Family History and Risk of Upper Gastrointestinal Cancer in the Linxian General Population

ObjectiveThe objective of this study was to investigate family history (FH) of upper gastrointestinal (UGI) cancer and risk of esophageal squamous cell carcinoma (ESCC), gastric cardia carcinoma (GCC), and gastric non-cardia carcinoma (GNCC) in the Linxian General Population Nutrition Intervention Trial (NIT) cohort. Methods: This prospective analysis was conducted using the Linxian NIT cohort data. Subjects with FH of UGI cancer was treated as an exposed group while the remainders were considered as a comparison group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between FH of UGI cancer and risk of UGI cancer incidence and mortality were estimated using Cox proportional hazards models.ResultsThere were 5,680 newly diagnosed UGI cancer cases during the follow-up period, with a total of 4,573 UGI cancer deaths occurred, including 2,603 ESCC, 1,410 GCC, and 560 GNCC deaths. A positive FH of UGI cancer was associated with a significantly increased risk of ESCC and GCC (Incidence: HRESCC = 1.45, 95%CI: 1.35–1.56; HRGCC = 1.27, 95%CI: 1.15–1.40; Mortality: HRESCC = 1.40, 95%CI: 1.30–1.52; HRGCC = 1.27, 95%CI: 1.14–1.42) after adjusting for age at baseline, gender, smoking status, alcohol drinking, education level, and frequency of fresh fruit and vegetable consumption. Subjects with FH in both parents had the highest risk of ESCC and GCC incidence (HRESCC = 1.65, 95%CI: 1.40–1.95; HRGCC = 1.42, 95%CI: 1.12–1.81) and deaths (HRESCC = 1.65, 95%CI: 1.38–1.97; HRGCC = 1.42, 95%CI: 1.09–1.85). Spouse diagnosed with UGI cancer did not increase the risk of any UGI cancers of the subjects. In subgroup analysis, FH of UGI cancer was shown to significantly increase the risk of GCC in non-drinkers (Incidence: HR = 1.31, 95%CI: 1.17–1.47; Mortality: HR = 1.33, 95%CI: 1.17–1.50). No associations were observed for risk of GNCC. Sensitivity analysis by excluding subjects who were followed up less than three years did not materially alter our results.ConclusionOur data point to the role of the FH of UGI cancer to the risk of ESCC and GCC incidence and mortality. The influence of family history on the risk of UGI cancer varies from different types of family members.

Immediate Post-Operative Outcomesof Stapled and Hand Sewn Techniques during Oesophagogastrostomy: A Randomized Clinical Trial

Background: Oesophagogastrostomy is a very crucial surgical management. Objective:The purpose of the present study was to observe the immediate post-operative outcomes of stapled and hand sewn techniques during oesophagogastrostomy. Methodology: This single centre, parallel randomized clinical trial was conducted in the Department of Thoracic Surgery at National institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh from January 2011 to December 2011 for a period of one year. Prior to commencement of this study the study protocol was approved by the thesis committee of NIDCH. Patients were purposefully selected from different surgery ward of NIDCH irrespective of age and sex of patients for the study.Patients were divided into two groups designated as group A and B.Stapled oesophagogastric anastomosis was performed in group A and hand sewn anastomosis was done in group B.Immediate post-operative complication were recorded. Result: A total of 60 patients of oesophageal or gastric cardia carcinoma were recruited for this study. Of them 32 cases were assigned to Stapler method and 28 cases to Hand-sewn method of oesophagogastrostomy. The mean age of the patients of group A and group B were 56.1±12.7 years and 55.3±8.3 years respectively. Regarding blood loss during operation, the table shows that in group A mean + SD were 430.4±63.2 ml and in group B mean + SD were 529.6 +86.9 ml. In one stage operation in group A it was mean + SD i.e. 362.2±38.3 ml and in group B it was mean + SD 529.6±86.9 ml. In two stage operation in group A it was mean 466.2±39.7 ml and in group B it was mean±SD 585.6±62.2 ml. Respiratory complication developed in 9.4% of the patients in group A and 17.9% patients in group B. Cardiac complication developed in 3.1 % of the patients in group A and 7.1 % of patients in group B. Wound infection developed in 12.5% of the patients in group A and 10.7% of the patients in group B. Conclusion: In conclusion most of the immediate anastomotic complications are less in stapled anastomotic technique than hand sewn technique Journal of National Institute of Neurosciences Bangladesh, 2020;6(1): 43-47

P13 DIFFERENCE IN LONG-TERM QUALITY OF LIFE BETWEEN MCKEOWN AND IVOR LEWIS ESOPHAGECTOMY

Aim The purpose of this study was to investigate the difference in long-term health-related quality of life (HR-QoL) between McKeown and Ivor Lewis esophagectomy in a tertiary referral center. Background & Methods The therapy of esophageal cancers consist of (neo)adjuvant chemo(radio)therapy and surgery. Often different surgical approaches are possible such as transthoracic esophagectomy with a cervical anastomosis (McKeown) or an intrathoracic anastomosis (Ivor Lewis). Evidence is scarce on whether either of these approaches is better in terms of survival, perioperative morbidity, pathology results and quality of life. Patients with mid-, distal esophageal, gastroesophageal (GEJ) or cardia carcinoma who have undergone a McKeown or an Ivor lewis esophagectomy in the period of 2003 – 2018 were included in this study. EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires were handed out during the outpatient clinic visits and a follow-up of at least one year was ensured. Problems with eating, reflux and nausea and vomiting were chosen as primary HR-QoL domain endpoints while the remaining HR-QoL domains, postoperative complications and pathology results were observed as secondary endpoints. Correction for confounders age and gender was performed. Results 147 patients were included in the McKeown group and 120 in the Ivor Lewis group. Mean age was 63.5 years and median follow-up was three years (range 12-137 months). No significant difference was found in problems with eating, reflux and nausea and vomiting. Significantly more problems with eating with others were found in McKeown group (β=10.435, 95% CI 4.474 – 16.395) and anastomotic leakage was significantly more common after McKeown esophagectomy (p=0.004). No significant difference was found in Clavien Dindo classification. During Ivor Lewis esophagectomy significantly more lymph nodes were resected (p<0.001). Number of lymph node metastases and R0 resection rate did not differ between groups. Conclusion No major differences in long-term HR-QoL were found in patients with mid-, distal esophageal, GEJ or cardia carcinoma following McKeown or Ivor Lewis esophagectomy. Problems with eating with others and anastomotic leakages were more common after McKeown esophagectomy, however, Clavien Dindo classification and radicality of surgery were similar between the two groups. Results of this study could assist the patient during the decision-making process prior to the surgery.