http://hdl.handle.net/2027.42/57498 Thu, 23 May 2013 21:10:26 GMT 2013-05-23T21:10:26Z http://deepblue.lib.umich.edu:80/bitstream/id/209093/263248.jpg http://hdl.handle.net/2027.42/57498 http://hdl.handle.net/2027.42/57525 Management of the cervical esophagogastric anastomotic stricture Chang, Andrew C.; Orringer, Mark B. Esophagogastric anastomotic stricture following esophagectomy with a gastric esophageal substitute can be a vexing problem for the patient and treating physician. We describe the clinical practice at a single center with extensive experience in esophageal surgery for management of this complication. Mon, 01 Jan 2007 00:00:00 GMT http://hdl.handle.net/2027.42/57525 2007-01-01T00:00:00Z http://hdl.handle.net/2027.42/57504 Transhiatal esophagectomy for distal and cardia cancers: implications of a positive gastric margin. DiMusto, Paul D.; Orringer, Mark B. BACKGROUND: A common operation for cancer of the esophagus and cardia consists of transhiatal esophagectomy, proximal gastrectomy, and a cervical esophagogastric anastomosis. The oncologic adequacy of dividing the stomach 4 to 6 cm distal to palpable tumor is not well documented, and when a positive gastric margin is present on the final pathologic analysis, the appropriate management is not established. This study was undertaken to determine the incidence of a positive gastric margin in these patients and the impact of adjuvant treatment. METHODS: A retrospective review was performed of 1044 patients undergoing transhiatal esophagectomy for adenocarcinoma of the distal esophagus or cardia. Twenty (1.9%) had a positive gastric margin on final the pathologic evaluation and met inclusion criteria for this study. RESULTS: Nine patients (45%) received adjuvant therapy consisting of radiation in 3, chemotherapy in 4, or both in 2. Their average postoperative survival was 477 days, compared with 455 days in those not receiving adjuvant therapy (p = 0.898). Local tumor recurrence developed in 1 patient (11%) in the treatment group and in 3 (27%) in the no treatment group (p = 0.386). CONCLUSIONS: A transhiatal esophagectomy and proximal gastrectomy for carcinoma of the distal esophagus and cardia, dividing the stomach 4 to 6 cm from palpable tumor, provides a negative gastric margin in 98% of patients. In the few patients who have a positive gastric margin, 80% die with distant metastases, which would not be influenced by more extensive gastric resection, and in about 20%, local tumor recurrence develops in the intrathoracic stomach, seldom causing dysphagia. Adjuvant therapy for a positive gastric margin neither improves survival nor reduces local tumor recurrence. Fri, 01 Jun 2007 00:00:00 GMT http://hdl.handle.net/2027.42/57504 2007-06-01T00:00:00Z http://hdl.handle.net/2027.42/57503 Transhiatal esophagectomy in the profoundly obese: implications and experience. Scipione, Christopher N.; Chang, Andrew C.; Pickens, Allan; Lau, Christine L.; Orringer, Mark B. BACKGROUND: Historically, obesity contraindicated an abdominal approach to the esophagogastric junction. The technique of transhiatal esophagectomy (THE) evolved without specific regard to body habitus. The dramatic increase in obese patients requiring an esophagectomy for complications of reflux disease prompted this evaluation of the impact of obesity on the outcomes of esophagectomy to determine whether profound obesity should contraindicate the transhiatal approach. METHODS: We used our Esophagectomy Database to identify 133 profoundly obese patients (body mass index [BMI] > or = 35 kg/m2) from among 2176 undergoing a THE from 1977 to 2006. This group was matched to a randomly selected, non-obese (BMI, 18.5 to 30 kg/m2) control population of 133 patients. Intraoperative, postoperative, and long-term follow-up results were compared retrospectively. RESULTS: Profoundly obese patients had significantly greater intraoperative blood loss (mean, 492.2 mL versus 361.8 mL, p = 0.001), need for partial sternotomy (18 versus 3, p = 0.001), and frequency of recurrent laryngeal nerve injury (6 versus 0, p = 0.04). The two groups did not differ significantly in the occurrence of chylothorax, wound infection, or dehiscence rate; length of hospital stay or need for intensive care unit stay; or hospital or operative mortality. Follow-up results for dysphagia, dumping, regurgitation, and overall functional score were also comparable between the two groups. CONCLUSIONS: With appropriate instrumentation, transhiatal esophagectomy in obese patients has similar morbidity and outcomes as in non-obese patients. Obesity, even when profound, does not contraindicate a transhiatal esophagectomy. Wed, 01 Aug 2007 00:00:00 GMT http://hdl.handle.net/2027.42/57503 2007-08-01T00:00:00Z http://hdl.handle.net/2027.42/55811 Automated integration of monolith-based protein separation with on-plate digestion for mass spectrometric analysis of esophageal adenocarcinoma human epithelial samples Yoo, Chul; Zhao, Jia; Pal, Manoj; Hersberger, Katherine; Huber, Christian G.; Simeone, Diane M.; Beer, David G.; Lubman, David M. A unique approach of automating the integration of monolithic capillary HPLC-based protein separation and on-plate digestion for subsequent MALDI-MS analysis has been developed. All liquid-handling procedures were performed using a robotic module. This automated high-throughput method minimizes the amount of time and extensive labor required for traditional in-solution digestion followed by exhaustive sample cleanup and analysis. Also, precise positioning of the droplet from the capillary HPLC separation onto the MALDI plate allows for preconcentration effects of analytes for improved sensitivity. Proteins from primary esophageal Barrett's adenocarcinoma tissue were prefractionated by chromatofocusing and analyzed successfully by this automated configuration, obtaining rapid protein identifications through PMF and sequencing analyses with high sequence coverage. Additionally, intact protein molecular weight values were obtained as a means to further confirm protein identification and also to identify potential sequence modifications of proteins. This simple and rapid method is a highly versatile and robust approach for the analysis of complex proteomes. Fri, 01 Sep 2006 00:00:00 GMT http://hdl.handle.net/2027.42/55811 2006-09-01T00:00:00Z