine. The purpose of the challenge was to provide a benchmark dataset and platform for evaluating performance of autosegmentation methods of organs at risk (OARs) in thoracic CT images.
METHODS
Sixty thoracic CT scans provided by three different institutions were separated into 36 training, 12 offline testing, and 12 online testing scans. Eleven participants completed the offline challenge, and seven completed the online challenge. The OARs were left and right lungs, heart, esophagus, and spinal cord. Clinical contours used for treatment planning were quality checked and edited to adhere to the RTOG 1106 contouring guidelines. Algorithms were evaluated using the Dice coefficient, Hausdorff distance, and mean surface distance. A consolidated score was computed by normalizing the metrics against interrater variability and averaging over all patients and structures.
RESULTS
The interrater study revealed highest variability in Dice for the esophagus and spinal cord, and in surface distances for lungs and heart. Five out of seven algorithms that participated in the online challenge employed deep-learning methods. Although the top three participants using deep learning produced the best segmentation for all structures, there was no significant difference in the performance among them. The fourth place participant used a multi-atlas-based approach. The highest Dice scores were produced for lungs, with averages ranging from 0.95 to 0.98, while the lowest Dice scores were produced for esophagus, with a range of 0.55-0.72.
CONCLUSION
The results of the challenge showed that the lungs and heart can be segmented fairly accurately by various algorithms, while deep-learning methods performed better on the esophagus. Our dataset together with the manual contours for all training cases continues to be available publicly as an ongoing benchmarking resource.
Topics: Algorithms; Humans; Organs at Risk; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Image-Guided; Thorax; Tomography, X-Ray Computed
PubMed: 30144101
DOI: 10.1002/mp.13141 -
PloS One 2017Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology...
OBJECTIVES
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior ossification of the spine and can lead to dysphagia and airway obstruction. The morphology of the newly formed bone in the cervical spine is different compared to the thoracic spine, possibly due to dissimilarities in local vascular anatomy. In this study the spatial relationship of the new bone with the arterial system, trachea and esophagus was analyzed and compared between subjects with and without DISH.
METHODS
Cervical computed tomography (CT) scans were obtained from five patients with dysphagia and DISH and ten control subjects. The location of the vertebral and carotid arteries, surface area of the hyperostosis and distance between the vertebral body and the trachea and esophagus was assessed in the axial view.
RESULTS
The surface area of the newly formed bone was located symmetrically anterior to the vertebral body. The ossifications were non-flowing in the sagittal view and no segmental vessels were observed. Substantial displacement of the trachea/esophagus was present in the group with DISH compared to the controls.
CONCLUSIONS
The hyperostosis at the cervical level was symmetrically distributed anterior to the vertebral bodies without a flowing pattern, in contrast to the asymmetrical flowing pattern typically found in the thoracic spine. The hypothesis that the vascular system acts as a natural barrier against new bone formation in DISH could be further supported with these findings. The significant ventral displacement of the trachea and esophagus may explain the mechanism of dysphagia and airway obstruction in DISH.
Topics: Aged; Aged, 80 and over; Airway Obstruction; Carotid Arteries; Case-Control Studies; Cervical Vertebrae; Deglutition Disorders; Esophagus; Female; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Male; Middle Aged; Tomography, X-Ray Computed; Trachea; Vertebral Artery
PubMed: 29155874
DOI: 10.1371/journal.pone.0188414 -
World Journal of Gastroenterology Dec 2018To identify the clinicopathological characteristics of pT1N0 esophageal squamous cell carcinoma (ESCC) that are associated with tumor recurrence.
AIM
To identify the clinicopathological characteristics of pT1N0 esophageal squamous cell carcinoma (ESCC) that are associated with tumor recurrence.
METHODS
We reviewed 216 pT1N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrence-free survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.
RESULTS
Forty-seven (24%) patients had a recurrence at 3 to 178 (median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence (Hazard ratios = 3.26, 3.42, and 2.06, < 0.001, < 0.001, and = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.
CONCLUSION
These results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.
Topics: Adult; Aged; Disease-Free Survival; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophagectomy; Esophagus; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Likelihood Functions; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Risk Factors
PubMed: 30568392
DOI: 10.3748/wjg.v24.i45.5154