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1.
Is a Central Venous Catheter Necessary for the Perioperative Management of Esophagectomy? A Prospective Randomized Pilot Study Comparing Two Different Perioperative Regimens.
Saito, K, Nakajima, Y, Kawada, K, Tokairin, Y, Kawano, T
Digestive surgery. 2016;(6):478-87
Abstract
BACKGROUND/AIMS: Our prospective randomized study examined the possibility of perioperative management of esophagectomy without a central venous catheter (CVC). METHODS Forty patients who underwent esophagectomy for esophageal cancer were divided into the total parenteral nutrition (TPN; receiving conventional perioperative management via a CVC) and peripheral parenteral nutrition (PPN; receiving perioperative management without a CVC) groups. Albumin and retinol-binding protein (RBP) levels were used as measurements of the nutritional status. Early postoperative complications and catheter-related complications were also evaluated. RESULTS The actual calories administered per kg of body weight and the albumin and RBP levels did not significantly differ between the groups. Additionally, there was no significant difference in the morbidity of early postoperative complications between the groups. Catheter-related complications were observed in 4 patients in the TPN group (2 catheter infections, 1 case of thrombosis, and 1 case of iatrogenic pneumothorax), and 4 cases of peripheral phlebitis occurred in the PPN group. The incidence of catheter-related complications did not significantly differ between the groups. CONCLUSIONS Perioperative management without a CVC can be safely performed in esophagectomy patients, and the decision to insert a CVC should be made based on the patient's perioperative condition.
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2.
Evaluating the effect of four extracts of avocado fruit on esophageal squamous carcinoma and colon adenocarcinoma cell lines in comparison with peripheral blood mononuclear cells.
Vahedi Larijani, L, Ghasemi, M, AbedianKenari, S, Naghshvar, F
Acta medica Iranica. 2014;(3):201-5
Abstract
Most patients with gastrointestinal cancers refer to the health centers at advanced stages of the disease and conventional treatments are not significantly effective for these patients. Therefore, using modern therapeutic approaches with lower toxicity bring higher chance for successful treatment and reduced adverse effects in such patients. The aim of this study is to evaluate the effect of avocado fruit extracts on inhibition of the growth of cancer cells in comparison with normal cells. In an experimental study, ethanol, chloroform, ethyl acetate, and petroleum extracts of avocado (Persea americana) fruit were prepared. Then, the effects if the extracts on the growth of esophageal squamous cell carcinoma and colon adenocarcinoma cell lines were evaluated in comparison with the control group using the MTT test in the cell culture medium. Effects of the four extracts of avocado fruit on three cells lines of peripheral blood mononuclear cells, esophageal squamous cell carcinoma, and colon adenocarcinoma were tested. The results showed that avocado fruit extract is effective in inhibition of cancer cell growth in comparison with normal cells (P<0.05). Avocado fruit is rich in phytochemicals, which play an important role in inhibition of growth of cancer cells. The current study for the first time demonstrates the anti-cancer effect of avocado fruit extracts on two cancers common in Iran. Therefore, it is suggested that the fruit extracts can be considered as appropriate complementary treatments in treatment of esophageal and colon cancers.
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3.
Initial experiences of an enhanced recovery protocol in esophageal surgery.
Blom, RL, van Heijl, M, Bemelman, WA, Hollmann, MW, Klinkenbijl, JH, Busch, OR, van Berge Henegouwen, MI
World journal of surgery. 2013;(10):2372-8
Abstract
BACKGROUND A recent development in gastrointestinal surgery is the implementation of enhanced recovery after surgery (ERAS) programs. Evidence regarding the benefit of these programs in patients undergoing esophageal surgery is scarce. We investigated the feasibility and possible benefit of a perioperative ERAS program in patients undergoing esophagectomy for malignant disease. METHODS The ERAS program was initiated in 2009. Patients who underwent esophagectomy and were treated according to the ERAS program were included. Items of ERAS included preoperative nutrition, early extubation, early removal of nasogastric tube, and early mobilization. Primary outcome parameters were hospital stay and the incidence of postoperative complications. Outcome parameters in the ERAS cohort were compared to a cohort of patients who underwent surgical resection in the year prior to the implementation of the ERAS protocol. A feasibility analysis was performed among a sample of ERAS patients to determine the number of achieved items per patient. RESULTS Between 2008 and August 2010, 181 patients in our department underwent esophagectomy. Of these, 103 patients were included in the ERAS program (ERAS+ group) and were compared to 78 patients who had undergone an esophagectomy in 2008 (ERAS- group). Overall hospital stay was 14 days versus 15 days (ERAS+ and ERAS-, respectively; p = 0.013). There were no significant differences in the incidence of postoperative complications in either group. The percentage of achieved items varied between 42 and 93 % per item. CONCLUSIONS The implementation of an ERAS program in esophageal surgery was feasible and resulted in a small but significant reduction in overall hospital stay, whereas overall morbidity was not affected.
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4.
Effectiveness of unsedated transnasal endoscopy with white-light, flexible spectral imaging color enhancement, and lugol staining for esophageal cancer screening in high-risk patients.
Arantes, V, Albuquerque, W, Salles, JM, Freitas Dias, CA, Alberti, LR, Kahaleh, M, Ferrari, TC, Coelho, LG
Journal of clinical gastroenterology. 2013;(4):314-21
Abstract
BACKGROUND AND AIMS Transnasal endoscopy (TNE) has been proposed to screen for esophageal squamous cell cancer (ESCC) in Asia. This study aimed to assess the feasibility and tolerance of Brazilian patients to undergo unsedated TNE for screening, the prevalence of ESCC in this population, and the effectiveness of white-light endoscopy (WLE) and digital chromoendoscopy [flexible spectral imaging color enhancement (FICE)] to diagnose esophageal neoplasia. PATIENTS AND METHODS This was a diagnostic test study that enrolled patients with head and neck squamous cell cancer (HNSCC) referred to ESCC screening. Patients' tolerance was rated by a numeric pain intensity scale. Interventions included unsedated TNE with WLE and FICE examination of the esophagus, in a tandem manner with blinded operators, followed by lugol chromoscopy. Performance of WLE and FICE for neoplasia detection was compared with the reference standard (lugol chromoscopy plus histology). RESULTS A total of 106 patients were recruited. TNE was feasible in 99.1%, and 92% of the patients rated the discomfort as absent or minimal. Thirteen ESCC were detected (12.3%), with 10 early cancers (77%). The tests showed an excellent performance and there was no difference between WLE (sensitivity 92.3%, specificity 98.9%, accuracy 98.1%, area under curve 0.995) and FICE (sensitivity 100%, specificity 98.9%, accuracy 99%, area under curve 0.956) for esophageal neoplasia detection. CONCLUSIONS Unsedated TNE is a feasible, well accepted, and efficient diagnostic tool for the screening of ESCC. The elevated rate of esophageal neoplasia strengthens the recommendations to screen patients with HNSCC. The yields of WLE and FICE were similar for ESCC detection.
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5.
Functional SNPs in human C20orf54 gene influence susceptibility to esophageal squamous cell carcinoma.
Ji, A, Wang, J, Yang, J, Wei, Z, Lian, C, Ma, L, Ma, L, Chen, J, Qin, X, Wang, Ld, et al
Asian Pacific journal of cancer prevention : APJCP. 2011;(12):3207-12
Abstract
OBJECTIVES C20orf54, also known as a human riboflavin transporter 2 (RFT2), encodes an open reading frame protein RFT2 newly identified to play an important role in esophageal carcinogenesis by modulating riboflavin uptake. Missense cSNPs on exon 3,1172 C>A (T391M) and 1246A>G (I416V) have been suggested to modulate protein expression. The aim of present study was to explore the association of C20orf54 functional SNPs with susceptibility to esophageal squamous cell carcinoma (ESCC) in a northern Chinese population. METHODS 240 patients with ESCC and 198 healthy individuals without overt cancer were chosen as our experimental subjects. Information about family address, sex, age, BMI, smoking and drinking habits and family history of cancer were collected. Blood samples were taken from all subjects and tumor tissues were freshly sampled from resected specimens. After DNA was extracted and amplified, the C20orf54 SNPs were sequenced by ABI 3730XL in BGI China. Frequencies were then calculated and associated with the collected suspicous risk factors. RESULTS Drinking status, a family history of ESCC, blood type and BMI were found to have great influence on the risk of developing ESCC. Overall genotype frequencies of the RFT2 SNP 1172 C>A (rs3746803) and 1246A>G (rs3746802) in ESCC patients are significantly different from that in healthy controls (x2=13.10, P=0.001 and x2=7.97, P=0.019, respectively). For RFT2 rs3746803, C/T+T/T genotype did not show a relationship with the risk of ESCC (the age and gender adjusted OR=0.66, 95% CI=0.41-1.05) when using C/C genotype as the reference. For RFT2 rs3746802, the A/G +G/G genotype demonstrated a significantly decreased risk to the development of ESCC (the age and sex adjusted OR=0.53, 95% CI=0.34-0.84) with A/A as the reference. CONCLUSIONS The present study suggests that the C20orf54 functional SNPs might be associated with a risk of ESCC development.
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6.
[Ex-vivo-chemoresponse testing of head and neck cancer: an old hat?].
Wichmann, G, Körner, C, Dietz, A
Laryngo- rhino- otologie. 2011;(8):464-8
Abstract
Reliable prediction of the chance of a successful treatment of head and neck squamous cell carcinoma by cytostatics and targeting therapies would be very valuable, since HNSCC due to their heterogenic biology mostly respond non-uniformly and moreover with low response rates. To raise the prospect of chemotherapy by using multimodal therapies usually goes hand in hand with a higher incidence of severe adverse events and acute toxicity but also chemo-associated increased cancer risk following successful treatment. In addition, the increasing numbers of treatment options without availability of reliable prognostic biomarkers for a probably successful outcome make the decision for one or the other medication to something rather like gambling. Therefore, quite early a pre-therapeutic predictive exvivo chemoresponse testing of bioptic specimens was intended. However, the results gained mostly were disillusioning and allowed not for reliable prediction of chance of successful outcome of treatment with tolerable doses of the pharmaceuticals and in particular their combinations. Predictive testing, hence, was belittled as improper for the clinical context. Based on advanced methods, some working groups reassume this subject. This review describes recent advances in ex-vivo chemoresponse testing, discusses pre-requisites which have to be fulfilled before their inclusion into decision-making, and outlines why ex-vivo chemoresponse testing probably is not an old hat.
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7.
Comparison of lifestyle and living environment among high risk immigrant and low risk host residents: implications for esophageal cancer etiology.
Yu, X, Zhang, T, Zhang, H, Hu, A, Hu, Y, Guo, W, Wang, Y
Asian Pacific journal of cancer prevention : APJCP. 2010;(6):1827-31
Abstract
BACKGROUND It has been hypothesized that the high prevalence of esophageal squamous cell carcinoma (ESCC) in China is associated with specific environments and lifestyles. A previous study found that immigrant residents (IR) from Henan, residing long term in the town of Caihu, had significantly greater risk of dying from ESCC than host residents (HR). OBJECTIVES This study was conducted to compare lifestyle and living environments between high risk IR and low risk HR to determine risk factors for ESCC. METHODS The subjects included randomly selected IR and HR living in Caihu. Information on lifestyle and the living environment of participants was collected by interview using a structured questionnaire. RESULTS The IR were found to have a higher consumption of hot food (P<0.05), pickled vegetables (P<0.05) and a lower consumption of fresh fruits and vegetables, and alcohol (P<0.05), compared with the HR. There were no significant differences in income and cigarette smoking between the two populations. Fewer IR families had a separate kitchen (P<0.05) than host families. CONCLUSIONS Our study provided some epidemiological evidence indicating that dietary factors, such as hot food, pickled vegetables, salt, and low fruit and vegetable intake, as well as a poor living environment, are possibly related to the higher prevalence of ESCC in IR. However, cigarette smoking, alcohol drinking and income were not shown to be risk factors for immigrant susceptibility to ESCC in our study.
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Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation.
Corry, J, Poon, W, McPhee, N, Milner, AD, Cruickshank, D, Porceddu, SV, Rischin, D, Peters, LJ
Journal of medical imaging and radiation oncology. 2008;(5):503-10
Abstract
Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.
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Methyl-beta-cyclodextrin treatment affects the thermotropic behaviour of membranes and detergent-resistant membrane fractions of cultured A431 cells.
Masserini, M, Pitto, M, Raimondo, F, Cazzaniga, E, Sesana, S, Bellini, T
Biological & pharmaceutical bulletin. 2005;(12):2185-8
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Abstract
Membranes and detergent-resistant membrane fractions isolated from human epidermoid carcinoma A431 cells after treatment with methyl-beta-cyclodextrin, a compound commonly used in pharmaceutical applications and in manipulation of membrane cholesterol content, display thermotropic transitions at about 15 degrees C and above 37 degrees C, respectively, when analyzed by differential scanning calorimetry. The transitions, absent in untreated cells, were reversible upon cycling through heating and cooling scans, and attributable to lipid components of the membranes, possibly sphingolipids. These results suggest that, after treatment with methyl-beta-cyclodextrin, membranes may show thermotropic transitions, an unusual feature for cellular bilayers, which is likely to influence biological functions.
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Results of a randomised phase II study comparing docetaxel with methotrexate in patients with recurrent head and neck cancer.
Guardiola, E, Peyrade, F, Chaigneau, L, Cupissol, D, Tchiknavorian, X, Bompas, E, Madroszyk, A, Ronchin, P, Schneider, M, Bleuze, JP, et al
European journal of cancer (Oxford, England : 1990). 2004;(14):2071-6
Abstract
We report the results of a randomised phase II trial of docetaxel tested as a single agent in patients with recurrent head and neck cancer using methotrexate as a control arm to validate the results. Eligibility criteria included: histologically-confirmed squamous cell carcinoma, measurable disease, adequate haematological, renal and hepatic functions, no prior chemotherapy for recurrent cancer, signed informed consent. 40 mg/m2 methotrexate was given as a short weekly bolus i.v. injection, and 40 mg/m2 docetaxel was administered as a one hour weekly infusion. A total of 57 patients were randomised based on a ratio of 2/1:37 and 20 patients received docetaxel and methotrexate, respectively. Patient characteristics included 49 males and 8 females; the median age was 59 years (range: 43-82 years). Twenty-eight patients had a local-regional relapse and 29 had distant metastasis, the median disease-free interval was 7.9 months (range: 0-165 months). For patients treated with docetaxel, the following grade 3-4 toxicities occurred: neutropenia (12.5%) with febrile neutropenia in one patient (1%), anaemia (19%) mucositis (9%) and ungueal toxicity (9%). In the methotrexate arm, the grade 3-4 toxicities were: anaemia (15%) and mucositis (5%). The response rate was significantly higher in the docetaxel arm with 27% (95% confidence interval (CI): 21.7-32.3%) of objective responses versus 15% (95% CI: 11.2-18.8%) in the methotrexate arm. Overall survival and time to progression were super-imposable between the docetaxel and methotrexate treatments. Docetaxel given as a weekly infusion has a high activity in patients with head and neck cancer. A phase III trial is needed to test if this translates into a survival benefit for docetaxel use.