• Drainage
• Esophageal stent
• Esophagogastric anastomotic leakage
• Interventional radiology

• Abscess/therapy
• Aged
• Anastomosis, Surgical
• Anastomotic Leak/diagnostic imaging
• Anastomotic Leak/therapy
• Decompression, Surgical/instrumentation
• Device Removal
• Drainage/instrumentation
• Enteral Nutrition/instrumentation
• Esophageal Fistula/diagnostic imaging
• Esophageal Fistula/therapy
• Esophagectomy/adverse effects
• Esophagus/surgery
• Feasibility Studies
• Female
• Fistula/diagnostic imaging
• Fistula/therapy
• Humans
• Male
• Mediastinal Diseases/diagnostic imaging
• Mediastinal Diseases/therapy
• Middle Aged
• Radiology, Interventional/methods
• Retrospective Studies
• Stents
• Stomach/surgery
• Survival Rate

• 81501569 National Natural Science Foundation of China

• Esophageal squamous cell carcinoma
• Prognosis
• Protein phosphatase  Mg2+/Mn2+ dependent 1D
• Tumor metastasis

AIM: To investigate the influence of nodal status on response and clarify the optimal treatment for operable esophageal squamous cell carcinoma (OSCC).

METHODS: We retrospectively analyzed 1490 OSCC patients who underwent transthoracic esophagectomy and lymphadenectomy between December 1996 and December 2009 at the Sun Yat-sen University Cancer Center. The surgical approach and the number of resected lymph nodes (LNs) were considered in the assessment of surgery. Patients were classified according to their nodal statuses (N0 vs N1 vs N2-3). Overall survival was defined as the time from the date of death or final follow-up. Survival analysis was performed using the Kaplan-Meier method and differences between curves were assessed by the log-rank test. Univariate and multivariate Cox regression analyses were used to identify factors associated with prognosis. Statistical significance was assumed at a P < 0.05.

RESULTS: With a median time from surgery to the last censoring date for the entire cohort of 72.2 mo, a total of 631 patients were still alive at the last follow-up and the median survival time was 35.5 mo. The surgical approach (left transthoracic vs Ivor-Lewis/tri-incisional) was verified as independent prognostic significance in patients with N0 or N1 status, but not in those with N2-3 status. Similar results were also observed with the number of resected LNs (≤ 14 vs≥ 15). Compared with surgery alone, combined therapy achieved better outcomes in patients with N1 or N2-3 status, but not in those with N0 status. For those with N2-3 status, neither the surgical approach nor the number of resected LNs reached significance by univariate analysis, with unadjusted HRs of 0.826 (95%CI: 0.644-1.058) and 0.849 (95%CI: 0.668-1.078), respectively, and aggressiveness of surgery did not influence the outcome; the longest survival was observed in those patients who received the combined therapy.

CONCLUSION: Combined therapy has a positive role in OSCC with LN metastasis, and aggressive surgical resection does not improve survival in patients with N2-3 status.

• Esophageal neoplasm
• Lymph nodes
• Prognosis
• Surgery

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell/mortality
• Carcinoma, Squamous Cell/secondary
• Carcinoma, Squamous Cell/surgery
• Chemoradiotherapy, Adjuvant
• Chemotherapy, Adjuvant
• China
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Esophageal Squamous Cell Carcinoma
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Esophagectomy/mortality
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision/adverse effects
• Lymph Node Excision/methods
• Lymph Node Excision/mortality
• Lymphatic Metastasis
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

AIM: To evaluate the benefit and safety of sivelestat (a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy.

METHODS: Online databases including PubMed, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases (Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio (RR) was used to express the effect size of dichotomous outcomes, and mean difference (MD) or standardized mean difference was used to express the effect size of continuous outcomes.

RESULTS: Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I² = 76.3%, SMD = -1.41, 95%CI: -2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery (I² = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever.

CONCLUSION: A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect.

• Neutrophil elastase inhibitor
• Esophageal cancer
• Esophagectomy
• Systematic review
• Meta-analysis

• Acute Lung Injury/etiology
• Acute Lung Injury/prevention & control
• Aged
• Esophagectomy/adverse effects
• Female
• Glycine/adverse effects
• Glycine/analogs & derivatives
• Glycine/therapeutic use
• Humans
• Leukocyte Elastase/antagonists & inhibitors
• Leukocyte Elastase/metabolism
• Male
• Middle Aged
• Odds Ratio
• Respiration, Artificial
• Risk Factors
• Serine Proteinase Inhibitors/adverse effects
• Serine Proteinase Inhibitors/therapeutic use
• Sulfonamides/adverse effects
• Sulfonamides/therapeutic use
• Time Factors
• Treatment Outcome

• Esophageal neoplasms
• Radiotherapy
• Resection margin