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St-Amour P, Mantziari S, Dromain C, Winiker M, Godat S, Schöpfer A, Demartines N, Schäfer M. Preoperative hiatal hernia in oesophageal adenocarcinoma: An impact on patient outcomes? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.003] [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: 11/13/2022]
Abstract
Abstract
Objective
Uncontrolled gastroesophageal reflux and the often-associated hiatal hernia (HH) are frequently encountered in oesophageal adenocarcinoma patients. Previous data suggest unfavourable long-term oncologic outcomes in the presence of a HH, but the evidence remains scarce. The aim of this study was to assess the potential impact of preoperative HH on histologic response after neoadjuvant treatment (NAT), as well as on overall and disease-free survival.
Methods
All patients operated for an adenocarcinoma of the oesophagus or gastro-oesophageal junction (GOJ) between 2012-2018 were assessed. Baseline endoscopy and CT-scan images were retrospectively reviewed to identify the presence of a clinically significant HH (≥3cm). Response to neoadjuvant treatment (Mandard TRG grade), postoperative outcomes and survival were compared between HH and non-HH patients. Categorical variables were compared with the x2 or Fisher’s test, whereas continuous ones with the Mann-Whitney-U test. Survival analyses were performed with the Kaplan-Meier method and log-rank test.
Results
Overall, 101 patients were included (84.1% male, median age 63 years); among them, 33 (32.7%) had a HH ≥ 3cm at diagnosis of oesophageal cancer. There were no significant baseline differences in demographics and tumour stages between the two groups. NAT was used in 80.9% of non-HH versus 81.8% HH patients (P = 0.910), most often chemoradiation (57.3% in non-HH versus 63.6% in HH patients, P = 0.423). Surgical approach and postoperative complication rates were similar in all patients. Good response to NAT (TRG 1-2) was observed in 32.3% of non-HH, versus 33.3% of HH patients (P = 0.297), whereas R0 resection was achieved in 94.1% vs 90.9% of patients respectively (P = 0.551). Overall survival was comparable between HH (median 28 mo, 95%CI 22-NA) and non-HH patients (median 41mo, 95% CI 29-NA) (P = 0.605). Disease-free survival was also similar (median 18 mo, 95%CI 12-NA for HH, vs 34mo, 95%CI 14-NA for non-HH patients, P = 0.283), although HH patients experienced higher rates of distant (51.6% vs 29.2% for non-HH, P = 0.033), but not locoregional recurrence.
Conclusion
A clinically significant HH is encountered in almost a third of patients with oesophageal adenocarcinoma. However, in our study, it was not associated with a worse response to NAT, nor did it lead to a worse overall and disease-free survival.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - C Dromain
- Institute of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Winiker
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Godat
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - A Schöpfer
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
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St-Amour P, Djafarrian R, Zingg T, La Rosa S, Demartines N, Matter M. Laparoscopic resection of an adrenal oncocytic neoplasm: Report of a case and review of the literature. Int J Surg Case Rep 2020; 76:305-309. [PMID: 33068855 PMCID: PMC7567174 DOI: 10.1016/j.ijscr.2020.09.185] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Oncocytic adrenal neoplasms are rare and mostly benign lesions. Preoperative determination of malignancy remains difficult. Surgical excision planification is based on preoperative investigations.
Introduction Oncocytic adrenal neoplasms are rare and mostly benign lesions. Available literature supports indication for a surgical resection, but criteria to predict aggressive behavior are unreliable, thus making decision of surgical approach (laparotomy versus laparoscopy), and extent of resection, difficult to define. Presentation of case This is the case of a 46-year-old male, with an incidental finding of a 10 cm asymptomatic tumor in the left adrenal gland identified by MRI, performed in the setting of the initial assessment of liver steatosis. Adrenal hormone levels were in the normal range, thus, a CT-guided needle biopsy was performed and showed an adrenocortical oncocytic neoplasm. A laparoscopic left adrenalectomy was performed sparing the adjacent left kidney. Histological examination of the resected tumor showed a 10 cm oncocytic adrenocortical neoplasm of uncertain malignant potential with negative resection margins. A follow-up MRI was scheduled at six months after surgery, and no recurrence was found. Conclusions Although rare, oncocytic neoplasms should be included in the differential diagnosis of adrenal “incidentalomas”. Determination of their malignant potential is difficult in the preoperatory setting. Final diagnosis is based on histological analysis of the whole surgical specimen. Laparoscopic complete excision with negative resection margins is feasible and safe.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - R Djafarrian
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - T Zingg
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - S La Rosa
- Institute of Pathology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Matter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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St-Amour P, Gaudet M, Claveau J, Dagnault A. Is Graded Prognostic Assessment (GPA) Superior to Recursive Partitioning Analysis (RPA) for Determination of Prognosis in Patients with Melanoma Brain Metastasis? Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.658] [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: 11/27/2022]
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