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Maillard J, Elia N, Ris F, Courvoisier DS, Zekry D, Labidi Galy I, Toso C, Mönig S, Zaccaria I, Walder B. Changes of health-related quality of life 6 months after high-risk oncological upper gastrointestinal and hepatobiliary surgery: a single-centre prospective observational study ( ChangeQol Study). BMJ Open 2023; 13:e065902. [PMID: 36813502 PMCID: PMC9950916 DOI: 10.1136/bmjopen-2022-065902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Postoperative health-related quality of life (HRQoL) is an essential outcome in oncological surgery, particularly for elderly patients undergoing high-risk surgery. Previous studies have suggested that, on average, HRQoL returns to premorbid normal levels in the months following major surgery. However, the averaging of effect over a studied cohort may hide the variation of individual HRQoL changes. The proportions of patients who have a varied HRQoL response (stable, improvement, or a deterioration) after major oncological surgery is poorly understood. The study aims to describe the patterns of these HRQoL changes at 6 months after surgery, and to assess the patients and next-of-kin regret regarding the decision to undergo surgery. METHODS AND ANALYSIS This prospective observational cohort study is carried out at the University Hospitals of Geneva, Switzerland. We include patients over 18 years old undergoing gastrectomy, esophagectomy, pancreas resection or hepatectomy. The primary outcome is the proportion of patients in each group with changes in HRQoL (improvement, stability or deterioration) 6 months after surgery, using a validated minimal clinically important difference of 10 points in HRQoL. The secondary outcome is to assess whether patients and their next-of-kin may regret their decision to undergo surgery at 6 months. We measure the HRQoL using the EORTC QLQ-C30 questionnaire before and 6 months after surgery. We assess regret with the Decision Regret Scale (DRS) at 6 months after surgery. Key other perioperative data include preoperative and postoperative place of residence, preoperative anxiety and depression (HADS scale), preoperative disability (WHODAS V.2.0), preoperative frailty (Clinical Frailty Scale), preoperative cognitive function (Mini-Mental State Examination) and preoperative comorbidities. A follow-up at 12 months is planned. ETHICS AND DISSEMINATION The study was first approved by the Geneva Ethical Committee for Research (ID 2020-00536) on 28 April 2020. The results of this study will be presented at national and international scientific meetings, and publications will be submitted to an open-access peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT04444544.
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Affiliation(s)
- Julien Maillard
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nadia Elia
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Frédéric Ris
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Quality of Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Dina Zekry
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Internal Medicine for the Elderly, University Hospitals of Geneva, Geneva, Switzerland
| | - Intidhar Labidi Galy
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Oncology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Stefan Mönig
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Digestive Surgery, Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Isabelle Zaccaria
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Bernhard Walder
- Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Nickel F, Studier-Fischer A, Hausmann D, Klotz R, Vogel-Adigozalov SL, Tenckhoff S, Klose C, Feisst M, Zimmermann S, Babic B, Berlt F, Bruns C, Gockel I, Graf S, Grimminger P, Gutschow CA, Hoeppner J, Ludwig K, Mirow L, Mönig S, Reim D, Seyfried F, Stange D, Billeter A, Nienhüser H, Probst P, Schmidt T, Müller-Stich BP. Minimally invasivE versus open total GAstrectomy (MEGA): study protocol for a multicentre randomised controlled trial (DRKS00025765). BMJ Open 2022; 12:e064286. [PMID: 36316075 PMCID: PMC9628650 DOI: 10.1136/bmjopen-2022-064286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The only curative treatment for most gastric cancer is radical gastrectomy with D2 lymphadenectomy (LAD). Minimally invasive total gastrectomy (MIG) aims to reduce postoperative morbidity, but its use has not yet been widely established in Western countries. Minimally invasivE versus open total GAstrectomy is the first Western multicentre randomised controlled trial (RCT) to compare postoperative morbidity following MIG vs open total gastrectomy (OG). METHODS AND ANALYSIS This superiority multicentre RCT compares MIG (intervention) to OG (control) for oncological total gastrectomy with D2 or D2+LAD. Recruitment is expected to last for 2 years. Inclusion criteria comprise age between 18 and 84 years and planned total gastrectomy after initial diagnosis of gastric carcinoma. Exclusion criteria include Eastern Co-operative Oncology Group (ECOG) performance status >2, tumours requiring extended gastrectomy or less than total gastrectomy, previous abdominal surgery or extensive adhesions seriously complicating MIG, other active oncological disease, advanced stages (T4 or M1), emergency setting and pregnancy.The sample size was calculated at 80 participants per group. The primary endpoint is 30-day postoperative morbidity as measured by the Comprehensive Complications Index. Secondary endpoints include postoperative morbidity and mortality, adherence to a fast-track protocol and patient-reported quality of life (QoL) scores (QoR-15, EUROQOL EuroQol-5 Dimensions-5 Levels (EQ-5D), EORTC QLQ-C30, EORTC QLQ-STO22, activities of daily living and Body Image Scale). Oncological endpoints include rate of R0 resection, lymph node yield, disease-free survival and overall survival at 60-month follow-up. ETHICS AND DISSEMINATION Ethical approval has been received by the independent Ethics Committee of the Medical Faculty, University of Heidelberg (S-816/2021) and will be received from each responsible ethics committee for each individual participating centre prior to recruitment. Results will be published open access. TRIAL REGISTRATION NUMBER DRKS00025765.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Alexander Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - David Hausmann
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Rosa Klotz
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Sophia Lara Vogel-Adigozalov
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Solveig Tenckhoff
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
- Study Center of the German Society of Surgery, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Samuel Zimmermann
- Institute of Medical Biometry, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Benjamin Babic
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Felix Berlt
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Christiane Bruns
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Ines Gockel
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, Universitatsklinikum Leipzig, Leipzig, Germany
| | - Sandra Graf
- Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Peter Grimminger
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Christian A Gutschow
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jens Hoeppner
- Department of Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
| | - Kaja Ludwig
- Department of General, Visceral, Thoracic and Vascular Surgery, Klinikum Sudstadt Rostock, Rostock, Germany
| | - Lutz Mirow
- Department of General and Visceral Surgery, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Stefan Mönig
- Department of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Daniel Reim
- Department of Surgery, University Hospital Munich, Munchen, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Central Würzburg Hospital, Wurzburg, Germany
| | - Daniel Stange
- Department of Visceral, Thoracic and Vascular Surgery, Technische Universität Dresden, Dresden, Germany
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Henrik Nienhüser
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of Surgery, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Thomas Schmidt
- Department of General, Visceral and Tumor and Transplantation Surgery, University Hospital Cologne, Koln, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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Kamarajah S, Evans R, Nepogodiev D, Hodson J, Bundred J, Gockel I, Gossage J, Isik A, Kidane B, Mahendran H, Negoi I, Okonta K, Sayyed R, van Hillegersberg R, Vohra R, Wijnhoven B, Singh P, Griffiths E, Kamarajah S, Hodson J, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, MA N, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández Díaz M, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez L, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel Gijs, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit. J Thorac Cardiovasc Surg 2022; 164:674-684.e5. [PMID: 35249756 DOI: 10.1016/j.jtcvs.2022.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. METHODS This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. RESULTS Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. CONCLUSIONS Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.
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Sleiman MJ, Abbassi Z, Jung M, Toso C, Chevallay M, Mönig S. Brain metastasis incidence in gastro-esophageal cancer: A meta-analysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac188.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
Upper gastrointestinal cancers (UGC) are a leading cause of cancer related deaths. Brain metastases (BM) from gastric and esophageal cancer are rare and associated with a poor survival time. The precise incidence of BM for UGC is lacking.
Methods
We searched: “Gastric cancer OR Oesophageal Cancer AND Cerebral Metastasis” in Pubmed, EMBASE, Cochrane Library. Inclusion criteria were all studies with an incidence rate of BM from UGC cancer patients cohort. When the inclusion criteria were met, we extracted the following endpoints: year of publication, country of population, tumor localization, histology, number of brain lesion, synchronous or metachronous brain metastases, stage of the primary tumor, other localization of metastases, surgical treatment of the primary tumor, brain metastasis treatment (surgery, steatosic radiosurgery, whole brain radiation, gamma knife surgery), survival and follow-up.
Results
52 studies were included. The total number of patients with oesophageal tumor were described in 30 studies with 41636 patients from which 1234 patients (2.9%) had BM. 526 patients (63%) had an adenocarcinoma, 287 (34%) had a SCC and 17 (3%) other histology. BM was unique in 288 patients (50%) and multiples in 282 patients (50%). A combined radiotherapy and surgery was performed in 129 patients (17.9%). Surgical metastasectomy was performed in 172 patients (24.25%). Stereotaxic radiotherapy was delivered in 60 patients. (8.5%) A whole brain radiotherapy was performed in 265 patients (35.9%). Gamma knife surgery was performed in 43 patients (5.9%). Chemotherapy in 10 patients (1.6%) and no treatment in 43 patients. (5.9%). The median survival was reported from 3 month to 24 months. We identified 12 articles which matched the research criteria for gastric cancer with a total of 73.781 primary gastric tumors where 645 presented brain metastasis (0.87%). 159 patients had single BM (42.3%) compared to 217 patients with multiple BM (57.7%). We identified 434 adenocarcinoma which represent 81.1% of the brain metastasis. Median survival for patients with brain metastasis from gastric cancer was described from 1.3 month to 27 months.
Conclusion
Brain metastases from UGI cancer are rare and associated with a low survival. Multimodal treatment is the most described treatment strategy. More studies are required to assess the role of brain imaging in the initial staging of UGI cancer.
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Affiliation(s)
- M-J Sleiman
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
| | - Z Abbassi
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
| | - M Jung
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
| | - C Toso
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
| | - M Chevallay
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
| | - S Mönig
- Department of Visceral Surgery, Geneva University Hospital , Geneva, Switzerland
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022. [DOI: https://doi.org/10.1093/bjs/znac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).
Results
Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.
Conclusion
Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Kamarajah SK, Evans RPT, Nepogodiev D, Hodson J, Bundred JR, Gockel I, Gossage JA, Isik A, Kidane B, Mahendran HA, Negoi I, Okonta KE, Sayyed R, van Hillegersberg R, Vohra RS, Wijnhoven BPL, Singh P, Griffiths EA, Kamarajah SK, Hodson J, Griffiths EA, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw-Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz MB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti Jr V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JH, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Balli E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin CB, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Tan YR, Thannimalai S, Ho CA, Pang WS, Tan JH, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Sluis PC, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Bernardes A, Campos JC, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Textbook outcome following oesophagectomy for cancer: international cohort study. Br J Surg 2022; 109:439-449. [PMID: 35194634 DOI: 10.1093/bjs/znac016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting. METHODS Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.). RESULTS Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome. CONCLUSION Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.
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Chevallay M, Wassmer CH, Bonino M, Mönig S. Laparoscopic for advanced gastric cancer—minimally invasive for maximal results? Transl Gastroenterol Hepatol 2022; 7:13. [DOI: 10.21037/tgh.2020.02.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 11/06/2022] Open
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Evans RPT, Kamarajah SK, Bundred J, Nepogodiev D, Hodson J, van Hillegersberg R, Gossage J, Vohra R, Griffiths EA, Singh P, Evans RPT, Hodson J, Kamarajah SK, Griffiths EA, Singh P, Alderson D, Bundred J, Evans RPT, Gossage J, Griffiths EA, Jefferies B, Kamarajah SK, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno JI, Takeda FR, Kidane B, Guevara Castro R, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra JS, Mahendran HA, Mejía-Fernández L, Wijnhoven BPL, El Kafsi J, Sayyed RH, Sousa M, Sampaio AS, Negoi I, Blanco R, Wallner B, Schneider PM, Hsu PK, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii MW, Jacobs R, Andreollo NA, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias-Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts JH, Dikinis S, Kjaer DW, Larsen MH, Achiam MP, Saarnio J, Theodorou D, Liakakos T, Korkolis DP, Robb WB, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White RE, Alghunaim E, Elhadi M, Leon-Takahashi AM, Medina-Franco H, Lau PC, Okonta KE, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak JI, Pal KMI, Qureshi AU, Naqi SA, Syed AA, Barbosa J, Vicente CS, Leite J, Freire J, Casaca R, Costa RCT, Scurtu RR, Mogoanta SS, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So JBY, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno Gijón M, Martín Fernández J, Trugeda Carrera MS, Vallve-Bernal M, Cítores Pascual MA, Elmahi S, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz TB, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath YKS, Turner P, Dexter S, Boddy A, Allum WH, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt AT, Palazzo F, Meguid RA, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira MP, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher OM, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum RAA, da Rocha JRM, Lopes LR, Tercioti V, Coelho JDS, Ferrer JAP, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García TC, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen PB, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort AP, Stilling NM, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila JS, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Baili E, Mpoura M, Charalabopoulos A, Manatakis DK, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Súilleabháin CBÓ, Hennessy MM, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual CA, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed HA, Shebani AO, Elhadi A, Elnagar FA, Elnagar HF, Makkai-Popa ST, Wong LF, Yunrong T, Thanninalai S, Aik HC, Soon PW, Huei TJ, Basave HNL, Cortés-González R, Lagarde SM, van Lanschot JJB, Cords C, Jansen WA, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda JP, van der Veen A, van den Berg JW, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon AH, Shaikh K, Wajid A, Khalil N, Haris M, Mirza ZU, Qudus SBA, Sarwar MZ, Shehzadi A, Raza A, Jhanzaib MH, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor MA, Ahmed HH, Naeem A, Pinho AC, da Silva R, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes MP, Martins PC, Correia AM, Videira JF, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu AE, Obleaga CV, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla RD, Predescu D, Hoara PA, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin TS, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Díez del Val I, Leturio S, Ramón JM, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles JA, Rodicio Miravalles JL, Pais SA, Turienzo SA, Alvarez LS, Campos PV, Rendo AG, García SS, Santos EPG, Martínez ET, Fernández Díaz MJ, Magadán Álvarez C, Concepción Martín V, Díaz López C, Rosat Rodrigo A, Pérez Sánchez LE, Bailón Cuadrado M, Tinoco Carrasco C, Choolani Bhojwani E, Sánchez DP, Ahmed ME, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki BE, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins TH, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan LC, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue Ling H, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly JJ, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar MMA, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, McCormack K, Makey IA, Karush MK, Seder CW, Liptay MJ, Chmielewski G, Rosato EL, Berger AC, Zheng R, Okolo E, Singh A, Scott CD, Weyant MJ, Mitchell JD. Postoperative outcomes in oesophagectomy with trainee involvement. BJS Open 2021; 5:zrab132. [PMID: 35038327 PMCID: PMC8763367 DOI: 10.1093/bjsopen/zrab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.
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Kamarajah S, Nepogodiev D, Bekele A, Cecconello I, Evans R, Guner A, Gossage J, Harustiak T, Hodson J, Isik A, Kidane B, Leon-Takahashi A, Mahendran H, Negoi I, Okonta K, Rosero G, Sayyed R, Singh P, Takeda F, van Hillegersberg R, Vohra R, White R, Griffiths E, Alderson D, Bundred J, Evans R, Gossage J, Griffiths E, Jefferies B, Kamarajah S, McKay S, Mohamed I, Nepogodiev D, Siaw- Acheampong K, Singh P, van Hillegersberg R, Vohra R, Wanigasooriya K, Whitehouse T, Gjata A, Moreno J, Takeda F, Kidane B, Guevara CR, Harustiak T, Bekele A, Kechagias A, Gockel I, Kennedy A, Da Roit A, Bagajevas A, Azagra J, Mahendran H, Mejía-Fernández L, Wijnhoven B, El Kafsi J, Sayyed R, Sousa M, Sampaio A, Negoi I, Blanco R, Wallner B, Schneider P, Hsu P, Isik A, Gananadha S, Wills V, Devadas M, Duong C, Talbot M, Hii M, Jacobs R, Andreollo N, Johnston B, Darling G, Isaza-Restrepo A, Rosero G, Arias- Amézquita F, Raptis D, Gaedcke J, Reim D, Izbicki J, Egberts J, Dikinis S, Kjaer D, Larsen M, Achiam M, Saarnio J, Theodorou D, Liakakos T, Korkolis D, Robb W, Collins C, Murphy T, Reynolds J, Tonini V, Migliore M, Bonavina L, Valmasoni M, Bardini R, Weindelmayer J, Terashima M, White R, Alghunaim E, Elhadi M, Leon-Takahashi A, Medina-Franco H, Lau P, Okonta K, Heisterkamp J, Rosman C, van Hillegersberg R, Beban G, Babor R, Gordon A, Rossaak J, Pal K, Qureshi A, Naqi S, Syed A, Barbosa J, Vicente C, Leite J, Freire J, Casaca R, Costa R, Scurtu R, Mogoanta S, Bolca C, Constantinoiu S, Sekhniaidze D, Bjelović M, So J, Gačevski G, Loureiro C, Pera M, Bianchi A, Moreno GM, Martín Fernández J, Trugeda Carrera M, Vallve-Bernal M, Cítores Pascual M, Elmahi S, Halldestam I, Hedberg J, Mönig S, Gutknecht S, Tez M, Guner A, Tirnaksiz M, Colak E, Sevinç B, Hindmarsh A, Khan I, Khoo D, Byrom R, Gokhale J, Wilkerson P, Jain P, Chan D, Robertson K, Iftikhar S, Skipworth R, Forshaw M, Higgs S, Gossage J, Nijjar R, Viswanath Y, Turner P, Dexter S, Boddy A, Allum W, Oglesby S, Cheong E, Beardsmore D, Vohra R, Maynard N, Berrisford R, Mercer S, Puig S, Melhado R, Kelty C, Underwood T, Dawas K, Lewis W, Al-Bahrani A, Bryce G, Thomas M, Arndt A, Palazzo F, Meguid R, Fergusson J, Beenen E, Mosse C, Salim J, Cheah S, Wright T, Cerdeira M, McQuillan P, Richardson M, Liem H, Spillane J, Yacob M, Albadawi F, Thorpe T, Dingle A, Cabalag C, Loi K, Fisher O, Ward S, Read M, Johnson M, Bassari R, Bui H, Cecconello I, Sallum R, da Rocha J, Lopes L, Tercioti V, Coelho J, Ferrer J, Buduhan G, Tan L, Srinathan S, Shea P, Yeung J, Allison F, Carroll P, Vargas-Barato F, Gonzalez F, Ortega J, Nino-Torres L, Beltrán-García T, Castilla L, Pineda M, Bastidas A, Gómez-Mayorga J, Cortés N, Cetares C, Caceres S, Duarte S, Pazdro A, Snajdauf M, Faltova H, Sevcikova M, Mortensen P, Katballe N, Ingemann T, Morten B, Kruhlikava I, Ainswort A, Stilling N, Eckardt J, Holm J, Thorsteinsson M, Siemsen M, Brandt B, Nega B, Teferra E, Tizazu A, Kauppila J, Koivukangas V, Meriläinen S, Gruetzmann R, Krautz C, Weber G, Golcher H, Emons G, Azizian A, Ebeling M, Niebisch S, Kreuser N, Albanese G, Hesse J, Volovnik L, Boecher U, Reeh M, Triantafyllou S, Schizas D, Michalinos A, Mpali E, Mpoura M, Charalabopoulos A, Manatakis D, Balalis D, Bolger J, Baban C, Mastrosimone A, McAnena O, Quinn A, Ó Súilleabháin C, Hennessy M, Ivanovski I, Khizer H, Ravi N, Donlon N, Cervellera M, Vaccari S, Bianchini S, Sartarelli L, Asti E, Bernardi D, Merigliano S, Provenzano L, Scarpa M, Saadeh L, Salmaso B, De Manzoni G, Giacopuzzi S, La Mendola R, De Pasqual C, Tsubosa Y, Niihara M, Irino T, Makuuchi R, Ishii K, Mwachiro M, Fekadu A, Odera A, Mwachiro E, AlShehab D, Ahmed H, Shebani A, Elhadi A, Elnagar F, Elnagar H, Makkai-Popa S, Wong L, Tan Y, Thannimalai S, Ho C, Pang W, Tan J, Basave H, Cortés-González R, Lagarde S, van Lanschot J, Cords C, Jansen W, Martijnse I, Matthijsen R, Bouwense S, Klarenbeek B, Verstegen M, van Workum F, Ruurda J, van der Sluis P, de Maat M, Evenett N, Johnston P, Patel R, MacCormick A, Young M, Smith B, Ekwunife C, Memon A, Shaikh K, Wajid A, Khalil N, Haris M, Mirza Z, Qudus S, Sarwar M, Shehzadi A, Raza A, Jhanzaib M, Farmanali J, Zakir Z, Shakeel O, Nasir I, Khattak S, Baig M, Noor M, Ahmed H, Naeem A, Pinho A, da Silva R, Bernardes A, Campos J, Matos H, Braga T, Monteiro C, Ramos P, Cabral F, Gomes M, Martins P, Correia A, Videira J, Ciuce C, Drasovean R, Apostu R, Ciuce C, Paitici S, Racu A, Obleaga C, Beuran M, Stoica B, Ciubotaru C, Negoita V, Cordos I, Birla R, Predescu D, Hoara P, Tomsa R, Shneider V, Agasiev M, Ganjara I, Gunjić D, Veselinović M, Babič T, Chin T, Shabbir A, Kim G, Crnjac A, Samo H, Díez del Val I, Leturio S, Ramón J, Dal Cero M, Rifá S, Rico M, Pagan Pomar A, Martinez Corcoles J, Rodicio Miravalles J, Pais S, Turienzo S, Alvarez L, Campos P, Rendo A, García S, Santos E, Martínez E, Fernández DMJ, Magadán ÁC, Concepción MV, Díaz LC, Rosat RA, Pérez SLE, Bailón CM, Tinoco CC, Choolani Bhojwani E, Sánchez D, Ahmed M, Dzhendov T, Lindberg F, Rutegård M, Sundbom M, Mickael C, Colucci N, Schnider A, Er S, Kurnaz E, Turkyilmaz S, Turkyilmaz A, Yildirim R, Baki B, Akkapulu N, Karahan O, Damburaci N, Hardwick R, Safranek P, Sujendran V, Bennett J, Afzal Z, Shrotri M, Chan B, Exarchou K, Gilbert T, Amalesh T, Mukherjee D, Mukherjee S, Wiggins T, Kennedy R, McCain S, Harris A, Dobson G, Davies N, Wilson I, Mayo D, Bennett D, Young R, Manby P, Blencowe N, Schiller M, Byrne B, Mitton D, Wong V, Elshaer A, Cowen M, Menon V, Tan L, McLaughlin E, Koshy R, Sharp C, Brewer H, Das N, Cox M, Al Khyatt W, Worku D, Iqbal R, Walls L, McGregor R, Fullarton G, Macdonald A, MacKay C, Craig C, Dwerryhouse S, Hornby S, Jaunoo S, Wadley M, Baker C, Saad M, Kelly M, Davies A, Di Maggio F, McKay S, Mistry P, Singhal R, Tucker O, Kapoulas S, Powell-Brett S, Davis P, Bromley G, Watson L, Verma R, Ward J, Shetty V, Ball C, Pursnani K, Sarela A, Sue LH, Mehta S, Hayden J, To N, Palser T, Hunter D, Supramaniam K, Butt Z, Ahmed A, Kumar S, Chaudry A, Moussa O, Kordzadeh A, Lorenzi B, Wilson M, Patil P, Noaman I, Willem J, Bouras G, Evans R, Singh M, Warrilow H, Ahmad A, Tewari N, Yanni F, Couch J, Theophilidou E, Reilly J, Singh P, van Boxel G, Akbari K, Zanotti D, Sgromo B, Sanders G, Wheatley T, Ariyarathenam A, Reece-Smith A, Humphreys L, Choh C, Carter N, Knight B, Pucher P, Athanasiou A, Mohamed I, Tan B, Abdulrahman M, Vickers J, Akhtar K, Chaparala R, Brown R, Alasmar M, Ackroyd R, Patel K, Tamhankar A, Wyman A, Walker R, Grace B, Abbassi N, Slim N, Ioannidi L, Blackshaw G, Havard T, Escofet X, Powell A, Owera A, Rashid F, Jambulingam P, Padickakudi J, Ben-Younes H, Mccormack K, Makey I, Karush M, Seder C, Liptay M, Chmielewski G, Rosato E, Berger A, Zheng R, Okolo E, Singh A, Scott C, Weyant M, Mitchell J. Mortality from esophagectomy for esophageal cancer across low, middle, and high-income countries: An international cohort study. Eur J Surg Oncol 2021; 47:1481-1488. [PMID: 33451919 DOI: 10.1016/j.ejso.2020.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND No evidence currently exists characterising global outcomes following major cancer surgery, including esophageal cancer. Therefore, this study aimed to characterise impact of high income countries (HIC) versus low and middle income countries (LMIC) on the outcomes following esophagectomy for esophageal cancer. METHOD This international multi-center prospective study across 137 hospitals in 41 countries included patients who underwent an esophagectomy for esophageal cancer, with 90-day follow-up. The main explanatory variable was country income, defined according to the World Bank Data classification. The primary outcome was 90-day postoperative mortality, and secondary outcomes were composite leaks (anastomotic leak or conduit necrosis) and major complications (Clavien-Dindo Grade III - V). Multivariable generalized estimating equation models were used to produce adjusted odds ratios (ORs) and 95% confidence intervals (CI95%). RESULTS Between April 2018 to December 2018, 2247 patients were included. Patients from HIC were more significantly older, with higher ASA grade, and more advanced tumors. Patients from LMIC had almost three-fold increase in 90-day mortality, compared to HIC (9.4% vs 3.7%, p < 0.001). On adjusted analysis, LMIC were independently associated with higher 90-day mortality (OR: 2.31, CI95%: 1.17-4.55, p = 0.015). However, LMIC were not independently associated with higher rates of anastomotic leaks (OR: 1.06, CI95%: 0.57-1.99, p = 0.9) or major complications (OR: 0.85, CI95%: 0.54-1.32, p = 0.5), compared to HIC. CONCLUSION Resections in LMIC were independently associated with higher 90-day postoperative mortality, likely reflecting a failure to rescue of these patients following esophagectomy, despite similar composite anastomotic leaks and major complication rates to HIC. These findings warrant further research, to identify potential issues and solutions to improve global outcomes following esophagectomy for cancer.
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Chevallay M, Jung M, Chon SH, Takeda FR, Akiyama J, Mönig S. Esophageal cancer surgery: review of complications and their management. Ann N Y Acad Sci 2020; 1482:146-162. [PMID: 32935342 DOI: 10.1111/nyas.14492] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
Esophagectomy, even with the progress in surgical technique and perioperative management, is a highly specialized surgery, associated with a high rate of complications. Early recognition and adequate treatment should be a standard of care for the most common postoperative complications: anastomotic leakage, pneumonia, atrial fibrillation, chylothorax, and recurrent laryngeal nerve palsy. Recent progress in endoscopy with vacuum and stent placement, or in radiology with embolization, has changed the management of these complications. The success of nonoperative treatments should be frequently reassessed and reoperation must be proposed in case of failure. We have summarized the clinical signs, diagnostic process, and management of the frequent complications after esophagectomy for esophageal cancer.
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Affiliation(s)
- Mickael Chevallay
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Minoa Jung
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Seung-Hun Chon
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | | | - Junichi Akiyama
- Division of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Stefan Mönig
- Division of Visceral Surgery, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
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Mönig S, Ott K, Gockel I, Lorenz D, Ludwig K, Messmann H, Moehler M, Piso P, Weimann A, Meyer HJ. [S3 guidelines on gastric cancer-diagnosis and treatment of adenocarcinoma of the stomach and esophagogastric junction : Version 2.0-August 2019. AWMF register number: 032/009OL]. Chirurg 2020; 91:37-40. [PMID: 31950198 DOI: 10.1007/s00104-020-01112-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Stefan Mönig
- Service de Chirurgie Viscérale, Hôpitaux Universitaires Genève, Rue Gabrielle-Perret-Gentil 4, 1205, Genf, Schweiz
| | - Katja Ott
- Klinik für Allgemein-, Gefäß- und Thoraxchirurgie, RoMed Klinikum Rosenheim, Pettenkoferstraße 10, 83022, Rosenheim, Deutschland
| | - Ines Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Department für Operative Medizin (DOPM), Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Dietmar Lorenz
- Chirurgische Klinik I - Allgemein- und Viszeral- und Thoraxchirurgie, Klinikum Darmstadt GmbH, Grafenstraße 9, 64283, Darmstadt, Deutschland
| | - Kaja Ludwig
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland
| | - Helmut Messmann
- III. Medizinische Klinik, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Markus Moehler
- I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland
| | - Pompiliu Piso
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Deutschland
| | - Arved Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129, Leipzig, Deutschland
| | - Hans-Joachim Meyer
- Deutsche Gesellschaft für Chirurgie e.V., Luisenstraße 58/59, 10117, Berlin, Deutschland
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Moehler M, Al-Batran SE, Andus T, Arends J, Arnold D, Baretton G, Bornschein J, Budach W, Daum S, Dietrich C, Ebert M, Fischbach W, Flentje M, Gockel I, Grenacher L, Haier J, Höcht S, Jakobs R, Jenssen C, Kade B, Kanzler S, Langhorst J, Link H, Lordick F, Lorenz D, Lorenzen S, Lutz M, Messmann H, Meyer HJ, Mönig S, Ott K, Quante M, Röcken C, Schlattmann P, Schmiegel WH, Schreyer A, Tannapfel A, Thuss-Patience P, Weimann A, Unverzagt S. S3-Leitlinie Magenkarzinom – Diagnostik und Therapie der Adenokarzinome des Magens und des ösophagogastralen Übergangs – Langversion 2.0 – August 2019. AWMF-Registernummer: 032/009OL. Z Gastroenterol 2019; 57:1517-1632. [PMID: 31826284 DOI: 10.1055/a-1018-2516] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bundred JR, Kamarajah SK, Siaw‐Acheampong K, Nepogodiev D, Jefferies B, Singh P, Evans R, Griffiths EA, Alderson D, Gossage J, McKay S, Mohamed I, van Hillegersberg R, Vohra R, Wanigsooriya K, Whitehouse T, Bagajevas A, Bekele A, Blanco‐Colino R, Da Roit A, El Kafsi‐Mawley J, Gjata A, Gockel I, Castro RG, Harustiak T, Hsu P, Isik A, Kechagias A, Kennedy A, Kidane B, Mahendran HA, Mejia L, Moreno JI, Negoi I, Santiago AJ, Sayyed R, Schneider P, Soares AS, Sousa M, Takeda FR, Vanstraten S, Wallner B, Wijnhoven B, Achiam M, Agustin T, Akbar A, Al‐Bahrani A, Al‐Khyatt W, Albertsmeier M, Alghunaim E, Alkhaffaf B, Allum W, Am F, Andreollo N, Arndt A, Babor R, Barbosa J, Bardini R, Beardsmore D, Beban G, Bernardes A, Berrisford R, Bianchi A, Bjelovic M, Boddy A, Bolca C, Bonavina L, Bryce G, Byrom R, Casaca R, Chan D, Charalabopoulos A, Cheong E, Ciotola F, Colak E, Collins C, Constantinoiu S, Costa R, Dahlke M, Darling G, Dawas K, de Manzoni G, Denewer A, Devadas M, Dexter S, Dikinis S, Dimitrios T, Dolan J, Duong C, Egberts J, Elgharably Y, Elhadi M, Elmahi S, Farias FA, Fekaj E, Fernández J, Forshaw M, Freire J, French D, Gacevski G, Gaedcke J, Gananadha S, Gijon MM, Gokhale J, Gordon A, Grimminger P, Guevara R, Guner A, Gutknecht S, Mahmoodzadeh H, Halldestam I, Hedberg J, Heisterkamp J, Higgs S, Hii M, Hindmarsh A, Hoppner J, Isaza A, Izbicki J, Jacobs R, Jain P, Johansson J, Johnston B, Kafsi J, Kassa S, Kelty C, Khan I, Khoo D, Khyatt S, Kjaer D, Korkolis D, Kreuser N, Larsen M, Lau P, Leite J, Lewis W, Liakakos T, Loureiro C, Mahendran A, Maynard N, Mcgregor R, Mcnally S, Medina‐Franco H, Meguid R, Melhado R, Mercer S, Migliore M, Mingol F, Mogoanta S, Mohri Y, Mönig S, Moreno J, Motas N, Murphy T, Naqi S, Ni R, Niazi S, Oglesby S, Okonta K, Ortiz SR, Pal K, Palazzo F, Pascher A, Pascual M, Pata G, Pera M, Puig S, Ramirez J, Raptis D, Räsänen J, Reim D, Reynolds J, Robb W, Robertson K, Rosero G, Rosman C, Rossaak J, Saarnio J, Santiago A, Schiesser M, Scurtu R, Sekhniaidze D, Sevinç B, Skipworth R, So J, Trugeda MS, Syed A, Takahashi AML, Takeda F, Talbot M, Tareen M, Terashima M, Testini M, Tewari N, Tez M, Thomas M, Tirnaksiz M, Tonini V, Tu C, Turner P, Underwood T, Uzair A, Vallve‐Bernal M, Valmasoni M, Vicente C, Videira JF, Viswanath YKS, Weindelmayer J, White R, Wigle D, Wilkerson P, Wills V, Zacharakis E, Zuluaga M. International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA). World J Surg 2019; 43:2874-2884. [PMID: 31332491 DOI: 10.1007/s00268-019-05080-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy. METHOD The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit. RESULTS Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001). CONCLUSIONS This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.
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Al-Batran SE, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, Kopp HG, Mayer F, Haag GM, Luley K, Lindig U, Schmiegel W, Pohl M, Stoehlmacher J, Folprecht G, Probst S, Prasnikar N, Fischbach W, Mahlberg R, Trojan J, Koenigsmann M, Martens UM, Thuss-Patience P, Egger M, Block A, Heinemann V, Illerhaus G, Moehler M, Schenk M, Kullmann F, Behringer DM, Heike M, Pink D, Teschendorf C, Löhr C, Bernhard H, Schuch G, Rethwisch V, von Weikersthal LF, Hartmann JT, Kneba M, Daum S, Schulmann K, Weniger J, Belle S, Gaiser T, Oduncu FS, Güntner M, Hozaeel W, Reichart A, Jäger E, Kraus T, Mönig S, Bechstein WO, Schuler M, Schmalenberg H, Hofheinz RD. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 2019; 393:1948-1957. [PMID: 30982686 DOI: 10.1016/s0140-6736(18)32557-1] [Citation(s) in RCA: 1230] [Impact Index Per Article: 246.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Docetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma. This study reports on the safety and efficacy of the docetaxel-based triplet FLOT (fluorouracil plus leucovorin, oxaliplatin and docetaxel) as a perioperative therapy for patients with locally advanced, resectable tumours. METHODS In this controlled, open-label, phase 2/3 trial, we randomly assigned 716 patients with histologically-confirmed advanced clinical stage cT2 or higher or nodal positive stage (cN+), or both, resectable tumours, with no evidence of distant metastases, via central interactive web-based-response system, to receive either three pre-operative and three postoperative 3-week cycles of 50 mg/m2 epirubicin and 60 mg/m2 cisplatin on day 1 plus either 200 mg/m2 fluorouracil as continuous intravenous infusion or 1250 mg/m2 capecitabine orally on days 1 to 21 (ECF/ECX; control group) or four preoperative and four postoperative 2-week cycles of 50 mg/m2 docetaxel, 85 mg/m2 oxaliplatin, 200 mg/m2 leucovorin and 2600 mg/m2 fluorouracil as 24-h infusion on day 1 (FLOT; experimental group). The primary outcome of the trial was overall survival (superiority) analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01216644. FINDINGS Between Aug 8, 2010, and Feb 10, 2015, 716 patients were randomly assigned to treatment in 38 German hospitals or with practice-based oncologists. 360 patients were assigned to ECF/ECX and 356 patients to FLOT. Overall survival was increased in the FLOT group compared with the ECF/ECX group (hazard ratio [HR] 0·77; 95% confidence interval [CI; 0.63 to 0·94]; median overall survival, 50 months [38·33 to not reached] vs 35 months [27·35 to 46·26]). The number of patients with related serious adverse events (including those occurring during hospital stay for surgery) was similar in the two groups (96 [27%] in the ECF/ECX group vs 97 [27%] in the FLOT group), as was the number of toxic deaths (two [<1%] in both groups). Hospitalisation for toxicity occurred in 94 patients (26%) in the ECF/ECX group and 89 patients (25%) in the FLOT group. INTERPRETATION In locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma, perioperative FLOT improved overall survival compared with perioperative ECF/ECX. FUNDING The German Cancer Aid (Deutsche Krebshilfe), Sanofi-Aventis, Chugai, and Stiftung Leben mit Krebs Foundation.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany.
| | | | - Claudia Pauligk
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Thorsten O Goetze
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany
| | - Johannes Meiler
- West German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany
| | - Stefan Kasper
- West German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen (RBCT), Stuttgart, Germany
| | - Frank Mayer
- Universitätsklinikum der Eberhard-Karls-Universität, Medizinische Klinik II, Abt. Onkologie, Hämatologie, Immunologie, Rheumatologie, Pneumologie, Tübingen, Germany
| | - Georg Martin Haag
- Nationales Centrum für Tumorerkrankungen, Abteilung Medizinische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Kim Luley
- Klinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Udo Lindig
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Onkologie, Jena, Germany
| | - Wolff Schmiegel
- Ruhr-University Bochum, Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany; Department of Gastroenterology and Hepatology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany
| | - Michael Pohl
- Ruhr-University Bochum, Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany
| | - Jan Stoehlmacher
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Gunnar Folprecht
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Stephan Probst
- Klinikum Bielefeld, Klinik für Hämatologie und Onkologie, Bielefeld, Germany
| | - Nicole Prasnikar
- Asklepios Klinik Barmbek, Hämatologie, Onkologie und Palliativmedizin, Hamburg, Germany
| | - Wolfgang Fischbach
- Klinikum Aschaffenburg, Medizinische Klinik II, Gastroenterologie und Onkologie, Aschaffenburg, Germany
| | - Rolf Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Med. Klinik I, Trier, Germany
| | - Jörg Trojan
- Universitätsklinikum Frankfurt, Goethe-Universität, Med. Klinik I, Frankfurt, Germany
| | - Michael Koenigsmann
- MediProjekt, Gesellschaft für Medizinstatistik und Projektentwicklung, Hannover, Germany
| | - Uwe M Martens
- SLK-Kliniken GmbH, Cancer Center Heilbronn-Franken, Klinik für Innere Medizin III, Heilbronn, Germany
| | - Peter Thuss-Patience
- Charité - Universitätsmedizin Berlin, Med. Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany
| | - Matthias Egger
- Ortenau Klinikum Lahr, Medizinische Klinik, Gastroenterologie und Onkologie, Sektion Hämatologie und Onkologie, Lahr, Germany
| | - Andreas Block
- Universitätsklinikum Hamburg-Eppendorf, UCCH, II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, KMT mit Sektion Pneumologie), Hamburg, Germany
| | - Volker Heinemann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Campus Grosshadern, Münich, Germany
| | - Gerald Illerhaus
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Stuttgart, Stuttgart, Germany
| | - Markus Moehler
- Johannes-Gutenberg Universität Mainz, I. Med. Klinik und Poliklinik, Mainz, Germany
| | - Michael Schenk
- Krankenhaus Barmherzige Brüder Regensburg, Klinik für Onkologie und Hämatologie, Regensburg, Germany
| | | | - Dirk M Behringer
- Augusta-Krankenanstalt Bochum, Klinik für Hämatologie und Onkologie, Bochum, Germany
| | - Michael Heike
- Klinikum Dortmund gGmbH, Medizinische Klinik, Gastroenterologie, Hämatologie/Onkologie, Endokrinologie, Dortmund, Germany
| | - Daniel Pink
- Helios Klinikum Bad Saarow, Klinik für Hämatologie, Onkologie und Palliativmedizin, Bad Saarow, Germany; Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin C - Hämatologie und Onkologie und Transplantationszentrum, Greifswald, Germany
| | | | - Carmen Löhr
- Horst-Schmidt-Kliniken, Innere Medizin 2, Wiesbaden, Germany
| | - Helga Bernhard
- Klinikum Darmstadt, Med. Klinik V, Hämatologie und Onkologie, Darmstadt, Germany
| | - Gunter Schuch
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | - Volker Rethwisch
- Klinikum Dortmund gGmbH, Medizinische Klinik, Gastroenterologie, Hämatologie/Onkologie, Endokrinologie, Dortmund, Germany
| | | | - Jörg T Hartmann
- Catholic Hospital Consortium Eastern Westphalia, Franziskus Hospital Bielefeld, Klinik für Innere Medizin II, Hämatologie, Internistische Onkologie, Immunologie, Bielefeld, Germany
| | - Michael Kneba
- Klinik für Innere Medizin II - Hämatologie und Onkologie, University Clinics Schleswig Holstein- Campus Kiel, Kiel, Germany
| | - Severin Daum
- Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Berlin, Germany
| | - Karsten Schulmann
- MVZ Arnsberg, Praxis für Hämatologie und Onkologie, Arnsberg, Germany
| | - Jörg Weniger
- Gemeinschaftspraxis Dr. Weniger /Dr. Bittrich/Dr. Schütze, Erfurt, Germany
| | - Sebastian Belle
- II. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Timo Gaiser
- Institut für Pathologie, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Fuat S Oduncu
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Germany
| | | | - Wael Hozaeel
- MVZ Onkologie GmbH, Am Marienhospital, Hagen, Germany
| | - Alexander Reichart
- Klinik für Onkologie und Hämatologie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt am Main, Frankfurt, Germany
| | - Elke Jäger
- Klinik für Onkologie und Hämatologie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt am Main, Frankfurt, Germany
| | - Thomas Kraus
- Klinik für Allgemein-, Viszeral- und Minimal Invasive Chirurgie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt, Germany
| | - Stefan Mönig
- Service de Chirurgie viscérale, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Wolf O Bechstein
- Frankfurt University Hospital and Clinics, Department of General and Visceral Surgery, Frankfurt, Germany
| | - Martin Schuler
- West German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen Essen, Germany
| | - Harald Schmalenberg
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Germany
| | - Ralf D Hofheinz
- Tagestherapiezentrum am ITM, III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany
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Lutz MP, Zalcberg JR, Ducreux M, Adenis A, Allum W, Aust D, Carneiro F, Grabsch HI, Laurent-Puig P, Lordick F, Möhler M, Mönig S, Obermannova R, Piessen G, Riddell A, Röcken C, Roviello F, Schneider PM, Seewald S, Smyth E, van Cutsem E, Verheij M, Wagner AD, Otto F. The 4th St. Gallen EORTC Gastrointestinal Cancer Conference: Controversial issues in the multimodal primary treatment of gastric, junctional and oesophageal adenocarcinoma. Eur J Cancer 2019; 112:1-8. [PMID: 30878666 DOI: 10.1016/j.ejca.2019.01.106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023]
Abstract
Multimodal primary treatment of localised adenocarcinoma of the stomach, the oesophagus and the oesophagogastric junction (AEG) was reviewed by a multidisciplinary expert panel in a moderated consensus session. Here, we report the key points of the discussion and the resulting recommendations. The exact definition of the tumour location and extent by white light endoscopy in conjunction with computed tomography scans is the backbone for any treatment decision. Their value is limited with respect to the infiltration depth, lymph node involvement and peritoneal involvement. Additional endoscopic ultrasound was recommended mainly for tumours of the lower oesophagogastric junction (i.e. AEG type II and III according to Siewert) and in early cancers before endoscopic resection. Laparoscopy to diagnose peritoneal involvement was thought to be necessary before the start of neoadjuvant treatment in all gastric cancers and in AEG type II and III. In general, perioperative multimodal treatment was suggested for all locally advanced oesophageal tumours and for gastric cancers with a clinical stage above T1N0. There was consensus that the combination of fluorouracil, folinic acid, oxaliplatin and docetaxel is now a new standard chemotherapy (CTx) regimen for fit patients. In contrast, the optimal choice of perioperative CTx versus neoadjuvant radiochemotherapy (neoRCTx), especially for AEG, was identified as an open question. Expert treatment recommendations depend on the tumour location, biology, the risk of incomplete (R1) resection, response to treatment, local or systemic recurrence risks, the predicted perioperative morbidity and patients' comorbidities. In summary, any treatment decision requires an interdisciplinary discussion in a comprehensive multidisciplinary setting.
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Affiliation(s)
| | - John R Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, The Alfred Centre, Melbourne, Australia
| | | | - Antoine Adenis
- Département d'Oncologie Médicale, Institut du Cancer de Montpellier, Montpellier, France
| | - William Allum
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Daniela Aust
- Institut für Pathologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Fatima Carneiro
- Department of Pathology, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Heike I Grabsch
- Department of Pathology and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, School of Medicine, University of Leeds, Leeds, UK
| | | | - Florian Lordick
- University Cancer Center Leipzig (UCCL) and Department of Hematology and Oncology, University Medicine Leipzig, Germany
| | - Markus Möhler
- Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Mainz, Germany
| | - Stefan Mönig
- Hôpitaux Universitaires de Genève, Service de Chirurgie Viscéral, Geneva, Switzerland
| | - Radka Obermannova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Guillaume Piessen
- Université de Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, 59000 Lille, France
| | - Angela Riddell
- Department of Diagnostic Radiology, The Royal Marsden, London, United Kingdom
| | - Christoph Röcken
- Department of Pathology, Christian-Albrechts-University, Kiel, Germany
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Paul Magnus Schneider
- Centre for Visceral, Thoracic and Specialized Tumor Surgery, Klinik Hirslanden, Zurich, Switzerland
| | - Stefan Seewald
- Gastroenterology Centre, Klinik Hirslanden, Zurich, Switzerland
| | - Elizabeth Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Marcel Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Florian Otto
- Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland
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16
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Baiocchi GL, Giacopuzzi S, Marrelli D, Reim D, Piessen G, Matos da Costa P, Reynolds JV, Meyer HJ, Morgagni P, Gockel I, Lara Santos L, Jensen LS, Murphy T, Preston SR, Ter-Ovanesov M, Fumagalli Romario U, Degiuli M, Kielan W, Mönig S, Kołodziejczyk P, Polkowski W, Hardwick R, Pera M, Johansson J, Schneider PM, de Steur WO, Gisbertz SS, Hartgrink H, van Sandick JW, Portolani N, Hölscher AH, Botticini M, Roviello F, Mariette C, Allum W, De Manzoni G. International consensus on a complications list after gastrectomy for cancer. Gastric Cancer 2019; 22:172-189. [PMID: 29846827 DOI: 10.1007/s10120-018-0839-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for recording complications generates wide variation in evaluating their impacts on outcomes and hinders proposals of quality-improvement projects. The aim of this study was to provide a list of defined gastrectomy complications approved through international consensus. METHODS The Gastrectomy Complications Consensus Group consists of 34 European gastric cancer experts who are members of the International Gastric Cancer Association. A group meeting established the work plan for study implementation through Delphi surveys. A consensus was reached regarding a set of standardized methods to define gastrectomy complications. RESULTS A standardized list of 27 defined complications (grouped into 3 intraoperative, 14 postoperative general, and 10 postoperative surgical complications) was created to provide a simple but accurate template for recording individual gastrectomy complications. A consensus was reached for both the list of complications that should be considered major adverse events after gastrectomy for cancer and their specific definitions. The study group also agreed that an assessment of each surgical case should be completed at patient discharge and 90 days postoperatively using a Complication Recording Sheet. CONCLUSION The list of defined complications (soon to be validated in an international multicenter study) and the ongoing development of an electronic datasheet app to record them provide the basic infrastructure to reach the ultimate goals of standardized international data collection, establishment of benchmark results, and fostering of quality-improvement projects.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. .,3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, 25127, Brescia, Italy.
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Daniel Reim
- Surgical Department, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Univ. Lille, and Claude Huriez University Hospital, Lille, France
| | - Paulo Matos da Costa
- Faculdade Medicina, Universidade Lisboa, Lisbon, Portugal.,General Surgery Department, Hospital Garcia de Orta, Lisbon, Portugal
| | - John V Reynolds
- Department of Surgery, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | | | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Lucio Lara Santos
- Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
| | | | - Thomas Murphy
- Department of Surgery, Mercy University Hospital, Cork City, Ireland
| | - Shaun R Preston
- Oesophageal Gastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Mikhail Ter-Ovanesov
- Oncological and Haematological RUPF, Moscow Municipal Oncological Hospital, Moscow, Russia
| | | | - Maurizio Degiuli
- Department of Oncology, Head, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Wojciech Kielan
- 2nd Department of General and Oncological Surgery, Wroclaw Medical University, Wrocław, Poland
| | - Stefan Mönig
- Division of Abdominal Surgery, University Hospital of Geneva, Geneva, Switzerland
| | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Manuel Pera
- Department of Surgery, Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, and Hospital Universitario del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Jan Johansson
- Department of Clinical Sciences, Surgery, Faculty of Medicine, Lund University, Lund, Sweden
| | - Paul M Schneider
- Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Wobbe O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute, and Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.,3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, 25127, Brescia, Italy
| | - Arnulf H Hölscher
- German Center for Esophageal and Gastric Surgery, Agaplesion Markuskrankenhaus, Frankfurt, Germany
| | | | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, Univ. Lille, and Claude Huriez University Hospital, Lille, France
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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17
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Chevallay M, Jung M, Morel P, Mönig S. [Gastric cancer : management and multidisciplinary treatment]. Rev Med Suisse 2018; 14:2221-2225. [PMID: 30516891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite a decreasing incidence, gastric cancer remains a burden. Generally discovered at an advanced stage, survival improved with progress in perioperative treatment and surgical management. Preoperative staging is essential to accurately classify the tumor and introduce the appropriate treatment. Tumor location is particularly important because the treatment of tumors of the esophageal junction and the stomach is different. Minimally invasive techniques can probably reduce postoperative morbidity and help to put patients in the best possible conditions for adjuvant treatment.
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Affiliation(s)
| | - Minoa Jung
- Service de chirurgie viscérale, HUG, 1211 Genève 14
| | | | - Stefan Mönig
- Service de chirurgie viscérale, HUG, 1211 Genève 14
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18
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Mönig S, van Hootegem S, Chevallay M, Wijnhoven BPL. The role of surgery in advanced disease for esophageal and junctional cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:91-96. [PMID: 30551863 DOI: 10.1016/j.bpg.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
The incidence of esophageal and junctional cancer has been increasing in western industrialized nations in the past 30 years. At the time of diagnosis, approximately 50% of patients with esophageal and junctional cancers have distant metastases and are considered incurable. In the recent ESMO guidelines and the German S3 guidelines, surgical therapy for metastatic disease is not recommended. In spite of these recommendations, the treatment of limited metastatic (oligo-metastastic) esophagogastric cancer is currently undergoing a shift towards a more aggressive therapy. Selected patients with oligo-metastatic disease may be considered for surgical resection of the primary tumor and the metastases after chemo(radio)therapy and careful evaluation in an interdisciplinary tumor board. We discuss in this review the literature and some guidelines for extended surgical approaches is laid out. In the future, randomized prospective studies like the German RENAISSANCE/FLOT5 trial and the French SURGIGAST trial will feed us with more evidence if multimodal therapy including surgery for limited metastatic disease is indicated.
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Affiliation(s)
- Stefan Mönig
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Sander van Hootegem
- Department of Surgery, Erasmus MC - University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, the Netherlands
| | - Mickael Chevallay
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC - University Medical Center Rotterdam, PO BOX 2040, 3000, CA, Rotterdam, the Netherlands.
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19
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Mönig S, Chevallay M, Niclauss N, Zilli T, Fang W, Bansal A, Hoeppner J. Early esophageal cancer: the significance of surgery, endoscopy, and chemoradiation. Ann N Y Acad Sci 2018; 1434:115-123. [PMID: 30138532 DOI: 10.1111/nyas.13955] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 12/22/2022]
Abstract
Early carcinomas of the esophagus are histologically classified as adenocarcinoma or squamous cell carcinoma and microscopically subdivided into mucosal and submucosal carcinomas depending on infiltration depth. The prevalence of lymph node metastasis in mucosal carcinoma remains low. However, lymph node metastases arise frequently from tumors with submucosal infiltration, with increasing prevalence in the deeper submucosal sublayers. According to current German guidelines, endoscopic resection is the recommended treatment in mucosal adenocarcinoma without histologic risk factors (lymphatic invasion 1, vascular invasion 1, >grade 2, R1-margin). In superficial submucosal infiltration without histologic risk factors, endoscopic resection can be considered. In squamous cell carcinoma, endoscopic resection is indicated up to middle layer mucosal carcinoma. Beyond these criteria, surgical resection should be considered. The gold standard is a subtotal transthoracic esophagectomy with two-field lymphadenectomy. Total esophagectomy is performed in cervical esophageal carcinoma and transhiatal extended gastrectomy in carcinoma of the cardia. Minimally invasive procedures show good oncologic results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection. In early squamous cell cancer, the combination of endoscopic resection and adjuvant chemoradiotherapy is a therapeutic option with promising results.
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Affiliation(s)
- Stefan Mönig
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Mickael Chevallay
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Nadja Niclauss
- Visceral Surgery Department, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital Clinical Center for Esophageal Diseases, Shanghai Jiaotong University, Shanghai, China
| | - Ajay Bansal
- Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.,Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Jens Hoeppner
- Department of General and Visceral Surgery, Faculty of Medicine, University of Freiburg Medical Center, Freiburg, Germany
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20
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Chevallay M, Bollschweiler E, Chandramohan SM, Schmidt T, Koch O, Demanzoni G, Mönig S, Allum W. Cancer of the gastroesophageal junction: a diagnosis, classification, and management review. Ann N Y Acad Sci 2018; 1434:132-138. [PMID: 30138540 DOI: 10.1111/nyas.13954] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/11/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Management of gastroesophageal junction (GEJ) adenocarcinoma is a controversial topic. The rising incidence of this cancer requires a clear consensus to ensure proper management. Application of oncological principles for tumors of the esophagus or stomach is not possible because of comparative differences in the biology of GEJ adenocarcinoma, leading to different therapeutic options. Staging work-up with endoscopy, endosonography, and PET is essential to inform the choice of neoadjuvant treatment and surgical approach to GEJ adenocarcinoma. Surgery remains the only curative treatment and should be undertaken in specialized centers.
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Affiliation(s)
- Mickael Chevallay
- Visceral Surgery Department, Geneva University Hospital, Genève, Switzerland
| | | | - Servarayan M Chandramohan
- Department of Surgical Gastroenterology and Center of Excellence for Upper Gastro Intestinal Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Oliver Koch
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | - Stefan Mönig
- Visceral Surgery Department, Geneva University Hospital, Genève, Switzerland
| | - William Allum
- Department of Surgery, Royal Marsden Hospital, London, UK
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21
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Kam TY, Kountouri M, Roth A, Frossard JL, Huber O, Mönig S, Zilli T. Corrigendum to "Endoscopic resection with adjuvant chemo-radiotherapy for superficial esophageal squamous cell carcinoma: A critical review" [Crit. Rev. Oncol./Hematol. 124, April (2018), 61-65]. Crit Rev Oncol Hematol 2018; 128:139. [PMID: 29731124 DOI: 10.1016/j.critrevonc.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tsz Yeung Kam
- Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Arnaud Roth
- Medical Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Olivier Huber
- Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Stefan Mönig
- Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
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22
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Kam TY, Kountouri M, Roth A, Frossard JL, Huber O, Mönig S, Zilli T. Endoscopic resection with adjuvant chemo-radiotherapy for superficial esophageal squamous cell carcinoma: A critical review. Crit Rev Oncol Hematol 2018; 124:61-65. [PMID: 29548487 DOI: 10.1016/j.critrevonc.2018.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 02/21/2018] [Indexed: 02/08/2023] Open
Abstract
Radical esophagectomy with extended lymph node dissection is considered the standard of care in treatment of squamous cell carcinoma of esophagus with deep mucosal invasion (pT1a m3) or submucosal involvement (pT1b). However, despite the increasing use of minimally invasive approaches, it remains a major surgery associated with significant morbidities and even mortality risk. Endoscopic resection (ER) results in excellent local control in early superficial mucosal (pT1a) disease yet there is substantial risk of lymph node metastases in T1b disease. Therefore, ER followed by combined with chemo-radiotherapy (CRT) would potentially improve the outcome in pT1a m3 or pT1b disease and would be an attractive conservative alternative to esophagectomy. Retrospective series published so far have shown promising results for this combined treatment. Herein the current literature of the indications, treatment outcome and toxicities of this treatment strategy are discussed and critically reviewed.
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Affiliation(s)
- Tsz Yeung Kam
- Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | - Arnaud Roth
- Medical Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Olivier Huber
- Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Stefan Mönig
- Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
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23
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Al-Batran SE, Homann N, Pauligk C, Illerhaus G, Martens UM, Stoehlmacher J, Schmalenberg H, Luley KB, Prasnikar N, Egger M, Probst S, Messmann H, Moehler M, Fischbach W, Hartmann JT, Mayer F, Höffkes HG, Koenigsmann M, Arnold D, Kraus TW, Grimm K, Berkhoff S, Post S, Jäger E, Bechstein W, Ronellenfitsch U, Mönig S, Hofheinz RD. Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial. JAMA Oncol 2017; 3:1237-1244. [PMID: 28448662 DOI: 10.1001/jamaoncol.2017.0515] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Surgical resection has a potential benefit for patients with metastatic adenocarcinoma of the stomach and gastroesophageal junction. Objective To evaluate outcome in patients with limited metastatic disease who receive chemotherapy first and proceed to surgical resection. Design, Setting, and Participants The AIO-FLOT3 (Arbeitsgemeinschaft Internistische Onkologie-fluorouracil, leucovorin, oxaliplatin, and docetaxel) trial is a prospective, phase 2 trial of 252 patients with resectable or metastatic gastric or gastroesophageal junction adenocarcinoma. Patients were enrolled from 52 cancer care centers in Germany between February 1, 2009, and January 31, 2010, and stratified to 1 of 3 groups: resectable (arm A), limited metastatic (arm B), or extensive metastatic (arm C). Data cutoff was January 2012, and the analysis was performed in March 2013. Interventions Patients in arm A received 4 preoperative cycles of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) followed by surgery and 4 postoperative cycles. Patients in arm B received at least 4 cycles of neoadjuvant FLOT and proceeded to surgical resection if restaging (using computed tomography and magnetic resonance imaging) showed a chance of margin-free (R0) resection of the primary tumor and at least a macroscopic complete resection of the metastatic lesions. Patients in arm C were offered FLOT chemotherapy and surgery only if required for palliation. Patients received a median (range) of 8 (1-15) cycles of FLOT. Main Outcomes and Measures The primary end point was overall survival. Results In total, 238 of 252 patients (94.4%) were eligible to participate. The median (range) age of participants was 66 (36-79) years in arm A (n = 51), 63 (28-79) years in arm B (n = 60), and 65 (23-83) years in arm C (n = 127). Patients in arm B (n = 60) had only retroperitoneal lymph node involvement (27 patients [45%]), liver involvement (11 [18.3%]), lung involvement (10 [16.7%]), localized peritoneal involvement (4 [6.7%]), or other (8 [13.3%]) incurable sites. Median overall survival was 22.9 months (95% CI, 16.5 to upper level not achieved) for arm B, compared with 10.7 months (95% CI, 9.1-12.8) for arm C (hazard ratio, 0.37; 95% CI, 0.25-0.55) (P < .001). The response rate for arm B was 60% (complete, 10%; partial, 50%), which is higher than the 43.3% for arm C. In arm B, 36 of 60 patients (60%) proceeded to surgery. The median overall survival was 31.3 months (95% CI, 18.9-upper level not achieved) for patients who proceeded to surgery and 15.9 months (95% CI, 7.1-22.9) for the other patients. Conclusions and Relevance Patients with limited metastatic disease who received neoadjuvant chemotherapy and proceeded to surgery showed a favorable survival. The AIO-FLOT3 trial provides a rationale for further randomized clinical trials. Trial Registration clinicaltrials.gov identifier: NCT00849615.
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Affiliation(s)
- Salah-Eddin Al-Batran
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, Universitären University Cancer Center, Frankfurt, Germany
| | - Nils Homann
- Medical Department II, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Claudia Pauligk
- Institute of Clinical Cancer Research, Krankenhaus Nordwest, Universitären University Cancer Center, Frankfurt, Germany
| | - Gerald Illerhaus
- Medical Department I, Universitätsklinikum Freiburg, Freiburg, Germany.,now with Clinic for Hematology, Oncology, and Palliative Care, Klinikum Stuttgart, Kriegsbergstraße, Stuttgart, Germany
| | - Uwe M Martens
- Medical Department III, SLK-Kliniken GmbH, Heilbronn, Germany
| | - Jan Stoehlmacher
- Medical Clinic and Polyclinic, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.,now with Institute for Clinical Genetics, Bonn, Germany
| | - Harald Schmalenberg
- Medical Department II, Universitätsklinikum Jena, Jena, Germany.,now with Medical Department IV, Krankenhaus Dresden-Friedrichstadt, Dresden, Germany
| | - Kim B Luley
- Medical Department I Hematology/Oncology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Nicole Prasnikar
- Medical Department I, Klinikum Ludwigsburg, Ludwigsburg, Germany.,now with Medical Department II, Asklepios Klinik Altona, Hamburg, Germany
| | - Matthias Egger
- Medical Department, Ortenau Klinikum Lahr, Lahr, Germany
| | - Stephan Probst
- Department of Hematology and Oncology, Klinikum Bielefeld, Bielefeld, Germany
| | - Helmut Messmann
- Medical Department III, Zentralklinikum Augsburg, Augsburg, Germany
| | - Markus Moehler
- Medical Department I, Universitätsklinik Mainz, Mainz, Germany
| | | | - Jörg T Hartmann
- Medical Department II, Universitätsklinikum der Eberhard-Karl-Universität, Tübingen, Germany.,now with Clinic for Hematology, Oncology, and Immunology, Franziskus Hospital Bielefeld, Bielefeld, Germany
| | - Frank Mayer
- Medical Department II, Universitätsklinikum der Eberhard-Karl-Universität, Tübingen, Germany.,now with Gemeinschaftspraxis, Friedrichshafen, Germany
| | | | - Michael Koenigsmann
- MediProjekt, Gesellschaft für Medizinstatistik und Projektentwicklung, Hannover, Germany
| | - Dirk Arnold
- Clinic and Polyclinic for Internal Medicine IV, Universitätsklinikum Halle, Halle, Germany.,now with CUF Hospitals Cancer Centre, Lisboa, Portugal
| | - Thomas W Kraus
- Department of Surgery, Krankenhaus Nordwest, Frankfurt, Germany
| | - Kersten Grimm
- Department of Surgery, Krankenhaus Nordwest, Frankfurt, Germany
| | - Stefan Berkhoff
- Department of Surgery, Krankenhaus Nordwest, Frankfurt, Germany
| | - Stefan Post
- Medical Department, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Elke Jäger
- Department of Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Wolf Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Stefan Mönig
- Department of General and Visceral Surgery, Universitätsklinik Köln, Köln, Germany
| | - Ralf D Hofheinz
- Medical Department, Universitätsmedizin Mannheim, Mannheim, Germany
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24
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Wirz S, Simon S, Frieling T, Bausewein C, Voltz R, Pralong A, Mönig S, Follmann M, Holtmann M, Becker G. Obstipation bei Patienten mit nicht-heilbarer Krebserkrankung. Dtsch Med Wochenschr 2017; 142:249. [DOI: 10.1055/s-0043-100769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Wirz S, Simon S, Frieling T, Bausewein C, Voltz R, Pralong A, Mönig S, Follmann M, Holtmann M, Becker G. Obstipation bei Patienten mit nicht-heilbarer Krebserkrankung. Dtsch Med Wochenschr 2016; 141:1177-81. [DOI: 10.1055/s-0042-101899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Fuchs H, Hölscher AH, Leers J, Bludau M, Brinkmann S, Schröder W, Alakus H, Mönig S, Gutschow CA. Long-term quality of life after surgery for adenocarcinoma of the esophagogastric junction: extended gastrectomy or transthoracic esophagectomy? Gastric Cancer 2016; 19:312-7. [PMID: 25627475 DOI: 10.1007/s10120-015-0466-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Esophagectomy with gastric tube reconstruction and extended transhiatal gastrectomy with Roux-en-Y reconstruction are alternative procedures in current therapeutic concepts for adenocarcinoma of the esophagogastric junction (AEG). The impact of these operations on long-term health-related quality of life (HRQL) is incompletely understood. METHODS Patients with cancer-free survival of at least 24 months after esophagectomy (ESO) or extended gastrectomy (GAST) for AEG were identified from a prospectively maintained database. EORTC questionnaires were sent out to assess health-related general (QLQ-C30) and cancer-specific (OG-25) quality of life. Numeric scores were calculated for each conceptual area and compared with those of healthy reference populations. RESULTS 123 patients (ESO n = 71; GAST n = 52) completed the self-rated questionnaires. HRQL was consistently lower in surgical patients (GAST and ESO) compared with healthy reference populations. Also, there was a general trend for a better HRQL in GAST compared with ESO patients. This trend was statistically significant for physical function (p = 0.04), dyspnea (p = 0.02), and reflux (p = 0.03). Subgroup analysis revealed no significant differences between patients with or without prior neoadjuvant therapy. CONCLUSIONS After mid- and long-term follow-up, HRQL after extended gastrectomy with Roux-en-Y reconstruction is superior to that after esophagectomy and gastric tube reconstruction. Improved HRQL after gastrectomy is mainly due to less pulmonary and reflux-related symptoms. Our findings may influence the choice of the surgical strategy for patients with AEG.
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Affiliation(s)
- Hans Fuchs
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Arnulf H Hölscher
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Jessica Leers
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Marc Bludau
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Sebastian Brinkmann
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Wolfgang Schröder
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Hakan Alakus
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Stefan Mönig
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany
| | - Christian A Gutschow
- Department of General-, Visceral-, and Cancer Surgery, University of Cologne, Kerpener Strasse 62, 50931, Cologne, Germany.
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27
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Baiocchi GL, D'Ugo D, Coit D, Hardwick R, Kassab P, Nashimoto A, Marrelli D, Allum W, Berruti A, Chandramohan SM, Coburn N, Gonzàlez-Moreno S, Hoelscher A, Jansen E, Leja M, Mariette C, Meyer HJ, Mönig S, Morgagni P, Ott K, Preston S, Rha SY, Roviello F, Sano T, Sasako M, Shimada H, Schuhmacher C, So Bok-Yan J, Strong V, Yoshikawa T, Terashima M, Ter-Ovanesov M, Van der Velde C, Memo M, Castelli F, Pecorelli S, Detogni C, Kodera Y, de Manzoni G. Follow-up after gastrectomy for cancer: the Charter Scaligero Consensus Conference. Gastric Cancer 2016; 19:15-20. [PMID: 26140915 PMCID: PMC4890702 DOI: 10.1007/s10120-015-0513-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 06/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Presently, there is no scientific evidence supporting a definite role for follow-up after gastrectomy for cancer, and clinical practices are quite different around the globe. The aim of this consensus conference was to present an ideal prototype of follow-up after gastrectomy for cancer, based on shared experiences and taking into account the need to rationalize the diagnostic course without losing the possibility of detecting local recurrence at a potentially curable stage. METHODS On June 19-22, 2013 in Verona (Italy), during the 10th International Gastric Cancer Congress (IGCC) of the International Gastric Cancer Association, a consensus meeting was held, concluding a 6-month, Web-based, consensus conference entitled "Rationale of oncological follow-up after gastrectomy for cancer." RESULTS Forty-eight experts, with a geographical distribution reflecting different health cultures worldwide, participated in the consensus conference, and 39 attended the consensus meeting. Six statements were finally approved, displayed in a plenary session and signed by the vast majority of the 10th IGCC participants. These statements are attached as an annex to the Charter Scaligero on Gastric Cancer. CONCLUSION After gastrectomy for cancer, oncological follow-up should be offered to patients; it should be tailored to the stage of the disease, mainly based on cross-sectional imaging, and should be discontinued after 5 years.
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Affiliation(s)
- Gian Luca Baiocchi
- Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Domenico D'Ugo
- Department of Surgical Sciences, Catholic University, Rome, Italy.
| | - Daniel Coit
- Memorial Sloan Kettering Cancer Center, New York, USA.
| | | | | | | | - Daniele Marrelli
- Surgical Oncology, Department of Human Pathology and Oncology, Siena University, Siena, Italy.
| | | | - Alfredo Berruti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Servarayan Murugesan Chandramohan
- Department of Surgical Gastroenterology and Center of Excellence for Upper Gastro Intestinal Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, India.
| | - Natalie Coburn
- Odette Cancer Research, Sunnybrook Research Institute, Toronto, Canada.
| | | | - Arnulf Hoelscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
| | - Edwin Jansen
- The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Marcis Leja
- Riga East University Hospital, University of Latvia, Riga, Latvia.
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital of Lille, Lille, France.
| | - Hans-Joachim Meyer
- Deutsche Gesellschaft für Chirurgie, Luisenstrasse 58/59, 10117, Berlin, Germany.
| | - Stefan Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy.
| | - Katia Ott
- Department of Surgery, University of Heidelberg, Heidelberg, Germany.
| | - Shaun Preston
- The Royal Surrey County Hospital and Minimal Access Therapy Training Unit, Guildford, Surrey, UK.
| | - Sun Young Rha
- Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
| | - Franco Roviello
- Surgical Oncology, Department of Human Pathology and Oncology, Siena University, Siena, Italy.
| | | | | | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, Tokyo, Japan.
| | | | - Jimmy So Bok-Yan
- Department of Surgery, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Vivian Strong
- Memorial Sloan Kettering Cancer Center, New York, USA.
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
| | | | - Michail Ter-Ovanesov
- Blokhin Center for Cancer Research, Russian Academy of Medical Sciences, Moscow, Russia.
| | - Cornelis Van der Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Francesco Castelli
- Medicus Mundi, Brescia, Italy.
- Infectious Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | | | | | - Yasuhiro Kodera
- Department of Gastroenterological Surgery 2, Nagoya University, Nagoya, Japan.
| | - Giovanni de Manzoni
- 1st Department of General Surgery, Borgo Trento Hospital, University of Verona, Verona, Italy.
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Metzger R, Schütze F, Mönig S. Evidence-Based Operative Details in Esophageal Cancer Treatment: Surgical Approach, Lymphadenectomy, Anastomosis. Viszeralmedizin 2015; 31:337-40. [PMID: 26989389 PMCID: PMC4789948 DOI: 10.1159/000441017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background This review depicts surgical treatment strategies in the management of esophageal cancer under the focus of evidence-based medicine. The main emphasis lies on technical details, i.e. surgical approach, lymphadenectomy, and current techniques of anastomosis. Methods The current literature on operative details in esophageal cancer treatment was reviewed. Surgical approaches and different techniques of anastomotic reconstruction utilizing a gastric tube were compared. The grade of evidence regarding the necessity and extent of lymphadenectomy was discussed. Results There is no level-1 evidence-based difference regarding the surgical approach for esophagectomy. The preferred anastomosis site is intrathoracic compared to the neck. Extended lymphadenectomy is still imperative in esophagectomy although neoadjuvant protocols might also result in a downstaging effect of lymph nodes. Neoadjuvant regimens have no negative influence on complication rate and anastomotic integrity. Conclusion A tailored interdisciplinary approach to the patients' physiology and esophageal cancer stage is the most important factor that influences operative outcome and oncological results after esophagectomy.
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Affiliation(s)
- Ralf Metzger
- Department of General-, Visceral-, Thoracic and Cancer Surgery, CaritasKlinikum Saarbrücken, Saarbrücken, Germany
| | - Frank Schütze
- Department of General-, Visceral-, Thoracic and Cancer Surgery, CaritasKlinikum Saarbrücken, Saarbrücken, Germany
| | - Stefan Mönig
- Department of General-, Visceral-, and Cancer Surgery, University Hospital Cologne, Cologne, Germany
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Berlth F, Mönig S, Pinther B, Grimminger P, Maus M, Schlösser H, Plum P, Warnecke-Eberz U, Harismendy O, Drebber U, Bollschweiler E, Hölscher A, Alakus H. Both GLUT-1 and GLUT-14 are Independent Prognostic Factors in Gastric Adenocarcinoma. Ann Surg Oncol 2015; 22 Suppl 3:S822-31. [PMID: 26183839 DOI: 10.1245/s10434-015-4730-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The role of glucose transporter 14 (GLUT-14/SLC2A14) in tumor biology is entirely unknown, and the significance of hypoxia inducible factor 1-alpha (HIF1-α) for gastric adenocarcinoma is controversial. The impact of GLUT-1/SLC2A1 has never been confirmed in a Caucasian cohort. METHODS Between 1996 and 2007, 124 patients underwent gastrectomy for gastric adenocarcinoma. Tumor sections were incubated with GLUT-1, GLUT-14, and HIF1-α antibodies. Expression was analyzed for correlations with histopathology, marker coexpression, and patient survival by uni- and multivariate analyses. RESULTS Expressions of GLUT-1, GLUT-14, and HIF1-α were detectable in 50, 77.4, and 27.1 %, respectively. Expression of GLUT-1 was associated with pT-category (p = 0.019), pN-category (p = 0.019), tubular (WHO, p = 0.008), and intestinal (Lauren classification; p = 0.002) histologic subtypes. Expression of GLUT-14 was correlated with pT category (p = 0.043), whereas HIF1-α did not show any correlation with histopathology or survival. The median survival period was 14 months (95 % confidence interval [CI] 9.2-18.8 months) for GLUT-1-positive patients and 55 months (95 % CI 25.8-84.2; p = 0.01) for GLUT-1-negative patients. An inferior prognosis also was seen for GLUT-14-positive cases compared with GLUT-14-negative cases (p = 0.004). Thus, worst survival was seen with both GLUT-1- and GLUT-14-positive expression followed by single-positive and then double-negative cases (p = 0.004). In multivariate analysis including International Union Against Cancer (UICC) stages, R category, Lauren classification, surgery alone versus neoadjuvant/perioperative chemotherapy, and marker expression as covariates, GLUT-1 (p = 0.011) and GLUT-14 (p = 0.025) kept their prognostic independence. CONCLUSIONS The study findings suggest that detection of GLUT-1 and GLUT-14 is of high prognostic value. It gives additional information to UICC stages and identifies patients with inferior prognosis. If confirmed in prospective studies, these markers need to be considered for future classification systems.
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Affiliation(s)
- Felix Berlth
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Stefan Mönig
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Berit Pinther
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Peter Grimminger
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.,Department of General, Abdominal and Transplant Surgery, University of Mainz, Mainz, Germany
| | - Martin Maus
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Hans Schlösser
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Patrick Plum
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Ute Warnecke-Eberz
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Olivier Harismendy
- Division of Biomedical Informatics and Moores Cancer Center, University of California San Diego, La Jolla, USA
| | - Uta Drebber
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Elfriede Bollschweiler
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Arnulf Hölscher
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany
| | - Hakan Alakus
- Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
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Meyer HJ, Hölscher AH, Lordick F, Messmann H, Mönig S, Schumacher C, Stahl M, Wilke H, Möhler M. [Current S3 guidelines on surgical treatment of gastric carcinoma]. Chirurg 2012; 83:31-7. [PMID: 22127381 DOI: 10.1007/s00104-011-2149-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current S3 guidelines on the diagnosis and treatment of gastric carcinoma including those of the esophagogastric junction describe optimal clinical practice based on a high level of evidence and expert consensus from different medical disciplines. Endoscopy and performance of multiple biopsies is the standard approach to detect malignant tumors in the upper gastrointestinal tract. Further diagnostic procedures are necessary to evaluate the tumor stage. With the exception of mucosal carcinomas, surgical therapy is the cornerstone of curative treatment in all potentially resectable stages. In locally advanced carcinomas perioperative chemotherapy should be carried out and in high-seated tumors preoperative radiochemotherapy might be an alternative option. Palliative surgical resection should be avoided in disseminated asymptomatic stages. In a palliative situation complications of the tumor should primarily be treated by interventional or conservative procedures.
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Affiliation(s)
- H-J Meyer
- Klinik für Allgemein und Viszeralchirurgie, Städtisches Klinikum Solingen gGmbH, Gotenstraße 1, 42653, Solingen, Deutschland.
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31
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Krug KB, Rehder O, Bovenschulte H, Schwabe H, Burst V, Engelmann U, Thul R, Mönig S, Hellmich M. [Effects of endovascular therapy for renal artery stenosis on blood pressure and renal function: retrospective analysis of an unselected patient collective from 1994 to 2007]. Urologe A 2012; 51:1562-71. [PMID: 22743982 DOI: 10.1007/s00120-012-2952-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A retrospective analysis of the long-term success rates of endoluminal therapy of renal artery stenosis in a university hospital was carried out. MATERIAL AND METHODS Preinterventional and postinterventional data contained in the clinical records of all 104 patients who underwent percutaneous transluminal angioplasty (PTA, 25 patients) or stent PTA (79 patients) from 01 January 1994 to 31 December 2007, were documented using an electronically structured questionnaire and a time period classification. Subgroup analyses and statistical calculations were done using t-tests for joint random samples. RESULTS At day 1 postintervention all patients showed a statistically significant decrease in mean systolic blood pressure (all patients: p=0.002, stent PTA group: p=0.023, PTA group: p=0.022). The significant decrease in mean systolic blood pressure persisted in years 1 and 2 postintervention (all patients: p=0.009 and 0.007, stent PTA group: p=0.039 and 0.015, respectively). Mean blood pressure values remained constant during the other time periods analyzed. In patients with a stent PTA carried out between 2001 and 2007 there was no significant reduction of prescribed antihypertonic drugs (p=0.023 and p=0.046, respectively). Mean serum creatinine concentrations decreased during years 1 and 2 postintervention and increased starting in year 3. In patients with elevated serum creatinine levels prior to the intervention the increase in mean serum creatinine level started in year 5. CONCLUSIONS Endoluminal therapy of arteriosclerotic renal artery stenosis delays further deterioration of renal function and stabilizes blood pressure as well as the number of prescribed antihypertonic drugs. This can be considered a response to treatment in view of the mostly chronic progressive course of the disease.
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Affiliation(s)
- K B Krug
- Institut und Poliklinik für Radiologische Diagnostik, Universität zu Köln, Josef-Stelzmann-Straße 9, 50924 Köln, Deutschland.
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Warnecke-Eberz U, Bollschweiler E, Drebber U, Metzger R, Baldus SE, Hölscher AH, Mönig S. Prognostic impact of protein overexpression of the proto-oncogene PIM-1 in gastric cancer. Anticancer Res 2009; 29:4451-4455. [PMID: 20032391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND PIM kinases are mediators of cytokine signalling pathways in hematopoietic cells and contribute to the progression of certain types of leukemia and solid tumor. Here the prognostic impact of proto-oncogene PIM-1 was analyzed in gastric carcinoma. PATIENTS AND METHODS Cancer tissues of 117 patients with potentially curative (R0) resections for gastric cancer were immunohistochemically stained for PIM-1. RESULTS Cytoplasmic immunoreactivity for PIM-1 in tumor (46%) was higher (p=0.003) compared to that in gastric glands (16%) and foveolae (1%). PIM-1 immunoreactivity in gastric carcinoma correlated with tumor grading (p<0.05) and Laurén category (p<0.02). Overexpression of PIM-1 in gastric glands (p<0.001) was associated with formation of lymph node metastases (p=0.035) and survival (p=0.04). Multivariate analysis of PIM-1 expression in gastric glands confirmed its association with prognosis. CONCLUSION Up-regulation of PIM-1 oncogene might be a tumor marker for gastric cancer. The correlation of PIM-1 overexpression in gastric glands with formation of lymph node metastases and survival proposes a prognostic role in gastric cancer.
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Affiliation(s)
- Ute Warnecke-Eberz
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Vallböhmer D, Drebber U, Schneider PM, Baldus S, Bollschweiler E, Brabender J, Warnecke-Eberz U, Mönig S, Hölscher AH, Metzger R. Survivin expression in gastric cancer: Association with histomorphological response to neoadjuvant therapy and prognosis. J Surg Oncol 2009; 99:409-13. [PMID: 19347901 DOI: 10.1002/jso.21271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Neoadjuvant therapy is applied to improve the prognosis associated with advanced gastric cancer. Only patients with a major response seem to have a survival benefit. Predictive markers to allow individualisation of treatment could be helpful. We examined the association of survivin protein expression with histopathologic response to neoadjuvant chemotherapy and prognosis in patients with gastric cancer. METHODS Forty patients with gastric cancer received neoadjuvant chemotherapy. Afterwards, 38 patients underwent total gastrectomy, while 2 patients received definitive chemotherapy because of tumour progression. Histomorphologic regression was defined as major response when resected specimens contained <10% tumour cells. Intratumoural survivin expression was determined by immunohistochemistry in pre- and post-therapeutic specimens and correlated with clinicopathologic parameters. RESULTS The pre- and post-therapeutic intratumoural survivin protein expression was not associated with histomorphologic regression. Post-therapeutic survivin expression did not have prognostic impact. A significant association was detected between pre-therapeutic survivin levels and prognosis: patients with a higher survivin protein expression showed a significant survival benefit. In multivariate analysis pre-therapeutic survivin expression was characterised as an independent prognostic marker, besides pN-status and histopathologic regression. CONCLUSIONS The pre-therapeutic survivin protein expression seems to be an independent prognostic marker in the multimodality treatment of advanced gastric cancer.
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Affiliation(s)
- D Vallböhmer
- Department of General, Visceral and Cancer Surgery, Center for Integrated Oncology, University Hospital Cologne, Cologne 50937, Germany
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Vallbohmer D, Holscher AH, Brabender J, Metzger R, Mönig S, Schmidt M, Dietlein M, Bollschweiler E. Evaluation of response in the multimodality treatment of esophageal cancer by [ 18F]-fluorodeoxyglucose-positron emission tomography: A systematic review and meta-analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15520 Background: Neoadjuvant therapy followed by surgery is frequently applied to improve the prognosis of patients with esophageal cancer. However, only a major histopathological response will provide a survival benefit. On the other hand, evidence suggests that patients with response to chemoradiation have no additional benefit from surgery compared with definitive chemoradiation. Consequently, effective methods for early and late response assessment are required in order to perform these different individualised, response-guided treatment concepts. The value of [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) for this diagnostic purpose is still under debate. This systematic review and meta-analysis aims to evaluate the potential of FDG-PETfor the assessment of response in the multimodality treatment of patients with esophageal cancer. Methods: A systematic literature search of studies published between 1990 and September 2008 was performed. The meta-analysis estimated the pooled sensitivity and specificity of histopathological response assessment by FDG-PET using a random effect model. Results: Thirty relevant studies with 1151 patients (865 adenocarcinoma, 493 squamous cell cancer) were identified and included in the systematic review. Mainly neoadjuvant chemoradiation (22 studies) was performed. FDG-PET was conducted mostly before and after neoadjuvant therapy (21 studies) and second most (6 studies) the subsequent FDG-PET was scheduled 7–14 days after the initiation of preoperative therapy. Sixteen studies were included in the meta-analysis. For metabolic response assessment 7–14 days after the initiation of therapy, including 254 patients (with 5 studies from one center), the pooled sensitivity was 85.5% (95% CI: 75.5%-92.8%) and specificity 76.1% (95% CI: 69.3%-82.0%). For late response assessment, including 446 patients, the pooled sensitivity was 77.1% (95% CI: 72.8%- 81.0%) and specificity 59.0% (95% CI: 55.3%-62.7%). Conclusions: For early response assessment FDP-PET seems to be useful in the multimodality treatment of esophageal cancer. In contrast, this study suggests FDG-PET invaluable for late response assessment. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - S. Mönig
- University of Cologne, Cologne, Germany
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Bollschweiler E, Breckheimer S, Mönig S, Hölscher A. Einfluss von Alter und Begleiterkrankungen auf die Prognose von Patienten mit operiertem Magenkarzinom. Zentralbl Chir 2009; 134:71-6. [DOI: 10.1055/s-2008-1076879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dienes H, Hölscher A, Mönig S, Bollschweiler E, Grass G, Nolden B, Baldus S, Drebber U. The overexpression of c-met as a prognostic indicator for gastric carcinoma compared to p53 and p21 nuclear accumulation. Oncol Rep 2008. [DOI: 10.3892/or.19.6.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Dienes H, Baldus S, Hölscher A, Drebber U, Landsberg S, Schneider P, Mönig S, Von Stockmar-Von Wangenheim C. p16, cyclin D1 and Rb expression in colorectal carcinomas: Correlations with clinico-pathological parameters and prognosis. Mol Med Rep 2008. [DOI: 10.3892/mmr.1.1.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mönig S, Luebke T, Soheili A, Landsberg S, Dienes H, Hölscher A, Baldus S. Rapid immunohistochemical detection of tumor cells in gastric carcinoma. Oncol Rep 2006. [DOI: 10.3892/or.16.5.1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Prokop A, Helling HJ, Andermahr J, Mönig S, Rehm KE. [Tossy III injuries of the acromioclavicular joint. In what circumstances is surgery still justified? Personal results and literature review]. Orthopade 2003; 32:432-6. [PMID: 12743695 DOI: 10.1007/s00132-002-0419-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In Germany AC-joint-dislocations type Tossy III are treated in most of the cases operatively. Over two times of period we treated AC-joint-dislocations type Tossy III with biodegradable PDS-cords. 54 patients were operated between 1989 and 1997 and followed up after 39 months. 87.5% of patients are satisfied with results and have 10.2 points at Taftscore. In this period we couldn't differentiated the results by Rockwood classification. 12 patients with Rockwood V were operated between 1998 and 2002 and followed up after 14 months. Excellent and good results were seen in 92% of cases. At Taftscore we seen 10.7 points. 3 patients with Rockwood III were treated conservative with 10.3 points and 3 patients were operated with 10.7 points at Taftscore. AC-joint dislocations should be classified to Rockwood. No differences were seen between operation and conservative treatment in Rockwood III in literature. We recommend operation with PDS cords with good results in Rockwood V.
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Affiliation(s)
- A Prokop
- Klinik und Poliklinik für Unfall, Hand- und Wiederherstellungschirurgie, Klinikum der Universität, Cologne.
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Mönig S, Baldus SE, Collet PH, Zirbes TK, Bollschweiler E, Thiele J, Dienes HP, Hölscher AH. Histological grading in gastric cancer by Goseki classification: correlation with histopathological subtypes and prognosis. Anticancer Res 2001; 21:617-20. [PMID: 11299815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Many different classification systems have been proposed for the histological classification and grading of gastric cancer. In 1992 Goseki described a novel classification system for gastric cancer based on tubular differentiation and mucus in the cytoplasm. The aim of the study was to compare the Goseki classification with the currently used classification systems and to define the prognostic significance of the Goseki classification system. PATIENTS AND METHODS The present study analyzed material from 200 gastric carcinoma patients who underwent gastrectomy with curative intention. All specimens were categorized to UICC-classification, WHO-classification, Laurén classification, tumor differentiation and Goseki classification. The median follow-up for surviving patients was 3.75 years (range, 0.14-11.52). RESULTS According to the Goseki classification 32% of patients were classified as group I, 11.5% as group II, 9.5% as group III and 48% as group IV. The Goseki classification was found to correlate with the WHO and Lauren classification as well as with conventional grading. Goseki classification as well as tumor differentiation, Lauren and WHO classification did not have prognostic value for survival. Only the UICC system presented as an independent prognostic factor in multivariate analysis (p < 0.000001). CONCLUSION In our series Goseki classification correlated with conventional classification systems, but not with survival.
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Affiliation(s)
- S Mönig
- Department of Surgery, University of Cologne, Joseph-Stelzmann-Strasse 9, 50924 Cologne, Germany.
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Abstract
The selective rupture of the calcaneocuboid ligament is extremely rare and frequently misdiagnosed. This study tries to clarify the mechanism, classification and treatment of this entity. The necessity of radiographs with varus stress and in certain cases of computer tomography (CT) and magnetic resonance imaging (MRI), beside the routine antero-posterior and lateral views, is emphasized. Thirteen cases out of five-hundred-twenty-one sprain injuries of the ankle are described, classified and the therapy discussed: If on varus stress radiographs, there is a calcaneocuboid angle <10 degrees without a bony flake (type 1) strapping for six weeks is indicated. A calcaneocuboid angle >10 degrees with or without a small bony flake of the ligament insertion (type 2) should primarily be treated with a shoe cast for 6 weeks; if there are persistent symptoms a secondary peroneus brevis tendon graft is recommended. A calcaneocuboid angle >10 degrees with a big flake (type 3) should be treated by open reduction and refixation of the ligament. Complex injuries (type 4) are characterised by cuboid compression fracture and ligament rupture.
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Affiliation(s)
- J Andermahr
- Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie der Medizinischen Einrichtungen der Universität zu Köln, Deutschland/Germany
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Schröder W, Baldus SE, Mönig S, Zirbes TK, Dienes HP, Hölscher AH. [Diagnostic relevance of lymph node size after 2-field lymph node excision in esophagus carcinomas]. Langenbecks Arch Chir Suppl Kongressbd 1998; 115:501-3. [PMID: 14518306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In 22 patients with thoracoabdominal esophagectomy and 2-field lymphadenectomy the lymph nodes (LN) were dissected according to a standardized protocol and classified in five groups regarding their size. 407 of 675 dissected LN (60.3%) were < 5 mm. 89.4% of the metastatic LN were < 10 mm although LN > 10 mm showed significantly more metastases than LN < 10 mm. Since diagnostic imaging defines metastatic LN by a diameter > 10 mm these results demonstrate the inaccuracy to evaluate preoperatively the cN-status. These results also support the need of a systematic lymphadenectomy in patients with esophageal cancer.
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Affiliation(s)
- W Schröder
- Klinik und Poliklinik für Visceral- und Gefässchirurgie, Universität zu Köln, Joseph-Stelzmann Str. 9, 50931 Köln
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Abstract
In a 73-year-old woman elective laparoscopic cholecystectomy for symptomatic cholelithiasis had to be changed to open cholecystectomy because of technical problems. Unsuspected microscopic adenocarcinoma of the gallbladder was found after operation. Two months later abdominal-wall metastasis developed at the periumbilical and the right abdominal laparoscopic tract through which the laparoscope and instruments had been introduced and removed. The paramedian abdominal wall incision for the laparotomy was free of tumor.
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Affiliation(s)
- C A Jacobi
- Department of Surgery, University Hospital, University of Cologne, Germany
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