Jessica Leers

Coincidence of Nutritional Habits and Esophageal Cancer in Germany

Introduction: The incidence rates for adenocarcinoma (AC) of the esophagus have risen rapidly in Western nations, whereas the incidence rates for esophageal squamous cell carcinoma (SCC) have remained nearly stable. There are studies about body mass index, smoking, alcohol, and development of AC or SCC. The aim of this study was to evaluate differences in nutritional habits of patients with AC or SCC compared with the population in Cologne. Patients and Methods: From January 1, 1997 to December 31, 1998, 85 patients with esophageal cancer (SCC n = 45, AC n = 40) were interviewed about their nutritional habits using a computerized program (EBIS). By random sample, 100 citizens of Cologne who were similar of age, residence, and nationality were chosen as healthy control group (CG) and were also interviewed with EBIS. Results: The known risk factors, alcohol and tobacco for SCC as well as alcohol and a high body mass index for AC, were confirmed in this study. The CG had a higher daily intake of calcium, magnesium and iron compared to patients with esophageal cancer (p < 0.05). In addition, the tumor group had a significant lower daily supply of carbohydrates, fruits, and dietary fiber (p < 0.001). About 80% of the patients ate more than 100 g meat/day in comparison to 50% of participants in the CG. Patients with AC consumed more magnesium, milk, and animal protein than patients with SCC or the participants of the CG. Conclusion: There are differences in nutrition between healthy controls and patients with esophageal cancer and between patients with SCC and AC. Patients with cancer of the esophagus had a nutritonal deficit in fresh fruit, vegetables, dietary fiber, and carbohydrates. Compared with the other groups, patients with AC had a higher intake of protein, fat, and milk.

Lack of prognostic significance of serum DNA methylation of DAPK, MGMT, and GSTPI in patients with non‐small cell lung cancer

To further improve the screening, diagnosis and therapy of patients with non‐small cell lung cancer (NSCLC) additional diagnostic tools are desperately warranted. Aim of this study was to investigate the potential of the DNA methylation of DAPK, MGMT, and GSTPI in serum of patients with NSCLC as a prognostic molecular marker in this disease.

High Prevalence of Colonic Polyps in White Males with Esophageal Adenocarcinoma

PURPOSE: There is ongoing discussion regarding Barretts esophagus and the prevalence of colonic neoplasms. The goal of this investigation was to evaluate colonoscopic findings in patients with esophageal carcinoma. METHODS: In this case-control study, we used the data of patients with esophagectomy. These patients underwent routine preoperative endoscopy of the entire colon to exclude pathologic findings pending the need for colonic bridging graft reconstruction. A total of 171 patients with esophageal cancer (78 adenocarcinomas, 93 squamous-cell carcinomas, and 168 control subjects) who underwent screening colonoscopy were included. Univariate analysis and multinomial logistic regression were used to calculate odds ratios for colonic polyps. RESULTS: The age of the three groups of patients was comparable (median age: adenocarcinoma = 62 years, squamous-cell carcinoma = 58 years, control subjects = 59 years). The male to female ratio differed significantly (adenocarcinoma = 71:7, squamous-cell carcinoma = 65:28, control subjects = 86:82; P < 0.001). Patients with adenocarcinoma had more findings on colonoscopy than patients with squamous-cell carcinoma (45 and 25 percent, respectively; P < 0.01) or control subjects (14 percent; P < 0.001). Analyzing the male data only, the difference was more pronounced. The histologic type of the esophageal tumor significantly impacted the presence of colorectal polyps even with age-adjusted and sex-adjusted data (P < 0.001), with an odds ratio of 4.03 for adenocarcinoma. CONCLUSION: These results demonstrate a significant relationship between the development of Barretts carcinoma and colonic polyps.

Effect of aging on esophageal motility in patients with and without GERD.

Background/Aims: The impact of aging on esophageal motility is not completely understood. This study aims at assessing 1) whether degeneration of esophageal body motility occurs with age and 2) whether this development is influenced by gastroesophageal reflux disease (GERD). Methods: 326 consecutive patients with symptoms of GERD underwent a diagnostic work-up including a water-perfused esophageal manometry. Patients were divided by age: 17–39 years (group 1, n=75), 40–49 years (group 2, n=79), 50–59 years (group 3, n=64), 60–69 years (group 4, n=74), and >70 years (group 5, n=34). GERD was diagnosed if patients had erosive esophagitis at endoscopy, a positive pH-metry, or both. The amplitude of esophageal contraction waves 3 cm and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed and correlated to GERD. Results: A normal esophageal manometry was found in 86.7%, 73.4%, 67.2%, 58.1%, and 55.9% (p<0.01) in groups 1–5, respectively. Esophageal contraction wave amplitudes were affected by age in patients positive for GERD only (p<0.01). Esophageal body peristalsis was affected by age (p<0.01) independent of the diagnosis of GERD. Conclusion: Aging is correlated to esophageal motor abnormalities. GERD has a significant impact on esophageal contraction wave amplitude, but not on peristalsis.

Incidence and management of chylothorax after Ivor Lewis esophagectomy for cancer of the esophagus.

OBJECTIVE Chylothorax is a major complication after esophagectomy. As recent studies refer to heterogeneous patient cohorts and surgical procedures, this study was conducted to report the incidence and evaluate the optimal management of chylous fistula in patients treated with transthoracic esophagectomy and 2-field lymphadenectomy for esophageal cancer. METHODS From January 2005 to December 2013, a total of 906 patients underwent transthoracic esophageal resection for esophageal carcinoma at our institution. En bloc esophagectomy was performed with routine supradiaphragmatic ligation of the thoracic duct. The incidence of chylothorax, and associated morbidity and mortality, were analyzed, and subsequent therapeutic management was reviewed. RESULTS Chylothorax after Ivor Lewis esophagectomy was observed in 17 (1.9%) patients. Fifteen patients required surgical intervention with rethoracotomy and repeat duct ligation. Thoracic duct ligation was successful in all patients. Two patients died within 90 days after primary esophageal resection. The median time between initial tumor resection and rethoracotomy was 13 days. Average daily chest-tube output at time of reoperation was 1900 mL. In 2 patients, pleural effusion did not exceed 1000 mL per day. In these cases, conservative management with additional thoracic drainage and total parenteral nutrition led to complete resolution of chylous fistula. CONCLUSIONS Occurrence of chylothorax after prophylactic thoracic duct ligation during transthoracic esophagectomy for esophageal cancer is rare. In patients with high-output chylous fistula, an early rethoracotomy with repeat ligation of the thoracic duct is safe and helps to shorten recovery time. In cases of low-volume drainage, a conservative approach is feasible.

Preoperative colonoscopy before esophagectomy and reconstruction with gastric interposition

ZusammenfassungEinleitungDie operative Standardtherapie des Ösophaguskarzinoms ist die Ösophagektomie und Rekonstruktion durch Magenhochzug. Im Rahmen der präoperativen Abklärung wird zum Ausschluss von pathologischen Befunden des Kolons endoskopiert, falls ein intraoperatives Umsteigen von Magen- zur Koloninterposition notwendig wird.Patienten und MethodikBei 228 Patienten erfolgte die Ösophagektomie wegen eines Ösophaguskarzinoms. 219 Patienten erhielten eine Mageninterposition, während 9 Patienten primär durch ein Koloninterponat rekonstruiert wurden. 171 von 228 (75%) Patienten wurden präoperativ koloskopiert.ErgebnisseBei keinem der Patienten mit geplantem Magenhochzug war ein intraoperatives Umsteigen auf eine Koloninterposition notwendig. Insgesamt wurden koloskopisch 2 pT1-Adenokarzinome entfernt und 62 Adenome abgetragen. Eine asymptomatische Divertikulose fand sich bei 53 Patienten (31%). Untersuchungsbedingte Komplikationen nach Koloskopie wurden nicht beobachtet.SchlussfolgerungDie präoperative Koloskopie vor geplantem Magenhochzug ist aus operationstechnischen Gründen nicht zwingend erforderlich, da ein intraoperatives Umsteigen auf eine Koloninterposition sehr selten notwendig ist. Die Rate von Adenomen oder Karzinomen des Kolons ist weder bei Patienten mit Adeno- noch mit Plattenepithelkarzinom des Ösophagus höher als in einem gleichaltrigem Normalkollektiv.AbstractIntroductionThe standard treatment of esophageal carcinoma is esophagectomy and reconstruction with gastric interposition. In many centers, preoperative colonoscopy is routinely performed in order to exclude any significant colonic pathology. This is important in case of the intraoperative necessity to use a colon interposition due to gastric pathology, anatomical variation, or injury of gastric vascularization.Patients and MethodsTwo hundred twenty-eight consecutive patients with esophageal carcinoma (adenocarcinoma 102, squamous cell carcinoma 126) who underwent esophagectomy were included in this study. Of them, 171 (75%) had preoperative colonoscopy. Reconstruction was done by gastric tube in 219 and colon interposition in nine.ResultsIntraoperative conversion to colon interposition was necessary in none of the 219 patients with intended reconstruction by a gastric conduit. In two of 171 patients (1.2%), preoperative colonoscopy revealed pT1 adenocarcinomas of the colon which were completely removed by endoscopy, and a total of 62 adenomas were histopathologically diagnosed. Fifty-three patients (31%) had endoscopic evidence of asymptomatic diverticulosis. No complications were observed after colonoscopy.ConclusionPreoperative colonoscopy prior to esophagectomy and intended gastric tube formation appears unnecessary from the surgical point of view, as intraoperative conversion to a colon interposition is rare. The rate of colon adenomas or carcinomas was not increased in patients with adeno- or squamous cell carcinoma of the esophagus than in an age-matched, normal population.

Results of endoscopic vacuum-assisted closure device for treatment of upper GI leaks

BackgroundEsophageal perforations and postoperative leakage of esophagogastrostomies are considered to be life-threatening conditions due to the potential development of mediastinitis and consecutive sepsis. Vacuum-assisted closure (VAC) techniques, a well-established treatment method for superficial infected wounds, are based on a negative pressure applied to the wound via a vacuum-sealed sponge. Endoluminal VAC (E-VAC) therapy as a treatment for GI leakages in the rectum was introduced in 2008. E-VAC therapy is a novel method, and experience regarding esophageal applications is limited. In this retrospective study, the experience of a high-volume center for upper GI surgery with E-VAC therapy in patients with leaks of the upper GI tract is summarized. To our knowledge, this series presents the largest patient cohort worldwide in a single-center study.MethodsBetween October 2010 and January 2017, 77 patients with defects in the upper gastrointestinal tract were treated using the E-VAC application. Six patients had a spontaneous perforation, 12 patients an iatrogenic injury, and 59 patients a postoperative leakage in the upper gastrointestinal tract.ResultsComplete restoration of the esophageal defect was achieved in 60 of 77 patients. The average duration of application was 11.0 days, and a median of 2.75 E-VAC systems were used. For 21 of the 77 patients, E-VAC therapy was combined with the placement of self-expanding metal stents.ConclusionThis study demonstrates that E-VAC therapy provides an additional treatment option for esophageal wall defects. Esophageal defects and mediastinal abscesses can be treated with E-VAC therapy where endoscopic stenting may not be possible. A prospective multi-center study has to be directed to bring evidence to the superiority of E-VAC therapy for patients suffering from upper GI defects.

Präoperative Koloskopie vor Magenhochzug

ZusammenfassungEinleitungDie operative Standardtherapie des Ösophaguskarzinoms ist die Ösophagektomie und Rekonstruktion durch Magenhochzug. Im Rahmen der präoperativen Abklärung wird zum Ausschluss von pathologischen Befunden des Kolons endoskopiert, falls ein intraoperatives Umsteigen von Magen- zur Koloninterposition notwendig wird.Patienten und MethodikBei 228 Patienten erfolgte die Ösophagektomie wegen eines Ösophaguskarzinoms. 219 Patienten erhielten eine Mageninterposition, während 9 Patienten primär durch ein Koloninterponat rekonstruiert wurden. 171 von 228 (75%) Patienten wurden präoperativ koloskopiert.ErgebnisseBei keinem der Patienten mit geplantem Magenhochzug war ein intraoperatives Umsteigen auf eine Koloninterposition notwendig. Insgesamt wurden koloskopisch 2 pT1-Adenokarzinome entfernt und 62 Adenome abgetragen. Eine asymptomatische Divertikulose fand sich bei 53 Patienten (31%). Untersuchungsbedingte Komplikationen nach Koloskopie wurden nicht beobachtet.SchlussfolgerungDie präoperative Koloskopie vor geplantem Magenhochzug ist aus operationstechnischen Gründen nicht zwingend erforderlich, da ein intraoperatives Umsteigen auf eine Koloninterposition sehr selten notwendig ist. Die Rate von Adenomen oder Karzinomen des Kolons ist weder bei Patienten mit Adeno- noch mit Plattenepithelkarzinom des Ösophagus höher als in einem gleichaltrigem Normalkollektiv.AbstractIntroductionThe standard treatment of esophageal carcinoma is esophagectomy and reconstruction with gastric interposition. In many centers, preoperative colonoscopy is routinely performed in order to exclude any significant colonic pathology. This is important in case of the intraoperative necessity to use a colon interposition due to gastric pathology, anatomical variation, or injury of gastric vascularization.Patients and MethodsTwo hundred twenty-eight consecutive patients with esophageal carcinoma (adenocarcinoma 102, squamous cell carcinoma 126) who underwent esophagectomy were included in this study. Of them, 171 (75%) had preoperative colonoscopy. Reconstruction was done by gastric tube in 219 and colon interposition in nine.ResultsIntraoperative conversion to colon interposition was necessary in none of the 219 patients with intended reconstruction by a gastric conduit. In two of 171 patients (1.2%), preoperative colonoscopy revealed pT1 adenocarcinomas of the colon which were completely removed by endoscopy, and a total of 62 adenomas were histopathologically diagnosed. Fifty-three patients (31%) had endoscopic evidence of asymptomatic diverticulosis. No complications were observed after colonoscopy.ConclusionPreoperative colonoscopy prior to esophagectomy and intended gastric tube formation appears unnecessary from the surgical point of view, as intraoperative conversion to a colon interposition is rare. The rate of colon adenomas or carcinomas was not increased in patients with adeno- or squamous cell carcinoma of the esophagus than in an age-matched, normal population.

Ösophaguskarzinom inkl. Karzinome des gastroösophagealen Übergangs

In der Behandlung von Patienten mit lokalisierten Osophaguskarzinomen (Tis, T1a und T1b ohne Risikofaktoren, <2 cm) haben sich endoskopischen Verfahren als ausreichende Alternative zur chirurgischen Therapie durchgesetzt. Fur Patienten mit resektabler Erkrankung ab T1b stellt die Osophagektomie mit Interposition eines Schlauchmagens oder in selteneren Fallen eines Kolon- oder Dunndarminterponates das chirurgische Vorgehen der Wahl dar. Fur Patienten mit resektablen Tumoren des gastroosophagealen Ubergangs werden sowohl die Osophagektomie als auch die transhiatal erweiterte Gastrektomie durchgefuhrt. Eine neoadjuvante Vorbehandlung hat sich fur fortgeschrittene Stadien ab cT2 durchgesetzt. Eine definitive Radiochemotherapie scheint fur Plattenepithelkarzinome vergleichbare onkologische Ergebnisse zu erzielen und wird in den Leitlinien als Alternative berucksichtigt. Bei einem Rezidiv nach definitiver Radiochemotherapie ist eine Salvage-Osophagektomie moglich.

Ist übergewicht ein Risikofaktor für das Adenocarcinom des gastroösophagealen übergangs in Deutschland

Einleitung: Die Inzidenz des Adenocarcinoms im gastroosophagealen Ubergang (ACG) steigt in den letzten 30 Jahren an. Es werden verschiedene Ursachen, wie Ernahrungsfaktoren, Lebensstil oder Medikamente, diskutiert. Bisher ist nicht geklart, ob Adenocarcinome im Oesophagus (Typ I) dieselbe atiologie haben wie Tumore in der Cardia (Typ II) oder subcardiale Adenocarcinome (Typ III). Ziel unserer Untersuchung war es, die Rolle des Ubergewichts auf die Entstehung des ACG unter Berucksichtigung von anderen Risikofaktoren zu evaluieren. Methode: In der Zeit vom 1.5.1996 bis zum 30.06.2001 wurden prospektiv alle Pat. in der Klinik mit der Diagnose eines ACG (n = 150, Typ I = 74 und Typ II = 56, Typ III = 35) mit einem standardisierten Fragebogen uber Lebensstil und Ernahrungsgewohnheiten befragt. Als Vergleich diente eine Gruppe von 1176 Kolner Burgern (> 40 Jahre), die per Randomliste ausgewahlt wurde. Die statistische Auswertung erfolgte uni- und multivariat.