133 SURGICAL MANAGEMENT OF ESOPHAGEAL STENOSIS DUE TO CORROSIVE SUBSTANCES

Corrosive ingestion is a significant challenge for healthcare support. Limited data is available regarding the best treatment, and there is still a lack of consensus about the optimal surgical approach and its outcomes. This study aims to show a single-institution experience of surgical treatment of esophageal stenosis due to corrosive substance ingestion and review the current literature. Methods A retrospective review, including demographics, psychiatric profile, surgical procedures, and outcomes, is described. A systematic review of the literature was performed in PubMed. Results In total, 27 surgical procedures for esophageal stenosis due to corrosive substances ingestion were performed from 2010 to 2019. Depression and drug abuse were diagnosed in 30% and 22% of the included patients, respectively. The incidence rate of cancer in patients with corrosive esophageal stenosis is 701.7–874.1 per 1,000,000 person-years, and the cancer latency between corrosion ingestion to carcinoma is 10–58 years. Esophagectomy and esophageal bypass were performed in 13 and 14 patients, respectively. No 30-day mortality was recorded. Conclusion The surgical intervention either by esophagectomy or esophageal bypass seems to show a high success rate. However, the outcomes depend on a high-quality multidisciplinary network of esophageal and thoracic surgeons, intensivists, psychologists, psychiatrists, and nutritional teams.

Estimating Cancer Latency Times Using a Weibull Model

Mathematical models can be useful tools in exploring population disease trends over time and can be used to gain insight into the fundamental mechanisms of cancer development. In this paper, we provide a systematic comparison between the exact and the approximate solutions for estimating the length of time between the biological initiation of cancer and diagnosis through the development of a Weibull-like survival model. A total of 1,608,484 malignant primary cancers were used in the analysis using cancer incidence data obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. We find that the approximate solution provides a reliable comparison of the latency periods for different types of cancer and has no significant effect on the estimation accuracy, which differs from the exact solution by 0% to 11.3%. Thirty-five of the 44 cancers in this analysis were found to progress silently for 10 years or longer prior to detection representing 89% of the patients in this analysis. The results of this analysis differentiate cancer types that progress undetected over a period of years to identify new opportunities for early detection which increases the likelihood of successful treatment and alleviates the ever-growing cancer burden.

Developing a Weibull Model Extension to Estimate Cancer Latency

The mathematical model discussed in this paper presents a technique to estimate the length of the cancer’s silent growth period. The methodology described utilizes information obtained from observed cancer incidence to reconstruct what is cautiously believed to be the period of time from malignant cancer initiation to diagnosis. Analyses show a decreasing hazard for cancer indicating that the longer a patient survives, the more likely they are to reach the upper limit of their natural lifespan. Based on previous research, the Weibull distribution has been used to describe the mechanisms of cancer development. In contrast to the memoryless exponential distribution which assumes a constant failure rate, the shape of the Weibull distribution is dependent on past events and preserves a memory of prior survival. This provides a simple but powerful way to characterize how the unobserved experience of cancer relates to the observed as a function to estimate the time between onset and diagnosis. The results indicate a window of opportunity for early intervention when cancer is most treatable. The method presented provides useful information to identify cancers with high mortality and prolonged periods of undetected growth to distinguish types of dire public health concern.