Abstract
Objective: The purpose of this experimental study was to investigate whether aortic stent grafting can be applied to the treatment of an esophageal cancer involving the thoracic aorta. Methods: The canine thoracic aorta was partially resected without aorta being clamped after emplacement of an endovascular stent graft. Study I; The aortic whole layer of 1 cm in length and 1/4 of the circumference was resected and was covered by a free fascia patch of the abdominal rectal muscle immediately after stent graft placement. Study II; The aortic adventitia and the outer half of the media of the same size was resected on day 3, 7,14, 21, and on day 28, after the stent graft placement. The resected portion was covered by the free fascia patch in half experimental dogs, and was uncovered in the others. Study III; The aortic adventitia and the outer half of the media of 1 cm in length and 1/2 of the circumference was resected and was uncovered on day 7 after stent graft placement. Histological examinations were performed on day 28 and at one year after aortic resection. Results: The aortic wall could be resected in all cases with no complication, except in resection of 1/2 the circumference where the aorta had become narrow. There was no difference in healing of the resected portion of the aorta between with and without fascia covering. Conclusion: An aortic endovascular stent graft could be applied to surgery for an esophageal cancer involving the aorta.
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Chak A, Canto M, Gerdes H, Lightdale CJ, Hawes RH, Wiersema MJ, et al. Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): A multicenter retrospective cohort study. Gastrointest Endosc 1995; 42: 501–6.
Fockens P, Kisman K, Merkus MP, van Lanschot JJ, Obertop H, Tytgat GN. The prognosis of esophageal carcinoma staged irresectable (T4) by endosonography. J Am Coll Surg 1998; 186: 17–23.
Stuschke M, Stahl M, Wilke H, Walz M, Oldenburg A, Stuben G, et al. Induction chemotherapy followed by concurrent chemotherapy and high-dose radiotherapy for locally advanced squamous cell carcinoma of the upper- thoracic and midthoracic esophagus. Am J Clin Oncol 2000; 23: 233–8.
Ancona E, Ruol A, Castoro C, Chiarion-Sileni V, Merigliano S, Santi S, et al. First-line chemotherapy improves the resection rate and long-term survival of locally advanced (T4, any N, MO) squamous cell carcinoma of the thoracic esophagus: Final report on 163 consecutive patients with 5-year follow-up. Ann Surg 1997; 226: 714–24.
Wang LS, Chi KH, Hu MH, Fahn HJ, Huang MH. Management for patients with advanced T4 epidermoid carcinoma of the esophagus. J Surg Oncol 1996; 62: 22–9.
Yano M, Tsujinaka T, Shiozaki H, Inoue M, Doki Y, Yamamoto M, et al. Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus. J Surg Oncol 1999; 70: 25–32.
Ikeda K, Ishida K, Sato N, Koeda K, Aoki K, Kimura Y, et al. Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. Dis Esophagus 2001; 14: 197–201.
Fujita H, Sueyoshi S, Tanaka T, Toh U, Mine T, Sasahara H, et al. New trends in neoadjuvant chemoradiotherapy for locally-advanced esophageal cancer: Esophagectomy—Is it necessary? (Eng abstr) Gan to Kagaku Ryoho 2000; 27: 2016–22.
Ayabe H. Esophagectomy combined resection of invaded neighboring organs for T4 esophageal carcinoma (Eng abstr). Nippon Geka Gakkai Zasshi 1997; 98: 773–7.
Ichiyoshi Y, Kawahara H, Taga S, Yoshino I, Ohsaki T, Kohno H, et al. Indications and operative techniques for combined aortoesophageal resection. Jpn J Thorac Cardiovasc Surg 1999; 47: 318–24.
Chowhan NM. Injurious effects of radiation on the esophagus. Am J Gastroenterol 1990; 85: 115–20.
Gabrail NY, Harrison BR, Sunwoo YC. Chemoirradiation induced aortoesophageal fistula. J Surg Oncol 1991; 48: 213–5.
Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vase Surg 1991; 5: 491–9.
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endo-vascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331: 1729–34.
Hollander JE, Quick G. Aortoesophageal fistula: A comprehensive review of the literature. Am J Med 1991; 91: 279–87.
Parodi JC. Endovascular repair of aortic aneurysms, arteriovenous fistulas, and false aneurysms. World J Surg 1996; 20: 655–63.
Kurokawa Y, Tsujinaka T, Kawasaki T, Ouoka M, Shibuya T, Ariyoshi H, et al. A case of covered stenting of aorta for prevention of aortoesophageal fistula in advanced esophageal cancer (in Japanese). Nippon Geka Gakkai Zasshi 1998; 31: 16–20.
Sasahara H, Sueyoshi S, Tanaka A, Fujita H, Aoyagi N, Shirouzu K. A case emplacing an aortic endovascular stent graft to prevent bleeding from an esophageal cancer involving the aorta (in Japanese). Shujutsu 2001; 55: 2105–9.
Kato N, Tadanori H, Tanaka K, Yasuda F, Iwata M, Kawahara Y, et al. Aortoesophageal fistula-relief of massive hematemesis with an endovascular stent-graft. Eur J Radiol 2000; 34: 63–6.
Kawahara H, Fujita H, Odagiri S, Hidaka M, Nagata M, Ishikura Y, et al. Combined resection of the thoracic aorta associated with subtotal esophagectomy for carcinoma of the esophagus (Eng abstr). Nippon Geka Gakkai Zasshi 1985; 86: 1546–51.
Kawahara H, Odagiri S, Nakanishi K, Watanabe H, Nakanishi R, Ishikawa H, et al. The use of the aortic bypass in the surgery of the esophageal carcinoma invading the thoracic aorta (Eng abstr). Rinsho Kyobu Geka 1989; 9: 551–6.
Kabuto T, Yasuda T, Furukawa H, Higashiyama M, Takami K, Yokouchi H, et al. Combined resection of the aorta for an esophageal carcinoma invading the aorta through a right transthoracic approach. Jpn J Thorac Cardiovasc Surg 1999; 47: 611–6.
Watanabe Y, Kashihara S, Kiyonari N, Tsuji Y, Hisano K, Okada M. Combined resection of the thoracic esophagus and thoracic descending aorta. Jpn J Thorac Cardiovasc Surg 1999; 47: 495–8.
Fujita H, Kawahara H, Odagiri S, Hidaka M, Yoshimatsu H. Clinical and pathological study on resection of the thoracic aorta associated with esophagectomy for esophageal cancer: Indication and method (Eng abstr). Nippon Kyobu Geka Gakkai Zasshi 1987; 35: 35–41.
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Sasahara, H., Sueyoshi, S., Tanaka, T. et al. Evaluation of an aortic stent graft for use in surgery on esophageal cancer involving the thoracic aorta. Jpn J Thorac Caridovasc Surg 52, 231–239 (2004). https://doi.org/10.1007/s11748-004-0116-x
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DOI: https://doi.org/10.1007/s11748-004-0116-x