• 대한기관식도과학회지
• /
• 제9권1호
• /
• pp.30-38
• /
• 2003

Cancers of the cervical esophagus occur uncommonly, but treatment is remaining a challenging problem and surgery demands special knowledge of abdominal, thoracic, and neck surgery. The primary risk factor is chronic heartburn, leading to a sequence of esophagitis, Barrett's esophagus, reflux esophagitis and etc. Among the various treatment modalities, Surgery is still a mainstay of treatment. The main aim of surgery is not only oncologically adequate resection but also preservation or restoration of physiologic functions, such as deglutition and phonation. Surgical treatment of cervical esophageal cancer is influenced by special problems arising from tumor factors, patient factors and surgeon factors. Complete clearance of loco-regional disease and prevention of postoperative complications are of particular importance for the improvement of long-term survival in patients with these cancers. So the cervical and thoracic extension of these tumors usually required an extensive lymphadenectomy with primary resection. Radical resection of the primary site almostly include sacrifice of the larynx, but the voice could be rehabilitated with various methods, such as tracheoesophageal prosthesis or tracheoesophageal shunts, etc. Restoration of the esophageal conduit can be performed using gastric or colon interposition, radial forearm free flap or jejunum free flap, etc. Recently, the advances of radiation therapy and chemotherapy will enable less extended resections with greater rates of laryngeal preservation. At initial presentation, up to 50％ to 70％ of patients will have advanced locoregional or distant disease with virtually no chance for cure. Patients with advanced but potentially resectable esophageal cancer are generally treated by surgery with some form of neoadjuvant chemotherapy, radiotherapy, or both, with 5-year survivals in the 20％ to 30％ range. So the significant adverse factors affecting survival should be taken into account to select the candidates for surgery.

• Journal of Preventive Medicine and Public Health
• /
• 제43권2호
• /
• pp.185-192
• /
• 2010

Objectives: We conducted a meta-analysis to investigate the relationship between low external doses of ionizing radiation exposure and the risk of cancer mortality among nuclear power plant workers. Methods: We searched MEDLINE using key words related to low dose and cancer risk. The selected articles were restricted to those written in English from 1990 to January 2009. We excluded those studies with no fit to the selection criteria and we included the cited references in published articles to minimize publication bias. Through this process, a total of 11 epidemiologic studies were finally included. A publication bias was tested for using Egger's test. The homogeneity test was performed before the integration of each of the standardized mortality ratios (SMRs) and the result proved that the studies were heterogeneous. Results: We found significant decreased deaths from all cancers (SMR = 0.75, 95% CI = 0.62 - 0.90), all cancers excluding leukemia, solid cancer, mouth and pharynx, esophagus, stomach, rectum, liver and gallbladder, pancreas, lung, prostate, lymphopoietic and hematopoitic cancer. The findings of this meta-analysis were similar with those of the 15 Country Collaborative Study conducted by the International Agency for Research on Cancer. A publication bias was found only for liver and gallbladder cancer (p = 0.015). Heterogeneity was observed for all cancers, all cancers excluding leukemia, solid cancer, esophagus, colon and lung cancer. Conclusions: Our findings of low mortality for stomach, rectum, liver and gallbladder cancers may explained by the health worker effect. Yet further studies are needed to clarify the low SMR of cancers, for which there is no useful screening tool, in nuclear power plant workers.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권8호
• /
• pp.3675-3679
• /
• 2014

We assessed the association between frequency of heavy binge drinking and mortality from oropharynx and esophagus cancer after controlling for the total volume of alcohol intake among Korean men. The cohort comprised 2,677 male residents in Kangwha County, aged 55 or older in March 1985, for their upper digestive tract cancer mortality for 20.8 years up to December 31, 2005. For daily binge drinkers versus non-drinkers, the hazard ratios (95% Cls) for mortality were 4.82 (1.36, 17.1) and 6.75 (1.45, 31.4) for oropharyngeal and esophageal cancers, respectively. Even after adjusting for the volume of alcohol intake, we found the hazard ratios for frequency of binge drinking and mortality of oropharyngeal or esophageal cancer to not change appreciably: the hazard ratios were 4.90 (1.00, 27.0) and 7.17 (1.02, 50.6), respectively. For esophageal cancer, there was a strong dose-response relationship. The frequency of heavy binge drinking and not just the volume of alcohol intake may increase the risk of mortality from upper digestive tract cancer, particularly esophageal cancer in Korean men. These findings need to be confirmed in further studies with a larger sample size.

• 대한두경부종양학회지
• /
• 제7권2호
• /
• pp.120-128
• /
• 1991

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

• Radiation Oncology Journal
• /
• 제6권2호
• /
• pp.211-226
• /
• 1988

방사선 단독 치료나 수술후 방사선 치료를 받았던 165명의 식도암 환자 중에서 평균 생존율은 6.6개원이였으며 3,5년 생존율은 $10\%,\;8\%$였다. 생존율을 semilogarithmical하게 나타낸 biphasic plotting에서 보면 non-responder group은 치료에도 불구하고 1년내 모두 사망하였고 responder group중에서는 수술후 방사선 치료를 받았던 환자 20명 $(54\%)$은 1, 2, 3년 생존율이 각각$80\%,\;70\%,\; 60%$였으며, 방사션 치료만 받은 환자 61명$(48\%)$의 생존율은 각각 $62\%,\;38\%,\;23\%$였다. 즉, 3년간의 생존율의 비교는 수술후 방사선 치료가 방사선 단독치료 보다는 좋았다 (P<0.01). 가장 많은 사망의 원인으로는 연하곤란$(55\%)$이였으며 환자의 대다수는 국소적인 치료실패에 의해 사망하였으며 $(62\%)$ 협착의 $88\%$는 지속적인 암의 존재와 관련이 있었다. 환자의 $50\%$는 국소적인 임파절 전이가 발견되었다. 수술전의 진단 실패율은 $54\%$가 국소임파절 전이 때문에, $29.7\%$가 육안적인 임파절 전이 때문에, $13.5\%$가 혈행성 전이 때문에 그리고 $14\%$가 국소적인 직접 침범 때문이였다. Conventional radiation (6000 cGy/30 fraction in 6 weeks)이나 hyperfractionation radiation (upto 6900cGy, l15cGy/fraction)이거나 관계없이 gross disease는 충분히 즉일수 없었다. 그러나 hyperfractionation 테크닉에 의해서 급성 방사선 염증이 감소되어서 환자의 고통을 덜어줄 수 있었으며 그 후의 만성 부작용으로서의 방사선 합병증이 현저히 감소되었다.

• Journal of Chest Surgery
• /
• 제24권9호
• /
• pp.895-902
• /
• 1991

The surgical experience on 18 patients with benign or malignant stricture of the esophagus who underwent isoperistaltic interposition of left colon from April 1989 to July 1991 was reviewed. During same period 22 esophageal reconstructions with colon were performed, but 3 patients who had intraabdominal adhesion in the left upper quadrant and one patient who had uncertainty of blood supply of left colic artery could not undergo iso-peristaltic interposition of left colon. There were 12 male and 6 female patients ranging from 16 to 65 years of age. 12 patients had corrosive esophageal stricture, two had cancer of esophagus, and another two had hypopharyngeal cancer. The postoperative complications developed in 7 patients [38.8%] and most frequently encountered complication was cervical anastomotic leakage, which was successfully managed with simple drainage in all cases but one malignant patient. There was no operative mortality. The esophageal reconstruction with isoperistaltic left colon resulted in good function in 14 patients[77.8%], fair in 3 patients[16.7], and poor in 1 patient[5.6%]. In this experience esophageal reconstruction using isoperistaltic left colon is a satisfactory method that can be accomplished with acceptable morbidity and mortality.

• Journal of Chest Surgery
• /
• 제24권8호
• /
• pp.807-813
• /
• 1991

Between October 1987 and October 1990, 6 patients underwent pharyngolaryngoesophagectomy with transhiatal gastric transposition and pharyngogastrostomy for hypopharyngeal and recurred laryngeal cancer. All patients had squamous cell carcinoma and were male, with age range from 54 to 67 years. Two patients had been treated initially by chemotherapy, but the tumor had persisted. One patient had been treated by radiotherapy and operation, but tumor had recurred in hypopharynx. There was no operative death. Major complications were anastomotic leakage in three cases, wound disruption in four cases and one postoperative bleeding. Anastomotic leakage was recovered in two cases with conservative management. The average hospital day was 33 days postoperatively. We conclude that reconstruction of the pharynx and cervical esophagus with gastric transposition is one of the recommendable procedures for extensive resection of pharynx or cervical esophagus with acceptable morbidity and functional recovery.

• Journal of Medicine and Life Science
• /
• 제17권1호
• /
• pp.21-24
• /
• 2020

Intramural esophageal dissection is a rare disorder characterized by a separation of the mucosa and/or submucosa from deeper muscular layers of the esophagus, with or without perforation. Iatrogenic instrumentation such as endoscopy is one of the major causes of IED. We report a case of IED after endoscopy in a patient with hypopharyngeal cancer treated with concurrent chemoradiotherapy, and suggest that a history of chemoradiotherapy can be a risk factor of IED on endoscopy. In this case, chest computed tomography scans show not only typical esophageal double lumen but also eccentric esophageal wall thickening and abnormally thin the other side esophageal wall, and this CT finding may also be important to diagnose IED.

• Journal of Chest Surgery
• /
• 제6권2호
• /
• pp.225-230
• /
• 1973

Five cases of esophageal cancer developed at the site of esophageal lye stricture were reported. Duration of lye stricture was between 13 and 40years, and all 5 cases had taken normal diet without appreciable troubles after recovery from the acute stage of burn till the suspected onset of esophageal malignaney. Outstanding symptoms of this grave condition were rather acute progressive dysphagia and frequent episodes of esophageal foreign bodies, Diagnosis could be confirmed easily by endoscopic biopsy in suspected eases, and all were epidermoid carcinoma histopathologically. Curative resection of this condition was made in neither of the cases, and their prognoses were more grave than other esophageal malignancies in our experience. The development of esophageal carcinoma at the site of corrosive esophagitis with resulting benign stricture has now been suspected as a cause and effect relationship between these two conditions, and Kiviranta: stated that the incidence of esophageal cancer in patients with lye stricture of longer duration is a thousand times higher than normal population. During last one decade the authors experienced 5 cases of esophageal carcinoma developed at the site of lye stricture of the esophagus among about 350 cases of lye burned esophagus at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul, Korea. In Korea they still use lye as a detergent in rural area, and there are still many persons ingesting lye for suicidal attempt or on accident. Lye stricture of the esophagus is, therefore, the most common esophageal disease needing surgical procedures, and the authors believe that there will be much more eases of lye stricture complicated by esophageal eareinoma repoted in near future in this Country.

• Journal of Gastric Cancer
• /
• 제19권3호
• /
• pp.290-300
• /
• 2019

Purpose: The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. Materials and Methods: This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. Results: The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien-Dindo classification grade ${\geq}II$) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. Conclusions: Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.