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Faucher M, Dahan S, Morel B, de Guibert JM, Chow-Chine L, Gonzalez F, Bisbal M, Servan L, Sannini A, Tezier M, Tourret M, Cambon S, Pouliquen C, Mallet D, Nguyen Duong L, Ettori F, Mokart D. The Effect of Postoperative Sepsis on 1-Year Mortality and Cancer Recurrence Following Transhiatal Esophagectomy for Esophageal-Gastric Junction Adenocarcinomas: A Retrospective Observational Study. Cancers (Basel) 2025; 17:109. [PMID: 39796735 PMCID: PMC11719752 DOI: 10.3390/cancers17010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/26/2024] [Accepted: 12/30/2024] [Indexed: 01/13/2025] Open
Abstract
INTRODUCTION Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence. METHOD A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022. RESULTS Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11-47); p = 0.038), number of lymph nodes removed (OR: 0. 78 (0.64-0.95); p = 0.011), recurrence at one year (OR: 9.22 (1.66-51.1); p = 0.011), mediastinitis (OR: 17.7 (1.43-220); p = 0.025) and intraoperative driving pressure (OR: 1.77 (1.17-2.68); p = 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07-0.95; p = 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5-18.9; p = 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99-41.0; p < 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36-5.19; p = 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79-0.96; p = 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71-25.32; p < 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70-25.13; p = 0.005). CONCLUSIONS Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Djamel Mokart
- Department of Anesthesiology and Critical Care, Paoli-Calmettes Institute, 13009 Marseille, France; (M.F.); (S.D.); (B.M.); (J.M.d.G.); (L.C.-C.); (F.G.); (M.B.); (L.S.); (A.S.); (M.T.); (M.T.); (S.C.); (C.P.); (D.M.); (L.N.D.); (F.E.)
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2
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Akhtar J, Imran M, Wang G. CRISPR/Cas9-Mediated CtBP1 Gene Editing Enhances Chemosensitivity and Inhibits Metastatic Potential in Esophageal Squamous Cell Carcinoma Cells. Int J Mol Sci 2023; 24:14030. [PMID: 37762332 PMCID: PMC10530806 DOI: 10.3390/ijms241814030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Innovative therapeutic strategies for esophageal squamous cell carcinoma (ESCC) are urgently required due to the limited effectiveness of standard chemotherapies. C-Terminal Binding Protein 1 (CtBP1) has been implicated in various cancers, including ESCC. However, the precise expression patterns and functional roles of CtBP1 in ESCC remain inadequately characterized. In this study, we aimed to investigate CtBP1 expression and its role in the resistance of ESCC to paclitaxel, an effective chemotherapeutic agent. Western blotting and immunofluorescence were applied to assess CtBP1 expression in the TE-1 and KYSE-50 cell lines. We observed the marked expression of CtBP1, which was associated with enhanced proliferation, invasion, and metastasis in these cell lines. Further, we successfully generated paclitaxel resistant ESCC cell lines and conducted cell viability assays. We employed the CRISPR/Cas9 genome editing system to disable the CtBP1 gene in ESCC cell lines. Through the analysis of the drug dose-response curve, we assessed the sensitivity of these cell lines in different treatment groups. Remarkably, CtBP1-disabled cell lines displayed not only improved sensitivity but also a remarkable inhibition of proliferation, invasion, and metastasis. This demonstrates that CtBP1 may promote ESCC cell malignancy and confer paclitaxel resistance. In summary, our study opens a promising avenue for targeted therapies, revealing the potential of CtBP1 inhibition to enhance the effectiveness of paclitaxel treatment for the personalized management of ESCC.
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Affiliation(s)
- Javed Akhtar
- Futian Biomedical Innovation R&D Center, The Chinese University of Hong Kong, Shenzhen 518172, China;
- Biomedical Science and Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
- Center for Endocrinology and Metabolic Diseases, Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
| | - Muhammad Imran
- Department of Computer Science & IT, Institute of Southern Punjab, Multan 60800, Pakistan;
| | - Guanyu Wang
- Futian Biomedical Innovation R&D Center, The Chinese University of Hong Kong, Shenzhen 518172, China;
- Biomedical Science and Engineering, School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
- Ciechanover Institute of Precision and Regenerative Medicine, School of Medicine, The Chinese University of Hong Kong, Shenzhen 518172, China
- Center for Endocrinology and Metabolic Diseases, Second Affiliated Hospital, The Chinese University of Hong Kong, Shenzhen 518172, China
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Babic B, Fuchs HF, Bruns CJ. [Neoadjuvant chemoradiotherapy or chemotherapy for locally advanced esophageal cancer?]. Chirurg 2020; 91:379-383. [PMID: 32140748 DOI: 10.1007/s00104-020-01150-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND According to international guidelines neoadjuvant chemoradiotherapy and chemotherapy are recommended for the treatment of locally advanced esophageal cancer. The treatment approach depends on the tumor entity (adenocarcinoma vs. squamous cell carcinoma). OBJECTIVE What benefits do patients with locally advanced esophageal cancer have from neoadjuvant treatment? Is there information in the international literature on whether a particular neoadjuvant treatment is preferred? Does the type of neoadjuvant treatment depend on factors other than the tumor entity? Is there a standard in the drug composition of chemotherapy or a clearly defined chemoradiotherapy regimen? MATERIAL AND METHODS A review, evaluation and critical analysis of the international literature were carried out. RESULTS Patients with locally advanced esophageal cancer benefit from a neoadjuvant treatment. The current data situation for squamous cell carcinoma of the esophagus demonstrates a better response to neoadjuvant chemoradiotherapy compared to chemotherapy alone. Locally advanced adenocarcinoma of the esophagus can be treated with combined neoadjuvant chemoradiotherapy as well as by chemotherapy alone. Both lead to an improvement in the prognosis. There are often differences particularly among radiation treatment regimens in the different centers. Furthermore, the localization of the tumor can also be important for treatment decisions. CONCLUSION A neoadjuvant treatment is clearly recommended for locally advanced esophageal cancer. Currently, chemoradiotherapy according to the CROSS protocol is preferred for squamous cell carcinoma. For adenocarcinoma both chemotherapy according to the FLOT protocol as well as chemoradiotherapy in a neoadjuvant treatment concept lead to an improvement in the prognosis.
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Affiliation(s)
- B Babic
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - H F Fuchs
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - C J Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
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Blais E, Vendrely V, Sargos P, Créhange G, Huguet F, Maingon P, Simon JM, Bourdais R, Ozsahin M, Bourhis J, Clément-Colmou K, Belghith B, Proudhom Briois MA, Gilliot O, Dujols JP, Peyras A, Dupin C, Riet FG, Canova CH, Huertas A, Troussier I. [Chemoradiation for oesophageal cancer: A critical review of the literature]. Cancer Radiother 2019; 23:62-72. [PMID: 30639379 DOI: 10.1016/j.canrad.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 10/27/2022]
Abstract
Locally advanced oesophageal cancer treatment requires a multidisciplinary approach with the combination of chemotherapy and radiotherapy for preoperative and definitive strategy. Preoperative chemoradiation improves the locoregional control and overall survival after surgery for locally advanced oesophageal cancer. Definitive chemoradiation can also be proposed for non-resectable tumours or medically inoperable patients. Besides, definitive chemoradiation is considered as an alternative option to surgery for locally advanced squamous cell carcinomas. Chemotherapy regimen associated to radiotherapy consists of a combination of platinum derived drugs (cisplatinum or oxaliplatin) and 5-fluorouracil or a weekly scheme combination of carboplatin and paclitaxel according to CROSS protocol in a neoadjuvant strategy. Radiation doses vary from 41.4Gy to 45Gy for a preoperative strategy or 50 to 50.4Gy for a definitive treatment. The high risk of lymphatic spread due to anatomical features could justify the use of an elective nodal irradiation when the estimated risk of microscopic involvement is higher than 15% to 20%. An appropriate delineation of the gross tumour volume requires an exhaustive and up-to-date evaluation of the disease. Intensity-modulated radiation therapy represents a promising approach to spare organs-at-risk. This critical review of the literature underlines the roles of radiotherapy for locally advanced oesophageal cancers and describes doses, volumes of treatment, technical aspects and dose constraints to organs-at-risk.
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Affiliation(s)
- E Blais
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - V Vendrely
- Service de radiothérapie, CHU de Bordeaux-Haut Lévêque, avenue du Haut-Lévêque, 33600 Pessac, France
| | - P Sargos
- Service de radiothérapie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - G Créhange
- Service de radiothérapie, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - F Huguet
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Maingon
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-M Simon
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Bourdais
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Ozsahin
- Service de radio-oncologie, CHUV, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - J Bourhis
- Service de radio-oncologie, CHUV, rue du Bugnon 46, 1011 Lausanne, Suisse
| | - K Clément-Colmou
- Service de radiothérapie, institut de cancérologie de l'Ouest (ICO) centre René-Gauducheau, boulevard Professeur-Jacques-Monod, 44800 Saint-Herblain, France
| | - B Belghith
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M-A Proudhom Briois
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - O Gilliot
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - J-P Dujols
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - A Peyras
- Service de radiothérapie, groupe de radiothérapie et d'oncologie des Pyrénées, 49, rue Aristide-Briand, 64000 Pau, France
| | - C Dupin
- Service de radiothérapie, CHU de Bordeaux-Haut Lévêque, avenue du Haut-Lévêque, 33600 Pessac, France
| | - F-G Riet
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C-H Canova
- Service de radiothérapie, hôpital de la Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Huertas
- Service de radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - I Troussier
- Service de radio-oncologie, hôpitaux universitaires de Genève, rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse
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Valmasoni M, Pierobon ES, De Pasqual CA, Zanchettin G, Moletta L, Salvador R, Costantini M, Ruol A, Merigliano S. Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study. Ann Surg Oncol 2016; 24:763-769. [DOI: 10.1245/s10434-016-5610-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Indexed: 12/12/2022]
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Markar S, Wahlin K, Lagergren P, Lagergren J. University hospital status and prognosis following surgery for esophageal cancer. Eur J Surg Oncol 2016; 42:1191-5. [DOI: 10.1016/j.ejso.2016.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/18/2016] [Accepted: 05/23/2016] [Indexed: 11/15/2022] Open
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7
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Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C, Dhahri A, Lignier D, Cossé C, Regimbeau JM, Luc G, Cabau M, Jougon J, Badic B, Lozach P, Bail JP, Cappeliez S, El Nakadi I, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Stan-Iuga B, Contival N, Pappalardo E, Coueffe X, Msika S, Mantziari S, Demartines N, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Mabrut JY, Bigourdan JM, Baraket O, Poncet G, Adam M, Vaudoyer D, Jourdan Enfer P, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Godiris Petit G, Karoui M, Tresallet C, Ménégaux F, Vaillant JC, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P, Lefevre JH, Chafai N, Balladur P, Lefrançois M, Parc Y, Paye F, Tiret E, Nedelcu M, Laface L, Perniceni T, Gayet B, Turner K, Filipello A, Porcheron J, Tiffet O, Kamlet N, Chemaly R, Klipfel A, et alBekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C, Dhahri A, Lignier D, Cossé C, Regimbeau JM, Luc G, Cabau M, Jougon J, Badic B, Lozach P, Bail JP, Cappeliez S, El Nakadi I, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Stan-Iuga B, Contival N, Pappalardo E, Coueffe X, Msika S, Mantziari S, Demartines N, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Mabrut JY, Bigourdan JM, Baraket O, Poncet G, Adam M, Vaudoyer D, Jourdan Enfer P, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Godiris Petit G, Karoui M, Tresallet C, Ménégaux F, Vaillant JC, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P, Lefevre JH, Chafai N, Balladur P, Lefrançois M, Parc Y, Paye F, Tiret E, Nedelcu M, Laface L, Perniceni T, Gayet B, Turner K, Filipello A, Porcheron J, Tiffet O, Kamlet N, Chemaly R, Klipfel A, Pessaux P, Brigand C, Rohr S, Carrère N, Da Re C, Dumont F, Goéré D, Elias D, Bertrand C. Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer. Br J Surg 2016; 103:855-62. [DOI: 10.1002/bjs.10121] [Show More Authors] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/11/2015] [Accepted: 01/05/2016] [Indexed: 12/28/2022]
Abstract
Abstract
Background
The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.
Methods
Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.
Results
Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).
Conclusion
NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.
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Affiliation(s)
- S Bekkar
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - C Gronnier
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
| | - F Renaud
- Department of Pathology, Lille University Hospital, Lille, France
| | - A Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - J Théreaux
- Cavale Blanche University Hospital, Brest, France
| | - J Gagnière
- Estaing University Hospital, Clermont-Ferrand, France
| | - B Meunier
- Pontchaillou University Hospital, Rennes, France
| | - D Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Dhahri
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - D Lignier
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - C Cossé
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - G Luc
- Department of Digestive Surgery, Pessac University Hospital, Bordeaux, France
| | - M Cabau
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - J Jougon
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - B Badic
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - P Lozach
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - J P Bail
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - S Cappeliez
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - I El Nakadi
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - G Lebreton
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - A Alves
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - R Flamein
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - F Pipitone
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - B Stan-Iuga
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - N Contival
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - E Pappalardo
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - X Coueffe
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Msika
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Mantziari
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Hec
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - M Vanderbeken
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - W Tessier
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - N Briez
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - F Fredon
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - A Gainant
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - S Mezoughi
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - C Ducerf
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J Baulieux
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J-Y Mabrut
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - O Baraket
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - G Poncet
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - M Adam
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - P Jourdan Enfer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - L Villeneuve
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - T Coste
- Department of Digestive Surgery, Montpellier, France
| | - J-M Fabre
- Department of Digestive Surgery, Montpellier, France
| | - F Marchal
- Department of Digestive Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - R Frisoni
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - A Ayav
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Brunaud
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Bresler
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - C Cohen
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - O Aze
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - N Venissac
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - D Pop
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - J Mouroux
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - I Donici
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - E Felli
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - S Lisunfui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Seman
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - G Godiris Petit
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - C Tresallet
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - F Ménégaux
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - J-C Vaillant
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - L Hannoun
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - B Malgras
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - D Lantuas
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - K Pautrat
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - M Pocard
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - P Valleur
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - P Balladur
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Lefrançois
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - F Paye
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Nedelcu
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - L Laface
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - T Perniceni
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - B Gayet
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - K Turner
- Department of Digestive Surgery, Rennes, France
| | - A Filipello
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - J Porcheron
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - O Tiffet
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - N Kamlet
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - R Chemaly
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Klipfel
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Carrère
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - C Da Re
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - F Dumont
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Goéré
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Elias
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - C Bertrand
- Mont-Godinne University Hospital, Yvoir, Belgium
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8
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Pasquer A, Gronnier C, Renaud F, Duhamel A, Théreaux J, Carrere N, Gagniere J, Meunier B, Collet D, Mariette C. Impact of Adjuvant Chemotherapy on Patients with Lymph Node-Positive Esophageal Cancer who are primarily Treated with Surgery. Ann Surg Oncol 2015; 22 Suppl 3:S1340-9. [PMID: 26065869 DOI: 10.1245/s10434-015-4658-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Whereas the optimal therapeutic strategy in node positive esophageal cancer primarily treated by surgery remains unknown, the study was designed to evaluate the impact of adjuvant chemotherapy on survival in such population. METHODS Among 2944 consecutive patients operated on for esophageal cancer between 2000 and 2010 in 30 European centers, patients with lymph node metastasis treated by adjuvant treatment (n = 178) were compared to patients who did not received adjuvant treatment (n = 378). Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. RESULTS After matching, patients were comparable between the two groups. When comparing adjuvant treatment and nonadjuvant treatment groups, there was no significant differences in 3-year overall (40.9 vs. 35.8 %, P = 0.560) and disease-free (33.9 vs. 28.5 %, P = 0.190) survivals. Locoregional recurrence was lower in the adjuvant treatment group (14.4 vs. 30.9 %, P = 0.012). In the adjuvant treatment group, 94 patients received chemotherapy and 84 chemoradiotherapy, without significant survival benefit over chemoradiotherapy compared with chemotherapy alone (P = 0.280). Predictive factors of overall survival were age ≥60 years, ASA III-IV score, and pN+ classification. No survival benefit was observed according to histological subtype or occurrence of postoperative complications. CONCLUSIONS Adjuvant chemo(radio)therapy did not offer survival benefit in lymph node-positive esophageal cancer patients primarily treated with surgery.
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Affiliation(s)
- Arnaud Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - Caroline Gronnier
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France.,North of France University, Lille Cedex, France.,Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France.,SIRIC OncoLille, Lille Cedex, France
| | - Florence Renaud
- SIRIC OncoLille, Lille Cedex, France.,Department of Pathology, Lille University Hospital, Lille Cedex, France
| | - Alain Duhamel
- SIRIC OncoLille, Lille Cedex, France.,Department of Biostatistics, University Hospital, Lille Cedex, France
| | | | | | | | | | - Denis Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Regional University Hospital Center, Place de Verdun, Lille Cedex, France. .,North of France University, Lille Cedex, France. .,Inserm, UMR S-1172, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis," JPARC, Lille Cedex, France. .,SIRIC OncoLille, Lille Cedex, France.
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9
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Locally advanced esophageal carcinoma: is there still a role of surgery alone without neoadjuvant treatment? J Gastrointest Surg 2015; 19:587-93. [PMID: 25652343 DOI: 10.1007/s11605-015-2762-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/23/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the impact of upfront surgery without neoadjuvant pretreatment on survival in patients with clinically staged locally advanced esophageal carcinoma before the new era of neoadjuvant therapy regimes. MATERIAL AND METHODS This is a retrospective analysis of prospectively collected data of patients with clinically advanced esophageal cancer (cT3) and without neoadjuvant treatment who underwent transthoracic esophagectomy (TTE) in curative intent between 1992 and 2009. Locally advanced esophageal cancer was defined based on presurgical computertomography, endoscopy, and endosonography findings as a tumor infiltrating the paraesophageal tissue or the adjacent structures, with or without lymph node affection. RESULTS Histological subtypes included 131 squamous cell carcinomas (SCC) and 81 adenocarcinomas (AC). Complete resection (R0) was achieved in 84.0% of all 212 patients. Thirty-day mortality rate was 7.1%. Final pathology revealed 50 patients (23.5%) with pT1 or pT2 carcinomas which were preoperatively overstaged. Median overall survival following TTE for SCC was 13.7 months (95% CI; 10.1-17.2 months) and 24.8 months (95% CI; 14.5-35.1 months) for AC, respectively (p = 0.007). The 5-year survival rates were 14% for SCC and 26% for AC, respectively. In median, 27 lymph nodes were resected. On multivariable analyses, histological type, tumor localization, tumor grading, and resection status remained independent factors influencing overall survival. CONCLUSION Our results in the treatment of patients with locally advanced esophageal carcinoma undergoing primary TTE are comparable to the results reported for patients undergoing neoadjuvant chemo-radio-therapy followed by surgery in the pre-CROSS-study era. Histological subtypes show different survival rates and should therefore be separately examined in future trials.
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10
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Markar S, Gronnier C, Duhamel A, Bigourdan JM, Badic B, du Rieu MC, Lefevre JH, Turner K, Luc G, Mariette C. Pattern of Postoperative Mortality After Esophageal Cancer Resection According to Center Volume: Results from a Large European Multicenter Study. Ann Surg Oncol 2015; 22:2615-23. [PMID: 25605511 DOI: 10.1245/s10434-014-4310-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND High center procedural volume has been shown to reduce postoperative mortality (POM); however, the cause of POM has been poorly studied previously. The aim of this study was to define the pattern of POM and major morbidity in relation to center procedural volume. METHODS Data from 2,944 consecutive adult patients undergoing esophagectomy for esophageal cancer in 30 centers between 2000 and 2010 were retrospectively collected. Data between patients who suffered 30-day POM were compared with those who did not. Factors associated with POM were identified using binary logistic regression, with propensity matching to compare low- (LV) and high-volume (HV) centers. RESULTS The 30-day and in-hospital POM rates were 5.0 and 7.3 %, respectively. Pulmonary complications were the most common, affecting 38.1 % of patients, followed by surgical site infection (15.5 %), cardiovascular complications (11.2 %), and anastomotic leak (10.2 %). Factors that were independently associated with 30-day POM included American Society of Anesthesiologists grade IV, LV center, anastomotic leak, pulmonary, cardiovascular and neurological complications, and R2 resection margin status. Surgical complications preceded POM in approximately 30 % of patients compared to medically-related causes in 68 %. Propensity-matched analysis demonstrated LV centers were significantly associated with increased 30-day POM, and POM secondary to anastomotic leak, and pulmonary- and cardiac-related causes. CONCLUSIONS The results of this large, multicenter study provide further evidence to support the centralization of esophagectomy to HV centers, with a lower rate of morbidity and better infrastructure to deal with complications following major surgery preventing further mortality.
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Affiliation(s)
- Sheraz Markar
- Department of Surgery and Cancer, Imperial College, London, UK
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11
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Chemoradiotherapy, with adjuvant surgery for local control, confers a durable survival advantage in adenocarcinoma and squamous cell carcinoma of the oesophagus. Eur J Cancer 2014; 50:1065-75. [PMID: 24480403 DOI: 10.1016/j.ejca.2013.12.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/18/2013] [Accepted: 12/31/2013] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Oesophageal cancer usually presents with systemic disease, necessitating systemic therapy. Neo-adjuvant chemoradiotherapy improves short-term survival, but its long-term impact is disputed because of limited accrual, treatment-protocol heterogeneity and a short follow-up of randomised trials. AIMS Long-term results of two simultaneous randomised controlled trials (RCTs) comparing neo-adjuvant chemo-radiotherapy and surgery (MMT) with surgical monotherapy were examined, and the response of adenocarcinoma (AC) and squamous cell carcinoma (SCC) to identical regimens compared. METHODS Between 1990 and 1997, two RCTs were undertaken on 211 patients. Patients with AC (n=113) or SCC (n=98) were separately-randomised to identical protocols of MMT or surgical monotherapy. RESULTS 211 patients were followed to 206 months; 104 patients were randomised to MMT (58 AC and 46 SCC, respectively) and 107 to surgery. MMT provided a significant survival-advantage over surgical monotherapy for AC (P=0.004), SCC (P=0.01). There was a 54% relative risk-reduction in lymph-node metastasis following MMT, compared with surgery (64% versus 29%, P<0.001). MMT produced a pathologic complete response (pCR) in 25% and 31% of AC and SCC, respectively. Survival advantage accrued to MMT, pCR and node-negative patients: AC pCR versus surgical monotherapy (P=0.001); residual disease following MMT versus surgical monotherapy (P=0.008); SCC pCR versus surgical monotherapy (P=0.033). CONCLUSIONS A survival advantage for MMT persisted long-term in AC and was replicated in SCC. MMT produced loco-regional tumour down-staging to extinction in 25-31% of patients, potentially permitting personalised treatment in this cohort that avoids the morbidity and mortality associated with resection. Node-negative patients with residual localised disease following MMT had a survival advantage over node-negative patients following surgery alone, supporting a systemic effect on micro-metastatic disease.
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12
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Abstract
The incidence of esophageal cancer is increasing in the developed world, with a relative increase in adenocarcinoma compared with squamous cell carcinoma. The distensible nature of the esophagus results in delayed development of symptoms associated with esophageal cancer; hence many patients have locally advanced or metastatic cancer at the time of initial presentation. Although resection remains the treatment of choice for early-stage esophageal cancer, the best treatment strategy for locally advanced esophageal cancer is debatable and, consequently, varies at different centers. This article discusses the published literature on various available therapeutic options for the treatment of locally advanced esophageal cancer.
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Affiliation(s)
- Ankit Bharat
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Saint Louis, St Louis, MO 63110-1013, USA
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13
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Jarral OA, Purkayastha S, Athanasiou T, Darzi A, Hanna GB, Zacharakis E. Thoracoscopic esophagectomy in the prone position. Surg Endosc 2012; 26:2095-103. [PMID: 22395952 DOI: 10.1007/s00464-012-2172-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 01/13/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive esophageal surgery has arisen in an attempt to reduce the significant complications associated with esophagectomy. Despite proposed technical and physiological advantages, the prone position technique has not been widely adopted. This article reviews the current status of prone thoracoscopic esophagectomy. METHODS A systematic literature search was performed to identify all published clinical studies related to prone esophagectomy. Medline, EMBASE and Google Scholar were searched using the keywords "prone," "thoracoscopic," and "esophagectomy" to identify articles published between January 1994 and September 2010. A critical review of these studies is given, and where appropriate the technique is compared to the more traditional minimally invasive technique utilising the left lateral decubitus position. RESULTS Twelve articles reporting the outcomes following prone thoracoscopic oesophagectomy were tabulated. These studies were all non-randomised single-centre prospective or retrospective studies of which four compared the technique to traditional minimally invasive surgery. Although prone esophagectomy is demonstrated as being both feasible and safe, there is no convincing evidence that it is superior to other forms of esophageal surgery. Most authors comment that the prone position is associated with superior surgical ergonomics and theoretically offers a number of physiological benefits. CONCLUSION The ideal approach within minimally invasive esophageal surgery continues to be a subject of debate since no single method has produced outstanding results. Further clinical studies are required to see whether ergonomic advantages of the prone position can be translated into improved patient outcomes.
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Affiliation(s)
- Omar A Jarral
- Department of Biosurgery and Surgical Technology, St. Mary's Hospital, Imperial College London, Praed Street, London, W2 1NY, UK
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14
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de Manzoni G, Zanoni A, Giacopuzzi S. Controversial Issues in Esophageal Cancer: Surgical Approach and Lymphadenectomy. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Treatment of Resectable Esophageal Cancer: Indications and Long-term Results. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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Abstract
The incidence of esophageal adenocarcinoma is increasing in Western countries with a tendency to exceed that of squamous-cell carcinoma. Prognosis is unfavorable with 5-year survival less than 15%, irrespective of treatment and the stage. At the time of diagnosis, more than two thirds of patients have a non-operable cancer because of extension or associated co-morbidities. Most studies have included different tumoral locations (esophagus and stomach) and different histological types (adenocarcinoma and squamous-cell carcinoma), making it difficult to interpret results. Surgery is currently the standard treatment for small tumors. Surgery should be preceded by neo-adjuvant treatment for patients with locally advanced resectable tumors, either preoperative chemotherapy or preoperative chemoradiation therapy. The therapeutic choice should be decided during multidisciplinary meetings according to patient and tumor characteristics and the expertise of the center. For patients with contraindications to surgery, exclusive chemoradiation therapy is recommended. Herein we reviewed and synthesized the different therapeutic strategies for esophageal adenocarcinoma.
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Affiliation(s)
- D Tougeron
- Service d'hépato-gastroentérologie, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers cedex, France.
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17
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Tougeron D, Richer JP, Silvain C. Traitement des adénocarcinomes de l’œsophage. JOURNAL DE CHIRURGIE VISCÉRALE 2011; 148:184-195. [DOI: 10.1016/j.jchirv.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
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18
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The safety and effectiveness of endoscopic and non-endoscopic approaches to the management of early esophageal cancer: a systematic review. Cancer Treat Rev 2010; 37:11-62. [PMID: 20570442 DOI: 10.1016/j.ctrv.2010.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/13/2010] [Accepted: 04/25/2010] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Traditionally, management of early cancer (stages 0-IIA) has comprised esophagectomy, either alone or in combination with chemotherapy and/or radiotherapy. Recent efforts to improve outcomes and minimize side-effects have focussed on minimally invasive, endoscopic treatments that remove lesions while sparing healthy tissue. This review assesses their safety and efficacy/effectiveness relative to traditional, non-endoscopic treatments for early esophageal cancer. METHODS A systematic review of peer-reviewed studies was performed using Cochrane guidelines. Bibliographic databases searched to identify relevant English language studies published in the last 3 years included: PubMed (i.e., MEDLINE and additional sources), EMBASE, CINAHL, The Cochrane Library, the UK Centre for Reviews and Dissemination (NHS EED, DARE and HTA) databases, EconLit and Web of Science. Web sites of professional associations, relevant cancer organizations, clinical practice guidelines, and clinical trials were also searched. Two independent reviewers selected, critically appraised, and extracted information from studies. RESULTS The review included 75 studies spanning 3124 patients and 10 forms of treatment. Most studies were of short term duration and non-comparative. Adverse events reported across studies of endoscopic techniques were similar and less significant compared to those in the studies of non-endoscopic techniques. Complete response rates were slightly lower for photodynamic therapy (PDT) relative to the other endoscopic techniques, possibly due to differences in patient populations across studies. No studies compared overall or cause-specific survival in patients who received endoscopic treatments vs. those who received non-endoscopic treatments. DISCUSSION Based on findings from this review, there is no single "best practice" approach to the treatment of early esophageal cancer.
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19
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Klein CA, Stoecklein NH. Lessons from an aggressive cancer: evolutionary dynamics in esophageal carcinoma. Cancer Res 2009; 69:5285-8. [PMID: 19549904 DOI: 10.1158/0008-5472.can-08-4586] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapid progression to metastatic disease and an intrinsic resistance to any type of systemic therapy are hallmarks of aggressive solid cancers. The molecular basis for this phenotype is not clear. A detailed study of the somatic progression from local to early systemic esophageal cancer revealed rapid diversification of cancer cells isolated from various sites, but also evidence for early clonal expansion. These findings have implications for diagnostic pathology and therapeutic decision making.
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Affiliation(s)
- Christoph A Klein
- Department of Pathology, Division of Oncogenomics, University of Regensburg, Regensburg, Germany.
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20
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Abrams JA, Fedi P, Vakiani E, Hatefi D, Remotti HE, Lightdale CJ. Depth of resection using two different endoscopic mucosal resection techniques. Endoscopy 2008; 40:395-9. [PMID: 18494133 PMCID: PMC3712272 DOI: 10.1055/s-2007-995529] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic mucosal resection (EMR) has been carried out for high-grade dysplasia (HGD) and intramucosal carcinoma (IMCA) in Barrett's esophagus using two different cap-assisted techniques, the "inject, suck, and cut" and the "band and snare." Previous work has demonstrated comparable specimen diameters. However, the two techniques have not been previously compared with respect to depth of resection. PATIENTS AND METHODS From a database of patients with Barrett's esophagus, we identified 40 consecutive specimens removed using EMR from patients with HGD or IMCA, 20 each from the "inject, suck, and cut" and the "band and snare" techniques. Specimens were evaluated and measured separately by two pathologists for greatest diameter and depth, and for the presence of submucosa and muscularis propria at the deepest margin of resection. Follow-up data were collected regarding clinical outcome and stricture formation. RESULTS The mean depth of the specimens from the two techniques was not significantly different (0.51 cm vs. 0.50 cm, P = 0.76). All specimens contained substantial submucosa, allowing accurate staging of the neoplastic lesions resected. Muscularis propria was identified at the base of 65% of the "band and snare" and 50% of the "inject, suck, and cut" specimens (P = 0.52). CONCLUSIONS The "inject, suck, and cut" and "band and snare" techniques both yield equivalent adequate depth of histological specimens from Barrett's esophagus with HGD or IMCA, and both provide accurate pathological staging.
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Affiliation(s)
- J. A. Abrams
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - P. Fedi
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - E. Vakiani
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - D. Hatefi
- Georgetown University School of Medicine, Washington, DC, USA
| | - H. E. Remotti
- Department of Surgical Pathology, Columbia University Medical Center, New York, NY, USA
| | - C. J. Lightdale
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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21
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Mariette C. Is there a place for esogastric cancer surgery in cirrhotic patients? Ann Surg Oncol 2008; 15:680-2. [PMID: 18172733 PMCID: PMC2234446 DOI: 10.1245/s10434-007-9765-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/14/2007] [Indexed: 01/10/2023]
Affiliation(s)
- Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez-Centre Hospitalier Régional Universitaire and University of Lille II, Place de Verdun, 59037, Lille cedex, France.
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22
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Mariette C, Piessen G, Triboulet JP. Therapeutic strategies in oesophageal carcinoma: role of surgery and other modalities. Lancet Oncol 2007; 8:545-53. [PMID: 17540306 DOI: 10.1016/s1470-2045(07)70172-9] [Citation(s) in RCA: 381] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Traditionally, surgery is considered the best treatment for oesophageal cancer in terms of locoregional control and long-term survival. However, survival 5 years after surgery alone is about 25%, and, therefore, a multidisciplinary approach that includes surgery, radiotherapy, and chemotherapy, alone or in combination, could prove necessary. The role of each of these treatments in the management of oesophageal cancer is under intensive research to define optimum therapeutic strategies. In this report we provide an update on treatment strategies for resectable oesophageal cancers on the basis of recent published work. Results of the latest randomised trials allow us to propose the following guidelines: surgery is the standard treatment, to be used alone for stages I and IIa, or possibly with neoadjuvant chemotherapy or chemoradiotherapy for stage IIb disease. For locally advanced cancers (stage III), neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is appropriate for adenocarcinomas. Chemoradiotherapy alone should only be considered in patients with squamous-cell carcinomas who show a morphological response to chemoradiotherapy, and produces a similar overall survival to chemoradiotherapy followed by surgery, but with less post-treatment morbidity. Although the addition of surgery to chemotherapy or chemoradiotherapy could result in improved local control and survival, surgery should be done in experienced hospitals where operative mortality and morbidity are low. Moreover, surgery should be kept in mind as salvage treatment in patients with no morphological response or persistent tumour after definitive chemoradiotherapy.
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Affiliation(s)
- Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C Huriez, Lille, France; University of Lille II, Lille, France.
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23
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Mariette C, Piessen G, Lamblin A, Mirabel X, Adenis A, Triboulet JP. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg 2006; 93:1077-83. [PMID: 16779882 DOI: 10.1002/bjs.5358] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to determine the effect of neoadjuvant radiochemotherapy (RCT) on postoperative complications and survival after surgery for locally advanced oesophageal squamous cell carcinoma. METHODS Postoperative course and survival were compared in 144 patients who had neoadjuvant RCT and 80 control patients who had surgery alone for locally advanced oesophageal squamous cell carcinoma (radiological stage T3, N0 or N1, M0). RESULTS The two groups were comparable in terms of American Society of Anesthesiologists grade, age, sex, weight loss, tumour location, presence of lymph node metastasis and surgical approach. Postoperative mortality rates were 6.3 and 9 per cent (P=0.481), with morbidity rates of 40.3 and 41 percent (P=0.887) in the RCT and control group respectively. Complete resection (R0) rates were 74.3 and 48 percent respectively (P<0.001). Significant downstaging was observed in the RCT group (P<0.001), with 16.0 percent of patients having a complete pathological response. Median survival was 29 versus 15 months, and the 5-year survival rate 37 versus 17 percent (P=0.002) in RCT and control groups respectively. CONCLUSION Neoadjuvant RCT significantly enhanced R0 resection and survival rates in patients with stage T3 oesophageal squamous cell carcinoma, with no increase in postoperative mortality and morbidity rates.
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Affiliation(s)
- C Mariette
- Department of Digestive and General Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, France.
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Pasquier D, Mirabel X, Adenis A, Rezvoy N, Hecquet G, Fournier C, Coche-Dequeant B, Prevost B, Castelain B, Lartigau E. External beam radiation therapy followed by high-dose-rate brachytherapy for inoperable superficial esophageal carcinoma. Int J Radiat Oncol Biol Phys 2006; 65:1456-61. [PMID: 16863928 DOI: 10.1016/j.ijrobp.2006.02.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 02/14/2006] [Accepted: 02/22/2006] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to retrospectively evaluate the feasibility, efficacy, and tolerance of external beam radiotherapy followed by high-dose-rate brachytherapy in inoperable patients with superficial esophageal cancer. PATIENTS AND METHODS From November 1992 to May 1999, 66 patients with superficial esophageal cancer were treated with exclusive radiotherapy. The median age was 60 years (range, 41-85). Fifty-three percent of them were ineligible for surgery owing to synchronous or previously treated head-and-neck cancer. Most of the patients (n = 49) were evaluated with endoscopic ultrasonography (EUS) or computed tomography (CT). The mean doses of external beam radiotherapy and high-dose rate brachytherapy were 57.1 Gy (+/-4.83) and 8.82 Gy (+/-3.98), respectively. The most frequently used regimen was 60 Gy followed by 7 Gy at 5 mm depth in two applications. RESULTS Among patients evaluated with EUS or CT, the complete response rate was 98%. The 3-, 5-, and 7-year survival rates were 57.9%, 35.6%, and 26.6%, respectively. Median overall survival was 3.8 years. The 5-year relapse-free survival and cause-specific survival were 54.6% and 76.9%. The 5-year overall, relapse-free, and cause-specific survival of the whole population of 66 patients was 33%, 53%, and 77%, respectively. Local failure occurred in 15 of 66 patients; 6 were treated with brachytherapy. Severe late toxicity (mostly esophageal stenosis) rated according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale occurred in 6 of 66 patients (9%). CONCLUSION This well tolerated regimen may be a therapeutic alternative for inoperable patients with superficial esophageal cancer. Only a randomized study could be able to check the potential benefit of brachytherapy after external beam radiation in superficial esophageal cancer.
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Affiliation(s)
- David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, University Lille II, Lille, France.
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Seitz JF, Dahan L, Jacob J, Artru P, Maingon P, Bedenne L, Triboulet JP. Esophagus cancer. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/s0399-8320(06)73584-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mariette C, Triboulet JP. Should Resectable Esophageal Cancer Be Resected? Ann Surg Oncol 2006; 13:447-9. [PMID: 16485145 DOI: 10.1245/aso.2006.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Accepted: 10/04/2005] [Indexed: 11/18/2022]
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Bouvier AM, Binquet C, Gagnaire A, Jouve JL, Faivre J, Bedenne L. Management and prognosis of esophageal cancers: Has progress been made? Eur J Cancer 2006; 42:228-33. [PMID: 16337786 DOI: 10.1016/j.ejca.2005.08.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 08/24/2005] [Accepted: 08/30/2005] [Indexed: 11/19/2022]
Abstract
The aim of this study was to investigate time trends in treatment and prognosis of esophageal cancer in a well-defined French population. Data was obtained from the Burgundy Cancer Registry (France) and three time periods were defined: 1976-90, 1991-96 and 1997-2002. A logistic regression was used to identify factors associated with an R0 resection. A multivariate survival analysis was performed using a Cox model. From 1976 to 2002, 2267 patients were included. The R0 resection rate slightly increased from 20.9% to 25.8% (P=0.019) then remained stable. Operative mortality decreased from 11.7% to 6.7% (NS). Age and subsite significantly influenced the rate of resection for cure whereas period had no effect. Chemotherapy alone was seldom used and radiotherapy alone dramatically dropped over time. Chemoradiation used as adjuvant treatment increased from 16.3% (1976-90) to 30.6% (1997-02) (P<0.001) and as sole treatment from 16.0% to 48.5% (P<0.001). The 3-year survival rates were respectively 10.1% and 9.7% (NS). Age and stage at diagnosis influenced the prognosis of esophageal cancer whereas time period and histology had no influence. This study claims that esophageal cancer remains a serious cancer problem and no improvement has been seen in the study population in France in its management over time.
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Affiliation(s)
- A M Bouvier
- Registre Bourguignon des Cancers Digestifs, INSERM EMI 0106, CIC-EC01, Faculté de Médecine, BP 87900, 21079 Dijon Cedex, France.
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Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, Ackland S, Gotley DC, Joseph D, Millar J, North J, Walpole ET, Denham JW. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 2005; 6:659-68. [PMID: 16129366 DOI: 10.1016/s1470-2045(05)70288-6] [Citation(s) in RCA: 702] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Resection remains the best treatment for carcinoma of the oesophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. We aimed to assess whether a short preoperative chemoradiotherapy regimen improves outcomes for patients with resectable oesophageal cancer. METHODS 128 patients were randomly assigned to surgery alone and 128 patients to surgery after 80 mg/m(2) cisplatin on day 1, 800 mg/m(2) fluorouracil on days 1-4, with concurrent radiotherapy of 35 Gy given in 15 fractions. The primary endpoint was progression-free survival. Secondary endpoints were overall survival, tumour response, toxic effects, patterns of failure, and quality of life. Analysis was done by intention to treat. FINDINGS Neither progression-free survival nor overall survival differed between groups (hazard ratio [HR] 0.82 [95% CI 0.61-1.10] and 0.89 [0.67-1.19], respectively). The chemoradiotherapy-and-surgery group had more complete resections with clear margins than did the surgery-alone group (103 of 128 [80%] vs 76 of 128 [59%], p=0.0002), and had fewer positive lymph nodes (44 of 103 [43%] vs 69 of 103 [67%], p=0.003). Subgroup analysis showed that patients with squamous-cell tumours had better progression-free survival with chemoradiotherapy than did those with non-squamous tumours (HR 0.47 [0.25-0.86] vs 1.02 [0.72-1.44]). However, the trial was underpowered to determine the real magnitude of benefit in this subgroup. INTERPRETATION Preoperative chemoradiotherapy with cisplatin and fluorouracil does not significantly improve progression-free or overall survival for patients with resectable oesophageal cancer compared with surgery alone. However, further assessment is warranted of the role of chemoradiotherapy in patients with squamous-cell tumours.
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Affiliation(s)
- Bryan H Burmeister
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
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