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  • 1
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Dysphagia 8 (1993), S. 98-104 
    ISSN: 1432-0460
    Keywords: Esophageal manometry ; Motility disorders ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Esophageal manometry allows to quantify intraluminal pressure changes as the basis of normal or abnormal esophageal motility. It is a complementary diagnostic procedure which should only be performed after endoscopic and fluoroscopic examinations and may be helpful in the detection of various motility disorders like diffuse esophageal spasm, nutcracker esophagus and vigorous achalasia. Manometry is recommendable for therapy control after medical and surgical therapy, and mandatory prior to surgical reflux therapy.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0460
    Keywords: Barrett's esophagus ; Gastroesophageal reflux ; Adenocarcinoma ; High grade dysplasia ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Barrett's esophagus (i.e. columnar epithelial metaplasia in the distal esophagus) is an acquired condition that in most patients results from chronic gastroesophageal reflux. It is a disorder of the white male in the Western world with a prevalence of about 1/400 population. Due to the decreased sensitivity of the columnar epithelium to symptoms, Barrett's esophagus remains undiagnosed in the majority of patients. Gastroesophageal reflux disease in patients with Barrett's esophagus has a more severe character and is more frequently associated with complications as compared with reflux patients without columnar mucosa. This appears to be due to a combination of a mechanically defective lower esophageal sphincter, inefficient esophageal clearance function, and gastric acid hypersecretion. Excessive reflux of alkaline duodenal contents may be responsible for the development of complications (i.e., stricture, ulcer, and dysplasia). Therapy of benign Barrett's esophagus is directed towards treatment of the underlying reflux disease. Barrett's esophagus is associated with a 30- to 125-fold increased risk for adenocarcinoma of the esophagus. The reasons for the dramatic rise in the incidence of esophageal adenocarcinoma, which occurred during the past years, are unknown. High grade dysplasia in a patient with columnar mucosa is an ominous sign for malignant degeneration. Whether an esophagectomy should be performed in patients with high grade dysplasia remains controversial. Complete resection of the tumor and its lymphatic drainage is the procedure of choice in all patients with a resectable carcinoma who are fit for surgery. In patients with tumors located in the distal esophagus, this can be achieved by a transhiatal en-bloc esophagectomy and proximal gastrectomy. Early adenocarcinoma can be cured by this approach. The value of multimodality therapy in patients with advanced tumors needs to be shown in randomized prospective trials.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-0460
    Keywords: Zenker's diverticulum ; Cervical myotomy ; Diverticulectomy ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6½ years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%. In 60% of the cases investigated preoperatively (N=40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum. The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-0460
    Keywords: Gastroesophageal reflux disease ; Diagnosis ; pH monitoring ; Diagnostic studies ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastroesophageal reflux disease (GERD) is one of the most frequent benign diseases of the gastrointestinal tract and in some cases the diagnosis may be very difficult. There are many diagnostic procedures but none of them could prove or definitely exclude the disease. The 24-h pH-monitoring is the “gold standard” for detection of gastroesophageal reflux and in many patients the reflux correlates with the GERD. The evaluation of a diagnostic method has to be done in a similar manner to the evaluation of therapeutic study (phase 1 to phase 4). For the definition of the “gold standard” for detection of a special diagnosis (e.g., the gastroesophageal reflux disease), the results of phase 3 studies for different methods had to be compared. The method with the best values for sensitivity and specificity is yet to be discovered. Until now, pH monitoring has been the gold standard for the diagnosis of GERD. However, there are many problems connected with using this method in clinical practice.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Dysphagia 8 (1993), S. 135-145 
    ISSN: 1432-0460
    Keywords: Esophageal motility ; Surgical therapy ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical treatment is either the therapy of choice or a facultative procedure in various types of esophageal motility disorders. In achalasia, cardiomyotomy, frequently combined with fundoplasty, achieves good or excellent results in 〉80% of cases, and is, therefore, advised in cases when pneumostatic dilatation fails. Diverticulectomy and myotomy of the upper or lower esophageal sphincter are proven procedures to treat cervical and epiphrenic diverticula, leading to good/excellent results or at least an improvement in more than 95%. If, exceptionally, parabronchial diverticula require therapy, they should be excised transthoracically. Cervical myotomy is indicated in cases of cervical achalasia, when sufficient pharyngeal propulsion is preserved. In systemic diseases like scleroderma reflux induced complications may require surgical intervention in medically intractable cases. In these rather few cases, subtotal gastrectomy with a Roux-en-Y anastomosis is advised. In patients suffering from diffuse esophageal spasm or symptomatic “nutcracker” esophagus, extended esophageal myotomy can relieve symptoms. If a clear diagnosis is provided, about 75% of patients will have an improvement of symptoms.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 16 (1992), S. 1103-1103 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 19 (1995), S. 483-483 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 19 (1995), S. 167-167 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    World journal of surgery 19 (1995), S. 198-204 
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé L'association chimiothérapie et radiochimiothérapie préopératoire a reçu beaucoup d'attention dernièrement. Alors que plusieurs études prospectives randomisées n'ont pu démontrer les bénéfices d'une thérapeutique néoadjuvante chez des patients ayant une tumeur potentiellement résécable, la chimiothérapie seule ou associée à la radiothérapie préopératoires semble augmenter le taux de résécablitié et la survie chez les patients avant des tumeurs locorégionates. La plupart des études disponibles démontrent une amélioration de survie lorsque la thérapeutique est multimodale, lorsque la réponse histologique initiale à la chimiothérapie préoperatoire est positive, c'est à dire, s'il n'y ait aucune tumeur visible dans la pièce opératoire. La radiochimiothérapie préopératoire augmente le taux de réponse et améliore le contrôle local, par rapport à la chimiothérapie seule, mais elle augmente également la mortalité et la morbidité périopératoires. Les métastases à distance ne sont pas bien controlées par la radiochimiothérapeutique associée. Ces donnécs indiquent que la thérapeutique néoadjuvante est encore au stade expérimental chez le patient ayant un cancer de l'oesophage résecable, mais est en voie de devenir la thérapeutique de l'avenir en ce qui concerne les tumeurs locorégionales. La recherche actuelle cherche à identifier les patients qui répondront au mieux à cette thérapeutique néoadjuvante. De plus, des drogues moins toxiques et plus efficaces sont nésessaires pour améliorer le taux de réponse et combattre les récidivcs systémiques. Enfin, des études randomisécs sont essentielles pour évaluer le rôle, l'étendue et le meilleur moment de la résection chirurgicale dans cette optique thérapeutique chez le patient ayant un cancer épithélial de l'oesophage.
    Abstract: Resumen La quimioterapia preoperatoria (CTx) y la combinación radioquimioterapia (RTx/CTx) en los pacientes con carcinoma escamocelular del esófago se constituye en motivo reciente de atención. En tanto que varios ensayos prospectivos y randomizados no han logrado demostrar beneficio de la terapia neoadyuvante en pacientes con tumores potencialmente resecables, la CTx preoperatoria o la combinación RTx/CTx parece aumentar la tasa de resección, la tasa de resección tumoral completa y el tiempo de sobrevida en los pacientes con tumores localmente avanzados. La mayoría de los estudios disponibles demuestra que el beneficio de supervivencia puede esperarse en los pacientes que exhiben respuesta histopatológica completa al tratamiento preoperatorio, o sea aquellos en que no se encuentran células viables en el espécimen de resección. Una combinación de RTx/CTx preoperatoria aumenta las tasas de respuesta y mejora el control tumoral local en comparación con la CTx preoperatoria sola, pero también se asocia con morbilidad y mortalidad perioperatorias considerables. Las recurrencias tumorales a distancia todavía no pueden ser bien controladas mediante los protocolos de terapias combinadas actualmente en boga. Estos datos indican que la terapia neoadyuvante debe ser considerada todavía como de tipo investigativo en los pacientes con carcinoma esofágico potencialmente resecable, pero que tal vez pronto puedan convertirse en tratamiento estandarizado en los pacientes con tumores localmente avanzados. La investigación debe enfocarse sobre las modalidades que permiten la identificación preterapéutica de aquellos pacientes que habrán de responder a la terapia neoadyuvante. Por lo demás, se requieren regímenes terapéuticos preoperatorios más eficaces y menos tóxicos con el objeto de aumentar las tasas de respuesta y de controlar las recurrencias sistémicas. Finalmente, es esencial ejecutar estudios prospectivos randomizados para determinar el rol, la magnitud y el momento de realizar la resección quirúrgica en el aproche multimodal de los pacientes con carcinoma escamocelular del esófago.
    Notes: Abstract Preoperative chemotherapy (CTx) and combination radiochemotherapy (RTx/CTx) in patients with squamous cell esophageal carcinoma has recently received increasing attention. Although several prospective randomized trials could not show any benefit of neoadjuvant therapy in patients with potentially resectable tumors, preoperative CTx and combination RTx/CTx appear to increase the resection rate, the rate of complete tumor resection, and survival time in patients with locally advanced tumors. Most available studies show that a survival benefit from multimodal therapy can be expected primarily in patients who have a complete histopathologic response to preoperative treatment (i.e., no viable tumor in the resected specimen). Preoperative RTx/CTx increases the response rate and improves local tumor control compared to preoperative CTx alone, but it is associated with substantial perioperative mortality and morbidity. Distant tumor recurrences are insufficiently controlled with current combined modality protocols. These data indicate that neoadjuvant therapy must be considered investigational in patients with potentially resectable esophageal carcinoma but may soon become standard in patients with locally advanced tumors. Research must focus on modalities that allow pretherapeutic identification of those patients who will respond to neoadjuvant therapy. Furthermore, more effective and less toxic preoperative therapy regimens are required to increase the response rates and combat systemic recurrences. Finally, randomized prospective studies are essential to assess the role, extent, and timing of surgical resection for the combined modality approach to patients with squamous cell esophageal carcinoma.
    Type of Medium: Electronic Resource
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