BACKGROUND: Second primary esophageal cancer often develops in patients with head and neck cancer, and esophagectomy in patients with a history of total pharyngolaryngectomy (TPL) is challenging. However, the clinical outcomes of these patients have yet to be examined in a multicenter setting.
METHODS: We evaluated the surgical outcomes of a nationwide cohort of 62 patients who underwent esophagectomy for esophageal cancer with a history of TPL.
RESULTS: Ivor-Lewis and McKeown esophagectomies were performed in 32 (51.6%) and 30 (48.4%) patients, respectively. Postoperatively, 23 patients (37.1%) developed severe complications, and 7 patients (11.3%) required reoperation within 30 days. Pneumonia and anastomotic leakage occurred in 13 (21.0%) and 16 (25.8%) patients, respectively. Anastomotic leakage occurred more frequently in the McKeown group than in the Ivor-Lewis group (46.7% vs. 6.2%, P < 0.001). The adjusted odds ratio for anastomotic leakage in the McKeown group was 9.64 (95% confidence intervals (CI), 2.11-70.82, P = 0.008). Meanwhile, the 5-year overall survival rates were comparable between the groups (41.8% for Ivor-Lewis and 42.7% for McKeown), and the adjusted hazard ratio of overall survival was 1.44 (95% CI, 0.64-3.29; P = 0.381; Ivor-Lewis as the reference).
CONCLUSIONS: In our cohort, anastomotic leakage occurred more frequently after McKeown than Ivor-Lewis esophagectomy, and almost half of patients in the McKeown group experienced leakage. Ivor-Lewis esophagectomy is preferred for decreasing anastomotic leakage when oncologically and technically feasible.

Subcutaneous metastasis from esophageal cancer (EC), particularly to the chest wall, is a very rare phenomenon. The present study describes a case of gastroesophageal adenocarcinoma that metastasized to the chest wall, invading the fourth anterior rib. A 70-year-old female presented with acute chest pain 4 months after undergoing Ivor-Lewis esophagectomy for gastroesophageal adenocarcinoma. A chest ultrasound revealed a solid hypoechoic mass on the right side of the chest. A contrast-enhanced computed tomography scan of the chest revealed a destructive mass on the right anterior fourth rib (7.5x5 cm). Fine needle aspiration revealed a metastatic moderately differentiated adenocarcinoma to the chest wall. Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography revealed a large FDG avid deposit on the right side of the chest wall. Under general anesthesia, a right-side anterior chest incision was made and the second, third and fourth ribs were resected with overlying soft tissues, including the pectoralis muscle and overlying skin. The histopathological examination confirmed a metastasized gastroesophageal adenocarcinoma to the chest wall. There are two common assumptions regarding chest wall metastasis from EC. The first one states that this metastasis can occur due to the implantation of the carcinoma during tumor resection. The latter supports the notion of tumor cell dissemination along the esophageal lymphatic and hematogenous systems. Chest wall metastasis from EC invading ribs is an extremely rare incident. However, its likelihood of occurrence should not be neglected following primary cancer treatment.

BACKGROUND: Synchronous visceral malignancy is rare especially for esophagogastric junction adenocarcinoma combined with malignancy in the pancreas. So far only 7 cases of combined partial pancreatoduodenectomy and esophagectomy for synchronous malignancy have been described in the literature and none for combined total pancreatectomy and esophagectomy.
METHODS: We report the case of a 67-year-old male patient, who underwent multi-modality treatment including two-stage total pancreatoduodenectomy and subsequent Ivor-Lewis esophagectomy for synchronous adenocarcinoma of the distal esophagus and pancreatic multilocal metastases of a renal cell carcinoma after nephrectomy 17 years ago. Pathology revealed R0 resections for both malignancies and there were no postoperative complications. A 12 months follow-up showed no signs of recurrence and a good quality of life.
CONCLUSIONS: Curative-intent, combined oncological two-stage open total pancreatoduodenectomy and esophagectomy with several days interval is safe and feasible in selected cases when performed by an experienced interdisciplinary team in a high-volume surgical center.

UNASSIGNED: In this study, we present our minimally invasive Ivor-Lewis esophagectomy technique and survival rates of this technique.
UNASSIGNED: Between September 2013 and December 2020, a total of 140 patients (56 males, 84 females; mean age: 55.5±10.3 years; range, 32 to 76 years) who underwent minimally invasive Ivor- Lewis esophagectomy for esophageal cancer were retrospectively analyzed. Preoperative patient data, oncological and surgical outcomes, pathological results, and complications were recorded.
UNASSIGNED: Primary diagnosis was esophageal cancer in all cases. Minimally invasive Ivor-Lewis esophagectomy was carried out in all of the cases included in the study. Neoadjuvant chemoradiotherapy was administrated in 97 (69.3%) of the cases. The mean duration of surgery was 261.7±30.6 (range, 195 to 330) min. The mean amount of intraoperative blood loss was 115.1±190.7 (range, 10 to 800) mL. In 60 (42.9%) of the cases, complications occurred in intraoperative and early-late postoperative periods. The anastomotic leak rate was 7.1% and the pulmonary complication rate was 22.1% in postoperative complications. The mean hospital stay length was 10.6±8.4 (range, 5-59) days and hospital mortality rate was 2.1%. The median follow-up duration was 37 (range, 2-74) months and the three- and five-year overall survival rates were 61.8% and 54.6%, respectively.
UNASSIGNED: Minimally invasive Ivor-Lewis esophagectomy can be used safely with low mortality and long-time survival rates in esophageal cancer.

Objective: To compare and analyze the perioperative clinical effects of minimally invasive Ivor-Lewis esophagectomy (MIE-Ivor-Lewis) and minimally invasive McKeown esophagectomy (MIE-McKeown). Methods: A total of 147 patients who underwent endoscopic esophageal cancer surgery from April 2018 to August 2019 were selected, including 85 patients undergoing MIE-McKeown surgery and 62 patients undergoing MIE-Ivor-Lewis surgery. The measurement data were expressed as (x±s), the comparison of normally distributed measurement data was performed by independent sample t-test, and the comparison of count data was performed by χ(2) test or Fisher\'s exact test. Results: The operation time of McKeown (M) group and Ivor-Lewis (IL) group were (219.2±72.4) minutes and (225.8±65.3) minutes. The mediastinal lymph node dissection number of M and IL groups were 13.3±4.8 and 11.6±6.5, respectively. The number of left recurrent laryngeal nerve lymph node dissection were 3.5±1.2 and 3.1±1.4, respectively. The intraoperative blood loss were (178.3±41.3) ml and (163.2±64.1) ml, respectively. The number of patients reoperated for postoperative bleeding were 1 and 0, respectively. The number of patients with postoperative gastric bleeding were 0 and 1, respectively. The postoperative chest tube retention time were (2.8±1.3) days and (3.1±1.2) days, respectively. The number of patients with anastomotic leakage were 7 and 1, respectively. The number of patients with lung infection were 13 and 5, respectively, and with chylothorax were 2 and 1, respectively, without statistically significant difference (P>0.05). The number of patients with hoarseness were 11 and 3, respectively. The total incidence of complication were 41.2% (35/85) and 17.7% (11/62), and the postoperative hospital stay were (14.7±6.5) days and (12.3±2.3) days, with statistical difference (P<0.05). Conclusion: MIE-Ivor-Lewis and MIE-McKeown are safe and effective in treating esophageal cancer, but the complication of MIE-Ivor-Lewis is less than that of MIE-Mckeown, and the perioperative clinical effect of MIE-Ivor-Lewis is better than that of MIE-McKeown.
目的： 探讨微创Ivor-Lewis(MIE-Ivor-Lewis)与微创McKeown(MIE-McKeown)术式治疗食管癌的围手术期临床效果。 方法： 选取2018年4月至2019年8月于东南大学附属中大医院接受全腔镜食管癌根治术患者147例，MIE-McKeown手术(McKeown组)患者85例，MIE-Ivor-Lewis手术(Ivor-Lewis组)患者62例。计量资料以(x±s)表示，呈正态分布的计量资料的比较采用独立样本t检验，计数资料的比较采用χ(2)检验或Fisher精确检验。 结果： McKeown组和Ivor-Lewis组患者手术时间[分别为(219.2±72.4)min和(225.8±65.3)min]、纵隔淋巴结清扫数[分别为(13.3±4.8)枚和(11.6±6.5)枚]、左喉返淋巴结清扫数[分别为(3.5±1.2)枚和(3.1±1.4)枚]、术中出血量[分别为(178.3±41.3)ml和(163.2±64.1)ml]、术后出血再手术患者数(分别为1和0例)、术后胃出血患者数(分别为0和1例)、术后胸管留置时间[分别为(2.8±1.3)d和(3.1±1.2)d]、吻合口瘘患者数[分别为7和1例]、肺部感染患者数(分别为13和5例)和乳糜胸患者数(分别为2和1例)差异均无统计学意义(均P>0.05)。McKeown组和Ivor-Lewis组患者声音嘶哑[分别为11和3例]、总并发症发生率[分别为41.2%(35/85)和17.7%(11/62)]和术后住院时间[分别为(14.7±6.5)d和(12.3±2.3)d]差异均有统计学意义(均P<0.05)。 结论： MIE-Ivor-Lewis术与MIE-McKeown术治疗食管癌安全有效，但MIE-Ivor-Lewis术较MIE-Mckeown术并发症少，MIE-Ivor-Lewis术围手术期临床效果优于MIE-McKeown术。.

For patients undergoing an Ivor Lewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. The aim of this study was to compare the 25 mm stapled versus the 28 mm stapled esophagogastric anastomosis after Ivor Lewis esophagectomy, focusing on anastomotic insufficiency and postoperative anastomotic strictures.
Between February 2008 and June 2019, 349 consecutive patients underwent Ivor Lewis esophagectomy with gastric conduit reconstruction and circular stapled anastomosis. Patient characteristics and postoperative results, such as anastomotic insufficiency rates, postoperative anastomotic stricture rates, time to anastomotic stricture rate, and the number of dilatations, were recorded in a prospective database and analyzed.
In 222 patients (64%), the 25 mm circular stapler was used and in 127 patients (36%) the 28 mm circular stapler was used. There were no differences in baseline characteristics. Anastomotic insufficiency rates were comparable between the 25 mm (12%) and the 28 mm groups (11%) (p = 0.751). There were no differences between postoperative anastomotic strictures in the 25 mm (14%) and the 28 mm groups (14%) (p = 0.863). Within patients with postoperative anastomotic strictures, a median number of 2 dilatations were observed in each group (p = 0.573) without differences in the time to first diagnosis (p = 0.412).
There were no differences in anastomotic insufficiency and postoperative anastomotic stricture rates between the 25 mm and the 28 mm circular stapled esophagogastric anastomosis after Ivor Lewis esophagectomy. Both the 25 mm and 28 mm stapler can be safely used to create a circular stapled esophagogastric anastomosis to restore continuity after esophagectomy.

BACKGROUND: The only curative treatment for most esophageal cancers is radical esophagectomy. Minimally invasive esophagectomy (MIE) aims to reduce postoperative morbidity, but is not yet widely established. Linear stapled anastomosis is a promising technique for MIE because it is quite feasible even without robotic assistance. The aim of the present study is to compare total MIE with linear stapled anastomosis to open esophagectomy (OE) with circular stapled anastomosis with special regard to postoperative morbidity in an expertise-based randomized controlled trial (RCT).
METHODS: This superiority RCT compares MIE with linear stapled anastomosis (intervention) to OE with circular stapled anastomosis (control) for Ivor-Lewis esophagectomy. It was initiated in February 2019, and recruitment is expected to last for 3 years. For inclusion, patients must be 18 years of age or more with a resectable primary malignancy in the distal esophagus. Participants with tumor localizations above the azygos vein, metastasis, or infiltration into adjacent tissue will be excluded. In an expertise-based approach, the allocated treatment will only be carried out by the single most experienced surgeon of the surgical center for each respective technique. The sample size was calculated with 20 participants per group for the primary endpoint postoperative morbidity according to comprehensive complication index (CCI) within 30 postoperative days. Secondary endpoints include anastomotic insufficiency, pulmonary complications, other intra- and postoperative outcome parameters such as estimated blood loss, operative time, length of stay, short-term oncologic endpoints, adherence to a standardized fast-track protocol, postoperative pain, and postoperative recovery (QoR-15). Quality of life (SF-36, CAT EORTC QLQ-C30, CAT EORTC QLQ-OES18) and oncological outcomes are evaluated with 60 months follow-up.
CONCLUSIONS: MIVATE is the first RCT to compare OE with circular stapled anastomosis to total MIE with linear stapled anastomosis exclusively for intrathoracic anastomosis. The expertise-based approach limits bias due to heterogeneity of surgical expertise. The use of a dedicated fast-track protocol in both OE and MIE will shed light on the role of the access strategy alone in this setting. The findings of this study will serve to define which approach has the best perioperative outcome for patients requiring esophagectomy.
BACKGROUND: German Clinical Trials Register DRKS00016773 . Registered on 18 February 2019.

BACKGROUND: Squamous Papilloma is a rare benign tumor of the esophagus. Esophageal squamous papilloma is thought to arise from a chronic inflammatory reaction due to mechanical or chemical irritant. ESP is usually considered to have a benign clinical course; however, some reports highlight the potential development of a malignancy. The development of extensive esophageal squamous papillomas also known as squamous papillomatosis of the esophagus is even less frequent.
UNASSIGNED: We present the case of an esophageal papillomatosis that developed into an invasive esophageal squamous cell carcinoma that was only diagnosed in the surgical specimen after minimally invasive Ivor-Lewis esophagectomy and in this case report, we discuss its etiology, diagnosis and treatment.
CONCLUSIONS: Extensive papillomatosis with continuous symptoms, especially persistent dysphagia, should always prompt a thorough analysis into a possible underlying malignancy.

暂无摘要。

OBJECTIVE: To introduce a two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy and assess its clinical application.
METHODS: One hundred and twenty-two patients with middle or lower esophageal cancer who underwent laparoscopic-thoracoscopic Ivor-Lewis esophagectomy at Liaoning Cancer Hospital and Institute from March 2014 to March 2016 were included in this study, and divided into two groups based on the procedure used for creating a gastric tube. One group used a two-step method for creating a gastric tube, and the other group used the conventional method. The two groups were compared regarding the operating time, surgical complications, and number of stapler cartridges used.
RESULTS: The mean operating time was significantly shorter in the two-step method group than in the conventional method group [238 (179-293) min vs 272 (189-347) min, P < 0.01]. No postoperative death occurred in either group. There was no significant difference in the rate of complications [14 (21.9%) vs 13 (22.4%), P = 0.55] or mean number of stapler cartridges used [5 (4-6) vs 5.2 (5-6), P = 0.007] between the two groups.
CONCLUSIONS: The two-step method for creating a gastric tube during laparoscopic-thoracoscopic Ivor-Lewis esophagectomy has the advantages of simple operation, minimal damage to the tubular stomach, and reduced use of stapler cartridges.