Surgical management of oligometastatic recurrence in primary esophageal melanoma: a feasible approach in resource-limited settings

Primary esophageal melanoma (PEM) is a rare and aggressive malignancy with limited treatment options. Due to its rarity, no standardized guidelines exist for managing oligometastatic recurrence, particularly in resource-limited settings. We present a case of a 60-year-old male with PEM who underwent esophagectomy followed by surgical resection of an adrenal metastasis. Despite the increasing use of immunotherapy, surgical resection remains a viable alternative for oligometastatic recurrence when access to systemic therapies is restricted. This case highlights the feasibility of surgery in achieving long-term disease control in select patients. Further studies are needed to establish evidence-based strategies for treating PEM recurrence in resource-constrained environments.

Utilization of Staging Laparoscopy for Patients With Gastric Cancer in Ukraine

BACKGROUND

The use of advanced diagnostic methods, such as high-resolution CT or PET-CT scans, are limited in low and middle-income countries (LMICs). In gastric cancer, occult peritoneal disease may be present in up to 20% of cases, limiting the benefits of surgical resection. Accurate staging of gastric cancer is essential to ensure optimal patient management and prevent undue morbidity from unnecessary surgery. Our study evaluated the diagnostic accuracy and safety of staging laparoscopy (SL) versus computed tomography (CT) in detecting peritoneal metastases for gastric cancer in Ukraine.

METHODS

Patients who underwent SL between October 2017 and October 2022 were retrospectively reviewed. SL was performed for each newly diagnosed patient with gastric cancer without evidence of distant metastases, except when peritoneal carcinomatosis was in question. Pathological findings at SL were compared with initial CT reports, and analysis of the sensitivity and specificity for SL was performed.

RESULTS

Of 516 patients undergoing SL, 410 had no radiological considerations for distant metastases. Among them, radiographically occult peritoneal metastatic disease was found in 134 (32.7%). Overall SL sensitivity for peritoneal metastases was 90.6% (95% confidence interval [CI]: 85.8%-94.1%) and specificity 100.0% (95% CI: 98.8%-100.0%). Complications after SL occurred in 5 (1%) of patients. No mortality was associated with SL.

CONCLUSION

SL is a safe and effective method to evaluate the presence of peritoneal disease in patients with gastric cancer. This method may be appropriate for LMICs, where availability of advanced imaging technologies is limited.