Esophagus

With the aging of society and increasingly longer of life expectancy, elderly patients with esophageal cancer are more commonly encountered. This study aimed to identify the risk factors for operative mortality after esophagectomy in elderly patients. We used data from the National Clinical Database of Japan. After cleaning the data, 10,633 records obtained from 861 hospitals were analyzed. A risk model for operative mortality was developed using risk factors from the entire study population. Then, odds ratios (OR) were compared between age categories using this risk model. In this study, 1959 (18.4%) patients were ≥ 75 years (defined as “elderly” in this study). Eighteen variables, including T4b, N2–N3, and M1 in the TNM classification, were included in the risk model for operative mortality. The ORs increased in age categories < 65, 65–74, and ≥ 75 years for N2–N3 (1.172, 1.200, and 1.588, respectively), and M1 (2.189, 3.164, and 4.430, respectively). Based on these results, we also focused on residual tumors, which are caused by extensive tumor development. The operative mortality in the elderly group with residual tumors increased to more than twice than that in the non-elderly groups (15.9 vs. 5.5 or 6.5%) and was much higher than that in elderly patients without residual tumors (15.9 vs. 4.6%). We should carefully select the treatment for elderly patients with highly advanced tumors, which result in N2–N3 and M1, to avoid unfavorable short-term outcomes. In addition, R0 resection is important in preventing operative mortality among elderly patients.

Patients with esophageal cancer often feel depression or fear of death influenced by multiple clinical factors. This study sought to investigate the clinical factors associated with psychological distress, focusing on the influence of health-related quality of life (HRQOL) for better psychological management of patients with esophageal cancer. In total, 102 of 152 consecutive patients surgically treated at Toranomon Hospital met the eligibility criteria for analysis. Questionnaires designed to identify psychological distress and QOL (EORTC QLQ C-30/OES18) were administered at five time points during the treatment course. Degree of psychological distress was assessed by Hospital Anxiety and Depression Scale (HADS). Patients with HADS score ≥ 11 at each visit showed significantly higher level of symptoms or problems measured by the score of EORTC QLQ C-30/OES18 compared with those with HADS score ≤ 10. Emotional status was a significant factor associated with psychological distress at all times. Although functional scales including global health status or QOL status and symptom scales associated with esophageal cancer were strongly associated with psychological distress before treatment, scales associated with changes in habitus after esophagectomy showed significant correlation with psychological distress after surgery. No significant correlation was observed between psychological distress and individual baseline characteristics, apart from history of surgery and pathological staging. Psychological distress during treatment course of esophageal cancer is significantly associated with HRQOL influenced by esophagectomy. The current results may warrant prospective intervention through enhanced recovery after surgery to better manage patients undergoing highly invasive procedures for esophageal cancer.

Assessment of the outcomes of laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease (GERD) is insufficient. Of the 256 patients with GERD who underwent surgery between December 1994 and December 2008, sufficient postoperative follow-up was completed in 205 patients. Of the 205 patients who were included in the study, 166 were younger than 70 years of age (mean, 49.2 ± 14.1 years; 108 men/58 women), and 39 patients were 70 years or older (mean, 74.8 ± 4.3 years; 11 men/28 women). Preoperative clinical conditions were assessed using the AFP classification. Recurrence was defined as postoperative recurrence of erosive esophagitis or evident hiatus hernia. Clinical conditions of cases with and without recurrence were compared to identify factors associated with the recurrence. Statistical analyses were performed using the Mann-Whitney U test. Five cases (13%) in the elderly patient group were judged to have a recurrence, all of whom had recurrent esophagitis and hernia. There was a significant difference in surgical procedures (P = 0.005) between the recurrence and nonrecurrence groups. There were 17 (10%) recurrent cases in the nonelderly patient group. In a comparison of the recurrence and nonrecurrence groups, there were signifi cant differences in age (P = 0.002), duration of symptoms (P = 0.029), A factor (P = 0.004), and AFP score (P = 0.007), but not in the surgical procedures. The risk factors for recurrence were different between nonelderly patients and elderly patients. The laparoscopic Collis-Nissen methods should be indicated with caution in elderly GERD patients with a short esophagus.

Esophagus is an important part of the alimentary canal that performs various functions, most important of which is the transfer of bolus from the pharynx to the stomach. This involves active contraction of both the circular and longitudinal esophageal muscles. Esophageal anatomical features are harmonized with the functional and physiological demands of esophagus. However, impairment of esophageal functions may occur resulting in symptoms like dysphagia, gastroesophageal reflux or esophageal pain. This review covers broadly the anatomical and physiological details of esophagus, mechanical function of esophagus and its motility. In particular, the mechanical characteristics of the esophageal tissue and its motile function have been scrutinized. An overlay of the diagnostic technologies tapping these metrics is also covered.

Esophageal endocrine cell carcinoma is a rare histopathological type thought to be highly malignant and to have a poor prognosis, but its clinical behavior has not been fully analyzed. We retrospectively reviewed our cases among 386 patients with esophageal cancer in our institution. Eight patients (2.1 %) were pathologically diagnosed with endocrine cell carcinoma. Median patient age was 63 years, and the male-to-female ratio was 7:1. Cancer stage according to the Japanese Classification of Esophageal Cancer (JCEC) 10th edition, was stage II in one case, III in three, IVa in one, and IVb in three. Chromogranin-A staining was positive in six cases, synaptophysin in six, cluster of differentiation (CD)56 in seven, and neuron-specific enolase (NSE) in seven. Treatment included surgery in two cases, chemoradiotherapy in four, best-supportive case in one, and rejection in one. Prognoses were 13 months after surgery for stage II, 6–28 months after chemoradiotherapy for stage III, and 0–10 months for stage IV.

Esophagectomy is a highly invasive procedure for patients aged > 70 years. Here, we compared the actual nutritional status of older and younger patients who underwent esophagectomy. A total of 118 patients who underwent radical esophagectomy between April 2013 and December 2016 were enrolled and divided into two groups based on age: group A (n = 41; ≥ 70 years) and group B (n = 77; < 70 years). Data pertaining to body mass index and nutritional variables (albumin; total cholesterol; cholinesterase; and prealbumin) were retrospectively analyzed preoperatively and at 3, 6, and 12 months postoperatively. Significant preoperative between-group differences were found in the cholinesterase, albumin, and prealbumin levels. The body mass index gradually decreased over the first 12 months after surgery in both groups, without significant between-group differences. Significant differences were observed in prealbumin and cholinesterase levels at 3 months postoperatively. 1 year postoperatively, both groups showed slight improvements; however, the between-group differences were not statistically significant. Group A had a significantly lower amount of the degree of decrement of BMI and chE than group B. Thus, patients aged > 70 years can recover within 12 months of esophagectomy.

A 14-year-old girl was admitted to our hospital for treatment of abdominal pain after an attempt to commit suicide by swallowing a caustic soda solution. Severe esophageal stricture following corrosive esophagitis occurred 2 weeks after admission. First, we tried to dilate the stenotic esophagus by using an esophageal bougie, but it was not effective and was also painful, and the treatment was stopped. Next, we tried endoscopic balloon dilation. This procedure was less painful and more effective for dilating the stenotic esophagus than was the bougie. At first, we used a pneumatic balloon and injected a steroid locally under the mucosal layer after dilation. The same procedure was continued in the outpatient clinic, but each interval of the procedures, about 3 weeks, was not changed for about 1 year. After 1 year of consecutive trials of frequent dilatation using a pneumatic balloon, the type of balloon was changed to a hydrostatic type. Three months after changing the type of balloon, treatment with tranilast, which was expected to be effective for prevention of restenosis, was started instead of steroid injection to the stenotic portion. After starting tranilast treatment, the interval of dilation became longer and the stricture itself gradually became dilated. Twenty-one months later, the interval of dilation was 3–4 months and oral intake had improved greatly. We therefore concluded that frequent endoscopic balloon dilation is effective for dilating stenosis after corrosive esophagitis. In addition, this case suggests that treatment with tranilast could be effective for preventing esophageal restenosis after balloon dilation.